It is well accepted that the breakage of wastewater suspended particles (flocs) can lead to better disinfection of effluent, especially when utilizing ultraviolet irradiation as the disinfection method. In this work, the breakage of wastewater flocs in orifice flow was investigated through numerical simulations. The strain rate along particle paths was estimated using computational fluid dynamics. Assuming that particle breakage occurs if the maximum strain rate experienced by the particle exceeds a critical threshold value, breakage of wastewater particles was predicted. The effectiveness of the model was supported by simple experiments. Based on the numerical simulations, under the same nominal orifice strain rate, particle breakage was higher in single-orifice systems compared to that of multi-orifice systems. This finding was further confirmed through experimentation. Furthermore, simulation results revealed that while single-orifice systems were the preferred choice for the breakage of strong particles, multi-orifice systems might be more effective in breaking 'weak' particles.


The sharing of scholarly articles is an intrinsic and often ignored facet of the value and mission of scholarship. It is so entwined in the daily work life of scholars that it has almost become second nature, an integral part of the research process itself. This article addresses this often overlooked area of research in usage studies. In an international survey of 1,000 published scholars, the Beyond Downloads project examined their sharing behaviours in order to gain a more contextualized and accurate picture of their usage beyond download patterns and citation counts. Scholars share published articles with others as a mode of content discovery and dissemination, particularly if they work in groups, and most expect to increase their sharing in the future. While their methods of sharing articles may change, and their reasons for sharing may vary from self‐promotion to the more altruistic motives of scientific progress, they desire to share the final published versions of articles with their colleagues.


The purpose of this project is to establish a dictionary of spoken Danish, titled Ordbog over Dansk Talesprog (ODT). Through the use of extensive empirical data, it is the aim of the project to convey the latest knowledge of spoken language to the broad public. ODT combines existing and new research based primarily on qualitative methods with the quantitative analysis of a corpus of spoken language. The result of this combined method will be made available to the public through the development of a web-based dictionary of spoken Danish. ODT is a project of the Centre for Language Change in Real Time (LANCHART) at the University of Copenhagen. Building on a large corpus of spoken language consisting primarily of sociolinguistic interviews, recorded from 1978 – 2010 and consisting of almost 7 million transcribed tokens, we are working on a dictionary portal. We inscribe the project into a tradition of significant national dictionaries, namely the Dictionary of the Danish Language (1918 – 1956) and The Danish Dictionary (2003 – 2005). Both were published by the Society for Danish Language and Literature, which is one of our foremost institutional cooperating partners along with the Danish Language Council. The ODT project pursues two spheres of action. One lets the editors conduct research of their own, both in the field of spoken-language research in line with the other activities at the LANCHART Centre, and in the new field of spoken-language lexicography. In this way the editors, future dissertation writers, and Ph.D. students working on the project will produce new knowledge. The other sphere of action concerns conveying this knowledge to the public. We see it as our job not only to promote and expose the research activities of the editors themselves and the other LANCHART researchers, but also to pass on knowledge and research on spoken language gained outside of the Centre. The user segment of ODT consists of two groups. The primary recipient is the linguistically curious layperson interested in spoken language; the secondary recipient is the research oriented user. Both groups will benefit from a web portal which allows fast access, is segmentally differentiated (i.e., relevant), has a high level of service, is free of advertising, and is free to use. ODT is designed as a web-based dictionary portal with a possibility for parallel comparable searches in a corpus of written Danish (KorpusDK) and in a dictionary mainly based on written Danish (The Danish Dictionary). Theoretical work on ODT consists in elaborating on well-established lexicographic methods and exploring the possibilities for transferring them into a dictionary of spoken language. The practical work consists of actual dictionary compilation: searching, editing, storing, and presenting the corpus data.


Ex-gay ministries train people who are attracted to members of the same sex in gender and religious conventions that such ministries hope will effect changes in erotic desire. However, they reject efforts at denial and repression in favor of frank acknowledgment of homosexual desire, and advocate for the full inclusion of those who struggle with that desire in the church community. In carving out this space between rejection and acceptance of homosexuality, they utilize discursive and cultural strategies that resemble the gender indeterminacy and gender play celebrated by queer theorists——who have very different socio-political aims. Using the work of queer theorist Judith Butler, this paper looks at the practice of ex-gay ministries, arguing that by grounding gender essentialism in creation rather than nature, these ministries are able to engage in and profit from strategies I call "queerish"——ones that are similar to queer strategies in certain conceptual moves, yet quite distinct in normative ends.


Case-based teaching systems, like good human teachers, tell stories in order to help students learn. A case-based teaching system engages a student in a challenging task and monitors his actions looking for opportunities to tell stories that will assist the learning process. In order to produce stories at the appropriate moment, a casebased teaching system must have a library of stories that are indexed according to how they should be used and a set of reminding strategies to retrieve stories when they are relevant. In this paper, I discuss CreANIMate, a biology tutor that uses stories to help teach elementary school students about animal morphology. In particular, I discuss the reminding strategies and indexing schemes that enable the system to achieve its educational objectives. These reminding strategies are example remindings, similarity-based remindings, and expectation violation remindings.


A fundamental challenge in calcium imaging has been to infer the timing of action potentials from the measured noisy calcium fluorescence traces. We systematically evaluate a range of spike inference algorithms on a large benchmark dataset recorded from varying neural tissue (V1 and retina) using different calcium indicators (OGB-1 and GCamp6). We show that a new algorithm based on supervised learning in flexible probabilistic models outperforms all previously published techniques, setting a new standard for spike inference from calcium signals. Importantly, it performs better than other algorithms even on datasets not seen during training. Future data acquired in new experimental conditions can easily be used to further improve its spike prediction accuracy and generalization performance. Finally, we show that comparing algorithms on artificial data is not informative about performance on real population imaging data, suggesting that a benchmark dataset may greatly facilitate future algorithmic developments.


Online sparse linear regression is the task of applying linear regression analysis to examples arriving sequentially subject to a resource constraint that a limited number of features of examples can be observed. Despite its importance in many practical applications, it has been recently shown that there is no polynomial-time sublinear-regret algorithm unless NP$\subseteq$BPP, and only an exponential-time sublinear-regret algorithm has been found. In this paper, we introduce mild assumptions to solve the problem. Under these assumptions, we present polynomial-time sublinear-regret algorithms for the online sparse linear regression. In addition, thorough experiments with publicly available data demonstrate that our algorithms outperform other known algorithms.


Every scientific theory implies that under certain conditions, certain things will happen. Every test consists in an attempt to realize these conditions, and to find out whether we can obtain a counter-example even if these conditions are realized; for example, by varying other conditions which are not mentioned in the theory. (This shows, by the way, that a ceteris paribus clause, like `all things being equal', must not be added to a theory since it would destroy its testability.) (p. 288) P...


Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the USA. A growing body of evidence indicates that CRC tumors contain a small population of stem/progenitor cells (colorectal cancer stem cells, CRCSCs) capable of self-renewal that contribute to tumor maintenance, resistance to therapy and metastasis. Selective therapeutic targeting of CRCSCs in combination with approved therapies could improve treatment response and prolong patient survival. The endogenous protein TNF-related apoptosis-inducing ligand (TRAIL; Apo2L) selectively induces cell death in cancer cells while sparing normal cells. This approach is particularly attractive for targeting CRCSCs potentially avoiding toxic effects in normal stem/progenitor cells in the colonic crypt. TIC10 is a first-in-class anti-tumor agent that transcriptionally induces TRAIL via the transcription factor Foxo3a, independent of tumor suppressor p53 status. We previously demonstrated that TIC10 activates Foxo3a by dual inhibition of the upstream regulators Akt and ERK. TIC10 induces TRAIL-mediated cell death in cancer cells in vitro and in vivo. TIC10 improves the half-life, tissue distribution, route of administration and spectrum of activity of TRAIL. These attributes overcome therapeutic limitations of recombinant TRAIL and TRAIL-agonist antibodies that have been or are in clinical trials to combat human cancer. TIC10 exhibits potent anti-tumor efficacy in a wide range of preclinical mouse models of cancer including subcutaneous and orthotopic colon cancer without observed toxicity. We hypothesize that the potent anti-tumor effect of TIC10 in colon cancer involves targeting of the CRCSC population. In this study we evaluated the effects of TIC10 on the CRCSC population in three human colon cancer cell lines. Flow cytometric analysis revealed that TIC10 significantly depleted CD133-, CD44- and Aldefluor-positive CRCSCs in HCT116 and SW480 cells. TIC10 significantly induced surface TRAIL expression in CD133- and CD44-positive CRCSCs. TIC10 also significantly inhibited colonosphere formation in DLD1 and SW480 cells. A targeted network analysis of gene expression profiles of HCT116 p53-null human colon cancer cells treated with TIC10 revealed that several stem cell-related pathways and proteins are affected by TIC10 and are likely involved in the anti-CRCSC effects of TIC10. In particular, mRNA transcript levels of Id2 (3.2 fold) and Wnt16 (13.5 fold) were significantly downregulated. Ongoing studies will validate these potential anti-CRCSC molecular targets of TIC10 and determine their contribution to the overall anti-CRCSC effect, evaluate the anti-CRCSC efficacy of TIC10 in vivo and examine combinatorial anti-CRCSC effects of TIC10 with chemotherapies used to treat CRC. In conclusion, TIC10 targets bulk tumor cells as well as CRCSCs, making this molecule a promising novel agent for the treatment of CRC. Citation Format: Varun Vijay Prabhu, Joshua E. Allen, David T. Dicker, Yifu Ding, Wafik S. El-Deiry. Therapeutic targeting of colorectal cancer stem cells by TRAIL-inducing small molecule TIC10. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3732. doi:10.1158/1538-7445.AM2013-3732


Female enthusiasm towards engaging in physical education (PE) significantly decreases with age as it provides females with positive and negative emotional experiences. This study examined emotions within four grade nine female PE soccer and fitness classes (N = 67). Emotional patterns were studied over time and across two units of instruction and in relation to student grades. A mixed-method approach was utilized assessing the state emotions of shame, enjoyment, anxiety, and social physique anxiety (SPA). Results revealed unsatisfactory internal consistency for shame and thus it was removed. Statistical analysis revealed no significant changes in emotions over time, whereas qualitative analysis found that state emotions were inconsistent. Statistical analysis indicated that students in the fitness classes reported significantly higher levels of anxiety and SPA on the final class (p < .01). Qualitative analysis signaled different origins and themes of students" emotions. No predictive relationship between emotion and students" grade was found.


Field experiments were conducted in 2007 to evaluate a cantaloupe (Cucumis melo L.) plant development model as a function of heat units accumulated after planting (HUAP). Field experiments were conducted in 2007 in the Yuma Valley, Arizona (32 o 42' N, 114 o 42' W), about 150 feet (~ 32 m) elevation in four commercial cantaloupe fields managed by a cooperator-grower using four varieties. Plant measurements were made on regular 14-day intervals and the following growth stages were identified in relation to plant measurement data collection: pre-bloom, early fruit set, early netting, and physiological maturity (harvest). The model was evaluated by comparing the observed HUAP versus the predicted HUAP values using a repeated measures design. Mean differences within each sampling stage were separated using the Fishers' protected least significance difference (LSD) test at P≤ 0.01. In addition, regression models were performed for all in-season data collected and the accuracy of the model was evaluated on the basis of the R 2 values with a specified level significance (α = 0.01). No statistical differences were found between the observed phenological data and the predicted values from the model throughout the study period. Also, the model presented an overall accuracy of 54 ± 37 HUAP (2 ± 1 day) in predicting cantaloupe-harvesting time. It can be concluded that the model can be used as a useful tool to assist cantaloupe growers in predicting and identifying critical stages of growth for irrigated spring cantaloupe crops in Arizona and the desert Southwest.


Computational modeling of human multimodal language is an emerging research area in natural language processing spanning the language, visual and acoustic modalities. Comprehending multimodal language requires modeling not only the interactions within each modality (intra-modal interactions) but more importantly the interactions between modalities (cross-modal interactions). In this paper, we propose the Recurrent Multistage Fusion Network (RMFN) which decomposes the fusion problem into multiple stages, each of them focused on a subset of multimodal signals for specialized, effective fusion. Cross-modal interactions are modeled using this multistage fusion approach which builds upon intermediate representations of previous stages. Temporal and intra-modal interactions are modeled by integrating our proposed fusion approach with a system of recurrent neural networks. The RMFN displays state-of-the-art performance in modeling human multimodal language across three public datasets relating to multimodal sentiment analysis, emotion recognition, and speaker traits recognition. We provide visualizations to show that each stage of fusion focuses on a different subset of multimodal signals, learning increasingly discriminative multimodal representations.


Friedrich Schiller (1759-1805) was one of the most influential of all playwrights, the author of deeply moving dramas that explored human fears, desires and ideals. Written at the age of twenty-one, "The Robbers" was his first play. A passionate consideration of liberty, fraternity and deep betrayal, it quickly established his fame throughout Germany and wider Europe. "Wallenstein", produced nineteen years later, is regarded as Schiller's masterpiece: a deeply moving exploration of a flawed general's struggle to bring the Thirty Years War to an end against the will of his Emperor. Depicting the deep corruption caused by constant fighting between Protestants and Catholics, it is at once a meditation on the unbounded possible strength of humanity, and a tragic recognition of what can happen when men allow themselves to be weak.


Debate over the proper use of racial and ethnic categories in biomedical research has raged in recent years. With the Human Genome Project showing that human beings are overwhelmingly alike genetically, exhibiting more genetic variation within supposed "races" than between them, many have come to doubt the scientific utility of such categories. Yet federal authorities use Directive 15 from the Office of Management and Budget (OMB) to mandate the continued use of such categories in research. Moreover, researchers studying health disparities argue that data collection using racial and ethnic categories is necessary to determine whether conditions and care vary by race and ethnicity. Epidemiologists also defend the use of racial and ethnic categories to understand contributors to disease such as the stress of experiencing racial prejudice and reduced access to care because of bias. A number of conflicting proposals have been offered, some to discipline and improve the use of racial and ethnic categories, and some to eliminate such categories. To make progress in this debate, the University of Minnesota's Consortium on Law and Values in Health, Environment & the Life Sciences and Center for Bioethics convened a conference on "Proposals for the Responsible Use of Racial and Ethnic Categories in Biomedical Research." The conference included the lead investigator and inventor on the patent for BiDil, the first drug approved by the FDA for patients of a particular racial or ethnic group -- in this case, African-American patients with heart failure. Substantial controversy surrounds the drug and the FDA's action. Conference participants debated the BiDil issues and more broadly considered the range of proposals for the responsible use of racial and ethnic categories in biomedical research, including proposals by researchers, journals, and federal authorities. The participants considered the constitutionality, scientific acceptability, and policy implications of those proposals. This 11-article symposium is the result, including articles by Troy Duster, Dorothy Roberts, Mildred Cho, Raj Bhopal, Gregg Bloche, Jay Cohn, Morris Foster, Rose Brewer, Margaret Winkler, Eric Lillquist, and Charles Sullivan.


Body mass is strongly related to both physiological and ecological properties of living organisms. As a result, generating robust, broadly applicable models for estimating body mass in the fossil record provides the opportunity to reconstruct palaeobiology and investigate evolutionary ecology on a large temporal scale. A recent study provided strong evidence that the minimum circumference of stylopodial elements (humerus and femur) is conservatively associated with body mass in living quadrupeds. Unfortunately, this model is not directly applicable to extinct bipeds, such as non‐avian dinosaurs. This study presents a new equation that mathematically corrects the quadruped equation for use in bipeds. It is derived from the systemic difference in the circumference‐to‐area scaling relationship of two circles (hypothetical quadruped) and one circle (hypothetical biped), which represent the cross‐section of the main weight‐bearing limb bones. When applied to a newly constructed data set of femoral circumferences and body masses in living birds, the new equation reveals errors that are significantly lower than other published equations, but significantly higher than the error inherent in the avian data set. Such errors, however, are expected given the unique overall femoral circumference–body mass scaling relationship found in birds. Body mass estimates for a sample of bipedal dinosaurs using the new model are consistent with recent estimates based on volumetric life reconstructions, but, in contrast, this equation is simpler to use, with the concomitant potential to provide a wider set of body mass estimates for extinct bipeds. Although it is evident that no one estimation model is flawless, the combined use of the corrected quadrupedal equations and the previously published quadrupedal equation offer a consistent approach with which to estimate body masses in both quadrupeds and bipeds. These models have implications for conducting large‐scale macroevolutionary analyses of body size throughout the evolutionary history of terrestrial vertebrates, and, in particular, across major changes in body plan, such as the evolution of bipedality in archosaurs and quadrupedality in dinosaurs.


The study set out to establish viable methods of assessing the creativity of primary school children. Teachers were asked to identify children whom they thought were creative. Two hundred and seventy nine children were assessed subsequently with the Test for Creative Thinking - Drawing Production - TCT-DP (Urban & Jellen 1993) and the results were compared with the teachers' assessments. Verbal protocols were taken with a subsample to establish children's strategies whilst working on the TCT-DP. The story-telling technique of creativity assessment was also explored with a further subsample. The results indicated that although teachers did better than chance in identifying creative children, the TCT-DP was much more accurately able to identify creative children. There was no significant correlation between iQ and TCT-DP scores. The verbal protocols suggested subtle differences of approach to the TCT-DP in highly creative children. The story-telling assessment proved labour intensive and, although no real conclusions could be drown, it showed interesting potential. General aspects of the assessment of creativity in primary school children are discussed.


Ideation, or the formulation of ideas pertaining to a particular topic, is the precursor to individuals making significant life decisions. Many individuals think about foster caring long before they actually become carers, and it stands to reason that in many cases, carer discontinuation also follows a period of ideation. This being the case, it is possible that by monitoring ideation, interventions could be introduced to prevent placement disruptions occurring, particularly if the sources of dissatisfaction are known. Using a sample of 205 foster carers, a posteriori segmentation analysis identifies groups of carers dissatisfied with the same aspects of their role. One group is particularly dissatisfied with factors that are within the control of foster care agencies and also reports high levels of discontinuation ideation. Recommendations include that the individual support needs of carers be identified such that customized support can be offered, including boosting initial and ongoing training to manage expectations and ensure carers feel prepared for the role. Results also highlight the important role of caseworkers in making carers feel appreciated and taken seriously.


The distribution and relative abundance of the 0 + year classes of 16 commercially and recreationally important fish species from the inshore marine and estuarine waters of south-western Australia were investigated. The results of this study, together with data obtained from an investigation of the way in which juvenile fish used the Blackwood River estuary (Lenanton 1977), revealed that only three of these species in this region could be exclusively regarded as estuarine-dependent: two of the species entered the estuary for the entire year and the third was a seasonal migrant. The remaining 13 species all made use of at least 30% of the inshore marine environment sampled during the study, which was equivalent to the total area of nursery habitat available in the Blackwood River estuary. The main conclusion of this study is that for these species, the inshore marine environments of south-western Australia provide otherwise unavailable alternative nursery areas to those traditionally found in estuaries.


Context.
Diffusive shock acceleration in the solar corona can accelerate solar energetic particles to very high energies. Acceleration
efficiency is increased by entrapment through self-generated waves, which is highly dependent on the amount of accelerated particles. This, in turn, is determined by the efficiency of particle injection into the acceleration process.

Aims.
We present an analysis of the injection efficiency at coronal shocks of varying obliquity.We assessed injection through reflection and downstream scattering, including the effect of a cross-shock potential. Both quasi-thermal and suprathermal seed populations were analysed. We present results on the effect of cross-field diffusion downstream of the shock on the injection efficiency.

Methods.
 Using analytical methods, we present applicable injection speed thresholds that were compared with both semi-analytical flux integration and Monte Carlo simulations, which do not resort to binary thresholds. Shock-normal angle θBn and shock-normal velocity Vs were varied to assess the injection efficiency with respect to these parameters.

Results.
We present evidence of a significant bias of thermal seed particle injection at small shock-normal angles. We show that downstream isotropisation methods affect the θBn-dependence of this result. We show a non-negligible effect caused by the crossshock potential, and that the effect of downstream cross-field diffusion is highly dependent on boundary definitions.

Conclusions.
Our results show that for Monte Carlo simulations of coronal shock acceleration a full distribution function assessment with downstream isotropisation through scatterings is necessary to realistically model particle injection. Based on our results, seed particle injection at quasi-parallel coronal shocks can result in significant acceleration efficiency, especially when combined with varying field-line geometry.


Radiation exposure is experienced in both radiotherapy and exploratory space missions. As cancer treatments improve and astronauts aim to explore beyond low earth, radiation's effects on bone must be clearly understood. Nine-week old female C57BL/6 mice were evaluated for cortical bone changes by mechanical testing, micro-computed tomography, quantitative histomorphometry, percent mineralization and micro-hardness indentation. Study one, Multi-Type study, mice received a 2 Gray (Gy) gamma, proton, iron and carbon whole body radiation dose and sacrificed 110 days post-exposure. Study two, High-Dose study, mice received a 7 Gy gamma radiation whole body dose and sacrificed 14 days post-exposure. Neither study revealed significant difference between irradiated nor control groups for any assay. Sublet effect between high Linear Energy Transfer (LET) and low LET radiation was observed. Lack of changes to cortical bone is particularly interesting and may indicate a unique biological microdosimetry microenvironment. This thesis specifically examines radiation effects on cortical bone.


Growth of hydroxyapatite (HA) on Tamarind Seed Polysacharide (TSP)–chitosan composite capped gold nanoparticles is presented for the first time by employing wet precipitation methods and we obtained good yields of HA. Fourier transform infrared spectroscopy (FTIR) spectrum has shown the characteristic bands of phosphate groups in the HA. Scanning electron microscopy (SEM) pictures have shown spherical nanoparticles with the size in the range of 50– 150 nm, whereas ≥2–50 nm sized particles were visualized in high resolution transmission electron microscopy (HR-TEM). X-ray diffraction (XRD) spectrum has shown Bragg reflections which are comparable with the HA. Energy dispersive X-ray (EDX) studies have confirmed calcium/phosphate stoichiometric ratio of HA. The thermogravimetric analysis (TGA) has shown about 74% of inorganic crystals in the nanocomposite formed. These results have revealed that TSP–chitosan capped gold nanoparticles, acted as a matrix for the growth of HA.


This is the second book from A. Dashchenko focussing on "XXI Century Technologies". In this book the problems of theory and practice of development in Reconfigurable Manufacturing Systems and Transformable Factories for various machine-building branches and above all automotive industry are discussed. Problems are studied concerning the development of a new class of production systems which in comparison to the Flexible Manufacturing systems are composed of a far less quantity of machine-tools. In comparison to the conventional automated lines they make it possible to rapidly transform the equipment for new products manufacturing. In 37 chapters more then 50 authors from all over the world discuss the main aspects of the mentioned above problem using their latest scientific and practical achievements.


The focus of this thesis is the rock art of Nevada, a state in the western United States.
While the previously dominant models of rock art interpretation (hunting-magic and
shamanism) have produced significant bodies of research, I argue that both are based on faulty
Anthropological theory and produce theorisations which are one dimensional because of the
focus on rock art imagery at the expense of site contexts. Because meaning is not derived from
the images themselves, but is rather derived from the social contexts of use and production,
it is these which must be reconstructed and which will elucidate the imagery. Therefore, it is
necessary to examine the details of rock art site contexts, rather than simply select a model and
apply it to the site regardless of fit. In short, rock art must be approached as archaeology,
albeit informed by ethnography when possible. In this thesis I examine in detail the official rock
art site records for the state of Nevada and identify patterns in the contexts and distributions
and examine variation and similarities throughout the state. Based on these, I suggest
alternative analyses of Nevada's rock art and discuss the role that it may have played in the
colonization of the Americas; the symbolic construction of social and ethnic identities; the
identification of ritual spaces in pre-history; and the significance of rock art to modern Native
Americans.


The use of high hydrostatic pressure (HHP) is an interesting approach to optimize the production of both firstand second-generation ethanol. It may be applied on Saccharomyces cerevisiae cells to enhance the fermentation pathway and on the lignocellulosic biomass to increase sugar release. HHP has a wide effect on many biological processes, such as growth, division and cellular viability. Actually, conformation, stability, polymerization and depolymerization of proteins are affected by HHP as well as lipid packaging. Moreover, transcriptional profile analysis indicates an activation of the general stress response. In yeast, HHP higher than 100 MPa leads to significant morphological and physiological alteration, and loss of cellular viability occurs over 200 MPa. A yield rate increase in ethanol production occurs at pressures of 10–50 MPa, but over 87 MPa alcoholic fermentation is interrupted.


Objective There has been a steady increase in the demand for cancer follow-up care in India. Compared with Western countries, there is little evidence on the capacity of the Indian primary care workforce to accommodate such tasks. We explored the perceptions of oncologists, general practitioners, and patients with regard to the involvement of primary care in cancer follow-up care. Methods We undertook semistructured focus-group discussions with eight oncologists, nine general practitioners, and 17 cancer patients to gain an understanding of their perceived roles and responsibilities with regard to primary care in delivering follow-up care and the potential concerns. Data from the focus groups were transcribed verbatim, translated, and analyzed with use of a thematic approach. Results Most general practitioners felt that their job is to see 'normal' patients, and cancer patients were exceptions to routine care. Oncologists were apprehensive with regard to the competence of general practitioners and patient trust. Patients consult oncologists for cancer follow-up care as they perceive it to be very specialized. Patients expressed difficulty in accessing follow-up care and want specialized oncological care by trained personnel in their vicinity. Conclusion Despite the growing number of cancer survivors, we found a disconnect between primary care and cancer follow-up care.


You can understand consumer psychology to drive profits and growth. Want to know exactly what's driving your customer's behavior? Noe you can! The Customer Service Solution explains how consumers perceive services and shows you how to enhance the customer experience - every time. In this economic climate, the customer service experience is more critical than ever. Most leading service firms advocate the TLC mantra: Think Like a Customer. That's a good practice, but first you have to understand what your customer is thinking and feeling. Today's business leaders cannot afford to neglect the psychological principles that govern customer satisfaction and long-term loyalty. What are the factors that really determine customer satisfaction? Two of the nation's leading authorities on service psychology, Sriram Dasu and Richard Chase, have written this groundbreaking guide that identifies and demystifies the psychological triggers behind customer behavior. You'll go where customer satisfaction surveys, mystery shoppers, and focus groups can't - and learn exactly why customers respond and behave the way they do. With findings drawn from behavioral science research, this book provides all the tools you need to evaluate your current service platforms and design future strategies to enhance customer perceptions positively and drive your sales. The Customer Service Solution illustrates why even companies with high levels of satisfaction are missing tremendous opportunities by neglecting the emotional elements that govern consumer interactions. This book will show you how to: shape and manage customer perceptions; understand implicit versus explicit outcomes; develop the roles of control and choice among buyers; design emotionally intelligent processes; and build trust among customers. Whatever your business may be - healthcare, hospitality, financial services, e-commerce, and more - this book is an essential tool to help you increase profits by leveraging your company's customer experience. Praise for the Customer Service Solution: "Harnessing the power of emotions will help to drive an exceptional customer experience creating customers for life to help your business thrive. Finally, a guide to help us better understand how to do this." (James Merlino, MD, Chief Experience Officer, Cleveland Clinic). "Required reading for anyone designing a service encounter." (James Heskett, Professor Emeritus, Harvard Business School, coauthor of The Service Profit Chain and Service Future). "I have always known that our customers shop with us because they want to, not because they have to. How to make them want to is the secret that this great book unlocks." (Kevin Davis, President and CEO, Bristol Farms). "[Dasu and Chase] share easy-to-understand ideas and guidance to operations managers who typically do not think about the psychology of customers in designing their services." (Mary Jo Bitner, PhD, Professor and executive Director, Center for Services Leadership, W. P. Carey School, Arizona State University). "Dasu and Chase provide an excellent set of ideas for delivering emotional customer service experiences through systems and operations." (Rodolfo Medina, Vice President, Marketing & Commercial, Rock in Rio). "This book provides valuable insights to managing and molding the customer's emotional journey, leading to ultimate satisfaction and sustainable loyalty." (Ali V. Kasikci, Regional Managing Director, Orient-Express).


The patterns of urban slavery in North American and pre-Civil War US cities reveal the ways in which individual men and women, as well as businesses, institutions, and governmental bodies employed slave labor and readily adapted the system of slavery to their economic needs and desires. Colonial cities east and west of the Mississippi River founded initially as military forts, trading posts, and maritime ports, relied on African and Native American slave labor from their beginnings. The importance of slave labor increased in Anglo-American East Coast urban settings in the 18th century as the number of enslaved Africans increased in these colonies, particularly in response to the growth of the tobacco, wheat, and rice industries in the southern colonies. The focus on African slavery led most Anglo-American colonies to outlaw the enslavement of Native Americans, and urban slavery on the East Coast became associated almost solely with people of African descent. In addition, these cities became central nodes in the circum-Atlantic transportation and sale of enslaved people, slave-produced goods, and provisions for slave colonies whose economies centered on plantation goods. West of the Mississippi, urban enslavement of Native Americans, Mexicans, and even a few Europeans continued through the 19th century.
 As the thirteen British colonies transitioned to the United States during and after the Revolutionary War, three different directions emerged regarding the status of slavery, which would affect the status of slavery and people of African descent in cities. The gradual emancipation of enslaved people in states north of Delaware led to the creation of the so-called free states, with large numbers of free blacks moving into cities to take full advantage of freedom and the possibility of creating family and community. Although antebellum northern cities were located within areas where legalized slavery ended, these cities retained economic and political ties to southern slavery. At the same time, the radical antislavery movement developed in Philadelphia, Boston, and New York. Thus, Northern cities were the site of political conflicts between pro- and antislavery forces. In the Chesapeake, as the tobacco economy declined, slave owners manumitted enslaved blacks for whom they did not have enough work, creating large groups of free blacks in cities. But these states began to participate heavily in the domestic slave trade, with important businesses located in cities. And in the Deep South, the recommitment to slavery following the Louisiana Purchase and the emergence of the cotton economy led to the creation of a string of wealthy port cities critical to the transportation of slaves and goods. These cities were situated in local economic geographies that connected rural plantations to urban settings and in national and international economies of exchange of raw and finished goods that fueled industries throughout the Atlantic world. The vast majority of enslaved people employed in the antebellum South worked on rural farms, but slave labor was a key part of the labor force in southern cities. Only after the Civil War did slavery and cities become separate in the minds of Americans, as postwar whites north and south created a mythical South in which romanticized antebellum cotton plantations became the primary symbol of American slavery, regardless of the long history of slavery that preceded their existence.


Algogenic organic matter (AOM) has been extracted from blue-green algae (cyanobacteria) by various means and analyzed by UV absorbance scanning, HPSEC-UV-fluorescence-DOC, FTIR, and fluorescence excitation emission matrix (EEM). AOM extracted in water as a solvent showed a high hydrophilic fraction (57.3%) with a low SUVA (1.0 L/m-mg). The molecular weight (MW) distribution showed a significant heterogeneity (high value of polydispersivity) and high protein content (as indicated by specific fluorescence). A significant amount of proteinaceous components such as mycosporine-like amino acids (MAAs, UV-screening components) and phycobilins (light-harvesting pigment) was detected by UV/visible absorption. The confirmation of proteins was proven by FTIR (at 1,661 cm -1 and 1,552 cm -1 ) and EEM spectra (EX: 278-282 nm and EM: 304-353 nm). A bench-scale cross-flow unit, employing a flat-sheet membrane specimen, was used to examine nanofiltration (NF) membrane fouling and removal of natural organic matter (NOM) derived from different blends of Suwannee River humic acid (SRHA) and AOM. The flux decline and organic matter rejection as a function of delivered DOC showed significantly different results depending on the organic matter composition of samples even though the test conditions were the same (organic matter concentration, pH, temperature, inorganic salt composition and concentration, and recovery). A higher flux decline was observed with increasing proportions of AOM. Organic matter rejections also decreased with higher AOM contributions to the samples, indicating that lower MW AOM components were not well rejected by the NF 200 membrane having a 360 dalton molecular weight cutoff (MWCO). However, SRHA that shows a relatively high MW (5,000-1,000 daltons) and high SUVA (7.4 L/m-mg) was preferentially rejected through electrostatic repulsion/size exclusion by the NF 200 membrane, having a high negative charge (zeta potential: -15.6 mV), low MWCO, and relatively low hydrophobicity. Even though the DOC concentration of feed water is a decisive factor for membrane fouling along with membrane properties and operating conditions, the characteristics of organic matter are more influential in fouling potential. Protein-like and polysaccharide-like substances were found as major foulants by FTIR.


Multinational firms unavoidably exert influence over politics through power that is generated by both structure and process. While both political economy and management scholars address international firms, neither field has an adequate understanding of the reciprocal relationship between multinational firms and geopolitical systems. The links between multinational firms form a distinct type of international system for the private sector – one that is simultaneously enmeshed in geopolitics and international markets even as it is also autonomous from them. The scholarly literature on the power of business in politics has demonstrated how influence derives from instrumental agency as well as structural influence, but it has taken an unnecessarily restrictive view of politics and an overly materialist theory of power. Politics are about much more than government policies. In this paper I propose an analytical framework for understanding the multinational firm as a set of relationships. I then apply one key element of that approach – the relationships among firms as a direct source of geopolitical outcomes – to the natural gas trade of Eurasia in three eras that span nearly 40 years. I conclude that the influence of business on a broader understanding of politics – and not just policies – should be central to the study of international and comparative political economy.


We consider a supervised machine learning scenario where labels are provided by a heterogeneous set of teachers, some of which are mediocre, incompetent, or perhaps even malicious. We present an algorithm, built on the SVM framework, that explicitly attempts to cope with low-quality and malicious teachers by decreasing their influence on the learning process. Our algorithm does not receive any prior information on the teachers, nor does it resort to repeated labeling (where each example is labeled by multiple teachers). We provide a theoretical analysis of our algorithm and demonstrate its merits empirically. Finally, we present a second algorithm with promising empirical results but without a formal analysis.


In this paper, we present an experiment in the context of a child-robot interaction where we study the influence of the child-robot spatial arrangement on the child's focus of attention and the perception of the robot's performance. In the "Co-Writer learning by teaching" activity, the child teaches a Nao robot how to handwrite. Usually only face-to-face spatial arrangements are tested in educational child robot interactions, but we explored two spatial conditions from Kendon's F-formation, the side-by-side and the face-to-face formations in a within subject experiment. We estimated the gaze behavior of the child and their consistency in grading the robot with regard to the robot's progress in writing. Even-though the demonstrations provided by children were not different between the two conditions (i.e. the robot's learning didn't differ), the results showed that in the side-by-side condition children tended to be more indulgent with the robot's mistakes and to give it better feedback. These results highlight the influence of experimental choices in child-robot interaction.


A series of new pyrido[3,4-b]pyrazine-based organic sensitizers (PP-I and APP-I–IV) containing different donors and π-spacers have been synthesized and employed in dye-sensitized solar cells (DSSCs). The absorption spectra properties of dyes are analysed by density functional theory (DFT). The calculated results in combination with the experiments suggest that the absorption characteristics and excited state features will mainly be dominated by charge transfer transitions from the highest occupied molecular orbital (HOMO) to the lowest unoccupied molecular orbital (LUMO) and to higher LUMO orbitals. Furthermore, attaching the octyloxy groups significantly extends the π-conjugation of the donor in APP-IV, which raises the HOMO energy and facilitates its oxidation. As a consequence, APP-IV exhibits the lowest HOMO–LUMO energy gap among all dyes, which, in turn, corresponds well with the red shift of the absorption spectra. Transient photovoltage and photocurrent decay experiments as well as electrochemical impedance spectroscopy indicate that the electron lifetime and charge recombination resistance are increased due to the introduction of octyloxy chains on the donor unit, resulting in the high photovoltage based on APP-IV. It was found that APP-IV based DSSCs with liquid electrolyte display the highest power conversion efficiency (PCE) of 7.12%. Importantly, a PCE of 6.20% has been achieved for APP-IV based DSSCs with ionic-liquid electrolytes and retained 97% of the initial value after continuous light soaking for 1000 h at 60 °C. This renders these pyrido[3,4-b]pyrazine-based sensitizers quite promising candidates for highly efficient and stable DSSCs.


Law and economics scholars have always had a strong interest in contract remedies. Perhaps the most explored issue in contract law has been the desirability of various contract remedies, such as expectation damages, specific performance, or liquidated damages, to name the most common. Scholars have been debating for years, from various perspectives, the comparative advantage of these remedies. Yet, most scholars have assumed that each of these remedies is exclusive, and their work has compared a single remedy contract to another single remedy contract. Interestingly, an analysis that assumes these remedies are optional (or cumulative) has not yet been explored, in spite of the fact that contract law provides the nonbreaching party with a variety of optional remedies to choose from in case of a breach, and in spite of the fact that parties themselves write contracts which provide such an option. In this paper we attempt to start filling in this gap by studying the relationship between these remedies. Specifically, we study the conditions at which a contract that grants the non-breaching party an option to choose from optional remedies is superior to an exclusive remedy contract. We show that under conditions of double-sided uncertainty and asymmetric information between a seller (who might breach) and a buyer (who never breaches) the interaction of the parties' distributions should determine whether a contract provides for exclusive or optional remedies. Specifically, if the buyer's conditional expected valuation is larger than the seller's conditional expected valuation (in both cases conditional that their expected valuation is above the buyer's mean valuation), then a contract which provides the buyer an option to choose between liquidated damages or specific performance (or actual damages) is superior. Our analysis in this paper informs transactional lawyers of the relevant economic factors they should consider when deciding the optimal composition of remedies in a given context. Moreover, our analysis is relevant for courts that interpret contracts because it will help them to better understand whether rational parties would have agreed that a particular remedy would be an exclusive remedy or an optional remedy when the language of the contract is ambiguous. Lastly, our analysis provides yet another economic rationale for why courts should enforce parties' liquidated damages clauses even if it seems ex-post over, or under, compensatory. We present a model which shows when parties will agree on a non-exclusive liquidated damages clause. Under such a contract the parties stipulate ex-ante that the buyer will have the option to choose upon breach whether she prefers an optional remedy, such as actual damages or specific performance, to the pre-determined liquidated damages. We focus on the ex-ante design of the contract in light of the new information that the parties anticipate they will gain after they draft the contract. Therefore, we assume that no renegotiation or investments are involved. We demonstrate the optimal way to design contract clauses which takes advantage of the information that the seller and the buyer receive between the time they enter into the contract and the time of the actual breach. We further suggest that parties indeed use such clauses and that courts honor them. After laying out the basic model we provide some extensions to it. As is well known, an exclusive liquidated damages contract is equivalent to granting the seller a call option to breach and pay, where the exercise price is equal to the amount of the agreed liquidated damages. What is perhaps less known is that a non-exclusive, or optional, contract, where the buyer can choose performance, is equivalent to giving the buyer a consecutive call option with the same exercise price. Yet, the consecutive call option to the buyer does not have to have the same exercise price but can rather have a higher one. We call this new contract a two-price contract and show that it is even more efficient than the basic contract we have explored before. Next, we introduce more rounds of sequential options and show that while the regular ex-ante contract can achieve on average about 4 Indeed, in an environment of asymmetric information renegotiation costs are high. More on this below. 90% of the first-best allocative efficiency, an n-rounds contract approaches the first best, as n goes to infinity. We show numerically that within just 4 rounds, 96% of the allocative efficiency can be achieved. Section two describes the legal background against which we have designed our model. Section three surveys the literature that evaluates contract remedies from an economic perspective. Section four presents a simple model with two-sided incomplete information and with a liquidated damages clause. In section four we compare the performance of a regime with optional remedies with a regime of exclusive remedy and then determine the conditions at which each regime should be applied. Section five discusses some interesting extensions meant to approach the first-best allocative efficiency. The appendix provides a more rigorous mathematical demonstration of the model.


Chemerin is an adipokine and potent chemoattractant for cells expressing chemokine-like receptor 1 (CMKLR1) which plays important roles in metabolism and immunity. Chemerin is secreted as inactive prochemerin and undergoes extracellular processing to generate a variety of isoforms that range in bioactivity. Clinical studies have demonstrated that chemerin levels are positively associated with obesity and inflammatory disorders. However, the role of chemerin signalling in adipose tissue, and how elevated chemerin levels affect inflammatory disease progression, are poorly understood. In this thesis, I describe the development of techniques to modulate levels of chemerin signalling. I then investigate the role of chemerin signalling in three physiological contexts: mature adipocytes, pathogenesis of colitis, and intestinal microbiome composition. Using a microarray-based approach, I identified matrix metalloproteinase (MMP)3 and several chemokines as novel targets of chemerin signalling in adipocytes. Decreased chemerin levels resulted in increased MMP activity and macrophage migration towards adipocyte-conditioned media, via an NFkBdependent mechanism. This suggests that elevated chemerin levels with obesity influence adipose tissue remodelling. Importantly, these effects were mediated through a unique adipocyte-processed chemerin isoform. I next demonstrated that local expression, secretion, and processing of chemerin were positively associated with colonic inflammation in a colitis model. CMKLR1 knockout (KO) mice developed signs of clinical illness more slowly than wildtype, but ultimately developed similar levels of inflammation. Intraperitoneal injection of bioactive chemerin had no effect on colitis severity, suggesting that local chemerin levels have a greater impact on the pathogenesis of colitis. Finally, I investigated differences in intestinal microbiome composition between wildtype, chemerin KO, and CMKLR1 KO mice. Significant differences in Akkermansia and Prevotella abundance were observed in the absence of CMKLR1. These bacterial populations are known to correlate with adiposity and glucose homeostasis, indicating that chemerin signalling might influence metabolic processes through modulation of microbiome composition. Considered altogether, this work demonstrates that local chemerin signalling and processing plays autocrine/paracrine roles in adipose tissue and intestinal homeostasis. Additionally, chemerin represents a novel biomarker in colon inflammation. Modulation of local, context-specific chemerin signalling therefore represents a potential therapeutic target for the treatment of metabolic and inflammatory processes. DEPARTMENT OF PHARMACOLOGY


This study reports results from a randomized evaluation of a mandatory six-month Internet-based sexual education course implemented across public junior high schools in 21 Colombian cities. Six months after finishing the course, the study finds a 0.4 standard deviation improvement in knowledge, a 0.2 standard deviation improvement in attitudes, and a 55 percent increase in the likelihood of redeeming vouchers for condoms as a result of taking the course. The data provide no evidence of spillovers to control classrooms within treatment schools. However, the analysis provides compelling evidence that treatment effects are enhanced when a larger share of a student's friends also takes the course. The low cost of the online course along with the effectiveness the study documents suggests this technology is a viable alternative for improving sexual education in middle-income countries.


Rate retardation in reversible addition-fragmentation chain transfer (RAFT)-mediated polymerizations is the topic of an ongoing debate. One of the main explanations for this rate retardation is termination of the intermediate radical. The use of a RAFT agent with a UV label in the leaving group acts as a means to identify products of intermediate radical termination (IRT). In the analysis of the polymeric samples with size exclusion chromatography (SEC), two different UV absorbance traces were compared (i.e., the UV absorbance of the label used and that of the thiocarbonyl thio moiety of the RAFT agent). Deviations in the ratio of the C=S of the RAFT moiety to the UV label indicate that IRT products could be formed. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry was used to identify these IRT products formed during a "normal" RAFT-mediated polymerization (not using forced conditions). These experimental findings support the postulated IRT model and therefore help to elucidate the fate of the intermediate radical during a RAFT mediated polymerization.


Background and Purpose: Vertebral artery dissection causes endothelial changes and stenosis that may lead to recurrent ischemic neurological events. The diagnosis may not be obvious because the dissection may be painless and "spontaneous" (no obvious trauma). Magnetic resonance angiography has increasingly been used to screen patients for this disorder, but its accuracy has not yet been established. Case Description: Two patients were admitted with repeated transient ischemic attacks and strokes over 11 months and 1 month, respectively. Neither had a history of trauma, cervical pain, or headache. Magnetic resonance angiography failed to visualize vertebral artery dissections that were later revealed by conventional angiography. One patient's events were stopped by balloon occlusion of the vertebral artery proximal to the posterior inferior cerebellar artery branch. Conclusions: Magnetic resonance angiography is not yet sensitive enough to always visualize vertebral artery dissection. Vertebral artery dissection is a life‐threatening condition that requires aggressive evaluation and treatment. (Stroke 1993;24:598‐602)


Background: The phenomenon of doctor shopping has not yet attracted the attention of managers in the South African healthcare sector. Satisfaction with services is known to be mediated by the personal connection inherent in interpersonal continuity with the provider. Such a connection hinges on the fulfilment of expectations of what a good doctor should be at a relational level. With the advent of managed care in South Africa, the restriction on doctor choice and use is being enforced. There is evidence that adherence to one doctor has clinical and financial benefits. Clinical benefits are related to continuity of care, whilst financial gains to the patient and the healthcare system are acquired mainly through better co-ordination of care to avoid inefficiency and wastages. This study explores the concept and context of a 'good doctor', a prerequisite for adherence to one doctor, among members of a health plan targeting the low income community in South Africa. Methods: This qualitative enquiry of what constitutes a 'good doctor' took place in the form of focus group discussions and key informant interviews and was conducted among members of a managed care health plan in Piet Retief, South Africa. The plan was designed specifically for the employed but uninsured population, a population group of strategic importance in the South African healthcare market. The participants in this study were purposively sampled to include a wide range of opinions about the characteristics of a good doctor. Results: The respondents looked for values in a doctor that range from fairness, lack of discrimination, autonomy, dignity, warmth and taking time to do a job properly. Generally, the participants expressed willingness to adhere to one registered doctor on condition that the doctor was a 'good doctor'. The definition of a good doctor as provided by the participants was not based on strict technical/clinical criteria, but rather on the patients' and the community's recent experiences of care under that particular doctor. The typical good doctor is a popular, friendly person who does not discriminate along racial lines, listens seriously to anything presented to him or her and examines the patient properly. He/she takes the patient's illness seriously, refers when necessary and gives sick leave that can be used to see a traditional healer. The determinants of the choice of doctor were practical (e.g. the cost), although many were humanistic and difficult to quantify (e.g. word of mouth from fellow patients; the attitude of the doctor toward people; the popularity of the doctor in the community). The specific needs of the respondents relating to traditional healing, migration and sick leave are not readily captured in a standard medical aid contract. Conclusion: Some characteristics of a 'good doctor' that are particular to the study population include emphasis on a non-discriminative approach, the value of understanding the patient, acceptance of traditional healing and the provision of sick leave when needed. This has important implications for the training of doctors (e.g. to expand the curriculum to include humanistic competencies) and the nature of a managed care contract. This article has been peer reviewed. Full text available at www.safpj.co.za SA Fam Pract 2008;50(4):66


Managers increasingly must make decisions based on almost unlimited information. How can they navigate and organize this vast amount of data? Essentials of Business Research Methods provides research techniques for people who aren't data analysts. The authors offer a straightforward, hands-on approach to the vital managerial process of gathering and using data to make clear business decisions. They include such critical topics as the increasing role of online research, ethical issues, data mining, customer relationship management, and how to conduct information-gathering activities more effectively in a rapidly changing business environment. This is the only such book that includes a chapter on qualitative data analysis, and the coverage of quantitative data analysis is more extensive and much easier to understand than in other works. The book features a realistic continuing case throughout the text that enables students to see how business research information is used in the real world. It includes applied research examples in all chapters, as well as Ethical Dilemma mini - cases, and interactive Internet applications and exercises.


PRAISE FOR MANAGING AGILE PROJECTS"In the hands of another, this class of material could become incoherent, but Sanjiv has enough intellectual power to ground his subject...Fans of APM and those who prefer new ideas as a catalyst for their management approach should find Managing Agile Projects rewarding."Wes Balakian, Chairman and Executive Advisor, PMI eBusiness SIG"I only wish I had read this book when I started my career in software product management, or even better yet, when I was given my first project to manage. In addition to providing an excellent handbook for managing with agile software development methodologies, Managing Agile Projects offers a guide to more effective project management in many business settings."John P. Barnes, former Vice President of Product Management at Emergis, Inc."The agile software development movement evolved from a half-dozen methodologies-Scrum, Adaptive, XP, Crystal-that while different, embodied a consistent set of values and similar practices. The agile project management movement is following the same path-strength through a blend of consistency and diversity. Sanjiv's book, Managing Agile Projects, adds both-consistency and diversity-to the concepts and practices of agile project management. His book is rich in ideas and practical advice. It is a wonderful addition to the growing literature about 'alternative' styles of project management."Jim Highsmith Sr. V.P. and Director Agile Software Development and Project Management Practice Fellow, Business Technology Council Cutter Consortium LLC, Arlington, MA"Here is an innovative approach to the management of agile projects, examining traditional project management practices that do not align well with new agile methodologies. Augustine's alternative approaches in regard to personnel, organization, and change make this a valuable resource for project managers as well as for the customer/product owner."Sydney H. Jammes, Retired C.I.A. Economist"Project management has almost become a new paradigm for getting work done in most corporations around the world. This book provides a long overdue synthesis of the diverse strategies and practices in project management. The holistic and organic approach in the book combines the people factor and task complexity elements nicely and delivers an easy-to-read narrative that should be a must-read for every manager."Tojo Thatchenkery, Professor of Organizational Learning, George Mason University"In our work with Sanjiv Augustine in New Zealand and Australia, he has always impressed me with his practical, lucid approach to the project management idea for our times-agile project management. This book captures the essence of that approach."Martyn Jones, Managing Director, Software Education Associates, Ltd."Rejoice! Sanjiv Augustine eloquently lays out a practical and elegant organic project management model for being innovative and delivering business value while maintaining a high quality of life. And in the process, he gives the world a proven alternative to mechanistic and rigid project management practices that have stifled software development and killed creativity. A brilliant piece of work."Doug DeCarlo, author, "eXtreme Project Management: Using Leadership, Principles and Tools to Deliver Value in the Face of Volatility""Sanjiv Augustine's informative new book, Managing Agile Projects, takes the mystery out of bringing about the successful completion of information technology projects. His innovative, clear, and sensible approach to the management of agile projects is a must-read for all members of the implementation team, from users to developers and from consultants to managers. This work is a major contribution to the field of project management."Martha C. Edmondson, Chief Financial Officer, African Development Foundation"This book significantly builds on and extends agile thinking."Jeff De Luca, creator of Feature Driven Development, www.nebulon.com"Sanjiv brings real world, interesting experiences to his topic and conveys the essentials of project management in the new era in a way that is both entertaining and enlightening. Busting the jargon and slicing through the marketing-speak, this book is an essential tool for anyone involved in development projects today."Shane Hastie, Chief Knowledge Engineer, Software Education Associates, Ltd."Managing Agile Projects extends the values and principles of more development-centric agile methodologies to project management, something essential to the creation and evolution of the truly agile organization. An excellent addition to the agile literature!"Steve Hayes, Professional Services Manager, Internet Business Systems"Agile Project Management, as outlined here, is a key component to building a software development organization that can effectively respond to changing market needs in a timely manner. "Madhu Garlanka, Senior Manager, eBusiness Application Development, Nextel Communications"Agile methods created by 'radicals' have matured into tools in common use in many organizations. Now that teams are using these methods on high-profile projects, executives are starting to ask, 'How can we manage these agile processes?' This book builds upon scientific research of complex adaptive systems to present a handbook for project managers and executives faced with the challenge of monitoring and controlling agile projects."Kevin J.J. Aguanno, PMP®, MAPM IBM Certified Senior Project Manager IBM Global Services, IBM Canada, Ltd."I read this book and immediately shared it with a manager of an XP team. It's got great ideas on how to manage agile teams using a 'light touch.'"William Wake, Independent Consultant"Agile Project Management, as outlined here, is a key component to building a software development organization that can effectively respond to changing market needs in a timely manner."-Madhu Garlanka, Sr. Manager, eBusiness Application Development, Nextel Communications"In the hands of another, this class of material could become incoherent, but Sanjiv has enough intellectual power to ground his subject....Fans of APM and those who prefer new ideas as a catalyst for their management approach should find Managing Agile Projects rewarding."-Wes Balakian, Chairman and Executive Advisor, PMI eBusiness SIGYour Hands-On, "In-the-Trenches" Guide to Successfully Leading Agile ProjectsAgile methods promise to infuse development with unprecedented flexibility, speed, and value-and these promises are attracting IT organizations worldwide. However, agile methods often fail to clearly define the manager's role, and many managers have been reluctant to buy in. Now, expert project manager Sanjiv Augustine introduces a proven management framework that addresses everything from team building to project control. Sanjiv bridges the disconnect between the assumptions and techniques of traditional and agile management, demonstrating why agility is better aligned with today's project realities, and how to simplify your transition: Customizing agile methods to your unique environment implementing full-life-cycle agility: from planning and coding to maintenance and knowledge transfer Learning how agile methods can scale to succeed in even the largest projects through a case study Managing the flow of customer value from one creative stage to the next Defining a high-value role for the manager in agile project environments Refocusing on outcomes-not rigid plans, processes, or controls Structuring and building adaptive, self-organizing "organic teams" Forming a guiding vision that aligns your team behind a common purpose Empowering your team with the information it needs to succeedWhether you're a technical or business manager, Managing Agile Projects gives you all the tools you need to implement agility in your environment-and reap its full benefits.© Copyright Pearson Education. All rights reserved.


Whitened Neural Network (WNN) is a recent advanced deep architecture, which improves convergence and generalization of canonical neural networks by whitening their internal hidden representation. However, the whitening transformation increases computation time. Unlike WNN that reduced runtime by performing whitening every thousand iterations, which degenerates convergence due to the ill conditioning, we present generalized WNN (GWNN), which has three appealing properties. First, GWNN is able to learn compact representation to reduce computations. Second, it enables whitening transformation to be performed in a short period, preserving good conditioning. Third, we propose a data-independent estimation of the covariance matrix to further improve computational efficiency. Extensive experiments on various datasets demonstrate the benefits of GWNN.


Introduction: Necrotizing enterocolitis (NEC) in neonates, especially in the preterm, is a life-threatening condition. This study aims to analyze the clinical profile of NEC to get an insight for better understanding and management.
 Method: This was a retrospective analysis of neonatal NEC during the six-year period from 2014 to 2019. The prevalence and time for the development of NEC, clinical profile (term and preterm, low birth weight, gender, breast and formula feeding, abdominal distension, vomiting, hematochezia, apnea, fever, altered mental status, blood transfusion, breast or formula-fed, intestinal perforation, Bell's stage and time for the development of NEC) and maternal factors (gestational hypertension, diabetes, premature rupture of membranes PROM, intrauterine fetal distress, placenta previa) were analyzed. Features in preterm and term neonates were compared. Ethical approval was obtained.
 Result: There were 106 NEC (0.87% of 12,184 neonatal admissions), 62 (58.49%) male, 90 (84.91%) preterm, and 85 (80.19%) LBW. Overall, 88 (83.02%) were Bell's stage II, and severe stage III was seen in eight (19.04%) out of 42 babies with formula feeding as compared to one (1.56%) out of 64 in breastfeeding. The median time for the development of NEC was 6 days of life. The yearly prevalence of NEC per thousand neonates admitted during 6-years increased from 2.90 in 2014 to 12.06 in 2019. Overall mortality was 14 (13.20%).
 Conclusion: The yearly incidence of NEC increased with a higher incidence in preterm, in low birth weight and formula-fed neonates.


Many genetic disorders of known etiology share behavioral characteristic with the autism spectrum disorders (ASD), including language delays, social difficulties, and unusual patterns of behavior. There exist tendencies to either over- or under-pathologize these similarities, resulting in both false diagnoses and diagnostic overshadowing. Recent findings in Williams syndrome (WS), a genetic disorder often contrasted with ASDs, have demonstrated a significant overlap between these two phenotypes in young children with limited language. Using a gold-standard autism diagnostic tool, the ADOS, the present study aimed to further characterize the nature of socio-communicative behaviors in verbal children with WS, both within WS and in comparison to children with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and developmental conditions of mixed etiology (ME). Results indicated that approximately one-third of the children with WS met threshold for classification on the autism spectrum. There were a number of items on which the children classified "ASD" and those classified "non-spectrum" received different scores, such as conversation difficulties, quality of social overtures including integrated eye contact and facial expressions, and play behaviors. Consistent with previous studies, children with WS who have significant socio-communicative difficulties (i.e., those classified "ASD") demonstrate a behavioral profile similar to that seen in children with Pervasive Developmental Disorder-Not Otherwise Specified. Implications for understanding the nature of the behavioral pattern in WS, and in genetic disorders in general, will be discussed.


Goal of the present work is the study of involutory automorphisms and their centralizers of reductive algebraic groups and of split Kac-Moody groups, outside of characteristic 2. The groups in question have in common that they admit a so-called twin BN-pair (B_+, B_-, N) and an associated so-called twin building C=(C_+, C_-, δ^*). Let G be such a group. An involutory automorphism θ of G for which θ(B_+) is conjugate to B_- induces an almost isometry of the building C which interchanges the halves of the building and which we also denote by θ. This now enables us to apply the rich structure theory of buildings. An important tool for this is the so-called flip-flop system C_θ, consisting of all chambers c of C_+ for which the distance between c and θ(c) is maximal (with respect to the codistance of the twin building). Since C_θ is a subsystem of the building C_+, we can also regard it as a simplicial complex. The centralizer G_θ of θ in G acts naturally on this complex. In the present work we give criteria under which C_θ is a connected and pure simplicial complex. For this we reduce the global question to a problem in rank 2. We then solve this rank 2 problem for several important cases. Additional, we study the orbit structure of G_Simplizialkomplex on the building C and the flip-flop system C_θ. As applications, we obtain for example a parametrization of the double coset space G_θ\G/B_+; a generlization of the Iwasawa decomposition; and a proof that for certain locally-finite Kac-Moody groups, the centralizer C_θ is finitely generated. In closing we would like to remark that our results also apply to further groups with a root group datum as defined by Tits (like e.g. finite groups of Lie-type).


ABSTRACT The bovine herpesvirus 5 (BHV-5) gE ectodomain contains a glycine-rich epitope coding region (gE5 epitope), residues 204 to 218, that is significantly different from the corresponding gE region of BHV-1. Deletion of the gE epitope significantly reduced the neurovirulence of BHV-5 in rabbits. Pulse-chase analyses revealed that the epitope-deleted and wild-type gE were synthesized as N-glycosylated endoglycosidase H-sensitive precursors with approximate molecular masses of 85 kDa and 86 kDa, respectively. Like the wild-type gE, epitope-deleted gE complexed with gI and was readily transported from the endoplasmic reticulum. Concomitantly, the epitope-deleted and wild-type gE acquired posttranslational modifications in the Golgi leading to an increased apparent molecular mass of 93-kDa (epitope-deleted gE) and 94-kDa (wild-type gE). The kinetics of mutant and wild-type gE processing were similar, and both mature proteins were resistant to endoglycosidase H but sensitive to glycopeptidase F. The gE epitope-deleted BHV-5 formed wild-type-sized plaques in MDBK cells, and the epitope-deleted gE was expressed on the cell surface. However, rabbits infected intranasally with gE epitope-deleted BHV-5 did not develop seizures, and only 20% of the infected rabbits showed mild neurological signs. The epitope-deleted virus replicated efficiently in the olfactory epithelium. However, within the brains of these rabbits there was a 10- to 20-fold reduction in infected neurons compared with the number of infected neurons within the brains of rabbits infected with the gE5 epitope-reverted and wild-type BHV-5. In comparison, 70 to 80% of the rabbits exhibited severe neurological signs when infected with the gE5 epitope-reverted and wild-type BHV-5. These results indicated that anterograde transport of the gE epitope-deleted virus from the olfactory receptor neurons to the olfactory bulb is defective and that, within the central nervous system, the gE5 epitope-coding region was required for expression of the full virulence potential of BHV-5.


This paper describes the conditions that influence technology acquisition through collaboration. From the analysis of semi-structured interviews and 11 case studies, we developed a technology acquisition framework that stresses the supplier involvement in the process and the factors that influence the outcomes. On the basis of this framework, we provide practical insights for suppliers to support their customers in order to raise the probability of success in collaborative projects. Our results suggest that effective acquisition of technology by means of collaboration is achieved by the combination of three conditions: effective partnership management, effective execution of the co-development project and effective transference of the technology to the recipient system in the acquiring firm.


Recombination through doubly excited states that can be formed only through spin-flip of the excited electrons can give very strong contributions to the recombination rate of Be-like ions. We demonstrate this, in this paper, with the electron–ion recombination spectra of Be-like Ne6+ and Be-like Si10+, recently measured at the CRYRING storage ring. These resonances have significant effects on the plasma rate coefficients. We show that neglect or imprecise calculation of these resonances is responsible for large spreads observed between various theoretical results from the literature.


Estimation of biomass, substrate, and specific growth rate (μ) by two nonlinear observers (nonlinear observer-based estimator—NLOBE, asymptotic observer with second-order dynamics tuning—AO-SODE) and a linear estimator (recursive least squares with variable forgetting factor—RLS-VFF) is presented. Heterologous protein production in Pichia pastoris PAOX1 (Mut+) and PFLD1-based systems is closely related to μ and has been addressed due to its high relevance in modern biotechnology and bioprocess engineering. μ was estimated by online gas analyses or substrate measurements, biomass, and substrate considering yield coefficients and mass balances. In simulation studies, NLOBE showed high sensitivity to tuning and initialization variables. Validation experiments demonstrated AO-SODE performs better than the RLS-VFF for moderate to rapid changes of μ and model parameters being known. If low changes on μ are presented, for instance, in substrate regulation, RLS-VFF comes up as the best option, because of its reduced requirements. © 2011 American Institute of Chemical Engineers AIChE J, 58: 2966–2979, 2012


Abstract. When wireless electromagnetic waves pass through the earth's atmosphere, they are affected by ionospheric irregularities, and their amplitude and phase will jitter rapidly in a short period of time, which is called ionospheric scintillation. With the human exploration of outer space and the demand for space communication, the study of ionospheric scintillation characteristics and its influence on electromagnetic communication has become increasingly important. This paper used the observation data received by GPS scintillation/TEC receivers in the Chengdu (104.07° N, 30.67° E) area of China from January 2018 to September 2020, and a data processing program was developed for the received GPS/BDS/GAL. The satellite data at multiple frequency points were processed to extract key data such as S4, azimuth angle, and elevation angle, and then the annual changes in ionospheric scintillation in the Chengdu region and the characteristics of local time changes were statistically analysed. The results show that the frequency and intensity of ionospheric scintillation events have obvious half-year changes. The scintillation intensity and frequency in spring and autumn are higher and more frequent than those in summer and winter; and scintillation events mainly occur at night. but they also occur during the day, mostly in the afternoon; and their occurrence is related to the airspace and is further closely related to the elevation and azimuth angles of the observation point. The overall scintillation events from 2018 to 2020 were in a gradual downward trend. At the end of May 2018, a scintillation event with a longer duration occurred. Further analysis showed that the occurrence of scintillation events increased with the rapid changes in solar activity and the geomagnetic environment. There is a certain positive correlation between the changes.


Minimum and maximum metabolism in response to cold were measured in 30 species of Australian monotremes, marsupials, eutherians and birds. In marsupials and the echidna, maximum metabolism was also determined during treadmill locomotion. These data were used to determine, for the first time, the relationships between maximum metabolism and body mass in the four endothermic groups and to compare aerobic factorial scopes (the ratio of maximum to minimum metabolism) elicited by cold and locomotion. The effect of body mass on maximum metabolism is the same in marsupials and eutherians (the therians) but is significantly less in birds. At the same body mass, there is no difference between the two therian groups for either minimum or maximum metabolism induced by either cold or locomotion. Aerobic scope during cold is significantly higher in marsupials (8.3) than in eutherians (5.1), birds (5.4) and monotremes (5.4). Aerobic scope during locomotion in all groups is almost twice that observed in cold conditions.


In the paper framework for indoor positioning utilizing Wi-Fi and GSM signals is introduced. Nowadays, indoor positioning is a very attractive topic for researchers, since accurate and reliable positioning system can unlock new market to service providers. In this paper we will analyse the use of Wi-Fi and GSM signals and their combination for the fingerprinting based positioning in the indoor environment. Performance of positioning system in terms of accuracy was analysed using simulations. In the simulations the position of the mobile device was estimated in three ways, when only GSM signals were used, when only Wi-Fi signals were utilized and when a combination of both signals was used. Three positioning algorithms from the Nearest Neighbour (NN) family were used in the simulations. Simulations were performed in the simulation model created in MATLAB environment.


Background Long-term immunosuppressive treatment does not efficiently prevent relapses of lupus nephritis (LN). This investigator-initiated randomised trial tested whether mycophenolate mofetil (MMF) was superior to azathioprine (AZA) as maintenance treatment. Methods A total of 105 patients with lupus with proliferative LN were included. All received three daily intravenous pulses of 750 mg methylprednisolone, followed by oral glucocorticoids and six fortnightly cyclophosphamide intravenous pulses of 500 mg. Based on randomisation performed at baseline, AZA (target dose: 2 mg/kg/day) or MMF (target dose: 2 g/day) was given at week 12. Analyses were by intent to treat. Time to renal flare was the primary end point. Mean (SD) follow-up of the intent-to-treat population was 48 (14) months. Results The baseline clinical, biological and pathological characteristics of patients allocated to AZA or MMF did not differ. Renal flares were observed in 13 (25%) AZA-treated and 10 (19%) MMF-treated patients. Time to renal flare, to severe systemic flare, to benign flare and to renal remission did not statistically differ. Over a 3-year period, 24 h proteinuria, serum creatinine, serum albumin, serum C3, haemoglobin and global disease activity scores improved similarly in both groups. Doubling of serum creatinine occurred in four AZA-treated and three MMF-treated patients. Adverse events did not differ between the groups except for haematological cytopenias, which were statistically more frequent in the AZA group (p=0.03) but led only one patient to drop out. Conclusions Fewer renal flares were observed in patients receiving MMF but the difference did not reach statistical significance.


Extreme ultra violet (EUV) patterning offers an opportunity to explore new hardmask materials and patterning approaches. Traditional patterning stacks for Deep UV (DUV) patterning have been based on optimizing multi-layer schemes for reflectivity control and pattern transfer. At EUV wavelength, the patterning challenges are dominated by stochastics and aspect ratio control. This offers an opportunity to think differently about underlayer design for sub-36nm pitch patterning. The choice of hardmask can be used to modulate post-litho defectivity to mitigate the stochastics effects and enable more efficient pattern transfer. Through different case studies this paper will explore a range of silicon-based inorganic hardmasks for sub36nm EUV patterning. How film properties dominate patterning performance will be studied systematically. The relative merits of patterning a chemically amplified organic resist directly on an inorganic hardmask or having different types of organic adhesion promoters as an intermediate layer will be also be presented.


The transcription factor Zic1 plays important roles in patterning the neural plate in early vertebrate development. A crucial step toward understanding the mechanisms of Zic1 function is to identify the downstream target genes. We misexpressed Zic1 in animal caps from Xenopus embryos, and screened for differential gene expression with DNA microarrays. Candidate genes from these microarray data were further validated by quantitative PCR. Through this study, eleven genes have been shown to be directly upregulated by Zic1. One of the direct targets of Zic1 is a novel gene that we have named Xfeb. Xfeb is expressed in the presumptive hindbrain region during neurula stages and in somite tissues later in development. Xfeb represses the hindbrain gene hoxB1 and the anterior neural gene otx2, suggesting that Xfeb is involved in regionalizing the neural plate, possibly by ensuring a posterior expression limit for otx2.


There are three main global temperature histories: the combined CRU-Hadley record (HADCRU), the NASA-GISS (GISTEMP) record, and the NOAA record. All three global averages depend on the same underlying land data archive, the Global Historical Climatology Network (GHCN). Because of this reliance on GHCN, its quality deficiencies will constrain the quality of all derived products. The number of weather stations providing data to GHCN plunged in 1990 and again in 2005. The sample size has fallen by over 75% from its peak in the early 1970s, and is now smaller than at any time since 1919. The collapse in sample size has increased the relative fraction of data coming from airports to about 50 percent (up from about 30 percent in the 1970s). It has also reduced the average latitude of source data and removed relatively more high-altitude monitoring sites. Oceanic data are based on sea surface temperature (SST) rather than marine air temperature (MAT). All three global products rely on SST series derived from the ICOADS archive. ICOADS observations were primarily obtained from ships that voluntarily monitored SST. Prior to the post-war era, coverage of the southern oceans and polar regions was very thin. Coverage has improved partly due to deployment of buoys, as well as use of satellites to support extrapolation. Ship-based readings changed over the 20th century from bucket-and-thermometer to engine-intake methods, leading to a warm bias as the new readings displaced the old. Until recently it was assumed that bucket methods disappeared after 1941, but this is now believed not to be the case, which may necessitate a major revision to the 20th century ocean record. There is evidence that SST trends overstate nearby MAT trends. The quality of data over land, namely the raw temperature data in GHCN, depends on the validity of adjustments for known problems due to urbanization and land-use change. The adequacy of these adjustments has been tested in three different ways, with two of the three finding evidence that they do not suffice to remove warming biases. The overall conclusion of this report is that there are serious quality problems in the surface temperature data sets that call into question whether the global temperature history, especially over land, can be considered both continuous and precise. Users should be aware of these limitations, especially in policy-sensitive applications.


The challenge of additive nanomanufacturing is to create and assemble literally quadrillions of nano-scaled structures. That cannot be done with typical 1-nozzle / 1- trace techniques. Instead there must be a utilization of macro-scale (e.g. easily controlled) forces to assemble large numbers of structures in parallel. For example, physical and chemical vapor deposition use momentum, condensation, and chemical reactions to deposit coatings, grow nanotubes, and form nanostructures from gas-phase precursors in a vacuum. An intriguing challenge is to utilize similar techniques, but move from traditional gas-phase materials in a vacuum to nanoparticles at atmospheric conditions. That transition would enable 1) larger area coating and cheaper processes, 2) an important meso-scale of structures that are on the order of 100's of nanometers to micrometers, which is the scale for wetting, adhesion, and other surface interactions, and 3) a straightforward path to polymer-particle nanocomposite structures by depositing multiple materials either in parallel or in sequence. We are investigating additive nanomanufacturing using nanoparticles formed by electrospray ionization (ESI). One key challenge is to determine the interplay between particle charge/momentum and the electric fields at the substrate to control assembly. Relevant forces include attraction to the grounded substrate, repulsion from likecharged particles in the spray, and repulsion from previously deposited particles or electrode patterning on the substrate. We examine three different cases: an electrically nonconductive substrate (Parylene), a nonconductive substrate with 1 mm gold bands about 1mm apart, and a nonconductive substrate with 1 mm gold bands 3 mm apart. These three cases give vital insight into the length-scales at which structures begin to develop in large-scale nanoparticle deposition systems. We show that the nature of the substrate did not appear to significantly affect the bulk spray, but deposition was strongly focused onto conductive, grounded bands. We also showed a gradient in the deposition with a length scale on the order of 1-100 I¼m.


This research project looks into the management information requirements of municipalities in the Netherlands, related to their customer relationship program. Information requirements engineering methodologies for data warehouses are reviewed and a method is proposed based on its perceived suitability for the municipality context. The used methodology by Winter and Strauch matches information requirements elicitation with analyses of the data sources to get an overview of requirements and whether they are attainable. Results are a list of management information requirement, representation requirements and an advice to Exxellence Group on how they can foresee in this demand.
The resulting list of management information requirements seems to indicate that the management of client contact centres would like to see more management information than what it currently prescribed by the Antwoord© concept on which they have based their management information needs for the most part. The list was sent back to municipalities to allow them to comment and rate the information needs on their usefulness. Also, the COPC standard on which the Antwoord© indicators are based and the Antwoord© indicators themselves were compared to the results. The results seem to cover almost all of the COPC metrics except for several process areas that are not as relevant in the municipality context. Also potentially interesting additions to the results that could be made from the COPC standard have been identified. The indicators from the Antwoord© concept score relatively high in the ranking of information needs and are a solid basis for measurements.
Overall, the information needs voiced by municipalities are on an operational level to measure performance of departments and individual employees over time. To satisfy the information needs, Exxellence group will have to combine data from several back-office source systems along with other information from other sources such as customer satisfaction surveys. These sources will have to be identified per municipality due to the large variance in the types of back-office systems that are used in different municipalities. A data warehouse schema should be created that matches the information needs. The sources of information used to fill the data warehouse can then be identified per municipality.
In addition municipalities will have to access their processes and the training level of their personnel to see whether they are able to correctly capture all the information required to satisfy the information needs.


Abstract : The author points out that Revolutionary Armed Forces of Colombia (FARC) insurgents actively are pursuing a strategy to mobilize the disaffected and disposed people of Colombia, and to control the entire national territory. At the same time, he argues that no one in the national political establishment has taken the initiative to conduct an appropriate effort to deny FARC its objective. As a result, the Colombian Army has been left alone to direct the fight, without a coordinated and integrated national campaign plan or other resources that would allow for success. The author concludes that the Army has bought time, and there is still an opportunity for the United States to help Colombia deal with its insurgent threat in new ways.


IMPORTANCE
In 2006, the Centers for Medicare & Medicaid Services approved coverage for the use of the 21-gene recurrence score (RS) assay in women with early-stage, estrogen receptor-positive, node-negative breast cancers to help guide recommendations for adjuvant chemotherapy. Use of the assay in community settings has not been previously examined in a nationally representative sample of patients.

OBJECTIVE
To examine trends in the use of the RS assay in routine clinical practice in a nationally representative sample of women with breast cancer.

DESIGN, SETTING, AND PARTICIPANTS
Retrospective observational study of Medicare beneficiaries diagnosed with incident breast cancer between 2005 and 2009, as recorded in a Surveillance, Epidemiology, and End Results data set with linked Medicare claims through 2010.

MAIN OUTCOMES AND MEASURES
Demographic and clinical variables associated with the use of the assay.

RESULTS
A total of 70,802 patients met the study criteria. Use of the RS assay increased from 1.1% in 2005 to 10.1% in 2009 (P < .001). The majority of tests (60.9%) occurred in patients with National Comprehensive Cancer Network-defined intermediate-risk disease (ie, estrogen receptor-positive, node-negative tumors >1 cm). Most patients with other than intermediate-risk disease had borderline indications for testing, including T1b (47.5%) or N1 (26.8%) disease. Testing was associated with younger age, fewer comorbid conditions, higher-grade disease, and being married. Among patients younger than 70 years with intermediate-risk disease, testing rates increased from 7.7% in 2005 to 38.8% in 2009 (P < .001). In multivariable analysis, testing was modestly higher in Northeast than in Western registries (odds ratio, 1.83; 95% CI, 1.49-2.26) but was otherwise not associated with region, local census tract demographic characteristics, black race, location in an urban area, or tumor histologic characteristics.

CONCLUSIONS AND RELEVANCE
The RS assay was adopted quickly in clinical practice after the Medicare coverage decision in 2006, and use appears to be consistent with guidelines and equitable across geographic and racial groups. Factors influencing adoption of the assay and its impact on adjuvant chemotherapy use in clinical practice remain important areas of study.