“
“Recently, the production of polymers loaded with inorganic nanomaterials has been one of the most economical techniques playing a special

role in improving the physical and mechanical properties of nanocomposites. Rubbers loaded with different concentrations of carbon nanoparticles CA4P (CNPs) were synthesized. The mechanical properties were tested according to standard methods. It was found that the properties of the investigated nanocomposites were improved, depending on the concentration of CNPs in the investigated composite. The optimum concentration was found to be 1.3 vol %. Affine deformation based on the Mooney-Rivilin model was used to visualize the effect of CNPs on the rubber. When polyethylene (PE) was added to rubber/CNPs at the optimum concentration (12.4 vol %), the modulus, tear resistance, and fatigue life were increased,

whereas the tensile strength decreased, and the strain at rupture MDV3100 remained almost same. A crosslink model was used to explain the influence of PE on the rubber/CNP nanocomposites. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci 122:3023-3029, 2011″
“PURPOSE: To compare the efficacy of conventional laser in situ keratomileusis (LASIK) in treating corneal astigmatism and in treating noncorneal ocular residual astigmatism.

SETTING: Private practice, Nashville, Tennessee, USA.

DESIGN: Retrospective case series.

METHODS: The records of dominant eyes of consecutive patients who had LASIK were retrospectively analyzed to compare the efficacy of LASIK in eyes with predominantly anterior corneal astigmatism with the efficacy in eyes with predominantly

ocular residual astigmatism (ORA). The ORA was determined by vector analysis using refractive cylinder and topographic astigmatism. Preoperatively, the ratio of ORA to preoperative refractive cylinder (R) was used to divide the patients Smoothened inhibitor into 2 groups; that is, eyes with predominantly anterior corneal astigmatism (ORA/R ratio <1.0) and eyes with predominantly ORA (ORA/R ratio >= 1.0). Efficacy was determined by examining the magnitude of the remaining uncorrected astigmatism and comparing the index of success (proportion of preoperative refractive astigmatism that remained uncorrected by LASIK) between the 2 groups.

RESULTS: The study evaluated 61 eyes of 61 patients. Conventional LASIK was twice as efficacious in the low-ORA group as in the high-ORA group. The index of success was 0.24 and 0.50, respectively, and the difference between groups was statistically significant (P = .036).

CONCLUSION: The efficacy of astigmatic correction by LASIK was significantly higher in eyes in which the preoperative refractive astigmatism was located mainly on the anterior corneal surface than in eyes in which it was mainly located posterior to the anterior corneal surface.

With excitation energy above the Tauc selleck chemical gap, the emission band systematically blue-shifts

and broadens with decreasing silicon content, suggesting tail to tail recombination as the prevailing luminescence mechanism. With subgap excitation, the response is instead peaked at 1.7 eV independently of the stoichiometry, likely as an effect of the spatial fluctuations of the gap. In this case, excitation and emission selectively occur in the Si rich domains within the material, and direct band to band recombination is proposed as the possible dominant process. Another effect of the nonuniform material composition is likely the unusual S-shaped evolution of the integrated photoluminescence intensity versus temperature observed for the sample richest in Si. This behavior has been described with a phenomenological model including two thermally activated nonradiative processes and one electron trap energy level. (C) 2011 American Institute of Physics. [doi: 10.1063/1.3575172]“
“Although a whole-cell pertussis vaccine was introduced in Pakistan in 1980, little is known about the pertussis prevalence and circulating strains in Pakistan. The aim of this study EPZ-6438 was to analyze Bordetella parapertussis isolates circulating between 2005 and 2009 in Pakistan and to compare them with those found in other countries during different periods. A total of 59 (7.35%) B.similar to parapertussis

isolates from 802 subjects (median age, 3 similar to years) from Pakistan, with pertussis-like symptoms were investigated. We carried out genotyping and DNA microarray analyses on these isolates and compared them with some international isolates of B.similar to parapertussis. We found that the allele for pertactin (prn) found in strains studied from

Pakistan was identical to the predominant type found in Europe. click here We showed that B.similar to parapertussis isolates circulating in Pakistan are part of the same pulsed-field gel electrophoresis group to those circulating in Finland during the period of 19822007. Finally, microarray analysis confirmed that the isolates collected in Pakistan, were quite similar to international strains. Overall, these results confirm that B.similar to parapertussis is extremely monomorphic. The high isolation rate of B.similar to parapertussis (7.35%) compared to Bordetella pertussis (0.5%) may suggest that the whole-cell vaccine used in Pakistan is effective against B.similar to pertussis (0.5% infections detected), but much less so against B.similar to parapertussis.”
“Each year in the past three decades has seen hundreds of thousands of runners register to run a major marathon. Of those who attempt to race over the marathon distance of 26 miles and 385 yards (42.195 kilometers), more than two-fifths experience severe and performance-limiting depletion of physiologic carbohydrate reserves (a phenomenon known as ‘hitting the wall’), and thousands drop out before reaching the finish lines (approximately 1-2% of those who start).

A linear relationship was observed between the maximum and mean tracheal areas and age for both the FETO group (maximum tracheal area: R(2) = 0.83, P = .0045; mean tracheal area: R(2) = 0.92, P = .0005) and the non-FETO group (maximum tracheal area: R(2) = 0.66, P = .0001; mean trachea area: R(2) = 0.66, P = .0001). The maximum tracheal area in both groups tended to decrease toward

the age of 5 years. Significantly different mean tracheal areas per tracheal quartile (P < .05) were found for all quartiles except for the proximal one-fourth.

Conclusion: The relative difference between proximal and largest tracheal width, area, and perimeter was significantly larger in patients who underwent FETO than in those treated expectantly, demonstrating tracheal dilatation in the former. Measurements BAY 73-4506 of tracheal dimensions at different levels indicate a maximum dilatation in the lower half of the trachea, which tends to level off toward the age of 5 years. (C) RSNA, 2010″
“A type of manganese

impurity center with two holes bound in it is disclosed in a lightly Mn-doped base layer of an n-i-p-i-n heterostructure. In addition to the intensively investigated Pexidartinib inhibitor (e, Lambda(0)(Mn)) peak, a photoluminescence (PL) peak appears at 820.3 nm under zero bias and is continuously shifted to 822.5 nm by negatively biasing the structure. Its circular polarization has the same polarity as PL (e, Lambda(0)(Mn)), and has a magnetic dependence fitted by a paramagnetic Brillouin function with S = 1/2 and g = 2.09.

These observations are consistent with the physical picture that in the Lambda(+)(Mn) center both the – 3/2 and the – 1/2 Selleck AZD1480 holes occupy the lowest 1S hydrogenic orbit with their spins parallel to each other and antiparallel to the 5/2 local spin of the 3d shell. This spin coupling picture in the Lambda(+)(Mn) center has been confirmed by a modified numerical calculation based upon effective mass theory. The feature of the ability to tune the impurity level of the A(Mn)(+) center makes it attractive for optically and electrically manipulating local magnetic spins in semiconductors. (C) 2011 American Institute of Physics. [doi: 10.1063/1.3575158]“
“Integral hair lipid (IHL) is bound to the keratinized cell surface to make an environmentally resistant lipid envelope. It is mainly positioned on the hair cuticle and inner root sheath. IHL in the hair follicle may regard as hair barrier to be similar to the epidermal lipid layer functioning as skin barrier. Major constituents of IHL are fatty acid, phytosphingosine, ceramide in decreasing order. Minor constituents of IHL are cholesterol, cholesterol sulfate and cholesterol oleate. Cuticle or cortical cell surface in hair are abundant in fatty acids unlike the keratinized area of epidermis or sebaceous gland, and about 30-40% of such fatty acids are composed of 18-methyl-eicosanoic acid which is known to be bound to proteins by ester or thioester bond.

CT images were acquired every minute during ablation to monitor MI-503 ic50 growth. Animals were sacrificed after the procedure. Ablation zones were then excised and sectioned transverse to the applicator in 5-mm increments. Minimum and

maximum diameter, cross-sectional area, length, and circularity were measured from gross specimens and CT images. Comparisons of each measurement were performed by using a mixed-effects model; P < .05 was considered to indicate a significant difference.

Results: Mean diameter (3.32 cm +/- 0.19 [standard deviation] vs 2.70 cm +/- 0.23, P < .001) was 25% larger with microwave ablation and mean cross-sectional area (8.25 cm(2) +/- 0.92 vs 5.45 cm(2) +/- 1.14, P < .001) was 50% larger with microwave ablation, compared with RF ablation. With microwave ablation, the zones of ablation were also significantly more circular in cross section (mean circularity, 0.90 +/- 0.06 vs 0.82 +/- 0.09; P < .05). One small pneumothorax was noted during RF ablation but stabilized without intervention.

Conclusion: Microwave ablation with a 17-gauge high-power triaxial antenna creates larger and more circular zones of ablation than does a similarly sized RF applicator in a preclinical animal model. Microwave ablation may be a more effective treatment selleck products of lung tumors. (C) RSNA, 2009″
“BackgroundIt

has been well documented that the diagnosis of cancer is psychologically devastating to both the patients and caregivers. The incidence and mortality

of esophageal cancer were 20.85 and 16.24 per 100,000 persons and the sixth most commonly diagnosed cancer and the fourth main cause of cancer death in China. We surveyed patients-caregivers dyad and examined the determinants of their depression and hopelessness.

ResultsThe AZD5363 purchase prevalence of depression among patients and caregivers was 52.8% and 47.2%, and the prevalence for hopelessness was 64.4% and 53.9%, respectively Regression models indicate that the variables measured could explain 58.9% and 51.7% of the variance in depression and 66.8% and 45.7% of the variance in hopelessness among patients and caregivers, respectively. Overall, hopelessness was a determinant of depression and vice versa to both patients and caregivers.

ConclusionEsophageal patients’ depression and hopelessness could also affect caregivers’ depression and hopelessness despite the social support that family caregivers have. Psychosocial interventions should be planned to both Chinese patients and caregivers considering the predictors found in this study. Copyright (c) 2013 John Wiley & Sons, Ltd.”
“The influence of Pr content on structure, magnetic properties, and magnetic entropy changes of La1-xPrxFe11.44Si1.56 was investigated.

[doi:10.1063/1.3582143]“
“Purpose: To prospectively determine the interpretation time associated with computer-aided detection (CAD) and to analyze how CAD affected radiologists’ decisions and their level of confidence in their interpretations of digital screening mammograms.

Materials and Methods: An Institutional Review Board exemption was obtained, and patient consent was waived in this HIPAA compliant study. The

Z-DEVD-FMK supplier participating radiologists gave informed consent. Five radiologists were prospectively studied as they interpreted 267 clinical digital screening mammograms. Interpretation times, recall decisions, and confidence levels were recorded without CAD and then with CAD. Software was used for linear regression fitting of interpretation times. P see more values less than .05 were considered to indicate statistically significant differences.

Results: Mean interpretation time without CAD was 118 seconds 6 4.2 (standard error of the mean). Mean time for reviewing CAD images was 23 seconds +/- 1.5. CAD identified additional findings in five cases, increased confidence in 38 cases, and decreased confidence in 21 cases. Interpretation time without CAD increased with the number of mammographic views (P<.0001). Mean times for interpretation without

CAD and review of the CAD images both increased with the number of CAD marks (P<.0001). The interpreting radiologist was a significant variable for all interpretation times (P<.0001). Interpretation Copanlisib time with CAD increased by 3.2 seconds (95% confidence interval: 1.8, 4.6) for each calcification cluster marked and by 7.3 seconds (95% confidence interval: 4.7, 9.9) for each mass marked.

Conclusion: The additional time required to review CAD images represented a 19% increase in the mean interpretation time without CAD. CAD requires a considerable time investment for digital screening mammography but may provide less measureable benefits in terms of confidence of the radiologists. (C) RSNA,

2010″
“Acute otitis media (AOM) is one of the most common infectious diseases in children. Nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis, Gram-negative bacteria, are considered major pathogens of AOM and respiratory tract infections. In this study, we used monophosphoryl lipid A (MPL) as a Toll-like receptor (TLR4) agonist to induce innate immune responses before challenge with NTHi and M.similar to catarrhalis to enhance bacterial clearance from the nasopharynx. Mice were intranasally administered 40, 10, or 1 similar to mu g of MPL and challenged with NTHi and M.similar to catarrhalis 12 and 24 similar to h later. At 6 and 12 similar to h after the bacterial challenge, the mice were killed and nasal washes were collected. The numbers of NTHi, M.similar to catarrhalis, and inflammatory cells were quantitated.

This is the first study

to evaluate the activity of the serum senescence marker GAL in colon cancer patients with a history of alcohol and nicotine dependence, as a potential factor of worse cancer prognosis.

Material and Methods: The material was serum of 18 colon cancer patients and 10 healthy volunteers. Ten colon cancer patients met alcohol and nicotine XMU-MP-1 mw dependence criteria. The activity of beta-galactosidase (pkat/ml) was determined by the colorimetric method. Comparisons between groups were made using the Kruskal-Wallis analysis and differences evaluated using the Mann-Whitney U test. Spearman’s rank correlation coefficient was used to measure the statistical dependence between two variables.

Results: The activity of serum GAL was significantly higher in colon cancer patients with a history of alcohol and nicotine dependence, in comparison to colon cancer patients without a history of drinking/smoking (p=0.015; 46% increase), and the controls (p=0.0002; 81% increase). The activity of serum GAL in colon cancer patients without a history of alcohol/nicotine dependence was higher

than the activity in the controls (p=0.043; 24% increase).

Discussion/Conclusion: 5-Fluoracil in vitro Higher activity of beta-galactosidase may potentially reflect the accelerated growth of the cancer, invasion, metastases, and maturation, when alcohol and nicotine dependence coincide with colon cancer. For a better prognosis of colon cancer, alcohol and nicotine withdrawal seems to be required.”
“OBJECTIVE: To estimate the risk for nodal metastasis in women with endometrial cancer based on uterine

characteristics on pathology.

METHODS: From a study of staging for uterine cancer, women were identified as being at low risk for nodal metastasis based on three specific criteria on final pathology reports: 1) less than 50% invasion, 2) tumor size less than 2 cm, and 3) well or moderately differentiated endometrioid histology. If the uterine specimen did not meet all three criteria, it was viewed as high risk for nodal metastasis.

RESULTS: Nine hundred seventy-one women were included in this analysis. Approximately 40% (or 389 of 971) of patients in this study were found to be at low risk, with a rate of nodal metastasis of only 0.8% (3 of 389; exact 95% confidence interval [CI] 0.16-2.2). No statistical differences in median Neuronal Signaling inhibitor age, body mass index, race, performance status, missing clinical data, or open or minimally invasive techniques were found among the patients with and without nodal metastases. Patients with high-risk characteristics of their uterine specimens compared with those with low-risk characteristics have 6.3 times the risk of nodal metastasis (95% CI 1.67-23.8, P=.007).

CONCLUSION: Low-risk endometrioid uterine cancer criteria may be used to help guide treatment planning for reoperation in patients with incomplete surgical staging information. (Obstet Gynecol 2072;119:286-92) DOI: 10.

The Andreev reflection current also exhibits a spin polarization

under the influence of both the spin-orbit interaction and the magnetic field through the ring. The spin polarization of the current can be tuned by varying the spin-orbit interaction strength and the magnetic flux. This provides an efficient mechanism to control https://www.selleckchem.com/products/cobimetinib-gdc-0973-rg7420.html the spin accumulation and the Andreev reflection in the quantum dot. (C) 2011 American Institute of Physics. [doi: 10.1063/1.3611398]“
“This work explores the possibility of using a polyethylene glycol (PEG)/sodium citrate aqueous two-phase system (ATPS) as a first step in a process for the purification of lectin from Canavalia grandiflora seed. Purification of lectins is a limiting step for its uses in the area of biotechnology. Extraction

by an aqueous two-phase see more system is a powerful technique for separation, concentration, and purification of biomolecules and pharmaceutical products. Four factors (PEG’s molar mass, PEG’s concentration, pH. citrate concentration) affecting the lectin ConGF partitioning were studied. A two-level factorial design (2(4)) was carried out. Lectin ConGF preferentially partitioned to the top (polyethylene glycol) phase. The statistical analysis showed that the citrate concentration chloride significantly affects the K(L) (partitioning coefficient for protein) value for lectin partitioning. An ATPS composed of 20% (w/w) PEG 400 and 20% (w/w) citrate, at pH 6, allowed the recovery of Selleckchem CA3 lectin ConGF with an 8.67 partition coefficient and 104% yield. Consequently, the system proved to be efficient and can be used as a first step in lectin purification from crude extract of ConGF seeds. (C) 2010 Elsevier B.V. All rights reserved.”
“Background: Delayed hypersensitivity is responsible for severe cutaneous adverse drug reactions (cADRs), especially in Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis, and drug-induced hypersensitivity syndrome (DIHS) (also known as drug rash with eosinophilia and systemic symptoms [DRESS] syndrome). The drug-induced lymphocyte stimulation test (DLST), or lymphocyte transformation test (LTT), is

used to identify the culprit drug in severe cADR cases.

Objective: The aim of this study was to examine the immune reactions in cADR patients through the identification of the drug-specific proliferating cells by flow cytometric DLST (FCM-DLST).

Methods: The peripheral blood mononuclear cells of 16 anticonvulsant-induced cADR patients were investigated by conventional DLST and a FCM-DLST protocol in which CFSE dilution and BrdU incorporation were combined. FCM-DLST allowed for the identification of the drug-specific proliferating cells in six cases. Three of these cases were DIHS cases, whereas there was one case of SJS, one case of maculopapular rash (MP), and one case of erythema multiforme (EM) among the six cases.

Resistance to Ggt has not been found in the Triticum germplasm so far. It was shown that a significant genetic

variation in fungus populations causes major problems for stability of host-plant disease resistance. In an attempt to understand the variation among isolates of G. graminis in depth, descriptive data are required in addition to morphological and physiological charactersation. Many molecular tools can be applied to assess intravarietal differentiation of Ggt. In the present study, the internal transcribed spacers of ribosomal DNA are shown to be sufficiently variable to distinguish Ggt isolates originated from different host crop species. The region analysed yielded fragments ranging in length from 502 to 503 nt and a total of five variable sites throughout the exons across all isolates was revealed. The hierarchical grouping revealed two major clades of

isolates named W (originating from winter wheat) and R (originating from winter rye).”
“RNA interference Selleck Bioactive Compound Library is a technique that has become popular in the past few years. This is a biological method to detect the activity of a specific gene within a cell. RNAi is the introduction of homologous double stranded RNA to specifically target a gene’s product resulting in null or hypomorphic ACY-738 solubility dmso phenotypes. This technique involves the degradation of specific mRNA by using small interfering RNA. Both microRNA (miRNA) and small interfering RNA (siRNA) are directly related to RNA interference. RNAi mechanism is being explored as a new technique for suppressing gene expression. It is an important issue in the treatment of various diseases. This review considers different aspects of RNAi technique including its history of discovery, molecular mechanism, gene expression study, advantages of this technique against previously used techniques, barrier associated with this technique, and its therapeutic application.”
“AimsTo evaluate the safety and efficacy of buprenorphine implants

(BI) versus placebo implants (PI) for the treatment of opioid dependence. A secondary aim compared BI to open-label sublingual buprenorphine/naloxone tablets (BNX).

DesignRandomized, double-blind, placebo-controlled trial. Subjects received either four buprenorphine implants (80mg/implant) (n=114), four placebo implants (n=54) or open-label GM6001 inhibitor BNX (12-16mg/day) (n=119).

SettingTwenty addiction treatment centers.

ParticipantsAdult out-patients (ages 18-65) with DSM-IV-TR opioid dependence.

MeasurementsThe primary efficacy end-point was the percentage of urine samples negative for opioids collected from weeks 1 to 24, examined as a cumulative distribution function (CDF).

FindingsThe BI CDF was significantly different from placebo (P<0.0001). Mean [95% confidence interval (CI)] proportions of urines negative for opioids were: BI=31.2% (25.3, 37.1) and PI=13.4% (8.3, 18.6). BI subjects had a higher study completion rate relative to placebo (64 versus 26%, P<0.0001), lower clinician-rated (P<0.

8 A m(2) kg(-1) is presented from the YSH films at 300 K with parallel and perpendicular magnetic field, respectively, which is 20% and

9% larger than that of pure HfO2 film at corresponding magnetic field. It is an indicative approach to control the dielectric properties of hafnium-based oxide films with electric and/or magnetic operation.”
“Background Many patients undergoing Mohs micrographic surgery (MMS) experience anxiety and stress. Although music has been proven to this website reduce anxiety and promote relaxation in other fields of medicine, scant research investigates the effect of music on anxiety during MMS. Objectives To determine whether music can reduce anxiety in patients undergoing MMS. Methods and Materials An open-labeled randomized controlled trial was conducted to assess anxiety before and after listening to music.

Subjects undergoing MMS were randomly allocated to listen to self-selected music (n=50) or to have surgery without music (n=50). Anxiety was measured using the State-Trait Anxiety Inventory (STAI) and on a visual analog scale (VAS). Results Subjects in the music group experienced statistically significantly lower STAI and VAS scores than those in the control group. STAI and VAS scores were significantly lower in subjects who underwent MMS for the first time. Anxiety measures did not correlate with sex or type of skin cancer. Conclusion AZ 628 solubility dmso Listening to self-selected music reduces anxiety in patients undergoing MMS, especially those who undergo MMS for the first time. Presenting patients the opportunity to listen to music is a simple strategy to minimize anxiety during MMS.”
“There are currently a

large number of “”orphan” G-protein-coupled receptors (GPCRs) whose endogenous ligands (peptide hormones) are unknown. Identification of these peptide hormones is a difficult and important problem. We describe a computational framework that models spatial structure along the genomic sequence simultaneously with the temporal evolutionary path structure across species and show how such models can be used to discover new functional molecules, in particular peptide hormones, via cross-genomic sequence comparisons. The computational framework PF-00299804 cost incorporates a priori high-level knowledge of structural and evolutionary constraints into a hierarchical grammar of evolutionary probabilistic models. This computational method was used for identifying novel prohormones and the processed peptide sites by producing sequence alignments across many species at the functional-element level. Experimental results with an initial implementation of the algorithm were used to identify potential prohormones by comparing the human and non-human proteins in the Swiss-Prot database of known annotated proteins. In this proof of concept, we identified 45 out of 54 prohormones with only 44 false positives.

05). Those with the answer “”when prescribing antibiotics, I pay attention to the patient’s clinical condition”" are the highest among physicians who were employed by private sector (p<0.05). A further study is suggested at this point, AZD9291 aiming to find out underlying reasons. Considering that this topic, the rational use of antibiotics, is being used in various symposiums and scientific activities in recent years, this study suggests we should keep paying the same attention on this scientific matter. At least, carrying out in-service trainings is suggested. Also suggested could

be conducting similar researches on the fields other than pediatrics.”
“Study Design. Retrospective review of a single tertiary care spine database to identify patients with C2 instrumentation between January 2001 and September 2008.

Objective. MK-1775 (1) Evaluate a large series of posterior C2 screws to determine accuracy by computed tomography (CT) scan, (2) assess dimensions of “”safe bony windows”" with CT, and (3) assess perioperative complication rate related to errant screw

placement.

Summary of Background Data. The variable C2 anatomy can make instrumentation challenging and prone to potentially severe complications. New techniques have expanded available options.

Methods. Clinical data were obtained from the medical record. Radiographic analyses included preoperative and postoperative CT scans to quantify the patients’ bone and to classify accuracy of instrumentation. Screws were graded using the following definitions:

Type I: Screw threads completely within the bone.

Type II: Less than (1/2) the diameter of the screw violates the surrounding cortex.

Type III: Clear violation of transverse foramen or spinal canal.

Results. Seven hundred and thirty-six screws in 383 patients were identified. Fifty-five patients were excluded because of lack of data leaving 328 patients (188 male patients, NVP-BSK805 140 female patients) with 633 screws. Three hundred and thirty-nine pedicle, 154 transarticular, 63 laminar,

and 77 short pars screws were placed, and of the 509 screws with postoperative CT scans, accuracy rates (Types I and II) were 98.8%, 98.5%, 100%, and 94.6%, respectively. Eight were unacceptably placed: two medially and six encroaching on the vertebral artery foramen. One patient had a vertebral artery occlusion and another had a dissection. There were no neurologic injuries. Mean CT measurements of pedicle height, axial width, and laminar width were 8.1, 5.8, and 5.7 mm respectively, with males having significantly larger pedicle height (P < 0.001), pedicle width (P < 0.001), and laminar width (P < 0.022).

Conclusion. We show a lower than previously reported incidence of complications associated with posterior C2 screw placement. The multiple techniques of posterior C2 fixation available allow for flexibility in determining ideal technique.