INTRODUCTION AND OBJECTIVES: Local complications such as gross hematuria and clotting, repetitive blood transfusions, upper and lower urinary tract obstruction, intestinal obstruction, and treatment-refractory pelvic pain represent significant complications of locally advanced CRPC despite the use of life prolonging agents. It is the purpose of our study to retrospectively review the surgical, symptomatic and oncological outcome following palliative, extensive pelvic surgery. METHODS: 103 patients with locally advanced CRPC underwent palliative pelvic surgery: radical cystoprostatectomy in n=80 (61.5%), radical prostatectomy with continent vesicostomy in n=9 (8.7%) and anterior plus posterior exenteration in n=17 (16.5%). All patients underwent local staging via MRI of the small pelvis, cystoscopy and rectoscopy. Systemic staging was done with CT scans of the chest, abdomen, pelvis and bone scans. Perioperative complications were assessed according to Clavien-Dindo classification and symptom-free (SFS), cancer specific survival (CSS) were evaluated. RESULTS: Indications for surgery were lower or upper urinary tract obstruction in 56 (54.3%) and 41 (39.8%), resp., hematuria and blood transfusions in 23 (22.3%), rectal infiltration with/without obstructive ileus in 17 (16.5%), refractory pelvic pain in 13 (12.6%). 67 (65.1%) pts had a combination of various symptoms. Clavien-Dindo grade 2, 3 and 4 complications developed in 27 (26.2%), 9 (8.7%) and 6 (5.8%), resp. After a median follow-up of 36.5 (3 – 123) months, the SFS at 1 and 3 years was 90.3% (n=90) and 66.9% (n=69). The median SFS was 27.9 months. CSS at 1 and 3 years was 92.2% and 43.7%, respectively. 78.6% of the patients were symptom-free during their remaining lifetime. CONCLUSIONS: Multivisceral radical pelvic surgery is a technically feasible approach in well-selected patients resulting in symptom relief of > 90% of patients which covered almost 80% of the remaining life time. Palliative surgery needs to be considered more frequently iin the therapeutic armentarium of locally symptomatic CRPC. Adequate preoperative imaging studies, endoscopic evaluation and extensive surgical experience is mandatory to achieving a benefit for the individual patient with improvement of quality of life. Source of Funding: none


Household tumble dryers are classified into three major categories according to their dehumidification process. Air vented dryers are the most simple and least efficient ones, in which humid air is directly vented to the outside environment, while the condenser tumble dryers have closed air loop with an air-to-air heat exchanger for dehumidification process. Heat pump tumble dryers are the most efficient products in domestic household dryers. In the heat pump systems of these dryers, the heat released from the condenser is used directed to the laundry and evaporator is used for the dehumidification of the humid air leaving the tumble. From the design point of the view, evaporator structure and dehumidification performance have a critical role on improving the heat pump dryer efficiency. In this study, effect of fin type and fin coating of an evaporator which is used for dehumidification process in terms of condensation rate and efficiency has been studied. In order to study the effect of these parameters on dehumidification performance, temperature and air velocity at the inlet of evaporator (respectively 38°C and 1.85 m/s) has been kept constant while varying the relative humidity (65%, 70%, 80%) of inlet air, fin type (plain and wavy) and surface type (hydrophobic and hydrophilic) of evaporators.


Wadi Dayqah dam (WDD) is still not operating, and its operation targets are not yet fixed. Arid hydrology and the presence of new users require a new look at this dam's operation plan. The updated and optimal operation plan of WDD is the central research gap about this dam. In this study, to fill this gap, Water Evaluation and Planning (WEAP) is used to model the system and six scenarios, including the reference target of 35 MCM per year suggested goal that considers different operation targets as well as a modification to water system configuration by the addition of an upstream dam is suggested. This model is validated and used for 37 years of historical flow. Results show that the reference scenario is less than 55%, and an annual goal of 15 MCM has a maximum of 85% supply reliability. Adding a 20 MCM upstream dam can increase reliability by 5%. It is recommended that to enhance the economic aspects of the dam, suitable energy generation schemes are studied with unique configurations, such as pumped-storage hydro, as well as studying the other sizes of upstream dams that can contribute more to water distribution and energy generation.


In a prospective clinical trial, patients with urinary schistosomiasis from the Sudan and from other African countries were treated with two or three doses of metrifonate (10 mg/kg), respectively, in two weeks' intervals. Patients seen in the Sudan (n = 37) were followed up for 3 months, those seen in Hamburg (n = 17) up to 20 months. Each dose of metrifonate led to a decrease of almost 90% in egg excretion independently of the pretreatment intensity of infection so that after three doses a reduction of almost 99.9% was achieved. The estimated proportion of parasitological cure after two doses of metrifonate was in the order of 24% in the lightly infected patients seen in Hamburg, and in the order of 8% in the heavily infected Sudanese patients. Almost 59% of the patients who received a complete metrifonate treatment of three doses stopped to excrete ova of S. haematobium. Drug failure was found in almost the same proportion in the two patient groups (17.5% and 16.2%, respectively) and could not be overcome by additional doses of metrifonate. The considerable reduction in egg excretion after a single dose of metrifonate might have a remarkable benefit in large scale programmes where the aim is drastic reduction of worm burden rather than complete cure.


Gli3 is a key regulator of development, controlling multiple patterning steps. Here we report the generation of a scFv antibody specific to the repressor domain of human Gli3. We show that this scFv retains the binding capacity of its parent anti-Gli3 monoclonal antibody derived from hybridoma clone 5E1. When expressed in mammalian cells, the anti-Gli3 scFv co-localizes with intracellular Gli3. Immunocytochemical staining of the intrabody in Gli3-positive TM4 cells shows a distinct perinuclear cytoplasmic localization. Such a scFv constitutes a useful tool for studying transcriptional regulation of the hedgehog pathway in mammals and offers a starting point for developing novel Gli-related therapeutic intrabodies.


Questioning of Catholic Church leaders in the Australian Royal Commission into Institutional Responses to Child Sexual Abuse has revealed a distinct sense of immunity and lack of responsibility for the crimes of church personnel, which has resulted in stymied justice for complainants in sexual abuse lawsuits. In this article, I explore this immunity by examining it in the context of treatments of sexual harms in other areas of private law, particularly religious exceptions to discrimination law, by which religious organizations are granted immunity from the modern rationale of the harms of discrimination on the grounds of sex and sexual orientation. In situating child sexual abuse claims in the broader sphere of private law, I aim to reveal law's incoherent logic of sexual harms, and its implications for justice. The example of religious exceptions illustrates an incoherent problematization of sexual harm and responsibility in contemporary legal and political systems that aim to uphold modern values of equality and dignity while sustaining incompatible doctrines of religious autonomy.


A point mutation at nucleotide 5258 in the B enhancer of the polyomavirus host range mutant F441 leads to productive infection of F9 embryonal carcinoma cells, which are refractory to infection by wild-type polyomavirus. Specific oligonucleotides were used to construct mutations in two other potentially important domains within the B enhancer of F441 DNA. One of these domains is the binding site for a factor present in nuclear extracts of F9 cells, and the other is a region that has sequence similarity to putative core sequences observed in a number of different viral enhancers. Mutation within either of these two domains, even in the presence of the F441 mutation, was detrimental to polyomavirus enhancer activity in F9 cells, as determined by both transfection and infection assays.


We have previously shown that the electronic conductivity of copper-containing glasses sensitively depends upon the microscopic phase structure as well as the extent of clustering phenomena. In this context, an accurate description of the transition-metal ion wavefunction appeared to be necessary. Further confirmation has been obtained from the investigation of glasses of general composition xZnO·yP2O5·zFe2O3. ESR analyses showed two types of iron(III) centres, the concentration of which apparently depends both on the total iron content and the matrix structure. A dramatic improvement of the agreement between theoretical predictions and experimental data has been achieved for the onset of the transport properties by a proper description of the electronic structure of the hopping centres. This conclusively demonstrates the general need of a realistic description of the localized states in order to account for the hopping processes in such systems, stressing in turn the primary role which can be played in their investigation by techniques that enable a direct observation of the environment of the metal sites.


ABSTRACT:During his 2016 election campaign, Donald Trump vowed to change U.S. priorities and strengthen his administration's relationship with Israel and its government. As president, Mr. Trump carried through his campaign promises: He recognized Jerusalem as the capital of Israel and moved the U.S. Embassy to Jerusalem; he recognized Israeli sovereignty over the Golan Heights; he withdrew the U.S. from the Iran Nuclear Deal; he cut funding for the Palestinians; took unilateral supportive actions at the U.N. and promoted peace negotiations between Israel and Arab countries in the region. The article reviews these measures as strategic partisan tools used by Donald Trump to fulfill commitments to his base and to appropriate issues which had long been avoided as partisan. In appropriating them for his own political gains, the former president tapped into and increased the ongoing partisan divide over Israel which may well become an irreversible trend.


: Effects of mixed non-stimulated saliva on NO synthesis in polymorphonuclear leukocytes (PMNs) have been studied. Saliva from healthy volunteers in concentration-dependent manner potentiates the NO formation. In patients with gingivitis and periodontitis this effect of saliva was altered and in some patients saliva did not stimulate NO synthesis or began to suppress it. By means of cluster-analysis, a classification of these effects of saliva in periodontal diseases has been elaborated. It was shown that in gingivitis and especially periodontitis a number of patients with depressed or inverted effects of saliva on NO synthesis significantly increased.


Understanding the interests of tourists is a key skill for attraction managers to prepare plans and make strategic decisions in tourism marketing. The rapid growth and spread of social media websites provide an information-rich channel from which tourism researchers and managers can collect a large amount of text-based reviews or comments and photos relating to the past travel experiences of users. The travel photos with geographic information are especially helpful in identifying the geographical location of the destinations. By analyzing these big data in various formats can help to understand the interests of tourists at destinations. In this paper, a framework is proposed to identify the interests of tourists by integrating information carried by the geotagged photos shared on social media websites. Such an approach is expected to provide sustainable tracking on popular places of interest (POIs) updated by tourists and pick the best representative photos taken by them. The performance of this model is evaluated by conducting a case study using the geotagged photos taken in Hong Kong. A case study proved this proposed framework could make a thriving tourism industry more efficient.


This article offers a condensed account of Asta Nielsen's interaction with the Swedish National Censorship Board in 1911 after the banning of her film In dem grosen Augenblick/The Great Moment for screening in Sweden. Her strategy, publishing open letters and inviting representatives from the press to non-public screenings, set the standard for other film companies dissatisfied with the slew of bans issued by the Board. A Nielsen letter to young movie fans, published in facsimile in a Swedish fan magazine in 1920, is translated to illustrate a different type of press interaction a decade later.


We respond to the comments (https://doi.org/10.5964/ps.9227) on our "Ten Steps" paper (https://doi.org/10.5964/ps.6029), focusing on the most prominent themes: (1) What motivates scientists?, (2) Consensus-building (Is our field ready? May there be adverse side-effects? How shall we do it?), (3) How may institutional change be facilitated?, (4) Diversity (of participants, stimuli, methodology, measures, and among researchers), (5) The reliability of our proposed scoring system, and (6) The real-world relevance of personality research. We stand by our call for more concerted consensus-building and offer a few clarifications in this regard. We also issue four specific calls to action to our colleagues in the field: (a) specify legitimate paths to greater consensus, (b) explicate what constitutes good "qualitative" research, (c) help establish a widely used, public domain item database, and (d) determine what the most important contemporary goals of personality research are.


Studying the touch as a sense developed by contact, and the necessity to redefine it, due to the global pandemic and social dissonance that occurred is the topic of this text. Questioning the approach to drawing under the influence of remoteness addresses the need to look closely, to get personal with the drawing, a manifestation of experience. Drawing of intimacy, evaluate concepts of encounter and isolation posing the question of whether we can experience the closeness of the other through the embodiment of the experience in the drawing. Re-examining tactile sensation observed through the obstacle of corporeal distance, a reflection of intimate experiences and spaces opens up for a new interpretation - of touch without the touch. Can this obstacle transform touch into gaze; and can an image in its making, construct a tactile sensation? Intertwining theoretical and practical approach, this text witness drawing and its visual consumption in space of violated closeness.


Morphogens such as Wnt proteins play a central role in embryonic patterning by providing positional information to cells in developing tissues. In recent years, it has become clear that such morphogenic gradients also contribute to the guidance of migrating cells and axons in the developing nervous system. Congenital Wnt signaling defects may result in malformations of the nervous system during development, such as spina bifida. In addition to acting as direct repulsive or attractive guidance signals, Wnt proteins can also function as permissive factors that enable cells to respond to other guidance cues. How migrating cells and growth cones interpret information from Wnt ligands to adopt a specific migratory response is, however, still largely unknown. In this thesis we have investigated in detail how migrating cells may respond to the Wnt signal. We found that the migration of the QR neuroblast and its descendants is divided in three sequential phases that are each controlled by a distinct Wnt signaling mechanism. Importantly, our results indicate that the different Wnts act permissively and that the QR cells switch between these different signaling pathways by temporally regulating the transcription of different Wnt signaling components. Furthermore, we have shown that an intricate network of interlocked negative and positive transcriptional feedback loops is required for robust activation of mab-5/Hox transcription in the QL neuroblast in response to canonical Wnt β-catenin signaling. Our modeling results demonstrate that the transcriptional feedback of Wnt signaling to both Frizzled receptors and Wnt target genes is required for robust target gene activation. Altogether, our results show that temporal transcriptional regulation and feedback of Wnt signaling components are important mechanisms to robustly and precisely regulate cell migration in response to the Wnt signal.


The aim of this study was to investigate serum amyloid A, haptoglobin and hepcidin levels in respiratory infections caused by various viral agents in calves. Pneumonia is an infectious or non-infectious disease affecting the lungs of all animals, and during the inflammation, blood levels of acute phase proteins increase rapidly. Hepcidin is a hormone that has many functions and is known as type II acute phase reactant. The blood samples were collected from a total of 20 calves to form the study group. The control group consisted of 10 healthy animals. Sera were analyzed with ELISA for antigen detection. According to the results, Bovine herpesvirus type-1 (BHV-1) was positive in 3 calves, Bovine viral diarrhea virus (BVDV) was positive in 3 calves, Bovine respiratory syncytial virus (BRSV) was positive in 1 calf, and Bovine parainfluenza virus type 3 (BPI3) was positive in 1 calf. Adenovirus infection was detected in 5 animals together with other viruses. Mixed infections were observed in 12 calves. Haptoglobin, serum amyloid A and hepcidin values were measured in sera. According to the results, statistically significant differences were observed between the two groups for the haptoglobin (P<0.01), serum amyloid A (P<0.05) and hepcidin (P<0.05). It was concluded that these parameters can be used to support the diagnosis of respiratory infections of the calves.


Abstract In the past decade, the use of drones has constantly increased, especially in the US military's global fight against terrorists. At a time when the acquisition of drones is widely debated, it is worth scrutinizing how the use of such technologies is legitimized. How do proponents use the visualization of possible worst-case scenarios to justify preemptive drone strikes and what does this mean for the reduction of risks? ----- Bibliographie: Staudenmeyer, Fabian: Drones. Preempting Future Risks in the 'War on Terror', 360°, 2-2014, S. 93-100. https://doi.org/10.3224/360grad.v9i2.22026


In the United States Supreme Court decision of Brown v Plata, handed down on 23 May 2011, the majority denounced the overcrowding conditions in Californian prisons insofar as they impacted upon the mental and physical health of prisoners and upheld an order mandating such prisons to reduce their populations to 137.5% of design capacity. The majority judgment found there had been a breach of the Eighth Amendment right to be free from cruel and unusual punishment and that it was appropriate for the courts to ensure that the right was enforceable. This paper reviews the landmark and controversial judgments in Brown v Plata and argues that it is a decision in relation to the obligation for imprisoning authorities to care for the wellbeing of prisoners that is likely to have significant repercussions well beyond the confines of the United States. It raises squarely the potential for the cruel and unusual punishment preclusion to be used as a potent protection for those made vulnerable and dependent by reason of their incarceration.


Original definition of the Wigner function can be extended in a natural manner to relativistic domain in the framework of quantum field theory. Three such generalizations are described. They cover the cases of the Dirac particles, the photon, and the full electromagnetic field.


The decision to speak Catalan to my daughter came naturally to me. How else would I tell a story, sing a lullaby or make her laugh but in the language I was told stories, sung lullabies to and made to laugh since I was a new-born! However, whereas the choice to speak one's mother tongue to your children is not questioned anymore in Spain, making this same choice when you live elsewhere seems to raise a lot of eyebrows. In this article I will reflect, from my own experience, on speaking a language of Spain other than Spanish in Australia. Catalan is one of 300 community languages in Australia, and it's spoken by a small and ageing population.


Objective: LVEDP is determined by pulse rate (PR), preload, and afterload etc., which are also blood pressure (BP)-determining factors. As a result, LVEDP is more likely to be associated with ambulatory blood pressure monitoring (ABPM) parameters. However, little is known of relationship between ABPM parameters and LVEDP. Thus, this study investigated how ABPM parameters were associated with the LVEDP during leg-raise. Design and Method: 134 euvolemic patients with exertional dyspnea underwent left cardiac catheterization, coronary angiography, echocardiography and ABPM during same admission. In patients with non-significant coronary stenosis and normal ejection fraction, the leg-raise was performed as 2 stages during left cardiac catheterization. Results: LVEDP at rest was mainly correlated with PR parameters (i.e. average real variability (ARV) of PR at wake, ARV of 24-hour PR, standard deviation (SD) of PR at wake, and SD of 24-hour PR). Although LVEDP at leg-raise showed the correlation with PR parameters (i.e. ARV of 24-hour PR, ARV of PR at wake, ARV of PR at sleep, mean PR at wake, mean 24-hour PR, SD of 24-hour PR, SD of PR at wake, and SD of PR at sleep), pulse pressure (PP) was also well correlated with LVEDP values at leg-raise (mean PP at wake and mean 24-hour PP). When the increased LVEDP at rest was defined as > 15 mmHg, SD of PP at wake and 24 hours were significantly higher in the increased LVEDP. Likewise, when the increased LVEDP at leg-raise was defined as > 18 mmHg, the increased LVEDP group had significantly higher values of PP and SBP at wake and 24 hours. Conclusions: Although PR was most commonly correlated with LVEDP, LVEDP at leg-raise was chiefly associated with PP and SBP at wake and 24 hours. It means that PP at wake may play an important role in the LVEDP hemodynamics.


Delay Tolerant Networks finds its application in variety of environments and addresses issues like intermittent connection, long and variable delays and high latency. Vehicular Delay Tolerant Networks was introduced due to its various characteristic matches with DTNs. In particular class of VDTN there are two types of nodes: Stationary and Mobile nodes. Stationary nodes are deployed along the roadside and mobile nodes are constrained to move over the roads with variable speeds. This letter presents a new routing algorithm based on Ant Colony Optimization in Vehicular Delay Tolerant Network. We performed extensive simulation in ONE simulator and compare with Probabilistic Bundle Relaying Scheme to gauge the benefits of Ant Colony Optimization based scheme over Probabilistic Bundle Relaying scheme.


The electromagnetic energy density w(r) is calculated outside an infinitely long and straight superconducting cosmic string of finite radius a. The feature distinguishing this situation from the analogous situation in Minkowski space is the presence of the factor in the azimuthal part of the line element, G being the gravitational constant and the string mass per unit length. We regularize w(r) by subtracting (i) one volume term arising from the (boundary independent) volume terms in the two scalar Green's functions, and (ii) one term giving the energy density for the same geometrical configuration but with the gravitational field switched off. The remaining regularized energy density is calculated and illustrated graphically. The expression is finite everywhere for r > a, but diverges near the surface as . This is the typical kind of divergence encountered for the electromagnetic field near a curved boundary even in Minkowski space. The physical reason for this divergence is the assumed idealized boundary conditions at the surface.


Molecular imprinting of theophylline in poly (methaerylie acid- ethylene dimethaerylate) as CEC stationary phases was synthesized by an in situ photo-initiated polymerization reaction. The effect of electrolyte pH on xanthine derivatives and the stability of MIP column performance were investigated, the relative standard deviation (DRS) of migration time of five consecutive runs on MIP column was in the range of 2.2%-3.1%. The reproducibility of migration time column to column of M(A) was in the range of 3.8%-4.9%. The highest column efficiency was more than 140 000 plates per meter. The MIP capillaries had showed better selective for theophylline, which comparing with the reference column.The urine sample was separated by spiked 5×10^-4 mol· L^-1 theophylline.


Deep neural network ensembles that appeal to model diversity have been used successfully to improve predictive performance and model robustness in several applications. Whereas, it has recently been shown that sparse subnetworks of dense models can match the performance of their dense counterparts and increase their robustness while effectively decreasing the model complexity. However, most ensembling techniques require multiple parallel and costly evaluations and have been proposed primarily with deterministic models, whereas sparsity induction has been mostly done through ad-hoc pruning. We propose sequential ensembling of dynamic Bayesian neural subnetworks that systematically reduce model complexity through sparsity-inducing priors and generate diverse ensembles in a single forward pass of the model. The ensembling strategy consists of an exploration phase that finds high-performing regions of the parameter space and multiple exploitation phases that effectively exploit the compactness of the sparse model to quickly converge to different minima in the energy landscape corresponding to high-performing subnetworks yielding diverse ensembles. We empirically demonstrate that our proposed approach surpasses the baselines of the dense frequentist and Bayesian ensemble models in prediction accuracy, uncertainty estimation, and out-of-distribution (OoD) robustness on CIFAR10, CIFAR100 datasets, and their out-of-distribution variants: CIFAR10-C, CIFAR100-C induced by corruptions. Furthermore, we found that our approach produced the most diverse ensembles compared to the approaches with a single forward pass and even compared to the approaches with multiple forward passes in some cases.


Extragenital pathology during pregnancy and childbirth occupies a leading place in maternal mortality and perinatal pathology. One of the main ways to maintain the health of mother and child is to identify somatic diseases in pregnant women and timely treat them. Nervous system diseases that occur in pregnant women are mainly epilepsy, multiple sclerosis, brain tumors, cerebrovascular disorders, although remain poorly understood, but require immediate decisions to prolong pregnancy, obstetric tactics during childbirth, conservative or conservative surgery. The pathology of cerebral vessels (arterial aneurysms and arteriovenous malformations) also remains an urgent problem, despite many years of experience in their diagnosis and treatment. The sudden development of symptoms, severity of clinical manifestations and high mortality in rupture of an aneurysm or arteriovenous malformation of cerebral vessels determine the urgency of this problem and increased interest in its study, especially in pregnant women. Material and methods. The paper presents a clinical case of arteriovenous malformation in a 25-year-old pregnant woman, her treatment and delivery. Results and discussion. Arteriovenous malformation is considered a congenital cerebrovascular pathology, which is accompanied by a sudden rupture of abnormal vessels with the development of hemorrhagic stroke, without specific clinical symptoms and precursors, which complicates lifelong diagnosis. Endovascular embolization during pregnancy saved the lives of women and children. An effective result was obtained after neurosurgical treatment of arteriovenous malformation in a pregnant woman in the second trimester of pregnancy (17 weeks), which allowed to bring the pregnancy to the physiological time of delivery. Taking into account the complex neurological pathology, neurosurgery, which requires the exclusion of a powerful period of childbirth, a pregnant woman gave birth by cesarean section at 38 weeks of pregnancy. Conclusion. An effective result was obtained after neurosurgical treatment of arteriovenous malformation in a pregnant woman in the second trimester of pregnancy, which allowed to bring the pregnancy to the physiological time of delivery. The obtained results indicated the possibility of full-term pregnancy, reduction of maternal and perinatal morbidity and mortality in pregnant women with arteriovenous malformation with timely preventive and curative measures with timely referral of pregnant women to the perinatal center on the basis of a multidisciplinary clinical institution to prevent complications


A general approach to the near-field far-field transformation from amplitude only near-field data is presented. The estimation of the far field is stated as an intersection finding problem and is solved by the minimization of a suitable functional. The difficulties related to the possible trapping of the algorithm by a false solution (common to any nonlinear inverse problem) are mitigated by setting the problem in the space of the squared field amplitudes (as already done in a number of existing papers) and by incorporating all the a priori knowledge concerning the system under test in the formulation of the problem. Accordingly, the a priori information concerning the far field, the near field outside the measurement region and the accuracy of the measurement setup and its dynamic range are properly taken into account in the objective functional. The intrinsic ill conditioning of the problem is managed by adopting a general, flexible, and nonredundant sampling representation of the field, which takes into account the geometrical characteristics of the source. As a consequence, the number of unknowns is minimized and a technique is obtained, which easily matches the available knowledge concerning the behavior of the field. The effectiveness of the approach is shown by reporting the main results of an extensive numerical analysis, as well as an experimental validation performed by using a very low cost near field facility available at the Electronic Engineering Department, University of Napoli, Italy.


Chronic expanding hematoma (CEH) is a rare disease that can develop in any region of the body, but it most frequently develops in the thorax. When intrathoracic CEH is left untreated, gradually expanding hematoma can be life‐threatening, leading to respiratory failure or hemoptysis. We encountered an 89‐year‐old man with cardiopulmonary arrest on arrival. He had been healthy, and it was unclear whether CEH had previously been detected. A very large mass was observed on chest computed tomography (CT), but the cause of death could not be determined. In the autopsy, this mass was identified as CEH and no malignant findings were noted. A fresh hemorrhage had occurred in the hematoma and perforated the bronchial lumen, which caused airway obstruction/asphyxia and resulted in sudden death. CEH should be suspected when a very large tumorous lesion occupying the entire hemithorax is observed on chest imaging, and it is important to recognize that sudden death can occur in the natural course of CEH.


Research and industrial installations have shown that the on-board temperature of wireless sensor nodes deployed outdoors can experience high fluctuations over time with a large variability across the network. These variations can have a strong impact on the efficiency of low-power radios and can significantly affect the operation of communication protocols, often compromising network connectivity. In this paper, we show the adverse effects of temperature on communication protocols and propose techniques to increase their resilience. First, we experimentally show that fluctuations of the on-board temperature of sensor nodes reduce the efficiency of data link layer protocols, leading to a substantial decrease in packet reception rate and to a considerable increase in energy consumption. Second, we investigate the reasons for such performance degradation, and show that high on-board temperatures reduce the effectiveness of clear channel assessment, compromising the ability of a node to avoid collisions and to successfully wake-up from low-power mode. After modelling the behaviour of radio transceivers as a function of temperature, we propose two mechanisms to dynamically adapt the clear channel assessment threshold to temperature changes, thus making data link layer protocols temperature-aware. An extensive experimental evaluation shows that our approaches considerably increase the performance of a network in the presence of temperature variations commonly found in real-world outdoor deployments, with up to 42% lower radio duty-cycle and 87% higher packet reception rate.


UNLABELLED
Nonspecific aortoarteritis (Takayasu's arteritis) is a systemic disease of unknown cause. No characteristic symptoms may delay diagnosis and treatment as well as deteriorate prognosis. The aim of the study was analysis of prevalence, course, diagnosis and treatment of Takayasu's arteritis. 10 patients (9 female, 1 male) with inflammatory phase of Takayasu's arteritis were seen at the Department of Hypertension of Institute of Cardiology between 1981 and 1992 (0.1% of all patients). The diagnosis was performed on the basis of typical arteriographic picture and laboratory investigations such as elevated of erythrocyte sedimentation rate and increase of immunoglobins, especially G fraction levels. Three patients were in poor general condition (fever, tachypnea, progressive weakness and severe arthralgia); in the remaining the symptoms were less severe, consisting mainly of weakness and arthralgia. All patients had multiple sites of arterial involvement (clinically and angiographically). Hypertension occurred in 9, aortic valve disease in 4, mitral valve disease in 2 and angina pectoris in 3 persons. All patients were treated with prednisone in initial dose of 1-1.5 mg/kg daily. After normalization of inflammatory indices (in average after 3 weeks therapy) this dose was gradually diminished to maintenance dose 5-15 mg daily. 4 patients were treated with prednisone in monotherapy, 6 received combined therapy--prednisone and cyclophosphamide or prednisone and azathioprine. Responses to immunosuppressive treatment were usually very good. In follow-up period (43.4 +/- 30.7 months) in 9 patients the regression of symptoms of inflammatory phase was observed (all patients were treated with maintenance dose of prednisone). Immunosuppressive therapy was ineffective in one woman, despite long term treatment with prednisone combined alternately with cyclophosphamide, azathioprine or methotrexate. She died of progressive heart and renal failure.

CONCLUSIONS
1. Takayasu's arteritis is serious systemic disease with considerable risk of death. 2. Early and proper management of Takayasu's arteritis can improve prognosis of this disease. 3. In every case with multiple sites of arterial involvement, especially with associated symptoms of unidentified inflammatory disease it is necessary to consider diagnosis of Takayasu's arteritis, which prevalence seems to be underestimated.


In this paper we use methods developed in Part 1 of The Dipion Cocktail, to fit the $p_t$ dependence of dipions for mid-central Au-Au collisions at $\sqrt{s_{NN}}$=200 GeV. For the minijet fragmentation part we use PYTHIA fragmentation as described in Part 1. For the thermal resonance production we use an exponential growth behavior. The interference between the direct production of dipion pairs from non-resonance minijet fragmentation and re-scattering through resonance states gives a measure of the size of the re-scattering region. This size is contain in the $\alpha$ parameter of Part1. We assumed a relationship between the $\alpha$ parameter and the mass shift of the $\rho$ resonance. The data used for the fits comes from the RHIC collider as measured in the STAR experiment.


Two prostaglandin (PG) H synthases encoded by Ptgs genes, colloquially known as cyclooxygenase (COX)-1 and COX-2, catalyze the formation of PG endoperoxide H2, the precursor of the major prostanoids. To address the functional interchangeability of these two isoforms and their distinct roles, we have generated COX-2>COX-1 mice whereby Ptgs2 is knocked in to the Ptgs1 locus. We then "flipped" Ptgs genes to successfully create the Reversa mouse strain, where knock-in COX-2 is expressed constitutively and knock-in COX-1 is lipopolysaccharide (LPS) inducible. In macrophages, flipping the two Ptgs genes has no obvious impact on COX protein subcellular localization. COX-1 was shown to compensate for PG synthesis at high concentrations of substrate, whereas elevated LPS-induced PG production was only observed for cells expressing endogenous COX-2. Differential tissue-specific patterns of expression of the knock-in proteins were evident. Thus, platelets from COX-2>COX-1 and Reversa mice failed to express knock-in COX-2 and, therefore, thromboxane (Tx) production in vitro and urinary Tx metabolite formation in COX-2>COX-1 and Reversa mice in vivo were substantially decreased relative to WT and COX-1>COX-2 mice. Manipulation of COXs revealed isoform-specific compensatory functions and variable degrees of interchangeability for PG biosynthesis in cells/tissues.


In 1959 a program to investigate improved silicon solar cells was initiated at the U. S. Army Signal Research and Development Laboratory. The study, under the technical guidance of Mr. Joseph Mandelkorn, was directed toward the construction of solar cells under highly controlled conditions and with phosphorous diffusion at temperatures much reduced from conventional methods. By early 1960, 10% efficient cells were being constructed and subjected to routine evaluation and analysis. While these devices did display improved diode characteristics, in general the overall properties of the N-P solar cells were quite similar to the commercial P-N cell. Testing of samples of the phosphorous diffused cells in May 1960 for radiation damage studies on a comparative basis with commercial cells revealed a significant difference between the two varieties. This was not a predicted result, but certainly a very significant one in view of the known radia-


Introduction Multiparametric MRI (mpMRI) has transformed the prostate cancer diagnostic pathway, allowing for improved risk stratification and more targeted subsequent management. However, concerns exist over the interobserver variability of images and the applicability of this model long term, especially considering the current shortage of radiologists and the growing ageing population. Artificial intelligence (AI) is being integrated into clinical practice to support diagnostic and therapeutic imaging analysis to overcome these concerns. The following report details a protocol for a systematic review and meta-analysis investigating the accuracy of AI in predicting primary prostate cancer on mpMRI. Methods and analysis A systematic search will be performed using PubMed, MEDLINE, Embase and Cochrane databases. All relevant articles published between January 2016 and February 2023 will be eligible for inclusion. To be included, articles must use AI to study MRI prostate images to detect prostate cancer. All included articles will be in full-text, reporting original data and written in English. The protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. The QUADAS-2 score will assess the quality and risk of bias across selected studies. Ethics and dissemination Ethical approval will not be required for this systematic review. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences. PROSPERO registration number CRD42021293745.


Abstract

Bureaucratic reform program is a bureaucratic change efforts towards the expected profile. One of program bureaucratic reform support is a knowledge management. Ministry of Industry (Ministry of Industry) as a driver and builder of national industry needs to change and improve bureaucracy so as to improve the ability of the industry sector in the face of global competition. Along with its efforts to implement bureaucratic reform, the Ministry of Industry has the implementation of knowledge management initiatives, but does not yet have a comprehensive knowledge management strategy. Ministry of Industry focus is on improving the quality of public services, one of which is supported by the development of e-government. ¬ the development process of e-government involves a variety of knowledge are scattered in various locations, both inside and outside the organization. This study seeks to formulate the knowledge management strategy with a focus on the development of e-government targets in order to reform the bureaucracy. The formulation of the strategy is done by using a knowledge strategy framework Zack. Strategies are formulated as follows: Ministry of Industry need to document work experiences into written form; Kemenperin need to increase the awareness of employees to share knowledge; Ministry of Industry needs to improve coordination and cooperation within the framework of knowledge management, both internal and inter-working unit with external parties; Ministry of Industry needs to facilitate storage and distribution of IT-based knowledge that can be reached easily by all employees of the Ministry of Industry; and the Ministry of Industry should establish management commitment to support the implementation of knowledge management.


The disposal of excess {sup 233}U as waste is being considered. Because {sup 233}U is a fissile material, a key requirement for processing {sup 233}U to a final waste form and disposing of it is the avoidance of nuclear criticality. For many processing and disposal options, isotopic dilution is the most feasible and preferred option to avoid nuclear criticality. Isotopic dilution is dilution of fissile {sup 233}U with nonfissile {sup 238}U. The use of isotopic dilution removes any need to control nuclear criticality in process or disposal facilities through geometry or chemical composition. Isotopic dilution allows the use of existing waste management facilities that are not designed for significant quantities of fissile materials to be used for processing and disposing of {sup 233}U. The amount of isotopic dilution required to reduce criticality concerns to reasonable levels was determined in this study to be approximately 0.53 wt % {sup 233}U. The numerical calculations used to define this limit consisted of a homogeneous system of silicon dioxide (SiO{sub 2}), water (H{sub 2}O), {sup 233}U and depleted uranium (DU) in which the ratio of each component was varied to learn the conditions of maximum nuclear reactivity. About 188 parts of DU (0.2 wt % {sup 235}U) are required to dilute 1 part of {sup 233}U to this limit in a water-moderated system with no SiO{sub 2} present. Thus for the U.S. inventory of {sup 233}U, several hundred metric tons of DU would be required for isotopic dilution.


Objectives: The objective of this study is to compare early versus late/standard initiation of renal replacement therapy (RRT) in patients with acute kidney injury (AKI). Data Sources: MEDLINE/PubMed, Embase, Google Scholar, Cochrane Central Register of Controlled Trials, and the Cochrane renal group till August 15, 2020. Study Selection: Randomized controlled trials (RCTs) comparing early versus late initiation of RRT in patients with AKI were included. The primary outcome measures were all-cause mortality and dialysis dependence on day 90. Secondary outcome measures were length of stay, recovery of renal functions, and adverse events. Data Extraction: Two authors independently performed study selection and data extraction using data extraction forms. Data Synthesis: A total of 14 RCTs with 5,234 participants were included. Three trials had low risk of bias in all the domains. There was no significant difference in the overall mortality (risk ratio (RR): 0.99; 95% confidence interval (CI): 0.89, 1.10; moderate certainty of evidence), day 30 mortality (RR: 1.0; 95% CI: 0.91, 1.09; high certainty of evidence), day 90 mortality (RR: 1.00; 95% CI: 0.88, 1.13; high certainty of evidence), and ICU mortality (RR: 1.00; 95% CI: 0.90, 1.10; moderate certainty of evidence) between the early versus late RRT. Dialysis dependence on day 90 was significantly higher in the patients assigned to early RRT (RR: 1.55; 95% CI: 1.15, 2.09; moderate certainty of evidence). The treatment-emergent adverse events (hypophosphatemia and hypotension) were significantly higher in the patients assigned to early RRT. Conclusion: There is no added benefit of early initiation of RRT in patient with AKI; this may lead to treatment-emergent adverse events. Delaying the initiation of RRT with close monitoring and initiating RRT for emergent indications should be the acceptable criterion in critical care nephrology. Prospero Registration: CRD42016043092.


Purpose: Advertisers setting up search engine advertising campaigns for the first time need to place bids on keywords, but typically lack experience and data to determine ranks that maximize a keyword's profit (generally referred to as a cold-start problem). This article aims at solving the problem of bidding on keywords in newly set-up search engine advertising campaigns. Approach: We suggest that advertisers collect data from the Google Keyword Planner to obtain precise estimates of the percentage increases in prices per click and clickthrough rates, which are needed to calculate optimal bids (exact approach). Together with the profit contribution per conversion and the conversion rate, the advertiser might then set bids that maximize profit. In case advertisers cannot afford to collect the required data, we suggest two proxy approaches and evaluate their performance using the exact approach as a benchmark. Findings: The empirical study shows that both proxy approaches perform reasonably well―the easier approach to implement (proxy 2) sometimes performs even better than the more sophisticated one (proxy 1). As a consequence, advertisers might just use this very simple proxy when bidding on keywords in newly set-up SEA campaigns. Originality/value: This research extends the stream of literature on how to determine optimal bids, which so far focuses on campaigns that are already running and where the required data to calculate bids is already available. This research offers a novel approach of determining bids when advertisers lack the aforementioned information.


Magnetic chitosan beads (MCBs) synthesized through a common embedding method and crosslinked with glutaraldehyde were studied for the adsorption of Cu2+ in aqueous solution. MCBs were investigated by means of hysteresis curves, thermo-magnetization curves, TGA, FTIR and XRD. Kinetic, isothermal and thermodynamic studies were applied to investigate the adsorption of Cu2+ by the MCBs. The effects of the pH value and the coexisting ions on the adsorption of Cu2+ were explored. Subsequently, the stability of the MCBs including the adsorption capacity (Qe) and the saturated magnetization (Ms) stability was investigated under various conditions. Simultaneously, FTIR and XRD were utilized to further analyze the change in the MCBs in the stability studies. The results suggested that the MCBs showed good stability without a significant loss in Qe and Ms after regeneration from five sequential cycles. The MCBs presented excellent storage stability while stored in a drying vessel for ten months. For thermal stability, the Qe and Ms of the MCBs presented similar variations after being heated in the atmosphere and in a vacuum at different temperatures for 30 h. The Qe changed slightly after being heated at 50 and 100 °C, and decreased sharply at 150 and 200 °C. The magnetization was stable in the lower temperature range (50–150 °C) and increased slightly at 200 °C. Different magnetic fields had little effect on the stability of the MCBs.


This thesis examines the processes of cultural change during the early Roman (before c. AD 250)
period in selected areas of Britain and Germany, namely western England and south-west Wales
in Britain, and along the Lower Rhine in Germany. The distribution patterns of sites and specific
categories of artefacts have been calculated using the extrapolative contour method of Kriging, as
well as statistical methods in particular instances.
In an attempt to move away from textually-driven descriptions of the Roman past, the resulting
distribution patterns of rural sites, military disposition, ceramics, stamped brick and tile, and
coinage were examined in terms of the concepts of structure and agency. The patterns of each
study region were examined separately, before comparing the sites of Cirencester, Kenchester,
and Frocester Court with the regional British patterns to investigate agency and structure at
increasingly smaller scales, and to scrutinise the relationship between material culture,
structure, and agency in greater detail.
Although not always conclusive, the results suggest that such broad patterns can be used to
form, at least, general deductions about the social, political, and economic structures of the
Roman period. The results also emphasise the importance of comparing archaeological patterns
from different provinces of the Empire.


Land demand in the Tanimbar Islands Regency has increased in recent years. The causes are President Joko Widodo's decision to move the oil and gas exploration of the Masela block from offshore to onshore, and the Indonesian Government's policy to develop the periphery. There are five villages affected by these two policies, namely Bomaki Village, Latdalam Village, Lermatang Village, Adaut Village, and Kandar Village. Land in these five villages attracts many investors and most have been sold. However, in the negotiation process, the sale of the land caused many conflicts among the local people. Based on the in-depth interviews we conducted with the respondents, who consisted of traditional leaders, village officials, and residents, we found that the high and low intensity of the conflict was determined by the role of the Adat Institutions in each village. Adat institutions have a significant role because of the inherent legitimacy and the practice of the custom 'Duan Lolat', that has been practised so far. The custom's role in conflict resolution is supported by its function as a communicator and mediator that connects village communities, village officials, and investors.


The human gut microbiome plays a vital role in both health and disease states and as a mediator of cognitive and physical performance. Despite major advances in our understanding of the role of gut microbes in host physiology, mechanisms underlying human-microbiome dynamics have yet to be fully elucidated. ABSTRACT The human gut microbiome plays a vital role in both health and disease states and as a mediator of cognitive and physical performance. Despite major advances in our understanding of the role of gut microbes in host physiology, mechanisms underlying human-microbiome dynamics have yet to be fully elucidated. This knowledge gap represents a major hurdle to the development of targeted gut microbiome solutions influencing human health and performance outcomes. The microbiome as it relates to warfighter health and performance is of interest to the Department of Defense (DoD) with the development of interventions impacting gut microbiome resiliency among its top research priorities. While technological advancements are enabling the development of experimental model systems that facilitate mechanistic insights underpinning human health, disease, and performance, translatability to human outcomes is still questionable. This review discusses some of the drivers influencing the DoD's interest in the warfighter gut microbiome and describes current in vitro gut model systems supporting direct microbial-host interactions.


makers may be unnecessary if appropriately trained and equipped physicians are available in the operating theatre. I would like however to recommend the insertion of a cannula into the right internal jugular vein prior to induction as, when necessary this would allow rapid placement of a pacemaker using an image intensifier, and would minimise the complications of displacement, dysrhythmias, infection and perforation of the myocardium where pacemakers had not actually been used. The use of such a cannula should have low morbidity in skilled hands and yet save much time in an emergency.


Despite 100 to 200 fold increases in waterborne selenium below coal mine operations in the Elk River basin, concentrations in sediments, attached algae, aquatic insects and fish tissues were only 2 to 5 times greater than reference sites. Selenium concentrations in Westslope cutthroat trout skeletal muscle and liver were higher in the near field populations and exceeded published toxic effects thresholds for fish tissue. Further study in 1998 compared the frequency of embryonic deformities and mortalities with the; Se concentration in the eggs of individual female cutthroat trout in an exposed and a reference population. Egg selenium concentrations ranged from 2.0 to 8.8 µg/g dry wt. in reference fish, and 8.7 to 81.3 µg/g dry wt. in exposed fish. Both reference and exposed populations showed low frequencies of deformities (<2.5%) and occasional high frequencies of mortalities (up to 100%) but no correlation with egg selenium. The lack of response in this population of cutthroat trout suggests an evolved tolerance to selenium at levels reported elsewhere to cause significant toxic effects. The findings of the Elk River studies provide evidence that development and application of universal criteria must be done with great caution. Management decisions made on residue data alone may be unnecessarily under or over protective. At this stage it appears necessary that site specific studies must be carried out to verify the absence: or presence of effects. BACKGROUND Selenium contamination of surface waters from human activities falls into two categories. The first could be described as accelerated mobilization of in situ minerals and would include mining in Se bearing strata, and the irrigation of seleniferous soils. The second includes industrial effluents, usually those associated with fossil fuels such as oil refineries or coal fired power plants.


Recent studies have shown remarkable success in image-to-image translation for attribute transfer applications. However, most of existing approaches are based on deep learning and require an abundant amount of labeled data to produce good results, therefore limiting their applicability. In the same vein, recent advances in meta-learning have led to successful implementations with limited available data, allowing so-called few-shot learning.In this paper, we address this limitation of supervised methods, by proposing a novel approach based on GANs. These are trained in a meta-training manner, which allows them to perform image-to-image translations using just a few labeled samples from a new target class. This work empirically demonstrates the potential of training a GAN for few shot image-to-image translation on hair color attribute synthesis tasks, opening the door to further research on generative transfer learning.


Bruxism is parafungsional activity includes clenching and grinding motion on day or night during sleep. Signs bruksisme most easily observed is the presence of attrition, fracture teeth and increase tooth sensitivity and degree of mobility. Bruksisme can also cause temporomandibular joint disorders, eksostosis and torus in the jaw bone, muscle hypertrophy mastication, periodontal tissue damage, as well as causing headaches, after the pain patients seeking help. Bruksisme etiology is multifactorial, with psychological factors such as stress, local factors such as premature contact, systemic and genetic factors are factors that can trigger bruksisme. Therapy of bruksisme include: medicine, selective grinding, orthodontic, stabilization splint,akupunktur and Botox injection. Support care of bruksisme to do, among which psychological treatments, muscle relaxation techniques and biofeedback techniques. There are alternative treatments such as infrared rays therapy.


During the last decade fitness has become the most popular sport in Germany and many other countries. Whereas sport was traditionally organised within the public sector, people today willingly exchange their sovereignty as a voter, tax payer, or club member for sovereignty as a consumer of fitness services. 'Health Clubs', 'Sports Studios', or 'Fitness Gyms' usually use the term 'Membership' in their customer contracts. In legal terms, however, health clubs are just ordinary businesses offering standard form contracts to individual customers, which usually enter into the contract for a private, non-commercial purpose. It follows that the fitness studio contract is subject to various consumer protection regulations, such as Sections 1812.80 ff. of the Civil Code of California, or the European Unfair Contract Terms Directive. However, the underlying economic rationale of the fitness club is not met in cases where the respective contractual arrangements are treated simply like any other business-to-consumer standard form contract. In this paper, I will forward the argument that the formal legal structure of fitness clubs is misguiding in a similar way, as is the case with corporate groups, just-in-time networks, or franchise systems. In contrast to the 'privity of contract'-dogma the very idea of the fitness club is about creating a community by means of networked contracts. After explaining the hybrid nature of the fitness club as a third model which goes beyond the traditional alternatives of sports associations and pay-per-visit facilities, I shall introduce and compare the US and European approaches to the regulation of fitness clubs, in order to show that both, in their aim to protect the individual consumer, tend to neglect the networked structure of the relevant contracts, although the European approach, with its inherent flexibility, could easily take the network rationale into account in the future.


Abstract This study was conducted to evaluate the allelopathic effect of essential oil (EO) extracted from five Foeniculum vulgare Mill. cultivars against two weed species, Portulaca oleracea L. and Amaranthus retroflexus L. Various EO concentrations (0, 100, 200, 400, 600, and 800 mgL−1) were used to determine their effects on germination and seedling growth of P. oleracea and A. retroflexus. Radicle length, plumule length, radicle wet weight, plumule wet weight, plumule dry weight, and germination percentage of the target plants were measured. GC-MS analysis revealed the presence of different compounds in studied F. vulgare cultivars. Cultivars containing α-pinene possessed strong inhibitory potential towards weeds growth. On the contrary, cultivars containing fenchone showed poor inhibitory potential on both weeds. Moreover, the results indicate that with increasing EO concentration of F. vulgare, radicle length, plumule length, radicle wet weight, plumule wet weight, plumule dry weight, and germination percentage of both weed species decreased. The highest inhibitory effects were observed at 600 and 800 mg L−1 concentrations. Boushehr F. vulgare cultivar showed the highest inhibitory effect, while Esfahan and Yazd cultivars were identified as least inhibitory against the two weeds. Both P. oleracea and A. retroflexus showed similar sensitivities to F. vulgare EO.


We all know that we will die one day. This is a fundamental aspect of our lives. Not only is death inescapable but the finitude of our lives structures what it means to be a human being, a person. We are born, we live, we die. The time of our lives, in all senses, makes us who we are. Yet, as much as this is clear it also constitutes a blind spot. It is one of the least understood aspect of human existence. We spend our lives living. This may seem an obvious statement, but it is impossible to comprehend and think our own death. And this impossibility seems to be essential to death.2 In other words death is fundamentally inexperiencable and therefore unthinkable. We live and when we stop living, we are no more; there is no identity that remains. To be dead is not to be. To be is to to live, to experience the world, continuously. How can we even begin to understand our death, which is outside of our lives, and so beyond ourselves? I shall argue that photography as a specific form of visual expression not only represents the world, but shows what being in the world means. Photography intimates our experience of the world beyond the visible. Photography's power to refer directly to the particular leads to its ability to show the particular moment. Therefore, it can illustrate death. This means that photography not only can represent dead objects but also disrupts the temporal structure of perceptual experience and therefore brings into consciousness the finality of our being. This happens through the immediacy of seeing and not intellectual understanding. Our own death is disturbing and frightening, because it is essentially unimaginable, which renders an analysis of it as a phenomenon or event futile. Photography, though, is a medium, which can express the belonging of death to life and show that living being is, with Heidegger, "being towards death".3


A 7-year-old boy was presented with a long-standing slowly growing mass of the left supraorbital area. A biopsy specimen revealed a bland spindle cell proliferation with scattered polygonal cells with acidophilic cytoplasm and cross-striations. Our differential diagnosis included rhabdomyoma of fetal type, leiomyoma with trapping of regenerating skeletal muscle elements, and rhabdomyomatous mesenchymal hamartoma of the skin. Immunohistochemistry demonstrated strong positivity of myoglobin and desmin as well as negativity of caldesmon, suggesting skeletal muscle lineage. The excisional specimen confirmed our diagnosis of cutaneous fetal rhabdomyoma of intermediate type. Additional immunostaining performed on the excisional specimen showed strong Wilms Tumor 1 but only a very faint and focal p63 expression.


Background BRAF and MEK inhibitors are emerging therapies in childhood malignancy. The cutaneous side effects are well described in adult patients, but not in children. We undertook to document the spectrum of cutaneous side effects seen in children treated with these agents at our tertiary hospital, as well as the onset, duration and severity of the skin findings. Methods Retrospective chart review of children treated with either a BRAF (dabrafenib) or MEK inhibitor (trametinib). Basic demographic and clinical characteristics were collected from patient records and the skin findings assessed in collaborations with a paediatric dermatologist. Results Twenty-four children aged 1–16 years (mean 8.4 years) treated with either a BRAF (11) or MEK inhibitor (13) for BRAF-V600-mutant refractory or relapsed intracranial malignancy (8), neurofibromatosis type 1 (NF1)-associated optic glioma and neurofibroma (7), Langerhan cell histiocytosis (LCH) (3), or leptomeningeal melanocytosis/melanoma (3) were identified. One patient received combination BRAF/MEK inhibitor therapy. Mean treatment duration was 39 weeks (7–92) for BRAF and 19 weeks (7–37) for MEK inhibitor therapy. Six (54%) children treated with dabrafenib developed new melanocytic naevi (7–36 weeks), 5 of these also developed a persistent erythema nodsum-like (EN) eruption (onset 1–32 weeks) 2 diffuse alopecia, (onset 29 and 40 weeks) and single cases keratosis pilaris, an acneiform facial rash. Six (46%) children on a MEK inhibitor developed paronychia (onset 4–20 weeks), 5 of these also developing hair thinning (onset 4–17 weeks) and generalised xerosis (onset 2–8 weeks). Four patients (30%) developed acneiform eruptions. 1 child required dose reduction of therapy due to cutaneous side effects. Two patients discontinued treatment and one patient died because of disease progression. Conclusions Cutaneous adverse effects of BRAF and MEK inhibitor therapy are common and well tolerated in paediatric patients. Our experience is that prophylactic management is beneficial.


The Mobile ad-hoc networks are auto configured systems where hubs can travel towards any direction. It doesn't rely on any other frame to build the framework. Because of its versatility, the black hole is a real security issue to be settled. It occurs once a malignant hub referred to as black hole goes into the framework. Black hole center point exhibits its fake lead among the methodology after all disclosure. Currently, varied strategies are made arrangements for Mobile ad-hoc networks. Regardless, at interims seeing Black hole or fake hubs, the entire Mobile ad-hoc frameworks are exposed to various sorts of assaults or network attacks. Among these issues, a black hole center points plugs itself of getting a most nearest targeted hub, whose data packet must be constrained to drop. In this flooding procedures, if the communication from the genuine hub accomplishes later than the fake hub reply as requested by the standard hub. A false communication path is framed through a fake center hub. A perfect method is one in which the package reach to target with less delay and lesser overhead. In this paper we'll talk about the implementation of Ant Colony Optimization Technique and Repetitive Route Configuration with Reactive Routing Protocol for obstruction of black hole Attack in Mobile ad-hoc networks.


: Objective: The aim of our study was to assess the relationship among heart rate, blood pressure and lipid profile in clinical hypothyroidism. Study Design: A comparative study. Place and Duration: This study was conducted at the Department of Physiology, Bahawal Victoria Hospital Bahawalpur for the duration of seven months starting from February, 2020 to September, 2020. Methodology: In our study selection of patients were done by non-probability purposive sampling. On the basis of thyroid profile, the patients were divided into two groups naming, case (clinical hypothyroids) and control (euthyroids). Clinical measurement for vital parameters like blood pressure, laboratorial evaluation and heart rate was systematically analyzed. Results: A very important statistical connotation was found in triglyceride, serum cholesterol and surface lipoprotein low density (calculated probability was less than 0.01). Similarly, a statistically significant relationship was found between maximum heart rate (the calculated probability was equal to 0.03) and normal heart rate (the calculated probability was equal to 0.02). Furthermore, a very important statistical relationship between the two study groups was found in systolic, mean arterial blood pressure and diastolic blood pressure (calculated probability was less than 0.01). Conclusion: At the end of the available data suggest that, even mild forms of treatment for heart risks, early diagnosis, and functional thyroid disorders may be beneficial in the vast majority of patients. Yet, overtreatment should be avoided and individual variances of age-related or pituitary thyroid set points must be respected. Clinical hypothyroid patients are in extraordinary risk of pro-atherogenic lipid abnormalities and hypertension. Relationship Heart Rate, Blood Pressure


The correction of severe trauma to both hands by two major microsurgical operations and additional minor interventions on the already functioning transplants is described. The excision of combined second and third toes as transplants inflicts an injury on the foot, but for our patient this iatrogenic trauma was justified. Careful investigation of the feet after transfer shows that their condition does not significantly impair the quality of the patient's life. The special importance of the patient's desire to regain his or her abilities and to collaborate with the medical staff is emphasized.


Along with the social demands for the amount of food and constantly improve, the cutting way is not able to meet the user's requirements. So the automatic production line for automatic vermicelli cutting machine is designed. This paper mainly introduces the design of control circuit for cutting off machine. The parameters are optimized by programs. Static analysis for supporting structure of cutting machine is given by ANSYS software. The distribution of stress and strain is obtained. The maximum stress position is found. Determine whether or not to meet the use requirements and provide optimization proposal, and discuss the feasibility of the improvement scheme. The modal analysis for the cutting machine is done by ANSYS which provides theoretical basis for optimization design.


This literature review explored the factors promoting interprofessional collaborative practice for the child maltreatment prevention in Japan. We searched the Japanese database of ICHUSHI-web, focusing on studies published between 1990 and 2015. The studies were examined for methodological quality using the critical appraisal checklists. We initially identified 161 articles and finally selected eight studies that met the selection criteria and were analyzed. The Collaborative Practice Circle based on the Interprofessional Education for Collaborative Patient-Centered Practice framework, was used as a conceptual framework to analyze the data and to discuss the review findings. Data analysis continued until categories were saturated using content analysis. Five categories as interactional factors, two categories as organizational factors and three categories as systemic factors were identified. The findings revealed that interactional factors were composed of practical competencies and experiences of professionals. Our findings also indicate that educational programs for improving practical competencies of professionals at the individual level and establishing a system of training and human resource development at the organizational level are required. Further research is warranted to examine the impact the challenges outlined in the interactional factors, the organizational interventions and support for clients.


ABSTRACT Aim The aim of the study is to analyze visual fields defects (VFDs) in epidemic retinitis (ER). Methods Patients with ER and Humphrey's visual field (HFA) 30–2 performed after resolution were studied. VFD severity grading was performed. Patients treated with oral doxycycline (Group-A) versus doxycycline-steroids (group-B) were compared. Results Thirty-five eyes of 25 patients were studied. Nasal, inferior, temporal and central VFD were seen in 19 (54.2%), 13 (37.1%), 7 (20%) and 6 (17.1%) eyes, respectively. Grade 0, 1, 2 and 3 VFDs were seen in 4 (11.4%), 15 (42.8%), 12 (34.2%) and 4 (11.4%) eyes respectively. Seven eyes with ≥1 year of follow-up post-resolution also showed grade 0–3 scotomas. Mean severity of scotoma was grade 1.15 (Median: 1) and 1.42 (Median: 1.5) in groups A (n = 13) and B (n = 14), respectively (p = .637). Conclusion ER can cause VFD persisting long after resolution. Treatment with oral doxycycline without steroids was non-inferior to combined treatment with respect to VFD.


This book covers recent developments in the interdisciplinary fields of actuarial science, quantitative finance, risk- and asset management. The authors are leading experts from academia and practice who participated in Innovations in Insurance, Risk- and Asset Management, an international conference held at the Technical University of Munich in 2017.
The topics covered include the mathematics of extreme risks, systemic risk, model uncertainty, interest rate and hybrid models, alternative investments, dynamic investment strategies, quantitative risk management, asset liability management, liability driven investments, and behavioral finance.
This timely selection of topics is highly relevant for the financial industry and addresses current issues both from an academic as well as from a practitioner's point of view.


This paper presents a mixed linear programming optimization model for determining the optimal path and location of sinks with respect to dead time and energy consumption, in order to maximize the amount of collected data in underwater wireless sensor networks. Solving this problem in polynomial time is not possible due to be centralizing. So, to solve this problem, a heuristic and greedy and fully distributed algorithm are proposed to determine the movement of sinks and their location based on maximizing the amount of collected data and the type of dead time of data. As long as be in a place data and energy, sinks can be repeatedly traveled to increase the amount of collected data. By comparing and simulating different routing methods with proposed model and algorithm, the collected data in the proposed method for sparse and dense networks and in the soft and hard dead time is at least 77% higher than the unaware heuristic methods such as TSP and LM and is 80 percent more than the RS method, and the energy consumption is about 45% lower than the TSP method, and the end-to-end delay is about 69% less than the TSP method, and network efficiency is about 23% more than the TSP method.


Background: The most common types of medical error are medication errors (MEs) which defined as any preventable event that may be caused by an inappropriate medication usage and lead to an adverse drug reaction (ADR) event in patients. In recent years, different approaches have been proposed to reduce MEs, one of which is reporting ADRs. The present study was designed to assess the Knowledge, Attitude and Practice (KAP) of medicine students towards MEs and ADRs reporting. Method: The validated 12-item questionnaire included subsequently 4 questions, 5 items and the final 3 questions related to the knowledge, attitude, and practice that was given to each participant before and after of the clerkship course. The study population were 40 students of fourth-year of medicine. Results: Demographic features of the participants have no significant difference. Medicine students had a poor KAP towards MEs. Only 8% of respondents had general knowledge about MEs and 50% of students believed MEs are inevitable events, less than 20% of them were acquainted with 5 rules of prescriptions. Students had good knowledge and attitude but poor practice towards ADRs reporting. 55% of participants were aware of their responsibility of ADRs reporting but only 5% of respondents were acquainted with ADRs reporting method and the ADR center in the hospitals. Conclusion: The educational intervention, alteration in medicine student's curriculum, and hold the interactive clerkship for health care professionals can improve the KAP towards ADRs reporting and diminish of the preventable medication errors.


Auditing capability is one of the requirements for secure databases. A secure database management system, among other things, has to provide not only facilities for recording the history of all updates and queries against the database but high-level support for querying this history as well. The authors present an audit model for object-oriented databases that satisfies both requirements. The model offers several additional advantages: (1) it imposes a uniform logical structure upon both the current and the audit data: (2) it results in zero-information loss, i.e. there is never any loss of historical or current information in this model; and (3) since it captures the entire database activity, a complete reconstruction of every action taken on the database is possible. They show how this third aspect can be exploited to provide high-level support for expressing audit and other database queries and therefore, they make a complete audit trail methodology available.<<ETX>>


Objectives: To examine technical aspects of pediatric tracheal intubation using video recording and to determine the association between tracheal intubation technique and procedural outcomes. Design: Prospective observational study. Setting: Emergency department resuscitation bay in single tertiary pediatric center. Patients: Children undergoing emergent tracheal intubation under videorecorded conditions. Interventions: None. Measurements and Main Results: A published scoring tool for characterizing patient positioning, intubator kinematics, and adjunctive maneuvers during tracheal intubation was applied to videorecorded pediatric resuscitations when tracheal intubation was performed. Procedural outcomes were measured from video review. Seventy-one children underwent 109 tracheal intubation attempts with an overall first attempt success rate of 69% and a median laryngoscopy duration of 34 seconds (interquartile range, 24–47 s). A significant subset of tracheal intubation attempts were made with the patient's bed at a height below the level of intubator's umbilicus (61%), the patient in a supine position without head elevation (55%), the intubator bent at the waist to greater than 45° (66%), less than 1 cm of mouth opening by the intubator's right hand prior to laryngoscopy (46%), and with the intubator's face less than 12 inches away from the patient's mouth (65%). Adjunctive maneuvers were used in a minority of attempts (cricoid pressure 48%, external laryngeal manipulation 11%, retraction of the right corner of the patient's mouth 26%). On multivariate analysis, including controlling for patient age category and intubator background, retraction of the right corner of the patient's mouth by an assistant showed an independent association with successful tracheal intubation. No other technical aspects were associated with tracheal intubation success. Conclusions: Intubators commonly exhibited suboptimal technique during tracheal intubation such as bending deeply at the waist, having their eyes close to the patient's mouth, failing to widely open the patient's mouth, and not elevating the occiput in older children. Retraction of the right corner of the patient's mouth by an assistant during laryngoscopy and intubation was associated with TI success.


This paper explains a Raspberry pi controlled remote monitoring system. Raspberry Pi is a credit card sized single board computer with ARMll microprocessor. In this study, a system is designed to continuously monitor the Electrocardiogram (EeG) and other vital parameters. This data is stored in a database and can be displayed in a website that can be accessed only by authorized personnel. This idea is familiar however; this paper presents a substantive and inexpensive method using Raspberry pi. The primary task of this system is to update the data to the database and alert the doctors for any aberrancy. The former is accomplished by using MySQLdb module to link Raspberry pi to the database whereas the latter is achieved by the combination of Raspberry Pi and GSM module. This system has much future scope as the data gathered by monitoring is so valuable and can be used for scientific research by the medical community. By determining the patterns in the parameters observed, the nature of disease can be predicted. The paper mainly emphasizes on the system design and the algorithm used to accomplish the task. The obtained results are presented.


As one of the most promising micro-machining methods, electrochemical micro-machining is widely used in the field of metal micro-structures. The electrochemical micro-milling on Nickel-base superalloy by using high-speed spiral electrode was studied in detail. Firstly, the electric field and flow field models of micro-electrochemical milling are established and analyzed by the finite element method. Then, the milling profile was predicted and the effect of high-speed rotation of electrodes on electrolyte promotion and secondary electrolysis prevention were analyzed. Secondly, the influence of the main machining parameters, such as rotating speed, electrical parameters, and feed rate on machining precision and efficiency was analyzed experimentally. Finally, by optimizing the machining parameters, a series of micro-graphic structures with a width of about 150 μm were obtained on Nickel-base superalloy 718 by using the spiral electrode with a diameter of 100 μm. The experimental and simulation results show that the high-speed rotation of electrodes can greatly improve the machining efficiency and stability. It was proved that micro-electrochemical milling with the high-speed rotating electrode technique is an effective method for machining micro-metal parts.


Abstract The aim of this study was to assess the effects of nicotinamide adenine dinucleotide hydride (NADH) on maximal oxygen uptake ([Vdot]O2max), maximal anaerobic running time, and mental performance. Eight men were exposed to a supplement treatment (30 mg NADH as ENACHI tablets per day) and to a placebo treatment, each of 4 weeks' duration, in a balanced, double-blind, and cross-over design. The two treatments were separated by a 14-week wash-out period. The results indicated that [Vdot]O2max, maximal anaerobic running time, and the ability to concentrate were similar in the NADH and placebo conditions. There were also no differences in blood lactate, creatine kinase, reaction time or feelings of fatigue between the treatments. A counter-movement jump performed at rest and 2 min after the aerobic test differed significantly (P ≤ 0.05) between the treatment conditions and was higher in the NADH group. In conclusion, the NADH supplementation for 4 weeks had no effects on [Vdot]O2max, maximal anaerobic running time or mental performance.


The aim of the study was to evaluate the effect of ethyl alcohol on blood estazolam level, to assess the usefulness of saliva in testing for the presence of the drug and to present selected issues concerning safety of traffic. This paper presents the results of estazolam determinations in blood samples taken from 25 volunteers, who were given a single dose of 1 mg of the drug orally. The subjects also received a single dose of ethyl alcohol (0.6 g/kg of body weight) 3.5 h after drug intake. Blood samples for estazolam determination were taken 1, 2, 3, and 4 h after doses and for ethanol determination, 0.5 h after alcohol intake and 4 h after estazolam administration. The samples were analysed using a developed and validated LC/MS/APCI method. The method enabled estazolam determination at concentrations exceeding 0.5 ng/ml. The determined average levels of blood estazolam in the first three hours were 20.0 ng/ml; 22.7 ng/ml; and 23.9 ng/ml respectively. On the basis of pharmacokinetic calculations using the obtained results, the studied persons were divided into three subgroups characterised by different speeds of metabolism of estazolam. The obtained results also indicated that the interaction of estazolam with alcohol led to changes in its pharmacokinetic parameters. An increase (of at least 20 percent) in the average estazolam concentration (29.0 ng/ml) compared with the extrapolated value of this concentration without administration of alcohol was noted.


BACKGROUND & OBJECTIVES
Urban Indians have a high prevalence of insulin resistance, hypertension and cardiovascular disease. We studied the prevalence of pre-hypertension and hypertension, as well their association with cardiovascular risk factors, in a north Indian upper socio-economic population.

METHODS
A total of 1746 adults (age >or=30 yr) residing in an urban colony of high-income group residents in the city of Lucknow, north India, were invited to be enrolled for the study. The response rate was 64 per cent (n=1112). Blood pressure, anthropometry, plasma glucose in response to oral glucose tolerance test and lipids were measured. The variables contributing significantly to pre-hypertension and hypertension were analyzed by multiple logistic regression analysis.

RESULTS
The age and sex adjusted prevalence of hypertension was 32.2 per cent and pre-hypertension was 32.3 per cent. In contrast to hypertension, which was highest in the age group 60-69 yr (64%), prehypertension was highest (36%) in the group 30-39 yr. There was a high prevalence of cardiovascular risk factors in the general population [central obesity (86.7%), elevated LDL cholesterol (22.8%), abnormal glucose tolerance (41.6%) and smoking (20.3% of males)]. Two or more of the cardiovascular risk factors were present in a higher proportion of hypertensive [66%, odds ratio (OR) 3.0, P<0.0001] and pre-hypertensive, (56%, OR 2.0, P<0.0001) compared to normotensive subjects (39%). Subjects with pre-hypertension had body mass index, waist-hip ratio and frequency of glucose intolerance, which was intermediate between normotensive and hypertensive subjects. In multiple logistic regression analysis, increasing age, body mass index, waist hip ratio and impaired glucose tolerance/diabetes were independent risk factors for both hypertension and pre-hypertension.

INTERPRETATION & CONCLUSION
A high prevalence of pre-hypertension and hypertension were noted in affluent urban north Indians. Increasing age, body mass index, central obesity and impaired glucose tolerance/diabetes were significantly associated with both hypertension and pre-hypertension. Pre-hypertension was associated with an increased prevalence of cardiovascular risk factors.


Diabetic nephropathy (DN) is the second most frequent and prevalent complication of diabetes mellitus (DM). The increase in the production of oxidative stress (OS) is induced by the persistent hyperglycemic state capable of producing oxidative damage to the macromolecules (lipids, carbohydrates, proteins, and nucleic acids). OS favors the production of oxidative damage to the histones of the double-chain DNA and affects expression of the DNA repairer enzyme which leads to cell death from apoptosis. The chronic hyperglycemic state unchains an increase in advanced glycation end-products (AGE) that interact through the cellular receptors to favor activation of the transcription factor NF-κB and the protein kinase C (PKC) system, leading to the appearance of inflammation, growth, and augmentation of synthesis of the extracellular matrix (ECM) in DN. The reactive oxygen species (ROS) play an important role in the pathogenesis of diabetic complications because the production of ROS increases during the persistent hyperglycemia. The primary source of the excessive production of ROS is the mitochondria with the capacity to exceed production of endogenous antioxidants. Due to the fact that the mechanisms involved in the development of DN have not been fully clarified, there are different approaches to specific therapeutic targets or adjuvant management alternatives in the control of glycemia in DN.


An analog computer to determine dynamic pulmonary compliance (C) and pulmonary resistance (R) on a breath-by-breath basis was tested in guinea pigs and dogs. C was determined by dividing volume by transpulmonary pressure at instants of zero flow. R was determined by the method of electrical subtraction at predetermined flows. In both species the computer outputs and the results of direct analysis were in close agreement. In guinea pigs, the device reliably followed the rapid three- to fourfold changes in C and R resulting from histamine infusion. In unanesthetized dogs, the dispersion and mean values of C and R were similar by the two methods.


Abstract : The objective of this program was to perform a coordinated research effort employing complementary electro-optical techniques to characterize optical and infrared propagation through the atmosphere. This effort included measurements of the parameters that affect propagation, at several wavelengths, under meteorological conditions of interest to DoD. Under this program we performed acquisition, reduction and interpretation of data using lidar techniques (both coherent and incoherent) and visible and infrared transmissometry. This included: Detection, tracking, and discrimination; Measurement of temporal and spatial chemical agents, rocket effluents, and airborne particulates and evolution of release gas and aerosol concentrations for development/ verification of dispersion models; Spectral characterization of atmospheric and terrain backscatter for input to performance studies for future airborne DIAL and Doppler lidar systems; Real time ballistic wind measurements for demonstrating and testing Doppler wind sensing lidar tactical applications as well as in support of munitions and delivery system tests; Development of compact eye-safe lidar systems for airborne applications.


Newtonian gravity is inadequate in accounting for the observed perihelion procession of Mercury around the Sun. Bagge (1981) and (1986) modified the equation of Newtonian gravity by replacing the rest mass m0 of Mercury by the so-called relativistic mass m(v) ( = m0/(1 - beta 2)1/2) and obtained the following equation of motion: (d/dt)(mo nu )/(1 - beta 2)1/2 = -((GMm0)/(r2(1 - beta2)1/2)r. The author states that this equation is false.


Anthropomorphic measurements have been found to be most useful in the assessment of nutritional and health status. Scattered cross-sectional community anthropomorphic measurements of rural preschool children from 8 regions of Tanzania were carried out in 1976 and 1977. This report involves 4766 preschool children and 341 school children who had their anthropomorphic measurements analyzed. The results showed that 2.4% of the preschool children had severe Protein Energy Malnutrition (PEM), whereas 42.6% suffered from mild to severe PEM. There were more underweight children among preschool girls than among the boys in all age groups, except in those aged 0-6 months. School girls, however, had fewer underweight children among them than school boys. This is a finding not reported in 4 other studies in Tanzania involving some 2000 preschool children, in the past. There is a cumulative stunting becoming maximum at the 18-30 month age group. The mean average "stunting" prevalence was 46.5% while the mean average "wasting" prevalence was 8.3%. There is a need to find out the reason why PEM prevalence among preschool children has not changed since about 15 years ago, while it is common knowledge that primary health care facilities have doubled or even quadrupled in quantity during the same period. It is rather expedient to find out if there is preferential treatment of preschool boys by parents.


We report the case of a 31-year-old woman with 4 episodes of myelitis with pleocytosis, a positive Borrelia burgdorferi serology with positive antibody indices, and full recovery each time after antibiotic and steroid treatment, suggesting neuroborreliosis. We nevertheless believe that recurrent neuroborreliosis is improbable based on the levels of the chemokine CXCL13 in cerebrospinal fluid and favor the diagnosis of post-infectious autoimmune-mediated transverse myelitis possibly triggered by an initial neuroborreliosis as the cause of the relapses observed in our patient. We demonstrate the diagnostic steps and procedures which were important in the differential diagnosis of this unusual and challenging case.


This paper examines the problem of using thermostat offset signals to directly control distributed air conditioning loads attached to the grid. The paper models these loads using a novel partial differential equation framework that builds on existing diffusion- based load modeling ideas in the literature. Both this PDE model and its finite-difference discretizations are bilinear in the state and control variables. This key insight creates a unique opportunity for designing nonlinear direct load control algorithms with theoretically guaranteed Lyapunov stability properties. The paper's main contribution to the literature is the development of the bilinear PDE model and Lyapunov- stable controller for real-time management of thermostatic air conditioning loads.


The ISO 9000 series of quality management systems standards and the more recent ISO 14000 environmental management systems standards have generated much controversy among practitioners. Although ISO 9000 has become a de facto requirement for many firms, its effects are poorly understood, and similarly the value and domain of applicability of ISO 14000 have been questioned. This paper reports on an exploratory study into the global spread of ISO 14000. We interviewed practitioners worldwide to identify factors that they believe explain differences between national ISO 14000 certification counts. We then collected quantititive data for these factors and, using regression analysis, we found that exports, environmental attitudes (combined with economic development), and ISO 9000 certification count were significant. The fact that ISO 9000 appears as an important factor explaining diffusion of ISO 14000 certifications suggests that the drivers behind the two have significant overlap. This indicates that, although ISO 14000 is an environmental standard, many of the factors driving national certification patterns are not at all environmental in nature, and that ISO 14000 therefore needs to be studied from a broader perspective than from a purely environmental point of view.


The objective of this paper is to investigate stress and strain of a special scale package-substrate on chip for reliability evaluation or manufacture strategy in deep-seated situation. A two-dimensional model with one-half of cross-section (2D model) and a three-dimensional model with one-fourth of whole package (3D model) were built, respectively, to simulate the thermal stress and strain of CSP-SOC under the condition of the standard industry thermal cycling temperature -40 to125°C. The different locations can be processed by using the two models, respectively, based on different modeling simplified modes. By using 2D model, the numerical simulation shows that the maximum deformation of the prototype occurs in printed circuit board (PCB), the maximum stress and strain occurs in the outer solder balls. In the meantime, by the results of 3D model, the simulation shows that the maximum elastic strain occurs in the interface between the solder balls and PCB, the minimum strain occurs in the underfill tape, the maximum packaging stress occurs in the edge area of the chip. The result from 3D model maybe more impersonal to reflect the stress and strain characteristics because the third direction is considered in modeling. The analysis by integrating the 2D model and 3D model can get a more comprehensive profile for the thermal investigation of chip scale package (CSP) than by using any single model. The investigation built a basis for improving reliability in engineering design of CSP product. Copyright © 2008 John Wiley & Sons, Ltd.