Abstract of the thesis "Effects of heart failure management programmes" The main purpose of the studies presented in this thesis, was to assess whether an intensive 1-year intervention at a heart failure clinic for patients with heart failure, NYHA classification III or IV, reduces the incidence of hospitalisation for worsening heart failure and/or all cause mortality and improves functional status and quality of life at acceptable costs and whether the observed effects may be (partly) attributable to beneficial changes in patient adherence to drug therapy. Important differences with many previous studies were that our heart failure clinic was directed by a combination of a clinician and a heart failure nurse and that the study was performed in a country with a relatively strong primary care health-care system. In a systematic review in the beginning of the thesis, the results of previous studies on heart failure management programmes are reviewed critically and their applicability to countries, such as the Netherlands, with well-structured primary care facilities is discussed. In the core chapters of the thesis the main results of the Deventer-Alkmaar Heart Failure study (DEAL-HF study) are presented first: the number of admissions for worsening heart failure and/or all-cause deaths in the intervention group was lower than in the control group (23 vs. 47; relative risk(RR) 0.49; 95% confidence interval 0.30 to 0.81; p= 0.001). There also was an improvement of the left ventricular ejection fraction (LVEF) in the intervention group (plus 2.6%) compared with a decrease in the usual care group (minus 3.1%; p=0.004). Patients in the intervention group were hospitalised for a total of 359 days, compared with 644 days for those in the usual care group. Beneficial effects were also observed on NYHA functional class, quality of life, self-care behaviour and health care costs. Then, several sub-studies within the DEAL-HF population are presented. First, we assessed the effect of the heart failure management programme on adherence of prescribers and patients to the medication regimes: beta-blocker dosaging and the number of patients using spironolactone increased. This may have been an important contributor to the observed improved clinical outcomes. Then we investigated the correlation between the change in a biochemical parameter, NT-proBNP, and the change in quality of life and functional class during the follow-up of the main study. Long-term changes in NT-proBNP were indeed accompanied by similar changes in quality of life, functional status and echo parameters. Finally we studied the costs of the heart failure management programme in relation to the observed effects. This more detailed analysis of the costs and effects of the heart failure management programme studied in the DEAL HF study confirms that such a programme exerts beneficial clinical benefit and saves costs.


Author Credentials and Financial Disclosure: James R. Roberts, MD, is the Chairman of the Department of Emergency Medicine and the Director of the Division of Toxicology at Mercy Health Systems, and a Professor of Emergency Medicine and Toxicology at the Drexel University College of Medicine, both in Philadelphia. Dr. Roberts has disclosed that he has no significant relationships with or financial interests in any commercial companies that pertain to this educational activity.


The objective of traffic engineering is to optimize network resource utilization. Although several works have been published about minimizing network resource utilization, few works have focused on LSR (label switched router) label space. This paper proposes an algorithm that takes advantage of the MPLS label stack features in order to reduce the number of labels used in LSPs. Some tunnelling methods and their MPLS implementation drawbacks are also discussed. The described algorithm sets up NHLFE (next hop label forwarding entry) tables in each LSR, creating asymmetric tunnels when possible. Experimental results show that the described algorithm achieves a great reduction factor in the label space. The presented works apply for both types of connections: P2MP (point-to-multipoint) and P2P (point-to-point).


The snowfall in the Baltimore/Washington metropolitan area during the winter of 2009/2010 was unprecedented and caused serious snow‐related disruptions. In February 2010, snowfall totals approached 2 m, and because maximum temperatures were consistently below normal, snow remained on the ground the entire month. One of the biggest contributing factors to the unusually severe winter weather in 2009/2010, throughout much of the middle latitudes, was the Arctic Oscillation. Unusually high pressure at high latitudes and low pressure at middle latitudes forced a persistent exchange of mass from north to south. In this investigation, a concerted effort was made to link remotely sensed falling snow observations to remotely sensed snow cover and snowpack observations in the Baltimore/Washington area. Specifically, the Advanced Microwave Scanning Radiometer onboard the Aqua satellite was used to assess snow water equivalent, and the Advanced Microwave Sounding Unit‐B and Microwave Humidity Sounder were employed to detect falling snow. Advanced Microwave Scanning Radiometer passive microwave signatures in this study are related to both snow on the ground and surface ice layers. In regard to falling snow, signatures indicative of snowfall can be observed in high frequency brightness temperatures of Advanced Microwave Sounding Unit‐B and Microwave Humidity Sounder. Indeed, retrievals show an increase in snow water equivalent after the detection of falling snow. Yet, this work also shows that falling snow intensity and/or the presence of liquid water clouds impacts the ability to reliably detect snow water equivalent. Moreover, changes in the condition of the snowpack, especially in the surface features, negatively affect retrieval performance. Copyright © 2011. This article is a U.S. Government work and is in the public domain in the USA.


The mutual information is a core statistical quantity that has applications in all areas of machine learning, whether this is in training of density models over multiple data modalities, in maximising the efficiency of noisy transmission channels, or when learning behaviour policies for exploration by artificial agents. Most learning algorithms that involve optimisation of the mutual information rely on the Blahut-Arimoto algorithm --- an enumerative algorithm with exponential complexity that is not suitable for modern machine learning applications. This paper provides a new approach for scalable optimisation of the mutual information by merging techniques from variational inference and deep learning. We develop our approach by focusing on the problem of intrinsically-motivated learning, where the mutual information forms the definition of a well-known internal drive known as empowerment. Using a variational lower bound on the mutual information, combined with convolutional networks for handling visual input streams, we develop a stochastic optimisation algorithm that allows for scalable information maximisation and empowerment-based reasoning directly from pixels to actions.


We develop a new approach to quantify how patients respond to dynamic incentives in health insurance contracts with a deductible. Our approach exploits two sources of variation in a differences-in-regression-discontinuities design: deductible contracts reset at the beginning of the year, and cost-sharing limits change over the years. Using rich claims-level data from a large Dutch health insurer we find that individuals are forward-looking. Changing dynamic incentives by increasing the deductible by €100 leads to a reduction in healthcare spending of around 3% on the first days of the year and 6% at the annual level. The response to dynamic incentives is an important part of the overall effect of cost-sharing schemes on healthcare expenditures- much more so than what the previous literature has suggested.


Vanadium and cerium supported on sulfated zirconia is an efficient SCR catalyst with dual resistance toward both potassium and SO2 poisoning. To the best of our knowledge, no examples of catalysts with a tolerance to both alkali metals and SO2 have been reported. Herein, the catalyst with a Ce : V molar ratio of 1 : 1 showed the highest activity (>97%) in the presence of potassium and SO2. The formation of thermally stable Ce2(SO4)3 disrupted the Ce(IV)/Ce(III) redox cycle, resulting in a significant deactivation of the CeSZ catalyst (93% to 63% in 400 min). Addition of a vanadium additive led to the transformation of CeO2 to CeVO4, thereby cutting off the reaction between CeO2 and SO2 and retaining the reactivity of the active sites. In addition, vanadium weakened the adsorption/oxidation of SO2 on the catalysts and thereby enhanced the tolerance toward SO2 by inhibiting the formation of ammonium bisulfate (NH4HSO4).


This study focuses on the effects of L1 on translating prepositions into L2 (English) among the students of grade 12. These students belonged to a developing town of the central Punjab, Pakistan. In addition to this, the study examines whether the students of government sector (learning through deductive method) make more prepositional errors than the private sector students (learning through inductive method). For the sample of the study 200 students (50% males and 50% females) were selected on the basis of similar reading skills from both types of schools. The results concluded in that the students committed considerable errors because of inter-lingual interference. Moreover, it was observed that the students of private sector schools committed more errors than the students of public sector schools. This study might be helpful for the English Language teachers in realizing the reasons of prepositional errors and in exploring new teaching approaches to lessen the ratio of prepositional errors in teaching to Pakistani English language learners.


Abstract The thistle-infesting fruit fly Tephritis conura Loew (Diptera: Tephritidae) forms host races on the melancholy thistle, Cirsium hetewphyllum (L.) Hill (Asterales: Asteraceae) and the cabbage thistle, Cirsium olemceum (L.). Scop. Previous research indicates that the host shift occurred from C. hetewphyllum to C. oleraceum. In this paper we address whether the host shift involved physiological adaptations by studying oviposition acceptance and survival of the two host races on the derived host C. oleraceum. Performance differed significantly between host races. T. conura originating from C. oleraceum produced adults in 75% of all egg-laying trials in contrast to only 6.6% in T. conura originating from C. hetewphyllum. Population fitness components measured as a function of life-stage was linear decreasing for T. conura on C. oleraceum but stepwise for T. conura on C. heterophyllum. Low performance of T. conura on C. hetewphyllum was determined by low plant acceptance and high mortality during the larval stage, whereas hatching (at least one larva per batch) and pupae survival were not affected.


The phenomenon of social entrepreneurship is receiving increased attention from policy makers, opinion leaders and academic researchers. The purpose of this article is to identify the factors influencing social entrepreneurial intent among a sample of 476 students studying in seven Moroccan universities. To achieve this objective, a quantitative study is conducted by questionnaire distributed via the Internet based on the technique of the snowball. At the end of this research, twelve factors contributing to the development of this intention. It should also be noted that women have a higher level of social entrepreneurial intent than men who participated in this research.


INTRODUCTION: Anomalies of renal vessels are rare and asymptomatic. It poses a great challenge during renal and retroperitoneal surgeries. Injury to anomalous renal vessels can lead to major morbidity and even mortality. Preoperative imaging like CT scan, MRI scan helps to identify these vessels and helps in planning of surgery avoiding injury. CASE REPORT: A 59-year-woman, a diagnosed case of carcinoma endometrium underwent extra fascial hysterectomy with bilateral pelvic lymph node dissection and para aortic dissection. Intra operatively a rare anomaly of Left renal vein was identified. Left renal vein was coursing posterior and lateral to aorta and caudally draining into Left common iliac vein. Para-aortic lymph node dissection was done safely, securing the anomalous left renal vein. CASE DISCUSSION: Various anomalies of renal vein were described in literature. Pre-operative identification of anomalous vessels and careful dissection intra-operatively can help in avoiding injury to these vessels. Awareness of such an anomaly has to borne in mind, although rare, it can prevent catastrophes.


abstract There is increasing interest in the drivers of industrial diversification, and how these depend on economic and industry structures. This article contributes to this line of inquiry by analyzing the role of industry relatedness in explaining variations in industry diversification, measured as the entry of new industry specializations, across 173 European regions during the period 2004–2012. First, we show that there are significant differences across regions in Europe in terms of industrial diversification. Second, we provide robust evidence showing that the probability that a new industry specialization develops in a region is positively associated with the new industry's relatedness to the region's current industries. Third, a novel finding is that the influence of relatedness on the probability of new industrial specializations depends on innovation capacity of a region. We find that relatedness is a more important driver of diversification in regions with a weaker innovation capacity. The effect of relatedness appears to decrease monotonically as the innovation capacity of a regional economy increases. This is consistent with the argument that high innovation capacity allows an economy to break from its past and to develop, for the economy, truly new industry specializations. We infer from this that innovation capacity is a critical factor for economic resilience and diversification capacity.


Background: The lack of reliable, valid and adequately standardized measures of mental illnesses in sub-Saharan Africa is a key challenge for epidemiological studies on mental health. We evaluated the psychometric properties and feasibility of using a computerized version of the Major Depression Inventory (MDI) in an epidemiological study in rural Kenya. Methods: We surveyed 1496 participants aged 13-24 years in Kilifi County, on the Kenyan coast. The MDI was administered using a computer-assisted system, available in three languages. Internal consistency was evaluated using both Cronbach's alpha and the Omega Coefficient. Confirmatory factor analysis was performed to evaluate the factorial structure of the MDI. Results: Internal consistency using both Cronbach's Alpha (α= 0.83) and the Omega Coefficient (0.82; 95% confidence interval 0.81- 0.83) was above acceptable thresholds. Confirmatory factor analysis indicated a good fit of the data to a unidimensional model of MDI (χ 2 (33, N = 1409) = 178.52 p < 0.001, TLI = 0.947, CFI = 0.961, and Root Mean Square Error of Approximation, RMSEA = .056), and this was confirmed using Item Response Models (Loevinger's H coefficient 0.38) that proved the MDI was a unidimensional scale. Equivalence evaluation indicated invariance across sex and age groups. In our population, 3.6% of the youth presented with scores suggesting major depression using the ICD-10 scoring algorithm, and 8.7% presented with total scores indicating presence of depression (mild, moderate or severe). Females and older youth were at the highest risk of depression. Conclusions: The MDI has good psychometric properties. Given its brevity, relative ease of usage and ability to identify at-risk youth, it may be useful for epidemiological studies of depression in Africa. Studies to establish clinical thresholds for depression are recommended. The high prevalence of depressive symptoms suggests that depression may be an important public health problem in this population group.


Contemptuous of Europe's 'civilising mission' in Africa, Mary Kingsley's (1862-1900) extraordinary journeys through tropical west Africa are a remarkable record, both of a world which has vanished and of a writer and explorer of immense bravery, wit and humanity. Paddling through mangrove swamps, fending off crocodiles, climbing Mount Cameroon, Kingsley is both admirable and funny. "Great Journeys" allows readers to travel both around the planet and back through the centuries - but also back into ideas and worlds frightening, ruthless and cruel in different ways from our own. Few reading experiences can begin to match that of engaging with writers who saw astounding things: great civilizations, walls of ice, violent and implacable jungles, deserts and mountains, multitudes of birds and flowers new to science. Reading these books is to see the world afresh, to rediscover a time when many cultures were quite strange to each other, where legends and stories were treated as facts and in which so much was still to be discovered.


INTRODUCTION: Kidney transplantation corrects endocrine imbalances. Nevertheless, these early favorable events are not always followed by rapid normalization of parathyroid hormone secretion. A possible deleterious effect of parathyroidectomy on kidney transplant function has been reported. This study aimed to compare acute and long-term renal changes after total parathyroidectomy with those occurring after general surgery. MATERIALS AND METHODS: This was a retrospective case-controlled study. Nineteen patients with persistent hyperparathyroidism underwent parathyroidectomy due to hypercalcemia. The control group included 19 patients undergoing various general and urological operations. RESULTS: In the parathyroidectomy group, a significant increase in serum creatinine from 1.58 to 2.29 mg/dl (P < 0.05) was noted within the first 5 days after parathyroidectomy. In the control group, a statistically insignificant increase in serum creatinine from 1.49 to 1.65 mg/dl occurred over the same time period. The long-term mean serum creatinine level was not statistically different from baseline either in the parathyroidectomy group (final follow-up creatinine = 1.91 mg/dL) or in the non-parathyroidectomy group (final follow-up creatinine = 1.72 mg/dL). CONCLUSION: Although renal function deteriorates in the acute period following parathyroidectomy, long-term stabilization occurs, with renal function similar to both preoperative function and to a control group of kidney-transplanted patients who underwent other general surgical operations by the final follow up.


The Channel Angular Extrusion (CAE) technique is a process, in which a deformable solid material is led to yielding through the intersection of inclined channels. Compared to classic plastic deformation, the process is technically simple but the material experiences, instantly, large plastic deformation. The deformation occurs locally and high internal stresses develop during the process. In most cases the process is used for grain size refinement. Equal Channel Angular Extrusion (ECAE) is a special case where the intersecting channels are of equal cross sections. In this paper, an analytical study of the internal stresses and those developed along CAE tools is presented. A deformation model is introduced for the general process of channel extrusion in which the intersecting channels are not necessarily equal. The procedure splits the material at the intersection of the channels into two zones; one causes the deformation while the other remains rigid. The analysis is also applied to the particular case of ECAE, and the results are compared with those obtained from a finite element analysis and the overall experimental pressure.


Tissue interactions with discs of dermal sheep collagen (DSC), subcutaneously implanted in rats, were evaluated using transmission electron microscopy. DSC cross-linked with hexamethylenediisocyanate (HDSC) had already been tested previously. In the present study, we compared tissue interactions of non-cross-linked DSC (NDSC) and glutaraldehyde-cross-linked DSC (GDSC) with those of HDSC. To gain more insight in the relation between basophil-like cells, foreign body multinucleate giant (FBM-G) cells derived from them, and aluminum/silicate (Al/Si)-crystals, we also implanted agarose-embedded Al/Si-crystals. GDSC induced early after implantation extensive lipid formation, cell degeneration and death, but NDSC did not have any cytotoxic effects. Basophil-like (FBM-G) cells specifically dealt with Al/Si-crystals, because they were attracted by the agarose-embedded Al/Si-crystals. These cells were also attracted by GDSC and NDSC, where Al/Si-crystals are present. Accumulation of Al/Si-crystals was especially prominent with GDSC. Degradation by phagocytosis was in part carried out by FBM-G cells, derived from macrophages or fibroblasts, and observed only with GDSC, which indicates that the presence of cross-links is a prerequisite for their formation.


The question of how to detect malicious programs seems like a practical one, but at its core depends on the fundamental nature of general purpose computers and deep theoretical questions about what computers can and cannot do. This essay starts by formalizing the question of what it means to detect a virus. Then, we discuss theoretical results that show solving this (and most other important computer security problems) is impossible for general purpose computers. But impossible doesn't mean hopeless — it just means we have to redefine our problems and approaches, and aim for solutions that work well in practice, even if nothing can work in theory.


Superimposed upon a long-term trend of aridification, the climate history of Africa was punctuated by episodes of extreme climate variability, characterised by the precessionally-forced appearance and disappearance of large lake systems within the East African Rift Valley. In order to investigate the nature of low-latitude climate variability during the Late Pliocene and Early Pleistocene, this thesis combines high-resolution analyses from one of the lake phases in the Central Kenyan Rift with the reconstruction of long-term changes in the transport of wind-borne terrigenous dust to the Arabian Sea. Climate in both regions is strongly influenced by relative changes in the strength of the Indian Ocean monsoons, which determine rainfall distribution in equatorial East Africa and generate the low-level winds which transport dust offshore from the Arabian Peninsula. In the Baringo-Bogoria basin in the Central Kenyan Rift, a well-dated package of fluvio-lacustrine sediments and diatomite units documents a major humid phase between 2.7 and 2.55 million years ago (Ma), coincident with the intensification of glaciation in the Northern Hemisphere. Stable oxygen isotope measurements of diatom silica, combined with the XRF analysis of whole-sample geochemistry, reveal that the deep lake phase was characterised by wet-dry cycles lasting, on average, 1,400 years. Over longer timescales, variations in the aeolian delivery of lithogenic matter to the Arabian Sea, reflected in normalised flux of titanium, show that monsoonal circulation prior to 2.6 Ma was highly variable and primarily driven by orbitally-forced changes in tropical summer insolation, modulated by the 400,000 year cycle of orbital eccentricity. Millennial-scale fluctuations in the dust record also support the evidence of abrupt wet-dry cycles in East Africa. Such high-resolution cycles are rarely found in older records, thus giving a valuable insight to the nature of short-term fluctuations in Plio-Pleistocene climate.


Abstract. Combustion of fuels in the residential sector for cooking and heating results in the emission of aerosol and aerosol precursors impacting air quality, human health, and climate. Residential emissions are dominated by the combustion of solid fuels. We use a global aerosol microphysics model to simulate the impact of residential fuel combustion on atmospheric aerosol for the year 2000. The model underestimates black carbon (BC) and organic carbon (OC) mass concentrations observed over Asia, Eastern Europe, and Africa, with better prediction when carbonaceous emissions from the residential sector are doubled. Observed seasonal variability of BC and OC concentrations are better simulated when residential emissions include a seasonal cycle. The largest contributions of residential emissions to annual surface mean particulate matter (PM2.5) concentrations are simulated for East Asia, South Asia, and Eastern Europe. We use a concentration response function to estimate the human health impact due to long-term exposure to ambient PM2.5 from residential emissions. We estimate global annual excess adult (>  30 years of age) premature mortality (due to both cardiopulmonary disease and lung cancer) to be 308 000 (113 300–497 000, 5th to 95th percentile uncertainty range) for monthly varying residential emissions and 517 000 (192 000–827 000) when residential carbonaceous emissions are doubled. Mortality due to residential emissions is greatest in Asia, with China and India accounting for 50 % of simulated global excess mortality. Using an offline radiative transfer model we estimate that residential emissions exert a global annual mean direct radiative effect between −66 and +21 mW m−2, with sensitivity to the residential emission flux and the assumed ratio of BC, OC, and SO2 emissions. Residential emissions exert a global annual mean first aerosol indirect effect of between −52 and −16 mW m−2, which is sensitive to the assumed size distribution of carbonaceous emissions. Overall, our results demonstrate that reducing residential combustion emissions would have substantial benefits for human health through reductions in ambient PM2.5 concentrations.


Understanding petroleum systems within a complex region such as East Africa requires an approach that focuses on identifying controls on distribution of hydrocarbon systems, reservoir and seal, and trap history. We have defined several genetic tectono-stratigraphic domains across the East Africa offshore margin that share key hydrocarbon system characteristics whilst at the same time reflecting important spatial and temporal margin trends.

East Africa's margin history records rifting, continental break-up and long-lived structural reactivation and rejuvenation due to far-field tectonic stresses. Continental rifted margins in the north (Somalia to Northern Mozambique) are characterized by hyper-extension and/or mantle exhumation. In contrast, magma-rich margins developed in the south between Southern Mozambique and Zululand, were influenced by the long-lived Karoo hot spot track.

The varied tectonic history observed along the margin will be discussed utilizing a series of geo-seismic transects from northern South Africa to Somalia. These will illustrate the influence that genetic margin character has on the potential for source rock deposition, reservoir and seal development, trapping styles and hydrocarbon retention.


ABSTRACT This article explores the livelihood challenges and opportunities of young people following Zimbabwe's land reform in 2000. The article explores the life courses of a cohort of men and women, all children of land reform settlers, in two contrasting smallholder land reform sites. Major challenges to social reproduction are highlighted, reflected in an extended 'waithood', while some opportunities for accumulation are observed, notably in intensive agricultural production and agriculture-linked business enterprises. In conclusion, the implications of generational transfer of land, assets and livelihood opportunities are discussed in the context of Zimbabwe's agrarian reform.


Glide efficiency, the ability of a body to minimize deceleration over the glide, can change with variations in the body's size and shape. The purpose of this study was to investigate the relationships between glide efficiency and the size and shape characteristics of swimmers. Eight male and eight female swimmers performed a series of horizontal glides at a depth of 70 cm below the surface. Glide efficiency parameters were calculated for velocities ranging from 1.4 to 1.6 m/s for female swimmers (and at the Reynolds number of 3.5 million) and from 1.6 to 1.8 m/s for male swimmers (and at the Reynolds number of 4.5 million). Several morphological indices were calculated to account for the shape characteristics, with the use of a photogrammetric method. Relationships between the variables of interest were explored with correlations, while repeated-measures ANOVA was used to assess within-group differences between different velocities for each gender group. Glide efficiency of swimmers increased when velocity decreased. Some morphological indices and postural angles showed a significant correlation with glide efficiency. The glide coefficient was significantly correlated to the chest to waist taper index for both gender groups. For the male group, the glide coefficient correlated significantly to the fineness ratio of upper body, the chest to hip cross-section. For the female group the glide coefficient had a significant correlation with the waist to hip taper index. The findings suggested that gliding efficiency was more dependent on shape characteristics and appropriate postural angles rather than being dependent on size characteristics. is that


Obesity and black race have been associated with excess risk of multiple myeloma. The association of obesity with monoclonal gammopathy of undetermined significance (MGUS) is unknown. Further, it is not known whether the increased risk of multiple myeloma and MGUS in blacks is related to socioeconomic status, genetic susceptibility, or both. We screened 1000 black and 996 white women (range, 40-79 years) of similar socioeconomic status for MGUS; the aim of the study was to assess MGUS risk in relation to obesity and race. A total of 39 (3.9%) blacks and 21 (2.1%) whites had MGUS. On multivariate analysis, obesity (odds ratio [OR] = 1.8; P = .04), black race (OR = 1.8; P = .04), and increasing age (> 55 vs < 43 years; OR = 2.5; P = .03) were independently associated with an excess risk of MGUS. Our findings support the hypothesis that obesity is etiologically linked to myelomagenesis. The 2-fold excess of MGUS among blacks compared with whites of similar socioeconomic status supports a role for susceptibility genes in MGUS.


Background: Methicillin-Resistant Staphylococcus aureus (MRSA) has become a leading cause of pneumonia in the United States and there is limited data on treatment outcomes in obese patients.We evaluated the effectiveness of linezolid compared to vancomycin for the treatment of MRSA pneumonia in a national cohort of obese Veterans.
Methods: This retrospective cohort study included obese patients (body mass index ≥ 30) admitted to Veterans Affairs hospitals with MRSA-positive respiratory cultures and clinical signs of infection between 2002 and 2012. Patients initiating treatment with either vancomycin or linezolid, but not both, were selected for inclusion. Propensity matching and adjustment of Cox proportional hazards regression models quantified the effect of linezolid compared with vancomycin on time to hospital discharge, intensive care unit discharge, 30-day mortality, inpatient mortality, therapy discontinuation, therapy change, 30-day readmission, and 30-day MRSA reinfection. We performed sensitivity analyses by vancomycin Minimum Inhibitory Concentrations (MICs) and true trough levels.
Results: We identified 101 linezolid and 2,565 vancomycin patients. Balance in baseline characteristics
between the treatment groups was achieved within propensity score quintiles and between propensity matched pairs (76 pairs). No significant differences were observed for the outcomes assessed. Among patients with vancomycin MICs of ≤ 1 μg/mL, the linezolid group had a significantly lower mortality rate, increased length of hospital stay, and longer therapy duration. There were no differences between the linezolid and vancomycin MICs of ≥ 1.5 μg/mL groups. Clinical outcomes among those with vancomycin trough concentrations of 15-20 mg/L were similar to patients treated with linezolid.
Conclusions: In our real-world comparative effectiveness study among obese patients with suspected MRSA pneumonia, linezolid was associated with a significantly lower mortality rate as compared to the vancomycin-treated patients with lower vancomycin MICs. Further studies are needed to determine whether this beneficial effect is observed in other study populations.


Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases.


Acetylation of an amino-terminal methionine is important for mediating specific protein-protein interactions. Acetylation of lysine residues in proteins can mediate protein-protein interactions, although few structural mechanisms of acetylation-dependent protein recognition have been elucidated. A common form of protein acetylation is N-terminal acetylation, which occurs cotranslationally for an estimated 30 to 90% of eukaryotic proteins. It is unclear how an N-terminally acetylated amino acid directly mediates protein-protein interactions. Scott et al. report that N-terminal acetylation of the E2 enzyme, Ubc12, dictates distinctive E3-mediated Nedd8 ligation to cullins. This mechanism of protein regulation connects protein acetylation with posttranslational modification by ubiquitin-like proteins. D. C. Scott, J. K. Monda, E. J. Bennett, J. W. Harper, B. A. Schulman, N-terminal acetylation acts as an avidity enhancer within an interconnected multiprotein complex. Science 334, 674–678 (2011). [Abstract] [Full Text]


Abstract. Monsoon has earned increasing attention from the climate community since the last century, yet only recently have regional monsoons been recognized as a global system. It remains a debated issue, however, as to what extent and at which timescales the global monsoon can be viewed as a major mode of climate variability. For this purpose, a PAGES (Past Global Changes) working group (WG) was set up to investigate the concept of the global monsoon and its future research directions. The WG's synthesis is presented here. On the basis of observation and proxy data, the WG found that the regional monsoons can vary coherently, although not perfectly, at various timescales, varying between interannual, interdecadal, centennial, millennial, orbital and tectonic timescales, conforming to the global monsoon concept across timescales. Within the global monsoon system, each subsystem has its own features, depending on its geographic and topographic conditions. Discrimination between global and regional components in the monsoon system is a key to revealing the driving factors in monsoon variations; hence, the global monsoon concept helps to enhance our understanding and to improve future projections of the regional monsoons. This paper starts with a historical review of the global monsoon concept in both modern and paleo-climatology, and an assessment of monsoon proxies used in regional and global scales. The main body of the paper is devoted to a summary of observation data at various timescales, providing evidence of the coherent global monsoon system. The paper concludes with a projection of future monsoon shifts in a warming world. The synthesis will be followed by a companion paper addressing driving mechanisms and outstanding issues in global monsoon studies.


Recent conditional image generation methods produce images of remarkable diversity, fidelity and realism. However, the majority of these methods allow conditioning only on labels or text prompts, which limits their level of control over the generation result. In this paper, we introduce MaskSketch, an image generation method that allows spatial conditioning of the generation result using a guiding sketch as an extra conditioning signal during sampling. MaskSketch utilizes a pretrained masked generative transformer, requiring no model training or paired supervision, and works with input sketches of different levels of abstraction. We show that intermediate self-attention maps of a masked generative transformer encode important structural information of the input image, such as scene layout and object shape, and we propose a novel sampling method based on this observation to enable structure-guided generation. Our results show that MaskSketch achieves high image realism and fidelity to the guiding structure. Evaluated on standard benchmark datasets, MaskSketch outperforms state-of-the-art methods for sketch-to-image translation, as well as unpaired image-to-image translation approaches. The code can be found on our project website: https://masksketch.github.io/


As the only American city under direct congressional control, Washington has served historically as a testing ground for federal policy initiatives and social experiments-with decidedly mixed results. Well-intentioned efforts to introduce measures of social justice for the district's largely black population have failed. Yet federal plans and federal money have successfully created a large federal presence-a triumph, argues Howard Gillette, of beauty over justice. In a new afterword, Gillette addresses the recent revitalization and the aftereffects of an urban sports arena.


Live streaming is gaining popularity across diverse application domains in recent years. A core part of the experience is streamer-viewer interaction, which has been mainly text-based. Recent systems explored extending viewer interaction to include visual elements with richer expression and increased engagement. However, understanding expressive visual inputs becomes challenging with many viewers, primarily due to the relative lack of structure in visual input. On the other hand, adding rigid structures can limit viewer interactions to narrow use cases or decrease the expressiveness of viewer inputs. To facilitate the sensemaking of many visual inputs while retaining the expressiveness or versatility of viewer interactions, we introduce a visual input management framework (VIMF) and a system, VisPoll, that help streamers specify, aggregate, and visualize many visual inputs. A pilot evaluation indicated that VisPoll can expand the types of viewer interactions. Our framework provides insights for designing scalable and expressive visual communication for live streaming.


Employing a wide range of travel and travel-related material from the period 1760-1860, this book offers new insights into the culture and history of late eighteenth and early nineteenth-century Ireland. It opens by exploring the development of the Home Tour as a rival to Grand Tour conventions, and assesses the ways in which Ireland deviated significantly from other Home Tour destinations. The book then focuses on the immediate Post-Union era which saw a dramatic increase in the number of, largely, British, travellers to Irish shores, and considers the extent to which post-Union optimism lay behind a reawakened interest in Irish affairs. In later chapters the author offers an assessment of the period 1820-50, when older, negative representations of the Irish re-emerged, while in the final chapter he examines the role of the Post-Famine writer, frequently brought to Ireland to assess the economic and social state of the country, though also to sometimes speculate about a place increasingly regarded as ripe for investment and resettlement. A book which blends a number of case studies within a consideration of wider contextual matters, Travel Writing and Ireland, 1760-1860 should appeal to students and researchers from across the Humanities.


Tropical regions are the main sources of the fruit, meat and non-forestry timber products that contribute to the state's food security and sovereignty, enhance producers' livelihoods and satisfy consumer demand. These tropical regions are rich in natural capital, but the lack of suitable technical, entrepreneurial and financial services impose considerable constraints on the development of these regions. This article shows the opportunities and challenges that producers face. Coca production systems suffer from plagues due to their mono-crop nature and incur high transaction costs from the use of chemicals. Agroforestry systems, on the other hand, are more resilient to shocks from both markets and nature due to their biodiversity and the advantages of the combination of integrated management practices (husbandry, agriculture, grazing).


Death and our experience of it is a fundamental aspect of life and consequently every human culture has developed practices associated with responding to, signifying, and dealing with its implications. As our technology pervades our cultures, we find that the digital is increasingly intersecting with these practices. This raises issues which have rarely been conceptualized or articulated in the HCI and CSCW communities. It is increasingly important to design "thanatosensitive" technologies which support death-centric practices such as collaborative acts of remembrance, bequeathing of digital data, or group reflection on the digital residua of a life. This workshop will bring together participants interested in such technologies and their implications. Potential topics include, but are not limited to: devices for reflection and meaning-making across multiple lifespans; interdisciplinary practices surrounding mortality, dying, and death; technology heirlooms; digital rights management; and methodological approaches to researching end-of-life technology issues.


We present a new approach for spatial interpolation of experimental raindrop size distribution (DSD) spectra. The DSD is fundamental to the study and understanding of precipitation and its monitoring and modelling. It is measured insitu using disdrometers at point locations. Disdrometers provide a (non‐parametric) DSD spectrum in which drop concentrations are provided per class of drop diameter. Our approach uses geostatistics to estimate the same non‐parametric DSD at unmeasured locations. Non‐stationarity due to intermittency is taken into account through estimation of the dry drift of drop concentrations, using a rain occurrence field. Principal component analysis is used to express the DSD spectra in terms of uncorrelated components that can be interpolated independently at a requested point. These interpolated components can then be recombined into the full DSD. Estimation uncertainty for the interpolated DSD spectra is provided. Because all bulk rainfall variables can be calculated from the DSD and the entire DSD is estimated, the technique effectively interpolates all bulk variables at once. Leave‐one‐out testing shows that the technique estimates the DSD with minimal bias, and it is shown that the technique can be easily adapted to perform stochastic simulation of the non‐parametric DSD.


Survey researchers often ask a series of attitudinal questions with a common question stem and response options, known as battery questions. Interviewers have substantial latitude in deciding how to administer these items, including whether to reread the common question stem on items after the first one or to probe respondents' answers. Despite the ubiquity of use of these items, there is virtually no research on whether respondent and interviewer behaviors on battery questions differ over items in a battery or whether interview behaviors are associated with answers to these questions. This article uses a nationally representative telephone survey with audio-recorded interviews and randomized placement of items within four different batteries to examine interviewer and respondent behaviors and respondent answers in battery questions. Using cross-classified random-effects models, the authors find strong evidence that there is more interviewer–respondent interaction on items asked earlier in the battery. In addition, interviewer and respondent behaviors are associated with both substantive and nonsubstantive answers provided to battery items, especially if the interviewer decided to reread or probe with the response options. These results suggest that survey designers should follow recommendations to randomize battery items and consider the importance of standardization of question administration when designing battery questions.


This essay draws on recent studies of the federal impeachment power and the issues swirling around the presidency of Donald Trump to consider the law and politics of impeachments. The impeachment process is inescapably political, but that does not mean that there are not constitutional rules, standards and considerations that can and will shape how the politics plays out. The most challenging constitutional questions surrounding the impeachment power relate to the scope of impeachable offenses. It is possible to rule out some possible interpretations of the constitutional language of "high crimes and misdemeanors," but the standard for impeachable offenses that we are left with will still require contestable political judgment to apply in any particular case. Knowing whether a given act could be regarded as an impeachable offense is only the first step in determining whether an individual should be impeached and removed from office.


The Pijao language was lost sometime during the last half of the 20th century and exactly how the language was lost has yet to be discerned. Using data from an investigation that examined perceptions of the causes and effects of the Pijao linguicide among focus groups of different ages in the Pijao community at Natagaima, Tolima, this article examines two themes that came out of the focus groups – how the language was lost and how the community has suffered since the loss of the Pijao language. The results show how loss of their native language has disadvantaged the Pijao as a result of pervasive linguistic essentialist attitudes pervasive in the country. At the national level, the Pijao have problems in terms of recognition from other indigenous groups, with many refusing to recognize the indigeneity of the Pijao on the grounds of lack of language, and at a local level with mestizos arguing the same. Additionally, the author offers a tentative hypothesis for the loss of the Pijao language in the south of Tolima – that the creation of indigenous reserves may have hastened the loss of the language.


Numbers ranging from half a trillion to two trillion dollars have been cited in recent years for global subsidies for fossil fuels. How are these figures calculated and why are they so different? The most commonly used methods for measuring subsidies are the price-gap approach -- quantifying the gap between free-market reference prices and the prices charged to consumers -- the inventory approach, which constructs an inventory of government actions benefiting production and consumption of fossil fuels. Practitioners are not faced with two choices. The two methods are complementary and should be used together -- price gaps cause distortions throughout the economy and quantification is needed for improving pricing policies; an inventory is useful for examining budgetary allocation. An inventory based on a full accounting framework for producer and consumer support estimates in fact captures price gaps as market transfers to producers or consumers. Differences in subsidy valuation arise from assumptions made to compensate for missing data and the scope of subsidy measurement. Having a common understanding of terms and standardizing calculation methods would go a long way in enabling comparison of subsidies across countries and sectors, benchmarking pricing, and assessing subsidy policies. Subsidy measurement should not be viewed as a one-off exercise to inform subsidy reform strategies. Just as subsidy reform in many countries does not have a clear end but is a continuous process of adjustment, so too is subsidy tracking. Devoting resources to data collection and analysis to track subsidies on a continuous basis can bring rich dividends by increasing transparency and enabling informed decisions.


Controlling power flow in modern power systems can be made more flexible by the use of recent developments in power electronic and computing control technology. The Unified Power Flow Controller (UPFC) is a Flexible AC transmission system (FACTS) device that can control all the three system variables namely line reactance, magnitude and phase angle difference of voltage across the line. The UPFC provides a promising means to control power flow in modern power systems. Essentially the performance depends on proper control setting achievable through a power flow analysis program. This paper presents a reliable method to meet the requirements by developing a NewtonRaphson based load flow calculation through which control settings of UPFC can be determined for the pre-specified power flow between the lines. The proposed method keeps Newton-Raphson Load Flow (NRLF) algorithm intact and needs (little modification in the Jacobian matrix). A MATLAB program has been developed to calculate the control settings of UPFC and the power flow between the lines after the load flow is converged. Case studies have been performed on IEEE 5-bus system and 14bus system to show that the proposed method is effective. These studies indicate that the method maintains the basic NRLF properties such as fast computational speed, high degree of accuracy and good convergence rate.


India has an estimated 26,000 startups, making it the third-largest startup ecosystem in the world, recording consolidated inflows of over $36 billion in the past 3 years with 26 "unicorns" – startups valued over $1 billion. The Indian startup ecosystem has expanded quite rapidly mainly through private investments including seed, angel, venture capital, and private equity funds, with technical support from incubators, accelerators, and the government. The government, for its part, is creating an enabling environment through its flagship Startup India initiative, which came into force in 2016. With India pushing towards a knowledge-based and digital economy, the government is attempting to deploy ICT infrastructure and provide policy support for enhanced e-governance, investments, and technology innovation through research and higher education to support entrepreneurship and spur economic growth. Data suggest that the expansion in the startup ecosystem has largely been clustered in the large (Tier 1) cities and states with financial depth, and especially in IT-enabled sectors including ecommerce, transport, and finance. Small businesses beyond the metros are not fully aware of, or integrated into, programs that provide startups with various government incentives and tax breaks. Despite the progress made so far, Indian businesses face huge challenges, such as the unorganized and fragmented nature of the market in most sectors, a lack of clear and transparent policy initiatives that startups can tap into quickly, as well as a lack of infrastructure, a lack of knowledge and exposure, and complications in doing business. Creating more awareness of government initiatives and incentives, credit disbursement to priority sectors, promoting outreach and network benefits to Tier 2 and Tier 3 cities, as well as easing financing and tax breaks for foreign and domestic investors could improve opportunities for startups in India.


This paper presents, analyses, and further develops the idea of a destination-based cash-flow tax (DBCFT). Its purpose is expositional: to describe the DBCFT, how it might work, what its effects would be and some of the challenges that its implementation would face. The paper starts by introducing the basic mechanics of the DBCFT before evaluating it against five criteria: economic efficiency, robustness to avoidance and evasion, ease of administration, fairness and stability. It does so both for the case of universal adoption by all countries and the more plausible case of unilateral adoption. The paper then looks closely at the application of DBCFT treatment to the financial sector, which is a familiar problem under the VAT but has been little considered under the DBCFT. Finally, the paper sets out some core implementation issues, and how they might be addressed. It also compares the implementation of a DBCFT with the economically equivalent reform option that introduces a broad-based, uniform rate VAT (or achieves the same effect through an existing VAT), and reduces taxes on payroll by the same proportion.


Public transportation services are vital for civic life. Recently, many countries in the Middle East have turned their attention towards developing and improving their public transport systems, as problems such as traffic congestion in cities, low mobility, high individual costs of transport, and a rural-urban divide in services have arisen. This study is a public needs assessment and opinion survey of an area in one such Middle Eastern country, the Al-Batinah region of Oman. The study finds public transport services in Oman are minimal and do not match demand, and there is an excessive reliance on private cars. Marketing of public transport services is constrained by certain environmental issues, particularly the socio-cultural and physical environments. The study is innovative from both an approach and implementation perspective and will help policy makers in Oman think about long-term strategies towards establishing viable public transport solutions.


AIMS
Brugada syndrome (BrS) remains genetically heterogeneous and is associated with slowed cardiac conduction. We aimed to identify genetic variation in BrS cases at loci associated with QRS duration.

METHODS AND RESULTS
A multi-centre study sequenced seven candidate genes (SCN10A, HAND1, PLN, CASQ2, TKT, TBX3, and TBX5) in 156 Caucasian SCN5A mutation-negative BrS patients (80% male; mean age 48) with symptoms (64%) and/or a family history of sudden death (47%) or BrS (18%). Forty-nine variants were identified: 18 were rare (MAF <1%) and non-synonymous; and 11/18 (61.1%), mostly in SCN10A, were predicted as pathogenic using multiple bioinformatics tools. Allele frequencies were compared with the Exome Sequencing and UK10K Projects. SKAT methods tested rare variation in SCN10A finding no statistically significant difference between cases and controls. Co-segregation analysis was possible for four of seven probands carrying a novel pathogenic variant. Only one pedigree (I671V/G1299A in SCN10A) showed co-segregation. The SCN10A SNP V1073 was, however, associated strongly with BrS [66.9 vs. 40.1% (UK10K) OR (95% CI) = 3.02 (2.35-3.87), P = 8.07 × 10-19]. Voltage-clamp experiments for NaV1.8 were performed for SCN10A common variants V1073, A1073, and rare variants of interest: A200V and I671V. V1073, A200V and I671V, demonstrated significant reductions in peak INa compared with ancestral allele A1073 (rs6795970).

CONCLUSION
Rare variants in the screened QRS-associated genes (including SCN10A) are not responsible for a significant proportion of SCN5A mutation negative BrS. The common SNP SCN10A V1073 was strongly associated with BrS and demonstrated loss of NaV1.8 function, as did rare variants in isolated patients.


The mining of user generated content in social media has proven very effective in domains ranging from personalization and recommendation systems to crisis management. The knowledge of online users' locations makes their tweets more informative and adds another dimension to their analysis. Existing approaches to predict the location of Twitter users are purely data-driven and require large training data sets of geo-tagged tweets. The collection and modelling process of tweets can be time intensive. To overcome this drawback, we propose a novel knowledge based approach that does not require any training data. Our approach uses information in Wikipedia, about cities in the geographical area of our interest, to score entities most relevant to a city. By semantically matching the scored entities of a city and the entities mentioned by the user in his/her tweets, we predict the most likely location of the user. Using a publicly available benchmark dataset, we achieve 3% increase in accuracy and 80 miles drop in the average error distance with respect to the state-of-the-art approaches.


A recent and prominent American appeals court case has revived a controversial international law question: can a state compel an individual on its territory to obtain and produce material which the individual owns or controls, but which is stored on the territory of a foreign state? The case involved, United States v. Microsoft, features electronic data stored offshore which was sought in the context of a criminal prosecution. It highlights the current legal complexity surrounding the cross-border gathering of electronic evidence, which has produced friction and divergent state practice. The author here contends that the problems involved are best understood—and potentially resolved—via examination through the lens of the public international law of jurisdiction, and specifically the prohibition of extraterritorial enforcement jurisdiction. Analysis of state practice reveals that unsanctioned cross-border evidence gathering is viewed by states as an intrusion on territorial sovereignty, engaging the prohibition, and that this view properly extends to the kind of state activity dealt with in the Microsoft case.


On 2009 June 5, the Gamma-ray Burst Monitor (GBM) onboard the Fermi Gamma-ray Space Telescope triggered on two short and relatively dim bursts with spectral properties similar to soft gamma repeater (SGR) bursts. Independent localizations of the bursts by triangulation with the Konus-RF and with the Swift satellite confirmed their origin from the same, previously unknown, source. The subsequent discovery of X-ray pulsations with the Rossi X-ray Timing Explorer confirmed the magnetar nature of the new source, SGR J0418 + 5729. We describe here the Fermi/GBM observations, the discovery and the localization of this new SGR, and our infrared and Chandra X-ray observations. We also present a detailed temporal and spectral study of the two GBM bursts. SGR J0418 + 5729 is the second source discovered in the same region of the sky in the last year, the other one being SGR J0501 + 4516. Both sources lie in the direction of the galactic anti-center and presumably at the nearby distance of ∼2 kpc (assuming they reside in the Perseus arm of our Galaxy). The near-threshold GBM detection of bursts from SGR J0418 + 5729 suggests that there may be more such "dim" SGRs throughout our Galaxy, possibly exceeding the population of "bright" SGRs. Finally, using sample statistics, we conclude that the number of observable active magnetars in our Galaxy at any given time is ≲10, in agreement with our earlier estimates.


We study a novel policy tool—interest rate uncertainty—that can be used to discourage inefficient capital inflows and to adjust the composition of external account between shortterm securities and foreign direct investment (FDI). We identify the trade-offs faced in navigating between external balance and price stability. The interest rate uncertainty policy discourages short-term inflows mainly through portfolio risk and precautionary saving channels. A markup channel generates net FDI inflows under imperfect exchange rate passthrough. We further investigate new channels under different assumptions about the irreversibility of FDI, the currency of export invoicing, risk aversion of outside agents, and effective lower bound in the rest of the world. Under every scenario, uncertainty policy is inflationary.


This contribution investigates the meanings and uses of the English and Dutch adverbs certainly and zeker . In the range of adverbial expressions of epistemic modality, the 'strong' adverbs (expressing 'certainty') clearly tend to be used in a much more 'flexible' way than the (relatively) weaker ones, and this contribution is an attempt to get a better view of what this flexibility actually involves, on the basis of a careful analysis of corpus data. The comparative approach allows us to distinguish between features which are whims of a single language, and hence have little meaning beyond the grammar of that language, and features which reflect more profound issues in the analysis of the meanings at stake, and which therefore may reflect fundamental conceptual issues.


The role of inequalities in information theory is reviewed, and the relationship of these inequalities to inequalities in other branches of mathematics is developed. The simple inequalities for differential entropy are applied to the standard multivariate normal to furnish new and simpler proofs of the major determinant inequalities in classical mathematics. The authors discuss differential entropy inequalities for random subsets of samples. These inequalities when specialized to multivariate normal variables provide the determinant inequalities that are presented. The authors focus on the entropy power inequality (including the related Brunn-Minkowski, Young's, and Fisher information inequalities) and address various uncertainty principles and their interrelations. >


How can transport and land-use transitions in urban regions be understood and supported? This question is increasingly relevant for researchers and policy makers alike given the growing urgency of sustainability issues confronting cities and the limited improvements can be observed despite continued policy attention, for example Transit-oriented development policies. To tackle this question, this thesis draws on theories and concepts from transition studies. This has led to a richer conceptualisation of transitions and the extent to which policy makers can actively influence them. Transport and land-use transitions can be seen as resulting from the interaction between established and novel structures and practices and exogenous developments. In historic case studies carried out in Munich and Zurich, we see that in transitions that have taken place troubles, or difficulties that people experience in their daily lives, play an important role in focusing political debates. In the process of reaching consensus regarding problems and solutions, interest groups, coalition building and both implicit and explicit societal rules open to conflict and supportive of its resolution play a pivotal role. To aid in supporting transition attempts, a reflexive planning approach has been developed and tested in the region of Amsterdam. The breadth of the focus in this approach in terms of developments considered and actors involved resulted in potential solutions that differed from traditional policy in terms of innovativeness and the extent of support for them.


Context: Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care. Aims: The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge test (PCKT). Settings and Design: Cross-sectional survey of 363 nurses in a multispecialty hospital. Materials and Methods: The study utilized a self-report questionnaire- PCKT developed by Nakazawa et al., which had 20 items (statements about palliative care) for each of which the person had to indicate 'correct', 'incorrect', or 'unsure.' The PCKT had 5 subscales (philosophy- 2 items, pain- 6 items, dyspnea- 4 items, psychiatric problems- 4 items, and gastro-intestinal problems- 4 items). Statistical Analysis Used: Comparison across individual and professional variables for both dimensions were done using one-way ANOVA, and correlations were done using Karl-Pearson's co-efficient using SPSS version 16.0 for Windows. Results: The overall total score of PCKT was 7.16 ± 2.69 (35.8%). The philosophy score was 73 ± .65 (36.5%), pain score was 2.09 ± 1.19 (34.83%), dyspnea score was 1.13 ± .95 (28.25%), psychiatric problems score was 1.83 ± 1.02 (45.75%), and gastro-intestinal problems score was 1.36 ± .97 (34%). (P = .00). The female nurses scored higher than their male counterparts, but the difference was not significant (P > .05). Conclusions: Overall level of knowledge about palliative care was poor, and nurses had a greater knowledge about psychiatric problems and philosophy than the other aspects indicated in PCKT.


With respect to treatment monitoring, conventional modalities such as physical examination, ultrasonography, and mammography are frequently used, but vary in reliability for measuring tumor's therapeutic response [1, 2]. Magnetic resonance imaging (MRI) is increasingly being used to evaluate locally advanced breast cancer undergoing neo-adjuvant chemotherapy. However, changes in lesion size or dynamic contrast enhanced MRI are not detected until several weeks following chemotherapy [3].

Recently, proton magnetic resonance spectroscopy (1H-MRS) has been proven helpful for the diagnosis of breast cancer based on total choline-containing compounds (tCho). The presence of tCho may indicate active cell replication, thus can be used for diagnosis. The role of 1H-MRS at 1.5 T for therapy response prediction is less established [4, 5]. Authors of this earlier study did not categorize which patients had a change in tCho signal nor did they describe when the change in the signal occurred. In this study, we applied longitudinal quantitative 1H-MRS using the internal reference method to monitor the change of tCho level during the full course of neo-adjuvant chemotherapy. The aim of our study was to determine whether the early changes can predict clinical response in women undergoing neo-adjuvant chemotherapy.

Twenty breast cancer patients (range 32-76 years old, mean 50 years) enrolled from June 2004 to December 2006, who were scanned with the MRI/MRS protocol, were included in this study. The inclusion criteria were patients with biopsy-confirmed diagnosis of malignant lesions that measured 2.4 cm or larger on MR images. All patients received biweekly doxorubicin (adriamycin) and cyclophosphamide (AC) as their first-line regimen. After the first two cycles, an oncologist evaluated patient response using all information available at that time (clinical examination, patient's tolerance, sonography, etc), and the oncologist decided whether the patient should continue to receive two additional cycles of AC or should be switched to a taxane-based regimen. In all patients, MRI and 1H-MRS were performed before treatment as the baseline, then at least two follow-up (F/U) times, F/U-1 after one to two cycles AC and F/U-2 after four cycles AC or two cycles AC followed by the first cycle of a taxane regimen.

The MRI study was carried out using a 1.5 T Phillips Eclipse MR scanner with a standard bilateral breast coil (Philips Medical Systems, Cleveland, OH). The imaging protocol consisted of high- resolution precontrast imaging from the concerned breast, bilateral dynamic contrast-enhanced imaging, and 1H-MR spectroscopy. For dynamic acquisition, the MR contrast agent gadodiamide (Omniscan®, GE Healthcare AS, Oslo, Norway, 1 cm3/10 lbs body weight) was manually injected. After the MRI study was completed, single-voxel 1H-MRS was carried out using a point-resolved spin-echo sequence (PRsESS). The spectroscopic voxel was carefully positioned to maximize the coverage of the contrast-enhanced lesions while minimizing the inclusion of adipose tissue. The voxel size was from 2.4 to 8.0 ml. The absolute tCho concentration was analyzed using as an internal reference method [6]. Tumor size was measured by a radiologist based on the maximum intensity projection of the contrast subtraction images. Based on the one-dimensional RECIST criteria [7], patients were categorized into one of two groups: responders or nonresponders. Responders were defined as subjects with ≥30% one-dimensional tumor size reduction at F/U-2 compared with the baseline. Nonresponders were patients with a <30% of tumor size or no change.

In this study, 14 of 16 patients who were responders had positive tCho before treatment. There is no significant difference in tCho level at the baseline between responder and nonresponder groups (2.30 ± 2.24 versus 2.51 ± 2.27 mmol/kg, P = 0.67). The mean percentage change in tCho level after one to two cycles AC was -50%, while the mean percentage change in lesion size was -18% (Figure 1). After completing F/U-2, all patients did not have positive tCho. The mean percentage change in lesion size in F/U-2 study was -76%. Three patients were classified as nonresponders. All three patients had a positive tCho at the baseline. The mean percentage change in tCho level after one to two cycles AC was -14%, while the mean percentage change in lesion size was -15%. Of them, two patients showed increased tCho in F/U-2, and the remaining one patient showed decreased tCho but was still positive. The mean percentage changes in tCho level and lesion size in F/U-2 study were 3.3% and -27%, respectively. For the responder group, significant reductions in tCho level and tumor size were observed at the early F/U-1 with respect to the baseline (P < 0.002, P < 0.008), whereas no significant change was observed for either in the nonresponder group.

Figure 1

A 33-year-old young woman with locally advanced breast cancer who were undergoing neoadjuvant chemotherapy. The core biopsy revealed an invasive ductal carcinoma. The tumor was a triple negative cancer, found to be negative for estrogen, progesterone, ...

As the therapeutic agents become more effective, more patients can achieve the pathological complete response which is expected to lead to a better prognosis. Our study carried out on breast cancer treated with chemotherapy showed that in the responder group the reduction in tCho level at the first follow-up (F/U-1, one to two cycles AC) was significantly higher compared with the reduction in the tumor size (P < 0.005). The result demonstrates that the metabolic changes were greater than the size changes, suggesting that they might have occurred before gross morphological changes. An early reduction of tCho level can be interpreted as reflecting the inhibition of cellular proliferation and the cytotoxic effect of chemotherapy. In addition, the tCho level showed significant reduction in the response group but not in the nonresponse group, suggesting an early response predictor. This finding suggests that a greater reduction in tCho at the F/U-1 may be associated with a final complete response, so they may help to predict pathological complete response.


We derive an upper bound on the local Rademacher complexity of lp-norm multiple kernel learning, which yields a tighter excess risk bound than global approaches. Previous local approaches analyzed the case p = 1 only while our analysis covers all cases 1 ≤ p ≤ ∞, assuming the different feature mappings corresponding to the different kernels to be uncorrelated. We also show a lower bound that shows that the bound is tight, and derive consequences regarding excess loss, namely fast convergence rates of the order $O(n^{-\frac{\alpha}{1+\alpha}})$, where α is the minimum eigenvalue decay rate of the individual kernels.


Circular economy approaches aim to close material cycles along the value chain. As such, the circular economy can be a long‐term strategy to mitigate the risks of critical raw material (CRM) supply. Tantalum, with a current end‐of‐life recycling rate of less than 1%, has been intermittently discussed as critical. Even though the specificity of tantalum applications and high‐mass fractions of tantalum in relevant components provide good boundary conditions, recycling barriers hinder the successful implementation of recycling technologies. With this case study, we identify potentials and barriers for implementing the recovery of CRM, using the example of tantalum. To this end, information about visually identifiable tantalum capacitors (VICs) and printed circuit boards (PCBs) in various equipment types was obtained by disassembly campaigns for mobile phones, smartphones, tablets, notebooks, desktop personal computers, flat screen monitors, servers, etc., and the chemical analyses of resulting fractions. Results show great differences in the application of tantalum in various equipment types. Because of this, the tantalum potential of put‐on‐market (POM) or of waste electric and electronic equipment (WEEE) devices differs between products and regions. Worldwide, the highest POM tantalum flows originate from desktop computers, but in Germany they originate from notebooks. A focus on particular products leads to higher yields in recycling and supports circular economy approaches. Recycling of tantalum from WEEE is generally possible. But an accurate separation of tantalum from PCBs is not feasible solely by separation of VICs. This process also leads to the loss of silver. Further, this study reveals potential miniaturization trends, decreasing the use of VICs, with an anticipated substitution of tantalum with niobium. These barriers impede long‐term recycling strategies for tantalum aimed at establishing a circular economy.


This paper suggests that the export performance of Pakistan can be well analyzed by considering both supply and demand sides simultaneously. Following Goldstein and Khan (1978) we formulate a simultaneous equations equilibrium model for Pakistan's exports. Our two-equation model, which is estimated for primary and manufactured goods exports for the period, 1960-80, is directly comparable with the estimated export supply equations reported in P.I.D.E.'s macroeconometric model. The estimation of our model using 2SLS provides consistent estimates of the export elasticities. As expected, Pakistan being a small open economy, price responses are not significant while world income and domestic production of exportable significantly explains the demand and supply sides of exports respectively.


Abstract Recent research has been concerned with whether speech accommodation is an automatic process or determined by social factors (e.g. Trudgill 2008). This paper investigates phonetic accommodation in New Zealand English when speakers of NZE are responding to an Australian talker in a speech production task. NZ participants were randomly assigned to either a Positive or Negative group, where they were either flattered or insulted by the Australian. Overall, the NZE speakers accommodated to the speech of the AuE speaker. The flattery/insult manipulation did not influence degree of accommodation, but accommodation was predicted by participants' scores on an Implicit Association Task that measured Australia and New Zealand biases. Participants who scored with a pro-Australia bias were more likely to accommodate to the speech of the AuE speaker. Social biases about how a participant feels about a speaker predicted the extent of accommodation. These biases are, crucially, simultaneously automatic and social. (Speech accommodation, phonetic convergence, New Zealand English, dialect contact)*


1. The bivalent cation-binding agent, cellulose phosphate, was given for 6 days to four normal subjects and six patients with latent hypoparathyroidism (diagnosed by impaired response to EDTA infusion), all of whom were on a moderately low calcium diet. 2. In normal subjects, there was a prompt and sustained fall in urinary calcium with no change in plasma calcium, indicating increased tubular reabsorption. Plasma and urinary magnesium fell, without increase in tubular reabsorption. The urinary total hydroxyproline increased and Tm,P/glomerular filtration rate fell after 2 days; these changes were transient and were consistent with a transient increase in parathyroid hormone secretion. 3. In the hypoparathyroid patients, urinary calcium fell more slowly and a fall in plasma calcium occurred in several subjects, the extent and duration of which corresponded with parathyroid status determined by EDTA infusion. Urinary conservation of calcium was impaired but plasma and urinary magnesium fell as in normal subjects. Urinary total hydroxyproline did not change and Tm,P/glomerular filtration rate fell more slowly than in the normal subjects. 4. The relative contributions of increased tubular reabsorption and reduced filtered load to calcium conservation in response to calcium depletion depend on the prevailing level of parathyroid function; the former is more important when parathyroid function is normal, the latter when parathyroid function is impaired. 5. In the detection of reduced parathyroid reserve, the assessment based on the plasma calcium response to cellulose phosphate agrees closely with the assessment based on the degree of recovery from EDTA-induced hypocalcaemia.


Abstract The global economy is experiencing digital transformation with impacts felt in developing countries. Digital firms and capabilities, however, remain concentrated in advanced economies. These processes indicate an emerging source of global economic inequality and a widening of the technological gap. Recently, there has been a growth in interventionist digital policy in developing and emerging economies but research has so far made a limited analysis of how this might fulfil economic objectives and support technological catch-up. In this paper, we examine this growth of national digital policies and highlight how industrial policy objectives are important drivers of digital strategies. Examining a number of cases based on an extensive analysis of national digital policies, with a focus on China, we illustrate that these policies often aim at facilitating global integration and linkages. However, our analysis shows that, under certain conditions, more interventionist approaches can be vital in countering structural challenges. Challenges include the power of digital platforms, limitations of domestic digital firms, and limited ability to leverage digitalisation for broad-based national development.


The escort factor Scap is essential in mammalian cells for the regulated activation of sterol regulatory element binding proteins (SREBPs), which are membrane-bound transcription factors. Cells lacking Scap cannot activate SREBP and are therefore deficient in the transcription of numerous genes involved in lipid synthesis and uptake; they cannot survive in the absence of exogenous lipid. Here we report that, conversely, Drosophila completely lacking dscap are viable. Flies lacking dscap emerge at about 70 % of the expected rate and readily survive as homozygous stocks. These animals continue to cleave dSREBP in some tissues. Transcription of dSREBP target genes in dscap mutant larvae is reduced compared to wild type but is greater than in mutants lacking dSREBP and remains responsive to dietary lipids in dscap mutants. In contrast to flies lacking ds2p , a gene encoding a protease that releases the transcription factor domain of dSREBP from the membrane, dscap mutants do not require the caspase Drice to activate dSREBP. Larvae doubly mutant for dscap and ds2p exhibit phenotypes similar to those of ds2p single mutants. Thus, dScap and dS2P, essential components of the SREBP activation machinery in mammalian cells, are dispensable in Drosophila owing to different compensatory mechanisms.


OBJECTIVE Insulin resistance is associated with mitochondrial dysfunction and decreased ATP synthesis. Treatment of individuals with type 2 diabetes mellitus (T2DM) with sodium–glucose transporter 2 inhibitors (SGLT2i) improves insulin sensitivity. However, recent reports have demonstrated development of ketoacidosis in subjects with T2DM treated with SGLT2i. The current study examined the effect of improved insulin sensitivity with dapagliflozin on 1) mitochondrial ATP synthesis and 2) substrate oxidation rates and ketone production. RESEARCH DESIGN AND METHODS The study randomized 18 individuals with T2DM to dapagliflozin (n = 9) or placebo (n = 9). Before and after 2 weeks, subjects received an insulin clamp with tritiated glucose, indirect calorimetry, and muscle biopsies. RESULTS Dapagliflozin reduced fasting plasma glucose (167 ± 13 to 128 ± 6 mg/dL) and increased insulin-stimulated glucose disposal by 36% (P < 0.01). Glucose oxidation decreased (1.06 to 0.80 mg/kg ⋅ min, P < 0.05), whereas nonoxidative glucose disposal (glycogen synthesis) increased (2.74 to 4.74 mg/kg ⋅ min, P = 0.03). Dapagliflozin decreased basal glucose oxidation and increased lipid oxidation and plasma ketone concentration (0.05 to 0.19 mmol/L, P < 0.01) in association with an increase in fasting plasma glucagon (77 ± 8 to 94 ± 13, P < 0.01). Dapagliflozin reduced the ATP synthesis rate, which correlated with an increase in plasma ketone concentration. CONCLUSIONS Dapagliflozin improved insulin sensitivity and caused a shift from glucose to lipid oxidation, which, together with an increase in glucagon-to-insulin ratio, provide the metabolic basis for increased ketone production.


Title of Dissertation: THE DEVELOPMENT OF AN AIR-COOLED ABSORPTION CHILLER CONCEPT AND ITS INTEGRATION IN CHP SYSTEMS Xiaohong Liao, Doctor of Philosophy, 2004 Dissertation Directed By: Professor Reinhard Radermacher, Ph.D. Department of Mechanical Engineering This dissertation focuses on the feasibility, crystallization issues, and the integration of LiBr-H2O air-cooled absorption chillers into Cooling, Heating and Power (CHP) systems. The concept of an air-cooled system is attractive because the cooling tower and the associated installation and maintenance issues can be avoided. However, crystallization of the LiBr-H2O solution then becomes the main issue in the operation of the unit, since the air-cooled absorber tends to operate hotter than the water-cooled absorber due to the relative heat transfer characteristics of the coolant leading to crystallization of the working fluid. Differently from the conventional approaches to air-cooled absorption chillers, novel temperature control strategies in conjunction with a specialized application is proposed. This prevents crystallization but presents unique system integration challenges and opportunities. A model to accurately reflect the thermodynamic characteristics of air-cooled absorption chillers and to facilitate control is developed as part of this research, and field experiments that simulate air-cooled conditions with a water-cooled absorption chiller, which was driven by the waste heat of a microturbine, were conducted to validate the feasibility of the air-cooled concept and the accuracy of computer model. While CHP provides a good opportunity for the application of air-cooled absorption chillers, system integration issues need to be investigated. The capital cost of CHP equipment and the load fluctuation of a commercial building restrict the advantage of designing a unit sized for peak load. Therefore, the conventional Heating Ventilation and Air Conditioning (HVAC) system is needed to pick up the residual loads. Thus, the result of an extensive system integration analysis is that CHP should be arranged in series with the HVAC system to ensure obtaining more operating hours at its full capacity, so that the cost savings achieved through the recovery of waste heat are fully realized to repay its higher initial capital cost. The primary energy savings are presented for all potential configurations. As a part of this research a fully integrated CHP system has been installed and instrumented at the Chesapeake Building. It is a commercial office building on the University of Maryland campus. The experimental setup, data processing, and experience gained are detailed here. Based on the computer simulation, extensive experiments, first hand installation, operation and maintenance experience, valuable guidelines on the integration of an air-cooled absorption chiller in CHP are developed. All the guidelines are also applicable to water-cooled absorption chillers. THE DEVELOPMENT OF AN AIR-COOLED ABSORPTION CHILLER CONCEPT AND ITS INTEGRATION IN CHP SYSTEMS


Elevated levels of CO 2 and O 3 affect plant growth and phytochemistry, which in turn can alter physiological performance of associated herbivores. Little is known, however, about how generalist insect herbivores respond behaviorally to CO 2-and O 3-mediated changes in their host plants. This research examined the effects of elevated CO 2 and O 3 levels on host plant preferences and consumption of forest tent caterpillar (FTC, Malacosoma disstria Hbn.) larvae. Dual choice feeding assays were performed with foliage from birch (Betula papyrifera Marsh.) and aspen (Populus tremuloides Michx., genotypes 216 and 259). Trees were grown at the Aspen Free Air CO 2 Enrichment (FACE) facility near Rhinelander, WI, USA, and had been exposed to ambient or elevated concentrations of CO 2 and/or O 3. Levels of nutritional and secondary compounds were quantified through phytochemical analyses. The results showed that elevated O 3 levels increased FTC larval preferences for birch compared with aspen, whereas elevated CO 2 levels had the opposite effect. In assays with the two aspen genotypes, addition of both CO 2 and O 3 caused a shift in feeding preferences from genotype 259 to genotype 216. Consumption was unaffected by experimental treatments in assays comparing aspen and birch, but were increased for larvae given high O 3 foliage in the aspen genotype assays. Elevated levels of CO 2 and O 3 altered tree phytochemistry, but did not explain shifts in feeding preferences. The results demonstrate that increased levels of CO 2 and O 3 can alter insect host plant preferences both between and within tree species. Also, consequences of altered host quality (e.g., compensatory consumption) may be buffered by partial host shifts in situations when alternative plant species are available. Environmentally induced changes in host plant preferences may have the potential to alter the distribution of herbivory across plant genotypes and species, as well as competitive interactions among them.


This article provides a critique of Atran's and Axelrod's conceptualization and application of bargaining theory to the Israeli-Palestinian conflict. Key notions such as ' the sacred,' and 'the symbolic' are either not defined at all or equivocally operationalized. The intrinsic relation between the symbolic and material levels of a phenomenon are misunderstood. Finally, the authors fail to modify their instrumental-rational bargaining paradigm to account for the uniquely existentialist challenges at the base of the Israeli-Palestinian confrontation.


To what extent can a neural network systematically reason over symbolic facts? Evidence suggests that large pre-trained language models (LMs) acquire some reasoning capacity, but this ability is difficult to control. Recently, it has been shown that Transformer-based models succeed in consistent reasoning over explicit symbolic facts, under a "closed-world" assumption. However, in an open-domain setup, it is desirable to tap into the vast reservoir of implicit knowledge already encoded in the parameters of pre-trained LMs. In this work, we provide a first demonstration that LMs can be trained to reliably perform systematic reasoning combining both implicit, pre-trained knowledge and explicit natural language statements. To do this, we describe a procedure for automatically generating datasets that teach a model new reasoning skills, and demonstrate that models learn to effectively perform inference which involves implicit taxonomic and world knowledge, chaining and counting. Finally, we show that "teaching" models to reason generalizes beyond the training distribution: they successfully compose the usage of multiple reasoning skills in single examples. Our work paves a path towards open-domain systems that constantly improve by interacting with users who can instantly correct a model by adding simple natural language statements.


The pavement community has recognized that moisture damage of hot mix asphalt (HMA) mixtures has been a serious problem since the early 1960s. Numerous additives have been evaluated with the objective of reducing the potential of moisture damage in HMA mixtures. Lime has been one of the most common additives used to reduce the potential of moisture damage. The Nevada Department of Transportation (NDOT) has been using lime in HMA mixtures since the mid 1980s. The objective of this research is to quantify the improvements in pavement performance that have been realized through the addition of lime to HMA mixtures. The research used two methodologies: 1) quantify the effectiveness of lime on NDOT's HMA pavements through the evaluation of field pavements and 2) evaluate the various techniques of adding lime to HMA mixtures through laboratory testing. The evaluation of field pavements consisted of evaluating field samples and pavement performance data from untreated and lime-treated pavements. The evaluation of various techniques to add lime into HMA mixtures conducted laboratory evaluation of laboratory-mixed/laboratory-compacted HMA mixtures treated with lime using different techniques. The properties of untreated and lime-treated mixtures from field projects in the southern and northwestern parts of Nevada indicated that lime treatment of Nevada's aggregates significantly improves the moisture sensitivity of HMA mixtures. The study showed that lime-treated HMA mixtures become significantly more resistant to multiple freeze-thaw than the untreated mixtures. The long term pavement performance data indicated that under similar environmental and traffic conditions, the lime-treated mixtures provided better performing pavements with less requirements for maintenance and rehabilitation activities. The analysis of the impact of lime on pavement life indicated that lime treatment extends the performance life of HMA pavements by an average of 3 years. This represents an average increase of 38% in the expected pavement life. The laboratory portion of the study showed that lime improves the tensile strength and resilient modulus properties of the HMA mixtures after single and multiple freeze-thaw cycling. The portion of the laboratory study dealing with the evaluation of lime application indicated that all methods of application can produce similar results 80% of the time. In the other 20% of the time, the NDOT process for 48-hours marination showed to be the most effective. Based on the data generated in this experiment, the addition of lime on wet aggregates with 48-hours marination would be the most desirable method of lime application because it provides effective results and it is less susceptible to field problems than the addition of lime to wet aggregates without marination.


Strained alkenes and alkynes are the predominant dienophiles used in inverse electron-demand Diels-Alder (IEDDA) reactions, however, their instability, cross-reactivity and accessibility are problematic. Unstrained dienophiles, although physiologically stable and synthetically accessible, react with tetrazines significantly slower relative to strained variants. Here we report the development of potassium arylethynyltrifluoroborates as unstrained dienophiles for ultrafast, chemically triggered IEDDA reactions. By varying the substituents on the tetrazine (e.g. pyridyl- to benzyl-substituents), cycloaddition rates can vary from nearly spontaneous (t1/2≈ 9 s) to no reaction with the unstrained alkyne-BF3 dienophile. The reported system was applied to protein modification and enabled mutually orthogonal labelling of two distinct proteins.


As billions of transistors are being placed on a few square millimeters of silicon, power dissipation is becoming a more crucial factor to be tackled for high performance computing. Reversible circuit synthesis has been considered as a promising direction for low power design due to its information lossless behavior. In addition, it forms the basis for quantum computing. However, synthesis of reversible circuits cannot be achieved with the classical approaches for irreversible logic due to the additional imposed constraints, consequently, neither fan-out nor feedback are allowed. Binary Decision Diagrams (BDDs) have been proposed as a compact data structure to represent a boolean function. They have been exploited to synthesize reversible circuits through proper mapping of each BDD's node into a cascade of reversible Toffoli gates. Nevertheless, reordering of BDD's nodes before circuit synthesis significantly impacts the overall cost of the synthesized circuit. In this paper, we present a comparative study for BDD reordering algorithms in terms of the cost of the generated reversible circuit. The studied algorithms include greedy, dynamic programming, and heuristic based approaches. The cost metric includes the number of lines, gate count, and quantum cost. Experimental results show that meta heuristic-based BDD reordering algorithms outperform other algorithms in terms of the overall synthesized circuit cost with slightly additional runtime. Thereafter, we conclude with a proposal for a new framework for reversible logic synthesis.


In an attempt to highlight the need for lecturers to adopt clear strategies for treating language usage errors in written assignments, the writer of this article analysed selected students' essays to determine some of the error handling strategies that can be used at tertiary level. The suggestions made at the end of the study were based on the analysis of data collected from student's written work in Discourse Analysis. Although there is generally no consensus on how lecturers should treat students' errors in written assignments, observations in this study enabled the researcher to provide certain strategies that lecturers can adopt.

Key words: Error treatment; error handling; corrective feedback, positive cognitive feedback; negative cognitive feedback; global errors; local errors; Terminable Units (T-Units)
[Jnl for Language Teaching 37(2) 2003: 224-236]


Several techniques have been developed for both identification and verification of faces. The most explored one is the eigen-based (Principal Component Analysis) method. Of all the variants of PCA considered, only the Projection Combined PCA used by Wu and Zhou, employed single training face per individual. In this experiment, an evaluation of Optimised PCA and Projection Combined PCA techniques was carried out based on following parameters, such as recognition accuracy, total training time, average recognition time. Overall results indicated


Academics generate circles of thought. Their preferred modes of conceptualization—the intellectual constructions in circulation within academic discourse at a given moment—readily pass across disciplinary boundaries. During the past two centuries, philosophical critique and the criticism of art have a history of informing each other (Robert Pippin's After the Beautiful is a current example of the syndrome). Although the concepts of societal "modernism" and "modernist" art exhibit variation, both are hybrids of philosophical (linguistic) and aesthetic (sensory) indeterminacies. Rather than fretting over interpretive instability, we are inured to conceptual change and indeterminacy in every domain. But our world becomes circular—ironically, quite stable—when we direct logical reasoning to illuminate its aesthetic double (as Hegel did) or direct art to illuminate its philosophical double (as Heidegger did). Inattentive to anything outside the circle, we imagine our intellectual progress, for circularity is self-confirming. Our illusory progress accompanies a spotty record of predicting actual change. With respect to where our philosophical concepts of change have led us, chance is a better guide to our immediate intellectual and aesthetic preferences, even though it presumes no explanation of our comprehensive cultural formation. Although never right, chance has the advantage of never being wrong.