The same results suggest that although there was no statistical d

The same results suggest that although there was no statistical difference between two methods, even rare human errors in manual analysis can reduce the recipients’ chance of transplantation or expose them to an unforeseen risk. As previously shown, the EpHLA software was capable of automatically executing the HLAMatchmaker algorithm as accurately as the conventional

manual method on an see more Excel spreadsheet. Therefore, the EpHLA software fulfilled the functionality requirements because it accomplished the task to which it was designed with no errors in applying the algorithm. During a period of 3 months, the EpHLA software was continuously used by 11 different users to perform analysis of 110 single antigen results. During this validation period there were no errors due to EpHLA software failures. Therefore, the automation tool enabled the performance of reliable Selleckchem PD0325901 histocompatibility analyses. The emerging results of this study make it evident that users with minimal knowledge of the fundamentals about HLAMatchmaker are able to easily operate the EpHLA software. It is noteworthy that the automation of manual steps enabled the user to have a higher productivity in analyzing single antigen results. The decrease in the average time for this analysis was evidenced when users improved their skills with the EpHLA software (Table 3). The EpHLA program does not need a computer with any special configuration in order to

run. An adequate efficiency can be obtained when running on low-performance machines. During its validation, the EpHLA software was used in Core 2 Duo machines with 2 GB of RAM. In these machines the response for each input applied to the EpHLA software was as fast as observed with the HLAMatchmaker algorithm run on an Excel spreadsheet (a few milliseconds). Thus, the acetylcholine EpHLA software may perform all necessary operations on standard computers. In spite of the ability of the HLAMatchmaker algorithm to improve the allocation

of solid organs for highly sensitized patients [15], the widespread use of this tool is limited by the manually demanding and time consuming intermediate steps. To solve this problem, we have developed a new software called EpHLA, which fully automates the functional steps of the HLAMatchmaker algorithm [16]. The present study has shown that the EpHLA software facilitates the identification of AMMs in a considerably shorter time while maintaining the same level of accuracy when using the conventional HLAMatchmaker algorithm. Since the EpHLA program is saving time and it is easy to use, we predict that it will have a significant impact on the applicability of epitope-based histocompatibility matches of donors for sensitized recipients. The EpHLA program is also very useful to interpret antibody-mediated rejections by identifying immunogenic epitopes. For these reasons, the speed of generating results and their accuracy have gained great importance [19].

For example, a slow-acting antioxidant must be added to frozen-st

For example, a slow-acting antioxidant must be added to frozen-stored products and a quick-acting antioxidant should be used in baked or fried products (Mariutti et al., 2008). Although the phenolic extract of fermented rice bran has shown a small loss of antioxidant activity with respect to the phenolic extract of unfermented rice bran, in terms of EC50 and AE, the high increase in phenolic content with

fermentation offsets this loss. Phenolic compounds derived from rice bran SCH772984 in vitro fermentation with the R. oryzae fungus display antioxidant activity. The production and extraction of bioactive compounds through fermentation is an alternative that deserves attention, since it provides high quality extracts and biological activity with little or no toxicity usually associated with the organic solvents used for the extraction of these compounds ( Martins et al., 2011, Nigam, 2009). Enzymatic browning is an undesirable reaction that occurs in fruits and vegetables. The browning reaction requires the presence of oxygen, phenolic compounds and oxidative enzymes (Pineli

& Moretti, 2007). Thus, antioxidant compounds with similar potential to those in this study are used to inhibit enzymatic browning. Bearing that in mind, phenolic extracts of the control rice bran and fermented rice bran were evaluated for their ability to inhibit polyphenol oxidase and peroxidase enzymes. The antioxidant solutions showed greater inhibition of the peroxidase enzyme, with EPZ-6438 datasheet the solutions of ferulic acid and from fermented and unfermented rice bran showing a similar inhibitory

power, reaching close to 60% inhibition when was used a concentration of about three times the value of their EC50 (approximately 0.1 mg/ml) was used (Fig. 3). The polyphenol oxidase was not inhibited at any concentration of antioxidant solutions from fermented and unfermented (control) rice bran extracts, while the solution of ferulic acid showed greater inhibition power at a concentration corresponding to three times the EC50. The fact that the phenolic extracts are not effective inhibitors of the polyphenol oxidase enzyme, even with high ferulic acid content, shows that the extracts have phenolic compounds which also serve as substrate for this enzyme, as in the case of chlorogenic, caffeic and gallic acids aminophylline (Queiroz, Silva, Lopes, Fialho, & Valente-Mesquita, 2011). The polyphenol oxidase catalyses the oxidation of polyphenols to quinones which react non-enzymatically to produce coloured pigments whereas peroxidase is capable of oxidising phenolic compounds in the presence of hydrogen peroxide (Pineli and Moretti, 2007 and Queiroz et al., 2011). The potato enzyme extract showed greater peroxidase enzyme activity (0.24 AU/min∗mgprotein) than for polyphenol oxidase (0.06 AU/min∗mgprotein), which behaviour has also been observed by other authors (Cantos et al., 2002 and Pineli et al.

These include a glassy carbon electrode (GCE) and a carbon paste

These include a glassy carbon electrode (GCE) and a carbon paste electrode with complexes and organic compounds, such as, Naphthol green B doped in polypyrrole film (Mohadesi & Taher, 2007), cobalt phthalocyanine nanoparticles (Wang, Xu, Tang, & Chen, 2005), poly(caffeic acid) (Li, Ren, & Luo, AT13387 nmr 2007)), octacyanomolybdate-doped-poly(4-vinylpyridine) (Thangamuthu, Senthil Kumar, & Chandrasekara Pillai, 2007), ferrocene and its

derivatives (Pournaghi-Azar and Ojani, 1999, Raoof et al., 2006 and Wang and Du, 2004), vanadium oxide polypropylene carbonate (Tian et al., 2006), ruthenium oxide (Shakkthivel & Chen, 2007) and polyaniline film (Mu & Kan, 2002). Enzymes have been used to improve the selectivity of many reactions using the amperometric detection. Due to the enzymes high cost, some strategies have been reported to reduce its consumption. Recently, various ion-exchange resins have gained considerable attention not only for separation purposes but also as carriers of catalytic active substances, as enzymes (Franchini et al., 2008). These resins must meet several requirements as having a porous structure that is strong enough Anti-cancer Compound Library screening to withstand a pressure increase, usually applied in flow bioreactors, and having a chemically and physically resistant membrane material. These requirements

can be met by several aromatic and aliphatic polyamides. Therefore, resin prepared from these polymers is a suitable substrate for the immobilisation of enzymes (Watkins et al., 1995). The covalent binding of the

enzymes to the polymer matrix is one of the most prospective methods for its immobilisation. It is known that the ascorbate oxidase enzyme catalyses fast and selectively the oxidation reaction of ascorbic acid. In this work, we describe a differential amperometric determination of ascorbic acid in honey using a gold electrode modified by electrodeposition with palladium, and a tubular reactor containing the ascorbate oxidase enzyme immobilised on amberlite IRA-743. The concentrations of ascorbic acid in each sample were calculated based on the difference between the current measured before and after the enzymatic treatment. The procedure adopted to immobilise the ascorbate oxidase enzyme was quick and simple (Matos, Pedrotti, & Angnes, 2001). Amberlite IRA-173 resin was selected as support, because it has active amine cAMP groups in its chemical structure. The enzyme immobilisation process begins with the addition of 100 μl of glutaraldehyde 0.1% to 250 mg of resin, and this mixture was stirred for 5 min. Subsequently, 50 units of enzymes were introduced into the mixture and stirred for an additional time of 10 min. In the next step, the resin was transferred to a tygon tubing (2.5 mm of i.d. and 25 mm long) with its extremities closed with a thin layer of glass wool to assemble the reactor. To adapt the enzymatic reactor to a FIA (flow injection analysis) system, the tubing (0.8 mm of i.d.

There was a clear conflict between the ‘precautionary approach’ a

There was a clear conflict between the ‘precautionary approach’ and the

‘pragmatic approach’, with the former supporting a ban on suspected endocrine disrupting pesticides until there are studies showing no adverse effects and the latter suggesting that all currently approved compounds have already been rigorously tested and not enough evidence found to deny their approval. Ultimately the decision to go pragmatic or precautionary must be made before all the evidence is in, but we should be careful of those who will continue to argue long past the point of reason that there is not enough evidence – look at the cigarette companies claiming for decades that there was no conclusive evidence linking smoking and lung cancer. The other area of distinct disagreement concerned exposure to mixtures of endocrine active compounds. On the one side was a group calling for ‘reality testing’ – humans and other non-target organisms are exposed to a mixture Gefitinib of endocrine active compounds not to a single compound a time. Thus current tests don’t give a true picture of the risks we face and, given the evidence of additive and synergistic

effects, we cannot afford to ignore this reality. Others, however, argued that adequate mixture testing is almost impossible because of the infinite number of compounds and concentrations possible and that we should focus on single compounds. There was disagreement on the relative value of academic versus industry-funded studies, with arguments that only open access, academic research Saracatinib in vivo be used when making regulatory decisions. Based on conversations during and after the workshop, the workshop goals of i) stimulating an informed debate on effects of exposure to endocrine-active pesticides and ii) stimulating policy making based on scientific evidence were achieved. It was largely agreed that this workshop contributed to a debate that should continue,

and that contentious issues related to endocrine disrupting effects, e.g., low dose effects, mixtures Rebamipide and worldwide vs. European regulatory efforts, need further examination. To address this, the SAFE consortium is organizing a second workshop on endocrines, with a focus on low dose exposures and non-monotonic dose–response curves in March 2011, and a report of that workshop will follow. “
“Clinical Nurse Consultants (CNCs) are a type of advanced practice nurse in the Registered Nurse scope in the state of New South Wales (NSW), Australia (NSW Health, 2011a). The CNC position was introduced into the NSW state award structure in 1986 (O’Baugh, Wilkes, Vaughan, & O’Donohue, 2007), and was modeled on the Clinical Nurse Specialist (CNS) role in the UK and USA (Baldwin et al., 2013). The role was created to provide a career pathway for experienced nurses who wished to maintain a clinical role, rather than moving into administration or education (Elsom, Happell, & Manias, 2006).

Moist mixed-conifer sites (hereafter Moist Mixed sites) are chara

Moist mixed-conifer sites (hereafter Moist Mixed sites) are characterized by several plant associations – such as White fir/snowbrush/strawberry, White fir/serviceberry,

and White fir/sedge (Johnson et al. 2008) – that are indicative of cooler and moister conditions than on the Dry Mixed sites. Transects were assigned to PVTs and, by extension, to habitat or site types using ESRI’s ArcMap software (release 10). For areas sampled after 1919, transects (1.6 ha) falling at least 90% within a ponderosa pine or mixed-conifer habitat type were selected for this analysis. The majority of the Chiloquin and Black Hills study areas were inventoried PD-1/PD-L1 cancer before 1919 (Fig. 1), while all of Wildhorse was inventoried in the early 1920s. Protocol during the earlier inventory period was to combine data for all transects in each quarter section on a single record. We assigned quarter sections to a habitat type if at least 90% of the area of the quarter

section fell within the mapped area of a single habitat type. Contemporary forest conditions were approximated with Current Vegetation Survey (CVS, www.fs.fed.us) data collected between 1998 and 2006 and restricted to live trees ⩾15 cm dbh. CVS plots (n = 95) classified in the Selleck Epacadostat field by survey crews as ponderosa pine or dry or moist mixed-conifer plant associations and located within the townships in each of the three study areas were included in this comparison. The CVS inventory system used a series of nested, fixed-radius subplots with each 1-ha sample

unit located on a 2.74 km square grid ( Max et al., 1996). Our results are based on a population of 424,626 conifers ⩾15 cm dbh located on 3068 transects covering a sampled area of 6646 ha. This represents a 10–20% sample of 38,651 ha of ponderosa Casein kinase 1 pine and dry and moist mixed-conifer sites within the 117,672 ha of the combined study areas. Stands with moderate basal areas, low tree densities, and dominance of large-diameter ponderosa pines characterized the inventoried forests across all of the habitat types from PIPO Xeric to Moist Mixed sites. Stand basal areas averaged 16 m2/ha over all plots with a standard deviation (SD) of ±7 m2/ha (Table 5). Basal area values ranged from 0 to 83 m2/ha, but the 95th percentile value was 24 m2/ha basal area (Fig. 3). Large diameter trees (>53 cm dbh) made up 83 ± 16% of total basal area (Table 5). Ponderosa pine overwhelmingly dominated both total (78% ± 21%) and large tree basal area (81 ± 20%, Table 5). Tree densities averaged 68 ± 29 tph (range = 0–296 tph, Table 5) with a 95th percentile value of 121 tph (Fig. 3). Mean large tree density (>53.3 cm) was surprisingly similar to mean small tree density (15–53 cm dbh) –38 ± 27 vs. 30 ± 14 tph respectively (Table 5). Small diameter trees (15–53 cm dbh) contributed just over 50% to mean tree density in historical forests.

Negative impacts may include: changing the abiotic environment, s

Negative impacts may include: changing the abiotic environment, such as lowering the water table (Kagawa et al., 2009); changing fire frequency or increasing temperature (do Nascimento et al., OSI-906 manufacturer 2010); damage to native forest remnants during harvesting (do Nascimento et al., 2010); changing the biotic environment, such as increasing the pest (mammal, invertebrate, fungal,

bacterial) load (Jairus et al., 2011); and changing native gene pools through the invasion of native forest by introduced seed (Potts et al., 2003). Anthropogenically induced gene flow of alien provenance may eventually swamp locally adapted genotypes in the natural forest if plantation areas occur over wide areas. A typical example of this concerns black pine in southern France, where the local subspecies Pinus nigra salzmann covers just over 5,000 ha, while planted non-native Pinus nigra currently covers over 200,000 ha ( Fady et al., 2010). Sampson and Byrne (2008) indicated that forest fragmentation can increase the level of deleterious contamination of natural stands by plantations by increasing gene flow distances. Both the EMEND and Dendrogene projects conducted in North America and Latin America, respectively, serve as good approaches Saracatinib research buy to understand the long-term genetic effects of logging for sustainable forest management. Silvicultural practices should take the population size, reproductive

biology and growth rate of a species into account to ensure that genetic diversity and evolutionary processes are maintained in forest populations. For a comprehensive view of genetic impacts of forest management practices, more than one molecular marker type (and perhaps more than one genome type) is advisable to be used, as different markers may provide complementary results. Allelic diversity measures are more suitable than expected heterozygosity (He) in assessing the genetic impacts of forest

management practices because He is not very sensitive to bottlenecks and perturbations in populations. The identification of genes directly involved in traits controlling productivity and quality is urgently needed to further explore the consequences of selective cutting. Density of a species can be a useful indicator of risk of genetic STK38 viability, rather than the overall disturbance level based on reduction in basal area of all trees. Mating and gene flow patterns tend to be similar in species with similar ecological characteristics. Therefore, information on mating system, gene flow and inbreeding depression from major species may be relevant to closely related taxa for management strategies. Hence, knowledge of the biological attributes of species including the main pollinators, flowering phenology and synchrony can be used to develop field guides for management to maintain genetic diversity.

All haplotypes are presented in Supplementary Table S2 For all 3

All haplotypes are presented in Supplementary Table S2. For all 36 marker selleckchem units, the alleles present in the 2085 DNA samples were counted and their frequencies were calculated (Table 3). DYS393 and DYS437 show the smallest allelic range with only five different alleles in our Dutch population sample; DYF399S1 has the largest range with 36 different alleles. Supplementary Table S2.   Y-STR haplotypes for 2085 Dutch male samples. Next, we examined the haplotypes resulting from different combinations of Y-STR marker units: the minimum YHRD marker

set, the various commercial kits (PPY, Yfiler and PPY23), the rapidly mutating Y-STRs (RMY1 + RMY2), and all 36 marker units together (PPY23 + RMY1 + RMY2). Table 4 shows the level of uniqueness of haplotypes (the number of times a haplotype was observed) and how many haplotypes have that level of uniqueness (the number of occurrences in our 2085 samples). PLX-4720 molecular weight In general, with more Y-STR markers, more unique haplotypes are found. The PPY23 markers resulted in 92.5% unique haplotypes (1929 haplotypes occurred only once (Table 4), haplotype diversity = 0.999959494976 (Table 5)), which is in the same range as the 93.5% described for the European

group analysed with PPY23 by Purps et al. [21]. For the RM Y-STRs (RMY1 + RMY2), 98.4% unique haplotypes were observed (2052 haplotype singletons (Table 4), haplotype diversity = 0.999991714881 (Table 5)), which is somewhat lower than the 100% reported by Ballantyne et al. [6] for the 112 Dutch samples in their set. When combining all 36 Y-STR marker units, 2065 from haplotypes were seen just once (99.0% unique haplotypes (Table 4), haplotype diversity = 0.999995397156 (Table 5)) and ten were each seen twice (representing ten haplotype pairs), resulting in 2075 different haplotypes for the complete set of 2085 samples. For these ten haplotype pairs we performed additional analyses

using the information of 23 autosomal STR markers [10]. Bonaparte software was used to deduce the most likely family relationship between the two donors residing in one haplotype pair, based on fictive family trees in which one of the donors of a pair was fixed (grey square in Fig. 1) and the other donor was tested for all the other possible male relationships (eight white squares in Fig. 1). When the donors were switched, slightly different log10(LR) scores were obtained, due to the differences in genotypes and their corresponding allele frequencies in the formulae, but all results were comparable, as expected (results not shown). Based on the log10(LR) results, we infer that two of the haplotype pairs have a father/son relationship (log10(LR) of 8.1 or 10.5), two have a brother/brother relationship (log10(LR) of 6.3 or 12.2) and the other six are likely to have a more distant relationship than the eight relationships tested in Fig. 1 (log10(LR) between −28.3 and 1.6).

5, Table 1) In the liver, swollen hepatocytes and a greater numb

5, Table 1). In the liver, swollen hepatocytes and a greater number of Kupffer cells containing malarial pigment grains were observed at days 1 and 5, which were concentrated in centrilobular or portal areas ( Fig. 5, Table 1). Kidney damage, characterised by tubular necrosis, interstitial oedema, and inflammatory cell infiltration, was more severe at day 5 compared to day 1 ( Fig. 5, Table 1). In the model used ATM Kinase Inhibitor purchase in this study, which has frequently been employed for the induction of experimental cerebral malaria, mechanical and histological lung impairment associated with neutrophil

infiltration were observed 1 day following inoculation with Plasmodium berghei. learn more Lung damage was accompanied by histological changes in distal organ tissues, namely the brain (which exhibited glial cell swelling, capillary congestion, increased number

of microglial cells), the heart (interstitial oedema, capillary congestion, and increased number of mononuclear cells), the liver (Kupffer cell injury), and the kidneys (tubular necrosis and interstitial oedema). These changes in lung mechanics and histology had reduced by day 5. However, there was progressive heart and kidney damage associated with an increase in pro-inflammatory cytokines. Moreover, mice inoculated with P. berghei-infected erythrocytes demonstrated greater mortality beginning 6 days post-infection, in accordance with previous studies ( Clemmer et al., 2011, Inositol monophosphatase 1 Martins et al., 2012 and Souza et al., 2012). Epidemiological studies suggest that 5% of patients with uncomplicated malaria and 20–30% of patients with severe malaria develop ALI (Mohan et al., 2008); nevertheless, the development of ALI during malaria is poorly understood. Indeed,

histopathological observation of human organs is limited to post-mortem analysis of fatal cases of severe malaria, and the sequence of events leading to the onset of cerebral malaria has not been described. Neuropathological syndromes have previously been described in susceptible strains of inbred mice infected with P. berghei ( Rest, 1982 and Curfs et al., 1993), but lung injury during experimental severe malaria has only been suggested and was only thought to occur during the late stages of P. berghei infection ( Epiphanio et al., 2010, Van den Steen et al., 2010 and Hee et al., 2011). Thus, we examined the development of ALI at early and late time points after P. berghei infection focusing on the following parameters: lung histology, inflammatory response, changes in the alveolar capillary barrier (oedema), physiological dysfunctions as well as the correlation of ALI with cytokine production and distal organ damage.

All authors declare no conflicts of interest This work was suppo

All authors declare no conflicts of interest. This work was supported by a grant from the

Kyung Hee University in 2013 (KHU-20130535). “
“The root of ginseng (Panax ginseng Meyer) has been traditionally used for medicine and food. The primary physiologically-active substances of ginseng are ginsenosides, polyacetylenes, ginseng proteins, polysaccharides, and phenolic compounds. Ginsenosides in particular have been identified as the principal component of ginseng, displaying various biochemical and pharmacological properties. A number of researchers have studied the components of ginseng since the late 1960s, starting with the research of Shibata HDAC inhibitor et al [1], whose research group identified the chemical structures of ginsenosides. Ginsenoside Re (C53H90O22) is the main ingredient of ginseng berries and roots. Notably, the amount of ginsenoside Re in the berries was four to six times more than that in the roots [2]. Research in the area has shown that ginsenoside Re exhibits multiple pharmacological activities via different mechanisms both in vivo and in vitro [3], [4], [5], [6], [7] and [8]. However, the pharmacological effects of ginsenoside Re on gastritis or gastric ulcer have not yet been studied. A gastric RG 7204 ulcer is one of the most common diseases in the world, which

affects approximately 5–10% of people during their lives. The therapy used to treat gastric ulcers includes control of acid secretion as well as the inflammation reversal to the mucosa. Korea red ginseng can assist in the eradication of Helicobacter pylori and alleviate H. pylori-induced halitosis [9]. A recent pharmacological investigation reports the antihistamine Cyclin-dependent kinase 3 and anticytokine releasing effects of ginsenoside Re isolated from the berries of Panax ginseng [7]. For the common treatment of mild gastritis, antacids in liquid or tablet form are typically used. When antacids do not provide sufficient

relief, H2 blocking medications, such as cimetidine, ranitidine, nizatidine, and famotidine, which help reduce the amount of acid are often prescribed [10]. Famotidine, the most potent H2 receptor antagonist, was used as a positive control [11]. The present study examined the protective effect of ginsenoside Re on acute gastric mucosal lesion progression in rats treated with compound 48/80 (C48/80). C48/80 causes degranulation of mast cells in connective tissue with the release of histamine from the cells, and causes the development of acute gastric mucosal lesions with neutrophils infiltrating into the gastric mucosal tissue [12] and [13]. Injecting C48/80 is consequently suggested as a good model for elucidating the mechanisms of clinical acute gastric lesions [14]. Ginsenoside Re was prepared according to a previously reported method [7]. In brief, dried ginseng berries (5 kg) were ground to powder and extracted twice with 1 L of 95% ethyl alcohol for 2 h in a water bath (60°C). The extracts were concentrated by a vacuum evaporator (Eyela Co.

Terraces remain along-side incised rivers because flood flows no

Terraces remain along-side incised rivers because flood flows no longer exceed discharge magnitude thresholds for floods to inundate the former floodplains (Leopold et al., 1964). The resulting archetypal incised alluvial river channel

is initially narrow and is characterized by high, steep channel banks with adjacent terraces. Incision in fluvial systems occurs globally and is ZD6474 research buy significant with respect to the geomorphic landscape, habitat diversity, and human development (Simon and Darby, 1999). Channel incision may lead to bank erosion and widening (Simon and Hupp, 1986), channel narrowing and embankment (Rinaldi, 2003), increased turbidity (Shields et al., 2010), and reduced habitat heterogeneity (Bravard et al., 1997). Combined with other anthropogenic changes at the landscape scale, incision renders riparian ecology less able to adapt to variable and episodic natural disturbance regimes (Palmer et al., 2008). In this paper, we review the weight of evidence for

natural and human causes of incision. We use the term “Anthropocene” as a metaphor in reference to systems that are affected by intense human interaction. We first note natural factors that may cause channel incision such as climate variation and tectonics, and then review effects of anthropogenic changes in flow to sediment discharge ratios, baselevel, and channelization, taking into account the spatial relationships between forcing factors at the watershed scale and incision. We then present a field study of an click here incised alluvial

channel (Robinson Creek in Mendocino County, California, USA; Fig. 1) that examined geomorphic evidence and processes for incision, including the timing of the initiation of incision, and short-term variability in channel bed Glutamate dehydrogenase elevations along the longitudinal profile between 2005 and 2008. We discuss the natural range of process dynamics in stable and incising alluvial systems and examine concepts of feedbacks in coupled human–geomorphic systems as they relate to channel incision—required for effectively managing modern incised systems. Finally, we develop a metric to identify and quantify the extent of incision that may be applied in other alluvial systems. This work has relevance to other incised systems globally where human activities have set in motion a combination of watershed-scale disturbances. Although similar rates and magnitudes of change have occurred in the geologic past within individual watersheds, incision occurring during the “Anthropocene” to an extent such that humans cannot readily manage modern incised rivers requires new conceptual frameworks for understanding such systems. The interplay of multiple factors often makes determining a single cause of incision difficult (Schumm, 1991 and Schumm, 1999).