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The radiocarbon (14C) calibration curve so far contains annually resolved data only for a short period of time. With accelerator mass spectrometry (AMS) matching the precision of decay counting, it is now possible to efficiently produce large datasets of annual resolution for calibration purposes using small amounts of wood. The radiocarbon intercomparison on single-year tree-ring samples presented here is the first to investigate specifically possible offsets between AMS laboratories at high precision. The results show that AMS laboratories are capable of measuring samples of Holocene age with an accuracy and precision that is comparable or even goes beyond what is possible with decay counting, even though they require a thousand times less wood. It also shows that not all AMS laboratories always produce results that are consistent with their stated uncertainties. The long-term benefits of studies of this kind are more accurate radiocarbon measurements with, in the future, better quantified uncertainties.
Introduction: Each year, 3/1000 Canadians sustain a mild traumatic brain injury (mTBI). Many of those mTBI are accompanied by various co-injuries such as dislocations, sprains, fractures or internal injuries. A number of those patients, with or without co-injuries will suffer from persistent post-concussive symptoms (PPCS) more than 90 days post injury. However, little is known about the impact of co-injuries on mTBI outcome. This study aims to describe the impact of co-injuries on PPCS and on patient return to normal activities. Methods: This multicenter prospective cohort study took place in seven large Canadian Emergency Departments (ED). Inclusion criteria: patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of ED visit, with a Glasgow Coma Scale score of 13-15. Patients who were admitted following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. A research nurse then conducted three follow-up phone interviews at 7, 30 and 90 days post-injury, in which they assessed symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to estimate the influence of co-injuries. Results: A total of 1674 patients were included, of which 1023 (61.1%) had at least one co-injury. At 90 days, patients with co-injuries seemed to be at higher risk of having 3 symptoms ≥2 points according to the RPQ (RR: 1.28 95% CI 1.02-1.61) and of experiencing the following symptoms: dizziness (RR: 1.50 95% CI 1.03-2.20), fatigue (RR: 1.35 95% CI 1.05-1.74), headaches (RR: 1.53 95% CI 1.10-2.13), taking longer to think (RR: 1.50 95% CI 1.07-2.11) and feeling frustrated (RR: 1.45 95% CI 1.01-2.07). We also observed that patients with co-injuries were at higher risk of non-return to their normal activities (RR: 2.31 95% CI 1.37-3.90). Conclusion: Patients with co-injuries could be at higher risk of suffering from specific symptoms at 90 days post-injury and to be unable to return to normal activities 90 days post-injury. A better understanding of the impact of co-injuries on mTBI could improve patient management. However, further research is needed to determine if the differences shown in this study are due to the impact of co-injuries on mTBI recovery or to the co-injuries themselves.
Introduction: Mild traumatic brain injury (mTBI) is a serious public health issue and as much as one third of mTBI patients could be affected by persistent post-concussion symptoms (PPCS) three months after their injury. Even though a significant proportion of all mTBIs are sports-related (SR), little is known on the recovery process of SR mTBI patients and the potential differences between SR mTBI and patients who suffered non-sports-related mTBI. The objective of this study was to describe the evolution of PPCS among patients who sustained a SR mTBI compared to those who sustained non sport-related mTBI. Methods: This Canadian multicenter prospective cohort study included patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of Emergency Department (ED) visit, with a Glasgow Coma Scale score of 13-15. Patients who were hospitalized following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. Three follow-up phone interviews were conducted by a research nurse at 7, 30 and 90 days post-injury to assess symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to demonstrate the impact of the mechanism of injury (sports vs non-sports) on the presence and severity of PPCS. Results: A total of 1676 mTBI patients were included, 358 (21.4%) of which sustained a SR mTBI. At 90 days post-injury, patients who suffered a SR mTBI seemed to be significantly less affected by fatigue (RR: 0.70 (95% CI: 0.50-0.97)) and irritability (RR: 0.60 (95% CI: 0.38-0.94)). However, no difference was observed between the two groups regarding each other symptom evaluated in the RPQ. Moreover, the proportion of patients with three symptoms or more, a score ≥21 on the RPQ and those who did return to their normal activities were also comparable. Conclusion: Although persistent post-concussion symptoms are slightly different depending on the mechanism of trauma, our results show that patients who sustained SR-mTBI could be at lower risk of experiencing some types of symptoms 90 days post-injury, in particular, fatigue and irritability.
To study the reliability of two depression assessment scales, the Montgomery-Asberg Depression Rating Scale and the Psychomotor Retardation Scale, 30 patients with depression according to Feighner's criteria were evaluated, by two groups of raters: 5 were trained psychiatrists or psychologists, and 6 were untrained raters. The experiment lasted three months. The patients were recorded on video-tape by two psychiatrists who did not take part in the experiment, during pre-designed interviews. Each scoring was discussed by the trained group but not by the untrained group. The Kappa test and the sign-test were used for the statistical analysis of global and itemized results, respectively. Intraclass coefficient Q3 was applied to global scores. With regard to global scores, there was no significant difference among the members of the trained group, who scored higher than those of the untrained group; a significant difference between some of the untrained raters, induced a significant difference with the trained group. With regard to each item of both scales, reliability appeared to be slight to moderate, and there was no significant difference between trained and inexpert raters. These results are discussed and modifications are proposed to improve the consistency of the two scales. The authors emphasize the necessity for therapeutic trials to be conducted with permanent groups of assessors who continue training even outside of trial procedures.
The transplant representations of patients waiting for a kidney transplantation have been studied recently. Our hypotheses is that these representations can be measured with a questionnaire and differ between recipients from living or cadaveric donor. As result of lack of clinical standardized instrument,we developed the Transplant Representation Questionnaire(TRQ) of 19 items in 4 degrees.
Compare results on the TRQ in patients waiting for a kidney transplantation from cadaveric or living donor.
390 patients included in waiting list for kidney transplantation with cadaveric or living donor were assessed with the TRQ. Since the beginning of the study, 170 patients were transplanted, 148 (87%) with cadaveric donor (CD group), and 22 (13%) with living donor (LD group). The principal component analysis has been performed on 390 patients.
The Principal component analysis of the TRQ has shown 2 factors.The factor “Donor” refers to the recipient concerns about the donor (11 items).The factor “Transplant” refers to the negative attitude of the recipient about the transplanted organ (8 items). The LD group was younger and had more social support than the CD group. It had also higher scores on the “donor” factor and similar scores on the “transplant” factor.
As compared to patients waiting for transplantation with cadaveric donor, patients waiting for transplantation with living donor have more concerns about the donor, and similar representations of their future transplant. Our preliminary results should be confirmed in more powerful studies. Further studies will assess prospectively the transplant representations after transplantation.
This study was conducted to investigate the corticotropic axis in anorexia nervosa. In 93 female inpatients who met DSM-III-R criteria for anorexia nervosa, subsample (n = 64) with DSM-III criteria was also considered. Using stepwise regression analysis, this study examined the relationship between independent variables ie, age, body mass index, scores on depression scales and postdexamethasone serum cortisol, considered as a dependent variable. In patients who met DSM-III criteria, 16.7% of the variance of serum cortisol can be explained. The main predictors are depressive retardation, emaciation and age. Using stepwise logistic regression the main categorical predictors of the test suppression vs non suppression are of the same nature. The condition of realisation of DST are discussed.
After 50 years of international experience and 15 years of use in France, the positive impact of drug replacement treatments on the care of patients with opiates dependence is now well established. Even though there is a vast literature on the two existing treatments (methadone and high-dosage buprenorphine), few works have focused on patients who have changed replacement therapy during follow-up.
Objectives and aims
The aim of our study was to analyze the follow-up of substituted patients throughout an 11-year period. Patients were characterized by the type of treatment: methadone only, high-dosage buprenorphine only, or both treatments.
These groups of patients were studied depending on their characteristics at the beginning of the treatment (sociodemographic data, addictive behaviours, psychiatric assessment) and in terms of healthcare and follow-up regularity. We also tried to bring to light predictive factors of unstable follow-ups at the point of entry in healthcare.
891 patients were included in our results. Patients having had two substitution treatments initially present with higher severity in terms of socio-professional integration, addictive behaviours and psychiatric comorbidity. Their treatment is more discontinued and they have longer healthcare.
Psychiatric comorbidities and poly-drug use seem to characterize unstable patients who jeopardize our treatments. They have to be identified very early in order to better adjust healthcare. This preliminary work underlines the necessity of carrying out a prospective study integrating better adapted assessment tools.
Opioid peripheral abnormalities were described in anorexia nervosa (AN). Until now no data have been published on cerebral activity of opioid system in these subjects. Diprenorphine is a ligand with non-specific binding to opiates receptors μ, κ and δ.
To evaluate in vivo brain opioid receptors binding potential (BP) in patients with lean and recovered from restrictive-type AN by comparison with controls and the relationship with eating-related psychochological and hormonal traits.
In 17 lean restrictive-type AN patients, 15 recovered AN subjects and 15 age-matched controls we assessed in vivo [11C]Diprenorphine binding by brain positron emission tomography and eating-related psychopathological traits. Inter-groups differences in [11C]Diprenorphine binding were evaluated by voxel-based analyses.
Lean restrictive AN and recovered AN patients presented with similar decreased [11C]Diprenorphine binding in bilateral medial frontal cortex and temporo-parietal cortex. We noted a lower BP in hypothalamo-pituitary structures and also in anterior cingulate gyrus in lean AN patients. Additionally, only recovered AN patients presented with a decreased [11C]Diprenorphine binding in caudate nuclei and putamen. Direct correlations were found between the anterior cingulate gyrus BP and mean cortisol and between the left amygdala [11C]Diprenorphine binding and eating concern score.
The opioid system is widely affected in AN even after recovery in regions known to be involved in the neurocircuitry of addiction and support the hypothesis of an organic dysfunction in AN.
While many homeless persons are suffering from mental illnesses, they are often not able or willing to actively seek psychiatric treatment. in order to provide psychiatric help for mentally ill residents of facilities for the homeless in Vienna, a psychiatric liaison service for these facilities was implemented.
This study provides an overview of a six year period of psychiatric liaison services for the homeless: who was reached, which services were performed, and what support was given to staff.
Sociodemographic and diagnostic data were collected from all residents seen by the psychiatric liaison service. Liaison services provided to residents and staff were documented.
Within the six year period, liaison services were offered to 29 homeless shelters. A total of 1.808 homeless people were examined and 11.757 psychiatric services were performed. in addition to the services provided to residents, 1.471 case discussions, 1.187 supervisory services, and 857 information sessions were provided to staff. Among the examined residents, the majority were men without regular income who had been homeless for over five years. the most common diagnoses were substance-related disorders for male residents and schizophrenia for female residents. High rates of comorbidity and multimorbidity were observed. Severity of illness and low level of global functioning correlated positively with homelessness duration.
Because homeless persons rarely actively seek psychiatric treatment, the psychiatric liaison services are an important and necessary means to reach homeless persons who need psychiatric services.
The organic personality disorder (OPD) is a multi-faceted group of dia-gnoses in the boarder area of psychiatry and neurology. In the current teaching books OPD is treated rather cursorily. Evidence-based guidelines have not been published. However, OPD is a frequently observed phenomenon both in psychiatry and neurology.
In the present study an overview is given over historic conceptual principles of OPD. Furthermore, we searched MEDLINE for relevant studies regarding psycho-pathology of OPD. Twelve studies were included in the final analysis. Findings regarding etiology, symptomatology and treatment are summarized.
Psychopathology was not specific to type of etiology. Three major groups of symptomatology were identified (enechy-type, apathy and depression-type, impulsiveness and affective lability-type). There are no evidence-based treatement recommendations for OPD, a small number of case reports suggest a possible therapeutic effect of carbamazepine and trazodone.
With regard to psychopathology the traditional classification of Kurt Schneider was affirmed. A multiaxial diagnostic process can integrate a symptomatological and etiological perspective on OPD. Pharmacotherapy should focus on specific syndromes, e.g. hostility. There is a need for further research with the objective of preparing a clinical guideline.
Pathological gambling is a behavioural addiction with negative economic, social, and psychological consequences. Identification of contributing genes and pathways may improve understanding of aetiology and facilitate therapy and prevention. Here, we report the first genome-wide association study of pathological gambling. Our aims were to identify pathways involved in pathological gambling, and examine whether there is a genetic overlap between pathological gambling and alcohol dependence.
Four hundred and forty-five individuals with a diagnosis of pathological gambling according to the Diagnostic and Statistical Manual of Mental Disorders were recruited in Germany, and 986 controls were drawn from a German general population sample. A genome-wide association study of pathological gambling comprising single marker, gene-based, and pathway analyses, was performed. Polygenic risk scores were generated using data from a German genome-wide association study of alcohol dependence.
No genome-wide significant association with pathological gambling was found for single markers or genes. Pathways for Huntington's disease (P-value = 6.63 × 10−3); 5′-adenosine monophosphate-activated protein kinase signalling (P-value = 9.57 × 10−3); and apoptosis (P-value = 1.75 × 10−2) were significant. Polygenic risk score analysis of the alcohol dependence dataset yielded a one-sided nominal significant P-value in subjects with pathological gambling, irrespective of comorbid alcohol dependence status.
The present results accord with previous quantitative formal genetic studies which showed genetic overlap between non-substance- and substance-related addictions. Furthermore, pathway analysis suggests shared pathology between Huntington's disease and pathological gambling. This finding is consistent with previous imaging studies.
It was not accidental that in February 1861 Jefferson Davis, a prominent slaveholder from Mississippi, was inaugurated at Montgomery, Alabama, as the new president of the Confederate States of America. Both states had long been at the center of antebellum political power, wielding the stunning influence wrought by cotton and slavery. While South Carolina led the secessionist impulse, the emerging Confederate project would almost certainly have faltered without the crucial support of the Deep South. The Lower South states that seceded in the winter of 1860–1 commanded great political and sectional influence, shaping how and when the incipient slaveholding republic would be formed. But with the advent of war in April 1861, military thinkers considered Mississippi and Alabama the constituent states of the Deep South, judging other parts of the rebellious South in wholly different strategic terms. Mississippi and Alabama indeed played central roles in the formation of the world’s largest slaveholding republic; they would accordingly feel the hard hand of war in response to that decision. Although both states did not incur the same kind of invasions and wartime scarring endured by Virginia, Tennessee, and Georgia, the Deep South functioned as a testing ground for some of the Civil War’s most transformative events, rooted almost entirely in the tense nature of civilian–military relations.
The German Twin Family Panel (TwinLife) is a German longitudinal study of monozygotic and dizygotic same-sex twin pairs and their families that was designed to investigate the development of social inequalities over the life course. The study covers an observation period from approximately 2014 to 2023. The target population of the sample are reared-together twins of four different age cohorts that were born in 2009/2010 (cohort 1), in 2003/2004 (cohort 2), in 1997/1998 (cohort 3) and between 1990 and 1993 (cohort 4). In the first wave, the study included data on 4097 twin families. Families were recruited in all parts of Germany so that the sample comprises the whole range of the educational, occupational and income structure. As of 2019, two face-to-face, at-home interviews and two telephone interviews have been conducted. Data from the first home and telephone interviews are already available free of charge as a scientific use-file from the GESIS data archive. This report aims to provide an overview of the study sample and design as well as constructs that are unique in TwinLife in comparison with previous twin studies — such as an assessment of cognitive abilities or information based on the children’s medical records and report cards. In addition, major findings based on the data already released are displayed, and future directions of the study are presented and discussed.
Apolipoprotein E (APOE) E4 is the main genetic risk factor for Alzheimer’s disease (AD). Due to the consistent association, there is interest as to whether E4 influences the risk of other neurodegenerative diseases. Further, there is a constant search for other genetic biomarkers contributing to these phenotypes, such as microtubule-associated protein tau (MAPT) haplotypes. Here, participants from the Ontario Neurodegenerative Disease Research Initiative were genotyped to investigate whether the APOE E4 allele or MAPT H1 haplotype are associated with five neurodegenerative diseases: (1) AD and mild cognitive impairment (MCI), (2) amyotrophic lateral sclerosis, (3) frontotemporal dementia (FTD), (4) Parkinson’s disease, and (5) vascular cognitive impairment.
Genotypes were defined for their respective APOE allele and MAPT haplotype calls for each participant, and logistic regression analyses were performed to identify the associations with the presentations of neurodegenerative diseases.
Our work confirmed the association of the E4 allele with a dose-dependent increased presentation of AD, and an association between the E4 allele alone and MCI; however, the other four diseases were not associated with E4. Further, the APOE E2 allele was associated with decreased presentation of both AD and MCI. No associations were identified between MAPT haplotype and the neurodegenerative disease cohorts; but following subtyping of the FTD cohort, the H1 haplotype was significantly associated with progressive supranuclear palsy.
This is the first study to concurrently analyze the association of APOE isoforms and MAPT haplotypes with five neurodegenerative diseases using consistent enrollment criteria and broad phenotypic analysis.
From 2007 to 2010, the largest reported Q-fever epidemic occurred in the Netherlands with 4026 notified laboratory-confirmed cases. During the course of the epidemic, health-seeking behaviour changed and awareness among health professionals increased. Changes in laboratory workflows were implemented. The aim of this study was to analyse how these changes instigated adjustments of notification criteria and how these adjustments affected the monitoring and interpretation of the epidemic. We used the articles on laboratory procedures related to the epidemic and a description of the changes that were made to the notification criteria. We compared the output of a regional laboratory with notifications to the regional Public Health Service and the national register of infectious diseases. We compared the international notification criteria for acute Q-fever. Screening with ELISA IgM phase II and PCR was added to the diagnostic workflow. In the course of the epidemic, serology often revealed a positive IgG/IgM result although cases were not infected recently. With increasing background seroprevalence, the presence of IgM antibodies can only be suggestive for acute Q-fever and has to be confirmed either by seroconversion of IgG or a positive PCR result. Differences in sero-epidemiology make it unlikely that full harmonisation of notification criteria between countries is feasible.
Introduction: Alberta has one of the highest rates of domestic violence (DV) in the country. Emergency departments (EDs) and urgent care centres (UCCs) are significant points of opportunity to screen for DV and intervene. In Alberta, the Calgary Zone began a universal education and direct inquiry program for DV in EDs and UCCs for patients > = 14 years in 2003. The Calgary model is unique in that (a) it provides universal education in addition to screening and (b) screening is truly universal as it includes all age groups and genders. While considering expanding this model provincially, we engaged in the GRADE Adolopment process, to achieve multi-stakeholder consensus on a provincial approach to DV screening, as herewith described. Methods: Using GRADE, we synthesized and rated the quality of evidence on DV screening and presented it to an expert panel of stakeholders from the community, EDs, and Alberta Health Services. There was moderate certainty evidence that screening improved DV identification in antenatal clinics, maternal health services and EDs. There was no evidence of harm and low certainty evidence of improvement in patient-important outcomes. As per Adolopment, the expert panel reviewed the evidence in the context of: a) values and preferences b) benefits and harms, and c) acceptability, feasibility, and resource implications. Results: The panel came to a unanimous decision to conditionally recommend universal screening, i.e., screening all adults above 14 years of age in EDs and UCCs. By conditional, the panel noted that EDs and UCCs must have support resources in place for patients who screen positive to realize the full benefit of screening and avoid harm. The panel deemed universal screening to be a logistically easier recommendation, compared to training healthcare professionals to screen certain subpopulations or assess for specific symptoms associated with DV. The panel noted that despite absence of evidence that screening would impact patient-important outcomes, there was evidence that effective interventions following a positive screen could positively impact these outcomes. The panel stressed the importance of evidence creation in the context of absence of evidence. Conclusion: A GRADE Adolopment process achieved consensus on provincial expansion of an ED-based DV screening program. Moving forward, we plan to gather evidence on patient-important outcomes and understudied subpopulations (i.e. men and the elderly).
Introduction: Acute aortic syndrome (AAS) is a time sensitive aortic catastrophe that is often misdiagnosed. There are currently no Canadian guidelines to aid in diagnosis. Our goal was to adapt the existing American Heart Association (AHA) and European Society of Cardiology (ESC) diagnostic algorithms for AAS into a Canadian evidence based best practices algorithm targeted for emergency medicine physicians. Methods: We chose to adapt existing high-quality clinical practice guidelines (CPG) previously developed by the AHA/ESC using the GRADE ADOLOPMENT approach. We created a National Advisory Committee consisting of 21 members from across Canada including academic, community and remote/rural emergency physicians/nurses, cardiothoracic and cardiovascular surgeons, cardiac anesthesiologists, critical care physicians, cardiologist, radiologists and patient representatives. The Advisory Committee communicated through multiple teleconference meetings, emails and a one-day in person meeting. The panel prioritized questions and outcomes, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. The algorithm was prepared and revised through feedback and discussions and through an iterative process until consensus was achieved. Results: The diagnostic algorithm is comprised of an updated pre test probability assessment tool with further testing recommendations based on risk level. The updated tool incorporates likelihood of an alternative diagnosis and point of care ultrasound. The final best practice diagnostic algorithm defined risk levels as Low (0.5% no further testing), Moderate (0.6-5% further testing required) and High ( >5% computed tomography, magnetic resonance imaging, trans esophageal echocardiography). During the consensus and feedback processes, we addressed a number of issues and concerns. D-dimer can be used to reduce probability of AAS in an intermediate risk group, but should not be used in a low or high-risk group. Ultrasound was incorporated as a bedside clinical examination option in pre test probability assessment for aortic insufficiency, abdominal/thoracic aortic aneurysms. Conclusion: We have created the first Canadian best practice diagnostic algorithm for AAS. We hope this diagnostic algorithm will standardize and improve diagnosis of AAS in all emergency departments across Canada.
Advanced Parkinson’s disease (PD) may place a high burden on patients and their caregivers. Understanding the determinants of caregiver burden is of critical importance. This understanding requires the availability of adequate assessment tools. Recently, the Parkinson’s disease caregiver burden questionnaire (PDCB) has been developed as a PD-specific measure of caregiver burden. However, the PDCB has only been evaluated in a sample of Australian caregivers of patients at a less advanced stage of the disease.
We tested whether a German translation of the PDCB qualifies as an adequate measure of caregiver burden in a German sample of caregivers of advanced patients with PD.
We collected PDCB data from 65 caregivers of advanced patients with PD. Reliability of the scale was assessed and compared against the original version. To validate the German version of the PDCB, we examined the correlations with the caregiver burden inventory (CBI), the short form 36 health survey (SF-36), the Parkinson’s disease quality of life questionnaire 39 (PDQ-39), disease duration, and the amount of caregiving time.
The total PDCB score proved to be reliable and to be significantly related to CBI and SF-36 scores. PDCB scores also increased with increasing amounts of caregiving time.
The German version of the PDCB appears to be an adequate measure of caregiver burden in caregivers of advanced PD patients.
A total of eight ileal and caecal cannulated Yorkshire barrows were used to determine the interactions of dietary fibre (DF) and lipid types on apparent digestibility of DM and fatty acids (FA) and FA flows in gastrointestinal segments. Pigs were offered four diets that contained either pectin or cellulose with or without beef tallow or maize oil in two Youden square designs (n 6). Each period lasted 15 d. Faeces, ileal and caecal contents were collected to determine apparent ileal digestibility (AID), apparent caecal digestibility and apparent total tract digestibility (ATTD) of dietary components. The interactions between DF and lipid types influenced (P <0·05) the digestibility of DM and FA flows. The addition of maize oil decreased (P <0·05) AID of DM in pectin diets, and the addition of beef tallow depressed (P <0·001) ATTD of DM in cellulose diets. Dietary supplementation with beef tallow decreased (P <0·05) the AID of FA in pectin-containing diets but had no effects in cellulose-containing diets. Dietary supplementation with beef tallow increased (P <0·05) AID of SFA and PUFA and the flow of ileal oleic, vaccenic, linolenic and eicosadienoic acids and reduced the flow of faecal lauric, docosatetraenoic and docosapentaenoic acids in pectin- and cellulose-containing diets. In conclusion, the interaction between DF type and lipid saturation modulates digestibility of DM and lipids and FA flows but differs for soluble and insoluble fibre sources, SFA and unsaturated fatty acids and varies in different gastrointestinal segments.