Hurston's work Their Eyes Were Watching God receives much attention and has been analyzed from different angles.This paper tries to explore the double consciousness in it to shown how the blacks can survive under ...Hurston's work Their Eyes Were Watching God receives much attention and has been analyzed from different angles.This paper tries to explore the double consciousness in it to shown how the blacks can survive under the influence of double con?sciousness.展开更多
According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appro...According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appropriate definition of clinical complete response(cCR)after neoadjuvant therapy and the role of surgery in patients who achieve a cCR.Surgical resection is associated with significant morbidity and decreased quality of life(QoL),which is especially relevant given the favourable prognosis in this patient subset. Accordingly, therehas been a growing interest in alternative approaches with less morbidity,including the organ-preserving watch and wait strategy, in which surgery isomitted in patients who have achieved a cCR. These patients are managed with aspecific follow-up protocol to ensure adequate cancer control, including the earlyidentification of recurrent disease. However, there are several open questionsabout this strategy, including patient selection, the clinical and radiologicalcriteria to accurately determine cCR, the duration of neoadjuvant treatment, therole of dose intensification (chemotherapy and/or radiotherapy), optimal followupprotocols, and the future perspectives of this approach. In the present review,we summarize the available evidence on the watch and wait strategy in thisclinical scenario, including ongoing clinical trials, QoL in these patients, and thecontroversies surrounding this treatment approach.展开更多
In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States a...In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage Ⅲ(node-positive) disease. For stage Ⅱ and Ⅲ colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluationthis is known as complete clinical response(cC R). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with c CR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.展开更多
AIM: To determine parental knowledge about acute otitis media(AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting(WW) approach in primary care settings in sou...AIM: To determine parental knowledge about acute otitis media(AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting(WW) approach in primary care settings in southern Israel.METHODS: The study was conducted in 3 primary care clinics and the pediatric emergency room of Soroka University Medical Center. Questionnaires(20 questions on education background, previous AOM experience, knowledge on antimicrobial resistance and attitude vs the WW approach) were filled by 600 parents(150 at each centers) of children < 6 years of age.RESULTS: Mothers represented 69% of parents; 2% had an education of < 10 school years, 46% had high-school education and 17% had an academic degree. 69% parents reported previous experience with AOM and 56% thought that antibiotics represent the only treatment for AOM. Knowledge on bacterial resistance to antibiotics was reported by 57% of the parents; 86% parents were willing to accept/probably accept the WW approach for their children. Logistic regression analysis revealed a significant association between parental education and knowledge about bacterial resistance to antibiotics and that previous experience with AOM was significantly associated with reluctance to accept the WW approach. More parents with knowledge on bacterial resistance were willing to accept the WW approach compared with parents without such knowledge. No correlation was found between the education level and willingness to accept the WW approach. CONCLUSION: A significant correlation was found between previous parental education and experience with AOM and the knowledge about antibiotic use, bacterial resistance and acceptance of the WW approach.展开更多
Strategic assessments are a landscape scale assessment and unlike project-by-project assessments which look at individual actions, they can consider a much broader set of issues;for example, a large urban growth area ...Strategic assessments are a landscape scale assessment and unlike project-by-project assessments which look at individual actions, they can consider a much broader set of issues;for example, a large urban growth area that will be developed over many years or a fire management policy across a broad landscape. Wetlands are important and effective ecosystems for biodiversity protection and improving environmental conditions. Bird watching as tourism and ecotourism activity is a complex process which it is compatible with conservation of wetlands and other aquatic zones. In this research, combination of SWOT analysis and FAHP method base on strategic fuzzy assessment are used for bird watch zoning in Bazangan Lake. By making internal and external matrix for SWOT factors, existing condition was in competitive strategies (ST) in the study area. Offered strategies in this condition were environment restoration to increase in environment resilience against hazards (natural and human), avoiding of land use and land cover changes and presence of ecotourism responsibly especially Bird watching. The sensitivity analysis results did not show any difference within the results of the present study and it was suitable and valid to use for similar situations. Base on the presented medium and short term strategies, it needed to have a short time training program to inform and empower local communities to wetlands partnership management by sharing them in the getting benefits in Bazangan Lake. By using the preferred frame in this study, decision makers can plan for each lake, dam and wetland and determine the best areas for tourist activities like bird watching. Conservation, protection and restoration of environment with its wildlife are guaranteed by using fuzzy assessment to provide reasonable strategies.展开更多
The present article deals with the effective use of film clips in the classroom to encourage active viewing. It argues that viewing material and activities should meet the needs and interest of learners and lead towar...The present article deals with the effective use of film clips in the classroom to encourage active viewing. It argues that viewing material and activities should meet the needs and interest of learners and lead towards a product that can benefit their language-learning capabilities. The selection of right film clips and the designing of appropriate tasks are discussed in detail.展开更多
Neuroendocrine neoplasms(NENs) are a group of rare and heterogeneous malignancies, which can develop in various organs. The clinical course of NENs is quite heterogeneous, with different spontaneous growth rates after...Neuroendocrine neoplasms(NENs) are a group of rare and heterogeneous malignancies, which can develop in various organs. The clinical course of NENs is quite heterogeneous, with different spontaneous growth rates after diagnosis, and different degrees of sensitivity to the same therapy even when they have similar characteristics. Watch and wait(W and W), is a term coined to indicate observation being conducted to assess the evolution of the tumor without administering any anti-tumor therapy. It has been applied to NENs since in extremely rare cases they tend to remain stable for a long time. Although W and W has been reported in several guidelines and recommendations it has never been validated, nor has it been specifically investigated. Furthermore it is not standardized. Therefore its application in clinical practice can differ in terms of tumor status assessment, type and timing of imaging or other exams utilized. In conclusion, while undertaking W and W to delay the first-line therapy by some weeks may be justified in good performance asymptomatic patients with low-grade NENs in order to usefully characterize the disease and patient and thereby choose the best therapy and therapeutic strategy, it seems to be far more difficult to justify W and W with the intent of avoiding an anti-tumor treatment. It should be considered that not only do NENs tend to grow even when they have very favorable biological characteristics but also that the alternative to W and W is most commonly a low toxic and effective treatment with somatostatin analogs.展开更多
In wrist watches gear drives with undercut pinions are used. Those pinions have got a tooth number as few as 5—7. The efficiency of such gear drives is important because of the limited energy supply. The mean efficie...In wrist watches gear drives with undercut pinions are used. Those pinions have got a tooth number as few as 5—7. The efficiency of such gear drives is important because of the limited energy supply. The mean efficiency of gear drives can be expressed as E<sub>m</sub>=1/（φ<sub>2</sub>-φ<sub>1</sub>）（integral from φ<sub>1</sub> to φ<sub>2</sub>（E（φ）dφ）） in which <sup>0</sup><sub>1</sub>, <sup><</sup>sub>2</sub> are the approach angle and the recess angle respectively. In the discussion we assume that the friction coefficient between the two tooth flanks is constant because the sliding speed is relatively low in wrist watches and the main purpose is to find out the relation between gear parameters and its efficiency rather than to calculate the exact value of the efficiency. In normal conditions <sup>o</sup><sub>1</sub> and <sup>o</sup><sub>2</sub> can be found from the gear geometry without much difficulty. However when the pinion is an undercut one we have to first find the forming diameter where the involute profile starts. In this paper equations for the computation of the efficiency and the contact ratio of those gear drives are discussed.展开更多
文摘Hurston's work Their Eyes Were Watching God receives much attention and has been analyzed from different angles.This paper tries to explore the double consciousness in it to shown how the blacks can survive under the influence of double con?sciousness.
文摘According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appropriate definition of clinical complete response(cCR)after neoadjuvant therapy and the role of surgery in patients who achieve a cCR.Surgical resection is associated with significant morbidity and decreased quality of life(QoL),which is especially relevant given the favourable prognosis in this patient subset. Accordingly, therehas been a growing interest in alternative approaches with less morbidity,including the organ-preserving watch and wait strategy, in which surgery isomitted in patients who have achieved a cCR. These patients are managed with aspecific follow-up protocol to ensure adequate cancer control, including the earlyidentification of recurrent disease. However, there are several open questionsabout this strategy, including patient selection, the clinical and radiologicalcriteria to accurately determine cCR, the duration of neoadjuvant treatment, therole of dose intensification (chemotherapy and/or radiotherapy), optimal followupprotocols, and the future perspectives of this approach. In the present review,we summarize the available evidence on the watch and wait strategy in thisclinical scenario, including ongoing clinical trials, QoL in these patients, and thecontroversies surrounding this treatment approach.
文摘In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage Ⅲ(node-positive) disease. For stage Ⅱ and Ⅲ colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluationthis is known as complete clinical response(cC R). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with c CR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.
文摘AIM: To determine parental knowledge about acute otitis media(AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting(WW) approach in primary care settings in southern Israel.METHODS: The study was conducted in 3 primary care clinics and the pediatric emergency room of Soroka University Medical Center. Questionnaires(20 questions on education background, previous AOM experience, knowledge on antimicrobial resistance and attitude vs the WW approach) were filled by 600 parents(150 at each centers) of children < 6 years of age.RESULTS: Mothers represented 69% of parents; 2% had an education of < 10 school years, 46% had high-school education and 17% had an academic degree. 69% parents reported previous experience with AOM and 56% thought that antibiotics represent the only treatment for AOM. Knowledge on bacterial resistance to antibiotics was reported by 57% of the parents; 86% parents were willing to accept/probably accept the WW approach for their children. Logistic regression analysis revealed a significant association between parental education and knowledge about bacterial resistance to antibiotics and that previous experience with AOM was significantly associated with reluctance to accept the WW approach. More parents with knowledge on bacterial resistance were willing to accept the WW approach compared with parents without such knowledge. No correlation was found between the education level and willingness to accept the WW approach. CONCLUSION: A significant correlation was found between previous parental education and experience with AOM and the knowledge about antibiotic use, bacterial resistance and acceptance of the WW approach.
文摘Strategic assessments are a landscape scale assessment and unlike project-by-project assessments which look at individual actions, they can consider a much broader set of issues;for example, a large urban growth area that will be developed over many years or a fire management policy across a broad landscape. Wetlands are important and effective ecosystems for biodiversity protection and improving environmental conditions. Bird watching as tourism and ecotourism activity is a complex process which it is compatible with conservation of wetlands and other aquatic zones. In this research, combination of SWOT analysis and FAHP method base on strategic fuzzy assessment are used for bird watch zoning in Bazangan Lake. By making internal and external matrix for SWOT factors, existing condition was in competitive strategies (ST) in the study area. Offered strategies in this condition were environment restoration to increase in environment resilience against hazards (natural and human), avoiding of land use and land cover changes and presence of ecotourism responsibly especially Bird watching. The sensitivity analysis results did not show any difference within the results of the present study and it was suitable and valid to use for similar situations. Base on the presented medium and short term strategies, it needed to have a short time training program to inform and empower local communities to wetlands partnership management by sharing them in the getting benefits in Bazangan Lake. By using the preferred frame in this study, decision makers can plan for each lake, dam and wetland and determine the best areas for tourist activities like bird watching. Conservation, protection and restoration of environment with its wildlife are guaranteed by using fuzzy assessment to provide reasonable strategies.
文摘The present article deals with the effective use of film clips in the classroom to encourage active viewing. It argues that viewing material and activities should meet the needs and interest of learners and lead towards a product that can benefit their language-learning capabilities. The selection of right film clips and the designing of appropriate tasks are discussed in detail.
文摘Neuroendocrine neoplasms(NENs) are a group of rare and heterogeneous malignancies, which can develop in various organs. The clinical course of NENs is quite heterogeneous, with different spontaneous growth rates after diagnosis, and different degrees of sensitivity to the same therapy even when they have similar characteristics. Watch and wait(W and W), is a term coined to indicate observation being conducted to assess the evolution of the tumor without administering any anti-tumor therapy. It has been applied to NENs since in extremely rare cases they tend to remain stable for a long time. Although W and W has been reported in several guidelines and recommendations it has never been validated, nor has it been specifically investigated. Furthermore it is not standardized. Therefore its application in clinical practice can differ in terms of tumor status assessment, type and timing of imaging or other exams utilized. In conclusion, while undertaking W and W to delay the first-line therapy by some weeks may be justified in good performance asymptomatic patients with low-grade NENs in order to usefully characterize the disease and patient and thereby choose the best therapy and therapeutic strategy, it seems to be far more difficult to justify W and W with the intent of avoiding an anti-tumor treatment. It should be considered that not only do NENs tend to grow even when they have very favorable biological characteristics but also that the alternative to W and W is most commonly a low toxic and effective treatment with somatostatin analogs.
文摘In wrist watches gear drives with undercut pinions are used. Those pinions have got a tooth number as few as 5—7. The efficiency of such gear drives is important because of the limited energy supply. The mean efficiency of gear drives can be expressed as E<sub>m</sub>=1/（φ<sub>2</sub>-φ<sub>1</sub>）（integral from φ<sub>1</sub> to φ<sub>2</sub>（E（φ）dφ）） in which <sup>0</sup><sub>1</sub>, <sup><</sup>sub>2</sub> are the approach angle and the recess angle respectively. In the discussion we assume that the friction coefficient between the two tooth flanks is constant because the sliding speed is relatively low in wrist watches and the main purpose is to find out the relation between gear parameters and its efficiency rather than to calculate the exact value of the efficiency. In normal conditions <sup>o</sup><sub>1</sub> and <sup>o</sup><sub>2</sub> can be found from the gear geometry without much difficulty. However when the pinion is an undercut one we have to first find the forming diameter where the involute profile starts. In this paper equations for the computation of the efficiency and the contact ratio of those gear drives are discussed.
