Determining the true, kinetically dominant catalytically active species, in the classic benzene hydrogenation system pioneered by Maitlis and co-workers 34 years ago starting with [RhCp*Cl(2)](2) (Cp* = [η(5)-C(5)(CH(3))(5)]), has proven to be one of the most challenging case studies in the quest to distinguish single-metal-based "homogeneous" from polymetallic, "heterogeneous" catalysis. The reason, this study will show, is the previous failure to use the proper combination of: (i) in operando spectroscopy to determine the dominant form(s) of the precatalyst's mass under catalysis (i.e., operating) conditions, and then crucially also (ii) the previous lack of the necessary kinetic studies, catalysis being a "wholly kinetic phenomenon" as J. Halpern long ago noted. An important contribution from this study will be to reveal the power of quantitiative kinetic poisoning experiments for distinguishing single-metal, or in the present case subnanometer Rh(4) cluster-based catalysis, from larger, polymetallic Rh(0)(n) nanoparticle catalysis, at least under favorable conditions. The combined in operando X-ray absorption fine structure (XAFS) spectroscopy and kinetic evidence provide a compelling case for Rh(4)-based, with average stoichiometry "Rh(4)Cp*(2.4)Cl(4)H(c)", benzene hydrogenation catalysis in 2-propanol with added Et(3)N and at 100 °C and 50 atm initial H(2) pressure. The results also reveal, however, that if even ca. 1.4% of the total soluble Rh(0)(n) had formed nanoparticles, then those Rh(0)(n) nanoparticles would have been able to account for all the observed benzene hydrogenation catalytic rate (using commercial, ca. 2 nm, polyethyleneglycol-dodecylether hydrosol stabilized Rh(0)(n) nanoparticles as a model system). The results--especially the poisoning methodology developed and employed--are of significant, broader interest since determining the nature of the true catalyst continues to be a central, often vexing issue in any and all catalytic reactions. The results are also of fundamental interest in that they add to a growing body of evidence indicating that certain, appropriately ligated, coordinatively unsaturated, subnanometer M(4) transition-metal clusters can be relatively robust catalysts. Also demonstrated herein is that Rh(4) clusters are poisoned by Hg(0), demonstrating for the first time that the classic Hg(0) poisoning test of "homogeneous" vs "heterogeneous" catalysts cannot distinguish Rh(4)-based subnanometer catalysts from Rh(0)(n) nanoparticle catalysts, at least for the present examples of these two specific, Rh-based catalysts.


In any important article in the field of clinical ethics, the focus should not be on the specific case example, but rather on the issues it presents for thought and discussion. Barbara Springer Edwards and Winston M. Ueno achieve this end admirably. They present a terminally ill patient who requested termination of ventilator support, despite the overwhelming odds that he would die as a result. The authors ask whether or not the physician acted appropriately in accommodating the patient's wish and in sedating him to decrease suffering in his last moments. They present compelling arguments that sedation was warranted in this case. They also note correctly that competent patients have the right to refuse treatment. However, in addition to the question of sedation, this case raises other important issues, specifically those related to pain management and depression in the terminally ill....


Monofunctional dendritic silicone branches were created from hydro- and alkoxysilanes using the Piers–Rubinsztajn reaction. Platinum-catalyzed hydrosilylation of the dendrons onto functional (MeHSiO) silicone backbones at various frequencies led to a library of branched silicones. Viscosities of the polymers increased with branch frequency to a maximum beyond which the viscosity decreased, as a consequence of a globular transition.


Dalit community is regarded as a group of people who have been victims of exploitation and traditionally considered as untouchables and socially considered an inferior class. They have had physical labour as a means of livelihood and from religious point of view all the principles and beliefs were laid down to humiliate and exploit them. Several Dalits have got converted to Christianity, Buddhism and other religions as a consequence of caste system and depicts exploitation and injustice. The main concern from a modern perspective is towards social justice that demands social reform and improvement in the condition of the depressed class to be able to lead a respectable life. Social disparity was prevalent in India since ancient times. Hence, to attain social justice was not easy. "Varna system", was entrenched in the Indian society. There was distribution of labour. A "Shudra" changed his/ her path if he/ she came in the way of a "Brahmin". The entry of, "Shudras", in the temples was prohibited. This social system established by the "Brahmins" had spread all across the Indian society like cancer. It was impossible to imagine about social justice in such a situation. Social justice is based on equal distribution of means, resources, materials, services, facilities, benefits, opportunities, power, duties and responsibilities and social equality at large. Social inequality prevailed in India since ancient times and this prevented social justice. The caste system in the Indian society deprived the "Shudras" of social, economical and political rights. Mahatma Gautam Buddha, Gurunanak, Raja Ram Mohan Roy, Dayanand Saraswati, Swami Vivekananda, Sant Kabir, Ravidas, Mahatma Jyotibaphule, Mahatma Gandhi are some of the prominent names known to promote social justice. One of the prominent personalities who devoted his entire life for the upliftment of the socially deprived and whose name is written in golden letters is, "Baba Saheb Dr. Bhimrao Ambedkar". He is also known as the, " Messiah" of Dalits and untouchables. Dr. Ambedkar considered the struggle for the cause of Dalits more important than the struggle for independence. Dr. Ambedkar firmly believed that the ultimate solution to this problem lied in complete eradication of the caste system and giving adequate participation to Dalits in governance. As an architect of the Constitution of India, Dr. Ambedkar introduced a system of reservations for the members of scheduled castes, scheduled tribes and other backward classes.


This paper analyzes the property rights/deforestation linkage in Latin America. The analysis recognizes two separate areas where tenure issues have an effect on land clearing pressures. The first deals with the security of individual property rights on established agricultural lands and their effects on agricultural production and employment. The second involves tenurial arrangements on forested areas and their impact on the sustainable management of resources. The analysis concludes that strengthening property rights should be an important part of a strategy to reduce deforestation rates in the region. However, it also suggests that tenurial reforms are not a solution by themselves to prevent excessive land clearing.


Abstract
The aim of this thesis is to explore nurses' understanding of technology in the intensive care unit. The study brings together empirical data gathered from nurses' practice in the ICU environment, along with theoretical insights from science and technology studies, to illuminate how nurses' understanding informs their use of technology in their care activities. The empirical data was gathered through intensive fieldwork over a period of 5 months in an ICU department within a large teaching hospital. In addition, recorded in-depth interviews were carried out with ICU nursing staff. The interviews uncover themes such as nurses' practice with technology; nurses' ambivalence around the use of technology in relation to patient care; and nursing identity and professional status.

Current theories of technological determinism, social essentialism and technology-in-practice within science and technology studies are examined for their usefulness in illuminating the world of ICU nursing research. In particular, Actor-Network Theory, as an example of technology-in-practice, is utilised as a theoretical lens to explore the contingent nature of social and technological relations on the ICU, where nurses' understanding of technology emerges as an effect of multiple associations between human and non-human actors.

The thesis informs existing research by offering further empirical insight into the ICU world through in depth analysis of the semiological and material qualities of technology in the ICU, and develops a number of conceptual themes such as 'balancing patients,' 'chasing numbers' and the 'technology vigil' to frame nurses' understanding of technology. The study also adds insight into the construction of nursing identity, suggesting it is an emergent property of nurses' interactions with technology. The thesis concludes by indicating that knowledge of how nurses understand, use and frame their identity in relation to technology can inform current research into technology adoption and diffusion in healthcare environments.


Abstract The objective of the OSCOSS research project on "Opening Scholarly Communication in the Social Sciences" is to build a coherent collaboration environment that facilitates scholarly communication workflows of social scientists in the roles of authors, reviewers, editors and readers. This paper presents the implementation of the core of this environment: the integration of the Fidus Writer academic word processor with the Open Journal Systems (OJS) submission and review management system.


Visual information is used for postural stabilization in humans. However, little is known about how eye movements prevalent in everyday life interact with the postural control system in older individuals. Therefore, the present study assessed the effects of stationary gaze fixations, smooth pursuits, and saccadic eye movements, with combinations of absent, fixed and oscillating large-field visual backgrounds to generate different forms of retinal flow, on postural control in healthy young and older females. Participants were presented with computer generated visual stimuli, whilst postural sway and gaze fixations were simultaneously assessed with a force platform and eye tracking equipment, respectively. The results showed that fixed backgrounds and stationary gaze fixations attenuated postural sway. In contrast, oscillating backgrounds and smooth pursuits increased postural sway. There were no differences regarding saccades. There were also no differences in postural sway or gaze errors between age groups in any visual condition. The stabilizing effect of the fixed visual stimuli show how retinal flow and extraocular factors guide postural adjustments. The destabilizing effect of oscillating visual backgrounds and smooth pursuits may be related to more challenging conditions for determining body shifts from retinal flow, and more complex extraocular signals, respectively. Because the older participants matched the young group's performance in all conditions, decreases of posture and gaze control during stance may not be a direct consequence of healthy aging. Further research examining extraocular and retinal mechanisms of balance control and the effects of eye movements, during locomotion, is needed to better inform fall prevention interventions.


Literature on self-assessment presents substantial evidence regarding the impact of self-assessment on practitioners and quality of care. Related dental hygiene research documents a need to enhance curricula; however, no published curriculum module exists to effectively teach self-assessment. The purpose of this study was to explore the impact of a self-assessment educational module for dental hygiene curricula designed using evidence from the literature and adult learning principles. This module was implemented with 33 junior dental hygiene students as a guest presentation with active learning strategies followed by a clinical practice time period. A one-group, pretest-posttest design was employed using a 2-part pretest and three-part posttest to determine if the module affected dental hygiene students' perceptions about self-assessment and their voluntary application of it in the clinical environment. The relationship between students' perceptions and voluntary application of self-assessment also was examined. In addition, students' comments on daily clinical self-assessment forms were evaluated to determine if the module affected the quality of those comments. Results using the Mann-Whitney test indicated the self-assessment module was effective (p


A flexible optical probe that accomplishes wafer-level directional coupling of light into optical waveguides is investigated theoretically and experimentally. Simulated results indicate high coupling efficiencies in excess of 80% for a range of parameters. Probe fabrication was implemented using SU8 as flexible waveguide material. Coupling of light from flexible probe to an S-shaped test waveguide demonstrated 11% efficiency compared to direct butt coupling. These results may lead to increased yield, shorter development cycles and overall savings in PLC packaging costs.


A fifth-order algebraic formula is derived for the axial deviation of the ray observed behind the GRIN lens exit face, whose expansion coefficients characterize the coefficients up to sixth-order in the index profile of a GRIN lens with arbitrary length; the index coefficients up to sixth-order of a near one-quarter pitch lens are estimated with the formula. The proposed technique would be useful for the evaluation of a GRIN lens with larger spherical aberrations and a longer GRIN rod.


Abstract This is the first study to examine the fiscal effects of the New York property tax levy limit, using variation from the degree of fiscal stringency across school districts and over time in its first five years of implementation. Based on a difference-in-differences estimator, coupled with an event study specification, we find that the tax limit has imposed a real cap on many school districts; that is, at-limit districts' total current expenditures per pupil are significantly lower than what they would have spent absent the limit. For those affected school districts, this expenditure gap does not come from spending on teacher salaries or fringe benefits but rather from other instructional salaries/expenses, central administration, transportation, interfund transfers, and undistributed spending. We also find heterogeneity in the constraining effects of the tax limit across different need-based groups of school districts.


The attractor network model embodies the properties of an associative content-addressable memory. Every stored pattern (meaning or note) corresponds appropriate minimum on the potential function. Imprinting a pattern lowers its energy and the energy of all pattern in the vicinity. This creates a basin of attraction. Such system would be able to recognize inputting pattern which is pulled into one of the closest keypattern. Almost all familiar melodies are built around a central tone toward which the other tones gravitate and on which the melody usually ends. This central tone is the keynote, or tonic. Three stable steps of tonality: tonic, median, and dominant are keynotes or attractors of neural network model. Others steps of tonality play the role of recognizable patterns, gravitating to some or other keynote. Some recent experiments indicate that music possibly represents control of chaos in the brain and one may suggest that stable steps of tonalities are namely these tiny perturbations by which this control is realized.


This paper compares the macroeconomic effects of global oil and iron ore price shocks on the Australian economy. Using a Bayesian structural vector autoregression model with sign restrictions, we identify three types of shock: supply, demand and specific demand. The main results suggest that, over the period from 1990Q1 to 2014Q4, the oil shock had a relative larger impact than the iron ore shock on output and inflation, while the iron ore shock was the dominant source of interest and exchange rate movements. The effects crucially depend on the underlying sources of oil or iron ore price shifts. As Australia is a small open economy, oil and iron ore prices should be treated as exogenous factors. Real GDP responds negatively to a rise in oil prices driven by supply disruptions, but positively to a similar shock on the iron ore market. Higher global demand for these commodities has a positive impact on the economy, but the iron ore demand shock is about twice larger. However, a positive oil and iron ore price shock driven by specific demand lead to a temporary decline in real GDP.


Pancreatic tumors are unresponsive to chemotherapy because their limited vasculature precludes efficient drug delivery. Pancreatic cancer is almost universally associated with a poor prognosis, in part because the tumors are resistant to chemotherapeutic drugs. Working with a mouse tumor model that displays many features of the human disease, Olive et al. (see Perspective by Olson and Hanahan) found that the tumors were poorly vascularized, a factor likely to impede drug delivery. Treatment of the mice with the chemotherapeutic drug gemcitabine in combination with a drug that depletes tumor-associated stromal tissue led to an increase in tumor vasculature, enhanced delivery of gemcitabine, and a delay in disease progression. Thus, drugs targeting the tumor stroma may merit investigation as a way to enhance the efficacy of conventional chemotherapy for pancreatic cancer. K. P. Olive, M. A. Jacobetz, C. J. Davidson, A. Gopinathan, D. McIntyre, D. Honess, B. Madhu, M. A. Goldgraben, M. E. Caldwell, D. Allard, K. K. Frese, G. DeNicola, C. Feig, C. Combs, S. P. Winter, H. Ireland-Zecchini, S. Reichelt, W. J. Howat, A. Chang, M. Dhara, L. Wang, F. Rückert, R. Grützmann, C. Pilarsky, K. Izeradjene, S. R. Hingorani, P. Huang, S. E. Davies, W. Plunkett, M. Egorin, R. H. Hruban, N. Whitebread, K. McGovern, J. Adams, C. Iacobuzio-Donahue, J. Griffiths, D. A. Tuveson, Inhibition of Hedgehog signaling enhances delivery of chemotherapy in a mouse model of pancreatic cancer. Science 324, 1457–1461 (2009). [Abstract] [Full Text] P. Olson, D. Hanahan, Breaching the cancer fortress. Science 324, 1400–1401 (2009). [Summary] [Full Text]


Decentralization initiatives are on-going in many developing countries. In Burkina Faso, the government has embarked on a long-term decentralization effort that groups rural villages into self-governing communes with the capacity to plan their own development programs. Nearly two decades before this process, a system of joint forest management was introduced. The new form of administrative decentralization has impacted on joint forest management. This study sought to examine the effects of decentralization on joint forest management and the livelihoods of the rural poor. Information was obtained through semi-structured interviews, interviews with local forestry officials, direct observation, and by reviewing existing literature. The results indicated that administrative decentralization brings legality to joint forest management, which was already legitimated by local people. In return, joint forest management generates benefits to local people through socio-economic infrastructure, wood and non-wood forest products, to the local government through tax collection systems, and to the forest through some extent improved ecological sustainability. There were shortcomings however, such as land tenure insecurity, low local organizational capacity; lack of transparency in the wood fuel market, low level of diversification of the sources of revenue and weakness of local institution to implement their functions. Thus, a concerted effort should be made to manage the remaining natural forests through the development of appropriate strategies to empower local communities to manage and benefit from forest resources through the new arrangements for administrative decentralization. Caution is needed regarding transparency, financial and technical incentives and long-term commitment from the central government.


The zero-field excitation spectrum of the strong-leg spin ladder (C7H10N)(2)CuBr4 is studied with a neutron time-of-flight technique. The spectrum is decomposed into its symmetric and asymmetric parts with respect to the rung momentum and compared with theoretical results obtained by the density matrix renormalization group method. Additionally, the calculated dynamical correlations are shown for a wide range of rung and leg coupling ratios in order to point out the evolution of arising excitations, as, e.g., of the two-magnon bound state from the strong to the weak coupling limit.


A primary policy concern in advocating cigarette prices as a mechanism to reduce adolescent smoking is whether higher prices will prevent them from becoming smokers as adults or will merely delay the initiation. In this paper we examine how prices that individuals face during their adolescent years affect their lifetime propensities of addiction. By estimating a longitudinal model of addiction we find that although prices may exert some short-run influence in terms of delaying initiation, but such an effect will diminish as a transition into adulthood is made. However, the influence that peers and family (parents smoking status and parent-child relationship) exert on individuals during adolescence remains till adulthood. This indicates that reliance on prices alone may not yield the desired policy results. Additionally, we find that state policies that are designed to restrict adolescent access to cigarettes and discourage its consumption exert an influence that also persists till adulthood. JEL classification: I12 – Health Production; I13 Government Policy; Regulation; Public Health.


We introduce a phase-only hologram generation method based on an integral imaging, and propose an enhancement method in representable depth interval. The computational integral imaging reconstruction method is modified based on optical °ow to obtain depth-slice images for the focused objects only. A phase-only hologram for multiple plane images is generated using the iterative Fresnel transform algorithm. In addition, a division method in hologram plane is proposed for enhancement in the representable minimum depth interval.


Wireless sensor networks represent an increasingly important example of distributed event systems. Unlike Internet-based distributed event systems, sensor networks are very bandwidth constrained and use sensor nodes that are often dedicated to the network and controlled by a single organization. Bandwidth constraints require, and administrative homogeneity allows, sensor networks to employ in-network processing, where application-specific code is used in the network to optimize data movement. The contribution of this paper is to describe the diffusion filter architecture, a software structure for a distributed event system that allows user-supplied software to interact with event routing. Sensor network nodes will span a wide range of capabilities, from tiny single-address space embedded processors to to desktop-class 32-bit computers. A second contribution of our architecture that it scales from 16to 32-bit computers with OS support for single or multiple address spaces. We describe what software approaches facilitate this flexibility and quantify the performance differences.


While the African Continental Free Trade Area (AfCFTA) provides opportunities for regional financial sector development, it also poses a real test for the continent's financial system. The ability of Africa's financial sector to perform the crucial function of facilitating economic growth and integration, at the required scale to support the capacity of small firms to benefit from the single African market remains shaky. In terms of opportunities, the elimination of inhibitive regulations under the AfCFTA is expected to ease cross border trade, enable capital and information flow, attract greater foreign and intra-continental investments, potentially increase capital funds, and provide a much larger customer base for financial institutions to serve. This potential new market base includes traditionally excluded micro, small and medium enterprises (MSMEs) that constitute a large share of the African economy. MSMEs are expected to be a major catalyst for increasing intra African trade and shared economic growth. However, the constraint to MSME financing is a major threat to the success of the AfCFTA as effective economic integration and development depend on easily accessible and affordable capital. This brief therefore advocates for urgent implementation of harmonized financial sector policy reforms across the continent to eliminate these funding constraints, and allow for a more supportive business environment.


School bullying is a common social problem, which affects children both mentally and physically, making the prevention of bullying a timeless topic all over the world. This paper proposes a method for detecting bullying in school based on activity recognition and speech emotion recognition. In this method, motion and voice data are gathered by movement sensors and a microphone, followed by extraction of a set of motion and audio features to distinguish bullying incidents from daily life events. Among extracted motion features are both time-domain and frequency-domain features, while audio features are computed with classical MFCCs. Feature selection is implemented using the wrapper approach. At the next stage, these motion and audio features are merged to form combined feature vectors for classification, and LDA is used for further dimension reduction. A BPNN is trained to recognize bullying activities and distinguish them from normal daily life activities. The authors also propose an action transition detection method to reduce computational complexity for practical use. Thus, the bullying detection algorithm will only run, when an action transition event has been detected. Simulation results show that the combined motion-audio feature vector outperforms separate motion features and acoustic features, achieving an accuracy of 82.4% and a precision of 92.2%. Moreover, with the action transition method, the computation cost can be reduced by half.


We study second-harmonic generation of picosecond pulses in bulk periodically poled lithium niobate using an all-semiconductor master oscillator-power amplifier with gain-switched seed as our fundamental source. Both during amplification and during the subsequent second-harmonic generation, the signal pulse shape improves, and the resulting pulses at 531 nm are nearly independent of the seed pump conditions. Over a wide range of repetition rates and seed settings, we obtain green pulses with a duration of less than 31 ps FWHM and a peak power of more than 5.1 W. We further investigate the influence of the fundamental's spectral dynamics on pulsed second-harmonic generation efficiency and obtain excellent agreement between our measurements and previously published theoretical treatments.


The remuneration of Australian authors has been decreasing over the last few decades, partly due to unfair contracts between authors and publishers. At the same time, Australian copyright law appears to do nothing to address the problem. The freedom of contract doctrine that still prevails in Australian copyright contract law is not able to tackle the problem of unfair distribution of revenues effectively, and its shortcomings are not well addressed by either general contract law doctrines or collective bargaining in the publishing sector. This article argues that Australia should consider addressing the problem by introducing certain rights inalienability restrictions in copyright law that are available in a number of jurisdictions overseas. The article discusses the rationales of introducing such provisions under Australian copyright law, such as unequal bargaining power, the prediction problem, fairness and utilitarian approaches. It counters the arguments that alienability restrictions are ineffective, and refers to the most recent empirical studies that show the ability of some alienability provisions to increase author remuneration.


— Knee Osteoarthritis (OA) is one of the most prominent diseases in an ageing society and has affected over 10 million people in Thailand. When people suffer from OA, it is very difficult to recover. Therefore, early detection and prevention are important. The typical way to detect OA is by using X-ray imaging. This research study is focused on early detection of OA by applying image processing and classification techniques to knee X-ray imagery. The fundamental concept is to find a region of interest, use feature extraction techniques and build a classifier that can classify between OA or non-OA imageries. There are four regions of interest obtained from each image: (i) Medial Femur (MF), (ii) Lateral Femur (LF), (iii) Medial Tibia (MT), and (iv) Lateral Tibia (LT). The ten texture analysis techniques are then adopted to generate the embedded properties of the bone surface. Once the feature vector has been generated the variety of techniques of machine learning mechanisms are applied to generate the desired classifiers, which can be used to distinguish between OA and non-OA images. From the conducted experiments, a total of 131 images (68 OA cases and 63 non-OA cases) was used, the results obtained show that LF region with Local Binary Pattern descriptor produced the most appropriate classifier with an AUC value of 0.912.


Exceptional sea ice conditions occurred in the West Antarctic Peninsula (WAP) region from September 2001 to February 2002, resulting from a strongly positive atmospheric pressure anomaly in the South Atlantic coupled with strong negative anomalies in the Bellingshausen-Amundsen and southwest Weddell Seas. This created a strong and persistent north-northwesterly flow of mild and moist air across the WAP. In situ, satellite, and NCEP-NCAR Reanalysis (NNR) data are used to examine the profound and complex impact on regional sea ice, oceanography, and biota. Extensive sea ice melt, leading to an ocean mixed layer freshening and widespread ice surface flooding, snow-ice formation, and phytoplankton growth, coincided with extreme ice deformation and dynamic thickening. Sea ice dynamics were crucial to the development of an unusually early and rapid (short) retreat season (negative ice extent anomaly). Strong winds with a dominant northerly component created an unusually compact marginal ice zone and a major increase in ice thickness by deformation and over-rafting. This led to the atypical persistence of highly compact coastal ice through summer. Ecological effects were both positive and negative, the latter including an impact on the growth rate of larval Antarctic krill and the largest recorded between-season breeding population decrease and lowest reproductive success in a 30-yr Adelie penguin demographic time series. The unusual sea ice and snow cover conditions also contributed to the formation of a major phytoplankton bloom. Unexpectedly, the initial bloom occurred within compact sea ice and could not be detected in Sea-Viewing Wide Field-of-View Sensor (SeaWiFS) ocean color data. This analysis demonstrates that sea ice extent alone is an inadequate descriptor of the regional sea ice state/conditions, from both a climatic and ecological perspective; further information is required on thickness and dynamics/deformation.


The '5 Principles of good sleep health' are proposed (a) to facilitate improved public health engagement with the importance of looking after your sleep; and (b) to offer a first line intervention for people with poor sleep and mild insomnia symptoms, that goes beyond the scope of what is traditionally known as 'sleep hygiene'. The '5 Principles' were developed by the author for the UK National Health Service (NHS) campaign 'Every Mind Matters', initiated in 2020 by Public Health England, and supported by the Mental Health Foundation. The author served as the campaign spokesperson for sleep as a critical ingredient in mental wellbeing. The '5 Principles' encourage people to Value, Prioritise, Personalise, Trust, and Protect their sleep. They are intended to educate about sleep health and to support evidence‐based self‐management of sleep, and not as an alternative to cognitive behavioural therapy (CBT) which is the guideline treatment for chronic insomnia disorder. However, they may bridge an important gap in self‐care practices for many people. The '5 Principles' would benefit from formal research evaluation.


Three cross‐shelf transects were conducted off northern Oregon in February, 2003, coincident with flooding of Coast Range rivers, to assess the riverine impact on coastal ocean biogeochemistry. During downwelling conditions, low salinity river‐influenced water was located in a narrow band near the coast and contained elevated macronutrient, iron, and organic carbon concentrations. Wind relaxation allowed the river‐influenced water to spread out at the surface across the shelf. Nutrients supplied by the rivers could result in winter carbon fixation equating to ~20% of the summer upwelling carbon fixation if conditions are suitable for phytoplankton growth, which is likely on the basis of recent studies. This implies that wintertime production may be significant and requires further study. Iron supplied by the rivers is sufficient to support the entire summer upwelling production and because downwelling conditions prevail during the winter and minimize cross‐shelf transport, this iron may be retained on the shelf to support the summer phytoplankton blooms. Of the major eastern boundary current systems, the northern California Current (including Oregon) and Portugal Current (i.e., Iberian Peninsula) have the highest riverine discharge rates normalized to coastline length. In contrast, riverine inputs to the central California, Canary (i.e., northwest Africa), Benguela and Peruvian Current systems averaged only 3‐35% of that in Oregon. This patchy riverine input (and narrower shelves) might explain why iron limitation is more widespread off California and Peru than Oregon. These results show that small coastal rivers, characteristic of the U.S. Pacific Northwest, can significantly alter coastal biogeochemical cycles and influence ecosystem structure.


Some general theorems are derived about spatial coherence properties of a two-dimensional statistically homogeneous source that gives rise to any prescribed angular distribution of radiant intensity. The results are applied to sources that radiate in accordance with Lambert's law. It is found that lambertian sources cannot be spatially strictly incoherent and that they have, in fact, certain unique coherence properties. This result is illustrated by calculations for a blackbody source. The idealized case of a spatially completely incoherent source is discussed for comparison.


This study investigates the work of educational interpreters working with D/deaf and hard of hearing (DHH) students who are refugees or immigrants. This investigation occurs at the intersection of several fields of study: American Sign Language (ASL) interpreting, Deaf education, and immigrant and refugee education. Despite the overlap in these fields found in interpreters' work with DHH refugee and immigrant students, to date no research has studied this work. This pilot study, conducted through four interviews of interpreters working in K-12 settings with DHH refugees and immigrants, explores the current practices of these interpreters in these settings. These practices are current practices and are not to be considered best practices. Interviews focus on the strategies interpreters use, as well as the decision-making processes behind these strategies. Results from this study suggest that interpreters use communication with the educational team, frequently outside of interpreting, with the goals of a) problem-solving and collaborating, b) following or making alterations to the IEP, and c) fostering student-teacher relationships. Interpreters also use communication strategies with DHH refugee and immigrant students during and outside of interpreting, including a) modifying the interpreter's language use, b) taking on additional responsibilities, c) establishing and maintaining relationships with students, d) monitoring student comprehension, e) fostering students' self-esteem, and f) encouraging communication with parents in order to foster DHH refugee and immigrant students' linguistic, academic, social, and emotional growth. The interpreters in this study also communicate with DHH refugee and immigrant students' peers and use interpreting strategies to facilitate interactions with DHH refugee and immigrant students and educators or peers. Interpreters use these strategies to foster the growth and success of DHH refugee and immigrant students in K-12 environments.


Asthma is the most common chronic illness among children in the United States, and families who have a child with asthma face daily challenges to maintaining a normal family life. A descriptive, cross-sectional study was performed that studied four risk factors and four protective factors derived from the literature that impact these families, in order to better understand how nurses can meet the health care needs of the children with asthma and their families. Knafl's (1990, 1996) family management styles framework was applied as the theoretical framework of the study, and the concept of normalization was measured using the Family Management Measure (FaMM). The sample consisted of 43 parent dyads that had a child with asthma, who answered questions about their family, the child's asthma, and various dimensions of managing daily life with an ill child. Regression models were generated to determine the effect of the risk and protective factors on the outcome variable of normalization. The maternal and paternal scores on the FaMM were compared and were significantly correlated (r= 0.532, n < 0.001), while also exhibiting a significant difference in mean scores (t = 2.73, p = 0. 009). The risk factor of asthma severity had a statistically significant effect on family normalization. Based on study findings, nurses should assess for differences between parents in managing their child's asthma. Also, nurses should increase interventions for the child who has severe asthma because the child and family are at increased risk for difficulty in achieving normalization. Recommendations are made to perform studies that include children with other chronic illnesses and to include a wider variety of family configurations.


The Balloon-borne Large Aperture Submillimeter Telescope (BLAST) has recently surveyed ≃8.7 deg2 centered on Great Observatories Origins Deep Survey-South at 250, 350, and 500 μm. In Dye et al., we presented the catalog of sources detected at 5σ in at least one band in this field and the probable counterparts to these sources in other wavebands. In this paper, we present the results of a redshift survey in which we succeeded in measuring redshifts for 82 of these counterparts. The spectra show that the BLAST counterparts are mostly star-forming galaxies but not extreme ones when compared to those found in the Sloan Digital Sky Survey. Roughly one quarter of the BLAST counterparts contain an active nucleus. We have used the spectroscopic redshifts to carry out a test of the ability of photometric redshift methods to estimate the redshifts of dusty galaxies, showing that the standard methods work well even when a galaxy contains a large amount of dust. We have also investigated the cases where there are two possible counterparts to the BLAST source, finding that in at least half of these there is evidence that the two galaxies are physically associated, either because they are interacting or because they are in the same large-scale structure. Finally, we have made the first direct measurements of the luminosity function in the three BLAST bands. We find strong evolution out to z = 1, in the sense that there is a large increase in the space density of the most luminous galaxies. We have also investigated the evolution of the dust-mass function, finding similar strong evolution in the space density of the galaxies with the largest dust masses, showing that the luminosity evolution seen in many wavebands is associated with an increase in the reservoir of interstellar matter in galaxies.


Many Heusler-like compounds as well as elemental Fe show large spin polarization in their bulk phase, which makes them possible candidates for spintronic applications. However, it has turned out that the magnetic properties may change significantly if the ferromagnet is grown on a semiconductor. Here, we investigate from first principles the magnetic properties of thin Fe, Fe3Si, and Heusler films on GaAs(110) and MgO(001) substrates, which show rather flat interfaces due to the absence of reconstruction. We observe high spin polarization for the Fe containing systems and both Heusler alloys considered here, even for ultra thin layers. These systems are mainly unaffected by the substrate.


Background: Internet is regarded as one of the most indispensable parts in our life, and majority of young and adolescent people interested in the usage of it, but in some cases, these uses are become out of the control which later on lead to a condition called internet addiction in which it will be the predominant life activity. Objective: A descriptive cross-sectional study was conducted on Kirkuk Technical Institute students from January 1, 2017, to May 30, 2017 to study, if there is any relation between the occurrence of depression and internet usage. Materials and Methods: The total number of students included in the study was 550 from different scientific departments after distributing a special questionnaire form prepared for that purpose, and face-to-face interview was conducted after receiving the written consent from them. Results: The study results show that 60.8% of technical study students and 47.3% of students from administrative departments used internet daily, while 46.0% of students of health department used it weekly. In addition to that 72.1% and 67.8% male students from technical and administrative departments used internet daily, while female students from all departments (technical, administrative, and health) used the internet monthly; in addition to that 53.1% of students from administrative departments have a depressive attempts which affects daily activity and work in comparison to 18.5% of students from technical departments. Conclusion: The study concluded that the time spent for internet was about 7–9 h/daily with the presence of a suggestive depressive symptom which affects daily activity and work. Recommendations: The study recommended that further advanced educational programs about the main adverse effects of the internet and the main possible ways to control its usage.


Accurately capturing the observed mean period of ENSO in general circulation models (GCMs) is often challenging, and it is therefore useful to understand which parameters and processes affect this period. A computationally efficient simulation-based approach is used to extract both the dominant eigenvalues and corresponding eigenvectors of the linearized model from the Zebiak–Cane intermediate-complexity model of ENSO without having to directly construct the linearization. The sensitivity of the period to a variety of parameters is examined, including atmosphere–ocean coupling, atmospheric heating parameterization, thermocline depth zonal profile, western boundary reflection coefficient, atmospheric and ocean wave speeds or Rossby radii of deformation, ocean decay time, and the strength of the annual cycle. In addition to the sensitivity information, the spatial structures of the main fields (SST, thermocline thickness, and more) that are involved in period changes are obtained to aid in the physical interpretation of the sensitivities.

There are three main time lags that together compose one-half of a model ENSO period: the Rossby-plus-Kelvin wave propagation time for a wind-caused central Pacific disturbance to propagate to the western ocean and back, SST dynamics that determine the lag between eastern ocean thermocline anomalies and eastern ocean SST anomalies, and the "accumulation" lag of integrating a sufficient delayed wave signal arriving from the western ocean to cancel the eastern ocean anomalies. For any of the parameter changes considered, the eigenvector changes show that the largest contributor to the period change is from changes to the last of these three mechanisms. Physical mechanisms that affect this accumulation delay are discussed, and the case is made that any significant change to ENSO's period is in turn likely to involve changes to this delay.


This report, on the planing and get-away characteristics of the F-5-L, gives the results of the second of a series of take-off tests on three different seaplanes conducted by the National Advisory Committee for Aeronautics at the suggestion of the Bureau of Aeronautics, Navy Department. The single-float seaplane was the first tested and the twin-float seaplane is to be the third. The characteristics of the boat type were found to be similar to the single float, the main difference being the increased sluggishness and relatively larger planing resistance of the larger seaplane. At a water speed of 15 miles per hour the seaplane trims aft to about 12 degrees and remains in this angular position while plowing. At 2.25 miles per hour the planing stage is started and the planing angle is immediately lowered to about 10 degrees. As the velocity increases the longitudinal control becomes more effective but over control will produce instability. At the get-away the range of angle of attack is 19 degrees to 11 degrees with velocities from the stalling speed through about 25 per cent of the speed range.


Clonal plants are prevalent in wetlands and play important roles in maintaining the functions of the ecosystem. In the present study, we determined the effect of clone sizes (R1, R2, and R3 comprising 1, 3, and 5clumping ramets) on the tolerance of Carex brevicuspis growing under 30-cm-deep water to three different periods (one, two, and three months) of submergence and its growth recovery one month after de-submergence. Our results showed that the relative growth rate (RGR) of C. brevicuspis significantly declined with increasing submergence time, and was higher in R3 and R5 than in R1 plants under both submergence and post-submergence conditions. The concentration of water-soluble carbohydrates (WSCs) was highest in R3, intermediate in R5, and the lowest in R1 plants during the first two months of submergence, indicating an optimal trade-off between energy investment and vegetative growth ( i.e. , buds and ramets production) in C. brevicuspis. WSCs were significantly reduced with increasing submergence time, while the starch content was significantly reduced only during the third month of submergence, implying that WSCs were a direct energy source for C. brevicuspis during submergence. The number of buds was higher in R5 than in R3 and R1 plants after two and three months of submergence, which directly resulted in a significantly higher post-submergence ramet production in R5 plants. These results indicated that plants with relatively larger clone sizes display better tolerance to submergence stress and post-submergence growth recovery. Therefore, we speculate that the large clone size in C brevicuspis might be an effective adaptive mechanism to survive under submergence stress in floodplain wetlands.


The primary sequences of the three individual glycoprotein (GP) chains, GPIb alpha, GPIb beta, and GPIX, comprising the normal platelet GPIb/IX receptor for von Willebrand factor (vWF) have recently been determined, opening the possibility for characterization of disorders of this receptor at the molecular level. The presence of a leucine tandem repeat in each of these chains is of particular interest, because such repeats may be involved in associations between polypeptide segments. We now report an autosomal dominant variant of Bernard-Soulier disease associated with the heterozygous substitution of phenylalanine for a highly conserved leucine residue within the GPIb alpha leucine tandem repeat. Affected individuals experienced a moderate bleeding tendency, thrombocytopenia, and an increased mean platelet volume. Platelet aggregation was decreased only in response to ristocetin or to asialo-vWF. The kd for 125I-vWF binding to patients platelets was significantly increased over control values at 0.5 mg/mL ristocetin, but was normal at 1.0 or 1.5 mg/mL ristocetin. While sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed an essentially normal complement of all components of the GPIb/IX complex, a minor amount of a putative proteolytic fragment was identified that migrated faster than GPIb and was immunoreactive with polyclonal anti-GPIb alpha antibody, but not with a monoclonal antibody directed against the 45-Kd amino-terminal region of GPIb alpha. However, because the great majority of patient GPIb alpha comigrates with normal GPIb alpha, the major functional abnormalities of the patient platelets are most likely a consequence of the altered structure of the nonproteolyzed protein. Full concordance within the studied family between phenotypic expression and a heterozygous single nucleotide substitution in genomic DNA coding for a phenylalanine in place of the wild-type leucine at residue 57 of the mature GPIb alpha, absence of this substitution in 266 alleles from the normal population, and the lack of any other abnormality of patient DNA throughout the entire coding sequence for GPIb alpha provide strong support that this substitution may constitute a pathologic point mutation responsible for the observed phenotypic abnormalities. While the roles that leucine tandem repeats may normally play within the GPIb/IX complex are not yet known, the perturbation of such a repeat in GPIb alpha may impair interaction with other components of the complex and/or with the binding of vWF.


Lipolytic enzymes have received huge attention due to their crucial role in lipid metabolism and as potential pharmacological targets against obesity and its related disorders. Non-alcoholic fatty liver disease (NAFLD) is highly associated with obesity and today, NAFLD is considered to be the most common chronic liver disorders worldwide.1 The NAFLD pathology covers a wide spectrum of changes, ranging from simple steatosis to non-alcoholic steatohepatitis, progressive fibrosis/cirrhosis and hepatocellular carcinoma (HCC). The underlying mechanisms, particularly those that drive disease progression, are only incompletely understood.1 Central drivers appear to be quantitative and qualitative alterations in lipid metabolic pathways in hepatocytes.1 2 In addition, the impact of altered lipid metabolism in non-parenchymal liver cells and immune cells is increasingly recognised.1 3 Importantly, lipids are stored within the cells and act as signalling molecules or precursors thereof, which further enhances the level of complexity how alterations in the lipid metabolism affect the course of obesity-related diseases.

In this regard, monoacylglycerol lipase (MAGL) plays a particularly critical role.4 In the 70th of the last century, MAGL was originally purified from adipose tissue, where it was found to be most abundant besides the brain and the liver.4 Traditionally, MAGL functions as a key lipolytic enzyme in the mobilisation of lipid stores for energy supply or lipid synthesis. MAGL is the rate-limiting enzyme in the hydrolysis of monoacylglyerides (MG) into glycerol and fatty acids. MGs are intermediary lipids deriving from the degradation of phospholipids and neutral lipids. In addition to its role in MG metabolisms, MAGL is a critical component of the endocannabinoid system, as it is catalysing the hydrolysis of 2-arachidonoyl glycerol (2-AG), the most abundant endogenous agonist of cannabinoid receptors in the body. Furthermore, 2-AG is an important source for arachidonic …


Using in vivo microdialysis, the caudate and nucleus accumbens dopamine (DA) responses to the psychomotor stimulants amphetamine (AMPH), cocaine (COC), and fencamfamine (FCF) were evaluated in rats concurrent with characterization of their behavioral response profiles. Doses of each stimulant that produced either enhanced locomotion or a prolonged period of intense focused stereotypies were examined to evaluate the quantitative relationships between stimulant-induced behaviors and changes in DA dynamics and to test the hypothesis that a balance between mesostriatal and mesolimbic DA activity contributes to the appearance of specific stimulant-induced behaviors. Although 10 mg/kg COC and 1.7 mg/kg FCF promoted levels of locomotor activity substantially greater than 0.5 mg/kg AMPH, the magnitude of the DA increases in both caudate and accumbens were markedly less than was obtained following AMPH. Thus, stimulant-induced locomotion appears to be dissociated from the quantitative DA response in both brain regions. This behavioral/DA dissociation was also apparent at higher doses of AMPH (2.5 mg/kg), COC (40 mg/kg), and FCF (6 mg/kg), doses that promoted a behavioral pattern that included a prolonged period of intense stereotypy. Indeed, the regional DA responses to these high doses of COC and FCF were substantially less than the response to 0.5 mg/kg AMPH. Furthermore, there were no differences in the ratio of the caudate and accumbens DA responses as a function of dose for any of the three drugs. Thus, the balance between the regional DA activation does not appear to regulate the expression of the behavioral response. Additionally, the effects of these stimulants on regional DA metabolite concentrations were compared. The results indicate that AMPH promoted an identical pattern of effects on caudate and accumbens DA metabolites, suggesting that similar mechanisms govern the dynamics of DA in response to AMPH in both brain regions. In contrast, the DA uptake blockers promoted some region-specific effects on DA metabolites that may be due to regional differences in the DA metabolism and rates of impulse flow.


Education has been the platform of many individuals in and out of politics. Often, the topic is focused on school test scores, student achievement, and the demand for highly qualified teachers in the classroom. The No Child Left Behind legislation mandates school systems to adhere to a curriculum that promotes academic growth. Therefore, teachers must incorporate strategies that will lead to increased academic performance. This applied quantitative study makes a comparison between two distinct instructional methods: Multiple Intelligence (MI) and Direct Instruction (DI). The current research examines how these methods affect the achievement scores in Mathematics. The results suggest that performance on a post mathematics assessment for students exposed to MI will show considerable increase when compared to those taught using DI. ********** Currently a new definition applied to the word learning is one that recognizes the components of cognition, philosophical, and multicultural research. According to this definition, meaningful learning occurs when a learner has a knowledge base which when used with fluency, can make sense of the world, problem solving, and decision making (Denig, 2004). A curriculum that supports this perception is one that has a dual agenda consisting of content and process. This curriculum includes in-depth learning; involves student in real-world, relevant tasks; engages students in holistic tasks; utilizes students' prior knowledge (Kulieke, et al., 1990). Compared to the educational beliefs of previous generations, there is a shift in the theory, methods, and practices as it relates to educating children. It has been established that children develop and learn differently; therefore, it is essential that the strategies employed, reflect the changing view points. There are two types of pedagogy discussed in this study, namely Multiple Intelligence (MI) and Direct Instruction (DI), both of which have been shown to enhance the academic experiences of students across all content areas. Statement of the Problem The problem of the current research was to determine whether Middle Grades students achieve higher mathematics scores when they are taught using Multiple Intelligence strategies than when they are taught using the traditional Direct Instructional method. Subsequently, the aim of this project was to summarize and evaluate the subset of literature that has special relevance to the comparison of Multiple Intelligence and Direct Instruction. The standard course of study, the formal curriculum guide for the content areas of North Carolina (for any subject area) does not provide teachers with a list of methods they can use to adhere to the guidelines of the curriculums' goals and objectives. Therefore, the methods discussed in this research represent the trial and errors of one teacher who was trying to find a more proficient and effective method of facilitating learning in their content area. Review of Related Literature History of intelligence According to Traub (1998), intelligence is not a crisp concept, but a term of value. Theories about intelligence, but more specifically, general intelligence, have been the focus of discussion since the early twentieth century. For all intent and purposes, general intelligence, as defined in 1904 by Charles Spearman, is the kind of intelligence that is used to an extent in all intellectual tasks; it is what is supposedly measured by standardized tests, such as IQ tests and the SATs (Standard intelligence vs. multiple intelligences). Kaplan & Saccuzzo (2001), define intelligence as the general potential, independent of prior knowledge. Individuals such as Howard Gardner, the creator of multiple intelligence, has challenged the notion that intelligence is merely a score made on a typical standardized pencil-and-paper test used to predict success in school. As stated by Gardner, intelligence is the "biopsychological potential to process information that can be activated in a cultural setting to solve problems or create products" (Denig, 2004). …


The energy spectrum of the neutron emission from beam–target reactions in fusion plasmas at the Joint European Torus (JET) has been investigated. Different beam energies as well as injection angles were used. Both measurements and simulations of the energy spectrum were done. The measurements were made with the time-of-flight spectrometer TOFOR. Simulations of the neutron spectrum were based on first-principle calculations of neutral beam deposition profiles and the fast ion slowing down in the plasma using the code NUBEAM, which is a module of the TRANSP package. The shape of the neutron energy spectrum was seen to vary significantly depending on the energy of the beams as well as the injection angle and the deposition profile in the plasma. Cross validations of the measured and modeled neutron energy spectra were made, showing a good agreement for all investigated scenarios.


This paper employs a DEA-type Malmquist index approach to evaluate the impact of financial liberalization on the productivity changes of public, private and foreign banks in Turkey during the period between 1981 and 1990. The results indicate that all forms of banks have benefited from financial liberalization. However, foreign banks were found to be the most productive, followed by private banks and public banks respectively. The major source of productivity gains is scale changes for public and private banks and technical progress for foreign banks. It also seems that productivity growth indices of all banks converge towards the end of liberalization period.


The modified method of estimation of the resistance of block ciphers to truncated byte differential attack is proposed. The previously known method estimate the truncated byte differential probability for Rijndael-like ciphers. In this paper we spread the sphere of application of that method on wider class of ciphers. The proposed method based on searching the most probable truncated byte differential characteristics and verification of sufficient conditions of effective byte differentials absence.


Single-node leafy cuttings of sweetpotato [Ipomoea batatas (L.) Lam. cv. Beniazuma] plants can be used to produce low-cost, pathogen-free sweetpotato plug transplants. This study was conducted to determine the effects of plug volume and root removal on sweetpotato growth and yield after planting in the field. The yield and growth of sweetpotato plants from transplants with 4 to 6 unfolded leaves (about 0.14-m shoot length) produced in 55- or 35-mL multicell plug trays, then planted intact or without roots were compared with a control treatment of unrooted conventional cuttings (about 0.3-m-long terminal vine cutting with 7 to 8 unfolded leaves). The plug transplants were grown from single node leafy cuttings under artificial light. Intact plug transplants (35 or 55 mL) produced 39 to 40 Mg ha -1 of storage roots 128 d after planting in the field, 11 to 12 Mg ha -1 greater than the control treatment. After 128 d of field growth, plug transplants (35 mL, with roots) gave a percent harvest index of 79%, 7% greater than the control. The maximum length and diameter of storage roots were, respectively, 271 and 68 mm when plug transplants were used (35 mL, with roots), and were, respectively, 58 mm longer and 18 mm wider than the control. Overall, growth and yield from plug transplants were significantly higher than from conventional cuttings, regardless of the plug volume or root removal. Plug transplants with intact roots produced greater growth and yield regardless of plug volume than did plug transplants without roots.


Background: Clinical trials aimed at shortening the time-to-discharge need to have rational and easily understood effect size estimates for health care management organizations. A natural choice is a scale model, where the distribution of time to discharge on one treatment is assumed to be the same as ρ times that on the other. If, for example ρ=0.6, then one treatment is associated with a 40% reduction in discharge time. In designing and analyzing these studies, we need to have the capability to accommodate right censored data, as it is plausible that some patients may never meet the discharge criteria, even though they do get discharged. Purpose: Utilizing the ideas of Hodges and Lehmann, to provide methods for analysis of trials aimed at shortening hospital discharge times, using point and interval estimates of scale parameters based on the Gehan generalization of the Mann—Whitney—Wilcoxon test, which accommodates right censoring for situations where patients never meet discharge criteria (+∞). Methods: For every value of ρ > 0, we shall test the null hypothesis that the distribution of discharge times on one treatment is the same ρ times that on the other. The values of ρ that we fail to reject form the confidence interval for the true ρ. Results: The methods were developed and applied to a real clinical trial for times to meet the three objective discharge criteria in knee replacement surgery for two post-operative pain control strategies (usual care plus a perineural infusion of either placebo or 0.2% ropivocaine, until the morning following surgery). Based on 48 randomized patients, the point estimate (95% confidence limits) for ρ was 0.47 (0.32—0.67), favoring ropivocaine. Limitations: The methods cannot as yet be applied to group sequential designs or studies with more than two treatments. Conclusion: This methodology is an effective way to analyze two-arm trials involving continuous hospital discharge time data.


The working state of lithium-ion batteries must be estimated accurately and efficiently in the battery management system. Building a model is the most prevalent way of predicting the battery's working state. Based on the variable order equivalent circuit model, this paper examines the attenuation curve of battery capacity with the number of cycles. It identifies the order of the equivalent circuit model using Bayesian Information Criterion (BIC). Based on the correlation between capacity and resistance, the paper concludes that there is a nonlinear correlation between model parameters and state of health (SOH). The nonlinear autoregressive neural network with exogenous input (NARX) is used to fit the nonlinear correlation for capacity regeneration. Then, the self-adaptive weight particle swarm optimization (SWPSO) method is suggested to train the neural network. Finally, single-battery and multi-battery tests are planned to validate the accuracy of the SWPSO-NARX estimate of SOH. The experimental findings indicate that the SOH estimate effect is significant.


Phenol formaldehyde (PF) resin has been extensively used in various branches of industry as adhesive especially in the production of wood-based panels. However, due to the use of expensive and limited petroleum-based phenol in its formulation, there is a strong interest to explore renewable biomass material to partially substitute the phenol. In this work, slow pyrolysis was used to convert oil palm frond into bio-oil. From there, the phenol-rich fraction of the bio-oil was separated and added into the formulation of PF resin to produce an economical and environmental-friendly type of PF resin, known as bio-oil-phenolformaldehyde (BPF) resin. Rhizophora particleboard was then fabricated with the BPF resin as adhesive. The particleboard was found to display excellent mechanical and physical properties with satisfactory formaldehyde emission. A morphological study of the particleboard also supported previous findings. The corresponding atomic number of the particleboard obtained from the morphological study was compared with those of water phantom and a fascinatingly favourable similarity was observed. This finding, hence, proposed a novel higher value-added application of the Rhizophora particleboard which has been largely researched as a potential phantom material in diagnostic radiography.


The newly identified goldsmiths' works of East Prussia are presented in the article: a chalice from Kaunas St. Cross Church forged by Otto Schwerdfeger, a master in Konigsberg, in 1704 (?), a ciborium from Vilnius St. Apostles Peter and Paul Church made by goldsmith Johann Kownatzky in Tilsit in the 1760–80s, and a monstrance from Valakbūdis Church made by Michael Greiffenhagen II, a master from Tilsit, in 1795 (?). After the World War II, East Prussia was annexed by the Soviet Union. Destruction of the region and its historical memory and enormous losses of the cultural heritage partly resulted in knowledge gaps in Lithuania about the goldsmithing in this region. For the knowledge of goldsmith history in East Prussia, works by Eugen von Czihak, a German scientist, based on the information collected before the First and Second World Wars are very important. The goldsmithing of Eastern Prussia is pretty seldom mentioned in the Lithuanian historiography. Only sparsely survived works by Konigsberg, Tilsit and Klaipėda (Memel) masters from the 17th – 19th century have been published. On the contrary, the context of Lithuanian goldsmith history is described based on data provided by the German writings. According to our knowledge, the goldsmith heritage from Konigsberg predominates in Lithuania. Not a few goldsmith works from Tilsit were also identified in Lithuania. The works of Eastern Prussian goldsmiths are of particular value. Because of the dramatic fate of Konigsberg region, the survived number of goldsmith works throughout Europe is relatively low.


The aerosol water content and volumetric growth factors of fine particulate matter were measured during July-August 2001 and January-June 2002 in an urban park about 6 km from downtown Pittsburgh, Pennsylvania. Most of the aerosol during the study was transported to the region from other areas, and its composition and concentration were characteristic of the regional particulate matter in the northeastern United States. During the summer months the ambient aerosol practically always contained water even when the relative humidity (RH) was as low as 30%. In contrast, during the winter the aerosol was dry below 60% RH. The spring months were characterized by a transitional behavior between these two states. The observed seasonal behavior can be explained by the aerosol acidity. The summer aerosol was acidic and retained water at low RH. The winter aerosol was neutral and became wet when the relative humidity reached the deliquescence point of ammonium nitrate. The observations during July 2001 were compared with the predictions of the thermodynamic Gibbs Free Energy Minimization (GFEMN) model and the aerosol inorganics model (AIM), neglecting the organic aerosol contribution to water absorption. The models under-predicted water concentrations by about 35%, but no clear correlation between organic mass and the excess water was observed. On average, the contribution of the organics to water absorption appeared to be higher during the afternoon hours and when the aerosol was presumably more oxidized.


Japan experienced a boom-and-bust cycle in the real estate and stock markets almost 20 years earlier than Europe. Since the bursting of the Japanese bubble economy, the country has fallen into a deep recession and has experimented with crisis therapies in the form of unconventional monetary expansion, Keynesian fiscal stimulus, and recapitalization of financial institutions. Japan reached a low interest rate environment in the mid 1990s and has accumulated an exceptionally high level of public debt during more than two decades of economic stagnation. This paper compares the boom-and-bust cycles in Japan and Europe with respect to the reasons for excessive booms, the characteristics of the crises, and the (potential) effects of the crisis therapies. It is argued that in both Japan and Europe the consequences of expansionary monetary and fiscal policies include the hysteresis of a low-interest rate and high government debt environment, the erosion of the allocation and signaling functions of the interest rate, the gradual quasi-nationalization of financial institutions, as well as gradual real income losses. The economic policy implication for Europe and Japan is the timely exit from crisis therapies in the form of excessively expansionary monetary and fiscal policies.


Objective This analysis was undertaken to determine how the data completeness, consistency, and other attributes of our local syndromic surveillance program compared to the National Syndromic Surveillance Platform. Introduction In 2005, the Cook County Department of Public Health (CCDPH) began using the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) as an emergency department (ED)-based local syndromic surveillance program (LSSP); 23 (100%) of 23 hospitals in suburban Cook County report to the LSSP. Data are transmitted in delimited ASCII text files (i.e., flat files) and contain a unique patient identifier, visit date and time, zip code, age, sex, and chief complaint. Discharge diagnosis and disposition are optional data elements. Prior to 2017, the Illinois Department of Public Health placed facilities participating in the Cook LSSP in a holding queue to transform their flat file submissions into a HL7 compliant message; however as of 2017, eligible hospitals must submit HL7 formatted production data to IDPH to fulfill Meaningful Use. The primary syndromic surveillance system for Illinois is the National Syndromic Surveillance Program (NSSP), which transitioned to an ESSENCE interface in 2016. As of December 2016, 20 (87%) of 23 hospitals reporting to the LSSP also reported to IDPH and the NSSP. As both syndromic surveillance systems aim to collect the same data, and now can be analyzed with the same interface, CCDPH sought to compare the LSSP and NSSP for data completeness, consistency, and other attributes. Methods Our comparison of NSSP to the LSSP focused on data completeness for key demographic and medical variables and consistency in total visit counts. Analysis of completeness utilized data from December 2016 for 20 hospitals contributing HL7 production data to IDPH at that time. Total visit counts in both systems were compared for the same 20 hospitals from February 5 th -11 th 2017, a randomly chosen time period. A target threshold of less than 3% difference in total visit counts was set by the CCDPH system users. Analysis was completed in Microsoft Excel 2010. Other attributes of the surveillance systems were qualitatively assessed by the primary system users at CCDPH. Results All variables required by the LSSP had 98-100% completeness in both the LSSP and NSSP (unique patient identifier, age, sex, zip code, visit time and date, and chief complaint). However, the LSSP optional data elements, discharge diagnosis and discharge disposition, were less complete in the LSSP, compared to the NSSP (Diagnosis: 56% versus 83%, Disposition: 66% versus 80%). Among variables required for NSSP reporting but not reported to the LSSP, completeness ranged from 100% (race, ethnicity) to 82% (county). Optional data elements within NSSP ranged in completeness from 73% (initial pulse oximetry) to 0% (initial blood pressure, insurance coverage). Of the 20 hospitals evaluated for visit counts, only one hospital had 3% difference in visit counts on all seven days. Average seven day differences for hospitals ranged from 0% to 54%. Eighteen (90%) of 20 hospitals were reporting larger numbers of visits to NSSP than to the LSSP. Conclusions Overall completeness of data was similar between the national and our local ESSENCE systems with most required variables having over 98% completeness. NSSP had higher completeness over the LSSP for discharge diagnosis and disposition. Additional data elements required by NSSP, but unavailable in the LSSP, had similarly high completeness but optional NSSP variables of interest showed greater variability in reporting. Differences in visit counts were higher than expected. An ongoing exploration of these differences has shown they are multifaceted and require hospital-specific interventions. There are strengths and limitations to both the NSSP and LSSP. CCDPH has direct control over data sharing between jurisdictions in the LSSP and there has historically been less system "down time" in the LSSP compared to the NSSP; however, the use of flat files instead of HL7, as well as having fewer incentives for hospital participation (e.g. Meaningful Use) after 2016, results in limited data collection and stagnant growth compared to the NSSP. Jurisdictions using their own LSSPs should consider analyzing their data completeness, consistency, and quality compared to the NSSP.


Objectives To assess the knowledge of members of the Royal College of General Practitioners (RCGP) on veteran's health issues, assess present support, and establish what support is required for GPs when treating veterans. Methods An electronic survey of RCGP members across selected faculties. Results Forty-seven per cent of respondents were 'unsure' or 'didn't know' how many veterans they were responsible for. However, many GPs replied that they had seen a veteran in the last month. Only 7.9% of respondents used the unique Read Code for veterans. Disappointingly, 75% of GPs indicated that they had not seen the RCGP leaflet on veterans' health, and less than 2% had used the RCGP On-Line e-learning resource. Conclusions Surveyed GPs had little understanding of how many veterans were registered with their practice, and only a few had accessed learning resources available. GPs requested more information on how to assess veterans and where they could be referred. Further work is required to identify the true size of the problem, while continuing to provide proactive guidance and support to GPs on the health needs of veterans.


Purpose - – The purpose of this paper is to add to the existing literature by examining a number of hypotheses relating to the capital structure decision in relation to the firms' size, namely by distinguishing among micro, small and medium firms. Design/methodology/approach - – The paper examines the hypothesis that the factors determining capital structure are different for firms belonging to different size groups. The authors use a panel data model capturing the dynamic concept of capital structure. Findings - – The authors find that whereas the size of the firm does affect how much debt a firm will issue, it does not influence the relationship between the other regressors and debt usage. Research limitations/implications - – The paper examines the small and medium enterprises (SMEs). Does not examine the large firms. Practical implications - – During the last decade there has been a gradually increasing interest shown in the field of SMEs. These enterprises represent important parts of all economies in terms of both their total number and their job offer and job creation. For example, in the European Union (EU), in 2005, SMEs accounted for 99.8 percent of the total number of enterprises operating in EU-27, covering 66.7 of total employment in the non-financial business economy sector. Social implications - – This paper relates capital structure decision to firms' size distinguishing them among micro, small and medium firms. Originality/value - – The paper tests differences in capital structure determination among different size groups of enterprises in a dynamic framework for more than one year.


The metabolic pathways of glycolysis and mitochondrial respiration in the corneal endothelial cell are the primary sources of the adenosine triphosphate (ATP) necessary to maintain endothelial structure and pump fluid to maintain the corneal stroma in its normally dehydrated and transparent state. The correlation between endothelial metabolism and morphology in rabbits was studied for 7 days after the application of three different agents: (1) iodoacetamide, used to inhibit ATP synthesis from both glycolysis and respiration; (2) potassium cyanide (KCN), used to inhibit ATP synthesis from respiration only; and (3) ouabain, used to inhibit fluid pumping but not ATP synthesis. After application of each of these three drugs to the corneal endothelium, changes in endothelial morphology were measured. The greatest change resulted from the use of iodoacetamide. Specular microscopic examination of the endothelium after the application of iodoacetamide showed progressive degradation of the integrity of the cellular structure; after 6 hr, there were no discernible cell borders. In those corneas treated with either KCN or ouabain, only minor changes in the endothelium were seen during the full 7 days of the investigation. Computer-assisted morphometric analysis showed an increase in the coefficient of variation of both cell area and perimeter in all cases. This increase was greater in the corneas treated with ouabain than those treated with either iodoacetamide or KCN. Redox fluorometry showed that the metabolic ratio (autofluorescence of reduced pyridine nucleotides divided by that of oxidized flavoproteins) decreased significantly in the iodoacetamide-treated corneas, increased significantly in the KCN group, and showed no significant change in the corneas in the ouabain group, all compared with a control group. The results showed that (1) when ATP produced by both glycolysis and respiration was inhibited by 0.1 mmol/l iodoacetamide, the endothelial cells could not survive, but (2) when ATP synthesis produced by respiration alone was inhibited by 1.0 mmol/l KCN, the cells could survive for at least 1 wk on the ATP produced by anaerobic glycolysis. Furthermore, the polymegathism seen after application of ouabain, a drug that is not believed to affect ATP synthesis but inhibits the endothelial pump function, is greater than that seen as a result of reduced pump function caused by inhibited respiration produced by 1.0 mmol/l KCN. Combining specular microscopy, computer-assisted morphometric analysis, redox fluorometry, and corneal pachymetry allowed correlations between corneal endothelial metabolism, pump function, and morphology to be studied.


We consider two hypotheses for the origin of a linear trough extending ∼800 km eastward from the intersection of the Louisville seamount chain with the Tonga-Kermadec trench. An extinct spreading center origin is suggested by the trough's eastward termination at a depth discontinuity that resembles a fracture zone. The morphology of the trough, however, is inconsistent with the morphology of other extinct spreading centers, and these two features do not appear to be connected to a larger paleo-plate boundary on their eastern end. We consider an alternative hypothesis in which the trough may be a recent rift in the Pacific plate. Coupling between a large subducting seamount and the overriding Australian plate may serve as a mechanism to focus stresses and nucleate a rift in the subducting Pacific plate. In this model, the seamount would act as a rigid indenter producing tangential extension in the subducting plate about the region where it is coupled to the overriding plate. Impeded subduction is suggested by a prominent seismicity gap around the subducting seamount. The graben morphology of the trough is also consistent with an extensional origin. If hotspot volcanism can produce obstructions and local weaknesses conducive to plate coupling, stress localization, and nucleation of fractures, it may provide a mechanism for subduction-induced plate reorganizations.


We consider differentiable games where the goal is to find a Nash equilibrium. The machine learning community has recently started using variants of the gradient method (GD). Prime examples are extragradient (EG), the optimistic gradient method (OG) and consensus optimization (CO), which enjoy linear convergence in cases like bilinear games, where the standard GD fails. The full benefits of theses relatively new methods are not known as there is no unified analysis for both strongly monotone and bilinear games. We provide new analyses of the EG's local and global convergence properties and use is to get a tighter global convergence rate for OG and CO. Our analysis covers the whole range of settings between bilinear and strongly monotone games. It reveals that these methods converges via different mechanisms at these extremes; in between, it exploits the most favorable mechanism for the given problem. We then prove that EG achieves the optimal rate for a wide class of algorithms with any number of extrapolations. Our tight analysis of EG's convergence rate in games shows that, unlike in convex minimization, EG may be much faster than GD.


Aims PCR amplicon-based next-generation sequencing (NGS) panels are increasingly used for clinical diagnostic assays. Amplification bias is a well-known limitation of PCR amplicon-based approaches. We sought to characterise lower-performance amplicons in an off-the-shelf NGS panel (TruSight Myeloid Sequencing Panel) for myeloid neoplasms and attempted to patch the low read depth for one of the affected genes, CEBPA. Methods We performed targeted NGS of 158 acute myeloid leukaemia samples and analysed the amplicon read depths across 568 amplicons to identify lower-performance amplicons. We also correlated the amplicon read depths with the template GC content. Finally, we attempted to patch the low read depth for CEBPA using a parallel library preparation (Nextera XT) workflow. Results We identified 16 lower-performance amplicons affecting nine genes, including CEBPA. There was a slight negative correlation between the amplicon read depths and template GC content. Addition of the separate CEBPA library generated a minimum read depth per base across the CEBPA gene ranging from 268x to 758x across eight samples. Conclusions The identification of lower-performance amplicons will be informative to laboratories intending to use this panel. We have also demonstrated proof-of-concept that different libraries (TruSight Myeloid and Nextera XT) can be combined and sequenced on the same flow cell to generate additional reads for CEBPA.


Interstellar Boundary Explorer (IBEX) measurements of energetic neutral atoms (ENAs) from the heliotail show a multi-lobe structure of ENA fluxes as a function of energy between ∼0.71 and 4.29 keV. Below ∼2 keV, there is a single structure of enhanced ENA fluxes centered near the downwind direction. Above ∼2 keV, this structure separates into two lobes, one north and one south of the solar equatorial plane. ENA flux from these two lobes can be interpreted as originating from the fast solar wind (SW) propagating through the inner heliosheath (IHS). Alternatively, a recently published model of the heliosphere suggests that the heliotail may split into a "croissant-like" shape, and that such a geometry could be responsible for the heliotail ENA feature. Here we present results from a time-dependent simulation of the heliosphere that produces a comet-like heliotail, and show that the 11-year solar cycle leads to the formation of ENA lobes with properties remarkably similar to those observed by IBEX. The ENA energy at which the north and south lobes appear suggests that the pickup ion (PUI) temperature in the slow SW of the IHS is ∼107 K. Moreover, we demonstrate that the extinction of PUIs by charge-exchange is an essential process required to create the observed global ENA structure. While the shape and locations of the ENA lobes as a function of energy are well reproduced by PUIs that cross the termination shock, the results appear to be sensitive to the form of the distribution of PUIs injected in the IHS.


Israel's occupation has been transformed in the social media age. Over the last decade, military rule in the Palestinian territories grew more bloody and entrenched. In the same period, Israelis became some of the world's most active social media users. In Israel today, violent politics are interwoven with global networking practices, protocols, and aesthetics. Israeli soldiers carry smartphones into the field of military operations, sharing mobile uploads in real-time. Official Israeli military spokesmen announce wars on Twitter. And civilians encounter state violence first on their newsfeeds and mobile screens.Across the globe, the ordinary tools of social networking have become indispensable instruments of warfare and violent conflict. This book traces the rise of Israeli digital militarism in this global context-both the reach of social media into Israeli military theaters and the occupation's impact on everyday Israeli social media culture. Today, social media functions as a crucial theater in which the Israeli military occupation is supported and sustained.


The unique hybrid nature of 2D Ruddlesden-Popper (R-P) perovskites has bestowed upon them not only tunability of their electronic properties but also high-performance electronic devices with improved environmental stability as compared to their 3D analogs. However, there is limited information about their inherent heat, light, and air stability and how different parameters such as the inorganic layer number and length of organic spacer molecule affect stability. To gain deeper understanding on the matter we have expanded the family of 2D R-P perovskites, by utilizing pentylamine (PA)2(MA) n-1Pb nI3 n+1 ( n = 1-5, PA = CH3(CH2)4NH3+, C5) and hexylamine (HA)2(MA) n-1Pb nI3 n+1 ( n = 1-4, HA = CH3(CH2)5NH3+, C6) as the organic spacer molecules between the inorganic slabs, creating two new series of layered materials, for up to n = 5 and 4 layers, respectively. The resulting compounds were extensively characterized through a combination of physical and spectroscopic methods, including single crystal X-ray analysis. High resolution powder X-ray diffraction studies using synchrotron radiation shed light for the first time to the phase transitions of the higher layer 2D R-P perovskites. The increase in the length of the organic spacer molecules did not affect their optical properties; however, it has a pronounced effect on the air, heat, and light stability of the fabricated thin films. An extensive study of heat, light, and air stability with and without encapsulation revealed that specific compounds can be air stable (relative humidity (RH) = 20-80% ± 5%) for more than 450 days, while heat and light stability in air can be exponentially increased by encapsulating the corresponding films. Evaluation of the out-of-plane mechanical properties of the corresponding materials showed that their soft and flexible nature can be compared to current commercially available polymer substrates (e.g., PMMA), rendering them suitable for fabricating flexible and wearable electronic devices.


ABSTRACT Introduction To combat COVID-19, scientists all over the world have expedited the process of vaccine development. Although interim analyses of clinical trials have demonstrated the efficacy and safety of COVID-19 vaccines, a serious but rare adverse event, thrombosis with thrombocytopenia syndrome (TTS), has been reported following COVID-19 vaccination. Areas covered This review, using data from both peer-reviewed and non-peer-reviewed studies, aimed to provide updated information about the critical issue of COVID-19 vaccine-related TTS. Expert opinion : The exact epidemiological characteristics and possible pathogenesis of this adverse event remain unclear. Most cases of TTS developed in women within 2 weeks of the first dose of vaccine on the receipt of the ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines. In countries with mass vaccination against COVID-19, clinicians should be aware of the relevant clinical features of this rare adverse event and perform related laboratory and imaging studies for early diagnosis. Non-heparin anticoagulants, such as fondaparinux, argatroban, or a direct oral anticoagulant (e.g. apixaban or rivaroxaban) and intravenous immunoglobulins are recommended for the treatment of TTS. However, further studies are required to explore the underlying mechanisms of this rare clinical entity. Plain language summary What is the context? Thrombosis with thrombocytopenia syndrome (TTS) usually develops within 2 weeks of the first doses of the ChAdOx1 nCoV-19 and Ad26.COV2.S COVID-19 vaccines.TTS mainly occurs in patients aged < 55 years and is associated with high morbidity and mortality. What is new? TTS mimics autoimmune heparin-induced thrombocytopenia and can be mediated by platelet-activating antibodies against platelet factor 4. Non-heparin anticoagulants, such as fondaparinux, argatroban, or a direct oral anticoagulant (e.g. apixaban or rivaroxaban) should be considered as the treatment of choice if the platelet count is > 50 × 109/L and there is no serious bleeding. Intravenous immunoglobulins and glucocorticoids may help increase the platelet count within days and reduce the risk of hemorrhagic transformation when anticoagulation is initiated. What is the impact? TTS should be a serious concern during the implementation of mass COVID-19 vaccination, and patients should be educated about this complication along with its symptoms such as severe headache, blurred vision, seizure, severe and persistent abdominal pain, painful swelling of the lower leg, and chest pain or dyspnea. The incidence of TTS is low; therefore, maintenance of high vaccination coverage against COVID-19 should be continued.


We describe the case of a 59-year-old man who had aortic regurgitation and a hypoplastic aortic valve and for whom an echocardiography evaluation revealed a vascular tumor in the roof of the left atrium, which was suspected to be a hemangioma. After undergoing preoperative invasive catheter coronary angiography, echocardiography, and multislice computed tomography examinations, the patient underwent an aortic miniroot replacement. Intraoperative findings confirmed the findings of the preoperative evaluations. The tumor, although macroscopically verified as a hemangioma, was not resected because of the tumor's position and size, and the threat of uncontrollable bleeding. After an uneventful postoperative clinical course, a subsequent successful transcatheter coil occlusion of the coronary fistula from the left circumflex coronary artery was performed as an alternative to surgical resection of the tumor. This case emphasizes the future role of a multimodality hybrid approach for diagnosis, planning (different 2- and 3-dimensional imaging modalities), and treatment in the form of combining interventional (transcatheter) and surgical (open heart) techniques, which could optimize different treatment strategies. This approach could be further improved by increasing the installations of hybrid operating rooms.


Background: Although UK general practice is highly computerised and data from it have been widely used for quality improvement and research in many diseases areas, most data about the prevalence and quality of management of mental illness come from secondary care-based studies. Many of these studies suggest that people with mental health problems have an excess of cardiovascular and respiratory disease. Objective: We carried out this study to determine whether routinely collected general practice data are of sufficient quality to be used for quality improvement, health service planning and research. Setting: Twelve computerised general practices in West Surrey with a combined list size of 117 000 patients. Method: Audit criteria were developed within a primary care research network. A data set was identified which would enable quality of care to be assessed. MIQUEST (Morbidity Information and Export Syntax - a Department of Health-sponsored data extraction application) was used to extract anonymised data, which was transferred to a relational database and then analysed using a statistical package. Results: The standardised prevalence of cardiovascular and respiratory disease for the population was 1.73%. Respiratory disease was more common in people with severe mental illness (SMI); 22.6% had respiratory illness, compared with 16.4%. Patients with SMI and coronary heart disease (CHD) were much less likely to have their cholesterol measured. Low-density lipoprotein cholesterol (LDL) was measured about half as frequently in both groups, with no significant difference found. There was less use of lipid-lowering therapy where only 61.4% of people with SMI and CHD are taking a statin compared with 74.4% of those without (χ2= 0.01.) Mean systolic blood pressure (BP) in people with SMI was 133.6 mmHg. People with SMI and CHD were no more likely to be ex- or current smokers; the percentages of each group who were likely current or ex-smokers were 43.3% and 43.7% respectively. Across all age groups people with SMI were recoaaed as receiving more health promotion advice than people without SMI - advice about smoking, alcohol, diet and exercise. Women with SMI were no more or less likely to have a cervical smear or mammogram performed than those without SMI. Conclusions: General practice data suggest that there may be higher levels of mental health problems than reported in other studies. People with mental health problems have higher levels of cardiovascular and respiratory disease. Although the levels of prevention and screening are lower, people with mental health problems are being advised more about smoking and lifestyle that other patients. Further studies are needed to explore whether people with mental health problems need new or additional interventions to improve lifestyle, as it appears that standard general practitioner (GP) interventions are failing them. © 2005 Radcliffe Publishing.


BACKGROUND: Surgical outcomes are determined by complex interactions among a variety of factors including patient characteristics, diagnosis, and type of procedure. OBJECTIVE: The aim of this study was to prioritize the effect and relative importance of the surgeon (in terms of identity of a surgeon and surgeon volume), patient characteristics, and the intraoperative details on complications of colorectal surgery including readmission, reoperation, sepsis, anastomotic leak, small-bowel obstruction, surgical site infection, abscess, need for transfusion, and portal and deep vein thrombosis. DESIGN: This study uses a novel classification methodology to measure the influence of various risk factors on postoperative complications in a large outcomes database. METHODS: Using prospectively collected information from the departmental outcomes database from 2010 to 2011, we examined the records of 3552 patients who underwent colorectal surgery. Instead of traditional statistical methods, we used a family of 7000 bootstrap classification models to examine and quantify the impact of various factors on the most common serious surgical complications. For each complication, an ensemble of multivariate classification models was designed to determine the relative importance of potential factors that may influence outcomes of surgery. This is a new technique for analyzing outcomes data that produces more accurate results and a more reliable ranking of study variables in order of their importance in producing complications. PATIENTS: Patients who underwent colorectal surgery in 2010 and 2011 were included. SETTINGS: This study was conducted at a tertiary referral department at a major medical center. MAIN OUTCOME: Postoperative complications were the primary outcomes measured. RESULTS: Factors sorted themselves into 2 groups: a highly important group (operative time, BMI, age, identity of the surgeon, type of surgery) and a group of low importance (sex, comorbidity, laparoscopy, and emergency). ASA score and diagnosis were of intermediate importance. The outcomes most influenced by variations in the highly important factors included readmission, transfusion, surgical site infection, and abscesses. LIMITATIONS: This study was limited by the use of data from a single tertiary referral department at a major medical center. CONCLUSIONS: Body mass index, operative time, and the surgeon who performed the operation are the 3 most important factors influencing readmission rates, rates of transfusions, and surgical site infection. Identification of these contributing factors can help minimize complications.