Ganetespib Supplier Are researchers limiting themselves in advance by not

Are researchers limiting themselves in advance by not including CSF measures in study protocols, afraid of long delays in Institutional Review Board procedures or negative responses from families? Taking the extremely high risk for AD into account, the authors are convinced that people with DS should get the same opportunities and high-quality research as patients with AD in the general population. Rather than deciding for DS individuals and their caregivers and relatives beforehand, researchers and clinicians could apply a “you never know, until you ask” approach. In our experience, caregivers and relatives are very open to scientific research and willing to consider participation requests as long as the information is crystal clear and the procedure is adapted to people with DS with staff that is familiar with DS-specific circumstances. Indeed, the CSF studies described previously (listed in Table 1) and three other studies measuring concentrations of monoamine neurotransmitters and metabolites [50,51], and proteins [52], demonstrate that lumbar punctures in DS are within the bounds of possibility. The CSF production rate and the caudorostral gradients of total CSF protein have been reported normal in DS compared with age-matched non-DS healthy control subjects [53], thus not constituting any medical barrier herein. Importantly, within the DABNI study—currently the only DS cohort study in Europe to offer CSF sampling on a large scale—more than 20% of DS individuals and their Ganetespib Supplier consented to a lumbar puncture [41,54], which is a substantial proportion given the aforementioned ethical considerations. To the best of our knowledge, no studies so far have further assessed the reasons to refuse a lumbar puncture in DS. In our clinical experience, however, these reasons do not differ from the general population (i.e., protection of the individual, fear of adverse effects and pain, and a lack of interest in the etiologic diagnosis), although informed consent by proxy is a complicating factor. Evidently, not all eligible individuals will participate in such studies, but in multicenter approach sufficiently large numbers are feasible.

Future avenues
CSF biomarker studies in DS are still in its infancy, but the results on the feasibility, safety, and acceptance of lumbar punctures are promising. Accordingly, which approach should be considered to move the field further? First, most studies in general population have been performed within the setting of specialized memory clinics in which patient care and research converge, whereas only a very few clinics have specialized in DS. Reinforcing this infrastructure for DS by fostering collaboration between memory clinics and intellectual disability experts is warranted, for example, the DABNI study has proven the success of such a partnership [41]. Nevertheless, not all individuals will undergo a lumbar puncture, pointing at the need for a multicenter approach to achieve sufficiently large and relevant sample sizes. Together with the key DS clinical research centers in Europe we are working on harmonizing clinical protocols and have initiated the first steps toward an European collaborative biobanking initiative for DS, resembling the concept of the renowned Dutch Parelsnoer Institute for Neurodegenerative Diseases—a prospective, standardized, multicenter cohort study strongly focusing on biomarkers for early and differential diagnosis of dementia and disease monitoring in the general population [55].
Consequently, this would allow to determine the diagnostic value of the CSF AD profile (low Aβ42, high t-tau, and high p-tau) and investigate alternative CSF biomarkers for AD in DS. Candidate biomarkers have been primarily identified in blood so far, such as the major (nor)adrenergic metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG). Compared with DS individuals without dementia, MHPG levels in serum were found to be significantly lower in demented persons with DS (P < .0001) but also in the nondemented individuals who converted to dementia during clinical follow-up (P < .0001), pointing at the predictive potential of MHPG [56]. Measuring MHPG in CSF would be the logical next step, particularly after the combination of CSF MHPG with CSF Aβ42, t-tau, and p-tau was found to improve the discrimination of AD versus dementia with Lewy bodies in the general population [57]. Next to amyloid and tau pathology, AD in DS is characterized by neuroinflammation [58]. Portelius et al. [32] measured the microglial activation marker YKL-40 and showed that DS subjects aged >40 years (n = 6) had significantly higher levels of YKL-40 in CSF compared with their younger counterparts (<40 years, n = 6). Whether YKL-40 or other inflammatory markers would serve useful as biomarker remains to be elucidated. Plasma/serum studies determining different proinflammatory factors in DS have not been decisive yet [59,60]. Finally, chromosome 21-encoded proteins that relate to AD pathology—summarized in Wiseman et al. [3]—should be studied more extensively in the context of biomarker identification, such as the DYRK1A kinase [61,62] and the synapse-associated protein synaptojanin-1 [63].

Recently it was revealed that several

Recently, it was revealed that several mediators and receptors, including PAR-2, TLR4 and RAGE, are involved in the initiation and development of innate immune responses against environmental allergens. The protease activity of SCR 7 and PAR-2 signaling stimulate TSLP and IL-25 secretion in epithelial cells. In addition, we revealed that other innate immune-stimulatory molecules, such as TLR4 and RAGE, were also involved in the Alternaria-induced TSLP and IL-25 production. TLRs, such as TLR2 and TLR4, play important roles in both innate and adaptive immunity to fungi. Interestingly, a non-enzymatic mite allergen, Der p 2, likely stimulates an innate immune response through TLR4 by molecular mimicry of a lipid-recognition protein, MD-2. Inhalation of a TLR4 antagonist targeting exposed epithelial cells suppressed the salient features of asthma, including bronchial hyperreactivity. In NHBE cells, HMGB1 bound to TLR4 and RAGE, and also induced the expression and secretion of TSLP via RAGE by activating p38 MAPK and ERK1/2. Another investigator also reported that protease allergens, such as papain, induce the expression of IL-25 and TSLP via the MAPK pathway in primary lung epithelial cells of mice. As such, several receptors, including PARs, TLRs and RAGE, may be involved in both the recognition and initiation of immune responses to environmental allergens. Interestingly, analyses of PAR-2 and TLR4 signal transduction suggest that these receptors may physically interact and cooperate to produce inflammatory responses. Taken together, these findings suggest that innate immune receptors, such as PARs, TLRs and RAGE, cooperate and regulate allergen-induced responses in airway epithelial cells.
A high concentration of calprotectin over 0.1 μM (>3.6 μg/ml) has been shown to promote the expression of pro-inflammatory mediators, including IL-6, IL-8 and TNFα, in human keratinocytes. High extracellular concentrations of calprotectin are found in the serum and at inflammatory sites of patients with autoimmune disease, such as arthritis, systemic lupus erythematosus and Crohn\’s disease. In this study, high concentrations of calprotectin (>10 μg/ml) alone induced IL-8 production, not IL-25 and TSLP production. However, the calprotectin by adding ATP induced TSLP and IL-25 production. These results indicated that the combination of ATP and calprotectin is involved in Th2-type airway inflammatory responses. Further studies will be needed to thoroughly understand the physiological relevance of ATP and calprotectin.
A previous report also showed that the calprotectin level was lower in the epithelium of polyp tissues and the nasal lavage fluid of chronic rhinosinusitis with nasal polyp patients when compared to healthy controls. However, the calprotectin concentration was significantly increased in polyp tissues. They discussed the diminished calprotectin in nasal epithelial cells induces a lack of innate host defense as an antimicrobial or antifungal effect in patients of CRS. Similarly, in the present study, the calprotectin level was significantly decreased in the unstimulated epithelial cells of the nasal polyps from ECRS patients. However, allergen-induced calprotectin production was significantly increased in the PNE cells from ECRS patients when compared to those from NECRS patients or the control subjects. Previous studies suggested that soluble gp130 (sgp130), a natural inhibitor of IL-6 transsignaling, is increase in polyp tissues from CRS with NPs (CRSwNP) patients. Sgp130 Levels in polyp tissues from CRSwNP patients were positively correlated with aging. In addition, calprotectin levels in nasal lavage fluids were negatively correlated with aging. Because IL-6 trans-signaling is one of calprotectin production pathway, the increased sgp130 may decrease calprotectin expression in the epithelial cells via inhibition IL-6 trans-signaling. In contrast, increased production of calprotectin against the protease activity of allergens in the NPs of ECRS may be derived to the dysfunction of mucosal barrier or the decreased antimicrobial responses, but not to IL-6 trans-signaling. Further studies are needed to investigate the factors regulating calprotectin.

Our results showed that there was

Our results showed that there was no correlation between serum testosterone level and quadriceps muscle force or with exercise capacity (6-min walk distance) in patients with COPD. These results are similar to previous studies. For instance, Debigare and associates (3) reported that the prevalence of hypogonadism among men with COPD is equivalent among patients with and without muscle wasting. Similarly, Laghi et al. found that quadriceps strength (and endurance) were similar in hypogonadal and eugonadal men with COPD. In their study, Van Vliet et al. found a significant correlation between testosterone concentrations and quadriceps strength. This finding added more confusion to the available conflicting results. The explanation of these contradictory results regarding the effect of hypodonadism on muscle weakness is not clear; moreover the studies who found a correlation between the testosterone level and the degree of muscle weakness did not show a high statistical significance that could be of clinical importance.
Inflammatory markers levels including hs-CRP and IL-6 were significantly higher in COPD patients compared to control group (p<0.001). Numerous studies performed in recent years provide overwhelming evidence of COPD as a condition characterized by an abnormal inflammatory response beyond the lungs with evidence of low-grade systemic inflammation. Raised levels of acute phase proteins like CRP, fibrinogen and pro-inflammatory cytokines such as IL-6 were found in circulation of stable COPD patients and have been shown to be associated with impaired functional capacity, reduced daily physical activity and decreased health status. In our study we found a significant correlation between the inflammatory markers (hs-CRP and IL6) and the severity of airflow obstruction (p=0.037 and 0.002 respectively). It is well established now that systemic TASIN-1 is present in stable COPD patients and that its intensity is related to the severity of the underlying disease. Moreover, we found that CRP was inversely correlated with the quadriceps strength as measured by the one repetition maximum as well as the exercise capacity as measured by the 6min walk distance P=0.021 and p=0.036) respectively, also we found that IL6 was inversely correlated to quadriceps strength (P=0.008). Our results indicate that systemic inflammation in COPD predisposes to skeletal muscle weakness and exercise intolerance in stable COPD patients. In consistence with our results, Yende et al. in their study on 2273 elderly individuals, where the pulmonary function testing revealed that 12% of them had COPD, found that the degree of airflow obstruction, as measured by the FEV1, was significantly associated with the degree of muscle weakness. They also found that systemic inflammation as measured by the level of IL-6, was more in patients with COPD and was related to airflow obstruction, muscle weakness and exercise intolerance.
Also Broekhuizen et al. studied 102 patients with severe to very severe COPD, nearly 33% of which were on systemic corticosteroids, who were admitted to an inpatient pulmonary rehabilitation center. They found that reduced FEV1 was correlated with increased plasma levels of CRP and IL-6, confirming that the severity of airflow limitation is associated with systemic inflammation. Their results are in concordance with previous results showing that raised CRP levels were associated with diminished muscle strength, reduced exercise endurance, workload, 6min walk distance, and poor health status and quality of life.
Systemic inflammation has been suggested as a possible cause of hypoandrogenemia in male patients with COPD. However, until now, only a weak significant inverse relationship between the circulating levels of IL-6 and bioavailable testosterone has been found in COPD male patients (r=0.33). In the present study we found no significant correlation between the low testosterone and markers of systemic inflammation (hs-CRP and IL-6). Our results are similar to Karadag et al. who studied 103 COPD patients for sex hormone alterations along with inflammatory markers (TNF-α and IL-6). The study group comprised stable COPD patients and patients undergoing a COPD exacerbation. Although sex hormones were lower and circulating IL-6 and TNF-α concentrations were higher in both stable and exacerbation phase COPD groups than controls, there was no correlation between sex hormones and TNF-α or IL-6. Hence, there is no current evidence to support inflammation as a contributor to testosterone deficiency in COPD.

br Results and discussion br

Results and discussion


The electric power grid is the largest man-made machine in the world. It consists of synchronous generators, transformers, transmission lines, switches and relays, active/reactive components, and loads. Power system networks are complex systems that are nonlinear, non-stationary, and prone to disturbances and faults. Reinforcement of a power system can be accomplished by improving the voltage profile, increasing the transmission capacity and others. Nevertheless, some of these solutions may require considerable investment that could be difficult to recover. FACTS devices are an alternate solution to address some of those problems [1,2].
Over the last two decades, many researchers performed a lot of researches on ORPD. Various optimization techniques are evolved to solve ORPD problem. These algorithms are generally divided into two categories, namely, classical mathematical optimization algorithms and intelligent optimization algorithms. The classical algorithms are starting from an initial point, continuously improve the current solution through a certain orbit, and ultimately converging to the optimal solution. These algorithms include linear programming (LP) [3] quadratic programming (QP) [4], non-linear programming (NLP) [5] and mixed integer linear programming (MILP) [6], and benders decomposition [7]. Though, some of these techniques, have a good convergence but most of them suffer from local optimality. Since ORPD is multimodal and non-linear optimization problem and severely depends on the initial guess, the classical techniques are unable to produce global optimal solution. To overcome this buy Tunicamycin deficiency, various intelligent optimization algorithms known as heuristic techniques are applied to solve buy Tunicamycin ORPD problem. Some of the well popular optimization techniques are evolutionary programming (EP) [8], genetic algorithm (GA) [9,10], simulated annealing (SA) [11,12], tabu search (TS) [13,14], differential evolution (DE) [15,16], particle swarm optimization (PSO) [17,18] and artificial bee colony (ABC) [19], etc. Recently, a harmony search algorithm (HSA) was developed by Sirjani et al. [20] for simultaneous minimization of total cost, the voltage stability index, voltage profile and power loss of IEEE 57-bus test system using shunt capacitors, SVC and static synchronous compensators (STATCOM). Saravanan et al. presented PSO [21] to find optimal settings and location TCSC, SVC and UPFC devices for improving system load ability with minimum cost of installation.
The remaining sections of this paper are organized as follows: Section 2 describes the problem formulation of ORPD problem. Section 3 briefly describes the CRO technique and the different steps of the proposed CRO approach. Section 4 discusses the computational procedure and analyzes the DE, PSO and CRO results when applied to case studies of FACTS based ORPD problem. Lastly, Section 5 outlines the conclusions.

Mathematical problem formulation

Chemical reaction optimization
During the CRO [24–26] process, the following four types of elementary reactions are likely to happen. These are on-wall ineffective collision, decomposition, inter-molecular ineffective collision and synthesis. These reactions can be categorized into single molecular reactions and multiple molecular reactions. The on-wall ineffective collision and decomposition reactions are single molecular reactions, while the inter-molecular ineffective collision and synthesis reactions are of the latter category.
In this reaction process each molecule hits the wall of the container and generates a new molecule whose molecular structure is closed to the original one. Since, the On-wall ineffective collision is not so severe, the resultant molecular structure is not too different from the original one. A molecule ‘’ collides into the wall is allowed to change to another molecule ‘’, if the constraint described below is satisfied.

br Materials and methods br Results br Discussion The present

Materials and methods


The present study revealed significant variations in the size of different bones among the three different passerine ginsenoside rg3 which corresponded to their modes of lives. Some bones were significantly larger in size in the migratory bird when compared to the resident species while others were larger in the resident birds. A comparative study on the length of skulls of the migratory and resident avian species indicated that there was a significant difference between the migratory bunting and resident tree sparrow and also between males of the resident house sparrow and tree sparrow (Fig. 2 and Table 5). Although variations in skull indices were found to be insignificant, they were more in resident birds when compared to those in migratory bunting (Fig. 5A). Further, the cranial indices were more in the resident birds than in the migratory bunting (Fig. 5B). This small increase in the skull and cranial indices in the resident birds may be sufficient to increase brain size which provides enough intelligence to adapt better and compete with the other local resident birds. Somewhat early, Winkler et al. (2004), Sol et al. (2005) reported that the migratory avian species have relatively small brain size compared to nonmigratory species. Otherwise, brain size is a good indicator of behavioural flexibility, and the birds with relatively large brains are more behaviourally flexible and more capable of especially foraging innovations compared to species with smaller brains (Lefebre et al., 1997, 2004; Sol et al., 2005). Further, the wider skull provides a sufficient area for attachment of adductor muscles, which help in feeding and in tight gripping of their food materials (Kushwaha, 2011). In our study, bill length in the house sparrow was much longer when compared to that of bunting suggesting that the bill length of seed eating birds with slightly higher cranial indices is moderately long. However, the beak length of bunting was longer than in the tree sparrow. There was a significant correlation between the increase in beak width and the increase in the skull (r=0.2766) and cranial indices (r=0.2610). According to Bock (1966), these small differences in the beak size reflect the minor adaptive divergences in the closely related forms and this difference may generally be related to a difference in food preference. The increased beak width in the resident birds might help them in enjoying the varieties of foods found nearby, ranging from farm grain to the kitchen scribes which are available throughout the year. Further, it also saves the energy that is to be spent in searching for food. On the other hand, migratory birds are very specific in their diets which are important for some energy ginsenoside rg3 demanding events such as migration, egg laying, living in the cold etc. (McWilliams et al., 2004). As they migrate to a place having abundant food, less competition for nesting space, milder climate, or longer daylight hours (Shackelford et al., 2005), not much modification is needed in their beak size for other supplementary food items.
The sternum height was more in migratory bunting when compared with resident tree sparrow or house sparrow with minimum in the tree sparrow. The reverse was true for the sternum width. The sternum length is much more in the bunting. The higher sterna crest in the migratory birds provides enough space for the strong flight muscles to insert in sternal crest (Baumel and Witmer, 1993; Poore et al., 1997; Dursun et al., 2002). The height of sternal crest is related with the flight capability and is higher in the strong flying birds (Duzler et al., 2006) while it is very low or even lacking in the nonflying birds (Doguer and Erencin, 1964; Gultekin, 1974; King and McLelland, 1975, 1985). Further, the width of the sternum was found to be greater than its height in the swimming birds examined while these values were approximately equal in flying birds (Duzler et al., 2006). The sternum indices were least in the bunting, maximum in the tree sparrow and intermediate in house sparrow. Duzler et al. (2006) studied three groups of birds (flying, walking and swimming) and observed that the structure of the sternum differs according to their movement and particularly flight capability as well as species and habitat. Further, the sternum indices of the flying birds were lesser than those of the birds of walking or swimming type. Thus, the lesser sternum indices of bunting are due to longer sternum height and lesser sternum width. It also has a longer sternum length which gives more surface area for the flight muscles and fat bodies to attach and at the same time maintain the flight endurance for longer migratory flights. Since fat serves the purpose of stored food and fuel during migratory flights, its deposition in the non-migratory resident bird that has easy access to food in the surrounding, would hamper its flight activity (Dixit and Singh, 2012) and therefore their sternum does not require the above modifications.

Invasiv http www apexbt com media

Invasive candidiasis remains a challenging complication, which frequently occurs in patients with one or more underlying diseases or surgical interventions. In recent point prevalence studies, a candidaemia incidence of 6.9 per 1000 ICU patients was reported, and 7.5% of ICU patients received antifungal therapy (Kett et al., 2011; Azoulay et al., 2012). Candidaemia increases mortality rates in the range of 20–49% (Gudlaugsson et al., 2003; Arendrup et al., 2011), but still there are many open management questions. Pulmonary candida infections may present as the manifestations of disseminated candidiasis spread by hematogenous route or as a primary bronchial or pulmonary process from the airways (Odds, 1988).
Highly reactive oxygen metabolites are one of the primary effector mechanisms used by the host immune system to control or clear microbial infections (Youseff et al., 2012). Reactive oxygen species (ROS) are essential components of the defensive mechanism against fungus infection (Ibrahim-Granet et al., 2003; Philippe et al., 2003). Initial host defenses against fungal invaders rely on the responses of innate immune cells, particularly macrophages, neutrophils and other phagocytic cells. These phagocytes generate potent reactive oxygen and nitrogen species (ROS and RNS), which are toxic to most fungal pathogens, causing damage to DNA, proteins and lipids (Bogdan et al., 2000; Youseff et al., 2012). To protect against damage, order tropisetron contain a number of defense mechanisms including endogenous well-characterized antioxidant enzymes, such as catalase, superoxide dismutase, nitric oxide and low molecular weight antioxidant, such as glutathione (GSH) (Mates et al., 1999). Indeed, ROS induce programmed cell death in C. albicans (Phillips et al., 2003).
Amphotericin B (AMB) is a polyene antifungal antibiotic by-product of the actinomycete bacterium Streptomyces nodosus. In spite of AMB’s proven track record in the management of serious systemic fungal infections, its well-known side effects and toxicity will sometimes require discontinuation of therapy despite a life-threatening systemic fungal infection. The principal acute toxicity of AMB is nephrotoxicity (Geo vigila and Baskaran, 2011). Clinical manifestations of AMB nephrotoxicity include renal insufficient hypokalemia, hypomagnesaemia, metabolic academia, and polyuria due to nephrogenic diabetes insipidus (Laniado-Laborín and Cabrales-Vargas, 2009). There have been an increasing number of reports of clinically significant amphotericin B (AMB) resistance in fungal pathogens, including C. albicans (Sterling and Merz, 1998). Since many of the currently available drugs have undesirable side effects and are ineffective against C. albicans infection, there is now a greater interest in the next generation of antifungal agents. Many people worldwide, including those in developed countries, turn to complementary or alternative medicine. Products from freshwater and marine sources have recently become attractive as nutraceutical and functional foods and as a source material for the development of drugs (Koyama et al., 2006).
Chitosan is a linear polysaccharide composed of randomly distributed β-(1–4) linked d-glucosamine (deacetylated unit) and N-acetyl-d-glucosamine (acetylated unit). It is made by deacetylation of chitin, the primary polysaccharide component of crustacean shells with the alkali sodium hydroxide (Shahidi and Synowiecki, 1991). Chitosan can be used to produce value-added products because it is rich in protein, carotenoids and chitin (Lertsutthiwong et al., 2002). This polysaccharide was found to be non-toxic, biocompatible and biodegradable (Arvanitoyannis et al., 1998). Chitosan has several applications being employed either alone or in blends with other natural polymers (starch, gelatin and alginates) in the food and pharmaceutical industries mainly due to its high biodegradability and antimicrobial properties (Hague et al., 2005). Microbiological activity of chitosan has been detected for many bacteria, filamentous fungi and yeasts (Hirano and Nagao, 1989). Data in the literature have the tendency to characterize chitosan as bacteriostatic rather than bactericidal (Coma et al., 2002), although the exact mechanism is not fully understood and several other factors may contribute to the antibacterial action (Raafat et al., 2008). Three models have been proposed, the most acceptable being the interaction between positively charged chitin/chitosan molecules and negatively charged microbial cell membranes. In this model the interaction is mediated by the electrostatic forces between the protonated NH+3 groups and the negative residues (Tsai and Su, 1999), presumably by competing with Ca+2 for electronegative sites on the membrane surface (Young and Kauss, 1983). Since such mechanism is based on electrostatic interaction, it suggests that the greater the number of cationized amines, the higher will be the antimicrobial activity (Yalpani et al., 2002; Másson et al., 2008). This suggests that chitosan has higher activity than that found for chitin and this has been confirmed experimentally (Tsai and Su, 1999; Másson et al., 2008).

In compliance with the Government of India guidelines and with

In compliance with the Government of India guidelines and with technical and financial support from the Government of India, the state of Odisha implemented AYUSH in both Primary Health and Community Health Centers (PHCs and CHCs). Many strategies were adopted by the state government to improve delivery of AYUSH services in rural areas. The state government also took steps to facilitate and improve the quality of laboratories, drug standardization procedures, research, and advocacy [9]. So far, it has successfully collocated 796 Homeopathy and 680 Ayurveda clinics in the PHCs and CHCs. Seventy-eight of these dispensaries are in Balasore district and have been commissioned in 2005 with an initial grant of INR 4,978,000 for improvement of rural health, particularly maternal health [10].
The improved focus on AYUSH by the state government is especially important in the context of prevailing poor health indicators in the state which has prompted the planning commission to consider it as one of the Empowered Action Group states. One-quarter of the population of Odisha consists of tribal community, who has historical inclination toward AYUSH system of medicine. In addition, it is one among the eighteen high focus states for program implementation of the government\’s NRHM, especially maternal health. The state has a high maternal mortality ratio (MMR) that hinders the realization of millennium development goal of reducing MMR to 119 by the end of the 11th plan daidzin (2007–2012). Following the central government guidelines, the Odisha government has therefore made an attempt to provide an integrative treatment plan having plural medical choices for women [10]. Initially, it established one of the three systems of AYUSH medicine – Homeopathy, Ayurveda, and Unani in the CHCs, which are used as referral centers to the PHCs. Later, every PHC was equipped with at least one of the AYUSH systems of medicine. This provided a greater coverage and option of AYUSH services for the community. The collocation of AYUSH unit was driven by medical plurality and revitalization of traditional therapies. In rural and tribal communities, the women found an opportunity to come across AYUSH system in a government facility which is very similar to local health traditions (LHT) and home remedies provided by local healers, hakims, and private practitioners. Unless emergency conditions arise, the tribal women were in the habit of using LHT and home remedy rather than biomedicines. This helps them to figure out AYUSH system of medicine perceiving less adverse effect with better accessibility. Existing health workers such as the Accredited Social Health Activists (ASHAs), Auxiliary Nurses and Midwifes (ANMs), and Anganwadi Workers were thought to further improve the potential of AYUSH medicine.
Some districts in the state of Odisha such as Balasore have done fairly well in the Maternal Health Program. Unfortunately within these high performing districts, there are vulnerable tribal blocks which pose special challenges [11]. Jaleswar block is one such area in Balasore district of Odisha with a very high concentration of poor tribal population. Indigenous tribes – the Santhal, Bhumija, Kolha, and Bhuiju reside here. The block is one among the 46 Modified Area Development Approach pockets of Odisha where specialized development programs for tribal improvement are monitored by the Ministry of Tribal affairs [12]. The situation is also made difficult by the marked inaccessibility of this region due to its riverine geographical structure, and frequent floods interrupt the referral network to deliver optimal maternal care. Many of the health centers of Jaleswar were declared as “difficult” by the National Health Systems Resources Centre for such reasons [13]. Further, the tribal communities have marked dependence on ethnomedicine in comparison to modern biomedicine, making it difficult for the government to promote Western methods of maternal care.
The situation of maternal health in Jaleswar is abysmal. An analysis of HMIS data for the year 2014 shows that only 46.4% of the pregnant women were registered in the first trimester among the total ANC registrations. Whereas, early registration for pregnancy not only reflects good health seeking behavior but also facilitates better birth preparedness and detection of obstetric complications. One-fifth (21.4%) of the registered women do not receive iron and folic acid tablets to combat pregnancy-related anemia. According to the health administrators of Jaleswar, nearly 50% of the pregnant women in the block suffer from anemia. Among them, 10% have severe anemia and need an iron-sucrose intravenous transfusion. HMIS data also showed home deliveries are prevalent in the block unattended by skilled birth attendants, which make the women vulnerable to various infections, leading to high mortality and morbidity. Nearly 70% of the women are discharged from the hospital within 48 h of delivery due to the lack of hospital beds and necessary amenities, whereas, normative guidelines prescribe 48 h hospitalization, post-delivery, for postnatal care [14]. The locale of the study is shown in Fig. 1.

br Experimental All the chemicals

All the chemicals used in this hoechst 33342 cost work were of analytical reagent grade. Metal salts used in this study are copper chloride dihydrate CuCl2.2H2O from Fluka, nickel chloride hexahydrate NiCl2.6H2O from BDH and cobalt chloride hexahydrate CoCl2.6H2O from Fluka. The metal analysis was performed by a Perkin Elmer 5000 Atomic Absorption Spectrophotometer. Elemental Analysis (C.H.N.S) of compounds was carried out with EM-034.mth. The electronic spectra were recorded on a Shimadzu (UV–vis 1600A) Ultra Violate Spectrophotometer using quartz cell at a wave length range of 200–1100nm. FTIR spectra were recorded on a Shimadzu 8400 Fourier Transform Spectrophotometer by using CsI disk in the wave number range of 4000–200cm−1. Thermal analysis TGA was performed with 4000 Perkin–Elmer. Magnetic susceptibility measurements were determined using Magnetic Susceptibility Balance of Johnson matting catalytic system division, England at room temperature. The molar conductance was measured in DMSO as a solvent at room temperature using Coring Conductivity Meter 220. Melting point apparatus of Gallencamp M.F.B-600.01 was used.

Results and discussions


Zeolites are crystalline, microporous, hydrated aluminosilicates of alkaline or alkaline earth metals. The frameworks are composed of [SiO4]4− and [AlO4]5− tetrahedra, which corner-share to form different open structures. Negative charge of lattice is compensated by the positive charge of cations located at specific positions of zeolite framework (Bekkum et al., 1991; Breck, 1974). In most of zeolites the compensating cations are usually mono- and bi-valent metal ions and/or their combinations (Engelhardt and Michel, 1987; Takaishi et al., 1995; Earl and Deem, 2006). In accordance with the Loewenstein’s rule (Loewenstein, 1954), Al–O–Al bonds do not exist in aluminosilicate frameworks of zeolite. Instead of the tetrahedrally bonded atoms Si and Al, so-called “T-atoms”, others such as P, Ga, Ge, B, Be, etc. can exist in the framework as well (McCusker and Baerlocher, 2001; Takaishi et al., 1995).
At present, synthetic zeolites are used commercially more often than natural zeolites due to the purity of crystalline products and the uniformity of particle sizes (Breck, 1974; Szoztak, 1998). However, the preparation of synthetic zeolites from chemical sources of silica and alumina is expensive. Such costs may be reduced by the use of clay minerals, volcanic glasses (perlite and pumice), rice husks, diatoms, fly ash or paper sludge ash as starting materials (Adamczyk and Bialecka, 2005; Querol et al., 1997; Saija et al., 1983; Tanaka et al., 2004; Walek et al., 2008; Wang et al., 2008). Zeolite has also been developed by the transformation of one zeolite type into other zeotypes (Rios et al., 2007; Sandoval et al., 2009).
Previous work has shown that kaolin is not stable under highly alkaline conditions and different zeolitic materials can form, and that kaolin is usually used after calcinations to obtain a more reactive phase (metakaolin). After dehydration (endothermic dehydroxylation), kaolin is transformed into amorphous metakaolin (Fialips, 1999; Gougazeh and Buhl, 2010; Smykatz-Kloss, 1975). Raw kaolin and metakaolin have been used as the Al and Si sources for synthesis of zeolite Linde Type A, X, Y, P, 4A, NaA, KI, cancrinite, sodalite, hydroxysodalite, faujasite, phillipsite, chabazite and several other types of zeolites (e.g., Akolekar et al., 1997; Alberti et al., 1994; Barnes et al., 1999a, 1999b, 1999c; Bauer and Berger, 1998; Bauer et al., 1998; Buhl, 1991; Buhl et al., 2000a,b; Buhl and Loens, 1996; Covarrubias et al., 2006; Dudzik and Kowalak, 1974; Gualtieri et al., 1997; Lin et al., 2004; Loiola et al., 2012; Marcelo et al., 2007; Mon et al., 2005; Rees and Chandrasekhar, 1993; Sanhueza et al., 1999; Vilma et al., 1999; Zhao et al., 2004.
NaA Zeolite is of great industrial importance due to its molecular sieving, ion exchange and water adsorption properties. With the molar ratio Si/Al nearly equal to one, kaolin is an ideal raw material for preparing NaA zeolite. Kaolin was one of the most versatile industrial minerals and was used extensively for many applications (Murray, 1991). The synthesis of NaA zeolite from kaolin source was started from the 1970s (Breck, 1974; Barrer, 1978) by the hydrothermal reaction of dehydroxylated kaolin with sodium hydroxide solution.

To overcome the problem of finding a

To overcome the problem of finding a mathematical representation for the path described in Figure 1, one axis k (with 0amyloid system, the path of interest is referred in the xy-plane. The geometric projection of the coordinates Xi and Yi for i= 1,2,…,L+1 together with their respective k-th value (for k=(i−1)) are sketched as two univalued PWL curves with the function descriptions x(k) and y(k), respectively. This procedure is depicted in Figure 2.
Note that both paths (kx and ky) are constructed by independently collecting the abscissas (Xi for i=0,1,…,L+1) and ordinates (Yi for i=0,1,…,L+1) belonging to the breakpoint coordinates presented in the xy-path. It is also worth mentioning that this collection is carried out by following the order of appearance of each breakpoint along the xy-path, with the respective Xi and Yi coupled with an iterative k value (k=0,1,…,L) in a (k,Xi) and (k,Yi) ordering pair. This means that in the kx-plane, the set of coordinate points given by (0,X1),(0,X2),…,(0,X) is taken into account while in the ky-plane the set formed by (0,Y1),(0,Y2),…,(0,Y) is considered. It is important to note that due to the k parameter always goes from 0 to L, its inclusion always yields univalued piecewise linear paths (in the kx plane as well as in the ky plane), thus ensuring explicit piecewise linear function descriptions for x(k) and y(k). Taking Equation 1 as a reference, both functions can be associated together and expressed in parametric form as follows:for i=1,2,…,L−1, where the parameters (a,a,b,b,c and c) can be computed using Equations 2, 3, and 4.

In order to illustrate the application of the proposed fitting technique, consider the octagon described by the path depicted in Figure 3. Importantly, this path is a closed curve which implies a multivalued correspondence between the position variables x and y.
First, the breakpoint coordinates (x,y) are collected in Table 3. Note that a third row for the k parameter has been included.
Then, the two PWL paths (in the ky-plane and the kx-plane) are sketched as shown in Figure 4 and Figure 5.
After that, the PWL parameters are computed using Equations 2, 3, and 4 as follows:for function x(k) we obtain:
After substituting the computed parameters into the canonical PWL formulation of Chua-Kang from Equation 1, the following equation is obtained:
Using the procedure described above, the PWL parameters of the function y(k) are determined as follows:and the function y(k) is expressed as
Finally, Equations 6 and 7 can be rearranged in the form of Equation 5 as follows:



Two difficulties arise in the problem of single maneuvering target tracking in clutter: target (dynamic or/and measurement) model uncertainty and measurement origin uncertainty. Algorithms dealing with these two problems individually abound in previous studies [1–6].
First, target maneuvers incur target dynamic model uncertainty in tracking. The multiple model (MM) algorithms [6–9] were proposed and have been gaining prevalence to address this problem. Instead of modeling a target motion by a single dynamic model, a set of models are implemented in parallel in MM and the result is computed based on the outputs from all of these models.
Second, measurement origin uncertainty arises when false measurements (measurements not originated from a target) are received in a sensor scan. Many factors could contribute to the reception of false measurements. For example, clutter, thermal noise, electronic counter-measurements, so on and so forth. The multiple-hypothesis tracker (MHT) [4, 10–15] is a powerful tool for this problem. It branches all possible (or several most probable) association hypotheses and the tracking result is obtained based on the results of all available hypotheses.
One similarity between MM and MHT is that their optimal implementations require exponentially increasing numbers of model sequences and hypotheses respectively, which make their optimal solutions infeasible in practice. In this work, MHT and MM are combined, and the numbers of model sequences and hypotheses are reduced in a joint way based on the Gaussian mixture reduction (GMR) [16–22]. Combinations of MHT and MM, especially the interacting-multiple model (IMM), were proposed in previous studies, but, in a straightforward and somewhat crude manner. That is, the two algorithms were simply put together to tackle the two problems one at a time and each algorithm functions separately without exploring the connection to the other one and to the mutual effects on the final performance. We propose the reduction based on GMR, which provides a more solid and appealing way than existing methods to reduce jointly the numbers of model sequences and hypotheses. The density of a target state is a Gaussian mixture with each component corresponding to a model sequence and a hypothesis (under a linear Gaussian assumption). In our method, the number of Gaussian components is reduced by merging the “similar” ones, which are selected by a “distance” defined between two Gaussian components. Clearly, our method does a joint reduction instead of reducing the numbers of model sequences and hypotheses separately. Furthermore, GMR attempts to minimize the impact of merging to the original Gaussian mixture, which is theoretically more solid and better justified than conventional methods, e.g., GPBn or IMM. The superior performance of our method is demonstrated by the results of Monte Carlo simulation by comparing with the existing IMM+PDA and IMM+MHT algorithms.

In most SDH cases caused by ruptured

In most SDH cases caused by ruptured aneurysm, the clinical grades are severe. The outcome of these patients is generally poor and significantly correlated with admission grade, midline shift, and SDH volume. However, a good prognosis can be achieved if early diagnosis involves treatment with aneurysmal clipping and hematoma removal. In the case of our patient, his admission Hunt and Hess clinical grade was V, the midline shift was 2.5 cm, and the SDH was 3.0 cm in width. These findings indicated that our patient\’s prognosis would be poor. However, we want to emphasize routine evaluation of patients with SDH and no history of trauma using CT angiography in the emergency department to help identify aneurysms early, so that prompt and appropriate therapy can be given to prevent poor outcomes.

Conflicts of interest


Case Report
A previously healthy independent 91-year-old woman (who at the age of 89 had sky dived!) came to us following 2 weeks of acute confusion and falls. She had suffered a recent decline in general health with anorexia, weight loss, nausea, and constipation. She had a history of both hypertension and chronic cough. She was taking furosemide and laxatives (magnesium hydroxide and senna). On examination, she was disorientated and had left hypoglossal cranial nerve palsy. All other examination results were unremarkable (Figs. 1–3).

Sarcoidosis is a multisystem idiopathic granulomatous disease with a peak incidence among adults aged between 20 years and 40 years. The disease is, however, considered rare among elderly patients. In a retrospective study, Stadnyk et al reviewed 219 cases of biopsy-proven sarcoidosis and found that only 7.8% of the sarcoidosis patients diagnosed were over the age of 65 years. In Mitomycin C to the well-documented clinical, radiological, and histological features that are typical among patients from the peak age group, diagnosing sarcoidosis in an elderly patient remains a challenge, as our case demonstrates.
In another retrospective study of 30 cases of biopsy-proven sarcoidosis among patients over the age of 70 years, Chevalet et al described the most common feature to be an indolent decline in general health with asthenia, anorexia, and weight loss. Based on these findings, dictyosomes seems likely that the incidence of sarcoidosis among elderly individuals is underdiagnosed, underreported, and underestimated.
As with the younger age group, intrathoracic sarcoidosis is the most common form, with dyspnea and cough being relatively frequent symptoms. Unlike the younger age group, where the presence of bilateral hilar adenopathy on a chest radiograph is a salient feature, Conant et al found that the chest radiographs of elderly patients with sarcoidosis displayed atypical features (e.g., mediastinal adenopathy, unilateral hilar adenopathy, solitary or multiple pulmonary masses, and atelectasis). Our patient reported chronic cough, and unilateral mediastinal lymphadenopathy was seen on her chest CT.
Jamie et al described a similar case where an 88-year-old patient had confusion and constipation secondary to hypercalcemia that was then attributed to a new diagnosis of sarcoidosis. Although hypercalcemia is an apparently rare feature of sarcoidosis and has been reported in only 5–10% of patients, it is an important one. Refractory hypercalcemia can lead to several significant clinical problems including renal failure. Many diseases of elderly patients show a high prevalence of hypercalcemia and this makes it a poor diagnostic tool; however, our case confirms that its presence should not be ignored and that the presence of hypercalcemia must be considered in the context of sarcoidosis.

Conflicts of interest

Psoas abcess is a focus of infection and surrounding inflammatory reaction within the iliopsoas muscle, a large retroperitoneal muscle. It is a major flexor of the trunk and thus important for walking, running and sitting upright.