The letter presents an MRI-compatible neurosurgical robotic system that is designed to operate the head-mounted meso-scale 6-degree-of-freedom (DoF) spring-based MINIR-II. The robotic system consists of an actuation module, a transmission module, and the robot module. The transmission module consist of a switching mechanism for reducing the required number of motors by half, an innovative linkage mechanism to insert and retract the robot with minimal tendon displacement and friction loss, and a quick-connect mechanism for easy attachment of the disposable MINIR-II. Design, analysis, and development of each module are described in detail. Most of the critical components such as the robot, the quick-connect, the linkage mechanism, and various gear-pulley combinations in our design are 3-D printed. Preliminary mechanical properties characterization of the system and the capability of the underactuated system to replicate the critical functions of the 6-DoF robot are presented. The robot motion capability in a brain phantom model and its MRI compatibility in a 7-T magnet were verified.


This paper presents the results obtained from tests of a new friction damping system, which has been proposed in order to improve the response of steel Moment Resisting Frames (MRF) and Braced Moment Resisting Frames (BMRF) during severe earthquakes. The system consists of a mechanism containing brake lining pads introduced at the intersection of frame cross-braces. Seismic tests of a three storey Friction Damped Braced Frame (FDBF) model were performed on an earthquake simulator table. The experimental results are compared with the findings of an inelastic time-history dynamic analysis. The results clearly indicate the superior performance of the FDBF compared to conventional building systems.


The movement of the face may provide information that facilitates recognition. However, in mostsituations people who are very familiar to us can be recognized easily from a single typical view of the face and the presence of further information derived from movement would not be expected to improve performance. Here the effects of movement on face recognition are investigated for faces presented under non-optimal conditions. Subjects were required to identify moving or still videotaped faces of famous and unknown people. Faces were presented in negative, a manipulation which preserved the two-dimensional shape and configuration of the face and facial features, while degrading face recognition performance. Results indicated that moving faces were significantly better recognized than still faces. It was proposed that movement may provide evidence about the three-dimensional structure of the face and allow the recognition of characteristic facial gestures. When the faces were inverted, no significant effect ...


This paper investigates how accurately the prediction of being an introvert vs. extrovert can be made with less than ten predictors. The study is based on a previous data collection of 7161 respondents of a survey on 91 personality and 3 demographic items. The results show that it is possible to effectively reduce the size of this measurement instrument from 94 to 10 features with a performance loss of only 1%, achieving an accuracy of 73.81% on unseen data. Class imbalance correction methods like SMOTE or ADASYN showed considerable improvement on the validation set but only minor performance improvement on the testing set.


Receptor tyrosine kinases (RTK) of the TAM family have been described as oncogenes. Axl and Mertk, two members of the TAM family, are also potent negative regulators of the inflammatory response. Inflammation is an enabling characteristic of cancer hallmarks and can promote tumorigenesis and tumor progression. Genetic ablation of Axl and Mertk in mice, results in heightened inflammation in the gut and increased susceptibility to inflammation-driven colon cancer (azoxymethane/dextran sodium sulfate treatment paradigm). We sought to understand the role of Axl and Mertk, individually, in colon cancer cells to identify the key TAM oncogene in this disease. Here we show that Axl, but not Mertk, was highly expressed and correlated with grade of metastatic colon cancer. Silencing Axl expression in RKO-AS45-1 and HCT116 colon cancer cells had no significant effect on proliferation and survival, but markedly decreased migration and invasion. R428, a selective Axl small molecule inhibitor, also drastically reduced migration in these colon cancer cell lines. Analyses of Axl knockout mice revealed that single, genetic ablation of this TAM RTK does not increase susceptibility to DSS-induced colitis, in contrast to that observed in Axl and Mertk double knockout mice. These results are consistent with a redundant function of Axl and Mer in the regulation of the inflammatory response. Our findings suggest that the selective targeting of Axl in colon cancer might disable the oncogenic function of TAM RTKs, while sparing the protective, anti-inflammatory function of this RTK family in this disease. Citation Format: Diana J. Uribe, Lidia Bosurgi, Nicola Gagliani, Leonel Joannas, Adam Watson, Jesse D. Martinez, Carla V. Rothlin, Sourav Ghosh. Axl overexpression drives migration and invasion in colon cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1991. doi:10.1158/1538-7445.AM2014-1991


Although the notion of leadership is semantically inflated, its meaning and semiotic potential are fading; Muslim societies await a saviour, but detailed studies on leadership are scarce. The article opens new avenues of interpretation for this and other Qur'anic terms, configuring geographic considerations and interpretational hot spots, starting from universal laws (sunnatullah), and addressing leadership references in religious practice and daily life. It highlights the most prominent leadership concepts in the Qur'anic text, and questions their core meanings and extended semantic fields. The conclusions develop more inclusive approaches to plural exegesis, and broaden the discourse of Qur'anic Studies.


Sensitivity studies with global climate models show that, by their influence on the radiation balance, Antarctic clouds play a major role in the climate system, both directly at high southern latitudes and indirectly globally, as the local circulation changes lead to global teleconnections. Unfortunately, observations of cloud distribution in the Antarctic are limited and often of low quality because of the practical difficulty in observing clouds in the harsh Antarctic environment. The best surface observations suggest that the fractional cloud cover at the South Pole is around 50-60% in all seasons, whereas the cloud cover rises to around 80-90% close to the coast of the continent. Microphysical observations of cloud parameters are also very sparse in the Antarctic. However, the few measurements that do exist show predominantly ice-crystal clouds across the interior, with mixed-phase clouds close to the coasts. Crystal sizes vary from 5 to 30 mm (effective radius) in the interior to somewhat larger ice crystals and water drops near the coast. A wide range of crystal shapes is observed at all sites. This review considers the available cloud observations and highlights the importance of Antarctic clouds and the need for better observations in the future.


OBJECTIVE It has been reported that several snakes of the Trimeresurus group of the pit viper family produce venoms which have effects on the platelets, such as aggregation or induction of release from of granules. Trimerusus albolabris is a green pit viper commonly found in Thailand. Its venom can cause platelet aggregation. This study attempted to use this function as a tool for the detection of antibody coated platelets from patients with systemic lupus erythematosus (SLE). METHOD Platelets from normal healthy individuals and patient with SLE were recovered and washed to remove the fibrinogen. Some of the platelets from the healthy individuals were coated with anti GP IIb/IIIa. The samples of coated and uncoated platelets and those from the patients with SLE were each mixed with a venom fraction containing phospholipase A2 acidic 1 precursors derived from T. albolabris and incubated at 37 ο C for 30 minutes. RESULTS The samples were observed under light microscope for aggregation of platelets. The uncoated platelets were observed to be aggregated, but there was no aggregation in the samples of coated normal platelets and platelets from the patient with SLE. CONCLUSIONS This preliminary report will open up a new outlook in the area of antibody detection in SLE and it appears that T. albolabris venom may be of use as a tool for monitoring disease activity.


The rise of Harappan settlement at Dholavira is attributed to multidimensional factors which may include industrial activities, overseas trade and commerce and distribution of resources available in the Kachchh to other parts of the Harappan domain. The very location of the site is highly intriguing because presently the area is surrounded by marshy land which is called as Rann of Kachchh. However, various studies have indicated the different environmental and morphological conditions in the area and have been suggested that during Harappan time Rann was navigable. Though there is a remote possibility of any port installation close to ancient Dholavira town but a few potential sites in the proximity such as Jhandiasar, Saran and Bambhanka might have played a decisive role in the rise of Harappan settlement at Dholavira. The present study is based on the preliminary surface exploration undertaken in the recent past at abovementioned sites.


The performance of a new contact material (Ti,W)C-Ag, has been evaluated. Two compositions of this contact, 50 percent by weight Ag and 35 percent by weight Ag, haye been Used. The former contact showed good performance under switching duty (20 A, 110 V, 99 percent power factor). The latter contact had insufficient Ag, however, to maintain a low contact resistance throughout the switching experiments. Both contact structures showed excellent resistance to arc erosion under short circuit conditions. Microchemical (EDAX, EMA, DIMA), metallographic, and X-ray diffraction techniques have been used to analyze the chemical and micr0structural factors. These have been used to explain the good electrical contact characteristics. Gravimetric oxidation tests have also been conducted to characterize the new contacts. Several factors have been identified that contribute to the improved contact material: a) good wetting of (Ti,W)C with silver; b) higher oxidation resistance of (Ti,W)C; c) wide stability range of the mixed Ti-W carbide phase; d) formation of oxygen solid solutions and/or suboxides of titanium; and e) the generation of a CO/CO2 gas blanket during oxidation. This new contact material is shown to be a significani addition to the family of materials used for electric contact applications.


Currently there is no automated deposition system available for support materials in Ultrasonic Consolidation. Support materials are important to the UC technology because of the benefits that can be geometrically achieved. Without an integrated support materials system many geometries and features will be impossible to create. This paper describes the approach taken to integrate UC and FDM in order to automatically deposit materials as a support in a UC machine. This includes the process setup, design, and planning. Finally a build process integrating the two machines is shown to demonstrate that automated support material deposition in UC is possible.


Structural phase transitions of titanium (Ti) have been investigated at pressures up to 220 GPa at room temperature using a monochromatic synchrotron x-ray diffraction technique. At 140 GPa, the hexagonal phase (ω-Ti) was transformed into an orthorhombic phase (δ-Ti) with a distorted bcc structure via an intermediate phase (γ-Ti), which has recently been proposed. The δ-Ti and γ-Ti phases had a unique zigzag-chain-like structure, which resulted from an orthorhombic distortion.


Every member of a social system sees that system in a particular way. This essay outlines a new way of seeing the uniquely human characteristics in these systems, with particular attention to what happens when this view is taken. Termed the Knowledge Lens, this view embraces complexity, sees the potential of innovation through conversation, and understands the barriers limiting the traditionally assumed powers of data, information, and knowledge. This lens is approached within the context of ensuring that graduates of a Knowledge School are equipped with the tools and understanding necessary to facilitate positive change and increase human agency--both in their jobs and their communities. Specific attention is also paid to the role of automation, with the suggestion that automation and information-centric views work only in areas with known and simple answers.


BACKGROUND This study was designed to evaluate the current situation of interhospital transport of pediatric patients requiring emergent care. METHODS Using a clinical prospective and multicenter design, 1,666 interhospital transports of pediatric patients were evaluated in 18 centers. Non-emergency transports and newborn transports were not included, so 854 transports were eligible for evaluation. Data were collected by means of a comprehensive form filled by a physician at the receiving hospital. RESULTS The physicians who gave the decisions for the transports were pediatricians in 60%, general physicians in 15.4%, and residents in 6%, while no identification existed in 159 transports (18.6%). The receiving hospitals were not notified prior to the transport in 79.3%. Pretransport information about the patients were adequate in 26.1% and inadequate in 31.8%; no information was available in 42.1%. Ambulances were used in 64.4% of the transports, of which only 16.2% was fully equipped. Unqualified or inexperienced personnel were in charge in 42.8% of the transports. In 26.3% of the transports, the patients arrived at the receiving hospital in an agonized state. CONCLUSION It appears that there are no established guidelines for the emergency transport of pediatric children in Turkey.


Objective. We examined the sensitivity and specificity of an obesity diagnosis in a nationally representative sample of pediatric outpatient visits. Methods. We used the 2005 to 2009 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys. We included visits with children 2 to 18 years, yielding a sample of 48 145 database visits. We determined 3 methods of identifying obesity: documented body mass index (BMI) ≥95th percentile; International Classification of Diseases, Ninth Revision (ICD-9) code; and positive answer to the question, "Does the patient now have obesity?" Using BMI as the gold standard, we calculated the sensitivity and specificity of a clinical obesity diagnosis. Results. Among the 19.5% of children who were obese by BMI, 7.0% had an ICD-9 code and 15.2% had a positive response to questioning. The sensitivity of an obesity diagnosis was 15.4%, and the specificity was 99.2%. Conclusions. The sensitivity of the obesity diagnosis in pediatric ambulatory visits is low. Efforts are needed to increase identification of obese children.


Proposed in this paper is a general parasitic-compatible LCR matching method suitable for N-path filter. Analysis of a conventional L-type matching is extended to accommodate the case of the N-path filter, where the different impedances of the band limited input matching network at multiple local oscillation (LO) harmonic frequencies have to be taken into consideration. Compared to the ideally wideband transformer matching technique, the proposed LCR method has advantages of smaller size and better harmonic folding rejection ratio, while keeping the same properties, such as impedance matching, in-band voltage gain, noise figure and ultimate rejection. Based on the derived equations, the procedure to determine the values of the matching components for given rejection specs has been described using design examples.


Keeping abreast of the numerous wound dressings available for patient care is an ambitious task. Being able to differentiate among the various treatment options, when and how to apply them, in what combinations, and when to change them has become a challenge for all healthcare practitioners.


The Kenyan education system is evaluation oriented. Excellent acquisition of numeracy and literacy skills are the majors indicators of quality education. The purpose of this study was to assess the teacher based factors affecting the student's performance in mathematics in the public secondary schools in Maara sub-county, Tharaka Nithi County. The study was guided by the following objectives: to establish how the teacher job satisfaction affects the students performance in mathematics in the public secondary schools, to find out how the teacher motivation affects the student performance in mathematics in the public secondary schools, to establish the effects of teacher training and experience on the performance in mathematics in the public secondary schools and to establish the strategies that can be employed to improve on the performance in mathematics in the public secondary schools in Maara sub-county. The target population for this study was all the 1140 form three students, 128 mathematics teachers and 49 headteachers in the 49 secondary schools in Maara sub-county, Tharaka Nithi County. A sample of 12 schools was proportionately sampled to participate in the study. From the sampled schools, the head teacher was purposively sampled, 10 students from form 3 were randomly sampled, to participate in the study. The study instruments were questionnaires and interview schedule. Piloting was done in two schools. This study employed descriptive and inferential' statistics to analyze the data obtained. For descriptive statistics, this specifically included percentages and frequency counts, while for inferential statistics was used to find the effects. The data obtained was presented through tables, bar graphs and pie charts. The study established that the mathematics teachers in Tharaka Nithi County were satisfied with their jobs, and this had a positive influence on the student's performance in mathematics, as was revealed by the corelational analysis. This implies that the increase in the variables of teacher job satisfaction, led to a direct increase in performance in mathematics. The mathematics teachers in secondary schools in Tharaka Nithi County were well motivated by the school management. Motivation was found to have a significant positive relationship with the student's performance. This means that with the increase in motivation, there was a significant positive increase in student's 'Performance in mathematics. The teachers training and experience was also found to have a considerable significance in determining the student's performance. This implies that with the increase in the variables related to teacher training, there was a positive significant increase in student's performance in mathematics. Based on the study findings, the researcher recommends that: The ministry of education should fund the schools in order to provide more incentives to the mathematics teachers, in order to make them more satisfied in their jobs. The headteachers should consider team building for the workers and motivation for the workers and the students, as a means of improving the performance. The government should review the current teacher training curriculum and include in it the emerging trends and issues in the field of education. The government through the ministry of education should increase the funding in the secondary schools, so as to enable them buy enough teaching and learning materials, and revision materials, so as to improve on the academic performance,


Abstract Congress passed the Virus-Serum-Toxin Act in 1913, giving the U.S. Department of Agriculture (USDA) authority to prevent the importation or interstate shipment of worthless, contaminated, dangerous, or harmful veterinary biological products. The passage of this act marked the beginning of regulatory requirements for veterinary biological products in the United States. In 1913, only a few biologics establishments produced products for the poultry industry. The first license issued by the USDA for a poultry product was in 1918 to the University of California, Berkeley, for fowlpox vaccine. The list of biological products for poultry grew slowly in the 1920s. However, this began to change with the licensing of laryngotracheitis vaccine in 1933; pigeonpox vaccine in 1939; several Newcastle disease vaccines (inactivated in 1946, Roakin strain in 1948, B1 strain in 1950, and La Sota strain in 1952); and the first bronchitis vaccine in 1953. With the development of these and other new products, the biologics industry began to move its emphasis on hog cholera serum and virus to one based on the production of numerous new vaccines and bacterial products. The USDA's approach to the regulation of biologics in the early 1950s was still geared to the production of hog cholera products; however, as a result of the intervention of a group of dedicated poultry scientists, who were concerned about the poor performance of Newcastle disease vaccines, this soon changed. This presentation describes the initiation and development of modern standards for poultry biologics that occurred as a result of this intervention. The development and improvement of standards and regulatory requirements to address mycoplasma, leukosis, and other extraneous virus contaminations in chicken embryo origin products are reviewed. The licensing of products to meet new and emerging disease problems in the poultry industry and the close interaction among research scientists, poultry industry, biologics manufacturers, and government regulatory officials that has been needed to ensure the availability of products that meet appropriate standards of purity, safety, potency, and efficacy are also addressed.


This paper examines the role market information can play in the performance of the grain marketing system. The analyses were based on data collected from a cross section of two sets of grain traders with and without access to market information. empirical results from the study show that grain traders obtained market related information from colleagues, market associations and mass media, which enables them to forecast likely future market trends, making business decisions and in allocating resources among competing alternatives. Statistical test indicated a significant difference between the marketing efficiency ratios of grain traders with and without access to market information at the five percent level of probability. the degree of spatial arbitrage between the markets showed that markets for those with access to information were integrated, while markets for traders without access to market information were not. setting up a mechanism for the collection, monitoring and analysis of price trend data, organizing training workshops for grain traders in processing and interpretation of market information, use of traders association in collecting information to a central pool where it can be collated and made available to members. Keywords : market information, performance, spatial integration, grain markets, Kaduna State International Journal of Agriculture and Rural Development Vol. 6 2005: 126-131


Many cities in Kosovo suffer from poor air quality, with ambient concentrations of particulate matter with a diameter of 2.5 micrometers or less (PM2.5) significantly exceeding the national and European Union (EU) standards and global air quality guidelines for PM2.5 established by the World Health Organization (WHO). The air pollution in the capital city of Prishtina rivals that of big cities like Beijing, Mumbai, and New Delhi. Especially in winter, urban areas face severe smog episodes, caused by the increased demand for heat from the residential and commercial sector, which is mainly provided by burning solid fuels. Such levels of air pollution are unsafe for Kosovo's population of 1.9 million and cause significant deleterious health impacts. This report is one in a series of three reports on air quality management (AQM) in Kosovo, Bosnia and Herzegovina, and North Macedonia. It examines the nature and magnitude of ambient air pollution (AAP) in Kosovo. It provides estimates of the health burden and the economic cost associated with the health impacts of AAP, that is, PM2.5, in Kosovo. It also analyzes of the roles of various sources of PM2.5 emissions on ambient air quality in Kosovo at a national level. The institutional and policy framework for AQM in the country is examined, including contributions of other development institutions in supporting Kosovo in addressing air pollution. Furthermore, the report presents experiences of selected countries that have applied different policy, investment, and technical interventions for air pollution, prevention, reduction, and abatement. Finally, it provides recommendations for reducing air pollution in Kosovo.


Abstract In anticipation of federal legalization of cannabis in Canada, Nathan Baker provides an excellent overview and a detailed account of how the federal and provincial governments propose to detect, investigate, and prosecute drug-impaired driving to ensure the safety of the public on its roads. Drug-impairment tests, such as Drug Recognition Evaluations (DRE) and Standardized Field Sobriety Testing (SFST) have been statutorily embedded in our criminal justice system for over ten years. However, the need for heightening awareness of these testing procedures, training for police officers who administer these tests, and education on the accuracy, validity, and credibility of drug detection technologies has been brought to the forefront of criminal law discussions as a result of legalized cannabis use. The author's goal is to "provide a better understanding of the science and how it should relate to the creation and interpretation of the law in Canada surrounding impaired operation by drugs." As such, Baker provides in-depth detail surrounding the efficacy of drug-impairment testing.


Considering the evolution of the treatment of filiation in cases of women in same-sex marriages, this article relativizes the idea of the increasing weight of biological arguments. While in the determination of the filiation there is a persisting focus on giving birth as evidence of the mother-child relationship, we can also observe how different interpretations and decisions regarding the spouse's maternity status are leaning toward giving greater relevance to factors such as the spouse's will to be a mother, the couple's parenthood project, and by extension marriage as an institution into which that project is subsumed. The article shows the emergence of matrimonial filiation as a third type of filiation that is based neither on biology nor on adoption. Although it is not expressly regulated by law, this different type of filiation is being effectively applied to establish filiation in cases of donor-conceived children born in lesbian sex-same marriages.


The Pamir salient defines the western end of the Himalayan-Tibetan orogen and has overthrust the Tarim-Tajik basin to the north by ∼300 km along a late Cenozoic, south-dipping intracontinental subduction zone. Field mapping, structural measurements, and analysis of mesoscale structures along a 32-km-long reach of the Yarkand River document the tectonic evolution of the east flank of this salient, between the North Pamir to the west and the Western Kunlun Shan to the east. The study area is cut by a set of four, north-northwest–striking, steeply dipping brittle faults. Microstructures and asymmetric outcrop- to map-scale folds indicate right slip along these faults. Between these structures, fault-bounded panels of Phanerozoic strata are deformed by en echelon folds with axes that trend more westerly than the adjacent faults, consistent with dextral transpression. The fault system described here extends for ∼350 km along the eastern flank of the Pamir salient. Transpressional right slip along this set of faults, here called the Kashgar-Yecheng transfer system, appears to have accommodated late Cenozoic separation of the North Pamir from the Western Kunlun Shan during south-directed intracontinental subduction beneath the leading edge of the Pamir salient. Correlation of major faults suggests total slip along the Kashgar-Yecheng transfer system is likely on the order of ∼280 km. This offset estimate implies long-term slip rates of 7–15 mm/a along the Kashgar-Yecheng transfer system when combined with previous sedimentologic, stratigraphic, and thermochronologic data that indicate deformation along the east flank of the Pamir started between the late Eocene and early Miocene. These results imply that the first-order structures on the western and eastern flanks of the Pamir are asymmetric: previous work has shown that deformation in the west was accommodated by anticlockwise vertical axis rotation of the Pamir over the eastern margin of the Tajik basin. This rotation is generally interpreted to reflect northwest-directed radial thrusting, in contrast to the transpressional right-slip transfer faulting on the east side reported here.


This study examines the desulfurization performances of a sorbent derived from waste concrete through thermal gravimetric analysis in the temperature range from 303 to 1173 K. The sorbent is fine particles having a mean diameter distribution of 10–200 μm generated as a byproduct in a recycling process of aggregates from waste concrete. The sorbent is mainly composed of hydrated cement component, i.e. calcium silicate hydrate (C-S-H) and calcium hydroxide (Ca(OH)2). The sorbent showed SO2 removal activity over the temperature range studied. The desulfurization rate was lower under a lower temperature range up to 773 K, where the desulfurization rate gradually decreased with increasing temperature. The desulfurization activity at the lower temperatures can be attributed to the direct reaction of SO2 with C-S-H and Ca(OH)2. For the higher temperature range, the desulfurization rate was much higher, being almost half that for pure calcium carbonate, a conventional sorbent for dry desulfurization.


One of the challenges for space biology and medicine is resolution of lots of problems of biomedical support of humans in the extreme environment of space flight. These problems include also designing of robust and efficiently functioning life support systems (LSS). The paper gives an overview of the investigations of ground-based BLSS with human subjects conducted in Russia and other countries. Also, it contains the basic data of studying the BLSS photoautotrophic components (higher plants) in the series of experiments with the total duration of 630 days fulfilled on orbital complex Mir and the series of experiments with the total duration of 820 days in the ISS Russian segment. Analysis of the results from the BLSS investigations on Earth and in space flights drives to the conclusion that some of the BLSS components, greenhouses specifically, can be integrated even now into the currently used systems of space crew life support.


Our purpose was to determine if feeding melengesterol acetate (MGA) for 1 week in combination with gonadotropin-releasing hormone (GnRH) and prostaglandin-F2" (PGF) would better synchronize heifers for timed artificial insemination. Sixty-nine yearling beef heifers received an injection of GnRH 7 days before receiving an injection of PGF. Half of the heifers were fed MGA between the GnRH and PGF injections (Cosynch+MGA), whereas the remaining heifers were not (Cosynch). All heifers were given a second GnRH injection 2 days after PGF and inseminated at that time. Pregnancy rate for the Cosynch group (43%) was greater (P<0.05) than that for the Cosynch+MGA group (15%). This experiment suggests that short-term feeding (7 days) of MGA in concert with a Cosynch protocol was detrimental to fertility in beef heifers.


AIM: A blindness prevalence survey in 1996 indicated that estimates of 40000 are blind from cataracts in Kano state, northwestern Nigeria. Many more were severely visually impaired. Eye care personnel and other resources for eye care delivery are located at the state capital. The state Ministry of Health organized an outreach program. The aim was to operate on 750 cataract patients and measure the visual acuity at two weeks follow up. METHOD: Patients were registered and examined. Cataract patients with accurate four quadrant light projection, briskly reacting pupils and normal intra ocular pressures were selected and had manual extra capsular cataract extraction with posterior chamber intra ocular lens implantation. Post operative medications were administered. Patients were reviewed at 2 weeks follow up after discharge during which their visual acuity was measured and recorded. RESULTS: 868 cataract patients were operated. Thirty two percent of the patients were blind before surgery and 77% of these had bilateral cataracts. The proportion of those who had posterior chamber intra ocular lens (PC IOL) was 85%. The proportion of patients who regained normal vision was 43% and overall, 94% had vision of 6/60 or, better after surgery compared with 20% in this category before surgery, (WHO vision category 0 and 1). CONCLUSION: Cataract outreach service is essential in reducing cataract blindness. There is need to follow up patients although the vision recorded for this study was obtained at two weeks follow up.


Between 1955 and 1979, a modification of the compression arthrodesis of the ankle was performed in twenty-eight patients at The Campbell Clinic. The ages of the patients ranged from twenty-one to seventy-seven years, with an average of 48.4 years. The modification narrows both the medial and lateral sides of the ankle, resulting in a much better cosmetic appearance as the fused ankle is essentially the same width as the normal ankle. The distal end of the tibia and the talus are easily approached through anteromedial and anterolateral incisions, and all articular cartilage can be removed without difficulty. A solid arthrodesis was achieved in 92.8 per cent of the ankles, a higher percentage than in most reported series. Not only is the final appearance of the ankle more pleasing to the patient, but the modification also eliminates the complication of irritation and abrasion of the soft tissue beneath the malleoli by the top of the shoe.


Abstract The saturated flashy colors used in exterior paintings of houses in the Romanian rural environment represent a discussion topic for on-lookers, whether they are local inhabitants, tourists or specialists interested in urban planning. The same colors are perceived differently and express different significances, denoting more than mere chromatic nuances. What are these significances and what role do they play in inter-human relationships? I have tried to answer this question by analyzing the interviews gathered in the summers of 2008 and 2009 in two touristic areas, Gheţari Plateau (Apuseni Mountains) and Apuseni Mountains (Bukovina). The results point to identity-defining elements shown by the owners of these houses in terms of aspirations towards modernity and the spectacular. They wish to escape the label of 'provincial' and to be connected to the 'global world'. Alternatively, many tourists are disappointed by the widespread usage of these colors in almost all the regions of the country and consider that as a process of homogenization, which erases local specific traits that one would expect to see in these areas.


This research is aimed to examine the winner-loser anomaly based on the overreaction hypothesis that can be decided whether the contrarian investment strategy in the short term can be applied in Indonesia Stock Exchange to obtain the return. The overreaction hypothesis is a manifestation of the inefficiency of the market (De Bondt and Thaler, 1985). Research on Short Contrarian Investment Strategy used a sample of 23 shares in the company's property and real estate sectors. The data used is stock price during the period of 2004-2008. Results obtained by using market-adjusted abnormal return indicates that the average six-month test period only loser in the stock portfolio return reversal happens. This research also examines the possibility of other factors that could explain the market overreaction return reversal, namely size and risk control. Results obtained using regression Zero Cost Investment Portfolio with the method of size and risk adjusted returns indicates that average during the six month test period showed that the loser stocks can not provide a return that is higher than the winner stocks. Thus the research indicates only loser anomaly, this is caused by an overreaction to the bad news. So it can be said that there is no potential for profit if the short-term contrarian strategy applied to the property and real estate sectors in BEI.


Aim: To clarify the characteristics of patients with rectal prolapse after laparoscopically assisted anorectoplasty (LAARP), estimate the causes, and evaluate its impact on postoperative bowel function. Methods: The medical records of patients who underwent LAARP for high- or intermediate-type anorectal malformation between 2000 and 2019 were retrospectively reviewed. Clinical data were compared between patients with (Group P) and without prolapse (normal, Group N). Fecal continence was evaluated using the clinical assessment score for fecal continence developed by the Japanese Study Group of Anorectal Anomalies. For patients who underwent pelvic magnetic resonance imaging (MRI) before LAARP, atrophy, or asymmetry of the anal sphincter and levator ani was evaluated by a radiologist. Results: Of the 49 patients, 29 (59%) had rectal prolapse after LAARP (Group P) and 20 did not (Group N). We found no significant difference in gender, type of malformations, incidence of associated spinal or lumbosacral anomalies, procedure time, and postoperative bowel function at ages 4, 8, 12, and 16 years. However, LAARP was performed significantly earlier in Group N (median [range], 180 [123-498] days) than in Group P (210 [141-570] days). In Group P, 18 patients (62%) developed prolapse before colostomy takedown. Eight of 26 patients who underwent surgical prolapse repair required redo procedures. Twenty-five patients who underwent preoperative pelvic MRI showed no significant relationship between the muscular abnormalities and the incidence of postoperative rectal prolapse. Conclusions: Although recurrence is common, performing LAARP at a younger age might prevent postoperative prolapse development.


Objective: This article describes design elements of the Multifaceted Depression and Diabetes Program (MDDP) randomized clinical trial. The MDDP trial hypothesizes that a socioculturally adapted collaborative care depression management intervention will reduce depressive symptoms and improve patient adherence to diabetes self-care regimens, glycemic control, and quality-of-life. In addition, baseline data of 387 low-income, 96% Hispanic, enrolled patients with major depression and diabetes are examined to identify study population characteristics consistent with trial design adaptations. Methods: The PHQ-9 depression scale was used to identify patients meeting criteria for major depressive disorder (1 cardinal depression symptom + a PHQ-9 score of > 10) from two community safety net clinics. Design elements included sociocultural adaptations in recruitment and efforts to reduce attrition and collaborative depression care management. Results: Of 1,803 diabetes patients screened, 30.2% met criteria for major depressive disorder. Of 387 patients enrolled in the clinical trial, 98% had Type 2 diabetes, and 83% had glycated hemoglobin (HbA1c) levels ≥ 7%. Study recruitment rates and baseline data analyses identified socioeconomic and clinical factors that support trial design and intervention adaptations. Depression severity was significantly associated with diabetes complications, medical comorbidity, greater anxiety, dysthymia, financial worries, social stress, and poorer quality-of-life. Conclusion: Low-income Hispanic patients with diabetes experience high prevalence of depressive disorder and depression severity is associated with socioeconomic stressors and clinical severity. Improving depression care management among Hispanic patients in public sector clinics should include intervention components that address self-care of diabetes and socioeconomic stressors.


During the conceptual design phase of a wing-body-canard type fighter class aircraft, as a method of maneuverability enhancement for an aircraft, effects of canard-leading edge flap scheduling have been studied. In this study, corrected supersonic panel method has been used to predict the drag polar characteristics due to canard-leading edge flap deflections in the high speed regime. Utilizing the predicted drag polar curves, the canard-leading edge flap scheduling laws have been established. These scheduling laws are the relation of canard-leading edge flap deflections and the flight conditions to maximize the lift-drag ratio. Based on the results obtained from the canard-leading edge flap scheduling, the present method has shown to be useful to enhance the maneuverability of wing-body-canard type fighter class aircraft.


Every year large amounts of residues accumulate from potato processing. The aim of this study is to develop a process to valorize these residues as feedstock for lactic acid fermentation in a way that is suitable for industrial production. An enzymatic hydrolysate obtained from potato residues (46 % w/w dry mass starch) was used as a substrate in batch and fed-batch fermentations with Lactobacillus casei. Supplementation of yeast extract (3 g L–1) was required to improve productivities. Despite the inhibitory effect exerted by phenolic compounds in the medium, reasonably high lactic acid concentrations (102 g L–1) and yields (92 %) were obtained, with 92 % (L-isomer) optical purity. It was clearly demonstrated that potato residues are suitable as feedstock for large-scale production of technical grade lactic acid and that the developed process is promising for large-scale biorefinery applications.


Advances in solid state laser technology have enabled tremendous performance increases in chip packaging technology. Organic composites are now available for high I/O flip chip modules due in part to the size, speed and flexibility of laser via creation methodologies. Generation of the third and fourth harmonics of the fundamental infrared Nd-YAG wavelength enable precision micromachining of alternating layers of organic insulators and metal conductors. The range of available pulse energies at high repetition rate, low M/sup 2/ values and superb pulse stability allows the formation of both high aspect ratio through vias and very small blind vias utilizing similar tools. The ability to fabricate chip packages with through vias, staggered blind vias, or any combination of blind, buried and through vias affords system and chip level design teams the maximum allowable flexibility to optimize performance versus cost. The most fundamental hardware improvements revolve around the conversion efficiency and power stability of Q-switched, lamp pumped Nd-YAG lasers utilizing BBO crystals for harmonic generation. The high pulse energies coupled with excellent beam quality translates into near theoretical focal depth values that in turn allow <50 micron, >7:1 aspect ratio interconnects to be manufactured at defect densities less than 50 ppm. Other advances including improved coatings on crystals and optics and improved thermal management at the rail, result in overall system availability exceeding 85% and via location accuracy of better than +/-20 microns. Future advances are likely to include a migration from lamp pumping to diode pumping, optimization of frequency conversion and laser design for greater power at high repetition rates, multi-rail systems and improved automation. A roadmap for past, current and future laser characteristics as they relate to via qualities and their relative costs will be discussed.


This paper reports the results of a ten-year effort to establish ethics as a learning objective for all business students, to assess the effectiveness in achieving that learning objective and to incorporate ethical conduct as a part of the school's organizational culture. First, it addresses the importance of ethics instruction for all business students. Then curricular concerns are addressed, specifically the establishment of ethics as an overarching learning objective and ensuring adequate coverage of ethics throughout the curriculum. Next, assessment mechanisms are described to demonstrate improvement in student's moral judgment and moral courage, in achieving the ethics learning objective using pre-tests and post-tests. These tests validated the use of ethical vignettes/cases to improve ethical awareness and exposure and writing about moral exemplars to increase student resolve to have moral courage. Finally, the paper addresses ways to measure and improve the ethical climate of the organization (faculty and students)


Quality assessment (assurance/improvement) is the set of methods used to measure and improve the delivered care and the department's performance against pre-established criteria or standards. The four stages of the self-maintained quality assessment cycle are: problem identification, problem analysis, problem correction and evaluation of corrective actions. Quality assessment is a measurable entity for which it is necessary to define and calibrate measurement parameters (indicators) from available data gathered from the hospital anaesthesia environment. Problem identification comes from the accumulation of indicators. There are four types of quality indicators: structure, process, outcome and sentinel indicators. The latter signal a quality defect, are independent of outcomes, are easier to analyse by statistical methods and closely related to processes and main targets of quality improvement. The three types of methods to analyse the problems (indicators) are: peer review, quantitative methods and risks management techniques. Peer review is performed by qualified anaesthesiologists. To improve its validity, the review process should be explicited and conclusions based on standards of practice and literature references. The quantitative methods are statistical analyses applied to the collected data and presented in a graphic format (histogram, Pareto diagram, control charts). The risks management techniques include: a) critical incident analysis establishing an objective relationship between a 'critical' event and the associated human behaviours; b) system accident analysis, based on the fact that accidents continue to occur despite safety systems and sophisticated technologies, checks of all the process components leading to the impredictable outcome and not just the human factors; c) cause-effect diagrams facilitate the problem analysis in reducing its causes to four fundamental components (persons, regulations, equipment, process). Definition and implementation of corrective measures, based on the findings of the two previous stages, are the third step of the evaluation cycle. The Hawthorne effect is an outcome improvement, before the implementation of any corrective actions. Verification of the implemented actions is the final and mandatory step closing the evaluation cycle.


Supercritical carbon dioxide is beneficial to the synthesis of superior ultrafine and uniform materials due to its high chemical stability, low viscosity, high diffusivity, and "zero" surface tension. γ-Alumina nanosheets were obtained by a simple hydrothermal route in the presence of supercritical carbon dioxide. XRD, FTIR, SEM, TEM and nitrogen sorption isotherm were employed to characterize the samples. Alumina as-prepared has a high specific surface area of up to 200 ± 6 m2 g−1, which presents a high adsorption capacity (4.66 ± 0.02 mg g−1) for uranyl ions from aqueous solution. Furthermore, the adsorption process was found to be endothermic and spontaneous in nature.


Severe malaria caused by Plasmodium falciparum poses a major global health problem with high morbidity and mortality. The P. falciparum harbours a family of pore forming proteins (PFPs), known as perforin like proteins (PLPs), which are structurally equivalent to prokaryotic PFPs. These PLPs are secreted from the parasites and by interacting to host cells they contribute to disease pathogenesis. The severe malaria pathogenesis is associated with dysfunction of various barrier cells including endothelial cells. A number of factors, including PLPs, secreted by parasite contribute to the host cell dysfunction. Here in, we tested the hypothesis that the PLPs mediate dysfunction of barrier cells and might have a role in disease pathogenesis. We analysed various dysfunction in barrier cells following rPLP2 exposure and demonstrate that it causes an increase in intracellular Ca2+ levels. Additionally, rPLP2 exposed barrier cells displayed features of cell death including Annexin/PI positivity, depolarized mitochondrial membrane potential and ROS generation. We further performed the time lapse video microscopy of barrier cells and found the treatment of rPLP2 triggers their membrane blebbing. The cytoplasmic localization of HMGB1, a marker of necrosis, further confirmed the necrotic type of cell death. This study highlights the role of parasite factor PLP in endothelial dysfunction and provides a rational for the design of adjunct therapies against severe malaria.


ABSTRACT The effect of Retrieval Practice refers to the phenomenon that taking a practice test is more effective for learning than re-study, probably due to the benefit from processes underlying successful retrievals during practice. However, it is rarely studied whether other processes (e.g., metacognitive monitoring) during retrieval practice may also play an important role. In two experiments, we examined whether the effectiveness of retrieval was affected by subjects' confidence in their retrieval success. Subjects studied word-pairs and rated their confidence after each practice test trial (cued-recall in Exp.1, multiple choice in Exp.2), or re-study trial. In both experiments, we observed the classic retrieval practice effect. Moreover, in Exp.2, the benefits differed as a function of subjects' confidence in their retrieval performance: the effect of retrieval practice only emerged for high-confidence trials with higher than 56% confidence. In summary, the retrieval practice only facilitates the retention of correct answers with high confidence.


: The importance of the blood acid-base state and of the electrolyte metabolism in pathogenesis of inflammatory diseases of internal genitalia is well known and these indexes were taken to clarify the effect of the application of therapeutic mud for treatment of these kinds of inflammations, especially in the sub-acute stage (after abortions). Under investigation were 92 women aged 19 to 36 years divided into 3 groups. The 1st group (60 women) were treated by common medications, including antibiotics, during the acute and sub-acute states. The 2nd group (32 women) in the acute stage (5-8 days) were treated the same as the 1st group while in the sub-acute stage therapeutic mud from Azov Sea was used for treatment. The 3rd group (25 healthy women) served as a control. It was found that the metabolic acidosis caused by the postabortion inflammation were normalized in all the women treated with the mud. The mud therapy influenced positively on the electrolyte metabolism also. A high concentration of potassium in blood, that occurred in 26.6% of the women from the 1st group and in 31.2% of the women from the 2nd group was completely normalized. After treatment 34 women (61.6%) in the 1st group and 26 women (81.2%) in the 2nd group recovered completely. After 1 year, relapse of inflammation occurred in 22 women (36.6%) from the 1st group, and only in 1 woman from the 2nd group. The conclusion was made that the mud therapy has to be recommended for treating postabortional inflammatory diseases of the internal genitalia.


Background and Purpose— Obesity has been associated with increased cardiovascular risk in atrial fibrillation, but little is known in elderly patients with atrial fibrillation. Methods— Post hoc analysis of data from the AMADEUS (Evaluating the Use of SR34006 Compared to Warfarin or Acenocoumarol in Patients With Atrial Fibrillation) trial. Results— We studied 1588 elderly patients, who were categorized as normal body mass index (BMI, 18.5–25 kg/m2; n=515 [32.4%]), overweight (BMI, 25–30 kg/m2; n=711 [44.8%]), and obese (BMI≥30 kg/m2; n=362 [22.8%]). There was a significant reduction in the composite outcome of cardiovascular death and stroke/systemic embolism with increasing BMI category, being 5.0%, 3.2%, and 1.5% per 100 patient-years, respectively (P for trend=0.01). Cox proportional hazards analysis found obesity to be associated with a lower risk of the primary composite outcome (hazard ratio, 0.29; 95% confidence interval, 0.11–0.77; P=0.01). In the warfarin arm (n=814), multivariate logistic regression analysis demonstrated that obesity was independently related to higher odds of time in therapeutic range ≥60% (odds ratio, 1.84; 95% confidence interval, 1.21–2.80; P=0.004). Conclusion— Obesity was associated with a lower stroke and mortality rate in elderly anticoagulated atrial fibrillation patients. Obesity was related to good quality anticoagulation control.


Purpose
This paper aims to explore a multi-stakeholder perspective on brand meaning co-creation in the context of the Olympic Games as a unique mega sports event brand with a strong brand identity, to understand how the brand manager may integrate such co-created meanings in a negotiated brand identity.

Design/methodology/approach
Using a qualitative methodology, the paper provides a tentative framework of co-created Olympic brand meanings by exploring the narratives of stakeholders' brand experiences of the brand. Sixteen semi-structured interviews with a purposive sample of Olympic stakeholders were conducted and analysed to identify key meanings associated with the Olympic brand.

Findings
Through their transformational and social experiences of the Olympic brand, stakeholders co-create brand meanings based on Olympic values of excellence, friendship and respect. However, at the same time, they offer their own interpretations and narratives related to competing meanings of spectacle, exclusion and deceit. Alternative brand touchpoints were identified, including blogs; fan and sports community forums; educational and academic sources; and historical sources and literature.

Practical implications
The brand manager must become a brand negotiator, facilitating multi-stakeholder co-creation experiences on a variety of online and offline engagement platforms, and exploring how alternative brand touchpoints can be used to access co-created brand meanings.

Originality/value
The study contributes to tourism branding literature by providing exploratory evidence of how brand meanings are co-created in the relatively under-researched multi-stakeholder sports mega-event context.


Gyrinops walla (Walla patta) is the only member of the family Thymelaeaceae naturally growing in Sri Lanka which produces agarwood, a fragrant resinous tissue which is highly demanded in the world market. Since natural formation is rare, fungal inoculations are commonly practiced to induce agarwood formation in Aquilaria species. However, the response of live wood tissues of G. walla for the growth of fungi has not been investigated, the present study was conducted to identify the behavior of the fungal spores on the G. walla stem tissues after the inoculation. Non-resinous, non-wounded, fresh G. walla stem samples were collected minimising contaminations and water loss from three different mature trees with the age of 10-15 years in three different locations. Samples were cut into 3.0×3.0×3.0 cm and cutting surfaces were sterilised and 5 ml of spore suspension of 107 spores ml -1 and 105 spores ml-1 of Aspergillus niger and Fusarium solani respectively were applied to four vertical surfaces of the wood cube until those were saturated and placed in a sterile moist chamber. Three replicates were used for each tree for both fungal species and spore germination in sterile distilled water was used as the control. Percentage of spore germination on live tissues was determined at every 3 hour intervals for 36 hours and data were analysed by Kruskal-Wallis test using MINITAB software. Results revealed that the percentage of germination was higher in F. solani spores than A. niger after 3 hours of incubation on fresh G. walla tissues. Further at the 15th hour, germination was almost equal in both A. niger and F. solani. Though A. niger germination was lower until the 15th hour, it was gradually increased with time and obtained the maximum germination percentage at about nearly 70% at the stationary phase. However, F. solani germination was lower after the 15th hour and reached its maximum level of about 66%. However, the germination of A. niger and F. solani spores on live G. walla wood were not significantly different (p=0.817). The findings of the present study showed that percentage of spore germination of A. niger on live wood (70%) was higher than in water (60%). Similarly F. solani also showed an increment of germination on live wood (66%) than in water (53%). Results revealed that the germination on live wood tissues of A. niger and F. solani was not inhibited by biochemical/ phytochemical compounds in wood of G. walla on the cutting surface. The findings demonstrated the compatible interactions between two tested fungal species and G. walla stem tissues. Keywords: Germination, Gyrinops walla, Aspergillus niger, Fusarium solani, Wood tissues


We study a multilevel Schwarz preconditioned Newton-Krylov algorithm to solve the Poisson-Boltzmann equation with applications in multi-particle colloidal simulation. The smoothed aggregation-type coarse mesh space is introduced in collaboration with the one-level Schwarz method as a composite preconditioner for accelerating the convergence of a Krylov subspace method for solving the Jacobian system at each Newton step. The important feature of the proposed solution algorithm is that the geometric mesh information needed for constructing the multilevel preconditioner is the same as the one-level Schwarz method on the fine mesh. Other components, such as the definition of the coarse mesh, all the mesh transfer operators, and the coarse mesh problem, are taken care of by the Trillinos/ML packages of the Sandia National Laboratories in the United States. After algorithmic parameter tuning, we show that the proposed smoothed aggregation multilevel Newton-Krylov-Schwarz (NKS) algorithm numerically outperforms than smoothed aggregation multigrid method and one-level version of the NKS algorithm with satisfactory parallel performances up to a few thousand cores. Besides, we investigate how the electrostatic forces between particles for the separation distance depend on the radius of spherical colloidal particles and valence ratios of cation and anion in a cubic system. AMS subject classifications: 65F08, 49M15, 65M55, 68W10


This position paper explores the practices and challenges of distributed requirements gathering through case studies taken from the telecommunications, gaming, and factory automation domains. The social organization of the participants, their formal and informal collaborations, and adoption of relevant tools are modeled as requirementsgathering collaborative networks. The study identifies specific problems and challenges that were observed in the three case studies.


The age‐dependent penetrance of organ manifestations in Marfan syndrome (MFS) is not known. The aims of this follow‐up study were to explore how clinical features change over a 10‐year period in the same Norwegian MFS cohort. In 2003–2004, we investigated 105 adults for all manifestations in the 1996 Ghent nosology. Ten years later, we performed follow‐up investigations of the survivors (n = 48) who consented. Forty‐six fulfilled the revised Ghent criteria. Median age: females 51 years, range 32–80 years; males 45 years, range 30–67 years. New aortic root dilatation was detected in patients up to 70 years. Ascending aortic pathology was diagnosed in 93 versus 72% at baseline. Sixty‐five percent had undergone aortic surgery compared to 39% at baseline. Pulmonary trunk mean diameter had increased significantly compared to baseline. From inclusion to follow‐up, two patients (three eyes) developed ectopia lentis, four developed dural ectasia, four developed scoliosis, three developed incisional or recurrent herniae, and 14 developed hindfoot deformity. No changes were found regarding protrusio acetabuli, spontaneous pneumothorax, or striae atrophicae. The study confirms that knowledge of incidence and progression of organ manifestations throughout life is important for diagnosis, treatment, and follow‐up of patients with verified or suspected MFS.


When isolated segments of human descending thoracic aorta were caused to change their volume rapidly and continuously in sinusoidal fashion with pulse pressures and pulse rates maintained in the physiological range, the resulting pressure-volume curves showed slight but consistent increases in stiffness, compared to pressure-volume curves obtained on the same specimens when inflated stepwise. There was introduced into the pressure measuring system a time lag of sufficient magnitude to eliminate the hysteresis loop. The extent of hysteresis in the aorta was not determined because time lags in the aorta could not be distinguished from time lags in the measuring equipment. Submitted on September 10, 1958


The determination of 11-dehydrothromboxane B2 (11-dehydro-TXB2) from unextracted human urine was studied by means of a specific radioimmunoassay based on the use of the 125I-labelled tyrosine methyl ester derivative of 11-dehydro-TXB2 as radioligand. The assay was evaluated in various incubation media by either dextran-coated charcoal (DCC) or polyethylene glycol (PEG) separation. Both the non-specific and the specific binding showed high variation in different assay media with DCC separation but with the use of PEG separation, however, the non-specific binding was constant. The verification tests carried out in both separation systems revealed a high variation of equilibrium with the individual samples. The albumin content of urine is proposed to be one important factor underlying poor reliability of direct radioimmunoassay. Both the immunoreactivity profiles observed after HPLC separation and the apparent 11-dehydro-TXB2-like immunoreactivity values determined by direct radioimmunoassay demonstrated that the unextracted urine contained a high ratio of interfering materials. It is concluded that efficient purification of human urine before determination is essential when this type of 125I-labelled radioligand is employed in radioimmunoassay.


The connecting rod (CR) is the main moving parts and an important component of engine. If the reliability is not strong enough, fatigue failure of the CR would occur, thereby leading to component fracture and engine failure. So much so that CR fracture. It will lead to engine fault as well as serious outcome. In this paper, stress distribution and fatigue life of CR in light vehicle engine were analyzed using the commercial 3D finite element software, ANSYS TM . The results showed that the medial surface of small end will be the critical surface whereby damage will initiate at the maximum stretch condition. The maximum stress and deformation values are 190.23 MPa and 0.0507mm respectively. The critical location is at the transition region between the big end and connecting shank at maximum compression condition. The maximum stress and deformation values are 459.21 MPa and 0.0702283 mm respectively. Safety factor is 1.584. In order to increase the reliability of CR, some improvement is carried out. Safety factor of CR increases by 59%.


Background: Sperm differentiation during spermatogenesis is highly regulated by different caspases and oxidant-antioxidant mechanisms. Objective: To assess the levels of the caspase -3 and total antioxidant capacity (TAC) in seminal plasma and evaluate its role in the pathogenesis of idiopathic infertile male in comparison with healthy individuals. Patients and Methods: Seminal fluids were collected from seventy males with idiopathic infertility and twenty male with proven fertility and were analyzed for the level of caspase -3 and TAC in seminal fluid and their correlation with seminal fluid quality parameters. Results: The results revealed that men with idiopathic infertility have significantly higher level of caspase-3 activity. Seminal TAC levels were significantly lower in those with idiopathic infertility compared with fertile men. A negative correlation was noticed between sperm quality parameters and TAC levels in idiopathic infertile men. Conclusion: Increased apoptotic index and decreased TAC activity are two important markers in idiopathic male infertility.


This paper introduces a way to systematically investigate the effect of compliant prismatic spines in quadrupedal robot locomotion. We develop a novel spring-loaded lockable spine module, together with a new Spinal Compliance-Integrated Quadruped (SCIQ) platform for both empirical and numerical research. Individual spine tests reveal beneficial spinal characteristics like a degressive spring, and validate the efficacy of a proposed compact locking/unlocking mechanism for the spine. Benchmark vertical jumping and landing tests with our robot show comparable jumping performance between the rigid and compliant spines. An observed advantage of the compliant spine module is that it can alleviate more challenging landing conditions by absorbing impact energy and dissipating the remainder via feet slipping through much in cat-like stretching fashion.


In this paper, a new current-mode second-order square-root-domain general notch filter is proposed. The design is based on the state-space synthesis method with two subcircuit; square-root and squarer/divider circuits. In the circuit, the input and the output values, and dominant variables are all currents. Only MOS transistors and grounded capacitors are required to realize the filter circuit. Three cases of the second-order notch filter were obtained. The regular notch was obtained when ωn = ωp, the lowpass notch was obtained when ωn > ωp, and the highpass notch was obtained when ωn < ωp. The center frequency, and the notch frequency of the filter can be electronically tuned by changing external currents. Time and frequency domain simulations are performed using PSPICE program for the filter to verify the theory and to show the performance of it. For this purpose, the filter is simulated by using TSMC 0.35 μm Level 3 CMOS process parameters.


This experiment was carried out to provide some information on the change of dry matter productivity and feed value (forage quality) according to growth stages of late-maturing variety, Hwasan 101, Italian ryegrass (Lolium multiflorum Lam.) in Grassland and Forages Division, National Institute of Animal Science, RDA, Suwon from 2000 to 2002. In Suwon, booting, first heading, full heading and flowering stages of cv. Hwasan 101 were May 8, 18, 28 and June 3, respectively. Dry matter (DM) and total digestible nutrients (TDN) yields of Hwasan 101 were tendency to be increased by the progress of growth. DM yield in first heading stage increased 50% more than DM 4,818 kg/ha of booting stage, and also DM yield in full heading stage was increased by 26% of DM 7,244 kg/ha of first heading. Crude protein content was decreased gradually by the progress of growth, which were 18.32, 15.12, 12.58 and 12.36% in booting, first heading, full heading and flowing stage, respectively. Acid detergent fiber and neutral detergent fiber contents was increased and in vitro dry matter digestibility decreased gradually with progress of growth, but there was no difference between full heading and flowering stages. Considering DM yield and feed value of Italian ryegrass, the suitable cutting times seems between full heading and flowering stage.


In this paper, a pilot-based MMSE technique is proposed for estimating the channel impulse responses of multiple co-channel users in the receiver of TETRA digital trunked system. Based on signal and channel models of TETRA digital trunked system, it allows time variation of the channels with and between the training sequences. The performance of this method is verified by simulations


A forty-year-old man presented with multiple, asymptomatic, raised lesions of one-year duration. Well-defined, non-tender papules and nodules were seen on the normal looking skin. Few giant lesions were seen over the lower legs and feet. Diffuse infiltration of the face and ears was present. Bilateral ulnar, radial cutaneous, sural and right superficial peroneal nerves were thickened. Slit-skin smear from a nodule had a BI of 6+. Biopsy showed features of histoid leprosy. The lesions had developed de novo, without previous dapsone monotherapy.


MCL is an aggressive type of non-Hodgkin lymphoma with poor prognosis and short survival. The genetic hallmark of MCL is the t(11;14) translocation leading to an aberrant expression of the oncogene cyclin D1. Several other deregulated pathways also contribute to the pathogenesis of MCL, including the DNA damage response-, B-cell receptor- and PI3K/mTOR pathway. Deregulated oncogenic pathways not only induce proliferation but also frequently lead to a constitutive stress signal. A common response to cellular stress is the transcriptional up-regulation of pro-apoptotic genes. By analyzing mRNA expression of these genes in MCL cells we found high levels of the pro-apoptotic Bcl-2 family member NOXA (PMAIP1). NOXA transcript was significantly higher in MCL cell lines as well as in samples from MCL patients when compared to other cancer cell lines and PBMCs. To analyze if these high transcript levels depend on activation of oncogenic pathways, we treated the MCL cells with a panel of inhibitors of different signaling pathways and found that the inhibition of the PI3K/mTOR pathway led to a significant reduction of NOXA mRNA levels. These results indicate that this signaling axis is not only acting pro-survival but also mediates up-regulation of NOXA mRNA. In contrast to the high transcript levels, NOXA protein is low in MCL cells. We found that NOXA protein is unstable with half-life times of 15-30 min. Inhibitors of the ubiquitin proteasome system (UPS) such as bortezomib, MG-132 and the cullin-ubiquitin ligase inhibitor MLN4924 stabilized NOXA and led to a strong accumulation of the protein. This was accompanied by a rapid induction of cell death. Interestingly, similar effects could be observed using the fatty acid synthase inhibitor orlistat indicating that fatty acid metabolism is also involved in the UPS. Reducing the high NOXA mRNA levels by treating the cells with the PI3K/mTOR dual-inhibitor Bez235 or using RNA interference prior to treatment with UPS inhibitors significantly reduced cell death and NOXA protein accumulation. These results indicate that the high NOXA mRNA levels are essential for the response of MCL cells to proteasomal inhibitors. In summary, our results show that MCL have a constitutive signal mediated by the PI3K/mTOR pathway resulting in a high expression of NOXA mRNA. The cells survive by rapidly degrading the NOXA protein. Therefore, an effective strategy to kill MCL cells is to target the high NOXA protein turnover in these cells by inhibiting the proteasome ubiquitin system. This mechanism apparently underlies the in vitro activity of bortezomib which is already used in the clinic for treatment of patients with mantle cell lymphoma. Moreover, also other inhibitors such as MLN4924 or increasing the metabolic stress by orlistat might be promising to selectively kill MCL cells. Citation Format: Michael A. Dengler, Andrea Weilbacher, Matthias Gutekunst, Annette M. Staiger, Heike Horn, German Ott, Heiko van der Kuip, Walter E. Aulitzky. High NOXA (PMAIP1) transcript levels combined with a short-lived NOXA protein primes mantle cell lymphoma (MCL) cells for death by inhibition of the ubiquitin proteasome system. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1717. doi:10.1158/1538-7445.AM2013-1717


Investigations were carried out in 38 patients with acute leukemias or with chronic myeloid leukemias in the blast phase and a correlation was made between the cytogenetic aspect and the survival time. The interpretation of results was made by the Weibull distribution function. It was mathematically demonstrated that in the leukemic patients with chromosomal aberrations there is a preclinical period of over 40 months necessary for the formation of these anomalies. Chromosomal aberrations, the absence of mitoses and age over 70 proved to be aggravating factors in the diseases investigated.


Abstract This study aimed at providing a reference for the selection of energy tonics for sportsmen engaging in high-strength training and competitions by investigating the effects of the intake of beverages containing glycerinum before exercise at high temperature on the physical functions of bicyclists. Forty bicyclists were selected as research subjects and divided into a test group and a control group. The indexes such as urine volume, weight loss value, oxyhemoglobin saturation, blood lactic acid, nervous tension difference value and reaction time were detected after the sportsmen took different beverages. The conclusions were drawn after the data were analyzed by SPSS ver. 18.0. The research results demonstrated that, the intake of beverages containing glycerinum could reduce urine output and lower weight loss value, prolong the endurance riding time of bicyclists in high temperature environment, reduce the concentration of blood lactic acid, improve the aerobic exercise ability of sportsmen, relieve nervous tension and fatigue, and improve physical functions.


Cervical cancer remains within the three most common cancer in women worldwide and is still the commonest female cancer in 41 of 184 countries. Within Latin America, cervical ranks as the most common cancer among women in Bolivia and Peru and the second most frequent in Brazil, Colombia, Ecuador, Mexico, Paraguay, The Guyanas, Surinam and Venezuela. Due to its relatively early age at onset, it ranks among the three most frequent cancers in women aged below 45 years in 82% of all countries in the world irrespective of their screening practices. DOI:  http://dx.doi.org/10.21149/spm.v58i2.7777


A limitation of current deep learning (DL) approaches for single-cell RNA sequencing (scRNAseq) analysis is the lack of interpretability. Moreover, existing pipelines are designed and trained for specific tasks used disjointly for different stages of analysis. We present scANNA, a novel interpretable DL model for scR-NAseq studies that leverages neural attention to learn gene associations. After training, the learned gene importance (interpretability) is used to perform downstream analyses (e.g., global marker selection and cell-type classification) without retraining. ScANNA's performance is comparable to or better than state-of-the-art methods designed and trained for specific standard scRNAseq analyses even though scANNA was not trained for these tasks explicitly. ScANNA enables researchers to discover meaningful results without extensive prior knowledge or training separate task-specific models, saving time and enhancing scRNAseq analyses.


Until recently, the pathogenesis of purulent hidradenitis was a little- and sporadically studied issue, which invariably created difficulties in the therapeutic treatment of this disease. Its often severe recurrency rate, high incidence and the lack of effective treatment have predetermined the urgency of the problem and raised the scientific and practical interest in this field among the scientists worldwide. Recent data indicate a significant role of damage-associated molecular patterns (DAMP) and the activation of congenital immunity, associated with Th17 lymphocytes, in the development of inflammatory disease. Likewise, the violation of the transmission of the cellular Notch signaling pathway plays an important role in the development of purulent hidradenitis.


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This volume includes guides for 15 of the field trips held in conjunction with the 2003 GSA Annual Meeting in Seattle. Topics covered include Glacial Lake Missoula and the Clark Fork Ice Dam; the Sauk Sequence in western Utah; the geology of wine in Washington state; the Columbia River basalt and Yakima Fold Belt; Alpine glaciation of the North Cascades; and recent geoarchaeological discoveries in central Washington. Quaternary geology of Seattle, engineering geology in the central Columbia Valley, and the tephrostratigraphy and paleogeography of southern Puget Sound also are covered, as are trips to central Cascade Range and the White River.


In this article a Vector Symbolic Architectures is purposed to implement a hierarchical Graph Neuron for memorizing patterns of Persian/Arabic isolated characters. The main challenge in this topic is using Vector Symbolic representation as a one-layered design for neural network while maintaining the previously reported properties and performance characteristics of hierarchical Graph Neuron. The designed architecture is robust to noise and enables a linear (with respect to the number of stored entries) time search for an arbitrary sub-pattern. The proposed method was implemented on a standard Persian database and the obtained results showed the ability of (not necessarily better) Graph neuron to recognize the Persian isolated character patterns.


A four-channel transimpedance amplifier to be used in a compact disc front-end is presented. The overall transimpedance gain of the four channels is set by controlling the gain of a gain-controlled buffer. This solution requires for setting the gain of the four channels only one external precise resistor. The system has been realized in a 0.7 /spl mu/m BiCMOS technology. It consumes 40 mW from a single 5 V supply and achieves 36 dB SNR for an input signal with a 0-3.2 MHz bandwidth, without requiring an equalizer in the signal path.


This study deals with the outcomes of labour inspection that extend beyond the traditional performance indicators – such as number of inspections, number of fines issued, number of workers assisted, etc. – and it examines the impacts of labour inspection on social and economic development. It provides the analytical lenses and investigative tools with which to examine the perception of when and how the interventions of labour inspectors promote positive changes in the mobilization and protection of workers, as well as in the reorganization of production and business practices, through legal, managerial and technological tools.


deliver the 2004 AMSUS international keynote address and I am very grateful to the programme organisers for giving me this opportunity to take stock of the present status of military medicine and, at this very fitting time, to consider the topic of Military Health Care in a Changing World. There has certainly been enormous change in the world throughout the past twenty years during which we have moved from the static stand-off of two great military alliances namely NATO and the Warsaw Pact each with large-scale combat medical provision based largely in the then-divided Europe to campaigns to combat the threats of global terror and to respond to regional crises necessitating rapid-reaction forces supported by lean and flexible medical facilities.Today's circumstances demand smaller more flexible medical services able to deliver a greater medical capability of a higher quality. These medical services need to be expeditionary in nature with many held at high readiness. (Our very recent and extremely short notice deployment to the Ivory Coast to evacuate British and other entitled foreign nationals is an example of the sort of operation that we may all face in the future). The key defence medical outputs, however, remain the same: trained and deployable operational medical capability; and the maintenance of fit service personnel by effective health promotion, education and injury prevention and by the provision of prompt and effective diagnosis, treatment and rehabilitation. I would like to map out how the United Kingdom's Defence Medical Services have met these challenges by reconfiguring the provision of healthcare both at home and on deployed operations. I will cover not only the nature of the operations and the political influences that have dictated our size and shape, but the changes in relationships with civilian colleagues and other Nations with whom we now work so closely. Associated with this we have had to respond to new national clinical quality initiatives demanding new standards of Clinical Governance in peace-time and on operations and to firmly establish Military Medicine on a sound scientific and evidence base. I will describe how we provide healthcare at home to the non-deployed military population as that is critical to being able to deploy a fighting force that is fit for task, and I will cover the changing face of medical support on deployed operations and how we are relying more on multinational cooperation to burden-share (for example through organisations such as NATO, the EU or through bilateral agreements and coalitions). Firstly, however, I will set the scene by briefly describing the recent history of the UK medical services which I inherited and which will be familiar to some of you. During the Cold war we contemplated a potentially large-scale war with the concomitant threat of nuclear devastation affecting much of Europe and possibly North America. Large armies composing NATO and the Warsaw Pact faced each other in Europe across the North German Plains. In Europe the United Kingdom had extensive medical support in the form of mobile Field Hospitals and up to five Rear-based hospitals. In 1994 the UK still had eleven Military Hospitals, seven in the British Isles, two in Germany with a Royal Naval Hospital in Gibraltar and a Royal Air Force hospital in Cyprus. Unexpectedly, however, in 1982 Great Britain suddenly found itself in an expeditionary conflict 8000 miles from home in the Falkland Islands in the South Atlantic. We were not well configured for such an event and we learned many lessons including the need to deploy smaller units more rapidly than before and how to deploy for operations which had not necessarily been planned or exercised. This brief, but intense, conflict highlighted some capability deficits leading to reviews of the principles of battle surgery, the management of major burns and of the importance of recognising and managing the consequences of battle stress. In addition we had to reconsider the implications of longrange logistics and strategic aeromedical evacuation. Following this brief expeditionary conflict the UK revisited its defence medical strategy in order to revitalise our expeditionary capability whilst maintaining our enduring contribution to the defence of Western Surgeon Vice Admiral Ian Jenkins Surgeon General of Her Majesty's Armed Forces Association of Military Surgeons of the United States, Denver, Colorado The Changing World Of Military Health Care


In this paper we present a model for polyhedral contact that may be llsed in a physically based simulation. The model is based on a geometric analysis formulated as a static problem in three-dimensional space. The geometric contact analysis between a pair of objects determines the set of surface areas which are in contact and their associated normals. From these areas and normals the dynamics simulator can formulate equations that model the physical consequences of the contact. For areas that come into contact with high relative velocity, these equations model the collision impulse force. The pushing and sliding behavior of low relative velocity contact is modeled by the addition of kinematic constraints over the areas in contact. The geometric analysis consists mainly of collecting adjacent contact points into separate regions which share the same normals. Since non-convex polyhedra are allowed, the intersection can produce surface areas which have more than one associated normal The geometric modeler can provide this entire set of normals or any small subset which spans the same space, whichever the dynamics modeler requires. When a contact region persists from time step to time step in the simulation, the contact analysis can return the normals for that region from the previous time step rather than recalculating them. This temporal coherence of the normals can resolve certain cases where the normals of a region are indeterminate. The interpretation of the contact requires a full set-theoretic intersection of the two objects. The objects in question are assumed to be already in contact or in close proximity. An efficient and robust implementation of the intersection is achieved by nsing the brep-index data structnre in conjunction with a back-face culling technique based on relative velocities at surface points.


Both the Averch-Johnson (A-J) model and the Chamberlin model fail to consider the value of excess capacity to consumers. Service industries, whether they are regulated or not, will usually have excess capacity in the Chamberlinian sense because this capacity conserves time for consumers. This paper examines a model of the taxi industry where allowance is made for capacity to affect the value or quality of the service through its effect on waiting time. The central issue is to determine equilibrium output, capacity, and the utilization of capacity when the market is organized as a franchised monopoly, through a medallion system, and when there is free entry, and to exhibit the relationship among these variables and prices, cost of capacity and output, and policies of the regulator. It is found that many of the characteristics of taxi markets that would appear to confirm the monopolistic-competition thesis arise because of the nature of regulation of these markets.


The effects of clenbuterol, a selective beta 2-agonist, on isolated smooth muscle preparations from the rabbit bladder body, bladder base and proximal urethra have been investigated. The inhibitory effects on resting tension and acetylcholine- and field stimulation-induced contractions in the bladder body were compared with those of flavoxate, atropine, and verapamil. Clenbuterol (10(-10)-10(-7) M) had a strong, concentration-dependent relaxant effect on resting tension of the bladder body, and the relaxant effect was antagonized by propranolol. However, clenbuterol had little effect on the bladder base or proximal urethra. Isoproterenol, a non-selective beta agonist, gave a similar result, but was less potent than clenbuterol. Flavoxate failed to reduce the resting tension, but rather enhanced the spontaneous rhythmic contraction in a concentration-dependent manner. Atropine had little effect. Verapamil produced a concentration-dependent relaxation in the bladder body. Acetylcholine-induced contraction in the bladder body was completely inhibited by pretreatment with atropine (10(-7) M). Clenbuterol, flavoxate, and verapamil concentration-dependently inhibited acetylcholine-induced contraction. Field stimulation-induced contraction in the bladder body was not completely inhibited by atropine. However, the residual contraction was completely inhibited by tetrodotoxin. Clenbuterol, flavoxate, and verapamil concentration-dependently inhibited field stimulation-induced contraction. The inhibitory effects of clenbuterol and verapamil were antagonized by an application of propranolol and an increase in external Ca, respectively. The data suggest that the selective relaxant effect of clenbuterol on the bladder body is due to beta 2-antagonistic action, resulting in the inhibition of the contractile response to acetylcholine or field stimulation. Also, its response was different from that of the other drugs used.


Intrusion detection in Wireless Sensor Network (WSN) is of practical interest in many applications such as detecting an intruder in a battlefield. The intrusion detection is defined as a mechanism for a WSN to detect the existence of inappropriate, incorrect, or anomalous moving attackers. For this purpose, it is a fundamental issue to characterize the WSN parameters such as node density and sensing range in terms of a desirable detection probability. In this paper, we consider this issue according to two WSN models: homogeneous and heterogeneous WSN. Furthermore, we derive the detection probability by considering two sensing models: single-sensing detection and multiple-sensing detection. In addition, we discuss the network connectivity and broadcast reachability, which are necessary conditions to ensure the corresponding detection probability in a WSN. Our simulation results validate the analytical values for both homogeneous and heterogeneous WSNs.


Only five binary systems have been found to emit at TeV energies. Each of these systems is composed of a massive O or B type star and a compact object (black hole or a pulsar). The type of compact object and the origin of the gamma-ray emission is unknown for most of these systems. Extending spectral observations to higher energies can help disentangle the nature of the compact object as well as the particle acceleration mechanisms present. Interestingly, the TeV emission from these systems does not always coincide with their emission in GeV or X-ray, which is how many such systems have been originally discovered. Increased coverage of these systems may allow HAWC to see precisely when in the orbit the TeV emission begins and ends. The HAWC Observatory detects TeV gamma-rays with high sensitivity, covering over two-thirds of the overhead sky every day. Applying a stacking method to known TeV binary systems can help HAWC enhance the signal from TeV binaries above the steady background from other sources in the galaxy. We will present results from this stacking analysis using 760 days of HAWC data.


The authors determined parameters of innate immunity (IIM) in patients with acute and chronic forms of viral hepatitis B and C and in persons with subclinic infections caused by hepatitis B and C viruses.The results obtained demonstrated that clinically manifested (acute and chronic) and subclinic forms of infections caused by hepatitis B and C viruses were accompanied by development of IIM depression. At the same time the signs of IIM's depression in patients with clinically manifested forms of infections were expressed in higher degree than in persons with subclinical forms of infections.


We summarize the pathogenesis of animal lentiviruses (visna-maedi virus, caprine arthritis and encephalitis virus, and equine infectious anemia virus), which have raised considerable interest since the discovery of human lentiviruses. The human lentiviruses possess structural, genetic, and clinical properties similar to those of animal lentiviruses. We describe the different mechanisms of and the principal work on reverse transcriptase inhibitors of animal lentiviruses, such as HPA-23, phosphonoformate, or 2',3'-dideoxynucleosides. Animal viruses of this family may serve as models for infection with human lentiviruses such as human immunodeficiency virus, the etiologic agent of AIDS.


Mosquitoes spread deadly infections around the world. Since decades Bacillus thuringiensis (Bt) δ-endotoxins have been used successfully as a biopesticide for controlling mosquito larvae. However, over a few years, mosquito larvae have evolved tolerance against Bt δ-endotoxins, rendering them ineffective for mosquito control. Such a problem entails the development of improved toxins with enhanced toxicity, affinity towards a wide range of mosquito receptors and ability to overcome or delay the resistance buildup. In this study, using in silico tools, we aimed to design a fusion protein by fusing active region of Bt subsp. jegathesan Cry11Ba protein with Aedes aegypti TMOF (trypsin modulating oostatic factor). Using computational study, the fusion protein was validated and its mosquitocidal potential was determined through molecular docking against cadherin and aminopeptidase N midgut receptors of Aedes aegypti, Anopheles gambiae and Culex quinquefasciatus. Molecular docking revealed that from Cry11Ba-TMOF fusion protein, domain II amino acids of Cry11Ba protein showed hydrogen bond interactions with cadherin and aminopeptidase N receptors of the targeted mosquitoes. These results conclude that Cry11Ba-TMOF fusion protein has a strong affinity for the receptors of Ae.aegypti, An.gambiae and Cx.quinquefasciatus. Thus the designed fusion protein can be used as a potent mosquitocidal agent for the control of targeted mosquitoes.


A 34-year-old male patient was referred to us as a case of non-resolving suprachoroidal hemorrhage. History revealed decrease in right eye vision following trauma to forehead. B scan ultrasonography (USG) of the right eye showed a high-reflective structure indenting the globe. It turned out to be an inferiorly displaced fracture fragment from the orbital roof on computerized tomography (CT) scan. The choroidal elevation disappeared after open reduction of the fracture fragment and patient had good recovery of vision. USG and CT scan were helpful in the diagnosis and management of this case.


A special emergency ward for paediatric patients was established at the University Hospital in Nantes on November 7, 1990. Both medical and surgical patients less than 15 years, 3 months of age are admitted. The initial organization of the ward (facilities personnel, on call duty) are described for the emergency paediatric surgery unit. The activity of the unit over a 4 month period (from June to September 1992) was retrospectively examined. During this period, 4,438 children were referred to the emergency ward and 2,905 (64.8%) involved a surgical pathology. The epidemiological characteristics of the patients (age, geographic origin, day and hour of admission), the causal pathology, the examinations and procedures performed, and outcome (length of stay in the ward long-term outcome) were studied. Based on these results, the authors analyzed the factors leading to dysfunction and proposed improvements in the organization of this emergency ward.


Four children aged 9 months, 11 months, 1 year, and 1 year 4 months, respectively, presented to the emergency room with an acute tender swelling of the sternum or sternocostal cartilage. Three of these resolved spontaneously within a few weeks of presentation, and in one curettage was carried out. We were unable to find any other references in the literature of this condition occurring in infants. Acute swelling of the chest wall frequently is due to neoplastic or infectious disease, and culture of aspirated material and possibly biopsy has been recommended in all cases. Our experience suggests that this may not always be necessary.


OBJECTIVE
To determine why students switch their career choices during the preclinical years of medical school.

DESIGN
Two questionnaires were administered: the first at the beginning of medical school and the second about 3 years later just before students entered clinical clerkship.

SETTING
University of British Columbia, University of Alberta, University of Toronto, University of Ottawa, Queen's University, University of Western Ontario, University of Calgary, and McMaster University.

PARTICIPANTS
Entering cohorts from 10 medical school classes at 8 Canadian medical schools.

MAIN OUTCOME MEASURES
Proportion of students who switched career choices and factors that influenced students to switch.

RESULTS
Among the 845 eligible respondents to the second survey, 19.6% (166 students) had switched between categories of family medicine and specialties, with a net increase of 1.2% (10 students) to family medicine. Most students who switched career choices had already considered their new careers as options when they entered medical school. Seven factors influenced switching career choices; 6 of these (medical lifestyle, encouragement, positive clinical exposure, economics or politics, competence or skills, and ease of residency entry) had significantly different effects on students who switched to family medicine than on students who switched out of family medicine. The seventh factor was discouragement by a physician.

CONCLUSION
Seven factors appear to affect students who switch careers. Two of these factors, economics or politics and ease of residency entry, have not been previously described in the literature. This study provides specific information on why students change their minds about careers before they get to the clinical years of medical training.