Apart from scientific study, general morphological description li

Apart from scientific study, general morphological description like size, colour, taste,

fracture and texture facilitates in identifying plant raw drugs. Consequently macroscopic descriptions of roots were studied according to T.E. Wallis.12 The etymological derivations were compiled from ‘Namarupajnanam’. The term ‘Namarupajnanam’ that represents nama (names) and rupa (characters) developed recently as a part of ‘Dravyagunavijnana’ in which identification of plants is studied in ancient and medieval approach to describe the plants by names and synonyms.13 Physicochemical parameters were done to analyse moisture content, total ash, acid insoluble ash, alcohol solubility and water solubility as per quality standards of API.9 Phytochemical screening was performed by using standard selleck kinase inhibitor procedures14 in order to establish chemical profile. Dried, powdered (mesh size 85) root samples of the species under study were successively extracted with solvents of increasing polarity, hexane, ethyl acetate, chloroform, methanol and water at 60–70 °C for 8 complete cycles. Crizotinib All root extracts were concentrated at 40–45 °C by using a rotary evaporator (Rotavapor R-3, Buchi, Switzerland) to 50 mL and tested for the presence of chemical constituents. One gram of each powdered

root sample of Patala namely, S. chelonoides, S. tetragonum and R. xylocarpa sieved (Mesh No. 85) was refluxed in water bath with methanol (50 mL) and filtered through Whatman No. 1 filter paper. These samples were subjected to extraction until it becomes colourless with same residue. Filtered extracts were evaporated by using rotary evaporator, followed by dissolving the residue with methanol (10 mL) and aliquots were taken for HPTLC analysis. The standard p-coumaric acid (purity ≥98%) HPLC purchased

from Sigma–Aldrich was dissolved in methanol to prepare working solution of 0.1 mg/mL concentration. The qualitative HPTLC analysis was Isotretinoin performed with 10 μL of methanolic extracts and standard solution of different concentrations (2–10 μL containing 20–100 μg/mL) using a solvent system, Toluene: Ethyl Acetate: Acetic Acid: Formic Acid (10:10:0.2:0.2 V/V). After development, the plate was dried in an oven at 110 °C for 10 min. The Rf values of marker and the compound of interest were measured and subjected to densitometric scan at λ = 310 nm in order to check the identity of the bands corresponding to the standard marker compound. The roots of S. chelonoides, S. tetragonum, and R. xylocarpa are similar in colour, texture and taste. The comparative analyses of macroscopic character are given in Table 2. The Ayurvedic literature describes Patala as: it is a tree having black peduncles. The leaflets become very rough on maturity. The flowers are fragrant, copper coloured and look like a pitcher shape. The seeds resemble like that of a human eye ball.

microplus varies according

microplus varies according Depsipeptide order to characteristics of the tick population targeted and host factors among other things [14] and [15]. Pen trials conducted in the state of Mato Grosso do Sul, Brazil revealed that the efficacy of Bm86-based vaccines against the Campo Grande strain of R. microplus ranged from 31 to 49% [17] and [18]. Efficacy around 99% against R. annulatus obtained with Bm86-based vaccines is an indication of the consistent high level of anti-R. microplus immunoprotection that a novel antigenic and immunogenic

tick molecule, or combinations thereof, could elicit in vaccinated cattle. Such level of efficacy offers the opportunity to incorporate vaccination as a tool for the integrated eradication of cattle fever tick populations [40] and [41]. The search for protective antigens that are highly efficacious against R. microplus continues. Proteinase inhibitors have received attention as a group of molecules found in ticks with potential for use as buy OTX015 immunogens in an anti-tick vaccine. Several trypsin inhibitors that are present in the egg, larval and adult stages of R. microplus have been described [19], [20] and [21].

It has been suggested that the R. microplus serine protease inhibitors may be involved in larval attachment at the bite site and blood feeding [22]. Trypsin inhibitors from R. microplus larvae purified in their native form elicited a protective immune response in vaccinated cattle yielding 72.8% efficacy, and 69.7% reduction in the number of adult female ticks completing the parasitic phase of their life cycle [22]. However, a peptide of designed from one of the R. microplus larval trypsin inhibitors afforded only 18.4% immunoprotection against tick infestation in crossbred cattle [23]. The use of recombinant trypsin inhibitors can circumvent the challenge of having to purify trypsin inhibitors in sufficient quantities to conduct cattle tick vaccination tests

[21] and [22]. An expressed sequence tag originally identified in R. microplus larvae was later reported to correspond to sequence amplified from ovarian tissue coding for the fragment of a Kunitz-BPTI domain protease inhibitor termed rBmTI-6 [21] and [24]. The rBmTI-6 was expressed in the Pichia pastoris system and characterized as a three-headed Kunitz-bovine pancreatic trypsin inhibitor, but its ability to protect immunized cattle against tick infestation remained to be determined [21]. Here, the partial nucleotide sequence of the putative R. microplus larval trypsin inhibitor was used to produce the recombinant polypeptide in the yeast expression system to probe its immunoprotective properties [24]. Results of the cattle immunization trial and other experiments using the recombinant R. microplus larval trypsin inhibitor (rRmLTI) are also reported. Ticks used for this study were obtained from a laboratory colony maintained at EMBRAPA Beef Cattle.

In consideration of these findings, SipC seems to be a promising

In consideration of these findings, SipC seems to be a promising candidate as a protective antigen. Because the N-terminal region of SipC may cause the insolubility of recombinant proteins and does not include the T cell epitope, the amino acid residues from 201 to 409, Wnt inhibitor corresponding

to the C-terminus of SipC (cSipC), were used in this study. Two types of cSipC fusion proteins, conjugated to either the N-terminus or C-terminus of FliC, were constructed in order to determine any differences in their immunogenicity. The present study attempted to evaluate the immunological properties of recombinant L. casei producing fusion antigens composed of FliC and cSipC in vitro and in vivo. An innate immune response through TLR5 was determined using human intestinal Caco-2 epithelial cells. Caco-2 cells express TLR5 and are responsive to flagellin [17] but are not responsive to TLR2 or TLR4 agonists due to the absence of TLR4

expression and the low expression level of TLR2, TLR1, and TLR6 [18], [19] and [20]. TLR5-stimulating activity was detected by the release of interleukin 8 (IL-8) from a Caco-2 cell culture [21]. Induction of acquired immunity was determined by parenteral immunization of mice followed by detection of antigen-specific this website antibodies and cytokines. A list of recombinant strains used in the present study is shown in Table 1. A plasmid-free strain of L. casei IGM393 and recombinant strains including a FliC-expressing strain (LCF) and a non-expressing control strain carrying pLPEmpty (LCN),

which were constructed in Ketanserin the previous study, were grown in de Mann Rogosa and Sharpe (MRS) broth (Difco). Erythromycin (5 μg/ml) was added to MRS only for recombinant strains. As described previously, Lactobacillus-carrying medium (LCM) supplemented with 1% mannitol and 5 μg/ml erythromycin was used for induction of the expression of heterologous antigens [5]. A human clinical isolate of Salmonella enterica serovar Enteritidis (SE) #40 [22] was cultured in Luria–Bertani (LB) broth (Difco). For the cloning of plasmids, Escherichia coli JM109, grown in LB medium containing 100 μg/ml ampicillin, was used in this study. Preparation of the SE antigen, the truncated C-terminus of SipC (cSipC), was performed using a histidine-tagged system in accordance with the manufacturer’s instructions (Qiagen). Briefly, the partial sipC gene encoding cSipC (amino acid residues 201–409) was amplified from SE chromosomal DNA by PCR with a set of primers, IGM389 (ccc cgg atc cga atg aaa gag gcg cgc tta aa) and IGM390 (ggg gct cga gag cgc gaa tat tgc ctg cga). The amplified DNA fragment was digested with BamHI and XhoI and inserted into the BamHI–SalI sites of pQE31. E. coli M15 was then transformed with the ligated plasmid. The expression and purification of His-tagged protein (His-cSipC) were carried out under denaturing conditions. The protein was renatured by dialysis against PBS.

More recently, Hu et al [26] also showed that a pretreatment

More recently, Hu et al. [26] also showed that a pretreatment

regimen of c-di-GMP administered alone subcutaneously three times at 2-week intervals followed by intravenous (i.v.) Selleckchem MK2206 methicillin-resistant S. aureus (MRSA) challenge 7 days after the last administration decreased bacterial burdens in both the liver and the spleen and also improved the 12-day survival rate after challenge [26]. To a lesser degree, i.p. injection of c-di-GMP 24 h before i.v. infection with MRSA results in some decrease in bacterial burdens in the liver but not in the spleen. Similarly, subcutaneous treatment of mice with c-di-GMP 48 and 24 h before intratracheal challenge with Klebsiella pneumoniae resulted in significantly improved survival rates over saline treatment [27]. The immunomodulatory effects of c-di-GMP are not limited to systemic administration. There also appears to be substantial immunomodulatory effects when selleck chemicals c-di-GMP is delivered intranasally. Two separate studies in mouse models of bacterial pneumonia indicate that i.n. treatment with c-di-GMP has protective efficacy against respiratory pathogens despite

no direct bactericidal activity in vitro. c-di-GMP pretreatment is able to significantly reduce local bacterial burdens and decrease dissemination from the lungs [21] and [27]. In an S. pneumoniae mouse model of lung infection, i.n. pretreatment of mice with c-di-GMP 48 and 24 h before infection led to significant decreases in bacterial burdens 24 h

post-infection in mice challenged with Type 2 (both lung and blood bacterial burdens) or Type 4 (lung bacterial burdens) S. pneumoniae [21]. In mice challenged with bioluminescent Type 3 S. pneumoniae, i.n. c-di-GMP pretreatment showed no effect on bacterial burdens at early time points Calpain but did result in lower lung bacterial burdens at 42 and 48 h post challenge. Similarly, when c-di-GMP was administered intranasally to mice before, at the time of, and after intratracheal challenge with K. pneumoniae, results showed that co-administration of c-di-GMP with K. pneumoniae plus treatment 6-h post-infection did not significantly affect survival rates while i.n. pretreatment 48 and 24 h before infection significantly improved survival rates. In the latter case, the bacterial burdens were lowered by 5-fold in the lung and ∼3 log in the blood on day 2 post-infection as compared to untreated mice [27]. Although the above studies convincingly demonstrate the immunomodulatory effect of c-di-GMP in the prevention of systemic and mucosal infection with various bacterial pathogens, the mechanism responsible for the immunomodulatory properties of c-di-GMP remains unknown. In an effort to begin dissecting this, Karaolis et al. [27] characterized the host immune response after c-di-GMP administration and K. pneumoniae challenge. Mice pretreated with c-di-GMP had significantly more neutrophils and αβT cells in the lung than controls (mice pretreated with cGMP) at day 2 post-infection.

The routine care of the maternity ward during the period of dilat

The routine care of the maternity ward during the period of dilation is based on the recommendations of the World Health Organization (WHO 1985) for more humanised childbirth. After admission to the hospital, a meal was offered to the participants and resources for pain relief were permitted,

if requested by the participant. Such resources include labour analgesia and oxytocin when necessary. The parturient was allowed to choose the most comfortable position. The presence of an accompanying person was permitted during labour and delivery as well as during any other medical procedures. Primary outcome: The primary outcome was the change in pain severity at the end of the intervention period. To measure this, pain severity was marked by the participant on a 0–100 mm visual analogue scale at the beginning and end of the intervention period. We considered 13 mm to be a clinically Depsipeptide in vivo relevant reduction in acute pain ( Bernstein et al 2006, Gallagher et al 2001, Todd et al 1996). Secondary

outcomes: The characteristics of the pain during labour were assessed using the Short-Form McGill Pain Questionnaire. This questionnaire results in several outcome measures that reflect the emotional and sensory aspects of pain. On all of these measures, higher scores reflect greater GSK J4 solubility dmso pain. The number of words chosen to describe the pain is tallied for sensory words, affective words, and total words. The estimated pain index combines sensory (0–33) and affective (0–12) scores to give a total score (0–45). Lastly, the present pain intensity is rated on a numerical scale (0 = no pain, 1 = mild, 2 = discomforting, Megestrol Acetate 3 = distressing, 4 = horrible, 5 = excruciating). The Short-Form McGill Pain Questionnaire has been used in several studies (eg, Chang et al 2006). It combines the properties of the standard McGill Pain Questionnaire

but takes substantially less time to administer, while using the same descriptive adjectives ( Costa etal 2011). The location of the pain was recorded using a standard body diagram. The areas of pain were pointed out by the participant and marked on the diagram by the secondary blinded researcher. Obstetric and neonatal outcomes were also collected by the secondary blinded researcher. Obstetric outcomes included the duration of labour, the time taken for the participant to request pain medication after the end of the intervention period, and the path of delivery. Neonatal outcomes were weight, length, head circumference, chest circumference, and APGAR score. After labour, each participant was asked to answer a few questions regarding their satisfaction with the care provided and the presence of a health professional during the study.

inpes sante fr) Le tabagisme de l’entourage fait partie intégran

inpes.sante.fr). Le tabagisme de l’entourage fait partie intégrante de l’évaluation. L’existence d’autres addictions Anti-diabetic Compound Library nmr devra être recherchée, telles que l’alcool (questionnaire CAGE-DETA) et le cannabis (questionnaire CA) [5]. Un accompagnement psychologique et motivationnel est la base de la prise en charge du patient lors de consultations spécifiquement consacrées à l’arrêt du tabagisme. Le patient doit recevoir l’information la plus complète possible

sur les méthodes de sevrage et, en cas de dépendance au tabac, sur les traitements médicamenteux. Si le niveau de dépendance le justifie, il est recommandé de prescrire les substituts nicotiniques en première intention avec adaptation de la posologie en fonction des symptômes [1] and [5]. La combinaison d’un timbre transdermique avec une forme d’administration rapide (gomme à mâcher, comprimés, inhaleur, spray buccal) est plus efficace qu’une seule

forme d’administration. Seuls ces médicaments sont remboursés sur la base d’un forfait de 50 €, porté à 150 € pour les patients bénéficiaires de la Ipatasertib in vivo CMU et les femmes enceintes. La HAS, et tout récemment l’OMS (rapport août 2014), considèrent que l’efficacité et l’innocuité de la cigarette électronique n’ont pas été suffisamment documentées à ce jour pour la recommander comme outil d’aide à l’arrêt du tabac [6]. Toutefois, du fait de sa toxicité beaucoup moins forte qu’une cigarette, son utilisation ne doit pas être découragée chez un fumeur qui souhaite arrêter mais devrait

s’intégrer dans une stratégie personnalisée et adaptée de sevrage en accord avec le médecin traitant. Les utilisateurs 4-Aminobutyrate aminotransferase de la cigarette électronique sont principalement des candidats à l’arrêt ou à la réduction des risques liés au tabagisme, même si par ailleurs des motifs économiques sont aussi invoqués [13]. Une étude récente montre que la cigarette électronique, avec ou sans nicotine, conduit à des résultats similaires au timbre nicotinique dans le sevrage tabagique mais pour autant la place de la cigarette électronique reste à préciser [14]. De plus, l’impact de la cigarette électronique sur le processus inflammatoire impliqué dans l’atteinte des voies aériennes dans la BPCO reste à évaluer. La varénicline, agoniste partiel des récepteurs nicotiniques α4β2, peut être proposée en deuxième intention en cas d’échec du sevrage à l’aide des substituts nicotiniques [1] and [5]. Le traitement initial dure 12 semaines avec une extension possible de 12 semaines supplémentaires, notamment si le sevrage est obtenu à la fin de la période initiale. Le patient et son entourage devront être informés des risques fréquents, en particulier de nausées, de rhinopharyngite et d’insomnies, et plus rarement d’agressivité, de troubles dépressifs, voire d’idées suicidaires. Ces modifications du comportement et de l’humeur doivent conduire à l’arrêt du traitement [5] and [15].

The objective of this postmarketing study was to conduct a broad

The objective of this postmarketing study was to conduct a broad assessment of LAIV safety, Bioactive Compound Library cell assay evaluating all events and specific prespecified events. The current analysis describes the results among adults 18–49 years of age; results for children will be reported separately. This study was conducted in the Kaiser Permanente (KP) Health Plans of Northern California, Hawaii, and Colorado, where membership totals approximately 4 million individuals. Through KP immunization registries, approximately 20,000 individuals 18–49 years

of age who were immunized from the 2003–2004 to 2007–2008 influenza seasons with LAIV as part of routine clinical practice were identified. The study’s objective was to assess the safety of LAIV by comparing the rates of medically attended events (MAEs) in LAIV recipients (all MAEs by diagnosis

and specifically serious adverse events [SAEs], anaphylaxis, urticaria, asthma, wheezing, prespecified diagnoses of interest, and rare events potentially related to wild-type influenza) to the rates in 3 non-randomized control groups. Commercially Sorafenib concentration available LAIV was supplied by MedImmune, and commercially available TIV was purchased by KP as part of routine practice. Each annual formulation of the vaccines contained the strains recommended for inclusion by the U.S. Public Health Service. Subjects were screened for underlying medical conditions and provided the appropriate vaccine based on the eligibility criteria in each vaccine’s package insert, physician discretion, and patient choice. Study subjects with high-risk underlying medical

conditions such as cancer, organ transplantation, diabetes, endocrine and metabolic disorders, blood disorders, liver disorders, kidney disorders, and cardiopulmonary disorders (for whom LAIV was not recommended) were identified via automated extraction of health care databases and excluded from all analysis cohorts. The protocol was reviewed and approved by the KP Institutional Review Board. Three nonrandomized control groups were identified for Bay 11-7085 comparison: a within-cohort (i.e., self-controlled) control, matched concurrent unvaccinated controls, and matched concurrent TIV recipient controls. For the within-cohort analysis, LAIV recipients served as their own controls based on the observation time after vaccination. Risk intervals of 3 and 21 days postvaccination were compared with control intervals from 4–42 days postvaccination (for the 3-day risk interval) and 22–42 days postvaccination (for a 0- to 21-day risk interval). Controls were matched 1:1 with LAIV recipients. If a match could not be found within a specific control group, the LAIV recipient was excluded from the cohort comparison. Unvaccinated controls were KP members who participated in the health plan during the same month as the reference LAIV recipient; for the unvaccinated population, the effective vaccination date was the date on which the matched LAIV recipient was vaccinated.

From this we can conclude, that the production of biohydrogen had

From this we can conclude, that the production of biohydrogen had showed great promise

in converting selleck screening library waste like mango juice effluent. All authors have none to declare. “
“Pharmaceuticals intended to be used in tropics like antimalarial compounds are required to maintain their stability under most severe storage conditions. Understanding of the stability characteristics of drug substances and drug products is a critical responsibility of pharmacist in formulation development.1 Determining appropriate storage conditions for a drug substance or product requires knowledge of the conditions that induce degradation mechanisms.2 Solubility of the compound, particularly the aqueous solubility, is required in order to design parenteral products.3 and 4 If the aqueous solubility is too low, then an organic co-solvent may be utilized. Co solvents offers way of increasing drug solubility, but the amount of co solvent used in parenteral IV formulation is constrained by toxicity considerations. They may cause haemolysis,5 or the drug may precipitate when diluted or injected, causing phlebitis.6 and 7 In the preliminary investigation, observations were made regarding sample stability includes exposure of solid state samples to heat, humidity, and light and exposure of solutions to pH extremes, oxidative condition.8, 9 and 10

Antimalarial compounds are weak acids or weak bases; hence their solubility is a function of pH. These compounds also show different photo reactivity in solution as well as in solid state. The formulation process can change crystal modification and photo stability of drugs. AS is in Alpelisib ic50 the class of medications known as artemesinins, which are derivatives from the “quinghaosu” or sweet wormwood plant (Artemisia annua) and it is recommended by the World Health Organization (WHO) in preference to quinidine for the treatment PAK6 of severe malaria and has been used worldwide for many years. 11 AS monotherapy, allowing the parasites to more easily adapt

to it, hence combination therapies have been widely used to overcome the problems of drug resistance. 12, 13 and 14 AS degradation is related to mainly moisture, light, acidic and basic conditions. Commercially AS injection is available in dry powder form and should be reconstituted in 5% sodium bicarbonate solution as AS dissolves carbon dioxide gas evolves, reducing the contact between drug and dissolution medium and thus lengthen the time needed to completely dissolves the formulation. 15 HCQ sulphate is a modified chloroquine and used in the treatment of obstructive vascular diseases as it inhibits sludging of erythrocytes. 4-Aminoquinolines like chloroquinine and HCQ are liable to phototoxic reactions in solutions and discolouration in the solid state. 16 The pH of the medium strongly influences the observation as well as the photochemical pattern.

The topics of the categories

were: reasons to be physical

The topics of the categories

were: reasons to be physically active, reasons to be sedentary, history of physical activity, subjective experience on physical activity, barriers to become physically active and the influence of social support and stress on physical activity. The reasons to be physically active could be categorised into four categories. The most frequently reported reason to be physically active was for the health www.selleckchem.com/products/abt-199.html benefits (reported by 65% of the participants), followed by enjoyment (44%), continuation of an active lifestyle in the past (28%), and functional reasons (26%). An example of a reported functional reason is that physical activity is necessary for certain daily life activities, like transportation or gardening. Topic  Response % Reasons to be physically activea

 health benefits 65  enjoyment 44  continuation of former active lifestyle 28  function 26 History of physical activity  gymnastics at school 88  sports after age 30 yr 49  physically active in lifestyle activities 48 Subjective experience of physical activity  pleasant 85  unpleasant 30  none 10  high self-efficacy for physical activity 85 Social support  positive 47  negative 3  positive and negative 4  none, not applicable 47 Effect of social support on physical Nutlin-3a datasheet activity  positive 19  negative 1  none 80 Topic  Response % Reasons to be sedentaryb  poor weather 48  health problems 43  lack of intrinsic motivation 11  miscellaneous answers 16  none 20 Barriers to becoming physically active  weather 75  health 68  weather, health-specific 53  financial constraints 32  not able to pay money 20  not willing to pay money 12  sleep 10  exercise facilities in neighbourhood 7  fear of movement 6  shame 4  time 3 Stress  positive influence on physical activity 18 Dichloromethane dehalogenase  negative influence on physical activity 13  none, not applicable 68 aNumber of reasons reported: one = 47, two = 57, three = 5, four = 6. The reasons to be sedentary could be grouped into three categories and there were 18 responses that did not fit into a category. (See Appendix 1 on the

eAddenda for details of these isolated responses.) The most frequently reported reason to be sedentary was poor weather (48%), followed by health problems (43%) and lack of intrinsic motivation (11%). In addition 20% of the participants reported having no reason to be sedentary. On average, participants reported 1.7 (range 1 to 4) reasons to be physically active and 1.2 (range 0 to 3) reasons to be sedentary. Self-efficacy for physical activity was explored during a conversation with the participant about whether he/she felt confident in the ability to perform the physical activities he/she executes. If a participant reported confidence this was categorised as ‘high self-efficacy’. Positive social support for physical activity was reported by almost 50% of the study population.

Factors showing consistent

Factors showing consistent VE-821 order evidence for being prognostic indicators for poor

recovery Factors showing consistent evidence of not being prognostic indicators Factors with inconsistent evidence • Initial pain levels: >5.5/10 • Initial disability levels: NDI > 29% • Symptoms of post-traumatic stress • Negative expectations of recovery • High pain catastrophising • Cold hyperalgesia • Accident related features (eg, collision awareness, position in vehicle, speed of accident) • Findings on imaging • Motor dysfunction • Older age • Female gender • Neck range of movement • Compensation-related factors Full-size table Table options View in workspace Download as CSV The Quebec Task Force (QTF) classification of whiplash injuries (presented in Table 1) was put forward selleck products in 199532 and it remains the classification method still currently used throughout the world. Whilst the QTF system is rather simplistic and based only on signs and symptoms, it allows practitioners and other stakeholders involved in the management of patients with WAD to have a common language about the condition. Most patients fall into the WAD II classification, although health outcomes for this group can be diverse and this has been outlined as one problem

with the QTF system.33 Modifications to the QTF system have been proposed but have generally been more complicated33 and, for this reason, not easily taken up by all stakeholders involved in the management of WAD. The diagnosis of WAD has changed little in recent times. In the vast majority of cases, specific tissue damage or a peripheral lesion cannot be identified.34 Although earlier research identified lesions in the cervical spine at autopsy in people who have died as a result of

a road traffic crash,35 this research has not translated to the clinical environment, likely due to insensitivity of available imaging techniques. The strongest clinical evidence available is for the zygapophyseal joint pathology detected via radiofrequency neurotomy techniques in highly selected patients with chronic WAD,36 but their prevalence in the general WAD population is not known. It is likely that mafosfamide injury to other structures including cervical discs, ligaments, and nerve tissue is present to varying degrees in some patients.34 Current clinical guidelines for the management of acute WAD recommend that radiological imaging be undertaken only to detect WAD grade IV (ie, fracture or dislocation) and that clinicians adhere to the Canadian C-Spine rule or Nexus rule when making the decision to refer the patient for radiographic examination.37 These rules show very high sensitivity and specificity to detect WAD IV.36 There is no evidence to support the use of imaging in any form in WAD II. For WAD III (neurological compromise), imaging may be used based on clinical judgement to further evaluate suspected nerve compromise.