The establishment of palliative care services in Cambodia is set against the background of palliative care being unavailable for the majority of patients in developing countries as reported by Lynch et al (2013). According to the WHO (2014) report, most palliative care is provided in high-income countries where it is now becoming well integrated into healthcare systems. However, a greater need for palliative care (almost 80% of the global requirement) exists in low and middle-income countries and this care deficit is now becoming more widely recognised. Moreover, in many countries the availability of opioid analgesics for patients suffering pain is severely restricted and the WHO (2014) report calls for universal access to pain relief to become a major policy objective.


Consumption of cigarettes and similar tobacco items and tobacco smoking are the world's largest common preventable of death. Multiple studies have observed that the overall life expectancy of a person dying from tobacco-related illnesses is 15 years quicker than those dying from natural deaths. Hence this study was done to assess the awareness on harmful effects of smoking in middle school children. This was a questionnaire-based cross-sectional type of study comprising 100 middle schools aged between 10-15 years in Chennai. A self-administered questionnaire containing 10 questions eliciting information on the awareness of the harmful effects of smoking among middle school students were circulated. The collected responses were tabulated and analysed.95% of students are not smokers and 5% smoke to get pleasure. 94% of students are not aware that smoking causes cancer and it is injurious to health. 68% feel the parental influence and 32% feel peer influence to be the reasons for smoking. 86% were not aware of smoking cessation therapy. The results of this study illustrate the need to increase understanding of the health consequences of smoking in middle school students. In order to promote quitting, especially in rural areas, where rates of education and health literacy are lower and where health services are less available, educational programs are an essential way to increase awareness.


An important role is supposed to be played by the collagenases in the physiological or pathological degradation of collagen. However, their exact effects in rheumatic diseases, especially in rheumatoid arthritis is still controversial. The aim of the authors is to give facts and datas up to date, about this important question of the pathogenic role of collagenases in rheumatoid arthritis, osteoarthritis and in several other rheumatic diseases.


A study of this case was undertaken because of the marked allergic manifestations to certain insulin products and because of the therapeutic problem which it presents. C. G., a man, aged 38, gave a history of bilateral pleurisy at the age of 16, which was diagnosed as tuberculosis and treated with rest for a period of about two years. He had had influenza while in the army in 1918, with a recurrence of the old chest condition, and pneumonia in 1922. For many years he had experienced attacks manifested by a rash over the body, with swelling of the hands and lips, and itching of the skin, without known cause. The attacks lasted from one to four hours and disappeared spontaneously. His mother had had diabetes mellitus and died at the age of 72. His father died of emphysema. One brother died of asthma. The start of the present illness


Memory loss is one of the first symptoms in patients suffering from Alzheimer's disease (AD). During the course of the disease patients experience problems with their language, mood swings, and behavioural issues. Due to these conditions patients often withdraw from family or society with the fear and embarrassment and gradually, bodily functions are lost leading to death. The pattern of memory loss correlates with structural and functional integrity of brain. In patients with AD the formation of memory will be affected at molecular level disturbing the framework of neural networks. Recently, many studies have focused on how the AD impacts episodic memory and the underlying neural processes. In this review the findings of these studies are discussed and the effects of current and promising treatments for AD on memory loss are summarized. The main aim of this review is creating awareness in understanding the intact and dysfunctional memory. Moreover the knowledge of a specific process of a particular memory loss due to AD helps the basic scientists in developing novel therapies and drugs.


Germfree mice were inoculated with both Lactobacillus acidophilus A10 and Bifidobacterium bifidum B11. Both strains were established and present in more than 10(8) cells per g of cecum and colon contents. Furthermore, L. acidophilus A10 was established in high numbers in stomach and small intestine. Contents from different parts of the intestine were investigated with regard to the following microflora-associated characteristics: degradation of mucin, beta-aspartylglycine and tryptic activity, conversion of cholesterol to coprostanol and bilirubin to urobilinogen, deconjugation of bilirubin glucuronides, and reduction of the cecum size. In spite of being established, the microbes were not able to mediate any alterations of the parameters investigated. All animals retained values as found in their germfree counterparts.


Abstract Corporate headquarters, which occupy the top of enterprise organizational hierarchies became the subject of an increased interest in last three decades. Until now, posttransformation economies suffer from a distinct cognitive gap in this respect. The main objective of this paper is to analyse and interpret the development of the spatial pattern of top 100 biggest companies in the Czech Republic. Both quantitative and qualitative dimension of this issue will be investigated in the frame of this article. The basic territorial level we examine is constituted by self-governing regions. Finally, particular managerial and regionally-orientated recommendations for both largest enterprises and public administration will be formulated.


This paper investigates numerically the heat transfer characteristics of confined slot jet impingement on a pin-fin heat sink. A variety of pin-fin heat sinks is investigated, and the resulting enhancement of heat transfer studied. The distribution of heat transfer coefficient on the top surface of the base plate and that along the fin height are examined. Both steady and pulsated jets are studied. It is observed that for a steady jet impingement on a pin-fin heat sink, the effective heat transfer coefficient increases with fin height, leading to a corresponding decrease in base plate temperature for the same heat flux. In the case of pulsated jets, the influence of pulse frequency and the Reynolds number is examined, and their effect on the effective heat transfer coefficient is studied.


Eating disorders ha ve increased over the last few years, as well as the age range of their initialonset which includes younger people. Food-related anxiety, fear of gaining weight, and obsession with thinness are associated with variables of age, sex, social leve!, body mass index, distortion and dissatisfaction with body image are considered risk factors for eating disorders. This research examined the relationship among these factors and analyzed their predictive value. The participants were 200 adolescents (104 boys and 96 girls), aged between 14 and 17 years. The testsused werc the STAI, EDI-2, EAT and two experimental tests. The results indicated that underlying these disorders were distorted body-image perception and dissatisfaction. The risk for girlsincreased between 15 and 16 years. Dissatisfaction with global physical aspect, distortion of body size, age, and trait anxiety were revealed as predictive factors.


This article promotes the philosophy that every office visit can and should be a sports physical examination for patients of all ages. The author educates providers about promoting exercise and preventing the preventable sports injuries. Providers are encouraged to become sports and exercise community activists.


Random number generators based on linear recurrences modulo 2 are among the fastest long-period generators currently available. The uniformity and independence of the points they produce, by taking vectors of successive output values from all possible initial states, can be measured by theoretical figures of merit that can be computed quickly, and the generators having good values for these figures of merit are statistically reliable in general. Some of these generators can also provide disjoint streams and substreams efficiently. In this chapter, we review the most interesting construction methods for these generators, examine their theoretical and empirical properties, describe the relevant computational tools and algorithms, and make comparisons.


Thirty-one revisions for aseptic or septic loosening of knee arthroplasty have been performed between 1983 and 1995. In 18 cases we had loosening of uni- or bicondylar prosthesis and in 13 cases a tricompartmental revision arthroplasty. With an average of 53 months (1.5 to 13 years) after the last operation 21 patients could be examined. Main reasons for failure of uni- and bicondylar prosthesis were as well a proceeding of the arthritis in other compartments, instability, incorrect alignment and other reasons depending on the surgical technique. We found similar reasons in aseptic loosening of total knee arthroplasties including wrong choice of non-constrained condylar prosthesis. Seven cases of late infection affected semi-constrained prosthesis. Two of the reimplantations in a 2-stage procedure failed. Using the Insall-Score in the follow-up the patients reached 71.9 points in the knee score and 58.9 points in the functional score. Patients with former aseptic loosening reached better results than these with septic loosening. 38% were absolutely painfree, 14% complained about permanent pain. Unlimited walking was found 5 times, none of the examined persons was unable to walk. Main problems in revision surgery concern reconstruction of a good alignment and the management of bone loss.


This life cycle assessment evaluates and quantifies the environmental impacts of the production of hydrogen and transportation fuels from the fast pyrolysis and upgrading of corn stover. Input data for this analysis come from Aspen Plus modeling, a GREET (Greenhouse Gases, Regulated Emissions, and Energy Use in Transportation) model database and a US Life Cycle Inventory Database. SimaPro 7.3 software is employed to estimate the environmental impacts. The results indicate that the net fossil energy input is 0.25 MJ and 0.23 MJ per km traveled for a light-duty vehicle fueled by gasoline and diesel fuel, respectively. Bio-oil production requires the largest fossil energy input. The net global warming potential (GWP) is 0.037 kg CO2eq and 0.015 kg CO2eq per km traveled for a vehicle fueled by gasoline and diesel fuel, respectively. Vehicle operations contribute up to 33% of the total positive GWP, which is the largest greenhouse gas footprint of all the unit processes. The net GWPs in this study are 88% and 94% lower than for petroleum-based gasoline and diesel fuel (2005 baseline), respectively. Biomass transportation has the largest impact on ozone depletion among all of the unit processes. Sensitivity analysis shows that fuel economy, transportation fuel yield, bio-oil yield, and electricity consumption are the key factors that influence greenhouse gas emissions.


Seven children with steroid resistant nephrotic syndrome (focal segmental sclerosis in six, mesangial proliferation in one) were treated with Cyclosporin A for 12 weeks. Five of these children were also resistant to cyclophosphamide. All patients had normal renal function. Cyclosporin was started at 8 mg/kg/day then increased until a trough blood level of 100-300 ng/ml (HPLC) was achieved. Three of the seven patients achieved complete remission, and the other four had a significant reduction in their proteinuria (p less than 0.05). In the three patients who achieved complete remission, relapse of proteinuria occurred within six weeks of ceasing Cyclosporin. All patients experienced some impairment in renal function with mean creatinine clearance decreasing from 129 +/- 19 to 91 +/- 13 ml/min/1.73m2 (p less than 0.05). One child was subsequently treated with Cyclosporin for 12 months. He remains in remission with a repeat renal biopsy showing no evidence of nephrotoxicity. One other child with steroid sensitive minimal change nephrotic syndrome who had severe steroid toxicity was treated with a lower dose (5 mg/kg/day) for 12 months. She remained in remission off steroids, but relapsed 16 weeks after Cyclosporin was ceased. A renal biopsy after 12 months showed no nephrotoxicity. Cyclosporin should be considered in steroid resistant nephrotic syndrome, and in children with minimal change disease who show signs of steroid toxicity and short remission period after cyclophosphamide. Serial renal biopsies are recommended with prolonged therapy.


kinship terminologies and kinship practices in eight Alor-Pantar languages forming a broad geographic and typological sample of the family. In spite of the close genealogical relationship between the languages, there is sur-prisingly little evidence of shared (cognate) kinship vocabulary, and the kinship systems exhibit great variation. The westernmost languages distinguish both maternal and paternal cross-cousins (children of opposite-sex siblings) as ideal marriage partners, while at the opposite extreme in the highlands of Alor are found languages which expressly forbid cross-cousin marriage. Even among languages whose kinship systems are roughly similar, the terms themselves are often not cognate. Likewise, cognate terms often have varying semantics across the languages. The current distribution of kinship terminologies suggests a recent drift toward symmetric exchange systems which distinguish both maternal and paternal cross-cousins, perhaps under the influence of neighboring Austronesian languages.


We report a high-resolution and high-efficiency monochromator with energy resolution, ΔE/E∼2.08*10-7, utilizing a hard x-ray single-mode Fabry-Perot (FP) resonator at Laue incidence at 14.4388 keV. Instead of using multiple-crystal diffraction via several asymmetric-cut crystals, a 3 meV single-peak is generated from the interference of a Si-made two-plate cavity with a thickness of 70 μm and a gap of 45 μm, where a (0-40) Laue reflection is used to excite the backreflection (12 4 0) for the enhancement of the FP efficiency. Due to the large angular acceptance of (12 4 0) and (0-40), the energy tunability can be achieved by changing the incident angle into the resonator. The application of x-ray resonators at Laue incidence as a monochromator can be further implemented to x-ray optics.


Leveraging the performance opportunities offered by programmable hardware, stateless load-balancing architectures allowing line-rate processing are appealing. Moreover, it has been demonstrated that significantly fairer load-balancing can be achieved by an architecture that considers the actual load of application instances when dispatching connection requests. Architectures which maintain per-connection state for resiliency and/or track application load state for fairness are, however, at odds with hardware-imposed memory constraints. Thus, a desirable load-balancer for programmable hardware would be both stateless and able to dispatch queries to application instances according to their current load. This paper presents SHELL, a stateless application-aware load-balancer combining (i) a power-of-choices scheme using IPv6 Segment Routing to dispatch new flows to a suitable application instance from among multiple candidates, and (ii) the use of a covert channel to record/report which flow was assigned to which candidate in a stateless fashion. In addition, consistent hashing versioning is used to ensure that connections are maintained to the correct application instance, using Segment Routing to "browse" through the history when needed. The stateless design of SHELL makes it suitable for hardware implementation, and this paper describes the implementation of a P4-NetFPGA prototype. A performance evaluation of this SHELL implementation demonstrates throughput and latency characteristics comparable to other stateless load-balancing implementations, while enabling application instance-load-aware dispatching and significantly increasing per-connection consistency resiliency.


Abstract Lyndon B. Johnson was a president who achieved great things. In the domestic arena, his legislative record is perhaps as extraordinary as that of Franklin D. Roosevelt, making him one of the most effective legislative leaders in American history. Johnson, however, became emotionally overwrought in response to the war in Vietnam that came to dominate his Administration. As a leader with narcissistic traits, he was deeply unsettled by the attacks he suffered during this period. He became obsessed with enemies and convinced that they were engaged in plots against him. Overall, during the last eight years of his political career, and applying diagnostic criteria specified by the American Psychiatric Association, Johnson increasingly exhibited behavior patterns that conform to those associated with paranoia. The paranoid reactions he showed as President seem to have been those of a wounded narcissist. These did not notably affect his work in the domestic arena where he was very self-assured but they inflicted damage on him and perhaps on the country in the international domain where he was much less secure. Keywords: Lyndon Johnson – childhood – narcissism – paranoia – legislative achievements – Bobby Kennedy – Vietnam


The discovery and use of antibacterials represents a primary success of modern pharmaceutical industry. However, the pace of antibacterial discovery was heavily hindered by a series of technical difficulties and the unfavorable economics in recent years. The past decade has witnessed rapid progresses in omics and systems biology, which provided an unprecedented opportunity to accelerate the discovery of antibacterials. In this article, we first summarize the successful use of metabolic network analysis in antibacterial discovery. Then, we reveal that metabolite concentration serves as a useful criterion for selecting antimicrobial targets. The essential enzymes with low substrate concentrations (< 0.5 mM) are more druggable antibacterial targets. Besides, we find that the solubility of clinically used competitive antibacterials is at least 100 times higher than the concentrations of the competed substrates. By the new-proposed criterion, we not only identify some promising antibacterial targets but also explain some perplexing experimental observations as well.


The emerging trend for handset antenna design puts strong constraints on their volume occupation and user's proximity resilience. Several PIFA antenna configurations are investigated, studying the influence of substrate/superstrate dielectric loading on both absorption and mismatch loss at 900 MHz. By using high-permittivity materials and by leaving a small clearance area between the PIFA top plate and the back of the handset, both absorption and mismatch loss can be reduced at the expense of a narrower bandwidth.


This article points out central historical themes in the debates and arguments given by the directors of Copenhagen Zoo for the zoo as an alternative to nature. When Copenhagen Zoo was founded in 1859, its purpose was divided equally between entertainment, enlightenment and symbolizing the glory of the Danish capital. During this period though, it also became possible for the zoo to stage itself as a kinder place for animals than "real" nature. In the early 20th century, the zoo attracted attention from animal rights movements, wherefore the debates came to be structured around two radically different perceptions of nature. The article takes its outset in the arguments formulated by the three successive directors: Julius Schiott, Waldemar Dreyer and Theodor Alving.


The preserving secrecy of sensitive data becomes very important in today digital communication. Steganography is the discipline of exchanging top secret information by embedding it into a multimedia carrier and Cryptography is the art of protecting information by transforming it into an undetectable form. The ultimate aim, here is to hide the very existence of the embedded information within seemingly innocuous carriers and transmit in such a way that the existence of information is undetectable. In this paper, proposed method extracts by combining the features of cryptography and steganography. Cryptography using Modified ASCII Conversion & Mathematical Function involves converting the secret message into unprintable form of same size as original message in any cases. Steganography is then applied using multilevel 2-D DWT to embed this encrypted data into a cover media using High Frequency Coefficients of each Dimension at all levels of 2-D Haar DWT and hides its existence. Finally, Performance can be measured by using statistical parameters peak signal noise ratio (PSNR) and Mean Square error (MSE). This proposed method provides all three aspects of data hiding such as capacity, security and robustness.


ABSTRACT Poliovirus RNA genomes that contained deletions in the capsid-coding regions were synthesized in monkey kidney cells that constitutively expressed T7 RNA polymerase. These replication-competent subgenomic RNAs, or replicons (G. Kaplan and V. R. Racaniello, J. Virol. 62:1687–1696, 1988), were encapsidated intrans by superinfecting polioviruses. When superinfecting poliovirus resistant to the antiviral compound guanidine was used, the RNA replication of the replicon RNAs could be inhibited independently of the RNA replication of the guanidine-resistant helper virus. Inhibiting the replication of the replicon RNA also profoundly inhibited its trans-encapsidation, even though the capsid proteins present in the cells could efficiently encapsidate the helper virus. The observed coupling between RNA replication and RNA packaging could account for the specificity of poliovirus RNA packaging in infected cells and the observed effects of mutations in the coding regions of nonstructural proteins on virion morphogenesis. It is suggested that this coupling results from direct interactions between the RNA replication machinery and the capsid proteins. The coupling of RNA packaging to RNA replication and of RNA replication to translation (J. E. Novak and K. Kirkegaard, Genes Dev. 8:1726–1737, 1994) could serve as mechanisms for late proofreading of poliovirus RNA, allowing only those RNA genomes capable of translating a full complement of functional RNA replication proteins to be propagated.


Developing some techniques for the approximation method, we establish precise versions of the following statements concerning lower bounds for circuits that detect cliques of size s in a graph with m vertices: For 5 s m=4, a monotone circuit computing CLIQUE(m; s) contains at least (1=2)1:8 min( p s 1=2;m=(4s)) gates: If a non-monotone circuit computes CLIQUE using a \small" amount of negation, then the circuit contains an exponential number of gates. The former is proved very simply using so called bottleneck counting argument within the framework of approximation, whereas the latter is veri ed introducing a notion of restricting negation and generalizing the sun ower contraction.


Polylactic acid (PLA) is a kind of environmental thermoplastic polymer. Aliphatic polyesters, such as PLA, are a biocompatible polymer with mechanical properties, transparencies and non-toxic properties. These properties are used in consumer products such as packaging, automobile, furniture, food, textile and pharmaceutical industry. In this study, PLA nanoparticle was produced by electrohydrodynamic atomization (EHDA) which is a nanotechnological method. The EHDA system produces micro or nanoparticles by providing an optimization network in the case of high pressure and controllable controllability. Structural properties of the produced nanoparticles (Fourier Transformed Infrared Spectroscopy (FTIR)), thermal (Differential Scanning Calorimeter (DSC)) and morphological (Field Emission Gun Scanning Electron Microscopy (FEGSEM)) characterization studies were made and their properties were determined. PLA nanoparticles with biodegradable properties can be used both as a master and as an additive in clean air filter, tissue engineering and biomedical applications.


In this article we propose a scheme for solving the coupled time-fractional nonlocal diffusion problem. The scheme consist of fractional Crank-Nicolson method with Galerkin finite element method (FEM) and Newton's method. We derive \emph{a priori} error estimates for fully-discrete solutions in $L^2$ and $H^1_0$ norms. Results based on the usual finite element method are provided to confirm the theoretical estimates.


T his corrigendum corrects errors in the published version of my article "Does the Meeting Style Matter? The Effects of Exposure to Participatory and Deliberative School Board Meetings" (Collins 2021). After reviewing my code, I have identified 5 errors. These errors involve using slightly incorrect samples, miscoding one value of an independent variable for the global analyses, and using incorrect subsamples for some categorical analyses. One error affected the size of the results of one of the subanalyses. Below, I summarize each error and its consequences. First, for the research design, all incomplete cases and cases where respondents completed the sample in less than 1 minute should have been eliminated. The version of the results from the originally published manuscript reports results that eliminate the vast majority of these incomplete and too rapid cases. However, there was an additional line of code missing that would have reduced the sample by 19 more cases. Second, the research design also intended to eliminate cases without posttreatment open-ended responses and those who did not answer a final posttreatment question about attending future meetings, but 40 of them remained in the sample that was used for the estimations. Third, individuals with household incomes between $50K and $75K were accidentally coded as a part of the low-income group ($50K or less). In most cases, these errors did not change the interpretation of the respective treatments relative to the control group experiencing standard meetings. However, they do alter the specific estimates in the analysis. The miscoded income error, for instance, changed the size of the low-income group by less than 1 percentage point (see updated descriptive statistics in the SupplementaryMaterials). As a result, I updated estimates for the figures that were impacted by this error, including the standard error bars. I also include ANOVA tests of differences in means between the deliberation treatment, the participation treatment, and the standard meeting, which tests whether there are significant differences across the three conditions. These results make it explicitly clear that there are statistically significant differences at the 0.05 level in analyses of key groups for trust in school boards in the overall sample (Figure 4) and among those with low levels of pretreatment trust (Figure 5). In addition, there are statistically significant differences in the willingness to attend a meeting across the three different conditions for the full sample (Figure 7), among people of color in general (Figure 9), and particularly among Asian Americans (Figure 10). While these results are similar to those reported in the published manuscript, the willingness to attend future meetings is not statistically significantly different across the three conditions for those who have never attended a prior meeting (Figure 7) or white, Black, or Latinx Americans (Figure 10). The estimates for Figures 4, 9, and 10 differ slightly from the original manuscript due to the change in the sample. The change in sample also leads to slight changes in regression model estimates. Therefore, I am providing updated estimations for Figure 6 and Figure 8. As the figures show, the deliberation and participation treatments, respectively, remain statistically different from the standard meeting control. Two additional errors do have implications for the estimates in the paper. The two subanalyses in the paper (individuals with low-trust pretreatment and individuals with no prior meeting attendance) inadvertently included participants who did not fit into the examined subcategories. When including only those individuals with low levels of trust, the results are what are now displayed on the amended Figure 5. The size of the effects of the meetings changes slightly, with deliberation meetings still producing a statistically and substantively significant improvement in trust over standard meetings. However, there is no longer a statistically significant difference between the participation and deliberation treatments. To correct Figure 7, I used only individuals with no prior meeting attendance for the subsample. When doing so, the size the of the effects on those who had not previously attended a meeting are smaller than originally reported. The effect of the deliberation treatment on that group is about half the size of the estimate from the original paper, and it is no longer statistically distinct from the participation treatment. Nonetheless, the deliberation treatment still has a stronger effect than the standard treatment, but the difference no longer reaches statistical significance, which is largely due to the change in sample size. Both the full sample results (which are the same as the original paper) and


THE effects of postwar inflation upon educational institutions have stimulated research in school support. The Research Division of the National Education Association (48, 49) has continued to report developments in the various states. In a report of the Council of State Governments, Chase and Morphet (10) summarized the status of school finance in 1948. Studies of school finance also were made in about one-fourth of the states between 1946 and 1949. These are reviewed only if they contain an approach, innovation, technic, or finding which may be of general signifi-


Parallel optimizations for the 2D Hierarchical Poincar\'e-Steklov (HPS) discretization scheme are described. HPS is a multi-domain spectral collocation scheme that allows for combining very high order discretizations with direct solvers, making the discretization powerful in resolving highly oscillatory solutions to high accuracy. HPS can be viewed as a domain decomposition scheme where the domains are connected directly through the use of a sparse direct solver. This manuscript describes optimizations of HPS that are simple to implement, and that leverage batched linear algebra on modern hybrid architectures to improve the practical speed of the solver. In particular, the manuscript demonstrates that the traditionally high cost of performing local static condensation for discretizations involving very high local order $p$ can be reduced dramatically.


In this study, six supervised classification algorithms were compared. The algorithms were based on cluster analysis, distance, deep learning and object-based image analysis. Our objective was to determine which of these algorithms has the highest overall accuracy in both detection and automated estimation of agave cover in a given area to help growers manage their plantations. An orthomosaic with a spatial resolution of 2.5 cm was derived from 300 images obtained with a DJI Inspire 1 unmanned aerial system. Two training classes were defined: 1) sites where the presence of agaves was identified, 2) "absence"; where there were no agaves but other plants were present. The object-oriented algorithm was found to have the highest overall accuracy (0.963), followed by the support-vector machine with 0.928 accuracy and the neural network with 0.914. The algorithms with statistical criteria for classification were the least accurate; Mahalanobis distance = 0.752 accuracy and minimum distance = 0.421. We recommend that agave plantation managers use drones for their efficiency and speed. We further recommend that the object-oriented algorithm be used, because in addition to having the highest overall accuracy for the image segmentation process, it yields parameters that are useful for estimating the coverage area, size, and shapes, which can aid in better selection of agave individuals for harvest.


Abstract Motivation Exploring metabolic pathways is one of the key techniques for developing highly productive microbes for the bioproduction of chemical compounds. To explore feasible pathways, not only examining a combination of well-known enzymatic reactions but also finding potential enzymatic reactions that can catalyze the desired structural changes are necessary. To achieve this, most conventional techniques use manually predefined-reaction rules, however, they cannot sufficiently find potential reactions because the conventional rules cannot comprehensively express structural changes before and after enzymatic reactions. Evaluating the feasibility of the explored pathways is another challenge because there is no way to validate the reaction possibility of unknown enzymatic reactions by these rules. Therefore, a technique for comprehensively capturing the structural changes in enzymatic reactions and a technique for evaluating the pathway feasibility are still necessary to explore feasible metabolic pathways. Results We developed a feasible-pathway-exploration technique using chemical latent space obtained from a deep generative model for compound structures. With this technique, an enzymatic reaction is regarded as a difference vector between the main substrate and the main product in chemical latent space acquired from the generative model. Features of the enzymatic reaction are embedded into the fixed-dimensional vector, and it is possible to express structural changes of enzymatic reactions comprehensively. The technique also involves differential-evolution-based reaction selection to design feasible candidate pathways and pathway scoring using neural-network-based reaction-possibility prediction. The proposed technique was applied to the non-registered pathways relevant to the production of 2-butanone, and successfully explored feasible pathways that include such reactions.


This paper explores the economic performance of Bt cotton and consequent perceived social benefits accrued for the technology adopters. Introduction of Bt cotton reduced number of sprays on cotton from 8.9 to 4.6 and the share of plant protection from 32.16 to 11.84 percent in total costs. Productivity increase is significant that 51.16 percent more yield with the introduction of Bt cotton. The percentage increase in net returns is 291 resulted in relief from debts, more spending on education, health and social functions. The amount of time spent in the field reduced. This makes them perceive better life after Bt introduction.


In a prospective study, the efficacy of noninvasive surveillance techniques including measurement of ABI and duplex-derived velocity parameters was studied after 74 infrainguinal arterial reconstructions. A decrease of ABI > or = 0.2 compared with prior examinations was considered abnormal. Results of the duplex scan were interpreted as abnormal when PSV was less than 45 cm/sec or greater than 200 cm/sec or when an interval decrease of greater than 30 cm/sec occurred. All patients meeting any of these criteria during the follow-up examinations were subjected to i.a. DSA. The combination of all duplex velocity criteria was significantly more sensitive to identify a failing graft than was measurement of ABI (90% vs. 18%; p = 0.00004). When independent variables (ABI- and PSV criteria, monophasic curve configuration) were entered into a logistic regression multivariate analysis, the model proved to be effective (F-value 5.551; df 4.8; R2 = 0.735; significance 98.03%; p < 0.02) in predicting angiogram findings (dependent variable). ABI measurements (significance 4.75%; p > 0.95) and the presence of a monophasic curve configuration (significance 89.58%; p > 0.1) failed to reach significance in the multivariate analysis. By excluding these latter parameters, the statistical power for the model could be improved (F-value 1036.57; df 2.1; R2 = 0.999; significance 97.69%; p = 0.0231): As a result normal PSV criteria indicated normal and abnormal angiographic findings in 83 and 17%, respectively. A PSV less than 45 cm/sec or greater than 200 cm/sec was suggestive of an abnormal angiogram in 80% and of a normal angiogram in 20%. The corresponding figures for a PSV interval decrease > 30 cm/sec were 71% and 29%. In conclusion, PSV parameters were found to be measurably more accurate to identify a failing graft than was measurement of ABI.


In this paper, the Cartan frames and the equi-affine curvatures are described with the help of the Frenet frames and the Frenet curvatures of a nonnull and non-degenerate curve in a 3-dimensional pseudo-Riemannian manifold. The constancy of the Frenet curvatures of such a curve always implies the constancy of the equi-affine curvatures. We show that the converse statement does not hold in general. Finally, we study the equi-affine curvatures of null curves in 3-dimensional Lorentzian manifolds, and prove that they are related to their pseudo-torsion.


What happens to pedagogy when a teacher's personal goals of supporting students' productive dispositions toward learning collide with her professional identity as a successful teacher whose students perform well on standardized tests? This dissertation is a mixed-methods case study that shows how context shapes one teacher's identity and decision-making, such that she seems to be two drastically different teachers in two different instructional contexts – a summer course in which she had complete flexibility over the curriculum, goals, and achievement measures and an academic year course in which she felt bounded by the state standards test. The dissertation examines the very real consequences these pedagogical decisions have for students. Using qualitative classroom observations and quantitative survey and assessment data, this dissertation examines why, despite the teacher's strong commitment to growth mindset instruction and equity in both contexts, the teacher implemented pedagogical moves that contributed to distinctly different opportunities for students to engage with rich mathematics in each, and what those shifts meant for students' mathematical identities and learning. The different cultural contexts in the summer and academic years offered the teacher identity resources about what was valued as good teaching, which led to distinct pedagogical decisions that aligned with the salient aspects of her professional identity in each context. Despite her commitment to growth mindset instruction in both contexts, this teacher implemented pedagogical moves that contributed to distinctly different opportunities for students to engage with rich mathematics and develop productive mathematical self-concepts. This dissertation examines the ways the institutional context shifted and practices changed subtly as a result, and uses these comparisons to unpack which elements of the whole system of teaching for a growth mindset are necessary to contribute to productive changes in student mindsets or dispositions toward mathematics, engagement, and persistence with learning. Using Ms. M as a case study, this dissertation sheds light on the ways in which school contexts - in concert with a teachers' multifaceted identity - contribute to decision-making while setting instructional goals.


Robotic applications require both correct task performance and compensation for undefined behaviors. Although deep learning is a promising approach to perform complex tasks, the response to undefined behaviors that are not reflected in the training dataset remains challenging. In a human–robot collaborative task, the robot may adopt an unexpected posture due to collisions and other unexpected events. Therefore, robots should be able to recover from disturbances for completing the execution of the intended task. We propose a compensation method for undefined behaviors by switching between two controllers. Specifically, the proposed method switches between learning-based and model-based controllers depending on the internal representation of a recurrent neural network that learns task dynamics. We applied the proposed method to a pick-and-place task and evaluated the compensation for undefined behaviors. Experimental results from simulations and on a real robot demonstrate the effectiveness and high performance of the proposed method.


Despite immense technological advances, learners still prefer studying text from printed hardcopy rather than from computer screens. Subjective and objective differences between on-screen and on-paper learning were examined in terms of a set of cognitive and metacognitive components, comprising a Metacognitive Learning Regulation Profile (MLRP) for each study media. Participants studied expository texts of 1000-1200 words in one of the two media and for each text they provided metacognitive prediction-of-performance judgments with respect to a subsequent multiple-choice test. Under fixed study time (Experiment 1), test performance did not differ between the two media, but when study time was self-regulated (Experiment 2) worse performance was observed on screen than on paper. The results suggest that the primary differences between the two study media are not cognitive but rather metacognitive--less accurate prediction of performance and more erratic study-time regulation on screen than on paper. More generally, this study highlights the contribution of metacognitive regulatory processes to learning and demonstrates the potential of the MLRP methodology for revealing the source of subjective and objective differences in study performance among study conditions.


IT system risk assessments are indispensable due to increasing cyber threats within our ever-growing IT systems. Moreover, laws and regulations urge organizations to conduct risk assessments regularly. Even though there exist several risk management frameworks and methodologies, they are in general high level, not defining the risk metrics, risk metrics values and the detailed risk assessment formulas for different risk views. To address this need, we define a novel risk assessment methodology specific to IT systems. Our model is quantitative, both asset and vulnerability centric and defines low and high level risk metrics. High level risk metrics are defined in two general categories; base and attack graph-based. In our paper, we provide a detailed explanation of formulations in each category and make our implemented software publicly available for those who are interested in applying the proposed methodology to their IT systems.


This study aimed to investigate the effect of text-based methods on male and female upper-intermediate students' English speaking accuracy. The question this study tried to answer is if Text-based vs. non text-based method has any effect on Iranian upper-intermediate EFL learners L2 speaking ability. To   find the answer to the question, 15 upper intermediate level students from Shookooh institute were selected. They were both male and female upper- intermediate level students who were deal for the current study because they were learning all skills of language at the same time, and they were familiar with words. Their English proficiency was enough to speak English and to understand the importance of speaking. The students were selected administrating OPT which divided them into two groups, one Experimental group (with text-based method) and one control group (non text-based method). And the results revealed that experiment group performed better on English speaking accuracy.


Background Emergency department (ED) providers are important collaborators in preventing falls for older adults because they are often the first health care providers to see a patient after a fall and because at-home falls are often preceded by previous ED visits. Previous work has shown that ED referrals to falls interventions can reduce the risk of an at-home fall by 38%. Screening patients at risk for a fall can be time-consuming and difficult to implement in the ED setting. Machine learning (ML) and clinical decision support (CDS) offer the potential of automating the screening process. However, it remains unclear whether automation of screening and referrals can reduce the risk of future falls among older patients. Objective The goal of this paper is to describe a research protocol for evaluating the effectiveness of an automated screening and referral intervention. These findings will inform ongoing discussions about the use of ML and artificial intelligence to augment medical decision-making. Methods To assess the effectiveness of our program for patients receiving the falls risk intervention, our primary analysis will be to obtain referral completion rates at 3 different EDs. We will use a quasi-experimental design known as a sharp regression discontinuity with regard to intent-to-treat, since the intervention is administered to patients whose risk score falls above a threshold. A conditional logistic regression model will be built to describe 6-month fall risk at each site as a function of the intervention, patient demographics, and risk score. The odds ratio of a return visit for a fall and the 95% CI will be estimated by comparing those identified as high risk by the ML-based CDS (ML-CDS) and those who were not but had a similar risk profile. Results The ML-CDS tool under study has been implemented at 2 of the 3 EDs in our study. As of April 2023, a total of 1326 patient encounters have been flagged for providers, and 339 unique patients have been referred to the mobility and falls clinic. To date, 15% (45/339) of patients have scheduled an appointment with the clinic. Conclusions This study seeks to quantify the impact of an ML-CDS intervention on patient behavior and outcomes. Our end-to-end data set allows for a more meaningful analysis of patient outcomes than other studies focused on interim outcomes, and our multisite implementation plan will demonstrate applicability to a broad population and the possibility to adapt the intervention to other EDs and achieve similar results. Our statistical methodology, regression discontinuity design, allows for causal inference from observational data and a staggered implementation strategy allows for the identification of secular trends that could affect causal associations and allow mitigation as necessary. Trial Registration ClinicalTrials.gov NCT05810064; https://www.clinicaltrials.gov/study/NCT05810064 International Registered Report Identifier (IRRID) DERR1-10.2196/48128


The main features of iron-tetra-amido macrocyclic ligand complex (a sub-branch of TAML) catalysis of peroxide oxidations are rationalized by a two-step mechanism: Fe(III) + H2O2 → Active catalyst (Ac) (kI), and Ac + Substrate (S) → Fe(III) + Product (kII). TAML activators also undergo inactivation under catalytic conditions: Ac → Inactive catalyst (ki). The recently developed relationship, ln(S0/S∞) = (kII/ki)[Fe(III)]tot, where S0 and S∞ are [S] at time t = 0 and ∞, respectively, gives access to ki under any conditions. Analysis of the rate constants kI, kII, and ki at the environmentally significant pH of 7 for a broad series of TAML activators has revealed a 6 orders of magnitude reactivity differential in both kII and ki and 3 orders differential in kI. Linear free energy relationships linking kII with ki and kI reveal that the reactivity toward substrates is related to the instability of the active TAML intermediates and suggest that the reactivity in all three processes derives from a common electronic origin. The reactivities of TAML activators and the horseradish peroxidase enzyme are critically compared.


Meningiomas that partially or completely occlude the superior sagittal sinus may create a pseudotumor-like syndrome in certain patients. These patients may have impaired CSF absorption as a result of higher proximal venous pressure. Higher pressures after resection may encumber adequate wound healing and worsen symptoms. Here, the authors present a small series of patients with meningiomas involving the posterior third of the superior sagittal sinus, with documented high intracranial pressure prior to surgery. This paper aims to address the proposed etiology of high intracranial pressure in these patients and its associated complications, including CSF leak, wound dehiscence, pressure-related headaches, and visual complaints. In this paper, the authors propose a management plan to avoid wound complications and pseudotumor-related complications. When considering surgical intervention for patients with compromise of the posterior third of the superior sagittal sinus, careful attention must be paid to addressing potentially elevated intracranial pressure perioperatively.


On the basis of the three-dimensional Hubbard model, the superconducting (SC) mechanism of CeIn3 under high pressure is investigated by means of third-order perturbation theory with respect to the on-site Coulomb interaction U. Here we propose a d-wave pairing state induced by antiferromagnetic spin fluctuations. The estimated SC transition temperature is lower by one order than that in the two-dimensional system for the same value of U/W (W = bandwidth). This result is consistent with the difference between CeIn3 and CeRhIn5.


Biofuels were first used, as motor fuel (bioethanol) in 1860 in Germany and soon after, biofuels became the main rival for petroleum. But the abundance and the low price of fossil fuels had severe impact on the use of biofuels. Decades later, in 1970s, the shortage of fossil fuels due to the geopolitical conflicts, and the subsequent rise in the price of crude oil in 2000s, alongside energy security and climate change concerns, once again attracted the attention of governments to the use of biofuels. As a result of investment in biofuel production, the share of biofuels among the total renewable energy sources has increased since the beginning of the new century. The crop-based fuels (the so-called first generation biofuels) were considered as panacea to solve energy problems and environmental concerns. At the same time, research in advanced biofuel production methods, i.e. the second (non-food crops and residues) and the third (algae) generation has increased. However, in 2007-2008, biofuels were blamed for pushing up food prices, failing to meet environmental standards, and destroying natural habitats. As such, the use of first generation biofuels has been controversial. As for the second and the third generation biofuels, there is a need for further technological breakthrough. Currently, they cannot compete with crude oil economically, and are not commercially viable yet. In addition, fracking and the discovery of the new shale gas resources add further complication to this already complicated case.

Although there is vast number of publications on biofuels, and they have been discussed extensively, to date, very little effort has been made to integrate the knowledge to provide new ideas to inform policy. The aim of this study is to investigate, bring together, and analyse the current biofuel science and regulations to provide recommendations for policy-makers in the UK/EU. Therefore, an extensive and critical literature review of the refereed journals, books, relevant publications, and official policy documents was carried out in this study, and views of the experts in three different sectors (academic, governmental, and industrial/private) were collated and analysed. The participants were recruited based on purposive sampling, and the semi-structured qualitative interviewing method was adopted. The participants' views were analysed in relation to the published literature in order to drive an inclusive and integrated insight to develop novel recommendations for the biofuels agenda and extend the knowledge about this platform.

This thesis suggests that, while the first generation biofuels are problematic, it is likely that they will remain dominant until 2022. The fate of the second generation biofuels is mainly determined by the advances in technology, and this type could become dominant beyond 2022. The potential of algae for the third generation biofuels is being increasingly recognised; however, to date, it is difficult to predict any time period for this method to become a commercial reality.

The future of biofuels is very much related to the price of fossil fuels. If the global supply of fossil fuels continues to be tight, the price of crude oil may go above US$100 per barrel beyond 2030. Increasing crude oil prices is interpreted as increasing demand for biofuels in the future. A robust development in biofuels research and technology, and tighter mandatory policies for biofuel blending is forecasted. But, if shale gas resources are used extensively in the coming years, the price of crude oil may decrease/stay under US$ 100 per barrel and as a result, at least the current level of investment in biofuels technology may be kept. However, a backing away from investing in biofuels and re-focusing on other climate mitigation methods beyond 2030 is also possible but very unlikely.

Based on the results of this study, there is no single, simple and generic solution for the issues surrounding biofuels. In this context, a range of recommendations are provided, a major one is for the UK/EU policy makers to push for the establishment of an international biofuels governing body, supported by the UN, to oversee sustained global biofuels production and consumption.


A set of physics-based and empirical equations are used to size a gas turbine combustor for take-off condition. A one dimensional analysis is performed to obtain a simple internal flow field model of the combustor and based on that a network of elementary chemical reactors created to model the combustion process. The model is executed for four ICAO engine power settings of idle, take-off, climb and approach to determine the level of )O x and CO emissions. A combustion mechanism of aviation fuel (Jet-A) is provided to be used by the network of reactors and combustion analysis.


When products and services are purchased, consumers expect certain results from their purchase. The aim of this study was to investigate the relationship between satisfaction and expectations of product quality and service on consumer buying behavior after sports with mediate role of brand awareness. Due to the nature and purpose of the present study, functional and in terms of descriptive and correlational in terms of searching for data, quantitative survey was carried out in a way. The number of samples to questionnaire of 500 people of Fila, randomly and voluntarily responded. 0/91 reliability test using Cronbach's alpha was calculated. In order to analyze the data, descriptive and inferential statistical methods and also for the calculation and information processing software packages SPSS was used. Results showed that between expectations and satisfaction, product quality and service After buying consumer behavior in sport with mediate role of brand awareness there is a significant relationship. According to the results, Confirmed the findings of other researchers of the study can be said to consent or not consumer behavior will affect his future Dissatisfied consumer will separate reaction, he tries to minimize internal conflict and to act in one of two ways or to cancel and return the goods or with the cancellation and return of the goods or by searching for information that may They have confirmed the high value reduces the conflict created.


This study hypothesizes that, by isolating the influences of contact surface friction, back foot support, and forward‐leaning body posture during pushing, the magnitude of recorded strength will be a closer estimate of physical capabilities of the shoulder. The shoulder strength of twelve participants during one‐handed pushing in constrained conditions in the coronal (frontal) plane, in a range from 5 to 30 degrees, was correlated with the anthropometric measures and two anatomical parameters of the shoulder joint. The data indicated that the acceptable loads at the handle for all the participants were lower than the recommended standards. Right arm length had the highest correlation coefficient with shoulder strength among anthropometric data, and the radius of the humerus bone among anatomical parameters. The findings from this study of one‐handed pushing will be used to help modify existing physical strength standards in an effort to reduce the high frequency of recorded shoulder injuries. © 2009 Wiley Periodicals, Inc.


In my article I take a constructivist perspective as a starting point. Giving some introductory remarks on the role of language and the constitution of meaning within a constructivist framework, the article discusses the role and relevance of Critical Discourse Analysis and Cognitive Linguistics within this frame for cultural studies. It is argued that a transdisciplinary approach is most valuable for a research taking the importance of linguistic processes for cultural analysis into account. Following especially Fauconnier (1999) and Verschueren (1999), the importance of a pragmatic and cognitive-linguistic approach to language is underlined. To exemplify the consequences that a transdisciplinary approach could have, the article focuses on the way intercultural communication has been conceptualized within linguistics so far. The critical analysis of traditional research on and conceptualization of intercultural communication shows, how a constructivist perspective can widen the scope of linguistic research.


Wireless multimedia sensor networks (WMSNs) are often used for rescue in heavy disasters, including a sudden earthquake, flood disaster and construction site collapse. Because the best time to rescue in these heavy disasters can be predicted, the network lifetime can be expected. According to this feature, this paper proposes a multipath routing algorithm for WMSNs. Firstly, a set of node-disjoint routing paths is found by the method similar to a mazing search algorithm to reduce the number of energy consumption gathering nodes and high risk nodes of network congestion. At the same time, it is easy to support hole-bypass for the nature feature of a mazing search algorithm. Then, a multipath selection strategy is introduced. It employs a new type of congestion control message, a gradual increase strategy based on a path and a gradual increase strategy based on a flow to balance load and energy. These systems integrating the algorithm can maximize the data gathering performance.


A field experiment was carried out during two successive growing seasons of 2013 and 2014, at The Experimental Farm, Faculty of Agriculture, Ain Shams University, Shoubra El-Kheima, Egypt. The aim of this study was to investigate the effect of mycorrhiza on vegetative growth and yield productivity of snap bean (Phaseolus vulgaris L.) under water deficit conditions. Results indicated that irrigation at 60 or 45 % of water holding capacity reduce all vegetative growth parameters such as plant height, branches number per plant, shoot fresh weight and shoot dry weight in both seasons as compared with irrigation at 75% of water holding capacity. Mycorrhiza gave a significant effect on enhancing growth vegetative characteristics, so its effect was clearly significant increment on snap bean yield. For the biochemical constituents, mycorrhiza increased total sugars, total protein, N, P, K, Mg, Ca, Fe, Zn, Mn and Cu concentrations in snap bean leaves under all irrigation treatments as compared to non mycorrhizal plants in both seasons. In contrast, mycorrhiza reduced proline concentration in snap bean leaves as compared to non mycorrhizal plants in both seasons. Mycorrhiza increased number of pods per plant, pod weight, pod length and pod yield per plant under all water treatments in the two tested seasons. Generally, the interaction between irrigation at 75 % of water holding capacity with mycorrhiza gave the highest values for all growth parameters, yield traits and biochemical constituents except the highest concentration of proline which resulted when snap bean irrigated at 45 % of water holding capacity without mycorrhiza in both seasons.


Prior to the privatization policies, implementation of the public private partnership / cooperation model, especially in the England, has started to be implemented. With this model, sharp borders between public and private organizations have been abolished. It is aimed to harmonize the government's service delivery policy with the objectives of the private sector. In the public and private sector partnerships in the England, the task of the government is to ensure that businesses continue to compete fully, institutionally and legally. Implementation of public-private partnership to steer the idle capital in the country's private sector in Turkey and capital efficiency in order to realize the "integrated health campus" and "city hospitals," as put into practice. England and Turkey as well as the similarities in this model contains some differences. While quite old and common practice for public-private partnership practices in England, is new for Turkey. Moreover, while there are many laws and regulations in our country on this issue, there is a limited number in England law.


The theory of the optimal-consumption leisure choice under price dispersion describes the phenomenon of moral hazard as the customer's reaction on unfair insurance policy. The unfair insurance offer does not equalize marginal costs of propensity to seek healthcare with marginal benefits on purchase. Under unfair insurance policy consumers increase ex post healthcare seeking activities and they optimize their consumption of medical services. The analysis of moral hazard results in the assumption that the increase in the time horizon of the unfair insurance offer makes it fair and moral hazard becomes inefficient. The time horizon competition between insurance companies can eliminate moral hazard effect that clears the way to the competitive equilibrium.


This work deals with the problem of force/position trajectory tracking under uncertainties arising from surface position and orientation. A robotic finger with a soft hemispherical tip of uncertain compliance parameter is considered in contact with a rigid flat surface. A novel adaptive controller is designed using online estimates of the unknown parameters and is proved to achieve force and position tracking by ensuring the convergence of the estimated normal to the surface direction to its actual value. The performance of the proposed controller is demonstrated by a simulation example.


Interdigitated finger (comb) structures are demonstrated to be effective for electrostatically exciting the resonance of polysilicon microstructures parallel to the plane of the substrate. Linear plates suspended by a folded-cantilever truss and torsional plates suspended by spiral and serpentine springs are fabricated from a 2- mu m-thick phosphorus-doped low-pressure chemical vapor deposited polysilicon film. Resonance is observed visually, with frequencies ranging from 18 kHz to 80 kHz and quality factors from 20 to 130. Simple beam theory is adequate for calculating the resonant frequencies, using a Young's modulus of 140 GPa and neglecting residual strain in the released structures. >


This article has as its object the translations of the Dominican American writer Junot Díaz to Spanish, with special emphasis on the work of the Cuban-born translator Achy Obejas. Author of a short but remarkable work, Díaz elaborates his narratives in a variety of English that often incorporates elements of Spanish. His writing poetics includes the lexicon of Caribbean Spanish and syntactic structures and proper rhythm of his native language, which results in a strongly hybrid text. The translation of this text into a language that is so intensely present in the original is a challenge. To understand how the construction of this translation is processed, this article tries to analize the strategies used to try to keep up with the translinguistic character of these narratives. In order to reach this objective, some theoretical references are used, concepts such as the foreignizing translation, by Lawrence Venuti; translingualism; and D'Amore's considerations on translations of texts originally written in Spanglish. The analysis makes it clear that the work of Achy Obejas was largely able to give the texts in Spanish the same hybrid character present in the original ones.


ABSTRACT Disturbance from human activity can cause reduced productivity of coastal birds that nest on sandy beaches. A common method to protect coastal birds from human disturbance is the use of signs and fencing to close off a section of beach used for breeding. This management action requires public compliance and might require enforcement, such as in the use of volunteer stewards stationed at protected colonies that provide education and enforcement. I assessed the effectiveness of active stewardship as a conservation measure to protect nesting Least Terns (Sternula antillarum) in coastal Mississippi by determining if colony-level productivity (fledglings produced per nest) was correlated with stewardship effort (hours that stewards protected each colony), the rate of disturbance from human and natural sources, and additional factors. Observers surveyed 24 Least Tern colonies in Harrison County, Mississippi, twice weekly during the 2017–2019 breeding seasons to record the number of nests present, the fate of marked nests, predator tracks within the colony, and the number of fledglings produced per colony. Concurrently, during their work shifts, stewards recorded all sources and durations of disturbance events that caused the terns to flush or respond with defense. Least Tern daily nest survival increased with colony size and stewardship effort, and was lower during intervals that included weekends and evidence of owl presence. Total productivity was negatively associated with avian predator disturbance rate and the total time adults spent flushed, but was not associated with stewardship effort. The results of this study demonstrate that active stewardship can have a positive effect on Least Tern productivity by increasing nest success, whereas current stewardship practices were not sufficient to increase chick survival, even in a system with a paucity of ground predators. LAY SUMMARY Birds that nest on public sandy beaches benefit from protective fencing and educational signs, but additional benefits may occur if volunteer stewards are stationed at the protected area. I assessed whether the presence of stewards benefited nesting Least Terns by reducing human disturbance and increasing reproductive success at breeding colonies. Audubon Mississippi staff monitored Least Tern colonies in coastal Mississippi from 2017 to 2019 while seasonal stewards observed the extent of disturbance at each colony. Colonies with greater disturbance rates were less productive, and stewardship efforts benefited colonies by increasing nest hatch probability. Posting stewards at breeding colonies is an effective management strategy for conserving Least Terns, although additional management actions are likely needed to increase chick survival.


A 21-month-old Cocker spaniel with a portosystemic shunt, a moderate thrombocytopenia and a history of pancreatitis, was anesthetized for a cystotomy to remove bladder polyps and stones. The portosystemic shunt had been treated conservatively with lactulose, ampicillin and a special diet. After premedication with methadone 0.2 mg/kg, by intramuscular (IM) injection, anesthesia was induced with propofol 4 mg/kg intravenously (IV) and maintained with isoflurane in oxygen. Additionally, 2 mL lidocaine 2% and 0.1 mg/kg morphine were injected in the lumbosacral epidural space and 0.1 mg/kg meloxicam was administered intravenously. Except for a moderate decrease in arterial pressure after the epidural injection and the need for intermittent positive pressure ventilation during surgery, anesthesia and recovery were uneventful. Postoperative analgesia was provided with methadone (0.2 mg/kg every 4 hours initially, then 0.1 mg/kg every 6 hours IM) and oral meloxicam (0.1 mg/kg the first day, 0.05 mg/kg during 4 days). SAMENVATTING


Introduction: Living things and human activities produce huge waste every day. Globally medical waste is the second most hazardous waste after radiation waste. In this context, this study was a modest endeavor to examine the current situation of 'Jamalpur 250 Bed General Hospital's' medical waste management practice.
Methods : This cross sectional study was conducted among doctors, nurses, laboratory technicians and sanitary staffs at 'Jamalpur 250 Bed General Hospital'. 185 healthcare personnel were purposively interviewed (face to face) to assess previous and existing knowledge and practices of medical waste management. Informed written consent was taken from the study subjects before taking interview. Data was collected by a pretested semi-structured questionnaire.
Results : In our current study, out of 185 respondents, 10.0% were doctors and 43.0% were nurses. Five among six color coding segregation system, below 50.0% of the respondent answered correctly. Only 23.8% respondents revealed that the waste handler use PPE properly. 90.8% respondents were mentioned about the lack of storage place for medical waste at hospital premise. 55.7% respondents didn't know about the in house disinfection process, 56.8% respondents didn't know about the municipal vehicle support and 52.4% didn't know about the availability of waste management equipment. Poor knowledge with favorable attitude and risky medical waste management practice of this hospital's healthcare personnel were detected.
Conclusion : This study were indicated that the majority of healthcare personnel did not apply the recommended medical waste management practice set by WHO. Moreover, the current medical waste management practice in selected district hospital was not managed properly and could pose a risk for human health and the environment.
J Bangladesh Coll Phys Surg 2020; 38(4): 160-165


The periodic vehicle routing problem (PVRP) first appeared in 1974 in a paper about garbage collection (Beltrami and Bodin, Networks 4 (1974), 65–74). The wide applicability and versatility of the problem has led to a vast body of literature addressing both novel applications and solution methods. This article discusses the wide array of circumstances and settings in which the PVRP has been applied and describes the development of solution methods, both exact and heuristic, for the PVRP. As with many core research problems, many variants have been proposed. We will describe additional problem variants and extensions, as well as discuss the future of research for the PVRP. © 2013 Wiley Periodicals, Inc. NETWORKS, Vol. 63(1), 2–15 2014


This paper discusses the suitability for Business Excellence Models (BEMs) to include Corporate Sustainability on business model criteria. The conceptual paper brings discussion of what sort of measures are required to fit organizations' needs in measuring performance in terms of economic, social, and environment bottom-lines. A literature review has been conducted for BEMs that includes the EFQM Excellence Model, Baldrige Model, ISO standards, GRI, and explores its integration with Corporate Sustainability. Then, an analysis is deployed in order to identify common frameworks and metrics used for assessing sustainability in the three dimensions of bottom-lines. Despite there are better frameworks to assess corporate sustainability, Business Excellence Models (BEMs) were found to be suitable performance measurement frameworks to integrate Corporate Sustainability; however, business criteria remain unclear and ambiguous, not addressing clearly how to measure Corporate Sustainability Performance. The research provides a general approach to explore suitability of BEMs to include corporate sustainability and it is limited in scope as some organizations' have specific maturity levels in both: deploying BEMs and corporate sustainability. Further research include the suitability of current economic systems to reach corporate sustainability, and the use of lean-six sigma methods to support corporate sustainability at strategic and operational levels.


This study examined the health implications of kolanut production and consumption. A desk research was done using past published literatures. The study outlined the effect of ill health on agricultural production. Numerous health benefits of kolanut consumption were identified despite several possible side effects when consumed in large quantity overtime. Benefits of kolanut consumption out-weigh the negative implications. Kolanut consumption should be encouraged as it is useful in treating some illnesses that otherwise will cost fortune when treated with conventional drugs. Also with the reported occurrence of Ochratoxin (A), safe and clean storage and shelf on-sale practices are encouraged. Government should also motivate more research on kolanut utilization in food and drug industries in order to stimulate production as this would also help boost the Gross Domestic Product (GDP).


ABSTRACT Background: Vaccine hesitancy is a leading threat to public health. It has been studied extensively in North America and Europe but much less in Arab countries. The Parent Attitudes about Childhood Vaccines (PACV) survey is a validated tool for identifying vaccine-hesitant parents; however, Arabic version is not available. This study aimed to assess the reliability of the PACV survey in the Arabic language and to determine the prevalence of vaccine hesitancy among parents in the United Arab Emirates (UAE). Methods Forward and backward translation of the PACV in the Arabic language was carried out. The reliability of the Arabic-PACV survey was tested among parents with children. The same survey was used to study vaccine hesitancy among parents attending seven ambulatory health-care services in Al-Ain city, UAE. The associations between vaccine hesitancy and socio-demographic characteristics were explored. Results: The Cronbach alpha for Arabic-PACV scores was 0.79. Three hundred participants answered the survey (response rate, 85.7%). The majority were Emirati mothers (77%) in the age group (30–49 years). Only 36 parents (12%, 95% CI 8.5,16.2) were found to be vaccine-hesitant. Parent's greatest concerns were mainly the side effects (35%), safety of vaccines (17% unsure and 28% concerned) and getting too many injections (28%). Divorced marital status was significantly associated with vaccine hesitancy (p < .001). Conclusion: The Arabic-PACV survey could serve as a tool in the evaluation of vaccine hesitancy among parents in UAE and other Arabic-speaking countries. Many parents in our community were concerned about the vaccine safety. Targeted preventive measures are needed.


Nowadays, security is a part that consent by many institution including academic for example in University campus, some of campus have been implement automatic system in campus area to control visitor to enter University also for the staffs and students, but the system is in standalone with introduce new gate pass. Most of University has been use Information Technology (IT) in application for academic system such as student information, registration, results information, etc. In this paper discuss on integration of student information to gate pass system then do not require new card or pass for every student to enter campus area. Gate pass system is required information to match to database that who allow entering to campus, normally a new database is create for the system. In this case, University has student and staff database including lecturer, thus to be efficient the data in existing database can be use and integration using protocol that gate pass system give a command to database as request then verification of those data. Currently, student database stored in server room and the place far away from gate pass system, in order to make it transaction faster for visitor to enter then a mini database is setup onsite of gate system, but periodic updating is require or every new update in database. Results shows, database stored in student information system is more than 30,000 number of student and transaction time is less than 1 second and in average cycle time is 5.5 seconds for motorcycle lane and 7 seconds for car, that mean time for visitor to access gate pass system for entry campus is most reasonable.


The Argument The belief in the existence of eternal mathematical truth has been part of this science throughout history. Bourbaki, however, introduced an interesting, and rather innovative twist to it, beginning in the mid-1930s. This group of mathematicians advanced the view that mathematics is a science dealing with structures, and that it attains its results through a systematic application of the modern axiomatic method. Like many other mathematicians, past and contemporary, Bourbaki understood the historical development of mathematics as a series of necessary stages inexorably leading to its current state — meaning by this, the specific perspective that Bourbaki had adopted and were promoting. But unlike anyone else, Bourbaki actively put forward the view that their conception of mathematics was not only illuminating and useful for dealing with the current concerns of mathematics, but that this was in fact the ultimate stage in the evolution of mathematics, bound to remain unchanged by any future development of this science. In this way, they were extending in an unprecedented way the domain of validity of the belief in the eternal character of mathematical truths, from the body to the images of mathematical knowledge. Bourbaki were fond of presenting their insistence on the centrality of the modern axiomatic method as a way to ensure the eternal character of mathematical truth as an offshoot of Hilbert's mathematical heritage. A detailed examination of Hilbert's actual conception of the axiomatic method, however, brings to the fore interesting differences between it and Bourbaki's conception, thus underscoring the historically conditioned character of certain, fundamental mathematical beliefs.


Abstract Digitization in transplantation is not a new phenomenon. Algorithms are being used, for example, to allocate organs based on medical compatibility and priority criteria. However, digitization is accelerating as computer scientists and physicians increasingly develop and use machine learning (ML) models to obtain better predictions on the chances of a successful transplant. The objective of the article is to shed light on the potential threats to equitable access to organs allocated through algorithms, whether these are the consequence of political choices made upstream of digitization or of the algorithmic design, or are produced by self-learning algorithms. The article shows that achieving equitable access requires an overall vision of the algorithmic development process and that European legal norms only partially contribute to preventing harm and addressing equality in access to organs.


Readings from earth pressure cells that were flushmounted in an instrumented retaining wall exhibited progressive change with time (drift) after backfill placement. The test procedures and conditions precluded the possibility that temperature effects could account for the drift. A series of experiments showed that the drift was caused by moisture migration from the backfill to the concrete retaining wall. It appears that the moisture causes a slight expansion of the concrete around the cells, resulting in distortion of the cells and decrease of the fluid pressure inside the cells. A surface treatment reduced the magnitude of the drift. A pressure cell design is proposed to mitigate this source of drift in new installations.


The invention provides a lithium secondary battery with improved withstanding overcharge and overdischarge characteristics which employs a cathode active material of lithium-containing manganese dioxide having a crystal structure of the Ramsdellite-type. An electrolyte combined with the cathode includes LiN(CF3SO2)2 as a solute. The solute is preferably dissolved in ethylene carbonate. A graphite or LiAl alloy is applied for an anode. LiAl alloy is corrosion-resistant, thereby improving high temperature as well as charge-discharge cycle life characteristics.


This study records the impact on workforce retention of the nearly doubling of wages for homecare workers in San Francisco County over a 52-month period. Using descriptive statistics and logistic regression analysis the author finds that the annual retention rate of new providers rose from 39 percent to 74 percent following significant wage and benefit increases and that a $1 increase in the wage rate from $8 an hour - the national average wage for homecare - would increase retention by 17 percentage points. The author also shows that adding health insurance increases the retention rate by 21 percentage points.


markers (SNPs) for each chromosome (Data S1). We generated these markers from a draft genome sequence for A. rhodensis , a genetic linkage map (S


With the rapid development of semiconductor chip technology, the role of parallel testing in the semiconductor testing is increasing. Aiming at the uncontrollable trigger delay caused by the test task startup delay, this paper proposes a parallel task synchronization trigger method for semiconductor testing. The LabWindows/CVI integrated development environment is used to implement the design and development. The method achieves the test task starting delay time stable and not subject to parallel number affects, then ensure the efficiency and stability of parallel testing.


During creation of obtaining technology of the inorganic acids range of high purity the authors developed information database of the flexible production, including 7 standard hardware modules: chemical cleaning, rectification, desorption, adsorption, absorption, content correction and filtration. The system of computer quality management is developed for analytical monitoring of high purity inorganic acids on the basis of information CALS-technologies.


In this work, the current-voltage characteristics of graphene structures with an superperiod are calculated by the transfer matrix numerical method.


Abstract : This report documents the results of a multi-year research project which employed a structured case study approach to examine-the history and processes that had resulted in the introduction of a number of technology-based Army systems in time to make a positive contribution to the outcome of Desert Storm. In addition to the case studies documented in Volume II of this report, a common set of data was obtained and analyzed to identify factors contributing to successful systems developments this) Volume I contains the results of this analysis. Several of the statistically significant relationships found involve factors that are related to the stability of the program. When key members of the project team left the program too early, project outcome suffered. Further, both project funding cutbacks and project team turn-over negatively correlated with the quality of the testing program and the timeliness of key test events. These two attributes of the testing program also had the strongest correlation with project outcomes. In addition, changes in systems requirements during development correlated with poor project cost performance, and, finally, turn-over in key user representative personnel correlated negatively with system performance in the field. A central conclusion from this study is that shorter development cycle times favorably correlate with key project outcome variables, largely by minimizing the exposure of the project to destabilizing influences which have also been shown to correlate negatively with these same outcome variables.


The syndrome of gait ignition failure is described in six patients in whom difficulty initiating walking was the major symptom. The gait had elements of parkinsonism with start and turn hesitation, shuffling, and freezing. Unlike parkinsonism, however, the gait was relatively normal once entrained; the posture was upright, and good arm swing, a normal stride length, and no festination were seen. Equilibrium was normal or near normal, and when seated or lying, rhythmic leg movements were generated normally. Facial expression, upper limb mobility, and whole body movements were wellpreserved. This gait disorder differed from that seen in Parkinson's disease and the so‐called "frontal" or "senile" disorders of gait and gait "apraxia". The causes of this gait syndrome are not clear but it may be due to frontal lobe vascular disease and/or focal degeneration of the frontal lobes.


Mesodermal-specific cDNA or transcript (MEST) was identified by suppression subtractive hybridization-PCR of cDNA isolated from embryonic day 13 vs. newborn mice kidneys. At day 13 of mouse gestation, a high expression of MEST, with a single approximately 2.7-kb transcript that was exclusively localized to the metanephric mesenchyme was observed. The MEST mRNA expression gradually decreased during the later stages and then abruptly decreased in the newborn kidneys and subsequent postnatal life, after which a very mild expression persisted in the glomerular mesangium. Regression in mRNA expression during embryonic renal development appears to be related to methylation of the MEST gene. Treatment of metanephroi, harvested at day 13 of gestation with MEST-specific antisense oligodeoxynucleotide resulted in a dose-dependent decrease in the size of the explants and the nephron population. This was associated with a selective decrease in MEST mRNA expression and accelerated apoptosis of the mesenchyme. These findings suggest that MEST, a gene with a putative mesenchymal cell-derived protein, conceivably plays a role in mammalian metanephric development.


This study was undertaken to evaluate whether genetic analysis in the stool can be useful for detecting malignant tumors in the colon and rectum. We searched for the possible presence of mutations in the p53 gene in the stool of patients with resectable colorectal cancer. Alterations in the p53 gene are the most frequent among mutant genes related to colorectal cancer.


Dengue is an important emerging viruses, posing a threat to one-third of the global human population. In 2002, the introduction of DENV-3 in the state of Bahia produced massive epidemic (about 35,000 cases detected) and the first cases of dengue hemorrhagic fever. To understand the nature of the virus circulating at Bahia, E/NS1 sequence was determined for 31 DENV viruses isolated in Bahia during the 2006 and 2007 transmission season, from patients presenting with different degrees of severity. The carboxi-terminal region of the E gene (220 nt) of 31 viruses, isolated from dengue patients with clinical diagnosis of dengue infection were used to determine the genetic variability of dengue 2 (DENV-2) and dengue 3 (DENV-3). Sequence data were used in phylogenetic comparisons with global samples of DENV-2 and DENV-3. DENV-2 sample grouped in the South East Indian genotype, while DENV-3 samples were grouped within Indian genotype. This study is the first report on Bahia isolates during two transmission seasons. Our data confirms reports from other parts of Brazil and different countries showing the DENV-3 (geno-type III) strains circulating in the Americas are closely related, and cluster within the genotype that has been associated with DHF epidemics in different conti-nents.


Germ cells are essential for fertility, embryogenesis, and reproduction. Germline development requires distinct types of RNA-protein (RNP) granules, including germ plasm in embryos, piRNA granules in gonadal germ cells, and the Balbiani body (Bb) in oocytes. However, the regulation of RNP assemblies in zebrafish germline development are still poorly understood. Asz1 is a piRNA protein in Drosophila and mice. Zebrafish Asz1 localizes to both piRNA and Bb granules, with yet unknown functions. Here, we hypothesized that Asz1 functions in RNP granule assemblies and germline development in zebrafish. We generated asz1 mutant fish to determine the roles of Asz1 in germ cell development. We show that Asz1 is dispensable for somatic development, but essential for germ cell and gonad development. asz1-/- fish developed exclusively as sterile males with severely underdeveloped testes that lacked germ cells, demonstrating that Asz1 is essential for spermatogenesis. Mechanistically, we provide evidence to conclude that zygotic Asz1 is not required for primordial germ cell specification or migration to the gonad, but is essential for germ cell survival during post-embryonic gonad development, likely by suppressing the expression of germline transposons. Increased transposon expression and morphologically mis-organized piRNA granules in asz1 mutants, argues that zebrafish Asz1 functions in the piRNA pathway. We generated asz1;tp53 fish to partially rescue ovarian development, revealing underdeveloped mutant ovaries with defective oocytes, and that Asz1 is also essential for oogenesis. We further showed that in contrast with piRNA granules, Asz1 is dispensable for Bb granule formation, as shown by normal Bb localization of Buc and dazl. By uncovering Asz1 as an essential regulator of germ cell survival and gonadogenesis in zebrafish, and determining its differential necessity in distinct RNP granule types, our work advances our understanding of the developmental genetics of reproduction and fertility, as well as of RNP granule biology. Author Summary Germ cells undergo a highly dynamic developmental program that begins in the early embryo and continues through juvenile and adult life. Identifying functional regulators and deciphering the developmental mechanisms of germ cells are critical for advancing our understanding of fertility and reproduction, as well as their associated diseases. Here, we identified Asz1 as an essential regulator of germ cell and gonad development in zebrafish. We demonstrate that zygotic Asz1 is dispensable for the specification and migration of primordial germ cells in the embryo, but is necessary for germ cell survival in the developing gonad, likely by protecting them from transposable elements. Upon loss of asz1, expression of germline transposons was induced, and piRNA granules were mis-organized, suggesting a conserved role for zebrafish Asz1 in the piRNA pathway. We show that Asz1 is required for both spermatogenesis and oogenesis. However, unlike RNA-protein (RNP) granules of the piRNA pathway, Asz1 was not required for RNP granules of the Balbiani body in differentiating oocytes, revealing its differential necessity in distinct types of germline RNP granules. In mice, Asz1 was shown to be essential for spermatogenesis but not oogenesis, but its functions in human gonads are unclear. Our work reports the functional requirements of Asz1 in both sexes in zebrafish, contributes to our knowledge of developmental reproduction biology, and sheds new light on the complexity of RNP granule assemblies.


Summary Aim: Early treatment response of head and neck cancer to radiotherapy concomitant with cetuximab was monitored by repetitive PET imaging with the proliferation tracer 18F-FLT. Patients, methods: Five head and neck cancer patients, treated with radiotherapy and concomitant cetuximab following cetuximab induction, received four 18F-FLT PET-CT scans before and during treatment. Changes in SUVpeak, SUVmean and CT- and PET-segmented gross tumour volumes were evaluated, as were correlations with immu- nohistochemical staining for Epidermal Growth Factor Receptor (EGFR) and Ki-67 (proliferation marker) in pre-treatment tumour biopsies. Results: 18F-FLT PET measured tumor responses to the induction dose of ce- tuximab varied from 43% SUVpeak decrease to 47% increase. After start of radiotherapy 18F-FLT PET parameters decreased significantly in all patients. No associations were found between PET parameters and EGFR or Ki-67 expression levels. Conclusion: Proliferation of head and neck carcinomas shows a varying response to cetuximab induction, but consistently decreases after addition of radiotherapy.


Adjustment of gene expression during acclimation to stress conditions, such as bright light, in the cyanobacterium Synechocystis sp. PCC 6803 depends on four group 2 σ factors (SigB, SigC, SigD, SigE). A ΔsigCDE strain containing the stress-responsive SigB as the only functional group 2 σ factor appears twice as resistant to photoinhibition of photosystem II (PSII) as the control strain. Microarray analyses of the ΔsigCDE strain indicated that 77 genes in standard conditions and 79 genes in high light were differently expressed compared with the control strain. Analysis of possible photoprotective mechanisms revealed that high carotenoid content and up-regulation of the photoprotective flavodiiron operon flv4-sll0218-flv2 protected PSII in ΔsigCDE, while up-regulation of pgr5-like, hlipB or isiA genes in the mutant strain did not offer particular protection against photoinhibition. Photoinhibition resistance was lost if ΔsigCDE was grown in high CO2, where carotenoid and Flv4, Sll0218, and Flv2 contents were low. Additionally, photoinhibition resistance of the ΔrpoZ strain (lacking the omega subunit of RNA polymerase), with high carotenoid but low Flv4-Sll0218-Flv2 content, supported the importance of carotenoids in PSII protection. Carotenoids likely protect mainly by quenching of singlet oxygen, but efficient nonphotochemical quenching in ΔsigCDE might offer some additional protection. Comparison of photoinhibition kinetics in control, ΔsigCDE, and ΔrpoZ strains showed that protection by the flavodiiron operon was most efficient during the first minutes of high-light illumination.


Online tests have been identified as a core learning activity in higher education. Unlike conventional online tests, which cannot completely reflect students' learning status, two-tier tests not only consider students' answers, but also take into account reasons for their answers. Due to such significance, research into the two-tier tests had mushroomed but few studies examined why the two-tier test approach was effective. To this end, we conducted an empirical study, where a lag sequential analysis was used to analyze behavior patterns while qualitative data from the questionnaire were applied to explain why these behavior patterns were happened. The results indicated students with a two-tier test tended to realize the rationale of a concept, instead of relying on their memories. In other words, the two-tier test can facilitate students to develop deep thinking skills. This may be because they considered the two-tier test as a learning tool, instead of an assessment tool only.


Infection by herpes simplex virus type 1 (HSV-1) induces a persistent nuclear translocation of NFkappaB. To identify upstream effectors of NFkappaB and their effect on virus replication, we employed mouse embryo fibroblast (MEF)-derived cell lines with deletions of either IKK1 or IKK2, the catalytic subunits of the IkappaB kinase (IKK) complex. Infected MEFs were assayed for virus yield, loss of IkappaBalpha, nuclear translocation of p65, and NFkappaB DNA-binding activity. Absence of either IKK1 or IKK2 resulted in an 86 to 94% loss of virus yield compared to that of normal MEFs, little or no loss of IkappaBalpha, and greatly reduced NFkappaB nuclear translocation. Consistent with reduced virus yield, accumulation of the late proteins VP16 and gC was severely depressed. Infection of normal MEFs, Hep2, or A549 cells with an adenovirus vector expressing a dominant-negative (DN) IkappaBalpha, followed by superinfection with HSV, resulted in a 98% drop in virus yield. These results indicate that the IKK-IkappaB-p65 pathway activates NFkappaB after virus infection. Analysis of NFkappaB activation and virus replication in control and double-stranded RNA-activated protein kinase-null MEFs indicated that this kinase plays no role in the NFkappaB activation pathway. Finally, in cells where NFkappaB was blocked because of DNIkappaB expression, HSV failed to suppress two markers of apoptosis, cell surface Annexin V staining and PARP cleavage. These results support a model in which activation of NFkappaB promotes efficient replication by HSV, at least in part by suppressing a host innate response to virus infection.


ABSTRACT Introduction: Chronic obstructive pulmonary disease is the fourth leading cause of death worldwide, one serious complication being pulmonary hypertension, which occurs in up to 30% of patients and increases mortality drastically. Difficulties in diagnosis and the unclear beneficial effects of PH-specific therapy have hitherto resulted in the absence of approved therapies. Consequently, PH and right heart failure in COPD are still currently treated according to symptoms and not underlying cause Areas covered: This review focuses on the current knowledge of its pathogenesis, clinical picture, diagnosis as well as methods for treatment Expert commentary: Since PH-COPD is an orphan disease with grievous consequences, and diagnosis as well as the right choice of possible treatment is crucial, referral to an expert center in cases of suspicion is necessary. Hitherto there is no officially approved treatment available even though several studies have shown notable improvement in selected individuals, making diagnostics, prognostic markers, and the search for therapeutic agents key issues of interest in this field.


The physiological airflow resistance from the anterior nares to the upper trachea has recently been documented. This resistance is thought to be important in preventing alveolar collapse and in maintaining the optimum lung ventilation: perfusion ratio. This resistance is lost in laryngectomees who may have a subsequent decline in lung function and arterial oxygen saturation. A stoma filter with a resistance approximating to that of the normal upper airway has been developed and laryngectomees who wear this device demonstrate a rapid increase in tissue oxygen saturation (median increase: 1.4 kPa, P = 0.0087) without significantly altering tissue carbon dioxide saturation. This finding will have a major impact on the future rehabilitation of laryngectomees and those with a temporary tracheostomy.