Due to a lack of valid Taiwanese instruments measuring Shared Medical Decision-making (SMDM) in Taiwan. The purpose of the study is to investigate the reliability and validity of the Shared Medical Decision-making process. Total 350 patients were randomly recruited from a medical centre in Taiwan. As a theoretical basis steps of the SMDM process were defined in an expert panel. Item formulation was then conducted according to the Delphi method and a pool of 16 items was constructed. In addition, the Winstep software was used to examine whether the data fit Rasch test model. Items with outfit or infit MNSQs (mean square errors) not in the range between 0.77 and 1.30 are usually deemed as potential misfits. Successive Rasch analyses were performed until a final set of items was obtained. After eliminating 1 item the remaining 15 form a unidimensional scale with an acceptable reliability for person measures 0.77 and very good reliability for item difficulties 0.97. Analysis of subgroups revealed a different use of items in different conditions. Taiwanese Shared Medical Decision-making Questionnaire (SMDMQ) is a 15 items normative instrument. In addition, a theory-driven instrument to measure the process of SMDM has been developed and validated by use of a rigorous method revealing first promising results. Yet the ceiling effects require the addition of more discriminating items, and the different use of items in different conditions demands an in depth analysis.

The loss of teeth can be an extremely traumatic and an upsetting experience. The art & science of denture therapy has beenespoused and debated for almost a century. This paradigm has been repeatedly passed from “tutor-to-pupil”, with modifications & amalgamations of various philosophies. The “pupil-in-time-becomes-the-tutor” & the process continues as such. One cannot deny that various procedures involved in making of complete dentures have advanced through keen observation, experience, empiricism, anecdote, artistry & science. The dental profession has come far in terms of better materials, tools & techniques. Newer materials & technologies are driving newer, more efficient & successful clinical treatment & yet there is so much left to do.

Upper gastro intestinal bleeding is a common presentation to the Emergency Department; aproportion of these bleeds are secondary to duodenal ulcers. The management of thesein young, fit patients who can tolerate a second bleed physiologically is well established. However in the elderly frail patient a second bleed may be terminal. Options for treatment for these blee ding duodenal ulcers (apart from resuscitation, including transfusion if need be and medical management with intra venous Proton Pump Inhibitors), include endoscopic control, laparotomy with under running of the bleeding artery and endovascular approaches. 98 percent of patients can be successfully managed with endoscopy and epinephrine injection, coagulation and / or clipping of the bleeder. The dilemma exists in those patients whom are high risk for surgical intervention (laparotomy) should a re-bleed occur. In these patients transcatheter arterial embolization has become a favourable treatment modality and especially in high risk patients, selective transcatheterembolisationhas been established as a safe approach (1,2,3,5,9). In this case report we discuss the management of a 98 year old male with a duodenal ulcer with stigmata of recent bleed who presented to our department in a rural setting in Victoria, Australia.

The protein S deficiency is an ischemic stroke main risk factor in black young people. The authors report three patients of 37, 45 and 56 years old of age who presented ischemic stroke with hemi body deficit (two lefts and one right). No personal or family history of any cardiovascular diseases and risk factor were found except protein S deficiency with 15%, 22% and 32%. One died at eight months later of follow up by stroke relapse, the second had completely health recovery after six months, and the third patient remained with partial paralysis. The research of protein S deficiency must be born in mind in patient with ischemic stroke if any other risk factor was not found.

Background: Neuromeningeal cryptococcosis (NMC) frequency has increased since the appearance of HIV/ AIDS infection with high mortality rate. Objective: To assess the clinical and epidemiological features of the NMC in hospital field. Patients and method: It was a retrospective study carried out on patients at 4 public health structures in the largest region of the country from 2005 to 2009. The mainly criteria were HIV+ conditions and the research of cryptococcus neoformans in CSF by Indiana ink test. The anthropometric, clinical, therapeutic and follow up data were also collected. Results: The study covered 41,327 patients. HIV + patients were 18.52% (7653/41327). CSF was analyzed in 1758 with 978 samples from HIV+ subjects. The research of cryptococcus in CSF was performed in 19.40% (341/1758). It was positive in 2.35% (8 cases). Culture was negative for all patients. Hospital frequency was 0.02% and 0.10% in HIV+ patients. The incidence rate was 1.6. The average age was 36 years (28 and 45 years), including 5 men and 3 women. The principal symptoms were marked by fever (75%) and headache (62.5%), associated to oropharyngeal candidiasis in 37.50%. T-lymphocytes accounts means was 37.4 cells /mm3.All patients were treated with fluconazole. The hospital length stay was 12.25 days. The mortality rate was 62.5%. Discussion: NMC remains under estimate with non specific signs. Early diagnostic and rapid therapeutic approaches are the challenges to achieve for all neurologists in tropical setting. Conclusion: We recommend to research cryptococcus in CSF forwards any meningo encephalitis in HIV infected patient.

The apartheid regime kept the black majority in theinformalsettlementswheretheyenduredthemostagonizingbrunt of urban underdevelopment. Democratic government ofSouth Africa today continues to shape, reshape and reinforcethisunderdevelopmentalbeitinnewforms.Thispaperexamines the vulnerability of residents of informal settlement inMidvaalMunicipalitypursuedthroughacasestudyofSiceloShiceka, an informal settlement. The empirical findings of thisstudyunpackedthatinformalsettlementsarelargelyvulnerabletolackofwater,ablation,HIV/AIDS,crimeandviolence,xenophobiaandunemploymentamongstothers.Inresponse to some the vulnerabilities such as lack of income,informalresidentshaveadoptedarangeoflivelihoodstrategiesincludingcommercializationofsex,domesticworkand so on. The study concludes that the vulnerability and livedexperiences of residents points to poverty. These findings areprojected through in-depth interviews which are a technique ofqualitativemethodology.Theoratically,thepaperisinformedbythesocialsustainabilityandsustainablelivelihoodapproach.

Vehicular Ad-hoc Networks (VANETs) are major popular wireless environment for Intelligence Transport Systems (ITS). This paper concentrates on Location Identification and Driver Safety (LIDS). Location identification is mapping out by using RFID (Radio Frequency Identification) technology to recognize the current location and also corresponding surrounded areas. The additional feature to be included is to control the speed of vehicle, when ever vehicle crosses school and hospital zones. For driver safety can be carried out using grip force sensor and eye-ball sensor. Driver’s drowsiness is detected by the sensors and alerts the buzzer and stops when ever driver comes to normal state and pressing reset button. The complete system is controlled by an effectual low cost version of 8051 microcontroller (AT89S52). On the whole, LIDS suits well for safety vehicle system. The implementation results show better performance than already existing methods.

Aboveground biomass (AGB) is one of the key parameters for carbon accounting in a forest area. However, estimating this parameter by using remote sensing approach has been challenging as the interpretation of remotely sensed data are constrained by various factors, especially in a complex tropical forest ecosystem. Synthetic aperture radar (SAR) sensor system has its potential in obtaining acceptable AGB estimation but several issues such as complex forest structure and saturation at certain biomass levels remain unanswered and continuously being studied. This study was carried out to identify factors that contribute to the variation of backscattering properties on forest biomass. The sensitivity of L-band backscatter from Alos Palsar satellite with a wavelength of about 23 cm to the forest biomass was examined. Natural and logged forests of Dungun Timber Complex in Terengganu, Peninsular Malaysia were selected as the study area. AGB at a number of sample plots were measured on the ground in the study area. Both aspects of forestry and remote sensing comprised several variables namely tree allometry, vertical forest strata, tree diameter classes, radar polarimetry, and spatial variability were examined in four experiments. AGB was calculated based on these parameters and tested by using statistical backward elimination method to identify the most significant factor that infer the backscatter. The study revealed that the L-band Alos Palsar backscatter interacts only with canopies of forest at certain size of trees.

A rapid, simple, accurate, and economical least time consuming rosuvastatin spectrophotometric method has been developed for the assay of atorvastatin and then compare assay of brand available in Karachi,Pakistan. The assay is based on the ultraviolet UV absorbance maxima at about 244nm wavelength of atorvastatin using methanol as solvent. A sample of drug was dissolved in methanol to produce a solution containing atorvastatin. Similarly, a sample of ground tablets of different brand were extracted with methanol and diluted with the same methanol. The absorbance of sample preparation was measured at 244 nm against the solvent blank and the assay was determined by comparing with the absorbance of available brand. The method can be applied for the routine QC quantitation of atorvastatin in tablet formulation and active.

Ureteroscopy is defined as upper urinary tract endoscopy performed most commonly with an endoscope passed through the urethra, bladder, and then directly into the upper urinary tract. Indications for ureteroscopy have broadened from diagnostic endoscopy to various minimally invasive therapies. Objectives: To evaluate the effectiveness of Ureteroscopy and retrograde studies in diagnosis and treatment different ureteric pathology. Materials and Methods: This is a prospective cross sectional hospital based study conducted in Khartoum Sudan, in IbnSina hospital, Omdurman Military base hospital ISH, OMBH and SUH in the period between Oct 2012-Sep 2012. It included all patients who underwent Ureteroscopy and retrograde studies Results: Most patients were males in the ages between 31-40 yrs old, Loin pain was the most common presenting symptom in 116(91.3%). The diagnosis was made initially using imaging using U/S, IVU, CT KUB The main indication for ureteroscopy in this study was Ureteric stone (78.7%), These imaging findings when compared to ureteroscopy results showed a discrepancy in diagnosis. Disintegration of stones done in 60 pts (74.2%) and stone extraction was performed in 26 pts (33% ) Post ureteroscopy DJ stenting was performed for all patients who underwent ureteroscopy , (20%) of patients had post-operative complications. Conclusion: In this study it is our opinion that Ureteroscopy and retrograde studies is an effective and safe interventional and diagnostic modality for different ureteal pathology.