Analysises on factors which impact the performance of the multi level algorithms have been made, and on the basis of which an immune algorithm with selfadaptive reduction has been proposed for the TSP problems. By using an evolutionary reduction set, the proposed algorithm refines the reduction edges which gradually increase in the number and enhance in the forecasting accuracy. As a result, the probability that the refined algorithm finds the global optimal solution can be improved. Experimental results show that the proposed algorithm can achieve better solutions than other approaches.


Abstract Background Despite the availability of factor replacement therapy, including prophylaxis, to treat and prevent bleeding, haemophilic arthropathy continues to be the most common complication of haemophilia and significantly impairs the quality of life in people with haemophilia (PwH). Regular periodic assessment of joint status in PwH is essential to identify early arthropathic changes and prevent the development or progression of haemophilic arthropathy. Kinematic and kinetic assessment are preferable and MRI is the gold standard for diagnosing haemophilic arthropathy, but availability is limited in developing countries. HJHS and ultrasound in conjunction with HEAD-US have been shown to effective in assessing changes indicating arthropathy. Aim This study is designed to identify which radiological assessment tool(s) works best when integrated with clinical assessment tools to examine joint health in PwH, with the aim of establishing a cheap, effective, multimodal approach to joint assessment in clinical practice in low resource settings which can then help to guide treatment. Methods A cross-sectional observational study was carried out among PwH attending a clinic in the department of medicine at Assam Medical College and Hospital, Northeast India, over a one-year time period. The elbow, knee and ankle joints of participants were assessed clinically and functionally using HJHS and FISH and radiologically by Pettersson (X-ray) and HEAD-US (ultrasound) scoring. The resulting data was analysed statistically to ascertain correlation between these parameters. Results Sixty-seven PwH were enrolled in the study, with a mean age of 21.69±8.24 years (median 21 years); 38 (57.72%) had severe factor deficiency. The majority (71.70%) presented with joint bleeds; 40 (59.70%) had the knee as a target joint, followed by the elbow (11; 16.41%) and ankle (6; 8.95%). Mean ABR (annual bleed rate), AJBR (annual joint bleed rate) and ATJBR (annual target joint bleed rate) values had a positive correlation with increased severity of factor deficiency (p <0.001). FISH score increased with factor activity level; HJHS, HEAD-US and Pettersson scores decreased with factor activity level. Significant positive correlation was established between Pettersson score, age and ABR. The degree of association was greatest between HJHS and HEAD-US at 60.62%; between HJHS and Pettersson it was 57.74%. Statistically significant negative correlation was established between FISH and HEAD-US. Conclusion A combined multimodal approach using the HJHS, FISH and HEAD-US scoring systems can provide a cheap, quick, more reliable and accurate option for assessing haemophilic joints, with minimal inter and intra observer reliability. This can support the optimisation of management of joint damage in PwH in resource-constrained settings.


INTRODUCTION
Inflammatory skin diseases are a very heterogeneous and extensive group of entities whose clinical and pathological diagnosis is difficult. In cases where the clinical diagnosis is doubtful, the histopathological study of one or more lesions can be of great help. The aim of our work is to compare the effectiveness of the histopathological diagnosis in inflammatory skin lesions according to the department performing the biopsy.

MATERIAL AND METHODS
A retrospective study was carried out on the reports for pathological study requests and the histopathological reports from the year 2003 from the Pathology Department of Hospital Santa María del Rosell. In the reports for the pathological study requests, the following data was assessed: department performing the biopsy, whether or not the type of lesion was stated on the request form, location, evolution and clinical diagnosis. The histopathological diagnoses were reviewed by one of the authors and classified into two major groups: a) specific diagnoses and b) non-specific diagnoses. Five departments took part in performing biopsies on inflammatory skin lesions: Dermatology, General Surgery, Primary Care, Internal Medicine and Gynecology. To better compare the data, we have divided the departments into two groups: 1. Dermatology Department and 2. Non-dermatology departments. We performed a statistical analysis (proportion comparison) of the specific diagnoses between the two groups and among the specific diagnoses of the non-dermatology departments.

RESULTS
The total number of inflammatory skin lesions studied was 97. The Dermatology Department performed 48 biopsies, and the non-dermatology departments performed 49. There was less clinical data in the reports sent by the non-dermatological departments than in those from the Dermatology Department. The pathologist made a specific diagnosis in 77 % of the biopsies performed by the Dermatology Department, compared to 41 % of the biopsies sent by the non-dermatology departments (p < 0.001). There are no statistically significant differences among the specific diagnoses made by the departments that make up the non-dermatology group.

CONCLUSION
The histopathological diagnoses made in the biopsies sent from the Dermatology Department are more specific (77 %) than those made in the biopsies performed by the non-dermatology departments (41 %). Thus, biopsies on inflammatory skin lesions should be performed by the Dermatology Department so that diagnostic effectiveness is maximized, and in order to prevent delays and inappropriate treatments that might be harmful to the patient.


Background: Information asymmetry between physicians and patients is one of the most unique characteristics of health care. But as consumerism spreads in health care sector, health care consumers are searching comparative information about quality and cost of providers from many information sources. Providing comparative information to health care consumers not only makes consumers choose hospital rationally, but also invigorates the health care market by providers' competition. However there are few studies regarding information searching behavior of health care consumers, then this study is carried out. Methods: The purpose of this study is to understand the information searching behavior of health care consumers based on their characteristics and the types of medical institutions. For this purpose, 313 spinal patients' data of 11 medical institutions (university hospital, spine specialized hospital, clinic) located in Seoul were collected by self-administered surveys. Results: The results of this study are as follows: 1) t-test/analysis of variance analysis showed that according to various characteristics of health care consumers and the types of medical institutions, the level of information searching of each source and the amount of information searching and searching outcomes are statistically different. 2) Regression analysis showed that influence on searching outcomes are statistically different according to the level of information searching of each source and searching content and the amount of information searching has positive effects on searching outcomes. Conclusion: The significance of this study is to provide empirical basis for establishment of health care policy reflecting information needs and preference of health care consumers.


Opioids are potent analgesics and are believed to be the best choice for moderate and severe nociceptive pain. Investigating all the possible administration route options for pain management in the different animal species is warranted in horses as systemic administration of these drugs in horses is difficult. In this study the authors describe for the first time in the literature the administration of methadone orally to MDR1 genotipically normal horses. Twelve adult healthy horses (6 females and 6 males) were studied. Horses randomly received one of the doses of methadone (0.1, 0.2, and 0.4mg/kg) per os, which was administered using a 60cc syringe containing 30ml of corn syrup The results showed all doses produced plasma levels compatible to analgesic plasma levels in human beings. The authors conclude that methadone is absorbed when orally administered in horses at doses of 0.1, 0.2, and 0.4 mg.kg -1 . It does not produce excitement, sedation, nor undesirable side effects in healthy horses. Further studies are necessary in order to establish clinical guidelines for oral methadone as an alternative for pain m anagement in the horse.


Our article seeks to understand how perceptions of social and societal responsibility of brands influence the process of consumer engagement. For this, we are interested in the specific expectations of consumers in terms of the social responsibility of the citizen brands they consume. Our results indicate that a consumer perceives a brand as socially responsible if it assumes, in addition to its environmental and philanthropic responsibility, a health responsibility for the respect of the health of its consumers. Our results confirm the influence of social responsibility perceptions on consumer engagement with the brand and offer a new understanding of the relationship process at work.


Purpose: To determine the maximum tolerated dose or maximal administered dose and pharmacokinetic and safety profiles of s.c. administered vascular endothelial growth factor Trap (aflibercept), a novel antiangiogenic agent. Experimental Design: In this open-label, dose-escalation study, patients with advanced solid tumors were treated with subcutaneous doses of aflibercept at seven dose levels. Patients received a single dose of aflibercept and then underwent safety and pharmacokinetic assessments over the next 4 weeks. Patients then received weekly or biweekly treatment over the subsequent 6 weeks. Patients tolerating and benefiting could continue on aflibercept at the same dose and schedule until progression of disease. Results: Thirty-eight patients received at least one dose of aflibercept. Maximum tolerated dose was not reached. Due to solubility/dosing limits with the subcutaneous formulation, 1,600 μg/kg/week was the maximal administered dose. The most common toxicities were proteinuria (37%), fatigue (32%), injection site reactions (18%), nausea (17%), myalgia and anorexia (16% each), hypertension (13%), and voice hoarseness (11%). Drug-related grade 3 to 4 toxicity was uncommon (7%) and reversible: dehydration, cerebral ischemia, proteinuria, hypertension, leukopenia, and pulmonary embolism. We identified dose-proportional increases in plasma concentrations of aflibercept bound to vascular endothelial growth factor with a t1/2 of 18 days. No antiaflibercept antibodies were detected. Stable disease was maintained for at least 10 weeks in 18 patients (47%), and 2 patients maintained on study for >1 year. Conclusion: Subcutaneous aflibercept was well tolerated and had manageable side effects. Its favorable pharmacokinetic profile and potential antitumor activity warrants further evaluation. Clin Cancer Res; 16(1); 358–366


Information-theory is being increasingly used to analyze complex, self-organizing processes on networks, predominantly in analytical and numerical studies. Perhaps one of the most paradigmatic complex systems is a network of neurons, in which cognition arises from the information storage, transfer, and processing among individual neurons. In this article we review experimental techniques suitable for validating information-theoretical predictions in simple neural networks, as well as generating new hypotheses. Specifically, we focus on techniques that may be used to measure both network (microcircuit) anatomy as well as neuronal activity simultaneously. This is needed to study the role of the network structure on the emergent collective dynamics, which is one of the reasons to study the characteristics of information processing. We discuss in detail two suitable techniques, namely calcium imaging and the application of multi-electrode arrays to simple neural networks in culture, and discuss their advantages and limitations in an accessible manner for non-experts. In particular, we show that each technique induces a qualitatively different type of error on the measured mutual information. The ultimate goal of this work is to bridge the gap between theorists and experimentalists in their shared goal of understanding the behavior of networks of neurons.


Production and enhancement of high value phycocyanin pigment from microalgae biofilms cultured on oilfield and natural gas produced wastewater were investigated. Cyanobacteria isolated from Logan City, Utah, wastewater treatment Lagoons (LLC2) was cultured in produced water using rotating algal biofilm reactors (RABRs). The RABRs were operated under "low" and "high" light conditions and biomass and phycocyanin content were compared. Phycocyanin content was enhanced by growth under low light conditions to a maximum yield of 31.7 mg/g ash-free dry weight (AFDW) biomass for an 87.6% increase in phycocyanin yield. Phycocyanin productivity was equivalent for both the low and high light treatments (327 ± 81 and 305 ± 39 mg/m2/day, respectively), due to the significantly lower AFDW biomass productivity of the low light treatment (2.7 ± 0.4 g/m2-day). An indoor laboratory evaluation of 14 substrata for biofilm growth showed that cotton rope and cotton belt material provided the highest biomass yields. Further evaluation in a pilot-scale outdoor produced wastewater pond showed that the biomass characteristics from the two substrata differed. The corrugated surface area of the cotton rope cultured a biofilm with a large community of non-photosynthetic organisms with an autotrophic index of 507 and a low phycocyanin yield of 3.4 mg/g AFDW. However, the cotton belt substratum cultured a healthy photosynthetic biofilm with an autotrophic index of 127 and a phycocyanin yield of 47.0 mg/g AFDW. These results demonstrate the cultivation of microalgae biomass and valorization of oilfield and natural gas produced wastewater through the design and management of algal-based biofilm photobioreactors.


A 61-year-old man was admitted to our hospital in December 1994 for a suspected retroperitoneal tumor. Systemic imaging investigations demonstrated retroperitoneal solid tumor, which was diagnosed as malignant fibrous histiocytoma (MFH) by immunohistochemistry for alpha 1-antitrypsin. In March 1995, he was treated with 3 courses of systemic chemotherapy with cisplatin, ifosfamide and doxorubicin followed by the same therapy in March 1996, without serious side effects. MFH is known to be resistant to ordinary chemotherapy. However, the CT showed a marked decrease in the size of the tumor, and the tumor disappeared within 2 months after the first treatment. The patient also recovered rapidly from abdominal pain, for which complete remission has been achieved for more than 5 years. The present chemotherapy may be an effective treatment for retroperitoneal MFH.


Background/Objective: China is now faced with a serious population aging challenge, and the health of the Chinese elderly is becoming an imminent concern. Consequently, it is critical to establish a lifestyle evaluation system for promoting the health of the Chinese elderly. Methods: Interviews with experts and questionnaire surveys were conducted. Factor analysis, analytic hierarchy process, and statistical analyses were also adopted in this study. Results: Besides evaluation metrics and standards, a two-level category system including 50 indices and associated weights from three level 1 categories (physical and mental health and social wellbeing) and thirteen level 2 categories were obtained. Discussion and Conclusions: Based on the confirmatory factor analysis and Cronbach's test, such an evaluation system excels in effectiveness and reliability, and is ready to be popularized in Chinese society. We expect that the Chinese elderly will benefit from our system and that it will lead to a healthy lifestyle accordingly.


This study investigated contribution of zonal quality assurers' feedback in improving instruction in secondary schools in Rombo District. The study was guided by four research questions. Cross sectional survey design under quantitative approach used. Stratified and simple random sampling techniques used to select the sample of this study. Questionnaires, interview schedule and document analysis schedule were used during data collection process whereby the validity of the research instruments was ensured through the use of experts of Mwenge Catholic University. The researcher gives the instruments together with the research questions to two expects at MWECAU. Reliability of the instruments was ensured by using Cronbach's alpha. Quantitative data is presented in tables and figures. The study found out that the QASOs feedback help teachers in developing creativeness and be innovative when teaching students. The findings revealed that teachers require the technical guidance and suggestions from quality assurance that are essential for enhancing their performance since they highlighted the strengths and limitations of certain teachers. The study found out that QASOs feedback improve teacher's preparation of professional documents since help in delivering content knowledge for determining in large measure what goes on in a class and for assessing what students do and do not learn. Based on the findings it was concluded that report and recommendations from QASOs enabling teachers in developing creativeness and be innovative when teaching students. The researcher recommended that there is a need for the government through Ministry of Education Science and Education (MOEST) to employ more QASOs based on the number of secondary schools in the country.


Rapid drainage of supraglacial lakes on the Greenland Ice Sheet enables the establishment of surface‐to‐bed hydrologic connections and subsequent basal water delivery. Estimates of the number and spatial distribution of rapidly draining lakes vary widely, and no study has so far quantified the impact of observation bias due to cloud cover in satellite imagery on reported frequency of rapid lake drainage. To better understand the rapid drainage mechanism, we map and track an average of 515 supraglacial lakes per year in central West Greenland from 2000 to 2015. We test four previously published definitions of rapid lake drainage and find the proportion of rapidly draining lakes to vary from 3% to 38% and to be strongly dependent on observation frequency. We then apply an observation bias correction and test three new drainage criteria, which reveal a bias‐corrected rapid drainage probability of 36–45%. When observation bias is addressed, we can also show that lakes above 1,600 m are as likely to drain rapidly as lakes located at lower elevations. We conclude that inconsistent detection methodologies and observation bias have obscured the true frequency of rapidly draining lakes and that the rapid lake drainage mechanism will establish surface‐to‐bed hydrologic connections at increasing distance from the margin as supraglacial lakes expand inland under climate warming.


Foreword John Elkington, Founder and Chief Entrepreneur, SustainAbility Foreword Peter Forstmoser, CEO, Swiss Re Introduction. Managing and Measuring the Business Case for Sustainability. Capturing the Relationship between Sustainability Performance, Business Competitiveness and Economic Performance Stefan Schaltegger, Centre for Sustainability Management, University of Luneburg, Germany, and Marcus Wagner, Dr Theo Schoeller Chair in Technology and Innovation Management, Technische Universitat Munchen and Centre for Sustainability Management, Universi Part 1. Theory - conceptual approaches 1. The link between environmental and economic performance Environmental and Economic Performance: The Basic Links Leena Lankoski, Helsinki University, Finland How Can Environmental Management Contribute to Shareholder Value? The Environmental Shareholder Value Approach Stefan Schaltegger, Centre for Sustainability Management, University of Luneburg, Germany 2. Social performance and economic success Do Social Objectives Integrate with Core Corporate Objectives? The Future of Social Auditing Trevor Goddard, Curtin University of Technology, Australia Social Performance and Competitiveness: A Socio-Competitive Framework Kuno Spirig, Zurich University of Applied Sciences, Winterthur, Switzerland 3. Integrative approaches Mapping the Links of Corporate Sustainability: Sustainability Balanced Scorecards as a Tool for Sustainability Performance Measurement and Management Marcus Wagner, Dr Theo Schoeller Chair in Technology and Innovation Management, Technische Universitat Munchen and Centre for Sustainability Management, University of Luneburg, Germany, and Stefan Schaltegger, Centre for Sustainability Management, Universi A Model of Financial Analysis at the Service of Sustainability Juan Pineiro Chousa and Noelia Romero Castro, Department of Finance and Accounting, University of Santiago de Compostela, Spain Sustainable Value Added: A New Approach to Measuring Corporate Sustainable Performance Frank Figge, School of the Environment, University of Leeds, UK, and Tobias Hahn, Institute for Futures Studies and Technology Assessment, IZT, Germany Sustainable Analysis of Industrial Operations: A Proof of Concept Demonstration Study Sonja Lynn Odom, Laboratory for Sustainable Solutions, Department of Mechanical Engineering, University of South Carolina, USA Part II. Empirical surveys - financial markets industry and country surveys 4. Views from the financial markets The Economic Performance of European Stock Corporations: Does Sustainability Matter? Klaus Rennings, Michael Schroeder and Andreas Ziegler, Centre for European Economic Research (ZEW), Germany Capital Markets and Corporate Environmental Performance: Research in the United States Dinah A. Koehler, Economics and Decision Sciences Research, National Center for Environmental Research, US Environmental Protection Agency, USA Sustainable Investment and Financial Performance: Does Sustainability Compromise the Financial Performance of Companies and Investment Funds? Eckhard Plinke and Andreas Knoerzer, Sarasin Sustainability Investments, Bank Sarasin & Co. Ltd, Basel, Switzerland Benchmarking Competitiveness and Management Quality with the Dow Jones Sustainability Index: The Case of the Automotive Industry and Climate Change Niki Rosinski, Sustainable Asset Management (SAM), Zurich, Switzerland 5. Industry surveys Have Trends in Corporate Environmental Management Influenced Companies' Competitiveness? Henning Madsen and John P. Ulhoi, The Aarhus School of Business, Denmark Competitiveness, Environmental Performance and Management of SMEs David Hitchens, Queen's University Belfast, UK, Jens Clausen, IOEW, Germany, Mary Trainor, Queen's University Belfast, UK, Michael Keil, IOEW, Germany, and Samarthia Thankappan, Cardiff University, UK IPPC and the Impact of Best Available Techniques (BAT) on the Competitiveness of European Industry: Survey of the European Non-Ferrous Metals Industry David Hitchens, School of Management and Economics, Queen's University Belfast, Northern Ireland, Frank Farrell, Environment Agency, Bristol, UK, Josefina Lindblom, Institute for Prospective Technological Studies (IPTS), Seville, Spain, and Ursula Triebsw 6. Country surveys The Mutual Relationship between the Environmental Context and Management in the Netherlands Ronald S. Batenburg, Department of Information Sciences, Utrecht University, the Netherlands The Norwegian Environmental Business Barometer Bjarne E. Ytterhus, Norwegian School of Management (BI), Sandvika, Norway Sustainability Performance of Countries: Based on the Example of Oekom Research AG's Country Rating Matthias Boenning, Oekom Research, Munich, Germany Does a Nation's Ecological Performance Affect its Economic Stability? The Potential for Enhancing Sovereign Credit Risk Assessments with Ecological Resource Accounts Mathis Wackernagel, Global Footprint Network, Oakland, CA, USA, Chris Martiniak, Global Footprint Network, Oakland, CA, USA, and University of Michigan Business School, USA, Fred Wellington, World Resources Institute, Sustainable Enterprise Program, and formerly Environmental Management Program, University of San Francisco, USA, Chad Monfreda, Sustainability and Global Environment Program, University of Wisconsin, Madison, USA, and Steve Goldfinger, Justin Kitzes and Deborah Cheng, Global Footprint Network, Oakland, CA, USA, Part III. Evidence - strategies, case studies and management systems 7. Strategies and the business case for sustainability Achieving Sustainable Corporate Competitiveness: Strategic Link between Top Management's (Green) Commitment and Corporate Environmental Strategy Ki-Hoon Lee, KwangWoon University, Korea, and Robert Ball, University of Stirling, UK Ecopreneurship and Competitive Strategies: Striving for Market Leadership by Promoting Sustainability Holger Petersen, Umweltbank Nurnberg and Centre for Sustainability Management, University of Luneburg, Germany Building a Business Case for Corporate Sustainability Ulrich Steger, Institute for Management Development (IMD), Lausanne, Switzerland Developing Value: The Business Case for Sustainability in Emerging Markets Jodie Thorpe and Kavita Prakash-Mani, SustainAbility, UK 8. Company cases Managing Sustainability Performance in the Textile Chain Stefan Seuring and Maria Goldbach, Supply Chain Management Centre, Carl von Ossietzky Universitat Oldenburg, Germany Sustainability and Competitiveness in the Renewable Energy Sector: The Case of Vestas Wind Systems Rolf Wustenhagen, Institute for Economy and the Environment, Switzerland Path-Dependent Thinking and Ecoproducts: An Empirical Study of Socio-Cognitive Models and Product Propositions of Ford and Volvo Cars Mats Williander, Fenix Centre for Research on Knowledge and Business Creation, Chalmers University of Technology, Sweden Honda and Toyota: Using Sustainability in a New Competitive Battleground Peter A. Stanwick and Sarah D. Stanwick, Department of Management and School of Accountancy, College of Business, Auburn University, USA Incremental Change towards Sustainanbility: Integrating Human and Ecological Factors for Efficiency Suzanne Benn, School of Management, University of Technology, Sydney, Australia, and E. Jane Probert, European Business Management School, University of Wales Swansea, Swansea, UK 9. Environmental management systems and competitiveness ISO 14001: Profitable? Yes! But is it eco-effective? Jost Hamschmidt and Thomas Dyllick, University of St Gallen, Switzerland What Makes Environmental Management Systems Successful? An Empirical Study in the German Manufacturing Sector Boris Braun, Department of Geography, Otto-Friedrich-University, Bamberg, Germany


The traditional tools of physical organic chemistry benefit from modern data analysis techniques [Also see Research Article by Milo et al.] Elucidating catalytic reaction mechanisms is often a challenge, and these difficulties are compounded in the case of enantioselective catalysts. The ability of a catalyst to preferentially form one enantiomer over the other often hinges on the balance of many attractive and repulsive nonbonded interactions that occur in competing transition states. On page 737 of this issue, Milo et al. (1) combine physical organic and computational quantum chemistry with modern data analysis techniques to identify these interactions. Their predictive mathematical models elucidate the underlying reaction mechanism and the role of nonbonded interactions in these enantioselective reactions, facilitating the rational design of more effective catalysts.


An orthogonal frequency division multiplexing (OFDM) system is sensitive to frequency errors, causing intercarrier interference (ICI) among subcarriers. We analyze the performance degradation of an OFDM system due to frequency offset errors and propose a new ICI cancellation method to reduce the effect of frequency offset errors. The main idea is to map each data symbol a/sub k/ which is to be transmitted onto a pair of non-adjacent subcarriers k and (N-1-k), with weightings +1 and -1, other than to a single subcarrier. The carrier-to-interference ratio (CIR) of the proposed method is better than that of normal OFDM by an amount between 10 dB to 30 dB. This method has another advantage of the frequency diversity effect in the multipath fading channel. This study shows that the proposed method performs better than the previously described self-ICI cancellation method for a small value of frequency offset.


The ethics of non-invasive scientific research on human skeletal remains are poorly articulated and lack a single, definitive analogue in western law. Laws governing invasive research on human fleshed remains, as well as bio-ethical principles established for research on living subjects, provide effective models for the establishment of ethical guidelines for non-invasive research on human skeletal remains. Specifically, non-invasive analysis of human remains is permissible provided that the analysis and collection of resulting data (1) are accomplished with respect for the dignity of the individual, (2) do not violate the last-known desire of the deceased, (3) do not adversely impact the right of the next of kin to perform a ceremonious and decent disposal of the remains, and (4) do not unduly or maliciously violate the privacy interests of the next of kin.


In order to optimize anesthetic management and avoid adverse maternal and fetal outcomes, a clear understanding of the changes in cardiovascular physiology that occur during pregnancy is paramount. The effects of normal gestation on the cardiovascular system are particularly significant in a parturient with cardiac valvular pathology. We present a case of a 27-year-old G2P0 at 37 weeks with a past medical history of diabetes, macrosomia, congenital bicuspid aortic valve with severe stenosis (valve area 0.7 cm2) who was scheduled for elective C-section. A multidisciplinary discussion involving cardiologists, cardiac surgeons, obstetric surgeons, neonatal intensivists, perfusion staff, anesthesiologists, and nursing staff was held to formulate a plan for the perioperative management of this parturient. Also, contingency plans were formulated and discussed with the care providers, in the event of acute decompensation of the mother and baby and possible need for emergency aortic valvuloplasty and/or aortic valve replacement.


Hydraulic fracturing is a widely used reservoir stimulation technique to exploit CBM in China. Compared with the original permeability of coal reservoir, the postfracturing permeability is more critical for the productivity evaluation of CBM wells. Based on hydraulic fracturing, microseismics monitoring, and well test data of the CBM wells in Zhengzhuang block of Qinshui Basin, this paper proposes a simple method to obtain the fitting pressure by the classic fracturing pressure decline analysis theory under the condition of corrected dynamic overall leakoff coefficient. In addition, the postfracturing permeability of coal reservoir is predicted by the injection well testing theory. The morphology of hydraulic fractures in the study area is mainly determined by in‐situ stress, and most fractures are vertical ones propagating along the direction of the maximum principal stress. The fracturing curves of the study area can be classified into stable curves, stably fluctuating curves, descending curves, ascending curves, and fluctuating curves, where the stable and descending fracturing curves represent better fracturing effect. The length of hydraulic fractures is much greater than the height. The PKN model has been selected as the hydraulic fracture propagation model to analyze the fracturing pressure decline. The slope value of liner segment of G(δ,0) curve is proposed as the criterion for the fitting pressure calculation. The postfracturing permeabilities of coal reservoir range from 1.55 to 8.83 × 10−3 μm2, all of which are remarkably higher than that of the original reservoir.


This paper presents an informal discussion of my attempts to escape the bonds of paper (bad pun). It recalls my experiences with a traditional PC, a PocketPC, and finally a TabletPC. The goal of this paper is to provide an anecdotal form of a "selfethnography" to share with others who have already made, or have future plans that include, exploring moving to a more paperfree environment.


This article is to review researches in Vietnam on the behavioral culture of medical staff towards patients in Ho Chi Minh City. As a result, the study summarizes the achievements and limitations of researches on behavioral culture in general as well as researches on behavioral culture of medical staff in particular. This is the basis for the author to build a theoretical framework, gaps in research on behavioral culture of medical staff towards patients in Ho Chi Minh City.


We describe the experimental procedures for a dataset that we have made publicly available at https://doi.org/10.5281/zenodo.2617084 in mat (Mathworks, Natick, USA) and csv formats. This dataset contains electroencephalographic recordings of 12 subjects listening to music with and without a passive head-mounted display, that is, a head-mounted display which does not include any electronics at the exception of a smartphone. The electroencephalographic headset consisted of 16 electrodes. Data were recorded during a pilot experiment taking place in the GIPSA-lab, Grenoble, France, in 2017 (Cattan and al, 2018). Python code for manipulating the data is available at https://github.com/plcrodrigues/py.PHMDML.EEG.2017-GIPSA. The ID of this dataset is PHMDML.EEG.2017-GIPSA.


We derive local microscopic optical potentials $U$ systematically for polarized proton scattering at 65 MeV using the local-potential version of the Melbourne $g$-matrix folding model. As target nuclei, we take ${}^{6}$He and neutron-rich Ne isotopes in addition to stable nuclei of mass number $A=4$--208 in order to clarify mass-number and isotope dependence of $U$. The local potentials reproduce the experimental data systematically and have geometries similar to the phenomenological optical potentials for stable targets. The target density is broadened by the weak-binding nature and/or deformation of unstable nuclei. For the real spin-orbit part of $U$ the density broadening weakens the strength and enlarges the radius, whereas for the central part it enlarges both of the strength and the radius. The density-broadening effect is conspicuous for halo nuclei such as ${}^{6}$He and ${}^{31}$Ne. Similar discussions are made briefly for proton scattering at 200 MeV. We briefly investigate how the isovector and the nonspherical components of $U$ affect proton scattering.


The history of economics, properly read, is very much a history of economics in the public sphere. Sir William Petty developed his most important insights in the process of providing advice on taxation to the monarch. Adam Smith wrote with a view to influencing the habits of thought of both the educated layman and policy makers. Jane Marcet and Harriet Martineau brought early classical political economy to the masses. David Ricardo formulated foundational elements of the nineteenth-century classical system writing policy pamphlets and then entered Parliament with a view to putting policy making on a solid economic footing. Karl Marx's intended audience was anything but the practitioners of the emerging science of political economy. Alfred Marshall buried his technical analysis in appendices to maximize the exposure of his work. John Maynard Keynes's influence can be ascribed, without too much injustice, as much to his effectiveness outside the walls of Cambridge as within them and to the use by others of his ideas in that same public realm. Yet, despite this lengthy history of economists' engagements with various publics, including those pulling the levers of policy, those writing on the history of economics have focused far more intently on the history of theory and the implications for the construction of a body of thought known as "economic analysis" than on the interplay among economists, economic ideas, and the public realm. It is as if the economic conversation went on solely within the space of academic departments of economics, even though those spaces are very recent creations.


Introduction: The novel coronavirus disease 2019 (COVID-19) is in the midst of worldwide panic. Sudden onset of an immediate life-threatening illness, quarantine and unemployment caused by epidemic are all contributors to depression. Ginseng has been reported to be an effective and safe clinical treatment on both immune-regulation and anti-depression. However, the mechanism of its anti-depression effect has not been fully characterized. In order to provide theoretical guidance for further clinical application in post-pandemic, we investigated active compounds and pharmacological mechanisms of ginseng to exert anti-depressant activity using network pharmacology, and discussed the active ingredients with immune-regulation and anti-depression.Methods: Information on compounds in ginseng was obtained from public databases, and genes related to depression were gathered using the GeneCards database. Networks of ginseng-associated targets and depression-related genes were constructed through STRING database. Potential targets and pathway enrichment analysis related to the therapeutic efficacy of ginseng for depression were identified using Cytoscape and Database for Annotation, Visualization and Integrated Discovery (DAVID). Results: Network pharmacological analysis of ginseng in treatment of depression identified 16 active ingredients, 47 potential targets, 32 GO terms, and 8 target gene-regulated major pathways. Among them, kaempferol, beta-sitosterol, stigmasterol, fumarine and frutinone A are bioactive compounds and key chemicals. Core genes in PPI network were AKT1, CASP3, NOS3, TNF, and PPARG. Enrichment results revealed that ginseng could regulate multiple aspects of depression through neuroactive ligand-receptor interaction, HIF-1 signaling pathway, and Serotonergic synapse. More importantly, we found that frutinone A and kaempferol are key ingredients in ginseng with dual activities of immune-regulation and anti-depression. Conclusions: We discovered that the therapeutic activities of ginseng for depression mainly involve neurotransmitters, neurotrophic factors, neurogenesis, HPA axis and inflammatory response. Pharmacological network analysis can help to explain the potential effects of ginseng for treating depression, indicating that ginseng is a preferable herb clinically for immune-regulation and anti-depression in post-pandemic.


This paper proposes a model of how biased individuals update beliefs in the presence of informational ambiguity. Individuals are ambiguous about the actual signal-generating process and interpret signals according to the model that can best support their biases. This paper provides a complete characterization of the limit beliefs under this rule. The presence of model ambiguity has the following effects. First, it destroys correct learning even if infinitely many informative signals can be observed. When the ambiguity is sufficiently high, individuals can justify their biases, leading to belief extremism and polarization. Second, an ambiguous individual can exhibit greater confidence than a Bayesian individual with any feasible model perception. This phenomenon comes from a novel complementary effect of different models in the belief set.


The purpose of this research is to verify the validity of A-RIDE, a developed vertical transportation planning program. A-RIDE is a web-based software program that can present reasonable vertical transportation plan alternatives for high-rise buildings, based on basic building information at an early design phase. This research focused on high-rise office buildings which have a complex vertical transportation system due to heavy traffic. For verification, an object building have been selected and vertical transportation has been planned using A-RIDE. The presented vertical transportation plan and the actual plan have been compared and analyzed. Results of A-RIDE were similar to the actual plan which verifies the significance of this program as a vertical transportation planning tool for the early design phase. Through further research, this program has the potential to become a powerful design tool for architects planning high-rise buildings.


The pharmacokinetics and pharmacodynamics of two multiple-dose regimens of piperacillin-tazobactam (3.375 g every 6 h and 4.5 g every 8 h) were evaluated at steady state for 12 healthy adult volunteers. Inhibitory and bactericidal activities for the two regimens were determined with five American Type Culture Collection (ATCC) organisms (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Bacteroides fragilis). The percentage of time that plasma concentrations remained above the MIC (T > MIC) for each organism and dosage regimen was calculated. Areas under the inhibitory (AUIC0-24) and bactericidal activity (AUBC0-24) curves were calculated with the trapezoidal rule by using the reciprocal of the inhibitory and bactericidal titers determined for each dosage regimen. In order to assess the validity of predicted measures of bactericidal (AUC0-24/MBC) and inhibitory (AUC0-24/MIC) activity to determine bacteriological response to beta-lactam antimicrobial agents, AUC0-24/MBC and AUC0-24/MIC values were compared with measured AUBC0-24 and AUIC0-24 values. Total body clearance values were equivalent for piperacillin (183.96 +/- 22.66 versus 181.72 +/- 19.54 ml/min/1.73 m2, P > 0.05) and tazobactam (184.71 +/- 19.89 versus 184.87 +/- 18.35 ml/min/1.73 m2, P > 0.05) following the administration of the 3.375-g-every-6-h and 4.5-g-every-8-h dosages, respectively. Comparison of area under the plasma concentration-time curve (AUC0-24) for piperacillin (967.74 +/- 135.56 microg x h/ml versus 978.88 +/- 140.96 microg x h/ml) and tazobactam (120.14 +/- 15.78 microg x h/ml versus 120.01 +/- 16.22 microg x h/ml) revealed no significant differences (P > 0.05) between the 3.375-g-every-6-h and 4.5-g-every-8-h regimens, respectively. Both regimens provided T > MIC values of > 60% for all organisms tested. Measured values of bactericidal (AUBC) and inhibitory (AUIC) activity were significantly different (P < 0.05) from predicted values (AUC0-24/MBC and AUC0-24/MIC) for all organisms studied with the exception of the bactericidal activity for P. aeruginosa and S. aureus. Additionally, ATCC organisms possessing the same MICs and MBCs exhibited great differences in measured AUBC0-24 and AUIC0-24 values. Reasons for this difference may be inherent differences in organism specific susceptibility.


In this paper we investigate the weight structure of cyclic codes of composite length n = n_{1} n_{2} . The actual minimum distances of some classes of binary cyclic codes of composite length are derived. For other classes, new lower bounds on the minimum distance are obtained. These new lower bounds improve on the BCH bound for a considerable number of binary cyclic codes.


Background: Antiphospholipid syndrome (APS) is an autoimmune`multisystem pathologic condition, characterized by recurrent arterial or venous thrombosis, pregnancy loss and thrombocytopenia. Also, APS were reported in many infectious disease including viral, bacterial, and parasitic infections (e.g.toxoplasmosis). There are however interesting association between the parasite response and specific auto-antibodies (aPL- serine Abs&aCL-Abs).Objective: To represent the role of autoantibodies in association with toxoplasmosis in the occurrence of the recent abortion.Patients and Methods: The present study included 76 women: 42women had recent abortion and 34 healthy women with no history of abortion, which constitute the control group, their ages ranged between (15-40) years. ELISA method was used for detection IgM-Abs of T.gondii, aPL-serine Abs and aCL- screen Abs. in the blood samples collected.Results: It was found that there was a statistical, high significant correlation between antiphosphatidyl-serine Abs and anti-toxoplasma IgM Abs, P-value<0.05. While no statistical significant correlation was found between anti-cardiolipin screen Abs and anti-toxoplasma Abs IgM Abs,P-value >0.05.Conclusion: Anitphosphatidyl serine –Abs in association with acute phase of toxoplasmosis had important role in recent abortion, more than the role of anticardiolipin Abs.


The idea of extending mobile IP capabilities to ad hoc networks introduces fast agent discovery, increases cell coverage of access points, and extends ad hoc network size by providing connection to the Internet. We aim to show that an adaptive protocol is required since different protocols are optimum for different environments. We propose two protocols called MEWLANA-TD and MEWLANA-RD based on DSDV and a novel ad hoc routing called tree based bidirectional routing (TBBR) respectively in addition to the proposed protocols based on on-demand routing. We classify the ad hoc environment into regions and present which protocol is appropriate for which region.


Suppose that an officer has the requisite probable cause necessary to obtain a search warrant to seize evidence, but seizes the evidence that a search warrant would have rendered before obtaining the warrant. Should the evidence that was seized be admissible under the theory of inevitable discovery? This question's answer ultimately depends on the jurisdiction's position on "active pursuit." The idea of active pursuit was born out of the facts of Nix v. Williams, and has caused a divide amongst the various circuits of the United States Court of Appeals. Some have required it while others have expressly held it unnecessary. This article is the first to draw upon the Court's dicta from Hudson v. Michigan to advance the argument that active pursuit should not be required and that the inevitable discovery doctrine should be analyzed through a "but-for" causal analysis. But-for causation is required in order to exclude evidence, and if police misconduct is not a but-for cause of the discovery of evidence the evidence should be admitted regardless of whether there was active pursuit. This article is also the first to break down the three different approaches taken at the circuit court level to resolve this issue, and then explain why the but-for causal analysis best effectuates the Court's holding from Nix v. Williams as well as the Court's recent exclusionary rule jurisprudence.


Abstract Non-uniform heating has been a challenging problem in microwave heating due to 'standing wave pattern' and 'thermal runaway' problems. Cycled microwave heating was used to improve microwave heating uniformity of frozen products, while a relatively new approach of inverter heating was claimed to help preserve food quality during thawing/heating. In this study, finite-element-method-based coupled multiphysics-kinetic models were developed, validated, and used to investigate these controversial results by comparing the heating performances of average temperature, heating non-uniformity, and nutritional value change between the inverter and cycled microwave heating of foods. The effect of food sizes/shapes and material properties (dielectric loss) was evaluated. Results showed that there was little difference in average temperature, heating uniformity, and Vitamin C content between cycled and inverter heating for different food products. A relatively more uniform heating and lower nutritional value degradation were observed for small size low loss material; however, the improvement was not significant enough to claim the benefit of inverter heating.


Correspondence Mark S. Rosenbaum, Graham School of Management, Saint Xavier University, 3825 W 103rd St, Chicago, IL 60655. Email: firstname.lastname@example.com Abstract These studies draw on evolutionary psychology and intrasexual female competition to examine why female shoppers often prefer working with gay male (GM) sales associates over heterosexual female (HF) sales associates. Study 1 finds that female shoppers often attribute trustworthiness to GM sales associates. Study 2 draws on theories of intrasexual competition and shows that female shoppers are more likely to trust product recommendations from a GM sales associate than an HF sales associate when they feel a sense of competitiveness with the female associate. Study 3 reveals that female shoppers' trust in GM sales associates is limited to situations in which they are intending to purchase products that are meant to enhance their physical appearance. Study 4 extends these findings by showing that women are more likely to trust GM sales associates (vs. HF sales associates) when the objective of their purchase is to attract a desirable mate. The findings suggest that retailers should hire a diverse workforce and consider the role of e‐commerce in helping some female shoppers avoid potentially uncomfortable situations.


Objectives: To determine the frequency of preeclampsia in obese women at civil hospital Karachi. Methods: A total 126 patients from March-2020 up to December-2021 were inducted in the study with non-probability consecutive sampling. Women of 18-40 years of age having singleton pregnancy with obesity with gestational age ≥ 20 weeks were included after informed consent. Blood pressure (BP) was measured after 20 weeks of gestation. Urine for protein was checked if BP was found to be ≥140/90 mmHg for diagnosis of pre-eclampsia. Result: The women had a mean age of 28.56 ± 3.848 years. Age at presentation was highest in the group 25-31 years which represented 87 (69.04%). 23.02% of the women were nulliparous, 76.98% were multiparous. The mean ± SD gestational age was 34.52 ± 3.775 and 72 (57.1%) were in their 35-40 weeks of gestation. 91 women representing 72.2% had a BMI of 30-33 kg/m2. Pre-eclampsia was diagnosed in 33 (26.2%) obese patients (Table 2). Conclusion: The frequency of 26.2% of Pre-eclampsia in obese women is significantly high. Women should be counseled before conception to decrease their BMI. Keywords: Obesity, Pre-eclampsia, Blood pressure


Zooplankton may be regarded as a sensitive tool for monitoring environmental variations in coastal lagoons due to their ability to immediately react to changes in the water column trophic features and salinity levels. As a coastal lagoon with a broad history of anthropic influence, Rodrigo de Freitas Lagoon (Rio de Janeiro, Brazil) is widely used for water sports and artisanal fishing. The present study aimed to expand the knowledge base about zooplankton in the Rodrigo de Freitas Lagoon by assessing the composition and time-spatial distribution of the major zooplankton groups. Samples were collected fortnightly from at four distinct sampling points August 2001 to July 2002. At each point, salinity, temperature, dissolved oxygen and water transparency were measured. During the study period, the lagoon behaved as an spatially homogeneous environment in what regards the abiotic variables. However, all these variables showed significant differences along the time, mainly related to seasonality (air temperature and rainy and dry periods). The zooplankton community showed low taxonomic richness, with the predominance of species commonly found in coastal lagoons, especially with mesohaline conditions, as well as those found in estuaries. An interesting fact was the rise in zooplankton abundance at all sampling points right after a fish kill event. Such increase was caused mainly by the Brachionus plicatilis O.F. Muller 1786 species. Thus, the zooplankton community was affected by physical and chemical factors, mainly by the dissolved oxygen decline event and variations in the influx of seawater into the lagoon. In addition, phytoplankton availability and fish predation pressure were suggested as important regulating factors of the zooplankton community.


A phenomenological theory involving interfacial charge is presented to account for the result that the diode constant n at low forward biases might be temperature dependent in some thinly oxidized (< 20 A) semiconductor‐insulator‐semiconductor and metal‐insulator‐semiconductor devices, resulting in parallel I‐V curves. Neither multistep tunneling through the semiconductor space‐charge region, nor conventional thermionic emission over the barrier, can explain the low‐voltage portion of the I‐V characteristics. In this paper it is shown that an interfacial charge redistribution occurs with changes in temperature, resulting in changes in the electron affinity of the base semiconductor and in the work function of the contact material. This results in a linear dependence of n on reciprocal temperature. An explanation is presented to account for the large temperature coefficient that has been observed for both the diffusion potential VD and open‐circuit photovoltage Voc in these devices. And an explanation of t...


BACKGROUND
The production of 2 monoclonal proteins characterizes biclonal gammopathic manifestations (BGMs). The available medical literature from India is chiefly restricted to case reports.

OBJECTIVE
To study the incidence of BGMs in a tertiary care center in Chandigarh, India, during a 4-year period. We evaluated these cases further for their laboratory characteristics.

METHODS
We scrutinized the contents of a database containing information from the studied 4-year period. Cases reported as BGMs on serum protein electrophoresis (SPEP) and confirmed by serum immunofixation electrophoresis (SIFE) were included.

RESULTS
A total of 15 cases, from a cohort of 914 cases of monoclonal gammopathic manifestations (MGMs), were available. On SPEP, 2 M bands were observed in 12 cases. On SIFE, 4 cases were reported as being of true BGMs. The most common heavy-chain combination observed was immunoglobulin (Ig)A-IgG. Follow-up was available in 2 patients.

CONCLUSION
Identification of BGMs increases diagnostic precision, despite that the treatment is similar to that for monoclonal gammopathic manifestations (MGMs). BGMs can be transitory and may be observed at presentation or during the disease course.


Early-stage drug discovery has been limited by initial hit identification and lead optimization and their associated costs (1). Ultra-large virtual screens (ULVSs), which involve the virtual evaluation of massive numbers of molecules to engage a macromolec-ular target, have the ability to significantly alleviate these problems, as was recently demonstrated in multiple studies (2–7). Despite their potential, ULVSs have so far only explored a tiny fraction of the chemical space and of available docking programs. Here, we present VirtualFlow 2.0, the next generation of the first open-source drug discovery platform dedicated to ultra-large virtual screen ings. VirtualFlow 2.0 provides the REAL Space from Enamine containing 69 billion drug-like molecules in a "ready-to-dock" format, the largest library of its kind available to date. We provide an 18-dimensional matrix for intuitive exploration of the library through a web interface, where each dimension corresponds to a molecular property of the ligands. Additionally, VirtualFlow 2.0 supports multiple techniques that dramatically reduce computational costs, including a new method called Adaptive Target-Guided Virtual Screening (ATG-VS). By sampling a representative sparse version of the library, ATG-VS identifies the sections of the ultra-large chemical space that harbors the highest potential to engage the target site, leading to substantially reduced computational costs by up to a factor of 1000. In addition, VirtualFlow 2.0 supports the latest deep learning and GPU-based docking methods, allowing further speed-ups by up to two orders of magnitude. VirtualFlow 2.0 supports 1500 unique docking methods providing target-specific and consensus docking options to increase accuracy and has the ability to screen new types of ligands (such as peptides) and target receptors (including RNA and DNA). Moreover, VirtualFlow 2.0 has many advanced new features, such as enhanced AI and cloud support. We demonstrate a perfectly linear scaling behavior up to 5.6 million CPUs in the AWS Cloud, a new global record for parallel cloud computing. Due to its open-source nature and versatility, we expect that VirtualFlow 2.0 will play a key role in the future of early-stage drug discovery.


The concentration and balance of major ions that comprise total dissolved solids (TDS) can influence the toxicity of effluents discharged to freshwater and marine environments. An additional complicating factor in waters released to saltwater systems is the effluent salinity since the toxicity of major ions changes with the salinity of the test solution. A study was conducted to evaluate the toxicity of six major seawater ions (bicarbonate, borate, calcium, magnesium, potassium, and sulfate) to the mysid shrimp, Americamysis bahia, at salinities of 10 and 20%. Logistic regression models were developed to predict organism survival at deficient and excess concentrations of the ions. Calcium and potassium caused significant mortality to mysid shrimp in both excess and deficient (relative to artificial seawater) solutions. Bicarbonate, borate, and magnesium displayed significant toxicity only in excess concentrations, while sulfate had no adverse impacts at any of the concentrations tested. As the salinity of the test solutions decreased, mysid shrimp tolerated increasingly lower calcium and potassium concentrations. Similarly, as salinity increased, the upper tolerance levels of calcium, potassium, and magnesium also increased. The models developed during these studies, and similar models developed by other researchers, were used to evaluate 11 actual effluents with unexplained toxicity that might be associated with TDS ions. The models correctly identified calcium as the primary toxicant in 9 of the 11 effluents. These results indicate the models can be used as an important tool to identify toxicity associated with major seawater ions.


The state of intracerebral hemocirculation in the pilots during expert examinations to determine the tolerance for special exercise tests was studied. The cerebral circulation reactions were evaluated with the use of ultrasonic transcranial Doppler vasography. It is found that exercise tests depending on an intensity of exposure and directionality result in different degree of changes in the cerebral circulation parameters. In an effect of the flight-surgeon's appraisal the use of transcranial Doppler vasography during LBNP test to identify the persons susceptible to the syncopal states is advisable.


Abstract Objective. The diagnosis of coeliac disease requires small-bowel mucosal villous atrophy with crypt hyperplasia. However, patients with endomysial antibodies but structurally normal villi may suffer from a disorder similar to those with villous atrophy. The aim of this study was to evaluate gastrointestinal symptoms, quality of life and bone mineral density in patients with mild enteropathy, and the effect of a gluten-free diet. Material and methods. A prospective trial was carried out in 73 adults having endomysial antibodies with normal villous morphology (Marsh I–II; mild enteropathy) or villous atrophy (Marsh III). Gastrointestinal symptoms and quality of life were surveyed by means of structured questionnaires and bone mineral density by means of X-ray absorptiometry. Altogether, 110 subjects served as non-coeliac controls. Results. At baseline, patients with mild enteropathy evinced more gastrointestinal symptoms than non-coeliac controls, but there were no significant differences in quality of life between the groups. After 1 year on a gluten-free diet, indigestion and depression were significantly alleviated in the mild enteropathy group. Osteoporosis or osteopenia was detected in 58% of subjects in the mild enteropathy group and there was a trend towards improved bone mineral density after the treatment. Conclusions. Endomysial antibody-positive patients with normal villous structure may suffer from gastrointestinal symptoms and have poor bone health. Furthermore, they benefit from a gluten-free diet similar to those with overt villous atrophy.


The paper aims to analyze positive and negative characteristics of Internet information, consider the peculiarities of social and historical change of knowledge, and identify the specifics of the phenomenon of human academic literacy. In the modern information and digital age, the role and importance of information is increasing at a rate that has allowed scientists to describe the situation as the information explosion. The dramatic increase in the volume of information was made possible by the fact that a wide range of users with their personal information materials have gained access to the Internet. The speed of obtaining information has also increased; it is transmitted in real-life mode. These and many other characteristics of modern information flows can undoubtedly be assessed as positive trends, but the negative aspects of information processes are also increasing. The abundance of information gives rise to its excess and the problem of its selection. The availability of information does not guarantee its reliability; there is a lot of false, distorted information in the Internet. Analyzing whether the wide access and abundance of Internet information implies increasing academic literacy, the author concludes that people tend to become much more informed, but the path to academic literacy is becoming longer. Academic literacy is what a person learned in the course of education and what became the basis for his/her daily life and self-awareness. The excess of information creates a problem of qualitative selection, which requires additional time. The abundance of unreliable, fake information requires its careful verification. Public morals are the most important element of academic literacy, but there are virtually no filters in the Internet that block immoral information, cruelty, Internet trolling. As a result, learning by processing Internet information makes the process of creating academic literacy much more challenging and complex.
Keywords: information age, information, digital technologies, academic literacy


I N RECENT years m a n y repor t s of i n t r a c ran ia l t u m o r s wi th ex t rac ran ia l me tas tases have a p p e a r e d in the l i t e ra ture . M o s t of these cases have been a d e q u a t e l y d o c u m e n t e d his to logical ly . L e y et al. 52 in a r ecen t r e p o r t have p resen ted a good review of i n t r ac r an i a l t u m o r s wi th me ta s t a se s ou t side the c ran ium. W e were s t i m u l a t e d b y this rev iew to r e p o r t a case of our own occurr ing in a child. L i t t l e emphas i s has been p laced upon the occurrence of ex t racran ia l me ta s t a se s in ch i ldren in p rev ious repor t s t h a t have appea red in t he l i t e ra ture . I n severa l of t he r epor t s va r ious t y p e s of i n t r ac ran i a l t u m o r s have been summar i zed , b u t no a t t e m p t has been m a d e to ana lyze t h e m in g rea te r deta i l . I t is our i n t en t ion to review the l i t e r a tu re of ex t r ac ran ia l me ta s t a se s wi th respec t to t y p e s of tumors , age groups, and the i r preference for si tes of me tas tases .


Additive manufacturing is a layer based manufacturing process aimed at producing parts directly from a 3D model. This paper provides a review of key technologies for metal additive manufacturing. It focuses on the effect of important process parameters on the microstructure and mechanical properties of the resulting part. Several materials are considered including aerospace alloys such as titanium (TiAl6V4 "UNS R56400"), aluminum (AlSi10Mg "UNS A03600"), iron-and nickel-based alloys (stainless steel 316L "UNS S31603", Inconel 718 "UNS N07718", and Invar 36 FeNi36 "UNS K93600").


Intraperitoneal administration of ATE obtained from pooled epididymal fat pads produced hypoglycemia in adrenalectomized rats. Injection of extracts from rat brain, liver and muscle did not affect the blood glucose levels of the adrenalectomized animals. With high ATE concentrations, a progressive decline in blood sugar was observed and most of the animals died from hypoglycemia ten to thirteen hours after intraperitoneal injection.Identical concentration of ATE did not affect the blood glucose levels in intact rats. In some adrenal ectomized rats injected with ATE (100 mg.) a progressive bound insulin fall was detected, but no significant change in free insulin was evidenced.


Persistent psychomotor agitation and psychotic ideation in patients with Alzheimer's disease are normally treated orally with antipsychotic drugs and are occasionally treated with other drugs. Neuroleptics administered intramuscularly at very low doses are an alternative, especially when the patient rejects medicine as a results of his or her anosognosia or of paranoid manifestations. We present the results we obtained after observing the effects of depot zuclopenthixol in six patients with probable Alzheimer's disease (based upon NINCDS-ADRDA criteria). Psychic abnormalities were assessed as per the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS). Possible extrapyramidal side effects were evaluated by means of the Abnormal Involuntary Movement Scale (AIMS). Initially 60 mg (0.3 ml) were administered intramuscularly and successive doses could be modified by +/-20 mg (0.1 ml) according to results seen on the various scales. During the first six weeks of treatment progressive improvement was noted on all three psychic functions scales in all patients. Between the sixth and twelfth weeks improvement continued although without significant change. The AIMS did not show significant changes in the twelve weeks of follow-up. We consider depot zuclopenthixol at low doses as efficacious in treating persistent psychomotor agitation and/or psychotic manifestations of Alzheimer's disease. No undesired side effects were observed in our group after a twelve week follow-up.


According to the United Nations (UN), about 70% of the world's population projected to live in urban areas by 2050. Therefore, cities are experiencing an enormous urban transition the world has ever seen, accounting for 80% of global carbon dioxide emissions, consuming over two-thirds of the world's energy, and producing 1.3 billion tons of waste per year. Leaders, governments, architects, urban designers, developers, planners and business leaders need to make decisions and find solutions for how billions of urbanites will live in the future. Therefore, future cities will require new design principles to face their urban challenges and problems such as pollution, poverty, poor environment, land use management, green-house gas emissions and socio-economic and environmental risks. In this context, the case study area of this paper will be El Raval district, which is in a medieval quarter of Barcelona. This area considered as one of the oldest and a significant part of the city that contains many heritage buildings and unique traditional urban context going back to hundreds of years. The district has an influx of immigrants, which has transformed its label from an industrial neighbourhood into a residential one and low rents that have attracted many people of low income, making it a vibrant and multicultural community. Therefore, the main aim of this paper is to address the implementation of innovative solutions, advanced technologies, ICT and IoT that might enhance people participation in the urban design processes and respond to urban futures challenges. The result of this research will lead to creating a platform to resolve the conflicting values of architectural heritage and smart cities principles, sourcing new sustainable technologies and the integration of the smart infrastructure systems.


The crystal structures of the 1:1 pyrene-pyromellitic dianhydride molecular compound at 110 and at 300 °K have been determined by three-dimensional X-ray diffraction methods (visual intensity measurement, least-squares refinement with isotropic Debye-Waller factors). The component molecules are arranged, plane to plane, in alternating array in mixed stacks. At 110 °K the pyrene molecules in the stacks alternate in two different orientations (about 12° apart) with respect to the interleaving pyromellitic dianhydride molecules, which themselves have small displacements of alternating sign off the stack axis. At about 200 °K this ordered structure changes to a disordered structure which has been determined at 300 °K. The component molecules appear in mean positions, abnormally large Debye—Waller factors indicating disorder. The transformation itself has not yet been studied in detail. Review of the literature suggest that the existence of positional disorder provides an explanation for the widespread reports of high degrees of thermal vibration in crystals of 77-molecular compounds. Some structure determinations appear to have been of disordered structures without this having been fully appreciated. Analysis of Debye-Waller factors, electron-density and difference syntheses suggests that different types of disorder are found in pyrene-pyromellitic dianhydride and pyrene- 1,3,7,9-tetramethyluric acid (Damiani et al. 1965) on the one hand and in naphthalene-tetracyanoethylene (Williams & Wallwork 1967) and naphthalene-1,2,4,5-tetracyanobenzene (Kumakura, Iwasaki & Saito 1967) on the other. The dimensions found for the planar pyrene molecule at 110 °K agree well with those in pyrene itself but are more accurate; the agreement between the present experimental bond lengths and those calculated by the simple valence-bond method is exceptionally good (r.m.s. discrepancy = 0*004 A). The dimensions of the pyromellitic dianhydride molecule agree well with previous results but are more accurate; the molecule is slightly twisted into a non-centrosymmetric shape.


PURPOSE
The study was designed to: (1) investigate the prevalence of high-risk human papillomavirus (HR- HPV) infection and cervical neoplasia; and (2) evaluate clinical performance of visual inspection with acetic acid/ Lugol's iodine (VIA /VILI), Pap smear, high-risk human papillomavirus (HR-HPV) DNA test for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and (3) explore appropriate screening approach in rural areas of Shandong Province.

MATERIALS AND METHODS
A total of 3,763 eligible women from Yiyuan County in Yimeng mountainous areas of rural Shandong, China, were enrolled and underwent Pap smear, HR-HPV DNA testing by Hybrid Capture 2 (HC2), and VIA /VILI tests. Women positive in any test were referred to colposcopy and biopsy as indicated.

RESULTS
The prevalence of HR-HPV infection among all enrolled women was 11.1% and that in healthy women was 9.9%. In total 33 cases of CIN1, 16 cases of CIN2, 6 cases of CIN3 but none of cervical cancer were detected and the crude prevalence of CIN2+ was 0.58%. For detecting CIN2+, the sensitivity of HR-HPV DNA testing, VIA/VILI, Pap smear was 90.9%, 77.3%, 81.8%, respectively. Pap smear had the best specificity of 98.2%, followed by HR-HPV DNA testing with specificity of 89.4%, VIA/VILI had the lowest specificity of 81.2%. Colposcopy referral rate of HR-HPV DNA testing, VIA/VILI, Pap smear was 11.1%, 18.5%, 2.3%, respectively.

CONCLUSIONS
Our results suggest that HR-HPV DNA testing alone might be appropriate for primary cervical cancer screening in rural low-resource areas of Shandong Province, China.


Guides to library resources in anthropology, including books, journal articles and how to cite sources. This page is for content regarding other resources.


Stress impairs hippocampal neurogenesis. The traditional animal model of stress contains a mixture of physical and psychological stress factors. This leads to difficulty in the evaluation of the effect of pure psychological stress on neurogenesis. In this study, we investigated the effect of pure psychological stress on hippocampal neurogenesis. The pure psychological stress model and the mixed stress model were carried out by terrifying sound and restraint, respectively. The open field test showed that restraint treatment improved the general locomotor activity levels, while terrifying sound treatment had opposite effects. Compared with a normal condition, both terrifying sound stimulation and restraint treatment significantly decreased the number of BrdU and Ki‐67 and reduced the positive rate of SOX2/GFAP in the hippocampus. These phenomena indicated that pure psychological stress could decrease the number of neural stem cells and inhibit cell proliferation in the hippocampus of a mouse. Furthermore, compared with the restraint treatment, the neurotransmitters including norepinephrine (NE), 5‐hydroxytryptamine (5‐HT), and gamma‐aminobutyric acid (GABA) had not been affected drastically by terrifying sound stimulation. Our results suggest that the terrifying sound stimulation can be considered as a novel and effective pure psychological stress animal model for the further research on the hippocampus.


Recent research observed a sensitive window, at about 14 years of age, in the acculturation rates of Chinese immigrants to Canada. Tapping an online sample of us immigrants (n=569), we tested these relationships in a broader population and explored connections with new potentially causally related variables: formal education, language ability and contact with heritage-culture and mainstream United States individuals, both now and at immigration. While we found that acculturation decreased with age at immigration and increased with years in the us, we did not observe a similar sensitive window (i.e., change in rate with age). We also present an exploratory path analysis, exposing the relationships in our sample between acculturation and the variables above. The novel relationships documented here can improve theorising about this rich and complex empirical phenomenon.


Four experiments are presented that explore situations in which a decision maker has to rely on personal experience in an attempt to minimize delays. Experiment 1 shows that risk-attitude in these timesaving decisions is similar to risk-attitude in money-related decisions from experience: A risky prospect is more attractive than a safer prospect with the same expected value only when it leads to a better outcome most of the time. Experiment 2 highlights a boundary condition: It suggests that a difficulty in ranking the relevant delays moves behavior toward random choice. Experiments 3 and 4 show that when actions must be taken during the delay (thereby helping compare delays), this increases the similarity of timesaving decisions to money-related decisions. In these settings the results reflect an increase in risk aversion with experience. The relationship of the results to the study of non-human time-related decisions, human money-related decisions and human time perception is discussed.


Study of the end results in thirty-five cases discloses that bony fusion was secured in thirty-two (91.4 per cent.). The fact that there were no operative deaths indicates that among patients who are in good or fair general condition, a carefully conducted operation to produce arthrodesis in the hip should be advised without hesitation. From such a small series an opinion cannot be expressed as to its value for children, for there were only two patients in the first decade of life; union resulted in both cases, however. Although postoperative drainage due to dissemination of the tuberculosis to the contiguous soft parts is not a comfortable situation, and occurred in eleven of the cases, it was not as serious as might appear. Drainage followed in forty-four per cent. of cases in which there were "wet" joints and in twenty-two per cent. in which there were "dry" joints. It occurred in a higher percentage of cases when the operation was extra-articular than it did when the combined operation was employed. I interpret this to mean that the occurrence of drainage is less if the tuberculous tissue is cleanly removed, to the best of the surgeon's ability. A purely extra-articular operation is occasionally possible, but often tuberculous tissue is encountered. The percentage of "wet" joints in the combined intra-articular and extra-articular group and in the extra-articular group was the same.

The great improvement in the general health in these patients following arthrodesis has been most striking. A stiff hip has not been an added handicap, for the hip was not only stiff before operation but was painful. More uniformly successful results have been obtained by the combined method of intra-articular and extra-articular operation together with bone graft than by any other method.


Interstitial determination of the tissue optical properties is important in biomedicine, especially for interstitial laser therapies. Continuous wave (CW) radiance techniques which examine light from multiple directions have been proposed as minimally invasive methods for determining the optical properties under an interstitial probe arrangement. However, both the fitting algorithm based on the P3 approximation and the analytical method based on the diffusion approximation (DA), which are currently used recovery algorithms, cannot extract the optical properties of tissue with low transport albedos accurately from radiance measurements. In this paper, we proposed an incomplete P3 approximation for the radiance, the P3in for short, which is the asymptotic part of the solution for the P3 approximation. The relative differences between the P3in and the P3 were within 0.48% over a wide range of clinically relevant optical properties for measurements at source detector separations (SDS) from 5 mm to 10 mm and angles from 0° to 160°. Based on the P3in, we developed an analytical method for extracting the optical properties directly using simple expressions constructed from the radiance measurements at only two SDSs and four angles. The developed recovery algorithm was verified by simulated and experimental radiance data. The results show that both the absorption and reduced scattering coefficients were recovered accurately with relative errors within 5.28% and 3.86%, respectively, from the simulated data and with relative errors within 10.82% and 10.67%, respectively, from the experimental data over a wide range of albedos from 0.5 to 0.99. Since the developed P3in-based radiance technique can obtain the optical properties rapidly from the measurements at only two SDSs and four angles, it is expected to be used for in vivo and in situ determination of the optical properties in online treatment planning during laser therapies.


Purpose – In the UK, while fashion apparel purchasing is available to the majority of consumers, the main supermarkets seem – rather against the odds and market conventions – to have created a new, socially-acceptable and legitimate, apparel market offer for young children. This study aims to explore parental purchasing decisions on apparel for young children (below ten years old) focusing on supermarket diversification into apparel and consumer resistance against other traditional brands. Design/methodology/approach – Data collection adopted a qualitative research mode: using semi-structured interviews in two locations (Cornwall Please correct and check againand Glasgow), each with a Tesco and ASDA located outside towns. A total of 59 parents participated in the study. Interviews took place in the stores, with parents seen buying children fashion apparel. Findings – The findings suggest that decisions are based not only on functionality (e.g. convenience, value for money, refund policy), but also on intuitive factors (e.g. style, image, quality) as well as broader processes of consumption from parental boundary setting (e.g. curbing premature adultness). Positive consumer resistance is leading to a re-drawing of the cultural boundaries of fashion. In some cases, concerns are expressed regarding items that seem too adult-like or otherwise not as children's apparel should be. Practical implications – The paper highlights the increasing importance of browsing as a modern choice practice (e.g. planned impulse buying, sanctuary of social activity). Particular attention is given to explaining why consumers positively resist buying from traditional label providers and voluntarily choose supermarket clothing ranges without any concerns over their children wearing such garments. Originality/value – The paper shows that supermarket shopping for children's apparel is now firmly part of UK consumption habits and choice. The findings provide theoretical insights into the significance of challenging market conventions, parental cultural boundary setting and positive resistance behaviour.


This study aimed to evaluate the tolerance of C. leprosum seedlings to salt stress during the emergence and early seedling development. The experiment was carried out between the months of August and September, in a greenhouse, and the substrate used was the commercial coconut fiber wetted with aqueous solutions of sodium chloride (NaCl), calcium chloride (CaCl2) and potassium chloride (KCl) with the electrical conductivities of 0.0, 1.5, 2.5, 3.5, 4.5, 5.5 and 6.5 dS m-1. We used a completely randomized design in a 3 x 7 factorial scheme (three salts x seven levels of electrical conductivity). We evaluated seedling emergence, emergence speed index, root length, shoot length, dry matter of roots and shoots. The results indicated significant interaction between both factors analyzed. The emergence and initial growth of C. leprosum plants decrease gradually due to the increase of the electrical conductivity levels, with root length being less affected by waters salinized with CaCl and KCl. C. leprosum seedlings show sensitivity to the three types of salts and are highly sensitive to KCl and NaCl.


Amavata is one of the common and most crippling joint disorders. It is a chronic, degenerative disease of the connective tissue mainly involving the joints. The clinical features of Amavata such as pain, swelling and stiffness of joints, fever and general disability are very much close to the Rheumatological disorder called rheumatoid arthritis. Ama associated with aggravated vata plays a dominant role in the pathogenesis of Amavata. According to its pathophysiology, one should treat the morbid doshas involve in are kapha and vata simultaneously. In the present study, four clinically diagnosed cases of Amavata with swelling of knee joints and morning stiffness , pain in multiple joints, raised rheumatoid factor and anti CCP factor are treated with Vaitarana basti along with Dhanwantara taila Matra basti on same day and changes are observed in subjective and objective criteria. Significant improvement is observed in reducing signs and symptoms of Amavata and in rheumatoid arthritis factor and anti CCP. Vaitarana basti eradicate Ama and kapha dosha as the drugs of Vaitarana basti having Ama pachaka, vatakapha shamaka and Anulomaka properties. On the other hand, Matra basti of Dhanwantara taila pacifies the vatadosha and reduced the pain and swelling. It also acts as neuroprotective, analgesic, anti-inflammatory, anti-arthritic and anti-paralytic. The combination of Vaitarana basti and Dhanwantara taila Matra basti can be an effective treatment for Amavata.


The brain is one of the largest and most complex organs in the human body. Some abnormal and uncontrolled growth of tissue taking place in human brain called "brain tumor". The objective of biomedical image processing is that the image will be enhanced to support doctors more easily in diagnosing and treating. The detection of brain tumor can be performed by using various image processing techniques like brain Magnetic Resonance Imaging (MRI), Computer Tomography (CT), Positron Emission Tomography(PET), Electroencephalography (EEG) etc. Among these techniques the brain MRI is widely adopted in the world due to its significant features. Its correct detection and identification at an early stage is the only way to get cure. Brain tumor tissues may become malignant (cancerous) if not diagnosed. This paper deals with the various aspects of the brain tumor detection. The paper discusses the significant researches which are meant for the brain tumor detection through MRI quality enhancement.


Sweet sorghum Sorghum bicolor (L.) Moench is a special purpose sorghum with a sugar-rich stalk, almost like sugarcane. Besides having rapid growth, high sugar accumulation, and biomass production potential, sweet sorghum has wider adaptability (Reddy and Sanjana 2003). Given that water availability is poised to become a major constraint to agricultural production in coming years (Ryan and Spencer 2001), cultivation of sugarcane becomes difficult. Sweet sorghum would be a logical crop option in lieu of sugarcane in such situations. Sweet sorghum can be grown with less irrigation and rainfall and purchased inputs compared to sugarcane. The sugar content in the juice extracted from sweet sorghum varies from 1623% Brix. It has a great potential for jaggery, syrup and most importantly fuel alcohol production (Ratnavathi et al. 2004a). The stillage after extraction of juice from sweet sorghum can be used for co-generation of power.


On the basis of the available literature about cancer and suicide, it is concluded that patients with cancer show a moderately increased risk of committing suicide. This risk is greatest during the first year after diagnosis of the disease. The forms of cancer which most frequently involves suicide are cancer in the gastro-intestinal canal in men and cancer of the breast and genitalia in women. Points of view as to how the risk of suicide in these patients may be reduced are presented and discussed.


Ground water is a major source of water in northeastern Wisconsin. The lower Fox River valley, located between Lake Winnebago and Green Bay in northeastern Wisconsin, is the second largest population center in Wisconsin. By 1957, ground-water withdrawals had lowered the potentiometric surface of the aquifer system as much as 440 feet below prepumping levels. With the exception of the city of Green Bay, which converted from ground water to surface water (Lake Michigan) for their municipal water supply in 1957, ground-water withdrawals have continually increased. The report evaluates the bedrock aquifer system in northeastern Wisconsin and describes how the flow regimes in the system have been altered due to ground-water withdrawals. A three-dimensional finite-difference groundwater flow model was used to aid in evaluation of the regional flow system. In order to simplify the study of the aquifer system, the geologic units were grouped into eight geohydrologic units consisting of four aquifers and four confining beds. The aquifers are the more permeable sand and gravel layers in the surficial deposits (aquifer 4), Devonian dolomite-Silurian dolomite (aquifer 3), St. Peter SandstonePrairie du Chien Group-Jordan Sandstone Member of the Trempealeau Formation (aquifer 2), and the Galesville Sandstone-Eau Claire Sandstone-Mount Simon Sandstone (aquifer 1). The confining beds are the less permeable silts and clays in the surficial deposits (confining bed 4), Maquoketa Shale-Galena Dolomite-Decorah Shale-Platteville Formation (confining bed 3), St. Lawrence Member of the Trempealeau Formation-Franconia Sandstone (confining bed 2), and the Precambrian crystalline rock (confining bed 1). The following aquifer and confining-bed characteristics were determined to represent the aquifer system of northeastern Wisconsin and were used in the development of the model. Aquifer 4 acts as an upper boundary of the bedrock aquifer system. The hydraulic conductivity of aquifer 3 was 7.9 feet per day and the storage coefficient was estimated to be 0.01. Transmissivity input values to the model for aquifer 2 are based on hydraulic conductivities ranging from 3 to 8 feet per day. The storage coefficient for aquifer 2 was 0.0002. The transmissivity input values to the model for aquifer 1 are based on hydraulic conductivities ranging from 2.5 to 8 feet per day and the storage coefficient was 0.0002. Confining bed 4 acts as an upper confining unit for the underlying bedrock aquifers. A vertical hydraulic conductivity of 0.007 foot per day was assigned to represent confining bed 4. The vertical hydraulic conductivity of confining bed 3 was assigned values of 0.0001 to 0.000004 foot per day. A value of 0.00001 foot per day was used as the vertical hydraulic conductivity for confining bed 2. Confining bed 1 is a lower boundary of the system and was not modeled. Model simulations indicate that, by 1914, ground-water withdrawals from the aquifer system had already impacted the study area. Pumping in the Green Bay metropolitan area had lowered the potentiometric heads in aquifer 1 by 69 feet and in aquifer 2 by 55 feet. Model simulations indicate that, by 1981, ground-water withdrawals have caused a cone of depression centered in the city of De Pere area. The influence of the cone affects almost the entire study area and has significantly altered the horizontal and vertical flow regimes in the aquifer system. In 1981, computed drawdowns below the prepumping potentiometric surface of aquifer 1 range from 0 feet on the western side of the study area to 330 feet in the center of the cone of depression. In aquifer 2, the computed drawdown ranges from 0 feet on the western side of the study area to 253 feet in the center of the cone.


In this paper, we propose a methodology for developing component-based real-time systems based on the concept of hierarchical scheduling. Recently, much work has been devoted to the schedulability analysis of hierarchical scheduling systems, in which real-time tasks are grouped into components, and it is possible to specify a different scheduling policy for each component. Until now, only independent components have been considered. In this paper, we extend this model to tasks that interact through remote procedure calls. We introduce the concept of abstract computing platform on which each component is executed. Then, we transform the system specification into a set of real-time transactions and present a schedulability analysis algorithm. Our analysis is a generalization of the holistic analysis to the case of abstract computing platforms. We demonstrate the use of our methodology on a simple example


Microsomes from rat liver have been shown to synthesize a squalene precursor from farnesyl pyrophosphate. This intermediate is identical with presqualene pyrophosphate, a 30-carbon cyclopropane containing pyrophosphate ester that had previously been isolated from yeast. The squalene precursor was found to be tightly, but not covalently, bound to microsomes.


Background: The impact of intensive care unit acquired pneumonia (ICU-AP), without etiologic diagnosis, on patient outcomes is largely unknown. Objective: To compare the clinical characteristics, inflammatory response and outcomes between patients with or without microbiologically confirmed ICU-AP. Methods: We prospectively collected 270 patients with ICU-AP. Patients were clustered according to positive or negative microbiologic results. We compared the baseline characteristics and outcomes between groups. Results: ICU-AP without etiologic diagnosis was found in 82 (38%) patients. In comparison with patients with microbiologically confirmed ICU-AP, patients without etiology presented more frequently chronic renal failure (15, 18% vs. 11, 6%, p=0.003), chronic heart diseases (35, 43% vs. 55, 29%, p=0.044), higher hypoxemia (PaO2/FiO2 165±73 vs. 199±79 mmHg, p=0.001) and shorter intensive care unit (ICU) stay before the onset of pneumonia (5±5 vs. 7±9 days, p=0.001). The systemic inflammatory response was similar between groups. Despite similar severity at the ICU admission and onset of pneumonia, in patients with microbiologically confirmed ICU-AP there was higher in-hospital (84, 45% vs. 25, 31%, p=0.040), and 90-day mortality (87, 51% vs. 28, 36%, p=0.043). Conclusion: Microbiologically not confirmed ICU-AP develops earlier and it is associated with better outcomes and specific underlying comorbidities that increase the risk of pulmonary edema, ultimately suggesting a potential misdiagnosis. Supported by: EC07/90390, SEPAR 2009, FUCAP, Ciberes (Ciberes is and initiative of Instituto Carlos III), IDIBAPS, Curetis AG.


The ever blurring line between online interactions and physical encounters presents an interesting challenge when recommending events. Events created on social networking sites may have ambiguous location scope. The location information provided may be fuzzy or non existent and additionally the reach and radius of interest in the event can vary greatly. In this work, we identify four categories of events: global, location dependent and socially independent, socially dependent and location independent, and location and socially dependent. We classify events from an organizations internal event management service where the location of the event is unknown, but the location of the attendees are known in order to improve scoping of event recommendations. Our results, investigate the impact of ignoring location properties when recommending events using classic collaborative filtering techniques. Additionally, once global and socially independent events are identified, they can be used to provide recommendations to new users, addressing the cold-start problem.


One hundred fourteen patients with rheumatic heart disease were seen between January 1994 and January 1995 at Gondar College of Medical Sciences Teaching Hospital. These patients were prospectively described using a prepared study protocol consisting of socio-demographic variables, clinical findings and laboratory tests. The mean and median age of the patients were 23 +/- 8 years and 22 years, respectively, (range = 5-50 years). About 66% of the patients were females with female to male ratio of 1.9:1. Eighty five cases (74.6%) were on follow up with mean and median duration of 4.32 +/- 4.5 years and 3 years, respectively (range = 1-20 years). The rest (25.4%) of the patients were new. History findings suggestive of rheumatic fever were obtained in 26% of the patients. Six patients (5.3%) had siblings with similar illness. Frequently encountered valve lesions were combined mitral regurgitation and stenosis seen in 29 (25.4%), followed by pure mitral stenosis in 25 (21.9%) and mitral regurgitation in 21 (18.4%). The commonest arrhythmia was atrial fibrillation, observed in 22.8% of the cases. Recurrence of rheumatic fever occurred in 11 patients (9.6%) over the study period. Of these, five were regularly taking a four weekly Banzanthine penicillin injections. The functional classes of patients according to the New York Heart Association's classification were 17%, 25%, 26% and 32% for classes I, II, III and IV, respectively. There were 85 episodes of decompensations. The commonest precipitating factor was drug discontinuation followed by infection and arrhythmia. Most episodes have multiple causes for deterioration. Critical evaluation and education of patients during follow up is recommended.


Objectives We aimed to explore the views of strategic level stakeholders on leadership for quality and safety in the UK National Health Service. Methods We interviewed 107 stakeholders with close involvement in quality and safety as professionals, managers, policy makers or commentators. Analysis was based on the constant comparative method. Results Participants identified the crucial role of leadership in ensuring safe, high quality care. Consistent with the academic literature, participants distinguished between traditional hierarchical 'concentrated' leadership associated with particular positions, and distributed leadership involving those with particular skills and abilities across multiple institutional levels. They clearly and explicitly saw a role for distributed leadership, emphasizing that all staff had responsibility for leading on patient safety and quality. They described the particular value of leadership coalitions between managers and clinicians. However, concern was expressed that distributed leadership could mean confusion about who was in charge, and that at national level it risked creating a vacuum of authority, mixed messages, and conflicting expectations and demands. Participants also argued that hierarchically based leadership was needed to complement distributed leadership, not least to provide focus, practical support and expertise, and managerial clout. Conclusions Strategic level stakeholders see the most effective form of leadership for quality and safety as one that blends distributed and concentrated leadership. Policy and academic prescriptions about leadership may benefit from the sophisticated and pragmatic know-how of insiders who work in organizations that remain permeated by traditional structures, cleavages and power relationships.


An overview of the applications of deep learning in ophthalmic diagnosis using retinal fundus images is presented. We also review various retinal image datasets that can be used for deep learning purposes. Applications of deep learning for segmentation of optic disk, blood vessels and retinal layer as well as detection of lesions are reviewed. Recent deep learning models for classification of diseases such as age-related macular degeneration, glaucoma,diabetic macular edema and diabetic retinopathy are also reported.


Approximately 5% to 15% cases of endogenous Cushing syndrome are due to ectopic adrenocorticotrophic hormone (ACTH)-producing neuroendocrine tumors, which are commonly located in bronchopulmonary system, thymus, and gastrointestinal tract including pancreas. Although carcinoid tumors of the appendix are revealed in 0.3% of patients undergoing routine appendectomy, ACTH-secreting appendicular carcinoid is a rare entity. We present a case of a 22-year-old woman with ectopic ACTH-dependent Cushing syndrome due to an appendicular carcinoid, which was localized with the help of Ga-DOTATATE PET/CT scan.