Journal articles on the topic 'Generalised 3-body problem'

Introduction: Construction workers are at a risk of a number of health-related problems, and are exposed to a plethora of occupational hazards. Due to dearth of studies on construction workers about various determinants playing key role on their health. Objectives: 1) To determine the socio-demographic status of construction workers. 2) To assess workplace hazard exposure among study subjects. 3) To evaluate the overall health of the study subjects. Method: An opportunity was created in a general health camp organised by Department of Community Medicine, VMMC and Safdarjung Hospital, Delhi in collaboration with Central Public Work Department (C.P.W.D) Officers’ Wives Association. All the construction workers attending the health camp were approached and only those who consented were included in the study. An interviewer administered questionnaire was filled for all the study subjects. Along with the questionnaire, detailed clinical examination was done, blood pressure and random blood sugar was measured. Simple tables and cross tables were made to present the data. Result: Total 129 construction workers were included in the study. Nearly 87% of the workers were employed on temporary or contract basis. 63.6% (n=82) spent 8 to 12 hours per day at work. Around half of the construction workers earned Rs. 10,000 per month or less. Thermal stress affected the maximum number of workers (54.3%), followed by dust (53.5%), followed by noise (38%). Around 10% (13) of the workers complained of having some health problem. Various complaints were generalised body ache, headache, weakness, fever, cough, cold, blood in sputum, decreased appetite and blood in stools. Conclusion: Construction workers are suffering from adverse health problems. There is the importance of regulating work hours of construction workers, periodic training on safe work culture and ways to reduce workplace injuries.

Scheifele (1970) applied Delaunay-Similar (DS) elliptic Keplerian elements (with the true anomaly as the independent variable) to the J2 Problem in Artificial Satellite Theory, making an element of the true anomaly. Deprit (1981) views Scheifele’s TR-mapping as an extension of Hill’s transformation from a 6-dimensional phase space to an enlarged, 8-dimensional one. To adapt this approach to elliptic-type two-body problems with a time-varying Keplerian parameter μ(t), Floía (1997, §3, §4) treated a Gylden system (Deprit 1983) and derived “Delaunay-Similar” variables via a TR-like transformation. Now we extend our treatment to perturbed Gylden systems, and modify the TR-map to deal with any kind of two-body orbit. We work out our generalization and the resulting variables within a unified pattern whatever the type of motion, in terms of universal functions (Stiefel & Scheifele 1971, §11; Battin 1987, §4.5, §4.6) and auxiliary angle-like parameters.

In terms of socio-economic significance, among the most burning problems of modern dentistry are periodontal diseases. According to modern ideas, in generalized periodontitis, one of the main mechanisms of destruction of the alveolar bone is considered to be an increase in prostaglandin levels. Data on the detection of receptors for PG E2 on the membranes of preosteoblasts and osteoclasts are described. Taking into consideration the effect of prostaglandins F2α and E2 on microvascular and cellular reactions in tissues, we can predict their important role in the development of healing and stabilization of the pathological process in periodontal tissues. The aim of this research was to study the dynamics of proand anti-inflammatory prostaglandins (F2α and E2) in the blood of patients with generalized periodontitis accompanied by normo-, hyperand hyporeactivity of the body after patch surgery. Materials and methods of research. 216 people aged 45 between 55 years old with the diagnosis of generalized periodontitis were examined. Depending on the condition of reactivity of the body, the patients were divided into three groups: 11 normoreaction; 2hyperreaction; 3 hyporeaction. After initial therapy, patch surgery was performed according to the indications. Blood sampling was performed after surgery on the 1st, 2nd, 4th, 6th and 9th day. The content of prostaglandins F2α and E2 was determined by radioimmunoassay. Statistical processing of the obtained digital data was performed using the computer program Statistica 8.0 (STA862D175437Q). Results of the research. The results of this study showed that for patients with generalized periodontitis accompanied by normoreactivity of the body after surgery by an imbalance between the proand antiinflammatory fractions of eicosanoids is typical. On the 1st day, the value of the PG correlation increased, reaching its maximum level on the 2nd day, exceeding the initial value by 1.8 times (p <0.05). This is due to a sharp increase in the content of PG F2α in the blood of patients with generalized periodontitis accompanied by falling concentrations of PG E2. Subsequently, the alignment of the primary balance of prostaglandins was observed on the 9th day, the correlation of PG F2α / PG E2 reached normal values. The change in the correlation of PG F2α / PG E2 in patients with generalized periodontitis accompanied by hyperreactivity of the body was monophasic in nature with its maximum value on the 1st day after surgery. The value of the correlation increased 1.4 times compared to the original (p <0,05) one. On the 2nd day, there was a significant decrease in the correlation of PG F2α / PG E2 to the value below the initial (0.18 ± 0.04). Subsequently, beginning with the 6th day, in the blood of patients with GP with hyperreactivity of the body, the correlation of eicosanoids was close to the initial one. The change in the correlation of PG F2α / PG E2 in patients with generalized periodontitis accompanied by hyporeactivity of the body was monophasic in nature with its maximum values on the 2-4th day after surgery. The value of the correlation became 1.6 times higher compared to the original (p <0,05) one. Subsequently, beginning with the 6th day, in the blood of patients with GP with hyporeactivity of the body the correlation of eicosanoids close to the original was revealed. Conclusion. Correction of altered parameters in patients with generalized periodontitis with impaired (hyperand hyporeactivity) of the body with bringing them to values, typical for normoreactivity is considered to be a condition for optimizing the healing of mucosal wounds after surgery and further stabilization of the process in periodontal tissues.

An inverse potential methodology is introduced for the solution of the fully 3-D target pressure problem. The method is based on a potential function/stream function formulation, where the physical space is mapped onto a computational one via a body-fitted coordinate transformation. A potential function and two stream vectors are used as the independent natural coordinates, whilst the velocity magnitude, the aspect ratio and the skew angle of the elementary streamtube cross-section are assumed to be the dependent ones. A novel procedure based on differential geometry and generalized tensor analysis arguments is employed to formulate the method. The governing differential equations are derived by requiring the curvature tensor of the flat 3-D physical Eucledian space, expressed in terms of the curvilinear natural coordinates, to be zero. The resulting equations are discussed and investigated with particular emphasis on the existence and uniqueness of their solution. The general 3-D inverse potential problem, with ‘target pressure’ boundary conditions only, seems to be illposed accepting multiple solutions. This multiplicity is alleviated by considering elementary streamtubes with orthogonal cross-sections. The assumption of orthogonal stream surfaces reduces the number of dependent variables by one, simplifying the governing equations to an elliptic p.d.e. for the velocity magnitude and to a second-order o.d.e. for the streamtube aspect ratio. The solution of these two equations provides the flow field. Geometry is determined independently by integrating Frenet equations along the natural coordinate lines, after the flow field has been calculated. The numerical implementation as well as validation test cases for the proposed inverse methodology are presented in the companion paper (Paper 2).

This prospective repeated-measures study explored potential factors (postmenstrual age, body weight, gender, chronological age, illness severity, and circadian rhythm) related to preterm infants’ circadian sleep/wake patterns. Circadian sleep/wake patterns were measured using an Actiwatch for 3 continuous days in preterm infants (gestational age of 28-36.4 weeks) in a neonatal intensive care unit and hospital nursery. Potential factors associated with circadian sleep/wake patterns were analyzed using the generalized estimating equation. For our sample of 30 preterm infants, better sleep/wake patterns were associated with male gender, younger postmenstrual and chronological age, lower body weight, and less illness severity. Preterm infants’ total sleep time ( B = 41.828, p < .01) and percentage of sleep time ( B = 3.711, p < .01) were significantly longer at night than during the day. These findings can help clinicians recognize preterm infants’ sleep problems, signaling the need to provide individualized support to maintain these infants’ sleep quality during their early life.

A method of the Riemann–Hilbert problem is employed for Zhang’s conjecture 2 proposed in Philo. Mag. 87 (2007) 5309 for a ferromagnetic three-dimensional (3D) Ising model in a zero external magnetic field. In this work, we first prove that the 3D Ising model in the zero external magnetic field can be mapped to either a (3 + 1)-dimensional ((3 + 1)D) Ising spin lattice or a trivialized topological structure in the (3 + 1)D or four-dimensional (4D) space (Theorem 1). Following the procedures of realizing the representation of knots on the Riemann surface and formulating the Riemann–Hilbert problem in our preceding paper [O. Suzuki and Z.D. Zhang, Mathematics 9 (2021) 776], we introduce vertex operators of knot types and a flat vector bundle for the ferromagnetic 3D Ising model (Theorems 2 and 3). By applying the monoidal transforms to trivialize the knots/links in a 4D Riemann manifold and obtain new trivial knots, we proceed to renormalize the ferromagnetic 3D Ising model in the zero external magnetic field by use of the derivation of Gauss–Bonnet–Chern formula (Theorem 4). The ferromagnetic 3D Ising model with nontrivial topological structures can be realized as a trivial model on a nontrivial topological manifold. The topological phases generalized on wavevectors are determined by the Gauss–Bonnet–Chern formula, in consideration of the mathematical structure of the 3D Ising model. Hence we prove the Zhang’s conjecture 2 (main theorem). Finally, we utilize the ferromagnetic 3D Ising model as a platform for describing a sensible interplay between the physical properties of many-body interacting systems, algebra, topology, and geometry.

ABSTRACT The important aspects of a dynamical system are its stability and the factors that affect its stability. In this paper, we present an analysis of the effects of the albedo and the disc on the zero velocity curves, the existence of equilibrium points and their linear stability in a generalized restricted three-body problem (RTBP). The proposed problem consists of the motion of an infinitesimal mass under the gravitational field of a radiating-oblate primary, an oblate secondary and a disc that is rotating about the common centre of mass of the system. Significant effects of the albedo and the disc are observed on the zero velocity curves, on the positions of equilibrium points and on the stability region. A linear stability analysis of collinear equilibrium points L1, 2, 3 is performed with respect to the mass parameter μ and albedo parameter QA of the secondary, separately. It is found that L1, 2, 3 are unstable in both cases. However, the non-collinear equilibrium points L4, 5 are stable in a finite range of mass ratio μ. After analysing the individual as well as combined effects of the radiation pressure force of the primary, the albedo force of the secondary, the oblateness of both the primary and secondary and the disc, it is found that these perturbations play a significant role in the design of the trajectories in the vicinity of equilibrium points and in the analysis of their stability property. In the future, the results obtained will improve existing results and will help in the analysis of different space missions. These results are limited to the regular symmetric disc and radiation pressure, which can be extended later.

We develop a novel method for finding sufficient experimental conditions for discriminating and quantifying individual biomolecule production sources in distributed, inhomogeneous multisource systems in vivo, and we apply it experimentally to a complex, unsolved problem in endocrinology. The majority of hormonal triiodothyronine (T3) is produced from prohormone thyroxine (T4) in numerous nonthyroidal organs and, with one exception, the T3 production rate has not been fully resolved in any single extrathyroidal organ of any species. Using a readily generalized graphic method called cut-set analysis, we show here that measured steady-state responses in several organs to three independent tracer infusions, two into blood and one directly into the organ(s) of interest, are sufficient to resolve this problem for organs fully accessible to direct infusion in vivo. We evaluated local T3 production in rat liver and intestine, which also required T3 bile flux measurements, and we found that liver produces ∼31% and whole intestine ∼6% of whole body T3 from T4. With thyroidal production included, liver contributes ∼15% and intestine ∼3% of whole rat T3 production. This new methodology is broadly applicable, especially to biosystems that include molecular interconversions at multiple sites.

Fibromyalgia is a condition which appears to involve disordered central afferent processing. The major symptoms of fibromyalgia include multifocal pain, fatigue, sleep disturbances, and cognitive or memory problems. Other symptoms may include psychological distress, impaired functioning, and sexual dysfunction. The pathophysiology of fibromyalgia remains uncertain but is believed to be largely central in nature. In 1990 the American College of Rheumatology (ACR) published diagnostic research criteria for fibromyalgia. The criteria included a history of chronic and widespread pain and the presence of 11 or more out of 18 tender points. Pain was considered chronic widespread when all of the following are present: pain in the left side of the body; pain in the right side of the body; pain above the waist; pain below the waist. In addition, axial skeletal pain must be present and the duration of pain must be more than 3 months. A tender point is considered positive when pain can be elicited by pressures of 4 kg/ cm2 or less. For tender points to be considered positive, the patient must perceive the palpation as painful; tenderness to palpation is not sufficient. However, over the next 20 years it became increasingly appreciated that the focus on tender points was not justified. In 2010 a similar group of investigators performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop new preliminary ACR diagnostic criteria, and to construct a symptom severity (SS) scale. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, un-refreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. The investigators combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI ≥ 7 AND SS ≥ 5). Although there is no known cure for fibromyalgia, multidisciplinary team efforts using combined treatment approaches, including patient education, aerobic exercise, cognitive behavioral therapy, and pharmacologic therapies (serotonin norepinephrine reuptake inhibitors [e.g., duloxetine, milnacipran] and alpha 2-delta receptor ligands [e.g., pregabalin]) might improve symptoms as well as function in patients with fibromyalgia. Key Words: Pain, fibromyalgia, fatigue, sleep, duloxetine, pregabalin, milnacipran

A necessary optimality condition for the minimum-drag shape for a non-magnetic solid body immersed in the uniform flow of an electrically conducting viscous incompressible fluid under the presence of a magnetic field is obtained. It is assumed that the flow and magnetic field are uniform and parallel at infinity, and that the body and fluid have the same magnetic permeability. The condition is derived based on the linearized magnetohydrodynamic (MHD) equations subject to a constraint on the body’s volume, and generalizes the existing optimality conditions for the minimum-drag shapes for the body in the Stokes and Oseen flows of a non-conducting fluid. It is shown that for any Hartmann number M , Reynolds number Re and magnetic Reynolds number Re m , the minimum-drag shapes are fore-and-aft symmetric and have conic vertices with an angle of 2 π /3. The minimum-drag shapes are represented in a function-series form, and the series coefficients are found iteratively with the derived optimality condition. At each iteration, the MHD problem is solved via the boundary integral equations obtained based on the Cauchy integral formula for generalized analytic functions. With respect to the equal-volume sphere, drag reduction as a function of the Cowling number S= M 2 /( Re m Re ) is smallest at S=1. Also, in the considered examples, the drag values for the minimum-drag shapes and equal-volume minimum-drag spheroids are sufficiently close.

A 10-year old male intact Shih Tzu, was presented to our clinic with complains of skin and hair problem. The condition had been appeared for 3 months. The antifungal medicated shampoo was given to the patient by the previous veterinarian, but there was no any clinical improvement. The clinical symptoms included alopecia in the dorsal body and trunk, comedones, hyperpigmentation, scales, lichenification, <em>pot bellied</em>, polyuria and polydipsia. Skin scraping and trichogram in the face area and fore limb found <em>Demodex sp</em>. Adult onset generalized demodicosis usually has an underlying cause. Endocrine disorders such as hypothyroidism and hyperadrenocorticism must be ruled out. From the clinical sign and laboratory work suggested for Low Dose Dexamethasone Suppressing Test (LDDST). Cortisol value after 8 hours of low dose dexamethasone injection was greater than basal cortisol, it means dexamethasone failed to suppressing cortisol level due to the high number of cortisol in the body. From LDDST the diagnose of hyperadrenocorticism (Cushing syndrome) has been made. The dog was given trilostane (Vetoryl^®) 3mg/kg SID for the Cushing and imidacloprid and moxidectine spot on (Advocate^® spot on) every 2 weeks for the demodicosis. Scales and lichenification was reduced and the skin got better after 3 weeks. Unfortunately, after 3 months of treatment, the dog had neurological sign including seizure, head tilt and nystagmus. From the neurological sign, we suspected that the dog had macroadenoma type of hyperadrenocorticism. A week after hospitalization, the owner decided to euthanize the dog.

Background: Dengue is a very common seasonal public health problem causing significant mortality every year. In 2019 an outbreak occurred in Bangladesh. Few new manifestations and multi organ involvement were found. Objective: The objective of the study was to see the clinical and laboratory manifestations and outcome of dengue fever in a medical college hospital. Methods: It was an observational study in a medical college hospital in Bangladesh. Study period was one year. The patients were confirmed cases of dengue. Apart from detailed clinical history, examination of patient, relevant investigations and follow up was done until discharge. Result: Total number of cases was 98. Out of them 62 (63.2%) were male and 36 (36.73%) were female. Fever was most common (100%) manifestation and duration of fever ranged from 5 to 8 days with a mean duration of 6.3 (± 1.0) days. Among other symptoms generalized body ache was most common (63, 64.3%). Generalized weakness was present in 60 cases (61.2% cases) Bleeding manifestations was present in 41 cases; abdominal manifestations were found in 11 cases. Blood for NSI was positive in 94 (95.9%) cases; most cases (71, 72.4%) became positive between 2nd to 4th day. Ninety (91.9%) cases developed thrombocylopcnia and it started at 5th day in 45 (45.9%) cases. Blood transfusion was given in 12 (12.2%) cases & Platelet transfusion was given in 3 (3.1%) cases. Complete recovery was in 96 (98%) cases and Death occurred in 2 (2.0%) cases. Conclusion: Bleeding was a dominant presentation. Some atypical manifestations like gastro intestinal features were also observed. These findings will help physicians in early diagnosis of dengue. Bang Med J Khulna 2020: 53 : 3-7

Abstract Background and Purpose: The selection of a “right” project management methodology for a particular project represents a problem of great importance. Its solution affects crucial project parameters like cost, duration, product quality, and the project’s success in general. The purpose of this study is to present a method for the formation of the project management methodology and illustrate its applicability on a software development project’s example. Design/Methodology/Approach: In this study, we describe the method of project management methodology formation that allows the forming of a specialized methodology for any IT project considering the fuzziness of information about the project, its environment, and existing expert’s recommendations. The method involves 1) collecting baseline information using a questionnaire, 2) calculating weighted Hamming and Euclidean distances, 3) solving a three-criterion optimization problem using a minimax approach with fuzzy input data. Results: All six stages of the project management methodology formation’s method (project evaluation, basis selection, alternative methodologies formation, methodology selection, methodology application, and methodology tailoring) were applied to form a specialized project management methodology for an IT project to increase the possibility of its success. The most appropriate alternative based on DSDM was selected and applied to manage the project. Conclusions: The given method allows the forming of a specialized project management methodology based on the components of Generalized Body of Knowledge for any IT project considering specific conditions of the project and its environment.

Ecological safety of water intakes in urban water management systems and the creation of comfortable living conditions for people can be ensured only with a comprehensive solution to the problems associated with improving water quality when it is taken from the source, preserving biodiversity in the water body, protecting against blue-green algae, zebra mussel and mechanical pollution. The water intake technological complex as a part of the natural-technical system (NTS) specialized type “Natural water environment - Urban water management complex - Urban water supply system” (“NWE - UWMC - UWSC”), as the main multifactorial technogenic component, includes various types of hydraulic structures and protective devices interconnection, interaction and relationship (IIR), which ensure the environmental safety (ES) of the urban economy. The studies have established that the functional IIR between the structural elements of the “UWMC” in the composition of this NTS type “NWE – UWMC - UWSC” determines the generalized design and technological solutions, which determine the complex of protective measures to ensure the ES preservation of health and the urban population life quality. Based on the results of complex (theoretical, laboratory, full-scale) studies, constructive and technological solutions have been developed to preserve the diversity of ichthyofauna (juvenile fish, etc.) in the water body, to ensure the protection of the water intake bucket from bottom and suspended sediments, sludge and floating objects coming from the water body, from toxic blue-green algae and fouling with zebra mussel of structural elements and technological equipment as part of the urban water management complex. Functional sequence of IIR structural and technological solutions (STS-1, STS-2, STS-3) between themselves (Fig. 1) provides regulatory requirements for environmental safety.

Abstract One of the types of gravitational scattering in the Solar system within the framework of the model of the restricted three-body problem (R3BP) is gravity assist maneuvers of the “particles of insignificant mass” [1] (spacecraft, asteroids, comets, etc.). For their description, a physical analogy with the beam scattering of charged α particles in a Coulomb field is useful. However, unlike the scattering of charged particles, there are external restrictions for the possibility of gravity assists executing related from the restricted size of planet’s sphere of influence. At the same time, internal restrictions for the gravity assists performance estimated by the effective radii of planets are known from the literature on R3BP [2] (gravitational capture by the planet, falling into it). They depend from the particle asymptotic velocity relative the planet. For obvious reasons, their influence cuts off the possibility of effective gravity assists performance [3]. In this work the generalized estimates of the sizes of the near-planetary regions (“perturbation rings”), falling into which is a necessary condition for the implementation of gravity assists, are presented. The detailed analysis shows that Neptune and Saturn have the characteristic “perturbation rings” of the largest sizes in the Solar system, and Jupiter occupies only the fourth place in this checklist.

In article presented theoretic generalization practical efficiency issues training and deployment of troops (armed forces) by improving the analysis system, generalization and implementation of combat experience (ASGIE) and an actual scientific problem was solved in a new way, consisting in the improvement of the scientific and methodological apparatus of its functioning. Performed analysis mathematical models for descriptions and assessment functioning system of training and use of troops (armed forces). In the same time, the results of researches in exercises and other activities of operational, combat training and daily activities of troops (armed forces) showed the absence of effective mathematical models for the functioning of ASGIE of troops (armed forces). The constituents for each of the three performance indicators have been substantiated and determined, which reproduce the corresponding reactions of the ASGIE to obtain a generalized experience. The connection of these constituents with the requirements for the mathematical model of the reaction of the ASGIE is shown. A discrete-continuous stochastic model of the ASGIE reaction has been developed to study the effectiveness of a promising ASGIE for various options for its implementation. A system of Kolmogorov-Chapman differential equations of the first order has been formed, the solution of which gives the opportunity to get the value of performance indicators ASGIE. Calculations performed for ASGI which includes the governing bodies of three military units and three OC with decision-making on the generalization of experience for the majority principle "2 with 3" show: acceptable values of the performance indicator "Experience is generalized" are achieved when the values of the probability of identifying experience and the probability of successful generalization of experience by the management body are greater than 0.9; with the values of the probability of experience identification and the probability of successful generalization of experience by the governing bodies in the range from 0.4 to 0.7 with a probability of not less than 0.7, it will be necessary to continue to accumulate generalized experience in order to make a decision on its dissemination; accordingly, a value in the range from 0.2 to 0.6 is unacceptable for organizing the process of generalizing experience for the developed ASGI.

Background: Sex differences are frequently encountered when diagnosing orthopaedic problems. Current literature suggests specific sex differences, such as a higher prevalence of cam-type femoroacetabular impingement syndrome in male patients and features of hip instability in female patients. Purpose: To identify hip pathology patterns according to sex, alpha angle deformity, and generalized ligamentous laxity (GLL) in a nonarthritic patient population that underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome and labral tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy between February 2008 and February 2017 were included and separated into male and female groups for initial analysis. Patients were excluded if they had Tönnis osteoarthritis grade >1, previous ipsilateral hip surgery, or previous hip conditions. The demographics, radiographic findings, intraoperative findings, and surgical procedures were then analyzed and compared. Subanalyses were performed for both groups. A threshold of 1 SD above the mean alpha angle in the male group was used to create 2 subgroups. For female patients, GLL based on a Beighton score ≥4 was used to divide the group. Intraoperative findings were compared for both subanalyses. Results: A total of 2701 hips met all inclusion and exclusion criteria. Of those, 994 hips were in the male group and 1707 in the female group. The mean ± SD age was 36.6 ± 13.8 and 37.1 ± 15.0 years for the male and female groups, respectively( P = .6288). The average body mass index was significantly higher in the male group ( P < .0001). GLL was more common in women (38.6%) than men (13.6%) ( P < .001). The male group had a higher proportion of acetabular Outerbridge grade 3 (21.8%) and 4 (19.2%) lesions when compared with the female group (9.3% and 6.3%, respectively) ( P < .0001). Men in the subgroup with an alpha angle ≥78° reported higher rates of acetabular Outerbridge grade 4 damage than men with an alpha angle <78° ( P < .001). Mean lateral center-edge angle was lower in the female subgroup with Beighton score ≥4 vs <4 (23.7°± 4.2° vs 31.3°± 5.8°; P < .0001). Conclusion: In this analysis of a large cohort of patients who underwent hip arthroscopy, 2 patterns of hip pathologies were related to sex. On average, male patients had larger alpha angles and increased acetabular chondral damage when compared with their female counterparts. Furthermore, a larger cam-type anatomy was associated with more severe acetabular chondral damage in men. In the female group, the incidence of features of hip instability such as GLL were significantly higher than in the male group.

Hematological abnormalities including thrombocytopenia are common in patients living with HIV infection. Patients with HIV infection related thrombocytopenia present generally with only minor bleeding problems. But cases of subdural hematoma are very rare. A 61-year-old female with a history of HIV infection of 9 years’ duration presented with a 3-month history of generalized headache associated with visual blurring and anterograde amnesia. There was no history of trauma or fever. She was treated empirically for cerebral toxoplasmosis for 6 weeks without any improvement of the symptoms. One week prior to admission, she developed weakness of the left side of the body. Clinical examination revealed left-sided hemiparesis. Computed tomography scan of the brain showed a 25 mm chronic right frontoparietotemporal subdural hematoma compressing the lateral ventricle with midline shift. There was no appreciable cerebral atrophy. A complete blood count showed leucopenia and thrombocytopenia at 92,000 cells/mm3. Her CD4-positive cell count was 48 cells/mm3 despite receiving combination antiretroviral therapy for 9 years. A complete blood count analysis suggestive of thrombocytopenia should raise suspicion of possibilities of noninfectious focal brain lesions like subdural hematoma amongst HIV infected patients presenting with nonspecific neurological symptoms. This will enable prompt diagnosis and allow early appropriate intervention.

Early dynamical evolution of close-in planetary systems is shaped by an intricate combination of planetary gravitational interactions, orbital migration, and dissipative effects. While the process of convergent orbital migration is expected to routinely yield resonant planetary systems, previous analyses have shown that the semi-major axes of initially resonant pairs of planets will gradually diverge under the influence of long-term energy damping, producing an overabundance of planetary period ratios in slight excess of exact commensurability. While this feature is clearly evident in the orbital distribution of close-in extrasolar planets, the existing theoretical picture is limited to the specific case of the planetary three-body problem. In this study, we generalise the framework of dissipative divergence of resonant orbits to multi-resonant chains, and apply our results to the current observational census of well-characterised three-planet systems. Focusing on the 2:1 and 3:2 commensurabilities, we identify three three-planet systems, whose current orbital architecture is consistent with an evolutionary history wherein convergent migration first locks the planets into a multi-resonant configuration and subsequent dissipation repels the orbits away from exact commensurability. Nevertheless, we find that the architecture of the overall sample of multi-planetary systems is incompatible with this simple scenario, suggesting that additional physical mechanisms must play a dominant role during the early stages of planetary systems’ dynamical evolution.

Obesity is a condition characterized by an excess of body fats. Obese persons differ in the amount of excess fat that stores and the regional distribution of that fat within the body. It is therefore essential to distinguish between those at risk as a result of abdominal obesity than those with generalized obesity. There are many studies about the obesity rate in Asia but these studies did not give a clear idea about it in the Asian subgroups, the present research aims to study: 1) obesity rate in another ethnic and cultural Asian subgroups , in Iraq, it depend on gender and age of the groups using different ways such as Body mass index (BMI) and percentage of total body fat (TBF), 2) studies which one way is better to give a realty average of obesity, and 3) diseases risk depend on gender and age of the groups using waist/hip ratio (W/H ratio). this study included 780 individuals. The age of the group was in the range of 6-60 years of both genders with apparently healthy status. The individuals were distributed to different age groups; (6-12 years) including primary school students, (13-19) years including secondary school students, (18-23 years) including undergraduate university students, and (≥24 years) including university employees. BMI, TBF, and W/H ratio were measured in all individuals as WHO reported. This study found that 1) the general frequencies of obesity status according BMI did not exceed (7.8%) from total number of subjects (5.7% in female and 2.1% in male) most of them were ≥24 years old, while it found that obese percentage increased to (44.7%) from total number of subjects according TBF (39% in females and 8% in males) most of them were ≥24 years old. 2) the high risk rate was higher in female compared to males. This risk is elevated with the age, the highest high risk was recorded in ≥24 years group which reached 66% (54.5% in females and only 11.5% in males). In conclusion, such high risk ratio related with the obesity rate according TBF is not reassuring especially for ≥24 year’s group and needs serious stand by, re-measured again larger than the current samples and gives a solution for this problem.

Purpose: In this study, a urinary management system was established to collect and analyze urinary time and interval data detected through patient-worn smart bands, and the results of the analysis were shown through a web-based visualization to enable monitoring and appropriate feedback for urological patients.Methods: We designed a device that can recognize urination time and spacing based on patient-specific posture and consistent posture changes, and we built a urination patient management system based on this device. The order of body movements during urination was consistent in terms of time characteristics; therefore, sequential data were analyzed and urinary activity was recognized using repeated neural networks and long-term short-term memory systems. The results were implemented as a web (HTML5) service program, enabling visual support for clinical diagnostic assistance.Results: Experiments were conducted to evaluate the performance of the proposed recognition techniques. The effectiveness of smart band monitoring urination was evaluated in 30 men (average age, 28.73 years; range, 26–34 years) without urination problems. The entire experiment lasted a total of 3 days. The final accuracy of the algorithm was calculated based on urological clinical guidelines. This experiment showed a high average accuracy of 95.8%, demonstrating the soundness of the proposed algorithm.Conclusions: This urinary activity management system showed high accuracy and was applied in a clinical environment to characterize patients’ urinary patterns. As wearable devices are developed and generalized, algorithms capable of detecting certain sequential body motor patterns that reflect certain physiological behaviors can be a new methodology for studying human physiological behaviors. It is also thought that these systems will have a significant impact on diagnostic assistance for clinicians.

One of the government's efforts to realize the highest health status and goals, especially for people who cannot afford it, is regulated in Law Number 24 of 2011 concerning the Social Security Administering Body. However, in practice, several problems were found, such as a tendency for the public to assume that the Social Security Administering Body for the Health Sector bears all the financing for health services and there is no guarantee of comfort received by the participants of the Social Security Administering Body for Contribution Assistance. This shows that the enforcement of legal protection regarding the rights of the poor as participants in the Health Insurance Contribution Assistance has not been realized from the perspective of human rights. The purpose of this study is to identify and analyze legal protection and problems for participants of the National Health Insurance Contribution Assistance Recipients (PBI), to identify and analyze the legal factors that affect the implementation of the National Health Insurance system for Contribution Assistance Recipients and to identify and analyze the reconstruction of Article 11 Law on the Social Security Administering Body for participants in the National Health Insurance for Contribution Assistance Recipients based on the value of justice. This study uses a type of research and a Socio-Legal (socio-legal research). The paradigm used is the Constructivism Paradigm to understand that the existing reality cannot be generalized to a particular context at a specific time. The results of the study show that it can be seen clearly both from theoretical studies and empirical studies, including a review of the products of laws and regulations as well as government policies and institutions in the context of the Welfare States and the government's effort to provide social security and social services to all its people in an integrated manner. fair. Legal protection for patients participating in the National Health Insurance Contribution Assistance Recipients (PBI) is an important thing because this is closely related to the handling and health services that will be received by patients. The implementation of legal protection for people who cannot afford has been implemented but is not optimal. The legal factors that most influence the implementation of protection for poor people in hospitals today are community factors, namely not being aware of the law and or not obeying the law, so there is no effectiveness. In addition, there are still differences in the health services received by patients participating in the Health Social Security Administering Body for Contribution Assistance Recipients with patients from the Social Security Administering Body for Non-Contribution Assistance Recipients. The Ideal Construction of the National Social Security System in the Health Sector Based on Welfare Values can be realized by reconstructing the law against Article 11 of Law Number 24 of 2011 concerning the Social Security Administering Body by reconstructing 3 (three) components, namely strengthening the legal substance component, strengthening the legal structure component and strengthening the legal culture component.

In this second paper we define a post-minkowskian (PM) weak field approximation leading to a linearization of the Hamilton equations of Arnowitt–Deser–Misner (ADM) tetrad gravity in the York canonical basis in a family of nonharmonic 3-orthogonal Schwinger time gauges. The York time 3K (the relativistic inertial gauge variable, not existing in newtonian gravity, parametrizing the family, and connected to the freedom in clock synchronization, i.e., to the definition of the the shape of the instantaneous 3-spaces) is set equal to an arbitrary numerical function. The matter are considered point particles, with a Grassmann regularization of self-energies, and the electromagnetic field in the radiation gauge: an ultraviolet cutoff allows a consistent linearization, which is shown to be the lowest order of a hamiltonian PM expansion. We solve the constraints and the Hamilton equations for the tidal variables and we find PM gravitational waves with asymptotic background (and the correct quadrupole emission formula) propagating on dynamically determined non-euclidean 3-spaces. The conserved ADM energy and the Grassmann regularization of self-energies imply the correct energy balance. A generalized transverse–traceless gauge can be identified and the main tools for the detection of gravitational waves are reproduced in these nonharmonic gauges. In conclusion, we get a PM solution for the gravitational field and we identify a class of PM Einstein space–times, which will be studied in more detail in a third paper together with the PM equations of motion for the particles and their post-newtonian expansion (but in the absence of the electromagnetic field). Finally we make a discussion on the gauge problem in general relativity to understand which type of experimental observations may lead to a preferred choice for the inertial gauge variable 3K in PM space–times. In the third paper we will show that this choice is connected with the problem of dark matter.

24 Background: The aim of this study was to compare the serial changes of health-related quality of life (HRQOL) after Endoscopic submucosal dissection (ESD) with those after surgery in patients with early gastric cancer (EGC). Methods: Gastric cancer patients were prospectively enrolled from 2004 through 2007. HRQOLs of 161 EGC patients were prospectively assessed by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) and the stomach cancer-specific module EORTC-QLQ-STO22 at the baseline, 1, 6, 12, 18 and 24 months after treatments. Analysis was done using the generalized linear model and paired- ttests. Results: Of 161 patients, 48 (29.8%) underwent ESD (ESD group) and 113 (70.2%) underwent surgery (surgery group). The median age of stomach cancer patients was 57 years. Surgery group had poorer scores compared with those of ESD group in the most HRQOL factors one month after treatments ( P< 0.05), except for emotional and cognitive functioning, financial problems, anxiety, and hair loss. However, most of the functional and symptom scales after surgery subsequently improved and became insignificant until 24 months of follow up. Only 3 parameters including physical functioning, diarrhea and body image in ESD group still remained better until 24 months after treatment ( P< 0.05). Conclusions: Because poorer HRQOLs after surgery in the early post-treatment periods become insignificant during long-term follow-up, surgical treatment should not be discouraged in EGC treatment solely based on the QOL aspects.

8586 Background: The oral fluoropyrimidine X has superior efficacy and improved safety vs. 5-FU/LV in MCRC and early-stage colon cancer. Consequently, X is replacing 5-FU/LV as the backbone of MCRC therapy and is moving into the adjuvant setting. The QoL benefits of oral agents like X over traditional i.v. drugs are becoming more important in MCRC. Methods: Pts with MCRC who received standard oral X (1,250 mg/m2 twice daily on days 1–14, every 3 weeks) until progressive disease or unacceptable toxicity completed EORTC QLQ C-30 (v3.0) and CR-38 questionnaires at baseline, before cycle 1, at weeks 7 and 13, and at end of treatment. The proportion of pts with improvement, stabilization or worsening of QoL scores from week 7 was analyzed using linear models with repeated measures (generalized estimating questions technique) and SAS (v8.2). Each questionnaire item was analyzed as a function of pts’ ECOG status before first cycle and the evaluation periods. Results: Here we report QoL findings in 1210 pts (male/female, 51%/49%); median age 60 years (range 20–91); 53% of males and 57% of females had ECOG 0 at baseline. Almost half of the pts completed QoL questionnaires through to the end of treatment. Around 42% of pts who presented ECOG ≥1 had ECOG 0 at the end of treatment. Regardless of the baseline ECOG score, pts had significant improvements (p<0.0001 unless stated) in pain (p<0.0002), stoma-related problems (p=0.0003), defecation problems (p=0.0112), appetite loss (p=0.001), weight loss, insomnia (p=0.0074), constipation, body image (p=0.0142), emotional functioning, social functioning (p=0.0170), financial problems (p=0.0407), future perspective, and global health status (p=0.0003). Conclusions: X was associated with improved QoL, with significant benefits observed in most functional/symptomatic QoL domains. The efficacy, safety and convenience benefits of X as reported previously appear to have a direct impact on QoL. These data support its increasing use in the first-line and adjuvant settings. No significant financial relationships to disclose.

Abstract Sexual dysfunction is a multidimensional problem caused by both physiologic and psychosocial factors. Yet little is known about the longitudinal trends of sexual functioning in HCT survivors, or the clinical or psychosocial factors associated with decline. Using a longitudinal study design, we administered the Derogatis Interview for Sexual Functioning (DISF-SR), the Global Sexual Satisfaction Index (GSSI), and the City of Hope-QOL instrument at 5 time points to a large cohort of patients undergoing HCT at City of Hope (COH): prior to HCT, at 6m, 1y-, 2y-, and 3y-post-HCT. DISF-SR assessed 5 domains of sexual functioning (Cognition/Fantasy, Arousal, Behavior/Experiences, Orgasm, and Drive/Relationship), and a Total score. GSSI elicited patients’ subjective appraisal of sexual satisfaction. The COH-QOL instrument was used to obtain self-reported levels of anxiety, distress, depression, pain, physical strength, and sleep changes, which were converted to composite scores of mental and physical stress. Long-term trends of sexual functions were estimated using the Generalized Estimating Equation. We examined the effects of sociodemographic factors, primary diagnosis, HCT conditioning regimens, disease status at HCT, presence of cGvHD, and composite mental and physical stress levels on the longitudinal trends of DISF-SR, the Total score, and GSSI. The cohort included 312 adults (median age at HCT 48y; 56% males) undergoing autologous (n=175) or allogeneic (n=137) HCT for hematologic malignancies or severe aplastic anemia; 144 patients completed the 3y sexual survey (participation rate at 3 years=75%). GSSI (general sexual satisfaction) declined significantly after HCT (p=0.001) for both men and women, and remained depressed over the 3-y study period, with 40% reporting poor or worse sexual satisfaction level at 3y. There were no significant differences between men and women in terms of general sexual satisfaction level. However, the degree of sexual dysfunction as measured by DISF-SR was worse in women than in men for all domains, and for Total score (p<.001) at all post-HCT time points (Fig. 1A). Furthermore, assessment of DISF-SR scores revealed that while men experienced a persistent decline in satisfaction with Orgasm and Drive/Relationship (p<0.05), women did not demonstrate a significant decline in sexual function in any of the domains post-HCT. Gender-specific multivariate analyses revealed certain subgroups that were more vulnerable to a decline in sexual functions after HCT. Notably, older age (≥40y) (Fig. 1B), being married, and TBI exposure in men (Fig. 1C), and older age (≥30y) (Fig. 1D), being overweight, and greater mental and/or physical stress in women were factors identified as significantly associated with decreased sexual functioning following HCT. Although cGvHD was not directly related to DISF-SR or GSSI, presence of cGvHD was accompanied by worse mental and physical composite scores (p<0.0001). Lower mental and/or physical composite scores in turn were significantly related to lower sexual functions for all domains of DISF-SR, the Total score (Fig. 1E) and GSSI in women (p<0.05). Thus, women may be vulnerable to the effects of cGvHD mediated through mental and/or physical stress, in turn resulting in compromised sexual functions and satisfaction after HCT. This study should inform healthcare providers that patients undergoing HCT require more attention to their sexual QOL within the first year after HCT. Routine inquiry of patients’ sexual health should be included in follow-up exams after HCT, especially for those at high risk (i.e. TBI-exposed men and those with cGvHD), with the ability to offer a multidisciplinary approach to managing this distressing complication. Figure Figure

Abstract Little longitudinal research exists on health and working among older racial and ethnic minority adults. Following previous cross-sectional research, we examine the Health, Aging, and Body Composition (HABC) study comparing working vs. not working overtime among older adults. We hypothesize: 1) Black vs. White adults are more likely to work; 2) Black vs. White differences in working are greater among women than men; and 3) Working relates to fewer prevalent health problems than not working. We used gender-stratified descriptive statistics and generalized mixed-effects logistic regression with covariate adjustments to analyze the HABC cohort study, with community-dwelling, well-functioning Black (42%) and White older adults aged 70-79 in year 1 (n=3,069) to year 6 (n=2,091). We found support for all three hypotheses. Black vs. White adults were more likely to work overtime. Women were less likely to work overtime compared to men. White women were less likely to keep working compared to men and Black women. Lastly, older adults with fewer chronic conditions were more likely to continue working. Our study finds racial and gender differences among older adults working overtime. Intersectionality plays a role in older adults’ health and work disparities, leading us to explore the needs and/or benefits of working past retirement in specific groups. Our policy implication is for society to pro-actively invest in older adults’ health and productive activities, which may act as social determinants of health solutions to reduce disparities and growing social safety net program costs.

Inviscid computational results are presented on a self-propelled swimmer modelled as a virtual body combined with a two-dimensional hydrofoil pitching intermittently about its leading edge. Lighthill (Proc. R. Soc. Lond. B, vol. 179, 1971, pp. 125–138) originally proposed that this burst-and-coast behaviour can save fish energy during swimming by taking advantage of the viscous Bone–Lighthill boundary layer thinning mechanism. Here, an additional inviscid Garrick mechanism is discovered that allows swimmers to control the ratio of their added-mass thrust-producing forces to their circulatory drag-inducing forces by decreasing their duty cycle, $DC$, of locomotion. This mechanism can save intermittent swimmers as much as 60 % of the energy it takes to swim continuously at the same speed. The inviscid energy savings are shown to increase with increasing amplitude of motion, increase with decreasing Lighthill number, $Li$, and switch to an energetic cost above continuous swimming for sufficiently low $DC$. Intermittent swimmers are observed to shed four vortices per cycle that give rise to an asymmetric time-averaged jet structure with both momentum surplus and deficit branches. In addition, previous thrust and power scaling laws of continuous self-propelled swimming are further generalized to include intermittent swimming. The key is that by averaging the thrust and power coefficients over only the bursting period then the intermittent problem can be transformed into a continuous one. Furthermore, the intermittent thrust and power scaling relations are extended to predict the mean speed and cost of transport of swimmers. By tuning a few coefficients with a handful of simulations these self-propelled relations can become predictive. In the current study, the mean speed and cost of transport are predicted to within 3 % and 18 % of their full-scale values by using these relations.

1. Global geometric variables represent high-order parameters in the control of cat posture. In particular, limb length and orientation are accurately controlled in response to tilts of the support platform. There is now electrophysiological evidence, obtained in anesthetized cats, that spinal sensory neurons projecting to the cerebellum are broadly tuned to limb length and orientation. Limb length and orientation specify the position of the limb end-points in body-centered polar coordinates. They define an intended posture in a global manner, leaving the detailed geometric configuration of the limbs undetermined. The planar covariation of limb joint angles described in the accompanying paper suggests the existence of an intermediate processing stage that transforms endpoint coordinates into the angular coordinates of the joints (inverse mapping). In this paper we address the question of the nature of this coordinate transformation. Because the number of degrees of freedom of angular motion in each limb exceeds that of endpoint motion in world space, several different angular configurations are compatible with any given endpoint position in world space. Thus the problem of coordinate transformation is a priori indeterminate. We have tested a number of different hypotheses. 2. Coordinate transformation could be accomplished implicitly by means of discrete kinematic synergies. Any given geometric configuration of the limb would result from a weighed combination of only two distinct patterns of angular covariations, the first pattern affecting selectively limb length and the second pattern affecting limb orientation. This decomposition, however, was found in only a few sporadic cases. 3. We also tested the possibility that the coordinate transformation involves the Moore-Penrose generalized inverse. We found that this algorithm produces a planar covariation of the joint angles, but with an orientation orthogonal to the experimental plane. By contrast, a linear transformation with constant, position-independent terms can fit the experimental plane of angular covariations but predicts large errors in endpoint position. 4. The particular orientation in joint space of the experimental plane, coupled with the scatter of data points around the plane, bears a specific implication for the problem of inverse mapping. The experimental plane crosses the constant position lines (the loci of all possible changes of the joint angles that correspond with an invariant position of the endpoint) at an acute angle. Consequently the specification of limb orientation is little sensitive to joint configurations: relatively small changes in orientation can be produced by large changes in joint configurations.(ABSTRACT TRUNCATED AT 400 WORDS)

Background and Study Purpose. Body stability is an important factor in the manifestation of human motor skills. The purpose of the research is to evaluate the efficiency of balance exercises, applied for 28 weeks, with a frequency of one activity / week, on a group of undergraduate students of the “Dunărea de Jos” University of Galați. Material and Methods. 195 subjects participated (99 males and 96 females), divided for analysis into 3 groups (underweight, N = 21, age = 20.16 ± .38, BMI = 17.46 ± .20); (normal weight, N = 111, age = 20.30 ± .21, BMI = 21.70 ± .17); (overweight / obese, N = 63, age = 19.90 ± .18, BMI = 30.69 ± .61). The tests were applied at 3 distinct times: initial T1 at the beginning of the academic year, intermediate T2 towards the end of semester 1 and final T3 at the end of semester 2. 3 static balance assessment tests were used (One leg standing test with closed eyes, Stork test and Flamingo test), respectively 4 tests to evaluate the dynamic balance (Bass test, Functional reach test, Walk and turn field sobriety test and Fukuda test). Results. ANOVA with repeated measurements and the differences between the test moments highlight in most cases values ​​of F associated with significant thresholds (p <0.05), so there is an improvement in results for all 3 groups. The differences between T1 and T2 tests are larger than those between T2 and T3, so for almost all tests the progress is higher in the first semester, and in semester 2 there is a slight reduction, as a result of adapting to the proposed exercises. Even if they progress significantly, the group of overweight people has obviously weaker average results than normal weight and underweight people, signaling numerous individual cases that have problems in maintaining static balance and commit errors in dynamic balance tests. The better performances of the underweight in 3 cases (One leg standing test, Flamingo test Fukuda test and Walk and turn field sobriety test) cannot be generalized due to their small number compared to the other 2 groups, and this aspect can be considered as a new direction of investigation. Conclusions. There are premises for a favorable evolution of the balance indices for the group tested in this age group, but it must be taken into account that the low initial fitness level (generated by the lack of concerns for a lifestyle based on physical activities) is a factor that facilitated these less spectacular advances, but still statistically significant.

Aims COVID-19 has compounded a growing waiting list problem, with over 4.5 million patients now waiting for planned elective care in the UK. Views of patients on waiting lists are rarely considered in prioritization. Our primary aim was to understand how to support patients on waiting lists by hearing their experiences, concerns, and expectations. The secondary aim was to capture objective change in disability and coping mechanisms. Methods A minimum representative sample of 824 patients was required for quantitative analysis to provide a 3% margin of error. Sampling was stratified by body region (upper/lower limb, spine) and duration on the waiting list. Questionnaires were sent to a random sample of elective orthopaedic waiting list patients with their planned intervention paused due to COVID-19. Analyzed parameters included baseline health, change in physical/mental health status, challenges and coping strategies, preferences/concerns regarding treatment, and objective quality of life (EuroQol five-dimension questionnaire (EQ-5D), Generalized Anxiety Disorder 2-item scale (GAD-2)). Qualitative analysis was performed via the Normalization Process Theory. Results A total of 888 patients responded. Better health, pain, and mood scores were reported by upper limb patients. The longest waiters reported better health but poorer mood and anxiety scores. Overall, 82% had tried self-help measures to ease symptoms; 94% wished to proceed with their intervention; and 21% were prepared to tolerate deferral. Qualitative analysis highlighted the overall patient mood to be represented by the terms ‘understandable’, ‘frustrated’, ‘pain’, ‘disappointed’, and ‘not happy/depressed’. COVID-19-mandated health and safety measures and technology solutions were felt to be implemented well. However, patients struggled with access to doctors and pain management, quality of life (physical and psychosocial) deterioration, and delay updates. Conclusion This is the largest study to hear the views of this ‘hidden’ cohort. Our findings are widely relevant to ensure provision of better ongoing support and communication, mostly within the constraints of current resources. In response, we developed a reproducible local action plan to address highlighted issues. Cite this article: Bone Jt Open 2021;2(8):583–593.

The article starts with a problem of finding a point that minimizes the sum of the distances to the vertices of an acute-angled triangle, a problem originally posed by Fermat in the 1600’s, and apparently first solved by the Italian mathematician and scientist Evangelista Torricelli. This point of optimization is therefore usually called the inner Fermat or Fermat-Torricelli point of a triangle. The transformation proof presented in the article was more recently invented in 1929 by the German mathematician J. Hoffman. After reviewing the centroid and medians of a triangle, these are generalized to Ceva’s theorem, which is then used to prove the following generalization of the Fermat-Torricelli point from [3]: “If triangles DBA, ECB and FAC are constructed outwardly (or inwardly) on the sides of any ∆ABC so that ∠DAB =∠CAF , ∠ DBA = ∠ CBE and ∠ ECB = ∠ ACF then DC, EA and FB are concurrent.”However, this generalization is not new, and the earliest proof the author could trace is from 1936 by W. Hoffer in [1], though the presented proof is distinctly different. Of practical relevance is the fact that this Fermat-Torricelli generalization can be used to solve a “weighted” airport problem, for example, when the populations in the three cities are of different size. The author was also contacted via e-mail in July 2008 by Stephen Doro from the College of Physicians and Surgeons, Columbia University, USA, who was considering its possible application in the branching of larger arteries and veins in the human body into smaller and smaller ones. On the basis of an often-observed (but not generally true) duality between circumcentres and in centres, it was conjectured in 1996 [see 4] that the following might be true from a similar result for circumcentres (Kosnita’s theorem), namely: The lines joining the vertices A, B, and C of a given triangle ABC with the incentres of the triangles BCO, CAO, and ABO (O is the incentre of ∆ABC), respectively, are concurrent (in what is now called the inner De Villiers point). Investigation on the dynamic geometry program Sketchpad quickly confi rmed that the conjecture was indeed true. (For an interactive sketch online, see [7]). Using the aforementioned generalization of the Fermat-Torricelli point, it was now also very easy to prove this result. The outer De Villiers point is similarly obtained when the excircles are constructed for a given triangle ABC, in which case the lines joining the vertices A, B, and C of a given triangle ABC with the incentres of the triangles BCI1, CAI2, and ABI3 (Ii are the excentres of ∆ABC), are concurrent. The proof follows similarly from the Fermat-Torricelli generalization.

Relevance. Injury indicators in military personnel reflect injuries and their consequences that occur in a certain period, as a rule, over a year. Injury indicators in the Armed Forces (AF) are important for assessing occupational safety.Intention: To compare injury indicators in military conscripts between the Russian Armed Forces and the Republic of Belarus for 18 years from 2003 to 2020.Methodology. We carried out a selective statistical analysis of medical reports on the health status of personnel and the activities of the medical service according to 3/MED form in military units where at least 80 % of the total number of conscripts of the Armed Forces of Russia and Belarus served. Groups (blocks) of injuries in Chapter XIX “Injuries, poisoning and certain other consequences of exposure to external causes” were agreed with the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Injury data were calculated per 1000 military personnel or ‰, mortality rates – per 100 000 military personnel.Results and their Discussion. In the Russian Armed Forces compared to the Belarusian Armed Forces, the average annual injury rates (primary morbidity) of conscripts were (15.91 ± 1.65) ‰ vs (20.23 ± 1.96) ‰, hospitalizations with injuries (14.16 ± 1.29 ) vs (14.50 ± 0.96) ‰, work days lost (303.4 ± 27.0) vs (303.4 ± 27.0) ‰, dismissal due to injuries (0.552 ± 0.066) vs (0.551 ± 0.051) ‰, injury-related mortality (21.96 ± 4.26) vs (24.18 ± 4.29) per 100 000, respectively. As a rule, polynomial trends with high determination coefficients showed a decrease in the levels of injury, hospitalization, work days lost and mortality. Dismissal trends showed decrease in the Russian Armed Forces and increase in the Belarusian Armed Forces. The conscripts of the Armed Forces of Russia and Belarus have a positive statistically significant congruence in indicators of injuries, hospitalizations, work days lost and mortality, which may indicate the influence of the same (unidirectional) factors in the formation of annual indicators. Injuries of the head (Group 1, Chapter XIX by ICD-10), shoulder girdle and upper limbs (Groups 5–7), the area of the hip joint and lower extremities (Groups 8–10), injuries, affecting several areas of the body (Group 11), and the consequences of injuries, poisoning and other external causes (Group 22) are of high military-epidemiological significance for conscripts in the Russian Armed Forces and the Belarusian Armed Forces. These injuries accounted for 78.7 % and 82.8 % of the generalized estimate in the Russian Armed Forces and the Armed Forces of Belarus, respectively.Conclusion. Taking into account the indicators of injuries will allow the medical service to optimize the calculation of forces and assets for treatment and rehabilitation of servicemen with injuries. Injuries are not only a medical problem; it is necessary to involve more extensively military professionals from various services to analyze the cause-and-effect relationships of injuries and develop measures for their prevention.

Background. Drug treatment of non-alcoholic fatty and alcoholic liver disease remains an urgent, unsolved problem. Due to the commonality of many pathogenetic mechanisms and predictors of progression, a universal approach to the search for a therapeutic agent can be considered. Aims pooled analysis of the results of two multicenter, randomized, double-blind, placebo-controlled studies of a fixed combination of glycyrrhizic acid and essential phospholipids in two dosage forms to study its efficacy and safety in non-alcoholic fatty and alcoholic liver disease, in the presence and absence of predictors of disease progression. Methods. The pooled analysis included 180 patients with non-alcoholic fatty liver disease (Gepard study) and 120 patients with alcoholic liver disease (Jaguar study). Patients of the main group received a fixed combination of 5.0 g intravenous jet 3 times a week for the first 2 weeks; then 2 capsules 3 times a day for the next 10 weeks. Patients in the control group received placebo according to the same scheme. The total duration of treatment was 12 weeks in the Gepard study (1 course of stepwise therapy) and 24 weeks in the Jaguar study (2 courses of stepwise therapy). A comparative analysis of the efficacy and safety of a fixed combination and a placebo was carried out, in the presence and absence of predictors of progression, separately for each nosology and in a mixed sample. Results. In patients with non-alcoholic fatty and alcoholic liver disease who received the fixed combination, in contrast to the placebo group, there was a statistically more significant decrease in the level of biochemical markers of inflammation alanine aminotransferase, aspartate aminotransferase, adiponectin, and the value of the AktiTest index. There was no negative trend in the NAFLD fibrosis score; more significant positive dynamics of FibroTest is shown. Predictors of disease progression hyperglycemia, hyperlipidemia, age did not have a negative impact on the results in the study group. The efficacy of the study drug was noted in patients with non-alcoholic fatty liver disease and normal body weight; data were obtained indicating its possible effectiveness with a high activity of the inflammatory process associated with alcoholic liver damage. The frequency of adverse events in the study and control groups was comparable. Conclusions. Based on a generalized analysis of the results of two studies, promising directions for the study and use of a fixed combination of glycyrrhizic acid and essential phospholipids were identified: non-alcoholic fatty liver disease without obesity, alcoholic steatohepatitis of high activity (as an adjuvant); steatohepatitis of non-alcoholic and alcoholic etiology, combined with hyperglycemia and hyperlipidemia.

Premature newborns are a special category of children with their inherent morpho-functional immaturity and specific pathological conditions that cause significant differences in the survival, morbidity and their baby care consequences in comparison with children of other weight categories. The problems of premature babies are at the forefront of neonatal research and perinatal care. Purpose - to establish a link between the formation of adverse consequences in preschool children born prematurely, with a body weight of less than 1500 g, and placental changes. Materials and methods. The study involved 220 preschool children born prematurely. The results of a pathomorphological study of the placentae of mothers of 220 children were analyzed. Its results enabled to distinguish 5 groups of mothers according to the classification of changes in the placentae. In the course of the study, this category of children was under observation of the doctors the Prematurity and Hight-Risk Neonates Post-discharge Follow-ups Department in order to regular assess their health. Clinical indicators such as body weight, height, head circumference, neurological, general cognitive development and low severity dysfunction, the post-discharge history including respiratory diseases, skeletal system problems, hematological and metabolic disorders, were analyzed. Ophthalmological and audiological examinations were performed prospectively to assess vision and hearing. Depending on the severity of disabling pathology, children with severe disabling consequences (n=54) were isolated - 24.5%. Further analysis concerned the state of health of these children, divided into 5 groups according to the identified changes in the placentas of their mothers. Results. All the children involved in the study had a disease combination in the neonatal period that caused severe conditions. Pathological changes of the placenta significantly affected the course of the neonatal period. Thus, newborns with signs of inflammatory changes and immaturity were 10 times more likely to suffer generalized intrauterine infections and neonatal sepsis, they also significantly more frequently have intraventricular hemorrhages, periventricular leukomalacia, and bronchopulmonary dysplasia. The course of the neonatal period in groups of children with signs of premature aging of placenta and blood flow disorders was characterized by a low frequency of infections, but periventricular leukomalacia was diagnosed 5 times more often. Conclusions. It was found out that transplacental infection and pathological placenta immaturity had a negative impact on the health of children of groups III and IV, causing their birth 3 weeks prematurely, unlike the children in the comparison group. Newborns of groups III and IV needed resuscitation care in the delivery room 9 times more often, and the need for respiratory support was 10 times higher than in the comparison group, which predetermined a significantly longer duration of hospital stay for children of groups III and IV - on average 30-45 days longer compared to newborns of Group V. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: premature babies, Neonates Post-discharge Follow-ups Department, disability, long-term consequences.

This article discusses the organization of training sessions on applied shooting. Attention is paid to the effect of physical and mental stress on the body of athletes in applied shooting. The practical experience of servicemen and athletes who have skills in handling and use of firearms of different tactical and technical characteristics is analyzed and generalized. Depending on the level of training, the athlete must be able to improve the imagination and technically correct execution of the entire movement from manufacture to shot, the consolidation of this imagination in the complex is ready. When an athlete clearly imagines his actions on the firing line during training, it is easier for him to control his actions in a stressful situation at competitions. To achieve this goal, the athlete must be able to concentrate on their own (team) actions, self-knowledge in the process of training and competition, the ability to control their actions on the firing line despite the actions of the opponent. So active training takes place a month before the event. Training sessions are organized and conducted in specially designated places: shooting range, shooting ranges, military training grounds, etc. Before training, you need to choose equipment for yourself in accordance with the rules of the competition. Everyone chooses his own equipment and adapts it to certain exercises that will be performed. The shooter must understand that during the performance of a particular exercise, the target situation may change. Therefore, it is necessary to consider the physical abilities and time of the reaction to the decision of various problems arising during exercise. Conditionally, training can be divided into subgroups: 1 week - studying the provisions of the competition and practice shooting for accuracy without regard to time; Week 2 - practice of shooting exercises with the addition of physical activity and taking into account the time for their implementation; Week 3 - improvement of skills when shooting from a place and in movement taking into account time; Week 4 - summarizing the work done for the entire period and working out control exercises. The work uses methods of analysis and generalization of scientific, educational and methodological literature, pedagogical observation.

Childhood excess weight and family food insecurity are food-system related public health problems that exist in Canada. Since both relate to issues of food accessibility, availability and utilization, which have elements of “place”, they may share common risk factors in the local environment that are amenable to intervention. In this area of research, the literature derives mostly from an American context, and there is a dearth of high-quality evidence, specifically from longitudinal studies. The main objectives of this thesis were to examine the adjusted associations between the place factors: material deprivation, social deprivation, social cohesion, disorder, and living location, with change in child body mass index (BMI) Z score and with change in family food insecurity status in a Canadian cohort of children. The Quebec Longitudinal Study of Child Development was used to meet the main objectives of this thesis. Response data from 6 collection cycles (4–10 years of age) were used in 3 main analyses. The first analysis examined change in child BMI Z score as a function of the place factors using mixed models regression. The second analysis examined change in child BMI Z score as a function of place factors using group-based trajectory modeling. The third and final analysis examined change in family food insecurity status as a function of the place factors using generalized estimating equations. Social deprivation, social cohesion and disorder were strongly and positively associated with family food insecurity, increasing the odds by 45%–76%. These place factors, on the other hand, were not consistently associated with child weight status. Material deprivation was not important for either outcome, except for a slight positive association in the mixed models analysis of child weight status. Living location was not important in explaining family food insecurity. On the other hand, it was associated with child weight status in both analyses, but the nature of the relationship is still unclear. Results do not suggest that addressing similar place factors may alleviate both child excess weight and family food insecurity. More high-quality longitudinal and experimental studies are needed to clarify relationships between the local environment and child weight status and family food insecurity.

Abstract Abstract 697 Phosphatidylinositol kinases are crucial in the generation of diverse membrane phosphoinositides that regulate the intracellular signaling for essential cellular processes including membrane trafficking. PIKFyve is a kinase that generates phosphatidylinostol 3,5 bisphosphate (PtdIns(3,5)P2) from PtdIns(3)P. Yeast mutants lacking the PIKFyve homologue were unable to synthesize PtdIns(3,5)P2 and exhibited enlarged vacuoles, defective membrane recycling and abnormal protein sorting to multivesicular bodies. In human platelets, PtdIns(3,5)P2 synthesis increased following thrombin stimulation, and our data indicated that murine platelets express PIKFyve mRNA. We hypothesized that PIKFyve and its phospholipid product, PtdIns(3,5)P2 would be critical in the membrane trafficking during the biogenesis of platelet granules. To test this hypothesis, we engineered mice to lack PIKFyve specifically within their platelets and megakaryocytes. The resulting PIKFyvefl/fl mice contained a conditional targeting mutation within two exons encoding for a critical component of its kinase domain. The conditionally targeted mice were crossed with transgenic mice expressing Cre recombinase under the control of platelet factor 4 (PF4) promoter. As expected, RT-PCR analysis confirmed a complete loss of normal PIKFyve mRNA in platelets derived from PIKFyvefl/fl PF4 Cre+ mice. Surprisingly, by 3 weeks of age, PIKFyvefl/fl PF4 Cre+ mice started to display a robust pleomorphic phenotype characterized by dorsal hair loss and progressive weight gain due to generalized body swelling. By 5–6 months of age, the body weight of the PIKFyvefl/fl PF4 Cre+ mice was about 30% higher than that of the control littermate mice (PIKFyvefl/fl PF4 Cre- or PIKFyvefl/+ PF4 Cre+) and appeared acutely ill with decreased ambulation and feeding. A DEXA scan revealed that PIKFyvefl/fl PF4 Cre+ mice had approximately 50% lower body fat content compared to their control littermates. Necropsy of PIKFyvefl/fl PF4 Cre+ mice at about 6 months of age demonstrated that their weight gain was due to massive infiltration of largely vacuolated F4/80 expressing macrophages in multiple organs including skin, muscle, lung, heart, liver, pancreas, small and large intestines, kidney, genital organs, thymus and bone marrow. The vacuoles within these macrophages occupied the entire cytoplasm and were reminiscent of PIKFyve null yeast mutant cells. Unexpectedly, PCR analysis of genomic DNA from tissues infiltrated by these vacuolated macrophages revealed that PIKFyve deletion had occurred within these cells. This indicated that the PF4 Cre was expressed in these macrophages and led to targeting of PIKFyve and ultimately to the development of vacuolated macrophages that infiltrated multiple organs. Despite the pleomorphic phenotype, the platelet counts of the PIKFyvefl/fl PF4 Cre+ mice were normal. Furthermore, platelets lacking PIKFyve normally exposed P-selectin from alpha granules and released ATP from dense granules in response to agonist stimulation. Nevertheless, the PIKFyvefl/fl PF4 Cre+ platelets exhibited a three-fold increase of basal b-hexosaminidase, a lysosomal hydrolase. This data suggests a role for PIKFyve in the biogenesis of platelet lysosomes. Furthermore, in vivo platelet thrombus formation analysis using the ferric chloride induced carotid artery injury model revealed that PIKFyvefl/fl PF4 Cre+ mice made an occluding thrombus significantly faster than the control littermate mice demonstrating that they are prothrombotic. Histological analysis of the carotid artery specimen at the site of thrombus demonstrated that the intravascular side did not contain vacuolated macrophages. This suggests that the enhanced thrombosis formation was due to the increased lysosomal content within the platelets, and not due to infiltration by abnormal macrophages. We conclude that PF4 promoter driven selective deletion of PIKFyve kinase is associated with defective biogenesis of platelet lysosomes and a prothrombotic effect in vivo. Furthermore, PIKFyvefl/fl PF4 Cre+ mice display a pleomorphic phenotype associated with vacuolated macrophage accumulation in multiple organs and suggest that PF4 promoter driven Cre expression is not restricted to megakaryocytes and platelets. This study also highlights a potential problem in previous and current work using the PF4 Cre transgenic model. Disclosures: No relevant conflicts of interest to declare.

Abstract Background From March 10 to May 3, 2020, Coronavirus disease 2019 (COVID-19) and subsequent enforced lockdown in Italy has led to an increased general psychological distress1. In particular, people with both compromised immune function and pre-existing physical or psychiatric problems are at increased risk of adverse psychosocial outcomes2. The purpose of this study was to compare mental health burden in Inflammatory Bowel Disease (IBD) paediatric patients with and without COVID-19 lockdown exposure. Methods We conducted a retrospective case-control study comparing mental health outcomes of two matched 1:1 IBD paediatric groups: Group 1 - before the exposure (January 2019-September 2019) and Group 2 - after COVID-19 pandemic lockdown (April 2020-December 2020). Matching criteria included gender, age, disease duration, IBD subtype, Body Mass Index and disease activity (remission or active). This study included patients with Crohn Disease (CD) and Ulcerative Colitis (UC), &gt;12 years, attending outpatient visits at Bambino Gesù Children Hospital. Data were collected using the Generalised Anxiety Disorder (GAD-7) for anxiety and the Patient Health Questionnaire (PHQ-9) for depression. We have estimated the prevalence of anxiety and depression between the two groups. Both groups were also compared with respect to the average score of anxiety and depression symptoms. Sociodemographic and clinical data were recorded from patients’ medical chart. Results A total of 108 IBD paediatric patients (62 males, 54 with CD and 54 with UC, mean age=16±2,5 years) was enrolled in this study. Out of these, 54 patients were enrolled in Group 1 and 54 in Group 2. Using a cut-off score ≥10, we found similar prevalence of anxiety (13.0% vs 22.2%, P=.206) and depression (13.0% vs 18.5%, P=.428) among the groups. Average scores were quite similar among the two groups, both for anxiety (5.78 vs 5.96, P=.924) and depression (5.89 vs 5.87, P=. 704). Symptom severity levels were mild (≃6) in both groups, according to standardized instrument cut-offs. No significant associations were found between disease activity and symptoms of anxiety and depression in both groups. Conclusion IBD-related symptoms (i.e. weight loss, persistent diarrhoea, abdominal pain and fatigue) lead to severe psychosocial impairment in paediatric IBD patients. COVID-19 pandemic outbreak and enforced isolation (i.e., lockdown, long distance learning, and social restrictions) limited patients’ stressful social situations engagement and paradoxically prevented a worsening of their mental health. References

SummaryObjectives - To present the results obtained from a cross-sectional evaluation of a sample of primary care attenders selected in Verona in the framework of the World Health Organization International Multicentre Study on Psychological Problems in Primary Care Settings. Methods - Among consecutive attenders at 16 primary care clinics in Verona during the period April 1991/February 1992, a random sample, stratified on the basis of GHQ-12 scores, was selected for a thorough evaluation of psychological status, physical status and disability in occupational and other daily activities. All patients with psychopathological symptoms at baseline assessment and a 20% random sample of those without psychopathological symptoms were interviewed again after 3 and 12 months (data not presented here). Results - Overall, 1,656 subjects were approached at the primary care clinics and 1,625 met inclusion criteria. The screening procedure was completed by 1,558 subjects and the second-stage evaluation by 250. Psychiatric disorders according to ICD-10 criteria were diagnosed in 12.4% of consecutive primary care attenders; of these, about one-third (4.5% of consecutive primary care attenders) satisfied ICD-10 diagnostic criteria for two or more disorders. Current Depressive Episode (4.7%) and Generalized Anxiety Disorder (3.7%) were the most common diagnoses. In addition, 11.2% of consecutive primary care attenders had ‘sub-threshold’ psychiatric disorders (i.e., they suffered from symptoms in at least two different areas among those listed in ICD-10, but they did not satisfy diagnostic criteria for well-defined disorders). Psychiatric disorders were more common among females and those aged 24-44 years. Only 20.6% of the subjects with psychiatric disorders contacted the general practitioner for their psychological symptoms, 5.7% complained of symptoms which might have had a psychological origin, whereas in about 70% of the cases the psychiatric disorder was concealed behind the presentation of somatic symptoms, pains in various parts of the body or chronic physical illness. Sixty-two percent of the subjects with psychiatric disorders rated their health status as fair or poor, as compared to 52.0% of those with chronic physical illness and 31.3% of those without such disorders. According to the general practitioner, 40.1% of the subjects with psychiatric disorders and 45.3% of those with chronic physical illness had a fair or poor health status, compared to 14.4% of those without such disorders. Disability in occupational and other daily activities was reported by 52.5% of the subjects with psychiatric disorders (in 40.1% of the cases disability was moderate or severe), 44.4% of those with chronic physical illness (in 26.8% of the cases disability was moderate or severe), and 15.0% of the subjects without such disorders (in 9.1% of the cases disability was moderate or severe). According to the interviewer, disability was identified in 48.4% of the subjects with psychiatric disorders, 39.0% of those with chronic physical illness, and 27.6% of the subjects without such disorders. Sixty per cent of the subjects with psychiatric disorders suffered from concurrent chronic physical illness; these subjects had a poorer health status and higher disability levels than those with psychiatric disorders only. Conclusions - Psychiatric disorders among primary care attenders are frequent and represents a major public health problem, since they entail severe functional limitations for the patients and high costs for the society. Thus, appropriate programs for their recognition and treatment are needed.

Abstract A variety of life threatening childhood conditions are now successfully treated with hematopoietic stem cell transplantation (HSCT), as either a first line or rescue therapy. Improved survival rates have sharpened the need for research focused on adverse medical effects that may emerge or persist many years after treatment. Few studies on late effects related to neurological functioning have been conducted among survivors treated with HSCT as children or adolescents. This analysis from the Bone Marrow Transplant Survivor Study quantified the frequency of neuromotor and neurosensory outcomes, including cataracts, using a self- or parent-reported questionnaire. Eligibility included HSCT survivors of 2-years or longer who were transplanted before age 21 years between 1974 and 1998 at the University of Minnesota or City of Hope Cancer Center. Outcomes on sensory, visual, auditory, or motor impairments among 235 HSCT survivors were compared to 705 siblings of childhood cancer survivors with similar age, sex, and race distributions (1:3 frequency matching). Risk ratios (RR) and confidence intervals were modeled using generalized estimating equations with a Poisson distribution and a log link. Cumulative incidence of cataracts by time since transplant was calculated in a competing risk analysis using the Markov Chain Approach. Wilcoxon signed rank tests were used to test differences in cataract cumulative incidence between allogeneic and autologous transplant, and by those with versus without a history of chronic graft versus host disease (cGVHD) among allogeneic transplant recipients. Of survivors successfully contacted, 60% participated in the study. Non-participants did not differ statistically from participants by transplant type, conditioning regimen, cGVHD (past or present), or age at transplant. Among participants, median age at HSCT was 10 years and 82% received their transplant at least 11 years before interview. Diagnoses included 57% with acute leukemia and 13% with aplastic anemia. Persistent pain was reported by 21% of survivors (RR 2.1, p&lt;.001) and cataracts by 38% (RR 270, p&lt;.001). The cumulative incidence of cataracts was 21% at year 5 post-transplant, 32% at year 10, and 36% at year 15. Although cumulative incidence curves for cataracts were significantly higher in allogeneic versus autologous recipients (p=.009), 86 of the 90 survivors with cataracts received total body irradiation (TBI). When the analysis was limited to those who received TBI, no differences in cataract incidence by transplant type (p=.47) or by cGVHD history (p=.43) were observed. Other than cataracts and persistent pain, motor impairments, including problems with swallowing (7.7%; RR 7.7, p&lt;.001); coordination (6.8%; RR 4.3, p&lt;.001) and muscle weakness (5.5%; RR 5.3, p=.002) constituted the most frequent late effects considered. Overall, with the exception of cataracts, relatively few neuromotor and neurosensory problems were reported by childhood HSCT recipients. However, one-fifth of childhood HCST survivors reported persistent pain, suggesting the need for further investigation to understand the causes. As in adults, cataracts are a frequent adverse effect of childhood HSCT, occurring in nearly 40% of these survivors within 15 years post-transplant. Close follow-up with preservation of vision, particularly among those who received TBI, should be a primary goal in this patient population.

Background. The coronavirus pandemic (COVID-19) currently dominates all health problems. Adequate initial antimicrobial therapy of viral and bacterial pneumonia in patients with COVID-19 requires compliance with a number of features that are fundamentally important in the context of global growth of resistance of pathogenic flora to antimicrobial drugs. Objective. To describe the features of antimicrobial therapy of viral and bacterial pneumonia in patients with COVID-19. Materials and methods. Analysis of literature data on this issue. Results and discussion. Severe coronavirus infection triggers an avalanche-like generalized inflammatory response with rapid vascular endothelial damage. Lungs is the main target organ of this aggression. A significant part of all endothelial cells of the body is concentrated in the lungs, so the cascade of multiorgan disorders begins with them. Liver, intestines, kidneys and muscles are the organs that suffer from extrapulmonary manifestations of COVID-19. SARS-CoV-2 сoronavirus also has neurotropism, so it is able to affect the nervous system, both central and peripheral. The pathogenesis, diagnosis and treatment of COVID-19 should be considered in terms of the approaches used in sepsis. This disease is characterized by the following laboratory changes: increased content of C-reactive protein, leukocytosis or leukopenia, lymphopenia, neutrophilia, increased activity of alanine and aspartate aminotransferases, creatine phosphokinase, lactate dehydrogenase, bilirubin and creatinine concentrations. However, sufficiently sensitive and specific markers for the diagnosis and prediction of COVID-19 are currently lacking. Until the results of the polymerase chain reaction for SARS-CoV-2 and, consequently, the confirmation of COVID-19, are absent, all patients with severe pneumonia and acute respiratory distress syndrome should be treated as patients with acute severe community-acquired pneumonia. Empirical combination antibiotic therapy should be started immediately. Patients over 60 years of age with pre-existing comorbidities need special attention. The spectrum of microbial flora in such patients includes Streptococcus pneumoniae, Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, gram-negative enterobacteria. This must be taken into account when choosing an antibiotic. In presence of intracellular pathogens, fluoroquinolones have an advantage over macrolides and tetracyclines. Due to the growing resistance of hospital flora to macrolides and the high risk of resistance to them in outpatient flora, the initial use of fluoroquinolones is one of the main trends in modern antibiotic therapy. The advantages of levofloxacin are the possibility of administration in short courses (750 mg once a day for 5 days), a wide activity spectrum, the ability to overcome the basic mechanisms of resistance, a good safety profile. Intravenous administration of levofloxacin is not inferior to the effectiveness of the combination of β-lactams and macrolides and can be completed by transferring the patient to oral treatment. For the treatment of patients at risk of Pseudomonas aeruginosa infection, combination therapy is prescribed – antipseudomonad cephalosporins of III-IV generation in combination with aminoglycosides, ciprofloxacin or levofloxacin. Alternatively, carbapenems are prescribed in combination with aminoglycosides (tobramycin – Braxon, “Yuria-Pharm”) or fluoroquinolones (levofloxacin – Leflocin, “Yuria-Pharm”). When methicillin-resistant Staphylococcus aureus is detected, the use of linezolid (Linelid, “Yuria-Pharm”) is advisable. Antibiotic therapy is often accompanied by fungal infections. In severe cases of the latter, as well as in pulmonary aspergillosis voriconazole (Vizealot, “Yuria-Pharm”) is prescribed. Conclusions. 1. Severe coronavirus infection triggers an avalanche-like generalized inflammatory reaction with rapid damage to the vascular endothelium. 2. In the presence of intracellular pathogens, fluoroquinolones have an advantage over macrolides and tetracyclines. 3. The initial use of fluoroquinolones is one of the main trends in modern antibiotic therapy. 4. In the detection of methicillin-resistant Staphylococcus aureus, it is advisable to use linezolid. 5. In severe fungal infections and pulmonary aspergillosis, voriconazole is prescribed.

Objective. To analyze the current state of diagnosis and treatment of patients with chronic hyperplastic laryngitis (CHL) for the period 2010–2021 in the Republic of Belarus on the example of patients in the Dobrush District of the Gomel Region and to identify shortcomings for the subsequent development of measures to prevent malignant diseases of the larynx. Material and research methods. The material for the study was patients of the Dobrush District of the Gomel Region (61 patients: 39 (64%) men and 22 (36%) women) with a diagnosis of chronic hyperplastic laryngitis who are registered with an otorhinolaryngologist. The median age at diagnosis was 45.6 years (18 to 76 years). In the age distribution, 2 peaks were observed: from 36 to 40 years and from 51 to 55 years – 16% (10 out of 61) of the entire group, 87% of patients were of working age. Results and discussion. Patients with precancerous diseases of the larynx, who are on regular medical check-up in the Dobrush Central District Hospital, were analyzed. Age-specific incidence rates were analyzed and differentiated by gender and place of residence. The analysis of symptoms, the time spent by patients on regular medical check-up, the frequency of visits to the otorhinolaryngologist in the order of regular medical check-up was carried out. All patients had voice changes of various nature and severity: 50 (82%) patients complained of hoarseness, 6 (10%), of hoarseness, 5 (8%) had aphonia. More than half of the patients had the following complaints: feeling of a coma or a foreign body in the throat – 90%, the presence of a cough not associated with colds – 75%, and shortness of breath on exertion – 70% of patients. The median time spent by patients on regular medical check-up was 5 years (from 0 for patients registered in 2021 to 30 years). The frequency of visiting an otorhinolaryngologist in the order of regular medical check-up was from 1 time in 2–4 months (10% of patients) up to 1 time in 5 years (3%), 44% – 1 time per year, 27 (44%) patients received outpatient treatment, 5 (8%) patients received inpatient treatment, and 29 (48%) patients received both outpatient and inpatient treatment. During inpatient treatment, 16 (47%) hospitalized patients underwent surgical treatment to remove hyperplastic areas of the mucosa, the rest received antibiotic therapy, 15 (44%) patients underwent a biopsy. Conclusion. The study revealed a number of problems in the diagnosis and treatment of CHL, the main of which is the establishment of a generalized clinical diagnosis without performing a biopsy and clarifying the form of CHL and, as a result, conducting numerous ineffective courses of conservative treatment, both on an outpatient basis and in a hospital setting. It is necessary to develop a system of measures to improve the effectiveness of treatment of patients with CHL and the prevention of malignant neoplasms of the larynx.

Abstract STUDY QUESTION What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI? SUMMARY ANSWER A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables. WHAT IS KNOWN ALREADY Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress. STUDY DESIGN, SIZE, DURATION A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children. PARTICIPANTS/MATERIALS, SETTING, METHODS Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude. MAIN RESULTS AND THE ROLE OF CHANCE Participants of the BMG showed decreased depression (mean difference (MD) = −1.69, [−3.01, −0.37], d = 0.44) and improved sleep quality (MD = −1.24, [−1.95, −0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG. LIMITATIONS, REASONS FOR CAUTION The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population. WIDER IMPLICATIONS OF THE FINDINGS The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER ChiCTR-IOR-16008452. TRIAL REGISTRATION DATE 9 May 2016 DATE OF FIRST PATIENT’S ENROLMENT 15 May 2016.

The design of ships or any other floating systems intended to operate on or close to the surface of the sea is controlled to a large extent by what is usually referred to as seakeeping, or, in more common terminology, safety at sea. This is a primary consideration and criteria, which has to be fully met. Safety of a ship naturally includes the crew, cargo and the hull itself. Seakeeping is, indeed, a generalized term and reflects the ship's capability to survive all hazards at sea such as collision, grounding, fire, as well as heavy-weather effects related to the environment in general and waves in particular. The two most likely types of failure under these conditions are due to structural causes and capsizing resulting from insufficient stability under severe weather conditions. Such criteria as economical navigation of the ship as related to speed-keeping abilities, fuel consumption, avoidance of damage to ship components and cargo, and comfort to crew or passengers, or both, are key items. The operational limits of electronic equipment, mechanical components and weapon systems on board warships are other aspects of sea keeping. In this work it is highlighted that seakeeping is a generalized term that includes a wide variety of subjects such as ship motions (amplitudes, accelerations, phases), deck wetness, slamming, steering in waves, added resistance, hydrodynamic loadings (pressures, forces, moments) and transient loads. Since the ship environmental operability or its sea keeping characteristics are closely linked to the severity of the sea, the description of the seaway is usually considered as an integral part of sea keeping. It is taken into consideration that the severity of the sea cannot be considered in absolute terms, since for each floating system, be it a ship, a platform or a buoy, the intensity of the sea state can only be determined in terms of the system's responses. Hence, different thresholds apply to different problems, and sea state 4 may be just as severe for a small patrol craft as sea state 8 may be for a larger containership. Hence, the characteristics and frequency of occurrence of waves in specific sea zones are required if a possible reduction in the system environmental operability is expected. It is demonstrated that most texts or papers, which deal with the overall question of sea keeping, devote some attention to the basic phenomena, that is, the seaway and the motions of the ship or other floating platforms as a result of the excitation imposed by the seaway. Ship motions, as such, do not always constitute the criteria for sea keeping, and much more often other responses directly related to the magnitude and phasing of the motions or the resulting velocities and accelerations constitute the prime cause for exhibiting good or bad sea keeping qualities. Such responses could be a function of the motion only, as in the case of added resistance or hydrodynamic pressures, or they could be a function of motion and other design parameters, such as freeboard in the case of deck wetness or the longitudinal weight distribution in the case of vertical bending moments. In this work, latest methods of modeling and computation for body-wave interactions described and compared with data observed for container carrier. The foregoing calculation routine Судноводіння | Shipping & Navigation ISSN 2306-5761 | 2618-0073 30-2020 Національний університет «Одеська морська академія» 79 is fairly well accepted today among naval architects specializing in the sea keeping aspects of the ship design process. Differences between the results obtained by various techniques as presented by the available computer programs are insignificant. However, since the regular-wave results are of little or no value except as input for the more realistic long- and short-term response predictions in a real seaway environment, it is important to determine which wave data information and what statistical extrapolation techniques are used to obtain the latter. The format used to describe the seaway in most ship response calculations is the wave spectrum. However, since measured spectrum for a specific sea zone or route are very rarely available, it is often necessary to use spectrum measured in one location for predictions in another location. In such a case, while the basic spectruml shape and scatter remain unchanged, the percentage of wave height distribution would vary to represent realistic conditions for the sea area in question. Such data usually are based on observations, and assuming the sample is large enough the distribution of expected wave heights should be quite reliable. An alternative approach often used in ship design is to utilize one of several theoretical spectruml formulations [2, 3, 4] such as the Pierson-Moskowitz one-parameter spectrum, the ISSC spectrum, the JONSWAP spectrum, and other. In each of these cases, some input parameters are required usually in the form of wave height, period, peak frequency, fetch, etc. The reliability of the wave data depends in these cases both on the quality of the input parameter and the adequacy of the theoretical formulation.

Тhe relevance of the topic is due to the need to expand the financial autonomy of higher educational institutions (hereinafter referred to as the HEI) in Ukraine, the need to maximize the generation of their own cash receipts by providing paid services of the HEI, to improve the management efficiency of the HEI in a market economy. The market, with its industries, is in a state of flux. We observe how the needs of sectors of the economy for resources and the level of training of specialists are changing. There is a change in the influence of factors on economic processes, the role of the segments of the regional economy participating in economic processes is changing. The educational complex should contribute to the formation of not only the labor resource of the country. To implement in the field of education and science support of the labor resource at the required level, effectively based on the needs of the regional economy and other resources - industrial. By predetermining the priority sectors in the development of the regional economy, the educational infrastructure of Ukraine should set the vectors for the development of the labor market of the economy as a whole, and not only serve the existing infrastructure of the regional economy. To maximize the satisfaction of the needs of both consumers of educational services and the needs of the regional economy in production resources. The article formed the author's understanding of the concepts of "market", "educational service", "market of paid services that can be provided by HEI", presented the features of the market of paid services that can be provided by HEI in Ukraine, carried out an analysis of the regulatory framework for the provision of paid services by HEI, identified a generalized composition of participants, which are divided into generally recognized and proposed, and developed a road map for the introduction of paid services by HEI. After conducting research in the direction of the chosen topic, it was determined that the formation and development of the educational services market is taking place in accordance with certain global trends, namely: 1) the desire for a democratic education system, that is, the availability of education to the entire population of the country and the continuity of its stages and levels, provision of autonomy and independence to educational institutions; 2) ensuring the right to education for everyone (the opportunity and equal chances for each person to get an education in an educational institution of any type, regardless of nationality and race); 3) the significant influence of socio-economic factors on education (cultural and educational monopoly of certain ethnic minorities, paid forms of education, manifestation of chauvinism and racism); 4) an increase in the range of educational and organizational activities aimed at both satisfying diverse interests and developing the abilities of students; 5) the growth of the educational services market; 6) expanding the network of higher education and changing the social composition of the student body (becoming more democratic); 7) in the field of education management, the search for a compromise between rigid centralization and full autonomy; 8) education is becoming a priority object of funding in the developed countries of the world; 9) constant updating and adjustment of school and university educational programs; 10) a departure from the orientation towards the "average student", an increased interest in gifted children and young people, in the peculiarities of the disclosure and development of their abilities in the process and by means of education; 11) search for additional resources for the education of children with developmental disabilities, children with disabilities. According to the results of the study, the authors proposed to expand the structures characteristic of the educational services market. Insofar as the market for educational services includes many national educational systems, each of which has its own management model, structure, goals, objectives and problems, and the profit from the activities of such structures can also be expanded.

Vitiligo is a chronic skin disease that causes loss of pigment in the skin. It is caused by a combination of auto-immune, genetic, and environmental factors. This clinical study was carried out to find out the familial tendency in patients of vitiligo. Literary review & clinical study in 60 patients of vitiligo done. The study included the detailed family history with pedigree analysis in patients under study. The conclusion drawn from the study is that the familial occurrence of vitiligo in the studied population is 26.66 % .Younger age group up to 20 Yrs. is predominantly affected. Genetic variations play a significant role in the aetiology of vitiligo. Introduction Historical background: (Rational of the study)- Vitiligo or leukoderma is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. It occurs when the melanocytes, the cells responsible for skin pigmentation, die or are unable to function. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. Vitiligo may also be caused by stress that affects the immune system, leading the body to react and start eliminating skin pigment. It creats a very bad social stigma for the victim, although no other major systemic abnormality is generally present. I have seen number of patients visiting my clinic for the treatment of this problem. So I decided to work on this subject to carry out this clinical study. Epidemiology: The population incidence worldwide is considered to be between 1% and 2%., or as many as 65 million people, have vitiligo.1 Clinical Presentation: In most cases, vitiligo develops early in life, between the ages of 10 and 30 years. Ninety-five percent of those affected will develop the disorder before age of 40 years. Both men and women are equally likely to affected by vitiligo. Vitiligo may run in families; those with a family history of vitiligo or premature graying of the hair are at increased risk for the development of vitiligo. Other risk factors that increase one's chances of developing vitiligo include having autoimmune diseases, such as autoimmune thyroid disease (Hashimoto's thyroiditis). However, most people with vitiligo have no other autoimmune disease. Vitiligo is associated with autoimmune and inflammatory diseases, commonly thyroid over-expression and under-expression. Vitiligo may also be hereditary; that is, it can run in families. Children whose parents have the disorder are more likely to develop vitiligo (not the rule). In fact, number of people with vitiligo has a family member with the disease. However, only 5 to 7 percent of children will get vitiligo even if a parent has it, and most people with vitiligo do not have a family history of the disorder.9 Clinical classifications of vitiligo10- The most widely used classification of vitiligo is localized, generalized, and universal Types and is based on the distribution, as follows: Localized Focal: This type is characterized by one or more macules in one area, most commonly in the distribution of the trigeminal nerve. Segmental: This type manifests as one or more macules in a dermatomal or quasidermatomal pattern. It occurs most commonly in children. More than half the patients with segmental vitiligo have patches of white hair or poliosis. This type of vitiligo is not associated with thyroid or other autoimmune disorders. Mucosal: Mucous membranes alone are affected. Generalized Acrofacial: Depigmentation occurs on the distal fingers and periorificial areas Vulgaris: This is characterized by scattered patches that are widely distributed. Signs: Half of people with vitiligo develop patches of de-pigmented skin appearing on extremities before their 20s. The patches may grow, shrink, or remain constant in size. Patches often occur symmetrically across both sides on the body. Occasionally small areas may repigment as they are recolonised by melanocytes. The location of vitiligo affected skin changes over time, with some patches re-pigmenting and others becoming affected. Vitiligo on the scalp may affect the color of the hair (though not always), leaving white patches or streaks. It will similarly affect facial and body hair. 14 Symptoms: Some symptoms are: white patches on the skin, including the face, limbs, trunk, and groin purple or golden brown patches on mucous membranes and around the eyes, nostrils, and mouth premature graying of hair sun sensitivity Psychological effects Vitiligo can have a significant effect on the psychological well being of the patient.8 This is especially true for darker skinned patients as the contrast between pigmented and depigmented skin can be quite drastic. In some cultures there is a stigma attached to having vitiligo. Those affected with the condition are sometimes thought to be evil or diseased and are sometimes shunned by others in the community. People with vitiligo may feel depressed because of this stigma or because their appearance has changed dramatically. Other people with vitiligo experience no negative psychological effects at all.14 Clinical Photographs: Disease mechanism: ( pathophysiology) According to Diseases Database: "A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached." In generalized vitiligo melanocytes are not found in the affected skin. Melanocytes contain the pigment melanin which serves a protective action against the harmful effects of sunlight. Phenylalanine (adrenals) → tyrosine→ dihydroxyphenylalanine(DOPA)→ melanin Melanin formation in skin is augmented by the hormone melanocyte stimulating hormone(MSH) or intermedion secreted by the pars intermedia of the pituitary gland (post.pituitary). ACTH by ant.pituitary has melanocyte stimulating activity similar to MSH although to a much lesser degree. 25% cases are autoimmune. 11 Patients with vitiligo have an increased incidence of several autoimmune disorders including hypothyroidism, Graves’disease, pernicious anaemia, Addison’s disease, alopecia areata, chronic mucocutaneous candidiasis etc. Diabetis mellitus is also associated in some subjects. Localized hypopigmentation is also found in chemical leukoderma, Piebaldism (autosomal dominant disorder), post-inflammatory, tinea versicolor etc.11-12 Vitiligo is a multifactorial polygenic disorder with a complex pathogenesis. It is related to both genetic and nongenetic factors. Although several theories have been proposed about the pathogenesis of vitiligo, the precise cause remains unknown. Generally agreed upon principles are an absence of functional melanocytes in vitiligo skin and a loss of histochemically recognized melanocytes, owing to their destruction. However, the destruction is most likely a slow process resulting in a progressive decrease of melanocytes. Theories regarding destruction of melanocytes include autoimmune mechanisms, cytotoxic mechanisms, an intrinsic defect of melanocytes, oxidant-antioxidant mechanisms, and neural mechanisms. 10 Vitiligo Genetics: Lerner (1959) suggested autosomal dominant inheritance.15 Genetic variations in NLRP1 are associated with susceptibility to vitiligo [MIM:193200]. Jin in the New England Journal of Medicine reported a study comparing 656 people with and without vitiligo in 114 families, which found several mutations (single-nucleotide polymorphisms) in the NALP1 gene.2-3 The NALP1 gene, which is on chromosome 17 located at 17p13, is on a cascade that regulates inflammation and cell death, including myeloid and lymphoid cells, which are white cells that are part of the immune response. NALP1 is expressed at high levels in T cells and Langerhan's cells, white cells that are involved in skin autoimmunity. NLRP1 Gene in genomic location: bands according to Ensembl, locations according to GeneLoc. The main text must be clearly paragraphed.5 State the objectives of the work and provide an adequate background, comprehensive insight on the purpose of the study and its significance, avoiding a detailed literature survey or a summary of the results.6 Among the inflammatory products of NALP1 are caspase 1 and caspase 5, which activate the inflammatory cytokine interleukin-1β. Interleukin-1β is expressed at high levels in patients with vitiligo. There are compounds which inhibit caspase and interleukin-1β, and so might be useful drugs for vitiligo and associated autoimmune diseases. Of the 656 people, 219 had vitiligo only, 70 had vitiligo with autoimmune thyroid disease, and 60 had vitiligo and other autoimmune diseases. Addison's disease (typically an autoimmune destruction of the adrenal glands) may cause vitiligo. In one of the mutations, the amino acid leucine in the NALP1 protein was replaced by histidine (Leu155->His). The original protein and sequence is highly conserved in evolution, and found in humans, chimpanzes, rhesus monkey, which means that it's an important protein and an alteration is likely to be harmful.3 The following is the normal DNA and protein sequence in the NALP1 gene: In some cases of vitiligo the first leucine is altered to histidine, by a Leu155→His mutation: (Leucine is nonpolar and hydrophobic; histidine is positively charged and hydrophilic, so it is unlikely both serve the same function.)4,5 The normal sequence of the DNA code for NALP1 of TCACTCCTCTACCAA is replaced in some of these vitiligo families by the sequence TCACACCTCTACCAA,6 which respectively code for the amino acid sequence of the normal NALP1 protein SLLYQ being replaced by SHLYQ.7 Aims and objectives: To study the familial occurrence of vitiligo. Study of genetics of vitiligo. Methodology: The following methodology is adopted to conduct the study. Literary review: For collecting all the available information about Vitiligo, literary review of available texts & Journals done thoroughly. Available information from internet also taken into consideration. Clinical study: Study design: This is a randomised single blind clinical study in vitiligo patients. The study was carried out on 60 patients. The study included the detailed family history with pedigree analysis in patients under study. Selection of patients: The study was carried out on outdoor patients. Inclusion criteria: Patients complaining of white depigmentation as a main complaint. Patients from all age groups. Selection was irrespective of sex, duration of the disease. Patients with or without family history of hypopigmentation. Exclusion criteria: Patients not ready for the study. Statistical Methods- proper statistical methods applied to find out the results. Place of work: Dept of Genetics, Immunology and Biochemistry Maharashtra University of Health Sciences, Pune Mulla Ayurvigyan Hospital, Islampur. Dist.- Sangli. Informed conscent: Informed conscent taken about nature and purpose of study from each patient. Observations: observations were made in the following ways, Out of total 60 patients observed 16 (26.66 %) patients have family history of vitiligo either paternal or maternal. While 44 patients don’t have family history for vitiligo. 41 patients are female & 19 are male. The age group affected more i.e 58.33 % (35 patients) is upto 20 Yrs. 26.66 % (16 Patients) are between the age group 20- 40. Just 15 % (9) patients are ≥ 40 Yrs. Statistical calculations - Data is , randomised selected, qualitative. So Chi-square (χ2) test is applied as a test of “goodness of fit ”.[13]to determine if actual frequency found in this study is similar to the expected or theoretical number. The theoretical(expected) number is taken as 30 % frequency of familial tendency in the patients with vitiligo.9,10 The calculated (χ2) value is 0.31. At one degree of freedom the (χ2) table value is 3.841 at 5% level of significance. The calculated (χ2) value 0.31 is much lower than the table value. Hence insignificant at probability 0.05. Hence the observed distribution fit to the hypothetical or expected distribution. Pedigree of Patients observed (for example) – Name of the patient - XXY age – 20 Yrs. sex- Female Results The above study shows that in the population studied for familial occurrence of vitiligo 26.66 % subjects have past family history of vitiligo. Statistically this observed frequency fits to the expected distribution. Younger age Group up to 20 Yrs. is predominantly affected. Conclusion The following conclusion can be drawn from the present study: The familial occurence of vitiligo in the studied population is 26.66 %. So genes & mutations play a significant role in the aetiology of vitiligo. Younger age Group upto 20 Yrs. is predominantly affected. Also the older patients might have the onset of vitiligo at the younger age. Suggestions: The results from the present study can be verified by taking larger sample size. Also further genetic research regarding aetiology & prevention may be of value. Research in the field of gene therapy can be of value. Application of this research: By knowing the familial tendency we can predict about aetiology & prognosis of vitiligo in total also & in a particular case also. Spread of disease can be prevented by proper pre- marital genetic counseling & carrier detection. Gene therapy may be useful in familial cases. References Ortonne J. Vitiligo and other disorders of Hypopigmentation. In: Bolognia J, Jorizzo J, Rapini R, eds. Dermatology. Vol 1. 2nd. Spain: Elsevier; 2008, 65. Gregersen PK. "Modern genetics, ancient defenses, and potential therapies". Engl. J. Med. 2007, 356(12), 1263–1266. doi:10.1056/NEJMe078017. Jin Y.; Mailloux CM.; Gowan K.; Riccardi SL.; LaBerge G.; Bennett DC.; Fain PR.; Spritz RA. "NALP1 in vitiligo-associated multiple autoimmune disease". Engl. J. Med. 2007, 356(12), 1216–1225. doi:10.1056/NEJMoa061592. List of Amino Acids and Their Abbreviations. The Genetic Code (DNA). Ensembl Transcript Report Ensembl Transcript ID: NST00000262467. Ensembl Protein Report Ensembl Peptide: ID ENSP00000262467. Mechri A.; Amri M.; Douarika AA.; Ali Hichem BH.; Zouari B, Zili J. "[Psychiatric morbidity and quality of life in Vitiligo: a case controlled study]" (in French). La Tunisie médicale.2006, 84(10), 632–635. com -Vitiligo Symptoms, Causes, Pigmentation Loss Treatment and Diagnosis on MedicineNet.com October 6, 200810. Article By (Medline.Updated: Aug 8, 2008)-Vlada Groysman, MD, Staff Physician, Department of Dermatology, University of Alabama School of Medicine Naveed Sami, MD, FAAD, Assistant Professor Department of Dermatology, University of Alabama School of Medicine. Harrison’s Principles of Internal medicine McGraw-Hill 14th edition. Golwalla-Medicine For Students Dr. Golwalla Dr. A. F. Golwalla 17th edition International. Methods in Biostatistics. By B.K. Mahajan 6th edition. Wikipedia, the free encyclopedia Lerner, A. B. Vitiligo. J. Invest. Derm. 1959, 32, 285-310. UniProtKB/Swiss-Prot Q9C000 (NALP1_HUMAN) Last modified November 25, 2008. Version 89.

Open water swimming ultra-marathon events ≥10 km have become increasingly popular amongst master athletes. However, very little is known about the timing of training sessions and the impact on sleep. This study aimed to examine sleep behaviours, sleep problems and disorders and the relationship with training timings. This study used a longitudinal observational design for 42 nights with 24 masters' swimmers (n = 13 females), aged 39 ± 11 years, body mass index of 26 ± 3 kg/m2 during a training squad for an ocean ultra-swim (19.7 km) in Western Australia. Objective measures of sleep were obtained from a wrist-activity monitor, the Readiband™ (Fatigue Science Inc., Canada). Swimmers completed a survey instrument related to sleep problems, disorders, chronotype, anthropometric and demographic information. Generalised linear mixed models were fitted to examine relationships between predictor variables and sleep responses. Body mass index was associated with a decline in Total Sleep Time (TST), each one-unit increase in BMI was associated with 5 min less TST (p = 0.04). Swimmers with a “high risk” of sleep apnea had 21 min more wake time (p = 0.04) and 5% lower Sleep Efficiency (p = 0.04). Sleep Offset on the morning of a morning training session was earlier by 48 min (p < 0.001) resulting in less TST by 39 min (p < 0.001). This study provides evidence that coaches need to consider sleep behaviours and problems before designing training schedules. Swimmers need to plan and allocate an adequate sleep opportunity and those who have a suspected sleep disorder or problem should seek the support of a sleep physician.

AbstractIn the planar circular restricted three-body problem and for any value of the mass parameter $$\mu \in (0,1)$$ μ ∈ ( 0 , 1 ) and $$n\ge 1$$ n ≥ 1 , we prove the existence of four families of n-ejection–collision (n-EC) orbits, that is, orbits where the particle ejects from a primary, reaches n maxima in the (Euclidean) distance with respect to it and finally collides with the primary. Such EC orbits have a value of the Jacobi constant of the form $$C=3\mu +Ln^{2/3}(1-\mu )^{2/3}$$ C = 3 μ + L n 2 / 3 ( 1 - μ ) 2 / 3 , where $$L>0$$ L > 0 is big enough but independent of $$\mu $$ μ and n. In order to prove this optimal result, we consider Levi-Civita’s transformation to regularize the collision with one primary and a perturbative approach using an ad hoc small parameter once a suitable scale in the configuration plane and time has previously been applied. This result improves a previous work where the existence of the n-EC orbits was stated when the mass parameter $$\mu >0$$ μ > 0 was small enough. Moreover, for decreasing values of C, there appear some bifurcations which are first numerically investigated and afterward explicit expressions for the approximation of the bifurcation values of C are discussed. Finally, a detailed analysis of the existence of n-EC orbits when $$\mu \rightarrow 1$$ μ → 1 is also described. In a natural way, Hill’s problem shows up. For this problem, we prove an analytical result on the existence of four families of n-EC orbits, and numerically, we describe them as well as the appearing bifurcations.