Unique Trends Research Articles

High-intensity efforts in elite soccer matches and associated movement patterns, technical skills and tactical actions. Information for position-specific training drills

ABSTRACTThis study aimed to translate movement patterns, technical skills and tactical actions associated with high-intensity efforts into metrics that could potentially be used to construct position-specific conditioning drills. A total of 20 individual English Premier League players’ high-intensity running profiles were observed multiple times (n = 100) using a computerised tracking system. Data were analysed using a novel high-intensity movement programme across five positions (centre back [CB], full-back [FB], central midfielder [CM], wide midfielder [WM] and centre forward [CF]). High-intensity efforts in contact with the ball and the average speed of efforts were greater in WMs than CBs, CMs and CFs (effect sizes [ES]: 0.9–2.1, P < 0.05). WMs produced more repeated efforts than CBs and CMs (ES: 0.6–1.3, P < 0.05). In possession, WMs executed more tricks post effort than CBs and CMs (ES: 1.2–1.3, P < 0.01). FBs and WMs performed more crosses post effort than other positions (ES: 1.1–2.0, P < 0.01). Out of possession, CFs completed more efforts closing down the opposition (ES: 1.4–5.0, P < 0.01) but less tracking opposition runners than other positions (ES: 1.5–1.8, P < 0.01). CFs performed more arc runs before efforts compared to CBs, FBs and WMs (ES: 0.9–1.4, P < 0.05), however, CBs completed more 0–90° turns compared to FBs, CMs and WMs (ES: 0.9–1.1, P < 0.01). The data demonstrate unique high-intensity trends in and out of possession that could assist practitioners when devising position-specific drills.

Multiscale damage analysis of carbon nanotube nanocomposite using a continuum damage mechanics approach

A multiscale-modeling framework is presented to understand damage and failure response in carbon nanotube reinforced nanocomposites. A damage model is developed using the framework of continuum damage mechanics with a physical damage evolution equation inspired by molecular dynamics simulations. This damage formulation is applied to randomly dispersed carbon nanotube reinforced nanocomposite unit cells with periodic boundary conditions to investigate preferred sites and the tendency towards damage. The continuum model is seen as successfully capturing much of the unique nonlinear trends observed in the molecular dynamics simulations in a volume 1000 times greater than the molecular dynamics unit cell. Additionally, application of the damage model to the continuum unit cell revealed insights into the failure of carbon nanotube reinforced nanocomposites at the sub-microscale.

Temporal changes in racial violence, 1980 to 2006: A latent trajectory approach

ObjectivesThe study examines the ability of a latent trajectory approach to advance our understanding of the temporal trends in white and black homicide rates over a critical period, 1980 to 2006. After establishing distinct trajectories that reveal hidden racial heterogeneity, we estimate which of two dominant arguments concerning the changes in homicide rates over time: 1) macrostructural conditions and 2) crime control and drug sales—best explain the latent class race-specific homicide rate memberships at the city level. MethodsUsing homicide data from the Uniform Crime Reports along with decennial U.S. census data across three time periods, we employ both latent trajectory and time series approaches. ResultsOur latent trajectory approach identified three unique trends or groupings of cities based on white and black homicide rates, reflecting “high”, “medium” and “low” temporal homicide trends. Time series models highlight variation in which characteristics contributed to the distinct race-specific homicide trends by trajectory group. ConclusionsTogether, this study reveals hidden heterogeneity among American cities with respect to temporal trends that inform the current debate about diversity in the location and magnitude of the crime drop as well as which factors contributed to homicide trends by racial groups. Implications are discussed.

Ion-water wires in imidazolium-based ionic liquid/water solutions induce unique trends in density.

Ionic liquid/water binary mixtures are rapidly gaining popularity as solvents for dissolution of cellulose, nucleobases, and other poorly water-soluble biomolecules. Hence, several studies have focused on measuring the thermophysical properties of these versatile mixtures. Among these, 1-ethyl-3-methylimidazolium ([emim]) cation-based ILs containing different anions exhibit unique density behaviours upon addition of water. While [emim][acetate]/water binary mixtures display an unusual rise in density with the addition of low-to-moderate amounts of water, those containing the [trifluoroacetate] ([Tfa]) anion display a sluggish decrease in density. The density of [emim][tetrafluoroborate] ([emim][BF4])/water mixtures, on the other hand, declines rapidly in close accordance with the experimental reports. Here, we unravel the structural basis underlying this unique density behavior of [emim]-based IL/water mixtures using all-atom molecular dynamics (MD) simulations. The results revealed that the distinct nature of anion-water hydrogen bonded networks in the three systems was a key in modulating the observed unique density behaviour. Vast expanses of uninterrupted anion-water-anion H-bonded stretches, denoted here as anion-water wires, induced significant structuring in [emim][Ac]/water mixtures that resulted in the density rise. Conversely, the presence of intermittent large water clusters disintegrated the anion-water wires in [emim][Tfa]/water and [emim][BF4]/water mixtures to cause a monotonic density decrease. The differential nanostructuring affected the dynamics of the solutions proportionately, with the H-bond making and breaking dynamics found to be greatly retarded in [emim][Ac]/water mixtures, while it exhibited a faster relaxation in the other two binary solutions.

Developing a gender-based approach to chronic conditions and women's health: a qualitative investigation of community-dwelling women and service provider perspectives.

BackgroundChronic conditions contribute to over 70 % of Australia’s total disease burden, and this is set to increase to 80 % by 2020. Women’s greater longevity means that they are more likely than men to live with disability and have unique health concerns related to their gender based roles in society. Cultural and social issues can impact on women's health and are important to consider in health services planning and research. In this study, we aimed to identify barriers and facilitators to providing a gender-based approach to chronic conditions and women's health in an eastern metropolitan region of Australia.MethodsFocus groups were used to engage both community-dwelling women who had chronic conditions and relevant professional stakeholders in the target area. Recorded proceedings underwent thematic analysis.ResultsFive focus groups were conducted with professional stakeholders and women community members in February and March 2014. Resultant themes included: women’s disempowerment through interactions with health systems; social and economic constraints and caregiving roles act to exclude women from participating in self-care and society; and empowerment can be achieved through integrated models of care that facilitate voice and enable communication and engagement.ConclusionsThis study underscores the importance of including perspectives of sex and gender in health care services planning. Tailoring services to socio-demographic and cultural groups is critical in promoting access to health care services. Unique epidemiological trends, particularly the ageing of women and new migrant groups, require particular attention.

High-dimentional data authentication protocol based on hash chain for Hadoop systems

Social media networks along with mobile devices are major sources of big data. A recent trend involves using Hadoop for big data to extract unique trends, insights, and patterns. However, Hadoop lacks secure authentication mechanisms that prevent unauthorized access to data. The current authentication token system that is used for user authentication in the Hadoop distributed file system (HDFS) is vulnerable to replay and datanode hacking attacks. This paper proposes a data authentication protocol that protects sensitive data in HDFS against malicious attacks. The proposed protocol uses the hash chain method instead of the key exchange method based on public-key encryption. An HDFS blocks in datanodes of the proposed protocol are accessed by a client with a valid block access token from a namenode. In addition, clients' anonymity is guaranteed because an HDFS adopting the proposed protocol passes hash-chained block values so the HDFS blocks that generates security awareness information is not exposed unnecessarily to a third party. An HDFS adopting the proposed protocol has the performance (e.g., communication power, computational power, and area efficiency) as good as that of conventional HDFS systems.

A GIS-based spatiotemporal study of the variability of water quality in the Dubai Creek, UAE

This paper presents the outcomes of a study on the water quality of Dubai Creek which aimed to assess its eutrophication status. Field water quality data from stations along the creek collected in 2012 and 2013 were used. Ordinary least squares (OLS) and spatial autocorrelation analyses were used as part of geographic information system (GIS)-based exploratory regression analysis to study the relationship between chlorophyll-a and nutrients, specifically total nitrogen and phosphate. Multiple logistic regression analysis was used to study the vulnerability of the creek to eutrophication. Results showed unique trends of spatiotemporal variability of chlorophyll-a and nutrients. OLS modeling showed high correlation between field and modeled chlorophyll-a values between Al Garhoud Bridge and Sanctuary stations, located about 2 km upstream and downstream of the Sewage Treatment Plant (STP) Outfall station. Furthermore, results showed the lower half of the creek was more vulnerable to eutrophication than the upper, which was believed to be due to the location of the STP station, poor flushing, shallow water depth, and irregular circulation patterns in the creek. Accordingly, this study recommends development of a mitigation plan in order to control the levels of nutrients in the creek.

Genetic diversity and population dynamics of Bordetella pertussis in China between 1950–2007

Pertussis is an acute respiratory infectious disease caused by the bacterium Bordetella pertussis. Although pertussis vaccination was introduced in the 1960s, pertussis is still an endemic disease in China. To better understand the genetic diversity of the Chinese B. pertussis population, we characterized 115 clinical isolates obtained in China during 1950–2007 using multilocus variable-number tandem repeat analysis (MLVA). Forty-six different B. pertussis MLVA profiles (MTs) were identified, of which 13 were new MTs. Analysis using a minimum-spanning tree showed that distinct MTs were prevalent during different periods, suggesting that a dynamic change in B. pertussis MTs occurred over time in China. The predominant MTs in recent isolates from China were different from those of many developed countries. A decreasing trend in genetic diversity of the B. pertussis population was observed following the introduction of pertussis vaccines. Similar to the pertactin 2 (prn2) allele, the novel pertussis toxin promoter (ptxP3) allele first emerged in 2000, but unlike trends elsewhere, ptxP1 remained predominant among the isolates, further reflecting the unique temporal trends in the B. pertussis population in China. Our results suggest that temporal changes in the B. pertussis population may be closely associated with vaccination coverage and the vaccine types used. These data may lead to an improved understanding of the virulence mechanism of B. pertussis and facilitate new strategies for controlling this infectious disease.

Exotic fauna and flora: fashion trends in the nineteenth century

The aim of this paper is to explore the extreme, unique and unusual fashion trends in the nineteenth century. The natural world in general, flora and fauna in particular, has always been a primary source of inspiration for the clothing and fashion. Victorian obsession for expertly worked curiosities from foreign lands using unusual flora and fauna, such as iridescent feathers, hummingbirds and beetle wings created an extensive European export market. Indian beetle wings created an extensive European export market for India in the nineteenth century as a fashion embellishment. Fashionable Victorian ladies swept through ballrooms with dresses, shawls and fans embellished with glittering touches of beetle wing exotica. In the 1851 Great Exhibition, held in the Crystal Palace in London, the main fur exhibitor, the Hudson's Bay Company, displayed the range of furs such as racoon, beaver, chinchilla, bear, fisher, fox, lynx, martin, mink, musquash, otter, fur seal and wolf.

Lighter Structural Clay Ceramics Manufactured with Marble Cutting Dust and Paperboard Based Packaging Waste

This work evaluates some preliminary results of adding two kinds of wastes in two characteristics clay mixtures with the aim of producing lighter structural ceramic products. The selected wastes are marble cutting dust and a packaging waste mainly composed by paperboard and polyethylene. In the case of clay mixtures, they are focused to the manufacture of both common and facing bricks. New waste based formulations are proposed on the basis of chemical and mineralogical compositions of clays and wastes and previous experiences in literature. Especial attention is paid to initial carbonate content in the selected clays, since marble waste is almost exclusively formed by calcite. Dynamic sintering tests and technological properties characterization were performed to analyse the feasibility of waste incorporation. Sintering behaviour shows a larger influence of marble dust waste and it is radically changed in the case of clay mixtures for facing products. Technology properties of unfired specimens are in general adequate for the industrial practice. Final technological properties of sintered specimens shows lower density for the new waste bearing products but not unique trends with sintering temperature for another properties as bending strength or water absorption capacity. These properties are mainly conditioned by the sintering behaviour associated to marble dust addition and, thus additional microstructure and mineralogy test would be necessary for a better knowledge of these materials and their optimised formulation.

Numerical Modeling and Experimental Validation by Calorimetric Detection of Energetic Materials Using Thermal Bimorph Microcantilever Array: A Case Study on Sensing Vapors of Volatile Organic Compounds (VOCs).

Bi-layer (Au-Si3N4) microcantilevers fabricated in an array were used to detect vapors of energetic materials such as explosives under ambient conditions. The changes in the bending response of each thermal bimorph (i.e., microcantilever) with changes in actuation currents were experimentally monitored by measuring the angle of the reflected ray from a laser source used to illuminate the gold nanocoating on the surface of silicon nitride microcantilevers in the absence and presence of a designated combustible species. Experiments were performed to determine the signature response of this nano-calorimeter platform for each explosive material considered for this study. Numerical modeling was performed to predict the bending response of the microcantilevers for various explosive materials, species concentrations, and actuation currents. The experimental validation of the numerical predictions demonstrated that in the presence of different explosive or combustible materials, the microcantilevers exhibited unique trends in their bending responses with increasing values of the actuation current.

A Survey on Trends and Techniques used in Hyperspectral Image Processing

Recent advancement in remote sensing facilitates collection of hyperspectral images (HSIs) in hundreds of bands which provides a potential platform to detect and identify the unique trends in land and atmospheric datasets with high accuracy. But along with the detailed information, HSIs also pose several processing problems such as1) increase in computational complexity due to high dimensionality. So dimension reduction without losing information is one of the major concerns in this area and 2) limited availability of labeled training sets causes the ill posed problem which is needed to be addressed by the classification algorithms. Initially classification techniques of HSIs were based on spectral information only. Gradually researchers started utilizing both spectral and spatial information to increase classification accuracy. Also the classification algorithms have evolved from supervised to semi supervised mode. This paper presents a survey about the techniques available in the field of HSI processing to provide a seminal view of how the field of HSI analysis has evolved over the last few decades and also provides a snapshot of the state of the art techniques used in this area. General Terms Classification algorithms, image processing, supervised, semi supervised techniques.

Compositional segregation, structural transformation and property-temperature relationship of high-Curie temperature Pb(In1/2Nb1/2)O3–Pb(Mg1/3Nb2/3)O3–PbTiO3 single crystals

Ternary ferroelectric single crystal Pb(In1/2Nb1/2)O3–Pb(Mg1/3Nb2/3)O3–PbTiO3 (PIN–PMN–PT) was grown by the modified Bridgman method. The compositional variation of different regions of the crystals was measured, and the segregation regularity of the crystals was proposed. Variations in the dielectric properties and domain structures of the PIN–PMN–PT single crystals were investigated as a function of temperature and composition, and the phase transformation behavior of the crystals was observed. The PIN–PMN–PT crystals showed high Curie temperatures (T C = 160–210 °C), ferroelectric phase transition temperatures (T R–T up to 132 °C) and coercive fields (E C = 6–8 kV/cm) as well as excellent piezoelectric properties (d 33 up to 2,800 pC/N) and electromechanical coefficients (k 33 > 0.90). As the temperature increased, k 33 values remained relatively constant and d 33 increased gradually prior to ferroelectric phase transformation, and these results reflect the wide temperature usage range of PIN–PMN–PT single crystals. The polarization (P r ) and E C of the crystals showed unique trends during the phase transformation process; high P r and E C values can be maintained prior to depolarization, which indicates that the PIN–PMN–PT single crystals are candidate materials for high-power applications. In summary, PIN–PMN–PT single crystals with ultrahigh electric properties, large coercive fields and excellent thermal stability may potentially be applied in harsh environments.

Abstract P6-14-08: Risk factors for developing inflammatory breast cancer: Unique trends among a single patient population

Abstract Introduction: Inflammatory breast cancer (IBC) is a virulent form of breast cancer, characterized by skin erythema and edema associated with enlargement of the breast rapidly occurring within 3-6 months (mo). Because of its rarity (&amp;lt;5% incidence), there is a paucity of data identifying epidemiologic risk factors, which may shed light on the potential causes of IBC, and guide prevention strategies. Methods: This study utilized retrospective data obtained from an IRB approved database of 275 patients (pts) with IBC evaluated at Dana Farber Cancer Institute (DFCI) from 1997-2012. Pts with confirmed invasive breast cancer had documented clinical characteristics of IBC clinically staged as T4d. The statistical software JMP 10 was used to perform statistical tests. Chi Square Tests, Fisher’s Exact Tests, and descriptive statistics were compiled. Results: The mean age of diagnosis among our study population was 50.2 years (yrs). IBC pts were more frequently diagnosed when premenopausal (55%) versus (v) postmenopausal (45%); 25% of pts had metastases upon presentation. The majority of patients (77%) were overweight (BMI 25-29.9) or obese (BMI≥30). More premenopausal pts (80.3%) had a BMI &amp;gt;25 v postmenopausal pts (73.5%). We observed no association with BRCA status among those undergoing genetic testing (13% BRCA positive (pos); 54 tested); however 52% of pts had a family history of breast cancer (5% BRCA pos). The majority of pts (81%) did not undergo genetic testing. The most common IBC subtype was HER2 pos (40%); 19% were triple negative (neg), and 16% were hormone receptor (HR) pos/HER2 neg. We also observed a trend of a longer duration of symptoms prior to diagnosis among younger pts. The mean age of pts who experienced &amp;gt;6 months (mo) of symptoms prior to diagnosis was 42 yrs v the mean age of 51 yrs among those experiencing &amp;lt; 2 mo of symptoms prior to diagnosis. Pts also displayed a temporal trend in diagnosis dependent upon time of year. 57% of pts were diagnosed with IBC during the warmer temperatures (Mar 21 – Sept 20) compared with 43% diagnosed during the cooler temperatures (Sept 21– Mar 20). Conclusion: This retrospective epidemiologic analysis demonstrated various trends in a single population of IBC pts. The association of high BMI and risk of developing IBC among premenopausal women contrasts with that seen in the non-IBC group, i.e. high BMI is a risk factor for non-IBC only among postmenopausal women. Targeting the obesity crisis may be a means of reducing the risk of developing IBC among younger women. A differentiating feature of IBC is the rapid onset of signs and symptoms of IBC, and yet, younger pts had a significant delay in diagnosis of &amp;gt;6 mo compared with older pts. This emphasizes the urgency to educate both pts and providers about IBC and facilitate rapid diagnostic procedures. The seasonal relationship with diagnosis observed in this cohort of IBC pts is intriguing. Investigators have hypothesized an infectious etiology contributing to the development of IBC, namely infection by viruses or bacterial pathogens may play a role in the pathophysiology of IBC. These unique trends seen in the DFCI IBC population deserve further investigation. Citation Format: Randie E White, Laura E Warren, Jennifer R Bellon, Faina Nakhlis, Heather A Jacene, Eren D Yeh, Judith Hirshfield-Bartek, Beth Overmoyer, Inflammatory Breast Cancer International Consortium. Risk factors for developing inflammatory breast cancer: Unique trends among a single patient population [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-14-08.

A history of drug development in four acts

• The future of pharmaceutical discovery is unclear in light of unique trends in marketing and R&D allocations.

Stratigraphic correlations using trace elements in apatite from Late Ordovician (Sandbian-Katian) K-bentonites of eastern North America

The early Late Ordovician sedimentary rocks of eastern North America contain a relatively large number (>100) of widespread heavily altered tephra layers (K-bentonites). These beds represent an intense period of subaerial volcanism that occurred from ca. 455 to 449 Ma. The sedimentary rocks that contain these K-bentonites display complex regional lithostratigraphic relationships ranging from clastic foreland basin facies to cratonic carbonate platform facies. Accurate correlation of these ancient ash-fall beds is essential for testing chronostratigraphic hypotheses that attempt to connect these different tectono-sedimentary provinces. Despite the relatively thorough study of a few of these K-bentonites over the past several decades, the full stratigraphic potential of these beds has yet to be realized. To test the utility of the apatite trace-element K-bentonite correlation method on a larger scale, we studied over 200 K-bentonite samples from the Mohawkian Stage of eastern North America and statistically compared our results with previous studies on the same suites of K-bentonites. Electron microprobe (EPMA) and laser ablation–inductively coupled plasma–mass spectrometry (LA-ICP-MS) results show that apatite trace-element data provide unique bed discriminators. Each of the K-bentonite layers exhibits unique and reproducible trends in Mg, Cl, Mn, Fe, Ce, Y, and other trace-element concentrations in apatite. Statistical evaluation of results from our apatite analyses suggests correlations for 12 K-bentonite beds, providing a significant improvement in stratigraphic resolution. The stratigraphic relations indicated by these new K-bentonite fingerprints provide a rigorous means by which to evaluate some previous interpretations of biostratigraphic, chemostratigraphic, and sequence stratigraphic studies in eastern North America.

A 30-Year Content Analysis of a State-Sponsored Professional Development Conference for Music Educators

Abstract Prior investigations of music conferences revealed trends in programing indicative of national organization priorities and norms (e.g., Orman &amp; Price, 2007; Sheldon &amp; Hartley, 2012). However, national conferences, by their very nature, reflect national interests and not necessarily those of music teachers at state and local levels. If tailoring national conferences to fit the proximate needs of music educators is a priority of the profession, then it would prove beneficial to understand how the content of state music conferences reflects the decisions and concerns of state Music Educators Association (MEA) leaders over time. This content analysis examined 30 years of professional development conferences sponsored by a southeastern state affiliate of the National Association for Music Education (NAfME). Events (N = 2558) listed in programs were classified by area, topic, and focus and graphed. Unique trends in the data were identified, and articles written by state leaders, organization minutes, and feedback from focus groups were used to formulate possible catalysts. Results demonstrated how the longitudinal contents of a state MEA conference reflected the values, priorities, interests, and events impacting conference scheduling at the state level and revealed a priority for providing educational sessions related to inservice teacher education and a strong presence of performances by high school ensembles, especially when compared with the contents of national conferences.

Potential toxicity assessment of novel selected pesticides against sand termite, Psammotermes hypostoma Desneux workers (Isoptera: Rhinotermitidae) under field conditions in Egypt

Abstract The sand termite, Psammotermes hypostoma Desneux is a major pest in the New Valley Governorate, Egypt. Great efforts have been taken to control the pest. We evaluated the toxicity of four selected neonicotinoids [acetamiprid (20% SP), imidacloprid (20% SL), thiamethoxam (18.6% SC), and thiamethoxam (40% WG)], and one organophosphate pesticide [chlorpyrifos (48% EC)] against P. hypostoma workers. The investigation was done under field conditions, using the palm fronds method. However, the reduction percentages in palm fronds was recorded as the height of the sandy clay formed by termite workers on palm frond surfaces, when the fronds had been treated with a different concentration of each pesticide. The results were recorded after 15, 30, 45, and 60 days. Chlorpyrifos (48% EC) was considered the most potent pesticide among all the pesticides tested, but acetamiprid (20% SP) was considered the most toxic among the neonicotinoid pesticides tested. Moreover, the formulation of thiamethoxam (18.6% SC) was more powerful than thaimethoxam (40% WG). Furthermore, the reduction percentages on palm fronds increased significantly with an increase of the exposure period (from 15 to 60 days), as a result of the surface foraging activity of the sand termite workers. These results are given as unique and encouraging trends in controlling sand termites in Egypt.

The Affymetrix DMET Plus platform reveals unique distribution of ADME-related variants in ethnic Arabs.

Background. The Affymetrix Drug Metabolizing Enzymes and Transporters (DMET) Plus Premier Pack has been designed to genotype 1936 gene variants thought to be essential for screening patients in personalized drug therapy. These variants include the cytochrome P450s (CYP450s), the key metabolizing enzymes, many other enzymes involved in phase I and phase II pharmacokinetic reactions, and signaling mediators associated with variability in clinical response to numerous drugs not only among individuals, but also between ethnic populations. Materials and Methods. We genotyped 600 Saudi individuals for 1936 variants on the DMET platform to evaluate their clinical potential in personalized medicine in ethnic Arabs. Results. Approximately 49% each of the 437 CYP450 variants, 56% of the 581 transporters, 56% of 419 transferases, 48% of the 104 dehydrogenases, and 58% of the remaining 390 variants were detected. Several variants, such as rs3740071, rs6193, rs258751, rs6199, rs11568421, and rs8187797, exhibited significantly either higher or lower minor allele frequencies (MAFs) than those in other ethnic groups. Discussion. The present study revealed some unique distribution trends for several variants in Arabs, which displayed partly inverse allelic prevalence compared to other ethnic populations. The results point therefore to the need to verify and ascertain the prevalence of a variant as a prerequisite for engaging it in clinical routine screening in personalized medicine in any given population.

A review of the total knee replacement pathway: Integrated care is quality care

A Total Knee Replacement (TKR) Pathway (adapted from the Credit Valley Hospital, Canada) is in place at the Apollo Health city facility since 2011. We re-visited the pathway design and the priority grid that led to its adaptation. We analyzed the data with the aim to analyze repetitive and unique trends and evaluate the performance of the pathway. Even with the increased volume the patient satisfaction rose from 56% at the time of pathway implementation to 77% at the end of the evaluation period of 45 months. The Average Length of Stay reduced by 27% from 7.94 to 5.78 days (the difference between the initial and final recorded values), in the same evaluation time period. The methodology of evaluation of the pathway was adapted from the Leuven Clinical Pathway Compass 5 way approach.9