Background Fluoroquinolone-resistance in Neisseria gonorrhoeae is spreading in the world and almost 80% of N. gonorrhoeae strains are resistant to fluoroquinolones in Japan. It is known that the resistance to fluoroquinolones is closely related to genetic mutations of quinolone-resistance determining regions (QRDR) on gyrase genes such as gyrA or parC. In 2009, the first national surveillance of antimicrobial susceptibilities of N. gonorrhoeae was performed in Japan. In this surveillance, we found that sitafloxacin, one of newer fluoroquinolones, had a strong activity to ciprofloxacin-resistant N. gonorrhoeae strains. The MIC90 of ciprofloxacin or sitafloxacin were 16 μg/ml or 0.25 μg/ml, respectively. Purpose In this study, the relationship between genetic mutations of QRDR and antimicrobial susceptibilities of sitafloxacin against ciprofloxacin-resistant N. gonorrhoeae strains was examined. Methods The subjects were 12 N. gonorrhoeae strains which were gotten by the Japanese national surveillance by three Japanese societies including the Japanese Association of Infectious Diseases, the Japanese Society of Chemotherapy and the Japanese Society of Clinical Microbiology. MICs of sitafloxacin to these 12 strains were more than 2 μg/ml, but MICs of sitafloxacin to these strains were less than 0.125 μg/ml. The base sequence of QRDR on gyrA or parC genes of these strains were examined Results On QRDRof gyrA of 12 strains, mutations of 2 amino-acids were found, such as Ser91to Phe, Asp95 to Ala or Asp95 to Gly. Regarding parC gene, mutations of 4 amino-acids were found, such as Asp86 to Asn in 1 strain, Ser87 to Asn in 6 strains, Ser87 to Arg in 5 strains, Glu91 to Lys, Gln or Gly in 3 strains and Ala123 to Ser in 3 strains. Conclusion Sitafloxacin had a strong activity to ciprofloxacin-resistant N. gonorrhoeae which had at least more than 3 mutations of amino-acids on QRDR on gyrA and parC genes.


Understanding what factors determine the success of an invasive species in its adopted range is crucial from an evolutionary ecology point of view, because it can provide insights into which biological characteristics are required for survival in varied environmental conditions. Successful establishment may depend on both maintaining genetic diversity, which will allow the species to evolve and/or adapt to new environments, and the presence or absence of natural enemies such as parasites. We tested these two hypotheses by studying populations of the amphipod crustacean Dikerogammarus villosus. This Ponto-Caspian invader has rapidly and successfully invaded western Europe and threatens macroinvertebrate biodiversity in its adopted ranges. It is a unique system to study since both its colonisation history and its geographic origins are well-known. Using samples from the whole geographic range of the invasion route, and using four molecular markers, we found no evidence for genetic bottlenecks during the invasion of D. villosus in western Europe, despite slight variations in allelic proportions according to spatio-temporal subdivisions of our dataset. In addition, we analysed the prevalence and diversity of parasites across its native and adopted range. We found no macro-parasites, and no significant parasite loss of microsporidian parasites during the invasive process. Our data suggest that D. villosus invasion was either massive, or recurrent, or both, allowing a parasitic cortege to follow the host. The maintenance of genetic diversity may have contributed to its success, including the variation in resistance in the face of the natural enemies.


Background Unsafe blood products may cause transfusion-transmissible infections. This study aimed to evaluate the knowledge and perceptions of blood donors regarding blood safety. Methods This was a cross-sectional study conducted in the Kelantan state of Malaysia. The questionnaire comprised 39 questions that covered areas such as donors' social demographic information, knowledge of transfusion-transmitted diseases, blood screening and donor eligibility and perceptions towards blood safety. The knowledge score was categorised as good or poor. Results Of the 450 distributed questionnaires, 389 were suitable for analysis. Only 18.5% of the donors had good knowledge, with 81.5% having poor knowledge. Less than 30% were aware that people with multiple sexual partners, bisexual people and male homosexual people are permanently deferred from blood donation. Only 29.4% agreed that donors are responsible if their blood causes infection. Furthermore, 39.3% assumed that they could check their HIV status through blood donation, and 10.3% and 5.4% of the respondents believed that donors are free from infection if they wear a condom during sex or only have oral sex when involved in prostitution, respectively. Conclusion Poor knowledge and notable misperceptions concerning safe blood donation were found among blood donors. The Ministry of Health should incorporate safe blood education in future public awareness programmes.


The British Empire created channels for imperially intended movement. Commodities, bodies, and ideas flowed along axes structured by imperial law and technology. Unintended motion also occurred along these same planes. With every legal structure meant to promote one type of behavior came litigants devising strategies to achieve the opposite. Collusion, bribery, forgery, and perjury were favorite ways to manipulate imperial law. The more permissible strategy of forum shopping was another. Forum shopping is the attempt to push one's case into a jurisdiction promising an optimal result when there is ambiguity over the controlling jurisdiction. It reveals the perception among litigants that bottom-up—and sideways—mechanics exist within legal systems. Unlike work on resistance to state law through extralegal means, I here examine the ways parties tried to work strategically within the confines of the legal system to reconfigure their marital situations. Rather than documenting the success of these maneuvers, however, I note their more common failure. The colonial courts usually saw through unconvincing attempts to forum shop. The fact that litigants continued to try reflects the ingenuity, arguably, of the "legal lottery" mechanism at work in British imperial law. Colonial law, and therefore colonial rule, reinforced its hold on subjects by dangling before them the possibility of individual relief through rule-of-law proceduralism.


With apologies to Allison, 1 a paraphrase of the title to his article is used to introduce an example of humanism in medicine which was gleaned from the Bible. The practice of medicine in Old Testament times was largely an ecclesiastical function. Ancient Hebrew priests were the physicians of the day. Illness was considered to be the result of derangement of the soul, due to past iniquities or to possession by demons. Not only health, but good fortune generally, was considered a token of righteousness. This proposition is questioned many times in the Old Testament, however. It is most profoundly challenged in the book of Job. There the reason for human suffering, why afflictions fasten not only on the guilty but also on the innocent, is treated in a most brilliant manner. Because the principal person in the book, Job, is beset, among other things, by a skin disease,


The authors look at the concept of social facilitation as a possible component of Russian social consolidation in the course of social reforms. The article focuses on the results of an empirical study of the levels and characteristics of competence in social facilitation, which is here understood as the ability to apply certain knowledge and systems of skills and as a success rate of actions based on experience in improving the conditions of social development. The study was conducted in the Kaliningrad region in 2012-2013. The data was obtained through a survey of 400 respondents using the authors' methodology encompassing eight basic elements of competence and a structured interview aimed at a better understanding of the subject of the study and attitudes towards it. The data is compared against the results of a similar study in two regions of central Russia with similar conditions. The results suggest a disharmonic and inconsistent structure of competence in social facilitation, low motivation for social activity in youth, and a narrow range of ideas about possible areas of personal activities in the current conditions. Gender differences are identified in the level and structure of competence. The authors believe that certain differences in competence components identified through mathematical methods are determined by the geographical characteristics of the Kaliningrad region its exclave nature, a relatively small territory, and proximity to the EU countries. It is stressed that the regional conditions affecting motivation, forms and areas of activities, and structure of experience should be taken into account in selecting means and methods of organising youth activities. They can also serve as a basis for the regional youth policy.


Taxicabs are a critical aspect of the public transit system in New York City. The yellow cabs that are ubiquitous in Manhattan are as iconic as the city's subway system, and in recent years green taxicabs were introduced by the city to improve taxi service in areas outside of the central business districts and airports. Approximately 500,000 taxi trips are taken daily, carrying about 800,000 passengers, and not including other livery firms such as Uber, Lyft or Carmel. Since 2008 yellow taxis have been able to process fare payments with credit cards, and credits cards are a growing share of total fare payments. However, the use of credit cards to pay for taxi fares varies widely across neighborhoods, and there are strong correlations between cash payments for taxi fares and the presence of unbanked or underbanked populations. These issues are of concern for policymakers as approximately ten percent of households in the city are unbanked, and in some neighborhoods the share of unbanked households is over 50 percent. In this paper we use multiple datasets to explore taxicab fare payments by neighborhood and examine how access to taxicab services is associated with use of conventional banking services. There is a clear spatial dimension to the propensity of riders to pay cash, and we find that both immigrant status and being 'unbanked' are strong predictors of cash transactions for taxicabs. These results have implications for local regulations of the for-hire vehicle industry, particularly in the context of the rapid growth of services that require credit cards. Without some type of cash-based payment option taxi services will isolate certain neighborhoods. At the very least, existing and new providers of transit services must consider access to mainstream financial products as part of their equity analyses.


OBJECTIVES
This research was conducted to determine low back pain in nurses and their methods of coping with low back pain.

METHODS
This descriptive, cross-sectional study was performed with 356 nurses in three university hospitals in the province of Istanbul in April-August 2016. Percentage calculations and Chi-square tests were used in statistical analyses.

RESULTS
The mean age of the nurses in the study was 28.70±5.92, 25.3% were working in intensive care, 46.6% worked 41-48 h a week, and 55.6% stood for 5-8 h within a 24 h period. Low back pain was moderate in 75.8% of participants, and low back pains sometimes affected work efficiency in 43.3% (n=154). In terms of coping, the great majority of participants did not visit a physician, but used analgesics, avoided wearing high-heeled shoes, and slept in hard beds. Statistical significance (p<0.05) was observed between participants' age groups, the unit where they worked, type of duty, the amount of time spent standing, and the amount of time standing in the same position and low back pain.

CONCLUSION
Based on the results obtained, nurses experienced a moderate level of low back pain, and we think that experiencing low back pain is a continuous risk for nurses because of their lengthy hours of work and time spent standing, and that their working hours should, therefore, be adjusted and that correct body mechanics should be included during in-service training.


The impurities in the methanol fuel that is used for direct methanol fuel cell (DMFC) could greatly affect the performance of membrane electrode assemblies (MEA). The most common impurities in the commercial methanol fuel are mainly ethanol, acetone, acetaldehyde, or ammonia. In this study, the effect of impurities in methanol fuel was investigated on the performance of MEA. The MEA for DMFC were prepared using a semi-automatic bar-coating machine, which can prepare the catalyst layer with uniform thickness for MEA. As a result, a single cell supplied with one of the 6 different kinds of methanol fuels showed a significant degradation of the fuel cell performance. The most common impurities in the commercial methanol fuel is mainly ethanol, acetone, acetaldehyde, or ammonia. The effects of the kind and the concentration of impurities in the methanol fuels were investigated on the performance of MEA for DMFC. We will propose the optimum compositions and limit concentration of impurities in methanol fuel for high performance of MEA for DMFC.


The quest to make Sweden accessible for all has a long tradition. Stemming from initiatives of charitable organisations in the early 20th century, accessibility became a physical requirement through the Swedish building act of the 1960s. It promoted a type of physical barrier-free architecture for the welfare state. The socio-political ambitions of the 1970s propelled Sweden to become a world-leading nation in the creation of equal opportunities and social inclusion. Architectural design was expected to meet the demands of people with cognitive, physical or sensory disabilities and, on signing the UN convention on equal rights for persons with disabilities in 2007, existing legislative frameworks were complemented with additional guidelines on removing physical barriers. By focusing on the national tripartite definition of accessibility, Sweden has paid little attention to the development of the universal design concept. Instead, accessibility has been associated with the elusive concept of usability in order to promote a user-environment fit. Since 2013, the increasing shortage of housing in densely populated areas has impeded work to create an accessible and inclusive welfare state and has fostered the notion that accessibility increases building costs. This study provides an overview of the Swedish development of accessibility in order to promote participation and social inclusion by removing physical barriers in the built environment and introducing user-oriented assistive technologies.


Information on the yield of individual trees within an orchard can be used to improve management practices. To achieve this goal, an automated yield monitoring system has been developed that is capable of correctly identifying trees in a commercial orchard and measuring yields of pistachio trees with small errors. Two commercial pistachio catch-frame harvesters were retrofitted and operated at approximately 75% of commercial harvesting field capacity. The system consists of a weighing bucket that measures individual tree yields in the transition between harvested trees. When the subsequent tree is shaken, nuts are weighed, dumped into the harvester's internal conveyor, and an embedded computer automatically records tree identification and yield. A DGPS-based automated row identification system was developed and tested throughout the 2006-2008 seasons. Inside dense orchard canopies, where a DGPS signal cannot be received with reliable accuracy, an algorithm was developed using real-time sensed odometric information to localize trees. System performance was tested in a commercial orchard by measuring yield and location of more than 70,000 trees over a six-year period. Tree identification and yield data were collected and mapped. Calibrations and validations of the weighing system resulted in weighing prediction standard errors of approximately 0.9 kg, while DGPS row identification was 100% accurate in over 480 estimates, and individual tree identification was highly accurate over 70,000 observations. The ability to measure individual tree yield provides previously unattainable information on tree productivity, facilitates precision field management, and enables the investigation of the mechanisms underlying fruit production and alternate bearing. The data recorded by the use of this system have been used in experimental studies to improve the productivity and management of pistachio orchards, investigate alternate bearing behavior, and provide the basis for developing efficient nutrient management protocols.


OBJECTIVE
To gain understanding about why a controlled intervention to reduce variability in lumbar spine imaging test use rates for low back pain patients was ineffective among internal medicine and family practice physicians in a large US health maintenance organization.

DESIGN
We retrospectively analyzed data from focus groups that had been conducted prior to the implementation of the intervention. The physicians were asked about the factors that influence their decisions to order such tests.

STUDY PARTICIPANTS
Internal medicine and family practice physicians in the intervention group. MAIN STUDY FINDINGS: Most of the variability in physicians' imaging test ordering appeared to occur in the care of patients with back pain of non-traumatic origin who had no radicular symptoms. Within that clinical context, nonclinical factors such as patient age and work status, time constraints, access problems and ambiguity about internal referral processes were important factors in physicians' decisions. Especially relevant were tensions and conflicts the physicians face as they attempted to meet conflicting role obligations in the health maintenance organization. These tensions raised issues of patient trust in their physicians and in medical care organizations, and it appeared that imaging test orders sometimes served social and symbolic functions in resolving them.

CONCLUSION
Our findings suggest that gaining information from focus groups prior to designing physician behavior change interventions may aid the design of more effective interventions.


Abstract. Data on the carbon and carbon relevant hydrographic and hydrochemical parameters from previously not publicly available cruises in the Arctic, Atlantic and Southern Ocean have been retrieved and merged to a new data base: CARINA (CARbon IN the Atlantic). These data have gone through rigorous quality control (QC) procedures to assure the highest possible quality and consistency. All CARINA data were subject to primary QC; a process in which data are studied in order to identify outliers and obvious errors. Additionally, secondary QC was performed for several of the measured parameters in the CARINA data base. Secondary QC is a process in which the data are objectively studied in order to quantify systematic differences in the reported values. This process involved crossover analysis, and as a second step the offsets derived from the crossover analysis were used to calculate corrections of the parameters measured on individual cruises using least square models. Significant biases found in the data have been corrected in the data products, i.e. three merged data files containing measured, calculated and interpolated data for each of the three regions (i.e. Arctic Mediterranean Seas, Atlantic, and Southern Ocean). Here we report on the technical details of the quality control and on tools that have been developed and used during the project, including procedures for crossover analysis and least square models. Furthermore, an interactive website for uploading of results, plots, comments etc. was developed and was of critical importance for the success of the project, this is also described here.


Over the past three years, a distinct change has become visible in the ideological discourse of the government of Belarus. To an increasing degree, the state ideology is focusing on strengthening national identity, emphasising the divergence of Belarus's interests from those of Russia, and re-examining the historical narration in a direction which emphasises the distinctiveness of the history of Belarus from that of Russia. Above all, the government has changed its attitude towards the Belarusian language and culture. A campaign promoting the Belarusian language is being carried out on a large scale – under the auspices of state ideologues. The government has also become involved in the promotion of vyshyvanki, traditional, embroidered Belarusian clothes and their ornamentation. This allows us to talk about a process of 'soft Belarusianisation'. Articles criticising Kremlin policy have begun to appear fairly regularly in the government media. Official representatives of the authorities, while not going so far as to promote the idea of friendship with the West, no longer refer to it using the rhetoric of the 'enemy', as was previously the case.


Lithium metal is an attractive anode material for rechargeable batteries because of its high theoretical specific capacity of 3860 mA h g−1 and the lowest negative electrochemical potential of −3.040 V versus standard hydrogen electrode. Despite extensive research efforts on tackling the safety concern raised by Li dendrites, inhibited Li dendrite growth is accompanied with decreased areal capacity and Li utilization, which are still lower than expectation for practical use. A scaffold made of covalently connected graphite microtubes is reported, which provides a firm and conductive framework with moderate specific surface area to accommodate Li metal for anodes of Li batteries. The anode presents an areal capacity of 10 mA h cm−2 (practical gravimetric capacity of 913 mA h g−1) at a current density of 10 mA cm−2, with Li utilization of 91%, Coulombic efficiencies of ≈97%, and long lifespan of up to 3000 h. The analysis of structure evolution during charge/discharge shows inhibited lithium dendrite growth and a reversible electrode volume change of ≈9%. It is suggested that an optimized microstructure with moderate electrode/electrolyte interface area is critical to accommodate volume change and inhibit the risks of irreversible Li consumption by side reactions and Li dendrite growth for high‐performance Li‐metal anodes.


Viral infection outcomes are sex-biased, with males generally more susceptible than females. Paradoxically, the numbers of anti-viral natural killer (NK) cells are increased in males compared to females. Using samples from mice and humans, we demonstrate that while numbers of male NK cells are increased compared to females, they display impaired production of the anti-viral cytokine IFN-γ. These sex differences were not due solely to divergent levels of gonadal hormones, since these differences persisted in gonadectomized mice. Instead, these differences can be attributed to lower male expression of X-linked Kdm6a (UTX), an epigenetic regulator which escapes X inactivation in female NK cells. NK cell-specific UTX deletion in females phenocopied multiple features of male NK cells, which include increased numbers and reduced IFN-γ production. Integrative ATAC-seq and RNA-seq analysis revealed a critical role for UTX in the regulation of chromatin accessibility and gene expression at loci important in NK cell homeostasis and effector function. Consequently, NK cell-intrinsic UTX levels are critical for optimal anti-viral immunity, since mice with NK cell-intrinsic UTX deficiency show increased lethality to mouse cytomegalovirus (MCMV) challenge. Taken together, these data implicate UTX as a critical molecular determinant of NK cell sex differences and suggest enhancing UTX function as a new strategy to boost endogenous NK cell anti-viral responses.


Background The European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) recommend that rheumatoid arthritis (RA) patients should be treated to the target of low disease activity or remission with traditional and biologic disease-modifying anti-rheumatic drugs (collectively referred to as DMARDs). However, significant numbers of RA patients in the US and Canada do not receive care consistent with these recommendations.1,2 Objectives To determine the influence of patient and physician factors on the decision to adjust DMARD therapy for RA patients with moderate to high disease activity. Methods Data was drawn from the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) observational registry (2009-12) on visits where patients had moderate to high disease activity for at least 3 months. Therapy adjustment was defined as adding, switching, or increasing the dose of DMARD therapy. Generalized estimating equations (GEE) with clustering by patient were used to assess the relationship between patient and physician factors and whether or not therapy was adjusted. After selecting a correlation structure, variables significant in univariable GEE analyses (Wald test on coefficient has p<0.2) were entered into a multivariable GEE model with logit link, then backwards selection was used to choose the final model by removing variables with p>0.05. The model controlled for patient demographic and disease characteristics: age, race, gender, RA duration, Disease Activity Score-28 joint (DAS28-CRP), Short Form 12 (SF12) physical and mental components, and Health Assessment Questionnaire (mdHAQ). Results There were 529 visits for 348 patients with moderate to high disease activity for at least 3 months. Therapy was adjusted at 24.8% of visits. The final GEE model used an exchangeable correlation structure to account for correlation between different visits for each patient. The odds ratios (OR; [95% CI]) of adjusting therapy were decreased by older patient age (0.980; [0.961,0.999]), longer disease duration (0.980; [0.962,0.999]), years since physician medical school graduation (0.958; [0.933,0.982]), being African American (0.511; [0.276,0.946]), current use of biologic therapy (0.437; [0.263,0.728]), and lower DAS28-CRP (0.556; [0.413,0.749]). Conclusions In the RACER observational cohort, 75.2% of RA patients with moderate/high disease activity for at least 3 months did not have DMARD therapy adjusted. Patient age, years of physician experience, duration of RA, lower DAS28, being African American, and current use of biologic therapy decreased the likelihood of therapy adjustment. While the estimated impact is milder for patient age, years of physician experience and duration of RA, the data suggests more substantial impact due to DAS28-CRP, being African American, and current use of biologic therapy. Our future research will explore how other factors such as comorbidities, prior use of DMARDs and use of corticosteroids may contribute to the observed effects. References Harrold et al (2012). Arthritis Rheum, 64(3): 630-8. Lacaille et al (2005). Arthritis Care Res, 53(2): 241-8. Acknowledgements Funding for the RACER registry and research personnel is provided by Genentech. Disclosure of Interest Y. Shaw Grant/research support from: Genentech, C.-C. Chang: None Declared, H. Eng Grant/research support from: Genentech, I. Metes Grant/research support from: Genentech, L. Moreland Grant/research support from: Genentech, S. Wisniewski Grant/research support from: Genentech, M. Roberts: None Declared, M. Levesque Grant/research support from: Genentech


The effects of group gymnastics on neck pain were studied among 44 women in a printing company. A randomized cross-over design was used with two groups matched according to the work task, frequency of symptoms, and age. The treatment consisted of gymnastics for 45 min once a week for 10 weeks. Neck pain was rated by visual analogue scale and pressure pain sensitivity of the neck muscles was measured with an algometer. The results showed no clear effects of the group gymnastics program. An equal and significant reduction in pain ratings was seen in both groups after the first intervention in the spring. Recurrence of symptoms was seen in both groups in September, and no significant reduction in pain occurred during the second intervention in the autumn. The results suggest a seasonal variation in neck symptoms which has to be considered when planning or evaluating intervention studies.


The SiC Schottky diode, with its high blocking voltage capability, absence of reverse recovery, and negligible temperature dependence on switching behavior, is suitable for most power electronics applications especially in circuits that demand high efficiency and high switching frequencies. Recent studies dealing with the comparison of SiC Schottky with ultra-fast diodes are application-specific and they do not quantify the contribution of the superior switching performance of the SiC Schottky to the improvement of the switch-mode converter's efficiency. To address this deficiency, we compare the performances of the D12S60 SiC Schottky diode to leading ultra-fast diodes of comparable rating, such as the STTA1206D, in hard-switching buck and buck-boost switching converters. Our study includes the measurement of the diode and FET switching and conduction losses as well as converter efficiency while varying the input voltage, load current, and switching frequency.


A review of statistics concerning fatal medical negligence in the NHS shows that, despite fears of a 'compensation culture' and the right to life protected by Human Rights legislation, only about one in every 1,000 such cases is investigated by the courts. This appears to be largely due to very poor reporting of adverse incidents by health authorities. However, as a result of recent healthcare scandals, the reporting of incidents is expected to significantly increase in the near future. The case of R v Southampton University Hospitals NHS Trust 2006 illustrates the striking effect that enhanced levels of scrutiny can have in these cases. While there was nothing extraordinary in the facts of this case, and the hospital's safety record did not appear to be any worse than average, the doctors involved were convicted of gross negligence manslaughter and the hospital was heavily fined under Health and Safety legislation for systemic failures. R v Southampton demonstrates that poor hospital systems are not immune from legal action in cases of fatal medical negligence, and recent developments suggest considerable potential liability for the NHS in this respect.


We have successfully demonstrated chemical vapor deposition of a silica film in which some of oxygen atoms of the pure silica network are replaced to methylene (-CH 2 ,) groups. The as-deposited film was thermally unstable owing to the unwanted decomposition reaction of the methylene group with the dense H 2 O in the film. It was found that the film could be dehydrated without decomposition of the methylene group by low temperature anncaling in a XeF 2 ambient. The dehydrated film showed not only good insulating and low-k characteristics (resistivity of 10 15 Ω cm, breakdown field of 3.3 MV/cm, and k of 2.8), but also good thermal properties, such as good thermal stability and high thermal conductivity.


Regeneration and tolerance factor (RTF) was originally identified in placenta where it is thought to be essential for fetal allograft survival. Here we report that RTF mRNA and protein are also expressed in human glioma cells in vitro and in vivo. Suppression of RTF expression by RNA interference promotes the lysis of glioma cells by natural killer (NK) and T cells in vitro. Moreover, RTF-depleted glioma cells are less tumorigenic than control cells in nude mice in vivo. Depletion of NK cells in these animals abolished this effect. RTF is thus a novel aberrantly expressed molecule which confers immune privilege to human malignant gliomas.


Abstract : The specter of biological weapons -- one of the three weapons of mass destruction (WMD) -- is an unusual and extraordinary threat to the national security of the United States. Since the U.S. unilaterally renounced biological warfare in 1969, biotechnology advances, aggressive nation-states, and terrorism have complicated a precarious balance of world and regional stability. U.S. shortfalls in biological warfare preparedness during the Persian Gulf War may convince potential adversaries that the U.S. is incapable of protecting its vital interests from biological assault. This paper examines the menace of biological weapons and global challenges to nonproliferation and counterproliferation. Analysis concludes that the United States can dissuade, deter, and defend against biological warfare and terrorism with an integrated national security strategy for Biological Weapons Engagement and Disarmament.


Despite having opportunities to enter retail or clinical practice, Britain's ethnic minority pharmacists display disproportionately high levels of self-employment within the distinctly entrepreneurial business sector of the pharmacy profession. This paper sets out to describe ethnic minority involvement in the profession of pharmacy, and highlights the role that preference plays in their decision to go into independent proprietorship. The study argues that while racism plays a small part, personal choice, available resources, and structural opportunities for business development within the profession largely account for the different work patterns found among white and ethnic minority pharmacists.


Short wave near-infrared spectrum of whole wheat was obtained by diffusion reflection. PLS method was used to analyze protein content of whole wheat. Different wavelength ranges were chosen for regression and information abstraction. The 3D curves were shown for different factors, prediction residual sum of squares (PRESS), and RMSECV. The best wavelength ranges and factors were determined. Analysis results for protein content of whole wheat were shown in three wavelength regions, and the predicted results were compared and discussed. The method of selecting advantageous wavelength ranges is feasible to obtain high prediction precision.


Although very sensitive chromogens have been adapted for localization of horseradish peroxidase in anterograde and retrograde tracing studies, they have not been successfully applied in immunocytochemical studies. This report describes a protocol which uses benzidine dihydrochloride (BDHC) as the chromogen for light (LM) and electron microscopic (EM) immunocytochemical studies. The protocol is comparable to that used for tetramethylbenzidine, except that the pH of the reaction is above 6.0. At the LM level, the BDHC reaction product is bluish-green and crystalline. Both the color and form of the product are readily distinguished from the reddish-brown DAB reaction product. LM double-labeling studies are therefore feasible. The use of BDHC also increases significantly the sensitivity of the immunoreaction. Higher fixative concentrations can be used, less detergent is necessary, and higher primary antibody dilutions are possible. By osmicating at 45 degrees C in an s-collidine buffer it is possible to preserve the soluble BDHC reaction product for EM analysis. Immunoreactive cells are particularly well labeled with this new protocol. The BDHC crystals are easily detected at the EM level and can be distinguished from flocculent DAB reaction product. This feature makes EM double-labeling studies possible.


The preparation of this paper was prompted by publicity and research evidence of neglect/abuse of older persons in residential care. It sets out to present a new way of combating neglect/abuse of individual residents, drawing also on preliminary findings from a long‐term research project on guardianship. This project, provisionally entitled Guardianship Relations: Models for ground rules, looks at the situations of all vulnerable persons irrespective of settings whereas the following notes concentrate on the need for guardians for persons who reside in homes for the elderly (residential care homes/RCHs).


Oral pathogens have been identified in bioptic specimens from Age-Related Macular Degeneration (ARMD) patients, and alveolar bone loss has been related to ARMD. Therefore, the possible association between ARMD and periodontal disease was investigated in the present case-control study, evaluating clinical and radiographic periodontal parameters, primarily, in cases vs. controls and, secondarily, in relation to ARMD risk factors, in cases, to highlight a possible pathogenic link between the disorders. Forty ARMD cases and 40 non-ARMD controls, matched for age (±3 years) and gender and homogeneous for ARMD risk factors, therefore comparable, underwent full-mouth periodontal charting, panoramic radiograph, and medical data, including ARMD risk factors, collection. Statistical analysis was conducted using the language R. Comparisons between groups were made using both traditional t-tests and Yuen's test with bootstrap calibration. Enrolled subjects were ≥55 years old, and 50 females and 30 males were equally distributed among the two groups. No statistically significant difference was found in clinical and radiographic periodontal parameters in cases vs. controls. In the case group, no differences were found when relating the periodontal parameters to ARMD risk factors, except for Clinical Attachment Level values that were statistically significantly higher in hypertensive ARMD subjects. A possible association between periodontal disease and ARMD may be hypothesized in hypertensive ARMD subjects, with hypertension as a possible pathogenic link between the disorders.


Abstract The novelty of the work lies in the creation and study of the physical and biological properties of biodegradable polymer coatings for stents based on poly(lactic-co-glycolic acid) (PLGA). Polymer coatings are capable of prolonged and directed release of molecules with a high molecular weight, in particular, protein molecules of prourokinase (m.w. 54 kDa). A technology has been developed to create coatings having a relative elongation of 40% to 165% and a tensile strength of 25–65 MPa. Coatings are biodegradable; the rate of degradation of the polymer in an isotonic solution varies in the range of 0.05%–1.0% per day. The created coatings are capable of controlled release of the protein of prourokinase, while about 90% of the molecules of prourokinase retain their enzymatic activity. The rate of release of prourokinase can vary from 0.01 to 0.08 mg/day/cm2. Coatings do not have a short-term toxic effect on mammalian cells. The mitotic index of cells growing on coatings is approximately 1.5%. When implanting the developed polymers in animals in the postoperative period, there are no complications. Histological examination did not reveal pathological processes. When implanting individual polymers 60 days after surgery, only traces of PLGA are detected. Thus, a biodegradable composite mechanically resistant polymer capable of prolonged release of the high molecular weight prourokinase enzyme has been developed.


Recent widespread protests and intensive media coverage of actual and alleged acts of police misconduct against members of vulnerable populations (e.g., Indigenous and racialized persons, mentally ill and/or addicted persons) overrepresented in the criminal justice system have renewed interest internationally in the factors influencing civilian complaints against police. In Canada, a major concern exists regarding how Indigenous persons who feel improperly treated by the police perceive and confront barriers to making formal complaints about such treatment. This study focuses on the Royal Canadian Mounted Police (RCMP), the police agency providing services to the majority of rural and northern reserve communities. Our survey and interviews with influential "community informants" (in this instance community court workers) with intimate knowledge of such local communities, shared culture and language, and vicarious appreciation of the experiences of community members support the view that Indigenous persons do encounter significant barriers to launching formal complaints and are consistent with other research literature. We discuss our findings, raise policy considerations for decision makers such as police leaders and police complaints bodies, and outline implications for future research.


So far, the methods used by teachers in the learning process tend to conventional teaching methods which only includes students come , sit , write material that has been written by the teacher on the board , listening to the teacher explaining the material and do the work , using the lecture method . The impact, learning tends to be passive and bored quickly. This kind of learning situation is almost no opportunity for students to express their creativity, so the quality of the quality of learning also becomes low. Constructivism learning model seems to be one of the answers to these problems. Therefore, in this learning model students are preferred. Teaching and learning process in constructivism model student centered more colored than teacher centered. Constructivism model is more empowering for the class as a learning centered not for teaching; not teaching process but learning process. This is in accordance with the curriculum 2013, is autenthic assessment; assessment process and results.


The purpose of this book is to demonstrate how the history and philosophy of science can be applied by teachers and curriculum writers to the effective teaching of science. The author provides a conceptual foundation for an alternative approach to science education. The book is divided into four parts: an overview of existing curricula; teaching and learning practices; an historical context of the changes that have taken place in the history and philosophy of science; and the practical application of the tenets of the history and philosophy of science to modern theories of learning and teaching.


This paper highlights the use of non-vascularised fibular graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high velocity injuries due to road traffic accidents, severe neglected infections, and osteolytic tumours. In majority of cases, the surgeon is left with the only option of an amputation especially where there is no access to microvascular surgery and microvascular bone grafting devices. This is a major problem in the West African subregion hence the need for this article. We present illustrative cases of limb conservation in an adult involved in a high velocity trauma and a child with a destructive osteolytic infection culminating in bone loss. The patients are still been followed up in our surgical outpatient clinics.


Seventeen cases of acute, first time, lateral patellar dislocations without fracture treated by immediate surgical repair were reviewed and evaluated. Nine patellar tendon realignments and 8 medial side reefing procedures were performed. There were no recurrences of patellar dislocation. Twelve knees were painful, of which 8 were rarely painful. All but one patient were satisfied with their results and participated in any desired sport. Surgical repair of acute patellar dislocation is advocated in the young patient who anticipates future participation in athletics.


Eucalyptus urophylla plants (family: Myrtaceae, order: Myrtales ) usually are used only wooden parts for the manufacture of frames, pulp and paper, whereas their leaves can be used to produce essential oils in the pharmaceutical usage. The aim of this research is to extract the essential oils from leaves of Eucalyptus urophylla with soxhlet extraction method, in order to obtain maximum recovery of essential oils with good quality. Prior to the extraction process, the fresh leaves of Eucalyptus urophylla were reduced so that its size become 1 × 1 cm, and then dried in an oven at a temperature of 70 °C for 1 hour after being wrapped in a filter paper, after that followed by the extraction of the leaves using a variety of solvents, namely 96 % ethanol, n-hexane and dichloromethane, then proceed with the analysis of essential oil products (cineol content analysis). In this study, experiments were conducted with a variety of treatments such as the ratio of the volume of solvent to yield, the ratio of the mass of leaves of Eucalyptus urophylla to the yield on 5 cycles , and temperature of the solvent to yield. The conclusions of this research are the best extraction results with maximum cineol value (29.17 %) was obtained using dichloromethane solvent, while using 96 % ethanol produced the maximum yield of extract.


This paper focuses on the adoption of Agent Technology to calculate and evaluate the Web Content Engagement Time (WCET). Traditional Web traffic analysis metrics such as pageviews, unique browser, visitor loyalty, etc have been used to analyze the web traffic behaviour for a long time since the birth of World Wide Web, but the emersion of software robots and web crawlers trigger a huge impact on the integrity and correctness of these traditional Web statistics. For advertisers, these statistics are not enough for them to evaluate the actual return-on-investment (ROI). For instance, large amount of pageviews but extremely short session duration will not have much impact for the advertisers to promote their products and brands. Web Content Engagement Time (WCET) for the reading on interactive Web content such as e-magazines and e-publications, which focuses on the page duration between each "page-flipping", will give advertisers much more information and confidence on whether such eye-balls (i.e. attention) are actually focused on the Web content (and hence the eAds) or not, especially during the browsing of e-magazines and e-publications. But such indicator involves significant amount of calculation within the Web server, especially when over thousands of users are reading a popular e-publication at the same time. To tackle with this problem, a multi-agent based Web Content Engagement Time (WCET) Analyzer is proposed on e-publication system. From the experimental perspective, popular Chinese e-magazine "MingPaoWeekly", with over 0.5 million readership in Hong Kong and oversea Chinese communities are tested over the IAToLife.com Web Channel platform, promising Web Content Engagement Time (WCET) are recorded, which provides not only integrity and confidence for the publishers and advertisers, but also shines a new light for the future agent-based target marketing and e-reader profile and reading behavior analysis.


I will summarise the main lessons learned from Fermi Gamma-ray Space Telescope observations regarding the behaviour of the photosphere. First, GRB090902B exhibited a clear and distinct component that is best attributed to the jet photosphere. Second, many GRBs have a "double hump" spectrum and a sole Band function cannot model their shapes. Third, Fermi confirms CGRO BATSE results on thermal emission in GRB pulses, its existence and temporal behaviour. Fourth, Fermi provides evidence for sub-photospheric energy dissipation, which can explain the non-thermal spectra seen in many bursts. Indeed, the inclusion of a photospheric emission component is the first step towards an understanding the physical origin of the prompt emission: The Band function does not provide it.


Objectives Co-production approaches, variously referred to as integrated knowledge translation, participatory research and co-design, provide an alternative to the traditional 'push' and 'pull' modes of translating research evidence into better healthcare. Despite the growing importance of the impact agenda and the proliferation of collaborative research partnerships, awareness about the practical realities of co-production remains low. This interactive workshop, drawing on the ongoing programme of research conducted by the workshop organisers as well as on their personal experiences, will address the following learning objectives: To explore different definitions and types of co–production in applied health research. To examine tensions and compromises involved in co–production. To discuss the implications of the co-production for the focus and outputs of research as well as for the structure and function of the research team. To analyse the factors influencing the processes and outcomes of co-production. To share personal experiences of co-production. Method The workshop will be delivered by an experienced team comprised of the Director of a large-scale co-production programme, an editor of Implementation Science and two researchers involved in studying co-production as part of the NIHR CLAHRC-funded research project. By combining experiential and empirical evidence, the workshop will provide both practical tips about how to make co-production work and a more critical exploration of its limitations and unintended consequences. The time will be split equally between the didactic component, summarising the existing research on co-production, and the interactive component, where workshop participants will work together in small groups, reflecting on the information presented and sharing their own experiences. We will facilitate a participatory group exercise, which will produce an outline of key practical steps involved in co-designing applied health research proposals with practitioners and/or service users. Microsoft PowerPoint sides, flip charts and post-it notes will be used during the workshop. Results We aim to show that although co-production approaches may differ depending on the stage(s) of the research process in which they are deployed as well as on the type of stakeholders involved, all of them require a number of compromises directly affecting the collaborators. Contrasting the expectations of healthcare practitioners with the researchers' way(s) of doing things, we categorise these compromises into three broad groups: (1) complementing 'research' by 'non-research activities', such as implementation, improvement and education; (2) opening up the research team to include project managers, practitioners, and service users as well as to bring together researchers espousing different epistemological and methodological paradigms; and (3) adapting to a practice-driven agenda and embracing impact as an essential component of evaluation and research. We will also discuss the 'dark side' of co-production, alerting the workshops participants to its potential limitations, and suggest possible ways to address these in practice. Conclusions By uncovering the tensions and complexities involved in co-production of evidence, our workshop will touch upon a number of broader topical issues currently facing the community of researchers involved in evidence-based healthcare. How to strike the balance between the production of high-quality evidence and its implementation in actual practice? Does participation in practice-driven research projects represent a 'career suicide' for early-career researchers or an opportunity to develop a unique and exciting career trajectory? How to foster the cadre of implementation-savvy researchers and research-savvy practitioners? This interactive workshop will aim to represent multiple perspectives and facilitate constructive dialogue between them.


Optimizing the laminates of large composite structures is nowadays well-recognized as having significant benefits in the design of lightweight structural solutions. However, designs based on locally optimized laminates are prone to structural discontinuities and enforcing blending during the optimization is therefore crucial in order to achieve structurally continuous and ready-tomanufacture designs. Bi-step strategies, relying on a continuous gradient-based optimization of lamination parameters followed by a discrete stacking sequence optimization step during which blending is enforced, have been proposed in the literature. However, significant mismatch between continuous and discrete solutions were observed due to the discrepancies between both design spaces. The present paper highlights the capability of the continuous blending constraints, recently proposed by the authors, in reducing the discrepancies between discrete and continuous solutions. The paper also demonstrates that more realistic optimal continuous designs are achieved thanks to the application of the blending constraints during the aeroelastic optimization of a variable stiffness wing. Additionally, the proposed blending constraints have been applied to NASTRAN SOL 200 showing their ease of implementation in commercial software.


: The article presents results of searches, devoted to haemodynamic damages against wide-spread ophthalmo-pathology--pseudoexfoliative syndrome and pseudoexfoliative glaucoma. Changes, appearing on different levels, confirm hypothesis about systemic character of the disease and prove the necessity of further examination of role of syndrome in development of different forms of vascular disease.


We use a novel transformation of the reduced Ostrovsky equation to the integrable Tzitz\'eica equation and prove global existence of small-norm solutions in Sobolev space $H^3(R)$. This scenario is an alternative to finite-time wave breaking of large-norm solutions of the reduced Ostrovsky equation. We also discuss a sharp sufficient condition for the finite-time wave breaking.


The purpose of the Generic Management Plan for Nitrosamines in Drinking Water is to provide background information on the group of organic contaminants known as nitrosamines, as well as help water quality managers and treatment plant managers and operators in three main aspects of nitrosamine management, namely:

This is a companion document to the Guidance manual for the minimisation of nitrosamines in drinking and recycled water . The latest edition of the guidelines has been published and a guideline value of 100 ng/L for NDMA has since been promulgated. A comprehensive survey of drinking water systems in Australia undertaken as part of project 1018 showed that the majority have levels of NDMA well below the guideline value. It also helped clarify and validate the risks and supported the suggested mitigation measures outlined in this document that can be applied for the production of drinking water that continuously complies with the guidelines.

This title is Co-published with WaterRA .

ISBN: 9781780406244 (eBook)


The reproductive fitness of a parasitoid depends on the oviposition decisions of a female in response to competition. The present study investigated the oviposition and sex ratio of offspring produced by the parasitic wasp Diaeretiella rapae while competing with other conspecific females and at different host densities. The number of Brevicoryne brassicae nymphs parasitised by female D. rapae increased with the number of nymphs offered to them. However, the proportion of nymphs parasitised by the female decreased when nymph density was high. The proportion of fertilised eggs oviposited by females decreased when nymph density increased. An increase in the number of foundresses (females ovpositing together) increased the total parasitism, but the contribution of each female (the number of nymphs each female parasitised) decreased. Smaller proportions of female offspring were produced when females were competing for the same hosts. The results of this study suggest that both host and foundress densities asymmetrically affect progeny production and sex allocation in this species.


Background: Patients with malignant pleural effusion (MPE) have a poor prognosis. Most patients are treated with tube thoracostomy and sclerotherapy but with a not satisfactory control rate of pleural effusion. This study aims to report the effect of intrapleural hyperthermic perfusion for MPE which is a standard practice at our center.Methods: This is a retrospective study of consecutive patients with MPE treated with hyperthermic perfusion from one single Institute. The procedure was done by perfusing the pleural cavity under video-assisted thoracoscope with 43.0°C distilled water using a standard extracorporeal circuit for 60 minutes. The efficacy of treatment was classified as follows: 1. complete response (CR; no re-accumulation of pleural effusion after IPH for at least four weeks); 2. partial response (PR; pleural effusion was reduced by 50% and this situation was sustained for four weeks; 3. no consequence (NC; pleural effusion was not reduced.Results: From January 2014 through December 2018, a total of 31 patients with MPE were treated using this technique. There were no serious reportable clinical complications associated with the procedures. The response rate was 100%, with 67.7% of PR and 32.3% of CR. The survival time ranged from 2 to 46 months, with a median survival of 12 months. The survival time of the patients received TKI treatment after IHP ranged from 13 to 45 months, with a median survival of 28 months. Multivariable analysis showed that TKI treatment (P=0.013) and male gender (P=0.004) were independent prognosis factors.Conclusions: Intrapleural hyperthermic perfusion is a feasible and safe strategy for patients with malignant pleural effusion.


In today's highly competitive environment, where so urces of product and process-based competitive advantage are quickly imitated by competitors, it i s becoming increasingly difficult to differentiate on technical features and quality alone. Companies may overcome this problem by incorporating the 'voice of the customer' into the design of new products and f ocusing on customer value, thereby offering total solutions to customer needs. Therefore, it is criti cal for all technology-based companies to gain an a ccurate understanding of the potential value of their offer ings, and to learn how this value can be further en hanced. An important tool to elicit customer value at an ea rly stage of the product development is the conjoin t analysis. Conjoint analysis is a research technique for measuring customers' preferences, and it is a method for simulating how customers might react to changes in current products or to new products introduced into an existing competitive market. The paper will show how conjoint analysis can be used to bridge the information gap between the company and its customers, by confronting the value the company intends to offer with the value desired by its customers.


Separation of the enantiomers of each of three different racemates, neutral rac-alpha-tetralol, acidic rac-2-phenylpropionic acid, and basic rac-1-phenylethylamine, using subcritical and supercritical fluid chromatography with two different chiral stationary phases, heptakis(2,3,6-tri-O-methyl)-beta-cyclodextrin (Sumichiral OA-7500 column) and tris(3,5-dimethylphenylcarbamate) of amylose (Chiralpak AD-H column), was compared. The elution order of the enantiomers of the three racemates was determined, and the effects of the type of alcohol modifier, column oven temperature, mobile phase composition, flow rate, and pressure were examined. The most appropriate column oven temperature depended on both the type of alcohol modifier and the compound analyzed. Lower alcohol content improved the peak separation of both rac-alpha-tetralol on the Sumichiral OA-7500 column and rac-1-phenylethylamine on the Chiralpak AD-H column, while the same phenomenon was not observed with either rac-alpha-tetralol or rac-2-phenylpropionic acid on the Chiralpak AD-H column. Decreasing outlet pressure improved the peak separation obtained with rac-2-phenylpropionic acid, but had little effect on either rac-alpha-tetralol or rac-1-phenylethylamine.


OBJECTIVE
To assess P-wave duration and dispersion (PD) in morbidly obese young subjects who do not have co-associated atrial fibrillation (AF) risk factors, such as hypertension, diabetes, atrial enlargement and diastolic dysfunction.

STUDY DESIGN
An observational cross-sectional study.

PLACE AND DURATION OF STUDY
Bolu Abant Izzet Baysal University Medical Faculty, Turkey; and the study was conducted between October 2017 and June 2018.

METHODOLOGY
P-wave duration and dispersions were determined on 12-lead surface ECG in 47 morbidly obese and 44 healthy weight subjects, aged between 21-40 years. Above mentioned risk factors were studied. The correlation between BMI, PD and Pmax were investigated by Pearson correlation analysis.  Results: Average body mass index (BMI) of obese and control groups were 42.3 (8.5) vs. 19.5 (1.5) (P <0.001). Maximum P-wave duration [(Pmax), 105.3±9.8 vs. 95.6±8.5, p<0.001] and PD [27.6 (7.6) vs. 12.2(8.3), p<0.001] were statistically significantly prolonged in obese patients when compared to the normal weight group. BMI correlation with Pmax and PD (r=0.485; p<0.001 and r=0.620; p<0.001, respectively) were significant.

CONCLUSION
  Pmax and PD, which are potential electrocardiographic AF predictors, may increase in lone obese patients having no comorbidities. Key Words:  Electrocardiography, Arrhythmia, P-wave duration, P-wave dispersion, Severe obesity.


Introduction: Tuberculosis (TB) is a chronic infectious disease and has major health implications. The disease has a global distribution, and the incidence is more in developing countries. The paucibasillary nature of tuberculous bacilli and varied clinical presentation puts the clinician in a quandary for clinical diagnosis of genital tuberculosis. According to some Indian studies, tubercular endometritis and salphingitis accounts for 4-9% cases of infertility. Objective: The objective of the present study was to evaluate the efficacy of PCR technique in the diagnosis of GTB in female infertility in comparison to culture and histopathological examination. Materials and Methods: 42 infertile women fulfilling inclusion and exclusion criteria were enrolled over a period of 24 months after Ethics Committee approval and written consent. The women were subjected to routine and specialised investigations of endometrium and ascitic fluid from pouch of douglas as culture, TB, PCR, and histopathology and the data was analysed. Out of results of 42 women of infertility studied, 19 women had positive findings on hysterosalpingography, 18 women had laparoscopic findings, 11 women had positive TB PCR, 2 cultures and 3 histopathology reports were positive. There was good agreement when microbiological culture was compared with histopathology whereas the agreement was poor between culture and PCR. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/)


This article explores the relationship between both popular and scholarly writing about women in the postwar years 1946 to 1962, and the literature of the women's liberation movement written from 1963 to the early 1970s. The current feminist movement was particularly eager to discredit Freudian theories of female psychosexual maturation. This women's liberationist focus was entirely appropriate, since Freudian theories about women represented the last respectable academic prop upholding a dichotomous estimation of the socio-politico-economic potential of the sexes--i.e., sexism, as it has come to be called. Postwar scholarship had manifested a split perspective--that is, it was anti-Freudian and pro-feminist or pro-Freudian and anti-feminist. What is more, considerable academic writing about the "woman question" proposed an expanded role for females, advocating a point of view quite similar to that of contemporary feminists. In contrast, the popular literature--e.g., Life, Look, Ladies Home Journal, and the like--proposed only a Freudian (dichotomous) answer to the question, "What are the proper roles of the sexes?" While the findings with regard to popular writing are not too surprising, the extent of early scholarly support (i.e., prior to the women's liberation movement--roughly before 1963) for an expanded role for women was entirely anticipated.


This work reports by the first time a method to control the geometry of Ga_2O_3 films nanocrystallites at 350 °C. The formation of controlled shaped nano-crystallites of γ-Ga_2O_3 from amorphous Ga_2O_3 films grown by RF-Sputtering at room temperature driven by nano-layers of group IB metals (Cu, Ag or Au) is studied. The reported results can be explained by the role of subsurface metal nano-layers and the non-equilibrium nature of the sputtering processes. To study the effects on the surface structure and their optical properties arrays of amorphous-Ga_2O_3/IB-metal/amorphous-Ga_2O_3 were annealed in dry N_2 atmosphere at 350 °C by 50, 100 and 150 min. The experimental results can be explained by the evolution of the amorphous character of the films amorphous films towards the nanocrystalline γ-Ga2O3 phase driven by the metal nano-layer seed nature. As the annealing time was increased the transition from amorphous-Ga_2O_3 to the nanocrystalline γ-Ga_2O_3 phase was detected by X-ray diffraction analysis. The transition to the nanocrystalline γ-Ga_2O_3 is demonstrated by the formation of octahedral, triangle and ball shape nanocrystallites with sizes of ∼5 to 50 nm according to FE-SEM analysis. The influence of the metal nano-layer is clearly seen by the shift of the plasmon frequency resonance produced by the Ga_2O_3/IB-metal/Ga_2O_3 arrays in the region from 400 to 600 nm caused by the modification of the interface Ga_2O_3/IB-metal produced by the applied annealing stages.


Many methods were developed to stabilize an RF excited CO/sub 2/ laser. However the RF excited laser lacked a simple and reliable stabilization method. We stabilized the RF excited laser to the centers of the Doppler broadened gain curves using an optogalvanic effect generated from the laser itself, thereby stabilizing the frequency without requiring any specific unit to be arranged inside or outside of a laser cavity. The oscillating frequency of a gas laser using a Fabry-Perot cavity depends on an optical length of the cavity. For this reason, in order to stabilize the oscillating frequency of the laser, it is important to prevent the optical length of the cavity from being affected by the environment where the laser is used. Otherwise, a variation of the optical cavity length should be compensated.


In aging humans, tooth loss is a predictor of decreased longevity. Tooth loss is mainly caused by dental caries and periodontal disease. Pulpitis refers to inflammation of the dental pulp caused by bacterial infection secondary to dental caries. It is accompanied by severe toothache and has infectious disease-associated pathophysiology. Pulpitis is mainly treated by pulpectomy, which is aimed at removing the infected dental pulp and controlling pain by removing nociceptive nerve fibers. However, teeth without dental pulp have a poor prognosis. In this report, we proposed a novel "super minimally invasive pulp" therapy for treating pulpitis without pulpectomy, which combines antibiotics, steroids, and ultrasound-guided trigeminal nerve block (UGTNB) to protect the dental pulp. UGTNB is used as an analgesic for severe pain, antibiotics for pulp infections, and steroids as antiinflammatory drugs. This novel therapy could improve the longevity of the tooth and thereby oral health.


Execution variance among different invocation instances of the same procedure is often an indicator of performance losses. On the one hand, instrumentation-based tools can insert calipers around procedures and identify execution variance; however, they can introduce high overheads. On the other hand, sampling-based tools insert no instrumentation and have low overheads; however, they cannot synchronize samples with procedure entry and exit. In this paper, we propose FVSampler, a lightweight, sampling-based variance profiler. FVSampler employs hardware performance monitoring units in conjunction with hardware debug registers to sample and monitor whole procedure instances (invocation till return) and collect hardware metrics in each sampled procedure instance. FVSampler, typically, incurs only 6% runtime overhead and negligible memory overhead making it suitable for HPC-scale production codes. We evaluate FVSampler with several parallel applications and demonstrate its effectiveness in pinpointing execution variance. Guided by FVSampler, we tune data structures and algorithms to obtain significant speedups.


Background Anti-topoisomerase antibodies (ATA) in systemic sclerosis (SSc) have been associated with poorer prognosis including diffuse skin involvement, pulmonary fibrosis, cardiac involvement and increased mortality. However, 30–60% of ATA-positive SSc patients demonstrate only limited skin involvement and some have only mild disease course. In SSc, optimal risk stratification is of utmost importance for tailored clinical management at the patient level. Objectives We aimed to determine the prevalence of mild disease among ATA positive patients and to investigate which readily available clinical parameters best identify patients with highest disease severity. Methods Clinical baseline data from SSc patients included in the Combined Care In Systemic Sclerosis (CCIS) cohort of the Leiden University Medical Center were extracted. Patients fulfilling ACR 2013 criteria and ATA positive were included. Descriptive statistics were used to summarize sociodemographic, clinical and serological features. Patients with grade 3 or 4 disease on any of the Medsger severity subscales were considered to be severely diseased. We compared presence of diffuse cutaneous involvement, Raynaud's, pitting scars, calcinosis, proximal muscle weakness, >10% weight loss, interstitial lung disease and pro-BNP between the severity groups and corrected for confounding by disease duration (time since non-Raynaud) by stratifying into quartiles. Results Of 422 SSc patients in the database, 344 patients had SSc meeting ACR criteria. 89 patients were exclusively ATA-positive, of which n=42 with mild disease and n=47 with severe disease. Patients with severe disease appeared to be younger (mean age 50 vs 55 yr), more often non-caucasian (51 vs 12%), with a longer time since non-Raynaud (median 4 vs 2 yr) and more often diffuse skin involvement (dcSSc;62 vs 41%), calcinosis (6 vs 0%) and weight loss (23 vs 7%). Stratification by disease duration, however revealed there are no real differences between mild en severe disease. Overall 47% of ATA+ patients in our cohort presented with mild SSc. When stratifying patients according to time of non-Raynaud, 55% of ATA+ patients presented with mild disease in the first disease duration quartile (median follow-up 0.5 years, range 0–0.8 years). In the forth disease duration quartile, according non-Raynaud time (median follow-up 12.7 years, range 8.2–44.1) the percentage with mild disease was still 27% (Figure 1). Conclusions In our cohort, 47% of ATA-positive patients presented with mild systemic sclerosis, which could not be explained by disease duration. This suggests that solely the presence of ATA is of limited clinical relevance. Readily available sociodemographic and clinical parameters including type of skin involvement seem to have only limited value in identifying ATA patients with more severe SSc. More complex serological findings as antibody titers and fine-specifity of ATA should be defined for optimal serological subsetting. Disclosure of Interest None declared


High-resolution replication banding was performed to (1) delineate at the prometaphase level small interstitial deletions of chromosome 13 in two unrelated patients with retinoblastoma (Rb) and (2) study the influence of these deletions in the replication autonomy of the regions involved. The present study indicates that, in spite of the fact that break points separate (split) bands q14 and q21 in different segments, these deletions do not produce a position effect or alteration in the replication behavior of the abnormal chromosome 13's. Each segment in the deleted chromosomes replicates with a chronology and pattern identical to the normal homolog's. The present data also indicate that metaphase bands are not only autonomous foci of replication but that they can be further divided into subunits of replication which correspond to sub-bands observed in more elongated prometaphase chromosomes. Our results strongly suggest that prometaphase sub-bands represent units of chromatid organization and replication.


Energy savings in the residential area are essential in order to achieve the overall goal for energy savings outlined in the recast of the Energy Performance of Buildings Directive. This was adopted by the European Parliament in 2010. Unfortunately, the large focus on energy performance has reduced the focus on indoor environment. This has, among other problems, resulted in problems with overheated buildings. Therefore, a need for a simple and cheap method for evaluation of possible problems with overheating has arisen among the designers. A method which can be used early in the design process. The paper compares the measured indoor temperatures of a Danish passive house with results of both a simple prediction of the 24-hour average and maximum indoor temperature during summer and a dynamic simulation of the indoor conditions in the building in order to find a useable method for prediction of problems with overheating.


Background: In India, health expenditure accounts for <5% of the Gross domestic product and the level of out-of-pocket (OOP) spending is 69.5% of total health expenditures. OOP expenditure (OOPE) has a negative impact on equity and can increase the risk of vulnerable groups slipping into poverty. Objectives: The study aimed to estimate the OOPE on health and catastrophic health expenditure (CHE) and their sociodemographic determinants in a rural area of Purba Barddhaman. Methods: A community-based cross-sectional study was conducted between July 2018 and February 2019 in Bhatar Block of Purba Bardhaman district, West Bengal. Required sample of 235 households, selected randomly were primary study units. One respondent from each household was interviewed with a predesigned, pretested schedule for sociodemographic and health-care expenditure-related variables. Mann–Whitney U test/Kruskal Wallis H test and multivariable logistic regression was applied. Results: The median OOP health expenditure was Rs. 3870 (inter quartile range: 2156–4952). Of 235 families, 38 (16.2%) had CHE over a period of 1 year. The significant correlates for CHE were type of village according to the presence of public health-care facility (adjusted odds ratio [AOR] = 4.748; 95% confidence interval [CI]: 1.886–11.956), presence of health insurance (AOR = 11.124; 95% CI: 3.690–33.535) and gender of the head of the family (AOR = 18.176; 95% CI: 3.353–98.534). Concentration curve suggested a higher concentration of CHE among poor households. Conclusion: CHE is substantially high in the area. The efforts are required to make the services available as close to the households as possible and to increase awareness about health facilities.


A halide-substituted higher acene, 2-bromohexacene, and its precursor with a carbonyl bridge moiety were synthesized. The precursor was synthesized through 7 steps in a total yield of 2.5%. The structure of precursor and thermally converted 2-bromohexacene were characterized by solid state NMR, IR, and absorption spectra, as well as by DFT computation analysis. It exhibited high stability in the solid state over 3 months, therefore can be utilized in the fabrication of opto-electronic devices. The organic thin-film transistors (OFETs) were fabricated by using 2-bromohexacene and parent hexacene through vaccum deposition method. The best film mobility of 2-bromohexacene was observed at 0.83 cm2 V−1 s−1 with an on/off ratio of 5.0 × 104 and a threshold of −52 V, while the best film mobility of hexacene was observed at 0.076 cm2 V−1 s−1 with an on/off ratio of 2.4 × 102 and a threshold of −21 V. AFM measurement of 2-bromohexacene showed smooth film formation. The averaged mobility of 2-bromohexacene is 8 fold higher than the non-substituted hexacene.


Through membership documents, this essay traces the decline in African American affiliation with Massachusetts Congregational churches-from the pre-Revolutionary era, when enslaved blacks, such as Cuffee Wright, routinely joined Congregational churches, to 1828–32, when four African Americans applying to Lyman Beecher's Boston church were among the last wave of blacks seeking membership in northern white churches.


Pursuant to the high usage of rotating the disk in aircraft gas turbine engine, turbo pumps in oil and gas industries, steam and gas turbines in power plants, marine gas turbine and other industrial rotary machines designing and getting under the mechanical and thermal loading casued this design and analysis to be as a special significance. These disks are subjected to mechanical and thermal loads. In this article, four methods, variable material properties (VMP), Galerkin, Runge-Kutta with two different rules compute the amount of displacement, stress, and strain of a rotary disk, which has been applied from a functionally graded material (FGM). The problem in dissimilar states of loading and temperature dependence and independence of the properties has been resolved. Disk properties with the specified function of radius change. Mechanical loading conditions result from the centrifugal disk and blades mounted on it and the effects of shaft pressure and thermal stress caused by temperature difference in the shaft. The results acquired through every four methods are closed together and can be applied to analyse the problems of this type. Combining all loads, the most radial stresses and environmental stresses respectively obtained in the center of the inner and outer radius and inner radius of the disk. Through applying the results can get most optimal design of the (FGM) disk.


The objective was to study the effect of equivalence ratio of secondary stage combustible mixture injected into the cross flow stream of vitiated air in a two staged combustion system on the characteristics of the secondary stage combustion zone. The primary cylindrical combustor equipped with low swirl air blast nozzle operating with kerosene generates vitiated air. A methane injector was flush mounted to the inner surface of the secondary combustor. It was used to inject the premixed methane-air mixtures perpendicular into the crossflow of vitiated air. An optical, double shell, secondary combustor with three optical windows on its outer shell was used to image the secondary stage flames. The inner shell was a quadratic fused quartz tube which acts as a thermal barrier and the outer thick quartz windows mounted in the quadratic stainless steel chamber withholds the pressure. Chemiluminescence imaging technique equipped with ICCD camera was used to image the OH* emissions of the secondary stage flame.The vitiated air was generated at 2 bar and 1700 K. The velocity of the vitiated air in the secondary combustor was 57 m/s. A premixed methane air mixture was injected into the cross flow stream of vitiated air. The momentum flux ratio between the jet and the vitiated air was maintained at 1.4. The equivalence ratio of the premixed methane-air mixture was varied from 0.5 to 1.0. As the equivalence ratio of the secondary stage combustible mixture moves towards stoichiometric condition, the secondary stage combustion zone becomes compact and also the distance between the burner and the combustion zone decreases.The turbulent flame stabilized in the secondary combustor exhibited large scale structures and other unsteady phenomena that require time-resolved computational methods. Large eddy simulations (LES) are well suited to the calculation of such complex flows. The flame was embedded in a strong turbulent flow where auto-ignition and quenching are important, which poses a significant challenge for the reaction modeling. The presumed JPDF turbulent reaction model, which has been proven to be a reliable model for these challenging conditions, was successfully coupled with the LES simulation. The qualitative agreement between the results of simulations and measurements was quite satisfactory.Copyright © 2012 by ASME


Self-protection is a key behavior that influences infectious disease risks. Spillovers in disease protection create different types of strategic interactions. Under certain conditions, multiple Nash equilibria may arise with the possibility of coordination failure involving excessively low selfprotection, in which case individuals' expectations of others' efforts determine which outcome arises. In prior studies, assumed technical relations between self-protection and infection probabilities drove the strategic interactions. We demonstrate that strategic relations can be endogenously determined and depend on the relative endogeneity of risk (RER), defined here as the degree to which individuals can take control of their own risks in a strategic setting. The potential for coordination failure may arise when RER is sufficiently small, whereas larger levels of RER may eliminate this possibility to ensure larger levels of self-protection. We find that imposing a behaviorally-dependent indemnity may increase RER to eliminate the possibility of coordination failure. We apply our analysis to the problem of livestock disease and illustrate the theory using a numerical example of the 2001 United Kingdom foot-and-mouth disease epidemic.


In the first chapter, we examine the tradeoffs that news organizations face between speed and accuracy in information provision. Journalists complain that the quality of news coverage is declining because of tradeoffs they face between speed and accuracy. We examine this tradeoff in a model where two players value being accurate, but also value being the first to report. Although delay allows players to improve the accuracy of their reports, we characterize equilibria and provide conditions for when competitive preemption concerns cause players to report without evidence. We explore the impact of competition on the quality of information provided, and consider the effectiveness of waiting periods in improving outcomes. The second chapter presents a model where a firm attempts to persuade a customer to purchase a product by committing to a message strategy, but does not know the customer's beliefs about the product's quality. We examine three contracting settings - firms can attach transfers to signals, purely wasteful costs, or condition transfers on the customer's purchase decision. We show that the optimal mechanism in each setting never provides information for free, and that customers with extreme beliefs are effectively denied any useful information. The third chapter presents a model of voter turnout, where some individuals vote because they are motivated by a civic duty to do so while others may vote because they wish to appear pro-social to others. It proposes a simple framework that captures these motivations, and provides results consistent with findings on turnout, e.g. that turnout is responsive to the expected closeness and importance of an election, to the observability of one's choice to vote, and to social rewards and punishments associated with voting. We study various extensions of this framework in which community monitoring plays a role, and explore the implications that voter mobilization has for electoral competition


OBJECTIVE:
To understand the change in blood glucose level and HbA1c following meridian massage.
BACKGROUND:
Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.
In acupuncture, there are many studies on its efficacy on diabetes. My study aims to understand the efficacy of meridian massage on diabetes.
DESIGN AND METHOD:
60 subjects were randomized Using computerized number generation method into Group A (meridian massage ; N = 30) and Group B (control ; N= 30). The Subjects of Group A received meridian massage once in a week for 3 months along with their regular allopathic medications and Group B continued their allopathy medicines. Data was collected before and after treatment through blood glucose test and HbA1C.
RESULTS:
Meridian massage intervention showed statistically significant changes in fasting blood sugar level (p = 0.001), postprandial blood sugar level (p = 0.001) and HbA1C (p = 0.001).
CONCLUSION:
This trial suggested that meridian massage along with conventional medications is better in reducing serum glucose level and HbA1C level in type 2 diabetes.


6~8% Y2O3 partially stabilized ZrO2 (YPSZ) nanostructured coatings were fabricated by atmospheric plasma spraying (APS). The fractured cross-section morphologies of the samples were observed by scanning electron microscopy (SEM). The thermal conductivities of free-standing pure nanostructured YPSZ coatings samples were determined using the laser flash technique. Specific heat was measured through a differential scanning calorimeter. The results showed that there is a great difference between the fractured cross-section microstructure of nanostructured and conventional zirconia coatings. The nanostructured one exhibits a bimodal distribution of microstructure, viz. directional crystal and isometric crystal structure. Plasma spraying parameters have a significant effect on the microstructure through changing the content of isometric crystal structure in the coating. The thermal conductivity decreased with increased isometric crystal microstructure content. The thermal conductivity can be lowered up to 60%.


Abstract The aim of this paper is an ontological clarification of the concept of artefact. The following questions are addressed: 1. Do artefacts constitute an ontological category of objects in its own right, and if so, how could this category be characterized? 2. How do artefacts come into existence? 3. What kind of artefacts are there, and in which relations do they stand to each other? It is argued that artefacts are characterized essentially through their genesis and that they owe their existence to mental acts of a particular kind, which I call "acts of creation". It is maintained that there are not only concrete, material artefacts, but also abstract artefacts, that is, artefacts that cannot be perceived through the senses and are not located in space. Furthermore, it shall be claimed that in a sense those abstract artefacts are even primary to the concrete, material artefacts.


Teaching English to secondary students needs to be considered in order to formulate their learning levels and their needs. This is crucial in order for the learning process to be successful. However, as teaching English should be integrated into other language skills, the use of media which is mostly helpful for particular skills sometimes can be time consuming, and not all teachers are able to prepare and use it in their classes. Thus, a teacher has no time to practice one of the skills sufficiently using particular media to support the learning process. Listening skills for instance, technology in which nowadays has been developed to facilitate students to improve their listening skills is better to be used by English teachers in order to find suitable listening sources. Thus, a research question of how is the significance of BBC Learning English to be used in teaching listening skills in secondary students was tried to be endeavored. Hence, a quantitative method was used in this research. It was found that BBC learning English is significant to be used in English classes of secondary school. Moreover, the questionnaire that students filled out showed that their motivation and enthusiasm revealed a positive response.
Keywords: ICT, teaching English, listening skill, secondary students, media


Our recent study using historic data of wheat yield and associated plantation area, rainfall, and temperature has shown that incorporating statistics and artificial neural networks can produce highly satisfactory forecasting of wheat yield. However, no comparison has been made between the outcomes from the spatial neural network model and commonly used temporal neural network models in crop forecasting. This paper presents the latest research outcomes from using both the spatial and temporal neural network models in crop forecasting. Our simulation shows that the spatial NN model is able to predict the wheat yield with respect to a given plantation area with a high accuracy compared with the temporal NARNN and NARXNN models. However, the high accuracy of the spatial NN model in crop yield forecasting is limited to the forecasting of crop yield only within normal ranges. Users must be cautious when using either NARNN or NARXNN for crop yield forecasting due to their inconsistency between the results of training and forecasting.


The stability problem of the boundary regions of cold blanket systems with induced currents parallel to the lines of force is formulated. Particular interest is focused on two types of mode: first electrostatic modes driven by the combined effects of a transverse resistivity gradient due to a spatially non-uniform electron temperature and a longitudinal current, second electromagnetic kink-like modes driven by the torque arising from a transverse current density gradient and magnetic field perturbations. It is found that the combination of various dissipative and neutral gas effects introduces strong stabilizing effects within specific parameter ranges. For particular steady-state models investigated it is shown that these effects become of importance in laboratory plasmas at relatively high densities, low temperatures and moderate magnetic field strengths. Stability diagrams based on specific steady-state cold plasma blanket models will be presented.


We review recent work in which perturbative, geometric and topological arguments are used to prove the existence of countable sets of orbits connecting equilibria in ordinary differential equations. We first consider perturbations of a three–dimensional integrable system possessing a line of degenerate saddle points connected by a two–dimensional manifold of homoclinic loops. We show that this manifold splits to create transverse homoclinic orbits, and then appeal to geometrical and symbolic dynamic arguments to show that homoclinic bifurcations occur in which 'simple' connecting orbits are replaced by a countable infinity of such orbits. We discover a rich variety of connections among equilibria and periodic orbits, as well as more exotic sets, including Smale horseshoes. The second problem is a four–dimensional Hamiltonian system. Using symmetries and classical estimates, we again find countable sets of connecting orbits. There is no small parameter in this case, and the methods are non–perturbative.


Durable goods manufacturers often design product lines by segmenting their markets on quality attributes--attributes that exhibit a ''more is better'' property for all consumers. Since products within a product line are partial substitutes, and consumers can self-select the products they want to purchase, multiproduct firms have to carefully consider the cannibalization problem in designing their product lines. Existing research has analyzed the cannibalization problem for a monopolist who faces consumers who differ in their quality valuations. If lower-quality products are sufficiently attractive, higher-valuation consumers may find it beneficial to buy lower-quality products rather than the higher-quality products targeted to them. That is, lower-quality products can potentially cannibalize higher-quality products. The cannibalization problem forces the firm to provide only the highest-valuation segment with its preferred (efficient) quality. All other segments get qualities lower than their preferred (efficient) qualities. When the cannibalization problem is very severe, the firm may not serve some of the lowest-valuation segments.However, not much is known about how and when the cannibalization problem affects product line design in an oligopoly. Also, consumers may differ not only in their quality valuations but also in their taste preferences. The objective of this paper is to fill these gaps by examining whether the cannibalization problem affects a firm's price and quality decisions in a model with consumer differences in quality valuations, as well as in their taste preferences, in both monopoly and duopoly settings. The paper addresses questions such as the following. With both types of consumer differences, should a firm, even a monopolist, provide efficient quality only to the top segment? Are there conditions under which other segments can also get their preferred quality levels? If so, how do consumer and firm characteristics affect the likelihood of different segments getting their preferred qualities? How does competition affect the firm's choice of qualities?I develop a model in which the market is made up of two segments, with one segment valuing quality more than the other. Consumers within each segment are distributed over Hotelling's (1929) linear city. Consumers in the two segments can have different taste preferences (transportation costs). Firm locations in the two segments may also be different.The paper begins with an analysis of the monopoly case. I find that when both segments are fully covered, the standard self-selection results of the high-valuation segment getting its preferred quality and the low-valuation segment getting less than its preferred quality do hold. Interestingly, when both segments are incompletely covered, under some conditions, the monopolist's price and quality choices are not determined by the cannibalization problem. In these cases, the monopolist finds it optimal to provide each segment with its preferred quality. Thus, the equilibrium quality levels in a second-degree price discrimination situation resemble the third-degree price discrimination solution. I characterize the relevant conditions in terms of consumer characteristics.I then consider the case of two firms competing in the market, each offering two products--one for the high-valuation segment and the other for the low-valuation segment. Here also both types of outcomes are possible, depending on consumers and firm characteristics. Under some conditions, the cannibalization problem does not affect the firms' price and quality choices, and each firm provides each segment with that segment's preferred quality. Each firm finds it optimal to serve both segments. When these conditions do not hold, only the high-valuation segment gets its preferred quality. I interpret the conditions necessary for these results to exist in terms of characteristics of the consumers and the firms.An interesting insight from the analysis is that as the taste preferences of the low-valuation segment become weaker (their ''transportation cost'' becomes lower), the more intense competition in the low-valuation segment makes it more attractive for the high-valuation consumers to buy the products meant for the low-valuation segment. This worsens the cannibalization problem, and the low-valuation segment may not get its preferred quality. On the other hand, when the taste preferences of the high-valuation segments are sufficiently weak, more intense competition in the high-valuation segment reduces that segment's incentives to buy the product meant for the low-valuation segment. This mitigates the cannibalization problem and makes it more likely for the low-valuation segment to get its preferred quality.Similarly, when firms are less differentiated in the low-valuation segment, stronger competition between the firms makes the cannibalization problem worse, and the low-valuation segment may not get its preferred quality. When the differentiation between the firms is sufficiently weak in the high-valuation segment, the high-valuation segment is more likely to be better off buying the product meant for it. As the high-valuation segment's incentives to buy the lower-quality product are reduced, the low-valuation segment is more likely to get its preferred quality.


Speaking is a part of language skills which is really essential. Among other skills, speaking is mostly used to communicate with people. The aim of this research was to observe and know the improvement of students' speaking ability at the second semester students of English Language Education Department, University of Muhammadiyah Malang. There were 24 students under observation. This research employed Classroom second semester students of English Language Education Department, University of Muhammadiyah Malang Action Research (CAR). The researcher implemented two cycles in this research. The first cycle (cycle 1) covered two meetings while cycle two covered three meetings. The test for the students' speaking performance at cycle 1 showed that the average score of the speaking performance test was 69.92. The standard deviation yielded 4.  Meanwhile, the lowest and the highest score were 62 and 78 respectively. At the cycle 2 test, the result showed the average score of the speaking test was 76.50. standard deviation yielded 2. Furthermore, the highest and the lowest score were 80 and 73 respectively. From the cycle 2 result, it proved that the implementation of snake & ladder board game could improve the speaking ability of the students at English Language Education Department, University of Muhammadiyah Malang.