In the medical clinic, we often face health problems that have no known cause, even after a thorough examination. Biomedicine is often unable to find a cure in these situations, leaving the problem unsolved or leaving the patient on a palliative pharmaceutical cure, which is often for a lifetime. In this case, consciousness-based, holistic medicine could be an alternative. Using the theories and tools of holistic medicine wisely, the physician can often provide treatment for the patient. The toolbox of holistic medicine makes it possible to work on everybody because there is always something related to the patients quality of life that can be improved: his love, his purpose of life, and the way he uses his talents, his mind, his feelings, his body, and his sexuality. For treatment in holistic medicine, it really does not matter as much that you cannot give the patient a precise medical diagnosis, because you can always work on the patient with the intention of healing his or her whole life and existence. It is quite a paradox that many of these diseases can be understood on the level of the individual patient at the same moment that the patient is cured; many of these diseases seem to be clearly related to the repression of the individual character, as stressed already by Hippocrates. So if you simply start working with the patient to help him confront old existential pain and coach him in his personal development of his life by intensifying its meaning and purpose, the symptoms very often simply disappear. The toolbox of holistic medicine also seems relevant to even difficult, neurotic, psychosomatic, and hypochondriac patients. Believing in the treatment and not giving up on your patient, and moving forward in the treatment with the patient himself is the ultimate goal, even when you yourself do not understand the mechanism fully. This will force you to develop your own competence and is, in essence, what makes an outstanding holistic physician.


Geometry is an essential component of mathematics which promotes the development of critical thinking and problem-solving skills. Geometry shapes are an integral part of our lives. This study focused on the teachers' practices, specifically on how teachers ought to be equipped with a good understanding on the effectiveness of the use of use of diagrams in geometry teaching and learning. A mixed method approach comprising of questionnaires and interviews was used in this study. Ninety-one teachers participated in this study. The research findings were categorized using the four themes of utility, positive attitudes, negative attitudes, and teachers' use of diagrams in geometry class.  The study showed that diagrams are effective in the teaching and learning of geometry concepts. It is recommended that teachers could do well if they make use of technology in designing diagrams to be used in the teaching and learning of geometry.


The aim of the thesis was to compare the short- and long-term effects of acupuncture and occlusal splint therapy in patients with craniomandibular disorders (CMD). One hundred and ten patients, 23 males and 87 females, participated in the study. All patients exhibited moderate or severe signs and symptoms of CMD and had had pain for more than six months. The participants were randomly assigned to three groups: acupuncture, occlusal splint therapy or control. Ten different subjective and/or clinical assessment variables were used in the evaluation of the treatment effect. Immediately after treatment, acupuncture and occlusal splint therapy had reduced the symptoms as compared with the control group which remained essentially unchanged. Acupuncture gave better subjective results than occlusal splint in the short-term. In the 12-month long-term follow-up, 57% of the patients who received acupuncture and 68% of the patients who received occlusal splints benefitted subjectively and clinically from the treatment. There were no statistically significant differences between the two groups in any of the assessment variables. Those patients who received various additional therapies following acupuncture and/or occlusal splints rarely responded favorably to additional treatment. No serious adverse events or complications were observed in the study. Acupuncture seems to have adverse events of a more general nature whereas adverse events of the occlusal splint seem to be more related to the orofacial region. The majority of the patients responded positively to the comfort of both treatment modes. In order to measure tenderness (pressure pain threshold, PPT) more objectively, the usefulness of an algometer was evaluated. A good reliability and validity was found for the algometer in recording the PPT in the masticatory muscles. The reliability was further improved by connection of a stopwatch to the algometer so that the pressure rate could be kept within acceptable limits. A moderate but statistically significant correlation was found between PPT and clinical and subjective variables. The algometer was sensitive enough to detect pre- and post-treatment changes. A statistically significant reduction in tenderness was found immediately after and at the 6-month follow-up for both treatment modes. This series of studies showed that acupuncture gave positive results similar to those of occlusal splint therapy in patients with primarily myogenic CMD symptoms over a 1-year period.


We study a recently introduced adaptation of Tukey depth to graphs and discuss its algorithmic properties and potential applications to mining and learning with graphs. In particular, since it is NP-hard to compute the Tukey depth of a node, as a first contribution we provide a simple heuristic based on maximal closed set separation in graphs and show empirically on different graph datasets that its approximation error is small. Our second contribution is concerned with geodesic core-periphery decompositions of graphs. We show empirically that the geodesic core of a graph consists of those nodes that have a high Tukey depth. This information allows for a parameterized deterministic definition of the geodesic core of a graph.


Transition metal sulfides have been widely studied as electrocatalysts for the hydrogen evolution reaction (HER). Though elemental doping is an effective way to enhance sulfide activity for the HER, most studies have only focused on the effect of doping sulfide edge sites. Few studies have investigated the effect of doping the basal plane or the effect of doping concentration on basal plane activity. Probing the dopant concentration dependence of HER activity is challenging due to experimental difficulties in controlling dopant incorporation. Here, we overcome this challenge by first synthesizing doped transition metal oxides and then sulfurizing the oxides to sulfides, yielding core/shell Co-doped WS2/W18O49 nanotubes with a tunable amount of Co. Our combined density functional theory (DFT) calculations and experiments demonstrate that the HER activity of basal plane WS2 changes non-monotonically with the concentration of Co due to local changes in the binding energy of H and the formation energy of S-vacancies. At an optimal Co doping concentration, the overpotential to reach −10 mA cm−2 is reduced by 210 mV, and the Tafel slope is reduced from 122 to 49 mV per decade (mV dec−1) compared to undoped WS2 nanotubes.


Approximate results based on samples often provide the only way in which advanced analytical applications on very massive data sets can satisfy their time and resource constraints. Unfortunately, methods and tools for the computation of accurate early results are currently not supported in MapReduce-oriented systems although these are intended for 'big data'. Therefore, we proposed and implemented a non-parametric extension of Hadoop which allows the incremental computation of early results for arbitrary work-flows, along with reliable on-line estimates of the degree of accuracy achieved so far in the computation. These estimates are based on a technique called bootstrapping that has been widely employed in statistics and can be applied to arbitrary functions and data distributions. In this paper, we describe our Early Accurate Result Library (EARL) for Hadoop that was designed to minimize the changes required to the MapReduce framework. Various tests of EARL of Hadoop are presented to characterize the frequent situations where EARL can provide major speed-ups over the current version of Hadoop.


In this contribution, we describe the basic principles to reconstruct parent microtextures from inherited ones. The different methods published in the literature are examined. Their various approaches lead to different restitution capabilities and we discuss their advantages and weaknesses.


Purpose: Membrane-associated mucins play an important role for protecting epithelial cells at the ocular surface from microbial invasion. The purpose of this study was to determine whether multipurpose solutions (MPSs) for contact lens care and their ingredients alter the expression of membrane-associated mucins in human corneal epithelial (HCE-T) cells. Methods: SV40-immortalized HCE-T cells were cultured in Dulbecco's modified Eagle medium/F12 medium with 5% fetal bovine serum to confluence and were then exposed to 10% dilutions of five different MPSs, or to their representative ingredients, 0.1% macrogolglycerol hydroxystearate, 0.1% poloxamer, 0.1% poloxamine, 1 and 5 ppm polyhexamethylene biguanide, or 0.05% and 0.1% boric acid for 24 hr. Quantitative real-time polymerase chain reaction was used to investigate the gene expression of MUC1, MUC4, and MUC16. Immunofluorescence staining of MUC16 protein on the surface of the HCE-T cells exposed to 10% diluted MPSs for 24 hr or undiluted MPSs for 30 min was observed by laser confocal scanning microscopy followed by quantitative image analysis. Results: Three MPSs containing boric acid significantly reduced gene expressions of MUC1 from 20.2% to 56.7% (P<0.01). Gene expressions of MUC4 and MUC16 were also reduced by these MPSs; however, there were no significant differences. Among ingredients, 0.1% boric acid significantly reduced gene expressions of MUC1 and MUC16 by 7.4% and 18.9%, respectively (P<0.01). Immunofluorescence microscopy also demonstrated that in undiluted form, three MPSs containing boric acid significantly reduced the expression of MUC16 protein. Conclusions: The MPSs containing boric acid downregulate membrane-associated mucins as compared with MPSs that do not contain boric acid. There may be some subtle membrane or other interactions between ingredients in lens-care solutions that adversely alter corneal cell mucins.


Models explaining the appearance of gregariousness in insect parasitoids assume the presence of a tolerance gene that enables nonsiblicidal behaviour in gregarious larvae. Under this assumption, nontolerant individuals should attack and kill tolerant individuals when sharing a host, making this behaviour susceptible to invasion by nontolerant individuals. We propose an alternative hypothesis where gregarious larvae retain their aggressiveness but are less mobile. We tested this hypothesis with two sympatric and congeneric species of Mymaridae, Anaphes victus and Anaphes listronoti, respectively, solitary and gregarious egg parasitoids of a Curculionidae, Listronotus oregonensis. Results obtained in competition experiments and from direct observation of movement in mymariform larvae of both species support the reduced mobility hypothesis. By being immobile while retaining their fighting capacity, A. listronoti mymariform larvae appear to optimize host utilization through gregarious development, but can still defend themselves against sympatric aggressive species.


A critical analysis was conducted in 39 publications on the prevalence of trace mineral deficiencies in Mexico, published since 1950. It can be concluded that: a) Iron deficiency is the most prevalent nutrient deficiency in Mexico. It occurs in 10 to 70% of the population depending on the region of the country. Rural areas in the southern and south-eastern regions are more drastically affected studies. This deficiency occurs even though iron intake in most studies is higher than recommended. b) Clinical signs of iodine deficiency have been reported in some mountainous regions of the country. These studies were carried out about 30 years ago, so the potential existence of iodine deficiency in these and other regions requires further study. c) There is some evidence of marginal zinc deficiency in some population groups. The magnitude of this deficiency, and the existence of other mineral deficiencies and their consequences for the health and function of the Mexican population, require further investigation.


Article omission is a well-documented phenomenon in early child speech. Interestingly, children differ in terms of how extensively they omit articles depending on their age and what language(s) they are exposed to. Different accounts have been proposed to account for this cross-linguistic variation. One of the most widely discussed models is the Nominal Mapping Parameter (NMP), originally proposed in Chierchia (1998), which relates variation in child language to the syntactic and semantic properties of noun phrases across languages (e.g. Chierchia, Guasti and Gualmini 1999, Guasti and Gavarro 2003, Guasti et al. 2004). Other influential accounts of determiner omission have been formulated in prosody-oriented research (e.g. Gerken 1991, 1994, Lleo 1998, 2001, Lleo and Demuth 1999, Roark and Demuth 2000, Demuth et al., in press). So far, no common agreement has been reached.This paper presents a study on article acquisition in English, German, Norwegian and Swedish, where article use is subject to similar syntactic and semantic conditions. Hence, the NMP predicts similar acquisition patterns. In terms of their metrical structure, noun phrases in these languages differ considerably. Accordingly, different acquisition patterns are expected.


A substantialincrease in the quantity of Students taking up Englishas the Second Language is so obvious in developing countries like India. The need for effective measures to augment and reinforce the learning of English with respect to such students has become paramount importance. A small group ofsuch students wasselected and their efficiency in the learning process of English in a specified time was carried out on different paraphernalia towardsof such an exercise. Two methods wereadopted in the evaluation of the learning process.. One group of students was taught both in English and in their respective mother tongue. The other group of students was taught only in English and at no point their mother tongue was involved in the exercise. The First group of students was taught to read in their respective mother tongue and gradually movedto English and the enhancement in the cognitive proficiency was evaluated with reference to the reading exercises.Students who have had both the efficiencies in their mother tongue andEnglish wereinvolved as assisting forces. The Second group of students was taught only in English. The various paraphernalia considered for the study remained the same irrespective of the student group. Standard procedures of Specially Designed Academic Instruction in English (SDAI) were adopted in following the augmentation process of learning and ability in acquiring English. All the basic and essential modalities were included in the study. Students were encouraged to involve themselves so voluntarily and wholeheartedly and their participation was encouraged. The group of students who used theirmother tongue was found to be in an advantageous position and use of mother tongue proved to be a significant factor in assisting themin the learning process. The group of students taught only in English didn't exhibit better understanding or perception of English than their counterparts. The shortcomings experienced in language perception in every aspectof the different paraphernalia taken up in the study, in respect of the group of students taught only in English could not be considered as lack of skill in the acquisition of English and the difficulties to cope with the learning process seems to be temporal and keeping up with efficiency of the other group is only transitional The findings of both of these approaches for students acquiring English are highlighted in the present paper.


Background: Background: Recently, along with traditional economic indicators, policymakers are increasingly dealing with Subjective Well-Being (SWB) as an evaluation criterion of their performance and as an index for the population's psychology health. This was done to define different determinants of SWB with a focus on some specific aspects of the living area. Also, this article investigateed the effect of urban and outskirts area on SWB. Method: This study is a cross-sectional study based on a structured interview and the samples (219 people ) were selected by a two-stage cluster sampling method in 2018 in Rasht city, a metropolis in Iran. In designing the local questionnaire, Gallup's Global Emotions questionnaire has been used. Two main contributions of this study are defining culturized and proper indices for measuring SWB, and the financial status of people while Iranian people used to understate their real income. Data analysis was conducted using STATA 14.2 applying Descriptive statistics, Correlation study, Ordered Probit regression Method. Results: Results show that improving the socio-economic status of people improve SWB. Having financial satisfaction, satisfaction with leaving area, being tenure, and living in more spacious residency have positive effects on SWB. Also, the city dwellers were found to have higher SWB (5.23 out of 7) than outskirt dwellers (4.9 out of 7) while keeping the other factors to be constant. They reported the same differences in positive feelings and negative feelings indices. Conclusion: The welfare policies should be revised to improve the financial status of all people, and increase the access to urban facilities for outskirts' dwellers.Determinants of Subjective Well-being: Do we Really Know What Makes People Happy? A Study on Rasht Metropolis, North of Iran


This article describes the urgent need for modern family planning (FP) services and supplies in the Soviet Union and presents the nations high induced abortion rate as one of its most serious medical and social problems. With more than 6 million legal abortions per year and another estimated 6 million performed illegally the problem of induced abortion is placed on par with heart disease and cancer in the Soviet Union. Induced abortion is the primary method of birth control responsible for terminating 2 out of 3 pregnancies. Many abortion seekers especially those employing illegal services suffer complications resulting in loss of ability to work or even death. The maternal mortality rate for 1988 was 43.0/10000. Efforts to decrease the level of abortion have increased during reconstruction and have been witness to a decline in the number of abortions by 866000 over the period 1985-1988. Contributory factors behind this decline as well as the decrease of the abortion ratio are an increased contraceptive prevalence level totalling 13.7% of reproductive-age women stabilization of the birth rate at a low level a smaller proportion of reproductive-age women in the population and rate reporting changes. Nonetheless inadequate family planning services prevail in the Soviet Union. Instead of focusing upon abortion and contraception services focus upon diagnosing and treating infertility and offer neither FP information nor services for premarital youths. Moreover contraceptive supplies suffer serious ongoing shortages. Research is needed on the social demographic medical and biological aspects of reproductive behavior in the Soviet Union. Regional differences abortion law public opinion on illegitimate pregnancy abortion methods health personnel training and maternal and child health are also discussed.


The European Union (EU) is the first target market for developing countries' and Least Developed Countries' agricultural exports. Preferential trade agreements, either reciprocal or not, play a central role in forming trade opportunities for numerous developing countries. Our objective is to measure the impact of eleven regional trade agreements (RTA) on European agricultural imports with an expanded gravity model. Also, in order to compare these RTAs and their effects we calculate the implied tariff equivalent. Results indicate that a large number of EU's RTAs support the agricultural exports of developing countries to the EU market. Thus, RTAs are generally an attractive alternative for countries wishing to speed up the move towards multilateral free trade in agriculture. Nevertheless, two most important and unilateral RTAs (Generalized System of Preference expanded by Everything But Arms) and the agreement with Mexico have the negative effect over agricultural exports to EU. We attempt to explain the reasons of their failure.


In the past few years, many new development toolkits such as the Nebula2 and/or mobile technologies including the WiFi or mobileTV have opened up exciting learning opportunities on mobile devices. On top of it, new technologies continue to fuel the rapid growth of newly merged fields of research like the edutainment for educational entertainment. In a recent teaching development project, we have developed an interactive game platform to facilitate learning and more importantly the spirit of teamwork for collaborative problem-solving on desktop and pocket PCs. With the great challenges imposed by globalization, we strongly believe that learning to collaboratively analyze and then apply the "appropriate" knowledge to solve a specific problem is always the key to success. In this paper, we discuss about an on-going work, and share our relevant experience in system development. Furthermore, evaluation strategies will be thoroughly examined. After all, our work shed light on many interesting directions for future exploration.


Acute promyelocytic leukemia (APL) is a distinct subtype of myeloid leukemia that in the USA and Italy alone affects more than 3,000 individuals every year. APL is characterized by three distinct and unique features: i) accumulation in the bone marrow of tumor cells with promyelocytic features; ii) invariable association with specific translocations which always involve chromosome 17 and the retinoic acid receptor alpha (RAR alpha) locus; iii) exquisite sensitivity of APL blasts to the differentiating action of retinoic acid (RA). From this point of view APL has become the paradigm for therapeutic approaches utilizing differentiating agents. The last five years have been crucial for the understanding of the molecular basis of APL. RAR alpha translocates in 99% of cases to a gene located on chromosome 15 that we initially named myl and is now known as PML. In a few cases RAR alpha variably translocates to chromosome 11, where it fuses to the PLZF gene or to a gene, also on 11, which has not yet been characterized. In addition, RAR alpha is also found translocated to chromosome 5, where it fuses to the NPM gene. The cloning of variant translocations in APL and comparative analysis of their associated products is crucial for the understanding of the molecular etiopathogenesis of the disease. Functional analysis of the various fusion proteins as well as RAR alpha partners is revealing strikingly common features beneath a misleading structural heterogeneity which unravels a possible unifying molecular mechanism towards APL leukemogenesis.


Intermittent infrastructures are often described as infrastructures that are not always on or accessible. In the face of climate change, infrastructures are facing increased challenges regarding intermittency. As the LIMITS community shifts to investigating and designing transitional systems— computing systems centered around sustainability and climate justice—understanding intermittency and its relations to infrastructure is necessary. In this paper, I use the lens of intermittency to examine infrastructures across southeast Louisiana, where stronger and more frequent hurricanes, increased Clooding and coastal land loss can cause disruptions in infrastructures. Drawing on this case study and existing work in networking research, infrastructure studies, and the LIMITS community, I propose key dimensions to examine intermittency for future research within the LIMITS community.


The rationale behind this study is to explore psychological matters relative to the satisfaction process of rural tourists. The Mediterranean Island of Cyprus was selected for this study, in which an ethnographic journey was undertaken. Towards this end, active participation, informal interviews and casual conversations with rural tourists were employed. The study's fieldwork findings reveal information of valuable importance to the tourism academic community and practitioners alike. The ethnographic techniques which attempted to gain insights into rural tourist psychological matters, such as motivation and expectations, shed clear light in the rather shady tourists' inners.


Today's businesses, government and society work and services are centered around interactions, collaborations and knowledge work. The pace, amount and veracity of data generated and processed by a worker has accelerated significantly to the level that challenged human cognitive load and productivity. On the other hand, big data has provided an unprecedented opportunity for AI to tackle one of the main challenges hindering the AI progress: building models of world in a scalable, adaptive and dynamic manner. In this paper, we describe the technology requirements of building cognitive assistance technologies that assists human workers, and present a cognitive work assistant framework that aims at offering intelligence assistance to workers to improve their productivity and agility. We then describe the design and development of a set of cognitive services offered by the framework, based on advanced NLP and machine learning methods. The cognitive services help workers in processing and linking information and identifying and tracking work items over interactions in communication channels such as email, social conversations and media, chats and messaging and calendar applications. These cognitive services are designed to be adaptive, online and personalized so that over time adapt to changing environment and knowledge, and the models become personalized through learning preferences and working language and style of the subject worker.


Metal-hyperaccumulating plants, which are hypothesized to use metals for defence against pests and pathogens, provide a unique context in which to study plant–pathogen coevolution. Previously, we demonstrated that the high concentrations of zinc found in leaves of the hyperaccumulator Noccaea caerulescens provide protection against bacterial pathogens, with a potential trade-off between metal-based and pathogen-induced defences. We speculated that an evolutionary arms race between zinc-based defences in N. caerulescens and zinc tolerance in pathogens might have driven the development of the hyperaccumulation phenotype. Here, we investigate the possibility of local adaptation by bacteria to the zinc-rich environment of N. caerulescens leaves and show that leaves sampled from the contaminated surroundings of a former mine site harboured endophytes with greater zinc tolerance than those within plants of an artificially created hyperaccumulating population. Experimental manipulation of zinc concentrations in plants of this artificial population influenced the zinc tolerance of recovered endophytes. In laboratory experiments, only endophytic bacteria isolated from plants of the natural population were able to grow to high population densities in any N. caerulescens plants. These findings suggest that long-term coexistence with zinc-hyperaccumulating plants leads to local adaptation by endophytic bacteria to the environment within their leaves.


Traveling-wave amplification along a carbon nanotube (CNT) under dc-ac fields is theoretically investigated. The ac conductivity of a metallic CNT is found with respect to the applied dc bias. For this purpose, the Boltzmann transport equation (BTE) is solved within the relaxation time approximation (RTA) by separating the ac and dc distributions. The problem is solved both exactly and approximately by semianalytical and analytical means, respectively. It is shown that an absolute negative ac conductivity accompanies a negative differential conductivity beyond a threshold dc field of 3 × 105 V/m. The complex propagation factor of the allowed surface wave modes is found by coupling the BTE current with Maxwell's equations and solving a transcendental equation. The slow-wave factor and attenuation steadily increase with the dc field amplitude. Beyond the threshold field, amplification occurs, which is a promising result toward enabling traveling-wave amplifiers using CNTs. The amplification is shown to be a result of Bloch-type oscillations.


well as other conditions, utilizing a battery of neuropsychological measures 1-2 years after initial assessment. Good test-retest stability in all diagnostic groups was obtained. Children with ADHD may be described as performing inconsistently over time. However, when a battery of appropriately and carefully administered neuropsychological tests are administered, clinicians can reliably assume that these measures will be valid over time.


The design of route guidance systems faces a well-known dilemma. The approach that theoretically yields the system-optimal traffic pattern may discriminate against some users in favor of others. Proposed alternate models, however, do not directly address the system perspective and may result in inferior performance. We propose a novel model and corresponding algorithms to resolve this dilemma. We present computational results on real-world instances and compare the new approach with the well-established traffic assignment model. The essence of this study is that system-optimal routing of traffic flow with explicit integration of user constraints leads to a better performance than the user equilibrium, while simultaneously guaranteeing superior fairness compared to the pure system optimum.


Over the past ten years, a number of regional water or watershed management efforts have been initiated in Georgia. The increasing number of regional initiatives demonstrates a growing need, or a growing recognition of the need, for management at a scale between local/community efforts and statewide programs implemented by state agencies. However, there is currently limited state support and no systematic effort to develop regional water management structures across Georgia. To date, regional water management efforts in the state have varied widely in their genesis, initial approach, development, and accomplishments. This session is designed to explore five representative regional management initiatives. The goals of the session are to illuminate common and distinctive features and to identify ways to support and enhance efforts to manage water resources and watersheds at the critical regional scale.


The distribution of the amphipod Gammarus lacustris on the Hardangervidda mountain plateau was mapped by screening published data from 245 lakes in 11 and 16 catchments in western and central/eastern areas, respectively. These data are primarily based on stomach analyses of brown trout Salmo trutta. In central/eastern areas, G. lacustris was recorded in 79% of all the lakes examined, while there are only two former records (4%) in the western area. The distribution pattern of G. lacustris on Hardangervidda appears to be related to environmental conditions. The apparent absence of G. lacustris in the western area may be explained by a combined effect of cold water due to higher deposits of snow and water with low ionic strength as a consequence of its bedrock of Precambrian gneisses and granites with little or no moraine cover. However, lakes in central/eastern areas sustain G. lacustris in spite of dilute water, as G. lacustris has been recorded in 89 lakes of which 28% had calcium concentration <1.0 mg L-1, eight of them with pH <6.0. The lower lethal threshold for calcium concentration seems to be ~0.5 mg L-1. Gammarus lacustris was found in lakes at altitudes of 832 to 1396 m a.s.l. Furthermore, their occurrence increased significantly with lake size, being 69% in lakes <1.0 km2 and 97% in larger lakes. The number of refugia with better water quality is likely to increase with lake size. Gammarus lacustris is highly searched for as prey by all size groups of brown trout (15-45 cm). Access to proximity refugia that reduce predation pressure from fish may also increase with lake size. Climate changes are now in progress in this mountain area, and detailed mapping of G. lacustris is important in order to trace future range changes.


Purpose

The purpose of this paper is to advance the current understanding of organisational conditions that facilitate service design. Specifically, the focus is on organisational capabilities, interactive practices and individual abilities as units of analysis across service system levels. Grounded in design principles, the paper conceptualises and delineates illustrative service design conditions and introduces a respective service design capability-practice-ability (CPA) portfolio. In doing so, an emerging microfoundations perspective in the context of service design is advanced.

Design/methodology/approach

Conceptual paper.

Findings

This paper identifies and delineates a CPA that contributes to service design and ultimately customer experiences. The service design CPA consists of six illustrative constellations of service design capabilities, practices and abilities, which operate on different organisational levels. The service design CPA builds the foundation for in-depth research implications and future research opportunities.

Practical implications

The CPA framework suggests that if an organisation seeks to optimise service design and subsequent customer experiences, then individual- and organisational-level (cap)abilities and interactive practices should be optimised and synchronised across specific CPA constellations.

Originality/value

This paper provides the first microfoundations perspective for service design. It advances marketing theory through multilevel theorising around service design capabilities, practices and abilities and overcomes extant limitations of insular theorising in this context.


Misconceptions still abound that plastic surgeons are predominantly cosmetic surgeons. Plastic surgery is a technique based specialty with the aim of reconstructing tissue so that patients gain normal function and appearance. As a result plastic surgery encompasses a vast range (see box and bmj.com). Our review focuses on advances in surgical techniques, technical and biological advances (see also bmj.com), and changes in the organisation of plastic surgery, with its intergration with other specialties.

### Conditions treated by plastic surgeons

We selected topics for review by searching Medline from 1 January 1998 and by reviewing abstracts from the past four annual meetings of the British and American Associations of Plastic Surgeons, the Congress of the International Confederation of Plastic, Reconstructive and Aesthetic Surgery, and the International Society of Craniofacial Surgeons.

### Microvascular free tissue transfer

The development of microsurgical techniques has made it possible to replant severed body parts, ranging from whole limbs to fingertips, by anastomosing the divided blood vessels along with nerves and other injured structures. Success depends on the mechanism of injury (clean cuts do better than crush injuries), the correct management of the amputated part (keeping it cool but not frozen), prompt surgery (ideally within a few hours of injury), and the skill of the microsurgeon.

### Recent developments

Microvascular free tissue transfer is part of routine plastic surgical practice

Surgical advances in microvascular free tissue transfer have focused on reducing morbidity at the donor site

A range of technological and biological advances promise to lead to improvements in the management of nerve injury, skin cancers, and wounds

Pioneering surgery involving neuroelectric stimulation of limb muscles in tetraplegic patients can restore hand function

The integration of plastic surgery into hospital practice has paralleled a multidisciplinary approach to …


With the growing popularity of Web applications, there is a considerable increase in the importance of managing Web sites to deliver high levels of performance and scalability to accommodate future growth and evolution. One of the key issues in this regard concerns a better understanding of the traffic patterns at multiple levels, such as the levels of requests, pages and sessions. This paper presents a detailed analysis of measurement data from various sources pertaining to a specific multi-tiered, geographically distributed architecture that has been used to host the Web sites for a number of recent, popular sporting events. Our analysis of the request-level and page-level patterns demonstrate differences among the Web sites depending upon the type of event and the breadth of interests of the user community. Some of these patterns are consistent with commercial Web sites, while others are significantly different These results further illustrate geographical differences in the request-level and page-level patterns. Our analysis also investigates in detail session-level characteristics. This includes an analysis of the session durations, the think time distributions, the dependence structure of the session arrival process, and the page views comprising each session.


Electron microscopic analysis of specimens from guinea-pig brain cell cultures infected with amyotrophic leucospongiosis agent (belonging to "unconventional" viruses) revealed accumulation in the culture fluid of abnormal filamentous structures similar to scrapie-associated fibrils (SAF) differing in morphology. Most of these SAF-like structures 10-15 nm in diameter contained helically wound protofilaments with a repeat at certain intervals (50-150 nm). When these structures were inoculated into guinea-pig brain astrocyte cultures they produced dystrophic-destructive changes in some (25%) astrocytes, and their intracerebral inoculation to guinea pigs produced an experimental disease. The abnormal SAF-like structures were reisolated from the brains of the inoculated animals which indicated the relationship between these structures and infectivity.


This article, arising out of quantitative and qualitative research studies conducted by the authors, begins with a brief overview of current knowledge about male adolescent sexual abusers and associated policies, procedures and services. A particular concern raised by professionals and welfare agencies, who are struggling to develop appropriate responses to young sexual abusers, concerns the circumstances and problems of young people who are placed in residential accommodation as a result of their sexually abusive behaviour, often where there are also child victims of sexual abuse. The vulnerability of young sexual abusers and the risk they pose to others is considered in the light of the findings of qualitative research by one of the authors into the construction and control of children and their sexualities in residential children's homes. This research suggests that the inadequate ways in which sexual behaviour in children's homes is perceived and managed, serves to compound the problems of both the sexually abusive and non-abusive adolescents placed there. The findings from both authors' research are then theorized within broader conceptual frameworks about the nature of childhood, childhood sexuality and institutionalization and its links with peer sexual abuse.


The trends of wind and wind power at a typical wind turbine hub height (80 m) are analyzed using the North American Regional Reanalysis (NARR) dataset for 1979-2009. Based upon the wind speeds at NARR's vertical layers right above and below the 80 m level, the wind speeds at 80 m are estimated using two methods assuming the wind profile respectively as linear and power-law distribution with respect to the altitude in the lower boundary layer. Furthermore, we calculate the following variables at 80 m that are needed for the estimation and interpretation of wind power: the air density, zonal wind (,)ݑ meridional wind (,)ݒ and total wind speed. It is found that the difference between using the power-law and linear interpolation for the derivation of the 80 m wind generally results in less than 20% difference in the estimate of annually-averaged wind power in the majority of U.S. Statistically significant and positive annual trends are found to be predominant over the contiguous United States with spring and winter being the two largest contributing seasons. Positive trends of surface wind speed (up to ~0.15 m s-1 dec-1) are generally smaller with less spread than those (up to ~0.25 m s-1 dec-1) to 80 m, reflecting stronger increases of wind speed at altitudes above the 80 m level. In the regional averages, trends are positive and linearly continuous during 1979-2009 for the West region, but for the East and Central regions, a larger positive trend is found for wind speed and wind power during 1991-2009. Large and positive trends of wind and wind power over the southeast region and high mountain regions are primarily due to the increasing trend of the meridional wind, which supports previous studies reporting the enhancement of subtropical (Bermuda) highs and the (Mexican Gulf) low level jet in response to global warming. In contrast, large and positive trends of wind and wind power over the northern states (bordering Canada) are primarily due to the increasing trend of the zonal wind, again reflecting the previous reports of the poleward expansion of the tropospheric zonal jet. The positive trend of wind power found in this study supports recent studies using radiosonde and reanalysis data that showed a positive trend of wind at the lower troposphere, but is inconsistent with previous ground-based reports. Further studies are needed to resolve such inconsistencies and to explain the trend of wind in the …


With the growth of presence based services, it is important to securely manage and distribute sensitive presence information such as user location. We survey techniques that are used for security and privacy of presence information. In particular, we describe the Session Initiation Protocol (SIP) specific authentication, integrity and confidentiality. We also discuss the IETF's common policy for geo-privacy, presence authorization for presence information privacy and distribution of different levels of presence information to different watchers. Additionally, we describe an open problem of getting the aggregated presence from the trusted server without the server knowing the presence information, and propose a solution. Finally, we discuss denial of service attacks on the presence system and ways to mitigate them.


Rapidly advancing practice and recognition of nursing, midwifery and medicine as a vital interrelated workforce, implies a need for a variety of curricula opportunities. This project addresses the challenge for healthcare educators to widen student engagement and participation through inter-professional education by creating learning environments whereby student interactions foster the desire to develop situational awareness, independent learning and contribution to patient advocacy. Overall aim of this 'Feeding and Nutrition in Infants and Children' project is to provide opportunities for integrated learning to enable students to advance their knowledge and understanding of current best practice. This Inter-professional (IPE) student-lead workshop was initially implemented in 2006–07 in collaboration with the Centre for Excellence in IPE, within the curricula of medical and nursing programmes.¹ Supported by the development of a student resource pack, this project is now being offered to Learning Disability nursing and Midwifery students since September 2014. Methods Fourth year medical students, undertaking a 'Child Healthcare module', alongside nursing and/or midwifery students are divided into groups with three or four students from each profession. Each group focuses on a specific feeding problem that is scenario-based on a common real-life issue prior to the workshop and then present their findings/possible solutions to feeding problem. They are observed by both facilitators and peers, who provide constructive feedback on aspects of performance including patient safety, cultural awareness, communication, decision making skills, teamwork and an appreciation of the role of various professionals in managing feeding problems in infants and children. Results Participants complete a Likert-scale questionnaire to ascertain their reactions to this integrated learning experience. Ongoing findings suggest that students evaluate this learning activity very positively and have stated that they value the opportunity to exercise their clinical judgement and decision making skills. Most recent comments: 'appreciate working alongside other student's/multidisciplinary team approach' As a group students engage in this team problem-solving exercise, drawing upon their strengths and abilities to learn from each other. This project provides a crucial opportunity for learning and knowledge exchange for all those medical, midwifery and nursing students involved. Reference Purdy J, Stewart M. Feeding and nutrition in infants and children: an interprofessional approach. Clin Teacher 2009;6(3)


In recent years, Europe has experienced a move towards religious diversity and pluralism, which is especially caused by the lasting wave of migrants fleeing conflicts in primarily Muslim countries. While in 2010 Muslims formed 3.8% of Europe's population, the Muslim population would be expected to rise to 14% by 2050. Even if this scenario does not materialise the European Union and its member states, they will be confronted more and more frequently with new challenges to the law regulating the relations between the state and religious organisations and currently unknown religious conflicts: disputes over religious symbols like the Christian crucifix, the Jewish mezuzah or the Muslim hilal in the public sphere, the debate on the Muslim head scarf, burka and niqab worn by teachers, police women or judges and controversies concerning religious practices in schools and universities – the list is almost endless – are only a few examples impressively demonstrating this. Although many of these problems have been the subject of debate within German higher court, federal administrative, and constitutional court cases, particular decisions as the headscarf ban for teachers (BVerfGE 108, 282, BVerfGE 138, 296) or the crucifix ruling (BVerfGE 93, 1) show that the judicial recognized idea of neutrality between state and religion is characterised by inconsistent results and rules: This leads to the paradox situation that in one and the same country Christian crucifixes in classes and court rooms are (predominantly) allowed and desired whereas on the other hand its strictly prohibited for Muslim teachers or legal clerks to wear a head scarf. Lastly, the current legal situation leaves affected people and legal practitioners helpless. This might be linked to the German model of rules regulating the relation between state and religion. The German Grundgesetz follows the so called hybrid or cooperation model – incorporated from the German constitution of 1918 – which is characterised by a basic separation of state and religion, simultaneously the state is responsible for maintaining religious freedom, diversity and plurality. This middle of the road approach be-tween an established church system and secularity is the most prevalent model in Europe. Particularly also our immediate European neighbours Austria and Italy follow this long-lasting co-operation-based tradition. Key objective of our contribution is to examine whether our neigh-bours are facing similar problems to those we have in Germany. In particular, we will focus our attention on the missing legal certainty and clarity with regard to the – positive and negative – freedom of religion. To ensure a comprehensive picture of the ambiguous legal situation our study will analyse and compare the relevant constitutional provisions, particular laws and jurisdiction in Austria, Italy and Germany and evaluate whether or not European countries still give privileges to their Judeo-Christian roots, (will) develop a religion-friendly attitude of neutrality towards all – also the Muslim – religions and world views or choose a way into a secular society. This question needs to be discussed on a multi-national forum, because it is a matter that concerns all European countries. The International Symposium on Religious Pluralism and European Integration provides a suitable framework to answer this question and to get in touch with experts from different fields of research and different ethical, racial and religious backgrounds.


OBJECTIVE To compare efficacy and safety of lixisenatide once daily versus exenatide twice daily in type 2 diabetes inadequately controlled with metformin. RESEARCH DESIGN AND METHODS Adults with diabetes inadequately controlled (HbA1c 7–10%) with metformin were randomized to lixisenatide 20 μg once daily (n = 318) or exenatide 10 μg twice daily (n = 316) in a 24-week (main period), open-label, parallel-group, multicenter study. The primary objective was a noninferiority assessment of lixisenatide versus exenatide in HbA1c change from baseline to week 24. RESULTS Lixisenatide once daily demonstrated noninferiority in HbA1c reduction versus exenatide twice daily. The least squares mean change was −0.79% (mean decrease 7.97 to 7.17%) for lixisenatide versus −0.96% (mean decrease 7.96 to 7.01%) for exenatide, and treatment difference was 0.17% (95% CI, 0.033–0.297), meeting a predefined noninferiority upper CI margin of 0.4%. Responder rate (HbA1c <7.0%) and improvements in fasting plasma glucose were comparable. Both agents induced weight loss (from 94.5 to 91.7 kg and from 96.7 to 92.9 kg with lixisenatide and exenatide, respectively). Incidence of adverse events (AEs) was similar for lixisenatide and exenatide, as was incidence of serious AEs (2.8 and 2.2%, respectively). Discontinuations attributable to AEs occurred in 33 lixisenatide (10.4%) and 41 exenatide (13.0%) patients. In the lixisenatide group, fewer participants experienced symptomatic hypoglycemia (2.5 vs. 7.9%; P < 0.05), with fewer gastrointestinal events (especially nausea; 24.5 vs. 35.1%; P < 0.05). CONCLUSIONS Add-on lixisenatide once daily in type 2 diabetes inadequately controlled with metformin demonstrated noninferior improvements in HbA1c, with slightly lower mean weight loss, lower incidence of hypoglycemia, and better gastrointestinal tolerability compared with exenatide twice daily.


Anytime search algorithms are useful for planning problems where a solution is desired under a limited time budget. Anytime algorithms first aim to provide a feasible solution quickly and then attempt to improve it until the time budget expires. On the other hand, parallel search algorithms utilize the multithreading capability of modern processors to speed up the search. One such algorithm, ePA*SE (Edge-Based Parallel A* for Slow Evaluations), parallelizes edge evaluations to achieve faster planning and is especially useful in domains with expensive-to-compute edges. In this work, we propose an extension that brings the anytime property to ePA*SE, resulting in A-ePA*SE. We evaluate A-ePA*SE experimentally and show that it is significantly more efficient than other anytime search methods. The open-source code for A-ePA*SE, along with the baselines, is available here:
https://github.com/shohinm/parallel_search


Acute pancreatitis is a rare, albeit severe, secondary effect of valproic acid which is probably due to an idiosyncratic reaction. Diagnosis is based on high clinical suspicion. A new case of pancreatitis by valproic acid an a review of the literature are presented. The authors suggest that strict clinical control of the patient be carried out and pancreatic enzymes be monitored on appearance of symptoms suggestive of this complication.


The editors of the Journal of Language, Identity, and Education thank our two editorial assistants, Kelly L. Graham (University of Texas, San Antonio) and Wayne E. Wright (Arizona State University), who have played an important role in producing Volume 3 of the Journal of Language, Identity, and Education. We also acknowledge the work of our production editor, Janet Roy of Lawrence Erlbaum Associates, Inc., and the many other professionals at Lawrence Erlbaum who have played an important role in the production of the journal. Finally, we are happy to acknowledge the contribution of the following scholars (including members of the Editorial Advisory Board, whose names are preceded by asterisks) who reviewed manuscripts in the period ending December 2003.


The study is devoted to the estimation of pollution deposit caused by vehicles into the city to-tal greenhouse gases emissions and to the forecast of the secondary air pollution with formal-dehyde.
The present study contains mathematic model which allows getting the estimation of vehicles emission in the total amount of polluted atmospheric air. The model consists of two intercon-nected parts: a dynamic and a kinetic one. The first part of the model is based on the Theory of Convective Jet and Thermals in the Atmosphere and allows to get the parameters of the contaminated air which is being formed over the highway. The Dynamic part of the model allows to get the total amount of hydrocarbons emission depending on the number of vehicles which is present at the same time on the highway. We also obtain the data on concentration of pollution and temperature increasing in the narrowest section of the thermal jet.
The kinetic part of the model allows to determine the concentration of the secondary atmos-pheric air contamination with formaldehyde as a result of photochemical transformation of hydrocarbons which are the part of emission of internal combustion engine. The speed of the transformation reaction was determined by the Can't Hoff-Arrhenius deferential equation.
The given mathematical model was tested with the help of the system of regular observation over the polluted atmospheric air in Kyiv city. The comparison of the estimated value of for-maldehyde concentration and the observation data doesn't exceed 5 % above the maximum values. According to average monthly rates there is a false positive error (to + 20 % in the warmest months).
Basing on the given model the calculator of concentration of pollution by vehicles was devel-oped. This calculator allows to obtain rapidly the values of formaldehyde concentration, de-pending on air temperature, solar radiation and number of vehicles on the highway. The amount of hydrocarbon emission from the vehicles, according the suggested model, allows to estimate the deposit of vehicles into the total amount of greenhouse gases of the city. The ob-tained results could be useful in forming of ecological policy of the cities and in managerial decision making.


one of the important property of endodontic sealer is antibacterial activity. This study aimed to compare the antibacterial properties of three common and widely used sealers: MTA-FillApex, AH Plus, and AH26 against Enterococcus faecalis. In this study, 25 Blood Agar plates were prepared, in each of which 5 wells were devised. In three wells, three sealers of MTA-FillApex, AH Plus, and AH26 were placed. Ampicillin was poured into the fourth well as the positive control group. Finally, distilled water was poured into the fifth well as the negative control group. Concurrently, 1/10 ml of Enterococcus faecalis bacteria suspension with a concentration of 0.5 McFarland was cultivated on the plates. Following 48 hours of incubation, the diameter of inhibition zone around the wells was measured. Finally, the obtained results were analyzed by one-way ANOVA, fisher LSD, Fisher individual 95% Cl. The results of our study on 25 plates after 48 h indicated AH26 sealer with the mean zone of inhibition diameter of 16.44 mm had the greatest antibacterial effects. AH26 was followed by MTAFillApex with the mean zone of inhibition diameter of 15.44 mm. Finally, the weakest antibacterial effect was related to AH Plus sealer, with the mean zone of inhibition diameter of 10.2 (p<0.1000). According to our study, AH26 sealer has the greatest power and antibacterial properties against Enterococcus faecalis bacteria, followed by MTA-FillApex, and AH plus (as the weakest antibacterial agent against the mentioned bacteria).


In eukaryotic cells, polypeptides are N glycosylated after passing through the membrane of the ER into the ER lumen. This modification is effected cotranslationally by the multimeric oligosaccharyltransferase (OST) enzyme. Here, we report the first cross-linking of an OST subunit to a nascent chain that is undergoing translocation through, or integration into, the ER membrane. A photoreactive probe was incorporated into a nascent chain using a modified Lys-tRNA and was positioned in a cryptic glycosylation site (-Q-K-T- instead of -N-K-T-) in the nascent chain. When translocation intermediates with nascent chains of increasing length were irradiated, nascent chain photocross-linking to translocon components, Sec61α and TRAM, was replaced by efficient photocross-linking solely to a protein identified by immunoprecipitation as the STT3 subunit of the OST. No cross-linking was observed in the absence of a cryptic sequence or in the presence of a competitive peptide substrate of the OST. As no significant nascent chain photocross-linking to other OST subunits was detected in these fully assembled translocation and integration intermediates, our results strongly indicate that the nascent chain portion of the OST active site is located in STT3.


PURPOSE
To identify aberrations created by making a laser in situ keratomileusis (LASIK) flap and treating the refractive error with laser ablation at a later date.

METHODS
Twenty-two eyes (11 patients) underwent a two-step LASIK procedure with the Alcon LADAR-Vision laser (Alcon Laboratories, Ft Worth, Tex). In the first step, a flap was created, and 1 month later the flap was lifted and laser ablation performed. Aberrations were measured with the LADARWave wavefront measurement device preoperatively, after making the flap (1 day, 1 week, 1 month) and after laser treatment (1 week and 3 months). Two different microkeratomes were used (Moria M2 [Moria; Antony, France] and SKBM [Alcon]). With the SKBM, all flap hinges were nasal; with the Moria M2, the flap hinge was randomly selected as superior in one eye and nasal in the other.

RESULTS
A slight hyperopic shift was seen in the manifest and wavefront refractions at 1 week and 1 month after flap creation for the Moria M2, but not for the SKBM. Statistically significant change in manifest sphere with the Moria M2 showed a mean shift at 1 month of +0.50 +/- 0.08 diopters (D) whereas the SKBM showed no mean shift, but less reproducibility, +0.06 +/- 0.17 D. Higher order aberrations after flap creation were statistically significantly higher for all except coma with both microkeratomes, but with no predictable trends observed. Although higher in magnitude, post flap aberrations were less than one quarter the increase noted in post laser aberrations, except for "other terms."

CONCLUSIONS
Creating a LASIK flap induces changes in lower and higher order ocular aberrations. The change in lower order terms is microkeratome dependent. Higher order aberrations increase to a much larger degree after laser than after flap, making a two-step procedure unnecessary in conventional LASIK.


This letter describes modelling and experimental results of low and high pressure shock waves (of the order of 100 and 1000 bar, respectively) induced by pulse laser radiation. Measurements were performed using piezoelectric polymer PVDF sensors. The results of numerical calculations and their comparison with an experiment have been posted. Measured and calculated results have been used in estimation of the temporary course of signals from a fibre VISAR interferometer which measured the movement velocity of steel plate driven by the analysed shock waves. Description is supplemented with results of magnitude measurements of surface plastic deformation and material microstructure of samples. Full Text: PDF References J. Wang, N.R. Sottos, R.L. Weaver, "Tensile and mixed-mode strength of a thin film-substrate interface under laser induced pulse loading", J. Mech. Phys. Solids 52, 999 (2004). CrossRef R. Ecault et al., "A study of composite material damage induced by laser shock waves", Composites A 53, 54 (2013). CrossRef K. Jach et al., Computer modeling of dynamic interactions of bodies using free point method, Wydawnictwo Naukowe PWN, Warszawa, (2000) (in Polish). D.H. Dolan, Foundations of VISAR analysis, SANDIA REPORT, SAND2006-1950 (2006). CrossRef


Calibration of passive-radon monitoring tool has been performed by using active charcoal and
many factors which influenced it. Radon gas is radioactive gas that naturally occurs and available in
everywhere. One of concentration meter is passive-radon monitoring tool which use active-charcoal.
Before used, the monitoring tools needs to be calibrate to get calibration factors. Factors which
influenced calibration factor are active-charcoal, filter and humidity type.
This research performed due to factors that influence radon-absorption to passive-radon monitor
using active-charcoal to identify calibration factor from many factor. Passive-radon monitoring tools
made by plastic hard pipe with 7.7 cm in diameter and 3 cm of high which contain active-charcoal 50
gram. This research use active-charcoal 4-type and 4 filter-type which used letter in papari for 3-5 days.
In varians humidity condition, that humidity are 70%, 80%, 90% and 95%.
The magnitude of calibration factor which obtained from research using active-charcoal from
lokal 2 use paper filter is the best result, that is 1.25 x 10-5 (Bq gram-1)/(Bq m3 x hour).


There is currently a need to develop high pressure composite butt-weld joint to meet the needs of deepwater activities. In this study, a tapered butt-weld composite joint configuration was proposed. Finite element analysis was conducted to validate the proposed structural configuration through stress-strain distribution analysis. Test samples were assembled using hand lay-up technique. The prepared specimens were hydro tested. The test results justified the proposed joint configurations. About 35.7% increase in bursting pressure in tapered butt-weld composite joint was observed over currently used composite butt-weld joint.Copyright © 2002 by ASME


Raised intracranial pressure (ICP) is a complication not just of traumatic brain injury and other acute cerebral insults, but also of a number of general medical conditions. Monitoring of ICP is of paramount importance in Neurointensive Care Unit. Increased ICP causes brain insult which may be associated with increased mortality and poor neurological outcomes.[1,2,3] Bedside clinical diagnosis can be difficult as early clinical signs may be misinterpreted, and heavy reliance on cross-sectional imaging studies may further delay diagnosis.

Ultrasound is a bedside imaging modality that is increasingly available in most critical care units. The diameter of the optic nerve sheath has been found to be a strong predictor of raised ICP, with a high sensitivity and specificity in multiple studies and in a systematic review.[4] The optic nerve sheath is bound more loosely to the optic nerve closer to the globe. This loose binding creates a much larger, and potentially more distensible, subarachnoid space in this region, which can appear bulbous on ultrasound.[5] Consistent with this, the optic nerve sheath is at its most distensible anteriorly, where it is potentially most reflective of raised ICP. As per a 1996 study, using modern ultrasonography (USG) techniques showed that optic nerve sheath diameter (ONSD) increased by up to 60% at a distance of 3mm behind the globe in comparison to only 35% at 10 mm.[6] This has been confirmed in subsequent studies, indicating that a position 3 mm behind the globe is preferred for measurement.[7] Measurements made at this point are more reproducible since ultrasound contrast is greater at this depth with a linear probe.

While papilloedema viewed by funduscopy may take the time to develop, dilatation of the optic nerve sheath occurs much earlier and may be a near instantaneous manifestation of raised ICP.[6,8]

Studies of sonographic ONSD have mainly correlated findings with clinical and radiological signs and symptoms of elevated ICP. Intraventricular measurement is the gold standard for measuring ICP. These measurement devices carry many risks, including hemorrhage and infection. These complications partly account for increasing interest in noninvasive methods such as neuroimaging, transcranial Doppler sonography, ONSD USG and computed tomography/magnetic resonance imaging (CT/MRI). In addition, invasive methods may not be available to individual patients due to contraindications, such as coagulopathy, thrombocytopenia, or the lack of local facilities.

The optic nerve and its surrounding sheath can be accurately imaged and measured on MRI using a fat-suppressed T2-weighted sequence. MRI is often spoken of as a reference test for ONSD, as it has a higher spatial resolution, and the images offer a more representative calculation of the mean diameter than CT. While Lagreze et al. contend the accuracy of MRI exceeds sonographic methods for determining ONSD,[9] Bauerle showed good scan-rescan reproducibility and good observer agreement in 15 healthy volunteers.[10]

Two questions that need to be answered when we talk about bedside measurement of ONSD by ultrasound for diagnosis of raised ICP: First, does the bedside ultrasound measurement of ONSD correlate strongly with a neuroimaging technique such as an orbital MRI; and secondly what should be the cut-off of ONSD values to determine raised ICP.

The authors of the current study[11] have attempted to resolve the first question regarding the correlation of ONSD measured by bedside ultrasound and MRI. They have studied 100 adult patients of either sex, diagnosed with meningoencephalitis who were to undergo MRI of the brain and measured the ONSD 3 mm behind the globe using a bedside ultrasound and correlated its measurement with that measured by MRI at the same point.

They found a high level of correlation between the ultrasound measurement and MRI measurement of ONSD. A Bland-Altman analysis was done to show agreement between both methods of measurement of ONSD, the analysis showed a significant correlation between ocular sonography and MRI. Previous Studies performed between both modalities to measure ONSD were done in subjects with normal ICP or in cadavers. This is the first study done with a relatively large group subjects with meningoencephalitis and it adds further proof that bedside ultrasound readings of ONSD may be as accurate as MRI, given the proper technique and training.

With regards to the second question, there is wide variation in the literature regarding in the optimal cut-off values, when ONSD was compared with invasive ICP monitoring, ranging from 4.8 to 5.9 mm.[12,13] The reasons cited for these varied cut-off include: Heterogeneous patient populations, varied methods for confirming raised ICP, and ethnic difference among the patient population. The current authors have selected cut-off values of 4.6 mm for females, and 4.8 mm for males in accordance to a study by Shirodkar et al.[14] on 101 Indian patients who demonstrated a high level of sensitivity and specificity with these cut-off values for the diagnosis of intracranial hypertension as evident on CT or MRI imaging. However, the current authors have limited themselves to comparing the numerical accuracy of ONSD values obtained with USG and MRI. They have not commented on the presence or absence of MRI findings of raised ICP and hence have not corroborated the cut-off values of ONSD for raised ICP in Indian patients which as per Shirodkar et al.[14] was found to be somewhat less than those from previous studies.

Nevertheless, the high level of correlation between MRI and a bedside ultrasound found in this study suggests that ultrasound can be used to detect acute rise in ICP with a high level of accuracy and despite its limitations, USG ONSD measurement is likely to be more reliable than clinical assessment in the diagnosis of intracranial hypertension and has the potential to become one of the first line modalities in detecting increased ICP especially in situations when altered sensorium or administration of sedative medication precludes such assessment.[15]

Further, larger studies need to be performed on Indian population to decide an optimal cut-off value for raised ICP and that needs to be correlated with a standard which could be either direct measurement of ICP or by means of characteristic findings on neuroimaging.


Dueling theories aim to explain why larger organisms tend to live longer; both conclude that the physics of nutrient distribution is key. On page
 1677, a research team proposes that the so-called quarter-power law--which states that life-span tends to lengthen in proportion to the quarter power of an animal9s body weight--derives from the physical constraints of an ideal system for distributing nutrients, whether it9s the blood conduits running through our body or the vascular network nourishing a plant. An alternative theory from a second group (Nature, 13 May, p. 130) differs in details but comes to the same conclusion: The constraints on life-span and metabolism lie within an organism and have nothing to do with outward size and shape.


Abstract  An estimated 50% of patients undergoing routine cardiac surgery require intravenous antihypertensive therapy to manage life‐threatening arterial bleeding, myocardial ischemia, or cardiac failure in the perioperative period. Managing hypertension in this setting can be challenging because of the need to reduce blood pressure while maintaining adequate end organ perfusion. Hypotensive episodes can increase the risk of cardiac complications and end organ hypoperfusion, particularly in patients whose underlying cardiovascular disease has altered autoregulation of blood flow. To decrease the risk of hypertensive or hypotensive episodes, blood pressure is monitored continuously, and short‐acting intravenous antihypertensive agents are administered in an effort to target a mean arterial pressure generally within 20% of the patient's baseline value. Efforts to optimize end organ perfusion and avoid recognized adverse drug effects may influence the choice of antihypertensive agents. The ideal agent for postoperative hypertension should have a rapid onset of action, be highly vascular selective, and be rapidly reversible. In addition, it should be safe, with little risk of overshoot hypotension or adverse drug reaction. Precise management of arterial pressure in the perioperative period has the potential to improve clinical outcome by avoiding hypotensive episodes, ensuring adequate end organ perfusion, decreasing the risk of adverse drug effects, and serving as a bridge to definitive long‐term therapy for essential hypertension.


This paper focuses on the multi-focus image fusion based on wavelet transformation, making in-depth discussion and improvement on the existing algorithms from the aspect of the rules of multi-focus image fusion. Especially the parameter of the regional contrast is selected in the algorithm which can reflect better distinct features of the image frequency domain in the high-frequency coefficients fusion. And according to the fusion rule :" the part of the large regional contrast of wavelet high frequencies coefficients corresponding to the clear part of the image " , an improved algorithm is proposed for multi-focus image fusion based on wavelet transform regions contrast. Finally, Matlab is employed to simulation the algorithm.


Understanding the variation of nanofluidic behavior in the presence of an external electric field is critical for controlling and designing nanofluidic devices. By studying the critical infiltration pressure of liquids into hydrophobic nanopores using molecular dynamics (MD) simulations and experiments, important insights can be gained on the variation of the effective liquid-solid interfacial tension with the magnitude and sign of electric field, as well as its coupling with the pore size and the solid and liquid species. It is found that the effective hydrophobicity reduces with the increase of electric intensity and/or pore size, and the behavior is asymmetric with respect to the direction of the electric field. The underlying molecular mechanisms are revealed via the study of the density profile, contact angle, and surface tension of confined liquid molecules.


Caffeine is considered a widely consumed natural and legal psychoactive stimulant with several effects on the body. The present study attempted to investigate the effects of caffeine consumed before and after a physical exercise on cardiovascular and cardiorespiratory functions in healthy adults. 36 healthy adult males were recruited and randomly allocated to one of the three (3) groups: group I (exercise without caffeine consumption), group II (caffeine beverage intake before exercise), and group III (caffeine beverage intake immediately after exercise). The heart rate (HR), QTc interval, blood pressure (BP), respiratory rate (RR), oxygen consumption (VO₂), and carbon dioxide emission (VCO₂) were measured at 0, 5, 10, and 15 min after the exercise. We observed a significant difference in all measured outcomes during the different recovery times in all the groups (p < 0.05). HR, RR, SBP, VO2, and VCO2 gradually decreased with time, DBP contrarily increased with time, and the QTc showed an irregular pattern. We can affirm that ingestion of caffeine before and after moderate aerobic exercise slows down the parasympathetic stimulation, heart rate recovery, and the recovery of HR and QTc with no major effects on BP, RR, VO₂, and VCO₂ in healthy adult men.


Understanding protein structures is vital to determining the function of a protein and its interaction with DNA, RNA and enzyme. The information about its conformation can provide essential information for drug design and protein engineering. While there are over a million known protein sequences, only a limited number of protein structures are experimentally determined. Hence, prediction of protein structures from protein sequences using computer programs is an important step to unveil proteins' three dimensional conformation and functions. As a result, prediction of protein structures has profound theoretical and practical influence over biological study. The explanation of how a decision is made during prediction is also important for improving protein structure prediction and guiding the "wet experiments". In this talk, we will show how to use machine learning methods to improve the accuracy of protein structure prediction and to interpret prediction results. We will report our research on using neural networks, support vector machines combined with decision tree and association rule for protein structure prediction, rule extraction and prediction interpretation. Evaluation and comparisons of various prediction and rule extraction systems will be presented and future research direction in this area will also be identified.


Server load balancing technology makes services highly functional by distributing the incoming user requests to different servers. Thus, it plays a key role in data centers. However, most of the current server load balancing schemes are designed without considering the impact on the network. More specifically, when using these schemes, the server selection and routing path calculation are usually executed sequentially, which may result in inefficient use of network resources or even cause some issues in the network. As an emerging architecture, Software-Defined Networking (SDN) provides new solutions to overcome these shortcomings. Therefore, taking advantages of SDN, this paper proposes a Joint Server Selection and Traffic Routing algorithm (JSSTR) based on improving the Shuffle Frog Leaping Algorithm (SFLA) to achieve high network utilization, network load balancing and server load balancing. Evaluation results validate that the proposed algorithm can significantly improve network efficiency and balance the network load and server load.


At any moment sensory systems are confronted with vast amounts of information, and therefore must represent information as efficiently as possible. In recent years, many studies have proposed ensemble coding as one strategy for forming a compact perceptual code. In a typical visual scene, both color and blur vary widely, and the average has important implications for representing visual norms (e.g. gray or focused) and visual function (e.g. to estimate the illuminant for color or the state of accommodation for blur). Yet whether and how the visual system uses an ensemble code for these features has received little attention. In this work, the properties of ensemble coding for the attributes of color and spatial blur were examined using behavioral and electroencephalogram (EEG) techniques. In a series of experiments, the sensitivity to this average in color and blur was studied using standard member identification and mean discrimination techniques used in summary statistics studies. The visual system has been reported to be biased towards aspects of a scene that are more meaningful to perception. In blur perception, a sharp/focused image is more relevant to vision than blurred images. In another set of experiments, adaptation to blur was studied to examine if the aftereffect is driven by the average blur level or biased towards blurred or sharper parts of the image. Finally, studies on color ensemble coding have focused on average color estimation in a visual scene. In the last set of experiments, aspects of color ensemble coding beyond the average were examined by probing the number of color levels that observers can distinguish in ensembles using both behavioral reaction times and an EEG oddball paradigm. In spite of important perceptual similarities, results from these experiments show that while color ensemble coding happens within opponent hues (e.g. separately for red and green), blur ensembles coding can happen even if an ensemble spans the whole blur spectrum from very sharp to ii very blurred. This work also shows that ensemble perception is unaffected by specific properties of the ensemble, or by whether or not an ensemble mimics natural variations of color and blur.


JOPERD • Volume 82 No. 2 • February 2011 T he dance process involves meeting psychological, social, and physical needs at multiple levels. Historically, many cultures danced to express emotion and used the body to connect with others by moving together to music and sounds; this is no different in the 21st century (Block & Kissell, 2001; Levy, 1992). As true artists, dancers know that they can move with confidence and mastery of technique. Performing these practiced skills should result in achievement at a personal level and through audience recognition (Dunn & Leitschuh, 2006). Of particular interest is that dance performances now include persons of various ages, abilities, and exceptional ways of moving. Unique movement abilities have been embraced by the dance world and public as legitimate. Increasing numbers of dance groups are multigenerational (Gilbert, 2006) and include dancers with disabilities who integrate wheelchairs and other assistive devices into their choreography (LaPointe-Crump & Sherrill, 2006). There are also dance companies made up solely of persons with disabilities. This cultural shift in thinking opens the door to another world for dancers with disabilities—a world that used to be dominated by highly skilled, "elite" dancers. Dynamic, transformative dance allows persons of all abilities to experience the personal growth and feelings of wholeness that come from performing natural movements with skill and grace, as well as the exhilaration and sense of community that come from partnering and performing with others (Dunn & Leitschuh, 2006). If the dance process is planned properly, exceptionally skilled dancers, dancers with average skill, and persons with disabilities can all display their skills in a creative, artistic, and relational manner, both in and outside the classroom. This presents unique opportunities for everyone to experience growth and well-being (Block & Elkins, 2006). This article describes how to address the affective, cognitive, and psychomotor domains in an inclusive dance class, in order to successfully include students with disabilities. Specific techniques and advantages developed for fully integrating persons with special needs into dance pedagogy should focus on these domains of learning and on how each domain plays a part in the integration process. Of great importance is the showcasing of dance skills by performing for audiences (Côté, 2006). Dance pedagogy should include some type of performance as an application component, just as sport skills are applied in a game setting. The application phase of learning allows dancers or athletes to apply what they have learned by using their skills in some type of context. Passion, professionalism, and unity displayed by dancers in a performance are The Adapted Dance Process Planning, Partnering, and Performing


Abstract Mt Pinatubo is located on the main island of Luzon in the Philippines. Its 1991 eruption is considered one of the most powerful volcanic explosions of the 20th century. The first victims of the eruption were the Aeta indigenous communities living on the slopes of the mountain. In 1999, approximately 50,000 people were still trying to resume life on the slopes of Mt Pinatubo. Their traditional way of life has been deeply affected by the disaster, which brought changes in the indigenous cultural fabric. The present article addresses the Aetas' response to the 1991 Mt Pinatubo eruption and subsequent cultural changes, using the concept of resilience. It particularly focuses on the communities located within the 200-km2 Pasig and Sacobia river basins on the eastern flank of the volcano, in the immediate vicinity of the former Clark American military base. The discussion relies on extensive fieldwork conducted between July 1999 and June 2000 and complemented by additional field explorations between June and September 2001. It recommends fostering community-based disaster recovery as a way to enhance community resilience.


Expanding edge experiments are promising to open new physics windows of quantum Hall systems. In a static edge, the edge excitation, which is described by free fields decoupled with the bulk dynamics, is gapless, and the dynamics preserve conformal symmetry. When the edge expands, such properties need not be preserved. We formulate a quantum field theory in 1+1 dimensional curved spacetimes to analyze the edge dynamics. We propose methods to address the following questions using edge waveforms from the expanding region: Does the conformal symmetry survive? Is the nonlinear interaction of the edge excitations induced by edge expansion? Do the edge excitations interact with the bulk excitations? We additionally show that the expanding edges can be regarded as expanding universe simulators of two-dimensional dilaton-gravity models, including the Jackiw-Teitelboim gravity model. As an application, we point out that our theoretical setup might simulate emission of analog Hawking radiation with the Gibbons-Hawking temperature from the future de Sitter horizon formed in the expanding edge region.


This report is based on a master thesis work aimed at improving the Simpow Dips program, by
implementing new features. Simpow Dips, in its existing version, simulates faults in all nodes
in a given network and creates a result-file containing the during-fault voltages at each node
for every fault. Improvements have been made in three aspects: the ability to also calculate
the dip duration, an improved method for calculating the magnitude of the dip and a graphical
presentation of the calculation results.
A method for defining statistical distributions of dip durations for subsets of the network
has been implemented in Simpow Dips. The method is able to produce calculation results with
good accuracy under an important condition: that the data used as basis for the distributions
is of sufficient accuracy. This data can be collected in different ways, but monitoring the network
(or a network with similar characteristics) togetherwith knowledge of the protection relay
settings can give data of desired accuracy.
In the existing version of Simpow Dips the dip magnitudes are calculated with faults only
occurring at the nodes. The Moving Fault Node method implemented in the new version of
Simpow Dips will result in more accurate calculations of the magnitude.
The calculation according to this method requires the bus impedance matrix, the impedance
for the faulted line, the fault position on the line and pre-fault voltages at three locations
in the system: the two terminals of the faulted line and the node where the customer is connected.
A uniformdistribution of the fault position over the line length has been assumed.
The calculation of the dip magnitude for a fault at a line is not yet implemented in Simpow
Dips itself, but is done in an analysis program, written under Matlab. The result-file produced
by Simpow Dips gives pre-fault voltages and sequence impedances necessary for the calculation.
The above-mentioned analysis program also produces graphical presentations of the results:
scatter plots, voltage dip coordination charts and voltage dip density charts are produced.
The voltage dip coordination chart is helpful when estimating the severity of the dip situation
for a certain customer by introducing the voltage-tolerance curve. By using the voltage dip
density chart and cumulative chart an impression of the power quality is given for the site.
The different plots also simplify the analysis of the effect of changes in the power system.
This is illustrated for a number of different changes to a small network.


It is of great knowledge nowadays that the use of fossil fuels is responsible for the emission of gases that intensify the greenhouse effect, which threatens the survival of the humankind. The gravity of this fact could be mitigated through the indirect use of solar energy for fuels derived from vegetable that can be planted and cultivated by the world of renewable and non-polisher. Microalgae play an important role in this regard, as they have promising characteristics as potential raw material for the production of biofuels, able to absorb large amounts of CO2. Chlorophyll organisms convert these simple substances in the atmosphere, absorbing sunlight into chemical energy stored, that is, compounds with high energy, biomass can also be used to obtain biocompounds human nutritional supplement and food animal, however, have been found an important number of difficulties to economically viable production like high cost of production of dry biomass and oil extraction. Here, we review the main approaches of biorefinery concept appearing as an alternative to achieve economic viability of the production of bio-diesel based on microalgae. The major points are the following: 1) use of re-residual water, 2) marketing of Carbon Credits, and 3) development of co-products resulting from high value added.


The relationship between community diversity and the stability of summed community biomass has been an area of great theoretical and empirical interest in basic ecology. In general, it has been found that the complementary/compensatory dynamics among species that comprise a community can stabilize aggregate measures of community biomass. Although the potential importance of diversity-stability relationships to restoration ecology has been recognized, to date there has been no quantification of the role these relationships play in increasing the persistence of restored communities in the face of altered disturbance regimes, climatic variability, and over the course of succession. In a large-scale experimental restoration of a California grassland community, aggregated abundance of restored grasses was more stable than were the individual species in response to disturbance, drought, and succession. Compensatory dynamics among the restored grass flora increased aggregate stability in response to natural and anthropogenic disturbances. Successful restorations must persist in the face of altered management and disturbance regimes, climactic variability, and over the course of succession. Incorporation of diversity-stability relationships into restoration plans will likely increase restoration success. This case study further demonstrates the relevance of community ecology theory to restoration ecology.


This present paper examines Ibsen's A Doll's House from the viewpoint of gender differences in the use of language by the characters in the play, and the way the lives of the characters are affected by the use of language. The study concludes that the prevalent ideologies in the society define the gender roles that stimulate women to maintain intimacy and connection and men to preserve their independence and status. However, females break this connection when they tend to preserve their identity and individuality instead of maintaining connection. The analysis of the selected text, from the play, is carried out through using Discourse analysis tools like Identity Building Tool, Turn Taking and Holding Floor, Story Telling, Empty Adjectives, Intensifiers. Tannen's theory of Genderlect Styles and Althusser's concept of Ideological State Apparatuses have been used to draw the conclusion.


ABSTRACT Australia has recently witnessed a dramatic reduction in the aid it provides to developing countries. Debates often focus on the implications for poverty eradication, but also at stake is Australia's leadership position in certain international financial institutions. To explore this political dimension, we examine the pattern of Australian aid to developing countries through the lens of the Bretton Woods Institutions: the International Monetary Fund and the World Bank. Specifically, we consider countries that elect Australia to the executive boards of these institutions. Using aid data from 1960 to 2009 for 186 countries, we test whether Australia rewards members of its voting bloc with more foreign aid. Descriptive data and regression analyses support our hypothesis: Australia gives as much as 10 times more annual aid to bloc-members than to other developing countries. We take the finding as evidence of one of the many ways in which Australian aid can advance foreign policy objectives.


The solid model and virtual prototype model are built. Kinematics, strength and rigidity analysis are completed with FEM simulation system of MSC.NASTRAN. The analysis results of stress, strain and displacement of finite element simulation are presented. The results of simulation were proved by vibration experiment. Based on the simulation and vibration experiment, the mechanics dynamical properties are proved, the main destroy form and locations are analyzed and indexed. The result shows that the rigidity and strengthen could meet the requirement of design of the motor. In the end, in order to satisfy the needs of kinds of clients, the effect of core length on the stress and displacement is also discussed through FEA simulation. Finally, an optimization structure of the Rotor of a vertical motor is given and analyzed, which has the guiding sense in the test and 0ptimizating for the rotor.


the operation and optimization of complex production and logistic enterprises requires modern, data and simulation driven multi criteria decision approaches. Digital enterprise systems are complex systems, in terms of layout variability, control strategies, business processes and system parameter. all of these aspects are not independent and even due to the system dynamics the optimal solution may differ depending on the actual situation applying specific requirements. in order to improve operative decision making in production and logistic enterprises a digital twin concept can be applied. these digital twins are virtual clones of real systems or subsystems. with simulation and artificial intelligence technologies new opportunities for operative decision making are possible. Digital twins can cover the entire lifecycle of an asset or process by forming a closed-loop chain for smart, connected products, services and production and logistic processes, from design to operation, from deployment to continuous improvement.


About the nature of museums, the review of the book W kręgu muzealnych przedmiotów by Justyna Żak The review concerns the book W kręgu muzealnych przedmiotów by Justyna Żak, published in 2020 by the Wydawnictwo Uniwersytetu Warszawskiego. The book deals with the nature of museum objects and objects that fill museum rooms and do not have the status of museum objects, being elements of arrangement, reproductions or reconstructions. In a broader sense it is a reflection on the nature of museums, in which the notion of authenticity is of key importance. The book's asset is a broad perspective of an object in a museum –its status, value, meaning – from theoretical reflection in the field of philosophy, sociology and aesthetics, to case studies and museum practice, supported by quotations from belles-lettres, however, the author fell into the trap of a superficiality that was difficult to avoid.


BACKGROUND
Transarticular screw (TAS) fixation is our preferred method for stable internal fixation of the atlantoaxial joint because of its excellent outcomes, versatility, and cost-effectiveness.

OBJECTIVE
In this article, we update our series of patients who have undergone TAS fixation, with attention to surgical technique, planning, complication avoidance, and anatomic suitability.

METHODS
We retrospectively reviewed 269 patients (150 women, 119 men; average age, 52.9 years; age range, 17-90 years) who underwent placement of at least 1 TAS. In total, 491 TASs were placed for stabilization necessitated by various pathologic conditions. The mean follow-up period was 15.7 months (range, 0-106 months).

RESULTS
Fusion was achieved in 99% of 198 patients monitored until fusion or nonunion requiring revision, or for 2 years. Forty-five patients had a complication, for a rate of 16.7%. Five early patients had vertebral artery injuries, 1 of which was bilateral and fatal. No recent patients had vertebral artery injuries. Other complications did not result in neurologic morbidity. Review of all atlantoaxial fusions by the senior author (R.I.A.) revealed that the TAS fixation technique could be successfully applied in 86.7% of sides considered. The main reasons for inapplicability were anatomic (recognized on preoperative planning) in 77% and abandonment secondary to concern about possible vertebral artery injury on the first side attempted in 13.8%.

CONCLUSION
The placement of TASs is safe and effective for stabilizing the atlantoaxial articulation. Refinements in technique, such as 3-dimensional stereotactic workstation for trajectory planning, have reduced the rate of serious complications. Clinical outcomes are excellent, with nearly 100% of patients achieving stable bony union.


This work deals with the construction of a low-order absorbing boundary condition (ABC) for 2D elliptic TTI media, preserving the system stability. The construction is based on comparing and then connecting the slowness curves for isotropic and elliptic TTI waves. Numerical experiments illustrate the performance of the new ABC. They are performed by integrating the ABC in a DG formulation of Elastodynamics. When applied in a TTI medium, the new ABC performs well with the same level of accuracy than the standard isotropic ABC set in an isotropic medium. The condition demonstrates also a good robustness when applied for large times of simulation. R esum


Introduction EPITHELIAL misplacements (heterotopias) in the gastrointestinal tract can often be mainly of academic interest. On the other hand, by virtue of their anatomical localization, some heterotopias might be expected to give rise to symptoms and these might present a difficulty in terms of differential diagnosis between a benign and a malignant condition. We report the case of a 10-year-old girl whose clinical and roentgenological picture was suggestive of a malignant process involving the stomach, and the diagnosis of heterotopic malformation was achieved by means of peroral gastric mucosal biopsy. Report of a Case Case History .—A 10-year-old girl, born in Israel of parents from Morocco, was referred to the Pediatric Outpatient Clinic of the Hadassah University Hospital because of anorexia of three months duration, associated with a loss of weight of about 22 lbs (10 kg). During these three months the child had stopped eating and had started to


Automated text-based or speech-based personal assistants, also known as chatbots, have been prevalent in several domains including marketing and technical support. Through mainstream applications, such as Siri or Alexa, their popularity has increased and we now see them being used in even more domains. Although the purpose of chatbots varies among domains, there are common elements that all chatbots share. By identifying these elements, it is possible to streamline the development of chatbots en masse and in a structured manner. Additionally, there can be common challenges in the development of such applications, for example, how to treat novice versus expert users or how to establish memory of the conversation. In this work, we propose a reference architecture for chatbots using concepts from Software Product Lines and Feature Models, where we outline the common elements as well as the common challenges. Using Watson and Bluemix as the basic platforms, we also present the creation of two chatbots, for different purposes, based on this reference architecture to highlight these commonalities.