This research intends to uncover the characteristics that are considered when members of the Sampit community choose cafés to frequent. Participants who have been to cafes in the city of Sampit are the subjects of this investigation. Their ages vary from 16 to 55, and there were a total of 100 people who participated in the research. Non-random sampling combined with a purposive sampling methodology was employed as the method of sampling, and the questionnaire in the form of a Likert scale was used as the research instrument. Multiple linear regression is the approach of data analysis that is used here. According to the findings of the research conducted, the diversity of menus has a major impact on the choices made by customers when selecting a cafe in the city of Sampit to which they will pay a visit for the purpose of making purchases. When it comes to selecting a cafe to visit in the city of Sampit, a customer's choice to buy a drink or meal at a certain establishment is not significantly influenced by factors such as location, price, level of service, or ambiance.


Major research conducted in this program falls into the following areas: (a) microstructure and micromechanics of superplastic ceramic composites; (b) solute segregation and grain boundary kinetics of ceramic alloys; (c) sintering, grain growth, and texture development of ceramics and thin films; and (d) in-situ and microlaminate oxide composites. The basic approach to the above research is to utilize the state of the art methods to process colloidal and green ceramics, to employ crystal chemistry and phase equilibria for microalloy and microcomposite design, to comprehensively characterize microstructure development and mechanical performance, to develop models, theories, and simulations to understand the energetics, kinetics and mechanics, and to explore novel microstructures and improved performance for practically important ceramics. Major accomplishments are here.


The artificial intelligence (AI) based human resource (HR) process related to recruitment and selection has gone from just being an assisting hand to a vital source thanks to the technological advancements made by the industry in the last few decades. From a tactical activity to a strategic business imperative, the recruitment function in organizations has changed many hats. For organizations and managers, AI-enabled recruiting services to source the right talent are a big sell-out based on the ease of use and the time and effort it saves for everyone. But even then, not many organizations except those in the IT and ITeS sectors are using AI extensively in all their recruitment processes. The motivation for this research stemmed from the increasing usage of AI across the different functional domains in business. The study was conducted utilizing both primary and secondary data. In this study, the perceived value of an AI platform for organizations that are using AI in the various HR processes is also ascertained. Novel themes that emerged from the usage of AI in sourcing talent were analyzed.


Understanding changes to acrylic emulsion paint films during wet surface cleaning treatments is a priority for conservators of modern painted surfaces. To explore the presence, extraction and removal of soluble components from acrylic paint films, contemporary paint samples and works of art were examined using several FTIR-based techniques including: transmission microscopy, attenuated total reflectance (ATR) and in-situ non-invasive mid-IR reflectance spectroscopy. The major constituents identified on paint surfaces and extracted from bulk films were non-ionic polyethoxylate (PEO) type surfactants used as dispersing agents and emulsion stabilisers. The identification of other extracted constituents was hampered by low concentrations and the proprietary nature of many additives. Surface surfactant was removed within five to twenty seconds by aqueous swabbing treatment, by accelerated light ageing, and was relatively unaffected by aliphatic solvents. Monitoring of contemporary paint films after aqueous cleaning treatment confirms that surfactant continues to migrate to the surface. The analysis of contemporary paint films suggests surface surfactant abundance is primarily influenced by brand. Combined results from the insitu analysis of five paintings dating between 1962 and 1973 confirmed the presence of surfactant on some paint layers and not others.


The main point of intelligent fault diagnosis data theory is fault mode distinguish principle based on data processing meth-ods. In this paper,combined with some practical problems in fault diagnosis inference of computer integrated service,the method of how to use the improved BP-NN in fault diagnosis and the problems which should be paid attention to is discussed. It presents same relationship diagrams to illustrate reasons of common background fault symptoms,the model of fault diagnosis nerve net-work,the nerve network parameters and study samples,The result indicates that this method fits satisfied.


Integration of carbon-isotope chemostratigraphic data with trace fossil assemblages suggests that a significant hiatus may be present within the Lower Member of the Deep Spring Formation, potentially impacting the placement of the Neoproterozoic-Cambrian boundary in eastern California and western Nevada. A positive carbon-isotopic excursion of 4% PDB is present in the lowermost Lower Deep Spring, and is associated with Zone 1 trace fossils (latest Vendian) and small shelly fossils of disputed age (latest Proterozoic or Tommotian). A negative isotopic excursion is observed throughout the remaining Deep Spring Formation, and is associated with Zone 3 trace fossils (latest Tommotian-Atdabanian in age). The positive excursion in the lowermost Deep Spring is tentatively correlated with the pronounced isotopic maximum in the latest Vendian (possibly Nemakit-Daldyn) of the Siberian Platform (cycle 1 of Kirshvink et al., 1991). The negative excursion is correlated with a similar trend in the latest Tommotian-Atdabanian of the Siberian Platform (cycle 4 of Kirshvink et al., 1991). Thus, a hiatus, potentially encompassing most of the Tommotian, is postulated to be present within the Lower Member of the Deep Spring Formation. Although the fossil and isotopic data are consistent with the presence of a break in the section, sedimentological field evidencemore » for the hiatus is somewhat cryptic. The recognition of this hiatus may impact the global significance of the presumed Tommotian small shelly fossils of the White-Inyo region, as well as the placement of the Neoproterozoic-Cambrian boundary in this sequence.« less


Interior permanent magnet synchronous machines (IPMSMs) are widely used due to features like high efficiency and high power density. For high performance drives, maximum torque per Ampère (MTPA) is employed to optimally balance the contribution of mutual and reluctance torque. However, conventionally the MTPA algorithm considers IPMSM with sinusoidal back-electromotive forces (back-EMFs). In practice, IPMSM often presents back-EMF waveforms that deviate from ideal sinusoid, exhibiting harmonic components. Thus, this paper presents a new algorithm for MTPA operation of IPMSM with non-sinusoidal back-EMF that includes the contribution of harmonic back-EMF components in average torque production. For the test machine the proposed optimal stator current provides approximately 2% higher average torque per Ampère ratio compared to the conventional MTPA. Due to the increase of torque undulations, this method is more suitable for applications non sensitive to torque ripple.


Summary In this study, the Alternate Life Styles Perceptions Scale (ALPS) was developed and administered to a sample of 768 college students representing five regions of the nation. The results indicated that the college students' perceptions toward alternate life styles are more conservative and negative than is often believed. The most favorable perceptions were expressed toward trial marriage, and the least favorable perceptions were expressed toward extramarital sexual relations without the knowledge of one mate. ALPS scores were found to be significantly related to several background factors.


Three-dimensional super capacitors consisting of NiSi2/silicon micro channel plates (MCPs) with Zr doped NiO layers have been fabricated. The silicon MCPs produced by electrochemical etching is utilized as a backbone of the 3D structure. Nickle layer was deposited on silicon MCP by electro less chemical deposition. The active Zr doped NiO film and NiSi2 layer are synthesized on the surface of the Si-MCP by annealing the backbone coated by a Zr doped nickel layer under oxygen at 500°C. The multi-layered electrode materials are characterized by field emission scanning electron microscopy (FESEM) and the electrochemical properties are determined by cyclic voltammetry (CV). In addition, the electrochemical properties of the NiSi2/silicon MCP structure with pure NiO layers and the NiSi2silicon MCP structure with Zr doped NiO layers are compared.


The lawyer occupies a status unique to cultures derived from Roman tradition or influenced by the West. This status has been one of great prestige and importance since medieval times and nowhere was it more important than in Spain, where possession of a law degree entitled one to greater economic and social perquisites than most other elite roles. Furthermore, the lawyer was perceived as having specific skills fitting him for the art of ruling, and lawyers therefore occupied very powerful policy-making positions. These aspects of social value and political function were later transplanted to Hispanic America.


The project analyzes the viability of the creation of a virtual store in the ecommerce industry of sports clothing, which serves as a buying platform for professional athletes and amateurs of Ecuador. First, project planning has seen the need to conduct an analysis of the external environment using investigative tools such as Pest and Porter, in order to gather opportunities and threats within the e-commerce industry of sports apparel. Then, to find the true buying behavior of the chosen segment, it has been decided to conduct a market research using investigative methods and techniques such as interviews, focus group and surveys, in order to know and identify consumer behavior in virtual media. The previous research directs the planning to find the business opportunity that is centered in three pillars that are: governmental and legal support, logistic administrative actions and adhesion of technologies of information and communication TIC s. As a consequence, the development of the service has planned the adhesion of the Differentiation Strategy which aims to concentrate on latent needs of the chosen segment and sell different sporting goods that are significant for the final consumer. In addition, administrative actions involving the Marketing Mix are proposed as the basis for the achievement and achievement of administrative and logistical objectives However, the organizational structure has defined the area of human talent which comprises six people who will manage the project and the area of technological infrastructure, which is the main basis for the sales development of the project. Finally, it is vitally important to make a financial plan that shows the investment needed for the project approach. In addition, of projections of costs, expenses and revenues for a period of 5 years and obtaining the NPV and IRR where the respective period of economic recovery is defined to validate the feasibility of the project.


A consistency relation between project elements, arises as a result of the optimal project configuration synthesis and IT-projects for newly created and development of distributed information systems were studied. Formalization of the following concepts was done: components of project's product, project element, project element characteristic, consistency relation. It was shown that a consistency relation occurs between project element characteristics and it is anti-reflexive and anti-symmetry. Project configuration showing the consistency relations between the project element characteristics was shown.


Different organic solvent crude extracts from the leaves of Alangium salviifolium (L.F.) Wangerin, were tested for their feeding deterrence, larvicidal activity and protein concentrations on the fourth instar larvae of Spodoptera litura L. under laboratory conditions. Treatments were given through two different host plant leaves such as brinjal and castor. The bioassay was carried out at different concentrations viz., 0.625, 1.25, 2.5 and 5%. The maximum antifeedant activity in brinjal (52.0%) and castor (29.97%) leaf discs was recorded in ethyl acetate extract as compared with hexane and chloroform extracts at 5% concentration. The result of larvicidal activity revealed that the maximum larval mortality was registered in brinjal leaves (65.81%) and castor with (57.48%) in ethyl acetate extract as compared to hexane and chloroform extracts at 5% concentration. The ethyl acetate extract of A. salviifolium contained alkaloids, diterpenoids, and saponins. The treatment also reduced haemolymph protein concentration after 48 h.


This study aims to analyze the cost of production applied by the company PT. Industrial Immortal Pratama. The research method used in this research is using qualitative research methods. The population and sample in this study are based on social issues that exist in the company PT. Pratama Abadi Industri using data collection techniques in the form of library research and in the form of field research with observations, interviews and documentation. The results of the analysis show that the process of the cost of production of PT. Pratama Abadi Industri has not fully used the existing theory, but the process of determining the cost of production of PT. Pratama Abadi Industri is considered normal because the company makes a reserve fee of 2%.

Keywords: Cost Of Goods Sold, Company, PT. Pratama Abadi Industri


We report the results of an x-ray-scattering study of the polarization and resonance properties of the magnetic cross section of holmium. Off resonance, we have measured the degree of linear polarization for several different chemical and magnetic reflections, and shown that the results are consistent with a nonresonant description of the x-ray-scattering cross section. When the incident x-ray energy is tuned near the {ital L}{sub III} absorption edge, large resonant enhancements of the magnetic scattering, and resonant integer harmonics, are observed. Detailed measurements of the dependence of the integrated magnetic intensity on the incident x-ray energy, on the x-ray momentum transfer, and on the sample temperature are described for incident x-ray energies in a range of 250 eV below and above the {ital L}{sub III} absorption edge. In addition, we have characterized the energy dependence of the linearly {sigma}- and {pi}-polarized components of the magnetic scattering in this range, and fitted the resulting line shapes to a simple model of the resonant cross section, including electric dipole and quadrupole transitions among atomic orbitals. The most striking feature of the line shapes is their asymmetry, which results from the interference of the resonant and nonresonant cross sections. Smaller resonant enhancements ofmore » the magnetic scattering are reported for incident x-ray energies tuned near the {ital L}{sub II} and {ital L}{sub I} absorption edges.« less


Achieving minimum staffing costs, maximum employee satisfaction with their assigned schedules, and acceptable levels of service are important but potentially conflicting objectives when scheduling service employees. Existing employee scheduling models, such as tour scheduling or general employee scheduling, address at most two of these criteria.

This paper describes a heuristic to improve tour scheduling solutions provided by other procedures, and generate a set of equivalent cost feasible alternatives. These alternatives allow managers to identify solutions with attractive secondary characteristics, such as overall employee satisfaction with their assigned tours or consistent employee workloads and customer response times.

Tests with both full-time and mixed work force problems reveal the method improves most nonoptimal initial heuristic solutions. Many of the alternatives generated had more even distributions of surplus staff than the initial solutions, yielding more consistent customer response times and employee workloads. The likelihood of satisfying employee scheduling preferences may also be increased since each alternative provides a different deployment of employees among the available schedules.


Background & Objective : In this study, we aimed to evaluate the status of World's leading universities in Ph.D. students' education and to compare it with Iranian universities applying the approach of educational status evaluation in a research based way.
 Methods: Using a systematic review, all documents present in the webs and related links of universities of first 10 countries in Shanghai's Academic Ranking of World Universities were systematically reviewed information related to Ph.D. education was systematically collected and analyzed.
 Results : Reviewing 28 leading universities revealed that the educational model in educating Ph.D. students in 22 of them was research based and the rest are using course based model. Passing taught courses, as an index in course based model, is considered to be among minimum course requirements in most of the universities which are using research based model. In cases where passing such courses is voluntarily, a consultant professor plays a significant role in guiding the students in selecting and attending theoretical courses.
 Conclusion : Based on the above explanation and similar to other successful countries, it seems that it is time to create various models for training postgraduate students to meet industrial needs. With revisions in educational curriculums, purposeful attempts should be made to solve possible problems and train people who meet country's developmental needs in regards with the twenty year prospect.
Keywords: Postgraduate education, Shanghai's Academic Ranking, Research based curriculum, Scientific development, Ph.D.,


The 1990 amendments to the Clean Air Act established strict SO{sub 2} emissions control requirements for U.S. utilities. For most utilities, compliance strategies are limited to the installation of flue gas desulfurization systems or fuel switching form high-sulfur coal to low-sulfur coal. Both strategies can be expected to have significant effects on electrostatic precipitators already installed for particulate collection. Switching fuel to lower sulfur coal, in particular, often will result in higher ash loadings and fly ash resistivity. To handle these changes, precipitators usually must be increased in size or be enhanced through new controls and/or flue gas conditioning. Consequently, many existing electrostatic precipitators will be undersized for the new flue gas conditions. an alternative to these ESP enhancement strategies, which is generating considerable interest among utilities, is the retrofit of a pulse jet-type fabric filter into existing ESP casings. This paper will discuss the feasibility of retrofitting existing electrostatic precipitator casings into highly efficient low pressure pulse jet fabric filter systems, which is both an economical and technically proven alternative to conventional upgrade alternatives.


The sediment-hosted polymetallic (Pb, Zn, Ag, Au-Cu) mineralization of the Vale do Ribeira Mineral District has been known since the beginning of the 20th century, but exploration was interrupted just before the turn of the century. The Vale do Ribeira Mineral District is part of the Southern Ribeira Belt, developed during the Brasiliano-Pan African orogeny. Polymetallic mineralization is mainly hosted in metalimestones of the Lajeado Group, a typical platform carbonate sequence of a passive margin, which has been deformed during the Gondwana assembly. The region has a gap of research since the mines were closed, which justifies new projects on their mineral economic potential. Fieldwork, petrographic and geochemical analyses were developed in five currently inactive mines (Panelas, Barrinha, Rocha, Lajeado, and Furnas) and their surroundings, along with the description of a drill core executed in the 1980s. The main type of ore consists of polymetallic fault-fill veins of massive sulfide, which are composed essentially by argentiferous galena, sphalerite, pyrrhotite, arsenopyrite, and chalcopyrite. The highest ore grades were obtained from samples in the Panelas Mine, with contents of up to 35% lead, 5% zinc, > 1% copper and 564 ppm silver, as well as 23% iron. New ore occurrences were described in a secondary gallery of the Barrinha Mine, whose gold grades reached up to 5,630 ppb. The main controls of the mineralization are lithological since the ore occurs exclusively in carbonate rocks, irrespective of the geological unit and structural, related to NE high-angle strike-slip fault zones, including evidence of fault-valve behavior. Fault zones as the main control of the polymetallic veins is an innovative interpretation, increasing the perspectives for mineral exploration in the area. Although they are small deposits, the presented data indicate that the region has potential for new discoveries and that the mined deposits are probably not exhausted. Mineralization constraints on the origin of polymetallic (Pb, Ag, Zn, Cu, Au) deposits hosted in the metasedimentary Lajeado Group, Southern Ribeira Belt, Brazil


Philosophers sometimes distinguish some types of discourse as being particularly suited for speech to or about God. For instance, Heidegger's analysis of onto-theo-logy suggests that classical metaphysical language reduces God to a being amongst beings, albeit the highest being. In a similar vein, Jean-Luc Marion argues that the discourse of praise avoids this reduction by drawing on the via eminentiae of apophatic theology. This paper will argue that, while there are clear differences between kinds of discourse, all discourse involves both the known and the unknown. Thus, apparently impersonal statements of scientific fact are actually historical, provisional, cultural and directed towards a particular purpose. They assert some knowns, but also imply unknowns, in relation to which they will be revised. Similarly, even religious discourse that explicitly prescinds from conceptual affirmations about God still depends on articulating shared meanings and concepts. Though it may be directed toward the excessive and transcendent, if it was concerned with the unknown only as unknown, it would become meaningless. The paper will conclude that there are significant resemblances between types of discourse such as scientific observation and religious worship, which are often radically separated from one another.


Purpose To explore the method of treatment of huge thyroid tumor inducing trachea compression and shift.Methods The data of 50 cases with huge thyroid tumor inducing trachea compression and shift which were comfirmed hy CT and B ultrasound examination were analyzed retraspectively.Results All of the thyroid tumors were resected completely. Fourty six cases were diagnosed as benign thyroid tumors and 4 cases,as papillary carcinoma.Among the 50 cases,1 case was made tracheotomy because of dyspnea induced from tracheomalacia.In 1 case recurrent laryngeal nerve palsy emerged.Conclusion Active preoperative measures should he taken in the treatment of huge thyrood tumor in order to achieve good therapeutic effect.


Asymmetric desymmetrization of 4-substituted cyclohexanones using proline amide-catalyzed direct aldol reaction afforded beta-hydroxyketones with three stereogenic centers in high enantioselectivities of up to >99% ee.


Mice with targeted disruptions in the T-cell receptor α gene (TCRα−/−) spontaneously develop inflammatory intestinal lesions with extensive B-cell lamina propria infiltrates. Cryptosporidium parvum infection accelerates intestinal lesion formation in TCRα−/− mice. In the present study, TCRα−/− mice were crossed with JH−/− (B-cell-deficient) mice and challenged with C. parvum to determine if B cells are required for intestinal lesion development. TCRα−/− × JH−/− mice challenged with C. parvum, either as neonates or adults, became persistently infected, whereas TCRα−/+ × JH−/+ heterozygote control mice cleared the parasite. Cryptosporidium parvum colonization of TCRα−/− × JH−/− mice was heaviest in the distal ileum, with fewer parasites detected in the cecum and distal colon. Despite persistent infection, TCRα−/− × JH−/− mice did not develop inflammatory or hyperplastic intestinal lesions as detected in C. parvum-infected TCRα−/− mice. These findings demonstrate that B cells are a necessary component for the development of inflammatory intestinal lesions of C. parvum-infected TCRα−/− mice.


We investigate determinants of patenting, focusing on effects of costs, complexity of technology and technological opportunity. In a theoretical model of patenting it is shown that in complex technologies greater technological opportunity reduces firms' incentives to patent while greater complexity of technology increases patenting incentives. In contrast firms' patenting incentives rise in discrete technolo gies as technological opportunity increases. Using European patent data a new measure of technological complexity is derived from patent citations. It is shown that patenting conf orms to our theoretical model. The theoretical predictions are tested in a panel which allows us to study patenting behaviour of 2074 firms in 30 technology areas over 15 years. Res ults from GMM estimation indicate that patent thickets exist in 10 of these areas and have important effects on patenting behaviour.


Mild traumatic brain injury (mTBI) can result in many structural abnormalities in the cerebral cortex. While thinning of the cortex has been shown in mTBI patients, there is high regional variability in reported findings. High‐resolution imaging can elucidate otherwise unnoticed changes in cortical measures following injury. This study examined age‐related patterns of cortical thickness in U.S. active duty service members and veterans with a history of mTBI (n = 66) as compared to a normative population (n = 67).


: To systematically evaluate the risk factors of the obesity in Chinese children and adolescents.Method: A search was done in electronic databases (PubMed, Web of Science, CBM, WanFang Data and CNK), Cohort or case-control studies of obesity risk factors in children and adolescents were collected from the database establishment to June 2021.Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan5.4 and Stata 15.0 software. Results: A total of 23 articles (19 case-control studies), involving 11,661 patients in the case group and 16,072 patients in the control group were included. The combined OR values (95% confidence interval) were: strong appetite 7.44(5.84,9.47), Both parents are overweight or obese 3.93(3.24,4.78), fast eating speed 2.97(2.34,3.76), overweight or obesity of father2.18(1.86,2.56), long video time 1.85(1.52,2.25), overweight or obesity of mother 1.84(1.66,2.04), big birth weight 1.54(1.36,1.75), eating fried food 1.14(1.05,1.23), meal time 0.33(0.23,0.46).Conclusion: It is Overweight or obesity of parents, birth weight, eating fried food, fast eating speed, strong appetite, long video time and other factors are the risk factors of childhood and adolescent obesity, among which the risk degree of strong appetite is the highest, followed by both overweight or obesity of parents. The duration of consumption is a protective factor for obesity in children and adolescents.


The aim of this article is to calculate the Conner-Floyd invariants of the fixed points of the action of a cyclic group, by analogy with Adams operators. We shall correct the mistakes made in a previous article.


So that the user is interested in a certain commodity to the commodity purchase process continuous until, when the fatigue of purchases. The portable telephone terminal of the user by shooting with a camera function of a product of interest, to the server (3) through the Internet (2) the image data (7). Server (3) having: various registration DB (4) images of goods, people, and other identification; registration DB DB (5) related information in the image data (4). Server (3) of the image data (7) performs image recognition processing, the image data retrieved from the DB and the image data (7) in the same high data (4), corresponding to the associated information extracted from the DB (5). Related information (2) presented to the user via the Internet. , Just by sending the image data (7) can be obtained related information of a product of interest, according to the association information associated with the access site item (6), to obtain more information or to purchase goods.


The problem of choosing the optimum locations for smart nodes in the integrated RFID and wireless sensor networks communications system is considered.All these choices must satisfy a set of imperative constraints and optimize a set of objectives.The factors affecting optimum selection are the complex propagation environments,the undesired mutual coverage and the unavoidable interference of smart nodes.This paper presents an improved genetic approach for tackling this complex optimization problem.To validate this approach,computational results are presented for a typical test scenario.It can not only accelerate the speed of finding optimal deployment of nodes,but can also effectively and rapidly converge to the optimal solution.What is more,it can have a good coverage rate and can minimize the interference.


Some spreading solutes were found to be effective in enhancing the absorption rate by provoking interfacial turbulence at the gas−liquid surface. In this work, the induction criterion of the Marang...


Examination with scanning electron microscopy (SEM) and scanning force microscopy (SFM) revealed etch pits, layers and islands on dolomite crystal faces synthesized from calcite in Ca‐Mg‐Cl solutions at 200 °C and a wide variety of natural dolomites. Layers are broad, flat structures bounded by steps less than 100 nm high and greater than 1 μm wide. Islands are rounded topographic highs <20 nm high and <200 nm wide. The nanotopography of synthetic dolomite changed from islands throughout most of the reaction to layers at 100% dolomite. Island nanotopography formed on both Ca‐rich and near‐stoichiometric dolomite. Analyses of reaction products from dolomite synthesis indicates that there are no SFM‐detectable products formed in <10 h. SEM‐detectable products formed in 15 h. X‐ray diffraction (XRD)‐detectable products formed in ≈18 h, and the reaction went to completion in ≈40 h. Based on SFM analyses, the induction period for dolomitization in these experiments accounts for ≈20% of the total reaction time necessary to dolomitize CaCO3 completely under the experimental conditions used here. Island nano‐ topography is inferred to occur at higher degrees of supersaturation than layer nanotopography for three reasons. First, island nanotopography on synthetic calcite and gypsum forms at higher supersaturations than layer nanotopography. Secondly, island nanotopography formed in solutions with higher degrees of supersaturation with respect to dolomite. Thirdly, the greater surface roughness of a crystal face composed of islands compared with layers indicates that island surfaces have higher surface energy than layer surfaces. Therefore, the stability of island surfaces requires a higher degree of supersaturation. Because islands and layers form under a wide range of conditions, their presence provides broadly applicable criteria for evaluating relative degrees of supersaturation under which ancient dolomite formed. Comparison of synthetic dolomites with natural dolomites demonstrates (1) similar nanotopography on natural and synthetic dolomites and (2) both natural planar and non‐planar dolomite may have island nanotopography.


Glycerate-based surfactants are a new class of swelling amphiphiles which swell to a finite degree with water. Among this class of surfactants, oleyl (cis-octadec-9-enyl) glycerate is very similar in structure to a well characterized mesophase-forming lipid, glyceryl monooleate (GMO). Despite the similar structural characteristics, a subtle change in connectivity of the ester bond substantially alters the binary surfactant-water phase behaviour. Whereas the phase behaviour of GMO is diverse and dominated by cubic phases, the phase behaviour of oleyl glycerate and a terpenoid analogue phytanyl (3,7,11,15-tetramethyl-hexadecane) glycerate is much simplified. Both exhibit an inverse hexagonal phase (H-II), which is stable to dilution with excess water, and an inverse micellar phase (L-II) at ambient temperatures. The inverse hexagonal phases formed by oleyl glycerate and phytanyl glycerate have been characterized using SAXS. Analogous to GMO cubosomes, the inverse hexagonal phase of phytanyl glycerate has been dispersed to form hexagonally facetted particles, termed hexosomes, whose structure has been verified using cryo-TEM.


Prior research has viewed competitive interference as undesirable due to its negative effects on brand-attribute recall. We propose that competitive interference is not inherently bad but may be beneficial under certain conditions. In the context of an established brand promoting a new attribute, we show that the new attribute information is interfered with by the brand's old attributes, causing lower retrieval. However, in the presence of competitive advertising, old attribute information is suppressed, and new attribute information is successfully retrieved. Copyright 2003 by the University of Chicago.


The purpose of this study was to investigate the effect of cardiovascular disease risk factors and cognitive function on combined exercise program(yoga and weight bearing resistance exercise) in elderly women. The subjects of this study were 68 elderly women with aged ranged between 65 and 74 years old that assigned to either a training group(n=38) and a control group(n=30). The effects of 24 weeks exercise program on cardiovascular disease risk factors and cognitive function test were measure at pre and 24weeks after exercise training. Subjects in the exercise group went through their training program for 60minutes per session and 3 sessions per week for 24 weeks. The results were as follows: The change of cardiovascular disease risk factors were compared with the control group that showed significant variations of exercise and time on HDL-C. Cognitive function were compared with the control group that showed significant variations of exercise and time on orientation, and memory. It was concluded that combined training of yoga and weight bearing resistance exercise has positive effect on cardiovascular disease risk factors and cognitive function in elderly women.


The fifth generation of telecommunication networks is going to be deployed. The European Space Agency (ESA) is investing significant effort and resources to achieve technological concepts and components capable to allow the satellite systems to play the role of an essential component of 5G and not only ancillary. The VIBeS project aims to develop a real time test bed built over a virtual-PEP (vPEP), implemented in compliance of 5G standard in terms of network architecture and function virtualization techniques. The paper provides the description of how the target use cases have been implemented in the VIBeS test bed, and the technology involved in the vPEP to improve on network performance. For each use case, we report the protocols and mechanisms enabled in the vPEP, their configuration and working modes as well as the expected benefits with respect to the benchmark case, in which vPEP is off.


Abstract Queer readings of the Bible are sometimes understood to be irrelevant for uses of the Bible in theology, theological education, and ministry. This address challenges that understanding by considering ways in which portions of the Bible take positions vis-à-vis religious tradition that parallel moves made in queer theory and queer theology. Using the task of preaching as an example, the address suggests that queer readings can be useful for the practice of Christian ministry even as such readings challenge certain 'common-sense' conceptions of ministry, theological education, and religious community.


Solcia and Buffa (16) in a Letter to the Editor reiterate their claim (17) that glutaraldehyde fixation permits benzy!idene and xanthydrol reactions of 5hydroxytryptamine (5-HT). They report experiments in which mucosal epithelial cells were first reacted with xanthydrol, photographed and then hydrated, during which process they largely lost their staining, and then reacted with fast garnet GBC. In 1957 Lillie (7) reported a positive xanthydrol reaction not only with indoles, tryptamines and tryptophans but also with tetrahydronorharman prepared by condensation of formaldehyde and tryptamine in Witkop's laboratory. Nevertheless we and others have been unable to demonstrate enterochromaffin cells (EC) in formaldehyde-fixed tissue with xanthydro! or any of the p-dimethylaminobenzaldehyde methods. In 1960 Lillie and Greco-Henson (9) reported what was at first thought to be a successful demonstration in formol sucrose-fixed guinea pig tissue with the postcoupled benzylidene reaction. However, when after application of fast garnet GBC and photography and then performing the postcoup!ed benzy!idene (PCB) reaction, all of the previously photographed enterochromaffin cells were still red and many blue stained cells appeared, at least a part of which closely resembled the blue colored cells previously thought to be enterochromaffin cells, the concept that they had shown enterochromaffin cells by the PCB reaction had to be abandoned. In our 1973 report (14) we went a step further. The postcoupled benzy!idene and p-nitrodiazobenzene reactions were combined in both directions. Fields were photographed after the first reaction. Then, without moving the section, the second reagent was applied under direct microscopic visual observation. The blue indole reaction was not lost during the following azo reaction. The positive red azo reaction was not lost during application of p-dimethy!aminobenza!dehyde in HC1-HAc mixture. No red stained cell was replaced by an indole-reactive cell. No indo!e-reactive cell was replaced by an azo-reactive one. Solcia and Buffa (16) report no such direct visual observation. Rather they relied on morphologic resemblance. Geyer's (4) claim that acetaldehyde fixation simi!arly would permit an indo!e reaction of 5-HT presumably by leaving the critical a-indole position open is contradicted by the known synthesis of harman (2methyl-fl-carboline) from trypt amine or tryptophan and acetaldehyde. Harvey and Robson (6) reported formation of the tetrahvdro-carboline derivative from the simple addition of a stoichiometric amount of freshly distilled acetaldehyde to a cold saturated aqueous solution of L-tryptophan. They cited also the preparat ion of tetrahydroharman from tryptamine and acetaldehyde by Akabori and Saito (2). Snyder, Parmertes and Katz (15) also prepared harman by a simple aceta!dehyde condensation with DL-tryptophan followed by dichromate oxidation. We were able to discern no difference whatever between formaldehydeand g!utaraldehyde-fixed guinea pig duodenum with respect to their reactivity to the indo!e or azo coupling reactions. It is true that glutaraldehyde inhibits the Clara hematoxylin reaction of enterochromaffin (11) but that reaction apparently depends on an entirely different mechanism. In the recent study we used freshly diazotized p-nitroaniline rather than fast garnet GBC, because in our 1961 study (10) it demonstrated practically all of the ferric ferricyanide reactive enterochromaffin cells at 2-10-mm exposures, and 1 mM, whereas fast garnet GBC only reacted 90% at 10 mM and 62% at 1 mM. The evidence of formaldehyde fluorescence indicates the presence of 5-HT both in EC (5) and rat and mouse mast cells (1, 3) and the latter has been established by isolation and chemical assay. The latter cells give the pH 3 diazosafranin reaction in agreement with the in vitro pH 3 p-nitrodiazobenzene reactivity of 5-HT and 5-hydroxytryptophan reported by us (12) in 1973. Carcinoid tumors have rarely given the histochemica! postcoupled benzylidene react ion (8). We are now occasionally finding a positive pH 3


Two of the most important sites of Arkadia are the ancient theatre of Megalopolis and the Thersilio. The main objectives of this study are the archaeological analysis of the theatre and the issue of its date. At first, some historical data about the place are presented along with the findings of the excavations which took place. Then, there is a presentation of Thersilio and the theatre, with special reference to skanotheka and if a movable skene existed or not. Finally, the construction phases are examined and an attempt to define the date of the theatre and the Thersilio is made.


This paper is concerned with the critical exponent of the porous medium equation with convection and nonlinear boundary condition. It is shown that the coefficient of the lower order term is an important factor that determines the critical exponent.


This paper presents high speed discrete wavelet transform based image compression using different wavelet families called Daubechies, Symlets, Coiflets Wavelets and result comparison has been done in terms of PSNR and image processing time using different wavelets. The wavelet transform has emerged as a benchmark, in the field of image compression. Wavelet based coding provides substantial improvements in picture quality at higher compression ratios. Images have been processed and simulated using MATLAB. The simulated results show that the Daubechies Wavelet has shown better PSNR by taking less processing time as compared to Symlet and Coiflet Wavelets for different scaling factors and Coiflet Wavelet works only for smaller values of scaling factors.


In this study, we investigated the hygroscopicity and the extension properties of wool fibers treated under high-temperature steam and water. The scale structure and the crystallinity of the treated wool fibers were analyzed with scanning electron microscopy and X-ray diffraction analysis. The experimental results show that the hygroscopicity of the wool fibers treated under high-temperature steam was higher than that of the wool fibers treated under high-temperature water. The strength, the breaking elongation, and the breaking work of the treated wool fibers decreased obviously compared with the untreated wool fibers. The scale surface became rough and the crystallization index decreased for the treated wool fibers. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008


The fauna and paleoecology of the Middle Permian conchostracanbearing beds of Kansas and Oklahoma constitute poorly understood, neglected, yet important subjects for investigation. The branchiopod conchostracan genus Cyzicus, a clam shrimp, has repeatedly been referred to as a "brine shrimp." The brine shrimp (Artemia) is also a branchiopod but belongs to the order Anostraca and is a soft-bodied form lacking a carapace. It does not occur in the Wellington or the Ninnescah. The present paper is a preliminary and condensed report on a pilot study of the Jester Creek Section.


Using new and archival data, we study the kinematic properties of the nearest field S0 galaxy, NGC 3115, out to $\sim6.5$ half-light radii ($R_\mathrm{e}$) from its stars (integrated starlight), globular clusters (GCs) and planetary nebulae (PNe). We find evidence of three kinematic regions with an inner transition at $\sim0.2\ R_\mathrm{e}$ from a dispersion-dominated bulge ($V_\mathrm{rot}/\sigma 1$), and then an additional transition from the disk to a slowly rotating spheroid at $\sim2-2.5\, R_\mathrm{e}$, as traced by the red GCs and PNe (and possibly by the blue GCs beyond $\sim5\, R_\mathrm{e}$). From comparison with simulations, we propose an assembly history in which the original progenitor spiral galaxy undergoes a gas-rich minor merger that results in the embedded kinematically cold disk that we see today in NGC 3115. At a later stage, dwarf galaxies, in mini mergers (mass-ratio $<$ 1:10), were accreted building-up the outer slowly rotating spheroid, with the central disk kinematics largely unaltered. Additionally, we report new spectroscopic observations of a sample of ultra-compact dwarfs (UCDs) around NGC 3115 with the Keck/KCWI instrument. We find that five UCDs are inconsistent with the general rotation field of the GCs, suggesting an \textit{ex-situ} origin for these objects, i.e. perhaps the remnants of tidally stripped dwarfs. A further seven UCDs follow the GC rotation pattern, suggesting an \textit{in-situ} origin and, possibly a GC-like nature.


While studies have focused on the subject of redundancy, empirical studies have rarely considered the case of total redundancy characteristic of the mining industry. This is a field where the organization has a fixed lifespan and at some point all functions become redundant. Studies have also concentrated on redundancy as a problem and not on solutions to effectively manage it. The study relies on a case of Base Titanium Ltd, which is a Kenyan subsidiary firm and affiliate of the Base Resources Group, an Australian mineral sands producer. The purpose of the study was to determine the effect of redundancy management on employee performance. A descriptive survey research design was used on a target population of 1,898 staff. A sample of 330 respondents was selected from whom primary data was collected with the help of a questionnaire. Quantitative data were analysed using descriptive (median and mode) and inferential analyses (regression analysis and Spearman rank correlation analysis). The regression analysis results provided evidence that each of the redundancy management variables – Prior Preparation and Training (β .396 p<.05), Compensation and Incentives (β.304 p<.05), Communication Strategy (β .301 p<.05), and Employee Engagement (β .233 p<.05) – has a positive and statistically significant effect on employee performance.


Reflective optical system free from chromatic aberration is essential for astronomical instruments, which usually require wider wavelength coverage. However, it cannot always be the optimum choice compared with refractive optical system in terms of cost-effectiveness because mirrors require high surface accuracy and also because non-co-axial systems force tough alignment work. This dilemma could be overcome by a monolithic reflective optical system made entirely of cordierite CO-720, a ceramic material by Kyocera, which is the first material that offers both high-precision 3D-shaping and surface polishing for optical quality. This material also possesses a very low coefficient of thermal expansion (CTE) enabling a genuine athermal system useful for various astronomical applications. This athermality could make a significant breakthrough especially for cryogenic infrared instruments since optical systems made of cordierite are expected to keep as-built performance throughout the cooling process, providing extremely high wavefront accuracy that has never been possible at cryogenic temperature with conventional optical systems made of glasses or metals. In this paper, we report the first cryogenic optical testing of a small cordierite-made imaging optical system that was simply assembled with mechanical accuracy at room temperature. We confirmed that the diffraction-limited optical performance is kept even down to ~80K as built in the room temperature.


A method has been developed for detection of arbitrarily oriented multiple open cracks in a slender shaft or beam of circular section. The method is based on changes in the natural frequencies of torsion vibrations. It has been verified based on finite element data for shafts with two, three and four cracks. Case studies are presented for shafts with fixed-free and free-free end conditions. Maximum error in the prediction of location is 2 % and size is ~23%. The method can be useful for detection of arbitrarily oriented multiple cracks.


#11# Summary . This research aims to present a number of developments for private sector services along an EU freight corridor. To achieve this, information technology developments for operating processes and market tested freight services are examined. The anticipated benefits of implementing IT developments for operating processes are presented along with a case study and pilot demonstration of innovative freight services. Analysis of pilot demonstration results suggest that there is potential for these types of services operated by the private sector along a European corridor. #11# #11# #11#


"Man as a human being is neglected in favor of man the jobholder." A brief for the liberal arts in secondary education


Background: Along with several significant factors in chemotherapy treatment management's nurses plays the pivotal role. The objective of this study was to evaluate the knowledge of nurses in relation to handling chemotherapy and the current practice of cancer centers in different hospitals in Bangladesh.Methods: The cross-sectional study was designed based on anonymous self-administered questionnaire. The questionnaire was developed from literature and expert input and validated by subject experts.Results: A total of 96 nurses were the respondents in this study. Around half of them already exposed directly with chemotherapy agents. Some 72.9% of nurses had not any training and 58.3% of respondents were not aware about use of closed system transfer devise in chemotherapy. A greater proportion 58.3% of nurses did not know the same health hazard of both oral and parenteral drugs. One third (33.3%) respondents used biological safety cabinet for doing preparation. Nurses' did not use especial personal protective equipment and the designed treatment room also was absent. None of nurses went through regular medical checkup.Conclusions: The evidence-based results suggested that nurses have average knowledge about chemotherapy handling, however, use of personal protective equipment and biological safety cabinet, follow guidelines, medical surveillance and training are appeared to be a hindrance. More fundamentally, nurses need more education and professional training about chemotherapy agents handling in nursing school and through in-service continuing education as well as adopt required facilities are necessary.


Abstract. This paper evaluates Papua provincial assets which are not utilized or not optimally utilized in Integrated Economic Development Zone (KAPET) of Biak.   Through a case study analysis, direct observation, direct interview and literature studies conducted in this research, we found that the KAPET of Biak assets which also are the Papua provincial government's assets have not been consistently well maintained and protected. Several assets were unutilized and were abandoned.  Considering the great potentials of KAPET-Biak area which has cultural richness, rich resources area, strategic position in the middle of world economic growth triangle and on the hub of the global route for trading in pacific region.  It would be better to develop the KAPET-Biak and its assets for further zonal developmental concept in this more global world.  The provincial government and all stake holders can also develop and utilize several assets to be the part of research and educational center (LIPTEK Lab and office). Keywords. Provincial assets, KAPET of Biak, direct observation, zonal developmental concept, research and educational center. JEL. D91, J24, J28, O14, Z22.


The results of two research projects supported by the US Department of Energy are reported. In the first, 32 different salts were tested in the flotation of -100 mesh bituminous coal. An arbitrary concentration of 0.07 moles/l was used and no other reagents were present. Results are quoted for sodium salts with various anions and sulphate salts with various cations. The rate of flotation was found to be considerably faster when salts were used rather than kerosene and Dowfroth as collector and frother. The mechanism of the process was investigated. In the second project, the use of micro-bubbles generated in the frother by several different techniques was investigated for the flotation of fine coal. Results are given for tests on -400 mesh coal under various conditions. Yields were found to be higher with conventional flotation, but the ash contents were much lower when using micro-bubbles.


This article is related to the research effort of constructing an intelligent agent, i.e., a computer system that is able to sense its environment (world), reason utilizing its internal knowledge and execute actions upon the world (act). the specific part of this effor presented in this article is reinforcement learning, i.e., the process of acquiring new knowledge based upon an evaluative feedback, called reinforcement, received by tht agent through interactions with the world. This article has two objectives: (1) to give a compact overview of reinforcement learning, and (2) to show that the evolution of the reinforcement learning paradigm has been driven by the need for more efficient learning through the addition of more structure to the learning agent. Therefore, both main ideas of reinforcement learning are introduced, and structural solutions to reinforcemen learning are reviewed. Several architectural enhancements of the RL paradigm are discussed. These include incorporation of state information in the learning process, architectural solutions to learning with delayed reinforcement, dealing with structurally changing worlds through utilization of multiple models of the world, and focusing attention of the learning agent through active perception. the paper closes with an overview of directions for applications and for future research in this area. © 1993 John Wiley & Sons, Inc.


In developing countries like India, the population is significantly growing. As the population grows, the number of vehicles on the roads are also exponentially increasing, which results in increase in road accidents and traffic congestion. Specifically, when an emergency vehicle such as Ambulance or Fire engine gets stuck in traffic jam, saving the human life becomes difficult. Under such circumstances, a promising system which can clear the traffic congestions especially in peak hours and thereby providing a safe path for emergency vehicles is very much essential. In the existing literature, less focus is given towards the problem of providing a clear path for emergency vehicles during traffic congestions. To solve these issues, an Ultrasonic sensor and RFID-based system is proposed, which manages and regulates the traffic signals at junctions when the emergency vehicle arrives, by allowing the easy passage out of the traffic congestions. The proposed frame work is modelled by means of an experimental setup using ARDUINO and LED's which simulates a real time traffic scenario. Ultrasonic sensors are installed on the roads to manage the traffic efficiently. The simulation results illustrate the better performance of the proposed framework in terms of detection as well as management of emergency vehicle by providing passage out of traffic congestions during peak hours. The ultrasonic sensor which is placed at a threshold distance from the junction calculates the vehicles density. This density is used by ARDUINO to regulate the traffic. The RFID receiver is also placed at a threshold distance from the junction. The RFID receiver informs the ARDUINO about the arrival of the emergency vehicle. The ARDUINO then takes the required measures to allow a safety passage for the emergency vehicle.


Proposed economic reforms often neglect to take into account the interests of groups which have benefitted from establishing or maintaining the status quo. Martin Ricketts, Reader in Political Economy at the independent University of Buckingham, assesses the political pressures that have produced regulation of the housing market, and suggests reform which accommodates realistic expectations of resistance from local politicians and subsidised tenants.


Some properties of the white light flare (WLF) that occurred on 18 January 1989 are presented. The flare consisted of 7 patched-shape kernels, with sizes (1.5 similar to 4) 10(17) cm(2). The lifetimes of the kernels were from several minutes to more than 40 minutes. The initial bright points of the WLF kernels originated between the umbra and penumbra in penumbra fibrils, between penumbra fibrils and the photosphere, or on the photosphere and light bridge. These kernels appeared 2 to 3 minutes after H alpha flares, and reached their maxima respectively before the first maximum and 1 to 2 minutes before the second maximum of the H alpha flare, and disappeared slowly before the disappearance of the H alpha flare. The direction and size of material motion in the kernels are different. The precur sors of the WLF are similar to those of ordinary flares. The magnetic pattern of the photosphere in the active region is in delta- structure, and the kernels lie at or near the changing magnetic neutral lines. The small longitudinal field gradient may be constrained by the small transverse field on the photosphere. The flare exhibited both temporal and spatial properties in the center reversal and line-width of H alpha profiles, and has characteristics of both class I and II. Thus it may be a mixed-class white light flare.


This paper presents a method for processing acceleration data registered on a train and determining the health condition of a subway's substructure. The acceleration data was converted into a dynamic deformation by applying a transfer function defined using the Empirical Mode Decomposition Method. The transfer function was constructed using data produced on an experimental rig, and it was scaled to an existing subway system. The equivalent deformation improved the analysis of the dynamic loads that affect the substructure of the subway tracks because it is considered the primary load that acts on the track and substructure. The acceleration data and the estimated deformations were analyzed with the Continues Wavelet Transform. The equivalent deformation data facilitated the application of a health monitoring system and simplified the development of predictive maintenance programs for the subway or railroad operators. This method better identified cracks in the substructure than using the acceleration data.


We examined the benefit of incorporating ESG factors over a more recent period to acknowledge the ongoing investment trend toward ESG. A review of academic literature suggests lack of consensus on the benefit of incorporating ESG factors. We find no evidence that suggests incorporating ESG criteria results in a performance headwind or subordinate return. Furthermore, we find strong evidence of idiosyncratic risk reduction as one moves from firms that are least ESG compliant toward firms that are most ESG compliant. Finally, we conclude that the source of ESG rating can alter the performance of ESG factors.


Objective:observing effecting of BCG amylose nucleic acid to treat bronchial asthma.Method: 51 cases of patients suffered from bronchial asthma divided into the treatment group and comparison group separately.Two groups accept normal treatment and also were given 0.5mg BCG amylose nucleic acid for muscle injection for the comparison of the treatment effect before and after the treatment of the patients for three months.Result: The effect for the treatment group(P0.05) is more remarkable than the comparison group.So the lung function keeps higher level for the treatment of three months.Conclusion: The BCG amylose nucleic acid is an ideal medicine to treat the bronchial asthma so as to be worth promoting it.


A new approach for the construction of statistical models for multimodal optimization is proposed; the examples of such models are given. The results of the psychological experiment show that the proposed approach is intuitively acceptable.


[Objective]To establish models of damp-heat syndrome rats by compound factors,and observe the effect of clearing away heat and dampness(compound therapy) on the expression of somatostatin receptor 1 mRNA(SSR1mRNA) in damp-heat rats models' gastric antrum [Methods] Forty-eight Wistar male gender rats of clean grade were randomly divided into six groups: normol control group;damp-heat syndrome model group;clearing away heat and dampness group;clearing away heat and relieving toxicity group;disepersing Qi to remove dampness group and mosapride group(n=8 each).The fat and sweet diet,artificial climate and mouse typhus salmonellabacillus were given to make rat model.Rats in the treatment groups were given medicine respectively for 5 days,while those in the model group given the isometric physiological saline.Then the expression of gastric antrum SSR1mRNA was examined by the method of in situ hybridization.[Results] The expression of gastric antrum SSR1mRNA in the model group was remarkably higher than that of normal control group(P0.01), while lower than that in clearing away heat and dampness group,clearing away heat and relieving toxicity group,disepersing Qi to remove dampness group and mosapride group respectively(P0.01).Compared with clearing away heat and relieving toxicity group,clearing away heat and dampness group elevated SSR1mRNA expression significantly(P0.001,P0.05).The effect of clearing away heat and dampness was better than clearing away heat and relieving toxicity and mosapride.There was not significant difference between clearing away heat and dampness group and disepersing Qi to remove dampness group(P0.05).[Conclusion]The therapeutic method of clearing away damp and heat can reduce the expression of SSR1mRNA in the damp and heat rat model's gastric antrum.


BACKGROUND
The introduction of the Quality and Outcomes Framework (QOF) provides a quantitative way of assessing quality of care in general practice. We explore the achievements of general practice in the first year of the QOF, with specific reference to practice funding and contract status.

AIM
To determine the extent to which differences in funding and contract status affect quality in primary care.

DESIGN OF STUDY
Cross-sectional observational study using practice data obtained under the Freedom of Information Act 2000.

SETTING
One hundred and sixty-four practices from six primary care trusts (PCTs) in England.

METHOD
Practice data for all 164 practices were collated for income and contract status. The outcome measure was QOF score for the year 2004-2005. All data were analysed statistically.

RESULTS
Contract status has an impact on practice funding, with Employed Medical Services (EMS) and Personal Medical Services (PMS) practices receiving higher levels of funding than General Medical Services (GMS) practices (P<0.001). QOF scores also vary according to contract status. Higher funding levels in EMS practices are associated with lower QOF scores (P=0.04); while GMS practices exhibited the opposite trend, with higher-funded practices achieving better quality scores (P<0.001).

CONCLUSION
GMS practices are the most efficient contract status, achieving high quality scores for an average of pound 62.51 per patient per year. By contrast, EMS practices are underperforming, achieving low quality scores for an average of pound 105.37 per patient per year. Funding and contract status are therefore important factors in determining achievement in the QOF.


Synchronisation occurs when large numbers of individuals co-ordinate to act in unison. In this wide definition of the word, many different types of collective behaviour are examples of synchronisation. A highly aligned group of birds, fish or particles can be said to have synchronised their direction of movement. More commonly however, when we use the word synchronisation we are thinking about time. Bank robbers synchronise their watches before a robbery, the instruments of the orchestra are synchronised by the conductor and the sound is synchronised to the pictures in a film. It is this narrower sense of the word synchronisation I use in this chapter. How and why do behaviours become synchronised in time? Given that synchronisation is a specific type of collective behaviour it should come as no surprise that it shares many properties with systems looked at in earlier chapters of this book. In particular, and unlike with the bank robbers or the orchestra, synchronisation can be achieved without a leader or centralised control. As with other types of collective behaviour, we can also build mathematical models that describe how synchronisation emerges from individual interactions. Indeed, some of the models of synchronisation are among the most elegant models of collective behaviour and have been employed successfully in understanding a wide variety of biological and social systems.


Sir, 5% cefazolin recommended for treating Gram‐positive bacterial keratitis (GPBK)[1] has been the mainstay of therapy for decades. In 2017, cefazolin sodium injection, from which the topical preparation was constituted, became unavailable in India. This inconvenienced treating GPBK, as a recent study[2] had reported an increase in fluoroquinolone resistance in Gram‐positive bacteria in India, which meant that fourth‐generation fluoroquinolones were less effective. While fluoroquinolone monotherapy is popular among ophthalmologists, cornea specialists still prefer fortified antibiotic combination to treat severe infections.[3] Left with little choice, we began Cite this article as: Pandey SK, Sharma V. July 1 is National Doctors' Day: How to regain the lost public trust in healthcare?. Indian J Ophthalmol 2018;66:1045-6.


The material point method (MPM) has demonstrated itself as an effective numerical method to simulate extreme events with large deformations including fracture problems. However, the traditional MPM encounters difficulties in simulating discontinuities due to its continuous nodal shape function. In this paper, The eXtended Material Point Method (XMPM) is proposed to simulate the three‐dimensional (3D) crack propagation. The XMPM modifies the particle displacement approximation by introducing the local enrichment functions based on the partition of unity into the MPM framework. To accurately trace the evolution of the crack surface, the XMPM employs both the level set method and an extra set of crack surface mesh, which is independent of the background grid. Only locally enriching the nodes near the crack makes the XMPM efficient and able to multiple cracks without extra tricks. Besides, a series of adaptive crack front processing methods, including crack front splitting, merging and locking with its meeting the material boundary, are developed in the XMPM framework to ensure the continuity and smoothness of the crack surface. Numerical examples demonstrate the capability of XMPM to simulate the discontinuity, calculate the fracture parameters and handle the evolution of the crack surface growth in 3D dynamic crack propagation.


This work was carried out because the company Confecciones y Bordados Natasha,
is not competitive within the local market, for this reason an Administrative
Management Model was designed to strengthen the competitiveness of said company,
with the objective of leaving the company Empiricism, be more competitive, increase
your sales and expand into new markets, promoting the textile offer that the company
offers.
This document details the methodology that was used for the development of the
administrative management model, it began with an external analysis where local
competition could be known, then an internal analysis of the company was carried out,
to know the flaws that the company He owned and found possible problems.
Subsequently, the search for information was carried out, for the dependent variable
that is the administrative management model and the dependent variable that is
strengthening of competence, each of them with a tool to know how to prepare the
different matrices and elements. The current situation of the company will be
determined through interviews with the manager and surveys to the operators where
it was obtained, strengths, weaknesses, threats and opportunities with their strategic
crossing respect.
With the information obtained, we proceeded to design the Strategic Administrative
and Commercial Plan where a proposal was made to strengthen the competitiveness
of the company that is composed of: mission, vision, internal analysis, external
analysis, objectives, strategy and budget.
Finally, we proceeded to show the results of the investigation to the owner of the
company, which was very favorable by the owner of the company, which guaranteed
to put the model into practice and make all workers known.
Finally, the respective conclusions and recommendations were made since applying
this model will show very positive results that improve the organization. Its
competitiveness and may expand into new markets.


Graphical Abstract Highlights d NF-kB inhibition in LPCs does not cause spontaneous HCC in contrast to NEMO ablation d Constitutive IKK2/NF-kB activation prevents liver damage and HCC in NEMO LPC-KO mice d RIPK1 kinase activity-mediated hepatocyte apoptosis drives HCC in NEMO LPC-KO mice d NEMO prevents formation of a RIPK1/FADD/Casp8 complex inducing hepatocyte apoptosis In Brief Kondylis et al. identify an NF-kB-independent function of NEMO in controlling RIPK1 kinase activity-dependent apoptosis of hepatocytes and thus hepatocarcinogenesis. NEMO-mediated NF-kB activity and kinase activity-independent scaffold function of RIPK1 also regulate hepatocyte apoptosis. SUMMARY IkB kinase/nuclear factor kB (IKK/NF-kB) signaling exhibits important yet opposing functions in hepatocar-cinogenesis. Mice lacking NEMO in liver parenchymal cells (LPC) spontaneously develop steatohepatitis and hepatocellular carcinoma (HCC) suggesting that NF-kB prevents liver disease and cancer. Here, we show that complete NF-kB inhibition by combined LPC-specific ablation of RelA, c-Rel, and RelB did not pheno-copy NEMO deficiency, but constitutively active IKK2-mediated NF-kB activation prevented hepatocellular damage and HCC in NEMO LPC-KO mice. Knock-in expression of kinase inactive receptor-interacting protein kinase 1 (RIPK1) prevented hepatocyte apoptosis and HCC, while RIPK1 ablation induced TNFR1-associated death domain protein (TRADD)-dependent hepatocyte apoptosis and liver tumors in NEMO LPC-KO mice, revealing distinct kinase-dependent and scaffolding functions of RIPK1. Collectively, these results show that NEMO prevents hepatocarcinogenesis by inhibiting RIPK1 kinase activity-driven hepatocyte apoptosis through NF-kB-dependent and-independent functions.


In this article, the design problem of ℓ2–ℓ∞ proportional–integral observer (PIO) is investigated for a class of discrete‐time systems with mixed time‐delays. The mixed time‐delays comprise both the discrete time‐varying delays and infinitely distributed delays. The round–robin protocol (RRP) is employed to schedule the data transmissions from the sensors to the observer so as to mitigate the communication burden and prevent the data collisions. A novel PIO is developed whose observer gain is dependent on the data transmission order as a reflection of the effects induced by the RRP scheduling. By resorting to the token‐dependent Lyapunov functional and the matrix inequality technique, the desired PIO is designed with exponentially stable error dynamics of the state estimation and guaranteed ℓ2–ℓ∞ disturbance attenuation/resistance capacity. Finally, a simulation example is exploited to verify the validity of the proposed observer design method.


In order to optimize the workflow of iterative 3D reconstruction and support the goal of massive image data processing, high performance and high scalability, this article proposes an image distributed computing framework FIODH. It is a distributed computing framework based on distributed hash algorithm, which accomplishes the task of storing, calculating and merging the image data in multiple nodes. A SIFT algorithm is used to extract feature points from the original images which are distributed on the hash nodes. During the process of image clustering computation, the agent nodes are responsible for task management and intermediate result calculation. The clustering results in hierarchical trees which can be converted into computational tasks and assigned to the appropriate nodes. The experimental analysis shows that the algorithm has achieved satisfactory results in efficiency and error adjustment. In a large amount of experiment data, the advantage of the algorithm is more obvious.


It is widely accepted that human errors rather than technical failures have the greatest potential to adversely affect contemporary aviation safety. In order to have a better understanding of how human factors and errors in aircraft maintenance may contribute to an aircraft accident/incident, a new human factor classification scheme, the A-SHELL Model (Airworthiness-Software-Hardware-Environment-Liveware), has been developed. Based on airworthiness regulations, the generic human factor model is aimed to identify less-than-satisfactory interactions between various components of the system and the aircraft maintenance staff. In the model, airworthiness has been incorporated to bind all the crucial SHELL Model elements together. The purpose is to provide a better compliance with airworthiness regulations, which in turn would enhance aviation safety. This paper outlined the impact of human factor on airworthiness compliance in aircraft maintenance and an application of A-SHELL model is demonstrated through a case study.


Introduction:Depression is common in adolescents and especially in high school students and is one of the most frequent mental disorders among teenagers. Depression in adolescents is an under recognized mental health problem because they remain indecisive to disclose their feelings and seldom seek psychiatric help. One of the factors that make depression so difficult to diagnose in adolescents is the common behavioural changes that are normally associated with the hormonal changes of this period. It has only been in recent years that the medical community has acknowledged childhood depression and viewed it as a condition which requires intervention.Materials and Methods:Aschool based cross-sectional study among adolescents was conducted by using self-administered structured "Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) questionnaire" in rural field practice area of A.J.Instituteof Medical Sciences & Research Center, Mangaluru.Results:Total 284 students participated in the study and prevalence of depression was 49%. Prevalence of depression increased with age (p-value:0.001) and was higher among females (p-value:0.02).Discussion:Prevalence of depression in this study matched with other studies conducted in India. Majority of the students suffered from mild depression which indicates early diagnosis is crucial in prevention of progression to moderate and severe forms of depression.Conclusion:Prevalence of depression among adolescents is high. There is an urgent need for incorporation of simple screening methods for depression in school health program.


The purpose of this paper is to provide a numerical modeling of intense dynamic loads on engineering materials. Numerical results illustrate the evolution of the state of elastic-plastic shells (filled with fluid or elastic-plastic material), which are subjected to explosive loads.


This study examines three datasets, notably the KDD Cup '99 and the NSL-KDD datasets, which are commonly used in intrusion detection research in computer networks. The KDD Cup '99 dataset contains five million records, each with 41 attributes that may be used to categorize malicious assaults into four categories: Probe, DoS, U2R, and R2L. Because it was developed by simulation over a virtual computer network, the KDD Cup '99 dataset cannot reflect real traffic statistics. Duplicate and redundant records from the KDD Cup '99 dataset are eliminated from the training and test sets, respectively, in the NSL-KDD dataset.


Pneumatic conveying pipeline is used to convey granular material,and the pipeline structure is designed according to the quantity of particles and time. Empirical formulas are used to get the gas column natural frequency and excitation frequency. It uses modal analysis ANSYS Workbench and theoretical calculation to calculate the natural frequency of the pipe and the fluid- structure interaction effect on the natural frequency of the pipeline structure. The results show that under the action of fluid- structure interaction,natural frequency of the pipe increases slightly,when the pipe length reaches a certain scope,pipelines,gas column or excitation source are in the resonance region. This provides a theoretical basis for the pipeline vibration analysis and structural design of the pipeline.


The article makes an attempt to analyze the directions of solar batteries utilization. Trends in the solar energy development show that the introduction of solar power plants is continuously growing. It is established that along with the undoubted ecological advantages of such stations in the conversion of solar energy into electrical energy, there is the problem of solar modules utilizing, the technology of which is associated with additional emissions of pollutants. This circumstance requires a separate study in assessing the lifecycle of solar powerplants.


The study was conducted to determine the yield and nutritional quality of sweet lupine (Lupinus angustifolius.) grown in midaltitude of Lemo District, Southern Ethiopia. The yield and nutritive value of sweet lupine in terms of quantity and quality was conducted using a factorial experiment arranged in a randomized complete block design (RCBD) with three replications. The treatments for the study were two sweet lupine varieties (Vitabore and Sanabore), two locations (Upper Gana and Jewe Kebeles, and six levels of planting spacing: 30 cm × 7 cm (S1), 40 cm × 7 cm (S2), 30 cm × 15 cm (S3), 40 cm × 15 cm (S4), 30 cm × 20 cm (S5), and 40 cm × 20 cm (S6)). The yield, chemical composition, and digestibility among parameters were studied. Sweet lupine varieties in Upper Gana Kebele gave the highest green forage yield (39.58 t/ha) and forage dry matter (4.84 t/ha) at 30 cm × 7 cm planting spacing, respectively. Seed yield (SYD) (t/ha) was highly affected (

 P
 <
 0.01

 ) by location. The maximum seed (2.98 t/ha) yield was observed in Upper Gana Kebele with the minimum (2.15 t/ha) at Jewe Kebele. The forage in Jewe Kebele gave the highest organic matter (OM) (87.01%) and acid detergent fiber (ADF) (37.50%) content at a stage of 100% flowering. Sweet lupine forage in Upper Gana Kebele gave the highest crude protein (CP) content (23.11%) while the highest forage CP content was recorded at a planting space of 40 cm × 20 cm (23.67%). Sweet lupine forage gave the maximum in vitro organic matter digestibility (IVOMD) (69.10%) at a spacing of 40 cm × 20 cm in Upper Gana. The highest CP (29.11%) content and IVOMD (80.49%) of seed were recorded in Upper Gana Kebele. The overall result of this study suggested that green forage yield and forage dry matter yield are affected by location, planting spacing, and stage of flowering, whereas the chemical composition of sweet lupine forage was affected by location and variety interaction (dry matter and acid detergent fiber), location and stage of flowering interaction (OM, ADF and total ash), location (CP, metabolizable energy (ME), and IVOMD), planting spacing (CP and IVOMD), and stage of flowering (CP and ME). On the other hand, sweet lupine seed yield, seed CP, and IVOMD were affected by location. The large differences in yield and nutritive values observed among sweet lupine varieties, growth environment, planting spacing, and their interactions entail consideration of these factors for appropriate utilization of sweet lupine as a feed resource for livestock.


The literature on globalization is vast and uneven. It is hard to keep up with it, as intellectuals across the planet contribute to its enormity each day. Millions of words have already been typed trying to define the process called globalization, with little agreement in sight. That is perhaps as it should be. The very idea of globalization is deeply inflammatory. For those firmly in the neoliberal camp, globalization captures their commitment to the breaking down of barriers to trade and finance, to economic activity that does not include the movement of people. A 'flat world' is both their goal and their description of the world as it is today. Others who are less enthused about the process portray globalization as a feint to strip ordinary people of their means to well-being. In the first case, globalization is seen as a universal project, and in the second as a class project to benefit a small number of people. Between these two opposed positions reside a number of descriptions and theories of the current conditions. It is hard to bifurcate or synthesize such diametrically opposed epistemologies, but that does not stop intellectuals from making the attempt. William Robinson comes at globalization from another track. His interest is in the operation of the elite, whether in his earlier work on the democracy industry (polyarchy) being foisted on the ordinary peoples of the world from Washington, DC or in his newer work on the convergence between the elites of the world against the multitudes. Refreshingly, Robinson comes at his theory with considerable empirical analysis, and at the same time with a close adherence to the theoretical literature on global flows and global blockages. A first pass at some of these ideas comes in his 'Globalisation: nine theses on our epoch' (1996). Here Robinson listed the overwhelming data on the North-South divide and yet pointed us in another direction: 'Given the accelerated creation under globalization of lakes of wealth in Third World countries and seas of poverty in First World countries, it makes more sense to see the world as increasingly divided along class, rather than national, lines.' Class has overwhelmed Nation, and a vision of the world divided along national lines might miss the convergence of class allegiances across borders. The figure of this convergence is Davos Man. What Robinson's work now edges toward is a theoretical ethnography of Davos Man. Reading 'Global capitalism theory and the emergence of transnational elites' (in this issue) is uncanny: one feels that one knows this or that point not because it is commonplace in the literature, but because it reflects the real social processes. A transnational elite has emerged, Robinson argues, based on 'transnational circuits of accumulation' but this does not mean at all that there is a world government. What we have instead is a new form of power, 'the ability to issue commands and


It is widely agreed that the opportunities for expansion of aggregate employment in the OECD area must be sought mainly in the private service sector. Thus,because of budgetary problems and voter resistance to higher tax rates, the scope for further expansion of public sector employment seems limited in most OECD countries. Furthermore, the primary sector will undoubtedly continue to release labour resources and, with normal growth rates, there is little prospect of a secular rise in manufacturing employment, since the increase in demand for manufactures is likely to be met through increases in labour productivity. In particular, the ongoing shifts in the international division of labour and the associated transition to the 'knowledge-based economy' within the OECD are likely to destroy a large number of manufacturing jobs for unskilled and lowskilled workers in the OECD area.


Data mining is one of the techniques in the knowledge discovery process and denotes to mining information from large amount of records. One of the significant and popular data mining process is association rule mining which is used to find frequent patterns in the given dataset in which the apriori algorithm are the most common for mining frequent item set. This paper explored DES algorithm in client side for generating the secret key to encrypt the items of the support table. Apriori algorithm is used at server side for getting transaction data from the client side by applying threshold or sigma value to filter out the item set whose frequency has to less than sigma value. The main focus of this paper is to achieve more security of the client side.


ABSTRACT The memory of the Great Patriotic War was one of the fundamental forces of political and societal integration in the Soviet Union. It has largely retained this towering status in contemporary Russia. Within the idealized retelling of a traumatic and devastating military conflict that claimed the lives of 27 million Soviet citizens, Hero Cities played a crucial role: The widely revered places where the bloodiest battles took place became, in official propaganda, exemplars of courage, steadfastness, and discipline. As such, they received the highest government awards during the reign of Leonid Il'ich Brezhnev (1964–1982), when official war memory became codified and propagated widely. This article traces the case study of Tula, one of the key cities during the Battle of Moscow in 1941, to shed light on the genesis and consequences of its Hero City status. As a provincial center that stood in the shadow of the capital, Tula nevertheless benefited from Moscow's elevation within official war memory in the mid-1960s. Still, it had to wait until 1976 to be welcomed into the exclusive 'club' of Hero Cities, as there was considerable resistance — not least because many actors in the Soviet elite feared that putting 'minor' locations like Tula on the same level as Stalingrad or Leningrad may inflate their significance. There was a clear link between wartime heroism and economic benefits in the post-war era: As part of a 'socialist contract', Soviet citizens made considerable sacrifices for the state — in return, they expected remunerations. Hero Cities like Tula used this well-established understanding to ask for and often receive investments into urban infrastructure and popular welfare. The case study also shows, however, that the Soviet system's ability to uphold its end of the deal increasingly waned during the stagnation of the 1970s. Disappointed hopes and expectations were the result.


A numerical model capable of predicting flow characteristics in a compound channel is described. The model solves the continuity and momentum equations along with the transport equations of kinetic energy of turbulence and the dissipation rate. Closure is achieved with the aid of algebraic relations for turbulence stresses. The model is capable of treating compound channels formed by regular geometrical sections of main channel and flood plain segments. The width of the main channel, the width of the total section, the depth of flow in flood plain, the total depth, channel slope and boundary roughness of main channel section and flood plain section can all be varied. The model predictions of total flow rate, shear stress distributions around the wetted perimeter, and the percentage of flow and shear force carried by the different sections were compared with published experimental data. Reasonable agreement between data and predictions was obtained.


This paper investigates whether the financial leverage of a company injluences the value maximization objective of an organization. Also, what kind of leverage levels would result in maximizing the shareholders' wealth of companies?Oliecau.se maximizing the shareholders' wealth is one of the important issues for management of the listed companies. The financial data from 60 listed companies in the Colombo Stock Exchange covering eight different sectors for a period of ten years from 1992 to 2001 are gathered and analyzed. The results do not show any clear relationship between financial leverage and shareholders' wealth among the selected sample companies. Besides, as the size of the sampling is small any findings could not be conclusively established as dependable. The findings expose evidence, which are contrary to strength of most western theories. Hence, Sri Lankan firms should bear this in mind when deciding the optimal capital mix.


The papers by Boehm and Spitze provide contrasts in approach, content, and conclusions. The Spitze paper reflects the issues as seen through the eyes of an observant professor located in a major Corn Belt university. Its ideas reflect sensitivity to articulation of policy problems confronting producers in the region. Boehm's paper is particularly strong in that it reflects the day-to-day sensitivity to the contemporary economic and political forces that currently affect the policy process. Both papers lack a clear sensitivity to the policy position and problems of southern agriculture.


We investigate the class of holomorphic maps of a disc into itself that have an interior and a boundary fixed point, as well as the class of holomorphic maps of a half-plane into itself that have a fixed point in the interior of the domain and a fixed point at infinity. Two-sided estimates for domains of univalence are obtained for these function classes in terms of the values of the angular derivative at the boundary fixed point and the position of the interior fixed point. Bibliography: 21 titles.


The present invention belongs to the field of inorganic non-metallic material, particularly relates to a ceramic film and method in a high-temperature gas treatment of toxic dust. 90-99% of the mass fraction of the ceramic membrane support and 1-10% of the catalyst to produce a composite, and then sprayed ceramic film formed on the outer coating. Wherein: SCR DeNOx catalyst is a catalyst, the ceramic membrane support is made of aggregates, high temperature binder, pore former, a molding aid and a release agent. The preparation method for preparing a ceramic membrane to a support, then the catalyst complex into the pores of the support, and then a ceramic outer surface coating film is a coating material, obtained by heat treatment after preparation of a ceramic membrane material. Ceramic membrane material prepared has high filtration precision, high permeability, resistant to erosion, dust and both catalytic function, denitrification and dust integration change the traditional model of the previously independent operating unit stepwise.


The synergistic effect of tungstate and benzotriazole on the corrosion inhibition of carbon steel was studied with weight loss method. It is found that there is not any synergistic effect of tungstate benzotriazole system in solutions containing 1.4×10 -3 mol/L Cl -, but the synergistic effect of tungstate and BTA can be observed after 6.2×10 -5 mol/L Zn 2+ were added to the solutions. The effect of Zn 2+ was explained with UV visible spectrum of BTA in solutions. The mechanism of synergistic effect of WO 2- 4 BTA Zn 2+ system was discussed by determination of potentiostatic polarization curves and surface analysis.


: The tourism industry is projected to be the largest foreign exchange earner in Indonesia in 2019, surpassing the oil and gas, coal and palm oil sectors. There is a paradigm shift in tourism from "sun, sand and sea" to "serenity, sustainability and spirituality". The purpose of this study is to examine the conditions and potential of pilgrimage tourism in Garut Regency as part of spiritual tourism destinations. By using a qualitative approach, beside in-dept intervew conducted toward a number of key persons, observation was also carried out to obtain a clear picture of both tangible and intangible elements in the tourist attraction. The results showed that the potential of  pilgrimage tourist attractions in Garut Regency were considered very good, even though it had not significantly impact  in increasing local revenue (PAD). The strengths and weaknesses of this pilgrimage tourism were discussed comprehensively in this research. The output of this study had a major impact toward the tourism agency of Garut Regency, as a consideration for the tourism potential of Garut which is packed in "Pesona Garut".
Keywords: pilgrimage tourism, spiritual tourism destinations, local revenue


Department of Chemistry, Pohang Univer 790–784, Republic of Korea. E-mail: jwpark Center for Core Research Facilities, DGIST, Center for Plant Aging Research, Institute Republic of Korea. E-mail: firstname.lastname@example.com Department of New Biology, DGIST, Daegu † Electronic supplementary informa 10.1039/c5ra00199d ‡ These authors contributed equally to th § Present address: Samsung Electronics, H Korea. Cite this: RSC Adv., 2015, 5, 18858


In this paper,an optimal lifetime model of a heterogeneous surveillance sensor network,which consists of two types of sensor nodes,is given.The optimal lifetime model takes connectivity and coverage of the surveillance areas as part of the constraints.From the KKT theorem,the corresponding inequalities become equalities at the optimal solution.Furthermore,the optimal solution of the given model is gained,which is instructive for tuning the sense/transmission radius of the sensor network in a real-time way.Numerical result shows that the maximal lifetime of the sensor network decreases as the sense/transmission radius increases and the tuning of sensor transmission radius can prolong the network lifetime.


Control of Neisseria gonorrhoeae infection continues to represent a significant public health challenge worldwide. Globally, an estimated 88 million new cases of gonorrhea occur annually [1]. In addition to causing urethritis and cervicitis, N. gonorrhoeae infection can result in serious complications such as pelvic inflammatory disease, chronic pelvic pain, tubal infertility and ectopic pregnancy in women, and can facilitate HIV transmission [2]. Timely and effective treatment for gonorrhea prevents severe complications in the individual and limits transmission of the disease in the community by shortening the duration of infection. However, N. gonorrhoeae has progressively acquired resistance to each of the antimicrobial agents that have been recommended for treatment over the past 70 years, and the remaining treatment options are dwindling. Since gonorrhea was first treated with sulfalinamide at the beginning of the antimicrobial era, N. gonorrhoeae has systematically developed resistance to sulfo namides, penicillins, tetracyclines and, most recently, the fluoroquinolones [3]. Thirdgeneration cephalosporins are one of the last classes of antimicrobials that remain highly effective against gonorrhea. They are the recommended first-line treatment for gonorrhea in many countries, including the USA; however, there is evidence that cephalosporin-resistant N. gonorrhoeae may be on the horizon. The first reports of possible cephalosporin treatment failures associated with decreased in vitro susceptibility came from Japan during 2001–2003, and decreasing suscepti bility of N. gonorrhoeae to third-generation cephalosporins has been observed in east Asia for more than 10 years [4]. Recently, cases of possible cefixime treatment failures in Europe were reported in 2010–2011 [5–9], and decreasing susceptibility to third-generation cephalosporins has been observed in Europe, Canada and the USA [10–12]. In the USA, the Gonococcal Isolate Surveillance Project (GISP) monitors antimicrobial susceptibilities in N. gonorrhoeae isolates obtained from approximately 5900 symptomatic men at 25–30 sexually transmitted disease clinics each year. Although the MIC breakpoints that correspond to cephalosporin resistance have not yet been defined, from 2006 to the first 6 months of 2011, the proportion of GISP isolates with elevated MICs of the oral cephalosporin cefixime (MIC ≥0.25 μg/ml) and the injectable cephalosporin ceftriaxone (MIC ≥0.125 μg/ml) increased from 0.1 to 1.7% and from 0.05 to 0.5%, respectively [13]. These increases were most marked in the western region of the USA and among men who have sex with men (MSM). In the western USA, the proportion of isolates with elevated cefixime MICs increased from 0.2 to 3.6% and the proportion Tackling multidrug-resistant gonorrhea: how should we prepare for the untreatable?


Multimorbidity and polypharmacy often result in numerous interactions with different Healthcare Professionals (HCPs) and many transitions of care. Keeping up-to-date medications list in people taking medicines and/or carers can reduce medication errors at care transitions. The HSE National Quality Improvement team is working on a national medication safety campaign which encourages people to keep lists. However, there is limited information about perceptions of Patient-Held Medication Lists (PHML) in clinical practice. The aim of this study was to examine attitudes to PHML among people taking/managing multiple medicines, HCPs; and how lists are used in practice.

 Purposive sampling was employed and recruitment through relevant organisations, social media and snowballing methods. Semi-structured telephone interviews were conducted with 39 people; HCPs (N=21), patients/caregivers (N=18). Interviews were transcribed and thematically analysed with behavioural frameworks - the Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF).

 Three core themes were identified: Attitudes to PHML; Function and preferred features of PHML and Barriers and facilitators to future use of PHML. All participants thought keeping medication lists had benefits for both people and HCPs (e.g. empowering, improving adherence). All who were taking medicines used lists and found them useful in particular situations (e.g. emergencies). However, HCPs and patient/caregiver groups expressed concerns about their accuracy. It was felt that some individuals may have difficulties keeping an accurate PHML (e.g. older adults, on multiple/changing medications). The participants also differed on the level of detail that should be included in PHMLs. Most patients favoured simple lists but HCPs reported the lack of detailed information in PHML may be an issue.

 Common concerns about the accuracy of PHML and diverging opinions on list content need to be addressed. Health promotion strategies which focus on promotion of lists by key HCPs and provide people with a variety of list options could increase the wider implementation of PHMLs.