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Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Heart and lung foundation Sweden. Background Over the last decades, significant improvements have been made in medical and lifestyle managements of patients with coronary artery disease (CAD). Nonetheless, "residual inflammatory risk" for recurrent cardiovascular events is high in this patient group and remains a diagnostic and therapeutic challenge. Activation of the NLRP3 inflammasome, involving release of interleukin (IL)-1β and IL-18 followed by their downstream target IL-6, is considered a major component of the inflammatory process in atherosclerosis. One major immunomodulator is the hypothalamic–pituitary–adrenal (HPA) axis. Interestingly, there is increasing evidence that cortisol exerts proinflammatory effects through the induction of NLRP3 expression. Purpose We investigated whether sustained inflammation was associated with altered HPA stress reactivity in patients with CAD. From 4 weeks up to 6 months after a coronary event, we measured systemic inflammation, with focus on inflammasome-related cytokines, and HPA axis hormones (ACTH and cortisol) before and after acute physical stress. Method We included 81 patients (mean age 62 years, 77 % males) and 30 controls (mean age 69 years, 67 % males). Patients underwent a standardized submaximal exercise stress test at 4 weeks (visit A) and 3-6 months after the coronary event (visit B) while controls performed one test only. Free cortisol was measured in saliva before, directly and 30 min after exercise. IL-18, IL-Ra (as a surrogate for IL-1 β), IL-6, ACTH and total cortisol were measured in plasma before and 30 min after exercise. Results At visit A, plasma levels of CRP (baseline only) and IL-6 did not differ between patients and controls while IL-18 and IL-1Ra were significantly higher in patients both before and after exercise, 500 (391-632) vs 386 (295-493), p=0.002; and 179 (141-267) vs 147 (117- 182), p=0.005, respectively(table 1). At visit B, CRP decreased while IL-18 and IL-1Ra levels remained at higher levels than controls. At both visits, patients showed a heightened cortisol reactivity (i.e. significant increase directly after exercise) while this did not occur in controls (Figure 1). At visit B, the relative increase in cortisol directly after exercise was even higher than at visit A (p=0.024). At both visits, ACTH decreased significantly after exercise in patients (p Conclusion Sustained elevations in IL-18 and IL-1Ra in CAD patients following a coronary event may indicate enhanced activity of NLRP3 inflammasome. Furthermore, patients exhibited a heightened cortisol stress reactivity, a phenomenon which has been associated with atherosclerosis progression and sedentary lifestyle in the population. It may be speculated that HPA axis alteration is directly associated with NLRP3 inflammasome activation in CAD, thus opening doors to new insights in prevention. However, this remains to be further investigated.

Utilization of modern breeding techniques for developing high yielding and uniform plant types ultimately narrowing the genetic makeup of most crops. Narrowed genetic makeup of these crops has made them vulnerable towards disease and insect epidemics. For sustainable crop production, genetic variability of these crops must be broadened against various biotic and abiotic stresses. One of the ways to widen genetic configuration of these crops is to identify novel additional sources of durable resistance. In this regard crops wild relatives are providing valuable sources of allelic diversity towards various biotic, abiotic stress tolerance and quality components. For incorporating novel variability from wild relative’s wide hybridization technique has become a promising breeding method. For this purpose, wheat-Th. bessarabicum amphiploid, addition and translocation lines have been screened in field and screen house conditions to get novel sources of yellow rust and Karnal bunt resistant. Stripe rust screening under field conditions has revealed addition lines 4JJ and 6JJ as resistant to moderately resistant while addition lines 3JJ, 5JJ, 7JJ and translocation lines Tr-3, Tr-6 as moderately resistant wheat-Thinopyrum-bessarabicum genetic stock. Karnal bunt screening depicted addition lines 5JJ and 4JJ as highly resistant genetic stock. These genetic stocks may be used to introgression novel stripe rust and Karnal bunt resistance from the tertiary gene pool into susceptible wheat backgrounds. Resumo A utilização de técnicas modernas de melhoramento para o desenvolvimento de tipos de plantas uniformes e de alto rendimento, em última análise, estreitando a composição genética da maioria das culturas. A composição genética restrita dessas plantações tornou-as vulneráveis a doenças e epidemias de insetos. Para uma produção agrícola sustentável, a variabilidade genética dessas culturas deve ser ampliada contra vários estresses bióticos e abióticos. Uma das maneiras de ampliar a configuração genética dessas culturas é identificar novas fontes adicionais de resistência durável. A esse respeito, os parentes selvagens das culturas estão fornecendo fontes valiosas de diversidade alélica para vários componentes de qualidade e tolerância ao estresse abiótico e biótico. Para incorporar a nova variabilidade da ampla técnica de hibridização de parente selvagem tornou-se um método de reprodução promissor. Para esse efeito, trigo-Th. As linhas anfiploides, de adição e translocação de bessarabicum foram selecionadas em condições de campo e de casa de tela para obter novas fontes de ferrugem amarela e resistência ao bunt de Karnal. A triagem de ferrugem em faixas em condições de campo revelou as linhas de adição 4JJ e 6JJ como resistentes a moderadamente resistentes, enquanto as linhas de adição 3JJ, 5JJ, 7JJ e as linhas de translocação Tr-3, Tr-6 como estoque genético de trigo-Thinopyrum bessarabicum moderadamente resistente. A triagem Karnal bunt descreveu as linhas de adição 5JJ e 4JJ como estoque genético altamente resistente. Esses estoques genéticos podem ser usados para introgressão da nova ferrugem e resistência ao bunt de Karnal do pool genético terciário em origens de trigo suscetíveis.

Health literacy is an independent predictor of health outcomes, including health knowledge and behavior. This study determined the influence of oral health literacy on knowledge and attitude towards children's oral health among pregnant women.A total of 130 pregnant women (65 nulliparous and 65 primiparous or multiparous) attending Hospital Universiti Sains Malaysia for antenatal care who did not have any diagnosed cognitive disorders and could read and write in the Malay language participated in this crosssectional study. A structured self-administered questionnaire was used to measure knowledge and attitude towards children's oral health, and the Malay version of the Oral Health Literacy Instrument (OHLI-M) was used to assess the oral health literacy of the participants.Multivariable linear regression analysis showed that older women and women with higher OHLI-M scores had higher mean knowledge scores than younger women (p=0.007) and women with lower OHLI-M scores (p=0.001), respectively. In addition, women with higher OHLI-M scores, women with higher mean knowledge scores, and women who had attended a talk about children's oral health were more likely to have higher mean attitude scores than women with lower OHLI-M scores (p=0.019), women with lower mean knowledge scores (p=0.006), and women who had never attended a talk about children's oral health (p=0.001).Pregnant women's oral health literacy was positively associated with their oral health knowledge and attitude towards children's oral health. Strategies to improve the oral health literacy of pregnant women are indicated.

The study aimed at developing and evaluating a simple green electrochemistry experimental kit named Lectrofun 2.0. Lectrofun 2.0 is an educational kit equipped with a module built with the criteria of user-friendly, costeffective, and laboratory free. The basic concept of electrochemistry was introduced through a guided learning approach via the module. The objectives of this research were to (1) develop Lectrofun 2.0 module using green chemicals, recyclable and easily accessible materials and (2) evaluate the module effectiveness in terms of student achievement/understanding of the Electrochemistry topic. This is a Design and Development Research (DDR) using the ADDIE model as an instructional design model. The development phase involves the first objective of the study, while the evaluation phase involves the second objective. Total of 46 respondents of pre-post tests were involved in evaluating effectiveness of Lectrofun 2.0 in terms of student achievement/understanding of the topic. The findings showed that 73.9% of students from the treatment group showed 4-grade increment (from grade E to grade A). This study showed that Lectrofun 2.0 has a significant impact on enhancing learner comprehension of Electrochemistry topic, enjoyment in learning, and learning to care for the environment.

Background Fibromuscular dysplasia (FMD) is a nonatherosclerotic arterial disease that has a variable presentation including pulsatile tinnitus (PT). The frequency and characteristics of PT in FMD are not well understood. The objective of this study was to evaluate the frequency of PT in FMD and compare characteristics between patients with and without PT. Methods and Results Data were queried from the US Registry for FMD from 2009 to 2020. The primary outcomes were frequency of PT among the FMD population and prevalence of baseline characteristics, signs/symptoms, and vascular bed involvement in patients with and without PT. Of 2613 patients with FMD who were included in the analysis, 972 (37.2%) reported PT. Univariable analysis and multivariable logistic regression were performed to explore factors associated with PT. Compared with those without PT, patients with PT were more likely to have involvement of the extracranial carotid artery (90.0% versus 78.6%; odds ratio, 1.49; P =0.005) and to have higher prevalence of other neurovascular signs/symptoms including headache (82.5% versus 62.7%; odds ratio, 1.82; P P P Conclusions PT is common among patients with FMD. Patients with FMD who present with PT have higher rates of neurovascular signs/symptoms, cervical bruit, and involvement of the extracranial carotid arteries. The coexistence of the 2 conditions should be recognized, and providers who evaluate patients with PT should be aware of FMD as a potential cause.

The authors are grateful to Associate Professor, Dr. Zulifqar Ali, Department of Mining Engineering, University of Engineering and Technology (UET), Lahore for his valuable support/ cooperation in X-ray diffraction (XRD) analysis and mineralogical evaluation of ore.

Image smoothing filters are applied to reduce the amount of noise in digital images by applying the convolution process on image pixels. However, the implementation of these filters in real time systems involves the complexity of implementation as floating numbers calculation and division. In this paper, the implementation of two smoothing filters, Mean and Gaussian is achieved using FPGA Spartan 3E device. The implementation was performed in a simplified and way that does not require division, and resultant images were displayed on LCD using configured VGA ports. Two filters were effectively implemented by utilizing 880 slices (5%) of Spartan 3E- XC3S160E device with maximum frequency of 56.6Mhz.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for coronavirus disease2019 (COVID-19) started in December 2019 in Wuhan, Hubei Province of China In multiple countries affectedby COVID-19, children are a small proportion of those affected by the disease In children who are affected,symptoms often range from absent to mild or moderate The exact mechanism by which children are affectedless severely is not yet understood, but adults may have more severe presentations secondary to immunedysregulation There remains limited data regarding COVID-19 infections in pediatric patients with underlyingmedical conditions, including immunodeficiency syndromes Myeloid differentiation factor 88 (MyD88)deficiency is a rare immunodeficiency characterized by increased susceptibility to infections caused bypyogenic bacteria with only 24 cases discussed in medical literature We present a case series of three siblingswith MyD88 deficiency with COVID-19 who had various presentations and courses The patients had closecontact with a family member who recently traveled and developed fever and cough SARS-CoV-2 PCR testing of nasopharyngeal specimens from all three patients was positive In case 1 and 2, the two females (16 y o and 15 y o ) presented with fevers, labs significant for lymphocytopenia and elevated inflammatory markersand chest x-rays (CXR) with lobar pneumonia They had persistent fevers and tachypnea with worseninghypoxia With worsening clinical condition and progression of radiologic evidence to multifocal pneumonia,they were transferred to the ICU They were initially started on NIV but rapidly progressed to moderate ARDSrequiring invasive mechanical ventilation The 16 y o remained on mechanical ventilation for 9 days andtransitioned to high-flow nasal cannula (HFNC) for 3 days The 15 y o progressed to severe ARDS and startedon veno-venous extracorporeal membrane oxygenation (VV-ECMO), which she remained on for 7 days Shewas subsequently extubated within 1 day to HFNC In case 3, the 13 y o male presented with cough withoutfevers, labs significant for mildly elevated inflammatory markers and CXR without consolidation Withworsening clinical condition and progression of radiologic evidence to multifocal pneumonia he wastransferred to the ICU for close monitoring He had no hypoxia and required no supplemental oxygen orventilatory support During hospitalization in the ICU, all three patients received hydroxychloroquine The twopatients on mechanical ventilation received tocilizumab and a 10-day course of remdesivir All three patientsrecovered from their respiratory illness COVID-19 in the pediatric population remains an area to be studied Patients with immunodeficiency may be at increased risk for infection not just secondary to the underlyingdisease pathology, but also from increased susceptibility to immune dysregulation This case series describesthe variability in illness severity in the context of the same underlying medical condition

The extent of the economic burden of malaria and its imposed mechanisms are both relevant to public policy. This paper investigates the economic burden of malaria and household behaviour in relation to the treatment and prevention of the illness in Pakistan. In this regard, data were collected from a randomly selected sample of 360 households using structured questionnaires. The survey results indicate that 23.4% of household members contracted malaria during the three-month reference period. The average per person cost of malaria is estimated at 3116 Pakistani rupees (PKR) (USD 32). The estimated cost of the illness was found to be equivalent to, on average, 6.7% of monthly household income. Although high-income households face a higher financial burden due to better preventive and mitigation measures, the negative consequences hit low-income households harder due to liquidity constraints and poor access to effective treatment. We recommend that malaria control policies be integrated into development and poverty reduction programs.

When the COVID-19 pandemic began, formal frameworks to collect data about affected patients were lacking. The COVID-19 and Cancer Consortium (CCC19) was formed to collect granular data on patients with cancer and COVID-19 at scale and as rapidly as possible. CCC19 has grown from five initial institutions to 125 institutions with >400 collaborators. More than 5,000 cases with complete baseline data have been accrued. Future directions include increased electronic health record integration for direct data ingestion, expansion to additional domestic and international sites, more intentional patient involvement, and granular analyses of still-unanswered questions related to cancer subtypes and treatments.

People are getting more concerned to protect their houses from unauthorized people, the status of the house environment like temperature, humidity, gas leakage and fire. The proposed system can monitor a house by use of sensors that are integrated with an Arduino microcontroller and an Ethernet shield unit. Notification message is used to alert users via mobile phone when a possible intrusion occurs or any abnormal events occurs in the Home environment. Nowadays, everyone is almost using mobile phone so via using this system, the users will not have to carry additional devices to monitor their house. This system is designed using modularity to become a flexible system that can be add more sensors without change the whole system, only add some sensors to increase systems functionality. So this system is a modular home security system using Ethernet that uses the internet via Blynk application function to initiate the communication between the system and the user.

A parallel brute force attack on RC4 algorithm based on FPGA (Field Programmable Gate Array) with an efficient style has been presented. The main idea of this design is to use number of forecast keying methods to reduce the overall clock pulses required depended to key searching operation by utilizes on-chip BRAMs (block RAMs) of FPGA for maximizing the total number of key searching unit with taking into account the highest clock rate. Depending on scheme, 32 key searching units and main controller will be used in one Xilinx XC3S1600E-4 FPGA device, all these units working in parallel and each unit will be searching in a specific range of keys, by comparing the current result with the well-known cipher text if its match the found flag signal will change from 0 to 1 and the main controller will receive this signal and stop the searching operation. This scheme operating at 128-MHz clock frequency and gives us key searching speed of 7.7 × 106 keys/sec. Testing all possible keys (40-bits length), requires only around 39.5h.

A highly effective and reusable immobilized unilayer thin coating of bentonite and photocatalyst was fabricated on the glass beaker to remove aqueous methylene blue solution. It was observed that the photocatalytic activity was much higher than that of pure titanium dioxide when applied with bentonite. Preliminary efficiency tests on immobilized TiO2bentonite unilayer coating under UV light for methylene blue removal proved that the immobilized TiO2-bentonite unilayer thin coating was suitable for degradation of dye. The influence of different compositions of TiO2 − Bentonite in unilayer was investigated that showed 0.50:0.50 ratios as a best for maximum photocatalytic degradation of methylene blue in aqueous medium. The photocatalytic activity was significantly dependent on the composition of bentonite − TiO2 that quenches the dye removal efficiency as composition increase or decrease 1;1 ratio. It is also reported that bentonite – TiO2 unilayer thing coating system is better than the bilayer system.

Background: Assessment of left ventricular (LV) filling pressure is among the important components of a comprehensive echocardiographic report. Previous studies noted wide limits of agreement using 2009 American Society of Echocardiography/European Association of Echocardiography guidelines, but reproducibility of 2016 guidelines update in estimating LV filling pressure is unknown. Methods: Echocardiographic and hemodynamic data were obtained from 50 patients undergoing cardiac catheterization for clinical indications. Clinical and echocardiographic findings but not invasive hemodynamics were provided to 4 groups of observers, including experienced echocardiographers and cardiology fellows. Invasively acquired LV filling pressure was the gold standard. Results: In group I of 8 experienced echocardiographers from the guidelines writing committee, sensitivity for elevated LV filling pressure was 92% for all observers, and specificity was 93±6%. Fleiss κ-value for the agreement in group I was 0.80. In group II of 4 fellows in training, sensitivity was 91±2%, and specificity was 95±2%. Fleiss κ-value for the agreement in group II was 0.94. In group III of 9 experienced echocardiographers who had not participated in drafting the guidelines, sensitivity was 88±5%, and specificity was 91±7%. Fleiss κ-value for the agreement in group III was 0.76. In group IV of 7 other fellows, sensitivity was 91±3%, and specificity was 92±5%. Fleiss κ-value for the agreement in group IV was 0.89. Conclusions: There is a good level of agreement and accuracy in the estimation of LV filling pressure using the American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 recommendations update, irrespective of the experience level of the observer.

Seventy kidney samples of broiler chickens 3-6 weeks old were collected from private chicken farms in Mosul province, used to study gross and histopathological changes in the kidneys. The most prominent gross pathological changes were variable ranging from swelling and congestion of kidney with petechial hemorrhage on the cortex to swelling and congestion w while other cases of kidney appears pale and small in size. Histopathological changes of the kidneys were characterized by acute tubular nephrosis leading to necrosis and desquamation of epithelial lining the renal tubules degeneration of the epithelial cell of renal tubules to diffuse degeneration of the epithelial cells of renal tubules leading to necrosis and desquamation of epithelial cells. Additionally there is infiltration of inflammatory cells (Lymphocytes) in the interstitial tissue of the kidney. In other samples the histological changes appears as proliferation in the mesengial cell of glomeruli with sever hemorrhage in the interstitial tissue. Also there is hyaline degeneration in the renal glomeruli. Moreover visceral gout was seen in some samples of kidney characterized by deposition of urates as clefts in the lumen of renal tubules with infiltration of inflammatory cells especially foreign body giant cell and macrophages in addition to congestion of blood vessels and hemorrhage in the interstitial tissue. From the result of the present study it was concluded that renal pathological changes occurred in broiler chicken associated with many diseases.

Human chromosome 1p35-p36 has long been suspected to harbor a tumor suppressor gene in pancreatic cancer and other tumors. We found that expression of rap1GAP, a gene located in this chromosomal region, is significantly down-regulated in pancreatic cancer. Only a small percentage of preneoplastic pancreatic intraductal neoplasia lesions lost rap1GAP expression, whereas loss of rap1GAP expression occurred in 60% of invasive pancreatic cancers, suggesting that rap1GAP contributes to pancreatic cancer progression. In vitro and in vivo studies showed that loss of rap1GAP promotes pancreatic cancer growth, survival, and invasion, and may function through modulation of integrin activity. Furthermore, we showed a high frequency of loss of heterozygosity of rap1GAP in pancreatic cancer. Collectively, our data identify rap1GAP as a putative tumor suppressor gene in pancreatic cancer. (Cancer Res 2006; 66(2): 898-906)

Separately collected urine (“yellow water”) can be utilized as fertilizer. In order to decrease storage volumes and energy consumption for yellow water transport to fields, enrichment of nutrients in yellow water has to be considered. Laboratory-scale batch freeze concentration of yellow water has been tested in ice-front freezing apparatus: a stirred vessel and a falling film freeze concentrator (coolant temperatures: -6 to -16°C). With progressing enrichment of the liquid concentrate, the frozen ice was increasingly contaminated with yellow water constituents (ammonia, total nitrogen, total phosphorus, TOC, and salts determined as conductivity). The higher the initial salinity of the yellow water and the lower the mechanical agitation of the liquid phase contacting the growing ice front, the more the frozen ice was contaminated. The results indicate, that in ice-front freezing devices multistage processes are necessary, i.e. the melted ice phase has to be purified (and the concentrates must be further enriched) in a second or even in a third stage. Energy consumption of this process is very high. However, technical scale suspension freeze concentration is reasonable in centralized ecological sanitation schemes if the population exceeds 0.5 million and distance of yellow water transportation to fields is more than 80 km.

Gastro-oesophageal reflux disease (GERD) was recognized as a clinical entity in the mid-1930s. It is the commonest disorder of the gastro-intestinal tract, resulting from failure of the gastro-oesophageal sphincter. It is a chronic condition and often requires life-long treatment with proton pump inhibitors in up to 25–50% of patients. The most common reported symptoms are heartburn and acid regurgitation, often exacerbated by eating. Heartburn alone occurs in 20– 40% of the adult population in European countries. This disorder is associated with considerable long-term morbidity and mortality. Symptoms of GERD can have a major effect on a patient’s lifestyle. In one survey conducted in the USA, 46% of patients were found to have moderate to extreme difficulty in eating certain foods that they wanted to include in their diet, and 30% also had difficulty eating the quantity of food they wanted. Half of respondents claimed that they did not have enough energy for activities they wanted to do, and 21–25% said that they felt tired or worn out almost all of the time. There has been a dramatic increase in the number of people suffering from GERD and fortunately, effective but costly medications are now available. These factors in combination have exponentially increased the cost of reflux management to health services. The estimation of the prevalence of GERD is difficult because of the lack of an accepted definition and of gold standard diagnostic criteria. European epidemiological data is lacking, however according to the available European data, the prevalence of GERD symptoms, mainly heartburn, has been reported to range from 10 to 40%. RISK FACTORS ASSOCIATED WITH GASTRO-OESOPHAGEAL REFLUX DISEASE

Pulp and paper mill effluents (PPMEs) are believed to contain some naturally occurring endocrine disrupting chemicals (EDCs) such as phytosterols or plant sterols, which may be related to a variety of physiological and morphological abnormalities in fish inhabiting receiving waters. Analyses of effluent streams from two Canadian pulp mills confirmed the presence of five different phytosterols in PPMEs. Sterol contents of biologically treated as well as untreated effluents are presented. ββ-Sitosterol, ββ-sitostanol (or stigmastanol), and campesterol formed the major fraction of plant sterols in PPMEs, accounting for 70 % or more of the total phytosterol content measured. Sterols entering the activated sludge treatment systems were generally removed from the effluents with average removal efficiencies of 72 and 66% for the two mills surveyed. Sorption and biodegradation may be responsible for the observed removal of plant sterols across the biological wastewater treatment systems. Key words: ββ-sitosterol, stigmastanol, campesterol, removal and mass flow of phytosterols or plant sterols, hormone disruptors, pulp mill effluents, activated sludge, industrial wastewater treatment.

Purpose To describe the ophthalmic and systemic features in a series of patients initially seen with eyelid basal cell carcinoma associated with Gorlin-Goltz syndrome. Design Retrospective noncomparative case series. Participants Of 105 consecutive patients with eyelid basal cell carcinoma managed at an Ocular Oncology Center between January 1973 and December 1999, four patients with Gorlin-Goltz syndrome were identified. Methods The ophthalmic and systemic features, management, and outcome of patients with eyelid basal cell carcinoma associated with Gorlin-Goltz syndrome were analyzed. The published literature on Gorlin-Goltz syndrome, specifically related to genetics, systemic features, ophthalmic associations, and prophylactic management strategies, was reviewed. Main outcome measures Response of the eyelid basal cell carcinoma to treatment and the final systemic condition were the main outcome measures. Results All four patients had a family history of Gorlin-Goltz syndrome. The systemic manifestations included multiple basal cell carcinomas in all the patients, frontal bossing or increased occipitofrontal circumference in three patients, palmar pits in two patients, odontogenic keratocyst in one patient, ectopic calcification in one patient, and bifid rib in one patient. The mean age at the detection of the first basal cell carcinoma was 30 years (range, 16–38 years). All four patients had multiple basal cell carcinomas on the face and elsewhere. The eyelid basal cell carcinoma was advanced with orbital infiltration in three patients, one of whom opted for palliative radiotherapy, whereas the other two underwent orbital exenteration. The fourth patient, who had localized recurrent basal cell carcinoma in the upper eyelid, was treated with excision and eyelid reconstruction. At the final follow-up (mean, 41 months), eyelid basal cell carcinoma was cured in three patients and stable in one patient. No patient had life-threatening sequelae of Gorlin-Goltz syndrome. Conclusions Gorlin-Goltz syndrome is a rare autosomal dominant cancer predisposition syndrome that may be associated with eyelid basal cell carcinoma. The associated systemic findings may be a clue to the diagnosis of this condition. It is important to recognize Gorlin-Goltz syndrome when a patient has multiple basal cell carcinomas or when a young patient with eyelid basal cell carcinoma is seen by an ophthalmologist, because lifelong monitoring is essential for patient management.

In this country, little research has been undertaken into the difficulties faced by students and the contributory stressors. It is apparent that they have a lot with which to content. Identification of stressors, assessement of stress levels and consequences on mental health appear vital.A pilot study was undertaken of 40 studets: 10 males aged under 21 years, ten males 21–40 years, 10 females under the age of 21 and 10 females 21–40 years, The purpose was to identify the potential factors leading to student discontent, problems and stress. Students were in the professions allied to medicine. Oral semi-structured interviews and a written questionnaire were used. Results indicated that for students the major difficulties were coursework and emotional state. Finance was a recurring problem but not as troublesome to the students as the other two problems. What must be considered are ways to alleviate student unhappiness. Emphasis should be placed on prevention where possible. Ongoing counseling thro...

A simple mixed triangular edge element is proposed for the finite elements, with which inhomogeneously-loaded and arbitrarily shaped waveguides are analyzed. The shape functions used for approximating the fields are found analytically to be divergence-free. The formulation has been found to encounter spurious-free solutions. As evidence, the non-physical solutions that appeared in the longitudinal component finite element formulation are shown to be absent in the present formulation. A comparison with another mixed element is furnished here in order to demonstrate the advantages provided by the present element

Meltback etching and selective meltback etching of GaN layers have been achieved using both liquid-phase epitaxy (LPE) and liquid-phase electroepitaxy (LPEE) techniques with GaAs solutions. Both the uniformity and the etching rate (∼ 2.4 μm/h) were improved using the LPEE technique.

Background: Experts agree that HF patients should practice appropriate self-care behaviors to minimize the risk of adverse clinical events, including early unplanned readmissions. We sought to understand patient perceptions and adherence to a web-based system designed to support self-care of HF patients. Methods: 100 HF patients were surveyed regarding their computer use and attitudes toward using an internet based web-portal (WP) to support self-care, provide patient education, and communicate with healthcare providers (HCP’s). We then consented 42 patients to participate in a 12 week trial of using the WP to track clinical parameters (daily weights, blood pressure, sodium/fluid intake, exercise), provide links for HF self-education, and update HCP’s on their progress. Patients received a face to face teaching session on accessing and using the WP. Results: The computer use survey (N=100) demonstrated that 72% of patients reported having a computer at home, 67% used email and 71% used the internet. In the WP intervention group (N=41) only 24 (58.5%) were able to successfully access the WP and enter data during the pilot (see table 1). Conclusions: Pilot data showed a significant positive correlation (see table 1) between patients indicating use of internet to access heaIth care information (HCI) and adherence with the WP. Despite strong interest to use a home based WP for self-care and communication with providers, we found that many hurdles prevented patients from using the WP. Internet based educational tools for HF patients may be desirable, but limitations in patients’ ability to access internet based programs may ultimately render the tools ineffective.

Background: Current legislation imposes financial penalties for institutions with high 30 day readmissions for acute myocardial infarction (AMI). BRIDGE is a nurse practitioner (NP) based post discharge transitional care program aimed at ensuring prompt (target: within 2 weeks) follow up (f/u) and facilitation of care for cardiac patients. Herein we report the effect of BRIDGE on readmissions and ED visits in over 1000 cardiac patients. Methods: Retrospective data was abstracted from June ‘08 to Dec ’10 for all patients referred to BRIDGE including demographics, comorbidities, medications, days to f/u with health care provider and 6 month outcomes for each diagnoses. Results: Of 1188 patients referred, 718 of 1020 (70.4%) patients attended BRIDGE, 178 patients were excluded from analysis due to invalid data or adverse events prior to the BRIDGE appointment. Diagnoses included: acute coronary syndrome (ACS) 268 (27%); angina 143 (14%), coronary disease 132 (13%); atrial fibrillation 148 (15%); heart failure 162 (16%); or other 157 (16%). There were no differences in baseline characteristics (table 1) of attendees vs. non-attendees, nor in Charlson Comorbidity Score for attend (4.42±2.48) vs. not attend (4.44±2.25; p=0.906). ACS patients attending BRIDGE had significantly lower rates of readmission at 30, 60, and 90 days, and a trend towards lower rates of ED visits at 30 and 60 days (table 2). This was not observed for other groups. Conclusions: A NP based transitional care clinic visit early post-discharge reduce early readmission and ED visits for patients with an ACS, but in this study did not impact other cardiac conditions.

Background: BRIDGE is a nurse practitioner (NP) based transitional care program for cardiac patients(pts) discharged from a large tertiary care health system. Attendance at the BRIDGE clinic has been shown to reduce early readmission and ED visits for acute coronary syndrome (ACS) pts. Little is known about causes of readmission for atrial fibrillation (AF) pts and whether an NP based program affects overall readmissions. Methods: Retrospective data on 1188 pts was abstracted from 2008 to 2010 for pts referred to BRIDGE. Early (30 day) readmission of pts with discharge diagnosis of AF underwent qualitative chart audit by a trained MD abstractor. When examining if BRIDGE affected readmissions, we excluded pts with ED visits/readmits prior to BRIDGE. Results: Median time to BRIDGE was 16 days. Of 1010 with complete data, 148 (15%) had a discharge diagnosis of AF; 110/148 (74%) AF pts attended BRIDGE. Thirty day readmission (30DR) for AF was 23% (34/148); 17/34 (57%) were sent to the ED by a MD or nurse. Attending BRIDGE had no effect on outcomes at all time points (table 1); 17 patients were readmitted before BRIDGE. Readmission at 6 months for AF was 41% for those who attended BRIDGE, 29% for those who did not (p=0.190). Table 2 details reasons for all 30DR in AF pts. Chart review demonstrated that all 30DR were appropriate, 83% (25/30) of non-elective readmissions were unavoidable, and of 5 potentially avoidable readmissions, 2 were due to patient non-compliance. Conclusions: 30-day readmission rates are high for pts recently discharged with a diagnosis of AF and most are unavoidable. A NP based transitional care clinic successful in reducing 30 day readmissions for ACS pts did not prevent either early or late readmissions in AF pts.

SUMMARY The influence of intake port design on the flow field in a dual-intake valve engine was investigated using computational fluid dynamics, in order to study the effect of inlet port design on the in-cylinder flow. A detailed 3D computational grid incorporating all the features of the Ford Zetec production engine inlet ports, valves and cylinder head was initially created and the flow structure modelled at 5 and lOmm valve lifts under steady flow conditions. Comparisons of computational results with experimental data obtained by laser Doppler anemometry indicate that the flow characteristics have been predicted well in most regions. Flow generated by different intake port designs was also simulated by introducing air into the cylinder at different directions to the inlet valve axes and the effects of port deactivation, throttling and exhaust gas recirculation were examined. The implications of the results for intake port design are discussed.

A regular boundary element method is employed for the variational formulation of the Helmholtz equation that governs waveguiding problems. The problems are defined on the boundary as usual, but as in the charge simulation method, the source points associated with the fundamental solutions are allocated outside the domain so that the singular integrals which occur in the standard boundary element procedure can be avoided. First, the formulation is developed for the two-dimensional (2-D) scalar Helmholtz problem, solving for the axial components of either electric or magnetic fields. Then the formulation is extended for the analysis of dielectric waveguides of the open type incorporating axial components of both electric and magnetic fields, for the solution of the propagating modes which are generally of hybrid types. Very close agreements have been found when the solutions obtained by the present formulation are compared with the ones obtained by different methods. One merit of the extended formulation is that it has been fixed to suppress the spurious solutions

Background: BRIdging the Discharge Gap Effectively (BRIDGE), a nurse practitioner delivered cardiac transitional care program, reduces 30-day readmissions and ED visits. Since psychiatric (psych) conditions are known to complicate care, we sought to determine if BRIDGE attendance reduces events in this at-risk population. Methods: Retrospective data was abstracted for all patients referred to BRIDGE (June ’08- Dec ’10) including: demographics, comorbidities and events within 6 months of discharge. Of 770 patients referred, 189 (24.5%) had a referral diagnosis of acute coronary syndrome (ACS). Results: Of these ACS patients, 73 (38.6%) were female, 162 (87%) were white, 16 (8.6%) were black. Mean age was 63.0±13.6 years, Charlson Comorbidity Index Score was 1.7± 1.0 and median length of initial hospitalization was 3[2-4] days. Fifty-five patients(29.7%) had psych disorders including 39 (20.6%) with depression, 21 (11.1%) with anxiety, 5(2.7%) with dementia and 17 (9%) with substance abuse. There was a high degree of correlation between the presence of anxiety and depression (r^2= 0.44376, p Conclusion: Data from this small sample suggests that BRIDGE does not improve outcomes for some patients with psych conditions. More research is needed to better understand the special needs of patients with anxiety or depression and the degree to which attending BRIDGE impacts outcomes in this population.

BRIDGE is a nurse practitioner (NP) based post-discharge cardiac transitional care program aimed at ensuring prompt follow-up (f/u) and facilitation of care. Pilot studies demonstrated improved 30 day outcomes for attendees. We expand our observations to a larger updated cohort referred to BRIDGE

This research extends the concept of [Lehrasab, 1999] to the domain of rotating machines. It aims at developing novel fault diagnostics techniques for the motor or rotating machines for diagnostics that is costeffective and easier to deploy from industrial perspective. Normally the encoders data is only used to measure speed, however this paper attempts to use the same data normally considered insufficient for mathematical modeling, in creating a set of model based residuals. The velocity measurements based on the timing between the hall effect sensors placed around the motor in form of a mini-plastic belt is accurately measured with a microprocessor without involving expensive A/D. Conventional schemes usually deploy the spectral analysis that requires expensive sensors and powerful data processing engines. This scheme employs the conventional encoder and with a very limited floating point implementations. The complete model based residual generator can be implemented that can relate the rotational jitters and mechanical faults and with further analysis it can be linked with a set of transformations from spectral domain to the jitter domain. The paper presents a novel model based residual generator for shaft Encoder of a motor based on its jitter model. The mechanical errors of the system are translated into variations in the angular velocity. The residual generator presented in this paper is sensitive to the resolution of jitters of 4us to cross 3s thresholds.

Aircraft jet engines produce loud thundering sound that is caused due to high rate of fuel-air combustion. However due to improper combustion caused by non proportional air-fuel ratios, malfunction of fuel feed or any other loose gauging, certain abnormal sounds are produced that indicate fault occurrence. This research is an attempt to automate fault detection in aircraft jet engines by acoustic observations. The experimental analyses were based on sound analysis of Teledyne J 69 Jet Engine. Noise features were identified and extracted for subsequent analysis from frequency spectrums of jet engine audio signals. A total of 100 samples were analyzed for noise feature extraction and a threshold for noise magnitude was empirically found for automated fault noise identification. The developed system was subsequently tested over 400 audio samples from 40 different engines of Teledyne J 69 type that resulted in the system's accuracy of 97%.