Incomplete Forms Research Articles

Small Steps for a Big Change: Attention towards Preanalytical Error

Aims: The study aimed to evaluate the preanalytical errors in the Indoor patient department in tertiary care Hospital. To calculate the percentage of preanalytical errors in the Indoor patient department in our Hospital and to recommend standard operative interventions to improve quality of results. To test the effectiveness of attention by continuous educational action at reducing preanalytical errors and improving patient care.
 Study Design: An observational study.
 Place and Duration of Study: The work was done from July 2014 to July 2015 at a tertiary care Hospital India.
 Methodology: We retrospectively reviewed the samples and test request forms received at Biochemistry laboratory for one month. The outcome measures were incomplete laboratory forms, mislabeling samples, inappropriate tests, wrong container, poor quality of samples and transportation problems. Two weeks of interventions in the form of continuous educational training and education regarding standard operative procedures were given to stakeholders to raise awareness towards the preanalytical phase. Two weeks later, data was monitored again for one month.
 Results: 2330 and 2130 samples and request forms were monitored before-after intervention respectively from wards for one month each. Of the total chances of preanalytical errors, 22.17% were due to inappropriate tests, 81.5% were related to incomplete patient information, 97% lacking clinical information, 18.8% errors related to specimen information, 3.5% errors were of the deranged quality of the specimen, and in4.5% transportation problems were observed. Subsequently, these were reduced to 10%, 20%, 16.4%, 7.5%, 2.3%, 3.1% respectively. A significant difference in percentage change was observed in all the above errors after the one-month interventions for the reduction in preanalytical errors.
 Conclusion: The results of the present study revealed that taking small steps in the form of implementing standard operative procedures for collection, storage and transport facilities and continuous educational training of stakeholders would reduce big errors occurring due to human factors in preanalytical phase. We need good interdepartmental communication and cooperation to achieve good laboratory results and patient well being. This study improved the quality of test results and patient care.

Obstacles to Providing Urinary Incontinence Care Among Nurses in Turkey: A Descriptive Study

This study was conducted to determine nurses' knowledge, attitudes, practices, and obstacles to managing patients' UI. A descriptive study was conducted between September 2017 and February 2018 at 2 university hospitals, 2 private hospitals, and 4 state hospitals in a metropolitan city in Turkey. All registered nurses present at the times of data collection were eligible to participate. After providing informed consent, they were asked to complete a 25-item demographic characteristic questionnaire, a 7-item UI assessment and care implementation form, a 12-item form assessing obstacles faced during UI care provision, a 24-item UI knowledge questionnaire (higher scores indicated more knowledge; a score of 70% correct was considered adequate), and the Urinary Incontinence Attitude Scale. The latter comprised 15 Likert-type questions that measures attitudes toward UI symptoms, treatment, and prevention (maximum score of 60; higher scores infer positive attitude). Data were collected and entered into a software program for statistical analysis including Mann Whitney U, chi-square, and correlation tests. Incomplete forms were excluded. Of the 475 potential participants, 254 nurses completed all forms; 228 (89.8%) were women, 177 (69.7%) had a bachelor's degree, 146 (57.5%) worked in a state hospital, and 105 (41.3%) worked for 2 to 3 years. The mean score for UI knowledge was 15.22 ± 3.43 (range 0-24), and the mean attitude score was 46.40 ± 5.50 (range 15-60). The major nurse- or hospital-related obstacles to providing UI care were a lack of systems for patient follow-up (67.7%) and lack of patient education materials (60.2%). A weak positive correlation was noted between UI knowledge level and attitude (r = 0.263; P = .000). Although nurses had a positive attitude toward UI, UI knowledge scores were low. Lack of patient follow-up systems and patient education materials were important obstacles to nurses providing UI care. In addition to addressing these obstacles, postgraduation evidence-based UI education for nurses is needed to optimize care.

Kawasaki disease in infants less than one year of age: an Italian cohort from a single center

Background and aimsFew data are currently available for Kawasaki disease (KD) below 12 months especially in Caucasians. This study aims to analyze clinical and laboratory features of KD among an Italian cohort of infants.MethodsA retrospective chart review of KD children aged less than 1 year at time of disease onset between January 2008–December 2017 was performed. Clinical data, laboratory parameters, instrumental findings, treatment and outcome were collected in a customized database.ResultsAmong 113 KD patients, 32 (28.3%) were younger than 1 year. Nineteen patients aged below 6 months, and three below 3 months. The median age was 5.7 ± 2.7 months. The mean time to diagnosis was 7 ± 3 days and was longer in the incomplete forms (8 ± 4 vs 6 ± 1 days). Conjunctival injection was present in 26 patients (81.2%); rash in 25 (78.1%); extremity changes in 18 (56.2%); mucosal changes in 13 (40.6%,) and lymphadenopathy only in 7 (21.8%). Mucosal changes were the least common features in incomplete forms (18.2%). Twenty-two patients (68.7%) had incomplete KD. Nineteen (59.4%) had cardiac involvement, of whom 13 (59.0%) had incomplete form. ESR, PCR and platelet values were higher in complete KD; especially, ESR resulted significantly higher in complete forms (80 ± 25.7 mm/h vs 50 ± 28.6 mm/h; p = 0.01). Conversely, AST level was statistically significant higher in patients with incomplete forms (95.4 ± 132.7 UI/L vs 29.8 ± 13.2 UI/L; p = 0.03). All patients received IVIG. Response was reported in 26/32 patients; 6 cases needed a second dose of IVIG and one required a dose of anakinra.ConclusionIn our cohort, incomplete disease was commonly found, resulting in delayed diagnoses and poor cardiac prognosis. Infants with incomplete KD seem to have a more severe disease and a greater predilection for coronary involvement than those with complete KD. AST was significantly higher in incomplete forms, thus AST levels might be a new finding in incomplete forms’ diagnosis. Eventually, we highlight a higher resistance to IVIG treatment. To our knowledge this is the first study involving an Italian cohort of patients with KD below 12 months.

SOCIAL JUSTICE AND ECONOMIC EFFICIENCY OF THE MODERN LABOUR MARKET

The purpose of the paper is to identify contradictions in the social and economic field in the process of achieving social justice and economic efficiency. Methodology. Methods of induction and deduction are used to determine the causal relationships; a systematic approach is applied to study research objects; abstract and logical methods of analysis, comparison and generalization allowed us to characterize the existing level of social injustice peculiar to the Ukrainian labour market. The results of the study are identified: manifestations of social injustice in Ukraine related to gender inequality in wages and different employment opportunities, income disparities in various sectors and regions, an increase in the gap between the income of rich and poor people, inconsistency between compensations for adverse working conditions and necessary expenses for labour rehabilitation, legal insecurity in informal, incomplete, and flexible forms of employment. Conclusions are made about their influence on the general situation on the labour market. Practical implications. To eliminate social inequality and injustice, ensure observance of labour rights and privileges, and create high social standards it is recommended to develop youth entrepreneurship programs; to provide free legal and informational support at the stage of opening own businesses and preferential lending and taxation in order to minimize youth unemployment; to develop a social unified agreement binding upon the execution of any work or provision of services to protect all participants in the social dialogue of the flexible and informal labour markets; to develop gender-sensitive personnel policies at all enterprises and organizations, to eliminate pay disparities, to develop state programs of promoting gender equality among legislators and senior officials to achieve gender equality; to attract the unemployed and economically inactive population for the growth of the labour potential of the country, which requires providing decent living conditions and remuneration to internally displaced persons, necessary working space for people with disabilities, creating a system of quality social care services for the elderly, sick and children with decent conditions and affordable services to people who receive social benefits in order to release the able-bodied population engaged in caring for relatives. Value/originality. The value of the research is the established facts of violations of human dignity and social injustice on the modern labour market and suggested recommendations for the elimination or minimization of them.

Median cleft lip: an uncommon and unique anomaly

Median or midline cleft lip [MCL] is an uncommon anomaly characterized by a midline vertical cleft through the upper lip and are either isolated or part of multiple anomalies. It can involve the pre-maxilla, the nasal septum, and the central nervous system. MCL includes Complete (42%), Incomplete (49%), and Minor forms (9%). The three main groups distinguished were: 1. Isolated MCL; 2. MCL with craniofacial malformations; and 3. MCL with extra-facial malformations. To analyze two operated cases of median cleft lip and review the relevant literature. The details of two cases of median cleft lip that were operated in 2017 were analysed. Both cases underwent wedge excision with the classical inverted V incision and muscle reconstruction with satisfactory result. Both the patients had no syndromic association or associated anomaly. All cases of MCL require evaluation for associated abnormalities. Isolated MCL can be repaired surgically with a good outcome.

Review of the Literature on Current Changes in the Timing of Pubertal Development and the Incomplete Forms of Early Puberty.

Puberty is a sensitive period of life characterized by the appearance of secondary sex characteristics which leads to a complete sexual maturation. It physiologically starts between the age of 8 and 13 years in girls and 9 and 14 years in boys. In the last two decades, several studies have showed that start of puberty has moved up to younger ages by 12–18 months, and some of the hypotheses trying to explain this change include the role of nutritional status and obesity and the influence of extrinsic factors such as exposure to endocrine-disrupting chemicals (EDCs), as well. The hypothalamic–hypophysis–gonadal axis develops during embryogenesis, and except for a period of activation immediately after birth, remains suppressed until the onset of pubertal development. At the beginning of puberty, the pulse generator is reactivated, probably due to progressive stimulatory influences on GnRH neurons from glial signals and neurotrasmitters. Kisspeptin and its receptor play a fundamental role in this phase. Premature Pubarche/Adrenarche, Premature Thelarche, and Premature Menarche are incomplete forms of precocious pubertal development that have their origin in endocrine mechanisms that only recently have started to be understood. It is important to distinguish these forms from the complete ones in order to reassure patients and parents about the non-evolution of pubertal progression and avoid non-useful treatments with analogous LHRH.

Measurement of equivalence between the web and paper versions of the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire

Objectives: Digitised patient-reported outcome may be beneficial for physicians and patients. The Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) can only be completed with paper and pencil (pJHEQ). We newly developed a web version of the JHEQ (wJHEQ). This study aimed to determine whether the scores obtained with the wJHEQ are equivalent to those from the pJHEQ, how much the wJHEQ would decrease missing answers, and which JHEQ the participants preferred to use.Methods: To measure equivalence between the pJHEQ and wJHEQ, we evaluated the mean score difference for each subscale (pain, movement, mental) and Visual Analogue Scale (VAS; satisfaction, right hip pain, left hip pain) and then assessed the intraclass correlation coefficients (ICC) between the two scores. ICC values ≥0.75 were defined as excellent agreement. We used Bland–Altman analysis to assess level of agreement between the values of the two questionnaires. We compared the number of incomplete forms and amount of missing data between the two questionnaires. We investigated ease of use by asking the participants which format was easier to use.Results: This study comprised 113 patients (mean age 58.1 years, 81% female) with hip disease. Mean score differences for each subscale between the wJHEQ and pJHEQ were not significantly different. The values of ICC for each subscale and each VAS were all >0.75. All 113 participants completed the wJHEQ questionnaire, whereas nine patients did not complete the pJHEQ form. There was a significant statistical difference between the completion rate of the wJHEQ and that of the pJHEQ (p = .0017). Fifty-seven participants (55%) preferred the wJHEQ, whereas 33 participants (32%) preferred the pJHEQ.Conclusion: The wJHEQ was found to be equivalent to the original pJHEQ. The wJHEQ significantly decreased the numbers of missing answers and incomplete forms. The participants felt ease of use was nearly equivalent. The wJHEQ might help facilitate more complete assessments in clinical trials and research.

Excess of Rare Missense Variants in Hearing Loss Genes in Sporadic Meniere Disease.

Meniere's disease (MD) is a clinical spectrum of rare disorders characterized by vertigo attacks, associated with sensorineural hearing loss (SNHL) and tinnitus involving low to medium frequencies. Although it shows familial aggregation with incomplete phenotypic forms and variable expressivity, most cases are considered sporadic. The aim of this study was to investigate the burden for rare variation in SNHL genes in patients with sporadic MD. We conducted a targeted-sequencing study including SNHL and familial MD genes in 890 MD patients to compare the frequency of rare variants in cases using three independent public datasets as controls. Patients with sporadic MD showed a significant enrichment of missense variants in SNHL genes that was not found in the controls. The list of genes includes GJB2, USH1G, SLC26A4, ESRRB, and CLDN14. A rare synonymous variant with unknown significance was found in the MARVELD2 gene in several unrelated patients with MD. There is a burden of rare variation in certain SNHL genes in sporadic MD. Furthermore, the interaction of common and rare variants in SNHL genes may have an additive effect on MD phenotype. This study will contribute to design a gene panel for the genetic diagnosis of MD.

Clinical spectrum of the anti-GQ1b antibody syndrome: a case series of eight patients.

Anti-GQ1b antibodies can be detected in the serum of patients with Miller Fisher syndrome (MFS) and its incomplete forms such as acute ophthalmoparesis (AO), acute ptosis, acute mydriasis, acute oropharyngeal palsy and acute ataxic neuropathy (AAN), as well as in pharyngeal-cervical-brachial weakness, Bickerstaff brainstem encephalitis (BBE) and in overlap syndromes with Guillain-Barré syndrome (MFS-GBS, BBE-GBS). We searched the laboratory medicine database at University Hospitals Leuven between 2002 and 2017 for serum samples with anti-GQ1b IgG antibodies. We identified eight patients with anti-GQ1b antibodies: 4 MFS, 2 AO, 1 MFS-GBS and 1 AAN. Mean age was 57years and five patients were males. Preceding illness was present in all patients. At nadir, we observed most frequently gait disturbance, external ophthalmoplegia and absent/decreased reflexes. Albumino-cytological dissociation was present in four patients. Mean time between onset and nadir was 4days, between onset and recovery 2.5months. Five patients recovered completely and three had minor residual symptoms. Interestingly, one patient with AO experienced a second identical episode, approximately 1year after the first one. Our data confirm the broad clinical spectrum associated with the presence of anti-GQ1b IgG antibodies. Incomplete MFS subtypes such as AO are a challenge for diagnosis, because of the limited (though invalidating) clinical presentation and the lack of confirming ancillary tests. Subacute onset of ophthalmoplegia and/or ataxia should urge the clinician to include the anti-GQ1b antibody syndrome in the differential diagnosis.

Treatment of refractory poor aPL-related obstetric outcomes with TNF-alpha blockers: Maternal-fetal outcomes in a series of 18 cases

BackgroundNo absolute data on the treatment of antiphospholipid antibodies (aPL) related to refractory obstetric complications exist to date. TNF-α play a major role in this disorder. ObjectiveTo assess the effectiveness of TNF-α blockers in 18 aPL-positive women with recurrent infertility after therapy with low-molecular-weight heparin (LMWH) plus aspirin (LDA) plus hydroxychloroquine (HCQ). MethodsProspective case-series of 12 women fulfilling Sydney criteria for obstetric antiphospholipid syndrome (OAPS) and 6 with incomplete forms (OMAPS). All women tested positive for aPL at least twice. Non-criteria aPL were tested in 15/18. Complement, TNF-α and IL-10 were also evaluated. Women were closely monitored for fetal well-being and possible malformations throughout gestation and the postpartum period. ResultsSixteen patients were started on adalimumab and 2 on certolizumab. Twelve women completed gestation: 9 at term and 3 pre-term. Differences in laboratory categories and outcomes were observed when OAPS and OMAPS were compared. First trimester miscarriage or implantation failure recurred in 6 cases, all of the OAPS group. Malformations were not seen in the newborns. ConclusionsOverall, good obstetric results were obtained in 70% of previous LMWH-LDA+HCQ refractory cases. TNF-α blockers were well tolerated without adverse effects. The combination of LMWH plus LDA plus TNF-α blockers appears to be a promising treatment for refractory obstetric complaints related to aPL; nevertheless, outcome differences between OAPS and OMAPS do exist.

The Brief «Walk-through» in the Archaeological Ceramic Investigations in the Way to a New Approach in Neolithic Ceramics Styles Research

The study of ceramic is one of the broadest research areas in archaeological sciences. Over the last two centuries, archaeologists have developed a number of approaches and methods that have had different goals of the studies: from the study of ceramics as an object of art to the reproduction of the manufacture technologies, and the study of pottery as a «mediator» for the study of everyday life of the ancient population. From the end of the XIX century of the archaeological research scholars looking for different algorithms and strategies in the ceramic studies and attributions. To the end of the XX century, ceramics studies became more complex: from pottery as an object to the technology of the manufacture. Scholars defined methodological groups of the ceramic’s investigation as 1. the description of the technologic information; 2. Form description; 3. Patterns analyses; 4. Reconstruction of the cultural traditions of the pottery. Different methodic together with physical-chemical analyses can prove a theoretical hypothesis. Together with the development of physical methods in archaeological research should also develop the methods of form and pattern analyses and fit to the new archaeological theories’ concepts The purpose of the article is a brief review of the scientific methods developed at different times in Western and Eastern Europe, North America, and to discover new combinations of research approaches that would allow archaeological ceramic complexes to be explored at a new level. This is especially true of the difficulties encountered in the study of Neolithic utensils, given the incomplete forms of utensils, the relatively small number of finds, and natural damage. The new paradigm in ceramics investigations is the studies of the raw material of Neolithic cera-mics using natural methods of analysis, such as binocular, p-XRF, spectrographic analyses. The results may open up new knowledge regarding the mobility of the ancient population and the cultural exchange between different groups of the Neolithic population. Key words: Neolithic, ceramic studies, pottery, migration, cultural exchange.

Burden sharing in families to children, adolescents and young adults with ADHD: Analysis of ADHD Helpline in Swedish Clinical Services.

Background:ADHD causes impairment in several life contexts and may increase stress and burden of care amongst family members. There is a lack of studies regarding gender inequalities in burden sharing in families of individuals with ADHD.Objective:The aim of this study was to investigate gendered burden sharing in families who were in contact with an ADHD telephone helpline in Sweden. A further aim was to identify perceived difficulties that prompted contact with the helpline.Methods:During a period of 28 months (from January 2013 to April 2015), calls were consecutively registered by psychologists manning the helpline through an anonymous digital form. After exclusion of 60 incomplete forms out of 1,410 (4%), information on 1,350 calls was analysed.Results:The analysis indicated that mothers (82.7% of all callers) had a more important role as information-coordinators for children or adolescents with ADHD, as compared to fathers (13%) or other callers (4.3%). This pattern was also observed among the calls regarding young adults with ADHD. Helpline calls primarily concerned entitlement to academic support (57.9% of calls concerning children or adolescents) and healthcare services (80.6% of calls concerning young adults and adults).Conclusion:The study concludes that a perceived lack of accessibility to and/or coordination of the school and health care services may be a major stressor for parents of individuals with ADHD. The burden of care through coordination of services and information-seeking may be especially increased in mothers of children, adolescents, and young adults with ADHD.

Are There Gender-Dependent Study Habits of Medical Students in Times of the World Wide Web?

This study evaluates how medical students rate the different types of teaching materials and methods available as well as possible gender-specific differences in the use of such materials. In this descriptive, cross-sectional study a questionnaire with short, one-dimensional questions with a 4-step Likert scale was developed by a presurvey within 493 students (4th year) at a University Medical School (January-December 2015). The anonymous survey was performed from July 2016 to February 2017 with 252 students within an orthopaedic surgery course at University Medical School. After exclusion of (1) nonnative speakers and (2) incomplete forms, 233 samples were included. Practical education was regarded as the most important (n=160/68.7%) teaching method followed by Internet research (n=147/63.1%) as the most important teaching material, while traditional frontal teaching (n=19/8.2%) and e-books (n=11/4.7%) ranked last. The evaluation of gender-specific differences in the use of teaching materials showed that female students prefer to highlight text (p<0.0001) as well as a trend to Internet research (p=0.053) and small-group teaching (p=0.057). Despite some gender-specific differences, traditional learning methods retain their importance besides new learning possibilities such as Internet research.

Esophageal shortening after rapid drink test during esophageal high-resolution manometry: A relevant finding?

Esophageal shortening (ES) might be observed during high-resolution manometry (HRM), in particular after the rapid drink test (RDT). We aimed to assess its diagnostic value in patients referred for HRM. HRM of patients without previous esophagogastric surgery or endoscopic treatment was retrospectively reviewed using the Chicago Classification v3.0. ES and pan-esophageal pressurization were analyzed during the RDT (200-ml free drinking in a sitting position). A total of 2141 cases (1291 females, mean age 54 years) were reviewed. During the RDT, ES occurred in 4% and pan-esophageal pressurization in 14% of patients. ES was almost exclusively encountered in patients with impaired esophagogastric junction relaxation or major disorders of peristalsis. Among 31 patients with ES and no definite diagnosis of achalasia, 19 had follow-up and 13 (68%) changed diagnostic category: two adenocarcinoma of the cardia, and 11 cases of atypical achalasia. The positive predictive value of ES for a significant esophageal disorder was 95%. ES is rarely observed during the RDT. When present, it is associated with major motility disorders, especially achalasia. When the diagnostic criteria for achalasia are not fulfilled, further complementary examinations should be performed to rule out incomplete forms of achalasia or an infiltrative process of the cardia.

The Nature of the Upper and Lower Modes of the Tang Pipa in the Akhakgwebeom

이 논문은 『악학궤범』 당비파의 상조와 하조 산형을 분석하여 그 성격을 밝히고, 이것이 우리나라 당악조와 어떤 관계가 있는지를 밝히는데 목적이 있다. 당비파의 악조(樂調)는 상조와 하조로 구분된다. 상조와 하조는 다음과 같은 차이가 있다. 첫째 개방현의 음이 다르다. 상조 개방현의 음은 무현(&#13447;)-대현(夾)-중현(&#13411;)-자현(林)이고, 하조 개방현의 음은 무현(&#13426;)-대현(太)-중현(&#13411;)-자현(林)이다. 즉 상조의 무현(&#13447;)과 대현(夾)의 개방현 음이 하조의 무현(&#13426;)과 대현(太)의 개방현 음보다 각각 1율씩 높다. 둘째 合(黃)의 음이 상조에는 무현 1주(柱)에, 하조에는 무현 2주(柱)에 위치해 있다. 셋째 상조 산형의 출현음은 황·태·협·중·임·남·무이고, 하조 산형의 출현음은 황·태·고·중·임·남·응이다. 출현음의 수는 동일하지만, 一과 凡에 해당하는 음이 서로 다르다. 즉 상조의 一은 夾, 凡은 無이고, 하조의 一은 姑, 凡은 應이다. 상조와 하조의 차이점은 출현음 중 一과 凡에 해당하는 음이 서로 다른 것과 상조 무현과 대현의 개방현 음이 하조보다 각각 1율씩 높은 점이다. 상조와 하조 산형의 음 구성을 기준으로 할 때 상조는 협종균, 하조는 중려균에 속한다. 그러나 당악조는 속악조(俗樂調)에 속하므로 협종균과 중려균에서 치조를 제외한 각각 네 종류의 악조가 상조와 하조의 악조와 일치 가능하다. 그리고 후대에 전승되는 당악조로 볼 때 협종균의 쌍각과 쌍조의 두 종류, 중려균의 정평조·도궁·소석조의 세 종류의 악조가 상조와 하조의 악조와 일치 가능하다. 그리고 공척조를 기준으로 할 때는 척자조와 소공조의 두 종류가 상조와 하조의 악조와 일치 가능하다. 당비파의 상조와 하조의 출현음만으로는 악조를 특정하기 어려우므로, 당비파 상조와 하조의 성격을 구체적으로 밝히기 위해 당악기와 당악곡의 악조를 살펴본 결과, 당악기의 경우 아쟁·대쟁 산형에는 황·태·협·중·임·남·무의 황종우조(협종우)가 표시되어 있고, 당적·당피리·퉁소 산형에는 황·태·고·중·임·남·응의 황종치조(중려치)가 표시되어 있었다. 그러나 아쟁·대쟁과 당적·당피리·퉁소 모두 연주법상으로는 황종치조와 황종우조 두 악조 모두 연주 가능하다고 보았다. 당악곡의 악조는 황종치조(중려치)와 황종우조(협종우)의 두 가지 형태로 나타났는데, 황종우조로 된 악곡의 경우 7음계의 완전형과 6음계의 불완전형으로 나뉘었고, 불완전형이 많은 것이 특징이었다. 이상과 같이 당악기와 당악곡에서 당악조의 성격이 분명히 드러남을 알 수 있었다. 즉 상조의 황·태·협·중·임·남·무는 협종우 즉 황종을 궁으로 하는 우조(황종우조)이고, 하조의 황·태·고·중·임·남·응은 중려치 즉 황종을 기본음(궁)으로 하는 치조(황종치조)이다. 결국 당비파의 상조와 하조는 산형의 출현음만으로는 여러 가지 악조로 해석 가능하지만, 당악기와 당악곡을 기준으로 했을 때는 상조는 황종우조, 하조는 황종치조의 각각 한 종류의 악조만 가능하다고 본다.The purpose of this study was to analyze the sangjo (上調 upper mode) and hajo (下調 lower mode) according to the sanhyeong (散形) turning diagrams of Tang pipa in the Akhakgwebeom, figure out their nature, and demonstrate their relation to “Tang music (dang ak) in Korea. The notes on the Tang pipa are divided into sangjo and hajo, which are different in various ways explained in the paper. Since it was difficult to specify tones only by analyzing notes used in the pieces, the investigator examined the notes of Tang instruments and melodies to shed light on the nature of the Tang pipa, the upper and lower sangjo and hajo modes more specifically, and found that Tang instruments used the same notes as the Tang pipa’s “lower mode in Korea. The notes of Tang melodies were also divided into sangjo and hajo types. The “upper” sangjo type had the complete form of a heptatonic scale and the incomplete form of a hexatonic scale, showing the incomplete form in many places. These findings indicate that the nature of Tang notes is clearly revealed through Tang instruments and melodies. In other words, the notes hwang, tae, hyeop, jung, im, nam and mu of the “upper” sangjo mode belong to Hyeopjongwu or ujo mode, the main hwangjong note of which is gung (hwangjong ujo), while the notes hwang, tae, go, jung, im, iam, and eung belong to jungryeochi or chijo mode, the main hwangjong tone is the basic note gung (hwangjong chijo). One can interpret the sangjo and hajo of the Tang pipa only with the notes used in the sanhyeong diagram, but sangjo and hajo can have only one type of tone each, hyeopjong ujo and hwangjong chijo, respectively, when the criteria are Tang instruments and melodies. Although the Tang pipa is a Tang instrument and should thus be related to sokakjo mode, its lower hajo mode is chijo without sokakjo. It is thus difficult to find a relationship between the sangjo and hajo of the Tang pipa in terms of sokakjo. There are a couple of questions still remaining, including the reasons behind differences between the tones of the string and wind instruments among Tang instruments and also a large number of incomplete forms for the sangjo type in Tang melodies. These questions may be addressed as research tasks in future studies.

Postpartum Tubal Sterilization: Making the Case for Urgency.

The parturient who requests postpartum sterilization has given consideration to and has made decisions regarding this aspect of her medical care long before her delivery. She arrives at parturition expecting the postpartum procedure to be performed as intended. The American Congress of Obstetricians and Gynecologists has reaffirmed its opinion that postpartum sterilization is an urgent procedure, owing to the safety and superior effectiveness of tubal sterilization via minilaparotomy in the immediate postpartum period, and the adverse consequences for mothers, babies, and society when the procedure is not actualized as desired and intended. In contrast, recent practice guidelines for obstetric anesthesia address anesthetic procedural aspects and short-term safety but overlook the long-term complications and considerations associated with failure to perform postpartum sterilization as planned. In practice, procedure completion rates are strikingly low, reportedly ranging from 31% to 52%. Reasons for failure to complete abound and include inadequate resources or inavailability of necessary personnel; obstetrician reluctance due to concerns for patient regret in younger women or medical comorbidities; barriers related to provision of obstetric care in a religiously affiliated hospital, or incomplete, improperly completed, or unavailable original federal consent forms among Medicaid-insured women. The federal requirement to wait 30 days after signing informed consent, and to retain the original signed document to be physically verified at time of the procedure, serves as a significant source of health care disparity for Medicaid-dependent mothers. This article reviews these larger issues of maternal health and comprehensive maternal care to broaden the anesthesiologist's appreciation of major benefits and potential risks of postpartum sterilization, including long-term effects, to promote an evidence-based, informed, and proactive role in delivering equitable, safe, and optimal care for these patients.

Discovering pan-correlation patterns from time course data sets by efficient mining algorithms

Time-course correlation patterns can be positive or negative, and time-lagged with gaps. Mining all these correlation patterns help to gain broad insights on variable dependencies. Here, we prove that diverse types of correlation patterns can be represented by a generalized form of positive correlation patterns. We prove a correspondence between positive correlation patterns and sequential patterns, and present an efficient single-scan algorithm for mining the correlations. Evaluations on synthetic time course data sets, and yeast cell cycle gene expression data sets indicate that: (1) the algorithm has linear time increment in terms of increasing number of variables; (2) negative correlation patterns are abundant in real-world data sets; and (3) correlation patterns with time lags and gaps are abundant. Existing methods have only discovered incomplete forms of many of these patterns, and have missed some important patterns completely.

Higher order divisor problems

An asymptotic formula is proved for the k-fold divisor function averaged over homogeneous polynomials of degree k in $$k-1$$ variables coming from incomplete norm forms.

Controversies in diagnosis and management of Kawasaki disease.

Kawasaki disease (KD) is a common medium vessel systemic vasculitis that usually occurs in small children. It has a predilection for the coronary arteries, but other medium sized arteries can also be involved. The etiology of this disorder remains a mystery. Though typical presentation of KD is quite characteristic, it may also present as incomplete or atypical disease in which case the diagnosis can be very challenging. As both incomplete and atypical forms of KD can be associated with serious coronary artery complications, the pediatrician can ill afford to miss these diagnoses. The American Heart Association has enunciated consensus guidelines to facilitate the clinical diagnosis and treatment of this condition. However, there are still several issues that remain controversial. Intravenous immunoglobulin remains the cornerstone of management but several other treatment modalities, especially glucocorticoids, are increasingly finding favour. We review here some of the contemporary issues, and the controversies thereon, pertaining to management of KD.

Anfore espagnole del depostio di Verona (Italia). Interpretazione dei dati analiticii

Presentamos un estudio de las ánforas béticas halladas cerca de la Tumba de Julieta en Verona que forma parte de un trabajo general sobre todas las ánforas béticas procedentes de la región. La mayoría de ellas se clasifican como Dr.7 y 8 (Beltrán IA y B), dudándose a qué tipo pertenecían algunas ánforas incompletas. Para verificarlo se realizaron análisis Petrográficos y mineralógicos (difracción de RX), aplicándose para la elaboración de los datos cuantitativos de estos últimos, además delos normales métodos estadísticos, uno nuevo que denominamos «hipercubo». Los mejores resultados se han obtenido con el método discriminante y el «hipercubo» que muestra cómo las pastas de la mayoría de las ánforas incompletas se asemejan a las del grupo Dr 7.