In adults vitrectomy and scleral

In adults, vitrectomy and scleral buckle have similar success rates. Typically, the surgeon aims to address all three of the above-mentioned goals. In order to achieve the reapproximation of the dabigatran etexilate to RPE, a vitrectomy with intraoperative heavy fluid tamponade or a posterior drainage retinotomy is often employed. This last step is not always necessary. Subretinal fluid is expected to resorb over time if the traction is relieved and the break is closed. Particularly for children, the desire to leave the retina completely flat at the end of the case must be weighed carefully against the additional morbidity of a pediatric vitrectomy. Even cases with extensive PVR can be successfully addressed with a sclera buckle. In the case series by Akabane et al., the authors report successful repair of 7/7 retinal detachments attempted with scleral buckling alone in cases with at least PVR grade C.
In pediatric cases that involve vitrectomy, large retinectomies are quite common, as the strength of the pediatric vitreoretinal interface often precludes a dissection that relieves all the surface traction. Lensectomy at the time of the repair is common as well (Table 1). Because of the challenges of postoperative positioning and the difficulty of monitoring postoperative intraocular pressure, silicon oil is often preferred to long-acting gas for tamponade (Table 1).
Retinal tears and other significant peripheral retinal pathology are often present in the fellow eye at the time of diagnosis (Table 1). Typically, this is treated with either cryotherapy dabigatran etexilate or laser retinopexy at the time of diagnosis. Children have an increased likelihood of bilateral retinal detachments. For this reason, many surgeons consider 360° prophylactic retinopexy for fellow eyes deemed to be at high risk for detachment. In the case of Stickler syndrome, there is some retrospective evidence to suggest this is beneficial. Interestingly, the retinal cryopexy in this study was applied anteriorly, just posterior to the ora serrata. Stickler eyes have abnormal vitreous bases. When retinal tears develop, they are often quite posterior. This treatment is thought to decrease the risk for development and progression of giant retinal tears. As would be expected, the eyes in this study that developed retinal detachment following prophylaxis did so as a result of posterior tears.
Compared to the success rates of retinal detachment repair in the adult population, repair of RRD in children has a modestly lower final anatomic success rate of 70–80% in most series (Table 1). However, the reattachment rate with one surgery is considerably lower at 50–80% (Table 1). Visual outcomes also tend to be significantly worse in children with most series showing only 30–40% of patients reaching a final acuity of 20/200–20/400 (Table 1). This is likely due in part to the increased proportion of chronic detachments as well as amblyopia. Anatomic success rates and visual outcomes are lowest among the younger age groups. Initial and final anatomic success rates for children less than eleven years old are only 50% and 60%. These patients are also more likely to undergo vitrectomy and lensectomy. When different etiologies of retinal detachment are considered, the poorest outcomes tend to be in patients with congenital abnormalities, trauma, and prior surgery. with only 22–44% success rate for the latter in some series. Other risk factors for poor outcome are macular involvement, the presence of PVR, the presence of giant retinal tear, and inability to determine pre-operative acuity. Four quadrant detachments also have worse outcome compared to three quadrant detachments.
The informed consent process is a critical part of the care of any patient with a retinal detachment. In the case of pediatric retinal detachments, particular challenges must be addressed. As evident in Table 1, the anatomic and visual success rate is relatively low. Often it takes a lengthy conversation for the family to comprehend the extent of the care required and to develop realistic expectations. Before surgery, they must understand the likelihood of multiple surgeries, the importance of follow-up, and the amount of visual recovery that can be realistically expected. When faced with this prognosis, it is not unreasonable for a family to conclude that the benefit of pursuing surgical repair is not worth the risks and hardship involved. This is particularly true of monocular cases with low-risk fellow eyes. Conversely, it is important not to discount the role of relatively low levels of vision to a child’s well-being. Forty percent of the time, the vision recovered from retinal detachment repair is better than the fellow eye. As always, families will rely on an informed and thoughtful surgeon to help them decide how best to care for their child.

Levy a r alis en la premi re tude

Levy a réalisé en 1972 la première étude épidémiologique sur les troubles sexuels chez les malades en insuffisance rénale chronique (IRC) [2]. Depuis lors, la majorité des études épidémiologiques, bien que peu nombreuses, a suggéré que l’importance des problèmes sexuels chez ces patients est bien fondée et mérite d’être approfondie [2–4].

Objectif

Patients et méthodes

Résultats
L’âge moyen de nos malades était de 45,5+/-1,5ans avec une médiane de 45ans et des extrêmes allant de 18 à 75ans. Environ 56% de nos malades étaient de sexe masculin.
La fréquence de la dysfonction sexuelle chez nos patients était de 78%, tous ces malades ont affirmé l’apparition de ces troubles après le début de l’HD (Figure N̊1).
Les résultats cliniques et paracliniques ont été résumés dans les tableaux N° 1 et 2.
Dans notre étude, les patients présentant une dysfonction sexuelle avaient un âge plus avancé, un début de dialyse plus ancien et des troubles hormonaux significativement plus marqués que les patients sans troubles sexuels. Le taux de téstostéronémie était bas chez 32 patients (78% des hommes) et a été significativement plus bas chez les hommes présentant une dysfonction (p=0,020).
L’anémie était un facteur significatif d’apparition de troubles sexuels (p=0,031). Dans notre étude, nous n’avons pas objectivé de corrélation entre les taux des LH, FSH et œstradiol et l’existence de dysfonction sexuelle.

Discussion
Il a été démontré que les troubles sexuels sont fréquemment rencontrés chez les malades souffrant d’IRC en stade d’HD [2,3]. Ces malades sont exposés à un certain nombre de comorbidités (HTA, diabète, dépression…) qui augmentent la fréquence de ces troubles par rapport à la Go 6976 Supplier générale. Notre étude confirme l’importance de ces troubles dans notre population de malades (78%) qui s’associent à d’autres facteurs contribuant à la détérioration de la qualité de vie. Le diagnostic et le traitement de ces troubles sexuels doivent entrer dans le cadre d’une prise en charge globale du malade.
Les troubles sexuels étaient très fréquents chez nos malades (73% des hommes et 84% des femmes), ces résultats rejoignent ceux de la littérature où ces taux atteignent 70% (95% CI, 62%-77%) chez les hommes et 30% à 80% chez les femmes [4–6]. Quoiqu’on doit noter la rareté des études sur la prévalence de ces troubles chez les femmes en HD. Mais dans tous les cas on trouvait que ces troubles étaient plus fréquents chez IRCT que dans la population générale malgré les avancées importante de la prise en charge des IRCT ces dernières décennies [4,6].
Il est démontré dans la littérature que l’apparition de ces troubles est liée à l’âge [6–8]. Malekmakan et al. [8] avait mené une étude sur 73 hommes âgés de 18 à 70ans et avait trouvé que la prévalence du dysfonctionnement érectile (DE) augmentait proportionnellement avec l’âge des patients allant de 70,8% pour les patients âgés de moins de 50ans à 95,9% pour les plus de 50ans. Strippoli et al. [6] a réalisé l’une des études les plus larges et les plus approfondies sur la dysfonction sexuelle chez 1472 femmes en HD, et a trouvé que leur apparition était intimement liée à l’âge, la ménopause et le niveau éducatif. Dans notre étude l’âge était significativement lié à la survenue de ces troubles chez les 2 sexes avec p<0,0001. Dans notre série, les malades avec une dysfonction sexuelle avaient une durée de dialyse supérieure aux malades sans trouble. Au contraire, plusieurs études trouvaient que la durée d’HD n’influençait pas la survenue de ces troubles [7,8]. Des études ont rapporté l’existence d’une relation significative entre la survenue des troubles sexuels et un poids sec diminué [8], ceci n’a pas été retrouvé dans notre travail. Il n’existait pas de lien entre diabète, HTA, dyslipidémie et tabagisme et la survenue de troubles sexuels chez nos patients. Néanmoins, on trouve dans la littérature que la néphropathie diabétique est un facteur de risque déterminant, induisant des neuropathies, artériopathies ou lésions endothéliales [6,9]. De même pour l’existence de facteurs de risque cardiovasculaires, d’une HTA, d’une surcharge pondérale ou dyslipidémie [9].

Wind power industry is developing rapidly more and more wind

Wind power industry is developing rapidly, more and more wind farms are being connected into power systems. In the next years, there will be more significant growth in wind energy. Although the great development in the technology of electrical generation from wind energy, there is only one way of generating electricity from wind caspase inhibitor is to use wind turbines that convert the energy contained in flowing air into electricity. Fixed speed wind turbines utilize squirrel cage induction generator directly connected to the grid to produce the electricity. These induction generators which are usually connected at weak end of a grid or at distribution networks draw large amount of reactive currents during disturbances such as faults. Consequently under these conditions the terminal voltage and the electrical output power are significantly reduced, whereas the mechanical torque may be still applied to the wind turbine and the rotor speed increases [1]. After fault clearance the generator needs reactive power for voltage recovery, however this reactive power to be supplied by network which in turn causes a voltage drop, so the machine terminal voltage cannot be recovered. If the voltage could be recovered and the generator speed is not too high, torque could be restored and the wind turbine may restore its normal operation eventually. Otherwise the generator would continue to accelerate and the rotor speed and reactive power consumption will increase, so the terminal voltage decreases further. If the rotor speed exceeds a certain critical value the generator set becomes unstable, thus must be tripped out by over speed protection devices [2]. As for cases in which a large amount of power is supplied by generators, theses generators should stay connected to the grid. Therefore, the stability becomes an important problem and has recently attracted considerable attention [3]. Various methods of stability improvement have been presented by researchers. The pitch control system is used to control the power output of the wind turbine and also for stabilization of the wind turbine at grid faults. When a fault occurs in the external power system, the blade-angle control orders the mechanical system to reduce the wind turbine mechanical power to improve stability. For fixed-speed rotor short-circuited induction generators, it is not possible to control the input mechanical power, and therefore the effective approach would be the use of reactive power compensators such as Static Synchronous Compensator STATCOM or Static Var Compensator SVC to help the voltage recovery. Squirrel cage induction generators can become easily unstable under low voltage conditions, as low terminal voltage lead to: larger rotor slip, larger reactive power consumption, further lowering of terminal voltage, and this may lead to disconnecting the turbine. Initial low voltage conditions may be originated by conditions different than faults. So that the wind turbines can be equipped with a controllable source of reactive power to deliver the reactive power required to accelerate the voltage restoration [4]. Since the induction generators do not perform voltage regulation and absorb reactive power from the utility grid, they are often the source of voltage fluctuations [5]. The ability of a wind power plant to stay connected during disturbance is important to avoid the time of reconnection process, which need from 4 to 5min and also to avoid cascading disturbance due to lack of generation. Furthermore it is economically convenient to handle the fault, without disconnecting the wind turbine from the grid [6–8]. It is necessary to examine the responses of SCIG wind farm during the faults and possible impacts on the system stability. In this paper, the impacts of fault location and its duration time on 9MW wind farm interconnected grid are studied by monitoring the active power, reactive power, and bus voltage of the wind farm. Also, the contribution of STATCOM to support the wind farm during different fault locations and durations are studied.

Methods br Main outcome measures

Methods

Main outcome measures

Results

Discussion
In the Asia-Pacific region, differing sociocultural and economic factors may prevent individuals from seeking medical help for sexual dysfunction; however, there has been increasing interest in assessing the prevalence of sexual dysfunction and PE in the Asia-Pacific region, but there is little knowledge regarding the initiators and barriers to the disorder and its management. The Asia-Pacific region is heterogeneous, with differing religious, social, and cultural beliefs. Masculinity is considered to be central to male social standing and may be a deterrent to seeking medical help for any sexual-health issues. Even when medical help is sought, PE is often under-treated because many Asian men generally believe that erectile function is the hallmark of the male sexual prowess and may even mistakenly believe that improving the strength of their erections can help resolve their PE condition.
There was a wide discrepancy between respondents who acknowledged having experienced PE and those diagnosed with the condition using the PEDT. Probable/definite PE based on the PEDT was high in the Asia-Pacific region, with a prevalence of 61%. This was 30% higher than the prevalence of probable/definite PE found in a similar demographic group in a 2012 survey. The reasons behind such high prevalence may be due to the backgrounds of the participants – who were predominantly urbanite, educated, having a higher income, and possessing more knowledge of sexual dysfunction. The web recruitment method from the database also can induce self-selection bias. Another factor that may play a role is that there has been an increase in awareness of PE and its treatment in the years subsequent to this olda survey.
The percentages for respondents who acknowledged experiencing PE were higher, and ranged from 71% to as high as 91% in China, which may have skewed the overall data. When the percentage of individuals with probable/definite PE based on PEDT and who acknowledged PE were combined, the prevalence dropped to 44%. It should be noted that this figure may be higher than in other studies reporting PE prevalence, as IELT was not taken into consideration. Additionally, as this was a web-based study, the proportion may be an overestimation compared to the general population. Notwithstanding that, it is clear from this study that PE has a negative impact on these men as well as on their partners and their relationship.
The main barriers for men to initiate a PE discussion were largely emotional in that they did not want to feel inadequate or were afraid of either being hurt or hurting their partner\’s feelings. The negative emotional impact was due to feelings of low confidence during sex. Furthermore, guilt or failure, anger, shame, depression, and lower confidence outside of the bedroom also may prevent open discussion of the issues with partners. It is likely that the growing influence of the Internet and social media will further educate and raise awareness on sensitive topics surrounding PE that couples currently find difficult to discuss. This would help to liberalize couples and particularly women to improve communication and for them to be a key part of a joint decision-making process regarding sexual issues in the relationship.
The role of the HCP in the treatment of men with PE also unveiled interesting observations. Men refraining from discussing the issues with their HCP, or even from finding the appropriate HCP, have concerns of social stigmatization and embarrassment. The large variation observed across the Asia-Pacific region in choosing a preferred HCP for PE management may be due to country-specific norms as well as the healthcare and referral systems in place in specific countries. The specific attributes that men looked for in their HCP were emotional or rational in nature, with either a higher desire to have an HCP they could trust, or the desire to consult someone who was knowledgeable about PE, including treatment options and possible side effects. Men also felt reassured when their HCP told them that PE is a common problem in males, and liked the fact that they were questioned about their sexual health as part of a general health screening. The latter could be used effectively to start the discussion of sensitive sexual topics, especially in male-dominant societies in the Asia-Pacific region, where the man may be reluctant to discuss these matters with the HCP. In Australia, Malaysia, and Thailand the pharmacist plays an important role in providing information on PE and its treatment. It may be that pharmacists could be an increasingly important link in the HCP network in the future, especially in countries where clinicians are particularly pressed for time.

In the current study lipid control

In the current study lipid control was somewhat better than glycemic control as about two thirds of diabetic patients attained the goal for lipid control but it should be noted that only total cholesterol and triglyceride were reported as low density lipoprotein (LDL) and high density lipoprotein (HDL) were not available for most patients. This may represent a drawback in the care of diabetic patients. Goal attainment for diastolic blood pressure was better than systolic blood pressure (72.5% versus 50.4%). The high proportion of elderly patients in this study may account for this finding because the isolated systolic pyruvate dehydrogenase kinase inhibitor is more prevalent in the elderly. Such suboptimal control of blood pressure was also reported by others (Charpentier et al., 2003).
Glycemic control in males was found to be significantly better than females, and this can be due to the fact that; females are usually the caregivers for the entire family not only the husband and children but also mothers and mothers-in-law which increases their heavy domestic responsibilities. This feature could be a local phenomenon as other studies (Charpentier et al., 2003) found that sex was not associated with glycemic control.

Conclusion

Acknowledgment

Introduction
Evidence-based medicine (EBM) is being recognized worldwide as an important clinical skill that aims at improving the way physicians practice medicine, teach medicine, and perform scientific research. EBM was defined as “the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients” (Sackett and Rosenberg, 1996). It was redefined in order to include the patient decision as “Integration of best research evidence with clinical expertise and patients values” (Sackett et al., 2000). EBM is a process for turning the clinical problems to questions, and then systematically reprehending and evaluating the use of the research findings as a basis for making clinical decisions. The practicing the EBM will positively benefit individual, clinical team and patients (Sackett and Rosenberg, 1995).
Different models have been proposed to study the evidence based information. The “4S” model was classified into four layers as studies at base, synthesis at above, synopses and systems next up followed by systems at the top (Haynes, 2001). The same model was modified and a new layer was added as “summaries” and called as “5S” model (Haynes, 2006). Another hierarchy model was proposed to access clinical information similar to the tertiary-secondary-primary literature pyramid (Grandage et al., 2002). Both providers and consumers of evidence-based health care can help themselves to these best current evidence hierarchical models by recognizing and using the most evolved information services for the topics that concern them. These models help for better information and reduce the comprehensiveness.
In the Middle East countries EBM goes back to at least 1999 when pioneers in Oman, Bahrain and Saudi Arabia began to introduce the idea through lectured courses (Ferwana, 2010). In Kuwait the EBM awareness in the primary care physicians was low and the study further recommended training the physicians and access to the EBM resources is a crucial step to practice the EBM (Ahmad et al., 2009). In Bahrain, family physicians are using EBM in their daily work, especially noted among those physicians who took EBM courses (Amin et al., 2006). In Jordan, the study showed positive attitude toward EBM, however it described different personal, interpersonal and organizational barriers that affect the implementation of the EBM, in addition the study also emphasises the importance to develop a national plan to overcome these barriers (Al Omari, 2009).
In most cases, physicians do not have enough time to follow the large quantity of the published research neither have tool to assist the quality of those studies. Skills to criticize the new finding from the published studies, and lack of time to practice the evidence based medicine are two of many barriers that affect the implementation of the EBM. There are increased calls worldwide for practicing the EBM, but as many studies showed, implementing the EBM is facing barriers in thinking and practicing EBM in health care setting could be related to practitioners, organizational or may be patient related factors (Scott et al., 2000; Freeman and Sweeney, 2001; Young and Ward, 2001). Till today in the Middle East studies were carried out to study the awareness and knowledge of EBM but not the factors affecting the EBM. Therefore the current study was aimed to evaluate the current practice and address the barriers toward implementing the EBM in Dubai Primary Health Care Sector (PHCS).

br Introduction Rational use of medicines RUM is an

Introduction
Rational use of medicines (RUM) is an essential element in achieving quality of health care for patients and the community. The World Health Organization (WHO) defined RUM as patients receive medications appropriate for their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their cyclosporin (WHO, 2002).
As part of a national effort to achieve the optimum use of medicines in United Arab Emirates (UAE), two conferences were held regarding the RUM. The First National Conference on RUM was held in May, 2008, by the Health Authority-Abu Dhabi (HAAD) in collaboration with the Ministry of Health (MOH), WHO Headquarters and the Regional Office for the Eastern Mediterranean (Fahmy, 2008). The objective of the conference was to promote therapeutically sound and effective use of medicines. This conference initiated the first step to promote and establish RUM program in Abu Dhabi and the other Emirates.
The second conference was the Pharmacy Education Forum with the theme “Join hands to promote RUM”, held in May, 2012, and organized by MOH in collaboration with Sharjah University (http://www.cpdpharma.ae/index.php?view=details&id=12%3A2nd+Pharmacy+Educational+Forum&option=com_eventlist&Itemid=84, 2013). The main objective was to promote awareness among pharmacists and other healthcare professional about all aspects of RUM. The MOH has taken several steps to establish RUM, by developing an essential medicine list (EML) which was developed by using a rigorous selection methodology. The methodology used to construct EML involved WHO guidelines and the UAE Ministry of Health policies on drug formulary.

Study methodology

Results
We compared the prescribing pattern among the four government hospitals in each Emirate using WHO prescribing indicators. The mean number of medicines per prescription for the four hospitals was 2.49±0.9. The average number of medicines per prescription in Dubai hospital-DHOSP was (2.52±0.2), in Sharjah hospital-SHOSP was (2.48±0.21), in Ajman hospital-AJHOSP was (2.37±0.19) and in Umm Al Quwain hospital-UMQHOSP was (2.59±0.16) which were all higher than the WHO optimal value (⩽2). There was statistically significant difference among these four hospitals in terms of the average number of medicines per prescription (P<0.001). The percentage of generic prescribing was 100% in all four hospitals as recommended by the WHO. The mean percentage of antibiotic prescribing was very low 9.8±4.8 but was within the WHO optimal value (⩽30). The percentage of antibiotic prescribing in DHOSP (6.5) and SHOSP (4.74) was low as compared to the other two hospitals; namely, AHOSP (14.33) and UHOSP (13.66) but all of them were within the WHO optimal value. Statistically significant difference was found among these four hospitals in terms of the percentage of antibiotics per prescription (P<0.001). The mean percentage of injection prescribing was (3.14±1.7) and was very low as compared to the WHO optimal value (⩽10). The distribution of this parameter was low in the surveyed hospitals as follows: DHOSP (1%), SHOSP (2.91%), AHOSP (3.33%) and UMQHOSP (5.33%). The percentage of prescribing from EML in the hospital representing Dubai Health Authority (DHA) and the three hospitals representing MOH was 100%, (Table 1).
Discussions

Conclusions

Submission statement

Acknowledgments

Introduction
Receptor tyrosine kinases (RTKs) are a large family of cell-surface transmembrane receptors having an important function in both normal and malignant cells to signal transduction (Verma et al., 2011). One subfamily of RTKs is referred to as the TAM family, containing Tyro-3, Axl, and Mer. The Mer (Mertk, Nyk, c-Eyk) protein consists of an extracellular domain with 2 immunoglobulin-like and 2 membrane proximal fibronectin III motifs, a transmembrane region, and an intracellular tyrosine kinase domain (Graham et al., 1995, 1995). Mer is expressed in hematopoietic lineages such as natural killer (NK) cell monocytes, dendritic cells, macrophages, megakaryocytes, and platelets (Angelillo-Scherrer et al., 2001). Mer in vivo regulates macrophage activation, promotes apoptotic cell engulfment, and supports platelet aggregation and clot stability. Mer overexpression has been reported in neoplastic progression of several human cancers and has been correlated with poorer prognosis. The growth arrest specific protein 6 (Gas6) as the biological ligand for Mer is a member of the vitamin K dependent protein family (Chen et al., 1997; Stitt et al., 1995). Gas6 is the common ligand among TAM family and interaction of Gas6 with Mer, Axl, and Tyro-3 is important in platelet degranulation and aggregation in response to known agonists.

Near dissociated heterophoria was determined with

Near dissociated heterophoria was determined with alternate cover test method with best semagacestat correction, and with subjects fixating on an accommodative target which was a small isolated letter “E” of approximately 20/30 (6/9) size on the fixation bar. Measurement of the deviation was carried out with prism neutralization. The lowest power of prism that neutralizes the recovery movement was taken as a measure of the deviation in prism diopters. For confirmation of the end point, the subjects were asked to observe an apparent jump of the fixation target when the cover test was repeated (subjective cover test or Phi test).
For determination of near point of convergence (NPC), a push-up test was carried out. A small isolated letter “E” of approximately 20/30 (6/9) size from a reduced Snellen chart target was slowly brought from 40cm toward the subject along the subject’s midline at a rate of approximately 3–5cm/s. The subjects were instructed to keep the target single during the test and report when it semagacestat appeared double (break point). The distance between break point to the plane of the lateral canthus was measured with a millimeter ruler. In cases in which subjects did not report diplopia, the examiner measured the distance at which one eye lost its fixation on the target.
For assessment of the jump convergence, the subjects were asked to alternate their fixation between two pencils placed at two different distances along the subject’s midline, one at 50cm and another at 15cm. Subject’s eyes were observed during the change of fixation from the more distant target to the nearer one and the quality of the convergence movement was evaluated. Only a rapid and simultaneous convergence movement was recorded as normal and other movements were considered abnormal.
For the measurement of stereopsis, the TNO test was used. With the best correction in a trial frame, the subjects wore the red and green anaglyphic filters and the booklet was held at a distance of 40cm, perpendicular to the subject’s visual axis. At first the screening plates (plates of I–IV) were presented, and if the subjects were able to successfully complete these pages, the graded plates from 480 to 15s of arc was showed until the subject was unable to identify three-dimensional shape (Pac-man shapes) correctly. The lowest discriminated disparity by each subject was recorded as his/her stereopsis in seconds of arc.
Vergence facility was tested at near by flipper prism. The selected power for the flippers was 3-prism diopters (Δ) base-in (BI) and 12 prism diopters (Δ) base-out (BO). A vertical column of small letters “E” of approximately 20/30 (6/9) size was used as an accommodative target at 40cm. The subjects were asked to observe the fixation target through the habitual correction. The flipper prism was changed from base-in to base-out and back again to the base-in; grana constituted one cycle. The target was to remain clear and single with each prism flip. The number of cycles the subject was able to complete during 1min was recorded as vergence facility in cycles per minute. We also noted any difference between the BI and BO responses and any evidence of fatigue. In checking for suppression, we used physiological diplopia.
A prism bar was used for the measurement of fusional reserves at near. The target was the same as the one used for vergence facility testing. The subject was asked to look at the target and the base-in prism was introduced over the habitual correction. The prism power was slowly increased until the subject reported sustained blur, break, and recovery. The above procedure was repeated with base-out prism and the blur, break and recovery points were determined. The determined prism powers were recorded in prism diopters. We observed the subject’s eyes during the measurement for the detection of possible suppression.
For calculation of Body Mass Index (BMI), subjects’ height (meters) and weight (kilograms) were measured with tape measure and scales, respectively, and then their BMI was determined using the standard formula.

For the last years confusion prevails over the

For the last 50years, confusion prevails over the taxonomic nomenclature of the genus Scylla, and in particular regarding the number of order Cabozantinib existing within the genus. Revised taxonomy of the genus Scylla through biotechnological approach proved the occurrence of four species (S. serrata, S. tranquebarica, Scylla olivacea and S. paramamosain) (Keenan et al., 1998). This recent revision with the aid of molecular tools creates ambiguity over previous works done regarding the identification of species of genus Scylla. Most of the earlier work on mud crabs mention the monospecific term S. serrata and as per the revised taxonomy, it unravels the fact that different species of genus Scylla might be erroneously treated as S. serrata.
The study of food and feeding based upon the analysis of stomach content has become a standard practice (Hyslop, 1980). Stomach content analysis provides important insights into feeding patterns and its quantitative assessment is an important aspect in fisheries management. Natural feeding activities of genus Scylla has been well recorded in S. serrata (Arriola, 1940; Chacko, 1956; Hill, 1976, 1979; Williams, 1978; Lee, 1992; Joel and Raj, 1986; Prasad and Neelakantan, 1988; Mamun et al., 2008). However, despite the ecological and economical importance of S. olivacea little information is available on its food and feeding habits. The present work is the first register on the food and feeding habits of S. olivacea from Indian waters, describing its prey and feeding intensity which was carried out separately for males and females of different size groups.

Materials and methods

Results

Discussion
The results of the present study of food and feeding in males and females of S. olivacea indicated that this species is an elite carnivore. This was confirmed by the high occurrence of fragments of crustacean appendages, pieces of shells, spats of molluscs and scales of fishes in the gut. Previous studies on other mud crab species also support the presence of such food items in the stomach (Hill, 1976; Kathirvel, 1981; Joel and Raj, 1986; Mohapatra et al., 2005). Warner (1977) stated that crabs were opportunistic omnivores with a preference for animal food and with predatory tendencies. In addition, he opined that portunids tend to be mainly carnivores and retain the ability to deal with a variety of food stuffs with predominance to a carnivorous diet.
The present study from Pichavaram mangroves revealed that the crustaceans form the principal food component in the stomach of S. olivacea. This was in agreement with the findings of Mamun et al. (2008) where mud crabs (S. serrata) off Bangladesh waters consume crustaceans as its major food component (44.48%). Kathirvel (1981) reported a higher percentage of crustacean remains (78.4%) in the gut of S. serrata from Cochin backwaters. Kathirvel and Srinivasagam (1992) recorded crustaceans as the chief food item in S. serrata from Ennore estuary (46.3%) and Pulicat Lake (46.6%) of southeast coast of India. The major crustacean food items in its diets were grapsid crabs and Penaeus spp. The molluscan prey includes Littorina scabra, Crassostrea madrasensis and Pila globosa which are common in Pichavaram mangroves (Kasinathan and Shanmugam, 1988) while fishes includes Gerres abbreviatus and Ambassis gymnocephalus. There was no significant difference recorded between the quantity of food consumed by males and females except slight variations, as reported earlier by Mohapatra et al. (2005). The present findings revealed that the stomach of juveniles and sub-adults are predominated by crustaceans and fishes. This was supported by Joel and Raj (1986), where they postulated that the ability of the order Cabozantinib juveniles to capture fast-moving prey like fishes, prawns, etc. may be linked to the long, slim and sharp toothed chelae with a relatively higher proportion of fast contracting muscles that are well adapted for the rapid snapping movements. Warner (1977) emphasized that portunids has the ability to capture faster moving prey.

br Agradecimientos br Introducci n La medicina dom

Agradecimientos

Introducción
La medicina doméstica, cuyo campo de acción suele ser en muchos casos las afecciones infantiles, pasa luciferin menudo inadvertida pese a su omnipresencia en la vida cotidiana y tiende a ser ignorada por los estudios relativos a la antropología médica, que suelen concentrar su atención principalmente en las representaciones y prácticas de los especialistas rituales indígenas (los representantes de la “medicina tradicional”), en la dinámica del personal y las instituciones hospitalarias de la tradición occidental (la llamada medicina oficial, alópata o biomedicina) o en la complejidad de las complementaciones, conflictos e itinerarios terapéuticos que se establecen entre ambos sistemas médicos. Sin embargo, la medicina doméstica —denominada “atención doméstica” (Kleinman, 1980: 50-59), “modelo de autoa-tención” (Menéndez, 1990), etcétera— suele ser al mismo tiempo destacada como un tercer e importante modelo de respuesta ante la enfermedad que implica a la vez formas específicas de clasificación de las dolencias, diagnóstico y tratamiento. En palabras de Lluís Mallart:
Una rápida ojeada a la literatura mesoamericanista revela que, con puntuales excepciones —algunos estudios etnográficos que se detienen en las prácticas médicas de las madres y padres de familia u otros parientes en comunidades rurales o urbanizadas—, lo cierto es que la medicina familiar raramente es objeto de trabajos monográficos que la presenten en su contexto sociocultural. El panorama plantea una térra incógnita y, al mismo tiempo, un terreno fértil por explorar. Como han señalado Zoila et al:.

El contexto etnográfico
Numerosos serranos trabajan diariamente en las ciudades de México y Texcoco como albañiles, policías, músicos y limpiadoras domésticas en estrecho contacto con las dinámicas de la vida urbana. La pérdida de la vestimenta indígena, debida al contacto, dio paso a un atuendo similar al citadino. A su vez, el proceso de escolarización y la implantación de los programas de educación oficial en 1940-50 promovieron la desaparición de la lengua náhuatl. Hoy los serranos mayores de 40 años de Amanalco, Tecuanculco y Santa Catarina hablan o entienden el náhuatl, pero los niños son monolingües de español, al igual que la totalidad de los habitantes de Totolapan e Ixayoc. Según el censo de INEGI correspondiente al año 2000, de los 15 976 pobladores serranos sólo 1 905, cerca del 10%, hablaban náhuatl. Sin duda, la lengua está en recesión. El proceso de modernización que implicó la llegada de valores, conceptos y prácticas procedentes del exterior se intensificó con la apertura de carreteras que conectaban las poblaciones con las ciudades de México y Texcoco, le siguió el aumento del transporte; en 1960 aparecieron los aparatos de radio, de 1960 a gastrin 1970 fue instalado el tendido eléctrico y llegaron enseres domésticos, como planchas y licuadoras, acto seguido los serranos adquirieron televisores y hoy existen cibercafés adonde acuden los jóvenes a frecuentar redes sociales, jugar videojuegos, hacer las tareas y enviar correos electrónicos.

La llegada de la atención sanitaria y su relación con la medicina indígena
Cabría decir que la biomedicina llegó a la sierra de la mano de la urbanización acelerada. En las localidades se erigieron viviendas de cemento y ladrillo que sustituyeron a las de adobe con techos de madera o de teja. Hacia 1950, un reducido número de vecinos se desplazaba a Texcoco, la capital municipal, para llevar a sus hijos al doctor o para comprar medicinas. En la sierra no hubo atención sanitaria sino hasta 1970, cuando se instalaron pequeños dispensarios que resultaron efímeros por el rechazo y desconfianza de los vecinos. En 1990 se establecieron los centros de salud, cuya ubicación en el centro de las poblaciones junto al edificio de la delegación, formando una especie de plaza, los hizo parte constitutiva de los nuevos patrones de urbanización. Se trata de edificios de una o dos plantas provistos de almacenes, salas de espera y consultorios para atender a la población; albergan camillas, instrumental sanitario, medicinas y aparatos de rayos X.

As the present research results on all

As the present research results on all kinds of semiconductor metal oxides have shown, ZnO may be one of the most hopeful candidates due to its mature fabrication technology, which can produce all kinds of ZnO nanostructures, such as nanowires, nanorods, nanobelts [12], nanoribbons, etc.
It is well known that the sensing performance of the gas sensors can be enhanced by adjustment of the microstructure, doping of dopant or using a small amount of noble catalyst, etc. [13–17]. Although it LY2606368 Supplier is proved that the nanocrystalline ZnO is one of the most promising metal oxides for gas sensors due to the unique conductance characteristics and large surface to volume ratio, their sensing performances can also be improved dramatically by the synergistic effects of the catalyst or dopant on the pure nanocrystalline ZnO.
Even though many ZnO-based gas sensing elements with high specific surface areas have been investigated and reported [18], and some of their grain sizes are as low as a few tens of nanometers, their gas sensitivities deriving from these ZnO nanomaterials have not been greatly enhanced as yet. The reasons for this phenomenon have not been discussed systematically up to now.
The sol–gel process is defined generally as: the process that involves the transition of a system from a liquid “sol” (mostly colloidal) into a solid “gel” phase [19]. Hydrolysis, condensation and drying are tree key steps in determining the properties of the final product in sol–gel processing. Sol–gel processes have several advantages over other techniques for synthesizing nanopowders of metal oxides. These include the production of ultrafine porous powders and homogeneity of the product as a result of homogenous mixing of the starting materials on the molecular level. Also, sol–gel processing holds strong promise for employment industrially on large scales [20]. In this work we have chosen the sol–gel technique for the previous advantages.

Materials and methods

Results and discussion

Conclusions
The main objective of presence work was attaining ZnO gas sensor devices with high sensitivity for gas detection via double and quadrature gas sensor array. Undoped and Al-doped ZnO nanopowders with were synthesized using the sol–gel method. Structural investigations, performed by X-ray diffraction technique indicate that, studied samples are polycrystalline hexagonal wurtzite structure. Surface morphology for Undoped and Al-doped ZnO nanopowders were analyzed by scanning electron microscopy. Chemical composition of Al-doped ZnO nanopowders was performed using energy dispersive X-ray (EDS) analysis for different doping ratios. Three kinds of gases were analyzed via both double and quadrature gas sensor devices using homemade gas chamber. For oxygen gas, the best doping ratio that has a maximum oxygen sensitivity was recorded at Zn:Al=99:1, which provided maximum sensitivity 90%. The fabricated gas sensor devices attain low carbon dioxide gas response, where the maximum CO2 sensitivity recorded for the Al doped ZnO gas sensors with dopant ratio for ZnO:Al of 95:5 that equal 94%. The highest sensitivity values for both double and quadrature gas sensor devices established for H2 gas. The maximum sensitivity is given at Zn:Al=95:5 weight ratio, that get to 98%.

Conflict of interest