There are not so many fluorine, trifluoromethyl and trifluoromethoxy contg. arenes and heterocycles that are com. available and inexpensive. To exploit this bonanza optimally, one should be able to introduce addnl. substituents, in particular functional groups, at any unoccupied position. This would give rise to a manifold of new building blocks to be incorporated into more elaborate structures and tested for therapeutic or pesticidal activity. The fluorine labels in the core materials could be used to modulate biol. key parameters such as acidity, lipophilicity and isosterism. At the same time they can help to control the regioisomeric outcome of any chem. transformation. The required regiochem. flexibility was achieved by implementing mechanism-based modifications into the two std. methods for the generation of organometallic intermediates, the permutational hydrogen/metal interconversion (qmetalationq) and the permutational halogen/metal interconversion. The set (qtoolboxq) of two times three qmutant methodsq which has emerged from these endeavors relies on the deployment of sterically shielding or electronically activating protective groups, basicity gradient-driven transmetalations or heavy halogen migrations and reagent-mediated or solvent-mediated optional site selectivities. As soon as the metal is properly positioned, it can be replaced by any kind of electrophile, the possibilities being virtually infinite. This approach to regioexhaustive functionalization will be illustrated by a series of typical case studies. By applying the principles specified above to 3-fluoro-phenol, all four possible carboxylic acids (2-fluoro-6-hydroxybenzoic acid, 2-fluoro-4-hydroxy- benzoic acid, 4-fluoro-2-hydroxybenzoic acid and 3-fluoro-4-hydroxybenzoic acid) were readily and selectively obtained. Other model studies focused on the prepn. of fluoroindolcarboxylic acids (all 12 isomers carrying the substituents in the benzo ring), derivs. of (trifluoromethyl)indoles and (trifluoromethoxy)indoles, (trifluoromethyl)pyridinecarboxylic acids (all 10 isomers), and halo(trifluoromethyl)pyridinecarboxylic acids, derivs. of fluoropyridines, difluoropyridines, 4-bromo-2-(trifluoromethyl)quinolines and (trifluoromethyl)pyrazoles. [on SciFinder (R)]


In the current study, the observed sea level off Port Said is analyzed over one year (February/1999 to January 2000). The analyses use least square harmonic analyses to separate tidal part from the observed sea level. The direct correlation between sea level off Port Said and the sea surface temperature, mean sea level pressure together with 10m-wind speed components are used to understand the dynamic of sea level variability. The present study indicates that, the observed sea level off Port Said is significantly affected by the tidal part than the non-tidal part particularly during May and September months. Observed sea level off Port Said is significantly affected by mean sea level pressure and sea surface temperature. However, zonal and meridional wind speed has only a small effect on the sea level variations.


© 2017 Peeters et al. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.


Built-up (BU) area extraction from remote sensing images is important to monitor and manage urbanization and industrialization. In this letter, we propose two BU area extraction techniques based on the analysis of fully polarimetric synthetic aperture radar (PolSAR) data. Both methods exploit the geodesic distance on the unit sphere in the space of Kennaugh matrices. The first method is based on the three dominant scattering types in the scene and compares them with scattering models; if any of them matches with BU type elementary scattering models, then the pixel is said to belong to a BU area. The second method is based on a novel PolSAR BU index (RBUI) composed by considering scattering mechanisms from BU structures. The two proposed techniques are validated on two different urban scenes, one acquired at C-band by RADARSAT-2 and other at L-band by ALOS-2 SAR sensors.


In the tropics, ticks parasitize many classes of vertebrate hosts. However, because many tropical tick species are only identifiable in the adult stage, and these adults usually parasitize mammals, most attention on the ecology of tick-host interactions has focused on mammalian hosts. In contrast, immature Neotropical ticks are often found on wild birds, yet difficulties in identifying immatures hinder studies of birds' role in tropical tick ecology and tick-borne disease transmission. In Panama, we found immature ticks on 227 out of 3,498 individually–sampled birds representing 93 host species (24% of the bird species sampled, and 13% of the Panamanian land bird fauna). Tick parasitism rates did not vary with rainfall or temperature, but did vary significantly with several host ecological traits. Likewise, Neotropical–Nearctic migratory birds were significantly less likely to be infested than resident species. Using a molecular library developed from morphologically–identified adult ticks specifically for this study, we identified eleven tick species parasitizing birds, indicating that a substantial portion of the Panamanian avian species pool is parasitized by a diversity of tick species. Tick species that most commonly parasitized birds had the widest diversity of avian hosts, suggesting that immature tick species are opportunistic bird parasites. Although certain avian ecological traits are positively associated with parasitism, we found no evidence that individual tick species show specificity to particular avian host ecological traits. Finally, our data suggest that the four principal vectors of Rocky Mountain Spotted Fever in the Neotropics rarely, if ever, parasitize Panamanian birds. However, other tick species that harbor newly–discovered rickettsial parasites of unknown pathogenicity are frequently found on these birds. Given our discovery of broad interaction between Panamanian tick and avian biodiversity, future work on tick ecology and the dynamics of emerging tropical tick-borne pathogens should explicitly consider wild bird as hosts.


Comprehensive counterion activity studies have revealed clear influence of the polyelectrolyte concn. and chain length on the polyion-counterion interaction, neither of which is evident from the existing theor. models. The counterion activity coeff. (fa) increases below the overlap concn. c* as calcd. from Odijk's scaling approach. At dilns. where the Debye length (lD) exceeds the contour length (L), this increase is more pronounced. These changes in the ionic interactions are primarily responsible for the strong increase of the equiv. cond. (L) below c*. The findings are not restricted to oligomers but apply to all chain lengths of polyelectrolytes at concns. less than c*. The correlation of fa and L with both c* and the ratio lD/L leads to a general description of polyelectrolyte behavior. Expts. were performed above and below c* and over the range 0.1 ? lD/L ? 10 using a series of poly(vinylbenzyltrialkylammonium) model polyelectrolytes with contour lengths over a range 7 nm ? L ? 102 nm and characterized by a charge d. parameter x = 2.85. [on SciFinder (R)]


The collapse of the Soviet Union initiated an unprecedented social and economic transformation of the successor countries and altered the gender balance in a region that counted gender equality as one of the key legacies of its socialist past. The transition experience of the region has amply demonstrated that the changes in the gender balance triggered by economic shifts are far from obvious, and that economic expansion and women's economic empowerment do not always go hand in hand. Therefore, active measures to enhance women's economic empowerment should be of central concern to the policy dialogue aimed at poverty and inequality reduction and inclusive growth. In this paper, we establish the current state of various dimensions of gender inequalities and their past dynamics in the countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan), South Caucasus (Armenia, Azerbaijan, and Georgia), and Western CIS (Belarus, Moldova, and Ukraine), and propose steps aimed at reducing those inequalities in the context of inclusive growth, decent job creation, and economic empowerment.


Theatre – whether in the form of an 'adaptation' or not – is theatre. Following much of the current critical literature on film adaptations (e.g. Bortolotti and Hutcheon, 2007; Leitch, 2008; Hutcheon, 2006), in this paper I am therefore rejecting as far as possible any sort of 'fidelity discourse', i.e. that the stage adaptation should be 'faithful' to its novel sourcetext in terms of plot, characters, dialogue and resolution, or even, arguably, in 'theme' or spirit. In some ways a stage adaptation, as a recontextualisation in a new medium, cannot be faithful to its sourcetext, in part because of the 'epistemological commitments' (Kress, 2003) of theatre. More interestingly and constructively, I argue that because of theatre's multiple and enriching 'affordances' (Bezemer and Kress, 2008), many of which are not shared with the novel, it should not even try. I illustrate this with two non-deferential stage adaptations of Kafka's Metamorphosis, to both of which the affordance of digitalisation is key. In one, a small TV-like screen facilitates representations of interiority (long seen as a challenge for theatre). In the other, sophisticated and extensive digital projection allows abstract and concrete images which go beyond visual enhancement of the mise en scene to foregrounding aspects of this particular retelling, and which give an appropriate nod to modernity and, in both the narrow (e.g. technological) and broad senses, to the value of change.


The NHS must be transformed into a patient centred culture with "zero tolerance" for patient harm and criminal sanctions for failure to provide safe care, a landmark report into one of the health service's biggest scandals has recommended.1

The public inquiry into Mid Staffordshire NHS Foundation Trust found failures at every level up to and including the Department of Health, which together allowed "terrible and unnecessary suffering" by patients to go undetected for years.

The trust, which ran Stafford and Cannock Chase hospitals, was intent on meeting targets set by the NHS and qualifying for the status of foundation trust, focusing on corporate governance and financial control. But patient safety and care were ignored, and there were nearly 500 excess deaths between 2005 and 2008, although signs that should have raised concerns were present years before.

Patients "were failed by a system which ignored the warning signs of poor care and put corporate self interest and cost control ahead of patients and their safety," said inquiry chairman Robert Francis QC.

"There was an institutional culture in which the business of the system was put ahead of the priority that should have been given to the protection of patients and the maintenance of public trust in the service."

Patients' voices were not heard, local GPs failed to raise concerns, primary care trusts did not have the tools to ensure the quality of the services they were buying, the strategic health authority defended trusts rather than …


Botticelli's Lehman Annunciation, a widely admired but seldom studied painting, is constructed in a unique fashion. The painter transferred the fully developed composition from paper onto his panel by means of inscribing the details of the architectural structure with a stylus into the soft gesso. Though he often used this technique to set the general framing or placement of figures he never previously drew the entire composition in detail on the panel. This decision suggests that he was intent on the precise placement of each line in the architectural frame. The golden section, an irrational proportional relationship between two unequal dimensions, may have been partly responsible for Botticelli's method. The dimensions of the composition as well as the placement of other elements of the architecture reflect the mathematical proportions of 1:1.618, the numerical statement of the ratio. The golden section had been known in the Quattrocento as an incidental part of Euclid's Elements but was not separately published until Luca Pacioli's De divina proportione of 1509. Prior to Botticelli's Annunciation it had not appeared in paintings, efforts to prove the contrary notwithstanding. Its use here was apparently the result of a connection between Botticelli and Pacioli in Florence in 1492, a firm date for the previously undated painting. Pacioli, a Franciscan monk, believed that the golden section was an expression of the ineffable nature of God, thus his name 'divine proportion'. Botticelli, in the sway of the charismatic mathematician, seized on the proportion as a way of expressing visually the miracle of the creation of the Son of God.


The purpose of this study was to identify principals' leadership styles in secondary schools in Sri Aman, Sarawak. Two secondary schools from urban and rural area were selected for the study. Data were collected using questionnaire and interview techniques. The questionnaire was distributed to a total of 188 randomly selected teacher respondents and 155 questionnaires were returned. Data were analysed using descriptive and inferential statistics. The principals' leadership styles of this study are idealized influence-attribute, idealized influence-behaviour, inspirational motivation, intellectual stimulation, individualized consideration, contingent reward, management by exception active, management by exception-passive, laissez-faire leadership, extra effort, effectiveness, and satisfaction. The data reveals that transformational leadership components were practiced at a frequent level by principals. On the other hand, transactional leadership components were still practiced by principals but at a moderate level and principals show low interest in incorporate Laissez-Faire leadership. Furthermore, teachers' gender, and secondary schools' location do not influence the level of leadership behaviours components practiced by principals. Additionally, teachers from different years in service perceived that principals' leadership behaviour increases when teachers' year in service increase, for example, principals' idealized influence attribute, Laissez-Faire leadership, effectiveness and satisfaction. But in overall, there were no significant difference of others principals' leadership behaviours. Besides, teachers from different teaching departments perceived that although the principals' leadership behaviours were frequently practiced, different teaching departments may have different needs and focus depending types of principals' leadership behaviours. Finally, principals were reported practiced both transformational and transactional leadership with transformation leadership was highly practiced in compared to transactional leadership components. Based on the findings, this study also provides recommendations for improvement of practices and future research.


Discover the power of Kaizen to make lasting and powerful change in your organization. "Maurer uses his knowledge of the brain and human psychology to show what I have promoted for the past three decades-that continuous improvement is built on the foundation of people courageously using their creativity. Kaizen is much more than a world-class management practice; it is a technique to remove fear from our mind's mind, enabling us to take small steps to better things. The process of change starts with awareness and desire in our minds and then leads to action and change in the physical world. Readers of this book will surely find new ideas and encouragement to make improvements in personal health, performance at work, and their own well-being." (Masaaki Imai, Chariman, Kaizen Institute KAIZEN: The Small-Step by Step Solution for You and Your Company). Today's businesses love the idea of revolutionary, immediate change. But major "disruptive" efforts often fail because radical change sets off alarms in our brains and shuts down our power to think clearly and creatively. There is, however, a more effective path to change. Change that is lasting and powerful. Change that begins with one small step...It's "The Spirit of Kaizen" - a proven system for implementing small, incremental steps that can have a big impact in reaching your goals. This step-by-step guide from renowned psychologist and consultant Dr. Robert Maurer shows you how to: lower costs - by offering little rewards; raise quality - by reducing mistakes; manage difficult people - one step at a time; boost morale and productivity - in five minutes a day; implement big ideas - through small but steady actions; and sell more - in less time. Filled with practical tips and ready-to-use tools for managers, innovators, and entrepreneurs, "The Spirit of Kaizen" is the essential handbook for a changing world. You'll learn how to think outside the suggestion box, remove mental blindfolds, manage stress with one-minute exercises, and handle rising health-care costs. You'll discover the "small step" secrets for dealing with all kinds of people, from tough bosses and listless workers to stubborn clients and fussy customers. These simple but powerful techniques can be applied to almost any workplace situation, especially when you're trying to navigate the stormy waters of radical change, high-pressure deadlines, and cut throat competition. These are the same methods of small, continual improvement that have been tested by the largest companies, such as Boeing, Toyota, and the U.S. Navy-methods that will work for you, too. No matter how big the obstacle or how big the dream, "The Spirit of Kaizen" has a small-step solution to help you succeed.


This paper considers both synchronous and asynchronous consensus algorithms with noisy measurements. For stochastic approximation based consensus algorithms, the existing convergence analysis with dynamic topologies heavily relies on quadratic Lyapunov functions, whose existence, however, may be difficult to ensure for switching directed graphs. Our main contribution is to introduce a new analytical approach. We first show a fundamental role of ergodic backward products for mean square consensus in algorithms with additive noise. Subsequently, we develop ergodicity results for backward products of degenerating stochastic matrices converging to a 0-1 matrix via a discrete time dynamical system approach. These results complement the existing ergodic theory of stochastic matrices and provide an effective tool for analyzing consensus problems. Under a joint connectivity assumption, our approach may deal with switching topologies, delayed measurements and correlated noises, and it does not require the double stochasticity condition typically assumed for the existence of quadratic Lyapunov functions.


The overarching goal of this dissertation was to elucidate the psychosocial and behavioral determinants of medication nonadherence among African Americans with hypertension. One in three Americans in the United States has hypertension, and the prevalence of hypertension among African Americans is among the highest in the world. In addition to healthy behaviors such as following a low-salt and low-fat diet, getting regular exercise, and reducing stress, patients with hypertension must also adhere to antihypertensive medications. Poor medication adherence may be driven by psychosocial and behavioral factors; however, the impact of these factors on medication adherence is unclear especially within the African American community. To date, a paucity of research has examined the relationship between psychosocial and behavioral factors such as reported racial discrimination, John Henryism (a measure of active coping and an unhealthy response to stress) and home remedies with medication nonadherence. However, each of these factors has individually been linked with poorer health outcomes among African Americans. Using data from the TRUST study (2006-2008) the association between these constructs and medication adherence was assessed within our sample of 788 African Americans and a comparison group of 137 White participants with hypertension. Ordinal logistic regression was used to assess the association between racial discrimination, John Henryism, home remedies, and medication adherence. The findings from this research indicated more reported racial discrimination, higher John Henryism scores, and greater use of home remedies were associated with lower medication adherence. These findings yield new knowledge about medication adherence and provide practical insights about the psychosocial and behavioral determinants of medication adherence.


A complete understanding of the physical-chemical mechanism and underlying genetic control of wheat (Triticum aestivum L.) endosperm texture will contribute to defining optimal grain utilization while assisting the breeding and development of new cultivars. World trade in wheat grain primarily is based on the two main market classes, soft and hard, which are mostly determined by the expression of the puroindoline genes at the Hardness (Ha ) locus. Here we identify and characterize new genetic stocks (near isogenic lines, NILs) in four different genetic backgrounds (20 NILs total, nine hard and 11 soft). Methods included identifying homogenous or mixed texture lines by Single Kernel Characterization System and Near-Infrared Reflectance Spectroscopy. Puroindoline genes and Ha alleles were determined through nucleic acid sequence analysis. The four different genetic sources for NILs were (i) accessions of Gamenya' cultivar which were physical mixtures of hard and soft types, (ii) existing near-isogenic lines from the cultivars Heron and Falcon, (iii) advanced-generation backcross lines involving Paha' and 'Early Blackhull,' and (iv) Nugaines' and Early Blackhull Derivative'. The NILs reported here provide new genetic materials for the study of wheat grain texture and the effect of puroindolines and the Hardness gene on end-use quality. Two of the four sets of NILs possess the Gly-46 to Ser-46 Pinb-Dlb hardness allele which has not been previously available in NILs. The results corroborate a model of wheat grain texture that identifies two major hardness classes, as opposed to one that accommodates intermediate texture classes such as semi-hard and medium-soft. A direct role of the puroindoline proteins in conferring soft grain phenotype is supported; conversely, no genetic basis for intermediate hardness was found. Rather, intermediate hardness resulted from mixtures of the soft and hard classes.


A number of approaches for multiattribute selection decisions exist, each with certain advantages and disadvantages. One method that has recently been developed, called the Hypothetical Equivalents and Inequivalents Method (HEIM) supports a decision maker (DM) by implicitly determining the importances a DM places on attributes using a series of simple preference statements. In this and other multiattribute selection methods, establishing consistent preferences is critical in order for a DM to be confident in their decision and its validity. In this paper a general consistency check denoted as the Preference Consistency Check (PCC) is presented that ensures a consistent preference structure for a given DM. The PCC is demonstrated as part of the HEIM method, but is generalizable to any cardinal or ordinal preference structures. These structures are important in making selection decisions in engineering design including selecting design concepts, materials, manufacturing processes, and configurations, among others. The effectiveness of the method is demonstrated and the need for consistent preferences is illustrated using a product selection case study where the decision maker expresses inconsistent preferences.


Goals: The study has been initiated
in order to describe the epidemiological, clinical and etiological aspect of
the ascites. Patients and methods: This was a retrospective and
descriptive study on the patients with an ascite and followed at the medicine
department of Borgou departmental teaching hospital. Results: A total of
190 patients have presented an ascite or a hospital prevalence at 3.93%. A male
predominance has been observed with a sex-ratio at 1.7. The average age was
39.7 ± 13.9 years. The reason for consultation is dominated
by the increase of the abdominal volume (69.5%). The ascite fluid is
macroscopically yellow citrine. The cirrhosis (28.5%) and the heart diseases
(18.6%) were the most encountered causes of the ascites. Conclusion: The
etiologies of ascites are various and dominated by the hepatic cirrhosis and
the heart diseases.


This paper presents a "learning to learn" approach to figureground image segmentation. By exploring webly-abundant images of specific visual effects, our method can effectively learn the visual-effect internal representations in an unsupervised manner and uses this knowledge to differentiate the figure from the ground in an image. Specifically, we formulate the meta-learning process as a compositional image editing task that learns to imitate a certain visual effect and derive the corresponding internal representation. Such a generative process can help instantiate the underlying figure-ground notion and enables the system to accomplish the intended image segmentation. Whereas existing generative methods are mostly tailored to image synthesis or style transfer, our approach offers a flexible learning mechanism to model a general concept of figure-ground segmentation from unorganized images that have no explicit pixel-level annotations. We validate our approach via extensive experiments on six datasets to demonstrate that the proposed model can be end-to-end trained without ground-truth pixel labeling yet outperforms the existing methods of unsupervised segmentation tasks.


We used axillary buds as initial explants for hormone interaction studies required for in vitro cultivation of S. allagophylla. Callus production was achieved on gelled Murashige & Skoog medium (MS) supplemented with indole-3-acetic acid (IAA= 0.1 and 0.5 mg.l1 alone or combined with 6 benzylaminopurine) (BA= 0.01 and 0.1 mg.l-1). A hormone balance between IAA and BA that would encourage shoot bud development was not found. Nodal segments from axenic cultures grown in the presence of cytokinin (0.1 mg.11 of BA) without any auxin on MS medium with half-strength macronutrients were used as a standard explant source for subsequent experiments on optimum mineral culture media composition for S. allagophylla in vitro cultivation. We found that explants kept in vitro on gelled Gamborg et al. (B5) mineral composition culture medium showed better shoot and specially root growth than on MS medium. Comparisons of the ammonium and nitrate ratios of MS and B5 media indicate that B5 medium has a substantial reduced ammonium ion when compared to MS medium, as well as a lower total nitrogen level. The growth response pattern obtained in vitro may be evidence of the adaptation of this species to soils of poor mineral composition as found in the Brazilian cerrado, as well as an indication that nitrogen levels play a key role for S. allagophylla growth.


BACKGROUND
Falls in older people are common, leading to significant harm including death. Coroners have a duty to report cases where action should be taken to prevent future deaths, but dissemination of their findings remains poor.

OBJECTIVE
To identify preventable fall-related deaths, classify coroner concerns and explore organisational responses.

DESIGN
A retrospective systematic case series of coroners' Prevention of Future Deaths (PFD) reports, from July 2013 (inception) to November 2022.

SETTING
England and Wales.

METHODS
Reproducible data collection methods were used to web-scrape and read PFD reports. Demographic information, coroner concerns and responses from organisations were extracted and descriptive statistics used to synthesise data.

RESULTS
Five hundred and twenty-seven PFDs (12.5% of PFDs) involved a fall that contributed to death. These deaths predominantly affected older people (median 82 years) in the community (72%), with subsequent death in hospital (70.8%). A high proportion of cases experienced fractures (51.6%), major bleeding (35.9%) or head injury (38.7%). Coroners frequently raised concerns regarding falls risks assessments (20.9%), failures in communication (20.3%) and documentation issues (17.5%). Only 56.7% of PFDs received a response from organisations to whom they were addressed. Organisations tended to produce new protocols (58.5%), improve training (44.6%) and commence audits (34.3%) in response to PFDs.

CONCLUSIONS
One in eight preventable deaths in England and Wales involved a fall. Addressing concerns raised by coroners should improve falls prevention and care following falls especially for older adults, but the poor response rate may indicate that lessons are not being learned. Wider dissemination of PFD findings may help reduce preventable fall-related deaths in the future.


This paper reviews academic journal articles and scholarly books focusing on organizational creativity and constructs a schematic representation of the antecedents of organizational creativity, i.e. of the associated drivers and barriers. The literature on organizational creativity is reviewed using a traditional review technique. The focus is especially on more recent developments of the discourse, and therefore this work can be labeled as a state-of-the-art review. The review shows that drivers have clearly been studied more extensively than barriers. It was also recognized that the predominant approach among organizational creativity scholars is to dichotomize the factors influencing organizational creativity, more specifically to discuss the antecedents of creativity mostly from the viewpoint of drivers. In some cases, the antecedents are discussed from the perspective of barriers, but only rarely has it been recognized that the very same factor may either enhance or inhibit creativity. In this paper, such factors are called 'either-or factors'. The paper suggests that the organizational creativity discourse should acknowledge that it is not enough to understand what enhances organizational creativity but also which kind of issues inhibit it and, especially, which factors may work either against or toward creativity under different circumstances. The review suggests that the majority of factors are most likely either-or by nature, although it has been overlooked in the discourse due to the dichotomizing tendency.


Background: Meticulous risk stratification for contrast-induced nephropathy (CIN) is important for patients with ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PPCI).
Aim of the work: To compare between different risk scores for predicting contrast-induced nephropathy (CIN) and short outcome after primary percutaneous coronary intervention in patients with ST segment elevation myocardial infarction.
Materials and methods: We prospectively enrolled 100 patients who presented with STEMI and treated with Primary PCI. Mehran, Gao, Chen, ACEF or AGEF (age, serum creatinine, or glomerular filtration rate, and ejection fraction); and GRACE (Global Registry for Acute Coronary Events) risk scores were calculated for each patient. The predictive accuracy of the 6 scores for CIN, in-hospital death and major adverse clinical events (MACEs) were assessed by Receiver operating characteristics (ROC) curve. CIN was defined as an absolute increase of serum creatinine by ≥ 0.5 mg/dl or a relative increase of serum creatinine by ≥ 25% from baseline value, at 48-72 h following the exposure to contrast media (CM). The data was analyzed using Chi-square test using SPSS (Statistical package for social science) software.
Results: All risk scores had relatively good predictive accuracy for CIN (Area under the curve (AUC) ranged from 0.671 to 0.829) and performed well for prediction of in-hospital death (AUC ranged from 0.838 to 0.973) and MACEs (AUC ranged from 0.815 to 0.926). The Mehran and Gao risk scores had better predictive accuracy for CIN. While Mehran and GRACE risk scores had better predictive accuracy for in-hospital death and MACEs.
Conclusion: Risk scores for predicting CIN perform well in stratifying the risk of CIN, in-hospital death and MACEs in patients with STEMI undergoing PPCI. The Gao, Mehran risk scores appear to have greater predictive value for CIN. While GRACE and Mehran scores had highest predictive accuracy for in hospital death and MACEs than the other risk scores.


Section I of this article briefly describes both the theoretical and historical origins of American direct democracy. Next, it completely categorizes the set of processes that together comprise the domain of direct democratic law making vehicles. These include both direct and indirect methods as well as mechanisms that provide for the modification of both statutory and constitutional law. Next, this section uses these classifications to describe current trends in citizen involved law-making.Prior research demonstrates an overall increase in use of direct democratic processes. This article, however, breaks new ground as it uses nearly three decades of empirical data, collected specifically for this article, to demonstrate that where available, the Direct Constitutional Initiative (DCI) is rapidly becoming the process of choice for the participants in direct democracy. In other words, at least within the sixteen DCI states the direct democracy phenomenon should be best understood as constitutional in dimension.To better understand the micro-foundations of this important empirical finding, Section II of the article reviews institutional rules of the relevant jurisdictions, comparatively considering the requirements for the proposal and ratification of direct constitutional and statutory changes. It finds that the institutional rules displayed in Direct Constitutional Initiative jurisdictions incentivize individuals and groups seeking a substantive policy change to select that approach.Both the empirical findings and the analysis of the incentive structure motivate Section III where the article evaluates the increased use of the Direct Constitutional Initiative. The section begins by reviewing the legal literature that considers the judicial review of direct democracy. This literature finds that judicial officials may be unwilling or unable to police direct democracy and in particular constitutional direct democracy. Drawing upon a host of interdisciplinary scholarship, Section III then presents critiques of not only direct democracy but also its role in constitutional change. Namely, this extant literature cautions against unnecessary constitutional change and cementing temporal proposals.Applying these lessons, this article does not directly consider substantive outputs of constitutional direct democracy. Instead, it focuses upon a set of procedural elements that would, at a minimum, both clearly demarcate constitutional and statutory change and help the Direct Constitutional Initiative embrace robustly supported institutional proposals. To do this, it surveys the nation for a set of best direct democratic practices that together may yield an optimal method of constitutional modification. In all, it seeks a process that takes state constitutions seriously and treats them as the supreme level of American state law.


Brazilian legal education is engaged since 1994 in a long and inconclusive process of curriculum reform in which the Brazilian Bar Association (Ordem dos Advogados do Brasil) has been one of its greatest players. The transformations undertaken in legal education in the last two decades, were buoyed by three things: (a) the redemocratization of the country, completed in 1988 with the promulgation of the new Constitution, (b) the expansion of higher education, which resulted in a amount of more than half of a million law students, and (c) the protection of interests of the lawyers' corporation, even though it has been done under the argument of a genuine defense of a minimum level of quality for the Brazilian legal education. Interestingly, all this reform process is done without any trace of dialogue with the Bologna process and rarely integrating the challenges of a legal practice increasingly internationalized. This article proposes a critical review of the incomplete process of legal education reform, seeking to understand how, despite its original purposes, it has been imprisoned on the one hand, by the corporate share of the Brazilian Bar Association and on the other hand, by the reproduction of old practices in the teaching of Brazilian law. Finally, between the reproduction of the past and the uncertainty of the future, Brazilian legal education is facing a broad challenge that goes beyond the definition of its curriculum structure. In short, rethink the foundations of its access, the parameters of its offer and the importance of its social impact is undoubtedly a necessity to adequately speculate about the future of Brazilian legal education.


Abstract Alan Westin's work Privacy and Freedom remains foundational to the field of privacy, and Westin is frequently cited for his definition of privacy as control over personal information. However, Westin's full definition of privacy is much more complex than this statement, describing four states of privacy (solitude, intimacy, anonymity, and reserve) that one achieves through physical or psychological means. The "claim" of privacy involves negotiating a balance between a desire for disclosure and social participation and a desire for withdrawal into one of the "states" of privacy. Influencing this adjustment process are social norms (and surveillance to enforce social norms), environmental conditions, and the curiosity of others. In this Article, I draw upon this complexity in order to reread Westin's definition of privacy as a claim of control over personal information and use this rereading to understand how the law should protect and promote privacy in the twenty-first century. I argue that the law should focus on securing meaningful privacy choices rather than on individual control over personal information. Meaningful choice requires that our informational infrastructure, and the social practices that it enables, make states of privacy available for choice along with the means of attaining them. To enable such meaningful individual choice, we need to shift our attention from a focus on individuals to a more systemic focus on our public norms and built infrastructure. Otherwise we risk protecting a narrow understanding of individual control, while ignoring a more general and systematic erosion of privacy.


This report describes the method used by the U.S. Geological Survey to determine the magnitude and frequency of momentary peak discharges at any place on a stream, whether a gaging-station record is available or not. The method is applicable to a region of any size, as a river basin or a State, so long as the region is hydrologically homogeneous. The analysis provides two curves. The first expresses the flood dischargetime relation, showing variation of peak discharge, expressed as a ratio to the mean annual flood, with recurrence interval. The second relates the mean annual flood to the size of drainage area alone, or to the size area and other significant basin characteristics. A frequency curve may be defined for any place in the region by use of these two curves. The procedure is: (a) measure the drainage area and other appropriate basin characteristics from maps; (b) from the second curve, select the mean annual flood corresponding to the proper drainage area factors; (c) from the first curve, select ratios of peak discharge to mean annual flood for selected recurrence intervals, as 2, 10, 25, and 50 years; and (d) multiply these ratios by the mean annual flood and plot the resulting discharges of known frequency to define the frequency curve. Two reports not previously given general circulation are included as sections of this report. These are "Plotting Positions in Frequency Analysis" by W. B. Langbein, and "Characteristics of Frequency Curves Based on a Theoretical 1,000-Year Record" by M. A. Benson.


Engen Refinery plant is part of the Engen Petroleum Limited, with operations in Southern Africa. The plant is situated in KwaZulu-Natal province of South Africa and it operates 24 hours a day, every day, including weekends. Although Engen operates 24 hours 7 days a week, the plant has to be shut down occasionally for maintenance. These shutdown periods are also used as an opportunity to implement most projects, especially those that could not be implemented during the normal run of the plant. In order to ensure that the plant operations are not interrupted, it is preferable to work on the equipment while the plant is not operational. The shutdown periods are very limited in time, so it is of utmost importance to complete tasks within the given turnaround period in order to get the plant back on line in time to deliver products as scheduled to customers. The main objective of this study is to explore the causes and consequences of delays in project execution and their impact on the success of the project. The study identified poor communication, repetition of tasks, resource allocation, scope change, procurement process management, inadequate planning and poor budget estimates as major contributors to delays and cost escalation during project execution. It is recommended that Engen Refinery put some means together to improve the above-mentioned issues.


The story of both a dramatic journey retracing the historic voyage of France's greatest 19th-century explorer up the mysterious Mekong river, and a portrait of the river and its peoples today. Any notion of sailing up the Mekong in homage to Francis Garnier has been unthinkable until now. From its delta in Vietnam up through Cambodia, Laos, Thailand, Burma and on into China, the Mekong has been a no-go river, its turbulent waters fouled by ideological barriers as formidable as its natural obstacles. But recently the political obstacles have begun to be dismantled - river traffic is reviving. John Keay describes the world of the Mekong as it is today, rehabilitating a traumatised geography while recreating the thrilling and historic voyage of Garnier in 1866. The French expedition was intended to investigate the 'back door' into China by outflanking the British and American conduits of commerce at Hong Kong and Shanghai. Two naval gunboats headed upriver into the green unknown, bearing crack troops, naturalists, geologists and artists. The two-year expedition's failures and successes, and the tragedy and acrimony that marked it, make riveting reading.


Fundamentally not requiring a vacuum chamber,atmospheric pressureglow discharges (APGDs) offer an exciting prospect for a wide range of material processing applications. To characterize their operation and establish their operation range, a radio frequency (rf) APGD is studied experimentally with measurement of discharge voltage, current, dissipated plasma power and plasma impedance. Different from the current understanding that rf APGD are operative only in the abnormal glow mode, we show the presence of two additional modes namely the normal glow mode and the recovery mode. It is shown that all three modes are spatially uniform and possess key characteristics of a glow discharge. So rf APGD have a much wider operation range than previously believed. To provide further insights, we investigate the transition from the abnormal glow mode to the recovery mode. It is established that the cause responsible for the mode transition is sheath breakdown, a phenomenon that is known in low- and moderate-pressure glow discharges but has not been reported before for atmospheric-pressure glow discharges. Finally we demonstrate that plasma dynamics, hence plasma stability, in these three modes are influenced crucially by the impedance matching between the plasma rig and the power source.


Climate change is one of the potent challenges facing smallholder farmers in sub-Saharan Africa in the recent past owing to the pattern and magnitude with which it presents the extreme events such as floods and drought. This review finds a general consensus that climate change is already happening in the region and the projections in the early, mid and end century all point to a much warmer future with highly variable rainfall across the region. These patterns in climate parameters is expected to trigger a negative trend in agricultural production for most food and cash crops in SSA. However, a few locations particularly the highland locations over eastern Africa will be expected to become more suitable for the production of some cereals such as maize leading to increased production. Overall, at present and in the future unless strategic interventions are judiciously implemented smallholder farmers in SSA produce below the optimal levels with considerable yield gaps in nearly all the cereals, legumes and tubers grown. Efforts to unlock the potential of smallholder farmers under the current and projected climate change situation ought to focus on strategic and systemic implementation of; options that yield multiple benefits such as climate smart agriculture, investing in capacity building at both technical and farmer level, creating multiple opportunities for investment capital including availing smallholders with credit as well as mobilizing private financing. Further, investing at the development of functional early and early warning systems, investing in agricultural value chains through a strategic focus on agribusinesses and gaining and strengthening political commitment through a focus on policy and governance in agricultural frameworks and processes. Finally, a no-one fit for all paradigm ought to be upheld at all time while dealing with smallholder farmers in SSA owing to the dynamic and complex farming systems under which they operate.


This paper examines cyclical changes in comparative subclauses, showing how operators are reanalysed as complementisers via the general mechanism of the relative cycle, and how this is related to whether certain lexical elements have to be deleted at the left periphery. I also show that only operators appearing without a lexical XP can be grammaticalised, which follows from the nature of the formal features associated with the various operator elements. Though the main focus is on Hungarian historical data, the framework can be applied to other languages too, such as German and Italian, since the changes stem from general principles of economy.


This paper describes the use of a board game, Civil War, as a learning experience in the context of a course on critical theory. Civil War was created by the Educational Games Company of Lebanon and is set during the 1975-1990 Lebanese civil war. The game functions both as a pedagogical instrument, in that players learn about the situation in Lebanon while playing the game, but also as a form of critique, in that its makers are clearly using it as a means of articulating their lived experiences and challenging the dominant narratives around the conflict. We suggest that the game is a rare example of one that is counter ideological in nature, as rather than perpetuating stereotyped views of Middle East conflicts that are constructed and imposed from outside, it instead directly presents the experience of those who are inside. A case study of using the game in the context of a class on postcolonialism is presented and responses by students are analysed. We argue that the active experience of playing a board game is an effective way of engaging students with a topic, and in this case in particular, an effective way of connecting them with the lived experiences of others.


Background and purpose: Suicide is one of the most important social issues and a major cause of mortality in Iran. This study was conducted to evaluate the factors associated with suicide deaths in Eyvan, Iran. Materials and methods: Data of all registered suicide cases during 2005-2011 in Eyvan was obtained from the suicide registry in Ilam province. Chi-square test was used to evaluate the relationship between qualitative variables, and logistic regression multivariate analysis was performed to assess the association between potential risk factors and suicide. Results: In this cross-sectional study, a total of 820 cases (mean age: 24.9±9.7 years), including 395 (48.2) males and 425 (51.8) females, had attempted suicide. Suicide resulted in death in 56 (7.1) cases. The majority of the study population were single (64) and about 50 were unemployed. The most common methods of suicide were drug poisoning and self-immolation. There was a significant relationship between marital status, educational level, method of suicide, age (P<0.01), and time of the event (P<0.05) and the suicide outcome. Risk of death due to suicide was four times higher in married individuals, compared to single ones. Moreover, illiterate individuals were 80 more likely to die after suicide, compared to literate ones. Suicide through self-immolation caused death 12 times more than that of agricultural pesticides. Conclusion: According to this study, suicide is a serious problem in Eyvan district. Risk of death due to suicide was found to be higher in married and illiterate individuals, as well as those who committed suicide through self-immolation. These results could be of great use for taking preventive measures. © 2017, Mazandaran University of Medical Sciences. All rights reserved.


As embedded computing evolves towards ever more powerful architectures, the challenge of properly interconnecting large numbers of on-chip computation blocks is becoming prominent. Networks-on-chip (NoCs) have been proposed as a scalable solution to both physical design issues and increasing bandwidth demands. However, this claim has not been fully validated yet, since the design properties and tradeoffs of NoCs have not been studied in detail below the 100 nm threshold. This work is aimed at shedding light on the opportunities and challenges, both expected and unexpected, of NoC design in nanometer CMOS. We present fully working 65 nm NoC designs, a complete NoC synthesis flow and detailed scalability analysis


Malaysia is one of develop country with wide activity in agricultural industry which produce abundance of agricultural by-product that may cause environmental pollution. Decreasing in the availability of topsoil and the effect of soil-borne disease to the plant has been a huge issue for the most of the planters. Thus, the used of agricultural by-products such as Empty Fruit Bunch (EFB), Coconut Husk (CH), Rice Husk (RH), and Sawdust (SD) as growing media shows a reliable positive impact to the environment and cost-effectiveness in order to recycle and reutilize the waste. The growth performance including plant height, leaf length and leaf width was measured on weekly basis. While the data on root length, pH of the medium, salinity of the medium and nutrient analysis for leaf and medium were taken at the end of the study. The result form the descriptive data shows that RH shows better as growing media based on the growth performance, plant biomass as well as the nutrient content compared to other growing media. However, the Analysis of Variance (ANOVA) shows that there was no significant difference among the growing media. In the other hand, nutrient content of growing media analysis shows there was a significant different among the availability of nutrient except for K-availability (p=0.228). Since there was no significant difference among the growing media, the best growing media was determined based on the cost effectiveness in producing the growing media. EFB has the lowest cost and the growth performance of oil palm seedling was higher compared to CH and RH. Thus EFB is the most suitable as growing media.


Chromium martensitic hot-work tool steel (AISI H13) is commonly used as die material in hot forming techniques such as die casting, hot rolling, extrusion and hot forging. They are developed to endure the severe conditions by high mechanical properties attained by a complex microstructure. Even though the hot-work tool steel has been improved over the years by alloying and heat treatment, damages still occur. Thermal fatigue is believed to be one of the most common failure mechanisms in hot forming tools. In this thesis tools used in hot forging and die casting were examined to determine damage, material response, thermal fatigue crack initiation and propagation. Different chromium martensitic hot-work tool steels, heat treated at four different austenitizing temperatures were experimentally tested in thermal fatigue and isothermal fatigue. The materials were then evaluated using X-ray line broadening analysis and transmission electron microscopy to explore the relation between fatigue softening and the change in microstructure. The high temperature fatigue softening was also simulated using an elasto-plastic, non-linear kinematic and isotropic model. The model was implemented in a numerical simulation to support the integration of die design, tool steel properties and its use. It was found that the dominant damage mechanisms in the investigated tools were thermal fatigue and that tool material experiences a three stage softening at high temperature loading. The primary stage was concluded to be influenced by the dislocation density and the second stage by the temper resistance i.e. carbide morphology. The microstructural changes during the softening stages were also connected to the non-linear kinematic and isotropic model. The general aim of this thesis is to increase the knowledge of the chromium martensitic hot-work tool steel damage, performance and microstructure.


A nonlinear PI controller for a system with a mismatched and unknown external disturbance is proposed in the present paper. A Sigmoidal function is proposed to be used in the nonlinear integral element to attenuate the disturbance effect. Formally the controller forces the state to a positively invariant set around the origin. As an application, the nonlinear PI controller is used as a virtual controller for the upper subsystem in the frame of Backstepping control approach for the DC motor system. In this Backstepping controller design the restriction about the disturbance form in the upper system is relaxed. The results show the effectiveness of the nonlinear PI controller to attenuate the effect of unknown and varying disturbance torque and force the angular velocity to follow the desired reference. Finally a reduced order observer is designed to estimate the armature current used in the designed controller for the DC motor system.


Vasileva, V. and A. Ilieva, 2017. Some physiological parameters in mixtures of cocksfoot and tall fescue with subterranean clover. Bulg. J. Agric. Sci., 23 (1): 71–75 Some physiological parameters (leafl et area, photosynthetic pigments) of subterranean clover, cocksfoot and tall fescue were studied in a fi eld trial in the Institute of Forage Crops, Pleven, Bulgaria (2011-2014). Three subspecies of subclovers – i.e. Trifolium subterraneum ssp. brachycalicinum (cv. Antas), Trifolium subterraneum ssp. yaninicum (cv. Trikkala) and Trifolium subterraneum ssp. subterraneum (cv. Denmark); and two grasses, i.e. cocksfoot (Dactylis glomerata L.) (cv. Dabrava) and tall fescue (Festuca arundinacea Schreb.) (cv. Albena) were grown purely and in mixture (a ratio of grass to subclovers 50:50%). From pure grown subclovers most leafl et area formed Trifolium subterraneum ssp. brachycalicinum (2.11 cm2), followed by Trifolium subterraneum ssp. yaninicum (1.98 cm2) and Trifolium subterraneum ssp. subterraneum (1.42 cm2). For the plastid pigments content subclovers were arranged as follows: Trifolium subterraneum ssp. brachycalicinum (300.18 mg/100 g FW), Trifolium subterraneum ssp. subterraneum (283.53 mg/100 g FW) and Trifolium subterraneum ssp. yaninicum (283.35 mg/100 g FW). Leafl et area of subclover was greater in mixtures with cocksfoot as compared to tall fescue. Total plastid pigments content (chlorophyll a+b and carotenoids) was found be higher in both components of the mixtures of cocksfoot with Trifolium subterraneum ssp. brachycalicinum (by 16.2% and 10.6%, respectively).


Physical inactivity among young people is a public health concern. Markers of physical inactivity, such as low cardio-respiratory fitness (CRF) and obesity are adversely related to higher order cognitive functions, which underpin goal directed behaviour (i.e. cognitive control) and are implicated in academic achievement. Regular aerobic exercise can benefit cognitive control in children. However, it remains unknown whether daily physical activity behaviour is associated with cognitive control. Investigating this is important as targeting increments in daily moderate-to-vigorous physical activity (MVPA) may initially be a more realistic policy goal than developing aerobic exercise interventions. Nominal number of studies assessed this relationship using objective monitoring of physical activity (accelerometry), and yielded mixed results. None of the studies into objectively measured physical activity and cognitive function in young people controlled for CRF, which is posited to mediate the relationship between regular aerobic exercise and cognitive control. Likewise, other important confounders such as intelligence, have yet to be addressed in the literature. Moreover, it is unknown whether this relationship varies with age, as extant studies looked solely at younger adolescents. For example, meta-analytical findings (Fedewa & Ahn, 2011) suggest that children can benefit more cognitively from CRF and chronic aerobic exercise than adolescents as greater effect sizes have been observed for younger compared to older youngsters. Alternatively, chronic aerobic exercise may be specifically needed for cognitive benefits to emerge. However, none of the aerobic exercise interventions included objective assessments of baseline physical activity and few studies assessed the effects of chronic aerobic exercise interventions on multiple indices of cognitive control. This thesis aimed to address the limitations of previous research and to investigate: 1) the associations between objectively measured daily MVPA and cognitive control in older adolescents (study 1), and 2) in preadolescent children (study 2), while controlling for CRF, general intellectual ability and a number of important confounders (e.g. adiposity, attention-deficit hyperactivity disorder); 3) the relationship between daily MVPA and academic achievement (study 2); 4) the effects of chronic aerobic exercise intervention on cognitive control in children, while controlling for objectively measured daily MVPA and time sedentary at baseline (study 3).
Methods: Study 1. A sample of 667 adolescents (Mage = 15.4, SD = .17, 55.5% girls) from the Avon Longitudinal Study of Parents and Children was included in the analyses. MVPA was measured with ActiGraph, GT1M accelerometer. CRF was assessed with sub-maximal cycle ergometer test and expressed as weight adjusted predicted physical work capacity at the heart rate of 170 beats per minute (PWC-170). Attentional control was measured with Stop Signal task. Study 2. A sample of 81 children (Mage = 8.64 years, SD = .57, 45.7 % girls) was included in the analyses. MVPA was objectively measured using the ActiGraph, wGT3X+ accelerometer. CRF was measured using a maximal graded exercise test on a treadmill. Inhibitory control was assessed with a modified Eriksen flanker task, working memory with Operation Span Task; and academic achievement with Kaufman Test of Educational Achievement. Study 3. 32 children (Mage = 8.64, SD = .58, 56.2% girls) were randomised into a physical activity intervention (FITKids2) or a waitlist control group. Changes in VO2max were measured using a maximal graded treadmill exercise test and changes in MVPA were objectively monitored for 7 days using the ActiGraph, wGT3X+ accelerometer. Behavioural measures of inhibition (reaction time, and accuracy) and working memory (accuracy) were taken using computerised laboratory tasks (modified Eriksen flanker task and Operation Span Task).
Results: Study 1. MVPA was not significantly related to cognitive processing speed or variability of cognitive performance in hierarchical linear regression models. In simple regression models, CRF was negatively related to mean RT on the simple go condition (R2 = 2.6%, F(1, 308) = 8.28, p = .004). Study 2. No significant associations were noted between MVPA and either inhibition, working memory, or academic achievement. In contrast, CRF explained 4.7% of variance in accuracy interference (∆R2 = .047, p = .045; β = -.22, t(78) = 2.03, p = .045, F(2, 78) = 4.95, p = .009). Study 3. FITKids2 physical activity intervention had a positive effect on the speed of responding during incongruent condition of flanker task (F(1, 30) = 4.69, p = .038, ƞp2 = .13). A significant increase in BMI percentile was observed in the control (Z = 2.17, p = .03) but not in the intervention group (p = .53).
Discussion: Study 1. Our results suggest that aerobic fitness, but not MVPA, was associated with cognitive processing speed under less cognitively demanding task conditions. The results thus indicate a potential global effect of aerobic fitness on cognitive functions in adolescents but this may differ depending on the specific task characteristics. Study 2. The results of this study suggest that CRF but not objectively measured MVPA was associated with better interference control in preadolescent children. Given the intermittent nature of children s daily MVPA, it is possible that aerobic exercise, which increases CRF is needed for cognitive benefits to emerge. Study 3. FITKids2 after-school physical activity intervention had a positive effect on children s inhibitory control, namely this cognitive function, which is closely related to academic achievement and future job and health outcomes. Thus, the results of this study convey a positive public health message, where promoting child s engagement in aerobic exercise can engender benefits to their cognitive function.
Conclusions: The findings from this thesis can inform development of physical activity interventions to benefit cognitive functions in young people and contribute to the evidence base to inform future health and educational policies.


ABSTRACT During the fall, hundreds of thousands of Eared Grebes (Podiceps nigricollis) stage on the Great Salt Lake, Utah. Mortalities resulting from birds being forced to the ground (downings) during migration occur every few years. A large (>7,000 birds) die-off of migrating Eared Grebes occurred 12 December 2011 in and around Cedar City, Utah. We examined body condition, age, sex, and heavy metal concentrations among downed birds and those that still occupied the Great Salt Lake both pre- and post-downing. Eared Grebes that we collected pre-downing were heavier (523 g) than deceased birds (433 g). Body weight (g) and subcutaneous fat thickness (mm) were lower in downed birds than pre-downing birds, likely the result of the 400-km flight from the staging area to Cedar City. Liver, heart, and intestine weights were all significantly greater in both pre- and post-downing birds than downed birds. This may be because of tissue catabolism during flight or incomplete physiological changes before migration. Adult biased age ratios were observed in all groups but pre-downing (34 adults: 5 juveniles) and post-downing (39: 2) groups were less biased than the downed group (100∶ 1). Mercury and selenium wet weight concentrations in all groups were above the level observed to impact some birds' reproduction and locomotion. Mercury concentrations in the liver ranged from 4.4–25.8 ppm wet weight and mercury concentrations measured in birds collected pre- and post-downing were lower than downed birds. Despite high levels of mercury and selenium, no adverse effects of heavy metal contamination have been noted in studies of Eared Grebes on the Great Salt Lake. Weather was likely the proximate cause of the downing, but impacts of heavy metal toxicity should be examined further to determine their effect on migrating Eared Grebes.


National Oceanic and Atmospheric Administration (NOAA) annually collects and chemically analyzes sediment samples from sites located in coastal marine and estuarine environments throughout the United States as a part of the National Status and Trends (NS&:T) Program. While the chemical data provide indications of the relative degrees of contamination among the sampling sites, they provide neither a measure of adverse biological effects nor an estimate of the potential for effects. Data derived from a wide variety of methods and approaches were assembled and evaluated to identify informal guidelines for use in evaluation of the NS&:T Program sediment data. The data from three basic approaches to the establishment of effects-based criteria were evaluated: the equilibriumpartitioning approach, the spiked-sediment bioassay approach, and various methods of evaluating synoptically collected biological and chemical data in field surveys. The chemical concentrations observed or predicted by the different methods to be associated with biological effects were sorted, and the lower 10 percentile and median concentrations were identified along with an overall apparent effects threshold. The lower 10 percentile in the data was identified as an Effects Range-Low (ER-L) and the median was identified as an Effects Range-Median (ER-M). Note that these ER-L and ER-M values are not to be construed as NOAA standards or criteria. The ambient NS&:T Program sediment data from sampling sites were compared with the respective ER-L and ER-M values for each analyte. The comparisons were used to rank sites with regard to the potential for adverse biological effects, assuming that the sites in which tlie average chemical concentrations exceeded the most ER-L and ER-M values would have the highest potential for effects. The rankings indicated that a sampling site located in the Hudson-Raritan estuary had the highest potential for effects, followed by a site located in Boston Harbor, a site located in western Long Island Sound, and a site located in the Oakland estuary of San Francisco Bay. ·


Introduction An Associated Press Poll released on the eve of the 2012 presidential election revealed that more Americans are overtly racist today than four years ago. (2) The implicit conclusion that many pundits made was that a black president caused more racial divisiveness, not less, than a white one. This is a particularly troubling paradox considering the wide-spread editorializing of the Obama presidency as the advent of a prejudice neutral era of post-racialism in America. This poll is also particularly troubling given the results of a recent study that found a greater number of white Americans feeling that they are victims of racism than blacks. (3) Both of these studies collectively reveal a complex development in the political, historical, and psychological landscape of the United States that would be best analyzed by academically trained experts on race rather than political pundits. These perspectives however, whether legitimate or not, have certainly influenced the political process and leadership agenda of the nation. For example, in 2009, House Republicans accused President Barack Obama of "leading from behind," in reference to his preference for Congress to be proactive in the process of legislative reform. Obama's background as a professor of constitutional law and his criticisms of the Bush Administration's expansion of executive power have certainly impacted his deference to the legislative branch. Obama is one of the few presidents (alongside Warren Harding and Abraham Lincoln) to be accused of not taking a hands-on role in the leadership of the nation while at the same time being accused by his adversaries as being overbearing. (4) Lincoln, considered one of the greatest American presidents, drew criticism during his day for suspending habeas corpus during the Civil War but he was also criticized by generals for his lack of leadership prior to 1863 on the emancipation question. Harding, considered by many to be one of the worst presidents, was characterized as being a weak leader for allowing his appointees to engulf the government in a series of scandals but was also criticized for his unpopular progressive views on civil rights and his "civic booster" approach to economic matters that put him at odds with the laissez faire mentality of his party. (5) Obama's presidency is likely to fall somewhere between these two extremes when historians looking back write the chapters of his story. However, we can be certain that race will play a key role in the chronicle of his leadership. It will be a challenging undertaking for chroniclers less adept in the parlance of structural racism to assess whether the difficulties Obama encountered were politics as usual or unique challenges of African American leadership maneuvering the landscape of race in a "post-racial" era. Paradoxically, many blacks today view the Obama presidency as not doing enough for black constituents while simultaneously he has been assiduously criticized by a white conservative segment of the electorate as catering only to the needs of blacks and Latinos. Despite one's perspective on this question, the characterization of "leading from behind" is an appropriate metaphor for another phenomenon--a gap of difference and distance in American politics and black leadership. Black leaders in the era of post-racialism face higher expectations from increasingly diverse constituencies that put them in power but face these challenges without adequate resources or mechanisms to address them. Well aware of these challenges, growing numbers of Black Studies academics have been very critical of Obama's leadership, citing his disregard for a black policy agenda amidst of a variety of other complaints. (6) Leading the chorus of criticism, public intellectuals like Cornet West, Eddie S. Glaude, Jr., and Tavis Smiley have bemoaned the lack of targeted policies to address systematic injustices perpetuated against communities of color in general and black communities in particular. …


OBJECTIVE
To systematically review the evidence on the efficacy, safety, and cost-effectiveness of urate-lowering therapy for gout: xanthine oxidase inhibitors (allopurinol and febuxostat), uricosuric medications (benzbromarone, probenecid and sulfinpyrazone), and uricases (pegloticase and rasburicase).

METHODS
A systematic review was performed as part of the 3e (Evidence, Expertise, Exchange) Initiative on Gout. The primary efficacy outcomes were frequency of acute gout attacks, study participant withdrawal due to adverse events, and cost-effectiveness. Serum urate-lowering was a secondary outcome and was the most commonly reported outcome in the included trials.

RESULTS
The search identified 17 articles for efficacy, 31 for safety, and 3 for cost-effectiveness. The main outcome described in these studies was serum urate-lowering. Allopurinol, febuxostat, and pegloticase are all effective at lowering serum urate compared to placebo and febuxostat (≥ 80 mg) was more effective at lowering serum urate than allopurinol. Compared to probenecid, benzbromarone was more effective at lowering serum urate. Regarding acute gout attacks, pegloticase and febuxostat (≥ 120 mg) resulted in more acute attacks than placebo. Regarding the primary safety outcome, more withdrawals due to adverse events were seen only when pegloticase was compared to placebo. The two trials of cost-effectiveness were inconclusive.

CONCLUSION
There is currently moderate quality data supporting the efficacy and safety of allopurinol, febuxostat, benzbromarone, and probenecid in gout. Pegloticase, while efficacious, is associated with more withdrawals due to adverse events and infusion reactions. There is insufficient evidence currently with respect to the cost-effectiveness or the most optimal sequencing of urate-lowering therapy.


Considerable resources are being devoted to tracking an exponential increase in the
number of voluntary ethical sourcing initiatives which promote objectives reflecting
principles in the Universal Declaration of Human Rights, the ILO Declaration on
Fundamental Principles and Rights at Work, or related practices. So far, the emphasis
has been more on which principles are endorsed and on arrangements for verification
of application. This includes statements on worker health and safety. Most of these
statements, however, remain general and refer to codes of practice in which
engineered or `scientific' monitoring systems are used to promote and verify a safe
product more than a healthy and safe work environment. Few statements address how
such standards are governed, whether they extend beyond the remit of the factory
floor, or how they address workers' own short and long-term health concerns.

By contrast, comparatively less emphasis is placed on understanding the management
methods, priorities and definitions such rights-based initiatives use to give effect to
their labor policy objectives, or to ascertain whether their objectives are attainable in
practice. Even less is known about the extent to which the scope of the application is
being enlarged to include appropriate and relevant issues and stakeholders. This
includes worker health and well-being issues and their relevant stakeholders,
including government bodies and institutions, and the extent to which they are
fulfilling their own remit in this application. Finally, knowledge is especially scant
about the way in which actors, particularly in developing countries, prioritize, implement and govern these worker health standards and how relevant in context or
beneficial they are to worker welfare.

The overarching aim of this thesis, therefore, is to consider how both the methods and
the purpose of ethical sourcing can lead toward establishing an ethic with which to
apply rights-based frameworks. Qualitative research was carried out to describe and
identify the opportunities and challenges implicit in promoting a right to health and
well-being for workers in transnational supply chains, particularly within the Kenyan
floriculture supply network. The objectives of the research reflect on: a) definitions
of ethics, human rights, health and well-being and the way they are being described in
current ethical sourcing trends; b) the benefits, tensions and ambiguities in
implementing worker health standards; and c) how and what worker health standards
should be governed.

The research primarily focused on a case study approach (Kenyan floriculture) to
explore the scope and involvement of stakeholders and the ways in which worker
health were interpreted and prioritized. Concepts emerged during the process of the
research and were analyzed using `grounded theory' (Glaser & Strauss 1967) as a
means to explore and explain key issues that contribute to the dilemmas and
opportunities of promoting ethical sourcing initiatives, particularly for worker health.
These categories of findings were then organized to ascertain the benefits, tensions
and ambiguities in promoting an ethic for applying human rights standards -- an ethic
that upholds a dynamic, comprehensive and democratic process in promoting worker
health and welfare. These data were then used to develop an analytical framework in
terms of viewing the scope and governance of worker health rights. Finally, key
recommendations are made on the opportunities and challenges of ethical sourcing
approaches in promoting worker health and welfare goals.

This thesis argues that worker health and well-being standards are often interpreted
and promoted according to the capacities and priorities of those who are managing
them. In the case study, it was found that larger export floriculture producers are able
to provide a range of health benefits and services to their workers unlike their smallerscale
cohorts. Other case study findings revealed that key worker health targets
involved addressing customer health concerns over worker wellness issues. These
findings support the idea that ethical standards are often interpreted and applied
according to consumer priorities and values over producer driven ones and only target
those workers directly linked to transnational enterprise networks. Some policies
intended to protect workers were rendered discriminatory in practice. Governance,
participation and responsibility in giving effect to worker health and well-being
standards remained predominantly with the business sector; government and civil
society were minimally engaged or responsible. Thus, this study's research findings
concurred with the evolving notion that worker health and well-being is not
sufficiently governed hen applyingt ransnationael thical standardsw ithout a local
context of support (via laws, infrastructure and civil society) and, therefore, at present
will not achieve a widespread realization of rights.


With growing concerns over human relations with respect to Nature within the Anthropocene increasingly expressed in terms of changing climates, the agentive relations between humans and the world come more sharply into anthropological focus. Cities, often described as devoid of Nature, are currently being recognised as one way to govern the twin problems of managing a changing climate and an increasingly compact city form. There are currently, 700 green (deliberately vegetated) roofs in place in London. This thesis examines the material culture of greenroofs, through a re-evaluation of J J Gibson's Affordance Theory. Materials and plants in combination provide the conditions for agentive action, not only for flora and fauna but for people. I propose that these resulting socio-biological capacities be described as phyto-materiality. This phyto-materiality becomes central to flexible and ongoing classificatory practices which, in turn, enables greenroofs to become incorporated into a palimpsest of policymaking at the local and city levels and facilitates the mainstreaming of greenroofing practice. During a greenroofing project, phyto-materiality becomes central to achieve movement across geographical and organisational boundaries re-shaping the governance of London's built environment and the working practices of professionals. However the material effects of greenroofing become problematic as imagined future plants become a source of concern for leaseholders or current flora and fauna escape the roof, revealing tensions and fractures in greenroofing practice. The thesis is informed by more than a year's participant observation within a local authority and a network of greenroof designers, builders, ecologists, policymakers and ecological activists. Greenroofing comes out of an engagement with British environmental discourses and in making greenroofs and greenroof policy-making people remake themselves as greenroofers. For these respondents, phyto-materiality becomes both the ends-in-sight vision of, and the methodology for, ecotopia.


Abstract Chaetoceros wighamii Brightwell is a planktonic diatom species originally described from brackish waters. Since its original description, the species has been reported in a wide variety of habitats, ranging from freshwater to marine. Varying descriptions exist in the taxonomic literature and several taxa have been considered as synonyms, including freshwater species Chaetoceros amanita. In this study we provide morphological and ultrastructural information on a cultured strain isolated from freshwater sample collected in the Lake Vrana (Vransko jezero) in Croatia, in April 2011. The cells form short and robust chains with very narrow apertures, often partially occluded by silica membranes. Other distinctive features observable in light microscopy are the shape and orientation of the setae which are very long, straight and robust, diverging in various directions from the chain axis and the single parietal chloroplast extending from valve to valve. Distinct ultrastructural characteristics are the absence of processes either in intercalary or terminal valves and the ornamentation of the valve face with densely distributed ribs spreading from an irregular eccentric hyaline area without a clearly defined annulus. The outer surface of the terminal valve is ornamented with small spines and setae are composed of fl at longitudinal filaments interconnected with short bars and ornamented with small spines tightly arranged around the setae. Our description agrees well with that reported for the freshwater morphotypes of C. wighamii (syn. C. amanita) and contributes for a reliable distinction of this intriguing taxon from similar morphotypes. This finding supports the interpretation of Chaetoceros wighamii as a freshwater/brackish species and represents the first report of a Chaetoceros species in lacustrine environment in Croatia and possibly in any Central European habitats.


Endothelin-1 (ET-1) has been implicated in coronary vasospasm by enhancing coronary vasoconstriction to vasoactive eicosanoids, and a role for protein kinase C (PKC) activation has been suggested. However, the cellular mechanisms downstream from PKC activation are unclear. We investigated whether physiological concentrations of ET-1 enhance coronary smooth muscle contraction by activating a PKC-mediated signaling pathway involving tyrosine phosphorylation and activation of mitogen-activated protein kinase (MAPK). Cell contraction was measured in smooth muscle cells isolated from porcine coronary artery, [Ca(2+)](i) was measured in fura-2 loaded cells, and tissue fractions were examined for reactivity with anti-phosphotyrosine (P-Tyr) and anti-MAPK antibodies using immunoprecipitation and immunoblot analysis. In Hanks' solution (1 mmol/L Ca(2+)), ET-1 (10 pmol/L) did not increase basal [Ca(2+)](i) (81 +/- 2 nmol/L) but caused cell contraction (10%) that was inhibited by calphostin C (10(-6) mol/L), inhibitor of PKC, tyrphostin (10(-6) mol/L), inhibitor of tyrosine kinase, and PD098059 (10(-6) mol/L), inhibitor of MAPK kinase. The vasoactive eicosanoid prostaglandin F(2alpha) (PGF(2alpha); 10(-7) mol/L) caused increases in cell contraction (11%) and [Ca(2+)](i) (122 +/- 9 nmol/L) that were inhibited by the Ca(2+) channel blocker verapamil (10(-6) mol/L) but not by calphostin C, tyrphostin, or PD098059. Pretreatment with ET-1 for 10 minutes enhanced cell contraction to PGF(2alpha) (33%) with no additional increase in [Ca(2+)](i) (124 +/- 10 nmol/L). Activation of PKC by phorbol 12-myristate 13-acetate (PMA; 10(-7) mol/L) caused cell contraction and enhanced PGF(2alpha) contraction (32%) with no additional increase in [Ca(2+)](i) (126 +/- 9 nmol/L). The ET-1-- and PMA-induced enhancement of PGF(2alpha) contraction was abolished by verapamil or calphostin C but not by tyrphostin or PD098059. ET-1 and PMA caused significant increases in tyrosine phosphorylation of MAPK that were inhibited by calphostin C, tyrphostin, and PD098059. PGF(2alpha) did not cause any additional increases in tyrosine phosphorylation of MAPK in tissues untreated or pretreated with ET-1 or PMA. Thus, physiological concentrations of ET-1 activate a Ca(2+)-independent PKC-mediated signaling pathway that involves tyrosine phosphorylation and activation of MAPK. The enhancement of PGF(2alpha)-induced coronary smooth muscle contraction by ET-1 involves additional activation of a Ca(2+)-sensitive PKC-mediated pathway but not tyrosine phosphorylation or activation of MAPK. The MAPK-dependent and MAPK-independent signaling pathways represent possible cellular mechanisms by which ET-1 could enhance coronary vasoconstriction to vasoactive eicosanoids in coronary vasospasm.


Application of the index velocity method for computing continuous records of discharge has become increasingly common, especially since the introduction of low-cost acoustic Doppler velocity meters (ADVMs) in 1997. Presently (2011), the index velocity method is being used to compute discharge records for approximately 470 gaging stations operated and maintained by the U.S. Geological Survey. The purpose of this report is to document and describe techniques for computing discharge records using the index velocity method. Computing discharge using the index velocity method differs from the traditional stage-discharge method by separating velocity and area into two ratings—the index velocity rating and the stage-area rating. The outputs from each of these ratings, mean channel velocity (V) and cross-sectional area (A), are then multiplied together to compute a discharge. For the index velocity method, V is a function of such parameters as streamwise velocity, stage, cross-stream velocity, and velocity head, and A is a function of stage and cross-section shape. The index velocity method can be used at locations where stage-discharge methods are used, but it is especially appropriate when more than one specific discharge can be measured for a specific stage. After the ADVM is selected, installed, and configured, the stage-area rating and the index velocity rating must be developed. A standard cross section is identified and surveyed in order to develop the stage-area rating. The standard cross section should be surveyed every year for the first 3 years of operation and thereafter at a lesser frequency, depending on the susceptibility of the cross section to change. Periodic measurements of discharge are used to calibrate and validate the index rating for the range of conditions experienced at the gaging station. Data from discharge measurements, ADVMs, and stage sensors are compiled for index-rating analysis. Index ratings are developed by means of regression techniques in which the mean cross-sectional velocity for the standard section is related to the measured index velocity. Most ratings are simple-linear regressions, but more complex ratings may be necessary in some cases. Once the rating is established, validation measurements should be made periodically. Over time, validation measurements may provide additional definition to the rating or result in the creation of a new rating. The computation of discharge is the last step in the index velocity method, and in some ways it is the most straight-forward step. This step differs little from the steps used to compute discharge records for stage-discharge gaging stations. The ratings are entered into database software used for records computation, and continuous records of discharge are computed.


The purpose of this paper is to build a policy focused knowledge-based economy (KBE) framework based on the OECD KBE definition in order to identify the KBE factors in the Association of South East Asian Nations (ASEAN) region. The paper utilises the Beta coefficient technique which allows us to rank the most important KBE input factors to KBE output factors. After identifying KBE input-output factors, following the Australian Bureau of Statistics KBE framework assumptions, standardized beta coefficients are used to assess how many standard deviations a dependent variable will change, per standard deviation increase in the predictor variable. Standardization of the coefficient is usually done to answer the question of which of the independent variables have greater effects on the dependent variable in a multiple regression analysis, when the variables are measured in different units. Data are mostly collected from secondary sources such as the World Bank's World Development Indicators and the International Institute for Management Development's World Competitive Yearbook. The results show Singapore is the best performer in knowledge acquisition, production and distribution and the Philippines is the best performer in knowledge utilization. Indonesia, on the other hand, shows weak performance in almost all the KBE dimensions. The lessons from the success of Singapore and the Philippines for weak performance countries in KBE are to improve the efficiency of FDI inflows, to optimise the use of research and development expenditure, to increase the secondary school enrolment ratio and finally to increase the interaction between academia and industry, which facilitates the creation and commercial use of knowledge. This paper provides empirical evidence to rank the important KBE input factors that gives governments some insight on where to focus investment in order to become a successful KBE.


OBJECTIVES
To evaluate (1) the clinical profile, treatment, and outcome of adult and pediatric patients presenting with intracranial abscess of otogenic origin and (2) the advantages of concurrent craniotomy and mastoidectomy.

DESIGN
A prospective case series.

SETTING
An academic tertiary referral center in India.

PATIENTS
Thirty-six patients clinically diagnosed as having intracranial abscess that was secondary to suppurative otitis media and confirmed by computed tomographic scanning.

INTERVENTION
Concurrent craniotomy and mastoidectomy.

RESULTS
Children were more commonly affected than adults, and there was a male preponderance. All patients had cholesteatoma at surgery, although one third of the children had only granulation tissue on otoscopy. More than two thirds of the patients in both the groups presented with more than one intracranial complication and definitive surgical intervention was done later than 24 hours. Meningitis was the most frequent intracranial complication, followed by cerebellar abscess. There was no significant intraoperative or postoperative morbidity, mortality, recurrence of intracranial complications, or residual neurological deficits. Three children (14%) showed evidence of recidivism cholesteatoma requiring revision surgery.

CONCLUSIONS
In suppurative otitis media with intracranial complications, it is accepted practice to treat the neurosurgical complication first, followed by mastoidectomy at a later date after the patient has been stabilized. Craniotomy with concurrent mastoidectomy is not only safe, but it also removes the source of infection at the same time the complications are being treated, thus avoiding reinfection while the patient is awaiting the ear surgery. In addition, the treatment is completed with a single, shorter hospital stay, which is more economical for the patient.


Research on relationship lending focuses attention on economic factors which influence the relationships between SMEs' owners/managers and banks but no previous work has focused on the role of trust. Trust is expected to reduce agency costs, the perceived credit risk and, thus, influence credit availability and credit terms. Trustworthiness is associated with three attributes of SME owner managers' namely; ability, benevolence and integrity. It is hypothesised that lending managers' assessment of the trustworthiness of SME owner managers affects the request of personal collateral from bank when credit is provided. Trustworthiness is hypothesised as negatively associated with personal collateral in the form of personal guarantees and personal assets. Using the data obtained from a survey of lending managers from banks in North East Italy we test this relationship. Research methods include construction of control variables and a vector of trustworthiness factors based on the data collected on a random sample of 535 borrowing firms. Results from the regression analysis show some evidence that the line of credit of firms enjoying high level of trust are less collateralised with entrepreneurs' personal assets even if the significance of both the specification and trust is low. Our findings support the view found in earlier literature on trust that personal collateral pledging is decided at the beginning of the relationship and then such a decision is not changed by the bank. Some implications of these results and future research are discussed.


Minimally invasive surgery offers advantages that make it the best choice for many diseases. The Virtual Reality technology gives a great support to this kind of surgical procedures through medical image processing and visualization, 3D organ's reconstruction and intra-operative surgical guidance. In this paper is presented an advanced visualization and navigation system and the surgeon has the possibility to visualize both the traditional patient information, as the CT image set, and a 3D model of the patient's anatomy built from this. Two different visualization modalities are available in real time and dynamically. According to the surgeon needs, it is possible to obtain the automatic reslicing of the orthogonal planes in order to have an accurate visualization of the 3D model and slices exactly next to the actual position of the surgical instrument tip. In addition, it is possible to activate the clipping modality that allows cutting the 3D model in correspondence of a chosen visualization plane. The system can be used as support for the diagnosis, for the surgical preoperative planning and also for an image-guided surgery.


Forest Fungi Boreal forest is one of the world's major biomes, dominating the subarctic northern latitudes of Europe, Asia, and America. The soils of boreal forest function as a net sink in the global carbon cycle and, hitherto, it has been thought that organic matter in this sink primarily accumulates in the form of plant remains. Clemmensen et al. (p. 1615; see the Perspective by Treseder and Holden) now show that most of the stored carbon in boreal forested islands in Sweden is in fact derived from mycorrhizal mycelium rather than from plant litter. Biochemical and sequencing studies show that carbon sequestration is regulated by functional and phylogenetic shifts in the mycorrhizal fungal community. The results will need to be explicitly considered in models of the role of the boreal forest in the global carbon cycle. Reservoirs of carbon in boreal forest soils are revisited in an island chronosequence, using modeling and molecular approaches. [Also see Perspective by Treseder and Holden] Boreal forest soils function as a terrestrial net sink in the global carbon cycle. The prevailing dogma has focused on aboveground plant litter as a principal source of soil organic matter. Using 14C bomb-carbon modeling, we show that 50 to 70% of stored carbon in a chronosequence of boreal forested islands derives from roots and root-associated microorganisms. Fungal biomarkers indicate impaired degradation and preservation of fungal residues in late successional forests. Furthermore, 454 pyrosequencing of molecular barcodes, in conjunction with stable isotope analyses, highlights root-associated fungi as important regulators of ecosystem carbon dynamics. Our results suggest an alternative mechanism for the accumulation of organic matter in boreal forests during succession in the long-term absence of disturbance.


K-nearest neighbors relies on the definition of a global metric. In contrast, discriminant adaptive nearest neighbor (DANN) computes a different metric at each query point based on a local linear discriminant analysis. In this paper, we propose a technique to automatically adjust the hyper-parameters in DANN by the optimization of two quality criteria. The first one measures the quality of discrimination, while the second one maximizes the local class homogeneity. We use a Bayesian formulation to prevent over-fitting


Working memory (WM) performance, which is an important factor for determining problem-solving and reasoning ability, has been firmly believed to be constant. However, recent findings have demonstrated that WM performance has the potential to be improved by repetitive training. Although various skills are reported to be improved by sleep, the beneficial effect of sleep on WM performance has not been clarified. Here, we show that improvement in WM performance is facilitated by posttraining naturalistic sleep. A spatial variant of the n-back WM task was performed by 29 healthy young adults who were assigned randomly to three different experimental groups that had different time schedules of repetitive n-back WM task sessions, with or without intervening sleep. Intergroup and intersession comparisons of WM performance (accuracy and response time) profiles showed that n-back accuracy after posttraining sleep was significantly improved compared with that after the same period of wakefulness, independent of sleep timing, subject's vigilance level, or circadian influences. On the other hand, response time was not influenced by sleep or repetitive training schedules. The present study indicates that improvement in n-back accuracy, which could reflect WM capacity, essentially benefits from posttraining sleep.


1 Sociedade Brasileira de Cirurgia Plástica, São Paulo, SP, Brazil. 2 Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. 3 Instituto PMG Carlos Chagas, Rio de Janeiro, RJ, Brazil. 4 Instituto Ivo Pitanguy, Rio de Janeiro, RJ, Brazil. Introduction: Cutaneous pilar leiomyoma (CPL) is a rare benign skin tumor arising from arrector pili muscles. Its most common clinical manifestation is the appearance of nodules that may either be isolated or clustered. In general, these tumors are painful and sensitive to cold, touch, pressure, and emotional stimuli. Several pharmacological agents have been used with some success to reduce local pain and discomfort. However, in cases with intensely painful symptoms or that cause social constraints to the patient, surgery becomes an alternative approach. Here, we report the case of a male patient with multiple cutaneous leiomyomas in the left anterior chest wall and abdomen, and the therapeutic approaches used for this case. Methods: The treatment included a complete surgical resection of the tumor and wound closure with partial skin graft taken from the anterolateral region of the right thigh. Results: The immediate reconstruction of the resulting defect with a partial skin graft ensured healing without complications. After the treatment, complete remission of the pain symptoms occurred, in addition to an acceptable aesthetic outcome, which allowed the full social reintegration of the patient. Conclusion: CPL is a disease that is difficult to treat; however, several therapeutic approaches can be used. The complete surgical resection of multiple cutaneous leiomyomas can prevent the recurrence of the disease, although some local recurrences have been reported in the literature. ■ ABSTRACT