Nigeria is one of the few African countries with a written cultural policy as well as government established and funded institutions charged with the implementations of this policy. This article interrogates the implementation of the tenets of the policy, given Nigeria's cultural diversity and the growing demand for tangible, verifiable economic indices of the contributions of the culture sector to both internally generated revenue (IGR) and the gross domestic product (GDP) of the nation. It suggests the need to expand the traditional understanding of cultural resource as land, labour and capital to embrace diverse forms of 'soft' cultural capital as assets whose management is critical to individual, community and national economic empowerment. The paper concludes with suggestions on strategies and best practices to enhance Nigeria's creative economy as integral evidence of continuing implementation of the cultural policy.
Keywords: Cultural policy, Cultural resource management, Cultural diversity, Creative economy


This study aimed to determine the effect of implementation Cognitive Behaviour Modification (CBM) to improve the ability to manage stres on new students. The design research is one group Pretest-Postest. Based on the recommendations and observations, specified the ten new students FITK UIN Maliki as research subjects who indicated experiencing stres. Data on the ability to manage stres obtained from student records to fill Manage Stress Inventory (MSI). Hypothesis test results indicate CBM approach has a significant effect p = 0.000> 0.05. The average score of 82.00 (posttes scor) > 62.4 (pretest scor) and N-gain = 20. It can be concluded CBM approach has a significant impact on improving the ability to manage stress for new students.


Screening is seen by many as a key element in cancer control strategies. Differences in uptake of screening related to socio-economic status exist and may contribute to differences in morbidity and mortality across socio-economic groups. Although a number of factors are likely to underlie differential uptake, differential access to subsequent diagnostic tests and/or treatment may have a pivotal role. This study examines differences in the uptake of cancer screening in Ireland related to socio-economic status. Data were extracted from SLÁN 2007 concerning uptake of breast, cervical, colorectal and prostate cancer screening in the preceding 12 months. Concentration indices were calculated and decomposed. Particular emphasis was placed in the decomposition upon the impact of private health insurance, evidenced in other work to impact on access to care within the mixed public-private Irish health system. This study found that significant differences related to socio-economic status exist with respect to uptake of cancer screening and that the main determinant of difference for breast, colorectal and prostate cancer screening was possession of private insurance. This may have profound implications for the design of cancer control strategies in countries where private insurance has a significant role, even where screening services are publicly funded and population based.


Color and light are two ambient attributes for interior spaces that can be used in the design and modification of workspaces. The visual and psychological effects of color and light of each have been studied separately and widely. The aim of this study was to investigate the simultaneous effects of warm/cool white light on visual perception and mood in a simulated colored workspace. Thirty-three healthy male participants were recruited. They were asked to judge the visual perception and mood of three types of workspace that were designed by colors of white, red, blue, and lights of a cool and warm white in the random six sessions. The participants have experienced higher levels of tension, anger, depression, anxiety and lower levels of visual comfort, attractiveness, brightness and calmness of environment in the red condition than to white in both state of light. The blue wall reduced brightness and increased attractiveness of environment compared to white wall. Cool white light reduced the warmth of color and increased brightness in all three color environments compared to warm light. The preference for cool or warm light depends on the color of the environment's indoor surface. It seems that the combination of the white color and warm light or the blue color with cool light has a more favorable effect on visual perception and people's mood in workplaces.


Noscapine is an isolated compound from the opium poppy, with distinctive chiral structure and chemistry, interacts with other compounds due to having multiple π-acceptors, hydrogen bond acceptors, and ionic sites. Therefore, it has promising applicability for the enantioselective separation of a wide range of polar, acidic, basic, and neutral compounds. A new noscapine derivative chiral stationary phase (ND-CSP) has been synthesized by consecutive N-demethylation, reduction, and N-propargylation of noscapine followed by attachment of a solid epoxy-functionalized silica bed through the 1,3-dipolar Huisgen cycloaddition. The noscapine derivative-based stationary phase provides a considerable surface coverage, which is greater than some commercial CSPs and can validate better enantioresolution performance. The major advantages inherent to this chiral selector are stability, reproducibility after more than 200 tests, and substantial loading capacity. The characterization by Fourier transform infrared (FTIR) spectroscopy and elemental analysis indicated successful functionalization of the silica surface. Chromatographic method conditions like flow rate and mobile phase composition for enantioseparation of various compounds such as warfarin, propranolol, mandelic acid, and a sulfanilamide derivative were optimized. Comparing the experimental results with docking data revealed a clear correlation between the calculated binding energy of ND-CSP and each enantiomer with the resolution of enantiomer peaks.


The wide range of clinical severities exhibited by invasive Kingella kingae infections strongly suggests that isolates differ in their genomic contents, and strains associated with life-threatening endocarditis may harbor distinct genomic determinants that result in cardiac tropism and severe tissue damage. The results of the present study show that no single gene discriminated between asymptomatically carried isolates and invasive strains. ABSTRACT As a result of the increasing use of sensitive nucleic acid amplification tests, Kingella kingae is being recognized as a common pathogen of early childhood, causing medical conditions ranging from asymptomatic oropharyngeal colonization to bacteremia, osteoarthritis, and life-threatening endocarditis. However, the genomic determinants associated with the different clinical outcomes are unknown. Employing whole-genome sequencing, we studied 125 international K. kingae isolates derived from 23 healthy carriers and 102 patients with invasive infections, including bacteremia (n = 23), osteoarthritis (n = 61), and endocarditis (n = 18). We compared their genomic structures and contents to identify genomic determinants associated with the different clinical conditions. The mean genome size of the strains was 2,024,228 bp, and the pangenome comprised 4,026 predicted genes, of which 1,460 (36.3%) were core genes shared by >99% of the isolates. No single gene discriminated between carried and invasive strains; however, 43 genes were significantly more frequent in invasive isolates, compared to asymptomatically carried organisms, and a few showed a significant differential distribution among isolates from skeletal system infections, bacteremia, and endocarditis. The gene encoding the iron-regulated protein FrpC was uniformly absent in all 18 endocarditis-associated strains but was present in one-third of other invasive isolates. Similar to other members of the Neisseriaceae family, the K. kingae differences in invasiveness and tropism for specific body tissues appear to depend on combinations of multiple virulence-associated determinants that are widely distributed throughout the genome. The potential role of the absence of the FrpC protein in the pathogenesis of endocardial invasion deserves further investigation. IMPORTANCE The wide range of clinical severities exhibited by invasive Kingella kingae infections strongly suggests that isolates differ in their genomic contents, and strains associated with life-threatening endocarditis may harbor distinct genomic determinants that result in cardiac tropism and severe tissue damage. The results of the present study show that no single gene discriminated between asymptomatically carried isolates and invasive strains. However, 43 putative genes were significantly more frequent among invasive isolates than among pharyngeal colonizers. In addition, several genes displayed a significant differential distribution among isolates from bacteremia, skeletal system infections, and endocarditis, suggesting that the virulence and tissue tropism of K. kingae are multifactorial and polygenic, depending on changes in the allele content and genomic organization. Further analysis of these putative genes may identify genomic determinants of the invasiveness of K. kingae and its affinity for specific body tissues and potential targets for a future protective vaccine.


The present study investigates the nature of spectral envelope perception using a spectral modulation detection task in which sinusoidal spectral modulation is superimposed upon a noise carrier. The principal goal of this study is to characterize spectral envelope perception in terms of the influence of modulation frequency (cycles/octave), carrier bandwidth (octaves), and carrier frequency region (defined by lower and upper cutoff frequencies in Hz). Spectral modulation detection thresholds measured as a function of spectral modulation frequency result in a spectral modulation transfer function (SMTF). The general form of the SMTF is bandpass in nature, with a minimum modulation detection threshold in the region between 2 to 4 cycles/octave. SMTFs are not strongly dependent on carrier bandwidth (ranging from 1 to 6 octaves) or carrier frequency region (ranging from 200 to 12 800 Hz), with the exception of carrier bands restricted to very low audio frequencies (e.g., 200-400 Hz). Spectral modulation detection thresholds do not depend on the presence of random level variations or random modulation phase across intervals. The SMTFs reported here and associated excitation pattern computations are considered in terms of a linear systems approach to spectral envelope perception and potential underlying mechanisms for the perception of spectral features.


Ecosystem retention of N is mediated by interactions among plant, soil, and microbial processes. These are likely to change with forest ecosystem development as living plant biomass accumulation slows and detrital biomass increases. We investigated linkages among N storage, N cycling processes, and N leaching losses in a study of replicate mid- successional (80-yr-old) and late-successional (uneven-aged old-growth). northern hardwood forests in the western upper peninsula of Michigan, USA. Our study tested hypotheses that detrital biomass and microbial immobilization of N function as larger N sinks and corre- spond to greater N retention in old-growth compared to maturing second-growth forests. Aboveground living and detrital biomass pools were greater in old-growth compared to second-growth forest, a difference due largely to coarse woody debris (CWD). The total amount of N in detrital pools was significantly greater in old-growth than second-growth forests. We also found more rapid rates of microbial N immobilization in old-growth forests than in second-growth forests. In situ net N mineralization ranged widely among individual stands and did not differ between old- and second-growth forests. Nitrogen (organic + inorganic) leaching did not differ significantly between old-growth and second-growth forests, and was substantially lower than wet deposition inputs. Nitrate leaching losses were significantly related to soil NO3- pools, litterfall N flux, and fine root biomass across both old- and second-growth forest stands. We conclude that CWD and microbial N uptake and turnover are greater N sinks in old-growth than in second-growth forests. This apparent N sink was not the primary factor influencing N leaching loss, however. Patterns of N dynamics among individual forest ecosystems indicate that N losses correspond to net rates of N mineralization and to litterfall N flux (indicators of plant N cycling), which are independent of forest age, biomass pools, and gross N transformations at the successional stages that we compared.


This is the legendary travel diary that the 24-year-old Charles-Edouard Jeanneret (Le Corbusier) kept during his first journey through central and eastern Europe. In a flood of highly personal impressions and visual notations, it records his first contact with the vernacular architecture that would preoccupy him for the rest of his life and with the monuments he most admired, the mosque complexes, the Acropolis, and the Parthenon. "'Very often, I left the Acropolis burdened by a heavy premonition, not daring to imagine that one day I would have to create.' Such words, are moving from any aspiring architect; from Le Corbusier they are an inspiration."-- "Progessive Architecture An this centenary year [1987] of his birth, many books are being published about Le Corbusier but none offers more insight into his character than this book from his own hand ... Every designer speculates at one time or another just what attributes other than talent are needed for success. In the case of the young Le Corbusier this travel journal reveals... extraordinary ego, energy, curiosity, and passion."-- "Interior Design Ivan Zaknic, the editor and translator, is Associate Professor of Architecture at Lehigh University.


SUMMARY The primary purpose of this paper is to present the actual role of accounting information systems. After the description of the theoretical background I state the main characteristics of modern accounting systems, and explain how these software packages can efficiently help not only the work of the accountant, but also of the management.


The generation of the acoustic vibration of laser back-irradiated thin metal foils and their influence on desorption of organic molecules from the foil's front surface were studied. The possible mechanisms of this phenomenon are discussed.


We present an operator‐splitting scheme for fluid–structure interaction (FSI) problems in hemodynamics, where the thickness of the structural wall is comparable to the radius of the cylindrical fluid domain. The equations of linear elasticity are used to model the structure, while the Navier–Stokes equations for an incompressible viscous fluid are used to model the fluid. The operator‐splitting scheme, based on the Lie splitting, separates the elastodynamics structure problem from a fluid problem in which structure inertia is included to achieve unconditional stability. We prove energy estimates associated with unconditional stability of this modular scheme for the full nonlinear FSI problem defined on a moving domain, without requiring any sub‐iterations within time steps. Two numerical examples are presented, showing excellent agreement with the results of monolithic schemes. First‐order convergence in time is shown numerically. Modularity, unconditional stability without temporal sub‐iterations, and simple implementation are the features that make this operator‐splitting scheme particularly appealing for multi‐physics problems involving FSI. Copyright © 2013 John Wiley & Sons, Ltd.


As flash flood events are becoming more frequent, the development of flood estimation methods for areas with limited or lack of data has attracted the interest of many scientists. The aim of the present paper is to develop a GIS based methodology in order to study the flood risk in Karlovassi basin. The annual probability of a flood event is relatively high at Karlovassi area (Samos Island – Greece). Especially, after the forest fires that took place in the summer of 2000, during which 90.000 hectares were burnt in Kerketeas Mountain, the phenomenon has become more intense. Primary data were collected from maps, literature, aerial photos and field work. The collected information data were analyzed through the use of the software ArcGIS in order to generate the appropriate background for the formation of the flood risk model. All the input parameters were weighted and the model was calibrated in situ through field work. The proposed methodology and the preliminary results, as exported for the Karlovassi area, prove the suitability of GIS-based methods in the creation of flood risk maps.


This thesis is conducted for Royal IHC and Witteveen+Bos. Royal IHC is a Dutch ship builder and Witteveen+Bos an engineering consultant. Both companies have encountered the problems of water hyacinth. Water hyacinth, Eichhorni Crasippus, is an aquatic weed which is widespread throughout the tropics and subtropics. It is an invasive species in most parts of the world and has a large impact on the local ecology, economy, livelihood and safety of people. Water hyacinth can be controlled by mechanical harvesting. Once the plant is harvested the biomass can be used as a resource. The aim of this research is to assess the potential value of the water hyacinth as a renewable resource and determine if it is economically feasible to process water hyacinth on an industrial scale, more than one hectare harvest a day. In order to assess the economic feasibility of water hyacinth usage, a literature study was conducted to evaluate the characteristics of the plant and define the processing options. Secondly a canvas business model and a cost-benefit analysis were made to assess the value chain and the theoretical feasibility of an investment in a large scale water hyacinth processing project. The final and third step was a business case based on a field trip to Kenya, to validate the theoretical business model and cost benefit analysis. Water hyacinth is a very fast growing plant which reproduces both sexually and vegetativly. The plant is so successful because it can adapt easily to its environment. The plant thrives in eutrophicated and polluted water bodies. In these water bodies heavy metals are taken up by the plant and these have to be taken into account for usage of the biomass. The biomass of water hyacinth can be used for three purposes 1) energy 2) agriculture and 3) industry. The biomass is least valuable when it is used for its minerals, for biogas and energy production. Based on the literature review it was found that water hyacinth can best be used for the production of 1) animal feed 2) biogas and 3) fertilizer. The business models for these three products were assessed because of the high value of the end products and the feasibility of production in developing countries. For the processing of water hyacinth into animal feed, the leaves and the roots should be separated as animal feed can only be produced from the leaves. The roots and shoots can be separated during harvest by specialized equipment. A business canvas was used to describe a business model for a company processing water hyacinth. The business models can vary because the location and water bodies where the weed grows are different. It was found that large scale processing is mostly feasible in big lake structures because of the availability of biomass. To evaluate if an investment in water hyacinth processing facilities is feasible the Net Present Value (NPV) was calculated. From the theoretical cost benefit analysis it could be concluded that water hyacinth processing is feasible for the production of animal feed, biogas and fertilizer. The production of electricity and compost is not economically feasible because of low prices and low efficiency. To validate the assumptions made for the theoretical business model a business case was conducted in Kisumu, Kenya. For the business case, market data was assessed on local markets and all main stakeholders were interviewed. The market prices found are variable. A Monte Carlo simulation was therefore conducted. It is concluded that a water hyacinth processing plant is economically feasible. The internal rate of return determined in the business case was higher than found in the theoretical model. This can be explained by high demand and prices for animal feed and cooking gas. There is a large milk deficit in the case study area and dairy projects are likely to be started. Animal feed is however a constraint in the area. Local governments are therefore interested in production of animal feed from the weed. The local authorities are also interested in removal of water hyacinth because of the negative impacts of the plant, in particular the blocking of waterways. There is however no budget for removal of the plant. Water hyacinth usage is not propagated by the national government because of concerns that the problem of water hyacinth will increase if a commercial use is found. The plant is not abundant throughout the year in Lake Victoria because it infests the lake in cycles. It is concluded that it is economically feasible to process water hyacinth into animal feed, biogas and fertilizer. Using water hyacinth to produce agricultural products will stimulate agriculture development and use nutrients to the best potential. Year round availability of water hyacinth for processing is however a problem. Cultivation of water hyacinth and alternative biomass sources need to be assessed. The processing of water hyacinth into animal feed is particularly recommended because it is the most valuable product. There will also be opportunities in the future for animal feed because of expected scarcity of animal feed. More research is needed for adapting harvesting equipment. For a pilot project a partner has to be selected as water hyacinth processing is not the core business of IHC or Witteveen+Bos. Partnerships with corporates in the feed and dairy industry should be evaluated. The whole value chain can then be established by processing water hyacinth into animal feed.


Knowledge Graphs (KGs) have emerged as fundamental platforms for powering intelligent decision-making and a wide range of Artificial Intelligence (AI) services across major corporations such as Google, Walmart, and AirBnb. KGs complement Machine Learning (ML) algorithms by providing data context and semantics, thereby enabling further inference and question-answering capabilities. The integration of KGs with neuronal learning (e.g., Large Language Models (LLMs)) is currently a topic of active research, commonly named neuro-symbolic AI. Despite the numerous benefits that can be accomplished with KG-based AI, its growing ubiquity within online services may result in the loss of self-determination for citizens as a fundamental societal issue. The more we rely on these technologies, which are often centralised, the less citizens will be able to determine their own destinies. To counter this threat, AI regulation, such as the European Union (EU) AI Act, is being proposed in certain regions. The regulation sets what technologists need to do, leading to questions concerning: How can the output of AI systems be trusted? What is needed to ensure that the data fuelling and the inner workings of these artefacts are transparent? How can AI be made accountable for its decision-making? This paper conceptualises the foundational topics and research pillars to support KG-based AI for self-determination. Drawing upon this conceptual framework, challenges and opportunities for citizen self-determination are illustrated and analysed in a real-world scenario. As a result, we propose a research agenda aimed at accomplishing the recommended objectives.


Endocytosis has been suggested to be crucial for the induction of plant immunity in several cases. We have previously shown that two Arabidopsis proteins, AtEHD1 and AtEHD2, are involved in endocytosis in plant systems. AtEHD2 has an inhibitory effect on endocytosis of transferrin, FM-4-64, and LeEix2. There are many works in mammalian systems detailing the importance of the various domains in EHDs but, to date, the domains of plant EHD2 that are required for its inhibitory activity on endocytosis remained unknown. In this work we demonstrate that the coiled-coil domain of EHD2 is crucial for the ability of EHD2 to inhibit endocytosis in plants, as mutant EHD2 forms lacking the coiled-coil lost the ability to inhibit endocytosis and signaling of LeEix2. The coiled-coil was also required for binding of EHD2 to the LeEix2 receptor. It is therefore probable that binding of EHD2 to the LeEix2 receptor is required for inhibition of LeEix2 internalization. We also show herein that the P-loop of EHD2 is important for EHD2 to function properly. The EH domain of AtEHD2 does not appear to be involved in inhibition of endocytosis. Moreover, AtEHD2 influences actin organization and may exert its inhibitory effect on endocytosis through actin re-distribution. The coiled-coil domain of EHD2 functions in inhibition of endocytosis, while the EH domain does not appear to be involved in inhibition of endocytosis.


When developing reinforcement learning agents, the standard approach is to train an agent to converge to a fixed policy that is as close to optimal as possible for a single fixed reward function. If different agent behaviour is required in the future, an agent trained in this way must normally be either fully or partially retrained, wasting valuable time and resources. In this study, we leverage multi-objective reinforcement learning to create tunable agents, i.e. agents that can adopt a range of different behaviours according to the designer's preferences, without the need for retraining. We apply this technique to sequential social dilemmas, settings where there is inherent tension between individual and collective rationality. Learning a single fixed policy in such settings leaves one at a significant disadvantage if the opponents' strategies change after learning is complete. In our work, we demonstrate empirically that the tunable agents framework allows easy adaption between cooperative and competitive behaviours in sequential social dilemmas without the need for retraining, allowing a single trained agent model to be adjusted to cater for a wide range of behaviours and opponent strategies.


This paper focuses on item recommendation for visitors in a museum within the framework of European Project CrossCult about cultural heritage. We present a theoretical research work about recommendation using bicluster-ing. Our approach is based on biclustering using FCA and partition pattern structures. We investigate the possibility of incorporating the order information using this approach. Then, given the dataset of visitor trajectories, the result of our biclustering can be used to build a collaborative recommendation system.


Mitochondrial and microsomal oxidation reactions were studied at varying intensities of lipid peroxidation (LPO). The latter were modelled by using thermal burn and combined radiation-thermal injury in animals. It was found that the differences in the intensity and duration of free radical oxidation and LPO reactions may lead to the activation or inhibition of mitochondrial respiration due to the oxidative phosphorylation uncoupling and impaired microsomal and microsomal-mitochondrial intermembrane electron transport and depend on the activities of superoxide dismutase, glutathione reductase and catalase.


The use of more powerful and sophisticated electronic devices on today's military and commercial aircraft has increased demands on the aircraft electrical system. These devices place additional loads on the main aircraft battery during preflight systems checkout and during an electrical power emergency. The maintenance-free Sealed Nickel-Cadmium (SNC) battery has demonstrated high reliability, high power capability, and increased energy storage for these applications. Electro Energy, Mobile Products (EEMP) Inc, (formerly the Power Systems Department of Eagle-Picher Technologies, LLC) has developed and manufactured sintered plate nickel cadmium (NiCd) batteries for several flight programs. The sintered plate construction in NiCd's allows for high power density, long cycle life, and good low temperature performance. Nickel based batteries continue to play a significant role in the aircraft battery industry; therefore, it is important to review the benefits of this battery chemistry. This paper includes a review of flight programs and important information for use in selection of battery chemistries for various applications. Several platforms have adopted this technology for flight and historical data will be presented that will identify the benefits of sintered plate NiCd batteries. Because reduction of maintenance and service costs continues to be a topic of significant importance, information on the sealed maintenance-free (SMF) aircraft battery and the variations in battery design for specific applications will be provided.


INTRODUCTION
Smoking occurs frequently during pregnancy, thereby putting mother and child at health risks. Low socio-economic status is a risk factor for smoking.

AIM
To investigate the relationship between smoking and low income in teenage and adult pregnancy, which is an important measure of poor socioeconomic status.

METHOD
The authors used subject-level data from the US NSDUH database, which contains information on pregnancies and smoking.

RESULTS
Teenage pregnancy is associated with higher, whereas adult pregnancy with lower prevalence of smoking, compared to the age-matched female population. The association between income and smoking is age-dependent. Among adults there is an inverse relationship (high income -- low-risk of smoking), while in teenage pregnancy smoking increases with income.

CONCLUSIONS
To investigate in teenage and adult pregnancy the relationship between smoking and low income, which is an important measure of poor socio-economic status. Higher socioeconomic status may be associated with risky behaviour, thereby increasing both the risk of smoking and early pregnancy.


The central goal of this master thesis is to improve the product communication of local SMEs in low-wage markets, by improving the advisory support given to these SMEs by BoP Innovation Center (BoPInc). BoPInc provides two-day trainings to support the SMEs on innovating their marketing and distribution. Currently, the SMEs are challenged by the implementation process of the training outcomes. The goal of this assignment was to improve the process of implementing the training outcomes.First, the current advisory support process and the training tools of BoPInc were analysed to identify the main changes that need to be made within the process. Two solution spaces were identified for which additional literature has been found. This literature address these solution spaces. To include more explicit insights into the training, the Cultura wheel (Hao, van Boeijen, a Jan Stappers, 2017) has been used. To create more practical outcomes of the training, Storytelling has been included. Both theories were reviewed, and together with the BoPInc knowledge taken towards the next phase of this project.During a Case study, this knowledge was combined and used to design a communication plan for an Ugandan SME that designs, produces and markets clean cooking stoves. During a three week full immersion, the cultural context, end user, current usage and current interactions were explored. These insights were structured and formed the desired interaction. Finally, a communication plan was designed. This communication plan targets low income peri-urban women during their community group meetings.The communication materials were designed with the use of Storytelling, while the insights were included in this design by using the Cultura wheel. Reflecting on the overall process, this thesis resulted in starting point of advice for BoPInc on the improvement of its current trainings. Two canvases were designed, a Cultura Canvas and a Storytelling Canvas. Together they create more practical outcomes of the trainings, while including insights of the cultural context.


The redistribution of spin‐ or fluorescence‐labeled phospholipid analogs across the plasma membrane of human osteoblast cells, either in suspension or grown as monolayers, was investigated. After incorporation into the outer membrane leaflet, analogs of the aminophospholipids phosphatidylserine and phosphatidylethanolamine moved rapidly to the inner monolayer, whereas the choline‐containing analogs of phosphatidylcholine and sphingomyelin disappeared more slowly from the outer leaflet. The fast inward movement of the aminophospholipids became reduced after lowering the intracellular ATP, suggesting the presence of an aminophospholipid translocase activity in the plasma membrane of these cells. From these data, a transverse phospholipid asymmetry in osteoblasts can be inferred with the aminophospholipids mainly concentrated in the inner monolayer and the choline‐containing phospholipids in the outer leaflet. A similar pattern of phospholipid internalization was inferred for osteoblasts from human osteoporotic bones and for a human osteosarcoma cell line. The relevance of the enrichment of phosphatidylserine in the cytoplasmic membrane leaflet for calcification in skeletal tissues is emphasized.


Abstract A virtual vibrational spectrometer HF-Spectrodyn, based on efficient computational codes and exploring both restricted and unrestricted Hartree-Fock approximations, is proposed to perform computational vibrational spectroscopy of large sp2 carbon clusters. The computational device allows obtaining one-quantum harmonic spectra of IR absorption and Raman scattering of closed-shell and open-shell molecules. The spectrometer facilities are manifested for the sp2 hydrocarbons on the example of polyacenes (naphthalene and pentacene) and polycyclic benzenoid-fused compounds (coronene as well as (5,5) and (9,9) periacenes). The observed trends disclose a new spectrometric approach for the consideration of vibrational spectra of the molecules in terms of standard valence bonds subjected to particular structural and atomic-content affects.


At a time when the South African water department and a circle of water experts in the country are defining their position on water users' associations (WUAs), this paper looks at people's actions and perceptions of local water management as a fundamental factor to understanding small farmers' interactions with these newly established institutions. It presents the preliminary results of a community study conducted at Thabina irrigation scheme, Limpopo, between September 2007 and April 2008. This study offers an original approach to analyzing the scheme's difficulties and, without providing a representative image of smallholder irrigation schemes in South Africa, it allows for interesting preliminary reflections around small farmers' perceptions of water management and local water management institutions. The study of perceptions is not new, nor does it belong as an analytical tool to one or other academic discipline. In order to fully grasp this complex and multidimensional object, a transdisciplinary approach is therefore applied and implemented in the field by using an innovative set of methods: interviews, verbal associations and participatory photography. The advantages and difficulties related to the use of a perception and transdisciplinary approach are discussed.


Recognition of diversity among learners' world over by teachers and school administrators' remains key in education. Teachers of Agriculture in secondary schools are aware of the existence of diversity among learners in their classes, but appear indifference in terms of demographic characteristics such as age, gender, level of training and years of teaching experience in managing learners with diversity in secondary schools. Although a number of studies have been conducted in Kenya on factors that affect learners' diversity management among teachers, much of such studies used cross sectional survey and were especially in the areas of special and inclusive education. The objective of this study was to examine the influence in gender of teachers of Agriculture on classroom diversity management in secondary schools in Homa Bay County, Kenya. A sample of 486 comprising of teachers and students of agriculture were considered in this study. Data collection instruments such as questionnaires and interview schedule were used and through a testretest method during the pilot study an acceptable Cronbach's coefficient Alpha of 0.79 were obtained. Data was analysed using descriptive and inferential statistics. It is evident that there was statistically significant difference in scores for males (mean =2.788, SD=.586) and females [mean=3.104, SD=.525; t (87) = -2.636, p=.010], with female teachers of Agriculture recording higher scores in classroom diversity. Thus, the findings imply that gender of teachers of Agriculture had greater influence on their classroom diversity management in secondary schools in Homa Bay County, Kenya is statistically significant. The study recommends the need to balance gender with other demographic structures while posting teachers of agriculture to secondary schools to enhance classroom diversity management.


Vertical Bragg grating mirrors are realized by the anisotropic etching of Si using deep reactive ion etching (DRIE), thus producing multiple vertical interfaces between Si and air. The Bragg mirrors are used to realize two optical filter configurations. The first is a tunable Fabry-Peacuterot cavity composed of two mirrors, where tuning is achieved by moving one of the mirrors using silicon-on-insulator (SOI) electrostatic microelectromechanical system (MEMS) actuation. The second is a drop filter, where a tilted Bragg mirror acts as a wavelength selective reflector. The enhanced etching process involving a mix of cryogenic and Bosch DRIE processes is presented. The realized structures, fabrication process, as well as measured performance are also presented


Theories of migrant transnationalism emphasize the enduring imprint of the premigration connections that the newcomers bring with them. But how do the children of migrants raised in the parents' adopted country develop ties to the parental home country? Using a structural equation model and data from a recent survey of adult immigrant offspring in Los Angeles, this article shows that second-generation cross-border activities are strongly affected by earlier experiences of and exposure to home country influences. Socialization in the parental household is powerful, transmitting distinct home country competencies, loyalties, and ties, but not a coherent package of transnationalism. Our analysis of five measures of cross-border activities and loyalties among the grown children of migrants shows that transmission is specific to the social logic underlying the connection: activities rooted in family relationships such as remitting are transmitted differently than emotional attachments to the parents' home country.


To scale with the on-chip wire delay, the inside of a processor will further be partitioned into more small banks. As the amount of data cache bank scales, the load routing latency will contribute a considerable portion to program executing time. In a tiled processor like T-Flex, we observed that the average load routing latency (hit in data cache) can be largely reduced (by 72.1%) when data is perfectly placed in where the load issues. To reduce the long routing latency of critical loads, we give out a solution for localizing load execution at issuing side in this paper. However, this method will induce overhead of data copies and extra communications to maintain coherence and memory order. We explore the design space for localizing data access, with special respect to maximizing benefits at expense of relatively small overhead. We observed the access frequency and load store behaviors for different copies vary largely, with large amount of successive load accesses concentrating on small amount of data blocks. Our experiments show that with special replication and data copy invalidation strategies, copying overhead will be controlled while maintaining considerable performance profits.


Susilawati, D. M., Syamsul Maarif, M., Widiatmaka & Lubis, I. (2019). Appraisal of shallot farming sustainability in Brebes Regency, Central Java Province, Indonesia. Bulgarian Journal of Agricultural Science, 25(5), 872–882 Shallot farming in Brebes Regency faces some problems to reach the sustainability. The objective of this study was to analyse index and sustainability status of shallot farming in Brebes Regency. The analysis used modifi cation of Rapfi sh method by using Multidimensional Scaling that we called RAP-SHALLOT. The analysis of sustainability of shallot farming in multidimensional revealed that shallot farming carried out by farmer was less sustainable with the sustainability index was 46.18. This index was contributed from ecological, technological, and institutional dimension which was in less sustainable category with index as 46.72; 43.24; and 37.52, while the economic and social dimension were fair sustainable with index as 52.99; 50.43. According to attribute leverage analysis showed that from 45 existing attributes, there were 17 sensitive attributes as leverage factor. They were no yield shallot caused by pests, no yield shallot caused of fl ood occurs, rainfall per year, the use of chemical fertilizers per ha, the capacity of farmer capital, farmer exchange rate of horticulture sub-sector, prices fl uctuations, inter-cropping plants, time allocation, shallot management system, time of fertilization, application of fertilization, integrated pest management, the existance of agricultural extension, the initial capital of shallot farming, the existance of broker/middleman, and farming main partner. Government intervention is needed to improve the performance of sustainability by prioritizing the sensitive attributes in ecology, technology and institutional dimensions that were categorized as less sustainable to be fair sustainable, while the economic and social dimensions which was categorized as fair sustainable should be developed well for getting a balancing and integrated sustainability.


Automatic recognition of an image's style is important for many applications, including artwork analysis, photo organization, and image retrieval. Traditional convolution neural network (CNN) approach uses only object features for image style recognition. This approach may not be optimal, because the same object in two images may have different styles. We propose a CNN architecture with two pathways extracting object features and texture features, respectively. The object pathway represents the standard CNN architecture and the texture pathway intermixes the object pathway by outputting the gram matrices of intermediate features in the object pathway. The two pathways are jointly trained. In experiments, two deep CNNs, AlexNet and VGG-19, pretrained on the ImageNet classification data set are fine-tuned for this task. For any model, the two-pathway architecture performs much better than individual pathways, which indicates that the two pathways contain complementary information of an image's style. In particular, the model based on VGG-19 achieves the state-of-the-art results on three benchmark data sets, WikiPaintings, Flickr Style, and AVA Style.


Extensive research has evaluated potential negative effects of military deployments on romantic relationships. Comparatively few studies have examined potential positive effects of such deployments. In stressful situations, benefit finding (BF) has been found to be linked with better functioning on both individual and interpersonal levels. This study reports on deployment-related BF in a sample of 67 male service members (SMs) who deployed at least once since 9/11/2001 and their wives. Couples completed measures of marital satisfaction at baseline (an average of 1 year postdeployment) and follow-up 4-6 months later. At follow-up, SMs also provided data on symptoms of posttraumatic stress, and both partners provided reports of deployment-related BF. Multivariate path analysis controlling for SMs' PTSD symptom severity revealed that wives' BF was positively associated with increases in SMs' relationship satisfaction. These findings suggest that wives' responses to deployment may be more influential than SMs' responses to deployment on military couples' relationships. This pattern indicates that support for spouses during deployments is essential; furthermore, such support should include an emphasis on trying to facilitate personal growth in spouses.


The necessity to develop new laser materials of tungstates and molybdates is our motivation to study a new family of molybdates activated by Nd3+ ions, which crystallizes in the scheelite-type structure (the tetragonal symmetry, the space group I41/a). A series of Cd1−3xNd2x□xMoO4 stable solid solutions with concentration of Nd3+ ions from 0.1 mol% to 66.67 mol% with respect to Cd2+ ions were successfully synthesized by a high-temperature annealing, using CdMoO4 and Nd2(MoO4)3 as the starting materials. Structural and spectroscopic characterizations of Nd3+ substituting Cd2+ ions were carried out. The substitution of divalent Cd2+ by trivalent Nd3+ cations leads to the formation of cationic vacancies in the framework (which are denoted in the chemical formula as □). The Nd3+ ions in this matrix occupy two non-equivalent symmetry sites depending on the location of these vacancies. Concentration of vacancies depends essentially on the composition of initial CdMoO4–Nd2(MoO4)3 mixtures. The SEM analysis of crystal morphology reveals high homogeneity of the nearly-spherical shaped products with an average grain size of about 1–10 μm. Optical analysis and the laser parameters suggest that Cd1−3xNd2x□xMoO4 can be considered as a potential laser material. Both the values of the absorption cross-section and the strong emission of the 4F3/2 → 4I11/2 laser channel of Nd3+ recorded under LED source excitation or OPO laser pumping, as well as the radiative lifetimes of NIR luminescence, are appropriate for potential applications of this optical material as a solid state laser.


Approximately 2% of the estimated 24,000 patients in the United States who contract cat-scratch disease annually develop neurologic complications. Between 1989 and 1999, 36 patients were admitted to our hospital with cat-scratch disease; 25% had neurolugic complications, and the majority experienced lengthy hospital stays. We describe a case of cat-scratch disease encephalopathy in a 4-year-old girl who responded to high-dose corticosteroid therapy. Further studies are warranted to determine if corticosteroid therapy shortens the duration of symptoms, lessens the severity of disease, and ultimately improves the outcome for patients with cat-scratch disease encephalopathy. (J Child Neurol 2001;16:762-763).


The purpose of this article is to provide a review of the current knowledge and opinions about the epidemiology, clinical findings (including sequelae), diagnosis, treatment and monitoring of equine pituitary pars intermedia dysfunction, particularly in the Australian context. This information and the recommendations provided will assist practitioners in making informed decisions regarding the diagnosis and management of this disorder.


Attitudes with regard to food are good predictors of behavior and a good knowledge of it plays an important part in dietary education according to different groups of the population especially high-risk groups lacking nutrients. An evaluation of attitudes of persons aged 65+ with regard to new and unknown food as well as the acquaintance and degree of approval presented in examining convenience products with health-focused properties was the main aim of the research. The level of neophobia of dietary practices in terms of the examined group of women was lower comparing to the level in men. Consumption and/or the desire for trying out new, unknown food of a high nutritional value by the group of seniors aged 60+ is beneficial and can be used to popularize health-focused dietary practices in this population group. Therefore, taking educational actions by producers of convenience food with health-focused properties is vital and should be aimed at propagating a health-focused model of eating in circles of elderly people. Such undertakings should be based on quality features of the product, the need for rational trophism and the influence of bioactive elements on health.


Production of successive clutches within the same breeding season has received less attention than many other aspects of avian reproduction. Waders are of particular interest because in these birds, multiple clutches are associated with at least three different breeding systems: double-clutching (uniparental care), monogamous double-brooding (biparental care) and polyandry (uni- or biparental care). Data from eight species and twelve breeding populations suggest that early second clutches, and thus brood overlap, are associated with parental role division and uniparental care, whereas species or populations with biparental care tend to have long intervals between successive clutches. We suggest that ecological factors influencing the relative timing of the second clutch will have consequences for the parental care system. In particular, conditions that favour early laying of the second clutch (large brood overlap) are likely to lead to parental role division, as found in double-clutching species. Factors determining the timing of second clutches are discussed, as are possibilities for testing these ideas.


Peer to peer technology plays an important role in spatial data sharing because of its distributed and decentralized nature. In spatial P2P each peer stores a part of the available spatial information and runs software with equivalent functionality rather than through a central server. Spatial P2P is dynamic in nature where the network structure is always changing. Spatial objects are having distinct properties like identity, location and relationship among them and spatial data is multidimensional. Spatial data sharing process like storing, querying and retrieving large amounts of data is a complex task. It requires the potential of preserving multidimensionality of heterogeneous spatial data without the time complexity and load balancing. It can be simplified if some intelligent techniques will be used. The main objective of this paper is to analyze the process of preserving the locality and dimensionality of space in the network. It maintains the multidimensionality of the spatial data in grid approximation which is done by some intelligent indexing technique and searching. Keywordsspatial data, p2p system, load balancing, grid, DHT


As the best thermal insulator, aerogels could be used for high-efficiency insulation under exoplanet environment. There is the high day-night temperature difference in the exoplanets, thus the failure analysis of the aerogels under thermal shock could be studied. In this paper, hydrophilic and hydrophobic fiber-reinforced silica aerogels were forced to undergo liquid nitrogen-room temperature thermal shocks. Thermal conductivity, mechanical property and the microstructure were characterized for understanding the failure mechanism. It was found that after multiple shocks, the thermal conductivity of hydrophilic aerogel increased 35.5% after the first shock and kept in a high value, while that of the hydrophobic aerogel increased 19.5% and kept in a relatively low value. Pore size distribution results showed that after the first shock the peak pore size of the hydrophilic aerogel increased from 18 nm to 25 nm due to the shrinkage of the skeleton, while the peak pore size of the hydrophobic aerogel kept at ~9 nm probably induced by the spring-back effect. The high-strain hardening and low-strain soften behaviors further demonstrated the skeleton shrinkage of the hydrophilic aerogel. The existence of the free water in the infrared spectra of both aerogels indicated the driving force of the skeleton shrinkage may be the volume change of the absorbed water during freezing process. For further demonstrating the mechanism, the aerogels were treated at 80 oC under vacuum environment before conducting shock experiments. After the first shock, the thermal conductivities of the hydrophilic and hydrophobic aerogels were increased only 14.0% and 0.4%, respectively. In addition, multiple shock experiments showed that the failure processes of the hydrophilic and hydrophobic aerogels are irreversible and reversible, respectively, revealing their different failure modes.


The ammonoid cephalopods range from the early Devonian to the late Cretaceous, a period of some 320 Ma. Because of their importance for biostratigraphic discrimination and their use in practical age dating for this period they have been intensively studied. Major extinctions at the close of the Devonian, end Permian, end Triassic and end Cretaceous have long been recognized and linked with regressional palaeogeographical events. The recognition of smaller-scale extinction events is relatively new and is especially well shown in the Palaeozoic, when there was a simpler distribution of land and sea pathways than in later periods when the influence of latitudinal distributions and local provinces was more severe. Extinction events in the Devonian show the nature of the process. Usually a gradual decline in diversity is followed by extinction; then there is a period of low diversity but often individual abundance. Then novelty appears and is seen in new characters of the early stages; elaboration and diversification follow. These fluctuations can often be correlated with changes in other groups and also with sedimentological and palaeogeographical changes. Usually a regression-transgression couplet is involved with evidence of ocean turnover indicated by anoxic or low-oxygen events. A new family, Sobolewiidae, is diagnosed. A new analysis of diversity, appearances and extinctions is made at the family level for 2 Ma time units throughout the history of the Ammonoidea. This record is compared with modern attempts to portray sea-level fluctuations and onlap and offlap movements of marine seas. The correlation, even in detail, is impressive and gives support for the species/area theory. But it is argued that temperature, as well as sea-level factors, is important. The evidence, on both large and small scales, shows an association of evolutionary change with palaeogeographical change. The new evidence does not suggest a role for periodicity above the Milankovitch Band level. Whether or not periodicity is involved, such factors seem more readily explained in endogenic earth causations and for the present these provide the most parsimonious explanations.


XPS has extensively been applied to the study of polymers, in which a considerably important topic is the surface phase separations in block copolymers and blends. Copolymers (or blends) will produce a phase separation if their components are in-


Increasing complexity of microprocessor-based systems puts pressure on a product's time-to-market. We describe a methodology used in designing the system interface of UltraSPARC-I. This methodology allowed us to define the system interface architecture, verify the functionality, perform timing and noise analysis and do the physical board design in parallel. This concurrency permitted rapid implementation of the microprocessor and the system.


s of the 2007 Conference on Gastrointestinal Function, Chicago, Illinois, USA. April 16 18th, 2007 O-1.1 New insights into the prokaryotic community of the mucosal fraction of human ileum: A metagenomic approach M. Leclerc, L. Sychova, C. Booijink, P. Lepage, C. Caron, R. Nalin, M. Gelfand, Ph. Marteau, and J. Doré INRA, Jouy en Josas, France NosGenetika, Moscow, Russia WCFS, Wageningen, The Netherlands Libragen, Toulouse, France HEGP, Paris, France In order to investigate the functions of uncultured microorganisms associated with the human ileum mucosa, a 20,000 clone-fosmid library was constructed from an ileum segment obtained from an individual. The high molecular weight DNA obtained was used for both constructing a fosmid library and performing PCR-based 16S rDNA archaeal and bacterial molecular inventories. A total of 76 clones from the metagenomic library were randomly selected, and full inserts were sequenced. Diversity of the fosmid inserts, based on protein identification, compared, at a phylum level, with its counterpart from the 16S rDNA molecular inventory performed on the same DNA: the dominant members of the ileum mucosa are part of the Bacteroides and Firmicutes phylum. Annotation of 76 full 40 kb fosmid inserts provided preliminary data of the putative functions of the microorganisms. Among the set of 1172 putative proteins, we will highlight the genes indicating the occurrence of an anaerobic trophic chain in the ileal mucosa, such as genes involved in sugar and carbohydrate catabolism. Sequence comparisons with the published TIGR metagenomic dataset were performed. Among the 43 fosmids with no hits with the published TIGR metagenomic dataset, 37 corresponded taxonomically to the Bacteroidetes phylum. Conversely, strong matches were observed for 12 fosmid inserts, described taxonomically as Firmicutes and Enterococcus . Two examples of biological validations of annotations will be given. Firstly, the expression of several proteins of interest could be obtained in the host strain background. We will show the xylanase activity assay and substrate utilization by fosmid clones. For the latter, the whole ileum fosmid library was screened for its capacity to grow on sugars and polymers including cellulose and cellobiose, on mucin and its components (fucose, N-acetyl glucosamine, N-acetyl galactosamine) and on the prebiotics GOS and FOS. Secondly, the prevalence of bacteriophages in our sequence data set (4/76 inserts consisted entirely of phage genes), prompted us to investigate the abundance and diversity of Virus-Like-Particles in human GIT. VLP numbers averaged 3.5 /10/g in fecal samples and strikingly 1.2 /10/biopsy in the mucosal samples, indicating that the mucosal environment of the intestine may represent an ecological niche for dense communities of bacteriophages.


Background Plasmodium vivax is responsible for a significant portion of malaria cases worldwide, especially in Asia and Latin America, where geo-helminthiasis have a high prevalence. Impact of the interaction between vivax malaria and intestinal helminthes has been poorly explored. The objective of this study was to evaluate the influence of intestinal helminthiasis on the concentration of hemoglobin in children with Plasmodium vivax malaria in rural areas in the municipality of Careiro, in the Western Brazilian Amazon. Methodology/Principal Findings A cohort study was conducted from April to November 2008, enrolling children from 5 to 14 years old in two rural areas endemic for malaria. A cross-sectional evaluation was performed in April to actively detect cases of malaria and document baseline hemoglobin and nutritional status. Children were followed-up for six months through passive case detection of malaria based on light microscopy. Throughout the follow-up interval, hemoglobin value and stool examination (three samples on alternate days) were performed on children who developed P. vivax malaria. For 54 schoolchildren with a single infection by P. vivax, hemoglobin during the malaria episode was similar to the baseline hemoglobin for children co-infected with Ascaris lumbricoides (n = 18), hookworm (n = 11) and Trichuris trichiura (n = 9). In children without intestinal helminthes, a significant decrease in the hemoglobin during the malarial attack was seen as compared to the baseline concentration. In the survival analysis, no difference was seen in the time (in days) from the baseline cross-sectional to the first malarial infection, between parasitized and non-parasitized children. Conclusion/Significance For the first time, a cohort study showed that intestinal helminthes protect against hemoglobin decrease during an acute malarial attack by P. vivax.


Every parent, caregiver - and toddler - knows the misery that comes with meltdowns and temper tantrums. Through rhythmic text and warm illustrations, this gentle, reassuring book offers toddlers simple tools to release strong feelings, express them, and calm themselves down. Children learn to use their calm-down place - a quiet space where they can cry, ask for a hug, sing to themselves, be rocked in a grown-up's arms, talk about feelings, and breathe: 'One, two, three...I'm calm as can be. I'm taking care of me.' After a break, toddlers will feel like new - and adults will, too. It features a dynamic, award-winning author/illustrator team of the best-selling "Best Behavior[trademark]" series. An unique and fresh series look and design complements gentle and reassuring text. The books engage toddlers in facing daily routines and transitions with confidence. Tips for parents and caregivers are included at the end of each book. It is ideal for both home and childcare settings.


A series of free-radical polymerization initiation systems, based on xanthene dyes as the absorbing chromophores [Rose bengal derivative, 3-(3-methylbutoxy)-5,7-diiodo-6-fluorone and 3-acetoxy-2,4,5,7-tetraiodo-6-fluorone] and sulfur-containing amino acids as the electron donors, were investigated. The photoredox pair xanthene dye/sulfur-containing amino acid was effectively used for photoinitiation of free-radical polymerization of the mixture composed of poly(ethylene glycol)diacrylate–1% NH4OH (3 : 1). The highest initiating efficiencies were observed for the system composed of methionine derivatives as the electron donor. The mechanism of photoinduced electron transfer between sulfur-containing amino acids and triplet state of xanthene dye was investigated using laser-flash and steady-state photolysis techniques. Based on photochemistry of xanthene dyes, photochemistry of sulfur-containing amino acids, and obtained results, the mechanism describing the major processes occurring during the photoinitiated polymerization by a photoinduced intermolecular electron-transfer process was postulated. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci 97: 358–365, 2005


TOTIlEEDITOR: The age-relateddecline in renal function indicates that many geriatric patients have mild to moderate renal insufficiency.' The dosage, dosage interval,or both of renally eliminated medications,such as ranitidineand cimetidine,can be adjusted withoutcompromisingefficacy (serum concentrations) when a patient has renal impairment.' Although guidelines for dosage adjustment in patients with renal insufficiency are available, they are not commonly applied in clinical practice. Renal impairment predisposes geriatric patients to central nervous system (CNS) toxicity from histamine Hj-antagorusts. Dosage adjustment would increase the safety margin in this regard. We chose to study the impactof renal function-based dosingof parenteralranitidineand cimetidine in our hospitalized geriatric population. Such dosage adjustment lends itself to continuedefficacy, a greater margin of safety for patients, and economicbenefitsfor the institution. During a 16-monthperiod, parenteral cimetidine and ranitidine regimens for patients aged 62 years and older were evaluated by pharmacists. Renal function for each patient taking an Hj-antagonistwas evaluated by measured creatinine clearance or calculatedcreatinineclearance using the Cockcroftand Gault formula.' Pharmacistsrecommendeda change in Hj-antagonistdosing intervals based on renal function from modified literature guidelines (Table 1).3,. The final recommendation included consideration of the patient's clinical conditionvia chart review and/or communicationwith the physician. A recommendation was entered in the progress notes by pharmacists with suggesteddosing alterations. Dosage adjustments were not recommended for patients with pancreatitisor active gastrointestinal bleeding, per agreementwith staff gastroenterologists. The patient data collected included Hj-antagonist, dosing regimen, age, height,weight,and serumcreatinineconcentration. The costs recorded were those of the drugs and piggyback bags saved with intervention. Monthlycomputerizedspreadsheets were programmedto calculatecreatinineclearanceor incorporate the measuredvalue, when available. Daily cost avoidancewas calculatedby multiplyingthe cost items by the number of doses saved per day. During the study period, 326 courses of Hj-antagonist therapy were monitored. The average age of the study population was 70.7 years (range 62-96). Pharmacists were responsible for altering 74 courses of therapy,resulting in $1728.48cost avoidance. This represented 10.3percent of the total expenditures for parenteral Hj-anragonists during the study. Pharmacist interventions not accepted were 61 for a total of 135 potential interventioncourses.The reasons offered for interventionsnot acceptedincludedthe physicianoverlookingthe pharmacist's note or disagreeingwith the suggesteddosing alteration.No documented therapeutic failuresattributableto dosage alterationwere observed.Additionally, no CNS toxicityor other toxicitieswere noted duringthe study period. Private sector hospitals may view this approach as undesirable because of a loss of charges. However,when consideringthis age group, to which the interventions typically will be applied, it becomes apparent


Odors can be powerful stimulants. It is well-established that odors provide strong cues for recall of locations, people and events. The effects of specific scents on other cognitive functions are less well-established. We hypothesized that scents with different odor qualities will have a different effect on attention. To assess attention, we used Inter-Subject Correlation of the EEG because this metric is strongly modulated by attentional engagement with natural audiovisual stimuli. We predicted that scents known to be "energizing" would increase Inter-Subject Correlation during watching of videos as compared to "calming" scents. In a first experiment, we confirmed this for eucalyptol and linalool while participants watched animated autobiographical narratives. The result was replicated in a second experiment, but did not generalize to limonene, also considered an "energizing" odorant. In a third, double-blind experiment, we tested a battery of scents including single molecules, as well as mixtures, as participants watched various short video clips. We found a varying effect of odor on Inter-Subject Correlation across the various scents. This study provides a basis for reliably and reproducibly assessing effects of odors on brain activity. Future research is needed to further explore the effect of scent-based up-modulation in engagement on learning and memory performance. Educators, product developers and fragrance brands might also benefit from such objective neurophysiological measures.


One of the fundamental issues in sensor networks is the coverage problem, which reflects how well a sensor network is monitored or tracked by sensors. In this paper, we formulate this problem as a decision problem, whose goal is to determine whether every point in the service area of the sensor network is covered by at least k sensors, where k is a given parameter. The sensing ranges of sensors can be unit disks or non-unit disks. We present polynomial-time algorithms, in terms of the number of sensors, that can be easily translated to distributed protocols. The result is a generalization of some earlier results where only k = 1 is assumed. Applications of the result include determining insufficiently covered areas in a sensor network, enhancing fault-tolerant capability in hostile regions, and conserving energies of redundant sensors in a randomly deployed network. Our solutions can be easily translated to distributed protocols to solve the coverage problem.


Container ships operate with large number of unit containers on the deck, and then they have many kinds of external ship forms due to the position of them depending on need for delivery demands. In the operation of the ships, wind load mostly works as resistance. The estimation of wind effect has important role for calculation of economical cost for operation. There is, however, no simple method to calculate the wind load for those container ships with crested or lacked containers without carrying out wind tunnel experiments. In this paper, ease estimation method for wind load on such kinds of container ships is proposed using experimental investigations.


Clinical and pathological findings in a patient with central nervous system lesions due to a disseminated aspergillosis are reported. Symptoms and signs were suggestive of a meningoencephalitis with onset two years after nephrectomy for cancer and four months after a corticotherapy was started for post-radiation digestive disorders. A review of the literature shows that C.N.S. is rarely involved in this disease, that the diagnosis is difficult in immunodepressed patients and that the prognosis is poor in the absence of a specific treatment.


We investigate the impact of two-step molecular beam epitaxy on the performance of GRINSCH lasers with In0.22Ga0.78As and GaAs quantum wells (QWs) in the active region. The buried regrown interface lies in the Al-containing optical waveguide section. The interface has been cleaned in situ prior to regrowth by hydrogen-assisted oxide desorption and re-evaporation of a sacrificial GaAs cap layer. Two-step epitaxy leaves the internal quantum efficiencies of the laser devices unchanged but increases the internal losses. The threshold current density increases for the lasers with GaAs QWs, whereas for those with In0.22Ga0.78As QWs it decreases by up to 35%. We attribute this to a thermal annealing during re-evaporation and find a similar behaviour for structures that have been treated with post-growth rapid thermal annealing.


Changes in the expression of the mismatch repair (MMR) genes hMSH2, hMLH1, hMSH6 and hPMS2 reflect dysfunction of the DNA repair system that may allow the malignant transformation of tissue cells. The aim of the present study was to address the mRNA expression profiles of the mismatch DNA repair system in cancerous and precancerous urothelium. This is the first study to quantify MMR mRNA expression by applying quantitative real-time PCR (qPCR) and translate the results to mRNA phenotypic profiles (r, reduced; R, regular or elevated) in bladder tumors [24 urothelial cell carcinomas (UCCs) and 1 papillary urothelial neoplasm of low malignant potential (PUNLMP)] paired with their adjacent normal tissues (ANTs). Genetic instability analysis was applied at polymorphic sites distal or close to the hMSH2 and hMLH1 locus. Presenting our data, reduced hMSH2, hMSH6 and hPMS2 mRNA expression profiles were observed in cancerous and precancerous urothelia. Significantly, the ANTs of UCCs revealed the highest percentages of reduced hMSH2 (r(2)), hMSH6 (r(6)) and hPMS2 (p(2)) mRNA phenotypes relative to their tumors (P<0.03). In particular, combined r(2)r(6) (P<0.02) presented a greater difference between ANTs of low-grade UCCs vs. their tumors compared with ANTs of high-grade UCCs (P= 0.000). Reduced hMLH1 (r(1)) phenotype was not expressed in precancerous or cancerous urothelia. The hMSH6 mRNA was the most changed in UCCs (47.8%), while hMSH2, hMLH1 and hPMS2 showed overexpression (47.8, 35 and 30%, respectively) that was associated with gender and histological tumor grading or staging. Genetic instability was rare in polymorphic regions distal to hMLH1. Our data reveal a previously unrecognized hMSH2 and hMSH6 mRNA combined phenotype (r(2)r(6)) correlated with a precancerous urothelium and show that hMLH1 is transcriptionally activated in precancerous or cancerous urothelium. In the present study, it is demonstrated that reduction of hMSH6 mRNA is a frequent event in bladder tumorigenesis and reflects a common mechanism of suppression with hMSH2, while alterations of hMSH2 or hMLH1 mRNA expression in UCCs does not correlate with the allelic imbalance of polymorphic regions harboring the genes.


Radon exhalation from soil and ores is among the most dangerous risks for the public health care. The impact becomes even more powerful when technological enhanced naturally occurring radioactive materials (TENORM) are used for public and private building. Here, we report the realization of a down-scaled model of a building, whose construction materials contain TENORM harvested in a site in Crotone (Italy). We observe an increase of the radon activity in the model when TENORM residues are employed. These results have then been compared to a real use case. The correspondence found between the values of radon activity concentration in the model and in the use case suggests that estimating the radon concentration is an useful method to target TENORM presence inside buildings.


As automotive systems become increasingly sophisticated with numerous onboard features that support extensive inward and outward facing communication, cybersecurity vulnerabilities are exposed. The relatively recent acknowledgement of automotive cybersecurity challenges has prompted numerous research efforts into developing techniques to handle individual threat vectors, the pathways and threat surfaces by which an attack can be realized. Security design patterns have been developed for many application domains (e.g., enterprise systems, networking systems, and distributed systems), but not much has been explored for automotive systems. This paper introduces a collection of security design patterns targeted for automotive cybersecurity needs. We leverage and extend the de facto standard template used to describe design patterns to include fields specific to the automotive domain and SAE J3061 cybersecurity development guidelines.


Introduction Proper nutrition during pregnancy is important for the wellbeing of the mother and foetus and supports health during pregnancy, delivery, and breastfeeding. However, there are little data on nutritional knowledge and dietary intake among adolescents who are pregnant in Ghana. Hence, the study assessed the nutritional knowledge and eating habits of this vulnerable group in the Ledzokuku-Krowor Municipality, Ghana. Methods The study was cross-sectional and employed a multistage sampling technique to select 423 participants. The study was conducted between October and November 2019. A statistical software was used to analyse data and employed Pearson's chi-square and logistics regression to assess associations between the outcome and predictor variables. A p value <0.05 at a 95% confidence interval was considered statistically significant. Results Less than half (44.9%) of the pregnant adolescents have high nutritional knowledge. About 19.4% of them have good eating habits, while 23.9%, 18.2%, and 6.4% of them do not take breakfast, lunch, and supper, respectively. However, 15.6%, 13.9%, and 9.2% do take snacks after breakfast, lunch, and supper, respectively. About 55.9%, 59.8%, and 23.0% do not take their breakfast, lunch, and supper on time, respectively. Additionally, only 3.8% of them do take fruits and vegetables daily, while 9.7%, 23.2%, 30.0%, and 26.5% of them do take animal products, energy drinks, carbonated drinks, and legumes/nuts/seeds daily, respectively. The study showed that educational level (p=0.014), occupation (p=0.016), ethnicity (p=0.017), and number of pregnancies (p=0.021) were associated with good eating habits. Conclusion Eating habit of adolescent pregnant women was not encouraging. Therefore, the municipal health authority with the concerned stakeholders should intensify efforts, including nutritional education to improve good eating habits, such as taking snacks in between meals, eating on time, and balance diet among pregnant adolescents, and to reduce adolescent pregnancy in the municipality.


We investigate the cosmological dynamics of a class of supersymmetric chameleon models coupled to cold dark matter fermions. The model includes a cosmological constant in the form of a Fayet-Illiopoulos term, which emerges at late times due to the coupling of the chameleon to two charged scalars. Supergravity corrections ensure that the supersymmetric chameleons are efficiently screened in all astrophysical objects of interest, however this does not preclude the enhancement of gravity on linear cosmological scales. We solve the modified equations for the growth of cold dark matter density perturbations in closed form in the matter era. Using this, we go on to derive the modified linear power spectrum which is characterised by two scales, the horizon size at matter-radiation equality and at the redshift when the chameleon reaches the minimum of its effective potential. We analyse the deviations from the ΛCDM predictions in the linear regime. We find that there is generically a region in the model's parameter space where the model's background cosmology coincides with that of the ΛCDM model. Furthermore, we find that characteristic deviations from ΛCDM are present on the matter power spectrum providing a clear signature of supersymmetric chameleons.


Abstract Introduction Physiotherapists' attitudes to hypermobility and its problems should be changing in ways which reflect current views on function, disability, and health. For example, rather than a focus on optimizing body functions, we should optimize activities and participation. We examined the current evidence base for guidance on the best therapeutic strategies when hypermobility is present. Methods We searched the databases Pubmed and Cinahl to find randomized controlled trials (RCTs) focusing on interventions for generalized joint hypermobility (GHM) and hypermobility syndrome (HMS). Results We found three RCTs regarding HMS and GHM and one RCT regarding intervention in children with the collagen disease osteogenesis imperfecta. All the trials had some methodological problems but suggested that improvements may result from exercise, education, and training. Conclusion Intervention seems to be effective, as reported by experience and case reports but further research is required to identify appropriate exercise and training, according to the problems and capabilities of individual cases.


Background The incidence of ischemic stroke has increased among adults aged 18 to 64 years, yet little is known about relationships between specific risk factors and outcomes. This study investigates in‐hospital and long‐term outcomes in patients with stroke aged <65 years with preexisting diabetes mellitus. Methods and Results Consecutive patients aged <65 years admitted to comprehensive stroke centers for acute ischemic stroke between 2003 and 2013 were identified from the Ontario Stroke Registry. Multinomial logistic regression was used to estimate adjusted odds ratio (OR [95% CI]) of in‐hospital mortality or direct discharge to long‐term or continuing care. Cox proportional hazards regression was used to estimate the adjusted hazards ratio (aHR [95% CI]) of long‐term mortality, readmission for stroke/transient ischemic attack, admission to long‐term care, and incident dementia. Predefined sensitivity analyses examined stroke outcomes among young (aged 18–49 years) and midlife (aged 50–65 years) subgroups. Among 8293 stroke survivors (mean age, 53.6±8.9 years), preexisting diabetes mellitus was associated with a higher likelihood of in‐hospital death (adjusted OR, 1.46 [95% CI, 1.14–1.87]) or direct discharge to long‐term care (adjusted OR, 1.65 [95% CI, 1.07–2.54]). Among stroke survivors discharged (N=7847) and followed up over a median of 6.3 years, preexisting diabetes mellitus was associated with increased hazards of death (aHR, 1.68 [95% CI, 1.50–1.88]), admission to long‐term care (aHR, 1.57 [95% CI, 1.35–1.82]), readmission for stroke/transient ischemic attack (aHR, 1.37 [95% CI, 0.21–1.54]), and incident dementia (aHR, 1.44 [95% CI, 1.17–1.77]). Only incident dementia was not increased for young stroke survivors. Conclusions Focused secondary prevention and risk factor management may be needed to address poor long‐term outcomes for patients with stroke aged <65 years with preexisting diabetes mellitus.


In this work, we developed ViSTa-MRF, which combined Visualization of Short Transverse relaxation time component (ViSTa) technique with MR Fingerprinting (MRF), to achieve high-fidelity whole-brain myelin-water fraction (MWF) and T1/T2/PD mapping at sub-millimeter isotropic resolution on a clinical 3T scanner. To achieve fast acquisition and memory-efficient reconstruction, the ViSTa-MRF sequence leverages an optimized 3D tiny-golden-angle-shuffling (TGAS) spiral-projection acquisition and stochastic subspace reconstruction with optimized k-space diagonal preconditioning. With the proposed ViSTa-MRF method, high-fidelity direct MWF mapping was achieved without a need for multi-compartment fitting.


›1948‹ is a key concept in Israeli identity discourse. A signifier of the violent clashes that took place at the end of the British Mandate in Palestine (between the fall of 1947 and the spring of 1949), it encompasses both the foundation of a democratic Jewish nation-state and the destruction of numerous Palestinian communities during the Israeli ›War of Independence‹ and thereafter. The Nakba, the Palestinian catastrophe, could not be overlooked by Israel's ›generation of 1948‹ and those that succeeded it: it was present in the deserted fields and houses now occupied by Israelis, in the names of the streams, hills and roads Israelis now visited during military drills or school field trips, and in the frequent encounters with Arab ›infiltrators‹ who sought to return to their abandoned homes and lands.1 The mass expulsion and the killings of Arab civilians by Jewish forces were regularly discussed and debated by Israeli politicians, intellectuals, journalists and artists in the ensuing decades.2 Yet with few exceptions, Israeli historians and politicians have seemingly effortlessly merged these atrocities with a commonly accepted ›narrative‹ by, for example, attributing them to rogue, marginal, right-wing militias; depicting cases of expulsion as sporadic and spontaneous events; or justifying them as ad hoc measures taken against the initiators of the violence during the war.


Abstract We report a patient with essential thrombocythemia (ET) who developed progressive occlusive cerebrovascular disease accompanied by ischemic events. A 40-year-old woman presented with an ischemic stroke in the territory of the left middle cerebral artery (MCA). Diagnostic work-up disclosed a moderate stenosis of the left carotid siphon and a mildly increased platelet count. Due to aspirin intolerance warfarin was administered. Twelve months later, ischemic strokes in the left MCA territory recurred. A left internal carotid artery occlusion at the origin was diagnosed. Bone marrow biopsy showed an increased number of megakaryocytes. Warfarin was replaced by clopidogrel. Cerebral artery obstructions remained unchanged during the next 3 years (six follow-up examinations); no further ischemic events occurred during that period, while mild thrombocytosis persisted. ET may be associated with progressive obstructions of large cerebral arteries; in our case, clopidogrel was effective in preventing recurrence of ischemic events.


Diversity
U.S. funding agencies are committed to bringing gender equality to STEM. As these programs begin to mature, is there evidence that they benefit more than just the women involved? Smith et al. designed and tested a gender-diversity program that supported the autonomy, relatedness, and competence of female faculty. Over the course of 3 years, researchers collected data from male and female tenure track faculty involved with the program and found positive changes in job satisfaction over time for everyone. Specifically, the more a faculty member felt involved with the project, the more positive changes were reported, suggesting that although diversity programs may target only one group, the results can have positive impacts on everyone who feels involved.

J. Divers. High. Educ. 10.1037/dhe0000066 (2017).


Sometimes considered as pests in their native Australia, rose breasted cockatoos (Eolopbus roseicapillus), or Galahs as they are known "down under," are a delight to the aviculturist and pet owner. With their brilliant pink breast and face, grey wings, back and tail, this moderate sized cockatoo stands out from the white cockatoos commonly seen in American aviaries. The Galah also stands alone in its monotypic genus, Eolopbus.


under normal tension the epithelium may grow over the opposing surfaces and so form a cyst. This work was confirmed by Uihlein (1939), and all subsequent writers on the subject have emphasized the necessity of suturing the graft under as great a tension as possible-in contradiction of all the accepted rules for hernia repair. It is obvious, however, that this is a factor which cannot be controlled with complete certainty, and Strahan concluded that, in spite of the most careful technique, any surgeon doing a large number of these operations will inevitably meet some cases of cyst formation. Whilst this does not condemn the method, it must temper enthusiasm for it. The present case is of interest for the large size of the cyst, requiring operative removal although the hemia itself had not recurred, and for the long interval of seven years between the implanting of the graft and the appearance of the cyst.


This paper presents the application of the two-way fluid-structure interaction method introduced by ANSYS to calculate the dynamic behaviour of a Francis turbine runner under operating condition. This time-dependant calculation directly takes into account characteristics of the flow and particularly the pressure fluctuations caused by the rotor-stator interaction. This formulation allows the calculation of the damping forces of the whole system implicitly. Thereafter, the calculated dynamic stress can be used for a fatigue analysis. A verification of the mechanical and fluid simulations used as input for the fluid-structure interaction calculation is first performed. Subsequently, a connection of these two independent simulations is made. A validation according to the hydraulic conditions is made with the measurements from the scale model testing. Afterwards, the static displacement of the runner under the hydraulic load is compared with the results of a classical static analysis for verification purposes. Finally, the natural frequencies deduced by the post-processing of the dynamic portion of the runner displacement with respect to time are compared with the natural frequencies obtained from a classical acoustic modal analysis. All comparisons show a good agreement with experimental data or results obtained with conventional methods.


Self-concept refers to an individual's conscious reflection of personal qualities constructed in a social context, and is a potent influence on the individual's social, psychological, and behavioral functioning. In this work we examine whether the use of online communities improves members' self-concepts, thereby increasing the social value they gain from, and loyalty they feel towards, these communities. Furthermore, we investigate whether the influence of self-concept improvement on perceived social value varies across two contrasting computing platforms for online communities--social networks and virtual worlds. The results of an online survey of Face book and Second Life members support the positive influence of self-concept improvement on perceived social value and member loyalty, and the moderating effect of computing platforms on these relationships.


5G poses severe challenges to PA design. In the first place, output power and efficiency are of prime importance because of battery lifetime. The tradeoff between linear output power and efficiency is typically challenged by the high PAPR due to QAM modulation and/or OFDM techniques. But this important trade-off is challenged even more in 5G due to the high bandwidth requirements. Furthermore, the shift to higher frequencies, where more unused spectrum is available, also puts a burden on the overall PA architecture.


Young children respond to energy dilution achieved using fat or sugar substitutes by compensating for reduced energy within a single meal. The ability to respond to energy dilution in the short term may diminish with age, since adults do not reliably demonstrate accurate caloric compensation in the short term. Two experiments were conducted to examine caloric compensation across age groups. In Experiment 1,15 young children (2–5 years) and 10 older children (7–10 years) received regular (100 g: 73 kcal) and low-calorie (100 g: 6 kcal) raspberry gelatin dessert as a mid-morning snack on two test days separated by at least 2 weeks. Young children demonstrated caloric compensation by consuming more following the low-calorie snack (571.3 ± 48.8 kcal) than after the regular snack (487.7 ± 31.5 kcal). Older children failed to adjust intake in response to the difference in energy. In Experiment 2, a similar procedure was used but young children (n = 19) received 150 g of raspberry gelatin dessert (9 kcal vs. 109 kcal) and older children (n = 12) received 225 g of gelatin dessert (13 kcal vs. 164 kcal). The compensation index (COMPX) indicated that young children (88.1 ± 22.4%) compensated better than older children (21.5 ± 21.9%). Short-term caloric compensation may diminish with age, possibly reflecting a transition from using unlearned internal cues to a more adult pattern of eating influenced by external cues and learning.


Performing smart computations in a context of cloud computing and big data is highly appreciated today. It allows customers to fully benefit from cloud computing capacities (such as processing or storage) without losing confidentiality of sensitive data. Fully homomorphic encryption (FHE) is a smart category of encryption schemes that enables working with the data in its encrypted form. It permits us to preserve confidentiality of our sensible data and to benefit from cloud computing capabilities. While FHE is combined with verifiable computation, it offers efficient procedures for outsourcing computations over encrypted data to a remote, but non-trusted, cloud server. The resulting scheme is called Verifiable Fully Homomorphic Encryption (VFHE). Currently, it has been demonstrated by many existing schemes that the theory is feasible but the efficiency needs to be dramatically improved in order to make it usable for real applications. One subtle difficulty is how to efficiently handle the noise. This paper aims to introduce an efficient and symmetric verifiable FHE based on a new mathematic structure that is noise free. In our encryption scheme, the noise is constant and does not depend on homomorphic evaluation of ciphertexts. The homomorphy of our scheme is obtained from simple matrix operations (addition and multiplication). The running time of the multiplication operation of our encryption scheme in a cloud environment has an order of a few milliseconds.


Terrorism in Modern Urdu Poetry  TERRORISM is the most influencing factor not only in our social set up but an important literary theme as well world over. Urdu literature is also much to do with the contemporary human problems. With the stat of the 20th century a wave of terrorism is spread round the globe. Pakistan is badly affected by this catastrophe. Urdu poets have depicted this matter to a large extent in modern poetry of the new millennium. This article deals with the presentation of terrorism in Urdu poetry by our intellectuals and poets of new thoughts. They feel themselves the part and parcel of the world intelligentsia and fully condemn the phenomenon of terrorism.


In recent years, integrated circuits (ICs) have become significant for various industries and their security has been given greater priority, specifically in the supply chain. Budgetary constraints have compelled IC designers to offshore manufacturing to third-party companies. When the designer gets the manufactured ICs back, it is imperative to test for potential threats like hardware trojans (HT). In this paper, a novel multi-level game-theoretic framework is introduced to analyze the interactions between a malicious IC manufacturer and the tester. In particular, the game is formulated as a non-cooperative, zero-sum, repeated game using prospect theory (PT) that captures different players' rationalities under uncertainty. The repeated game is separated into a learning stage, in which the defender learns about the attacker's tendencies, and an actual game stage, where this learning is used. Experiments show great incentive for the attacker to deceive the defender about their actual rationality by "playing dumb" in the learning stage (deception). This scenario is captured using hypergame theory to model the attacker's view of the game. The optimal deception rationality of the attacker is analytically derived to maximize utility gain. For the defender, a first-step deception mitigation process is proposed to thwart the effects of deception. Simulation results show that the attacker can profit from the deception as it can successfully insert HTs in the manufactured ICs without being detected.


Gaussian curvature is an intrinsic local shape characteristic of a smooth object surface that is invariant to orientation of the object in 3-D space and viewpoint. Accurate determination of the sign of Gaussian curvature at each point on a smooth object surface (i.e., the identi-cation of hyperbolic, elliptical and parabolic points) can provide very important information for both recognition of objects in automated vision tasks and manipulation of objects by a robot. We present a multiple illumination technique that directly identiies elliptical, hyper-bolic, and parabolic points from diiuse reeection from a smooth object surface. This technique is based upon a photometric invariant involving the behavior of the image intensity gradient under varying illumination. The nature of this photometric invariant allows direct seg-mentation of a smooth object surface according to the sign of Gaussian curvature independent of knowledge of local surface orientation, independent of diiuse surface albedo, and with only approximate knowledge of the geometry of multiple incident illumination. In comparison with photometric stereo, this new technique determines the sign of Gaussian curvature directly from image features without having to derive local surface orientation, is invariant to incident orientation errors of two of three light sources, and is invariant to the relative strength of incident radiance with respect to each of these light sources. We demonstrate how this segmentation technique works under conditions of simulated image noise, and actual experimental imaging results.


Since the time of Hippocrates, the vaginal douche has been a common item of pelvic therapeutics. It is extensively used by uninstructed women. It is prescribed by many physicians, though condemned by some. As a rule, however, neither patient nor physician has any clear idea of its proper uses and its limitations. While in selected cases douching accomplishes definite good, as actually practiced it is for the most part worthless, if not positively harmful. According to the results expected, there are three general types of douches. These are used for purposes of (1) simple cleansing, (2) local medication and (3) hydrotherapeusis. THE CLEANSING DOUCHE The cleansing douche is ordinarily a short douche, 1 or 2 quarts in volume. It is of indifferent temperature, cool or tepid. While some drug, most often a mild antiseptic, may be added to the douche water, the purpose of the douche is primarily a mechanical


Introduction:

Endoscopic lung volume reduction (ELVR) provides a minimally invasive, effective therapy for patients with severe, progressive lung emphysema. However, its impact on right ventricular (RV) function is unknown.

Objectives:

The aim of this study was to assess, by use of speckle tracking based RV deformation analysis, the extent of global and regional RV dysfunction in patients undergoing ELVR, and to correlate the results with the clinical outcomes.

Methods:

We enrolled 25 patients (62±9.8 yrs, 68% male) with severe emphysematous COPD scheduled for bronchoscopic LVR using endobronchial valves (Zephyr®, PulmonX, Inc.). Echocardiography was conducted one day prior to ELVR and at 6-week follow-up visit. Clinical responsiveness was defined by a pre- to post-procedural increase in 6-minute walk test (6MWT) distance of ≥26 m. 15/25 treated patients were clinically responders, with an improvement mean value in 6-MWT distance of 126.3±67.5 m.

Results:

After ELVR, RV global longitudinal strain improved significantly in the responder group (-17.9±5.4% vs. -21.4±5.2%, p=0.049), whereas there was no significant differences in other parameters of RV function such as RV apical and medial longitudinal strain, TAPSE or mPAP; no significant effect was seen in non-responding patients. These results correlated with the Nt-proBNP-levels showing a statistical trend towards a relevant post-procedural Nt-proBNP decrease in the responder group (239.6±344.6 pg/ml vs. 90.3±69.3 pg/ml, p=0.07).

Conclusion:

ELVR improved RV function in patients with advanced emphysema. RV global longitudinal strain appears to be the best index to detect RV alterations in these patients.