AfterMedicare's implementationof thebundledpayment fordialysis in2011, therehasbeenapredictabledecrease in the use of intravenous drugs included in the bundle. The change in use of erythropoiesis-stimulating agents,which decreased by 37% between 2007, when its allowance in the bundle was calculated, and 2012, was because of both changes in the Food andDrug Administration labeling for erythropoiesis-stimulating agents in 2011 and cost-containment efforts at the facility level. Legislation in 2012 requiredMedicare to decrease (rebase) the bundled payment for dialysis in 2014 to reflect this decrease in intravenous drug use, which amounted to a cut of 12% or $30 per treatment. Medicare subsequently decided to phase in this decrease in payment over several years to offset the increase in dialysis payment that would otherwise have occurred with inflation. A 3% reduction from the rebasing would offset an approximately 3% increase in themarket basket that determines a facility's costs for 2014 and 2015. Legislation inMarch of 2014 provides that the rebasing will result in a 1.25% decrease in the market basket adjustment in 2016 and 2017 and a 1% decrease in the market basket adjustment in 2018 for an aggregate rebasing of 9.5% spread over 5 years. Adjusting to this paymentdecrease in inflation-adjusteddollarswill bechallenging formanydialysis providers inan industry thatoperates at an average 3%–4%margin. Closure of facilities, decreases in services, and increased consolidation of the industry are possible scenarios.Newermodels of reimbursement, suchas ESRDseamless careorganizations, offer dialysis providers the opportunity to align incentives between themselves, nephrologists, hospitals, and other health care providers, potentially improving outcomes and saving money, which will be shared between Medicare and the participating providers. Clin J Am Soc Nephrol 9: 2195–2202, 2014. doi: 10.2215/CJN.03830414 The Legislative and Regulatory Basis for Rebasing As of January 1, 2011, the dialysis treatment bundled payment was expanded to include all technical services in the composite rate, intravenous (IV) medications related to kidney disease and their oral equivalents, and laboratory testing. Congress predicted that there would be efficiencies achieved and reduced the overall bundled payment by 2%. It was assumed by many dialysis providers, nephrologists, and kidney patient groups that this 2% payment reduction was primarily on the basis of an expected decrease in erythropoiesisstimulating agent (ESA) use under the bundled payment. In July of 2011, the Food andDrugAdministration issued a Black Box Warning on ESAs stating that physicians should prescribe the lowest dose possible to prevent the need for blood transfusion. Between the label change and the effect of the bundle, the use of ESAs decreased. Although the intent of the bundle was to incentivize more efficient practices, the decrease in ESA use was highly publicized. The Government Accountability Office issued a report that highlighted the decrease in drug use in dialysis (1) (Figure 1). In addition, major newspapers, such as The Washington Post, ran front page stories criticizing the Federal Government for overpaying for these drugs (2). The Congressional Budget Office had estimated that a decrease in payments reflective of the decreased use of EPA and other drugs would reduce overall Medicare spending on ESRD by $4.9 billion over 10 years (3). This potential saving was picked up by Congress as a "pay for" (or offset) when it drafted the American Taxpayer Relief Act (ATRA) in 2012. As a "pay for", the anticipated savings were used to cover the cost of an extension of the sustainable growth rate, delaying the implementation of cuts to all physician payments by Medicare until April 1, 2014. Congress mandated that Centers for Medicare and Medicaid Services (CMS) adjust the ESRD Prospective Payment System (PPS) in 2014 to account for the change in use of IV drugs. This reimbursement cut was referred to as rebasing, because it set the payment for ESRD IV drugs at 2012 use rates rather than the 2007 level used to establish the original bundled payment in 2011. However, it did not rebase the bundled payment system, because it only affected one cost center instead of the entire set of costs associated with providing services to beneficiaries with ESRD. Before the time that the bundled payment was implemented in 2011, many providers, on average, lost money on composite rate treatments and made money on the separately billable IV medications. Reducing the bundle because of decreased drug use and totally ignoring the prior composite rate losses would result in inadequate reimbursement. To implement ATRA, CMS issued a Notice of Proposed Rulemaking (Proposed Rule) in July of 2013. The Proposed Rule would have cut the per-treatment payment rate by approximately $30 or 12%, which was *Centers for Dialysis Care, Inc., Cleveland, Ohio; Dialysis Clinic, Inc., Nashville, Tennessee; and Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana Correspondence: Dr. Jay Wish, Division of Nephrology, Indiana University Hospital, 550 North University Boulevard, Suite 6100, Indianapolis, IN 46202. Email: email@example.com www.cjasn.org Vol 9 December, 2014 Copyright © 2014 by the American Society of Nephrology 2195 significantly higher than estimates made by the industry on the basis of provider experiences. Although many dialysis providers, nephrologists, and kidney patient groups agreed that use of ESAs had decreased, they also raised concerns that CMS had not calculated the original bundled payment rate correctly. They also raised concerns that the Proposed Rule ignored the fact that Congress had already reduced the payment rate by 2% in 2011 to adjust for assumed efficiencies, including changes in the use of drugs such as ESAs. Compounding the situation was an across-the-board 2% cut in reimbursement to all Medicare providers, including dialysis facilities, that began in March of 2013 as part of the sequester to respond to the Federal budget crisis. The threat of a $30 per treatment cut on top of the 2% sequester cut was overwhelming to most providers. The concerns were validated by the Medicare Payment Advisory Commission (MedPAC) (4), which estimated that the dialysis facility aggregate Medicare margin was between 2% and 3% in 2011 and projected that the aggregate Medicare margin would be between 3% and 4% in 2013 before the proposed cut. These data points were also consistent with the independent analysis prepared by The Moran Company (5) using CMS cost reports. Thus, a 12% cut would result in significantly negative Medicare margins and could lead to substantial changes in the way that patients receive dialysis treatments. Small, rural, and inner city facilities were at the highest risk for these negative Medicare margins, and their possible closure could threaten patient access to ESRD care. In the Final Rule published in December of 2013 (6), CMS maintained the magnitude of the per-treatment cut but indicated that the cut would be spread over 3–4 years. During 2014, the portion of the cut implemented was slightly greater than the market basket increase in payment for 2014 for technical reasons. The market basket increase is the annual adjustment that dialysis providers receive in their payment from CMS because of the changes in the costs of labor, supplies, and overhead. CMS promised to set the rebasing cut at the market basket amount for 2015. Thus, the final payment adjustment for 2014 and 2015 amounts to a 2-year market basket freeze. CMS did not indicate how it planned to implement the remainder of the rebasing payment cut in 2016 and/or 2017. At the end of March of 2014, Congress passed H.R. 4302: "Protecting Access to Medicare Act of 2014" (PAMA) (7), which includes a provision that would reduce the magnitude of the ATRA rebasing cut. The legislation requires CMS to set the market basket increase at zero for 2015 to accomplish the intent that CMS expressed in the Final Rule to set 2015 reimbursement rates at the 2014 level. The new law then replaces the remainder of the cut with a 1.25% reduction in the market basket for 2016 and 2017 and a 1.0% reduction in the market basket for 2018. Table 1 summarizes the magnitude of the cuts in percentages from 2014 to 2018. Analysis of this provision suggests that the overall cut has been reduced from 12% to approximately 9.5%. Although the Medicare rebasing cuts are less than the originally proposed $30 per treatment in inflation-adjusted dollars, many dialysis providers, nephrologists, and kidney patient groups remain focused on the dramatic reduction in Medicare payments to dialysis facilities because of its potential to negatively affect patient care. The Moran Company estimates that, even with a market basket freeze in 2014 and 2015, .55.6% of dialysis facilities will have negative Medicare margins in 2014 when taking into account the 2% sequestration cut that occurred in 2013 (5). That number increases to .65% in 2015. Even with the relief provided Figure 1. | Use of ESRD drugs per beneficiary per quarter through 2011 relative to average level in 2007. Use was expressed in dollars by multiplying the number of units per beneficiary of a drug administered in a given quarter by Medicare's average sales price for this drug in the first quarter of 2011. FDA, Food and Drug Administration. Includes use of erythropoiesis-stimulating agents (ESAs), intravenous (IV) iron, and IV vitamin D. Reprinted from ref. 1, Government Accountability Office (GAO). 2196 Clinical Journal of the American Society of Nephrology


Cases of illegal drugs and drug abuse in the elementary school community in Indonesia is increasingly massive and alarming. An innovation to protect elementary school students from that situation is through the colaboration of academics from Bandung Institute of Technology with FDA in Palu in the form education of  anti-drug abuse for elementary school students through quartet card media. The aim of the study was to determine the effect of the education on anti-drug abuse knowledge in fifth grade students in Palu City. The research method used pre-experimental design with the design of one group pretest-posttest on three elementary schools which were representatives of three ranks namely; good, quite good and not good based on the results of the Smart-Accurate Quiz FDA in Palu for elementary school level in 2017. The sampling technique used purposive sampling. Observation of knowledge of elementary students using questionnaires that have been tested for validity and reliability had been carried out. The pretest and posttest were conducted before and after education. The comparison of pretest and posttest data in each elementary school was analyzed using paired T test whereas for all elementary school data analyzed using the Wilcoxon test with hypotheses. There was an influence of anti-drug abuse education through quartet card media on anti-drug abuse knowledge in fifth grade students in Palu City. The results showed that there was an influence of education on anti-drug abuse knowledge in fifth grade students from elementary school representatives "good and quite good ranking" with p values of 0.005 and p ≤ 0.001, while in elementary schools representatives "not good ranking", the education did not influence their knowledge with a p value of 0.149. Analysis of the Wilcoxon test in all elementary schools showed a p value p ≤ 0,001, which meant that education had an influence on the knowledge of fifth grade students in elementary schools in Palu City.


This article examines the main trends in the development of Belarus's foreign economic ties since 2000. We analyze the dynamics and structure of Belarus's foreign trade, its distribution across the country's major trading partners, and the country's migration ties, including labor migration. We show that Russia is undoubtedly Belarus's main foreign economic partner in all major areas.


Calcium‐carbonate‐loaded systems were tested for abrasive wear on extruder parts through a test that measures the weight of a bronze alloy screen placed in a supporting screen pack before and after 5500 g extrusion run. The effects of particle size and mineral identity were explored in this work as well as the effect of mineral loading level. It was found that the abrasiveness of calcium carbonate is, as expected, much lower than that of titanium dioxide and increases with increased loading levels. It was also shown that the larger the median of the particle size distribution (PSD), the greater the abrasive wear on the screen. Finally, it was shown that the degree of wear could be correlated with the level of impurities present in the natural mineral.


German municipal landfill disposal is based on a multi-barrier principle, involving waste treatment plus physical barriers such as containment plus site criteria, as defined in a Technical Regulation for municipal solid waste disposal. The appropriateness of these measures is critically reviewed, and in particular the need for independently acting systems is questioned.


7004 Background: Unmet needs remain for red blood cell (RBC) TD pts with LR-MDS R/R or ineligible for ESA. In P2 of the IMerge study (NCT02598661), heavily RBC TD ESA R/R non-del(5q) LR-MDS pts naive to lenalidomide and hypomethylating agents (len/HMA) treated with imetelstat, a telomerase inhibitor, achieved durable and continuous transfusion independence (TI). We report primary data from the P3 study of imetelstat in such pts. Methods: Heavily RBC TD ESA R/R non-del(5q) LR-MDS pts naive to len/HMAs were randomized 2:1 to receive imetelstat 7.5 mg/kg or placebo every 4 wks. Primary endpoint was 8-wk TI; subgroup analyses included IPSS risk, prior transfusion burden and ring sideroblast (RS) status. Secondary endpoints included 24-wk TI, TI duration and hematologic improvement-erythroid (HI-E). Variant allele frequency (VAF) changes were explored. Results: As of Oct 2022, 178 pts were randomized. The primary endpoint was met (Table); 39.8% vs 15.0% of pts receiving imetelstat vs placebo, respectively, achieved 8-wk TI. The rate of 8-wk TI was significantly higher with imetelstat vs placebo across subgroups, including RS negative pts. Median TI duration was significantly longer for imetelstat vs placebo, 51.6 vs 13.3 wks, P < 0.001. Pts receiving imetelstat had significantly higher mean hemoglobin (P < 0.001) and fewer transfusions (P = 0.042) over time than those on placebo. In 3 of 4 genes frequently mutated in MDS, VAF reduction was significantly greater in pts treated with imetelstat than placebo: SF3B1 (P < 0.001), TET2 (P = 0.032), DNMT3A (P = 0.019) and ASXL1 (P = NS). SF3B1 VAF reduction correlated with longer TI duration, P < 0.001. No new safety signals were identified. The most common Grade 3/4 AEs were thrombocytopenia and neutropenia, with similar rates of Grade ≥3 bleeding and infections on imetelstat and placebo. In pts treated with imetelstat, cytopenias were manageable, of short duration, and >80% were reversible to Grade ≤2 within 4 wks. Conclusions: For this LR-MDS pt population, imetelstat demonstrated statistically significant and clinically meaningful efficacy with high 8- and 24-wk TI rates, prolonged TI duration and increased hemoglobin. VAF reduction and its correlation to clinical endpoints support imetelstat's disease-modifying potential. Safety results were consistent with prior reported experience. Clinical trial information: NCT02598661 . [Table: see text]


Reinvestigation of the glycosphingolipid composition of the marine sponge Agelas clathrodes revealed the presence of a new tetraglycosylated alpha-galactoglycosphingolipid (1a), containing an unusual l-rhamnose unit in the sugar head. The structure of the new compound was elucidated using extensive 2D NMR studies. Because of the strong overlapping of the signals of the sugar protons in the (1)H spectrum, (13)C-coupled and (13)C-decoupled phase-sensitive HMQC spectra were used to study the multiplicity of the overlapping signals. In addition, the absolute configuration of sugars was determined using a simple and efficient, yet underutilized CD method.


This paper analyses inter-state variations in agricultural labour productivity, sources of labour productivity growth. It also examines the incidence of rural poverty and the interrelations between labour productivity and rural poverty over four selected time points. Our analysis reveals that yield was the major source of growth in labour productivity. The major conclusion that emerges from the analysis on the relationship between labour productivity and rural poverty is that the poverty reducing impact of labour productivity has increased in the post-new technology periods as compared to the pre-new technology period.


Water chemistry control is one of the key technologies to establish safe and reliable operation of nuclear power plants. Continuous and collaborative efforts of plant manufacturers and plant operator utilities have been focused on optimal water chemistry control, for which, a trio of requirements for water chemistry should be simultaneously satisfied: (1) better reliability of reactor structures and fuel rods; (2) lower occupational exposure and (3) fewer radwaste sources. Various groups in academia have carried out basic research to support the technical bases of water chemistry in plants. The Research Committee on Water Chemistry of the Atomic Energy Society of Japan (AESJ), which has now been reorganized as the Division of Water Chemistry (DWC) of AESJ, has played important roles to promote improvements in water chemistry control, to share knowledge about and experiences with water chemistry control among plant operators and manufacturers and to establish common technological bases for plant water chemistry and then to transfer them to the next generation of plant workers engaged in water chemistry. Furthermore, the DWC has tried and succeeded arranging R&D proposals for further improvement in water chemistry control through roadmap planning. In the paper, major achievements in plant technologies and in basic research studies of water chemistry in Japan are reviewed. The contributions of the DWC to the long-term safe management of the damaged reactors at the Fukushima Daiichi Nuclear Power Plant until their decommissioning are introduced.


An analysis is made of some problems involving electron transport to the oxidized photoactive pigments in photosynthesis. Electron donors for chlorophyll a+ may be H2O or X(HCO3−). On the basis of published experimental data, it is concluded that the primary electron donor is most likely the compound X(HCO3−).


A set of test system which is applied to aircraft landing gear drop tests is designed,the system software uses LabVIEW and Matlab programming technology,the acquisition,display,analysis,storage of test paramreters and output of experiment results and curves are realized.By the verification of experiment,this system is highly automatic,stable,and has small data analysis error,and fully meets the function requirements of data acquisition and data analysis in the drop test.


The invention discloses an automatic glue-pouring machine. The automatic glue-pouring machine comprises a fixed frame, a glue supply device, a PLC (Programmable Logic Controller) control system and a glue-pouring head, wherein the glue supply device is fixed on the fixed frame; the glue-pouring head is connected to a sliding track; the sliding track comprises a horizontal track and a vertical track which are perpendicular to each other; the horizontal track can slide up and down on the vertical track; the glue-pouring head is connected to the horizontal track by a sliding block in a sliding manner; and a blowing device is also arranged below the horizontal track. The automatic glue-pouring machine has the beneficial effects that the PLC control system can accurately control the glue-pouring head to realize glue pouring in x-axis and y-axis directions through the horizontal track and the vertical track which are perpendicular to each other, thereby facilitating the glue pouring and sealing of square air return windows and the like, and the automatic glue-pouring machine is simple in structure and relatively low in manufacturing cost and has good glue pouring efficiency and a glue sealing effect.


Background: Anorexia nervosa is a common and very serious mental illness that most people know about. The fear of losing control and the low motivation for change makes it difficult for the patient ...


school disappeared. Despite low average ability, Greta was on the honor roll. There was no truancy for a year. But misbehavior at home increased. The own mother was increasingly the bad mother. Sure of her contact at last, the visiting teacher dared to begin to identify herself with the mother, admiring the mother to the child, interpreting the mother's lack of demonstration of affection, calling on the mother in her home. Greta continued to come for the interviews but she was sullen. Then, precipitated by the visiting teacher's suggestion, "Your mother must seem different to you from some mothers you know," came the verbal torrent of slightly more than an hour briefly summarized above. During the day of this interview, Greta invented excuses three times to come to the visiting teacher's office, possibly wondering, in her anxiety over having expressed her hostility both to her own mother and to the visiting teacher, then identified, whether she had lost both completely. In the week following the interview the child truanted twice from school for the first time in more than a year. At this time the visiting teacher was able to make her first successful contact with the mother, in whose mind she was of course identified with Greta. Two weeks later Greta said, "My mother is better to me. She got me a new skirt and some new shoes." School behavior is once more exemplary. The mother's statement is "Greta better now."


Three ozone-based advanced oxidation treatments (O3; O3 with initial pH adjustment and; O3/UV with initial pH adjustment) were compared for the treatment of a recalcitrant wastewater generated during washing/cleaning of surfaces and equipment used in filling and gluing processes (urea-formaldehyde and phenol-formaldehyde resins) in a wood-floor industry in Sweden. The wastewater (initial COD 3,400-4,000 mg/L) was obtained at the outlet of a sedimentation tank, which receive an inflow with an average COD of 45,000 mg/L. The experiments were performed in a semi-batch microbubble column reactor connected to a UV reactor, where 2.5 L samples of wastewater were submitted to the maximum dose of 2 g of O3 per gram of initial COD. For the full-factorial design, the independent variables were O3 concentration (g O3/Nm); recirculation flow (L/min); and initial pH (pHi). The evaluation of the treatment performance was based on COD and TOC reductions (in %), and the effluent obtained was used in respirometric assays with activated sludge obtained at a municipal wastewater treatment plant to assess biodegradability/inhibitory effects. The results showed that ozonation at the original low pH promoted a reduction of 65% and 31% of COD and TOC respectively, but made the effluent less biodegradable. The highest COD and TOC reductions were achieved when O3 /UV treatment with pHi = 9.3 were applied (93% e 56% reductions for COD and TOC respectively). The results with the respirometry tests suggest that application of O3 only at higher pH values promoted biodegradability enhancement of the effluent, making it treatable by microbiota obtained with activated sludge from a municipal wastewater treatment plant.


Regulations concerning the position, status and model of functioning of capitals in European countries have not been unified. Both Poland and other European Union countries use their own, autonomous solutions. It is a fact that there are a lot of similarities in this area, but nevertheless they do not have formal, legal, regulatory or directive conditions. The many similarities have historical or geopolitical roots. A number of regulations are also related to the care for the stability of legal solutions, the organizational stability of the state and international bodies and institutions. The conducted analysis allows, however, to distinguish three main organizational models, which have certain advantages, but also negative management and organizational aspects.


【Objective】 To investigate the effect of Fenofibrate on serum liver function,cytokine,hepatocyte apoptosis and collagen fiber with obstructive jaundice.【Methods】 Rats were subjected to bile duct ligation to establish the cholestasis mode1.Forty-eight male Wistar rats were randomly divided into four groups equally: Group A = normal group,Group B = bile duct ligation(BDL) only,Group C = BDL + Fenofibrate [30 mg/(kg·d)],Group D = BDL + Fenofibrate [60 mg/(kg·d)].All rats were sacrificed on 7th day after obtaining blood samples and liver tissue.Serum ALT,AST,ALP,GGT,TBA were tested by Automatic Chemistry Analyzer,serum TNF-α,IL-1βwere tested by radioimmunoassay kits,the number of hepatocyte apoptosis were tested by TUNEL and collagen fiber was tested by Masson.【Results】 Serum ALT,AST,ALP,GGT,TBA levels in rats of group D were significantly lower than in group B(P 0.01),while Serum AST,ALP,GGT,TBA levels of group D were significantly lower than in group C(P 0.01);L-1β level of group D is lower than group C(P 0.01),when IL-1β level of group C and D is lower than group B(P =0.000,0.001),TNF-α of group D is lower than group B(P 0.01);hepatocyte apoptosis in the animals of group C were significantly lower than in group B(P 0.01) when hepatocyte apoptosis in group D were significantly lower than in group B or C(P 0.01);collagen fiber area of group C is smaller than group B(P 0.01),while collagen fiber area of group D is smaller than group B and C(P 0.01).【Conclusion】 Short administration of Fenofibrate can significantly attenuate cholestasis-induced liver injury by improving serum liver function,suppressing inflammatory response,inhabiting hepatocyte apoptosis and performing anti-hepatic fibrosis effect.


Marshall McLuhan is considered by many "the most important thinker since Newton, Darwin, Freud, Einstein, and Pavlov." McLuhan defines his own approach as "systems development," that is, "a structural analysis…concerned with the inner dynamics of the form," with "structure and configuration." In fact, with the posited lawful closure of the system under the determinations of the dominant technological environment (and its relations with antecedent technologies), McLuhan's account is effectively cut off from its genuine living foundation by a deep and unbridgeable methodological abyss into which essential constituents of socio-historical life, for example, creative praxis, class struggle, and the project of liberation, disappear without trace.


Research into executive functioning (EF) has indeed grown exponentially across the past few decades, but as the Willoughby et al. critique makes clear, there remain fundamental questions to be resolved. The crux of their argument is built upon an examination of the confirmatory factor analysis (CFA) approach to understanding executive processes. Beyond the methodological critique, questions about the study of individual differences in EF surface throughout their thoughtful review and analysis. Below we consider each of these topics in turn. The more distant reader may be surprised by the lack of agreement among EF researchers about basic theoretical and methodological issues. There is widespread agreement that EF refers to a suite of processes mediated by the prefrontal cortex that support goal-directed actions (Diamond, 2013), but beyond this general description, disagreement emerges. Perhaps the most difficult challenge for EF research has been the problem of task measurement (e.g., poor intertask correlation, lack of precision in targeting specific EF processes or "task impurity"). The CFA approach, yielding latent traits, has provided one resolution to the problems associated with task impurity. The seminal Miyake et al. (2000) has been hugely influential, giving rise to widespread acceptance of the tripartite model. Again, it is easy to find fundamental disagreements in EF research (see, for example, the disagreement about the distinction between working memory and inhibitory control, reviewed in Diamond, 2013), but it is fair to say that the original Miyake et al. (2000) CFA gave rise to a widely accepted framework. Since then, the CFA approach has been implemented to explore new directions in EF research, such as the emerging "hot" versus "cool" distinction that we believe is central to the exploration of individual differences (Welsh & Peterson, 2014).


Enhancing munition maneuverability is a key enabling technology for both range extension and terminal maneuvers of long-range precision munitions. One approach to munition maneuverability is to deflect control surfaces to achieve body attack angles that generate lift from the body and other aerodynamic surfaces. This report presents a methodology to analyze aerodynamic control surfaces to determine effectiveness at generating a pitching or yawing moment on a projectile to attain an angle of attack that produces significant lateral accelerations in flight. The methodology demonstrated in this report is for a gun-launched, aerodynamically stabilized, fin-controlled projectile, but is applicable to other control surface design problems


Objective. To study anatomical features of anterior and lateral vertebral body surface dissection in thoracic and lumbar region from anterolateral and lateral approaches. Materials and methods. Twenty surgeries were performed on 5 unembalmed cadavers. Procedures were provided in autopsy room. On every cadaver full lateral and anterior vertebral body dissection from right thoracotomy on middle-thoracic (Th4-Th8) level, left thoracotomy on low-thoracic (Th9-Th12) level, left extracaelomic retropleural-retrophrenic-retroperitoneal, thoracotomy with horizontal dissection of diaphragm and wide classical thoraco-abdominal with hemisection of diaphragm in thoraco-lumbar junction (Th12-L1), right and left lateral lumbotomy in middle lumbar levels (L2-L4), middle retroperitoneal in low lumbar levels (L4-L5). Results. Parietal pleura incision allow on thoracic level ease subpleural dissection anterior and lateral surface of vertebral body, without risk of visceral and vascular complication. For direct anterior vertebral wall visualization ventral widening of approach must be done. Dissection of mid-lumbar vertebral body surface can be done as from classical left, as right sided lateral approach without vascular problem, if 3 level segmental arteries and veins ligation was done, according to technique we use. Common iliac vessels transposition can be done after meticulous ligation all venous afferents at L5 level. Conclusions. Limited small transthoracic (rib resection 5-10 cm), extracaelomic approach in all cases far enough for full lateral wall vertebral body dissection. But no vascular control and anterior vertebral body wall visualization can be accomplished. To obtain direct control for wide dissection of vertebral body with full aorta delineation direction of surgical manipulation should be changed from posterolateral to anterolateral (rib resection 15-20 cm, hemisection of diaphragm). Ligation of all lateral afferent at L5 level of common left iliac vein allow uncomplicated dissection of L5 vetebral body wall in experiment.


By Using an Optical fiber Michelson interferometer, an experimental setup of optical coherence tomography(OCT) was developed. Using this system, we measured the OCT signals of two metal wires in milk and behind a slice of potato. Then we reconstructed the corresponding gray-scale maps from the OCT signals. Some advices on how to improve the system are also given.


To improve the performance of secondary structure prediction, a multi-SVM ensemble was applied, bagging was used to resample the training dataset. The SVM ensemble was made of two-layer, one is composed by three SVM network decided by winner-take-all, the other is a ensemble network composed of five classifier decided by majority voting. Seven-fold cross-validation test on RS126 dataset indicated that the multi-SVM ensemble could achieve better performance on secondary structure prediction.


This paper describes the implementation of a Corporate Geographical Information System "COGIS" into Gloucestershire County Council. The major justification for this project was the benefits corporately sharing information across the whole authority. The GIS was the tool which would and has enabled this to happen. Both the County Surveyor's and Planning Departments have been at the forefront of corporately sharing information with other departments. The "COGIS" A project encompasses all major departments, they are Surveyor's, Planning, Education, Police, Fire, Commercial Services, Corporate Services, Libraries, Emergency Planning and Social Services, all are using the corporate GIS. For the covering abstract see IRRD 881556.


The paper investigates gross profit, net profit and profit after tax of securities firms listed on the Vietnam's stock market. The paper employs a set of aggregate data from 22 securities firms listed on the Vietnam's stock market, and comments from experts in this research field. The authors used descriptive statistics, comparison with the support of Stata13 software to evaluate and measure gross profit (GP), net profit (NP) and profit after tax (PAT) of securities firms listed on the Vietnam's stock market. The results show that there is a difference in the gross profit, net profit and profit after tax of securities firms listed on the Vietnam's stock market. Enterprises had 10 years old posted up or more have a larger profit than the rest of firms.


Purpose
This paper aims to examine the complexity of administrative reform and its implications.

Design/methodology/approach
This paper is based on an extensive review of the literature.

Findings
The most conspicuous fashion might be new public management (NPM) and its successor, post-NPM. However, recent reforms which involve complexity created the challenge of "rational calculation" in terms of an understanding of administrative reform. The authors observe that the measure of coordination in a response to fragmentation increases complexity and the rationale behind that reform is based on the instrumental rationality. This hinders real meaning of administrative reform, thereby failing to provide lessons for the future administration. Whether market-based reform or neo-Weberian model of reform, the thing should be considered is the condition under which the reform works.

Originality/value
This paper reaffirms the importance of the political-bureaucratic system which has multi-functional nature and competing institutional values when the different recipes for reform are imported into different context and a compatibility test by leaders.


With retail competition intensifies,the hypermarkets,supermarkets how to survive and develop in the fierce fighting is an important issue currently facing.Zhuzhou A.Best boli shops increasingly depressed business conditions,through field investigation and research,from the external environment and internal environment,store operations,staff management,crisis management,five in-depth analysis,and proposed countermeasures.


With the use of the analytical works of the prominent Belgian researcher Sven Biscop, the article examines the main topics of discussion regarding changes in the global strategy of the European Union. EU foreign policy has been associated with the concept of "normative power", which is seen as a kind of European "soft power". Due to the influence of the global governance crisis, the COVID pandemic, the shift of USA geopolitical interests from Europe to Asia, China's great-power policy, Russia's geopolitical ambitions and other challenges, EU researchers and politicians are raising questions aimed at changing the strategic culture in order to ensure the primacy of EU vital interests. S. Biscop believes that while developing a new global strategy, it is necessary to turn to the traditions of geopolitics to be ready to protect interests and democratic values with the use of "hard power" both internally and externally. Strategic autonomy is a promising task for the further building of the EU. Under the instruction of the European Commission, the work has begun on the creation of a new political and strategic document "Strategic Compass", its goals include defining the EU targets in the field of security, defense, and identification of threats. The discussion of a new global strategy outlines a trajectory for the transformation of the European Union into a global "Third Pole". Sven Biscop's recommendations show that shaping a new global strategy will require a revision of the concept of "normative power" and turning closer to geopolitical realism.


In order to promote the teaching of higher mathematics and the quality of students,we investigate and analyses the teaching circumstance of higher mathematics in engineering(college.) Investigation indicated that undergraduates are content with the teaching of higher mathematics.A lot of undergraduates hoped to have more practical content correlatively with professional knowledge.They thought it necessary that traditional teaching method be combined with CAI.They didn't hope teachers teach the knowledge of graduate entrance examination in the daily course.Teachers should cultivate students' mathematic culture,and shouldn't become the education for all-around development to the exam-oriented education.


Chromospheric bright points are sites where intense heating takes place by 3-min period waves. A 35-min-long time series of photographic spectra obtained in CaII H-line on a quiet region at the center of the solar disk under high spatial, spectral, and temporal resolution at the Vacuum Tower Telescope (VTT) of the Sacramento Peak Observatory has been analyzed to show that the period of intensity oscillations associated with bright points in the interior of the supergranular cells is independent of their intensity enhancements. We find evidence for a constant period of oscillations in bright points, independent of their peak brightness, and different from the period of network oscillations. This suggests that the heating mechanism may be identical (by 3-min period waves) in any class of bright points while in the case of network elements it may be an entirely different mechanism (by 5-7 min period waves). In addition, it is shown that the amplitudes of the main and the follower pulses of bright points decay exponentially with time and the decay rate is constant with their brightness in any class of bright points.


activitywascompletelyinactivatedbyAg 1 andHg 21 ions,indicatingthatasulfhydrylgroupisinvolved.Aratio of sucrase to inulinase activity of 1.2 was found for the purified enzyme with substrate concentrations of 50 mg/ml. The mechanism of enzyme action was investigated. No liberation of fructo-oligomers from inulin and levan could be observed by thin-layer chromatography and size exclusion chromatography‐low-angle laser light scattering‐interferometric differential refractive index techniques. This indicates that levanase is an exoenzyme acting by the single-chain mode.


Aims: The antisecretory, antibacterial on Helicobacter, and antacid properties of Eremomastax speciosa ( E. speciosa ) and MY41g clay respectively, led us to evaluate the potential use of this clay in the anti-ulcer tri-therapy formulated with Eremomastax speciosa. and Materials and Methods: In vitro antacid were evaluated by studying: Fordtran's method, and the influence of temperature on the pH values. I n vivo activity was studied on chronic gastric ulcers induced by injection of 0.05 ml of acetic acid (30%) into the stomach wall. Rats were treated daily for 10 days after ulcer induction with a combination of E. speciosa and MY41g (ESMY) ; (ESMY 100+250 and 200+250 mg/kg). The model of "unhealed" gastric ulcers was also used: from day 5 to day 18 of experimentation, rats were given ESMY orally concomitantly with indomethacin (1 mg/kg/day) subcutaneously. Ulcer index, percentage of healing, mucus secretion, gastric acidity, histological, hematological, and oxidative stress parameters were evaluated. Results: ESMY showed good neutralizing capacity in vitro in Fordtran's method. Treatment with ESMY accelerated the spontaneous healing of chronic gastric ulcers (93.82-96.14%). However, administration of indomethacin did not induce significant variations in the percentage of healing (90.73-94.60%). For both ulcer models performed, ulcer healing was accompanied by a significant ( P = 0.001) increase in mucus mass at 200/250 mg/kg. ESMY increased antioxidant activity, decreased gastric acidity, lipid peroxidation, and maintained hematological balance. Conclusion: In addition to its buffering properties, the healing mechanism of ESMY includes reduced gastric acidity, enhanced mucus production, re-epithelialization of gastric mucosa, improvement of hematological and antioxidant status. ESMY can be used in traditional medicine, as a therapeutic regimen against gastric ulcers.


The aim of this study was to model groundnut production in Turkey using data from the period 19502015 in Turkey in an effort to forecast groundnut production amounts between the years 2016 and 2030 by using Autoregressive Integrated Moving Average (ARIMA) models. In the study, ARIMA (0,1,1) was found to be the most appropriate model among six studied ARIMA models in forecasting the groundnut production amounts for the next 15 years. We forecasted that annual amount of groundnut production obtained in the year 2016 was 138,98 thousand tons and it reached to 167,28 thousand tons in the year 2030 with a significant acceleration for groundnut production. Forecasting results of the ARIMA (0,1,1) illustrated an increasing trend in the amount of groundnut production, and they might help to determine a better policy for increasing groundnut production in Turkey.


Abstract The cities on both sides of the U.S.-Mexico international boundary face common problems related to extreme levels of poverty and rapid population and industrial growth. The conditions in this region pose serious threats not only to the health and environment of the population, but also to their social well-being. These problems transcend international boundaries, a fact that cannot be ignored in the provision of social welfare assistance to these communities. The purpose of this article is to analyze the significance of U. S.-Mexico social and economic interaction for the provision of responsive social welfare. Strategies for cross-national collaboration that have emerged in response to the interrelated problems facing the border region are discussed.


Cholesterol was determined by a two-step method. The modification allows accurate analysis of about 100 samples per hour. A cholesterol standard dissolved in TRITON X-100 is described. This composition gives a colour development which more closely resembles that of serum than the conventional standard of cholesterol in glacial acetic acid.


Introduction: Today, health tourism is one of the growing sectors of the tourism industry in the world. Health tourism as a source of income and job creation can be an approach to national economic development. Therefore, the aim of this study was to identify the factors related to creating a competitive advantage in the tourism business in the field of health. Methods: This descriptive analytical study was conducted cross-sectionally in 2019. The Target population of this study includes activists and business owners of Mazandaran tourism industry. A questionnaire was used to collect data. Experts were used to measure the validity of the questionnaire. Two hundred copies were distributed, out of which 165 questionnaires were completed and returned. The reliability of the data collection tool was confirmed by Cronbach's alpha and composite reliability. Data analysis used structural equation method and Smart PLS software . Results: The results showed that the socio-cultural situation with a path coefficient of 0.96 had a significant effect on creating a competitive advantage in health tourism in Mazandaran province. Having welfare ، access to accommodation, recreational facilities, and skilled manpower with a route coefficient of 0.95 and 0.85 were in the next ranks, respectively. Conclusion: While identifying the exact list of socio-cultural and historical capabilities of the province and introducing the welfare complexes and service-treatment centers, the trustees of the organizations should provide the necessary preparations for attracting health tourists. Furthermore, ways to identify facilities for tourists should be facilitated. Also, by training and employing skilled labor, the health tourism business will be strengthened.


The domain partitioning concept is applied to the circuit-level simulation of complex nonlinear microwave subsystems of arbitrary topology, such as entire front-ends. The subsystem is described as a whole at the data entry level, but is automatically split into the interconnection of a near-optimal number of nonlinear blocks at run time. Nonlinear analysis is based on a scattering-matrix version of Krylov-subspace harmonic balance (HB) in order to avoid Y-matrix singularities in the decomposition process. This leads to high numerical efficiency and allows an excellent tradeoff between the piecewise and nodal HB approaches to be established.


Historians writing during the later nineteenth and the twentieth centuries unambiguously recognized the importance, indeed the central role, played by siege warfare in European military history during the Middle Ages, i.e., from the dissolution of the Roman empire in the West at least until the emergence of high quality gunpowder weapons. Thus, for example, Hans Delbruck observed: "Throughout the entire Middle Ages we find...the exploitation of the defensive in fortified places."(1) Charles Oman, Delbruck's contemporary, took much the same position. (2) Recognition of the importance of siege warfare, however, did not lead historians to the obvious conclusion that the subject merited intensive study as an essential aspect, if not the essential aspect, of medieval military history, and as a key to our understanding of the Middle Ages. Indeed, Henry Guerlac observed in 1943: "nothing is more conspicuously lacking in the field of military studies than a well-illustrated history of the arts of fortification and siegecraft."(3) Yet, only two years later Ferdinand Lot wrote in the introduction to his classic study, L'Art militaire et les armees au moyen age et dans le proche orient: "il laisse de cote une parti essentielle du sujet, la Guerre de sieges, qui a joue un si grand role dans les siecles qu'on a passes en revue."(4) In 1980, Philippe Contamine noted: "In its most usual form medieval warfare was made up of a succession of sieges accompanied by skirmishes and devastation." Indeed, Contamine goes so far as to suggest that medieval warfare was dominated by "fear of the pitched battle" and a "siege mentality." Like Lot, Contamine did not provide a major change of focus.(5) The failure of military historians to pursue the study of medieval siege warfare can be rather simply, if not simplistically, explained as a result of "presentism." During the later nineteenth century and throughout much of the twentieth, military planners cleaved to the doctrine which is often styled "the strategy of overthrow." This emphasized "the importance of battle to such a degree that they regarded it as the only important act in war."(6) Indeed, those historians who wrote medieval military history, whether professional scholars or amateurs, not only would appear to have adhered to this doctrine but regarded any other way of conducting warfare as ostensibly unworthy of study.(7) Thus, when scholars such as Delbruck, Oman, and Lot wrote medieval military history they looked for battles to study. Even more importantly, they focused attention upon the so-called "knights" or "heavily armed cavalry." This element in society putatively dominated the battlefield, and thus they are also thought to have dominated medieval warfare with the shock of their mounted charge. This model is still regarded as the "key" to understanding the military history of the Middle Ages.(8)


Turmeric has been used as a functional food material but, other parts of the plant such as leaves are wasted as byproducts. This project aims at utilization of turmeric leaves which is generally thrown off or burnt as waste. Disposal of turmeric leaves after harvest of turmeric possesses a huge challenge for the farmers, removal of leaves from the plant comes with an extra cost as the workers need to be paid for removing the leaves, thus to cut the cost farmers burn the leaves. India dominates the world production scenario contributing 80% of turmeric growth, which is mainly used as spice with other applications being used in preparation of dyes, drugs, cosmetics and for religious ceremonies. Karnataka is the third largest producer of turmeric in India. According to studies, the phytochemical characteristics of the turmeric leaf extract demonstrates functional effects such as cosmeceutical, skin immunity, anti-inflammation, antimicrobial, anti-insecticidal activities and antixidant activities. Turmeric leaves also have large volume and surface area and thus can be used for industrial applications. Turmeric leaf oil is rich in phenolic components. The main constituents of the turmeric leaves are curcumnene, limonene, phellandrene and turmerone. In this regard, this project aims at complete utilization of turmeric leaves and turning the leaves which is generally regarded as waste into value added products. The final products developed from the leaves are Dhoop sticks and Room Freshener. The Dhoop sticks developed are organic and chemical free and has aroma that can be refreshing and relaxing as turmeric leaves have strong aroma. Turmeric leaves are rich in Curcumin which is known to have Anti-insecticidal properties in this regard Dhoop sticks are being developed. Perfumes/Room freshener are developed using turmeric leaves as they have anti-bacterial properties and prevents any type of skin allergy while producing fresh fragrance. The products are developed keeping in the mind the source of extra income they act as for the farmers. When tested for anti-bacterial activity the results gave positive results, which is an indication that turmeric leaves have great applications and needs to be explored.


DOI:10.1097/HJH.0b013e328361a4ae T he current interest of investigators and clinicians in hypertension-related organ damage is well witnessed by a substantial number of papers devoted to this research area in the current issue of the journal. In an unselected population cohort (the Finn-Home Study), Hänninen et al. (pp. 1136–1143) have found that signs of organ damage (electrocardiographic voltages, carotid intima–media thickness, pulse wave velocity) had significantly higher values in masked and sustained hypertension than in normotension, with white-coat hypertensive patients showing intermediate values. In another community sample from a different part of the world (South Africa), Booysen et al. (pp. 1124–1130) also found that among individuals with normal or high normal blood pressure those with or without organ damage (assessed by pulse wave velocity, estimated glomerular filtration rate, left ventricular mass) had similar clinic blood pressures, but different calculated aortic SBP. In an editorial commentary, Perlini and Grassi (pp. 1083–1085) remark that these data suggest a continuum of target organ damage related to the blood pressure load, which in the Finn-Home Study could be better assessed by home blood pressure and in the South African study by central blood pressure estimation. Other studies focus on specific types of organ damage. Milan et al. (pp. 1189–1195) call attention on the high prevalence of aortic root dilatation among treated and untreated hypertensive patients, and suggest criteria for a correct diagnosis. Peralta et al. (pp. 1196–1202) report a high prevalence of occult chronic kidney disease among hypertensive patients included in the US National Health and Nutrition Surveys underlining the diagnostic role of cystatin C or albumin-to-creatinine ratio. Antikainen et al. (pp. 1224–1232) have investigated electrocardiographic left ventricular hypertrophy in the very old hypertensive patients of the Hypertension in the Very Elderly Trial (HYVET) and found that the Cornell product criteria appear to be the most useful measure owing to its close relationship to SBP. Collins et al. (pp. 1214–1223) provide evidence that diurnal variations in excitation-contraction coupling are lost in the spontaneously hypertensive rat heart. Cognitive function is often considered to be unfavorably affected by blood pressure, but evidence is scanty and controversial. Controversial observations are also presented in the current issue of the journal. Lyngdoh et al. (pp. 1175–1182) have examined the association between cognitive endpoints and blood pressure in school children and found no association. Levy-Marpillat et al. (pp. 1073–1082) have assessed available evidence on prevention of cognitive decline and dementia with blood pressure-lowering treatment by a systematic review and


Roads in Hokkaido, the northernmost island of Japan, suffer poor visibility from snowfall, snowstorm and dense fog. Fog often occurs at mountain passes separating the Pacific Coast of Hokkaido from inland areas. Such visibility reduction increases the risk of rear-end collisions, because leading vehicles are recognized later than in clear weather. To support trip planning, it is important to provide drivers with fog forecasts in addition to conventional winter road weather information. The authors provided fog forecasts via Internet on a trial basis for Nissho Pass on National Highway 274, where fog occurs in every season. Fog was forecast using a statistical model based on analyses of weather and fog data for the past three years. They found that fog tends to occur when the humidity is high and weak winds blow from cardinal points ranging from east to south and that the most influential weather factors in fog occurrence are wind speed, wind direction, and humidity. Based on these three factors, they categorized weather conditions into six combinations. They divided the road section that includes Nissho Pass into six subsections. The fog percentage (hours of fog/hours of that weather condition × 100) for each of the six combinations of weather conditions on each of the six road sub-sections was calculated from meteorological records. This percentage is regarded as the probability of fog occurrence, and the probabilities were classified into the four ranges of 0%–10%, 10%–40%, 40%–70%, and 70%–100%. The model output a current fog forecast and a forecast for each of the next 6 h as one of the four fog probability ranges, and these were provided by web page in July 2006. To determine the forecast accuracy, the authors analyzed road image data recorded during the same period. A fog percentage was calculated for each of the six combinations of weather conditions on each of the two road subsections of the mountain pass by visually judging image data for fog. Each observed fog percentage fell within the probability range of the fog forecast. Finally, to evaluate the usefulness of the fog forecast web page, the authors surveyed website visitors by online questionnaire. Eighty percent of the respondents responded that they thought fog forecasts were useful, attesting to their high acceptance of the system.


Active evacuation guidance using a sensor agent is explored. The sensor agent robot is equipped with a high precision servo-accelerometer with a uplifting mechanism for axles to ensure accurate measurement of floor response. The story drift angle is estimated from the acceleration data obtained by the sensor agent robot to decide whether evacuation is needed or not. This sensor agent robot is used for services in the living space in a normal situation. Thus, the evacuation system can be economical and feasible as the system for this evacuation added to the robot is small.


Innovative collaboration between schools and universities can enhance teacher education. The model described in this paper was developed as part of a partnership between a school principal leading a cluster of diverse primary schools and a local university school of teacher education. The partnership established a memorandum of understanding to support targeted and standards-based professional learning for teachers and new leaders across the schools in the cluster. Novice preservice teachers were also assigned to these schools for an extended weekly professional placement. This paper outlines the model as it was designed—to respond to the strategic demands of particular school communities, and to ensure teaching and leadership development for preservice and in-service teachers. The paper will explain the model's conceptual and research base for professional learning. It will identify practical theories for skill and leadership development in preservice and in-service teacher education.


Photoionization is one of the most fundamental photoreactions that leads to the ejection of an electron and the formation of an ion. With the help of modern 3D momentum imaging spectrometers, the interplay between the time and frequency domain upon ionization is studied.

In this work, single photoionization of helium is investigated in the few-cycle pulse regime of the driving infrared laser pulses with ultrashort attosecond pulses in a dressing infrared field. By varying the carrier-to-envelope phase of the infrared field to modify the spectro-temporal structure of the attosecond pulses, we analyze how the infrared field impacts the measured angularly-resolved photoelectron energy distribution. To this end, a newly built coincidence 3D momentum spectrometer was used. A thorough understanding of the experiment is achieved by using simulations within the strong field approximation. This analysis allows us to separate our observation into two scenarios, one at two attosecond pulses when the carrier-to-envelope phase is $\pi/2$ and the second one at three attosecond pulses when the carrier-to-envelope phase is 0 or $\pi$. When the dressing infrared field is added, the photoelectron spectrum changes in comparison to photoionization with attosecond pulses only. While two attosecond pulses in the dressing infrared field modify the photoelectron spectrum in a continuous way, we observe sidebands appearing in the spectrum generated by three pulses in the dressing infrared field.

Finally, the resolution of the spectrometer is studied before and after an upgrade of the spectrometer was performed in the context of this work. This study allows us to understand the limiting factors of the energy resolution. In particular, it shows that the resolution is essentially limited by the source volume of the emitted particles, while the magnetic field does not limit the resolution as it was expected.


Introduction: The SLC6A4 gene encode for serotonin transporter which regulates synaptic concentration of serotonin thus influences perception, mood, emotion, behavior, and cognition which are the main symptoms of Schizophrenia (Sz). This study investigated the association of SNPs within SLC6A4 gene with Sz.
Methods: A total of 240 Sz patients and 364 normal controls were studied. Genomic DNA was extracted from peripheral blood. Rs12449783, rs140700, rs6352 and rs6354 were selected and genotyped using allelic discrimination real time Taqman® assay.
Results: A significant association was found between rs12449783 of SLC6A4 gene and Sz for both alleles and genotypic frequencies (p = 1.68 x 10−8 and 5.11 x 10−7 respectively).
Conclusion: The significant association between rs12449783 of SLC6A4 gene in our Sz samples reaffirmed the previous similar findings in other population thus support role of SLCA4 gene in Sz.


To determine the effects of strength training (ST) on glucose regulation , 26 untrained men (age=54 ±9 years; mean--SD) with either noninsulin-dependent diabetes (N=8) or impaired glucose tolerance (IGT) (N = 10) and/or hyperinsulinemia (N = 12) were studied before and after completion of 20 weeks of either circuit weight training (N=8), aerobic (treadmill walk/jog) training (AT) (N=8), or no exercise (NE) (N=10). The AT group served as reference controls and the NE group served as inactive controls. Plasma concentrations of glucose and insulin were measured after a 12 to 14 hour fast and during a standard oral glucose tolerance test (OGTT) before and approximately 20 hours after training. Multivariate analysis of variance was used prior to univariate analyses and planned comparisons were made to determine the effects of each training modality and whether training-induced changes between ST and AT differed. In contrast to AT, ST had no significant effect on VO2 max. However, ST produced significant reductions in total plasma glucose area (mg•dL' 120min-1) under the OGTT curve (24079±4482 vs 21257 ±5880, p<0.05) and in plasma glucose levels (mg•dL') at 60 minutes (233±35 vs 202±57, p <0.05), 90 minutes (203±54 vs 195±68, p <0.05), and 120 minutes (211±58 vs 184±68, p <0.05) after glucose ingestion. ST also lowered the total plasma insulin area (μ U•ml-'•120min-') under the OGTT curve (8368±3547 vs 6508±1570, p <0.05) and plasma insulin levels (MU-ml-1) during fasting (20±15 vs 13 ±8, p <0.05) and at 90 minutes (87 ±36 vs 58±15, p<0.01) and 120 minutes (100±50 vs 69±18, p <0.05) after glucose ingestion. There were no significant differences in OGTT results between ST and AT and no changes were observed in the NE group. All men with IGT who participated in ST normalized their glucose tolerance. Results indicate that ST improves glucose tolerance and increases insulin sensitivity to the same extent as AT in men with glucostatic abnormalities, independently of changes in aerobic capacity. These findings suggest that ST may reduce risk for coronary heart disease by improving abnormal glucose regulation.


National Institute for Environmental Studies (NIES) has been implementing a joint monitoring project of greenhouse gases (GHGs) and air pollutants in Indonesia with Bogor Agricultural University (IPB), Agency for the Assessment and Application of Technology (BPPT), and Meteorological, Climatological, and Geophysical Agency (BMKG). To estimate the amount of anthropogenic emissions from Jakarta megacity (Jabodetabek) and compare with city activities, we developed a ground-based comprehensive monitoring system of GHGs and air pollutants and installed it at Bogor (center of Bogor city) in March 2016, Serpong (Jakarta suburb) in August 2016, and Cibeureum (mountainous area, background-like site) in March 2017. The monitoring system consists of data acquisition/control units and the instruments for continuous measurements of CO2, CH4, CO, NOx, SO2, O3, aerosol concentrations (PM2.5, PM10, BC) and the chemical components, and meteorological parameters. Flask sampling of air is also done to analyze N2O, SF6, and carbon isotopes (13C, 14C) in CO2 and to validate the continuous measurement data. The result shows that CO2 mole fractions observed at three sites have clear diurnal variations representing the minimum values from 12 to 15 local time while the values at Bogor and Serpong are 6.8 and 7.1 ppm higher than Cibeureum, respectively.


The purpose of this study was to describe the development of fine motor skills through 3 M activities (coloring, cutting and sticking) on students in the B2 kindergarten group Al-Ittihad. This study is a Classroom Action Research (CAR). The procedure for implementing classroom action research consists of two cycles. Each cycle is carried out in accordance with the changes to be achieved as what has been designed in the factors to be investigated. The subjects in this study were as many as 20 people consisting of 10 male children and 10 female students in Musdalifah Poasia Kindergarten 2010/2011 Academic Year. From the results of the evaluation of observations, it can be concluded that through 3M activities (coloring, cutting and sticking) that are carried out optimally can develop the fine motoric abilities of students in the kindergarten Al-Ittihad B2 group. Recommendations for further research in order to re-raise the same problems but with other methods, techniques and strategies as well as different actions in order to provide input or new findings in optimally developing the potential of students in kindergarten Keywords: Fine motor skills , early childhood, activities (coloring, cutting and sticking)


ABSTRACTPurpose-The global recession in the recent past is presenting new and difficult challenge for marketers wishing to provide goods that retain loyalty of consumers both during and after the recession. The purpose of this paper is to understand the impact of global recession on consumer shopping behaviour moreover how consumer consumption and saving pattern changed across different product categories during and after recession.Design/methodology/approach - A total of 235 consumers across shopping malls, beaches, parks in Dubai were personally surveyed with a structured questionnaire. Paired sample t-test & ANOVA was used to test the effect of recession on consumption pattern of different good and leisure related activities.Findings- The study provides empirical evidence that the priorities of the consumer have significantly changed after recession.Practical Implications-The results may help the marketers to understand the evolving consumption and saving patterns, and fine -tune their strategies accordingly.Originality/Value-The study differs from previous works as it provides empirical evidence that recession has impact on the shopping behaviour of the customers specially in Islamic Country-Dubai.Keywords: pre and post Recession, Consumer Behaviour, Shopping Behaviour, Islamic Country Dubai.INTRODUCTION:The global recession present changing patterns in consumers' behaviour and companies' marketing strategies either propel or undermine performance (Quelch & Jocz, 2009). Which generate panic among consumers and present a stressful situation for the marketers resulting to immediate changes in consumer priorities (Dawson, 2006; Amalia & Ionut, 2009; Deparez & Amara. 2011; Per-Henrik. 2010).Marketing researchers study consumer behaviour as part of the broader survival tactic for marketers during downturns (Perner, 2008, Hansen, 2004, Arnold, Price & Zinkhan, 2002; Gulf News, 2009; John, 2010), but more specifically it can develop, enhance, maintain and terminate relationship with specific consumer segment; as it include a wide set of prior and after purchase activities.Between 2009 and 2010 the recession was exerting a broad influence on consumer trends and attitudes, propelling some trends forward while slowing, halting and even reversing others (Flatters and Willmott, 2009). As economies implode, and the frailty and folly of many business decisions are exposed, there has been, unsurprisingly, considerable criticism that marketers have been complicit through their encouragement of unsustainable patterns of consumption with messages of rampant consumerism, endless credit, and disposable culture (James, 2007; de Graaf, 2005; Schor, 1998). In particular, encouraging even greater consumption of fossil fuels, fast food and cigarettes, as well as over -packaging products, and building in unnecessary product obsolescence have done little to position marketing as the planet's saviour (Kleanthous and Peck, 2007). However, marketing is central to global society, and when harnessed responsibly, those messages encourage us to recycle, reuse, buy fairtrade, eat healthily, drink sensibly, save energy, spend intelligently and support good causes (Carrigan & Pelsmacker, 2009). Though, the commercial potential for marketers in this current economic crisis encourages people desire for simplicity and accelerating the maturing trend. Consider the rise of edited retailing (consumers are offered limited collections of coordinated product choices), a growing demand for trusted brands and value, an increasing desire for advisers - ranging from social networks to product ranking web sites - that can simplify choice making, and enthusiasm for less complicated, more user-friendly technologies. This trend will continue to accelerate through the recovery into the long term. Unlike consumers in previous recessions, who greeted the return of financial stability with a buying spree, current consumers entered the recession feeling bloated. …


Structural properties of texture elements in a surface have successfully been applied to characterize textures. For this purpose, histograms of a texture element's properties are used. The compactness property of an element has been used for characterization. The compactness depends upon it's perimeter. A novel method based on perimeter contribution, to compute the value of the perimeter is presented. The perimeter value computed using the proposed method is closer to the actual, than the perimeter value computed using the conventional methods. The value of perimeter using the proposed method is also more consistent than the conventional methods. The value of compactness using the proposed method is not only closer to the actual value but also more consistent under affine transformations. The invariant histogram of compactness using the invariant value of compactness characterizes the texture invariant of scaling and rotation.


This paper expounds several main forms of non-verbal communication and its application in library's circulation services,and points out that the non-verbal communication,which is an important form of interpersonal communication,has great significance for establishing the harmonious relationship between librarians and readers.


In general views, tourists of different nature may be able to tolerate different degree of risks with regards to their travels. This study was designed to explore the public views towards risks on tourism. We conducted a combination of online and offline surveys which asked respondents to rank their perceived impacts of the collection of risks on their travel decision. Based on 103 respondents, we could detect two groups of tourists with somewhat comparable characteristics. The statistical analysis of group differences reveals that the two groups have different perceptions towards risks concerning travelling in Thailand, especially for the risks relevant to terrorist attacks, facility security, cultural difference, and local economic condition.


Nanoparticles have been proven to be efficient catalysts for a variety of chemical reactions, with added advantages such as reuse of catalysts, increasing the scale of reactions employing continuous flow techniques, and simple separation of the reaction milieu, making them green, efficient, and lucrative choices. Over the last decade, gold nanoparticles (AuNPs) have appeared as promising and efficient catalysts in the field of sustainable organic synthesis. On the other hand, heterocycles are significant scaffolds in a variety of natural products and other biologically active molecules, as well as useful compounds for organic and material chemistry. Therefore, the progress of proficient techniques for the synthesis of heterocyclic compounds is always of major significance. This mini-review focuses on some of the most important AuNPs catalyzed heterocyclic compound synthesis processes. Wherever essential, the exclusivity of the approaches has been discussed by emphasizing the substrate diversity, selectivity, product yields, and mechanistic features.


[Objective]To investigate the clinical utilization status of aspirin in geriatric outpatients,and to discusse the main reasons for its inappropriate use.[Methods]A total of 300 patients who were taking aspiring were randomly selected from geriatrics outpatient to inquire their doses of aspirin and analyze the varied causes of underdose.[Results]Among the 300 patients studied,57.0% had a wrong dose of aspirin.Of 202 geriatric outpatients never hospitalized,71.78% took underdose of aspirin,and only 26.53% of outpatients discharged from the hospitals took underdose of aspirin.The main causes of underdose were the patients' afraid of the adverse reaction of bleeding,wrong instructions from non-cardiac doctors,and doctors' negligence of inquiring pateints to use aspirin during their visits.[Conclusion]Aspirin is widely used in primary and secondary prevention for cardiovascular diseases,but underdose of aspirin is still common in practice.


With the continually increasing 1evel of the coal separation automation.PLC has been used in many coal separation trades.This article analyses the main factors of influencing the dependability of the coal separation plant PLC control system in work.Puts forward the main measures of resisting interference from software and hardware.These measures can satisfy the request of the control system.


The shock state which occurs as a complication of bacteremia due to gram-negative bacteria is a problem encountered in urological practice. The seriousness of the problem is reflected by the 82% mortality noted in the series herein reported. This type of shock is frequently precipitated by urological instrumentation and manipulation. The clinical features are sufficiently distinctive to permit early diagnosis. Prompt treatment, including appropriate antibiotics, pharmacological amounts of corticosteroid, and judicious use of vasopressor agent, favors survival.


In a distributed system, an algorithm used to select a distinguished node or leader to coordinate some activity in the system is known as a leader election algorithm. While traditional approaches to leader election, based on node ID numbers, are of considerable theoretical interest, we believe that these approaches are not very practical. A leader in a distributed system provides some important service to the system. Therefore, it would be desirable to choose as leader a node that can render this service most efficiently. It is clear that a node with the largest ID will not necessarily make a "good" leader.
In this thesis, we propose and examine socially-inspired leader election schemes that attempt to locate the leader at a "good" node (from a performance standpoint) in the system. We assume that each node in the system uses locally available information to "vote" for the various candidates (potential leaders) on the basis of the performance level it would realize under each of them. These votes are combined using an election scheme to determine the elected leader.
We present twelve different election schemes and examine the quality of the elected leader in three different system models. We show (via both analysis and simulation) that six of the election schemes elect the "optimal" leader with a high probability.
Finally, efficient algorithms to implement the leader election schemes are developed. We show that most of the election schemes (ten out of the twelve) require at most $O$($n$) messages. The other two schemes require $O$($n\sp2$) messages.


Abstract This analytical method was adapted to determine the sorption of oxytetracycline (OTC), an antibiotic of large use for animal and agriculture, to tropical soils. Tetracycline antibiotics for veterinary are considered emerging environmental contaminants. The high performance liquid chromatography (HPLC) with UV-visible detector in reverse mode was used to generate quantitative data that allowed the construction of sorption Freundlich isotherms for soils-OTC at pH 4.8. The Freundlich isotherm was presented as a mathematical model suitable for the verification of soils-OTC sorption from chromatographic data, proving the sorption and its type, as well as the soil-OTC sorption capacity. The method consists of: • Measuring the presence of the oxytetracycline (OTC) veterinary in tropical soils • Constructing Freundlich isotherm for sorption soil-OTC to understand the OTC's fate on environment


Objective To observe the efficacy of Yanshu injection(compound matrine injection) combined with cisplatin chemotherapy in the treatment of advanced non-small cell lung cancer(NSCLC).Methods 182 patients with advanced(Ⅲa,Ⅲb,IV phase) NSCLC were randomly divided into two groups,both groups received TP,NP,GP programs of chemotherapy,the treatment group(n=92) was treated with Yanshu injection 20 ml/days,intravenous drip in addition.The median survival time,tumor objective response,clinical symptoms,quality of life,immune function,serum tumor markers and chemotherapy-related adverse reactions were observed before and after the treatment.Results The median survival time of the treatment group was significantly prolonged(P0.05).The clinical benefit rates(CBR) of treatment group and control group were 85.9% and 66.7% respectively,with significant difference between the two groups(P0.05).The subsets of plasma T lymphocyte NK,CD3,CD4,CD4/CD8 ratio of treatment group were significantly higher than those of the control group(P0.05).After treatment,CEA,VEGF of treatment group significantly decreased compared with the control group(P0.05).The clinical symptoms and quality of life of the treatment group were better than those of the control group(P0.05 or P0.01),and the rates of common chemotherapy-related adverse reaction in the treatment group were markedly lower than those in the control group(P0.05).Conclusion Yanshu injection(compound matrine injection) for the treatment of advanced NSCLC can prolong median survival time,improve the overall CBR,enhance immune function,reduce the level of serum tumor markers,reduce chemotherapy-related adverse reaction and improve quality of life.


Background and Aim:  The aim of the study was to investigate the burden of headache in neurology outpatient clinics (NOCs) regardless of their primary complaint.


Objective To know the relationship among glycosylated hemoglobin(HbA1c) and blood glucose and complications of diabetes mellitus and nosocomial infection in patients with type 2 diabetes mellitus.Methods One hundred and forty-three cases with type 2 diabetes mellitus were divided into three groups according to HbA1c levels to measure blood pressure and level of fasting blood glucose,glycosylated hemoglobin Ac.Evaluation on the complication and the nosocomial infection were carried out.Results With the HbA1c levels increasing,the incidence rates of the complications and nosocomial infection elevated accordingly.There were totally 58 cases with nosocomial infection with the rate of 40.56%.The infections concentrated on pulmonary,urinary system and skin.Conclusions Testing the level of HbA1c is important for the patients with type 2 diabetes mellitus in diagnosis and treatment.


Evidence has been obtained for the involvement of μM levels of Ca2+ in phospholipid catabolism during petal senescence by following the breakdown of [U-14C]-phosphatidylcholine by microsomal membranes from cut carnation (Dianthus caryophyllus L. cv. White-sim) flowers. Phospholipid degradation was mediated by three membrane-associated lipases, viz. phospholipase D (EC 18.104.22.168), phosphatidic acid phosphatase (EC 126.96.36.199) and lipolytic acyl hydrolase. The activities of phospholipase D and phosphatidic acid phosphatase were stimulated by 30 and 100%, respectively, in the presence of 40 μM free Ca2+, and the Ca2+-stimulation of phosphatidic acid phosphatase was calmodulin-dependent. When L-3-phosphatidyl-[2-3H]-inositol and L-3-phosphatidyl-[N-methyl-3H]-choline were used as substrates, inositol and choline accounted for 95 and 99%, respectively, of the water-soluble radiolabelled products. This suggests a predominance of phospholipase D activity over phospholipase C activity in these membranes.

Breakdown of membrane phospholipids in senescing carnations is known to be accelerated by treatment of young flowers with ethylene. To determine whether this involves a specific turnover of phosphatidylinositol as observed in animal systems in response to certain agonists, young flowers pre-labelled with 32PO3-4 were treated with 10 ppm ethylene. All phospholipids incorporated the label, but no enhanced turnover of phosphatidylinositol was observed. Inositol 1,4,5-triphosphate did not release Ca2+ from preloaded microsomal vesicles at concentrations known to be effective in animal systems (i.e. < 5 μM) although release of Ca2+ was observed when a higher (20 μM) concentration was used.


This article discusses the application of the frequency-context classification algorithm to texts of various styles. The main features of different styles that affect the efficiency of the algo-rithm are highlighted. It is proved that the method of selecting the subject of the text using the fre-quency-context classification algorithm works best in relation to scientific and legal documents and, in its current form, is practically inapplicable for literary texts. This makes the task of modifying the algorithm to determine the subject of literary texts relevant.


A gas flow sensor has been developed for home-appliances applications. The main requirements were to obtain a low cost single device able to work in the range 0-1slm with high linearity, low power, reliability and robustness. A thermal flow sensor has been designed with the help of thermal and flow FEM simulation for the design of the sensor chip as well as its packaging. The process flow is based on a simple silicon micromachined technology. Chip-on-board solution has been selected to simplify the packaging. Electronics for driving the sensor and for compensation offsets and temperature dependence and for linearising the output signal has been implemented. Final device shows good sensitivity and linearity in different zones of the range of interest.


Pure-play Internet retailers haven't made a profit and probably never will. The winners on-line will be experienced retailers that can execute a multichannel strategy. Retailing on the World Wide Web has alerted the general public to the Internet's potential for transforming business and everyday life. Yet so far, the financial performance of most Web-based retailers has been dismal. Their experience provides an object lesson for the new economy: businesses have to make money. As the Web continues to transform retailing, can retailers hope to generate profits on-line? The evidence is sobering. Our recent research into the underlying economics and competitive dynamics of Web retailing shows that it will be structurally impossible for most pure Web retailers --unless they hit Amazon.com-like scale--ever to turn a profit, let alone to take a dominant position. The clear advantage in retailing goes to big, highly skilled traditional retailers that use the Web to extend their already potent physical presence. So though pure plays may indeed be doomed, the demise of e-tailing has been greatly exaggerated for multichannel players. The problem Most e-tailers lose money on every transaction. Even the flagship e-tailer, Amazon, is losing about $7 an order on its nonbook sales after taking into account product, shipping, and fulfillment costs. (Its book sales generate about $5 an order.) Fogdog Sports, a sporting-goods outlet, loses $5 an order. For others, the losses are even starker: Drugstore.com loses about $10 to $15 an order (Exhibit 1). Three weaknesses lie at the core of this problem: 1. Many product categories, such as toys, start off with a big disadvantage-- they are difficult to pick, pack, and ship; they attract only small orders; or both. 2. Plain inexperience and lack of scale are inflating fulfillment costs to as much as $12 to $16 an order for many pure plays. 3. Inexperienced merchandising and sourcing organizations, intense price competition, and problems with inventory management and product returns give pure plays particularly poor gross margins. Established retailers in categories like apparel and drugs enjoy an advantage of 2,000 to 3,000 basis points in gross margins. They are thus in a much stronger position to make profits and prosper. To post comfortable contributions on each transaction, e-tailers would need efficient order fulfillment, average order sizes of at least $100, and gross margins of at least 25 percent (Exhibit 2). Since money generally vanishes with each order, it follows that almost all e-tailers are losing money on every customer, for those customers generate too few orders or too little profit per order to cover the cost of winning them. Soaring acquisition costs of $50 to $100 a customer, generated by the difficulty of building virtual brands without stores or catalogs, put pure plays in a deep hole. In addition, many of them have relied on scattershot marketing campaigns using high-profile ads that generate buzz among investors but don't bring customer accounts to the servers. This combination of low repeat buys, high acquisition costs, and small orders explains why pure plays are destroying value with every customer. Retailers with established brands and marketing engines are relatively insulated from such problems, for these retailers can leverage their traditional marketing mix to acquire on-line customers more cheaply. In highly brand-sensitive categories like apparel, multichannel retailers can spend as little as one-third or even one-fourth of what their pure-play rivals pay for that purpose. Fixed costs come unfixed The lower costs per order and per customer of multichannel retailers help them break even. But contrary to the early business plans of many players, e-tailing doesn't amount to a free new channel where established retailers can test new product categories, reach new customers, and increase revenue. …


Energy efficiency is a trend due to ecological and economic benefits. Within this field, energy efficiency in buildings sector constitutes one of the main concerns due to the fact that approximately 40% of total world energy consumption corresponds to this sector. Climate control in buildings has the potential to increase its energy efficiency planning strategies for the heating, ventilation and air conditioning (HVAC) machines. These planning strategies may include a stage for long term indoor temperature forecasting. This chapter entails the use of four prediction models (NAÏVE, MLR, MLP, FIS and ANFIS) to forecast temperature in an office building using a temporal horizon of several hours. The obtained results show that the MLP outperforms the other analyzed models. Finally, the obtained predictors are deeply analyzed to obtain information about the influence of the HVAC settings in the building temperature.


Glass granules and grains of crushed glass usually replace sand if photo-elastic observation of load-transmitting 'force chains' is planned. Still an open question exists however, how well glass granules can represent real sand grains. This paper in its first part compares simple uniaxial crushing tests on glass grains (both granules and crushed glass) and on coarse sand grains (micro-scale). Some basic geometrical characteristics of glass and sand grains are discussed, then the measurement techniques are presented and the results of crushing tests demonstrated. The second part of the paper contains the results of 'macro-scale' loading tests on big granular samples, made of ~106 glass or sand grains. The deformation characteristics of these samples differ significantly.


The elementary education requires the normal students to grow into mature teachers rapidly after their graduation.For this purpose,the normal education should cultivate students' vocational ability in the real situation.The evaluation of their grades as the guidance,encouragement and supervision for their study can stimulate their participation in the practical activities and hence improve their comprehensive caliber.


Recent years have seen unprecedented fire activity at high latitudes and knowledge of future wildfire risk is key for adaptation and risk management. Here we present a systematic characterization of the probability distributions (PDFs) of fire weather conditions, and how it arises from underlying meteorological drivers of change, in five boreal forest regions, for pre-industrial conditions and different global warming levels. Using initial condition ensembles from two global climate models to characterize regional variability, we quantify the PDFs of daily maximum surface air temperature (SATmax), precipitation, wind, and minimum relative humidity (RHmin), and their evolution with global temperature. The resulting aggregate change in fire risk is quantified using the Canadian Fire Weather Index (FWI). In all regions we find increases in both means and upper tails of the FWI distribution, and a widening suggesting increased variability. The main underlying drivers are the projected increase in mean daily SATmax and decline in RHmin, marked already at +1 and +2 °C global warming. The largest changes occur in Canada, where we estimate a doubling of days with moderate-or-higher FWI between +1 °C and +4 °C global warming, and the smallest in Alaska. While both models exhibit the same general features of change with warming, differences in magnitude of the shifts exist, particularly for RHmin, where the bias compared to reanalysis is also largest. Given its importance for the FWI, RHmin evolution is identified as an area in need of further research. While occurrence and severity of wildfires ultimately depend also on factors such as ignition and fuel, we show how improved knowledge of meteorological conditions conducive to high wildfire risk, already changing across the high latitudes, can be used as a first indication of near-term changes. Our results confirm that continued global warming can rapidly push boreal forest regions into increasingly unfamiliar fire weather regimes.


Today, the lack of realistic practice among students leads to many mistakes in practice and fear of the future work. The purpose of this work is to study the effectiveness of applying the newly developed educational module in the discipline "local anesthesia in dentistry" in groups of students with different levels of professional training. In this study, a new concept of learning to perform inferior alveolar nerve block (IANB) was tested. The study involved 240 people (80 in each of the 3 groups – students, residents and dentists, then the groups were divided into equal subgroups – 40 people in each). After the briefing, the subgroups started studying the program: subgroup 1 of each group followed the Skull-Phantom-Simulator (PSS) training module, where the training format included skill-building exercises on the skull followed by phantom practice and an exam on a hybrid simulator. Subgroup 2 of each group used the Phantom-Skull-Simulator (PSF) training module, where the training format included skill-building exercises on a semi-anthropomorphic phantom followed by a correction practice on the skull and an exam on a hybrid simulator. The study showed the effectiveness of using the Phantom-Skull-Simulator (PSS) system for educational purposes for residents (the efficiency of the procedure was increased by 90%), both types of simulations are equally suitable for training doctors, and the Skull-Phantom-Simulator (SPS) system is more suitable for teaching students – the efficiency increased by 83.36%. Clinical article (J Int Dent Med Res 2021; 14(1): 257-264)


Ultrasonic propagation through nanofluids has now become a subject of great interest. It is a typical technique to examine the structure formation in nanofluid. Speed of sound can be considered to evaluate acoustical parameters and hence, to investigate physico-chemical properties of nanofluid. Investigation of these physico-chemical properties enables to understand the nature and strength of particleparticle and particle-fluid interactions. Zinc oxide nanoparticles are synthesized by co-precipitation method, while ZnO-ethylene glycol nanofluids are prepared with the aid of sonication. Characterization of synthesized nanoparticles are carried out by XRD, FTIR, UV-visible, TEM, SEM and EDX spectroscopic techniques. Speed of sound, density and viscosity values are measured for different concentrations of ZnO nanofluids at 298.15, 303.15 and 308.15 K. Different acoustical parameters, such as adiabatic compressibility ($ad), intermolecular free length (Lf), relaxation time (τ), absorption coefficient (α/f2), acoustic impedance (Z), Gibb's free energy ()G) and free volume (Vf) are evaluated from the experimental data. Variation in these acoustical parameters helps to know the mechanism of cluster formation and or interaction between particles in the ZnO nanofluids. It is found that particle-fluid interaction increases up to a critical concentration of 0.6 wt% beyond, which there is predominance of particle-particle interaction.


Background: In the context of the coronavirus disease 2019 (COVID-19) pandemic, frontline nurses were active in this event and faced numerous challenges. This study aimed to discover the emotional challenges nurses faced on shifts in COVID-19 wards. Methods: In this phenomenological qualitative research, purposive sampling was used to collect the data. A phone interview was conducted with nurses who worked in COVID-19 wards in five Medical Science Universities in Iran in 2020. Then, the recorded interviews were written down. Findings were analyzed using a 6-step thematic analysis guided by Van Manen's hermeneutic phenomenological approach. The validity and reliability of the study were assessed based on the four criteria proposed by Lincoln and Guba: credibility, dependability, confirmability, and transformability of data. Results: According to analyzed data obtained from interviews with 15 nurses working in the COVID-19 ward, the age average of participants was about 32±5.05. The thematic analysis consisted of four themes, including unpleasant reception (subthemes of limited resources, lack of knowledge, and unpreparedness to deal with the crisis), full involvement and various conflicts (subthemes of extreme fatigue, affected family life, uncontrollable fear, and career change), mental or psychological tortures (subthemes of unexpected incidents, distressing observations, and performance dissatisfaction), and patients' emotional deprivation (subthemes of disappointment and frustration, communication disorder, and isolation). Conclusion: This study described the experiences of nurses working in COVID-19 wards facing four emotional challenges. It is suggested to provide psychological support for nurses, meet their needs, and boost their morale as effective measures to expand the quality of care and society's satisfaction with healthcare services.


From the introduction of spinal anesthesia (in 1899) to the present time speculation has been almost continuously rife concerning the behavior of the anesthetic after injection. Although the suggestion was made as early as 1901 by J. S. Miller 1 that it would be important to study the actual concentration of the anesthetic in the cerebrospinal fluid, most attempts to solve the problem have been based on studies of the behavior of fluids injected into inanimate models, into cadavers and occasionally into experimental animals. On the basis of such studies and on a priori reasoning of doubtful validity these authors have concluded that anesthetic solutions of greater density than the cerebrospinal fluid flow downward toward the head if the patient is immediately placed in the Trendelenburg position. In a recent paper 2 this point of view has been adopted again, and various measures have been indicated to prevent untoward results


The effects of the introduction of silver carrying attapulgite on the mechanical properties and antibacterial properties of PMMA were studied in this paper.By the in situ polymerization method,silver carrying attapulgite / PMMA nano-composites were prepared.The mechanical and antibacterial properties were characterized.The results showed that the antibacterial performance of composite improved significantly with the increase of the content of silver ion;when the content of silver carrying attapulgite clay was 3%,the impact strength of composites reached at the maximum as 8.49 kJ / m2,while the relative wear rate was the lowest as 0.52%;when silver carrying attapulgite clay content was 2 wt%,the flexural strength of the composites reached at the maximum as 87.37 MPa.


Objective To explore the building plan and application effects of digital center for surgery anesthesia and anabiosis.Methods Via analyzing the work flow of surgery anesthesia center,a digitized system was designed,and anesthesia and anabiosis related systems were developed and integrated,including HIS,LIS,PACS and intensive care information system,etc.Results The digitized system involved 8 subsystems:surgery registration information system,clinic anesthesia information system,intensive care information system,nursing information system,electronic medical record information system,message whiteboard system,surgery video teaching system and department management system,which realized the automatic collecting,processing,storing and administrating of surgery,anesthesia and anabiosis information.Conclusion The foundation of digital surgery anesthesia and anabiosis center will improve the quality and level of surgery anesthesia,and promote the building and development of anesthesiology.