Abstract : Riverside Research Institute, located in New York City, is a nonprofit organization engaged in scientific and engineering research. Substantially all revenue is derived from contracts with United States Government agencies. The Institute expended $69 million in Federal awards for the fiscal year ended November 30, 2009, under one Federal program, the research and development (R&D) cluster. Of the $69 million, $30.1 million was expended for Department of Defense programs. Raich Ende Malter & Co. LLP failed to perform, document, and report on the FY 2009 audit of Federal programs in accordance with auditing standards and Circular A-133 audit and reporting requirements (Findings A and B). Raiche Ende and Malter audit of internal control and compliance was based on a determination that 10 of the 14 compliance requirements were applicable to the Institute. However, the audit working papers for all 14 of the compliance requirements were not adequate to support conclusions on applicability, internal control, and the audit opinion on compliance with laws, regulations, and award provisions applicable to the R&D cluster program. In addition, the audit firm did not appropriately report an audit finding disclosed in the audit. Because of these audit deficiencies, Federal agencies cannot rely on the audit report for assurance that the Institute managed Federal awards in compliance with laws, regulations, and award provisions. Riverside Research Institute did not have an understanding of the requirements for preparing the Schedule of Expenditures of Federal Awards. The Schedule provided to the audit firm may not have appropriately identified and classified all Federal and pass-through awards in the R&D cluster. Because the audit firm did not perform appropriate procedures to verify the award information in the Schedule, there is no assurance that the single audit covered all Federal awards expended or administered by the Institute in FY 2009. The audit needs to be re-performed.


For more than one hundred years, sucker rod pumping has been the method used for a large majority of wells requiring artificial lift in the industry. During this time, there have been continual efforts to improve and optimize performance by generations of manufacturers, engineers and field personnel with varying degrees of success. Concepts that have proven effective continue to be used and those that haven't have fallen by the wayside. The industry has not been static, and even good ideas have been improved on over time, either through experimentation or from improvements in technology. This paper will summarize some of the concepts and applications that have led to sucker rod pumping to be one of the most efficient and effective methods of artificial lift.
 Rod pumping's principal advantages are relatively high efficiencies and the ability to maximize bottomhole drawdown. The concept of efficient operation with long, slow strokes has been recognized since at least the early 1930's. In 1987, R.H. Gault published a paper (Gault, 1987) that quantified the benefits based on data extracted from API Bull 11L3, a table of pumping system calculations using an analog computer simulation that was a result of an industry supported effort to understand and optimize performance. Using a freely available wave equation design program based on the Everitt-Jennings method, this study was duplicated and found, with some variation in results, they essentially verify Gault's premises. Carrying this evaluation further, the true way to optimize efficient design is to use the largest pump size that fits operating parameters with longer surface strokes and a reduction in the pumping speed. Call it Big and Slow is the Way to Go


Compared to other countries, in Germany landscape planning was developed early and has many variations in different federal states. This has generated many experiences with different planning arrangements. Additionally, it makes Germany an interesting example for learning about the strengths and pitfalls of landscape planning under certain framework conditions. The objective of this paper is to describe the system of German landscape planning, its development and its features in the context of governance conditions. The method applied for this purpose is a literature review. An important milestone for landscape planning was its inclusion into the Federal Nature Conservation Act in 1976. Here, landscape planning was established as a precautionary planning, covering a broad range of natural assets and spatially specifying the general legal objectives of nature conservation and landscape management. It turned out to be effective for the inclusion of environmental concerns into spatial development. However, landscape planning could not halt strong driving forces such as urbanization and intensification of agriculture. The specific form and implementation options of German landscape planning can be explained by (i) a governance context with rather strong legalization and respective boundaries for public participation; (ii) by the constitutional barriers to unlimited use of private property and (iii) by a federal system with an unbalanced distribution of competencies between planning tiers. For enhancing the effectiveness of German landscape planning, recommendations are deduced, which include, for example, better access to and homogenization of the information in landscape plans. Furthermore, links between planning and implementation instruments should be strengthened.


Purpose of review Despite effective therapies, asthma outcomes remain suboptimal. Education in self-management is crucial to maintaining control in a variable condition such as asthma and reducing the risk of severe asthma exacerbations, hospitalizations and deaths. This review considers the evidence for supported self-management. Recent findings Recent systematic reviews have clarified and confirmed the major benefits from effective self-management education, but have also shown that implementation is rare in routine practice, with consequent avoidable morbidity and mortality. Recent research has focused on the most effective ways of delivering and supporting self-management in different patient groups and has clarified the relative effectiveness of the different components. Self-management support using new digital technologies has been investigated. Summary All clinicians treating patients with asthma should be supporting their patients to understand and manage their own condition. Optimal self-management incorporates education, provision of a personalized asthma action plan and is supported by regular professional review. Action plans in a written or digital format should advise on recognizing deterioration and the actions to take, including when to seek professional help, appropriate changes in medication dose or commencing rescue oral steroids. Action plans should be personalized and agreed by the patient, and provided in a culturally tailored form.


A project in Togo, West Africa, demonstrated that motivated and skilled district health teams can increase community involvement in promoting positive health behavior. Village health committees, village volunteers, health workers, itinerant health agents, and school teachers collaborated with district health personnel in village-wide efforts to increase the use of health services targeted to children under five years of age. The project also demonstrated that in areas where health services are accessible, high levels of service utilization can be achieved by villages through a combination of strategies that rely on person-to-person and group methods of communication. Village-level educational programs, which included theater, storytelling, patient education at health facilities, and child-to-child activities in schools contributed to improvements in immunization coverage levels in children twelve to twenty-three months of age after less than one year following the educational intervention. The major factors responsible for the success of the project are summarized, and issues related to project replication and diffusion are discussed.


Abstract Obesity has been associated with osteoarthritis and increased morbidity and mortality. Most joint arthroplasty patients have a high body mass index (BMI). Some surgeons are reluctant to operate on obese patients due to technical difficulties and the anticipated higher complication rate. The purpose of this prospective study was to determine whether obesity is associated with longer operative times. We attended 100 consecutive primary total joint arthroplasties. Patients were divided into four groups depending on their BMI: the normal group (BMI: 18 to 24.9 kg/m2), the overweight group (BMI: 25 to 29.9 kg/m2), the obese group (BMI: 30 to 39.9 kg/m2), and the morbidly obese group (BMI ≥ 40 kg/m2). Anesthesia type and time, duration of surgery, time needed for scrubbing, draping, and transferring the patient to the operating table were all documented. The mean operative time for total hip arthroplasty (THA) was significantly increased in morbidly obese patients (R 2 = 0.197, p = 0.003). The mean scrubbing time for total knee arthroplasty varied with BMI (p = 0.028). Time to administer spinal anesthesia was significantly increased in morbidly obese patients (R 2 = 0.1466, p = 0.018). Morbid obesity is associated with a significant increase in the time needed to administer spinal anesthesia and the overall time needed to perform a THA.


Objective: To evaluate the independent and combined effects of high-frequency oscillatory ventilation (HFOV) and partial liquid ventilation (PLV) on gas exchange, pulmonary histopathology, inflammation, and oxidative tissue damage in an animal model of acute lung injury. Design: Prospective, randomized animal study. Setting: Research laboratory of a health sciences university. Subjects: Fifty New Zealand White rabbits. Interventions: Juvenile rabbits injured by lipopolysaccharide infusion and saline lung lavage were assigned to conventional ventilation (CMV), PLV, HFOV, or high-frequency partial liquid ventilation (HF-PLV) with a full or half dose (HF-PLV1/2) of perfluorochemical (PFC). Uninjured ventilated animals served as controls. Arterial blood gases were obtained every 30 mins during the 4-hr study. Histopathologic evaluation was performed using a lung injury scoring system. Oxidative lung injury was assessed by measuring malondialdehyde and 4-hydroxynonenal in lung homogenates. Measurements and Main Results: HFOV, PLV, or a combination of both methods (HF-PLV) resulted in significantly improved oxygenation, more favorable lung histopathology, reduced neutrophil infiltration, and attenuated oxidative damage compared with CMV. HF-PLV with a full PFC dose did not provide any additional benefit compared with HFOV alone. HF-PLV1/2 was associated with decreased pulmonary leukostasis compared with HF-PLV. Conclusions: The combination of HFOV and PLV (HF-PLV) does not provide any additional benefit compared with HFOV or PLV alone in a combined model of lung injury when lung recruitment and volume optimization can be achieved. The use of a lower PFC dose (HF-PLV1/2) is associated with decreased pulmonary leukostasis compared with HF-PLV and deserves further study.


International competition, and to some extent the CRINE initiative, have stimulated oil and gas operators to minimise production costs wherever possible. Underwater inspection, repair and maintenance (IRM) of the platform jacket consumes a major proportion of the overall maintenance budget and consequently any reduction in this area is likely to have a significant impact on overall costs. All offshore jackets are inspected regularly to ensure structural integrity and satisfy the strict statutory requirements. Technical advances have been achieved in recent years, particularly in ROV capability, which have led to a general reduction in highly expensive diver time. However, it is widely recognised within the industry that inspection costs could be further reduced by combining such advances with a much more rigorous planning philosophy, the aim being to reduce the total amount of inspection activity whilst maintaining or improving the effectiveness of the work carried out. Quest Consulting Ltd and Aberdeen University are working jointly on a Teaching Company Scheme, part funded by the Government, to develop methods and tools for targeting the inspection of offshore structures at areas of greatest criticality on a sound scientific basis. This paper presents the results of ongoing research and proposes that planned inspection should include a refined risk assessment to rank components and define the most appropriate inspection methods and optimum inspection intervals for a given structure. This will result in the most cost effective approach to underwater inspection being implemented.


OBJECTIVE
To investigate the effectiveness and safety of extracorporeal detoxification using the fractionated plasma separation and adsorption system (FPSA, Prometheus® 4008H, Fresenius Medical Care, Germany) in patients suffering from acute liver failure due to intoxication with Amanita phalloides (AP) toxin.

METHODS
The study population consisted of 20 patients with proven AP intoxication (FPSA treatment group n=9, control group n=11). Urinary amanitin toxin concentration was measured by the Amanitin ELISA Kit (Bühlmann Laboratories, Germany, cut off level 1.5 ng/ml). All patients received standard medical treatment with activated charcoal, i.v. crystalloid fluids, silibinine and N-acetylcysteine. Additionally 9 patients underwent treatment with FPSA until undetectable amanitin levels.

RESULTS
Mean urinary amanitin levels were significantly reduced by FPSA with 42.5 +/- 21.9 ng/ml before and 1.2 +/- 0.31 ng/ml after treatment (p=0.04). No hemodynamic, respiratory or hematological complications were observed. None of the patients had to undergo liver transplantation. All patients in the treatment group survived and were discharged fully recovered. One patient in the control group died due to shock and lactic acidosis; one patient remained dialysis dependent. Mean duration of hospital stay was 7.1 days in the treatment group and 11.7 days in the control group (p=0.30).

CONCLUSIONS
Use of liver support therapy by fractionated plasma separation and adsorption (Prometheus®) offers a safe way for elimination of Amanita toxin with the potential to avoid the need for liver transplantation.


In this article, we study some quotient sets on permutations built from peaks, valleys, double rises and double descents. One part is dedicated to the enumeration of the cosets using the bijection of Francon-Viennot which is a bijection between permutations and the so-called Laguerre histories. Then we study the algebraic properties of these quotient sets. After having shown that some of them give rise to quotient algebras of $\mathbf{FQSym}$, we prove that they are also free.


Formamide and urea were used as plasticizers for corn starch to prepare formamide plasticized-thermoplastic starch (FPTPS) and urea plasticized-thermoplastic starch (UPTPS), respectively. The properties of thermoplastic starch (TPS) were tested by scanning electron microscope (SEM), x-ray diffraction (XRD), differential scanning calorimetry (DSC), thermo gravimetric analysis (TGA) and mechanical testing machine. Scanning electron microscope result shows that both formamide and urea can make corn starch plasticized form uniform continuous phase, but plasticizing effect of formamide was better than that of urea. X-ray diffraction exhibits that the crystallization peaks of FPTPS were disappeared, and a reduction minish for UPTPS, the crystallinity of FPTPS was smaller than UPTPS. The gelatinization temperature of two kinds of thermoplastic starches was basically the same, but the gelatinization enthalpy of FPTPS was much less than UPTPS. Formamide was better plasticized than urea for corn starch, which made the TGA inflection temperature and residual quantity of FPTPS was lower than UPTPS. FPTPS tensile strength was lower than UPTPS, but the elongation at break was much bigger than UPTPS.


I. 240 Male mice from the aggressive C57BL/I05 strain and non-aggressive A/J strain were subjected to temperatures of I8.3°C, 2I.I°C, 26.7°C, 32.2°C or 35°C for 24 hours. 2. The mice were then crowded in groups of 8 into enclosures with floor areas of 0.09, 0.2I, or 0.38 m2. 3. The frequency of aggression acts (biting frequency) was recorded for each animal 30, 60, and 90 min. after being put in the enclosures. 4. Aggression was lowest at I8.3°C and 35°C and tended to increase as the temperature increased from I8.3°C to 32.2°C. 5. There appeared to be more aggression in the more crowded conditions than in the less crowded conditions. 6. The results were attributed to metabolic changes induced by increasing temperature and to perceptual and proximity effects resulting from increasing population density.


The purpose of the study is to observe the impact of policy intervention on financial sustainability using the structural vector autoregression (SVAR) analysis. The population of the study is the manufacturing sector of Pakistan, which is an emerging economy. Data for 249 firms operating in the manufacturing sector are taken, collected from Datastream from 2005 to 2019, with total observations of 2,400. To conduct the analysis, R software is used for its better visualization. Results show that firm performance, corporate governance, and sectoral policies have a positive and long-term impact on financial sustainability, whereas earning management and financialization not only have a negative impact, but this impact affects the operations of the corporate for a longer period. This study would be helpful for policymakers as it gives a framework for financial sustainability based on the policies and strategies developed by the sector.


A number of studies suggest there is an over-supply of specialists and an undersupply of GPs in many developed countries. Previous econometric studies of specialty choice from the US suggest that a number of factors play a role, including expected future earnings, educational debt, and having predictable working hours. Given endogeneity issues in revealed preference studies, a stated-preference approach is warranted. This paper presents results from a discrete-choice experiment completed by a sample of 532 junior doctors in 2008 before they choose a specialty training program. This was conducted as part of the first wave of the MABEL (Medicine in Australia: Balancing Employment and Life) longitudinal survey of doctors. We include key job attributes such as future earnings and hours worked, but also allow the choice to be influenced by academic research opportunities, continuity of care and the amount of procedural work. Interactions of attributes with doctor characteristics, including gender, educational debt, and personality traits are also examined. We find the income/working hours trade-offs estimated from our discrete choice model are close to the actual wages of senior specialists, but much higher than those of senior GPs. In a policy simulation we find that increasing GPs' earnings by $50,000, increasing opportunities for procedural or academic work can increase the number of junior doctors choosing General Practice by between 8 and 16 percentage points, approximately 212 to 376 junior doctors per year. The results can inform policymakers looking to address unbalanced supply of doctors across specialties.


This work aims to compare the operation costs (energy, reagents, waste management) for the three layouts usually used in wastewater treatment plants incorporating biofilters, using technical and economical data acquired during 10 years of operation of a Parisian plant (Seine Centre, 240,000 m(3) d(-1) -800,000 equivalent inhabitants). The final objective is to establish general economical data and tendencies that can be translated from our study to any biofiltration plant. Our results evidenced the savings achieved through the treatment process combining upstream and downstream denitrification. To use this layout reduced the operating costs by some 10% as compared with conventional processing only comprising downstream denitrification. Operating costs were respectively estimated at 37 and 34 €/1,000 m(3) for downstream denitrification and combining upstream and downstream denitrification layouts.


A new keypose estimation method for dance figures of Halay has been introduced in this paper. The motion data have been captured by using Xsens Moven motion capture hardware. Extensive simulation results expose that the proposed method is succesful at the extraction of key-frames.


&NA; Moraxella corneal ulcers are uncommon but may be complicated by marked inflammation and corneal perforation. In a series of eight cases treated over a period of 6 years, despite appropriate antibiotic therapy, descemetoceles and/or perforations developed in four cases, resulting in loss of the eye in two cases. In our series, the final visual acuity was count fingers or less in most patients (six of eight; 75%). Ulcers not only occurred in patients with systemic diseases, including alcoholism and malnutrition, but also in patients with various pre‐existing ocular surface diseases. It is important to be aware of the potential of Moraxella ulcers to result in loss of vision and the eye.


Brushless DC motors (BLDCM) are widely used for industry control field. Steady speed control accuracy and speed control bandwidth are the key indexes in industrial application. In this paper, a phase-locked loop control system for BLDCM is proposed to achieve better dynamic performance and steady-state accuracy. A ten-state phase-frequency detector is designed to detect the speed error of the rotor. And an all digital PLL control system for BLDCM is realized with Verilog HDL. Finally, a control and drive circuit based on FPGA is implemented and applied to momentum flywheel to verify the feasibility of the proposed control system. Experimental results show that steady speed accuracy could be achieved better than 0.1%.


BACKGROUND
Hypothermia is a serious immediate consequence of traumatic injury in children. Although numerous studies have addressed the treatment of hypothermia in adults after trauma or surgery, few have examined this issue in injured children.

OBJECTIVES
To evaluate the research literature on when and how to treat hypothermia during emergency care of children with trauma and to apply these findings to clinical nursing practice.

METHODS
Electronic literature searches conducted periodically for 3 years yielded more than 50 publications on hypothermia and its treatment in trauma and surgical patients. Publications were grouped by cause of hypothermia and by warming methods. Single case reports and publications related to submersion injuries were excluded.

RESULTS
Three clinical trials of patients with head injuries included adolescents aged 15 years and older. One study compared peripheral and core warming methods used during operative management of infants and young children. Only one study evaluated core warming in children with trauma.

DISCUSSION
The treatments examined in the few research-based studies on the treatment of hypothermia during emergency care of children with trauma were given low recommendations. Although the warming methods were successful in selected surgical and adult patients, the methods cannot be recommended for treating children with trauma because of the lack of evidence-based findings.

CONCLUSIONS
Caution should be used when extrapolating published data on the treatment of hypothermia in injured adults to injured children. Ongoing clinical trials should evaluate in children with trauma those warming methods that have been used successfully in surgical patients.


In the present day, medicinal plants increasingly play important role in human health, while about 60-75% of world population depending on plants and their extracts for medication. Selaginella Pal. Beauv. (Selaginellaceae Reichb.) is a potent medicinal plant source. This plant contains biflavonoid compounds, a dimeric form of flavonoids. Flavonoids are secondary metabolite that is most used in medical purposes. They are often occurred in daily consumed vegetables and fruits. Chemical constituents of flavonoids are very diverse, because they are generated in many biosynthetic methods. There are many biflavonoid compounds of Selaginella, i.e. amentoflavone, 2',8''-biapigenin, ginkgetin, heveaflavone, hinokiflavone, isocryptomerine, kayaflavone, podocarpusflavone A, robustaflavone, sumaflavone, and taiwaniaflavone. For the plants, these biflavonoid are used to response environmental condition such as defense against pests, diseases, herbivory, and competitions; while for the people, these compounds are used as antioxidant, anti-inflammatory, anti cancer, antimicrobial (antivirus, antibacterial, anti fungal, antiprotozoan), neuroprotective, vasorelaxant, anti UV-irradiation, antispasmodic, anti allergic, antihaemorrhagic, antinociceptive, etc. The antioxidant purpose of biflavonoid is the most important activities of this secondary metabolite. It is related to the anti cancer and anti-inflammatory functions. The antioxidant of biflavonoid is more powerful than I²-carotene, vitamin C and E. In the future, Selaginella research exhaustively needs to be conducted on morphological and molecular characteristics. It deeply needs to explore on biflavonoid and other natural products constituents, and it also needs to search on their bioactivities.© 2008 Jurusan Biologi FMIPA UNS SurakartaKey words: flavonoid, biflavonoid, Selaginella.


Background: The purpose of this study was to utilize the Reasoned Action Approach (RAA) to evaluate the impact of COVID-19 on the physical activity (PA) behaviors of college student athletes, including aerobic, muscle strengthening, and sport-specific conditioning PA. Theory-based determinants of intentions to all three PA behaviors were assessed using multiple regression analyses.Results: Outcomes demonstrated that perceived norms, perceived behavioral control, and attitudes predicted a significant amount of the variance of intentions for muscle strengthening PA (44.8%) and a moderate amount for aerobic PA (28.5%) and conditioning PA (35.2%). Additionally, intentions, attitudes, perceived norms, and perceived behavioral control were compared between PA type using a repeated measures ANOVA, and results showed there were significant differences. Conclusion: These findings can assist public health practitioners, coaches, and trainers to develop and implement more effective interventions and training sessions for all types of PA with college athletes.


This article discusses the role of NGOs at the WTO and analyses the interface in order to ascertain the democratic potential of the former, particularly at ministerial conferences. In practice, interaction with the WTO is confined only to a handful of powerful and networked groups, with limited access for most southern NGOs. Further, participating NGOs overwhelmingly include business associations and interest groups, whereas grassroot organisations have little or no presence. NGOs in themselves are not democratising forces and there are important issues of autonomy, transparency and accountability that they need to address. At a more fundamental level, the WTO?s method of alleviating the democratic deficit largely by involving NGOs has severe limitations.


Selective classification is the task of rejecting inputs a model would predict incorrectly on through a trade-off between input space coverage and model accuracy. Current methods for selective classification impose constraints on either the model architecture or the loss function; this inhibits their usage in practice. In contrast to prior work, we show that state-of-the-art selective classification performance can be attained solely from studying the (discretized) training dynamics of a model. We propose a general framework that, for a given test input, monitors metrics capturing the disagreement with the final predicted label over intermediate models obtained during training; we then reject data points exhibiting too much disagreement at late stages in training. In particular, we instantiate a method that tracks when the label predicted during training stops disagreeing with the final predicted label. Our experimental evaluation shows that our method achieves state-of-the-art accuracy/coverage trade-offs on typical selective classification benchmarks.


This paper proposes a decentralized cognitive radio based multi-channel MAC protocol for dynamic access spectrum (DSA) networks. In our proposed MAC protocol, each secondary user is equipped with a cognitive radio-based transceiver and multiple channel sensors. With the help of the two-way handshakes of control packets, the proposed MAC protocol enables the secondary users to opportunistically utilize the unused frequency spectrum while avoiding the collisions among secondary users and those between secondary and primary users. Applying the M/GY /1 queuing theory, we develop a rigorous analytical model to analyze the performance of our proposed MAC protocol in terms of aggregate throughput and packet transmission delay. We validate our developed analytical model through extensive simulations.


The blood-brain barrier (BBB) to endogenous albumin was studied in the cerebral cortex and hippocampus of the senescence-accelerated prone (SAMP8) mouse and senescence-accelerated resistant (SAMR1) mouse strains in corresponding age groups by using a quantitative immunocytochemical procedure. Brain samples after immersion-fixation were embedded at low temperature in Lowicryl K4M and sectioned with an ultramicrotome. Thin sections were exposed to anti-mouse albumin antiserum followed by protein A-gold. Labeling density (gold particles per microns 2) was recorded over four compartments: vascular lumen, endothelium, subendothelial space, and brain parenchyma (neuropil). Morphometric analysis of the electron micrographs revealed that the barrier function of capillaries located in the cerebral cortex of SAMP8 mice was not significantly different from that in control (SAMR1) mice. Nevertheless, in SAMP8 mice, the percentage of leaking microvessels was higher than in control animals. In the older (11-month-old) group of control mice, the percentage of leaking microvessels was higher in the hippocampus than in the cerebral cortex. In SAMP8 mice, however, these differences were negligible. In contrast, in 4-month-old animals, the labeling density of the subendothelial space, which was considered an indicator of albumin escape, was significantly higher in SAMP8 than in SAMR1 mice. Also, the labeling density of the neuropil in the hippocampus of both groups of mice was significantly higher than that in the cerebral cortex. This finding suggests that albumin has an access to the parenchyma of the hippocampus in normal conditions, and that this phenomenon becomes more pronounced during the process of senescence.


We address here the problem of detection of targets obscured by foliage clutter using X-band portable continuous wave radar. The weak signal, backscattered from the target and the impulsiveness nature of the foliage clutter are the two problems which make the reliable detection not so easy task. The impulsive foliage clutter is more accurately modeled with the symmetric alpha stable distribution, compared to the most used distributions in the radar community. With this more accurate model and giving an account that the Doppler statistic can not be considered as simple stationary system, we investigate here the applicability of new multiresolutional approach recently proposed from Donoho and Yu (2000), namely a kind of pyramid transform based on median interpolation. We also derive computational effective approximation for the computation of the optimal thresholds for the last approach


Abstract To date, the overwhelming use of motion in computational vision has been to recover the three-dimensional structure of the scene. We propose that there are other, more powerful, uses for motion. Toward this end, we define dynamic perceptual organization as an extension of the traditional (static) perceptual organization approach. Just as static perceptual organization groups coherent features in an image, dynamic perceptual organization groups coherent motions through an image sequence. Using dynamic perceptual organization, we propose a new paradigm for motion understanding and show why it can be done independently of the recovery of scene structure and scene motion. The paradigm starts with a spatiotemporal cube of image data and organizes the paths of points so that interactions between the paths, and perceptual motions such as common , relative , and cyclic are made explicit. The results of this can then be used for high-level motion recognition tasks.


In a toxicological context, the cellular effects of a variety of molecular compounds interacting with membranes may be understood in terms of their ability to affect and modulate lipid-membrane physical properties and even slight changes in membrane fluidity may cause aberrant function and pathological processes. Different model systems (mice splenocytes and liposomes) have been used in modelling studies of the physical effects on lipid bilayers underlying the action of membrane active phenolic compounds, considered by EPA (Environmental Protection Agency) as priority pollutants (phenol; 2-chlorophenol; 2,4-dichlorophenol; 2,4,6-trichlorophenol; pentachlorophenol; 2-nitrophenol; 2,4-dinitrophenol; 2-methyl-4,6-dinitrophenol). Membrane fluidity was assessed by fluorescence steady-state anisotropy of a fluorescent probe 1,6-diphenil-1,3,5-hexatriene (DPH). The substituted phenols increased the fluidity of cells and liposome membranes in a concentration dependent manner and the nitro substituted phenols were the most efficient perturbing the biophysical properties of the membrane. A good parallelism has been established between the results obtained with cell models and artificial liposome model systems, implying that liposomes are useful alternative systems in membrane modification studies and can be conveniently used in order to evaluate the potential toxic effect of phenol derivatives that are common environmental pollutants.


The definition of the scattering cross section for the pressure field scattered by a rough interface uses the underlying assumption that the ensonified area does not affect its shape. This assumption holds so long as the incident field is a good approximation of a plane wave, which situation occurs when the ensonified area is large compared to a wavelength. In the opposite situation, when the ensonified dimensions approaches a wavelength, the incident plane wave assumption does not hold and the cross section can depart from modeled behavior. This research uses the perturbation approximation to derive a model for the low grazing-angle behavior of the scattering cross section. The primary results are (1) the appearance of an additive Lambertian term and (2) a separation of scales imposed by the acoustic resolution. This separation can then be used as a criterion for the application of the composite roughness model. Model results are checked against direct numerical solution of the governing integral equatio...


: The possible interaction between vecuronium and propofol or thiopentone has been investigated. Cumulative dose response curves for vecuronium and the pharmacodynamic variables measured were similar with both anaesthetic agents. Patients were intubated following the topical application of lignocaine to the larynx and before the administration of vecuronium. A greater degree of relaxation of the vocal cords was noted in patients anaesthetized with propofol.


Plio-Quaternary volcanic eruptions in southeast of Nehbandan are composed of basic rocks, overlying the Late Cretaceous flysch-type and younger alluvium deposits. Petrographically, these rocks are basalt, basaltic andesite and andesite. These lavas are characterized by porphyritic, microlitic-porphyry, trachytic and glomeropophyritic textures. They contain plagioclase, clinopyroxene (augite), olivine and amphibole (hornblende) phenocrysts and fine-grained plagioclase-clinopyroxene microlite in groundmass. Geochemically, these rocks are calc-alkaline and represented by 47.8 57 wt. %. SiO2 and about 17 wt. % Al2O3. In chondritenormalized REE diagram, these rocks show enrichment in LREEs and depletion in HREEs. In primitive-mantle normalized trace elements diagram, they are characterized by Nb (and P, Ti, Zr) negative anomalies and positive anomalies in Pb, K, Ba and Sr. These chemical characteristics of Nehbandan Plio-Quaternary lavas associated with high LILE/HFSE and LREE/HREE ratios are consistent with derivation from a subduction environment. Y/Zr ratio of these rocks is similar to that of continental arc lavas. Discrimination tectono-magmatic diagrams suggest an active continental margin for the formation of Nehbandan Plio-Quaternary lavas.


Introduction. Myocardial perfusion scintigraphy (MPS) with dipyridamole is an accepted method for assessment of ischaemic heart disease, in case of contraindication to exercise testing. However, very often we observe clinical symptoms and changes in ECG while monitoring patients during the study with pharmacologic stress with dipyridamole. The aim of this study was to investigate the safety of patients diagnosed with MPS with dipyridamole. Material and methods. Twenty-five patients with stable coronary artery disease participated in a 2-day protocol (0.56 mg/ kg dipyridamole i.v. and then rest) using Tc-MIBI imaging. Continuous clinical monitoring and 12-lead serial ECG has been used since the beginning of the MPS up to 20 minutes after the examination. High-sensitive cardiac troponin I (hscTnI) concentration was measured before, four hours and the next day after stress test. Primary endpoint included hscTnI concentration above 99 percentile of the upper reference limit in second or third measurement or new persistent ST-T segment changes. Secondary endpoints were: new persistent or transient ECG changes (ST-T segment elevation or depression or negative T waves, prolongation of QRS complex, PR interval or QTc), or any drug-related adverse event. Results. The concentrations of hscTnI were below 99 percentile of the upper limit among all the patients. Primary and secondary endpoint were observed in 6 (24%) and 23 (92%) patients, respectively. Transient ST-T segment elevation occurred in 4 (16%) patients, transient ST-T segment depression or negative T wave — in 7 (25%) patients, QRS complex prolongation — in 11 (44%) patients, PR interval prolongation — in 18 (75%) patients, QTc prolongation — in 22 (88%) patients, any clinical adverse event related to dipyridamole — in 16 (64%) patients. Following endpoints were correlated with positive MPS results: ST-T segment changes, RP interval prolongation, and with a history of chest pain: ST-T segment changes, QRS complex and QTc prolongation. Conclusions. MPS with dipyridamole stress is relatively safe, as hscTnI concentration remains within normal in prolonged observation after the examination. While there is a significant risk of minor clinical and electrocardiographic adverse events it is not related with a myocardial necrosis.


Computational methods and advanced numerical techniques have been extensively used in biomechanics and biomedical engineering which enables to promote computer aided surgical design and plan for enhancing therapeutic outcomes. Nowadays, numerous prosthetic devices are employed to replace damaged/lost tissues in human body to restore proper functionality. Such artificial structures are required to withstand various mechanical loading over a desired service duration without failure. Further, implantable prostheses need to play a role in engaging the surrounding tissue for osseo-integration and bone remodeling, thereby strengthening the entire system of prosthesis - tissues. These issues have drawn significant attention over the past two decades, where computational biomechanics has been seen extensive applications from fundamental science to clinical therapy. Nevertheless, one problem remains, which needs substantial studies, is structural optimization in biomedical engineering field. As a well-established engineering method, structural optimization has been mature through development of rigorous computational methods for general engineering problems. This paper aims to introduce its specific features and potential in biomedical fields through a series of typical design optimization case scenarios in dentistry [1,2], cardiology [3], orthopedics [4,5], tissue engineering [6] and biofabrication.


This work explains the strategies for better understanding of the difference between conventional solid oxide fuel cell (SOFC) and electrolyte-layer free fuel cell (EFFC). Based on the devices performance conditions, it can be explained how both of the technologies are working in the same way while the internal mechanisms could be different. Mainly, this work will show the structural differences between the two devices.


This paper describes a carrier-based multi-band UWB transceiver front-end in CMOS 90nm designed for full UWB band biomedical radar sensing and sensor node communications. The transceiver operates in band 3–10GHz. The transceiver consists of a transmitter and a receiver. The transmitter includes a pulse generator, a mixer, a VCO, and a driver amplifier. The receiver includes a filter bank, a ultra wideband LNAs, mixers, integrators, and decision-making circuits. The system was simulated using CMOS 90nm technology to verify functions for both the sensor communications and radar sensing. The overall power consumption is 62.75mW.


Competencies have been used for many years to align the values, behavior, knowledge, and skills of individuals with the goals of the organizations in which they are employed. The organization in which I am employed in the role as a technical instructor, previously did not have a curriculum in place to support a competency based model for the apprentices who are working in an aviation maintenance capacity. This action research paper outlines the redesigned curriculum, grafting reflective and social learning aspects; the result of is intended to affect positive change in the learning practices of both the individual and organization.


: In this paper, the influence of impact damage to the induction motors on the zero-sequence voltage and its spectrum is presented. The signals detecting the damages result from a detailed analysis of the formula describing this voltage component which is induced in the stator windings due to core magnetic saturation and the discrete dis-placement of windings. Its course is affected by the operation of both the stator and the rotor. Other fault detection methods, are known and widely applied by analysing the spectrum of stator currents. The presented method may be a complement to other methods because of the ease of measurements of the zero voltage for star connected motors. Additionally, for converter fed motors the zero sequence voltage eliminates higher time harmonics displaced by 120 degrees. The results of the method application are presented through measurements and explained by the use of a mathematical model of the slip-ring induction motor.


We explore the effect of neutron lifetime and its uncertainty on standard big bang nucleosynthesis (BBN). BBN describes the cosmic production of the light nuclides, 1H, D, 3H+3He, 4He, and 7Li+7Be, in the first minutes of cosmic time. The neutron mean life τn has two roles in modern BBN calculations: (1) it normalizes the matrix element for weak n↔p interconversions, and (2) it sets the rate of free neutron decay after the weak interactions freeze-out. We review the history of the interplay between τn measurements and BBN, and present a study of the sensitivity of the light element abundances to the modern neutron lifetime measurements. We find that τn uncertainties dominate the predicted 4He error budget, but these theory errors remain smaller than the uncertainties in 4He observations, even with the dispersion in recent neutron lifetime measurements. For the other light element predictions, τn contributes negligibly to their error budget. Turning the problem around, we combine present BBN and cosmic microwave background (CMB) determinations of the cosmic baryon density to predict a "cosmologically preferred" mean life of τn(BBN+CMB)=870±16s, which is consistent with experimental mean life determinations. We show that if future astronomical and cosmological helium observations can reach an uncertainty of σobs(Yp)=0.001 in the 4He mass fraction Yp, this could begin to discriminate between the mean life determinations.


An InGaP/GaAs two-stage HBT linear power amplifier MMIC for the 5GHz Wireless-LAN Application was developed. By using a novel linearizer and a small-size via-hole technology, the power amplifier showed high output power (19dBm) with high power-added-efficiency (PAE : 18.5%), sufficient gain (21.0dB) and high linearity (4.78% error vector magnitude : EVM) at supply voltage 3.3V. It is the highest PAE in the power amplifier MMIC for the 5GHz Wireless-LAN application ever reported.


We present a microscopic model for Na clusters embedded in raregas matrices. The valence electrons of the Na cluster are described by time‐dependent density‐functional theory at the level of the local‐density approximation (LDA). Particular attention is paid to the semi‐classical picture in terms of Vlasov‐LDA. The Na+ ions and Ar atoms are handled as classical particles whereby the Ar atoms carry two degrees of freedom, position and dipole polarization. The interaction between Na+ ions and electrons is mediated through local pseudo‐potentials. The coupling to the Ar atoms is described by (long‐range) polarization potentials and (short‐range) repulsive cores. The ingredients are taken from elsewhere developed standards. A final fine‐tuning is performed using the NaAr molecule as benchmark. The model is then applied to embedded systems Na8ArN. By close comparison with quantum‐mechanical results, we explore the capability of the Vlasov‐LDA to describe such embedded clusters. We show that one can obtain a reasonable description by appropriate adjustments in the fine‐tuning phase of the model.


The research aims to define the role of strategic Renewal in promoting organizational Innovation among a selected sample of employees of the General Company for the manufacture of medicines and medical supplies in Samarra, The research problem revolves around the difficulty of the success of the competitive scene due to the rapid developments in the contemporary business environment. A hypothetical scheme has been adopted through which the research objectives and hypotheses were defined and the descriptive and analytical method was used in order to reach the results. The questionnaire was one of the statistical methods used to collect data and information related to the field aspect of the research, The views of (25%) of the employees of the mentioned company were explored, and the research came out with a set of conclusions and recommendations, one of the most important of which was the more the company directed the research sample to adopt the strategic renewal whenever it contributed to enhancing the company's capabilities to provide better products to its customers.


Objective: To explore and analyze the expression of eukaryotic translation elongation factor 1 alpha 2 (eEF1A2) gene in cervical cancer tissues, its relationship with patient survival, gene mutations, and changes in copy number in cervical cancer and chronic cervicitis tissues. Methods: The expression of the eEF1A2 gene in cervical cancer and its relationship with patient survival were analyzed using gene expression profile interactive analysis. Changes in eEF1A2 expression in cervical cancer tissues were analyzed using cBioPortal, a portal for cancer genomics analysis. The eEF1A2 copy number in cervical cancer tissues and chronic cervicitis tissues was determined by real-time fluorescence quantitative polymerase chain reaction. The relationship between the expression of eEF1A2 protein and the clinical stage, pathological grade, and patient survival of cervical cancer was analyzed by the database: The Human Protein Atlas, an integrated repository portal for tumor-immune system interactions. Results: Gene expression profile interactive analysis database analysis showed no significant differences in the expression of eEF1A2 between cervical cancer and normal cervical tissues (P > .05). The eEF1A2 gene expression level was not correlated with the survival of cervical cancer patients (P > .05). Analysis of the cBioPortal database showed that 18 of 297 cervical cancer patients had eEF1A2 gene changes, including missense mutation, splice mutation, amplification, and messenger RNA increase. There was no significant difference in eEF1A2 gene copy number between cervical cancer and chronic cervicitis (P > .05). The Human Protein Atlas and an integrated repository portal for tumor-immune system interactions database analysis of immunohistochemical data showed that eEF1A2 protein expression was no significant difference in clinical stage, pathological grade and patient survival of cervical cancer (P > .05). Conclusion: The eEF1A2 gene was mutated in cervical cancer tissues. The eEF1A2 gene copy number was not associated with changes in the expression of the eEF1A2 gene in cervical cancer tissues.


STUDY OBJECTIVES
Heart rate increases after obstructive events in patients with obstructive sleep apnea (OSA). This response is generally attributed to arousal from sleep. Opening of the obstructed airway, however, is associated with ventilatory and hemodynamic changes that could result in physiologic responses unrelated to arousal. Our objective was to determine the contribution of these physiologic responses to postevent tachycardia.

DESIGN
Analysis of data obtained during previous research protocols.

SETTING
Academic sleep laboratory.

PARTICIPANTS
Twenty patients with severe OSA.

INTERVENTIONS
Patients were placed on a continuous positive airway pressure (CPAP) device. CPAP was reduced during sleep to different levels (dial-downs), producing obstructive events of varying severity. Some dial-downs with severe obstruction were maintained until spontaneous airway opening. In others, CPAP was increased after three obstructed breaths, terminating the events approximately 10 sec before spontaneous termination in long dial-downs.

MEASUREMENT AND RESULTS
Beat-by-beat heart rate (HR) was measured for 20 sec following airway opening. Spontaneous opening during sustained dial-downs occurred 21.9 ± 8.4 sec after dial-down, was associated with arousal, and resulted in the greatest postevent tachycardia (7.8 ± 4.0 min(-1)). However, deliberate termination of events (12.2 ± 2.6 sec after dial-down) was also followed by tachycardia that, in the absence of cortical arousal, showed a dose-response behavior, increasing with severity of obstruction and without apparent threshold. ΔHR following deliberately brief, severe obstruction (3.8 ± 3.0 min(-1)) was approximately half the ΔHR that followed spontaneous opening of equally severe obstructions despite the shorter duration and absence of cortical arousal.

CONCLUSIONS
Postevent tachycardia is due in large part to physiologic (arousal-unrelated) responses that occur upon relief of obstruction.


Brood size in the Great Tit (Parus major) was manipulated (increased, decreased, or unchanged) when nestlings were 5 days old. Both the frequency of second clutches and the interbrood interval were affected. The number of nestlings and hatching date, but not nestling and female mass, differed between first broods followed and not followed by second clutches. Hatching date and the number of nestlings in the first brood explained most of the variation in interbrood interval, whereas female mass did not contribute. Feeding first-brood nestlings and fledglings is an energy-demanding process, and the female may have to allocate resources to brood-feeding at the expense of reproductive de- velopment. Furthermore, a larger brood requires a longer period of feeding than a smaller brood. These circumstances probably explain why the size of the first brood affects the timing of the second clutch. Female condition and food depletion of the territory do not seem to be important. Because late second clutches have a lower probability of fledgling survival than do earlier ones-and consequently are of lower value from the female's standpoint-a large first clutch may delay laying to the point that a second clutch is not worthwhile. We conclude that a female's decision whether to lay a second clutch is a strategic one based on the value of the second clutch; a female that "decides" to lay a second clutch starts as quickly as possible. (Less)


Abundant anthaspidellid orchoclad lithistids occur in thin biostromes of Wenlockian age of the Canadian Arctic. The sponges are well preserved, and many have similar internal architecture. Synonymization of Calycocoelia Bassler, 1927, Rhopalocoelia Raymond and Okulitch, 1940, Somersetella Rigby and Dixon, 1979, and Steliella Hinde, 1889 under the genus Archaeoscyphia Hinde, 1889 is necessary in light of continuous morphological variation of the more than 100 specimens in the study collection. Synonymization takes into consideration various features formerly used to define the five taxa, including parietal width, canal diameter, annulation, presence of monaxons in trabs, dermalia, position of the trab-pinnation surface, spicule dimension, and canal disposition. Several features previously thought to be distinctive generically are shown to be species significant or to be a result of variation within a single species or specimen.


The 6m class high speed boat is developed with a durable hull and inflatable tube, which is called RIB(Rigid Inflatable Boat), for the purpose of marine leisure. In the stage of the conceptual design, its requirements to be optimized are determined based on the presented information of similar marine leisure RIBs. The 3-D graphical technique using Marine Rhino is utilized to optimize the compartment layout of RIB. The stability analysis is performed for the light and full load conditions with and without the inflatable tube. In addition, the sea keeping and hydrodynamic performance was tested using the proto-type ship in the sea condition. From the results of the computation and the sea trial test, it shows that the performance of the marine leisure RIB satisfies the speed, the convenience, and the stability requirements. This study provides the typical information of the design factors and the procedure to manufacture the marine leisure RIB.


ABSTRACT Despite advancements in diagnosing and treating invasive pulmonary aspergillosis (IPA), there is limited knowledge of real-world treatment pathways and medication switches. We queried the TrinetX global research network database and identified 5,410 patients diagnosed with IPA. The most common initial treatments were voriconazole (49%), fluconazole (11%), and posaconazole (7%). Most patients remained on voriconazole (80%) or isavuconazole (78%) throughout the treatment duration. Switches were more frequent for those initially treated with fluconazole, echinocandins, or posaconazole.


Growth in facilities management (FM) and project management (PM) have been remarkable over the last decade. Simultaneously, the adoption of sustainability principles among organisations has also increased. The purpose of this study was to determine the connection between sustainability in PM and FM. Specifically, this research study aimed at understanding the common principles involved in both PM and FM that allowed sustainable development goals (SDGs) to be achieved by the United Nations in 2015 and to be an integral part of the European Green Deal in 2019. A systematic literature review of more than 200 different resource materials was performed, 55 of which were finally selected as falling under the scope of the study. The chosen literature was published between 2001 and 2020, except for the Brundtland Commission Report, which was published in 1987. Based on the collected material, a simplified facility lifecycle model was produced to illustrate the connection between sustainability in FM and PM. Developing this model will help practitioners and researchers incorporate PM as a function of FM, including the application of sustainable activities in different phases of a facility's lifecycle.


Neurofibromatosis type 1 (NF-1) is a significant autosomal dominant disorder with a wide spectrum of clinical findings. These signs (Café au lait spots, bone dysplasia, Lisch nodules) usually start to emerge after the first months of life and most are benign in nature. On the other hand, neoplasms (optic glioma, neurofibroma, malignant peripheral nerve sheath tumor, soft tissue sarcoma, leukemia, breast cancer) are a major cause of morbidity and mortality in NF-1 patients. Cancer risk during the lifetime of an NF-1 patient is almost 10 times more than a person without NF-1, but what drives these patients into cancer is still unknown.
This study aims to analyze the possible association of clinical findings with malignancies in children with NF-1.
Medical records of 55 children with NF-1 who were followed up in a tertiary care pediatric oncology clinic between January 2005 and December 2014 were analyzed. We assessed clinical and demographic characteristics of patients, as well as the NF-1 diagnostic criteria, NF-1 related complications, and malignancies. The NF-1 patients without malignancy were classified in Group 1 while patients with malignancy were in Group 2. Logistic regression analysis was used to determine the risk factors of malignancy in NF-1.
The mean age was 7.68 ± 4.65 years. Female sex was dominant in both groups. Café au lait spots were present in all patients. Axillary-inguinal freckling was observed in 76.4% of patients, followed by neurofibromas in 30.9%, Lisch nodules in 29.1%, bone dysplasia in 14.5%, optic gliomas in 23.6%, and a history of first degree relative with NF-1 in 63.6%. Central nervous system (CNS) tumors were present in 40%. Tumors other than CNS tumors were acute myeloid leukemia and schwannoma. None of the diagnostic criteria was a risk factor for predisposing to malignancy by itself. Having >3 criteria was found to be the risk factor for malignancy in NF-1 (OR:5.891, CI 95%: 1.676-20.705, p=0.006).
There are no clearly defined risk factors predicting occurance of malignancies in NF-1 at present. However, we found a higher risk of malignancy association in patients who meet more than 3 diagnostic criteria of NF-1.


Background. Pregnancy is associated with adaptive alterations affecting almost all organs and systems of the female body and is also a time when pathologies appear which would otherwise remain asymptomatic for many years. 1H Magnetic Resonance Spectroscopy (1H-MRS) of urine, a modern diagnostic method, can disclose discrete changes in organ function. It seemed interesting to search for pregnancy-dependent renal pathology in healthy women and thus prognosticate progression to overt disease after pregnancy. Objectives. To determine whether physiological pregnancy is accompanied by alterations in renal structures detectable by 1H-MRS of urine and to assess the type and reversibility of alterations. Material and Methods. Eighty women were enrolled in two groups: a study group (B) consisting of 40 healthy pregnant women and a control group (K) of 40 healthy nulligravida women. Enrollment criteria included normal health status, unrevealing physical and gynecological examination, and normal results of laboratory tests (complete blood count, urea, creatinine, uric acid, urinalysis). MRS of urine and laboratory tests were done in group B during each trimester (B1, B2, and B3, i.e. the 1st, 2nd, and 3rd trimesters, respectively) and six weeks after delivery (BP). In group K, the tests were done only once. The spectra were processed with MestReC software and then multidimensional statistical analysis using Unscrambler software was performed. The results were presented as the distribution of the variables in multidimensional space. Results. The patterns in multidimensional space revealed a clustering of points when comparing the first and third trimesters of pregnancy and comparing the third trimester and the healthy non-pregnant women. Also, a partial clustering of points comparing healthy non-pregnant and pregnant women after the puerperium was noticeable. Conclusions. Differences in 1H-MRS profiles of urine between healthy pregnant and non-pregnant women reflect alterations of specific structures of the kidney accompanying pregnancy. In the majority of patients the effect of pregnancy on renal tubules is transient and (presumably) does not lead to permanent lesions (Adv Clin Exp Med 2010, 19, 2, 177–183).


Physics informed neural networks (PINNs) are deep learning based techniques for solving partial differential equations (PDEs). Guided by data and physical laws, PINNs find a neural network that approximates the solution to a system of PDEs. Such a neural network is obtained by minimizing a loss function in which any prior knowledge of PDEs and data are encoded. Despite its remarkable empirical success, there is little theoretical justification for PINNs. In this paper, we establish a mathematical foundation of the PINNs methodology. As the number of data grows, PINNs generate a sequence of minimizers which correspond to a sequence of neural networks. We want to answer the question: Does the sequence of minimizers converge to the solution to the PDE? This question is also related to the generalization of PINNs. We consider two classes of PDEs: elliptic and parabolic. By adapting the Schuader approach, we show that the sequence of minimizers strongly converges to the PDE solution in $L^2$. Furthermore, we show that if each minimizer satisfies the initial/boundary conditions, the convergence mode can be improved to $H^1$. Computational examples are provided to illustrate our theoretical findings. To the best of our knowledge, this is the first theoretical work that shows the consistency of the PINNs methodology.


Group-theoretical methods used in quantum chemistry have been reviewed. The method for constructing the basis functions of the irreducible representations of finite groups by means of projection operators has been examined in detail. Particular attention has been paid to the use of the theory of permutation groups for constructing the eigenfunctions of the operator of the square of the total spin S2 and obtaining closed equations for the matrix elements of the Hamiltonian in a state having a definite value of S. A method has been described for finding the allowed molecular states and the orders of the secular equations obtained in variation quantum-chemical calculations. The use of the mathematical apparatus of continuous groups in quantum-chemical calculations has been discussed. The bibliography contains 60 references.


257 Acute leukemia, especially for the acute monocytic leukemia, were frequently accompanied by extramedullary infiltrations. MMPs and TIMPs are thought to be involved in the infiltration and invasion in solid tumors. Our laboratory had established a SCI- nu/nu mice model of extramedullary infilatration by using a human monocytic leukemic cell line SHI-1. In the present study we aimed to investigate the functions of TIMP-2 on the growth and infiltration of SHI-1 cells in SCI- nu/nu mice. Retroviral vector MSCV carrying human TIMP-2 cDNA was constructed and transfected into SHI-1 cells. The expression of TIMP-2 was detected by real-time PCR, western-blotting and FCM. SHI-1 cells proliferation was examined by MTT and the invasive capability was detected by trans-matrigel invasion assay using transwell chambers. The trasfected SHI-1 cells were IV injected into nu/nu mice pretreated by splenectomy, cytoxan intraperitoneal injection, and sublethal irradiation (referred to as SCI- nu/nu mice). Mice were sacrified within 30 days after IV challenged with SHI-1 cells. All tissues from variety of organs were properly sectioned and stained. CNSL were graded based on the degree of leukemia cell infiltration into the brain. A 2.975 times higher of TIMP-2 mRNA in SHI-1/TIMP-2 cells than in SHI-1/MSCV cells was found. TIMP-2 expressed on the SHI-1/TIMP-2 cells (99.3%±0.1%) were significantly higher than that on SHI-1/MSCV cells (85.9%±2.6%), with an 2.06 times increase in fluorescent intensity. In company with a faster proliferation rate, SHI-1/TIMP-2 cells demonstrated significantly stronger ability of trans-matrigel invasion. The median survival time of SCI- nu/nu mice with SHI-1/TIMP-2 were 33.7 days (30-40days), significantly shorter than 40 days (36-44days) in those with SHI-1/MSCV. The SCI- nu/nu mice inoculated with SHI-1/TIMP-2 cells demonstrated more remarkable features of leukemic infiltration than those inoculated with SHI-1/MSCV cells, evidenced by both gross anatomical and histopathological observations. More serious central nervous system infiltration (higher percentage in higher degrees ) were also found in the brain of the SCI- nu/nu mice injected with SHI-1/TIMP-2 cells. By contrary to the notion that TIMP-2 inhibits the infiltration in solid tumor, our results that SHI-1/TIMP-2 cells overexpressing TIMP-2 enhance proliferation and infiltration of leukemia cells in SCI- nu/nu mice, may be attributed to the activation of proMMP by TIMP-2 through the formation of more MT1-MMP-TIMP-2-proMMP-2 complexes on the cell membrane, and resulting in the higher invasion of SHI-1/TIMP-2 cells in the SCI- nu/nu mice. These results suggest that higher expression TIMP-2 in leukemia may promote instead of inhibit the leukemic extramedullary infiltration.


Aim: To determine and compare differences in the results following arthroscopic anterior cruciate ligament reconstruction using patellar-tendon-bone (PTB) auto-grafts and hamstrings tendon auto-grafts. Study design: Randomized controlled trial. Place and duration: Department of Orthopedic Surgery, Shaikh Zayed Hospital Lahore from July 2019 to July 2021. Methodology: This prospective study included 72 of total patients with clinical diagnosis of having anterior cruciate ligament (ACL) tear who did not have activities like a healthy person and wished to maintain a level of activity as it was before injury. Institutional ethical committee granted approval and a written informed consent was taken. Two groups of study population (patellar tendon and hamstring tendon) were formed. Lottery method was used for randomization of patients. Arthroscopic ACL reconstruction was done according to their respective groups. Patients of patellar tendon group (n=36) and hamstring tendon group (n=36) were under examination for 4 to 5 days and to grant 0 to 900 movement, knee brace was locked. Patients were questioned about their activities on follow up visits. Results: No significant difference amongst patients of two groups was noted.14 patients (38.9%) with PTB graft were unable to kneel on their knee as compared to 12 patients (33%) with hamstrings graft. Patients with BTB graft had similar difficulty in bending their knee as compared to the patients of the other group. Conclusion: Patients from PTB graft group showed comparable results as compared to the hamstrings group in terms of strenuous activity, highest level of activity, rising from a chair and kneeling and squatting on functional outcomes. Keywords: Anterior Cruciate Ligament, Patellar Auto-graft, Hamstring Auto-graft, Bone Graft


Abstract Objective: To investigate whether delivery of a small for gestational age (SGA) neonate poses a risk for subsequent long-term maternal renal disease. Study design: A population-based study was conducted. Comparison was performed regarding the incidence of long-term renal morbidity in a cohort of women with and without a previous delivery of a SGA neonate. Deliveries occurred during a 25-year period, with a mean follow-up duration of 11.2 years. Renal morbidity included kidney transplantation, chronic renal failure and hypertensive renal disease. Cox proportional hazards model was used to estimate the adjusted hazards ratio (HR) for renal-related hospitalizations and mortality. Results: Out of 99 342 deliveries that met the inclusion criteria, 10 701 (10.7%) occurred in patients who had at least one previous delivery of a SGA neonate. During the follow-up period, patients with a delivery of an SGA neonate had higher rates of renal-related hospitalizations (0.2% versus 0.1%; OR = 1.6, 95% CI 1.01–2.5; p = 0.04). In a Cox proportional hazards model, adjusted for confounders, previous delivery of a SGA neonate was independently associated with subsequent maternal renal-related hospitalizations (adjusted HR, 1.7; 95% CI 1.1–2.8). Conclusion: Delivery of a SGA neonate is an independent risk factor for long-term maternal renal disease.


Introduction: The SCALP block is an important regional anesthesia method. In this study, we analyzed the SCALP block model for the first time in a rat model. Materials and Methods: In this study, 16 rats were divided into four different groups. Six nerve blocks were planned in both halves of the skull for the SCALP block, and three entry points were determined for each. Bupivacaine (Marcaine, AstraZeneca) 0.5 mg/kg was injected in the "low-dose" group, 1 mg/kg in the "medium-dose" group, 2 mg/kg in the "high-dose" group, and 4 mg/kg in the "very high-dose" group. A midline fronto-occipital incision was made, and a craniectomy was performed. At 0, 30, 60, 90, and 120 minutes after the surgical procedure, the rats were evaluated using the Rat Grimace Scale, and their pain scores were evaluated. At the end of 2 hours, the rats were sacrificed, blood samples were taken, and methemoglobin levels were studied. Finally, a comparative analysis was performed between the four groups. Results: In 30, 60, 90, and 120 minutes after surgery, the differences between the grimace scores between low-dose and medium-dose and high-dose and low-dose groups were statistically significant (p<0.001). There was no significant difference between the high-dose and very high-dose groups regarding the grimace scale (p>0.05). Methemoglobin levels were statistically significantly higher after SCALP block with a very high dose of bupivacaine than blockade with a high dose of bupivacaine (p<0.001). Therefore, very high-dose bupivacaine injection was not superior to high-dose bupivacaine injection in pain control. In addition, very high doses of bupivacaine injection can be associated with increased morbidity and mortality due to increased methemoglobin levels. Conclusion: In this SCALP block technique described in rats, a 2 mg/kg bupivacaine injection can be considered an appropriate dosage for both safety and efficacy.


Increasingly stringent environmental regulations in different sectors of industry, especially the aeronautical sector, suggest the need for more investigations regarding the effect of environmentally friendly corrosion protective processes. Passivation is a finishing process that makes stainless steels more rust resistant, removing free iron from the steel surface resulting from machining operations. This results in the formation of a protective oxide layer that is less likely to react with the environment and cause corrosion. The most commonly used passivating agent is nitric acid. However, it is know that high levels of toxicity can be generated by using this agent. In this work, a study has been carried out into the electrochemical behavior of 15-5PH (precipitation hardening) and 17-4PH stainless steels passivated with (a) citric and (b) nitric acid solutions for 60 and 90 min at 49 °C, and subsequently exposed to an environment with chlorides. Two electrochemical techniques were used: electrochemical noise (EN) and potentiodynamic polarization curves (PPC) according to ASTM G199-09 and ASTM G5-13, respectively. The results obtained indicated that, for both types of steel, the passive layer formed in citric acid as passivating solution had very similar characteristics to that formed with nitric acid. Furthermore, after exposure to the chloride-containing solution and according with the localization index (LI) values obtained, the stainless steels passivated in citric acid showed a mixed type of corrosion, whereas the steels passivated in nitric acid showed localized corrosion. Overall, the results of the Rn values derived show very low and similar corrosion rates for the stainless steels passivated with both citric and nitric acid solutions.


This article describes the impact on physicians of recent developments in PRO review and provides practical guidance for physicians in dealing with those developments.


The medical professionalism for faculty members of medical schools has some different implication from other medical professions. They have to work as educator, researcher, and manager as well as clinician. The professionalism of each duties has its own uniqueness, which sometimes causes a conflict between them. Therefore, the faculty members of medical schools have to harmonize their different tasks and duties each other, looking after the professional development through the professional life.


Abstract. Alang H, Kusnadi J, Ardyati T, Suharjono. 2020. Optimization and characterization of enterocin Enterococcus faecalis K2B1 isolated from Toraja's Belang Buffalo Milk, South Sulawesi, Indonesia. Biodiversitas 21: 1236-1242. The growing bacterial resistance needs to be controlled with effective antimicrobials. Bacteriocins are proteinaceous toxins produced by bacteria to inhibit the growth of pathogens. Bacteriocin industry has substantially grown, replacing the role of chemical preservatives in enhancing shelf-life and food safety. Bacteriocin produced by genera Enterococcus can be used as an antimicrobial against pathogen. In this study, we used Enterococcus faecalis K2B1 which was first isolated from Toraja's Belang Buffalo Milk Makassar, Indonesia. The study aimed to optimization and characterization of Enterocinroduced by Enterococcus faecalis K2B1, isolated from Toraja's Belang buffalo milk. Research Method: including optimization and characterization of antimicrobial metabolite (BLIS) using MRS broth with different initial pH (pH 6, 7 and 8), and partial purification with ammonium sulfate on different concentration (40, 60 and 80 %). Result showed that BLIS production was most optimal on MRS broth at initial pH of 8 after13th hour fermentation, at late exponential phase. BLIS characterization visibly active at high temperatures and very wide range of pH, and disappeared after treating with proteinase-K. Crude had a broad spectrum, was sensitive to Proteinase-K and estimated to have molecular weight of 5 kDa.


Investor-State arbitration (ISA) consists of numerous individual ad hoc Tribunals as a mechanism to settle disputes between an investor and a State arising out of an investment, however, the aggregate effect of individual tribunals presents certain systematic structure of governance of which the awards have policy implications beyond the very individual disputes to both stakeholder in host states and other ISA tribunals per se. Philip Morris v. Uruguay offers us a chance to conceptualize ISA as a governance mechanism. Philip Morris v. Uruguay involves public health measures of tobacco control which is of broad implications to multilevel stakeholder, including foreign investor, industrial competitors, public authority in host state, and public interests in host state as a whole. Uruguay has made prerequisite domestic litigation procedure for investment treaty claims which constitutes an interface of interaction of two governance mechanisms. Detailed analysis of Jurisdiction decision of Philip Morris v. Uruguay reveals the flexible self-enforcement approach to jurisdiction, including confirmation of broad treaty terms, e.g. investment, disputes, and satisfactions of prerequisite jurisdiction conditions, which could be characterized as reflections of ISA as governance mechanism. ISA awards have the policy externality of which the implications go beyond disputants in individual disputes to stakeholders in host state because foreign disputes always involve public interest per se as well as through individual case reasoning and awarding, tribunals review states' measures, either regulatory or commercial, and by interpretation of treaty obligations and general international law, set standards for states in their internal administrative process. Policy externality of individual awards is only the initial step of institutionalization of ISA as governance which is ultimately fulfilled through the conscious or unconscious self-enforcement of ISA as a system by individual arbitrators. With direct rights of foreign investors to sue state in international arbitration and abstract but similar IIA terms, considerable discretions are vested to ISA arbitrators. The large number but homogenous arbitrators interact with each other, gradually establishing certain shared understanding concerning the interpretation method, the content of core concepts in IIAs. With the long term and large scale evolvement, ISA finally becomes an institution which de facto and should exercise public authority over public policy issues in domestic level, rather than an simple ad hoc dispute settlement tribunal, which could escape from individual states' treaty design and acquire certain institutional ability of self-maintenance. ISA achieve public policy function through two approaches - substitution effect and review effect - in dealing three kinds of disputes, namely contract disputes, regulatory disputes and administrative disputes (if not overall overlapped with regulator disputes). During the institionalization process, critics follow. Justifications and safeguard measures to ISA as governance mechanism are of great urgency and significance which call for further research.


We studied the kinase activity of partially purified insulin receptor preparations from various rat and human tissues. Time courses for in vitro autophosphorylation were determined, and times to reach half-maximal (t1/2 max) and maximal (tmax) 32P incorporation were compared. Insulin receptors from rat muscle, liver, and fat had a t1/2 max of 7-10 min and a tmax of 60 min; human-derived insulin receptors had a t1/2 max in excess of 30 min and a tmax of 120 min. A spectrum of autophosphorylation time courses was present in human tissues; placenta-derived receptors exhibited a t1/2 max of 13 min while receptors from monocytes and fibroblasts had t1/2 max values of 60 and 80 min, respectively. The ATP Km for autophosphorylation of human-derived receptors was 5-fold greater than that of rat-derived receptors (266 +/- 27 vs. 48 +/- 8 microM, respectively). In contrast, when the receptors were first maximally prephosphorylated, the ATP Km values for substrate phosphorylation of human- and rat-derived receptors were equivalent (12.5 and 11.4 microM). Kact values for Mn were comparable in both human- and rat-derived adipocyte receptors. In addition to the functional differences between species, the apparent mol wt of the beta-subunit of rat-derived receptors (96,000) was consistently greater than that of human-derived receptor beta-subunits (93,000). In contrast to these in vitro findings, the ability of insulin to stimulate receptor kinase activity in isolated adipocytes was rapid, with a maximal effect by seconds. This was comparable for both rat and human tissues, suggesting that the in vitro autophosphorylation differences may not govern kinase activity in vivo.


Introduction: A comparative study of family members of persons working in lead based industries and non-lead based industries were undertaken to evaluate the effect of lead on family members of lead based industrial workers and its effect on their liver function tests. As lead can be brought home though the shoes and dresses of lead based industrial workers, this study was done to evaluate the extent of lead exposure and its ill effects on liver functions on their family members as there were very few studies available to show the ill effects of lead on family members of lead based industrial workers.
Materials and Methods: Subjects were classified as.
Group-A: Controls- individuals who were working in non-lead based industries.
Group B: Adult Family members of individuals who were working in lead based industries.
Biomarkers of lead exposure estimated were BLL, ?-ALAD, Hb and ZPP.
Liver function tests conducted were- estimation of serum enzymes like AST, ALT, ALP, GGT, serum bilirubin, serum total proteins and A/G ratio.
Results: The study showed statistically significant increase in BLL (p Conclusions: This study shows that lead brought home through the shoes and dresses of lead based industrial workers affects their family members. This could be prevented by taking simple precautionary measures such as changing clothes and taking shower before reaching home.

Keywords: Occupational lead, Family members, Liver function tests, Preventive measures.


Abstract : The discipline of software process management has grown remarkably since the Software Engineering Institute (SEI) introduced the concept in 1985. Since then, our work in software development process has spurred the growth of a worldwide market, connecting researchers, tool developers, consultants, educators, and software professionals. Today, de facto and de jure standards continue to emerge, signaling a maturing of the field. Yet, new opportunities and new challenges are already before us, extending the discipline of process management into exciting new areas. From software-intensive systems to the software-dependent enterprise, from health care to agriculture, and from technology acquirers to service providers, the SEI has seen growing demand to bring the benefits of process management to a diversity of software-critical domains. To prepare for the road ahead, the SEI undertook a collaborative effort with other leaders in the process community to explore process needs for today, the foreseeable future, and the unforeseeable future. In August of 2004, the SEI launched the International Process Research Consortium (IPRC) as the primary forum for accomplishing this task. Through a series of six workshops of intensive discussion, debate, imagination, and expertise, the 28 members of the IPRC, along with the support of several notable and objective reviewers, developed this Process Research Framework. It is a thematic guide to critical process research. It is wide-ranging and far-reaching. And while the primary audience is the membership of the IPRC and the organizations and constituents they represent, it is our sincere hope that it will also prove valuable to those with the drive, the influence, and the vision to turn research into solutions.


The incorporation of transition metals into hematite may limit the aqueous concentration and bioavailabity of several important nutrients and toxic heavy metals. Before predicting how hematite controls metal-cation solubility, we must understand the mechanisms by which metal cations are incorporated into hematite. Thus, we have studied the mechanism for Ni2+ and Mn3+ uptake into hematite using extended X-ray absorption fine structures (EXAFS) spectroscopy. EXAFS measurements show that the coordination environment of Ni2+ in hematite corresponds to that resulting from Ni2+ replacing Fe3+. No evidence for NiO or Ni(OH)2 was found. The infrared spectrum of Ni-substituted hematite shows an OH-stretch band at 3168 cirr−1 and Fe-OH bending modes at 892 and 796 cm−1. These vibrational bands are similar to those found in goethite. The results suggest that the substitution of Ni2+ for Fe3+ is coupled with the protonation of one of the hematite oxygen atoms to maintain charge balance.The solubility of Mn3+ in hematite is much less extensive than that of Ni2+ because of the strong Jahn-Teller distortion of Mn3+ in six-fold coordination. Structural evidence of Mn3+ substituting for Fe3+ in hematite was found for a composition of 3.3 mole % Mn2O3. However a sample with nominally 6.6 mole % Mn2O3 was found to consist of two phases: hematite and ramsdellite (MnO2). The results indicate that for cations, such as Mn3+ showing a strong Jahn-Teller effect, there is limited substitution in hematite.


Galectin-3, a β-galactoside-binding lectin, exhibits pleiotropic biological functions and has a role as one of the immunological modulators. However, the associations between circulating galectin-3 and immunological, inflammatory and nutritional parameters have not yet been fully elucidated. The serum concentration of galectin-3 was examined in association with interleukin-10 (IL-10), IL-12 and IL17 production, lymphocyte stimulation, neutrophil/lymphocyte ratio (NLR), white blood cell count (WBC), C-reactive protein (CRP) and rapid turnover proteins, including retinol-binding protein (RBP), prealbumin (PA) and transferrin (TF) in 50 patients with untreated colorectal cancers. Significant increases (P<0.05) were observed in the serum galectin-3 levels in patients with untreated colorectal cancer (9.6±4.5 ng/ml) compared with the normal controls (3.2±1.6 ng/ml). Higher serum galectin-3 concentrations were observed in patients with colon cancer (11.5±4.4 ng/ml) compared to in patients with rectal cancer (8.0±4.0 ng/ml) (P=0.005). The levels of circulating galectin-3 inversely correlated with the production of IL-10 (r=-0.59, P<0.001), and IL-12 (r=-0.69, P<0.001). Galectin-3 concentration also inversely correlated with the lymphocyte stimulation assay stimulation index (r=-0.42, P=0.021). However, the level of serum galectin-3 correlated with IL-17 production (r=0.67, P<0.001). Serum galectin-3 levels exhibited significant correlations with NLR (r=0.41, P=0.009), WBC (r=0.32, P=0.035), and CRP (r=0.63, P<0.001), and statistically significant inverse correlations with RBP (r=-0.45, P=0.002), PA (r=-0.46, P=0.001) and TF (r=-0.72, P<0.001). Galectin-3 may be one of the key factors in the regulation of immunological, inflammatory and nutritional conditions.


The purpose of this paper is to study the consumer's perception towards Value Added Tax (VAT) in the United Arab Emirates. Consumers' perception and awareness are evaluated on the basis of their opinion to what extent they are aware of VAT and its impacts on their spending, consumptions and savings. The paper also aims at presenting the importance of VAT among the consumers and shows how it can enhance the revenue of UAE. The data are collected through well-structured questionnaire distributed to 300 respondents in three different emirates, Dubai, Sharjah, and Ajman. For the purpose of analysis and interpretation, the researchers have used the statistical tools of EXCEL and SPSS software. The analysis of results showed that most of the respondents are either aware of VAT or they are neutral. The respondent's also feel that the VAT has some impact on their consumptions and savings, which ultimately had some impact on their allocation of resources and adverse effect on their living cost. A recommendation was made byputting more effort to enhance public awareness on VAT matters through media campaigns and organized workshops for specific groups and low-income people. Such knowledge and awareness has the tendency to promote voluntary tax compliance amongst the taxpayers in the future.


Objective: The objective of this research was to enhance the dissolution characteristic of diterpene lactone fraction of Andrographis paniculata Nees (DTLF) containing 75.9% andrographolide. The effect of carboxymethyl chitosan concentration on physical characteristics, entrapment efficiency and in vitro release of diterpene lactone fraction of Andrographis paniculata Nees (DTLF) particulate system were investigated. Methods : Diterpene lactone fraction of Andrographis paniculata Nees (DTLF) particulate system with different amount of carboxymethyl chitosan (CMChi) were prepared by ionic gelation followed by spray drying methods with CaCl2 a s c r o s s l i n k e r . T h e p a r t i c l e s w e r e evaluated in terms of physical state, drug entrapment efficiency and in vitro release rate. Results : The result showed that DTLF is already entrapped in the system hence the crystallinity reduced. The entrapment efficiency increases with increasing the amount of carboxymethyl chitosan, between 84% up to 90%. The release rate of the particles in 0.5% SLS media were 1.5 times higher than DTL substance, but not significantly different as the polymer amount increased. Conclusion : Entrapment of DTL in CMChi particulates system could reduce the crystallinity. Hence DTL - CMChi particles were able to enhance release rate of DTL up to 1.5 times.


In this paper we show, theoretically and empirically, that stronger employment protection legislation (EPL) in a host country has important and differing effects on the various activities of multinational enterprises (MNEs). Using micro data on affiliates to Swedish multinational firms in 20 countries for the period of 1965–1998, we find that increased stringency in EPL is associated with fewer investments in new affiliates and lower employment in existing affiliates. We also find that it is mainly affiliate exports that are affected negatively by stronger EPL, while the impact on local sales is small. This is in accordance with our theoretical model, which predicts that the impact of EPL on the costs of competing firms is likely to put affiliates at a smaller disadvantage when selling for the local market than in the production for exports.


Given the widespread impacts of climate change and environmental degradation on human health, medical schools have been under increasing pressure to provide comprehensive planetary health education to their students. However, the logistics of integrating such a wide-ranging and multi-faceted topic into existing medical curricula can be daunting. In this article, we present the Warren Alpert Medical School of Brown University as an example of a student-driven, bottom-up approach to the development of a planetary health education program. In 2020, student advocacy led to the creation of a Planetary Health Task Force composed of medical students, faculty, and administrators as well as Brown Environmental Sciences faculty. Since that time, the task force has orchestrated a wide range of planetary health initiatives, including interventions targeted to the entire student body as well as opportunities catering to a subset of highly interested students who wish to engage more deeply with planetary health. The success of the task force stems from several factors, including the framing of planetary health learning objectives as concordant with the established educational priorities of the Medical School's competency-based curriculum known as the Nine Abilities, respecting limitations on curricular space, and making planetary health education relevant to local environmental and hospital issues.


Self-assembly of AgOTf and AgF with the hexatopic ligands hexakis(pyridin-2-yl)benzene (2) and 2,4,6-tris(pyridin-2-yl)-1,3,5-tris(quinolin-2-yl)benzene (3) affords the discrete sandwich-shaped complexes [Ag4F(2)2](OTf)3, [Ag4F(3)2](OTf)3, and [Ag5F(2)2](OTf)4. The solid-state structures of the complexes were characterized by single-crystal X-ray diffraction analysis, which revealed that the fluoride anion is coordinated in the center of the Ag4-square or Ag5-pentagon units which are positioned between two molecules of the hexakis(azaheteroaryl)benzene. The generation of complexes is dictated by a unique cooperation of ligand coordination, argentophilicity, and fluoride anion inclusion. All three complexes adopt highly symmetrical structures in solution, as evidenced by appearance of one set of proton resonances for the two ligands arranged face to face.


Carbon nanotubes (CNTS) coating with europium oxide by a simple method is reported in this letter for the first time. The CNTS were refluxed in a solution of nitric acid containing europium nitrate, and the pH value was subsequently ajusted with ammonia solution. At last, the mixture was filtered and annealed. The TEM micrograph showed that the CNTS were covered with a uniform thin layer with thickness of about 15 nm. The XRD results revealed that the CNTS were coated with europium oxide.


For the last quarter century, I have coached soccer at some level. Like many parents, I started coaching when my kids developed an interest in soccer, and coaches were needed if the kids were to play. I knew little about soccer and had to learn both about soccer and about coaching. Now that I have retired from such endeavors, I would like to share some observations about coaching, orthopaedic training programs, and leadership. Leadership has become a hot topic for our national orthopaedic organizations, and several programs have been developed to train leaders.

My postulate is that the coaching model is an excellent choice for leadership training, especially for academic departments. The issues faced by coaches are remarkably similar to those faced in academic training programs, and the tools necessary to meet those challenges are also remarkably similar. The major difference is temporal; the same process that plays out over one season for a coach lasts five years for a residency. As I have spent the last fifteen years coaching goalkeepers at a large high school, I will use the high-school level of play as the basis for the remainder of my comments.

There are admittedly differences between the hospital environment and the playing field, but the principles remain constant. An orthopaedic department is not competing in the same manner as a high-school team; however, a department demonstrating excellence in patient care and education will be recognized by the institution and will be more successful in obtaining such necessities as office space and operating-room time, both competitive endeavors. The increasing fiscal and temporal pressures on academic departments can no longer be managed only by the chair—a cohesive team of faculty members committed to excellence will achieve much more. Although my observations are primarily directed toward resident education, successful academic leaders …


Introduction Digital therapeutics (DTx) can be a valuable contribution to the successful scale up of P5 Medicine (personalized, participatory, predictive, preventive, precision medicine) as they offer powerful means of delivering personalization and active patient participation in disease self-management. We investigated how the approval and adoption of DTx within health systems have been approached in five selected European countries and regions, with a view to proposing success factors scaling up their adoption. Methodology Preliminary research established best countries or region candidates as being Germany, UK, France, Belgium, and the Spanish Region of Catalonia. The research was informed by a literature review, interviews with public bodies and industry, and a multi-stakeholder workshop to validate the findings and fill in existing gaps. Results To authorize the use of digital technologies, the countries and regions passed legislation and developed policy instruments, appointed bodies to assess and certify the products and formalized mechanisms for permitting reimbursement. While DTx is not a commonly used nomenclature, there are digital health technology types defined that have similar requirements as DTx. Assessment and certification frameworks are usually built around the Medical Device Regulation with additional criteria. Reimbursement considerations often observe reimbursement of therapeutic devices and/or medicines. To be integrated into reimbursement systems, countries require manufacturers to demonstrate clinical value and cost-effectiveness. As there are currently very few DTx approved in practice, there is resistance toward clinical acceptance and organizational change, and change management is highly needed to integrate DTx into healthcare systems. The integration and secondary use of DTx data is not encountered in daily practice. Although some enablers exist, there remain technical and legal barriers. Discussion DTx strategies should be considered as an integral part of digital health strategies and legislation, and specific DTx pathways with clear and transparent assessment and guidelines that balance regulation and innovation should be defined. To help manufacturers, countries should recommend and list methods that are widely accepted and ensure scientific robustness, aligned to the MDR requirements to support transfer of relevant and comparable data across countries. To facilitate rapid uptake of innovation, countries should add flexibility to the framework by allowing temporary market authorization to enable data collection that can support the clinical and socio-economic evaluation and data gathering phase. Certification should trigger rapid price setting and reimbursement mechanisms, and dynamic ways to adjust price and reimbursement levels in time should be established. Relevant stakeholders should be approached on the potential impacts of DTx through transparent communication and change management strategies should be considered. These findings should be validated with a wider range of stakeholders.


The authors have developed and validated algorithms, programs, regimens and techniques of manual and instrumental treatment which produced positive effects in 99% of patients with neurological syndromes of spinal affections. The criteria of the treatment discontinuation were alleviation of painful syndrome by 25-50%. This occurred, as a rule, after 3-4 sessions. The course averaged 10 sessions and more. The treatment was discontinued after stabilization of subjective improvement.


Antenna selection, as a special case of power adaptation, can enhance the capacity of layered space time codes under rate control without any overhead feedback. To efficiently fight back rates quantization, this contribution considers a joint optimization of the best active transmit antennas associated to rate control together with antenna partitioning (i.e., layered multidimensional coding) and decoding order degrees of freedom. We propose an iterative antenna selection, which initializes the decoding order, so as to keep a low computational complexity while achieving near-optimal performance. Gains get all the more important as the signal-to-noise ratio increases.