In this paper we first identify a basic limitation in gradient descent-based optimization methods when used in conjunctions with smooth kernels. An analysis based on the spectral properties of the kernel demonstrates that only a vanishingly small portion of the function space is reachable after a polynomial number of gradient descent iterations. This lack of approximating power drastically limits gradient descent for a fixed computational budget leading to serious over-regularization/underfitting. The issue is purely algorithmic, persisting even in the limit of infinite data.
To address this shortcoming in practice, we introduce EigenPro iteration, based on a preconditioning scheme using a small number of approximately computed eigenvectors. It can also be viewed as learning a new kernel optimized for gradient descent. It turns out that injecting this small (computationally inexpensive and SGD-compatible) amount of approximate second-order information leads to major improvements in convergence. For large data, this translates into significant performance boost over the standard kernel methods. In particular, we are able to consistently match or improve the state-of-the-art results recently reported in the literature with a small fraction of their computational budget.
Finally, we feel that these results show a need for a broader computational perspective on modern large-scale learning to complement more traditional statistical and convergence analyses. In particular, many phenomena of large-scale high-dimensional inference are best understood in terms of optimization on infinite dimensional Hilbert spaces, where standard algorithms can sometimes have properties at odds with finite-dimensional intuition. A systematic analysis concentrating on the approximation power of such algorithms within a budget of computation may lead to progress both in theory and practice.


Abstract The Internet has tremendous potential as a positive addition to the life of senior citizens, including those who are homebound and isolated. However, seniors lag in computer use. This study surveyed grandchildren about Internet use by their living grandparents. It took data on 124 over-65s in Japan, 124 in Korea, 108 in Hong Kong and 117 in Taiwan, as well as 135 in the United States. More females (314) than males (159) were included in the Asian sample. Of the Asian subjects, only one, a grandmother in Taiwan, was reported to use the Internet, compared with nearly one-third of U.S. grandmothers. Intra-Asian similarities in Internet usage contrasted with differences from U.S. usage patterns. Hofstede's (2001) work on cultural differences, Rogers' (1995) work on diffusion and adoption of innovations and Riggs' (2004) work on how gender interacts with age in matters of technology were used to explain Internet usage in Asia and the United States.


The paper investigates the hypothesis that the separation of ownership and control is made viable by an organizational structure that separates decision making from monitoring. The paper analyses the choice of organizational form and contrasts a hierarchy where executive management is monitored and remunerated by a director who acts as a supervisory agent, and an entrepreneurial firm in which all control rights are concentrated in the hands of a single agent. It is shown how the organizational form affects the allocation and the tradeoff between risk-sharing and incentives. The model predicts that the hierarchy is a dominant choice in environments where monitoring information is precise, whereas the entrepreneurial firm is a better choice if productive efforts are difficult to monitor. Also, more efficient hierarchies have a lower correlation between shareholder value and managerial compensation. The paper shed some light on the decision to go private and on the reverse-LBO phenomenon.


In some cases, it is difficult to differentiate essential tremor (ET) from Parkinson's disease (PD), especially in the early stages of the disease. We investigated cardiac sympathetic dysfunction using 123I‐metaiodobenzylguanidine (MIBG) myocardial scintigraphy in 22 patients with ET, in comparison with early PD and tremor‐dominant PD (TDPD). The mean ratio of 123I‐MIBG uptake in the region of interest in the heart to that in the mediastinum (H/M ratio) was significantly greater in patients with ET (1.99 ± 0.21) than in those with either TDPD (1.28 ± 0.11) or early PD (1.28 ± 0.17; each P < 0.001). The H/M ratio in all patients with ET was greater than two standard deviations above the range of the ratio in the patients with early PD or TDPD. © 2006 Movement Disorder Society


Reaction to insect sting and bite may be local, such as erythema, edema and pruritus, or systemic, such as anaphylactic reaction. Diagnosis can be made by patient history, clinical picture, skin testing, total and specific IgE level, and provocation test. Local reactions are treated with cold compresses, topical corticosteroids and oral antihistamines. Oral and intramuscular antihistamines and corticosteroids are used for the treatment of mild systemic reactions, and in severe reaction epinephrine injections are added. Hyposensitization is indicated in patients with severe systemic reaction, positive skin tests and high level of specific IgE antibodies.


We explore the effect of the behaviour of a virtual robot agent in the context of a real-world treasure-hunt activity carried out by children aged 11-12. We compare three conditions: a traditional paper-based treasure hunt, along with a virtual robot on a tablet which provides either neutral or affective feedback during the treasure hunt. The results of the study suggest that the use of the virtual robot increased the perceived difficulty of the instruction-following task, while the affective robot feedback in particular made the questions seem more difficult to answer.


Varicocele is detected in about one-third of men with subfertile semen quality. Treatment by means of transcatheter embolization using the tissue adhesive Histoacryl improves Sertoli cell function with increased concentrations of transferrin in semen, and a significant increase in sperm concentration, normal morphology and linear velocity. Failure to attain pregnancy after varicocele treatment occurs if pre-treatment sperm quality is normal, or in the case of azoospermia with elevated blood FSH levels or obstruction, or when there is severe coincidental pathology impairing fertility of the male or female partner. In all other cases, the poor results of varicocele treatment reported in some studies can only be explained by inadequate techniques. Varicocele detection and embolization treatment at puberty or during adolescence should be advocated to prevent deterioration of testicular function.


The effect of hydrogen bonding secondary interactions on the crystalline and liquid crystalline phases of quaternary ammonium salts functionalized with a carboxylic group attached at the polar head through a decyl spacer of a homologous series of N-alkyl-N-carboxydecyl-N,N-dimethylammonium bromides was investigated by polarizing optical microscopy, differential scanning calorimetry, and X-ray diffraction. The low-temperature crystal phases were found to have a lamellar structure in which the ammonium bromide groups are arranged within the layers in two distinct planes, alternately separated by single layers of alkyl chains and double layers of carboxydecyl chains coupled through the carboxyl end groups. At higher temperatures although these molecules were made from soft flexible chains smectic H mesophases were identified. The smectic layers were found to be formed by the same two ionic planes alternately separated by the alkyl and carboxydecyl sub-layers. The smectic structure was compared with the three-dimensional positional order observed in the smectic T phase of dihydroxyl functionalized quaternary ammonium salts already described in the literature.


ABSTRACT Cyclic diguanylic acid (c-di-GMP) is an intracellular signaling molecule involved in regulation of cellular functions such as motility, biofilm formation and virulence. Intracellular level of c-di-GMP is controlled through opposing diguanylate cyclase (DGC) and phosphodiesterase (PDE) activities of GGDEF and EAL domain proteins, respectively. We report the identification and characterization of cdpA, a gene encoding a protein containing an EAL domain in the Gram-negative soil bacillus and human pathogen Burkholderia pseudomallei KHW. Purified recombinant CdpA protein exhibited PDE activity in vitro. Evidence that CdpA is a major c-di-GMP-specific PDE in B. pseudomallei KHW was shown by an 8-fold-higher c-di-GMP level in the cdpA-null mutant as compared to the wild type and the complemented cdpA mutant. The presence of higher intracellular c-di-GMP levels in the cdpA-null mutant was associated with increased production of exopolysaccharides, increased cell-to-cell aggregation, absence of flagella and swimming motility, and increased biofilm formation. The relevance of CdpA in B. pseudomallei virulence was demonstrated by a 3-fold reduction in invasion of human lung epithelial cells and a 6-fold reduction in cytotoxicity on human macrophage cells infected with the cdpA mutant.


Friction stir welding (FSW) with a Zr interlayer was employed to join dissimilar alloys of 6061 Al and AZ31 Mg. The microstructures of Al/Mg and Al/Zr/Mg joints were investigated by optical microscopy (OM), scanning electron microscopy (SEM), and energy dispersive X-ray spectrometer (EDS). The results showed that the central part of the Zr interlayer was smashed and intermixed with the base materials in the stir zone, whereas the undamaged part remained stable at the Al/Mg interface. The formation of Al–Mg intermetallic compounds (IMCs) was suppressed by the Zr interlayer due to its synergetic effects of chemical modification and thermal barrier. The electrochemical measurements revealed a differentiated corrosion behavior for each joint, where the corrosion rate of representative regions increased in the order of Al alloy < Mg alloy < heat-affected zone < stir zone. The immersion tests indicated an enhancement in corrosion resistance for the Al/Zr/Mg joint compared with the Al/Mg joint, which is owing to the mitigated galvanic corrosion between the base materials by the Zr interlayer.


University subjects trend to be very theoretical, while enterprise usually demands graduate students with high practical skills. The major concern in remote teaching and online learning is the high trend to create a theoretical course. This is usually solved adding remote practices and hands on practices in a real laboratory. In this paper, we present a blended learning training plan carried out during three years with graduate students. First, we will present the course content and the pursued objectives. Then we will show the learning methods performed to achieve our goals. This paper also analyses the profile of the students included in this course and reviews, in terms of age and gender, how they impact to the class results. The most part of course is conducted through an online learning platform where all students are supervised through tutorials. During the attendance days, students perform collaborative practices with real devices. Finally, we will analyze the student's opinions and their qualifications during the three years. As results show, the level of acceptance of this kind of teaching innovations depends on the age of the participants and their previous knowledge of these new technologies. DOI: http://dx.doi.org/10.4995/HEAd15.2015.491


Aims: There is an 18 years age limit for cigarette purchase in Sweden and in order to implement this law outlets need to perform ID checks. This study investigates the rate of cigarette sales and ID checks when pseudo-underage mystery shoppers attempted to purchase cigarettes. It explores possible factors associated with sales outcomes. Design: Nine mystery shoppers (6 females and 3 males) attempted to purchase cigarettes without providing ID. The mystery shoppers were 18 years old but had a younger appearance as judged by an expert panel. During each attempt, the adolescents worked in pairs (shopper and observer). A total of 320 outlets in 13 municipalities in Stockholm County were randomly selected based on an outlet type stratum (i.e., gas station, convenience store, kiosk, grocery store). Effects of variables on sales outcomes were analysed using Pearson's chi-square and binominal regression analysis. Results: In 25.4% of the purchase attempts (total n = 287), cigarettes were sold although the pseudo-underage mystery shopper did not provide a valid ID. In 82.6% of the attempts, the shopper was asked to provide ID, and cigarettes were sold in 9.7% of these cases. The rate of sales was significantly higher among female mystery shoppers (29.5%) compared to male (15.0%). Age limit signs were observed in 89.5% of the outlets but they were not significantly associated with the success rate in a regression analysis. Conclusions: The results of the present study indicate that cigarettes could potentially and frequently be sold to underage adolescents by outlets within Stockholm County. Therefore, routines established for checking IDs clearly need to be improved. For example, strategies to improve adherence to the legal age limit on the purchase of cigarettes, such as compliance checks using mystery shopping with feedback to retailers, are needed.


These results suggest that DSG and RATG are an especially favored combination in reducing PNF of discordant pig islet xenografts, probably related to the effect of DSG on the macrophage, humoral antibody, or blockade of NK cell activity. More effective immunosuppression such as demonstrated in this study could well be critical in permitting the application on discordant islet xenografts to human clinical diabetes.


Cast steel joints have been widely utilized in large-span spatial structures. Based on Ordos airport terminals engineering, the structure and design method of ribbed steel ball nodes is put forward in this essay, in which nonlinear finite element method is applied, bearing capacity and deformation capacity of ribbed steel ball nodes in the complex stress state is made a penetrating analysis to determine mechanical performance of the ribbed steel ball. Among other things, the manufacturing process and technical standards of cast steel ball nodes are elaborated.


Commander Ernesto Che Guevara Nickel Company's Carbonate thickener effluent, as an average, contains 183,03 mg/L of total nickel, from this 81,3 % is in a dissolve nickel form. This paper aim was to recover the greatest quantity of nickel as possible from this effluent by using the coagulation –flocculation process. Test runs were carried out with hydrated lime addition in different dosages, for aiding coagulation and other ones with the previously distilled effluent. Six coagulants from different companies were assessed in different dosages, including an effluent that is common for all the tests. The best results were obtained with the use of the aluminum sulfate in dosages of 300 mg/L as well as hydrated lime at 150 mg/L, with a recovery of 91,70 % of the total nickel and 88,67 % of the dissolved nickel. With the predistilled effluent no high precipitation values were achieved.


In our daily life, we confront with people from different nations. Whether we travel, work or just walk on the street, a situation can occur, when we must react appropriate. The trend of globalization, in today?s business environment also calls for global citizens with advanced intercultural communication skills. During the internationalized activities there is a high danger for problems because of the lack of intercultural understanding. Intercultural communication as an object of study and analysis is regarded as a special case of interpersonal communication and takes place during the interaction among people of different cultural identities. Due to the difference in the models of codification, it is expected that in a multicultural environment there will possibly be more misunderstandings and misinterpretations in the decipherment of the messages. This means that the effective intercultural communication presupposes the awareness of the other person? s cultural reality. The aim of the authors with creating their first book was to give a helping hand to all those, who whether travel or go to work into a different, foreign culture, let it be not only Hungary, but any other country.


BACKGROUND
The possibility of using 3D mapping of AMD-related RPE detachments by means of laser scanning tomography was evaluated to correlate the fluorescein and tomographic findings.

METHODS
Sixty eyes with AMD-related RPE detachments of 55 consecutive patients (19 men, 36 women) between 54 and 87 years of age (mean: 72.2 years) were examined using the Heidelberg Retina Tomograph (HRT). The parameters considered were area, volume, maximal height and 3D configuration of the RPE detachments. The tomographic data were analyzed and correlated with the fluorescein angiographic findings. Follow-up examinations were done at 3 and 6 months later.

RESULTS
The mean +/- SD area of elevation was 10.59 +/- 5.51 mm2 (range, 0.93-19.73), which correlated well with the angiographic measurements. The mean maximal height was 0.42 +/- 0.19 mm (range, 0.11-0.83), mean volume was 2.55 +/- 1.9 mm3 (range, 0.073-6.63). We found a tendency to grow for untreated RPE detachments, depending on the volume at the first measurement. Three RPE detachments of high volume (mean 0.501 +/- 1.3 mm3) resulted in tearing of the RPE. The angiographic findings of localized neovascularizations in the RPE detachment area (39 of 60 eyes) showed a corresponding irregularity of the surface in most of the correlating 3D HRT figures.

CONCLUSIONS
Confocal laser scanning tomography allows analysis of 3D configurations and a quantitative measurement of RPE detachments in AMD. Therefore, this diagnostic technique appears to be useful, especially for differentiated follow-up examinations (as in therapy-control studies). Furthermore, the analysis of 3D configurations seems to be useful to estimate the risk of tearing of the RPE and may help to indicate underlying neovascularizations.


Abstract The aim of the work was to analyze the possibilities of measuring the phenomenon of financialization on a regional basis. The article attempts the move with the measurement of financialization from the level of countries to the level of regions. In the paper, some variables that can measure financialization at the level of voivodeships were used to create an index of regional financialization. The research proposal was verified empirically, using data from 2005–2015 for 16 Polish voivodeships. The results obtained allowed for the ranking of individual regions of the country, in terms of the degree of intensification of financialization. The regional approach is a subject, which is poorly recognized in the literature on the subject. However, according to the authors of the article, individual regions of the country may have a different degree of intensity of financialization, and knowledge on this subject may form the basis for strategic decisions regarding further development of these regions. The authors of the work wanted to pay attention to this issue and initiate further research in this direction. The presented methodology is only an attempt to measure this phenomenon and can be developed in subsequent studies.


Energy transport models of carrier behaviour in semiconductors are based on equations of carrier momentum and carrier energy conservation. Some terms of the modelling equations describe momentum and energy transfers between carriers and the lattice during scattering. The authors demonstrate how empirical parameters can quantify the inter-band scattering components of energy transport models for the Shockley-Hall-Read, band-to-band, impact ionisation and optical recombination and generation mechanisms. An evaluation of the empirical parameters is presented for Shockley-Hall-Read recombination and generation. Further, energy transfer is considered from the point of view of the lattice, and it is shown that a lattice energy conservation equation, which describes thermal effects in semiconductors, can easily be appended to the energy transport modelling equations. The explicit consideration, in energy transport models, of carrier energy gain from the electric field and carrier energy loss due to scattering leads to a more accurate thermal model than is possible with drift-diffusion transport models appended with a lattice heat flow equation incorporating a Joule-type heating term.


Abstract This is the eighth Appellate Body Report in which some aspect of zeroing was adjudicated. As in the prior cases, the AB again found the US practice inconsistent with several aspects of the Anti-Dumping Agreement. The novelty in this dispute was the EC attempt to broaden the concept of what constitutes an appealable measure. The EC challenged whether a WTO decision regarding zeroing could apply to subsequent proceedings that might modify duty levels and asked the AB to decide whether the United States' continued use of zeroing in the context of a given case was consistent with WTO obligations. The AB stated that in its attempt to bring an effective resolution to the zeroing issue, the EC is entitled to frame the subject of its challenge in such a way as to bring the ongoing use of the zeroing methodology in these cases, under the scrutiny of WTO dispute settlement. The AB then cautiously applied the new perspective to US zeroing practice.


Photo‐ and mechanoluminescent materials that exhibit tunable emission properties when subjected to external stimuli have a wide variety of applications. However, most mechanoresponsive materials have a mechano‐induced structural transition from crystalline to amorphous phase, and there are only few reports on the crystalline to crystalline transformation. This study reports an amide‐linked dyad P1 containing spiropyran and naphthalimide chromophores with dual sensitivity of photochromism and mechanochromism. Under light and mechanical stimuli, P1 performs different color transition. With mechanical force, the morphologies of P1 change from microfiber to nanosphere and the amide group in P1 plays a vital role in these transition processes. Mechanical force can induce the morphology change of P1 through enhancing π–π stacking and destroying hydrogen bonds. These results demonstrate the feasibility of the design strategy for new mechanoresponsive switching materials: both π−π stacking and hydrogen bonding of the dyad contribute the mechano‐induced crystalline/crystalline transformation.


In a recent paper, Joly and MacCullum (1990) described an algorithm for the Segre classification of the Ricci tensor and its implementation in the computer algebra system SHEEP. In this work useful extensions and improvements of the algorithm in terms of the computational efficiency are presented. Some comparative examples are tested in both versions.


The threat of an AIDS (acquired immune deficiency syndrome) epidemic in the early 1980s saw the emergence of strong negative attitudes from both the public and health care professionals alike. Certain 'high risk' groups in society, who were considered as susceptible to the disease, homosexuals and intravenous drug users in particular, became the victims of prejudice and discrimination. More recent research has indicated a possible shift to a more positive orientation, although the findings are far from conclusive. In this current study, the Prejudicial Evaluation and Social Interaction Scale (PESIS) was administered to four separate cohorts of student nurses approximately a year apart in training (n = 192). Each cohort was divided into four groups, each one completing the PESIS after reading a version of a vignette that described either a person with AIDS or leukaemia, and who was either homosexual or heterosexual. The design therefore allowed for within-group and between-group comparisons. Overall the results showed that the student nurses held positive attitudes although they reported a significantly greater prejudice towards AIDS. No significant differences were found for sexual orientation. Additionally significantly greater levels of blame and responsibility were associated with the person with AIDS, but again there was no effect for sexual orientation. The findings suggest that a slightly more negative attitude continues to be associated with a diagnosis of AIDS but no longer with homosexuality. No effect across cohorts was noted either, student nurses being as positive at the beginning of training as at the end. Some of the limitations of PESIS and the difficulties of attitude assessment in general are discussed and future areas of research are identified.


A systematic study of the surface morphology of sputtered YBa2Cu3O7 films, as a function of temperature, was performed by means of atomic force microscopy. The investigated films display spiral-shaped islands with a central terrace that is typically much larger than the subsequent terraces. A careful analysis of the observed spirals shows that the change in terrace width occurs within a narrow range of angles. Possible causes for this cross-over, e.g. the role of dislocation stress or the existence of an Ehrlich–Schwoebel barrier, are discussed. Furthermore, the temperature dependences of the central terraces, as well as of the outer terraces, are found to follow an Arrhenius law. These findings are discussed within the framework of a recently developed two-component growth model, where a rate-limiting metallic species (Y, Ba or Cu) is deposited in a reactive gas (in our case O2). The model indicates that the supersaturation of the components involved is much less than assumed previously.


Any skillful prediction is of great benefit to North China, a region that is densely populated and greatly impacted by droughts. This paper reports potential predictability of North China summer drought 1 month ahead based on hindcasts for 1961–2005 from the "ENSEMBLES" project. Correlation scores of the standardized precipitation–evapotranspiration index and standardized precipitation index reach 0.49 and 0.39, respectively. The lower-level northwestern Pacific cyclonic circulation anomaly (NWPCCA) and East Asian upper-tropospheric temperature (UTT) cooling are the crucial circulations with regard to summer drought. Two sources of predictability are identified: 1) Pacific–Japan and Silk Road teleconnections forced by well-established eastern Pacific Ocean El Niño sea surface temperature anomalies (SSTA) in summer, when the two key circulations are both well predicted because of a good prediction of enhanced equatorial central Pacific (CP) rainfall and Indian rainfall deficit, and 2) the subtropical atmosphere–ocean coupling associated with CP El Niño developing, when the skill mainly arises from the reasonable prediction of NWPCCA. In observations, the NWPCCA persists from the preceding spring to summer through a wind–evaporation–SST feedback related to the Pacific meridional mode (PMM). In predictions, the persistence of the NWPCCA is mainly forced by the enhanced convection over the subtropical central North Pacific due to the persistence of the PMM-related meridional SSTA gradient over the CP. This predicted SSTA suppresses the equatorial Pacific rainfall, contributing to low prediction skill for the East Asian UTT cooling. This study demonstrates the importance of extratropical signals from the preceding season in North China summer drought prediction.


Physically awkward children face a host of difficulties, which include difficulties in the school environment. Therefore, it is important to identify Developmental Coordination Disorder (DCD) early in a child's life to allow for proper and timely intervention and support. The objective of this study was to determine the prevalence of DCD and examine the relationship of the degree of motor difficulties on learning-related skills. This comparative study made use of quantitative data. Three hundred and forty-seven ( N =347) Grade 1 children took part and were between the ages of five and eight years (mean age=6.58±0.4). There were 190 girls and 157 boys. The Movement Assessment Battery for Children-2 (MABC-2 Test) was used to identify DCD. In addition, each participant was evaluated with the Aptitude Test for School Beginners (ASB). Learning-related skills of children with DCD were compared to those without DCD. The prevalence of DCD (severe motor difficulties) was 6% and the at-risk group constituted another 6%. Motor difficulties had a significant effect on five of the eight learning-related subtypes, namely reasoning, numerical skills, gestalt, coordination and memory. Children with DCD experienced more learning-related problems compared to their peers without DCD. Key words: Developmental Coordination Disorder (DCD); Movement Assessment Battery for Children-2; Learning-related skills; Aptitude Test for School Beginners questionnaire.


INTRODUCTION
Complete Hydatidiform mole is one of the most frequent abnormal pregnancies. This review studies the trend of complete mole in Paropakar Maternity and Women's hospital and clinical ability to detect it.

METHODS
This is a retrospective study of 504 cases of complete hydatidiform mole recorded at Paropakar maternity and women's hospital, Kathmandu, during 2058-2065 B.S. Medical records were reviewed and incidence, clinical presentation and method of diagnosis were studied.

RESULTS
During the study period, there were 13,9117 births and 504 complete moles, 12 partial moles, 48 persistent gestational tumours, six choriocarcinoma and four invasive moles recorded in the hospital. The incidence of complete mole was one per 276 births. It was prevalent among women younger than 29 years (80%) and among the primigravidae (36.7%). More than 90% women presented in the first half of their pregnancy and vaginal bleeding was the main complaint (68.3%). Suction evacuation, dilation and evacuation followed by sharp curettage and abdominal hysterectomy were performed in 80.6%, 17.6% and 1.2% of the women respectively. Persistent mole and choriocarcinoma developed in 9.5% and 0.4% respectively.

CONCLUSIONS
Complete mole has the highest incidence. It affects mostly younger women and presents with vaginal bleeding most of the time, usually in the first half of their pregnancy.


It was recently found from ab initio investigations [J. L. F. Da Silva et al., Phys. Rev. Lett. 90, 066104 (2003)] that polarization effects and the site dependence of the Pauli repulsion largely dictate the nature of the interaction and the site preference of Xe adatoms on close-packed metal surfaces. It is unclear if the same interaction mechanism occurs for all rare-gas atoms adsorbed on such surfaces. To address this question, we perform all-electron density-functional theory calculations with the local-density approximation (LDA) and generalized gradient approximations (GGA) for [He, Ne, Ar, Kr, and $\mathrm{Xe}]∕\mathrm{Pd}(111)$ in the $(\sqrt{3}\ifmmode\times\else\texttimes\fi{}\sqrt{3})R30\ifmmode^\circ\else\textdegree\fi{}$ structure. Our results confirm that polarization effects of the rare-gas adatoms and Pd atoms in the topmost surface layer, together with the site-dependent Pauli repulsion, largely determine the interaction between rare-gas atoms and the Pd(111) surface. Similar to the earlier ab initio study, the on-top site preference is obtained by the LDA for all rare-gas adatoms, while the GGA functionals yield the on-top site preference for Xe, Kr, and He adatoms, but the fcc site for Ne and Ar.


Looks at the problem of global warming from the viewpoint of wholeness. That is, the problem of global warming will be looked at in a comprehensive study considering several aspects of the cosmos, the Earth, and the phenomenon of life. With such a broad understanding in mind, first analyzes both the disadvantageous and advantageous aspects of the current global warming. Second, compares three typical environmental conditions in which humans have lived. Third, employing the concept of global warming, looks at the myth of how ancient civilizations appeared and disappeared. Then, considering our Earth system as an open system travelling in the universe, provides an explanation for the current global warming and for global climate changes. It is expected that the explanation presented can be applied to produce long‐term predictions for climate changes.


In this study, we introduced 1H-1,2,4-triazole into the ordered nanochannels of propyl amino functioned MCM-41 and then investigated the hybrids' proton conducting performance. A high proton conductivity of 8.34 × 10−3 S cm−1 has been obtained at 120 °C, with 5 mol% mole ratio of dangling propyl amino and fully loaded 1H-1,2,4-triazole in the silica. The activation energy is 0.55 eV and 1.303 eV in the temperature range below and above 80 °C respectively, indicating that the charge transfer mechanism of the material involved both vehicle and Grotthuss process. The above results showed that loading of 1-H-1,2,4-triazole molecules into silica's ordered mesopores is a good strategy for excellent proton conductivity under intermediate temperature.


Organic Rankine cycle power systems have recently emerged as promising solutions for waste heat recovery in low- and medium-size power plants. Their performance and economic feasibility strongly depend on the expander. Its design process and efficiency estimation are particularly challenging due to the peculiar physical properties of the working fluid and the gasdynamic phenomena occurring in the machine. Unlike steam Rankine and Brayton engines, organic Rankine cycle expanders have to deal with small enthalpy drops and large expansion ratios. These features yield turbine designs with few highly-loaded stages in supersonic flow regimes. This paper proposes a design method where the conventional cycle analysis is combined with calculations of the maximum expander performance using a validated mean-line design tool. The high computational cost of the turbine optimization is tackled building a model which gives the optimal preliminary design of the turbine as a function of the cycle conditions. This allows to estimate the optimal expander performance for each operating condition of interest. The test case is the preliminary design of an organic Rankine cycle turbogenerator to increase the overall energy efficiency of an offshore platform. The analysis of the results obtained using a constant turbine efficiency and the method proposed in this paper indicates a maximum reduction of the expander performance of 10 % points for pressure ratios between 10 and 35. This work also demonstrates that this approach can support the plant designer on deciding the optimal size of the organic Rankine cycle unit when multiple exhaust gas streams are available.


While there are studies that describe the patient demographics of both Australian and American chiropractic clinics, such information appears difficult to find for physiotherapy or osteopathic clinics comparative data of any kind doesn't appear to exist. This study attempted to provide this data for Australian practices and to analyse any similarities or differences between populations.

Results obtained for chiropractors and osteopaths would appear to suggest that there may be significant differences between the diagnostic profiles of the two professions. Physiotherapists withdrew from the - process during data collection.

Suggestions are made relating to possible modifications I to the survey instrument and possible directions any future study might take.


The business model of many banks -selling financial products, services and advising customers -has not changed significantly during the last twenty-five years. Nevertheless, the process by which ideas are identified, required knowledge is incorporated and utilised, innovations developed and distributed, has changed radically. The reasons for this transformation are the volatile, uncertain geopolitical climate driven by increasing competition, economic pressure, regulatory changes, technological innovations, and the changing nature of demand. Although banking has traditionally been a conservative industry, resistant to change, these strategic challenges are forcing firms to make extensive adaptations to the changing environment, with innovation as a source of competitive advantage. The blend of openness, flexibility, discipline, and focus on the core business captures the innovation zeitgeist.
The overall phenomenon that will drive change, beneath the surface of banking in years to come, is anticipated to be the shift from a closed to an open innovation paradigm. In recent years, most banks have embraced "open architecture" as a model that offers clients a full range of products, regardless of suppliers. Some banks have gone even further and restructured their client advisory processes as a complementary service to their product portfolio, with the aim of increasing customer value. Managing multiple product offerings, serving, and advising clients across the globe triggered investments in organisational and technological infrastructures. The capability for open, flexible, and aligned interactions is required for all business practices, but is particularly important for integrating acquired institutions. This capacity is crucial for the bank's growth strategy of onshore banking operations for wealthy private clients.
The bank, whose experience forms the basis of this doctorate, has been a leading example in the financial service industry of a firm that has embraced the need for open innovation. It realised that the strategic value of the future will be the combination of technology, knowledge, and innovation, as given emphasis to some extent in the knowledge-based view of the firm. This study examines how open innovation was adopted and developed in the context of the banking industry. In particular, it analyses how the studied bank responded to the trends and negotiated the transition to open innovation. This transition was based upon organisational and technological innovation and required a set of new management practices focused upon developing dynamic capabilities.
The findings, represented in a proposed integrative framework, provide multiple contributions to knowledge. The core of the theoretical contribution builds on the concept of leveraging capabilities as a set of resources and capabilities aligned through social capital and based on an open innovation culture. This overall picture and novel account, shows that firms can manage strategic change and simultaneously increase efficiency and flexibility by aligning various initiatives and strategies. Another key contribution of this management research is its applied nature, obtained by seeking information that explains the process, rather than just the outcomes of social actions. Through this process, it became apparent that the successful transition relies heavily on the firm's leadership and their ability to provide the organisation with conditions that facilitate innovation and learning. These key issues addressed the integrative aspects of the study, in which theory-and practice-led research combined contributed to the production of knowledge for both academics and managers.


As a result of the globalization of access and provision of continuing education and continuing professional development (CE/CPD), the national CE/CPD accreditation organizations of Australia, Canada, Ireland, New Zealand, South Africa, United Kingdom and United States formed the Global Forum on Quality Assurance of Continuing Education and Continuing Professional Development (GFQACE) to investigate and develop means of recognizing CE/CPD across boundaries. Two priorities were identified at their first meeting in 2016: (1) the development of an accreditation framework and (2) the identification of models and approaches to mutual recognition. The GFQACE approved an accreditation framework and facilitated review approach to mutual recognition in 2018 and is currently working on implementation guides. As background to the work of the GFQACE, this article provides a brief history of continuing education (CE) and continuing professional development (CPD) and discusses the value and benefits of CE/CPD to professional development of pharmacy professionals, innovation of pharmacy practice and the provision of quality patient care. Due to the essential role of CE/CPD accreditation in enabling recognition across boundaries, the nature and role of accreditation in defining, assuring and driving quality CE/CPD is described. Four conclusions regarding the broad sharing of perceptions of quality CE/CPD, the potential for expansion of the GFQACE and the benefits to pharmacy professionals, providers and pharmacy practice are discussed.


The multidomain target of rapamycin (TOR) is an atypical serine/threonine protein kinase resembling phosphatidylinositol lipid kinases, but retains high sequence identity and serves a remarkably conserved role as a master signalling integrator in yeasts, plants, and humans. TOR dynamically orchestrates cell metabolism, biogenesis, organ growth, and development transitions in response to nutrient, energy, hormone, and environmental cues. Here we review recent findings on the versatile and complex roles of TOR in transcriptome reprogramming, seedling, root, and shoot growth, and root hair production activated by sugar and energy signalling. We explore how co-ordination of TOR-mediated light and hormone signalling is involved in root and shoot apical meristem activation, proliferation of leaf primordia, cotyledon/leaf greening, and hypocotyl elongation. We also discuss the emerging TOR functions in response to sulfur assimilation and metabolism and consider potential molecular links and positive feedback loops between TOR, sugar, energy, and other essential macronutrients.


In mammals, anti-Müllerian hormone (AMH) expression is detected in the granulosa cells of all growing follicles and is highest in healthy small antral follicles, which contribute most significantly to AMH endocrine levels. AMH is a reliable endocrine marker of this population of gonadotrophin-responsive follicles in ruminants and, over the longer term, plasma AMH concentrations are characteristic of individual animals. In the cow, plasma AMH concentrations follow specific dynamic profiles throughout the prepubertal period, the oestrous cycle and the change from gestation to the post partum period, with the alterations most likely reflecting numerical changes in the population of high AMH-producing follicles. In granulosa cells, bone morphogenetic proteins (BMP) enhance AMH gene expression and AMH synthesis, with these effects antagonised by FSH. BMP could both support follicular growth and contribute significantly to the induction and/or maintenance of AMH expression in small growing follicles. AMH expression decreases sharply in large follicles when they become oestrogenic, suggesting a role for FSH and/or oestradiol in these changes, but the underlying mechanisms remain hypothetical. A better understanding of the factors and mechanisms regulating AMH production is needed to propose new strategies for managing the reserve of primordial and small growing follicles, as well as for improving embryo production.


Today's industrial organizations use multi-team (MT) efforts to achieve effective performance and enhance the quality of their work. MT work is characterized by multiple teams acting concurrently or sequentially to produce a specific outcome over time. This outcome could be in many cases accomplished only by team replacement (TR). MT's may also generate risks. These risks might not cause damage to the team right away, but might possibly create risk dormancy (RD). TR is a crucial interface between teams, and therefore successful TR should consider a set of risk evaluation procedures to avoid accidents. The risks include, but might not be limited to, hazard identification, alert from each other's hazardous activities, etc. The emphasis of this analysis is on the TR, its role, significance and attributes, from the standpoint of risk evaluation and detection, and its effect on RD. A new probabilistic model is suggested. The model is intended to predict the role of TR over the entire RD range. The model can be used to manage the RD as far as TR is concerned. The analysis is, in effect, an extension of the authors' earlier research on the problem of the MT risk dormancy (MTRD).


Whether you have launched your online store or not, its clear you are going to need traffic to make sales. You have heard people mention blogging but what exactly does it involve? Let us take out the guesswork. Our complete guide goes step by step through the different steps of blogging for your ecommerce site. From deciding what to write to finally publishing. All blogging is not created equally. If you are trying to drive more traffic to your store and looking to get serious about blogging, this is the book for you. Blogging for an online store is not straightforward. We will walk you through what you should be blogging about and how to attract traffic. We will discuss the details of optimizing your posts to be found and shared. Our blogging guide is designed to drive traffic to your online store. If you are considering blogging as a business, this book is not for you. We are trying to increase sales in your store and thats the focus of our step by step guide. Learn the same tricks that we have used to generate over $1,000,000 in online sales. Topics Covered In This Book: Free Traffic Do it over and over Building an Audience Give Them What They Want The Blended Mix Long Road Listicles You Are The Best How To Interviews Opinions and Tone What is a Keyword Finding Keyword Phrases Google Keyword Planner Breaking Down The Results Looking in the Ruff Understanding Google What is Organic Anyhow? The Golden Free Tool Can I Compete My Secret Keyword Finding Tool Writing means writing Relate With the Reader Google Doesn't Have Eyes Email Opt-ins Call to Action Outsource Hemingway Why Do I Like Some Blog and Dislike Others Graphic and Photo Sites Photo Outsourcing Spacing and Font Subheaders Blog Titles The Slug Keywords in Your Copy Your Images Meta Description Links in your Blog Posts Webmaster Tools and Analytics Backlinks Email Your People Get Social Reach out to Influencers Commenting on Blogs RSS feeds Free Gift


In previous years, the Internet using a conventional IP mechanism had a lot of problems such as slow packet forwarding, complex routing and inefficient usage of network resources. Multi-Protocol Label Switching (MPLS) is one of the mechanisms that are proposed to solve these problems. In addition, multicast is one of the big issues in the Internet society because it can efficiently support real-time multimedia traffic. Therefore, the next generation Internet will be a system which have an MPLS backbone and can support multicast. An MPLS multicast mechanism is considered under Internet broadcasting systems. Specially, the scalability problem of common problems in MPLS and multicast is solved using label aggregation. In the proposed algorithm, the Label Edge Router (LER) of edge router in MPLS has a new table containing information of each tree node. The table is called the multicast Tree Node Table. Extending the Constraint-based Routed Label Distribution Protocol (CR-LDP), the label allocation is performed by using this table. The scalability problem can be solved using this algorithm because it reduces label consumption. So, the MPLS multicast mechanism can be easily supported in a large Internet backbone network.


Frilund GE, Koksvik J, Rikstad A and Berger HM. 20092009. Cottus gobio (Linnaeus, 1758), a new fish-species in Nord-Trondelag County, Norway. Fauna Norvegica 29: 55-60. Cottus gobio, a freshwater sculpin, was discovered by electrical fishing in rivers draining to Murusjoen in Lierne, Nord-Trondelag County in the middle of Norway. Until now, this sculpin has only been found in a few river systems in the south-eastern and north-eastern parts of Norway. Species specific characters (glands and fins) were used to distinguish C. gobio from the close relative C. poecilopus. The sculpin dominated the catches in all the investigated rivers. In August 2008 in the River Fiskloysa, a total of 194 specimens were collected. Their length varied from 37 mm to 105 mm, indicating the presence of both juvenile (age 0) and adult individuals. In September 2008, qualitative sampling was conducted in another part of Fiskloysa and in the rivers Kveelva and Murubekken. In River Fiskloysa, the species was not registered above a presumably impassable waterfall about 1.6 km from Lake Murusjoen. In River Kveelva sculpins were caught below a nine meters moderate waterfall, close to the outlet of Lake Kvesjoen, but no sculpins were registered above the waterfall. This indicates that the waterfall is a possible barrier for further upstream dispersal into Lake Kvesjoen. Sculpins were also registered in River Murubekken.The paper discusses possibilities for C. gobio being spread naturally or artificially into the river systems in Lierne. It is predicted that the dispersal most likely has been natural from populations in Sweden, as there are no distinct barriers preventing the sculpin from spreading westwards. The time-period of the dispersal, however, is still unknown, and the sculpin may still be expanding its home range in these water systems.


Tumoral obstructions in almost the entire gastrointestinal tract can be resolved with interventional digestive endoscopy techniques. Self-expanding metal stent (SEMS) insertion in the obstructed colon is a minimally invasive and relatively simple procedure providing an effective first-line treatment for relief of acute malignant obstruction symptoms and serving either as a preoperative or "bridge to surgery" procedure or as palliative definitive care. This technique was introduced in the early 1990s. Although there is still debate about its real value, a lot of reports have been published since then and the procedure is advocated by many surgical groups as the method of choice for the initial treatment of left-sided tumoral colonic obstruction. Before the procedure, colonic obstruction has to be diagnosed by abdominal radiographs, water contrast enema and/or a computed tomography scan. The greatest information is provided by the latter and it is perhaps the method of choice prior to stenting. Skills and training are mandatory, as in all interventional procedures. The key step for success is to cross the malignant stricture with a guidewire. Care must be taken not to over insufflate an obstructed colon during the procedure. SEMS slide over the guidewire through the endoscope working channel or in parallel, outside the endoscope. An average 7% perforation rate has been reported during the procedure and other minor complications can appear in the follow up. However, as a whole, this technique seems to compare favorably with surgery.


OBJECTIVES
We examined the association between the expansion of methadone and buprenorphine treatment and the prevalence of heroin overdose deaths in Baltimore, Maryland from 1995 to 2009.

METHODS
We conducted a longitudinal time series analysis of archival data using linear regression with the Newey-West method to correct SEs for heteroscedasticity and autocorrelation, adjusting for average heroin purity.

RESULTS
Overdose deaths attributed to heroin ranged from a high of 312 in 1999 to a low of 106 in 2008. While mean heroin purity rose sharply (1995-1999), the increasing number of patients treated with methadone was not associated with a change in the number of overdose deaths, but starting in 2000 expansion of opioid agonist treatment was associated with a decline in overdose deaths. Adjusting for heroin purity and the number of methadone patients, there was a statistically significant inverse relationship between heroin overdose deaths and patients treated with buprenorphine (P = .002).

CONCLUSIONS
Increased access to opioid agonist treatment was associated with a reduction in heroin overdose deaths. Implementing policies that support evidence-based medication treatment of opiate dependence may decrease heroin overdose deaths.


This article considers the translation of verbs of movement within texts between English and Spanish in general and includes a closer study of the English motion and manner verbs in The Fencing Master, the English translation of Arturo Perez-Reverte's novel El maestro de esgrima. This study was originally sparked off by the following observation: "Spanish translators omit manner information about half of the time, whereas English translators actually add manner to the Spanish original in almost a quarter of their translations". (Slobin, 1996/99: 212). After considering relevant theoretical issues related to observations in early Translation Studies, studies within Pragmatics and finally within Cognitive Linguistics, I turn to the novel itself and focus on the differing methods employed for dealing with the verbs of movement in the translation of this novel and classify them. This article argues that Slobin's observation above can be modified as we conclude that it is for pragmatic reasons that the English translation explicitly states what is in fact implicit in the Spanish original.


Poor appetite is a common symptom among cancer patients. It can lead to inadequate food intake, weight loss, physical debilitation and reduced tolerance to anti-neoplastic treatment. Although cancer-induced anorexia is not fully understood, there are some theories relating to its development. Interventions may be aimed at improving nutritional intake to prevent excessive weight loss when poor appetite exists, or it may concentrate on improving appetite by pharmacological means. Appetite should be considered alongside other aspects of symptom control and tackled aggressively when it is contributing to a poor quality of life.


The new taxon Paraclausastrea vorarlbergensis sp. nov. is described from the upper Barremian-lower Aptian (Schrattenkalk Fm.) of western Austria (Vorarlberg). It belongs to the montlivaltiids and is characterized by thamnasterioid to submeandroid corallite integration, diameters of corallites ranging between 3 and 6.5 mm, and septa that are generally developed in 4 incomplete cycles in 6 generally irregular systems. In a small number corallites that are around 6 mm in diameter, 4 complete cycles are present. In corallites that are around 2 mm in diameter, usually between 12 and 18 septa are present. The new species differs from all other forms of Paraclausastrea in having the largest number of septa. This is the first report of this genus for the Schrattenkalk Formation.


PURPOSE
A process evaluation was conducted of the Northern Fruit and Vegetable Pilot Program (NFVPP), a government-funded health promotion initiative. The objectives were to determine how the program was implemented and to identify program facilitators and challenges.

METHODS
Facilitators and challenges in the implementation of the free fruit and vegetable snack program were assessed through qualitative interviews with school-level stakeholders (i.e., food preparers, teachers, and principals) and tracking wasted produce. The implementation of an enhanced nutrition education (ENE) component was assessed through a teacher survey.

RESULTS
School-level stakeholders saw the NFVPP as a valuable program. Key facilitators included teacher role-modelling and sufficient funding for supplies and personnel. Key challenges included produce delivery, quality, wastage, and variety. The ENE component was minimally implemented.

CONCLUSIONS
The study identified program strengths and areas that could be improved. As a result, changes were made to how the NFVPP was implemented in schools the following year. The use of qualitative methods enabled program planners to understand the program implementation process.


Reports on the design and implementation of a multi-modal user interface of the Virtual World Database (VWDB) system. VWDB is currently under development at Ochanomizu University with the aim of realizing a new-generation database system for cyberspace applications. The system is being constructed by integrating a virtual reality system and an object-oriented database system. Since VWDB provides a virtual world as the user's database interface, the system must support a multi-modal database language with which users can interact with VWDB by means of gestures and voice. We introduce an automata-based approach to designing the multi-modal language. This idea is in response to the observation that an object in the virtual world changes its state according to a user's query or an update request issued in a multi-modal manner. We identify a set of automata to characterize the multi-modal interaction and describe a semantic network approach for translating a multi-modal user input to an equivalent message to access and manipulate database objects.


People with mild to medium cognitive impairments may have difficulty with remembering when to perform an activity of daily living (ADL). For people with more severe cognitive impairments, it can be difficult to learn and/or recall the sequence of steps needed to complete a task. In this paper , we present a survey of devices that provide step-by-step det ail of ADL tasks with picture, text, audio, video, and/or vibration prompts. We provide a description of each device's overall capabilities, an analysis of contextual awareness and auto matic plan adaptation, and end-user evaluation.


Objective. To prospectively evaluate a set of clinical care schemata that would facilitate early discontinuation of antibiotics and hospital discharge in children with cancer admitted for management of infection. Methods. Based on recent published studies identifying children with fever and neutropenia who are at ''low risk'' for infection, and studies where antibiotics were discontinued quickly in such populations. We developed a set of four clinical schemata by which children with cancer would be managed at our institution. The schemata were prospectively evaluated over a period of 15 months. Results. The schemata were evaluated in 103 consecutive admissions in 69 children with cancer, admitted for treatment of presumed infection. In 61% of cases, children could be discharged home within 5 days of admission; only 9% was re-admitted within 7 days of discharge. In 77% of cases, children could be sent home on no antibiotics; in the remaining 23%, antibiotics could be narrowed in spectrum, and the majority sent home on an oral agent. Median length of stay for the entire cohort of patients was 5 days. In children receiving prophylactic G-CSF, the use of this agent did not impact on the length of stay, the need for subsequent re-admission, or the requirement for antibiotics at time of discharge. Conclusions. Early discontinuation of antibiotics and discharge from hospital is safe, provided that the child is clinically well and afebrile. Children with a clinical or microbiologic focus can have their spectrum of coverage narrowed, and can be safely discharged on oral agents. J Oncol Pharm Practice (2001) 6, 131-137.


This paper investigates fundamental properties of throughput and energy cost in large wireless linear networks with very limited local resources that do not grow with the size of the network. The maximum throughput of the network is derived and the arrival process that maximizes throughput, given a fixed arrival rate, is established. An asymptotically critical loading regime is identified such that the probability of an arbitrary packet being lost is strictly within (0, 1) as the network size increases. Such a regime delivers throughput comparable to the maximum at a reasonable energy cost.
 The paper also establishes the asymptotic network energy cost under this critical loading. These results are then used to consider a performance-cost tradeoff within an optimization problem for which the unique equilibrium point that maximizes the difference between performance benefits and costs is derived. Finally, from a mathematical perspective, the paper furthers our understanding of large stochastic linear networks for which, in general, no explicit solutions have been previously available.


OBJECTIVES
To analyze the results of pulmonary valve insertion late after initial repair of Fallot's tetralogy. Pulmonary insufficiency (PI) after correction of Fallot's tetralogy is usually well tolerated in the short term, but is associated with symptomatic right ventricular dilatation and an increased risk of ventricular arrhythmias over longer periods of time.

METHODS
From 1993 to July 2000, 51 patients were reoperated for PI at a mean age of 25.7+/-11.9 years. The mean age at initial repair was 6.4+/-7.2 years. Patients with a conduit inserted at initial operation, with absent pulmonary valve syndrome or with a more than moderate ventricular septal defect at reoperation were excluded from the study. A cryopreserved pulmonary (96%) or aortic (4%) homograft was implanted in the orthotopic position with the use of cardiopulmonary bypass 19.3+/-9.1 years (2.7-40.3 years) after initial correction. Preoperative symptoms (New York Heart Association, NYHA class), degree of PI (echo-Doppler, MRI), right ventricular dimensions (MRI) and QRS duration were compared to findings at last follow-up.

RESULTS
Follow-up is complete and had a mean duration of 1.7+/-1.4 years. Hospital mortality was 2%. No serious morbidity occurred. Severe PI was present preoperatively in all patients. At last follow-up echo-Doppler studies showed PI to be absent or trivial in 96% and mild in 4% of patients. In 13 patients MRI studies were performed both pre- and postoperatively: in this group PI was reduced from a mean of 48 to 4%. After 6 months NYHA capacity class had improved significantly from 2.3+/-0.6 to 1.4+/-0.5. After 1 year end-diastolic and end-systolic right ventricular volumes were reduced significantly. Right ventricular ejection fraction and QRS duration remained unchanged.

CONCLUSIONS
PI late after correction of Fallot's tetralogy may lead to serious symptomatic right ventricle dilatation. After pulmonary homograft insertion right ventricular dimensions decrease rapidly and functional improvement is observed in almost all patients.


Using Problem Based Instruction method is capable to improve Learning outcomes compare to Cooperative Learning method, particularly Think Pair Share type. Outcomes is measured based on final exam result. The intent of this comparison study using two above methods is allowing us to differentiate the average cognitive aspect of student's learning outcomes in physics. The design of this study uses Post Test-Only Control type in Quasi Experiment Design form. The analytical of learning outcome uses the mean score of final exam, while the hypothetical uses independent Sample T-Test, Refers to independent test result analysis between Problem Based Instruction and Think Pair Share method, there is difference in average mark two clases gained in their final exam. Quantitative data shows that Problem Based Instruction method has higher value compare to Think Pair Share method. Students in the class who are using Problem Based Instruction methode have become proactive and directly involve in learning process. It may lead us to effectivemess of the method that has significant contribution in improving student's learning outcom. Keywords: Problem Based Instruction, Cooperative Learning Think Pair Share Type, Learning Outcomes.


Rabies virus causes an invariably fatal encephalitis following the onset of clinical disease. Despite the availability of safe and effective vaccines, the clinical stages of rabies encephalitis remain untreatable, with few survivors being documented. A principal obstacle to the treatment of rabies is the neurotropic nature of the virus, with the blood-brain barrier size exclusion limit rendering the delivery of antiviral drugs and molecules to the central nervous system inherently problematic. This review focuses on efforts to try and overcome barriers to molecule delivery to treat clinical rabies and overviews current progress in the development of experimental live rabies virus vaccines that may have future applications in the treatment of clinical rabies, including the attenuation of rabies virus vectors through either the duplication or mutation of existing genes or the incorporation of non-viral elements within the genome. Rabies post-infection treatment (PIT) remains the holy grail of rabies research.


This Article first traces the errors of law and policy that have led a few courts to discover an economic loss rule barring recovery for fraud on either a tort cause of action or a consumer protection statutory theory where the fraud victim had a contract with the fraudfeasor. It then turns to explaining how use by analogy of federal and state consumer protection statutes could help to clarify and expand common law fraud doctrine. The argument for this use of consumer protection statutes as persuasive authority is particularly strong in mass-market transactions, where business customers often have the same difficulties trying to avoid or redress deception as household consumers do.


A smooth concave configuration represents the most common quasi-equilibrium profile of alluvial rivers. In the present paper a generalized, unified set of models for the longitudinal profile of rivers is presented. Various independent effects that drive concavity in longitudinal rivers are considered and classified. The driving mechanisms considered here are (1) horizontal wavelike progradation of the river profile, (2) abrasion of bed particles, (3) aggradation of the river profile balancing subsidence at a constant speed, and (4) the effect of tributaries adding sediment and water to the main stem of the river. For simplicity it is assumed that the long-term supply of water and sediment is constant; hence a single discharge, that is, bank-full discharge, is used as an approximate characterization of the hydrologic regime for each point along the river. Sediment sorting has been studied elsewhere and is excluded from this analysis. The river is assumed to have uniform bed material, although the mean size may vary downstream. It is concluded that the quasi-equilibrium longitudinal profile created by each of the first three driving mechanisms mentioned above is concave. The degree of concavity varies, however, depending on a set of physical conditions that can be identified by a set of dimensionless numbers. A comparison of these numbers reveals the relative importance of the driving mechanisms for concavity. A condition for concavity driven by the fourth mechanism, that is, tributary input, is delineated.


Estrogen receptor (ER) expression by breast tumors is an important predictor of disease-free survival in breast cancer patients and, more importantly, is a strong predictor of response to endocrine therapy. Variant forms of the ER may play an important role in the loss of hormone responsiveness and the progression to hormone independence. We have examined a panel of human breast tumor cell lines, both ER-positive and ER-negative, and have identified an ER mRNA variant containing a deletion of exon 5 in the ER-negative BT-20 and ER-positive MCF-7 cell lines. This exon 5 deletion variant has been previously reported to be overexpressed in ER-negative/progesterone receptor-positive breast tumors. Using RNase protection analysis, we have found that the predominant ER transcript in the BT-20 cells is the exon 5 deletion variant, while the principal transcript in MCF-7 cells is the wild-type ER mRNA. The variant ER transcript is translated into a truncated receptor protein of approximately M(r) 42,000 when expressed in yeast and, more important, in breast tumor cells. This is the first demonstration of an exon 5 deletion variant ER protein. Functional analysis has shown that this variant ER possesses constitutive transcriptional regulatory activity with respect to an estrogen-regulated reporter gene construct in a yeast expression system. The presence of this ER variant in breast tumor cell lines, as well as breast tumor biopsies and uterine tissue, suggests that it is a naturally occurring variant that may arise by alternative splicing, and whose overexpression may be involved in the progression of breast tumors to a hormone-independent state.


OBJECTIVE
The aims of this study were to define imaging findings and to identify any predisposing factors for the development of the round lytic lesion across the margins of sternotomy during the process of bone healing.

METHODS
We searched all chest CT scans performed between 2007 and 2012 and selected patients who had three studies performed in the recent, late and latest post-operative periods. Patients presenting any complications related to wound healing were excluded from the study. CT features of the sternotomy and possible instability factors were assessed.

RESULTS
From 15689 chest CT images analysed, 68 patients fulfilled the criteria. The development of a round lytic lesion was observed in 35 and 39 patients in the late and latest post-operative periods, respectively, and there was an association between mild misalignment of margins in the recent post-operative period and the development of a round lesion in the follow-up periods (p=0.010 and p=0.002, respectively).

CONCLUSION
Sternotomies exhibit a delayed and unusual pattern of bone healing, and minimal instability factors during bone closure could trigger the development of a lytic lesion that is part of the normal healing process.

ADVANCES IN KNOWLEDGE
This lytic bone lesion is part of the bone healing, and its appearance should not be mistaken as infection or malignancy, even in a suggestive clinical setting.


Purpose of Study Saratoga, WY, like many rural towns in Wyoming, has a ranching economy. The prevailing attitude among men of this town is that they do not need to visit the doctor unless severely ill or injured. While some men visit the doctor for a yearly physical, most do not. This community medicine project focused on creating a well man exam form for Platte Valley Medical Clinic (PVMC) in Saratoga, as well as promoting men's health in general. Methods Used The well man exam form was modeled after PVMC's existing well woman exam form. The primary health care provider was interviewed to determine the preferred content of the form. Additionally, national screening guidelines were consulted to ensure that it met preventive medicine recommendations. Summary ofResults A well man exam form was created for use in PVMC. An article was placed in the Saratoga Sun newspaper promoting Men's Health Week 2005 and highlighted the rationale for men receiving yearly physical exams. Flyers and posters were placed in PVMC drawing attention to the importance of men's health. Conclusions Reached The newspaper article provided excellent community education about the importance of men's health and the need for men to receive yearly exams. The well man exam form at PVMC provides an efficient mechanism to ensure that consistent health information is elicited from male patients and documented in the medical record.


Classical one-time-pad key can only be used once. We show in this Letter that with quantum mechanical information media classical one-time-pad key can be repeatedly used. We propose a specific realization using single photons. The reason why quantum mechanics can make the classical one-time-pad key repeatable is that quantum states can not be cloned and eavesdropping can be detected by the legitimate users. This represents a significant difference between classical cryptography and quantum cryptography and provides a new tool in designing quantum communication protocols and flexibility in practical applications.
Note added: This work was submitted to PRL as LU9745 on 29 July 2004, and the decision was returned on 11 November 2004, which advised us to resubmit to some specialized journal, probably, PRA, after revision. We publish it here in memory of Prof. Fu-Guo Deng (1975.11.12-2019.1.18), from Beijing Normal University, who died on Jan 18, 2019 after two years heroic fight with pancreatic cancer. In this work, we designed a protocol to repeatedly use a classical one-time-pad key to transmit ciphertext using single photon states. The essential idea was proposed in November 1982, by Charles H. Bennett, Gilles Brassard, Seth Breidbart, which was rejected by Fifteenth Annual ACM Symposium on Theory of Computing, and remained unpublished until 2014, when they published the article, Quantum Cryptography II: How to re-use a one-time pad safely even if P=NP, Natural Computing (2014) 13:453-458, DOI 10.1007/s11047-014-9453-6. We worked out this idea independently. This work has not been published, and was in cooperated into quant-ph 706.3791 (Kai Wen, Fu Guo Deng, Gui Lu Long, Secure Reusable Base-String in Quantum Key Distribution), and quant-ph 0711.1642 (Kai Wen, Fu-Guo Deng, Gui Lu Long, Reusable Vernam Cipher with Quantum Media).


This paper describes a controller which optimizes the step response of a silicon, micromachined, electrostatic salient-pole micromotor. The control algorithm is based on the determination of two parameters, the critical and final times of the step response, which are obtained from a second-order differential equation of the micromotor model. The parameter values have been determined utilizing both analytical and empirical methods, which yield similar results.


PURPOSE: An air-conditioning system of high-storied building is provided to easily control ventilation, outside air cooling, cooling and heating. CONSTITUTION: A system comprises a heat exchange system comprising an air supply flow path(110) and an exhaust flow path(120), a heat exchanger(130), an air supply air blower(111) and an exhaust air blower(112), an exhaust inlet(121) and an air supply inlet(122), an upper valve(123) and a lower valve(124), a first exchanger(113) and a second exchanger(114); a compressor(200) having an inlet valve(210) and an outlet valve(220) to compress and discharge refrigerant; a four-way valve(300) placed to selectively connect the inlet valve of the compressor with the first exchanger and the outlet valve of the compressor with the second exchanger or the inlet valve of the compressor with the second exchanger and the outlet valve of the compressor with the first exchanger; an expansion valve(400) placed on a flow path connecting the first exchanger and the second exchanger; a variable air capacity device(500) having one side connected with the air supply air blower and the other side with an air supply port(510) placed indoors to supply air into a room through the air supply port by operation of a damper motor(520); an exhaust duct(600) having one side connected with the exhaust inlet and the other side connected with an exhaust port(610) placed indoors to discharge indoor air through the exhaust port; and a switch(700) controlling the variable air capacity device, the air supply air blower and the exhaust air blower by set temperature of an automatic thermostat.


In this paper, a compact filtering Wilkinson power divider exhibiting the high isolation with an ultra-wideband spurious suppression is proposed. The open-stub loaded coupled-line (OSLCL) is introduced for the power divider design to obtain the passband enhancement with two transmission zeros close to center frequency of $f_{0}$. Besides, hybrid microstrip T-stub/defected ground structure (HMT/DGS) cells are employed to introduce intrinsic slow-wave effect, which leads to the performance of high isolation and rejection level within a wide stopband. To verify the mechanism mentioned above, a filtering power divider operating at $f_{0}$ of 2.31 GHz with 3-dB FBW of 17.7% is implemented and fabricated. The measurement exhibits more than 28 dB stopband isolation and 30 dB stopband rejection level up to 20 GHz (i.e., 8.66 $f_{0})$.


To perform efficient activities aimed at managing population health risks, it is necessary to examine regularities related to distribution of chemical elements in the biosphere; especially in so called biogeochemical provinces of natural or technogenic origin. We used semimetals of arsenic and antimony as an example to show that similarity of their physical and chemical properties is accompanied with similar effects they produce on living organisms. However, amphoteric character of arsenic and antimony determines wide range of possible interactions between these elements and biological molecules in a body. As a result, combined influence exerted by these substances on living organisms leads to both antagonistic relations and competition between them and to synergy as well. Basing on reviewed literature data, we showed that animals selectively limited accumulation of arsenic in their bodies and consumed less toxic antimony in greater quantities in case of biochemical anomalies while plants were much less selective and accumulated toxic arsenic easily. Accordingly, any activities aimed at population health risk reduction that are to be performed on territories of biogeochemical provinces should take into account peculiarities related to accumulation of these elements in bodies of warm-blooded animals and people. These peculiarities should also be taken into account when hygienic research programs and hygienic inspections are drawn up. When such research is performed experts should do the following: to analyze ways and chemical forms of elements migration in the environment; to determine molecular mechanisms of elements penetration into a cell and conditions of various scenarios of their metabolism and biological efficiency.


Stacking faults (SFs) are commonly observed crystalline defects in III-V semiconductor nanowires (NWs) that affect a variety of physical properties. Understanding the effect of SFs on NW mechanical properties is critical to NW applications in nanodevices. In this study, the Young's moduli of GaAs NWs with two distinct structures, defect-free single crystalline wurtzite (WZ) and highly defective wurtzite containing a high density of SFs (WZ-SF), are investigated using combined in situ compression transmission electron microscopy and finite element analysis. The Young's moduli of both WZ and WZ-SF GaAs NWs were found to increase with decreasing diameter due to the increasing volume fraction of the native oxide shell. The presence of a high density of SFs was further found to increase the Young's modulus by 13%. This stiffening effect of SFs is attributed to the change in the interatomic bonding configuration at the SFs.


Annual working hours in Japanese pear orchards were compared between two training systems designed for easier tractor operation and one common training system. They were the Y form training, the hedgerow training and the vase form training.Annual working hours were somewhat less in the Y form training and the hedgerow training than in the vase form training.However, the difference was not as large as expected. The main cause of this small difference owing to 1) scanty tractor operation in all three training systems and 2) limitations in machine operations in the hedgerow due to the situation of the hedgerow, i. e. the northern side of the northernmost row had to be mowed by hand and spraying for pest control had to be done over a fence from a road outside the orchard.In the year 1984, total working hours per 10a were, about 243 hours in the vase form, about 224 hours in the Y form, about 250 hours in the hedgerow, with the Y form being somewhat labour saving. All three training systems experimented in our orchard required less working hours compared to statistical data on Japanese pear growing farmlands.However, total working hours per yield were the same as the statistical data for the vase form, but about 20% higher for the hedgerow and about 110% higher for the Y form.The reason why working hours per yield were higher in the hedgerow were that 1) it required more fertillizer due to dense plantation, 2) more mowing and pest control than the vase form and Y form due to the situation of the orchard. The reason why working hours per yield was higher in the Y form was that the yield was lower due to the aftermath of the typhoons in 1982, as mentioned in a previous report3).In the year 1985, total working hours per 10a were, about 216, 172, and 194 hours for vase form, Y form, and hedgerow respectively. That in the latter two were somewhat shorter than in the vase form.Working hours in all three systems were about 80% of statistical data.However, total workig hours per yield were, about 108 hours per ton for vase form and Y form, about 80% of the statistical data. Total working hours per yield were about 85 hours/t for the hedgerow, less than 80% of vase form and Y form, about 60% of statistical data, showing that Y form and hedgerow would be largely labour saving if yield of 2 tons per 10a is maintained.In Y form and hedgerow, trees of proper vigour could produce higher yield than trees of vase form constantly with less working hours.For the pursuit of higher yield and labour saving training systems, investigation of not only plant physiological and ecological aspects, but detailed research on working hours of work such as soil management, spraying, harvesting, etc. are also required. Detailed investigation on working hours of Japanese pear culture in the three training systems are in progress and will be reported in the near future.


Tuberculosis is one of the prioritized zoonotic diseases in Nepal producing severe health hazard in humans and animals including both wildlife species and livestock species. It is also one of the most important bacterial diseases of nonhuman primates, especially macaques which is caused by Mycobacterium tuberculosis and M. bovis. A study was conducted from 2010 to 2012 in macaques of Nepal to find out the status of tuberculosis. Altogether 326 macaques were tested for tuberculosis by Intradermal Skin test on the eyelid and M. tuberculosis/M. bovis antibody testkit. Out of 326 macaques tested, 62 were found positive for the tuberculosis. So, the overall prevalence rate of tuberculosis in rhesus macaques was found to be 19.02%. From the study it is concluded that not only humans, but the monkeys are also equally vulnerable to this disease condition and produce more severe health hazards, resulting even in death. These macaques should also be given priority concerning this as they may pose risk to other wild life species and humans. More researches should be directed towards exploring disease condition and status in these animals to protect other wildlife species and human contacting this disease.


INTRODUCTION
Quality of life (QoL) is an important aspect in the treatment of patients with epilepsy.

AIM
To analyse the QoL using the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) in adults with idiopathic generalised epilepsy and to study factors associated with a worse QoL.

PATIENTS AND METHODS
A cross-sectional, multicentre, observational study conducted by 141 neurologists in all the autonomous communities of Spain. Each researcher analysed the QOLIE-10 of two males and two females over 18 years of age with idiopathic generalised epilepsy seen consecutively in public or private practice. The results were standardised: 0 was the worst QoL and 100 was the best.

RESULTS
A total of 546 patients were analysed. Women: 51.1% (n = 279). Mean age: 36 ± 15.3 years old (18-87). Childhood absence seizures: 7.5% (n = 41); juvenile absence seizures: 9.2% (n = 50); juvenile myoclonic seizures: 29.8% (n = 163); only tonic-clonic seizures: 53.5% (n = 292). Monotherapy: 63.2% (n = 345). Seizure-free in the last year: 53.1% (n = 290). Psychiatric comorbidity: anxiety: 28.4% (n = 155); depression: 14.1% (n = 77); attention deficit: 10.1% (n = 55). Employment status: in active employment: 47.2% (n = 258); student: 20% (n = 109); housewife/husband: 7.3% (n = 40); pensioner: 10.2% (n = 56); unemployed: 14.3% (n = 78). Marital status: married or in a relationship: 49.1% (n = 268); single: 43.7% (n = 239). Mean score on the QOLIE-10: 71.4 ± 19.1. Being female (p = 0.006), greater frequency of seizures (p < 0.001), polytherapy (p < 0.001), psychiatric comorbidity (p < 0.001) and unemployment (p < 0.001) were significantly associated with a worse QoL.

CONCLUSIONS
The QoL of patients with idiopathic/genetic generalised epilepsy is affected by poor seizure control, psychiatric comorbidity and unemployment, and women are more affected than men.


Audio-Visual Speech Recognition (AVSR) faces the difficult task of exploiting acoustic and visual cues simultaneously. Augmenting speech with the visual channel creates its own challenges, e.g. every person has unique mouth movements, making the generalization of visual models very difficult. This factor motivates our focus on the generalization of speaker-independent (SI) AVSR systems especially in noisy environments by exploiting the visual domain. Specifically, we are the first to explore the visual adaptation of an SI-AVSR system to an unknown and unlabelled speaker. We adapt an AVSR system trained in a source domain to decode samples in a target domain without the need for labels in the target domain. For the domain adaptation of the unknown speaker, we use Coupled Generative Adversarial Networks to automatically learn a joint distribution of multi-domain images. We evaluate our character-based AVSR system on the TCD-TIMIT dataset and obtain up to a 10% average improvement with respect to its AVSR system equivalent.


Albeit revealing impressive predictive performance for several computer vision tasks, deep neural networks (DNNs) are prone to making overconfident predictions. This limits the adoption and wider utilization of DNNs in many safety-critical applications. There have been recent efforts toward calibrating DNNs, however, almost all of them focus on the classification task. Surprisingly, very little attention has been devoted to calibrating modern DNN-based object detectors, especially detection transformers, which have recently demonstrated promising detection performance and are influential in many decision-making systems. In this work, we address the problem by proposing a mechanism for calibrated detection transformers (Cal-DETR), particularly for Deformable-DETR, UP-DETR and DINO. We pursue the train-time calibration route and make the following contributions. First, we propose a simple yet effective approach for quantifying uncertainty in transformer-based object detectors. Second, we develop an uncertainty-guided logit modulation mechanism that leverages the uncertainty to modulate the class logits. Third, we develop a logit mixing approach that acts as a regularizer with detection-specific losses and is also complementary to the uncertainty-guided logit modulation technique to further improve the calibration performance. Lastly, we conduct extensive experiments across three in-domain and four out-domain scenarios. Results corroborate the effectiveness of Cal-DETR against the competing train-time methods in calibrating both in-domain and out-domain detections while maintaining or even improving the detection performance. Our codebase and pre-trained models can be accessed at \url{https://github.com/akhtarvision/cal-detr}.


In a country like India where neither the expensive time-consuming tissue culture or immunofluorescent antibody tests nor the rapid ELISA test for chlamydia are available clinical and patient risk factors may be useful to predict chlamydial infections. In U.S. women age >25 non-use of barrier contraception purulent cervical discharge endocervical bleeding on swabbing and 2 or more sexual partners in the last month are predictive or chlamydial infection. In U.S. men without overt discharge significant numbers of polymorphonuclear lymphocytes in first catch urine or in a urethral smear may be markers for chlamydia infection. In sexually transmitted disease clinics such high risk persons could be identified and treated to prevent transmission and complications.


Abstract This study aimed to investigate the effect of insulin on the reticuloendothelial system (RES) in the liver and spleen in diabetic rats. Sprague Dawley rats were divided into control, diabetic rats (DM) and diabetic rats treated with insulin (IDM) for 2 weeks. Rats were imaged with technetium-99m-sulfur colloid (99mTc-SC) tracer to determine regional distributions of the tracer for all groups by drawing regions of interest and then obtained the ratios as the cumulative counts of heart, liver, and spleen to the whole body (WB). Liver tissue from sacrificed rats from each group was examined by light and electron microscopy. 99mTc-SC uptake ratios showed a lower liver to WB uptake ratio in the DM rats compared to both controls and IDM rats. Electron microscopy showed severe vacuolization of the hepatocytes of DM rats. The IDM rats show complete resolution of the vacuolization. The early administration of insulin for 2 weeks to diabetic rats could significantly resolve the phagocytic RES function and histological changes in the liver.


This study presents a description and understanding of the physical activity of low-income older adults in Singapore, with specific focus on their communication and interactions with social partners. Ethnographic observations and participant interviews (N = 10) were conducted with a purposive sample. Findings contained descriptions of actual behaviors of the target group and explanations of the influences on their physical activity, ranging from the intrapersonal sphere, to communication with their strong-tie networks, and finally, interactions with the community and environment surrounding them. The author takes a social ecological viewpoint on the topic, uncovering the lived experiences of the target audience, and suggests how theory, research, and practical policies may be improved to better support those at the lower end of the socioeconomic strata.


This Anti-Mandal Mania THERE is perhaps no issue on which we are such hypocrites as caste; Nor any other which brings out all that is worst in us with such shameful ease. The moment V P Singh announces the decision to implement the Mandal Commission's recommendation of reservations for the backward castes, an avalanche of obscenity hits the country. It carries before it the Press, the universities, and opinion- makers of all kinds.


We associated clinical-pathological features of 142 OSCC with the expression pattern of GLUT1 and GLUT3 in order to estimate their prognostic value. Methods: Clinical-pathological features and overall survival data of 142 patients with Oral Squamous Cell Carcinoma (OSCC) were retrospectively reviewed from A.C.Camargo hospital records. A tissue microarray (TMA) was built for the immunohistochemical (IHC) analysis of GLUT 1 and GLUT 3. IHC results were evaluated according to the staining pattern and number of positive cells. Results: GLUT 1 was over expressed in 50.3% of OSSC cases showing membrane staining pattern. However, nuclear expression was observed in 49.7% of the analyzed cases. GLUT 3 over expression was detected in 21.1% of OSCC cases. The pattern of GLUT 1 expression showed significant association with alcohol consumption (p = 0.004). Positive cell membrane GLUT 3 protein expression was associated with advanced clinic-staging of tumours (p = 0.005) as well as with vascular embolization (p = 0.005). Positive expression of GLUT 3 was associated with unfavorable free-disease survival (p = 0.021). Conclusion: GLUT1 and GLUT3 protein expression evaluated by immunohistochemistry are, significantly, indicators of poor prognosis outcome in oral squamous cell carcinoma, probably due to the enhanced glycolytic metabolism of more aggressive neoplastic cells.


The objective of this research was to estimate, by haematophysiological parameters, the physical performance of horses under exercise of mid intensity and fed diets with two levels of vegetal oil (250 and 500 g/day). Eighteen castrated thoroughbred horses aging from 4 and 8 years old and averaging body weight of 456±2.90 kg were alloted to a split plot approach with repeated measures over time in a completely randomized design, with the collection times in the sub-plots and the soybean oil levels (0, 250 and 500 g per horse per day) in the plots. During 30 days, the horses were fed 8.40, 7.95, and 7.30 kg/day of diets with 0, 250 and 500 g of oil, respectively, divided in three daily feeds. At the end of 30 days, the exercise test was performed with all horses, during 2 hours, at large trot. At the beginning and at the end of the exercise, the levels of glucose, lactate, haematocrit, body temperature were estimated. The heart and respiratory rates were taken at the beginning, 1 and 2 hours of exercise and 15 minutes after the end of the exercise. Interaction of collection times ´ dietary oil levels on the levels of glucose, lactate, and haematocrit, body temperature, and heart and respiratory frequencies was observed. The supplementation of 250 and 500 g of oil in the diet of equines under exercise of mid intensity increased haematophysiological performance, that can improve horse athletic performance. The horses daily fed 500 g of oil showed better recovery post-trial, and that is verified by the values of heart rate and of haematocrit.


Background: Prevalence of diabetes increasing world-wide particularly in low income countries. Management of diabetes sometimes requires insulin injection due to various reasons. Proper usage of insulin and injection techniques are important for diabetes control among who requires insulin. This study was aimed to assess current insulin practices and associated complications.Methods and material: This was a cross sectional study conducted among diabetes patients attended all medical clinics and Diabetic Centre in Jaffna teaching Hospital which is the only tertiary hospital in the Northern Sri Lanka in May 2020.Insulin practices retrieved by using interviewer administered questionnaire. Data was analyses by using SPSS 26.Results: Out of 360 patients 64.2% were female and mean age was 58.19 (12-89).Majority (61.9%) of them belongs to low income category and most (73.3%) of them using insulin more than 1 year. Main reason for the insulin initiation was oral hypoglycaemic failure (81.7%) and majority of them (80.0%) were using twice daily premixed insulin regime followed by daily basal insulin (11.4%) and basal bolus insulin (5.6%) regime. Most of the participants (81.4%) reported they do cleaning of the injection site before injection and 89.7% usually rotate the injection site. Approximately half of them (50.8%) inject themselves and majority use syringes (91.4%). Common injection site complications reported were skin changes (25%), followed by 15.3% persistent swelling (15.3%) and thinning of skin(7.8%). Angle of injection (P-0.039) and insulin regime (P<0.001) showed statistically significant association with skin changes.High proportion of participants 68.6% (95%CI: 63.7%-73.2%) experienced hypoglycaemia, using syringes 2.21 times (95%CI-1.05-4.64) more risk of compare to pen users and missing meals 2.22 times more risk of hypoglycaemic events (95%CI: 1.18-4.17). Majority of them reported reusing the needles for injection (83.6%) and 35% were disposing needle into common garbage pin.Conclusion: This study revealed significant gaps in current insulin practices from expected norm and hypoglycaemic events alarmingly high among participants. Exploring Continuous Glucose Monitoring Devices or flash monitoring can be a mitigation strategy and urgent attention from health professionals needed to improve the safe insulin practices.


During a reconnection event on 7 August 2004, Cluster and Double Star (TC-1) were near the neutral sheet and simultaneously detected the signatures of the reconnec- tion pulses. AT 22:59 UT tailward flow followed by earth- ward flow was detected by Cluster at about 15 RE, while earthward plasma flow followed by tailward flow was ob- served by TC-1 at about 10RE. During the flow reversal from tailward to earthward, the magnetic field Bz changed sign from mainly negative values to positive, and the X com- ponent of the magnetic curvature vector switched sign from the tailward direction to the earthward direction, which indi- cates that the reconnection site (X-line) moved tailward past the Cluster constellation. By using multi-point analysis and observation of energetic electron and ion flux, we study the movement and structure of the current sheet and discuss the braking effect of the earthward flow bursts in the inner mag- netosphere.


BACKGROUND
Recently, we reported a donation consent rate of only 80% for patients designated as donors with the Department of Motor Vehicles (DMV), which equaled missed opportunities for 17 potential transplant recipients during 3 months. We undertook the current study to increase our donation consent rate in patients with prior DMV donor designations.

METHODS
In October 2006, we modified our approach for donor consent by asking to honor the patient's wishes rather than asking for permission. The consent rates from January through September 2006 (preinitiative) were compared with rates from October through April 2007 (postinitiative).

RESULTS
During the preinitiative period, 66 approaches were made; 24 patients were registered as donors with the DMV (36%). In total, consent for donation was obtained from 43 families (65%). Only 20 of 24 (83%) families of patients with prior DMV designation donated, and 23 of 42 families of patients with no DMV designation donated (55%). One hundred forty-one organs were successfully transplanted (average 3.3 organs per procurement). Of 71 postinitiative approaches, 42 families donated (59%) and 125 organs were transplanted (average 3.0 organs per procurement). Consent for donation was obtained in 23 of 52 non-DMV-designated donors (44%). The families of all 19 DMV-designated donors consented for donation (100%).

CONCLUSION
Modifying our approach to consent for organ donation to honor the patient's wishes based on DMV donor designation rather than ask for permission increased organ procurement in this population to 100%. However, further efforts are needed at the state and national levels regarding the recognition of first-person consent for organ donation.