Scaffold of hydroxyapatite for further tissue-engineering application was produced by hydrothermal treatment of cuttlefish bone originated aragonite at 200°C. Aragonite (CaCO3) monoliths were completely transformed into hydroxyapatite after 48 hours of HT treatment. The substitution of CO3- groups predominantly into the PO4 3- sites of the Ca10(PO4)6(OH)2 structure was suggested by FTIR spectroscopy. SEM micrographs have shown that the interconnected hollow structure with pillars connecting parallel lamellae in cuttlefish bone is maintained after conversion. Specific surface area (SBET) and total pore volume increased and mean pore size decreased by HT treatment.


The recording of turbocharger maps is usually ensured through measuring points on constant speed lines at a quasi-steady operating point of the turbocharger. Operating points can be controlled by the parameters hot gas mass flow and gas temperature on the turbine side of the turbocharger as well as the output air flow resistance at the compressor side. Because of the simultaneous usage of the controls, long settling times are required to reach a turbocharger operating point that can be assumed to be stationary.
The present paper takes up that even transient measured characteristic operation points are comparable to stationary measured ones. Influences from a transient operation mode on characteristic diagrams for compressor and turbine are investigated experimentally. By transient operation for t/c map measurement, the possibility of a significant time saving is expected compared to that of quasi-steady operating points.


Objectives The identification and recognition of occupational diseases (OD) has important and longstanding limitations in Spain. The creation of an Occupational Disease Unit (ODU) at the Parc de Salut Mar health system (PSMAR) in 2010 is among the latest innovative initiatives to address these restraints. Its aims are to identify, evaluate and report suspected cases of OD among PSMAR patients, based on the collaboration of clinical and occupational health services, and patients. Methods Prospective clinical study of a series of suspected cases of OD identified at PSMAR between 2010 and 2014, referred to the ODU for an in-depth protocol-driven confirmatory clinical evaluation, leading to a standardised causation report. Confirmed cases were followed up to provide continued support. The official OD recognition process was tracked to determine whether it had been initiated and followed to final administrative closure. Results A total of 115 potential cases were referred to ODU by PSMAR health system physicians, of which 46 (40%) were confirmed as cases of suspected OD. The majority of confirmed cases were men (80%), with diagnoses of hearing loss (43%), musculoskeletal disorders (24%), cancer (22%) and dermatoses (11%). The positive predictive value was 39% (95% CI = 27.39–50.99). With respect to final administrative decision, 14 of 31 patients who initiated the official recognition process were rejected, 4 remained open, and 13 had been recognised as OD. Of these, 11 were recognised by the administrative route and two through litigation. The mean time to recognition was 295 days. Conclusions The results obtained from this experience have shown the ODU to be useful and effective. The challenge now is to expand this approach for identification and management of OD to other hospitals of the Spanish National Health Service. Fondo de Investigaciones Sanitarias (FIS: PI12/02556), Instituto de Salud Carlos III, Subdireccion General de Evaluacion y Fomento de la Investigacion, Ministerio de Ciencia e Innovacion, Spanish Government


: Exponents of Critical Heritage studies maintain that people, communities, events, and places linked with the working class are often underrepresented and misrepresented by dominant discourse. Working-class communities tend to be erased from official history or portrayed in a negative light. This article concerns the role played by a social history museum to promote social inclusion through representation made for and with a community faced by detrimental economic, social, and political social changes. Cultural reclamation is crucial for communities that bear the brunt of deindustrialization and the consequent loss of power, leading to social and economic dislocation. Changes in the world's political economy have endangered many of these communities. These changes also threaten the heritage that provide these social groups with a positive sense of place and identity since low-income areas are often perceived as blighted, in need of bulldozer renewal by urban planners. This participatory action research demonstrates that circumstances may push social history museums to go beyond education and embrace social activism in an effort to bring about social justice.


Despite the important effects of diet and parasite infection on male reproductive behavior, few studies have simultaneously addressed their influence on intrasexual selection (male--male competition). We examined the synergistic effects of 2 naturally varying environmental factors, lifetime food intake and infection, with the monogenean parasite Gyrodactylus turnbulli on the mating tactics and foraging behavior of male guppies (Poecilia reticulata). We allowed fish to interact directly with each other during observations and found that unparasitized males won more intermale contests, courted females more frequently, and received positive responses to courtship displays more frequently than males that had been infected. Infected males devoted more time to foraging and less time to courtship and competition than uninfected males, suggesting that they were energetically limited and could not increase reproductive effort despite their reduced expected lifespan. This interpretation was supported by the observation that greater food intake ameliorated the negative effects of parasite infection on courtship effort. Our results have bearing on how natural variation in food availability and parasite prevalence influence geographic variation in reproductive behavior. Copyright 2009, Oxford University Press.


The number of women murdered and mutilated by Jack the Ripper is impossible to know, although most researchers now agree on five individuals. These five canonical cases have been examined at length in Ripper literature, but other contemporary murders and attacks bearing strong resemblance to the gruesome Ripper slayings have received scant attention. These unsolved cases are the focus of this intriguing book. The volume devotes separate chapters to a dozen female victims who were attacked during the years of Jack the Ripper's murder spree. Their terrible stories--a few survived to bear witness, but most died of their wounds--illuminate key aspects of the Ripper case and the period: the gangs of London's Whitechapel district, Victorian prostitutes, the public panic inspired by the crimes and fueled by journalists, medical practices of the day, police procedures and competency, and the probable existence of other serial killers. The book also considers crimes initially attributed to Jack the Ripper in other parts of Britain and the world, notably New York, Jamaica, and Nicaragua. In a final chapter, the drive to find the identity of the Ripper is examined, looking at contemporary and later suspects as well as several important theories, revealing the lengths to which some have gone to claim success in identifying Jack the Ripper.


Abstract Situated in the broader context of educational aid for Tibet and higher education reform in China, this article examines efforts to develop higher education in the Tibet Autonomous Region (TAR). Based on document analyses, observations and interviews, we interrogate the thoughts and actions of university officials in the TAR when responding to the state's call for the creation of "double first-class" (shuangyiliu 双一流) universities and disciplines. Our study identifies two main strategies adopted by university officials: capitalizing on the plateau's unique geography and China's system of preferential ethnic policies. University administrators hope to use the TAR's unique and strategic location as a springboard for curriculum and research development, while drawing on aid and assistance from the central government and partner universities. We conclude that the future of higher education in the TAR is highly dependent on external assistance and that the region faces an uphill battle in building a truly world-class university.


Every times a lot of business is facing difficult condition that makes their performance poorer, and sometimes went to failure and bankrupt. Business failures are not without cost, it entails economic and social cost. Even though organizational decline is an important and unavoidable concern of organizations, it has received little research attention to the study how business can turnaround its operations to be profitable, especially in developing countries. The objectives of this empirical research are to fill the gap of research on turnaround strategy of the Indonesian listed companies. Moreover, this research tries to answer two main questions; (1) what are the main turnaround strategies adopted by Indonesian listed company? (2) Arc there any different on tumaround strategy implemented by the finns at differcnt industries listcd on Jakarta Stock Exchange? Sample of this study is the firms that experiencc turnaround listcd on Jakarta Stock Exchange from the year 1995 to 2001, based on this criterion, ten firms comprise of five in manufacturing sector and five in non manufacturing sector were chosen as the sample. This research found out that most of the firms that successfully turnaround implemented operational turnaround, by cutting the operational cost, conducting debt restructuring and sold unproductive assets. Moreover, the study also revealed that there were not different between turnaround strategy implemented by firms in manufacturing sector and non manufacturing sector. Keyword: Strategic Turnaround, Operational Turnaround, Company Performance


The prevalence of coronary artery disease (CAD) has increased over several decades. With increased awareness, early diagnosis and improved non-invasive and invasive modalities, the population has significantly grown. Patients present with varying degrees of pathology, from stable angina to myocardial infarction and cardiogenic shock. As a result, some patients may develop left ventricular dysfunction and subsequent heart failure, whereas others may avoid this complication. Heart failure patients have received increased attention given their acuity, the need for repeated hospitalizations due to recurrent decompensations, increasing healthcare costs and subsequent poor quality of life. With increased data, evidence based medications have proven to reduce mortality and re-hospitalizations in patients with heart failure, with less hospital admissions and shorter stays as well as improved quality of life.


Ultra long-term EEG registration using minimally invasive low-channel devices is an emerging technology to assess sporadic seizure events. Highly sensitive automatic seizure detection algorithms are needed for semi-automatic evaluation of these prolonged recordings. We describe the design and validation of a deep neural network for two-channel seizure detection. The model is trained using EEG recordings from 590 patients in a publicly available seizure database. These recordings are based on the full 10-20 electrode system and include seizure annotations created by reviews of the full set of EEG channels. Validation was performed using 48 scalp-EEG recordings from an independent epilepsy center and consensus seizure annotations from three neurologists. For each patient a three-electrode subgroup (two channels with a common reference) of the full montage was selected for validation of the two-channel model. Mean sensitivity across patients of 88.8% and false positive rate across patients of 12.9/day was achieved. The proposed training approach is of great practical relevance because true recordings from low-channel devices are currently available only in small numbers and the generation of gold standard seizure annotations in two EEG channels is often difficult. The study demonstrates that automatic seizure detection based on two-channel EEG data is feasible and review of ultra long-term recordings can be made efficient and effective.


Recently, Optical Coherence Tomography (OCT) has become one of the preferred clinical techniques for intracoronary diagnostic imaging. Thanks to its high resolution imaging capability, the OCT technique allows to identify microscopic features associated with various types of coronary plaque and to track of stent position, malaposition and neo-intimal tissue growth after stent implantation. Accurate visualization of stent struts can help to examine the status of implanted stents potentially leading to proper treatment of the coronary artery disease. However, unfortunately, current stent identification involves time-consuming segmentation algorithms sometimes requiring labor-intensive manual analysis process. To resolve the problem, we propose a high-speed automatic segmentation algorithm of intravascular stent struts in OCT images. Unlike the other "automatic" stent segmentation algorithms, which are mainly based on time-consuming machine learning algorithms with manual addition and removal of stent struts for correction during the analysis process, our algorithm does not require any manual adjustments of stent struts. Our algorithm first analyzes 10 consecutive crosssectional OCT images to take boundary information into account to enhance the accuracy of guide-wire segmentation and lumen segmentation. Then, it performs stent segmentation by automatically eliminating guide-wire signals using the previous segmentation results. The implementation of our algorithm uses the Intel(R) IPP library on CPU and the CUDA technology on GPU, which achieves the average analysis time of 0.28 s/frame and the detection rate ranging from 84% to 88.6% for about 120 continuous images per patient. As such, the proposed algorithm is robust and fast enough to be integrated in clinical routine.


Synopsis : The structural variation in the thickness direction of ultra-low C sheet steel rolled in the ferrite region without lubrication is analyzed with EBSD technique as well as conventional measuring method. (1) A nonuniform microstructure through the thickness is formed due to the additional shear strain introduced by frictional force between the rolls and the material, and the fine grains with the size of 1.0 to 1.5 microns are observed near the surface where the shear strain is maximum. Since the dislocation density of these grains is relatively low and these grains are surrounded by high-angle boundaries having a misorientation angle over 15•‹, these grains might be recrystallized ones. (2) The microstructure observed in the etched steel with SEM are changed continuously from the deformed grains to the subgrains and the recrystallized grains with increasing shear strain. On the other hand, the size of the subgrains consisting of substructure is 0.5 to 1.0 microns by means of EBSD, and it is independent of shear strain. (3) The misorientation angle between the adjacent subgrains is increased with increasing shear strain, and high-angle boundaries are formed near the surface. (4) These experimental results suggest that the fine recrystallized grains might have formed in such a way that the subgrains are rotated continuously and the misorientation angle between the adjacent subgrains is increased over 15•‹ with increasing shear strain, and the rearrangement of dislocations occurs during and/or after rolling, resulting in the formation of recrystallized grains.


ABSTRACT Seventy-three green turtles, Chelonia mydas (Linnaeus, 1758), were observed in 84 sightings along 28 transects covering 67% of Rota's shoreline and outer reef perimeter in the Commonwealth of the Northern Mariana Islands. No other sea turtle species were encountered. Juvenile turtles of various sizes dominated in all surveyed environments, and observations of turtles with estimated straight carapace lengths ≤40 cm suggested recent and continuing recruitment at Rota. Distribution of turtles appeared temporally stable when compared with previously reported observations and data, with turtle concentrations highest along northeast, east, and southeast coasts of the island. Approximately 118 turtles were projected to inhabit nearshore habitats at Rota. Although this population may appear minor and indistinct compared with those at nearby Tinian and Saipan, continued monitoring would be useful for comparison of Mariana Islands trends. Thirty-five species of cyanophytes, algae, and a sea grass noted as green turtle forage in other world regions were identified at Rota in this and previous surveys.


The relation between myocardial adenosine content and coronary vascular resistance was studied in the open-chest dog. Cardiac performance was increased by aortic constriction or by intravenous infusion of isoproterenol. Coronary blood flow was measured by the microsphere tracer technique. In control animals, adenosine content and coronary vascular resistance were 0.22 +/- 0.03 nmol/g and 1.9 +/- 0.11 mmHg . ml-1 . min . 100 g, respectively. A range of myocardial oxygen consumptions of 5.3-24 ml O2 . min-1 . 100 g-1 was elicited. This was associated with a range of coronary blood flows of 33-166 ml . min-1 . 100 g-1. There was a significant negative correlation between coronary vascular resistance and the log of the myocardial adenosine content (r = 0.77). There was no transmural gradient in adenosine content in the control and aortic-constricted groups, but there was a significant adenosine gradient in the isoproterenol-infused group in which coronary input pressure was decreased. The hearts were not ischemic, as indicated by low myocardial lactate contents and a stable coronary sinus blood pH. These results provide support for a role of adenosine in the local control of the coronary circulation during increased cardiac performance.


Referring to the technology of SAW wireless identification systems, a multi-resolution wireless force sensing system, including a passive time-delay SAW device and a specific interrogation unit, is introduced in this paper. Using an IDT, which connects with an antenna, as the force sensing element is a design to transduce the electromagnetic wave into surface acoustic wave and vice versa. Several reflectors are designed to get multi-resolution. Sample/hold devices are used instead of high-speed A/D converter to construct a low-cost interrogation system. Properties of the sensing system are theoretically predicted and experimentally verified.


The main aim of this article is to improve knowledge on applicability of Big Data (BD) techniques in social research, by exploring the validity of using BD as an approach in emerging news contexts. In particular, we constructed and examined a large database of historical data of public online comments on a recent constitutional bill review. We using BD technology in order to analyze people's opinions to this particular reform.


Clusters of galaxies are expected to be reservoirs of cosmic rays (CRs) that should produce diffuse gamma-ray emission due to their hadronic interactions with the intra-cluster medium. The nearby Perseus cool-core cluster, identified as the most promising target to search for such an emission, has been observed with the MAGIC telescopes at very-high energies (VHE, E greater than or similar to 100GeV) for a total of 253 h from 2009 to 2014. The active nuclei of NGC1275, the central dominant galaxy of the cluster, and IC310, lying at about 0.6 degrees from the centre, have been detected as point-like VHE gamma-ray emitters during the first phase of this campaign. We report an updated measurement of the NGC1275 spectrum, which is described well by a power law with a photon index Gamma = 3.6 +/- 0.2(stat) +/- 0.2(syst) between 90GeV and 1200 GeV. We do not detect any diffuse gamma-ray emission from the cluster and so set stringent constraints on its CR population. To bracket the uncertainties over the CR spatial and spectral distributions, we adopt different spatial templates and power-law spectral indexes alpha. For alpha = 2.2, the CR-to-thermal pressure within the cluster virial radius is constrained to be less than or similar to 1-2%, except if CRs can propagate out of the cluster core, generating a flatter radial distribution and releasing the CR-to-thermal pressure constraint to less than or similar to 20%. Assuming that the observed radio mini-halo of Perseus is generated by secondary electrons from CR hadronic interactions, we can derive lower limits on the central magnetic field, B-0, that depend on the CR distribution. For alpha = 2.2, B-0 greater than or similar to 5-8 mu G, which is below the similar to 25 mu G inferred from Faraday rotation measurements, whereas for alpha less than or similar to 2.1, the hadronic interpretation of the diffuse radio emission contrasts with our gamma-ray flux upper limits independently of the magnetic field strength.


I come to you this morning not as an intellectual property lawyer but as a former general counsel of biotechnology and pharmaceutical related companies, as an attorney with significant exposure to intellectual property issues and as one who has seen first-hand the importance of intellectual property in shaping commercial strategies in biotechnology. With that as a backdrop, I would like to thank you for allowing me the opportunity to share with you today thoughts that I have regarding patents and the impact of patent reform on biotechnology. It has been said that the best way to predict the future is to invent it. However, I believe that the best way to control the future is to patent it.


Simplified environments characterize agroecosystems, reducing the diversity of associated plants, which are not cultivated for economic purposes, causing unbalances that can promote the emergence of cultivated plants pests, as well as the reduction of their natural enemies. Management systems that increase diversity in agroecosystems can extend the action of natural enemies of pests. Studies to understand the diversity of insects associated with rice cultivation and determine their ecological guilds can provide information about the composition and structure of such ecosystems, which can be applied to integrated pest management. Therefore, the study aimed to describe and compare groups of insects in irrigated rice fields, with organic management using two different systems of levees vegetation management, and relate them to the phenological states of rice cultivation (seedling, vegetative, and reproductive). Samples were taken in a plantation located in Águas Claras district of Viamão, RS. The total area of 18 ha was divided into two. A subarea called not cut (NC), where wild vegetation of levees was maintained, and the subarea named cut (C), where monthly cuts were made to levees vegetation, from the beginning of soil preparation until the harvest. From October 2012 to March 2013 were held weekly collections in quadrats randomly located in both the rice fields and the levees. A total of 800 insects were collected, 429 in the C subarea and 371 in the NC. There were identified 97 morphospecies in the C and 108 in NC, being 54 shared between the subareas. The captured insects were grouped into guilds: saprophages (C = 38.2%; NC = 27.5%), phytophagous (C = 28.5%; NC = 33.2%), entomophagous (grouping parasitoids and predators) (C = 29.4%; NC = 35%) and finally other insects (C = 4 %; NC = 4.3%). The peak abundance of phytophagous and entomophagous was registered in the vegetative stage of rice. At the same stage the UPGMA analysis showed that similarity in species composition was greater than 90% in the groups obtained in the paddy fields of C and NC subareas. The vegetation of levees can positively influence the presence of entomophagous in the field. Although the abundance did not change clearly, the greatest diversity in the NC areas of all the groups, may contribute to the maintenance of ecological services expanding the system resilience.


Purpose of review In the absence of an established critical pathway to evaluate patients with syncope presenting to the emergency department, this review is timely because of new clinical evidences supporting a specialized syncope management unit in the emergency department, and it is relevant because of the potential impact on a very large and heterogeneous population. Recent findings Three observational syncope studies from Italy showed a high degree of variability in practice patterns, diagnostic yields, and lengths of hospital stay. An appropriate and efficacious syncope management pathway in the emergency department remains far from established. In a randomized trial from a tertiary care hospital in the US, the SEEDS study demonstrated that a designated 'syncope unit' in the emergency department, with a multidisciplinary effort and appropriate resources, significantly improved diagnostic yield, reduced hospital admission and total length of hospital stay in intermediate-risk patients. Long-term follow-up showed that reduced hospital stay did not negatively affect survival and recurrent syncope. Summary Limited randomized trial data suggest a designated syncope unit in the emergency department holds promise to provide specialized and efficient care for patients with syncope. Additional data are needed to assess the general applicability of this critical pathway in community-based hospitals.


1. The effects of animal size and of type and concentration of food particles upon the rate of faecal pellet production in Artemia have been investigated. 2. The rate of pellet production in starved animals, and the relation between the nature of ingested particles and the size and shape of the pellet, have been determined. 3. Chitinous membranes enclose the pellets. The origin of these membranes from the gut wall has been studied. 4. The possible function of these membranes in relation to the passage of food through the gut is discussed.


Bronchial asthma is a chronic respiratory disease,characterized by airway inflammation,airway hyperresponsiveness,reversible airway obstruction and airway remodeling,in which a variety of cells including airway inflammatory cells and structural cells are involved. Previous studies have shown that asthma is mainly driven by Th2 cytokines IL-4,IL-5,and IL-13,leading to airway eosinophil inflammation. With further research,however,it has been found that neutrophils are also closely related to asthma. Numbers of neutrophils are elevated in airway through increased chemotaxis and decreased apoptosis,which is earlier than eosinophils,leading to airway neutrophilic inflammation. Neutrophils can produce elastase,myeloperoxidase,neutrophil extra- cellular traps,chemokines and cytokines,participating in the occurrence and development of asthma. The antagonists against these molecules,such as anti-IL-8 receptor antibody,anti-IL-17 antibody,and DNase,have shown positive effects on neutrophilic asthma,but further studies are needed to support their clinical application. This article mainly reviews the role of neutrophils in asthma and related mechanisms.


Many contemporary text reinterpret the ambiguous character of Morgan le Fay. However, whether they cast her as an evil enemy or as misunderstood martyr, a surprising number of contemporary depictions share one element: they change the traditional number and/or the identity of Morgan's children. Mordred is depicted as her son, rather than Morgawse's, and there are often other sons and daughters. Morgan's children may be her allies or adversaries, or symbols of her feminity and sexuality: the texts differ in their approaches. In this paper; I discuss the various uses made of the portrayal of Morgan as mother in texts by Bradley, Sampson, Lawhead, and others.


Please allow me to make the following address for the launch of the JMA Journal. The Asian Medical Journal (later renamed JMAJ), the one preceding the JMA Journal, was started in 1958 by Taro Takemi, a former president of the Japan Medical Association (JMA), who recognized the importance of professional exchanges in the medical field between Japan and various other countries including those of the Asian region. The Asian Medical Journal aimed to introduce medical care as practiced in Japan, the beliefs and activities of the JMA, as well as stateof-the art medical sciences to other countries, and was distributed mostly over the Asian region. It is quite remarkable that transmission of information targeting areas outside Japan was initiated in as early as 1958. Taking over this mission, the newly produced JMA Journal consists of a wide range of submitted articles describing and documenting studies encompassing the fields of medicine and medical policies, as well as opinions and other relevant topics. All articles are published following a thorough and strict review of submitted manuscripts. A decrease in the number of scientific articles in Japan has been pointed out for some years. It is desirable that many manuscripts be submitted by various researchers and medical experts for the sake of improving the quality of scientific research and information in Japan. My hope is that the JMA Journal will become Japan's representative general medical journal leading other scientific journals in Japan and that it will expand to serve as an international electronic journal of science information prevailing throughout the global community. Morito Monden, MD, PhD President, The Japanese Association of Medical Sciences


The tropical hydrologic cycle affects atmospheric trace gases and global climate change, and thus records of hydrologic change encompassing a variety of time scales from the low latitudes are important in paleoclimatology. Isotopic analysis of calcite from Lake Junin, Peru, provides a record of hydrologic variability that spans the last glacial-interglacial transition in the southern tropics. The record reveals a 6‰ enrichment in δ 18 O calcite during the late glacial followed by a gradual depletion during the Holocene, which can be interpreted as a decrease followed by a long-term increase in effective moisture. Close agreement between δ 18 O calcite and rainy season insolation indicates that long-term changes in tropical hydrology were linked to orbital variations. Furthermore, hydrologic change was out of phase in the northern and southern tropics over this time period.


SIMOBJECT is a portable, model-building framework of objects embedded in a graphical editing environment. This framework facilitates the prototyping of systems as diverse as communications or transportation networks, manufacturing processes, and business operations. OB JECT.MGR, the graphical object editor, is used to extend these prototypes and evolve them into detailed applications as more is learned about the system that is being simulated.


Eosinophilic granuloma is part of the clinical spectrum of Langerhans cell histiocytosis (LCH), that ranges from congenital LC histiocytoma, to congenital LCH Hashimoto-Pritzker type, to acquired self-healing LCH till to multisystem acquired LCH without or with organ dysfunction. Eosinophilic granuloma, usually involving the bone, is often diagnosed after the second year of life; its clinical course is favorable towards the remission, which is spontaneous or favored by curettage or radiation therapy.The skin can be affected in contiguity with the bone lesions or even at a distance, more often in periorificial sites (1).The primary involvement of the skin is rather exceptional (2). Its prognosis is good by analogy to eosinophilic granuloma of the bone. However, the rarity of published cases suggests careful clinical monitoring.


Background Chondroitin sulfate (CS) is one the most used molecules in the management of OA. Its mechanism of action remains to be detailed. Objectives To identify the differentially expressed genes between the inflammatory (I) and normal/reactive (N/R) synovial areas using a unique ex vivo culture model and to investigate the genetic modulatory effects of CS in this model. Methods Synovial cells (SC) were isolated from OA synovial specimens from 12 patients undergoing knee replacement. The synovial membrane was dissected and SC from N/R and I areas cultured separately for a period of 7 days with or without highly purified bovine CS (200 µg/ml, Bioibérica S.A., Barcelona, Spain). Gene expression profiling was performed using Illumina's multi-sample format Human HT-12 BeadChip (Illumina Inc.). Differential analysis was performed with the BRB array tools software. Class Comparison test between N/R and I conditions, N/R and N/R-CS conditions and I and I-CS conditions was based on paired t-test where N/R and I, N/R and N/R-CS and I and I-CS were paired for each patient. The biological relevance of up- and down-regulated genes was analyses with Ingenuity Pathways Analysis (Ingenuity® Systems). Results From among 47000 probes, 18253 were filtered out. Probes with a p-value below than 0.005 were chosen and classified as up- or down-regulated ones. By this way, 465 differentially expressed genes between N/R and I areas were identified. Many inflammatory mediators appear differentially expressed. The interferon alpha-inductible protein 6 (IFI6) was the most up-regulated. We also identified the hydroxysteroid (11-beta) dehydrogenase 1 (HSD11B1), the cathepsin K (CTSK), the chemokine (C-X-C motif) ligand 1 (CXCL1) and the EBV-induced G-protein coupled receptor 2 (EBI2). The differential expression of intermediates involved in angiogenesis pathway was also revealed between N/R and I areas. Among them, R-spondin-3 (RSPO3), the secreted phopshoprotein 1 (SPP1) and aquaporin 9 (AQP9) were up-regulated whereas ADAMTS1 was down-regulated. Finally, in the Wnt signaling, RSPO3 was up-regulated unlike dickkopf homolog 3 (DKK3) which was in turn down-regulated. We next performed a class comparison test between N/R and N/R-CS in one hand and between I and I-CS the other hand. 489 genes were identified as differentially expressed genes between N/R and N/R-CS conditions while 219 genes were identified between I and I-CS conditions. In this latter, our attention was focused on the down-regulated genes. Among them, we identified a number implicated in angiogenesis and cell migration pathways. Thus, the endothelial cell-specific molecule-1 (ESM1), the Transmembrane-4-L-six-family-1 (TM4SF1), the 5'-Ectonucleotidase (NT5E) and the growth arrest-specific gene 6 (GAS6) were down-regulated by CS. Conclusions Our work demonstrates the differential gene expression profile between paired inflammatory and normal/reactive areas of synovial membrane as well as the modulatory effects of CS on gene expression in the inflammatory areas, especially regarding genes involved in both angiogenesis and cell migration. Disclosure of Interest C. Lambert: None Declared, J.-E. Dubuc: None Declared, E. Montell Employee of: BIOIBÉRICA, S.A, Barcelona, Spain; Pre-Clinical R&D Manager, J. Vergès Employee of: BIOIBÉRICA, S.A, Barcelona, Spain; Medical Director, Y. Henrotin Grant/research support from: This study was supported by a grant from BIOIBÉRICA, S.A, Barcelona, Spain


I    ntroduction: TCD is an expensive diagnostic investigation for patients and health insurance companies. Based on the therapeutic view, cost-effectiveness of transcranial doppler (TCD) is important in patients with cerebrovascular disease. Material and Methods:This descriptive study was conducted in Neurosonology Center, Ghaem Hospital, Mashhad, within 2006-2007. Indication of TCD was made by neurologists previously. 200 TCD on 166 patients was performed by neurosonologists based on the standard protocol with AKAI device, France and 2MHz probe. The effect of TCD results on changing the dose and type of medicine and neurosurgical consultation of the patients was recorded. Data was analyzed with descriptive statistics and frequency distribution tables. Results: 166 patients (64 males and 80 females) with mean age of 53.4 years were investigated. Abnormal results were found in 27.5 of TCD. Performance of 3D TCD (15) had influence on therapeutic decisions of the patients. Among this later group, 83 were patients with subarachnoid hemorrhage and 17 had high risk cardiac source of embolism or sever carotid stenosis with recurrent cererbral ischemic events. The cost of 200 TCD in non-private center was evaluated to be about 10 million thomans. Conclusion:Due to high expenses and low percentage of therapeutic influences, performance of TCD is recommended in a restricted group of patients. However TCD is a safe and non-invasive test for assessent of main cerebral arteries, which provide useful information.


Homozygous familial hypercholesterolemia (HoFH) is an inherited disorder caused by homozygous mutations in the lowdensity lipoprotein receptor (LDL-R) gene. The genetic basis of this autosomal co-dominant disorder is distinguished by loss of function mutations in both LDL-R gene loci, resulting in reduced uptake and clearance of circulating low density lipoprotein cholesterol (LDL-C) by the liver. The LDL-R gene is located on chromosome 19 and more than 1,000 mutations, affecting the function of the receptor, have been described [1]. The resulting defects refer to different functions, i.e. ligand binding, transport, internalization, recycling, or total lack of receptors [2]. Types of LDL-R mutations include single amino acid substitutions, premature stop codons, large rearrangements, mutations affecting the promotor region and splicing of pre-messenger RNA. Rarely, similar clinical phenotypes occur with a recessive pattern of inheritance i.e. autosomal recessive hypercholesterolemia (ARH). In this case the mutations are located on chromosome 1. The differential diagnosis can be done only with genetic analysis [3]. The accumulation of cholesterol after birth produces several clinical manifestations, including xanthomas located on the hands, elbows, feet, Achilles tendons and cardiovascular complications, such as aortic valve disease. The combination of high total cholesterol (TC) and LDL-C can lead to early-onset accelerated atherosclerosis and premature coronary death, usually before the patient turns 30 years old. The diagnosis of this disease is performed during the first decade of life. In patients with HoFH, the main cause of morbidity and mortality is represented by coronary arteries disease. The majority of patients with HoFH will not achieve sufficient reductions in LDL-C levels even with the maximal doses of statin and non-statin therapies. These patients often require additional therapy such as LDL-C apheresis. This is an effective way to lower LDL-C levels in patients with FH who are not responsive to or are intolerant to drug therapy. Unlike statins, apheresis also lowers Lp(a) levels [4-6]. Apheresis is a procedure that physically remove plasma lipoproteins from the blood using dextran sulfate cellulose adsorption (DSA), heparin-induced extracorporeal LDL-C precipitation (HELP), immunoadsorption, double filtration plasmapheresis (DFPP), or direct adsorption of lipoproteins [7]. Unfortunately many patients with HoFH do not achieve the desired reduction of lipoproteins and the LDL-C levels return to pre-treatment levels within 2 to 4 weeks [7]. Specific recommendations exist for the management of children and adolescents with HoFH. The NLA Expert Panel on Familial Hypercholesterolemia recommends initial treatment for pediatric patients with statin therapy beginning at the age of 8 years, although patients with HoFH may require treatment at an earlier age [8]. The majority of pediatric patients with HoFH will require apheresis to achieve adequate control of LDL-C levels [8]. Actually LDL-apheresis is the standard treatment for patients with HoFH [9-11]. However, the decision to start LDL-apheresis is difficult because of the cost and practical considerations involved. Problems with insurance, venous access, and patient compliance must be observed for this procedure [12]. Recent new therapeutic strategies are involved to treat this rare disease. One of them, is the PCSK9 inhibitor. It is a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), a serine protease that binds LDL-R and promotes its degradation. PCSK9 gain-of-function represents a cause of FH, although rare [13]. On the other hand, more common loss-of-function mutations lead to very low LDL-C levels [14]. Gain-of-function and loss-offunction mutations in the gene for PCSK9 have been described. PCSK9 inhibition is considered an attractive target for therapy, especially in light of the fact that a large proportion of high-risk patients do not reach the target LDL-C levels, despite the maximal dosage tolerated of currently available lipid-lowering agents. Preliminary results of a study conducted by Amgen with AMG145 (evolocumab) showed a consistent reduction of LDL-C (mean -16.5% for monthly regimen and – 13.9% for bi-weekly regimen). This reduction was not however seen in the receptor-negative patients [15]. Mipomersen is another therapy. It is a second-generation antisense oligonucleotide, designed to inhibit apo-B100 protein synthesis [16]. Mipomersen binds to the mRNA sequences that encode apo-B100 and promote degradation of the apo-B mRNA by ribonuclease H. It specifically binds to the mRNA and blocks translation of the gene product. Decreasing the production of apo-B 100 reduces the production of very low density lipoprotein (VLDL) in the liver, which consequently reduces circulating levels of atherogenic VLDL remnants, intermediate density lipoproteins (IDL), LDL and lipoprotein (a) particles. Mipomersen has been granted orphan drug status by the Food and Drug Administration (FDA), which approved mipomersen in January 2013 for the treatment of HoFH [17]. Efficacy and safety of 200 mg/week of mipomersen has been assessed in patients with a clinical diagnosis or genetic confirmation of HoFH [18]. The mean reduction of LDL-C concentration was significantly greater with mipomersen (-24.7%) with a maximum reduction around to 17 weeks. A third of these patients have showed an increase in hepatic fat content from 9.6% to 24.8% [18]. Longer term studies will be needed to more fully evaluate the benefits and risks, particularly if use must be extended for patients with HoFH. Although recently approved by the FDA, in Europe The European Medicines Agency (EMA) has decided not to recommend approval for Isis and Genzyme as cholesterol-lowering drug mipomersen. Genzyme's group has requested a re-examination of the opinion. After considering the grounds for this request, the EMA re-examined the initial opinion, and has confirmed the refusal of the marketing authorization on 21 March 2013 because of safety concerns such as signs of liver toxicity and cardiovascular risks. Another drug currently evaluated as an adjunct to a low-fat diet and other lipidlowering therapies for reducing LDL-C in patients with HoFH is the orphan drug lomitapide. Lomitapide (AEGR-733; BMS-201038) is a small molecule MTPinhibitor [19], a protein located in the endoplasmic reticulum of enterocytes and hepatocytes and needed for the formation of chylomicron and VLDL particles. MTP is a chaperone that facilitates the apoB-containing lipoprotein assembly and secretion [20]. Inhibition of MTP represents a way to reduce LDL-C, apoB and TG concentrations. Lomitapide has been approved by FDA in December 2012 for the treatment of HoFH. A pilot trial with six patients with


Abstract As high-dynamic range (HDR) and wide-color gamut (WCG) contents become more and more popular in multimedia markets, color mapping of the distributed contents to different rendering devices plays a pivotal role in HDR distribution eco-systems. The widely used and economic gamut-clipping (GC)-based techniques perform poorly in mapping WCG contents to narrow gamut devices; and high-performance color-appearance model (CAM)-based techniques are computationally expensive to commercial applications. In this paper, we propose a novel color gamut mapping (CGM) algorithm to solve the problem. By introducing a color transition/protection zone (TPZ) and a set of perceptual hue fidelity constraints into the CIE-1931 space, the proposed algorithm directly carries out CGM in the perceptually non-uniform space, thus greatly decreases the computational complexity. The proposed TPZ effectively achieves a reasonable compromise between saturation preserving and details protection in out-of-gamut colors. The proposed hue fidelity constraints reference the measurements of human subjects' visual responses, thus effectively preserve the perceptual hue of the original colors. Experimental results show that the proposed algorithm clearly outperforms the GC-CGM, and performs similarly or better than the expensive CAM-CGM. The proposed algorithm is real-time and hardware friendly. It is an important supplement of the SMPTE ST.2094-40 standard.


In this paper, we highlight the key role played by Si nanowire/nanowire junctions in the electrical performance of field-effect transistors (FETs) based on percolating Si nanowire (SiNW) networks, also called nanonets. Using our original technological process to fabricate simultaneously numerous silicon nanonet-based transistors with a variable geometry, we thoroughly investigated in this paper their electrical properties for various channel lengths from 5 to 100 μm. In particular, we evidenced a clear transition in the FET performance, when NW/NW junctions are involved in the conduction path. On the one hand, for channel length shorter than that of nanowires (NWs), the devices are called multiple-parallel-channel FETs as NWs directly bridge the channel, and they exhibit poor electrical performance in terms of OFF current, ON-to-OFF ratio, and subthreshold slope. On the other hand, for channel length longer than that of nanowires (NWs), the devices are called nanonet-FETs (NN-FETs) as the current flows through percolating paths made of NWs and NW/NW junctions and the performance are considerably enhanced. By combining our structural knowledge of the material with experimental observations of electrical properties and modeling results, by relying on the percolation theory, the model for electrical transport in polycrystalline silicon and the principle of potential barrier lowering by the field effect, we propose the junction driven percolation mechanism. It explains the role played by the nanowire/nanowire junctions in the electrical properties of semiconductor percolating nanowire networks and how they drastically enhanced the electrical properties of nanowire-based field-effect transistors despite the disorder introduced by the increasing number of nanowires. As a consequence, by controlling properly the junction interfaces and device geometry for a given NW density, thanks to NW/NW junctions, the NN-based devices are a valuable and promising alternative to improve the electrical performances of NW-based devices for future developments.


The U.S. Court of Appeals for the Ninth Circuit has long been a target for those who view the court as out of step with the rest of the nation's federal appellate courts. Conservatives have been particularly critical of the Ninth Circuit for its ostensibly liberal leanings and rebellious abandonment of precedent. Others have criticized the circuit's disproportionately large caseload and apparent inability to resolve appeals at the same rate as other circuit courts. Although the Ninth Circuit began as one of the least prolific appellate courts, its docket now hosts one fifth of the nation's federal appeals. Tracing back to the 1970s, there have been recurrent calls to divide the court into several smaller circuits. Such efforts have been met with resistance from those who believe dividing the circuit is merely a politically motivated scheme to dilute the court's liberal composition—though the court's tilt is much more a function of history (many judgeships added and filled under President Carter) than geography. In dispelling the critiques often raised by opponents, this Article maintains that the Ninth Circuit should be split into several smaller circuits—but not because of its ideological composition. Splitting up the Ninth Circuit makes perfect sense when looking to the court's unwieldly size, procedural inefficiencies, jurisprudential unpredictability, and unusual en banc process. The untenable nature of the Ninth Circuit's current configuration supports the proposition that Congress should finally adopt one of the many reasonable proposals for reorganizing the court.


This Master thesis work was carried out at theWireless Center at KTH and it is part of a pilot project. This thesis is conducted for the Institute for Microelectronics and Information Technology (IMIT) at the Royal Institute of Technology (KTH) in Stockholm (Sweden) and for the Department of Telecommunications at Politecnico di Torino in Turin (Italy). This thesis addresses an area with significant potential for offering services to mobile users. In such a scenario users should have minimal interaction with applications which, by taking into account available context information, should be able to make decisions, such as setting up delivery paths between peers without requiring a third party for the negotiation. In wireless reconfigurable networks, the mobile users are on the move and must deal with dynamic changes of network resources. In such a network, mobile users should be able to contact other peers or resources by using the current route. Thus although manual configuration of the network is a possible solution, it is not easily used because of the dynamic properties of the system which would demand too much user interaction. However, existing discovery protocols fall short of accomodating the complexity of reconfigurable and heterogeneous networks. The primary objective of this thesis work was to investigate a new approach at the application level for signaling by taking advantage of SIP's features. The Session Initiation Protocol (SIP) is used to provide naming and localization of the user, and to provide functionality to invite users to establish sessions and to agree on communication parameters. The Specific Event Notification of the SIP protocol provides a framework for the notification of specific events and I believed that it could be instantiated as solution to the problem for reconfigurable application networks. This thesis proposes a method for providing localization information to SIP User Agents in order to establish sessions for service discovery. Furthermore, this method should consider context meta-data to design strategies effective in heterogeneous networks. A viable solution must support (re)location of users at the application layer when they roam between different wireless networks, such as GPRS and WLAN. An analysis of the implications of the proposed model is presented; in this analysis emphasis has been placed on how this model interacts with existing services.


BACKGROUND
Hypodontia is one of the most common developmental anomalies in man. The most frequently missing tooth is the third molar. Agenesis of canine in the secondary dentition is rarely reported .

OBJECTIVE
To report a very rare form of missing tooth in the secondary dentition due to agenesis.

METHODS
A 49-year Nigerian male consulted with a desire to have a dental check-up. Extra- and intr-oral exminations were carried out. Following observation of a a missing tooth orthopanthomograph was carried out. with a missing lower right canine. All other teeth were well formed and have all erupted into the oral cavity.

RESULTS
There was no history of systemic disease or family history of oligodontia and was generally well. Systemic examination was essentially normal. Intra oral examination revealed that he had full complement of teeth but for a missing lower right canine. There was a gap of about 2mm between the lower right lateral incisor and the lower right first premolar and a buccal displacement of the upper left second molar as well as a carious lesion on the upper first left molar. The orthopanthomograph showed that the tooth was not within the mandible in this patient.

CONCLUSION
The cause of the aplasia resulting in this rare condition is not clear but may be due to inadequate secretion of some of the signaling molecules or localized absence of their receptors in the ectomesenchye destined to differentiate into the right canine tooth.


Our work on targeting redox equilibria of malarial parasites propagating in red blood cells has led to the selection of six 1,4-naphthoquinones, which are active at nanomolar concentrations against the human pathogen Plasmodium falciparum in culture and against Plasmodium berghei in infected mice. With respect to safety, the compounds do not trigger hemolysis or other signs of toxicity in mice. Concerning the antimalarial mode of action, we propose that the lead benzyl naphthoquinones are initially oxidized at the benzylic chain to benzoyl naphthoquinones in a heme-catalyzed reaction within the digestive acidic vesicles of the parasite. The major putative benzoyl metabolites were then found to function as redox cyclers: (i) in their oxidized form, the benzoyl metabolites are reduced by NADPH in glutathione reductase-catalyzed reactions within the cytosols of infected red blood cells; (ii) in their reduced forms, these benzoyl metabolites can convert methemoglobin, the major nutrient of the parasite, to indigestible hemoglobin. Studies on a fluorinated suicide-substrate indicate as well that the glutathione reductase-catalyzed bioactivation of naphthoquinones is essential for the observed antimalarial activity. In conclusion, the antimalarial naphthoquinones are suggested to perturb the major redox equilibria of the targeted infected red blood cells, which might be removed by macrophages. This results in development arrest and death of the malaria parasite at the trophozoite stage.


Inhalation as a route for administering drugs and dietary supplements has garnered significant attention over the past decade. We performed real-time analyses of aerosols using secondary electrospray ionization (SESI) technology interfaced with high-resolution mass spectrometry (HRMS), primarily developed for exhaled breath analysis with the goal to detect the main aerosol constituents. Several commercially available inhalation devices containing caffeine, melatonin, cannabidiol, and vitamin B12 were tested. Chemical characterization of the aerosols produced by these devices enabled detection of the main constituents and screening for potential contaminants, byproducts, and impurities in the aerosol. In addition, a programmable syringe pump was connected to the SESI–HRMS system to monitor aerosolized active pharmaceutical ingredients (APIs) such as chloroquine, hydroxychloroquine, and azithromycin. This setup allowed us to detect caffeine, melatonin, hydroxychloroquine, chloroquine, and cannabidiol in the produced aerosols. Azithromycin and vitamin B12 in the aerosols could not be detected; however, our instrument setup enabled the detection of vitamin B12 breakdown products that were generated during the aerosolization process. Positive control was realized by liquid chromatography-HRMS analyses. The compounds detected in the aerosol were confirmed by exact mass measurements of the protonated and/or deprotonated species, as well as their respective collision-induced dissociation tandem mass spectra. These results reveal the potential wide application of this technology for the real-time monitoring of aerosolized active pharmaceutical ingredients that can be administered through the inhalation route.


Protection of biodiversity is a major objective in environmental management. However, standard protocols for ecological risk assessments use endpoints that are not directly related to biodiversity. In the present study, the changes in five biodiversity indicators, namely, the Hill, Shannon‐Wiener, Simpson's diversity index, AZTI's Marine Benthic Index (AMBI), and Benthic Quality Index (BQI), are calculated in case species experience direct chemical effects. This is done for an uncontaminated situation as well as for situations in which the effect concentration of a certain fraction of species (x%) is exceeded, that is, at the hazardous concentration (HCx) of the species sensitivity distribution (SSD) of the considered community. Results indicate that the response of the biodiversity indicators to concentrations spanning the complete concentration range of the SSD is variable. This response depends mainly on the type of indicator, the species assemblage, and the ratio of the slope of the concentration effect curves of the species and the slope of the SSD. At the HC5, a commonly used threshold in environmental risk assessment, biodiversity indicators, are affected at a marginal level (change is less than 5% in 99.6% of the simulated cases). Based on the results, the HC5 level is likely to be a protective threshold for changes in biodiversity in terms of richness and heterogeneity in the vast majority of the simulated cases (99.6%) for chemicals for which direct effects are dominant. Environ. Toxicol. Chem. 2010; 29:1868–1876. © 2010 SETAC


Abstract:This article discusses the potential of satire as a valuable source of knowledge for historical research, specifically for understanding the Dutch Age of Revolution (c. 1780-1800). Using the practice of petitioning—the submission of formal requests by (groups of) citizens—as a case study, it argues that satire can lay bare feelings and opinions that non-satirical sources cannot. More specifically, satirical sources address problems that in other sources are deemed taboo, as they conflict with the existing political consensus. Thus, studying satire enables historians to better understand the tensions hidden beneath the surface of a given historical epoch.


This study investigates whether there is a political business cycle (PBC) on the agricultural supports in the Turkish economy. In this respect, we investigate the policies of different Turkish governments for the agricultural supports measured by the producer support estimates for the period 1986-2011. To this end, first the series for the producer support estimates are filtered by the Hodrick-Prescott filter, and then an econometric model is employed to estimate the effects of a set of explanatory variables including the economic crisis, the opportunistic and the partisan characteristics of the incumbent parties. Our results provide limited support for the opportunistic type PBC. Moreover, it seems that some Turkish governments have created the partisanship type PBCs.


Date Presented 4/20/2018
 This study assessed light intensity and light color preferences of college students when reading using the LuxIQ. Participants preferred a very dim, pale yellow light when reading.
 Primary Author and Speaker: Carolyn Dorfman
 Contributing Authors: Lauryn Albee, Jenny Burgos, Kaitlyn Evans, Katrina Holvik, Alecia Palmer


OBJECTIVES
To define indices of completeness and accuracy of clinical information in the skin biopsy requisition form (RF) and correlate them with health care delivery outcomes and pathology service utilization.

METHODS
RFs in our pathology information system were reviewed and assessed for the presence of 10 clinical elements considered critical for dermatopathologic diagnosis. Accuracy was determined by reviewing corresponding clinical notes.

RESULTS
In total, 249 RFs were reviewed. In inflammatory dermatoses, provision of a clinical impression, provision of more than two elements, and achieving more than 75% accuracy were associated with improved outcomes and decreased utilization. For all nonlymphoproliferative cases, higher quality clinical information was associated with decreased turnaround time (P < .001). More clinical information was associated with increased utilization and turnaround time (P = .0235) for lymphoproliferative cases and higher resampling rates for melanocytic lesions (P = .0066).

CONCLUSIONS
In inflammatory dermatoses, providing high-quality clinical information on the RF promotes optimal histopathologic diagnostic performance and appropriate pathology service utilization.


Background Recent progress in pulmonary arterial hypertension (PAH) research has made possible the expansion of treatment options improving the prognosis of patients. Due to multimorbidity and increasing age, patients are much more likely to be exposed to polypharmacy. As a result, there is an increased risk of drug–drug interactions affecting efficacy as well as the toxicity of the treatment. In 2012, the pulmonary hypertension unit of our hospital was designated as a reference unit by regional health authorities. Purpose To identify potential drug–drug interactions (PDDIs) between oral drugs (OD) for PAH and medications used to treat concomitant illnesses. Material and methods A cross sectional study was conducted in April 2016 in a tertiary hospital. All outpatients on OD for PAH with their chronic medication recorded in the regional electronic database were included. We collected demographic data, concomitant pharmacotherapy and PAH treatment. PDDIs were identified using the local Guide of Interactions in Pulmonary Hypertension. Results 174 patients (224 OD) were included: 63.8% women, mean age 59 years (range 18–91). Most of the OD prescribed were bosentan and sildenafil (both 29%) followed by tadalafil (15.2%), ambrisentan (13.8%), riociguat (8.5%) and macitentan (4.5%). Approximately 30% of the patients received combined oral therapy. Median number of drugs per patient was 9 (range 2–19) and 83.9% were polymedicated (≥ 5 drugs). We identified a total of 237 PDDIs (67% of patients had at least one and over 30% more than two): 83% were moderate and 16% contraindicated according to their possible clinical relevance; 62% were pharmacokinetic and 38% pharmacodynamic; 70% affected the co-medication, 27% the OD and 3% both; 68% resulted in an increase in toxicity, 29% in decreased of efficacy and 3% both. The main contraindicated PDDIs were: beta-blockers with bosentan (n=10) and sildenafil (n=8), and bosentan with immunosuppressants (n=7). Polymedicated patients were more likely to have PDDIs (p<0.05). Conclusion PDDIs represent a significant issue among patients with PAH. Evaluation of these PDDIs could result in the establishment of a better treatment plan for these patients. However, more prospective studies are required to investigate the clinical relevance of PDDIs and their influence on therapeutic outcomes. References and/or acknowledgements Ciraci R, et al. Pulm Pharmacol Ther2014;28:1–8. No conflict of interest


Introduction:
 In May of 2010 Mayo Clinic Florida (MCF) partnered with Parrish Medical Center (PMC) in Titusville, Florida to provide remote evaluation and treatment of acute ischemic stroke patients and triage of patients for urgent transfer. PMC was initially accredited as a Joint Commission Primary Stroke Center in 2003. In the 12-month period prior to the telemedicine partnership acute neurology coverage was not continuously available, and the rt-PA utilization rate was 0.8%.

 Methods:
 Demographic data, baseline stroke severity, time of symptom onset, telemedicine diagnosis, rt-PA utilization, complications, discharge stroke severity and discharge disposition were collected prospectively. Analysis was also performed on the success of the administrative effort, including sharing of patient and statistical information, credentialing, faculty cooperation and patient satisfaction.

 Results:
 During the first 15 months of the partnership, 193 robotic telemedicine consultations were performed. The mean time from consultation request to telephone response was 3 minutes. 86 patients had a telemedicine diagnosis of stroke and 18 (21%) patients were treated with intravenous rt-PA within 3 hours of stroke onset. Among those treated with iv rt-PA, the mean time from telemedicine evaluation to rt-PA treatment was 54 minutes. The sICH rate was 0%. The median baseline NIHSS was 8.5; the median discharge NIHSS was 2. 18 patients were urgently transferred for consideration of endovascular/surgical stroke therapies. PMC was re-certified as a primary stroke center since by the joint commission in May of 2011 with no deficiencies.

 Conclusions:
 These data confirm that telemedicine can identify patients eligible for local treatment with intravenous thrombolysis or those who would benefit from urgent transfer to a comprehensive stroke center. Telemedicine can deliver stroke care at the benchmark levels required to maintain primary stroke center certification.


Due to increased interest in miniaturization, great attention has been given in the recent decade to the micro heat exchanging systems. Literature survey suggests that there is still a limited understanding of gas flows in micro heat exchanging systems. The aim of the current thesis is to further the understanding of fluid flow and heat transfer phenomenon inside such geometries when a compressible working fluid is utilized. A combined experimental and numerical approach has been utilized in order to overcome the lack of employable sensors for micro dimensional channels. After conducting a detailed comparison between various data reduction methodologies employed in the literature, the best suited methodology for gas microflow experimentalists is proposed. A transitional turbulence model is extensively validated against the experimental results of the microtubes and microchannels under adiabatic wall conditions. Heat transfer analysis of single microtubes showed that when the compressible working fluid is used, Nusselt number results are in partial disagreement with the conventional theory at highly turbulent flow regime for microtubes having a hydraulic diameter less than 250 microns. Experimental and numerical analysis on a prototype double layer microchannel heat exchanger showed that compressibility is detrimental to the thermal performance. It has been found that compressibility effects for micro heat exchangers are significant when the average Mach number at the outlet of the microchannel is greater than 0.1 compared to the adiabatic limit of 0.3. Lastly, to avoid a staggering amount of the computational power needed to simulate the micro heat exchanging systems with hundreds of microchannels, a reduced order model based on the porous medium has been developed that considers the compressibility of the gas inside microchannels. The validation of the proposed model against experimental results of average thermal effectiveness and the pressure loss showed an excellent match between the two.


Objectives: To assess how children requiring endotracheal intubation are mechanically ventilated in Italian pediatric intensive care units (PICUs). Design: A prospective, national, observational, multicenter, 6-month study. Setting: Eighteen medical-surgical PICUs. Patients: A total of 1943 consecutive children, aged 0–16 yrs, admitted between November 1, 2006 and April 30, 2007. Interventions: None. Measurements and Main Results: Data on cause of respiratory failure, length of mechanical ventilation (MV), mode of ventilation, use of specific interventions were recorded for all children requiring endotracheal intubation for >24 hrs. Children were stratified for age, type of patient, and cause of respiratory failure. A total of 956 (49.2%) patients required MV via an endotracheal tube; 673 (34.6%) were ventilated for >24 hrs. The median length of MV was 4.5 days for all patients. If postoperative patients were excluded, the median time was 5 days. Bronchiolitis (6.7%), pneumonia (6.7%), and upper airway obstruction (5.3%) were the most frequent causes of acute respiratory failure, and altered mental status (9.2%) was the most frequent reason for MV. The overall mortality was 6.7% with highest rates for heart disease (nonoperative), sepsis, and acute respiratory distress syndrome (26.1%, 22.2%, and 16.7% respectively). Length of stay, associated chronic disease, severity score on admission, and PICU mortality were significantly higher in children who received MV (p < .05) than in children who did not. Controlled MV and pressure support ventilation + synchronized intermittent mandatory ventilation were the most frequently used modes of ventilatory assistance during PICU stay. Conclusions: Mechanical ventilation is frequently used in Italian PICUs with almost one child of two requiring endotracheal intubation. Children treated with MV represent a more severe category of patients than children who are breathing spontaneously. Describing the standard care and how MV is performed in children can be useful for future clinical studies.


Embedded systems with digital signal processor (DSP) become more and more popular for the increasing requirement of supercomputing these days. Efficient development of DSP serials used in embedded systems shortens the embedded system R&D cycle. Functional verification is one of the most complex and expensive tasks during DSP serials design process. A random test platform which is urged for DSP serials verification is proposed in this paper. The platform can automatically generate the random test program. The platform also realized the recording and checking of simulation results, which make the verification more effective. In order to improve the efficiency of DSP verification, a testing experience library has been generated through the testing procedure. This platform can be transplanted for different DSP models easily by updating few modules. According to the verification results, this platform has satisfactory coverage of DSP models.


Terbinafine 250 mg po daily was administered to 21 patients affected by tinea unguium of the toenails. In 14 cases Trichophyton rubrum was the aetiological agent while Trichophyton mentagrophytes var. interdigitale affected the rest. The treatment was administered randomized during 12 or 24 weeks in two groups of 11 (group A) and 10 (group B) patients. The clinical and mycological response was evaluated at week 12, 24 and 48. Adverse events were registered during the therapeutic period. At week 24, 55.5% of patients from group A were cured, only one patient did not improve and cultures were positive. In group B 66.6% were cured and three were clinically improved but cultures were positive. In the last control after 48 weeks the results were similar except one patient of the group B who worsened of his nails lesions. Only one case of acute urticaria was noted, the symptoms disappeared after the withdrawal of terbinafine. Terbinafine per os is a safe and effective antifungal for the treatment of the tinea unguium of the toenails. A period of 12 weeks of administration is enough in most of cases but when T. rubrum is the aetiology relapse could be possible.


The authors examined the effectiveness of a 2-year (kindergarten and first grade) oral English intervention provided to 534 Hispanic English-language learners in transitional bilingual education (TBE) and structured English immersion (SEI) programs. Using latent growth modeling, the authors compared instructional programs in relation to growth trajectories and rates in academic English oracy. The findings revealed that students in all four programs (treatment TBE, control TBE, treatment SEI, and control SEI) improved significantly (p < .05) in a linear pattern over 2 years, and students receiving the intervention developed at a faster rate than those receiving typical instruction (p < .05, effect sizes >0.46). The authors concluded that (a) first-language instruction did not impede the learning of a second language, and (b) enhancements and best practices in TBE and SEI programs are needed to accelerate oral English acquisition to remove the initial disadvantage of low levels of English proficiency.


In 2013, the CJEU ruled on the 'Lyocentre' case touching upon an important and contemporary issue in the EU Medical Device regime – the classification issue between medical devices and medicinal products. This problem is connected with the internal market v. protection of health dilemma as well as the choice between minimum and maximum harmonization. The Commission aspires to solve the above dilemma by going towards maximum harmonization in this area in the form of a proposal for a new Regulation on medical devices. My hypothesis is that the new regulatory framework may be able to better balance these objectives and also deal with several problematic issues of the medical device regime. However, it is not likely to solve the problem of borderline products. In order to check that, I will explore harmonization and internal market law literature as well as the relevant case law. My argument is that because classification of borderline products is strongly related to technology and medical science, which are constantly changing, a strict and inflexible regulatory framework cannot abide by their fast pace. I conclude that this problem cannot be fully eliminated, but it can be improved through soft law instruments, as they can be easily adapted to change.


The integrin alphaEbeta7, which is predominantly expressed on mucosal T lymphocytes, has recently been shown to recognize the cell adhesion molecule, E-cadherin, on epithelial cells. We have carried out mutations on E-cadherin, involving domain deletions as well as substitutions of specific amino acids, in order to identify the sites recognized by the integrin. Binding of alphaEbeta7 required the presence of the first two N-terminal domains of E-cadherin. Deletion of extracellular domains 3 and 4 or truncation of the cytoplasmic domain of E-cadherin had no consequence on integrin binding. Substitution of a glutamic acid in the BC loop of the Ig structure of the fist, N-terminal, domain of E-cadherin abrogated binding of alphaEbeta7. This mutation did not appear to affect the conformation of the domain nor the pattern of expression of E-cadherin on the cell surface. Synthetic peptides encompassing the first domain of E-cadherin had very little inhibitory effect on the interaction with alphaEbeta7. Our results highlight structural dissimilarities between recognition of E-cadherin by alphaEbeta7 and recognition of other members of the IgSF by integrins and show that the heterophilic (integrin binding) and homophilic sites in the N-terminal domain of E-cadherin are distinct.


This research explores how healthcare organizations are leveraging business analytics (BA) capabilities and techniques to improve quality of care and reduce cost. Given the increased interest and investment in BA, it is important to have a good understanding of what analytics capabilities healthcare organizations use to enhance value. Using Burns et al. (2002) healthcare value chain framework as a basis, we will identify the various analytics techniques/capabilities and subsequently classify them into three generally accepted classification of analytics: descriptive, predictive and prescriptive. Based on extensive search of the literature, complimented by a follow-up case study of a large regional hospital, analytics applications will be mapped onto the value chain framework in the contest of healthcare. The study will contribute to practice and academia by clearly illustrating how healthcare organizations currently utilizes or should be using analytic capabilities and techniques in order to enable them close the quality gaps.


Taxes often discourage work effort. Is this a necessary but unfortunate byproduct of policies intended to redistribute from rich to poor? Or is discouraging work effort the primary goal of policy? I examine the case of 100 percent labor income tax rates and argue that 100% tax rates have some of the expected disincentive effects and hence that their prevalent use is inconsistent with the goal of redistributing from rich to poor. I then introduce a model where the primary policy goal is to discourage taxable income and show how 100 percent taxes are optimal over a relatively wide range of incomes, arguing that discouraging taxable income as a primary policy goal provides a better description of policies actually used -especially policies with respect to the elderly. Such a goal may also explain high but less-than-confiscatory tax rates, minimum wage laws, maximum hours laws, and the world-wide lack of means testing of social security programs.


The increasing use of social media platforms to advertise rental opportunities creates new challenges for fair housing enforcement. The Fair Housing Act, 42 U.S.C. §§ 3601-19 ("FHA") makes it unlawful to discriminate in the sale or rental of housing on the basis of race, color, religion, sex, familial status, national origin, and disability ("protected classes"). The FHA also prohibits discriminatory advertising, including distributing advertisements in a way that denies people information about housing opportunities based on their membership in a protected class. Accordingly, advertisers and digital platforms that intentionally or unintentionally cause housing advertisements to be delivered to users based on their membership in a protected class may be liable for violating the FHA.

In March 2018, in response to what they perceived to be discriminatory advertising on Facebook, the National Fair Housing Alliance ("NFHA") and several housing organizations filed suit in federal court in New York City. The lawsuit alleged that Facebook's advertising platform enabled landlords and real estate brokers to prevent protected classes from receiving housing ads. Facebook settled the suit on March 19, 2019. As part of the settlement, Facebook agreed to make a number of changes to its advertising portal so that housing advertisers can no longer choose to target users based on protected characteristics such as age, sex, race, or zip code. Facebook also committed to allow experts to study its advertising platform for algorithmic bias. It remains to be seen whether this agreement goes far enough in curtailing discriminatory advertising practices, as Facebook is confronting further enforcement action from a government watchdog in respect to similar issues. Moreover, a recent research study found that Facebook's digital advertising platform may still lead to discriminatory outcomes despite changes already made.

On August 13, 2018, the Assistant Secretary for Fair Housing and Equal Opportunity filed a complaint with the Department of Housing and Urban Development ("HUD") alleging that Facebook is in violation of the FHA. The Office of Fair Housing and Equal Opportunity determined in March, 2019 (the same time as the settlement agreement with NFHA) that reasonable cause exists and issued an official Charge against Facebook.

Notwithstanding these suits and administrative actions, it remains that, for fair housing claims to survive in court against media giants like Facebook, HUD and future plaintiffs must first successfully argue that Facebook is not protected by the Communications Decency Act ("CDA").


There is growing consensus around pluralism as the orientation of the social sciences in general, and British sociology in particular, towards research methodology. However, the profession of methodological pluralism, is not always apparent in research practice. This thesis seeks to explore the dimensions of a truly pluralistic sociology. It takes as its starting point Pierre Bourdieu's central methodological arguments for pluralism and reflexivity in all aspects of research practice, which involves using "all the techniques that are relevant and practically usable, given the definition of the object and the practical conditions of data collection" (Bourdieu and Wacquant, 1992, p. 227). Each paper explores the implications of this mandate for a different facet of research methodology. The first paper examines the social survey method in the UK and the US and its relationship to the social world that it sought to account for. Through a secondary review of historical literature, I observe how the social problems that demanded explanation, practical/technological constraints and advances, and the cultural climate shaped the development of the method, with the processes of institutionalisation, professionalisation and economisation shaping its trajectory in recent history. Methodological history, I argue, enables survey practitioners to reflectively appraise the idiosyncrasies of the method's development, current practices and future prospects. The second paper problematises the compartmentalisation of sociology's diverse methodological repertoire within the data collection stage of research. I explore how a creative, multi-modal method – storyboarding – can serve as a useful tool to the researcher in the pre-empirical processes of conceptualisation and research design. This is exemplified through examining the challenge of operationalising trust. Using Bourdieu's notion of the construction of the sociological object, I argue that the use of creative, visual/multimodal methods serves to highlight where conceptual slippages, suggests new aspects of that concept and approaches to its investigation, and facilitates the researcher's reflexive exploration of their own relation to the object of research. For Sociology to achieve genuine methodological pluralism, it is not sufficient to apply a wide range of methods: the implications of those methods in practice must also be continually questioned. The third paper argues that there lacks a sufficient theoretical account of the micro-dynamics of power in focus group discussions, while much of the standard guidance on their conduct serves to control interactions in a way that sanitises them of these dynamics. I exemplify an approach using Bourdieu's concept of fields to address these deficiencies, based on focus group discussions which used photo elicitation to examine national identity among South Sudanese diaspora in the UK. These papers indicate that the attitude of 'relentless self-questioning' that Bourdieu describes as reflexivity is key to the achievement of pluralism. Pluralism sits in the tension between a permissive view as to what constitutes knowledge, and the constraints of methodological reflexivity and ethics: issues that are bound up in the relationship between the researcher and the researched.


The ability to automatically identify a speaker's accent would be very useful for a speech recognition system as it would enable the system to use both a pronunciation dictionary and speech models specific to the accent, techniques which have been shown to improve accuracy. Here, we describe some experiments in unsupervised accent classification. Two techniques have been investigated to classify British- and American-accented speech: an acoustic approach, in which we analyse the pattern of usage of the distributions in the recogniser by a speaker to decide on his most probable accent, and a high-level approach in which we use a phonotactic model for classification of the accent. Results show that both techniques give excellent performance on this task which is maintained when testing is done on data from an independent dataset.


Superspreading events have characterised previous epidemics of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infections. Using contact tracing data, we identified and characterized SARS-CoV-2 clusters in Hong Kong. Given a superspreading threshold of 6-8 secondary cases, we identified 5-7 probable superspreading events and evidence of substantial overdispersion in transmissibility, and estimated that 20% of cases were responsible for 80% of local transmission. Among terminal cluster cases, 27% (45/167) ended in quarantine. Social exposures produced a greater number of secondary cases compared to family or work exposures (p<0.001) while delays between symptom onset and isolation did not reliably predict the number of individual secondary cases or resulting cluster sizes. Public health authorities should focus on rapid tracing and quarantine of contacts, along with physical distancing to prevent superspreading events in high-risk social environments.


With the work-in-progress research project ColorTracker we explore color as a formal design tool. This project-based paper describes a novel software application that processes color composition of a place and transcribes the data into three-dimensional geometries for architectural design. The research comprises two parallel trajectories: a theoretical survey and the software application design. The theoretical survey presents the historical background of color. The project-based research seeks to develop digital methods and techniques that analyze the color compositions of the environment. Subsequently the objective is a novel application software for smart mobile devices in order to demonstrate the potentials of examining the color composition and chromatic parameters of a given environment and how it can contribute to the design. for


Cookie paywalls allow visitors of a website to access its content only after they make a choice between paying a fee or accept tracking. European Data Protection Authorities (DPAs) recently issued guidelines and decisions on paywalls lawfulness, but it is yet unknown whether websites comply with them. We study in this paper the prevalence of cookie paywalls on the top one million websites using an automatic crawler. We identify 431 cookie paywalls, all using the Transparency and Consent Framework (TCF). We then analyse the data these paywalls communicate through the TCF, and in particular, the legal grounds and the purposes used to collect personal data. We observe that cookie paywalls extensively rely on legitimate interest legal basis systematically conflated with consent. We also observe a lack of correlation between the presence of paywalls and legal decisions or guidelines by DPAs.


Comparative studies of some biological subjects with different water content (yeast cells, swollen starch grains, gels and gelatin and casein solutions) were conducted in scanning and transmitting electron electron microscope. The objects were prepared by cryogenic methods: freezing--drying; freezing--fracture, freezing--etching. It has been shown that when interpreting the micrographs of scanning microscopy for the systems biopolymer--water it is useful to apply the results of transmitting microscopy by using different procedures of preparation both with dehydration and without dehydration of the object. The electron micrographs have shown that with a rise in water content in the object the probability of artefact occurrence is increased for the objects studied in the scanning microscope by using freezing--drying method.


Business Intelligence (BI) is recognized as one of the most important IT applications in the coming big data era. In recent years, non-uniform memory access (NUMA) has become the de-facto architecture of multiprocessors on the new generation of enterprise servers. Such new architecture brings new challenges to optimization techniques on traditional operators in BI. Aggregation, for example, is one of the basic building blocks of BI, while its processing performance with existing hash-based algorithms scales poorly in terms of the number of cores under NUMA architecture. In this paper, we provide new solutions to tackle the problem of parallel hash-based aggregation, especially targeting at domains of extremely large cardinality. We propose a NUMA-aware radix partitioning (NaRP) method which divides the original huge relation table into subsets, without invoking expensive remote memory access between nodes of the cores. We also present a new efficient aggregation algorithm (EAA), to aggregate the partitioned data in parallel with low cache coherence miss and locking costs. Theoretical analysis as well as empirical study on an IBM X5 server prove that our proposals are at least two times faster than existing methods.


Omphalocele is a congenital anomaly with substantial morbidity. Rieger syndrome, an autosomal dominant disorder, is characterized by craniofacial abnormalities and abdominal wall defects. PITX2 mutations are etiologic in >40% of cases of Rieger syndrome. We demonstrate that the birth prevalence of omphalocele is significantly higher in Rieger syndrome than in the general population, with omphaloceles found in 0.03% in the Iowa newborn population and 4.3% of patients with Rieger syndrome. Our objective was to screen coding and conserved non‐coding regions of PITX2 for mutations in 209 patients with omphalocele. We identified remarkable evolutionarily conserved regions by comparing the 3′UTR of Pitx2 in 13 vertebrate and 3 invertebrate species. No mutations changing the amino acid sequence were found within the omphalocele population. In one case of omphalocele with VATER‐like additional anomalies, a three nucleotide deletion was found in the 3′UTR. This deletion was not seen in 1,186 controls. Also in the 3′UTR, we identified a single nucleotide polymorphism at a highly conserved residue. Our findings suggest additional studies of PITX2 conserved regions will be valuable. We also screened the omphalocele cases for mutations in exon 5 of the gene FLNA. Mutations in FLNA have been shown to cause a broad range of congenital malformations, including otopalatodigital syndrome type 2 in which a missense mutation occurring in exon 5 of FLNA results in omphalocele as part of the phenotype. We did not find any mutations in exon 5 of FLNA in 179 omphalocele cases studied. © 2004 Wiley‐Liss, Inc.


Optimization techniques have developed into a modern-day solution for real-world problems in various industries. As a way to improve performance and handle issues of uncertainty, optimization research becomes a topic of special interest across disciplines. Problem Solving and Uncertainty Modeling through Optimization and Soft Computing Applications presents the latest research trends and developments in the area of applied optimization methodologies and soft computing techniques for solving complex problems. Taking a multi-disciplinary approach, this critical publication is an essential reference source for engineers, managers, researchers, and post-graduate students.


Requirements Engineering (RE) is known to be critical for the success of software projects, and hence forms an important part of any Software Engineering (SE) education curriculum offered at tertiary level. In this paper, we report the results of an exploratory pilot study conducted to assess the effectiveness of Case-Based Learning (CBL) methodology in facilitating the learning of several RE concepts. The evaluation was made on the basis of graduate students' responses to a set of questions representing various key learning principles, collected after the execution of two CBL sessions at DA-IICT, Gandhinagar (India). We investigate the perceived effectiveness of CBL in students' learning of various RE concepts, based on factors like case difference, gender diversity, and team size. Additionally, we collect and analyse the Teaching Assistants' (TAs) opinions about the conducted CBL sessions. The outcome of this CBL exercise was positive as maximum students were able to achieve all the five stated learning objectives. The authors also report various challenges, recommendations, and lessons learned while experiencing CBL sessions.


Polar ring galaxies (PRGs) are peculiar systems where a gas-rich, nearly polar ring surrounds a host galaxy. They are the result of galaxy interactions that form mainly by tidal accretion of material from a gas rich donor galaxy. There is a number of formation mechanisms for PRGs: minor or major mergers, tidal accretion events, or direct cold gas accretion from filaments of the cosmic web. These objects can be used to probe the three-dimensional shape of dark matter haloes, provided that the ring is in equilibrium with the gravitational potential of the host galaxy. The polar ring galaxy, AM 2040-620, which has not yet been well studied, is the subject of this work. This galaxy contains an almost perpendicular warped ring and one possible companion galaxy to the NW. The radial velocity of this object is 3301±65 Km s^−1 and is part of a group of fifteen possible polar ring galaxies, according to the literature. In order to better  understand this system, images and long slit spectra were observed with the 1.60 m OPD/LNA telescope. In the I band image, the outer parts of the ring are not symmetrical. A disturbance in the Eastern side and a faint plume were detected. Two small satellites are located to the north. The bulge is elliptical but not perfectly symmetrical in this image. The B-band image shows material that extends beyond the ring in the western and eastern directions. After processing, the B-image shows that the possible companion galaxy 2MASX J20441668-6158092 has a tidally disturbed disk. Its radial velocity is unknown, but the spectroscopy, which is still under analysis, will furnish this information.


The article discusses the reception of Grotius by Catholic lawyers at the university of Prague. It focuses on the Grotius commentary by Nicolaus Ignaz Königsmann (1688–1752), which was meant as a response to the discussion of Central European Catholic lawyers on questions of toleration and permissions in law. I argue that Königsmann agreed with Grotius because his conception could be combined with the Catholic belief in free will and dictamen sanae rationis. He grounded natural law in rational human nature and rejected attempts to derive natural law from the highest principle.


Gender differences in health care are controversially discussed. Results show superfluous, insufficient or inappropriate health care of female and male patients. Many publications show that women are not sufficiently included in clinical trials and therefore data are not useful for analysing gender differences. Survey data like the German National Health Interview and Examination Survey 1998 (Bundes-Gesundheits survey 1998) can be used alternatively to analyse gender specific issues. This survey was used to show possible age and gender differences in prevalence, drug usage and health counselling of female and male patients with coronary heart disease and mental disorders. The number of physician attendances differs in sex and age group in both groups of illnesses. Women have higher number of physician consultations than men and the elderly more than the younger persons. For elderly women with coronary heart disease the control of blood cholesterol levels seems to be poorer than in men. Men get more health counselling from their doctors than women. The results emphasize the importance of considering gender differences in medical research.


Aims: The aim of the present study was to find out the hearing improvement in different types of tympanoplasties. Settings and Design: Prospective, hospital-based. Subjects and Methods : A total of 50 patients were included who were 12 years old and above, of both sexes with conductive hearing loss due chronic otitis media with or without perforation. Results: The ratio of males (28) was more as compared with females (22). Maximum number of patients belonged to the age group of 10-20 years (34%), followed by 20-30 years (30%), whereas least number of cases was found in the age group of > 50 years. Hearing loss and otorrhea were present in majority of the cases (100% and 72%, respectively). A total of 18 of the cases had cholesteatomatous chronic suppurative otitis media, while 32 ears were observed to be noncholesteatomatous chronic suppurative otitis media. The average preoperative air conduction (AC) in the present study was found to be 46.6 dB ranging from 20 dB to 112.5 dB, while the average postoperative AC was found to be 39 dB with an average gain of 7.6 dB. The four frequency average preoperative and postoperative air-bone gap (ABG) were found to be 26.48 dB and 20.17 dB respectively, with the average gain of 6.3 dB. The average ABG closure within 0-30 dB was seen in 33 (82%) of the cases. Social hearing was achieved in 86% of the cases in type I, 46% in type II, and 40% in type III tympanoplasty. Conclusions: Tympanoplasty as a procedure when indicated without compromising for the disease, can be effectively used to improve hearing in chronic suppurative otitis media, and other types of conductive hearing losses.


Tumor cells have an altered regulation of their cell cycle and commence to proliferate uncontrollably owing to mutations in their genetic material. Furthermore in addition to the altered proliferation there are genetic modifications which alter the expression of proteins in the malignant cell. This is manifested in the overexpression of some genes or activation which in normal tissue are not normally expressed. These genes encode for proteins which can be recognized as aberrant by the immune system thus generating an anti-tumor response. Recently in studies of animal models and in patients it has been shown that the principal anti-tumor effect is caused by the cellular immune response. In this situation it is the T lymphocyte which play a principal role, by way of their antigen receptors which have been processed and presented in association with the molecules of the major histocompatability complex (MHC). The majority of tumor associated antigens and recognized by CD8+ cytotoxic T lymphocytes are peptides derived from proteins expressed by the tumor cells and furthermore are encountered in the normal tissue of origin. For example in human melanoma exist antigens derived from proteins involved in the synthesis of melanin and expressed both in the tumor and normal melanocytes. There are other MHC restricted antigens which are common to various tumor types. These are embryologically derived proteins and normally are not expressed in the somatic tissues. The identification of various TAA has permitted the production of modern anti-tumor vaccines which are in the experimental stage. These vaccines based on descrete antigens which could be of peptide or DNA origen and would come to replace immunological therapies of less specificity, such as cytokines or adaptive therapy. Pre-clinical and clinical studies in the last two years indicate that the form of immunization essential in order to produce an effective immune response and avoid anergia or tolerance. Here play an important role the dendrite cells in their function as presenting cells of antigens and some preinflammatory citokines. The parody exists between the presence of anti-tumor cells in the patients with cancer and the systemic progression of the disease, this suggests the existence of mechanisms mediated by the tumor to evade the immune response. This strategies range from the secretion of factors immuno-inhibitory to mutations in the molecules related to the presenting antigen. An understanding of the immunological mechanisms involved in the anti-tumor response permits the development of immunotherapy as an alternative or complementary therapy to those already established in the fight against cancer.