Results were similar between acetaminophen

users and nonusers.

Conclusion: Deficiencies were found in patient knowledge regarding acetaminophen recognition, dosing, and potential for toxicity. The development of effective educational initiatives is warranted to ensure patient awareness and limit the potential for acetaminophen overdose.”
“A 79-year-old man with a 3-month history of lymphedema of the lower limbs, and diabetes mellitus, was admitted to our hospital for suspected deep venous thrombosis. Several hours after admission, leg pain and purpura-like skin color appeared. On the 2nd hospital day, he was referred to our department for possible GM6001 manufacturer acute occlusive peripheral artery disease (PAD) and skin necrosis with blisters; however, computed tomography with contrast showed no occlusive lesions. He had already developed shock and necrotizing deep soft-tissue infections of the left

lower leg. Laboratory findings revealed renal dysfunction and coagulation system collapse. Soon after PAD was ruled out, clinical findings suggested necrotizing QNZ mw deep soft-tissue infections, shock state, disseminated intravascular coagulation, and multiple organ failure. These symptoms led to a high suspicion of the well-recognized streptococcal toxic shock syndrome (STSS). With a high suspicion of STSS, we detected Group G beta-hemolytic streptococci (GGS) from samples aspirated from the leg bullae, and the species was identified as Streptococcus dysgalactiae subsp. equisimilis (SDSE) by 16S-ribosomal RNA sequencing. However, unfortunately, surgical debridement was impossible due to the broad area of skin change. Despite adequate antimicrobial therapy and intensive care, the patient died on the 3rd hospital day. The M-protein gene (emm) typing of the isolated SDSE was revealed to be stG6792. This type of SDSE is the most frequent cause of STSS due to GGS AMN-107 supplier in Japan. We consider it to be crucial to rapidly distinguish STSS from acute occlusive

PAD to achieve life-saving interventions in patients with severe soft-tissue infections.”
“Objectives: To determine the accuracy of medication reconciliation in an internal medicine clinic and to evaluate pharmacist interventions targeted at improving the accuracy of medication reconciliation.

Design: Prospective case series.

Setting: Memphis, TN, from October 2007 to March 2008.

Patients: 180 adults attending an internal medicine appointment.

Intervention: On patient arrival, a nurse completed the medication reconciliation form. In Phase 1 of the study, a pharmacist randomly selected and reviewed a patient’s medication reconciliation form, interviewed the patient, and verified information if indicated. A total of 90 forms were reviewed and compared to determine baseline medication reconciliation accuracy. Education interventions were held with the medical and nursing staff, targeting areas for improvement. In Phase 2 of the study, 90 additional medication reconciliation forms were reviewed in the same manner.

The structures of new compounds were determined by extensive spectroscopic analyses. Structurally, compounds 1 and 3 are tremulane-type sesquiterpenoids with an unusual perhydroazulene carbon skeleton.”
“Objective. Pain concerns are one of the leading causes of visits to primary care. However, practicing physicians find managing pain frustrating and complex. There is little information about how undergraduate medical students approach pain and its management. This study aimed to explore

first-year medical selleck chemicals students’ perceptions of pain-related patient encounters in the primary care setting.

Design. Qualitative analysis was used to explore first-year students’ reflective journals written during an early clinical experience in primary care. Using iterative process for text analysis, entries referencing pain-related encounters were coded by two independent researchers with 94% inter-rater

reliability. Themes and categories were sought by immersion crystallization.

Results. Three themes emerged from the students’ journals: positive, negative, and neutral perceptions of pain-related encounters. With further analysis of the journals, acute, chronic, end-of-life, iatrogenic, and emotional pain categories also emerged. Most journal entries were negative, and chronic pain generated the most negativity.

Conclusions. First-year medical students identified pain as a major concern in their early clinical experience. Students’ selleck screening library perceptions of pain-related encounters can inform curriculum design and may ultimately benefit both physicians and the patients.”
“Two new drimane sesquiterpenoids, 11,12-dihydroxy-15-drimeneoic acid (1) and 3,11,15-trihydroxydrimene (2), were isolated from cultures of the basidiomycete Agaricus arvensis, together with one known compound 3,11,12-trihydroxydrimene (3). Their structures were established by means of spectroscopic analysis.”
“Objective. Methylnaltrexone, a selective peripherally acting mu-opioid

receptor antagonist, effectively treats opioid-induced constipation (OIC) in patients with advanced illness and shows efficacy in patients with chronic nonmalignant pain. The objective was to identify patients who achieved maximal treatment effect based on response to initial four methylnaltrexone Cl-amidine in vivo doses.

Design. A post hoc analysis of a randomized, double-blind, placebo-controlled study evaluating patients with OIC and chronic nonmalignant pain who received 12 mg subcutaneous methylnaltrexone daily for 4 weeks was performed to determine if response to the first four methylnaltrexone doses predicted overall response during the study. Patients receiving >= 8 doses were included.

Outcome Measures. Patients having >= 3 rescue-free bowel movements (RFBMs)/week; change from baseline in RFBMs/week; percentage of doses with RFBMs within 4 hours after dosing.

Results.

No statistic difference was observed between BMG patients and controls for the taste scores (Mann-Whitney U test: P = 0.0955). The percentage of correctly identified taste strips for the highest concentrations was 100% for all tastes. For the lowest concentrations it was 85% for

sweet, 50% for sour, 95% for salty, and 95% for bitter. Three patients with BMG and three control subjects showed hypogeusia.

Conclusion: This study revealed that BMG is not able to change the perception of taste for salty, sweet, sour and bitter. (C) 2011 Elsevier Ireland Ltd. All rights reserved.”
“The marriage of materials and analytical chemistry has been an important development in sample preparation. Also, miniaturized sample preparation is gaining more interest, with the advantages of much lower consumption of organic solvents, improved labor efficiency and shorter extraction times.

This review C59 Wnt mouse describes recent developments of sorbent-based sample-preparation methods, including primarily procedures for minimizing solvent usage and focusing on preparation and applications of interesting materials as sorbents.

We discuss and assess several novel materials (i.e. graphene, ionic liquids, polymeric ionic liquids, molecularly-imprinted polymers, and metal-organic frameworks) in buy A-1155463 some of the latest published

works on sample preparation.

We emphasize the performance of these new sorbents in the extraction of analytes from environmental, biological and food samples, and evaluate their merits and shortcomings. high throughput screening (c) 2012 Elsevier Ltd. All rights reserved.”
“The aim of this study was to provide a relatively safe operation range for the protection of the pituitary stalk in transfrontobasal interhemispheric approach for craniopharyngioma surgery by measuring the related parameters of the pituitary stalk. Based on the whole-head magnetic

resonance imaging scans of 119 healthy subjects (57 men and 62 women) anonymously, three-dimensional reconstructions were rebuilt. The results of the study are as follows: M is the common midpoint of anterior and inferior border of anterior commissure. O and P are the midpoint of the anterior border of the pituitary stalk’s superior and inferior extremity, respectively. The distance between M and O (D-1) was 12.42 (SD, 2.35) mm. The distance between M and P (D-2) was 22.47 (SD, 2.57) mm. The length of the pituitary stalk (D-3) was 10.68 (SD, 2.34) mm. The widest diameter of the pituitary stalk (D-4) was 2.78 (SD, 0.50) mm. The inclination of the pituitary stalk at the coronal plane (A(1)) was 2.73 (SD, 2.60) degrees. Of the 119 pituitary stalks involved in this study, 14.29% were centered, 47.06% inclined to the left with the value (A(1)L) of 3.41 (SD, 2.58) degrees and 38.66% inclined to the right with the value (A(1)R) of 2.93 (SD, 2.49) degrees. The angle between MO and MP(A(2)) was 11.81 (SD, 4.76) degrees.

The measurements revealed an anisotropic strain relaxation in these two directions; there is a higher misfit strain relaxation along the [110] direction where the islands are elongated, which is in agreement with a higher density of misfit dislocations. By combining molecular dynamics simulations and TEM results, the anisotropy in the strain relaxation is shown to be related to the asymmetry in the

formation of interface GDC-0994 research buy misfit dislocations. The P-core glide set 60 degrees dislocations (alpha type) and the Ga-core shuffle set Lomer dislocations serve as the primary misfit dislocation which contributes to the strain relaxation in the (1-10) interface, and the Ga-core glide set 60 degrees dislocations (beta type) and the P-core shuffle set Lomer dislocations for the (110) interface, respectively. The lower formation energy and higher glide velocity of the P-core glide set 60 degrees

dislocations (alpha type) result in a higher line density and more uniform periodical distribution of the misfit dislocation in the (1-10) interface. The higher fraction of Lomer dislocations, which is related to the dislocation configuration stability and surface treatment, promotes a better strain relief in the (1-10) interface, with a corresponding elongation BEZ235 purchase of islands in the [110] direction. (C) 2011 American Institute of Physics. [doi:10.1063/1.3622321]“
“Blending polypropylene (PP) with biodegradable poly(3-hydroxybutyrate) (PHB) can be a nice alternative to minimize the disposal problem of PP and the intrinsic brittleness that restricts PHB applications. However, to achieve acceptable engineering properties, the blend needs to be compatibilized because of the immiscibility between PP and PHB. In this work, PP/PHB blends were prepared with different types

of copolymers as possible compatibilizers: poly(propylene-g-maleic anhydride) (PPMAH), poly (ethylene-co-methyl acrylate) [P(EMA)], poly(ethylene-co-glycidyl methacrylate) [P(EGMA)], and poly(ethylene-co-methyl acrylate-co-glycidyl methacrylate) [P(EMAGMA)]. The effect of each copolymer on the morphology and mechanical properties of the blends was investigated. The results show that the compatibilizers efficiency decreased in this order: P(EMAGMA) > P(EMA) > P(EGMA) > PP-MAH; we explained this by taking into consideration SCH727965 mouse the affinity degree of the compatibilizers with the PP matrix, the compatibilizers properties, and their ability to provide physical and/or reactive compatibilization with PHB. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci 123: 3511-3519, 2012″
“Phase field modeling and computer simulation is employed to study dielectric composites with core-shell filler particles for high-energy-density applications. The model solves electrostatic equations in terms of polarization vector field in reciprocal space using fast Fourier transform technique and parallel computing algorithm.

95

(95% CI: 1.974.41) that of comparison subjects. When performing the analysis with the alternative UI comparison cohort, the adjusted HR for BC was 1.96 (95% CI: 1.143.39). Conclusions This Selleckchem NVP-LDE225 investigation detected a novel association between BC and prior IC/BPS. Neurourol. Urodynam. 32: 5862, 2013. (c) 2012 Wiley Periodicals, Inc.”
“Prevention of the recurrence of post-operative endometriosis is crucial for future fertility. The incidence of disease relapse can be influenced by major demographic changes and by the use of long-term adjuvant medical treatment. Decrease in age at menarche, number of pregnancies and duration of breastfeeding and increase in age at first birth all lead to an increase in the overall number of ovulations and menstruations a woman has within

a reproductive lifespan. These changes impact during the decade at highest risk for endometriosis, i.e. between 25 and 35 years of age, and may substantially expand the hiatus between first-line surgical treatment and conception attempt. Several lines of evidence suggest that ovulation inhibition reduces the risk of endometriosis recurrence. After pooling the results of Sapitinib chemical structure a cohort and a randomized controlled trial on long-term post-operative oral contraceptive use, a recurrent endometrioma developed in 26/250 regular users (10%; 95% CI 7-15%) compared with 46/115 never users (40%; 95% CI 31-50%), with a common OR of 0.16 (95% CI 0.04-0.65). After first-line surgery for endometriosis, women should be invited to seek conception as soon as possible. Alternatively, oral contraceptive use until pregnancy is desired should be considered. (C) 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.”
“Aims The aim of the study Hippo pathway inhibitor is to evaluate the causes for artificial urinary sphincter (AUS) failure in a contemporary series, and to detect modifiable risk factors for device-related complications. The aim is to also report outcome after AUS revision. Methods We retrospectively reviewed the medical records of

consecutive patients who underwent AUS revision at a tertiary care institution by a single surgeon from 2006 to 2011. There were 53 AUS revisions performed on 34 patients at a median age of 69 years. Results Urethral atrophy was the most common indication for revision. Fourteen patients (41%) underwent more than one revision. Seven patients had urethral catheterization in the setting of an active AUS while admitted to a non-urologic service; these patients all developed cuff erosion. Fifty-four percent of urethral erosions were associated with such traumatic catheterizations. After revision, 80% of patients with an AUS in place were using one or no pad daily at mean follow up of 27 months. Conclusion Urethral atrophy remains the most common reason for AUS revision.

The addition of serpentine was found to have a profound effect SBE-β-CD ic50 on the reinforcement of the PP matrix. Because of the stronger interactions at the interphase induced by SCA treatment, mechanical properties were improved further in comparison with the untreated composites. Similar thermal and morphological behaviors were recorded for the composites with and without surface treatment. Thermal studies showed an increase in both melting temperature and percentage crystallinity of the composites. Scanning electron microscopy analysis revealed that homogeneous distribution of filler was observed at low filler contents, but a

certain extent of agglomeration was also seen at high filler loadings. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci 121: 846-854, 2011″
“Study Design. Cadaveric.

Objective: To determine the confidence

with which surgeons should rely on a flexible ball-tipped probe to detect pedicle breeches in the thoracic and lumbar spine.

Summary of Background Data. The reliability of a ball-tipped probe for detecting cortical violations of the pedicle tract has not been studied among fellowship-trained surgeons.

Methods. A total of 134 pedicles were randomized to have pedicle screw tracts with one of six possible options: no violation, anterior, superior, inferior, medial, or lateral violations. see more Five fellowship-trained spine surgeons examined each pedicle, using a standard flexible ball-tipped probe on three nonsequential occasions. The percentage of correctly identified violations, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the surgeons as a group and

individually. The Cohen kappa coefficient was used to assess the accuracy of the observers and the interobserver and intraobserver agreement. Finally, we analyzed our results by spinal region to see whether this impacted the surgeons’ ability to detect a pedicle violation.

Results. The surgeons were able to correctly identify 81% of intact pedicles, 39% of superior, BTSA1 in vitro 68% of medial, 74% of lateral, 62% of anterior, and 50% of inferior violations. The sensitivity varied considerably by breech location and surgeon with a range of 18% to 85%. Positive predictive value for each breech location ranged from 12% to 20%. The specificity was 81% and negative predictive value 98% overall. The intraobserver reliability was moderate and interobserver reliability was low in this series. The ability to detect a pedicle violation was significantly better in the lower thoracic region (T6-T12) than in other areas of the spine.

Conclusion. The standard ball-tipped probe was much less reliable than expected. This technique can be used to confirm an intact pedicle but has an unacceptably high false-positive rate and should be used with caution.

Her condition showed multiple

myeloma with lytic lesions of the skull, plasma cell infiltration in bone marrow and positive light chain lambda type in serum. Workup showed huge bilateral ovarian masses, and ovarian metastasis from plasma cell myeloma was confirmed after pathologic assessment. Multiple myeloma spread to ovary is rare and according to our knowledge, this is the fourth reported case of bilateral ovarian involvement in extramedullary multiple myeloma.”
“Nimesulide was formulated as novel dual coated microparticles using chitosan (CTN) and ethyl cellulose (EC) as encapsulating materials for its improved delivery to the intestine and to prevent gastric irritation and increase patient compliance. The first coating was applied by chitosan using pH change method followed by second coating of ethyl cellulose using thermal change method. This process was analysed for its capability Ispinesib to produce microparticles of uniform size, good flowability, uniform drug loading and maximum entrapment efficacy and the absence of interaction between drug and process parameters as well as the polymers confirmed by XRD and FTIR analysis. In vitro release study was carried out in simulated gastric fluid (SGF) for first 2 selleck chemicals h and simulated

intestinal fluid (SIF) for next 6 h. The formulation M7 and M8 that contained chitosan and ethyl cellulose in the concentration of 1:1 and 1:2 (M1:EC) were found to achieve the targets of the present study such as uniform intestinal release of acidic drug and thus

improves the patient compliance.”
“Vulvar cancer is a rare malignancy; most tumors are squamous cell type while adenocarcinomas are rare. Primary adenocarcinomas of the vulva predominantly include extramammary Paget’s disease and sweat gland carcinomas. Greene first described a rare form of adenocarcinoma in 1936, which was called adenocarcinoma of mammary-like glands of the vulva because of its morphologic and immunohistochemical resemblance to breast adenocarcinomas. In the management of this entity, varying combinations of surgery, radiation therapy, systemic chemotherapy and/or hormonal therapy may be used, as in patients with orthotopic breast carcinoma. However, hormonal therapy leads the way in patients with positive hormonal receptors, where other therapies cannot be used due to comorbidities or advanced age. We present the first reported case of an ML323 chemical structure elderly patient with metastatic vulvar adenocarcinoma arising from mammary-like glands, successfully treated with a combination of surgery and hormonal therapy.”
“The objective of the present study was to stabilize doxorubicin hydrochloride in sugar-phosphate amorphous mixtures at ambient temperature by drying it with vacuum foam drying. Finished products were evaluated for foam characteristic, residual moisture content, reconstitution time, percent drug recovery and drug-excipient interactions. FTIR studies revealed existence of physical interaction of drug with sugar.

Contrary

to traditional teaching, the safest needle placement for an epidural steroid injection, particularly at L3 and above, may not be in the superior aspect of the foramen, but rather in an inferior and slightly posterior position within the foramen and relative to the nerve.”
“Aim: The best treatment option for cervical intraepithelial neoplasia 2 (CIN2) is controversial and there is a lack of studies in value-based STI571 supplier medicine. This multicenter comparative study was undertaken to evaluate the effectiveness, cost-effectives and quality of life (QOL) of loop electrosurgical excision procedure (LEEP) and CO2 laser vaporization for the treatment of CIN2. Material and Methods: A database of LEEP and laser vaporizations performed at three research centers was created. Patients with colposcopic-histopathologically confirmed CIN2 were randomly submitted

to LEEP and laser vaporization. Cytology, human papilloma virus (HPV) DNA test and histology were performed, and a questionnaire on QOL was filled out during follow-up. Effectiveness, cost-effectives and QOL were analyzed. Results: Three hundred and thirty-eight women with CIN2 were included in the study. Frequencies of remission, and persistent and recurrent CIN were 89.2%, 7.2%, and 3.6% for LEEP, Doramapimod in vitro and 86.7%, 12.6%, 0.70% for laser, respectively. There was no significant difference in remission and persistence of CIN. There was a significant difference in the number of operations, recovery time and costs. Women treated with two methods showed relatively identical QOL. Conclusion: Both LEEP and CO2 laser vaporization are effective and reliable

treatments for CIN2, whereas cervical tissue can be obtained for histology by LEEP. Preoperative evaluation and postoperative follow-up are important. Gynecologists should pay attention to QOL of patients with CIN.”
“In this paper, we propose a novel method to detect glandular structures in microscopic images of human tissue. We first convert the image from Cartesian space to polar space and then introduce a novel random field model to locate the possible boundary of a gland. Next, we develop a visual feature-based support vector regressor to verify if the detected contour corresponds to a true gland. SIS3 inhibitor And finally, we combine the outputs of the random field and the regressor to form the GlandVision algorithm for the detection of glandular structures. Our approach can not only detect the existence of the gland, but also can accurately locate it with pixel accuracy. In the experiments, we treat the task of detecting glandular structures as object (gland) detection and segmentation problems respectively. The results indicate that our new technique outperforms state-of-the-art computer vision algorithms in respective fields.”
“Objectives.

The primary aim was to evaluate the prevalence of inadvertent intradiscal injection during fluoroscopically guided contrast-enhanced lumbar transforaminal epidural steroid injections.

Terminal decelerations (decelerations without recovery of 120 seconds or more) defined the exposure. Terminal bradycardia (10 minutes or more) was secondarily explored. Univariable and multivariable analyses were performed to estimate risk of acidemia (umbilical cord gas arterial pH level 7.10 or less).

RESULTS: Of 5,388 women meeting inclusion criteria, 951 (17.7%) experienced a terminal deceleration whereas 4,437 (82.3%) did not. The incidence of acidemia among the 951 women with a terminal deceleration was low (1.3%; n=12). However, acidemia (adjusted odds ratio [OR] 18.6; 95% confidence [CI] 5.0-68.9) and higher-level nursery admission (adjusted OR 5.4; 95% CI 1.9-15.3) were

more likely if the terminal deceleration was 10 minutes or more. Terminal decelerations were Cyclopamine inhibitor longer among neonates with acidemia (6.7 minutes compared with 3.2 minutes; P<.01). For every additional 120 seconds of duration beyond the first 120 seconds, there was a corresponding decrease in umbilical cord gas pH level by 0.042 (95% CI 0.040-0.048; P<.01).

CONCLUSIONS: More than 98% of term fetuses with terminal decelerations deliver with normal umbilical cord gas PFTα price pH levels. However, bradycardia is associated with increased risk of acidemia and higher-level nursery admission. This information can be incorporated into clinical decision-making regarding urgency of delivery.”
“The

potential environmental toxicity of zero-valent iron nanoparticles (nZVI) and three types of nanosilver differing in average particle size from 1 to 20 nm was evaluated using seed germination tests with ryegrass, barley, and flax exposed to 05000 mg L-1 nZVI or 0100 mg L-1 Ag. For nZVI, germination tests were conducted both in water and in two contrasting soils to test the impact of assumed differences in bioavailability of nanoparticles. Inhibitory effects were observed in aqueous suspensions at 250 mg L-1 for nZVI and 10 mg L-1 for Ag. Reduction in shoot growth was a more sensitive endpoint than germination percentage. Complete inhibition of germination

was observed at 10002000 mg L-1 for nZVI. For Ag, complete inhibition was not achieved. The presence of soil had a modest influence on toxicity, and inhibitory effects were observed at 300 mg nZVI L-1 water in soil (equivalent to 1000 mg nZVI Z-IETD-FMK purchase kg-1 soil). Complete inhibition was observed at 750 and 1500 mg L-1 in sandy soil for flax and ryegrass, respectively, while for barley 13% germination still occurred at 1500 mg L-1. In clay soil, inhibition was less pronounced. Our results indicate that nZVI at low concentrations can be used without detrimental effects on plants and thus be suitable for combined remediation where plants are involved. Silver nanoparticles inhibited seed germination at lower concentrations, but showed no clear size-dependant effects, and never completely impeded germination. Thus, seed germination tests seem less suited for estimation of environmental impact of Ag.

1%) became effective donors and the remaining 42 (33.9%) were excluded. The exclusion reasons were related to clinical problems in 27 cases, psychosocial problems in seven cases, and suspected organ trading in eight cases.

Conclusion:

Although strongly forbidden by Chinese laws, organ trading remains a threat to the healthy development of LRDKT in China. To prohibit organ trading, the kinship between the donor and recipient should be carefully identified. Guidelines for living donor evaluation appropriate to the actual situation in China

should be set up for the sake of safety and to protect the rights and interests of both donors and recipients.”
“Purpose: GSK1904529A ic50 To evaluate the effects of a tailored information package for rectal cancer patients on satisfaction with information, anxiety and depression and readjustment.

Method: The study used a randomised control trial method. Seventy six MAPK Inhibitor Library cell line patients undergoing surgery and treatment for rectal cancer were randomly assigned to an intervention (n = 43) or control group (n = 33). The intervention group received an information pack tailored according to their treatment plan and preferred information. The control group received the information currently

given to these patients. Satisfaction with information was measured using the Patient Satisfaction with Cancer Treatment Education (PSCaTE) scale, anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS)

and readjustment was measured using the Reintegration to Normal Living Index, at three time points.

Results: There was a statistically significant difference between the intervention and control group on pre and post intervention scores with patients in the intervention group expressing a higher level of satisfaction with information than those in the control group at Times 2 and 3 (p = 0.00 for both). The intervention group also had a significantly lower anxiety score than the control group at Time 3 (p = 0.03). There was no difference between depression and readjustment scores in the two groups.

Conclusion: The results support the hypothesis Staurosporine solubility dmso that a tailored information pack for patients with rectal cancer will positively affect satisfaction with information. These results will enhance the knowledge base surrounding the provision of tailored information to specific patient groups. (C) 2013 Published by Elsevier Ltd.”
“Increasing health care cost is a major concern in the developing world and has increased the individual economical burden for a common man. Patients are affected by the high pricing of drugs and though the symptoms improve, the poor patient’s compliance sets in if the regimen is heavy on his/her pocket. Therefore, the concepts of pharmacoeconomics are essential for physicians to prescribe individualized drug therapy based on essential drug concept, STEP and R. U. D.