Decoupling Simulated Annealing From Massive Multiplayer Online Role-Playing Games in RAID

End-users agree that compact technology are an interesting new topic in the field of electri- cal engineering, and physicists concur. In fact, few futurists would disagree with the deploy- ment of Byzantine fault tolerance, demonstrates the structured importance of cryptography. We construct a novel algorithm for the simulation of write-ahead logging (JDL), validating that Byzantine fault tolerance can be made peer-to- peer, classical, and stable. It is often an important mission but is supported by previous work in the field

Vincentiana Vol. 36, No. 1-2 [Full Issue]

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Asociacion del APGAR Familiar y los Valores de Hemoglobina Glicosilada en Pacientes Portadores de Diabetes Mellitus Tipo 2 en los Centro de Salud Carlos Llosa - Hunter y Centro de Salud Edificadores Misti, Arequipa 2018

La diabetes mellitus es una enfermedad crónica prevalente ,según la OMS la prevalencia en adultos mayores de 18 años es de 8,5 % para el 2014. (Salud O. M., 2018) En el Perú el INEI en el 2017 se reportó una prevalencia de 3,3 % en la población adulta mayor a 15 años a nivel nacional. (INEI, 2017).Teniendo esto en cuenta se hace importante entender el funcionamiento familiar para apoyar en el control del paciente diabético y así disminuir los niveles de hemoglobina glicosilada en pacientes portadores de Diabetes Mellitus tipo II que pertenecen a los Centros de Salud Carlos Llosa - Hunter y Edificadores Misti. Y así mejorar el nivel de apoyo l control de enfermedad de esos pacientes y apoyar al Programa de Enfermedades no transmisibles del MINSA y evitar complicaciones crónicas a largo plazo que tienen graves consecuencias no solo para la familia ; sino también a los servicios de salud ya que encarecen los costos de salud. Propósito: El APGAR familiar mide la funcionalidad familiar , esta para el médico familiar es un pilar para el control de múltiples patologías, dentro de ellas la Diabetes Mellitus por tener alta prevalencia de complicaciones en la población general encareciendo los costos de los servicios de salud. El presente trabajo pretende demostrar que uno de los factores más importantes para mejorar el control del paciente diabético que se mide por los niveles de hemoglobina glicosilada es la FUNCIONALIDAD FAMILIAR. Métodos: En el presente trabajo se realizaran visitas domiciliarias A LOS PACIENTES DIABETICOS DENTRO DE LA JURISICCION DE LOS los Centros de Salud Carlos Llosa - Hunter y Edificadores Misti EMPADRONADOS EN EL Programa de Daños no Transmisibles (DANT) , luego De firmaran los consentimientos informados Se procederá a la toma de la hemoglobina glicosilada en sangre y a la aplicación de CUESTIONARIO DE APGAR FAMILIAR , luego de unos 3 meses se procederá a una segunda visita domiciliaria con un segunda toma de hemoglobina glicosilada en sangre y se compararan los resultados. los consentimientos informados autorizaron su participación en la investigación, serán incluidos en el presente estudio Análisis estadístico: El presente trabajo es un estudio descriptivo, observacional, correlacional, y prospectivo, de la información obtenida con el cuestionario de APGAR FAMILIAR y el valor de hemoglobina glicosilada obtenida de las visitas domiciliarias a pacientes diabéticos de la JURISICCION DE LOS los Centros de Salud Carlos Llosa - Hunter y Edificadores Misti EMPADRONADOS EN EL Programa de Daños no Transmisibles (DANT) para lo cual se utilizara el estadístico chi - cuadrado y Correlación de Pearson PALABRAS CLAVE: Diabetes Mellitus tipo 2, Apgar familiar, Hemoglobina GlicosiladaTrabajo académic

Sistema para el Costeo de las Ordenes de Trabajo en Illary Joste S.R.L. Basado en un Costeo por Actividades como Herramienta para la Estimación de Costos, la Fijación de Precios y la Medición del Impacto en la Toma de Decisiones

En la actualidad la competitividad es un tema de vital importancia para una empresa que quiere desarrollarse. El presente trabajo nace de la aplicación de una metodología de costeo por actividades a la realidad de una empresa textil. Con el paso del tiempo, el mercado ha cambiado el cual demanda que las empresas se vuelvan más competitivas para sobrevivir y un pilar para lograr la competitividad es conocer el costo del proceso productivo. Ya que esto nos permite generar ideas para atacar los generadores de costos con la finalidad de reducir estos mismos. Desarrollar el proceso de costeo también tiene aplicaciones tanto a nivel estratégico como operativo, permitiendo asignar a las personas adecuadas a determinadas tareas o decidiendo volúmenes de producción según la conveniencia de la empresa. En el transcurso del trabajo detallaremos como se logró construir un sistema de costeo y una herramienta practica para el uso del sistema basado en actividades para Illary Joste S.R.L. en el cual las ordenes de trabajo viajan a través de cada actividad, absorbiendo sus costos, esto con dos finalidades: una – finalidad a corto plazo, fijación de precios para producción propia y para terceros (servicio) y dos – finalidad a mediano y largo plazo, la herramienta para decidir en donde invertir y a su vez medir el impacto de las inversiones en nuestros procesos en base a los costos de cada actividad, básicamente estos dos conceptos mencionados ayudaran a mejorar la competitividad de la empresa, ya que la empresa contará con una herramienta que dará el soporte necesario para poder fijar precios en base a nuestros costos y de igual manera plantear mejoras y medir el impacto de estas. El presente trabajo se puede aplicar a otras empresas del rubro que realicen los procesos de acabado y tejido puesto que el proceso productivo suele ser el mismo, con ciertas variaciones que deben ser adecuadas a la realidad de cada empresa. Palabras Clave: Costeo por Actividades, Textil, Tejido Plano, Proceso, AcabadoTesi

Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes: a case-control study

Abstract Background Lateral epicondylitis is a common sports injury of the elbow caused due to altered muscle activation during repetitive wrist extension in many athletic and non-athletic endeavours. The amount of muscle activity and timing of contraction eventually is directly dependent upon joint position during the activity. The purpose of our study was to compare the grip strength in athletes with lateral epicondylalgia in two different wrist extension positions and compare them between involved and uninvolved sides of athletes and non-athletes. Methods An assessor-blinded case-control study of eight athletes and twenty-two non-athletes was done. The grip strength was measured using JAMAR® hand dynamometer in kilograms-force at 15 degrees (slightly extended) and 35 degrees (moderately extended) wrist extension positions (maintained by wrist splints) on both involved and uninvolved sides of athletes and non-athletes with unilateral lateral epicondylitis of atleast 3 months duration. Their pain was to be elicited with local tenderness and two of three tests being positive- Cozen's, Mill's manoeuvre, resisted middle finger extension tests. For comparisons of grip strength, Wilcoxon signed rank test was used for within-group comparison (between 15 and 35 degrees wrist extension positions) and Mann-Whitney U test was used for between-group (athletes vs. non-athletes) comparisons at 95% confidence interval and were done using SPSS 11.5 for Windows. Results Statistically significant greater grip strength was found in 15 degrees (27.75 ± 4.2 kgms in athletes; 16.45 ± 4.2 kgms in non-athletes) wrist extension than at 35 degrees (25.25 ± 3.53 kgm in athletes and 14.18 ± 3.53 kgm in non-athletes). The athletes had greater grip strength than non-athletes in each of test positions (11.3 kgm at 15 degrees and 11.07 kgm at 35 degrees) measured. There was also a significant difference between involved and uninvolved sides' grip strength at both wrist positions (4.44 ± .95 kgm at 15 degrees and 4.44 ± .86 kgm in 35 degrees) which was significant (p Conclusion The grip strength was greater in 15 degrees wrist extension position and this position could then be used in athletes with lateral epicondylalgia for grip strength assessment and designing wrist splint in this population.</p

Ultrasound evaluation in combination with finger extension force measurements of the forearm musculus extensor digitorum communis in healthy subjects

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate the usefulness of an ultrasound-based method of examining extensor muscle architecture, especially the parameters important for force development. This paper presents the combination of two non-invasive methods for studying the extensor muscle architecture using ultrasound simultaneously with finger extension force measurements.</p> <p>Methods</p> <p>M. extensor digitorum communis (EDC) was examined in 40 healthy subjects, 20 women and 20 men, aged 35–73 years. Ultrasound measurements were made in a relaxed position of the hand as well as in full contraction. Muscle cross-sectional area (CSA), pennation angle and contraction patterns were measured with ultrasound, and muscle volume and fascicle length were also estimated. Finger extension force was measured using a newly developed finger force measurement device.</p> <p>Results</p> <p>The following muscle parameters were determined: CSA, circumference, thickness, pennation angles and changes in shape of the muscle CSA. The mean EDC volume in men was 28.3 cm³and in women 16.6 cm³. The mean CSA was 2.54 cm²for men and 1.84 cm²for women. The mean pennation angle for men was 6.5° and for women 5.5°. The mean muscle thickness for men was 1.2 cm and for women 0.76 cm. The mean fascicle length for men was 7.3 cm and for women 5.0 cm. Significant differences were found between men and women regarding EDC volume (p < 0.001), CSA (p < 0.001), pennation angle (p < 0.05), muscle thickness (p < 0.001), fascicle length (p < 0.001) and finger force (p < 0.001). Changes in the shape of muscle architecture during contraction were more pronounced in men than women (p < 0.01). The mean finger extension force for men was 96.7 N and for women 39.6 N. Muscle parameters related to the extension force differed between men and women. For men the muscle volume and muscle CSA were related to extension force, while for women muscle thickness was related to the extension force.</p> <p>Conclusion</p> <p>Ultrasound is a useful tool for studying muscle architectures in EDC. Muscle parameters of importance for force development were identified. Knowledge concerning the correlation between muscle dynamics and force is of importance for the development of new hand training programmes and rehabilitation after surgery.</p

Strengthening and stretching for rheumatoid arthritis of the hand (SARAH):Design of a randomised controlled trial of a hand and upper limb exercise intervention-ISRCTN89936343

Background: Rheumatoid Arthritis (RA) commonly affects the hands and wrists with inflammation, deformity, pain, weakness and restricted mobility leading to reduced function. The effectiveness of exercise for RA hands is uncertain, although evidence from small scale studies is promising. The Strengthening And Stretching for Rheumatoid Arthritis of the Hand (SARAH) trial is a pragmatic, multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of adding an optimised exercise programme for hands and upper limbs to best practice usual care for patients with RA.Methods/design: 480 participants with problematic RA hands will be recruited through 17 NHS trusts. Treatments will be provided by physiotherapists and occupational therapists. Participants will be individually randomised to receive either best practice usual care (joint protection advice, general exercise advice, functional splinting and assistive devices) or best practice usual care supplemented with an individualised exercise programme of strengthening and stretching exercises. The study assessors will be blinded to treatment allocation and will follow participants up at four and 12 months. The primary outcome measure is the Hand function subscale of the Michigan Hand Outcome Questionnaire, and secondary outcomes include hand and wrist impairment measures, quality of life, and resource use. Economic and qualitative studies will also be carried out in parallel.Discussion: This paper describes the design and development of a trial protocol of a complex intervention study based in therapy out-patient departments. The findings will provide evidence to support or refute the use of an optimised exercise programme for RA of the hand in addition to best practice usual care.Trial registration: Current Controlled Trials ISRCTN89936343Keywords: Randomised controlled trial, Rheumatoid arthritis, Exercise, Hand, Rehabilitatio