Group G-D was inoculated with 107 C6/36 derived RVFV Group G-E w

Group G-D was inoculated with 107 C6/36 derived RVFV. Group G-E was inoculated with 105 PFU of Vero E6 RVFV stock, and re-inoculated IV with the same inoculum at 1 dpi. Group G-F was inoculated with 105 PFU of C6/36 derived RVFV, and re-inoculated

IV with the same inoculum at 1 dpi. Group G-G was inoculated with 107 C6/36 derived RVFV and re-inoculated SC with the same inoculum at 1 dpi. All goats were kept for four weeks following the inoculation to monitor an antibody development. Serum samples collected at 0, 4, 5, 6, 7, 14, 21 and 28–30 dpi were analyzed for presence of neutralizing antibodies. Differences in susceptibility to RVFV infections were observed between sheep and goats, and also between breeds of sheep. In the first study,

conducted DNA-PK inhibitor in Suffolk-cross sheep, all animals developed viremia at 3 dpi, both by virus isolation and RNA detection when inoculated with 105 PFU of virus produced in Vero cells. However, when the Rideau Arcott cross lambs were inoculated via the same route and the same inoculum, only three out of four animals had detectable RVFV RNA in their blood and only two developed viremia (Fig. 1). Subsequently different inoculation approaches were tested to obtain a more reliable viremia model. Genomic sequences of the inocula were verified prior to the start of the animal inoculations. Concurrently with the infection experiments, characterization on protein level of RVFV Caspase pathway generated in Vero E6 cells or the C6/36 was taking place. There was no difference in genome of RVFV generated in Vero E6 cells

compared to virus generated in C6/36 cells, including the stock viruses used in experimental Thymidine kinase inoculations, and the sequences corresponded with sequences published for RVFV ZH501 in Gen Bank. Both viruses had functional NSm and NSs coding genes, as immunoblots of infected cell lysates indicated that all proteins from the M and S segments were expressed. The viruses however differed in protein composition of virions, with the mosquito-cell generated RVFV having an additional large glycoprotein (78 kDa) incorporated into virions [23]. Subcutanous inoculation was used in all primary inoculation. Two doses (105 or 107 PFU/animal) and two different inocula (prepared either in Vero E6 or in C6/36 cells) were tested. The titer of inoculum was confirmed by back-titration at the time of inoculation, and stayed within 0.5 log10 difference from the targeted dose. In specific groups, attempts were made to increase the viremia by re-inoculation, either by the subcutaneous or by the intravenous route at 1 dpi. A summary of the experimental groups is presented in Table 1. Using the same mode of inoculation as for the Suffolk breed (group S-A), the 105 PFU dose of Vero E6 produced RVFV in Rideau Arcott cross lambs (group S-B) lead to development of viremia only in three out of four animals at 2 dpi.

Delegates from the countries subsequently presented these data at

Delegates from the countries subsequently presented these data at the international workshop. This document provides a summary of the workshop and outlines the presented results and the recommendations from the meeting. Surgeons from 13 hospitals representing 10 African

countries attended the meeting. Countries represented at the meeting included: Botswana, Cote D’Ivoire, Ghana, Kenya, Malawi, Nigeria, South Africa, Tanzania, Zambia and Zimbabwe. In all countries except South Africa and Botswana, the data were collected from hospital records at the largest paediatric hospital in the capital city of each country. In South Africa, Apoptosis Compound Library we collected data from three large academic hospitals in three cities. In Botswana, a review of hospital data was performed by a single surgeon from two government hospitals. From 1993 to 2003,

a total of 1069 case-patients with intussusception were treated at the 13 hospitals represented at the meeting. Age data were available on 729 infants with intussusception (Fig. 1). The age distribution of intussusception in the 10 African countries was similar to that in the published literature from other regions of the world, with 13% of the burden among infants <3 months of age, 56% among infants 4–6 months, 23% among infants 7–9 months, and 8% among infants 10–12 months of age. Intussusception events occurred during most months of the year, without any evident seasonal Selleckchem PLX 4720 all peaks (Fig. 2). The diagnosis of intussusception, clinical management, and outcome was presented from 10 sites. At these sites, the vast majority of intussusception case-patients were diagnosed surgically (69%) some at autopsy. Contrast enema and ultrasonography were used to diagnose intussusception only in 10% and 11% of the case-patients,

respectively. Surgical treatment (reduction or resection) was employed in 90% of the case-patients. In six countries that specified the proportion that required resection, this varied from 27% in Kenya to 62% in Nigeria. In one analysis in South Africa, resection was performed in 46% of cases at Ga-Rankuwa Hospital over a 20 year period between 1983 and 2003 (L. Marcisz, unpublished data). At the 9 sites with available data on outcome, 108 of 863 (13%) intussusception case-patients died after presentation to the hospital. The past history of rotavirus vaccines has necessitated the consideration of intussusception with all new rotavirus vaccines and WHO has recommended that post-marketing surveillance is implemented in countries that introduce rotavirus vaccines [2] and [8]. Thus, monitoring of intussusception is an important activity after the routine introduction of rotavirus vaccines in national immunization programmes [3] and [14].

The effect of hydro-alcoholic extract was less than the alcoholic

The effect of hydro-alcoholic extract was less than the alcoholic extract at all the concentrations against MCF-7 cell lines ( Fig. 1). In all the cell lines the less growth inhibition by hydro-alcoholic extract was observed as compared to alcoholic extract at10, Sunitinib supplier 30 and 100 μg/ml. In case of fractions, it was observed that all the four fractions of the alcoholic extract had also shown growth inhibition in dose dependent manner in all the cell lines at 10, 30, 100 μg/ml ( Fig. 2) and chloroform fractions was most active than rest of the fractions and aqueous fraction was least effective. Chloroform fraction

showed 4–80, 8–91 and 19–99% growth inhibition at 10, 30 and 100 μg/ml respectively against various cell line used in study. The maximum effect was observed against HT-29 cell line and minimum, effect was observed against Hep-2 cell line. 5-Flurouracil (20 μM), adriamycin (1 μM), paclitaxel (10 μM) and mitomycin C (1 μM) were used as positive selleck chemicals llc control and they induced significant cell growth inhibition (data not shown). Chloroform (F002) of the alcoholic extract showed dose dependent cytotoxicity against most of the cancer cell lines of different tissue used. The alcoholic extract showed

significant (p < 0.05) tumor growth inhibition of 42.62% and 25.96% at 40 mg/kg against Ehrlich and Sarcoma-180 solid tumor murine models respectively. Whereas, hydro-alcoholic and aqueous extract extracts showed much less tumor growth inhibition against these models (data not included). Also, chloroform fraction of the alcoholic extract showed significant tumor growth inhibition of 48.98% (p < 0.05) and 44.11% (p < 0.05) at 10 mg/kg for Ehrlich tumor and 3-mercaptopyruvate sulfurtransferase Sarcoma-180 respectively ( Table 1). A consistent proportion of people in developing countries depend on traditional medicines for their primary health needs. According, to the

several studies conducted on medicinal plants it suggested that besides possessing various medicinal benefits they also retain antitumor properties.20 Therefore, study of medicinal plant could help in identification of antitumor compounds.21 In this study, we analyzed the effects of Cuscuta reflexa (whole plant) medicinal plants, extracts and fractions on cell growth of the human cancer cell lines and the in vitro studies indicated that all the three extracts (alcoholic, hydro-alcoholic and aqueous) of Cuscuta reflexa (whole plant) have anticancer potential. The alcoholic extract has maximum potential activity whereas the aqueous extract has the least. The hydro-alcoholic extract was much better than aqueous extract but not superior than alcoholic extract. The cancer growth inhibition by these extracts was cell line and concentration dependent.

Some flavones have potential as radioligands for imaging the mult

Some flavones have potential as radioligands for imaging the multidrug resistance associated protein (ABCC1/MRP1). 21 Adequately abundance in plants and their low mammalian toxicity, chromones are present in large amounts in the diet of humans. 22 Flavones have been synthesised by the dehydrative cyclisation of 1,3-diones by the use of NaOAc/AcOH, Br2/CHCl3, H2SO4 and ionic liquid

under microwave irradiation. 23 MORE (microwave induced organic reaction enhancement) chemistry has become a popular tool in the recent years as a nonconventional technique for organic synthesis.24 It is selleck kinase inhibitor an efficient and environmentally benign method to activate various organic transformations, which affords products in higher yields MEK pathway in shorter reaction periods involving a very small amount of solvent. Thus this technique is easy, economical, effective and eco-friendly and hence called as ‘e-chemistry’. It is believed to be a step towards green chemistry. Thus, in view of these observations we report the synthesis of few cinnamoylchalcones and consequently their cyclisation to cinnamoylflavones using conventional method (I2/DMSO) as well as microwave irradiation. The purity of the compounds was checked by TLC on silica gel-G. Melting points were taken in open capillaries and are uncorrected. The IR spectra (ν cm−1) were recorded

on a Perkin–Elmer 1800 spectrophotometer using KBr discs. 1H NMR spectra were recorded in DMSO on Brucker (400 MHz)

using TMS as internal standard (δ in ppm). The following abbreviations were used to indicate the peak multiplicity s – singlet, d – doublet and m – multiple. 1-(2-hydroxyphenyl)-5-phenyl-4-pentene-1,3-diones [1(a,b)] were synthesised by the literature method.25 Equimolar quantities of 1-(2-hydroxyphenyl)-5-phenyl-4-pentene-1,3-diones, [1(a,b), 0.01 mol] and substituted aromatic aldyhydes [2(a–d), 0.01 mol] were dissolved in ethanol (30 mL) and refluxed in presence of piperidine (5–10 drops) for 1–1.5 h (Reaction Scheme 1). The yellow solid that separates on cooling was washed with ethanol and crystallised from ethanol: acetic acid (1:1) mixture to get 3(a–h). α-cinnamoylchalcones [3(a–h), 0.001 mol] were Carnitine dehydrogenase suspended in DMSO (10 mL) and catalytic amount of iodine was added to it. The mixture was refluxed for 40 min and on cooling diluted with water. The solid obtained was filtered off, washed with 10% sodium thiosulphate and crystallised from ethanol: acetic acid (1:1) mixture to get compounds 4(a–h). α-Cinnamoylchalcones [3(a–h), 0.001 mol] were suspended in DMSO (10 mL) and catalytic amount of iodine was added to it. A simple household microwave oven equipped with a turntable was used for microwave heating. The output power indicated in the equipment is 800 W. The mixture was irradiated in the microwave oven for five to seven minutes at microwave power level 40. The completion of reaction was monitored by TLC.

They were maintained in well-ventilated room temperature with rel

They were maintained in well-ventilated room temperature with relative humidity of 45–55% and natural 12 h: 12 h day–night cycle in propylene cages. All the experiments were carried out between 10:00 am and 2:00 pm. The animals were housed for one week, prior to the experiments to acclimatize laboratory temperature. Food not water was withdrawn 3 h before and during experiment. The drugs used were Cilostazol (Cilodoc, Lupin Laboratories, India), Gabapentin (Gabapin, Intas Pharmaceuticals, India), Vincristine sulphate injection (Vinkem Labs, India). All chemicals and reagents used were of analytical

grade. Cilostazol was made into www.selleckchem.com/products/chir-99021-ct99021-hcl.html suspension in 10% aqueous Tween 80 for oral administration and Gabapentin was suspended in 0.25% of carboxy methyl cellulose (CMC) in 0.9% saline solution and were freshly prepared prior to administration. Animal dose was calculated according to the body mass surface ratio.8 CZ was administered at a dose of (40, 20 mg/kg, p.o) and GBP was administered at a dose of (100 mg/kg, i.v). VC was administered at a single dose of 100 μg/ml9 to all the group of animals on the first day of the study. Drugs were administered for 5 days of the study. Mechanical hyperalgesia and mechanical Allodynia was determined prior to and after 5 days of vincristine treatment. The control

animals received 10% Tween 80 in 0.9% saline solution. All the parameters were performed to all the groups i.e. control as well as drugs treated. Mechanical hyperalgesia was evaluated by pin prick test10 and tactile allodynia was assessed by lightly stroking the injured www.selleckchem.com/products/iwr-1-endo.html leg with a paintbrush and the response was recorded.11 Statistical significance test was done by ANOVA followed by Dunnett’s ‘t’test. Values were considered significant when p < 0.01. All data were expressed as mean ± S.E.M

of 6 animals per group. When compared to the baseline readings, the 5th day (after vincristine administration) readings showed a decrease in the paw withdrawal latency indicating the development of mechanical hyperalgesia.9 In contrast, CZ (20 mg/kg & 40 mg/kg) treated animals reversed mechanical hyperalgesia on 5thday (after vincristine aminophylline administration) at both doses. However standard (Gabapentin) showed significant attenuation of mechanical hyperalgesia at 5th day. Results are shown in Fig. 1. The baseline paw withdrawal frequencies determined by mechanical stimulation with paintbrush was enhanced at 5th day.9 When compared to the baseline readings, the 5th day (after vincristine administration) readings showed an increase in the paw withdrawal frequency indicating the development of mechanical allodynia. CZ at both doses (20 mg/kg & 40 mg/kg) decreased the allodynic score on 5th day (after vincristine administration) at both doses. However standard showed significant attenuation of mechanical allodynia at 5thday. Results are shown in Fig. 2.

of MIAF-DENV-4 and incubated at 4 °C for 8 h in constant agitatio

of MIAF-DENV-4 and incubated at 4 °C for 8 h in constant agitation. After incubation, 0.1 vol. of Sepharose Protein A was added to precipitate the antigen–antibody complex, and incubated at 4 °C for 16 h. After incubation, the complexes were recovered by

centrifugation PD0325901 cost at 12,000 × g for 30 s at 4 °C, washed 3 times with PBS, suspended in load buffer and submitted to SDS-PAGE. Following SDS-PAGE, the proteins were transferred to a nitrocellulose membrane and were visualized by an western blot assay. In summary, after protein transfer, the nitrocellulose was blocked for 4 h with PBS Tween-20 albumin 5%; the membrane was washed 3 times with PBS Tween-20 and incubated for 2 h at room temperature with DENV-4 MIAF (1:100). The membrane was then washed and incubated for 2 more hours with alkaline phosphatase conjugated anti-mouse IgG (Sigma, Saint Louis, MO). Finally, the membrane was washed 3 more times with PBS-Tween-20, stained with the Western Blue Substrate for Alkaline Phosphatase Kit (Promega, Wiscosin), and correct prM/E

protein expression was defined according to the molecular weight control. DENV-4-DNAv was prepared with EndoFree Plasmid Mega Kit (QIAGEN) as specified by the manufacturer. Ten 5-week-old female BALB/c mice per immunization group were inoculated three times into the quadriceps muscle with 100 μg of DENV-4-DNAv or pCI (empty vector), GSK1210151A cell line DENV-4 heat inactivated (1 × 105 PFU), or PBS. The mice were primed on day 0 and boosted 15 and 30 days after the initial inoculation. Blood samples were obtained right before each boost and 15 Rutecarpine days after the last inoculation. Sera from these mice were stored at −70 °C until use. Pooled mouse sera were also assayed for DENV-4 (H-241 strain) neutralizing antibody in a plaque-reduction neutralization

test (PRNT) slightly modified from that previously described by Russell and Nisalak in 1967 [21]. Shortly, DENV-4 stock was serially diluted in 1X sterile PBS (10-fold dilutions) and titrated on duplicate wells of confluent Vero cell monolayers grown in 12-well plates. Serum samples were heat inactivated at 56 °C for 30 min, serially diluted in 1X PBS (1:2–1:256), and then incubated overnight at 4 °C with an equal volume of a DENV-4 dilution containing approximately 30 plaque-forming units/ml (pfu/ml). As a control, we used the same virus preparation mixed with uninfected mouse serum. The virus–antibody mixes were inoculated on confluent Vero cell monolayers and after virus adsorption, monolayers were washed with PBS, overlaid with 2.0 ml of 3% carboxymethylcellulose-L15 overlay medium containing 2% fetal calf serum (FCS), and incubated at 37 °C/5%CO2 for 7 days. Cells were then stained with 2% neutral red to determine the number of plaque forming units per dilution. The number of plaques reported for each serum dilution was the average of the duplicate wells.

When presented side by side, the minimal risks associated with th

When presented side by side, the minimal risks associated with the decision to vaccinate may be completely over-shadowed by the health risks associated with the decision to not vaccinate, potentially aiding parents and young adults in making decisions Regorafenib clinical trial about HPV vaccination. Communication concerning the high prevalence of HPV and the high likelihood of acquisition of the virus shortly after sexual debut also may be instrumental in conveying the risk of inaction as a counterpoint to discussion of risk of vaccination. As a note of caution, however, acknowledging the known minor risks associated with HPV vaccination (e.g.,

pain at the injection site, syncope, dizziness, mild fever) is very important. Recent research suggests that communicating that vaccination entails no risk may, paradoxically, lead patients to view vaccines as more risky ( Betsch and

Sachse, 2013). Particularly in the U.S., where HPV vaccination typically occurs in medical settings, the recommendation from a HCP plays a central role in the decision to receive HPV vaccine (Brewer et al., 2011 and Guerry et al., 2011). A recent study of Canadian undergraduates showed similar results (Krawczyk et al., 2012). Conversely, among those who have not received HPV vaccine, the lack of HCP recommendation has been identified as a major reason for non-vaccination (Liddon et al., 2012a and Zimet et al., 2010). While HCPs generally embrace their important role in recommending the HPV vaccine, these learn more recommendations may nevertheless be unevenly carried out due to such issues as time constraints, patient age, availability of insurance isothipendyl or other coverage, safety and/or efficacy concerns, and discussion of sexuality and information needs (Vadaparampil et al., 2011). Vaccine risk communication, in general, is a challenge to HCPs (Evans and Bostrom, 2002). Some providers feel that extensive discussion of risks and benefits of vaccines (including sexuality issues related to HPV transmission

in particular) might alarm rather than reassure and may take up too much time. Many HCPs report feeling uncomfortable engaging in discussions regarding sexuality with their adolescent patients (Esposito et al., 2007 and Schnatz et al., 2010), while others feel more comfortable discussing sexuality primarily with older adolescents or with males over females (Kahn et al., 2005 and Ko et al., 2010). One potential strategy for overcoming the problems associated with reliance on HCP recommendations would be to establish alternate venues for vaccination, such as schools or pharmacies. The success of school-based HPV vaccination policies, for example, is demonstrated by the high rates of vaccination achieved in Australia, the U.K., and Canada (Franceschi, 2010, Garland et al., 2011 and Shearer, 2011).

Parking was available for a fee and a limited volunteer driver pr

Parking was available for a fee and a limited volunteer driver program was offered to patients who could not otherwise access the hospital. The pulmonary rehabilitation program followed a standard format (Nici et al 2006), with seven weeks of twice-weekly group exercise and self-management education sessions. The exercise component was individually prescribed and consisted of 30 minutes of aerobic training (walking and exercise bike) with intensity progressed weekly, and resistance training using functional tasks such as step ups and sit to stand. Sessions were conducted in the morning. Patients were included in the study if they had a diagnosis of COPD and were aged 18 years or over. Patients were excluded if

they did not speak English and www.selleckchem.com/products/cobimetinib-gdc-0973-rg7420.html find more could not participate in an interview. Individuals who were eligible to take part were contacted by an independent investigator not involved in delivery of the clinical program who provided written information and obtained consent. Nine interview questions were developed (Box 1) and reviewed by two experts in the delivery of pulmonary rehabilitation programs. The questions allowed exploration of possible reasons for and individual experiences associated with non-attendance and non-completion. All participants who undertook the semi-structured interview were given the option of doing it at their home or over the telephone. Interviews were recorded

and took 20–40 minutes to complete. Researcher triangulation was employed, with interviews conducted by one of two researchers (AK or AH) in order to reduce the potential Idoxuridine for bias (Patton 1999).

Researchers were encouraged to make observational memos for use during analysis (Boije 2010). Each interview was transcribed verbatim by a single researcher. If clarification was needed on the content or meaning of an interview the participant was contacted to review the information. Demographic information collected directly from participants and from their medical record was gender, age, body mass index (BMI), lung disease severity using the Global Initiative for Obstructive Lung Disease (GOLD) criteria (Rabe et al 2007) based on recent (within six months) spirometry, smoking status, home oxygen use, living situation, comorbidities score (Charlson et al 1987) and distance between their home and the pulmonary rehabilitation venue. 1. Who suggested that you might attend a pulmonary rehabilitation program? De-identified interview transcripts were examined independently by two researchers (AK and AH). Line-by-line iterative thematic analysis (Boyatzis 1998) of the transcribed interviews took place, where descriptive codes were devised to represent the data. Three rounds of coding were used. Open coding commenced during data collection and was used to compile a hierarchical coding scheme. Axial coding was then used to refine and delineate the relationship of themes to subthemes.

, changes occur rapidly The biochemicals measured in ginkgo leaf

, changes occur rapidly. The biochemicals measured in ginkgo leaf extracts, in buy ABT-199 the present study, are on the higher side as compared to the earlier reports from other countries.13 and 14 The 5 locations in the present study, falling between 1742 and 2260 m altitude representing temperate climatic conditions,

are likely to be associated with the higher contents of phytochemicals and antioxidants. Findings on production of polyphenols and antioxidants, in respect to environmental stress, have been linked to the defense mechanism.15 Total phenolic content in ginkgo leaf extracts varied significantly with respect to season and organic solvent, being maximum in autumn (Fig. 2A). Phenolic content was exceptionally higher in rainy and spring season in EA and n-B. Total flavonoid content

was higher in spring in 3 solvents, AW, WE and n-B, during rainy season in ME and during autumn in EA (Fig. 2A). selleckchem Antioxidant activity performed by three assays showed significant variation with respect to the seasons, maximum being in ABTS and DPPH in autumn (Fig. 2B). In case of FRAP, higher activity was recorded during spring followed by autumn (Fig. 2B). Importance of seasonal variation in accumulation of total phenolic and flavonoid contents and antioxidants has been recognized. Although a clear and regular trend due to seasonal variation was not observed in the present study, the total phenolic content was relatively higher in autumn. Kobus et al13 reported higher level of polyphenols in October as compared to August. Besides, higher accumulation of phenolic and flavonoids during winter is likely to be attributed to the stress conditions such as temperature and plant growth stage. In general, the secondary metabolites remain at low level in ginkgo during spring and summer which are the initial stages for the growth of shoots and leaves. Afterward, towards autumn and winter, as the growth and metabolism become slower, the phytochemicals tend to accumulate in higher

amounts. The optimization experiments conducted for preference of solvent revealed that AW was the best solvent for extracting phenolic content in all the three seasons; followed by ME > WE > n-B > EA. Similarly, total MYO10 flavonoid content was recorded highest in AW during rainy and autumn followed by ME during spring (Fig. 3A). Different solvent systems also influenced the extraction of antioxidant activity in different seasons. Antioxidant activity measured by ABTS assay was highest in ME in rainy and autumn and in WE in spring. In DPPH assay, the activity was recorded highest in WE in all the seasons. Also, the reducing power assay showed higher antioxidant activity in AW during all the seasons (Fig. 3B). Factorial analysis exhibited that the solvents and seasons individually and their interaction significantly (p < 0.001) influenced the accumulation of phytochemicals and antioxidant activity ( Table 1).

Participants were asked on which days they used their prosthesis

Participants were asked on which days they used their prosthesis and for one day of normal activity how long they wore the prosthesis, how many sit to stands they performed, and the duration they performed prosthetic walking

and standing activities. Prosthetic non-users did not use their prosthesis for locomotor activities on any days. Individuals who only wore their prosthesis for cosmesis were classified as non-users. Non-users were asked their reasons for prosthetic non-use and to recall how selleck chemical many months after physiotherapy discharge they stopped using their prosthesis. Important calendar events (eg, last amputee outpatient clinic, birthday, Christmas) were used as verbal prompts to assist with recall accuracy. Participants were interviewed with a previously piloted survey on their prosthetic use from 4 months onwards after discharge and re-interviewed approximately at 2-monthly intervals until data were collected for 12 months. The procedure used for clinical prediction rules validation were the same as for the development procedure, except

that data were prospectively collected during the participants’ rehabilitation using a physiotherapy assessment form. This form was developed and implemented by the senior physiotherapist during clinical prediction rules development. The statistical models used in the present study are consistent with clinical selleck kinase inhibitor prediction rules reports27, 28, 29 and 30 and are not equivalent to a regression analysis. The primary outcome variable was prosthetic non-use at 4, 6, 8 and 12 months post-discharge. Descriptive statistics were generated. The univariate relationship between categorical variables and prosthetic users and non-users was analysed using the chi-square test. For each of the continuous variables,

ROC curves were used to determine the threshold at which specificity and sensitivity were equal to generate dichotomous classification for the univariate analyses. Univariate contingency tables were used to identify a smaller subset of variables related to Phosphoprotein phosphatase prosthetic non-use that had a significance level of 10% (chi-square p < 0.10). This conservative significance level was selected to avoid missing critical variables. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for the variables. A backwards stepwise logistic regression model was used to reduce these variables to a set of flags or key variables that contributed to predicting non-use. To generate clinical prediction rules for the time frames, the set of variables from the regression was used to establish cumulative numbers of items present for any one individual at discharge. A list of likelihood ratios (negative and positive, 95% CI) were calculated to determine the cumulative effect of having a number of these predictors (1, 2, 3, etc) on non-use.