Fasting before procedural sedation is a hot topic in everyday medical life with the main concern regarding pulmonary aspiration. Fasting guidelines before procedural sedation have always been the same as those used for general anaesthesia. However, procedural sedation and general anaesthesia differ in terms of invasiveness, drugs, duration and patient characteristics. This results in lower risk of pulmonary aspiration during procedural sedation, when compared to general anaesthesia. Moreover, a large case series of sedations performed in the emergency department with no respect for the proper fasting times showed no association between fasting duration and any type of adverse event with the latter occurring also in patients that properly fasted. The type of procedure (with the need of airway management) and characteristics of the patient seem to matter more. Furthermore, prolonged fasting is uncomfortable and has been associated with hypoglycaemia and dehydration. For this reason, fasting guidelines before procedural sedation should be adapted on the presence of risk factors, such as ASA score, need for airway management, comorbidities, type of procedure and drug used.


ABSTRACT Matrix (M) protein mutants of vesicular stomatitis virus have recently been used as oncolytic viruses for tumor therapies and are being developed as vaccine vectors for heterologous antigens. Because dendritic cell (DC) maturation is an important correlate of tumor immunosurveillance and vaccine efficacy, we sought to determine the ability of a recombinant M protein mutant virus (rM51R-M virus) to mature DC in vitro. We have previously shown that rM51R-M virus is defective at inhibiting host gene expression in several cell lines compared to its recombinant wild-type counterpart, rwt virus. Therefore, rM51R-M virus allows the expression of genes involved in antiviral responses, such as the type I interferon (IFN) gene. Our results demonstrate that, in contrast to the rwt virus, rM51R-M virus induced the maturation of myeloid DC (mDC) populations, as indicated by an increase in the surface expression of CD40, CD80, and CD86 as well as the secretion of interleukin-12 (IL-12), IL-6, and type I IFN. In addition, mDC infected with rM51R-M virus effectively activated naïve T cells in vitro, whereas rwt virus-infected mDC were defective in antigen presentation. The inability of rwt virus to induce mDC maturation was correlated with the inhibition of host gene expression in rwt virus-infected cells. Our studies also indicated that the production of costimulatory molecules on mDC by rM51R-M virus was dependent on the type I IFN receptor, while maturation induced by this virus was largely independent of MyD88. These data indicate that rM51R-M virus effectively stimulates the maturation of mDC and has the potential to promote effective T-cell responses to vector-expressed antigens, activate DC at tumor sites during therapy, and aid in tumor immunosurveillance and destruction.


An innovative facility for testing high-power, pulsed plasmoid thrusters has been constructed to develop the electrodeless Lorentz force (ELF) thruster concept. It is equipped with a suite of diagnostics optimized to study the physical processes taking place within ELF and evaluate its propulsive utility including magnetic field, neutral gas, and plasma flux diagnostics, a method to determine energy flow into the plasma from the pulsed power systems, and a new type of ballistic pendulum, which enables thrust to be measured without the need for installing the entire propulsion system on a thrust stand. Variable magnetic fields allow controlled studies of plume expansion in a small-scale experiment and dielectric chamber walls reduce electromagnetic influences on plasma behavior and thruster operation. The unique capabilities of this facility enable novel concept development to take place at greatly reduced cost and increased accessibility compared to testing at large user-facilities.


The cortical networks that underlie behavior exhibit an orderly functional organization at local and global scales, which is readily evident in the visual cortex of carnivores and primates1-6. Here, neighboring columns of neurons represent the full range of stimulus orientations and contribute to distributed networks spanning several millimeters2,7-11. However, the principles governing functional interactions that bridge this fine-scale functional architecture and distant network elements are unclear, and the emergence of these network interactions during development remains unexplored. Here, by using in vivo wide-field and 2-photon calcium imaging of spontaneous activity patterns in mature ferret visual cortex, we find widespread and specific modular correlation patterns that accurately predict the local structure of visually-evoked orientation columns from the spontaneous activity of neurons that lie several millimeters away. The large-scale networks revealed by correlated spontaneous activity show abrupt 'fractures' in continuity that are in tight register with evoked orientation pinwheels. Chronic in vivo imaging demonstrates that these large-scale modular correlation patterns and fractures are already present at early stages of cortical development and predictive of the mature network structure. Silencing feed-forward drive through either retinal or thalamic blockade does not affect network structure suggesting a cortical origin for this large-scale correlated activity, despite the immaturity of long-range horizontal network connections in the early cortex. Using a circuit model containing only local connections, we demonstrate that such a circuit is sufficient to generate large-scale correlated activity, while also producing correlated networks showing strong fractures, a reduced dimensionality, and an elongated local correlation structure, all in close agreement with our empirical data. These results demonstrate the precise local and global organization of cortical networks revealed through correlated spontaneous activity and suggest that local connections in early cortical circuits may generate structured long-range network correlations that underlie the subsequent formation of visually-evoked distributed functional networks.


Large employers are not the enemy of health reform some make them out to be. But they are worried about how to comply with the proliferation of newly enacted state reform laws and what impact a federal health reform law is likely to have.


Dexmedetomidine has been shown to provide good perioperative hemodynamic stability with decreased intraoperative opioid requirements. This study was conducted to compare the effect of dexmedetomidine-remifentanil (DR) anesthesia and propofol-remifentanil (PR) anesthesia on perioperative hemodynamics and postanesthesia recovery profiles in patients undergoing intracranial surgery. After receiving Ethics Committee approval and informed patient consent, 78 American Society of Anesthesiologists physical status I or II patients between the ages of 19 and 70 years with a Glasgow Coma Scale score 14 or 15 who were scheduled for elective intracranial surgery with general anesthesia were recruited. Anesthesia induction was provided by intravenous remifentanil (0.5 μg/kg) and propofol (1.5-2 mg/kg) in both groups and maintained with infusion of DR (0.6-1.2 mg/kg/h and 0.25 μg/kg/min)-nitrous oxide/oxygen (n2o/o2) in the DR group (n = 39) and infusion of PR (3-10 mg/kg/h and 0.25 μg/kg/min)-n2o/o2 in the PR group (n = 39). Hemodynamic variables were recorded before surgery, during the induction of anesthesia, after intubation, and during application of the headholder and skin incision; brain relaxation was also recorded. Times to extubation and awakening, eye opening, and response to commands as well as analgesic requirements were recorded after surgery. No significant difference was found in systolic blood pressure and mean arterial pressure throughout the study period except at the time of the dural incision (P < 0.05). These variables were significantly lower in the DR group (P < 0.05). Brain relaxation scores were similar between the 2 groups (P > 0.05). Time to extubation was significantly shorter in patients receiving PR anesthesia than in patients receiving DR anesthesia (3.6 minutes vs. 5.5 minutes). Analgesic requirements were significantly higher in the PR group than in the DR group (P = 0.013). No significant side effects were reported in the 2 groups (P > 0.05). In conclusion, dexmedetomidine (0.6-1.2 μg/kg−1/h−1) plus remifentanil (0.25 μg/kg−1 min−1) anesthesia offered lower analgesic requirements, a longer extubation time, and better hemodynamic stability compared with PR anesthesia for patients undergoing intracranial surgery.


It has been suggested from in vivo and cryoelectron micrographic studies that the large ribosomal subunit protein L11 and its N-terminal domain play an important role in peptide release by, in particular, the class I release factor RF1. In this work, we have studied in vitro the role of L11 in translation termination with ribosomes from a wild type strain (WT-L11), an L11 knocked-out strain (ΔL11), and an L11 N terminus truncated strain (Cter-L11). Our data show 4-6-fold reductions in termination efficiency (kcat/Km) of RF1, but not of RF2, on ΔL11 and Cter-L11 ribosomes compared with wild type. There is, at the same time, no effect of these L11 alterations on the maximal rate of ester bond cleavage by either RF1 or RF2. The rates of dissociation of RF2 but not of RF1 from the ribosome after peptide release are somewhat reduced by the L11 changes irrespective of the presence of RF3, and they cause a 2-fold decrease in the missense error. Our results suggest that the L11 modifications increase nonsense suppression at UAG codons because of the reduced termination efficiency of RF1 and that they decrease nonsense suppression at UGA codons because of a decreased missense error level.


The Internet of Things paradigm lacks end-to-end privacy solutions to consider its full adoption in real life scenarios in the near future. The recent enactment of the EU General Data Protection Regulation (GDPR) indeed emphasises the need for stronger security and privacy measures for personal data processing and free movement, including consent management and accountability by the data controller and processor. In this paper, we suggest an architecture to enforce end-to-end data usage control in Distributed Event-Based Systems (DEBS), from data producers to consumer services, taking into account some of the GDPR requirements concerning consent management and data processing transparency. Our architecture proposal is based on UCONABC usage control models, which we overlap with a distributed hash table overlay for scalability and fault-tolerance concerns, and across and within systems data usage control. Our proposal highlights the benefits of combining both DEBS and end-user usage control architectures. To complete our approach, we quickly survey existing encryption models that ensure data confidentiality in topic-based Publish/Subscribe systems and highlight the remaining obstacles to transpose them to content-based DEBS with an overlay of brokers.


BACKGROUND:

Addition of trastuzumab to neoadjuvant chemotherapy (NAC) improved pathologic complete response (pCR) rate in HER2-positive breast cancer. Although recent trials have shown favorable prognosis with NAC plus trastuzumab, clinicopathological factors to predict the outcome have not been fully understood. The aim of this study was to investigate the survival after NAC with trastuzumab and to explore the predictive factors.

PATIENTS AND METHODS:

This is a multicenter retrospective observational study. Patients with HER2-positive primary breast cancer treated with NAC plus trastuzumab from 2001 to 2010 were identified from the institutional database. Primary end point was disease-free survival (DFS). pCR was defined as ypT0/is+ypN0. Kaplan-Meier method was used to estimate DFS. Logistic regression and proportional hazard analysis were used to identify clinicopathological factors to predict pCR and DFS, respectively.

RESULTS:

733 patients were included in the analysis (whole dataset). 425 were ER/PgR-negative (HR- dataset) and 306 were ER/PgR-positive (HR+ dataset). Radiation therapy was performed in 90% of lumpectomy and 31% of mastectomy. Hormonal therapy was performed in 84% of HR+ dataset. pCR rate was 45% in whole dataset, 60% in HR- dataset, and 34% in HR+ dataset. Table 1 showed the result of multivariate analysis for pCR in whole dataset. When HR+ and HR- dataset were analyzed separately, no definitive predictors for pCR were identified in multivariate analysis. Although the patients with pCR showed a significantly favorable prognosis than those without pCR at 3 years DFS, in whole dataset (93% vs 83%, p<0.0001) and HR- dataset (94% vs 80%, p<0.0001), there was no significant difference in HR+ dataset (89% vs 86%, p = 0.10). Different predictors were selected for DFS when multivariate analysis was conducted separately between HR- and HR+ dataset (Table 2).

CONCLUSIONS:

In this observational study, we clarified predictors for pCR and DFS in HER2-positive patients treated with neoadjuvant trastuzumab containing therapy based on tumor subtype. Our results may help us to predict the prognosis more precisely and to simulate the disease course.

View this table:

Table 1) Multivariate logistic regression analysis for pCR in whole dataset

View this table:

Table 2) Multivariate proportional hazard analysis for DFS

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-20.


This study aims to examine the importance of air transportation on regional development in Indonesia as an archipelago and developing country. Using cross-section dataset in regencies level and multiple regression analysis, we found that the number of flight, air passenger, and air cargo give positive and significant impact on regional per capita income. The effect of air cargo is the strongest, which imply that airport will provide the more substantial impact on regional economic growth if the airport is intended to use for trade and business activities. The motivations of regency to have an airport are if Regency is an independent island, manufacturing industry with its high-skilled and mid-skilled workers, and tourism sector. DOI: 10.15408/sjie.v7i1.6178


Games are trouble. As faculty members in a Game Development program we are aware of the troubles. As inside–outsiders, given our status as queer women in the male-dominated Games field, both with interdisciplinary art-tech-humanities backgrounds as opposed to STEM, we are the ones commonly tasked with 'fixing' these troubles. This tasking comes to us in the form of both assumptions and requests about our providing particular types of education to others, both faculty and students, as fixes to Game-troubles: teaching the gender module; sitting on an LGBTQ+ committee; advising a particular student who is also outside the more comfortable purview of Games; and so forth. While our labor is often assumed, it is not fully valued, evidenced by the ways in which it is chronically under-resourced. And, given this lack of sustainability, our labor is not effective in the ways we intend. Often, our fixes only serve to a fix ourselves, further cementing us as outsiders. Our fixes are diluted until they become performative gestures, absolving others of the need to act, but changing little else. Acting 'in a fix' is something we no longer wish to do. Instead we untangle and re-tangle in a new way, drawing on the work of Feminist New Materialists (Ahmed, 2008; Alaimo, 2016; Alaimo and Hekman, 2008; Barad, 2011; Bennett, 2010; Braidotti, 2013; Coole and Frost, 2010; Dolphijn and Tuin, 2012; Grosz, 1994; Kirby, 1997) to develop imaginative new models for a more just and joyful future Games pedagogy. We share not only our research on this topic, but also invite you into our own intimate experiences of play-making, foregrounding this as knowledge-making too. We offer these crossings between text and context, history and future Ahmed, 2008, memory and fiction as a speculative fabulation for future Games pedagogies.


Law No 37 Year 2004 on Bankruptcy and Liability Payment Postponement (PKPU) enables a debtor to come up with a settlement offer to the creditor, prior to or after bankruptcy, in order to pay for liabilities or end bankruptcy and PKPU. A settlement offer from a debtor, discussed and submitted after liability verification, which has been agreed and approved by both the debtor and the creditor must first be legalized by a panel of judges that decide on the case. This will give the settlement offer a fixed and binding legal status. Hence, it can be executed. However, the panel of judges do has the right to legalize a settlement offer agreed and approved by both the debtor and the creditor, as stipulated in Article 159 subsection (2) and Article 285 subsection (2) of Law no 37 Year 2004. This right to deny legalizing a settlement offer is against the universal principles of agreement, especially concerning mutual agreement, pactasuntservanda, freedom of contract, and common justice. The issues discussed in this research include (1) Why legalizing a settlement in the bankruptcy law does not reelect justice? (2) What are the consequences of legalizing a settlement in the bankruptcy law that does not reflect justice? (3) What is the law construction for legalizing a settlement in the bankruptcy law that is based on the values of justice? The method employed was judicial sociology. Data were collected from interviews, observations, and documentations. Those data were then analyzed using the interactive analysis method.  Results show that (1) Legalizing a settlement in both the bankruptcy law and PKPU is not yet based on justice values, especially the value of dignified justice based on Pancasila, namely Principles, 2, 4, and 5. (2) Hindrances in legalizing a settlement among others are; the agreement between a debtor and all creditors or most/the majority of creditors in a settlement offer is not recognized by the panel of judges; It is against the universal principles of agreement, especially the freedom of contract, the principle of pactasuntsevanda, and mutual agreement, and it does not recognize the deliberation between both the debtor and creditors, which is presided by a curator and a supervising judge and is in line with Principle 4 of Pancasila. (3) There needs to be a reconstruction for the ideal values of legalizing a settlement in bankruptcy law and PKPU, based on the values of dignified justice, that is aimed at protecting all parties involved in the settlement and PKPU. Keywords: legalizing a settlement, bankruptcy law, PKPU, dignified justice


Monika Brugger and her work represent a creative tradition of Conceptual jewellery in France - which is otherwise scarcely encountered there at all. This book shows the development undergone by her work since its beginnings in 1992. Pierre-Damien Huyghe has this to say about it: '...the salient feature of Monika Brugger's works is, first of all, not even a particular link between form and content but rather idea, category, linguistic tradition. Her art is in a certain sense Conceptual. It constitutes the question of the relationship between the word as convention and the thing made...'. Anatomical fragments, particles of still vivid memories become foliage and polished forms that are transmuted via gold and silver into delicate, tongue-in-cheek pieces of jewellery. In an approach worthy of sculpture, Brugger adroitly uses photographs, texts, boxes and articles of clothing in constructing her own distinctive 'installations', presenting her objects in a size and on a scale commensurate with the space used. Her works are owned by museums and private collections. A native of Germany, Monika Brugger has been living in France for thirty years. She teaches in Limoges, Strasbourg and Paris.


Unravelling the SM-SNARE conundrum So-called SNARE proteins mediate and lend specificity to the fusion between different intracellular membranes. The SM proteins are universally required for intracellular vesicle fusion, yet their mechanism of action has long been enigmatic. Baker et al. have solved a piece of the puzzle by "capturing" SNAREs in the process of assembling into fusogenic complexes on the surface of an SM protein. The findings suggest exactly how and why SM proteins help vesicular fusion during intracellular membrane trafficking. Science, this issue p. 1111 Structures of a Sec1/Munc18 protein engaging two SNARE motifs reveal a key mechanism in cellular membrane fusion. Fusion of intracellular transport vesicles requires soluble N-ethylmaleimide–sensitive factor attachment protein receptors (SNAREs) and Sec1/Munc18-family (SM) proteins. Membrane-bridging SNARE complexes are critical for fusion, but their spontaneous assembly is inefficient and may require SM proteins in vivo. We report x-ray structures of Vps33, the SM subunit of the yeast homotypic fusion and vacuole protein–sorting (HOPS) complex, bound to two individual SNAREs. The two SNAREs, one from each membrane, are held in the correct orientation and register for subsequent complex assembly. Vps33 and potentially other SM proteins could thus act as templates for generating partially zipped SNARE assembly intermediates. HOPS was essential to mediate SNARE complex assembly at physiological SNARE concentrations. Thus, Vps33 appears to catalyze SNARE complex assembly through specific SNARE motif recognition.


ASEAN Economic Community (AEC) promotes the development and economic welfare in ASEAN nation. Indonesia, on the other side, accept it as a big chance of investment. Through investment, the government hopes to achieve economic development. Policies, regulation, even deregulation has been made for a friendly investment. But, there is no guaranteed investment will also bring social welfare. Regulation not only as a tool for investment but also to protect socio-economic rights of people's. As the example, the regulation made for protecting the local worker, or employment opportunities. The regulation also provided for protection and  empowerment for small and middle economies or the poverty alleviation.  This condition will be the dilemma for the government to balance the investment and to fulfill socio-economic rights at the same time. Truly are UUDNRI 1945 already formulate to solve this dilemma. We can learn from article 33 UUDNRI 1945, about the idea to keep it economic development work together in harmony with the will to fulfill socio-economic rights. This paper focuses on seeing how regulation consistence in fulfills socio-economic rights in AEC Free Trade, with the normative method through legislation, social, and economic approach, The research result describe the regulations used for facing AEC dominate by investment design and forgot about socio-economic rights.


Welcome to our Basic Skills for the OR Series!

Complete series includes:

Scalpels
Surgical Sutures
Surgical Staplers
Opening Sterile Surgical Packs
Opening Sterile Surgical Instrument Containers
Laparoscopic Instruments


Through analysis on drillability of frozen soil, it is concluded that the main factors affecting the drillability of frozen soil are temperature, wave velocity, impact inductility and chiseling specific work. Based on the foundation it is discussed that applying the neural networks method to classify the drillability of frozen soil is simple and feasible, and the inputted vectors quantity of networks don't be restricted, which make the classification on drillability of frozen soil rather well match the objective practice.


To the Editor.— History teaches that scientists are inclined to eat carcasses of test animals. Indeed, a well-known double-doctorate space scientist dined frequently on rats during his salad days. A group on the Eastern seaboard eats exotic animals at their annual banquets. Even nonscientists do it. For example, a sparring Southern editor and his cocky Governor had an election bet in which the loser would eat a crow at a specified banquet. He did and when asked how it tasted said, "Well, it tasted a lot like owl." The Scoggin (231:176, 1975) report on catfish stings is noteworthy because it shows that research is needed to identify this toxin. To achieve this goal, some interested soul will have to brave the elements to catch some study specimens. Then he'll have to remove the dorsal and pectoral fin spines for scientific purposes. I hope he knows what to do with the


Objective: The aim of this study is to determine Swedish parents' willingness to pay (WTP) for coeliac disease (CD) screening of their child. Subjects and Methods: CD screening was undertaken involving 10,041 12-year-old children, with 7567 (75%) agreeing to participate. Blood samples from the children were analysed for CD serological markers. Parents received a questionnaire including a scenario describing the health-related risks of having CD and screening and diagnostic procedures. Parents were also asked whether they were willing to pay for CD screening, should this not be offered free of charge, and, if so, what their maximum WTP would be. Their WTP was compared with the average cost per child for the screening and case ascertainment procedures. Results: The questionnaire was answered by 6524 parents, and of 6057 valid responses 63% stated that they were willing to pay something. The mean WTP was 79 EUR and the median 10 EUR. The average cost per child for the screening and case ascertainment procedures was 47 EUR, which 23% of the parents stated they were willing to pay. Parents' WTP increased with higher education and income, and with child symptoms that may indicate CD. Conclusions: Swedish parents' WTP for school-based CD screening of their child was higher than the average cost per child; however, only a minority of the parents were willing to pay that amount.


The research presents the robot which aims in walking as person. The human gait will be analyzed and what kind of biped robot will be stabilized naturally and will be able to apply. To connects the data which acquires from ZMP in gait, the front continuous pattern in order to guarantee a stability of walking robot that are considered a wheel track and combined the walking pattern of this robot.


Ninety-four human non-small cell lung carcinomas (NSCLC) of previously untreated patients were analyzed for the presence of metallothionein (MT) expression by means of immunohistochemistry. Of the tumors investigated, expression of MT was detected in 63%. The expression of MT was correlated with the results of doxorubicin resistance of the tumors in vitro. A significant relationship between MT expression and doxorubicin resistance was found (p=0.01). Significant correlations also exist between MT and P-glycoprotein or glutathione-S-transferase-pi expression respectively (p<0.005).


Abstract The lithium aluminosilicate mineral petalite (LiAlSi4O10) has been studied with high-pressure single-crystal X-ray diffraction (HP-XRD) up to 5 GPa. Petalite undergoes two fully reversible pressure-induced first-order phase transitions, not previously reported in the literature, at ca. 1.5 and 2.5 GPa. The first of these transforms the low-pressure α-phase of petalite (P2/c) to an intermediate β′-phase that then fully converts to the high-pressure β-phase at ca. 2.5 GPa. The α → β transition is isomorphic and is associated with tripling of the unit-cell volume. Analysis of the HP-XRD data show that although the fundamental features of the petalite structure are retained through this transition, there are subtle alterations in the internal structure of the silicate double-layers in the β-phase relative to the α-phase. Measurement of the unit-cell parameters of petalite as a function of pressure, and fitting of the data with third-order Birch-Murnaghan equation of state, has provided revised elastic constants for petalite. The bulk moduli of the α- and β-phases are 49(1) and 35(3) GPa, respectively. These values indicate that the compressibility of the α-phase of petalite lies between those of the alkali feldpsars and alkali feldspathoids, whereas the β-phase has a compressibility more comparable with layered silicates. Structure analysis has shown that the compression of the α-phase is facilitated by the rigid body movement of the Si2O7 units from which the silicate double-layers are constructed.


Introduction: The government of Nepal has been providing free dialysis for a lifetime to its citizen since 2016. Most of the patients have to spend from pocket to meet their medical demands to sustain life. This leads to a financial burden and may lead to the sale of the property. The aim of this was study to look into different categories of expenses done by patients in the Bipanna nagarik free HD program provided by the government of Nepal.Materials and Methods: This descriptive cross-sectional study was carried out from 9th February 2022 till 30th September 2022 under the Nephrology Unit, Department of Internal Medicine at Universal College of Medical Sciences, Bhairahawa, Nepal. Ethical clearance was taken from the Institutional Review Committee (IRC letter reference no. UCMS/IRC/049/22). Patients receiving free basic hemodialysis services under the Bippana Nagarik Scheme of the Government of Nepal and giving informed and written consent were enrolled in the study. Non-Probability Sampling Method – Convenience Sampling was done.Results: In our study of 50 patients on HD, the mean age was 46.24 ± 15.31 years. The mean duration of dialysis of the study population was 126.80 ± 332.52 months. The average family income per annum was approximately NRs. 31000. The total out-of-pocket expenditure was approximately NRs. 35305/month. The cost of blood investigations was approximately NRs. 13000 in three months.Conclusion: The monthly out of pocket expenditure was approximately NRs. 35000 which was directly related to hemodialysis in spite of free basic hemodialysis services by the Government of Nepal.


A fully depleted lean-channel transistor (DELTA) that has a gate with a vertical ultrathin SOI structure is reported. In the deep submicrometer region, selective oxidation is useful in realizing SOI isolation. It provides high crystalline quality, as good as that of conventional bulk single-crystal devices. Using experiments and three-dimensional simulation, it was shown that the gate structure has effective channel controllability and its vertical ultrathin SOI structure provides superior device characteristics.<<ETX>>


Background: Inguinal hernia repair is the most common general surgical procedure. External oblique hernioplasty utilizes the aponeurosis of external oblique muscle to strengthen the posterior wall of inquinal canal. Objective: To assess the outcome of external oblique hernioplasty in terms of early complications and recurrence. th Material and Methods: The study design was descriptive and was conducted in MMC Mardan from 14 June 2015 till 20th June 2016. An informed consent about the procedure was taken. The patients conditions were optimized before surgery after conducting investigations. All patients fit for general anesthesia were included in the study. All the patients were operated by a experienced surgeons and postoperative complications were recorded. All the patients were followed up for a period of six months. Results: All the 57 patients were operated and all were male suffering from inguinal hernia. In the early postoperative period 14% of patients had urinary retention. Chronic pain was observed in 14% of patients while 7% of patients reported with SSI. Conclusion: Results of the procedure are comparable to the results of mesh repairs in terms of immediate postoperative period. Long term complications like recurrence are awaited.


BACKGROUND The resection of the meningiomas surrounding the dura is an important goal during the removal of a convexity meningioma. The authors present the first application of sodium fluorescein (SF) as a tool for tumor and dural tail identification in convexity meningiomas. METHODS Five frontal convexity meningiomas operated on between December 2012 and April 2013 were included. After initial dissection a dose of 1 g of the SF, 20% was injected into a peripheral vein. Tumor and dural tail were removed using the correlation between magnetic resonance imaging (MRI) findings and transoperative SF enhancement. RESULTS Simpson Grade 1 removal was obtained in three cases, grade 2 in one atypical meningioma and grade zero in one case. SF dural tail enhancement was positive in all cases and histologic analysis evidenced involvement of the dura by tumors. CONCLUSION SF enhancement was evident in meningiomas and dura surrounding the lesions. Histologic analysis confirmed dural involvement. SF could represent an universally available fluorescent tool for meningioma surgery.


In this paper, the so-called Husimi operator Δh(q,p; κ), which is introduced by smoothing out the Wigner operator Δw(q,p) by averaging over the "coarse graining" function exp[-κ(q'- q)2 - (p' - p)2/κ], is now regarded as a Weyl correspondence connecting the Husimi operator Δh(q,p; κ) with its classical correspondence, since the integration kernel is just the Wigner operator. In this way we can easily identify |p,q;κ such that Δh(q,p;κ) = |p,q;κ p,q;κ|, where |p, q; κ is a new kind of squeezed coherent states. The entangled Husimi operator is also treated in this way. Thus a simple way to find the Husimi operator is presented.


The antiferromagnetic order in the cubic heavy-fermion compound CeIn3−xSnx can be suppressed by Sn doping until a quantum critical point is reached at xc = 0.67. Thermodynamic measurements indicate changes to the simple magnetic order for x > 0.2, which is corroborated by the fact that neutron scattering experiments failed in observing signatures of the magnetic order for x > 0. We performed muon spin relaxation measurements in zero magnetic field (ZF-μSR) on single crystals of CeIn3−xSnx with x = 0.2; 0.4; 0.55. The spectra for x = 0.2 can be fitted by a Gaussian Kubo-Toyabe function with exponential depolarization, whereas the damping in the case of x = 0.55 has Lorentzian shape. The data for x = 0.4 are represented best by a superposition of Gaussian and Lorentzian damping. For all investigated Sn concentrations the muon spin depolarization rate is high at low temperatures and decreases towards TN. Our measurements demonstrate that magnetic order is present in CeIn3−xSnx also for higher Sn content (x ≥ 0.2) and that the distribution of internal fields broadens with increasing x.


: Amino acid composition was determined in the cells of Candida utilis VKM Y-1668 growing in the regime of chemostat. The growth was inhibited by pH of the medium, copper and silver ions, and glycerol deficiency as a control. Some specific differences have been found in the amino acid composition of the yeast depending on the nature of the inhibitor.


Obesity and its metabolic complications have emerged as the epidemic of the new millennia. The use of obese rodent models continues to be a productive component of efforts to understand the concomitant metabolic complications of this disease. In 1978, the JCR:LA-cp rat model was developed with an autosomal recessive corpulent (cp) trait resulting from a premature stop codon in the extracellular domain of the leptin receptor. Rats that are heterozygous for the cp trait are lean-prone, while those that are homozygous (cp/cp) spontaneously display the pathophysiology of obesity as well as a metabolic syndrome (MetS)-like phenotype. Over the years, there have been formidable scientific contributions that have originated from this rat model, much of which has been reviewed extensively up to 2008. The premise of these earlier studies focused on characterizing the pathophysiology of MetS-like phenotype that was spontaneously apparent in this model. The purpose of this review is to highlight areas of recent advancement made possible by this model including; emerging appreciation of the "thrifty gene" hypothesis in the context of obesity, the concept of how chronic inflammation may drive obesogenesis, the impact of acute forms of inflammation to the brain and periphery during chronic obesity, the role of dysfunctional insulin metabolism on lipid metabolism and vascular damage, and the mechanistic basis for altered vascular function as well as novel parallels between the human condition and the female JCR:LA-cp rat as a model for polycystic ovary disease (PCOS).


Potato is one of the most common food crops cultivated in Amhara region. However, the current production supply couldn't satisfy demands for this crop. As a result, effective method of assessing environmental suitability analysis to increase the production of this crop is needed. A multi factor spatial analysis can effectively assess the environmental suitability of an area for potato cultivation. However, there are no comprehensive spatial Multi-Criteria Decision Analysis (MCDA) of agricultural land suitability analysis for the study yet. In an attempt to underscore its significance, this study conducted GIS and MCDM based land suitability analysis. This approach uses the combination of traditional MCDA and GIS technology. It involves identifying suitability factors, hierarchical organization, standardization, rating and ranking, and weighing the factors selected and finally implementing the suitability model. The evaluation criteria used are elevation, slope, soil, rainfall, temperature variations and poor crop management. They were collected from different government agencies. The ranking and weighting were conducted through pairwise comparison of variables using experts from Amhara Region Agricultural Research Institute. The weights of factors were estimated by computing Eigen values and Eigen vectors of experts' pairwise ratings of criteria using IDRIS tools. Different suitability maps were prepared by combining MCDA and GIS. IDRIS and ArcGIS 10.3 extension tools were used in this regard as they have the capacity to integrate these modules. Four suitability scenarios were developed using different standardization and combination methods. Using the suitability scenario method, finally physical land suitability analyses were conducted. The results of the analyses disclosed that large area of land on the highland plateau and plain of South Gondar, West Gojjam and Awi are suitable for potato crop cultivation. On the other hand, North Gondar and some part of East Gojjam are not suitable for potato growing. Keywords: GIS, Remote Sensing, MCDA, Suitability, Eigen vectors


We describe a probabilistic framework for detecting and tracking motion boundaries. It builds on previous work (M.J. Black and D.J. Fleet, 2000) that used a particle filter to compute a posterior distribution over multiple, local motion models, one of which was specific for motion boundaries. We extend that framework in two ways: 1) with an enhanced likelihood that combines motion and edge support, 2) with a spatiotemporal model that propagates beliefs between adjoining image neighborhoods to encourage boundary continuity and provide better temporal predictions for motion boundaries. Approximate inference is achieved with a combination of tools: sampled representations allow us to represent multimodal non-Gaussian distributions and to apply nonlinear dynamics, while mixture models are used to simplify the computation of joint prediction distributions.


The abnormal detection of nuclear power electric valve actuator components can effectively improve its operation safety and reliability. With the rise of artificial intelligence technology, data-driven fault diagnosis methods have become more and more popular. However, in practical application, there are few or almost no fault data of valve actuator. For the problem of anomaly detection of actuator components of valve in the scenario of only normal data, anomaly detection method based on the fusion of deep autoencoder (DAE) and weighted deep weighted support vector data description (WDSVVD) is proposed. It uses normal data to train the depth self-encoder, and the reconstruction error of the depth self-encoder to train the support vector data description. Compared with the traditional anomaly detection method, it significantly improves the anomaly detection accuracy and can realize more sensitive and robust component anomaly detection.


Purpose— to evaluate mid-term outcomes of reverse joint replacement in patients with shoulder arthropathy and massive rotator cuff tear.Material and Methods. Reverse shoulder arthroplasty with delTa xTeNd (depuy) was performed in 38 patients in the period from december 2010 to december 2016 by the same surgical team. patients' age ranged from 38 to 82 years. Indications for replacement were pain syndrome and pseudoparalysis of the upper limb in presence of a large or massive Rc tear as well as shoulder arthropathy of various severity degree. Outcomes were evaluated by standard aSeS, cS and ucla scales. Roentgenological examination included ap and axial x-rays during follow up from 1 to 6 years after the surgery with analysis of implants positioning. Mean follow up was 24,2±6,6 months.Results. good outcomes were reported in 6 (15,8%) patients. average functional scores were: aSeS 87,4±2,1, ucla 29,7±1,5 and cS 14,0±2,3. Satisfactory outcomes were observed in 27 (14,2%) patients: aSeS 76,2±2,3, ucla 26,8±1,3 and cS 22,0±1,4 scores. poor outcomes were reported in 5 (14,2%) patients with persisting pain syndrome.Conclusion.To avoid significant and multiple complications after reverse shoulder replacement a precise preoperative planning considering particular destructive changes of glenoid fossa is required. For young and physically active patients the authors recommend to use alternative treatment options aiming at restoration of normal shoulder biomechanics and prophylaxis of arthropathy.


The TMT first light AO facility consists of the Narrow Field Infra-Red AO System (NFIRAOS), the associated Laser Guide Star Facility (LGSF) and the AO Executive Software (AOESW). Design, fabrication and prototyping activities of the TMT first light AO systems and their components have significantly ramped up in Canada, China, France, and in the US. NFIRAOS is an order 60 x 60 laser guide star (LGS) multi-conjugate AO (MCAO) system, which provides uniform, diffraction-limited performance in the J, H, and K bands over 34 x 34 arc sec fields with 50 per cent sky coverage at the galactic pole, as required to support the TMT science cases. NFIRAOS includes two deformable mirrors, six laser guide star wavefront sensors, one high order Pyramid WFS for natural guide star AO, and up to three low-order, IR, natural guide star on-instrument wavefront sensors (OIWFS) and four on-detector guide windows (ODGW) within each client instrument. The first light LGSF system includes six sodium lasers to generate the NFIRAOS laser guide stars. In this paper, we will provide an update on the progress in designing, prototyping, fabricating and modeling the TMT first light AO systems and their AO components over the last two years. TMT is continuing with detailed AO modeling to support the design and development of the first light AO systems and components. Major modeling topics studied during the last two years include further studies in the area of pyramid wavefront sensing, high precision astrometry, PSF reconstruction for LGS MCAO, LGSF wavefront error budget and sophisticated low order mode temporal filtering.


Fingerprint technique is a promising enabler for mobile terminals (MTs) localization in rich scattering environments, such as urban areas and indoor corridors. In this paper, we investigate fingerprint-based localization for massive multiple- input multiple-output (MIMO) orthogonal frequency- division multiplexing (OFDM) systems with deep convolutional neural networks (DCNNs). By taking full advantage of the high resolution in the angle domain and the delay domain in massive MIMO-OFDM systems, we first propose an efficient angle-delay channel amplitude matrix (ADCAM) fingerprint extraction method. Then a DCNN enabled localization method is proposed, in which the modeling error for fingerprint similarity calculation can be overcome. Both DCNN classification and DCNN regression are considered. For practical implementation, a hierarchical DCNN architecture is proposed. Numerical simulation results demonstrate that DCNN performs well in achieving high localization accuracy as well as reducing storage overhead and computational complexity.


The purpose of this study was to investigate whether supraspinatus tendon failure stress at the footprint can increase by improving the bone density at the rotator cuff footprint in a rat model. Bilateral ovariectomies were performed in twenty‐four 4‐month‐old Sprague‐Dawley rats. Half received bisphosphonate (zoledronic acid) and the other half received no treatment (OVX + ZOM and OVX, respectively). Twelve additional rats did not undergo ovariectomy or receive bisphosphonate treatment (CON). All rats were sacrificed at 7 months of age. Quantitative micro‐computed tomography was used to assess bone density in the proximal humerus. A series of stress–relaxation tests were performed to assess stiffness and failure stress of the supraspinatus tendon. Bone density in OVX + ZOM was significantly higher at the rotator cuff footprint when compared to CON and OVX rats (p < 0.0001). The supraspinatus tendons in the OVX group were significantly stiffer when compared to the CON and OVX + ZOM groups (p < 0.05). The failure stress of the OVX + ZOM group was significantly greater than the CON and OVX groups (22.89 ± 4.43 MPa vs. 18.36 ± 3.16 and 17.70 ± 4.92, respectively). In conclusion, improving the bone density at the rotator cuff footprint enhances failure stress of the suprapinatus tendon. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:308–314, 2010


Chronic gastritis caused by Helicobacter pylori (H. pylori) infection could lead to the development of gastric cancer. The finding that multiple gastric cancers can develop synchronously and/or metachronously suggests the development of field cancerization in chronically inflamed, H. pylori‐infected gastric mucosa. The genetic basis of multiple tumorigenesis in the inflamed stomach, however, is not well understood. In this study, we analyzed the microsatellite instability (MSI) status and copy number aberrations (CNAs) of 41 multiple intramucosal early gastric cancers that synchronously or metachronously developed in 19 patients with H. pylori infection. Among the 41 intramucosal gastric carcinomas, 9 (22%) exhibited MSI, and the remaining 32 (78%) exhibited the microsatellite stable (MSS) phenotype. Metachronous multiple intramucosal gastric carcinoma exhibit inter‐tumor heterogeneity by individually acquiring genetic aberrations. All synchronous multiple intramucosal gastric carcinoma pairs shared a common MSI/MSS profile, and CNA analysis revealed that synchronous multiple intramucosal gastric carcinoma pairs with the MSS phenotype shared common aberrations of representative tumor‐suppressor genes, including focal deletion of APC, TP53, CDKN2A, and CDKN2B. Multiregional CNA analysis revealed that heterogeneous gene amplifications/deletions, including PDL1 amplification, evolved under the presence of shared "trunk" genetic alterations in a subpopulation of individual intramucosal gastric carcinomas. These data suggest that multiple gastric carcinomas develop in a multicentric/multifocal manner exhibiting features of inter‐ and intra‐tumor heterogeneity in H. pylori‐infected gastric mucosa, whereas synchronous multiple intramucosal gastric carcinomas could share partially common genetic alterations, possibly via common oncogenic pathways.


Coir pith is being considered as the reject generated during the extraction of coir fibre from coconut husks. It is a light weight and fluffy material with dusts and bits of fibres. The coir pith has many undesirable components and hence it does not carry any value addition. It needs to be degraded for the effective utilization for further activities. Microbes have the ability to decompose coir pith. Coir pith itself posses its own native microbes. Hence in the present study, raw coir pith and the soil dumped with coir pith in the dumping yards along the vicinity of the coir fibre factories were subjected for the enumeration and characterization of microorganisms. The coir pith for the study was collected from two locations in Cuddalore District. The results exhibited the presence of huge quantity of microbes in the raw coir pith than the coir pith dumped soil. Furthermore, the percentage occurrence of bacteria was significantly higher when compared with that of the fungi and actinomycetes. Totally 12 species of bacteria, six species of fungi and three species of actinomycetes were recorded. The results showed significant variation in the quantity and quality of the microbes.


One aim of this research program has been to increase our understanding of the mechanisms of fatigue crack growth as influenced by such parameters as the specific material, crack length, R-ratio, overloads, temperature and the environment. A second objective has been to utilize this understanding in the development of semi-empirical quantitative methods for the prediction of fatigue crack growth behavior. Although there are still many questions remaining concerning fatigue crack growth, we feel that some significant progress in meeting these two objectives has been made.


Doctor | Living With Narcolepsy | Resource Guide Lifestyle Changes to Manage Narcolepsy by Rosalyn Carson-DeWitt, MD En Espanol (Spanish Version) Most people with narcolepsy find that certain lifestyle changes can help them improve their daytime alertness. General Guidelines for Managing Narcolepsy Get Sufficient Nighttime Sleep It's important for you to regulate your sleep in order to optimize your alertness during the day. Try to get about eight hours of sleep each night. For more information on getting a good night of sleep, click here. Take Planned Naps During the Day Scheduling regular naps can help you remain alert. Some people find that two to three short (10-15 minute) naps scheduled throughout the day are very helpful; others find that one longer afternoon nap refreshes them enough to finish out their day with minimal sleepiness. Try each of these methods to see which works better for you. Avoid Substances That Can Interfere With Alertness or Refreshing Sleep Be careful when drinking caffeinated beverages or alcohol, or using nicotine products. Alcohol can increase your drowsiness and can interfere with getting a good night of sleep. Nicotine and caffeine are stimulants and may interfere with getting refreshing sleep at night or during daytime naps. Exercise Regularly Exercise can increase your energy level and improve your alertness during the day. However, do not exercise within three hours of the time you're planning to go to bed for the night. Exercise can boost your energy to the degree that it prevents you from falling asleep. Before starting an exercise program, check with your doctor about any possible medical problems you may have that would limit your exercise program. For more information on starting an exercise program, click here. REFERENCES: Goetz CG, Pappert EJ. Textbook of Clinical Neurology . Philadelphia, PA: WB Saunders Company; 1999. Narcolepsy. National Heart, Lung, and Blood Institute. National Institutes of Health website. Available at: http://www.nhlbi.nih.gov/ . Updated November 2008. Accessed April 7, 2009.


Electromagnetic metasurface with chaos patterned surface could bring rich interaction modes contributing to fully disordered random motions in deterministic systems, which preform uncertainty, irreducibility and unpredictability. We investigate the influence of the correlation function (CF) properties of surface random patterns on the wave absorption performance. The complicated correlation function provides a fully developed random state, broadening the absorption bandwidth significantly and is helpful for reaching higher absorption rate. With the increasing number of peaks in the correlation function, the absorption band at –15 dB reflectivity widens significantly, band at –20 dB reflectivity begins to emerge. As the first peak's distance from the original point in the CF is enlarged, the absorption trough is gradually formed and deepened to –35 dB level. The results give in-depth understanding of the relation between absorption behavior and controlling parameters including correlation, image information and foam spacer layer thickness. This high absorption absorber has great application potential in customizable radio communication compatibility device and anechoic testing chamber.


A 71-year-old woman, in whom computed tomography revealed a solitary mass shadow at the base of the left lung, underwent resection of the mass. Histopathological examination showed estrogen receptor-positive leiomyoma cells growing in cords and mixed with glandular structures composed of alveolar cells. These findings led to a diagnosis of benign metastatic leiomyoma. Benign metastatic leiomyoma is a rare disease in which histologically benign uterine leiomyoma cells metastasize to different sites of the body. However, in this patient, the presence of uterine myoma was not confirmed in the past or at present. She had a history of cervical conization, which suggests that a small amount of the leiomyoma component contained in cervical tissue may have been forced into blood vessels during surgical manipulation, causing lung metastasis.


A monoclonal antibody against rat liver glutathione S-transferase B, which consists of subunits Ya (Mr 27,000) and Yc (Mr 29,500), was produced in a mouse hybridoma system. The monoclonal antibody, BE6Yc1, was of the immunoglobulin G1 class and specifically recognized glutathione S-transferase B showing no cross-reactivity against the dimeric form of Ya, ligandin, in enzyme-linked immunosorbent assay. A glutathione S-transferase B-BE6Yc1 monoclonal antibody complex was identified from the zymogram pattern on starch gel electrophoresis. On sodium dodecyl sulfate-polyacrylamide gel electrophoresis of rat liver glutathione S-transferase B, followed by Western blotting with BE6Yc1 antibody, a single polypeptide with a molecular weight of 29,500, identical to the Yc subunit of rat liver glutathione S-transferase B, was identified. The antibody showed no cross-reactivity with the Ya subunit with a molecular weight of 27,000 of either glutathione S-transferase B or ligandin. These results show that there are at least two distinct epitopes in the Ya and the Yc subunit. The monoclonal antibody did not block the catalytic activity of glutathione S-transferase B toward cumene hydroperoxide and possibly also 1-chloro-2,4-dinitrobenzene. Quantitative differences in expression of the Yc subunit of glutathione S-transferases were demonstrated in extracts of various normal tissues with the BE6Yc1 antibody by Western blot analysis. The Yc subunit was found to be present at much lower levels in kidney, small intestine, spleen, and lung than in liver and testis.


More and more often we hear about animals as a part of social work. The idea of animals having positive effects on peoples' physical and psychological health seem to be generally accepted among both active practitioners in the human service professions and the general public. We established two main purposes. First we examined which effects of animal assisted social work the active practitioners identifies in their clients. We also ascertained if and how they explained the identified effects in a scientific manner. To fulfill our purpose we did some semistructured interviews with practitioners who are using the help of dogs and horses in their work with clients. We also analyzed the content of an amount of Swedish websites belonging to active practitioners and organizations in the field of animal assisted social work. Our results and analysis led us on to present some scientific declaration concerning the effects, but mainly discuss the lack of evidence and scientificity in the methods used, and the difficulties that could bring. Further discussions are presented concerning organizational management versus professional management, acting space and tacit knowledge. We also discussed the importance of evaluation and an element of standardized methods to legitimize animal assisted social work amongst field constituents. Conclusions drawn was that the field needs more large-scaled research done, both to legitimate and promote its methods.


Although it is widely accepted that the doctor should allow the patient to speak freely at the start of the consultation, many doctors find it difficult not to interrupt, and tend to medicalise the patient's presentation prematurely. To help overcome these tendencies we use a simple description of the consultation as consisting of three parts, according to who should be leading the dialogue at the time (Figure 1).1–3 The consultation begins with the 'Patient's part', during which the patient has the freedom to express their pre-consultation experience (symptoms, problems) and thoughts (ideas, concerns, and expectations [ICE]). Next comes the 'Doctor's part', when the doctor selectively gathers information relevant to the task of translating the patient's narrative from 'lay' language into 'medical' constructs. Finally, in the 'Shared part', doctor and patient cooperate to arrive at plans and decisions acceptable to both of them.

Figure 1.
The three parts of the consultation.

The patient will usually open with a condensed account of what the consultation is about, often including cues to associated feelings and latent agenda. However, because of time pressure and our wish to find a medically solvable problem as quickly as possible, we are tempted to interrupt with questions about, for example, symptoms and duration: questions that belong in the Doctor's part. This disrupts and distorts the prepared story, to which the patient will try to return having dealt with the interruption. Moreover, asking about the patient's own thoughts and anxieties is often reduced to a few cursory and formulaic questions.

In studying nearly 3000 GPs' video-recorded consultations in residential workshops over 20 years (www.kalymnos-kurser.dk), we have noticed that two patterns of behaviour frequently recur:

1. When the doctor clearly acknowledges what the patient has said by giving a verbal 'receipt', the patient listens and is prepared to let …


Background and aims. The aim of this study was to evaluate the effect of different etching times on enamel color stability after immediate versus delayed exposure to colored artificial saliva (CAS). Materials and methods. Human first premolars were divided into five groups of twenty. A colorimeter was used according to the CIE system on the mid-buccal and mid-lingual surfaces to evaluate initial tooth color. Samples in group A remained unetched. In groups B to E, buccal and lingual surfaces were initially etched with phosphoric acid for 15 and 60 seconds, respectively. Then, the samples in groups A and C were immersed in colored artificial saliva (cola+saliva). In group B, the teeth were immersed in simple artificial saliva (AS). Samples in groups D and E were immersed in AS for 24 and 72 hours, respectively before being immersed in colored AS. The teeth were immersed for one month in each solution before color measurement. During the test period, the teeth were retrieved from the staining solution and stored in AS for five minutes. This was repeated 60 times. Color changes of buccal and lingual surfaces were calculated. Kruskal-Wallis and Wilcoxon tests were used for statistical analysis (α ≤0.05). Results. There were no significant differences between the groups in term of ΔE of buccal (P = 0.148) and lingual surfaces (P = 0.73). Conclusion. Extended time of etching did not result in significant enamel color change. Immediate and delayed exposure of etched enamel to staining solutions did not result in clinically detectable tooth color changes.


We propose an enhanced blind constrained minimum variance (CMV) CDMA receiver with joint channel estimation for frequency selective channels. We develop a CMV solution for multipath using a recently proposed enhanced correlation matrix and investigate the performance of the proposed approach with a low complexity blind channel estimation algorithm based on the power method. Simulation results show significant improvements for the proposed receiver design.


We have analysed the role of topoisomerase II (topo II) in plasmid DNA replication in Xenopus egg extracts, using specific inhibitors and two‐dimensional gel electrophoresis of replication products. Topo II is dispensable for nuclear assembly and complete replication of plasmid DNA but is required for plasmid unlinking. Extensive unlinking can occur in the absence of mitosis. Replication intermediates generated in the absence of topo II activity have an increased positive superhelical stress (+ΔLk), suggesting a deficiency in precatenane removal. The geometry of replication intermediates cut by poisoning topo II with etoposide and purified by virtue of their covalent attachment to topo II subunits demonstrates that topo II acts behind the forks at all stages of elongation. These results provide direct evidence for unlinking replicating DNA by precatenane removal and reveal a division of labour between topo I and topo II in this eukaryotic system. We discuss the role of chromatin structure in driving DNA unlinking during S phase.


Purpose: The aim of this study was to evaluate the time delays in reperfusion of patients with ST elevation myocardial infarction (STEMI) according to the mode of transportation and patient arrival time. Methods: An observational study of patients with STEMI treated with primary percutaneous coronary intervention (PCI) was performed from January 2004 to May 2009. The patients were classified into several subgroups according to the transportation method (self-transportation, EMS, and transfer) and patient arrival time (regular hours: weekdays, 7 AM~6 PM, off-hours: weekdays, 6 PM~7 AM, weekend and holiday). The symptom-to-door time (STDT), door-to-balloon time (DTBT), and the timeline to reperfusion were compared in each group. Results: The median STDTs, DTBTs and the percent of the timeline to reperfusion (DTBT ≤90 min) differed significantly according to the transportation mode (p<0.001, respectively). Especially, the transfer group had longer median STDT (200 min, IQR 120~330), shorter median DTBT (80 min, IQR 66~102) and a significantly higher rate of achieving a timely DTBT (64.8%), compared to the other groups (self-transport and EMS use). Compared to the regular hour group, the off-hour group had a shorter STDT (129 min vs. 180 min, p=0.016) and longer DTBT (99 min vs. 81 min, p<0.001). The percent of patients achieving a timely DTBT was much lower during off-hours (41.1% vs. 61.5%, p<0.001). Conclusion: The results of this study showed that the transfer group and regular hour group had a significantly shorter median DTBT, and the timeline for reperfusion was longer in the transfer group compared to the regular hour group in this study.


Next-generation sequencing prototypes for the routine diagnosis of resistance to antiretrovirals approved for the treatment of HIV infection are now being used in many clinical diagnostic laboratories. As some of the next-generation sequencing platforms may be a source of errors, it is necessary to improve the currently available protocols and implement bioinformatic tools that may help to correctly identify the presence of resistance mutations with clinical impact. Several studies have addressed these issues in recent years. Some of them are mainly focused on improving protocols for decreasing the magnitude of errors during the polymerase change reaction. Other studies propose specific bioinformatic tools, able to reach both a 93-98% reduction of indels (insertions/deletions) and a sensitivity and specificity close to 100% in single nucleotide polymorphism variant calling. The implementation of new protocols and bioinformatic tools improving the accuracy of next-generation sequencing results must be considered for a correct analysis of HIV resistance mutations for making clinical decisions. This review summarizes the most relevant data available for the optimization of next-generation sequencing applied to HIV resistance testing.


The behavior of interacting spins subject to randomness is a longstanding issue and the emergence of exotic quantum states is among intriguing theoretical predictions. We show how a quantum-disordered phase emerges from a classical antiferromagnet by controlled randomness. ^{1}H NMR of a successively x-ray-irradiated organic Mott insulator finds that the magnetic order collapses into a spin-glass-like state, immediately after a slight amount of disorder centers are created, and evolves to a gapless quantum-disordered state without spin freezing, spin gap, or critical slowing down, as reported by T. Furukawa et al. [Phys. Rev. Lett. 115, 077001 (2015)]PRLTAO0031-900710.1103/PhysRevLett.115.077001 through sequential reductions in the spin freezing temperature and moment.


Reshoring refers to the emerging practice of once-offshoring manufacturers moving their factories back onshore. Conventional wisdom suggests that reshoring offers demand responsiveness due to market proximity, whereas offshoring provides lower cost. We however argue that, if a manufacturer remains heavily dependent on offshore suppliers for component sourcing, moving its factory back onshore may also bring disadvantages due to the loss of supply proximity. For such manufacturers, we show that the market and supply proximities enable different operational flexibilities, leading to an operational tradeoff between offshoring and reshoring even under identical cost structures. We find a simple characterization of the manufacturers' preferences between offshoring and reshoring, which sheds light on how demand and cost structures can affect the profitability comparison of the two manufacturing modes. We further identify operational strategies that can swing the manufacturers' preferences between offshoring and reshoring.


Background & Objectives: Aedes aegypti is the main vector of dengue and chikungunya diseases. This mosquito is known to have proteins and fats that play a role in the process of life. This study aims to determine the fraction of protein and fat content of Aedes aegypti larvae and its ability to inhibit the growth of Escherichia coli bacteria.
Methods: Fractionation of protein with ammonium sulfate at levels of 0-30%, 30-40%, 40-60%, and 60-80%. Determination of protein content by Lowry method and fat by standard laboratory operations. Test of effectiveness by measuring the diameter of inhibition zone around the paper disc.
Result: The results of protein content measurements using 0.2 ml with 10 times dilution showed that 30-40 % of fraction contains highest levels of total protein 5.26 mg and lowest in the 0-30 % fraction 3.76 mg. The results of protein content measurements using 0.02 ml of sample extract with 100 times dilution showed that 40-60 % of fraction contains the highest total protein content 27.03 mg and lowest in the 0-30% fraction 4.88 mg. Fat content is only found in the protein fraction of 0-30% and 30-40 %. Result of effectiveness test showed that protein fraction of 30-40% and 60-80 % are bakteriocide. Fraction of 30-40 % has 0.6 % fat content and the fraction of 60-80 % have no fat content. Crude extract, fractions of 0-30 %, and 40-60 % are bacteriostatic. Protein fraction of 0-30 % has fat content of 0.8%, while the crude extract and fractions of 40-60 % do not have fat content.
Interpretation & Conclusion: Protein fraction of Ae.aegypti showed inhibition to the growth of E. coli. Fat content does not give effect to bacteriostatic or bacteriocide of bioactive compounds of Ae.aegypti.


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease (COVID-19), a highly contagious infectious disease that has caused many deaths worldwide. Despite global efforts, it continues to cause great losses, and leaving multiple unknowns that we must resolve in order to face the pandemic more effectively. One of the questions that has arisen recently is what happens, after recovering from COVID-19. For this reason, the objective of this study is to identify the risk of presenting persistent symptoms in recovered from COVID-19. This case-control study was conducted in one state of Mexico. Initially the data were obtained from the participants, through a questionnaire about symptoms that they had at the moment of the interview. Initially were captured the collected data, to make a dataset. After the pre-processed using the R project tool to eliminate outliers or missing data. Obtained finally a total of 219 participants, 141 recovered and 78 controls. It was used confidence level of 90% and a margin of error of 7%. From results it was obtained that all symptoms have an associated risk in those recovered. The relative risk of the selected symptoms in the recovered patients goes from 3 to 22 times, being infinite for the case of dyspnea, due to the fact that there is no control that presents this symptom at the moment of the interview, followed by the nausea and the anosmia with a RR of 8.5. Therefore, public health strategies must be rethought, to treat or rehabilitate, avoiding chronic problems in patients recovered from COVID-19.


The Food Safety Modernization Act (FSMA), and associated regulations, is the most sweeping reform of the food safety regulatory system in the USA in more than 70 years. The FSMA confirms the primary role of the food manufacturing industry in assuring food safety, requires the food industry to conduct risk-based hazard analysis and implement preventive controls to minimize identified hazards, and applies to domestic as well as imported foods.


Laparoscopic preparation before colectomy consists of freeing the colon laparoscopically followed by a small elective laparotomy for resection and anastomosis. From January 1993 to October 1994, we performed 86 consecutive planned colectomies including 16 (19%) which had laparoscopic preparation. In 3 of these cases (19%) the procedure was converted to laparotomy due to difficult dissection. The 13 patients with complete laparoscopically prepared colectomy were retained for this study. There were 9 men and 4 women, mean age 54 +/- 14 years (range 34-79). Indications for surgery were benign tumor (n = 4), metastatic cancer (n = 3), diverticulosis (n = 3), volvulus of the pelvic colon (n = 2), and endometriosis involving the sigmoid (n = 1). Operative procedures were: short segmentary colectomy (n = 6), sigmoidectomy (n = 5), right colectomy (n = 2). Surgery duration was 280 +/- 75 minutes (range 150-390). The post-operative period was uneventful in all patients. Bowel activity resumed on the second day after surgery in most patients. Mean hospitalization time was 7.4 +/- 1.4 days (range 5-10 days). Laparoscopically prepared colectomy is a reliable simple method providing good patient comfort post-operatively. This technique should find its place in surgery of the colon.


Modularity of ontologies is currently an active research field, and many different notions of a module have been proposed. In this paper, we review the fundamental principles of modularity and identify formal properties that a robust notion of modularity should satisfy. We explore these properties in detail in the contexts of description logic and classical predicate logic and put them into the perspective of well-known concepts from logic and modular software specification such as interpolation, forgetting and uniform interpolation. We also discuss reasoning problems related to modularity.


The image formation and support, reputation-building and active marketing are vital for the existence of the nowadays modern country and its development. Today the country's nature, history, people and traditions became the exclusive brands that strengthens the economy and cross-border relations, a competitive advantage is obtained. There are many image definitions and classifications, each author analyses it from own perspective. It was found that individual elements make a big influence for a general country's image. In order to use it effectively systemic attitude is required. Country's image in the international tourism market is explained by tourist behavioural characteristics: how a person behaves in respect of country, how he or she perceives the country – as a neighbour or distant, closed or open, acceptable or unacceptable, how much the person trusts the provided information, if he or she is ready to travel to the country. Personal characteristics has an influence for perceived location's image. Despite Lithuania's efforts to make the image better abroad and inside the country, it's rank on the international agencies surveys, evaluating country's political and economic situation in the world context and how famous it is, remains low. There are no innovative strategy for building Lithuania's image. During the 2006–2015 period, there were no core changes in associations, created for foreigners by the word "Lithuania". The research found that foreigners imagine Lithuania as underdeveloped, neglected agriculture country, people are closed, not willing to communicate – the same as was imagined in 2006. Lithuania's touristic image was better after the visit. More facts about Lithuania was known by tourists from neighbouring countries. During the 9 years Lithuania's touristic image has not changed.KEYWORDS: Lithuania's touristic image, tourism economics.JEL CODES: L83, Z19


Background: Pain associated with laparoscopic cholecystectomy is most severe during the first 24 h and the port sites are the most painful. Recent multimodal approaches target incisional pain instead of visceral pain which has led to the emergence of abdominal fascial plane blocks. This study embraces a novel combination of two independently effective fascial plane blocks, namely rectus sheath block and subcostal transversus abdominis plane (TAP) block to alleviate postoperative pain. Study Objective: The aim is to evaluate the effectiveness of the combination of rectus sheath block and subcostal TAP block, to compare its efficacy with that of subcostal TAP block alone and with conventional port site infiltration (PSI) in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. Methodology: This prospective, randomized control, pilot study included 61 patients scheduled for elective laparoscopic cholecystectomy and distributed among three groups, namely Group 1: Combined subcostal TAP block with rectus sheath block (n = 20); Group 2: Oblique subcostal TAP block alone (n = 21); and Group 3: PSI group as an active control (n = 20). Results: Combined group had significantly lower pain scores, higher satisfaction scores, and reduced rescue analgesia both in early and late postoperative periods than the conventional PSI group. Conclusion: Ultrasound-guided combined fascial plane blocks is a novel intervention in pain management of patients undergoing laparoscopic cholecystectomy and should become the standard of care.


Recent research has indicated that measured contact stress distributions under radial truck tires are highly complex. These stress distributions help to explain near-surface distresses that have become more prevalent since the inception of radial tires, indicating that realistic contact stresses must be considered when pavement response and performance are evaluated. However, because of the complexities involved in measuring contact stresses under tires, obtaining these measurements directly on real pavements is not possible. Consequently, contact stress measurements have been made on systems having rigid foundations with embedded sensors. Therefore, determining whether tire contact stresses measured on a rigid foundation are significantly different from contact stresses under the same tire on an actual pavement is critical. Finite element analyses conducted indicated that both vertical and lateral tire contact stresses measured on rigid foundations accurately represent the contact stresses for the same tire on typical asphalt pavement structures. Some minor differences were observed for thin (50-mm surface) pavements on weak bases, but the correspondence in terms of both distribution and magnitude was still very good. The conclusion was that contact stresses measured by devices with rigid foundations appear to be suitable for predicting response and performance of highway pavements.


This paper demonstrates the effect of incorporating distributed plasticity in nonlinear analytical models used to assess the potential for progressive collapse of steel framed regular building structures. Emphasis on this paper is on the deformation response under the notionally removed column, in a typical Alternate Path (AP) method. The AP method employed in this paper is based on the provisions of the Unified Facilities Criteria – Design of Buildings to Resist Progressive Collapse , developed and updated by the U.S. Department of Defense [1]. The AP method is often used for to assess the potential for progressive collapse of building structures that fall under Occupancy Category III or IV. A case study steel building is used to examine the effect of incorporating distributed plasticity, where moment frames were used on perimeter as well as the interior of the three dimensional structural system. It is concluded that the use of moment resisting frames within the structural system will enhance resistance to progressive collapse through ductile deformation response and that it is conserative to ignore the effects of distributed plasticity in determining peak displacement response under the notionally removed column.


Little attention has been given to the preparation of the patient's family prior to surgery, even though nurses' clinical experience suggests that family members are often more anxious than the patient. This study explored the knowledge and anxiety of spouses and significant others of patients preparing for cardiac surgery. The subjects were selected by convenience from a preoperative class offered at the hospital where surgery was to occur. Before and after the class, the subjects completed a cardiac-surgery knowledge test and an anxiety test. The significant others were significantly more anxious than the patients prior to the class. The anxiety level of significant others was significantly reduced after the class. There were no statistically significant differences between patients and significant others on the cardiac-surgery knowledge test. These results suggest that significant others may benefit from preoperative instruction.


Abstract : AVL technology is assisting decision support, situation awareness, and emergency response situations. It a well known that the most critical time factor is the availability of basic information such as the location of an incident, location of emergency resources, distance to a certain location and travel time. Aside from emergency response support, AVL technology provides improved response time, resource management, schedule adherence and increased productivity on a day to day application. The use of this technology can support many activities such as fleet management, snow plow routing, garbage truck tracking, and mobile workforce management. The value of dynamic geospatial information is extremely powerful especially when it is integrated with existing static geospatial information because of the added capability it provides. Knowing where ?something? is located as it moves along the earth's surface, gives you the ability to predict, react, and respond accordingly. By having the authority or ability to change the direction of a moving vehicle, certain users are essentially "enabled" to make more efficient use of these valuable resources in real time. In response to a previous accident, Peterson AFB established a satellite based GPS tracking system in 2003. The system was designed to monitor missile transport using GPS, satellite communication and web based mapping capabilities. This same tracking system was later installed on emergency response vehicles to provide the similar capabilities including incident management. The Air Force Academy (AFA) Fire Department was a recipient of this system that was offered to all military installations in the region. Shortly after installation, it was discovered that although the GPS tracking system was efficient for tracking missile transport vehicles, it did not meet Emergency Management response requirements because of the eight to ten minute latency in data transmission.


The dissertation is a qualitative study of Suryoyo (Syrian Othodox) women living in Sweden. The main theme is the relation between the integration process in Swedish society and the women1s cultural and religious background and ethnic identity. The core question posed is whether the women can be looked upon as "genuinely integrated" as participant subjects and citizens in the host society.

A variety of qualitative methods are used: participation, observation, open interviews and narratives. Secondary analyses of available empirical material is also used.

The narrative analysis is based on seven short life stories. Two separate cases are also presented: one - on the individual level - about a handicapped Suryoyo woman and the encounter with the immigrant receiving society and one - on the meso level - about the Suryoyo women1s effort to organize as a women1s committee in the Suryoyo Association. An overview of the religious and political history is a context presented which is of importance for understanding the women1s situation in the Swedish exile.

The conclusion is that the women are partly "pseudo intergrated" in a genuine political , structural and societal meaning. The obstacles to intergration are gender related but reasons are also to be found in the religious/cultural background, weakness in language and education and general segregating mechanisms in Swedish society. All these factors are mutually connected and make a complex background to the women1s integration process. At the same time the women have a platform in their strong ethnic identity and experiences as active subjects mirrored in their life stories. This platform is a tool of importance in the mobilizing process.

A critical discussion on the grounded theory tradition in qualitative research is a second main theme in the study. It ends whith a reflection on methodological and ethical aspects connected to migration and ethnic research.


Biostite® is a hydroxyapatite-derived biomaterial that is used in periodontal and bone reconstructive procedures due to its osteoconductive properties. Since the molecular effects of this biomaterial on osteoblasts are still unknown, we decided to assess whether it may specifically modulate osteoblast functions in vitro. We found that a brief exposure to Biostite® significantly reduced the proliferation of MG-63 and SaOS-2 osteoblast-like cells to ~ 50% of the plateau value. Furthermore, gene array analysis of MG-63 cells showed that Biostite® caused a differential expression of 37 genes which are involved in cell proliferation and interaction, and related to osteoblast differentiation and tissue regeneration. Results were confirmed by RT-PCR, Western blot, and by an increase in alkaline phosphatase (ALP) specific activity. Biostite® also increased levels of polycystin-2, a mechano-sensitive Ca2+ channel, a promising new marker of bone cell differentiation. Biostite®, therefore, may directly affect osteoblasts by enhancing chondro/osteogenic gene expression and cytoskeleton-related signaling pathways, which may contribute to its clinical efficacy.


Introduction/Background High grade serous ovarian cancer (HGSOC) is generally detected in an advanced stage with poor long-term survival. This therapeutic resistance is attributed to its extensive inter- and intratumoural heterogeneity. Several non-tumoural cells within the tumour specimen — such as immune cells, fibroblasts and endothelial cells — are increasingly recognized as important contributors to tumoural development as they shape the microenvironment and the tumour's ability to metastasize. Methodology In this project, we employed ´3 single-cell RNA-sequencing (scRNA-seq) on randomly dissociated cells from tumour biopsies of seven HGSOC patients before first-line treatment. Results Based on gene expression and principal component analysis, we clustered 18,403 cells into 11 tumoural and 35 non-tumoural cell subtypes (figure 1). Analysis of differential gene expression enabled us to correlate known and new biological functions to most subtypes. Furthermore, we selected specific markers genes (MG) for each subtype by differential gene expression analysis within and across cell subtypes. As a downstream analysis, we evaluated these subtype-specific MG in publically available datasets containing bulk expression and curated clinical annotation of 1467 HGSOC patients. We performed a meta-analysis using multivariate Cox proportional hazards regression, adjusting for age, residual disease and FIGO stage. This allowed us to discover a prognostic effect for 7 cell subtypes across cohorts, of which 3 were associated with improved overall survival (OS) (1 type of dendritic cell, b-cell and t-cell) and 4 were associated with worsened OS (2 types of fibroblasts, 1 type of tumour cell and endothelial cell). Conclusion ScRNA-seq enabled us to disentangle the heterogeneous microenvironment of HGSOC and detect several relevant tumoural and non-tumoural cells that influence OS. These subtypes can act as novel biomarkers for treatment stratification. Quantification of these novel cell types by specific MG in bulk RNA data can make clinical implementation feasible and pave the way to a more personalized therapy. Disclosure Nothing to disclose Abstract EP1126 Figure 1 t-distributed stochastic Neighbour Embedding of the 18,403 profiled single cells with each colour coding for a cell subtype based on differential expression analysis (n=46)


A direct numerical technique has been used to investigate the kinetics of impurity precipitation on dislocations making full allowance for diffusion and with a strong elastic interaction between the solute atoms and the dislocations. A distinction is made between the growth of discrete precipitate particles and continuous rod-like precipitates on the dislocations. The kinetics for the former mode of precipitation are obtained for various values of a constant transfer velocity across the precipitate matrix interface; it is found that the fraction of solute remaining in free solution decreases exponentially with time. The continuous rod-like mode of precipitation is a consequence of a relatively high binding energy in the dislocation core, and it is shown that such a situation should lead to a transient variation of the transfer velocity across the matrix-core interface. Under these conditions, the kinetics of precipitation closely resemble the experimentally determined strain ageing kinetics in some low -carbon and nitrogen steels.


A major change took place in trilobite faunas during Late Cambrian and Early Ordovician time, that is, during the Tremadoc Epoch. The majority of preexisting families died out shortly before or during this epoch. They were replaced by several short-lived, new groups and the earliest members of other families which dominated succeeding Ordovician trilobite faunas. The dissimilarities between samples of Tremadoc trilobite faunas from 18 areas in the world were analyzed by a nonmetric multidimensional scaling technique. Groupings obtained by such analyses reveal faunal provinces of the Ordovician, and for the early part of the period 4 provinces were recognized. The analyses of Tremadoc faunas should reveal whether or not changes in provinces occurred during this epoch. The ssumption that a faunal province originally extended over the shallow seas surrounding a single continental mass is used, with palaeomagnetic data, to propose a model for Tremadoc paleogeography. End_of_Article - Last_Page 662------------


Aims
Coronary microvascular dysfunction (CMD) can cause angina in the absence of obstructive coronary artery disease (CAD). We studied the frequency and angiographic characteristics of CMD in symptomatic patients with suspected stable CAD and identified CMD as diffusely abnormal coronary vasodilator capacity by positron emission tomography (PET) perfusion imaging.

Methods and results
We recruited prospectively 189 patients with intermediate pre-test probability of CAD who underwent coronary computed tomography angiography and quantitative 15O-water PET perfusion imaging followed by invasive coronary angiography, and assessment of fractional flow reserve when feasible. Prevalence of obstructive epicardial CAD was 37%. Absolute myocardial blood flow was diffusely reduced (<2.4 mL/g/min) within the left ventricle during adenosine stress in 32 (17%) patients. In 15 (8%) patients, this was explained by three-vessel obstructive CAD, whereas the remaining 17 (9%) were diagnosed with CMD. Of these, 2 (1% of all patients) had no coronary atherosclerosis, 5 (3% of all patients) had non-obstructive atherosclerosis, and in 10 (5% of all patients) CMD co-existed with obstructive CAD. Atypical angina or non-anginal chest pain (53%) was the most common presentation. Older age and male sex were associated with CMD, but other risk factors of CAD were equally common in patients with or without CMD.

Conclusion
Coronary microvascular dysfunction exists in 9% of symptomatic stable patients with suspected CAD. However, the prevalence of microvascular dysfunction without any coronary atherosclerosis is low (1%) in this population.


In this paper the interfering resonances parameters determination ambiguity is considered. It is shown that there are two solutions for two fixed width resonances. Analytical relation between different solutions is derived. Numeric experiments for fixed width three and four resonances, and for model energy-dependent width two resonances confirm ambiguity of the resonances parameters determination.


Numerous genera and species of shrubs occur throughout the Intermountain region in addition to those included in the Asteraceae, Chenopodiaceae, and Rosaceae families. Although shrubs are widespread throughout this region and dominate many areas, species richness is low compared to the shrub flora of the Pacific United States, Chile, western Australia, and South Africa (Stebbins 1975). Generally, evolution proceeds most rapidly when populations are isolated from one another and exposed to different environmental conditions (Dobzhansky 1970; Stebbins 1950); this is the case in the Intermountain region. However, fewer numbers of species within this region are, in part, due to the relatively recent advance and retreat of continental seas, drastic environmental changes, and instability that result in a high rate of extinction (Stebbins 1975).


Many scholars of political power and public law contributing to this volume, alike with much of the world's population, have been driven in the 2020s epidemics to turn our minds to medicine, government and justice in ways we have not turned them previously. For myself – and I suspect for numerous academics – the starkest questions usually came prefaced in my mind with 'why had I not done enough to have thought more about this before?' Power and law in these kinds of troubled times were infused with, and bound into, the great issues of virus justice and vaccine justice with which the world and every kind of society is required daily to grapple. More abstractly, many of the initial questions for me were located in the large puzzle of how to place lifeessential medicalscientific knowledge and associated technologies into these politicosocial spaces and their governance. My own work recently has been on physical and digital infrastructures and the workers within and around them, and on the legal and infrastructural governance of datainformationknowledgewisdomjustice. In nearly every society, the existential importance of the visible and nonvisible work of medical professionals as well as many other workers and caregivers on the front line in infectious disease epidemics was at the forefront in coping with covid19. Considerable notice and thought has long been given to this work by the people doing it, of course, and in academic terms it is also prominent in feminist and sts traditions, as well as in rich historicocultural studies of many kinds, including specific histories of professions. Much of the deep thought about this outside EuroAtlantic political theory has barely been absorbed inside it. In this little note, though, I write just about asking what is said (and not said) on medics in epidemic disease times within the traditional


Therapeutic Area: Painmanagement. Format: This is a hardcover bookdividedinto 14chapters, withreferences. Audience: Health-care providers seekingto expandtheirknowledge of managing paininolderadults. Purpose: As stated by the editor in the introduction, the purposeof the textis to "provide an updated andcomprehensive approach to relievingsuffering in olderadultsthrough reliefof theirpain." Content: The organization of the secondedition is similarto that of the firstedition,with 14chapters thatcovermanydiversetopicsrelated to pain management.Chapters I and 2 give an overview of the challenges to managing painin olderadults. Chapter 3 provides a framework forpainassessment. Chapter4, a newchapterin thisedition, summarizes the American Geriatrics SocietyGuidelines for Pharmacological Management of Persistent Pain in OlderAdults (2009). Chapters 5 and6 discuss the role of spiritualityand nonpharmacologic approachesto pain management. Chapters7 (non-opioids)and 8 (opioidsand adjuvants) discuss pharmacologic management of pain.The remaining chapters discuss invasivepain managementstrategies,pain managementin longterm care,legislative and public policy issues,Internet and electronic records to assistwithpainrelief,and suggestions for changeat the societallevel to improve painmanagement. Usability: Overall, the text is wellorganized and easyto read.An index is included for easy location of topics,and eachchapterincludes an updated listof references. Highlights:The2 chapters thatfocuson pharmacologic management of pain are comprehensive and wellwritten,with an emphasison nonsteroidal antiinflammatory drugsandopioids. A chapterwritten withthe patient in mindis devoted to providing patients withinformation so they can become betteradvocates for theirpainreliefgoals. Limitafions: Some chaptershave a moregeneralfocus than others. At times,opportunities weremissedto discussstudies thathaveexaminedage-related differences in pharmacokinetics or adverse events when thesedatawereavailable for specific medications. Giventhechapters are organized by drug class, it was challenging to find a comprehensive treatment recommendation for specific painconditions (eg, neuropathic pain,postoperative pain,or painat theendof life).Thisbookwould have beenstrengthened byaddressing theroleof complementary andalternativemedicine inpainsyndromes, which arecommon modalities forolder adults(eg,acupuncture, glucosamine/chondroitin). Comparison with Previous Edition: The previous edition of this handbook waspublished in 2005.The 2ndeditionupdates chapters with new information. Missingfrom thiseditionwas the excellentappendix that provided comprehensive dosinginformation andconsiderations for useof individual medications. Comparison with Other Related Books: The other textbook available on this topic, namely,Pain in Older Adults (published2005), is morecomprehensive, but isa full-sized textbook on thetopic. Reviewer's Summary: This book is one of the few updatedbooks devotedto pain management in olderadults,and therefore is an importantcontribution to the field.The editorhas achievedthe statedgoalof providing a holistic approach to painmanagement. The usability of this reference wouldbe enhanced withthe inclusion of treatment algorithms for common painsyndromes encountered in olderadults(eg,neuropathic pain,postoperative pain or end-of life issues). This handbook willbe useful to healthcare providers who want to expandtheir knowledge in managing painin olderadults.


For the processes described by dynamical systems, closed trajectories of dynamical systems are in line with periodic oscillations. Therefore, there is a considerable interest in describing the bifurcations of the generation of closed trajectories from equilibrium when the parameters change. In typical one-parameter and two-parameter families of smooth dynamical systems on a plane, closed trajectories can be generated only from equilibrium – weak focus. In mathematical modeling in the theory of automatic control, in mechanics and in other applications, piecewise smooth dynamical systems are often used. For them, there are other bifurcations of the generation of closed trajectories from equilibrium. The paper describes one of them, which is a typical family of dynamical systems specified by a piecewise smooth vector field on a two-dimensional manifold depending on two small parameters. It is assumed that for zero values of the parameters the vector field has a singular point O on the line of discontinuity of the field, and the point O is stable; in one half-neighborhood of the point O the field coincides with a smooth vector field for which the point O is a weak focus with positive (negative) first Lyapunov value, and in the other half-neighborhood it coincides with a smooth vector field directed at the points of the line of discontinuity inside the first of the semi-neighborhoods. The paper describes bifurcations in the neighborhood of the point O as the parameters change, in particular, indicating the regions of the parameters for which the vector field has a stable closed trajectory.