The traditional hormonal cascade of the 1970s and 1980s used tamoxifen followed by megestrol acetate and subsequently by aminoglutethimide. In the 1990s, however, three trials of third-generation aromatase inhibitors (AIs) compared with megestrol acetate and two trials of third-generation AIs compared with aminoglutethimide showed improved efficacy and decreased toxicity for the newer AIs. Thus, the hormonal cascade changed in the late 1990s, to one in which tamoxifen, followed by a third-generation AI, followed by megestrol acetate, seemed more suitable. Now, however, several trials comparing anastrozole, letrozole, and exemestane to tamoxifen as first-line hormonal agents for metastatic breast cancer have shown that these drugs are at least equivalent and perhaps superior to tamoxifen in that setting in terms of response rate and time to progression. Results from 1021 patients randomized to receive anastrozole versus tamoxifen showed a slightly improved overall response rate (RR; 29% versus 26%), slightly improved clinical benefit (CB; 57% versus 52%), and a significantly improved time to progression (TTP; 8.5 months versus 7.0 months) in favor of anastrozole. In 907 women randomized to treatment with letrozole versus tamoxifen, significantly improved RR (30% versus 20%), CB (49% versus 38%), and TTP (9.4 months versus 6 months) have all been shown for those treated with letrozole. In addition, a randomized Phase II trial of 121 patients has shown nonsignificant benefits in favor of exemestane (RR 41% versus 14%; CB 56% versus 42%; TTP not available). To date, none of these trials has demonstrated any overall survival benefit. Additional follow-up in regard to survival in the trial of tamoxifen versus letrozole and an expanded Phase III trial of tamoxifen versus exemestane are ongoing.


Page I Abstract This is an ethnographic study of the creation of a particular type of standard enterprise software package: Enterprise Resource Planning (ERP) systems, which support wide-ranging organisational functions within large and medium sized enterprises. Drawing upon the Social Shaping of Technology perspective and recent related attempts to theorise the Biography of Artefacts, this thesis addresses the under-researched area of ERP system development and ERP system support. In providing a system vendor's viewpoint, it seeks to overcome current shortcomings in social research, notably from Information Systems and Organisational Studies, which focus almost exclusively on a user organisation perspective. Mostly concentrating on the moment of implementation, existing studies do not help us to better understand the software producer's viewpoint or to find explanations as to how ERP systems are produced and supported in such a way that they can meet the specific requirements of their highly diverse users (the current market leader SAP had over 12 million users (2008)). Overall, we have very limited understanding of what happens within software package laboratories and how such organisations organise their relationship with their wide and diverse user base throughout the different phases of the product life cycle. Addressing this gap in the social study of software packages, this research offers an ethnographical insider's perspective of the day-to-day working practices within one of the world's leading ERP system providers, encompassing both its development and support functions. Based on rich ethnographic data, the study demonstrates first, how a supplier manages its relationship with its diverse user base during the moment when the system re-enters the vendor's circle of responsibility through the software packages support channel. The sophisticated and mature mechanisms and policies are highlighted, which allow the vendor not without challenges – to accommodate competing exigencies of its user base at this moment of product life cycle. Second, this research highlights how the software development phase is organised, by empirically describing and analysing


Congenital syphilis in Russia is an actual problem. The number of children with this disease was respectively 2005–325, 2006–321, 2007–325, 2008–249, 2009–190, 2010–175 persons. The source of the high morbidity are pregnant women with syphilis, who didn't know about their disease before childbirth. The aim is to evaluate the importance of prevention of syphilis that is possible with the deepest analysis of health of each child. Complex inspections of 51 children with early congenital syphilis revealed that 84.3% had manifested forms. At birth 62.7% had Apgar score below 7/8 points, 25.4% - 7/8 points, 11.8% - above 7/8 points. While in the hospital 5.9% - had satisfactory status, 13.7%– moderately grave condition, 80.3% - critical condition, among them 54.9% - premature babies. Clinical signs of early congenital syphilis symptoms were bone changes - 66.7%. In 19.6% of cases, the bone changes were the only specific clinical signs. The skin and mucous membranes observed in 37.3%: syphilitic pemphigus - 27.5%, infiltration of the palms and soles with desquamation krupnoplastinchatym - 7.8%, roseola - 5.9%, rhinitis - 7.8%. Changes in the internal organs was found in 68.6%, hepatomegaly - 60.8%, hepatitis - 9.8%, splenomegaly - 39.2%, myocarditis - 2%, pneumonia - 5.9% and nephritis- 3 9%. Damage of nervous system (specific meningitis) registered at 23.5% that is every 4th child. All children had a hypoxic-ischemic damage of central nervous system with syndromes of depression and agitation, psychomotor retardation, perinatal encephalopathy. Almost all of them had immaturity of the functional-and-morphological systems (lengthening period of neonatal jaundice, syndrome of respiratory disorders and nervous regulation). Thus the syphilis infection in pregnancy increases the risk of developing specific and non-specific disorders in formation of bodies and systems of a foetus. Moscow Center uses obtained analytical data for planning preventive measures in this target group.


The Semantic Web effort has steadily been gaining traction in the recent years. In particular, Web search companies are recently realizing that their products need to evolve towards having richer semantic search capabilities. Description logics (DLs) have been adopted as the formal underpinnings for Semantic Web languages used in describing ontologies. Reasoning under uncertainty has recently taken a leading role in this arena, given the nature of data found on the Web. In this paper, we present a probabilistic extension of the DL ℇL++ (which underlies the OWL2 EL profile) using Markov logic networks (MLNs) as probabilistic semantics. This extension is tightly coupled, meaning that probabilistic annotations in formulas can refer to objects in the ontology. We show that, even though the tightly coupled nature of our language means that many basic operations are data-intractable, we can leverage a sublanguage of MLNs that allows to rank the atomic consequences of an ontology relative to their probability values (called ranking queries) even when these values are not fully computed. We present an anytime algorithm to answer ranking queries, and provide an upper bound on the error that it incurs, as well as a criterion to decide when results are guaranteed to be correct.


Biofilm formation has been explored as a means of harvesting microalgae for bioprocessing applications. Recently, environmental stressors have been implicated in the induction of biofilm formation; however, it is unclear whether all stressors, or a select few, are responsible for this phenomenon. This study aimed to investigate the effects of three stressors on biofilm formation of Chlorella vulgaris. We hypothesized that C. vulgaris would experience stress in response to nitrogen depletion (glyoxylate treatment), reduced or elongated day lengths, and with increased culture turbulence. Additionally, we hypothesized that common indicators of stress, such as growth inhibition, cell size changes, and production of reactive oxygen species, would correlate with biofilm formation.

A turbulence level of 300-rpm decreased growth while increasing superoxide production and flocculation efficiency. Although a significant increase in EPS secretion was measured in both short and long day lengths, stress responses to day length changes were not observed. Nitrogen depletion induced low-level superoxide production for the highest glyoxylate concentrations. Collectively, the results indicate that stress response varies according to the applied stress, biofilm formation is not linked to a particular stress indicator, and that C. vulgaris uses cell stickiness both as a mechanism for substrate adherence and cellular aggregation.


Microsoft Visual Studio 2005 Unleashed isi¾ a deep dive into the Visual Studio 2005i¾ tool. Specifically, it will provide you withi¾ solid guidance and education that will allow you to squeeze the ultimate productivity and use out of the Visual Studio 2005 development environment. This book folds in real-world development experience with detailed information about the IDE to make you more productive and ease transition from other development environments (including prior versions of Visual Studio). This book will also help youi¾ increase team collaboration and project visibility with Visual Studio Team Systemsi¾ and it willi¾ give youi¾ straight, to-the-point answers to common developer questions about the IDE.Chapters include: Code Viewers, Explorers, and Browsers Refactoring Code 8 Writing ASP .NET Applications Defining Standards and Practices Introduction to Visual Studio Team System Work Item Trackingi¾ Unit and Load Testing


The Free Tropospheric Experiment (FREETEX'98) was conducted at the Jungfraujoch Observatory in the Swiss Alps (3580 m above sea level) during the well-documented spring maximum in ozone. In spring the Jungfraujoch frequently lies in the free troposphere but can also be influenced by air from the planetary boundary layer. Measurements of NOx, NOy, peroxyacetylnitrate (PAN), HCHO, O3, CO, nonmethane hydrocarbons, peroxy radicals, j(O1D), j(NO2), and a variety of other tropospheric constituents crucial to ozone photochemical cycles were made over a 1-month period. Two independent measurements of NOx, NOy, and PAN showed good agreement. Average free tropospheric daytime NO levels were about 50 pptv, sufficient to sustain photochemical ozone formation. Although high mixing ratios were encountered, PAN decomposition did not contribute to NOx production during FREETEX'98. Ozone production efficiencies (EN) derived from observed ?O3/(NOz) ratios in free tropospheric air were 20-30 molecules of O3 produced per NOx molecule oxidized and agreed well with a photochemical model. A much lower ozone production efficiency of 4 was determined in a photochemically aged air mass arriving from southern Europe, in line with other measurements and calculations in regimes containing high levels of oxidized nitrogen. Model simulations indicated that by sequestering NOx and HO2, low-temperature formation of peroxynitric acid (PNA) decreased ozone production by 20% and instantaneous ozone production efficiencies by 40%, whereas PAN formation had little effect. The model reproduced well the observed sharp transformation from ozone production to ozone destruction (defined as ?O3/?(NOz) = 0) at 20-25 pptv NO. The observed and calculated strong dependence of EN on NOx concentration in the low-NOx regime highlights the difficulty in assigning a single O3 production efficiency value to remote regions, where most of the CO and CH4 in the atmosphere are oxidized.


Vitamin C is a powerful dietary antioxidant that has received considerable attention in the literature related to its possible role in heart health. Although classical vitamin C deficiency, marked by scurvy, is rare in most parts of the world, some research has shown variable heart disease risks depending on plasma vitamin C concentration, even within the normal range. Furthermore, other studies have suggested possible heart-related benefits to vitamin C taken in doses beyond the minimal amounts required to prevent classically defined deficiency. The objective of this review is to systematically review the findings of existing epidemiologic research on vitamin C and its potential role in cardiovascular disease (CVD). It is well established that vitamin C inhibits oxidation of LDL-protein, thereby reducing atherosclerosis, but the cardiovascular outcomes related to this action and other actions of vitamin C are not fully understood. Randomized controlled trials as well as observational cohort studies have investigated this topic with varying results. Vitamin C has been linked in some work to improvements in lipid profiles, arterial stiffness, and endothelial function. However, other studies have failed to confirm these results, and observational cohort studies are varied in their findings on the vitamin's effect on CVD risk and mortality. Overall, current research suggests that vitamin C deficiency is associated with a higher risk of mortality from CVD and that vitamin C may slightly improve endothelial function and lipid profiles in some groups, especially those with low plasma vitamin C levels. However, the current literature provides little support for the widespread use of vitamin C supplementation to reduce CVD risk or mortality.


Abstract The Physical Externality Model is used to illustrate the potential limitations of blindly adopting formal models for economic investigation and explanation in varied geographical contexts. As argued by institutional economists for the last hundred years the practice limits the value and relevance of most general economic inquiry. This model postulates that the geographical location of farmers along a given watercourse, in which water is diverted individually, leads to structural inefficiencies that negatively affect the whole farming community. These effects are felt more severely at downstream sites and lead to a status quo where upstream farmers possess relative economic and political advantages over their counterparts elsewhere. In the study of the Kat River basin these predictions appear to be true only in as far as they relate to legal and political allocations and use of water resources. In terms of lawful uses of land resources aimed at expanding citrus production, the model's predictions are not met. The status quo is however fully explained by the implications of having adopted formal water scheduling rights by upstream farmers as well as other geographical factors. Hence, the case for investigating the effects of important institutions within general economic research is strengthened.


We investigate the role of firm-level bribes in explaining the efficiency of within-sector production factor allocation across firms in nine Central and Eastern European (CEE) countries in 2003-2012. We find a positive association between corruption and both labour and capital misallocation dynamics, once country framework conditions are controlled for. The link is larger the smaller the country, the lower the degree of political stability and of civil liberties, and the weaker regulatory quality. Results hold when instrumenting corruption with female representation in Parliament and the freedom of the press. Targeted action against corruption in the CEE region would thus enhance within-sector allocative efficiency, in turn a determinant of sectorial, and aggregate, TFP growth.


Michael Wallerstein was a leader in developing a rigorous comparative political economy approach to understanding substantive issues of inequality, redistribution, and wage-determination. His early death from cancer left both a hole in the profession and a legacy that will surely provide the foundation for research on these topics. This volume collects his most important and influential contributions, organized by topic, with each topic preceded by an editorial introduction that provides overview and context.


Purpose To determine whether HIV-1 produces microRNAs and elucidate whether these miRNAs can induce inflammatory response in macrophages (independent of the conventional miRNA function in RNA interference) leading to chronic immune activation. Methods Using sensitive quantitative Real Time RT-PCR and sequencing, we detected novel HIV-derived miRNAs in the sera of HIV+ persons, and associated with exosomes. Release of TNFα by macrophages challenged with HIV miRNAs was measured by ELISA. Results HIV infection of primary alveolar macrophages produced elevated levels of viral microRNAs vmiR88, vmiR99 and vmiR-TAR in cell extracts and in exosome preparations from conditioned medium. Furthermore, these miRNAs were also detected in exosome fraction of sera from HIV-infected persons. Importantly, vmiR88 and vmiR99 (but not vmiR-TAR) stimulated human macrophage TNFα release, which is dependent on macrophage TLR8 expression. These data support a potential role for HIV-derived vmiRNAs released from infected macrophages as contributing to chronic immune activation in HIV-infected persons, and may represent a novel therapeutic target to limit AIDS pathogenesis. Conclusion Novel HIV vmiR88 and vmiR99 are present in the systemic circulation of HIV+ persons and could exhibit biological function (independent of gene silencing) as ligands for TLR8 signaling that promote macrophage TNFα release, and may contribute to chronic immune activation. Targeting novel HIV-derived miRNAs may represent a therapeutic strategy to limit chronic immune activation and AIDS progression.


Indigenous knowledge has sustained Indigenous peoples for centuries. Despite the traumatizing and coercive impacts of European, and later American colonization, Indigenous peoples have been able to maintain many aspects of their cultural knowledge and ways of life.  In 2002, the Navajo Nation initiated a process through which they codified ethical standards their ancestors lived by since their emergence to Dine Bikeyah (Dine land). These ethical standards are known as the Fundamental Laws of the Dine.  Since its codification process, Dine people have interpreted these laws and principles in various ways reflecting the variety of contemporary tribal individuals, groups, and institutions and their interests. In this article, I discuss how the Fundamental Laws are understood and applied by the Navajo Nation Council and tribal grassroots cultural and environmental organizations.  I pay particular attention to how ancestral knowledge coded in the Fundamental Laws is interpreted by the government and the people and why the codification of these laws has not helped the people to decolonize and sustain their way of life.


Based on the calculation formulas of heat treatment temperature field for an arbitrary incident laser intensity distribution, the transformation intensity distribution of CO2 laser beam passing an integrating mirror is studied theoretically and experimentally. The derived formulas are applied in laser heat treatment research which is transformed by optical system, and the theoretical calculation results are compared with experimental results. It is shown that the formulas can be used to calculate the laser heat treatment temperature field accurately, and the calculation speed is obviously faster than the numerical calculation methods with the same precision. The calculation software can be used to select proper experiment parameters.


Objectives Water polo requires high aerobic power to meet the demands of match play. Live high:train low (LHTL) may enhance aerobic capacity at sea level. Before the Olympics, the Australian women's water polo team utilised LHTL in an attempt to enhance aerobic fitness. Methods Over 6 months, 11 players completed three normobaric LHTL exposures (block 1:11 days at 3000 m; block 2+3:9 days at 2500 m, 11 days normoxia, 10 days at 2800 m). Haemoglobin mass (Hbmass) was measured through carbon monoxide-rebreathing. Before each block, the relationship between Hbmass and water polo-specific aerobic fitness was investigated using the Multistage Shuttle Swim Test (MSST). Effect size statistics were adopted with likely, highly likely and almost certainly results being >75%, >95%, >99%, respectively. A Pearson product moment correlation was used to characterise the association between pooled data of Hbmass and MSST. Results Hbmass (mean±SD, pre 721±66 g) likely increased after block 1 and almost certainly after block 2+3 (% change; 90% confidence limits: block 1: 3.7%; 1.3–6.2%, block 2+3: 4.5%; 3.8–5.1%) and the net effect was almost certainly higher after block 2+3 than before block 1 (pre) by 8.5%; 7.3–9.7%. There was a very large correlation between Hbmass (g/kg) and MSST score (r=0.73). Conclusions LHTL exposures of <2 weeks induced approximately 4% increase in Hbmass of water polo players. Extra Hbmass may increase aerobic power, but since match performance is nuanced by many factors it is impossible to ascertain whether the increased Hbmass contributed to Australia's Bronze medal.


OBJECTIVE
The purpose of this study was to compare the effectiveness and tolerability of tranylcypromine and combination treatment with extended-release venlafaxine and mirtazapine in patients with treatment-resistant major depression whose current depressive episode had not responded adequately to treatment in three prior prospective medication trials.

METHOD
Adult outpatients with nonpsychotic major depressive disorder who had not achieved remission or had withdrawn from treatment because of intolerance in three previous prospective medication trials were randomly assigned to receive open-label treatment with either tranylcypromine (N=58) or extended-release venlafaxine plus mirtazapine (N=51). The primary outcome measure was whether patients achieved remission, which was defined as a score < or =7 at exit on the 17-item Hamilton Depression Rating Scale (HAM-D). The HAM-D was administered by telephone by raters to whom treatment was masked.

RESULTS
Remission rates were not significantly different between the two treatment groups (6.9% for the tranylcypromine group and 13.7% for the venlafaxine plus mirtazapine group). The mean daily dose at exit for tranylcypromine was 36.9 mg (SD=18.5); for venlafaxine, 210.3 mg (SD=95.2); and for mirtazapine, 35.7 mg (SD=17.6). Tranylcypromine was associated with significantly less symptom reduction and greater attrition due to intolerance.

CONCLUSIONS
Remission rates were modest for both the tranylcypromine group and the extended-release venlafaxine plus mirtazapine group, and the rates were not statistically different between groups. The lower side effect burden, lack of dietary restrictions, and ease of use of venlafaxine and mirtazapine suggest that this combination may be preferred over tranylcypromine for patients with highly treatment-resistant depression who have not benefited adequately from several prior treatments.


This Article explores the particular challenges encountered by an attorney when his client disclosed damaging information over the course of his representation in immigration court which conflicted with information that was previously on the record. In so doing, this Article attempts to address the broader question of how to apply ethical norms in an increasingly draconian legal environment. Attorney S confronted an ethical crisis at the eleventh hour of his case. The crisis was the result of competing obligations Attorney S had towards his client ('Bertha Harwood') and the tribunal when his client provided him with certain information after her Individual Hearing that conflicted with information on the record. The Article examines the process by which Attorney S assessed his ethical obligations towards his client of zealous advocacy and confidentiality and his competing duty of candor toward the tribunal under both the Model Rules of Professional Conduct ('Model Rules') [FN12] and the EOIR Rules of Professional Conduct. [FN13] Specifically, the attorney in this case grappled with the question of whether he had to take remedial action under the rules, and if so, what remedial measures were appropriate. After much reflection, he chose a course of action that reframed certain questionable evidence but which favored the interests of his client over absolute candor towards the tribunal. Although he ultimately concluded that he was acting within the bounds of the relevant rules, Attorney S recognized that the choices he made tested the outer limits of his ethical obligation of candor toward the immigration court, and that a more cautious attorney might have made different ethical choices.


Lack of eucalypt regeneration is a key factor in the decline of forest and woodland remnants in low rainfall agricultural regions in Australia. This thesis provides a new insight into dry forest and woodland regeneration by demonstrating how important and tightly circumscribed the eucalypt seedling regeneration niche is in these forests in Tasmania. The potential of soil water repellency to be a barrier to eucalypt recruitment and the difficulty of mimicking the regeneration niche to improve natural regeneration processes in degraded forests are highlighted. A section on management implications is included.
Key to effective management of dry forests and woodlands is an understanding of the requirements and conditions that promote seed germination and seedling establishment (recruitment niche) and the persistence of lignotuberous sprouts (juvenile persistence niche). The processes of eucalypt recruitment and persistence were investigated in dry forest and woodland remnants in the Midlands of Tasmania at the scales of the stand and microsite. The work was conducted with a view to applying the results to the discipline of restoration ecology.
Measurements of structural complexity at thirty remnant forest stands that were in a range of stages of decline revealed that healthy remnants contained four times the amount of eucalypt regeneration (seedlings, lignotuberous sprouts and saplings) than stands in a degraded condition and that regeneration was absent in stands of paddock trees (except for one stand in which there had been a fire). An additional lack of trees in smaller diameter size classes in both intermediate and paddock tree sites relative to the amounts shown in healthy sites implies a long-term recruitment scarcity and an unavoidable future bottleneck in the development of mature trees. The quantity of eucalypt regeneration was positively associated with other structural attributes: perennial species and life form richness; cover of vegetation 0.5-6m high; litter; dead trees; large trees; and total length of fallen logs >10cm diameter; and negatively associated with quadratic mean tree diameter at breast height. Across the thirty stands, the majority of eucalypt regeneration was in the form of lignotuberous sprouts and saplings. Only in stands burnt 2-6 years prior to the survey did newly recruited seedlings form part of the regeneration.
Within these burnt sites the seedling recruitment niche differed significantly to the juvenile persistence niche (occupied by lignotuberous sprouts), while the juvenile persistence niche had characteristics similar to the general forest floor. Seedling microsites were characterised by the following: canopy gaps and ashbeds; a predominantly northerly aspect; over 220° shelter in profile; an average distance to a sheltering object of < 30cm; shelter provided by coarse woody debris (80% of seedlings sheltered by logs and branches); soil that was significantly softer and less water repellent than the forest floor; and low cover of grass. All these characteristics of seedling microsites affect moisture availability.
The role of ashbeds, coarse woody debris and soil water repellency in eucalypt recruitment was further investigated. Soil water repellency (hydrophobicity) can be severe in dry eucalypt forests as hydrophobic organic compounds coat the surfaces of soil particles and this has implications for the movement and storage of water in the system. Other studies have shown that soil hydrophobicity is differentially affected by fire depending on the temperatures reached, with repellency increasing as temperature increases until a threshold is reached at which repellency is removed (approximately 260°C). Logs lying on the forest floor provide heavy fuel for intense fire which creates ashbeds. The current study showed that in ashbeds hydrophobicity was removed in surface layers but the hydrophobic layer moved lower (1-3cm) down the soil profile. The wettable surface soil zones enabled the germination of eucalypt seed and subsequent establishment of seedlings. Remaining adjacent and partially burnt coarse woody debris provided a soil moisture store (with threefold the amount of moisture in soil under logs compared to 5m away) and probably protection from microclimatic fluctuations and browsing animals. Surface soil outside of the ashbed areas was severely water repellent suggesting that soil water repellency may be a barrier to eucalypt recruitment in lightly burnt and unburnt soils.
These findings were applied to restoration ecology. Patch scale restoration trials were conducted in six dry forest remnants in the Midlands of Tasmania in an attempt to mimic the eucalypt recruitment and persistence niches through the use of intense spot burns or cultivation with and without the addition of large logs. Survival of seedlings established from introduced seed and natural seed rain was variable within and among sites resulting in no treatment effects. Thus the 'Burn with the addition of logs' treatment did not successfully mimic the recruitment niche, probably because the experiment did not mimic the natural heterogeneity of hydrophobicity following wildfire. However, the survival of planted seedling was greatest in 'Cultivated with no log' treatments, which most closely resembled the juvenile persistence niche. Burning treatments did provide a relatively weed-free seed bed for over a year and surviving seedlings grew significantly better than those in cultivated treatments which quickly became infested with grassy weeds despite granular herbicide application.
Survival of planted seedlings and the amount of observed germination of sown seed were each significantly correlated with the structural complexity score of the planting site with seedling survival significantly higher in sites of healthy condition. This suggests that the more degraded sites had crossed an abiotic threshold (using state and transition model terminology) that was not completely removed by the experimental restoration treatments. The early establishment of planted eucalypt seedlings was also shown to be significantly affected by species; the underlying soil water repellency of the planting plot; the proximity to an adult tree and the type of soil amelioration used in the restoration treatment but not by the presence or absence of logs.
Suggestions for further work include trialling treatments that more closely mimic the recruitment niche by partially burning and retaining logs in situ rather than post burn addition; investigating the timing and intensity of weed control in cultivated treatments; testing the effects of soil water repellency amelioration through the use of wetting agents; and investigating spatial aspects of treatment patch placement.


International comparative studies of student performance have initiated political discussions in countries all over the world on how to improve the educational achievement of students. The empirical evidence suggests that central exams help to achieve higher student performance. Central exams direct the incentives of all educational actors towards furthering students' knowledge. By providing the education system with performance information they improve the monitoring of students, teachers, schools, administrators, and parents. Using an international micro database of nearly half a million students, this paper finds that students in countries with central exitexam systems perform substantially better in their middle-school years in both math and science than students in countries without central exams. In quantitative terms, their advantage is 35 to 47 percent of an international standard deviation in test scores, or roughly the equivalent of one year of schooling. The beneficial effect increases as students advance through middle school. Good and bad students alike perform better in central-exam systems. In math, the gain of high-performing students is slightly larger than that of low-performing students. There is some evidence that central-exam systems equalize educational opportunities for students from different parental backgrounds. School autonomy in budgetary and salary decisions is detrimental in systems without central exams but turns around to be beneficial in systems with central exams. Thus, central exams seem to be a prerequisite for a decentralized system of autonomous schools to achieve high performance. The efforts of teachers and students are more concentrated on the goals of the education system when central exams are in place, and parental involvement becomes more informed and effective. Thus, central exams exert their effects through several different impact channels by changing the behavior of different actors in the education process. Given the shortcomings of most school- and teacherbased accountability systems and the substantially higher costs of most resource-based policies, central-exam systems seem a highly attractive policy alternative.


The mathematical basis of signal processing and its many areas of application is the subject of this book. Based on a series of graduate-level lectures held at the Mathematical Sciences Research Institute, the volume emphasizes current challenges, new techniques adapted to new technologies, and certain recent advances in algorithms and theory.


Objective: The objective of this study was (1) to find the prevalence of urogenital (UG) complaints after menopause, (2) to evaluate the various risk factors for UG problems in postmenopausal women, and (3) to assess the severity of the symptoms depending on the duration of menopause. Materials and Methods: This study is a prospective study conducted at the Specialty Outpatient Department in Safdarjung Hospital over a period of 1 year. Two hundred postmenopausal women during this period were screened for UG complaints by eliciting detailed history in a pro forma and were divided into two groups based on the duration of menopause. Women with preexisting complaints before menopause and those with some medical disorders such as diabetes, stroke, or neurological problems were excluded from the study. Data were analyzed by standard statistical analytical tests. Results: The prevalence of UG symptoms in our study was 67%. Group A constitutes 127 (63.5%) participants in which menopause attained was of 1–5-year duration. Group B comprises the women with >5-year duration of menopause and it includes 73 (36.5%) patients. Among the genital complaints, vaginal dryness was the most common complaint in both the groups (Group A: 62% and Group B: 48%) followed by vaginal discharge or infection (Group A: 28% and Group B: 25%). Around 19 (15%) in Group A and 10 (13.6%) in Group B were having burning micturition (dysuria), the most common complaint encountered. The UG complaints were not statistically significantly different in both the groups. The severity of the symptoms was significantly different in two groups with more severe complaints in Group A as compared to Group B. Conclusion: UG complaints associated with estrogen loss can occur episodically throughout a women's life, but it is most common and chronic in the duration in postmenopausal women.


The problem of free will arises because of the conflict between two inconsistent impulses, the experience of freedom and the conviction of determinism. Perhaps we can resolve these by examining neurobiological correlates of the experience of freedom. If free will is not to be an illusion, it must have a corresponding neurobiological reality. An explanation of this issue leads us to an account of rationality and the self, as well as how consciousness can move bodies at all. I explore two hypotheses. On the first, freedom is a complete illusion. On the second, it is not an illusion, and there is a corresponding indeterminism at the neurobiological level. This can only occur if there is in fact a quantum mechanical element in the fundamental neurobiology of consciousness.


By combining autobiography with cultural history, English professor Howard Wolf takes us through the 1960s and up to the present much in the way a personal guide would lead us through a museum full of wonders. "The Education of a Teacher" traces Wolf's odyssey as he discovers his vocation, from his own college days to his tenure in a Turkish university as a visiting Fulbright scholar. The decades unfold for us: the cold war, student activism, Vietnam, and a trend toward student apathy all prepare us for the technological immediacy of the 1980s. Wolf was and is a passionate participant in the political, literary, and social events that have constituted our recent culture.This is a collection of essays about higher education and American culture that dramatises and humanises the often abstractly treated subject of education. Howard Wolf always tries to understand the classroom and the setting of his university in terms of the larger currents of the culture and to make his approach to literature and his students relevant to these currents. Wolf's connections between autobiography and the significant trends of our time enrich the historical record.


【Objectives : This study was designed to compare the effects of Jungsongouhyul pharmacopuncture treatment with bee venom pharmacopuncture treatment in hospitalized patients with peripheral facial paralysis. Methods : This study was done on a total of 41 patients with peripheral facial paralysis who were admitted into the Korean Medicine Hospital from February 1st, 2013 to April 30th, 2014. Wedivided patients into two groups. The Jungsongouhyul group was treated by Jungsongouhyul pharmacopuncture once a day and the bee venom group was treated by bee venom pharmacopuncture once a day. To compare the therapeutical effects of the two treatments, we used Yanagihara's unweighted grading system, House-Brachmann grading system, lip-length & snout indices and facial disablity index twice - before initial treatment and after final treatment. Results : Both Yanagihara's score and House-Brachmann grading system score improved in each group. However, there were no significant differences in improvement between the bee venom group and the Jungsongouhyul group. Conclusions : Jungsongouhyul pharmacopuncture treatment appears to be as effective as bee venom pharmacopuncture treatment to improve symptoms of peripheral facial paralysis.】


This outstanding collection of original essays brings together some of the leading experts in competition economics, policy and law. They examine what lies at the core of the 'economic approach to competition law' and deal with its normative and institutional limitations. In recent years the 'more economic approach' has led to a modernisation of competition law throughout the world. This book comprehensively examines for the first time, the foundations and limitations of the approach and will be of great interest to scholars of competition policy no matter what discipline.


Clostridioides difficile infection (CDI) remains an important healthcare-associated infection and threat to patient safety since the height of the NAP1/027 epidemic in the early part of the millennium. In 2011, C. difficile caused almost half a million infections and 29 000 deaths in the USA alone, with 24% of those cases occurring in hospital settings.1 The US Centres for Disease Control identifies C. difficile as one of three pathogens that poses 'an immediate antibiotic resistance threat that requires urgent and aggressive action'.2 Many jurisdictions now require public reporting of hospital CDI rates. In some countries, hospitals face financial penalties for elevated CDI rates. CDI rates are also top priorities on hospital quality agendas, often associated with ambitious reduction targets. Some institutions even aim for complete elimination of healthcare-associated CDI—a goal referred to as 'getting to zero'.

There is no argument that healthcare-associated CDI is a significant patient safety issue and that aggressive efforts should be taken to prevent its harmful effects. However, external pressures and a lack of appreciation for the complexity of C. difficile epidemiology are interfering with the mission to prevent healthcare-associated CDI. We expose the challenges of the current approach to CDI prevention in hospitals and highlight where prevention efforts deserve further attention.

With the focus on reducing CDI rates, diagnostic test stewardship for CDI is a popular quality improvement initiative in hospitals. Typical symptoms for CDI—diarrhoea and abdominal pain—are common in hospitalised patients due to comorbidities, medication exposures (including laxatives) and initiation of enteral feeds. Coupled with the increasing use of highly sensitive C. difficile molecular tests, CDI is overdiagnosed in up to half of those under investigation.3 Algorithms thus exist to discourage testing in patients with alternative aetiologies of diarrhoea. Diagnostic C. difficile test stewardship may provide the benefit of heightening accurate case …


We propose a generalization of the Cohen-Daubechies-Feauveau (CDF) and 9/7 biorthogonal wavelet families. This is done within the framework of non-stationary multiresolution analysis, which involves a sequence of embedded approximation spaces generated by scaling functions that are not necessarily dilates of one another. We consider a dual pair of such multiresolutions, where the scaling functions at a given scale are mutually biorthogonal with respect to translation. Also, they must have the shortest-possible support while reproducing a given set of exponential polynomials. This constitutes a generalization of the standard polynomial reproduction property. The corresponding refinement filters are derived from the ones that were studied by Dyn et al. in the framework of non-stationary subdivision schemes. By using different factorizations of these filters, we obtain a general family of compactly supported dual wavelet bases of L2. In particular, if the exponential parameters are all zero, one retrieves the standard CDF B-spline wavelets and the 9/7 wavelets. Our generalized description yields equivalent constructions for E-spline wavelets. A fast filterbank implementation of the corresponding wavelet transform follows naturally; it is similar to Mallat's algorithm, except that the filters are now scale-dependent. This new scheme offers high flexibility and is tunable to the spectral characteristics of a wide class of signals. In particular, it is possible to obtain symmetric basis functions that are well-suited for image processing.


The recent exposure of an erroneous latent print identification by the FBI that led to the false arrest of Oregon attorney Brandon Mayfield has punctured the myth of the "infallibility" of fingerprint identification and generated renewed interest in the "error rate" of fingerprint identification. This article undertakes a comprehensive review of what is known about the potential error rate of latent print identification. The article first presents a compilation of all known exposed cases of fingerprint misattributions. Although only twenty such cases have been documented, an analysis of these cases suggests that these cases likely represent only a small portion of the true set of latent print misattributions. Then, the article compiles and analyzes proficiency test data that sheds some light on the potential error rate of fingerprint identification. The second half of the article is devoted to the fingerprint profession's and courts' rhetorical accounts of the potential error rate of latent print identification. This section analyzes efforts to minimize, dismiss, or otherwise account for fingerprint error. Fingerprint examiners make claims of error-free practice that belie the reality of error. The article concludes that we must confront, analyze, and seek to understand error if we want to reduce it.


The paper analyses the relationship between deposit insurance, debt-holder monitoring, and risk taking. In a stylised banking model we show that deposit insurance may reduce moral hazard, if deposit insurance credibly leaves out non-deposit creditors. Testing the model using EU bank level data yields evidence consistent with the model, suggesting that explicit deposit insurance may serve as a commitment device to limit the safety net and permit monitoring by uninsured subordinated debt holders. We further find that credible limits to the safety net reduce risk taking of smaller banks with low charter values and sizeable subordinated debt shares only. However, we also find that the introduction of explicit deposit insurance tends to increase the share of insured deposits in banks' liabilities.


This text offers a modern view of process control in the context of today's technology. It provides the standard material in a coherent presentation and uses a notation that is more consistent with the research literature in process control. Topics that are unique include a unified approach to model representations, process model formation and process identification, multivariable control, statistical quality control, and model-based control. This book is designed to be used as an introductory text for undergraduate courses in process dynamics and control. In addition to chemical engineering courses, the text would also be suitable for such courses taught in mechanical, nuclear, industrial, and metallurgical engineering departments. The material is organized so that modern concepts are presented to the student but details of the most advanced material are left to later chapters. The text material has been developed, refined, and classroom tested over the last 10-15 years at the University of Wisconsin and more recently at the University of Delaware. As part of the course at Wisconsin, a laboratory has been developed to allow the students hands-on experience with measurement instruments, real time computers, and experimental process dynamics and control problems.


New information and communications technologies, such as mobile phones and social media, have presented the humanitarian community with a dilemma: how should humanitarian organisations integrate information from crisis-affected communities into their decision-making processes whilst guarding against inaccurate information from untrustworthy sources? Advocates of crisis mapping claim that, under certain circumstances, crowdsourcing can increase the accuracy of crisis information. However, whilst previous research has studied the geography of crisis information, the motivations of people who create crisis map mashups, and the motivations of people who crowdsource crisis information, the geography of, and the uncertainty associated with, crowdsourced crisis information has been ignored. As such, the current research is motivated by the desire to explore the geographic uncertainty associated with, and to contribute a better understanding of, crowdsourced crisis information.

The current research contributes to the fields of GISc (Geographic Information Science) and crisis informatics; crisis mapping; and geovisualisation specifically and information visualisation more generally. These contributions can be summarised as an approach to, and an understanding of, the geographic uncertainty associated with crowdsourced crisis information; three geovisualisation software prototypes that can be used to identify meaningful patterns in crisis information; and the design, analysis, and evaluation model, which situates the activities associated with designing a software artefact-and using it to undertake analysis-within an evaluative framework. The approach to the geographic uncertainty associated with crowdsourced crisis information synthesised techniques from GISc, geovisualisation, and natural language processing. By following this approach, it was found that location descriptions from the Haiti crisis map did not 'fit' an existing conceptual model, and, consequently, that there is a need for new or enhanced georeferencing methods that attempt to estimate the uncertainty associated with free-text location descriptions from sources of crowdsourced crisis information.


The objective of this study was to compare the efficacy of an intramammary infusion, containing tilmicosin phosphate, to an infusion of a negative control intramammary placebo for preventing new intramammary infections (IMI) during the dry period. Cows were enrolled from 24 dairy herds from three geographical regions of Canada. Data from 248 cows and 938 bacteriologically negative quarters at drying-off are summarized. Overall, the rate of new IMI during the dry period was 16.7% of quarters. The new infection rates for quarters that received intramammary tilmicosin compared with the intramammary placebo were 14.4 and 19.4%, respectively. The majority of new IMI was caused by coagulase-negative staphylococci (49%) and environmental streptococcal organisms (26.8%). The probability for quarters to develop new IMI in the dry period was significantly increased when cows had higher milk production before drying-off (P = 0.04), when cows had longer dry periods (P = 0.02), and when dry cows were housed in tie-stall barns (P = 0.002). Higher parity cows and those that had a linear score somatic cell count (SCC) above 4 on the last DHI test were also at increased risk for new IMI (P < 0.10). Administration of intramammary tilmicosin appears to be an efficacious therapy for prevention of new IMI; however, there is currently no approved intramammary formulation of this product available. Use of blanket dry cow antibiotic therapy compared to selective dry cow therapy, as well as the importance of identifying risk factors and managing the environment of dry cows are discussed.


BACKGROUND
Alterations in hedgehog signaling are implicated in the pathogenesis of basal-cell carcinoma. Although most basal-cell carcinomas are treated surgically, no effective therapy exists for locally advanced or metastatic basal-cell carcinoma. A phase 1 study of vismodegib (GDC-0449), a first-in-class, small-molecule inhibitor of the hedgehog pathway, showed a 58% response rate among patients with advanced basal-cell carcinoma.

METHODS
In this multicenter, international, two-cohort, nonrandomized study, we enrolled patients with metastatic basal-cell carcinoma and those with locally advanced basal-cell carcinoma who had inoperable disease or for whom surgery was inappropriate (because of multiple recurrences and a low likelihood of surgical cure, or substantial anticipated disfigurement). All patients received 150 mg of oral vismodegib daily. The primary end point was the independently assessed objective response rate; the primary hypotheses were that the response rate would be greater than 20% for patients with locally advanced basal-cell carcinoma and greater than 10% for those with metastatic basal-cell carcinoma.

RESULTS
In 33 patients with metastatic basal-cell carcinoma, the independently assessed response rate was 30% (95% confidence interval [CI], 16 to 48; P=0.001). In 63 patients with locally advanced basal-cell carcinoma, the independently assessed response rate was 43% (95% CI, 31 to 56; P<0.001), with complete responses in 13 patients (21%). The median duration of response was 7.6 months in both cohorts. Adverse events occurring in more than 30% of patients were muscle spasms, alopecia, dysgeusia (taste disturbance), weight loss, and fatigue. Serious adverse events were reported in 25% of patients; seven deaths due to adverse events were noted.

CONCLUSIONS
Vismodegib is associated with tumor responses in patients with locally advanced or metastatic basal-cell carcinoma. (Funded by Genentech; Erivance BCC ClinicalTrials.gov number, NCT00833417.).


This thesis investigates the properties of backscattered polarized light from layered scattering media with a view to application in the imaging of in-vivo skin for medical application. The research includes investigation of numerically simulated samples, tissue phantoms and in-vivo tissue.

The aim of the early research is to identify the differences in behaviour between initially linearly and circularly polarized illumination concerning the rates of depolarization with scattering. Initial examination is made through Monte Carlo simulations. The analysis yields results which indicate, for forward scattering media, circular polarizations maintain their initial state to greater depths within a scattering medium than linearly polarized light. This result is exploited to show sensitivity of the different polarizations to different layers within a medium and indicates the potential to achieve coarse optical sectioning.

These fundamental properties are extended to a full field imaging arrangement, using both simulated and experimental results to illustrate polarization gating to perform subsurface object imaging in a medium composed of uniform scatterers. The concepts are extended to imaging an in-vivo sample. The removal of multiple scatter and surface reflections is performed using a combination of linearly and circularly polarized illumination coupled with image subtraction, to provide a sub-surface, localised tissue image. This provides an improvement on currently applied techniques, which use linearly polarized light and the application of a flat glass plate and matching fluid.

To exploit the spectral properties of tissue, the development and construction of a fully automated, multiple wavelength, polarization imaging system, suitable for testing in a clinical setting is presented.

Theoretical investigation into the potential to perform the determination of the optical properties of a two layered sample, using simulated results in-keeping with the system's detection regime, is performed. It is illustrated that the variation of top layer thickness, bottom layer scattering, top and bottom layer absorption coefficient provides well-conditioned data when combining polarization and spectral information.


Abstract. As cloud resolving models become more detailed, with higher resolution outputs, it is often complicated to isolate the physical processes that control the cloud attributes. Moreover, due to the high dimensionality and complexity of the model output, the analysis and interpretation of the results can be very complicated. Here we suggest a novel approach to convective cloud analysis that yields more insight into the physical and temporal evolution of clouds, and is compact and efficient. The different (3-D) cloud attributes are weighted and projected onto a single point in space and in time, that has properties of, or similar to, the Center Of Gravity (COG). The location, magnitude and spread of this variable are followed in time. The implications of the COG approach are demonstrated for a study of aerosol effects on a warm convective cloud. We show that in addition to reducing dramatically the dimensionality of the output, such an approach often enhances the signal, adds more information, and makes the physical description of cloud evolution clearer, allowing unambiguous comparison of clouds evolving in different environmental conditions. This approach may also be useful for analysis of cloud data retrieved from surface or space-based cloud radars.


Character prototype approaches for writer identification produces a consistent set of templates that are used to model the handwriting styles of writers, thereby allowing high accuracies to be attained. This paper extends such work on writer identification by investigating the usage of alphabet knowledge derived from the character prototypes. In addition, we demonstrate the concept of discriminative power of alphabets. It is not unconceivable that certain alphabets allow writers to express their individuality of handwriting with a more distinct and unique style compared with other alphabets. This paper establishes that such alphabets have higher discriminative powers in identifying writers. Experiments related to the reduction in dimensionality of the writer identification system are also reported. Our results show that the discriminative power of alphabet can be used to reduce the complexity while maintaining the same level of performance for the writer identification system.


The aim of this research was to determine the differences in the rate of development of ventilation capabilities in 12 to 15-year-old boys who systematically train football, and boys in the same age group who are not involved in any sports. The research included 40 football players and 40 non-players, divided into chronological age groups U12, U13, U14, and U15. Ventilation capabilities are represented with 10 parameters: forced vital capacity, forced vital capacity in percentage predicted, volume of air exhaled during the first second, volume of air exhaled during the first second in percentage predicted, Tiffeneau index, percentage of the predicted Tiffeneau index, forced expiratory flow, forced expiratory flow 25-75% of FVC, forced expiratory flow 75-85% of FVC, and maximum expiratory flow. The difference between the arithmetic mean of groups and the development rate of the variables is determined by one-way analysis of variance (ANOVA). Non-players have a higher and faster growth in value for most variables until the age of 13, followed by a gradual stagnation and decline in values, while football players have a more balanced growth in values until the age of 13, and they experience the maximum in development at 14 years of age, after which it begins to decline slightly. The obtained values confirm that boys who are participating in systematic sport training have a continuous rate of development of pulmonary ventilation, and have greater capacity values, as well as better airway patency.


In this paper we present a novel transliteration technique which is based on deep belief networks. Common approaches use finite state machines or other methods similar to conventional machine translation. Instead of using conventional NLP techniques, the approach presented here builds on deep belief networks, a technique which was shown to work well for other machine learning problems. We show that deep belief networks have certain properties which are very interesting for transliteration and possibly also for translation and that a combination with conventional techniques leads to an improvement over both components on an Arabic-English transliteration task.


Anthocyanins are important components in the skins of grapes and in the development of wine colour. Various environmental factors cause poor coloration in some areas, even for the same cultivars planted in different production areas. The objective of this study was to evaluate the effect of exogenous brassinosteroids (BR) on the accumulation of anthocyanins and gene expression of anthocyanin biosynthesis in wine grape berry skins. The results show that total anthocyanin content in BR-treated grapes was higher than that in the control (CT) grapes, and that 0.4 mg/L was the most effective treatment concentration. The effect of BR on downstream genes was more effective than that on upstream genes. Full coloration of BR-treated grapes was achieved seven days earlier than in the case of CT. Moreover, BR enhanced the transcript level of the downstream genes of anthocyanin biosynthesis, which caused the total anthocyanin content to increase. The induction of structural and regulatory genes of the flavonoid pathway suggests that the interrelationships between developmental and environmental signalling pathways were magnified by BR treatment, which actively promoted fruit coloration, namely anthocyanin biosynthesis.


This study explores and illustrates an analytical framework to assess the performance factors for logistics companies through a managerial view rather than a market view. The factors integrating the strategic and operational targets are evaluated within a framework based on four levels; performance targets, planning activities, logistics operations and logistics operations' performance attributes. The analytic network process is used to determine the most effective performance attributes. The framework is applied and studied in two major logistics companies of South East Europe in international competition, which have different focuses in terms of customer relations and information technology. Relying on the first evidence of the application, recommendations will be made for further studies


It once took two decades to replace one-third of the Fortune 500; now a subset of new firms are challenging and displacing this elite group at a breathtaking rate, while armies of startups come and go within just a few years. Most new jobs are, in fact, coming from small firms, reversing the trend of a century. David Audretsch takes a close look at the U.S. economy in motion, providing a detailed and systematic investigation of the dynamic process by which industries and firms enter into markets, either grow and survive, or disappear. He shapes a clear understanding of the role that small, entrepreneurial firms play in this evolutionary process and in the asymmetric size distribution of firms in the typical industry. Audretsch introduces the large longitudinal database maintained by the U.S. Small Business Administration that is used to identify the startup of new firms and track their performance over time. He then provides different snapshots of the process of industries in motion: why new-firm startup activity varies so greatly across industries; what happens to these firms after they enter the market; the extent to which entrepreneurial firms account for an industry's economic activity and why that measure varies across industries; how small firms compensate for size-related disadvantages; and who exits and why. Audretsch concludes that the structure of industries is characterized by a high degree of fluidity and turbulence, even as the patterns of evolution vary considerably from industry to industry. The dynamic process by which firms and industries evolve over time is shaped by three fundamental factors: technology, scale economies, and demand. Most important, the evidence suggests that it is the differences in the knowledge conditions and technology underlying each specific industry -- key elements in innovation -- that are responsible for the pattern particular to that industry.


Abstract Despite the headway the world has experienced over the last couple of years in terms of a substantial increase in digital access, there are still significant challenges to overcome in ensuring women are included in the transformation to a digital society, which in turn will enhance productivity and social development. Efforts to increase internet adoption access through broadband plans and legislative reforms have yielded improvements in use and adoption. However, there is still a stark and pervasive gender inequality in terms of access, ownership of digital devices, digital fluency as well as the capacity to make meaningful use of the access to technology. Even though affordability is a key source of exclusion, there are also significant socio-cultural norms that restrict access for women. This paper brings forward the argument that access alone is not enough, women need agency and capacity to leverage access. The authors thus highlight the need to make an assessment of the global gender gap and develop meaningful indicators that contribute to the design and implementation of effective policies that drive adoption. We need effective promotion of women´s digital adoption not only from the government but also from the private sector and civil society in order to lead the digital adoption of best practices for women around the world.


Rethinking Development in East Asia: From Illusory Miracle to Economic Crisis. Edited by Pietro P. Masina. Surrey: Curzon Press, 2002. Pp. 326. This edited volume, consisting of fifteen chapters, is the product of a conference at Roskilde University in October 1998. While the conference was timely, with much of East Asia in deep recession, the pace of events in the region and volume of timely research into the crisis gives this volume a dated appearance. The bibliographies at the back of the edited chapters largely trail off in 1999. The authors adopt a "political economy" framework. The power relationships, both political and economic, between the developmental state, the transnational corporations (TNCs), and the multilateral institutions are examined. Institutionalist, Marxist, and Structuralist flavours pepper the content of the individual contributions. The conclusion is that the Asian crisis was systemic. Authors reject explanations of the crisis as the product of "crony capitalism" and attack World Bank explanations of the preceding period of growth as the product of limited government intervention. This book is not about the Asian crisis per se. Rather, the crisis is viewed as an example of "inherent contradictions" in the system that it highlights. The crisis is seen as the product of two forces: regional economic development strategies, heavily reliant on international markets and capital flows; and an unstable international financial framework within which such institutions as the TNCs, International Monetary Fund (IMF), World Bank, and U.S. Treasury exercise an over-arching influence, all with the shared objectives of international integration and globalization. This volume is strongest in elaborating the development of this system. The chapters by Ngai-Ling Sum (Chapter 3), and Chandrasekhar and Ghosh (Chapter 6), in particular relate the immediate circumstances of the crisis, that is, the reversal of historically high private capital flows, to the underlying vulnerabilities of the structure that constitutes the "East Asia Model". These two chapters, together with the contribution by Putzel (Chapter 8) are the strongest empirical contributions. The deficiency of a structural analysis, and this volume is a good example, is that "the model" is applied to the region as a whole with little indepth consideration of country variations. Specific influences operating at the country level, in terms of economic structure or government policy responses, are often ignored or brushed over. Six chapter titles of the book are dedicated to four countries: Thailand, South Korea, Vietnam, and Mongolia. There is little on Indonesia and Malaysia. Thailand is examined by a number of contributors. The result is unsatisfactory. For example, Bullard's Chapter 7, "Taming the IMF: How the Asian Crisis Cracked the Washington Consensus", produced this howler: "By early 1997, it was evident that Thailand's boom was about to bust, with a slowdown in export earnings" (p. 146). In fact, export growth was negative in 1996, resulting in a rising current account deficit and currency speculation. The seeds of the crisis lie in 1996, a fact Bullard misses. There are important omissions. There is no mention of the Bangkok International Banking Facility (BIBF). The possible connection between the establishment of this institution and the observed accelerated increase in short-term capital inflows, particularly international interbank loans from 1993 is simply not noticed. In part, this oversight is due to the inadequate statistical treatment of the structure of short-term capital inflows. Also overlooked is the authoritative Nukul Commission Report (1999) into the Bank of Thailand's foreign exchange market policies and foreign exchange transactions in 1997. …


Abstract An advanced design of a Large Assembly with Small Pins (LASP) has been proposed at the Massachusetts Institute of Technology to increase the power density of boiling water reactors (BWRs) while keeping most of the operating conditions of current BWRs. LASP is based on replacing four traditional assemblies and the large water gap regions with a single large assembly having a 22 × 22 square lattice. In-assembly water rods accommodate control rods as well as provide help to the moderation of neutrons. Previous steady-state analysis showed that the LASP core allows for operation with 20% higher power density than the core with traditional 9 × 9 fuel assemblies. However, the void reactivity coefficient of the LASP core is 25% more negative and the steam flow rate is 20% higher than that of the reference core. In this study, the performances of the LASP core and reference core are compared for selected design-basis accidents and transients. Generally, the LASP design is found to behave in a manner similar to the traditional assemblies. First, the clad peak temperature during a large-break loss-of-coolant accident analysis satisfies regulatory criterion, and it is possible to preserve peak cladding temperature margin of the reference design if the capacity of the low-pressure core injection system is increased by 20%. Second, the generator load rejection with bypass failure and feedwater controller failure analyses show a decrease in dryout margin for the LASP core because of the combination of more negative void coefficient and increased steam load. However, this problem could be remedied by increasing the steam line flow area or allowing an additional flow restrictor in the steam line to attenuate the back propagating pressure wave in the main steam pipe following the turbine stop valve closure. Finally, the LASP core preserved the same level of margin to dryout as the reference core in the cases of four other evaluated events.


This paper documents labor mobility flows from multinationals (MNEs) to nonMNEs in Norwegian manufacturing during the 1990s. 14,400 workers in MNEs move to non-MNEs during this period. By the year 2000, 28 percent of the non-MNEs employed workers with experience from MNEs. Consistent with spillovers through mobility, I estimate a robust and significantly positive correlation between the share of workers with MNE-experience and the productivity of non-MNEs. Workers with MNE-experience contribute 20% more to the productivity of their plant than workers without experience from MNEs, even after controlling for differences in unobservable worker characteristics. The difference between the private returns to mobility and the productivity effect at the plant level suggests that labor mobility from MNEs to non-MNEs represents a true knowledge externality.


The conodont fauna extracted from a boulder in the Lorentz River (southern Irian Jaya) is described. Arguments are put forward that the elements of Distomodus dubius (Rhodes, 1953) sensu Jeppsson, 1972 are part of the apparatus of species of Coryssognathus Link & Druce, 1972, a genus that ontogenetically acquires an apparatus of multidenticulate elements on account of the phenomenon that one coniform element of each of the several (curvature-transition ?) series successively incorporates its - to that time independently growing - coniform neighbours within its lamellae. Attention is called to the fact that probably also the apparatus of Distomodus kentuckyensis Branson & Branson, 1947 - as described by Cooper (1975) had a similar ontogeny and that it needs to be investigated whether other species assigned to Distomodus are congeneric.


The finalized "Return to Europe" of the new EU members states of Central and Eastern Europe (CEE) has created a whole new ballgame for Eurosceptic political actors. In rational choice terms, the costs of Euroscepticism (and even Eurorejection) have gone down dramatically, while the benefits will most probably go even further up. While the effects of EU accession on the party systems of CEE are multifold, this paper develops one possible effect: the transformation of the already present regional divide within CEE countries into a populist, anti-EU center-periphery cleavage


Rice is staple food for people in many countries for centuries. It is therefore considered as safe and environmental friendly material for pharmaceutical formulations. In the present study, aqueous extracts of three different parts of rice grain; rice bran (RB), rice husk (RH), and rice germ (RG) were compared for their use as reducing agents in synthesis of silver nanoparticles (AgNPs). AgNPs from those three different parts of rice, RB-AgNPs, RH-AgNPs, and RG-AgNPs, respectively showed different reducing activity, which the highest capacity was RB. RG-AgNPs and RB-AgNPs showed the maximum absorption of AgNPs at 440 nm whereas that of RH-AgNPs was at 480 nm. FTIR spectra of all AgNPs indicated the presence of different functional groups from rice attached to the nanoparticles and these groups prevented the particle agglomeration. Size analysis using dynamic light scattering revealed that RB-AgNPs was the smallest particles (346.4 ± 36.8 nm) and possessed the highest negative zeta potential. Antimicrobial test showed that the AgNPs obtained from green synthesis mediated by rice extracts have great antimicrobial activity against Streptococcus mutans, the severe oral pathogenic bacteria causing dental caries. These results suggest that aqueous extracts of RB, RH, and RG have potential to be used as reducing agents in synthesis of silver nanoparticles.


Many waterbird populations have faced declines over the last century, including the common tern (Sterna hirundo), a waterbird species with a widespread breeding distribution, that has been recently listed as endangered in some habitats of its range. Waterbird monitoring programs exist to track populations through time; however, some of the more intensive approaches require entering colonies and can be disruptive to nesting populations. This paper describes a protocol that utilizes a minimally invasive surveillance system to continuously monitor common tern nesting behavior in typical ground-nesting colonies. The video monitoring system utilizes wireless cameras focused on individual nests as well as over the colony as a whole, and allows for observation without entering the colony. The video system is powered with several 12 V car batteries that are continuously recharged using solar panels. Footage is recorded using a digital video recorder (DVR) connected to a hard drive, which can be replaced when full. The DVR may be placed outside of the colony to reduce disturbance. In this study, 3,624 h of footage recorded over 63 days in weather conditions ranging from 12.8 °C to 35.0 °C produced 3,006 h (83%) of usable behavioral data. The types of data retrieved from the recorded video can vary; we used it to detect external disturbances and measure nesting behavior during incubation. Although the protocol detailed here was designed for ground-nesting waterbirds, the principal system could easily be modified to accommodate alternative scenarios, such as colonial arboreal nesting species, making it widely applicable to a variety of research needs.


This thesis looks at a series of stories written for children by Maurice Sendak. They are: Where The Wild Things Are (Chapter 3), In the Night Ki tchen (Chapter 4), Outside Over There (Chapter 5) and Dear Mili (Chapter 6). Through analysis of these works I hoped to find a way of helping young children recognise and work through their fears. As the study progressed, it became apparent that the stories were written less and less to deal with the concerns of young children and more and more to deal with Maurice Sendak's own concerns. As I still felt that it was possible through literature to recognise and deal with children's fears, I wrote a series of seven children's stories. They are based on concerns which, as a preschool teacher and parent, young children have expressed to me. They appear in Chapter 7. I have tried to resolve the situations in realistic and easily understood ways. In Chapter 8, I have related my stories to the Sendak stories I have analysed, as well as relating my personal experiences to those of Sendak. The result is this thesis: THE FEARS OF EARLY CHILDHOOD Writing in Response to a Study of Maurice Sendak.


We report on weakly interacting massive particles (WIMPs) search results in the XENON100 detector using a nonrelativistic effective field theory approach. The data from science run II (34  kg×224.6 live days) were reanalyzed, with an increased recoil energy interval compared to previous analyses, ranging from (6.6–240)  keVnr. The data are found to be compatible with the background-only hypothesis. We present 90% confidence level exclusion limits on the coupling constants of WIMP-nucleon effective operators using a binned profile likelihood method. We also consider the case of inelastic WIMP scattering, where incident WIMPs may up-scatter to a higher mass state, and set exclusion limits on this model as well.


The primary goal of this work is to measure the acoustic properties of a surface in situ. This generally involves sound pressure measurements and a calculation of the acoustic reflection factor of a surface, which may then be used to calculate the acoustic impedance or the acoustic absorption coefficient. These quantities are of use in acoustic simulations, architectural design, room acoustics and problems in noise control. It is of great interest to determine the performance of a particular surface where it is used, as opposed to measurements conducted in a laboratory. In situ measurements are not trivial, caution must be taken to ensure that high signalto-noise levels are achieved and that the reflections of sound from the measurement environment are taken into consideration. This study presents five measurement methods that may be applied in situ. The acoustic absorption coefficient is calculated for each method on various surfaces spanning the whole range of absorption. Emphasis is placed on frequency resolution, in order to determine absorption characteristics in the bass region (50 Hz to 200 Hz). Advantages and disadvantages of each method are demonstrated and discussed. Finally, the in situ implementation of the surface pressure method is presented and measurements are made in order to test the limitations of this approach.


Service Overlay Network (SON) was proposed to alleviate the difficulties encountered in providing end-to-end Quality of Service (QoS) guarantees. SON is able to provide QoS guarantees by purchasing bandwidth from individual network domains and building a logical end-to-end data delivery infrastructure on top of the existing Internet. We focus on SON topology design problems under a generalized cost model. Earlier research in this topic considered two distinct cost models - fixed (leased) cost model and variable (usage-based) cost model. However in most applications, the costs of both nodes and links have a fixed component as well as a variable component that often depends on usage. Our generalized cost model takes this fact into account and our topology design algorithm uses this cost model to And the optimal topology. Since the SON topology design problem is NP-complete, we provide approximation algorithm with guaranteed performance bound. We validate the effectiveness of our algorithm through extensive simulation.


This paper presents the results of an experiment that employed a 2 (low vs. high information) by 2 (male vs. female profile) design to investigate the relationship between amount of information displayed in a Social Network Site (SNS) profile and profile viewers' intentions to engage in further social interactions (communicate online, add to SNS profile, and meet face-to-face) with the profile owner. The results indicate that more information increases the likelihood of relationship initiation for male profiles but decreases it for female profiles. Also, viewers are inclined to initiate an interaction when less information is presented in an SNS profile of a person from the opposite sex; but require more information from their own sex.


Hutto, Richard L.; Young, Jock S. 1999. Habitat relationships of landbirds in the Northern Region, USDA Forest Service. Gen. Tech. Rep. RMRS-GTR-32. Ogden, UT: U.S. Department of Agriculture, Forest Service, Rocky Mountain Research Station. 72 p. A series of first-generation habitat-relationships models for 83 bird species were detected in a 3-year study on point counts conducted in association with the USDA Forest Service's Northern Region Landbird Monitoring Program. The models depict probabilities of detection for each of the bird species on 100-m-radius, 1 O-minute point counts conducted across a series of major vegetation cover types. Based on these models, some bird species appear to be restricted in their habitat distribution to: (1) postfire, standing-dead forests, (2) relatively uncut, older forests, (3) harvested forest types, (4) marshes, (5) riparian environments, and (6) grasslands and sagebrush. Such restricted distributions highlight the need to provide adequate amounts of these cover types to maintain viable species populations. Many bird species were relatively abundant in harvested forests, suggesting a need for nesting success studies because timber harvesting creates unnatural cover types that may elicit settling responses by species that are 'iprogrammed" to respond to similar naturally occurring cover types. Thus, these unnatural cover types could be acting as "ecological traps," where species are being attracted to sites where suitability is relatively poor. These preliminary results demonstrate the utility of a landbird monitoring program, and suggest that agencies such as the Forest Service should consider broadening the indicator species concept to monitor groups of species (such as landbirds and butterflies) that can be easily sampled with a single field method. The list of species covered by this program is indeed large enough and ecologically broad enough to help managers predict and monitor the effects of management activities on almost all the major vegetation types in the region. The detail and region-specific nature of this information can be matched by no other database in existence on landbirds, and the information should prove useful to land managers in planning areas that might consist of alternative cover types.


The characteristics of solitons with a localized impurity in Bose-Einstein condensates (BECs) are investigated with numerical simulations of the Gross-Pitaevskii (GP) equation, the effects of the impurity on BEC solitons are discussed, and the atom population transferring ratios between the two BECs as time goes on are analyzed. It is found that population transfer depends on the impurity strength and the parameters of the system of BECs.


Significance The earliest way humans can learn what their body is and where the outside world begins is through the tactile sense, especially through touch between parent and baby. In this study, we demonstrated differential processing of touch from self and others at cortical and spinal levels. Our results support top-down modulation of dorsal horn somatosensory processing, as recently shown in animal studies. We provide evidence that the individual self-concept relates to differential self- vs. other-processing in the tactile domain. Self- vs. other-distinction is necessary for successful social interaction with others and for establishing a coherent self. Our results suggest an association between impaired somatosensory processing and a dysfunctional self-concept, as seen in many psychiatric disorders. Differentiation between self-produced tactile stimuli and touch by others is necessary for social interactions and for a coherent concept of "self." The mechanisms underlying this distinction are unknown. Here, we investigated the distinction between self- and other-produced light touch in healthy volunteers using three different approaches: fMRI, behavioral testing, and somatosensory-evoked potentials (SEPs) at spinal and cortical levels. Using fMRI, we found self–other differentiation in somatosensory and sociocognitive areas. Other-touch was related to activation in several areas, including somatosensory cortex, insula, superior temporal gyrus, supramarginal gyrus, striatum, amygdala, cerebellum, and prefrontal cortex. During self-touch, we instead found deactivation in insula, anterior cingulate cortex, superior temporal gyrus, amygdala, parahippocampal gyrus, and prefrontal areas. Deactivation extended into brain areas encoding low-level sensory representations, including thalamus and brainstem. These findings were replicated in a second cohort. During self-touch, the sensorimotor cortex was functionally connected to the insula, and the threshold for detection of an additional tactile stimulus was elevated. Differential encoding of self- vs. other-touch during fMRI correlated with the individual self-concept strength. In SEP, cortical amplitudes were reduced during self-touch, while latencies at cortical and spinal levels were faster for other-touch. We thus demonstrated a robust self–other distinction in brain areas related to somatosensory, social cognitive, and interoceptive processing. Signs of this distinction were evident at the spinal cord. Our results provide a framework for future studies in autism, schizophrenia, and emotionally unstable personality disorder, conditions where symptoms include social touch avoidance and poor self-vs.-other discrimination.


Randomized partition trees have recently been shown to be very effective in solving nearest neighbor search problem. In spite of enjoying strong theoretical guarantee, it suffers from high space complexity, since each internal node of the tree needs to store a d dimensional projection direction leading to aO(nd) space complexity for a dataset of size n. Inspired by the fast Johnson-Lindenstrauss transform, in this paper, we propose a sparse version of randomized partition tree where each internal node needs to store only a few non-zero entries, as opposed to all d entries, leading to significant space savings without sacrificing much in terms of nearest neighbor search accuracy. As a by product of this, query time of our proposed method is slightly better than that of its non-sparse counterpart for large dataset size. Our theoretical results indicate that our proposed method enjoys the same theoretical guarantee as that of the original non-sparse RP-tree. Experimental evaluations on four real world dataset strongly suggest that nearest neighbor search performance of our proposed sparse RP-tree is very similar to that of its non-sparse counterpart in terms of accuracy and number of retrieved points.


Abstract
Abdominal aortic aneurysm (AAA) is a hideous life threatening disease that most often is asymptomatic until it ruptures. Ruptured
abdominal aortic aneurysm (rAAA) is a painful and serious predicament with a mortality of 80-90%. Half of the patients die before
arriving to hospital, leaving family members in sorrow and shock. In Sweden about 700-1000 patients die each year due to rAAA,
corresponding to 1.5% of all deaths in men.
Four randomized trials have shown that screening for AAA is cost-effective to reduce both AAA related mortality by 50% and all-cause
mortality by 3%. These trials have been the reason why screening 65 year-old-men for AAA has been introduced in Sweden.
In this thesis we evaluated different aspects on screening for AAA.
Study I; the aim was to study whether a biological marker (APC PCI complex) may be used as a screening marker for AAA in patients
with peripheral vascular disease without previously known AAA. However, the sensitivity and specificity were both to weak to be used as
a screening marker for AAA in the clinical praxis. Nevertheless, we discovered that the prevalence of AAA was 13% in patients with
peripheral vascular disease.
Study II; the aim was to investigate the impact of socioeconomic status (SES) and demographical aspects on compliance to AAA-
screening and also to evaluate the associations between AAA prevalence and SES. Our results indicated that the prevalence of AAA is
higher in demographic areas with lower SES. The compliance to AAA-screening was also lower in areas with lower SES.
Study III; the aim was to investigate if a collaboration between a professional advertising agency and an academic vascular unit can
result in increased compliance to AAA screening. The results showed that compliance to AAA-screening can be increased significantly
by consulting an advertisng agency.
Study III; the aim was to evaluate if screening is still cost-effectivley in the new era of decreased AAA prevalence, EVAR as the
predominant treatment method and improved medical treatment. By using a Markov model we could show that it is still cost-effective
to screen for AAA even with the aformentioned changes.
In conclusion; Screening for AAA seems justified in the new era of changing prerequisites. However, importance of SES and different
aspects on improving AAA compliance are of great importance and need to be studied further.


Background Patients with neck pain, headache, torticollis, or neurological signs should be screened carefully for upper cervical spine instability, as these conditions are "red flags" for applying physical therapy interventions. However, little is known about the diagnostic accuracy of upper cervical spine instability tests. Purpose The purpose of this study was to evaluate the diagnostic accuracy of upper cervical spine instability screening tests in patients or people who are healthy. Data Sources PubMed, CINAHL, EMBASE, and RECAL Legacy databases were searched from their inception through October 2012. Study Selection Studies were included that assessed the diagnostic accuracy of upper cervical instability screening tests in patients or people who are healthy and in which sensitivity and specificity were reported or could be calculated using a 2 × 2 table. Data Extraction and Quality Assessment Two reviewers independently performed data extraction and the methodological quality assessment using the QUADAS-2. Data Synthesis Depending on heterogeneity, statistical pooling was performed. All diagnostic parameters (sensitivity, specificity, predictive values, and likelihood ratios) were recalculated, if possible. Results Five studies were included in this systematic review. Statistical pooling was not possible due to clinical and statistical heterogeneity. Specificity of 7 tests was sufficient, but sensitivity varied. Predictive values were variable. Likelihood ratios also were variable, and, in most cases, the confidence intervals were large. Limitations The included studies suffered from several biases. None of the studies evaluated upper cervical spine instability tests in patients receiving primary care. Conclusions The membranes tests had the best diagnostic accuracy, but their applicability as a test for diagnosing upper cervical spine instability in primary care has yet to be confirmed.


The evaluation of labor market policies has become an important issue in many European countries. In recent years, a number of them have opened their administrative databases for evaluation studies. The advantages of administrative data are straightforward: they are accurate, contain a large number of observations (in some cases the whole population) and usually cover a long period of time. However, the information contained in administrative data is normally limited to administrative purposes. Therefore, information that might be relevant for economic modeling is often absent. The IZA Evaluation Dataset aims to overcome such limitations for Germany by complementing administrative data from the Federal Employment Agency with innovative survey data. The administrative part of the dataset consists of a large random sample of inflows into unemployment in Germany from 2001 to 2008 and contains around 920,000 individuals. The complementary survey covers a panel of more than 17,000 individuals who entered unemployment between June 2007 and May 2008. They were initially interviewed shortly after becoming unemployed and then again one year later. In addition, a quarter of individuals were interviewed already after six months. The survey data also contain information on search behavior, ethnic and social networks, psychological factors, (non-)cognitive abilities, and attitudes. This paper describes the sampling and contents of the IZA Evaluation Dataset and outlines the future development.


SUMMARY An extensive S-wave velocity survey had been carried out in the frame of a recent seismic microzonation study of Basel and the border areas between Switzerland, France and Germany. The aim was to better constrain the seismic amplification potential of the surface layers. The survey included single station (H/V spectral ratios) and ambient vibration array measurements carried out by the Swiss team, as well as active S-wave velocity measurements performed by the German and French partners. This paper is focused on the application of the array technique, which consists in recording ambient vibrations with a number of seismological stations. Several practical aspects related to the field measurements are outlined. The signal processing aims to determine the dispersion curves of surface waves contained in the ambient vibrations. The inversion of the dispersion curve provides a 1-D S-wave velocity model for the investigated site down to a depth related to the size of the array. Since the size of arrays is theoretically not limited, arrays are known to be well adapted for investigations in deep sediment basins, such as the Upper Rhine Graben including the area of the city of Basel. In this region, 27 array measurements with varying station configurations have been carried out to determine the S-wave velocity properties of the geological layers down to a depth of 100‐250 m. For eight sites, the outputs of the array measurements have been compared with the results of the other investigations using active sources, the spectral analysis of surface waves (SASW) and S-wave reflection seismics. Borehole information available for a few sites could be used to calibrate the geophysical measurements. By this comparison, the advantages and disadvantages of the array method and the other techniques are outlined with regard to the effectiveness of the methods and the required investigation depth. The dispersion curves measured with the arrays and the SASW technique were also combined and inverted simultaneously to use the advantages of both methods. Finally, the paper outlines and discusses the contribution of the S-wave velocity survey to the new seismic microzonation of the Basel region. In this regard one major outcome of the survey is the quantification of vertical and lateral changes of the S-wave velocity, due to changing lithology or changing compaction and degree of weathering of the layers.


The emergence and dissemination of Enterobacteriaceae isolates harboring carbapenemases in various geographic regions represent a significant threat to the management of nosocomial infections. Carbapenem-hydrolyzing β-lactamases can be metallo β-lactamases, expanded-spectrum oxacillinases, or Ambler class A enzymes (8, 9). The class A KPC β-lactamases hydrolyze all β-lactams except cephamycins. They are increasingly reported in data from studies of isolates of enterobacterial species (mostly Klebsiella pneumoniae species) collected in the United States, especially in New York City hospitals (1, 2, 4, 9, 12). Outside of the United States, single KPC-producing isolates containing members of the Enterobacteriaceae or containing Pseudomonas aeruginosa strains have been reported from France, China, and Colombia, but an epidemic situation has also been reported from Israel (5-7, 10, 11). We report here a K. pneumoniae isolate from Greece that produced β-lactamase KPC-2.

On 17 July 2007, a 22-year-old woman was hospitalized in the intensive care unit of the hospital of Heraklion, Greece, for severe cranial trauma with coma (Glasgow coma scale score, 7) and multiple cranial and costal fractures subsequent to a traffic accident. On 10 August, she was initially transferred to the orthopedic ward and then to the intensive care unit of the hospital of Meaux, France. The day of her admission, bacteriological screening and wound samples revealed the presence of panresistant Acinetobacter baumannii (susceptible only to colistin) and of K. pneumoniae GR, which was resistant to all antibiotics except gentamicin according to disk diffusion susceptibility testing results (3). The patient was treated locally with antiseptics and fortunately did not experience a systemic infection with K. pneumoniae requiring antibiotic treatment. No other A. baumannii or K. pneumoniae isolates with similar antibiotic resistance patterns were recovered from the hospital during this same period of time.

The MICs of β-lactams tested by the Etest method (AB BIODISK, Solna, Sweden) and interpreted according to CLSI standards (3) for K. pneumoniae GR showed values for expanded-spectrum cephalosporins and carbapenems only slightly modified after the addition of clavulanic acid (Table (Table1).1). A crude β-lactamase extract of that isolate showed significant carbapenem hydrolyzing activity, as measured spectrophotometrically (0.2, 0.06, and 0.05 μmol of imipenem, meropenem, and ertapenem/min/mg of total protein, respectively) (6, 8).

TABLE 1.

MICs of β-lactams for K. pneumoniae GR, its E. coli transconjugant TcGR, and an E. coli recipient strain

Plasmid analysis detected a ca. 75-kb self-conjugative plasmid that conferred a β-lactam resistance pattern for Escherichia coli transconjugants that was consistent with the presence of a slightly clavulanic acid-inhibited carbapenemase (Table (Table1).1). A β-lactamase extract from a transconjugant culture subjected to analytical isoelectric focusing (8) identified two β-lactamases with pI values of 5.4 and 6.8. PCR experiments using primers for detection of Ambler class A, class D, and class B β-lactamase genes (6, 8) followed by sequencing identified β-lactamase genes coding for carbapenemase KPC-2 (pI 6.8) and the narrow-spectrum TEM-1 (pI 5.4). Then, using a series of successive PCR primers, the 2.8-kb sequences surrounding the blaKPC-2 gene were found to be identical to those surrounding the same blaKPC-2 gene in a K. pneumoniae isolate from New York (6).

Up to now, carbapenemases of the KPC type seemed to be limited to Israel in this Mediterranean region. This is the first evidence of the identification of carbapenemases of the KPC type in Greece, a country located near Israel. It remains to be determined to what extent the spread of KPC-type enzymes contributes to the high level of carbapenem resistance that until now had been thought to occur only in the presence of class B carbapenemases (VIM-type enzymes).