The cutoff of the normalized iodine concentration ratio for identifying patients with intracerebral hemorrhage development was 222.8%, with a sensitivity of 67.6% and specificity of 76.4%. BACKGROUND AND PURPOSE: Intracerebral hemorrhage poses a severe threat to the outcomes in patients with postthrombectomy acute stroke. We aimed to compare the absolute intracerebral iodine concentration and normalized iodine concentration ratio in predicting intracerebral hemorrhage in patients postthrombectomy. MATERIALS AND METHODS: Patients with acute anterior circulation large-vessel occlusion who underwent mechanical thrombectomy and had successful recanalization were retrospectively included in the study. Dual-energy CT was performed within 1 hour after mechanical thrombectomy. Postprocessing was performed to measure the absolute intracerebral iodine concentration and the normalized iodine concentration ratio. The correlation between the absolute intracerebral iodine concentration and the normalized iodine concentration ratio was analyzed using the Spearman rank correlation coefficient. We compared the area under the receiver operating characteristic curve of the absolute intracerebral iodine concentration and the normalized iodine concentration ratio using the DeLong test. RESULTS: We included 138 patients with successful recanalization. Of 43 patients who did not have parenchymal contrast staining on postthrombectomy dual-energy CT, 5 (11.6%) developed intracerebral hemorrhage. Among patients (95/138, 68.8%) with parenchymal contrast staining, 37 (38.9%, 37/95) developed intracerebral hemorrhage. The absolute intracerebral iodine concentration was significantly correlated with the normalized iodine concentration ratio (ρ = 0.807; 95% CI, 0.718–0.867; P < .001). The cutoffs of the normalized iodine concentration ratio and absolute intracerebral iodine concentration for identifying patients with intracerebral hemorrhage development were 222.8%, with a sensitivity of 67.6% and specificity of 76.4%, and 2.7 mg I/mL, with a sensitivity of 75.7% and specificity of 65.5%, respectively. No significant difference was found between the areas under the receiver operating characteristic curve for the absolute intracerebral iodine concentration and the normalized iodine concentration ratio (0.753 versus 0.738) (P = .694). CONCLUSIONS: The hemorrhagic transformation predictive power of the normalized iodine concentration ratio is similar to that of the absolute intracerebral iodine concentration in patients with successful recanalization.


Promissory Notes on the Treasury of Merits: Indulgences in Late Medieval Europe. Edited by R. N. Swanson. [Brill's Companions to the Christian Tradition, Vol. 5.] (Leiden: Brill. 2006. Pp. xii, 360. $124.00; euro95,00.) Since indulgences were arguably the keystone of later medieval religious practice and certainly at the heart of Luther's attack on the entire penitential and sacramental system, it is odd indeed that they have not elicited more systematic attention from scholars. The standard work, R. N. Swanson says, remains Nikolaus Paulus' three-volume Geschichte des Ablasses im Mittelalter, originally published in 1922-23 and reprinted in 2000, and recently supplemented in part by the study of collective indulgences by Alexander Siebold, Sammelindulgenzen. Ablassurkunden des Spatmittelalters und der Fruhneuzeit (2001). This is not quite correct, for if one consults the germane bibliographical entry in the third edition of the Oxford Dictionary of the Christian Church (1997), one encounters such formidable names as Henry Charles Lea, Bernhard Poschmann, and Karl Rahner; yet it remains true that in the last half-century or so indulgences have not loomed as large as one might expect, partly perhaps because so many great scholars have gone before. To remedy this defect, therefore, Swanson, a distinguished scholar of late medieval religion, has assembled this collection of thirteen highly diverse essays to which he has provided a succinct, if incomplete, introduction (pp. 1-9). The authors and their contributions are as follows: Robert Shaffern, "The Medieval Theology of Indulgences" (pp. 11-36); Giovanna Casagrande, "Confraternities and Indulgences in Italy in the Later Middle Ages" (pp. 37-63); Charles Caspers, "Indulgences in the Low Countries, c. 1300-c. 1520" (pp. 65-99); Eva Dolezalova et al., "The Reception and Criticism of Indulgences in the Late Medieval Czech Lands" (pp. 101-45); John Edwards," 'Espana es diferente? Indulgences and the Spiritual Economy in Late Medieval Spain" (pp. 147-68); Alastair Minnis, "The Construction of Chaucer's Pardoner" (pp. 169-95); Anne Hudson, "Dangerous Fictions: Indulgences in the Thought of Wyclif and His Followers" (pp. 197-214); R. N. Swanson, "Praying for Pardon: Devotional Indulgences in Late Medieval England" (pp. 215-40); Diana Webb, "Pardons and Pilgrims" (pp. 241-75); Norman Housley "Indulgences for Crusading, 1417-1517" (pp. 277-307); Falk Eisermann, "The Indulgence as a Media Event: Developments in Communication through Broadsides in the Fifteenth Century" (pp. 309-30); and David Bagchi, "Luther's Ninety-Five Theses and the Contemporary Criticism of Indulgences" (pp. 331-55). Since one cannot possibly comment on all these essays, I shall confine myself to a few observations here. In the "Introduction" Swanson notes that, curiously, indulgences figured very little in later medieval pastoral and sermon literature, a lacuna which Peter Dykema discovered while researching this subject and which caused him to abandon a projected essay for this volume. Robert Shaffern's discussion of the theology of indulgences, especially in the period 1175-1260, is useful, but he fails to situate his specific contribution within the historiographie tradition, to appreciate the mess created by Pope Urban II's vague promises offered at Clermont in November 1095, which the "crown lawyers" (the theologians and canonists) then had to clean up, or to underscore the novel elements involved in the full emergence of indulgences, including the fateful connection with money. Caspers' study of indulgences in the Low Countries is rich with concrete examples of the system in action at its best (e.g., indulgences for the poor [pp. 95-97]) and at its most distorted (the three-year "dike" indulgence obtained by Charles V in 1515, which yielded 53,445 ducats for St. …


The article examines the problem of interpreting normal and revolutionary science in the concept of Thomas Kuhn. It is shown that the "normal science" is the central concept of the Kuhn's history of science, designed in accordance with the normative definition of science adopted by him. Such a story serves an internal purpose – to justify the special epistemical status of expert knowledge. But there is also an external goal – to establish professional science as an institution with special epistemological status and social function, which is situated in a center of intellectual power and property. Historians are those who are forced to constantly rewrite history – either following the methodology of "rational reconstruction" or responding to the challenges of their time. To be a "conservative" or a "revolutionary" in the history of science is a choice made not only for philosophical reasons, but also under the influence of the general socio-cultural situation of the epoch.


This article analyzes fifteen children's picture books published over the past twenty-five years that include a character with Down syndrome (DS). From the perspective of both an educator and a parent of a child with DS, this article focuses on the changes in these picture books over time, the common threads connecting these books, an evaluation of these titles, and suggestions for use in the educational setting. In addition, an annotated bibliography is provided.


Social aspects of the person should have a salience that they are not usually accorded in considerations of relative distribution. When their relation is adequately taken into account, economic justice can be seen to be different from that which is ordinarily posited. Conceptions of economic justice differ on the question of the relative distribution of income. But they do not sufficiently consider how some social aspects of the person might bear on the question. This book develops the view that these aspects of the person affect the degree of equality that is involved in the conception of economic justice. A revised understanding of economic justice, derived from social premises, can then have implications for the nature of democracy. These implications are, however, often discounted in theories of democracy. For example, the "procedural" theory of democracy does not incorporate considerations of economic justice, because it views democracy and economic justice as separate concepts by defining democracy solely in terms of political equality. This book, by contrast, postulates an integral relation between democracy and economic justice that leads to the inclusion of principles of distributive justice within democratic rule. I develop a "substantive" theory, holding that the just distribution of economic resources is a defining characteristic of democratic rule. The theory cannot simply be synthesized with existing concepts of economic justice, because new principles for regulating the distribution of income and wealth are needed. These may be developed by revising the ethics of reward for economic contributions and the ethics of economic community.


Author(s): Talsky, Kristin Benjamin | Advisor(s): Collins, Kathleen | Abstract: RNA-dependent RNA polymerases (RdRPs) induce sequence-specific gene silencing through the production of double-stranded RNA (dsRNA) from a single-stranded RNA template. In Tetrahymena thermophila, dsRNA products are synthesized by the only genome-encoded RdRP (Rdr1) and then cleaved by an associated Dicer endonuclease (Dcr2) into 23-24 nt small RNAs (sRNAs). These sRNAs accumulate constitutively, dependent on Rdr1 activity. They are derived from endogenous transcripts and map in clusters to specific genomic loci. Rdr1 activity is robust on all templates in vitro, yet the silencing process remains selective in the sequences it targets in the cell. RNA targeting specificity is likely an absolute requirement for cell viability, and, until now, the factors controlling it have not been clearly defined. This dissertation details (1) the roles that Rdr1- interacting proteins play in the biogenesis of multiple classes of 23-24 nt sRNA, (2) the in vitro template selectivity and initiation mechanisms by distinct Rdr1 complexes (RDRCs) and (3) the identification of a new RNA silencing protein (Rsp1) that, along with Rdr1, is required for bulk sRNA accumulation. Rsp1 shares several protein partners with Rdr1, including the uridyltransferase Rdn1 and two factors (Rdf1 and Rdf2) that control RNA target specificity in vivo through an unknown mechanism. Characterization of Rdn1, Rdf1 and Rdf2 functions in vitro revealed that Rdf1 and Rdf2 are adaptors that activate the polyuridylation of RNA by Rsp1-bound Rdn1. The data suggest that Rsp1 functions upstream of Rdr1 in sRNA generation, as discussed in greater detail in Chapter 3. These findings demonstrate that sRNA generation requires the coordination of a complex array of protein machines. Future studies on how these proteins mediate RNA targeting in vivo will offer exciting insights into the molecular mechanisms that are central to controlling the specificity of RNA fates in the cell.


We introduce a field theoretic formalism enabling the direct study of dislocation and interstitial dynamics. Explicit expressions for the energies of such defects are given. We provide links to earlier numerical, discrete elastic, time dependent Ginzburg Landau, and other approaches sought by numerous authors for the problem of defect dynamics. The formalism introduced in this article may be extended to address many other systems. Apart from their heavily studied role in dislocation mediated crystal melting, defect dynamics recently gained much interest due to their viable role in various electronic and other systems of current interest. These systems include, yet are not limited to, stripe phases of Quantum Hall liquids, theories addressing the melting of stripe phases in various doped oxides (including the high temperature cuprate superconductors, the nickelates, and manganates), defects in supersolids, as well as colloidal crystals.


As one of the most promising technologies for next-generation mobile platforms, Augmented Reality (AR) has the potential to radically change the way users interact with real environments enriched with various digital information. To achieve this potential, it is of fundamental importance to track and maintain accurate registration between real and computer-generated objects. Thus, it is crucially important to assess tracking capabilities. In this paper, we present a benchmark evaluation of the tracking performances of some of the most popular AR handheld devices, which can be regarded as a representative set of devices for sale in the global market. In particular, eight different next-gen devices including smartphones and tablets were considered. Experiments were conducted in a laboratory by adopting an external tracking system. The experimental methodology consisted of three main stages: calibration, data acquisition, and data evaluation. The results of the experimentation showed that the selected devices, in combination with the AR SDKs, have different tracking performances depending on the covered trajectory.


Our attempts to grow Mycobacterium leprae in mice have been made in the midst of studies of the cultivation of Mycobacterium lepraemurium. The supposed contamination occurred in Exp (4) in which four times intravenous injection of bacterial suspension of Mycobacterium leprae had been carried out. At 12 month autopsy, the superficial lymph nodes exhibited varying degrees of macroscopic enlargement, one mouse (no. 8) revealed gross involvement also in the spleen, liver, and lungs. Microscopically, all the animals at this stage acid-fast bacilli harbored in the tissues of various organs such as spleen, liver, lungs, kidneys and pooled superficial lymph nodes ; the tissues of mouse no. 8 had the highest number of the bacilli. Results of cultivating test were as follows: Macroscopically rough, reddish-violett-colored colonies could be isolated from the tissues of spleen and lungs of mouse no. 8. The primary growth occurred only on STC mixed egg yolk medium after 2 months incubation. These colonies changed to pale yellowcolored by Subcultivation on egg yolk medium. When being stained and examined microscopically, the isolate was found to be an acid-fast bacillus similar to Mycobacterium tuberculosis.This is here after referred to as Bacillus No. 4.The Bacillus No. 4 is very similar to Mycobacterium lepraemurium in many respects such as colony appearance, cell morphology, pyridin extraction, growth response on the egg and egg yolk media, growth temperatur and niacin test. The Bacillus No. 4 is now under examination so that no final conclusion can be made yet about its taxsomic position.


Purpose Current staging criteria for papillary thyroid cancer (PTC) do not include the number of metastatic lymph nodes (LNs), which is highly predictive of survival in multiple cancers. The LN metastasis burden is particularly relevant for older adults with thyroid cancer because of their poor prognosis. We examined a modified staging system for this population utilizing node number (Nn). Methods Overall, 14,341 patients aged 55 years or older with stage I-IVB PTC were identified in the 2004–2015 Surveillance, Epidemiology and End Results database. Cox regression models were conducted to test the relationship between positive LN number and PTC-specific survival (PTCSS). Independent training/validation sets were used to derive and validate a new revised TNnM grouping. The 8th edition American Joint Committee on Cancer TNM staging system was compared with TNnM stage by calculating the 10-year PTCSS rates, Harrell's concordance index (C-index), and Akaike's information criterion (AIC). Results An increase in number of LN metastases was identified as an independent, negative prognostic factor for PTCSS in multivariate analysis. 10-year PTCSS for stage I-IVB based on the AJCC 8th edition TNM were 98.83%, 93.49%, 71.21%, 72.95%, and 58.52%, respectively, while 10-year PTCSS for the corresponding stage in the TNnM were 98.59%, 92.2%, 83.26%, 75.24%, and 56.73%, respectively. The revised TNnM stage was superior, with a higher C-index and a lower AIC in both the training and validation cohorts. Conclusion The TNnM staging system for PTC patients ≥ 55 years could be associated with improved outcomes. External validation studies of this system are warranted.


: This project involved both simulation design and mechatronics implementation of solar tracking system that ensures that solar panel is perpendicular to the sun to obtain maximum energy falling on it. The unique feature of this project is that it takes the sun as a guiding source by actively monitoring the sunlight and rotating the panel towards the direction where the intensity of sunlight is maximum. The light-dependent resistor's (LDRs) are the sensors that play the role of continuously monitoring the position of the sun which changes the position of the solar panel by switching on and off the servo motor. The Atmega328p logic circuit fetches the input from the LDR sensor and gives the command to the servo motor to rotate in order to position the solar panel to the direction of the sun. This has enabled this project to generate additional energy of around 15% to 25% with very low consumption by the system itself. The dual-axis sun tracker was designed and when tested for the power output of the solar panel, it was found that on the average the solar panel would achieve maximum power generated from the hour of 10:00 am to 4:00p.m, where 4.92W was stored at 10:00 am, 4.80W at 11:00 am, 4.92W at 12:00 pm, 4.68W at 1:00 pm, 4.88W at 2:00 pm, 4.87W at 3:00 pm and 4.93W at 4:00 pm which was a much greater output as compared to a fixed solar panel which achieved maximum power output between hours of 12:00 pm and 1:00 p.m. The dual-axis sun tracker would be recommended for use in solar power generation because it increases the efficiency of the solar power generated, and it's cost-effective.


We report work on a cold, windy South American steppe dominated by tussock grasses and shrubs of small stature that, together, cover only half of the soil surface. Our objective was to find out why seedlings and juveniles of these dominant species are generally absent from the bare or poorly-populated spots (gaps) that exist between established individuals. We hypothesized that matrix-forming species fail to colonize gaps because of a lack of properly-placed seeds, contained in diaspores which because of their morphology are blown away from gaps that otherwise would constitute safe sites for recruitment. We evaluated diaspore size and wing loading (weight:area ratio) for all common species in the community, collected seed-bank samples in different occasions and microsites, and performed detailed field observations for one gap-dwelling species during several years. We found that: 1) Seeds of the dominant, matrix-forming species are uncommon in the soil bank of the center of the gaps between established vegetation. 2) Seeds of the dominant species are more abundant towards the edges of the gaps than at their center. 3) Diaspores of those species present in the seed bank of the gaps are smaller than diaspores of absent species; contrary to expectations, not all gap-dwelling species had larger diaspore wing loading than non-gap species. 4) Seeds and adult densities of the most common gap species (the annual Camissonia dentata), were correlated between them and across subsequent years. We conclude that it is not an overall shortage of seeds that precludes the dominant species from becoming established in the gaps, but rather the seeds' uneven spatial distribution. We further argue that gaps would be suitable sites for recruitment, but large diaspore size makes seeds of the dominant species to be blown away by the strong westerly winds.


Only one more word concerning the desire to teach the world what it ought to be. For such a purpose philosophy at least always comes too late. Philosophy, as the thought of the world, does not appear until reality has completed its formative process, and made itself ready. History thus corroborates the teaching of the conception that only in the maturity of reality does the ideal appear as counterpart to the real, apprehends the real world in its substance, and shapes it into an intellectual kingdom. When philosophy paints grey in grey, one form of life has become old, and by means of grey, it cannot be rejuvenated but only known. The owl of Minerva takes its flight only when the shades of night are gathering (Hegel 1836:XXX).


Airflows and their impact on microclimatic parameters were studied in the two‐entranced Císařská Cave (Moravian Karst, Czech Republic). Basing on the airflow direction with respect to the upper entrance (UE) and lower entrance (LE), three ventilation modes were distinguished: upward airflow one (UAF mode), downward airflow one (DAF mode), and transitional mode. A switching between the UAF and DAF happens in the transitional mode, in the range of external temperatures from 9.5 to 11.1 °C. Basing on the extent of cave ventilation, a period of active ventilation and period of stagnant ventilation were recognised. The cave air is intensively exchanged with external airs during the active ventilation period when the cave persists in either the DAF or UAF mode. During the stagnant ventilation period, the single airflow modes switch during diurnal cycle and only cave entering passages are vented (impacted). The airflows were found to depend (i) linearly on the differences in cave‐outdoor air densities, (ii) nonlinearly on the external temperature, and (iii) both linearly (LE) and non‐linearly (UE) on the temperature gradient. Majority of the airflows showed high‐frequency oscillations with the period from tens of seconds to minutes and with the amplitude up to 0.1 m3 s−1. Different airflow spectra were found at the individual entrances. The highest spectral densities were registered at low driving forces. The air circulation changed the pattern of temperature distribution depending on the ventilation mode and ventilation period. The cave relaxation length varied in the extreme range from 1 to 69.6 m. The asymptotic temperature and asymptotic specific humidity varied from 7.5 to 11.8 °C, and from 5.47 to 7.15 kg kg−1, respectively. The impact of airflows on the cave CO2 levels is discussed based on a dynamic model. Copyright © 2011 Royal Meteorological Society


Background: The aim of this study was to evaluate the expression of Bcl-2 and Ki-67 in tamoxifen (TAM)-associated endometrial polyps and postmenopausal polyps. Material and Methods: For this purpose, a retrospective analysis of paraffin-embedded specimens was carried out. Polyps of 20 postmenopausal and 14 TAM-treated patients, 11 simple endometrial hyperplasia, 10 atypical complex endometrial hyperplasia and 8 endometrial adenocarcinoma specimens were included in the study. Hematoxylin/eosin-stained sections were evaluated. Immunohistochemical staining was performed to investigate the expression of Bcl-2 protein and the Ki-67 proliferation index. Results: There was no statistically significant difference between the 5 groups with regard to Bcl- 2 staining (p > 0.05). However, Bcl-2 expression in TAM-associated polyps was higher (86%) than in the postmenopausal control group (80%). Positive Ki-67 was highest in the endometrial adenocarcinoma specimens, followed by the atypical complex endometrial hyperplasia group (p < 0.0001). Compared to these 2 groups, Ki- 67 expression was lower in TAM-associated polyps, but Ki-67 indexes were significantly higher in the TAM-associated group than in the control group (p < 0.0001). Conclusion: Since TAM-associated polyps tend to have higher proliferation indexes and Ki-67 ratios than control groups, we suggest that they are likely to have a higher malignant potential.


The low mathematical communication skills in SMA 2 Natar, South Lampung, are caused by various factors, including the assumption that mathematics is very difficult so students still tend to be passive. The purpose of this study was to determine the mathematical communication skills of students who used the Gerlach and Ely learning models that characterized Islamic values better than conventional learning. The population in this study were students of class X Natar 2 Public High School. This research is a pre-experimental design with one-group pretest-posttest type. The test prerequisite analysis was done by Liliefors test for normality and F test for homogeneity, then the data were analyzed using N-Gain test and correlated t-test. The results of the analysis in the t-test test correlates mathematical communication skills in the material of the nilier equation system three variables at the significance level α = 0.05 obtained by tcount = 24.19 Ttable = 2.045 24, Thitung> T table so that in the calculation of H0 is rejected. Similarly, mathematical communication skills can be improved after using the Gerlach and Ely learning model characterized by Islamic values on the subject of the three-variable linear equation system


In many cases, the programmer may require to encode business rules into the database applications. To do this, a large number of program elements may need to be examined by the programmer, to determine which have the capacity to violate a new rule and if so what minimal changes are required to prevent such violations. This process can be time-consuming, and even seasoned programmers can miss difficult and obscure cases in the mass of code. In this paper, we describe a static source code analysis technique to assist the programmer in enforcing business rules in a way that cuts down the amount of irrelevant code to be examined. Our technique derives all the possible ways in which a new business rule can be violated by the programs in the system being modified, and the specific program elements responsible.


One of the major challenges of nano-biotechnology is to engineer potent antimicrobial nanostructures (NS) with high biocompatibility. Keeping this in view, we have performed aqueous olive leaf extract mediated one pot facile synthesis of CuO-NS and CeO2-NS. Prepared NS were homogenous, less than 26 nm in size, and small crystallite units as revealed by scanning electron microscopy (SEM) and X-ray diffraction (XRD) analyses. Fourier transform infrared spectroscopy (FTIR) of CuO-NS and CeO2-NS showed typical Cu-O prints around 592–660 cm-1 and Ce-O bond vibrations at 453 cm-1. The successful capping of CuO-NS and CeO2-NS by compounds present in the plant extract was further validated by high performance liquid chromatography (HPLC) and thermal gravimetric analysis (TGA). Active phyto-chemicals from the leaf extract simultaneously acted as strong reducing as well as capping agent in the NS synthesis. NS engineered in the present study showed antibacterial potential at extremely low concentration against highly virulent multidrug-resistant (MDR) gram-negative strains (Escherichia coli, Enterobacter cloacae, Acinetobacter baumannii and Pseudomonas aeruginosa), alarmed by World Health Organization (WHO). Furthermore, CuO-NS and CeO2-NS did not show any cytotoxicity on HEK-293 cell lines and Brine shrimp larvae indicating that the NS green synthesized in the present study are biocompatible.


The Challenge for small islands planners and managers in Indonesia right now is to develop resources and environment service of small islands for the maximum benefit and, at the same time, to maintain the sustainable capacity of ecosystems (meaning does not exceed the carrying capacity of the ecosystems). This paper applied carrying capacity concept for sustainable development of small islands. To determine carrying capacity of utility space of small islands through two aspects: (1) freshwater, and (2) spaces. Analysis result of carrying capacity for directing utility land area (settlements and agricultures), the freshwater aspects would be fullness, if annual absorption to rainy stayed at 50%. The space area of aquatic which could be utilized for marine culture, shore and marine ecotourism there were around 70%. It was 30% recommended for marine protected zone. Keywords : sustainable development, small islands, carrying capacity .


Background and Aims: Rheumatic Heart Disease (RHD) is the most common heart disease among children and young adults in Nepal. Identifying the prevalence of RHD is important in planning RHD prevention program. There are few studies on RHD conducted among children of unreached population of Nepal. This study aimed to determine the epidemiological status of RHD among school going children living in rural and underdeveloped community of Jajarkot, Nepal.
Methods: This is a cross-sectional study of 6,147 school going children of age group 5 to 16 years from 24 randomly selected schools of Jajarkot in the month of May, 2018. A team of cardiologists from Nepal Heart Foundation examined the children. Diagnosis of RHD was confirmed by echocardiography. Selected socio-demographic data were collected. All positive cases were reviewed by senior cardiologist. Information obtained were analyzed. Frequency and percentage for the categorical data were calculated. Prevalence was reported as cases per thousand school children.
Results: The overall prevalence of RHD was 7.32 per 1000 schoolchildren. Borderline RHD was 1.30 per 1000 and definite RHD 6.02 per 1000. On severity scale, mild RHD was 6.18, moderate RHD 0.81 and severe RHD 0.33 per 1000 respectively. Prevalence of RHD varied with age, sex, ethnicity, and severity. RHD was found higher among males, 10-16 years age group and underprivileged children.
Conclusion: Jajarkot is found to be a RHD endemic zone in Nepal where prevention efforts should be initiated urgently.


The year 2019 was ending and the New Year was also bringing a novel coronovirus to the world.   COVID-19, the novel Coronavirus, was notified as a PHEIC and later a Pandemic on the 11th of March, 2020. The Disease has symptoms which are similar to the flu (influenza) or the common cold, which are a lot more common than COVID-19. In more severe cases, an infection can present as pneumonia or acute onset breathlessness with a mode of transmission as direct Contact with respiratory droplets. The Indian government was instrumental in taking action swiftly right from the time when this disease was just an epidemic and yet to be declared as a pandemic. GOI started the measures like screening of interbnational travelers, surveillance through IDSP network, Quarantine for 14 days on entry, suspension of entry of any foreign nationals from PRC, establishment of control room and many more to delay the inevitable outcome and buy time for health department to do the mitigation.GOI had responded to the 'Test, Track and Treat' strategy proactively. It included augmentation of lab facilities, involvement of private sector, declaring mask & sanitizers as essential commodity, constitution of RRT's in states, testing at maximum number of sites followed by contact tracing of positives and furthermore active surveillance in a few parts of country. India learned a lesson from other countries and adopted social vaccine as a definite measure until the vaccine was there. Benefits of non- pharmacological interventions was acknowledged and percolated to the masses through various IEC measures. These all measures were taken before the 'LOCKDOWN' was being imposed on 24th of March, 2020. Although lockdown had many anticipated negative consequences but it was the only preventive measure viewed by GOI to curb the surge. The lockdown had no impact on the delivery of essential health services. All Health Facilities, Govt & Private, were instructed to remain functional. All the above-mentioned measures had contributed to serving the prime purpose of early, emphatic containment of SARS-CoV-2 in a country like India, inhabited by 1.3 billion people. Although later there was a surge of cases, but when we infer the same result in comparison to the no of cases would have been there without the lockdown, no action at policymakers would have overwhelmed the health services severely. Hence, the lockdown in India had served the purpose for which it was imposed, thereby had prevented major humanitarian losses on account of COVID-19.


The objective of the study was to assess the feasibility of measuring human immunodeficiency virus 1 (HIV-1) proviral deoxyribonucleic acid (DNA) and associated single-nucleotide polymorphism (SNP) of monocyte chemoattractant protein 1 (MCP1) in pediatric cerebrospinal fluid (CSF). The importance of HIV DNA and MCP1 SNP has been suggested to be independently important in progression to acquired immune deficiency syndrome (AIDS) and neurocognitive impairment in adults. In children, measuring both factors in the CSF may help us understand the neuropathogenic process leading to HIV-1-associated encephalopathy (HAE). Repository specimens from 27 perinatally HIV-1-infected children with HAE were assessed for HIV DNA copy by real-time polymerase chain reaction and compared with MCP1 2578G SNP mutations measured by digesting amplified 361 bp fragments. When compared with MCP1 2578G SNP, a significant number with the mutation had high HIV DNA compared with those with wild type (p < .01), with no levels detected in HIV-1-seronegative control specimens. There were six CSF specimens with enough supernatant to measure MCP1 levels by enzyme-linked immunosorbent assay, which showed high levels in those with the MCP1 2578G mutation. This study demonstrates, for the first time, that CSF HIV DNA and MCP1 SNP can be measured and could be potential tools in future clinical studies to understand the pathogenesis of pediatric HAE.


The posterolateral part of the parietal association cortex (area 7 of Brodmann) was investigated in three awake, behaving macaque monkeys using transdural microelectrode recording technique. Only one of the 114 cells isolated remained unidentified. Of the cells 79% responded to somesthetic (39%) or visual (23%) or both somesthetic and visual (17%) stimulation. The somesthetic receptive fields were large, covering, for instance, the whole arm or hand. Most receptive fields were on the upper extremities. Half of the somesthetically drivable cells had bilateral receptive fields. The visually drivable cells responded only to stimuli moving in a certain direction. The effective stimuli for most of the cells responding both to visual and somatosensory stimulation were: touching of the skin and visual stimuli moving towards the cutaneous receptive field. Of the cells 20% were active only during the monkey's own movements, most often during grasping and manipultion with fingers. The results indicate that the area studied is specialized in the control of hand movements, e. g. grasping, grooming and somesthetic recognition of the forms of objects.


Background The continuous overexpression of B lymphocytes in Primary Sjögren's syndrome (pSS) produces a variety of autoantibodies, like anti-Ro/SS-A or anti-La/SS-B, required for the diagnosis, albeit others pose an uncertain clinical significance. According to recent data, anti-α-fodrin antibodies could be used as a reliable diagnostic marker in those patients seronegative to other antibodies. Objectives Thus, the aim was to determine the frequency of anti-α-fodrin antibodies in patients withpSS and describe their clinical association. Methods Forty patients, who fulfilled the 2002 American-European criteria for pSS and 23 controls matched for age and gender, were included. Those who had received any biologic therapy were excluded. Demographic data, clinical manifestations and laboratory findings were recorded. Minor salivary gland biopsies were considered positive according to Chisholm scale. Anti-α-fodrin antibodies were determined utilizing an ELISA immunoassay (Orgentec-Germany) according to the manufacturer's instructions. Mann-Whitney test was used to compare numeric variables, and chi-square or Fisher's test for categorical. A p value of 0.05 was considered statistically significative. Confidence intervals (CI) were estimated for a value of 95%. Results Of the 40 patients with pSS, 22 (55%) tested positive for anti-α-fodrin antibodies, with a sensitivity of 100% (CI =40% - 70%) and a specificity of 56% (CI =40% - 70%). All controls resulted negative (p<0.0001). Gender was 91% female for the positive group (2/22) and 100% for the negative group. Age at diagnosis was 57.6±12 years (range =30-85) for the positive group, and 59.3±12.9 years (range =19-77) for the negative group. Mean disease duration was 74 months (range =2-234) and 54 (range =3-246) respectively. There was no statistically significative difference between gender, age and disease duration between both groups. The positivity of anti-α-fodrin antibodies was significantly associated with low C4 levels (27% vs. 0%, p=0.01), polyclonal hypergammaglobulinemia (68% vs. 33.3%, p=0.03) and minor salivary gland biopsy positivity (31.8% vs. 5.5%, p=0.04). Neither glandular nor any systemic manifestation of pSS was associated with seropositivity for anti-α-fodrin antibodies. The titers of anti-α-fodrin levels were not associated with systemic involvement. Conclusions The frequency of anti-α-fodrin antibodies in patients with pSS was 55% and significantly different from healthy controls. The patients who tested positive for these antibodies had a significantly higher frequency of hypergammaglobulinemia and hypocomplementemia. Due to the considerable frequency of anti-α-fodrin found in our population, and its correlation with serological markers of pourer outcome, its detection may prove to be a useful and sensitive tool in those patients with pSS seronegative for anti-Ro/SS-A and anti-La/SS-B. Disclosure of Interest None declared


Resin-impregnated high-field Nb3Sn type of accelerator magnets are known to require extensive training campaigns and even may exhibit performance-limiting defects after thermal or electromagnetic cycling. In order to efficiently explore technological solutions for this behaviour and assess a wide variety of impregnation material combinations and surface treatments, the BOnding eXperiment (BOX) sample was developed. BOX provides a short-sample test platform featuring magnet-relevant Lorentz forces and exhibits associated training. Here we report on the comparative behaviour of BOX samples comprising the same Nb3Sn Rutherford cable but impregnated either with common resins used in high-field magnets, or with less conventional paraffin wax. Remarkably, the two paraffin wax-impregnated BOX samples reached their critical current without training and are also resilient to thermal and mechanical cycling. These rather encouraging results strongly contrast to those obtained with resin impregnated samples, which show the characteristic extensive training and at best barely reach their critical current value.


Anxiety is common among postpartum women and can have adverse effects on mother's and child's somatic and psychological health if left untreated. In the UK, nurses or midwifes with a specialisation in community public health nursing, also called health visitors (HVs), work with families who have children younger than 5 years of age and are therefore in a key position to identify and support women with postpartum mental health issues. Until recently, postpartum mental health support provided by HVs mainly focused on identifying and managing depression, but the updated clinical guidance by the National Institute for Health and Care Excellence also includes guidance regarding screening and psychological interventions for perinatal anxiety. This study therefore aimed to explore HVs' experiences of supporting women with postpartum anxiety and their views on currently available care. Using a qualitative approach, in-depth semi-structured interviews were conducted with 13 HVs from the UK between May and October 2015. Participants were interviewed in person at their workplace or on the phone/Skype. Using thematic analysis, four main themes emerged: identification and screening issues; importance of training; service usage; and status of current service provision. Women with postpartum anxiety were commonly encountered by HVs in their clinical practice and described as often heavily using their or other related healthcare services, which puts additional strain on HVs' already heavy workload. Issues with identifying and screening for postpartum anxiety were raised and the current lack of perinatal mental health training for HVs was highlighted. In addition, HVs described a current lack of good perinatal mental health services in general and specifically for anxiety. The study highlights the need for HV perinatal mental health training in general and postpartum anxiety specifically, as well as better coverage of specialist mental health services and the need for development of interventions targeted at postpartum anxiety.


Background: Insulin resistance induced by genetic and metabolic disorders is the main cause of the prevalence or severity of type 2 diabetes (T2D). Protein tyrosine phosphatase 1B (PTP1B) plays a key role in regulating glucose homeostasis as a negative regulator of insulin signaling pathway. Objectives: This study aimed to assess the effect of interval training on PTP1B expression in gastrocnemius muscle and insulin resistance in male rats with T2D. Methods: T2D was induced by high fat diet (HFD) and intraperitoneal injection of STZ in 14 male Wistar rats and then they were divided randomly into exercise (n=7) or control (n=7) groups. Exercise rats completed an 8 weeks interval training (5 days/week) and control rats remained without training. Fasting glucose, serum insulin, and PTP1B expression in gastrocnemius muscle were measured 48 hours after the last exercise session. Insulin resistance was assessed using homeostasis model assessment of insulin resistance (HOMA-IR) formula based on fasting insulin and glucose levels. An independent t test was used to compare each parameter between 2 groups. A P value less than 0.05 was considered statistically significant. Results: Interval training resulted in a significant decrease in fasting glucose level (P<0.0001) and insulin resistance (P=0.018) as well as an increase in serum insulin level (P<0.0001). PTP1B expression in gastrocnemius muscle decreased significantly compared with control rats (P=0.003) Conclusion: Interval training can improve insulin resistance in T2D rats. This improvement may be attributed to the decrease in PTP1B expression in gastrocnemius muscle by interval training.


The Hosomi–Sakurai reaction has received enormous attention since its inception and will continue to do so, owing to its atom-economical carbon–carbon bond forming ability. The remarkable feature of this reaction is the use of simple achiral starting materials which leads to the product having a chiral carbon centre with two active functionalities which serve as the guiding stone towards easy synthesis of natural products/bioactive heterocyclic scaffolds/drug candidates. The journey which started with the use of stoichiometric amounts of catalyst has now reached catalytic quantity and that too with economical and ecological aspects. In this review we have emphasized on this journey with regard to Lewis acids, metal triflates, Brønsted acids, heterogeneous catalysts and easily available inexpensive catalysts such as iodine. Our objective is to brief the readers with in-depth knowledge on the development and recent trends in the use of novel catalysts so as to provoke research in this fascinating and enormously useful area which will lead to the development of environmentally benign and economically viable protocols to a greater extent.


Background and Objectives To estimate the proportions of patients with relapsing-remitting multiple sclerosis who despite achieving the no evidence of disease activity-3 (NEDA-3) status in the first 2 treatment years experienced relapse-associated worsening (RAW) or progression independent from relapse activity (PIRA) in the following years. Methods We selected patients with NEDA-3—defined as no relapse, no disability worsening, and no MRI activity—in the first 2 years of either glatiramer acetate or interferon beta as initial treatment. We estimated the long-term probability of subsequent RAW and PIRA (considered as 2 contrasting outcomes) by cumulative incidence functions. Competing risk regressions were used to identify the baseline (i.e., at treatment start) predictors of RAW and PIRA. Results Of 687 patients, 224 (32.6%) had NEDA-3 in the first 2 treatment years. After a median follow-up time of 12 years from treatment start, 58 patients (26%) experienced disability accrual: 31 (14%) had RAW and 27 (12%) had PIRA. RAW was predicted by the presence of >9 T2 lesions (subdistribution hazard ratio [SHR] = 3.92, p = 0.012) and contrast-enhancing lesions (SHR = 2.38, p = 0.047) on baseline MRI scan and either temporary or permanent discontinuation of the initial treatment (SHR = 1.11, p = 0.015). PIRA was predicted by advancing age (SHR = 1.05, p = 0.036 for each year increase) and presence of ≥1 spinal cord lesion on baseline MRI scan (SHR = 4.08, p = 0.016). Discussion The adoption of NEDA-3 criteria led to prognostic misclassification in 1 of 4 patients. Different risk factors were associated with RAW and PIRA, suggesting alternative mechanisms for disability accrual. Classification of Evidence This study provides Class II evidence that in patients with RRMS who attained NEDA-3 status, subsequent RAW was associated with baseline MRI activity and discontinuation of treatment and PIRA was associated with age and the presence of baseline spinal cord lesions.


Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology : We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Eleven RCTs comparing the two therapies were included. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: Restrictive fluid therapy is safe but may have potential dangers, so caution is warranted in its application.


By combining ab initio time-dependent density functional calculations for electrons with molecular dynamics simulations for ions in real time, we investigate the microscopic mechanism of collisions between energetic protons and graphitic carbon nanostructures. We identify not only the amount of energy lost by the projectile, but also the electronic and ionic degrees of freedom of the target that accommodate this energy as a function of the impact parameter and projectile energy. Our results establish validity limits for the Born-Oppenheimer approximation and the threshold energy for defect formation in carbon nanostructures.


Tuberculosis (TB) is one of the leading causes of morbidity and mortality, especially in developing and underdeveloped nations. To add to the burden, drug resistant TB is on the rise and India is handling the dual burden of drug sensitive TB and resistant TB. Previously treated TB cases when compared to the newly diagnosed, have poor treatment success rates and nearly seven times higher incidence of multi drug resistant TB. Proper management of patients treated with Category-II anti-tuberculous treatment (ATT) can result in decrease in emergence of drug resistant bacilli and interruption of disease transmission. Very few studies have reported the treatment outcomes of re-treatment cases and the associated factors in the literature. Favourable outcome rates are highly variable among the failure, relapse and default subgroups. There are many challenges faced by the treating physicians in diagnosis, treatment and follow-up of the re-treatment cases. This review describes the outcomes of patients treated with Category-II ATT and the challenges in managing the previously treated cases successfully. Relapse type of retreatment cases had better success rates compared to other subgroups.


Despite the popularity of the early retirement schemes in the Netherlands, little attention has been paid to the factors underlying this phenomenon. In this article an initial step is taken towards a multivariate modelling of the retirement behaviour of older employees. Data for this have been obtained from a survey conducted among civil servants eligible for early retirement. We conclude that mainly the organizational context, the normative context, as well as the employee's disposition towards retirement (expectations regarding the consequences of retirement with respect to the loss of income and social contacts, as well as the perceived (positive or negative) attitude of the partner) play a major role in explaining the early retirement behaviour. [ABSTRACT FROM AUTHOR]; Copyright of Mens en Maatschappij is the property of Amsterdam University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)


The planet is currently going through a period of global climate change, the pace of which is unprecedented in geological history. Marine phytoplankton contribute approximately 50% of the total global primary productivity and play a vital role in global carbon cycling. Consequently it is extremely important to understand the impact that global climate change will have on the ecological performance of these organisms. In this review we summarise current understanding of the influence that global climate change has on the physiological properties, productivity and assemblage composition of marine phytoplankton. While most phytoplankton are likely to show little direct effect of elevated CO2 on photosynthetic rates, some, including the ecologically important coccolithophorids, are likely to show significant stimulation of growth. The rise in temperature consequent upon the elevated atmospheric levels of CO2 and other greenhouse gases will stimulate growth of some species and increase ocean temperatures in some areas beyond their current optima. However, more importantly, increasing global temperatures will stimulate stratification of the water column which, in tropical and mid-latitudes will exacerbate nutrient limitation in surface waters. This in turn will lead to changes in phytoplankton assemblage composition, primary productivity and sensitivity to UVB radiation.


The Persistence of Polygamy: Fundamentalist Mormon Polygamy from 1890 to the Present Newell G. Bringhurst and Craig L. Foster (Eds). Independence, Missouri. John Whitmer Books 2015, 629 pages.Polygamy is a fascinating topic for evolutionary anthropologists and psychologists alike because it is practiced by most primitive societies, meaning it was practiced in our own history. In these societies, females sexually select for the status of the males and thus the qualities that determine high status in such societies: physical health and, perhaps to a lesser extent, intelligence and certain personality traits. They do this because such a male provides them with healthier and more successful offspring and because the high status male will be able to invest in them and their offspring. In such societies, the headman might have 5 wives and many illegitimate children while around 40% of males will father no children at all. Indeed, Lynn (2011) has noted the persistence of polygyny among the British upper class right into Early Modern times, as it was effectively acceptable for them to father bastard children by mistresses.This volume is, therefore, significant because it explores, in painstaking detail, the only European-origin group which continues to practice polygamy in modern, Western society: the polygamous sects that have broken away from the mainline Church of Jesus Christ of Latter Day Saints (Mormons) in the USA. It is the third in a series of Persistence of Polygamy essay collections, with the same editors. The first looked at Joseph Smith and the origins of the practice (Bringhurst & Foster, 2010), while the second explored the practice in the early history of the church (Bringhurst & Foster, 2013).In the Introduction, the editors provide a readable history of the practice from 1890 onwards, when the official Mormon church banned it. It is appreciated that this is the third volume in a broader history of polygamy in the Mormon church, but it might have been useful to provide a little more background for the non-specialist on Mormon polygamy and the church in general. Joseph Smith, the first Mormon prophet, declared that all Mormons should be polygamous and himself had around 40 wives. The subject of intense persecution, the Mormons fled to Utah and established it as a state, but the persecution continued and the Mormon prophet in 1890 (a new prophet succeeds on the death of the last one, as with popes) banned polygamy. This led, eventually, to more fundamentalist Mormons deciding that the mainline church was disingenuous and establishing their own sects. One schism is known as the Apostolic United Brethren and is based in Utah. This split from the even more conservative, Fundamentalist Church of Jesus Christ of Latter Day Saints (FLDS) in the 1980s. This has established itself in Hildale-Colorado City on the Utah-Arizona border. It was in the news in 2008 as its dictatorial and puritanical prophet, Warren Jeffs, was jailed in Texas for child abuse. He remains in prison and is still regarded as the sect's prophet.Other chapters give various enlightening insights into the history of Mormon polygamy. Barbara Jones Brown explores how, in the 1880s, various Mormons fled to Mexico in order to avoid persecution by the US government and set up colonies there. …


Thanks to brain-computer interface systems, patients with muscular impairments could have control of a device to communicate with people and manipulate their environment using only their brain signals, without the need of any muscular activity. The present preliminary study with four subjects is focused on the control of a 3x4 P300-based speller matrix which allows users to write and communicate. Seven different types of flashing stimuli were used to highlight the letters: i) white letters, ii) colored letters, iii) white blocks, iv) colored blocks, v) neutral pictures, vi) positive and excitatory pictures, and vii) negative and excitatory pictures. These preliminary results showed that conditions with pictures could offer the best performance, specially the set of negative and excitatory pictures. Regarding the other conditions, those ones with blocks presented better results than the standard letter


Summary Here, we present GraphBio, a shiny web app to easily perform visualization analysis for omics data. GraphBio provides 15 popular visualization analysis methods, including heatmap, volcano plots, MA plots, network plots, dot plots, chord plots, pie plots, four quadrant diagrams, venn diagrams, cumulative distribution curves, PCA, survival analysis, ROC analysis, correlation analysis and text cluster analysis. It enables experimental biologists without programming skills to easily perform popular visualization analysis and get publication-ready figures. Availability and implementation GraphBio, as an online web application, is freely available at http://www.graphbio1.com/en/ (English version) and http://www.graphbio1.com/ (Chinese version). Contact email@example.com


In the multi-objective shortest-path problem we are interested in computing a path, or a set of paths that simultaneously balance multiple cost functions. This problem is important for a diverse range of applications such as transporting hazardous materials considering travel distance and risk. This family of problems is not new with results dating back to the 1970's. Nevertheless, the significant progress made in the field of heuristic search resulted in a new and growing interest in the sub-field of multi-objective search. Consequently, in this paper we review the fundamental problems and techniques common to most algorithms and provide a general overview of the field. We then continue to describe recent work with an emphasis on new challenges that emerged and the resulting research opportunities.


Numerical simulation of three-dimensional rough surfaces based on fast Fourier transform (FFT) is revisited. A more systematic approach, which is an extension of the current FFT-based simulation models, is proposed to approach surface reconstruction. Moreover, the simulation of the surfaces with machining signature by prescribing the parameters, take ultrasonic-assisted grinding as an example, has been taken as the research focus for the first time. The effectiveness is tested by three cases of simulation examples. Excepting the surface with exponential autocorrelation function, the simulation of surfaces with grinding machining marks is considered both by prescribing the theory autocorrelation function and by measuring a small area as a sample. The results show that the proposed method has great potential in engineering applications.


This paper deals with good software design principle. On what do you base your design decisions-established conventions, past experience, or principles? The author discusses about three principles that seemed to underlie many of those experts decisions: 1) distribute behavior among objects (rather than concentrate it into a single controlling object). 2) preserve design flexibility by hiding implementation details.3) define abstractions and interfaces first (before focusing on data and coding details).


According to the theory of social systems of Niklas Luhmann, communication is regarded as an open process and the only authentic social function which allows the interface of mental as well social systems, with a view to autopoiesis, that is the reproduction of communication itself. Therefore, only communication can affect communication, just because whatever is not communicated cannot contribute to communication and the function of society. The operation of an organization - as it is the school for example - as well as the interaction of all its members cannot be achieved without the communication system, the level of its systemic maturity which indicates correspondingly the level of the organizational maturity of the organization. Therefore, the educational system, because of its complexity, is a self-rational organization of communication energetics. This paper, based on the systemic approach, aims to study the role of communication in the organization, operation and school development using as a research tool a prototype categorical system of content analysis of two of the five dimensions of complexity; the social and cognitive dimension of complexity in order to make a systematic study of the written texts of the legal framework of primary education in the post-dictatorship Greece. Through the communication indicators of the two dimensions mentioned above we will emphasize the degree and the kind of communication relations developed by the school, both internally and with the important environmental systems. Moreover, we will find out whether the "communications" of the school allow it to become a learning organization.


The current model of health care delivery is designed to address acute health problems and is based on episodic face-to-face interactions between health care provider and patient, which often do not address the needs of chronically ill individuals (1). Diabetes is a well-documented example of a high cost prevalent chronic illness where a significant quality chasm exists. It is one of the most expensive chronic illnesses affecting over 23 million Americans (2) at a cost of $174 billion in 2007 (3). Despite the high expenditures for diabetes care, very few patients with diabetes are at goal for evidence based recommendations, with only 7% of patients at goal for A1C, blood pressure, and LDL cholesterol (4).

In the recent years, much discussion has taken place regarding future health policies and the need to strengthen primary care. It is believed that improvements in the mode of delivery of primary care will better serve the needs of the chronically ill (5). Health outcomes are better in regions in which there is an adequate supply of primary care physicians, and patients receiving care from primary care physicians are healthier (6) and have fewer inpatient hospitalizations (7), fewer emergent admissions (8), a lower length of stay (8), and lower costs of care (9–11).

The Patient-Centered Medical Home (PCMH) has been proposed as a practical solution to the primary care crisis and holds promise to deliver better chronic care. Diabetes lends itself well to the principles of the PCMH given its robust evidence-based guidelines, high cost, and well demonstrated quality gap. Although a common definition of the PCMH has remained elusive (12), the basic elements of a PCMH are well described by the Joint Principles of the American Academy of Family Medicine, American Academy of Pediatrics, American College of Physicians and the …


The objective of this paper is to examine some specific question on the theory of law in international human rights law. International human rights law has played an important role in the evolution of International law. There are different ways of approaching and understanding International law, different schools and certain central theoretical questions. This paper tackles theoretical questions within international law in the light of International law of human rights, such as the questions of hierarchy, unity, coherence, structure, time, power, justice and legitimacy. Furthermore, analyse theoretical horizons, like the question evolution/revolution, progression/regression, justiciability, sustainability and efficacity.


BACKGROUND
 Advances in reconstructive microsurgery have led to significant improvements in the surgical care of complex interdisciplinary cases. At the same time, however, this also increases the resource expenditure of the plastic surgeon involved. This study aimed to analyse the relationship between increase in revenue and resource expenditure in reconstructive microsurgery at a university hospital of maximum care with regard to the treatment of interdisciplinary patients.

METHODS
 In 2018 and 2019, all cases of interdisciplinary cooperation were followed up at one location of a plastic surgery department of a university clinic. The interdisciplinary surgical cases were identified from the collective and evaluated prospectively with regard to inpatient treatment days, surgical resource expenditure and economic development (DRG before and after microsurgical reconstruction).

RESULTS
 In 2018 and 2019, a total of 68 free microsurgical flaps were performed in 64 interdisciplinary cases. 62 of these cases met the criteria for interdisciplinary surgical treatment. Considering the contribution of plastic surgery to the economic development and the associated resource expenditure, there is a significant increase in all parameters (p < 0.0001). Thus, the Case Mix Index (CMI) rose by 20.2 %, inpatient treatment days by 79.1 %, the number of surgical interventions by 62.4 %, cumulative incision-suture time by 131.4 % and total surgeon hours by 75.4 %.

CONCLUSION
 Reconstructive microsurgical procedures lead to a significant increase in revenue in interdisciplinary surgical cases. However, a significant increase in resource consumption is observed as well. Moreover, these additional costs are not always adequately reflected in the revenue of the DRG. This especially applies to DRGs with a high initial cost weight. To ensure modern, individual, patient-oriented and guideline-compliant patient care, there is, therefore, an urgent need to adapt the (G-)DRG system to the additional resource consumption. In addition, in the case of interdisciplinary surgical cases, a clear internal cost allocation must be carried out in accordance with the surgical resource expenditure.


The stable oxygen isotopic composition of precipitation (δ18Op) is used as a proxy for modern and past atmospheric, biologic, and surface processes. Although the physical processes that fractionate 18O in vapor are known, regional controls of δ18Op are not well understood. Here we present results from a limited‐domain general circulation model (REMOiso) to quantify regional controls on modern (1976–1999) interannual and spatial variations of δ18Op across four Andean domains spanning 50° latitude. Results are compared to observed δ18Op from meteorological stations. Simulated annual amount‐weighted mean δ18Op ranges between −4 and −7‰ (0–5°S), −8 and −20‰ (14°S–26°S), −4 and −8.5‰ (30°S–35°S), and −7 to −10‰ (45°S–50°S). Relationships between climate and δ18Op on interannual timescale vary along the Andes and are tied to changes in precipitation and large‐scale dynamics. In the northern Andes, interannual variations in δ18Op are mainly associated with precipitation amounts driven by low‐latitude sea surface temperature and Amazon Basin conditions. In the north central Andes, δ18Op correlates with precipitation amount and wind trajectory, which is related to the position of the Bolivian High. In the south central Andes, δ18Op variability is mainly influenced by precipitation amounts that are controlled by the position and strength of the westerlies. In the southern Andes, interannual δ18Op variability is linked to the intensification and weakening of the South Pacific High. The regional climate‐δ18Op relationships are discussed in the context of pre‐Quaternary sedimentary δ18O proxy records.


Surface modification of textile fabrics and leathers is very versatile and allows the products quality improvement. In this work, cotton and leather substrates were pre-treated with cold atmospheric pressure plasma (CAPP) and further coated with TiO2-SiO2-reduced graphene oxide composites in dispersion form. By using a Taguchi scheme, this research evaluated the effect of three significant parameters, i.e., the pre-treatment with CAPP, organic dispersion coating and TiO2-SiO2-reduced graphene oxide (TS/GR) composites, that may affect the morpho-structural properties and photocatalytic activity of modified cotton and leather surfaces. The characteristics of cotton/leather surfaces were evaluated by morphological, structural, optical and self-cleaning ability using scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDX), X-ray powder diffraction (XRD), attenuated total reflection–Fourier Transform Infrared spectroscopy (ATR-FTIR) and UV–Vis spectroscopy. The self-cleaning performance of the obtained cotton and leather samples was evaluated by photocatalytic discoloration of berry juice surface stains under UV light irradiation for 12 h. The successfulness of coating formulations was proven by the SEM analysis and UV–Vis spectroscopy. The XRD patterns and ATR-FTIR spectra revealed the cellulose and collagen structures as dominant components of cotton and leather substrates. The CAPP treatment did not damage the cotton and leather structures. The photocatalytic results highlighted the potential of TiO2-SiO2-reduced graphene oxide composites in organic dispersion media, as coating formulations, for further use in the fabrication of innovative self-cleaning photocatalytic cotton and leather products.


This paper addresses fundamental limits on the ability to communicate over optical fiber and optical free-space channels. The underlying limits on the sensitivity of optical receivers dictated by quantum effects are reviewed. Receiver sensitivity limitations caused by background light, dark current, post detection amplifier noise, and transmitter imperfection are then considered. Finally the limitations of the channels related to input coupling, loss, and delay distortion are reviewed. Throughout, comparisons are made between the optical systems and their microwave counterparts to highlight differences and the origins of those differences.


Purpose
This study aims to examine the relationship between brand engagement in self-concept (BESC), value consciousness (VC) and brand loyalty among Generation Z consumers. In addition, the study aims to segment the Generation Z consumers based on BESC and VC and examine the differences between the segments.

Design/methodology/approach
A self-administered questionnaire was developed and administered to a sample of 346 undergraduate students in Malaysia. The hypothesized structural models are tested using partial least squares structural equation modeling. The study also uses cluster analysis to segment the Generation Z consumers.

Findings
The results reveal that among Generation Z consumers both BESC and VC have a positive effect on brand loyalty. Additionally, the mediation analysis established that BESC plays a mediating role in the relationship between VC and brand loyalty. The study also identified four consumer groups – attentive group, dedicated group, prospective group and switchers group. Furthermore, consumer classification according to BESC can be used by marketers and managers in marketing strategy development.

Originality/value
The study has originality and value in developing and testing a new model linking BESC with VC and brand loyalty. Further, market segmentation on the basis of BESC and VC has been rarely studied. Even less, has been studied among Generation Z consumers and this study fills this important gap.


The aim of this study is to explore the structural characteristics of the ribosomal protein L36A (RPL36A) gene from giant panda and to investigate its similarities and differences with other species reported. The cDNA and genomic sequence of RPL36A gene were cloned using RT-PCR and touchdown-PCR technology. The results showed that the length of cDNA cloned was 342 bp containing an ORF of 321bp encoded 106 amino acids with an estimated protein molecular weight 12.44kD and a theoretical pI of 11.29. The genomic DNA fragment was 2227 bp containing four exons and three introns. Topology prediction showed that there were one cAMP- and cGMP-dependent protein kinase phosphorylation site, three protein kinase C phosphorylation site, one tyrosine kinase phosphorylation site, one amidation site, one ribosomal protein L44e signature in the RPL36A protein of giant panda. The RPL36A gene could be readily expressed in E. coli. When it was fused with the N-terminally His-tagged protein, it gave rise to accumulation of an expected 17.5kD polypeptide, in good agreement with the predicted molecular weight. The expression product obtained can be purified for studies of its function. Alignment analysis indicated that the nucleotide sequence and the deduced amino acid sequence shared a high homology with other four mammals. In this paper, the cDNA of RPL36A was cloned successfully for the first time from giant panda. The results provided scientific material for enriching and improving the mammals RPL36A gene database.


The appearance of the Hamiltonian constraint in the canonical formalism for general relativity reflects the lack of a fixed external time. The dynamics of general relativistic systems can be expressed with respect to an arbitrarily chosen internal degree of freedom, the so-called internal clock. We investigate the way in which the choice of internal clock determines the quantum dynamics and how much different quantum dynamics induced by different clocks are. We develop our method of comparison by extending the Hamilton–Jacobi theory of contact transformations to include a new type of transformation which transforms both the canonical variables and the internal clock. We employ our method to study the quantum dynamics of the Friedmann–Lemaitre model and obtain semiclassical corrections to the classical dynamics, which depend on the choice of internal clock. For a unique quantisation map we find the abundance of inequivalent semiclassical corrections induced by quantum dynamics taking place in different internal clocks. It follows that the concepts like minimal volume, maximal curvature and the number of quantum bounces, often used to describe quantum effects in cosmological models, depend on the choice of internal clock.


Abstract : During April and May 1991 the R/v New Horizon made a detailed study of the flow and thermohaline structures around Fieberling and neighboring seamounts as part of a multi-investigator, multi-institutional ONR sponsored Flow over Abrupt Topography Accelerated Research Initiative. A total of 122 stations were taken in the working area and 2 test stations were taken outside it. This report gives a numerical and graphical summary of the CTD field measurements and of surface meteorological observations. (MM)


In this paper we consider a redundant system with reduced reserve and investigate the rate of convergence of the distribution of its failure-free time to the exponential law under the fast recovery of its elements. The results for systems with loaded and unloaded reserve are presented as particular cases.


The process of skin carcinogenesis involves a series of transitional events, which can be initiated and promoted by many events such as exposure to physical or chemical carcinogens, chronic inflammation and viral infection. Precancerous skin lesions and carcinomas in situ of the skin represent the early stages of epithelial skin tumors. Clinical observations, histological analysis, as well as molecular and cytogenetic studies have shown actinic keratoses and Bowen's disease to be precursors of squamous cell carcinomas. The presence of arsenical keratoses, tar-induced dermatosis and X-ray irradiation-related keratosis may be associated with basal and/or squamous cell skin cancers. Other intraepithelial neoplasms include mammary and extramammary Paget's disease. Anogenital HPV can cause intraepithelial vulvar, penile and anal intraepithelial neoplasias, each named for the affected site: AIN (anal intraepithelial neoplasia), PIN (penile intraepithelial neoplasia), and VIN (vulvar intraepithelial neoplasia). This article provides an update on the diagnosis and management on these premalignant conditions.


lower in the early stent removal group (10 vs 21 days, p (cid:3) 0.05). There was no difference in rate of postoperative UTI when comparing early versus late stent removal (10.8% vs 10.2%, p [ 0.9). Similarly, there was no difference in rate of urine leak when comparing early versus late stent removal (0% vs 1.3%, p [ 0.31). Readmission rates were similar for early versus late stent removal (7 vs 12%, p [ 0.3). CONCLUSIONS: Earlier stent removal and reduced duration of antibiotic prophylaxis after RC does not result in an increased rate of UTI or urine leak. Decreasing ureteral stent duration reduces post- operative antibiotic exposure without increasing adverse outcomes in patients undergoing RC.


Alzheimer's Disease (AD) is the most prevalent form of dementia and the 6th cause of death in the USA with an age-adjusted death rate of 25.4 per 100,000. For the past 25 years, 5 drugs (Tacrine, Donepezil, Rivastigmine, Galantamine, Memantine) have been approved by the FDA for the treatment of AD. However, these drugs are not costeffective and no new drugs for AD have been introduced in the market since 2005. About 10-20% of the total cost of AD in the USA ($226 billion/year) and in Europe (€160 billion/year) is dedicated to pharmacological treatment. It is estimated that by the year 2050 in the USA alone the direct cost of AD could be over $1.1 trillion in people older than 65 years of age, with a global cost of $20.8 trillion for the 2015-2050 period [1].


Oedanomerus Waterhouse, 1875 (Coleoptera: Scarabaeidae: Melolonthinae: Tanyproctini) was established for a single species Oedanomerus hirsutus Waterhouse, 1875 from Botswana. Arrow (1936) later described O. longicornis from Zambia and Frey (1960) described O. pilosus from Mozambique. Evans (1987) revised the genus and described O. capriviensis and O. bicolor from Namibia. Finally, Lacroix (2005) described O. snizeki from Zimbabwe, O. squamosus from Botswana, and O. uhligi from Namibia.


Objective(s): Regarding the global burden of uropathogenic Escherichia coli (UPEC) infections, prevention and treatment of such infections play a significant role in healthcare management. The inordinate use of fluoroquinolones led to a worldwide spread of quinolone-resistant strains. Therefore, this study aimed to investigate mutations in codons 83 and 106 of gyrA gene in UPEC isolates in the north of Iran. Materials and Methods: This cross-sectional study performed on a total of 223 UPEC isolates which were recovered within 6 months in 2017. Isolates were identified and confirmed by standard microbiologic tests, and antimicrobial susceptibility testing was carried out by disk diffusion and E-test methods. PCR reaction was performed to amplify gyrA gene, and PCR-RFLP was performed using BsiEI and BstUI restriction enzymes to investigate mutations in gyrA gene. Results: The nalidixic acid, ciprofloxacin, ofloxacin, and norfloxacin resistance rates were 61.9%, 50.2%, 48.25, and 45.3%, respectively. Overall, 55.2% of E. coli isolates had a mutation in gyrA gene in codon 83, and 20.2% in codon 106. Also, 15.2% of isolates had simultaneously mutation. Moreover, a significant association was found between mutations in gyrA gene and quinolone and fluoroquinolones resistance pattern of UPEC isolates. Conclusion: Our results revealed a high level of quinolone resistance associated with the mutations in gyrA among the clinical isolates of UPEC in our region. To the best of our knowledge, this study is the first investigation on the role of gyrA alteration in quinolone resistance among UPEC isolates from the north of Iran.


In the teaching unit being reported more than 3500 sterilization procedures were performed between 1969 and 1973. Laparoscopy was used for 643 and laparotomy for almost 2900. The failure and complication even serious complication rates were significantly higher with laparoscopy. It would be possible to improve the success rate for laparoscopy only by restricting its performance to widely experienced operators a procedure unacceptable in a gynecological teaching unit. Tubal ligation by an altered technique gives good results with minimal failure and complication rates and equally short hospital stays. Madlener and Pomeroy procedures are performed on each Fallopian tube and as small an incision as possible is made.


The analysis of the behavior of a tunnel requires the evaluation of numerous parameters, relative to the ground and the support structure and which are generally only known with a certain degree of approximation. The uncertainty of these parameters is reflected on the results of the calculation, that is, on the state of stress in the support structure. In order to be able to manage this uncertainty on the representative ground and support structure parameters in a rational way, it is useful to resort to a probabilistic type analysis, making use of the Monte- Carlo method and to simple analytical methods for an analysis of the tunnel-support structure interaction. A calculation procedure of probabilistic type that is able to establish representative values of the maximum moment and of the associated normal force in the support structure is presented in this study. This procedure can be used to verify the suitability of the support structure to sustain the induced loads


Objective Although genetic mapping of quantitative trait loci for blood pressure to large chromosome segments is readily achievable, their final identification confronts formidable hurdles. Restriction of the genes lodging in one quantitative trait locus interval to experimental limitation can facilitate their positional cloning. We previously delineated several quantitative trait loci for blood pressure on chromosome 10 of Dahl salt-sensitive rats, but their chromosome delimitations were either large or not definitive. Methods In this study, we systematically and comprehensively constructed congenic strains with submegabase (Mb) genome resolution and analyzed their blood pressure by telemetry. Results Three quantitative trait loci have been conclusively delimited by three congenic strains, each independently lowering the blood pressure. Their intervals are demarcated by genomic regions between 350 and 910 kilobases (kb) in size. Two of the three quantitative trait loci share an epistatic relationship and are separated from one another by less than 170 kb. Two additional quantitative trait loci for blood pressure were also tentatively delineated and their intervals range from 520 kb to 1.75 Mb. Possible genes dwelling in each quantitative trait locus-interval number between 11 and 17. None of these genes is known to exert a functional impact on blood pressure. Work is underway to find candidate genes with mutations that could be responsible for the blood pressure effect. Conclusion Novel diagnostic, prognostic, preventive and/or therapeutic targets for essential hypertension and hypertension-associated diseases are likely to emerge from the identification of these quantitative trait loci. Potential applications of these quantitative trait loci to humans are suggested from the positive results from several association studies, demonstrating the existence of quantitative trait loci in the broad homologous regions.


dispensable accomplishments to the excellent music in this English Songbook, for he urges readers to select a table, "load it down with good cheer, leaving place for this book." The monophonic selections should be tried by the reader solo, "after your morning coffee." To be sure, these 47 pieces are fine for social singing or for playing on recorders, lutes, etc.; and we hope they will contribute to the revival of "Hausmusik" which would certainly be a great reinforcement to formal music education. But Greenberg's anthology is more than just music to eat by. It is a kind of DavisonApel or Schering for English vocal music before 1650, containing sacred and secular pieces by Dunstable, Tallis, Byrd, Morley, Gibbons, Ravenscroft, King Henry VIII, and others, as well as such anonymous classics as the "Summer Canon." A good deal of editorial work has been done to make these pieces easier for the layman to interpret; and a "note on editorial policy" explains what the editor has added. Most of the pieces are reprinted from other modern published sources. Each piece is preceded by a brief introductory note, but there is little in the way of technical analysis. Without going into a discussion of them, it can be said that this English Songbook has handled matters of notation and interpretation in the first half of the book in a very satisfactory manner. It is a welcome work, an addition to the growing stock of practical editions of early music, and it is suitable for use in recreation, study, and teaching. BRUNO NETTL


A new technique is developed for zonal filtering of transformed environmental images that avoids some of the disadvantages of already existing techniques and results in better image compression. The two-dimensional discrete Hartley (DHT) and Fourier transforms (DFT), are used to investigate the performance of the new technique and compare it with that of other currently used schemes. The basic idea behind the suggested technique is that each image has an optimal slope direction choice that specifies the zone that gives the best reconstruction results. This slope is determined by the nature of the image and its statistics. So, the authors call their new technique Matched-Slope Zonal-Filtering (MSZF). It can be considered as an improved generalisation of most known zonal filtering schemes. True remote satellite sensing images are used to test the technique.


In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new system of records, "Demonstration and Evaluation of the Medicare Insured Group (MIG) Model," HHS/HCFA/ORD No. 09-70-0044. We have provided background information about the proposed system in the "Supplementary Information" section below. Although the Privacy Act requires only that the portion of the system which describes the routine uses of the system be published for comment, HCFA invites comment on all portions of this notice. See Date Section for comment period. DATES: HCFA filed a new system report with the Chairman of the Committee on Government Operations of the House of Representatives, the Chairman of the Committee on Governmental Affairs of the Senate, and the Administrator, Office of Information and Regulatory Affairs, Office of Management and Budget (OMB) on November 22, 1988. The new system for records will become effective January 30, 1989, unless HCFA receives comments which would necessitate alterations to the system.


The purpose of this research was to investigate the interrogation of Afrikaner culture and identity in the work of Andries Botha (1952) and Marlene de Beer (1957) in the context of Afrikaner nationalism. Anthony Smith's theory of ethno symbolism (2010) and writings on nationalism by Montserrat Gibernau (1996, 2004a, 2000b) are used as a theoretical framework for an analysis of Afrikaner culture and identity, in the form of Afrikaner nationalism. A qualitative research methodology was used, within an art historical, theoretical and practice led investigation into the interrogation of Afrikaner culture and identity. A reflective approach clarified and made meaningful concepts which relate to both my theoretical and practical work, which are interlinked. De Beer makes use of cultural symbols, in interrogating the position of the female in Afrikaner identity and culture, in the context of South African history. Botha interrogates masculinity and patriarchy in Afrikaner culture and identity through a reference to his father and events and imagery from South African history. A personal exploration of Afrikaner culture and identity, in the context of my family history and life experiences, reveals a persistent questioning of Afrikaner culture and identity, resulting in the formation of an individual identity. Arising from this research, it is evident that there is a need for further research into the possible formation of a multicultural identity post 1994 in South Africa.


AIM: To detect early changes in the metabolic profile of pregnant ewes subject to acute feed restriction at 130 days of gestation, and to establish indicators of risk for ovine pregnancy toxaemia (OPT) for diagnostic purposes. METHODS: Twenty Corriedale ewes with known mating dates, carrying a single fetus, were used. Ewes were maintained on meadow grasslands and at 130 days of gestation were randomly divided in two groups of 10 ewes. The control group had ad libitum access to pasture. Ewes in the restricted group were subjected to an acute feed restriction for a maximum of 144 hours (6 days), with free access to water. From the start (0 hours) until the end of feed restriction, blood samples were collected from all ewes to monitor concentrations of cortisol, non-esterified fatty acids (NEFA), ß-hydroxybutyrate (BOHB) daily, and glucose in plasma every 6 hours; urinary pH was also measured. Every 6 hours the food restricted ewes were observed to detect clinical signs of OPT e.g. apathy, grinding teeth, empty chewing movements, head leaning against the wall, tachypnea and not drinking water. RESULTS: In food-restricted ewes, concentrations of glucose decreased and differed from control ewes from 54 to 90 hours (p<0.001), and 96 to 102 hours (p<0.05). Concentrations of BOHB, cortisol and NEFA increased following feed restriction and differed from control ewes after 48 to 144 hours (p<0.01). Eight of the 10 restricted ewes showed clinical signs of OPT after 102–132 hours. Mean concentrations of glucose, BOHB and cortisol differed between control and restricted ewes prior to the onset of clinical signs of OPT, after 48–96 hours of feed restriction (p<0.01). Mean gestational length, and time from birth to placental expulsion was not affected by the feed restriction. CONCLUSIONS: Our results suggest that concentrations of glucose, BOHB and cortisol in plasma may provide a precocious diagnosis of subclinical OPT, using values of 1.59 (SD 0.24) mmol/L, 2.26 (SD 1.03) mmol/L and 15.09 (SD 7.75) nmol/L, respectively. The identification of a potentially harmful metabolic imbalance could lead to the improvement of treatment success.


An ambipolar light-emitting organic field-effect transistor (LE-OFET) based on a 1,4-Bis(4-methylstyryl)benzene (BSB-Me) single crystal was developed. The BSB-Me single crystal has very high photoluminescence quantum efficiency (ΦPL) of 89±2%, while ΦPL of the BSB-Me vapor-deposited film is limited to a much lower value of 54±2%. Ambipolar operation with successive blue electroluminescence from the FETs based on the BSB-Me single crystals was demonstrated by realizing nearly equal electron and hole mobilities [about 0.005 cm2/(V s)] with asymmetric gold–calcium contacts. Since BSB-Me single crystals can perform light amplification, the BSB-Me-based ambipolar LE-OFET is a promising candidate for future electrically driven organic blue-emitting solid-state lasers.


The impact of memory B cells and alloantibodies on the ability to induce transplantation tolerance has not been elucidated. We have developed a murine heart transplant model that isolates the contributions of functional memory B cells from memory T cells in allograft rejection. Memory 3-83 B cells with dual specificity for H-2Kk and H-2Kb were generated in 3-83 Igi BCR knockin (BALB/c background) mice by the transplantation of C3H (H-2Kk) hearts in the absence of immunosuppression. To test the effect of functional memory 3-83 B cells, C3H-primed 3-83 Igi recipients were challenged with C57BL/6 hearts (H-2Kb) at 60–90 days post-C3H heart transplant and treated with anti-CD154 mAbs. Despite immunosuppression, the C57BL/6 hearts were acutely rejected within 10–13 days and graft rejection was associated with increased frequencies of C57BL/6-specific IFN-γ-producing T cells. Histology revealed significant numbers of infiltrating T cells, consistent with acute T cell-mediated rejection. The resistance to tolerance induction was dependent on the synergistic effects of memory 3-83 B cells and alloantibodies, whereas memory T cells are not necessary. We conclude that the combined effects of functional memory B cells and alloantibodies prevent anti-CD154-mediated graft acceptance by facilitating the CD40-CD154-independent activation of alloreactive T cells. This study provides insight into the potential ability of memory B cells and alloantibodies to prevent anti-CD154-mediated graft acceptance.


OBJECTIVE
A barrier to safe therapy for transgender patients is lack of access to care. Because transgender medicine is rarely taught in medical curricula, few physicians are comfortable with the treatment of transgender conditions. Our objective was to demonstrate that a simple content change in a medical school curriculum would increase students' willingness to care for transgender patients.

METHODS
Curriculum content was added to the endocrinology unit of the Boston University second-year pathophysiology course regarding rigidity of gender identity, treatment regimens, and monitoring requirements. All medical students received an online, anonymous questionnaire 1 month prior to and 1 month after receiving the transgender teaching. The questionnaire asked about predicted comfort using hormones to treat transgender individuals. Shifts in the views of the second-year students were compared with views of students not exposed to the curriculum change.

RESULTS
Prior to the unit, 38% of students self-reported anticipated discomfort with caring for transgender patients. In addition, 5% of students reported that the treatment was not a part of conventional medicine. Students in the second-year class were no different than other students. Subsequent to the teaching unit, the second-year students reported a 67% drop in discomfort with providing transgender care (P<.001), and no second-year students reported the opinion that treatment was not a part of conventional medicine.

CONCLUSION
A simple change in the content of the second-year medical school curriculum significantly increased students' self-reported willingness to care for transgender patients.


This paper deals with two design procedures of a control system for a proportional or integrator time-delay plant using a suitable placement of the closed-loop poles to have a small response time, a zero or small overshoot and a given magnitude ratio of the controller output to a step reference or disturbance. To obtain these performances, the both controller design procedures provide a unique solution for the closed-loop pole placement, such that the open-loop system is of simple integrator type (with one pole in origin) to have zero steady-state error to a step input. Three numerical examples for time-delay plants of proportional and integrator type are given to illustrate the effectiveness of the proposed control procedures.


Steam injector (SI) is a passive jet pump which is driven by high-performance steam condensation onto water jet and it is expected to be active at severe accident of nuclear power plant with no electricity. SI is mainly consists of convergent-divergent nozzle. Supersonic steam flow condenses onto water jet in the mixing nozzle and mass, momentum, and energy of steam is transferred to water in the mixing nozzle. Condensed water jet is accelerated at the throat and kinetic energy is converted into pressure in the diffuser, which produces higher pressure than inlet steam pressure. It is easy to apply the SI to nuclear power plant since SI has quite simple and compact structures.The objectives of the present study are to clarify the mechanism of heat and momentum transfer in the mixing nozzle and to determine operating range of SI for practical use.A transparent test section is adopted to conduct visualization of the flow structure with a high-speed video camera as well as measurement of pressure distribution in mixing nozzle, throat, and diffuser with changing back pressure. Fundamental parameters change between operative and inoperative state of the injector were evaluated by measuring pressure and temperature distribution along axial direction of the test section. Discharge pressure as one of operating characteristics of the injector was also measured in changing back pressure by decreasing the opening ratio of the back pressure valve attached downstream of the test section.It was confirmed that discharge pressure increased and the injector became inoperative unsteadily with decreasing opening ratio of the back pressure valve just after it produced the maximum discharge pressure. In the present investigation, this maximum discharge pressure is evaluated as the operation limit of the injector. Furthermore, discharge pressure from diffuser, which is one of the indicators of operating performance as well as operating limit is predicted from inlet condition adopting one-dimensional analysis model proposed previously. By comparing analytical result with experimental data, as well as visualization of flow structure in throat and diffuser, physics model including two-phase flow structure with shock wave which was observed at throat and diffuser are discussed in order to predict injector's operation with high accuracy.Copyright © 2012 by ASME


The Internet has two faces, positive and negative. Its positive aspect is that the Internet enables the enrichment and improvement of human functioning in many areas, including health, education, commerce, and entertainment. On its negative side, the Internet may provide a threatening environment and expose individuals to great risks. Paralleling this overall dual perspective, the Internet facilitates sexual exploration, education, and pleasure; on the other hand, it furnishes an opportunity for criminal and other negative and harmful sexual conduct. The current special issue presents a multi-perspective view of sexuality issues related to the Internet, reflecting its dual nature.


A novel likelihood particle filter is proposed to estimate the carrier frequency offset for uplink MIMO-OFDMA systems. In the proposed scheme, the likelihood is employed to approximate to the posterior rather than the prior, because the likelihood is more similar to the posterior than the prior. The importance density is an approximation to the posterior. Therefore, using a better approximation based on the likelihood, rather than the prior, can be expected to achieve better performance. In addition, the multiuser interference (MUI) cancellation strategy is combined in every recursion. Simulation results show that the proposed algorithm has lower mean square error (MSE) than the regular particle filter and the extended Kalman filter, while approaching the Cramer-Rao Bound (CRB) closely with quite reduced complexity.


Orbital emphysema is rare in the absence of trauma, and is unlikely to result in visual loss. The authors describe a patient with no prior trauma who presented with decreased vision and increased intraocular pressure due to severe orbital emphysema after a sneeze. Computed tomography revealed subcutaneous emphysema of the lid and extraconal air in the orbit. Emergency needle decompression resulted in improvement in vision and intraocular pressure.