A woman may offer to be a surrogate mother to help someone well known to her discount ezetimibe 10mg without a prescription ldl cholesterol definition wikipedia, such as a sister discount ezetimibe 10mg mastercard cholesterol chicken breast, or may act as a surrogate to a complete stranger 10mg ezetimibe for sale cholesterol levels hdl. However ezetimibe 10 mg visa definition of no cholesterol, parental rights may pass to the commissioning parties with 63 the consent of the surrogate 10 mg ezetimibe sale cholesterol ratio diabetes, through a parental order made by a court. Once such an order is made, the surrogate mother will no longer be the legal mother of the child she has borne, although the now-legal parents may choose to retain some form of contact with her. These trials are defined by regulation as a clinical trial to study the pharmacology of an investigational medicinal product when administered to humans, where the sponsor and investigator have no knowledge of any evidence that the 64 product has effects likely to be beneficial to the subjects of the trial. They are used to test the safety of new medicines in humans, after laboratory and animal testing and before testing the 65 efficacy of the medicine in patients. Volunteers do not expect to receive any medical benefit from the medicine being tested. Participants in such trials are usually healthy volunteers; however, for safety reasons (for example where the medicine may be too toxic to be used on a person not suffering from the particular disease), it may sometimes only be appropriate to test the new medicine on a patient with the particular condition being targeted. It should be emphasised that these trials form a very small percentage of all clinical trials, and that the volunteers concerned constitute an even smaller percentage of those contributing to all forms of research on a voluntary basis (see paragraph 1. Sometimes the (deceased) bodies that individuals have donated to medical schools for education or training may be found to be unsuitable, and hence they may occasionally be referred on for research if this is authorised by the terms of the original consent. Such an increase reflects the developments in medical science that have led first to experimentation in areas such as transplantation and embryology, and then to the refinement of techniques and processes that result in innovative and experimental methods becoming routine medical practice. In particular, they highlight the crucial role played by transactions in the sphere of donation. The central role played by tissue banks in modern medicine, in providing material for treatment and for research, highlights the complicated networks that may now connect the sources and recipients of donated bodily material, and the many intermediaries involved in processing the material to facilitate its use by the end-recipient. The transaction between donor and recipient was therefore a relatively straightforward one. Although the governance requirements of the Human Tissue Act are now encouraging organisational management of sample collections (as opposed to past practice where individual researchers collected samples for their own research), co-operation between tissue banks is still relatively limited. The whole field of transplantation also relies on there being an infrastructure of research activity aiming to improve the transplantation process and to minimise rejection of the transplanted organ. Professional knowledge and expertise is required for the treatment involved in egg donation, for the health screening and testing required in sperm donation, for the embryology involved in creating the embryo in vitro, and for the subsequent transfer of the embryo into the recipient. Specialist facilities are required for treatment, embryology, storage and transport. It also points to the added complexities in the form of legal agreements, liabilities and obligations that may arise where donated material is transformed, banked or otherwise handled as a commodity by successive intermediaries. Such dealings are different in kind from the activities of explicitly commercial organisations, such as pharmaceutical and biotechnology companies or private fertility clinics, where the use of bodily material (whether in research or as part of medical treatment) is an intrinsic part of a profit-making endeavour. Moreover, their employing organisations may also benefit financially from such research. It has 75 now been reconstituted as a limited company also wholly owned by the Department of Health. It goes without saying that there is a wide spectrum of attachment to, or sense of personal identification with, different parts of the body. In undertaking this enquiry, the Council has quite deliberately considered a wide range of forms of 73 Parry B (2008) Entangled exchange: reconceptualising the characterisation and practice of bodily commodification Geoforum 39: 1133-44. Each box gives certain indicative examples, set out in many cases as a series of contrasts (a versus b). Moreover, scientific developments may lead to additional layers of complexity in what currently appear to be simple distinctions: material that is currently non-reproductive for example may, in the future, have reproductive capacities as cloning techniques involving induced pluripotent stem-cells develop.
Family-friendly programs often have an edge in recruiting and retaining ex- cellent residents who cheap 10 mg ezetimibe visa cholesterol in cage free eggs, in turn purchase 10 mg ezetimibe overnight delivery cholesterol chart for seafood, contribute to the goals of the department in a spirit of collegiality best ezetimibe 10 mg lower cholesterol without medication quickly, community and respect proven ezetimibe 10 mg cholesterol medication is bad for you. They have learned to delay gratifca- erodes one s energy level and sense of well-being even more buy discount ezetimibe 10mg on line cholesterol in shrimp webmd. They are idealistic, and most come to medicine because they are inspired to contribute Emotional and physical fatigue lead to behavioural changes. Decreased interest in activities that were once enjoyed during free time leads to social withdrawal and personal isolation. However, the profession of medicine is demanding, and it is Relationships with family and friends are compromised, and diffcult to put limits around its practice. Physicians are acutely Faced with some or all of these effects, one might experience aware of the distress of others but are often less attentive to at the same time a reduced sense of accomplishment and the stress and fatigue that they experience themselves. It is easy to lose sight of one s accomplishments caring for others often leads to neglect of oneself. This is the sign of We know that physicians, as a group, are well informed with signifcant stress. We also know that when physicians are overwhelmed by the demands Given that the demands of the profession are ever present, of their profession, they are vulnerable to neglecting those what is the solution? It requires, frst and foremost, awareness of the risks mises not only the physician s health, but his or her ability to that will be present and deliberate attention to measures of continue to provide care for others. Physicians self-care presents a perfect opportunity to practise preventative care. When self-care is neglected When a physician becomes immersed in his or her work to the Solutions: Think self-care exclusion of self-care, a cascade of stress-induced symptoms In The 7 Habits of Highly Effective People, Steven R. A feeling of being chronically overwhelmed a compelling case for what he describes as the Principles of leads to frustration and irritability. The physician may become Balanced Self-Renewal, which he describes as preserving and prone to emotional outbursts, or may be tearful at work in enhancing the greatest asset you have you. He or she may take domains that require attention in self-care: physical, emotional, less pleasure in activities that were once much enjoyed. Effective self-care requires consideration meantime, a denial of the signifcance of these symptoms and of these four domains, and taking control of the things that the vulnerability they reveal can lead the physician to take on can be controlled. In caring for one s physical self, planning for healthy eating is Physical symptoms can include intermittent headache, gastro- a good place to start. We can decide what to eat and when to intestinal complaints, and poor sleep, often with a tendency to eat. Taking the time to purchase healthy food and preparing wake between 2:00 and 4:00 a. These symptoms can be ac- meals that are nutritious will lead to an improved sense of companied by a change in appetite and a slide into poor eating energy and well-being. Planning the use of time away from the habits, for example by relying on fast-food outlets rather than workplace, so that exercise is a regular part of one s routine, is taking the time to prepare healthy meals. Regular exercise is The tools for self-care are evident to most physicians: their therefore one of the best self-care tools for reducing stress. However, although they apply this knowledge on a daily in the activity and make a commitment to participate regularly. Although these strategies that self-care, and employing the tools necessary to attend to for self-care are simple and lie within our control, they are one s own needs, is not only wise: it is essential to sustain an frequently forgotten when we are busy.
High intragastric acidity in H pylori infected duodenal ulcer patient ezetimibe 10mg line keeping cholesterol levels down, persisted for one and a half months alter infection eradication regime discount ezetimibe 10 mg without a prescription cholesterol x?u trong mau. Bleeding oesophageal varices (22%) were more common than bleeding duodenal ulcer (17%) purchase ezetimibe 10mg cholesterol in eggs benedict. Ten patients (17%) with endoscopically proved duodenal ulcer were bleeding from another site and 28% of all patients had more than one lesion purchase 10mg ezetimibe overnight delivery cholesterol food chart. This fact cheap ezetimibe 10mg is cholesterol in eggs hdl or ldl, and inability to detect the surface lesions limits the value of acute barium radiology, which was performed in 32 patients. Accurate diagnosis will help us in better understanding of individual lesion and more rational management of patients. Herewith we report the association of Helicobacter pylori in 49 Myanmar patients presenting with dyspepsia. Of 49 specimens, 3 were histologically normal and 46 showed histologic evidence of gastritis. Histologic evidence of Helicobacter pylori were demonstrated in 35 patients (76%). This preliminary but new study in Myanmar delineated the strong association between Helicobacter pylori and gastritis/peptic ulceration similar to other investigations. The three commonest causes were bleeding from acute erosive gastritis (32%), duodenal ulcer (22. Rare causes of upper gastrointestinal bleeding such as Mallory- Weiss tear (1 patient), bleeding from carcinoma stomach (2 patients), hepatocellular carcinoma with bleeding oesophageal varices (2 patients), haemobilia due to haemangioma left lobe of liver (1 patient) 106 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar were included in th study. All of them are clinically diagnosed as acute gastric erosion to whom endoscopy was done rather late. Compared to other 4 studies, the incidence of cases and endoscopic accuracy of this study were not much differed. Both are consistently sensitive to gentamycin, furoxone and norfloxacin but resistance to ampicillin, chloramphenicol and tetracycline. Gentamicin and furoxone were employed in 40 cases and average time for a clinical response was 4 days whereas with norfloxacin the symptoms stopped 2 days after employing the drug. Norfloxacin, a new quinolone antibiotic, is effective in drug resistant shigellosis and it also cuts down the duration of symptoms. Frequency distribution of cases, radiological findings and radiological diagnosis are discussed. Usefulness specificity and sensitivity of some importance radiological signs and radiological diagnosis seen on 2 films study are presented. The duration of illness before attending the hospital was found to be one to seven days. The frequency of motion among dysentery cases were found to be from 16 to 20 times per day. The initial safety record of this procedure has continued unblemished and it remains the safest operation in treating duodenal ulcer disease. Position of appendix was also studied on 21 barium Enema x-ray films and records of 32 cases of acute appendicitis from surgical unit of North Okkalapa General Hospital. Rectocaecal appendix were also observed and more than 90% of retrocaecal appendix were associated with ileal attachments. Half of the total numbers of appendicdes studied were provided with triangular mesoappendix which extended to the tip and one third of the cases lacked mesentry. The arterial supply to the appendix was studied on 78 cases by (a) plain gross dissection and after injection the ileocolicartery with plastic latex; (b) histological study after injecting the ileocolic artery with 1% trypan blue solution and (c) radiological examination after aqueous dionosil injection. Six trypan blue injected specimens were studied with Van Gieson s stain to study the intramutal arterial pttern.
Health designates a process by which each person is responsible 10 mg ezetimibe cholesterol test and coffee, but only in part responsible to others cheap ezetimibe 10mg without a prescription cholesterol test kit ebay. A man is responsible for what he has done effective 10 mg ezetimibe cholesterol and eggs 2012, and responsible to another person or group generic ezetimibe 10 mg online cholesterol in eggs study. Health is a task cheap ezetimibe 10mg mastercard cholesterol test kit new zealand, and as such is not comparable to the physiological balance of beasts. Knowledge encompassing desirable activities, competent performance, the commitment to enhance health in others these are all learned from the example of peers or elders. These personal activities are shaped and conditioned by the culture in which the individual grows up: patterns of work and leisure, of celebration and sleep, of production and preparation of food and drink, of family relations and politics. Long-tested health patterns that fit a geographic area and a certain technical situation depend to a large extent on long-lasting political autonomy. They depend on the spread of responsibility for healthy habits and for the sociobiological environment. The level of public health corresponds to the degree to which the means and responsibility for coping with illness are distributed among the total population. This ability to cope can be enhanced but never replaced by medical intervention or by the hygienic characteristics of the environment. That society which can reduce professional intervention to the minimum will provide the best conditions for health. The greater the potential for autonomous adaptation to self, to others, and to the environment, the less management of adaptation will be needed or tolerated. A world of optimal and widespread health is obviously a world of minimal and only occasional medical intervention. Healthy people need minimal bureaucratic interference to mate, give birth, share the human condition, and die. As he becomes dependent on the management of his intimacy, he renounces his autonomy and his health must decline. It consists in making not only individuals but whole populations survive on inhumanly low levels of personal health. Medical nemesis is the negative feedback of a social organization that set out to improve and equalize the opportunity for each man to cope in autonomy and ended by destroying it. Ackerknecht, History and Geography of the Most Important Diseases (New York: Hafner, 1965). Anderson and Monroe Lerner, Measuring Health Levels in the United States, 1900-1958, Health Information Foundation Research Series no. Marc Lalonde, A New Perspective on the Health of Canadians: A Working Document (Ottawa: Government of Canada, April 1974). This courageous French-English report by the Canadian Federal Secretary for Health contains a multicolored centerfold documenting the change in mortality for Canada in a series of graphs. A critique of the political trends that seek to endow medical technology with an effective impact on health levels by a "democratization of medical consumer products. To use medicine for political liberation it will be necessary to "find in sickness, even when it is distorted by medical intervention, a protest against the existing social order. This well-researched report to the layman substantiates the view that American Cancer Society proclamations that cancer is curable and progress has been made are "reminiscent of Vietnam optimism prior to the deluge. Weisfert, "Das Problem des Schwindsuchtskranken in Drama und Roman," Deutscher Journalistenspiegel 3 (1927): 579-82. Ebstein, "Die Lungen- schwindsucht in der Weltliteratur," Zeitschrift fr Bcherfreunde 5 (1913). On the social, literary, and scientific aspects of 19th- century tuberculosis; an analysis of its incidence.
With 100% Alcohol discount 10 mg ezetimibe with amex cholesterol levels blood test, obliteration of the varices was obtained in 4 patients ezetimibe 10mg low price cholesterol counter chart, 3 patients had some improvement and 1 patient died during the follow up period 10 mg ezetimibe with visa unesterified cholesterol definition. The incidence of oesophageal ulceration and other side effects after the procedure were the same in both series purchase ezetimibe 10mg overnight delivery cholesterol reducing kerala foods. It is evident that 100% Alcohol is as effective as 1% Thrombar in the sclerosis of the oesophageal varices discount 10mg ezetimibe mastercard cholesterol levels in fish. Ulcer healing was achieved in 24 out of patients (95%) in Denol group and 29 out 30 patients (96. Helicobacter eradication was achieved in 17 out of 25 patients (68%) in Denol group and 8 out of 30 patients (26. Denol is superior in eradication of Helicobacter pylori infection, however, one week treatment of antibiotics is not sufficient to obtain satisfactory eradication rate for Helicobacter pylori infection. The specific study regarding bowel habit included retrospective and prospective studies done on 300 children aged 1 to 5 years. In the retrospective study investigated by asking the questionnaires to the mothers, each child passed 2 soft stools per day with an average of one tea cup for each motion. In the prospective study, in which each motion of every child was observed for one week, the amount of stool passed per motion ranged from 54. On average, they passed stools once daily for 5 days, and twice daily for at least one day. The small intestinal transit time, done on 74 children by breath hydrogen test, was 90. The whole gut transit time done on 30 children by colorimetric method using Norit capsules were 1009. The amount of daily stool output in our children was very much larger than that of children from the United Kingdom. The whole gut transit time of our 153 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar children was similar to those in Bangladesh. The study involved 1206 children aged 2-12 years in 21 villages in Myanmar [Burma] starting in August 1984. The intervention and non- intervention villages were comparable regarding almost all the important baseline variables, including prevalences of Ascaris infection (80. A significant increment of th th height gain was found, starting after the 6 month, and of weight gain after the 24 month, of the study among the treated 2-10 years old children when compared with the non-treated ones. Lesser increments in height-for-age and weight-for-age were also observed after successive treatments among the treated children with initially higher mean worm burdens. The findings are discussed in the context of causal relationship between ascariasis and malnutrition in children. The controls, consists of 6 children from the same locality as patients, were apparently healthy and in the same age group. Serum chloride tends to increase in the patients and the increase was more pronounced in the group suffering from both malnutrition and diarrhea. Serum aldosterone levels were raised in all the three groups of patients namely malnutrition, diarrhea. Rural area of Shwepyithar Township, Yangon Division and rural area of Tharbaung Township, Ayeyarawaddy Division were chosen for diarrhoea case management trained area (case) and non trained area (control) respectively.
Moreover 10 mg ezetimibe with visa cholesterol healthy foods, communication is of learning confict management skills as part of their irreversible once the message is sent trusted ezetimibe 10 mg cholesterol test without fasting, we might be able to training buy 10 mg ezetimibe with mastercard high cholesterol foods diet. Conversations importance of trust generic 10 mg ezetimibe mastercard cholesterol test limerick, coaching them on a process of ac- involving confict are likely to foster defensiveness and a tive listening that uses a non-confrontational vocabulary order ezetimibe 10 mg on-line cholesterol yahoo answers. Stick to what you personally during an interpersonal confict, it is important to remove the experienced: I m noticing that emotional charge from the situation. Describe conclusions that you drew from what you saw or heard: I m thinking that Working at effective communication leads to better understand- Feelings. Sharing your feelings to allow others ing between people and reduces judgmental assumptions. We to have greater empathy: I m feeling must work to appreciate how the other individual sees the issue Needs. Expressing needs doesn t blame or as- that has prompted the confict, rather than infexibly insisting sign fault. Confict resolution requires please us: It would be helpful for me What a genuine desire to understand. It involves a commitment to would work for me is (McKay et al 1995) engage in problem-solving with the other party, and requires ground rules that permit open exchange and reduces the need for defensiveness. Fortunately, resisting the urge to respond defensively is a skill that can be learned. Viewing the confict as a problem to be solved mutually so that both parties feel that Key references they are benefting from the resolution is the goal of collabora- Lindahl K and A Schnapper. No relationship can be long-lasting Forty Refections for Cultivating a Spiritual Practice. It is not unusual for these physicians to be highly response to situations involving disruptive behaviour. They commonly see themselves Case as superior to others in their clinical competence and insist The chief resident in internal medicine has arranged to that others submit to their way of doing things. The resident doesn t come to teaching sessions, doesn t show up for clinics on time, is always late when Causes showing up for on-call responsibilities and therefore never There is no single cause of disruptive behaviour. The it is not generally associated with substance use disorders, other residents are complaining to the chief. The nurses other underlying physician health issues such as stress and on the ward and the emergency room staff have started burnout can be contributing factors. The been associated with certain personality characteristics such chief wants something to be done. It is often a result of an inability to deal The term disruptive doctor is often thought of in relation to with the confict inevitable in the face of stressful work envi- physicians who demonstrate a pattern of offensive or objec- ronments and rapid change. Indeed, disruptive behaviour can tionable behaviour, such as berating staff in front of patients be a sign of failure within a system, where confict has become or using intimidation tactics when supervising residents. The focus is often exclusively Many defnitions have been developed to describe disruptive on the individual s behaviour, to the exclusion of any examina- behaviour. But focusing solely on changing defnes it as follows: Disruptive behaviour is demonstrated the physician s behaviour is not productive. Disruptive behaviour has negative consequences both for the But is it clear that physicians themselves must show leadership delivery of patient care and for the smooth running of medical in addressing disruptive behaviour in their practice settings departments. The issue should be approached and other adverse events, and has the potential to stife the even-handedly, taking logical steps. First, what constitutes respectful collaboration and interdisciplinary collegiality that disruptive behaviour needs to be clearly defned and its impact are crucial to effective care delivery in today s complex health understood.
Streptogramins: Quinupristin/Dalfopristin (Synercid): consists of an A and B component (Synergistic) 10mg ezetimibe fast delivery cholesterol test error margin. Ketolides: Telithromycin: Represents a novel class that has received much attention recently due to their excellent activity against resistant organisms generic 10mg ezetimibe visa cholesterol in fresh shrimp. Inhibitors of Protein Synthesis Tetracyclines Glycylcyclines Tetracyclines International Common Name Tetracycline Minocycline Doxycycline Glycylcyclines Tigecycline Inhibitors of Protein Synthesis Tetracyclines: Spectrum of Action: Broad spectrum best 10mg ezetimibe cholesterol effects, but resistance is common which limits its use buy ezetimibe 10mg visa cholesterol vegetables. Primarily for treatment of genital infections (chlamydiae) and atypicals (Rickettsiae ezetimibe 10 mg fast delivery cholesterol medication pain, Mycoplasma). Not recommended for pregnant women and children (less than 2 years old) because of the toxicity on bones and teeth of the fetus. Tetracycline = Short acting Minocycline and Doxycycline = Long acting Minocycline and Doxycycline are more active than Tetracycline. Inhibitors of Protein Synthesis Mode of Action - Tetracycline Mode of Action Effect Tetracyclines Irreversibly binds to Inhibits elongation the 30S ribosomal sub-unit step of protein synthesis Tetracycline exists as a mixture of two forms - lipophillic and hydrophillic. Inhibitors of Protein Synthesis Phenicols Chloramphenicol Inhibitors of Protein Synthesis Phenicols: Chloramphenicol Spectrum of Action: Very active against many Gram-positive and Gram-negative bacteria, Chlamydia, Mycoplasma and Rickettsiae. Toxicity: High toxicity, causes bone marrow aplasia and other hematological abnormalities. Inhibitors of Protein Synthesis Chloramphenicol Mode of Action Effect Chloramphenicol Binds to the 50S Inhibits elongation ribosomal sub-unit step of protein synthesis Relativelysmallmolecule,easilyenters Gram-positive and Gram-negative bacteria TargetisRibosome Bindsto50Ssubunitwhereitinhibitselongation step of protein synthesis bioMrieux,Inc. Inhibitors of Protein Synthesis Ansamycins Rifampin (Rifampicin) Inhibitors of Protein Synthesis Ansamycins Rifamycins Rifampin (Rifamipicin): Spectrum of Action: PrimarilyGram-positiveorganisms and some Gram-negatives Usedincombinationswithother drugs to treat tuberculosis UsedtotreatcarriersofN. It has come into recent use for treating multi-drug resistant Acinetobacter infections. Inhibitors of Membrane Function Mode of ActionMode of Action ofof PolymyxinsPolymyxins Lipopeptides Polymyxins Polymyxin B Colistin CyclicLipopeptides Daptomycin bioMrieux,Inc. Outer and Cytoplasmic Membrane Effect: Polymyxins are positively charged molecules (cationic) which are attracted to the negatively charged bacteria. The antibiotic binds to the cell membrane, alters its structure and makes it more permeable. This disrupts osmotic balance causing leakage of cellular molecules, inhibition of respiration and increased water uptake leading to cell death. The antibiotic acts much like a cationic detergent and effects all membranes similarly. Little or no effect on Gram-positives since the cell wall is too thick to permit access to the membrane. Anti-Metabolites Mode of ActionMode of Action ofof Anti-metabolitesAnti-metabolites bioMrieux,Inc. Therefore, folate pathway inhibitors do not have direct antibiotic activity but the end result is the same, the bacteria is unable to multiply. Inhibitors of Nucleic Acid Synthesis Quinolones International Common Name Quinolones Nalidixic Acid 1st Generation Narrow Cinoxacin Spectrum Fluoroquinolones Ciprofloxacin Enoxacin Garenoxacin Levofloxacin Lomefloxacin Norfloxacin Ofloxacin Sparfloxacin Gatifloxacin Moxifloxacin Trovafloxacin Inhibitors of Nucleic Acid Synthesis Quinolones: 1st Generation Quinolones: Only for Gram-negatives, used to treat urinary tract infections because they reach high concentrations in the site of infection. Spectrum extended to cover Staphylococci, Streptococci and Pneumococci (sparfloxacin). Inhibitors of Nucleic Acid Synthesis Mode of ActionMode of Action ofof QuinolonesQuinolones bioMrieux,Inc. Inhibitors of Nucleic Acid Synthesis Entry of Quinolones Quinolones Outer Membrane Peptido - glycan Cytoplasmic Membrane Quinolone Mode of Action Smallandhydrophilic,quinoloneshave no problem crossing the outer membrane. The nick is only introduced temporarily and later the two ends are joined back together (i. In the bacterial cell, nitrofurantoin is reduced by flavoproteins (nitrofuran reductase). It is not known which of the actions of nitrofurantoin is primarily responsible for its bactericidal acitivity.
Get your project done all under one roof…
"“Laurence has become an integral part of my business over the last few years creating websites, creatives and more. He always comes up with fresh ideas and is incredibly efficient at getting things done quickly when you have tight deadlines to meet. I would recommend his services to anybody looking for design work.”
Director, Lead Ad Ventures"
"“Laurence created brand designs, icon and website for our iPad app TagNotate. He was a pleasure to work with, providing a great selection of original artwork and design ideas, and then developing those with us through to the finished product. In all respects he provided a professional, high quality service which I would recommend without reservation.”
"“LJA Studios were very professional in their approach and delivery. They are responsive to feedback and the website evolved exactly as discussed. They were very friendly and walked us through the process, so that at all times we knew exactly what was going on. It exceeded our expectations by far. We have no hesitation in recommending their services, and have actually done so already.”
Palace Green Finance Ltd."