The geopolitical characteristic and strategic position of Taiwan are reflected in the Chinese policies of great powers,which surely are also upgraded gradually with China's national development strategies.So,it is inevitable to interpret the tripartite interestings on the question of Taiwan,which is based on the demand of United State,Japan and China.The competition of the tripartite interestings on the question of Taiwan just reflects the strategic connotation of the relations of Sino-Japanese as well as Sino-US.


SYNOPSIS A brief review of Failure Modes and EEects Analysis is given, with particular reference to the relevant British Standard. The options for computer simulation are discussed, from which it emerges thatòrder of magnitude reasoning' provides the best approach. The seminal work, O(M), is discussed in detail. The paper concludes with an outline of the implementation for a FMEA.


This study investigates the effects of toluene adsorption on the filtration efficiency of nanoparticles by a fluidized-bed adsorption reactor. Simulated flue gas is modified by different types of nanoparticle (SiO2 and Al2O3) with various particle sizes (10 and 80 nm) are also carried out in experiment. Therefore, the experimental results show that the removal efficiencies of the nanoparticles and toluene are in the range of 97% to 87% and 99.8% to 99.4%, respectively. Particularly, BET results show that the particles of 10 nm SiO2 increase obstruction of the adsorbent volume with increasing toluene content. This finding shows that filtration efficiency increases with the addition of toluene.


The author presents the results of her research into realization of individuals creative potential with the focus on the ways such potential is realized by university students


Service recovery performance is highly significant in the hotel sector as it ensures customers' satisfaction and loyalty. Long and inconsistent working hours and schedules, along with strenuous tasks, are the norm for jobs in the hotel sector and these challenging traits can greatly effect the job performance of hotel employees. Hence it is fundamental to identify the factors affecting their performance of service recovery. In developed countries, a large number of studies have been reported on service recovery performance. However, only a small number of such studies have been undertaken in developing countries. In addition, the number of studies on the effects of supportive management and employees' commitment to service quality in influencing their service recovery performance is also limited. Hence, the purpose of the current study is to investigate the effects of supportive management and employees' commitment to service quality towards service recovery performance, amongst 3-star hotels situated in the northern region of Peninsular Malaysia. The data was collected from a total of 104 hotel employees and analysed using the structural equation modeling-partial least square (SEM-PLS) approach. The outcomes unveiled that supportive management and employees' commitment to service quality has a significant, positive effect on service recovery performance. In conclusion, the outcomes lead to the hotel sector and the existing body of knowledge by verifying the relevance of equity theory in service recovery performance in the hotel sector framework.


Fiber-Wireless (FiWi) access network provide high bandwidth and flexibility due to its hybrid architecture of passive optical network and wireless mesh network. For high speed access network any failure results in huge data loss, so survivability for such network is an inevitable issue. In this paper we propose a star topology based protection scheme, which aims to reduce blocking probability as compared to existing schemes. Simulation results are provided in support of proposed work.


The purpose of this paper is to explore the potential of enriching the library subject headings with folksonomy for enhancing the visibility and usability of the library subject headings.,The WorldCat-million data set and SocialBM0311 are preprocessing and over 210,000 library catalog records and 124,482 non-repeating tags were adopted to construct the matrix to observe the semantic relation between library subject headings and folksonomy. The proposed system is compared with the state-of-the-art methods and the parameters are fixed to obtain effective performance.,The results demonstrate that by integrating different semantic relations from library subject headings and folksonomy, the system's performance can be improved compared to the benchmark methods. The evaluation results also show that the folksonomy can enrich library subject headings through the semantic relationship.,The proposed method simultaneous weighted matrix factorization can integrate the semantic relation from the library subject headings and folksonomy into one semantic space. The observation of the semantic relation between library subject headings and social tags from folksonomy can help enriching the library subject headings and improving the visibility of the library subject headings.


credit market. While the overall structure of the market as identified by L. remained largely unchanged as far as this is possible to make out (the amount of documentary evidence from two of his three locales drops sharply for this period), the same period also witnessed an inflation and a rise in prices at first halting (170–190 CE) and then galloping (starting from 275 CE). This, together with the appearance of members of higher social strata in the documentary evidence of the money market, meant that the sums on loan again rose significantly. A concluding summary sets out the main results of the study, which is followed by a complete list of the papyrological corpus used, a bibliography and detailed indexes. This is an important and stimulating book. Its main hypotheses are well argued and convincing, as is L.'s decision to test these hypotheses by comparing the situation in two (at first glance) strongly different regional contexts. While the evidence clearly shows regional differences in the structure and organisation of credit markets (as is to be expected), it also shows that the situation in Egypt was less exceptional than has sometimes been presumed and that similar developments occurred, in varying forms, elsewhere. Furthermore, by shining a light on the inner functioning of two separate sets of local customs and law governing the business of money-lending, L. has not only shown a credit market to have existed, but has also significantly enhanced our understanding of economic processes within the Roman Empire.


As a critical component of high-speed locomotive, wheel set bearing fault identification and prognosis based on vibration analysis has attracted an increasing attention in recent years. However, heavy background noise and adverse working conditions make it difficult to excavate the hidden weak fault feature. Variational Mode Decomposition (VMD), which can extract the Intrinsic Mode Functions from the non-stationary signal, brings a feasible method. However, the inaccurate pre-set mode number may lead to information loss or over decomposition problem. In this paper, an improved VMD method via correlation coefficient is proposed to automatically extract modes. To overcome the information loss problem, the appropriate mode number is determined by the criterion of approximate complete reconstruction. Then the similar modes are combined to solve the over decomposition problem according to the similarity of their envelops. Finally, an application to wheel set bearing fault of high speed locomotive verify the validity of the proposed method.


This paper investigates hun1an resource practitioner opinions of the characteristics, restrictions, and surveillance of en1ployee con1puter hun1or. The humor is associated \\"ith reading or \vriting e-n1ail and inte111et content. Based on a survey of I 02 public and pri\·ate sector hurnan resource n1anage111ent prac1i1ioners_ "reading hun1orous e-n1ail at \vork fron1 colleagues" \Vas the 1110s! con1n1011 perceived en1p!O)'ee behavior associated \vi th con1puters and hun1or. Roughly half of their organizations placed restrictions on c-n1ail and Inten1et usage. About halfperfo1111ed son1e surveillance ofen1ail and the Inten1et. ivfost correlations bet\veen policies Jin1iting personal con1puter use \Vere not significa11tly associated \Vith perceived en1plO)'ee con1puter behaviors. Ho\ve\'er_ the strongest correlation \\'as bet\veen the total ban of personal con1puter use and entering hun1or into hon1e \\'eb pages. l\un1erous future research in1plications are


A novel Ir/IrO/sub 2//Pt-PZT-Pt/IrO/sub 2//Ir capacitor is proposed for a highly reliable mega-scale FRAM. It was observed that charge degradation in retention test depends on the condition of the interface between top electrode and PZT thin film in ferroelectric capacitor. Nonvolatile polarization value of the novel capacitor after the retention acceleration is 4.7 times larger than that of Ir/IrO/sub 2/-PZT-Pt/IrO/sub 2//Ir capacitor. The novel Pt-inserted capacitor shows a great endurance up to 10/sup 11/ fatigue cycles. The 4 Mb FRAM device with Ir/IrO/sub 2//Pt-PZT-Pt/IrO/sub 2//Ir capacitor has a wide sensing window of 90 fC even after baking at 125/spl deg/C for 88 hours.


One of the most important aspects related with automatic speech recognition (ASRs) systems is to find a set of characteristics that represent speech signal; nowadays, LPC, CLPC, cepstrum, MFCC, LFCC, and Melspec, among others, have been used to solve that problem. Likewise, analyzing the audible behavior of the ear has shown to have good performance in comparison with those methods that consider the pronunciation as element to obtain speech signal representation. In this paper an analysis related with Gaussian wavelets representation based on Bark and Mel audible representations is presented. For these wavelets, a Gaussian function represents the basis decomposition function; further, we need a modulator to displace the function associated with each of the scales of analysis to the central frequency into Bark and Mel audible representations. At the same time, we use the variance parameter of the Gaussian function to adapt its bandwidth to the Bark and Mel audible representations. Finally, we show a comparison between two alternatives in time and frequency representations.


Linear Subspace and Manifold Learning via Extrinsic Geometry by Brian St. Thomas Department of Statistical Science Duke University Date: Approved: Sayan Mukherjee, Supervisor


An accurate identification of stages of spermatogenesis in freshly isolated unstained seminiferous tubules is possible by a simple transillumination. Physiologically, the acrosome and maturation phase spermatids are arranged in bundles or as a continous layer and give rise to light absorption patterns characteristic for different cell associations. The damaged and dying cells cause alterations in the light absorption pattern which helps their specific selection for further analyses by morphological and biochemical methods.

In model experiments, we have analyzed the early stage-specific effects of two alkylating anticancer agents, nitrogen mustard and ThioTepa. Increased light absorption was seen in segments V–VI caused by degenerating early spermatids and mid-pachytene spermatocytes, and in segments XII–I caused mainly by pachytene spermatocytes. Phase contrast microscopy proved to be valuable in analysis of the phagocytosing function of the Sertoli cells. Electron microscopy revealed that probably the earliest observable alterations were disintegrations of the developing acrosomic system, of the chromatoid body in early spermatids and of the spermatid nuclei during the late acrosome phase. Biochemical analyses revealed an inhibition of physiological DNA and RNA syntheses and an activation of unscheduled repair-DNA synthesis.

The "living cell method" gives new possibilities for combined morphological and biochemical analyses of specific effects of antifertility and anticancer drugs on different stages of mitotic and meiotic cell cycles during spermatogenesis.


The modern scientists have been considering philosophy as meaningless field for long time because it questions non exact field, not real and not actual. Therefore, it is believed that they do not need philosophy anymore. Islamic philosophy discussing a lot about mystic and metaphysic also get significant challenge in the era of modern science. This paper will try to discuss the construction built by Islamic philosophy particularly in its contestation in the era of modern science. Some of that constructive efforts are by demonstrating and introducing Islamic philosophy in more actual sense, for example by remapping Islamic philosophy followed by rearranging Islamic epistemology in order to reveal that Islamic philosophy does not only limit the object of knowledge on physical object but also nonphysic. Hence, we need to discuss the reality of mystical experience intensively in order to explain rationally that the reality of mystical experience is real. Another problem we are going to discuss here is the objectivity and integrity of knowledge in Islamic Philosophy's view and to make historical reflection in order to build scientific tradition to develop Islamic philosophy in the future.


The present invention relates to a method for ensuring the mandatory access control module mandatory access control in a virtual machine (VM) based on (Instr_module), the configuration to execute object-oriented program is strongly typed languages (strongly typed language) by (MAC) (100 ) at the time that the method is received that indicates the access policy (Acc_pol) to force the access control module (Instr_module) step, and a request for access to a variable member or method call (Meth_entry) that make up the event relates to, a method (Meth) call or called by the object and method (Meth) referred to as the "caller" (CalR) requesting access or the caller and callee to the object, referred to as the "callee" to which access is requested (CalE) language type (Typ_CalR , Typ_CalE) access control label (LabE, LabR) with additional steps, the access control label (LabE, LabR), the instance number of the caller and the called party (Inst_Num) which in accordance with a liquid Depending on the scan policies (Acc_pol) and access authorization, determined to block the enforcement of access or method (Meth) for the variable members (Dec) - "negative decision" to refer to search-line or cause the virtual machine (VM) variable decision (Dec) that perform access or method (Meth) for members - a "positive decision" to refer to search - the performing stage, and decisions to block or permit the corresponding access attempt (Dec) virtual machine (VM ) is a step of transmitting.


SUMMARY: Solar heat radiation can impose significant heat stress on employees performing outdoor tasks. A prototype infrared reflecting vest was developed to offer protection to agricultural workers and constructions workers who are exposed to high levels of outdoor solar radiation. The prototype vest was tested using a laboratory based thermal manikin exposed to controlled heat radiation intensity levels. The tests showed that a vest including 3.2 cm spacers was able to reduce heat gain by 30% without imposing a significant corresponding insulation heat gain. The thermal cross-over point for such a vest was lowest in comparison to others configurations tested. Commercial development of such a vest for use by agricultural workers and construction workers in desert environments is encouraged.


This study examines the effects of Mg depletion on myocardial bioenergetic, carbohydrate, lipid and phospholipid metabolism. Rats were studied after long‐term (12 week) selective dietary restriction of Mg (20% normal dietary intake). Myocardial biopsy samples were examined for glucose 6‐phosphate and glycogen to evaluate carbohydrate pathways and for glycerol phosphate and mitochondrial fatty acid oxidation and phospholipid contents to evaluate lipid and phospholipid turnover. Dietary Mg deficiency resulted in falls in myocardial glycogen, glucose‐6‐phosphate, glycerol phosphate, as well as the contents of phosphatidylcholine (PC), phosphatidylethanolamine (PE), diphosphatidyl glycerol (DPG), phosphatidyl inositol (PI) and total phospholipid phosphorus. These observations demonstrate impaired phospholipid metabolism, probably at the biosynthetic level. The mitochondrial oxidation of long‐chain fatty acids was also impaired after Mg depletion. Mg depletion (serum Mg fell 60%) also resulted in significant falls in myocardial [ATP], phosphocreatine (PCr), and Mg with a concomitant rise in myocardial Ca content. These observations are consistent with the tenet that prolonged low [Mg2+]. can result in marked reduction in oxygen and substrate delivery to the cardiac myocytes, with concomitant changes in membrane phospholipids (potentially resulting in a pro‐oxidant state) probably as a result of coronary vasoconstriction.


Summary
The antioxidant properties of nine different samples of freshly drawn, pasteurised and UHT milk were examined before and after fermentation with several lactobacilli, individually and in combination with the yeast Saccharomyces boulardii. The results showed no statistical differences for the content in proteins, fats and carbohydrates of the different milk. The antioxidant properties of the unfermented milk were positively affected by the thermal treatment. All samples of fermented milk had a greater antioxidant activity than unfermented but only for the freshly drawn milk that increase was significantly different. The co-incubation of lactobacilli with the yeast determined a stronger antioxidant activity especially for the freshly drawn milk. The stability of the tested strains during storage in standard conditions was determined in UHT fermented milk to enable a possible use in probiotic food production. The results showed that the yeast incubated with lactobacilli determined an improvement of the viability of bacteria.


Abstract In 15-30% of acute myeloid leukemia (AML) patients aberrant proliferation is a consequence of a juxtamembrane mutation in the FLT3 gene (FLT3-ITD) causing constitutive kinase activity. ABT-869 (a multi-targeted receptor tyrosine kinase inhibitor) inhibited the phosphorylation of FLT3, STAT5 and ERK, and Pim-1 expression in MV-4-11 and MOLM-13 cells (IC 50 ~ 1-10 nM) harboring the FLT3-ITD. ABT-869 inhibited the proliferation of these cells (IC 50 = 4 and 6 nM, respectively) through the induction of apoptosis (increased sub G0/G1 phase, caspase activation and PARP cleavage), whereas cells harboring wt-FLT3 were less sensitive. In normal human blood spiked with AML cells, ABT-869 inhibited phosphorylation of FLT3 (IC 50 ~100 nM), STAT5 and ERK, and decreased Pim-1 expression. In methylcellulose-based colony-forming assays, ABT-869 had no significant effect up to 1,000 nM on normal hematopoietic progenitor cells; whereas in AML patient samples harboring both FLT3-ITD and wt-FLT3, ABT-869 inhibited colony formation (IC


It has become evident that present methods of current control for the electrophoretic apparatus of Tiselius can be improved. It is common practice to use a voltage-stabilized power supply to furnish the current. While this power supply gives a constant voltage across the whole cell, it does not furnish a constant current because of fluctuations of resistance within the cell. Most of these fluctuations probably arise within the electrode vessels. Inasmuch as the resistance of the central part of the cell is not a constant fraction of the total resistance of the cell, the voltage drop across this part and the field strength within it do not remain constant. Because of this it is customary 1 to measure the current and to calculate the field strength by means of the equation: X = I/qk8. X = field strength in volts per cm. I = current in amperes. q = cross-sectional area of the central part of the cell. k8 = specific conductance of sample in reciprocal ohms. In order to apply this equation to apparatus employing a voltage-stabilized power supply it is necessary for the operator to make frequent observations of the current and to compensate for fluctuations by altering the applied voltage. This frequent adjustment is tedious as well as time-consuming. It is preferable that current-stabilization rather than voltage-stabilization be used. The simple circuit which has been found suitable for the Tiselius apparatus is herein given. It is based on the principle that the plate current of a pentode vacuum tube remains constant despite changes in plate voltage. Further stabilization is obtained by the degenerative effect of the resistance in the cathode circuit. In operation the switch S2 is connected to the dummy load R3 and then the switch S1 is closed.


Aging asset management requires careful consideration of end-of-life of any asset. This is particularly serious with aging infrastructure which may require complete replacement of a large asset which has a long lead time. In many current End-of-Life analysis approaches to calculate unavailability, the period of interest is sub-divided into yearly cycles with the assumption that the asset is available at the start of the year. Although this assumption is adequate if the replacement time for the asset occurs within the year, with longer lead times this can create excessively optimistic availabilities. This paper presents an improved probabilistic tool for risk assessment due to End-of-Life failure unavailability which overcomes this deficiency. The End-of-Life methodology proposed in this paper is required when aging assets have long lead times to replacement and so the capital investment decision must be made several years ahead. The method is applied to evaluate the End-of-Life unavailability of Manitoba Hydro Bipole II HVdc converters. The results are corroborated using Monte Carlo simulation. Finally, the risk of End-of-Life is incorporated into an economic cost-benefit analysis corresponding to the presented unavailability evaluation method.


Boston — New research discoveries demonstrate that melanoma is highly dependent on cyclin-dependent kinase 2 (CDK2) for growth and proliferation. Inhibiting expression of the gene regulating CDK2 stops the cancer dead in its tracks.


TPS370Background: Combining anti-angiogenic drugs with immune checkpoint inhibitors (ICI) after progression on ICIs presents a promising therapeutic approach in renal cell carcinoma (RCC). Atezoliz...


The present paper describes effect of water stress on biochemical parameters of tomato (Lycopersicon esculentum Mill. var. Pusa Sheetal) and its alleviation by incorporation of sodium silicate in soil during pot study. Different biochemical parameters such as chlorophyll, total soluble protein, sugar content, proline, nitrate reductase activity and activities of antioxidant enzymes (superoxide dismutase, catalase, ascorbate peroxidase and peroxidase) were examined in tomato leaves at 40 and 60 days after sowing. The activity of antioxidant enzymes such as SOD, CAT, APX and POX were significantly enhanced under 3 and 6 days water stress treatment at flowering stage. The results of the present investigation revealed the protective mechanism of sodium silicate via the modulation of antioxidative defense system in tomato plants against water stress.


The present invention discloses an automobile wheel bearing ball cage automatic machine comprising a fixed reduction gearbox rack, drive motor, pressing the ball pusher mechanism, the mechanism and the ball holder holding the feed mechanism, the roof rack fixed to the central gear box, a drive motor fixed on the gear box, the drive motor output shaft extends into the gear box and extends into the center hole splined drive gear reduction box, the gearbox output shaft vertical straight and fixed on the rotary disk, the rotary disk having a plurality of through-holes, the upper end of push rod sleeve is inserted in the through hole, the push bar holding frame fixed mold mounting, the die holder is mounted on the rotary disk, the push bar lower downward projecting rotary disk, the rotary disk fixed finite bit next die holder bar is mounted at each bottom end of the stopper rod downwardly through the rotary disk; it can automatically cage, balls and automatically cutting pressing ball cage is completed, then feed the ball cage Bahrain, its high installation efficiency.


Two physicians examine the history of cancer drug pricing and the barriers to setting fair prices for life-saving cancer medications. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.


This paper analyzes the overall situation of religion in the Republic of China, and mainly takes Taoism as an example to analyze and summarize the situation and adjustment of religion in the aspects of "miaochan xingxue (build schools with temple property)", "dispelling superstition", "operating schools" and "charity enterprises". The study of traditional religion in the Republic of China is an important subject in the modern study of religion. This paper uses various historical materials to investigate the overall living environment (political environment, economic environment, humanistic environment, religious policy, temple reform) and the development of Taoism in the Republic of China, as well as the historical development circles of Taoist institutions (Taoist association, Taoist educational institution, etc.), the relationship between government dignitaries, local warlords and Taoists, and the charity of Taoism.


Implicit interaction between human and computer is worthy of being researched, especially in the entertainment application. The reason is that in order to be more natural, computers need to interact and collaborate with persons actively. For this purpos e, a computational model of implicit interaction is proposed and applied to a computer for entertainment. Firstly, emotional Hidden Markov Model (eHMM) as a part of the computational model of implicit interaction is researched. Then, three parts of ACT-R cognitive architecture are integrated into it to apply for entertainment. Finally, some experiments are carrie d out with styles of game process recording. Results indicate that the proposed model is helpful to make computers more active and adaptive to persons by adjustting entertainment process, which illustrates a good prospect of application.


Forty cytoplasmic male sterile (CMS) sorghum lines were evaluated for different physiological and biochemical traits under drought stress. Considerable genetic variability was found among all physio-biochemical traits i.e. water potential (Ψ w), stomatal conductance (gs), photosynthetic efficiency, acid detergent fiber (ADF), neutral detergent fiber (NDF), ash and sugar contents. Results indicated that ash contents were found to be most adversely affected by drought stress followed by sugar contents and stomatal conductance respectively. However, the values of crude protein, acid detergent fiber (ADF) and neutral detergent fiber (NDF) were observed to be increase under stress condition. Principal component analysis (PCA) was applied to recognize drought tolerant lines. Selection criteria was based upon findings of correlation analysis among all studied traits. The positive association of water potential, stomatal conductance and photosynthetic efficiency with desirable traits viz. ash and sugar contents; and NDF association with undesirable traits viz. ADF and NDF revealed a way forward to design future breeding programs of sorghum crop under the prevailing scenario of climate change.


: In most cases, devolution is concerned with sharing of natural resources as well as decentralization of power within the county. Even though people participate in guaranteeing good governance, there exists an information gap on what comprises citizen participation and its role in efficient management of counties in Kenya. The aim of this research was to evaluate the influence of citizen participation and performance of county governance in Kenya. Specific objectives that were guided by the study where: to find out the technological factors that affect citizen participation in Vihiga county governance, to establish socio-cultural factors influencing citizen participation in Vihiga county, to determine institutional factors influencing citizen participation in the governance of Vihiga county, and to find out individual determinants of citizen participation in the governance of Vihiga county. The study was guided by two theories namely; the civic voluntarism theory and the public value theory. The study adopted Simple random and purposive research design targeting 530 respondents from the county of Vihiga. This comprised of Vihiga county Ministries, The Public service board, constituencies, Sub-county wards. For the 10 County Ministries, 10 respondents was sampled from each ministry. For the Public service board, a sample of 5 respondents was selected for the study. For the 6 constituencies, a sample of 100 citizens was selected for the study. The constituencies included Emuhaya, Hamisi, Luanda, Sabatia and Vihiga constituencies. A sample of 10 respondents from each of the 25 sub-county ward were interviewed.The finding were.The study recommended that more awareness be created among the members of the public. This will encourage their participation in governance as they will know the importance of participation and ways by which they can participate.The study also recommended that County government should be accountable for the County resources by eliminating corruption, tribalism and nepotism. This will change the attitude of the people towards participating in governance as it will reflect true and fair allocation of resources and job opportunities.The study further recommended that members of the public should change their attitude towards participation in governance and create time within their busy schedules. Their participation will allow the incorporation of their views for the betterment of lives.The study finally recommended that members of the public should be allowed to participate in governance without discrimination based on gender. This will encourage general public participation thus ensuring effective governance and development aimed at improving the lives of the public.


Cofired multilayer piezoceramic actuators as extremely fast valve driving elements will lead to a significant progress in the field of fuel injection systems. A careful adaptation of the component performance to the system demands, an extraordinary high reliability, and competitive low production costs are prerequisites for this large-scale industrial application. With proper material selection as basis, conventional multilayer technology has to be substantially extended in order to achieve large stack volumes, to avoid degradation effects during cofiring and nevertheless to meet the target costs. Under large-signal driving conditions, the static and dynamic behavior of the component is essentially influenced by driving pulse shape, clamping force, and stiffness of the load. Linear FE methods are employed to calculate the performance criteria of different actuator designs. Moreover, a FE-implementation using a micromechanical domain switching model was developed in order to describe the strongly nonlinear material behavior. Together with a quantitative estimation of crack initiation and propagation by means of fracture mechanics, these methods can give valuable hits for controlling the effects of fatigue and deterioration which may limit the operating life time. In order to optimize the interaction of the electrical and mechanical parts in the injection system, dynamic models of piezoelectric components must be provided. A nonlinear model of the stack actuator has been developed for the analysis software MATLAB/SIMULINK. Special attention has been paid to the hysteresis properties.


Historic Perspective During the 1953 storm surge at sea Palling in east anglia (Figure 1), the sea overtopped the dunes and seven people drowned. Following that event, a sea wall was built to protect the village from further risk. In recent years, however, the sea has begun to undercut these defences, and a series of shore parallel breakwaters were installed in conjunction with beach recharge in an attempt to protect the earlier sea wall (Figure 2). These new breakwaters were designed to better retain the sand and hence continue the protection to that part of the coast. however, they have performed better than expected at this site and the first breakwater on the northern updrift end of the structures now has a permanent tombolo linking the breakwater to the shore, interrupting the flow of sediment down the coast. Research Project In 2005, the Uk engineering and Physical sciences research Council (ePsrC) funded LeaCOast2 (Liverpool-east anglia Coastal study Phase 2), a collaborative research project to study the hydrodynamics and sediment processes around these breakwaters that followed on from the earlier LeaCOast project. The aim was to improve the understanding of how such structures interact with their environment and hence improve future design guidelines.


Serving as the building blocks for triacylglycerides and membrane phospholipids, fatty acids are essential in all forms of life. Given their chemical inertness, fatty acids need activation into a more water-soluble form (as acyl-CoA esters), prior to their utilization in complex lipid assembly, cellular energy generation, or conversion to other metabolites. To participate in such physiological processes, acyl-CoA esters must be delivered from the site of de novo biosynthesis, namely the plastids in plants, to various subcellular locations such as the cytoplasm, endoplasmic reticulum, plasma membrane and peroxisomes, where they bind to specific members of the acyl-CoA-binding protein (ACBP) family. By this reversible lipid-protein association, acyl-CoA esters are protected from hydrolytic degradation. In turn, the conformations of cellular membranes and their associated enzymes are preserved from the harmful detergent-like activities of acyl-CoA esters, which structurally resemble soaps (salts of fatty acids). for genetic manipulation of agronomically important boost crop


Vehicular visible light communication (V2LC) is expected to complement radio frequency (RF) technologies for higher reliability in vehicular connectivity. Since high mobility makes the line-of-sight V2LC channel very dynamic, an adaptive physical layer (PHY) design is required for realizing a rate-optimal and reliable V2LC system. Existing studies on adaptive PHY designs have mostly considered indoor scenarios with low mobility and require a feedback channel for both reporting the received signal-to-noise ratio (SNR) to the transmitter and channel equalization (CE), which increases system complexity and introduces overhead. This paper presents a novel low-complexity adaptive PHY design that provides rate-optimal and reliable V2LC without a feedback channel. The proposed design utilizes a priori measurements of the BER with respect to SNR, which are static for V2LC on the road. SNR is predicted in real-time based on the relative locations of the transmitting (TX) and receiving (RX) vehicles using a path loss model based on a priori measurements of the SNR-distance relationship and the polar beam pattern for a given TX/RX pair, in a given setting. The proposed design is validated via night-time experiments with On-Off-Keying (OOK), 4-Pulse-Position Modulation (4-PPM) and Direct Current-Biased Optical OFDM (DCO-OFDM). The proposed location-aware adaptive PHY design can be expanded for general reliable rate-optimal V2LC use by updating the path loss model with additional measurements for different settings.


The standard (JGJ133-2001) sets out requirements of the application of non-granite stone curtain walls, which are increasingly used nowadays. Based on the experts' comments and engineering practice, the paper puts forward some suggestions on the application including the stone performance, requirements, load-bearing design methods, construction measures, surface treatment, experiment, stone process and quality control, etc.


The aim of this prospective study was to assess the usefulness of pretreatment with ulinastatin to reduce cerebral ischemia/reperfusion injury during carotid endarterectomy under general anesthesia. Forty patients were randomized into the ulinastatin group and the control group. Patients in the ulinastatin group received a 500000 U dose of ulinastatin immediately before anesthesia induction. Participants in the control group were administered with equal normal saline. Blood samples were drawn from the ipsilateral jugular bulb before skin incision, at 15 min after clamping and 15 min after declamping individually, and daily postoperatively for 3 d for malondialdehyde(MDA),tumor necrosis factor α(TNF-α) determination, before skin incision, at 15 min after clamping and 15 min after declamping for blood gas analysis, and before skin incision, daily postoperatively for 3 d for neuron-specific enolase(NSE) determination. Blood samples were drawn from the artery before skin incision, at 15 min after clamping and15 min after declamping individually for blood gas analysis. Compared with the control group, the ulinastatin group had the lower concentration of TNF-α at every time point(P0.05), but the higher cerebral arteriovenous oxygen content difference at 15 min after declamping(P0.05), and the decreased ICU stay of 38.7%(27.1±15.7 h vs.44.1±29.6 h, P0.05). There were no differences between the ulinastatin group and the control group in MDA and NSE(P0.05). Pretreatment with ulinastatin was useful to prevent inflammatory response and to improve cerebral oxygen metabolism and outcomes after carotid endarterectomy.


It is tempting to say that Diego de Ocana and the manuscript he composed between 1599 and 1608 'have arrived.' For under review here are two recent editions of the account of a journey he made on b...


Abstract A meaningful life, we shall argue, is a life upon which a certain sort of valuable pattern has been imposed by the person in question—a pattern which involves in serious ways the person having an effect upon the world. Meaningfulness is thus a special kind of value which a human life can bear. Two interrelated difficulties face ths proposal. One concerns responsiblity: how are we to account for the fact that a life that satisfies the above criteria can have more meaning than a life with the same positive outcomes but which lacks responsiblity on the part of the agent? The other turns on these outcomes themselves: how can the meaningfulness engendered by actions you perform now be affected by what those actions go on to produce in the future, perhaps even after your death? We provide a response to both of these difficulties.


Enterprise Risk Management (ERM) is an effective technique in managing risk within an organization strategically and holistically. Risk culture relates to the general awareness, attitudes and behaviours towards risk management in an organisation. This paper presents a conceptual model that shows the relationship between risk culture and ERM implementation. The dependent variable is ERM implementation, which is measured by the four processes namely risk identification and risk assessment; risk treatment; monitor and consult; communicate and consult. The independent variables under risk culture are risk policy and risk appetite; key risk indicators; accountability; incentives; risk language and internal relationships. This study aims to empirically test the relationship between risk culture and ERM implementation among Malaysian construction public listed companies. Risk culture is expected to have direct effects and significantly influence ERM. This study contributes to enhance the body of knowledge in ERM especially in understanding significant of risk culture that influence its' implementation from Malaysian perspective.


The Tang Dynasty's stone inscription "WEI Jun-jing Tablet" and the marshal messenger Wei Jun-jing cannot be found in Tang history.Historians generally take the inscription as a make up of the history.But the paper by WANG regarded WEI Jun-jing just as an officer in East Sichuan and doubted the his identity of a marshal messenger.Through textual research,exploration,Wei' identity of a messenger is affirmed without any doubt.


The predominant syntax of the serin song is sequential, whereby nonrepeated syllables follow a well-organised circular structure. This is an evolutionarily derived condition in serins, as most congener species use relatively more syllable repetitions. Repetition of syllables persists as a minor part of serin song, mostly at the beginning of songs. We investigated the possible existence of a female preference selecting for sequential syntax in the serin that could, explain its preponderance. Female preferences were assessed by analysis of their vocal responses and their operant eliciting of playbacks. Contrary to prediction, females tended to respond more to repetitive syntax, when choosing between the two natural serin syntaxes. This result could, however, be due to the syntactical and phonological similarities of the repetitive syntax and the species contact calls. When controlling for this possibility by giving the choice between repeated and sequential songs constructed from the same syllables in a second experiment, females expressed no preference. Taken together these experiments fail to link female preferences to the evolution of the serin sequential syntax. This result is discussed in the context of paucity of the evidence for a role of female choice in the evolution of song syntax in passerines.


Recently, plant construction throughout the world, including nuclear power plant construction, has grown significantly. The scale of Korea's nuclear power plant construction in particular, has increased gradually since it won a contract for a nuclear power plant construction project in the United Arab Emirates in 2009. However, time and monetary resources have been lost in some nuclear power plant construction sites due to lack of risk management ability. The need to prevent losses at nuclear power plant construction sites has become more urgent because it demands professional skills and large-scale resources. Therefore, in this study, the Analytic Hierarchy Process (AHP) and Fuzzy Analytic Hierarchy Process (FAHP) were applied in order to make comparisons between decision-making methods, to assess the potential risks at nuclear power plant construction sites. To suggest the appropriate choice between two decision-making methods, a survey was carried out. From the results, the importance and the priority of 24 risk factors, classified by process, cost, safety, and quality, were analyzed. The FAHP was identified as a suitable method for risk assessment of nuclear power plant construction, compared with risk assessment using the AHP. These risk factors will be able to serve as baseline data for risk management in nuclear power plant construction projects.


An analysis of liquid-waste-disposal methods employed at ORNL is made. High-level wastes are stored in tanks and allowed to decay; medium-level wastes are pumped to seepage pits; and low-level wastes are passed to a nearby creek with or without treatment, depending upon the level of radioactivity. Methods of monitoring and control are discussed. (C.J.G.)


The purpose of this study was to develop a model of Green and happiness community for the rural villages of E-San (Northeast region). The research design was consisted of both quantitative and qualitative analyzes. The study was carried out with 20 resource persons and the samples of 72 operators in communities, 365 community leaders selected by multi-stage sampling, and 360 heads of families selected by systematic sampling. The research instruments were questionnaires, interviews and focus groups. The data were analyzed by using descriptive statistics, MANOVA, and one-way ANCOVA with the use of SPSS for Window. For the confirmatory factor analysis and the test of hypothesized model to fit the empirical data, LISREL Program version 8.30 was applied. The research results revealed that, regarding the communities with Green and happiness in the rural villages of E-San, there were 6 factors and 22 sub-factors and 107 indicators. They were 14 indicators for the factor of good environment and natural resources, 20 indicators for the factor of good health, 13 indicators for the factor of strong community economy, 19 indicators for the factor of appropriate technology, wisdom and learning, 24 indicators for good society and culture with morality, and 17 indicators for the factor of strong community administration and management. The model for communities with Green and happiness was fitted with the empirical data (χ= 2807.14, GFI=.91, AGFI = .91 and RMSEA = 0.000). All 6 main factors had statistical significance at the level of .05. Each factor was mutually related with statistical significance at the level of .05. As regarding the evaluation, the Green and happiness of communities was generally at a high level. The comparison of the means of Green and happiness among different areas show that the means were different with statistical significance at the level of .01. For the appropriate model and guidelines for developing communities with green and happiness according there were 21 guidelines for development and 71 major activities. In conclusion, the model for communities with Green and happiness from the results of study, it is appropriate to bring the model into practice in developing communities with Green and happiness in the rural villages. §" "§—≠ : O¬Ÿa‡¬Aπ‡aiπ y¢ °"√ae—≤π"√Ÿa·∫∫ TMπ∫∑O' "π


Background: A prospective study to analyze the facial nerve branching pattern as seen in various parotidectomy surgeries in Kashmiri population. Main objective was to find out various branching patterns among peripheral branches of facial nerve in parotid tissue so that new young ENT surgeons could get benefited and it should be easy for them to perform parotid surgeries with less complications and unpredictable outcome. Methods: The prospective study was conducted in 35 patients undergoing superficial parotidectomy in our department of otorhinolaryngology GMC Srinagar over a period of one and half year. Facial nerve branching pattern was classified according to the description given by Davis et al. Branching pattern of main trunk was also observed in all cases. Results: The most common type of branching pattern of facial nerve in our study was type I seen in 12 (34.2%) patients, followed by type III seen in 9 (25.7%), followed by type II in 5 (14.2%), type IV in 4 (11.4%) patients, followed by type V in 3 (8.5%) and VI in 2 (5.7%). Conclusions: Type I branching pattern is the most common branching pattern of the facial nerve (34.2%) followed by type III (25.7%), following the pattern as described by Davis. Main trunk was found single in 32 (91.4%%) patients however in 3 (8.57%) patients trunk was dividing in 2 branches before dividing in peripheral branching pattern as described above.


over time which is useful only if the various factors that influence a trainee's progress can be factored out. In-service test scores, monthly reports in each subspecialty area, impressions of resident conduct and Interesting Case Conference performance are available and dominate the overall evaluation process. The compositive goal is the determination of whether the resident is learning at an appropriate rate and mastering the techniques of an effective consultant. The evaluation process results in documentation of the resident's improvement or lack of improvement throughout the successive years of training. This becomes especially important if a trainee is shown to be unsuited for the discipline and dismissal is deemed necessary, as counselling of the resident and documentation of inadequate performance are essential in this litigation oriented society. We also employ the results of the evaluation system to identify the weakness of the curriculum and utilise this information to change what we are teaching, how we are teaching it, or who is teaching it. In this regard the faculty is provided information from the Director of the Radiology Residency Training Programme concerning how their trainees are doing in the specific faculty's area of expertise. Also the faculty is expected to lk provide an up-to-date, annual revised reading list. If the residents are shown to be consistently out-of-date with respect to the body of knowledge in a specific area, remedial action can be taken to reorient that subspecialty section. In this regard retrospective evaluations identify aspects of the programme where curriculum modification may lead to a richer educational experience. At Vanderbilt University Medical Center we use our resident evaluation programme to assess educational goals


The use of brackish water for the production of vegetables is a reality mainly in the semi-arid regions of the Brazilian Northeast due to the low availability of good quality water. In this sense, the objective was to evaluate the use of brackish water used for the preparation of the nutrient solution and for the replacement of the evapotranspiration and flow rates of this solution on the water consumption and the efficiency of water use by cauliflower cv "Piracicaba Precoce". The experiment was conducted in the Department of Agricultural Engineering of the Federal Rural University of Pernambuco, in a hydroponic system NFT (Nutrient Film Technique). The experimental design was completely randomized in a 6 x 2 factorial scheme, corresponding to six saline levels (0.2, 1.5, 2.5, 3.5, 4.5 and 5.5 dS m) and (1.5 and 2.5 L min), with four replications, totaling 48 experimental plots. The saline water levels were obtained by addition of NaCl to the local supply water (0.2 dS m). The variables water consumption and water use efficiencies of the fresh and dry biomass of the aerial part were analyzed. The data of the experiment were submitted to analysis of variance by the F test and when significant effects were verified to the regression analysis. The increase in water salinity reduced the water consumption and water use efficiencies of the fresh and dry biomass of the aerial part of the crop, regardless of the nutrient solution flow rates evaluated. However, the reductions were more pronounced in the flow rate of 2,5 L m.


This paper discusses the ways in which mature students orientate themselves towards the future in making decisions to access higher education (HE). Their narratives connect their past, often difficult, educational and personal lives to their future aspirations and to their current experiences in further education (FE) and HE. The research was part of a larger project undertaken for the UK Higher Education Academy Centre for Sociology, Anthropology and Politics (C-SAP) exploring FE and HE mature learners' future 'possible selves' including those selves that are desired and those that are not. Students were asked to reflect on both their past journeys as well as on what their possible future(s) might look like. In this paper, we focus on the mature learners in our study as they emerged as having distinctive orientations towards their futures.


Introduction: Platelet-rich fibrin (PRF) is the newer treatment option for treatment of chronic non-healing ulcers of leg and it contains various growth factors which boosts the wound healing. Objectives: To detect the efficacy of autologous PRF dressing in chronic non-healing leg ulcers and to assess the reduction in ulcer area at the end of each week. Materials and Methods: 30 patients (17 females, 13 males) were taken in this prospective study with informed consent. PRF was prepared by drawing 10cc venous blood and directly centrifuging it at 3000rpm (approximately 400g) for 10 minutes without adding anticoagulant. Three fractions were formed consisting of red coloured lower fraction containing RBCs, middle fraction containing PRF and upper fraction consisting of upper straw coloured platelet poor plasma (PPP). PPP fraction was discarded; middle PRF fraction was collected by separating it from the lower RBC fraction with forceps and scissors. PRF was then applied over the healthy bed of chronic non-healing ulcers every week till the wound heals. Reduction in ulcer at the end of each week is assessed by calculating area (Length×Width×0.7854). Results: The mean size of the ulcers was 10.4 cm2 initially; mean duration of ulcer was 4.7months. Complete healing required minimum 3 and the maximum 8 sittings (mean 4) no adverse events seen. Conclusion: We conclude that PRF dressing can be used as it is effective, safe, outpatient procedure in chronic non-healing leg ulcers.


Results of the long range sediment tomography inversions using the broad band acoustic data from the Asian Seas International Acoustic Experiment (ASIAEX) is discussed in this paper. A hybrid inversion scheme is used for the sediment tomography technique which utilizes the modal travel time data. The conventional approach is modified in this study incorporating the model sensitivity to tune the parameter search intervals. Model parameters with high sensitivity are searched at closer intervals and vice versa. This results in computational efficiency by concentrating search effort to model subspace which is more sensitive. The results of the tomographic inversions compare well with core measurements and estimates using other techniques.


Purpose: The follicular variant of papillary thyroid carcinoma (FVPTC) is the most common variant of papillary thyroid carcinoma (PTC). Preoperative diagnosis of FVPTC is often confused with cPTC, follicular neoplasm (FN), and benign follicular lesion because of the paucity of nuclear changes of PTC and overlapping features with benign and other neoplastic follicular lesions. The aim of this study is to elucidate whether ultrasonography and/or intraoperative frozen section analysis (FSA) have a supplementary role in the diagnosis of FVPTC. Methods: Fifty-five patients diagnosed with histologically confirmed FVPTC from January 2007 to December 2013 were identified. All patients had undergone either lobectomy with/without completion thyroidectomy or total thyroidectomy. Medical records, final histological reports and sonographic (US) findings were reviewed. All sonographic images, 53 fine needle aspiration cytology (FNAC) slides, and FSA slides for 24 cases were available for reexamination. Results: Three histologic types of FVPTC were identified: encapsulated (n=39); infiltrative (n=15); and diffuse (n=1). There were two distinct sonographic patterns: FN-type (n=28) and PTC-type (n=27). The encapsulated type is more common in the FN-like pattern, compared to the PTC-like one (85.7% vs. 55.6%, P=0.009). Among the 24 cases in which sonographic images and FNAC and FSA slides were available for review, six cases (25%) were diagnosed as either FN in FNAC and suspicious PTC(R/O PTC)/PTC in FSA or R/O PTC/PTC in FNAC and FN in FSA. Among those 24 cases described above, 13 cases (54.2%) were diagnosed as either FN-type in US and R/O PTC/PTC in FNAC/FSA or PTC-type in US and FN in FNAC/FSA. Conclusion: It is difficult to make a correct diagnosis of FVPTC before definitive treatment even with US, FNAC and FSA. However the possibility of FVPTC must be considered, especially when diagnoses in US, FNAC and FSA are different and include R/O PTC/PTC and FN in the same case.


In this paper two different decision tree learning systems for modeling of a switched reluctance motor have been developed. The design vector consists of the design parameters in the first one whereas in the second one, it is a combination of hysteresis current band in the current limiter and the switching angles. The output performance variables are efficiency and torque ripple in both systems. An accurate analysis program based on improved magnetic equivalent circuit (IMEC) method has been used to generate the input-output data. These input-output data is used to produce the decision trees for predicting the performance of switched reluctance motor (SRM). The performance prediction results for a 6/8, 4 kw, SR motor show good agreement with the results obtained from IMEC method or finite element (FE) analysis. The developed decision tree systems can be used for fast prediction of motor performance in the optimal design process or on-line control schemes of SR motor.


In this study, the effects of a flat foot and series ankle spring on walking stability and efficiency are investigated with three passive dynamic walking models. These models are tuned on the same gait parameters to compare local and global stability with three indicators, including the largest Floquet multiplier, size of basin of attraction, and incircle of basin of attraction. Investigations show that the flat foot helps achieve better global stability on most gait parameters and better local stability near the human-like gait parameters. However, the series ankle spring degrades local stability and global stability on most gait parameters. These findings may provide an insight into the design of efficient and robust bipedal robots.


The purpose of this research was aimed: 1) to develop the information system for database management regarding the MSU undergraduate admission, and 2) to examine the user satisfaction with information system for the MSU undergraduate admission for the further guideline to develop database management regarding the MSU undergraduate admission. The samples included twenty participants using an information system for database management regarding the MSU undergraduate admission. The research instrument used included the MSU Undergraduate Admission Questionnaires. The statistics implemented for data analysis included mean ( X ) and standard deviation (SD). The results demonstrated that the information system for database management regarding the MSU undergraduate admission comprising applicant records system, applicant data editing, reporting system, application form, and application statistics, and 2) the users were วารสารวิชาการการจัดการเทคโนโลยีสารสนเทศและนวัตกรรม คณะเทคโนโลยีสารสนเทศ มหาวิทยาลัยราชภฏัมหาสารคาม ปีท่ี 6 ฉบับท่ี 1 มกราคม – มิถุนายน 2562 99 mostly satisfied with the information system for database management regarding the MSU undergraduate admission overall ( X = 4.59, S.D = 0.26), and in each respect of areas it found that the users reported highest satisfaction with the information system for database management on eight items and the users reported considerable satisfaction the information system for database management on four items.


It is difficult to prove a capable sufficient condition for the exact
controllability of systems containing nonlinearities and randomness. As
a result, scientists are investigating the concept of approximate
controllability for such systems. In this paper, we handle the so-called
C-controllability, which was suggested as a weaker analog of the exact
controllability at the beginning of the period when controllability
issue oversteps to stochastic systems. We prove a sufficient condition
of C-controllability for a semilinear stochastic system driven by a
Wiener process. This sufficient condition is verified on examples. Two
ways of improvement of this sufficient condition are discussed.


Glucocorticoids (GCs), steroid hormones produced predominantly by the adrenal gland, are key mediators of stress responses. Whilst the acute and chronic effects of pharmacological glucocorticoid excess are well-recognized (including induction of hyperglycemia, insulin resistance, hyperlipidemia, hypertension and dysphoria, with suppression of immune, inflammatory and cognitive processes), their role in the biology of the response to stress is more nuanced, with balanced homeostatic effects to facilitate short-term survival and recovery from challenge [1, 2]. In addition, glucocorticoids play an essential role in normal fetal development and are important for the development and maturation of various fetal tissues including the liver, lungs, gut, skeletal muscle and adipose tissue in preparation for extrauterine life. Glucocorticoids most notably act during late gestation to stimulate surfactant production by the lung. This action is critical to prepare the fetus for extrauterine life, and it is for this reason that synthetic glucocorticoid treatment is so widely used in preterm pregnancies where lung immaturity threatens neonatal viability. Although these treatments greatly improve survival [3], they are not without adverse effects.


In this paper, a process optimization method is proposed for cooling crystallization process of β form L-glutamic acid, based on the moving horizon estimation (MHE) of the moment information of crystal growth kinetics. By transforming the population balance equations (PBEs) of the process kinetic model into differential algebraic equations using the quadrature method of moments (QMOM), a modified MHE estimation algorithm with variable horizon is developed to estimate low-order moments reflecting the fundamental characteristics of cooling crystallization process. Based on these estimated moments, an optimization program is established to solve the optimal operation profile of cooling temperature, by imposing the constraints of moment and cooling rate for numerical computation. An illustrative example of seeded cooling crystallization process of β-LGA is studied, which demonstrates that the proposed MHE algorithm could obtain better accuracy compared to the classical state estimation methods of extended Kalman filter (EKF) and MHE. Moreover, the optimized result of target crystal size distribution (CSD) by the proposed method is significantly better than those of the conventional linear or programming cooling strategies in practice.


The present invention relates to a torque control system for roll stabilization, the moment acts in a chassis of a wheel suspension of a vehicle in order to correct the inclination of the vehicle body on the rolling system in which the vehicle is detected at least two a spring-travel values of the wheels. This moment is based on a difference between the spring travel values of the two wheels is determined, and the determined moment is applied to the wheel suspension system. These preferably based on a difference between the spring travel is determined that a practical magnitude of the torque acting on the wheel suspension system. The actual torque is used as a roll stabilizing system calculates a setpoint torque. The present invention relates to a control device for performing the method.


Process for the preparation of dispersible, water-soluble polygalactomannanes and polygalactomannane derivatives by crosslinking with borate ions, in which the polygalactomannane-containing endosperm of legumes is allowed to swell in an aqueous alkaline solution of a borate ion-containing material in which the concentration of the borate ions, expressed as borax, is between 0.001 and 0.09% by weight, and the hydroxyl ion concentration, expressed as NaOH, is between 0.2 and 10% by weight of the polygalactomannane, and, after taking up solution, the cell structure of the moistened-through splits is mechanically destroyed using high shear forces in a flocculation, pressing or extrusion process, and the process products are then dried and ground in a known manner.


While transfusion with banked blood is essential for the critically ill patient, it is increasingly being recognized that storage itself may result in a product that contributes to various transfusion related toxicities[1]. Recent evidence, using leukodepleted banked blood suggests that this effect is mediated at least in part by storage dependent changes to the red blood cell (RBC) itself. The positive association between the age of transfused RBC with an increased incidence of transfusion related pathologies is referred to as the RBC storage lesion, key features of which are with microcirculatory dysfunction and inflammatory tissue injury [2]. How storage induced changes in RBC promote these toxicities remains unclear however [3], with both gain of toxic functions (e.g. accelerated nitric oxide scavenging[4, 5]) or loss of protective mechanisms (e.g. pro-inflammatory cytokine scavenging and inhibition of inflammation[6]) being reported. In the current issue, Zhu et al[7] provide evidence for a novel mechanism involving dysfunctional ATP release from stored RBC.

Controlled release of ATP from RBC in response to mechanical deformation or hemoglobin desaturation is a key physiological process for matching oxygen supply with demand in both pulmonary and systemic tissues[8]. Released ATP binds to endothelial purinergic receptors and initiates signaling events that ultimately lead to increased vasodilator and/or decreased vasoconstrictor activity[9]; the net effect being increased blood flow. Seminal studies over the last decade have mapped out elements of the signaling pathway in RBC that regulates ATP release and involves Gi-proteins, cAMP activation of PKA and key roles for CFTR and Pannexin proteins[8] and have done much to dispel the notion that RBC are 'dead' cellular bags whose sole function is to compartmentalize hemoglobin. Furthermore, dysfunction in this signaling pathway has been demonstrated in diabetic and pulmonary hypertensive patients with the concomitant loss of ATP dependent regulation of blood flow discussed as a possible mechanism underlying vascular complications that characterize these diseases[10, 11]. The study presented by Zhu et al adds RBC storage lesion and development of transfusion induced lung injury and pulmonary hypertension into this emerging list of diseases associated with compromised ATP release from RBC.

Zhu et al confirm previous studies showing roles for CFTR, K+ATP channels and pannexin 1 in mediating ATP release and show that this is impaired in stored RBC. Importantly, from using a combination of experimental approaches that either blocked ATP release from young cells, that inhibited extracellular ATP dependent effects by enzymatic degradation of this nucleotide, or by performing ATP add back studies to stored RBC that were unable to release ATP, Zhu et al show that RBC derived ATP is i) important in preventing stored RBC dependent increases in pulmonary arterial pressure in isolated perfused lungs, and, ii) important in preventing RBC adhesion to endothelial cells in vitro and in the lung after transfusion. These data begin to establish a cause-effect relationship for inhibited ATP release from stored RBC and transfusion related toxicity in the lung specifically.

Zhu et al also show that transfusing stored RBC into nude mice results in a relatively rapid (within mins) RBC adhesion and migration across the pulmonary vasculature that correlates with poor lung function. Adhesion was shown to be mediated by RBC ICAM-4 ligation of endothelial αvβ3 and moreover the only stimulus required for this was the lack of ATP release. This observation suggests that under physiologic conditions, RBC adhesion is tonically suppressed by RBC derived ATP with the pathologic consequences in the lung only manifesting when ATP release is inhibited. As discussed by the authors, an important consideration with respect to implications for storage lesion mechanisms is that the current studies did not incorporate the two-hit concept [6] whereby addition of stored RBC to critically ill patients, who are already under an inflammatory burden, provides the second hit to exacerbate organ damage. Testing how compromised ATP release contributes to transfusion related toxicity in relevant injury models is clearly an important next step.

Additional questions that arise from the present studies include how does RBC storage lead to inhibited ATP release? Does storage compromise RBC responsiveness to ATP releasing stimuli and if so, does this involve alterations in the amount and/or activity of proteins or molecules that regulate the ATP release signaling pathway? Additionally, how does ATP prevent ICAM-1 - αvβ3 interactions and does this involve endothelial purinergic receptors and why are the proadhesive effects of inhibiting ATP release from RBC only observed in the lung? These questions are not only of academic interest, but their elucidation, have the potential to provide novel therapeutic targets and strategies for preventing RBC storage lesion related effects. Pursuing this line of research is critical since the need for RBC transfusions is not waning and coupled with limitations in donor blood supplies, and the current lack of alternative resuscitation agents necessitates the use of older RBC units first in the clinic. Relying on use of only young RBC is not feasible therefore, underscoring the importance of developing strategies that prevent detrimental changes in RBC during storage and / or preventing detrimental effects of transfusing with stored RBC.

In summary, the data presented by Zhu et al expand on an emerging paradigm for the RBC storage lesion in which aging of cells under blood banking conditions results in molecular alterations in the RBC that lead to either loss of, or gain of function which ultimately leads to RBC that are pro-inflammatory, pro-coagulative and hypertensive [12]. Interestingly, sustaining ATP levels is one primary goal in current RBC storage protocols. The current study suggests protocols that maintain RBC responsiveness to stimuli that release ATP may be equally important.


In this study, a dynamic weight-based method combined with principal component analysis (PCA) was developed for the first time for detecting measurement data in manufacturing. This weight-based learning technique can learn and train the measurement data sequence to isolate incorrect data sources for achieving high accuracy when detecting various types of data. Research has revealed that unsuitable image or data features might cause poor performance in industrial inspections. In contrast to the previous inspection methods, the weight-based learning method proposed in this study employs a dynamic learning algorithm for effectively and adaptively selecting optimal principle components to the support vector machine (SVM) algorithm and then establishes indicators. Finally, these PCA-based indicators act as substitutes for massive amounts of data in data processing and can be applied to timely detect data when the data contain redundant and incorrect inputs in a sequence. The experimental results indicate that the proposed method, which combines dynamic weight-based feature extraction with PCA, can provide useful indicators for detecting various types of manufacturing data and exhibited satisfactory performance in the data detection.


Background : Hypertension is one of the most prevalent risk factors for myocardial infarction, strokes, congestive cardiac failure and chronic kidney disease (CKD)and its prevalence is significantly higher inthe elderly population. Objectives : To assess the demography, various presentations and the prevalence of risk factors among elderly hypertensive patients followed up in a tertiary care hospital in Sri Lanka. Materials and Methods : This was a cross sectional descriptive study involving 250 patients whose age was 60 years or above on antihypertensives for at least 6 months. Results : Approximately 65.2% of the study population was female. The mean age was 70.17.Dizziness and chest pain were the most prevalent symptoms. The mean age at first detection was 58.17 years. Mean SBP and DBP were 128.5mmHg and 81.14mmHg respectively. The prevalence of alcohol consumption and smoking among men were 70.1% and 72.4% respectively. Approximately 54.7% were either overweight or obese. Approximately 81.6% females and 41.4% males had a waist circumference of more than the risk level with p-value<0.05. Approximately 36% had diabetes mellitus and 27.6% of the patients had at least one parent and 36.8% had at least one sibling diagnosed with hypertension. Approximately 61.3% of the patients had adequate levels of physical activity while 31.8% had IHD,11.5% had stroke and 3.8% had CKD. Conclusion : Dizziness and chest pain were the most disturbing symptoms while abdominal obesity among females,and alcohol consumption and smoking among males were the major risk factors in elderly hypertensive patients DOI : Coming Soon Corresponding author: Dr. Udaya Ralapanawa, Consultant Physician and Senior Lecturer in Medicine, Professorial Medical Unit, Teaching Hospital, Peradeniya, Sri Lanka ,Email Id : firstname.lastname@example.com Running Title: Study on cardiovascular risk factors among elderly hypertensive


Dilute aqueous solutions of acrylonitrile and polyvinyl alcohol were frozen in sheet form. Ionizing radiation from a cobalt-60 source was used to achieve polymerization in a network of voids between ice crystals. Dosages were 5 to 64 megarads for acrylonitrile at -100°C and 1 to 25 megarads for polyvinyl alcohol at -20°C. Subsequent to thawing and evaporation, stable fabric-like webs were obtained.


The SPIRAL2 linear accelerator [1] will produce entirely new particle beams enabling exploration of the boundaries of matter. Coupled with the existing GANIL machine this new facility will produce light and heavy exotic nuclei at extremely high intensities. The field deployment of the Control System relies on Linux PCs and servers, VME VxWorks crates and Siemens PLCs; equipment will be addressed either directly or using a Modbus/TCP field bus network. Several laboratories are involved in the software development of the control system. In order to improve efficiency of the collaboration, a special care is taken to the software organization. During the development phase, in a context of tough budget and time constraint, this really makes sense, but also for the exploitation of the new machine, it helps us to design a control system that will require as little effort as possible for maintenance and evolution. The major concepts of this organization are the choice of EPICS, the definition of an EPICS directory tree specific to SPIRAL2, called "topSP2", this is our reference work area for development, integration and exploitation, and the use of version control system (SVN) to store and share our developments independently of the multi-site dimension of the project. The next concept is the definition of a "standardized interface" between high level applications programmed in Java and EPICS databases running in IOCs. This paper relates the rational and objectives of this interface and also its development cycle from specification using UML diagrams to test on the actual equipment.


Good mechanical equipment * Good operation . Minimum upkeep Like all other construction, the hotel pool buyer can avoid costly repairs, replacements and maintenance through careful planning and wise investments. Unless the hotel pool buyer has personal experience in building and operating pools, it is imperative that he have competent advice from a qualified engineer or builder to avoid costly mistakes.


Introduction: Iatrogenic laceration of the median nerve motor branch during carpal tunnel release is a devastating complication that has been reported with both open and endoscopic techniques. The purpose of this study is to highlight a previously underreported relationship between an aberrant course of the median nerve motor branch and an anomalous thenar muscle that places the motor branch at high risk. Materials and methods: This was a two part study. The first part was a retrospective review of over 500 cases of carpal tunnel release over a 7 year period. There were 530 carpal tunnel releases performed and 20/530 cases were found to have a characteristic anomalous thenar muscle associated with a consistent aberrant course of the motor branch of the median nerve. Part two was an anatomic study in which 42 cadaveric wrists were dissected to determine median nerve branching patterns, dimensions of the transverse carpal ligament, and thenar musculature dimensions. Results: Twenty patients (3.8%) in the clinical arm were found to have anomalous musculature. In each case, the characteristics of the muscle were similar; the muscle was triangular in shape, was distal to the FPB, and had minimal fascial covering. In 100% of the cases the motor branch was found to be more anterior/central or ulnar in its take-off. In the anatomic study, two hands (5%) had aberrant musculature extending distal to the transverse carpal ligament (TCL). Both were associated with an anterior/central or ulnar median motor branch take-off with recurrent course. Larger thenar musculature dimensions and anomalous thenar muscle were associated with more anterior and ulnar motor branch take-off. Conclusion: There appears to be a high association between anomalous thenar musculature and an aberrant course of the motor branch of the median nerve placing it a greater potential risk for iatrogenic injury.


The information recording medium 100 includes a first recording layer (LO) and a second recording layer (L1) can be recorded in the alternative recording information on each recording layer. The first recording layer and the second recording layer of at least one of them, of recording and reproduction of the recording information, file system information for controlling at least one (AP # 1-4) and provided, update, and record the information of the anchor It includes an update area for. File system information, anchor information, the update region


TH ROUG HOUT history, language, being a basic means of communication, has been a rallying point for those ready for strife. This is understand able and indeed natural in a world where the first step of the conqueror has often been to attempt to destroy the culture and the language of the con quered. It is extraordinary that any victor should have persisted in this attitude in spite of the lessons that history could have taught him. The language which has been suppressed has seldom died: it has gone underground, to be preserved and fostered in resentment and bitterness, and has then gradually or explosively emerged from its hiding place either to be incorporated in the conqueror's tongue or to absorb it. For settlers in a new land, as for a conquered people, there must always be a strong emotional tie with the mother tongue. In South Africa, in spite of the long view of the British Government, which took no strong measures to suppress the language of the Afrikaners, we have seen both sides of this story. Afrikaans became for many the symbol of the "oppressed", as well as the badge of an emer gent race; English became the symbol of those whose ties were outside South Africa. For those who can see through the fog of emotion it is obvious that these early attitudes are no longer valid, if indeed they were ever held by intelligent and balanced persons. Afrikaans no longer needs the sentimental boost of the past; English in South Africa has not for many years deserved the stigma attached to it in some quarters as being the language of the lingoist whose pride it is to be an "uitlander" and whose thoughts are always with his far-off "Home" across the seas. Proof of this is to be found in the activities and aims of those clubs and societies set up specifically to preserve for South Africa the English tongue and the English way of life: the Sons of England, the Victoria League, the Society of St. George, the Royal Commonwealth Society, the Royal Overseas League —names to make the ignorant think that they all Miss V. E. Hanna needs little introduction to educa tionists in South Africa. As headmistress of the Jeppe High Preparatory School she played a leading role in primary education. Always active in professional matters, she was an outstanding President of the Transvaal Teachers' Asso ciation, and today carries on her work as its General Secre tary. She is a valuable member of the Witivatersrand Central School Board.


This prospective study was designed to evaluate the feasibility, safety, predictive factors of success, and 6‐month follow‐up of stent implantation without balloon predilatation (direct stenting) in 250 patients undergoing elective stent implantation. Balloon dilatation prior to stent implantation was a prerequisite to facilitate passage and deployment of the stent. Stent technology has changed tremendously, resulting in stents with improved properties, which may allow stent placement without prior balloon dilatation. Patients with coronary lesions suitable for elective stent implantation were included in this trial. Coronary interventions were undertaken predominantly via the transradial route using 6 Fr guiding catheters. Direct stent implantation was attempted using AVE GFX II coronary stent delivery systems. Upon failure, predilatation was undertaken before reattempting stent implantation. Patient data and ECGs were obtained from case records and from personal or telephone interviews 6 months after the procedure. Values were presented as mean ± standard deviation. Student's t‐test, two‐tailed at 5% level of significance, was used to compare the difference of two means. Multivariate logistic regression analysis was performed to establish predictive factors for failure of direct stenting. Two hundred and sixty‐six direct stent implantations were attempted in 250 patients. Direct stenting was successful in 226 (85%) cases. Out of 40(15%) cases where direct stenting failed, balloon predilatation facilitated stent implantation in 39. In one lesion, stent implantation was not possible despite adequate predilatation. Predictive factors for failure of direct stenting on multivariate analysis were LCx lesions (P < 0.01), complex lesions (P < 0.01), and longer stents (P < 0.001). Minimal luminal diameter and percentage diameter stenosis of lesions in the successful and the failure group were not significantly different (0.94 ± 0.39 mm vs. 0.84 ± 0.41 mm, P = NS, and 70.2 ± 11.2 vs. 73.2 ± 11.2, P = NS). Stent loss occurred in five (2.0%) cases, with successful retrieval in four. One stent was lost permanently in a small branch of the radial artery. Post‐percutaneous coronary intervention (post‐PCI) myocardial infarction occurred in four (1.6%) patients. There were no other in‐hospital events. Six‐month‐follow up information was obtained in 99% of patients. Subacute stent thrombosis was noted in four (1.6%) cases. Target vessel–related myocardial infarction rate was 3.2%, of which half was caused by subacute stent thrombosis. The overall reintervention rate (coronary artery bypass grafting or PCI) was 9.7%. Target lesion revascularization by PCI occurred in only 4.0%. At 6 months, overall mortality was 2.0%, of which 1.2% was due to coronary events. Direct stent implantation is safe and feasible in the majority of cases with low rate of complications. Unfavorable factors include circumflex lesion, more complex lesion morphology, and increasing length of stent. Severity of stenosis does not appear to be of predictive value. Long‐term outcome is favorable with a low target lesion revascularization rate. Cathet Cardiovasc Intervent 2001;52:443–448. © 2001 Wiley‐Liss, Inc.


This study examines eight images by the world renowned—and incognito— graffiti street artist known only as Banksy. The eight images are all of lone children; fourteen paintings comprise the total of Banksy's 2008 visit to post-Katrina New Orleans. For the research, the eight images of children are referred to collectively as the "NOLA Children Series." Banksy critics and fans have provided their own names for each piece: Simpsons Boy, Umbrella Girl, Fridge Kite, Levee Boy, Life Preserver Swing, Girl on Stool, and Trumpet Boy 1 & 2. The primary research objective was to understand Banksy's motives for creating these eight "dramas" as he did. Secondarily, the research also advances the interpretative framework for Visual Rhetoric. Close Textual Analysis and Kenneth Burke's Dramatistic Pentad combine as methods informed by scholarship in visual design and visual rhetoric. The study concludes by noting Banksy's condemnation of authority figures for their role in betraying the children of New Orleans. Recent studies confirm that the failed levees and failed leadership of 2005 still haunt those who were children when Hurricane Katrina made landfall in Southeast Louisiana.


A procedure is described for identifying and quantitatively determining the glucosinolates found in edible cabbage. The intact glucosinolates are extracted and their aglucons are released into solvent after a special enzymatic hydrolysis step. The resulting isothiocyanates and oxazolidinethiones are separated by a gas-liquid chromatographic procedure that allows the individual aglucons to be identified and their amounts to be estimated by comparison with an internal reference.


This warm and engaging festschrift in celebration of Richard Lee's important contribution to anthropology is a welcome reminder of the continuing relevance and theoretical importance of anthropological studies of egalitarian societies and the value of a critical, socially engaged anthropology for those studied. Richard Lee rightly earned his anthropological reputation through his vivid, meticulous and empathetic ethnographic accounts of the changing lives of Kalahari peoples, especially of the San hunter-gatherers of Dobe in Botswana. Beginning in the early 1960s, Lee and other colleagues involved in the Harvard Kalahari Project set about a multi-disciplinary documentation of the Kalahari San. The corpus of work produced by this project, of which Lee's The !Kung San: Men, Women and Work in a Foraging Society (1979) is an ethnographic centrepiece, has had a great impact on anthropological theorizing about hunter-gatherers, and our understanding of social systems that do not depend on structural inequality and institutionalized hierarchy. Lee's ethnographic accounts, along with those of Colin Turnbull and James Woodburn, critically inspired Sahlins's famous essay 'The Original Affluent Society'. An abridged version of this masterful polemic is reprinted here and prefaced with an interesting appraisal of how it has stood the test of time. One encounters more than just Lee the anthropologist. We also read about his family and upbringing, his cultural origins as a Jewish American committed to social justice and the impact this has had on his work and long-term support for the San. Stimulated by Lee's work, Christine Ward-Gailey re-examines Marx's Ethnological Notebooks, and Bruce Trigger seeks to challenge the ideological hegemony of 21stcentury capitalism. He asks ambitious questions for 'progressive anthropologists' about how large-scale enduring egalitarian societies might be fashioned – what mechanisms would ensure both democracy and economic egalitarianism, or social control without an elitist state? There is some excellent new ethnography presented in the volume. In particular, Elizabeth Marshall Thomas provides a beautifully observed and fascinating account of how the lion–Bushman relationship has transformed since the 1950s as the San at Nyae Nyae have moved from hunting to herding. Matthias Guenther describes how modern San artists have evolved in conjunction with their communities' political awakening. In the hubris of cultural politics in southern Africa following the fall of apartheid, the San developed an awareness of their dispossession and marginalization that led to them making claims for political, civic and territorial rights. Guenther's analysis criticizes the Western predilection for 'primitivizing' this work. Instead he emphasizes the relationship of the San's artistic production with their increasing engagement with modernity and their desire to promote a vision of San culture – from veldt animals and plants to the trance dance and mystical worlds of healers – that provides a platform for political claims. At a subtler level, Guenther argues that the artists' frequent juxtapositions of items coming from the new economic and social order with things from tradition serve to refer the former back to the latter and thus challenge the forces pushing for absorption into the modern nation-state. Ida Susser's recent research at Tsumkwe and Dobe into the epidemiology of HIV and AIDS infection provides a disturbing but elegant summary of the contemporary situation of San. She considers the relationship between high levels of sedentarism, migrant work, alcoholism, domestic violence and HIV/AIDS infection in comparison with other San communities, such as Dobe, which did not have so many migrants 108


EnglishThe notion of post conflict, as defined by the United Nations, designates an ideal postwar transition model. It includes international institutions, States and civil, private and non-profit actors to overcome together the tensions and promote peace building. The international post conflict terminology defines rules for intervention and a series of standardized actions : humanitarian emergency, post-emergency, transition, state-building, reconciliation process, rebuilding and development... However, institutional narratives presenting post conflict intervention as a neutral technic may be disputed because they leave behind political stakes, power rivalries and undesirable impacts of the process itself. It justifies the aim of this issue to assemble different territorial perspectives showing the discrepancy between an ideal and the reality, as well as the common points with international programs engaged in similar ways in different contexts. This issue also contributes to position geography as a specific analysis tool with contributions offering different analyses of stakeholders and territorial dynamics between war and peace. francaisLa notion de « postconflit », definie par les Nations unies, designe un modele ideal de transition apres une guerre, impliquant institutions internationales, Etats et acteurs civils, prives et associatifs pour surmonter ensemble les tensions et (re)construire une paix durable (peace-building dans le jargon international). La terminologie internationale du postconflit definit une norme d'intervention impliquant une serie d'actions standardisees : urgence humanitaire, post-urgence, transition, state-building, processus de reconciliation, reconstruction et developpement, etc. Cependant, les discours institutionnels presentant l'intervention postconflit comme une technique neutre sont contestables car ils evacuent les enjeux politiques, les rivalites de pouvoir et les impacts indesirables du processus lui-meme. L'objectif de ce numero est de rassembler differents eclairages territoriaux montrant les decalages entre ideal et realite, ainsi que les points communs a des programmes internationaux engages de maniere similaire dans des contextes differents. Il contribue aussi a un positionnement de la geographie comme outil de lecture specifique, les contributions proposant des analyses a differentes echelles des jeux d'acteurs et dynamiques territoriales entre guerre et paix.


This work aims to study the effects of culture conditions and storage time on stirred yogurt acidity and texture and to determine relationships in order to better control product viscosity. A four-factor experimental design was carried out to display the simple and combined effects of the ratio of two Streptococcus thermophilus strains, incubation temperature, final fermentation pH, and storage time on bacterial concentrations, acidification activity (determined by the time corresponding to the maximum acidification rate), texture (determined by the flowing time coefficient measured with a modified Posthumus funnel), and postacidification. The development of viscosity was influenced by all four factors studied and by some two-factor interactions. The acidification activity was affected by temperature and strain association. Greater viscosity was correlated to lower acidification activity, thus indicating that fermentation time affects the development of texture. As a consequence, linear relationships between the flowing time coefficient and final fermentation time were established. Finally, the most viscous yogurt was obtained by low temperature and fermentation at a low final pH with a texturing strain of S. thermophilus, which required the longest fermentation time.


Covid-19 besides pneumonia, may be associated with hematological disorders. Among these is thrombocytopenia, and when severe thrombocytopenia occurs, it may have impact on patient's survival. One of the possible reasons may be immune associated thrombocytopenia. Prompt treatment of this condition is required with steroids and intravenous immune globulin. Herein, we report the case of an 83-year-old man with extremely low platelet count (1 x 109/L), which was attributed to immune thrombocytopenia.


Abstract The purpose of this study is to examine the 30-day postoperative complications after hip arthroscopy as a function of patient age. The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2016 was used to identify all patients undergoing hip arthroscopy using Current Procedural Terminology and International Classification of Disease codes. Patient characteristics and postoperative complications were compared in a retrospective cohort study with a level of evidence 3 across patient age cohorts using bivariate and multivariate analysis that corrected for differences in baseline patient characteristics. In total, 2,427 patients undergoing hip arthroscopy were identified. Of all identified patients, 667 (27.5%) were under 30 years of age, 596 (24.5%) were between 31 and 40, 599 (24.6%) were between 41 and 50, and 566 (23.3%) were older than 50. Chondroplasty, abrasion arthroplasty, and/or resection of the labrum were the most commonly performed procedures in all age groups. As age increased, patients were more likely to be female and have a higher body mass index, more medical comorbidities, a shorter operative duration, and a higher American Society of Anesthesiologists class. The rate of any 30-day postoperative complication was 1.35% in patients under 30 years of age, 1.68% in patients between 31 and 40, 2.67% in patients between 41 and 50, and 5.12% in patients older than 50 (p < 0.001). Older patients also had a higher rate of deep surgical site infections and blood transfusions (p ≤ 0.001). However, no differences were identified with multivariate analysis. While older patients had higher short-term complications following hip arthroscopy, age alone was not an independent predictor of adverse outcomes. Further investigation is necessary to determine the risk factors associated with significant postoperative morbidity in older patients undergoing hip arthroscopy.


We present the case of a 30-year-old woman who presented with 8-month history of intermittent fever, joint pains with morning stiffness, recurrent oral ulcers, photosensitivity, weight loss and hair fall. For the last 2 month she had developed dry cough with progressive shortening of breath. On examination, a cachexic lady with malar hyperpigmentation, alopecia, pallor, nail dystrophy and erythema over hands and feet were noted. There were multiple punched-out skin ulcers of variable size over legs, arms and abdomen usually round in shape with well-defined even wound margins and scant serous discharge. Musculoskeletal examination revealed synovitis of both elbows and few metacarpophalangeal and proximal interphalangeal joints. Chest X-ray and HRCT showed bilateral ground-glass opacification. Anti-Nuclear Antibody (ANA) was positive, 1:320, homogenous nuclear pattern. Anti-Ro antibody was high positive and serum complement (C3, C4) levels were reduced. She was diagnosed as Lupus Vasculitis and started on steroids, mycophenolate mofetil and hydroxycholoroquine.


My vision for the NHS 10 years hence is not far removed from the orthodox aspirations of today, but it is a considerable advance on what is often found, what is poorly reported, and what is seriously misunderstood. Of course, it is folly to imagine the utopia Aneurin Bevan once envisaged. But it would be worse to believe that we have achieved all that is possible. Health, health care, the experience of patients and their families—and of health staff—can all be made better than they are today.

The current government has set core standards describing what must be done, supplemented by developmental standards, designed to drive up quality of care.1 By 2015, these will all have been met and we will have a service that is safe, clinically effective, and patient focused.

The need to preserve health, protect health, and prevent or delay ill health casts responsibilities far beyond the …