A simple and inexpensive cubic zirconia anvil cell has been developed for the performance of in situ Raman spectroscopy up to the conditions of 500 °C and 30 kbar pressure. The design and construction of this cell are fully described, as well as its applications for Raman spectroscopy. Molybdenum heater wires wrapped around ceramic tubes encircling two cubic zirconia anvils are used to heat samples, and the temperatures are measured and controlled by a Pt–PtRh thermocouple adhered near the sample chamber and an intelligent digital control apparatus. With this cell, Raman spectroscopic measurements have been satisfactorily performed on water at 6000 bar pressure to 455 °C and on ice of room temperature to 24 kbar, in which the determinations of pressures make use of changes of the A1 Raman modes of quartz and the shift of the sharp-line (R-line) luminescence of ruby, respectively.


HYPOTHESES
(1) Antibiotic restriction policies result in alteration of microbiologic features of surgical site infections (SSIs) and (2) reported SSI rates are underestimated when postdischarge surveillance is not included in SSI surveillance efforts.

DESIGN
Retrospective analysis of prospectively collected SSI surveillance data.

PATIENTS AND METHODS
We compared initial microbial isolates from SSIs between (1) January 1, 1993, and December 31, 1995, and (2) January; 1, 1996, and December 31, 1998. Antibiotic restriction policies were implemented at Fairview-University Medical Center, Minneapolis, Minn, on March 1, 1995. For the combined periods (January 1, 1993, to December 31, 1998), we determined SSI rates for 20007 operations according to the extent of bacterial contamination at surgery (wound class). Then, we analyzed SSI rates for 10559 of these operations (selected based on availability of Anesthesia Society of America score and type of procedure) using the surgical wound risk index (wound class, Anesthesia Society of America score, and length of operation). We categorized SSI rates by 17 procedures for comparison with SSI rates reported by 286 hospitals that contributed data confidentially and voluntarily to the National Nosocomial Infections Surveillance System in 1998. We compared SSI rates with and without postdischarge surveillance.

RESULTS
Coagulase-negative staphylococcus and group D enterococcus were the 2 most frequent isolates before and after antibiotic restriction policies were implemented. Candida albicans isolates decreased from 7.9% (1993-1995) to 6.5% (1996-1998; P=.46). Methicillin-resistant Staphylococcus aureus (1.8% of isolates) and vancomycin-resistant enterococcus (2.4% of isolates) organisms were first identified between 1996 and 1998. Our SSI rates were 2.6% for class I wounds, 3.6% for class II wounds, and 10.5% for class III/IV wounds; 53.9% of SSIs were identified after hospital discharge.

CONCLUSIONS
Antibiotic restriction policies did not alter the microbial spectrum of SSIs during the observation period. Reporting SSI rates in the absence of postdischarge surveillance dramatically underestimates actual SSI rates, especially in tertiary care hospitals that provide care for large populations of elderly and immunosuppressed patients.


In the half century since the World War II, France has developed from a conservative, semi-rural society in which the great majority of the population had only a primary education to a highly developed modern one with a remarkably well-educated and well-trained citizenry and labour force. Technical and vocational education, which before 1960 were confined to an enclave within the French education system, now permeate the entire system. Business and industry, long isolated from education, now play a major role in educational decision making. The French educational system today meets the demand for skilled personnel in almost all fields while maintaining "a complement of general culture." The first book in English to treat the important subject of technical education in France, Schools and Work places technical education within the larger field of French public education, including the administrative and political backdrop, European industrial development, the nature of work, and global competitiveness.


Objectives: To review the efficacy of early second trimester ultrasonography for detecting fetal structural abnormalities in a low risk population. Methods: Retrospective study of the ultrasonographic findings and outcome of all pregnancies in women scanned in 2010–2011. 3242 fetuses were scanned in the first trimester with Voluson Expert abdominal and transvaginal. 489 scans performed around 16 weeks, were selectioned because fetal abnormalities or unsatisfactory views, or extrafetal anomalies (uterus, placenta, cord or amniotic fluid abnormalities). Main outcome: correlation of prenatal ultrasonografic findings with outcome in the neonate Results: 3215 babies were born during 2010–2011, 489 (15%) were scanned in early second trimester, 158 because fetal reasons and 331 because of extrafetal causes. In the group of fetal reasons, 27 fetuses (17,7.5%) were found to have serious abnormalities at birth or after termination of pregnancy. There were 2 spontaneous miscarriage and 16 therapeutic abortion before 18 weeks. In the group of extrafetal causes, 36 umbilical single artery were found, and others findings, irrelevant to the outcome in the neonate. Two false positive diagnoses occurred, in both cases the pregnancies were not terminated and the babies were born. This gives a specificity of 99.1% (78.2% to 99.7%). The positive predictive value of early second trimester ultrasonography was 98.1% (91.3% to 99.7%). Conclusions: Fetal examination by ultrasonography in early second trimester, in low risk population, detects many fetal abnormalities but can present 5% work overload.


The aim of the study was to explore the relationship among brain functional activations elicited by an emotional paradigm, clinical scores (PTSD, anxiety, and depression), psychopathic traits, and genetic characteristics (5-HTTLPR) in a group of severely maltreated children compared to a healthy control group before and after the implementation of a Trauma Focused-Cognitive Behavioral Therapy. The final sample consisted of an experimental group of 14 maltreated children (mean age = 8.77 years old, S.D. = 1.83) recruited from a non-governmental shelter in Mexico City for children who had experienced child abuse and a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender and were assessed before and after the implementation of the aforementioned therapy by means of clinical scales and an emotional paradigm that elicited brain activations which were recorded through functional magnetic resonance imaging. Genotyping of the 5-HTTLPR polymorphism was made at first assessment. A region of interest analysis showed amygdala hyperactivation during exposure to fear and anger stimuli in the maltreated children before treatment. Following therapy, a decrease in brain activity as well as a decrease in clinical symptoms were also observed. 5-HTTLPR polymorphism did not show any effect on the severity of clinical symptoms in maltreated children. Trauma-Focused Behavioral Therapy may help reorganize the brain's processing of emotional stimuli. These observations reveal the importance of an early intervention when the mechanisms of neuroplasticity may be still recruited.


On the basis of a Pavlovian conditioning analysis of morphine tolerance, cues signaling the systemic effects of morphine come to elicit conditional pharmacological responses that attenuate the effect of the drug. Experiments were conducted to evaluate the relevance of this analysis to recent reports that morphine-experienced rats, anesthetized with pentobarbital prior to a final test injection of morphine, do not display the analgesic tolerance seen in nonanesthetized rats. It was hypothesized that such pentobarbital blockage of morphine tolerance represents an instance of state-dependent learning: the barbiturate alters predrug cues so that the final, barbiturate-signaled morphine administration is presented in the context of different signals than those accompanying pretest administrations of the opiate. Results of the present experiments confirmed the finding that pentobarbital interferes with the expression of morphine tolerance in rats that had not previously received barbiturate-opiate pairings. In addition, the results supported the state-dependency interpretation of this interference: Rats that had pretest administrations of morphine signaled by pentobarbital, as well as the test administration, displayed substantial morphine tolerance. Moreover, if pretest morphine administrations were signaled by pentobarbital, omission of the barbiturate cue on the test session attenuated tolerance.


The regulation of the synthesis of the enzymes involved in the utilization of L-arginine, L-ornithine, agmatine, and putrescine as a sole nitrogen source in Escherichia coli K-12 was examined. The synthesis of agmatine ureohydrolase, putrescine aminotransferase, and pyrroline dehydrogenase is dually controlled by catabolite repression and nitrogen availability. Catabolite repression of agmatine ureohydrolase, but not that of putrescine aminotransferase or pyrroline dehydrogenase, is relieved by the addition of cAMP. Agmatine ureohydrolase synthesis in addition is subject to induction by L-arginine and agmatine. Arginine decarboxylase and ornithine decarboxylase synthesis is not sensitive to catabolite repression or to stimulation by nitrogen limitation or subject to substrate induction.


This report aims to establish a design methodology for meeting basic fire safety objectives within single storey industrial buildings using a 'common-sense' approach. A wide range of fire safety issues are addressed, ranging from environmental protection to life safety and structural performance. The emphasis is on meeting the performance requirements of the New Zealand Building Code for fire safety and hazard management. Given that industrial buildings are likely to fall into a high fire hazard category, alternative fire engineering design methods are deemed necessary for Building Code compliance. Attention is also given to issues that are not part of Building Code requirements or acceptable solutions. A fire safety strategy is recommended for an industrial site, with the focus on establishing a level of 'acceptable loss'. A risk assessment provides the means to meet loss control objectives. This should form the basis for a new buildings' fire protection design, plus the on-going fire safety management programme. Automatic alarms are considered essential for life safety and property protection, with sprinklers being the only method of controlling a fire within a typical industrial complex. The Fire Service cannot be expected to attack and suppress a fire from receiving an alarm call without sprinlder support. The Fire Service can, however, be expected to control the spread of fire to neighbouring property given certain conditional events work in their favour. The act of prewetting neighbouring combustible surfaces and thereby increasing the critical radiation intensity for pilot ignition, is considered very effective in preventing fire spread. Increasing fire rating requirements fo_r boundary walls based on withstanding equivalent fire severities for the 'design' fire, is considered overly conservative. A maximum rating of 4 hours is recommended for any boundary wall. This recommendation is based on maximum values used in overseas Codes and assumes that boundary walls are connected to primary support structures and adjoining wall panels, so that if they fail they collapse inwards as one complete unit. The report provides a comprehensive list of conclusions that expand on the above overview, plus recommends areas for future research. j j j j j j j j j j j j j j j j j j j j j j j j j ·' j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j


This guide is a snapshot of some of the work done in the ASD libraries for the 2014-15 school year. It is organized by the school's five strategies.


BACKGROUND
Hyperparathyroidism is both underdiagnosed and undertreated, but the reasons for these deficiencies have not been described. The purpose of this study was to identify reasons for underdiagnosis and undertreatment of hyperparathyroidism that could be addressed by targeted interventions.

MATERIALS AND METHODS
We identified 3,200 patients with hypercalcemia (serum calcium >10.5 mg/dL) who had parathyroid hormone (PTH) levels evaluated at our institution from 2011 to 2016. We randomly sampled 60 patients and divided them into three groups based on their PTH levels. Two independent reviewers examined clinical notes and diagnostic data to identify reasons for delayed diagnosis or referral for treatment.

RESULTS
The mean age of the patients was 61 ± 16.5 years, 68% were women, and 55% were white. Fifty percent of patients had ≥1 elevated calcium that was missed by their primary care provider. Hypercalcemia was frequently attributed to causes other than hyperparathyroidism, including diuretics (12%), calcium supplements (12%), dehydration (5%), and renal dysfunction (3%). Even when calcium and PTH were both elevated, the diagnosis was missed or delayed in 40% of patients. For 7% of patients, a nonsurgeon stated that surgery offered no benefit; 22% of patients were offered medical treatment or observation, and 8% opted not to see a surgeon. Only 20% of patients were referred for surgical evaluation, and they waited a median of 16 months before seeing a surgeon.

CONCLUSION
To address common causes for delayed diagnosis and treatment of hyperparathyroidism, we must improve systems for recognizing hypercalcemia and better educate patients and providers about the consequences of untreated disease.

IMPLICATIONS FOR PRACTICE
This study identified reasons why patients experience delays in workup, diagnosis, and treatment of primary hyperparathyroidism. These data provide valuable information for developing interventions that increase rates of diagnosis and referral.


From a modest beginning in 1935 to an income replacement scheme for workers in commerce and industry, the social security system has grown to cover 90 percent of working Americans. It now pays $78 billion a year in benefits and is obligated to pay $4 trillion in future retirement benefits to workers now covered. With a projected tax rate of 30 percent of gross wages by the year 2050 to meet its obligations under current law, the system, in the author's words, is at ""the most crucial juncture of its forty-year life.""This comprehensive review and analysis, the thirteenth in the Brookings series of Studies in Social Economics, discusses social security in relation to other sources of retirement income and clarifies its financing problem, benefit structure, and ambivalent goals. It deals with two main financing questions. First, will the payroll tax yield the revenue needed to pay benefits as the retired population rises as a fraction of the working population? Second, is the regressive social security tax really the best source of revenue for a system with welfare components such as the minimum benefit and dependents' benefits? Though such benefits are viewed as progressive, they are not paid according to need. They meet neither the income redistribution requirements nor the individual equity goals of the social security program. The author provides a comprehensive account of the benefit structure and clarifies its relation not only to the basic goals of social security but also to the country's three-tiered system of income security. She offers recommendations for eliminating ""an irrational and correctable feature of the benefit formula,"" for lowering the dependency ratio, and, most important, for a definition of goals.


The calcium binding protein calbindin‐D 28K (CaBP) has been localized in the cat superior colliculus (SC). Four important features of SC organization have been revealed by using CaBP immunocytochemistry. 1) CaBP neurons formed three laminar tiers in SC, one within the upper one half of the superficial gray layer (SGL), the second bridging the deep optic (OL) and intermediate gray layers (IGL), and the third within the deep gray layer (DGL). 2) CaBP labeled several classes of interneuron in SC. In the upper CaBP tier, the labeled neurons were all small, but they varied in morphology and included horizontal, pyriform, and stellate neurons. A unique class of interneuron was labeled by anti‐CaBP in the OL‐IGL tier. This cell was stellate‐like with highly varicose dendrites and broad dendritic trees. Other labeled neurons in the intermediate and deep tiers included nonvaricose stellate neurons and rare large neurons in the DGL. 3) A few anti‐CaBP neurons were projection neurons. Virtually no CaBP neurons were retrogradely labeled after injections of HRP into the predorsal bundle and dorsolateral midbrain tegmentum or into the lateral posterior nucleus. However, 2.4% of anti‐CaBP neurons were retrogradely labeled after HRP injections into the dorsal and ventral lateral geniculate nuclei. These represented 14.7% of all neurons projecting to the LGN complex. 4) A small percentage of CaBP neurons co‐localized GABA. A two‐chromagen double‐labeling technique showed that about 4.0% of labeled neurons were labeled by both antibodies. In summary, antibodies to CaBP densely labeled subpopulations of neurons in the cat SC, most of which were interneurons, some of which projected to the LGN, and a few of which co‐localized GABA.


In collaboration with an online seller of home-improvement products, the authors conduct a large-scale randomized field experiment to study the effects of retargeted advertising, a form of internet advertising in which banner ads are displayed to users after they visit the advertiser's website. They find that switching on experimental retargeting causes 14.6% more users to return to the website within four weeks. The impact of retargeting decreases as the time since the consumer first visited the website increases—indeed, 33% of the effect of the first week's advertising occurs on the first day. Furthermore, the authors find evidence of the existence of complementarities in advertising over time: the effect of advertising in week 2 of the campaign is higher when the user was assigned to a nonzero level of advertising in week 1. The authors discuss mechanisms that can explain their findings and demonstrate a novel low-cost method that can be applied generally to conduct valid online advertising experiments.


The unique relations between the Israeli-armed forces and the local hi-tech industry have been identified as a strong explanatory variable for the Israeli hi-tech boom. This article highlights the role of the military as a socialization institution in those relations. We identify how the accumulation of "military capital" during military in service contributes to soldiers as veterans and employees in the hi-tech sector. Military service brings with it professional training, social ties, and social codes that influence the composition of the hi-tech workforce and hi-tech industry's organizational and functional culture. Examination of Israeli hi-tech workers' profiles reveals not only a very high proportion of military capital amongst the employees but also an institutional preference for those who possess it.


As schumpeterian creative destruction is increasingly popular, this leads to focus on high-growth firms. These firms have been called gazelles by Birch. Among the SME employing 20 to 250 workers in 1993 and still alive in 2003, the top 5% of the distribution of growth - henceforth called gazelles - multiply their employment by 5 in 10 years. They create as many jobs as the 50% creating jobs at a more moderate rate (the other 45% loss jobs). Gazelles growth is uneven: half of their ten-year growth is concentrated on only one year. Gazelles defined on the basis of their growth between 1993 and 1998 do not create any more jobs on the following period, between 1998 and 2003. External growth, including mergers and acquisitions, accounts for a big part of gazelles growth: according to their size, gazelles belong more often to a group. Between1998 and 2001, period of strong growth, external growth accounts for one half of the growth of the gazelles. Every industry, even those in relative decline, has some gazelles. Gazelles in low growth industry grow mainly by external growth, which seems to correspond to a concentration process, possibly defensive.


This study investigated the anti-inflammatory activity of barley leaf extract in lipopolysaccharide (LPS)-stimulated RAW264.7 cells and hairless mice. Pre-treatment with barley leaf extract significantly inhibited the protein expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-II (COX-II) in a dose-dependent manner in LPS-stimulated RAW264.7 cells. Barley leaf extract also significantly inhibited the secretion of inflammatory cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6). Moreover, phosphorylation of mitogen-activated protein kinases (MAPKs) and nuclear translocation of nuclear factor-kappa B (NF-κB) were strongly suppressed by barley leaf extract in LPS-stimulated cells. In hairless mice, barley extract significantly decreased the pathological phenotypes of contact dermatitis, such as erythema, edema, and scabs. These results indicate that barley leaf extract has an anti-inflammatory effect and therefore a possible role in the treatment of inflammatory diseases or in functional cosmetics.


Antimicrobial susceptibility, integron carriage, genetic relationship and presence of some important virulence genes of the integron-carrier strains of Shigella sonnei (n = 230) and Shigella flexneri (n = 22) isolated from stool samples of patients in Hungary between 1998 and 2008 were investigated. Sixty-seven per cent (168/252) of the strains were resistant to sulfamethoxazole/trimethoprim (SxT) followed by streptomycin (S, 47%), ampicillin (A, 32%) and tetracycline (Tc, 28%). Thirty-six per cent (90/252) exhibited multidrug resistance, mostly showing SSxTTc or ASSxTc, ASSxTTc resistance patterns. An S. sonnei strain of imported origin was resistant to cefotaxime and harboured a blaCTX-M-55-type extended-spectrum β-lactamase gene. Altogether 33% of the S. sonnei (n = 75) and 14% of the S. flexneri (n = 3) strains had either class 1 or class 2 integrons or both. The variable regions encoded aadA1 or dfrA1-aadA1 genes for the class 1 and dfrA1-sat2-aadA1 or dfrA1-sat2 genes for the class 2 integrons. Pulsed-field gel electrophoresis analysis revealed that those strains that have different integron types represented different genetic clusters. The Shiga toxin (stx1) gene was identified in one S. sonnei strain and the cdtB gene was detected in an S. flexneri strain. The results reveal the high incidence of antibiotic resistance among Shigella isolates and the presence of the stx1 gene in S. sonnei and the cdtB gene in S. flexneri. The genetic diversity of Shigella spp. isolated recently in Hungary was also demonstrated.


TEL2 is a member of the ETS family of transcription factors, which is highly similar to TEL1/ETV6. It binds to DNA via the ETS domain and interacts with itself or TEL1 via the pointed domain. The expression of TEL2 in normal and leukemic hematopoietic cells suggests a role in hematopoietic development. In this article, we describe the role of TEL2 in hematopoietic differentiation and cellular transformation. Quantitative reverse transcription-PCR showed that the expression of TEL2 mRNA was down-regulated during monocytic differentiation of U937 and HL60 induced by 1,25-(OH)2 vitamin D3 and 12-O-tetradecanoylphorbol 13-acetate, respectively. Overexpression of TEL2 in U937 cells inhibited differentiation induced by vitamin D3. In contrast, overexpression of a TEL2 mutant lacking either the pointed domain or a functional ETS domain induced both differentiation of U937 cells and inhibited their growth in vitro and in vivo. In addition, these mutants blocked TEL2-mediated transcriptional repression of a synthetic promoter containing TEL2 binding sites. These data suggest that dominant-negative inhibition of TEL2 might cause differentiation. Quantitative reverse transcription-PCR demonstrated that TEL2 is expressed at higher level in some primary human leukemia samples than in normal bone marrow. Furthermore, overexpression of TEL2 in NIH3T3-UCLA cells blocked the inhibitory effect of TEL1 on Ras-induced cellular transformation. These results suggest that TEL2 may play an important role in hematopoiesis and oncogenesis.


Background. The aim of this study was to investigate neutrophil activation and its role in long pentraxin‐3 (PTX3) release and oxidative stress generation during haemodialysis (HD) and to correlate neutrophil PTX3 and oxidant expression with endothelial dysfunction. Methods. Forty‐seven uraemic patients on stable HD, 12 healthy subjects and 15 patients with congestive heart failure (New York Heart Association classes III and IV) were enrolled. Neutrophil PTX3 protein expression was evaluated by confocal microscopy. l‐selectin expression, intracellular PTX3 localization and reactive oxygen species (ROS) generation in human neutrophils were measured by flow cytometry. NADPH‐dependent superoxide generation was investigated by chemiluminescence. PTX3 plasma concentrations were measured by ELISA. Endothelial dysfunction was studied by flow‐mediated dilation (FMD). Results. The low baseline levels of FMD significantly improved after HD, but worsened by 24 h. A significant up‐regulation of PTX3 protein expression, localized within secondary granules, was detected in neutrophils isolated at 30 and 240 min of HD, along with an increase in l‐selectin expression. The up‐regulation in intracellular PTX3 in neutrophils was associated with a significant increase in PTX3 plasma concentrations at 240 min. HD increased ROS production and NADPH oxidase activity in neutrophils. In a univariate analysis, pre‐treatment with FMD was inversely correlated with PTX3 expression and ROS generation in neutrophils. In a multivariate analysis, both circulating pre‐HD PTX3 and intracellular ROS generation by neutrophils were independent predictors of abnormal FMD. Conclusions. Neutrophil overexpression of PTX3 is associated with ROS overproduction and endothelial dysfunction and may represent an emerging marker of vascular damage progression in HD patients.


This study was conducted as part of the Human Exposure Assessment Location (HEAL) Project which comes under the United Nations Environment Programme/World Health Organisation (UNEP/WHO) Global environmental Monitoring System (GEMS). The objective of the study was to evaluate workers' exposure to lead in industries with the highest exposure. All subjects were interviewed about their occupational and smoking histories, the use of personal protective equipment and personal hygiene. The contribution of a dietary source of lead intake from specified foods known to contain lead locally and personal air sampling for lead were assessed. A total of 61 workers from two PVC compounding and 50 workers from two lead acid battery manufacturing plants were studied together with 111 matched controls. In the PVC compounding plants the mean lead-in-air level was 0.0357 mg/m3, with the highest levels occurring during the pouring and mixing operations. This was lower than the mean lead-in-air level of 0.0886 mg/m3 in the lead battery manufacturing plants where the highest exposure was in the loading of lead ingots into milling machines. Workers in lead battery manufacturing had significantly higher mean blood lead than the PVC workers (means, 32.51 and 23.91 mcg/100 ml respectively), but there was poor correlation with lead-in-air levels. Among the lead workers, the Malays had significantly higher blood lead levels than the Chinese (mean blood levels were 33.03 and 25.35 mcg/100 ml respectively) although there was no significant difference between the two ethnic groups in the control group. There were no significant differences between the exposed and control group in terms of dietary intake of specified local foods known to contain lead. However, Malays consumed significantly more fish than the Chinese did. There were no ethnic differences in the hours of overtime work, number of years of exposure, usage of gloves and respirators and smoking habits. Among the Malays, 94.3% eat with their hands compared with 9.2% of the Chinese. Workers who ate with bare hands at least once a week had higher blood lead levels after adjusting for lead-in-air levels (mean blood lead was 30.2 and 26.4 mcg/100 ml respectively). The study indicated that the higher blood lead levels observed in the Malay workers might have been due to their higher exposure and eating with bare hands.


Because of its excellent process advantages such as high energy efficiency, short irradiation time and rapid heating, high energy electron beam (HEEB) irradiation is becoming of interest as a future surface modification technology. In this study, surface alloying of TiC, TiB2 and VC ceramic particles with a low carbon steel substrate was carried out using HEEB of 1.4 MeV. Surface alloyed layers of all the specimens were about 2 mm thick and consisted of a melted region, an interface region, a heat affected zone (HAZ) and the matrix. In all the specimens, the hardness at the surface was the highest, and then decreased sharply into the interior reaching the lowest values at the matrix. A remarkable increase in the mechanical properties was observed for the VC surface alloyed specimen. Vanadium carbides of large (~ 5 µm) and fine sizes (~ 20 nm) were formed uniformly, which resulted in an increase of hardness to 2-3 times of that of the matrix, and highest wear resistance.


Damage control surgery (DCS) is a concept of abbreviated laparotomy, designed to prioritize short-term physiological recovery over anatomical reconstruction in the seriously injured and compromised patient. Over the last 10 yr, a new addition to the damage control paradigm has emerged, referred to as damage control resuscitation (DCR). This focuses on initial hypotensive resuscitation and early use of blood products to prevent the lethal triad of acidosis, coagulopathy, and hypothermia. This review aims to present the evidence behind DCR and its current application, and also to present a strategy of overall damage control to include DCR and DCS in conjunction. The use of DCR and DCS have been associated with improved outcomes for the severely injured and wider adoption of these principles where appropriate may allow this trend of improved survival to continue. In particular, DCR may allow borderline patients, who would previously have required DCS, to undergo early definitive surgery as their physiological derangement is corrected earlier.


While feedback is essential for learning in the health professions, clinical teachers rarely get feedback on their teaching, and the existing feedback is often non-specific and distant from teaching encounters. To enhance clinical teaching, we created a peer assessment program for clinical faculty. This program has been well-received and sustained for five years despite the challenges of faculty turnover and the pandemic. In this article, we identify twelve tips for creating and sustaining a peer assessment program for clinical faculty based on this experience. These tips focus on how to create a culture that supports peer assessment, on how best to implement a peer assessment program in practical terms, and on how to sustain a peer assessment program long-term. We hope these tips help educators receive better feedback about their clinical teaching and improve the future care delivered by our learners.


The new type of ring-imaging Cherenkov detector technology called DIRC (an ac- ronym for Detection of Internally Reflected Cherenkov Light) has been used successfully for hadronic particle identification in the BABAR experiment at the B Factory (PEP-II) located at the SLAC National Accelerator Laboratory. This paper describes the R&D for and the construction of the DIRC radiator bars and the performance of the DIRC during more than eight years of B Factory operation.


A Multi-hop Control Network consists of a plant where the communication between sensors, actuators and computational units is supported by a (wireless) multi-hop communication network, and data flow is performed using scheduling and routing of sensing and actuation data. With the aim of rendering the system robust with respect to packet losses, we exploit network coding and redundancy in data communication (i.e. sending multiple copies of sensing and actuation data via multiple routing paths associated to possibly different delays) and assume that such data is re-combined as a weighed linear combination. The main contribution of this paper is to provide efficient computational methods to find the optimal choice of such weights either to maximize or to constrain a robustness metric based on the notion of Asymptotic Mean Square Stability. Since we observe that such metric induces an objective or constraint function that is highly non-linear, we propose an approximation that takes into account both the network parameters and the system dynamics: it is based on the assumption that packet loss probabilities are much smaller than correct transmission probabilities and leverages the well known Gerschgorin disks. We then compare our approximation with the optimal choice from the communication designer point of view, which neglects the system dynamics and is based on the idea of minimizing the quadratic error induced by the network on the actuation signal. The comparison of the above approximations quantitatively shows that the optimal choices from the points of view of control and communication theory are often at odds.


Mammalian nuclear function depends on the complex interaction of genetic and epi-genetic elements coordinated in space and time. Structure and function overlap to sucha degree that they are usually considered as being inextricably linked. In this work Icombine a experimental approach with a computational one in order to answer two mainquestions in the field of mammalian chromosome organization.In the first section of this thesis, I attempted to answer the question to what extent doeschromatin from different chromosome territories share the same space inside the nucleus?This is a relatively open question in the field of chromosome territories. It is well-knownand accepted that interphase chromosomes are spatially constrained inside the nucleus andthat they occupy their own territory, however, the degree of spatial interaction betweenneighbouring chromosomes is still under debate. Using labelling methods that directlyincorporate halogenated DNA precursors into newly replicated DNA without the needfor immuno-detection or in situ hybridization, we show that neighbouring chromosometerritories colocalise at very low levels. We also found that the native structure of DNAfoci is partially responsible for constraining the interaction of chromosome territoriesas disruption of the innate architecture of DNA foci by treatment with TSA resulted inincreased colocalisation signal between adjacent chromosomes territories.The second major question I attempted to answer concerned the correlation betweennuclear function and the banding pattern observed in human mitotic chromosomes. Hu-man mitotic chromosomes display characteristic patterns of light and dark bands whenvisualized under the light microscope using specific chemical dyes such as Giemsa. De-spite the long standing use of the Giemsa banding pattern in human genetics for identi-fying chromosome abnormalities and mapping genes, little is known about the molecularmechanisms that generate the Giemsa banding pattern or its biological relevance. Therecent availability of many genetic and epigenetic features mapped to the human genomepermit a high-resolution investigation of the molecular correlates of Giemsa banding.Here I investigate the relationship of more than 50 genomic and epigenomic features withlight (R) and dark (G) bands. My results confirm many classical results, such as the lowgene density of the most darkly staining G bands and their late replication time, usinggenome-wide data. Surprisingly, I found that for virtually all features investigated, Rbands show intermediate properties between the lightest and darkest G bands, suggest-ing that many R bands contain G-like sequences within them. To identify R bands thatshow properties of G bands, I employed an unsupervised learning approach to classify Rbands on their genomic and epigenomic properties and show that the smallest R bandsshow a tendency to have characteristics typical of G bands. I revisit the evidence sup-porting the boundaries of G and R bands in the current cytogenomic map and concludethat inaccurate placement of weakly supported band boundaries can explain the interme-diate pattern of R bands. Finally, I propose an approach based on aggregating data frommultiple genomic and epigenomic features to improve the positioning of band boundariesin the human cytogenomic map. My results suggest that contiguous domains showing ahigh degree of uniformity in the ratio of heterochromatin and euchromatin sub-domainsdefine the Giemsa banding pattern in human chromosomes.


The COVID-19 pandemic mandating isolation, quarantine, and social distancing has accelerated and expanded the use of telemedicine. This study examines the extent of the use of telemedicine and the relationship between eHealth literacy and satisfaction with using telemedicine during the pandemic. A total of 156 participants from a clinic in a peripheral community in southern Israel completed an online questionnaire. We found that 85% knew how to use the internet for health information, but only one third felt safe using it to make health decisions. Furthermore, 93% used the internet for technical needs, such as renewing prescriptions or making a doctor's appointment. Even lower use for telemedicine was found (38%) for consultation or treatment sessions. A positive association was found between eHealth literacy and satisfaction variables with using telemedicine (rp = 0.39, p < 0.001). Although respondents understood the benefits of telemedicine, they were not satisfied nor interested in online sessions after the epidemic's end, preferring a meeting involving personal interaction. Young people and academics benefit more from telemedicine, thereby creating usage gaps and potentially increasing existing inequality. We recommend developing intervention programs, especially among vulnerable populations, to strengthen eHealth literacy and remove barriers causing skepticism about the use of telemedicine during and after the pandemic.


The electrical modeling of a proton exchange membrane electrolyzer (PEMELZ) to determine the voltage-current (V-I), the power current (P-I) characteristics and the electrolytic cell efficiency has been extensively reported in the literature. However, the dynamic cell performance, the possibility of overpotential, and the ohmic losses demand special attention. This paper proposes an electrical equivalent modeling of the PEMELZ where the dynamic cell performance can be evaluated by taking into account the fluctuations in the external current profile. The overpotential and the ohmic losses variations as the operating conditions, such as temperature and pressure, vary are also taken into account. The performance of the proposed model is compared with those of the reported models. The proposed electrical equivalent model can play an important role in analyzing PEMELZ, where the PEMELZ is supplied by a renewable resource, such as solar PV or wind, to produce and store the green hydrogen, and integrated with other electrical energy storage systems in a power grid.


Objectives To test the hypothesis that, on average, male surgeons are taller and better looking than male physicians, and to compare both sets of doctors with film stars who play doctors on screen. Design Comparative study. Setting Typical university hospital in Spain, located in Barcelona and not in a sleepy backwater. Participants Random sample of 12 surgeons and 12 physicians plus 4 external controls (film stars who play doctors), matched by age (50s) and sex (all male). Interventions An independent committee (all female) evaluated the "good looking score" (range 1-7). Main outcome measures Height (cm) and points on the good looking score. Results Surgeons were significantly taller than physicians (mean height 179.4 v 172.6 cm; P=0.01). Controls had significantly higher good looking scores than surgeons (mean score 5.96 v 4.39; difference between means 1.57, 95% confidence interval 0.69 to 2.45; P=0.013) and physicians (5.96 v 3.65; 2.31, 1.58 to 3.04; P=0.003). Surgeons had significantly higher good looking scores than physicians (4.39 v 3.65; 0.74; 0.25 to 1.23; P=0.010). Conclusions Male surgeons are taller and better looking than physicians, but film stars who play doctors on screen are better looking than both these groups of doctors. Whether these phenotypic differences are genetic or environmental is unclear.


The article provides a critical account of the impact of the European Employment Strategy (EES) on national labour market policies and labour law systems. It gives an overview of the development of the EES from the 1990s until the introduction of the European Social Pillar (ESP) and analyses its impact in the Member States of the European Union. In particular, it highlights the origins of the EES in debates about European Economic and Monetary Union (EMU) and examines the importance and the specific nature of the new governance approach adopted by the EES and its significance for labour law reform in the Member States. The article argues that the latest stage in the development of European social policy, associated with the introduction of the ESP, has not led to a change in direction in European social and employment law and policy. Despite its rights-based approach, the ESP merely constitutes the latest stage in the development of the EES and continues in its attempt to prioritize labour market policy concerns in reforming labour law. However, the article also argues that the ESP has potential to be the platform for a proper Social Union.


We propose a photonic structure stacked sequentially by one-dimensional photonic crystals and cavities. The whole structure is composed of single-negative and double-negative materials. The optical Wannier–Stark ladder(WSL) can be obtained in a low frequency region by modulating the widths of the cavities in order. We simulate the dynamical behavior of the electromagnetic wave passing through the proposed photonic structure. Due to the dispersive characteristics of the metamaterials, a very narrow WSL can be obtained. The long-period electromagnetic Bloch oscillation is demonstrated theoretically to have a period on a microsecond time scale.


This book is designed to facilitate the introduction of international, transnational, and comparative law issues into an employment discrimination course. The book is very accessible for law students (and their professors). The chapters can be used in any combination and in any order. The book can be assigned or recommended as optional reading to supplement a domestic-only course to advance the students' understanding of their own system. For more information visit the companion site .


ABSTRACT Based on 20 semi-structured interviews, this qualitative study explores young Chinese women's understandings of female beauty. It reveals that participants' understandings of female beauty are not limited to outer beauty (waizaimei, 外在美), but rather foreground the importance of 'inner beauty' (neizaimei, 内在美). The data found that these concepts have a symbiotic relationship whereby each affects the other. According to the findings, the concepts of inner and outer beauty are not oppositional but are both important for participants to gain 'empowerment'. Yet participants placed a higher value on inner beauty which was seen as enabling them to resist the pressures of outer beauty standards. The article argues, however, that discourses of inner beauty are not value free and are influenced by a variety of dominant discourses such as state interest and the beauty industry. In this regard, inner beauty needs interrogation and cannot simply be perceived as a tool for women's empowerment. The discussion sheds light on the young Chinese women's understanding of beauty in relation to gender and feminism in a Chinese context. The article provides a culturally grounded approach to beauty in China and adds to feminist understandings about beauty.


The traditional approaches to training surgeons are becoming increasingly difficult to
apply to modern surgical procedures. The development of Minimally Invasive
Surgery (MIS) techniques demands new and complex psychomotor skills, and means
that the apprentice-based system described by "see one, do one, teach one" can no
longer be expected to fully prepare surgeons for operations on real patients, placing
patient safety at risk. The use of cadavers and animals in surgical training raises issues
of ethics, cost and anatomical similarity to live humans. Endoscopic sinus surgery
involves further risk to the patient due to the proximity of vital structures such as the
brain, eyes, optic nerve and internal carotid artery. In recent years, simulation has
been used to overcome these problems, exposing surgeons to complex procedures in a
safe environment, similarly to its use in aviation. However, the cases simulated in this
manner may not be customised by training staff to present desired pathology.
This thesis describes the design and development of a new tool for the creation of
customised cases for the training of sinus surgery. Users who are inexperienced and
non-skilled in the use of three-dimensional (3D) Computer Aided Design (CAD)
modelling software may use the tool to implement pathology to the virtual sinus
model, which was constructed from real CT data. Swelling is applied in five
directions (four horizontal, one vertical) to the cavity lining of the frontal and
sphenoid sinuses. Tumours are individually customised and positioned in the frontal,
sphenoid and ethmoid sinuses. The customised CAD model may then be latterly
manufactured using Three-Dimensional Printing (3DP) to produce the complex
anatomy of the sinuses in a full colour physical part for the realistic simulation of
surgical procedures. An investigation into the colouring of the physical model is also
described, involving the study of endoscopic videos to ascertain realistic shades.
The program was evaluated by a group of medical professionals from a range of
fields, and their feedback was taken into account in subsequent redevelopment of the
program, and to suggest further work.


Histopathological images of tumours contain abundant information about how tumours grow and how they interact with their micro-environment. Better understanding of tissue phenotypes in these images could reveal novel determinants of pathological processes underlying cancer, and in turn improve diagnosis and treatment options. Advances of Deep learning makes it ideal to achieve those goals, however, its application is limited by the cost of high quality labels from patients data. Unsupervised learning, in particular, deep generative models with representation learning properties provides an alternative path to further understand cancer tissue phenotypes, capturing tissue morphologies. In this paper, we develop a framework which allows Generative Adversarial Networks (GANs) to capture key tissue features and uses these characteristics to give structure to its latent space. To this end, we trained our model on two different datasets, an H&E colorectal cancer tissue from the National Center for Tumor diseases (NCT, Germany) and an H&E breast cancer tissue from the Netherlands Cancer Institute (NKI, Netherlands) and Vancouver General Hospital (VGH, Canada). Composed of 86 slide images and 576 tissue micro-arrays (TMAs) respectively. We show that our model generates high quality images, with a Frechet Inception Distance (FID) of 16.65 (breast cancer) and 32.05 (colorectal cancer). We further assess the quality of the images with cancer tissue characteristics (e.g. count of cancer, lymphocytes, or stromal cells), using quantitative information to calculate the FID and showing consistent performance of 9.86. Additionally, the latent space of our model shows an interpretable structure and allows semantic vector operations that translate into tissue feature transformations. Furthermore, ratings from two expert pathologists found no significant difference between our generated tissue images from real ones. The code, generated images, and pretrained model are available at https://github.com/AdalbertoCq/Pathology-GAN


Aggregate planning is one of the most important activities of operations management for a competitive supply chain. Aggregate planning balances supply and demand during the planning time horizon. Aggregate planning in a food industry with perishable goods characteristics is a common problem. Mostly, studies on aggregate planning are only concerned with single product and single-phase production processes. This paper proposes a two-stage aggregate planning model that can be applied in the food industry with perishable goods characteristics. The two stages of the production process consist of processing raw materials into intermediate products and processing intermediate products into final products by implementing postponement or intermediate product storage. Processing of raw materials into intermediate materials is expected to solve the problem of material deterioration rate. The aggregate planning model uses a mathematical model approach and is solved by using Goal Programming. Based on the results of model verification using hypothetical data, the aggregate planning model can be applied to the food industry which implements a two-stage production system.
[Keywords: aggregate planning, two-stage production system, perishable goods, modelling]


A great deal of bullying behavior takes place at school, however, existing literature has predominantly focused on individual characteristics of children associated with bullying with less attention on school-level factors. The current study, comprising 23,215 children (51% boys) recruited from Year 4 or Year 5 (M = 9.06 years, SD = .56 years) from 648 primary schools in England, aimed to examine the independent and combined influence of child- and school-level predictors on bullying behavior in primary school. Children provided information on bullying behavior and school climate. Demographic characteristics of children were obtained from the National Pupil Database, and demographic characteristics of schools were drawn from EduBase. Multilevel logistic regression models showed that individual child gender, ethnicity, deprivation and special educational needs status all predicted bullying behavior. Of the school-level predictors, only overall school deprivation and school climate were predictive of bullying behavior once child-level predictors were taken into account. There was a significant interaction between child- and school-level deprivation; high-deprivation schools were a risk factor for bullying only for children that came from nondeprived backgrounds, whereas deprived children reported engaging in bullying behavior irrespective of school-level deprivation. Given the independent and combined role of child- and school-level factors for bullying behavior, the current study has implications for targeted school interventions to tackle bullying behavior, both in terms of identifying high-risk children and identifying high-risk schools.


We report a new nanolaser technique for measuring characteristics of human mitochondria. Because mitochondria are so small, it has been difficult to study large populations using standard light microscope or flow cytometry techniques. We recently discovered a nanooptical transduction method for high-speed analysis of submicrometer organelles that is well suited to mitochondrial studies. This ultrasensitive detection technique uses nanosqueezing of light into photon modes imposed by the ultrasmall organelle dimensions in a semiconductor biocavity laser. In this paper, we use the method to study the lasing spectra of normal and diseased mitochondria. We find that the diseased mitochondria exhibit larger physical diameter and standard deviation. These morphological differences are also revealed in the lasing spectra. The diseased specimens have a larger spectral linewidth than normal, and have more variability in their statistical distributions.


This study is the eighth in a series of stated-preference studies designed to enhance the basis for international benefits transfer of value of statistical life (VSL) estimates. The series has fielded essentially similar stated-preference surveys in Canada, China, France, Italy, Japan, Mongolia, the United Kingdom, and the United States. This Chinese study estimates the willingness to pay for contemporaneous and future mortality risk reductions of residents of Shanghai, Jiujiang, and Nanning, China using a stated-preference payment-card survey. The pooled VSL for a contemporaneous reduction in annual mortality risk reduction of 5 in 10,000 is about 1.47 million 2009 yuan ($614,805 U.S. $2016), with income elasticities of 0.2 to 0.25. This VSL estimate is at the lower end of estimates from the eight countries, between those from Mongolia and Japan, and in the mid-range of estimates of willingness to pay (WTP) for mortality risk reductions as a percentage of household income. We find lower discount rates in the Mongolia, Japan, and China studies than in those fielded in North America or Europe. The study also explores the relative performance of dichotomous choice and stated-preference card elicitation methods in a middle income country setting and develops a computerized "payment card" that allows testing for anchoring. Implicit transfer elasticities across countries, calculated using the VSLs we estimate and each country's income, relative to those of the United States, yields estimates of 0.88–0.95 for the lower income countries. These compare with the default assumption of 1.0 or assumed elasticities of 1.2 for developing countries.


OBJECTIVE
Although left atrial (LA) expansion index is associated with cardiovascular prognosis, whether it affects recurrent strokes is still unknown.

METHODS
This study enrolled 176 patients hospitalized with first ischemic stroke. Their stroke subtypes were classified as cardioembolic stroke (CE), noncardioembolic stroke (NCE), embolic stroke of undetermined source (ESUS), or transient ischemic attack. The LA expansion index was calculated as (Volmax-Volmin) × 100%/Volmin, where Volmax was defined as maximal LA volume and Volmin as minimal LA volume. The study endpoint was recurrent ischemic stroke.

RESULTS
Over a five-year (mean 4.9 years) follow-up period, 21 (11.9%) participants reached the study endpoint, including 10 with CE, five with NCE, and six with ESUS. The LA expansion index was lower in the event groups compared with the non-event group. For predicting recurrent stroke, LA expansion index <62.5% (76% sensitivity and 68% specificity) was superior to LA volume and E/e'. Kaplan-Meier curves revealed that the five-year cumulative recurrent stroke rate in patients with LA expansion index <62.5% was 23.9%, which was significantly higher than the five-year cumulative recurrent stroke rate of 4.6% in patients with LA expansion index >62.5% (log rank p<0.001). The LA expansion index was a significant independent predictor of recurrent stroke (hazard ratio=0.873; 95% confidence interval: 0.790-0.973 per 10% increase in LA expansion index; p=0.009).

CONCLUSION
The LA expansion index is useful for predicting recurrent stroke.


. Abstract ! Due to the broad variation of clinical presentation in metastasised malignant melanoma, a careful staging and individual treatment of these patients is required. Especially, the occurrence of locoregional or/and distant metastasis presents an important problem. Not only treatment with a curative intent but also sophisticated surgical procedures with a palliative intent are necessary in patients with tumour complications. These procedures do not improve the oncological prognosis. However, they may rescue patients from life-threatening situations. Therefore, palliative surgery of metastases plays an important role and requires assessment by an experienced oncological team.


Introduction In France, three complementary surveillance networks involving hospitals and paediatrician practices currently allow pertussis surveillance among infants (<1 year old) and children (1–12 years old). Data on incidences among adolescents (13–17 years old) and adults (≥ 18 years) are scarce. In 2017, a sentinel surveillance system called Sentinelles network, was implemented among general practitioners (GPs). Aim The purpose of Sentinelles network is to assess pertussis incidence, monitor the cases' age distribution and evaluate the impact of the country's vaccination policy. We present the results from the first 4 years of this surveillance. Methods GPs of the French Sentinelles network reported weekly numbers of epidemiologically or laboratory-confirmed cases and their characteristics. Results A total of 132 cases were reported over 2017–2020. Estimated national incidence rates per 100,000 inhabitants were 17 (95% confidence interval (CI): 12–22) in 2017, 10 (95% CI: 6–14) in 2018, 15 (95% CI: 10–20) in 2019 and three (95% CI: 1–5) in 2020. The incidence rate was significantly lower in 2020 than in 2017–2019. Women were significantly more affected than men (83/132; 63% of women, p = 0.004); 66% (87/132) of cases were aged 15 years or over (median age: 31.5 years; range: 2 months–87 years). Among 37 vaccinated cases with data, 33 had received the recommended number of doses for their age. Conclusions These results concur with incidences reported in other European countries, and with studies showing that the incidences of several respiratory diseases decreased in 2020 during the COVID-19 pandemic. The results also suggest a shift of morbidity towards older age groups, and a rapid waning of immunity after vaccination, justifying to continue this surveillance.


In this experimental work, castable refractory has been used. In pressing the water percent was in the range of 7.5-9.5 % weight, and the seven cylindrical specimens for each mixture have been pressed under 4000 N/cm 2 into a steel mould. In casting the water percent was in the range of 10-12 % weight. After mixing castable with water, the specimens, which contain more than 9.5 % water, have been casted to 40 x 40 x 40 mm 3 into a steel mold by vibrating.


Sulphide generation in sewers and waste water facilities is a world wide problem and much research has been done concerning this issue to determinate its causes, effects, prevention and control. Due to the lack of systematic research in Austria several investigations were carried out in different pressure sewers from different waste water treatment plants (WWTP) in order to assess the efficiency of the available technologies to control sulphide generation. Within this project some of the most applied technologies like pipe "pigging" or mechanical cleaning to remove the biofilm from the pipe wall, pneumatic waste water transport to minimise retention times, air or oxygen supply or addition of nitrate salts to avoid anaerobic conditions were tested. Finally the addition of iron salts proposed to eliminate accumulated sulphide by precipitation was also evaluated.


The best and worst major Canadian cities for business investment as measured by overall tax burden are identified in a new report by authors Adam Found and Peter Tomlinson.

Before a business decides to locate or expand in a given jurisdiction, it must consider the tax implications of such an investment. Heavy tax burdens reduce potential returns, driving investment away to other jurisdictions and, with it, the associated economic benefits.

Municipal business tax burdens are highest in Montreal, Halifax and St. John's, while near the group average in Calgary, Charlottetown and Moncton. Vancouver showcases the most competitive municipal business tax environment, followed by Saskatoon, Toronto and Winnipeg.


Receiver operating characteristic (ROC) studies and analyses are often used to evaluate medical tests and are very useful in the field of radiology to evaluate a single diagnostic imaging system, to compare the accuracy of two or more diagnostic imaging systems, or to assess observer performance. There have been many refinements in the development of different ROC type study designs and the corresponding statistical analysis. These methods have become increasingly important and ROC methods are the principal approach for evaluating imaging technologies and/or observer performances. The systems that are often evaluated using ROC methodology include digital and radiographic images of the chest and breast. An improved method of evaluating diagnostic imaging systems contributes to the development of better diagnostic methods; hence, improving imaging systems for diagnoses of breast and lung cancer would have major public health significance. In our work with observer performance studies, in which receiver operating characteristic (ROC) analysis is used, we have noted that some contributions of readers and cases can substantially alter the conclusions of the analysis. To the best of our knowledge, to date there is no statistical test cited in the statistical literature that addresses the detection and influence of outliers on the estimate of the area under the ROC curve. Evaluating outliers may be especially important for the ROC model since subtle (difficult) cases have the potential for being missed by a reader (e.g. a difficult positive case is rated as an unquestionably negative case), and can have a considerable influence on the estimated area under the ROC curve, especially if the study has a small set of cases. Therefore, we believe it is important to develop a method for detecting and measuring the influence of outliers for ROC models. The development of this method will involve deriving a test statistic for outliers based on the jackknife influence values and conducting a preliminary validation of the test.


FOR OVER 30 years, surgeons have more and more frequently recommended early surgery in the treatment of acute cholecystitis and have preferred to remove the inflamed gallbladder at the time of surgery rather than drain it. Some surgeons and many physicians, however, continue to treat such patients medically or in a so-called conservative manner and undertake surgery only if signs of advancing inflammation develop. This conservative therapy may continue for many days before a decision is reached to remove or drain the gallbladder. Most surgeons also continue to advocate cholecystostomy in certain poor risk individuals or in those patients in whom cholecystectomy would be technically difficult. Our own preference has been to undertake immediate cholecystectomy in all patients with acute cholecystitis no matter what the patient's age or condition; we have almost never used cholecystostomy. A trial at medical or conservative therapy has its proponents, even among surgeons. Wright and


DcCDPK8 involved in abiotic stress such as low temperature and signal transduction of hormones ABA and MeJA,but the transcriptional regulation is still unclear. In order to study the core promoter region of DcCDPK8 gene in Dendrobium catenatum and explore its transcriptional regulation mechanism,the DcCDPK8 gene promoter sequence was cloned by PCR from D. catenatum. Promoter sequence function was studied by fusion of 5 'terminal deletion and GUS gene. The results showed that the promoter sequence of DcCDPK8 gene has a low-temperature responsive element( LTR) between~(-1) 749 bp and-614 bp,two MeJA responsive elements between~(-1) 749 bp and-230 bp,and one ABA responsive elements between-614 bp and-230 bp. Three 5'-end different deletion fragments were constructed to fuse the eukaryotic expression vectors p BI121 with GUS,which were transformed into tobacco leaves. The GUS activity under cold stress treatment was DcCDPK8-p1>DcCDPK8-p2>DcCDPK8-p3. GUS activity under exogenous ABA induction was DcCDPK8-p1>DcCDPK8-p2>DcCDPK8-p3,and GUS activity under exogenous MeJA induction was DcCDPK8-p1>DcCDPK8-p2>DcCDPK8-p3. It is speculated that the ABA response element( ARE) in the promoter sequences of DcCDPK8 is positive regulatory role in response to exogenous ABA,the MeJA cis-acting element plays a negative role in response to exogenous MeJA.


A study on the effect of substrate conditions was performed for the plasma beam deposition of amorphous hydrogenated carbon ( a -C:H) from an expanding thermal argon/acetylene plasma on glass and crystalline silicon. A new substrate holder was designed, which allows the control of the substrate temperature independent of the plasma settings with an accuracy of 2 K. This is obtained via a combination of a good control of the holder's yoke temperature and the injection of helium gas between thermally ill connected parts of the substrate holder system. It is demonstrated that the substrate temperature influences both the a -C:H material quality and the deposition rate. The deposition rate and substrate temperature are presented as the two parameters which determine the material quality. In situ studies prove that the deposition process is constant in time and that thermally activated etching processes are unlikely to contribute significantly during deposition. Preliminary experiments with an additional substrate bias reveal that an energetic ion bombardment of the growingfilm surface does not influence the deposition process. A tentative deposition model is proposed based on the creation and destruction of active sites, which depend on the particle fluxes towards the substrate and the substrate temperature. This model allows the qualitative explanation of the observed deposition results.


Objectives: The purpose of this study is to provide basic data on the continuous management and institutional measures in the future by understanding the research trends of patient safety in healthcare field. Methods: The data were extracted from 2011-2016 KoreaMed, KMBase, KISS, NDSL and KISTI. Data were analysis by frequency analysis using the SPSS 14.0 program. Results: 87.0% of the studies were quanti-tative studies. As for the method of sampling, 'No use' was the highest at 56.5%. Most of the participants in the study were 'nurses' (50.7%). 19 hospitals (35.8%) were the most common. The subjects of the study consisted of 35 (51.5%) patients' safety culture (awareness) and 20 (29.4%) 'safety nursing activities'. Conclusions: Patient safety and patient safety should be maintained. Further, a mature patient safety culture should be settled through cooperation management among medical staff.


An attempt has been made to assess the exposure of adult humans and infants to chlorinated hydrocarbons from food. Basing on the results from monitoring performed by the sanitary epidemiological stations in Poland the average concentrations of DDT, HCH, HCB and PCBs in variety of foods items were calculated. These average values were used as a base for the estimation of daily intake of polychlorinated hydrocarbons. For this purpose the average consumption of various groups of foods, including breast milk, were taken into consideration. The Estimated Daily Intakes (EDI) of the compounds were compared with the corresponding ADI values.


The primary objective of the marketing set-up is the customers' satisfaction. It is a measure of how products and services supplied by a company meet customer expectations. The companies that know customer expectation can deliver services/products of superior quality compared with those services provided by conceivable competitors, this is the key for the company success in the modern era. This paper presents QuAM (Qu-ality A-ssessment M-odel), a quality assessment model. QuaM is a customer-centric model: the quality of the asset/item/service is evaluated by the customer perceptions. The customers are invited to express their opinions by filling in an informative questionnaire, this way, all the answers are collected and then processed to get a global evaluation. For this purpose the model exploits the fuzzy linguistic approach to represent the users' judgments and Computing with Words (CWW) paradigm, based on two linguistic aggregation operators LOWA and LWA to compute the overall quality assessments. This model has been applied to public transport domain, where a stringent requirement is to reach a balanced trade-off between the company goals and the customer expectations. The public transport company indeed would like to increase the quality perceived by customers, optimizing bus routes in the area and reducing costs, at the same time, users demand reliability, safety and quality for the bus lines. A case study in this domain shows that our model provides a straightforward quality evaluation to support the company in the marketing strategies and in achieving the customers' satisfaction.


Low-density lipoprotein (LDL) receptor mRNA was found in both rat and hamster adrenals. Within 30 min after ACTH administration a significant increase in the levels of both LDL receptor and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) mRNAs was observed in rat adrenals; these levels remained increased for up to 240 min. The increase in the levels of LDL receptor and HMG-CoA reductase mRNAs produced by ACTH was reduced by co-administration of aminoglutethimide while, at the same time, the adrenal cholesterol content of rats treated with both aminoglutethimide and ACTH was significantly increased compared with that in groups treated with ACTH alone. Cycloheximide also induced increased levels of rat adrenal mRNAs for LDL receptor and HMG-CoA reductase, but this effect was not additive with that of ACTH. These results suggest that, in the rat, the short-term effect of ACTH on the levels of mRNAs for the LDL receptor and HMG-CoA reductase is similarly controlled and might be mediated through changes in the adrenal cholesterol content. In the hamster adrenal, however, no significant fluctuations were found in the level of LDL receptor mRNA, although a marked increase was found in the level of HMG-CoA reductase mRNA, 2 h after ACTH administration. This indicates that an important effect of ACTH on cholesterol metabolism in the hamster adrenal is at the level of HMG-CoA reductase. In the hamster, therefore, where the main source of cholesterol for the adrenal gland is de-novo synthesis, it seems that a complex mechanism is involved in the control of LDL receptor gene expression.


Despite the advancements in software testing, bugs still plague deployed software and result in crashes in production. When debugging issues —sometimes caused by "heisenbugs"— there is the need to interpret core dumps and reproduce the issue offline on the same binary deployed. This requires the entire toolchain (compiler, linker, debugger) to correctly generate and use debug information. Little attention has been devoted to checking that such information is correctly preserved by modern toolchains' optimization stages. This is particularly important as managing debug information in optimized production binaries is non-trivial, often leading to toolchain bugs that may hinder post-deployment debugging efforts. In this paper, we present Debug2, a framework to find debug information bugs in modern toolchains. Our framework feeds random source programs to the target toolchain and surgically compares the debugging behavior of their optimized/unoptimized binary variants. Such differential analysis allows Debug2 to check invariants at each debugging step and detect bugs from invariant violations. Our invariants are based on the (in)consistency of common debug entities, such as source lines, stack frames, and function arguments. We show that, while simple, this strategy yields powerful cross-toolchain and cross-language invariants, which can pinpoint several bugs in modern toolchains. We have used Debug2 to find 23 bugs in the LLVM toolchain (clang/lldb), 8 bugs in the GNU toolchain (GCC/gdb), and 3 in the Rust toolchain (rustc/lldb)—with 14 bugs already fixed by the developers.


GaN‐based p–i–n X‐ray detectors have been fabricated. We observed using SEM that the surface of a GaN sample has a large number of hexagonal defects. The SEM results show that GaN itself contains numerous screw dislocations that will be the flow channel of leakage current, which in turn increased the reverse‐bias leakage current of detectors. We have observed a two‐step increase in X‐ray photocurrent, which is caused by two different detection mechanisms: photovoltaic and photoconductive, and the total photocurrent (Jp) to dark current (Jd) ratio is about 27.7 times and the net photocurrent is about 2.52 µA at 110 V reverse bias. As the X‐ray accelerating voltage increases, the photocurrent has a sublinear trend.


Classical novae are the result of thermonuclear flashes of hydrogen accreted by CO or ONe white dwarfs, leading eventually to the dynamic ejection of the surface layers. These are observationally known to be enriched in heavy elements, such as C, O and Ne, that must originate in layers below the H-flash convection zone. Building on our previous work, we now present stellar evolution simulations of ONe novae and provide a comprehensive comparison of our models with published ones. Some of our models include exponential convective boundary mixing to account for the observed enrichment of the nova ejecta even when accreted material has a solar abundance distribution. Our models produce maximum temperature evolution profiles and nucleosynthesis yields in good agreement with models that generate enriched ejecta by assuming that the accreted material was pre-mixed. We confirm for ONe novae the result we reported previously, i.e. we found that 3He could be produced in situ in solarcomposition envelopes accreted with slow rates (M < ˙ 10−10 M yr−1) by cold (TWD < 107 K) CO WDs, and that convection was triggered by 3He burning before the nova outburst in that case. In addition, we now find that the interplay between the 3He production and destruction in the solar-composition envelope accreted with an intermediate rate, e.g. M˙ = 10−10 M yr−1, by the 1.15 M ONe WD with a relatively high initial central temperature, e.g. TWD = 15 × 106 K, leads to the formation of a thick radiative buffer zone that separates the bottom of the convective envelope from the WD surface. We present detailed nucleosynthesis calculations based on the post-processing technique, and demonstrate in which way much simpler single zone T and ρ trajectories extracted from the multi-zone stellar evolution simulations can be used, in lieu of full multi-zone simulations, to analyse the sensitivity of nova abundance predictions on nuclear reaction rate uncertainties. Trajectories for both CO and ONe nova models for different central temperatures and accretion rates are provided. We compare our nova simulations with observations of novae and pre-solar grains believed to originate in novae.


This paper derives exact expressions for the level crossing rate and average fade duration of multibranch pure-selection, equal-gain, and maximal-ratio combiners operating over independent non-identical α-μ (also called generalized Γ or Stacy) fading channels. The derived expressions are in closed form for pure-selection combining and in integral form for equal-gain and maximal-ratio combining. For the two latter schemes, accurate closed-form approximations are then provided. The analytical results are validated by reducing the general expressions to known particular cases and, more generally, by means of simulation. Numerical examples are also given to illustrate the high accuracy of the proposed closed-form approximations.


This study investigates the relationship between interest rate and stock price volatility in textile sector of Karachi Stock Exchange. Initially, EWMA model is used to calculate the volatility of stock prices. Stock returns are calculated as a proxy to stock prices. Afterwards, linear regression analyzes the relation between interest rate and stock price volatility. The significance F change is below the limit of 0.05 showing goodness-to-fit of the model to project the responses from predictor to be reliable. The research concludes the relationship of interest rate with volatility of stock prices as slightly inverse in nature.


This paper addresses the problem of efficiently turning the connectivity of an initial triangular mesh into a new one, using combinatorial edge flip operations only, excluding vertex insertion and deletion. More precisely, we provide a practical but provably good solution for determining a sequence of edge flips between two surface triangulations sharing the same topological genus and the same number of vertices, with a one-to-one correspondence between the vertices of the two meshes. This is original in that the sequence of edge flips can be determined without using any canonical geometric or topological configuration, classically acting as a pivot between the two triangulations. The paper identifies the main difficulties that must be overcome by this direct algorithm, putting in place the foundation for a generic strategy. An efficient instantiation of this strategy is then presented, with an algorithm that proceeds by successive conformation of the facets, through a region-growing mechanism. The effectiveness of this approach is illustrated by practical benchmarks.


Superplastic carburizing (SPC) is a carburizing process that combines carburizing with superplastic deformation. Since SPC involves direct interaction between the superplastically deformed surface and the solid carbon medium, the effect of surface roughness on the process cannot be disregarded. This paper presents the study of surface roughness and initial pressure effects on superplastic carburizing of duplex stainless steel (DSS). SPC was conducted under four different surface roughness (Ra) conditions of 0.9, 0.3, 0.1 and 0.03 μm. The microstructure, surface hardness, and carburized layer thickness were studied. Comparisons were also done on non-superplastic material which has a coarse microstructure. The results showed that the surface roughness strongly affected the properties of the superplastically carburized duplex stainless steel while its effects on the non-superplastic material were not that obvious.


Offshore marine renewable energy installations (MREI) introduce structure into the marine environment and can locally exclude destructive, bottom trawl fishing. These effects have the potential to aid restoration of degraded seabed habitats but may be constrained by timescales of ecological succession following MREI construction, and the removal of infrastructure during decommissioning. To inform managers about appropriate decommissioning strategies, a 25 km cable and associated rock armouring (Wave Hub, UK), installed on rocky reef, was monitored up to 5 years post-deployment. The epibenthic Assemblage composition, and Number of taxa remained significantly different from surrounding controls, while Abundance was similar in all survey years between the cable and controls. Six morphotaxa showed four patterns of colonization on cable plots compared to the controls: (i) Early colonization, which remained in greater abundances (Porifera), (ii) early colonization, converging (Turf), (iii) slow colonization, converging Anthozoa and Vertebrata), and (iv) slow colonization, remaining lower in abundance (Tunicata and Echinodermata). The environmental relevance of this MREI is considered relatively benign as it covers 0.01% of the surrounding bioregion, appears to be supporting similar assemblages to the surrounding habitat, and exhibited minimal evidence of invasive species (three records of two non-native species). Longer monitoring timescales are required to provide comprehensive, site-specific decommissioning advice.


Pelagic cyanobacteria are key players in the functioning of aquatic ecosystems, and their viruses (cyanophages) potentially affect the abundance and composition of cyanobacterial communities. Yet, there are few well-described freshwater cyanophages relative to their marine counterparts, and in general, few cyanosiphoviruses (family Siphoviridae) have been characterized, limiting our understanding of the biology and the ecology of this prominent group of viruses. Here, we characterize S-LBS1, a freshwater siphovirus lytic to a phycoerythrin-rich Synechococcus isolate (Strain TCC793). S-LBS1 has a narrow host range, a burst size of ∼400 and a relatively long infecting step before cell lysis occurs. It has a dsDNA 34,641 bp genome with putative genes for structure, DNA packing, lysis, replication, host interactions, DNA repair and metabolism. S-LBS1 is similar in genome size, genome architecture, and gene content, to previously described marine siphoviruses also infecting PE-rich Synechococcus, e.g., S-CBS1 and S-CBS3. However, unlike other Synechococcus phages, S-LBS1 encodes an integrase, suggesting its ability to establish lysogenic relationships with its host. Sequence recruitment from viral metagenomic data showed that S-LBS1-like viruses are diversely present in a wide range of aquatic environments, emphasizing their potential importance in controlling and structuring Synechococcus populations. A comparative analysis with 16 available sequenced cyanosiphoviruses reveals the absence of core genes within the genomes, suggesting high degree of genetic variability in siphoviruses infecting cyanobacteria. It is likely that cyanosiphoviruses have evolved as distinct evolutionary lineages and that adaptive co-evolution occurred between these viruses and their hosts (i.e., Synechococcus, Prochlorococcus, Nodularia, and Acaryochloris), constituting an important driving force for such phage diversification.


The aim of the study was to investigate the role of cTnT for the prediction of long term cardiac dysfunction after epirubicin-containing adjuvant chemotherapy for breast cancer. The study group comprised of 45 patients (all female; mean age 48 ±8 years), treated with epirubicin-containing adjuvant chemotherapy for stage 2 and stage 3 breast cancer. Patients received either 4 cycles of cyclophosphamide plus epirubicin (90 mg/m2) (n=23; stage 2 breast cancer) or 6 cycles of cyclophosphamide plus epirubicin (75 mg/m2) plus fluorouracil (n=18; stage 3 breast cancer). Venous blood samples were drawn, before and 72 hours after, every cycle of chemotherapy for the measurement of cTnT. Cardiac assessment was carried out at baseline and 1 year after chemotherapy by clinical evaluation, electrocardiography, radio-nuclide ventriculography (RNV) and transthoracic echocardiography. All patients remained free of clinical heart failure during the study period. In 26 patients (63%), cTnT was elevated after chemotherapy. Mean left ventricular ejection fraction, assessed by RNV at baseline and one year after chemotherapy, were 61±8% and 56±7% (p<0.0001). The sensitivity and specifity of cTnT for the detection of left ventricular systolic dysfunction at one year were 69% and 39% respectively. Echocardiographic examinations at baseline and one year after chemotherapy revealed a significant decrease in E/A ratio from 1.15±0.3 to 0.9±0.2 in cTnT positive patients, suggesting diastolic dysfunction. In conclusion, elevated serum cTnT levels after epirubicin-containing adjuvant chemotherapy for stage 2 and stage 3 breast cancer, predict future cardiac dysfunction with moderate sensitivity and poor specificity.


PURPOSE
To assess the safety and efficacy of 37.5 mg ephedrine i.m. in preventing hypotension associated with spinal anaesthesia for Caesarean section.

METHODS
In a double-blind randomised controlled study, 40 patients (20 in each group) were given either 37.5 mg ephedrine or placebo i.m. The following parameters were recorded: (i) blood pressure; (ii) heart rate; (iii) ephedrine i.v. supplementation; (iv) umbilical venous blood gases and neonatal Apgar scores.

RESULTS
The incidence of hypertension in the study group was 30% compared with 20% for the control group (P:NS). There was no difference in mean highest blood pressure or mean highest heart rate between the groups. The incidence of hypotension was lower but not significantly lower in the study group (50%) than in the control group (80%) (P:NS). However, the incidence of delayed hypotension was only 10% in the study group patients compared with 50% in the control group patients (P < 0.05).

CONCLUSION
Giving 37.5 mg ephedrine i.m. prior to spinal anaesthesia was not associated with reactive hypertension or tachycardia. Intramuscular ephedrine provided more sustained cardiovascular support than intravenous ephedrine.


This qualitative study reports on the content analysis of 62 essays written by clients about their experiences in an Alaska public health nursing home visitation project for prevention of child abuse and neglect. Home visitation services were provided to two groups of demographically matched first-time mothers: intense protocol services (intervention group) and "usual" services (current practice group). Intervention and current practice group essays were analyzed separately. The purpose was to determine how congruent client experiences were with public health nurse perspectives of the care they gave to clients. Similarities and differences between groups were also examined. Although in different order of frequency, themes about knowledge and learning, nurse qualities, validation of parenting skills, and suggestions emerged for both groups, but the intervention group essays were, on average, seven times longer and more descriptively rich. Client experiences were similar to public health nurse concepts of effective service and to other findings in existing research.


In this paper we study a generalization of both proper edge-coloring and strong edge-coloring: $k$ -intersection edge-coloring, introduced by Muthu, Narayanan and Subramanian. In this coloring, the set $S(v)$ of colors used by edges incident to a vertex $v$ does not intersect $S(u)$ on more than $k$ colors when $u$ and $v$ are adjacent. We provide some sharp upper and lower bounds for $\chi'_{k\text{-int}}$ for several classes of graphs. For $l$-degenerate graphs we prove that $\chi'_{k\text{-int}}(G)\leq (l+1)\Delta -l(k-1)-1$. We improve this bound for subcubic graphs by showing that $\chi'_{2\text{-int}}(G)\leq 6$. We show that calculating $\chi'_{k\text{-int}}(K_n)$ for arbitrary values of $k$ and $n$ is related to some problems in combinatorial set theory and we provide bounds that are tight for infinitely many values of $n$. Furthermore, for complete bipartite graphs we prove that $\chi'_{k\text{-int}}(K_{n,m}) = \left\lceil \frac{mn}{k}\right\rceil$. Finally, we show that computing $\chi'_{k\text{-int}}(G)$ is NP-complete for every $k\geq 1$. An addendum was added to this paper on Jul 4, 2015.


Disaster plans almost always do not benefit from the knowledge and values of disadvantaged people who are frequently underrepresented in disaster planning processes. Consequently, the plans are inconsistent with the conditions, concerns, and capabilities of disadvantaged people. We present an approach to community-based participatory planning aimed at engaging marginalized and distrustful communities to build their capacity to be more disaster resilient. We review the experiences of six disadvantaged communities under the Emergency Preparedness Demonstration (EPD) project. The EPD effort revealed several critical implications: recruit a diverse set of participants for inclusive collaboration; provide analytical tools to co-develop information and empower people; employ coaches to organize and facilitate sustainable community change; design a bottom-up review process for selection of strategies that holds communities accountable; and build capacity for implementation of strategies.


This article argues that, during the Weimar period, physical exercises were linked to debates about a "human economy." Especially in the aftermath of the First World War, physical exercises became a vital component of population policies aiming at the restitution of the productive capacities of the population. Within this framework, representatives of sports physiology and psychotechnics interpreted sports as a kind of work. The goal was to improve the mental and physical performance of workers in the interest of efficiency, job performance, and the national economy. This article, focusing on interactions between sport sciences, work physiology, and debates on efficiency, places the objectives and discourses of these debates and the history of sport in the 1920s within the context of the Weimar rationalization movement.


In 1990, Donehower editorialized in the Journal of the National Cancer Institute, entitled "Evaluating Cancer Chemotherapy by Infusion" (92). In the same issue, Goldberg reported a phase III study comparing etoposide and cDDP administered by either bolus or infusion to patients with non-small cell lung cancer (93). There was no advantage to the infusional schedule; in fact, it produced greater myelotoxicity. In the editorial, Donehower commented that the daily etoposide dose was not substantially pharmacokinetically different from a daily bolus schedule (because of the drug's relatively long half-life), and the greater myelotoxicity of infusional cDDP might have been predicted by preclinical studies. He suggested that studies of cancer drugs given by infusion should only be undertaken in the context of strong accompanying pharmacologic and preclinical experimental rationale, and that phase III studies of this concept should only be undertaken after a strong justification is developed. The concept that infusions of AA are generally less toxic than bolus dosing formed much of the rationale for infusional AA administered with BMT. The detailed studies of Teicher (1) and Frei (89), cited above, provided strong preclinical data suggesting that improvement in the therapeutic index could be achieved for most AA when infusional schedules were used. Additionally, the high toxic risk accompanying high-dose combination AA therapy with hematopoietic cell support mandated detailed PK studies. Data produced by these efforts (5, 12) now add additional basis for systemic exploration of AA infusions. Armed with the basic data suggested by Donehower, a more scientifically based study of AA infusion can take place in the future. Compelling rationales now support such studies. The availability of means to avoid fatal hematologic toxicity for virtually all patients suggests that the next era of exploration of AA infusions will be fruitful, and accompanied by a deeper understanding of the relationship between visceral organ toxicities and PK/PD changes produced by AA administered over prolonged periods.


The combination of rising sea level and increased storminess that is expected to accompany changes in global climate due to the greenhouse effect may well have severe impacts on low lying coral islands in tropical oceans. This paper deals principally with the atoll island states of Kiribati, Maldives, Marshall Islands, Tokelau and Tuvalu which comprise only coral-rubble islands with land rarely rising more than 3 m above present sea level. Their combined populations are about 300,000, and since colonial times, island economies have not achieved self-sufficiency. Presently they are substantially dependent on foreign aid and remittances from islanders who work overseas. The situation is worsening as natural resources decline, populations grow, aspirations for better living standards increase and the terms of trade worsen. Atoll island ecology and the ability to sustain human habitation depend in large part on fresh ground water reserves which are related to island size. Ground water degradation due to greenhouse- induced coastal erosion and inundation of low-lying ground will further reduce agricultural productivity and other island resources. The economic and social viability of atoll island states in the future is therefore doubtful; their people may become the first environmental refugees of the greenhouse era.


Amanda N. Pioppi USING THEATRE EDUCATION AS A MEDIUM FOR BULLYING PREVENTION 2008/09 Dr. Beth A. Wassell Master of Science in Teaching The purpose of this study was to educate high school students about bullying prevention through the use of theatre education. A unit was designed to enhance student discussion and interpretation of the issue. The use of student journals, discussions, and student work artifacts were used as data sources for this action research study. Along with this, students rehearsed and produced a play, Bang, Bang, You're Dead, designed to create prevention awareness. The Advanced Acting class, eighteen junior and senior level high school students, went through a continuum of change during the study. There was a visible change in their discussions and interpretations during the process. The students took ownership of the information toward the conclusion of the study and created material to reach out to their school community. The data in this study show that students can use their skills and strengths to both comprehend the subject and produce


Species of the Herniaria genus have been reported to have several medicinal uses. Two of the species from this genus, Herniaria glabra and Herniaria hirsuta, have both been documented to contain saponins. This can explain the health benecial use of these plant species, since saponins are known for their many biological properties. However, the lack of information on one of their relatives, Herniaria incana, makes this species a target for further investigation. The aim of this master thesis is to determine the total saponin content of H. incana, as well as to extract, isolate and closely investigate saponin compounds in this species. The total saponin content was determined by colorimetry, using ginsenoside Rb1 as standard. Measurements were carried out at 550 nm, and the results gave a total saponin content of 35.2 ug ginsenoside equivalent saponin content per gram of the plant extract. A saponin was isolated from H. incana by means of TLC and column chromatography. The structure was elucidated by the use of a combination of 1D (1H, 13C) and 2D NMR techniques (COSY-45, edited HSQC, HMBC, H2BC, HSQC-TOCSY, NOESY and 1H,1H J - resolved experiment) as O-a-L-rhamnopyranosyl-(1->4)-O-b-D- glucopyranosyl-( 1->6)-O-[b-D-6-O-acetylglucopyranosyl-(1->2)]-b-D-glucopyranosyl Medicagen-28-ate. The monosaccharide sequence was also confirmed by ESI-CID.


Dairy animals have a significant role in every country's agricultural economy. Livestock is the major sub-sector of the agricultural industry and the value of dairy products is increasing globally. Under pathological circumstances heat shock proteins (HSPs) promote protein repair, folding, refolding of misfolded peptides, and possible breakdown of irreparable proteins. Heat shock protein 27 (HSP27) is a member of the small heat shock protein family (sHSPs) also called HSPB1. HSP27 is crucial in the regulation and progression of different types of tumors and also acts as an oncotherapeutic target in humans and other mammals especially sheep. By using computational tools, a detailed in silico investigation of HSP27 sequences from humans and sheep has been examined with respect to their structural, functional, expression and phylogenetic properties. An extensive study has been made to compare the human protein with that of other mammals using computational tools. However, the sequences of HSP27 in humans and sheep are closely linked with each other. Although the sequences of HSP27 vary, their structural characteristics and functional properties remain the same. In this study, hydrophilic proteins with an average molecular weight of 27kDa were discovered both in humans and sheep. This study helps to understand the economic worth of dairy animals worldwide. HSP27 phosphorylation has been predicted as an anticancer agent. Recent research shows that new strategies have been developed for cancer treatment based on therapy of HSP27. This research will highlight the characterization and significant role of HSP27 in sheep.


We present a sample of Type Icn supernovae (SNe Icn), a newly discovered class of transients characterized by their interaction with H- and He-poor circumstellar material (CSM). This sample is the largest collection of SNe Icn to date and includes observations of two published objects (SN 2019hgp and SN 2021csp) and two objects not yet published in the literature (SN 2019jc and SN 2021ckj). The SNe Icn display a range of peak luminosities, rise times, and decline rates, as well as diverse late-time spectral features. To investigate their explosion and progenitor properties, we fit their bolometric light curves to a semianalytical model consisting of luminosity inputs from circumstellar interaction and radioactive decay of 56Ni. We infer low ejecta masses (≲2 M ⊙) and 56Ni masses (≲0.04 M ⊙) from the light curves, suggesting that normal stripped-envelope supernova (SESN) explosions within a dense CSM cannot be the underlying mechanism powering SNe Icn. Additionally, we find that an estimate of the star formation rate density at the location of SN 2019jc lies at the lower end of a distribution of SESNe, in conflict with a massive star progenitor of this object. Based on its estimated ejecta mass, 56Ni mass, and explosion site properties, we suggest a low-mass, ultra-stripped star as the progenitor of SN 2019jc. For other SNe Icn, we suggest that a Wolf–Rayet star progenitor may better explain their observed properties. This study demonstrates that multiple progenitor channels may produce SNe Icn and other interaction-powered transients.


Medical shortages are seen as the driving force behind the recent implementation of the advanced nurse practitioner (ANP) role in some Canadian hospitals. The authors analyzed the implementation of the ANP role in one tertiary care teaching hospital from the organizational change perspective. Despite successful implementation, issues of role definition, scope of practice boundaries, and staff reactions remain unresolved. Recommendations are discussed for implementing ANP roles in other acute care facilities.