DONALD D. TRUNKEY, MD: * In this Trauma Rounds we will depart from our regular format of patient presentation. Instead, we will examine the problem of sepsis in surgical patients, and also discuss the improved treatment and prevention of septic complications. During the past five years at the Trauma Center, sepsis (and its sequelae) has become the leading nonneurologic cause of morbidity and mortality in the postoperative state. Last year sepsis alone accounted for more deaths than did cardiogenic shock and hypovolemic shock combined. Figure 1 shows the major interactions that influence the development of a septic focus after injury. Although clinicians cannot control the situational factors of the inoculum, the virulence or the tissue damage, they can substantially modify the host resistance and iatrogenic factors that also contribute greatly to the development of sepsis. There are additional iatrogenic and systemic causes of decreased resistance not listed in the figure but which include patient age and antecedent diseases such as diabetes. Table 1 lists local wound factors that can interfere with host resistance and also contribute to the development of a septic focus. With this introduction, let us examine more


The Sixth International Conference on Streptococcal, Lactococcal, and Enterococcal Genetics, sponsored by the American Society for Microbiology, convened 14 to 17 April, 2002, in Asheville, N.C. From its inception in 1981, this conference has highlighted the best science in the field and has provided a forum for young investigators to present their work, often for the first time, to an international audience. This year's conference continued both traditions, with 39 outstanding presentations from established and young investigators alike, along with 150 poster presentations from among the more than 250 attendees of the meeting. Many of the contributions to the meeting are highlighted in this review, and a number of related articles appear in this issue of the Journal of Bacteriology (1, 5, 10, 13, 16-18, 24, 25).

The streptococci have played a central role in the development of bacterial genetics, beginning with experiments described by Griffith in 1928, in which he provided the first demonstration of bacterial gene transfer (12). Those experiments, involving Streptococcus pneumoniae, were the first description of genetic transformation in bacteria and led to the discovery in 1944 by Avery, MacLeod, and McCarty that DNA was the "transforming principle" of Griffith's experiments and hence the genetic material (2). Since the first streptococcal-genetics meeting, the lactococci and enterococci have been designated as separate genera; antibiotic resistance has increased from an emerging observation to a worldwide health issue; historic observations such as Griffith's capsule transformation have been described at the molecular genetic level; and the gene transfer systems, plasmids, phage, and transposons that first brought streptococcal researchers together now provide the tools for dissecting metabolic and virulence pathways, while still maintaining their own allure. The present time represents another significant era in the history of the streptococci, as we witness the completion of the genome sequences of many streptococcal, lactococcal, and enterococcal species (3, 4, 8, 11a, 14, 26, 27a, 28) and begin the transcriptional and proteomic analyses that will lead us to an unprecedented understanding of the regulatory events that take place within the cell.

The opening lecture by Claire Fraser (The Institute for Genomic Research, Rockville, Md.) provided an overview of the genomic revolution and set the scene for a number of presentations on genomes of Streptococcus, Enterococcus, and Lactococcus species. The next frontiers, made possible by newly developed technologies, will be the discovery and analyses of genomes of yet-to-be-cultured microbes and the genomic analyses of microbes colonizing the oral cavity, respiratory tract, and intestinal system of the human body. Moreover, with the increasing number of known genome sequences and the exploding number to come, comparative genomic analysis will be a powerful tool with which to monitor microbial evolution and will provide insights into the multiple processes that shape microbial diversity. A special case that may become a paradigm in this area is the comparative sequence analysis of seven strains of Bacillus anthracis. The chromosomal sequence comparison of two related strains revealed the presence of only two short inserted or deleted sequences (indels) and two single-nucleotide polymorphisms (SNPs) in their 5.2-Mb chromosomes, while a few dozen more SNPs were found on each of the two plasmids (23). This detailed genomic analysis allowed for an unprecedented distinction at the strain level, revealing a powerful tool for investigating infectious-disease outbreaks. Other medical applications relevant for the pathogenic streptococci involve the discovery of new drug targets and the identification of candidates for vaccine production. However, the challenges ahead deal with all areas of microbiology and include analysis of gene expression under natural conditions, identification of regulatory networks, and expansion and continuous curating of microbial databases, for which there is an urgent need.


The thought of rural residents' sports has been continually changed since the establishment of China.Especially it realized the breakthrough type leaps for the ideas of sports fitness in recent years.But the ideas and behavior of sports fitness is not the same thing.Investigation shows that the pearson correlation coefficients is only 0.268 between the thought and behavior of the sports fitness in Xuzhou city.The paper uses the research methods of documentation method and questionnaire to analyze that the essence of the contradiction between the thought and behavior of the sports fitness is the absence of internalization force on their contradictory situation.Accordingly,the paper studies the exploration of internalization force for the realization of farmers' sports fitness behavior from four aspects as follows:the environment function of different organization,the model leading of many groups,the publicity and persuasion of media,the edification and infectious functions of film and TV.To sum up,the study aims to establish the theoretical foundation for the realization of the internal process of farmers' sports fitness attitude,and accelerates the pace from fitness thoughts to fitness behavior for the farmer.


Abstract The search for recycling methods of composite materials indicated the possibility of using composites with polyester-glass recyclate as structural elements. The main aim of the article was to analyse the influence of the graphite percentage content on the mechanical and structural properties of such composites. Composite materials were made by hand laminating with 10% polyester-glass recyclate and graphite nano-additive. Samples for the static tensile test were prepared, which was carried out in accordance with the applicable standard on a universal testing machine. The obtained results showed that with the increase in the amount of graphite, the properties of the composite decrease; however, disproportionately to the % of its content.


Health misinformation on social media devastates physical and mental health, invalidates health gains, and potentially costs lives. Understanding how health misinformation is transmitted is an urgent goal for researchers, social media platforms, health sectors, and policymakers to mitigate those ramifications. Deep learning methods have been deployed to predict the spread of misinformation. While achieving the state-of-the-art predictive performance, deep learning methods lack the interpretability due to their blackbox nature. To remedy this gap, this study proposes a novel interpretable deep learning approach, Generative Adversarial Network based Piecewise Wide and Attention Deep Learning (GAN-PiWAD), to predict health misinformation transmission in social media. Improving upon state-of-the-art interpretable methods, GAN-PiWAD captures the interactions among multi-modal data, offers unbiased estimation of the total effect of each feature, and models the dynamic total effect of each feature when its value varies. We select features according to social exchange theory and evaluate GAN-PiWAD on 4,445 misinformation videos. The proposed approach outperformed strong benchmarks. Interpretation of GAN-PiWAD indicates video description, negative video content, and channel credibility are key features that drive viral transmission of misinformation. This study contributes to IS with a novel interpretable deep learning method that is generalizable to understand other human decision factors. Our findings provide direct implications for social media platforms and policymakers to design proactive interventions to identify misinformation, control transmissions, and manage infodemics.


The widespread use of advanced Imaging techniques has dramatically improved the diagnosis of cauda equina syndrome in geriatric small animal patients. Two different techniques (sternal vs lateral recumbency) were tested in twelve cadavers for the L7-S1 disk injection under fluoroscopic guidance. Twelve dogs were enrolled in the study: eight intervertebral lumbosacral disks were injected with a gelatinous radiopaque compound and the remnants four disks with an alcoholic radiopaque solution. The dogs were randomly positioned either in lateral recumbency with the lumbo-sacral joint in neutral position (six dogs), or in sternal recumbency with the hind limbs extended cranially along the body and the lumbosacral joint flexed (six dogs). The correct injection of the compounds within the lumbosacral disk was checked both by computed tomography (CT) and gross anatomic examination. The lateral technique required less time of execution and minor attempts for the correct positioning of the needle. All the injected disks were visible on CT, while necroscopy resulted satisfactory only in five patients. Leakage of the compounds outside the disk was observed in two cases. The percutaneous injection in lateral recumbency under fluoroscopic guidance resulted rapid and feasible in a cadaveric model. Future clinical trials are required to assess the safety of chemonucleolysis in diseased patients.


In this paper, some different types of fuzzy normal spaces, viz., fuzzy δpnormal space, fuzzy mildly δp-normal space, fuzzy almost δp-normal space are introduced and studied. Also, relationships of these newly defined spaces with others defined earlier are established.


We show that the familiar Cartesian lattice, while convenient for signal processing and representation, is suboptimal when it comes to signal fidelity. We explore various applications of optimal sampling lattices, such as the Hexagonal and Body Centered Cartesian (BCC) lattices for 3D Computed Tomographic (CT) Reconstruction, both in terms of the (2D) detector and the (3D) reconstructed object. We find that BCC lattices compare favorably with CC lattices for both CT data acquisition and reconstruction. For example they increase the recovery and detectability of small features, such as small tumors in the brain.


Voluntary non-commercial Internet-based distributed computing ('social sharing' for short) is an open source activity that is emerging as a distinct mode of resource allocation and economic production. This paper presents an exploratory cross-country analysis of factors determining the output of the paradigmatic social sharing project, the Search for Extraterrestrial Intelligence (SETI@home). The key hypothesis proposed is that SETI@home output is correlated with the average level of happiness in a country. Happiness is arguably a major motivational factor for participating in this type of project. The second major hypothesis explored is that trust, i.e. a form of social capital, is a less important motivational factor. I find some support for both hypotheses, but only for the group of developed and advanced countries. However, given the data limitations and the simple model tested, the results can only be regarded as suggestive, not conclusive. It is hoped they will stimulate further research into the link between open source and happiness economics.


Depressions are one of the most widespread forms of psychiatric pathology in the population. Depressions have serious socioeconomic consequences. At present time depressions take the 4-th place among all diseases as a cause of death and disability. The development of depressive disturbances is under influence of neurobiological factors. Various somatic diseases can cause depressions by means of biologic or psychosocial mechanisms. That is why there is a great amount of types and variants of depressions in general doctor's practice.


As we introduce this year's Hot Chips theme issue, the frequency slowdown trend that is upon us as a result of the CMOS technology outlook has to be the single major point that stands out. It is not just the per-chip power dissipation envelope that is forcing this trend, although that factor alone is perhaps the major deterrent to frequency escalation at prior (historical) rates.


which, based on the analysis of data flows, will provide support for the adoption of effective management decisions. The complexity and power of the ACS are constantly increasing, and their effectiveness depends on the use of modern hardware and software, the flexibility of algorithmization, innovative approaches to modelling, analysis and forecasting. In the aspect of ensuring a high level of efficiency of ACS of an enterprise we must take into account endogenous and exogenous factors of influence on the construction and functioning of such a system, which should ensure the successful achievement of the business objectives set by the enterprise. In order to achieve a high level of efficiency of an enterprise management system, it is necessary to take into account external and internal factors of influence on its construction and functioning. This should provide the company successfully achieve their business goals. The analysis of scientific sources concerning the classification of external and internal factors, which influencing the construction of efficient automated enterprise management systems was conducted. External factors are influenced by the world market of software and hardware, as well as concepts and standards for the design, development and implementation of modern software and hardware. Internal factors arise as a result of the company's corporate policy on the use of information technology, the use of innovative means of production, modern management methods etc. The author of the article internal factors is divided into: organizational-administrative, cost-consuming, techno-technological and socio-psychological. The external factors of influence include groups of financial-strategic, innovation-investment, institutional-legal and socio-economic factors. It is suggested to use the BSC method for estimation of influence of exogenous and endogenous factors.


E. L. Thorndike contributed significantly to the field of educational and psychological testing as well as more broadly to psychological studies in education. This article follows in his testing legacy. I address the escalating demand, across societal sectors, to measure individual and group competencies. In formulating an approach to measuring competence, I draw on measurement research I have done over my career; the Thorndike lecture is to be as much autobiographical as substantive and/or methodological. I present an approach to defining, measuring, and statistically modeling competency measurements. The article unpacks Hartig et al.'s (2008) definition of competence as a complex ability construct closely related to real-life-situated performance. The intent is to make the construct, competence, amenable to measurement. Once unpacked, criteria for building competence measurements are set forth and exemplified by research from business, military, and education sectors. Generalizability theory, a statistical theory for modeling and evaluating the dependability of competence scores, is applied to several of these examples. The article then pulls together the threads into a general competency measurement model and concludes by noting its limitations.


The effects of valence of feedback, credibility of superior, and expertise of superior on subordinates' reactions to superior and effort intentions were examined in a 2 × 2 × 2 experimental study in which 120 management students participated. A significant main effect was found for feedback but not for credibility or expertise. It is argued that subordinates' reactions to feedback from superiors may sometimes be relatively unaffected by the perceived credibility or expertise of the superior.


The equations of mathematical physics are a natural environment for modeling physical phenomena, an example of the above is evidenced by the heat equation in relation to its use in a variety of applications; directly related to the equations of mathematical physics are the solution methods that are used to construct the predictive models. This paper describes step by step the analytical method of separation of variables to perform a complete description of the heat conduction phenomenon in the presence of a heat generation source. The investigation by using mathematical arguments allowed to calculate the temperature function as the addition of a Fourier series and a function which represents the steady state; by performing a computational simulation, it was possible to demonstrate the accuracy of the results achieved.


In this paper, I investigate how the idea of the "Yellow Box" can together provide a novel approach to the concepts of time and space for typography design history and development in China. I then argued that the concept of 'play-appreciation' is one of the elements of the 'Yellow Box'. The idea of using long scroll as a form of visual representation, as well as the idea of using Chinese chairs, applies and enacts the viewers' experience of 'play-appreciation'.


Environmental problems can be seen as a growing problem. The studie will show how big the knowledge of ordinary people in specific environmental problems and risks are. In this study the issues concerning environmental and health hazardous metals that accumulate in the sludge at the Swedish treatment plants are analysed. The metals may have serious health effects on humans and appear in a series known everyday products. The study is based on a survey with 200 participating respondents and the purpose is to measure their knowledge. The respondents are divided into a younger and an older age group. Similarities and differences have been analysed between the younger and the older ones. The study addresses the environmental and health impacts of each metal, and its incidence in different goods and products. The general state of knowledge about the environmental problems and risks will be addressed, as well as if metals can be purified in Swedish sewage or not. Another part of the study deals with the common man's reliability to the different actors who have the ability to disseminate information about environmental problems and risks. The respondents have also answer what routes of dissemination of information they prefer.The survey is divided into a quantitative and a qualitative part. The quantitative part has come to the conclusion that the older age group have a higher level of knowledge than the younger age group in terms of the four metals in general. They also have greater knowledge regarding the metals health effects and occurrence of goods and products. The younger age group has a better understanding of environmental problems and risks in general and about if metals can be purified in wastewater treatment or not. In the qualitative part the study examines the methods of dissemination respondents prefer and which actor they feel the greatest reliability to. Respondents prefer that knowledge should be conveyed by including the school system and the media. Reliable traders considered in the dissemination of information to be authorities, researchers and organizations.


The Danda River is an important river running through the heart of the urban city of Siddharthanagar, Nepal. For the past several years, the quality in and around the Danda River has degraded from industrial and agricultural runoff, household sewage disposal, and unplanned waste management practices. This paper develops a choice experiment method to assess the potential for a sustainable management of the Danda River and its ecosystem. We use a primary survey data from 637 geocoded households (effective response rate of 90%), and the empirical analysis is conducted using the Generalized Multinomial Logit model. The results indicate significant and substantial demand for the river ecosystem services. Our analysis incorporates respondent preference uncertainty, and we also explore the presence of spatial heterogeneity using the hot spot analysis. We find that the inclusion of preference uncertainty increased the precision of the marginal willingness to pay estimates, while the hot spot analysis indicates that heterogeneity in preferences for the ecosystem services surfaces from the central region of Siddharthanagar. We also observe that the public prefers community-based management of the Danda River, highlighting the need for policymakers to decentralize management to the local communities so as to enhance interest in conservation of common pool resources like the Danda River.


The magnetic behaviours of a mixed Blume-Capel Ising ferrimagnetic system on a square lattice having spins 2 1   A i  and spins 1 , 0   B j  , in the absence and presence of an external magnetic field, are investigated, respectively. Our results which are examined have interesting features depending on higher positive values of anisotropy field. The longitudinal magnetic fields dependence of the spin compensation temperature is the essential substance of research. It is worth to note that in this model, the contribution of magnetic free energy to the thermodynamic stability of the mixed spin ferrimagnet with first nearest neighbour interaction is indicated.


Considering punctuation to be the main means of conveying semantically significant aspects of prosody in written text, we discuss the basic cases of discrepancy between meaningful prosodic features and punctuation markers for Russian. Such cases need special attention in the development of TTS systems.


Cognitive architectures are computational frameworks that support the development of computational models of human cognitive processes. They have typically been used to advance our understanding of human cognition in specific task environments; however, they have also been used to support the development of a variety of intelligent systems and agents (e.g., cognitive robots). There are a broad range of reasons to motivate the effort to integrate cognitive architectures with virtual environments. These include the development of intelligent virtual characters for the purposes of training simulations, enhanced gameplay experiences and the modelling of user/gamer behaviour. Virtual environments also support simulations of actual real-world environments (e.g., using physics engines and advanced lighting models) that can be used to perform computational simulations into embedded, extended, and embodied cognition. In the current report, we describe the effort to develop an integration framework that enables the ACT-R cognitive architecture to be used in conjunction with the Unity game engine. The resulting framework, referred to as the ACT-R Unity Integration (ACT-R UI) framework, enables individual ACT-R models to control the behaviour of virtual non-player characters that inhabit 3D virtual environments built on top of Unity. We first provide an overview of the ACT-R architecture and the Unity game engine. We describe the key features of both systems and discuss why they provide such a compelling target for integration. We then go on to describe the nature of the integration solution itself. We outline the extensions to the ACT-R architecture that enable ACT-R models to exchange information with Unity, and we also present the Unity components that enable virtual characters to be controlled or influenced by ACT-R models. Finally, we provide a concrete example of the use of the ACT-R UI. In particular, we show how an ACT-R model can be used to control the behaviour of a virtual robotic character that inhabits a Unity-based virtual environment.


The temperature dependence of the bulk modulus of polyisoprene has been studied using molecular dynamics simulations. Virtual polyisoprenes have been submitted to volume contractions above and below the glass transition. Bulk modulus has been observed to be linearly dependent on temperature both above and below the glass transition respectively, and it dropped by a factor of about 2 while temperature was raised above the glass transition. By monitoring the energy changes during volume contractions, it was observed that the bulk modulus arises mainly from the Van der Waals interactions. Nevertheless, the entropy contribution to the bulk modulus becomes significant above the glass transition. At a first order, the entropy part of the bulk modulus can be considered as independent of the temperature.


Research Thesis Submitted to the School of Education in Partial Fulfilment of the Requirement for the Award of the Degree of Master of Education of Kenyatta University, December, 2016


A power packet dispatching system for the robot arm operation is discussed. The power packet dispatching system is the power distribution system which DC voltage is delivered with the information tag in the same power line. To include the information into the packet, switching speed of the switching device is desired over MHz range. SiC or GaN device is attracting solution to realize the power packet system. Six arm robot operation with the power packet dispatching system using GaN device is designed and evaluated. Design concept is described to interface the power and the information in simultaneously. Realization of the proposed method was verified.


Objective To determine the effect of purine nucleotides on conditioned place preference and acute withdrawal in chronic heroin dependent rats.Methods 50 male Wistar rats were randomly divided into control,heroin,heroin+AMP+GMP,heroin+AMP and heroin+GMP groups.Conditioned place preference(CPP) trial was done at 0,5,9 d.Naloxone was used to observe and evaluate the precipitated syndrome.Results In the CPP trial,the rats of control group showed obvious conditioned place aversion(CPA) because their total time staying in the drug-pairing side was decreased dramatically after 5 d treatment and dropped even more after 9 d treatment.In contrast,total time staying in the heroin-pairing side was increased significantly after 9 d heroin administration which proved that the rats formed CPP to heroin.The total time staying in the drug-pairing side of the heroin+AMP+GMP group,heroin+AMP group and heroin+GMP group were changed little which confirmed that purine nucleotides compensated with heroin inhibits rats' CPP to heroin after 9 d heroin treatment.In acute withdrawal evaluation,the counts of ptosis,tooth chattering and chewing of heroin+AMP+GMP,heroin+AMP and heroin+GMP groups were significantly higher than those in heroin group(P0.05).Conclusions Purine nucleotides can inhibit development of psychological dependence to heroin and alleviate some of the withdrawal symptoms.


Intraocular surgery endophthalmitis prophylaxis with self-reported iodine allergy Although postoperative endophthalmitis is rare, it is potentially a sight-threatening condition and often has a poor prognosis. There is a consensus that povidone– iodine 5% solution should be administered into the conjunctival sac, immediately preoperatively, for postoperative endophthalmitis prophylaxis. However, there is a paucity of evidence regarding the best practice for patients with self-reported iodine allergy, potentially leading to variations in practice. We conducted an online survey to establish the current practice among consultant ophthalmologists in the United Kingdom with regard to postoperative endophthalmitis prophylaxis for patients with self-reported iodine allergy and allergies linked to iodine: seafood and iodinated contrast media. The survey was sent to all consultant ophthalmologists registered with the Royal College of Ophthalmologists, London, in February 2018. The survey showed that 323 respondents (97.3%) had encountered a patient with self-reported iodine allergy during their practice, highlighting the relevance of this topic; 246 respondents (74.1%) reported they would continue the normal practice with povidone–iodine in the event of self-reported seafood allergy, as supported by the current literature, which suggests that seafood allergies are caused by various protein allergens, rather than their high levels of contained iodine (Fig. 1). Unlike with seafood allergy, just 127 participants (38%) reported they would continue the normal practice with povidone–iodine for patients with self-reported iodinated contrast media allergy (Fig. 1). The majority (170 participants) would instead administer aqueous chlorhexidine into the conjunctival sac preoperatively. The current literature suggests that an iodinated contrast media allergy has been misattributed to iodine allergy. Although the mechanism of the iodinated contrast media allergy remains unclear, there is sufficient evidence to suggest that the allergen within the contrast media is not iodine. Thus, iodinated contrast media allergy is not an absolute contraindication to topical povidone–iodine use. Only 11% of participants reported they would continue the normal practice with povidone–iodine in the event of self-reported iodine allergy, with 70% opting to administer the alternative, aqueous chlorhexidine (Fig. 1). There were also more responses supporting the use of antibiotics, other actions, and the organization of allergy testing for iodine allergy, compared with seafood and iodinated contrast media allergies. The current literature suggests that iodine itself is not an allergen; it is required for thyroid function and other normal biological processes and does not have the complexity necessary for antigenicity. There are currently no reports


A Schottky diode mixer has been realised at 2.5 THz in a waveguide configuration. Measured RF performance is comparable to that obtained using the conventional corner reflector mount and the waveguide mixer has the added benefits of excellent beam efficiency and circuit tuning capability. In addition, the structure has been demonstrated to be reliable and rugged. The mixer design and construction is briefly described and first RF performance results are presented.


The IEEE802.11MAC protocol is the key component for WLAN standard that determined the network performance of wireless LAN.In this paper,it analyzes and simulaes the performance of WLAN including throughput,packet drop rate and end-to-end delay.The result shows there are relativity between the performance of network and the node numbers.


Aim: This study aims to determine the effectiveness of home-based pelvic floor muscle training on decreasing the symptoms of stress urinary incontinence and improving the quality of life among multiparous women
Methods: Women who were diagnosed with Stress Urinary Incontinence were invited to take part in this study. These subjects were randomly allocated to either an intervention group or a control group. A 6-week assessment of both groups were carried out for the pelvic floor muscle strength using the modified oxford grading system, for the severity of Incontinence, the ICIQ- short form was used, & for the Quality of Life, Incontinence QoL Scale was used.
Results: A total of 60 subjects were included in the study. At the baseline, both the groups were similar in terms of PFM strength, ICIQ score& Incontinence QoL Scale. At the end of 6 weeks of assessment, there was a significant difference (p<0.001) between the control & the intervention group in terms of MOGS, ICIQ score and Incontinence QoL Scale score.
Conclusion: The home-based pelvic floor muscle training was found as a safe and effective intervention in decreasing the severity of symptoms and improving the quality of life in multiparous women with SUI.


Significance Developing a mathematical model that predicts the response of the cochlea over the entirety of the cochlear spiral has been an outstanding challenge in the field. Without such a model, an accurate representation of interactions occurring inside the cochlea in response to complex signals like speech sounds or tone combinations that evoke clinically relevant otoacoustic emissions is impossible. We show that incorporation of the taper of the cochlear ducts and macro- and microscale fluid viscosity along with the subtle change of the intricate cochlear cytoarchitecture into a mechano-electric–acoustic model provide the key ingredients to represent the mechanical and neural tuning from the base to the apex of the cochlea. The spatial variations of the intricate cytoarchitecture, fluid scalae, and mechano-electric transduction in the mammalian cochlea have long been postulated to provide the organ with the ability to perform a real-time, time-frequency processing of sound. However, the precise manner by which this tripartite coupling enables the exquisite cochlear filtering has yet to be articulated in a base-to-apex mathematical model. Moreover, while sound-evoked tuning curves derived from mechanical gains are excellent surrogates for auditory nerve fiber thresholds at the base of the cochlea, this correlation fails at the apex. The key factors influencing the divergence of both mechanical and neural tuning at the apex, as well as the spatial variation of mechanical tuning, are incompletely understood. We develop a model that shows that the mechanical effects arising from the combination of the taper of the cochlear scalae and the spatial variation of the cytoarchitecture of the cochlea provide robust mechanisms that modulate the outer hair cell-mediated active response and provide the basis for the transition of the mechanical gain spectra along the cochlear spiral. Further, the model predicts that the neural tuning at the base is primarily governed by the mechanical filtering of the cochlear partition. At the apex, microscale fluid dynamics and nanoscale channel dynamics must also be invoked to describe the threshold neural tuning for low frequencies. Overall, the model delineates a physiological basis for the difference between basal and apical gain seen in experiments and provides a coherent description of high- and low-frequency cochlear tuning.


Ramp metering offers great potential to mitigate traffic congestion and improve freeway management efficiency under traffic congestion conditions. This paper proposes an optimization program for freeway dynamic ramp metering based on Cell Transmission Model (CTM). This problem has been formulated as a discrete time optimal control problem with smooth state equations and constraints to meter traffic inflow from on-ramps. In the proposed model, the 'min' operators in the primal CTM are non-differentiable and thus, the corresponding optimal control problem cannot be solved directly using conventional gradient based methods. In this paper, we introduce a smooth approximation to approximate the 'min' operators and then a unified computational approach is developed to solve the problem. Theoretical analysis is carried out, showing that the optimal solution obtained from the approximated problem converges to the optimal solution of the primal CTM. Compared to the classical inequality relaxation method, our method can resolve the flow holding-back problem and reduce under fundamental diagram phenomenon. Compared with the Big-M method, our method has better efficiency. To achieve the desired traffic response control in real application, a series of online optimal control problems are solved using Model Predictive Control (MPC). Simulation studies show that our method can significantly improve freeway traffic management efficiency.


AODV-MR (on-demand routing protocol with multi-radio extension) has been designed to support multi-radio interfaces; it uses more than one interface of the same mesh router or gateways for broadcasting duplicated control packets (i.e., RREQ, RRER, and HELLO message) or to rebroadcast it. We have modified AODV-MR, by allocating one interface in a dynamic manner for sending routing/control packets or data packets. This allocation of interfaces is based on type of mesh routers and traffic direction. The efficiency and effectiveness of the modification work have been evaluated compared with AODV-MR in terms of packet delivery ratio, routing packet overhead, end to end delay, and throughput.


JOVAN BYFORD, Lecturer in Psychology, Department of Social Sciences, Nottingham Trent University, UK ANDREI CORNEA teaches political philosophy at the University of Bucharest and is a columnist for the political weekly magazine 22 MARTIN DEWHIRST, Honorary Research Fellow, Department of Slavonic Studies, University of Glasgow SLOBODAN DRAKULIC, Lecturer, Sociology Department, Ryerson University, Toronto GENNADY ESTRAIKH, Associate Fellow, Oxford Centre for Hebrew and Jewish Studies; CoEditor, East European Jewish Affairs LARS FISCHER, PhD student and Postgraduate Teaching Assistant, Hebrew and Jewish Studies Department, University College London FRANK FOX, Professor Emeritus in East European History, West Chester University, Pennsylvania MARAT GRINBERG, Doctoral student and Lecturer, Department of Comparative Literature, University of Chicago ALENA HEITLINGER, Professor of Sociology, Trent University, Peterborough, Ontario, Canada HENRIETTA MONDRY, Associate Professor in Russian, University of Canterbury, New Zealand MARCIN STARNAWSKI, Doctoral candidate, Department of Sociology, University of Wrocław ANNA VERSCHIK, Associate Professor, Division of General and Applied Linguistics, Faculty of Philology, Tallinn Pedagogical University MARCIN WODZIŃSKI, Head, Research Centre for the Culture and Languages of Polish Jews, University of Wrocław


Let G a finite group. For conjugacy classes A and B of G, the subset AB of G is a union of conjugacy classes of G, and for irreducible complex characters χ and ϕ of G, the product χϕ is a linear combination of irreducible characters of G with positive integer coefficients. In this article we give the structure of finite groups G whenever C 2 contains a central conjugacy class or does not contain a central conjugacy class of G, for all conjugacy classes C of G. Also in the case of (C −1) m C n ⊆ Z(G) the structure of G is given. Similar results when C is replaced by an irreducible character χ of G are discussed.


While stuttering may sometimes seem benign and appear as an aestheticization of thought, it is a communication disorder that can be painful for the stutterer and his/her family. The stutterer may be subjected to taunts that lead to isolation or fits of violent rage. This paper discusses the therapeutic treatment of stuttering, which aims to restore verbal capacities and facilitate contact with others.


This paper analysed how three teacher-researchers of Singapore's elementary school used online space extensively in Grade 2–Grade 4 classrooms. Such online space, made possible by free and readily available web 2.0 and open source applications, was meant to complement the physical learning space as such space can allow learning activities, which were otherwise not possible in the typical classroom setting, to be carried out. The results revealed that students have positive learning experience but the learning impact was small. Despite such unfaltering results, the teacher-researchers were not daunted due to their strong conviction that technology is vital in their students' learning.


[1] An advantage of examining atmospheric gravity waves using high vertical-resolution radiosonde data over other measurement techniques is that horizontal wind, temperature, and vertical ascent rate can be measured directly. This allows the kinetic, potential, and vertical velocity fluctuation energies to be derived independently. Each of these gravity wave energies is shown to have sensitivity to different gravity wave frequencies. Observed correlations among these energies are consistent with this, and simulations of these correlations are shown to constrain gravity wave frequency spectra. The climatology of these energies shows quite different variations with month of the year and with latitude such that the vertical fluctuation energy seems to be a better indicator of convectively forced higher-frequency gravity waves.


The purpose of this paper is to propose a quantitative methodology for setting targets in the framework of Balanced Scorecard (BSC) in order to achieve vision and goals.,Response Surface Methodology is proposed to find the significant relationships that should be included in the strategy map and the optimal values of performance measures are assessed by using the desirability function-based approach of RSM. The proposed method was created by reviewing the existing literature, modeling the problem, and applying it in an oil company. In fact, RSM is used to execute the design matrix, analyze the collected data, extract models, analyze the results, and optimize the procedures that generate multiple responses.,By applying this methodological design, a clearer picture of the relationships between strategic objectives is obtained and the influence of strategic objectives on one another is determined. Afterward, optimal values for performance measures are determined.,This paper proposes a framework for constructing a strategy map and setting quantitative targets to translate the goals and strategies into corresponding performance measures and targets. Also, this paper presents a case study to demonstrate the applicability and effectiveness of the proposed approach. However, RSM-based techniques require a greater amount of data to generate more accurate results. Although the advent of the Information Age has forced organizations' decision makers to provide sufficient information and data for business analysis, the data requirements of RSM-based techniques are met.,In practice, the process of setting targets for performance measures can be challenging in terms of reaching a consensus between managers and decision makers. The findings of this paper can offer a new approach for performance evaluation based on the BSC which allows the organization's decision makers to reach a more accurate picture of the relationship model between organization goals and those objectives within the BSC. It also demonstrates how decision makers can be guided in the process of defining performance target values in the BSC method.,Reviewing the literature on setting quantitative targets within the framework of the BSC showed no prior study in which RSM is used. This approach has two main contributions: the associations among strategic objectives are investigated and obtained in an effective way which analytically identifies the direction and degree of the relations among the performance measures. Considering the performance evaluation structure based on the BSC, quantitative targets have been determined to help in achieving the long-term goals of the organization. The application of the proposed method in a company showed that the contributions of this research are not only theoretical, but practical as well.


The object of the present invention relates to the provision of such cosmetic make skin beautiful and healthy development of a given evaluation methods may become cosmetic. By providing a method to change the thickness of the stratum corneum after drying the wet process as an index to evaluate the improvement of skin cosmetics is applied to solve the problem.


On Oct. 17, 2018, the government of Canada will launch a national, uncontrolled experiment in which the profits of cannabis producers and tax revenues are squarely pitched against the health of Canadians. When Bill C-45 comes into force in mid-October, access to recreational marijuana will be legal


Set the charge balancing circuit, to provide a charge balance for the bank of the charge storage device connected in series. 1 embodiment of the present charge balancing circuit consists of the voltage divider is connected between the two capacitors, an amplifier, and a negative feedback resistor. The circuit is configured to monitor the voltage of each capacitor, in the case in one voltage of the capacitor is higher than the other capacitor, the circuit of energy from a high electric charge capacitor to between the capacitors is balanced in low charge capacitor transfer it is intended to. To limit the output current of the amplifier to a safe value, and may include a current limiting resistor for providing feedback information about the state of the capacitor. May be the bank of a large charge storage device further comprises a gain stage in order to increase the output current of the amplifier. This circuit can be used in bipolar devices.


Subject
 Congo's presidential elections.

 Significance
 As the deadline for candidates to register for December's presidential elections expired on August 8, the government announced that Emmanuel Ramazani Shadary would be the candidate for the ruling coalition and its allies, ending persistent speculation that President Joseph Kabila would attempt to run again, despite having already served the constitutional maximum of two terms.

 Impacts
 Kabila's decision not to stand may ease constraints on donor funding for the elections.
 Opposition rhetoric advocating a single candidate will intensify, but reaching consensus on who this should be may prove challenging.
 The proposed use of electronic voting machines will be deeply controversial and a focus of likely fraud allegations.


The characterization of the socioeconomic profile isanessential tool for various types of analysis, whe nonewantsto know the relations of social processes, economic production over a givenarea, the living conditions of a particular community orgroup of people, and howto determine Its patternofgrowth and development. The present study aimed to evaluate the socioeconomic profile of fishfarmers in the city of Porto Grande, Amapa, Brazil. Eighteen fishfarmers wereinterviewed, as a methodological support, weused qualitative and quantitative research, with application of forms, in these are exposed structured and semi-structured questions. With statistical analysis encompassingallstages of descriptive statistics. The main research findings are the predominance of males in the activity, the mean age of 48.07 ± years, the majority of respondents are married. In school, therewas a predominance of incomplete fundamental level. Fish farmingis not presented as exclusive income, requiring supplementation to meet the needs of families, including agriculture. From the seresults, it was possibleto analyze a range of situations that were never discussed in o thers cientific studies for this region, which praises the importance of this socioeconomic survey.


Background  Psoriasis is recognized as the most prevalent T‐cell‐mediated inflammatory disease in humans, with predominantly activated T‐helper (Th) 1 cell effectors. Leflunomide exerts its anti‐inflammatory activities by preventing the generation of proinflammatory Th1 effectors and promoting Th2 cell differentiation.


The great concern about environment issues has stimulated the development of new mechanical drives concepts in machine and automotive systems, in search of better performance, functionality and efficiency. However, the identification of the applicability of a new concept involves the analysis and tests over physical models and prototypes. This work presents the concept of a new mechanical drive system, composed of bevel and face gears of involute profile teeth, with multi-step angular velocities ratios, for industrial and automotive purposes. There is an especial interest in the use of face gears in mechanical drives because of recent innovations in manufacture and computerized design processes, witch allowed to obtain high quality parts, with high mechanical strength and considerably lower costs as compared with bevel gears. To proceed with the synthesis and analysis process over this new mechanical drive concept, it was necessary to implement two mathematical models, converted into algorithms: i) kinematics of gear meshing, with the final purpose of obtain the gear tooth profile and an accurate solid model in a CAD software (it is important to emphasize that the tooth profile of a face gear, represented by the envelope generated by a succession of involute curves, does not presents the involute profile) and ii) teeth dimensioning, based on standards and in solid mechanics tools, to obtain the gears magnitude. This paper presents in details the first mathematical model, based on linear algebra and differential geometry. The coordinate transformation matrices are shown, as well as the meshing equation for the face and bevel bands of the proposed transmission. The implemented algorithm allowed to build an accurate solid model, in a CAD software, of the bevel and face gears adopted in the system. The mathematical model also permits to define in which cases is interesting to adopt a work band (corresponding to one of the angular velocities ratio) composed by conical teeth (contrary to face gear teeth). The solid models of the gears were used to CNC code generation and manufacturing process on a high speed machining center. In succession, all the subsystems of a prototype were designed and constructed. This prototype was built to validate the functional attribute of the drive system. The concept validation was based on the verification of the movements necessary to shift the ratio of velocities simultaneously to the gears rotation, without teeth collision. Some aspects related to the system operation are discussed, and positive points and constraints observed are explained.


A double quantum dot coupled to electrodes with spin-dependent splitting of chemical potentials (spin bias) is investigated theoretically by means of the nonequilibrium Kyldysh Green's function formalism. By applying a large spin bias, the quantum spin in a quantum dot (dot 1) can be manipulated in a fully electrical manner. To noninvasively monitor the manipulation of the quantum spin in dot 1, it is proposed that the second quantum dot (dot 2) is weakly coupled to dot 1. In the presence of the exchange interaction between the two dots, the polarized spin in dot 1 behaves like an effective magnetic field and weakly polarizes the spin in the nearby quantum dot 2. By applying a very small spin bias to dot 2, the spin-dependent transport through dot 2 can be probed, allowing the spin polarization in dot 1 to be identified nondestructively. These two steps form a complete scheme to manipulate a trapped spin while permitting this manipulation to be monitored in the double-dot system using pure electric approaches.


1Next generation wireless personal area networks (WPAN) are intended for a variety of applications. The Multiband OFDM Alliance (MBOA) is currently developing a new physical layer (PHY) and medium access control (MAC) protocol, which fit the needs of this mass market. The MBOA standards provide wireless technology offering data rates of up to 480 Mbit/s [1]. Motivated by the sub-band approach, this paper presents measurement analysis of the mean (excess) delay, RMS delay spread and number of significants paths for different locations. First, we present the channel measurements based in this study. Secondly, the interpretation of the obtained results show a correlation between the channel bandwidth and the tow main dispersion parameters namely τrms and τm in all tested settings, Laboratory, Corridor and Outdoor. Our measurement included terminal separations of 1 – 14 meters, the based data are for terminal separation 6 m.


Currently there are 34 universities in Ethiopia which enrolled hundreds of thousands of students which generated large volume of waste paper a year. Therefore, this article has an objective of assessing the socio-economic and environmental impacts of poor paper management at higher education institutions of Ethiopia with a particular focus on Hawassa University. The findings of the study revealed that a large volume of paper is consumed for different academic purposes. Due to the poor management of paper consumption as well as poor waste management practices, the university faced socio-economic and environmental problems. By 2015/16 academic year a total of 94,025 reams of paper were used at Hawassa University. This has created a large volume of waste paper at offices, which resulted in unpleasant working environment. Incineration is the only means of waste paper disposal, which created environmental pollution and health risks to the university community. Moreover, the university also lost a significant amount of money which would have been gained from selling to paper recycling industries.


The utility model relates to a multi-functional static fog gun for administering atmosphere pollution and raise dust is aimed at providing in the atomizer field. This a multi-functional static fog gun for administering atmosphere pollution and raise dust is including penetrating day with fog, motor A, liquid pump, electrostatic generator, automatic control device and water pipe, penetrating the day with fog and including fan, motor B, spout a section of thick bamboo and nozzle, the fan sets up in the rear end of spouting an inner chamber with the motor B who is used for driving fan work, and the nozzle setting is at the front end that spouts a section of thick bamboo, motor A and liquid pump link to each other, and the liquid pump is used for outside fluid passage water pipe pump sending to electrostatic generator, and the nozzle of penetrating the day with fog passes through the water pipe and links to each other with the electrostatic generator. The utility model discloses a with water smoke lotus electricity, can be better with the atmosphere in the pollutant combine to it pollutes to clear away the ambient atmosphere, and can adjust spraying angle, spraying orientation, have rotatory spraying function and excellent in use effect simultaneously.


ii TABLE OF CONTENTS v LIST OF TABLES vii LIST OF FIGURES ix ACKNOWLEDGEMENTS xi 1. GENERAL INTRODUCTION TO THE IDEAS AND THE STUDY SYSTEM . . 1 1.


Strength development and heat evolution at hydration are two of the most important properties when analysing concrete structures concerning young concrete. The present model for strength developmen ...


Production and control of electron cyclotron resonance (ECR) plasma for volume sources have been studied and preliminary results are presented. Effects of magnetic filter in ECR plasmas are discussed by comparing with ones in DC plasmas. Electron energy distribution in DC plasma is well controlled with the use of the magnetic filter. In ECR plasmas, however, electron cooling due to the magnetic filter in the extraction region is not so effective as ones in DC plasmas.


A promising application for high temperature polymer electrolyte fuel cells is the efficient electrical onboard power supply of commercial vehicles. By combining the fuel cell with a fuel processing system the same fuel as for the main engine can be used. In this case the fuel cell will be supplied with reformate gas consisting mainly of hydrogen, nitrogen, carbon dioxide, water and carbon monoxide. In such an environment the use of high temperature polymer electrolyte fuel cells is favorable because of their high tolerance to carbon monoxide. Under these conditions it is a challenge to optimize the operation of fuel cell stacks regarding power density, efficiency and longevity. The chosen approach is the combined analysis of the local and global operating characteristics of the fuel cells. By the combined analysis interrelationships are revealed, which would otherwise remain concealed. For local analysis the current density distribution across the active cell area was measured by introducing a tailor made measuring board into the stack assembly. With the developed method the influence of fuel composition, stoichiometry, flow and thermal management on the operating characteristics is evaluated. This covers the direct influence on power and efficiency as well as the influence on the development of power and efficiency over time. The latter is usually addressed as degradation of fuel cells. The improved understanding of reformate supplied high temperature polymer electrolyte fuel cell stacks leads to optimized operating strategies. One major conclusion is that the longevity of the fuel cell stacks can be increased by a homogenization of the current density distribution over the active cell area.


According to the correlation between language teaching and testing,language tests involve five basic types:proficiency test,aptitude test,achievement test,diagnostic test,placement test.If these five different kinds of language test can be used correctly,it can improve foreign language learning and ultimately attain a communicative goal.


Proverbs is one of the best examples of Pashto oral literature, which has given special beauty, richness and value to Pashto folk literature. Proverbs are the most precious, best and mature sayings of our forefathers, which have been passed down from mouth to mouth and come to date where the phrases are humorous, short and have a great purpose. The purpose of this study is to discuss the role and effectiveness of proverbs in resolving social conflicts and disputes in the society, how to find solutions to these conflicts on the strength of proverbs and put an end to them. In the present study descriptive and library methods were used. The finding of this research shows that proverbs play a crucial and unique role in resolving social conflicts, so that leaders and Jirgas can easily and simply convince both sides of the conflict, briefly provide a comprehensive concept and reconciliation between the two sides.


AbstractThe purpose of this work is to design a new layout for a quadrotor unmanned aerial vehicle (UAV) for experimental customized control-system validation. Geometrical and structural properties have been computed, and commercial off-the-shelf equipment has been selected. The flight control system, both hardware and software, has been custom developed; the same applies for the mathematical model describing the flight dynamics. Two proportional-derivative (PD) controllers have been designed and experimentally tested. A different control strategy with a state feedback controller has been implemented, assigning a robust eigenstructure and the desired dynamic specifications. An adaptive algorithm, which guarantees a uniformly bounded response for both the inputs and the outputs, has been presented. An L1 adaptive controller has been studied and implemented, including the state predictor and the adaptive and control laws. Tests with the PD controller have shown slowly stable response even in the event of nu...


A design of 12.4-24 R-1S puncture resistance agricultural tire was described.In structure design,the following parameters were taken:overall diameter 1 146 mm,cross sectional width 302 mm,width of running surface 290 mm,bead diameter at rim seat 613 mm,pattern depth 36 mm,pattern circular pitch 24,block/groove ratio 22.84%,with the design of one long and one short pattern block.In construction design,the following processes were taken:253# agricultural tire recipe for tread compound,2 layers 1400dtex/2V1 and 2 layers 1400dtex/2V2 nylon 66 cord for carcass ply,and tirecure using autoclave with the building drum diameter of 735 mm.The inflated overall dimensions and the physical properties of finished tire met the requirements of national standard.


Objective: To explore the clinical features and early diagnosis of pulmonary embolism (PE). Methods: Clinical symptoms, electrocardiogram, chest X ray/CT manifestations and pulmonary angiography's findings of 38 cases with PE were analyzed. Results: Main symptoms were as follows: chest pain in 33 cases, dyspnea in 37,cough in 15, haemoptysis in 9 , faint in 2,etc. 32 cases with hypoxemia and 15 cases showing carotid venous engorgement. Electrocardiogram in typical PE showed S\-ⅠQ\-ⅢT\-Ⅲ in 18 cases. Chest X ray showed local decrease of pulmonary markings in 31 cases, spiral CT is an alternative technique. Conclusions: The clinical features of PE are non specific, to be closely connected with the extent of embolism. In case of clinical suspicion of PE especially with risk factors, such as venous thrombosis, surgery, trauma, etc. the patient should be further examined to confirm the early diagnosis of PE in order to lower clinical fatality.


The Indian banking sector has witnessed a series of reforms since 1991 with the major objective to promote flexibility, operational autonomy and competition in the system and to raise the banking standards in India to the international best practices. There is a change in the importance of public sector banks because of the entry of foreign and private sector banks. In the recent past, the banking industry has succeeded to draw attention of investors by its steady performance and tremendous prospects to grow and to meet broad challenges like threats of risks from globalisation; implementation of Basel II; improvement of risk management systems; implementation of new accounting standards; enhancement of transparency and disclosures etc. The competitive pressures force banks to improve their efficiency scores, and mapping the progressive pathway is an education tool for investors. In this backdrop, this study evaluates the technical efficiency (TE) of public sector banks (PSBs) operating in India during the post reforms period from 1992-1993 to 2009-2010, using non-parametric linear programming-based technique data envelopment analysis (DEA). The results exhibit the positive impact and greater propel of reforms on 20 banks and seven showed an inverse trend.


Early modern European collectors proclaimed that their cabinets contained 'the world'. What do collections from the sixteenth and seventeenth centuries reveal about the ways in which those who assembled, owned and visited them understood objects from other regions and cultures? Inventories, catalogues and descriptions of European collections from the period reveal that the reception of non-European objects was characterized, above all, by practices of geographical and cultural indeterminacy, most notably: (1) empty attribution, (2) misattribution, (3) unstable attribution, and (4) lack of attribution. When considered as early versions of museums of 'world cultures', cabinets functioned not as sites for the production of knowledge but as sites of worldmaking, which absorbed, recontextualized and repurposed objects with specific geographical and cultural origins and meanings to create undifferentiated, fungible foreignness.


In Texas, three pharmacists are fired for refusing to fill a rape victim's prescription for emergency contraception because it "violated [their] morals."[1][1] A Wisconsin pharmacist refuses to fill, or transfer out, a similar prescription and is put on trial for violating the state's


Library Education in Brazil had gone through distinct historical periods til! the nineties when, reflecting a world context and based mainly on the work developed by FIO, it began to face a new reality: the need of a Modern Information Professional (MIP). A review of the literature of the area has been the starting point for a broad discussion involving aspects of the concept, features and functions of the MIP specially concerning Archivology, Librarinaship and Museology aiming at establishing purposes for the Information Professional formation in Brazil, both concerning graduation and continuing education.


Muscle glycogen at slaughter causes variation in pork technological qualities, since it affects the ultimate pH (24 h postmortem). This review addresses various factors influencing muscle glycogen storage and the ultimate pH of pig meat. Results discussed in this paper indicate that breed and preslaughter handling, i.e., waiting time in lairage, mixing, and to a lesser extent fasting, significantly influence ultimate pH. Furthermore, interactions between handling procedures and breed could be highly significant, as with PSE meat. Since the recent discovery of the major gene rn+/RN− which is assumed to influence glycogen concentration in the muscle of live pigs, genotype is considered an important source of variation in ultimate pH. All factors likely to influence glycogen concentration must be considered relative to the metabolic and contractile properties of muscle. These play an important role in the amount of glycogen at rest and in its depletion during chronic stress or muscular exercise.


An augmented reality-based simulation system for cooperative plant dismantling work has been developed and evaluated. In the system, behaviors of virtual objects such as the dismantling target, chain blocks, and trolleys are physically simulated. Their appearance is superimposed on camera images captured with cameras on users' tablet devices. The users can manipulate virtual objects cooperatively via touch operation. They can cut the dismantling targets, lift them on the trolleys using chain blocks, and convey them through narrow passages to ascertain whether the dismantling targets can be conducted without colliding with the passages. During the simulation, collisions between the virtual objects and real work environment are detected based on their three-dimensional shape data measured in advance. The collided parts are visualized using augmented reality superimposition. Four evaluators assessed the simulation system. Results show that the simulation system can be useful for prior examination of dismantling works, but some points were also found to need improvement. Corresponding author, E-mail: firstname.lastname@example.com Present address: Panasonic Corp. Eco Solutions Company, 1048, Kadoma, Osaka 571-8686, Japan Present address: NTN Corp., 1-3-17 Kyomachibori, Nishi-ku, Osaka 550-0003, Japan


As a result of an extensive research, different models of review and follow-up/monitoring of transport demand and freight flows have been obtained. Transport demand is either related either to the origin or destination while freight flows may be incoming and outgoing (inward and outward-bound) in (to) a given location or facility, as for instance a container terminal. Furthermore, simulation and mathematical models of monitoring and review of distribution channels and transport flows optimization have been dealt with in this paper.


In November and December of 1995 primus Theatre performed Alkoremmi, The Night Room and Far Away Home in St John's. The singular quality of their work attracted a great deal of attention, and audiences were impressed and intrigued by the performances. On 27-29 November primus conducted two series of workshops which were attended by some 15 local theatre practitioners. The workshops ran in two series—mornings for two hours and afternoons for four—and each series could be taken as an independent entity or in combination. The morning workshops, consisting of video presentations, group discussions, and presentations by the primus actors, were geared toward participants interested in the creation and organization of original, alternative, artist-based performance. The afternoon workshops introduced the participants to the physical and vocal exercises which primus uses in their development of characters and performance material. According to Ker Wells of primus , who undertook to read a draft of this article,


Background & Objectives: Probiotics are living microorganisms which when administrated adequately, confer benefits to hosts. In order to estimate the probiotic potential of these microorganisms, it is necessary to assess their health benefits, efficacy, and safety. This study was aimed to evaluate gut adhesion capacity of Lysinibacillus sphaericus DY13 and Bacillus clausii DY14 strains which were previously isolated from healthy human milk, and to assess the effects of natural and commercial prebiotics on bacteriocin production by these two strains. Material & Methods: L. sphaericus DY13 and B. clausii DY14 isolates were evaluated for tolerating the artificial gastrointestinal conditions. Moreover, isolates were examined for auto-aggregation, co-aggregation, and cell surface hydrophobicity properties. The prebiotic effect of mannitol, sorbitol, garlic, onion and honey on the enhancement of bacteriocin production against Escherichia coli, Bacillus cereus, Bacillus subtilis, Pseudomonas aeruginosa and Staphylococcus aureus was also evaluated. Results: Compared to the control, auto-aggregation potential of DY13 and DY14 was found to be decreased by 4%. Both isolates have demonstrated preeminent auto-aggregation potential. The hydrophobicity percentage of DY13 and DY14 isolates typically ranged between 51-52.7% and 59.1-66.1%, respectively. Comparing the effect of selected prebiotics on bacterial isolates growth and bacteriocin production revealed that honey is the best source to improve the growth of bacterial strain, and also to stimulate bacteriocin production. Conclusion: Due to considerable adhesion potential of both selected strains, they can be applied as suitable and efficient probiotics, along with honey as prebiotic.


The reaction of potato clones of Solanum acaule , S. bulbocastanum , S. canasense , S. cardiophyllum , S. chacoense , S. commersonii , S. etuberosum , S. fendleri , S. tarijense , S. tuberosum and S. tuberosum × S. phureja to Italian populations of Meloidogyne arenaria , M. hapla, M. incognita and M. javanica was evaluated in a glasshouse. Five seedlings of each clone were transplanted into trays filled with steam sterilized sandy soil and inoculated with 10,000 eggs of each nematode species per plant. One clone each of S. chacoense and S. tuberosum were resistant to all Meloidogyne spp. tested. One clone each of S. commersonii , S. tarijense and S. tuberosum were resistant only to M. javanica . The remaining clones were susceptible to all four species of root knot nematodes. The potential of resistant genotypes in potato breeding is discussed.


Electrical conductivity measurements on a 2D packing of metallic beads have been performed to study internal rearrangements in weakly perturbed granular materials. Small thermal perturbations lead to large non-Gaussian conductance fluctuations. These fluctuations are found to be intermittent in time, with peaks gathered in bursts. The distribution of the waiting time Δt between two peaks is found to be a power law Δt−(1 + αt) inside bursts. The exponent αt is independent of the bead network, the intensity of perturbation and external stress. These bursts are interpreted as the signature of individual bead creep rather than collective vault reorganisations. We propose a simple model giving αt = 1 − ζ, where ζ is the roughness exponent of the surface of the beads.


Abstract Cross-stratification is a common sedimentary structure in alluvial deposits and can often be recognized in core. The quantitative study of cross-strata can potentially yield information concerning the behaviour of alluvial systems through time. Such information is valuable to a reservoir geologist when assessing the architecture of an alluvial reservoir. Several alluvial systems in the Munster Basin (Devonian), southwest Ireland, display the characteristics of terminal fans generated in a 'hydrographically-closed' basin. Analysis of three formations reveals cyclical variations ('megacycles') in the dimensions of cosets and sets within channel sandbodies. The 'megacycles' are 100–200 m thick and record increases and subsequent decreases in the dimensions of sedimentary structures. The megacycles are also reflected by the density of channel deposits such that high densities are associated with relatively large channels and low densities are associated with relatively small channels. Cyclicity is also locally developed in the flood-plain deposits as alternations of red beds with calcretes (oxidizing conditions) and green/grey beds with pyrite nodules (reducing conditions). Established relationships between dune size and flow depth suggest that cyclical variations in the size of sedimentary structures reflect discharge fluctuations. This is supported by the close correlation between set thickness and coset thickness, the latter being closely related to sandbody thickness. The cyclical variations in channel sandbody density and flood-plain conditions are also thought to reflect discharge variation. Available biostratigraphic data and radiometric dates suggest that the cycles represent periods of several hundred thousand years. The periodicity and regularity of the cycles together with their relationship to discharge variation suggests that they may be related to astronomical forcing of the Earth's climate.


According to disadvantages of monitor style heat catalytic element's low precision,narrow monitor range,and fatal mistake information to monitor high-concentration methane gas(CH4),we use infrared methane sensor to collect CH4 gas concentration signal.After magnifying,sampling,holding,and A/D transferring,which is processed by SCM.AT89C51 controls area aeration equipment to work or not,assures CH4 concentration for coalmine is under regulation,and avoid accident occurrence.AT89C51 connects up each other based on CAN bus,and PC links with CAN bus through CAN bus interface,which detecting in real-time,data analyzing and processing is carried out.This paper describes system hardware and parts of software flow in design.From experiments,system communication is right,monitoring error is less than 0.2%,linearity character is good,stabilization time is short and excursion error is little under room temperature.


The design, operation, and uses of major types of field-erected incinerators for the disposal of industrial wastes are discussed. The incorporation in incinerators of steam recovery boilers for heat or power generation is described. (LCL)


To compare the response rates of three storage process pagination algorithms.Using the WAST1.1 test tool,testing each algorithm with five levels′records,and taking down the Total Time to First Byte(TTFB) of first page and the last page in the records which meet the query criteria.In small data sets,there is slight difference between TTFB of the first page and the last page.In large amount data,the difference of the TTFB between the first page and the last page in algorithms I and algorithms II is big,but there is hardly any difference in algorithm III.In mass data,the algorithm III is the most efficient pagination one in the three algorithms.


In this paper, the authors outline preliminary results on the introduction of entrepreneurs and innovators in classrooms, demonstrating the positive impact on both teaching kids STEM, as well as influencing certain demographics to aspire to STEM-related careers. The authors hypothesize that connecting students to STEM in elementary school, primarily through the introduction to STEM-based entrepreneurs and innovators, will ultimately result in a more STEM-inspired and STEM-literate workforce. If this model is followed collectively by educators, business, and government alike, the authors believe that significant progress can be made in mitigating the loss of students interested in STEM during middle school.


In the silkworm, Bombyx mori L., interference occurs between the two types of cytoplasmic-polyhedrosis viruses which produce icosahedron and hexahedron polyhedra, hexagonal and tetragonal in outline, respectively (ARUGA et al., 1961 ; 1963). The administration per os of small amounts of cytoplasmicpolyhedrosis viruses and of inactivated polyhedrosis viruses partly prevents the occurrence of cytoplasmic


This is a user's guide to the Virginia Tech online repository, VTechWorks. Virginia Tech's faculty reporting system (sometimes called EFARs)


The influence of combined forced and free convection on the surface reaction of a laminarly flowing species in a rectangular channel is studied. The free convective motion, which is superimposed upon the main axial flow, arises from a transverse density gradient produced by the release of a reaction product, or heat, at the channel wall. A numerical stream function-vorticity method is employed to solve the three-dimensional conservation equations in the case of large Schmidt number. Effects of aspect ratio, diffusivity ratio, surface reaction rate, and Rayleigh number upon the overall reactant conversion rate and local Sherwood number are examined. Reasonable agreement is obtained with experimental data for a hydrochloric acid-calcium carbonate surface reaction.


To assess the tissue iron concentration of the left ventricle (LV) using a multislice, multiecho T2* MR technique and a segmental analysis.


In order to more rapidly and effectively obtain the geospatial location and quantitative distribution of the trapped people who are under the ruins or besieged by special serious natural disasters, such as earthquake, flood and landslide, a kind of natural disaster emergency rescue system based on the mobile phone's high-precision positioning of the trapped people is put forward. Being integrated with the mobile phone positioning, mobile cellular communication, BeiDou satellite positioning and short message communication and 3D geographic scene technologies, this system can apply to the condition of the ground communication interruption and monitor the positions of trapped people and the rescue process in time. And it is by the three-level administrative application platforms that are respectively deployed on the ministry-level, the province-level and the disaster site that the on-site emergency rescue information collaboration is achieved so as to be helpful to improve the ability of the serious natural disaster emergency rescue and relief decision support.


Patellar tendon ruptures after anterior cruciate ligament (ACL) surgery can become a potentially serious postoperative complication if handled incorrectly. Proper surgical and rehabilitation must be undertaken to ensure that the overall results of both the initial ACL reconstruction and subsequent tendon rupture are satisfactory. If properly managed, postoperative patellar tendon rupture can be treated and the overall outcome of the ACL surgery is not affected. In our experience of 5,000 ACL reconstructions, a total of 11 patellar tendon ruptures have occurred with 6 occurring after an ipsilateral ACL reconstruction and 5 occurring after a contralateral ACL reconstruction. All patellar tendons were repaired using suture anchors and augmented with a Dall-Miles cable. Follow-up at an average of 3.1 years postoperatively shows that patients regained full knee hyperextension with 141° of flexion on the involved side with average of 143° on the uninvolved knee. Average return of strength was 94% measured with isokinetic testing. Single leg hop scores averaged 96% compared with opposite noninvolved knee. In this article, we discuss the surgical technique, rehabilitation, and results of our experience treating this potentially difficult postoperative complication after ACL reconstruction.


After the enlargement, the college material resources are comparatively short, the overall physique declines.Therefore, the sport teaching should outgrow the traditional teaching mold and perceive the sport teaching tendency of the world, reform the teaching object, content, form and method.The detailed countermeasures are: renew the teaching ways and guidelines, train the teachers, hire retired teachers and lengthen teaching time.


Mathematical modeling of the estimation of the long–term noise indicators on the basis of random "momentary" environment control investigations, is presented in the paper. An attention was directed towards deficiencies of the obligatory estimation procedures of their representation, which is given by assessments of the average of the random test and the standard deviation value of the environment test results. Possible ways of looking for the problem solution were discussed. The proposed method of modeling the results of a random, "momentary", test of control investigations, leading to the determination of the expected values of the long–term noise indicators and to the assessment of their uncertainty, was described. The selection and realization of the proposed solution was related to the theory and methods of analysis of time series. Investigations, analyses and verifying procedures accompanying the proposed mathematical formalization, were given. Exemplifying contents of the presented paper were related to the assessment of the traffic noise at one of the main arteries of Krakow. They are considered in a context of the practice of the "momentary" measurements and the estimation of the long-term noise indicators performed on their basis.


(0) The Rebound Phenomenon.~Several 'years lligo in a paper writt~nin \ collaboration, Dr, Grainger Stewartand I pointed out a sign of cerebellar involvement that is of considerable importance in" the interpretation of the disturbances of voluntary movement produced by this condition. The patient's elbows are supported on a bed or table _and he is asked to pull each hand in succession' towards his mouth against resistance offered by the observer wh~ grasps his wrists; . when this J;'esistance is suddenly released the hand of the affected side flies to his mouth or shoulder, often with considerable violence, but the movement of the normal limb "is arrested almost immediately by a contractio:p. of the antagonists (triceps), and may even lie jerked back or rebound: The rebound is excessive in _ spastic 1imbs~ / The absence of this rebound may he demonstrated in' various other , ' actions" as extension of the elbow, elevation or. depression of the -arm at the shoulder, flexion or ext~nsion of the hip and extepsion of the knee. It occurs only on the samt=; side as the lesion when this is unilateral, but it is seen on both sides when the wound is bilateral. Iti~ on)y necessary to resist any movemen1Y which the patient attempts to perform and remoye the resistance sudderlly; then the limb' or the segment of the limb which he wishes to move swings unchecked or excessively in the


The objectives of this study are (1) examine about the preparation of Javanese Gamelan Music curriculum; (2) to describe the implementation of Javanese Gamelan Music learning; and (3) examine about the evaluation of Javanese Gamelan Music curriculum at SDN Wonosidi II Tulakan Pacitan. This research is basically a qualitative research with ethnography research design. This study was conducted at SDN Wonosidi II Tulakan Pacitan with the informant consisted of the principal, teacher and students of SDN Wonosidi II Tulakan Pacitan. For data collection method, it used interview, observation and documentation. Data analysis was started from data reduction, data display and drawing conclusion or verification. Data validity used credibility, transferability, confirmability, and dependability. The results of the research show that: (1) preparation of Education Unit Level Curriculum of Javanese Gamelan Music was a collaboration of several parties consisting of the principal, teachers, committee, and stakeholder of SDN Wonosidi II Tulakan Pacitan. The Annual Program created bytecher of local subject Javanese Musical art. The total amount of time allocated was 84 hours of class IV and V, and 86 hours of class VI. Semester Program derived from the anual program. In the syllabus ; Standards of competency, Basic competence , materials, learning activities, indicators, assessment tools, time allocation, and learning resources. Lesson plan drawn up by the teacher includes 9 components and requested approval of the principal. Minimum Kompetenees Creteria estabilished in accordance with the guidelines issued by the National Education Standards . Minimum Kompetenees Creteria score for grade 4 was 65, while grade 5 and 6 was 70. (2) Implementation of Javanese Gamelan Music was started by a greeting from teacher, a motivation and apperception. The instructional methods used included: (a) expository method (explaining), (b) Question and Answer, (c) demonstration, and (d) direct practice. Instructional instrument used was a set of gamelan Slendro and Pelog. (3) Evaluation of Javanese Gamelan Curriculum was ever done at SDN Wonosidi II Tulakan Pacitan. This evaluation aimed at evaluating the extent to which learning programs have been realized. It was done in a micro evaluation. Evaluation model used was the CIPP evaluation model.


The gas phase electron paramagnetic resonance spectrum of vibrationally excited molecular O2 has been obtained using a discharge sampling technique. Measurements of line intensities indicate vibrational temperatures up to 600°K with maintenance of a translational‐rotational equilibrium temperature of 300°K. Analysis of the O2 spectrum allows a determination of the vibrational variation of the ``spin‐spin'' parameter, λv, and the ``spin‐rotation'' parameter, γv. Combination of these values with previous microwave results for the v=0 state of O2 gives much improved values for these parameters at the equilibrium inter‐nuclear distance of O2. Further analysis of these results gives values for the first and second derivatives of the parameters with respect to internuclear distance.


After an investigation to the status of shipbuilding production plan management in China,it points out major problems To meet challenges in the shipbuilding production plan management,the paper proposes a production plan management system based on WBS(work breakdown structure),and explains its planning principle,functions and advantages.The proposed system can facilitate the production planning,balance various resources,and give visual views through dashboards.Case studies show that the system has improved the management level and efficiency of shipbuilding production significantly.


This study explores how carers and older people with dementia utilise community care at home. To achieve this, this study interviewed 14 family carers in Edinburgh city in Scoltand. This study provides the accessibility of services information and process of services delivery is discussed. It also investigates what services are involved in the lives of carers and older people with dementia, how the services affect their lives in reality. In fact, Scottish older people with dementia have regular visits from district nurses after a diagnosis of dementia. They get packages of care services like free personal care at home and daycare. It finds the influence of social policy upon on lives of carers and older people with dementia in Scotland. This study shows that packages of free personal care services affect the quality of lives of the older people with dementia and their carers.


This paper addresses the challenge of designing spoken dialogues that are of educational benefit within the context of an intelligent tutoring system, yet predictable enough to facilitate automatic speech recognition and subsequent processing. We introduce a design principle to meet this goal: construct short dialogues in which the desired student utterances are external evidence of performance or learning in the domain, and in which those target utterances can be expressed as a well-defined set. The key to this principle is to teach the human learner a process that maps inputs to responses. Pilot results in two domains – self-generated questions and morphology exercises – indicate that the approach is promising in terms of its habitability and the predictability of the utterances elicited. We describe the results and sketch a brief taxonomy classifying the elicited utterances according to whether they evidence student performance or learning, whether they are amenable to automatic processing, and whether they support or call into question the hypothesis that such dialogues can elicit spoken utterances that are both educational and predictable.


Abstract. To determine the effects of low‐input agriculture on soil properties, we compared several forms of arable land management in a rotation experiment lasting 8 years on a Cambisol in Lithuania. Conventional arable cropping with applications of inorganic fertilizers increased the potassium (K) status of the soil, but resulted in losses of nitrogen (N) from the soil by mineralization and leaching. With ley–arable integrated cropping, a similar fertilizer regime based on farmyard manure (FYM) augmented with inorganic fertilizers increased the phosphorus (P), K, organic matter and N in the soil, as well as increasing N loss by leaching. These two high‐input regimes were compared to three systems with less or no input. A reference treatment with no input, which produced small crop yields, maintained its nutrient status and organic matter. An organic regime receiving FYM and green manure lost only P, but maintained its K and N status, while a second organic regime in which the FYM was replaced by composted sewage maintained its fertility. The microbial activity varied somewhat from treatment to treatment, with the largest numbers of almost all groups of microorganisms in the reference treatment. All treatments led to decreases in fulvic acid, and the soil managed conventionally lost humic acid, too. The content of humic acid increased in the treatments where FYM was applied and in the reference soil, and the fraction bound to calcium increased in the integrated and the first organic treatments. The soil structures under the integrated cropping and second organic regime were the most stable. Of the low‐input systems, the second organic regime seemed the most sustainable.


Gender diversity and issues facing transgender people are poorly covered in the medical curriculum, yet these will be some of the most vulnerable patients that we work with, facing higher rates of mental health issues, violence, stigma and discrimination. Unfortunately, the continuing global pandemic and associated Government response have only served to further entrench the discrimination and inequalities faced by trans people in the UK, particularly trans people of colour, those with disabilities and trans young people. This paper seeks to provide an overview of who trans people are in the UK and to outline key issues facing this community. It will consider in further details the context of transphobia in the UK, including the Government's failure to meaningfully reform the Gender Recognition Act, and the specific challenges facing trans young people in accessing healthcare. It argues we need to take a human-rights approach to trans issues and move away from a medical model which seeks to define gender diversity as pathology. Only if we better understand our trans patients can we both better meet their health needs and help to challenge entrenched structures of discrimination.


A Concrete Pavement Evaluation System (COPES) has been developed for direct use or as a guide for the creation of similar systems tailored to the specific needs of users. COPES provides a framework and procedures for collecting historical and field data on the characteristics and performance of in-service portland cement concrete pavements. As part of the research study, data were collected in six states using COPES. These data were subsequently analyzed to demonstrate the potential applications for such data analyses in examining the design, construction, maintenance, and rehabilitation of concrete pavements. The report will be of interest to engineers and researchers concerned with the performance and the evaluation of concrete pavements. COPES procedures and data items should also be of direct benefit to those involved in the development or execution of pavement management systems. Data collected during the study are available on request. (Author)


Several models of new physics beyond the Standard Model predict the existence of neutral particles that decay to pairs of leptons. These particles can also be long-lived with decay length comparable to, or even larger than, the LHC detectors dimensions. The triggering and the standalone tracking capabilities of the ATLAS muon spectrometer have been exploited to search for neutral long-lived particles decaying to pairs of muons in LHC Run-2 13 TeV data and set exclusion limits on their mass and lifetime. The enormous amount of data that will be collected by ATLAS during the Run-3 (300 fb−1) and High-Luminosity (3000 fb−1) 14 TeV LHC phase, and the updated ATLAS detector setup, will offer a unique opportunity to probe unexplored regions of phase space in the context of such searches. This note presents sensitivity prospects for Run-3 and High Luminosity LHC discussed in the context of a Hidden Sector model predicting the decay of the Higgs boson to two neutral long-lived particles subsequently decaying into a pair of displaced muons. Two new muon trigger algorithms are studied to improve the selection efficiency of displaced muon pairs.


UNLABELLED
We present and review coupled two-way clustering, a method designed to mine gene expression data. The method identifies submatrices of the total expression matrix, whose clustering analysis reveals partitions of samples (and genes) into biologically relevant classes. We demonstrate, on data from colon and breast cancer, that we are able to identify partitions that elude standard clustering analysis.

AVAILABILITY
Free, at http://ctwc.weizmann.ac.il..

SUPPLEMENTARY INFORMATION
http://www.weizmann.ac.il/physics/complex/compphys/bioinfo2/


Most of HEV are built using existing engines. These engines have been developed for conventional car and are not especially tailored for HEV. The objectives of this work are to establish general requirements placed on an ICE for a HEV application, to draw the main characteristics of the engine and to find the best configuration of twin-cylinder ICE to motorize an HEV. The twin-cylinder engine offer interesting perspectives in the field of HEV thanks to its small size, low weight and low cost.


We describe an autosomal‐dominant locus for Restless Legs Syndrome (RLS) in a French‐Canadian (FC) pedigree. Genome‐wide microsatellite scan and linkage analysis were used in this study. The locus maps to chromosome 16p12.1 and spans 1.18 Mega bases. The maximum multipoint LOD scores are of 3.5 over the total of 10 markers. Evidence for the same locus was also found in a smaller FC pedigree sime095. The analysis of the sequence of 8 annotated genes within the region did not reveal any pathogenic mutations. Copy number variation and karyotype analyses did not reveal any chromosomal abnormality in the region. Further analyses of the region are necessary to find the genetic cause of RLS in this family. © 2008 Movement Disorder Society


Through collecting stems,leaves,fruits and root soils of wheat in Hetao area,this paper analyzes the pollution conditions of heavy metals in wheat fruits and root soil.The heavy metal content of wheat is ranked in the order of root soilstemfruit.The absorptive capacity of heavy metal of wheat is ranked in the order of ZnCuCrNiCdPb.On the whole,the soil of Hetao area is green food base,suitable for developing pollution-free food of AA grade.But there exists Pb pollution in individual fruits of wheat in Hetao area,so this problem of excessive Pb needs to be further researched and paid more attention to.


Combining with the development items of state "863" high technology and taking the open up of NC rotary table based on spherical parallel mechanism as the target,this paper established the highly effective forward solution model of kinematics and presented the explicit analytic expression thus provided theoretic basis for the development of NC system.


A parallel navigation computation algorithm with a single update frequency was proposed and analyzed to increase the navigation computation updating rate in high dynamic conditions.The parallel algorithm includes 4 parallel computation modules: the parallel attitude computation module,the parallel velocity computation module,the parallel position computation module,and the parallel parameter computation module.The computation speed analysis shows that the total implement periods of the parallel algorithm are about 6% of conventional algorithms.The results of FPGA-based experiment show that the design significantly increases the updating rate of the navigation computation,thus greatly benefiting the navigation accuracy in high dynamic conditions.


This manuscript summarizes a presentation to the ESRD State of the Art conference held in Boston, April 23 to 26, 2009. The steering committee asked me to summarize the development and use of the clinical data system of National Medical Care (NMC), the Patient Statistical Profile (PSP), which is now Fresenius Medical Care's Knowledge Center (KC). The committee also asked me, as former Principal Investigator for the National Cooperative Dialysis Study (NCDS), to comment on how dialysis dosing methods have evolved and how PSP/KC was used to evaluate them.

I will first describe PSP/KC, focusing on its intended use to support care in a network of dialysis units. I will then discuss dialysis dose measures, illustrating how data systems can be used to evaluate evolving concepts and technologies.

### The Early Roots

NMC began distributing analyses of laboratory data to affiliated physicians in 1979, consistent with its company/physician network culture (1); some reports were shared publicly (2). Patient survival and demographic data were then added. Estimating survival was key to clinical and business imperatives (3).

An early project showed lower death risk with higher albumin and creatinine concentrations (4). U-shaped risk profiles for urea, cholesterol, phosphorus, and potassium were observed. Longer treatment time was associated with better survival. Statistical risk scores for facilities were constructed and were well associated with facility death rates (4).

Those observations informed a continuous quality improvement initiative patterned after Deming (5,6) and supported by clinical data. Its philosophy, design, and implementation are described elsewhere (7,8).

### Initial Efforts

The idea was to prioritize measures contributing most to mortality to assist physicians with their own clinical decisions. The first such report, using 1991 data, was sent to facilities and published (9).

Figure 1 is a prioritization curve that focused attention on important measures. The sequence …