CASE REPORT: CHOANAL ATRESIA IN CHILDREN

Choanal atresia is a disorder in which there is a congenital membrane or bone in one or both choanas due to the failure of the buconasalis membrane to divide from the embryonic period. Currently, there is still controversy about the effectiveness of various surgical techniques and the need for post-surgical use of stents and anti-neoplastic agents. Provides information regarding the diagnosis and management of choanal atresia. A 15-year-old female with bilateral choanal atresia. The patient underwent endonasal choanoplasty. Choanal was patented until the 8th week of post-operative evaluation. Management of choanal atresia. Making a neo-unicoana with a mucosal mesh is one of the effective surgical techniques for treating choanal atresi

Lerøy Seafood Group ASA : Strategisk regnskapsanalyse og verdivurdering

I denne masterutredningen er det blitt utført en omfattende strategisk regnskapsanalyse og verdivurdering av Lerøy Seafood Group ASA (Lerøy). Masteroppgavens formål er å estimere verdien av egenkapitalen per 31. desember 2022. Fundamental verdivurdering er oppgavens hovedmetode, supplert med komparativ verdsettelse. Det endelige verdiestimatet ble avslutningsvis sammenlignet med børskurs på verdsettelsestidspunktet, for å avgi en anbefalt handlingsstrategi av Lerøy-aksjen. Første del av masteroppgaven begynner med en presentasjon av Lerøy og oppdrettsbransjen, deretter følger strategisk analyse. Den eksterne bransjeanalysen belyser at oppdrettsnæringen er attraktiv, dette bekreftes senere av lønnsomhetsanalysen som viser en bransjefordel på 7,3 %. Restriktiv konsesjonspolitikk medfører høye inngangsbarrierer som følgelig demper konkurransen. Miljømessige utfordringer er bransjens største trussel og svekker produksjonen av laks. Høy etterspørsel etter laks som sådan kombinert med begrensninger i tilbudet, driver prisene opp. Internanalysen avdekker at Lerøy ikke har varig konkurransefortrinn. Den negative ressursfordelen tilskrives en marginulempe, som beror på at Lerøy har høyere driftskostnader per krone i driftsinntekter enn bransjen. Dette mener vi skyldes høyere relative fôrkostnader. Rentabilitetsanalysen konkluderer med negativ ressursfordel på -2,4%. Del 2 av oppgaven begynner med en omfattende omgrupperings- og justeringsprosess av Lerøy og de komparative selskapenes regnskap. Fra regnskapsanalysen fremgikk det at Lerøy ikke innehar likviditets- eller soliditetsrisiko, og er godt rustet til å håndtere potensielle nedgangstider. Videre ble selskapets historiske avkastningskrav estimert, samt utarbeiding av rentabilitetsanalyser. Lønnsomhetsanalysen slo fast at Lerøy i perioden 2016-2022 har oppnådd strategisk fordel på 5,58%, bakteppet er i hovedsak bransjefordelen. I siste del av oppgaven ble det utarbeidet et fremtidsregnskap og -krav. Usikkerhet i dag vedrørende grunnrenteskatt vil medføre en lavere strategisk fordel på kort sikt, men mot steady state har vi estimert en vekst på 3,29%. Den fundamentale verdsettelsen resulterte i et verdiestimat på 55,5 kr per aksje. For å fastslå usikkerheten i verdiestimatet ble det foretatt en simuleringsanalyse av de viktigste budsjettdriverne. Analysen fastslo høy usikkerhet, verdiestimatet var særlig følsomt overfor endringer i driftsinntektsvekst og netto driftsmargin ved budsjetthorisonten. Vi benyttet multipler som supplerende verdsettelse, gjennomsnittet av disse ble 71,17 kr per aksje. Ved å vekte den fundamentale metoden 80 % og den komparative verdsettelsen 20 %, kom vi frem til et endelig estimat på kroner 58,6 per aksje. Den 23. mai 2023 var børskursen 50,8, dermed konkluderer oppgaven med kjøpsanbefaling på aksjen. Årsaken til at vårt estimat er høyere enn børskursen, skyldes i hovedsak at markedet er mer pessimistisk til grunnrenteskatten.nhhma

PERAN GEREJA DALAM MENINGKATKAN MOTIVASI UNTUK BERIBADAH SECARA TATAP MUKA PASCA PANDEMI COVID

After two years of a pandemic where worship activities could not be carried out and were limited, the government began to relax the rules for worship, and churches resumed their activities and held face-to-face worship. Even though some congregations are starting to come to worship face-to-face enthusiastically, others are still choosing to worship online. During the hybrid worship period, where online services are still held simultaneously as face-to-face services, the church seeks various ways to invite the entire congregation back to attend services. Based on direct observations and interviews with pastors and congregations that have attended, various factors have been found that can be a driving force for congregations longing to attend face-to-face activities; the church also uses various creative ways to provoke the desire of congregations that are not present to be able to feel and remember the enjoyment worship directly. Efforts to attract the congregation to return to attendance, thanks to the role of the pastor's attention to the congregation and various supporting factors, have resulted in the return of almost the entire congregation for face-to-face worship.Setelah dua tahun pandemi dimana kegiatan beribadah tidak dapat dilakukan dan dibatasi, pemerintah mulai melonggarkan aturan beribadah, gereja memulai kembali beraktifitas dan mengadakan ibadah tatap muka. Walaupun sebagian jemaat mulai antusias datang beribadah tatap muka, sebagian jemaat yang tetap memilih beribadah daring. Dalam masa ibadah hybrid dimana ibadah on line masih dilaksanakan bersamaan ibadah tatap muka, gereja mencari berbagai cara kembali mengajak seluruh jemaat kembali hadir dalam ibadah. Berdasarkan pengamatan dan wawancara secara langsung dengan gembala dan jemaat yang telah hadir didapati berbagai faktor yang dapat menjadi pendorong untuk jemaat rindu untuk hadir dalam kegiatan tatap muka, gereja juga menggunakan berbagai cara yang kreatif untuk memancing keinginan jemaat yang belum hadir dapat merasakan dan mengingat kembali kenikmatan beribadah secara langsung. Usaha untuk menarik jemaat untuk kembali hadir berkat peran perhatian gembala kepada jemaat dan berbagai faktor pendukungnya membuahkan hasil dengan kembali hadirnya hampir seluruh jemaat untuk beribadah tatap muka

Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force

Background: Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). Objective: To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. Methods: Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. Results: Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9-10 (10: maximum agreement) for all recommendations. A research agenda was formulated. Conclusions: The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA

Immunological corollary of the pulmonary mycobiome in bronchiectasis:The Cameb study

Understanding the composition and clinical importance of the fungal mycobiome was recently identified as a key topic in a “research priorities” consensus statement for bronchiectasis. Patients were recruited as part of the CAMEB study: an international multicentre cross-sectional Cohort of Asian and Matched European Bronchiectasis patients. The mycobiome was determined in 238 patients by targeted amplicon shotgun sequencing of the 18S–28S rRNA internally transcribed spacer regions ITS1 and ITS2. Specific quantitative PCR for detection of and conidial quantification for a range of airway Aspergillus species was performed. Sputum galactomannan, Aspergillus specific IgE, IgG and TARC (thymus and activation regulated chemokine) levels were measured systemically and associated to clinical outcomes. The bronchiectasis mycobiome is distinct and characterised by specific fungal genera, including Aspergillus, Cryptococcus and Clavispora. Aspergillus fumigatus (in Singapore/Kuala Lumpur) and Aspergillus terreus (in Dundee) dominated profiles, the latter associating with exacerbations. High frequencies of Aspergillus-associated disease including sensitisation and allergic bronchopulmonary aspergillosis were detected. Each revealed distinct mycobiome profiles, and associated with more severe disease, poorer pulmonary function and increased exacerbations. The pulmonary mycobiome is of clinical relevance in bronchiectasis. Screening for Aspergillus-associated disease should be considered even in apparently stable patients.MOE (Min. of Education, S’pore)NMRC (Natl Medical Research Council, S’pore)Published versio

Distinct 'Immuno-Allertypes' of Disease and High Frequencies of Sensitisation in Non-Cystic-Fibrosis Bronchiectasis

Rationale: Allergic sensitization is associated with poor clinical outcomes in asthma, chronic obstructive pulmonary disease, and cystic fibrosis; however, its presence, frequency, and clinical significance in non–cystic fibrosis bronchiectasis remain unclear. Objectives: To determine the frequency and geographic variability that exists in a sensitization pattern to common and specific allergens, including house dust mite and fungi, and to correlate such patterns to airway immune-inflammatory status and clinical outcomes in bronchiectasis. Methods: Patients with bronchiectasis were recruited in Asia (Singapore and Malaysia) and the United Kingdom (Scotland) (n = 238), forming the Cohort of Asian and Matched European Bronchiectasis, which matched recruited patients on age, sex, and bronchiectasis severity. Specific IgE response against a range of common allergens was determined, combined with airway immune-inflammatory status and correlated to clinical outcomes. Clinically relevant patient clusters, based on sensitization pattern and airway immune profiles (“immunoallertypes”), were determined. Measurements and Main Results: A high frequency of sensitization to multiple allergens was detected in bronchiectasis, exceeding that in a comparator cohort with allergic rhinitis (n = 149). Sensitization was associated with poor clinical outcomes, including decreased pulmonary function and more severe disease. “Sensitized bronchiectasis” was classified into two immunoallertypes: one fungal driven and proinflammatory, the other house dust mite driven and chemokine dominant, with the former demonstrating poorer clinical outcome. Conclusions: Allergic sensitization occurs at high frequency in patients with bronchiectasis recruited from different global centers. Improving endophenotyping of sensitized bronchiectasis, a clinically significant state, and a “treatable trait” permits therapeutic intervention in appropriate patients, and may allow improved stratification in future bronchiectasis research and clinical trials.Ministry of Education (MOE)Ministry of Health (MOH)National Medical Research Council (NMRC)Published versionSupported by the Singapore Ministry of Health’s National Medical Research Council under its Transition Award NMRC/TA/0048/2016 (S.H.C.) and Changi General Hospital Research grant CHF2016.03-P (T.B.L.). The work performed at NUS was supported by the Singapore Ministry of Education Academic Research Fund, SIgN, and National Medical Research Council grants N-154-000-038-001, R-154-000-404-112, R-154-000-553-112, R-154-000-565-112, R-154-000-630-112, R-154-000-A08-592, R-154-000-A27-597, SIgN-06-006, SIgN-08-020, and NMRC/1150/2008 (F.T.C.); J.D.C. is supported by the GSK/British Lung Foundation Chair of Respiratory Research

Les droits disciplinaires des fonctions publiques : « unification », « harmonisation » ou « distanciation ». A propos de la loi du 26 avril 2016 relative à la déontologie et aux droits et obligations des fonctionnaires

The production of tt‾ , W+bb‾ and W+cc‾ is studied in the forward region of proton–proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98±0.02 fb−1 . The W bosons are reconstructed in the decays W→ℓν , where ℓ denotes muon or electron, while the b and c quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions.The production of $t\overline{t}$, $W+b\overline{b}$ and $W+c\overline{c}$ is studied in the forward region of proton-proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98 $\pm$ 0.02 \mbox{fb}^{-1}. The $W$ bosons are reconstructed in the decays $W\rightarrow\ell\nu$, where $\ell$ denotes muon or electron, while the $b$ and $c$ quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions

Physics case for an LHCb Upgrade II - Opportunities in flavour physics, and beyond, in the HL-LHC era

The LHCb Upgrade II will fully exploit the flavour-physics opportunities of the HL-LHC, and study additional physics topics that take advantage of the forward acceptance of the LHCb spectrometer. The LHCb Upgrade I will begin operation in 2020. Consolidation will occur, and modest enhancements of the Upgrade I detector will be installed, in Long Shutdown 3 of the LHC (2025) and these are discussed here. The main Upgrade II detector will be installed in long shutdown 4 of the LHC (2030) and will build on the strengths of the current LHCb experiment and the Upgrade I. It will operate at a luminosity up to 2×1034 cm−2s−1, ten times that of the Upgrade I detector. New detector components will improve the intrinsic performance of the experiment in certain key areas. An Expression Of Interest proposing Upgrade II was submitted in February 2017. The physics case for the Upgrade II is presented here in more depth. CP-violating phases will be measured with precisions unattainable at any other envisaged facility. The experiment will probe b → sl+l−and b → dl+l− transitions in both muon and electron decays in modes not accessible at Upgrade I. Minimal flavour violation will be tested with a precision measurement of the ratio of B(B0 → μ+μ−)/B(Bs → μ+μ−). Probing charm CP violation at the 10−5 level may result in its long sought discovery. Major advances in hadron spectroscopy will be possible, which will be powerful probes of low energy QCD. Upgrade II potentially will have the highest sensitivity of all the LHC experiments on the Higgs to charm-quark couplings. Generically, the new physics mass scale probed, for fixed couplings, will almost double compared with the pre-HL-LHC era; this extended reach for flavour physics is similar to that which would be achieved by the HE-LHC proposal for the energy frontier

LHCb upgrade software and computing : technical design report

This document reports the Research and Development activities that are carried out in the software and computing domains in view of the upgrade of the LHCb experiment. The implementation of a full software trigger implies major changes in the core software framework, in the event data model, and in the reconstruction algorithms. The increase of the data volumes for both real and simulated datasets requires a corresponding scaling of the distributed computing infrastructure. An implementation plan in both domains is presented, together with a risk assessment analysis

Multidifferential study of identified charged hadron distributions in ZZ-tagged jets in proton-proton collisions at s=\sqrt{s}=13 TeV

Jet fragmentation functions are measured for the first time in proton-proton collisions for charged pions, kaons, and protons within jets recoiling against a $Z$ boson. The charged-hadron distributions are studied longitudinally and transversely to the jet direction for jets with transverse momentum 20 $< p_{\textrm{T}} < 100$ GeV and in the pseudorapidity range $2.5 < \eta < 4$. The data sample was collected with the LHCb experiment at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 1.64 fb$^{-1}$. Triple differential distributions as a function of the hadron longitudinal momentum fraction, hadron transverse momentum, and jet transverse momentum are also measured for the first time. This helps constrain transverse-momentum-dependent fragmentation functions. Differences in the shapes and magnitudes of the measured distributions for the different hadron species provide insights into the hadronization process for jets predominantly initiated by light quarks.Comment: All figures and tables, along with machine-readable versions and any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2022-013.html (LHCb public pages