Activating the Method of Management by Objectives and its Impact on Institutional Performance: A Field Study for the Tax Directorate in the State of Mascara

This study aimed to identify the extent of the effect of activating the management according to the objectives method in improving institutional performance and to test the relationship between management In terms of dimensions (participation in setting goals, developing an action plan, periodic review, performance evaluation). To demonstrate this, we conducted a field study for the Tax Directorate in Camp Campus of a sample of 64 questionnaires, where the SPSS program was used in statistical processing and data analysis. In order to test the hypotheses, the simple and multiple linear regression method was used. The study concluded that there is no statistically significant effect at the level (α = 0.05) for the two dimensions (participation in setting goals, developing an action plan) on institutional performance, in contrast there is a statistically significant effect at Level (α = 0.05) for two dimensions (periodic review, performance evaluation) on institutional performance

Role of serum tumour necrosis factor alpha and its soluble receptors in predicting acute renal allograft rejection

Tumour necosis factor alpha (TNF-?) is known to be involved in pathogenesis of acute renal allograft rejection. However, measurement of cytokine serum levels alone are not a reliable index of acute rejection episodes. TNF-?induces the release of soluble receptors (TNF-SR55 and TNF-SR75) that have an inhibitory activity and catabolized by the kidney.Twenty nine transplant recepients were studied and compared to ten healthy controls. TNF-?, TNF-SR55 and TNF-SR75 were measured before and after renal transplantation. The mean pre-transplantation values were 26.3 9.7 pg/ml, 28.2 8.3 and 42.5 11.1 ng/ml respectively. According to post-transplant course patients were divided into 3 groups. Group I (stable transplant group: no= 17): The mean level of TNF-?value was 7.5 4.6 pg/ml, TNF-SR55 6.4 4.7 and TNF-SR75 12.5 8 ng/ml (p NS). Group II (acute allograft rejection group: no = 8): The mean values were 37.2 16.2 pg/ml, 16.9 9.6 and 30.9 13.4 ng/ml respectively (p< 0.05). Group III cyclosporine (CS) nephrotoxicity group: no= 4): The mean level of TNF-? was 9.9 2.1 pg/ml with a highly significant increase in its receptor values (9.4 1.0 & 21.2 6.8 ng/ml; vs 5.5 1.2 & 12.4 4.8 ng/ml respectively (P< 0.01). To improve the predictive value of this cytokine and its receptors,we calculated the ratios of TNF-a to both receptors (SR55-SR75). During acute rejection episode, the ratio values tocontrol were 2.4 0.6 vs 1.4 0.7 and 1.3 0.5 vs 0.7 0.4 respectively (P< 0.01). However, these ratios did not change significantly from control group during CS nephrotoxicity 1.5 0.5 vs 2.0 0.7 and 0.5 0.3 vs 0.9 0.2 respectively (p>0.05). Thus, TNF-? and its soluble receptor levels might be of diagnostic value in renal allograft rejecion.In conclusion: 1) TNF-? and its soluble receptors are highly increased during hemodialysis. 2) There is no significant difference between healthy controls and patients with stable grafts. 3)There is highly significant increase of TNF-? and its receptors during acute rejection episodes and the day (R-2) prerejection in contrast to internal controls. 4) There is insignificant decrease of TNF-? during CS nephrotoxicity with highly significant increase of TNF-SR55, TNF-SR75 when compared to internal controls. 5) The ratios of TNF-?to SR55 & SR75 showed highly significant increase during acute rejection episodes and insignificant decrease during CS nephrotoxicity when compared to internal controls

Social Media and Dermatology During the COVID-19 Pandemic: Analyzing User-Submitted Posts Seeking Dermatologic Advice on Reddit

INTRODUCTION: Reddit, a popular social media website, has numerous forums where users may discuss healthcare-related topics and request diagnostic and treatment advice for dermatologic conditions. We sought to analyze and grade user-submitted requests for dermatologic advice and their top responses on Reddit. METHODS: User-submitted posts requesting diagnostic advice and their respective responses on two popular Reddit forums, SkinCareAddiction (ScA) and DermatologyQuestions (DQ), were reviewed by three board-certified dermatologists using a grading rubric designed for this study. RESULTS: 300 posts and comments were reviewed. Diagnoses among all graders matched in 52.3% of posts with a mean grader confidence score of 4/5 (95% CI 3.89-4.11). 31% of responder\u27s comments recommended a diagnosis not included by any reviewer. Mean scores for the top comment\u27s accuracy, appropriateness, and potential to be misleading/dangerous were 3.28/5 (95% CI 3.12-3.45), 3.3/5 (95% CI 3.14-3.45), and 2.33/5 (95% CI 2.18-2.48), respectively. CONCLUSION: Reddit may be informative to patients requesting dermatologic advice. However, responses should be taken with caution as the information provided may be inaccurate or insufficient for treatment recommendations. Dermatologists should be aware of these resources used by patients

Advances in Cutaneous Squamous Cell Carcinoma Management

cSCC is increasing in prevalence due to increased lifespans and improvements in survival for conditions that increase the risk of cSCC. The absolute mortality of cSCC exceeds melanoma in the United States and approaches that of melanoma worldwide. This review presents significant changes in the management of cSCC, focusing on improvements in risk stratification, new treatment options, optimization of existing treatments, and prevention strategies. One major breakthrough in cSCC treatment is the advent of immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1), which have ushered in a renaissance in the treatment of patients with locally advanced and metastatic disease. These agents have offered patients with advanced disease decreased therapeutic toxicity compared to traditional chemotherapy agents, a more durable response after discontinuation, and improved survival. cSCC is an active field of research, and this review will highlight some of the novel and more developed clinical trials that are likely to impact cSCC management in the near future

Characterization of Two Historical Postage Stamps Made from Cotton Fibers and Their Restoration Trials Based on the Experimental Studies

This is the final version. Available on open access from Hindawi via the DOI in this recordData Availability: The data used to support the findings of this study are included within the article.Ancient stamps are suffering from the destructive effects of different kinds of inks that were prepared from different ingredients. Two Egyptian historical postage stamps printed in blue and red printing inks were evaluated and examined for their composition using a light microscope, SEM-EDS, FTIR, and Raman spectroscopic analyses. Mechanical, chemical, and deacidification treatments were done for the two stamps. Model stamps were made from the cotton pulp in the book house to simulate historical stamp paper with an average thickness of 11 microns. The unprinted and printed paper samples with printing inks that aged and unaged were treated with 0.7% Klucel G, 0.2% TiO2 NP, or a mixture of 0.7% Klucel G + 0.2% TiO2 NP, and the color change was measured and compared with the blank samples. The two stamps are suffering from high pH, where the margin color of the stamps changed to yellow-brown with weakness of the stamp paper. By SEM examination, stamps have suffered from fibers’ weakness and dryness resulting from the self-oxidation reactions. EDS elemental composition of the red stamp showed the presence of C, O, Na, Al, Si, Mg, S, Ca, Ba, and Fe, while in the blue stamp, it was C, O, Na, Al, Si, P, S, Cl, and Ca. Raman spectrometer wavelengths turn out that the blueprinting ink of the stamp was characterized with spectra of ultramarine blue (lazurite), while hematite was characterized by the red stamp. FTIR analysis for the printing inks identified that gum Arabic sample and linseed oil were the binding and color medium, respectively. From the model trials, it was observed that the treatment of a mixture of Klucel G and TiO2 NP had the best properties for the consolidation of stamps. The two historical stamps were documented through different spectroscopic analyses, and from the restoration trials, it was observed that the mixture of 7% Klucel G + 0.2% TiO2 NP appeared to be a new and effective method for recovering the historical postage stamps.King Saud University, Riyadh, Saudi Arabi

Outcomes of surgical treatment for upper urinary tract transitional cell carcinoma: Comparison of retroperitoneoscopic and open nephroureterectomy

<p>Abstract</p> <p>Objectives</p> <p>To determine the surgical and oncologic outcomes in patients who underwent retroperitoneoscopic nephroureterectomy (RNU) in comparison to standard open nephroureterectomy (ONU) for upper urinary tract transitional cell carcinoma (TCC).</p> <p>Patients and methods</p> <p>From April 2001 to January 2007, 60 total nephroureterectomy were performed for upper tract TCC at Siriraj Hospital. Of the 60 patients, thirty-one were treated with RNU and open bladder cuff excision, and twenty-nine with ONU. Our data were reviewed and analyzed retrospectively. The recorded data included sex, age, history of bladder cancer, type of surgery, tumor characteristics, postoperative course, disease recurrence and progression.</p> <p>Results</p> <p>The mean operative time was longer in the RNU group than in the ONU group (258.8 versus 190.6 min; p = 0. < 001). On the other hand, the mean blood loss and the dose of parenteral analgesia (morphine sulphate) were lower in the RNU group (289.3 versus 313.7 ml and 2.05 versus 6.72 mg; p = 0.868 and p = 0.018, respectively). There were two complications in each group. No significant difference in p stage and grade in both-groups (p = 0.951, p = 0.077). One patient with RNU had lymph node involvement, three in ONU. Mean follow up was 26.4 months (range 3–72) for RNU and 27.9 months (range 3–63) for ONU. No port metastasis occurred during follow up in RNU group. Tumor recurrence developed in 11 patients (bladder recurrence in 9 patients, local recurrence in 2 patients) in the RNU group and 14 patients (bladder recurrence in 13 patients, local recurrence in 1 patient) in the ONU group. No significant difference was detected in the tumor recurrence rate between the two procedures (p = 0.2716). Distant metastases developed in 3 patients (9.7%) after RNU and 2 patients (6.9%) after ONU. The 2 year disease specific survival rate after RNU and ONU was 86.3% and 92.5%, respectively (p = 0.8227).</p> <p>Conclusion</p> <p>Retroperitoneoscopic nephroureterectomy is less invasive than open surgery and is an oncological feasible operation. Thus, the results of our study supported the continued development of laparoscopic technique in the management of upper tract TCC.</p

Sporadic renal cell carcinoma in young and elderly patients: are there different clinicopathological features and disease specific survival rates?

BACKGROUND: Sporadic renal cell carcinoma (RCC) is rare in young adults. In the present retrospective study we reviewed clinicopathological features and disease specific survival rates in young patients (≤45 years) with RCC and compared them to old patients (≥75 years) with RCC. METHODS: Between 1992 and 2005 a total of 1042 patients were treated for RCC at our institution. We found 70 patients 45 years or younger (YP) and 150 patients 75 years or older (OP) at time of diagnosis. There were no differences in therapeutical approaches between both groups. Clinical and biologic parameters at diagnosis were compared and subjected to uni- and multivariate analysis to study cancer specific survival and progression rate. Mean postoperative follow-up in both groups was 50.1 months. RESULTS: Mean age was 39 years in YP and 80 years in OP, respectively. YP demonstrated significantly lower stage (pT1-pT2 N0 M0, p = 0.03), lower tumor grade (p = 0.01) and higher male-to-female ratio (p < 0.001). The rate of lymph node metastases or distant metastatic disease at presentation did not differ significantly between both groups. In multivariate analysis young age was independently associated with a higher 5-year cancer specific survival (95.2% vs. 72.3%, p = 0.009) and a lower 5-year progression rate (11.3% vs. 42.5%, p = 0.002). CONCLUSION: Sporadic RCC in young patients have lower tumor stages and grades and a better outcome compared to elderly. Age≤45 years was an independent prognostic factor for survival and progression