Opportunities opened up by the Industry 4.0 paradigm are related to the acceleration of flexible and open business planning and governance mechanisms to foster the adaptability of the value chain to the rapid changes during ongoing operations by reducing gaps and controlling efforts. The constant search for a dual perspective (short- to medium/long term) and a twofold equilibrium (micro and macro vs. internal and external) is creating new challenges for sustainable business models. The Self-Tuning Open Reengineering Model (STORM) is well suited to explain the organizational behaviours of both industrial and craftsman firms in terms of the strategic and operational aspects of the smart factory paradigm.


For full access, view the book at USF St. Petersburg Library -- RC489.B4E485 2005, check it out through your local library, request it on interlibrary loan, or order it through a book dealer.


US pharmacies tend to be located at intersections of major
cross streets throughout a city, while in the case of Mexican border cities pharmacies
are clustered close to US-Mexico border crossings. Presumably this is due
to the volume of US clients who frequent the pharmacies. Although the precise number
of border crossings to purchase medications is unclear, it is thought to be significant. In the past, patient-based
surveys were the primary source for information regarding US residents crossing
the border into Mexico for prescription medications. The current study examines
the distribution of pharmacies throughout Ciudad Juarez, Chihuahua, Mexico, recording
the change in the number of pharmacies over a 15-year period and suggesting the
scale of US residents who use Mexican pharmacies. Field research was conducted in
1996 and 2011. Maps showing the location of pharmacies for these two years indicate
a clustering of pharmacies within one and one-half miles of the city's two principal
border-crossings between the United States and Mexico. Provider-based surveys revealed
that the majority of patients who use pharmacies closest to the border were US residents.


The swelling /shrinkage are complex phenomenon in the steam power plants. One of the important reasons is the chemical effects, which causes a bubble formation and hence serious foaming carryover problems in the boiler. The present work is devoted to study and measure the chemical effects of the swelling and shrinkage phenomena due to the disturbance of the variables in the drum boiler of steam generation unit. The problem was studied and analyzed to find a suitable solution to reduce the foaming carryover, and hence to control the swelling and shrinkage phenomena. The theoretical part is describ ing the mathematical model for the boiler variables. The drum pressure and drum level at different load demands of boiler were measured experimentally. The feed water was treated carefully in order to study the reduction of foam produced from a small amount of lubricant oil in the boiler water. The foam was treated using silicon antifoam [SN 6010]. T he experimental results proved that the silicon antifoam is efficient to remove the foam completely and then reduce the disturbance in the pressure by 18.6% and the reduction in swell ing and shrinkage was by 29.4%, and 16% respectively.


Public health officials and doctors in sub-Saharan Africa say innovative approaches to treating AIDS in poor settings have so far been successful on a small scale. Can these efforts be expanded to provide antiretroviral therapy (ART) on a massive scale? Uganda is one of the sub-Saharan countries that has led the way in the treatment scale-up. But while the country is expected to reach the 50% treatment target, scaling up to provide ART treatment for every Ugandan who needs it will be a major challenge. Building on years of AIDS awareness and prevention programmes, Uganda has almost completed training of health staff in all of its 56 districts to deliver a simplified version of chronic HIV/AIDS care--that includes ART--to people living with HIV/AIDS. So far, just over one-third of patients in Uganda who need antiretroviral (ARV) drugs were receiving them at the end of December 2004 and the proportion is expected to reach 50% by July. This might appear low, but it is one of the highest proportions in Africa. According to the '3 by 5' progress report released by WHO in January, 72% of people in Africa who need ARVs were still not getting them at the end of last year. Botswana was the only African country that had reached the 50% target level by that time, the report said. Many public health experts believe that the main obstacle to the '3 by 5' campaign, which aims to scale-up delivery of ART to at least three million people in poor countries by the end of 2005, is the severe and growing shortage of health workers. In an editorial on page 243 of this issue, Lincoln Chen, Director of the Global Equity Initiative, Harvard University, calls on governments for urgent action to address this shortage. Government officials from many countries gathered in Abuja, Nigeria last December conceded that the shortage of health workers in Africa threatened to derail development goals on the continent (Bulletin Vol. 83. No. 1, pp. 5-6). In Uganda, officials say there are enough staff to treat the 42 000 patients currently on ARV drugs, but that more human resources and more drugs are needed to scale this up to the remaining 58 000 in need of treatment too. Of those 42 000, three-quarters are paying for ARV medicines out of their own pockets, while a quarter get the drugs free from the Ugandan Government and donor projects. Rosette Mutambi, coordinator of the Uganda Coalition for Access to Essential Medicines, argued that more should be done to make free and partly-subsidized ARV drugs more widely available. Mutambi said she feared emphasizing the shortage of health workers could slow down funding for ARV drugs in Africa. "The issue of human resources is not a problem at the moment, but it may be in future," Mutambi told the Bulletin. Dr Elizabeth Madraa, Manager of Uganda's AIDS Control Programme, said that the workforce shortage was already a constraint and that this was largely due to the 'brain drain' of doctors and nurses. She said Uganda's medical schools and nursing colleges do not produce enough doctors and nurses, and that there is a lack of public funds to recruit adequate numbers of health workers. "We keep training and they go to NGOs (nongovernmental organizations) or abroad where they can get better money, then we have to train [more people] again," said Madraa, who organizes and oversees ART training for health workers across Uganda. In order to overcome the financial and staffing constraints, Uganda has adopted what Madraa called an "innovative" approach to treating HIV/AIDS patients. Uganda is the first sub-Saharan country to roll-out ART on a national level taking this innovative approach. Ethiopia, the Eastern Cape region of South Africa, Swaziland and Zambia have also started training health workers to provide HIV/MDS chronic health care using this simplified approach (see graph). …


This study examined the utility of electronic mail (e-mail) as an instructional tool for limited-English-proficient (LEP) adult females who have made little progress in learning writing in English as a Second Language (ESL). Six subjects, aged 30-50 years, enrolled in a university ESL program produced 25 e-mail exchanges with the research over a 5-week period. Subjects fell into two groups: those under age 40 with e-mail experience, and those aged 40-50 who were unfamiliar with e-mail. Analysis of the messages focused on number of messages, word counts, acquisition of new vocabulary directly related to comprehensible input, and syntactic complexity resulting from the use of connectors in the subordination of clauses. Results indicate that supervised e-mail had a positive effect on the writing skills of adult learners who have few opportunities to interact with target language speakers, and can be used as an effective extracurricular learning tool, particularly with older students. Appended materials include a brief subject questionnaire, summary of subjects' responses to it, letter of consent, and tables summarizing characteristics of the data and subordination and connectors in the data. Contains 32 references. (MSE) (Adjunct ERIC Clearinghouse on Literacy Education) ******************************************************************************** * Reproductions supplied by EDRS are the best that can be made * * from the original document. * ********************************************************************************


We report a case of nasopharyngeal carcinoma with Chest Metastasis in a 38-year-old man. The patient presented with nasal obstruction, epistaxis, a huge neck mass and conductive hearing loss in the right ear. Examination under anaesthesia revealed a mass in the nasopharynx, which was confirmed on histology to be squamous carcinoma. He responded remarkably well to external radiotherapy with disappearance of primary tumor and neck metastasis. One year later he presented with thoraco-lumbar spine pain and cough. The nasopharynx and neck remained free of tumor while radiographs demonstrated multiple metastasis to the lungs and vertebrae.


"[W]e must never forget, that it is a constitution we are expounding." If there was such a danger when Chief Justice John Marshall wrote those words, there is none today. Americans regularly assume that the Constitution is special, and legal professionals treat it differently from other sources of law. But what if that is wrongheaded? In this Article, we identify and question the professional practice of constitutional exceptionalism. First, we show that standard arguments from text, structure, and history work differently in constitutional law. Second, we examine the possible justifications for such distinctive interpretation among lawyers, and we find them mostly unconvincing. Neither entrenchment, nor supremacy, nor democratic legitimacy sets the Constitution apart from other sources of law in a way that supports interpretive exceptionalism. In fact, the best argument for the practice is simply that the Constitution is regarded as unique — that it occupies a privileged place in American culture and political mythology. But even if that status can justify applying some specialized methods to the document, it cannot explain every markedly divergent practice that we see among contemporary legal professionals. In the conclusion, we reveal one normative motivation for the project. All too often, constitutional argument is deployed in ordinary politics as a kind of trump, with the purpose and effect of shutting down policy debate. Legal professionals contribute to this tactic when they craft rarified interpretive methods without justification. Demythologizing constitutional law undercuts its use as a political blunderbuss.


Yield strength has been shown to correlate well with ultrasonic longitudinal bulk wave velocities in hot rolled steel. With a laser ultrasonic's technique developed at the institute, velocities in different directions along the plate can be measured and correlated to the yield strength in the corresponding direction.


Childhood deafness interferes with the cognitive development of the child, so it is considered a major handicap. The present work was carried out to reveal possible risk factors of deaf-mutism and the magnitude of each. The case control design was chosen as a research methodology. A 50% sample of deaf-mute pupils at the primary level were selected at random from each of the two governmental schools for the deaf-mutes in Alexandria (boys=96, & girls=76). A control group chosen at random from a main stream governmental school and matched by age and sex of the pupils as well as with education and occupation of the father. Matching was carried out at the sampling phase, pairing each case to its control. Data were collected by interviewing the mothers using an interviewing schedule. Matched analysis was carried out where pairing of cases and controls was retained. The likelihood estimate of Odds ratio conditional on the number of discordant pairs was estimated using McNemer's test. The 5% level was chosen as the level of significance. The study revealed 172 deaf-mute pupils. Their mean age was 9.48+/-1.981 years. Boys outnumbered girls (55.8% and 44.2% respectively). In 59.4% parents were cousins. Deafness was first noticed at 6 to 60 months of age with a mean of 14.70+/-10.2 months. Most fathers and mothers were illiterate (48.84% and 61.63%). Heredity was a risk factor, where 84.82% of cases had a positive family history compared to none of the controls. Moreover, in case of consanguinity the Odds ratio=5.60. Acquired deafness constituted the second important group of all causes of deafness. Meningitis featured as the most important cause of acquired deafness with an estimated relative risk of 18.5, followed by fever (Odds ratio=4.67), then repeated attacks of acute tonsillitis and ear disease where the case control percent difference was 8.72% and 4.65% respectively.


The benefit of intravitreal anti-VEGF therapy in treating wet age-related macular degeneration (AMD) is well established. Identification of VEGFR-2 inhibitors with optimal ADME properties for an ocular indication provides opportunities for dosing routes beyond intravitreal injection. We employed a high−throughput in vivo screening strategy with rodent models of choroidal neovascularization and iterative compound design to identify VEGFR-2 inhibitors with potential to benefit wet AMD patients. These compounds demonstrate preferential ocular tissue distribution and efficacy after oral administration while minimizing systemic exposure.


Ultracold polar RbCs molecules are produced via photoassociation in a laser-cooled mixture of 85Rb and 133Cs atoms. The a 3Σ+ state molecules which decay from electronically excited (2)0- state RbCs molecules are detected by resonance-enhanced two-photon ionization. The new rovibrational levels (v = 189, 190) in the (2)0- state are also observed, which exist in theory and have not been observed in experiments yet. The corresponding rotational constants are measured by photoassociation spectroscopy, which are consistent with theoretical calculations using a nonrigid rotor model.


BACKGROUND
Proteinuria is a feature of pyometra-associated renal dysfunction, but its prevalence and clinical relevance are not well characterized.

OBJECTIVES
To define which subset of dogs with pyometra has clinically relevant kidney injury by quantification of proteinuria; light, immunofluorescence, and electron microscopic examination of kidney biopsy specimens; and measurement of urinary biomarkers.

ANIMALS
Forty-seven dogs with pyometra. Ten clinically healthy intact bitches of comparable age.

METHODS
Prospective study. Routine clinicopathological variables including urinary protein to creatinine ratio (UPC) were analyzed. Validated assays were used to quantify urinary biomarkers for glomerular (urinary albumin, urinary immunoglobulin G, urinary C-reactive protein, urinary thromboxane B(2)) and tubular function (urinary retinol-binding protein, urinary N-acetyl-β-d-glucosaminidase). Kidney biopsy specimens from 10 dogs with pyometra and dipstick urine protein concentrations of 2+ or 3+ were collected during ovariohysterectomy. Urinalysis was repeated within 3 weeks after surgery in 9 of the 10 dogs.

RESULTS
UPC (median, range) was significantly higher in dogs with pyometra (0.48, 0.05-8.69) compared with healthy bitches (0.08, 0.02-0.16) (P < .01). Twenty-two of 47 dogs with pyometra had UPC>0.5, 12 had UPC>1.0, and 7 had UPC>2.0. Glomerulosclerosis and tubulointerstitial nephritis were common kidney biopsy findings in proteinuric dogs with pyometra. Dogs with glomerulosclerosis (5/10), either global or focal and segmental, had UPC>1.0 at ovariohysterectomy and afterward. Dogs with structural glomerular and tubular changes mostly had urinary biomarker to creatinine ratios above the 75th percentile.

CONCLUSION
Dogs with pyometra and UPC>1.0 or high ratios of urinary biomarkers appear likely to have clinically relevant renal histologic lesions and require monitoring after ovariohysterectomy. Future studies should evaluate the role of pyometra-associated pathogenic mechanisms in causing or exacerbating focal and segmental glomerulosclerosis in dogs.


As physicians, we strive to provide the most appropriate care for our patients and to provide them with accurate assessments of both the risks and benefits they can expect to realize. Unfortunately, as humans, we are notoriously bad at estimating risk.1,2 However, as the choices of treatments for cardiac disease expand, accurate assessment of risk becomes increasingly important. A patient with coronary artery disease may have the option of medical therapy, coronary artery bypass grafting, or percutaneous intervention. Transcatheter aortic valve replacement may soon be a viable alternative to surgical aortic valve replacement for patients with aortic valve disease. For patients to be able to make the choice that best suits their goals, they must have accurate information regarding risks and benefits.

Article see p 151

In the current article, Jain et al3 compared cardiac surgeons' assessments of mortality after coronary artery bypass grafting and valve surgery and that calculated from the Veterans Affairs Continuous Improvement in Cardiac Surgery Program (VA CICSP) risk model with actual mortality rates. The focus of the study was perioperative mortality; however, 1- and 5-year mortality rates were also considered. Although neither the statistical risk model nor surgeon estimates were perfect, the risk models performed somewhat better at all time points. Both the risk models and the surgeons' estimates were better at estimating perioperative mortality than they were at estimating late mortality. These findings are informative and may help us to improve our estimates of procedural risk.

When examining the predictive validity of a risk model (or surgeons' estimates), 2 factors are regularly used: calibration and discrimination. Calibration measures to what degree the model assigns risk to the population, or in a population of 100 patients with an estimated mortality risk of 3%, were there 3 observed deaths? The current article …


My study is focused on one organization with is Unicef, the organization that is workning on a UN mission. The mission is about children's rights and Unicef has brought children's actions since 1946.The purpose of this essay was to research whether the images can be used alone or as a complement to the text that the communication organizations use. By examining the way images are used, I hoped to be able to deduce the results of image use. I study if the effect out messages with only pictures will be more effective than the message in which the verbal mixed with the non-verbal.Theoretical part of this essay has a communication perspective. The essay is structure by tree elements, non-verbal communication, mass communication and intercultural communication. With these elements, or keywords, have I interpret UNICEFs communications through two media channels, internet and TV.The methodology I have chosen is qualitative method with a hermeneutic approach. I have carried out three qualitative interviews with women within the organization and one group interview consisting of four persons. I have also observation a qualitative media observation of charity gala on TV4. My conclusions were that non-verbal communication is most likely more effective as a tool too the verbal instead of the only communication. I also got the conclusion that UNICEF communicate with people thought picture that's gives hope for the future.


Blocky fragments of aegirine-augite trachyte (with accompanying icerafted gravels.) were recovered from the upper slopes of Kodiak Seamount in several dredge hauls. An alkali basalt pillow segment was also dredged from a moatlike depression, at a depth of 5000 meters, near the west base of the seamount. These retrievals confirm the volcanic origin of Kodiak Seamount and further support the view of Engel, Engel, and Havens that the higher elevations of seamounts are composed of alkali basalts or related variants.


Ionospheric variability as a result of earth- quake events is a confirmed phenomenon as published in various seismo-ionospheric coupling studies. Generally, ionospheric variations resulting from earthquake activity are much weaker than disturbances generated by different sources, e.g. geomagnetic storms. However, geomagnetic storm disturbances exhibit more global behaviour, whereas seismo-ionospheric variations occur only locally in an area that is specified by the magnitude of the earthquake. Cross- correlation coefficient analysis is a technique proposed some years ago, and ensures cancelation of geomagnetic storm variations of the ionospheric plasma, provided that the mea- surements are taken from stations with similar behaviour in these phenomena. In this paper we will use the aforemen- tioned technique for analyzing data from ionospheric stations in Rome and Athens, and apply it to a series of earthquakes in Greece. Considering the local behaviour of the seismo- ionospheric variations, we expect that the Athens station, which happens to be inside the area affected by the earth- quake, will accurately capture the disturbances. Due to its distance from the activity, we also do not expect the Rome station measurements to be affected by the seismic events in Greece. In addition, due to the fact that ionospheric plasma parameters exhibit non-stationary and nonlinear behaviour, we propose a novel signal processing technique known as the Hilbert-Huang transform in order to denoise the data before we calculate the cross-correlation coefficient of the two signals. Results from our analysis are in accordance with previously-conducted studies covering the same topic, clearly demonstrating that there are ionospheric precursors 1 to 7 days prior to strong seismic events as well as 1 to 2 days following such events.


Personal inspections, such as "crawl throughs" or "walk-throughs," of buried pipelines need standardized terminology for describing the interior condition of a pipe. In many cases, personal inspection is less expensive and more effective than a closed circuit television inspection. Remote video inspection of a pipeline interior is a valuable method of inspecting pipeline interiors. However, when accessible, a personal inspection can provide quantitative data not available from video inspection. The Pipeline Assessment and Certification Program (PACP) of the National Association of Sewer Service Companies promotes a uniform system of describing conditions encountered during video inspections of pipe. However, there are no national standards, programs, or instructions for terminology of observations made during a personal inspection. A condition assessment protocol, such as the PACP system, would also be useful. The descriptive terms and nomenclature of the PACP is generally recommended for use in personal pipeline inspections, modified for the means and methods available during "crawl-through" and "walk-through" investigations.


Vacuum ultraviolet Si i wavelengths have been recalculated using all available low-pressure-source data. One hundred calculated and forty-one measured wavelengths, all with uncertainties less than 0.002 A, should be useful as wavelength standards in the region 1560 to 2000 A. Seventy-seven of the proposed standards were originally calculated by Radziemski and Andrew [ J. Opt. Soc. Am.55, 474 ( 1965)]; although the two sets of wavelength values agree to within their uncertainties, the new set has a greater internal consistency. Included also is a complete list of low-pressure-source levels for Si i, which contains new values for 30 odd levels previously determined exclusively from relatively high-pressure (450–740 torr) arc data.


Since the first uniportal video-assisted thoracoscopic surgery (uVATS) performed in 2010, the uniportal approach has evolved up to a point where even the most complex cases can be done. This is thanks to the experience acquired over the years, the specifically designed instruments and improvements in imaging. However, in these last few years, robotic-assisted thoracoscopic surgery (RATS) has also shown progress and distinct advantages compared to the uniportal VATS approach, thanks to advanced maneuverability of the robotic arms as well as the three-dimensional (3D) view. Excellent surgical outcomes have been reported and so too, the ergonomic benefits to the surgeon. The main limitation we find of the robotic systems is that they are designed for a multiport approach, requiring between three to five incisions to be able to perform surgeries. With the aim to offer the least invasive approach, using the robotic technology we decided to adapt the Da Vinci Xi® in September 2021 to develop the uniportal pure RATS approach (uRATS) performed by a single intercostal incision, without rib spreading and using the robotic staplers. We have now reached a point where we perform all type of procedures, including the more complex sleeve resections. Sleeve lobectomy is now widely accepted as a reliable and safe procedure to allow complete resection of centrally located tumors. Although it is a technically challenging surgical technique, it offers better outcomes when compared to pneumonectomy. The intrinsic characteristics of the robot such as the 3D view and improved maneuverability of instruments make the sleeve resections easier compared to thoracoscopic techniques. As in uVATS vs. multiport VATS, the uRATS approach, due to its geometrical characteristics, requires specific instrumentation, different movements and learning curve compared to multiport RATS. In this article we describe the surgical technique and our initial uniportal pure RATS experience with bronchial, vascular sleeves and carinal resections in 30 patients.


SUMMARY: Vertical ultrathin sections of a colony of Mycoplasma orale serotype 1, N-1 strain, which had been isolated from a patient with leukaemia, have been examined by electron microscopy.
In the micrographs, the ultrastructural appearance of Mycoplasma orale in agar growth could be divided into two patterns. One was a mycelial growth form which was observed in the surface area and resembled growth in broth. The other was a pattern of binary fission observed in the deep area of the agar. These growth features differ from those of human mycoplasmas previously reported.


This study is concerned with improving the Service Engineering methodology for experience-oriented service systems. It critiques the Service Engineering methodology based on the motivating example of automotive navigation service system design, and it describes the Service Experience Engineering (SEE) methodology, which extends Service Engineering by making three improvements, namely the use of formal models of experiences, service-experience requirement analysis, and the simulation of service experiences. The example presented here demonstrates that SEE can help capture context-wide service-experience requirements and translate them into functional requirements. This study further indicates that a methodology for engineering service experiences is possible and promising.


Cryopreservation has an immunomodulating effect on tracheal tissue as a result of class II antigen depletion due to epithelium exfoliation. However, not all epithelium is detached. We evaluated the role of apoptosis in the remaining epithelium of 30 cryopreserved tracheal grafts. Caspase-3 immunoreactivity of tracheal epithelium was studied in canine tracheal segments cryopreserved with F12K medium, with or without subsequent storage in liquid nitrogen at -196°C for 15 days. Loss of structural integrity of tracheal mixed glands was observed in all cryopreserved tracheal segments. Caspase-3 immunoreactivity in tracheal mucosa and in mixed glands was significantly decreased, in contrast to the control group and to cryopreserved tracheal segments in which it remained high, due to the effect of storage in liquid nitrogen (P < 0.05, ANOVA and Tukey test). We conclude that apoptosis can be triggered in epithelial cells during tracheal graft harvesting even prior to cryopreservation, and although the epithelial caspase-3 immunoreactivity is reduced in tracheal cryopreservation, this could be explained by increased cell death. Apoptosis cannot be stopped during tracheal cryopreservation.


Abstract. Base on establishing the model of channel part deep drawing , the eat / DYNAFORM finite element analysis software is used to simulate and analysis the hot forming process of Ti-6Ai-4V channel part, the technological parameters which influenced the basic forming characteristics of the channel are researched. The result shows that: as with the punch and die clearance increases, the growth trend of the maximum effective stress value decreases, the thinning ratio has an increasing trend, the effect of clearance value on the material thickening ratio is small; as the fraction coefficient increases, the maximum effective stress increases in the whole forming stage, and along with the forming depths increase, friction can only influence the thinning ratio of material to a certain extent, the maximum thickening ratio decreases as the friction coefficient increases and decreases more quickly with the forming depths increase; the effect of different blank holder force on the maximum effective stress is not obvious in the forming process, under the role of first decrease and then increase type blank holder force curve, the maximum thinning ratio increases rapidly, exert the type of decreasing and the first increase then decrease blank holder force curve, the thickening ratio of the slab is small after forming, it can inhibit wrinkle and obtain better forming quality.


The RNG turbulence model is used to carry out the 3D steady turbulent calculation on the runner and draft tube of the Francis turbine. And the prototype of the Francis turbine is HLA351. Under 8 typical operating conditions, numerical simulation on how the runner outlet urge the vortex rope in draft tube are accomplished in this paper, and the calculation models are long blade model and mixed blade model. The results show that the runner outlet of the mixed model can lead the vortex rope location to the downstream relatively, reduce the circumfluence and cushion area and the probability of the second-vortex. What's more, the flow pattern in mixed model is superior to the long model and that benefits the operation stability and economy of the unit.


We consider the lossless Kaspi/Heegard-Berger source coding problem where an encoder communicates a common description of two sources to two decoders, and each decoder wants to reconstruct one of the sources with the help of side information. We present new results on the utility of encoder side information for this scenario. We show that for some sources and side informations - e.g., for some instances of conditionally less noisy side information - the minimum rate that is required to describe the sources is strictly reduced when the side information is also known at the encoder. On the other hand, we identify classes of sources and side informations - e.g., physically degraded side information - where encoder side information does not change the minimum description rate. We show similar results for a scenario where one decoder has to reconstruct both sources and for a scenario where the encoder is informed only about one of the decoder's side information.


The primary sample of the Gaia Data Release 1 is the Tycho-Gaia Astrometric Solution (TGAS): ≈2 million Tycho-2 sources with improved parallaxes and proper motions relative to the initial catalog. This increased astrometric precision presents an opportunity to find new binary stars and moving groups. We search for high-confidence comoving pairs of stars in TGAS by identifying pairs of stars consistent with having the same 3D velocity using a marginalized likelihood ratio test to discriminate candidate comoving pairs from the field population. Although we perform some visualizations using (bias-corrected) inverse parallax as a point estimate of distance, the likelihood ratio is computed with a probabilistic model that includes the covariances of parallax and proper motions and marginalizes the (unknown) true distances and 3D velocities of the stars. We find 13,085 comoving star pairs among 10,606 unique stars with separations as large as 10 pc (our search limit). Some of these pairs form larger groups through mutual comoving neighbors: many of these pair networks correspond to known open clusters and OB associations, but we also report the discovery of several new comoving groups. Most surprisingly, we find a large number of very wide ( pc) separation comoving star pairs, the number of which increases with increasing separation and cannot be explained purely by false-positive contamination. Our key result is a catalog of high-confidence comoving pairs of stars in TGAS. We discuss the utility of this catalog for making dynamical inferences about the Galaxy, testing stellar atmosphere models, and validating chemical abundance measurements.


The relationships between the percent body fat and other nutritional predictors were assessed among forty male and forty female children aged 2 – 10 years. Both sexes were age – matched. There was no significant difference in age between the two groups (P >0.001). A weak significant positive correlation was observed between the percent body fat and height – armspan ratio in female children (r = 0.300;P = 0.05). Height showed a high positive correlation with body's armspan in males (r = 0.916; P= 0.001) Body mass armspan (BMA) correlated positively and significantly with body mass index (BMI) in female (r = 0.922;P = 0.001). The corrected bone – free arm muscle area (AMA) gave positive values in females while two negative values of corrected AMA were observed in males. Mid – upper arm circumference (MUAC) appeared to be a more sensitive predictor of protein – energy malnutrition (PEM) in these children. The mean MUAC was 17.03cm in males and 17.0 cm in females, respectively. There was evidence of overweight and obesity in both children. The mid – arm muscle circumference (MAMC) gave mean value of 14.44 and 13.07 cm in males and females, respectively. The clinical significance of MUAC, MAMC and corrected AMA measurements are discussed (Afr. J. Biomed. Res. 9: 45 – 52, 2006) Keywords: body fat, Nutrition, anthropometric, children, Nigeria


Soils at the crests of moraines are commonly used to estimate the relative ages of moraines. However, for various pedologic and geomorphic reasons, soil development at crest sites may not truly reflect the time since moraine formation; for example, some crest soils on moraines of greatly different age are similar in morphology and development. Soil catena data for soils at several sites aligned downslope from the crest can greatly improve on the usefulness of soil data for estimating moraine ages. For this purpose, the authors use the weighted mean catena profile development index, which condenses field data for all of the soils in each catena into a single value.


The distribution of Dark-bellied Brent Geese Branta b. bernicla moulting on the Taimyr Peninsula, in the Russian arctic, varies between years depending on whether the birds had a successful breeding season. Counts made of moulting flocks show that major shifts in numbers occur, particularly in non-breeding years, when in line with Salomonsen's (1968) hypothesis a higher proportion of the population moults further north. For instance, the delta of the Lower Taimyr River in the northern part of the Taimyr Peninsula held 10-times more moulting Dark-bellied Brent Geese in 1989, a non-breeding year, than it did in the good 1990 breeding season. At a more local scale, in good breeding years family groups with small goslings tend to move away from breeding islands in the Pyasina Delta, western Taimyr, to avoid gosling predation by Taimyr Gulls Larus taimyrensis which nest in colonies on the same islands, whereas in poor breeding years adult geese concentrate on these same islands to moult and avoid the mainland sites used for moulting in good breeding years. Failed breeders have greater freedom than parent birds to choose where to moult as successful breeders remain with their goslings to protect and guide them to the safest nursery and moult areas. Re-captures of ringed Darkbellied Brent Geese at a moulting site in the Pyasina Delta found that, in poor breeding years, up to one-fifth the birds had moulted at the site previously, but that the majority of ringed birds known to be still alive were not site-faithful to their moulting grounds.


Solar pores are active regions with large magnetic field strengths and apparent simple magnetic configurations. Their properties resemble the ones found for the sunspot umbra although pores do not show penumbra. Therefore, solar pores present themselves as an intriguing phenomenon that is not completely understood. We examine in this work a solar pore observed with Hinode/SP using two state of the art techniques. The first one is the spatial deconvolution of the spectropolarimetric data that allows removing the stray light contamination induced by the spatial point spread function of the telescope. The second one is the inversion of the Stokes profiles assuming local thermodynamic equilibrium that let us to infer the atmospheric physical parameters. After applying these techniques, we found that the spatial deconvolution method does not introduce artefacts, even at the edges of the magnetic structure, where large horizontal gradients are detected on the atmospheric parameters. Moreover, we also describe the physical properties of the magnetic structure at different heights finding that, in the inner part of the solar pore, the temperature is lower than outside, the magnetic field strength is larger than 2 kG and unipolar, and the LOS velocity is almost null. At neighbouring pixels, we found low magnetic field strengths of same polarity and strong downward motions that only occur at the low photosphere, below the continuum optical depth $\log \tau=-1$. Finally, we studied the spatial relation between different atmospheric parameters at different heights corroborating the physical properties described before.


Abstract Central for this paper is the assumption that the Linguistic Landscape is a complex phenomenon that provides an insight not only into practices of symbolic place-making of communities but also into the relation between place, language, and belonging. According to Tietz (2002), a community is based on shared norms and attitudes, a collectively binding horizon of values and understanding which also mark the boundaries of a community. Starting from these considerations, we will explore processes of community ma(r)king in the Ruhr Metropolis, Germany, drawing on data collected in the interdisciplinary research project Metropolenzeichen/Signs of the Metropolis (Ziegler et al., 2018). Our multi-method approach combines data of geocoded digital photographs (N = 25,504) with metalinguistic data collected in on-site interviews (N = 180) and telephone interviews (N = 1,000) to gain a deeper insight into the formation of communities in the Linguistic Landscape of the Ruhr Metropolis.


Abstract Leg ulcers are the most common cutaneous complication of sickle cell disease. These lesions occur mainly in homozygous forms, are slow to heal and often relapse, causing negative physical, emotional, and economic impacts. In this paper, we discuss the clinical presentation, diagnosis, and pathophysiology of sickle cell leg ulcers and their implications for treatment.


OBJECTIVE
The incidence of some cancers has been reported to be higher in diabetic patients than in the general population. We estimated the incidence of lung cancer in diabetic patients and investigated the hypothesis that the rate of lung cancer is different in diabetic compared with nondiabetic patients.

RESEARCH DESIGN AND METHODS
Diabetic patients and age-, sex-, and general practice-matched nondiabetic control subjects were identified from U.K. computerized general practice records (General Practice Research Database), and these records searched for any incident lung cancer, demographic details, and smoking status. Primary lung cancer incidence was calculated and rates compared between diabetic patients and nondiabetic control subjects using multivariate Cox regression, adjusting for age, sex, and smoking. The comparison was repeated for incident diabetic patients followed from diagnosis and after stratifying by diabetic treatment.

RESULTS
The incidence of primary lung cancer in all 66,848 diabetic patients was 1.63 per 1,000 patient-years (95% CI 1.48-1.79) and 2.05 per 1,000 patient-years (1.76-2.38) among diabetic patients followed from diagnosis. When compared with nondiabetic control subjects, the hazard ratio was 0.88 (0.79-0.97) for all diabetic patients and 1.12 (0.95-1.34) for those followed from diagnosis. When observation was truncated to allow for shorter life expectancy, the hazard ratio for the total cohort was 0.98 (0.84-1.13), and no association was found with any treatment group.

CONCLUSIONS
No increased risk of lung cancer in diabetes was found. We hypothesize that the lower incidence may be partly due to shorter life expectancy.


There is nothing uniform about wearing a uniform. This one article of clothing has arguably had a greater impact on the world than any other. From fascists to fashionistas, Uniforms Exposed looks at this most extraordinary of ordinary garments and its cultural meaning in our everyday lives. Tracing the troubling connections amongst religious orders, the military, schools and fetish clubs, Craik shows how uniforms alternately control bodies and enable subversion. What does it mean to wear one? Why do certain professions require them? Do they really tell wearers how to act and others how to respond? Answering these intriguing questions and many more, Craik shows how the uniform inspires fear and love, conformity and subversion, and why it has continued to fascinate across cultures and throughout history.


Application of flat welded ends with stress relief grooves in high-pressure vessels is a common alternative to use of dished vessel ends. It is well established and follows calculation rules given in codes: EN-12952-3 [1], EN-13445-3 [2], or in ASME code [3]. However the calculation rules do not give any definite answer what should be the choice of parameters defining a circular stress relief groove, for example, position of the groove and its radius. Usually the choice of them relies on engineering practice. The present paper clearly shows the influence of this choice on stress concentration in the cylinder-endplate junction area. The results of numerical study are verified in experimental investigations performed for a cylindrical high-pressure vessel.


Permanent magnet synchronous motor systems are usually used in industry. This kind of systems is nonlinear in nature and generally difficult to control. The ordinary linear constant gain controller will cause overshoot or even loss of system stability. Application of adaptive controller to a permanent magnet synchronous motor system is investigated in this paper. The dynamic model of the system is given and the stability is also analyzed using Popov's criterion. The steady state error can be eliminated using adaptive controller combined with an integration term. Simulation results show the performance of adaptive controller with fast response and less overshoot.


We study the possibility of the primordial black holes (PBHs) formation with the aim of finding a considerable fraction of dark matter (DM), using the gravitationally enhanced friction mechanism which arises from a nonminimal derivative coupling between the scalar field and the gravity. Assuming the nonminimal coupling parameter as a special function of the scalar field and considering the potential of natural inflation, we find three parameter sets that produce a period of ultra slow-roll inflation. This leads to sufficiently large enhancement in the curvature power spectra to form PBHs. We show that under the gravitationally enhanced friction mechanism, PBHs with a mass around 10−12M⊙ can constitute around 96% of the total DM and so this class of PBHs can be taken as a great candidate for DM. We further study the secondary gravitational waves (GWs) in our setting and show that our model predicts the peak of the present fractional energy density as ΩGW0 ∼ 10−8 at different frequencies for all the three parameter sets. This value lies well inside the sensitivity region of some GWs detectors at some frequencies, and therefore the observational compatibility of our model can be appraised by the data from these detectors.


Artificial recharge of Aquifers with treated wastewater is one of the most promising techniques for its reuse. Usually laboratory and pilot scale field studies are conducted for investigating the feasibility of wastewater recharge for any aquifer. The addition of sand to the local soil can improve the performance of the Soil Aquifer Treatment (SAT) process. Thus, a laboratory study was conducted to investigate the effect of sand amendment with local Sandy Clay Loam (SCL) texture soil collected from Anna University Sewage Treatment Plant (STP), Chennai, India. Four 35 cm long PVC soil columns were fabricated and were filled with 5 % (R5), 10 % (R10), 15 % (R15) and 20 % (R20) sand amended soil. The experiments were run simultaneously for a period of ten cycles with 3 days wet/4 days dry cycles. Water samples were collected at the outlet of the columns and analysed for TDS, ammonia, nitrite and nitrates. The removal of ammonia was through nitrification process which was found to be a dominant removal mechanism of nitrogen. When reduction performance achieved with different sand amendment columns were compared, it could be seen that R10 column yielded with least nitrate value of 0.69 and 1.57 mg/l after 1st and 3rd wetting day.


IEEE 802.11-based wireless technology is widely applied in many areas, supporting communications where wired devices are not available. However, providing satisfactory QoS is still a challenging topic in 802.11-based wireless networks because of the problems such as error-prone wireless channel condition, power consumption, short of centralised facility, mobility as well as channel contention. For addressing these issues, one feasible solution can be to implement resource reservation for the sessions that require QoS assurances. The responsibility of resource reservation scheme is to make sure that QoS-sensitive sessions get sufficient bandwidth in order to sustain their high performance. Difficulties are already identified for designing resource reservation schemes in both network and MAC layers. However, there is no profound investigation outcome for this kind of QoS mechanism. Therefore, in this paper, we intend to produce a comprehensive survey of resource reservation approaches for IEEE 802.11-based wireless networks. The associated research works are summarised and also classified. Moreover, both the drawbacks and the merits of each kind of resource reservation scheme are highlighted.


To the serious student of Assyrian history, it is obvious that we cannot write that history until we have adequately discussed the sources. We must learn what these are, in other words, we must begin with a bibliography of the various documents. Then we must divide them into their various classes, for different classes of inscriptions are of varying degrees of accuracy. Finally, we must study in detail for each reign the sources, discover which of the various documents or groups of documents are the most nearly contemporaneous with the events they narrate, and on these, and on these alone, base our history of the period.


PURPOSE
Tracking metrics over time is a well-established means of establishing a quality control program. The number of metrics followed and testing frequency is limited by available resources. Automating the image analysis and data archival of a QC program enables objective and efficient tracking of performance metrics. The purpose of this study was to develop such a QC method and to assess its utility at a large clinical facility.

METHODS
The QC program at our institution is based on the acquisition of daily water-phantom scans, and biweekly ACR-phantom scans for each CT system. We developed a QC program to analyze these data. The QC software operates on the images sent directly to our server. The relevant information from DICOM headers was extracted, data analyzed, and a database was populated. The measurements performed on the waterphantom included water CT-number, uniformity, noise, and artifact. The measurements performed on the ACR-phantom included the MTF, NPS, detectability, artifact, uniformity, CNR, and the CT-numbers for water, polyethylene, bone, air, and acrylic. Email notifications and criteria limits were directly based upon ACR accreditation requirements and developing threshold values.

RESULTS
Across ten clinical CT scanners, the daily water CT-number was -0.2+/-1.4 HU(mean+/-standard deviation). The corresponding numbers for 10%MTF, uniformity, CNR squared normalized to CTDI, and detectability squared normalized to CTDI were 0.69+/-0.01 (1/mm), 0.93+/-0.29, 0.06+/-0.02 (1/mGy), and 3.3+/-0.7 (1/mGy), respectively. For all ACR-phantom inserts, the largest standard deviation for any individual scanner was 1.9 HU. Artifact analysis triggers successfully identified problematic images.

CONCLUSION
Automating image analysis allows one to frequently track meaningful metrics that would be impractical to follow otherwise. System inconsistencies are more likely to be identified and corrected earlier. Much tighter system specific criteria limits are possible.


This paper presents a general method for selectively refining or coarsening progressive meshes. Our method works for arbitrary meshes, deals with non-manifolds, and allows the change of manifold and genus properties of the mesh. We introduce new definitions for edge contraction and expansion operations, which make solely use of the vertex hierarchy. These definitions in conjunction with their legal conditions lead to many provable properties of the refinement process. In addition, we propose a locally re-stripping method to dynamically generate the strips during selective refinements, which efficiently forms strips for meshes coarsening or refining process.


Parents who bring home an infant requiring constant home apnea monitoring often face a stressful situation with their child's medical difficulties and their own financial concerns. The home care nurse must be aware of the difficulties facing these families to offer the necessary support and education.


Past studies have examined the climatology of derechos and suggest very different distributions of derechos within the United States. This uncertainty in the climatology of derechos is a concern for forecasters, since knowledge of the relevant climatological information is a key piece in the forecast process. A 16-yr dataset from 1986 to 2001 is used to examine the effects that changing the method of identifying derechos may have on the interpretation of the derecho climatology. In addition, an attempt is made to visualize the favored regions of particularly intense derecho events. The results show aspects seen in earlier climatologies, including a southern axis in the southern plains that is favored in the mid-1980s and early 1990s and a northern axis centered from the upper Mississippi River valley into Ohio that is favored in more recent years. However, altering the criteria to not require three 33 m s 21 gust reports or F1-type damage (low-end events) significantly increases the number of events that are identified in the lower Appalachians, the Ohio valley, and in portions of the southern axis, particularly in the earlier period. To a lesser extent, the inclusion of low-end events also increases the frequency values in the northern axis in the later period. The overall effect of including the low-end events is to create a distribution that still suggests both a southern and northern axis, and a shift of the primary axis from the southern plains in the early period to the upper Mississippi valley in the later period. However, the frequency values of the maxima are noticeably reduced when the low-end events are excluded. Therefore, both the length of the dataset and the criteria used to define derechos can significantly influence the resulting climatology. High-end derechos, which require three wind gust reports (or comparable damage) exceeding 38 m s21, appear to be favored in the northern corridor during the warm season, particularly in the later period, and are favored along the lower Mississippi River valley during the colder months in both periods.


Due to its band-gap energy, gallium nitride (GaN) is well-suited for light emission in the blue spectral region. By alloying with aluminium and/or indium, an energetical range even wider than the whole visible spectrum can be covered. For electronic devices based on group-III nitrides, the influence of strain is a non-negligible intrinsic physical effect. An easy way to experimentally evaluate the strain is the monitoring of lattice vibrations via Raman spectroscopy. With experimental data providing a reliable reference for the strain effects not being available, it is desirable to obtain them from a full quantum-mechanical treatment of the material via first-principles calculations. In this work, the strain dependence of the structural and dielectric properties and of the phonon frequencies of the cubic and the hexagonal polytype of GaN and AlN as well as of short-period superlattices are investigated by ab-initio methods. Three types of strain are considered, corresponding to the application of hydrostatic pressure, of an isotropic biaxial stress in the basal plane, and of a uniaxial pressure along the crystal axis. After a careful internal relaxation of the structures for given external stress, the dielectric constant, Born effective charges and phonon frequencies are calculated using density-functional perturbation theory. Since typical structural changes are of the order of one hundredth of the lattice parameters, to resolve these changes to a precision of a few percent the lattice parameters themselves have to be determined to a precision of 1E-4, which indeed can be achieved. The elastic properties of GaN and AlN are characterized in terms of ratios of the elastic stiffness constants, which allow for a critical comparison with literature data; unreliable ones are pointed out. The calculated pressure behavior of the phonon modes compares rather well to experimental results. The observed increase of the LO-TO splitting results from a reduced dielectric screening, not from an increase in ionicity. A frozen-phonon calculation shows that the softening of the low-frequency E2 mode is mainly caused by an increased destabilization due to the Ewald energy, which is differently counterbalanced in GaN and AlN by the other contributions to the total energy. From the strain dependences, phonon mode coefficients and deformation potentials are obtained, which agree with measured values for GaN; for AlN, no other published values are available. Seeming discrepancies between experimental and theoretical results can be widely resolved using suitable parameters and correct stress-strain relations. We find that the stress obtained from biaxial-strain-induced shifts of the high-frequency E2 phonon should be higher than determined by other authors. The short-period superlattice show a structural relaxation behavior differing significantly from the bulk one. Their phonon modes are grouped in separate frequency regions for LO and TO modes as well as for acoustic ones, they exhibit properties typical both for thicker superlattices as well as for a bulk material of its own kind. Folded AlN-confined TA modes appear due to the mutual strain of the GaN and AlN layers. For all superlattices, independent of the number of layers and the polytype, the following special features are found, which can be considered as intrinsic properties: All but one of the TO modes are confinded modes, with the propagating one being found in the GaN frequency region, well separated from the AlN range; it shows a vibrational pattern similar to a bulk zone-center TO mode. In the gap between the AlN- and GaN-confined TO modes an interface mode exists, showing strong angular dispersion. The uppermost LO mode changes its polarization direction and it is strongly IR active, thus for all propagation directions it couples to the electric field, in complete analogy to the polar LO mode of bulk material.


Deep learning technologies, which are the key components of state-of-the-art Artificial Intelligence (AI) services, have shown great success in providing human-level capabilities for a variety of tasks, such as visual analysis, speech recognition, and natural language processing and etc. Building a production-level deep learning model is a non-trivial task, which requires a large amount of training data, powerful computing resources, and human expertises. Therefore, illegitimate reproducing, distribution, and the derivation of proprietary deep learning models can lead to copyright infringement and economic harm to model creators. Therefore, it is essential to devise a technique to protect the intellectual property of deep learning models and enable external verification of the model ownership. In this paper, we generalize the "digital watermarking'' concept from multimedia ownership verification to deep neural network (DNNs) models. We investigate three DNN-applicable watermark generation algorithms, propose a watermark implanting approach to infuse watermark into deep learning models, and design a remote verification mechanism to determine the model ownership. By extending the intrinsic generalization and memorization capabilities of deep neural networks, we enable the models to learn specially crafted watermarks at training and activate with pre-specified predictions when observing the watermark patterns at inference. We evaluate our approach with two image recognition benchmark datasets. Our framework accurately (100%) and quickly verifies the ownership of all the remotely deployed deep learning models without affecting the model accuracy for normal input data. In addition, the embedded watermarks in DNN models are robust and resilient to different counter-watermark mechanisms, such as fine-tuning, parameter pruning, and model inversion attacks.


Mixed dish is a food category that contains different dishes mixed in one plate, and is popular in Eastern and Southeast Asia. Recognizing individual dishes in a mixed dish image is important for health related applications, e.g. calculating the nutrition values. However, most existing methods that focus on single dish classification are not applicable to mixed-dish recognition. The new challenge in recognizing mixed-dish images are the complex ingredient combination and severe overlap among different dishes. In order to tackle these problems, we propose a novel approach called contextual relation networks (CR-Nets) that encodes the implicit and explicit contextual relations among multiple dishes using region-level features and label-level co-occurrence, respectively. This is inspired by the intuition that people are likely to choose dishes with common eating habits, e.g., with multiple nutrition but without repeating ingredients. In addition, we collect a large-scale dataset of mixed-dish images that contain $9,254$ mixed-dish images from $6$ school canteens in Singapore. Extensive experiments on both our dataset and a smaller-scale public dataset validate that our CR-Nets can achieve top performance for localizing the dishes and recognizing their food categories.


When is the last time that you performed an eye exam for an energetic two-year-old? Does the thought scare you, or do you refer these patients to the nearest pediatric specialist? With just a little patience and a quick response time, you, too, can perform a 2-year-old eye exam as smoothly as an adult eye exam (sometimes even easier).


Mortality and morbidity trends in South Africa have been dominated by the HIV epidemic. Despite imperfect health statistics, it has been possible to observe a substantial increase in mortality of young adults during the last decade that has severely affected women aged 20 to 44 years and men in a wider age band. HIV-related diseases are by far the leading cause of death among young women as well as non-HIV-related TB and pneumonia together with homicide and road traffic accidents. Women in the slightly older age group of 45-54 years are more affected by chronic diseases such as stroke, diabetes mellitus, hypertensive heart disease, ischemic heart disease and cervical cancer. In 1998 there were indications that the maternal mortality ratio for South Africa was relatively high. Indications are that this has been exacerbated by the HIV epidemic. Mortality rates do not reflect some important aspects of health such as mental health problems. A review of available data suggest that a sizable burden of mental health problems also affect women in this age range.
While it is estimated that HIV has increased child mortality rates in South Africa, reliable data for this essential indicator are completely lacking. Government is urged to improve the situation and collect good quality data that will provide accurate statistics on this critical indicator, a key indicator to monitor the Millennium Development Goals.
Provincial variations in the mortality of children and women allude to much larger inequalities in health status that are masked by the average mortality rates presented in this chapter. Health managers at all levels of health care are urged to consider the health status of the population in their planning of programmes and services. This will require extensive improvements to the current health information system.


Introduction Papillary thyroid carcinomas are one of the most common endocrine neoplasms. It is well known for its low malignant potential. Papillary carcinomas mostly metastases to lymph nodes of level six. Recent advances in the pathology that is with proper ultra sound guided FNAC, early diagnosis can be made. Here we are presenting a patient with a huge neck mass that presented to our medical college hospital and how we managed the same.
Case Blog 53 years old male patient, presented to a tertiary hospital with complaints of swelling in front of neck for the past 7 years. The patient was having a progressive swelling, it started as a small pea shaped swelling and it slowly progressed and has reached the present size (Figure 1). The patient was having no difficulty in respiration. CT scan of the neck region with chest was taken as the lower extent was not palpable and the FNAC of the swelling was taken. FNAC revealed papillary thyroid carcinoma.
CT scan showed a huge soft tissue mass over left supra clavicular region with solid and cystic attenuation extending to the superior aspect of the thoracic inlet. The mass was shifting trachea to the right side (Figure 2). There were no palpable neck nodes. The patient was planned for surgical exploration of the tumour with sternotomy as the tumour was extending in to the thoracic inlet. A total thyroidectomy with central compartment neck dissection was done. The mass was proved to be papillary thyroid carcinoma of intra cystic variant.
Discussion Papillary thyroid carcinoma is the most common thyroid cancer. Papillary thyroid cancer also has an excellent prognosis. Total thyroidectomy is done once histo pathological diagnosis is established [1].
This patient to begin with presented with a small pea shaped swelling on front of left side of neck and it started slowly progressing in size. Once the size of the tumour is more than 10 mm, total thyroidectomy is indicated. These papillary carcinomas mostly metastases to central neck nodes [2]. Hence for a better outcome it is always mandatory to go for central neck node dissection for proven cases of lymphatic spread. Biochemical analysis of free T4 and TSH is necessary before surgery. This patient was euthyroid before surgery was planned. Surgery of total thyroidectomy and neck dissection of central compartment was done [3]. Recurrent laryngeal nerve was identified during the procedure. Parathyroid glads were identified and preserved on the right side. The patient was kept on regular followup. Histopathological diagnosis confirmed it to be a papillary thyroid carcinoma.
Conclusion Total thyroidectomy with central compartment dissection appears to be adequate treatment even for masses that are extending upto supra clavicle also with extension to thoracic inlet. CT scan plays a very important role in pre-operative planning for huge neck mass. Preservation of recurrent laryngeal nerve and parathyroid glands are very important in this surgery. Though it is controversial in the absence of neck node one should go for central node dissection, from our institutional experience, it is always safer to go for central node dissection, so that recurrence of the tumour can be avoided.


The entire genome of grapevine leafroll-associated closterovirus-2 (GLRaV-2), except the exact 5' terminus, was cloned and sequenced. The sequence encompasses nine open reading frames (ORFs) which include, in the 5' to 3' direction, an incomplete ORF1a encoding a putative viral polyprotein and eight ORFs that encode proteins of 52 kDa (ORF1b), 6 kDa (ORF2), 65 kDa (ORF3), 63 kDa (ORF4), 25 kDa (ORF5), 22 kDa (ORF6), 19 kDa (ORF7) and 24 kDa (ORF8) respectively, and 216 nucleotides of the 3' untranslated region. An incomplete ORF1a potentially encoded a large polyprotein containing the conserved domains characteristic of a papain-like protease, methyltransferase and helicase. ORF1b potentially encoded a putative RNA-dependent RNA polymerase. The expression of ORF1b may be via a +1 ribosomal frameshift mechanism, similar to other closteroviruses. A unique gene array, which is conserved in other closteroviruses, was also identified in GLRaV-2; it includes genes encoding a 6 kDa small hydrophobic protein, 65 kDa heat shock protein 70, 63 kDa protein of function unknown, 25 kDa coat protein duplicate and 22 kDa coat protein. Identification of ORF6 (22 kDa) as the coat protein gene was further confirmed by in vivo expression in E. coli and immunoblotting. Phylogenetic analysis comparing different genes of GLRaV-2 with those of other closteroviruses demonstrated a close relationship with beet yellows virus (BYV), beet yellow stunt virus and citrus tristeza virus. GLRaV-2 is the only closterovirus, so far, that matches the genome organization of the type member of the group, BYV, and thus can be unambiguously classified as a definitive member of the genus Closterovirus.


OBJECTIVE
Current management of hospitalised patients with community-acquired pneumonia (CAP) in an Australian regional hospital in accordance with the recommended guidelines is unknown. The prescription rate of inappropriate antibiotic therapy was measured and analysed.

DESIGN
A retrospective audit, December 2012 to November 2013.

SETTING
Regional Australian hospital in North East Victoria.

INTERVENTIONS
Interventions were the average of inpatient and intensive care unit length of stay, time to first antibiotic and to first chest X-ray, days of intravenous antibiotics, and extra intravenous therapy; proportion of intensive care unit admissions, average time to first antibiotic administration, patients with failed outpatient management of CAP, initial microbiological investigations, positive investigations, predominant microbiology, antibiotic choice, and concordance with guidelines; proportion of justifiable deviation from guidelines, ratio of patients switched to oral therapy appropriately, complications during therapy, clinical failure, inpatient mortality, mortality at 30 days, mortality at 6 months, and readmission with CAP in 30 days and in 3 months.

MAIN OUTCOME MEASURES
To improve the rates of concordance with guidelines by following a specified method to rate severity of CAP, to clearly document reasons for non-concordance with guidelines, and to rationalise investigations.

RESULTS
To improve antibiotic stewardship in the management of CAP.

CONCLUSION
In an Australian regional hospital, ceftriaxone and azithromycin were the predominant combination used at 56%, demonstrating that mild CAP was frequently overtreated. Mild CAP was eight times more likely to be treated as severe CAP (odds ratio = 8.2 (95% confidence interval, 1.7-40.3) P < 0.009). There is a need for a simple yet effective strategy to be introduced to rationalise treatment and investigation of CAP in this setting.


ABSTRACT Standard language cultures are characterised by beliefs in idealised standard forms of the language in question. In this paper, these beliefs are connected to the concepts of referee design and speech community, through analysis of how Swedish adolescents reflect upon and self-assess their language proficiencies. The data consist of interviews where 111 participants self-assess their Swedish, English and additional home languages. During the self-assessment, participants use different points of reference when reflecting on the different languages in their repertoires. Four main categories of answers are found, all relating to an absent referee in some manner: the participants' evaluations of other people's language proficiency compared to their own; their proficiency in other languages; their evaluation of their proficiency in relation to formal grading and feedback given in school; and their own experiences of their limitations and abilities in different situations. When assessing Swedish, participants display attitudes towards 'good' and 'bad' language and contextualise their proficiency in a way that focuses on standard language ideologies and their speech community. The same pattern does not occur when participants reflect on their other languages, indicating the important role that the peer group and speech community have in creating and facilitating these ideologies.


OBJECTIVES
This study tested a simple model of the relationship between the lead concentration in bone (bone-Pb), exposure time, and lead in plasma (P-Pb) and whole blood (B-Pb) to make it possible to use bone-Pb as a retrospective exposure index.

METHODS
Seventy-seven active lead workers and 24 referents were studied. The bone-Pb in tibia (T-Pb) and calcaneus (C-Pb) was measured by in vivo X-ray fluorescence. P-Pb was calculated from B-Pb by use of the nonlinear relationship between these variables. Cumulative B-Pb (cumB-Pb) and P-Pb (cumP-Pb) were calculated to the time of the bone-Pb measurements. In addition, cumP-Pb was adjusted by applying varying rate constants for the transfer of lead from bone to plasma.

RESULTS
There were close linear associations between the lead concentrations in tibia (proportion of variance explained, R2 = 0.78) and calcaneus (R2 = 0.80), on one hand and the cumB-Pb on the other. The best fit of bone-Pb to the adjusted cumP-Pb (0.79 for T-Pb; 0.82 for C-Pb) was obtained for the terminal phase half-times of 13 and 12 years, respectively.

CONCLUSIONS
The combined data on bone-Pb and exposure time make it possible to estimate previous mean P-Pb and B-Pb. Such estimates will be valuable in studies of toxic effects on long-term exposed lead workers when data on the intensity of previous exposure are lacking. The use of P-Pb in modeling bone-Pb kinetics is physiologically relevant, but the use of adjusted cumP-Pb, as compared with cumB-Pb, did not significantly change the variance in the relation to bone-Pb.


Objective: Breakthrough cancer pain (BTcP) affects 19-95% of cancer patients (dependent on the definition and methods used and the populations studied) and is associated with detrimental physical, psychological and social complications in affected individuals as well as with significant economic burden on society and the healthcare system. This study evaluated the analgesic efficacy and safety of intranasal fentanyl spray (INFS) for the treatment of BTcP in a clinical setting with a special focus on its impact on health care resource utilization. Research design and methods: This was a prospective, open-label, noninterventional, multi-center study. Opioid-tolerant adult patients with BTcP received INFS in the course of routine clinical practice, and completed standardized questionnaires as well as BTcP diaries over a 28-day observation period. Clinical trial registration: ClinicalTrials.gov Identifier: NCT00994760 Main outcome measures: Efficacy was assessed using measures of BTcP intensities, the times to first and to the maximum effect of INFS, as well as changes in BTcP-related restrictions in quality-of-life (QoL), activities of daily life (ADL) and overall wellbeing. Further analyses based on INFS-related changes in health care resource utilization. Treatment emergent adverse events (TEAEs) were recorded throughout. Results: Overall, 58 centers participated and enrolled 131 patients, of whom 116 (88.5%) completed the observation period and documented a total of 556BTcP episodes. The 100µg dose was judged as the most effective INFS dose in 64.0a% of patients, followed by 50 µg (28.0a%) and 200 µg (8.0 a%). The study recorded a substantial INFSrelated improvement in maximum BTcP intensity, compared with baseline as well as prior use. Patients reported experiencing the first effects of the study drug within 5 minutes of administration in 81.9% of episodes, and a time to maximum effect within 10 minutes in 81.4% of episodes. QoL and BTcP-related restrictions in ADL showed considerable improvements during the observation period. INFS was well tolerated, with sixpatients (4.6%) experiencing ≥1 study drug-related adverse event. Study limitations include a modest size and duration, and the single-arm design. Conclusion: Under the conditions of this non-interventional open-label study, INFS proved to be a rapid onset, highly effective and well tolerated alternative for the treatment of BTcP in opioid-tolerant cancer patients. INFS treatment was not only associated with substantial improvements in BTcP intensity as well as related restrictions in QoL and ADL, but also with a respectable decrease of health care resource demands – especially in the field of ambulatory palliative care nursing services.


AIM
The aim of this paper was to discuss the importance of ethical aspects when implementing eHealth services in health care.

BACKGROUND
Challenges in healthcare today include a growing older population and, as a consequence, an increased need for healthcare services. One possible solution is the use of eHealth services.

DESIGN
Discussion paper.

DATA SOURCES
Research literature published from 2000-2017 in CINAHL, PubMed and Scopus.

IMPLICATIONS FOR NURSING
Implementing eHealth services in health care involves ethical challenges where different technologies can solve different problems in different ways. eHealth services should therefore be developed and implemented based on the patient's specific needs and conditions for use and in accordance with the healthcare professionals' presumption to provide high-quality care.

CONCLUSION
To preserve patients' integrity, dignity and autonomy, healthcare professionals must include ethical aspects when implementing and using eHealth services in health care. Healthcare professionals have to take responsibility for the eHealth services introduced, explaining why and how they are implemented based on a person-centred approach. More knowledge is needed about ethical aspects when implementing eHealth services to improve the quality of care.


A community research model developed in the UK was adopted in a multi-country interdisciplinary study of health and welfare in superdiverse neighbourhoods. The model involves training a diverse group of community members in qualitative research methods, and engaging them in research in their own community. In Uppsala, Sweden, five community researchers were recruited to facilitate access to diverse groups in the two study neighbourhoods, including ethnic, religious, and linguistic minorities. After training, community researchers recruited study participants from the study neighbourhoods, and assisted during interviews. Their local networks, and knowledge about the neighbourhoods were invaluable for contextualising the study and finding participants. However, they were not able to recruit participants from certain groups due to language barriers, and it was difficult to retain community researchers in the project. The study took place in the context of an unprecedented number of asylum-seekers arriving in Sweden, which took up many collaborators' time. Various contextual factors made it difficult to fully apply this particular model of community research in the Swedish setting. Employing several people on short-term contracts is complicated as Swedish Universities are public authorities. Other aspects of Swedish culture and the labour market, such as strong expectations of stable full-time employment, make flexible part-time work undesirable. The community research model was only partly successful in embedding the research project as a collaboration between community members and the University. While there was interest and some short-term involvement from residents of study neighbourhoods, the research remained University-led with limited sense of community ownership.


Failures during web service execution may depend on a wide variety of causes. One of those is loss of Quality of Service (QoS). Failures during web service execution impose heavy costs on services-oriented architecture (SOA). In this paper, we seek to achieve a self-healing architecture to reduce failures in web services. We believe that failure prediction prevents the occurrence of failures and enhances the performance of SOA. The proposed architecture consists of three agents: Monitoring, Diagnosis and Repair. Monitoring agent measures quality parameters in communication level and predicts future values of quality parameter by Time Series Forecasting (TSF) with the help of Neural Network (NN). Diagnosis agent analyzes current and future QoS parameters values for diagnose web service failures. Based on its algorithm, the Diagnosis agent detects failures and faults in web services executions. Repair agent manages repair actions by using Selection agent.


Response of a micro volume (0.01 ml) ionization chamber has been studied with pulsed proton beams which are used for clinical purposes and has been compared with those of some JARP ionization chambers (0.6 ml). All chambers used had been calibrated by standard 60Co beams at the Electrotechnical Laboratory (ETL) and exposure calibration factors, Nx, were obtained on advance. Two methods are used to compensate the general recombination which occurs during pulsed beam irradiations: theoretical correction by a Boag's formulation and a modified two-voltage technique. An evaluation of absolute absorbed dose-to-water is performed on the basis of the protocol provided by ICRU report 59. The results imply that, to a first approximation, both chambers indicate the almost same result within 2% when unknown chamber-dependent parameters of the micro chamber are tentatively assumed to be identical to those of the JARP chamber for the calibration with 60Co beams. The about 1.5% discrepancy observed in the response of both chambers is not discussible due to presumably 1-2% uncertainty of the protocol of ICRU report 59 which does not include any chamber-dependent corrections for the perturbation effects in proton beams.


Furniture joints can tell historians, conservators and curators much about the history of a piece. Although there are many varieties of wood working joints, it is often the dovetail that is seen as the quintessential cabinet-makers' joint. Indeed, even to the nonprofessional, the dovetail is one of the most recognisable joints in furniture. Considered one of the strongest of cabinet joints, whether hidden or exposed, it so often reflects quality and artisanship. Ranging from the elementary to the complex, the dovetail joint has a number of variations from the simply functional to the clearly decorative. This paper considers the origins of the dovetail from ancient Egyptian cabinetwork, through its development as a builders' and joiners' joint, to becoming the symbol of refined cabinet making. It will consider the applications of the joint in both hand and machine-cut versions. Of particular interest are the attempts to mechanise the method of dovetail joint cutting. The nineteenth century in particular has left a legacy of patented processes and developments that show us how creating dovetails changed from a skilfully crafted hand operation to a simple and speedy machine process using the modern-day router and jig combinations. The development of this simple, though sophisticated joint and its many variations, is a fascinating story.


Allopurinol (Zyloric - BW) is an isomer of hypoxanthine, and marks a new approach to the long-term treatment of gout.1 2 It is well established that drugs which increase uric acid excretion such as probenecid (Benemid - MSD) and sulphinpyrazone (Anturan - Geigy), although liable to precipitate acute attacks of gout at the beginning of treatment, eventually reduce the incidence of such attacks and lead to the disappearance of tophaceous deposits in the body. With these drugs the plasma levels of uric acid tend to become normal and remain so. Allopurinol produces the same effects, not by increasing uricosuria, but by inhibiting xanthine oxidase, the enzyme responsible for converting xanthine and hypoxanthine to uric acid: the solubility and renal clearance of these two substances are greater than those of uric acid, and so they are more easily excreted.


IEEE 802. lie has a new coordination function, which has both contention-based and contention-free medium access methods, in order to support applications with Quality of Service (QoS) requirements. The contention-based MAC protocol, Enhanced Distributed Channel Access (EDCA) supports QoS; however, it cannot guarantee strict QoS required by real-time applications without proper tuning of QoS parameters and network control mechanisms. In this paper we adjust QoS parameters trading off between call admission control and rate control to enhance the EDCA access mechanism of IEEE 802.11e wireless LAN. Performance of the proposed scheme is analyzed using an OPNET modeler 12.0.


— We define the resultant of two power series with coefficients in the ring of integers of a p-adic field. In order to do this, we prove a universal version of the Weierstrass preparation theorem.


Objective The objective of this study was to investigate arsenic induced changes in blood 8-aminolevulinic acid dehydratase (ALAD) after in vitro and in vivo exposure to this element and its response to co-administration of meso 2,3-dimercaptosuccinic acid (DMSA) and monoisoamyl DMSA (MiADMSA) either individually or in combination. Methods Rat whole blood was exposed to varying concentrations (0.1, 0.2 and 0.5 mmol/L) of arsenic (III) or arsenic (V), to assess their effects on blood ALAD activity. Varying concentrations of MiADMSA and DMSA (0.1,0.5 and 1.0 mmol/L) were also tried in combination to determine its ability to mask the effect of arsenic induced (0.5 mmol/L) inhibition of blood ALAD in vitro. In vitro and in vivo experiments were also conducted to determine the effects of DMSA and MiADMSA either individually or in combination with arsenic, on blood ALAD activity and blood arsenic concentration. Results In vitro experiments showed significant inhibition of the enzyme activity when 0.1-0.5 mmol/L of arsenic (III and V) was used. Treatment with MiADMSA increased ALAD activity when blood was incubated at the concentration of 0.1 mmol/L arsenic (III) and 0.1 mmol/L MiADMSA. No effect of 0.1 mmol/L MiADMSA on ALAD activity was noticed when the arsenic concentration was increased to 0.2 and 0.5 mmol/L. Similarly, MiADMSA at a lower concentration (0.1 mmol/L) was partially effective in the turnover of ALAD activity against 0.5 mmol/L arsenic (III), but at two higher concentrations (0.5 and 1.0 mmol/L) a complete restoration of ALAD activity was observed. DMSA at all the three concentrations (0.1,0.5 and 1.0 mmol/L) was effective in restoring ALAD activity to the normal value. Conclusions The results thus suggest that arsenic has a distinct effect on ALAD activity. Another important toxicological finding of the present study, based on in vivo experiments further suggests that combined administration of DMSA and MiADMSA could be more beneficial for reducing blood ALAD inhibition and blood arsenic concentration than the individual treatment.


Manufacturing companies tend to separate technology development (TD) from product development (PD) as has been devised by research within the field of innovation management. When a technology is ready it somehow has to be made available to the PD teams so that the engineers working in PD projects can adapt the new technology into new products. The question is how that work can be supported. The ultimate goal of the research presented in this paper is to develop methods and tools to assist the knowledge transfer between TD and PD with a focus on supporting the actual use of the new technology in PD. This paper presents an industrial case along with a proposed method to achieve this. The TD and PD processes in the case company were reviewed with focus on how simulation models evolve over time and how they are used for different purposes. It was discovered that simulation ready CAD-models can be used to transfer the output from TD to PD.


Like children's academic performance in school, children's body weight and fitness are under siege. Fatness has become a central issue in the school curriculum as schools are being held accountable for obesity among children. Cultural discourses of "bodies at risk," and a "society at risk" in the United States, including the circulation of "fat phobia" (Evans, Rich, & Davies, 2004; Gard, 2004; Gard & Wright, 2001) reflect a pervasive social preoccupation with the body. Doctors, epidemiologists, kinesiology researchers, and fitness advocates have declared war against fatness, contending that obesity/overweight is an "epidemic," a world problem, a "public health crisis among children worldwide" (Whitlock, Williams, Gold, Smith, & Shipman, 2006, p. 125). Schools, as microcosms of society, are not immune to, but are implicated in the production of these alarming discourses. To respond to this crisis, schools have been called to embrace, be responsible for, and help young people develop a healthy, slim physicality.


This paper explores the use of community technology centers (CTCs) by U.S. adults. In this context, CTCs are broadly defined as public, not for profit facilities where individuals can access the internet and information communication technologies, the most common of which are public libraries. Furthermore, CTCs are a junction where technology usage and community participation can occur concurrently. Two rounds of data collection using Amazon Mechanical Turk (n = 585) and a Qualtrics Survey Panel (n = 330) were used to develop a unique measure of social capital generated at CTCs. Through multiple regression analyses, this study identifies that the activities completed at CTCs but not the frequency of attendance are associated with higher levels of community technology center social capital (CTCSC), or rather the feelings of trust and reciprocity captured by our measure.


Conventional cancer treatments such as chemotherapy, radiotherapy, or combination of these two result in side effects, which lower the quality of life of the patients. To overcome problems with these methods, altering the drug properties by conjugating them to carrier polymers has emerged. Such polymeric carriers also hold the potential to make tumor cells more sensitive to radiation therapy. Herein, poly(p-phenylene) (PPP) polymer with poly(ethylene glycol) (PEG) chains and primary amino groups (PPP-NH2 -g-PEG) is synthesized and conjugated with anticancer drug Doxorubicin (DOX). pH dependent drug release experiments are performed at pH 5.3 and pH 7.4, respectively. Cell viability studies on human cervix adenocarcinoma cells show that lower doses of DOX inhibit cell proliferation when conjugated with nontoxic doses of PPP-NH2 -g-PEG polymer. Additionally, PPP-NH2 -g-PEG/Cys/DOX bioconjugate significantly increases radiosensitive properties of DOX. It is possible to use lower doses of DOX when conjugated to PPP-NH2 -g-PEG in combination with radiotherapy.


A novel series of symmetric compartmental 16-membered tetraaza macrocyclic complexes were synthesized using template method with the help of ligands 1,8-diaminonaphthalene, 2,4-dioxopentane and metal ions in 2:2:1 ratio. The synthesized complexes afforded hexacoordinated geometry of the general formula [M(TML)X2] where TML= Tetraazamacrocyclic ligand; M = Co(II), Ni(II) and Cu(II); X = Cl–, CH3COO– or NO3 -or M= Zn (II)and Cd(II); X = CH3COO–. The resulting complexes have been characterized with the help of elemental analyses, conductance measurements, magnetic measurements, TGA, electronic, infrared, far infrared, NMR, ESR and Mass spectral studies. The optimized energy calculations were also carried out. Powder X-ray diffraction points towards the presence of triclinic crystal system. The metal complexes have also been identified for antioxidant activities as well as screened for in vitro antimicrobial activities.


From the planner's point of view, a taxonomy of the urban daily activity spaces (DAS) is considered as an introductory step toward explaining the differential growth within an urban system. The cluster-analysis method of Rubin and Friedman (1967) is applied to the Belgian DAS, and yields three types. A first cluster identifies the large agglomerations including the older regional centres. The second and third clusters clearly show various aspects of regional structure. They demonstrate the taxonomic power of the method as well as providing a possible basis for planning policy.


Books on sports injuries are common, but "The Anatomy of Sports Injuries" takes a more fundamental approach than the others, taking the reader inside the body to show exactly what is happening when a sports injury occurs. At the heart of the book are 300 full-color illustrations that illustrate the sports injury, together with 200 line drawings of stretching, strengthening, and rehabilitation exercises that the reader should use to speed up their recovery process. Author Brad Walker brings years of expertise - he works with elite-level and world-champion athletes, and lectures on injury prevention - to this how-to guide.


We present a U-Pb detrital zircon age and provenance study of a sequence of metasedimentary rocks in the northwestern Thor–Odin high-grade gneiss dome within the Omineca crystalline belt of the Canadian Cordillera. Despite strong overprint by deformation and metamorphism, we successfully analyzed the age and provenance of six samples collected at various structural levels, using U-Pb detrital zircon laser-ablation–inductively coupled plasma–mass spectrometry (LA-ICP-MS) analysis. The Thor–Odin dome consists of Paleoproterozoic basement and a metasedimentary cover sequence of previously unknown age and tectonic significance. Our results indicate that the oldest units of this sequence may be Paleoproterozoic, and some of the oldest known metasedimentary rocks in the Canadian Cordillera, originally deposited on top of Laurentian basement rocks. The youngest rocks are Devonian and deposited shortly before the onset of widespread Late Devonian to early Mississippian igneous activity in the Selkirk Domain or Kootenay arc. The cover sequence of the Thor–Odin dome thus preserves some of both the oldest and the youngest (meta)sedimentary rocks deposited between the formation of supercontinent Columbia and the onset of igneous activity and convergence that marked the beginning of Cordilleran deformation and metamorphism. Parts of as many as ∼1.4 b.y. of sedimentary history are preserved in the Thor–Odin dome, implying that much information on the sedimentary history of the Canadian Cordillera may be hidden in other Cordilleran gneiss domes.


Auditory displays have been used in both human-machine and computer interfaces. However, the use of non-speech audio in assistive communication for people with language disabilities, or in other applications that employ visual representations, is still under-investigated. In this paper, we introduce SoundNet, a linguistic database that associates natural environmental sounds with words and concepts. A sound labeling study was carried out to verify SoundNet associations and to investigate how well the sounds evoke concepts. A second study was conducted using the verified SoundNet data to explore the power of environmental sounds to convey concepts in sentence contexts, compared with conventional icons and animations. Our results show that sounds can effectively illustrate (especially concrete) concepts and can be applied to assistive interfaces.


PURPOSE The current model of primary care in the United States limits physicians' ability to offer high-quality care. The patient-centered medical home (PCMH) shows promise in addressing provision of high-quality care, but achieving a PCMH practice model often requires comprehensive organizational change. Guided by Solberg's conceptual framework for practice improvement, which argues for shared prioritization of improvement and change, we describe strategies for obtaining organizational buy-in to and whole-staff engagement of PCMH transformation and practice improvement. METHODS Semistructured interviews with 136 individuals and 7 focus groups involving 48 individuals were conducted in 20 small- to mid-sized medical practices in Pennsylvania during the first regional rollout of a statewide PCMH initiative. For this study, we analyzed interview transcripts, monthly narrative reports, and observer notes from site visits to identify discourse pertaining to organizational buy-in and strategies for securing buy-in from personnel. Using a consensual qualitative research approach, data were reduced, synthesized, and managed using qualitative data management and analysis software. RESULTS We identified 13 distinct strategies used to obtain practice buy-in, reflecting 3 overarching lessons that facilitate practice buy-in: (1) effective communication and internal PCMH campaigns, (2) effective resource utilization, and (3) creation of a team environment. CONCLUSION Our study provides a list of strategies useful for facilitating PCMH transformation in primary care. These strategies can be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers. Our study findings also extend Solberg's conceptual framework for practice improvement to include buy-in as a necessary condition across all elements of the change process.


Azaspiracids (AZAs) are microalgal toxins that can accumulate in shellfish and lead to human intoxications. To facilitate their study and subsequent biomonitoring, purification from microalgae rather than shellfish is preferable; however, challenges remain with respect to maximizing toxin yields. The impacts of temperature, growth media, and photoperiod on cell densities and toxin production in Azadinium spinosum were investigated. Final cell densities were similar at 10 and 18 °C, while toxin cell quotas were higher (~3.5-fold) at 10 °C. A comparison of culture media showed higher cell densities and AZA cell quotas (2.5–5-fold) in f10k compared to f/2 and L1 media. Photoperiod also showed differences, with lower cell densities in the 8:16 L:D treatment, while toxin cell quotas were similar for 12:12 and 8:16 L:D treatments but slightly lower for the 16:8 L:D treatment. AZA1, -2, and -33 were detected during the exponential phase, while some known and new AZAs were only detected once the stationary phase was reached. These compounds were additionally detected in field water samples during an AZA event.


The bioconversion of glycerol was carried out using Lactobacillus strain. Lactobacillus was grown on nutrient broth. The pre-culture was added to MRS (De Man, Rogosa and Sharpe) broth medium where glycerol was used as carbon source to acquire 1,3-propanediol (1,3-PDO). Bioconversion of glycerol was carried out at 200C, 250C, 300C, 350C and 400C, using Lactobacillus strain. The atmospheric pressure and temperature were maintained for 1, 2, 3 and 4days. Optimum result was obtained at 350C and 3rd day where 0.59mole of 1,3-PDO produced per mole of glycerol. Resulted 1,3-PDO was characterized by Gas chromatography (GC), Fourier Transform Infrared Spectroscopy (FTIR) and Proton Nuclear Magnetic Resonance (1H NMR) techniques.


The development of a new technique aside from insecticide spraying was necessary to control the insect pest population of agricultural crops. Insecticides are the cornerstones upon which pest management practices are based in the current civilization of farmers and are likely to remain so as long as effective and inexpensive chemicals are available. However, many insectpest management techniques using Non-lethal mechanisms for insect pest control have been successful. Therefore the study on the feasibility of disrupting communication using synthetic sex pheromone is the need of the hour. These techniques include the use of pheromones to disrupt mating. Hence the present study is focused to identify the pheromonalcuticular compounds using GC-MS, SDS-PAGE and MALDI-TOF matrix analysis. In the GC-MS analysis we found 39 compounds and the compounds such as octadecane, heptadecane, undecane, dodecane and heptacosane were reported as pheromone carrier protein in earlier studies.