Abstract In this case study of a young, Thai "cause lawyer", advocacy for human rights is considered in context. The most important elements of that context are the path of development of Thai political and legal institutions, globalisation of law, and the networks of relationships that penetrate the state. The case study shows that human rights advocacy by NGO lawyers can adapt creatively to unpromising conditions under which courts provide little access or oversight. At the same time, the case study raises profound questions about the ultimate independence of cause lawyers when the state must be made a partner in order to establish the authority of law needed to make human rights advocacy possible. The ambiguity of the lawyer's position is apparent from the relative ineffectiveness of her interventions and her growing moral authority on behalf of best practices under law. Her position suggests the limitations on law imposed by the underpinnings of the Thai state itself.


Introduction: The lumbar puncture is frequently used in medical facilities to collect data on the cerebrospinal fluid (CSF). The method aids in the diagnosis of conditions affecting the spine and brain's central nervous system. However, in routine practice out of the many challenges posed by the parents due to lack of education, denial of consent for this procedure is a great challenge at clinical settings. Objectives: To determine the association of various factors with parental refusal for lumbar puncture among pediatric population (age from 1 moth to 18 years). Materials and Methods: A descriptive, cross-sectional study was carried out at the department of pediatrics and child health and department of Emergency at Aga Khan University Hospital, Karachi from June 2017 to May 2018. A total of 178 children 1 month to 18 years old admitted with febrile fits, suspected meningitis or encephalitis who were advised for lumber puncture were included. Results: In the present study, the age of the patients ranged from 1 month to 18 year. Majority of the patients 153 (85.39%) were between 1 month to 6 years of age. There were 115 (64.61%) male patients.. Fever and fits was the most frequent indication (n=151, 84.83%) for lumber puncture in the study. Most of the parents were educated, 68.54% of mothers and 65.17% fathers had graduate level of education, and parents of 47 (26.4%) patients refused for lumber puncture. Conclusion: This study concluded that frequency of parental refusal for lumbar puncture was 26.4% and the most common reason for refusal was fear of complications. Keywords: lumbar puncture, febrile seizures, parental refusal.


Background The management of the pediatric trauma patient is variable among trauma centers. In some institutions, the trauma surgeon maintains control of the patient throughout the hospital stay, while others transfer to a pediatric specialist after the initial evaluation and resuscitation period. We hypothesized that handoff to the pediatric surgeon would decrease the length of stay by more efficient coordination with pediatric subspecialists and ancillary staff. Methods A retrospective review from October 2014 to October 2018 was conducted at our rural level 1 trauma center analyzing the length of stay across all demographics and trauma triage levels before and after institution of a handoff protocol from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window. Further analysis included emergency department (ED) disposition to include the effect of handoff on the length of stay in the setting of a higher post-ED acuity, that is, disposition of monitored beds. Results 1267 patient charts were analyzed and the mean length of stay was reduced by .38 days (t = 5.92, P < .0005) across all demographics, trauma triage levels, post-ED dispositions, and mechanisms of injury after institution of our handoff protocol. Conclusion Handoff from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window at a rural level 1 trauma center significantly improved the length of stay by .38 (t = 5.92, P < .0005) among pediatric trauma patients in all demographics, trauma triage activations levels, mechanisms of injury, and post-ED dispositions acuity levels.


Daptomycin is a cyclic lipopeptide with potent bactericidal activity against Gram-positive organisms and has been approved by the United States Food and Drug Administration for the treatment of Staphylococcus aureus bacteremia and infectious endocarditis (right-side). We evaluated the activity of daptomycin against bloodstream infection S. aureus strains from 4,799 patients hospitalized in 32 medical centers (12 European countries, Turkey and Israel) with bloodstream infections (BSI) during a 5-year period (2002-2006). Intravenous catheters were the source of infection in 15% of cases, and those strains were analyzed separately. All strains were susceptibility tested by reference broth microdilution methods utilizing calcium supplementation (50 mg/L) when testing daptomycin. Bactericidal activity of daptomycin and vancomycin were evaluated against a subset of 50 randomly selected strains. Daptomycin (MIC(50/90), 0.25/0.5 mg/L), vancomycin (MIC (50/90), 1/1 mg/L), and linezolid (MIC(50/90), 2/2 mg/L), were highly active (>99.9% susceptibility) against the strains evaluated; and daptomycin was the most potent (lowest MIC(90) ) among these compounds. Resistance rates to oxacillin and levofloxacin were generally elevated, especially when an intravenous catheter was the source of infection.


cUSYQ]YSb]USXQYc]VbWUUbQdY VQ cSQUTUVb]QdY dgYcodXUWU eration of nanotwin pairs at grain boundary (GB) dislocation pile-ups in nanocrystalline and ultrafine-grained materials is suggested and theoretically described. In doing so, the generation of a pair of nanotwins at a grain boundary is realized through simultaneously occurring events of stress-driven splitting of a gliding GB dislocation into two partial lattice dislocations (emitted to adjacent grains) and a sessile GB dislocation. The energy and stress characteristics of the generation process in question are calculated.


Metastasis and disease relapse are hypothesized to result from tumor initiating cells (TICs). Previously, we have defined a CD44+/CD24−/low mammosphere-forming tumorigenic 493-gene signature in breast cancer. Stat3 was identified as a critical node in self-renewal based on an ongoing lentiviral shRNA screen being conducted in two breast cancer cell lines SUM159 and BT549. In corroborating work, targeting the SH2 domain of Stat3 with a novel small molecule decreased the percentage of cells expressing TIC markers (CD44+/CD24−/low and ALDH+) and mammosphere formation in p-Stat3 overexpressing human breast cancer xenografts in SCID-beige mice. Importantly, we observed a four-fold improvement in the 30-day recurrence-free survival relative to docetaxel alone with the addition of the Stat3 inhibitor in the chemoresistant tumor model. Thus, these findings provide a strong impetus for the development of selective Stat3 inhibitors in order to improve survival in patients with p-Stat3 overexpressing tumors.


We propose a novel attention mechanism for a Convolutional Neural Network (CNN)-based Drug-Drug Interaction (DDI) extraction model. CNNs have been shown to have a great potential on DDI extraction tasks; however, attention mechanisms, which emphasize important words in the sentence of a target-entity pair, have not been investigated with the CNNs despite the fact that attention mechanisms are shown to be effective for a general domain relation classification task. We evaluated our model on the Task 9.2 of the DDIExtraction-2013 shared task. As a result, our attention mechanism improved the performance of our base CNN-based DDI model, and the model achieved an F-score of 69.12%, which is competitive with the state-of-the-art models.


Coupled degrees-of-freedom exhibit correspondence, in that their trajectories influence each other. In this paper we add evidence to the hypothesis that spatiotemporal correspondence (STC) of distributed actuators is a component of human-like motion. We demonstrate a method for making robot motion more human-like, by optimizing with respect to a nonlinear STC metric. Quantitative evaluation of STC between coordinated robot motion, human motion capture data, and retargeted human motion capture data projected onto an anthropomorphic robot suggests that coordinating robot motion with respect to the STC metric makes the motion more human-like. A user study based on mimicking shows that STC-optimized motion is (1) more often recognized as a common human motion, (2) more accurately identified as the originally intended motion, and (3) mimicked more accurately than a non-optimized version. We conclude that coordinating robot motion with respect to the STC metric makes the motion more human-like. Finally, we present and discuss data on potential reasons why coordinating motion increases recognition and ability to mimic.


The 2015 drought in the Indo‐Gangetic Plain posed new challenges related to food and water security and affected the lives of millions. All‐India monsoon rainfall in 2015 was the tenth driest year on record (1906–2015) with a deficit of 14.5%, and the Indo‐Gangetic Plain witnessed a rainfall deficit of 25.8% (third rank event). Drought severity was amplified by deficits from the previous years in the Indo‐Gangetic Plain and other parts of India. The Indo‐Gangetic Plain faced a 2 year cumulative deficit of 51%, and the drought of 2014–2015 was unprecedented with a return period of 542 years. The GRACE data showed the occurrence of consecutive negative terrestrial water storage and groundwater anomalies in 2014 and 2015, mainly centered over the Indo‐Gangetic Plain region. Notwithstanding uncertainty in future projections, the multiyear droughts in the same regions can pose challenges for water resources and agriculture.


The information super highway, the Internet has come to stay. This paper x-rays the wonderful opportunity, which the Internet has brought to bear on the librarian/information specialist in providing library and information services to clients. The paper establishes that the Internet came into being in the 1960s by the US Department of Defense. The Internet provides "promotional information" which entails that the library is still very important in the life of the people. To succeed with the challenges posed by the Internet, the librarian/information specialist should develop operational result- oriented Internet strategy. The Internet literate and aided librarian/Information specialist should really prove that he is the expert by sharing his knowledge and skills with both his colleagues and clients. The information specialist should regularly hold lectures, seminars, symposia and demonstrations with all concerned. Above all, he should be proactive, forward looking, and exposed to continuous learning because Internet is constantly changing the fact of information provisioning from the quest for quick reference questions to research questions. The Information Technologist Vol.1(1&2) 2004: 71-80


Objectives: This study was performed to investigate the relationship between individual-level social capital and depression. And, we assessed if depressive symptom mediates the relationship between social capital and self-rated health status. Methods: Data from the 2011 Community Health Survey were analyzed for this study. We used chi-square tests and analyzed a four step approach in which several regression analyses were conducted and significance of the coefficients was examined at each step. Results: In men, the results of controlling mediating factor (depression): social participation was not significantly associated with self-rated health status(p=0.082), the finding supports that social participation was fully mediated by depression. In women, the relationship between social capital(trust, social participation) and self-rated health status was partially mediated by depression. Conclusions: In order to increase self rated health status, not only improvement in trust and social participation are needed but effort to reduce depression must be combined.


The performance of a novel ridge-waveguide, distributed-Bragg-reflector laser was tested for spectroscopic remote sensing applications. The laser exhibits a narrow linewidth, excellent side-mode suppression, and flexible, highly repeatable wavelength tuning. These characteristics are significant improvements over current Fabry-Perot lasers, and indicate that distributed-Bragg-reflector lasers are promising candidates for implementing advanced semiconductor-based optical remote sensing systems.


thin films, possessing potential for MIS electronic applications, have been deposited on clean Si and InP surfaces by evaporating powder from a graphite cell heated by electron bombardment. The build up of the films was monitored by Auger electron spectroscopy (AES). Continuous, amorphous films were also prepared on microgrids, for TEM studies. The film thickness was measured using multiple angle of incidence (66 - ) and angle ellipsometry using a 633 nm laser line. Calibration curves have been calculated for n = 1.61 - 1.77 limits for and various substrates. They were considerably affected by the substrate optical constants. Evaluation of ellipsometric data resulted in typical thickness values of 5 - 10 nm as confirmed with cross-sectional TEM.


This study interrogates how protesters learned about and planned the 2020 #EndSARS protests in Nigeria. Analyses of survey data collected in 2020 during the protests and content analysis of tweets demonstrate that protesters who used Facebook, WhatsApp and Twitter to learn about and plan the 2020 #EndSARS protests in Nigeria and reported to be 30 years and older are more likely to report joining on the first day of the protest. Data showed a relationship between protesters' perceived ease of use of a social media platform and their use of such platforms during protests. Practical and theoretical implications are discussed.


This work is concerned with the role that friction and inertia effects can play on the magnitude of dam-break wave-front celerity. Classic analytical solutions are presented. A large collection of experimental data is used, covering a wide range of different initial conditions: fixed bed or mobile bed five types of bed material , dry or wet bed downstream, and with or without bed step. To overcome the limitations of analytical solutions, a numerical model is used. The model is based on the shallow-water approach with contact-load dominated sediment transport, and it makes use of developments recently made in the study of sheet flows. The analytical and numerical results are compared with experimental data. It was found that the celerity is mainly dictated by the friction coefficient, by the sediment inertia, by the initial downstream water depth, and by the initial bed step height. For good data fitting, the friction coefficient must be influenced by the type of bed, fixed or mobile. In the latter, the coefficient must vary with the bed material characteristics. The dissimilarities between the experimental, analytical, and numerical results are interpreted. DOI: 10.1061/ ASCE 0733-9429 2006 132:1 69 CE Database subject headings: Dam failure; Waves; Risk management; Numerical models.


Summary
A phage which attacks many motile strains of the Proteus-providence group did not replicate on aflagellate or paralysed mutants. The phage consisted of an hexagonal head, a tail and one tail fibre and resembled φx1. Electron micrographs demonstrated adsorption of the phage to the flagellar shaft of the host and the presence of phage at the flagellar base. Some of the latter phage possessed empty heads, and we postulate that the phage injects its nucleic acid at the base. This phage and φx1 had a slight serological relationship.


By observing the fundamental and second harmonic emission from a plasma produced by a 150 fs, 5 mJ laser at 800 nm, the electron temperature, the expansion speed and the scalelength of the plasma have been diagnosed. Moreover the polarization of the fundamental and second harmonic emission has been studied. This could be a useful diagnostic for modulation at the critical surface of the plasma.


Employing voice-based emotion recognition function in artificial intelligence (AI) product will improve the user experience. Most of researches that have been done only focus on the speech collected under controlled conditions. The scenarios evaluated in these research were well controlled. The conventional approach may fail when background noise or non-speech filler exist. In this paper, we propose an ensemble framework combining several aspects of features from audio. The framework incorporates gender and speaker information relying on multi-task learning. Therefore it is able to dig and capture emotional information as much as possible. This framework is evaluated on multimodal emotion challenge (MEC) 2017 corpus which is close to real world. The proposed framework outperformed the best baseline system by 29.5% (relative improvement).


When East Pakistan1 broke away from Pakistan to become the independent and sovereign nation of Bangladesh in 1971after nine month long war of independent against west Pakistan, many observers believed that South Asia was irrevocably on its route to a secular nationalism beyond religious 'tribalism'2 and 'two nation theory'3 (G.Allana (ed),1967, Pakistan Movement: Historic Documents,p-77 ) which purported the 1947 partition of British India and establishment of Pakistan on the basis of religious separate identity. As later events proved, they were sadly mistaken. The primacy of Islamic traditions and sentiments cast aside by the Bengalis in East Pakistan in 1971 to fight the Pakistani crackdown and later deliberately excised by the new Bangladesh government, subsequently returned as a resilient and widespread political phenomenon. This was loosely characterized as Muslim identity, different from the Bang alee nationalism which was focused on secularism, language and literature.4 The international community was familiar with 'militant' Islam but Muslim consciousness in Bangladesh was not identical to the global Islamic fundamentalism. The growing Muslim consciousness in Bangladesh was still evolving its goals, strategies and tactics. In its broadest connotation, Muslim nationalism in Bangladesh was the sentiment and spirit of 'Muslim heritage and rule in Bengal. It was also the passion of belonging which girded, the Muslims through a common monotheistic faith and a nexus of culture, values, customs, experiences, traditions, personal laws, ways of life and rituals. These were perceived as their distinctive heritage which might, in fact, be the product of coevolving forces over a history. Its basic appeal was the sense of pride, recognition, a yearning for harmony and a mystique which made them 'feel good' and secure against internal constraints and external threats. However, the real arena of dispute between Islamic identity and Bang alee nationalism was its domestic politics. After the breakup of Pakistan, it was an uphill slog for the Islamists to regroup and reassert themselves as a viable political force. The primary objective of this paper is to examine the cultural and political dynamics of Islam and Muslim consciousness in Bangladesh and their confrontation with the secularists and the Bang alee nationalists and try to give an analysis on the nationalism trends of Bangladesh. DOI: 10.5901/ajis.2014.v3n1p439


In 1992, the Ontario Ministries of Transportation and Municipal Affairs and Housing published the Transit-Supportive Land Use Planning Guidelines. The Guidelines were focused on transit-friendly land use planning and urban design practices. Since it was published, the Ontario government has introduced policies such as the Growth Plan for the Greater Golden Horseshoe (2006) and the updated Provincial Policy Statement (2005) to manage growth, encourage more livable and walkable communities and to develop sustainable, multi-modal transportation networks. At the same time, Ontario has made the growth of transit ridership a priority through more than $10.8 billion in transit investments since 2003. Recently, the Ministry of Transportation undertook to update the original Guidelines to support continued progress in building more compact, transit-supportive communities. The new Transit-Supportive Guidelines (draft) take a comprehensive approach, bringing together the most current thinking on transit-supportive urban planning and design and best practices in transit planning and delivery of customer-oriented transit service. The Guidelines emphasize the inter-dependent relationship between transit ridership and land use patterns: that higher density communities need dependable transit systems to thrive, and in turn, transit systems rely on transit-supportive land uses to sustain and increase ridership. This paper illustrates the close relationship between land use, transportation options and travel behaviour, and the strategic approaches needed to integrate principles and practices of land use, transportation and transit service planning to achieve sustainable communities and multi-modal transportation systems. For the covering abstract of this conference see record control number 201111RT334E.


Ankle or subtalar arthroscopy is a commonly performed procedure. It is often desirable to perform a diagnostic or therapeutic ankle arthroscopy followed by an open lateral ankle or hindfoot surgery. Standard positioning for ankle or subtalar arthroscopy is supine with or without the use of noninvasive distractor. In order to save operative time and avoid repositioning and redraping the patient intraoperatively, the authors have developed a positioning technique for performing ankle or subtalar arthroscopy, as well as anterior or medial procedures, followed by sequential procedures of the lateral ankle or hindfoot.


Recently, Peer-to-Peer (P2P) techniques for Internet Protocol Television (IPTV) have attracted a lot of attention due to their high potential at improving the performance of today's multimedia systems. In this paper, we propose a novel concepts and mechanisms that enable the use of Scalable Video Coding (SVC) in Peer-to-Peer Television (P2PTV) system to achieve the quality adaptation. Using SVC, we have developed a two-stage quality adaptation algorithm that matches the video quality with available local and system resources. Key components with different our design options are presented and experimentally evaluated, with the objective of investigating benefits of network P2P in combination with SVC. We have carried out extensive experiments on real stream data to (i) evaluate the performance of our design in terms of adapted video stream SVC with available resources (ii) more robustness against high churn rates, heterogeneous peers, and flash crowd scenarios. Our results demonstrate the feasibility of the approach and bring us one step closer to real adaptive peer-to-peer streaming.


Between August 1990 and February 1991, nearly 1 million servicemen and women (670 000 from the United States, 45 000 from the United Kingdom and the rest from other nations) representing the United Nations were deployed to the Persian Gulf to oppose the Iraqi invasion of Kuwait. Within months of returning from the Gulf conflict, case reports of veterans complaining of multiorgan, non-specific symptoms began to emerge first in the United States and then the United Kingdom. Since then hundreds of millions of dollars and millions of pounds in research grants have been spent, yet the nature of ill health in Gulf veterans remains controversial.

Methodological flaws hampered early studies based on case reports, highly selected samples, and voluntary registers. These were followed by population based studies representative of the military that provided prevalence data on various indices of health. The main findings from these studies were firstly, Gulf veterans report symptoms more often than appropriate military controls; secondly, there is no evidence of a group of symptoms or conditions that are unique to Gulf veterans; thirdly, hospital admissions and death rates, except for accidents, are not increased in Gulf veterans; and fourthly, the most common symptoms reported are suggestive of mental health conditions—such as fatigue, sleeping problems, low mood, and cognitive difficulties.

Various exposures specific to the Gulf have been postulated: oil fires, pesticides, depleted uranium, vaccinations against biological agents, chemical agents, and combat stress. Several population based studies have now shown that self reported illness is associated with self reported exposures, but the same pattern is found in non-Gulf veterans, and no exposure has yet emerged as the single most important causal factor.1

Some investigators have used factor analysis, which considers the question of whether the correlations between a set of reported symptoms can be explained by a few …


The purposes of this research are to analyze factors affecting purchasing decision process and attitudes on evaluation of various brands of instant coffee powder.  The research samples were 99 students, selected from four faculties of the University of Lampung, who were met at the break time and agreed to be interviewed using questionnaires.  Data were analyzed using principal component analysis and Fishbeinmulti-atribute attitude analysis.  The results of this research showed that Torabika is the instant coffee powder brand was the most widely purchased, followed by Luwak White Koffie, Nescafe, Good Day, Kapal Api, ABC, and Indocafe. The results of factor analysis showed that the fourteen expected variables influenced the purchasing decision of instant coffee powder could be reduced into four main components.  The first principal component (internal factors) consists of aroma, flavor, consistency, and creamer.  The second principal components (external factors) consist of brand, advertising, pricing, and bonuses.  The third principal component (benefit factors) consists of reducing drowsiness and suitability of drinking with other food variables.  The fourth principal component (factors of excellence) consists of a non-pulpy, easily obtained.  Based on the evaluation of the consumer attitude variables, it showed that although the consumption of ABC brand was the least but it got the highest attitude value compared to other brands. If the attitudes of the students were sorted, ratings of the highest student attitudes were ABC, Nescafe, followed by Luwak White Koffie, Torabika, and Good Day. Key words: factor analysis, principal component analysis, analysis of Fishbein attitude, instant coffee


Condition assessment is an integral component in any infrastructure asset management system. Without condition information, asset managers lack the ability to make appropriate decisions regarding needed maintenance, rehabilitation, and replacement of infrastructure. Existing and emerging technologies for assessing the condition of water and sewer pipes provide a better picture of the state of these buried assets. Unfortunately, many of these technologies are costly and provide results that are not always highly reliable. This paper presents a methodology to assist asset managers in balancing the value of information revealed by a condition assessment technology with the cost of obtaining this information. The paper describes the computational platform of the developed methodology and focuses primarily on the optimization process that utilizes the partially observable Markov decision process (POMDP) and genetic algorithms. This policy determines the most appropriate condition assessment technology and interval between inspections. The developed methodology takes into consideration direct and indirect costs of infrastructure failure. Optimization models are developed at both the asset and network levels. A case study of the water distribution network for the city of Hamilton, Canada, is presented to demonstrate the use and capabilities of the developed methodology. At the asset level, results allow the asset manager to select the most suitable condition assessment technology and inspection interval for a particular pipe. At the network level, results enable the proper allocation of a condition assessment budget across all pipes in the system.


Many chronic diseases or health conditions manifest with recurring episodes, each of which can be characterized by a measure of intensity or severity. Both the number of episodes and the severity of each episode can depend on the latent severity of an individual's underlying condition. Data such as this are commonly gathered repeatedly at fixed follow‐up intervals. An example is a study of the association between stressful life events and the onset of depression. Stress exposure is assessed through the frequency and intensity of stressful life events occurring each month. Both the number of events and the intensity of each event at each measurement occasion are informative about the underlying severity of stress over time. One might hypothesize that people that approach the onset of a depressive episode have worse stress profiles than the controls, reflected by both more frequent and more intense stressors. We propose models to analyze data collected repeatedly on both the frequency of an event and its severity when both of these are informative about the underlying latent severity. Maximum likelihood estimators are developed, and simulations with small to moderate sample sizes show that the estimators also have good finite sample properties, and they are robust against misspecification of the model. This method is applied to a psychiatric data set. Copyright © 2013 John Wiley & Sons, Ltd.


Global quantitative estimations of ecosystem functions are vital. Among those, ecosystem respiration and photosynthesis contribute to carbon cycling and energy flow to food webs. These can be estimated in streams with the open channel diel oxygen method (single or two stations) essentially relying on a mass balance of oxygen over a defined reach. The method is generally perceived as low cost and easy to apply with new drift free optic sensors. Yet, it remains challenging on several key issues reviewed here: measurements of gas transfer at the air‐water interface, appropriate mixing of tracers, uncertainty propagation in the calculations, spatial heterogeneity in oxygen concentrations, the derivation of net primary production (NPP) or autotrophic respiration, and the temperature dependence of photosynthesis and respiration. An extremely simple modeling tool is presented in an Excel workbook recommended for teaching the basic principles of the method. The only method able to deal with stream spatial heterogeneity is the method by Demars et al. Example data, Excel workbook, and R script are provided to run stream metabolism calculations. Direct gas exchange determination is essential in shallow turbulent streams, but modeling may be more accurate in large (deep) rivers. Lateral inflows should be avoided or well characterized. New methods have recently been developed to estimate NPP using multiple diel oxygen curves. The metabolic estimates should not be systematically temperature corrected to compare streams. Other recent advances have improved significantly the open channel diel oxygen method, notably the estimation of respiration during daylight hours.


Objective. To evaluate if magnetic resonance imaging (MRI) is superior to conventional radiography for detection of erosions in the fifth metatarsophalangeal (MTP5) joint. Methods. Within one year from the onset of rheumatoid arthritis (RA) (baseline), one and three years thereafter MRI and conventional radiographs of the MTP5 joint were performed in 23 patients. Results. MRI revealed erosions in 10 patients at baseline, in 15 after one year and in 15 patients after 3 years. On conventional radiography, there were erosions in 10 patients at baseline, 16 after one year as well as after 3 years. The agreement between the two imaging methods was fair to good at baseline and after one and three years (kappa 0,65, 0,51 and 0,51 respectively). The number of patients with clinical evidence of synovitis decreased considerably over time although the number of patients with MRI‐synovitis was unchanged and the number of patients with erosions increased. Conclusions. MRI was not superior to conventional radiography in detecting erosions in MTP5 joints in patients with early RA. Most erosions developed during the first year of observation. Synovitis on MRI may be a marker of future development of erosions in the MTP5 joint.


This work presents an effective algorithm for radio frequency interference (RFI) identification using dynamic power spectrum statistics in the frequency domain. Statistical signal processing techniques such as hypothesis testing and variance analysis are utilized to derive a test statistic for effective and efficient RFI identification. Starting from the generalized likelihood ratio test (GLRT), we formulate the problem systematically and propose a practical test statistic T(x; f), shown to be F distributed, for RFI identification. A threshold approach working on this test statistic is developed to identify the presence of narrowband RFI in the power spectrum with additive Gaussian noise and/or solar flare background, corresponding to a desired constant false alarm rate (CFAR). Detailed analysis on detector performance and effect of RFI duty cycle are also provided. The proposed statistical test is applied to experimental solar data collected by our frequency-agile solar radio telescope (FASR) subsystem testbed (FST) to demonstrate the robustness and scalability of the algorithm, as well as its capability for real-time implementation.


Background: Obesity during pregnancy is associated with increased risk of gestational diabetes and other complications. Although physical activity (PA) is a modifiable lifestyle factor that may help prevent these complications, many women become less active in pregnancy. Antenatal interventions are on-going but few identify the behaviour change mechanisms by which the intervention is expected to work. To enhance the effectiveness of interventions tools in behavioural science; the Theoretical Domains Framework (TDF) and COM-B model have been employed to help understand behaviours. Using these methods, this study aimed to identify the enablers and barriers to PA in overweight and obese pregnant women.

Methods: Semi-structured interviews were conducted with a purposive sample of overweight and obese pregnant women attending a public antenatal clinic in a maternity hospital in Cork, Ireland. Interviews were recorded and transcribed. The framework approach was employed, drawing on the TDF and COM-B model.

Results: Social opportunity to engage in PA was identified as an enabler; pregnant women suggested being active was easier when supported by their partners. Knowledge was a commonly reported barrier with women lacking information on safe activities and describing the information received as 'limited'. Physical capability and physical opportunity to carry out PA were also identified as barriers; experiencing pain, lack of time, other children, and working prevented women from being active.

Conclusion: This study is a theoretical starting point in making a 'behavioural diagnoses' and the results will be used to inform the development of a PA intervention for overweight and obese pregnant women.


Whether the volcanism of the Columbia River Plateau, eastern Snake River Plain, and Yellowstone (western U.S.) is related to a mantle plume or to plate tectonic processes is a long-standing controversy. There are many geological mismatches with the basic plume model as well as logical flaws, such as citing data postulated to require a deep-mantle origin in support of an "upper-mantle plume" model. USArray has recently yielded abundant new seismological results, but despite this, seismic analyses have still not resolved the disparity of opinion. This suggests that seismology may be unable to resolve the plume question for Yellowstone, and perhaps elsewhere. USArray data have inspired many new models that relate western U.S. volcanism to shallow mantle convection associated with subduction zone processes. Many of these models assume that the principal requirement for surface volcanism is melt in the mantle and that the lithosphere is essentially passive. In this paper we propose a pure plate model in which melt is commonplace in the mantle, and its inherent buoyancy is not what causes surface eruptions. Instead, it is extension of the lithosphere that permits melt to escape to the surface and eruptions to occur—the mere presence of underlying melt is not a sufficient condition. The time-progressive chain of rhyolitic calderas in the eastern Snake River Plain–Yellowstone zone that has formed since basin-range extension began at ca. 17 Ma results from laterally migrating lithospheric extension and thinning that has permitted basaltic magma to rise from the upper mantle and melt the lower crust. We propose that this migration formed part of the systematic eastward migration of the axis of most intense basin-range extension. The bimodal rhyolite-basalt volcanism followed migration of the locus of most rapid extension, not vice versa. This model does not depend on seismology to test it but instead on surface geological observations.


After a patient presents with symptoms of illness and undergoes treatment, there are three features of care that require assessment: the impact of delivering care on the patient, the benefits and harms of treatment, and the functioning of the health care system. This formulation leads to three types of outcomes of care delivery that require assessment: 1) patient outcomes, which reflect the impact on patients of undergoing care; 2) treatment outcomes, which reflect the intended and unintended medical consequences of undergoing therapy; and 3) system outcomes, which reflect the impact on the system of delivering health care to a group of patients. In this paper, examples of these three types of outcomes are presented, with particular reference to coronary artery bypass graft surgery. It is argued that the current focus of computer simulation models on system outcomes should be expanded to include patient and treatment outcomes.


Quantum Cascade Lasers (QCL's) are unipolar semiconductor lasers offering the
potential for low cost, high power, laser sources emitting in the mid- and far- infrared.
Single-mode devices are required for spectroscopic and imaging applications because
of their narrow emission linewidth and are achieved through distributed feedback
(DFB) designs where gratings are incorporated in or close to the active region. This
thesis describes design and fabrication technologies for single-mode yield
improvements and improved wavelength targeting of QC lasers.
Mid-infrared, single-mode laser designs are developed utilising novel fabrication
processes and designs in the indium phosphide (InP) based material system. Lasers
without facet coatings, with single-mode yields up to 80% and side mode suppression
ratios (SMSR) greater than 25dB are observed. Metalised surface gratings, buried
(overgrown) gratings and lateral gratings are defined using inductively coupled
plasma (rCP) etching to produce DFB lasers operating above room temperature for
wavelengths near to lOllm. A deep etched lateral grating quantum cascade DFB is
demonstrated for the first time in the InP material system.
Waveguide modelling demonstrates accurate methods to predict the grating coupling
strength of the DFB lasers with good agreement to experimental results. The emission
wavelength (A. -IOllm) is found to be highly dependent on the laser ridge width with
the experimental shift in wavelength found to be much greater than that predicted. A
ridge width and temperature dependence on emission wavelength is utilised in an
array device where a continuous tuning range in excess of 230nm is observed.
ii
Finally, an increase in thermal conductance and a symmetric far-field profile are
observed for lasers (A. - 4J.lm) with narrow ridge widths. The lasers were designed for
improved heat extraction from the active region and a beam quality factor of M2 ::::: 1.
Almost identical lateral and vertical far-field profiles with high duty cycle operation at
thermoelectric temperatures are observed for a ridge waveguide laser that is
approximately 5 J.lm wide.


Job satisfaction is a positive feeling of employees toward their job because unsatisfied employees are quite their job. Satisfied employees are less absent, contribute to the benefit of an organization and stay in the organization. Only happy employees should enhance organizational efficiency and performance. It is a combination of psychological, physiological and environmental circumstance which derives to the person; I am satisfied with my job. It is accepted that individual differences in employee job satisfaction can be measured and managed by an organization. This study was organized to identify the variables influencing job satisfaction of administrative staffs, so the samples were taken from randomly selected campuses, TU in Kathmandu Valley.
Primary data were collected from distribution 148 structured questionnaires with six points Likert scale developed in the Job description index (JDI). Only 106 respondents' opinions were analyzed by the bits of the help of descriptive and inferential statistical tools. The finding showed that satisfied variables are co-workers, supervisors and promotion. The satisfaction level of gender has not found different but different according to age groups.


Summary Storage of aseptically packed UHT milk produced changes in the electrophoretic pattern of the milk caseins when the milk was stored at ambient or higher temperatures. Lower temperature storage at 4°C did not give rise to these changes. The alterations in electrophoretic properties of the caseins appeared to be due to the action of carbonyl compounds, produced by a Maillard type of reaction, which led to changes in the charge of the protein together with some degree of polymerization. These conclusions have been drawn from results obtained on model systems of casein-lactose subjected to various heat treatments, and on casein and milk treated with acetaldehyde. Changes in the sensitivity to calcium ions of individual caseins, whole casein and milk that had been subjected to various heat treatments or to treatment with acetaldehyde showed that all these different treatments gave rise to modified casein which, in general, became less sensitive to calcium. κ-Casein when treated alone rapidly lost its ability to protect αs1-casein from precipitation by calcium ions, while αs1-casein treated alone only gradually became more soluble in the presence of calcium. Thus, on treating whole casein there was evidence for a stability minimum when the protective ability of the κ-casein has been destroyed without a compensating gain in the stability of the αs1-casein. The importance of these changes in relation to the stability of UHT milks has not yet been elucidated but the results indicate that cross linking between protein chains and changes in calcium sensitivity occur during long-term storage.


TO THE EDITOR: MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) syndrome has not been reported previously in the Aboriginal Australian population. Here, we describe a patient with MELAS syndrome in this population. A 29-year-old Aboriginal Australian woman presented with a 3-day history of seizures and confusion and a background of cognitive impairment, sensorineural deafness, epilepsy and short stature. On admission, she weighed 29.9 kg and was 1.46 m tall (body mass index, 14 kg/m). She had myopathic facies, generalised mild motor weakness (4/5) and brisk reflexes (3+). These neurological findings represented a stepwise deterioration from previous assessments. On admission, the patient's blood count, liver function tests, and serum urea, electrolytes and creatinine levels were normal. Her plasma bicarbonate level, anion gap and thyroid function were also normal. The patient had elevated resting arterial lactate (2.7mmol/L; reference interval [RI], 0.7–2.5 mmol/L) and pyruvate (98mol/L; RI, 30–90mol/L) levels. The cerebrospinal fluid (CSF) protein concentration was 820 mg/L (RI, 150–500 mg/L) and the CSF lactate level was 5.4mmol/L (RI, 0.7–2.5 mmol/L). Magnetic resonance imaging of the patient's brain demonstrated increased T2 signal involving grey and white matter throughout both cerebral hemispheres, most confluent in the right temporal and parietal lobes (Box 1, A). An electroencephalogram displayed a slow rhythm with epileptic activity in the temporal and centroparietal regions. Histological examination of a biopsy of the gastrocnemius muscle was consistent with MELAS syndrome (Box 1, B). Electron microscopy of a muscle biopsy sample revealed mitochondria with abnormally arranged cristae and abnormal electron densities. Mitochondrial respiratory chain enzyme studies on muscle samples were within normal limits, but the common m.3243A>G mutation in the MTTL1 gene was detected in about 70% of the mitochondrial DNA (mtDNA) in muscle tissue and in 10% of the mtDNA of the peripheral blood. MELAS syndrome is a maternally inherited multisystem disorder resulting from mutations in mtDNA.1 Mitochondrial dysfunction leads to the clinical phenotype and lactic acidosis. Cerebral ischaemia unrelated to vascular territories is suggestive of the diagnosis, which is confirmed by genetic studies, enzyme assays and histological examination of affected tissue.3 The patient's family was of Aboriginal Australian descent and she was not aware of any European ancestry. Further inquiry revealed a family history of deafness, diabetes and epilepsy (Box 2). Consequently, the family were offered genetic counselling. A literature review prompted initiation of arginine and coenzyme Q10 therapy. Twelve months "MELAS ... syndrome has not been reported previously in the Aboriginal Australian population


A 36-year-old woman with diabetes mellitus complained of left flank pain and high fever. Drip infusion pyelogram (DIP) did not visualize the left kidney, but revealed crescent-shaped gas formation within the left renal shadow. Abdominal computerized tomography showed a subcapsular shadow in the left kidney. Because her symptoms was aggravated, left nephrectomy was performed under the diagnosis of emphysematous pyelonephritis. There was no manifestation of her prior symptoms after the operation, and she was discharged on the 19th postoperative day. In Japan, 43 cases of emphysematous pyelonephritis have been reported in the literature. These 43 cases were studied clinically and in comparison to the cases reported in Western countries. The male-to-female ratio was approximately 4 to 1, in contrast to the Western ratio of female preponderance. The age of the patients showed its peak at the 50-60's, the mean age being not significantly different from that of Western patients. 37% of the patients had the affected side on the right, 56% on the left, and 7% bilaterally. This was comparable to the results of Western countries. 93% of the subjects suffered from diabetes mellitus as the basal malady, which was comparable to that in Western studies. However, patients afflicted with urinary passage impairment accounted for 14%. This incidence was lower than that reported in Western studies.(ABSTRACT TRUNCATED AT 250 WORDS)


The rapid developments of internet and communication technologies have materially altered many characteristics and concepts of the learning environment. E-learning is highly beneficial to developing countries and believed to have high potential for governments struggling to meet a growing need of education while facing shortage of expert teachers, shortage of update textbooks and limited teaching materials. The objective of this study is to investigate the vital challenges of implementing e-learning systems in far western region of Nepal. The results of this study provided basic mechanism for improving higher education in developing countries. There are a number of commercial or free e-learning systems in the market. Majority of these e-learning systems provide lot of functions and modules. Some courses are entirely based on e-learning instead of traditional learning model. E-learning system also offers graphs and charts of student's results. This system is based on linear workflow. That means students can see new learning resources and tests only after previous was done. Students can also create their own learning plan by defining dates. System is able to export this plan into general calendar format or remind students via e-mail.


Despite almost three decades of strong and stable growth after World War II, the US economy, like the economies of many developed nations, faced new headwinds and challenges after 1970. Although the United States eventually overcame many of them, and continues to be one of the most dynamic in the world, it could not recover its mid-century economic miracle of rapid and broad-based economic growth.
 There are three major ways the US economy changed in this period. First, the US economy endured and eventually conquered the problem of high inflation, even as it instituted new policies that prioritized price stability over the so-called "Keynesian" goal of full employment. Although these new policies led to over two decades of moderate inflation and stable growth, the 2008 financial crisis challenged the post-Keynesian consensus and led to new demands for government intervention in downturns.
 Second, the government's overall influence on the economy increased dramatically. Although the government deregulated several sectors in the 1970s and 1980s, such as transportation and banking, it also created new types of social and environmental regulation that were more pervasive. And although it occasionally cut spending, on the whole government spending increased substantially in this period, until it reached about 35 percent of the economy.
 Third, the US economy became more open to the world, and it imported more manufactured goods, even as it became more based on "intangible" products and on services rather than on manufacturing. These shifts created new economic winners and losers. Some institutions that thrived in the older economy, such as unions, which once compromised over a third of the workforce, became shadows of their former selves. The new service economy also created more gains for highly educated workers and for investors in quickly growing businesses, while blue-collar workers' wages stagnated, at least in relative terms.
 Most of the trends that affected the US economy in this period were long-standing and continued over decades. Major national and international crises in this period, from the end of the Cold War, to the first Gulf War in 1991, to the September 11 attacks of 2001, seemed to have only a mild or transient impact on the economy. Two events that were of lasting importance were, first, the United States leaving the gold standard in 1971, which led to high inflation in the short term and more stable monetary policy over the long term; and second, the 2008 financial crisis, which seemed to permanently decrease American economic output even while it increased political battles about the involvement of government in the economy.
 The US economy at the beginning of the third decade of the 21st century was richer than it had ever been, and remained in many respects the envy of the world. But widening income gaps meant many Americans felt left behind in this new economy, and led some to worry that the stability and predictability of the old economy had been lost.


On my (AK) first day on the patient floors as a medical student, I couldn't help but notice the buzzing, beeping, cacophony of alarms that ostensibly indicated impending danger for just about every patient on the unit. I looked around, waiting for someone (a nurse, a doctor, anyone) to react. Yet thus far in my brief career, I've come to learn that most of the alarms I hear do not indicate emergencies, and in fact most do not warrant any clinical intervention at all. As a result, the buzzing and beeping fades into the background now.

Physiologic monitor alarms are intentionally designed to alert clinicians immediately to any deviation from the norm, regardless of the quality of the signal or cause of the deviation.1 In theory, this design ensures that doctors and nurses will always be informed of physiologic changes to respond to important deterioration events quickly.

However, we know that monitors generate frequent alarms (39–352 alarms per patient, per day)2–9 and that a high proportion are false, defined as not being actionable (>90% of pediatric ICU2,3 and >70% of adult intensive care alarms).6,7 The task of separating the true, actionable alarms from the false or nonactionable alarms falls to the clinicians responsible for responding to alarms, who in most settings are nurses.

However, we rely on nurses for myriad other important responsibilities that we really care about, from administering antibiotics to a septic child, to discharging a kid with asthma so the mother can pick up the child's inhaler before the pharmacy closes. Thus, nurses are forced to make difficult decisions on a nearly continuous basis about whether to respond to alarms from different patients or to continue with the tasks at hand, assuming that the alarms do not …


Purpose: The goal of this study was to develop a technique for creating a computerized composite maxillofacial-dental model, based on point-based surface best fit algorithm and to test its accuracy. The computerized composite maxillofacial-dental model was made by the three dimensional combination of a 3-dimensional (3D) computed tomography (CT) bone model with digital dental model. Materials and Methods: This integration procedure mainly consists of following steps : 1) a reconstruction of a virtual skull and digital dental model from CT and laser scanned dental model ; 2) an incorporation of dental model into virtual maxillofacial-dental model by point-based surface best fit algorithm; 3) an assessment of the accuracy of incorporation. To test this system, CTs and dental models from 3 volunteers with cranio-maxillofacial deformities were obtained. And the registration accuracy was determined by the root mean squared distance between the corresponding reference points in a set of 2 images. Results and Conclusions: Fusion error for the maxillofacial 3D CT model with the digital dental model ranged between 0.1 and 0.3 mm with mean of 0.2 mm. The range of errors were similar to those reported elsewhere with the fiducial markers. So this study confirmed the feasibility and accuracy of combining digital dental model and 3D CT maxillofacial model. And this technique seemed to be easier for us that its clinical applicability can good in the field of digital cranio-maxillofacial surgery.


This mixed-methods study explored how participation in an intensive course on human-animal relationships impacted preservice teachers' views about human-animal welfare and advocacy and animal-focused curriculum. Participants were 25 undergraduate students (24 female; 1 male) following a teacher education pathway. Participants completed the Animal Rights Scale, and their insights on assigned readings were captured through weekly journal entries and responses to summative prompts. Participants reported feeling increased responsibility to advocate on behalf of nonhuman animals and greater support of animal welfare during the post-course (versus pre-course) assessment, and participants' weekly and summative responses revealed some of the nuances and internal tensions in their thinking about integrating animal-focused curriculum as part of their future professional practice. As teachers play key roles fostering humane literacy and engaging young people with actual nature and animals, these findings have implications for both education and higher education curriculum and initiatives.


Since 1980, the number of legal abortions reported to CDC has remained fairly stable, varying each year by less than 3%. In 1988, 1,371,285 abortions were reported--a 1.3% increase from 1987. The abortion ratio for 1988 was 352 legally induced abortions/1,000 live births, and the abortion rate was 24/1,000 women ages 15-44 years. The abortion ratio was higher for black women and women of other minority races and for women less than 15 years of age. However, the abortion ratio for women less than 15 years was lower in 1988 than in any previous year since 1972. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to live in a metropolitan area, 3) to have had no previous live births, and 4) to be having the procedure for the first time. Approximately half of all abortions were performed before the eighth week of gestation, and greater than 85% were performed during the first trimester of pregnancy (less than 13 weeks of gestation). Black women and women of other minority races tended to obtain abortions later in pregnancy than did white women; however, age was a more dominant influence than race. Younger women tended to obtain abortions later than older women. Educational level strongly influenced when an abortion was performed; better educated women had an abortion earlier in gestation.


Introduction: Rasaushadhies (metal and mineral) preparations are unique preparations that include Bhasma, herbo-mineral preparations and Kupipakwa rasayana hold a significant place in Ayurvedic pharmaceutics. Nearly 70 % of formulations include a combination of one or more metallic/mineral with several herbs which have a supporting role in improving efficacy, relieving symptoms of the disease and to achieve long and healthy life. Shilasindur is a one of the Kupipakwa rasayana containing mercury, sulphur and arsenic disulphide and indicated in skin disorders, respiratory tract disorders and other infectious diseases.
Aim and Objectives: Evaluation of repeated dose (Sub chronic) toxicity study of Shilasindur along with its characterization and antimicrobial activity.
Materials & Methods: Shilasindur will be prepared in three batches as per classical reference and by using Electric Muffle furnace. The prepared formulation will be assessed with Organoleptic characters, physicochemical parameters and ICP – AES (Inductively coupled plasma atomic emission spectroscopy), FTIR (Fourier-transform infrared spectroscopy), XRD (X-Ray Diffraction). Sub chronic toxicity study will be carried out according to the OECD guidelines 408 and 452 as well as CCRAS guidelines of safety and toxicity.  Epsilometer test (E-test) will be used to check antimicrobial activity of Shilasindur.
Results: The analytical parameters will be assessed to establish the pharmaceutical standardization. Toxicity study will be done in three doses to ensure its safety. Statistical analysis will be done by applying unpaired t-test and ANOVA test.
Conclusion: If significant positive results obtained in this work then it will be a valuable contribution and evidence that the drug Shilasindur is safe for consumption at treatment doses.


While natural gas is achieving unrivalled penetration in the power generation sector, especially in gas-turbine combined cycles (CCGT), an increasing number of alternative fuels are in a position to take up the ground left vacant by this major primary energy. In particular, within the thriving family of liquid fuels, the class of volatile products opens interesting prospects for clean and efficient power generation in CCGT plants. Therefore, it has become a necessity for the gas turbine industry to extensively evaluate such new fuel candidates, among which: naphtha's; kerosines; gas condensates; Natural Gas Liquids (NGL) and alcohols are the most prominent representatives. From a technical standpoint, the success of such projects requires both a careful approach to several specific issues (eg: fuel handling & storage, operation safety) and a clear identification of technological limits. For instance, while the purity of gas condensates meets the requirements of heavy-duty technologies, it generally appears unsuitable for aeroderivative machines.This paper offers a succinct but comprehensive technical approach and overviews some experience acquired in this area with heavy duty gas turbines. Its aim is to inform gas turbine users/engineers and project developers who envisage volatile fuels as alternative primary energies in gas turbine plants.© 1998 ASME


The accidental or therapeutic exposure of human skin to ionizing radiation is known to cause the radiation syndrome with its various manifestations. The aim of the study was to investigate the potential radioprotective effects of the protein-free hemodialysate Actovegin. After exposure to X-rays (single dose, 6 Gy), 70% of the cells died. In the presence of the hemodialysate, irradiation did not lead to cell death. Instead a slight increase in cell number was observed. A 5-fold increased cell number was found after 6 days when the cells were treated with the hemodialysate alone. To elucidate molecular mechanisms of the observed biological effects the correlation between the expression of the epidermal growth factor receptor (EGFR) and the demonstrated growth activation was investigated. Radiation alone resulted in a clear induction of EGFR, whereas the combination of irradiation and Actovegin treatment led to a strong downregulation after 2 days. Thus, the hemodialysate suppressed one of the radiation-induced effects. Further investigations have to elucidate the role of other proteins which are involved in the signal transduction cascade of tyrosine kinases (e.g. Ras, Raf, MAP kinases) leading to the transcription factor AP-1 in response to radiation under Actovegin treatment.


A male infant affected by type 0 SMA with one copy of SMN2 received early treatment with Nusinersen at the age of 13 days. He showed mild motor improvement 2 months after treatment started but despite also showing some minimal respiratory improvement, required tracheostomy at the age of 4 months and had increasing cardiac and autonomic dysfunction leading to exitus at 5 months. Our findings, expanding the results available on Nusinersen, confirm its relative efficacy in the most severely affected infants and provide clinical evidence to be used at the time requests for treating severe infants are discussed.


BACKGROUND
The trend of chronic diseases is increasing globally. Socioeconomic status (SES) is a major factor underlying many chronic diseases. This study was conducted to investigate the socioeconomic inequalities in distribution of chronic diseases in Iran, as a middle-income country.

METHODS
This cross-sectional study was conducted using the baseline data of the Kharameh cohort study, that were collected between 2014 and 2016. The number of participants in this study was 10663 people in the age range of 35 to 70 years. Principal component analysis was used for calculating the SES of the people under study. In addition, we used concentration index and concentration curve to measure socioeconomic inequality in chronic disease.

RESULTS
The mean age of 10,663 participants in our study was 52.15±8.22 years and the male to female ratio was 1.26. Recurrent headache (25.8%( and hypertension (23.5%) were the most prevalent diseases. The concentration index showed that the distribution of movement disorder, recurrent headaches and gastroesophageal reflux diseases is significantly concentrated among people with low SES, and obesity among people with high SES. The results of the analysis by gender were similar to the results seen in all participants.

CONCLUSION
The findings of this study show that socioeconomic inequality is the cause of the concentration of non-communicable diseases among people with low socio-economic status. Therefore, health policy makers should pay special attention to identifying vulnerable subgroups and formulate strategic plans to reduce inequalities.


We describe aortic valve endocarditis caused by Bartonella quintana in a 31-year-old man. The diagnosis was made on the basis of polymerase chain reaction amplification of the B quintana citrate synthase gene from cardiac valve tissue, the compatibility of histochemical stains of cardiac valve tissue, and serologic studies.


Introduction: Asosiasi untuk Demokrasi dan Kesejahteraan Sosial (Ademos) was founded as a form of anxiety towards rural communities whose majority of the population does not receive enough attention and access to economic development. One of the empowerment programs is a program to improve the quality of the Bojonegoro batik craftsmen. Workers can work more than 8 hours a day in a sitting and bending position for long periods of time. This study aimed to determine the correlation between the length of work and exercise routines on musculoskeletal complaints among batik craftsmen of Ademos, Bojonegoro Regency. Methods: This research was a descriptive analytic study using a cross-sectional design. The research was conducted in July-August 2020 on Ademos batik craftsmen in Bojonegoro Regency. The total population of the study was 42 batik craftsmen who were selected using a total sampling technique. The variables studied included tenure, exercise routines, and musculoskeletal complaints. Data collection was carried out through questionnaire sheets, observations and the Nordic Body Map Questionnaire. Results: The results of the study found that there was a significant correlation between working period and musculoskeletal complaints (p=0.032) experienced by Batik craftsmen of Ademos Bojonegoro. On the other hand, there was no correlation found between exercise routines and musculoskeletal complaints (p=0.361) on Batik craftsmen of Ademos Bojonegoro. Conclusion: The significant factor causing musculoskeletal complaints in Ademos Bojonegoro Batik craftsmen was the working period factor.


Low river flows and droughts are increasingly being observed over the last decades in Europe. Moreover, in vast areas drought will likely increase due to climate change? The increasing trends to more severe drought are explained in the context of growing water scarcity that also is reported in many European regions. Water scarcity often enhances drought impacts. First, trends in historic European drought events are discussed. Then understanding of transformation of meteorological drought into soil moisture and hydrological drought (groundwater, streamflow), which is called drought propagation, is described. Knowledge on drought propagation is essential for water resources management. Water scarcity in Europe and its spatial distribution is touched upon, incl. an observational- modelling framework that is being proposed to distinguish between water scarcity and drought. We conclude with an assessment of future drought and water scarcity due to global change and implication of the use of modeling chain approaches, incl. uncertainty.


In this study, a thermodynamic model of an active direct methanol fuel cell (DMFC) system, which couples in‐house experimental data for the DMFC with the mass and energy balances for the system components (condenser, mixing vessel, blower, and pumps), is formed. The modeling equations are solved using the Engineering Equation Solver (EES) program. This model gives the mass fluxes and thermodynamic properties of fluids for each state, heat and work transfer between the components and their surroundings, and electrical efficiency of the system. The effect of the methanol concentration (between 0.5 and 1.25 M) and air flow rate (between 20 and 30 mL cm−2 min−1) on the net power output and electrical efficiency of the system and the condenser outlet temperature is investigated. The results essentially showed that the highest value for the electrical efficiency of the system is 23.6% when the current density, methanol concentration, and air flow rate are taken as 0.2 A cm−2, 0.75 M, and 20 mL cm−2 min−1, respectively. In addition, the air flow rate was found to be the most significant parameter affecting the condenser outlet temperature.


Nuclear fusion reactor plasmas will need to exhaust a significant proportion of energy flux through radiative processes, to enable acceptable divertor loads. This can be obtained by line radiation from impurities, injected from the plasma edge. There are however limitations on the sustainable impurity content, since radiation from the core can lead to a deleterious electron heat sink. Moreover, dilution of the main ions reduces the available fuel. Simultaneously, impurities have an impact on the turbulent transport, both by dilution and by changes in the effective charge. Recent experiments at JET point towards an improvement in plasma confinement in neon seeded discharges with respect to purer equivalent plasmas. In this paper the impact of the impurities on the confinement is studied, isolating various effects. First-principle-based integrated modelling with the QuaLiKiz quasilinear turbulent transport model explains the improvement by a combination of higher pedestal temperature, increased rotation shear, and impurity-induced microturbulence stabilization. These results are optimistic with respect to the maximum impurity levels allowed in ITER and future reactors. Comparison between QuaLiKiz and higher fidelity gyrokinetics has exposed issues with QuaLiKiz impurity peaking predictions with rotation.


Waterborne acrylic emulsion was obtained by using methyl methacrylate, ethyl and butyl acrylate monomers. Emulsions containing nanoparticles were prepared by blending the stable dispersions containing SiO2 or MMT nanoparticles. The films were prepared from emulsions and coating tests were applied. The physical properties of prepared emulsions are better than the commercial emulsions. The addition of the nanoparticles especially SiO2 have positive effect on the resistance to environmental conditions of emulsions. Waterborne acrylic emulsions containing nanoparticles prepared in this study can be used in the manufacturing of the semi-lustrous emulsion type nano paint with low cost, high performance and environmentally friendly.


The affinity of patulin for sulfur dioxide (SO2) is much less than was previously reported and is of little significance at the SO2 concentrations (below 200 ppm) used in the processing of apple juice and cider. However, at concentrations of 2000 ppm SO2 and 15 ppm patulin, combination was 90% complete in 2 days. Removal of SO2 liberated only part of the patulin, which suggests that 2 mechanisms are involved: one reversible (opening the hemiacetal ring) and one irreversible (SO2 addition at the double bond). Test with 2 yeasts used in English commercial cider making confirmed that patulin is effectively removed during yeast fermentation.


Localizing a bug in a program can be a complex and time- consuming process. In this paper we propose a code coverage-based fault localization method to prioritize suspicious code in terms of its likelihood of containing program bugs. Code with a higher risk should be examined before that with a lower risk, as the former is more suspicious (i.e., more likely to contain program bugs) than the latter. We also answer a very important question: how can each additional test case that executes the program successfully help locate program bugs? We propose that with respect to a piece of code, the aid introduced by the first successful test that executes it in computing its likelihood of containing a bug is larger than or equal to that of the second successful test that executes it, which is larger than or equal to that of the third successful test that executes it, etc. A tool, chiDebug, was implemented to automate the computation of the risk of the code and the subsequent prioritization of suspicious code for locating program bugs. A case study using the Siemens suite was also conducted. Data collected from our study support the proposal described above. They also indicate that our method (in particular Heuristics III (c), (d), and (e)) can effectively reduce the search domain for locating program bugs.


The image search engines have been effective tools to find pictures from the Internet. They provide a list of image items in response to a user's query, and rank the items according to their relevance to the query. An image item is often accompanied with a short descriptive text, which is brief text summaries extracted from the webpage title, content, image caption, or its metadata, to provide auxiliary information about the image. In this paper, we present a new and effective descriptive text generation method by using the idea of summarizing an image's surrounding text, using text's position information, and finding an image's nearest neighbors.


The study aims to reveal the transition features of agricultural land use in the Groundnut Basin of Senegal from 2009 to 2018, especially the impact of urbanization on agricultural land and the viewpoint of farmland spatiotemporal evolution. Integrated data of time series MCD12Q1 land-use images of 2009, 2012, 2015, and 2018 were used to provide a land transition in agricultural and urban areas through the synergistic methodology. Socio-economic data was also used to serve as a basis for the argument. The results highlight that: (1) Agricultural land increased by 14.53%, with a dynamic index of 1.45 from 2009–2018. (2) Over the same period, urbanization increased by 2.80%, with a dynamic index of 0.28. (3) In different regions, the transition of agricultural land in Kaffrine is most intense (expansion rate: 22.80%). The same situation of urbanization happened in Thiès Region with a value of 7.94%. Except for Thiès, agricultural land in other regions has not yet been subject to major pressure due to urbanization. Overall, the farming system in Groundnut Basin is an extensive model, the recommendations from the point of view of land-use planning and land law are necessary to ensure efficient agricultural land management in the area.


We consider the quickest change detection problem where both the parameters of pre- and post- change distributions are unknown, which prevents the use of classical simple hypothesis testing. Without additional assumptions, optimal solutions are not tractable as they rely on some minimax and robust variant of the objective. As a consequence, change points might be detected too late for practical applications (in economics, health care or maintenance for instance). Available constant complexity techniques typically solve a relaxed version of the problem, deeply relying on very specific probability distributions and/or some very precise additional knowledge. We consider a totally different approach that leverages the theoretical asymptotic properties of optimal solutions to derive a new scalable approximate algorithm with near optimal performance that runs~in~$\mathcal{O}(1)$, adapted to even more complex Markovian settings.


BackgroundThe Covid-19 pandemic brought many changes to palliative care. Services had to rapidly adapt to provide the structures needed in challenging and evolving conditions. Service workforces contained palliative medicine trainees who, alongside providing clinical care, were also required to fulfil training competencies. This study explored the impact of the pandemic on training (both positive and negative) including the adaptations made and the ongoing legacies.MethodA UK-wide survey was distributed to all palliative medicine trainees through Association of Palliative Medicine regional trainee representatives. Responses were received from over 70% of deaneries. The survey collected qualitative and quantitative data and considered changes to the workplace and training.ResultsAll trainees recognised changes to consultations across all care settings with a particular increase in telephone and video interactions. There were numerous positive work opportunities. Trainees were involved in policy, guideline and educational resource development and complex clinical situations such as the withdrawal of non-invasive ventilation. Education changed. Initially formal education provision was suspended. Subsequently, the shift to virtual platforms had the benefit of reducing travel and increasing flexibility allowing easier access to national speakers and shared resources. Consequently, for many regions it has remained in place. The survey respondents highlighted challenges in assessments particularly Direct Observation of Procedural Skills (DOPS) and Mini-Clinical Examinations (mini-CEX) due to a combination of increased workload, reduced joint reviews and limitations on movement between different clinical areas.ConclusionThe survey showed that there were definite challenges for trainees that arose from the Covid-19 pandemic however there were also positive changes particularly around education. Further work should explore whether there needs to be a greater emphasis on virtual consultation skills in training.


Background and Aims: Frontal QRS-T angle has been previously correlated with long term mortality in ST-segment elevation myocardial infarction patients. This study aimed to investigate the prognostic value of frontal QRS-T angle and in-hospital outcomes in the setting of ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.
Methods: We evaluated 97 consecutive patients presenting to the emergency department of Shahid Gangalal National Heart Centre with chest pain of less than 12 hours duration, who were subsequently diagnosed as ST-segment elevation myocardial infarction in a prospective observational study. The study was conducted from July 2020 to June 2021.The data evaluation included demographics, clinical variables, electrocardiogram, length of hospital stay and in hospital mortality. Patient outcomes were stratified into three groups according to frontal QRS-T angle. The relationship between mortality and frontal QRS-T angle was tested with chi-square test. The p-value across the groups was again tested for inter-group significance.
Results: Out of 97 patients 67 (69.07%) were male and 30 (30.92%) were female., The mean age of study population was 55.8±11.8 years. The patients under study were divided into three groups based on the calculation of fQRST angle as Group 1 (0-45°) being 46(47.4%), Group 2(46-90°) being 20(20.6%) and Group 3 (>90°) with 31(32%) cases. Diabetes and Congestive heart failure (CHF) patients were more likely to have increase in frontal QRST angle (P value 0.029, 0.012 respectively). Atrial fibrillation (AF) was higher among patients in group 3(>90° frontal QRST angle) which was statistically significant (0.012). Although the mean length of hospital stay was higher among patients with highest frontal QRST angle, it was statistically insignificant (p Value 0.062) however, the chance of hospital stay durations significantly increases across three groups at a 5% significance level (p-value: 0.018). In hospital mortality increased with increase in frontal QRST angle with 8.7%, 15% and 22.6% in group 1, 2 and 3 respectively however it was statistically insignificant.
Conclusion:  Diabetes, CHF and AF patients were more likely to have increase in frontal QRST angle. The chance of hospital stay duration significantly increases with increase in frontal QRST angle Although the in hospital mortality increased with increase in the frontal QRST angle, it was statistically insignificant. A prospective study with larger sample size will help to clarify its association.


RDA has been conducting soil survey for farmland all over the korean countries (1964-1999), including small islands and areas of the civilian passage restriction line (2000-present). We conducted a soil survey in Dokdo and Ulreungdo islands and found a new soil series "Dokdo" in Dokdo island. Soil properties of Dokdo were similar to those of Ulreungdo. Representative profiles of Dokdo soil was located at the south 20m of Daehan peak on Seodo (longitude 131°51′53′′, latitude 37°14′35′′), Dokdo. The soil series "Dokdo" was interpreted as the soils were derived from trachyandesite, trachyte, rhyolite, and tuff. The soil properties of Dokdo series were classified as different ones from Korean soil series previously. The soil depth of Dokdo series was very shallow (0-20cm) and soil layer was consisted of very dark brown (10YR 2/2) rocky sandy loam and dark brown (7.5YR 3/2) gravelly silt loam in AC layer. The soils of Dokdo displayed characteristics of a mesic temperature regime, similar as Ulreungdo soils, which were classified as coarse loamy, mesic family of Lithic Udorthents. The total area of Dokdo soil was 18.7 ha, containing Dongdo (7.3 ha), Seodo (8.9 ha), and the others (2.6 ha). The area of Dokdo series in Dokdo was 10.47 ha (Dongdo 4.13 ha, Seodo 6.34 ha) and 808.56 ha in Ulreungdo, where the total soil area was 7,256 ha.


Introduction There were several reasons for investigating the effects of sleep deprivation in man. One was simply a curiosity about the unusual consequences of prolonged insomnia described by earlier investigators. Kleitman 1 and Tyler 2 cited in detail the hallucinations and "psychotic-like" symptoms that occur under these circumstances and also described subjects who developed short-lived "schizophrenic" psychoses. Psychological alterations, such as inattention, apathy, illusions, and hallucinations, which commonly appear after 36 to 50 hours of wakefulness, have been noted to coincide with an increase in high-frequency, low-amplitude waves on the electroencephalogogram. 3-5 In contrast to such spontaneous psychological disturbances, sleep-deprived subjects have been able to perform normally on specific tests designed to measure work capacity, psychomotor performance, intellectual acumen, and personality structure. 1,8 Measurements of the basal metabolic rate, blood sugar, alkaline reserve, blood and urinary adrenal steroids, etc., have not been found to change significantly with sleep deprivation. 1,5


This paper aims to examine waqf from an economic point of view. Land waqf as one of the economic instruments with social dimensions and is a logical consequence of the system of thought in Islam. Waqf entering the territory of the economic system can be understood if it is accompanied by a study of the economic paradigm, which leads to benefit. The approach used is a socio-economic approach, by looking at the importance of studies from an economic perspective on waqf, because waqf is essentially taking the benefits of productive waqf assets. Waqf has a solution contribution to social economic problems. Social understanding should be instilled on an ongoing basis, that property is not enough to be owned and controlled alone, but also to be enjoyed together. The distribution of wealth so that it can be enjoyed by others is through waqf and proper and proper management. Economically, waqf land that meets the requirements to be developed is in a strategic location, can be developed and will certainly produce, of course preceded by a careful study through an economic paradigm approach to make it happen. Its embodiment is based on waqf regulations that provide encouragement and motivation to optimize waqf goals, especially economic goals.


Mesenchymal stem/stromal cells (MSCs) are multipotent cells residing in the stromal tissues of the body and capable of promoting tissue repair and attenuating inflammatory processes through their immunomodulatory properties. Preclinical and clinical observations revealed that not only direct intercellular communication mediates MSC properties; in fact, a pivotal role is also played by the release of soluble and bioactive factors, such as cytokines, growth factor and extracellular vesicles (EVs). EVs are membrane-coated vesicles containing a large variety of bioactive molecules, including lipids, proteins, and nucleic acids, such as RNA. EVs release their contents into target cells, thus influencing cell fate through the control of intracellular processes. In addition, MSC-derived EVs can mediate modulatory effects toward different effector cells belonging to both innate and adaptive immunity. In this review, we will discuss the literature data concerning MSC-derived EVs, including the current standardized methods for their isolation and characterization, the mechanisms supporting their immunoregulatory properties, and their potential clinical application as alternative to MSC-based therapy for inflammatory reactions, such as graft-versus-host disease (GvHD).


Laboratory experiments were carried out to evaluate the effect of steaming cowpeas on the oviposition and larval development of the cowpea beetle, Callosobruchus maculatus (F.). The possibility of oven and solar drying as well as the effect of the initial temperature of the cowpeas on the steaming effect were also investigated. Samples of four cowpea varieties (Soronko, Asontem, Amantin and US Blackeye) were steamed for 10 and 15 minutes and solar or oven dried. Some initially stored at 4°C or at room temperature were steamed for ten minutes while other samples were oven dried, solar dried, treated with Actellic super dust or untreated. The results showed that when Soronko, Asontem and Amantin cowpeas were steamed for 15 minutes and oven dried at 70 °C for 8 hours, oviposition by C. maculatus was not significantly different from unsteamed beans. Of the four cowpea varieties tested, US blackeye cowpeas were most preferred as oviposition substrate and also for larval development followed by Soronko, Asontem and Amantin. The drying method (solar or oven drying) did not affect oviposition of the bruchids. Significantly fewer eggs were laid on steamed beans compared with unsteamed beans. When US blackeye were steamed for 10 or University of Ghana http://ugspace.ug.edu.gh


Abortion is illegal in Nigeria except to save a woman's life. It is also common, and most procedures are performed under unsafe, clandestine conditions. In 1996, an estimated 610,000 abortions occurred (25 per 1,000 women of childbearing age), of which 142,000 resulted in complications severe enough to require hospitalization. The number of abortions is estimated to have risen to 760,000 in 2006. Unsafe abortions are a major reason Nigeria's maternal mortality rate--1,100 deaths per 100,000 live births--is one the world's highest. According to conservative estimates, more than 3,000 women die annually in Nigeria as a result of unsafe abortion.


Aluminum or CFRP is representative one of the lightweight materials. Collapse behavior of Al/CFRP square structural member was evaluated in this study based on the respective collapse behavior of aluminum and CFRP member. Al/CFRP square structural members were manufactured by wrapping CFRP prepreg sheets outside the aluminum hollow members in the autoclave. Because the CFRP is an anisotropic material with mechanical properties, The Al/CFRP square structural members stacked at different angles(±15°, ±45°, ±90°, 90°/0° and 0°/90° where the direction on 0° coincides with the axis of the member) and interface numbers(2, 3, 4, 6 and 7). The axial impact collapse tests were carried out for each section members. Collapse mode and energy absorption characteristics of the each member were analyzed.


Introduction The authors examined a tablet computer application (iPad app) for its effectiveness in helping students studying pre-algebra to solve mathematical word problems. Methods Forty-three visually impaired students (that is, those who are blind or have low vision) completed eight alternating mathematics units presented using their traditional literacy medium or an iPad app. Twenty percent of the mathematics problems included graphics such as maps, line graphs, and bar graphs. During each session, teachers of visually impaired students rated the amount of support they provided for students and the student motivation. Results Students answered more mathematics problems correctly when using the iPad app and, overall, teachers reported that their students were more motivated with the app than with their traditional literacy medium. Students often used the hints provided in the app when they did not solve a problem correctly the first time. Discussion Visually impaired students and their teachers found the app and graphics to be easy to use and motivating. The built-in Scratch pad was used by almost all students who were print users. Implications for practitioners The study results contribute to the growing body of knowledge about the potential value of tablet-type devices for use by visually impaired students.


No dependence of electroreflectance line shapes upon polarization direction or crystal orientation is found for any core-level electroreflectance structure from the Ga 3dv core levels to the conduction bands in GaP. Matrix-element effects that are responsible for anisotropy in sp3 valence-conduction-band electroreflectance spectra appear to be too weak to be detected in core-level spectra. The result may be general. The field-induced modulation line shape, Δε1, for the Ga 3dv32,52−Xc6 critical points is obtained from the dependence of the spectra and the generalized Seraphin coefficients upon angle of incidence. The line shape is further analyzed to obtain the Δε1 spectrum for Ga 3dv52−Xc6 alone. This procedure yields a spin-orbit splitting Δ3d=0.43±0.02 eV. A weighting of 0.65 ± 0.05 is also obtained for the j=32band relative to the j=52 band. This is in good agreement with the 4:6 ratio expected on d-band occupancy, showing that the matrix elements are also independent of j. The line shape of Δε1 is in good agreement with that predicted by the lifetime-broadened, Coulomb-enhanced Franz-Keldysh theory given by Blossey. The line shape shows a broadening of 160 meV for this transition, and a momentum matrix element about 1/3 as large as that characteristic of sp3 valenceconduction-band transitions.


Intervening on academic skills early in a child's academic career can remediate reading difficulties quickly and set the stage for early literacy skills (Velluntino, Scanlon, Small, & Fanuele, 2006). There are several evidence-based interventions suggested for use when a child presents with academic skill deficits (Shapiro, 2011); however, what is unknown in reading intervention research is exactly how much is needed to prevent or remediate skill deficits. Research has yet to inform practitioners of how much intervention a child will likely need to remediate the presenting difficulties. In essence, research has yet to suggest what dose of intervention to give a struggling student when presenting with reading skill deficits. This study sought to understand how the dosage (i.e., frequency of administration) of reading intervention effects learning. Specifically, in a group administered repeated readings intervention, what is the difference in intervention effectiveness when students are given different dosages of intervention between every day and every other day? Further, is there a more efficient dosage between reading intervention given every other day and every day? The current study examined these questions in an elementary school in the Southern Plains of the U.S. Students from grades 2-5 participated with a total of 34 students who received reading intervention daily or every other day, based on random assignment to groups. Oral reading fluency was measured weekly for progress monitoring and words correct per minute were calculated across a total of 6 weeks. A repeated measures ANOVA found significant growth for both groups across time, suggesting a group administered, peer-mediated repeated readings intervention is effective in increasing words correct per minute for all students who received intervention. However, there were no differences detected between groups. Post-hoc analyses were conducted to inform future research examining the dosage of intervention. Overall, the current study found significant results for a main effect of a peer-mediated repeated readings intervention, therefore suggesting a peer-mediated group administered repeated readings intervention is an effective tool for increasing a student's oral reading fluency performance. Limitations are discussed, and implications for practice and future research are examined.


This paper presents a new method for estimating the average heart rate from a foot/ankle worn photoplethysmography (PPG) sensor during fast bike activity. Placing the PPG sensor on the lower half of the body allows more energy to be collected from energy harvesting in order to give a power autonomous sensor node, but comes at the cost of introducing significant motion interference into the PPG trace. We present a normalised least mean square adaptive filter and short-time Fourier transform based algorithm for estimating heart rate in the presence of this motion contamination. Results from 8 subjects show the new algorithm has an average error of 9 beats-per-minute when compared to an ECG gold standard.


The exponential explosion of the set of patterns is one of the main challenges in pattern mining. This challenge is approached by introducing a constraint for pattern selection. One of the first constraints proposed in pattern mining is support (frequency) of a pattern in a dataset. Frequency is an anti-monotonic function, i.e., given an infrequent pattern, all its superpatterns are not frequent. However, many other constraints for pattern selection are neither monotonic nor anti-monotonic, which makes it difficult to generate patterns satisfying these constraints.
In order to deal with nonmonotonic constraints we introduce the notion of "projection antimonotonicity" and SOFIA algorithm that allow generating best patterns for a class of nonmonotonic constraints. Cosine interest, robustness, stability of closed itemsets, and the associated delta-measure are among these constraints. SOFIA starts from light descriptions of transactions in dataset (a small set of items in the case of itemset description) and then iteratively adds more information to these descriptions (more items with indication of tidsets they describe).


The BRCA2 interactor, centrobin, is a centrosomal protein that has been implicated in centriole duplication and microtubule stability. We used genome editing to ablate CNTROB in hTERT-RPE1 cells and observed an increased frequency of monocentriolar and acentriolar cells. Using a novel monoclonal antibody, we found that centrobin primarily localizes to daughter centrioles but also associates with mother centrioles upon serum starvation. Strikingly, centrobin loss abrogated primary ciliation upon serum starvation. Ultrastructural analysis of centrobin nulls revealed defective axonemal extension after mother centriole docking. Ciliogenesis required a C-terminal portion of centrobin that interacts with CP110 and tubulin. We also depleted centrobin in zebrafish embryos to explore its roles in an entire organism. Centrobin-depleted embryos showed microcephaly, with curved and shorter bodies, along with marked defects in laterality control, morphological features that indicate ciliary dysfunction. Our data identify new roles for centrobin as a positive regulator of vertebrate ciliogenesis.


Several neuroimaging methods have been proposed to assess the integrity of the corticospinal tract (CST) for predicting recovery of motor function after stroke, including conventional structural magnetic resonance imaging (sMRI) and diffusion tensor imaging (DTI). In this study, we aimed to compare the predicative performance of these methods using different neuroimaging modalities and optimize the prediction protocol for upper limb motor function after stroke in a clinical environment. We assessed 28 first-ever stroke patients with upper limb motor impairment. We used the upper extremity module of the Fugl-Meyer assessment (UE-FM) within 1 month of onset (baseline) and again 3 months poststroke. sMRI (T1- and T2-based) was used to measure CST-weighted lesion load (CST-wLL), and DTI was used to measure the fractional anisotropy asymmetry index (FAAI) and the ratio of fractional anisotropy (rFA). The CST-wLL within 1 month poststroke was closely correlated with upper limb motor outcomes and recovery potential. CST‐wLL ≥ 2.068 cc indicated serious CST damage and a poor outcome (100%). CST‐wLL < 1.799 cc was correlated with a considerable rate (>70%) of upper limb motor function recovery. CST-wLL showed a comparable area under the curve (AUC) to that of the CST-FAAI (p = 0.71). Inclusion of extra-CST-FAAI did not significantly increase the AUC (p = 0.58). Our findings suggest that sMRI-derived CST-wLL is a precise predictor of upper limb motor outcomes 3 months poststroke. We recommend this parameter as a predictive imaging biomarker for classifying patients' recovery prognosis in clinical practice. Conversely, including DTI appeared to induce no significant benefits.


Background and Purpose— Few studies have prospectively examined the risk of recurrent stroke associated with patent foramen ovale. We present the results of the Spanish right-to-left shunt (RLSh) multicenter study. Methods— Four hundred eighty-six patients with cryptogenic stoke were included at 17 participating hospitals. Patients were examined by contrast transcranial Doppler methods at baseline. The magnitude of RLSh was quantified during the Valsalva maneuver. Transthoracic and/or transesophageal echocardiography, computed tomography scan, or magnetic resonance imaging was performed. Functional outcome and stroke recurrence were evaluated at 3 months and yearly thereafter. The independent relation between RLSh magnitude and stroke recurrence was analyzed by logistic-regression analysis in the whole group and in the younger subgroup (<55 years). Results— Massive RLSh was detected in 200 patients (41.2%). The mean follow-up was 729±411 days. Stroke recurrence was low (5.8%, n=28) and similar in patients with massive RLSh, with nonmassive RLSh, and with no RLSh, in both the younger group (3.4% vs 2.3% vs 4.5%, respectively; P=0.75) and in the whole population (5.0% vs 6.2% vs 6.3%, respectively; P=0.58). Regression analysis found no association between massive RLSh and recurrent stroke in either group (in the whole population, odds ratio=0.94; 95% CI, 0.36 to 2.40; P=0.89; in the younger population, odds ratio=0.93; 95% CI, 0.18 to 4.91; P=0.93). These results were similar when concurrent atrial septal aneurysm and massive RLSh were analyzed and when antithrombotic treatment and concomitant stroke risk factors were included. Conclusions— These results suggest that neither massive RLSh nor massive RLSh with concurrent atrial septal aneurysm is an independent risk factor for recurrent stroke, in either the general or younger stroke populations.