Clostridium difficile, a Gram-positive spore-forming bacterium, is a source of considerable morbidity
and mortality for patients treated in hospitals and other healthcare settings. Intestinal colonisation by C.
difficile can cause infection (CDI) if the normal flora is disrupted, e.g. by the use of antimicrobials and
some other drugs. Vaccines targeting C difficile main virulence factors, toxins A and B are currently
undergoing clinical trials, however, their potential population impact is largely unknown. The work
presented in this thesis aims to quantify the effectiveness of C. difficile vaccination in preventing hospitalonset
CDI, including both its direct effects (reduction in individual patient morbidity and mortality) and
indirect effects (prevention of onward transmission of the bacteria) using a mathematical dynamic
transmission model framework.
Based on a systematic literature review, it was shown that mathematical dynamic-transmission models
have become an increasingly popular tool to help understand the patient-to-patient spread of nosocomial
pathogens and predict the impact of healthcare prevention and control strategies. Methods have generally
improved, with an increased use of stochastic models, and more advanced methods for formal model
fitting and sensitivity analyses. Nonetheless, in contrast to methicillin-resistant Staphylococcus aureus –
another bacterium commonly found in the healthcare setting – the transmission of C. difficile has rarely
been considered within a dynamic modelling framework.
Using national English CDI hospital surveillance data to fit a generalised additive mixed-effects
model, this thesis revealed that, in line with recent evidence based on highly discriminatory genetic typingmethods,
whilst transmission between symptomatic carriers was significant, this did not account for the
majority of CDI cases in English hospitals. Asymptomatic carriers have been suggested as cocontributors,
but their role in transmission remains uncertain to date.
Previous estimates of additional excess bed days attributable to healthcare-acquired-CDI have varied
widely, partly due to methodological weaknesses, and no robust estimates from a European setting are
available. Both form key determinants to help quantify the health and economic burden of CDI, and are
also likely to have an impact on the transmission-dynamics of the infection. Therefore, this thesis
quantified the hospital burden of CDI, expressed in excess length of stay and mortality. A Cox
proportional hazard model revealed that CDI was associated with a significantly decreased daily risk of
discharge and increased risk of mortality, where the former was even further reduced for severe CDI
patients. Using a multi-state model more intuitive estimates, i.e. the excess length of stay associated with
mild (5 days [1.1-9.5]) and severe CDI (11.6 days [95% CI = 3.6-19.6]) were obtained.
Finally, the results of an individual-based "state-of-the-art" dynamic transmission model in an
English ICU (with epidemiological parameters informed by the findings of the statistical models
mentioned, and with data-driven patient movement between the community, LTCF and ICU) showed
that in settings with in-hospital acquisition rates comparable to the national average in English ICUs,
immunising three patient groups: LTCF residents, elective patients and patients with a history of CDI in
the ICU, resulted in a 43%, reduction of ICU-onset CDI. This required a relatively high number of
vaccine doses, and a targeted strategy involving patients at high risk of colonisation on admission, such as
LTCF residents proved more efficient. As these results proved highly sensitive to the level of
antimicrobial use and in-ward acquisition rates, it was concluded that vaccination might be most efficient
when targeting patient risk groups or settings where implementation of antimicrobial stewardship proves
challenging.


Water is a valuable resource needing conservation. Excessive water pressure in water distribution systems causes leakages leading to substantial losses of treated water. It also places additional strain on networks reducing their efficiency and increasing annual maintenance costs. Conversely, too low a water pressure can be an inconvenient annoyance to the user and, more importantly, mean inadequate conditions to meet fire fighting requirements. The North Shore City Council (NSCC) in Auckland, is not free from the aforementioned pressure-related problems. Water is a valuable resource needing conservation. Excessive water pressure in water distribution systems causes leakages leading to substantial losses of treated water. It also places additional strain on networks reducing their efficiency and increasing annual maintenance costs. Conversely, too low a water pressure can be an inconvenient annoyance to the user and, more importantly, mean inadequate conditions to meet fire fighting requirements. The North Shore City Council (NSCC) in Auckland, is not free from the aforementioned pressure-related problems. This paper summarises the outcome of a study undertaken, using GIS technology, to identify areas with potential pressure problems and suggest options for consideration to resolve pressure issues with the intension of (a) reducing water losses, (b) providing customer satisfaction, (c) ensuring fire-fighting readiness, and (d) making long term savings by strategic capital investment in the water supply network of the NSCC. First, the clusters of properties with potential pressure problems were identified. A sensitivity analysis was carried out to determine the optimum pressure for the key zones to minimise the number of properties affected by either low or high pressure issues. Then, the optimum pressure for each user was determined while ensuring (a) a minimum supply head of 30m for each property, (b) a maximum static head of 90m, (b) no property experiences a reduction in pressure exceeding 30m as a result of the implementation of the remedial measures suggested, and (c) a minimum residual pressure of 10m at fire hydrants during fire-fighting. Finally, a range of suggestions ranging from pressure zone boundary adjustments to sample designs that can eventually lead to potential capital expenditure are made. This paper summarises the outcome of a study undertaken, using GIS technology, to identify areas with potential pressure problems and suggest options for consideration to resolve pressure issues with the intension of (a) reducing water losses, (b) providing customer satisfaction, (c) ensuring fire-fighting readiness, and (d) making long term savings by strategic capital investment in the water supply network of the NSCC. First, the clusters of properties with potential pressure problems were identified. A sensitivity analysis was carried out to determine the optimum pressure for the key zones to minimise the number of properties affected by either low or high pressure issues. Then, the optimum pressure for each user was determined while ensuring (a) a minimum supply head of 30m for each property, (b) a maximum static head of 90m, (b) no property experiences a reduction in pressure exceeding 30m as a result of the implementation of the remedial measures suggested, and (c) a minimum residual pressure of 10m at fire hydrants during fire-fighting. Finally, a range of suggestions ranging from pressure zone boundary adjustments to sample designs that can eventually lead to potential capital expenditure are made.


This article investigates whether differences in information-based trading can explain observed differences in spreads for active and infrequently traded stocks. Using a new empirical technique, we estimate the risk of information-based trading for a sample of New York Stock Exchange (NYSE) listed stocks. The authors use the information in trade data to determine how frequently new information occurs, the composition of trading when it does, and the depth of the market for different volume-decile stocks. Their most important empirical result is that the probability of information-based trading is lower for high volume stocks. Using regressions, we provide evidence of the economic importance of information-based trading on spreads. Coauthors are Nicholas M. Kiefer, Maureen O'Hara, and Joseph B. Paperman. Copyright 1996 by American Finance Association.


Among the roughly 150 Italian songbooks published between 1610 and 1665 with the guitar tablature known as alfabeto , about thirteen are anthologies. These anthologies often advertise the role of a compiler who has gathered together music by diverse authors. The extent to which compilers also functioned as authors and editors is not well understood. This essay considers the case of Giovanni Stefani, a compiler who, in the preface to his Scherzi amorosi of 1622, describes the anthology as a collection of his choosing that contains "varie compositioni de Virtuosi della prima classe" (various compositions of first-class virtuosos). Intriguingly, none of the settings Stefani prints (in both this alfabeto anthology and two others) include attributions. Since the 1880s, scholars have been preoccupied with matters of transmission and attribution, unearthing a network of textual and musical concordances. This article expands the nexus of Stefani's songs and their concordant sources, revealing an array of examples that range from identical copies to "partial" concordances that take over motives, phrases, refrains, or harmonic schemes. These examples indicate that in preparing his anthologies, Stefani mined a corpus of existing prints and manuscripts while also relying heavily on oral transmission. The complex nature of Stefani's approach, taken together with his complete avoidance of composer attributions, points toward an editorial process shaped by a fluid exchange between oral and written musical practices.


We demonstrate the control of the spatiotemporal emission dynamics of a broad-area semiconductor laser in an external optical feedback configuration formed by a spatially filtering mirror. The emission properties are studied with a single-shot streak camera with temporal resolution of approximately 7 ps and spatial resolution of approximately 5 microm. Our results show a significant reduction of the spatial filamentation and, furthermore, suppression of the spatiotemporal instabilities, which are both intrinsic emission properties of standard high-power broad-area lasers. Associated with the control of the emission dynamics, strong improvement of the beam quality, which is essential for numerous high-power applications, is possible.


In this report decommissioning of offshore petroleum platforms have been investigated. It treats decommissioning in general, the process of a typical project. A variety of suitable lifting vessels have been presented, and some concepts of removal have been evaluated. Decommissioning is important to go through with because of the environment and the use of the area after the petroleum activities ceases. Other ocean users benefit from the decommissioning because the area can be utilized when it is opened for ordinary traffic. The environment will benefit from the cessation of production because of fewer spills to sea or risk of it and being restored to a state as close to possible to original. Sometimes it is found acceptable to leave facilities behind, partially or wholly, and the marine life in the area can actually benefit from this in some cases. A decommissioning project consists of the elements planning and approval, topside and jacket preparatory work, topside removal, jacket removal, transport, and onshore dismantling and recycling. There are two main concepts of removal, reverse installation and single lift. The elements of the project are the same whichever of the concepts are used. The vessels to be used need large lifting capacities in either concept. Especially designs that lift topsides and jacket in single lifts can improve the efficiency in the projects. Several lifting vessels have been presented and a few concepts were reviewed regarding future requirements. The concepts were platform removal using only a traditional HLV, topside removal using HLV and jacket removal using buoyancy tanks, and removal using the new lifting vessel design Pieter Schelte. It is found that all the concepts can remove fixed platforms, but Pieter Schelte was especially well-suited. When Pieter Schelte is used, personnel will be exposed to less risk because more work is done onshore. Onshore work is in general more inexpensive, faster, cleaner, and safer. This gives a better HSE profile to the project as well as being more cost-efficient. On the downside, the vessel is not available before 2013. In the meantime the alternative with the HLV and buoyancy tanks can gain some more experience. This alternative scored the same as removal with reverse installation and is therefore not so successful in this comparison. There are however uncertainties involved and the solution with the buoyancy tanks are still interesting. The challenges in decommissioning are to make it less expensive, less time-consuming, and safer than today as well as keeping the environmental issues satisfactory. This can probably be reached by making the process more standardised to some extent, making use of new technologies like new vessels, doing less work at the offshore site, carrying out less lifts offshore, and do a lot of the dismantling work onshore. Pieter Schelte can to a great extent be the solution to these challenges.


Abstract Calcification in necrosis has long been known. Of the tissue components, the cells are most vulnerable. Nevertheless, little attention has been paid to the role of cell death in calcification. This review attempts to update the mechanism of calcification with an emphasis on the role of apoptosis in calcification. A brief review on the basic sciences relevant to calcification is followed by a discussion of abnormal Ca2+ and Pi homeostasis in cell injury and apoptosis. Concomitant increases in Ca2+ and Pi in blebs (and matrix vesicles) formed by apoptotic and/or necrotic cells are apparently the primary mechanism of calcification. In addition, membranous cellular degradation products (CDP) resulting from cell disintegration in toto frequently serve as the nidus of calcification. Published data on physiological calcification are compared with findings in various dystrophic calcinoses. This led to the conclusion that apoptosis most likely underlies the mechanism of both physiological and pathological calcifications. It is concluded that calcification is an important function of apoptosis. The mechanism of calcification by CDP and morphology of the resultant calcific deposits are complex.


This study examined the behaviour of tourist companies in relation to the adoption of e-business technologies and applications. The study aimed to identify groups of companies with homogenous behaviour among three European countries (Greece, Portugal and Norway). Based on data from a European survey, the study employed two-step cluster analysis which revealed 14 clusters of common behaviour (five clusters in Greece, five in Portugal and four in Norway). These clusters were named as: Leaders' 'Technology Experts', 'Fast Adopters' 'Beginners', 'Late Adopters'. In Norway, the group 'Late Adopters' also included companies characterised as 'Beginners' in the other two countries. We suggest further investigation among European countries in order to reveal more groups of similar behaviour toward e-business adoption.


Nanotechnology is the new field of technological innovation on their application in human biology and medicine. On the other hand, there is an important concern about the potential health and environmental risks, due to exposure to human body of nanoparticles. These nanoparticles led to the appearance in the scientific disciplines such as nanotoxicology and nanomedicine.  Nanotoxicology is the study toxicity effects of nanoparticles on human health as well as environment. Nano-particles have been developed for beneficial studies with applications in medical field and devices. Also, nanomedicines have been applied to the sector of molecular biology, tissue culture, bio-materials, genetic engineering, bio and bio-imaging sensors. Actually, nanotechnologies have followed healthcare improvements including potentially revolutionary treatments for cancer, critical diseases and also drug improvements with reduction of side effect. With all these descriptions, the extent of potential impact on human health is still a major concern due to lack of reliable toxicity data of nanoparticles. The main purpose of present literature is providing of better understanding on nanobiotechnology principles and its applications in biomedicine have been discussed as well as to their side effects.


This deeply researched book describes one of the great forgotten battles of the 20th century. At its height it involved nearly a million Chinese and Japanese soldiers, while sucking in three million civilians as unwilling spectators and, often, victims. It turned what had been a Japanese adventure in China into a general war between the two oldest and proudest civilizations of the Far East. Ultimately, it led to Pearl Harbor and to seven decades of tumultuous history in Asia. The Battle of Shanghai was a pivotal event that helped define and shape the modern world. In its sheer scale, the struggle for China's largest city was a sinister forewarning of what was in store for the rest of mankind only a few years hence, in theaters around the world. It demonstrated how technology had given rise to new forms of warfare, or had made old forms even more lethal. Amphibious landings, tank assaults, aerial dogfights and most importantly, urban combat, all happened in Shanghai in 1937. It was a dress rehearsal for World War II-or perhaps more correctly it was the inaugural act in the war-the first major battle in the global conflict. Actors from a variety of nations were present in Shanghai during the three fateful autumn months when the battle raged. The rich cast included China's ascetic Generalissimo Chiang Kai-shek and his Japanese adversary, General Matsui Iwane, who wanted Asia to rise from disunity, but ultimately pushed the continent toward its deadliest conflict ever. Claire Chennault, later of"Flying Tiger" fame, was among the figures emerging in the course of the campaign, as was First Lady Eleanor Roosevelt. In an ironic twist, Alexander von Falkenhausen, a stern German veteran of the Great War, abandoned his role as a mere advisor to the Chinese army and led it into battle against the Japanese invaders. Written by Peter Harmsen, a foreign correspondent in East Asia for two decades, and currently bureau chief in Taiwan for the French news agency AFP, Shanghai 1937 fills a gaping chasm in our understanding of the Second World War.


In the days following Justice John Paul Stevens's death last year, numerous tributes and remembrances immediately poured forth. Former clerks, journalists, and legal scholars all grasped for the perfect words to capture the man and the justice we had just lost.

Yet many readers of these tributes and homages might have begun to wonder whether they were actually all talking about the same person. Because, taken together, the various portraits appeared to be full of contradictions. In one piece, for example, Justice Stevens is described as a frequent lone dissenter, while in another he is praised for his consensusbuilding leadership. For every tribute depicting him as a moderate around whom the Court shifted rightward, there seemed to be another painting him as a jurist who drifted leftward. He was a Republican yet also a liberal giant. He was deeply patriotic, while also a sharp critic of governmental institutions.

So who was the real Justice Stevens? How can we possibly be expected to understand his legacy if we can't even agree on the basic characteristics he embodied? Which of these portraits is correct?

The answer is that they all are. If Justice Stevens were a multiple-choice test, the right answer to pretty much every question would likely be "all of the above." He was, in so many ways and at so many times, both a thing and also the opposite of that thing. And the secret to understanding Justice Stevens's legacy is to appreciate how his seemingly paradoxical nature was, in fact, his greatest strength.


SIGNIFICANCE
E-Scoop, a spectacle lens, provides no clinically relevant improvements on quality of life, visual acuity, and contrast sensitivity for patients with AMD. Because patients' burden is high and therapeutic options are scarce, the incentive to develop effective vision rehabilitation interventions remains.

PURPOSE
Patients with AMD experience low quality of life due to vision loss, despite angiogenesis inhibitor interventions that slow down progression for some patients. E-Scoop, which includes low-power prisms, 6% magnification, yellow tint, and antireflection coating, might aid in daily activities by improving distance viewing. Separately, these features have little proven effectiveness. E-Scoop has not been formally tested. This study aimed to determine the impact of E-Scoop on quality of life and the effect on visual acuity and contrast sensitivity.

METHODS
In this randomized controlled, open-label trial, 190 of 226 eligible patients were included. The primary outcome was quality of life measured with the 25-item National Eye Institute Visual Function Questionnaire. Secondary outcomes were visual acuity and contrast sensitivity. The follow-up for quality of life was after 6 weeks for controls and after 3 weeks of use for E-Scoop wearers. The visual measures were repeated after 6 weeks, with optimal refractive correction, with and without E-Scoop.

RESULTS
Randomization resulted in 99 E-Scoop and 86 control group patients for intention-to-treat analysis. No differential change was found between the E-Scoop and control groups on the 25-item National Eye Institute Visual Function Questionnaire using Rasch analysis (Cohen d = -0.07, P = .53). Statistically significant but small effects were found in favor of E-Scoop on binocular visual acuity (mean difference, 0.05 logMAR [2.5 letters, P < .001]) and contrast sensitivity (mean difference, 0.10 logCS [2 letters, P < .001]).

CONCLUSIONS
No effect of E-Scoop on quality of life was found. E-Scoop showed effects that were statistically significant, although not clinically meaningful and within typical variability, on visual measures.


Comparing the genome sequences of distantly related species can yield valuable information about the locations of genes and of the control elements that regulate them. In their Perspective, [Gibbs and Nelson][1] discuss a new technique called phylogenetic shadowing which enabled comparison of the genome sequences of 17 closely related primate species and Homo sapiens ([ Boffelli et al .][2]). This method revealed the location of exons and regulatory regions in the human genome with increased precision.

 [1]: http://www.sciencemag.org/cgi/content/full/299/5611/1331
 [2]: http://www.sciencemag.org/cgi/content/short/299/5611/1391


Given increasing complexity of many safety-critical systems, many organizations like NASA need to identify when, where, and how inappropriate perceptions of risk and anchoring of trust affect technology development and acceptance, primarily from the perspective of engineers and related management. Using the adoption of Dynamic Radioisotope Power Systems (RPS) for space exploration as a backdrop, we define and explain factors that contribute to inappropriate risk perception of various stakeholders. Three case studies (Mars Science Laboratory, Parker Solar Probe, and Titan Mare Explorer) demonstrate how NASA considered Dynamic RPS but decided against the new technology for less efficient alternatives of solar power and solid-state RPS. In the case of Dynamic RPS, increased design complexity that differs from previous successful solid-state power systems flown on the Voyager probes and Cassini spacecraft is one contributing factor, but not the only one. Problems with system performance and incorrect technology readiness labeling of Dynamic RPS technology led to an increased perception of distrust in Dynamic RPS for future missions. We also find that the perception of risk for Dynamic RPS future development is exacerbated by ongoing organizational challenges requiring multi-agency collaboration and coordination. Difficulties in setting realistic expectations for the new technology as well as maintaining coherent roles and responsibilities among the disparate teams involved challenged the technology's credibility and confidence of mission planners. Further, the lack of an independent technology readiness assessment process and a lack of transparency into ongoing technical problems also constrained mission planners from gaining critical information about the technology's reliability. Though technology development budgets and schedules are often constrained due to sociotechnical and political reasons, technology development teams that address the challenges identified here could allow them to mitigate the sources of inappropriate trust that are within their control.


MAPs (microtubule-associated proteins) were isolated from crayfish walking leg nerves. A major MAP was identified as a high molecular weight protein (270K). This protein co-migrated with mammalian MAP2, stimulated the polymerization of rat brain tubulin into microtubules, and was heat resistant. Rotary shadowing revealed that the 270K MAP is a long thin flexible structure. It formed cross-bridges of fine strands, linking microtubules with each other in vitro. These strands resemble the cross-bridges between microtubules observed in the crayfish axon permeabilized with saponin and quick-frozen, deep-etched. Antibodies against mammalian MAP2 cross-reacted with this crayfish MAP and stained the axoplasm of the walking leg nerves. Thus MAPs, especially the 270K MAP, appear to be a major component of the cross- linking strands between microtubules observed in the crayfish axon.


Arranged chronologically, Film Histories is a wide-ranging anthology that covers the history of film from 1885 to the present. Each chapter contains an introduction by the editors on key developments within the respective period, followed by a classic piece of historical research about that period. Various approaches to film history are taken by the authors of the articles, exposing readers to different forms of historical research. Topics include: the history of audiences, exhibition, marketing, censorship, aesthetic history, political history, and historical reception studies.Film Histories concentrates on the so-called historical turn in film studies, demonstrating that film history is about more than simply key films, directors, and movements. Also included is a preface explaining the structure and organization of the book. The contents are divided into sections on American and non-American research, thus designed to reach a wide student audience at the undergraduate level. Chapter introductions provide an overview of international developments in film.


Keeping Democracy at Bay: Hong Kong and the Challenge of Chinese Political Reform, by Suzanne Pepper. Lanham: Rowman & Littlefield, 2008. x + 448 pp. US$85.00/£56.00/euro88.20 (hardcover), US$39.95/£26.00/euro40.95 (paperback). The Sino-British Joint Declaration in 1984 on reversion of sovereignty over Hong Kong from the British government to the Chinese government on 1 July 1997 not only signified the transformation of Hong Kong from a British colony to a special administrative region of the People's Republic of China (PRC) but also changed the territory's internal and external political environment in the years preceding and following the political transition. Apprehension at the Chinese government's increasingly authoritarian stance with regard to political and social control has become one of the key concerns of the Hong Kong people. In particular, the government's agenda for the democratization of Hong Kong's political system has been a major crux of local demonstrations and protest actions. Moreover, in the past Hong Kong was part of the Western alliance, tolerated by the PRC only as a window of foreign information and technology and because of its contribution to the Chinese economy. Since its return to Chinese sovereignty, Hong Kong has found itself in the crossfire of Sino-US relations. Suzanne Pepper offers a unique perspective of Hong Kong's political evolution from its founding as a British colony to its present as a special administration region, with a focus on the interplay between colonial, capitalist, Communist and democratic forces that shaped Hong Kong's political culture and institutions. The book is divided into three sections, which examine, respectively, colonial foundations, local reforms during British rule, and Chinese rule in Hong Kong. In the section on colonial foundations, Pepper considers the British government's long delay in introducing representative government in relation to the naissance of Hong Kong amidst the mid-19th-century Anglo-Chinese trade wars, continual Hong Kong Chinese dissent and traditional forms of Chinese "self-governance". In the section on local reforms during British rule, she discusses the reasons for the eventual initiation of representative government in Hong Kong during the 1992-97 tenure of its last British governor, Christopher Patten-the reasons being deeply rooted in Britain's own struggles for electoral reform-and the PRC's pursuit of various ideologies and its more recent reopening to Western capitalism. …


Under reporting of adverse drug reactions (ADRs) by healthcare personnel is a common problem of many Pharmacovigilence programs. Lack of involvement of healthcare professionals such as pharmacists and other pharmaceutical dispensers has been cited as one of the reasons for under reporting. Pharmaceutical dispensers in the community pharmacies are in unique position by virtue of their training and profession to observe ADRs in patients, as many patients often try to avoid doctor consultation fees by visiting community pharmacies. The knowledge and ability of dispensers in Tanzanian community pharmacies to identify and report ADRs is however unknown. To determine the knowledge, attitude and practices of dispensers in community pharmacies in Dar es Salaam towards the ADRs reporting. A descriptive cross sectional survey was conducted involving 254 dispensers from selected retail pharmacies in Dar es Salaam region. SPSS version 16 was used for data entry, cleaning and subsequently analysis. Results: The majority of personnel working in community pharmacies are non pharmaceutical professionals i.e 52% were nurse assistants. Community dispensers have limited knowledge and practices with regard towards ADRs reporting. Only 13.8% of respondents had good ADRs reporting knowledge, while only 8.7% had ever submitted ADRs reports to the relevant authorities. There was a significant difference in the level of knowledge with regard to ADRs reporting between Pharmaceutical professionals (i.e Pharmacists, Pharmaceutical technicians and pharmaceutical assistants) and non Pharmaceutical professionals (P value = 0.000). The knowledge levels correlated positively with profession and attendance of continuous professional education courses (CPE). The majority of dispensers (68.9%) however had a positive attitude towards ADRs reporting. Community pharmacies dispensers in Dar es Salaam have limited knowledge and experience with regard to ADRs reporting. Thus community pharmacies in Dar es Salaam cannot presently act as centres to collect data on ADRs effectively. The staffing of community pharmacies with unqualified pharmaceutical professionals is the main reason for the lack of knowledge, thus sincere and sustained efforts should be made by the Government through its National Regulatory Authorities and Schools of Pharmaceutical Sciences to ensure that there is an increased output of vii pharmaceutical professionals in Tanzania, ADRs reporting forms and guidelines are available in community pharmacies and that continuous professional education is provided to in-service pharmaceutical professionals to improve their ADRs reporting capabilities.


Gamma-ray astronomy explores the most energetic photons in nature to address some of the most pressing puzzles in contemporary astrophysics. It encompasses a wide range of objects and phenomena: stars, supernovae, novae, neutron stars, stellar-mass black holes, nucleosynthesis, the interstellar medium, cosmic rays and relativistic-particle acceleration, and the evolution of galaxies. MeV gamma-rays provide a unique probe of nuclear processes in astronomy, directly measuring radioactive decay, nuclear de-excitation, and positron annihilation. The substantial information carried by gamma-ray photons allows us to see deeper into these objects, the bulk of the power is often emitted at gamma-ray energies, and radioactivity provides a natural physical clock that adds unique information. New science will be driven by time-domain population studies at gamma-ray energies. This science is enabled by next-generation gamma-ray instruments with one to two orders of magnitude better sensitivity, larger sky coverage, and faster cadence than all previous gamma-ray instruments. This transformative capability permits: (a) the accurate identification of the gamma-ray emitting objects and correlations with observations taken at other wavelengths and with other messengers; (b) construction of new gamma-ray maps of the Milky Way and other nearby galaxies where extended regions are distinguished from point sources; and (c) considerable serendipitous science of scarce events -- nearby neutron star mergers, for example. Advances in technology push the performance of new gamma-ray instruments to address a wide set of astrophysical questions.


Abstract. Honorification in Korean elevates the social status of a participant in a clause with respect to the subject and/or the hearer. Honorific marking may occur as a nominal suffix, a special honor-ific form of a noun, an honorific case particle, an honorific marker on a verb, or a special honorific form of a verb. Previous accounts have proposed a specification [HON +], with unmarked forms typically being [HON -]. Our key idea is that honorific forms introduce a dimension of meaning, the expressive meaning of Potts (2005), which is privative, and hence simply absent from all non-honorific forms.All previous accounts fail with regard to three types of fact: first, the different expressions of 'honor-ification' do not mean exactly the same thing. Second, multiple expressions of honorific marking within the same clause progressively elevates the social status of the referent: the effect is cumula-tive. Third, under the traditional analysis, some nouns have to be given a spurious and ultimately inconsistent ambiguity. We further argue that it is mistaken to consider honorific marking to be 'agreement' between, say, a subject and a verb. This position puts us in contrast with all of the syn-tactic literature on Korean (and Japanese), and some of the semantic and pragmatic literature.


The Alarmingly Undemocratic Drift Of the European Union EVER SINCE THE COLD WAR ended 10 years ago, the nations of Western and Central Europe have rapidly moved to transform the European Economic Community, the "Common Market," into a genuine political union. One after the other, major areas of policymaking responsibility, including important aspects of economic, monetary, social, and legal policies, have been transferred from the nation-states of Europe to the institutions of the European Union (EU). The goal and purpose of this new Europe's leaders are no secret. In a November 2000 speech in Germany, Romano Prodi, president of the European Commission, the EU'S principal executive and legislative body, stated that the objective of this "European Project" is not just to create "a superstate but a superpower" -- a superpower that will work to spread its values and concepts of governance on the international level. During this critical period, the United States has continued to endorse European integration, as it has done for the past 50 years. The political traditions of the EU-member states, which include principles of popular sovereignty, the fact that European integration has been accomplished through peaceful means, and decades worth of Cold War era support by Washington for a stronger, more unified, Europe better able to stand up to Moscow, have led American policymakers to continue viewing the European Project as democratic and, by and large, beneficial. This is true even of those U.S. officials and commentators who are otherwise uncomfortable with the prospect of an emerging European power capable of challenging U.S. "leadership" in global affairs, and who oppose many of the EU's policy positions. However, the assumption that the new Europe, or at least the new Europe planned by the EU's current leadership, will continue to share the democratic values of the United States is badly in need of reexamination. Although only time will reveal the truth, there are a number of very troubling indicators suggesting that Europe is not moving towards a unified, democratic state on the American model, a "United States of Europe," but rather retreating to a model of governance characteristic of the Continent before the period of Reformation, Enlightenment, and Revolution that spawned the United States. In this regard, at the heart of the European Project lies the notion of a supernational or "universal" authority, spread across the whole of Europe, very similar to the universalist ideas of the Middle Ages. Moreover, this goal has manifested itself in institutions and assumptions about the role of the citizenry in government that are more characteristic of the Age of Absolutism than of American-style republicanism. If, in the long run, the political ideas of the Reformation and Enlightenment prove to be exceptions to a more permanent and ancient European rule, departures rather than transformations, this will create unique and serious problems for the United States. The American republic has no place, intellectually or politically, in the pre-Enlightenment European world, and while Francis Fukuyama's "end of history" thesis is partially correct -- communism, at least outside of the halls of academe, does not offer a viable ideological threat to democracy -- what model of nontotalitarian governance will ultimately triumph globally is still very much in doubt. Few Americans would disagree with the proposition that popular legitimacy, accountability, limited government, and the existence of a large sphere of private activities free from government involvement are essential attributes of democracy, necessary for both domestic tranquility and international stability. It appears that few of the EU's leaders would agree, judg ing by its institutions and their goals. At the same time, Europe has rarely been content, for long, to manage its own affairs without seeking to export its vision of the proper order of things. …


Background: Providing infrastructure and land uses to encourage active travel (i.e., bicycling and walking) are promising strategies for designing health-promoting cities. Population-level exposure to air pollution during active travel is understudied. Objectives: Our goals were a) to investigate population-level patterns in exposure during active travel, based on spatial estimates of bicycle traffic, pedestrian traffic, and particulate concentrations; and b) to assess how those exposure patterns are associated with the built environment. Methods: We employed facility–demand models (active travel) and land use regression models (particulate concentrations) to estimate block-level (n = 13,604) exposure during rush-hour (1600–1800 hours) in Minneapolis, Minnesota. We used the model-derived estimates to identify land use patterns and characteristics of the street network that are health promoting. We also assessed how exposure is correlated with indicators of health disparities (e.g., household income, proportion of nonwhite residents). Our work uses population-level rates of active travel (i.e., traffic flows) rather than the probability of walking or biking (i.e., "walkability" or "bikeability") to assess exposure. Results: Active travel often occurs on high-traffic streets or near activity centers where particulate concentrations are highest (i.e., 20–42% of active travel occurs on blocks with high population-level exposure). Only 2–3% of blocks (3–8% of total active travel) are "sweet spots" (i.e., high active travel, low particulate concentrations); sweet spots are located a) near but slightly removed from the city-center or b) on off-street trails. We identified 1,721 blocks (~ 20% of local roads) where shifting active travel from high-traffic roads to adjacent low-traffic roads would reduce exposure by ~ 15%. Active travel is correlated with population density, land use mix, open space, and retail area; particulate concentrations were mostly unchanged with land use. Conclusions: Public health officials and urban planners may use our findings to promote healthy transportation choices. When designing health-promoting cities, benefits (physical activity) as well as hazards (air pollution) should be evaluated. Citation: Hankey S, Lindsey G, Marshall JD. 2017. Population-level exposure to particulate air pollution during active travel: planning for low-exposure, health-promoting cities. Environ Health Perspect 125:–534; http://dx.doi.org/10.1289/EHP442


This Article examines the application of the Supreme Court of India's enterprising Public Interest Litigation (PIL) mechanism to a subject of compelling global concern: violations of women's rights. India is currently receiving much international attention for its dynamism and innovation on various fronts, yet the country also remains steeped in centuries-old norms and conventions. This tension is reflected in the decisions of the Supreme Court, which has assumed an active role in enforcing women's rights through PIL but is sometimes limited in this regard by the complex cultural context in which it operates. Based on an analysis of Indian constitutional law, case studies of landmark Supreme Court decisions, and extensive interviews with stakeholders in India, the Author argues that the PIL vehicle has great potential for advancing gender justice. However, the success of this endeavor in a society that is rapidly evolving — yet still deeply patriarchal — will depend upon strategic mobilization by women's rights advocates and committed efforts by the Court to enforce the rights of women, independent of mainstream opinion and within the boundaries of the separation-of-powers doctrine. If India can assume a leading role in advancing gender justice through its judiciary, its PIL mechanism could serve as an inspiring model for other constitutional courts and international human rights bodies.


Abstract Two C2/c pyroxene suites from sodic alkaline rocks (Basanite-Phonolite: B-Ph and Alkali basalt- Trachyphonolite: AB-T) belonging to the McMurdo Volcanic Group (Mt. Melbourne province and Mr. Erebus, Antarctica) were investigated by single-crystal X-ray diffraction combined with electron probe microanalysis which together provide accurate site occupancy and site configuration parameters. Variations in site volumes distinguish the clinopyroxenes belonging to the more alkaline B-Ph suite from those of the AB-T suite. The former have higher VM2 and, for similar cell volume, lower VM1 and higher VT. In these C2/c pyroxenes, the bond lengths of M1 depend on R3+ content, necessary to balance AlIV in the T site. M1 geometric variations are similar for both B-Ph and AB-T suites. However, the M2 site is crucial for variations in polyhedral configurations. The increase in AlIV affects the shortest M2-O bond lengths in different ways depending on (Ca+Na) contents in the M2 site. Thus, the clinopyroxenes were distinguished in two different groups not related to the two suites. The first group is characterized by (Ca+Na) higher than 0.90 atoms per formula unit but shows a good positive correlation between the shortest M2-O bond lengths and AlIV content, at quite constant (Ca+Na). The second group has (Ca+Na) less than 0.90 atoms per formula unit but shows a poor correlation between the shortest M2-O bond lengths and AlIV content. In general, shortening of the longest M2-O bond lengths is associated with increase in AlIV. The cell and M1 volumes suggest that the clinopyroxenes, including the larger and sometimes resorbed macrocrysts, crystallized at a pressure lower than 5 kbar, fitting the petrography and evolved character of the rocks in question.


The Lightning Network (LN) is one of the most promising off-chain scaling solutions for Bitcoin, as it enables off-chain payments which are not subject to the well-known blockchain scalability limit. In this work, we introduce CLoTH, a simulator for HTLC payment networks (of which LN is the best working example). It simulates input-defined payments on an input-defined HTLC network and produces performance measures in terms of payment-related statistics (such as time to complete payments and probability of payment failure). CLoTH helps to predict issues and obstacles that might emerge in the development stages of an HTLC payment network and to estimate the effects of an optimisation action before deploying it. We conducted simulations on a recent snapshot of the HTLC payment network of LN. These simulations allowed us to identify network and payments configurations for which a payment is more likely to fail than to succeed. We proposed viable solutions to avoid such configurations.


Cuckoo Search Algorithm (CSA), a new meta-heuristic algorithm based on natural phenomenon of Cuckoo species and Levy flights random walk, has been successfully applied to several optimization problems so far. In the paper two modified versions of CSA, where new solutions are generated using two distributions including Gaussian and Cauchy distributions are proposed for economic emission load dispatch (EELD) problem with multiple fuel options. The advantages of CSA with Gaussian distribution (CSA-Gauss) and CSA with Cauchy distribution (CSA-Cauchy) over CSA with Levy distribution are fewer parameters and fewer equations and shorter computational process. The proposed method is tested on one test system consisting of ten generating units with various load demands and compared to other methods. In addition, the best compromise from the set of obtained solutions is found and compared to this from lamda-iteration (LI) method and Hopfield Lagrange Network (HLN). The result comparisons have indicated that the proposed method is a highly effective method.


This article introduces Voting Advice Applications (VAAs) as a data-generating tool that can be used to measure the positions of party supporters in multidimensional policy space. It begins with an overview of the state of the art as regards methods for locating parties on a common policy space, in terms of how data are gathered and also in terms of how policy dimensions are identified and measured. We then use a dimension reduction technique to identify latent policy dimensions from a dataset obtained from a VAA carried out in Scotland in 2011. These dimensions are used to map the policy positions of supporters of five Scottish political parties. We argue that this tool allows more leverage on understanding the relative locations of parties 'in the electorate' in multidimensional policy space.


70/30 cupronickel designated in the Naval Engineering Standard NES 824 is associated with high integrity cast components. However this specification restricts the use of welding to recover castings if they are to be wetted by sea water. Hot isostatic pressing is considered to be an alternative recovery process. The mechanisms of pore closure and the processing parameters for successful recovery have been investigated together with their effect on microstructural and mechanical property characteristics. In addition models have been identified which accurately predict pore closure rates in cupronickel castings.Hot isostatic pressing trials were carried out using processing temperatures within the range 850°C and 1025°C and argon gas pressures of 45MPa to 145MPa. Two time, temperature, pressure procedures were investigated; successive cycles of short duration and single continuous cycles. The investigations were carried out on 70/30 cupronickel (NES 824) specimens that contained artificially introduced porosity in the form of closed internal pores and surface-connected porosity: the latter required encapsulation prior to processing. These investigations have revealed that for the removal of surface-connected porosity, successive cycles of short duration were more effective in closing large pores than a single cycle of the same total duration. In addition elongated pores of small diameter were removed more quickly than pores of equivalent volume porosity but smaller aspect ratio. Shorter recovery times were required for the consolidation of internal porosity in comparison with surface-connected porosity indicating that encapsulation restricts the densification process.Initially the rate of densification during HIPping was rapid suggesting that plastic flow was occurring.Subsequent densification probably by viscous flow mechanisms occurred at a much lower rate once the sustain conditions had been reached. This fall off in the densification rate applied in particular to encapsulated castings.The optimum processing conditions for the successful densification of 70/30 cupronickel castings are short sustain times of 45 minutes, a temperature of 950°C and argon gas pressures within the range 83-103MPa.Hot isostatic processing significantly increases the ductility of 70/30 cupronickel castings without a reduction in strength and has no adverse effects on corrosion resistance.


In traditional marketing advertising is part of product promotion, one of the four P's of marketing. In the 20th century media channels such as papers and magazines, and later on radio and television, were used to distribute and broadcast advertisements in order to create product and brand awareness and preference amongst consumers, in order to raise product sales. In the last two decades however, economical developments resulted in the experience economy: a new era of marketing and branding, in which traditional advertising is becoming less effective and meaningful experience branding is key. Meaningful (brand) experiences can make a difference to consumers, because of the personal relevance for people with regard to their personal values and beliefs that are the basis of people's consumer behaviour and brand preferences. Pervasive advertising should seek for applications with which people can interact with brands in an intellectual, an emotional and a physical way.


A total of 295 junior, intermediate, and senior professional Java consultants (99 individuals and 98 pairs) from 29 international consultancy companies in Norway, Sweden, and the UK were hired for one day to participate in a controlled experiment on pair programming. The subjects used professional Java tools to perform several change tasks on two alternative Java systems with different degrees of complexity. The results of this experiment do not support the hypotheses that pair programming in general reduces the time required to solve the tasks correctly or increases the proportion of correct solutions. On the other hand, there is a significant 84 percent increase in effort to perform the tasks correctly. However, on the more complex system, the pair programmers had a 48 percent increase in the proportion of correct solutions but no significant differences in the time taken to solve the tasks correctly. For the simpler system, there was a 20 percent decrease in time taken but no significant differences in correctness. However, the moderating effect of system complexity depends on the programmer expertise of the subjects. The observed benefits of pair programming in terms of correctness on the complex system apply mainly to juniors, whereas the reductions in duration to perform the tasks correctly on the simple system apply mainly to intermediates and seniors. It is possible that the benefits of pair programming will exceed the results obtained in this experiment for larger, more complex tasks and if the pair programmers have a chance to work together over a longer period of time


The shores of the Great Lakes are a battleground, and their future use is shrouded in uncertainty and controversy. Lakefront owners, armed with their deeds, assert an exclusive right to use their properties at least down to the water's edge. Members of the public, brandishing the venerable but amorphous public trust doctrine, claim a right to walk on even privately owned shores up to the high water mark. Courts to date have diverged widely, in approach and result, when deciding whether, and to what extent, the public has a right to use the Great Lakes shores. This article proposes a uniform framework, grounded in the core principles of the public trust doctrine, for use in each Great Lakes state to ascertain the public's right to use the Great Lakes shores. This framework offers much-needed predictability, yet is flexible enough to allow each state to strike its own balance between public and private interests. The framework employs a principled, two-prong approach. First, it determines the geographic scope of the public trust doctrine applicable to the Great Lakes shores. Reconciling Supreme Court precedents, the framework provides that the geographic scope of the public trust in each state begins at a common starting point informed by the equal footing doctrine, and a state's ability to alter the scope is circumscribed. Second, the framework determines what public uses of the Great Lakes shores are protected by the public trust doctrine. Important, non-traditional public uses that do not unreasonably interfere with the rights of lakefront owners can be protected as well as the traditional uses of navigation, fishing, and commerce. Using as a focal point the controversy regarding the public's right to walk the Great Lakes shores, this article shows how the proposed framework is consistent with existing law in each of the Great Lakes states.


Background: The incidence of lower extremity complications associated with diabetes mellitus has been increasing as the number of patients with diabetes rises. Amputation is the most critical complication. The aim of this study was to elucidate the correlations of the preoperative platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) with wound complications, re-amputations, and mortality.
Materials and Methods: This study included 258 patients who underwent lower extremity amputations due to diabetes (152 with below-knee amputations and 106 with above-knee amputations). The preoperative PLR, NLR, and hemoglobin concentration were calculated. Postoperative deaths were classified as those that occurred within the first 6 months (Group I), from 6 months to 1 year (Group II), from 1 to 3 years (Group III), and beyond 3 years (Group IV). Age, sex, re-amputation, and wound complications were investigated.
Results: The amputation level and mortality rate were significantly correlated (p=0.017). No significant difference was found among Groups I to IV in either the haemoglobin concentration (9.4, 10.1, 10.1, and 10.7 g/dl, respectively; p=0.709) or PLR (247.7, 222.3, 229.4, and 195.0, respectively; p=0.678). The NLR was significantly higher in Group I (9.2) than in Groups II to IV (5.5, 6.3, and 5.6, respectively; p=0.012).
Conclusion: Patients with a high preoperative NLR and above-knee amputation due to diabetes had a higher mortality rate. The PLR is not a suitable prognostic marker for patients undergoing amputation due to diabetes.


The skin plays an important role in protecting the body from pathogens and chemicals in the external environment. Upon injury, a healing program is rapidly initiated and involves extensive intercellular communication to restore tissue homeostasis. The deregulation of this crosstalk can lead to abnormal healing processes and is the foundation of many skin diseases. A relatively overlooked cell type that nevertheless plays critical roles in skin homeostasis, wound repair, and disease is the dendritic epidermal T cells (DETCs), which are also called γδT-cells. Given their varied roles in both physiological and pathological scenarios, interest in the regulation and function of DETCs has substantially increased. Moreover, their ability to regulate other immune cells has garnered substantial attention for their potential role as immunomodulators and in immunotherapies. In this article, we describe a protocol to isolate and culture DETCs and analyse them in vivo within the skin. These approaches will facilitate the investigation of their crosstalk with other cutaneous cells and the mechanisms by which they influence the status of the skin. Graphic abstract: Overall workflow to analyse DETCs in vitro and in vivo.


Evidence suggests that vigorous-intensity exercise interventions may be effective for smoking cessation among women; however, few studies have examined the efficacy of a moderate-intensity exercise program. The present study examined the efficacy of moderate-intensity exercise for smoking cessation among female smokers. Healthy, sedentary female smokers (N = 217) were randomly assigned to an 8-week cognitive-behavioral smoking cessation program plus moderate-intensity exercise (CBT+EX) or to the same cessation program plus equal contact (CBT). A subsample received nicotine replacement therapy. Results indicated that the CBT+EX and CBT groups were equally likely to attain smoking cessation at the end of treatment, as measured by cotinine-verified 7-day point-prevalence abstinence (20.2% for CBT+EX vs. 18.5% for CBT). The CBT+EX group was more likely to report smoking cessation, as measured by 7-day point prevalence at the 3-month follow-up (11.9% vs. 4.6%, p<.05), compared with the CBT group. No group differences were found at 12 months by either 7-day point prevalence (7.3% for CBT+EX vs. 8.3% for CBT) or continuous abstinence (0.9% for CBT+EX vs. 0.9% for CBT). Additionally, among participants in the CBT+EX group, those with higher adherence to the exercise prescription were significantly more likely to achieve smoking cessation at the end of treatment than were participants reporting lower adherence to exercise. Our findings indicate that the empirical support for moderate-intensity exercise as an adjunctive treatment to CBT for smoking cessation may be limited. Perhaps future studies could compare moderate- vs. vigorous-intensity physical activity to test their relative efficacy.


We propose a new member of the family of mixednorm stochastic gradient adaptive filter algorithms for system identification applications based upon a convex function of the error norms that underlie the least mean square (LMS) and least absolute difference (LAD) algorithms. A scalar parameter controls the mixture and relates, approximately, to the probability that the instantaneous desired response of the adaptive filter does not contain significant impulsive noise. The parameter is calculated with the complementary error function and a robust estimate of the standard deviation of the desired response. The performance of the proposed algorithm is demonstrated in a system identification simulation with impulsive and Gaussian measurement noise.


This paper is a reminder of the danger of allowing "risk" when synchronizing a parallel discrete-event simulation: a simulation code that runs correctly on a serial machine may, when run in parallel, fail catastrophically. This can happen when Time Warp presents an "inconsistent" message to an LP, a message that makes absolutely no sense given the LP's state. Failure may result if the simulation modeler did not anticipate the possibility of this inconsistency. While the problem is not new, there has been little discussion of how to deal with it; furthermore the problem may not be evident to new users or potential users of parallel simulation. This paper shows how the problem may occur, and the damage it may cause. We show how one may eliminate inconsistencies due to lagging rollbacks and stale state, but then show that so long as risk is allowed it is still possible for an LP to be placed in a state that is inconsistent with model semantics, again making it vulnerable to failure. We finally show how simulation code can be tested to ensure safe execution under a risk-free protocol. Whether risky or risk-free, we conclude that under current practice the development of correct and safe parallel simulation code is not transparent to the modeler; certain protections must be included in model code or model testing that are not rigorously necessary if the simulation were executed only serially.


Abstract The modernization of the National Weather Service (NWS) will provide new datasets along with advanced technological capabilities that will enhance our understanding of meteorological and hydrological processes. Improved local warning and forecast techniques should flow from this new understanding. The knowledge transfer to improved services can be greatly accelerated by local partnerships with universities and others in the scientific community. Hence, a key objective of the modernization and associated restructuring of the NWS is to stimulate collaborative research activities among weather forecast offices, river forecast centers, universities, and others in the scientific community. This article describes steps the NWS is taking to improve opportunities for collaboration.


A method of evaluating image-recovery algorithms is presented that is based on the numerical computation of how well a specified visual task can be performed on the basis of the reconstructed images. A Monte Carlo technique is used to simulate the complete imaging process including generation of scenes appropriate to the desired application, subsequent data taking, image recovery, and performance of the stated task based on the final image. The pseudorandom-simulation process permits one to assess the response of an image-recovery algorithm to many different realizations of the same type of scene. The usefulness of this method is demonstrated through a study of the algebraic reconstruction technique (ART), a tomographic reconstruction algorithm that reconstructs images from their projections. The task chosen for this study is the detection of disks of known size and position. Task performance is rated on the basis of the detectability index derived from the area under the receiver operating characteristic curve. In the imaging situations explored, the use of the nonnegativity constraint in the ART dramatically increases the detectability of objects in some instances, particularly when the data consist of a limited number of noiseless projections. Conversely, the nonnegativity constraint does not improve detectability when the data are complete but noisy.


How can we efficiently propagate uncertainty in a latent state representation with recurrent neural networks? This paper introduces stochastic recurrent neural networks which glue a deterministic recurrent neural network and a state space model together to form a stochastic and sequential neural generative model. The clear separation of deterministic and stochastic layers allows a structured variational inference network to track the factorization of the model's posterior distribution. By retaining both the nonlinear recursive structure of a recurrent neural network and averaging over the uncertainty in a latent path, like a state space model, we improve the state of the art results on the Blizzard and TIMIT speech modeling data sets by a large margin, while achieving comparable performances to competing methods on polyphonic music modeling.


Abstract Objective To compare different methods of indexing health care service prices for the commercially insured population across geographic markets. Data Sources Health Care Cost Institute commercial claims data from 2012 to 2016. Study Design We compare price indices computed using methods with differing levels of computational intensity: weighted‐average versus regression‐based methods. We separately compute indices of the prices paid for set of common inpatient and set of common outpatient services in different markets across the United States using each type of method. We subsequently examined the variation of and correlations between the resulting index values. Data Collection/Extraction Methods We computed health care service price indices separately using samples of inpatient and outpatient facility claims from 2012 to 2016 across 112 Core‐Based Statistical Areas. Within each category of services, claims were limited to members under the age of 65 with employer‐sponsored insurance. Both samples were limited to a common set of services that made up nearly 80 percent of the service use in the full sample every year. Principal Findings We found that the methods studied produced highly correlated price indices (r > .94) with similar distributions across years for both inpatient and outpatient services. Conclusions Our findings suggest that weighted‐average methods, which are much less computationally intensive, will generate results similar to regression‐based methods.


The purpose o f this study is to examine the information system (IS) success o f the accounting software based on the user perception. The model used to examine the IS success is the modified IS success model ofSeddon (1997). The model employed in this study is applied on data collected through 204 questionnaires distributed to the users o f accounting software who work at the variety o f companies in Indonesia. In examining the model, we employ the Structural Equation Model (SEM) with the use o f LISREL 8.72 sojH>are. The results o f the study show that system quality significantly affects the perceived usefulness and the user satisfaction. Furthermore, the results show that informc\tion quality significantly affects the perceived usefulness and user satisfaction. On the other hand, the study finds that user satisfaction does not affect the system use.


The aim of the present study was to explore methods, concepts, and techniques that provide recognition of circulatory deficiencies at the earliest possible time in the patient's illness. We used both the standard invasive pulmonary artery thermodilution catheter and noninvasive hemodynamic monitoring systems consisting of a new bioimpedance cardiac output device, pulse oximetry, transcutaneous oxygen (PtCO2) and carbon dioxide tensions as well as the transcutaneous oxygen tension/fraction of inspired oxygen ratio (PtCO2/FIO2). These three noninvasive systems were used to evaluate cardiac function, pulmonary function, and tissue perfusion, respectively. This approach to early noninvasive monitoring is based on recent evidence suggesting that poor tissue perfusion and oxygenation initiate circulatory dysfunction that leads to shock and organ failure. We studied 303 acute episodes of circulatory dysfunction and shock in 261 patients in a university-run county hospital; 75 were acute traumatic injuries and 109 acute nontrauma medical emergencies on admission to the emergency department, and 77 ICU patients with an acute illness or exacerbation of their current illness. The study was a prospective, descriptive study to identify early abnormal circulatory patterns reflecting the cardiac, pulmonary, and perfusion functions associated with death and with survival. We described noninvasively monitored patterns in individual illustrative cases, in common etiologic groups, and in physiologic categories representing various abnormal functional patterns. We found that hypotensive shock usually was preceded by episodes of high flow followed by low flow and inadequate tissue perfusion indicated by reduced PtCO2; this frequent pattern was modified by associated co-morbid conditions, especially hypovolemia, limited cardiac reserve capacity, age, hypertensive states, and increased body metabolism from infection, trauma, stress, exercise, temperature, and endocrine disorders. Reduced pulmonary function occurred in 18% of emergency patients; these were usually patients with thoracic trauma, severe hypovolemia, head injuries, chronic obstructive pulmonary disease, asthma, drug overdose, and central nervous system failure (massive stroke and coma). We concluded that noninvasive measurements identify early circulatory problems reliably and provide objective criteria for physiologic analysis as well as for definition of therapeutic goals and titration of therapy.


For decades, the development of transportation infrastructure in the Brazilian Amazon has been the government's main social and economic development policy in the region. Reductions in transportation costs have not only opened the agricultural frontier to cattle ranching and logging but have also caused more than two-thirds of Amazonian deforestation. Currently, soybean cultivation is a new economic force demanding improvements to roads in the region. Profitable soybean crops have spread over the Mato Grosso's cerrados and now head toward the core of the Amazon rain forest. One of the main constraints for soy expansion into the Amazon has been the poor condition of roads. In this study, we analyze the effect Amazon transportation infrastructure programs have on soybean expansion by lowering transport costs. The analysis is based on spatial estimates of transportation costs for the soybean sector, first using current road networks and then projecting changes based on the paving of the Cuiaba-Santarem road. Our results indicate that paving the Cuiaba-Santarem road would reduce transportation costs by an average of $10 per ton for farmers located in the northern part of Mato Grosso, by allowing producers to reroute soybean shipments to the Santarem port. Paving the road also would expand the area where growing soybeans is economically feasible by about 70 percent, from 120,000 to 205,000 km2. Most of this new area would be located in the state of Para and is covered largely by forests. A Cost-Benefit analysis of the road project indicates that the investments in infrastructure would generate more than $180 million for soybean farmers over a period of twenty years. These benefits, however, ignore the project's environmental impacts. If the destruction of ecological services and products provided by the existing forests is accounted for, then the Cuiaba-Santarem investment would generate a net loss of between $762 million and $1.9 billion. This result shows the importance of including the value of the natural capital in feasibility studies of infrastructure projects to reflect their real benefits to society as a whole.


Membrane-based total heat exchangers are devices to recover both sensible heat and latent heat from the exhaust air. The performances of exchangers assembled with different structures and membranes vary dramatically. To investigate performances, five modules are fabricated for comparison. A test rig is built to measure the performance of these total heat exchangers. The heat and moisture transfer in the cores are studied simultaneously. These cores can be divided into two categories: with different structures and with different membranes. For the first category, parallel-plates, plate-fins and cross-corrugated structures are used. For the second category, three kinds of membranes, i.e. one-step hand-made CA membrane, hydrophobic-hydrophilic composite membrane and machine-made CA membrane are used. The heat and mass transfer coefficients, sensible cooling and latent effectiveness are obtained through experimental measurements. The experimental results show that the cross-corrugated ducts can enhance heat and mass transfer effectively. And the one-step hand-made CA membrane has the lowest resistance in heat and moisture transfer.


As a sport and exercise physician, my clinical work includes the prevention, diagnosis, treatment, rehabilitation and determining prognosis of exercise-related injuries (ERI). These components of clinical care are not only confined to dealing with ERI in elite athletes but also as important for recreational athletes and patients who are given an exercise prescription as part of a lifestyle intervention programme for the primary, secondary and tertiary prevention of the chronic disease of lifestyle.

For the clinician, the basis of any assessment of an ERI is a good clinical history and physical examination. In addition to this, the clinician can then decide to perform special investigations to confirm or refine a clinical diagnosis, identify risk factors related to injury, determine factors that may affect choices of treatment or determine factors that may affect prognosis. These special investigations can include imaging, a variety of functional tests (eg, muscle function, clinical biomechanical assessment) and blood tests for biochemical, haematological, hormonal and other biomarkers. Owing to the large number of possible special investigations, the clinician has a very important responsibility to choose special investigations on the basis that there is a clear indication to perform the test, tests are based on sound scientific evidence, and that the result will substantially alter clinical decision making to the benefit of the patient. Furthermore, the clinician has a responsibility to consider the cost of any special investigation.

As a clinician-scientist, I have had the privilege of being part of a team that started investigating possible genetic factors that may be associated with ERI's. The results of the first study were published more than 7 years ago, and used a candidate-gene approach in a gene-association design of a small number of patients presenting with symptoms of an Achilles tendon injury.1 Since then, additional genetic biomarkers that may be …


Translational landslides and debris flows are often initiated during intense or prolonged rainfall. Empirical thresholds aim to classify the rain conditions that are commonly associated with landslide occurrence and therefore improve understating of these hazards and predictive ability. Objective techniques that are used to determine these thresholds are likely to be affected by the length of the rain record used, yet this is not routinely considered. Moreover, remotely sensed spatially continuous rainfall observations are under‐exploited. This study compares and evaluates the effect of rain record length on two objective threshold selection techniques in a national assessment of Scotland using weather radar data. Thresholds selected by 'threat score' are sensitive to rain record length whereas, in a first application to landslides, 'optimal point' (OP) thresholds prove relatively consistent. OP thresholds increase landslide detection and may therefore be applicable in early‐warning systems. Thresholds combining 1‐ and 12‐day antecedence variables best distinguish landslide initiation conditions and indicate that Scottish landslides may be initiated by lower rain accumulation and intensities than previously thought. © 2017 The Authors. Earth Surface Processes and Landforms published by John Wiley & Sons Ltd.


Development of the management of research and development (R&D) has experienced very rapid progress, especially in relation to win business opportunities at the global level. The evolution of R&D management at the global level now has up to the fifth-generation led to the sixth generation, which is characterized by the magnitude of dependence on the information and communication technology as well as the application of the principles of knowledge management in R&D activities. In order to know the development of R&D management in Indonesia, the study focused on the agricultural and estate crops sectors. The analysis is performed against several criteria of operational R&D Management, which are characterized by their respective R&D generation. Results of the study showed that the majority of the operational criteria of R&D management in agriculture and estate crops sectors in Indonesia mostly are still at the third generation. Challenges of R&D facing in agriculture and estate crops sectors in entering a higher R&D generation is increasing capacity of researchers to become more professional as well as a self-managing knowledge workers, focusing on the user or providing solutions for all user problems', develop a broader job networking (network), an R&D organization that fosters continuous learning and transnational oriented by developing a more open communication and use ICT as an intelligent knowledge processors, as well as implement collaborative strategies in daily activities, and resulting patent/licences.


Introduction and Aim: NABH accreditation is seen as an assurance towards quality services and patient safety. We conducted study at a 150 bedded, NABH non-accredited, speciality hospital to identify extent of compliance of practices and policies of the hospital with NABH standards for patient centric activities and to study staff attitude towards practices followed. Materials and Methods: In 5 patient-centered activities chapters of the NABH standards, 61 standards with 403 observable elements were identified applicable to the hospital. The prevalent practices of the staff were observed (each element observed 50 times), relevant records checked to assess compliance with the NABH standards. A sample population of staff (doctors, nurses, technicians) was randomly selected and interviewed on a set of 9 questions to assess awareness of hospital policies and rationale of the practices followed. Results: Compliance to NABH documentation requirements was 37%. Where predefined policies were present, a highly uniform practice (uniform on ≥80% observations) was observed for 96% elements, high uniformity was observed for only 15% elements in cases where no predefined policies were present. The hospital performed best on standards in 'Hospital Infection Control', where documentary compliance was 60%; and 78% elements complied at ≥80% observations with 63% complying at all observed times. The compliance rate was least for standards in 'Patient Rights and Education' where documentations compliance was 14% and only 37% elements complied at ≥80% observed times. Only 50% of the sampled population was aware of all departmental policies while 12% was completely ignorant of the policies. Practices of most of the care providers, 76%, was based on learning by seeing others doing the job, while some (18%) followed verbal instructions. Deviations from established practices were common and gave rise to near misses (66% responders). Most of the care providers, 85%, did not report such events; events not resulting in obvious harm to the patient and consideration that the event was not because of one's own fault were major factors for underreporting. Introduction of checklists and regular training was recognised as a means to prevent such events. Conclusion: The hospital needs to formulate more policies and SOPs. Training and sensitisation of staff regarding work protocols and safety measures were infrequent and inadequate.


Summary for policymakers Technical summary Part I. Setting the Stage for Impact, Adaptation, and Vulnerability Assessment: 1. Overview 2. Methods and tools 3. Development and application of scenarios in Climate Change Impact, Adaptation, and Vulnerability Assessment Part II. Sectors and Systems: Impacts, Adaptation, and Vulnerability: 4. Hydrology and water resources 5. Natural and managed ecosystems 6. Coastal zones and marine ecosystems 7. Energy, industry, and settlements 8. Financial services 9. Human health Part III. Regional Analyses: Impacts, Adaptation, and Vulnerability: 10. Africa 11. Asia 12. Australasia 13. Europe 14. Latin America 15. North America 16. Polar regions (Arctic and Antarctic) 17. Small island states Part IV. Global Issues and Synthesis: 18. Adaptation to climate change in the context of sustainable development and equity 19. Synthesis and integration of impacts, adaptation, and vulnerability Index.


ABSTRACT The field of nonprofit education is rapidly growing, but the nonprofit literature has a noticeable gap about the impact of nonprofit education degree programs on their graduates, the organizations that employ them, and the wider nonprofit sector. This article reports findings from a study investigating the profile and motivations of students completing these nonprofit-related degrees. A survey was deployed to alumni from three different nonprofit graduate programs (i.e., nonprofit management and philanthropic studies), and findings indicate that students are largely similar across schools and primarily drawn to the degree for its nonprofit nature. Differences are noted about the appeal of nonprofit graduate programs between in-service and pre-service students. These findings are rich with implications for students, researchers, and most of all the administrators and faculty of these graduate programs.


We present one of the first empirical assessments of the prominent ossification thesis in administrative law scholarship. Scholars argue that the federal courts' embrace of the "hard look" doctrine of judicial review in the 1970s, along with the imposition of procedural constraints on agency autonomy by the White House and Congress in the 1980s, have severely limited the ability of federal agencies to regulate in the public interest. This conventional wisdom has remained largely untested. To test it, we constructed an original database of the universe of notice-and-comment rules proposed and promulgated by the U.S. Department of the Interior (DOI) from 1950-1990. We examine whether DOI agencies promulgated fewer rules in the supposedly ossified era of 1976-1990 than they did in earlier years; whether there is evidence of a movement away from notice-and-comment rules toward ostensibly illegal regulation via more informal policy devices; and whether notice-and-comment regulations took significantly longer to complete in the allegedly ossified era. We find mixed and relatively weak evidence of ossification. The federal agencies in our study remain able to promulgate large volumes of regulations, and do not appear to be systematically substituting informal policy devices for notice-and-comment regulations. Additionally, while rules do take somewhat longer to complete in the ossified era than before, the major-ity of supposedly ossified regulations are promulgated within one year of proposal and the vast majority are promulgated within two years. We conclude that attempts made by the courts, White House, and Congress to restrict bureaucratic autonomy in favor of increased accountability have probably not unduly harmed rule-making in the aggregate. Would-be reformers of the federal administrative process may wish to think twice before radically altering the current system in ways that decrease opportunities for oversight.


The earliest ideas of the polaron recognized that the coupling of an electron to ionic vibrations would affect its apparent mass and could effectively immobilize the carrier (self-trapping). We discuss how these basic ideas have been generalized to recognize new materials and new phenomena. First, there is an interplay between self-trapping and trapping associated with defects or with fluctuations in an amorphous solid. In high dielectric constant oxides, like HfO2, this leads to oxygen vacancies having as many as five charge states. In colossal magnetoresistance manganites, this interplay makes possible the scanning tunnelling microscopy (STM) observation of polarons. Second, excitons can self-trap and, by doing so, localize energy in ways that can modify the material properties. Third, new materials introduce new features, with polaron-related ideas emerging for uranium dioxide, gate dielectric oxides, Jahn–Teller systems, semiconducting polymers and biological systems. The phonon modes that initiate self-trapping can be quite different from the longitudinal optic modes usually assumed to dominate. Fourth, there are new phenomena, like possible magnetism in simple oxides, or with the evolution of short-lived polarons, like muons or excitons. The central idea remains that of a particle whose properties are modified by polarizing or deforming its host solid, sometimes profoundly. However, some of the simpler standard assumptions can give a limited, indeed misleading, description of real systems, with qualitative inconsistencies. We discuss representative cases for which theory and experiment can be compared in detail.


Correlation of geophysical and geological data with the western margin of the Bohemian massif, re-interpretation of the ECORS-DEKORP deep seismic sections, transformations and 3 D modelling of gravimetric and magnetic maps allow to define sequentional Saxothuringian and Rhenohercynian Paleozoic subduction systems in NE France and SW Germany where only 10% of the Early Paleozoic basement is outcropping. Two 35 km spaced and NE-SW trending gravity highs associated with SE dipping reflectors are interpreted as the western continuation of the Tepla Devonian paleo-subduction zone of the Saxothuringian ocean and Early Carboniferous underthrusting of the Saxothuringian passive margin, thereby defining the Saxothuringian subduction system in west Europe. South-eastwards dipping reflectors beneath the Moho are interpreted as witnesses of the Early Carboniferous subduction of the Rhenohercynian ocean. The suture is marked by the gravity high in the phyllite zone of the southern Rhenish Massif. Gravity lows in the SE of gravity highs and weak ondulating reflectors are interpreted in terms of crystalline bulges in the hangingwalls of sutures. The numerous highly magnetic anomalies correspond to magmatic bodies emplaced in the time-range 335–330 Ma, along NW dipping and sinistral normal faults. Located in the hangingwall of the Rhenohercynian subduction zone, this wide magmatic arc trends obliquely with respect to the Saxothuringian subduction system, which is almost obliterated by the wide front of magmatic bodies.


Objective: The aim was to conduct a review on the literature on objective cognitive impairment in patients after COVID-19. Methods: We performed a literature review and searched Ovid Medline in February 2021 based on a PECO scheme. Results: Twelve articles met all inclusion criteria. Total patient sample was <1,000. All studies on global cognitive function found impairment, ranging from 15 to 80% of the sampled patients. Seven studies on attention and executive functions reported impairment, with varying results depending on sub-domain and different tests. Three out of four studies reported memory difficulties, with two studies reporting short-term memory deficits. Although results indicate possible language impairment, only one study used domain-specific language tasks. Two out of four studies on visuospatial function did not report any impairment. Conclusion: Patients with recent SARS-CoV-2 infection appear to experience global cognitive impairment, impairment in memory, attention and executive function, and in particular verbal fluency. Based on the current results, we recommend clinicians to evaluate the need for cognitive assessment of patients with a recent COVID-19 infection, regardless of the severity of the disease, treatment methods and length of ICU stay. We need studies with larger sample and control group.


Last century witnessed the increase of metropolitan regions and much attention has been paid on them. The concept of megacity appeared during the development process of metropolitan regions. Due to the rapid urbanisation and the population explosion in China, there are three main megacities which have great influence on the national economy. In this thesis, we choose one of the main megacities Beijing megacity, as our case and the research question is how to strengthen the polycentricity of Beijing megacity to achieve more balanced development. In order to find out the answers to the research question, the concepts of metropolitan region, megacity and polycentric megacity are discussed in the conceptual section of this thesis. The empirical section analyses the Tokyo megacity and Los Angeles megacity on purpose of finding the lessons and experiences that could be learned and applied to strengthen the polycentric characters of Beijing megacity. In the case study chapters, firstly we analyses the problems of monocentric Beijing municipality, then we suggest the approaches of being polycentric Beijing megacity where Beijing, Tianjin and Tangshan participate actively.


As the intra-ASEAN tariffs are virtually eliminated, it is the non-tariff measures and trade costs associated with moving goods and services across border that hinder intra-ASEAN trade. This paper focuses on reviewing the state of trade facilitation initiatives in ASEAN, especially on customs modernization, National Single Window, and National Trade Repository. The study uses questionnaires and interviews with the government officials of eight ASEAN Member States (Malaysia and Singapore are excluded). The questionnaires are similar to the ones for the ERIA Mid-Term Review Study 2011, thus, allowing for monitoring of progress across period. The result shows there has been significant progress in trade facilitation in the region in recent years. Nonetheless, there remains a huge gap between the front runners and the tail-enders. The main challenges include inadequacy of funds, availability of technical talent, long process of development of the technical infrastructure of the system, and coordination issues among agencies. For initiatives post-2015, the paper recommends amplification of the WTO Trade Facilitation Agreement at the regional level. The paper also notes that political will, human capital, and persistence are the key determinants for the success of trade facilitation initiatives in the region.


Until recently, the relationship between the United States and Europe constituted one of the most intimate in modern times. Indeed, as we 'over here' love reminding our American friends 'over there', the United States was in the beginning a mere by-product of Europe – initially created by a rising European power in the form of Great Britain, then born out of a long war between Britain and France, and finally transformed into a world power in large part because of large-scale European migration between 1814 and 1914. Europe's long twentieth century crisis, however, had a massive impact on the balance within this relationship, and by 1945 not only had Europe lost its place at the head of the international table but had become highly dependent on the United States itself. Still, in uncertain times, the US continued to need as many friends as it could muster, and whether one prefers to view the nature of the postwar relationship in the more liberal sense of being a 'community', or in more realist terms as being one in which an American hegemon dictated terms to weak dependencies, matters less than in recognising how important the relationship was to become to both countries during the Cold War. Thus, Europe needed the US to survive in a bipolar world: the United States, however, required Europe in order to protect that world from the threat posed by its many anti-western enemies around the world.


This paper presents selected findings from a wider study on the expression of health within physical education (PE) curricula in secondary schools in England and Wales. The study revealed that the expression of health in PE broadly reflected ideologies associated with promoting 'fitness for life' and 'fitness for performance' and that representations of both discourses were present, to a lesser or greater extent, in all schools in the study. Curiously, however, rhetorical 'fitness for life' discourses were commonly expressed through 'fitness for performance' practices in the form of testing and training activities. This paper attempts to explain this mismatch between health-related policy and practice by focusing on what was revealed about the influences on the expression of health in PE. A case study approach was adopted, involving five state secondary schools, three in England and two in Wales. Data sources included health-related school documentation, interviews with PE teachers and observation of a health-related unit of work in one of the schools. The reasons that testing and training activities were the most common contexts for the delivery of health-related learning included the following: conceptual confusion and limited understanding, leading to a belief that training and testing activities are unproblematic and result in increased health, activity and fitness levels; the resolution of pragmatic issues associated with large groups, limited space and minimal equipment as well as preparation for accredited courses in PE; tradition and a desire by teachers to remain with familiar content and teaching approaches, and limited awareness of alternative 'fitness for life' pedagogies. This study has served to increase awareness of the influences on and tensions between health-related discourses in secondary school PE curricula in England and Wales and has provided further demonstration of and insight into the complex relationship between health-related policy and practice.


In subjects older than 25–30 years the number of enzymatically active melanocytes detectable by the dopa reaction decreases by about 10–20% per decade, with exposed skin having approximately twice as many pigment cells as unexposed skin. Chronic exposure to sunlight may stimulate the epidermal melanocyte system rather than accelerating chronological ageing. The number of melanocytic naevi declines with age. Despite the decreased melanocyte density, photoaged skin has irregular pigmentation and, frequently, there is hyperpigmentation. This may be due to greater positivity of dopa of chronically irradiated melanocytes. Heterogeneity in skin colour in exposed areas of skin is due to uneven distribution of pigment cells, a local loss of melanocytes, and a modification in the interactions between melanocytes and keratinocytes. The most common pigmented lesions in sun‐exposed skin include ephelides, actinic lentigo, pigmented solar keratoses and seborrhoeic keratoses, and lentigo maligna. The white spots in aged skin are usually stellate pseudoscars or idiopathic guttate hypomelanosis. Greying of the hair is due to progressive loss of melanocytes from the hair follicles. In vivo and in vitro studies are necessary to increase overall understanding of the processes involved and to improve treatment of the pigmentary changes in ageing skin.


Bug handling represents a major effort in most software projects. To improve this relevant task, software organizations must first understand the current status of their bug resolution process. Although there are plentiful research in bug reports, few of them address the bug handling workflow to better understand and reason about the maintenance process. To this purpose, we report a characterization study focused on the typical workflow followed by Mozilla Firefox developers when resolving bugs. We propose the concept of Bug Flow Graphs (BFG) to help understand the characterization. We analyze 13,564 bugs reported for Firefox in 2015 and we discovered some interesting characteristics of Firefox's bug workflow: (a) when a bug is not formally assigned to a developer it requires ten more days to be resolved; (b) approximately 94% of duplicate bugs are closed within two days or less after they appear in the tracking system (which reveals the efficiency of Firefox's duplicate bug detection procedures); (c) incomplete bugs, which are never assigned to developers, usually require 70 days to be closed; (d) more skilled developers show a faster resolution time than less skilled ones; (e) for less skilled developers a bug usually spends more time waiting to be assigned than being fixed.


In an attempt to increase opportunity and quality of life for people living in poverty,governments and non-government organisations (NGOs) sell and donate products to developing countries. Typically, these are essential household items such as cook stoves, water filters and solar lighting. However, to date there has been limited research into the uptake and long term effectiveness of these products and few methods or tools are available to guide the product development process. This has resulted in a number of well documented product failures as a result of poor design choices.

To overcome this problem and provide guidance to future or existing designers and NGOs this research investigated the factors required for long lasting and effective product design. This was carried out through the use of a literature review, the analysis of 64 products, a survey, interviews with product designers, and a case study with a Social Enterprise in Myanmar (Burma). The information gathered was analysed and used to create a framework consisting of various tools to guide designers and NGOs. Specifically, the research focused on the creation of a taxonomy of products designed for developing countries and an assessment method consisting of eight critical indicators for product success. These were presented as a website, set of cards and book which guides and
assists designers during the process to ensure that future products are appropriate and to prevent current unacceptable levels of waste.

Following the creation of the framework it was evaluated by students, practitioners and existing product users in Myanmar. The findings revealed that participants felt the assessment method and indicator cards were beneficial during the design process and assisted them in the development of more suitable and appropriate products.