THE TENSION BETWEEN THE REAL AND THE PAPER DEAL CONCERNING “NO ORAL MODIFICATION” CLAUSES

This article proposes a new model for the regulation of no oral modification (NOM) clauses. First, the article seeks to offer a deeper understanding of the wishes of the parties in contracts from the perspective of parties' autonomy, distinguishing between intentions focused on the legal relationships and those focused on extra-contractual relations. Second, we explain how enforcement of NOM clauses may influence the parties' relations. Third, the article includes an economic analysis clarifying the roles of efficiency and institutional considerations in the NOM phenomenon. Applying the results of our analysis, we propose a comprehensive model for regulating NOM clauses. The key innovation of the model is context-dependent regulation differentiating among sophisticated and equally powerful parties, unsophisticated parties of equal power, and relationships with power disparities. Our model also offers an auxiliary test to help distinguish between parties' legal relationships and their extra-contractual relations.

The Association between IgG and Disease Severity Parameters in CF Patients

Assessing disease severity in patients with cystic fibrosis (CF) is essential when directing therapies. Serum immunoglobulin G (IgG) levels increase with disease severity. Lung clearance index (LCI) is recognized as an outcome measure for CF clinical trials. Our aim was to evaluate the correlations between IgG and disease severity markers. This was a single-center retrospective study, evaluating association between IgG and markers of severity in CF patients (including clinical characteristics, lung spirometry, LCI, clinical scores and computed tomography (CT) scores) during stable conditions. There were 69 patients, age 20.5 ± 11.6 years. Nineteen (27.5%) patients had elevated IgG. IgG correlated positively with LCI (r = 0.342, p = 0.005). IgG was higher in pancreatic insufficient (PI) and patients with liver disease (1504.3 ± 625.5 vs. 1229 ± 276.1 mg/dL in PI vs. PS, p = 0.023, and 1702.6 ± 720.3 vs. 1256.2 ± 345.5 mg/dL with vs. without liver disease, p = 0.001, respectively). IgG also correlated positively with CRP, CT score, and days with antibiotics in the previous year (r = 0.38, p = 0.003; r = 0.435, p = 0.001; and r = 0.361, p = 0.002, respectively), and negatively with FEV1% and SK score (r = −0.527, p < 0.001 and r = −0.613, p < 0.001, respectively). IgG correlated with clinical parameters, pulmonary functions, and imaging. However, this is still an auxiliary test, complementing other tests, including lung function and imaging tests. Larger multi-center longitudinal studies are warranted.

A case of pulmonary thromboembolism with ST elevation and literature review

Electrocardiography (ECG) is an auxiliary test applied for differential diagnosis of Pulmonary Thromboembolism (PTE). However, its specificity is low, but it is more often used for differential diagnosis. Although there are some changes on ECG in PTE, ST elevation is not a finding that we expect to see. With this case report, we aimed to draw attention to the issue with the diagnosis of PTE in a patient with ST elevation in ECG. 52-year-old male patient presented to the emergency department with a complaint of convulsion after chest and back pain. During the examination in the emergency department, he had a convulsion and woke up on his own without entering a postictal phase. After that, he had a chest pain. For this reason, ECG was performed to the patient and revealed ST elevation in leads DI, AVL, V1-4. The results of the patient’s EEG and head computer tomography (CT) were normal, so coronary CT angiography was performed. And it was observed that the coronary arteries were patent but embolism was detected in his cross-sectional pulmonary arteries. Thus, he was treated with the diagnosis of PTE. By the obtained results in this case that ST elevation may be a finding of PE, although it is rare.

Homoplasy as an Auxiliary Criterion for Species Delimitation

Homoplasy is a sort of noise in phylogenetic reconstructions, due to the accumulation of backmutations, convergent evolution and horizontal gene transfer (HGT), which is considered the major trigger of homoplasy in microorganism for its massive presence. It is also known that homoplasy increases with the complexity of the tree with both real and simulated data. In this paper, we analyzed the variation of homoplasy with the two widely used taxonomic markers ITS and LSU in four taxonomic models characterized by differences in the intra-specific distances. An algorithm (HomoDist) was developed to analyze the homoplasy index (HI) variation upon addition of a single element (strain or species) in increasing distance from a starting element. This algorithm allows to follow changes of the consistency index (CI), complementary to the HI, with the increase of the number of taxa and with the increase of the distance among elements. Results show that homoplasy increases—as expected—with the number of taxa, but also as a function of the overall distance among species, often with an almost linear relationship between distance and HI. No HI change was observed in trees with few taxa spanning through short distances, indicating that this noise is not prohibitive in this context, although the analysis of the ratio between HI and distance can be recommended as a criterion for tree acceptance. The absence of large changes of the HI within the species, and its increase when new species are added by HomoDist, suggest that homoplasy variation can be used as an auxiliary test in distance-based species delimitation with any type of marker.

Effect of COVID-19 on platelet count and its indices

SUMMARY BACKGROUND Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS In total, 215 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant. RESULTS The patients’ mean age was 64,32 ± 16,07 years. According to oxygen saturation, 81 patients had moderate and 134 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times. CONCLUSION In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

A Recruitment and Selection Process at Hi-Tech Civil Engineers Pvt.Ltd, Port Blair

Better enrollment and determination techniques bring about improved authoritative results. With reference to this unique situation, the exploration paper entitled Recruitment and Selection has been set up to put a light on Recruitment and Selection process. The fundamental target is to distinguish general practices that associations use to enlist and choose representatives and, to decide how the enrollment and choice practices influence authoritative results at SMC Global Securities Ltd. The examination procedure connected is the exploratory. The information was gathered through very much organized polls. The wellspring of information was both essential and auxiliary. Test size was 30. Information investigation has been finished with the assistance of SPSS programming. The organization thought about entries as the most significant vehicle of procuring workers. The representatives working in the organization consider the worker references are one of the most solid wellspring of contracting the new workers. Organization consistently takes in thought the money saving advantage proportion.

Comparison of molecular markers in a cohort of patients with chronic myeloproliferative disorders

Decreased expression of c-MPL protein in platelets, increased expression of polycythemia rubra vera 1 (PRV-1) and nuclear factor I-B (NFIB) mRNA in granulocytes, and loss of heterozygosity on chromosome 9p (9pLOH) were described as molecular markers for myeloproliferative disorders (MPDs). To assess whether these markers are clustered in subgroups of MPDs or represent independent phenotypic variations, we simultaneously determined their status in a cohort of MPD patients. Growth of erythropoietin-independent colonies (EECs) was measured for comparison. We observed concordance between EECs and PRV-1 in MPD patients across all diagnostic subclasses, but our results indicate that EECs remain the most reliable auxiliary test for polycythemia vera (PV). In contrast, c-MPL, NFIB, and 9pLOH constitute independent variations. Interestingly, decreased c-MPL and elevated PRV-1 also were observed in patients with hereditary thrombocythemia (HT) who carry a mutation in the thrombopoietin (TPO) gene. Thus, altered c-MPL and PRV-1 expression also can arise through a molecular mechanism different from sporadic MPD.