The survey included questions about the symptoms patients identified as adverse, causal associations with treatment, and the impact of contextual factors. Dinaciclib Descriptive statistics are reported, and Poisson modeling predicted factors associated with identification of adverse responses.

Results: A response rate of 76.2% (324 of 425) was obtained. Having lumbar spine dysfunction was a significant

predictor of all adverse responses (incidence rate ratio [IRR] 95% confidence interval [CI] = 1.513 [1.025, 2.235], P = 0.037) and was associated with 51% greater identification of adverse responses compared with those with an extremity disorder. Expectation of soreness was “”protective”" against identifying major adverse responses (IRR [95% CI] = 0.915 [0.838, 0.999], P = 0.047); they had an 8.5% lower rate of identifying major adverse responses relative to those without this expectation.

Conclusions: The patient perspective is important to consider if a comprehensive framework for defining adverse responses in manual therapies is to be developed. (C) 2013 Elsevier Inc. All rights reserved.”
“Substituted salicylaldehydes reacted with ethyl diazoacetate to give ethyl 1-benzofuran-3-carboxylates

containing various substituents in the aromatic ring. The Diels-Alder Kinase Inhibitor Library screening reaction of these compounds with Danishefsky’s diene was regioselective, and it provided an effective method for the construction of the heterocyclic skeleton of hexahydrodibenzo[b,d]furan-7-one or tetrahydrodibenzo[b,d]furan-7-one. The adducts were found to undergo rearrangement to substituted 4′-hydroxybiphenyl-2-yl methyl carbonates during column chromatography on silica gel.”
“Eruptive pseudoangiomatosis is a skin eruption characterized

by millet-sized erythema with an anemic halo appearing on exposed body areas. Insect bites, particularly FK228 mosquito bites, have been reported as one of the causes of eruptive pseudoangiomatosis. We experienced two cases of eruptive pseudoangiomatosis and the eruption was seen on the face and upper extremities of two women aged 48 and 77 years old. The two cases consented to be experimentally bitten by Culex pipiens mosquitoes and Aedes albopictus to determine if eruptive pseudoangiomatosis could be experimentally elicited by these mosquitoes. Our results showed that several minutes after a C.similar to pipiens mosquito bite, an erythematous spot appeared on the bite site, followed by the formation of an anemic halo surrounding the erythema in 30 min; a successful reproduction of eruptive pseudoangiomatosis. The erythema lasted for more than a week and was not accompanied by any pruritus. With A.

“
“Fragrances are very common in everyday products. A metalworker with chronic hand eczema and previously diagnosed type IV sensitizations to epoxy resin, balsam of Peru, fragrance mix and fragrance mix II was diagnosed with additional type IV sensitizations to geraniol, hydroxycitronellal, lilial, tree moss, oak moss absolute, citral, citronellol, farnesol, Lyral((R)), fragrance mix II and fragrance mix (with sorbitan sesquioleate). In addition,

a type IV sensitization to the skin protection cream containing geraniol and citronellol used at the workplace was detected, and deemed occupationally relevant in this case. The patient could have had contact to fragrances through private use of cosmetics and detergents. On the other hand, the fragrance-containing skin protection cream supports occupational exposure. This case report demonstrates that selleck products fragrance contact allergy has to be searched for and clarified individually, which requires a thorough history and a detailed analysis of the work place.”
“Basic studies have proven that cranberries may prevent urinary tract infections through changing the adhesiveness of Escherichia coli (E. coli) to urothelial cells. Various cranberry preparations, including extract powder, capsules, and juice, have been shown to be effective in clinical and epidemiological research. Because cranberries are most commonly consumed as juice in a diluted concentration,

the aim of this study was to investigate whether the equivalent daily dose of cranberry juice is sufficient to Copanlisib manufacturer modify host urine to change the uropathogenicity of E. coli. Urine from rats taking an equivalent daily dose of cranberry juice has been shown to decrease the capability of E. coli in hemagglutination, urothelium adhesion, nematode killing, and biofilm formation. All these changes occurred after E. coli was incubated in cranberry metabolite-containing urine, defined as urine opsonization. Urine opsonization of E. coli resulted

in 40.9 % (p = 0.0038) decrease in hemagglutination ability, 66.7 % (p = 0.0181) decrease in urothelium adhesiveness, 16.7 % (p = 0.0004) increase in the 50 % lethal time in killing Selleckchem PARP inhibitor nematodes, and 53.9 % (p = 5.9 x 10(-4)) decrease in biofilm formation. Thus, an equivalent daily dose of cranberry juice should be considered sufficiently potent to demonstrate urine opsonization in E. coli.”
“BACKGROUND: Confocal laser scanning microscopy (CLSM) provides critical information of the presence of autofluorescence signals inherent to the samples under study, which may interfere with probe fluorescence. Therefore, it is important to determine the emission spectrum of the biomass autofluorescence under study in order to avoid, as much as possible, this wavelength range when selecting specific probe emissions and to modify, if necessary, the original fluorescence in situ hybridization (FISH) protocol in order to enhance probes signals.

25% neuroblastoma tumors have somatic amplifications at this locus but little is known about

its constitutional aberrations and their potential role in carcinogenesis. Here, we have performed an array-CGH and qPCR characterization of two patients with constitutional partial 2p trisomy including HM781-36B manufacturer MYCN genomic region.

Results: One of the patients had congenital neuroblastoma and showed presence of minute areas of gains and losses within the common fragile site FRA2C at 2p24 encompassing MYCN. The link between 2p24 germline rearrangements and neuroblastoma development was reassessed by reviewing similar cases in the literature.

Conclusions: It appears that constitutional rearrangements involving chromosome 2p24 may play role in NB development.”
“Induced-fit responsive dopamine (DA) imprinted polymer, poly (melamine-co-chloranil). was used as a suitable coating material for the modification of a hanging mercury drop electrode. The zwitterionic conformation of the imprinted polymer responded differential pulse, cathodic stripping voltammetric current, without any false-positive or false-negative contributions of non-specific sorptions, in aqueous

environment of complex matrices. Selonsertib inhibitor The limit of detection (3 sigma) of dopamine was found to be as low as 0.148 ng mL(-1). by the proposed sensor that could be considered a sensitive marker of dopamine depletion in Parkinson’s disease (PD). (C) 2008 Elsevier B.V. All rights reserved.”
“Background: The wearable cardiac defibrillator (WCD) is an alternative to the implantation of cardioverter defibrillator (ICD) for patients at risk for sudden death who do not fulfill standard criteria for ICD implantation or in whom the risk:benefit ratio is equivocal. Published data pertaining to the WCD in children is sparse. We describe the utility of the WCD in children at a single tertiary care center.

Methods: We retrospectively identified all patients aged birth to 18 years of age who were prescribed a WCD between January 1, 2007, and June 30, 2009.

Patient information regarding diagnosis, clinical history, electrocardiograms, rhythm Selleck GSK3235025 reports, and outcome at last follow-up was reviewed. Information regarding the WCD was obtained including indication for use, patient compliance, and accuracy of rhythm determination, inappropriate and appropriate shock events, and other complications.

Results: Since 2007, four patients age less than or equal to 18 years have been prescribed the WCD at our institution. None of the patients had an inappropriate shock. Two patients had documented noncompliance with wear, which resulted in failure to detect and treat a life-threatening arrhythmia in one. Two patients required downsizing of the WCD during use in order to improve electrode contact and rhythm detection.

Methods: In this case-control study

we included 192 patients with HIV-1 infection: 64 patients with presumptive CT (cases) and 128 patients with other diseases (controls). Blood samples to perform indirect Selleckchem CBL0137 immunofluorescense reaction (IFI) to detect anti-T. gondii IgG antibodies and polymerase chain reaction (PCR) were collected before or within the first three days of anti- Toxoplasma therapy. Two multivariate logistic regression models were performed: one including the variable qualitative serology and another including quantitative serology. Results: In the first model, positive IgG anti- T gondii (OR 4.7, 95% CI 1.2-18.3; p = 0.027) and a positive T gondii PCR result (OR 132, 95% CI 35-505; p < 0.001) were associated with the diagnosis. In the second model, IgG anti- T gondii titres >=. 1:1024 (OR 7.6, 95% CI 2.3-25.1; p = 0.001) and a positive T gondii PCR result (OR 147, 95% CI 35-613; p < 0.001) were associated with the diagnosis. Conclusions: Quantitative serology

and molecular diagnosis in peripheral blood samples were Stem Cell Compound Library nmr independently associated with the diagnosis of CT in HIV-infected patients. These diagnostic tools can contribute to a timely diagnosis of CT in settings where Toxoplasma infection is common in the general population.”
“BACKGROUND Histologic differences (e. g., dermal thickness, collagen fibers) between Caucasian and other racial and ethnic groups may affect wrinkle formation and influence responses to treatment with botulinum toxin type A (BoNT-A).

OBJECTIVE To evaluate the degree and duration of efficacy of 20 and 30U of BoNT-A for the

treatment of glabellar lines in African-American women with skin types V and VI.

MATERIALS & METHODS Women aged 18 to 65 with a glabellar rhytid score of 2 or more SC79 datasheet at maximum frown on an investigator-rated 4-point facial wrinkle scale (FWS; 0 = none, 3 = severe) were eligible for this study. Patients were randomly assigned to receive 20U or 30U of BoNT-A in the glabellar region. Evaluations were conducted at baseline and days 30, 60, 90, and 120 postinjection. The investigator and patient graded the severity of wrinkles at maximum frown and repose on the same 4-point FWS. BoNT-A was administered at the assigned dose, divided between five equal intramuscular injections into the procerus muscle, each corrugator muscle, and a site above the midpupillary line on each side.

RESULTS The percentage of responders at maximum frown did not differ significantly between the two groups. Although not statistically significant, the effect lasted somewhat longer in the subjects receiving the 30U dose. No differences were evident between groups at repose through day 120. Adverse events were mild and transient and did not differ between the groups.

CONCLUSION These results indicate that doses of 20 and 30 U of BoNT-A demonstrate efficacy and safety in African-American women with skin types V and VI.

VSM, change learn more and throughput times for 48 patient flows (VSM-A(1), actual state = initial situation) served as the starting point. Interdisciplinary development of an optimized VSM (VSM-O) was evaluated. Prospective analysis of 42 patients (VSM-A(2)) without and 75 patients (VSM-O) with an optimized process in place were conducted.

Results The prospective analysis resulted in a mean change time of (mean +/- SEM) VSM-A2 1,507 +/- 100 s versus VSM-O 933 +/- 66 s (p<0.001). The mean throughput time VSM-A(2) (mean +/- SEM) was 151 min (+/- 8) versus VSM-O 120 min (+/- 10) (p<0.05).

This corresponds to a 23% decrease in waiting time per patient in total.

Conclusion Efficient OR capacity utilization and the optimized use of human resources allowed an additional 1820 interventions to be carried out per year without any increase in human resources. In addition, perioperative patient monitoring was increased up to 100%.”
“In response to sudden decrease in osmotic pressure, halophilic microorganisms secrete their accumulated osmolytes. This specific stress response, combined with physiochemical responses to the altered environment, influence the membrane properties and integrity of cells, with consequent effects on growth and yields in bioprocesses, Copanlisib mw such as bacterial milking. The aim of this study was to investigate changes in membrane

fluidity and integrity induced by environmental stress in ectoine-secreting organisms. The halophilic ectoine-producing strains Alkalibacillus haloalkaliphilus and Chromohalobacter salexigens were treated hypo- and hyper-osmotically at several

temperatures. The steady-state anisotropy of fluorescently labeled cells was measured, and membrane integrity assessed by flow cytometry and ectoine distribution. Strong osmotic downshocks slightly increased the fluidity of the bacterial membranes. As the temperature increased, the increasing membrane fluidity encouraged more ectoine release under the same osmotic shock conditions. On the other hand, combined shock treatments increased the number of disintegrated MX69 solubility dmso cells. From the ectoine release and membrane integrity measurements under coupled thermal and osmotic shock conditions, we could optimize the secretion conditions for both bacteria.”
“Surgical strategies for patients with aortic arch aneurysm extending to the descending aorta remain controversial. The antero-lateral partial sternotomy (ALPS) approach has been developed as a less invasive alternative single-stage strategy for extensive thoracic arch aneurysm (ETAA).

From September 2007 to April 2011, 18 patients underwent elective total arch replacement for ETAA by the ALPS approach (ALPS group). In this approach, a skin incision was made from the bottom of the xiphoid to the anterior axillary line at the third intercostal space with a convex curved line.

Conclusions: In the studied population, DLG5 R30Q was associated with all forms of IBD. An elevated presence of the R30Q variant was observed in all members of a familial IBD registry. This association of the R30Q variant with IBD was male-specific.”
“Circumscribed GSK1904529A mw palmar or plantar hypokeratosis was first described by Perez et al in 2002 as a unique entity of the skin in which they reported 10 patients who presented with well-circumscribed areas of erythematous depressed or eroded skin mostly over the thenar or hypothenar eminences of the palms and less commonly on the soles. Histologically, the lesions demonstrated an abrupt drop-off in the cornified layer

resulting in a broad area of hypokeratosis. Perez et al hypothesized that these lesions were a distinctive epidermal malformation. There have been several reports since, some of which implicate trauma as an etiologic agent; however, the exact etiology remains unclear. The authors present the first case of circumscribed palmar or plantar hypokeratosis on a nonacral site (chest of a 63-year-old man) with novel histological features, including granular parakeratosis and evidence of trauma (subepidermal fibrin and ulcerations).”
“The glutathione

S-transferases (GST) play important roles in the detoxification of microcystins (MCs). For better understanding of the responses of GST isforms to MCs exposure, informations about the effects of MCs on GSTs are necessary. In this AZD7762 clinical trial experiment, we cloned the full length cDNA of 14 GST isoforms (GST alpha, kappa, mu, omega, pi, theta,

zeta, and microsomal GST) from Wistar rat. The mRNA abundance of each rat GST isoform in the liver, kidney, and testis was analyzed by real time quantitative PCR. Multiple GST isoforms were constitutively expressed in all examined organs, but Staurosporine research buy some isoforms were expressed at higher level in one organ than in others. The relative changes of the mRNA abundance in the liver, kidney, and testis of Wiatar rat i.v. injected with crude MCs extract at dose of 1LD(50) were also analyzed. Generally, the expression of most GSTs in the liver and testis was suppressed while that in kidney was induced after being injected with MCs. It is suggested that the transcription of GST isoforms varied in different ways within an organ and between organs of Wistar rat exposed to MCs. (c) 2009 Wiley Periodicals, Inc. Environ Toxicol 26: 187-194, 2011.”
“Syphilis, a sexually transmitted disease caused by the spirochete Treponema pallidum, can affect nearly every organ system in the body. In particular, skin manifestations of secondary syphilis are common but nonspecific and can be a true masquerader of other skin disorders. Concomitant infection with HIV has been increasing and may cause even more unusual skin presentations. We present a patient with the atypical combination of palmoplantar keratoderma and ocular symptoms that closely resembled reactive arthritis (or Reiter’s syndrome).

“
“Nanocomposites based on poly (methyl methacrylate) (PMMA) and 3 wt % of clay (montomorillonite) organomodified with alkylammonium cations bearing alkyl halide function (OCTANBr(i)BBr-CL) have been obtained by melt blending. The “”nanohybrid”" masterbatch approach,

already used within other matrices, has also been tested to produce this type of material. Accordingly, highly filled (similar to 30 wt %) PMMA-OCTANBr(i)BBr-CL nanohybrid has been synthesized by atom transfer radical polymerization (ATRP) see more of MMA as in situ initiated from the alkyl halide functions decorating the nanoclay surface. This nanohybrid, i.e., PMMA-grafted organomodified check details clay, has been added as masterbatch and melt-blended within commercial PMMA. A significantly better clay nanoplatelet dispersion of the samples prepared via the masterbatch process was evidenced by wide-angle X-ray diffraction (WAXD) and transmission electron microscopy (TEM). As a result, these exfoliated nanocomposites proved to be characterized by better thermal and mechanical properties than the more conventional physical blends, as evidenced by thermogravimetrical analysis (TGA) and dynamical mechanical analysis

(DMTA), respectively. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci 121: 1355-1364, 2011″
“High-intensity focused ultrasound as a trackless, noninvasive method of ablating tissue has been a concept with potential for more than 60 years. It is only in the past 10 to 15 years that technological advances in both the delivery system and the monitoring systems have allowed us to begin to truly explore this potential clinically. Although unique technical challenges remain to be overcome, this ablative technique has been successfully applied in nearly all regions of the body, even some hidden by dense bone. The possibility that HIFU may be synergistic in ways that other ablative therapies are not, with both chemotherapeutics and immune system modifiers, positions HIFU for further investigations

into multidisciplinary, individualized therapy unique to the patient.”
“If distinct biological species are to coexist Apoptosis inhibitor in sympatry, they must be reproductively isolated and must exploit different limiting resources. A two-niche Levene model is analysed, in which habitat preference and survival depend on underlying additive traits. The population genetics of preference and viability are equivalent. However, there is a linear trade-off between the chances of settling in either niche, whereas viabilities may be constrained arbitrarily. With a convex trade-off, a sexual population evolves a single generalist genotype, whereas with a concave trade-off, disruptive selection favours maximal variance.

As this traditional sausage is fermented naturally or only with back-slop, learn more knowledge about the native LAB population in the product is very important to understand the microflora that has been active in fermenting the nem chua and to ensure the safety of this uncooked sausage. (C) 2010 Elsevier Ltd. All rights reserved.”
“A case of enterococcal meningitis in a toddler is presented. The organism was highly resistant to all drugs previously used for pediatric Gram-positive meningitis. She was successfully treated with intraventricular and intravenous daptomycin and intravenous tigecycline. The organism was characterized

as a member of CC17, a notorious emerging nosocomial clone of Enterococcus faecium.”
“Polypropylene meshes are frequently used in abdominal and vaginal reconstructive surgery. Recently, several authors have claimed that mesh-associated complications may be linked to mesh shrinkage. We have performed a prospective study with postoperative follow-up by ultrasound examination at two time points after Prolift anterior implantation to assess changes in the ultrasound appearance GSK2126458 of mesh implants over time.

We assessed 36 patients who

had undergone mesh implantation with Prolift anterior((TM)) mesh for the correction of symptomatic anterior vaginal wall prolapse. During the surgery, we measured the actual midline length of the mesh (initial length). On the fourth postoperative day, we performed a vaginal ultrasound examination (US) to measure mesh length in the midsagittal plane. A second US was performed 3-5 months after surgery to repeat this measurement.

There was a significant difference in mesh length determined before and 4 days after surgery (90.3 vs. 57.1 mm, P = < 0.0001) indicating intraoperative folding. On comparing early and late postoperative ultrasound measurements, there was a reduction in length from 57.1 to 48.3 mm (P < 0.0001), indicating possible shrinkage or retraction.

Intraoperative GSK2879552 folding seems to be responsible for a large part of the difference between preoperative (in

vitro) and postoperative (US) measurements of mesh dimensions, suggesting that surgical techniques may require adjustment.”
“Strawberries (Fragaria ananassa), raspberries (Rubus idaeus) and red currants (Ribes rubrum), as well as two drupes, cherries (Prunus avium), and sour cherries (Prunus cerasus), were subjected to two storage temperatures (4 degrees C and 25 degrees C) and phytochemicals concentrations (total phenols, flavonoids and anthocyanins) as well as antioxidant capacity (DPPH, ABTS and FRAP assays) were monitored until the fruit visually spoiled. Red currants and strawberries exhibited the highest initial total phenol (TP) contents (322.40 +/- 5.56 and 335.47 +/- 6.12 mg GAE/100 g FW, respectively) and maintained the highest TP contents throughout storage at both temperatures. Storage of at 25 degrees C as opposed to 4 degrees C. facilitated faster spoilage of analyzed fruits.

35 W/cm(2), energy 0.2 J, energy density 7.0 J/cm(2), time 20 s per irradiated point, and number of points 3. Animals in groups GII, GV, and GVI received treatment with PRP, consisting of a single dose of 0.2 mL directly into the surgical site, on top of the tenotomy. Animals were killed on the 13th day post-tenotomy and their tendons were surgically

removed for a quantitative analysis using polarization microscopy. The percentages of collagen fibers of types I and III were expressed as mean +/- SD. Higher values of collagen fibers type I were obtained for groups GV and GVI when compared with all other groups (p < 0.05), whereas groups GIII and GIV showed no significant difference between them (p > 0.05). For collagen type III, a significant difference was observed between GII and all other groups (p < 0.5), but no significant Tariquidar in vitro difference was found between GIII and GIV and between GV and GVI. Results showed that the deposition of collagen type I was

higher when treatment with PRP and LLLT was combined, suggesting a faster regeneration of the tendon.”
“This study aimed to AZD2171 nmr evaluate the presenting symptoms, the effectiveness of imaging methods, and the surgical treatment of vascular rings. Data for 44 patients (32 enrolled prospectively, 12 reviewed retrospectively) over a 10-year period in a tertiary referral center were analyzed. These patients comprised 25 patients with a left aortic arch and an aberrant right subclavian

artery, 13 patients with a right aortic arch and a left subclavian artery originating from Kommerell’s diverticulum, 1 patient with a right aortic arch and an aberrant left subclavian artery, 3 patients with a double aortic arch, and 2 patients with a pulmonary sling. Respiratory symptoms were found in 25 patients and dysphagia in 6 patients. Atypical symptoms such as reflex apnea, cyanosis, syncope episodes, and exercise-induced wheezing were noted in five patients. Associated congenital heart defects were detected in 41% of the patients. The diagnostic yield was 95.23% for barium esophagography, 54.54% for echocardiography, and 66.66% for computed tomography. The anatomy could be correctly identified by magnetic resonance imaging selleck (MRI) in 97.43% and by angiography in 90.5% of the patients. Of the 30 patients who underwent surgery, 80% were completely relieved of symptoms during a mean follow-up period of 25 +/- A 33.5 months. Vascular rings should not be overlooked in infants with atypical symptoms. The authors’ diagnostic procedure of choice is MRI because it is superior to angiography for delineating the relationship between abnormal vascular structures, trachea, and esophagus.”
“Outpatient surgery is increasingly being performed on patients with pre-existing cardiovascular and pulmonary disorders. These are relevant for anesthesia because of the inherent risk of hemodynamic instability.

039) but

not the extracellular signal-regulated kinase pathways (ERIC) 1/2, c-Jun N-terminal kinases (JNK) or nuclear factor kappa B (NF kappa B).

Conclusions: This study elucidates one potential protective mechanism of Se, namely through the alteration of cell signaling and downstream transcription of pro-inflammatory effects of IL-1 beta. (C) 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.”
“OBJECTIVE: Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant Crenigacestat recipients and analyze the variables affecting sleep quality in the first years after renal transplantation.

METHODS: Kidney transplant recipients were evaluated at two time points after a successful transplantation: between three and six months (Phase 1) and between 12 and 15 months (Phase 2). The following tools were used for assessment: the Pittsburgh Sleep Quality Index; the quality of life questionnaire Short-Form-36; the Hospital Anxiety and this website Depression scale; the Karnofsky scale; and assessments of social and demographic data. The prevalence of poor sleep was

36.7% in Phase 1 and 38.3% in Phase 2 of the study.

RESULTS: There were no significant differences between patients with and without changes in sleep quality

between the two phases. We found no changes in sleep patterns throughout the study. Both the physical and mental health scores worsened from Phase 1 to Phase 2.

CONCLUSION: Sleep quality in kidney transplant recipients did not change during the first year after a successful renal transplantation.”
“Objective: LY3039478 Stem Cells & Wnt inhibitor Reclassification of acquired cholesteatoma into the commonly observed presentations of this condition to provide a simple and clear grouping that indicates the pathology, management, and outcomes of the group cases.

Patients: Virgin acquired cholesteatoma cases from a single center managed from 1986 to 2008 (515 cases).

Interventions: Cases were managed by transcanal (20%) or intact canal wall techniques. Wall repairs successively used autograft cartilage (transcanal and early intact canal wall mastoidectomy cases), hydroxylapatite plates (1989-2007), or titanium sheeting (2007). Drum repairs used cartilage-perichondrial composite grafts. Assembly techniques were the preferred ossiculoplasty method.

Results: Distribution: attic, 41%; pars tensa, 45%; and combined attic-pars tensa, 14%. Unclassifiable cases (n = 14) were excluded. Contralateral disease was present in 15% and effusions in 34% during or after surgery. Cell formation was most extensive in attic disease, least in combined patterns. Ossicular pathology was worse in the collapsed drum cases.