We implemented culture- and shotgun metagenomic sequencing (SMS)-based methods to assess the gut colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESC-R-Ent) in 42 volunteers. Both methods were performed using native and pre-enriched (broth supplemented with cefuroxime) stools. Native culture screening on CHROMID® ESBL plates resulted in 17 positive samples, whereas the pre-enriched culture (gold-standard) identified 23 carriers. Overall, 26 ESC-R-Ent strains (24 Escherichia coli) were identified: 25 CTX-M and 3 DHA-1 producers (2 co-producing CTX-Ms). Using the SMS on native stool ("native SMS") with thresholds ≥60% for both identity and coverage, only 7 of the 23 pre-enriched culture-positive samples resulted positive for blaCTX-M/blaDHA genes (native SMS reads mapping to blaCTX-M/blaDHAs identified in gold-standard: sensitivity, 59.0%; specificity 100%). Moreover, an average of 31.5 and 24.6 antimicrobial resistance genes (ARGs) were detected in the 23 pre-enriched culture-positive and the 19 negative samples, respectively. When the pre-enriched SMS was implemented, more blaCTX-M/blaDHA genes were detected than in the native assay, including in stools that were pre-enriched culture-negative (pre-enriched SMS reads mapping to blaCTX-M/blaDHAs identified in gold-standard: sensitivity, 78.3%; specificity 75.0%). In addition, the pre-enriched SMS identified on average 38.6 ARGs/sample, whereas for the corresponding native SMS it was 29.4 ARGs/sample. Notably, stools resulting false-negative by using the native SMS had lower concentrations of ESC-R-Ent (average: ~105 vs. ~107 CFU/g) and E. coli classified reads (average: 193,959 vs. 1.45 million) than those of native SMS positive samples. Finally, the detection of blaCTX-M/blaDHA genes was compared with two well-established bioinformatic tools. In conclusion, only the pre-enriched SMS assured detection of most carriers of ESC-R-Ent. However, its performance was not comparable to the pre-enriched culture-based approach.


The asymptotically fastest algorithms for many linear algebra problems on integer matrices, including solving a system of linear equations and computing the determinant, use high-order lifting. Currently, high-order lifting requires the use of a randomized shifted number system to detect and avoid error-producing carries. By interleaving quadratic and linear lifting, we devise a new algorithm for high-order lifting that allows us to work in the usual symmetric range modulo p, thus avoiding randomization. As an application, we give a deterministic algorithm to assay if an n x n integer matrix A is unimodular. The cost of the algorithm is O((log n)nω M(log n + log||A||)) bit operations, where ||A|| denotes the largest entry in absolute value, and M(t) is the cost of multiplying two integers bounded in bit length by t.


Moderate size defects of the shin of tibia are frequently encountered following trauma and infection. They may be associated with or without a fracture. Such defects require resurfacing by a flap. Many different types of flaps have been described but most of them proved to be more bulky than desired. Although these procedures cover the defects successfully the results they produce are not aesthetically appropriate. The flap looks bulkier because the native subcutaneous tissue is thin over the shin and distal leg. Hence a search for a vascularized tissue of minimal bulk for suitable resurfacing was initiated. A turnover fascial flap fulfilled the requirement. Such a flap can be made thinner by splitting its distal part into two layers while maintaining a common vascular fascial pedicle with both the layers of the fascia. This allowed a larger surface area to be covered. Such refinement is based on the following parameters (a) fresh cadaveric dissection, (b) demonstration of live microcirculation individually in the superficial and deep layers of the deep fascia and (c) intraoperative flourescein study of the split fascial flap. The technique has been used in 5 cases over the upper and middle third of the shin of tibia. The split fascial flap was turned over and inset in the defect and covered with a split skin graft. The donor site was primarily closed. The functional and aesthetic results were highly satisfactory. The follow up of 18 months proved the durability and usefulness of the flap.


An approach to manage seed-transmitted Fusarium crown-foot-root rot (FCR, Fusarium spp.) and common root rot (CRR, Bipolaris sorokiniana) on wheat, avoiding environmental risks of chemicals, is seed treatments with microbial metabolites. F. sambucinum strain FS-94 that induces resistance to tomato wilt was shown by this study to be a source of non-fungitoxic wheat-protecting metabolites, which were contained in a mycelium extract purified by gel-chromatography and ultrafiltration. Plant-protecting effect of the purified mycelial extract (PME) was demonstrated in vegetation experiments using a rolled-towel assay and by small-plot field trials. To elucidate mechanisms putatively underlying PME protective activity, tests with cultured Triticum aestivum and T. kiharae cells, particularly the extracellular alkalinization assay, as well as gene expression analysis in germinated wheat seeds were used. Pre-inoculation treatments of seeds with PME significantly decreased the incidence (from 30 to 40%) and severity (from 37 to 50%) of root rots on seedlings without any inhibition of the seed germination and potentiation of deoxynivalenol (DON), DON monoacetylated derivatives and zearalenon production in FCR agents. In vegetation experiments, reductions in the DON production were observed with doses of 0.5 and 1 mg/mL of PME. Pre-sowing PME application on seeds of two spring wheat cultivars naturally infected with FCR and CRR provided the mitigation of both diseases under field conditions during four growing seasons (2013–2016). PME-induced ion exchange response in cultured wheat cells, their increased survivability, and up-regulated expression of some defensins' genes in PME-exposed seedlings allow the suggestion of the plant-mediated character of disease-controlling effect observed in field.


The latency-associated nuclear antigen (LANA1) of Kaposi's sarcoma-associated herpesvirus (KSHV) is a multi-function protein involved in maintenance of the viral episome and has been shown to interact with several proteins including p53 and pRB. It is likely that the multifunctional role of LANA1 exceeds these observations therefore the work in this thesis aimed to study LANA1 at both the transcription and protein-protein interaction level. I developed a lentiviral system for the infection of primary endothelial cells with LANA1, to analyse changes in gene expression profiles by gene expression microarrays. While the system was successfully developed, no significant changes in gene expression could be attributed to LANA1. Subsequently, using the yeast two-hybrid system and large-scale immunoaffinity purification coupled to mass spectrometry, I identified 26 novel binding partners of the KSHV LANA1 complex. The majority of these proteins have functions in splicing or mRNA processing and further analysis lead to the discovery of predominant protein domains. Several of the identified proteins, including heterogeneous nuclear ribonucleoprotein (hnRNP) A1, A2/B1, D and I, constitute members of the human H-complex. hnRNP A1, A2/B1 and D are also implicated in telomere biogenesis. I show that LANA1 binds UP1, the proteolytic derivative of hnRNP A1, which modulates telomere elongation and maintenance. Furthermore, I show an in vivo interaction between LANA1 and human telomerase reverse transcriptase (hTERT) and the ability of LANA1 to recover telomerase activity from cell lysates. These findings suggest a function for LANA1 in the maintenance of telomeres and may have important implications for the role of LANA1 in KSHV-related tumours. I propose models for the role of these complexes in splicing and telomere biogenesis.


The USNS Mercy (T-AH 19) is a unique environment for its staff and patients. Several environmental influences distinctively affect health, medical, and nursing care. Six main areas of environmental concern for operational nursing were examined. The strengths, weaknesses, opportunities, and threats to the internal environment of a hospital ship were explored. Findings indicate that the USNS Mercy meets or exceeds many environmental standards. However, there is significant room for improvement and nursing involvement in issues related to the management of infectious diseases, patient transport, care of patients with nuclear, biological, or chemical agents, and management of wastes aboard the ship. Nursing implications for research and practice are proposed.


The theme of this paper is to design Emergency Robot which is remotely controlled through Wi-Fi technology and android application by using smart phone, this is of use in providing a visible and obviously evinced interface that is access remotely from hundred meters. The robots consist of a wireless camera transmitting video data to the controlling side thence intervention team. The robot able to move in all direction transmitting life video and audio. This project is very helpful in the hazardous places where a human cannot go in, places like ground canals, smoke oriented caves and all emergency situations. KeyWards: Wi-Fi module, EPS8266 module, android application, stepper motor, robot.


This study is aimed at obtaining a better understanding of vadose zone flow and transport processes at the field scale and establishing defensible links between laboratory- and field-derived transport parameters for conservative and reactive elements in the vadose zone. The study site (Vadose Zone Research Park [VZRP] at INEEL) provides a three dimensional instrumentation array strategically surrounding a new infiltration pond slated for initial use in the upcoming year, and the Big Lost River, and intermittent stream proximal to the infiltration ponds. The proposed research will utilize the infiltration ponds and the Big Lost River to study the effects of fluid flux, water chemistry and degree of saturation on contaminant transport in the vadose zone. Our research plan has four major objectives: (1) determine the transport of conservative and reactive solute and colloid tracers through the vadose zone and local perched water zones; (2) examine isotopic variations of U and Sr a nd compare these to introduced sorbing and non-sorbing tracers; (3) develop and calibrate a conceptual flow and transport model, and (4) examine the effects of flow and geochemical transients on tracer transport.


Which physical parameter of vibrissa deflections is extracted by the rodent tactile system for discrimination? Particularly, it remains unclear whether perception has access to instantaneous kinematic parameters (i.e., the details of the trajectory) or relies on temporally integration of the movement trajectory such as frequency (e.g., spectral information) and intensity (e.g., mean speed). Here, we use a novel detection of change paradigm in head-fixed rats, which presents pulsatile vibrissa stimuli in seamless sequence for discrimination. This procedure ensures that processes of decision making can directly tap into sensory signals (no memory functions involved). We find that discrimination performance based on instantaneous kinematic cues far exceeds the ones provided by frequency and intensity. Neuronal modeling based on barrel cortex single units shows that small populations of sensitive neurons provide a transient signal that optimally fits the characteristic of the subject's perception. The present study is the first to show that perceptual read-out is superior in situations allowing the subject to base perception on detailed trajectory cues, that is, instantaneous kinematic variables. A possible impact of this finding on tactile systems of other species is suggested by evidence for instantaneous coding also in primates.


Squeeze film dampers (SFD) provide load isolation and attenuate rotor vibrations in high speed turbomachinery. Operating parameters such as whirl frequency, amplitude of journal motion, and value of external pressure supply determine the SFD dynamic force response and its dissipation of mechanical energy. Measurements of pressure fields and fluid film forces in a fully submerged open-end squeeze film damper are presented for tests with rotor speeds to 5,000 cpm and low supply pressures. The damper has a clearance of 381 {micro}m (0.015 in.) and the journal describes circular centered orbits of amplitudes ranging from 30 to 50% of the bearing clearance. Experimental film pressures depict a vapor cavitation (close to zero absolute pressure) zone increasing in extent as the whirl frequency increases. Estimated fluid film forces from the measured pressure profiles are found to be proportional to whirl speed and lubricant viscosity. Test cross-coupled damping coefficients (C{sub rt}) are smaller than predicted values based on the short-length bearing model with a {pi} film cavitation assumption. The direct damping coefficients (C{sub tt}) are larger than theoretical values, especially at low frequencies where the dynamic cavitation region has not grown to half the circumferential flow extent. The experiments demonstrate the viscous charactermore » of the fluid film forces in a SFD test apparats where fluid inertia effects are minimal (squeeze film Reynolds number less than one). On the other hand, the extent of the cavitation zone appears to be dominant on the generation of fluid film forces.« less


Starting point: Hospitals are an essential element of every health care system and have priority in the healthcare industry. Healthcare buildings are highly complex infrastructural buildings and their future-oriented planning and long-term economy is extremely relevant for the sustainability of a hospital. These facilities are open 24/7, 365 days a year and used by numerous of patients, employees, visitors and suppliers. More than 1,1 million employees work in over 1.900 hospitals in order to guarantee high quality medical care all over Germany (cf. Statistisches Bundesamt, 2015).All hospitals have to deal with individual challenges regarding the building plot, structure of hospital buildings (comb structure, linear structure), the progression of medical technologies and patient wishes (cf. McKee, M. and Healy, J., 2002, p.45).Problem definition: The big challenges for hospitals in Germany are currently the demographic development of the population, the rural exodus and the progression of the medical technologies (cf. Klauber, 2015, p.2). This paper will explore the effects of varying changes in health care developments on the flexibility of hospital design and how much the future viability and existence of an hospital depends on its location and the inherent hospital functions as well as realised planning decisions in the past and its future perspective.State of research: The regional planning of healthcare buildings is of high interest for politics, people and the economy. According to my research, there are various scientific publications which deal with this topic in Germany as well as on an international level (e.g. McKee, M. and Healy, J. (2002): Hospitals in a changing Europe).Objective: Based on an analysis of different locations and building types of hospitals as well as their underlying basic conditions in Germany, the overall objective of this research is to evaluate the future potential and risk level for hospitals.What are the primary future challenges for hospital buildings? And in which way does hospital planning react those challenges?Methodology: Literature study, structural surveys of hospitals in Germany and interviews with the CEOs, project leaders and employees, architects and the local administrative unit are conducted in order to focus on weaknesses in hospital planning in the past to avoid in future-oriented planning.


To attempt to justify the expense of using propofol for day-surgery, we have compared propofol with methohexitone for induction of anaesthesia for elective minor gynaecological procedures. Seventy healthy patients were randomised to receive either induction agent and postoperatively they were compared for recovery times, side-effects and patient appraisal the following day. The results showed that propofol was superior to methohexitone for most parameters, with small but statistically significant differences in response time, ambulation time, vomiting and drowsiness during recovery. There were minor differences in patient appraisal the next day. However, it is doubtful whether the advantages of propofol are sufficiently substantial to justify the expense of its routine use in preference to methohexitone and its place is a matter for individual judgement.


Malaysia is a developing country in Asian. The capital of Malaysia is Kuala Lumpur. Kuala lumpur is famous as the hosts of Menara Berkembar Petronas. Tourist usually come to see the splendor of Menara Kembar Petronas, and many of them visiting Menara Kembar Petronas to take picture.


A procedure has been described for the biosynthesis of radioactive digitoxin from Digitalis purpurea L. plants grown in an atmosphere of radioactive CO 2 . Employing the growing chamber described, it was possible to administer as much as 4.2 mc. of C 14 to each plant without causing any noticeable inhibition in growth rate when compared to control plants grown simultaneously in a second chamber under similar conditions, but without the labeled CO 2 . However, histological studies of radioactive plant leaves (Beal, 1949) indicate that C 14 does cause injury to the plant leaves. It is believed that larger amounts of C 14 can be administered to the plants although this has not yet been attempted. An extraction procedure for the labeled drug utilizing chemical and chromatographic methods has also been described. The yield of non-crystalline digitoxin was approximately 0.06 per cent: after crystallization the yield was reduced to approximately 0.04 per cent. Depending upon the amount of C 14 administered, the specific activity of the labeled glycoside ranged from 0.26 to 0.54 µc. per milligram. This range of specific activity was found to be sufficient for biological tracer studies. Using the radioactive method of assay and adding non-labeled carrier digitoxin to the biological sample, it is possible to isolate and detect as little as 0.02 microgram of radioactive digitoxin (original sp. activity—0.537 µc./mgm.) per 100 ml. of human urine. Identification tests performed on the radioactive drug indicated that the isolated compound was digitoxin of high purity.


New vaccine developments will reflect achievements of the World Health Organizations (WHO) Expanded Programme on Immunization (EPI) as well as resistance from the public toward increasing numbers of vaccines. WHOs EPI program has concentrated on tuberculosis diphtheria tetanus whooping cough polio and measles. 35 countries are attempting to control hepatitis B with universal vaccination. Now some countries are also recommending vaccination against Haemophilus influenza mumps and rubella. The complexity of multiple injections has prompted new research on acellular vaccines for pertussis hepatitis A and B varicella and malaria. Combined vaccines and new adjuvants are also targets of intense research. Vaccines are a priority because they are among the most cost-effective of medical interventions.


This article considers Lessing's theatrical project of establishing a German National theatre aimed at founding a "school of morality" in Hamburg. In the 18 th century, Hamburg was considered a stronghold of freedom in the opposition between the two forms of being the feudal and burgher's ones having become a capital of the new system of values. Philosophy and arts served as a means in this struggle against dogmatism and feudal absolutism. In this atmosphere, a new conceptual culture emerged. This culture, warmly welcomed by the society, rested on reason, virtue, justice, and tolerance, which reflected the common attitudes of burgher Germany towards apparently natural human inclinations. It contradicted both Augustine's teaching of human corruption and Hobbes's misanthropic anthropology. This German sensitivity served as the basis for Lessing's philosophy of hope. Lessing's "code of hope", whose ideas developed in the "pre-critical" period of the Elightenment is based on trust in human sensibility, within which, probably unconsciously, in the conditions of newly established autonomy, he discovers the heteronomous orientation of the "compassion" and "fear" existentials underlying his theory of catharsis. In Lessing's system, these "vertically" positioned psychological states prove to be bridges to nature, in which he seeks the truth. It explains his theory of realism in Hamburg Dramaturgy, which differs radically from Kant's philosophy. Lessing's theory of art is characterized by aesthetic hope for the sensible ability of people to unite in moral intersubjectivity through existential purification in the realm of beauty. This hope is based on Lessing's pantheistic belief in the unbreakable unity between nature and the truth manifested in the code of the category of the beautiful. In the stress field between the rust of greed and the gold of sensible heart, Lessing relies on the pedagogical power of catharsis of morals under the influence of true art.


Background Levetiracetam (LEV) is a second-generation antiepileptic drug used as a unique or adjunctive therapy for treating partial or generalised epilepsy. Its maximum dose according to the summary product is 3000 mg/day. In patients with resistant epilepsy sometimes it is used at doses higher than recommended. A recent report suggests that high doses may still be possible without toxicity.1 Purpose To describe the importance of therapeutic drug monitoring (TDM) of LEV for minimising toxicity when it is used at doses higher than recommended. Material and methods Case report of 57-years-old male diagnosed with symptomatic focal epilepsy and human immunodeficiency virus (HIV). Antiepileptic treatment consists of LEV 4000 mg/day, topiramate 300 mg/day and clonazepam 4 mg/day since 2010 plus lacosamide 200 mg/day added in 2015. In September 2016 he had a new neurological crisis and dosage was increased to 4500 mg/day. Antiretroviral medication (AM) was changed in 2013 from tenofovir/efavirenz/emtricitabine to abacavir/lamivudine plus efavirenz. In January 2017 AM medication was simplified to dolutegravir/abacavir/lamivudine. Results LEV trough plasma levels (LEVTPL) were 35.9 µg/mL (therapeutic range is 10–40 µg/mL) at the beginning of 2016, 6 years after treatment with LVT 4000 mg/day, glomerular filtration (GFR) calculated by CKD-EPI was >60 ml/min/1.73 m2 and the patient did not have clinical signs of toxicity. Three months after increasing LEV dose to 4500 mg/day the patient presented symptoms of intoxication, felt tired and sleepy. TDM confirmed supratherapeutic LEVTPL of 67.1 µg/mL accompanied by a slight deterioration of renal function (GFR: 50 ml/min/1.73 m2). Concomitant medication seemed not to interact with LEV. LEV dose was reduced to 3500 mg/day. Three months' later, LEVTPL values returned to normal (36.3 µg/mL) and clinical signs of toxicity disappeared. Conclusion LEV at doses higher than recommended could be used safely if there is a close TDM programme to ensure treatment effectiveness and minimise adverse effects. References and/or Acknowledgements 1. Stepanova D, Beran R. Measurement of levetiracetam drug levels to assit with seizure control and monitoring of drug interactions with other Anti-Epileptic Medication (AEMs). Seizure2014;23:371–376. No conflict of interest


Using a large recent representative sample of the German population this paper contributes to the entrepreneurship literature by empirically testing the hypothesis that young and small firms are hothouses for nascent entrepreneurs. The empirical estimation takes the rare events nature of becoming a nascent entrepreneur and the regional stratification of the sample into account. Controlling for various individual characteristics and attitudes (sex, age, risk aversion, presence of a role model in the family, and the width of professional background) we illustrate both the statistical significance and the economic importance for entrepreneurship of work experience in a firm that is both young and small.


Brokerage is an essential yet understudied function in social life. In one of the classics in the field of sociology, Georg Simmel differentiated three types of the "third" which help to analyse brokerage: the disinterested mediator or arbitrator, tertius gaudens and divide et impera. Studies that conceptualise traffickers and smugglers as brokers are extremely rare. Scholars lack a typology which can serve as a basis for comparative research. To advance scholarship on brokerage this article seeks to develop a conceptual-typological matrix by setting out to explore three questions: Why does brokerage exist? What kind of social mechanism is brokerage? What are the implications of brokerage for social inequalities and equalities? The analysis concludes with the consequences of different types of brokerage for the (re)production of social inequalities.


Coronene is the smallest homologue of benzene and is the smallest fragment of graphene among 6-fold symmetric polycyclic aromatic hydrocarbons. In this study, we obtained the first coronene cation radical solid containing magnetic counterions by an electrochemical method. Coronene monocations in the 1:1 salt, (coronene•+)(FeBr4-), assemble in a stacking manner via π-π interactions, which lead to a rather high room-temperature conductivity of 0.6 S cm-1. The salt shows semiconducting behavior as expected from the calculated band structure, and activation energies were estimated to be 0.25 eV at T ≥ 220 K and 0.18 eV at T ≤ 220 K. The magnetic susceptibility follows the Curie-Weiss law down to about 30 K, with a Curie constant (4.47 emu K mol-1) expected for S = 5/2 spins of iron(III) ions and a high Weiss temperature (-32.2 K). Upon further cooling, the salt exhibits a susceptibility kink at 16.2 K followed by the loss of a significant fraction of the susceptibility due to long-range antiferromagnetic ordering. Theoretical calculations predicted that the indirect π-d magnetic exchange interaction through C-H···Br hydrogen bonds is equal to Jπd = -3.10 K. Although the absolute value is lower than that of the direct d-d magnetic exchange interaction between the FeBr4- anions (Jdd = -13.35 K), it is evident that the π-d interactions play a certain role in determining the magnetic behavior. Considering that an isomorphous salt, (coronene•+)(GaBr4-) involving a nonmagnetic counterpart GaBr4-, exhibits singlet-triplet magnetic behavior with a spin gap of 1.44 × 103 K, it is most likely that in (coronene)(FeBr4) the nonmagnetic π-electrons serve as mediators of the magnetic ordering of d-spins through the π-d interactions.


The Enlightenment philosophy, inspired by the intellectual movements of the Renaissance and Reformation, emerging from the scholastic darkness of the Middle Ages, led to the emergence of the Industrial Revolution with its strong light; With the great acceleration given by the production, it has become the dominant ideology of science, culture and art by spreading first to Europe and then to the whole world. Modernism, which was shaped by the idea of Enlightenment, transformed into capitalism in a short time and caused the formation of a consumption culture. The enlightenment ideology brought the understanding of "objective reason" and "progressive history" to humanity, which transformed it into a consumer society shaped by capitalism instead of the "promised paradise". This is why the 'Age of Modernity' is called the age of capitalist transformation. The spread of capitalism to the whole world has been achieved through mass communication and production techniques. TVs, which are the broadcasting organs of capitalism, have become the main tool of capital transformation and have ensured the spread of consumption culture with advertising and marketing techniques. Modernism has carried the material, thinking and comprehension stages of art to a materialistic dimension within a structure that is far from emotional, formed by a technocentric and mechanical mentality. Art integrated with technology has become commodified with capitalist regulation and institutionalization; has gained a commercial dimension. Pop Art, which emerged in the 1960s, has become the symbol of commercialized art; It has emerged as an art movement that deals with the consumption society and its values. Andy Warhol, the famous representative of Pop Art, is one of the artists known to play a role in the commodification of works of art. Warhol's art has made serious contributions to the process of transforming today's art into commodity aesthetics. Meta art/aesthetics is a tradeable world of copies. This artificial world has turned into the real world in the consumer society, which can be reproduced in line with the possibilities of art production technologies; They have become objects of consumption whose uniqueness has been lost. Keywords: Art, Consumption Culture, Commercialization, Kitsch, Andy Warhol


Background: Education is the backbone of societal transformation in all aspects of life. The interdependence among different part of the society is very essential to share the limited resources as well as to achieve their common goal. In this support, as Ashley Montagu stated that without the cooperation of its members society cannot survive, and the society of man has survived because the cooperativeness of its members made survival possible in a similar manner. Objective: The main objective of the study was to assess action needed to minimize students' absenteeism from cooperative learning class and impact of the cooperative learning on students' performance in Adigrat University, College of Medicine and Health Science. Method: an institutional based qualitative, participatory action research study was conducted among Adigrat University, College of medicine and Health Science under graduate students. In the College there are six departments of these conveniently we select four departments Medicine, Public Health, Nursing and Midwifery. The data collecting method was In-depth interview and focus group discussion. The total number of sample collected was four In-depth interview with department heads, one focus group discussion with mentor teachers, four focus group discussion with leaders of the cooperative learning students' team and with the member students' of the cooperative learning team from each departments. Finding: The finding of the study suggested that, cooperative learning is important in improving students' performances, not only in knowledge, skill but also development of their communication skill and ethics. Absenteeism of students from cooperative learning class as taken attendance from department of Midwifery, public health and nursing found to be 5 %, 7-9%, 60-70% respectively. the reason of students' absenteeism from cooperative learning was the mentor teachers, department heads, had no follow up on the cooperative learning process and the reason of student' absenteeism from the cooperative learning was, load of courses, preference to study alone and shortage of time to cover the courses. Besides luck of awareness on cooperative learning is also one of the reasons for student absenteeism. Conclusion and recommendation: This study concludes that cooperative learning is important to increase the students' performance as the students and mentor teachers said in the in-depth and focus group discussion but still lacks awareness on cooperative learning and lack of follow up from departments. So, giving training on cooperative learning, follow up by quality assurance of the college and department heads is mandatory, in addition to these research an interventional research should be studied in future.


Background It is now established that non-alcoholic fatty liver disease (NAFLD) drives increased morbidity and mortality, both through a specific impact upon the liver, but perhaps more importantly, through adverse cardiovascular outcomes (1, 2). Its prevalence continues to rise, and by 2020, NALFD will become the leading indication for liver transplantation worldwide (3). NAFLD is a spectrum of disease ranging from simple steatosis through to inflammation (non-alcoholic steatohepatitis, NASH), scarring, fibrosis with the potential to progress to cirrhosis with the consequent increased risk for the development of hepatocellular carcinoma. NAFLD is more common in patients with type 2 diabetes (T2D) and our own recently published data, generated as part of our local 'think NAFLD' campaign, suggest that more than 13% of all patients with T2D have advanced fibrosis (4). In addition, NAFLD is associated with worsening of diabetes-related complications (5) and crucially, the development of T2D hastens the progression of NAFLD to the more advanced stages that are associated with the poorest clinical outcome (6). Finally, cross-sectional data suggest that poor glycaemic control is associated with more advanced liver disease in some, but not all clinical studies (7, 8, 9).


Abstract The optoelectronic properties of semiconductor nanoparticles make them valuable candidates for the long-term monitoring of transmembrane electric fields in excitable cells. In this work, we show that the electric field sensitivity of the fluorescence intensity of type-I and quasi-type-II quantum dots and quantum rods is enhanced under two-photon excitation compared to single-photon excitation. Based on the superior electric field sensitivity of the two-photon excited fluorescence, we demonstrate the ability of quantum dots and rods to track fast switching E-fields. These findings indicate the potential of semiconductor nanoparticles as cellular voltage probes in multiphoton imaging.


Abstract The food enzyme non‐reducing end α‐l‐arabinofuranosidase (α‐l‐arabinofuranoside non‐reducing end α‐l‐arabinofuranosidase; EC 220.127.116.11) is produced with the genetically modified Trichoderma reesei strain NZYM‐GV by Novozymes A/S. The genetic modifications do not give rise to safety concerns. The food enzyme is free from viable cells of the production organism and its DNA. It is intended to be used in grain treatment for the production of starch and gluten fractions. Since residual amounts of total organic solids (TOS) are removed by washing and purification steps applied during grain treatment, the estimation of a dietary exposure is considered not necessary. Genotoxicity tests did not indicate a safety concern. The systemic toxicity was assessed by means of a repeated dose 90‐day oral toxicity study in rats. The Panel identified a no observed adverse effect level of 1,116 mg TOS/kg body weight per day, the highest dose tested. Similarity of the amino acid sequence to those of known allergens was searched and no match was found. The Panel considered that, under the intended conditions of use, the risk of allergic sensitisation and elicitation reactions by dietary exposure cannot be excluded, but the likelihood for this to occur is considered to be low. Based on the data provided and the removal of TOS during the grain treatment, the Panel concluded that this food enzyme does not give rise to safety concerns under the intended conditions of use.


A two-dimensional position-sensitive neutron detector (PSD) was constructed using a scintillator attached to a position-sensitive photo-multiplier with 100 mm diameter. Position determination is based on charge division. Spatial resolution, gamma sensitivity, linearity, temperature dependence and radiation shielding have been investigated. The shaping amplifiers used in the detection electronics were optimized. Two kinds of scintillators were examined: LiI(Eu) crystal and Li-glass. Concerning the gamma sensitivity and resolution, the best performance was obtained using the LiI. A spatial resolution with full width half maximum of 1.3(1) mm was measured. A good shielding against gamma radiation was found to consist out of three layers: 5 mm of boron rubber, 5 cm of lead and 5 mm of boron rubber. The influence of the temperature on the PSD signal output was measured and indicates that a stabilization is necessary. The PSD will be used in a time-of-flight neutron reflectometer.


Abstract In the age of competition under the flow of capitalism and the progress of materialism, there are many disharmony-problems. As the result, people have called for the harmonious society. At present, Thai society are confronting many problems especially the political problem that causes conflicts and disharmony. That leads to the political separation and nepotism – an important cause of conflicts. It is different attitudes of the leaders, the governors, the scholars, or theorists. Buddhism is the hope that brings the civilized way toward the peace development based on the conditions of Aparihāniya-Dhamma. In order to make the society to have peace, the people who yearn for the harmony must accept the difference of the subjectivity of people and must adapt themselves following the objectivity and the progress of technology that the mental progress cannot follow up. Keywords: Harmony, Aparihāniya-Dhamma


Abstract Many, but not all people experience diminished health, performance and well-being as a function of exposure to stress. However, the underlying neurophysiological processes which characterize hardy or resilient people are not well understood. This study examines psychological hardiness and several indicators of cardiovascular health, including body mass index (BMI) and blood cholesterol markers in a sample of 338 middle-aged adults enrolled in a national security education program. Hierarchical regression analyses reveal that after controlling for the influence of age and sex, high hardiness is related to higher HDL – high density lipoprotein and less body fat (BMI). Lower hardiness is associated with greater total cholesterol to HDL ratio, a cardiovascular disease risk factor. These results suggest that psychological hardiness confers resilience in part through an influence on cholesterol production and metabolism.


Background: Bronchial carcinoma is one of the most common neoplastic disorders in which the majority of patients present at advanced stages. Fibre- optic bronchoscopy is an established investigational procedure in bronchial carcinoma, and is of paramount importance in tumor staging and hispathological typing. But there are a few studies regarding the diagnostic yield of fibre-optic bronchoscopy in our country.Methods: This was a cross-sectional study done in the respiratory medicine ward of National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka from September 2011 to February 2012. All consecutive patients who were suspected clinically and radiologically as a case of bronchial carcinoma and attending in NIDCH were included in this study. There were inclusion and exclusion criteria for selecting the patients. A standard proforma and questionnaire were designed and filled up for each patient. Data was analyzed in computer using software (SPSS) and mean ± SD was applied.Results: Among the total 68 cases 56 patients (82.35%) revealed bronchial carcinoma by fibre-optic bronchoscopy (FOB). Among the 50(73.63%) patients having central lung lesion, 42(84%) patients revealed bronchial carcinoma by bronchial biopsy. Bronchial brushing was taken from 30 patients having central lung lesion and it revealed bronchial carcinoma in 18 patients( 60%). Peripheral lung lesions was found in 18 cases. Bronchial biopsy and bronchial brushing were taken in 6 cases but revealed nonspecific result. Bronchoalveolar lavage was taken in all 68 cases and revealed bronchial carcinoma in 46(67.65%) cases. Bronchial biopsy, bronchial brushing and bronchoalveolar lavage were performed on 56, 30 and 68 cases which yielded bronchial carcinoma in 42 (75%), 18 (60%) and 46 (67.65%) cases respectively. Stepwise performance of bronchial biopsy, bronchial brushing and bronchoalveolar lavage provided a diagnostic yield of 82.35% of cases who had subsequently proven bronchial carcinoma. Combined biopsy, brushing and bronchoalveolar lavage technique is more effective than single technique (P=<O.O01), which is highly significant, gives the diagnostic yield of 82.35%. Out of 50 patients having central lesion in chest X-ray the fibre-optic bronchoscopy yielded bronchial carcinoma in 45 patients (90%). But out of 18 patients having peripheral lesion in chest X-ray the fibre-optic bronchoscopy revealed bronchial carcinoma in 11 patients (61.11%). So fibre-optic bronchoscopy is more effective in the diagnosis of central mitotic lesion than peripheral mitotic lesion. The effectiveness of the combined technique (bronchial biopsy, bronchial brushing and bronchoalveolar lavage all together) is increased to 82.35%. The effectiveness is significantly lower when applied a single technique.Conclusion: By Combined bronchial biopsy, brushing and bronchoalveolar lavage 82.35% cases were diagnosed as bronchial carcinoma which is significantly higher than a single technique. Bronchoalveolar lavage may be an important diagnostic procedure in the peripheral lung lesions.TAJ 2014; 27(2): 50-57


A plant formula and its five components were evaluated independently for their gastric protective effect against ethanol‐induced stomach lesions in rats. Aqueous extracts of the plant formula (0.25–2 g crude drug/kg orally) and its individual components (at the same dose) all showed significant stomach protective effects dose dependently. However, when these extracts were given to rats at a dose of 0.25 g/kg, the five single‐herb preparations did not show any activity, but the formula‐extract still exhibited a strong protective effect. These findings suggest the presence of a synergistic effect among the plant components. Chemical examination of the extracts indicated that the major ingredients of the five plants were essential oils, terpenoids, flavonoids, glycosides and saccharides and these may contribute to the stomach protective activity observed. Copyright © 2002 John Wiley & Sons, Ltd.


ABSTRACT Previous work characterizing ovarian bioenergetics has defined follicular metabolism by measuring metabolic by-products in culture media. However, culture conditions perturb the native state of the follicle, and these methods do not distinguish between metabolism occurring within oocytes or granulosa cells. We applied the phasor approach to fluorescence lifetime imaging microscopy (phasor FLIM) at 740-nm two-photon excitation to examine the spatial distribution of free and protein-bound nicotinamide adenine dinucleotide hydride (NADH) during primordial through preovulatory stages of follicular development in fresh ex vivo murine neonatal and gonadotropin stimulated prepubertal ovaries. We obtained subcellular resolution phasor FLIM images of primordial through primary follicles and quantified the free/bound NADH ratio (relative NADH/NAD+) separately for oocyte nucleus and oocyte cytoplasm. We found that dynamic changes in oocyte nucleus free/bound NADH paralleled the developmental maturation of primordial to primary follicles. Immunohistochemistry of NAD+-dependent deacetylase SIRTUIN 1 (SIRT1) in neonatal ovary revealed that increasing SIRT1 expression in oocyte nuclei was inversely related to decreasing free/bound NADH during the primordial to primary follicle transition. We characterized oocyte metabolism at these early stages to be NADH producing (glycolysis/Krebs). We extended the results of prior studies to show that cumulus and mural granulosa cell metabolism in secondary through preovulatory follicles is mainly NADH producing (glycolysis/Krebs cycle), while oocyte metabolism is mainly NADH consuming (oxidative phosphorylation). Taken together, our data characterize dynamic changes in free/bound NADH and SIRT1 expression during early follicular development and confirm results from previous studies defining antral and preovulatory follicle metabolism in culture.


Eftaxias et al. [2001], hereafter cited as E01, claim to have observed VLF (very low frequency) radio waves that might be considered as signatures of a pending earthquake. For the following reasons, this claim should not be accepted. (1) Previous such claims have proved groundless. In the absence of compelling evidence, which E01 do not provide, further such claims should be regarded skeptically. (2) The observed signals appear consistent with well known types of background noise that are unrelated to earthquakes. (3) E01 did not present a quantitative and objectively testable model of the relation between the observed signals and the earthquake source parameters. (4) E01's correlation between the observed signals and the earthquake appears to be arbitrary. (5) E01 did not present any objective evidence of a correlation beyond random chance, nor did they present any method by which objective tests might be made in the future.


Due to the increasing demand for copper day by day, copper tailings (CT) are the wastes that mining and human-induced activities caused have become a problem all over the world due to the increasing demand for copper. This study evaluates the effect of using CT together with nano silica (NS) and micro silica (MS) in mortars as a partial substitution for cement on mechanical strength properties. Physical, morphological, chemical, mineralogical thermo gravimetric analyzes of CT have been made. In addition, heavy metal concentrations were determined. The mechanical features of the mortars produced by replacing by weight with different proportions of (5%, 10%, 15%) CT, 2% NS and 10% MS cement were determined. As a result, it has been observed that the sum of SiO2, Al2O3 and Fe2O3 of the CT, which has a mostly crystalline structure, is 91.40% and its ignition loss is 4.04%. An improvement in compressive strength (compared to the reference mixture) was observed with the use of 5% CT. Up to 10% of CT has provided standard compressive strength values in both NS and MS combinations.


The aim of this paper is to determine if there is a causal relationship between multivariate constructs for quality (i.e., customer satisfaction, employee satisfaction, and employee service quality) and organizational performance. The presence of such relationships, as well as the identification of key indicators within each quality construct for different types of firms, are explored in this empirical study on the perceptions of middle managers in Taiwan and the United States.

The study found a significant causal relationship between the quality constructs and organizational performance. These relationships are different, however, for the four types of firms based on age and size. Also, within the same firm types, there are differences among countries. For example, for older firms, Taiwanese managers tend to perceive customer satisfaction as the most important quality construct in improving organizational performance, while U.S. managers tend to perceive employee satisfaction as the most important. For younger firms, U.S. managers perceive customer satisfaction as influencing organizational performance, while Taiwanese managers perceive both customer satisfaction and employee satisfaction as doing so.

A further breakdown of the quality constructs identified the key indicators within each construct that separates "better performers''from "lesser performers''in both countries for the four types of firms. These indicators are dissimilar, thus suggesting that focus on quality constructs may lead to improvements in organizational performance by focusing on different indicators in different environments. These results have implications for the adoption and implementation of quality practices in different countries.


Transfer learning from pretrained language models recently became the dominant approach for solving many NLP tasks. A common approach to transfer learning for multiple tasks that maximize parameter sharing trains one or more task-specific layers on top of the language model. In this paper, we present an alternative approach based on adversarial reprogramming, which extends earlier work on automatic prompt generation. Adversarial reprogramming attempts to learn task-specific word embeddings that, when concatenated to the input text, instruct the language model to solve the specified task. Using up to 25K trainable parameters per task, this approach outperforms all existing methods with up to 25M trainable parameters on the public leaderboard of the GLUE benchmark. Our method, initialized with task-specific human-readable prompts, also works in a few-shot setting, outperforming GPT-3 on two SuperGLUE tasks with just 32 training samples.


This paper introduces a new efficient way of controlling or "managing" the active and reactive resources of the system on line in such a way as to maintain viable voltage and current "profiles", that is to keep all voltages within normal limits and all currents within their thermal limits. The disruption to system operation is minimized by using tools of control in priority order. The computational burden is minimized by restricting the computations to moderate size clusters within the large system. The clusters consist of sets of violations and control tools which are effective on these violations along with such nonviolated elements which are responsive to the controls within the cluster. A novel, simple and effective method for finding the clusters is introduced. Because of the limited size of the clusters the computation of the controls is inherently fast but in addition a fast and efficient algorithm is introduced. This overall approach can be operated as an "emergency control" or an ongoing dispatch. In the latter case it will routinely handle any emergencies of the type consisting of more or less widespread voltage and current problems within segments of the system. On the other end of the spectrum these techniques can be used effectively in establishing a restoration sequence or plan for a failed system (with or without blackout).


Skin cancer is the most common class of malignancy in humans. In the United States, there are over 3 million cases of skin cancer a year with significant costs not only in morbidity and mortality, but an estimated $500 million in treatment-related costs and $2 billion in overall economic impact including lost productivity. The vast majority of these skin cancers arise in keratinocytes and within this group, cutaneous squamous cell carcinoma (cSCC) comprises 15-20% of cases. cSCC has the best-defined progression from a distinct precancerous lesion, the actinic keratosis (AK) to invasive cSCC which has appreciable metastatic potential particularly in high-risk scenarios. Beyond serial, disfiguring surgeries, there is no effective therapy. AKs are the most common precancerous lesion in humans, affecting upwards of 5.5% of women and 13.9% of men in U.S. Our understanding of the molecular events that lead from normal skin to AK to cSCC is very poor and represents a fundamental gap in our understanding of this progression sequence. Such an understanding would be of enormous importance. While destructive modalities are the mainstay of treatment of AK, they must be repetitively used and there is no basis for identifying those most likely to progress. Therefore, there is a tremendous need for rationally designed targeted diagnostics and therapy for AKs, which presents an ideal opportunity for molecularly-informed skin cancer screening and secondary prevention. We have performed next generation sequencing (Illumina HiSeq) for microRNA and mRNA on matched samples from 10 patients. Each matched set is composed of clinically normal skin, AK, and cSCC from the same patient, minimizing background genetic heterogeneity. For miRNA-seq, 6.1 million reads with 720,000 mapped reads were obtained on average. RNA-seq analysis yielded over 64 million reads per sample with 92% mapped. Following unsupervised clustering, we found cSCCs clustered together, and AKs clustered with both normal skin and with cSCC confirming the clinico-pathologic characterization of these lesions as precursors to cSCC. Changes in expression of only two miRNA and 367 mRNA emerged as the most significant predictors of overall progression from normal skin to AK to cSCC. In pairwise comparisons between normal skin and cSCC, we identified 628 functional miRNA-mRNA pairs comprising a total of 59 miRNA and 179 predicted mRNA targets. Surprisingly, the number of miRNA and mRNA expression changes between AK and cSCC were very limited ( Citation Format: Vida Chitsazzadeh, Weimin Xiao, Preethi Gunaratne, Cristian Coarfa, Xiaoping Su, Tri H. Nguyen, Valencia D. Thomas, Aaron K. Joseph, Elsa R. Flores, Kenneth Y. Tsai. Integrated genomic analysis of cutaneous squamous cell carcinoma progression. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 815. doi:10.1158/1538-7445.AM2013-815


The side effects of chemotherapy in lung cancer are reviewed and a methodological scheme proposed to prevent and monitor them by means of scrupulous preliminary selection. This is done by studying heart, liver and renal function, as well as by screening the patient's immunity condition. The side-effects of chemotherapy are monitored by monthly repetition of the above tests. Personal cases showing the good results obtained are reported.


In this letter we report the observation of the Gunn effect in n‐type InSb at 77°K and atmospheric pressure. This result is surprising, since it was previously thought that the large amount of carrier multiplication at fields below the Gunn threshold would preclude observation of the Gunn effect in InSb and similar materials. Several explanations for the negative differential conductivity underlying the Gunn effect in this case are possible, but the intervalley transfer mechanism is most consistent with the observed negative pressure coefficient of the threshold field.


This paper studies and compares the quality of service mechanisms based on dynamic reconfiguring of queues for providing service differentiation in IEEE 802.11 wireless networks. Various schemes like 802.11 Distributed coordinator Function (DCF), 802.11e Enhanced Distributed coordinator Function (EDCF) with existing queues and 802.11e EDCF with the reconfigured queues have been evaluated. Evaluation has been done based on important (Quality of service) QOS parameters like access delay, jitter, packet loss, round trip time (RTT) and throughput of the traffic. The results indicate that there is considerable QOS improvement using 802.11e EDCF with reconfigured queues over the ordinary DCF mechanism. All the three schemes have been evaluated on experimental testbed using various types of UDP and TCP traffic


Introduction: Nodular malignant hidradenoma (NH) of vulva is a rare entity. It is a malignant, aggressive
tumor of the eccrine glands that was first reported in literature as a clear cell eccrine carcinoma in 1954.
It is a rare tumor with predilection for the head face and extremities. It usually present in sixth decade of
life with equal male/female distribution but cases have also been reported in children and neonates. Here
we present a case of malignant nodular hidradenoma vulva in a 20yr pregnant woman.
Case Presentation: A 20yrs old primi patient at 38weeks pregnancy presented to our outpatient
department with a painless vulval swelling since 3 months which had increased rapidly in size. On
examination the swelling was arising from upper one third of right labia minora. The mass was 4 x 4
cm in size and was displacing the urethral meatus towards left and involving the vagina upto the fornices.
The patient had history of excision of similar vulvar swelling 7 months back and the histopathology
was suggestive of hidradenoma vulva. Patient delivered vaginally after 2 days. She was thoroughly
investigated.CT scan lower abdomen and pelvis and chest x-ray revealed that it was a locally invasive tumor
with distant metastasis. Patient was given neoadjuvant chemotherapy for 3 cycles after which surgical
excision of the residual disease with bilateral inguinal lymphadenectomy done post operatively 3 more
cycles of chemotherapy given. Patient was kept in regular follow up.
Conclusion: Malignant hidradenoma of vulva is a locally aggressive tumor with rapid progression, poor
prognosis and high recurrence. Early diagnosis and excision with adjuvant chemotherapy is imperative.

Keywords:  Malignant, Hidradenoma, Vulva, Metastasis.


This paper treats the fundamentals of the *vector differential calculus* part of *universal geometric calculus.* Geometric calculus simplifies and unifies the structure and notation of mathematics for all of science and engineering, and for technological applications. In order to make the treatment self-contained, I first compile all important *geometric algebra* relationships, which are necessary for vector differential calculus. Then *differentiation by vectors* is introduced and a host of major vector differential and vector derivative relationships is proven explicitly in a very elementary step by step approach. The paper is thus intended to serve as reference material, giving details, which are usually skipped in more advanced discussions of the subject matter.


Molecular dynamics (MD) simulations are used to investigate chemical reactions that take place on surfaces exposed to ion bombardment and neutral radicals extracted from plasmas. Such chemical reactions occur in a nano-meter-scale thin top layer of the material and their characteristics significantly differ from those of ordinary chemical reactions in thermodynamical equilibrium. As applications of MD simulations to microscale fabrication and thin film formation processes, recent MD simulation results on organic polymer etching by hydrogen/nitrogen plasmas and surface diffusion of Si on highly hydrogenated Si surfaces are reviewed.


This study was conducted to compare continuous suturing technique with interrupted method for the procedure of Episiotomy and second degree perineal tear following vaginal delivery. It was a comparative prospective study conducted in department of Obstetrics & Gynecology of M.K.C.G. Medical college, Berhampur , Odisha, India, from November 2012 to February 2013. Patients were randomized into two groups; One group (A) was repaired with continuous, non-locking sutures involving the vaginal mucosa, perineal muscles and subcutaneous tissues for skin following delivery. The other group (B) with the same match had continuous locking sutures of vaginal mucosa, interrupted sutures in the perineal muscles and interrupted transcutaneous sutures for skin. The sutures used were absorbable (chromic catgut) and identical in both the groups. The participants were asked about pain in sitting position and during movement, the use of analgesics on the 2, 10th day and 6weeks postpartum. A total of 700 women underwent vaginal deliveries with episiotomies and/or with second degree perineal tear. Less repair time (five minute p=0.0001) was noted in continuous technique group and suture material consumed was also less (1 suture RR 3.10, 95% CI: 2.63-3.65). The comparison of pain on the 2nd, 10th day showed that continuous suture techniques compared with interrupted sutures for perineal closure are associated with less pain for up to 10 days postpartum (RR 1.61, 95% CI: 1.39-1.87 for 2 day and RR-1.23, CI:1.15-1.33 for 10 day). There was no difference between the severity of pain in long term period [6weeks postpartum] [RR-1.0, CI: 0.98-1.03] in both the techniques. Repair with continuous suturing was quicker and less suture material was used in comparison with interrupted suturing. There was less pain in short term periodin continuous technique and no difference between the severities of pain in long term period in both the techniques.


1.1 Coronary Artery Bypass Grafting defined It has been reported that over 13 million individuals in the United States have been diagnosed with Coronary Artery Disease (Morrow & Gersh, 2008), and it is the leading cause of death in the United States with more than 650,000 deaths in 2005 (Centers for Disease Control and Prevention, 2009). One of the most effective and common methods of treating Coronary Artery Disease is Coronary Artery Bypass Grafting surgery (Niles et al., 2001). Typically, those patients with severe narrowing of the left main coronary artery and/or those with disease in at least 3 coronary arteries are candidates for Coronary Artery Bypass Grafting Surgery.


To detect regional lymph node metastases 217 patients with melanoma were examined both sonographically and clinically. Metastases were found in 15 patients by means of palpation, and in 26 patients via ultrasound. Sonography was evidently superior and enabled differentiation between metastatic changes and inflammatory enlargements of lymph nodes. Because of its excellent accuracy ultrasound examination should be performed both in preoperative tumour staging and in posttherapeutic monitoring.


The least known aspect of the functional architecture of hippocampal microcircuits is the quantitative distribution of synaptic inputs of identified cell classes. The complete dendritic trees of functionally distinct interneuron types containing parvalbumin (PV), calbindin D28k (CB), or calretinin (CR) were reconstructed at the light microscopic level to describe their geometry, total length, and laminar distribution. Serial electron microscopic reconstruction and postembedding GABA immunostaining was then used to determine the density of GABA-negative asymmetrical (excitatory) and GABA-positive symmetrical (inhibitory) synaptic inputs on their dendrites, somata, and axon initial segments. The total convergence and the distribution of excitatory and inhibitory inputs were then calculated using the light and electron microscopic data sets. The three populations showed characteristic differences in dendritic morphology and in the density and distribution of afferent synapses. PV cells possessed the most extensive dendritic tree (4300 μm) and the thickest dendrites. CR cells had the smallest dendritic tree (2500 μm) and the thinnest shafts. The density of inputs as well as the total number of excitatory plus inhibitory synapses was several times higher on PV cells (on average, 16,294) than on CB (3839) or CR (2186) cells. The ratio of GABAergic inputs was significantly higher on CB (29.4%) and CR (20.71%) cells than on PV cells (6.4%). The density of inhibitory terminals was higher in the perisomatic region than on the distal dendrites. These anatomical data are essential to understand the distinct behavior and role of these interneuron types during hippocampal activity patterns and represent fundamental information for modeling studies.


Decapterus maruadsi is a small pelagic fish and is of great significance to the ecosystems in the northern South China Sea. We collected and analyzed the data recorded by the fishing vessels in the western Guangdong waters in winter and summer and remote sensing data including sea surface temperature (SST), chlorophyll a concentration (Chl a) and sea level anomalies (SLA) from 2011 to 2015, using generalized additive model (GAM). Results showed that the catch per unit effort (CPUE) of D. maruadsi in the western Guangdong waters had a significant positive linear correlation with longitude, and the D. maruadsi populations were concentrated in the east of the study area. The total explanation of D. maruadsi CPUE in GAMs was 47.40%, among which, the factors year, month, lunar phase, latitude, Chl a, SLA and water depth explained 9.30%, 13.50%, 6.50%, 1.90%, 1.70%, 4.60%, and 9.90%, respectively. The D. maruadsi populations in the study were concentrated in the area of latitude 21°N, Chl a 0.10.5 mg·m, SLA -0.05 m and water depth 80 m. Results of this work will help in understanding the environmental factors affecting D. maruadsi distribution in the western Guangdong waters.


Tumor-infiltrating T cells have recently been found to upregulate immunosuppressive pathways, such as programmed cell death protein 1 ligand 1 (PD-L1), in a paracrine fashion on tumor cells, but tumor cell-intrinsic regulation of PD-L1 is another potential mechanism. In this issue of Cancer Discovery, Akbay and colleagues show that signaling via mutant EGF receptor (EGFR) in murine lung tumor cells directly upregulates tumor PD-L1 and that therapeutic blockade of this pathway improves survival in EGFR-driven preclinical models-highlighting the dynamic interplay and therapeutic opportunities of cancer cell biology and immune biology.


People with type 1 diabetes (T1DM) want to enjoy the benefits of sport and exercise, but management of diabetes in this context is complex. An understanding of the physiology of exercise in health, and particularly the control of fuel mobilization and metabolism, gives an idea of problems which may arise in managing diabetes for sport and exercise. Athletes with diabetes need to be advised on appropriate diet to maximize performance and reduce fatigue. Exercise in diabetes is complicated both by hypoglycaemia and hyperglycaemia in particular circumstances and explanations are advanced which can provide a theoretical underpinning for possible management strategies. Management strategies are proposed to improve glycaemic control and performance.


Photoellipsometry, a new contactless optical method, was applied to n-AlGaAs/GaAs heterojunctions used for solar cells. Two samples were studied each having an MOCVD-grown AlGaAs layer of thickness of /spl sim/100 nm, with a different Al composition and a different doping density, on top of an undoped GaAs substrate. The authors' main objective was to determine surface built-in electric field strength, depletion width, broadening, and critical point energies of AlGaAs for each given sample. The measured spectra were analyzed using the Franz-Keldysh theory with the inclusion of field inhomogeneity and broadening effects. Good agreement between the measured and calculated spectra indicates that theories and models used were appropriate for the samples investigated and that the calculated results were reliable.


P-R segment depression is an early ECG change in the evolution of acute pericarditis. This is widely recognized in the USA and appears in several major emergency medicine texts. A telephone survey was conducted to gain an overview of the knowledge of accident and emergency career doctors in the UK. We hope to use the results to highlight this potentially useful sign. One hundred accident and emergency departments, listed in the 1999 British Association for Accident and Emergency Medicine as seeing more than 40 000 new patients per year, were contacted in a telephone survey. The registrar, staff grade or consultant on call was asked to respond to a brief questionnaire. One hundred accident and emergency (A&E) specialist doctors were contacted—60 specialist registrars, 23 consultants and 17 staff grades. Of those questioned, 24% had a background in general medicine. The remainder had trained in surgery, A&E medicine or anaesthetics. None of the doctors questioned volunteered knowledge of P-R depression when asked an open question. Six doctors (6%) admitted, when prompted, to having previously heard of this sign. Knowledge of P-R segment depression is not widespread amongst UK A&E specialists. It is a potentially useful early electrocardiogram change in the evolution of acute pericarditis. Its recognition may aid diagnosis and prevent the inappropriate administration of thrombolytic therapy.


We consider an M/G/1 retrial queue with finite capacity of the retrial group. We derive the Laplace transform of the busy period using the catastrophe method. This is the key point for the numerical inversion of the density function and the computation of moments. Our results can be used to approach the corresponding descriptors of the M/G/1 queue with infinite retrial group, for which direct analysis seems intractable.


The radiological feature of the radioactive material leak incident at the J-PARC Hadron experimental facility has been investigated. From the systematic analysis focusing on the species and behavior of radionuclides originated in the gold target that had been used for nuclear and particle physics experiments since December 14, 2012, we have figured out the major process that resulted in the release of radioactive materials into the user working areas in the Hadron experimental hall as follows; 1) a variety of radionuclides had been produced in the gold target via nuclear spallation reactions, 2) radionuclides with boiling points lower than the melting points of gold were mainly discharged from the gold target because of the instantaneous overheat which raised the temperature of the gold target above the melting point of gold by injection of the anomalously intense-pulsed beam, 3) the radionuclides diffused in the primary beam line room by the air circulation system and leaked into the user working area through the inadequate hermetic sealing for cables and bulk shields between the primary beam line room and the user working areas.


Background The triblock copolymers PEG-P(Asp-DIP)-P(Lys-Ca) (PEALCa) of polyethylene glycol (PEG), poly(N-(N',N'-diisopropylaminoethyl) aspartamide) (P(Asp-DIP)), and poly (lysine-cholic acid) (P(Lys-Ca)) were synthesized as a pH-sensitive drug delivery system. In neutral aqueous environment such as physiological environment, PEALCa can self-assemble into stable vesicles with a size around 50-60 nm, avoid uptake by the reticuloendothelial system (RES), and encase the drug in the core. However, the PEALCa micelles disassemble and release drug rapidly in acidic environment that resembles lysosomal compartments. Methodology/Principal Findings The anticancer drug Paclitaxel (PTX) and hydrophilic superparamagnetic iron oxide (SPIO) were encapsulated inside the core of the PEALCa micelles and used for potential cancer therapy. Drug release study revealed that PTX in the micelles was released faster at pH 5.0 than at pH 7.4. Cell culture studies showed that the PTX-SPIO-PEALCa micelle was effectively internalized by human colon carcinoma cell line (LoVo cells), and PTX could be embedded inside lysosomal compartments. Moreover, the human colorectal carcinoma (CRC) LoVo cells delivery effect was verified in vivo by magnetic resonance imaging (MRI) and histology analysis. Consequently effective suppression of CRC LoVo cell growth was evaluated. Conclusions/Significance These results indicated that the PTX-SPION-loaded pH-sensitive micelles were a promising MRI-visible drug release system for colorectal cancer therapy.


The measured data transmission signaling performance for an AM broadcast (outbound) VHF radio (inbound) two-way distribution automation system is presented. The performance data are presented as a function of signal level, transmission path length and time of day. The outbound link, which uses inaudible low-speed phase modulation of the carrier of a standard AM broadcast station, demonstrated overall average signaling success rates of better than 99% in operational transceiver units. For the 154 MHz VHF return link, which used unconventional low-speed amplitude modulation resolved by a real-time FFT detector-receiver, the measured overall signaling success rate averaged about 60%. >


This study presents a novel design of a wideband high-gain resonant cavity antenna (RCA) for millimetre and submillimetre wave bands, and its fabrication using additive manufacturing (AM). The proposed RCA antenna consists of a partially reflecting surface and three impedance matching layers fed by a waveguide. AM techniques are utilised to fabricate the design operating at 30 GHz. Two fabrication techniques are assessed for printing the antenna. The first technique is based on printing a dielectric material and fully coating the parts with a metallic layer, while the second technique involves printing the parts in a single process using metal three-dimensional printing. The first technique offers a lightweight solution while the second technique can print the whole model in one run. The antenna design is investigated by both simulations and experiments. The measured results show a 3 dB gain bandwidth of about 10%, and high gain over 15 dBi for all the three resulting antennas. Good agreement between simulation and measurement is obtained. The antenna is of low cost and achieved good performance in terms of wide bandwidth and high gain, thus it is potentially useful for high-speed wireless communications at millimetre-wave and sub-millimetre-wave frequencies.


Coagulation alterations in patients with chronic liver disease occur frequently, although they are usually described as auto-anticoagulation phenomena. Changes in hemostasis are broad and diffuse. They include changes in procoagulant and anticoagulant substances, hemodynamic modifi cations, endothelial dysfunction and platelet malfunction which are the causes of different clinical conditions varying from hemorrhaging to thrombosis. Given the complexity of theses alterations, laboratory tests do not correlate well with the clinical events. Treatment for these patients has been controversial. Currently we do not have objective methods for de- termining the hemostatic balance between bleeding and thrombosis in patients with chronic liver disease. In addition to this, the medical literature does not include guidelines for dealing with this special population. Also, the risk of thrombosis indicates the need to consider the use of thromboprophylaxis.


Abstract Whale Rider and Once Were Warriors portray families who struggle to reconcile their Maori identity with life in twentieth-century Aotearoa/New Zealand. The two movies mirror one another in so far as the former features a Maori chief struggling to prevent the loss of Maori culture within his rural tribal group while the latter follows a nuclear family struggling to reconcile its urban identity with its rural Maori roots. Both movies pit an image of the city as an urban ghetto associated with 'social deprivation and lack of traditional culture' against that of the country as a site of 'Maori cultural identity and salvation' (Spooner 2001: 95). The task of reconciling both falls to women who must undergo symbolical and/or actual death before being reborn as leaders. Though both movies conclude on a hopeful note, the path to reconciliation they suggest points 'to a contradiction which continues unresolved in practical reality' (Webster 1998: 39) and fails to address issues inherent in the concept of Maoritanga.


Artificial Intelligence (AI) as a technology has the potential to interpret and evaluate alternatives where multidimensional data are involved in dynamic situations such as supply chain disruption. This article aims to explore the role of resilient information systems in minimizing the risk magnitude in disruption situations in supply chain operations. The article is conducted in the qualitative mode through a semistructured interview schedule for professionals of supply chains. A thematic analysis has been used to create emerging categories. The findings of this article present critical gaps in current information systems and demonstrate how AI-oriented systems can facilitate the ecosystem of disrupted supply chains to save costs and drive efficiency on multiple parameters. The article also proposes a conceptual framework where organizational values and architectural components can be viewed jointly for quick and adequate business decisions in complex and uncertain disruptions. The framework presents the relationships among AI, information systems, and supply chain disruption. Installing appropriate AI-based data acquisition, processing, and self-training capabilities along with information system infrastructure can help organizations lessen the impact of supply chain disruption while aligning the transportation network and ensuring geographically suitable supply chains and cybersecurity. Finally, the implications for theory and practice with the limitations and scope for future research are described.


The aim of this chapter is to summarize the current state of the art in poly(lactic acid) (PLA) nanostructured biomaterials in tissue engineering applications. This chapter starts with an introduction to tissue engineering (TE), followed by an outline of the stem cells used in TE and we finally focus on current PLA-based biomaterials, in this respect across various nanostructured PLA including blend, nanoparticles, nanocomposites and surface modifications. Finally, we will consider some proposed mechanisms that underline the interaction between nanomaterials and stem cells, with the aim that such understanding will enable the optimization of these processes in a more efficient way to achieve better clinical outcomes.


Emotions have been induced by either discrete approaches or dimensional approaches. The former approach included six basic emotions such as anger, disgust, fear, joy, sadness and surprise. The latter was to represent the structure of affect as a two dimensional bipolar space, including valance and arousal axes. The dimensional approach to emotions in this study was tried to define new affective domains in mobile services. The circumplex model, a representative model in dimensional approaches has been proved to be an effective way in representing complicated emotions of people. In addition, lots of studies related to the dimensional approach have been done to reveal the structure of actual affective experience. However, few attempts have been made to systematically define the structure of affect in mobile services. This study was to construct a new affective model for mobile services and to define proper affect domains. The procedures of this study were as follows: affective words had been gleaned from user reviews, depth interviews, behavior analysis and literatures on emotion-denoting adjectives elicited while using mobile services. The collected 207 words were stratified and integrated by frequency analysis and KJ method. Systematic methods such as FGI, scenario techniques and factor analysis were used to extract proper emotion words and to verify them. The resulting 26 words were analyzed in two approaches based on judgments and experiences. In spite of differences in the measurement models and in the procedures employed in collecting data, the two approaches yielded a remarkably consistent structure of affect except for differences in a few emotions. The thing that matters most in the processes was that the common axes of valance and arousal dimensions were obtained from both the self-reported and similarity data. In this study, we proposed a new affective model for mobile services in order to help grasp users' emotions. The proposed model will contribute to revealing the structure of actual affective experiences in mobile services. Also, this model is expected to be a framework in developing affective mobile services and in enhancing the quality of mobile services. More studies on mapping the affective domains obtained from this study onto some specific mobile services should be followed in the future.


Zirconia graphite refractory is used in continuous casting of steel. Slag corrosion resistance influence on time of casting. With factorial experiment 2 5-1 influence mixture of refractory (content of graphite, silicon carbide, boron carbide) on oxidation resistance and interaction with mould powder (C/S = 1, F = 8 %) at 1400 °C. Boron carbide is better antioxidant than silicon carbide. Boron carbide 3 % mass decrease slag corrosion resistance of ZG-refractory. The thicknesses de-carbonized layer are within 1–7 mm Additives of boron carbide and silicon carbide reduce the thickness of the oxidized layer. It was established experimentally that the boron carbide has the best antioxidant properties than silicon carbide therefore, in the study circolatorio materials action SiC less effective than B 4 C.


Many modern datasets don't fit neatly into $n \times p$ matrices, but most techniques for measuring statistical stability expect rectangular data. We study methods for stability assessment on non-rectangular data, using statistical learning algorithms to extract rectangular latent features. We design controlled simulations to characterize the power and practicality of competing approaches. This motivates new strategies for visualizing feature stability. Our stability curves supplement the direct analysis, providing information about the reliability of inferences based on learned features. Finally, we illustrate our approach using a spatial proteomics dataset, where machine learning tools can augment the scientist's workflow, but where guarantees of statistical reproducibility are still central. Our raw data, packaged code, and experimental outputs are publicly available.


Significantly improved reaction conditions for the synthesis of oxycodone (1), via the conventional two-step process involving oxidation of thebaine (3) into 14-hydroxycodeinone (5) and the subsequent reduction of 5via catalytic hydrogenation, are reported. Employing the hydrochloride salt of thebaine (3) in the oxidation step, in place of the more traditionally used free base form of this opiate, now provides 5 in high yield and purity. For the reduction step, aqueous acetic acid has typically been employed as the solvent. However, this was found to generate varying amounts of 14-hydroxydihydrocodeine (16) as the dominant by-product. Instead, using 5% Pd/BaSO4 as the catalyst and MeOH as the solvent completely eliminated the formation of 16, giving oxycodone (1) in high yield and purity, without the need to purify the intermediates. These improved conditions have also proved effective in the synthesis of other 14-hydroxyopiates, such as oxymorphone (2) and N-noroxymorphone (9). In the latter case, a high overall yield was achieved by starting from N-nororipavine (10), without the need to employ protecting groups.


Movement disorders are neurological syndromes affecting either the voluntary movements, or implying abnormal postures and also a large category of involuntary movements. The movement disorders in children are difficult to classify and describe and most of the time need repeated video visualisation. In children the difficult part is to establish the main symptom, the dominant movement disorder, taking into consideration the variable pattern of symptoms with age and also in the context of the causative disease progression. The aim of the presentation is to help distinguish between different movement disorders, emphasising clinical clues and key-investigations which could offer a rapid aetiology orientation. Acute or chronic movement disorders, permanent or episodic, progressive or not will be exemplified through cases from the experience of a tertiary clinic of paediatric neurology. What would the algorithm of investigation of the ataxic child should be? What questions should be asked when facing a child with acute onset or at the other end of the spectrum – a progressive ataxia? Acute intoxication, opsoclonus-myoclonus, ataxia-telangiectasia, neuronal ceroid lipofuscinosis will be examples for these situation. The extrapyramidal, dyskinetic child will be presented in various instances – the chronic presentation being a sign in many neurometabolic conditions: Lesch-Nyhan, monocarboxylate transporter 8 deficiency, glutaric aciduria type 1, mitochondrial and neurotransmitters disorders will be a few examples of different situations. Conclusion The semiological recognition of the patterns of abnormal movements and the model of evolution help the etiological diagnostic, the history taken from patient and family and the videos being very useful for identifying correctly the abnormal movement. In approaching a child with movement disorder we should think simple, in well defined steps, starting from simple investigations and moving forward in an individualised manner. Early diagnosis might allow early treatment, anticipatory management of complications, sometimes improving outcome and ultimately the quality of life and also would allow in a number of cases genetic advise for the affected families.


Low doses of the exogenous flavonoid quercetin increased in contents of sugars in tomato fruits of various cultivars. The content of glucose in tomato fruits of cv. Ukrainskii teplichnyi increased from 3.62 to 11.24% per unit dry weight. Increases in the content of glucose were found in all tomato cultivars examined. An analysis of qualitative and quantitative compositions of amino acids showed that their levels were markedly decreased in fruits of quercetin-treated plants. Our studies and data found in the literature suggest that this effect is due to the synthesis of sugars from amino acids by gluconeogenesis. The reverse process of sugar hydrolysis does not occur because exogenous quercetin inhibits the activity of pyruvate kinase.


Background: Ensuring the effective participation of both public and private healthcare providers is essential to fulfill the goals of universal access to tuberculosis (TB) care. Objectives: The objective was to assess the knowledge, attitude, and practice about TB, Directly Observed Treatment Short (DOTS) program and Public-Private Mix-DOTS course (PPM-DOTS) strategy among allopathic private practitioners (PP) and to explore their extent of involvement in PPM-DOTS strategy in the diagnosis, notification, and management of TB in Puducherry, India. Materials and Methods: A sequential explanatory mixed-method study was conducted from November 2017 to February 2018 with quantitative survey using a pretested semistructured questionnaire followed by in-depth interview (IDI) using field guide. Descriptive manual content analysis was performed after verbatim transcription of the manuscripts from IDIs. Results: Qualitative data based on survey revealed that 97.66% of PPs were aware of subjecting patients with cough for more than 2 weeks for sputum examination and 93.75% were aware of mandatory TB notification. About 88.28% preferred to get the investigation done for presumptive TB cases from nearby DOTS centers. About 89.06% preferred to refer TB cases to nearby primary health centers whereas only 20.31% preferred to notify TB cases. IDIs revealed that PPM-DOTS was not utilized optimally due to the following reasons: minimal TB caseload to collaborate and function with DOTS centers, fear of losing the patient, distrust in PP, busy schedule, availability of Anti-tubercular treatment (ATT) in the nearby pharmacy, breach of confidentiality while notification and finally the easy referral mechanism due to nearby DOTS centers. Conclusions: Involvement of PPs in PPM-DOTS remains sub-optimal. Strategies such as conducting regular workshops, providing timely information about policy changes, and constructive communications individually with PPs to dispel any misconceptions might enhance PPM-DOTS.


Cucumis melo (melon) is a species from the Iberian Peninsula and is included in the family Cucurbitaceae. Despite the knowledge about the physical structure of melon chromosomes, little is known about the intraspecific karyotype diversity of the species. To study karyotype diversity in eight melon accessions, the following methods were used: Giemsa 3% staining; application of CMA 3 /DAPI fluorochromes; and location of 45S and 5S rDNA sequences by fluorescence in situ hybridization. Conventional staining analysis revealed stability in the chromosome number, with accessions presenting 2 n = 24. There were significant variations in the mean chromosome size between accessions, ranging from 0.98 μm to 1.46 μm for accessions A26 and A18, respectively. Scott-Knott clustering distributed the accessions into two groups. GC-rich heterochromatic blocks (CMA 3 + /DAPI - ) were observed in pericentromeric regions of all chromosomes in the complement. CMA 3 + /DAPI - blocks were also located in terminal regions, being specific to satellite regions. Hybridization sites of 45S rDNA probes revealed the presence of a chromosome pair with this locus . In addition, 5S rDNA sites revealed a labeled chromosome pair. No quantitative variation was observed in rDNA sites between the accessions analyzed, indicating these markers as ideal for the verification of karyotypic stability in C . melo .


The structure of the three pattern classes defined by the sets of forbidden permutations $\{2143, 4321\}$, $\{2143, 4312\}$ and $\{1324, 4312\}$ is determined using the machinery of monotone grid classes. This allows the permutations in these classes to be described in terms of simple diagrams and regular languages and, using this, the rational generating functions which enumerate these classes are determined.


Over the last two decades, agile software development (ASD) has garnered much attention in both research and practice. Several ASD methods and techniques have been developed and studied. In particular, researchers have provided several theoretical perspectives on ASD and contributed rich insights to the ASD practice. Still, despite calls for a more unified theoretical understanding of ASD, a theoretical core of ASD has not been identified. This paper offers a theoretical core of ASD research, clarifying what is essential and what is less essential for IS agility, hoping to spark a scholarly discussion, and provides implications of such a core for understanding method tailoring.


The UK Emergency Medicine training pathway has three phases; Core (CT1-2), Intermediate (ST3), and Higher (ST4-6) [1]. The transition from Core to ST3 can be daunting – whilst not 'registrars', ST3s are often on 'middle grade' rotas. Trainees are expected to manage complex adult and paediatric cases with new portfolio requirements to demonstrate these competencies. They further develop leadership skills when supporting junior doctors and managing the department [2]. An 'Introduction to ST3' course was developed initially in the North West Deanery to address this transition. Using the original concepts, course content and format were adjusted for a Merseyside step up course.
 The redesigned three-day course contained workshops including ST3 challenges, paediatrics, night shifts, and wellbeing. 12 scenarios were organised into 'leadership' (sick medical and trauma patients), paediatrics (including major trauma and safeguarding), and 'challenges' (e.g. behavioural disturbance, burns, managing conflict with colleagues and supporting juniors). They took place in a simulation suite with either manikins or simulated patients. Data were analysed pre-course, post-course, and at one to two years post-course with thematic analysis used for free-text responses.
 47 candidates took part in 2019–2021. Pre-course questionnaires showed a key concern was caring for paediatric patients. Other themes were supporting juniors, management skills, being an isolated leader, and confidence. Contemporaneous feedback showed the simulations and talks were rated positively throughout. Simulations were challenging and rated as a useful aspect. The highest rated talks have been night shift work (9.78/10, n=18), supervising others (9.67/10, n=12), and paediatrics (9.67/10, n=12). Improved confidence particularly in challenging situations has been a common theme. Lower rated talks from 2019 were replaced subsequently, and the course remains receptive to feedback. In 2021, 'The Floor' game [3] was incorporated for departmental management skills and participants found this particularly useful. One to two years later, candidates reiterated the importance of the course in their transition, particularly regarding paediatric cases. They highlighted the benefit of discussing portfolio requirements and the value of networking with peers.
 The step up course has been an important aid when transitioning to ST3 with feedback consistently positive at the time of the course and subsequently. Analysis of this feedback has informed improvements for the 2022 iteration happening shortly, and reinforced aspects including 'The Floor', to provide a supportive transition for trainees. As one trainee reported, the course 'made me excited for ST3, [a] reminder why I'm an ED trainee'.
 1. The Royal College of Emergency Medicine, 2021. Curriculum 2021.
 2. Walthall K, editor. Introduction to ST3; Course Guide. 2019.
 3. Focus Games, 2022. The Floor Game.


Spinal tuberculosis, a presentation of extrapulmonary tuberculosis, usually presents with chronic back pain or deformity. The diagnosis is often delayed due to the insidious and nonspecific nature of the initial symptoms. The thoracic spine is more commonly affected, but it can affect other segments or be multisegmental. The site and extent of the lesion will determine the resulting neurological deficits which can lead to significant morbidity and functional impairment. Combination chemotherapy for 6 months is recommended, but some experts may recommend therapy for 9 to 12 months depending on the circumstances. Adjunct corticotherapy and surgery are also options in specific cases. Further studies will be needed in order to better understand the role of these therapies in severe tuberculosis, and in particular spinal tuberculosis.


Recent century‐long experiments performed with global climate models have simulated observed trends in global‐mean temperature quite successfully when both greenhouse gas and aerosol forcing has been included. The performance of these same experiments in simulating observed global‐scale changes in precipitation has not previously been examined. Here we use a gridded terrestrial precipitation dataset for the period 1900 to 1996 to examine the extent to which observed global and zonal‐mean precipitation sensitivities to global warming have been captured by a series of model simulations recently completed by the UK Hadley Centre. There are signs that the model has been able to reproduce at least some of the observed zonal‐mean variations in the precipitation sensitivity to warming. Questions remain both about the quality of the observed precipitation data and about the spatial scale at which anthropogenically‐forced global climate models can be expected to reproduce observed variations in precipitation.


Background To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. Materials and methods Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: "Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?"; Question 2: "Is it achievable to secure the aneurysm with pure simple coiling?" The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. Results In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. Conclusions Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.


Cranial computerized tomography (CT) is an aid in the diagnosis of the spinocerebellar degenerations and may be used to define and categorize individual cases based on the extent and localization of atrophy. We discuss a case of Marie's ataxia and the cranial computerized tomographic appearance.


The role of stress, trauma, and adversity particularly early in life has been identified as a contributing factor in both drug and food addictions. While links between traumatic stress and substance use disorders are well documented, the pathways to food addiction and obesity are less established. This review focuses on psychosocial and neurobiological factors that may increase risk for addiction-like behaviors and ultimately increase BMI over the lifespan. Early childhood and adolescent adversity can induce long-lasting alterations in the glucocorticoid and dopamine systems that lead to increased addiction vulnerability later in life. Allostatic load, the hypothalamic-pituitary-adrenal axis, and emerging data on epigenetics in the context of biological embedding are highlighted. A conceptual model for food addiction is proposed, which integrates data on the biological embedding of adversity as well as upstream psychological, social, and environmental factors. Dietary restraint as a feature of disordered eating is discussed as an important contextual factor related to food addiction. Discussion of various public health and policy considerations are based on the concept that improved knowledge of biopsychosocial mechanisms contributing to food addiction may decrease stigma associated with obesity and disordered eating behavior.


55 patients suffering from diverticulosis of the sigmoid colon underwent surgery, 32 of them in a state of emergency (peritonitis, ileus); mortality rate 22%. In 28 patients a colostomy was performed, which later on could be removed to restore the continuity of the colon. The therapy of choice in the early stage of diverticulosis is resection of the sigmoid colon performed as a ono-stage procedure (mortality rate les than 1%).