مکان‌یابی رقابتی ترتیبی با در نظر گرفتن قابلیت اطمینان و گرانشی

Fesoterodine is a new antimuscarinic agent developed for the treatment of overactive bladder. Fesoterodine itself is inactive and is rapidly and extensively converted by ubiquitous esterases to its principal active moiety, 5-hydroxymethyl tolterodine (5-HMT). 5-HMT is formed via biotransformation of both fesoterodine and tolterodine, albeit by different metabolising enzymes, viz. esterases and CYP2D6 respectively. Tolterodine is a potent muscarinic receptor antagonist and has been used for the treatment of overactive bladder for over ten years. The objective of this study was to establish the pharmacokinetic profile of fesoterodine and to highlight ist potential pharmacokinetic advantages over tolterodine. Single-centre, open-label, randomised, 4-way crossover study in a total of 24 healthy male volunteers. Single oral doses of 4, 8, or 12 mg fesoterodine were administered after an overnight fast. In addition, the 8 mg dose was also administered after a standard high-fat and high-calorie breakfast. Blood and urine samples for the analysis of 5-HMT were collected before and multiple times after drug administration for pharmacokinetic analysis. The mean peak plasma concentration (Cmax) of 5-HMT and the mean area under the time versus concentration curve (AUC) increased proportionally with the fesoterodine dose. These two parameters were some 2-fold higher in CYP2D6 poor metabolisers, whereas the time to peak plasma concentration (tmax) and half life (t1/2) were not influenced by the dose or the CYP2D6 metaboliser status. If fesoterodine was taken following a high-fat breakfast, we observed small increases in Cmax and AUC. In spite of these modest genetic influences and food effects on the pharmacokinetics of fesoterodine, the overall interindividual variability in Cmax levels was relatively little compared to previously published reports using tolterodine. Due to the esterase-mediated cytochrome P450-independent formation of 5-HMT and involvement of multiple metabolic and renal excretion pathways in the elimination of 5-HMT, the effects of patient-intrinsic and -extrinsic factors on the pharmacokinetics of fesoterodine are only modest, with some 2-fold higher 5-HMT exposure. Therefore, in contrast to tolterodine, no reduction of fesoterodine dosage is required under conditions of reduced elimination. In most cases of drug interaction or renal/hepatic impairment, the fesoterodine dose may be increased to 8 mg/day based on individual patients' response, or patients may be required to remain at the initial recommended dose of 4 mg/day.

Returning to driving following a traumatic brain injury (TBI) is often a key rehabilitation goal, as the ability to drive enables return to independence and many previous life roles. The ‘gold standard’ assessment of driving after TBI is considered to be the on-road assessment, usually conducted by a specialised occupational therapy driver assessor (OTDA). However there have been few studies investigating the patient characteristics and pre-injury and injury related factors associated with passing or failing the on-road OT driver assessment after TBI. In addition, little is known about the processes and goals of driver rehabilitation provided to those who fail the initial on-road assessment. There has also been limited research into the post-assessment driving behaviour and safety of individuals returning to driving after driver rehabilitation. <br> Accordingly, the main aims of the PhD program of research were to a) examine which patient characteristics and pre-injury and injury-related factors were associated with the outcome of initial on-road driver assessment, b) describe the range of goals, processes, timing and outcomes, including the use of restricted licensing and resources, associated with providing on-road training to those who failed an initial OT driver assessment and c) examine and compare the characteristics and self-reported pre- and post-injury driver safety and patterns of driving behaviour of those drivers who returned to driving after one on-road assessment with those who received on-road training and subsequent reassessments. <br> In Study 1, the results of all on-road driver assessments completed by patients with a TBI (n = 207), in a rehabilitation setting, over an 8-year period were reviewed retrospectively. Two outcome groups were identified: a ‘pass’ group who resumed driving after passing the initial on-road assessment and a <i>‘rehabilitation’</i> group who failed and required on-road training in the form of driving lessons. <br> <b>Key-findings</b>; Post traumatic amnesia (PTA) duration proved to be more strongly associated with driver assessment outcome than Glasgow coma scale (GCS) score. Participants, who were male, had shorter PTA duration, faster reaction time and no physical or visual impairment and were at least 3 months post-injury were more likely to pass the initial on-road assessment. These variables correctly classified 87.6% of the <i>pass</i> group and 71.2% of the <i>rehabilitation</i> group. On-road training, followed by subsequent on-road re-assessments were associated with a high probability of return to driving after TBI. <br> <b>Recommendations</b>; Factors to consider when determining whether to refer for a practical driver assessment include; ensuring that the client is at least 3 months post-injury, evidence of moderate to severe TBI measured by PTA, slowed choice reaction times and presence of physical or visual impairment that may impact on driver capacity. On–road training is an important driver rehabilitation intervention and should be offered to drivers with TBI who fail the initial on-road assessment. <br> From a sample of 340 participants, Study 2 examined the goals, outcomes, timing, use of restricted licenses and number of on-road training lessons and OT driver reassessments provided to the 94 participants who failed the initial on-road assessment. <br> <b>Key-findings</b>; The use of goal directed driving lessons to facilitate compensation for cognitive, physical or visual impairment, improve confidence or enhance previously learned driving skills and restricted licensing were found to be associated with return to driving following moderate/severe TBI. An average of seven driving lessons (range 1 – 35) and 2.5 OT driver reassessments (range 1-6), were provided to participants, resulting in 93% (n=87) of cases resuming driving and 7 (7%) failing to meet licensing standards. An open license was recommended for 42 (45%) cases and 45 (48%) resumed driving with a restricted license. The mean time for referral for driving assessment varied significantly between the pass (7.62 months) and <i>rehabilitation</i> groups (13.31 months). <br> <b>Recommendation</b>; Investment in on-road training lessons addressing individual goals, followed by reassessment and use of restricted licenses, can achieve successful return to driving following TBI. Although delaying driving by at least 3 months appears to be appropriate, a much longer time frame is often required, particularly with severe TBI. <br> Finally, Study 3 examined self-report responses of 106 participants regarding post-injury changes in driving behaviour and number of pre- and post-injury crashes. <br> <b>Key findings</b>: No significant differences were found in pre- and post-injury crash rates or in crash rates between the <i>pass</i> (n= 74) and <i>rehabilitation</i> (n= 32) groups. Many drivers reported changes to their driving behaviour: Compared to pre-injury, 36.8% of drivers reported limiting driving time, 40.6% drove more slowly and 41.5% reported greater difficulty with navigating. The <i>rehabilitation</i> group (with greater injury severity) was significantly more likely to drive less frequently, shorter distances and avoid driving with passengers, in busy traffic, at night and on freeways than the pass group. <br> <b>Recommendation</b>: As most of the study participants resumed driving and were safe to do so in the longer term, the importance of offering driver assessment and rehabilitation following moderate to severe TBI has been emphasized. <br> This PhD program of research, has also highlighted the complexity of the decision-making process required by rehabilitation clinicians in determining fitness to drive after TBI. Factors that were found to contribute to this situation included the wide variation in optimum timing for resuming driving and the range of variables that may impact on the outcome of the on-road assessment, such as injury severity, physical/visual issues, driver confidence, ability to compensate for cognitive issues and driver experience. The findings and recommendations of this PhD program may contribute to development of improved referral criteria and guidelines for resuming driving after TBI.

Performance enhancement strategies in sport have frequently attempted to help athletes gain control over their thoughts and their emotions (Vealey, 1994) . These are 'content-focused' approaches try to change the content of the athlete's internal experience. Recently, increasing attention has been directed toward interventions that try to change an athlete's relationship with those internal experiences, instead of changing the content. These 'context-focused' approaches-including mindfulness and acceptance-based interventions - aim to help athletes perform well with anxiety, rather than trying to remove the anxiety (Gardner & Moore, 2012b) . These approaches promote similar acceptance of other unhelpful cognitions and emotions, such as anger or self-doubt. In this thesis, I aimed to explore the effectiveness of these approaches for promoting performance in sport. Chapter 1 identified the theories underlying context-focused approaches and outlined how they might reduce the likelihood of performance problems. For example, due to decreased self-focused attention, context-focused approaches may reduce the likelihood of choking due to explicit control of otherwise automatic skills. To see how well these theories held up to empirical exploration, Chapter 2 systematically reviewed the literature on context-focused approaches in sport. This review included prototypical context-focused approaches, like mindfulness, and also the wider range of approaches that operate by a similar mechanism, such as self-compassion. It found consistent trends in the research that these approaches improve athletic present-moment awareness, flow, performance, and help to reduce anxiety. It also revealed preliminary evidence for other outcomes like improved confidence and reduced rates of injury. However, none of the 66 studies met the Cochrane Collaboration criteria for low risk of bias (Higgins, Altman, Gotzsche, et al., 2011) . In Chapter 3, I aimed to test a brief context-focused intervention using a study design that met these Cochrane criteria. Golfers were randomised into either a acceptance-based intervention or a control condition. The study was double-blinded, randomised, prospectively registered with putting performance as the primary outcome. This study found few benefits of the acceptance-based intervention for performance, anxiety, or state mindfulness. It found a significant improvement on a secondary outcome: swing mechanics as measured by a SAM PuttLab (Science & Motion, 2016) . While brief interventions are well-established for testing context-focused interventions (Levin, Hildebrandt, Lillis, & Hayes, 2012) , Chapter 3 did not find strong evidence that a brief context-focused intervention leads to short-term improvements in sport performance. One barrier to testing interventions in sport is the questionnaire response burden placed on athletes. This is not unique to context-focused literature, because half of athletes in high-performance environments complete questionnaires every day (Taylor, Chapman, Cronin, Newton, & Gill, 2012) . However, in mindfulness and acceptance literature, reducing response burden would help researchers in many ways. Shorter measures allow researchers to assess more constructs in parallel, or assess the same construct more regularly (Basarkod, Sahdra, & Ciarrochi, 2018) . Many short measures fail to meet psychometric criteria (Smith, McCarthy, & Anderson, 2000) because the process of optimally shortening a questionnaire requires complex evaluations of many factors (Marsh, Ellis, Parada, Richards, & Heubeck, 2005) . As an alternative method, Chapter 4 demonstrated that an advanced machine learning algorithm can shorten athletic questionnaires without compromising reliability or validity. As an example of this process, the substantive-methodological synthesis presents multiple versions of the Mindfulness Inventory for sport. Although reliability was compromised when measures were very brief, shorter measures showed equivalent validity to the full measure. The resulting measures offer future researchers some alternate methods of measuring mindfulness that can be adapted to their needs. The paper also outlined ways for other researchers to efficiently shorten their own measures. Chapter 5 describes limitations of the previous chapters, but also identifies some ways in which researchers might assess the utility of context-focused approaches in the future. Many of these approaches require that athletes make significant investments in time. The thesis concludes that, although there is evidence these approaches might have widespread benefits inside and outside sport, it is not yet clear whether they are an effective use of time for optimising athletic performance.

Introduction: Some factors related to obesity, such as inflammation and oxidative stress may play a substantial role in telomere attrition and, consequently, obesity is associated with telomere shortening. Emerging evidences have demonstrated that green tea and its most abundant catechin (polyphenol epigallocatechin-3-gallate, EGCG) had anti-inflammatory and antioxidant effects. In line of this, green tea may be positively related to telomere length (TL). Aim: In this context, the present study aimed to evaluate the effect of decaffeinated green tea supplementation in obese women on TL. Materials and Methods: We conduced a cross-sectional interventional study with 10 obese (BMI>40 kg/m²) and 8 normal weight (BMI >18.5 and <24.9 kg/m²) women (age between 27 and 48 years). We did not include patients with alterations in liver biomarkers. The supplementation was carried out with capsules (one capsule daily, each containing 450.7 mg of epigallocatechin-3-gallate) for 8 weeks. Anthropometric (weight, height and body mass index - BMI) and dietary intake assessment and blood collection [for biochemical (glycemia and lipidic profile) and TL analysis by quantitative PCR] were performed before (day 0) and after supplementation (day 56). Normal weight patients were evaluated at a single moment. Shapiro-Wilk test, paired t-test, independent t-test, Pearson correlation and multiple regression analysis were performed as statistical analyses (p<0.05). Results: There were not any significant weight loss (119.7±17.8 to 120±18 kg, p=0.772) or BMI (45.3±4.7 to 45.4±5gm², p=0.695) changes linked with the intervention. However, we observed a significant increase on TL after supplementation (1.57±1.1 to 3.2±2.1 T/S ratio; p<0.05). Moreover, we found shorter TL in obese patients (day 0) when compared to normal weight individuals (3.2±1.9 T/S ratio; p<0.05) and an inverse association between TL and BMI, even after age adjustment (beta=-0.527; r²=0.286; IC= -0.129, -0.009). There was no correlation between the biochemical profile and TL. Conclusion: Obesity is related to shorter telomeres. Green tea supplementation for 8 weeks promotes telomere elongation in obese women. Acknowledgements : This work was supported by grants #2013/08916-4 and #2014/00669-0 from the SA£o Paulo Research Foundation (FAPESP) and grant #166191/2015-9 from the National Council of Scientific and Technological Development (CNPq)

The implementation of conventional and laparoscopic intestinal joining is a problem, remotely solved. Along with many routine methods described, different modifications with automatic staplers are presented, each of certain value and benefits. Achieving an appropriate balance between price, reliability and health benefits is the operator-surgeon responsibility, sometimes in a condition of emergency. We aimed at assessing the safety and effectiveness of the fulfillment of end-to-end continuous anastomoses in the intraabdominal intestinal relations. Author`s own experience of 88 consecutive intra-abdominal anastomoses was presented. They were performed in the period from 01.01.2010 to 30.06.2013, since the technique has been applied. Patients were evaluated in the following groups: Group 1 - after colonic resections: right, intermediate, left hemicolectomies, resection of sigma or rectosigmoid, subtotal colectomy (N1=56, 63,6%). Group 2 - after restoring passages operation, regarding low rectal resection with double-loop protective ileostomy or transversostomy (N2=24, 27,3%). Restoring the transversostomy was performed with partial anastomosis preserving the mesenteric side of the intestine. Group 3 - patients after internal derivation (N3=8, 9,1%). Modified and applied two-layer end-to-end technique suitable for double differences in lumens, with adequate correction approach and saving blood supply of the mesentery. Digital hedging during the implementation of the second floor of the anastomosis allows additional control over the achievement of the other important for success factors: adequate lumen and tight attachment of the bowel ends serous surfaces. A total of 4 (4,54%) of the patients monitored had complications in the form of late postoperative paresis (in three patients until postoperative day 7) and partial insufficiency in one (sigmoid resection). All they were overcome conservatively. There was one exitus (1,14%) after cardiac death on the 6th postoperative day. Three of the patients were operated under a condition of urgency and in all the others a standardized preoperative preparation of the bowel tract was used. Anastomotic time was significantly shorter (25-35 min) due to the following factors: not performing close intestinal loop, small layers widths of the opposite bowel parts, better control of intestinal blood supply. Possible surgical site contamination is minimized. Anastomosis is very simple, fast, and extremely reliable. Early feeding is practiced (after 24 hours), which is the basis for a rapid (fast track) recovery of these patients. Not to ignore the low price of the joining accomplished (1A·3 nontraumatic sutures 3/0). The variability in the performance of intestinal anastomoses allows an opportunity for individualized approach. End-to-end continuous bowel connections have some tactical, technical and economic advantages, and combined with their reliability present a very good option.

Previously, we developed seed-shooting seeder of rice and the machine was able to get some seeds to be hill-seeded along rows. We developed a new cell roller and investigated some factors which influenced the form of the hill-seeding spots.The results were as follows:1) The new cell roller was developed to discharge the CaO2 powder of the seed coat in the cell.2) The new cell roller remodeled successfully performed hill-seeding, i. e., it was able to release several seeds intermittently.3) The form dimensions of the hill-seeded spot (ellipse in shape), which was obtained during paddy field and laboratory tests, were 7 to 12cm (longer diameter) and 3 to 6cm (shorter one).4) Test results clearly showed that the factors influencing the form of hill-seeded spot were as follows: (a) the timing of seeds release, (b) the timing of providing or delivering seeds to the saw-toothed disc, (c) the traveling speed of the tractor, and (d) viscosity of puddled soil and other soil conditions.

Clinical trials often judge the efficacy of a new treatment by comparing the survival patterns of patients who are randomly assigned to undergo the new or a standard/placebo treatment. Usually, the entire groups are analyzed, although certain subgroups of patients may react differently to the new treatment than others. Some patients taking the new treatment might benefit from it (the positive responders) while others may be harmed by it (the negative responders). We applied a newly developed responder identification method (Kehl&Ulm, 2003) on the doubleblinded placebo controlled European Myocardial Infarction Amiodarone Trial (EMIAT). The method, which is based on bump hunting, proceeds to find the so called predictive factors, which describe positive and negative trends in survival in special subgroups of patients, solely due to Amiodarone. Factors found to be predictive were: age, previous infarction, beta-blocker treatment, onset, NYHA classification, and sex. Negative responders to Amiodarone, i.e. patients taking Amiodarone who survived shorter than a similar group under placebo, were patients who were older than 65 years, have had a previous infarction, and were not on beta-blockers. Positive responders to Amiodarone, (longer survival time), were male patients who were not negative responders, had NYHA classification greater than or equal to two, and onset greater than one. Further studies are needed to investigate this hypothesis.

Menarche is the process of first menstrual occurrence that signifies women's biological maturity. Achievement of height obtained from combination between genetic and non-genetic factors. Non-genetic factors included health status, nutritional status, physical activity and socioeconomic status. The purpose of this study is to determined the correlation between menarcheal age and height on female students of Unisba faculty of medicine. This study is an observational analytic research using cross sectional method. The subjects of the study were female student of Unisba Faculty of Medicine who met the inclusion and exclusion criteria. The study was conducted at the campus of Faculty of Medicine Unisba on April 2017. Subjects were interviewed about menarche age and then grouped into menarcheal age groups, 8 - 10, 11 - 12, 13 - 14, 15 - 16 and 17 - 18 years. Measurement of height was conducted on research subject. Statistical analysis was performed using anova test. Anova test results showed there was a correlation between menarcheal age and height on female student of Unisba Faculty of Medicine with p value = 0,001 (p≤0,05). On 38 subject studied, the average height in the younger menarcheal age group had a shorter height than the average height in the older menarcheal age group. It is associated with an increase in serum estrogen levels before the menarche that causes closing of epiphyseal plates in the lower limbs.

Modern network technologies first evolved in wired networks and subsequently entered the wireless network field. Applications may work in pure wired network, pure wireless network or hybrid network. Improving performance in these network infrastructures has been a continuous effort for decades. In this dissertation, we tackle two important challenges: (1) improving handover performance in heterogeneous wireless network, and (2) improving TCP performance in multi-hop wireless network. In heterogeneous network, users expect uninterrupted services moving from one network to another. IEEE proposed Media Independent Handover (MIH) to make it possible to achieve better handover performance. Currently, Mobile IPv4 (MIP) is the dominant mechanism for mobility management and is expected to persist into the future. However, when multiple interfaces of a mobile client are connected to a Foreign Agent (FA), MIP and its existing improvements do not perform well when the active interface fails unexpectedly. In this dissertation, we propose novel mechanism and MIP extension with MIH support. We prove experimentally that the new approach eliminates the FA-HA latency and achieves much faster handover, compared with existing mechanism. Our method also allows FA-bicasting, which can improve transmission reliability by combining traffic from different links, through the same FA. In multi-hop wireless networks, the main network factor that affects TCP performance is the medium-access contention, complicated by other factors like hidden terminal. We analyze the TCP congestion window and provide a more accurate estimate of its optimal value than those reported in the prior work. We also show that the much shorter TCP-ACK packets consume comparable channel capacity as the much longer data packets. We therefore propose two methods to improve TCP throughput, as follows. (1) Segregate the flows of data and ACK using static routing in grid wireless network, (2) Develop an improved variant of delayed TCP ACK by minimizing the number of ACK packets. Our evaluation validates the effectiveness of the proposed method, which can enhance TCP performance significantly. In terms of throughput, it achieves up to 204% improvement over the regular TCP in chain-topology wireless networks, and about 35% improvement in a complex grid wireless network. We also propose a new architecture to achieve higher throughput when multiple TCP connections exist.

In this research, we have used 102 strong motion recordings from 2012 Ahar-Varzaghan earthquakes (Mw=6.5 and Mw=6.3) to study the form of attenuation of shear wave Fourier amplitude spectra of those two events. The analysis is carried out in a broad-band frequency range from 0.1 to 20 Hz. A bilinear shape for geometrical spreading is assumed based on nonparametric regression of the data. The hinge point of the bilinear shape is around 60 km away from the earthquake source; the geometric spreading forms for the first and second segments are R-0.9 and R-0.5, respectively. The results of this study show that there is considerable dependency of the rate of geometrical spreading on frequency. If only frequencies above 1 Hz are considered, the first segment of geometrical spreading will have a slope steeper than R-1. In contract, for lower frequencies it has a gentle slope. The associated quality factor for the assumed shape of geometrical spreading (appropriate for frequencies logarithmically spaced between 0.1 to 20 Hz) is Q(f)=148 f 0.62. The estimated Q(f) in this study agrees well with the other estimated shear wave quality factors in the region; however, if the whole attenuation model (consisted of geometrical spreading and quality factor) is considered, there will be conspicuous differences between different models.

SUMMARY The note circulation is subject to long term fluctuations and also to shorter ones which reflect themselves every month in successive movements of expansion and contraction The expansion is primarily due to the fact that wages and salary pay ments are usually concentrated upon the end of the month which gives rise to temporary increases in the cash holdings of individuals The movements of contraction during the month appear to be primarily connected with tax payments loan flotations and uso with the degree of confidence in the currency Taking aside these monthly movements it has been possible however to trace definite trend towards slackening of the expansionist movement in the past years On the basis of such findings one can safely conclude that the note circulation is governed by series of independent factors besides those who influence the various sources of the money supply Government borro wings industrial and commercial advances inflow of foreign exchange This concept is particularly important since it shows hoiw the fluctuations In the various items of the weekly statement of Banque de France are to be interpreted

The feasibility of utilizing cellulosic biomass as an energy feedstock is domi- nated by factors such as facility location, feedstock availability, and transportation cost. Our previous case study showed improvements in quantification of feedstock availability for a biorefinery by introducing the effect of field-level yield variance and variable resi- due removal rates as improvement parameters into the GIS-based analysis. Even though the improved GIS-based method enhanced quantification of feedstock availability with the addition of the improvement parameters, a biorefinery would most likely procure more than one feedstock type. In this case study, quantification of feedstock availability based on multi-crop rotation cropping systems was done using the previously improved GIS-based variable residue removal (VRR) method. We observed on average a 3,793 ±5,733 DT per service area difference when increasing the number of crops used to esti- mate feedstock quantification. The supplementary use of crop-specific VRR rates affected residue availability, given that a crop's residue removal rate is influenced by crop yield, crop rotation, soil characteristics, as well as field location and management. It was also observed that the amount of available hectares of the three main crops analyzed in this case study affected residue availability. Corn represented 26.2% (440,636 ha; 1,101,591 acres), sorghum represented 12.9% (217,432 ha; 543,579 acres), and wheat represented 60.9% (1,024,607 ha; 2,561,518 acres) of the hectares in the study area. The validation study showed the importance of taking into account the seasonal availability of crop residue when estimating procurement service areas, given that in some cases feed- stock requirements were not met.

We consider various bi-objective models for the semi desirable facility location problem. In these problems, the disservice caused by the facility is traditionally measured by distance-related objective functions. In this paper, we modify the objective function representing the disservice using the Lorenz curve and the Gini coefficient. Both of these concepts are widely used in the economics literature to measure the discrepancy in wealth distribution within a population. The use of the Gini coefficient enables the measurement of how the disservice caused by the facility varies across different Pareto optimal solutions. We use a bi-objective particle swarm optimizer (bi-PSO) to compare how the change in the objective function representing the disservice affects the recommended location of the facility. Results suggest that some solutions identified as "Pareto optimal" by traditional formulations are dominated by other solutions when the Gini coefficient is used. Additionally, the use of the Gini coefficient causes a change in the "optimal" location of a semi desirable facility in some instances.

This paper combines analytic hierarchy process (AHP) and quality function deployment (QFD) techniques to support a facility location decision from a requirement perspective. The proposed approach begins by identifying location requirements, followed by the derivation of location evaluating criteria. Then, a central relationship matrix is established to display the degree of relationship between each pair of location requirement and location criterion for the QFD process. The AHP is used to measure the relative importance weighting for each location requirement. The importance degree and the normalised importance degree of each location criterion are then computed using the QFD transformation for constructing the facility location model. The AHP is used to assess the evaluating score for each candidate location for each particular location criterion. Finally, an overall score for each of the candidate locations is computed for the decision-maker to select the optimal location. An example is given to demonstrate how the proposed approach works.

The research was motivated by the implementation of face-to-face tutorial in UPBJJ-UT Medan that is still considered to have several problems, such as the declining of student attendance rates in several study groups (pokjar). This study aimed to: (1) describe the implementation of face-to-face tutorial (TTM) and the criteria of the tutorial systems in UPBJJ-UT Medan, (2) analyze the factors that determine the quality of tutorial, and (3)identified factors that impede the quality of tutorial. The researchis descriptive with a qualitative approach. Data were collected through interviews and distributing questionnaires to 75 respondens who were randomly assigned; and analyzed by qualitative descriptive. The results showed that : (1) TTM held in UPBJJ-UT Medan through the stages of the recruitment of tutors, tutor training, delivery of instructional materials timely, and tutorial monitoring. While the geographical factors used as criteria for the establishment of tutorial areas with the system model block, semi-block and regular. (2) supporting factors of tutorial quality: (a) tutors, (b) instructional materials, (c)students, (d) tutorial location, and (e) the examination system; and (3) inhibiting factors include: (a) distance, (b) age, (c) time, (d) economic and (e) cultural-religion.