OBJECTIVE: This study aimed to investigate the effect of the COVID-19 outbreak on infertile couples dealing with stress and anxiety during in vitro fertilization treatment.
STUDY DESIGN: 252 infertile patients who applied for in vitro fertilization treatment were included in this cross-sectional study. Data were collected via four data collection tools including socio-demographic form, COVID-19 Inventory (COVID-I), COMPI fertility problem stress scale (COMPI-FPSS), and state-trait anxiety scale. Data analysis was conducted by SPSS statistical software included statistical analysis such as averages, standard deviations, correlation, regression, and t-test.
RESULTS: Both negative and weak correlations were found between COMPI fertility problem stress scale and subscales of state-trait anxiety scale as well as the total score of state-trait anxiety scale. In terms of socio-demographic characteristics of the participants and their responses in state-trait anxiety scale and ISS forms, the correlation coefficients were also so low. The results also showed that public officials, health professionals, and educators showed lower state-trait anxiety scale (stress-related anxiety) scores.
CONCLUSION: During the COVID-19 pandemic, there was an increase in spontaneous pregnancy expectations. Although participants were mostly stressed because of the COVID-19 outbreak, they didn't change their in vitro fertilization treatment plans during the outbreak.


Article about the new form of trade in a network the Internet. Advantages of dropshipping open to the Russian manufacturers and businessmen new horizons in international trade and marketing. The author considers features of evolution and a role of dropshipping in electronic commerce of a new millennium.


Describes the development of an adaptive fuzzy logic system that continuously estimates cardiac output (CO) from the blood pressure waveform. This fuzzy logic system was evaluated using 133 sets of experimental data from 10 baboons. The mean error (or bias) between the model-estimated CO and the thermodilution-measured CO was 0.001 liter/min (4.0%) with a standard deviation (or precision) of 0.97 liter/min (27.7%) when using the aortic blood pressure waveform. The mean error (or bias) was 0.045 liter/min (5.9%) with a standard deviation (or precision) of 0.97 liter/min (26.9%) when using the radial blood pressure waveform. These results demonstrate the significant potential of using a fuzzy logic model to estimate cardiac output from blood pressure waveforms.


Compared to the better known Second World War entertainment organisations , like ENSA, Stars in Battledress and the RAF Gang Shows, the Bengal Entertainment Services Association (BESA) was small and short lived. Yet it was in the right place at the right time and became a key component in General Bill Slim's plans to rescue Burma Corps' morale following the retreats of 1941-1942. Its contribution to forces welfare was equally important in 1943-1944 after the creation of the 14th Army, destined, under Slim, first to stand firm then throw back the Japanese foe. Necessity dictated that BESA used available personnel (civilian and Services) and self-generated resources to entertain British, Indian and Allied troops based across a vast area of Eastern India.


Inclusive Practice for Health Professionals equips students with knowledge of the social, political and cultural factors that influence health care in Australia, to prepare them to be well informed, considerate health professionals. It embraces the multidisciplinary nature of work in the health professions, and applies the term inclusive practice to focus attention on its relevance to all healthcare professionals and improving health outcomes. The book considers the interface between health care delivery, health care professionals and population groups, and examines the key concepts, influences and strategies of inclusive practice to help students develop best practice skills for working in complex and diverse healthcare settings.


Purpose
The purpose of this paper is to discuss how the failed finance companies in Sri Lanka used fair value accounting practices as an opportunistic earnings management practice to launder money under weak corporate governance structures.

Design/methodology/approach
This paper uses a qualitative design under the philosophy of interpretivism. The case study research strategy is used inductively to investigate how fair value accounting had been used for money laundering.

Findings
The dishonest intention of major shareholders and board of directors had forced failed companies to misuse fair value accounting to manipulate performance and use them for personal benefits which were detrimental to the depositors and stability of the companies. The weak corporate governance structures which were developed because of regulatory forbearance were influential for manipulations. The concentrated ownership had reduced agency conflicts between shareholders and managers because major shareholders were the members of the board of directors. The appointed committees were not effective because of an inadequate number of independent directors with sufficient expertise. The reduced agency conflict between shareholders and managers has exaggerated the agency conflict with depositors. Therefore, it is recommended to dilute ownership concentration to establish good corporate governance structures and make stable institutions.

Research limitations/implications
This study does not discuss the dishonest fair value accounting practices of all licensed finance companies because of the sensitivity of the matter for surviving companies.

Originality/value
This paper is an original work of the authors which discusses how fair value accounting practices had been used to launder money in failed finance companies in Sri Lanka as an emerging market context.


Abstract Background and objective Sex maturity rating (SMR), defines different levels of sexual maturity, based on the development of secondary sexual characteristics. Periodic assessment of pubertal maturation by physicians is crucial for timely identification of puberty-related disorders. With this pilot study, we aimed to assess the attitudes, knowledge and practices of pubertal assessment by current US pediatric trainees. Methods An anonymous online survey questionnaire was sent to categorical pediatric residents at different levels of training and pediatric chief residents across the US. Results We received responses from 2496 pediatric residents from all over the US. We found that 96% of trainees understand the importance of assessing SMR, 62% feel confident in assessing it and 55% feel comfortable assessing the need for an endocrinology referral. Only 33% of trainees performed external genital exams during all regular clinic visits while 26.9% never performed them during sick visits and 6% never assessed SMR during any of the patient visits. Higher levels of training and having completed an endocrinology rotation were associated with improvement in comfort level, practice and knowledge of trainees regarding pubertal assessment. Conclusion This study revealed that the current clinical practices of performing external genital exams and SMR among pediatric residents need improvement. Stronger reinforcement from continuity clinic preceptors and/or online and clinic based resources for SMR assessment for trainees may improve adherence to the recommended guidelines.


Abstract We report a case of an asymptomatic, 77-year-old, male patient with arterial hypertension and no other comorbidities or risk factors for coronary disease. During a routine abdominal ultrasound examination, he was diagnosed with a hepatic vascular mass with an approximate diameter of 5 cm. Abdominal computed angiotomography was requested, showing an aneurysm of the hepatic artery, with maximum diameter of up to 5.2 cm, longest longitudinal axis of 7.2 cm, and a maximum true lumen caliber of 3.0 cm. We opted for endovascular aneurysm repair with implantation of three sequential Lifestream covered vascular stents (7x58mm, 8x58mm, and 8x37mm), successfully diverting the flow through the stents and excluding the aneurysm. The patient remains asymptomatic and free from clinical complications 2 years after the procedure. Control examinations with arterial duplex ultrasound 6 and 12 months after the procedure showed good flow through the stents with no leakage into the aneurysmal sac.


The understanding of fiber-matrix integrity in fiber-reinforced polymer composites from strain rate sensitivity concept was considered from interfacial energetics point-of-view. The methodology involved the preparation of plantain fibers, treatment of fibers with nine different liquids to render their surfaces hydrophobic, molding of fiber reinforced composites, measurement of contact angles on fibers and composites, composites tensile strength determination, and fiber pullout tests. The results showed that Methyl Ethyl Ketone Peroxide (MEKP) and mercerization (NaOH) rendered the fibers most hydrophobic. MEKP and NaOH treated fibers gave the lowest surface energies, maximum works of adhesion and hence better fiber-matrix bonding (increased fiber-matrix integrity) when compared with other treatments. The strain-rate sensitivity index, m, obtained ranged from 0.2264 for phosphoric acid-treated fiber in the composite to 0.2385 MEKP treatment fiber with an overall average value of m of 0.2341, while the value of m, for untreated fiber reinforced composite was 0.2321. MEKP and NaOH treated fibers were most hydrophobic gave the highest m values and therefore most desired for treatment of fibers for composite formation. The pullout tests result showed that increase in work of adhesion led to an increase in the tensile energy, showing that stronger bonding will guarantee fiber-matrix composite stability and integrity. MEKP and NaOH with maximum free energies of adhesion also exhibit maximum pullout forces which implied that the bonding between fiber and matrix was stronger for these treatments and hence higher fiber-matrix integrity in the composite. It was also shown that the pull-out force increased with the strain rate sensitivity index confirming that one would need composites with higher m-values for stronger fiber/matrix composites. The results of this work are very important in structures that are made with fiber reinforced composite materials, such as, airplane and car bodies. This work shows that the use of the adhesive energy-stress concept to determine the strain rate is valid since the values of strain rate sensitivity indices calculated are comparable with values reported in the literature and that fiber-matrix integrity can be understood from interfacial free energies and strain rate sensitivity concepts.


The size and shape of an organism is tightly controlled during embryonic and postembryonic development to ensure proper functionality. However, in the light of the breath-taking diversity of body forms observed in nature, developmental processes must have evolved to allow evolutionary changes in adult morphology. Therefore, gene regulatory networks (GRNs) that orchestrate organ development are mostly constrained, but nodes and edges within such networks must change to give rise to morphological divergence. Identifying such tuning nodes remains a major challenge in evolutionary developmental biology. Here, we combined comparative transcriptomics and chromatin accessibility data to study developmental differences leading to natural variation in compound eye size and head shape in the two closely related Drosophila species D. melanogaster and D. mauritiana. We show that variation in expression of the GATA transcription factor Pannier (Pnr) is associated with extensive remodeling of the transcriptomic landscape during head development. Since U-shaped (Ush), a co-factor of Pnr, is involved in the same regulatory context, we argue that variation in expression of both factors may be a driver of divergence in head morphology. Applying functional genetics and geometric morphometrics we confirmed that manipulation of pnr expression in D. melanogaster largely phenocopies D. mauritiana dorsal head shape and ommatidia number. Therefore, we propose that the regulatory module composed of Pnr and Ush represents a tuning node within the otherwise highly conserved GRN underlying head development in Drosophila.


The use of resin-based luting agents is ever expanding with the development of adhesive dentistry. A multitude of different adhesive systems are used with resin-based luting agents, and new products are introduced to the market frequently. Traditional adhesives generally required a multiple step bonding procedure prior to cementing with active resin-based luting materials; however, combined agents offer a simple application procedure. Self-etching 'all-in-one' systems claim that there is no need for the use of a separate adhesive process. The following review addresses the advantages and disadvantages of the available adhesive systems used with resin-based luting agents.


Risks and uncertainties are ever more noted and factored into decision making today, and those stemming from supply chains are prominent in the competitiveness and viability of companies and organizations. The idea that every supply chain is made up of five internal chain/network constructs is presented, and these are physical, financial, informational, relational, and innovational. Further, four categorizations of relevant product/supply costs are presented as are four types of supply risks.


This paper deals with autotransformer-based multipulse ac--dc converters with reduced magnetics feeding vector controlled induction motor drives for improving the power quality at the point of common coupling. The proposed 12-pulse ac--dc converter-based harmonic mitigator consists of an autotransformer alongwith a passive shunt filter tuned for 11th harmonic frequency. This results in the elimination of 5th, 7th, and 11th harmonic currents. Similarly, the proposed 18-pulse ac--dc converter-based harmonic mitigator eliminates the 5th, 7th, 11th, 13th, and 17th harmonic currents, thereby improving the power quality at ac mains. The experimentation is carried out on the developed prototype of autotransformers-based ac--dc converters. Different power quality indexes of the proposed 12-pulse and 18-pulse ac--dc converters are obtained from simulation and verified from experimental results.


Abstract:In February 1817, the publication of Wat Tyler spectacularly destabilised Robert Southey's roles as Poet Laureate and chief literary policeman for the Quarterly Review. In April 1817, the 'famous, and famously belated' English premiere of Mozart's Don Giovanni at the King's Theatre represented the storming of a court citadel by city radicals. William Hazlitt drew on the symbolism of these two exhumed works when he invited Southey to Don Giovanni as an antidote to the Laureate's self-righteous 'prudery'. Byron was certainly paying attention (if not always respect) to Hazlitt's output when he began Don Juan: this article examines some of the overlaps in their anti-Laker rhetoric, the possibility that Hazlitt influenced Byron's choice of dedicatee and hero, and the ways in which the Southey stanzas in the suppressed Dedication vibrate with the energy of contributions to the Wat Tyler Controversy by Hazlitt and other anti-ministerial writers.


We have studied the stability of Barley aleurone and embryo expressed (Balem) transcripts in aleurone layers. The Per1, Ole1 and Ole2 transcripts are abundant during desiccation and in dry resting seeds, while B12D and B22E transcripts are expressed mainly during seed maturation and germination. From 21 to 40 days post anthesis (DPA) incubation of aleurone layers resulted in a substantial, but differential reduction in the levels of these transcripts. In contrast, Balem transcript levels in aleurone layers of incubated embryoless grains were (except for B22E) similar to those of freshly dissected layers. Cycloheximide lowered transcript levels significantly. This indicates that a protein-synthesis-dependent mRNA-stabilizing mechanism is active in the aleurone cells when attached to the starchy endosperm. At the onset of seed desiccation (40 DPA), half-lives of transcripts to be stored in the dry seed were up to several days longer than the half-life of B22E, which decreases during seed maturation. While the Per1, Ole1 and Ole2 transcript levels decline rapidly in the aleurone layers of mature, germinating seeds, the genes are actively transcribed and their transcripts highly stable in the aleurone of incubated embryoless seeds. The expression of Ole1 and Ole2, as well as Per1, can be repressed 100-1 000-fold by gibberellic acid (GA3) in a dose-dependent manner. Abscisic acid can counteract the GA3 repression. Incubations with transcriptional and translational inhibitors indicate that GA3 inhibits the transcription of these genes and at the same time induces a protein-synthesis-dependent mechanism destabilizing their mRNA molecules present.


The use of long-tendon ground support elements (cable bolts) is now a common practice in modern underground coal mines, hard rock mines, tunnels, and other underground structures. The paper briefly introduces the development of test methods for rock and cable bolts, including single- and double-shear methods, in the last 30 years and focuses on the novel development of the fourth generation of cylindrically shaped shear test apparatus (MK-IV Double Shear Box) for assessing tendon performance in shear based on the experience gained from the development of previous versions of shear experiment apparatus. The results were compared with similar test findings using a rectangular-shaped double-shear apparatus with and without friction across joint faces. The sequence of wire failure was studied by using the newly developed double-shear test apparatus, and the performance of abnormal phenomena in the double-shear tests was analyzed. The sequence of wire failure can be inferred based on the positive and negative values of strain gauge readings, and the wire of cable bolt under shearing may be broken in the joint area. The failure possibly occurred from one side to the other instead of from top to bottom. The modified double-shear test apparatus with a long section of concrete cylinder was proposed to conduct further research on cable bolt debonding.


Material containing chromium means a material that contains chromium (Cr, atomic number 24) in amounts greater than or equal to 0.1 percent by weight. Material containing manganese means a material that contains manganese (Mn, atomic number 25) in amounts greater than or equal to 1.0 percent by weight. Pelleting operations means all operations that make pelleted animal feed, including but not limited to, steam conditioning, die-casting, drying, cooling, and crumbling, and granulation. Prepared feeds manufacturing facility means a facility that is primarily engaged in manufacturing animal feed. A facility is primarily engaged in manufacturing animal feed if the production of animal feed comprises greater than 50 percent of the total production of the facility on an annual basis. Facilities primarily engaged in raising or feeding animals are not prepared feed manufacturing facilities. Facilities engaged in the growing of agricultural crops that are used in the manufacturing of feed are not considered prepared feeds manufacturing facilities.


An overview of studies on the physical-and-chemical, biochemical, immunological properties of synovial fluid normally and for pathology development is represented in the work, as well as the possibilities and prospects of their use in clinical practice.


Selfconsistent Augmented Plane Wave (APW) calculations have been performed on transition metal disilicides TMSi2 (with TM = Fe, Co, Ni and Y) in the high symmetry fluorite structure. For each compound a set of tight binding parameters is deduced from a Slater and Koster fit on the APW bands structures. The basis used is orthogonal and includes d states for transition metal and sp states for silicon, interactions are taken up to third neighbours. We show that these tight binding parameters are very accurate as the DOS of CoSi2 calculated through a decimation technique is in good agreement with the APW one. CoSi2 set of parameters is then compared to data deduced from Harrison scheme and Papaconstantopoulos handbook.


The article presents the results of studies on the use of an associated vaccine against salmonellosis and pasteurellosis. It was found that the number of erythrocytes and leukocytes in the blood of vaccinated animals increases, as well as the levels of hemoglobin, total protein and its fraction, which indicate a positive effect of the associated vaccine on hematological parameters and the content of total protein in the blood of animals.


The influence of electron correlations on spin-polarized transport is examined within a phenomenological approach based on the Landau theory of Fermi liquids. The inclusion of a spin-dependent interaction in the drift terms of the Boltzmann transport equation satisfied by the spin-dependent distribution function nσ leads to an 'apparent' charge current that is different from the spin σ current associated with the quasiparticle momentum flow. This effect originates in the back-flow current of opposite spins and its magnitude is proportional to the Landau phenomenological parameter that describes the angular average of the opposite-spin interaction and with the relative drift velocity of the two spin species.


Abstract: Researchers have long recognized that subjective perceptions of risk are better predictors of choices over risky outcomes than science-based or expert's assessment of risk. More recent work suggests that uncertainty about risks also plays a role in predicting choices and behavior. In this manuscript we develop and estimate a formal model for an individual's perceived health risks associated with arsenic contamination of their drinking water. The modeling approach treats risk as a random variable, with an estimable probability distribution whose variance reflects uncertainty. The model we estimate uses data collected from a survey given to a sample of people living in arsenic prone areas in the United States. The findings from this paper support the fact that scientific information is essential to explaining the mortality rate perceived by the individuals, but uncertainty about the probability remains significant.


The aim of this study was to compare mathematical models describing growth curves of white-egg layers at different population densities. To fit the models, 4,000 growing white-egg layers were utilized. The experimental design was completely randomized, with population densities of 71, 68, 65, 62, and 59 birds per cage in the starter phase and 19, 17, 15, 13, and 11 birds per cage in the grower phase, with 10 replicates each. Birds were weighed weekly to determine the average body weight and the weight gain. Gompertz and Logistic models were utilized to estimate their growth. The data analysis was carried out using the PROC NLMIXED procedure of the SAS® statistical computer software to estimate the parameters of the equation because mixed models were employed. The mean squared error, the coefficient of determination, and Akaike's information criterion were used to evaluate the quality of fit of the models. The studied models converged for the description of the growth of the birds at the different densities studied, showing that they were appropriate for estimating the growth of white-egg layers housed at different population densities. The Gompertz model showed a better fit than the Logistic model.


The incidence of esophageal cancer continues to rise in the Western world. Prior studies have suggested that gastroduodenal content reflux from gastroesophageal reflux disease induces the inflammation-mediated progression from hyperplasia to metaplasia, and to adenocarcinoma. We further investigated the sequential development of esophageal adenocarcinoma (EADC) with the use of an established surgical rat model. The present paper will describe the impact of the inflammation-metaplasia-adenocarcinoma sequence and chemoprevention in surgical rat models. A clinically relevant rat reflux model was used to investigate the cause of carcinogenesis, the sequential development of adenocarcinoma and chemoprevention with the use of a proton pump inhibitor. We found that duodenal reflux plays an important role in the inflammation-induced transformation of esophageal mucosa to adenocarcinoma. We were able to inhibit this transformation with rabeprazole, a proton pump inhibitor. Duodenal reflux promotes inflammation in the esophagus. The inflammation-metaplasia-adenocarcinoma sequence is important in the progression and development of EADC. Carcinogenesis can be prevented with chemoprevention agents such as rabeprazole. These results will need to be validated in clinical trials.


This paper presents results of the threedimensional numerical modelling of the air/oil twophase flow inside an aero engine bearing chamber. Simulations with different shaft speeds and chamber geometries were carried out and compared to experimental data in order to evaluate the potential and accuracy of the Volume-of-Fluid method for the modelling of complex multiphase flows. For different bearing chamber scavenge offtake geometries and shaft speeds, the resulting scavenge characteristics, film thicknesses and flow pattern were analysed. Especially for the prediction of the scavenge characteristics, good agreement of numerical and experimental results was obtained. However, the accurate prediction of oil distribution and film thicknesses showed to be sensitive to the mesh resolution. Nevertheless, even with a coarse mesh, correct tendencies were observed. With the application of a local Adaptive Mesh Refinement algorithm, the prediction of the oil film formation was improved. An additional influence of the surface-capturing scheme within the Volume-ofFluid method on the solution accuracy has been identified.


The microbiological needs of the epidemiologist for the investigation of waterborne disease outbreaks are reviewed. The density of indicators needs to be determined during outbreaks, but the isolation of pathogens from the water provides more definitive data. It is suggested that the measurement of chlorine residual is more useful than bacteriological monitoring of drinking water supplies.


Single‐unit afferent activity was recorded from the hepatic‐duodenal branch of the vagus nerve of chloralose‐anaesthetized sheep during acute electrophysiological experiments. The impulse activity of sixty‐seven slowly adapting mechanoreceptors situated in the muscularis externa of the proximal duodenum and pyloric sphincter was synchronous with alterations in electromyographic and tension records. Afferent units were excited during passive distension, compression and drug‐induced increases in muscle tension, thus satisfying the criteria for 'in series' tension receptors (Iggo, 1955). From the responses to compression some evidence was found for the existence of separate populations of tension receptors with different mechanical thresholds. Two fibre populations were found: non‐myelinated (0.70 +/‐ 0.26 S.D. ms‐1) and myelinated (7.6 +/‐ 1.6 S.D. m s‐1). Mucosal application of solutions of hydrochloric acid, volatile fatty acids, alkali and amino acids, and mucosal probing modified the activity of most units. These changes were reduced by anaesthesia of the mucosa. It is concluded that tension receptors in the sheep duodenum occupy a position 'in series' with longitudinal muscle, and that their activity can be modified by the particulate and chemical composition of chyme by a mechanism involving local nerve plexuses. The activity of tension receptors is compared with that of two other mechanoreceptor classes located serosally (five units) and in the lesser omentum (eleven units). Receptors in neither of these two classes were directly excited by active contraction of the duodenum.


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don't wish to apply for the ESRA Prizes Background and Aims Single-shot neuraxial techniques are not useful for most labor analgesia. Intravenous patient-controlled analgesia (iv-PCA) is indicated for parturients who cannot receive neuraxial analgesia. We present two cases managed with a combined single-shot technique and iv-PCA. Methods Case 1: A 37-year-old, G1P0 woman presented at 19 weeks gestation for abortion indicated with fetal abnormalities. She had a medical history of thoracic to lumber spine surgery for scoliosis. We determined continuous epidural analgesia was not possible and choose a combination of singleshot spinal anesthesia combined with iv-PCA. Before cervical dilatation procedures, 200 mcg of morphine with 7.5mg of bupivacaine was administered intrathecally using a 25-gauge needle. Following induction with prostaglandin E2, iv-PCA with fentanyl (10 mcg/h, 25 mcg/bolus, lockout time 10 min) was initiated. Standard monitors were placed, and the respiratory monitored with ETCO2 continuously until 24 hours after administration. The low dose of naloxone was administered to manage opioid side effects such as pruritus or nausea. Pain control during labor was adequate and the parturient was delivered without serious complications. Case 2: A 27-year-old, G5P0 presented at 21 weeks gestation for abortion indicated with a fetal abnormality. She was not eligible for epidural analgesia due to anticoagulant therapy. 200 mcg of morphine with 10mg of bupivacaine was administered and then the same protocols were used in this parturients. Pain control during labor was good and opioid side effects were well controlled with naloxone. Conclusions A single-dose technique combined with iv-PCA provided adequate labor analgesia in mid-term delivery without serious complications.


This research develops and implements a practical model of real-time redesign and problem solving for front line healthcare professionals using systems thinking methodologies. Healthcare quality, safety and service issues have been well-documented and lamented, calling into question the current approaches for addressing these issues. The work environment for healthcare professionals has become overburdened with time pressure, workarounds, waste, and failure to learn from the small events which occur on a frequent basis at the front-line. Desensitization may occur until sentinel events stimulate an organizational reaction. Other industries have developed system engineering methodologies, including the Toyota production system, theory of constraints, six sigma and others, to address manufacturing quality, service and safety issues. Many of these concepts were developed within the context of a linear manufacturing environment, with solutions often derived "off-line" by external experts. Healthcare reality is considered more complex and requires adaptive approaches, suggesting that modifications based on complex adaptive systems theory may be necessary. The development of the model evolved based on key systems thinking principles adapted to meet the needs of the healthcare experience and introduced to front-line healthcare workers using on-line problem solving. This research includes real-time understanding of what is working or not working in the current condition as it occurs, the ideas of the staff to improve the patient experience, including asset-based problem-solving and introduction of system thinking and design principles using ideas from various systems engineering methodologies in a healthcare worker friendly way. The research focuses on the deep systems of the organization (or clinical microsystem) and ability of front line teams to redesign processes in real-time using rapid cycle mini-experiments and the results of the redesign. Using case study and action research design, the research analyzes the experiences of an intact work group of a clinical microsystem to test the implementation of a model, labeled an Excellence Makeover. The researcher acts as a participant-observer of the emergent experience and solutions from the staff. The model will then be analyzed and additional refinements will be suggested for additional research.


Research on Russian women shows that definitions of sexual harassment are different from those in the United States, and that when it occurs there is a preference for dealing with it informally rather than through institutional channels.


Oesophageal cancer is one of the most frequent solid malignancies and the leading cause of cancer‐related death around the world. It is urgent to develop novel therapy strategies to improve patient outcomes. Acetylation modification of histones has been extensively studied in epigenetics. BRD4, a reader of acetylated histone and non‐histone proteins, has involved in tumorigenesis. It has emerged as a promising target for cancer therapy. BRD4 inhibitors, such as JQ1, have exerted efficacious anti‐proliferation activities in diverse cancers. However, the effects of JQ1 on oesophageal cancer are still not fully described. Here, we demonstrate that JQ1 suppresses cell growth and triggers cellular senescence in KYSE450 cells. Mechanistically, JQ1 up‐regulates p21 level and decreases cyclin D1 resulting in G1 cycle arrest. The inhibitory effects of JQ1 on KYSE450 cells are independent on apoptosis. It activates cellular senescence by increasing SA‐β‐gal activity. BRD4 knockdown by shRNA recapitulates cellular senescence. We also display that administration of JQ1 decreases recruitment of BRD4 on the promoter of aurora kinases A and B. Inhibitors targeting at AURKA/B phenocopy JQ1 treatment in KYSE450 cells. These results identify a novel action manner of BRD4 in oesophageal cancer, which strengthens JQ1 as a candidate drug in oesophageal cancer chemotherapy.


Congenital heart disease is the most common fetal abnormality resulting in high pediatric disability and mortality. Congenital heart disease is a heterogeneous group of cardiac abnormalities including atrial septal defect, valvular defects and cardiac outflow tract anomalies. Genetic, epigenetic and ecological factors leading to the development of congenital heart defects in each particular case remain poorly understood. Nevertheless, multifactorial and polygenic mechanisms underlying the disease may be suggested. Moreover, advanced genetic technologies including single nucleotide polymorphism testing, copy number variation and next-generation sequencing ensure early detection of genetic causes of heart abnormalities. Recent studies suggested the contributing role of small non-coding RNA (miRNA) in the pathogenesis of congenital heart defects. miRNA is known to coordinate the development of heart and stimulate such pathological processes like fibrosis, hypertrophy and impaired angiogenesis. Thus, the study of miRNA and its impact on the pathogenesis of various heart diseases has demonstrated its promising potential for therapeutic targets in regenerative medicine. The review presents recent genetic findings, miRNA functions, signaling pathways and evidences on its role in the development of certain congenital heart defects.


Body weight, as an essential physiological trait, is of considerable significance in many applications like body management, rehabilitation, and drug dosing for patient-specific treatments. Previous works on the body weight estimation task are mainly vision-based, using 2D/3D, depth, or infrared images, facing problems in illumination, occlusions, and especially privacy issues. The pressure mapping mattress is a non-invasive and privacy-preserving tool to obtain the pressure distribution image over the bed surface, which strongly correlates with the body weight of the lying person. To extract the body weight from this image, we propose a deep learning-based model, including a dual-branch network to extract the deep features and pose features respectively. A contrastive learning module is also combined to the deep-feature branch to help mine the mutual factors across different postures of every single subject. The two groups of features are then concatenated for the body weight regression task. To test the model's performance over different hardware and posture settings, we create a pressure image dataset of 10 subjects and 23 postures, using a self-made pressure-sensing bedsheet. This dataset, which is made public together with this paper, together with a public dataset, are used for the validation. The results show that our model outperforms the state-of-the-art algorithms over both 2 datasets. Our research constitutes an important step toward fully automatic weight estimation in both clinical and at-home practice. Our dataset is available for research purposes at: https://github.com/USTCWzy/MassEstimation.


Background The evaluation of abatacept (ABA), a modulator of T-cell costimulation, in lupus nephritis (LN) was supported by favorable preclinical studies in murine LN. Objectives To compare the efficacy and safety of IV ABA to placebo (PBO) on a background of mycophenolate mofetil (MMF) and steroids in a 12-month Phase II/III multicenter, double-blind, study of patients (pts) with active Class III or IV LN, including exploratory, post-hoc, and subset efficacy analyses. Methods 298 pts received PBO, ABA 30 mg/kg (30/10), or ABA 10 mg/kg (10/10) in a 1:1:1 ratio on Days 1, 15, 28, 57; thereafter, all ABA pts received 10 mg/kg through Week 48. Prespecified efficacy outcome measures: a) Primary: time to complete response (CR) (CR: eGFR within 10% of preflare/screening; urine protein/creatinine ratio [UPCR] <0.26 g/g; inactive urine: confirmed at 2 consecutive visits); b) CR at Week 52; c) renal improvement (RI) (RI: UPCR <50% of preflare/screening; no worsening of eGFR; inactive urine); d) renal response (RR) (RR: serum creatinine ≤125% of baseline [BL]; UPCR <50% of BL and <3.0 g/g if nephrotic, otherwise <1.0 g/g). Post-hoc efficacy endpoint: CRrev (defined post-hoc to account for renal function misclassifications): eGFR ≥90% of preflare/screening, otherwise same as CR. Results Time to confirmed CR did not differ between groups (p=0.549 and 0.422 for ABA 10/10 and 30/10 vs PBO). Efficacy at Week 52 is shown (Table). Subset analyses of 122 nephrotic pts (BL UPCR >3.0 g/g) found approximately 20–30% greater reduction in mean UPCR. Safety, assessed as deaths, serious adverse events (SAEs) and serious infections, was similar across groups. AEs were generally mild, self-limited and similar in frequencies across groups, with the exception of Herpes zoster (reported in 2.0%, 11.1%, 8.1% of PBO, ABA 10/10, ABA 30/10, respectively). Post-hoc subset analyses suggested Asian race and early reduction of proteinuria (8–12 weeks) were associated with response (CRrev and RR at Week 52) in all groups. Efficacy: Treatment group Placebo ABA 10/10 ABA 30/10 Treated N=100 ABA 10/10 N=99 N=99 Confirmed CR at Month 12, % 3.0 3.0 5.1 CR at Month 12, % 8.0 10.1 10.1 RI at Month 12, % 55.0 52.5 55.6 RR at Month 12, % 33.0 39.4 45.5 Post-hoc: CRrev at Month 12, % 12.0 22.2 15.2 Conclusions Abatacept and PBO, administered on a background of MMF and steroids to pts with LN, exhibited similar safety profiles, time to confirmed CR, and proportion with CR and RI. Exploratory and post-hoc analyses indicated more complete (CRrev) and renal (RR) responders with abatacept compared to PBO. Disclosure of Interest R. Furie Grant/Research support from: Bristol-Myers Squibb, Consultant for: Bristol-Myers Squibb, K. Nicholls: None Declared, T. Cheng: None Declared, F. Houssiau: None Declared, R. Burgos-Vargas Grant/Research support from: Bristol-Myers Squibb, Consultant for: Bristol-Myers Squibb, S. Chen: None Declared, J. Hillson Employee of: Bristol-Myers Squibb, S. Meadows-Shropshire Employee of: Bristol-Myers Squibb, M. Kinaszczuk Employee of: Bristol-Myers Squibb, J. Merrill Consultant for: Bristol-Myers Squibb


OBJECTIVE
To screen efficient and specific new drugs against hepatitis C virus (HCV) and find the best target sequence of antisense oligodeoxynucleotides (ASODNs) targeting at HCV gene.

METHODS
Fifteen S-ASODNs targeting at the 5'NCR and start AUG of HCV RNA were designed and synthesized according to the predicted RNA secondary structure of the HCV 5'NCR and the adjacent AUG region. HepG(2) cells were co-transfected with pHCV-neo4 and S-ASODN. The inhibitory effects of S-ASODNs on gene expression controlled by HCV 5'NCR were determined by the assay of luciferase activity.

RESULTS
Five S-ASODNs, i.e. HCV65, HCV279, HCV363, HCV349 and HCV352, showed sequence-specific and dose-dependent inhibitory activities with an inhibition rate of more than 80% at a concentration of 100 nmol/L. According to 50% inhibitory concentrations, the inhibitory activity of HCV363 was the best. On the other hand, ASODNs had only little non-specific effect by negative control trials. In addition, the results also indicated that there were some coordinate effects between ASODNs at different targets.

CONCLUSION
Stem-loop 2a and 3d of HCV 5'NCR and the start AUG of polyprotein precursor are candidate targets of S-ASODNs.


OBJECTIVE
To determine the influence of gamma-hydroxy-butyrate (GHB) on spontaneous and lipopolysaccharide (LPS)-stimulated release of tumour necrosis factor-alpha (TNF), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and interleukin-10 (IL-10) in whole blood from patients undergoing coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). In addition, the pharmacological modulation on lipopolysaccharide (LPS)-stimulated cytokine release by GHB (GHB-Na and GHB-ethanolamide) was characterized in a separate in vitro-assay.

METHODS
In a prospective, randomized, double-blinded study, 12 patients undergoing elective CABG were assigned to receive either saline (control) or GHB-Na (25 mg/kg as loading dose followed by 25 mg/kg/h) intraoperatively. Blood samples were obtained (A) preoperatively, (B) 20 min after ECC and (C) 24 h after ECC. Plasma levels (spontaneous release) as well as LPS-stimulated cytokine secretion were measured in a whole blood culture system ex vivo and correlated with mRNA-expression in peripheral blood mononuclear cells (PBMC). In addition, the dose-response characteristics of modulation of the cytokine response by GHB was studied in vitro in the same assay.

RESULTS
Plasma IL-6 and IL-10 levels were significantly elevated after CABG, while TNF and IL-1 beta were detectable only occasionally in both groups. Expression of all cytokines studied was significantly reduced upon ex vivo LPS-stimulation at time point B. Despite maintained expression of TNF and IL-1 beta mRNA-transcripts upon ex vivo LPS-stimulation in patients treated with GHB, release of the cytokines in the supernatant was decreased to a similar degree as in the control group. Cytokine response upon LPS-stimulation was restored 24 h after CABG for the group mean, however, with substantial individual heterogeneity. In vitro, pharmacological doses of GHB-Na (2 mg/ml) attenuated LPS-induced IL-1 beta release. However, application of the GHB-receptor antagonist NCS-382 caused a nearly complete cessation of IL-1 beta release in vitro (to 2.5% of control). GHB-ethanolamide (LK 544) did not influence the LPS-stimulated release of the cytokines studied.

CONCLUSION
The results suggest a biphasic response of stimulated PBMC cytokine gene expression during CABG with an initial tolerance to LPS-stimulation shortly after termination of ECC. However, whether or not PBMC express functional GHB receptors remains unclear in light of contradictory effects of the different ligands. In spite of the ex vivo and in vitro results, application of GHB-Na in doses which are primarily based on its use as an anesthetic agent do not seem to modulate the release of the cytokines studied.


Understanding spatial and temporal variations of habitat suitability is fundamental for species' conservation under global change. Steppic species are particularly sensitive to anthropogenic change and have undergone large declines in the last decades. We aimed to describe current and future breeding habitat suitability for the Eurasian stone-curlew Burhinus oedicnemus, a steppic species of conservation concern, and to identify critical areas for its conservation. We collected 1628 presence records covering the period 1992-2016. We developed a species distribution model using a dynamic Maxent algorithm and a set of pseudo-absences with a spatial density weighted on a fixed kernel density estimated on the presences, to mitigate the potential sampling bias. We projected this model under a set of carbon emission, socioeconomic and land-use/land-cover scenarios for the years 2030, 2050, 2070 and 2090. Finally, we described the cell-wise and mean change of breeding habitat suitability through consecutive time intervals and identified the areas critical for the species' conservation. All scenarios predicted a short-term northward shift of suitable areas, followed by a period of stability. We found no consistent trends in the mean change of breeding habitat suitability, and similar extents of suitable areas under current and future scenarios. Critical areas for the conservation of the species are mainly located in Northern Europe, Israel and parts of North Africa, the Iberian Peninsula and Italy. According to our results, the Eurasian stone-curlew has the potential to maintain viable populations in the Western Palearctic, but dispersal limitations might hinder the colonization of shifted suitable areas. Targeted conservation interventions in the critical areas are therefore recommended to secure the future of the species under global change.


The study aims to expose the pattern of education in surau as a traditional islamic education institution located in the minangkabau chain, west Pasaman. The pattern of education is seen in terms of the many aspects of education, educators, participants, materials and learning methods used. The western surau region is interesting because it is demographic in the west sumatran region, with its multicultural population, such as minang, mandailing, Java, and Batak, but surau as a traditional islamic education institute minangkabau continues to exist in this area. This type of research is qualitative with observation, interviews, and documentaries. The subject of this study is scholars and teachers who teach in surau, public and tribal leaders, children and youth. The study found, first, surau in the western market continues to exist on a broad scale, namely, education for children, youth, adult parents, and elderly parents. Second, educators who teach are clerics of religious science who have studied at islamic institutions such as madrasarah, boarding schools, or islamic colleges. Fourth, materials that are taught mostly islamic studies, for the children's level emphasize on reading the Qur'an, youth associated with the development of Islamic Religious Education at the school/madrasah, for the parents of the taklim council emphasize on understanding the basics of akidah and guidance in practical worship, while parents and older ones place greater emphasis on tasawuf studies by the suluk method. The research has contributed to a study of the original islamic education institute of minangkabau that exists in branches that are already in contact with other ethnic groups, such as in the West Pasaman.
Keywords : traditional education, Surau, west Pasaman


Kaolin particle film was developed to reduce heat stress and improve water use efficiency in perennial fruit crops. A study was done to determine how the film impacts water relations of wine grape (I/ills vinijera L.) cultivars '%iognier' and Merlot' grown without rootstock in the high desert region of southwestern Idaho. Vines were either sprayed with kaolin or unsprayed (control) and either wellwatered at 100% estimated crop evapotranspiration (ET,), or deficit-irrigated at 35% ET until veraison followed by 70% ET until harvest. As expected, kaolin reduced leaf temperature under both irrigation regimes. However, a reduction in stomatal conductance and less negative leaf water potential values for kaolin-treated vines were observed only under well-watered conditions. Lack of response to kaolin under deficit water conditions was probably due to a water-stress-induced increase in stomatal closure that was independent of leaf temperature. When leaf temperature difference between kaolin and non-kaolin sprayed leaves was at its daily maximum, deficit-irrigated vines had already reached their minimum or most negative values for stomatal conductance and leaf water potential, but values for well-watered vines had just begun to change. Kaolin had no effect on canopy total light interception, pruning weight, yield, berry titratable acidity or soluble solids concentration, though cluster weight of well-watered, kaolin-sprayed Viognier' was larger than well-watered non-kaolin 'Viognier' vines. The leaf water potential of 'Merlot' was more responsive to diurnal changes in vapor pressure deficit than 'Viognier' vet neither showed a response to foliar kaolin application under deficit irrigation. Better understanding of the mechanism by which kaolin film increases water use efficiency will provide insight as to the relative roles of plant hormones, evaporative demand, and plant water status on leaf gas exchange and facilitate determination of its potential for enhancing production efficiency of wine grapes in


In this paper, based on the fact of water resources shortage, environmental degradation in Chanba River basin, using multi-objective optimization theory, we established the ecology-oriented water resources optimal allocation model and achieved the coupling between water quantity and quality. According to supply and demand of water resources in two levels of years (2020, 2030) and the guaranteed rate 75%, developed model parameters (coefficients), called the optimization function to solve it. The model is applied to Chanba River basin, indicating that the model is reasonable, efficient algorithms The optimal allocation model and the results reflect the concept of sustainable development for ecological, economic efficiency and help to improve water supply reliability, the sustainable use of water resources planning and management provides a basis for decision making.


One hundred and forty four maize inbreds were evaluated for 15 different quantitative characters. Analysis of variance and the phentotypic range showed the availability of considerable variation for all the characters studied. The difference between PCV and GCV was very low for all the characters except Anthesis - Silking interval, cob yield/plant and grain yield/plant which showed that there was very little environmental effect on these characters. Anthesis-silking interval recorded high PCV, GCV, heritability and genetic advance as per cent of mean. Characters such as grain yield/plant, cob yield/plant and ear height showed comparatively moderate PCV and GCV values, moderate to high heritability with moderate genetic gain. This shows the presence of considerable variation among the inbreds for these traits and the possibilities of improvement in these characters through selection. Days to 50% tasseling, days to 50% silking and number of leaves/plant showed low PCV, GCV and GA with very high heritability suggesting that there is very little scope for improving these characters by selection.


In this paper, we consider a bilateral control of an assistive mobile robot over communication channels with constant/variable time delays. The mobile robot is used for exploring a domestic environment. The main purpose of the present work is to help the human in controlling better the slave robot. In addition, the proposed control scheme improves the operator perception of the remote environment. The human operator can actively control the mobile robot, using its intrinsic sensors, and "feel" the robot's environment. The haptic device is used like a joystick and controls the linear velocity and heading angle of the mobile robot. Many experiments have been performed to validate the proposed control scheme, and to show, in the same time, the importance of the force feedback in such applications and accessibility situations : doorways, obstacle exploration, wall tracking, etc.


The delimitation of the Norwegian continental shelf is not finalized, but the size of the area with a sediment thickness of significance from hydrocarbon potential is of the order of 1.5 × 106 sq km. From an exploration point of view the shelf can be subdivided into 2 areas: (1) the North Sea south of 62°N where exploration drilling has been going on since 1966; by November 1, 1978, 205 exploration wells had been spudded; (2) the area north of 62°N where no exploration drilling has been permitted up to now. Recoverable reserves of 1.4 × 109 tons of oil or oil equivalents have been discovered. The fields are located along the Central and Viking grabens, north-south Mesozoic basins along the central North Sea. Three zones have proven to be the main reservoir rocks. (1) In Jurassic sandstone, Statfjord is the most prominent field. (2) In Maestrichtian-Danian chalk, Ekofisk is the most prominent field. (3) In Paleocene-Eocene sandstone, Frigg is the most prominent field. The Norwegian Petroleum Directorate (NPD) has risk evaluated undrilled structures south of 62°N and concluded that another 2 × 109 tons of oil or oil equivalent recoverable reserves are to be found. Evaluation of the area north of 62°N is based mainly on NPD seismic surveys. The three main areas are: (1) More Lofoten between 62 and 69°N, (2) Barents Sea north of 70°N, and (3) Jan Mayen Ridge. The first two areas are the most extensively explored and are considered to be the most prospective. Several different types of basin development are defined. Favorable conditions for formation and accumulation of substantial amounts of hydrocarbons prevail over extensive parts. The two areas are generally considered highly prospective, but there are variations within them. The Jan Mayen Ridge is considered to be a continental block with sediments of considerable thickness. The possibility of commercial hydrocarbon deposits is highly questionable but should not be ruled out. End_of_Article - Last_Page 419------------


A real time system for graphically displaying premature ventricular beat trends is described. The system consists of analog detector circuits coupled to a Fortran based software program for premature ventricular beat processing. The software program runs four independent channels and has three available analysis modes: a "counting" mode which provides a running total of counts to date; an "averaging" mode which displays average number of events overtime, and a "ratio" mode which provides an output reflecting changes in the ratio of premature ventricular beats to all beats. Various scale factors can be applied to accommodate differing background states. The system's strengths lie in its simplicity, accuracy, and simultaneous analog display of both the original ECG signal as well as the derived quantitative data.


Results from a continuous seismic survey along closely spaced ship tracks in the northern Gulf of California are presented in terms of the tectonics of this region. Apparent vertical offsets of the most recent sediments, ranging in height from several to a few hundred meters, are associated with the central basins (Delfin and Wagner basins), indicating they are the loci of active tectonism. Structural relations inferred from mapping these features are consistent with plate tectonic concepts of the Gulf. Delfin basin represents a single, complex, northeast-southwest–trending, spreading center. Two parallel transform faults, which flank Angel de la Guarda Island and strike northward into Delfin basin from the south, and a complementary transform fault to the north represented by the Wagner basins, end at this spreading center. With the possible exception of the San Jacinto fault, no correlation of active faults was found between the northern Gulf and contiguous land areas. Interpretations of other geophysical and geological data are complicated by the high sedimentation rate in the northern Gulf, yet are generally consistent with our conclusions. Spatial and temporal characteristics of plate boundaries in the northern Gulf are probably influenced by the proximity of continental structures.


The computer tomographic investigation of two epidural and 26 subdural haematomas is described. Various computer tomographic signs are discussed and illustrated by some examples. Measurements of absorption values of subdural haematomas were related to in-vitro experiments.


Why a special interest group on Population Health Management? Context, aims and objectives. In the past the responsibilities for health care services provision and public health have largely been seen as separate functions of the health system. This was rooted in the evolution trajec-tories of both functions, one dealing with an increasingly effective array of services for the curative treatment of individuals and the other addressing collective responsibilities targeting _classic_ public health functions (e.g. immunization and environmental health risk reduction) and _new_ public health functions (e.g. a focus on health-related behaviour and the social de-terminants of health). Both functions have contributed to increasing life expectancy and im-proving health-related quality of life. Addressing the current and future health system chal-lenges characterized by the burden of chronic diseases and an ageing population; however, requires a better alignment of care provision and public health: the main risk factors of dis-ease and disability in developed countries (such as hypertension, tobacco, alcohol misuse, high body mass index, low physical activity) are amenable to a range of health care and pub-lic health interventions that require a coordinated effort across the health system. Thus, a common element of recent health system innovations is the link between integrated care provision and public health functions, culminating in strategies to improve population health. Population health, defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group" (Kindig D & Stoddard G, American Journal of Public Health 2003), implies a co-responsibility of the health care and public health system to reach the shared aim of health improvement. Examples of such innovations include Kaiser Permanente in the USA, the integrated care pioneers and vanguards in the UK, the Alzira care model in Spain, the experience of Gesundes Kinzigtal in Germany, or the population health approach in Jonkoping Council in Sweden. Common to these models is the shared responsibility for integrated care provision and population health, the use of innovative approaches to management, and improvement strategies supported by health data analytics. The key question is now: can the excellent results of these innovators be translated to other systems and be scaled up to address larger populations? Moreover, which factors need to be considered in this process (such as population health structures and demographic profiles, baseline performance of the existing health service de-livery network, legal, technological and methodological prerequisites for advanced data analytics, etc.)? In order to address these questions, a Special Interest Group (SIG) Population Health Man-agement will be initiated under the auspices of the International Foundation for Integrated Care (IFIC). The _aim_ of the Special Interest Group is *to support the identification and scal-ing up of innovative approaches to improvement population health*. In order to reach this aim, the SIG will pursue the following objectives: - Identify, synthesize and share information on innovative examples that link integrated care provision and public health functions - Appraise their evidence base, develop and recommend robust methods for the evalu-ation of these complex interventions - Identify context factors crucial for their transferability and scalability - Assess, develop and publish tools that can be widely applied for population health im-provement A first step to inaugurate the SIG will be an overview on innovative case studies, which will be discussed at the workshop. Workshop participants will then have the opportunity to split into working groups to identify the questions that underlie the transferability, scalability and practi-cal implementation of the case studies. The SIG will provide a forum to discuss the current state-of-the-art in population health man-agement, connect interested researchers, managers and policy makers to pursue research and implementation projects and develop discussion and position papers on the topic. The SIG will also aim to set up a special section in which junior researchers can identify and dis-cuss topics for PhD projects and discuss these with senior members of the SIG. Target participants : The target audience consists of researchers, managers and decision-makers engaged in or in interested in improving population health. Other participants of the ICIC2016 with a relevant background and junior researchers are welcome.


There is very little practical information available on the acoustical performance of suspended ceilings used in an office environnent. It is very difficult to determine the influence of specific elements through a ocnparison of field measurements since there are many unknown conditions that change frcan one site to the next. The purpose of this study was to evaluate the inportanœ of various cannon parameters associated with suspended ceilings in a realistic but controlled manner. Effects of ceiling panel STC, return air openings, plenum absorption, plenum barriers and ceiling sandwich construction were measured.


The practice of intercultural communication should be a primary goal of Language for Specific Purposes (LSP) courses in tertiary education, because, through language instruction, future professionals can become aware of intercultural differences and develop strategies to deal with them, thus equipping themselves with necessary skills for effective cross-cultural communication in a globalized work environment. In this study, the intercultural awareness of first and second year undergraduate students attending an English for Business and Economics course was examined in relation to their interest in the economy and culture of other countries as well as to their preferred sources of information about current economic issues. Their preferences and perceptions regarding the intercultural elements incorporated in the methods and material used in the English course were also explored. The analysis of the Likert-type questionnaire revealed that intercultural awareness needs to be further practiced in class and led to important implications for the teaching methods and tasks used in the LSP courses.


We propose a novel method for code summarization utilizing Heterogeneous Code Representations (HCRs) and our specially designed HierarchyNet. HCRs effectively capture essential code features at lexical, syntactic, and semantic levels by abstracting coarse-grained code elements and incorporating fine-grained program elements in a hierarchical structure. Our HierarchyNet method processes each layer of the HCR separately through a unique combination of the Heterogeneous Graph Transformer, a Tree-based CNN, and a Transformer Encoder. This approach preserves dependencies between code elements and captures relations through a novel Hierarchical-Aware Cross Attention layer. Our method surpasses current state-of-the-art techniques, such as PA-Former, CAST, and NeuralCodeSum.


This paper describes a methodology for a common task of audio application implementation from the referent C code to executable image targeting an audio fixed-point mid-scale DSPs. This methodology tries to efficiently cover the gap between the referent code and the assembler code by usage of the C compiler, which supports fixed-point types defined in C language extensions for the embedded processors. By relaying on C++ classes this methodology deliveries a possibility to debug a DSP compiler ready C code in a C++ environment (e.g. Visual C++). The methodology was successfully applied to several audio applications, such as Dolby Volume, SRS TSHD, SRS VIQ, and Audyssey Dynamic EQ, and their implementation to Cirrus Logic Coyote DSP family. Experience with those applications shows that this methodology greatly shortens time to market for DSP firmware product.


OBJECTIVE
Functionalizing surfaces with specific peptides may aid osteointegration of orthopedic implants by favoring attachment of osteoprogenitor cells and promoting osteoblastic differentiation. This study addressed the hypothesis that implant surfaces functionalized with peptides targeting multiple ligands will enhance osteoblast attachment and/or differentiation. To test this hypothesis, we used titanium (Ti) surfaces coated with poly-l-lysine-grafted polyethylene glycol (PLL-g-PEG) and functionalized with two peptides found in extracellular matrix proteins, arginine-glycine-aspartic acid (RGD) and lysine-arginine-serine-arginine (KRSR), which have been shown to increase osteoblast attachment. KSSR, which does not promote osteoblast attachment, was used as a control.

MATERIALS AND METHODS
Sandblasted acid-etched titanium surfaces were coated with PLL-g-PEG functionalized with varying combinations of RGD and KRSR, as well as KSSR. Effects of these surfaces on osteoblasts were assessed by measuring cell number, alkaline phosphatase-specific activity, and levels of osteocalcin, transforming growth factor beta-1 (TGF-β1), and PGE(2).

RESULTS
RGD increased cell number, but decreased markers for osteoblast differentiation. KRSR alone had no effect on cell number, but decreased levels of TGF-β1 and PGE(2). KRSR and RGD/KRSR coatings inhibited osteoblast differentiation vs. PLL-g-PEG. KSSR decreased cell number and increased osteoblast differentiation, indicated by increased levels of osteocalcin and PGE(2).

CONCLUSIONS
The RGD and KRSR functionalized surfaces supported attachment but did not enhance osteoblast differentiation, whereas KSSR increased differentiation. RGD decreased this effect, suggesting that multifunctional peptide surfaces can be designed that improve peri-implant healing by optimizing attachment and proliferation as well as differentiation of osteoblasts, but peptide combination, dose and presentation are critical variables.


We present an approach to recognition of complex objects in cluttered 3-D scenes that does not require feature extraction or segmentation. Our object representation comprises descriptive images associated with each oriented point on the surface of an object. Using a single point basis constructed from an oriented point, the position of other points on the surface of the object can be described by two parameters. The accumulation of these parameters for many points on the surface of the object results in an image at each oriented point. These images, localized descriptions of the global shape of the object, are invariant to rigid transformations. Through correlation of images, point correspondences between a model and scene data are established and then grouped using geometric consistency. The effectiveness of our algorithm is demonstrated with results showing recognition of complex objects in cluttered scenes with occlusion.


responses by unpaired Student's t test. The time course of the effect was made from the data of several blocks of trials. The average time courses for all the patients were compared with the normal values described elsewhere2 by analysis of variance (ANOVA). Traces in the figure (A) are typical responses in a patient with Fisher's syndrome. The test magnetic stimulus elicited a response of above 1-6 mV in peak to peak amplitude (first trace). The conditioning electrical stimuli significantly (p < 0-01) reduced the size of EMG responses to the


A rectangular notch is introduced to obtain a broadband dual-frequency operation of a planar monopole antenna fed by a coplanar waveguide (CPW). The antenna is printed on a single metal layer and therefore is easily constructed. Prototypes of the proposed antenna designed for WLAN operations in the 2.4 and 5.2 GHz bands have been constructed and tested. Both theoretical and experimental results for bandwidths and radiation characteristics are presented and discussed.


To design a new electrochemical horseradish peroxidase (HRP) biosensor with excellent analytical performance, black phosphorene (BP) nanosheets and single-walled carbon nanotubes (SWCNTs) nanocomposites were used as the modifier, with a carbon ionic liquid electrode (CILE) as the substrate electrode. The SWCNTs-BP nanocomposite was synthesized by a simple in situ mixing procedure and modified on the CILE surface by the direct casting method. Then HRP was immobilized on the modified electrode with Nafion film. The electrocatalysis of this electrochemical HRP biosensor to various targets was further explored. Experimental results indicated that the direct electrochemistry of HRP was realized with a pair of symmetric and quasi-reversible redox peaks appeared, which was due to the presence of SWCNTs-BP on the surface of CILE, exhibiting synergistic effects with high electrical conductivity and good biocompatibility. Excellent electrocatalytic activity to trichloroacetic acid (TCA), sodium nitrite (NaNO2), and hydrogen peroxide (H2O2) were realized, with a wide linear range and a low detection limit. Different real samples, such as a medical facial peel solution, the soak water of pickled vegetables, and a 3% H2O2 disinfectant, were further analyzed, with satisfactory results, further proving the potential practical applications for the electrochemical biosensor.


This report describes calculations and analysis performed in an attempt to provide a new estimate for the yield of the Hiroshima weapon. Newly discovered meteorological data was adapted for use in one- and two-dimensional hydrodynamic codes, and a series of calculations was then run for different values of yield. The objective was to determine what yield produced an overpressure record which could best be correlated with an actual trace measured at a parachute-dropped canister. Altitude of the bomb and canister-carrying aircraft at drop time was also a variable parameter. The analysis provides an estimate of 16.6 + 0.3 kt for the yield of the Hiroshima weapon. A drop altitude of near 35,500 feet is shown to be consistent with the signal time-of-arrival. This yield value is within the range of other estimates, but the drop altitude is higher than that previously assumed to be reasonable.


We investigate the propagation of noise via the Bellini attenuation correction method and Frequency-Distance Principle (FDP) restoration filtering technique in SPECT imaging. The Bellini method, a Fourier-domain technique, is an exact solution to the attenuated Radon transform under the constraint of uniform attenuation. The FDP states that points in the object at a specified distance from the source to the center-of-rotation (COR) will contribute predominantly to particular regions of the 2D Fourier transform of the sinogram. Using this frequency distance information, the nonstationary response of the collimator can ideally be deconvolved using an inverse filter. However, in the presence of noise, the FDP filter needs to be regularized in order to control noise amplification caused by the deconvolution. The noise is characterized by calculating the population covariance matrix of the processed projection data and of the reconstructed images for a point object located near the edge of a uniformly attenuating medium. Two different implementational combinations of the Bellini attenuation correction and FDP filtering methods, which we term mirroring and no mirroring, are considered. The results show that the mirroring implementation of Bellini-FDP introduces angular noise correlations into the processed projection data, that are induced by low-pass filtering of the sinogram in the angular direction. Furthermore, mirroring is shown to highly correlate the noise in opposing projection views. The impact on the reconstructed image is the presence of arc-like noise artifacts. In contrast, implementing Bellini-FDP using no mirroring does not result in introducing low-pass angular noise correlations. However, images reconstructed using no mirroring show a higher noise variance relative to the mirroring implementation.


In this paper we present HighRes: a laboratory demonstration of a 3U CubeSat with a deployable primary mirror that has the potential of achieving high-resolution imaging for Earth Observation. The system is based on a Cassegrain telescope with a segmented primary mirror composed of 4 petals that form an effective aperture of 300 mm. The design provides diffraction limited performance over the entire field-of-view and allows for a panchromatic ground-sampling distance of less than 1 m at an altitude of 350 km. The alignment and co-phasing of the mirror segments is performed by focal plane sharpening and is validated through rigorous numerical simulations. The opto-mechanical design of the prototype and its laboratory demonstration are described and measurements from the on-board metrology sensors are presented. This data verifies that the performance of the mirror deployment and manipulation systems is sufficient for co-phasing. In addition, it is shown that the mirrors can be driven to any target position with an accuracy of 25 nm using closed-loop feedback between the mirror motors and the on-board metrology.


In our earlier article, we proposed that recent episodic experiences in patients with semantic dementia support the production of nongeneralisable, autobiographically constrained, "semantic-like" facts (Graham, Lambon Ralph, & Hodges, 1997). We argued that this type of "semantic-like" knowledge was distinguishable from true semantic information because our two patients with semantic dementia showed no facilitatory effect of recent autobiographical experiences on their knowledge of golf and bowls; information which was presumably learnt prior to the onset of their disease. In this paper, we discuss the implications of these results for current views relating to the nature and organisation of long-term memory.


Professional Institutional Original Effective Date: May 13, 2011 Original Effective Date: June 13, 2011 Revision Date(s): January 1, 2012; April 10, 2012; January 15, 2013; March 26, 2013; August 21, 2013; January 1, 2015; March 18, 2015; January 1, 2016; February 3, 2016; May 25, 2016; November 9, 2016; December 8, 2017; February 18, 2019; April 24, 2019; July 1, 2019 Revision Date(s): January 1, 2012; April 10, 2012; January 15, 2013; March 26, 2013; August 21, 2013; January 1, 2015; March 18, 2015; January 1, 2016; February 3, 2016; May 25, 2016; November 9, 2016; December 8, 2017; February 18, 2019; April 24, 2019; July 1, 2019 Current Effective Date: April 24, 2019 Current Effective Date: April 24, 2019


Introduction: Number of patients with ischemic heart disease has tremendously increased in South East Asia during last 25 years. India has witnessed similar epidemic of coronary artery disease, especially among the urban individuals during this period. Early onset ischemic heart disease is more common in Indians (12-16%) if we compare with people of western countries (5%). Here we have planned this investigation to identify various risk factors which are responsible for relatively higher episodes of ischemic heart disease in young population (< 40 years). Materials and Method: The study was carried out on young (<40 years) patients attending Jaipur National University Medical College and Hospital from Aug 2015 to April 2017 for coronary artery disease. Total 50 persons were investigated for this study. Results: In patients with early onset IHD deranged lipid profile was seen in 74% cases, elevated blood pressure in 27 patients (54%), impaired fasting glucose or diabetes mellitus in 12 patients (20%). Tobacco use was seen in 36 patients (72%). 34 patients (68%) had one or more first degree relatives with history of CAD. 25 patients (50%) were obese. 25 patients (50%) had STEMI. In that, 20 patients had AWMI and only 5 had IWMI. 3 had new onset LBBB. 14 had NSTEMI and 8 had unstable angina. On echocardiography, 36 patients (72%) had LV dysfunction. Conclusion: Most common clinical presentation was STEMI and AWMI. Males were commonly affected especially in the younger age group. Major risk factors like smoking, high blood sugar, and high blood pressure were also evident.


The characteristics of a parabolic-bottomed triangle cross section of a channel are introduced. For this geometry the best hydraulic cross section is determined by using the undetermined multipliers method of Lagrange. For a given flow, roughness coefficient, and longitudinal slope, the best hydraulic section is the channel section having the least wetted perimeter or cross-sectional area. The cross-sectional parameters of this novel geometry are compared with those of trapezoidal, parabolic, and round-bottomed triangle cross sections. It is shown that for all values of side slopes, the flow area and wetted perimeter in a parabolic-bottomed triangle cross section are less than those of trapezoidal and parabolic cross sections for the same discharge. This indicates that less excavation and linings are involved and therefore implies that the parabolic-bottomed triangle cross section is more economical than trapezoidal and parabolic cross sections.


Acral lentiginous melanoma (ALM) is named so for its site and histological orientation. It is an infrequent form of melanoma that usually presents with lesions on the palms, soles, or nails. Although rare, it's the most commonly discovered subtype of melanoma in the non-Caucasian population, including Africans, Chinese, Koreans, and Latin Americans. It's most likely to be diagnosed in the sixth or seventh decade of life. Acral lentiginous melanoma can clinically mimic ulceration, verrucous lesions, onychomycosis, subungual hematomas, vascular lesions, and infections. Here, we are presenting the case of a 65-year-old male who was admitted to the surgery ward in Acharya Vinobha Bhave Rural Hospital with a chief complaint of a lesion over the plantar surface of his left foot for the last one or two years and was referred to the Department of Dermatology for the same. The lesion was sighted by the patient a long time before his visit to Acharya Vinobha Bhave Rural Hospital. A physical examination showed a blackish, poorly delineated soft tissue lesion on the left heel. An excisional biopsy and proper management were carried out for the patient. Patient education and greater awareness about this tumor and its early detection can serve as important weapons to increase the patient survival rate and prognosis of acral lentiginous melanoma.


Dispersion relations for acoustic surface waves in piezoelectrics with periodic metal strips applied to the surface are developed. Particular emphasis is given to the modification in effective piezoelectric coupling due to strip geometry, and the details of the dispersion relations around the stop bands. The general results are applied to discuss devices such as multistrip directional couplers and strip-coupled amplifiers.


The sequencing of aggressive pediatric solid tumors is revealing remarkably stable genomes. In the cases of malignant rhabdoid and retinoblastoma, there is a paucity of recurrently mutated genes, and oncogenesis appears to be driven, at least in part, by epigenetic deregulation. It has been suggested that pediatric tumors characterized by oncogenic fusions will exhibit relatively few additional somatic driver aberrancies. Ewing sarcoma, the second most common pediatric bone tumor, is characterized by rearrangements of the EWS gene and ETS-family transcription factor genes, most commonly FLI and ERG. In experimental models, Ewing sarcoma demonstrates dependency on the expression of the resulting chimeric fusion products. As such, Ewing sarcoma represents a paradigm for studying the genomic landscape of fusion-driven cancers. To this end, we performed whole-exome sequencing of 96 Ewing sarcoma tumors and 11 Ewing sarcoma cell lines, as well as whole-genome sequencing, transcriptome sequencing, and copy-number analysis of a subset of these samples. We found that Ewing sarcoma is one of the most genetically normal cancers sequenced to date, but that treatment, which generally employs genotoxic chemotherapy and radiation, is associated with an increase in mutation rate and single nucleotide substitutions associated with DNA damage. There was a marked absence of recurrent mutations in immediately druggable targets, such as tyrosine kinases, calling into question the feasibility of utilizing tumor sequencing to nominate targeted therapies for patients with Ewing sarcoma. Rather, these results highlight the importance of directly targeting the EWS/ETS fusion events or identifying synthetic lethal dependencies. To this end, we clarified a number of outstanding questions regarding the EWS/ETS fusions. We found that reciprocal ETS/EWS fusions are not expressed in Ewing sarcoma and therefore unlikely to play a role in Ewing pathogenesis as is seen with reciprocal fusions of PML-RARα in acute promyelocytic leukemia. We also found that wild-type FLI and wild-type ERG are not expressed in Ewing sarcoma tumors. However, there appears to be a role for ETS gene deregulation in this disease beyond the expression of EWS/ETS fusion proteins because we found recurrent somatic events in ERF and ETS1. We also identified a small number of other recurrently mutated genes that likely collaborate with EWS/ETS fusions in a minority of cases and confirmed that loss of STAG2 occurs in approximately 15% of Ewing sarcoma tumors. Thus, massively parallel sequencing of a large collection of Ewing sarcoma tumors supports the notion that fusion-driven pediatric malignancies bear quiet genomes, underscores the importance of identifying new treatment approaches targeting EWS/ETS fusions, and also identifies new genetic abnormalities that warrant further biological validation. Citation Format: Brian Crompton, Chip Stewart, Amaro Taylor-Weiner, Gabriela Alexa, Kyle Kurek, Monica Calicchio, Adam Kiezun, Scott Carter, Sachet Shukla, Swapnil Mehta, Aaron Thorner, Carmen de Torres, Cinzia Lavarino, Mariona Sunol, Aaron McKenna, Andrey Sivachenko, Kristian Cibulskis, Michael Lawrence, Lauren Ambrogio, Daniel Auclair, Ivan Rosshandler, Angela Schwarz-Cruz y Celis, Miguel Rivera, Carlos Rodriguez-Galindo, Mark Fleming, Todd Golub, Gad Getz, Jaume Mora, Kimberly Stegmaier. The genomic landscape of pediatric Ewing sarcoma. [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 999. doi:10.1158/1538-7445.AM2014-999


There is a growing interest in the food industry and in preventive health care for the development and evaluation of natural antioxidants from medicinal plant materials. In the present work, extracts of three medicinal plants (Tilia argentea, Crataegi folium leaves and Polygonum bistorta roots) used in Turkish phytotheraphy were screened for their phenolic profiles and antioxidant properties. Crude extracts were obtained from different parts of plants, by solidliquid extraction with pure water, 70% acetone and 70% methanol aqueous solvents. The antioxidant activity of the extracts was determined by ABTS.+ radical cation scavenging activity. The Folin Ciocalteu procedure was used to assess the total phenolic concentrations of the extracts as gallic acid equivalents. A modified liquid chromatography-electro spray ionization-mass spectrometry (LC-ESI-MS) was used to obtain chromatographic profiles of the phenolic compounds in the medicinal plants. The predominant phenolic compounds detected in different extracts of the plants were catechin, protocatechuic and chlorogenic acids. The highest phenolic contents were obtained by using 70% acetone as aqueous solvent, whereas the lowest phenolic contents were obtained by water extraction due to Folin Ciocalteu results. The results indicate that acetone extracts of Tilia argentea had the highest antioxidant capacity as free ABTS radical scavengers. The lowest phenolic contents and antioxidant capacities were obtained from Polygonum bistorta root extracts. Keywords— Medicinal plants, antioxidant activity, total phenolics, LC-ESI-MS.


A 57-year-old man presented with abdominal pain following a collapse, with peritonism in his lower abdomen. He was haemodynamically stable, with haemoglobin of 12.6 g/dl. His significant medical history included open bilateral inguinal hernia repairs. CT demonstrated fluid within the abdominal cavity, and an area of stranding lying medially within the left iliac fossa. Ultra-sound guided fluid aspiration demonstrated frank blood. During admission, the patient noted a recurrence of his left inguinal hernia. Laparotomy revealed haemoperitoneum, and a haematoma arising in the left iliac fossa, walled off by mesentery of the sigmoid colon and adherent omentum. The open repair of the recurrent inguinal hernia identified the sac contents to be similar to the omentum. This association implies the omentum had herniated within the inguinal canal, tore or avulsed, resulting in haemorrhage from the proximal omental blood vessel resulting in haemoperitonism.


Oceanographers need to study, analyse and interpret the biological and physical characteristics of marine organisms in the waterbed and sea floor. Images and Videos are important source of information and aids for their study. However, there are unique set of constraints in underwater environment that have limited our ability to process underwater images. Some of the important constraints in underwater images are associated with the physics of the light and attenuation of the electromagnetic spectrum. Processing issues also need to be dealt for the required application. Some of the research issues underwater have been the tasks associated with reconstructing three-dimensional information about the world from its twodimensional Projections. In this paper the techniques of underwater video processing for detecting and tracking moving objects are discussed, analysed and compared.


A person's lifestyle is essentially the result of their physical and psychological capabilities working together. This lifestyle is manifested in their habits, behaviour, diet and way of life and is based on the training they received as children from their parents, siblings, peer and other close family members. As a result, it requires purely psychological and natural control over the activities of the body and senses. This behaviour was described by Ayurveda as "Pragyaparadha" (intellectual blasphemy), one of the three fundamental causes of any ailment. As a result of Pragyaparadha, numerous inappropriate behaviours that are the underlying causes of different ailments, like Pragyaparadha is a tendency of repressing any natural need, which is identified as the root of roughly 50% of disorders. The fundamental cause of a disease is the reversal of any neurotransmission or inappropriate elimination of the waste products created during metabolism, which results in an accumulation of toxins. Therefore, one of the main causes of lifestyle disorders can be attributed to the habit of suppressing urges in an unhealthy lifestyle. To understand the physiology of blood pressure and the etio-pathogenesis of hypertension from the perspective of Ayurveda, a thorough examination of the existing Ayurvedic literature was conducted. According to one theory, hypertension should be viewed as the Prasara-Avastha, which refers to the spread of vitiated Doshasfrom their specific places, specifically of Vyana Vata, Prana Vata, Sadhaka Pitta, and Avalambaka Kapha along with Rakta in their disturbed phases.


Aim : Idiopathic myelofibrosis (IMF) is associated with an increased risk of pulmonary arterial hypertension (PAH). We investigated the prevalence of PAH in a large cohort of IMF patients and its possible association with some mechanisms known to be involved in PAH generation. Materials and methods: Systolic pulmonary arterial pressure (sPAP) was evaluated by transthoracic doppler echocardiography in 37 IMF patients (20 males and 17 females; median age 65.1 years, range 37–83). The patients with sPAP ≥35 mmHg were further evaluated by high-resolution lung CT, lung perfusion scintigraphy, arterial blood gas analysis and pulmonary function tests (PFT), including lung carbon monoxide diffusing capacity. The patients' circulating endothelial cells (CECs: CD45 − , CD146 + , CD31 + ) and endothelial progenitor cells (EPCs: CD45 − , CD133 + , CD34 + ) were evaluated using 4-parameter 3-colour flow cytometry and compared with those of 11 age-matched healthy controls. Serum VEGF, ET-1, TGFβ, PDGF-AB and sE-selectin levels were also determined. Results : PAH (sPAP ≥35 mmHg) was documented in 13 patients (35%), six of whom (16% of the whole series) had mild PAH (sPAP ≥45 mmHg); three of the patients with PAH were symptomatic. No case of pulmonary hypertension was due to cardiac or lung disease, or thromboembolic events. Median EPC levels were higher in the IMF patients than controls (0.78/μL [range 0–4.3] vs 0.32/μL [range 0.11–0.65]; p=0.003), and lower in the IMF patients with PAH than in those with sPAP vs 0.94/μL [range 0.13–4.3]; p=0.02). Additionally, EPC levels in the patients with PAH inversely correlated with SPAP (p=0.02). There were no significant differences in cytokine (ET1, PDGF-AB, TGFβ, sE-selectin) or CEC levels between the IMF patients and controls, or between the IMF patients with or without PAH. Median VEGF levels were higher in the IMF patients than in controls (1449 pg/L [range 266.9–2369.4] vs 281.2 pg/L [range 68.8–1151.7]; p=0.008) and higher in the patients with PAH than in those without (1782.8 pg/L [range 406.8–2306] vs 1037.6 pg/L [range 266.9–2369.4]; p Conclusion : This study shows that PAH is frequent in IMF patients without any known pulmonary or heart complications, being moderate in a subset in whom close follow-up is advisable. IMF and PAH have abnormal angiogenesis in common, and the patients with IMF complicated by PAH had markedly high VEGF levels together with relatively low EPC levels. Our findings suggest that PAH in this setting is associated with abnormalities in angiogenic status rather than the direct endothelial damage expressed by the increased CEC shedding found in other diseases associated with PAH. These results support the hypothesis that common mechanism(s) may be involved in the pathogenesis of IMF and PAH, thus warranting studies of CEP clonality.


Abstract Increasingly health professions schools and academic health centers are required to include interprofessional education (IPE) as a standard part of their core curricula to maintain accreditation. However, challenges continue to surface as faculty struggle to develop and participate in IPE activities while balancing increasing workloads and limited resources, and also trying to keep current in the changing profession-specific accreditation and standards. This guide shares lessons learned from developing and sustaining IPE activities at the University of Washington (UW) based in the United States. In 2008, the UW Schools of Nursing and Medicine were awarded funds to develop, implement, and evaluate an interprofessional program focused on team communication. This funding supported the creation of two annual large-scale IPE events, provided infrastructure support for the Center for Health Sciences Interprofessional Education, Research and Practice (CHSIERP), and supported numerous interprofessional activities and initiatives in the health professions curricula. Our experiences over the years have yielded several key lessons that are important to consider in any IPE effort. In this guide we report on these lessons learned and provide pragmatic suggestions for designing and implementing IPE in order to maximize long-term success.


Introduction The molecular mechanisms of syndesmophyte formation in ankylosing spondylitis (AS) are yet to be characterised. Molecules involved in bone formation such as Wnt proteins and their antagonists probably drive syndesmophyte formation in AS. Methods This study investigated sequential serum levels of functional dickkopf-1 (Dkk1), a potent Wnt antagonist involved in bone formation in arthritis, by capture ELISA with its receptor LRP6 in 65 AS patients from the German Spondyloarthritis Inception Cohort. Dkk1 levels were then related to structural progression (syndesmophyte formation) as well as sclerostin and C-reactive protein (CRP) levels. Results Functional Dkk1 levels were significantly (p=0.025) higher in patients with no syndesmophyte growth (6.78±5.48 pg/ml) compared with those with syndesmophyte growth (4.13±2.10 pg/ml). Dkk1 levels were highly correlated to serum sclerostin levels (r=0.71, 95% CI 0.53 to 0.82; p<0.001) but not to CRP (r=0.15, 95% CI −0.10 to 0.38; p=0.23). Conclusion AS patients with no syndesmophyte formation show significantly higher functional Dkk1 levels suggesting that blunted Wnt signalling suppresses new bone formation and consequently syndesmophyte growth and spinal ankylosis. Similar to serum sclerostin levels, the functional Dkk1 level thus emerges as a potential biomarker for structural progression in patients with AS


Bones: These may require internal fixation by small plates or intra-medullary wires. This provides stability for skin closure and allows early mobilization after healing has occurred. Heat and exercises in elevation are the basis of post-operative physiotherapy. DelayedProblems Skin may require replacement, especially tethering scars or thin unstable ones. Thick split, or preferably free full-thickness grafts are necessary after scar excision.


In his works the American philosopher Willard van Quine constantly rejects the analytic/synthetic distinction claiming that it is not justified. This happens because, in his opinion, human statements about the external world face the tribunal of experience not individually but as a corporate body, which implies that the judgment on their validity ultimately rests on experience itself. Many problems arise at this point, since even language plays a fundamental role in the Quinean view, and it must be accommodated into the picture if the picture itself means to be coherent. Conceptual scheme and external world are both necessary, but language does not seem to be a factor whose ultimate legitimacy relies on something outside the conceptual sphere, and this means in turn that we face a dualistic situation. Conceptual schemes or world-views, like the ones provided by Newtonian mechanics or quantum theory, are the primary bearers of truth, and the truth of a statement strictly depends from the particular conceptual scheme one currently adopts.


Trigeminal neuralgia (TN) is also known as 'tic douloureux' (in French, 'painful twitch'). It is a rare chronic facial pain syndrome, characterized by severe, brief, stabbing, 'electric shock-like 'recurrent pain attacks felt in one or more divisions of trigeminal nerve innervation areas. So intense is the elicited pain that TN has a significant effect on a sufferer's quality of life, rendering many patients unable to consider a future with the ongoing threat of recurrent pain. The aim of this article is to discuss the diagnosis and management of this disabling facial pain condition. CPD/Clinical Relevance: As general medical practitioners may struggle differentiating TN from toothache, primary care dentists have an important role in excluding odontogenic cause of pain, diagnosing TN and referring patients to a facial pain clinic for further investigations and multidisciplinary team management.


Epilepsy is a chronic disease of the central system with a wide range of neuropsychiatric disorders. Cognitive disorders are quite common with this disease and significantly reduce the quality of life of patients and their families. In approximately 35% of patients, despite treatment, various impairments of memory, attention and bradyphrenia persist in the interictal period. Causes of cognitive impairment in patients with epilepsy can be directly the underlying factor of epilepsy (genetic disease, structural brain defect, etc.), epileptic seizures, interictal epileptiform activity, side effects of antiepileptic drugs (AEDs). Modern neurophysiological and neuroimaging diagnostic methods allow us to identify new features of the course and progression of dysfunctions of higher nervous activity in epilepsy.


Background: Along with obesity's epidemic growth, came the need for new therapeutic options, tendencially less invasive, associated with lower morbidity and lower cost. Gastroenterolgy plays a promissing role in this field, with emerging new endoluminal procedures and the future perspective for transgastric bariatric treatments. Methods: A literature review was done, selected from computerized medical data bases (MEDSCAPE, MEDLINE), on currently available and investigational bariatric endoscopic procedures. Results: Several prospective european studies have shown that endoluminal obesity's treatment with intra-gastric balloon is safe and well tolerated, with satisfactory short and long-term success rates. It allows shorter weight loss when compared to bariatric surgery, but enough to accomplish WHO's main goals for obesity treatment, with improvement in major medical comorbidities. New endoluminal and transgastric procedures combining the skills and techniques of flexible endoscopy with minimally invasive surgery are under investigation, with the perspective of a future relevant part in obesity's multidisciplinary management. Conclusions: Intra-gastric balloon shows high technical and clinical success rates, with prompt improvement in associated medical complications. Evolving endoluminal and transgastric procedures come as valuable therapeutical options in this worldwide health problem. Keywords: obesity; therapeutic endoscopy; intragastric balloon; bariatric.