optical coherence tomography ( oct ) is a noninvasive method that evaluates biological tissues by in vivo imaging.1 since its introduction , oct has undergone several improvements and revolutionized the diagnostic , monitoring , and therapeutic approaches to many retinal diseases and glaucoma .
computerized algorithms can be used on the high - resolution images obtained by modern oct devices in order to identify and measure the thicknesses of discrete retinal layers , including the retinal nerve fiber layer ( rnfl ) , macular ganglion cell complex ( gcc ) , and choroid.2,3 the choroid is the most vascular tissue in the eye and is known to have an important role in ocular nutrition , volume regulation , and temperature control.4 choroidal abnormalities are critical to the onset and progression of many chorioretinal disorders such as age - related macular degeneration ( amd ) , polypoidal choroidal vasculopathy , vogt - kayanagi - harada disease , and central serous chorioretinopathy.5 with the recent development of enhanced depth imaging ( edi ) , in vivo assessment of the choroid has become an area of interest .
edi allows better visualization and quantitative evaluation of the choroid , which was not possible before .
information about the choroidal thickness ( ct ) is useful in many clinical situations for decision making regarding the management and monitoring of disease progression.6 neurodegenerative diseases such as glaucoma preferentially affect the gcc , which is the sum of the three innermost layers : the rnfl , the retinal ganglion cell layer , and the inner plexiform layer .
these contain the axons , cell bodies , and the dendrites of the retinal ganglion cells , respectively.7,8 recent studies have shown that measurement of macular gcc thickness has the same diagnostic potential for glaucoma as rnfl thickness.911 moreover , it has been reported that measurements of average gcc thickness had better sensitivity in detecting changes in retinal thickness in multiple sclerosis neurodegeneration than rnfl thickness measured by oct.12 both ct and gcc thickness measurements can be affected by several factors such as pupil size , scan quality , and cataract . in this study
, we aimed to evaluate the effect of uneventful cataract surgery on subfoveal ct and gcc thickness measured by edi - oct .
this prospective study included consecutive patients who had undergone uneventful phacoemulsification surgery for senile cataract at sakarya university medical education and research hospital between november 2013 and june 2015 .
the present study was approved by the institutional review board of sakarya university medical education and research hospital and adhered to the tenets of the declaration of helsinki and all patients signed informed consent after they received an explanation of the nature and possible consequences of the procedure .
exclusion criteria included a history of prior ocular surgery and systemic / ocular diseases such as diabetes mellitus , hypertension , glaucoma , amd , diabetic retinopathy , retinal vein occlusion , uveitis , or other inflammatory and vascular pathologies .
patients with unstable fixation or dense cataracts leading to a poor scan quality of oct images and eyes with increase in postoperative intraocular pressure ( iop ) or cystoid macular edema were also excluded .
all patients had a full ophthalmic examination , including best - corrected visual acuity ( bcva ) assessment , as well as slit - lamp biomicroscopy and dilated fundoscopy evaluation , and iop measurement by goldmann applanation tonometry .
axial length ( al ) was measured by immersion echography ( axis ii ; quantel medical inc . , cedex , france ) and central corneal thickness ( cct ) was measured by ultrasonographic pachymetry ( pacline ; optikon 2000 spa , rome , italy ) .
prior to the operation , tropicamide 1% and phenylephrine hydrochloride 2.5% were applied to patients eyes for pupil dilation .
phacoemulsification was performed by one experienced surgeon ( ec ) using infiniti vision system ( alcon laboratories , inc . ) . a clear corneal incision of 2.8 mm , 600 mmhg vacuum , an aspiration flow rate of 30 ml / min , bottle height of 75 cm , and quick - chop technique were used in all surgeries .
two different dispersive viscoelastics ( viscoat and bivisc ) and two different cohesive viscoelastics ( healon and bio - hyalur ) were used during cataract surgery .
one - piece hydrophobic acrylic intraocular lens ( sensar model : aab00 ; abbott medical optics inc . , santa ana , ca , usa ) was used in all surgeries .
viscoelastics were cleaned out with marked attention , even behind the intraocular lenses . the procedure ended with intracameral cefuroxime axetil 1 mg/0.1 ml for prophylaxis for endophthalmitis .
the operative times ( ots ) and effective phaco times ( epts ) were recorded in each case .
postoperatively , all patients were treated with topical antibiotics ( ofloxacin 0.3% ) for 1 week and topical steroid drops ( prednisolone acetate 1% ) for 4 weeks .
cirrus edi - oct ( carl zeiss meditec ag , jena , germany ; software version 6.5.0.772 ) was used to obtain subfoveal ct and gcc thickness measurements using high - definition one - line raster and ganglion cell analysis ( macular cube 512128 ) scan protocols , respectively .
scans with misalignment , segmentation failure , decentration of the measurement circle , and poor illumination , or those out of focus , were also excluded .
the one - line raster is a 6 mm line consisting of 4,096 a - scans .
scan 3 of the five scans taken , which passes through the fovea , was used for all measurements .
ct was defined as the vertical distance from the outer portion of the hyperreflective line corresponding to bruch s membrane beneath the retinal pigment epithelium to the outermost hyperreflective line of the inner scleral border . to avoid the effects of mydriatic agents or diurnal changes ,
the ct was measured from the subfoveal region by using the cirrus linear measurement tool .
when there was a discrepancy of > 10% of the mean of the two values between the observers in two eyes in the study , observers discussed and repeated the measurements , and the average results from the two observers were determined as the final ct readings .
the cirrus oct device allows a quantitative assessment of the ganglion cell and inner plexiform layers ( gcipl ) in six circular sectors centered in the fovea .
it also gives information on the mean and minimum gcipl thickness for each eye and compares these figures with a normative database .
macular cube 512128 acquisition protocol generates a cube through a 6 mm square grid of 128 b - scans , each composed of 512 a - scans .
a built - in gcipl analysis algorithm detects and measures the thickness of the macular gcipl within a 662 mm elliptical annulus area centered on the fovea .
the annulus has an inner vertical diameter of 1 mm , which was chosen to exclude the portions of the fovea where the layers are very thin and difficult to detect accurately , and an outer vertical diameter of 4 mm , which was chosen according to where the ganglion cell layer again becomes thin and difficult to detect .
the ganglion cell analysis algorithm identifies the outer boundaries of the rnfl and the inner plexiform layer .
the difference between the rnfl and the inner plexiform layer outer boundary segmentations yields the combined thickness of the retinal gcipl .
similar to other cirrus printouts , it provides gcipl measurements in six wedge - shaped sectors with a pseudocolor scheme .
those that are abnormal at the < 5% and at the < 1% level are represented by yellow and red backgrounds , respectively .
the primary objective of this study was to evaluate the subfoveal ct and average gcc thickness changes ; however , central macular thickness ( cmt ) and peripapillary rnfl thickness were also obtained by the macular cube 512128 and optic disc cube 200200 protocols , respectively , using the cirrus oct device .
statistical analysis was performed using spss statistics for windows , version 20.0 ( ibm corporation 2011 , armonk , ny , usa ) .
paired - samples t - test was used for equality of means , and analysis of variance regression and pearson correlation analysis were used for correlations between parameters .
this prospective study included consecutive patients who had undergone uneventful phacoemulsification surgery for senile cataract at sakarya university medical education and research hospital between november 2013 and june 2015 .
the present study was approved by the institutional review board of sakarya university medical education and research hospital and adhered to the tenets of the declaration of helsinki and all patients signed informed consent after they received an explanation of the nature and possible consequences of the procedure .
exclusion criteria included a history of prior ocular surgery and systemic / ocular diseases such as diabetes mellitus , hypertension , glaucoma , amd , diabetic retinopathy , retinal vein occlusion , uveitis , or other inflammatory and vascular pathologies .
patients with unstable fixation or dense cataracts leading to a poor scan quality of oct images and eyes with increase in postoperative intraocular pressure ( iop ) or cystoid macular edema were also excluded .
all patients had a full ophthalmic examination , including best - corrected visual acuity ( bcva ) assessment , as well as slit - lamp biomicroscopy and dilated fundoscopy evaluation , and iop measurement by goldmann applanation tonometry .
axial length ( al ) was measured by immersion echography ( axis ii ; quantel medical inc . , cedex , france ) and central corneal thickness ( cct ) was measured by ultrasonographic pachymetry ( pacline ; optikon 2000 spa , rome , italy ) .
prior to the operation , tropicamide 1% and phenylephrine hydrochloride 2.5% were applied to patients eyes for pupil dilation .
phacoemulsification was performed by one experienced surgeon ( ec ) using infiniti vision system ( alcon laboratories , inc . ) . a clear corneal incision of 2.8 mm , 600 mmhg vacuum , an aspiration flow rate of 30 ml / min , bottle height of 75 cm , and quick - chop technique were used in all surgeries .
two different dispersive viscoelastics ( viscoat and bivisc ) and two different cohesive viscoelastics ( healon and bio - hyalur ) were used during cataract surgery .
one - piece hydrophobic acrylic intraocular lens ( sensar model : aab00 ; abbott medical optics inc . , santa ana , ca , usa ) was used in all surgeries .
viscoelastics were cleaned out with marked attention , even behind the intraocular lenses . the procedure ended with intracameral cefuroxime axetil 1 mg/0.1 ml for prophylaxis for endophthalmitis .
the operative times ( ots ) and effective phaco times ( epts ) were recorded in each case .
postoperatively , all patients were treated with topical antibiotics ( ofloxacin 0.3% ) for 1 week and topical steroid drops ( prednisolone acetate 1% ) for 4 weeks .
cirrus edi - oct ( carl zeiss meditec ag , jena , germany ; software version 6.5.0.772 ) was used to obtain subfoveal ct and gcc thickness measurements using high - definition one - line raster and ganglion cell analysis ( macular cube 512128 ) scan protocols , respectively .
scans with misalignment , segmentation failure , decentration of the measurement circle , and poor illumination , or those out of focus , were also excluded .
the one - line raster is a 6 mm line consisting of 4,096 a - scans .
scan 3 of the five scans taken , which passes through the fovea , was used for all measurements .
ct was defined as the vertical distance from the outer portion of the hyperreflective line corresponding to bruch s membrane beneath the retinal pigment epithelium to the outermost hyperreflective line of the inner scleral border . to avoid the effects of mydriatic agents or diurnal changes ,
the ct was measured from the subfoveal region by using the cirrus linear measurement tool . when there was a discrepancy of > 10% of the mean of the two values between the observers in two eyes in the study , observers discussed and repeated the measurements , and the average results from the two observers
the cirrus oct device allows a quantitative assessment of the ganglion cell and inner plexiform layers ( gcipl ) in six circular sectors centered in the fovea
. it also gives information on the mean and minimum gcipl thickness for each eye and compares these figures with a normative database .
macular cube 512128 acquisition protocol generates a cube through a 6 mm square grid of 128 b - scans , each composed of 512 a - scans .
a built - in gcipl analysis algorithm detects and measures the thickness of the macular gcipl within a 662 mm elliptical annulus area centered on the fovea .
the annulus has an inner vertical diameter of 1 mm , which was chosen to exclude the portions of the fovea where the layers are very thin and difficult to detect accurately , and an outer vertical diameter of 4 mm , which was chosen according to where the ganglion cell layer again becomes thin and difficult to detect .
the ganglion cell analysis algorithm identifies the outer boundaries of the rnfl and the inner plexiform layer .
the difference between the rnfl and the inner plexiform layer outer boundary segmentations yields the combined thickness of the retinal gcipl .
similar to other cirrus printouts , it provides gcipl measurements in six wedge - shaped sectors with a pseudocolor scheme .
those that are abnormal at the < 5% and at the < 1% level are represented by yellow and red backgrounds , respectively .
the primary objective of this study was to evaluate the subfoveal ct and average gcc thickness changes ; however , central macular thickness ( cmt ) and peripapillary rnfl thickness were also obtained by the macular cube 512128 and optic disc cube 200200 protocols , respectively , using the cirrus oct device .
statistical analysis was performed using spss statistics for windows , version 20.0 ( ibm corporation 2011 , armonk , ny , usa ) .
paired - samples t - test was used for equality of means , and analysis of variance regression and pearson correlation analysis were used for correlations between parameters .
a total of 30 eyes of 30 patients ( 16 male and 14 female ) , with a mean age of 60.24.2 years were included in this study .
mean bcva improved in all eyes , and this improvement was statistically significant ( 0.460.15 logarithm of minimum angle of resolution [ logmar ] units preoperatively and 0.060.49 logmar units postoperatively ; p<0.001 ) .
mean preoperative al was 22.80.6 mm ( range : 21.524.1 mm ) and mean cct was 551.522.1 m .
mean ot was 8.62.7 minutes and mean ept was 6.92.5 seconds ( table 1 ) .
the mean subfoveal ct was 294.439.2 m ( range : 201356 m ) preoperatively and 301.439.9 m ( range : 231367 m ) postoperatively .
the mean gcc thickness was 85.04.4 m ( range : 7894 m ) preoperatively and 89.25.3 m ( range : 8199 m ) postoperatively .
the mean cmt was 247.917.6 m preoperatively ( range : 211280 m ) and 249.017.8 m ( range : 213278 m ) postoperatively .
the mean rnfl thickness was 97.45.4 m preoperatively ( range : 87110 m ) and 101.75.6 m ( range : 91113 m ) postoperatively .
regression analysis showed that age , sex , al , cct , ot , and ept were not associated with ct changes ( p=0.834 , p=0.129 , p=0.203 , p=0.343 , p=0.547 , and p=0.147 , respectively ) and gcc thickness changes ( p=0.645 , p=0.542 , p=0.152 , p=0.664 , p=0.448 , p=0.268 , respectively ) after cataract surgery .
in this study , we investigated the effect of cataract surgery on subfoveal ct and gcc thickness , as measured by edi - oct , and we found that both subfoveal ct and gcc thickness increased slightly after cataract surgery .
cmt and peripapillary rnfl thicknesses were also evaluated as a secondary objective , and we observed statistically significant increases in cmt and rnfl thickness .
our results indicate that cmt , subfoveal ct , as well as rnfl and gcc thicknesses are slightly affected after phacoemulsification surgery .
although our study included a small group ( only 30 eyes ) , we assume that our data reliability is high because of the homogeneous nature of the patients ( similarities of age , cataract type and severity , cct , al , ot , ept and so on ) and the careful / detailed oct examinations performed by two observers , avoiding the effects of diurnal changes and mydriatic agents .
zhao et al13 revealed significant diurnal variations of the ct at the macular region in young healthy female individuals .
cataract surgery by phacoemulsification is one of the most common intraocular surgeries that improve the quality of vision .
however , it is an invasive procedure leading to an inflammatory response  mostly induced by the release of prostaglandins  in the retina and choroid and , in many patients , can lead to worsening of preexisting retinal diseases such as diabetic macular edema.15,16 recent studies have shown subclinical increase of cmt and peripapillary rnfl thickness after uneventful cataract surgery.1719 however , the morphologic changes that this inflammatory insult produces in the choroid have not been studied well because of the lack of detailed imaging techniques for the choroid .
after the introduction of edi , changes in ct in several pathologic ( central serous chorioretinopathy , choroidal neovascularization , and high myopia ) and physiologic ( age , sex , and al ) conditions can be easily assessed.2022 therefore , ct is being measured increasingly often and is becoming an accepted procedure for clinical and research applications .
falco et al23 evaluated the effect of uneventful phacoemulsification on the subfoveal ct and cmt , and they reported that phacoemulsification induced nonpathologic increases in cmt ; however , these changes were not accompanied by significant changes in ct .
they claimed that the inflammatory insult due to phacoemulsification mainly affects at the retinal level and seems to be independent of ct changes.23 by contrast ; our results support the recent studies by ohsugi et al24 and noda et al,25 which report significant increases in ct after uneventful phacoemulsification .
ohsugi et al24 evaluated 100 eyes and emphasized that the al and changes in iop were critical for evaluating the changes in ct after cataract surgery .
noda et al25 evaluated 29 eyes and observed that the increase in subfoveal ct did not subside to baseline even at 6 months postoperatively .
they also found that male sex and thicker baseline ct predicted a larger magnitude of increase in ct after cataract surgery.25 in our study , interestingly , the parameters of age , sex , al , baseline ct , and cct did not influence the postoperative ct statistically in regression analysis .
we also analyzed the effect of ot and ept on postoperative ct and we did not find any relationship .
this may be explained by the short / similar results in terms of ots and epts , as well as the experience of the surgeon conducting a quick surgery with less anterior segment manipulation , thus reducing the inflammatory response after cataract surgery .
a speculation is that it may be related to postoperative inflammation because proinflammatory prostaglandins and cytokines are considered to explain macular edema after cataract surgery , and inflammatory disorders are also known to increase the ct.26,27 another speculation is that cataract surgery introduces more light into the eyes , leading to greater metabolic activation in the retinal pigment epithelium , causing angiogenesis and inflammation.28,29 in the beaver dam and blue mountains eye studies,3032 it has been suggested that cataract surgery is associated with the onset of amd , resulting in visual impairment due to neovascularization originating from the choroid .
noda et al25 report that cataract surgery influences the ct and this influence persists for as long as 6 months postoperatively and may affect the process of amd .
choroidal abnormalities are central to chorioretinal disorders such as amd , polypoidal choroidal vasculopathy , and central serous chorioretinopathy .
furthermore , it has been claimed that pathologic choroidal blood supply is an important factor in open - angle glaucoma leading to optic nerve damage.33,34 cts of glaucomatous eyes have been reported to be thinner in postmortem histologic studies .
in addition , significant increases in choroidal extravascular volume have been confirmed in many primary angle - closure glaucoma eyes and abnormal ct has been hypothesized to be a contributing feature in these eyes.35,36 however , it is unclear whether these findings represent a risk factor or a consequence of these diseases .
the hallmark of glaucoma is the loss of the retinal ganglion cell axons , which leads to a typical optic neuropathy .
qualitative and quantitative evaluations of the optic nerve head and rnfl have been used to detect evidence of glaucomatous damage.911 in a recent study,8 it has been suggested that the gcc thickness may be the most relevant parameter to measure in glaucoma .
nouri - mahdavi et al37 also reported that regional gcc measurements derived from cirrus hd - oct performed as well as regional rnfl outcomes for the detection of early glaucoma .
moreover , macular gcc thickness has been found to have better structure  function correlations than rnfl thickness with both visual function and central nervous system findings in multiple sclerosis neurodegeneration.12 as oct uses near - infrared light and is based on interferometry , its image quality is influenced by opacities in the optical path .
loss of oct image quality is caused by attenuation of the light in the oct scanning spot on the retina.17,18 several studies have shown that lens opacity decreased image quality and postoperative rnfl thickness measurements increased significantly.3840 the more advanced the cataract , the less is the signal quality and the thinner are the recorded rnfl and gcc thicknesses .
the coexistence of neurodegenerative diseases such as glaucoma and cataract among elderly patients is not unusual , and cataract may decrease the quality of fundus images , leading to an incorrect evaluation in the diagnosis and follow - up of these patients .
nakatani et al7 examined the effect of cataract on the measurements of gcc and rnfl thicknesses , and they reported that all thickness parameters in gcc and rnfl increased slightly after phacoemulsification surgery .
therefore , we decided that the presence of cataract may lead to an underestimation of the thicknesses of gcc and rnfl , and this should be taken into account when analyzing progression in glaucoma and/or neurodegenerative diseases such as multiple sclerosis .
after cataract surgery , the examiners should consider obtaining new baseline measurements , as suggested in previous studies .
this study has many limitations such as short follow - up time , relatively small sample size , and lack of eyes with glaucoma and neurodegenerative diseases .
in addition , we analyzed just mean subfoveal ct and mean thickness of gcc and rnfl , leading to lack of segmentation of these parameters .
scleral interface and measured ct with cirrus linear measurement tool . although we used scans with signal strength 6 for analysis and excluded poor images , the effect of signal strength index on measurements was not investigated .
furthermore , we used postoperative topical steroids after cataract surgery ; thus , the true effect of phacoemulsification on oct parameters could not be evaluated and we could not determine whether and when the increased ct can return to baseline measurements .
phacoemulsification surgery increased ct and it should be kept in mind that the small changes in ct may affect the onset of amd , which is a serious disease that results in central visual impairment .
although the mechanism is unclear , it has been postulated that ct changes may also play a role in glaucoma .
we suggest establishment of new baseline measurements after cataract surgery for monitoring patients with glaucoma and neurodegenerative diseases .
further studies with a greater number of patients and longer duration of follow - up and conducted using new computerized oct algorithms are needed .

 purposewe aimed to evaluate the effect of cataract surgery on subfoveal choroidal thickness ( ct ) and ganglion cell complex ( gcc ) thickness , as measured by enhanced depth imaging - optical coherence tomography ( oct).methodsthis prospective study included 30 eyes of 30 patients who had undergone uneventful phacoemulsification surgery for senile cataract but had no previous ocular surgery or other ocular abnormality .
 best - corrected visual acuity , slit - lamp biomicroscopy , intraocular pressure , axial length , and central corneal thickness were measured preoperatively .
 the operative times ( ots ) and effective phaco times were also recorded in each case .
 oct measurements were performed at the preoperative visit and 1 month after cataract surgery .
 study of ct and gcc thickness changes was the primary objective , but central macular thickness ( cmt ) and peripapillary retinal nerve fiber layer ( rnfl ) thicknesses were also obtained by oct.resultsthe mean subfoveal ct was 294.439.2 m preoperatively and 301.439.9 m postoperatively ( p<0.001 ) .
 the mean gcc thickness was 85.04.4 m preoperatively and 89.25.3 m postoperatively ( p<0.001 ) .
 the mean cmt was 247.917.6 m preoperatively and 249.017.8 m postoperatively ( p=0.029 ) .
 the mean rnfl thickness was 97.45.4 m preoperatively and 101.75.6 m postoperatively ( p<0.001 ) .
 regression analysis showed that age , sex , axial length , central corneal thickness , operative time , and effective phaco time were not associated with ct changes ( p=0.834 , p=0.129 , p=0.203 , p=0.343 , p=0.547 , and p=0.147 , respectively ) and gcc thickness changes ( p=0.645 , p=0.542 , p=0.152 , p=0.664 , p=0.448 , and p=0.268 , respectively ) after cataract surgery.conclusionour results indicate that all subfoveal ct , cmt , as well as rnfl and gcc thicknesses are slightly affected after uneventful phacoemulsification surgery .
 after cataract surgery , the examiners should consider obtaining new baseline measurements .


only 2030% of patients with group a beta hemolytic streptococcus ( gabhs ) pharyngitis presents with classical symptoms of the disease .
reliance on clinical judgment alone has a poor predictive value and results in 80% to 95% overestimation of disease [ 2 , 3 ] .
diagnostic strategies for acute gabhs pharyngitis are thus based on epidemiological factors , signs , and symptoms , as well as the result of throat cultures ( tcs ) .
several studies have shown that the use of throat culture leads to more judicious use of antibiotics [ 57 ] .
physicians prescribe antibiotics for acute pharyngitis as they are concerned that patients with this complaint may be suffering from gabhs infection that if left untreated might develop suppurative complications , such as , tonsillar abscess or nonsuppurative complications , such as , rheumatic fever [ 6 , 8 ] . antibiotics , however ; confer only minor symptomatic benefits for gabhs sore throat .
they shorten the duration of symptoms by merely half a day on average [ 8 , 9 ] .
more recent studies have shown that antibiotic use only reduced the incidence of rheumatic fever by a mere 0.5 cases per 100,000 .
the importance of preventing rheumatic fever has lessened as the incidence of rheumatic fever and rheumatic heart disease has declined significantly in the last 20 years , from a mean annual incidence of 13.4 per 100,000 to 5 per 100,000 .
prevalence has decreased as well from 5.7 per 1,000 in the eighties to 0.5 per 1,000 in 2000 [ 8 , 10 , 11 ] .
this failure probably stems from the fact that about 20% of children with gabhs is infected with bacteria which contain m protein , a virulence factor located on the surface of the bacterial wall that confers resistance to commonly used antibiotics .
newer beta - lactamase - resistant antibiotics did not prevent this treatment failure [ 13 , 14 ] .
review of the literature from 1945 to 1999 , which includes 10,484 cases of gabhs sore throat , found that antibiotic treatment reduced the occurrence of acute otitis media , a common complication of this disease , by a mere 25% , compared to the placebo group and sinusitis by only 50% .
rheumatic fever , a nonsuppurative complication , was reduced by less than 33% , compared to placebo [ 8 , 10 , 11 , 15 ] .
in addition to the uncertainly in the scientific literature , parents seem to be uncertain regarding the benefits of antibiotic treatment for acute gabhs pharyngitis and tend to stop treatment earlier than prescribed . in a pilot study
, we randomly followed 75 children with gabhs pharyngitis for 6 months and have found that more than 75% of them did not complete ten days of antibiotics .
this finding led us to conduct a multisite , prospective cohort observational study , the results of which are reported here .
the goal of this study was to determine whether noncompliance with antibiotic treatment affects short - term or long - term complications .
two central , primarily rural , and agricultural regions of the largest health maintenance organization ( hmo ) in israel , comprising approximately one million patients . using a standard protocol
, we located from our computerized data base 107,840 patients , aged 6 months to 18 years , who were examined by their primary care physician for upper respiratory tract infection , tonsillitis , pharyngitis , sore throat , tonsillopharyngitis , neck pain , cervical lymphadenopathy , pta , rpa , from january 1 , 1999 until december 31 , 2000 .
we then accessed the charts of 78,473 of these children who were diagnosed with infected throat or one of the differential variants , excluding all children diagnosed as having viral upper respiratory infections .
47,000 of these patients were formally diagnosed with acute pharyngitis or acute tonsillitis and received a prescription for antibiotics , indicating that their physician suspected bacterial disease . in the index visit , 35,000 of these children had at least four out of five symptoms in the modified centor criteria used for this study and nadir modified breese epidemiological and clinical score card ( ecsc ) that has 91% sensitivity and 98% specificity when the score was above 15 ( score between 4 and 36 ) for the diagnosis of gabhs [ 1719 ] .
colonies yielding beta - hemolysis were grouped for surface carbohydrate assessment by using a latex bead agglutination test ( figure 1 ) . of the 6336 children ( with positive cultures with 4 or more centor criteria and 15 or higher ecsc ) , 4,775 parents consented to enroll their children to the study ( figure 1 ) . excluded from the study were children who were diagnosed as gabhs chronic carriers or who had suffered from post - gabhs complications ; had any chronic illness , such as , renal or hepatic impairment ; had bleeding disorder ; had congenital or acquired immunodeficiency or suffered from malignancy .
initial patient / parent contact was made by one of the authors ( m. sarrell ) within 3 to 5 days of the initial positive throat culture . at that time , initial information regarding the illness and whether a prescription for antibiotics was given by the primary care physician .
the attending physicians of the two thousand study patients were contacted by email within 48 hours of the enrollment by one author ( m. sarrell ) .
the physicians were requested to inform the authors of any additional cultures taken during therapy , and to request that they obtain two additional throat cultures and engage in improve adherence strategies by providing information , counseling , reminders , reinforcement , and if needed personal attention or supervision .
while repeated cultures are not routinely recommended for asymptomatic patients who have completed a course of antimicrobial therapy , in light of the poor compliance with treatment in the pilot study , performance of such follow - up cultures was considered important for the purposes of the study .
the first follow - up culture was performed within 10 to 14 days of the initial positive culture regardless of treatment status .
the purpose of this culture was verification of antibiotics treatment failure or persistence of gabhs in the oropharynx of the untreated patients .
the second additional throat culture was taken between days 21 and 30 after the initial positive culture , regardless of treatment status , to ascertain the presence of residual gabhs or recurrences . treating physicians
were also requested to obtain blood for liver enzymes , renal function tests , and urine analysis from all the participants and to perform annual follow - up evaluation thereafter .
a second patient / parent contact was made by our study coordinator within 10 to 14 days of initiation of antibiotic treatment .
she collected information about demographic characteristics , past medical history , febrile status , need for repeat throat culture during the treatment period ( that was not part of the study protocol ) , and type of medication prescribed . during this contact she obtained information about the number of days of actual treatment , omission compliance and complications , the patients / parents perceived as deriving from the treatment ( or lack thereof ) .
the computerized charts of the participants were searched within 2 to 4 weeks of the second patient / parent contact for additional information , including demographic characteristics , medical and environmental history , initial clinical data , such as , in - office fever evaluation , results of the physical examination , additional culture taken , type of antibiotics used , and disposition of prescription received .
a second search of the computerized medical charts was performed by our research assistant between 30 and 90 days of initiation of medical treatment , to ascertain that the 2 requested throat cultures were obtained . relapse or recurrence of clinical or bacterial pharyngitis ,
suppurative or nonsuppurative complication , or even whether the participants complained of any sore throat within 30 days of completion of treatment were also evaluated . in order to assure that all possible short - term complications that occurred within 90 days of the index case were obtained ,
an additional comprehensive search of the hmo database was done within 120 days of the second computer search .
we ascertained that findings that were either not available on the original computerized chart or were seen by other than their primary care physician , ( e.g. , emergency departments , patients that relocated ) , were not overlooked .
the charts of the participants were then reviewed by one of the authors on a yearly basis , from january 2000 to january 2010 , noting possible late nonsuppurative complications of gabhs infection .
no patients were lost to followup , even if they had changed physicians , due to our ability to track them through the centralized database to their new physician or another hmo .
the children that were enlisted to the army ( and thus not members of any hmo during their military service ) were contacted either through their former attending physician or the military physician .
minor treatment failure was defined as any clinical or bacterial recurrence of pharyngitis during the short - term follow - up period and its correlation to compliance with treatment .
major treatment failure was defined as retropharyngeal or peritonsillar abscess or long - term complications , such as rheumatic fever .
suppurative complications were chosen as a model , because the nonsuppurative complications ( rheumatic heart disease , arthritis , carditis ) have been practically eradicated in our region .
this cohort study was designed to analyze rare events ( according to the cioms classification 110 events per 10,000 children years ) .
the annual incidence of peritonsillar abscess ( pta ) in our region is 24 cases per 100,000 and the incidence of retropharyngeal abscess ( rpa ) is 57 cases per 100,000 .
power calculations suggested 6,500 to 7,000 person - years of intervention would be needed to detect a 22% difference in pta and rpa between the fully treated ( ft ) and partially treated ( pt ) arms of the study population .
furthermore , one - sided alpha of 0.025 , a statistical power of 95% , and the pta / rpa incidence given above showed that approximately 19,000 children - years would be needed to show the noninferiority of ft versus pt . since the primary outcome of interest is the pta / rpa hazard ratio between ft and pt .
the null hypothesis to be tested is hr pta / rpa > 2 ( i.e. , the pta / rpa hazard ratio for ft versus pt is higher or equal to 2 ) .
the pta / rpa hazard ratio was calculated for ft versus pt .   for purposes of analysis ,
participants were divided into four subgroups based on length of treatment : 1st subgroup ( untreated ) , those who did not receive any treatment , 2nd subgroup ( partially treated ) , children that received antibiotics for 1 to 3 days , 3rd subgroup ( mostly - treated ) , children treated for 4 to 6 days , and 4th subgroup ( fully - treated ) children treated between 7 to 10 days .
data are presented as proportions ( with 99% confidence intervals [ cis ] ) , means ( with sds ) , or medians ( with interquartile ranges ) , using pearson  tests , student 's tests , or fisher exact test .
comparisons of length of treatment according to time and treatment were assessed using the repeated measures and analysis of variance and the paired t test .
a 2-tailed p value of.05 was used to determine the statistical significance of differences observed between groups and to calculate confidence intervals around differences in sample means and odds ratios .
we used the mcnamara test to measure the changes between the groups and their subgroups regard to the length of antibiotic treatment .
over half of their children ( 1023 , 51% ) were between the ages of 6 months and 6.9 years , and over half 1,039 ( 52% ) were female .
the majority of children ( 1,821 , 91% ) were prescribed penicillin or amoxicillin , allergic or intolerant to penicillin were treated with cephalosporin 25 ( 1.5% ) , erythromycin 109 ( 5.5% ) , and azithromycin 45 ( 2.5% ) , all medication were prescribed twice daily for 10 days , except azithromycin once daily for 5 days .
no statistical correlation was found between the type of antibiotics , the children received , or the demographic characteristics and the complications found in the later medical examinations .
only 196 children ( 9.8% ) actually completed 10 days of antibiotic treatment . despite having received a prescription from their physician , two hundred and thirteen participants ( 11% )
did not start taking any treatment whatsoever , including those who did not even purchase antibiotics .
as shown in table 1 a no statistical correlation was found concerning length frequency and duration , palatability , number of daily dose of treatment , but a statistically significant difference was found between all the subgroups concerning the length of antibiotics treatment ( p   <
the majority of children ( 1192 , 59.6% ) had 3 days or less of fever , defined as any rectal temperature less than 38.5c or oral temperature less than 37.8c .
the majority of children ( 1591 , 80% ) received medication for four to six days at the most ( partially treated subgroup ) .
as illustrated in table 1 , the association between the duration of fever and the number of days of treatment was statistically significant ( p < .0001 ) .
of the 306 ( 15.3% ) children with clinically diagnosed recurrent tonsillopharyngitis , only 236 ( 12.3% ) had positive gabhs findings on the throat culture taken within 10 to 14 days after conclusion of the primary infection .
an additional thirty - four ( 1.7% ) had a positive second study culture ( taken 2130 days after the index positive gabhs culture ) .
of note is the fact that the majority ( 156 , 66% ) of the positive study culture at 1014 days were found among the subgroup treated for 7 to 10 days .
no such positive results were found in the subgroup treated for 1 up to 3 days .
furthermore , no positive gabhs throat cultures were found on the second study culture in the untreated group .
the majority ( 26 , 76% ) of positive gabhs cultures were in the mostly treated subgroups .
as illustrated in table 2 , these findings were both statistically significant ( p  <  .0001 ) ( table 2 ) .
cervical lymphadenitis , acute otitis media , and impetigo were the only suppurative complications noted .
110 ( 5.5% ) children developed cervical lymphadenitis , most ( 52 , 47% ) among the 6 to 7 days treatment subgroup and 33 ( 33% ) among the 4 to 5 days treatment subgroup , a significant difference among the treatment subgroups ( p < .0001 ) .
additionally , no children developed nonsuppurative complications during 10 years of followup nor did any of the children develop iga nephropathy during the follow - up period .
furthermore , they were no association between the five modified centor criteria and development of complication , even when stratified by type of antibiotics or the season of the year . altogether , 304 ( 15% )
new onset cases of acute otitis media ( aom ) were diagnosed within 30 days of the initial diagnosis .
however , only 31 ( 10% ) of those were in the untreated subgroup , as compared to 141 ( 46% ) in the 7 to 10 days treatment subgroup , 98 ( 38% ) in the 4 to 6 days treatment subgroup and 98 ( 33% ) in the 1 to 3 days subgroup , a statistically significant difference among the all treatment subgroups ( p  <  .0001 ) .   attempting to elucidate the possible causes for the differences between the recurrence of gabhs and the length of antibiotic treatment or clinical score on enrolment or illness severity , a multivariate stepwise logistic analysis was performed .
the duration of fever was the most significant predictor for such recurrence , age under 6 years being less significant , while treatment for 7 to 10 days had no significant influence on the recurrence of gabhs .
of note is that the contribution of the duration of fever was apparent even after controlling for the concomitant influence of age , gender , medical history , single- or two - parent home , type of antibiotics or the season of the year , and concomitant illnesses , such as , conjunctivitis , otitis media , upper respiratory infection , gastroenteritis , or lymphadenitis , which may have otherwise explained the influence of the length of treatment in relation to those illnesses ( table 3 ) .
this study found a very poor parent / child compliance to antibiotic treatment prescribed for symptomatic , culture - positive gabhs tonsillopharyngitis .
11% of children did not start taking any treatment at all , and only 10% completed a full course of treatment .
the reason for this low rate of compliance is unclear , but it coincides with other reported studies [ 14 , 16 ] . we speculate that a large proportion of lack of compliance is the parent 's sensation that antibiotics are potentially dangerous   and overprescribed [ 18 , 19 ] . despite this poor compliance , in our study as in others , there was a very low rate of suppurative complications .
furthermore , despite the poor compliance , we found no increase in the incidence of acute rheumatic fever , the most dreaded complication of gabhs , in our patients .
in fact , since the year 2000 , the incidence of rf in our region has declined from 2.2 per 100,000 to 0.2 per 100,000 in 2008 , according to the epidemiological department of the israeli ministry of health .
this is in concordance with other developed countries , including , the united states , where the original recommendation for 10 days of antibiotic treatment of gabhs originated . in that country ,
currently there are only 10 cases of rf per 100,000 patients with gabhs pharyngitis , and only 1 case per 10,000 patients with acute rheumatic fever develop rheumatic heart disease [ 2022 ] .
in fact , concomitant with the increased use of antibiotics , recurrence of gabhs in the usa rose from 9% and 10.7% in the years 1975 to 1979 , respectively , to 25.9% and 37.5% in the years 1995 to 1996 , despite the decline in acute rheumatic fever .
14% of patients in our study had a recurrent infection , proven by a gabhs - positive throat cultures .
this percentage is similar to other studies which found that penicillin failed to eradicate gabhs from the throat in approximately 13% to 26% of the patients evaluated [ 23 , 24 ] .
the majority of recurrences in our study were in the younger group ( mean age of 10.2 years , and 60% of them younger than 9.9 years ) .
this is consistent with other published studies where such recurrences were more frequent among children aged 1 to 8 years than among children aged between 13 and 19 years [ 24 , 25 ] .   historically ,
prescribing 10 days of oral penicillin began in the 1950s , substituting the intramuscular injections of long - acting parenteral penicillin , based on surrogate markers of eradication of gabhs from the tonsillopharynx . however , no study has conclusively proven that this practice unequivocally prevents acute rheumatic fever [ 26 , 27 ] . even though orally prescribed penicillin appeared to be equally effective for clinical and laboratory resolution of signs and symptoms , it is difficult to administer and expensive , considering the staggering financial burden of approximately 140 office visits per annum per 1,000 children younger than 15 years [ 28 , 29 ] . substituting azithromycin or cephalosporins for penicillin was found to produce better bacteriological and clinical results and also required a shorter course of treatment [ 30 , 31 ] .
our results may not apply to adults , sick people , or chronic gabhs carriers .
it does not address the optimal length of treatment required to achieve appropriate eradication of the microbe or whether complete eradication is required at all .
the method of pill / doses counts is not a good measure of adherence , but due to it simplicity and empiric nature it was found adequate for this study .
we were unable to assess the true variation of the incidence of acute rheumatic fever , due to the fact that this disease has been practically eradicated from our population .
our data suggest that the large majority of parents / patients stop administering antibiotics to their children who suffer from gabhs prior to the completion of the recommended course .
a more judicious use of antibiotics would promote and improve compliance , cut costs , and prove more convenient to parents and children alike .

 background .
 uncertainty exists concerning the necessity of 10-day antibiotic treatment of group a beta hemolytic streptococcus ( gabhs ) pharyngitis . objective . to assess the incidence of gabhs recurrence and suppurative and nonsuppurative complications in relation to compliance
 . methods .
 ( design ) . prospective cohort observational study .
 ( subjects ) .
 2,000 children aged 6 months to 18 years with sore throat and positive gabhs culture .
 ( main outcome measures ) .
 recurrence of symptomatic culture positive gabhs pharyngitis , incidence of suppurative , and long - term , regional , nonsuppurative complications of gabhs pharyngitis , over a ten year period . results .
 213 ( 11% ) of the children received no treatment .
 most children received antibiotics for only 46 days ( in correlation with the duration of fever , which in most cases lasted up to 3 days ) .
 three hundred and six ( 15.3% ) children had clinically diagnosed recurrent tonsillopharyngitis ; 236 ( 12.3% ) had positive gabhs findings within 10 to 14 days and thirty - four ( 1.7% ) within 2130 days after the index positive gabhs culture .
 the remaining 1.3% had no positive culture despite the clinical findings .
 almost all recurrences [ 236 ( 11.6% ) ] occurred within 14 days and 156 ( 7.6% ) in the fully treated group .
 the presence of fever during the first 3 days of the disease was the most significant predictor for recurrence .
 other predictors were the age younger than 6 years and the presence of cervical lymphadenitis .
 no increase in the incidence of nonsuppurative or suppurative complications was noted during the 10-year follow - up period , compared to the past incidence of those complications in israel .
 conclusions .
 our data suggests that the majority of children discontinue antibiotics for gabhs tonsillopharyngitis a day or two after the fever subsides .
 the incidence of complications in our study was not affected by this poor compliance .


neurofibromatosis affects 1:3,000 individuals , and characterized by largely benign but often debilitating tumors that grow in the nervous system .
its course is unpredictable : it can cause a variety of benign nerve tumors including plexiform , dermal , and optic glioma tumors ; in some cases malignant peripheral nerve sheath tumors can develop in the plexiform tumours .
down 's syndrome is one of the most common and easily recognized genetic conditions in humans .
the estimated prevalence in the united states is approximately 15 per 10,000 live births ( ie , 1 out of every 700 )
most often , it is the result of nondisjunction on chromosome 21 during maternal meiotic division .
we herein present the case of a 17-year - old boy with complaints of skin lesions over the back associated with mild itching since 3 months .
he was a known case of down 's syndrome with a history of seizures in childhood [ figure 1 ] .
the lesions gradually increased in size and number , and similar lesions started developing over his forehead since 23 weeks . on examination , multiple skin colored papules of varying size were present over the entire back and the forehead .
velvety thickening of the skin and hyperpigmentation of the axillae suggestive of acanthosis nigricans was present .
the characteristic features of down 's syndrome , including simian crease , mongoloid facies , and mental retardation were present .
canities and a solitary keloid over the chest were also seen apart from the clinical features of down 's syndrome . on oral examination , scrotal tongue , abnormal dentition , and
other investigations such as ct scan brain , 2d echo , and ecg were normal .
histopathology of the nodule from the back revealed focally thinned out epidermis with intact basal layer ; the papillary dermis showed a mild perivascular infiltrate .
deeper dermis showed a benign spindle cell proliferation suggestive of neurofibromatosis [ figure 3 ] .
physical appearance of down 's syndrome ( a ) neurofibromas ( b ) sebaceous cyst ( c ) acanthosis nigricans , and axillary freckling ( d ) scrotal tongue focally thinned out epidermis with intact basal layer with the papillary dermis showing a mild perivascular infiltrate .
the presentation of a patient with two unrelated genetic disorders is uncommon , although not statistically impossible .
however , in two of these reports , a third medical condition was also present . in one report , breast cancer was reported . in the other ,
our patient had down 's syndrome , neurofibromatosis , dental anomalies , and ocular defects and keloids . in the large majority of cases , trisomy 21
there is no current evidence to support the idea that this is anything other than a chance occurrence .
the two conditions are not related , and the likelihood of a person being born with these two conditions is approximately 1 in 2,700,000 births .
they however overlap in their manifestations . both are associated with intellectual impairment to differing degrees .
macroglossia occurs in both conditions , as may facial , dental , and occlusal abnormalities .
hearing and speech are affected in both conditions , as may the ability to maintain an acceptable level of oral hygiene .
mutations in the gene results in abnormal control of cell growth , differentiation , and aberrant myelination . our patient with of neurofibrmatosis type 1 with down 's syndrome is the first such to have a keloid and sebaceous cyst apart from myopia and dental anomalies . the unpredictable nature and course of the two genetic disorders along with multiple acquired conditions in this patient make it difficult for patients , teachers , care givers , and medical / dental providers to create and maintain long - term care plans . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s )
has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal .
the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .
the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s )
has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal .
the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .

 we report a patient with down 's syndrome and neurofibromatosis who presented with a keloid , sebaceous cyst and acanthosis nigricans , along with dental and ophthalmological defects .
 the coexistence of neurofibromatosis type 1 and down 's syndrome which are two unrelated genetic conditions is itself a rarity .


Altia 's operating profit jumped to EUR 47 million from EUR 6.6 million .


The agreement was signed with Biohit Healthcare Ltd , the UK-based subsidiary of Biohit Oyj , a Finnish public company which develops , manufactures and markets liquid handling products and diagnostic test systems .


Kesko pursues a strategy of healthy , focused growth concentrating on sales and services to consumer-customers .


Vaisala , headquartered in Helsinki in Finland , develops and manufactures electronic measurement systems for meteorology , environmental sciences , traffic and industry .


Also , a six-year historic analysis is provided for these markets .


Elcoteq 's stock of orders has stabilised in the past weeks , Mr Krippl said .


Also , a six-year historic analysis is provided for this market .


In addition , nine fixed-term employment contracts will not be extended and two people will leave the company under pension arrangements .


Operating loss totalled EUR 0.9 mn , down from a profit of EUR 2.7 mn .


The Insolvency Act regulates the amount of debt that borrowers are permitted to write off .


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"The conversation my son and I will have on Christmas Eve."


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"Today one of my 4th grade students renamed himself "reconecting ..." on our Zoom call and pretended that he was having internet issues to avoid participating in our lesson."


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illustrative embodiments of the invention will be described below in the context of a battery . however , it is to be understood that the encapsulation techniques and mechanisms described herein are more generally applicable to any power source for which it would be desirable to prevent harmful chemical leakage , reduce harm caused by ingestion , and / or other related harms caused by the power source and its components . fig1 illustrates an encapsulated battery system 100 . the system 100 includes a power source 102 having a set of power terminals 103 - 1 and 103 - 2 . in this embodiment , the power source 102 is a battery , by way of example only , a button or cylindrical type battery such as , but not limited to , a lithium cell battery . the power source 102 can also be a disposable battery or a rechargeable battery . in this example , power terminal 103 - 1 is the positively charged electrode of the battery or anode , while power terminal 103 - 2 is the negatively charged electrode of the battery or cathode . however , the power terminals can be reversed in alternate embodiments . furthermore , the power terminals do not have to be located on opposite sides of the battery as illustrated in fig1 but rather can be located in other locations on the battery . as further shown in the system 100 of fig1 , a cover 104 encapsulates the power source 102 as well as the set of power terminals 103 - 1 and 103 - 2 , thus sealing the power source 102 and the set of power terminals 103 - 1 and 103 - 2 within the cover 104 . in one embodiment , the material used for the cover 104 to encapsulate and seal the power source 102 and the set of power terminals 103 - 1 and 103 - 2 is a natural elastomer such as natural rubber or other natural polymer . in another embodiment , the cover material is a synthetic elastomer such as a synthetic rubber or other synthetic polymer . for example , the material is a rubber material or silicone gel material in certain illustrative embodiments . some of the advantages of elastomer materials include , but are not limited to , prevention of leakage of the battery chemicals into nature when they are thrown away instead of being recycled , as well as when they are ingested by a human or animal . the cover 104 can also be formed with a silk material that can be ingested without harm to the human or animal that ingests it . as is known , silk can be processed into various forms such as gels and films . as such , a gel or film - like silk material can be used to encapsulate and seal the power source 102 and the set of power terminals 103 - 1 and 103 - 2 . still further , the cover can be formed with an electrical conducting material that is harmless if swallowed by humans or animals , e . g ., gold , platinum or silver . in this case , the cover 104 could also have insulating material surrounding the power terminals 103 - 1 and 103 - 2 of the power source 102 or otherwise electrically separating the two terminals to prevent shorting of the anode and the cathode . as further shown in the system 100 of fig1 , a set of conductive contacts 106 - 1 and 106 - 2 are configured to pass through the cover 104 and contact the set of power terminals 103 - 1 and 103 - 2 , respectively , thus providing conductive access to the set of power terminals of the power source 102 from outside the cover without allowing exposure of the power source or the power terminals to an environment outside the cover 104 . this means that none of the harmful chemicals of the power source 102 are able to escape from the cover 104 when the power source leaks . note that the set of conductive contacts are made of an electrical conducting material , and are configured to be removable from the cover 104 without allowing exposure of the power source 102 or the set of power terminals 103 - 1 and 103 - 2 to the outside environment . in the embodiment shown in fig1 , the conductive contacts 106 - 1 and 106 - 2 are pin - shaped ( but can be pointed in shape in some other manner ) such that they penetrate the cover 104 but allow the cover to re - seal upon removal of one or more of the contacts . while two pin - shaped structures for each conductive contact are shown penetrating the cover 104 and contacting each of the power terminals ( 103 - 1 and 103 - 2 ), it is to be understood that more or less pin - shaped structures can be used to form each conductive contact . while the set of conductive contacts 106 - 1 and 106 - 2 are preferably removable from the system 100 , in an alternative embodiment , the conductive contacts are integrally - formed with the cover 104 . fig2 illustrates a conductive contact for an encapsulated battery system , according to an embodiment of the invention . recall that the system 100 of fig1 illustrates a set of conductive contacts 106 - 1 and 106 - 2 that are pin - shaped in form . in an alternate embodiment of a conductive contact 200 shown in fig2 , the conductive contact also includes an electrically conductive spring 201 in the form of an adjustable spiral structure . the spring 201 allows for compressive pressure to be put on the conductive contact and the corresponding power terminal ( 106 - 1 or 106 - 2 ) of the power source 102 in order to make a better electrical connection between the conductive contact 200 and the corresponding power terminal of the power source . the spring 201 is also configured to be able to penetrate the cover 104 , if needed for a given configuration , without exposing the power source or power terminals to the outside environment , both while installed and after being removed from the cover . fig3 illustrates an encapsulation structure for an encapsulated battery system , according to an embodiment of the invention . recall that the system 100 of fig1 illustrates a cover 104 that encapsulates the power source 102 as well as the set of power terminals 103 - 1 and 103 - 2 , thus sealing the power source 102 and the set of power terminals 103 - 1 and 103 - 2 within the cover . in one embodiment , a cover 300 is shown in fig3 . as mentioned , the cover can be made of various materials including , in one or more embodiments , a rubber material that encapsulates the power source and power terminals so as to seal the power source and power terminals from exposure to the outside environment . in one embodiment as shown in fig3 , a tyer 301 is included as part of the cover 300 . in this embodiment , the tyer 301 is an integral part of the cover structure that securely attaches the cover 300 to the power source . the tyer 301 , in one example , is made from the same rubber material as the cover with adhesive material on the portion of the tyer that comes into contact with the body of the power source . other tyer configurations are possible within the scope of alternate embodiment . whether or not the cover includes a tyer structure , it is to be appreciated that the power source and power terminals remain sealed from exposure to the outside environment once the power source is encapsulated within the cover . fig4 illustrates a methodology for forming and installing an encapsulated battery system , according to an embodiment of the invention . as shown in a methodology 400 , a battery ( one example of a power source and its power terminals ) is encapsulated in a rubber cover , in step 402 . one of ordinary skill in the art will realize various known rubber application processes for encapsulating and sealing a component such as a battery . it is assumed the conductive contacts ( e . g ., contacts such as shown as 200 in fig2 ) are installed by pressing the pin structures of the contact through the rubber cover in the vicinity of the power terminals of the battery . in step 404 , the contacts ( pins ) are adjusted to place the encapsulated battery in a compartment . the compartment may be , for example , the battery compartment of an electronic device that requires battery power for operation . in step 406 , the encapsulated battery is placed in the compartment . it is to be understood that when the conductive contacts each include a spring ( 201 in fig2 ), the springs are compressed on each side of the battery ( e . g ., contacts are compressed between the fingers of the installer ) so that the encapsulated battery can fit into the compartment . in step 408 , the contacts ( pins ) are released so that the contacts respectively connect with the electrical contacts of the electronic device ( located inside the compartment ). in step 410 , a check is made to verify that the battery is properly installed and sufficiently contacting the contacts of the electronic device . this may be verified by checking whether or not current is flowing through the battery , i . e ., check to see that the electronic device is getting the power it needs to operate . if yes , then the methodology ends at block 412 . however , if the electronic device is not getting the needed power from the battery , in step 414 , the encapsulated battery is removed and the penetration of the pins of the conductive contacts is increased through the rubber cover . this is to ensure that there is more sufficient contact between the conductive contacts and the power terminals of the battery sealed inside the rubber cover . once this is done , the methodology 400 returns to step 404 and repeats . it will be appreciated and should be understood that the exemplary embodiments of the invention described above can be implemented in a number of different fashions . given the teachings of the invention provided herein , one of ordinary skill in the related art will be able to contemplate other implementations of the invention . indeed , although illustrative embodiments of the present invention have been described herein with reference to the accompanying drawings , it is to be understood that the invention is not limited to those precise embodiments , and that various other changes and modifications may be made by one skilled in the art without departing from the scope or spirit of the invention .

a method comprising the steps of encapsulating a power source including a set of power terminals in a cover and sealing the power source including the set of power terminals within the cover and inserting a set of conductive contacts through the cover to contact the set of power terminals and provide conductive access to the set of power terminals of the power source from outside the cover without allowing exposure of the power source to an environment outside the cover .


fig1 schematically shows a longitudinal cross - sectional view of a portion of a pipe assembly 10 according to a preferred embodiment of the present invention . fig2 , 3 and 4 schematically show perspective views of pipe assembly 10 , with fig2 and 3 showing cut - away perspective views of the two longitudinal halves of pipe assembly 10 and fig4 showing an upstream view of pipe assembly 10 . pipe assembly 10 may transport fluids , such as steam flowing from a nuclear reactor . pipe assembly 10 includes a main pipe 12 , a standpipe 14 , a relief valve 16 ( omitted from fig2 to 4 for clarity ) and a scoop insert 18 . a first end 61 of standpipe 14 is coupled to main pipe 12 at an intersection 44 and a second end 62 of standpipe 14 is coupled to relief valve 16 . during normal operation , when a pressure in pipe assembly 10 is below a predetermined threshold of relief valve 16 and relief valve 16 is closed , steam in main pipe 12 flows from upstream of standpipe 14 to downstream of standpipe 14 . scoop insert 18 is arranged to extend into main pipe 12 and drive a small portion of steam flowing through main pipe 12 upward into standpipe 14 to closed relief valve 16 and back into main pipe 12 . the upwardly directed steam then recirculates back into the main pipe 12 , thereby disrupting vortex shedding past the inlet of standpipe 14 . scoop insert 18 includes a coupling portion 20 , which may be flange 20 , a body portion 22 , which in this embodiment has semi - cylindrical shape , and a scoop 24 . flange 20 may be fixed in between a flange 30 of standpipe 14 and a flange 32 of relief valve 16 . body portion 22 extends downwardly from flange 20 against an inner circumference 41 of standpipe 14 and connects scoop 24 to flange 20 , which couples scoop 24 to second end 62 of standpipe 14 . scoop 24 is positioned with a top end 34 of scoop 24 in standpipe 14 and a bottom end 36 of scoop 24 in main pipe 12 , so that scoop 24 is located at intersection 44 of standpipe 14 and main pipe 12 on an upstream side of standpipe 14 with respect to main pipe 12 and extends from within standpipe 14 into main pipe 12 . scoop 24 may include a front face 26 extending downward from body portion 22 having an opening 40 formed therein . in this embodiment , front face 26 is integral and flush with body portion 22 . scoop 24 also includes a channeling face 28 opposite of front face 26 extending from within standpipe 14 into main pipe 12 . channeling face 28 is positioned to channel steam flowing through main pipe 12 into standpipe 14 . channeling face 28 is substantially parallel with standpipe 14 at top end 34 and is angled with respect to standpipe 14 at bottom end 36 , so scoop 24 redirects steam flowing through main pipe 12 by approximately ninety degrees . in this embodiment , front face 26 has a semi - cylindrical shape and channeling face 28 has a semi - cylindrical shape at top end 34 . thus , at top end 34 , front face 26 has a convex shape with respect to channeling face 28 and channeling face 28 has a concave shape with respect to front face 26 . scoop 24 may also include channeling sides 27 , 29 connecting front face 26 and channeling face 28 that assist in directing steam from main pipe 12 to standpipe 14 . in a preferred embodiment , standpipe 14 is six inches in diameter and main pipe 12 is twenty - four inches in diameter . in alternative embodiment , flange 20 and body portion 22 may be omitted and scoop 24 may be directly coupled to at least one of main pipe 12 and standpipe 14 , for example by welding . fig5 and 6 show a downstream perspective view and side perspective view , respectively , of scoop insert 18 . flange 20 has evenly spaced holes 38 formed therein . fasteners such as bolts may be passed through holes 38 to secure flange 20 to at least one of standpipe 14 ( fig1 to 4 ) or relief valve 16 ( fig1 ). front face 26 extends downward from body portion 22 and has opening 40 defined therein for steam to enter and be directed upwards by channeling face 28 towards body portion 22 and flange 20 . channeling face 28 is parallel to body portion 22 at top end 34 , but extends downward and curves towards front face 26 at bottom end 36 . fig7 and 8 show a perspective upstream view and a perspective downstream view of a scoop insert 118 according to another embodiment of the present invention . scoop insert 118 may be inserted in standpipe 14 ( fig1 to 4 ) to direct steam from main pipe 12 ( fig1 to 4 ) into standpipe 14 in substantially the same manner as scoop insert 18 ( fig1 to 6 ). scoop insert 118 includes a flange 120 , a body portion 122 and a scoop 124 . scoop 124 includes a front face 126 , a channeling face 128 and channeling sides 127 , 129 . channeling sides 127 , 129 connect front face 126 and channeling face 128 and assist in directing steam from main pipe 12 ( fig1 to 4 ) to standpipe 14 ( fig1 to 4 ). body portion 122 extends downward from flange 120 to front face 126 at a top end 134 of scoop 124 , which curves away from body portion 122 at a bottom end 136 and protrudes past body portion 122 upstream in main pipe 12 ( fig1 to 4 ). at bottom end 136 , at least a portion of front face 126 may contact an inner circumference of main pipe 14 ( fig1 to 4 ). channeling sides 127 , 129 extend inwardly from front face 126 , connecting front face 126 with channeling face 128 . front face 126 , channeling face 128 and channeling sides 127 , 129 define an opening 140 for steam to flow through , which scoop 124 directs towards body portion 122 and flange 120 . at both ends 134 , 136 , opening 140 has a semi - annular shape . fig9 shows a top view of scoop insert 118 . top end 134 of scoop 124 is shown , with channeling sides 127 , 129 extending radially inward from front face 126 towards channeling face 128 . front face 126 has a convex shape with respect to channeling face 128 and channeling face 128 has a concave shape with respect to front face 126 . in the preceding specification , the invention has been described with reference to specific exemplary embodiments and examples thereof it will , however , be evident that various modifications and changes may be made thereto without departing from the broader spirit and scope of invention as set forth in the claims that follow . the specification and drawings are accordingly to be regarded in an illustrative manner rather than a restrictive sense .

a piping assembly for directing fluid and mitigating acoustic and vortex coupled resonance is provided that includes a main pipe delivering fluid in a first direction ; a standpipe coupled to the main pipe at an intersection ; and a scoop positioned at the intersection directing the fluid towards the standpipe . a scooping insert and a method for disrupting vortex shedding in a piping assembly are also provided .


an overall block diagram of a preferred embodiment of the present invention is shown in fig1 . the major components are an integrated circuit chip 110 , an external if filter 111 , a filter coefficient adjustment circuit 112 , an operating cycle timer 113 , and configuration changing gates 113a . the integrated circuit chip 110 includes thereon a radio receiver 110a , an on - chip filter 110c and a signal comparator 110b . the blocks shown in fig1 are not meant to show the actual layout of the components on the chip 110 since the layout of the chip can be conventional and it forms no part of this invention . the details of the radio receiver 110a and its associated external components are shown in fig6 and they will be explained in detail later . it is noted that what is generally termed an fm radio receiver includes if filters . herein for the sake of convenience the parts of the radio receiver on integrated chip 110 , that is , the radio receiver minus the if filter , is called a radio receiver . a key aspect of the present invention is that it reduces the number of external or off - chip components required . the invention is applicable to a receiver system that includes two if filters . with the present invention one of these filters , namely filter 110a , is implemented on - chip and the second filter 111 is an off - chip component . as will be explained later , the on - chip filter is made to conform to the off - chip filter prior to the activation of the receiver . while the on - chip filter may drift out of the acceptable range of specifications in a relatively short time , the receiver is only activated for a short period and during this period the on - chip filter 110a operates appropriately . the radio receiver 110a is designed for operation in a time slot paging system such as that shown in u . s . pat . no . 4 , 713 , 808 ( gaskill ) wherein the receiver is only active for very short periods , each active period being followed by a relative long period of inactivity . since the receiver is only active for very short periods , it uses relatively little power . this is important in applications such as where the radio receiver is part of a wristwatch where there are very severe power limitations . with the present invention the system operates with an operating cycle which has three portions : second : the receiver 110a is turned on for a short period . fig2 shows the relative length of the three portions of the operating cycle . key to the present invention is the fact that the first and second portions of the operating cycle are relatively short with respect to the third portion of the operating cycle . the length of the various portions of the operating cycle is shown in fig2 . the components within the system are connected in a different manner during the first and second portion of the operating cycle . fig3 shows how the components in the system are connected during the first portion of each operating cycle . fig4 shows how the components are connected during the second portion of each operating cycle . as shown in fig3 during the first portion of each operating cycle , the circuit is connected so that the on - chip filter 110c can be adjusted . during the first portion of each operating cycle , the frequency characteristics of on chip filter 110c are made to match the frequency characteristics of external filter 111 . this portion of the cycle requires approximately 4 . 3 milliseconds . after the first portion of each operating cycle , the on - chip filter 110c and the off - chip filter 111 are connected in series as shown in fig4 and the receiver is activated for approximately 33 milliseconds . as explained in the above referenced gaskill patent , while the receiver is only active for a short period of time , this is time enough to span one time slot in a time slot protocol . in the third , and relatively long portion of each operating cycle , the receiver is deactivated . fig5 shows the details of the on - chip filter 110c . on - chip filter 110c is a two pole filter which includes two coupled resonators 550a and 550b . the two resonators 550a and 550b are connected by a series coupling capacitor 550c . resonator 550a includes on - chip capacitors 501a and 502a , gyrator 503a , and variable resistor 504a . resonator 550b includes on - chip capacitors 501b and 502b , gyrator 503b and variable resistor 504b . the on - chip components shown in fig5 are connected in a conventional fashion to form a band pass filter . such filters are well know ; however , it is also well known that such on - chip gyrators working at 10 . 7 mhz are relatively unstable . that is , once they are adjusted to certain parameters , they will retain those values for only a short period of time . the present invention takes advantage of the fact that the receiver 110a is only active for a very short period , that is , for 33 milliseconds . thus , the parameters are adjusted during the first portion of each cycle and they only need retain their value for the 33 milliseconds that the receiver is active during the second portion of each cycle . unique to the invention is the fact that the parameters are automatically adjusted each time that the receiver 110 is activated . the particular adaptive algorithm used to adjust the parameters or gyrators 503a and 503b is not relevant to the present invention and such adjustment algorithms are known in the art . for example the algorithm shown in a paper by d . a . johns , w . m . snelgrove , and a . s . sedra entitled &# 34 ; continuous - time analog adaptive recursive filters &# 34 ; published in iscas 1989 pages 667 - 669 . as shown in fig3 during the first or &# 34 ; adjustment &# 34 ; portion of each operating cycle the antenna 116 is removed and the rf amplifier 22 is connected to a fixed voltage . mixer 28 and if amplifier 34 are connected in series , thus providing a &# 34 ; white noise &# 34 ; signal input to filters 110c and 111 . the output of filters 110c and 111 are compared by comparator 110b , and if they are not equal a signal is sent to adjustment circuit 112 . the adjustment process continues until both filters 110 and 111 produce the same output signal . at this point the on - chip filter 110c has the same frequency response as does external filter 111 and the first portion of each operating cycle ends . next the components are connected as shown in fig4 . the gates 113a for switching the connections are not specifically shown in fig3 and 4 since such gates can be conventional . the switching gates 113a are activated by cycle timer 13a as shown in fig1 . as shown in fig4 during the receive portion of each cycle , the components are connected as a receiver such as that shown in the previously referenced patent application . this connection will be explained in detail with reference to fig6 . the details of how receiver 110 is connected into the system during the second or &# 34 ; receive &# 34 ; portion of each cycle are shown in fig6 . the system as shown in fig6 includes an rf stage 10 , an if stage 12 and a baseband stage 14 . the rf stage 10 includes an antenna 116 which may be fabricated into the wristband 17 of the wristwatch 19 in which the receiver 8 is mounted . ( a suitable wristwatch enclosure is described in the gaskill et al patent ). the antenna 116 provides rf signals to an antenna tuner stage 18 . antenna tuner stage 18 is a conventional varactor controlled bandpass filter which also performs limited impedance match functions . a tuning voltage is applied to a tune voltage port 20 from a microprocessor based control system not shown earlier . such a microprocessor system is discussed in gaskill et al . the voltage supplied via port 20 tunes a voltage - variable capacitor in tuner 18 . the antenna tuner 18 also serves a limited impedance transformation function . the antenna 116 is typically a very small loop and consequently has a very small impedance . receiver performance and noise figure are optimized if this impedance is transformed up to more closely match the input impedance of the following rf amplifier stage 22 . rf amplifier stage 22 is a low noise broadband amplifier tuned for maximum gain in the fm broadcast band ( 88 - 108 megahertz ). the maximum gain of rf amplifier stage 22 is approximately 10 db . the actual gain is controlled by an agc control circuit discussed below . a receiver mixer stage 26 is provided with a wide band of amplified input signals . to minimize the effect of image signals which pass the tuner stage 18 , mixer stage 26 is configured in an image canceling topology . two individual quad mixers 28 and 30 are driven with quadrature local oscillator signals on lines 27 and 29 from a local oscillator synthesizer 31 . high side injection is used , so the local oscillator tunes the 98 . 7 to 118 . 7 megahertz range to yield a 10 . 7 megahertz intermediate frequency . the output of the mixer 28 driven from local oscillator line 27 is delayed 90 degrees and is combined with the output of the mixer 30 that is driven from the delayed local oscillator line 29 . the combination of these signals cancels any image response while reinforcing the desired signal response . mixer 26 has a conversion gain at the desired signal frequency of approximately 7 db . the output of mixer stage 26 is provided to an if chain 32 comprised of two if amplifiers 34 and 36 and ceramic band pass filters 111 and adaptive filter 110a . as shown in the previously referenced patent applied the filter 110 is of chip construction and may be of the sfec 10 . 7 series manufactured by murata . in accordance with the present invention only filter 40 is implemented using an ic chip . if amplifiers 34 and 36 have gains of approximately 20 db each and filters 38 and 49 have about 6 db each of loss . the if amplifiers 34 and 35 can be gain controlled , to optimize noise figure . the output of if chain 32 is provided to a synchronous , or coherent detector comprised of a mixer 49 injected with a 10 . 7 megahertz local oscillator signal . the synchronous detection process adds the side band signal voltage and the side band noise powers , resulting in a 3 db improvement in signal - to noise ratio . the technique also permits detection at a much lower signal level than would be possible if a limiter stage was employed . consequently , the if stage gain can be lower than would normally be the case , thereby reducing the risk of feedback . the local oscillator 48 which provides the 10 . 7 megahertz signal is locked to the frequency of the if by a feedback circuit 71 , discussed below . a 90 degree phase shift of the local oscillator signal by a phase shifter 47 causes the signal output by mixer 49 to an output line 51 to be proportional to the frequency of the signal modulating the 10 . 7 megahertz if . this baseband frequency modulated signal is fed to a low pass filter 52 and then to a baseband amplifier 53 . baseband amplifier 53 has a break point of about five kilohertz for discrimination against the left plus right fm stereo channel . the breakpoint also minimizes distortion caused by the main audio channel bleeding into the subcarrier channel . the high end rolloff breakpoint is at about 150 kilohertz . the output of the baseband amplifier 53 is provided to conventional decoder circuitry , as disclosed in the gaskill et al . patent . a second synchronous detector is also driven by the if chain 32 and provides an agc signal for application to the rf and if gain stages . this second synchronous detector again includes a mixer 60 , this one driven in phase with the 10 . 7 megahertz local oscillator signal . the output of this mixer 60 is thus related to the amplitude of the if signal and can be used to gain control preceding stages . the limiting stages found in most fm receivers were found disadvantageous in the present system . limiting does not benefit the receiver &# 39 ; s signal - to noise or signal - to - interference ratio due to the low modulation index of the subcarrier being decoded . consequently , the automatic gain control technique was employed . the agc circuitry 24 employed in the preferred embodiment of the present invention is disclosed in pending u . s . patent application ser . no . 07 / 146 , 446 of suter entitled &# 34 ; agc delay on an integrated circuit ,&# 34 ; the disclosure of which is incorporated herein by reference . an agc loop filter 70 is a single rc stage with a break point at about one kilohertz . all other bypassing of agc points is done with much higher break points so that the one pole is clearly dominant . radio receiver as shown herein is afc controlled in a relatively continual manner . afc is effected by a dc component on the feedback loop 71 produced by a synchronous detector 49 . an amplifier 74 is included to insure that the loop gain is high enough to control local oscillator drift . the afc loop controls two local oscillators : the synthesized local oscillator 31 used for high side rf injection and the 10 . 7 megahertz local oscillator 48 used by the synchronous detectors 49 and 60 . both oscillators respond to any dc component on the feedback loop 71 to adjust their frequencies to minimize the resulting dc output from synchronous detector 49 . the afc feature is included here not for threshold extension ( which is not viable with a low modulation index ), but to reduce cross - modulation of entertainment energy into the receiver &# 39 ; s subspectrum due to distortion in the filters 111 and 110b . afc of the synthesizer 31 can be disabled by a switch 72 , which can be operated to apply a fixed reference voltage to the synthesizer 31 instead of the afc signal . further details concerning the operation and system organization of the receiver shown in fig6 can be found in the previously referenced co - pending patent application . while the invention has been described with reference to a preferred embodiment thereof , it will be understood by those skilled in the art that various changes in form and details may be made without departing from the scope of the invention .

the present invention provides an improved single chip radio receiver which has less external components than do previous similar receivers . with the present invention the integrated circuit which includes the radio receiver also has an on - chip adaptive filter . the radio receiver is designed for use in a radio pager which is only active for a very short time slot during a relative long repeat cycle . thus the adaptive filter only need remain stable for a short period after its coefficients are adjusted to the desired values . the radio receiver includes an external filter which has the same frequency response as desired from the adaptive filter . immediately prior to activating the radio receiver , the circuit is activated to adjust the parameters of the adaptive filter so that the adaptive filter matches the external filter . the radio receiver is then activated using both filters in series thereby producing the desired radio reception . the adaptive filter quickly changes characteristics ; however , since the radio receiver is only active for a short period of time , operation of the system is not affected .


the following description of the preferred embodiment is merely exemplary in nature and is in no way intended to limit the invention , its application , or uses . referencing fig1 , a passenger compartment 10 of a golf car 12 is shown . the passenger compartment 10 includes a seat 14 , a floor 16 , and a dash panel 18 , steering wheel 20 , a brake pedal 22 , and an accelerator pedal 24 . a non - skid floor mat 30 , designed in accordance with the principles of the present invention , covers the floor 16 of the passenger compartment 10 . with particular reference to fig2 , 3 and 3 a , the non - skid floor mat 30 will be discussed in detail . the non - skid floor mat 30 is formed of an elastomeric material 32 having an outer perimeter 34 shaped to conform with the floor 16 of the passenger compartment 10 . the floor mate 30 has the advantages of which are discussed in further detail herein below , but may also be formed of alternate materials . the non - skid floor mat 30 may include a steering wheel aperture 36 , a brake pedal aperture 38 , and an accelerator pedal aperture 40 . a series of attachment apertures 42 are positioned about the perimeter 34 for enabling fixed attachment of the non - skid floor mat 30 to the floor 16 . the non - skid floor mat 30 further includes a first section 44 having a flat surface 46 and a second section 48 having a flat surface 50 with a plurality of protrusions , or nibs 52 , extending upward therefrom . it is anticipated , however , that the flat surfaces 46 , 50 are textured of either or both of the first and second sections 44 , 48 may be rough , or otherwise textured . as best seen in fig3 a , the nibs 52 are generally semi - spherical in form with a sufficient radius . however , it is anticipated that the nibs 52 may take any one of a number of forms including , but not limited to , conical , frusto - conical , pyramid , truncated , cylindrical and the like at the bottom . as discussed in further detail below , each nib 52 is formed to fit within recesses of a soft spike . with particular reference to fig4 through 6 , a typical soft spike 60 of a golf shoe is shown engaging the nibs 52 of the non - skid floor mat 30 . soft spike 60 described herein is one of a number of soft spike configurations known in the art . the soft spike 60 generally includes a conical body 62 having a threaded post 64 extending upward therefrom , for threaded attachment with a golf shoe sole 66 . a series of ribs 68 extend downward from a conical face 70 of the soft spike 60 , thereby forming recesses 72 . as the soft spike 60 contacts the non - skid floor mat 30 , the nibs 52 are received into the recesses 72 of the soft spike 60 , as seen in fig5 and 6 , and as shown in phantom in fig4 . in this manner , the non - skid floor mat 30 provides traction for the soft spikes 60 , promoting passenger safety and comfort . it should further be noted that application of sufficient downward force through the soft spike 60 ( e . g . when passenger is standing ) enables the ribs 68 to contact the flat surface 50 between the nibs 52 concurrent to the nibs 52 engaging the recesses 72 . in this manner , improved traction is provided . as discussed briefly above , the nibs 52 are preferably semi - spherical in form for efficiently fitting within the recesses 72 . however , it is anticipated that other forms of the nibs 52 would suffice to fit within the recesses 72 for providing traction . for example , as shown in fig6 , partially frusto - conical nibs 52 are one possibility . more importantly , however , the size and spacing of the nibs 52 must be appropriate for enabling sufficient engagement between the nibs 52 and soft spike 60 , provide clearance to prevent a tripping hazard , and providing clearance for cleanability . additionally , spacing of the nibs 52 must be appropriate to enable hard spikes ( not shown ) to contact the flat surface 50 . in this manner , the non - skid floor mat 30 provides traction for both hard spike and soft spike golf shoes . to that end , the nibs 52 have a center - to center distance no greater than 0 . 80 inches . the center - to - center distance ensures that at least two nibs 52 , and optionally four nibs 52 , engage the recesses 72 of the soft spike 60 . additionally , the center - to - center distance ensures that a hard spike may pass between the nibs 52 for contacting the flat surface 50 , as well as enabling easy cleaning of the non - skid floor mat 30 . for example , if the nibs 52 were positioned too close together it would be difficult to remove dirt and debris deposited therebetween . further , the nibs 52 preferably have a height within the range of 0 . 12 to 0 . 19 inches . this height range ensures that there is adequate engagement between the soft spike recesses 72 and the nibs 52 . if the nibs 52 are too low , the non - skid floor mat 30 would fail to provide adequate traction . on the other hand , if the nibs 52 are too high , a soft spike may not move smoothly over the enon 0 skid floor mater 30 . similarly to the center - to - center distance , the height of the nibs 52 influences the cleanability of the non - skid floor mat 30 . if the nibs 52 are too high , removal of dirt and debris from between the nibs 52 is hindered . both the height and spacing of the nibs 52 are limited to prevent grabbing of the passenger &# 39 ; s golf shoe . as mentioned above , the non - skid floor mat 30 is formed using an elastomer component . the elastomeric material 32 provides toughness and wear resistance to extend the service life of the non - skid floor mat 30 . as an elastomer , the non - skid floor mat 30 is resilient and deformable for enabling improved traction . in the case of a hard spike , the tip of the hard spike may engage the flat surface 50 between the nibs , thereby gripping the non - skid floor mat 30 to provide traction for the passenger . if , however , the hard spike contacts a nib 52 , the hard spike can similarly project into the nib 52 , providing traction regardless of whether direct contact with the flat surface 50 is achieved . with regard to a typical soft spike 60 , as the recesses 72 engage the nibs 52 , the nibs 52 are able to slightly deform under the applied force of the passenger , thereby increasing the contact surface between the soft spikes 60 and the nibs 52 , thus increasing the traction . additionally , nib deformation enables the soft spike 60 to engage the nibs 52 and concurrently contact the flat surface 50 . the description of the invention is merely exemplary in nature and , thus , variations that do not depart from the gist of the invention are intended to be within the scope of the invention . such variations are not to be regarded as a departure from the spirit and scope of the invention .

a non - skid floor mat for use in a golf car is provided to enable traction with one of a hard spike and a soft spike of a golf shoe . the non - skid floor mat includes a sheet of elastomeric material and nibs in the wall area of the mat . the nibs are sufficiently spaced from one another to enable one of direct contact of the hard spike with the sheet and contact of the soft spike with both the nibs and the sheet . preferably , the nibs have a height between 0 . 12 and 0 . 19 inches , and are offset from one another by a center to center distance of between 0 . 5 and 0 . 8 inches .


I did. Thank you for your opinion.


What is this an excerpt from? [NAME] was a treasure. I should read more of his stuff.


It's amazing how utterly lacking in self-awareness this sub is, that it can upvote this without a hint of irony.


Yeah, I agree. It left a bad taste in my mouth that they weren't even gonna mention it, so at least it's something.


Sure thing my dude. You keep on doing you. I wish you the best, good luck.


thanks for this


Ah thank you! I just remembered it the way I said. Was never sure if that's what it meant.


Thanks for finding out! That's cool


What does IANAL mean? Thanks!