For voice restoration after total laryngectomy, there are three options for artificial speech: the larynx voice, esophageal voice and tracheoesophageal voice. The method must be chosen only after a discussion between surgeon, speech therapist and patient, taking into account the communication needs, the physical and mental condition and personal preference. The authors aim to present variants of vocal rehabilitation, with a replacement voice that ensures socio-professional reintegration of the patient. In order to asses the new voice quality, we use spectral analysis of the voice and psychoacoustics analysis of speech formation with an analytical scale.


The aim of this article is to describe the development of total quality management (TQM) models using a grounded theory research methodology where a key part of the methodology is a longitudinal study. The models seek to capture the development of quality within organizations over time and thus to contribute a dynamic perspective. Much of existing literature on longitudinal TQM development in organizations is anecdotal and descriptive, without any obvious theoretical base. This article seeks to help fill the void by examining organizational practice with the view to develop underpinning theoretical models through grounded theory research. The article describes five models, which can be combined to describe the effective development of TQM within an organization. The models include TQM environment, TQM life cycle, the key points of TQM application, the strategic application of TQM, and the strategic application of the business excellence model (BEM). The case study is used to illustrate the application of the models in a dynamic situation.


Abstract. In recent years, the requirements in the industrial production, e.g., ships or planes, have been increased. In addition to high accuracy requirements with a standard deviation of 1 mm, an efficient 3D object capturing is required. In terms of efficiency, kinematic laser scanning (k-TLS) has been proven its worth in recent years. It can be seen as an alternative to the well established static terrestrial laser scanning (s-TLS). However, current k-TLS based multi-sensor-systems (MSS) are not able to fulfil the high accuracy requirements. Thus, a new k-TLS based MSS and suitable processing algorithms have to be developed. In this contribution a new k-TLS based MSS will be presented. The main focus will lie on the (geo-)referencing process. Due to the high accuracy requirements, a novel procedure of external (geo-)referencing is used here. Hereby, a mobile platform, which is equipped with a profile laser scanner, will be tracked by a laser tracker. Due to the fact that the measurement frequency of the laser scanner is significantly higher than the measurement frequency of the laser tracker a direct point wise (geo-)referencing is not possible. To enable this a Kalman filter model is set up and implemented. In the prediction step each point is shifted according to the determined velocity of the platform. Because of the nonlinear motion of the platform an iterative extended Kalman filter (iEKF) is used here. Furthermore, test measurements of a panel with the k-TLS based MSS and with s-TLS were carried out. To compare the results, the 3D distances with the M3C2-algorithm between the s-TLS 3D point cloud and the k-TLS 3D point cloud are estimated. It can be noted, that the usage of a system model for the (geo-)referencing is essential. The results show that the mentioned high accuracy requirements have been achieved.


The aim of this article is to examine whether informational manipulation, used intentionally by the researcher to increase recruitment in the research study, can be morally acceptable. We argue that this question is better answered by following a non-normative account, according to which the ethical justifiability of informational manipulation should not be relevant to its definition. The most appropriate criterion by which informational manipulation should be considered as morally acceptable or not is the researcher's special moral duties towards their subjects. We also propose that a broader definition of manipulation of information should be adopted (than that already existing in the literature) since informational manipulation can affect not only a person's beliefs but also their desires in decision-making. We conclude that manipulation of information can either be used to protect the potential subject and facilitate the informed consent process or be used to exploit and merely use a person for scientific goals.


Context-aware recommender systems are becoming a popular topic, still, there are many untouched aspects. In this paper, research involving context identification and the concepts related to hybrid and context-aware systems is presented. A conceptual architecture for a context-aware recommender system for movies and TV shows is furthermore introduced. The system consists of a number of processes for context identification and recommendation. Key contextual features are identified and used for the creation of several sets of recommendations, based on the predicted context. The main focus of the research presented here is the identification of context, which in turn is used for recommendation. The results will be evaluated and incorporated into the recommendation engine of movie and TV recommendation website Moviepilot.


Background and Aim: Employees suggestion plan (ESP) is designed to encourage and improve employees' participation in developmental planning. The establishment of this system needs cultural, individual and structural preparedness. This study is aimed to determine organizational preparedness in Tehran University of Medical Sciences (TUMS). Materials and Methods: This research was a cross-sectional, descriptive and analytical study conducted in TUMS headquarters in Tehran, Iran. The heterogeneous sample of this study consisted of 155 employees. They were asked to fill out a researcher-made questionnaire to assess their attitude towards organizational preparedness for ESP establishment. The validity and reliability of the questionnaire were confirmed. The data were analyzed by SPSS, and descriptive results were presented. The data were also analyzed by Friedman and ANOVA statistical methods. Results: Most of the employees had a positive attitude towards the existence of individual and cultural preparedness for ESP establishment in TUMS. However, they believed the desired structural preparedness for this process did not exist. Conclusion: The desired organizational preparedness for ESP establishment exists in TUMS, although structural preparedness is not desirable. Therefore, it is suggested that necessary modifications should be made in TUMS organizational structure for effective ESP implementation.


Controlled induction of parturition is a very useful tool for managing calving and post-parturition management and successful parturition in dairy farms. In the present study, 12 pregnant buffaloes were treated with dexamethasone in combination with cloprostenol for controlled induction of parturition in Lal Teer Livestock Research and Development Farm, Mymensingh, Bangladesh. The buffaloes were divided into two groups according to their gestation length. The gestation length of buffaloes of group-A was up to 330 days (305-330) and group-B was more than 330 days (331-345). Buffaloes were injected with 6 mL Roxadex and 2 mL Ovuprost intra-muscularly (Roxadex®, Nuvista Pharma Limited, Bangladesh containing 5 mg Dexamethasone sodium phosphate mLG1 and Ovuprost®, Bayer Animal Health, New Zealand containing 250 μg Cloprostenol sodium mLG1). Induction of parturition was occurred in all buffaloes in an average time 29.17±3.06 h after the treatment. The duration between treatment and the induction of parturition showed a significant difference (p<0.01) between two groups. Retention of placenta was recorded in 33.33% of animals and the occurrence of dystocia was 25.00%. The viability of newborn (calves) was 91.67% as compared with dead calves 8.33%. It was concluded that dexamethasone in combination with cloprostenol can be used successfully for induction of parturition in buffaloes of Bangladesh although there was a moderate incidence of dystocia and retention of placenta, which needs to be minimized by careful follow up, critical observation and prompt assistance. Further therapeutic trials are needed to minimize the incidence of retention of placenta and dystocia.


Cultural conflict and shifting identities in Stephen Black's The Dorp (1920) This article deals with journalist, dramatist and novelist Stephen Black's The Dorp (1920), a novel which I regard as the earliest example of what I have named the small-town novel sub-genre of the South African English novel. Other early examples of the small-town novel are Willemsdorp by H.C. Bosman, The Mask by C. L. Leipoldt and Too Late the Phalarope by Alan Paton. Black satirizes the goings-on in a typical South African town called Unionstad. The name of the town reveals the novel's threefold thematic impulse: an allegorical evocation of the Union Period (1910-48) in South Africa; an ironic-satirical thrust (the Union period was one of increasing political polarization and ultimately, an idealistic vision of cultural-political reconciliation. Unionstad, like the towns in the novels mentioned above, is portrayed as a microcosm of the national macrocosm. The Dorp reveals the ill effects of historical events such as the Boer War and the 1914 Rebellion, specifically the animosity that it created between English and Afrikaner townspeople. Black's keen awareness and representation of how the political turmoil in the country impacts on the lives of ordinary people and how town culture reflects key aspects of a bigger problem, are the main strengths of the novel. Black's vision for reconciliation is symbolized by the union in marriage of Anita van Ryn, the mayor's daughter and Ned Oakley, the English shopkeeper's son. Keywords: Afrikaner nationalism, small-town novel, South African literature, , , , , Stephen Black.


The recent cloning of a breast-ovarian cancer susceptibility gene (BRCA1), and determination of the locus of a related gene (BRCA2), offers potential for clinical genetic testing for breast cancer susceptibility. This study examined interest in and expectations about an impending genetic test among first-degree relatives (FDRs) of breast cancer patients. One hundred five females completed two structured telephone interviews to assess demographics, breast cancer risk factors, psychological factors, and attitudes about genetic testing for breast cancer susceptibility. Overall, 91% of FDRs said that they would want to be tested, 4% said they would not, and 5% were uncertain. The most commonly cited reasons for wanting genetic testing were to learn about one's children's risk, to increase use of cancer screening tests, and to take better care of oneself. Women with less formal education were motivated by childbearing decisions and future planning to a greater degree than were women with education beyond high school. Most women anticipated a negative psychological impact of positive test results, involving increased anxiety (83%), depression (80%), and impaired quality of life (46%). In addition, 72% of women indicated that they would still worry if they tested negative. In multivariate regression analysis, level of baseline depression was the strongest predictor of an anticipated negative impact of genetic testing (Beta = .15; P, .0001). These results suggest that the demand for genetic testing for breast cancer susceptibility may be great, even among women who are not likely to have predisposing mutations.(ABSTRACT TRUNCATED AT 250 WORDS)


This narrative qualitative research study explored the stories of four youth about their experiences of living in Rexdale, a neighbourhood in Toronto, Ontario. The stories shared by participants shared showed the similarities, differences, and complexities of the youths' experiences of living in Rexdale. A narrative approach to research was used to collect the data, which are referred to as stories. The theoretical framework draws from critical race theory with an emphasis on the concept of race and space. Data analysis included a thematic and structural narrative analysis. The findings provided insight into what it is like for youth to live in Rexdale. The themes that emerged include: the positive/negative or good/bad binary, defying stereotypes, the portrayal of Rexdale, experiences of living in Rexdale, community resources, potential growth and sense of community. The implications for future social work research and practice are discussed followed by the author's final thoughts.


Aliteracy, the state in which the skill to read has been acquired, but not the will, is a growing concern in research on adolescence internationally. The West Australian Study in Adolescent Book Reading (WASABR) aimed to discover current attitudes toward and levels of engagement in recreational book reading among 520 adolescent students from 20 Western Australian schools. It also explored the role of social agents in influencing recreational book reading in this cohort, examining the influences of parents, English teachers, the peer group and friends on adolescents' recreational book reading in order to understand how adolescents' engagement in recreational book reading is affected by social factors. These understandings were sought with a view to ultimately enhance the participation of high school students in recreational book reading. This paper outlines the current body of research findings from the WASABR, drawing together the broad areas covered within the study into a cohesive whole.


 ABSTRACT : Potential answers concerning the existence or not of specific stage structures in the Theatre of Dionysus, during the life of Aeschylus, may only be tentative and offered mainly on the basis of hints supplied by the texts themselves. Owing to the lack of further evidence, it is preferable to opt for the most straightforward and economical solutions (in terms of both complexity and cost). In this study I am dealing with two Aeschylean tragedies, Persae and Supplices , where the issue of the possible existence of specific stage installations or of a raised stage needs to be addressed. I will equally consider the fragmentary satyr play Theoroi , which raises the question of the possible influence of contemporaneous artistic styles upon stage constructions or


Individuals diagnosed with an autism spectrum disorder (ASD) present with language and reading abilities that range from far below average to far above average. There is a lack of research investigating the classification of children diagnosed with a high-functioning ASD (HFASD) according to language and reading ability. The present study aimed to explore the language and reading profiles within a group of young children diagnosed with a HFASD and to establish whether or not the language and reading profiles identified within this group were similar to those seen in age-matched children without a diagnosis of ASD. The results showed that children diagnosed with a HFASD present with language and reading ability profiles similar to those of non-ASD peers. Furthermore, regression analyses revealed that the predictors of decoding and also reading comprehension were similar for children with HFASD and their non-ASD peers.


We describe the WIKIQA dataset, a new publicly available set of question and sentence pairs, collected and annotated for research on open-domain question answering. Most previous work on answer sentence selection focuses on a dataset created using the TREC-QA data, which includes editor-generated questions and candidate answer sentences selected by matching content words in the question. WIKIQA is constructed using a more natural process and is more than an order of magnitude larger than the previous dataset. In addition, the WIKIQA dataset also includes questions for which there are no correct sentences, enabling researchers to work on answer triggering, a critical component in any QA system. We compare several systems on the task of answer sentence selection on both datasets and also describe the performance of a system on the problem of answer triggering using the WIKIQA dataset.


Effective from 1 June 2014, all foreign businesses supplying digital products such as mobile applications to be used in South Africa are required to register as vendors. This amendment was made to align South Africa with an international trend of bringing cross-border supplies of electronic services into the Value-Added Tax regime. It effectively shifts the Value-Added Tax liability from the importer to the foreign supplier. The reverse-charge-mechanism resulted in an erosion of the tax base and placed local suppliers of digital services at a competitive disadvantage compared to foreign suppliers. This paper critically evaluates the amendment to the Value-Added Tax Act using a literature review. The aim is to determine to what extent the amendments address the shortcomings of the reverse-charge mechanism, are aligned with practices in the European Union and New Zealand and whether they comply with the principles of an effective tax system.


In many of Spike Lee's films, jazz is a medium of cultural transformation, enabling African-Americans and other ethnic and racial groups to understand the cultural legacies on which their collective identity depends, by reconciling them for better or worse to their common history as citizens of the United States. The recurrent theme in all of Lee's films is the cultural consequences of excluding African-Americans from that history, especially given their enormous influence on it, and the losses and distortions that necessary follow from such exclusions. In When the Levees Broke (2006), his four-part television documentary about the destruction of New Orleans by Hurricane Katrina, Lee transforms this theme into a powerful story of individual and collective cultural rebirth through jazz. In this essay, I want to offer some initial thoughts on how Lee connects this story with the dominant historical metaphors and mythical realities of nationhood in the United States, especially those that identify jazz with the themes of displacement, homelessness and homecoming.


Findings from a 2011 ERS study show that due to geographical food-price variation, the new fruit and vegetable voucher for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) buys substantially smaller amounts in some U.S. areas than in others. In 2009, the WIC program began providing cash vouchers for fruit and vegetables. WIC mothers now receive a $10 voucher each month (WIC children get a $6 voucher) to purchase any fruit and vegetables, except white potatoes. The other WIC benefits are quantity vouchers for a specified amount of nutritious foods, such as a dozen eggs or 1 to 2 pounds of whole wheat bread. Using Nielsen Homescan data from 2004-06, ERS researchers examined average prices of 20 frequently purchased fruit and vegetables in 26 metropolitan markets. Average prices were calculated based on the dollar amounts spent on different forms of fruit and vegetables (fresh, canned, and frozen) purchased from all stores across all households and then averaged over the 3 years. For comparison, researchers also calculated a single national average price for each fruit and vegetable. To account for the small sample size in some cities, the original 52 Nielsen market areas were consolidated into 26 metro markets based on geography and other market characteristics. Individual fruit and vegetable prices were 30 to 70 percent higher in the most expensive markets versus the lowest priced metro markets. For example, tomatoes, the most popular vegetable, averaged $1.66 a pound nationwide but were least expensive in the Nashville/Birmingham/Memphis/ Louisville market group at $1.42. In contrast, tomatoes were the most expensive in San Francisco at $1.98 per pound. A WIC mother living in Nashville would have been able to purchase 7.0 pounds of tomatoes with her $10 voucher but only 5.1 pounds in San Francisco. Oranges—another favorite—had a price spread of 73 percent and cost $0.85 per pound, on average. Oranges were least expensive in the Kansas City/ Minneapolis/St. Louis/Des Moines/ Omaha market group at $0.72 per pound, and they were most expensive in the Hartford/New Haven market group at $1.25. A WIC mother would have been able to buy 13.9 pounds of oranges with her $10 voucher in Kansas City and only 8.0 pounds in Hartford.


There are huge discrepancies between the official Chinese and U.S. estimates of the bilateral trade balance. The discrepancies are caused by different treatments accorded to re-exports through Hong Kong, re-export markups, and trade in services. Deficit-shifting between China, on the one hand, and Hong Kong and Taiwan, on the other, due to direct investment in China from Taiwan and Hong Kong, is partly responsible for the growth in the China - United States bilateral trade deficit. The 1995 China - United States bilateral balance of trade in goods and services, adjusted by both re-exports and re-export markups, may be estimated as US$23.3 billion, a large deficit but considerably smaller than the often-cited official U.S. figure of US$33.8 billion.


Years of heavy regulation and a long-standing focus on compliance have co-opted the ability of the healthcare industry to implement novel data sharing approaches. We now face a critical need for such innovation, as personalization and data science prompt patients to engage in the details of their healthcare and restore agency over their medical data. This thesis proposes MedRec: a novel, decentralized record management system to handle EHRs (Electronic Health Records), using blockchain technology. The system design gives patients a comprehensive, immutable log and access to their medical information across providers and treatment sites. Leveraging unique blockchain properties, MedRec manages authentication, data retrieval, update tracking for existing records, data entry (both for patients and providers) and data sharing. MedRec accomplishes record management without creating any centralized data repositories; a modular system design integrates with providers' existing, local data storage solutions, facilitating interoperable data exchange between data sources and the patients. We incentivize healthcare industry stakeholders (government-funded researchers, public health authorities, etc.) to participate in the network as blockchain "miners". This provides them with access to aggregate, anonymized data as mining rewards, in return for sustaining and securing the MedRec network via Proof of Work. We emphasize the flexibility and extensibility of our system components to other dimensions of the healthcare industry and to applications beyond healthcare as well. This thesis describes the MedRec technical design and early-stage prototype, our pilot with Beth Israel Deaconess Medical Center (BIDMC), and an analysis of MedRec's contribution in the context of national healthcare priorities. This work is supported by the MIT Media Lab Consortium. Thesis Supervisor: Andrew Lippman Title: Associate Director and Senior Research Scientist, MIT Media Lab


We consider the use of decision trees for decision-making problems under the predict-then-optimize framework. That is, we would like to first use a decision tree to predict unknown input parameters of an optimization problem, and then make decisions by solving the optimization problem using the predicted parameters. A natural loss function in this framework is to measure the suboptimality of the decisions induced by the predicted input parameters, as opposed to measuring loss using input parameter prediction error. This natural loss function is known in the literature as the Smart Predict-then-Optimize (SPO) loss, and we propose a tractable methodology called SPO Trees (SPOTs) for training decision trees under this loss. SPOTs benefit from the interpretability of decision trees, providing an interpretable segmentation of contextual features into groups with distinct optimal solutions to the optimization problem of interest. We conduct several numerical experiments on synthetic and real data including the prediction of travel times for shortest path problems and predicting click probabilities for news article recommendation. We demonstrate on these datasets that SPOTs simultaneously provide higher quality decisions and significantly lower model complexity than other machine learning approaches (e.g., CART) trained to minimize prediction error.


The proportion of older people in the general population is steadily increasing worldwide, with the most rapid growth in lowand middle-income countries.1 This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population aging also has important implications for society – in diverse areas including health systems, labor markets, public policy, social programs, and family dynamics.2 A successful response to the aging population will require capitalizing on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterized by poor health outcomes and very high health care costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease and stroke – all of which are key causes of death and disability in older people.3 Since the prevalence of CKD is higher in older people, the health impact of population aging will depend in part on how the kidney community responds. March 13, 2014 will mark the celebration of the 9th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort to raise awareness among policymakers and the general public about the importance of kidney disease. The topic for WKD 2014 is "CKD in older people". This article reviews the key links between kidney function, age, health and illness – and discusses the implications of the aging population for the care of people with CKD.


The text describes the practice of the Anartist, which consists of interventions that subvert the urban space with an antagonist and countercultural spin inspired by the Black Bloc. The evil aura and the symbolic violence of the Black Blocks, a sort of magical Black Mana, are folded into a subversive aesthetic expressiveness that opens a line of escape in the urban space and provokes a viral infection in the Integrated Spectacle of Capitalism. The Anartist, a masked transpersona that can be embodied by anybody, extends the counter-spectacle of the Black Bloc destructive actions in disruptive line of flights that actualize their telluric subversion in site-specific situations of the urban space. The Anartist is a sort of simulacrum that decentralizes, remodulates and intensifies the counter-cultural mythology of Black Blocks. The practice of the Anartist, which can be defined as Disturbanism, unworks the money-form of the space, unleashing an event that is out of capitalist design but which arises from within itself as a virus that causes a negative diarrhea of dissensus. In fact, the Anarchist Disturbanist intervention can be considered as the unappropriated other that cannot be expelled outside by a totalitarian system that has no outside and returns as a viral scatological hauntology. The Anartist produces chaos, symbols and experiences through Black shit, ghosts and antagonist viruses to operate witchcraft rituals, which not only cannot be subsumed by the Capitalist Spectacle but continue to infect it in an eternal return producing a counter-culture and a counter-spell.


The mounting demand for high density non-volatile flash memories consequences new challenges of flash memory reliability issues [1,2]. Common reliability-improving techniques approaches are addressing device and process manufacturing improvements [3] or error correction codes (ECC) techniques [4]. This paper proposes a novel memory architecture and method of increasing reliability through reducing the program-erase (P/E) cycles. Reduction of P/E cycles is achieved through a memory architecture which enables rewrite operation in a single flash memory cell, instead erase-and-program which is currently applied. Furthermore, a potential improvement of the write operation time is also achieved when using sufficiently large write buffer, regarding modern write techniques [5,6].


This book addresses the need to re-imagine and re-conceptualise the Just City in light of recent systemic shocks: climate change, the pandemic, a generalised erosion of democratic standards and more. It contains texts by a number of guests and 43 manifestos written by students from 25 universities from all over the world.
A "Manifesto for the Just City" comes in the wake of the realisation that socio-spatial justice is a crucial dimension for sustainability transitions. Growing inequality and the erosion of the public sphere undermine the social and political structures required to fight climate change, pandemics and other systemic shocks. With this book, we have sought to encourage students to formulate their own visions for the Just City and for a just transition.
This book is result of an Urban Thinkers Campus organised between 9 and 30 November 2020. The Urban Thinkers Campus (UTC) model is an initiative of UN-Habitat's World Urban Campaign, conceived in 2014 as an open space for critical exchange between stakeholders and partners. It aims to promote debate and action on sustainable and inclusive urbanization upholding the principles and guidelines contained in the New Urban Agenda, launched at Habitat-III in 2016 in Quito, Ecuador.


This article examines the triangular relationship among the Chinese community of northern Vietnam, the North Vietnamese government, and China, focusing in particular on how the relationship affected the ethnic and national identities of Chinese residents in North Vietnam between 1954 and 1978. Scrutiny of the two important issues of citizenship and the Chinese school system reveals that North Vietnamese leaders adopted lenient policies toward Chinese residents mainly because they saw the relationship between the Vietnamese state and the Chinese community as part and parcel of North Vietnam's relationship with China. These policies ultimately contributed to a delay in the assimilation of Chinese residents, and by the end of the 1970s they still had not completed the transformation from well-treated sojourners into citizens of Vietnam. Though many Chinese residents embraced a status of privileged outsider, others willingly participated on Vietnam's behalf in the war against America. After reunification, the desire to clarify loyalty, i.e. to "purify" the nation-state, led the Vietnamese government to initiate an aggressive process of forced assimilation. This policy, and the deterioration of relations between Vietnam and China in the late 1970s, triggered an exodus of Chinese residents.


I present an investigation into Type Ia Supernovae (SNe Ia). The aim of this investigation is to explain the physics and diversity of SNe Ia, motivated by the fact that, although SNe Ia are known to come from a thermonuclear explosion of a C+O Chandrasekhar mass (Ch-mass) White Dwarf (WD), their exact explosion scenario is one of debate, and their full diversity is not fully understood. As SNe Ia are used as cosmological distance probes, understanding their explosions and progenitors systems in more detail could have important consequences. To examine the diversity of SNe Ia, I first present a large sample analysis of their B and V - band light curves, separated by host galaxy type. A new method for calculating host galaxy extinction is implemented and the width luminosity relation (WLR) is examined. After correction for host galaxy extinction, 'normal' SNe Ia (∆m15(B) < 1.6 mag) fill a larger parameter space in the WLR than previously suggested. Even excluding fast declining SNe, 'normal' (MB <−18mag) SNeIa from star forming(S- F) and passive galaxies are distinct. This may indicate that various progenitor channels are prevalent in different galaxy types. Furthermore, it was also confirmed that sub- luminous SNe Ia tend to favour passive galaxies, which implies that this subset of SNe Ia come from an older progenitor system. There was a lack of transition SNe Ia in the dataset used in this project. These are SNe Ia with a luminosity between normal and sub-luminous SNe Ia. Understanding transitional SNe Ia is important in determining whether sub-luminous SNe Ia are a totally different population. With the aim of understanding how normal SNe explode, I first turn my attention to SN 2014J. SN 2014J was the closest type Ia in the last 410 years, and it was a once in a life time opportunity to study. Therefore, a detailed spectroscopic and photometric analysis and abundance stratification modelling of SN 2014J is presented. SN 2014J is a spectroscopically normal type Ia SN with a B band decline rate of 0.95 mag, before correction for extinction. It was located in the dusty starburst galaxy M82, and does not follow the average Galactic extinction law of Rv = 3.1. With the knowledge about the diversity of SNe Ia and the ability to carry out de- tailed modelling, SN 1986G was next chosen to be modelled. SN 1986G sits in an interesting area of parameter space in the WLR. It is located in the 'gap' between normal and sub-luminous SNe Ia. It has been theorised that sub-luminous SNe Ia come from a different progenitor system than standard SNe Ia. Therefore, understanding SN properties in this 'gap' is important for determining at which point SNe Ia properties begin to diverge from the normal scenario. A full abundance tomography modelling of SN 1986G was carried out. It was found that this SN is a low energy Chandrasekhar mass explosion. It had 70% of the energy of a standard W7 model. These findings raise the possibility that only SNe Ia with very large decline rates deviate from a Chandrasekhar mass.


How parents negotiate over parental care is a central issue in evolutionary biology because it affects the evolutionary outcome of sexual conflict. A recent theoretical model shows that 'turn-taking' in provisioning visits by the parents is an evolutionarily stable negotiation strategy, and empirical studies have shown that parental nest-visits do indeed alternate more than expected by chance. However, such alternation may also be generated by a refractory period, or by correlated temporal heterogeneity (CTH) in provisioning rates of the two parents driven by temporal environmental variation. Here we use a recently developed measure of alternation and a novel measure of CTH in the provisioning rates of pairs to clarify what can be concluded about the occurrence of turn-taking from the provisioning patterns of pairs. First, we show using a simulation model that turn-taking can, by itself, generate both a refractory period and CTH in provisioning rates. Second, we incorporate this insight into a conceptual framework that combines an existing randomization analysis with a novel analytical approach in which 'pseudo-pairs' are created by analytically pairing the provisioning sequence of a parent at one nest with the contemporaneous provisioning sequence of the other-sex parent at a nearby nest. This allows us to partition the alternation score into different components. This approach confirms that isolating a component of alternation that can be unequivocally attributed to turn-taking is probably impossible. However, the pseudo-pairs analysis does isolate a component that can be unequivocally attributed to general temporal environmental variation (environmental variation that causes CTH in provisioning rates across [as well as within] pairs). Third, we use these techniques to partition the alternation score of 17 pairs of great tits Parus major provisioning in the wild. Approximately 8% of the observed alternation score is due to the frequency distribution of the inter-visit intervals, 74% to nest-specific effects on the sequence of inter-visit intervals, and 18% to general effects on the sequence of inter-visit intervals. This last component can be unequivocally attributed to general temporal environmental variation, and is the first empirical demonstration of alternation by free-living provisioning parents being generated by temporal environmental variation.


Recent research has provided mixed findings as to whether older adults find dual tasking problematic. Here, we examined whether methodological variations across studies can account for the discrepancies in the literature. Meta-analyses conducted on the results of 34 studies conducted between 1981 and 2003 found a strong overall effect size (d = .68), which indicated a clear age-related dual tasking impairment. However, this effect size was not representative of all the individual studies reported. Subsequent analyses, using an analysis of variance analogue (Hedges & Olkin, 1985), investigated potential moderators responsible for the variability in the effect sizes across studies. These secondary analyses included a comparison of dependent measure used, whether baseline differences in performance had been controlled for, and task domain. Task domain was found to be the critical moderator variable. Notably, tasks with a substantial controlled processing, or motor component showed greater dual task impairment than tasks that were relatively simple or relied on automatic processing.


BACKGROUND
Melanoma escape mechanisms include immunosuppressive and angiogenic cytokine production.

OBJECTIVE
We sought to determine vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) expression by immunohistochemistry, and soluble circulating plasma levels of VEGF, bFGF, IL-10, and transforming growth factor-beta2 in patients with different stages of melanoma.

METHODS
Biopsy specimens from 42 patients with primary melanoma and 9 with cutaneous metastases were studied by immunohistochemistry. In another 46 patients with melanoma (8 stage I and II; 18, III; and 20, IV) and in 10 healthy control participants, bFGF, VEGF, IL-10, and transforming growth factor-beta2 circulating levels were analyzed.

RESULTS
bFGF was positive in 85% and VEGF in 47.5% of 42 primary melanomas. Of 10 patients with primary melanoma (Breslow depth 1.5-3 mm) 6 were VEGF positive and had metastases develop, whereas 4 were VEGF negative and had no metastases at 5 years of follow up. VEGF, bFGF, and IL-10 plasma levels in patients with stages III and IV melanoma were higher than the control group (P <.05 and P <.01, respectively). An inverse relationship was found between VEGF and IL-10. Specifically, in 7 patients with IL-10 levels higher than 10 pg/mL, VEGF levels were less than 49 pg/mL (P <.05); in 9 patients with VEGF levels higher than 100 pg/mL, IL-10 levels were less than 6.7 pg/mL (P <.01).

CONCLUSION
VEGF expression in 1.5- to 3.0-mm Breslow depth melanomas may be considered as an unfavorable prognostic factor. Immunosuppressive (IL-10, transforming growth factor-beta2) and proangiogenic (bFGF, VEGF) cytokines are increased in metastatic melanoma. Inverse plasma levels between IL-10 and VEGF in patients with metastatic melanoma are shown in vivo for the first time, the significance of which must be further investigated.


As human-robot collaboration increases in the workforce, it becomes essential for human-robot teams to coordinate efficiently and intuitively. Traditional approaches for human-robot scheduling either utilize exact methods that are intractable for large-scale problems and struggle to account for stochastic, time varying human task performance, or application-specific heuristics that require expert domain knowledge to develop. We propose a deep learning-based framework, called HybridNet, combining a heterogeneous graph-based encoder with a recurrent schedule propagator for scheduling stochastic human-robot teams under upper- and lower-bound temporal constraints. The HybridNet's encoder leverages Heterogeneous Graph Attention Networks to model the initial environment and team dynamics while accounting for the constraints. By formulating task scheduling as a sequential decision-making process, the HybridNet's recurrent neural schedule propagator leverages Long Short-Term Memory (LSTM) models to propagate forward consequences of actions to carry out fast schedule generation, removing the need to interact with the environment between every taskagent pair selection. The resulting scheduling policy network provides a computationally lightweight yet highly expressive model that is end-to-end trainable via Reinforcement Learning algorithms. We develop a virtual task scheduling environment for mixed human-robot teams in a multi-round setting, capable of modeling the stochastic learning behaviors of human workers. Experimental results showed that HybridNet outperformed other human-robot scheduling solutions across problem sizes for both deterministic and stochastic human performance, with faster runtime compared to pure-GNN-based schedulers.


Background World Health Organization (WHO) recommends systematic screening of high-risk populations, including household contacts (HHCs) of adult pulmonary tuberculosis (TB) patients, as a key strategy for elimination of TB. QuantiFERON-TB Gold In-Tube (QFT-GIT) assay and tuberculin skin test (TST) are two commonly used tools for the detection of latent tuberculosis infection (LTBI) but may yield differential results, affecting eligibility for TB preventive therapy. Materials and methods A prospective cohort study of adult pulmonary TB patients and their HHCs were recruited in 2 cities of India, Pune and Chennai. HHCs underwent QFT-GIT (QIAGEN) and TST (PPD SPAN 2TU/5TU). A positive QFT-GIT was defined as value ≥0.35 IU/ml and a positive TST as an induration of ≥5 mm. A secondary outcome of TST induration ≥10mm was explored. Proportion positive by either or both assays, discordant positives and negatives were calculated; test concordance was assessed using percentage agreement and kappa statistics; and risk factors for concordance and discordance including age categories were assessed using logistic regression. Sensitivity and specificity was estimated by latent class model. Results Of 1048 HHCs enrolled, 869 [median (IQR) age: 27 years (15–40)] had both TST and QFT-GIT results available and prevalence of LTBI by QFT-GIT was 54% [95% CI (51, 57)], by TST was 55% [95% CI (52, 58)], by either test was 74% [95% CI (71, 77) and by both tests was 35% [95% CI (31, 38)]. Discordance of TST+/QFT-GIT- was 21% while TST-/QFT-GIT+ was 26%. Poor to fair agreement occurred with TST 5mm or 10mm cutoff (60 and 61% agreement with kappa value of 0.20 and 0.25 respectively). Test agreement varied by age, TST strength and induration cut-off. In multivariate analysis, span PPD was a risk factor for QFT-GIT+ and TST- while absence of BCG scar was for TST+ and QFT-GIT-. Being employed and exposure to TB case outside the household case were associated with positivity by both the tests. Sensitivity of TST and QFT-GIT to diagnose LTBI was 77% and 69%. Probability of having LTBI was >90% when both tests were positive irrespective of exposure gradient. Conclusion Prevalence of LTBI among HHCs of adult pulmonary TB patients in India is very high and varies by test type, age, and exposure gradient. In our high TB burden setting, a strategy to treat all HHCs or a targeted strategy whereby an exposure index is used should be assessed in future preventive therapy and vaccine studies as HHCs have several factors that place them at high risk for progression to TB disease.


Biotransformation of the triazolobenzodiazepine triazolam to its hydroxylated metabolites, alpha-hydroxy (OH)- and 4-OH-triazolam, was studied in vitro using microsomal preparations of human liver. Mean values of Vmax (10.3 nM/min/mg of protein) and Km (304 microM) for the 4-OH pathway exceeded values for the alpha-OH pathway (2.4 and 74, respectively). However the mean Vmax/Km ratios for the two pathways were nearly identical, indicating that both contribute approximately equally to intrinsic clearance. Ketoconazole was a powerful inhibitor of triazolam biotransformation, having mean competitive Ki values of 0.006 and 0.023 microM for the alpha-OH and 4-OH pathways. This is consistent with the role of P450-3A isoforms in mediating triazolam biotransformation. The serotonin2 antagonist antidepressant nefazodone inhibited the alpha-OH and 4-OH pathways (Ki = 0.6 and 1.7 microM, respectively), but with considerably less activity than ketoconazole. Among six selective serotonin reuptake-inhibitor antidepressants, norfluoxetine was the most potent inhibitor (Ki = 2.7 and 8.0 microM) and fluoxetine itself was the weakest (Ki = 7.0 and 44.3 microM). In a double-blind clinical pharmacokinetic-pharmacodynamic study, administration of triazolam (0.125 mg) preceded by ketoconazole, compared to triazolam preceded by placebo, produced a nearly 9-fold reduction in apparent oral clearance of triazolam (41 vs. 337 ml/min) and a 4-fold prolongation of half-life (13.5 vs. 3.4 hr). Pharmacodynamic testing indicated enhancement of electroencephalographic beta activity, and enhanced decrements in digit-symbol substitution test performance, attributable to coadministration of ketoconazole. Plasma ketoconazole concentrations measured in the clinical study ranged from 0.02 microgram/ml (projected minimum) to 4.95 micrograms/ml (maximum). An in vitro-in vivo scaling model, using these plasma ketoconazole concentrations together with liver partition ratios and the in vitro Ki values, predicted a decrement of triazolam clearance due to ketoconazole coadministration that was consistent with the 88% decrement in clearance actually observed in vivo.


Biopharmaceutical companies have the most complete and up-to-date information about the medicines that they research, develop and manufacture for use by patients.  However, companies are often unable to proactively share valuable information about their medicines, especially for information that is not contained in the FDA-approved prescribing information (the package insert you often receive with a prescription), with physicians and other healthcare providers. The new FDA draft guidance opens the door for companies to share truthful, scientifically accurate, and data-driven information with healthcare professionals to inform treatment decisions.


Margarite is recorded here for the first time in the alteration zones (blackwall) of ultramafic rocks. The mineral occurs in metasomatized metapyroxenites (chloritites) of the Barramiya area in the central Eastern Desert of Egypt. These metapyroxenites belong to the Neoproterozoic Pan-African melange of northeast Africa. Two sub-types of chloritites are distinguished, namely margarite-free and margarite-bearing chloritites. Margarite is only found in the metapyroxenites when they are in direct contact with the melange metadiabases. Margarite is considered here as a metasomatic mineral resulting from the addition of both Ca 2+ and Al 3+ from the juxtaposing metadiabases. This is also accompanied by Fe-Mg substitution causing the conversion of the coexisting chlorite species from sheridanite to ripidolite. Also, extensive alteration of ilmenite to rutile is observed. The formation of post-kinematic margarite followed the event of chloritization but it is contemporaneous with the appearance of andalusite (chiastolite) in the matrix metapelites due to the intrusion of within-plate granites (GII). The assemblage margarite-ripidolite-rutile-ilmenite is free of quartz and plagioclase and hence its formation characterizes very low silica activity (μ SiO 2 ) in the system. It is suggested that the stability limits of the mineral in this case are within the temperature range of 355–405°C at 1–3 kbar.


Micro-tipping point (MTP) theory includes the proposal that a specific stream of unconscious and conscious thoughts result in a go and no-go discretionary action in a given context (e.g., whether or not to visit a given destination in a given season or year, with particular persons being included or excluded from the trip). The specific stream represents a stream or conjunctive combination of thoughts in context that results in a tourist party actually taking the steps that include booking the trip and experiencing a destination firsthand. Building such contingency models that are applicable to real-life combinations of unconscious and conscious thinking requires collecting data from informants on both implicit and explicit beliefs, attitudes, and thinking rules relevant for a specific yes or no context. This article illustrates applying the long interview for collecting such data and using quantitative comparative analysis for constructing MTP models.


In New Zealand, as in other developed nations, community-led conservation groups work to maintain and restore ecosystems and conserve indigenous biodiversity. These groups receive support in the form of materials, technical advice and funding from central and local government and non-governmental organisations, who are required increasingly to demonstrate delivery of benefits or conservation returns on investments. However, there is little empirical evidence for the objective evaluation of the effectiveness of community-based programmes in achieving national conservation outcomes. In the absence of such evidence, we investigated whether information on community groups' desired outcomes, gleaned from a sample of applications to a major national fund, could indicate their likely contributions to the outcomes in the national New Zealand Biodiversity Strategy. We assessed groups' outcomes in terms of their alignment with those in the strategy and against SMART (specific, measurable, achievable, relevant and time-bound) project evaluation criteria. Of 89 individual project proposals, 53% contained one or more identifiable outcomes that were aligned to the national strategy; the remainder contained no clear, identifiable outcome statement. Project outcomes, where present, tended to focus on increasing awareness of and participation in conservation, and making positive changes to terrestrial and freshwater habitats and to indigenous species. In our sample, none of the aligned project outcomes met all five SMART criteria, only seven were measurable and only three were time-bound. The absence of clear outcome statements in many, and of measurable outcomes in most, community group applications means that funders would struggle to conclude anything about conservation returns on investments from the information provided. Without clear and measurable outcomes, empirical evaluation of projects' effectiveness is impossible. We suggest that funding providers can facilitate project evaluation by presenting requirements and advice for specifying project outcomes in applications. Furthermore, they should provide technical and financial support for identifying what to monitor and how to do so.


Tick-borne encephalitis (TBE) virus causes a severe disease that can lead to permanent neurological complications. The whole inactivated TBE vaccine is highly effective, as proven by high seroconversion rates and near eradication of the disease in countries where vaccination programs have been implemented. TBE vaccine potency testing currently requires the use of in vivo methods that present issues of reproducibility as well as animal discomfort. As an alternative, public and private entities are currently exploring a batch-to-batch consistency approach which would demonstrate conformity of a newly produced vaccine batch with a batch with proven in vivo efficacy with respect to a range of in vitro measurable quality parameters. For the identification of a suitable cellular platform to be used in a panel of in vitro batch-to-batch assessments for the TBE vaccine, we exposed human cell-based systems, both of primary origin and cell line-derived, to vaccine formulations of high and low quality. Following stimulation, cell responses were evaluated by assessing the expression of selected genes by qPCR. Our findings show that the expression of interferon-stimulated genes differed after treatment with non-adjuvanted vaccine batches of different quality in peripheral blood mononuclear cells (PBMCs) and in monocyte-derived dendritic cells, but not in monocyte-free PBMC suspensions nor in cell line-derived immune cells. These results indicate suitable platforms and potential biomarkers for a cell-based assay that, together with other immunochemical analyses, could serve for batch-to-batch assessment of the TBE vaccine, reducing (and eventually replacing) in vivo methods for potency testing.


The PanGeo service has been designed with the original project aims, user requirements and technical requirements in mind. The PanGeo service will create an attributed, spatially referenced vector polygon dataset outlining all areas of ground instability for 52 European towns. INSPIRE compliant attributes will provide the reason for the instability, its area and the geologists confidence in their interpretation. The supporting Geohazard Description Document will be available as both a standalone document and the relevant section will be hyperlinked to the Ground Stability Layer polygon displayed in the portal. Along with providing a geological background to the PanGeo town the Geohazard Description will give detailed geological interpretation and evidence for the area of instability and provide information on how the instability was recognised and mapped.
The PanGeo interpretation will be carried out by the National Geological Survey for the country for which the town resides. The inputs to the interpretation are; satellite radar derived data on ground motion, ground motions observed with other surveying techniques, geological data and models and ancillary data. The satellite radar derived ground motion data will be delivered to the geological surveys by the PSIPs within in the PanGeo Production Pack.
Two types of ground instability will be recognised; observed and potential. Observed instabilities are those observed on ground motion data or through geological field campaigns. Potential instabilities are those areas that the geologist believes may be subject to instabilities given their knowledge of the area or the results of geological modelling. One of eighteen geohazards is assigned to each area of ground instability; geohazards are grouped into four categories for display on the portal.
Once the Geological Survey has completed the GSL and GHD they will be validated by the British Geological Survey before being made available to the PanGeo portal. In the first instance the GSL will be submitted to an online validating tool which will carry out automated topological data checks of the vector data and attributes. Once passed the GSL is sent to BGS who will carry out manual checks of the GSL and GHD to ensure they meet the specifications.
Once validated the Geological Survey will make the GSL and GDH available on their IT servers for harvesting by the PanGeo portal. The display of the GSL on the portal will depend on the viewing scale; at the European scale PanGeo towns will be highlighted, at the regional scale a graphic showing the number of hazards affecting an area will be displayed. At the local scale the GSL polygons will be displayed according to the geohazard category, the boundary line will distinguish potential and observed hazards. The user can also choose to integrate the GSL with the Urban Atlas; the GSL polygons will highlight those Urban Atlas land cover types affected by hazards


A new tundish is designed with the aim to produce a swirling flow in a tundish SEN by an economical way of using the steel flow potential as the required power. This design is easily obtained by adding a cylindrical part of the tundish onto a traditional tundish. The results show that a swirling flow in the SEN of the new tundish is successfully obtained, also, that the tangential velocity in the SEN can reach around 1.6 m s−1. The installation of weirs in the cylindrical tundish can contribute to stabilize the steel flow at the top of the tundish. However, this reduces the swirling flow intensity in the SEN around 30%. In addition, the possibility of slag entrainment at the top of the tundish is analyzed. The calculated Weber Number is around 5.0 for no weir case and 2.8 for the weir case, which means that the risk of slag entrainment is small. A high value of shear stress is found on the SEN wall due to the swirling flow in SEN. A further investigation shows that a smooth transition of SEN inlet can reduce the maximum shear stress level in the SEN, without decreasing the swirling flow intensity.


Growing interest in data for bicycling planning has many jurisdictions aiming to develop a sampling strategy for measuring bicycle counts. However, it can be difficult to determine where bicycling counters should be placed to generate a representative sample of bicycling, and bicycle counts tend to only occur on heavily used bicycle routes. Our goal, is to utilize crowdsourced data on bike ridership, from Strava Metro, and continuous signal processing data mining techniques to map regions of bicycling behaviour in San Francisco – CA, US. Bicycling behaviour regions can be used to stratify bicycle count sampling. Our results indicate it is possible to differentiate bicycling behaviour from Strava and we mapped routes categorized into six unique ridership behaviours including commute to work, commute to school, leisure, 8 am peak , 11 am peak and least utilised. We recommend sampling ridership from each of the categories when developing count programs.


The optical properties of a four-level atomic system via coherent and incoherent pumping fields are investigated. The giant Kerr nonlinearity with reduced linear and nonlinear absorption, which has a major role in decreasing the threshold of optical bistability (OB), can be obtained with subluminal light propagation via adjusting the intensities of coupling fields. An incoherent pumping field is noticed to be an extra parameter to reduce the threshold of OB and multistability, and it can be used as an effective parameter in producing lasing with or without population inversion. In this model, optical multistability is achieved simply by tuning the intensity of coupling laser fields. Furthermore, it is shown that the subluminal and the superluminal light propagation can be obtained by appropriate values of the incoherent pumping rate.


This timely book casts new light on the key issues arising from the contentious debate around the future of the European Social Model. The book brings together leading experts to provide a thorough and well-informed response to the recent developments in European social and labour law and policy, in the light of institutional changes. The contributors provide unique insights as they evaluate the impact of the enlargement processes, the implications of the Lisbon treaty, the integration of the Charter into EU law – and, crucially, the consequences of the economic crisis.


The Purdue Center for Commercial Agriculture Crop Basis Tool is an open-access web-based tool that provides members of the grain industry with access to weekly historical and contemporaneous corn and soybean basis data for local market regions in the eastern Corn Belt. Previously unavailable to most producers in the region, the information the Crop Basis Tool provides has the potential to greatly improve producers' marketing risk management decisions through improved basis forecasts. In addition, there are a myriad of opportunities for Extension personnel to incorporate the Crop Basis Tool in their marketing risk management education and outlook programming.


For the case of severa1 interacting chiral superfields the prop- agators for the unconstrained superfield potentials in the 'shifted' theory, where the supersymmetry is explicitly broken, are derived in a compact form. They are used to compute the one-loop effective potential in the general case, while a superfield calculation of the renormalized effective po- tential to two loops for the Wess-Zumino madel is performed.


Second person forms of pronouns (e.g. Engl. you , Germ. du ) or verbs (e.g. Russian pises 'you write') have a basically deictic function and refer to the addressee. In uses that have been called "impersonal" or "non-canonical", the second person forms are used in a generalizing way (e.g. You only live once ), often in combination with predicates that are not literally true of the addressee (e.g. As the Pope you have to be righteous , said by the Pope to a reporter). In this contribution we pursue two main goals. First, we propose a taxonomy of non-canonical uses of the second person as a frame of reference for future, especially quantitative, studies. Our second goal is to determine the pragmatic (non-truth-conditional) interpretive effects of impersonal uses of the second person. We argue that all instances of such forms imply, at an interactional level, the establishment of solidarity between the interlocutors, and at an expressive level, the presence of empathy with the members of the category over which a generalization is made. Accordingly, we propose the term "generalized empathy" as the main function of the relevant uses of the second person.


Efficient processing of continual range queries over moving objects is critically important in providing location-aware services and applications. A set of continual range queries, each defining the geographical region of interest, can be periodically (re)evaluated to locate moving objects that are currently within individual query boundaries. We study a new query indexing method, called CES-based indexing, for incremental processing of continual range queries over moving objects. A set of containment-encoded squares (CES) are predefined, each with a unique ID. CESs are virtual constructs (VC) used to decompose query regions and to store indirectly precomputed search results. Compared with a prior VC-based approach, the number of VCs visited in a search operation is reduced from (4L2-1)/3 to log(L)+1, where L is the maximal side length of a VC. Search time is hence significantly lowered. Moreover, containment encoding among the CESs makes it easy to identify all those VCs that need not be visited during an incremental query (re)evaluation. We study the performance of CES-based indexing and compare it with a prior VC-based approach


BACKGROUND
The bio-psychosocial model of spinal cord injury (SCI) highlights that psychosocial care is of equal importance as physical rehabilitation, and should be offered in the earlier stages of inpatient rehabilitation.

AIM
This systematic review aimed to identify interventional research regarding psychosocial care for people with SCI during inpatient rehabilitation and synthesize the evidence of the effects and characteristics of these studies.

METHODS
A systematic search of relevant literature published between 1985 to July 2016 was conducted with six databases (Scopus, MEDLINE, CINAHL, Science Citation Index Expanded, PsycINFO, and the China Academic Journal Full-text Database). Reference lists of the identified articles were reviewed to find additional relevant articles.

RESULTS
A total of four randomized controlled trials and seven non-randomized controlled trials were included in this review. The interventions focused on specialized types of SCI population with relatively high levels of psychological distress, pain or pressure ulcers. Studies reported some varied or inconsistent improvements in participants' cognitive appraisal, psychosocial adaptation or mental health but there were no significant effects on their coping ability. Due to the heterogeneity of the studies, findings were synthesized narratively without conducting meta-analysis.

LINKING EVIDENCE TO ACTION
This review found promising evidence that approaches to psychosocial care for people with SCI can improve their cognitive appraisal and psychosocial adaptation. Significant methodological limitations weakened study findings. Additionally, because studies were conducted in only a few developed countries with subgroups of patients having specific illness characteristics or severity, their generalizability to the wider SCI population is uncertain. Therefore, future research should adopt more robust study designs to test psychosocial interventions for SCI patients with different socio-cultural backgrounds and psychological adjustment conditions in the early stages of rehabilitation.


Development of a Teach-Back Educational Module for Heart Failure Discharge Teaching by Marissa Blair Jamarik MSN, George Mason University, 2005 BSN, Shenandoah University, 1997 Proposal Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2016 Abstract Heart failure (HF) readmissions create a financial burden for healthcare nationwide and speak to the lack of effective discharge preparation for patients to be successful with selfcare at home. The 183-bed hospital where this DNP quality initiative will take place currently reports an observed-over-expected (O/E) readmission rate for HF patients (Centers for Medicare and Medicaid [CMS]). Core measures on HF developed by theHeart failure (HF) readmissions create a financial burden for healthcare nationwide and speak to the lack of effective discharge preparation for patients to be successful with selfcare at home. The 183-bed hospital where this DNP quality initiative will take place currently reports an observed-over-expected (O/E) readmission rate for HF patients (Centers for Medicare and Medicaid [CMS]). Core measures on HF developed by the Joint Commission and the Centers for Medicare and Medicaid Services do not appear to be enough to ensure successful transitions of care from hospital to home. Guided by the LOGIC model, the purpose of this quality improvement initiative was to develop a HF educational module to improve patients' readiness to learn in order to promote self-care and prevent readmission to the hospital within 30 days. The design of the educational program was supported by the evidence-based literature and incorporated best practices promoted by the Joint Commission, the Institute for Healthcare Improvement, and the Agency for Healthcare Research and Quality. Content evaluation of the newly developed HF educational program was conducted by 10 experts using a quantitative Likert-type scale and qualitative narrative feedback. Descriptive findings from the Likert scale showed a range of 3.9 to 4.0 in the content, process, and design of the program. Recommendations for improvement included more detail around pathophysiology, as well as how to initiate the process in the outpatient setting. Positive social change can result from the program which offers a relevant strategy to reduce readmissions for HF and has wide-application options for many chronic illnesses that can be better managed through effective discharge teaching. Development of a Teach-Back Educational Module for Heart Failure Discharge Teaching. by Marissa Blair Jamarik MSN, George Mason University, 2005 BSN, Shenandoah University, 1997 Proposal Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2016


The diapycnal diffusivity of mass supported by turbulent events in the ocean interior plays a fundamental role in controlling the global overturning circulation. The conventional representation of this diffusivity, due to Osborn (1980), assumes a constant mixing efficiency. We replace this methodology by a generalized‐Osborn formula which involves a mixing efficiency that varies nonmonotonically with at least two nondimensional variables. Using these two variables, we propose dynamic parameterizations for mixing efficiency and turbulent Prandtl number (the latter quantifies the ratio of momentum to mass diapycnal diffusivities) based on the first synthesis of an extensive direct numerical simulation of inhomogeneously stratified shear‐induced turbulence. Data from Argo floats are employed to demonstrate the extent of the spatial and statistical variability to be expected in both the diapycnal diffusivities of mass and momentum. We therefore suggest that previous estimates of these important characteristics of the global ocean require reconsideration.


At present, the complexity of the communication problem between mobile devices is a subject of study among the scientific community, since several researchers have been given the task of proposing a better solution using different types of algorithms, in this article we will focus on the search for communication proposals between mobile devices that use bioinspired algorithms.
Some of these algorithms are inspired by neural networks, immune system, swarm of bees, termites, flock of birds, fish, to name just a few. Each of the aforementioned algorithms are inspired by nature, what is intended in this article is to try to understand how these animals communicate with each other to achieve their objectives.
Mainly we will focus on the imitation of communication, and examining the work done we will realize which is the most optimal to help us optimize times and improve communication on mobile devices.


ABSTRACT The lion of Bubasteion to Saqqara (Egypt).An uncommon mummy among mummies of cats If a publication revealed the discovery of a lion's skeleton at Saqqara (Callou et al. 2004), it was not possible to publish all the information. This article aims at filling this gap and discusses the results in the light of new evidence. The skeleton discovered at the second level of the Maia's tomb, Princess Meritaten, sister of the king Tutankhamun (Zivie 2009), belongs to a male adult who is at least 9 years old. Several indications support the idea that the body had been mummified. In the absence of radiometric dating, the stratigraphic position assigns the deposit of this large mummy (approx. 1.50 m) to the Ptolemaic and Roman periods. The animal lived many years in captivity, in poor conditions, particularly in terms of food. Indeed, there are no teeth in good preservation on the jaws; teeth are fractured and present signs of chronic and old inflammation. Fractures on the right ribs and on some thoracic vertebrae show also that the animal has suffered at least one fall. This skeleton of a lion, animal whose geographic origin is unknown, is the first to be whole discovered in Egypt.


Utilitarianism is a general term for any view that holds that actions and policies should be evaluated on the basis of the benefits and costs they will impose on society but in the respect of Kant's categorical imperative approach, intention is more important than result while we behave in an action. The purpose of the study is to investigate the insider trading which is about buying or selling of securities on the basis of material, non public information, with these two theories as utilitarian principles and Kant's approach from the perspectives of Business Administration Students. The data was collected by different scenarios which reflect the insider trading in the stock market. The results show that insider trading should be analyzing according to the condition of this perspectives in order to find out that is ethical or unethical.


A fundamental challenge to the foundations of the discipline of international law. This book offers an internal critique of the discipline of international law whilst showing the necessary place for philosophy within this subject area. By reintroducing philosophy into the heart of the study of international law Anthony Carty explains how traditional philosophy has always been an integral part of the discipline. However, this has been driven out by legal positivism, which has, in turn become a pure technique of law. He explores the extent of the disintegration and confusion in the discipline and offers various ways of renewing philosophical practice. A range of approaches are covered -- post-structuralism, neo-Marxist geopolitics, social-democratic constitutional theory and existential phenomenology -- encouraging the reader to think afresh about how far to bring order to, or find order in, contemporary international society. Key features: * Offers a broad survey of possible philosophical approaches to international law * Provides a fundamental critique of the basic techniques of the international lawyer * Includes case studies of colonial style interventions, the problem of American Empire and a vision of the shape of post-imperial, post-colonial world society.


In recent years we have seen growth on interest for Deep Learning (DL) algorithms on a variety of problems, due to their outstanding performance. This is more palpable on a multitude of fields, where self-learning algorithms are becoming indispensable tools to help professionals solve complex problems. However as these models are getting better, they also tend to be more complex and are sometimes referred to as "Black Boxes". The lack of explanations for the resulting predictions and the inability of humans to understand those decisions seems problematic. In this project, different methods to increase the interpretability of Deep Neural Networks (DNN) such as Convolutional Neural Network (CNN) are studied. Additionally, how these interpretability methods or techniques can be implemented, evaluated and applied to real-world problems, by creating a python ToolBox.


The Aspen Strategy Group's Policy Books is an annual series of pieces on the United States most pressing foreign policy and national security issues written by contemporary thought leaders. This edition is a collection of papers commissioned for the 2014 Aspen Strategy Group Summer Workshop. On the occasion of the 30th year anniversary of the Aspen Strategy Group (founded in 1984), the Summer Workshop in Aspen, CO convened a nonpartisan group of preeminent U.S.-Russia policy experts, academics, journalists, and business leaders. The Group's policy discussions were guided by the papers found in this volume, whose scope ranges from exploring the history of the U.S.-Russia relationship, current developments in the Sino-Russian relationship, the NATO and European responses to Russian aggression in Eastern Europe, energy considerations, areas of potential U.S.-Russia cooperation, and finally, the broader question of U.S. national security and interests in the European region.


Representation theorems are often taken to provide the foundations for decision theory. First, they are taken to characterize degrees of belief and utilities. Second, they are taken to justify two fundamental rules of rationality: that we should have probabilistic degrees of belief and that we should act as expected utility maximizers. We argue that representation theorems cannot serve either of these foundational purposes, and that recent attempts to defend the foundational importance of representation theorems are unsuccessful. As a result, we should reject these claims, and lay the foundations of decision theory on firmer ground.


Optimal location on the transport infrastructure is the preferable requirement for many decision making processes. Most studies have focused on evaluating performances of optimally locate p facilities by minimizing their distances to a geographically distributed demand (n) when p and n vary. The optimal locations are also sensitive to geographical context such as road network, especially when they are asymmetrically distributed in the plane. The influence of alternating road network density is however not a very well-studied problem especially when it is applied in a real world context. This paper aims to investigate how the density level of the road network affects finding optimal location by solving the specific case of p-median location problem. A denser network is found needed when a higher number of facilities are to locate. The best solution will not always be obtained in the most detailed network but in a middle density level. The solutions do not further improve or improve insignificantly as the density exceeds 12,000 nodes, some solutions even deteriorate. The hierarchy of the different densities of network can be used according to location and transportation purposes and increase the efficiency of heuristic methods. The method in this study can be applied to other location-allocation problem in transportation analysis where the road network density can be differentiated.


Productivity is pivotal when assessing the performance of service systems. The aim of this article is to provide a novel benchmarking method to measure productivity. Based on authoritative theories on service productivity, the ontological concepts of four theories of service productivity management are unified. Subsequently, formulations of Data Envelopment Analysis (DEA) are stated to implement these concepts of service productivity. However, there hasn't been a single DEA-based approach detected that unifies the service productivity concepts for the purpose of service benchmarking. Therefore, such a model is developed by taking DEA as a starting point. It is then applied to benchmark shifts of 63 service technicians from a field force unit of one of Germany's biggest mobile service providers. In an evaluation based on data from these shifts the model delivers sound results. Hence, it is deemed suitable for benchmarking productivity in the service sector.


This paper examines the connection between educational grit, as espoused by Dr. Angela Duckworth, and psychological trauma. The authors explore the relationships between education, mental health, and societal needs. Since there is limited research available, the authors begin by addressing the basics. Part One answers the question, what is grit, and explains the components of grit. Part Two provides a definition and overview for trauma, with special emphasis on psychological trauma. From that discussion of terms, the authors provide further analyses in Parts Three and Four. Part Three addresses the question: How does trauma affect learning, and what is the impact on educational outcomes? The authors draw conclusions as to what educators can reasonably expect from injured individuals and what resources may be available for disenfranchised populations. Part Four closes with the question: How does education affect trauma? Specifically, can education alleviate the impact of trauma, and is healing (lifelong learning and/or improvement in symptoms) possible? Without being too clinical, the authors explain one piece of the symbiotic relationship between education and psychology, with the focus being on trauma. Recognizing that education is not a cure for all contemporary social problems, nonetheless practitioners use education as a method to relieve some aspects of human suffering.


In December of 2010, a Regis University student from Belize and a Regis University faculty member launched an entrepreneurial adventure by planting 1,000 teak trees on one acre of land near the town of Punta Gorda in southern Belize.  The trees survived four months of drought, and in June of 2011 another 1,000 trees were planted.  In June of 2012, the student and professor will do a third planting of 1,000 trees, bringing the grand total to 3,000 trees.  Two full-time Mayan Indians are employed; they trim, fertilize, and water the trees.  Future expansion will require hiring additional workers.  The operating life cycle of a teak tree is approximately 20 years from planting to harvest.  A unique plan is being developed by faculty, students, and administrators of Regis University that will facilitate student entrepreneurship education and increase sustainable environmentally-friendly economic opportunities in southern Belize.  Planting, caring for, harvesting, and marketing teak trees is a complex task.  Teak tree suppliers must be located, trees must be planted and fertilized, and jungle vegetation must be abated.  "Green" certification must be obtained.  Harvesting requires the services of logging, milling, drying, and transportation technicians.  Finally, finished teak wood must be priced, buyers located, and delivery secured.  Students of Regis University are fashioning business plans to own and grow teak trees; scaling and repeating the teak tree farming business model provided; addressing the needs of tree farmers in Belize by creating a saw mill and kiln, and developing marketing channels.  The Belize business opportunity requires students to understand international entrepreneurship, both theoretically and experientially, and requires students to align economic opportunities with the indigenous population.


The paper describes a new method for the design of optimum weighted order statistic (WOS) filters. WOS filters form a general class of increasing filters which generate an output based on the weighted rank ordering of the samples within the filter window. They include the median, weighted median, stack filters and morphological filters with flat structuring elements. This new design method is applicable to all of these operators. It has the advantage over existing techniques in that the filter weights are calculated directly from the training set observations and require no iteration. The method makes an assumption about the training set observations known as the weight monotonic property. It tests if the training set corruption is suitable for correction with an increasing filter. Where the assumption does not hold then a WOS filter should not be used for that training set. The paper includes two examples to demonstrate the design method and a justification for a training set approach to image restoration problems. Other benefits arising from the new design method are outlined in the paper. These include a method to determine the minimum MAE possible for a given training set and filter window.


A thin layer of micro-tephra particles has been discovered in a lake sediment sequence from Sutherland, Scotland. The tephra is attributed to the Vedde Ash on the basis of ash geochemistry. The Vedde Ash, which has been dated to c. 10 300 radiocarbon years BP and which was thus deposited during the Younger Dryas chronozone, has previously been reported from lake sequences in Norway, from sediment cores from the NE North Atlantic and from Greenland ice cores, but this is the first reported record from the British mainland. It is likely that this ash layer also occurs in other lake sediment sequences in northern Britain, thus providing the potential for more precise correlations of Younger Dryas sequences than has hitherto been the case. The way in which correlation by tephrochronology may revolutionize approaches to reconstructing the sequence of events in theNE Atlantic region during the last glacial-interglacial transition is briefly considered.


This report describes a new set of macromolecular descriptors of relevance to nucleic acid QSAR/QSPR studies, nucleic acids' quadratic indices. These descriptors are calculated from the macromolecular graph's nucleotide adjacency matrix. A study of the interaction of the antibiotic Paromomycin with the packaging region of the RNA present in type-1 HIV illustrates this approach. A linear discriminant function gave rise to excellent discrimination between 90.10% (91/101) and 81.82% (9/11) of interacting/noninteracting sites of nucleotides in training and test set, respectively. The LOO crossvalidation procedure was used to assess the stability and predictability of the model. Using this approach, the classification model has shown a LOO global good classification of 91.09%. In addition, the model's overall predictability oscillates from 89.11% until 87.13%, when n varies from 2 to 3 in leave-n-out jackknife method. This value stabilizes around 88.12% when n was > 3. On the other hand, a linear regression model predicted the local binding affinity constants [log K (10-4M-1)] between a specific nucleotide and the aforementioned antibiotic. The linear model explains almost 92% of the variance of the experimental log K (R = 0.96 and s = 0.07) and LOO press statistics evidenced its predictive ability (q2 = 0.85 and scv = 0.09). These models also permit the interpretation of the driving forces of the interaction process. In this sense, developed equations involve short-reaching (k < 3), middle-reaching (4 < k < 9) and far-reaching (k = 10 or greater) nucleotide's quadratic indices. This situation points to electronic and topologic nucleotide's backbone interactions control of the stability profile of Paromomycin-RNA complexes. Consequently, the present approach represents a novel and rather promising way to chem & bioinformatics research.


Can a monetary system in which privately issued cryptocurrencies circulate as media of exchange work? Is such a system stable? How should governments react to digital currencies? Can these currencies and government-issued money coexist? Are cryptocurrencies consistent with an efficient allocation? These are some of the important questions that the sudden rise of cryptocurrencies has brought to contemporary policy discussions. To answer these questions, we construct a model of competition among privately issued .at currencies. We .nd that a purely private arrangement fails to implement an efficient allocation, even though it candeliver price stability under certain technological conditions. Currency comptition creates problems for monetary policy implementation under conventional methods. However, it is possible to design a policy rule that uniquely implements an efficient allocation by driving private currencies out of the market. We also show that unique implementation of an efficient allocation can be achieved without government intervention if productive capital is introduced.


A model for the determination of an acoustic field in a closed room with several sound sources is presented. In this model the sound source is divided into sound rays, which are followed in the room, with these characteristics: (1) The sound pressure and the particle speed are the working variables used, so that calculating the most important qualification parameters of a room is possible; (2) the ray emission from the source is done randomly; (3) the sound ray is represented by a cone including the corresponding solid angle; (4) the receiver is a dimensionless point; (5) the outputs obtained in the receiver have a statistical treatment; (6) ray diffusion on rough walls are considered, by means of a calculation based on the Markoff–Chain theory; and (7) obstacles are allowed in the room, and the diffraction over them is considered by a combination of the Helmholtz–Kirchhoff theorem and the Markoff–Chain method. The model was applied to the Lecture Theatre of the High Technical School of Industrial Engineering at Valencia, and the results that were obtained were compared with the measurements taken there. The experimental values were, in 90% of the cases, between those given by the model as probables.


Undergraduate pre-law education must prepare prospective law students for the challenges of law school and the law school admissions process. Although law school does not require a prerequisite course of study, it is my contention that the optimal undergraduate preparation consists of interdisciplinary liberal arts education. Such a pedagogical approach allows for students to understand law in the context of society and its practice beyond the theoretical fundamentals taught in most law schools. Many law school faculty favor interdisciplinary education in law school and law admissions officials stress liberal arts education for undergraduates. Accordingly, the optimal pre-law undergraduate education should take into account both interdisciplinarity and liberal arts approaches to law. I highlight some programs providing such undergraduate education.


Documentation created as part of the Perceptual Form of the City, a research project investigating the individual's perception of the urban landscape.


The objective of this paper is to provide quantitative information on the degree of regionalism in raw and processed agrifood trade and the trends in regional trading patterns between 1965 and 1994. The analysis shows that world agrifood trade is currently more regionalized than it was in the second half of the 1960's and is moving towards even more regional concentration. However, for processed agrifood products, increasing regionalism is a dimension of growing openness and multilateral interdependence. Conversely, for raw products the pattern of regionalism has been significantly affected by domestic and trade policies, with welfare losses borne mainly by the European Union and other exporting regions.


Website quality measurement tools have been largely static and have struggled to determine relevant attributes of user satisfaction. This study compares and contrasts attributes of user satisfaction based on usability guidelines seeking to identify practical easy-to-administer measurement tools. The website users assessed business school homepages according to six criteria and fulfilled a randomly assigned yet typical task. After completing the task, respondents assessed the same six website quality/satisfaction criteria again. The consumer–product relationship seems similar to the link between a user and a website. User satisfaction, just like consumer satisfaction, is asymmetric and non-linear. Content and navigation have been identified as key ingredients when users judged website quality, alerting web designers and website practitioners to focus more closely on those attributes. Similar lessons can be drawn for marketing professionals, who typically supervise or determine the content, structure and other website facets.


We examined the effects of chronic unilateral lesions to either the inferior parietal lobe, or to the dorsolateral prefrontal cortex including the frontal eye fields (FEFs), upon human visual perception and saccades in temporal-order-judgment (TOJ) tasks. Two visual events were presented on each trial, one in each hemifield at various stimulus onset asynchronies (SOAs). In the saccade task, patients moved their eyes to whichever stimulus attracted gaze first. In the perceptual-manual task, they pressed a button to indicate which stimulus was perceived first. Frontal patients showed appropriate TOJs for visual targets in both tasks. Parietal patients showed appropriate TOJs in the perceptual-manual but not the saccade task; their saccades tended to be ipsilesional unless the contralesional target led substantially. This reveals a bias in saccade choice after parietal damage that cannot be attributed to deficient visual perception. These results challenge previous claims that only anterior lesions produce motoric spatial biases in humans. However, they are in accord with recent neurophysiological evidence for parietal involvement in saccade generation, and also with suggestions that visuomotor transformations in the parietal lobe serving direct spatial motor responses can dissociate from conscious perception as indicated by indirect arbitrary responses.


Simulations of hypercube networks by certain Cayley graphs on the symmetric group are investigated. Let Q(k) be the familiar k-dimensional hypercube, and let S(n) be the star network of dimension n defined as follows. The vertices of S(n) are the elements of the symmetric group of degree n, two vertices x and y being adjacent if xo(1,i)=y for some i. That is, xy is an edge if x and y are related by a transposition involving some fixed symbol (which we take to be /spl I.bold/1). This network has nice symmetry properties, and its degree and diameter are sublogarithmic as functions of the number of vertices, making it compare favorably with the hypercube network. These advantages of S(n) motivate the study of how well it can simulate other parallel computation networks, in particular, the hypercube. The first step in such a simulation is the construction of a one-to-one map f:Q(k)/spl rarr/S(n) of dilation d, for d small. That is, one wants a map f such that images of adjacent points are at most distance d apart in S(n). An alternative approach, best applicable when one-to-one maps are difficult or impossible to find, is the construction of a one-to-many map g of dilation d, defined as follows. For each point x/spl isin/Q(k), there is an associated subset g(x)/spl sube/V(S(n)) such that for each edge xy in Q(k), every x'/spl isin/g(x) is at most distance d in S(n) from some y'/spl isin/g(y). Such one-to-many maps allow one to achieve the low interprocessor communication time desired in the usual one-to-one embedding underlying a simulation. This is done by capturing the local structure of Q(k) inside of S(n) (via the one-to-many embedding) when the global structure cannot be so captured. Our results are the following. 1) There exist the following one-to-many embeddings: a) f:Q(k)/spl rarr/S(3k+1) with dilation (f)=1; b) f:Q(11k+2)/spl rarr/S(13k+2) with dilation (f)=2. 2) There exists a one-to-one embedding f:Q(n2/sup n/spl minus/1/)/spl rarr/S(2/sup n/) with dilation (f)=3. >


Topological insulators (TI) are a new phase of matter with very exotic electronic properties on their surface. As a direct consequence of the topological order, the surface electrons of TI form bands that cross the Fermi surface odd number of times and are guaranteed to be metallic. They also have a linear energy-momentum dispersion relationship that satisfies the Dirac equation and are therefore called Dirac fermions. The surface Dirac fermions of TI are spin-polarized with the direction of the spin locked to momentum and are immune from certain scatterings. These unique properties of surface electrons provide a platform for utilizing TI in future spin-based electronics and quantum computation. The surface bands of 3D TI can be directly mapped by angle-resolved photoemission spectroscopy (ARPES) and the spin polarization can be determined by spin-resolved ARPES. These types of experiments are the first to establish the 3D topological order, which demonstrates the power of ARPES in probing the surface of strongly spin-orbit coupled materials. Extensive investigation of TI has ranged from understanding the fundamental electronic and lattice structure of various TI compounds to building TI-based devices in search of more exotic particles such as Majorana fermions and magnetic monopoles. Surface-sensitive techniques that can efficiently disentangle the charge and spin degrees of freedom have been crucially important in tackling the multi-faceted problems of TI. In this thesis, I show that laser-based ARPES in combination with a time-of-flight spectrometer is a powerful tool to study the spin structure and charge dynamics of the Dirac fermions on the surface of iv TI. Chapter 1 gives a brief introduction of TI. Chapter 2 describes the basic principles behind ARPES and time-resolved ARPES (TrARPES). Chapter 3 provides a detailed account of the experimental setup to perform laser-based ARPES and TrARPES. In Chapters 4 and 5, how these two techniques are effectively applied to investigate two unique electronic properties of TI is elaborated. Through these studies, I have obtained a complete mapping of the spin texture of several prototypical topological insulators and have uncovered the cooling mechanism governing the hot surface Dirac fermions.


Graduates face a world of complexity which demands flexibility, adaptability, self-reliance and innovation, but while the development of creativity is embedded in the English National Curriculum and in workplace training, the higher education sector has yet to fully recognise its importance. This book highlights how pressures such as quality assurance, peer review systems, demands for greater efficiency and increased research output are effectively discouraging innovation and creativity in higher education. It makes a bold case for the integration of creativity in higher education, drawing together contributors and research from around the world and explores valuable lessons learnt from those working in schools and professional organisations. Offering a wealth of advice on how to foster creativity on an individual and an institutional level, this book encourages lecturers to engage with the ideas and practice involved in helping students to be creative in all areas of their study.


Objective:Very elderly persons admitted to ICUs are at high risk of death. To document life-sustaining interventions (mechanical ventilation, vasopressors, renal replacement therapy) provided in the ICU and outcomes of care. Design:Multicenter, prospective cohort study. Setting:ICUs of 24 Canadian hospitals. Participants/Setting:Patients 80 years old or older admitted to the ICU. Interventions:None. Measurements and Main Results:One thousand six hundred seventy-one patients were included. The average age of the cohort was 85 years (range, 80–100 yr). Median total length of stay in ICU was 4 days (interquartile range, 2–8 d) and in hospital was 17 days (interquartile range, 8–33 d). Of all patients included, 502 (30%) stayed in ICU for 7 days or more and 344 (21%) received some form of life-sustaining treatment for at least 7 days. ICU and hospital mortality were 22% and 35%, respectively. For nonsurvivors, the median time from ICU admission to death was 10 days (interquartile range, 3–20 d). Of those who died (n = 5 85), 289 (49%) died while receiving mechanical ventilation, vasopressors, or dialysis. The presence of frailty or advance directives had little impact on limiting use of life-sustaining treatments or shortening the time from admission to death. Conclusions:In this multicenter study, one third of very elderly ICU patients died in hospital, many after a prolonged ICU stay while continuing to receive aggressive life-sustaining interventions. These findings raise questions about the use of critical care at the end of life for the very elderly.


Malta's socio-economic successes have been remarkable. Key policy decisions have enabled this small island state to cope with its inherent vulnerabilities. This book reviews the implementation of macroeconomic policies in Malta, identifying the key issues, lessons learnt and best practices which could be adapted by other small states. It also sets out the country's challenges for the future, which include managing a huge fiscal deficit, a high unemployment rate and attending to the conflicting demands of environmental conservation and economic development.