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H. Kent, M.B. B.CH. B.A.O., M.B.B.Ch., Ph.D.

Medical Instructor, Campbell University School of Osteopathic Medicine

Semi-structured interviews and observations were carried out as main data collection techniques. Experienced professionals in the field of procurement were also consulted to ascertain their opinions on verification of the feasibility of the scope of the proposed e-procurement system. Findings of the study analysed and presented by using Content Analysis and Cognitive Mapping. Keywords: E-Procurement System, Information Technology, Manual Procurement Process, Procurement. Foreign funding agencies emphasise that the advantages of that development should be utilised by the government organisations in Sri Lanka in order to improve and upgrade the existing manual process with the experience of other developed countries. Therefore water supply and sanitation sector has shown continues growth during the last three decades. However existing manual procurement process is the key problem to * Corresponding Author: E-mail - gayanik@uom. Hence, there is a necessity requirement to enhance the effectiveness of manual procurement process in the Ministry in order to achieve the desired result. In compatible with that, the significant gaps from the manual procurement process to propose upgraded system are also identified and then explored the feasibility areas for enhance the effectiveness of existing procurement process. Finally e-procurement system is identified as a solution to fulfil the requirement of the funding agencies. E-Procurement is practically used by not only developed countries but also developing countries such as Thailand, Korea, and Malaysia further numbers of benefits have been utilised by these countries when compared the earlier manual procurement process, on the other hand, rests of other developing countries also (like India) have started to convert procurement system from manual process to e-procurement system with affected from technological development (Bulusu, 2004). Finally, attention draws to explore the impact of e-procurement system as a solution of improve and upgrade the manual procurement process of the Ministry. Table 1 illustrates the overview of evolution of procurement process throughout the years. Government also identified procurement system as the integral part of the development separation of the economy through the new procurement Guideline of 2006, further consider as the key driver that use all the stages of the project life cycle 1900-1950 Procurement used for obtain raw 2006material, supplies, and services onwards 1950-1960 Procurement system developed as professional function 1960-1980 Procurement system developed as purchasing strategy 1980-1990 Enhance the procurement system as strategic method to the business 1990onwards Procurement system is used as integral part/ method of sustainable development for the organisations World Bank (2010) describes that public procurement as the process by the government which buys the inputs for vital public sector investments. In procurement terms those inputs are generally grouped into three categories; civil works, goods, and services. Sri Lankan Procurement Guidelines (2006) state that there are three stages should be followed in the project life cycle in order to complete the procurement process as shown in Table 2. E-procurement system was used to enhance the efficiency of the each stage in the supply chain (Sheth, 2010). E-procurement system was used for all the commercial and administrative transactions as an alternative method to improve and upgrade the existing procurement system (Inman, 2010). The internet could streamline inefficient procurement processes by removing the manual, paper based, administrative and bureaucratic elements inherent in traditional purchasing systems (Bartezzaghi and Ronchi, 2003). Inman (2010) highlights that eprocurement is the business-to-business (B2B) or business-to-consumer (B2C) or Business-to-government (B2G) purchase and sale of supplies, works and services through the internet as well as other information and networking systems such as Electronic Data Interchange and Enterprise Resource Planning. By comparison, countries like Sweden and Singapore have high overall e-facilities ranking scores of over 9. The preliminary scope has identified under the two stages illustrate as follows; Initial stage of introduce and implement e-procurement system for selected limited number of activities. Subsequent Stage implements e-procurement system as a total solution to the manual procurement process. Therefore, following research methodology was adopted to identify and develop the feasibility areas to initiate the eprocurement system. Even though the case study organisation is singular, the study involves two echelons in the procurement process such as government officers and the contractors. Further, Eisenhadt (1989) explains that case study useful for exploring new or emerging process or behaviour of the organisation. Furthermore, according to the research problem," how to enhance the effectiveness of the existing manual procurement process", suggests that the case study research approach for the study concerned (Yin 1994). Fifteen numbers of officers were selected as the study profile including the profession of Engineering, Quantity surveying, Architecture, Planning, Contract Administration, Procurement and Project Management, and Accounts to cover all grades of the Ministry and further extended the collection of information up to the opinions of the five numbers of the experts in the field of procurement.

Propionic Acid Shapes the Multiple Sclerosis Disease Course by an Immunomodulatory Mechanism. Treatment of an acute motor and sensory axonal neuropathy with propionate in a 33-year-old male. Therapeutic Advances in Neurological Disorders, 11, 175628641880958­175628641880956. Serum and cerebrospinal neurofilament light chain levels in patients with acquired peripheral neuropathies. Serum neurofilament light chain in chronic inflammatory demyelinating polyneuropathy. Intravenous immune globulin (10% caprylate-chromatography purified) for the treatment of chronic 111. The Lancet Neurology [online serial], 7, 136­144 Accessed at: message: %3Cf720eff71eb4defaabf55dad1ee51e96@ruhr-uni-bochum. Pharmacokinetics of intravenous immunoglobulin and outcome in Guillain-Barrй syndrome. A prospective study comparing tryptophan immunoadsorption with therapeutic plasma exchange for the treatment of chronic inflammatory demyelinating polyneuropathy*. Immunomodulatory treatment other than corticosteroids, immunoglobulin and plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy. Standard and escalating treatment of chronic inflammatory demyelinating polyradiculoneuropathy. Combined azathioprine and prednisone in chronic inflammatory-demyelinating polyneuropathy. A randomized controlled trial of recombinant interferon-beta 1a in Guillain-Barre syndrome. Intramuscular interferon beta-1a in chronic inflammatory demyelinating polyradiculoneuropathy. Rituximab in chronic inflammatory demyelinating polyradiculoneuropathy with associated diseases. Rituximab in refractory chronic inflammatory demyelinating polyradiculoneuropathy: Report of four cases. Rituximab in patients with chronic inflammatory demyelinating polyradiculoneuropathy: A report of 13 cases and review of the literature. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of paraproteinemic demyelinating neuropathies (2006). Placebo-controlled trial of rituximab in IgM anti­myelin-associated glycoprotein antibody demyelinating neuropathy. Antibodies against peripheral nerve antigens in chronic inflammatory demyelinating polyradiculoneuropathy. Resistance training and aerobic training improve muscle strength and aerobic capacity in chronic inflammatory demyelinating polyneuropathy. The evaluation of changes in peripheral neuropathy and quality-of-life using low-frequency electrostimulation in patients treated with chemotherapy for breast cancer: a study protocol. The diagnosis is based on a combination of clinical examination findings, electrodiagnostic studies, and other supportive evidence. Predominantly distal weakness may occur but this finding should prompt further investigation to exclude other types of neuropathy (as discussed below). Once within the peripheral nervous system these activated T cells generate pro-inflammatory cytokines and produce cytotoxic activity against myelin. Potential auto-antigens include myelin protein zero, myelin basic protein, connexin 32, and W W W. Further research may assist in defining subtypes of disease and how they respond to particular treatments. Review of the details of the various diagnostic criteria and their differences is outside the scope of this review. Hereditary neuropathies, in particular the demyelinating forms of Charcot-MarieTooth disease, must also be considered in the differential diagnosis, especially in cases where there is a family history of neuropathy.

As regards statutory nuisance, the Nuisance Ordinance provides that whosoever shall commit any of the offences specified in that Ordinance shall be guilty of an offence. Apart from this Ordinance, Municipal Councils, Urban Council Ordinance and Pradeshiya Sabha Act also provide for the prevention of nuisance. A public nuisance may also be a private nuisance and a tort, but to prevent multiplicity of actions a public nuisance is actionable as a tort only by one who has suffered particular damage over and above that suffered by the public at large. This is some unlawful act or omission endangering or interfering with the lives comfort, property, or common rights of the public. A public nuisance is also a crime for which the remedy is criminal proceedings brought by the AttorneyGeneral. Private nuisance consists essentially of damage to the plaintiff arising from unlawful interference with his use of employment of land of which he is the owner of occupier. In this case the Petitioner-Company had established a metal quarry, a metal crusher and a premix plant at a site taken on lease for developing and rehabilitating the Ambepussa - Dambulla - Anuradhapura road: the Informant-Respondents complained of a public nuisance created by the Petitioner-Company. The Magistrate granted an injunction restraining the operation of the quarry under section 104(1) of the Code and also entered a conditional order under section 98(1) of the Code for the removal of the public nuisance caused by the quarry. The laws governing the protection, conservation and the use of natural resources in Sri Lanka are largely based on legislative enactments and government introduced a statue called National Environmental Act No. Towards the protection of environment, aspects of physical planning and built environment in the country have a considerable role to play. The objective of this Ordinance is to deal with the problem of insanitary conditions of urban overcrowding as well as to prevent such situation. Urban Development 21 World Construction Conference 2012 ­ Global Challenges in Construction Industry 28 ­ 30 June 2012, Colombo, Sri Lanka Authority Law No. The nuisance action was one of the earlier tools used for the purposes of environmental protection. Despite all these current regulations for environmental protection, it is observed that improvements are needed to make sustainability concept more effective. Arbitration is a voluntary procedure available as an alternative resolution to litigation, however not enforceable as the means of settling disputes except where the parties have entered into an arbitration agreement. Construction claims tend to be of the most technical nature - intensive and multifaceted than most other commercial disputes. The desirable features of arbitration are fast, inexpensive, fair, simple, flexibility, confidentiality, minimum delay. However, there is a necessity to reviewing and improving of the arbitration practice periodically in order to minimise the cost and complexity of the procedure. This research is ultimately aims to assess significant attributes of arbitration in construction industry of Sri Lanka. This paper reports on findings gained from the literature review and preliminary survey conducted to explore the current status of arbitration as an alternative dispute resolution method in Sri Lankan construction industry. Current findings indicate that the construction professionals have minimum level of satisfaction on the current arbitration practice; however, they believe that arbitration is an effective mechanism for dispute resolution. The results of this study enabled to gain an understanding on the current arbitration practice and its significance and offer suggestions to improve current arbitration practices in the Sri Lankan construction industry. Construction contracts have evolved significantly in recent times, mainly as a result of the enormous growth of buildings, economic infrastructure and urban development. Disputes connected with construction contracts are becoming a common feature in the industry and number of disputes within this sphere continue to increase. If the dispute resolving mechanism becomes too expensive or too slow or otherwise fail to meet the legitimate requirements of the clients, they will become frustrated and decide to take their enterprises elsewhere to greener pastures. On the other hand, conflicts and the ensuing matters signify a general state of hostility between parties. The Sri Lankan courts refused to incorporate the arbitration agreement into a subcontract. Justice Saleem Marsoof (2006) suggested that there should be a change of attitude of parties concern to improve the arbitration procedure and it is better to improve the effectiveness of proceeding to obtain its advantages. The main aim of the research was to review the current situation of arbitration practice in the construction industry of Sri Lanka and introduce new legal amendments to arbitration legislation.

Syndromes

• Confusion or other changes in mental status
• Uterine cancer
• Voiding cystourethrogram (VCUG)
• Underactive thyroid
• Liver cirrhosis
• Mitral valve surgery - minimally invasive
• Unintentional weight loss

Barium Enema to assess anatomy and rule out stenosis or stricture (must obtain at least 2 days before to allow contrast to pass) ii. If suspect blood products may be required, type and screen with indicated products on hold c. Acetaminophen (Tylenol), diphenhydramine (Benadryl), and methylprednisolone (Solu-Medrol) 30 minutes before administration 2. In spite of premedication, patients may still react with tachycardia, tachypnea, sudden high fever, and anxiety. Breakthrough reaction may be treated with a high dose of short-acting steroid such as hydrocortisone (Solu-Cortef). Dose may need to be adjusted for patients also receiving acyclovir or gancyclovir. Due to possibility of anaphylaxis, ensure reaction medications are ordered prior to administration. Sirolimus delays wound healing so is usually not initiated until 3 weeks post op 2. Due to absorption interference, space sirolimus at least 4 hours after prograf or cyclosporine h. Acetaminophen (Tylenol) and diphenhydramine (Benadryl) 30 minutes prior to each infusion iv. Anticoagulants: Anticoagulation is indicated in liver transplant recipients to prevent thrombosis of hepatic vessels. Dosed daily for 5 days; should be timed to 2200-0600 with at least 18 hours between doses 3. Prevents reabsorption of ammonia in the colon (binds ammonia for excretion in the stool), stimulates bowel motility, softens stool by drawing fluid into the colon c. Consult pheresis nurses to determine what type of plasmapheresis line patient will require 2. Provide pheresis center with dates patient will be getting pheresis based on protocol 3. Contact Pharmacy to notify them of plan to give bortezomib and make sure medication is available 5. Must call pharmacy on bortezomib days to notify them that medication is "okay to give. New Management Options for End-Stage Chronic Liver Disease and Acute Liver Failure: Potential for Pediatric Patients. Pediatric Liver, Intestine, and Multivisceral Transplantation: A Manual of Management and Patient Care. This paradigm has been promulgated across the spectrum of medicine, but with more limited critical analysis in the realm of pathology. The question is, `On what basis are diagnostic opinions rendered in Anatomic Pathology? Specifically, the top 150 most-cited liver pathology articles were analyzed for: authorship; journal of publication; type of publication; and year of publication. Second, the most cited articles in hepatopathology are not published in the pathology literature, but are instead published in much higher impact clinical journals. The remainder of our discipline rests predominantly upon the time-honored identification of disease process through the publication of narrative case series. The critics note that when Frost pondered these two roads, he did not call for a randomized controlled trial. In the latter instance, Laboratory Medicine is bedrock data for determination of efficacy of pharmacologic therapies. Indeed, there is an implicit assumption that an evidence-based culture underpins the use of laboratory medicine. Test utilization may expand well beyond the evidence supporting its initial implementation. Moreover, a key deficiency in the published literature is the absence of a statement of specific need for a laboratory test, namely, the clinical or operational question that the use of the test is seeking to answer. In the first instance, there is an ongoing need for Medical Directors of Clinical Laboratories to evaluate the impact of laboratory tests on clinical outcomes. This includes relevance of the test to clinical management decisions, role of timeliness of resulting (turnaround times), and the impact of test availability (or not).