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A single small actuation system that provides high resolution [step size] of 2 nanometers (nm) over an extended range of 20 mm with consistent forces of 100 Newtons [peak values exceed 180 N] and integral power-off hold is described. Speeds of 60 mm/second can be shown but electronic efficiencies are much higher at 1 to 10 mm/s. Open- and closed-loop control is described. Progress on potential applications in adaptive optics, large optical beam control, and photonic and semiconductor test and measurement are noted. New data is presented showing ± 5-nm control of 100 Newton loads. Heat generation is estimated to be very small [110 mJ/hr] while actively holding position. Comparison of encoder and capacitance gage stability over time and temperature is discussed because it affects control in the 5-nm regime. This response can be contrasted with previous 2 kHz over 30-micrometer response for vibration or adaptive optics control. Performance of a new Class D switching amplifier that offers higher efficiencies at peak demands is described. The actuator design uses a set of three piezoelectric elements. These constitute 1100 nF of load. High speeds in the 20 to 60 mm/s range [up to 2500 Hz clamp change cycles] significantly affect power needed and design efficiencies. Alternative design options are presented with rationale for present design choices and resultant performance. The basic design allows for choices based on performance needed.

Numerous recommendations on the initial evaluation and treatment of the head injured patient have been proposed over the last several years. Most assume there is readily available access to computed tomography and neurosurgical specialists. Many clinicians in Alaska must evaluate and begin treatment of head injured patients in circumstances quite different from this. Vast distances, severe weather and limited medical evacuation capability are factors that come into play while caring for these patients. The current medicolegal climate also contributes to clinician anxiety over missing rare but potentially serious injuries. These guidelines developed by Alaska clinicians from multiple specialties are meant to assist clinicians dealing with this very common problem and represent a reasonable approach to these patients in remote and rural Alaska.

Novel potent trisubstituted pyridazine inhibitors of p38 MAP (mitogen activated protein) kinase are described that have activity in both cell-based assays of cytokine release and animal models of rheumatoid arthritis. They demonstrated potent inhibition of LPS-induced TNF-alpha production in mice and exhibited good efficacy in the rat collagen induced arthritis model.

Systems that require multiple actuators for range and precision, such as adaptive optics, large optical beam control, photonics metrology, and semiconductor test-measurement, are candidates for this evolving actuator system. Designers can now consider one system to provide over 100 N force in nanometer steps at up to 50 mm/s with features such as, greater than 20 millimeter travel, power-off hold, high acceleration, and high stiffness. High mechanical power density is beneficial whether fitting an actuator into limited real estate or minimizing total mass for launch or inertia considerations. Smaller mechanical systems benefit from higher stiffness and are less susceptible to environmental transients. The actuator design uses sets of three piezoelectric elements. These constitute 1100 nF of load driven at up to 2500 Hz. In addition to the mechanical actuator, a new high efficiency amplifier and controller are being developed. Total system power density benefits will be noted and clamp design detail is presented.

Novel alphavbeta3 antagonists based on the N-aryl-gamma-lactam scaffold were prepared. SAR studies led to the identification of potent antagonists for alphavbeta3 receptor with excellent selectivity against the structurally related alpha(IIb)beta3 receptor. Additional interactions of N-aryl-gamma-lactam derivatives with alphavbeta3 were found when compared to c(-RGDf[NMe]V-) peptide antagonist. The effects of the conformation and configuration of the gamma-lactam core on the binding were also assessed.

One of the biggest strengths of Dreamweaver MX is that it makes creating database driven web sites simple. Before Dreamweaver MX, it was a real chore to sit and manually hand-code the PHP pages that retrieved data from a database and displayed it neatly in a page. To handle this, Dreamweaver MX introduced recordsets and server behaviors that can be quickly and easily integrated into an overall page design.

In the first two chapters, we took a look at the underlying technologies that drive the examples and applications in the upcoming chapters. Now, it’s time to introduce the environment that you will be working in when you build those applications.

The expression code reuse means different things to different people. If you’ve been creating static web sites with Dreamweaver for some time, you’ll probably be familiar with Dreamweaver templates and library items. These are powerful tools for redeploying standard sections of XHTML and other code throughout a site, and updating them in a single operation. Like all powerful things, they also have their dangerous side. If you have any experience with programming or using scripting languages like JavaScript, code reuse will more likely mean building your own library of custom-built functions or snippets of frequently used code. The Dreamweaver Snippets panel is a convenient place to store such items for rapid deployment in your sites.

It’s now time to put everything together and build a complete real world project. The case study presented in this chapter is based on building a web site for a fictitious garden club. It was chosen because it incorporates a lot of features that are found in a wide range of sites, so it can be adapted relatively easily to serve as a personal web log and contacts list, a news site, or a staff record list for an intranet.

My SQL is a very popular open-source relational database management system (RDBMS) that you will find installed at most ISPs. The ease of installation of MySQL, its stability across multiple platforms, and the wealth of applications that support it make it an obvious choice for many developers. MySQL is licensed under the GNU General Public License (GPL), which means that you can use it for free, as long as you do not incorporate it in a product that is not itself licensed under the GPL.

In this chapter, we’ll take a good look at PHP. Although Dreamweaver MX 2004 provides you with an excellent interface for doing a large number of PHP programming-related tasks, it’s always good to know about the language you are using. So, in this chapter, you’ll see how the underlying PHP language operates. In the next chapter, we’ll introduce the MySQL relational database management system (RDMS) and the structured query language (SQL).

The recent advances in laboratory technologies have resulted in a wealth of chemical and biological data. The rapid proliferation of a vast amount of data has led to a set of cheminformatics and bioinformatics applications that manipulate dynamic, heterogeneous, and massive data. An example of such application in the pharmaceutical industry is the computational process involved in the early discovery of lead drug candidates for a given target disease. In this paper, an efficient implementation of a drug candidate database is presented and evaluated. This study shows that high performance data access can be achieved through proper choices of data representation, database schema design, and parallel processing techniques.

Assembly and measurement of photonic subsystems or integrated optical components is transitioning from manual to semi-automated and fully automated configurations. Controlled motion, which allows movement in the 10-millimeter range with resolution of nanometers, is a critical requirement for successful assembly or functional verification of an assembly. Application specific requirements may include holding position at sub-micrometer levels for hours, repeatability of 0.1 percent over 100 micrometers to 0.005 percent over 10 millimeters, and simple controls for systems as basic as 2 degrees of freedom to multiple robots with 6 degrees of freedom each. New clamping technology, in an INCHWORM(brand motor, utilizes a combination of MEMS fabricated features and proprietary clamp interface materials to increase the clamp friction. This allows much higher push forces to be generated or the design freedom to trade force for size. Power versus Force curves are presented. Resolution, velocity, stiffness, and simple control are maintained in a much smaller package. Single mode fiber optic devices have active areas in the 5-10 micrometer range. Assembly needs are going smaller. A relatively powerful motor with dimensional resolution and time stability that can be incorporated into ever smaller robots will be needed to meet future photonic automation requirements.© (2002) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Context Prior studies suggest that providing patients with online access to health records and e-mail communication with physicians may substitute for traditional health care services. Objective To assess health care utilization by both users and nonusers of online access to health records before and after initiation of MyHealthManager (MHM), a patient online access system. Design, Setting, and Participants Retrospective cohort study of the use of health care services by members (≥18 years old) who were continuously enrolled for at least 24 months during the study period March 2005 through June 2010 in Kaiser Permanente Colorado, a group model, integrated health care delivery system. Propensity scores (using age, sex, utilization frequencies, and chronic illnesses) were used for cohort matching. Unadjusted utilization rates were calculated for both MHM users and nonusers and were the basis for difference-of-differences analyses. We also used generalized estimating equations to compare the adjusted rates of utilization of health care services before and after online access. Main Outcome Measures Rates of office visits, telephone encounters, after-hours clinic visits, emergency department encounters, and hospitalizations between members with and without online access. Results Comparing the unadjusted rates for use of clinical services before and after the index date between the matched cohorts, there was a significant increase in the per-member rates of office visits (0.7 per member per year; 95% CI, 0.6-0.7; P Conclusion Having online access to medical records and clinicians was associated with increased use of clinical services compared with group members who did not have online access.

Background/Aims To compare utilization of office and telephone encounters by patients with online access to their electronic medical record (EMR) to patients without online access.

e16513 Background: Despite the fact that chronological age alone does not determine tolerance to cancer treatment, there is a general perception that elderly cancer patients do not receive standard treatment. We sought to review breast cancer patients above 80 years in our practice. Methods: Retrospective analysis was performed ofall women with breast cancer over the age of 80 either at the time of diagnosis or at the time of relapse since July 2005 till July 2011. Results: There were total of 492 breast cancer patients seen during the study period, 207 below 65, 213 between 66-79 and 70 above 80. 59 women met the study criteria. The median age was 86 (81to 99 years). 47 had activities of independent living, 8 were in an assisted living facility and 4 in nursing homes. Median Charlson Co morbidity Index was 2 (0-5). Pathological types: DCIS 2, Invasive ductal carcinoma 50, invasive lobular carcinoma 6 and 1 had apocrine carcinoma. 50 had ER+, PR+ and Her-, 2 patients had triple negative disease and 4 Her+. 2 patients had stage 0, 22 stage I, 23 Stage II, 7 stage III and 5 stage IV. All patients stage 0-III had surgical management, 39 had breast conservative surgery with sentinel node biopsy and 15 had mastectomy. Out of 28 patients referred for adjuvant radiation therapy 17 received it. 49 patients received hormone treatment (39 aromatase inhibitors- AIs and 14 tamoxifen) Chemotherapy was offered but refused by two stage III patients. 2 Her + patients received and tolerated well trastuzumab based chemotherapy. After a median follow up of 48 months (8-120 months) there was 1 local recurrence, 1 distant relapse and 14 deaths ( 11 from other causes 3 from breast cancer). Conclusions: In ourpractice, a majority of octogenarians and nonagenarians live independently and have minimal co morbidities and tolerate standard surgical and hormonal treatment. Although radiation therapy would be considered optional in this group of women, it was offered based on predicted longevity. Mortality form other causes was higher than that from breast cancer ( 18% vs 5%).

The development of potent antithrombotic agents from the fibrinogen platelet receptor binding sequences Fg-alpha 572-575 -Arg-Gly-Asp-Ser- and Fg-gamma 400-411 -HHLGGAKQAGDV, believed to be a cryptic RGD-type sequence, is described. The tetrapeptide Ac-RGDS-NH2 itself is capable of inhibiting platelet aggregation in vitro at high concentrations, IC50 91.3 +/- 0.1 microM [in vitro antiaggregatory activity employing dog platelet rich plasma (PRP)/ADP], due to low platelet fibrinogen receptor affinity, Ki 2.9 +/- 1.9 microM (purified, reconstituted human platelet GPIIb/IIIa), relative to fibrinogen, Ki 38.0 +/- 6.0 nM. The peptide is also unstable to plasma, suffering total loss of in vitro activity upon incubation in PRP for 3 h (T1/2 90 min). Only modest improvements in potency were achieved with linear analogues of Ac-RGDS-NH2, while dramatic results were achieved with cyclic analogues, culminating in the cyclic disulfide Ac-cyclo-S,S-[Cys-(N alpha-Me)Arg-Gly-Asp-Pen]-NH2 (SK&F 106760) with improved plasma stability (100% activity after 3 h), affinity (Ki 58 +/- 20 nM purified human receptor), and potency (IC50 0.36 +/- 0.4 microM dog PRP/ADP). The affinity of this peptide is 2 orders of magnitude greater than that of Ac-RGDS-NH2. The affinity of the analogue is also comparable to fibrinogen. This peptide constitutes a first potent small peptide entry into the class of novel antithrombotic agents called fibrinogen receptor antagonists.

For more than a millenium, fatwas have guided and shaped Muslim understandings of Islamic law. The whole world knows of Ayatollah Khomeini's fatwa in the Salman Rushdi case, yet this key institution in Muslim society has not been the subject of a major examination until now. Ranging in import from the routine to the revolutionary, and in form from one-line answers to short treatises, fatwas have served to reaffirm received wisdom, caution against error, and chart novel responses to changing circumstances. The interpreters, the muftis of Islam, have included the greatest independent scholars of the ages, heads of large state bureaucracies, and unassuming jurists in local districts. Their vital task, which continues today in published collections as well as on radio and television, is to strive to interpret God's design for the Muslim community. "Islamic Legal Interpretation" is a casebook of analyses of fatwas from a wide range of times and places. The editors' first chapter sets forth the origins, classical diversity and modern development of the fatwa, while the following chapters illustrate particular opinions and their contexts. The approach throughout is interdisciplinary, as historians, lawyers, language specialists and social scientists address fatwas as fundamental sources on both Islamic legal thought and Islamic social history.

Atrial natriuretic peptide (ANP) and arginine vasopressin concentrations were measured in 9 patients with pregnancy-induced hypertension. The results were compared to those found in 7 normal pregnant women matched for age, duration of pregnancy, and parity. Plasma ANP levels were significantly higher in the pregnancy-induced hypertension patients than in the control group. Plasma arginine vasopressin concentrations, however, were not significantly different in the two populations. The mechanism of the observed rise in ANP concentrations in the patients with pregnancy-induced hypertension is not known. However, it may be related to a rise in intra-atrial pressures secondary to hypertension, an increase in baroreceptor discharge as a result of hypertension, or, less likely, the ANP may be released from extracardiac sites.

The reactions of [hydroxy(tosyloxy)iodo]benzene with a series of olefinic diacids to produce bislactones are reported. The products are the result of a stereospecific cis -addition of the two carboxylic acid functions to the double bond.

Disseminated intravascular coagulation, thrombocytopenia, consumption of factors VIII and II, and antithrombin deficiency have been previously demonstrated in pre-eclampsia. However, the precise mechanism responsible for initiation of disseminated intravascular coagulation has not been elucidated. The present study documents activation of the intrinsic coagulation pathway in a patient with severe pre-eclampsia. The studies revealed marked reductions of plasma coagulant activities of all intrinsic pathway factors, i.e., XII, XI, IX, and VIII. In addition, the ratio of plasma factor XII activity to antigen concentration was markedly abnormal, and plasma high-molecular-weight kininogen concentration was diminished. It is suggested that activation of the intrinsic coagulation pathway may be operative in the genesis of disseminated intravascular coagulation in pre-eclampsia.

Two cases of acute renal failure associated with ticrynafen administration are reported. Both patients had received hydrochlorothiazide prior to the institution of ticrynafen therapy and were mildly hyperuricemic. Flank pain, oliguria, and azotemia developed after the institution of ticrynafen in both cases. Clinical and laboratory features were consistent with acute uric acid nephropathy in both patients. In addition, a newly formed collection of radiolucent material was found by intravenous urography in the renal pelvis of one of the patients. Both patients were treated with intravenous fluids and sodium bicarbonate. One of the patients received allopurinol as well. Complete recovery of renal function was observed in both patients. Ticrynafen-induced hyperuricosuria in these previously volume-depleted and hyperuricemic subjects is felt to have been responsible for intrarenal and extrarenal deposition of uric acid in our patients.

The reactions of [hydroxy(tosyloxy)iodo]benzene with a series of olefinic diacids to produce bislactones are reported. The products are the result of a stereospecific cis -addition of the two carboxylic acid functions to the double bond.