\n\nMethod\n\nA survey

was mailed in 2007 to a stratified random sample of 1,000 U. S. primary care physicians, selected from the American Medical Association Physician Masterfile. Participants were classified into three groups according to agreement or disagreement with two statements: “A physician should never do what he or she believes is morally wrong, no matter what experts say,” and ” Sometimes physicians have a professional ethical obligation to provide medical services even if they personally believe it would be morally wrong to do so.”\n\nResults\n\nThe response rate was 51% (446/879 delivered questionnaires). Forty-two percent and 22% believed they are never and sometimes, respectively, obligated to do what they personally believe is wrong, and 36% agreed with both statements. Physicians MGCD0103 concentration who are more religious are more likely to believe that physicians PF-00299804 in vivo are never obligated to do what they believe is wrong (58% and 31% of those with high and low intrinsic religiosity, respectively; multivariate odds ratio, 2.9; 95% CI, 1.2-7.2). Those with moral objections to any of three controversial practices were more likely

to hold that physicians should never do what they believe is wrong.\n\nConclusion\n\nA substantial minority of physicians do not BMS-777607 believe there is ever a professional obligation to do something they personally believe is wrong.”
“The effects of prepartum supplementary feeding on the productive and reproductive performance were investigated using grazing gestating Bunaji cows with an average initial body weight of 294.50 +/- 3.75 kg. Twenty cows were allocated to a completely randomized design, with five animals per treatment. The treatments were: A, range grazing (RG); B, RG + 100% corn bran (CB); C, RG + 60% CB + 40% palm kernel cake (PKC), and D, RG + 60% CB + 40% dried brewer’s grains (DBG).

The average daily gains (ADG) and body condition scores (BCS) of supplemented cows were significantly better than the non-supplemented cows. Postpartum weight loss was markedly reduced in supplemented cows compared to their non-supplemented counterparts. Mean milk offtake and mean milk yield per lactation were significantly lower in non-supplemented cows than the supplemented ones. Among the supplemented cows, ADG, BCS, mean milk offtake and milk yield per lactation were significantly better for cows on treatments C and D than those on treatment B. Though insignificant, longest lactation length (LL) and shortest calving interval were obtained for supplemented cows. Calf’s birth weight was similar among the treatments. Milk yield was significantly influenced (R-2 = 0.8601) by cow’s weight, BCS and LL.

Relevant patient characteristics and follow-up were recorded. Complications were categorized by type and end outcome, including

nonoperative, operative, or explantation. Both groups had comparable follow-up (acellular dermis, 23.2 +/- 8.9 months; no acellular dermis, 24.4 +/- 12.7 months; p = 0.23). Appropriate statistical analyses, including multiple regression, were performed.\n\nResults: Acellular dermis patients (n = 199 breasts) had larger body mass indexes (p = 0.0001) and more nipple-sparing mastectomies (p = 0.04) than non-acellular dermis patients (n = 393 breasts). Breasts with acellular dermis had larger intraoperative fill volumes (p = 0.0001) and decreased postoperative expansions (p = 0.02), but no decrease in time to implant exchange. There were no significant differences in complication profiles between acellular dermis and non-acellular dermis breasts, after adjusting for other relevant patient check details variables on regression analysis. After stratifying patients by exposure to radiation, acellular dermis breasts had a decreased risk of all complications https://www.selleckchem.com/products/lcl161.html related to radiation as compared with non-acellular dermis breasts.\n\nConclusions:

This study suggests that acellular dermis does not adversely affect complication rates following prosthetic breast reconstruction. It may be advantageous, however, in select patients, particularly those undergoing postoperative radiation therapy. Therefore, the choice to use acellular dermis does not compromise outcomes but should be individualized to each patient. (Plast. JIB-04 nmr Reconstr. Surg. 130: 750, 2012.)”
“A novel thia-Prins bicyclization approach has been developed for the first time for the synthesis of hexahydro-2H-thieno[3,2-c]thiopyran derivatives from the coupling of homoallylic mercaptans

such as hex-3-ene-1,6-dithiol with various aldehydes using 10 mol % InBr3 in dichloromethane with high selectivity. In addition, the, coupling of (E)-N-(6-mercaptohex-3-enyl)-4-methylbenzenesulfonamide with aldedydes affords the corresponding N-tosyloctahydrothiopyrano-[4,3-b]pyrrole derivatives in good yields. This reaction is a stereoselective affording trans-fused product from E-homoallyllic mercaptan and cis-fused product from Z-homoallyllic mercaptan.”
“A series of novel fluorinated aromatic polyesters containing trifluoromethylphenoxy pendant groups was synthesized by interfacial polycondensation of 2-(4-trifluoromethylphenoxy)terephthalyl chloride with various bisphenols in dichloromethane. The polyesters obtained in good yields had weight-average molecular weights of 70,600-29,800 g/mol, polydispersities of 1.81-2.08, and were all amorphous. All polyesters were easily soluble in organic solvents such as N,N-dimethylformamide, tetrahydrofuran, o-chlorophenol, pyridine, and dichloromethane.

So far, a number of studies have shown that, in the vicinity of strong anthropogenic emission sources, Ca-rich dust particles

can be converted into Vorinostat manufacturer aqueous droplets mainly by the reaction with gaseous HNO3 to form Ca(NO3)(2). Here we show that other similar processes have the potential to be activated under typical remote marine atmospheric conditions. Based on field measurements at several sites in East Asia and thermodynamic predictions, we examined the possibility for the formation of two highly soluble calcium salts, Ca(NO3)(2) and CaCl2, which can deliquesce at low relative humidity. According to the results, the conversion of insoluble CaCO3 to Ca(NO3)(2) tends to be dominated over urban and industrialized areas of the Asian continent, where the concentrations of HNO3 exceed those of HCl ([HNO3/HCl] > similar to 1). In this regime, CaCl2 is hardly detected from dust particles. However, the generation of CaCl2 becomes detectable around the Japan Islands, where the concentrations of HCl are much higher LY2606368 purchase than those of HNO3 ([HNO3/HCl] < similar to 0.3). We suggest that elevated concentrations of HCl in the

remote marine boundary layer are sufficient to modify Ca-rich particles in dust storms and can play a more important role in forming a deliquescent layer on the particle surfaces as they are transported toward remote ocean regions.”
“All of us regularly face situations that require the integration of the available information at hand with the established rules that guide behavior in order to generate the most appropriate action. But where individuals differ from one another is most certainly in terms of the different strategies that are adopted during this process. A previous GW69A study revealed differential brain activation patterns for the implementation of well established higher-order stimulus-response (S-R) rules depending on inter-individual strategy

differences (Wolfensteller and von Cramon, 2010). This raises the question of how these strategies evolve or which neurocognitive mechanisms underlie these inter-individual strategy differences. Using functional magnetic resonance imaging (fMRI), the present study revealed striking strategy-effects across regions of the lateral prefrontal cortex during the implementation of higher-order S-R rules at an early stage of learning. The left rostrolateral prefrontal cortex displayed a quantitative strategy-effect, such that activation during rule integration based on a mismatch was related to the degree to which participants continued to rely on rule integration. A quantitative strategy ceiling effect was observed for the left inferior frontal junction area. Conversely, the right inferior frontal gyrus displayed a qualitative strategy-effect such that participants who at a later point relied on an item-based strategy showed stronger activations in this region compared to those who continued with the rule integration strategy.

In addition, non-bridging oxygens do not frame. The conversion of Ge(IV) to Ge(VI) does not continue further FDA-approved Drug Library research buy to the formation of the isolated octahedrons

because begins to reconvert Ge(VI) back to Ge(IV) and Ge(V) with the simultaneous formation of non-bridging oxygens. The excess of oxygen can be accommodated in the host network by the formation of the [CuO(n)] structural units. (C) 2010 Elsevier B.V. All rights reserved.”
“Myelination by oligodendroglial cells (OLs) enables the propagation of action potentials along neuronal axons, which is essential for rapid information flow in the central nervous system. Besides saltatory conduction, the myelin sheath also protects axons against inflammatory and oxidative insults. Loss of myelin results in axonal damage and ultimately neuronal loss in demyelinating disorders. However, accumulating evidence indicates that OLs also provide support to neurons via mechanisms beyond the insulating function of myelin. More importantly, an increasing volume of reports indicates defects of OLs in numerous neurodegenerative diseases, sometimes even preceding neuronal loss in pre-symptomatic episodes, suggesting that OL pathology may be an important mechanism contributing to the initiation and/or progression of neurodegeneration.

This review focuses on the emerging picture of neuronal support buy A-1331852 by OLs in the pathogenesis of neurodegenerative disorders through diverse molecular and cellular mechanisms, including direct neuron-myelin interaction, metabolic support by OLs, and neurotrophic factors produced by and/or acting on OLs.”
“Purpose of review\n\nHuman cytomegalovirus (CMV) reactivation and disease remains one of the major complications after allogeneic haemopoietic stem cell transplantation. Cell-mediated immunity is essential in counteracting CMV infection as evident by detection of high frequencies of CMV-specific CD8(+) and CD4(+) lymphocytes among the healthy CMV-seropositive individuals. Adoptive transfer of

CMV-specific CT99021 research buy T cells to speed up reconstitution of CMV-specific immunity potentially offers clinical protection and reduces drug toxicities as well as outgrowth of drug-resistant strains from prolonged antiviral therapy.\n\nRecent findings\n\nDifferent strategies to generate CMV-specific T cell have been explored. Similarly, vast diversities in term of cell dose and composition of the cellular product have been infused into small cohorts of patients. To date, a number of phase I/II clinical trials have demonstrated the feasibility of adoptive transferred CMV-specific T cells as prophylaxis, pre-emptive or therapeutic measure. In general, all these strategies showed variable degrees of efficacy without obvious adverse event particularly with regard to the induction of graft-versus-host disease.\n\nSummary\n\nIn this review, we would like to give a comprehensive synopsis regarding therapeutic application of CMV-specific T cells in fighting CMV infection.

9) were compared with those in the low seismic intensity area ( smaller than 4.9). Results: SIRs increased with the increased flood severity: 0.94 (0.59-1.30) at smaller than 20%, 1.02 (0.70-1.34) at 20-40%, selleck inhibitor 1.26 (0.661.86) at 40-60% and 1.98 (1.25-2.72) at bigger than = 60%. However, SIRs did not increase with increased seismic intensity: 0.95 (0.601.29) at smaller than 4.5, 1.52 (1.07-1.98) at 4.5-5.0 and 1.17 (0.80-1.54) at bigger than = 5.0. ORs and adjusted

ORs for seismic intensity in the high flood area compared with the low flood area were significant: 1.68 (1.07-2.65) and 1.78 (1.08-2.96), respectively. However, ORs and adjusted ORs for flood severity in the high seismic intensity area compared with the low intensity area were not significant: 1.33 (0.82-2.17) and 1.19 (0.62-2.31), respectively. Conclusions: Cerebrovascular disease incidences after the Great East Japan Earthquake and Tsunami of 2011 increased because of tsunami damage and not because of the earthquake Selumetinib datasheet magnitude. (C) 2014 S. Karger AG, Basel”
“Aim:\n\nTo investigate how the survival of Listeria monocytogenes on parsley leaves may affect its ability to sustain process-related harsh conditions and its virulence.\n\nMethods and Results:\n\nParsley seedlings were spot inoculated with stationary phase cells of L. monocytogenes EGD-e and incubated for 15 days. Each day, bacterial

cells were harvested and enumerated, and their ability to survive acetic acid challenge (90 min, pH 4 center dot 0), to colonize abiotic surfaces and to grow as biofilms was assessed. After a 3-log decrease over the first www.selleckchem.com/products/BKM-120.html 48 h, the population stabilized to about 106 CFU g-1 until the sixth day. After the sixth day, L. monocytogenes was no longer detected, even

after specific enrichment. Incubation on parsley leaves affected the ability of L. monocytogenes to survive acetic acid challenge (90 min, pH 4 center dot 0) and to adhere to stainless steel although the ability to grow as biofilm was preserved. To further investigate these physiological alterations, the mRNA levels of six target genes (bsh, clpC, groEL, inlA, opuC, prfA) was quantified using reverse transcription qPCR after 5 h of incubation on parsley leaves. A decrease was observed in all but one (bsh) target, including groEL and clpC which are involved in resistance to salt and acid. Moreover, the decrease in the levels of inlA, prfA and opuC transcripts after incubation on parsley suggested a repression of some genes involved in pathogenicity. In vitro assessment of mammalian cell adherence and invasion using Caco-2 cells confirmed the repression of the virulence factor InlA; however, the virulence potential in vivo in the chick embryo model was not affected.\n\nConclusion:\n\nListeria monocytogenes did undergo rapid changes to adapt its physiology to the phyllosphere.\n\nSignificance and Impact of the Study:\n\nThis study highlights the physiological changes undergone by L. monocytogenes during/after survival on parsley leaves.

Much less attention has been paid to the biliary tree, although this is considered the Achille’s heel even of normal liver transplantation. To evaluate the response of the biliary compartment of FLs to the various phases of OLT reliable markers are necessary. Previously we demonstrated that Alkaline Phosphatase was scarcely active in bile canaliculi of FLs and thus ruled it out as a marker. As an alternative, dipeptidylpeptidase-IV (DPP-IV), was investigated. This ecto-peptidase BMS-754807 purchase plays an important role in glucose metabolism, rapidly inactivating insulin secreting hormones (incretins) that are important regulators of glucose metabolism. DPP-IV inhibitors

are indeed used to treat Type II diabetes. Neuropeptides regulating bile transport and composition are further important substrates of DPP-IV in the enterohepatic axis. DPP-IV activity was investigated with an azo-coupling method in the liver of fatty Zucker rats (fa/fa), using as controls lean Zucker (fa+) and normal Wistar rats. Protein Quisinostat manufacturer expression was studied by immunofluorescence with the mono-clonal antibody (clone 5E8). In Wistar rat liver, DPP-IV activity and expression were high in the whole biliary tree, and moderate in sinusoid endothelial cells, in agreement with the literature. Main substrates of DPP-IV in hepatocytes and cholangiocytes could

be incretins GLP-1 and GIP, and neuropeptides such as vasoactive intestinal peptide (VIP) and substance P, suggesting that these substances are

inactivated or modified through the biliary route. In lean Zucker rat liver the enzyme reaction and protein expression patterns were similar to those of Wistar rat. In obese rat liver the patterns of DPP-IV activity and expression in hepatocytes reflected the morphological alterations induced by steatosis as lipid-rich hepatocytes had scarce activity, located either in deformed bile canaliculi or in the sinusoidal and lateral domains of the plasma membrane. These findings suggest that bile canaliculi in steatotic cells have an impaired capacity to inactivate incretins and neuropeptides. Incretin and/or neuropeptide Tipifarnib deregulation is indeed thought to play important roles in obesity and insulin-resistance. No alteration in enzyme activity and expression was found in the upper segments of the biliary tree of obese respect to lean Zucker and Wistar rats. In conclusion, this research demonstrates that DPP-IV is a promising in situ marker of biliary functionality not only of normal but also of fatty rats. The approach, initially devised to investigate the behaviour of the liver during the various phases of transplantation, appears to have a much higher potentiality as it could be further exploited to investigate any pathological or stressful conditions involving the biliary tract (i.e., metabolic syndrome and cholestasis) and the response of the binary tract to therapy and/or to surgery.

The results show that basal and early angiosperms have maternal plastid transmission, whereas all potential biparental transmission occurs at terminal branches of the tree. Thus, unlike previous studies, we suggest that biparental P505-15 in vivo plastid inheritance in angiosperms was unilaterally converted from the maternal transmission mode during late angiosperm evolution.”
“Background\n\nPostoperative pain may lead to adverse effects on the body, which might result in an increase

in morbidity. Its management therefore poses a unique challenge for the clinician. Major shoulder surgery is associated with severe postoperative pain, and different modalities are available to manage such pain, including opioid and non-opioid analgesics, local anaesthetics infiltrated into and around the shoulder joint

and regional anaesthesia. All of these techniques, alone or in combination, have been used to treat the postoperative pain of major shoulder surgery but with varying success.\n\nObjectives\n\nThe objective of this review was to compare the Selleck SHP099 analgesic efficacy of continuous interscalene brachial plexus block (ISBPB) with parenteral opioid analgesia for pain relief after major shoulder surgery.\n\nSearch methods\n\nWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12), MEDLINE (1950 to December 2012), EMBASE (1980 to December 2012), Web of Science (1954 to December 2012), CINAHL (1982 to December 2012) and bibliographies of published studies.\n\nSelection criteria\n\nWe included randomized controlled trials assessing the effectiveness of continuous ISBPB compared with different forms of parenteral opioid analgesia in relieving pain in adult participants undergoing elective major

shoulder surgery.\n\nData collection and analysis\n\nTwo review authors independently assessed trial quality and extracted outcome data.\n\nMain results\n\nWe included two randomized controlled trials (147 participants). A total of 17 participants were excluded from one trial because of complications related to continuous ISBPB (16) or parenteral opioid analgesia (one). Thus we have information on 130 participants (66 in the continuous ISBPB group and 64 in the parenteral opioid group). The studies were clinically heterogeneous. No meta-analysis was WZB117 cost undertaken. However, results of the two included studies showed better pain relief with continuous ISBPB following major shoulder surgery and a lower incidence of complications when interscalene block is performed under ultrasound guidance rather than without it.\n\nAuthors’ conclusions\n\nBecause of the small number of studies (two) relevant to the subject and the high risk of bias of the selected studies, no reasonable conclusion can be drawn.”
“Motivation: Transcription factor (TF) ChIP-seq datasets have particular characteristics that provide unique challenges and opportunities for motif discovery.

\n\nConclusions: Perioperative probiotic treatment can reduce the rate of postoperative septicemia and GDC-0068 in vivo is associated with reduced serum zonulin concentrations in patients undergoing colectomy. We propose a clinical regulatory model that might explain this association. This trial was registered at http://www.chictr.org/en/ as ChiCTR-TRC-00000423. Am J Clin Nutr 2013;97:117-26.”
“Nonspecific lipid transfer proteins (nsLTPs) are members of the prolamine superfamily and they are found in pollen and food, as well as in latex. Due to the strong

stability both against pepsin digestion and thermal denaturation, sensitisation towards these proteins is often associated with severe systemic reactions (angioedema, urticaria, asthma, anaphylaxis, etc.) following the ingestion of both raw or fresh food and cooked or preserved food. Many studies have shown reactivity towards nsLTPs both via inhalation and orally

and in this study we present selleckchem two cases of nsLTPs-sensitive patients who manifested the immediate onset of skin reactions following the use of cosmetic products containing these proteins. Thus, in order to prevent immediate reactions linked to their use, it is necessary to recommend nsLTPs-sensitive patients to avoid the topical use of products containing these proteins (and obviously the ingestion of foods containing these proteins).”
“A quantitative trait locus (QTL) has been identified on chromosome 18 in Texel sheep (TM-QTL) that increases depth and area of the longissimus dorsi muscle. The study aimed to assess the pleiotropic QTL effects on key meat quality traits (toughness and intramuscular fat content after >= 7 days aging) of crossbred lambs carrying one copy of the TM-QTL. The results showed that male Texel x Mule lambs carrying the TM-QTL had significantly less intramuscular fat (1.86% versus 2.25%) and higher toughness, with increased variation, in the loin muscle, compared to non-carrier

males. Similar conclusions were obtained using two different types of tenderometer equipment: one using PD98059 the Volodkevitch test (average shear force of 4.17 kgF or 40.9 N for carrier males, 2.61 kgF or 25.6 N for non-carrier males) and one using the MIRINZ test (average shear force of 6.18 kgF or 60.6 N for carrier males, 5.22 kgF or 51.2 N for non-carrier males). Although most toughness measurements were within published consumer acceptability limits, a few individual TM-QTL carrier lambs had unacceptably tough meat, despite enhanced post-slaughter processing. The TM-QTL did not significantly affect loin toughness in female lambs, leg toughness in either sex, or intramuscular fat content. These results should be considered, alongside direct effects of the TM-QTL on muscling and carcass composition, in recommendations for the use of this QTL by sheep breeders. (C) 2010 Elsevier Ltd. All rights reserved.

\n\nMethods. PPD skin test was performed in H 5 children with JIA who were

vaccinated with bacillus Calmette-Guerin (BCG), and then they were compared to the PPD response of 45 healthy children of the same age who were vaccinated with BCG. Children with a PPD induration >= 5 mm were accepted as PPD-positive. PPD induration >= 10 mm was accepted as a limit for suspecting tuberculosis.\n\nResults. PPD induration size and PPD positivity Caspase inhibitor rates (PPD >= 5 mm) of children with JIA were significantly lower than those of healthy children. The mean of PPD induration size was significantly lower (p < 0.0001) in patients with either I BCG vaccine (3.7 +/- 3.6) or more than I BCG vaccine than controls TH-302 with either

1 BCG vaccine (7.10 +/- 3.2) or more than I BCG vaccine (10.05 +/- 4.1). PPD was positive in 35.9% of patients with JIA vaccinated once (n = 32), in 50% of patients with JIA vaccinated more than once (n = 13), in 82.1% of controls vaccinated once (n = 23), and in 88.2% of controls vaccinated more than once. This result was statistically significant (patients, p = 0.03; controls, p = 0.039). It was determined that neither the activity of the disease nor the use of corticosteroid and methotrexate affected the PPD response.\n\nConclusion. The response to PPD, which is one of the Th1 cell-type responses, was significantly lower in BCG-vaccinated children with JIA compared

to healthy children. (First Release Aug 1 2009; J Rheumatol 2009;36:2029-32; doi:10.3899/jrheum.090173)”
“H5N1 avian influenza continues to be a potential pandemic threat. Several vaccine candidates based on potentially pandemic influenza strains and antiviral drugs have been tested in preclinical and clinical studies. The data obtained so far have shown some promise, but have also revealed some shortcomings with both of these approaches. We have identified and characterized an H5N1 neuraminidase-specific monoclonal antibody which specifically inhibits N1 neuraminidase 3-deazaneplanocin A concentration activity of highly pathogenic avian influenza (HPAI) strains from clades 1 and 2. We have also shown the protective efficacy of this antibody in animal challenge models using homologous virus. Specific and effective inhibition of N1 NA could make this mAb a useful therapeutic tool in the treatment of human infection, in particular with oseltamivir- and zanamivir-resistant strains of HPAI.”
“Environmental, genotypic and agronomic factors have an effect on the yield value of an onion crop, which is determined primarily by number, weight and size of bulbs. Spatial variability of soil properties affects crop yield. Remote sensed hyperspectral vegetation indices (VIs), calculated using crop reflectance at field scale can be used either as an index of the plant biophysical status, or as a tool to estimate crop variability.

The seven patients who

clearly performed below the range of controls in future thinking, were also significantly poorer on the Frontal Assessment Battery (FAB), a battery assessing executive control, but showed no deficits in immediate or delayed memory tests. These results suggest that poor performance in the future thinking task is associated with poor executive control and less so with memory impairment. Flexible searching activities of past details might be crucial CBL0137 purchase capacities for envisaging one’s own future. (C) 2012 Elsevier Ltd. All rights reserved.”
“Although predator-prey cycles can be easily predicted with mathematical models it is only since recently that oscillations observed in a chemostat predator-prey (rotifer-algal) experiment offer an interesting workbench for testing model soundness. These new observations have highlighted the limitations of the conventional modelling approach in correctly reproducing some unexpected characteristics of the cycles. Simulations are improved when changes in algal community structure, resulting from natural selection operating on an assemblage of algal clones differing in competitive ability and defence against rotifer predation, is considered in multi-prey models. This approach, however, leads to extra complexity in terms of state variables and parameters.

We show here that multi-prey models with one predator can be effectively approximated with a simpler (only a few differential equations) model derived in the context of adaptive Nepicastat order dynamics and obtained with a moment-based

approximation. The moment-based approximation has been already discussed in the literature but mostly in a theoretical Selleck Luminespib context, therefore we focus on the strength of this approach in downscaling model complexity by relating it to the chemostat predator-prey experiment. Being based on mechanistic concepts, our modelling framework can be applied to any community of competing species for which a trade-off between competitive ability and resistance to predators can be appropriately defined. We suggest that this approach can be of great benefit for reducing complexity in biogeochemical modelling studies at the basin or global ocean scale. (C) 2009 Elsevier B.V. All rights reserved.”
“TKA is among the fastest growing interventions in medicine, with procedure incidence increasing the most in younger patients. Global knee scores have a ceiling effect and do not capture the presence of difficulty or dissatisfaction with specific activities important to patients. We quantified the degree of residual symptoms and specific functional deficits in young patients who had undergone TKA. In a national multicenter study, we quantified the degree of residual symptoms and specific functional deficits in 661 young patients (mean age, 54 years; range, 19-60 years; 61% female) at 1 to 4 years after primary TKA.