Background Since 2014, the French Medicine Agency contraindicates alfuzosin with strong cytochrome P450 3A4 (CYP 3A4) inhibitors, but gives no information on how to manage it. We dispense drugs to haematological outpatients whose treatments can combine alfuzosin (for lower urinary tract symptoms, LUTS) with anti-infective drugs that may be strong CYP 3A4 inhibitors. We conducted a pharmaceutical intervention (PI) but lacked a clear and consensual management for physicians. However, to be efficient and accepted by prescribers, the PI must propose a clear, synthetic and argued way to proceed, adapted to the patient. Purpose The objective of this work was to determine the incidence and clinical importance of this drug interaction (DI), how to manage it and what are the non-interacting alternatives. Material and methods A review was conducted of the scientific literature, drug databases and regulatory documents, on the mechanism, clinical evidence and incidence of this DI. Then, the most recent French recommendations on the management of LUTS were used to identify non or less interacting alternatives. Finally, a clinical decision tool was redacted to help the pharmacist manage this DI, depending on patient condition. Results The mechanism of this DI is established, but no clinical evidence has been found, except for two studies in healthy volunteers that mainly showed an increase in the area under the curve of alfuzosin when associated with ketoconazole. The contraindication was extrapolated from the DI between alfuzosin and telaprevir. Expected side effects are mainly an increased risk of postural hypotension, depending on risk factors that can be managed. In haematological patients, the CYP 3A4 inhibitor generally cannot be stopped because of the infectious risk. Stopping alfuzosin can put the patient at risk of urinary retention (as seen for one patient), but less or non-interacting alternatives exist for each type of LUTS. A guide was developed to offer an argued management of clinical situations when making a PI. Extensive work should be conducted on the positive impact of this guide on acceptance of a PI. Conclusion Regulatory information may not be sufficient to manage a new DI but appropriate information searches to produce clinical decision tools can provide argued PI. References and/or Acknowledgements M Boucquin (documentary search) No conflict of interest.


A method of indirect background digital calibration of the dominant static nonlinearities in pipelined analog-to-digital converters (ADC) is presented. The method, called decision boundary gap estimation (DBGE), monitors the output of the ADC to estimate the size of code gaps that result at the decision boundaries of each stage. Code gaps result from such effects as capacitor mismatch, finite opamp gain, finite current source output impedance, comparator offset, and charge injection. DBGE does not require special calibration signals or additional analog hardware and can even reduce the performance requirements of the analog circuitry. The calibration is performed using the input signal and thus requires that the input signal exercise the codes in the vicinity of the decision boundaries of each stage. If it does not exercise these codes, then lack of calibration is less critical because the nonlinearities will not appear in the output signal. DBGE is simple and amenable to hardware and/or software implementations. Simulation results indicate DBGE is highly accurate, robust, and adaptive even in the presence of parameter drift and circuit noise.


Abstract Circular nucleic acids have been utilized for versatile applications by taking advantage of the unique characteristic of their circular structure. In our previous study, we found that the chemically-cyclized ODN (cyODN) with double-tailed parts formed a pseudorotaxane structure with the target via the slippage process. We now report the investigation of the slippage properties and the mechanism of the slippage process using six different cyODNs. Our results indicate that the formation efficiency significantly depend on the temperature, the ring size, the target length and the mismatched position of the target. The kinetic studies also showed that this pseudorotaxane formation would proceed via a non-threaded structure which hybridizes with the target at the double-tailed parts. In addition, the resulting pseudorotaxanes showed interesting characteristics unlike the canonical duplex such as the hysteresis loop in the Tm measurements and the kinetic stabilization by lengthening the target. This information will be fundamentally important for finding new functions of circular nucleic acids and elucidating the threading mechanism regarding other synthetic small molecules and biopolymers.


Background. The aim of this study was to assess visual information processing and cognitive functions in unaffected siblings of patients with schizophrenia, bipolar disorder and control subjects with a negative family history. Methods. The siblings of patients with schizophrenia (N = 25), bipolar disorder (N = 20) and the controls subjects (N = 20) were matched for age, education, IQ, and psychosocial functioning, as indexed by the Global Assessment of Functioning scale. Visual information processing was measured using two visual backward masking (VBM) tests (target location and target identification). The evaluation of higher cognitive functions included spatial and verbal working memory, Wisconsin Card Sorting Test, letter fluency, short/long delay verbal recall and recognition. Results. The relatives of schizophrenia patients were impaired in the VBM procedure, more pronouncedly at short interstimulus intervals (14, 28, 42 ms) and in the target location task. Marked dysfunctions were also found in the spatial working memory task and in the long delay verbal recall test. In contrast, the siblings of patients with bipolar disorder exhibited spared performances with the exception of a deficit in the long delay recall task. Conclusions. Dysfunctions of sensory-perceptual analysis (VBM) and working memory for spatial information distinguished the siblings of schizophrenia patients from the siblings of individuals with bipolar disorder. Verbal recall deficit was present in both groups, suggesting a common impairment of the fronto-hippocampal system.


Olfactory reference syndrome: a case report Olfactory Reference Syndrome (ORS) has been defined as a psychiatric condition characterized by persistent preoccupation about body odor accompanied by shame, embarrassment, significant distress and avoidance behavior. Patients often limit their public appearances and restrict their social and occupational encounters. In DSM-IV, delusions about personal odor are described as an example of the somatic subtype of delusional disorder. However, patients with ORS are different from delusional disorder. These patients feel themselves responsible from the smell and live a shame. In this article, we present a case of a 32 year old single male whose delusion of emitting a foul body odor has caused significant depressive symptoms. He showed remarkable improvement with a combination of paroxetine and olanzapine therapy. ORS is discussed in the light of literature with regard to diagnosis and treatment.


Neris is the second longest river in Lithuania, flowing over the territory of Vilnius, the capital of Lithuania. It played an important role in the history of Vilnius, particularly, as a waterway, which, in the past, connected the Grand Duchy of Lithuania (GDL) with the neighbouring regions and countries. The river and its tributary, Vilnia, played the main role in the economic development of the city, as well as the development of the industry based on water-driven mechanisms, fishing and other riverside trades, recreational activities of the inhabitants and the urban infrastructure of Vilnius. The role of the river, which decreased in the second half of the 19th century because of the development of land (railway and automobile) transport, became negligible in the years of the soviet power (1945-1990). It happened due to the drop of water elevation caused by the intense drainage of the areas and, particularly, the barbarous construction of a dam at the riverhead in Belarus in 1974, which fenced off a large area of the Vileyka Reservoir. Moreover, the works for deepening the riverbed by removing stones and shoals were stopped, and it made the river unnavigable. The paper also describes frequent floods caused by the drifting of ice in the spring, which brought great damage to the city in the past, as well as the types of ships and rafts used for navigation. DOI: http://dx.doi.org/10.5755/j01.sace.13.4.13593


A case of congenital dislocation of the hip is reported in which initial closed reduction during infancy was apparently successful but atypical changes in the femoral head, coxa vara, and shortening of the femoral neck became apparent subsequently. Treatment by distal transplantation of the epiphysis of the greater trochanter and contralateral epiphyseodesis led to a very good result.

The probable explanation of the complication is that there was partial vascular insufficiency in the unossified femoral head, due to injury to the epiphyseal vessels, particularly on the medial side, and that the metaphyseal changes were secondary to asymmetrical growth disturbances in the epiphyseal plate.


A multilayer fluidic laminar proportional amplifier (LPA) was fabricated from silicon wafers by using state-of-the-art photolithography and silicon deep-reactive ion-etching (DRIE) technologies. The assembled silicon amplifier showed a factor of 10 improvement in null offset when compared to an amplifier fabricated with traditional stainless steel laminates. Null offset is a measure of fabrication quality.
 The pressure gain, which is a measure of performance, of the silicon amplifier was lower than expected. The low gain values resulted from a more faithful fabrication of the selected LPA design in silicon, producing a constricted flow condition. The same condition did not exist in the traditional stainless steel amplifier because patterning and overetching of the control features during photochemical milling widened the gap between the control edges beyond the designed value. The fabrication capability of the DRIE process has forced a reevaluation of the current LPA design.


Puerarin (PU), a natural flavonoid, has been reported to possess anti-oxidative and anti-inflammatory activities. In the present study, female Sprague-Dawley rats received lead (Pb) nitrate (300 mg/L, via drinking water) and/or PU (400 mg/kg/day, orally) to investigate the protective effects of PU on Pb-induced renal damage. Renal toxicity was evaluated by detecting urinary proteins excretion as well as levels of serum urea nitrogen and serum creatinine. Ultrastructural observations and real-time quantitative polymerase chain reaction analyses were performed on kidney cortex tissues to identify the mitochondrial damage and quantify gene expression levels of cytochrome oxidase submits (COX-I/II/III), respectively. Renal cell damage was assessed by light microscopic examination. Lipid peroxidation (LPO) levels and antioxidant status in kidney were also evaluated. Animals that received both Pb and PU showed a better renal function than those that received Pb alone, with minor pathological damage. Moreover, PU significantly reduced LPO and markedly restored the enzymatic and non-enzymatic antioxidants levels in kidney of Pb-treated rats, which may be related to its restoring mitochondrial function. Furthermore, PU administration significantly increased urinary Pb excretion and decreased its level in the serum and kidney. In conclusion, these results suggested that PU reduces renal damage induced by chronic Pb administration through its antioxidant properties and chelating ability.


major outbreaks has many similarities to the control of chemical incidents. There is often a similar sense of urgency and public alarm. Also, consultants in communicable disease control still often act as advisers on environmental health and toxicological issues to local authorities. These consultants should participate in planning for, and controlling, major releases of chemicals. Improving training in this subject for consultants in communicable disease control should be a high priority.


In a traditional threat model it is necessary and sufficient to protect against all attacks. While simple, and appropriate in high-assurance settings, we show that this model does not scale and is entirely inappropriate to the financially-motivated cyber-crime that targets two billion Internet users. The attackers who prey on Internet users are very constrained. The have finite gains, non-zero costs, and must make profit in expectation. Above all their techniques must scale. This means that they must have attacks with scalable costs or efficient ways of finding viable targets in a large population. We show that many technically possible attacks are economically infeasible. We show that incorporating target selection and monetization in addition to an attacker's technical constraints offers new directions on how defense tradeoffs can be made.


Renal disease leads to perturbations in calcium and phosphate homeostasis and vitamin D metabolism. Dietary fructose aggravates chronic kidney disease (CKD), but whether it also worsens CKD-induced derangements in calcium and phosphate homeostasis is unknown. Here, we fed rats diets containing 60% glucose or fructose for 1 mo beginning 6 wk after 5/6 nephrectomy or sham operation. Nephrectomized rats had markedly greater kidney weight, blood urea nitrogen, and serum levels of creatinine, phosphate, and calcium-phosphate product; dietary fructose significantly exacerbated all of these outcomes. Expression and activity of intestinal phosphate transporter, which did not change after nephrectomy or dietary fructose, did not correlate with hyperphosphatemia in 5/6-nephrectomized rats. Intestinal transport of calcium, however, decreased with dietary fructose, probably because of fructose-mediated downregulation of calbindin 9k. Serum calcium levels, however, were unaffected by nephrectomy and diet. Finally, only 5/6-nephrectomized rats that received dietary fructose demonstrated marked reductions in 25-hydroxyvitamin D(3) and 1,25-dihydroxyvitamin D(3) levels, despite upregulation of 1alpha-hydroxylase. In summary, excess dietary fructose inhibits intestinal calcium absorption, induces marked vitamin D insufficiency in CKD, and exacerbates other classical symptoms of the disease. Future studies should evaluate the relevance of monitoring fructose consumption in patients with CKD.


Variable names play a major role in program comprehension. However, their choice is often subject to the intuition (or intention) of individual programmers: although code conventions and style guides may constrain identifier usage, programmers are individuals naming program concepts individually. Especially if different parts of a program are written by different programmers, inconsistent naming of program entities may follow. This is unfortunate, since consistent naming would aid program comprehension, in particular if references pointing to same objects used in similar ways are named equally. As a first approach, we focus on assignments to discover possible inconsistency of naming, exploiting that a variable assigned to another likely points to same objects and, if declared with the same type, is likely used for the same purpose.
 To explore the feasibility of our approach, we implemented a tool recommending rename refactorings to harmonize variable names based on an analysis of assignments and static type information. Evaluated on some open source projects the results seem promising enough to aim for some extensions, such as application to method names, inferred type information, and weakly type-checked languages.


This work was supported by the UK Engineering and Physical Sciences Research Council (EPSRC) grant EP/H023348/1 for the University of Cambridge Centre for Doctoral Training, the Cambridge Centre for Analysis.


Sphingolipids are bioactive lipids involved in the regulation of cell survival, proliferation, and the inflammatory response. The SphK/S1P/S1PR pathway (S1P pathway) is a driver of many anti-apoptotic and proliferative processes. Pro-survival sphingolipid sphingosine-1-phosphate (S1P) initiates its signaling cascade by interacting with various sphingosine-1-phosphate receptors (S1PR) through which it is able to exert its pro-survival or inflammatory effects. Whereas sphingolipids, including ceramides and sphingosines are pro-apoptotic. The pro-apoptotic lipid, ceramide, can be produced de novo by ceramide synthases and converted to sphingosine by way of ceramidases. The balance of these antagonistic lipids and how this balance manifests is the essence of the sphingolipid rheostat. Recent studies on SARS-CoV-2 have implicated the S1P pathway in the pathogenesis of novel coronavirus disease COVID-19-related lung damage. Accumulating evidence indicates that an aberrant inflammatory process, known as "cytokine storm" causes lung injury in COVID-19, and studies have shown that the S1P pathway is involved in signaling this hyperinflammatory response. Beyond the influence of this pathway on cytokine storm, over the last decade the S1P pathway has been investigated for its role in a wide array of lung pathologies, including pulmonary fibrosis, pulmonary arterial hypertension (PAH), and lung cancer. Various studies have used S1P pathway modulators in models of lung disease; many of these efforts have yielded results that point to the potential efficacy of targeting this pathway for future treatment options. Additionally, they have emphasized S1P pathway's significant role in inflammation, fibrosis, and a number of other endothelial and epithelial changes that contribute to lung damage. This review summarizes the S1P pathway's involvement in COVID-19 and chronic lung diseases and discusses the potential for targeting S1P pathway as a therapeutic option for these diseases.


One of the largest constraints to the retrieval of accurate ozone profiles from UV backscatter limb sounding sensors is altitude registration. Two methods, the Rayleigh scattering attitude sensing (RSAS) and absolute radiance residual method (ARRM), are able to determine altitude registration to the accuracy necessary for long-term ozone monitoring. The methods compare model calculations of radiances to measured radiances and are independent of onboard tracking devices. RSAS determines absolute altitude errors, but, because the method is susceptible to aerosol interference, it is limited to latitudes and time periods with minimal aerosol contamination. ARRM, a new technique introduced in this paper, can be applied across all seasons and altitudes. However, it is only appropriate for relative altitude error estimates. The application of RSAS to Limb Profiler (LP) measurements from the Ozone Mapping and Profiler Suite (OMPS) on board the Suomi NPP (SNPP) satellite indicates tangent height (TH) errors greater than 1 km with an absolute accuracy of +/-200 m. Results using ARRM indicate a approx. 300 to 400m intra-orbital TH change varying seasonally +/-100 m, likely due to either errors in the spacecraft pointing or in the geopotential height (GPH) data that we use in our analysis. ARRM shows a change of approx. 200m over 5 years with a relative accuracy (a long-term accuracy) of 100m outside the polar regions.


A silicon surface barrier detector is used to analyse diagnostic x-ray spectra. This detector, usually employed to detect charged particles, has a very low efficiency for x-ray. This characteristic is advantageous in overcoming experimental problems caused by the high fluence rates typical of diagnostic x-ray beams. The pulse height distribution obtained with silicon surface barrier detectors is very different from the true photon spectra because of the presence of escaped Compton photons and the fact that detection efficiency falls abruptly when photon energy increases. A detailed analysis of the spurious effects involved in detection is made by applying a Monte Carlo method. A stripping procedure is described for implementation on a personal computer. The validity of this method is finally tested by comparison with the experimental results obtained with a Ge detector. The spectra obtained with the Si detector are in fairly good agreement with the analogous spectra measured with a Ge detector. The advantages of using Si as opposed to Ge detectors in x-ray spectrometry can be summarised as: its simplicity of use, its greater economy for use in routine diagnostic x-ray spectroscopy and the possibility that the stripping procedure can be implemented on a personal computer.


The simulation of thermal recovery processes and their variations like non-condensable gases (NCG) co-injection with steam in SAGD require reliable gas-liquid relative permeability curves. In this work, three experiments were conducted to extract equivalent thermal relative permeability curves, and the experimental curves were used as an input in a numerical simulation model to evaluate the NCG co-injection with steam in SAGD. Heavy oil was diluted with toluene to mimic the viscosity of the oil at 165, 195, and 225°C. It was assumed that the viscosity variation was the main factor affecting the temperature-dependent gas-liquid relative permeability curves. Athabasca sand was packed, and after water and oil were flooded, gas was injected. Three sets of gas-liquid relative permeability curves were extracted through history match. The experimental curves were used as an input in a simulation model to evaluate the effect of the amount of NCG and time of NCG co-injection in SAGD using CMG STARS.
 In contrast to previous simulation studies, the current simulation results showed that most of the injected gas leaked from the steam chamber and accumulated at the top of the reservoir. Part of the gas stayed at the top of the steam chamber insulating the steam chamber from the overburden rock. The gas that leaked from the steam chamber aided in additional recovery of oil. According to the simulation results, for a homogeneous reservoir, small amounts of NCG (about 1 mole %) can be co-injected with steam at any time of a SAGD project to reduce its energy requirements without a negative impact in the oil recovery. This amount can be progressively increased to further reduce the energy requirements and increase the ultimate oil recovery. With the introduction of the new experimental gas-liquid relative permeability curves, it would be possible to optimize NCG co-injection processes in SAGD with the use of numerical simulation, taking into account the flow behaviour of gases in the reservoir that usually is not considered.


In the reaction of Ninhydrin (1a)/1,2,3-indantrione (1b) with potassium thiotosylate, 1,4-oxathiin 6 is formed in up to 63% yield as the trapping product of the intermediary α,α'-dioxothione 1c with trans-cyclooctene (3a). Additionally, up to 18% of the available sulfur is transferred to olefin 3a to thiirane 3b through the intermediary oxathiirane.


This article attempts to demystify the term "best execution" as it offers the reader a suggestion for improving execution quality through use of the available technology. The authors see best execution as a process that may be achieved through automated trading tools that monitor the trading process and facilitate access to liquidity, as well as analyze orders and trades throughout the trading cycle to assess whether trading costs are commensurate with expectations.


Summary The Faculty of Agronomy at the University of Life Sciences in Poznań conducted laboratory tests on the content of B vitamins in the grain of three varieties of yellow-colored fodder maize. The grains of the variety ES Metronom had the statistically significantly highest content of vitamins B1 and B9. In the case of vitamin B3, the significantly highest concentration was recorded in the grain of the variety ES Abakus, while the lowest concentration was found for the variety ES Metronom. In contrast, the grain of the variety ES Bombastic had significantly higher vitamin B6 content than that of the varieties ES Abakus and ES Metronom. The grain of the variety ES Metronom had significantly higher vitamin B9 content than the other two varieties tested. In general, it should be concluded that the content of B vitamins in maize grain is not determined by the type of maize hybrid.


Cheddar cheese cultures were isolated and purified from indigenous sources using various microbiological techniques and characterized on basis of sugar fermentation, biochemical and enzyme activity tests, growth at various temperatures, pH and NaCl concentrations and using API identification kits. Raw milk and sour cream were found the most suitable indigenous sources for isolation and purification of Lactococcus lactis ssp. lactis and Lactococcus lactis ssp. cremoris. The later was differentiated from the former by no acid production from maltose, ribose, mannitol, arabinose, inositol, trehlose, negative arginine hydrolysis test, no growth either in 4% w/v NaCl or at 40°C and pH 9.2. Commercially available and locally isolated strains of Lactococcus lactis ssp. cremoris and Lactococcus lactis ssp. lactis were propagated in combination of 95:5 to prepare the mother cultures. These mother cultures were employed in standardized buffalo and cow's milks to manufacture Cheddar cheese and ripened at 4°C and 12°C for 120 days. During ripening, cheese was evaluated for physico-chemical composition and sensory quality. Buffalo milk cheese contained significantly higher fat, protein, ash, lactose, sodium, calcium, potassium and organic acids contents; particularly lactic, citric and butyric acid contents as compared to cow. Cheddar cheese prepared from indigenous cultures had significantly lower lactose and pH and higher acidity than commercial cultures. The concentrations of all the organic acids produced by indigenous cultures were distinctly higher than commercial cultures. During ripening, lactose and pH decreased while acidity increased significantly. The concentrations of all the organic acids increased highly significantly during ripening and elevated temperature considerably accelerated the production of all organic acids except pyruvic acid. Starter cultures and ripening temperatures substantially influenced the aldehydes, ketones and alcohols, while milk composition considerably affected the alcoholic and sulphur compounds. Descriptive sensory evaluation indicated that cheese samples prepared from buffalo milk using indigenous cultures were scored significantly higher for most of the attributes. Elevated temperature perceptibly accelerated the development of odor, flavor and texture characteristics during ripening. Hence, it is concluded that indigenous starter cultures and buffalo milk produced the cheese with improved quality and elevated temperature accelerates the process of ripening.


Health For All HIGHROADS TO HEALTH. By S. \Veir Newmayer, Supervisor of Medical Inspection of Public Schools, Philadelphia, and Edwin C. Broome, Superintendent of Schools, Philadelphia. New York. Cincinnati, Chicago, Boston, Atlanta: American Book Company. A sensible, well written text on the essentials of bodily health, is "Highroads to Health," by Newmayer and Broome. It is a practical guide for the boy or "irl who wishes to keep well and tit. Even the pupil who is rather indifferent to such matters is led to see their importance and encouraged to form proper health habits. Unusually effective this text should be in selling the importance of abundant health and in conveying the simple rules and principles that must be followed. The present revised edition has taken into account the most recent studies in hygiene and the methods of presenting it to children. The change in the status of alcoholic drinks has brought that age-old problem back into the field of education, and So we find in this text an excellent chapter on the detrimental effects of alcohol upon the human body. The treatment given to tea, coffee, and tobacco is wholesome and sane. Due emphasis is given throughout to the community aspects of health, although the book's primary aim is to teach good health as a way of living for the individual. A decidedly teachable, learnable text is this; interesting and to the point; plentifully related to the' everyday experiences and observations of the pupil


Historically, evolutionary biologists have taken the view that an understanding of development is irrelevant to theories of evolution. However, the integration of several disciplines in recent years suggests that this position is wrong. The capacity of the organism to adapt to challenges from the environment can set up conditions that affect the subsequent evolution of its descendants. Moreover, molecular events arising from epigenetic processes can be transmitted from one generation to the next and influence genetic mutation. This in turn can facilitate evolution in the conditions in which epigenetic change was first initiated.


We propose an online topic model for sequentially analyzing the time evolution of topics in document collections. Topics naturally evolve with multiple timescales. For example, some words may be used consistently over one hundred years, while other words emerge and disappear over periods of a few days. Thus, in the proposed model, current topic-specific distributions over words are assumed to be generated based on the multiscale word distributions of the previous epoch. Considering both the long- and short-timescale dependency yields a more robust model. We derive efficient online inference procedures based on a stochastic EM algorithm, in which the model is sequentially updated using newly obtained data; this means that past data are not required to make the inference. We demonstrate the effectiveness of the proposed method in terms of predictive performance and computational efficiency by examining collections of real documents with timestamps.


In a post-COVID world, how can higher education embrace unforeseen changes and enable self-starting, entrepreneurial students to thrive? The interdisciplinary design firm Sasaki, has learned from its experience in the planning and implementation of university campuses around the world that a nimble, multi-faceted 21st century living-learning education positions universities to be adaptable for years to come. We argue that flexibility must be integrated at the planning level to break down silos and support interdisciplinary pedagogies inside and out of the classroom. Campus master plans need to embrace the idea of the plan as a "living document" or framework that can adapt to future needs. Designers and educators must also work together to harness the next generation of technology to create transparent, accessible and impactful learning environments. Flexible plans, buildings, and landscapes can connect different disciplines, integrate the latest technology, stitch together the campus, and encourage a lifelong learning mentality. The following case studies drawn from Sasaki's practice in the United States, Asia, and Latin America will be used to support our argument: Instituto Tecnológico de Monterrey, Singapore University of Technology and Design, Anant National University, The Lawrenceville School, Xinyang University, Syracuse University, and Dartmouth College.


CONTEXT
Although microfollicles are a well-known feature of follicular neoplasms in fine-needle aspirates of the thyroid, the level of agreement about classifying groups as microfollicles is not known.

OBJECTIVE
To determine what features are present in groups that are consistently classified as microfollicles.

DESIGN
We showed 45 small groups of follicular cells each composed of fewer than 50 cells from fine-needle aspirates of the thyroid to 12 members of the College of American Pathologists Cytopathology Committee, who then classified the groups into microfollicles, macrofollicles, and indeterminate groups.

RESULTS
Twenty groups were consistently classified as microfollicles, 7 groups as macrofollicles, and 18 groups as indeterminate. Cases that were consistently classified as microfollicles were composed of fewer than 15 cells (19/20 cases), were arranged in a circle with a lumen (13/20 cases) that was at least two-thirds complete (12/20 cases), and were flat (18/20 cases). Cases that were classified as macrofollicular had between 8 and 35 cells, were arranged in sheets composed of at least 15 cells (5/7 cases) or rows of 8 cells (2/7 cases), and were flat (7/7 cases). In contrast, cases that were indeterminate were composed of either 3-dimensional groups (5/18 cases), flat groups of fewer than 10 cells (11/18 cases), or single cells (1/18 cases).

CONCLUSION
Not all small groups of follicular cells are consistently classified as microfollicles, and some are more often classified as macrofollicles. The criteria described here for reproducible microfollicles (<15 cells, arranged in a circle that is at least two-thirds complete, and flat) may help improve the agreement in classification of microfollicles and lead to more consistent classification of thyroid fine-needle aspirates.


1. Two experiments were carried out to determine the heat production associated with food intake in laying hens allowed access to food for one (experiment 2) or two hours (experiment 1) daily. 2. In experiment 1, heat production in the fed state was measured for two successive days after 46 h of food deprivation. The rate of heat production in the fasting state was measured from 47 to 69 h after feeding. 3. In experiment 2, heat production was measured at 4 fixed food intakes: 100, 70, 40 and 0 g/bird. Heat production associated with food intake, eating activity, net availability of ME and maintenance ME requirement was estimated. 4. Heat production after 46 h of food deprivation did not differ from that after 22 h of deprivation. In the hens receiving 100 g of food, heat production reached the pre-feeding level by 20 h after eating; the hens with lower food intakes reached the pre-feeding level more rapidly. It is suggested that the heat production associated with feeding had been eliminated by 22 h after eating. 5. Heat production associated with feeding was 16% of ME intake. Because the total energy cost of eating activity was only 0.8% of ME intake, the heat production associated with food intake in the limited-access hens came mainly from the effects of digestion, absorption and metabolism of the ingesta. 6. The net availability of ME was estimated to be 0.84. The estimated maintenance ME requirement was 569.6 kJ/kgW0.75 d.


Purpose: Implementing process management methodology through Lean Management and Design Thinking provides a new way to manage surgical blocks, maximize efficiency and adapt to the high variability of demand. This article presents our experience of implementing a set of improvement actions within the surgical process in the context of Lean Healthcare Processes. The project involved a total of 900 healthcare professionals over a 3-year period (2017-2019) and has impacted over 38,000 surgical patients each year at the Vall d'Hebron University Hospital in Barcelona, Spain.The purpose of this article is to present a set of improvement projects within the surgical process and show the indicators that monitor its evolution. These projects have been implemented successfully in a hospital with high surgical complexity and indicate how health care professionals and process engineers can work together as a team to improve healthcare resources.Design/methodology/approach: To evaluate the effectiveness of the actions presented, we propose a series of standardized indicators showing how our findings increase the efficiency of the surgical process. We also indicate Lean projects that can reduce patient waiting times and increase capacity. Below is a management model for the surgical process that considers industrial production criteria such as resource planning, optimizing the use of operating rooms and professionals' time and generating the best surgery combinations.Findings: Projects that have increased efficiency in the surgical block the most have been standardized and converted into a model of action. This is designed to adapt to any level of complexity within the hospital process. The set of improvement projects has been divided into 6 stages: Programming, Material logistics process, pre-surgical stage, intra-surgical stage, post-surgical stage and transversal projects; each affecting a different area of the general hospital (not only the surgical unit). Furthermore, a visual flow chart was designed using the results of the project.Findings from the study have led to a 15% increase in surgical capacity without the need for new resources. The average hospital stay also dropped from 7.2 days to 4.1 days. The flow vision in the care process improves the experience of both patients and health care professionals, who see their participation as part of the whole health care process.Research limitations/implications: the projects were mainly developed at the Vall d'Hebron University Hospital. Although several of these projects have been carried out in other hospitals in Spain by the same team of process engineers, results may be biased when the team provides support within its own process department, compared to when it supports the local team in another hospital temporarily.Another important limitation is that it takes several months to implement and consolidate the improvement projects and demonstrate improved indicators in a sustainable way over time. This matrix of projects is more than a specific action, a cultural change with the entire surgical department.Originality/value: This study sets out a proposed practical example of applying surgery management tools in the surgical process. Our proposal can offer hospital managers and surgical coordinators an orderly, streamlined project guide for overall surgical performance indicators.The main results from developing the model include the degree of satisfaction shown by healthcare professionals and the determined commitment from the center's management team to promote process management using Lean methodology. This commitment continued despite the challenges of shifting the organizational structure towards process management, which is a complex task requiring a period of adaptation and learning.Healthcare management has always prioritized increasing surgical patient safety and satisfaction. Patient flows are increased and resources used more efficiency by shifting the focus to the patient and the processes gone through during their hospital stay. This improvement project provides us with the best example of Lean methodology implementation if reinvested in bettering healthcare. This in turn increases the value perceived by patients, which is the ultimate purpose of the process.


End-grained wood/polyurethane composites were obtained by a water-based one-pot process free of diisocyanates. Wood was impregnated with both PEG and CBC-functionalized PEG as a coupling agent. A thorough study of the CBC-mediated end-groups conversion of PEG was achieved. It came out that functionalization conditions strongly affected the polyurethane chain extension and its grafting onto the wood structure. Antiswelling efficiency measurements showed that the one-pot procedure allowed to reach comparable dimensional stabilization than the diisocyanate-based process previously described. Morphological analysis demonstrated that such an improvement was attributable to the formation of cell wall-bulked WPCs.


Protein kinase Mζ (PKMζ) is a persistently active protein kinase C isoform that is synthesized during long-term potentiation (LTP) and is critical for maintaining LTP. According to "synaptic tagging," newly synthesized, functionally important plasticity-related proteins (PRPs) may prolong potentiation not only at strongly tetanized pathways, but also at independent, weakly tetanized pathways if synaptic tags are set. We therefore investigated whether PKMζ is involved in tagging and contributes to a sustained potentiation by providing strong and weak tetanization to two independent pathways and then disrupting the function of the kinase by a selective myristoylated ζ-pseudosubstrate inhibitory peptide. We found that persistent PKMζ activity maintains potentiated responses, not only of the strongly tetanized pathway, but also of the weakly tetanized pathway. In contrast, an independent, nontetanized pathway was unaffected by the inhibitor, indicating that the function of PKMζ was specific to the tagged synapses. To further delineate the specificity of the function of PKMζ in synaptic tagging, we examined synaptic "cross-tagging," in which late LTP in one input can transform early into late long-term depression (LTD) in a separate input or, alternatively, late LTD in one input can transform early into late LTP in a second input, provided that the tags of the weak inputs are set. Although the PKMζ inhibitor reversed late LTP, it did not prevent the persistent depression at the weakly stimulated, cross-tagged LTD input. Conversely, although the agent did not reverse late LTD, it blocked the persistent potentiation of weakly tetanized, cross-tagged synapses. Thus, PKMζ is the first LTP-specific PRP and is critical for the transformation of early into late LTP during both synaptic tagging and cross-tagging.


Background We have previously identified very primitive human cord blood (CB)-derived CD34-negative (CD34-) severe combined immunodeficiency (SCID)- repopulating cells (SRCs) using the intra-bone marrow injection (IBMI) method (Blood 2003:101;2924). A series of our studies suggests that the identified CD34- SRCs are a distinct class of primitive hematopoietic stem cell (HSC) and that they are at the apex of human HSC hierarchy. Recently, we developed a high-resolution purification method for primitive CD34- SRCs using 18 lineage (Lin)-specific antibodies, which can enrich CD34- SRC at 1/1,000 level (Exp Hematol 2011: 39:203). In the present study, we tried to identify the positive marker of CD34- SRCs in order to further purify and characterize the CD34- SRCs (HSCs).

Materials and Methods First, we extensively analyzed candidate positive markers, including known HSC markers and various adhesion molecules by FACS using highly purified CB-derived 18Lin-CD34+/- cells. Finally, we identified CD133 as a positive marker of human CB-derived CD34- SRCs. Then, CB-derived 18Lin- CD34+/-CD133+/- cells were sorted by FACS, and hematopoietic stem/progenitor cell (HSPC) capacities of these four fractions of cells were extensively investigated. HSPC capacities were evaluated using (1) colony-forming cell (CFC) assays, (2) measurement of maintenance/production of CD34+ cell capacities in co-cultures with human bone marrow-derived mesenchymal stromal cells (BM-MSCs) (Blood 2010:24:162), (3) SRC activities using NOG mice, (4) limiting dilution analyses (LDA) to determine the SRC frequency in the 18Lin-CD34-CD133+ fractions, and (5) comparison of gene expression profiles between 18Lin-CD34+/-CD133+/- cells by real-time RT-PCR.

Results Seventy-five percent of 18Lin-CD34+ and 13.5% of 18Lin-CD34- cells highly expressed CD133. In the CFC assays, the plating efficiencies of 18Lin-CD34+CD133+, CD34+CD133-, CD34-CD133+ and CD34-CD133- cells were 57%, 65%, 39% and 19%, respectively. Interestingly, most of 18Lin-CD34-CD133+/- cells formed erythroid-bursts (71% and 73%) and erythro/megakaryocytes-containing mixed colonies (25% and 27%). On the contrary, they formed few granulocyte/macrophage colonies (4.2% and 0%). Then, we co-cultured these four fractions of cells with human BM-MSCs. One thousand of 18Lin-CD34+/-CD133+/- cells were seeded into each well and cells were co-cultured for 7 days in the presence of SCF+TPO+FL+IL-3+IL-6 +G-CSF. Both the 18Lin-CD34-CD133+/- cells produced CD34+ cells. However, the percentage and absolute number of CD34+ cells produced from 18Lin-CD34-CD133+ cells (31.7 % and 3.2 x 104 cells) were greater than those of 18Lin-CD34-CD133- cells (13.2 % and 0.4 x 104 cells). In addition, both the 18Lin-CD34- CD133+/- cells generated higher percentages (13.5 % and 11.5%) of CD41+ cells compared to those of the 18Lin- CD34+CD133+/- (1.8% and 4.2%) cells. Collectively, 18Lin-CD34+/-CD133+/- cells showed different in vitro lineage differentiation potentials. Then, these four fractions of cells were transplanted into NOG mice by IBMI. We performed primary and secondary transplantations for up to 36 weeks. In the results, all of the mice received 18Lin-CD34+CD133+ cells (n = 5) or 18Lin-CD34-CD133+ cells (n = 9) showed primary and secondary human CD45+ cell repopulations. However, neither 18Lin-CD34+CD133- cells nor 18Lin-CD34-CD133- cells showed human cell repopulations (n = 6 in each group). These results clearly demonstrated that the CD133 expression clearly segregated SRC activities in the 18Lin-CD34+/- cells. Moreover, LDA demonstrated that the frequency of SRCs in the 18Lin-CD34-CD133+ fraction was 1/142. Interestingly, HSC self-renewal maintenance genes, such as Notch1, HoxB4, HoxA9, and Bmi-1, were highly expressed in both 18Lin-CD34+/-CD133+ cells.

Conclusion These results clearly demonstrated that CD133 is a positive marker of human CB-derived CD34- SRCs (HSCs). Furthermore, CD133 segregated SRC activities of 18Lin-CD34- as well as 18Lin-CD34+ cells in its positive fractions. More importantly, these findings suggest that number of CD133+ cells in cord blood units is a more appropriate marker to detect/predict HSC potentials in cord blood stem cell transplantation in comparison to currently used CD34+ cell numbers.

Disclosures: No relevant conflicts of interest to declare.


Dramatist and critic Sarah Grochala's The Contemporary Political Play confirms by way of conclusion some of the shortcomings of a too-fixed political theory of the theatre. Grochala's formalist, dramaturgical aspirations regarding what political theatre is does not regard a genre of dramatic or postdramatic writing for performance, but rather a changing theory of it. Case studies involve instances where new dramaturgical strategies for making theatre of political consequence have emerged in our contemporary moment. Grochala joins a school of theatre and performance thought that theatre is political when it challenges how audiences confront spectacle and spectacle-making. Don't misunderstand the title, though. However general and theoretical the book might sound, the survey of plays substantiating Grochala's dramaturgical analyses is limited to the British Isles and does not extend beyond the English Channel, nor the Irish Sea for that matter. That choice behoves that the author assemble from the specificities of their context a case for that context's influence upon the general category of "the contemporary political play". The question of Grochala's achievement in this area I will return to later in the review. Numerous works of contemporary British theatre are considered across five chapters of the book's six (Chapter 1 rethinks the category of "serious drama" and politics in modern theatre in general), including Mark Ravenhill's The Experiment (2009), debbie tucker green's Generations (2007), and Caryl Churchill's Love and Information (2012). Broad categories such as "Time", "Space", and "Character" structure a discussion of dramaturgical experiments initiated by unconventional playwrights whose plays reshape theatre as we know it and force us to rethink what we consider to be of political consequence there.


Recommender systems apply data mining techniques and prediction algorithms to predict users' interest on information, products and services among the tremendous amount of available items. The vast growth of information on the Internet as well as number of visitors to websites add some key challenges to recommender systems. These are: producing accurate recommendation, handling many recommendations efficiently and coping with the vast growth of number of participants in the system. Therefore, new recommender system technologies are needed that can quickly produce high quality recommendations even for huge data sets.
To address these issues we have explored several collaborative filtering techniques such as the item based approach, which identify relationship between items and indirectly compute recommendations for users based on these relationships. The user based approach was also studied, it identifies relationships between users of similar tastes and computes recommendations based on these relationships.
In this paper, we introduce the topic of recommender system. It provides ways to evaluate efficiency, scalability and accuracy of recommender system. The paper also analyzes different algorithms of user based and item based techniques for recommendation generation. Moreover, a simple experiment was conducted using a data mining application -Weka- to apply data mining algorithms to recommender system. We conclude by proposing our approach that might enhance the quality of recommender systems.


In this article the author elucidates the main aspects of Gustave Guillaume's (1883-1960) linguistic theory and demonstrates that, despite Guillaume's frequent references to the Cours, central portions of his system are quite distinct from Saussure's position. Apart from a number of other differences between the two, there are in particular two important components that receive special treatment, namely, G's attempt at introducing the dynamic aspect into the (synchronic) system of language, and the renunciation of the bilateral concept of the sign (signifie/signifiant) within langue. In an effort to avoid the essentially static conceptions of certain structuralist trends, G regards the content of individual signs as such as not actually existing. In his understanding, on this linguistic level, only a given series of programmes is entitled to be taken as an entity within which individual moneme-signifiers represent merely virtual positions. Whenever needed in actual linguistic expression, these programmes begin ab ovo with each speech-act and may be halted as the case may be by other co-existing and superimposed programmes with different functions. Actualization of these programmes always takes place within a certain minimal, albeit real, time span, the temps operatif. However, the semantic structures thus conceived frequently diverge from the 'semiological' or expression system, and, consequently, its individual constituents (signifiants) are ignored on the level of 'programmes'. In fact, it is only on the threshold between langue and discqurs that these signifiers are related to the contents generated within the framework of a given temps operatif, in order to form a sentence, the basic unit of discours.Taking Saussure's theory as a starting-point, Guillaume's linguistic argument is critically analyzed. In effect, it is shown that G misunderstood S frequently, to the extent that on some occasions it may appear that G knowingly misinterpreted S's doctrine in order to fit its components into his own, at times idiosyncratic, theoretical system.


Risk-based regulation is a new arrival in the lexicon of risk and regulation. Regulators in Australia, Canada, and the UK have begun developing systems and processes to assess the probability and impact of compliance failures by regulated firms, and to adjust their relationship with firms accordingly. This article explores the motivations for, and key elements of, the risk-based frameworks of one of those regulators, the Australian Prudential Regulation Authority (APRA). It broadens out from this case study to argue first, that risk-based regulation goes hand in hand with the technique of "meta" regulation, the regulation of the firm's own internal self regulation, and will both fuel and be fueled by any trend towards the latter. Second, it argues that risk-based frameworks are not risk-free: whilst they seek to manage risks they inevitably introduce their own. Third, risk-based regulatory frameworks have the potential both to expose and obscure key sociopolitical and socioeconomic choices as to the amount or types of regulatory failures that an agency will tolerate, and which in effect it is requiring society to tolerate. "Risk based frameworks" are attempt to define what are acceptable "failures" and what are not, and thus to define the parameters of blame.


Combined infarction scintigraphy with 201Tl-chloride and 99mTc-pyrophosphate (PPi) by simultaneous seven-pinhole tomography was investigated with a phantom as well as in patients. No artificial defects occurred when the collimator was centered correctly in axial position, but a very high standard of image uniformity and linearity of the gamma camera was required. Artefacts by overlying activity from the skeleton or cardiac blood pool were not observed. All 11 controls showed normal results. Despite a poor depth resolution due to limitations of the system even small areas of partially damaged myocardium could be recognized and correlated three-dimensionally. Of 24 patients with proven myocardial infarction, in 16 both a positive (99mTc-PPi) and a negative (201Tl) image was obtained in congruence with the necrosis. 8 patients (33%) showed discordant results providing however additional information on the nature and extent of the necrosis. 4 out of 6 non-transmural infarctions seen by tomography had been suspected clinically.


Preterm infants have higher nutrient requirements than term infants. Enteral tube feeding is the preferred route to feed preterm infants because premature infants are unable to coordinate sucking, swallowing, and breathing. There are two common tube feeding methods: intermittent (bolus) or continuous infusion. Minimal enteral nutrition or trophic feeding has many advantages for preterms and should be started as soon as possible if an infant is clinically stable. Mother's own milk is the best food for preterm infants. It also has many important non-nutrient advantages for preterm infants. However, breast milk alone may not meet their special nutritional needs. For this reason, it is common clinical practice to fortify human milk. Fortified human milk is an appropriate nutritional source for preterm infants compared to preterm formula and unfortified human milk. Fortification of maternal breast milk begins when feeding volume reaches 100 ml/kg/day. In the absence of mother's own milk, donor milk and premature infant formula may be used. The aim of this brief review is to discuss the current practical concepts about enteral feeding in preterm infants.


In device-to-device (D2D) underlaying cellular networks, interference generated by D2D communications can be exploited to improve secrecy rate of cellular users (CUE). The security-oriented distributed access selection algorithm is proposed, in which each D2D pair decides whether to access to radio resources according to its local channel state information without considering the locations of D2D pairs and Eve. The ergodic secrecy rate of CUE and the data rate of D2D pairs in the proposed scheme are investigated. Simulation results show that the proposed scheme can achieve an impressive secrecy performance gain.


Background: The efficacy and safety of a combination of cetuximab, irinotecan, and 5-fluorouracil/leucovorin (FOLFIRI) in downsizing unresectable colorectal liver metastases was investigated. Patients and Methods: Patients with unresectable colorectal liver metastases with or without resectable extrahepatic metastasis were enrolled. 23 patients initially received 400 mg/m2 of cetuximab, followed by a weekly infusion of 250 mg/m2 and a biweekly dose of irinotecan (180 mg/m2), with 5-fluorouracil both by bolus (400 mg/m2) and by a 46-h infusion (total of 2,400 mg/m2) with leucovorin (400 mg/m2). Results: The overall response rate was 39.1% (n = 9; 95% confidence interval (CI): 17.6-60.7%). The most common grade 3-4 toxicities were skin reactions (30.4%) and diarrhea (26.1%). The rate of conversion to resectable liver metastases was 30.4% (n = 7; 95% CI: 10.1-50.8%). The factors found to be significantly associated with R0 resection were lower serum carcinoembryonic antigen levels after chemotherapy (p = 0.039), being chemonaive (p = 0.002), and showing a higher incidence of grade 3-4 skin toxicity (p = 0.011). Conclusions: Cetuximab with FOLFIRI may be an effective and safe treatment option for downsizing unresectable colorectal liver metastases.


The requirement of the Health Politics and the constant demand for professionals has favored the opening of professional education schools forming nursing technicians. However, the number of nurses with pedagogical formation is not sufficient to fulfill these courses. Distance learning proposes to fill this gap creating an interactive teaching dynamics. This study evaluated how many nurses have finished and their difficulties in doing Distance Education in the Specialization of Teachers. This was a retrospective research in a private college in Brazil. The sample was of 120 students from the 2009 to 2010, in 11 regions of education. The data has been collected from the system of communication and in academic office. Results: 88% of the students finished the course, and the difficulty in accessing the system was reported by 67% of them. 92% of respondents preferred the Forum because the scales of shifts limited the chats. 32% of the students approved the methodology of the course, however 70% still preferred face-to-face courses for they value dialogue or because they do not dominated the technological process. Acceptance of distance learning courses to train teachers in nursing still shows pedagogical and technological resistance


The purpose of this study was to explore antimicrobial effect of four plant extracts Mentha cervina , Mentha longifolia,Ocimum basilicum and Origanum vulgare against multi-drug resistance (MDR) Staphylococcus aureus isolated from wound infections in Al madinah Almounawarah, Saudi Arabia. MRSA is resistant to not only methicillin and other β- lactam antibacterial agents but also other antibacterial agents; therefore new agents are needed to treat MRSA. Antibacterial activity of the medicinal plant extract was determined using well diffusion assays and paper disc diffusion method. The medicinal plant extract exhibited antibacterial activity against multi-drug resistance (MRSA) Staphylococcus aureus. The synergetic effect was clearly observed with Mentha longifolia were combined with Ocimmum basilicum , and followed by Mentha longifolia + Origanum vulgare, Mentha longifolia + Mentha cervina and Ocimmum basilicum + Mentha cervina then , Origanum vulgare + Ocimmum basilicum and Origanum vulgare + Mentha cervina and showed the strongest antimicrobial activity. Our result confirmed that ethanolic extracts, could be a possible source to obtain new and effective herbal medicines to treat infections caused by multi-drug resistant strains of microorganisms from community as well as hospital settings. In addition ethanolic extracts of our medicinal plants may have the potential to restore the effectiveness of β-lactam Antibacterial agents against MRSA.


The interspecific variation of dye ascent in the stems of 44 broadleaved deciduous species growing in Japan was studied using freeze-dried samples after dye injection. The dye ascending pattern differed both within and between ring-porous and diffuse-porous species. In large earlywood vessels of all ring-porous species, the dye ascended only in the outermost annual ring, and the inner annual rings had lost their water transport function. The dye ascending pattern within the inner annual rings in the ring-porous species was categorized into three types: i) the dye ascended both in the many latewood vessels throughout the latewood and small earlywood vessels; ii) the dye ascended in the many vessels throughout the latewood; and iii) the dye ascended mainly in the late latewood vessels. In diffuse-porous species, the dye ascending pattern within the annual rings also was categorized into three types: i) the dye ascended throughout the annual rings; ii) the dye ascended mainly in the earlywood vessels; and iii) the dye ascended mainly in the latewood vessels. Xylem water distribution was also examined by cryo-SEM in three ring-porous and three diffuse-porous species that had different dye ascending patterns. The water distribution pattern within annual rings was correlated with the dye ascending pattern except for one diffuseporous species (Salix gracilistyla). In this case, water was distributed in the whole region of the annual rings although dye was mainly distributed in the earlywood. These results showed that the functional area of water transport within annual rings differed among ring-porous species and diffuse-porous species.


We provide a geometric representation of the Poisson and Martin boundaries of a transient, bounded degree triangulation of the plane in terms of its circle packing in the unit disc. (This packing is unique up to Mobius transformations.) More precisely, we show that any bounded harmonic function on the graph is the harmonic extension of some measurable function on the boundary of the disk, and that the space of extremal positive harmonic functions, that is, the Martin boundary, is homeomorphic to the unit circle. All our results hold more generally for any "good"-embedding of planar graphs, that is, an embedding in the unit disc with straight lines such that angles are bounded away from $0$ and $\pi$ uniformly, and lengths of adjacent edges are comparable. Furthermore, we show that in a good embedding of a planar graph the probability that a random walk exits a disc through a sufficiently wide arc is at least a constant, and that Brownian motion on such graphs takes time of order $r^2$ to exit a disc of radius $r$. These answer a question recently posed by Chelkak (2014).


Objectives Background Digital mammography clearly distinguishes gland tissue density from the overlying nonglandular breast tissue coverage, which corresponds to the existing tissue between the skin and the superficial layer of the fascia superficialis surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning and reducing the rate of necrotic complications after direct to implant (DTI) reconstruction in nipple sparing mastectomy (NSM). Methods Thirty NSMs in 22 patients with type 3 tissue coverage (subcutaneous tissue thickness of 2 cm or more) were selected for DTI reconstruction after NSM to evaluate immediate skin flap/nipple areola complex ischemic complications and patient satisfaction. Results Results: We experienced no wound healing problems or ischemic complications immediately after surgery in our population. Only 1 seroma was observed as a shortterm complication. Quality of life and patients' satisfaction level were optimal at 3 and 6 months follow-up, respectively. The aesthetic results have been evaluated as good/excellent in all cases. Conclusions DTI immediate reconstruction with silicone implants following NSM appears to be a safe option in selected cases with enough tissue coverage, also providing a high level of patient satisfaction. The possibility of selecting cases for this procedure according to the preoperative digital mammogram showing more than 2 cm of superficial tissues thickness may help reducing the risk of immediate ischemic complications.


We study an even-dimensional manifold with a pseudo-Riemannian metric with arbitrary signature and arbitrary dimensions. We consider the Ricci flat equations and present a procedure to construct solutions to some higher- (even-) dimensional Ricci flat field equations from the four-dimensional Ricci flat metrics. When the four-dimensional Ricci flat geometry corresponds to a colliding gravitational vacuum spacetime our approach provides an exact solution to the vacuum Einstein field equations for colliding gravitational plane waves in an (arbitrary) even-dimensional spacetime. We give explicitly higher-dimensional Szekeres metrics and study their singularity behaviour.


Purpose: Precise and comprehensive analysis of neuroblastoma genetics is essential for accurate risk evaluation and only pangenomic/multilocus approaches fulfill the present-day requirements. We present the establishment and validation of the PCR-based multiplex ligation-dependent probe amplification (MLPA) technique for neuroblastoma. Experimental Design: A neuroblastoma-specific MLPA kit was designed by the SIOP Europe Neuroblastoma Biology Committee in cooperation with MRC-Holland. The contained target sequences cover 19 chromosomal arms and reference loci. Validation was performed by single locus and pangenomic techniques (n = 174). Dilution experiments for determination of minimal tumor cell percentage were performed and testing of reproducibility was checked by interlaboratory testing (n = 15). Further 156 neuroblastomas were used for establishing the amplification cutoff level. Results: The MLPA technique was tested in 310 neuroblastomas and 8 neuroblastoma cell lines (including validation and amplification cutoff level testing). Intertechnique validation showed a high concordance rate (99.5%). Interlaboratory MLPA testing (κ = 0.95, P < 0.01) revealed 7 discrepant of 1,490 results (0.5%). Validation by pangenomic techniques showed a single discordance of 190 consensus results (0.5%). The test results led to formulation of interpretation standards and to a kit revision. The minimal tumor cell percentage was fixed at 60%. Conclusions: The recently designed neuroblastoma-specific MLPA kit covers all chromosomal regions demanded by the International Neuroblastoma Risk Group for therapy stratification and includes all hitherto described genetic loci of prognostic interest for future studies and can be modified or extended at any time. Moreover, the technique is cost effective, reliable, and robust with a high interlaboratory and intertechnique concordance. Clin Cancer Res; 17(4); 792–804. ©2011 AACR.


Marine clay deposits are commonly found worldwide. Considering the cost of dumping and related environmental concerns, an alternative solution involving the reuse of soils that have poor conditions is crucial. In this research, the authors examined the strength, microstructure, and wet–dry resistance of triple-binder composites of marine-deposited clays and compiled a corresponding database. In order to evaluate the wetting–drying resistance of the laboratory-produced samples, the accumulated mass loss (ALM) was calculated. The use of slag alone as a binder, at any percentage, increased the ALM up to 2%. However, the use of lime as the third binder seemed to accelerate the chemical reactions associated with the hydration of clay and cementitious material and to enhance the chemical stability, i.e., specimens that included both lime and slag experienced the same ALM as specimens treated with cement only. Scanning electron microscopy analysis confirmed the durability improvements of these clays. The proposed unconfined compressive strength–porosity and accumulated mass loss relationship yielded practical approximation for the fine- and coarse-grained soils blended with up to three binders until 60 days of curing. The laboratory-produced mixes showed reduction of embodied energy and embodied carbon dioxide (eCO2) emissions for the proposed models.


This study was designed to elucidate the specific features of the distribution of 2,4- and 2,6-dimethyl derivatives of hydroxybenzene in the body of the warm-blooded animals (rats) after the intragastric administration of these poisonous substances. It was shown that large amounts of these compounds are present in the unmetabolized form in the blood and internal organs of the experimental animals. Their largest quantities were found in the stomach contents, spleen, and small intestines.


This article discusses bone as * source of lead to the rest of the body and u « record of past lead exposure. Bone lead levels generally increase »ith age at rates dependent on the skeletal site and lead exposure. After occupational exposure, the slow decline in blood lead, a 5to 19-year half-life, reflects the long skeletal half-life. Repeated measurements of bone lead demonstrate the slow elimination of lead from bone. Stable isotope ratios have revealed many details of skeleul uptake and subsequent release. The bulk turnover rate* for compact bone are about 2% p«r year and 8% for spine. Turnover activity varies with age and health, Even though lead approximates calcium, radium, strontium, barium, fluorine, and other bone seekers, the rates for each are different. A simple, twopool (bone and blood) kinetic model is presented with proposed numerical values for the changes in blood lead levels that occur with changes in turnover rate*. Two approaches are offered to further quantify lead turnover. One involves a study of subjects with known pa*t exposure. Chanties in the ratio of blood lead to bone lead with time would reflect the course of bone lead availability. Also, stable isotopes and subjects who move from one geographical area to another offer opportunities. Sequential isotope measurements would indicate how much of the lead in blood is from current exposure or bone store*, distinct from change* in absorption or excretion.


The paper proposes a model of a unitary quantum field theory where the particle is represented as a wave packet. The frequency dispersion equation is chosen so that the packet periodically appears and disappears without changing its form. The envelope of the process is identified with a conventional wave function. Equation of such a field is nonlinear and relativistically invariant. With proper adjustments, they are reduced to Dirac, Schrodinger and Hamilton-Jacobi equations. A number of new experimental effects are predicted both for high and low energies.


Genera Esfera is an interactive installation that allows the audience to interact and easily become a VJ (visual
DJ) in a world of generative visuals. It is an animated and generative graphic environment with a music playlist,
a visual spherical world related with and suggested by the music, which reacts and evolves. The installation has
been presented at MIRA Live Visual Arts Festival 2015, in Barcelona. Genera Esfera was envisioned, developed
and programmed on the basis of two initial ideas: first, to generate our spherical planets we need to work with
spherical geometry and program 3D graphics; second, the interaction should be easy to understand, proposing a
direct mapping between the visuals and the interface. Our main goal is that participants can focus on exploring the
graphic worlds rather than concentrate on understanding the interface. For that purpose we use a trackball to map
its position onto sphere rotations. In this paper, we present the interactive installation Genera Esfera, the design
guidelines, the mathematics behind the generative visuals and its results.


During the last couple of decades our perception of what constitutes a good learning environment has changed. Thanks to the use of technology, education is evolving from a passive model towards a more productive model, where students generate knowledge, teach each other, and collaborate on activities that make learning fun and interesting. In some previous works we have adopted this attitude: creating interactive installations thought for learning in an amusing way. Design-based research has demonstrated its potential as a methodology suitable to both research and design of technology-enhanced learning environments, a further step consists in co-design: students directly involved in designing with researchers. This paper provides some comments on the evaluation of the learning experience using two interactive installations promoting eco-friendly behaviours, and describe our experience in codesigning with pupils. We also report the ethnographic research performed underlining the weaknesses and the strengths, the difficulties and findings during the whole work.


A counter-rotating type tidal stream power unit, composed of tandem propellers and a peculiar generator with double rotatable armatures, was provided for verification tests at offshore. The front propeller with diameter of 1 m has three blades, and the rear propeller with diameter of 0.95 m has five blades. The blade profiles were optimized with the blade element-momentum theory and CFD, and then covered with CFRP. The front and the rear propellers connect to inner and outer armatures in a synchronous type generator with net output 1.5 kW, whose efficiency was improved by heat pipes and the modification of the armature profiles. The shafts are equipped with mechanical seals to protect electric circuits from seawater. A rotational speed control system was also prepared not only to adjust the output but also to overcome the static friction torque due to bearings, slip rings and mechanical seals while starting-up. The power unit takes the maximum output with excellent efficiency at the relative tip speed ratio specified in the unit design. The unit can start-up after maintenance works and the output can be adjusted smoothly in the stream.


We propose a mean-field vaccination game framework that combines two distinct processes: the simultaneous spreading of two strains of an influenza-like disease, and the adoption of vaccination based on evolutionary game theory presuming an infinite and well-mixed population. The vaccine is presumed to be imperfect such that it shows better efficacy against the original (resident) strain rather than the new one (mutant). The vaccination-decision takes place at the beginning of an epidemic season and depends upon the vaccine-effectiveness along with the cost. Additionally, we explore a situation if the original strain continuously converts to a new strain through the process of mutation. With the aid of numerical experiments, we explore the impact of vaccinating behavior on a specific strain prevalence. Our results suggest that the emergence of vaccinators can create the possibility of infection-prevalence of the new strain if the vaccine cannot bestow a considerable level of efficiency against that strain. On the other hand, the resident strain can continue to dominate under large-scale vaccine avoidance. Moreover, in the case of continuous mutation, the vaccine efficacy against the new strain plays a pivotal role to control the disease prevalence. We successfully obtain phase diagrams, displaying the infected fraction with each strain, final epidemic size, vaccination coverage, and average social payoff considering two-different strategy-update rules and provide a comprehensive discussion to get an encompassing idea, justifying how the vaccinating behavior can affect the spread of a disease having two strains. Highlights –We build a mean-field vaccination game scheme to analyze the effect of an imperfect vaccine on a two-strain epidemic spreading taking into account individuals' vaccination behavior. –En masse vaccine avoidance can enhance the possibility of the original strain prevalence. –Propensity for vaccination can create the possibility of infection by the new strain if the vaccine is unable to provide a considerable level of efficiency against that strain.


Nine other cases of cardiomyopathy in patients taking tricyclic antidepressants have been reported. The patient we have described had been taking tricyclic antidepressants for years before cardiomyopathy developed. While a cause-and-effect relationship between tricyclic antidepressants and cardiomyopathy cannot be proven, physicians should keep in mind the association and discontinue the medication if cardiomyopathy develops. Further, tricyclic antidepressants should be used with great caution in patients with cardiomyopathy because of possible risk of ventricular fibrillation.


The number of steel-frame buildings is increasing as a result of development of social economy. However, the fire-resistant property of steel-frame buildings is much weaker than that of brick-frame buildings and RC-frame buildings. In response to such demand, fire-resistant steel has been developed since the last two decades. Mo is one of the most effective strengthening elements for the high-temperature strength of steels. With the increase of the Mo content in steels, there is a dramatic increase in costs which is unacceptable for the cost-sensitive construction area. Therefore, a fire-resistant steel with a low Mo content is highly desired. Two fire-resistant steels with low Mo content (<0.3%) were designed in this paper. The interdependence of microstructure, properties and temperature was studied and analyzed in hot-rolled testing steels. The results show that the low-Mo fire-resistant steels have improved elevated temperature strength (The yield strength of Nb content steel is 240MPa, which can met the requirements of grade Q345 fire-resistant steel), low yield ratio (<0.6) and good welding performance (Ceq≈0.40). The bainite and fine grains are mainly beneficial to the elevated temperature UTS. Nb is an alloying element effective in increasing elevated temperature strength (especially for YS) as well as Mo.


Abstract Purpose To describe and analyze the microstructural changes in herpetic stromal keratitis (HSK) observed in vivo by spectral-domain ocular coherence tomography (SD-OCT) at different stages of the disease. Methods A prospective, cross-sectional, observational, and comparative SD-OCT analysis of corneas with active and inactive keratitis was performed, and the pathologic differences between the necrotizing and non-necrotizing forms of the disease were analyzed. Results Fifty-three corneas belonging to 43 (81.1%) women and 10 (18.8%) men with a mean age of 41.0 years were included for analysis. Twenty-four (45.3%) eyes had active keratitis, and 29 (54.7%) had inactive keratitis; the majority (83.0%) had the non-necrotizing form. Most corneas (79.1%) with active keratitis showed stromal edema and inflammatory infiltrates. Almost half of the active lesions affected the visual axis, were found at mid-stromal depth, and had a medium density. By contrast, corneas with inactive keratitis were characterized by stromal scarring (89.6%), epithelial remodeling (72.4%), and stromal thinning (68.9%). In contrast to non-necrotizing corneas, those with necrotizing HSK showed severe stromal scarring, inflammatory infiltration, and thinning. Additionally, most necrotizing lesions (77.7%) affected the visual axis and had a higher density (P = 0.01). Conclusion Active HSK is characterized by significant epithelial and stromal thickening and the inactive disease manifests epithelial remodeling at sites of stromal thinning due to scarring. Necrotizing keratitis is characterized by distorted corneal architecture, substantial stromal inflammatory infiltration, and thinning. In vivo SD-OCT analysis permitted a better understanding of the inflammatory and repair mechanisms occurring in this blinding corneal disease.


Regular meshes are frequently used for modeling physical phenomena on both serial and parallel computers. One advantage of regular meshes is that efficient discretization schemes can be implemented in a straightforward manner. However, geometrically-complex objects, such as aircraft, cannot be easily described using a single regular mesh. Multiple interacting regular meshes are frequently used to describe complex geometries. Each mesh models a subregion of the physical domain. The meshes, or subdomains, can be processed in parallel, with periodic updates carried out to move information between the coupled meshes. In many cases, there are a relatively small number (one to a few dozen) subdomains, so that each subdomain may also be partitioned among several processors.
We outline a composite run-time/compile-time approach for supporting these problems efficiently on distributed-memory machines. This paper describes these methods in the context of a multiblock fluid dynamics problem developed at the NASA Langley Research Center.


Small-scale parallel platforms have become prevalent in the marketplace. These machines feature globally shared address spaces, complex kernels and an emphasis on throughput-based parallelism. These new platforms require new tools for concurrent programming. Programs written for these new platforms must be efficient, portable and adaptable to differing machine conditions. In addition, programming environments for these new platforms should integrate concurrency into the design process in order to exploit the multiple processors for speedup when sufficient workloads arise. This functionality can be effectively embedded at the framework/API level. Efficient design of these features can be facilitated using object-oriented design techniques known as design patterns. To illustrate these concepts, we developed a framework called aggregates. Aggregates are a suggested replacement for arrays, linked lists, or other structures for holding large collections of C++ objects. Aggregates use run-time partitioning to support concurrent application of a member function to all objects in the aggregate. Experimental results on a single-processor Windows NT system and a multiprocessor Silicon Graphics Power Challenge have demonstrated a single program using aggregates performed comparably to traditional arrays and linked lists in a single processor environment while providing speedup in a multiple processor environment.


The great transatlantic steamship lines revolutionized Anglo-American commerce and travel. In a wave of British and American entrepreneurial zeal, the ploddingly slow, ugly and uncomfortable vessels of the early 19th century were transformed into vast, swift, graceful and often luxurious ocean-going liners. Steamships became emblems of an age, of a Victorian audacity of spirit - cathedrals to man's harnessing of new technology. Through the innovations and designs of key engineers and shipping magnates - Samuel Cunard (later Sir), Isambard Kingdom Brunel and Edward Knights Collins - "the largest moveable objects in human history" were created, and under turbine propulsion transatlantic crossing times shrank from six weeks to six days. To the wealthy, the great steamships would come to represent travel with style and glamour, but to most they offered cheap fast passage out of Europe to the New World and new opportunities. At their peak, the steamships would deliver one million new Americans each year, transforming the world's oceans from barriers into highways. In this book, Stephen Fox also chronicles the tragedies that marked the evolution of the ocean liner, including, the sinking, in 1852, of Edward Knight Collins' steamship the Arctic, with the loss of 322 lives including Collins' wife and daughter, alongside the early 20th century losses of the Lusitania and the Titanic. Stephen Fox recreates the experience of transatlantic passage through contemporary records, diaries and writings (including those of Dickens and Emerson), and examines the societies created on the vast floating cities with cultures and conditions of their own.


The distribution of a number of membrane proteins on plasmalemmal microdomains (microvilli, coated pits) and in endosomes and lysosomes of the proximal tubule epithelial cell was determined in normal rat kidneys by immunofluorescence and immunoelectron microscopy. Two major brush border proteins, 130 and 94 kD, and gamma-glutamyl transpeptidase were detected on the membranes of the microvilli but were not found on membranes of coated pits. Gp330, the Heymann nephritis antigen, and clathrin were localized in coated pits. The lysosomal membrane glycoprotein, lgp120 (Lewis, V., S. A. Green, M. Marsh, P. Vihko, A. Helenius, and I. Mellman, 1985, J. Cell Biol., 100: 1839-1847) was restricted to lysosomes where it co-localized with beta-glucuronidase. Endosomes, identified by preloading with HRP injected 5-15 min before rats were killed, did not contain detectable amounts of any antigen tested. The distribution of the same proteins was also determined in rats given sodium maleate, which is known to slow or reduce protein absorption by the proximal tubule and to cause vacuolation of the endocytic apparatus. After maleate treatment the distribution of microvillar and lysosomal markers was unchanged, but the coated pit markers were redistributed--gp330 was concentrated in newly formed apical vacuoles, and clathrin was diffusely distributed in the apical cytoplasm or on apical coated vesicles. These findings indicate that the membrane composition of microvilli, coated pits, endosomes, and lysosomes is distinctive in the proximal tubule cell; and that gp330, unlike other known coated pit membrane components, is not transferred to endosomes during endocytosis. After maleate treatment, the coated pits lose their clathrin coats, and the corresponding membrane is internalized.


In this study, hydrogen is generated from water via photoelectrochemical (PEC) process by using CdS/TiO2 photoanode, which is obtained in sequence chemical bath deposition (s-CBD) process. Experimentally, the CdS was deposited on TiO2 NTAs in s-CBD process. First, the TiO2 NTAs is immersed in Cd(NO3)2 and Na2S solution subsequently several cycles followed by annealing to get CdS/TiO2 photoanode. In this work, the factors were studied including immersion cycle, annealing temperature and UV illumination. The surface morphology, crystalline structure and CdS amount were characterized by SEM and XRD. The photoactivities of CdS/TiO2 photoanodes and hydrogen generation rate were investigated by PEC splitting of water. The results showed that the photoanode annealing in air at 300 °C had the highest photoactivity and the crystalline structure of CdS was composed of zinc blende and a small amount of wurtzite. The saturated current density was 6.163 mA/cm2 and the maximum photoelectrochemical conversion was 4.45 % under Xenon lamp (I0 = 100 mW/cm2) illumination. Besides, the photoactivity of CdS(UV)/TiO2 prepared under UV (λmax=253.7 nm) illumination was reduced. This was probably due to the aggregation of CdS. To sum up, the CdS/TiO2 photoanodes for photoelectrochemical splitting water could be a high prospective process of the energy source.


A competitive enzyme immunoassay was developed to detect antibodies to a glycoprotein (gI) of Aujeszky's disease virus. Infected cell monolayers were used as antigen and a monoclonal antibody directed against an epitope of gI as indicator antibody. It was demonstrated that pigs vaccinated with the Bartha, BUK or NIA-4 strains did not produce antibody to the epitope of gI, whereas all wild-type viruses tested did induce this antibody. The antibody to the gI epitope persisted for at least 15 weeks. The present test, which enables us to distinguish pigs vaccinated with certain attenuated strains from pigs infected with wild-type Aujeszky's disease virus, may be of great value in future combined vaccination-eradication programmes for Aujeszky's disease.


Conventional eddy current bobbin probes, multi-pancake and/or rotating pancake probes, and transmit-receive eddy current probes are currently utilized in testing metal tubing. Each method has respective strengths and weaknesses. This paper proposes another eddy current probe with new features. The structure is designed to be sensitive to circumferential cracks, which are not easily detected with ordinary bobbin coil probes. The directions of the magnetic field and the eddy current around the coil were considered in design of the probe structure. Signals of these probes from the artificial defects were acquired and analyzed. Experimental results show that the developed probes are more sensitive to circumferential defects than comparable ordinary bobbin probes. In addition, the new probes are insensitive to axial defects. By employing both the new probes and ordinary bobbin probes, more reliable ECT can be performed.


Soft actuation materials, such as Ionic Polymer-Metal Composites (IPMCs), are gaining increasing interest in robotic applications since they lead to compact and biomimetic designs. In this paper, we propose the use of soft actuation materials as active joints for propelling biomimetic robotic fish. An analytical model is developed to compute the thrust force generated by a two-link tail and the resulting moments in the active joints. The computed joint moments can be combined with internal dynamics of actuation materials to provide realistic kinematic constraints for the joints. Computational fluid dynamics (CFD) modeling is also adopted to examine the flow field, the produced thrust, and the bending moments in joints for the two-link tail. Good agreement is achieved between the analytical modeling and the CFD modeling, which points to a promising two-tier framework for the understanding and optimization of robotic fish with a multi-link tail. We also show that, comparing to a one-link bending tail, a two-link tail is able to produce much higher thrust and more versatile maneuvers, such as backward swimming.


This research aims to closely read and analyze William Faulkner's As I Lay Dying critically and deconstructively utilizing ideas from Georg Hegel's one of the most controversial and influential philosophical masterpieces, Phenomenology of Spirit. As I Lay Dying describes the Bundrens' absurd odyssey to bury their mother's corpse, which turns out to be a mosaic of comic, cosmic, and cacophonic narrative narrated by four brothers, a sister, father, and dead mother who also narrates her esoteric and existential story that deconstructs Western idea of family and ethics setting up Hegel's 'ethical community.' This research is divided into two sections: Hegelian interpretation of characters' inter-conflict and their struggle to recognition; analysis of the family in the novel through deconstructive reading of Hegelian ethical community in the novel. Then I will present how Hegelian negativity and dialectics work and implode within the novel to prove that the Bundren's Odessey is not a heroic but absurd drama depicting the collapse of Hegelian idea of ethical community.


This paper addresses the idea of the superpositional model based on the DCT (Discrete Cosine Transform) parameterization of the F0 contours. We examine the capacity of the DCT coefficients to estimate the fast variations in the F0 contour at syllable level and also the overall trend of the phrase level. The method determines the coefficients at syllable level, based on the subtraction of the estimated phrase level contour from the original one; thus considering that the syllable has an additive prosodic effect over the phrase level. We also compare the use of 3 different decision and regression tree algorithms for DCT coefficients clustering and prediction. Additional features are selected based on a greedy stepwise without backtracking feature selection method. The results support the proposed method through low average square errors and little or no perceivable errors in the synthesized speech.


This article uses data from the ledgers of the financial broker Charles Blunt to explore the market in equity options that emerged in London during the stock market boom of the early 1690s. Blunt's ledgers provide a unique opportunity to observe the workings of an early modern derivatives market. They reveal a broadly based and highly active trade in options. The market functioned well, determined value using agreed criteria, and was utilized by a diverse range of individuals to facilitate both risk-seeking and risk-averse investment strategies.


Study Design: Retrospective radiographic review. Objectives: The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores. Methods: A retrospective radiographic review was performed on 48 deformity patients between July 2015 to January 2017 with a 2-year follow-up. Using the same methodology as the original GAP study, the partial iGAP score was calculated with the sum of the scores for age, relative lumbar lordosis (RLL), and lordosis distribution index (LDI). Therefore, the iGAP score (0-7) was grouped into proportional (0-2), mildly disproportionate (3-5), and severely disproportionate (6-7). Logistic regression was performed to assess the ability of the partial iGAP score to predict postoperative mechanical failure. Results: The mean iGAP for patients with a mechanical failure was 3.54, whereas the iGAP for those without a mechanical failure was 3.46 (P = .90). The overall mechanical failure rate was 27.1%. The mechanical failures included 8 proximal junctional kyphosis, 7 rod fractures, and 1 rod slippage from the distal end of the construct. Logistic regression analysis revealed that the partial iGAP score was not able to predict postoperative mechanical failure (χ2 = 1.4; P = .49). Conclusion: The iGAP scores for RLL or LDI did not show any significant correlation to postoperative mechanical failure. Ultimately, the proposed partial iGAP score did not predict postoperative mechanical failure and thus, cannot be used as an intraoperative alignment assessment to avoid postoperative mechanical complications.


The 7th Annual Congress on Cardiology and Cardiac Surgery 2020 was hosted by Allied Academies during June 15 in Edinburgh, Scotland
through webinar on the theme "Innovative approaches in making heart secure with the secret of surgery". The meeting received an active
response from Cardiologist, Cardiac Surgeons, Pediatric Cardiologist, professors, researchers, students and delegates all over the world
and made it a huge success. The conference was embarked with an opening ceremony followed by a series of the speech delivered by both
prestigious delegates and members of the Keynote forum and speakers. The adepts who proclaimed the theme with their outstanding talk.
We would like to thank keynote speaker, speaker, Delegates, our supporting media partners and sincere thanks to our Organizing committee
members for their support and assistance towards the success of Cardiac Surgery2019, we value your time and expertise with us.


—We were pleased to read the letter from Dr Miller and hear about his experience with the sclerosis of thyroid cysts. His reference to the book that he and his colleagues have written was appreciated. In reply to the first of the three caveats he mentions, we agree that it is possible that some cysts may recur after aspiration alone because of rebleeding from a small tissue remnant that is too small to resolve with conventional thyroid ultrasound. It is possible that small-field, high-resolution ultrasonography would identify such small lesions. However, we do not feel that rebleeding necessarily implies the presence of malignant neoplasm. The fact remains that only 1% to 2% of primary thyroid carcinomas are cystic,1and only 1% to 2% of all purely cystic thyroid lesions contain a neoplastic component.1,2 The second caveat Miller mentions is the occurrence of a thyroid carcinoma in the wall


Panama, officially Republic of Panama, is the southernmost country of Central America and the whole of North America. Situated on the isthmus connecting North and South America, it is bordered by Costa Rica to the west, Colombia to the southeast, the Caribbean to the north and the Pacific Ocean to the south. The capital is Panama City. Explored and settled by the Spanish in the 16th century, Panama broke with Spain in 1821 and joined a union of Nueva Granada, Ecuador, and Venezuela, named the Republic of Gran Colombia. When Gran Colombia dissolved in 1831, Panama and Nueva Granada remained joined. Nueva Granada later became the Republic of Colombia. With the backing of the United States, Panama seceded from Colombia in 1903, allowing the Panama Canal to be built by the U.S. Army Corps of Engineers between 1904 and 1914. In 1977, an agreement was signed for the complete transfer of the Canal from the United States to Panama by the end of the 20th century Panama's economy is one of the most stable in America. The main economic activities are financial, tourism and logistics, which represent 75% of the GDP (Gross Domestic Product). From 2003 to 2009 the GDP doubled, propelled by high foreign and domestic investment, coupled with the tourism and logistics industries. According to the Bank, the IMF and the UN, the country has the highest per capita income in Central America, which is about $13,090; it is also the largest exporter and importer at the regional level, according to ECLAC. The GDP has enjoyed a sustained growth for more than twenty years in a row (1989). The country is classified in the category of investment grade by these credit rating companies: Standard and Poor's, Moody's and Fitch Ratings.


Using a Melitz-style model of heterogeneous firms, Baldwin and Okubo (2006) recently presented a theoretical model in which self-sorting occurs and more productive factories choose to locate in more productive areas. The model suggests that firm-specific factors and regional factors affect each other through the endogeneity of location decisions. However, to date there have been few studies empirically testing this issue. Against this background, our aim is to examine the relationship between firms and location-specific factors in location decisions using factory-level panel data from Japan's Census of Manufactures. We begin by estimating how much of the differences in factories' TFP levels can be explained by both firm and location effects. The estimation results show that both effects have a significant impact on the productivity level of a factory, and that the firm effects are more important than the location effects. We also find a statistically significant negative correlation between firm effects and location effects, and investigate what causes this relationship. One potential explanation is that more productive firms may tend to set up new factories in less productive locations such as rural areas, where factor prices such as land prices and wage rates are usually low, in order to benefit from low factor prices. To examine this issue, we estimate a mixed logit model of location choice. The results indicate that more productive firms indeed tend to set up new factories in low-productivity locations, which is consistent with our hypothesis.