Management and Evaluation of Patient Satisfaction to Health Care in the Pediatric Clinic of the University Clinical Center of Kosovo

The aim of this research is to reflect the real data with the approach of health services in the University Clinical Center of Kosovo and also have received different opinions from parents of children who have been hospitalized in the pediatrics clinic than they were satisfied with the provision of this clinical services offered.Keywords: health management, evaluation of satisfaction of patients to health services, Pediatrics Clinic

Cold ultrarelativistic pulsar winds as potential sources of galactic gamma-ray lines above 100 GeV

The evidence of a line-like spectral feature at 130 GeV recently reported from some parts of the galactic plane poses serious challenges for any interpretation of this surprise discovery. It is generally believed that the unusually narrow profile of the spectral line cannot be explained by conventional processes in astrophysical objects, and, if real, is likely to be associated with Dark Matter. In this paper we argue that cold ultrarelativistic pulsar winds can be alternative sources of very narrow gamma-ray lines. We demonstrate that Comptonization of a cold ultrarelativistic electron-positron pulsar wind in the deep Klein-Nishina regime can readily provide very narrow distinct gamma-ray line features. To verify this prediction, we produced photon count maps based on the Fermi LAT data in the energy interval 100 to 140 GeV. We confirm earlier reports of the presence of marginal gamma-ray line-like signals from three regions of the galactic plane. Although the maps show some structure inside these regions, unfortunately the limited photon statistics do not allow any firm conclusion in this regard. The confirmation of 130 GeV line emission by low-energy threshold atmospheric Cherenkov telescope systems, in particular by the new 27 m diameter dish of the H.E.S.S. array, would be crucial for resolving the spatial structure of the reported hotspots, and thus for distinguishing between the Dark Matter and Pulsar origins of the `Fermi Lines'.Comment: 5 pages. 4 figure

Association between hospital case volume and the use of bronchoscopy and esophagoscopy during head and neck cancer diagnostic evaluation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102212/1/cncr28379.pd

Very-high energy gamma-ray astronomy: A 23-year success story in high-energy astroparticle physics

Very-high energy (VHE) gamma quanta contribute only a minuscule fraction - below one per million - to the flux of cosmic rays. Nevertheless, being neutral particles they are currently the best "messengers" of processes from the relativistic/ultra-relativistic Universe because they can be extrapolated back to their origin. The window of VHE gamma rays was opened only in 1989 by the Whipple collaboration, reporting the observation of TeV gamma rays from the Crab nebula. After a slow start, this new field of research is now rapidly expanding with the discovery of more than 150 VHE gamma-ray emitting sources. Progress is intimately related with the steady improvement of detectors and rapidly increasing computing power. We give an overview of the early attempts before and around 1989 and the progress after the pioneering work of the Whipple collaboration. The main focus of this article is on the development of experimental techniques for Earth-bound gamma-ray detectors; consequently, more emphasis is given to those experiments that made an initial breakthrough rather than to the successors which often had and have a similar (sometimes even higher) scientific output as the pioneering experiments. The considered energy threshold is about 30 GeV. At lower energies, observations can presently only be performed with balloon or satellite-borne detectors. Irrespective of the stormy experimental progress, the success story could not have been called a success story without a broad scientific output. Therefore we conclude this article with a summary of the scientific rationales and main results achieved over the last two decades.Comment: 45 pages, 38 figures, review prepared for EPJ-H special issue "Cosmic rays, gamma rays and neutrinos: A survey of 100 years of research

Towards the development of a community-based model for promoting cervical cancer prevention among Yoruba women in Ibadan Nigeria: Application of PEN-3 model

Through the identification of the barriers to the uptake of prevention services for cervical cancer and ways topromote prevention of cervical cancer in the community, this research study purposed the development of a community-based model for promoting cervical cancer prevention among Yoruba women living in Ibadan, Nigeria. An exploratory, descriptive design was used to collect data from 20 health workers and four policy makers using semi-structured interviews and key informant interviews respectively. The PEN-3 cultural model developed by Airhenbuwa in 1998guided the exploration of the barriers to the uptake of available prevention services for cervical cancer, and the ways topromote the prevention of cervical cancer. Three interrelated and interdependent primary domains, namely cultural identity,relationships and expectations, and cultural empowerment, form the basis of the PEN-3 model. Cultural identity emphasisesthe subjective responses in relation to the community and cervical cancer prevention

A new, very massive modular Liquid Argon Imaging Chamber to detect low energy off-axis neutrinos from the CNGS beam. (Project MODULAr)

The paper is considering an opportunity for the CERN/GranSasso (CNGS) neutrino complex, concurrent time-wise with T2K and NOvA, to search for theta_13 oscillations and CP violation. Compared with large water Cherenkov (T2K) and fine grained scintillators (NOvA), the LAr-TPC offers a higher detection efficiency and a lower backgrounds, since virtually all channels may be unambiguously recognized. The present proposal, called MODULAr, describes a 20 kt fiducial volume LAr-TPC, following very closely the technology developed for the ICARUS-T60o, and is focused on the following activities, for which we seek an extended international collaboration: (1) the neutrino beam from the CERN 400 GeV proton beam and an optimised horn focussing, eventually with an increased intensity in the framework of the LHC accelerator improvement program; (2) A new experimental area LNGS-B, of at least 50000 m3 at 10 km off-axis from the main Laboratory, eventually upgradable to larger sizes. A location is under consideration at about 1.2 km equivalent water depth; (3) A new LAr Imaging detector of at least 20 kt fiducial mass. Such an increase in the volume over the current ICARUS T600 needs to be carefully considered. It is concluded that a very large mass is best realised with a set of many identical, independent units, each of 5 kt, "cloning" the technology of the T600. Further phases may foresee extensions of MODULAr to meet future physics goals. The experiment might reasonably be operational in about 4/5 years, provided a new hall is excavated in the vicinity of the Gran Sasso Laboratory and adequate funding and participation are made available.Comment: Correspondig Author: C. Rubbia (E-mail: [email protected]), 33 pages, 11 figure

Internal shock model for the X-ray flares of Swift J1644+57

Swift J1644+57 is an unusual transient event, likely powered by the tidal disruption of a star by a massive black hole. There are multiple short timescales X-ray flares were seen over a span of several days. We propose that these flares could be produced by internal shocks. In the internal shock model, the forward and reverse shocks are produced by collisions between relativistic shells ejected from central engine. The synchrotron emission from the forward and reverse shocks could dominate at two quite different energy bands under some conditions, the relativistic reverse shock dominates the X-ray emission and the Newtonian forward shock dominates the infrared and optical emission. We show that the spectral energy distribution of Swift J1644+57 could be explained by internal shock model.Comment: 6 pages, 3 figures, accepted for publication in MNRA

Application of gamification for sustainable construction: an evaluation of the challenges

Purpose This paper aims to identify and evaluate the challenges affecting the adoption of gamification practices in developing countries through the lens of the Nigerian construction industry. Design/methodology/approach A scoping literature review was conducted through which challenges to the adoption of gamification practices were identified, which helped in the formulation of a questionnaire survey. Data was obtained from construction professionals including architects, builders, engineers and quantity surveyors. Retrieved data were analyzed using several statistical tools such as percentages, frequencies, mean item scores (MIS) and exploratory factor analyses. Findings Based on the MIS ranking results, the top five significant challenges to the adoption of gamification were lack of capacity and expertise, lack of budgeting for innovation, lack of technical infrastructure, hesitation to adopt and limited internet connectivity. Through factor analysis, the challenges identified were categorized into five principal clusters, namely, organizational challenges, technical-related challenges, human-related challenges, data security challenges and economic challenges. Practical implications The identification and evaluation of the key challenges hindering the adoption of gamification practices would help construction organizations and stakeholders to understand the need to embrace and implement the concept into their activities, operations and processes to improve the engagement and motivation levels of employees. Originality/value To the best of the authors’ knowledge, this study is the first of its kind in the study area to identify and evaluate the challenges affecting the adoption of gamification practices using a structured quantitative approach

A Beta Beam complex based on the machine upgrades for the LHC

The Beta Beam CERN design is based on the present LHC injection complex and its physics reach is mainly limited by the maximum rigidity of the SPS. In fact, some of the scenarios for the machine upgrades of the LHC, particularly the construction of a fast cycling 1 TeV injector (``Super-SPS''), are very synergic with the construction of a higher $\gamma$ Beta Beam. At the energies that can be reached by this machine, we demonstrate that dense calorimeters can already be used for the detection of $\nu$ at the far location. Even at moderate masses (40 kton) as the ones imposed by the use of existing underground halls at Gran Sasso, the CP reach is very large for any value of $\theta_{13}$ that would provide evidence of $\nu_e$ appearance at T2K or NO$\nu$A ($\theta_{13}\geq 3^\circ$). Exploitation of matter effects at the CERN to Gran Sasso distance provides sensitivity to the neutrino mass hierarchy in significant areas of the $\theta_{13}-\delta$ plane

T lymphocytes induce human cancer cells derived from solid malignant tumors to secrete galectin-9 which facilitates immunosuppression in cooperation with other immune checkpoint proteins.

BACKGROUND Galectin-9 is a member of the family of lectin proteins and crucially regulates human immune responses, particularly because of its ability to suppress the anticancer activities of T lymphocytes and natural killer cells. Recent evidence demonstrated that galectin-9 is highly expressed in a wide range of human malignancies including the most aggressive tumors, such as high-grade glioblastomas and pancreatic ductal adenocarcinomas, as well as common malignancies such as breast, lung and colorectal cancers. However, solid tumor cells at rest are known to secrete either very low amounts of galectin-9 or, in most of the cases, do not secrete it at all. Our aims were to elucidate whether T cells can induce galectin-9 secretion in human cancer cells derived from solid malignant tumors and whether this soluble form displays higher systemic immunosuppressive activity compared with the cell surface-based protein. METHODS A wide range of human cancer cell lines derived from solid tumours, keratinocytes and primary embryonic cells were employed, together with helper and cytotoxic T cell lines and human as well as mouse primary T cells. Western blot analysis, ELISA, quantitative reverse transcriptase-PCR, on-cell Western and other measurement techniques were used to conduct the study. Results were validated using in vivo mouse model. RESULTS We discovered that T lymphocytes induce galectin-9 secretion in various types of human cancer cells derived from solid malignant tumors. This was demonstrated to occur via two differential mechanisms: first by translocation of galectin-9 onto the cell surface followed by its proteolytic shedding and second due to autophagy followed by lysosomal secretion. For both mechanisms a protein carrier/trafficker was required, since galectin-9 lacks a secretion sequence. Secreted galectin-9 pre-opsonised T cells and, following interaction with other immune checkpoint proteins, their activity was completely attenuated. As an example, we studied the cooperation of galectin-9 and V-domain Ig-containing suppressor of T cell activation (VISTA) proteins in human cancer cells. CONCLUSION Our results underline a crucial role of galectin-9 in anticancer immune evasion. As such, galectin-9 and regulatory pathways controlling its production should be considered as key targets for immunotherapy in a large number of cancers