Abstract: Teachers need a strategy in their instructional process to assist them develop both students' skills and characters. KWL is one of alternative reading strategies that can be used by teachers to enhance the students' reading skills characters. This study aimed at investigating the influence of KWL toward students' reading comprehension achievement and five aspects of characters; (1) Motivating Oneself, (2) Self awareness, (3) Managing Emotion, (4) Emphaty, and (5) Social Skill. Seventy four seventh graders were selected as the sample and equally divided into experimental (N=37) and control groups (N=37), in which only the experimental group was given the treatment using the strategy. However, both groups were tested before and after the treatment. The results of paired sample t-test showed that there were significant improvement in students' reading comprehension achievement. In addition, the experimental group outperformed the control group with a significant mean difference of 10.16 ( p =.000) on reading comprehension. Furthermore, the result of modus showed improvement on  students' characters and there were also found difference in each aspects of characters after they were taught by using KWL strategy. Hence, based on the results of this study, KWL strategy was effective to enhance the students' reading comprehension and characters. Key words: Reading Comprehension, Characters, KWL strategy , seventh graders


Mithramycin induces a reversible inhibition of cellular RNA synthesis without affecting DNA synthesis. The authors have shown this drug induces myeloid differentiation of HL-60 promyelocytic leukemia cells and is an effective agent in certain patients with chronic granulocytic leukemia. In order to investigate the mechanism by which this drug inhibits RNA synthesis we have compared the effect of mithramycin on RNA synthesis by whole cells, isolated nuclei, and RNA synthesis by isolated E. coli RNA polymerase and eukaryotic RNA polymerase II. Exposure of HL-60 cells to mithramycin at concentrations of 4.6 X 10(-7) m or higher for 48 hours causes an almost immediate inhibition of RNA synthesis (up to 85% at 4 hours) with only modest cytotoxicity at these concentrations. Endogenous RNA synthesis by isolated nuclei can be inhibited by mithramycin only at high concentrations (greater than 10(-5) m), suggesting that mithramycin primarily may inhibit initiation, rather than elongation. Mithramycin inhibits in vitro transcription of salmon sperm DNA by E. coli RNA polymerase at DNA:drug ratios similar to those required for RNA synthesis inhibition in whole cells. Similar DNA binding studies with synthetic oligonucleotides demonstrate that mithramycin is a potent inhibitor of transcription of Poly dG.dC by E. coli RNA polymerase but has no effect on transcription of Poly dA.dT. The rapid inhibition of whole cell and isolated RNA polymerase transcription, and the relative insensitivity of isolated nuclei, suggest mithramycin may interact with specific DNA sequences in order to inhibit the initiation of RNA synthesis in intact cells.


This trial was undertaken to assess extremity dosemeters, which were made available to Devonport Royal Dockyard and determine the most suitable to the site. The trial included operational and laboratory-based exposures. Operational exposures were within a submarine reactor compartment and a waste storage area. Laboratory exposures were undertaken using (241)Am, (137)Cs and (60)Co sources to compare and contrast the dosemeters energy response. In addition, the low dose response and the response if placed in the incorrect orientation were also assessed. Ten passive and two active dosemeters were tested, with three highlighted as the most technically suitable, DSTL Harshaw DXT-RAD, HPA Harshaw EXT-RAD and the AMEC Panasonic UD-807A. The most technically suitable dosemeter was the DSTL Harshaw DXT-RAD, due to good responses within all aspects of the trial and the user's preference for the ring type design. The John Caunt ED2 electronic dosemeter 2 (ED2) also performed well, but suffered radio frequency interference.


Conventional full-custom reconfigurable logic device design and implementation are time consuming processes. In this research, we propose a design framework in order to improve FPGA IP core design efficiency by link academic FPGA design flow and commercial VLSI CADs based on the synthesizable method. A novel FPGA routing tool is developed in this framework, namely the EasyRouter. By using simple templates, EasyRouter can automatically generate the HDL codes and the configuration bitstream for an FPGA. With this design flow, accurate physical information can be reported when a new FPGA architecture is evaluated with reliable commercial VLSI CADs. For FPGA architectures that cannot be easily implemented with present VLSI process, EasyRouter provides a fast performance analysis flow, which improved delay accuracy 5.1 times than VPR on average.


OBJECTIVE
To describe a noninvasive method for preventing mandibular drift (MD) after mandibulectomy in dogs.

STUDY DESIGN
Technique description and case series.

ANIMALS
Dogs (n=18) that had mandibulectomy involving resection of a portion of the mandible caudal to the 2nd mandibular premolar tooth.

METHODS
One orthodontic button was attached to the lingual aspect of the canine tooth of the intact mandible and 1 to the buccal aspect of the ipsilateral maxillary 4th premolar tooth. An orthodontic elastic rubber chain was attached to the buttons creating tension sufficient for maintaining normal occlusion. The rubber chain was replaced weekly by the clients. Follow-up appointments were scheduled 2, 6, 10 weeks postoperatively and monthly thereafter if indicated. The appliance was removed when dogs had resumed normal occlusion of the canine teeth.

RESULTS
All dogs maintained normal occlusion, normal jaw function, had no apparent disfigurement, and resumed preoperative activity levels while wearing the appliance. Eight dogs achieved temporomandibular joint stability and normal occlusion 4.5-6 months postoperatively and 8 did not, resulting in MD. One dog was lost for follow-up and 1 was euthanatized.

CONCLUSION
Elastic training using orthodontic buttons and power chain is a viable option for prevention of MD but requires good client compliance. More data and longer follow-up are required to determine the long-term mandibular stabilizing potential of this technique.

CLINICAL RELEVANCE
Elastic training is a quick, simple, cost-effective and noninvasive technique, preserving normal occlusion and function in many dogs after mandibulectomy.


Arakoda (tafenoquine) for malaria; Annovera (segesterone acetate and ethinyl estradiol vaginal system) for contraception; and Oxervate (cenegermin-bkbj) for neurotrophic keratitis.


The hemodynamic and gas exchange alterations resulting from treatment of multifocal atrial tachycardia (MAT) with intravenous verapamil were monitored in 13 critically ill patients. Administration of verapamil (mean dose 12.9 +/- 1.0 mg) produced immediate if usually transient reduction in heart rate. Stroke volume index rose, but no significant changes in cardiac index, blood pressure, or pulmonary artery or capillary wedge pressures were demonstrated. Verapamil appeared to increase pulmonary venous admixture. Oxygen transport, however, did not decrease significantly. Verapamil is generally beneficial in the treatment of MAT, but its utility may be limited in many patients by its tendency to aggravate pre-existing arterial hypoxemia.


Continuous instability events take place, within Tremp Basin, causing landslides and earthflows. Translational slides along this region are very common, especially during rainy events were the presence of water in the subsoil seems to assist the instability of some slopes. Some of the factors
which are related with mass movements in the area of study are: geometry of slopes, geology, hydrology, and other geotechnical factors. The study consists on analyze characteristic intact slopes and existing landslides to derive their stability conditions by means of the laboratory and back-analysis results. For modeling purposes, stable slopes are analyzed by applying peak
parameters, while active landslides are analyzed using residual parameters.
A sensitivity analysis of the groundwater changes on the safety factor in order to restrict the variability of said parameters is also included.
Once the analysis has been made, such results are corroborated with the parameters resulting from the laboratory in order to establish actual parameters and identify the conditions that lead to the reactivation of active landslides and the possible activation of soil mass movements along stable slopes.
Despite we have worked with incomplete information, the analysis has allowed us to obtain consistent results by characterizing, in a non-linear form, the active landslides and intact slopes. Back-analysis reveals that for a higher slope angle, reactivation may take place with relative shallow landslides, and vice versa, and that landslides are very susceptible to low piezometric variations, among others. While in stable slopes there is a relation between slope angle, slope height, and required soil strength parameters in order to achieve the steady state.


0 0 1 182 1043 firstname.lastname@example.com 8 2 1223 14.0 Normal 0 false false false EN-US JA X-NONE Smoking is known as a variable that can be changed through a specific intervention activity. Recently in Indonesia, research related to chronic complication among elderly with type 2 Diabetes Mellitus (DM) was not available. This research has objective in exploring the risk of smoking towards chronic complication among elderly with type 2 DM. This research was using Riset Kesehatan Dasar (Riskesdas) in 2007. Riskesdas is a representative Indonesia Health Survey. 1,565 elderly (aged 60++ years) with type 2 DM have selected by random. 70-80% of the elderly have Chronic Complications and 32.11% of the sample is smokers. The elderly who smoke more than 24 cigarettes per day have risk 2.5 (95% CI, 1.54-3.97), smoker 1-12 cigarettes per day, and smoker 13-24 cigarettes per day have risk 1.3 and 1.6 respectively to get chronic complication compared with those who do not smoke, controlled by age, obesity, and physical activity. The proportion of smokers among elderly with type 2 DM is high, most of them are low education, low socioeconomic status, lack of access to the health services, low of physical activity, and low consume vegetables and fruit. Smoking increases the risk of chronic complication of type 2 DM.


Available online at: http://npt.tums.ac.ir Background & Aim: Clinical outcomes and mortality rate of patients with ST-segment elevation myocardial infarction (STEMI) strongly depend on the time of percutaneous coronary intervention (PCI). One way to reduce the delay in this treatment is to use telecardiology in the prehospital setting. The purpose of this study was for comparison of telecardiology on the first medical contact to balloon time and outcome (size of infarct area, left ventricular ejection fraction, and major adverse cardiac events) of patients with myocardial infarction (MI) transported by Tehran Emergency Medical Services to selected hospitals in Tehran, Iran. Methods & Materials: The present retrospective, comparative study was conducted in 2018 in Tehran city on the medical records of 300 patients with STEMI transported with and without telecardiology (150 records per group). Data for this study included demographic characteristics; how to transport the patients to medical centers, first medical contact to balloon time (FMCTB), and clinical outcomes. Data were analyzed using independent t-test, Fisher's exact test, Chi-square, Mann-Whitney and Kruskal-Wallis test by SPSS software, Version 20. Results: First medical contact to balloon (FMCTB) time, infarction size based on creatine kinase, the patient mortality rate in one month, and repeated PCI in the group transported with telecardiology was significantly lower than that of the group transported without telecardiology (P<0.05). Left ventricular ejection fraction (LVEF) in the first 24 hours, infarction size based on troponin I level, the rate of readmission due to acute coronary syndrome (ACS) and the rate of coronary artery bypass grafting (CABG) were not statistically significant between the two groups (P<0.05). Conclusion: The results of this study showed that the use of telecardiology could reduce the delay in performing PCI and improve some of the clinical outcomes of patients with STEMI. These results can be used to improve the quality of care for patients with STEMI by prehospital emergency personnel, physicians and nurses involved in the care of these patients.


An approach is presented for evaluating the performance achieved by a closed-loop adaptive-optics system that is employed with an astronomical telescope. This method applies to systems incorporating one or several guide stars, a wave-front reconstruction algorithm that is equivalent to a matrix multiply, and one or several deformable mirrors that are optically conjugate to different ranges. System performance is evaluated in terms of residual mean-square phase distortion and the associated optical transfer function. This evaluation accounts for the effects of the atmospheric turbulence Cn2(h) and wind profiles, the wave-front sensor and deformable-mirror fitting error, the sensor noise, the control-system bandwidth, and the net anisoplanatism for a given constellation of natural and/or laser guide stars. Optimal wave-front reconstruction algorithms are derived that minimize the telescope's field-of-view-averaged residual mean-square phase distortion. Numerical results are presented for adaptive-optics configurations incorporating a single guide star and a single deformable mirror, multiple guide stars and a single deformable mirror, or multiple guide stars and two deformable mirrors.


High-speed and high-saturation-power photodetectors operating at 1.3 and 1.55 /spl mu/m wavelength are attracting considerable attention for the purpose of configuring receivers with no broadband electronic post-amplifier. The uni-traveling-carrier photodiode (UTCPD) having a p-type photo-absorption layer and a widegap electron-collection layer is one candidate that fulfills the requirements. In this paper, we study photo-absorption layer design for faster response and demonstrate UTC-PD operations with 3-dB bandwidth of 152 GHz.


Developing a universal vaccine for S. aureus is a top priority but to date we have only had failures in human clinical trials. Given the plethora of bacterial virulence factors, broad range of the health of humans at-risk for infections, lack of any information regarding immune effectors mediating protection for any manifestation of S. aureus infection and overall competence of this organism as a colonizer, commensal and pathogen, we may just simply have to accept the fact that we will not get a universal vaccine. Antigenic variation is a major challenge for some vaccine targets and for many conserved targets the organism can easily decrease or even eliminate expression to avoid immune effectors without compromise to infectivity and ability to cause disease. Studies of human immune responses similarly have been unable to identify any clear mediators of immunity and data from such studies can only eliminate those found not to be associated with protection or that might serve as a marker for individuals with a higher level of resistance to infection. Animal studies are not predictive of success in humans and unlikely will be except in hindsight if and when we develop an efficacious vaccine. Successful vaccines for other bacteria based on capsular polysaccharides have not worked to date for S. aureus, and laboratory studies combining antibody to the major capsular serotypes and the other S. aureus surface polysaccharide, poly-N-acetyl glucosamine, unexpectedly showed interference not augmentation of immunity. Potential pathways toward vaccine development do exist but for the foreseeable future will be based on empiric approaches derived from laboratory-based in vitro and animal tests and not on inducing a known immune effector that predicts human resistance to infection.


ACT Community Living Project Inc (CLP) is a not-for-profit organisation seeking quality life choices for people with disability, including a choice of accommodation that suits their individual needs as well as social inclusion opportunities within the wider community. CLP conducted a survey in 2010-11 in the ACT designed at gathering detailed information on the areas of care and supervision levels for the person with disability, availability of respite and other disability services, future planning and financial support levels for the person with disability once they are no longer able to be supported in the family home. The aim of the survey was to obtain data from impacted families to develop an evidence-based supported accommodation model that meets the needs of care recipients, their families and carers.


The aim of this study was to investigate the effectiveness of drill teaching model with peer teaching approach compared to the conventional methods in terms of interest and achievement in learning mathematics student. Research type was design research for experiments that non-equivalent control group design. This study was conducted in SMAN 3 Selong, East Lombok district. The samples were 60 students consisting of experimental class and control class. After analyzing both descriptive and infrensi, it was found that drill learning model with peer teaching approach was effective in increasing the interest in mathematics learning and achievement. There were differences in the effectiveness of drill learning using peer teaching approach with conventional learning in terms of interest and achievement in learning mathematics student.


abstract Literature in evolutionary economic geography has emphasized knowledge spillover benefits of co-location with related industries. We draw on resource curse literature to demonstrate that relatedness also comes with costs in the form of labor market competition. Using a case study of a growth period in the Norwegian petroleum industry, we show that this had positive as well as negative implications for related industries. Industries related to petroleum grew faster than unrelated industries over the period. However, they also suffered from high labor costs and loss of human capital. Related industries had to pay higher wages than unrelated industries, even after controlling for worker characteristics. Furthermore, several of their employees, in particular the most productive ones, left for the petroleum industry. The relationship between petroleum and related industries is asymmetric insofar as workers tend to leave related industries for petroleum at higher rates than vice versa. Furthermore, the petroleum industry recruits the most productive workers from related industries and returns its least productive workers. Overall, this could potentially lead to de-skilling in related industries, which could more than outweigh any potential knowledge spillover benefits from their relatedness to the petroleum industry. Consequently, we argue that relatedness is not an even playing field: there may be losers, as well as winners, from relatedness.


Introduction In addition to proving the visualisation data, studies on the intimal flaps of aortic dissection based on echocardiography have been very limited. Methods Twenty-seven patients undergoing an operation of type A aortic dissection with preoperative transthoracic and/or intraoperative transesophageal echocardiography archived in the Horizon Cardiology Web of the hospital available for review and measurement were selected into this retrospective study. By way of quantitative and qualitative approaches, flap movement, dissection extent and aortic obstruction were sufficiently evaluated. Results An intimal flap was visualised in 22 (81.5%) patients and linear artifact was viewed in 1 (3.7%), and in the remaining 4 (14.8%), neither an intimal flap nor a linear artifact was visible. Dissection extents were 2.78±1.53 cm and 2.03±1.19 cm in the horizontal and vertical direction, respectively. Sub- or semi-circumferential dissection was noted in 14 (51.8%) patients. No total circumferential dissection was found in this patient population with type A aortic dissection. The obstruction of the aortic valve orifice or aortic cavity developed in 11 (40.7%) patients. Flow disturbance and thrombus in the false lumen were visualised in 24 (88.9%) and 4 (14.8%) patients, respectively. The breadth of flap movement in short-axis plane was much larger in the Aortic Obstruction Group than that of the Non-Obstruction Group (1.55±1.14 cm vs. 0.75±0.526 cm, p <0.05). Conclusions Preoperative transthoracic or transesophageal echocardiographic evaluations offer a convenient and precise diagnostic tool for aortic dissection. The dissection extent may directly correlate and substantially reflect the clinical symptoms of the patients with type A aortic dissection in response to the haemodynamic impairment. Preoperative echocardiographic delineation would assure adequate means and extent of the impending operation.


Under a conception of community welfare, the "Health home" (Casa della Salute) allows the re-organization of primary care and the implementation of the "initiative medicine" based on the integration and participation of professionals, associations and citizens. Starting from an analysis of the regional laws, the article presents the results of a comparative research on the Health homes of different Italian areas. The organizational analysis is based on structural indicators, functional indicators and process indicators.


Background Spondyloarthritis (SpA), one of the most common inflammatory joint diseases in France is associated with HLA-B27. However data on its prevalence remain scarce. Moreover, the precise frequency of SpA in HLA-B27 individuals has never been directly determined at the population level. Objectives to estimate SpA and HLA-B27 prevalence in the large observational French cohort GAZEL. Methods GAZEL is an ongoing general population cohort of 20,000 subjects that were enrolled in 1989 among employees of the French national gas and electricity company. In 2010, all participants to the study, aged from 56 to 71 years at that time, were screened by a questionnaire previously validated for the detection of SpA (1). Respondents with stored DNA having declared to be affected with SpA or psoriatic arthritis were then interviewed by phone by a rheumatologist (RSN) to verify clinical grounds of the diagnosis. Anteroposterior radiograph of the pelvis was obtained in all patients suspected of having SpA. HLA-B27 typing was performed by PCR in confirmed SpA patients and in healthy controls without any SpA feature. In addition to HLA-B27 typing, single nucleotide polymorphism (SNP) rs4349859, known to strongly tag HLA-B27 allele, was genotyped by Taqman®. Results 18,757 subjects were screened for participation. The overall response rate was 74.4%. Among the responders, 6,556 had stored DNA; their male:female ratio was 3.6:1 and their mean age was 65.5±3.3 years. Seventy of them (1.1%) declared to have SpA or psoriatic arthritis. A diagnosis of SpA was confirmed in 25 (0.38% [0.25-0.57%]): 16 had ankylosing spondylitis, 4 psoriatic SpA, 1 SpA associated with Crohn's disease and 4 undifferentiated SpA. Moreover, 5 cases of peripheral psoriatic arthritis without axial involvement were diagnosed. Diagnosis remained doubtful in 6 cases. 76% [54.5-89.8%] of the confirmed SpA were HLA-B27 positive. Among 2,551 individuals without any SpA feature, HLA-B27 positivity rate was 6.9% [5.9-7.9%]. A lower rate of HLA-B27 was observed in subjects older than 70 years (5.1% [3.4-7.4%]), as compared to younger subjects (7.3% [6.2-8.6%]), that was close to significance (p=0.06). The estimated prevalence of SpA in HLA-B27+ individuals was 4.1% [2.5-6.4%] with a higher prevalence in men, as compared to women (Table 1). Finally, SNP rs4349859 showed high sensitivity (97.0%) and high specificity (99.7%) for tagging HLA-B27. Conclusions In a French population aged of more than 55 years and predominantly male, the estimated prevalence of SpA was 0.38% [0.25-0.57%]. The relative risk of SpA in HLA-B27+ individuals was 43 [17-108]. The estimate prevalence of SpA in HLA-B27+ individuals was 4.1% [2.5-6.4%]. As previously reported, we observed a lower rate of HLA-B27 positivity in older subjects (2). References Said-Nahal R, et al. Arthritis Rheum (Arthritis Care Res) 2001;45:478-84 Reveille JD, et al. Arthritis Rheum 2012;64:1407-11 Disclosure of Interest None Declared


The ratio of the electron attachment coefficient eta to the gas pressure p (reduced to 0 degrees C) evaluated from the Townsend current growth curves in binary mixtures of electronegative gases (SF6, CCl2F2, CO2) and buffer gases (N2, Ar, air) clearly indicate that the eta /p ratios do not scale as the partial pressure of electronegative gas in the mixture. Extensive calculations carried out using data experimentally obtained have shown that the attachment coefficient of the mixture eta mix can be expressed as eta mix= eta (1-exp- beta F/(100-F)) where eta is the attachment coefficient of the 100% electronegative gas, F is the percentage of the electronegative gas in the mixture and beta is a constant. The results of this analysis explain to a high degree of accuracy the data obtained in various mixtures and are in very good agreement with the data deduced by Itoh and co-workers (1980) using the Boltzmann equation method.


Summary A field experiment was conducted over five years (1992–97) at Bangalore (13.58N, 77.558E, 930.m above mean sea level) to study the effect of nitrogen application (0, 50, 100 and 150.kg N ha–1 year–1) on yield, oil quality and soil fertility of lemongrass (Cymbopogon fiexuosus) in the semi-arid tropical conditions of South India. Fresh herbage yield of lemongrass differed significantly between years; the yields increased up to the second year after which they started to decline. During the five years, the response to nitrogen was linear, while still maintaining the same content and quality of essential oil. The oil content and chemical composition of oil did not change as the crop aged. Application of nitrogen and phosphorus maintained the fertility of the soil while potassium depletion was noticed.


A method for the stable interpolation of a bandlimited function known at sample instants with arbitrary locations in the presence of noise is given. Singular value decomposition is used to provide a series expansion that, in contrast to the method of sampling functions, permits simple identification of vectors in the minimum-norm space poorly represented in the sample values. Three methods, Miller regularization, least squares estimation, and maximum a posteriori estimation, are given for obtaining regularized reconstructions when noise is present. The singular value decomposition (SVD) method is used to interrelate these methods. Examples illustrating the technique are given. >


The etiology of preeclampsia is complex, with susceptibility being attributable to multiple environmental factors and a large genetic component. Although many candidate genes for preeclampsia have been suggested and studied, the specific causative genes still remain to be identified. Catechol-O-methyltransferase (COMT) is an enzyme involved in catecholamine and estrogen degradation and has recently been ascribed a role in development of preeclampsia. In the present study, we have examined the COMT gene by genotyping the functional Val108/158Met polymorphism (rs4680) and an additional single-nucleotide polymorphism, rs6269, predicting COMT activity haplotypes in a large Norwegian case/control cohort (ncases= 1135, ncontrols= 2262). A low COMT activity haplotype is associated with recurrent preeclampsia in our cohort. This may support the role of redox-regulated signaling and oxidative stress in preeclampsia pathogenesis as suggested by recent studies in a genetic mouse model. The COMT gene might be a genetic risk factor shared between preeclampsia and cardiovascular diseases.


Our previous studies have demonstrated that 2,3,7,8‐tetrachlorodibenzo‐p‐dioxin (TCDD) increases Bovine Herpesvirus 1 (BHV‐1) replication through a dose‐dependent increase in cytopathy and increased viral titer. Furthermore, TCDD was able to trigger BHV‐1‐induced apoptosis by up‐regulating the activation of initiator caspases 8 and 9, as well as of effector caspase 3. Since TCDD activates caspase 3 after 4 h of infection, we have hypothesized an involvement of BHV‐1 infected cell protein 0 (bICP0) in this process. Such protein, the major transcriptional regulatory protein of BHV‐1, has been shown to indirectly induce caspase 3 activation and apoptosis. In order to elucidate the role of bICP0 in this apoptotic pathway, here we have analyzed the effects of TCDD on bICP0 expression. Following infection of bovine cells with BHV‐1, we detected apoptotic features already at 12 h after infection, only in TCDD exposed groups. Furthermore, in the presence of different doses of TCDD, we observed a time‐dependent modulation and increase of bICP0 gene expression levels, as revealed by RT‐PCR analysis. Western blot analysis and immunocytochemistry revealed that TCDD induced an increase of bICP0 protein levels in a dose‐dependent manner, compared to unexposed groups. Moreover, Western blot analysis of nuclear and cytosolic fractions of infected cells revealed that TCDD anticipated the presence of bICP0 protein in the cytoplasm. In conclusion, both the increase of replication of BHV‐1 and anticipation of BHV‐1‐induced apoptosis could be the result of a relationship between TCDD and bICP0. J. Cell. Biochem. 111: 333–342, 2010. © 2010 Wiley‐Liss, Inc.


Polarization of the radiation from Zn and Cd atoms (n = 4 for Zn and 5 for Cd, respectively) was observed after electron impact with energy slightly above the threshold excitation energy. The observing direction was perpendicular to both the incident electron beam and the atomic beam. All of the triplet radiation (J = 0, 1 and 2) was slightly polarized. The observed fractional polarization degrees were and corresponding to J = 0, 1 and 2 spectra in the final states of the Zn atom and , 4.3 and for the Cd atom. These values could be explained by assuming populations in the sublevels and of the states deviating from an equal mean value of for each sublevel. It is interesting and reasonable that the deviations determined independently for different states coincided with each other quite well. The deviated values of fractional population for the sublevel were 0.36 for Zn and 0.37 for Cd, respectively.


Many economists and policy makers advocate a fundamental shift towards "green growth" as the new, qualitatively-different growth paradigm, based on enhanced material/resource/energy efficiency and drastic changes in the energy mix. "Green growth" may work well in creating new growth impulses with reduced environmental load and facilitating related technological and structural change. But can it also mitigate climate change at the required scale (i.e. significant, absolute and permanent decline of GHG emissions at global level) and pace? This paper argues that growth, technological, population-expansion and governance constraints as well as some key systemic issues cast a very long shadow on the "green growth" hopes. One should not deceive oneself into believing that such evolutionary (and often reductionist) approach will be sufficient to cope with the complexities of climate change. It may rather give much false hope and excuses to do nothing really fundamental that can bring about a U-turn of global GHG emissions. The proponents of a resource efficiency revolution and a drastic change in the energy mix need to scrutinize the historical evidence, in particular the arithmetic of economic and population growth. Furthermore, they need to realize that the required transformation goes beyond innovation and structural changes to include democratization of the economy and cultural change. Climate change calls into question the global equality of opportunity for prosperity (i.e. ecological justice and development space) and is thus a huge developmental challenge for the South and a question of life and death for some developing countries (who increasingly resist the framing of climate protection versus equity).


Impoliteness and rudeness are two different terms although both of them refer to the similar offensive behaviour. The difference of those terms lays on the intention of the speaker in doing the offensive behaviour. Culpeper (1996) introduces Impoliteness Theory as something he calls the parasite of Brown and Levinson's (1987) Politeness Theory by exposing five super strategies: Bald on Record Impoliteness, Positive Impoliteness, Negative Impoliteness, Sarcasm or Mock Impoliteness, and Withhold Politeness. Furthermore, he divides impoliteness into three types: Affective, Coercive, and Entertaining Impoliteness. Meanwhile, rudeness is defined as what          a speaker said or did –or even not said and done– which offends a hearer and prevents him/her     to feel comfortable or convenience with the speaker's words or acts. (Rondina and Workman, 2005:3). It is a kind of negative behaviour which is insensitive or disrespectful reflecting someone's disregard towards others (Dubrin, 2011:87). In relation with Brown and Levinson (1987) Face Threatening Act (FTA), Beebe (1995) defines rudeness as "an FTA or features of FTA" breaking social interaction norms of the social context of it (in Culpeper, 2011:19). Culpeper (2005) himself considers impoliteness is done either intentionally or accidentally because impoliteness comes about when: (1) a speaker intentionally hold face-attack communication, or (2) a hearer assumes and/or considers a particular behaviour as "intended face-attacking", or a combination of (1) and (2)" (in Bousfield and Locher, 2008:131). According to Segara (2007:141), rudeness happens when someone disregard and disobey the proper social manners with discourteous intention. It can be said that impoliteness is intentionally or accidentally occurs because of the hearer's linguistics's incompetence, while rudeness                   is intentionally happens to offend the hearer whether he/she gets offended or not. This research is done to show the difference of impoliteness and rudeness by using Sawungkampret Comics created by Dwi Koendoro as data source to get the sample of impoliteness and rudeness.            The result shows that impoliteness can be done intentionally or not depending on what a speaker wants to show with his/her impoliteness, the hearer himself/herself gets the effect of impoliteness, and it is mainly used linguistics component. On the other hand, rudeness is done intentionally to show the speaker's want, the hearer and people around him/her get the effect of rudeness, and         it uses linguistics component along with culture and the sense of humanities embedded in it.


A femtosecond laser (pulse duration 30 fs, centre of the emission spectrum at λ = 1260 nm) with a chromium-doped forsterite crystal was developed. This laser operated on the basis of Kerr-lens mode locking. Synchronous pumping with an Nd3+:YAG picosecond laser resulted in forced generation of femtosecond pulses characterised by an enhanced stability of the output power, which was 5–7 times better than the stability of the pump laser. The output radiation of the forsterite laser was converted efficiently to the second harmonic (central wavelength 630 nm) in a thin nonlinear BBO crystal. The average power of the second-harmonic radiation was 15 mW.


The aim of this study was to assess the most probable number-polymerase chain reaction (MPN-PCR) technique for detection of Listeria monocytogenes in salad vegetables in comparison with reference EN ISO 11290-2 and Food Drug Administration Bacteriological Analytical Manual method using artifcial and naturally contaminated samples. Based on recovery of L. monocytogenes from artifcially contaminated samples, MPN-PCR showed a moderate correlation (R=0.67) between spiking concentration and microbial levels which was better than the FDA-BAM method (R=0.642) and ISO 11290-2:1998 method (R=0.655). With naturally contaminated samples, it was found that L. monocytogenes was detected in 25% of the vegetable samples using MPN-PCR; 15% of the samples by the FDA-BAM method and 8% of samples using ISO 11290-2:1998 method. Overall, MPN-PCR was found to be a rapid and reliable method that could facilitate the enumeration of L. monocytogenes in vegetables.


Background: Sphincter of Oddi manometry (SOM) is recommended in the evaluation of suspected Type II sphincter of Oddi dysfunction (SOD2), though its utility is uncertain. Little is known about the practice of expert endoscopists in the United States regarding SOD2. Methods: An anonymous electronic survey was distributed to 128 expert biliary endoscopists identified from U.S. advanced endoscopy training programs. Results: The response rate was 46.1 % (59/128). Only 55.6 % received training in SOM, and 49.2 % currently perform SOM. For biliary SOD2, 33.3 % routinely obtain SOM, 33.3 % perform empiric sphincterotomy, and 26.3 % perform single session endoscopic ultrasound/endoscopic retrograde cholangiopancreatography (EUS/ERCP). In contrast, an equal number (35.1 %) favor SOM or single session EUS/ERCP for suspected acute idiopathic recurrent pancreatitis, while 19.3 % would perform empiric sphincterotomy. Those who perform SOM believe it to be important in predicting response to treatment compared with those who do not (71.8 % vs 23.1 %, P = 0.01). Yet only 51.7 % of this group performs SOM for suspected SOD2. Most (78.6 %) believe that < 50 % of patients report improvement in symptoms after sphincterotomy. Common reasons for not obtaining SOM included unreliable results (50 %), and procedure-related risks (39.3 %). Most (59.3 %) believe SOD2 is at least in part a functional disorder; only 3.7 % felt SOD is a legitimate disorder of the sphincter of Oddi. Conclusions: Our survey of U.S. expert endoscopists suggests that SOM is not routinely performed for SOD2 and concerns regarding its associated risks and validity persist. Most endoscopists believe SOD2 is at least in part a functional disorder that will not respond to sphincterotomy in the majority of cases.


Vesicular fragments of Golgi apparatus, smooth- and rough-surfaced microsomes from rat liver are differently partitioned in aqueous polymer two-phase systems consisting of dextran, polyethylene glycol, and sodium phosphate buffer. At a given polymer concentration, the amount of material partitioned in the top phase increases in the following order: rough microsomes less than smooth microsomes less than Golgi fragments. Counter-current distribution of Golgi fragments in the system consisting of 6.8% (w/w) dextran T500 and 6.8% polyethylene glycol 4,000 results in the separation of the fragments into three fractions; i.e. Fractions I, II, and III. NADH- and NADPH-cytochrome c reductase activities are detected almost exclusively in Fraction I, whereas the activities of galactosyltransferase, acid phosphatase, 5'-nucleotidase, and thiamine pyrophosphatase are maximal in Fraction III and minimal in Fraction I. The distribution of these enzymes suggests that Fraction I is similar to, though not identical with, microsomes, Fraction III resembles plasma membrane and lysosomes, and Fraction II is between the two. It is concluded that NADH- and NADPH-cytochrome c reductases are localized in a restricted region of the Golgi structure and that intra-Golgi differentiation seems to proceed in a discontinuous manner.


We analyze a mathematical model for the transmission of cholera. The model is already defined and involves variables such as the pathogen agent, which in this case is the bacterium Vibrio cholera, and the human population. The human population is divided into three classes: susceptible, infectious and removed. Using Computer Algebra, specifically Maple we obtain two equilibrium states: the disease free state and the endemic state. Using Maple it is possible to prove that the disease free state is locally asymptotically stable if and only if R0 1. Using the package Red-Log of the Computer algebra system Reduce and the SMT-Solver Z3Py it is possible to obtain numerical conditions for the model. The formula for the basic reproductive number makes a synthesis with all epidemic parameters in the model. Also it is possible to make numerical simulations which are very illustrative about the epidemic patters that are expected to be observed in real situations. We claim that these kinds of software are very useful in the analysis of epidemic models given that the symbolic computation provides algebraic formulas for the basic reproductive number and such algebraic formulas are very useful to derive control measures. For other side, computer algebra software is a powerful tool to make the stability analysis for epidemic models given that the all steps in the stability analysis can be made automatically: finding the equilibrium points, computing the jacobian, computing the characteristic polynomial for the jacobian, and applying the Routh-Hurwitz theorem to the characteristic polynomial. Finally, using SMT-Solvers is possible to make automatically checks of satisfiability, validity and quantifiers elimination being these computations very useful to analyse complicated epidemic models.


Climate change is a huge environmental issue that our society currently faces. This thesis develops and tests two bias correction methods for regional climate simulations of precipitation and runo . Biases in the soil water physics are corrected by including new physics in the soil moisture parameterisation and the regional model inputs are corrected statistically. Case studies are performed on the Olifants River basin in the Limpopo region of South Africa using the Weather Research and Forecasting (WRF) regional climate model. Accurate knowledge of water availability in this water-stressed region is of great importance for adaptation and future water policy development. The concept of tightly bound water, in which a reservoir of soil water is held stationary within small soil pores but is still available for evapotranspiration, is parameterised for the rst time within the land surface scheme of a regional atmosphere-land surface model. Results of a WRF simulation forced by reanalysis show that the standard NOAH land surface scheme over-estimates mean annual runo by 120% with respect to observations, despite rainfall and atmospheric conditions similar to observed. Use of the tightly bound water scheme within the NOAH model reduces this bias to 22%. Simulations with the WRF model forced with 1980s and 2040s CCSM3.0 general circulation model data show that the tightly bound water scheme signi cantly reduces runo in di erent climates. The new scheme projects a 10% decrease in runo by the 2040s compared to a 4% decrease projected by the standard model. A new quantile-mapping bias-correction of inputs to regional climate models is proposed. Linear correction and quantile-mapping methods are implemented to correct CCSM3.0 data using re-analysis. Simulation results show a signi cant di erence between the correction methods. The results indicate that the quantile-mapping correction method could be developed to help produce more accurate regional climate predictions for impact studies.


The Superpave® mix design system includes design criteria for a range of mixes with nominal maximum aggregate sizes (NMASs) between 9.5 and 37.5 mm. Many agencies in the United States have expressed an interest in using a 4.75-mm NMAS mix. Such a mix could provide benefits; that is, it should provide a very smooth riding surface, could be used for thin lift applications, could correct surface defects (leveling), could decrease construction time, could provide a use for manufactured screening stockpiles, and could provide a very economical surface mix for facilities with low traffic volumes. A study was done to establish the standard mix design criteria needed for 4.75-mm mixes. On the basis of the findings of the study, the recommended Superpave mix design criteria include a specified gradation control of 30% to 54% passing on the 1.18-mm (No. 16) sieve and 6% to 12% passing the 0.075-mm (No. 200) sieve. During design, the following were recommended: a design air void content of 4%, minimum voids in mineral aggregate (VMA) of 16% for all traffic levels, maximum VMA of 18% for mix designs with more than 75 gyrations, voids filled with asphalt (VFA) of 75% to 78% for mix designs with 75 gyrations and above, and VFA of 75% to 80% for mix designs with 50 gyrations. The results of the study showed that 4.75-mm NMAS mixes can be successfully designed. These types of mixes should provide economical mixes for low-volume roadways.


: Purpose: The objectives of this study were to analyse certain aspects of the Board composition of Maltese listed companies (MLCs), namely Board size, independence, expertise, gender diversity and the chairperson/CEO links, and how these may be improved. Design/Approach/Methodology: The study was designed around a qualitative approach of data collection. Semi-structured interviews were conducted with seventeen participants, consisting of fourteen company secretaries of MLCs, a representative of the Maltese regulator, a corporate advisor and a corporate lawyer. Findings: The nomination and appointment process of directors in MLCs relies mainly on networking, with a tendency to continuously appoint the same tried network of directors. This creates a barrier towards new talent being introduced into boardrooms. A general disagreement also persists as to what constitutes a truly independent Board member. Practical Implications: Practical experience often supplants academic qualifications when nominating and appointing directors. Moreover, female representation on the Boards of MLCs is still lacking. Notwithstanding the fact that the importance of having separate chairperson/CEO roles is acknowledged, there is likely to be strong resistance to any law rendering this mandatory. Originality/Value: Studies relating to the composition of the Board of Directors in smaller states such as the island state of Malta are infrequent. This paper provides information that is of particular value to listed companies in smaller states and their stakeholders, including regulators and sheds more light on the priniciple of proportionailty when dealing with requirements imposed by the authorities.


Traditionally in hospitals the task of dispensing medications to patients can be strenuous for the hospital staff, as many variables have to be considered, such as searching for a particular medicine in shelves, finding alternative active components and possible interactions, verifying the amount or dosage of the medicine, keeping in mind the intake timings and other meticulous details. In addition to that, the dispensation process is the combination of many manual and computerized steps which do not function together. In this work, we have gone a step forward towards automating the whole process by combining information from different sources and providing it on a single centralized rich internet application. The application Smart Dosing helps nurses in performing the filling and dispensing of the medicine tray more efficiently. The application allows nurses to keep history of the medication distributed and dispensed to patients, as well as it makes the whole process smoother by improving the patient safety. A survey was conducted among nurses to validate the application prototype usability.


OBJECTIVES
The case presented here describes the clinical evolution of a malignant prolactinoma with occurrence of intra- and extra-cranial metastases. In this case, the presence of dopamine 2 receptor (D2R) was studied at the mRNA and protein level, in order to understand the pathological background of the resistance to treatment with different dopamine agonists.

DESIGN
Together with an extensive description of the clinical history of this case, a combination of in vitro and in vivo techniques was performed to provide the basis of the dopamine resistance developed in the course of the disease.

METHOD
A comparison of the D2R was performed in specimens obtained at presentation of the disease compared with autoptic specimens derived from local invasion and metastasis using in situ hybridization and immunohistochemical techniques.

RESULTS
Intact D2R mRNA was found in the primitive tumor and metastatic tissues, whereas protein for the same receptor was present only in the tissues derived from neurosurgical operations and not in the metastases obtained post-mortem.

CONCLUSION
This is the first report of the absence of D2R protein despite the retention of the transcript in an advanced stage of a malignant prolactinoma. The findings of this single case suggest the hypothesis that postranscriptional mechanisms may contribute to the development of dopamine resistance in prolactinomas.


Although the heterogeneity of the therapeutic response to TNF‐α blockers seems to be mainly due to genetic factors, several studies showed that a range of factors may influence it. The aim of our study was to investigate the impact of patients' demographic and clinical characteristics on primary response to an anti‐TNF‐α therapy in psoriatic patients. We retrospectively examined the relationship between various clinical and demographic features and response to treatment with etanercept, adalimumab, and infliximab, evaluated as PASI75 and average PASI improvement at weeks 12, 16, and 14, respectively. We analyzed data obtained from 199 patients. A better response to the treatment was significantly associated with male gender (OR = 2.59), coexistence of psoriatic arthritis (OR = 1.97), and PASI ≤15 at baseline (OR = 0.91). The present study supports that some clinical factors may be potential predictors of response to anti‐TNF‐α agents in psoriatic patients.


This work describes studies on the preliminary processing of calcium aluminate mortars based on several industrial wastes and natural sub-products. The starting materials are sludges (generated in Al-anodising and surface coating industrial processes, potable water filtration/cleaning operations and cutting process of natural marble rocks), and foundry sands. These materials are all classified as non-hazardous but high daily-produced amounts involve high transportation costs for disposal. Reusing alternatives should be sought. The characterization of the waste materials is reported, including physical and chemical parameters and thermal behaviour. Several powder mixtures were prepared and fired at different temperatures. Compositional changes were assessed by XRD and powder density, average particle size, and specific surface area, were determined. The compression and flexural strengths of the corresponding pressed and sintered samples are also given.


OBJECTIVE
To find out the differentially expressed genes in the hippocampus of the rats with genetic epilepsy so as to lay a foundation for exploring the pathogenesis of epilepsy by means of cDNA array technology.

METHODS
Gene expression patterns in the hippocampus of the genetic epilepsy-prone P77PMC rats and normal Wistar rats were established using the alpha-32P-labeled cDNA probes hybridized with the Atlas Rat cDNA Expression Array, and then were analyzed by an image analysis instrument to get the differentially expressed genes.

RESULTS
Fifteen genes were found having differential expression patterns in hippocampus between the P77PMC rats and the Wistar rats, while there may be many other differentially expressed genes left undiscovered due to having no appropriate image analysis software. And among the fifteen genes, the expression levels of twelve genes in the P77PMC rats were higher than those in the Wistar rats, while the expression levels of the other three genes were lower. The results of reverse transcription-polymerase chain reaction(RT-PCR) have demonstrated the reliability of cDNA arrays method.

CONCLUSION
cDNA array is a powerful tool for identifying differential expression genes of epilepsy on large scales. There are several differentially expressed genes in hippocampus of the P77PMC rats and the Wistar rats. All these identified genes could play potentially important roles in the pathogenesis of epilepsy.


Senegal has tremendous potential to raise incomes and create jobs in agriculture. This potential is particularly strong in the horticulture sector where Senegal enjoys a comparative advantage because of the following factors: favorable climatic and water conditions; capacity to supply European markets at a time when others cannot; proximity to European markets with availability of competitive air and sea transport; access to quality inputs; and few policy distortions. The fact that exports have increased from 2,700 tons in 1991 to 51,270 tons in 2011 indicates the quality and demand for Senegalese horticulture products. However, only about 5 percent of the fruits and vegetables grown in Senegal are processed. The country imports many processed products that could be produced competitively domestically, and exports raw materials that, if processed, could be sold at much higher margins. Processing could also help reduce post-harvest losses, which dramatically affect farmers' incomes. The country is, therefore, not realizing the income and job generating potential offered by its comparative advantage. This document proposes a new model for promoting the growth of a competitive value adding horticulture sector in Senegal. The Agribusiness Innovation Center (AIC) will provide a set of financial and nonfinancial services to high-growth potential entrepreneurs, aiming to accelerate the growth of their enterprises and demonstrating product, process, and business model innovation across the horticulture sector. AIC complements existing efforts focused on farm-level improvements and foreign investment facilitation.


Since an inter-governmental review of Canada's retirement income sufficiency was launched in 2009, a number of high-profile expert studies have analyzed the level of preparedness of Canada's future retirees. Each of the five studies reviewed in this Commentary has a "headline conclusion" for which it is widely associated, and each gives a very different impression of the extent to which the future elderly are likely to experience a decline in their standard of living in retirement. The partisan roles in which the studies have been cast have diverted attention from some conclusions common to some or all of them and that are important in considering the retirement income situation of the future elderly. This Commentary reviews these studies with an aim to look beyond the headline conclusions in the five papers to assess the degree of difference among them when they focus on a commonly defined population and to make note of any shared conclusions. A McKinsey (2012) report concludes that 23 percent of the future elderly will suffer a decline in their standard of living in retirement, with that number falling to 17 percent in its 2015 report (McKinsey 2015). Horner concludes that 22 percent of the future elderly will suffer a significant decline in their standard of living, while Moore, Robson and Laurin (MLR 2010) and Wolfson (2011), concludes the future elderly will face declines of 44 percent and 50 percent, respectively. The studies use different methodologies in coming up with these results. The MRL and Wolfson studies both make use of Statistics Canada's LifePaths microsimulation model. These studies employ complex datasets and probability assumptions to simulate future outcomes of synthetic individuals. In contrast, the two McKinsey studies use proprietary survey results, while Horner relies on income tax data. McKinsey and Horner use a deterministic approach, projecting current states forward at a steady rate. The five studies give very different impressions of outlook for the future elderly. If attention is focused on young middle-income earners, however, the differences in results diminish significantly. The risk of a declining standard of living is largely a middle- and upper-income earner problem, concentrated among the youngest age group and those not participating in a workplace pension plan.


Cake is a bakery product with high sugar content which is appreciated by the consumer with its flavour and soft texture. Studies on sugar content reduction increased due to foods with high sugar content causing dental problems, cardiovascular diseases, obesity and type 2 diabetes. Sugar used in cakes affects colour, flavour and texture of the cake. 15-20% sugar reduction can be achieved without major changes in cake formulation. However, to reduce sugar more than 20%, it is determined that a mixture of sweeteners and sweeteners in combination with bulking agents should be used in order to obtain the colour, flavour and texture of the sugar-reduced cake similar to the cake with high sugar content. In sugar replacement studies in cakes natural and artificial sweeteners as sweetener, sugar alcohols as sweetener and polymers such as polydextrose, inulin, oligofructose, hydrocolloids and some fiber sources as bulking agent are used. In this review, it is aimed to give information about sugar replacement applications in cakes and effect of these applications on cake characteristics. Keywords: cake, sucrose, sucrose replacement, sugar reduction. DOI: 10.7176/JSTR/5-8-03


Problem Solving is considered as a very important learning activity in formal educational settings. The accompanied research studies indicate the significance of this skill for human life and relate it to the acquisition of higher-order thinking skills such as the self-regulative skill. Adults seem to acquire such higher-order thinking skills due to the accumulation of their social and cognitive experiences. Nevertheless, in younger students this skill needs to be fostered. Thus, the question arises as to whether or not they can be supported to develop such skills. The sample of this study included 262 students of public elementary schools from Attiki and Larisa regions. The effectiveness of the proposed instructional method for developing higher-order thinking skills was initially tested in traditional classroom settings. The proposed method was found to be effective in terms of the acquisition of problem solving skill. However, there were existing difficulties in implementing it. It was necessary for all students involved in the problem solving process to work together and have access to the same shared space and educational material so that the problem solving environment would have the same setting. All these hindrances made it necessary to utilize networked environments and enable students perform the activities as proposed by the proposed instructional method. The second sub-phase of the study lasted for two months (from April 15th to June 10th, 2006) and 198 students participated in. Ten problem solving scenarios were designed to frame and support the proposed method of self-regulated problem solving. All students attended a two-hour lesson to familiarize themselves with the tools of Synergo and LMS Moodle.


A low-power CMOS Subscriber Line Interface Circuit (SLIC) in a 1 /spl mu/m high voltage technology is presented. A systematic approach to extract the necessary specification for each block to achieve stability, accuracy, and other desired SLIC characteristics is applied. For this purpose a proper sense and feed system is introduced. The proposed SLIC shows a longitudinal balance of 53.7 dB while consumes 2.5 mA current with 16 mm/sup 2/ area. This transformer-less SLIC met transmission specifications without trimming.


Most countries will need a shift in their energy strategies in order to limit the increase in global warming and to reduce the emissions of greenhouse gases. It is worrying that while technologies with little or no greenhouse gas emissions exist, and are used for a couple of decades now, the increase of their market share is extremely low and the investments and subsidies in fossil fuels are substantially larger on a world wide scale. For changes to accrue it is necessary to carefully plan both the energy consumption and supply. A correct and rational prediction of future energy consumption is the basic assumption for the advanced analysis and modelling of energy systems and it will, as an input, have a profound influence on them. In this paper a bottom up approach was selected because it is the most suitable methodology to describe the legal, economic or purely technical mechanisms. Scenarios for the energy supply in 100% renewable systems in 2050 and the possibility to create a low-carbon society were simulated using the EnergyPLAN model for energy system analysis. Comparison of the necessary useful energy for space heating in 2050 shows a difference greater than 16% for different rates of renovation of the existing buildings in the residential sector of 1% and 3% annually. The electrification of road transport for passenger cars in combination with increased requirements for energy efficiency of internal combustion engines can reduce the energy consumption in the transport sector by 30% in comparison to the reference scenario for 2050. It is possible to reduce the emission of greenhouse gases by 82% in the period 2030-2050 and the use of renewable energy sources and the production of synthetic fuels can enable a transition to a 100% renewable energy system in Croatia in 2050. Doing so would create 192000 jobs in plant maintenance and fuel production alone, increase the security of energy supply and reduce the expenditure for the purchase of fossil fuels by 45 billion EUR according to the results of the simulation.


With the increase of teaching resources in universities, allocation for teaching resources has gradually attracted people's attention. How to optimize and reorganize the numerous teaching resources so as to maximize the teaching efficiency and achieve the best teaching effect is a question that the majority of college management workers must think deeply. Due to the development of computer science, artificial neural networks and wireless networks have made considerable progress. )is article optimizes the resources of colleges and universities from these two aspects. First, this work proposes an improved artificial neural network to optimize school resources. )e algorithm pointed out that the adaptive genetic algorithm itself has problems such as slow evolution speed and poor individual diversity of the population. After that an improved adaptive genetic algorithm is proposed to optimize BP network training process. By introducing individual evolutionary trend adjustment parameters, a new calculation formula for crossover probability as well as mutation probability is constructed. Improved BP algorithm can effectively avoid the shortcomings of local minima. Second, additional momentum and adaptive learning rate strategies are used to optimize BP network to promote the efficiency for network training. )ird, the artificial intelligence network is deployed in the wireless network, and the wireless network will complete the work of data collection, processing, and transmission, so as to optimize the resources of colleges and universities.


Autoimmune cholangitis would be the appropriate name to define the immune-mediated bile duct injury following the breakdown of tolerance to mitochondrial proteins and the appearance of serum autoantibodies and autoreactive T cells. Nevertheless, the condition is universally named primary biliary cirrhosis (PBC). The disease etiology and pathogenesis remain largely unknown despite the proposed lines of evidence. One twin study and numerous epidemiology reports suggest that both a susceptible genetic background and environmental factors determine disease onset while a recent genome-wide association study proposed highly significant associations with several common genetic polymorphisms in subgroups of patients. Specific infectious agents and chemicals may contribute to the disease onset and perpetuation in a genetically susceptible host, possibly through molecular mimicry. Importantly, several murine models have been proposed and include strains in which PBC is genetically determined or induced by immunization with chemicals and bacteria. From a pathogenetic standpoint, new exciting data have demonstrated the unique apoptotic features of bile duct cells that allow the mitochondrial autoantigens to be taken up in their intact form within apoptotic blebs. We are convinced that the application of the most recent molecular techniques will soon provide developments in PBC etiology and pathogenesis with likely implications in diagnostics and therapeutics.


The neutrophil is an important cell in host defense against infections, acting as the first line of microorganism control. However, this cell exhibits dysregulated activity in sepsis and may contribute to the pathogenesis of the disease. This systematic review aimed to highlight the major scientific findings regarding neutrophil activity in sepsis reported in clinical and experimental research published in the last 10 years. The search was conducted in the Virtual Health Library of PAHO-WHO (BVS) and PubMed databases, and articles published between January 2007 and May 2017 in Portuguese, English, and Spanish were eligible. Article selection was carried out independently by two reviewers (CB and IB). A total of 233 articles were found, of which 87 were identified on PubMed and 146 on BVS. Eighty-two articles were duplicates. Of the remaining 151 articles, 19 met the inclusion criteria after title, abstract, and full-text analysis. Overall, research in clinical samples and animal models of sepsis showed reduced capacity of neutrophils to migrate and delayed apoptosis, but there was no consensus on the phagocytic activity of neutrophils in sepsis. Molecules, such as pentraxin 3 (PTX3), have been analyzed as potential diagnostic markers in sepsis but the diversity of soluble molecules detected in blood samples of sepsis patients did not enable further understanding of the correlation of these circulating molecules with neutrophil activity during sepsis. Optimal understanding of the function of neutrophils in sepsis remains a challenge that, if overcome, would eventually allow targeted therapeutic interventions in patients affected by this severe syndrome.


Retaining registered nurses (RNs) in post during their first year of employment is a problem for the Marie Curie Home Nursing Service. This article describes an initiative undertaken by Marie Curie Northern Ireland's (NI) Regional Nursing Service's manager in conjunction with clinical management and RNs to develop a peer-mentoring programme that would support newly appointed RNs during their first 3 months and strengthen the possibility that they would remain in post. A scoping exercise of key stakeholders clarified that peer mentoring could address the sense of remoteness and isolation that newly appointed nurses expressed as lone workers. RNs taking on a peer-mentoring role received additional remuneration during the 3-month period. Through the initiative, the stakeholders recognised that the peer-mentoring programme should be simple, responsive to the needs of the newly appointed nurses and provide the necessary support and guidance when required.


The physical properties of groundnut seeds such as length, width, thickness, mass, size, shape, surface area, volume, aspect ratio, sphericity, true density, bulk density, porosity and angle of repose were reviewed. The methods of determination of these properties and their applications in food processing technology were discussed. Some researches about the effects of moisture on physical properties of groundnut seeds were also studied. These physical characteristics which when measured are relevant for the design and development of harvesting, seed sizing, handling, processing grading machines and in their separation from undesirable materials and decorticating and storage equipment for groundnut seeds.


Based on a unique hand-collected database of 389 loans obtained from a French social bank dealing with small businesses, this paper compares two predictive models of future default events: the first relies on soft information (SI model), the second on hard information (HI model). The results indicate that the SI model outperforms the HI model in terms of forecast quality and goodness of fit. In so doing, this paper provides further empirical evidence that, when they serve small businesses, small or decentralized banks have a greater ability to collect and act on soft information. This empirical conclusion conveys practical implication for social banks' internal credit rating procedures, especially in their calibration of capital requirements.


The National Research Institute of Mother and Child (NRIMC) school anti-tobacco programmes are presented. They are discussed with reference to the Centres for Disease Control and Prevention (CDC) guidelines and other effective school programmes to prevent tobacco use among children and young people. The general objectives of the programmes at different educational levels and the elaborated strategic recommendations are presented. The own conceptualised evaluation model of school anti-tobacco programmes is analysed, including process and outcome evaluation. The presented model clarifies concepts and procedures of planning the design and evaluation of the programme in its different stages. In our opinion, the NRIMC evaluation model can be applied in other heath promotion programmes.


Recovery after total hip arthroplasty (THA) is influenced by several psychological aspects, such as depression, anxiety, resilience, and personality traits. We hypothesized that preoperative depression impedes early functional outcome after THA (primary outcome measure). Additional objectives were perioperative changes in the psychological status and their influence on perioperative outcome. This observational study analyzed depression, anxiety, resilience, and personality traits in 50 patients after primary unilateral THA. Hip functionality was measured by means of the Harris Hip Score. Depression, state anxiety, and resilience were evaluated preoperatively as well as 1 and 5 weeks postoperatively. Trait anxiety and personality traits were measured once preoperatively. Patients with low depression and anxiety levels had significantly better outcomes with respect to early hip functionality. Resilience and personality traits did not relate to hip functionality. Depression and state anxiety levels significantly decreased within the 5-week stay in the acute and rehabilitation clinic, whereas resilience remained at the same level. Our study suggests that low depression and anxiety levels are positively related to early functionality after THA. Therefore, perioperative measurements of these factors seem to be useful to provide the best support for patients with risk factors.


A versatile ultra high frequency radiofrequency identification (UHF RFID) antenna system is proposed. Spatial, polarization and radiation pattern diversity is demonstrated with a very reduced number of components. The diversity contribution of such an antenna is then characterized in terms of radio coverage in a RFID portal environment. Radio coverage in complex environment is greatly improved compared to the classical geometry.


Pulmonary toxicity is a known complication of the proliferation signal inhibitor (PSI) sirolimus and consists of diverse entities such as interstitial pneumonitis, lymphocytic alveolitis, bronchiolitis obliterans with organizing pneumonia, and diffuse alveolar hemorrhage. Several cases of interstitial pneumonitis have also been reported with the more recently developed PSI everolimus. In this report, a case of diffuse alveolar hemorrhage attributed to everolimus is described. The patient presented with respiratory symptoms of insidious onset, ultimately resulting in severe respiratory failure characterized by high lactate dehydrogenase levels, patchy ground-glass infiltrates, and bloody BAL fluid with predominance of iron-loaded macrophages and monocytes. Withdrawal of the offending drug and temporary association of high-dose steroids resulted in a rapid recovery. Given that prompt drug discontinuation is potentially life saving, PSI-induced pulmonary toxicity should be considered in the differential diagnosis of patients treated with PSIs and presenting with respiratory symptoms or pulmonary lesions.


Depression haunts the lives of many, especially our young people, this is becoming more
and more apparent in Western countries. Depression is a common mental disorder
characterized by sadness, loss of interest in activities and by decreased energy.
Depression is no respecter of status, intelligence, class or race. It can strike anyone at any
time. The severity of depression can range from mild to acute. At the most severe end of
the continuum individuals can experience life threatening and profound feelings of
despair and sadness. Depression is differentiated from normal mood changes by the
extent of its severity, the symptoms and the duration of the disorder. The aim of my
study is to look at young people's experience of depression. This will be done by using
interviews with several suffers of depression. They will tell their stories of how they
came to realize they were depressed, challenges which they faced with the medical
profession, elements of stigma and in some cases the loss of hope. These are real people
with real account of their experiences. It is important to realize that young people get
depressed and that it is an important issue, which needs to be highlighted.


One of the most important aspects when we are evaluating a machine learning system is its capability for synthesizing knowledge available in input data. Also it is to have the right proce-dures for measuring and comparing the levels of absorption of such knowledge. Another point to take in consideration is the format this knowledge is showed to us for being applied. However, synthesizing capabilities of a system are often reduced by the way input data is presented to the algorithm. Here is shown a method that tries to decrease this factor through reusing less-successful previously generated classifiers. This method, as seen in experimental tests, is efficient in most of the examples tested. We also analyze advantages and problems encountered when using this type of methods.


This article examines the Qur'anic manuscripts written by Prince Paku Ningrat in 1793 at the Sumenep Palace. Through a philological approach, it aims to know the history and characteristics of the manuscripts. This study found the characteristics of philology in Islamic studies through the characteristics of the Qur'anic manuscripts. There are several patterns that make the Mushaf stand out, such as the illumination on the Mushaf, which is beautiful and full of Madura culture. The use of Rasm script, punctuation, Tajweed and Waqf are characteristics of 18th 18th-century scripts from the post-modern era that are different from modern manuscripts.


Energy efficiency is a key issue in wireless ad hoc and sensor networks. In order to maximize network lifetime, several directions have been explored, among them energy efficient routing. In this report, we show how to extend the standardized OLSR routing protocol, in order to make it energy efficient. To take into account residual node energy, the native selection of multipoint relays of OLSR is changed. Three selection algorithms based on the minimum residual energy are evaluated and the best one is chosen. The OLSR extension we propose, selects the path minimizing the energy consumed in the end-to-end transmission of a flow packet and avoids nodes with low residual energy. As it has been shown that two-path routing is energy efficient, we compare this extension with a two-path source routing strategy (with different links or different nodes). An extensive performance evaluation allows us to conclude that our proposal maximizes both network lifetime and the amount of data delivered.


INTRODUCTION
Endometriosis is a quite common condition in women of reproductive age. The purpose of this study is to delineate the association between hemoperitoneum and endometriosis.

MATERIALS & METHODS
The records of all patients with endometriotic ovarian cysts treated at the 3rd Department of Obstetrics and Gynecology of the University of Athens and at "Lito" Maternity Hospital of Athens from 2000 through 2007 were reviewed.

RESULTS
During this 7-year period 720 women underwent surgery due to endometriotic ovarian cysts. The average age was 40.9 years (range: 17-70). The median diameter of the cysts was 4.49 cm and 59% were located in the right ovary. Hemoperitoneum was identified in 16 (2.22%) of them. The average age of these women was 28.5 years (range: 22-44). Ten (62.5%) of these women presented with acute and strong abdominal pain and moderate signs of cardiovascular shock. The rest presented with abdominal pain and distension worsening at the onset of menses, nausea and/or vomiting and hemorrhagic fluid in the pelvis. Ultrasound examination was performed in all women and afterwards they underwent laparoscopy to identify the source of bleeding. In all cases a ruptured endometriotic cyst was found. In 68.8% (11/16) the ruptured cyst was located in the left ovary and the rest (31.2%) in the right. A thorough examination did not reveal any other sources of bleeding. No operative complications were observed.

DISCUSSION
The simultaneous occurrence of ascites and endometriosis is rare. A physician, though, must always take into consideration endometriosis in the differential diagnosis of ascites and acute abdominal pain or pelvic mass.


The 3e (Evidence, Expertise, and Exchange) Initiative in Rheumatology is a multinational collaborative task force aiming at developing recommendations for rheumatologists' daily clinical practice. This program addresses practical questions that rheumatologists face every day, by combining both systematic literature reviews (SLR) and opinions from international experts.

Since 2006, the 3e Initiative has successively taken interest in the management of ankylosing spondylitis1, the use of methotrexate in rheumatoid arthritis2, the management of patients with undifferentiated peripheral inflammatory arthritis3, and the management of pain by pharmacotherapy in inflammatory arthritis4.

For its fifth project, the 3e Initiative investigated the diagnosis and management of an old, but apparently increasingly prevalent disease, namely gout. Today, it is the most common form of inflammatory arthritis in industrialized countries, affecting 1% to 2% of men in …


The future DEMO tokamak will be equipped with a suite of diagnostics which will operate as sensors to monitor and control the position and operation parameters of DT plasmas. Among the suite of sensors, an integrated neutron and gamma-ray diagnostic system is also studied to verify its capability and performance in detecting possible DEMO plasma position variations and contribute to the feedback system in maintaining DEMO DT plasma in stable conditions. This work describes the progress of the conceptual study of the gamma-ray diagnostic for DEMO reactor performed during the first Work-Package contract 2015–2020. The reaction of interest for this Gamma-Ray Spectrometer Instrument (GRSI) consists of D(T, γ)5He with the emission of 16.63 MeV γ rays. Due to DEMO tokamak design constraints, the gamma and neutron diagnostics are integrated, both featuring multi-line of sight (camera type), viewing DEMO plasma radially with vertical (12) and horizontal (13) viewing lines to diagnose the γ and neutron emission from the DT plasma poloidal section. The GRSI design is based on the investigation of the reaction cross sections, on the calculations performed with GENESIS and MCNP simulation codes and on the physics and geometry constrains of the integrated instrument. GRSI features long collimators which diameters are constrained by the neutron flux at the neutron detectors of the Radial Neutron Camera (RNC) system placed in front, which are key to control DEMO DT plasma position. For these reasons, only few GRSI parameters can be independently selected to optimize its performance. Among these, the choice of the collimator diameters at the back side of the neutron detector box up to the GRSI detector, the use of LiH neutron attenuators in front of the GRSI detectors, the GRSI detector material and shielding. The GRSI detector is based on commercial LaBr3(Ce) inorganic scintillating crystal coupled with a photomultiplier tube or a silicon photomultiplier. They are designed to operate at high count rate although GRSI geometry constraints severely impact on this feature. The GRSI can also provide an independent assessment of DEMO DT fusion power and T burning.


This paper describes a generalized approximate method for assessing the effect of topography on the state of stress at depth in the crust and applies it to the site of the Cajon Pass Scientific Drilling Project. While previous studies have addressed idealized topography with regular shapes, we develop a three-dimensional (3-D) method for arbitrary surface topography. The analysis leads to four sets of elastic boundary value problems that are solved by convolutional methods based on the Green's functions of Boussinesq's problem and Cerruti's problem. The effect of topography on the state of stress can be divided into two parts by the linear superposition theorem. The first part is the effect on gravitational stress in the crust. In this case the effect of the topography can be expressed by the summation of the zero-order vertical load and the first-order horizontal shear at the base of the relief. The second part is the effect of topography on tectonic stress. In this case the effect of topography involves only the first-order horizontal shear. The total effect of the topography on the state of stress in the crust can be obtained by adding the effect on gravitational stress with the effect on tectonic stress. The stresses caused by a simple case of 3-D topography are calculated with this approach to serve as illustration. The identity of this study with previous studies (McTigue and Mei, 1981; Savage et al., 1985) for the same two-dimensional case demonstrates the correctness of this method. In applying this technique to the Cajon Pass Scientific Drilling Project, we considered stresses induced by the topography associated with the San Gabriel and the San Bernadino mountains as a function of depth at the site. The regional topography induces stresses of several megapascals at the drilling site which decrease rapidly with depth. The induced maximum horizontal compressive stress is approximately in the N-S direction. If we assume that in the absence of topography there is little right-lateral shear stress acting on the San Andreas fault at depth (a weak fault assumption), the regional topography tends to cause a slight increase of right-lateral shear on the San Andreas fault at a shallow depth in the crust. On the other hand, if we assume the strong fault model, the topography has no effect on the sense of shear on the San Andreas fault at all. Therefore it is clear that the small amount of left-lateral shear stress on the San Andreas fault observed in the upper 3.5 km at the Cajon Pass site is not associated with the topographic effect.


Best mean square prediction for moving average time series models is generally non-linear prediction, even in the invertible case. Gaussian processes are an exception, since best linear prediction is always best mean square prediction. Stable numerical recursions are proposed for computation of residuals and evaluation of unnormalized conditional distributions in invertible or non-invertible moving average models, including those with distinct unit roots. The conditional distributions allow evaluation of the best mean square predictor via computation of a low-dimensional integral. For finite, discrete innovations, the method yields best mean square predictors exactly. For continuous innovations, an importance sampling scheme is proposed for numerical approximation of the best mean square predictor and its prediction mean square error. In numerical experiments, the method accurately computes best mean square predictors for cases with known solutions. The approximate best mean square predictor dominates the best linear predictor for out-of-sample forecasts of monthly US unemployment rates.


[Introduction]: An operating theatre waiting list (OTWL) is a list that patients are enrolled in once they opt to pursue an elective procedure, assuming they cannot get this
procedure performed immediately (Chua, 2005). Operating
Theatre Waiting Lists are of great concern in society nowadays because of their societal and political priority, their link to the quality of individual patients' lives, relation to the economic management of operating theatres and management of patient flow through the hospital, and distribution of scarce medical resources (Al-Hakim & Fitzgerald, 2003; Foote, North & Houston, 2004; NSW Health, 2002). They are used by politicians as measures of success or otherwise measures of government action on the health services.
It is generally accepted that waiting lists are unacceptably long and create a number of problems (Foote
et al., 2004). Long waiting times are a problem for patients, not only because of uncertainty but also because the state of the patient may deteriorate if he or she is
not treated early enough (Council of Europe, 2005).
Nothing is more important to patients than the length of time they have to wait for treatments. The impact of fast, effective treatment, diagnosis and treatment on a patient's health and well-being is incalculable (Scottish Executive, 2001). Disruptions and delay affect the quality of patient care and may cause stress, anxiety, and discomfort for patients as well as cause costs to escalate as sessions overrun and much more (Buchanan & Wilson, 1996). Also, if a patient does not arrive in the operating theatre on time, the surgeon may be left idle or left to perform routine duties, which is expensive for the hospital and frustrating for the staff (Buchanan, 1998). There also have been reports
about the depressing effects on patients of cancelling
surgeries and on the high level of emotional involvement
before surgeries. Late cancellation of scheduled operations is also a major cause of inefficient use of operating-room time and a waste of resources; it is potentially stressful and costly to patients in terms of working days lost and disruption to daily life as well (Schofield et al., 2005).
Sometimes waiting lists are so long that patients have to be turned away. In September 2005, it was found that more than 30 patients were turned away daily from the Royal Brisbane and Women's Hospital (Sommerfeld, 2005). Long waiting lists also have been found to distort the clinical judgement of doctors, thereby causing suffering for some of the most seriously ill patients. It has been found that half of the consultants in England admitted deferring surgery in high priority cases to treat less urgent patients because of the pressure to cut waiting lists in those areas (Carvel, 2001). The consultants who admitted to treating patients in the wrong order said that this had a negative impact on the patients' conditions.


The high performance computing industry is undergoing a period of substantial change. Not least because of fabrication and lithographic challenges in the manufacturing of next-generation processors. As such challenges mount, the industry is looking to generate higher performance from additional functionality in the micro-architecture space as well as a greater emphasis on efficiency in the design of networkon-chip resources and memory subsystems. Such variation in design opens opportunities for new entrants in the data center and server markets where varying compute-to-memory ratios can present end users with more efficient node designs for particular workloads. In this paper we compare the recently released Marvell ThunderX2 Arm processor - arguably the first high-performance computing capable Arm design available in the marketplace. We perform a set of micro-benchmarking and mini-application evaluation on the ThunderX2 comparing it with Intel's Haswell and Skylake Xeon server parts commonly used in contemporary HPC designs. Our findings show that no one processor performs the best across all benchmarks, but that the ThunderX2 excels in areas demanding high memory bandwidth due to the provisioning of more memory channels in its design. We conclude that the ThunderX2 is a serious contender in the HPC server segment and has the potential to offer supercomputing sites with a viable high-performance alternative to existing designs from established industry players.


GaAs quantum dots (QDs) with high density and remarkable uniformity in dot size and distribution grown on Si(100) surface with artificial topography by radio-frequency sputtering have been demonstrated. The photoluminescence spectrum has been recorded. The growth of GaAs QDs is initiated with the preferential nucleation of small dots along ripples controlled by the Stranski-Krastanow growth mode. This method may be useful in combining high-speed and optoelectronic GaAs devices with Si integrated-circuit technology.


Objective. Evaluation of changes of morphometric skin indicators of patients with moderate severity of acne in the course of treatment with systemic isotretinoin in the LIDOSE form. Materials and methods. 30 patients have been under study in the course of isotretinoin therapy ( LIDOSE form) with the dosage of 0.6-0.8 mg/kg per day till the course dose was reached 100-120 mg per kg of the body mass. Control group comprised 30 apparently healthy people. Results. The research conducted has revealed a high efficacy and tolerance of the therapy, and a valid positive tendency of changes in morphometric skin indicators has also been traced in the course of treatment. Conclusion. The conducted research has indicated that isotretinoin LIDOSE form has a positive effect on pathogenic mechanisms acne.


As System On a Chip (SoC) designs become more like Programmable Heterogeneous Multiprocessors (PHMs), the highest levels of design will place emphasis on the custom design of elements that were traditionally associated with systems in the large. We motivate how schedulers that make dynamic, data-dependent decisions at run-time will be key design elements in PHM SoCs. Starting from a fundamental model, the role schedulers play in PHMs is developed. Model-based scheduling is introduced as an approach to designing schedulers that optimize a PHMs performance. Due to the complexity of the PHM design space, convergence on optimal design requires high-level modeling and simulation. In model-based scheduling, high-level models of scheduling decisions result in actual design elements that appear in real systems. Experiments for a simple two-processor PHM that does a mix of image and text compression are included. Results show the effectiveness of model-based scheduling.


BACKGROUND
Respectful maternity care (RMC) is a rights-based approach to childbirth that centers the dignity, autonomy, and well-being of birthing women. This study aimed to examine factors associated with RMC among women giving birth in Tanzania and to examine whether HIV status was associated with self-reported RMC.

METHODS
We enrolled 229 postpartum women in six clinics in the Kilimanjaro Region; of them, 103 were living with HIV. Participants completed a survey within 48 h after birth before being discharged. RMC was measured using a 30-item scale with three subscales (dignity and respect; supportive care; communication and autonomy), each standardized from 0 to 100. Univariable and multivariable regression models examined factors associated with RMC.

RESULTS
The median score of the full RMC score was 74, differing slightly by subscale: 83 for dignity and respect, 76 for supportive care, and 67 for communication and autonomy. RMC did not differ by HIV status (median 67.0 vs. 67.0, p = 0.89). In multivariable linear regression, women who would not recommend the birth facility to their friends and who did not receive breastfeeding education had significantly lower RMC scores on the full RMC scale. In the dignity and respect subscale, variables associated with significantly lower RMC scores were not being able to read and write, delivering in a public facility, and delivering vaginally.

CONCLUSIONS
Although self-reported RMC was generally high, we identified areas for improvement. Practitioners need ongoing training on RMC principles and the delivery of equitable care.


All day long we hear how great agile is that his, and how great agile is at that. agile-agile, agile!" That"s what it"s felt like in any IT organization for the past few years. The title of this paper reflects the issue of separation of ownership and control. In this article, we focused on a broad range of cornerstone issues and ways to improve with agile methodologies.We have managed software teams and established organization governance as part of program life cycle implementation. The organization"s open to new things, but very pragmatic, like most of you. If it shows value and potential improvement, we"re in. If not, it goes into the back seat. Leading software implementation governance with keeping ownership and control means you have to do what"s needed and don"t have time for much else.


Objective: To determine the frequency of sore throat in patients undergoing intubation as part of general anesthesia using intravenous dexamethasone and lidocaine before endotracheal intubation.
Methodology: In this randomized controlled trial, total of 200 patients equally divided into two groups were selected. Group A was given inj dexamethasone 8mg i/v and Group B was given inj lidocaine 1mg/kg body weight i/v. Mean ages in both the groups were 40.20+13.12 and 47.21+10.68, respectively. Patients with sore throat were mild 25(25%), moderate 28(28%) and severe 12(12%) in dexamethasone group and mild 25(25%), moderate 28(28%), severe 14(14%) in lidocaine group. Patients with no sore throat in Group A were 35(35%) and patients in Group B with no sore throat were 33(33%). We considered mild sore throat as no sore throat, this complaint is only by asking the patient according to scoring of sore throat. Chi-square test was used to compare the frequency of sore throat between two groups.
Results: The frequency and severity of sore throat in Group A (dexamethasone) was 40% and Group B (Lidocaine) was 42% (p=0.998).
Conclusion: Dexamethasone and lidocaine before endotracheal intubation reduced the frequency and severity of postoperative sore throat in patients receiving general anesthesia with endotracheal intubation. However, the difference was not statistically significant.


Background The efficacy of endovascular therapy (EVT) as the standard of care for acute ischemic stroke attributable to vessel occlusion improves when delivered quickly. Time metrics have been proposed in order to facilitate quality assurance and there are numerous strategies to streamline workflow. The concept of a combined CT-Angiography-surgical (hybrid) suite in close proximity to the emergency room has been proposed as an innovative and multidisciplinary opportunity to reduce the time required for diagnosis and treatment of neurovascular disease including stroke. We describe our interval times for the endovascular treatment of stroke from patient arrival in the emergency room (door) and imaging (CT) to initiation of treatment (arterial access) before and after two interventions: first, a multifaceted but intuitive quality improvement initiative and second, the opening of an interdisciplinary hybrid operating room composed of a sliding CT scanner, a robotic C-arm and both sterile and non-sterile functionality. Methods Data are from a single center's neurointerventional database from January 2017 to July 2019, excluding in-house stroke patients and patients who had imaging at an outside hospital. Workflow metrics acquired were: door to arterial access (DTA) and CT first image acquisition to arterial access (ITA). Data are described by calendar year and half-years and subdivided by two different angiography suites: the usual neuroangiography biplane suite (BS) located distant to the emergency room (ER) and the hybrid suite (HS) immediately adjacent to the ER. The details of the quality improvement initiative were obtained from internal organizational documents as were the details of the training required for the opening of the hybrid room and the subsequently encountered problems. Results After the launch of a modest stroke quality improvement initiative in January 2018 until July 2019 (n=208), both average DTA and ITA decreased every 6 months in the BS, from 116 to 81 minutes and 86 to 64 minutes, respectively. Despite extensive training and preparation, the opening of the HS in the second half of 2018 showed worse DTA and ITA not only for the first 6 months (18 patients) but also for the first half of 2019 (33 patients) compared to the BS although improvement was demonstrated over the first year of operation. Several setbacks and challenges were associated with the HS most notably with the monoplane robotic C-arm and monitor. Conclusion A workflow quality improvement initiative had a durable effect on reducing EVT treatment times overall and particularly in the existing, geographically distant biplane suite, however, the new lower times were not reproducible within the complicated infrastructure of a new modern hybrid suite next to the ER. Disclosures K. Blackham: None. G. Karwacki: None. D. Zumofen: None. T. Schubert: None. M. Psychogios: None.