Long-Acting b-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

Acknowledgments The authors thank Prof. Stanley Szefler for his comments on the paper and Lisa Law for help with editing

Four obstacles facing the management accounting professionals as they seek to step up as global leaders

No matter how aspirational they are, management accountants face a series of roadblocks in the course of building careers in organisations. Experts reveal the four key obstacles that need to be addressed in the course of becoming global leaders.

Directional synthesis of tin oxide@graphene nanocomposites via a one-step up-scalable wet-mechanochemical route for lithium ion batteries

Directional synthesis of SnO2@graphene nanocomposites via a one-step, low-cost, and up-scalable wetmechanochemical method is achieved using graphene oxide and SnCl2 as precursors. The graphene oxides are reduced to graphene while the SnCl2 is oxidized to SnO2 nanoparticles that are in situ anchored onto the graphene sheets evenly and densely, resulting in uniform SnO2@graphene nanocomposites. The prepared nanocomposites possess excellent electrochemical performance and outstanding cycling in Li-ion batteries.

step-up epicyclic gear-train and flowgraph analysis

An epicyclic gear-train system with a speed step-up of 1:10, useful for numerical control work, is presented. Also, the analysis of such a system is carried out using flowgraph techniques.

New maths frameworking: Step-Up Workbook 1.

Este libro asegura una transición sin problemas desde el nivel de enseñanza primaria Key Stage 2 a Key Stage 3 (enseñanza secundaria), las ilustraciones basadas en las preguntas hacen que los conceptos básicos sean fáciles de entender y recordar. Los temas del libro son: entendiendo los números (ordenando los números, contando), la suma, la resta, fracciones (mitades y cuartos), medidas de longitud y tiempo (midiendo en metros, midiendo en centímetros, la era digital), entendiendo las formas (lados y esquinas), multiplicación y división, medidas de peso, capacidad y tiempo.

New maths frameworking: Step-Up Workbook 3.

Este libro asegura una transición sin problemas desde el nivel de enseñanza primaria Key Stage 2 a Key Stage 3 (enseñanza secundaria), las ilustraciones basadas en las preguntas hacen que los conceptos básicos sean fáciles de entender y recordar. Los temas del libro son: números y álgebra (ordenando números, números negativos), fracciones y decimales (fracción de un número, décimas como decimales), suma y resta, multiplicación y división, dinero (libras y peniques), medidas de longitud y tiempo (midiendo en milímetros, usando unidades métricas de longitud, perímetro, área), ¿formas regulares o irregulares?, medidas de peso, capacidad y tiempo (gramos y kilogramos, fracciones de un litro).

The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study

BACKGROUND: In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol. METHODS: Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration. RESULTS: Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy. CONCLUSIONS: The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.

Tax-Optimal Step-Up and Imperfect Loss Offset

In the field of mergers and acquisitions, German and international tax law allow for several opportunities to step up a firm's assets, i.e., to revaluate the assets at fair market values. When a step-up is performed the taxpayer recognizes a taxable gain, but also obtains tax benefits in the form of higher future depreciation allowances associated with stepping up the tax base of the assets. This tax-planning problem is well known in taxation literature and can also be applied to firm valuation in the presence of taxation. However, the known models usually assume a perfect loss offset. If this assumption is abandoned, the depreciation allowances may lose value as they become tax effective at a later point in time, or even never if there are not enough cash flows to be offset against. This aspect is especiallyrelevant if future cash flows are assumed to be uncertain. This paper shows that a step-up may be disadvantageous or a firm overvalued if these aspects are not integrated into the basic calculus. Compared to the standard approach, assets should be stepped up only in a few cases and - under specific conditions - at a later point in time. Firm values may be considerably lower under imperfect loss offset.

Prevalence and Risk Factors for Therapy Escalation in Ulcerative Colitis in the Swiss IBD Cohort Study.

BACKGROUND Physicians traditionally treat ulcerative colitis (UC) using a step-up approach. Given the paucity of data, we aimed to assess the cumulative probability of UC-related need for step-up therapy and to identify escalation-associated risk factors. METHODS Patients with UC enrolled into the Swiss IBD Cohort Study were analyzed. The following steps from the bottom to the top of the therapeutic pyramid were examined: (1) 5-aminosalicylic acid and/or rectal corticosteroids, (2) systemic corticosteroids, (3) immunomodulators (IM) (azathioprine, 6-mercaptopurine, methotrexate), (4) TNF antagonists, (5) calcineurin inhibitors, and (6) colectomy. RESULTS Data on 996 patients with UC with a median disease duration of 9 years were examined. The point estimates of cumulative use of different treatments at years 1, 5, 10, and 20 after UC diagnosis were 91%, 96%, 96%, and 97%, respectively, for 5-ASA and/or rectal corticosteroids, 63%, 69%, 72%, and 79%, respectively, for systemic corticosteroids, 43%, 57%, 59%, and 64%, respectively, for IM, 15%, 28%, and 35% (up to year 10 only), respectively, for TNF antagonists, 5%, 9%, 11%, and 12%, respectively, for calcineurin inhibitors, 1%, 5%, 9%, and 18%, respectively, for colectomy. The presence of extraintestinal manifestations and extended disease location (at least left-sided colitis) were identified as risk factors for step-up in therapy with systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and surgery. Cigarette smoking at diagnosis was protective against surgery. CONCLUSIONS The presence of extraintestinal manifestations, left-sided colitis, and extensive colitis/pancolitis at the time of diagnosis were associated with use of systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and colectomy during the disease course.

Review and Comparison of Step-Up Transformerless Topologies for Photovoltaic AC-Module Application

This paper presents a comprehensive review of stepup single-phase non-isolated inverters suitable for ac-module applications. In order to compare the most feasible solutions of the reviewed topologies, a benchmark is set. This benchmark is based on a typical ac-module application considering the requirements for the solar panels and the grid. The selected solutions are designed and simulated complying with the benchmark obtaining passive and semiconductor components ratings in order to perform a comparison in terms of size and cost. A discussion of the analyzed topologies regarding the obtained ratings as well as ground currents is presented. Recommendations for topological solutions complying with the application benchmark are provided.

The Step-Up program : a casebook : final report /

"January 1999."

Ultrahigh step-up dc-dc converter for distributed generation by three Degrees of Freedom (3DoF) approach

This paper proposes a novel dc-dc converter topology to achieve an ultrahigh step-up ratio while maintaining a high conversion efficiency. It adopts a three degree of freedom approach in the circuit design. It also demonstrates the flexibility of the proposed converter to combine with the features of modularity, electrical isolation, soft-switching, low voltage stress on switching devices, and is thus considered to be an improved topology over traditional dc-dc converters. New control strategies including the two-section output voltage control and cell idle control are also developed to improve the converter performance. With the cell idle control, the secondary winding inductance of the idle module is bypassed to decrease its power loss. A 400-W dc-dc converter is prototyped and tested to verify the proposed techniques, in addition to a simulation study. The step-up conversion ratio can reach 1:14 with a peak efficiency of 94% and the proposed techniques can be applied to a wide range of high voltage and high power distributed generation and dc power transmission.

Design of a modular, high step-up ratio DC–DC converter for HVDC applications integrating offshore wind power

High-power and high-voltage gain dc-dc converters are key to high-voltage direct current (HVDC) power transmission for offshore wind power. This paper presents an isolated ultra-high step-up dc-dc converter in matrix transformer configuration. A flyback-forward converter is adopted as the power cell and the secondary side matrix connection is introduced to increase the power level and to improve fault tolerance. Because of the modular structure of the converter, the stress on the switching devices is decreased and so is the transformer size. The proposed topology can be operated in column interleaved modes, row interleaved modes, and hybrid working modes in order to deal with the varying energy from the wind farm. Furthermore, fault-tolerant operation is also realized in several fault scenarios. A 400-W dc-dc converter with four cells is developed and experimentally tested to validate the proposed technique, which can be applied to high-power high-voltage dc power transmission.

Facilitators of recovery for step-up and step-down clients of a sub-acute residential mental health service