BACKGROUND AND OBJECTIVES
Disability-based discrimination in health care can lead to low quality of care, limited access to care, and negative health consequences. Yet, little is known regarding the experiences of disability-based discrimination in health care for children with medical complexity and disability. An understanding of disability-based discrimination in pediatrics is needed to drive change and improve care.

METHODS
We conducted in-depth, semistructured interviews with caregivers of children with medical complexity and disability. Participants were purposefully recruited through national advocacy and research networks. Interviews were conducted via video conferencing, recorded, and transcribed. Data collection and analysis occurred iteratively. An inductive thematic analysis approach with constant comparison methods was used to identify themes that form a conceptual framework of disability-based discrimination in health care.

RESULTS
Thirty participants from diverse backgrounds were interviewed. Six themes emerged, forming a conceptual framework of disability-based discrimination in health care. Three themes described drivers of discrimination: lack of clinician knowledge, clinician apathy, and clinician assumptions. Three themes described manifestations of discrimination: limited accessibility to care, substandard care, and dehumanization.

CONCLUSIONS
Children with medical complexity may face disability-based discrimination in health care. Themes describing the drivers and manifestations of discrimination offer a conceptual framework of disability-based discrimination. Understanding the drivers and acknowledging perceived manifestations can provide insight into improving patient care for children with disabilities.


Tuberculosis of the maxillary sinus is rare. Likewise, an acute onset that necessitates incision and drainage is also very uncommon. We report the case of a 15-year-old girl who came to us with an abscess on the left side of her face. She was found to have tuberculosis of the left maxillary antrum.


This paper presents an evaluation of a complete vehicle dynamics model for a 1997 Jeep Cherokee to be used for the National Advanced Driving Simulator. Vehicle handling and powertrain dynamics are evaluated and simulation results are compared with experimental fieldtesting. NADSdyna, the National Advanced Driving Simulator vehicle dynamics software, is used. The Jeep evaluation covers vehicle directional dynamics that include steady state, transient and frequency response, and vehicle longitudinal dynamics that include acceleration and braking.


Modern knowledge discovery activities occur in highly dynamic environments. Specific activities may involve multiple tools, techniques, systems, individuals, and locations. In addition to these complexities, the span of time involved with discovery may vary from short to long, as well as being contiguous or disjoint. This paper presents a framework for tracking the history, or provenance, of the discovery process across applications, systems, and users. The resulting capabilities provide fine-grained provenance information relative to the discovered information. Along with the provenance framework, a prototype system is used to demonstrate the main concepts of the proposed approach.


Gamma ray spectra have interesting information about energy and intensity of gamma photons. Normally, this information is available in the peak area and background region. A full energy peak sits on a background continuum and produced by full energy absorption of high energy photons, while background region is produced by Compton scattering of the photons. The most essential concern of errors is in the method of determining the events in both peak and background areas. The uncertainty is low when the background counts are small relative to the peak counts. However, it becomes high when the counts of the peak area are low with respect to that of background. The detection threshold for the peak is ultimately determined by the uncertainty in the background counts. This depends on the technique used and the form of the produced spectra. This paper reviews different methods of determining peak area and their associated uncertainties in terms of the principle and application of the techniques used . .


The purpose of this research is to assess the application of recycled-aggregate that is gained from construction wastes as the material of compaction pile method. At the same time, the development of the new technique rectifies defects of the existing compaction pile method for soft ground improvement. In this research, laboratory chamber tests were carried out analyzing the effect of the soft ground improvement by porous concrete pile using recycled aggregate. Through the results of the laboratory chamber tests, the variations of settlement, excess pore pressure, and increment of the vertical stress with time and the behavior of the composite ground were elucidated.


Abstract Increases in the risk of infections and malignancy due to immune suppressive therapies of inflammatory bowel diseases (IBDs) have led the researchers to focus on more nontoxic and acceptable natural products like curcumin. Here we investigate whether prophylactic and therapeutic application of the curcumin alters the enzyme activities of paraoxonase (PON), carbonic anhydrase (CA), glucose-6-phosphate dehydrogenase (G6PD) and cytosolic β-glucosidase in dextran sulphate sodium (DSS)-induced ulcerative colitis mice. Prophylactic application of curcumin resulted in higher MPO activity, less body weight loss and longer colon lengths compared to therapeutic group indicating preventive role of curcumin in IBDs. DSS-induced decrease in liver and serum PON activities were completely recovered by prophylactic administration of curcumin. DSS-induced reduction in liver cytosolic β-glucosidase activity was not affected by curcumin neither in the prophylactic group nor in the therapeutic group. Erythrocyte CA activity was significantly increased in curcumin groups, however no remarkable change in G6PD activity was observed.


In Amci Pty Ltd ACN 124 249 485 v Corcoal Management Pty Ltd [2013] QSC 50 Jackson J considered an application for an order under r117 of the Uniform Civil Procedure Rules 1999 (Qld) (UCPR) in relation to informal service of an originating process on a corporation registered in the Ajman Free Zone in the United Arab Emirates. The decision appears to be the first time a Queensland court has examined the scope of r117 of the UCPR, and relevant considerations influencing the exercise of the discretion under the rule, when the defendant is outside Australia.


Ecological footprint aims to compare the demand on ecological services to the available supply. Such a metric is needed to make policy makers understand the threat of overshoot of natural resources and to facilitate the emergence of a consensus over the actions that are needed to address the ecological risks. During the 2000's, the Global Footprint Network has endeavored to develop and mature the methodology of the National Footprint Accounts [1]. This metric attends to assess current ecological supply and demand, at a macro-economic scale. The aim of this paper is to question whether applying such a metric at a micro-economic scale is possible and relevant. Which method can be used to estimate the ecological footprint of an organization? Does this estimation make it possible to set goals of improvement, to identify options for action, and to track progress toward these goals? Which are the limits of such an exercise? The method, that will be presented, has been developed and validated for the Vanoise National Park, in the Alps, France. This public organization is in charge of preserving the territory of the Vanoise, getting knowledge about its natural and cultural patrimony and making the public aware about the necessity to protect it.


Soil C-CO2 emissions are sensitive indicators of management system impacts on soil organic matter (SOM). The main soil C-CO2 sources at the soil-plant interface are the decomposition of crop residues, SOM turnover, and respiration of roots and soil biota. The objectives of this study were to evaluate the impacts of tillage and cropping systems on long-term soil C-CO2 emissions and their relationship with carbon (C) mineralization of crop residues. A long-term experiment was conducted in a Red Oxisol in Cruz Alta, RS, Brazil, with subtropical climate Cfa (Köppen classification), mean annual precipitation of 1,774 mm and mean annual temperature of 19.2 oC. Treatments consisted of two tillage systems: (a) conventional tillage (CT) and (b) no tillage (NT) in combination with three cropping systems: (a) R0monoculture system (soybean/wheat), (b) R1winter crop rotation (soybean/wheat/soybean/black oat), and (c) R2intensive crop rotation (soybean/ black oat/soybean/black oat + common vetch/maize/oilseed radish/wheat). The soil C-CO2 efflux was measured every 14 days for two years (48 measurements), by trapping the CO2 in an alkaline solution. The soil gravimetric moisture in the 0–0.05 m layer was determined concomitantly with the C-CO2 efflux measurements. The crop residue C mineralization was evaluated with the mesh-bag method, with sampling 14, 28, 56, 84, 112, and 140 days after the beginning of the evaluation period for C measurements. Four C conservation indexes were used to assess the relation between C-CO2 efflux and soil C stock and its compartments. The crop (1) Part of the Ph.D. Thesis of the first author presented at the Soil Science Post-Graduation Program of the Federal University of Santa Maria, UFSM. Received for publication in February 2010 and approved in March 2011. (2) Professor, Federal Institute of Rio Grande do Sul, Ibirubá Campus, IFRS. 1111 Nelsi Fritsch Road, CEP 98200-000 Ibirubá (RS) Brazil. E-mail: firstname.lastname@example.com (3) Associate Professor, Soil Department, UFSM. 1000 Roraima Ave., CEP 97105-900 Santa Maria (RS) Brazil. CNPq Scholarship. E-mail: firstname.lastname@example.com (4) Adjunct Professor, Soil Department, Federal University of Rio Grande do Sul, UFRGS. 7712 Bento Gonçalves Ave., CEP 91540-000 Porto Alegre (RS) Brazil. E-mail: firstname.lastname@example.com (5) Researcher, Embrapa Swine and Poultry. Road BR 153 km 110, P.O. BOX 21, CEP 89700-000 Concórdia (SC) Brazil. CAPES/ PNPD Scholarship. E-mail: email@example.com (6) Researcher, Foundation Center of Experimentation and Research, FUNDACEP. Professor, Cruz Alta University, UNICRUZ. Road RS 342 Km 149, CEP 98100-970 Cruz Alta (RS) Brazil. E-mail: email@example.com 820 Ben-Hur Costa de Campos et al. R. Bras. Ci. Solo, 35:819-832, 2011 residue C mineralization fit an exponential model in time. For black oat, wheat and maize residues, C mineralization was higher in CT than NT, while for soybean it was similar. Soil moisture was higher in NT than CT, mainly in the second year of evaluation. There was no difference in tillage systems for annual average C-CO2 emissions, but in some individual evaluations, differences between tillage systems were noticed for C-CO2 evolution. Soil C-CO2 effluxes followed a bi-modal pattern, with peaks in October/November and February/March. The highest emission was recorded in the summer and the lowest in the winter. The C-CO2 effluxes were weakly correlated to air temperature and not correlated to soil moisture. Based on the soil C conservation indexes investigated, NT associated to intensive crop rotation was more C conserving than CT with monoculture.


In regional and local 3-kV dc railway lines, energy storage systems (ESS) along the catenary can manage energy coming from electrical braking; in the actual low-carbon economy scenario, besides environmental considerations, better energy utilization goes to a general rationalization of the existing and future electrical substations. Modular multiport converters based on power electronic transformers and ESS can be used for this purpose. This work analyzes as case study a regional 3-kV dc line, obtaining by simulations and GPS measurements the train current and the pantograph voltage profile on the catenary. Energy savings are calculated placing ESS and multiport converters inside existing substations.


Aim: To describe the incidence of safety events after immune checkpoint inhibitor (ICI) initiation for advanced-stage non-small-cell lung cancer. Methods: Retrospective cohort study using the HealthCore Integrated Research Database in the USA to examine the incidence of prespecified safety events of interest after ICI initiation (n = 5278). Results: The most common safety events after ICI initiation included malaise/fatigue (incidence rate [IR]: 70.7 per 100 person-years; 95% CI: 66.5-75.1) and nausea/vomiting (IR: 32.4; 30.0-34.8). Other potential immune-mediated events, including colitis (IR: 7.11; 6.26-8.04) and pneumonitis (IR: 5.47; 4.76-6.25), were less frequent but higher than after any systemic anti-cancer therapy. No safety event rate substantially increased 6 months after ICI initiation. Conclusion: This large real-world study reports the incidence of safety events with ICI regimens for advanced-stage non-small-cell lung cancer.


The ophthalmologist has available three distinct medical methods to reduce intraocular pressure: improvement of the facility of aqueous outflow; reduction of aqueous inflow, and reduction of ocular volume through the use of osmotic (hypertonic) agents. The first two methods are well known and are used extensively. The third is seldom used and then usually under urgent circumstances and with poor results. However, the osmotic method is theoretically so valuable that if an ideal agent for its application were available, it would be employed with greater frequency, under a greater variety of conditions, and with more success. An agent approaching this ideal is urea. Though osmotic agents for reduction of intraocular pressure are infrequently used, they have a long history in ophthalmology and their mechanism of action is fairly well known. Hertel 1 did extensive studies with a variety of osmotic agents and showed that intraocular pressure could be elevated with


We study in this note the Fisher-KPP equation where the Laplacian is replaced by the generator of a Feller semigroup with slowly decaying kernel, an important example being the fractional Laplacian. Contrary to what happens in the standard Laplacian case, where the stable state invades the unstable one at constant speed, we prove here that invasion holds at an exponential in time velocity. These results provide a mathematically rigorous justification of numerous heuristics about this model.


. Siriwadee P, Wirot L, Thanapol P, Wirawan N. 2023. Genetic diversity among five native Thai chickens and Khiew-Phalee chickens in lower-northern Thailand using mitochondrial DNA barcodes. Biodiversitas 24: 1962-1970. Native chickens are an important biological resource in Thailand, with each breed having distinctive features. Khiew-Phalee chickens are a valuable investment in cultural wisdom and an invaluable Thai resource worthy of conservation. It is the royal rooster of Phraya Phichai Dab Hak. Due to a crisis concerning a sharp decline in the size of the Khiew-Phalee native chicken population, the identification of potential biomarkers is important for the determination of different chicken breeds for future planning. This study aimed to investigate the molecular identification of different native Thai chicken breeds based on mitochondrial DNA (mtDNA) barcodes, especially Khiew-Phalee chickens, which is difficult using the morphological examination. Partial sequences of 648 bp mtDNA control region fragments were determined for 53 specimens of six breeds of native Thai chickens (Khiew-Phalee, Thao Thong, Leung Hang Khao, Chee, Pra Dhu Hang Dam and Kai Jae). Genetic diversity was accessed based on the number of polymorphic sites, number of haplotypes, haplotype diversity, nucleotide diversity, and average number of differences. A phylogenetic tree was constructed based on maximum likelihood. The results showed that eighteen haplotypes were identified from 9 polymorphic sites with polymorphism between nucleotides 1074, 1107, 1109, 1177, 1213, 1214, 1268, 1276 and 1305. The haplotype diversity, nucleotide diversity, and the average number of differences for all chickens were 0.917, 0.00504 and 2.69086, respectively. All Khiew-Phalee chickens showed 7 haplotypes with 0.897 haplotype diversity, 0.00696 nucleotide diversity, and an average number of differences at 3.1795 clustered with other breeds in the phylogenetic tree. The findings indicated that the DNA barcoding gene is an effective method to identify the Khiew-Phalee and five other native Thai chicken breeds. It is a better choice for using molecular biology DNA barcoding to identify Thai native chicken breeds to plan for further conservation and development by the Department of Livestock Development of Thailand.


Velocities achieved by the upper punch of an eccentric tablet press during compaction have been compared with those predicted by equations describing the movement of the punch in an empty die. Up to the point of maximum punch penetration, actual speeds are invariably less than the predicted speed, the magnitude of the deceleration being determined by the machine speed and applied force. As the punch withdraws from the die, its speed can exceed that predicted on theoretical grounds, due to the elastic expansion of the tablet assisting punch ejection.


We present a map-less path planning algorithm based on Deep Reinforcement Learning (DRL) for mobile robots navigating in unknown environment that only relies on 40-dimensional raw laser data and odometry information. The planner is trained using a reward function shaped based on the online knowledge of the map of the training environment, obtained using grid-based Rao-Blackwellized particle filter, in an attempt to enhance the obstacle awareness of the agent. The agent is trained in a complex simulated environment and evaluated in two unseen ones. We show that the policy trained using the introduced reward function not only outperforms standard reward functions in terms of convergence speed, by a reduction of 36.9\% of the iteration steps, and reduction of the collision samples, but it also drastically improves the behaviour of the agent in unseen environments, respectively by 23\% in a simpler workspace and by 45\% in a more clustered one. Furthermore, the policy trained in the simulation environment can be directly and successfully transferred to the real robot. A video of our experiments can be found at: this https URL


The authors describe a practical path planner for nonholonomic robots in environments with obstacles. The planner is based on building a one-dimensional, maximal clearance skeleton through the configuration space of the robot. Rather than using the Euclidean metric to determine clearance, a special metric which captures information about the nonholonomy of the robot is used. The robot navigates from start to goal states by loosely following the skeleton. The resulting paths taken by the robot are of low complexity. Much of the computation can be done offline for a given robot, making for an efficient planner. The focus is on path planning for mobile robots, particularly the planar two-axle car, but the underlying ideas may be applied to planners for other nonholonomic robots.<<ETX>>


To the Editor:— The translumbar method of abdominal aortography is advocated by Leadbetter and Markland 1 for renal artery studies, and their compilation of experience shows relatively few serious complications. Perhaps the commonest complication is hemorrhage, which is usually self-limited, manifested as a retroperitoneal hematoma noted subsequently at surgery, and rarely of any magnitude. However, retroperitoneal dissection and exsanguination may develop. Presented here is a most unusual hemorrhagic complication, that of massive bleeding into the chest. A 38-year-old Negro male was under investigation for arterial hypertension (180/110 Hg mm) of recent origin. The intravenous pyelogram, regitine test, and total and differential renal function studies were normal. Under epidural anesthesia, an 18-gauge needle was passed through the left flank and into the aorta on the first attempt. A 5 cc test dose of 50% sodium diatrizoate was injected and the films examined for needle placement, which was deemed satisfactory. The second


In this paper, based on SCORM Sequencing Model, we propose the learning content structure which has structure informations of learning object and decision rules how to transfer learning object to learner. It is intended to provide the technical means for learning content objects to be easily shared and reused across multiple learning delivery environment. We develop the generation tool of learning object sequencing, for processing the learning with variable teaching methodologies. The teaming objects also are automatically packaged the PIE(Package Interchange File) to transmit with SCORM RTE(Run-Time Environment) and attached SCO(Sharable Content Object) function for tracking learner information.


The approach is based on neighborhood information derived from the Voronoi diagram of the underlying spatial data set and can handle fundamental spatial query types. It opts for a monitoring environment, the privacy model that has been employed by location cloaking and other privacy-aware approaches. The idea is that a client encapsulates its exact position in a bounding box, and the timing and mechanism with which the box is updated to the server are decided by a client-side location updater as part of PAM.


Type IV pili (T4P) are retractable multifunctional nanofibers present on the surface of numerous bacterial and archaeal species. Their importance to microbiology is difficult to overstate. SUMMARY Type IV pili (T4P) are retractable multifunctional nanofibers present on the surface of numerous bacterial and archaeal species. Their importance to microbiology is difficult to overstate. The scientific journey leading to our current understanding of T4P structure and function has included many innovative research milestones. Although multiple T4P reviews over the years have emphasized recent advances, we find that current reports often omit many of the landmark discoveries in this field. Here, we attempt to highlight chronologically the most important work on T4P, from the discovery of pili to the application of sophisticated contemporary methods, which has brought us to our current state of knowledge. As there remains much to learn about the complex machine that assembles and retracts T4P, we hope that this review will increase the interest of current researchers and inspire innovative progress.


OBJECTIVES
Exploration of bone metabolism changes at different levels of disease activity, both with and without oral corticosteroid therapy, and prediction of changes in joint damage and bone density from the observed changes in markers of bone turnover.

METHODS
Data analysis from a randomized clinical trial with 155 rheumatoid arthritis (RA) patients; median age 50 yr, early and active disease (diagnosis < 2 yr); one group treated with a combination of sulphasalazine (SSZ; 2000 mg/day), methotrexate (MTX; 7.5 mg/week) and prednisolone (initially 60 mg/day, tapered in six weekly steps to 7.5 mg/day), the other group with SSZ alone. Prednisolone and MTX were tapered and stopped after weeks 28 and 40, respectively, while SSZ was continued. Urine and serum samples were collected at baseline and weeks 16, 28, 40 and 56. Measurements of urinary pyridinoline (PYD) and deoxypyridinoline (DPD) and serum alkaline phosphatase (tAP) and osteocalcin (OC) were performed, as well as standard clinimetry and bone densitometry.

RESULTS
Over time and in both treatment groups, bone formation and bone resorption markers showed a pattern similar to erythrocyte sedimentation rate (ESR): a significant decrease compared with baseline and a larger decrease with combined treatment at weeks 16 and 28. PYD excretion, tAP, OC, and joint damage scores were significantly lower in the combined treatment group. Changes in bone density (of spine and hips) did not significantly differ between treatment groups. Mainly cumulative ESR explained progression of joint damage.

CONCLUSIONS
Prednisolone and disease-modifying anti-rheumatic drug therapy in patients with early and active RA are both independently associated with decreased levels of urinary excretion of bone collagen resorption markers PYD and DPD. Markers of bone formation and resorption closely followed changes in ESR in both treatment groups. Reduced bone resorption together with reduced bone formation-initially at a somewhat faster pace-resulted in less bone turnover and explain the observed (non-significant and partially reversible) extra bone loss in the lumbar spine associated with prednisolone (combined treatment).


Ethnographic research aimed to explore drinking context, drinking behaviors, and perception of lay people about their drinking and drinking-related behaviors in Thai-Isaan context. The study was conducted in a suburban village in the northeast of Thailand during 2008. Participant observation and informal interview were employed for data collection throughout the year. Findings of the study revealed that alcoholic beverages and drinking were woven into everyday life and integrated into various social events and traditional rites as part of social life. Alcohol consumption was permitted overtly with positive attitudes toward drinking and a low level of restriction. Enjoyment and social functions of drinking were recognized by direct experience in real life. Conversely, problem drinking and overt intoxication with loss of self-control or lack of responsibility were not expected or acceptable. Drinking was rarely perceived as a social distress. From an insiders' view, their drinking was less correlated to alcohol abuse or alcohol-related social problems. In the context of a permissive drinking culture, the existing alcohol regulation measures may be neither supported nor conformed as expected. An alcohol policy that aims to reduce the overall volume of consumption or to indicate the negative consequences may dispute local perceptions and norms. The challenge for public health within this culture is how to persuade the drinkers to realize such negative potential and how to raise societal awareness of negative consequences. Positive local norms and values should be emphasized and strengthened to promote a more healthy drinking culture.


Amperometry in stirred solution has been used for the systematic evaluation of modified screen-printed carbon electrodes (SPCEs) with a view to developing a reagentless biosensor for uric acid. The developed system consists of a base cobalt phthalocyanine (CoPC) electrode tailored to the electrocatalytic oxidation of H2O2 by means of a cellulose acetate (CA)-uricase bilayer. Uricase was immobilized by drop-coating the enzyme onto the CA membrane covering the CoPC-SPCE. The device exploits the near-universal H2O2-generating propensity of oxidases, the permselectivity of the CA film towards H2O2 and the electrocatalytic oxidation of this product at the CoPC-SPCE. The electrochemical oxidation of the resulting Co+ species was used as the analytical signal, facilitating the application of a greatly reduced operating potential when compared with that required for direct oxidation of H2O2 at unmodified electrodes. The time required to achieve 95% of the steady-state current (t95i(ss)) was 44 s [relative standard deviation = 7.5% (n = 10)]. Amperometric calibrations were linear over the range from 13 x 10(-6) to 1 x 10(-3) mol dm-3, with the former representing the limit of detection. The CA membrane extended the linear range of the biosensor by over two orders of magnitude, when apparent Michaelis-Menten constants (Km') of immobilized and free enzymes are compared. This suggests that the process is diffusion-controlled and not governed by the kinetics of the enzyme. The precision of electrode fabrication was determined by cyclic voltammetry to be 4.9% (n = 6).(ABSTRACT TRUNCATED AT 250 WORDS)


Abstract The problem in the measurement of cyclosporin (CyA) is that the widely used immuno-based assays suffer from interference by metabolites present in unpredictable excess. To resolve this, the consensus view has been to develop more specific and robust procedures for the measurement of CyA alone in order to give values similar to those obtained by HPLC. We developed an alternative strategy based on Abbott poly- and monoclonal assays to derive an adjusted monoclonal value as an equivalent measurement to HPLC. We have now evaluated a recently developed semi-automated HPLC procedure and used it to test the validity of the adjusted monoclonal value. The automated HPLC procedure with online clean-up was optimised for the separation of CyA and internal standard CyD. The assay was simple to use, precise and gave good recovery of cyclosporin from whole blood. Comparisons with the more specific immunoassays Abbott AxSym and EMIT showed close agreement, whereas Abbott monoclonal values indicated up to 20% positive bias. In contrast, the adjusted monoclonal values gave good agreement with HPLC. Data obtained from HPLC linked to tandem mass spectrometry (MS) indicated closer agreement with Abbott monoclonal values than expected, suggesting some positive bias with MS. The benefit of using an adjusted monoclonal value is that a result equivalent to HPLC is obtained, as well as an indication of the concentration of metabolites from the Abbott polyclonal measurement.


The observation and study of macroscopic quantum coherence (MQC), i.e. the coherent superposition and evolution of macroscopically distinct quantum states, is of great importance for both our understanding of nature and for quantum engineering, for example in quantum computing. Recently a first indication of MQC in a system of SQUIDs has been indirectly observed by means of spectroscopic techniques. Applications like quantum computing, however, require the manipulation and the observation of the time evolution of the MQC states. We have realized a system of SQUIDs for the study of MQC. Our system, based on trilayer Nb/AlOx/Nb technology, consists of a double rf-SQUID, source of the MQC state, inductively coupled to a non-hysteretic dc-SQUID magnetometer and to a hysteretic dc-SQUID threshold detector, used for the read-out of the magnetic flux state. The magnetometer is used to test and monitor the rf-SQUID behaviour, while the hysteretic dc-SQUID is used to perform fast measurements with a reduced back action on the rf-SQUID. We present measurements performed at 4.2 K and at 20 mK to characterize the single devices and their overall behaviour, and a scheme for the use of a set of SQUIDs as a qubit system.


We study the dynamics of borrower reputation in bank loan markets following revelations of financial misreporting by the borrower. Misreporting firms pay greater loan spreads than matched firms for at least six years following revelation of the misreporting, and there is no evidence of a downward trend in the misreporting premium. Following revelation, misreporting firms are more likely to engage in various actions to potentially rebuild their reputations, but even firms that engage in multiple actions continue to pay greater loan spreads for at least six years. Our results suggest that misreporting causes long-lasting and costly reputation losses that firms find very difficult or prohibitively costly to restore.

Data and the online appendix are available at https://doi.org/10.1287/mnsc.2017.2739 .

This paper was accepted by Wei Jiang, finance.


A 28 year old woman has suffered over the previous month from a post-traumatic swelling sensation of the left breast. Ultrasonography demonstrates a 9 cm, sharply-cut, rounded, hypo-echogenic lesion. Surgery is performed, with the hypothesis of an haematoma. The pathological analysis of the lesion shows a malignant phyllodes tumour with heterologous rhabdomyosarcomatous features. No metastasis is found. A radical mastectomy is performed and the patient benefits from an adjuvant radio-chemotherapy. Phyllodes tumours represent up to 1 % of all mammary cancers, with 10-20 % of malignant lesions. These tumours behave differently from usual breast cancers. This atypical case, arising in a traumatic context, provides the opportunity to discuss the treatment and classification of phyllodes tumours of the breast.


Aims: This article describes the apical infection in endodontically treated tooth 4.5 that spread to adjacent tooth 4.4. Case Report: A 52-year-old woman was referred for the presence of radiolucency extending from tooth 4.5 and mental foramen. Spontaneous symptoms were present. Tooth 4.5 showed poor-quality endodontics. The vitality of tooth 4.4 was negative, even though no mechanical trauma had been reported, nor was caries present. Both teeth were sensitive to percussion. Endodontic re-treatment of 4.5 and endodontic treatment of 4.4 were performed in a single visit. A large amount of endodontic sealer squeezed mesially from the root of tooth 4.5, where a partial horizontal root fracture was hypothesized. 6-, 12-, and 18-month radiographic follow-ups, by both periapical and cone-beam computed tomography (CBCT) analyses, showed incomplete osseous healing. CBCT excluded root fracture on 4.5. Local symptoms were still present. Clinical and radiological conditions led to extractions, and a cystic lesion was enucleated for histopathologic analyses. Histopathologic diagnosis was a periapical cyst. The supposed partial horizontal root fracture of 4.5 was actually a large lateral canal. Although the root canal treatments followed high standards in terms of quality, a persistent chronic infection developed histologically. The cystic lesion was one consistent reason for the unsuccessful healing of 4.5.


Abstract Previous laboratory and clinical data have shown evidence for the concept of rebalanced hemostasis in liver disease. We evaluate whether this concept of rebalanced hemostasis can be applied in patients with idiopathic thrombocytopenic purpura (ITP). Twenty patients with ITP (platelet count < 100 × 109 /l) who visited our hospital were enrolled. We measured the von Willebrand factor (vWF) antigen levels and performed native blood thromboelastography (TEG) to evaluate the hemostasis. As a subgroup analysis, we compared patients with elevated vWF levels with those with normal levels. Bleeding symptoms of the patients were followed up for 6 months. The mean (SD [IQR]) platelet count was 44.23 × 109 /l (25.78 [27.00–60.50]). The following TEG parameters were within the normal range in most patients (number of patients with a normal value): clotting time (17), clot formation time (17), α-angle (15), maximum clot formation (10), and maximum lysis (12). The mean (SD) vWF antigen level (%) was 163% (80). There were eight patients (40%) with elevated vWF antigen levels [218% (104) vs. 126% (19), p = 0.007, elevated vs. normal patients, respectively]. Those with elevated vWF antigen levels were older [58 year (10) vs. 40 year (13), p = 0.004] and had a longer disease status [67 months (39) vs. 33 months (25), p = 0.028]. Although the platelet count was not different, the CFT was shorter [287 (104) vs. 561 (291), p = 0.042] and the α-angle was larger [49 (6) vs. 34 (15), p = 0.033] in those with elevated vWF antigen levels. There were no patients with major bleeding events during the follow-up period. Four patients showed minor bleeding events (n = 1 vs. n = 3, elevated vs. normal patients, respectively). We found that the vWF antigen level was elevated and the TEG profiles were better in older ITP patients with longer disease statuses. Patients with ITP appeared to achieve a rebalance hemostasis through an elevation of their plasma vWF antigen levels and hemostatic changes that promote thrombosis. Measuring the vWF antigen levels and performing TEG analysis can help determine the treatment strategy in ITP patients.


• Patients with cirrhosis and ascites show systemic and splanchnic arterial vasodilation, which causes a reduction in effective arterial blood volume and the activation of hormonal anti-natriuretic systems. • Renal impairment is the most important predictor of hospital mortality in cirrhotic patients with SBP. • In patients with SBP, the inflammatory response to the infection (TNF-α, IL-6) may be an important mechanism of renal dysfunction. Ascitic-fluid NO metabolites are related independently to the development of renal impairment. • Treatment of SBP with intravenous albumin in addition to cefotaxime prevents renal impairment and reduces mortality in comparison with treatment with cefotaxime alone. • As soon as ascites develops, liver transplantation should be considered in eligible patients, especially when local mean waiting times exceed life expectancy. Nitric oxide (NO), tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) have been implicated in the pathogenesis of circulatory alterations observed in cirrhotic patients with ascites. Kidney failure is one of the main factors associated with mortality in patients with end-stage liver disease developing complications, particularly severe infections and variceal haemorrhage. Renal impairment occurs in patients with the highest concentration of cytokines in plasma and ascitic fluid and is associated with marked activation of the renin–angiotensin system. In patients with spontaneous bacterial peritonitis (SBP), serum and ascitic fluid levels of NO metabolites (nitrites and nitrates) were higher than those of patients with sterile ascites, and renal impairment is considered to be caused by a decrease in effective arterial blood volume as a result of the infection. The administration of albumin prevents deterioration of renal function and reduces mortality in these patients. However, SBP and renal dysfunction are late complications in the course of liver cirrhosis. As soon as ascites develops, liver transplantation should be considered in eligible patients, especially when local mean waiting times exceed life expectancy. A better knowledge of metabolic disorders associated with the early stage of cirrhosis is essential for the development of optimal therapeutic strategies for the prophylaxis and treatment of portal hypertension and its complications.


One of the most rapidly developing areas in laser velocimetry is concerned with measuring aerosol velocity using methods that do not directly depend on the coherence properties of the laser. These methods do not rely on an interferometric measurement of the Doppler shift in the scattered light frequency to determine particle velocity. Some other method such as time of flight between two or more beams, particle arrival rate through a single beam, or pulse shape analysis is used. In this column I want to discuss some relatively recent work in the development of these techniques.


The localization system for tour guide robot was developed which is inevitable and important for the guide robot in order to guide the tourists and explain the history or contents of the site. The localization system is based on the non-inertial sensors such as a DGPS, Dead-Reckoning. The information of the DGPS is used to update the estimated positions from Dead Reckoning. The extended Kalman filter was used for the fusion of the measured information from the sensors and estimated positions by Dead Reckoning. The simulation results show that it is very reliable and the position error is bounded within a certain extend.


This short paper makes a quick note on an attempt of novel experience-based program on vibration engineering lecture in Nagoya University. In the program, the building to perform the lecture is vibrated freely. The building "Disaster mitigation research building (Gensai-kan)" possesses the base isolation system and can be vibrated by using the oil jack loading system. Students experience real motion of five-floor building free vibration from both inside and outside of the building. The goal of this attempt is that the students understand the vibration phenomenon and its isolation technique effectively by the combination of real experience, simulations, and theoretical explanation.


The exploitation of computational techniques to predict the outcome of chemical reactions is becoming commonplace, enabling a reduction in the number of physical experiments required to optimize a reaction. Here, we adapt and combine models for polymerization kinetics and molar mass dispersity as a function of conversion for reversible addition fragmentation chain transfer (RAFT) solution polymerization, including the introduction of a novel expression accounting for termination. A flow reactor operating under isothermal conditions was used to experimentally validate the models for the RAFT polymerization of dimethyl acrylamide with an additional term to accommodate the effect of residence time distribution. Further validation is conducted in a batch reactor, where a previously recorded in situ temperature monitoring provides the ability to model the system under more representative batch conditions, accounting for slow heat transfer and the observed exotherm. The model also shows agreement with several literature examples of the RAFT polymerization of acrylamide and acrylate monomers in batch reactors. In principle, the model not only provides a tool for polymer chemists to estimate ideal conditions for a polymerization, but it can also automatically define the initial parameter space for exploration by computationally controlled reactor platforms provided a reliable estimation of rate constants is available. The model is compiled into an easily accessible application to enable simulation of RAFT polymerization of several monomers.


Background Survivin is recognized as a marker of persistently active and erosive RA. The findings in experimental arthritis suggested that survivin co-ordinates the antigen-dependent leukocyte maturation and function by regulating transcriptional activity of Bcl-6, essential factor of germinal center formation and a factor involved neoplastic transformation to lymphoma. Objectives We studied intracellular expression of survivin and Bcl-6 in the peripheral lymphocytes and its relation to clinical features and treatment of RA patients. Methods The intracellular expression of survivin and Bcl-6 was studied on the effector and memory subsets of CD4+ and CD8+ T-cells and in CD19+ B-cells in 18 RA patients using flow cytometry. Serum and mRNA levels of survivin were analysed in 144 RA patients (age 21-71 years, disease duration 1-49 years) using ELISA and qPCR, respectively. Patients with serum levels of survivin >0.45 ng/mL comprised the serum survivin-positive (sSurv+) group. Results The sSurv+ group (n=76) was characterized by higher frequency of RF+ and aCCP+ patients, as well as by higher levels of aCCP and of differentiation factor Flt3-ligand compared to sSurv– (n=68). The sSurv+ and sSurv- patients were similar with respect to age, disease duration, DAS28 and anti-rheumatic treatment. Intracellular mRNA levels of Bcl-6 were lower in sSurv+ compared to sSurv– patients, while RNA of survivin were similar. Flow cytometry showed that survivin was present in >85% of non-stimulated T-cells and B-cells lymphocytes of RA patients. The survivinhi subset comprised 2-14% of T-cells and was enriched in the effector (CD62Lneg) population of CD4+ T-cells compared to central memory and naïve CD4+ T-cells. The expression of Bcl-6 was found within 7-38% of survivin+ effector CD4+ T-cells and in 21-69% of CD19+ B-cells. The subsets of survivin+ and of survivin+Bcl-6+ T-cells was smaller in the sSurv+ patients compared to sSurv– patients, and was inversely correlated to the levels of serum survivin in these patients. The subset of survivin+Bcl-6+ B-cells was similar in sSurv+ and sSurv- patients. Conclusions In this pilot study we demonstrate that RA patients have co-expression of the two oncoproteins involved in neoplastic transformation to lymphoma, survivin and Bcl-6. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5490


The authors study the essence and evolution of views on such an important economic category as wages, as well as the main modern directions of theories of wages. Salary, which is the price of labor, is considered the most important source income of the population, and its level is determined by the action of certain forces on the labor market, the interaction of demand and supply of labor. When a market economy is a commodity, labor, respectively, acquires properties corresponding to the product, such as, for example, the dependence of its price on correlation of supply and demand for certain professions and specialties, and, as a result, this price may be unstable. The first economist to implement a systematic interpretation of wage theory in the framework of a clear classification of income in a capitalist society, was A. Smith, although various theories were put forward before him in this field, but they had a comprehensive character. To date, there are various views, methods, tools studies in the framework of the theory of employment, presented by various directions and schools, the main ones are: neoclassical school, Keynesian school, monetary school, institutional and sociological school, the concept of a flexible market. The competitiveness of national economies in the global market is determined by greater part of the ability to innovate and perceive the latest technological achievements based on human, intellectual, social capital, that is, quality labor force and employee motivation. Raising wages and the quality of education, modernization based on new technologies, etc. considered as the main factors in the growth of productivity of human capital.


We describe the case of a young woman with systemic lupus erythematosus (SLE) who presented with painful acute swelling and limited motion of the elbow. Analysis of synovial fluid exhibited a noninflammatory cell count, negative cultures, amorphous nonbirefringent particles, and a positive Alizarin red S staining. X-rays showed calcifications, spurring, sclerosis, and despite the short duration of symptoms, loss of radial-humeral and cubital-humeral joint spaces. The diagnosis of an acute attack within a chronic degenerative arthropathy of the elbow associated with hydroxyapatite crystals was established. Such crystal-induced arthropathy can be an occasional explanation for acute arthritis in SLE.


Two heterocystous cyanobacteria strains, belonging to the genera Anabaena and Nostoc isolated from sandy and clay soil samples, soils were collected from superficial surface crust at El-Ismailia Research Farm, El-Ismailia Governorate, (30°35'41.901''N, 32°16'45.834''E) and Sids Res. Farm Beni Sweif Governorate, (29°4'54.349''N, 31°5'25.775''E), Agric. Res. Center, Egypt. Cyanobacteria strains were tested for their ability to form tight associations with the roots of wheat seedlings (15 days old) under Lab. conditions. Both Nostoc muscorum and Anabaena variabilis and /or their mixed culture were inoculated to wheat seedlings. Nostoc muscorum was able to form close associations with wheat plants, and was able to enter through root hairs and penetrate the epidermal layer of wheat roots. While, Anabaena variabilis formed loose association with wheat seedling roots. The mixture of both cyanobacteria strains formed weak association with root of wheat seedlings. The tight association of Nostoc muscorum with the roots of wheat seedling resulted in the accumulation of Chlorophyll a in wheat roots and also exhibited nitrogenase activity by the roots. The tight association of Nostoc muscorum increased significantly the dry weight of seedlings plants. In contrast, Anabaena variabilis formed loose association against weak association for the mixture of both Nostoc muscorum and Anabaena variabilis.


During NASA Increment 4 (January to May 1997), about 5 gigabytes of acceleration data were collected by the Space Acceleration Measurements System (SAMS) onboard the Russian Space Station, Mir. The data were recorded on 28 optical disks which were returned to Earth on STS-84. During this increment, SAMS data were collected in the Priroda module to support the Mir Structural Dynamics Experiment (MiSDE), the Binary Colloidal Alloy Tests (BCAT), Angular Liquid Bridge (ALB), Candle Flames in Microgravity (CFM), Diffusion Controlled Apparatus Module (DCAM), Enhanced Dynamic Load Sensors (EDLS), Forced Flow Flame Spreading Test (FFFT), Liquid Metal Diffusion (LMD), Protein Crystal Growth in Dewar (PCG/Dewar), Queen's University Experiments in Liquid Diffusion (QUELD), and Technical Evaluation of MIM (TEM). This report points out some of the salient features of the microgravity environment to which these experiments were exposed. Also documented are mission events of interest such as the docked phase of STS-84 operations, a Progress engine burn, Soyuz vehicle docking and undocking, and Progress vehicle docking. This report presents an overview of the SAMS acceleration measurements recorded by 10 Hz and 100 Hz sensor heads. The analyses included herein complement those presented in previous summary reports prepared by the Principal Investigator Microgravity Services (PIMS) group.


Since Eugene Famais seminal contribution in 1970 it is a hotly debated question whether and in how far financial markets are information efficient and what lessons should be drawn for investment strategies. By now it seems established that capital market efficiency in its strong form does not hold. The weak and half strong form of information efficiency, however, is rarely questioned anymore. While it is also established that currency markets are the most efficient, real estate markets are said to be less efficient. We discuss the reasons for the low level of information efficiency on real estate markets. Using GDP and CPI expectations from Consensus Economics Surveys we are able to decompose fundamental determinants of rental growth in expected and unexpected parts. Using standard economic techniques we find that both components add to the explanation of rental growth in a sample of European countries. Furthermore, for some countries it can be shown that lagged GDP and CPI surprises are significant determinants of rental growth. Our results conflict with the assumption of information efficiency on real estate markets in its strong and half strong version.


Abstract This article examines secularists' efforts over 41 years to shape civic morality and civic culture in their own image. Through pressure groups – the Moral Instruction League (1897–c.1923) and the League of Nations Union (1919–1938) – activists aimed to create secular citizens in English schools. In so doing, they aimed to act as 'agents of secularisation'. Some (limited) political influence was achieved, and their publications reached many thousands. Yet campaigners were unable to unite a majority of Christians, or even all secularists, behind their proposals. The process of forming the non-Christian citizen proved a complex one, involving shifting alliances, dialogue and compromise.


The purpose of the research was to study the infl uence of microbiological nitrogen and phosphorus fertilizers on the yield and general condition of blue honeysuckle plants on sod-podzolic soils in the conditions of the Republic of Mari El. The experiment was conducted according to the following scheme – factor A– varieties: Goluboye Vereteno (control), Elite form No. 50, Pamiati Silaeva, Nizhegorodsky Dessert, Elite form No. 81, Podarok Dergunovu, Lakomka; factor B – fertilization: control (without fertilizer), bacterial fertilizers Azotovit, Phosfatovit, Azotovit + Phosfatovit, the rate of application in each option was 14 l/ha, water – 3000 l/ha, ammofoska (N12, P15, K15), the application dose was 300 kg/ha. The repeatability of the experiment was 3-fold, the placement of plots was rendominized, the term for applying microbiological and mineral fertilizers was the fi rst decade of May, once. The application was superfi cial. Joint application of "Azotovit" and "Phosphatovit" as an early spring top dressing, it allows to signifi cantly increase the yield of blue honeysuckle berries, the increase was 0.4 t/ha with a yield of 2.0 t/ha. The use of bacterial fertilizers Azotovit and Phosphatovit in the initial period of growth of honeysuckle plants has a positive eff ect on their further development and general condition, as well as increases the potential yield. The highest average annual increase was obtained in the option of joint application of bacterial nitrogen and phosphorous agrochemicals in the elite form No. 81 variety (36 cm), which exceeded the control (Goluboye Vereteno variety on an unfertilized background) by 2.1 times.


Three contributions to elasticity (chain entropic contribution, orientational distortion of the director of a nematic phase, interfacial tension) in viscoelastic fluids are compared experimentally using hydroxypropylcellulose (HPC) solutions in water. Elasticity is assessed by measuring the elastic recovery after a simple shear. The entropic contribution to elasticity is measured after shearing an isotropic concentrated solution. The contribution of orientational distortions of the director of a nematic phase to elasticity is measured on HPC-water solutions with HPC concentrations above the isotropic-nematic (or twisted nematic) concentration. Finally, an incompatible blend of HPC-water and polydimethylsiloxane is used to measure the elastic contribution due to an increase of interfacial area. Results show that by far, the elastic recovery of the distortion of a nematic director is much higher than the contribution of the entropic elasticity.


Background: The prevalence of atopic dermatitis (AD) has been increased for several decades. T-helper cell (Th)1 and Th2 disregulation influence the level of immunoglobulin (Ig)E and interfere Scoring Atopic Dermatitis (SCORAD) index. Management approachment only relieved the symptoms, therapy with probiotic are potentially  improve this disregulation. Lactobacillus plantarum (LP) has been fullfilled as probiotic criteria and it's safely used in human. Methods: In a randomized, double-blind, placebo-controlled trial, twenty (22) patients were randomized to take LP or placebo for 12 weeks with 2 weeks wash-out period in Pediatric Division, Dermatology and Venereology Outpatient Clinic. Total IgE serum level  and SCORING indeks were evaluted before and after intervention. Results : Twelve (12) patients in probiotic group and 10 patient in placebo group completed the study. Our findings revealed that there is no significant different in total IgE serum between LP (504.533 IU/ml ± 415.686 IU/ml) and placebo (909.580 ± 885.051 IU/ml) respectively (p=0.117). Mean decreased difference of SCORAD index in LP group (36.784 ± 8.705) significant greater than placebo (26.860 ± 5.021) respectively (p= 0.000). Conclusion : Total IgE serum in both group not significantly different. However, SCORAD indeks in LP group showed a significantly greater reduction.  LP is beneficial in the treatment of children with AD.


A novel HPLC method was developed for detection of the Fusarium mycotoxin, moniliformin in whole maize plants. The method is based on hydrophilic interaction chromatography (HILIC) on a ZIC zwitterion column combined with diode array detection and negative electrospray mass spectrometry (ESI(-)-MS). Samples were extracted using acetonitrile-water (85:15), and the extracts were cleaned up on strong anion exchange columns. By this procedure we obtained a recovery rate of 57-74% moniliformin with a limit of detection at 48 ng/g and a limit of quantification at 96 ng/g using UV detection at 229 nm, which is comparable to current methods used. Limit of detection and quantification using ESI(-)-MS detection was 1 and 12 ng/g, respectively. Screening of maize samples infected with the moniliformin producing fungi F. avenaceum, F. tricinctum, or F. subglutinans detected moniliformin levels of 1-12 ng/g in 15 of 28 samples using ESI(-)-MS detection. To our knowledge this is the first example of HILIC separation in mycotoxin analysis.


Generally, the synthesis of coherent spatial filters is restricted to the linear region of the transfer characteristic of a photographic film. However, a technique of synthesizing a nonlinear spatial filter such that the signal detection may be optimum will be described. In this paper, a generalized linear optimization technique is formulated. The application of this optimization technique toward a simple nonlinear spatial filter is demonstrated, and the extension of this optimization technique for a more complicated nonlinear spatial filter is also given. The signal detection by nonlinear optimum spatial filtering is analyzed. Finally, it is concluded that, instead of restricting the spatial-filter recording to the linear region of the transfer characteristic of the photographic film, an optimum nonlinear spatial filter may be achieved.


Statewide averages of temperature and precipitation, from January 1895 to April 1981, were interpolated to a grid and Palmer Drought Severity Indices (PDSI) calculated for each of the grid points. Principal component (PC) analysis was performed on the gridded values of PDSI. By rotating the PC, nine readily identifiable patterns of drought are delineated. Each PC relates to different regions of the country, and is characterized by a distinct annual oscillation of monthly average precipitation. A high degree of confidence is placed in the state gridded data as patterns compare favourably to those derived using smaller averaging areas.

Univariate and multivariate autoregressive spectral estimation procedures together with the traditional spectral estimation techniques were used to investigate the spectra and coherence of the PC scores. No significant cycles were found in the 86-year (1036 months) data set. Coherence was very low (<0.30) for all frequencies between the various patterns depicted by the PC.

Both the spectra of PC scores and drought duration statistics point to the major difference in droughts across the United States; droughts persist much longer in the interior portions of the country than in areas closer to the coasts. Sensitivity tests on the PDSI indicate that this is not directly attributable to the spatially varying available soil water capacity parameter used in the PDSI calculations. This is not to say that soil moisture evaporation does not indirectly influence drought duration, but merely that the differing lengths of droughts in the United States are real and not an artefact of the mechanics in the PDSI calculations.


Abstract : This report contains three independent but closely related papers which were written to address a request by Mr. Walter Hoffis, Deputy Undersecretary of the Army, Operations Reseerch. Each paper was presented at a symposium in FY96 and was published in the respective symposium proceedings: 1 'A VIL Taxonomy for Analyzing Ballistic Live Fire Events,' 46th Annual Bomb and Warhead Technical Symposium, held at Naval Postgraduate School, Monterey, CA, May 13-15, 1996; 2 'Modeling Ballistic Live-Fire Events,' 7th Annual TARDEC Symposium, held at Naval Postgraduate School, Monterey, CA, March 26-28, 1996; and 3 'Developments in Modeling Ballistic Live-Fire Events,' 16th International Symposium on Ballistics, held in San Francisco, CA, September 23-28, 1996. In combination, this trilogy documents the current state of the art in Army capabilities and specifies the future directions for modeling live-fire events in support of requirements specified in United States Code, Title 10, Section 2366, Chapter 139, National Defense Authorization Act for FY87, 'Live Fire Testing.'


Numerical simulations of streamer propagation involving photoionization are presented, utilizing an ANSYS Fluent implementation that employs unstructured meshes and automatic mesh refinement. Two approximate methods for radiative transfer, used to handle computation of the photoionization source terms, are compared: the Eddington approximation and the discrete ordinates (DOs) method. The former is commonly employed in streamer simulations, while the latter is well-established in other branches of computational physics, such as radiative heat transfer. A 2D test case with two distinct regions, where streamer propagation can be triggered thanks to the protruded electrodes, is introduced. The two regions are partially separated by an opaque solid insulator barrier to study the effects of photoionization shadows on streamer inception and propagation. The primary positive streamer is initiated by placing a neutral plasma patch close to one of the electrode protrusions, while the secondary positive streamer, in the other region of the computational domain, is initiated by photoionization originating from the primary streamer zone. The Eddington approximation results in an excessively high photoionization source in the secondary streamer inception zone, as it fails to capture the shadowing effects of the opaque dielectric barrier. Consequently, this leads to a fast secondary streamer inception process, followed by rapid streamer propagation. On the other hand, the DOs method accurately captures the shadow, leading to a delayed secondary streamer inception. It is also shown that both methods exhibit very similar results when the dielectric barrier is transparent and the shadow is absent. This work demonstrates that using the DOs method for streamer simulations offers considerable advantages over the Eddington approximation, especially in cases involving more complex geometries where shadows need to be captured for accurate streamer inception and dynamics.


Aim: The aim of this article is to present the conclusions of a research conducted in the area of identifying threats to the economic interests of the state related to the trading of cryptoassets, as well as the presentation of legal solutions functioning in the cryptoasset environment and possible remedial actions to be taken by the state authorities competent in this regard. Introduction: Due to the technological features, undefined legal status, regulatory and organizational risks of this instrument, the threats related to the trading of cryptoassets are one of the most important current threats from the point of view of the economic security of the country. They are identified both by domestic and foreign financial market supervision authorities, tax and law enforcement authorities, and those dealing with counteracting money laundering and the financing of the terrorists. The article presents the identified risk areas, legal regulations in the field of trading in these assets, and regulatory perspectives. An attempt was also made to describe the actions necessary to be taken to mitigate the threats. Methodology: In this work, theoretical research was used, such as: analysis of literature, on legal and strategic studies as well as industry literature, synthesis, generalization and inference. In addition, analysis was carried out of the legal acts related to the regulation of the market of cryptoassets, international strategic documents describing this market and the Polish financial supervision. Draft legal acts of a legislative nature were also presented. Conclusions: The market of cryptoassets is subject to constant legal, organizational and institutional transformations. Its socio-economic environment is also changing. Due to the characteristics of cryptoassets, their dispersed and unregulated nature, institutions of this market, both entities participat - ing in transaction brokerage, as well as natural persons, can be used for money laundering, concealing property from various forms of crime. However, the identified vulnerabilities do not pose a significant threat to the economic security of the country – they are of a sectoral nature. The relevant state institutions undertake specific activities in order to counteract threats, both of a legal, institutional and organizational nature. Keywords: cryptoassets, threats to economic security, legal regulations in the area of cryptoassets, counteracting money laundering and financing of terrorism, mitigation of threats related to cryptoassets Type of article: review article


In recent years, with the development of the global economy, the pressure of competition between enterprises is increasing. Both the old and the new enterprises should be aware of their own problems in management. In order to stand firm in the market competition, improving management can better ensure the long-term competition in the market. With the constant changes of the economic situation and the increasingly fierce market competition, some problems in the management of enterprises are becoming more and more prominent, and it is necessary to constantly strengthen the management innovation, which is a very urgent and realistic problem that should be considered. Market economy competition is extremely fierce, enterprises should strengthen internal management and control, through management innovation to stimulate the vitality of enterprises. Under the condition of the new normal, set up the sound management rules and regulations, establishing good image of foreign, according to the market development trend, grasp the market change rule, update management idea, adhere to the management mode of keeping pace with The Times, improve enterprise management level and their competitiveness, promote sustainable development of enterprises. Improved management can better ensure the long-term competition in the market. With the constant change of economic situation and the increasingly fierce market competition, some problems in enterprise management are becoming more and more prominent. How these modern enterprises in the new era can effectively run their businesses to achieve an increasingly stable life is a very urgent and realistic issue that should be considered. This paper takes enterprise management innovation under the new normal as the starting point, points out the existing problems of enterprise management under the new normal, analyzes the necessity of management innovation, and carries on the feasibility analysis of the innovation path of enterprise management.


—Joint radar and communications (JRC) can realize two radio frequency (RF) functions using one set of resources, greatly saving hardware, energy and spectrum for wireless systems needing both functions. Frequency-hopping (FH) MIMO radar is a popular candidate for JRC, as the achieved communication symbol rate can greatly exceed radar pulse repetition frequency. However, practical transceiver imperfections can fail many existing theoretical designs. In this work, we unveil for the first time the non-trivial impact of hardware imperfections on FH-MIMO JRC and analytically model the impact. We also design new waveforms and, accordingly, develop a low-complexity algorithm to jointly estimate the hardware imperfections of unsynchronized receiver. Moreover, employing low-cost software-defined radios and commercial off-the-shelf (COTS) products, we build the first FH-MIMO JRC experiment platform with radar and communications simultaneously validated over the air. Corroborated by simulation and experiment results, the proposed designs achieves high performances for both radar and communications.


OBJECTIVE
To explore the clinical effect of bridging system in the treatment of severe comminuted femoral fracture.

METHODS
From March 2016 to October 2018, 50 patients with severe comminuted femoral fracture including 35 males and 15 females, aged 48 to 72(54.6±8.7) years, were admitted. All cases were comminuted fractures of the femoral shaft, 16 with proximal femur fractures and 7 with distal femur fractures. All cases were all unilateral fractures, 23 on the left and 27 on the right. The time from injury to operation was 5 to 60 (26.7±13.3) hours. The cause of injury was traffic accident, 12 cases with high fall, 35 cases fell and 3 cases fell accidentally. The patients were treated with bridge combined internal fixation system, and the operative effect and fracture healing were analyzed.

RESULTS
The operation was successful in all patients. There was no change to other fixed operation. The operation time was (75.8±12.3) min, the amount of bleeding was(356.4±64.8) ml, and there was no serious postoperative complications such as infection, internal fixation displacement, re fracture and nonunion. After 6 to 36 months follow-up, the fracture healing was evaluated by Warden's score. With the extension of observation time, Warden's score gradually increased, and the time of bone healing was(5.5±0.9) months. Harris score and HSS score were used to evaluate the function of hip and knee joint respectively. With the extension of time, Harris score and HSS score increased gradually. Six months after operation, Harris score was 83.5±11.2, HSS score was 79.7±10.5. During the follow-up period, there were no serious complications such as internal fixation displacement, re-fracture, nonunion of fracture and deep vein thrombosis of lower extremity.

CONCLUSION
The bridge combined internalfixation system has better safety and effectiveness in the treatment of severe comminuted femoral fracture. As long as the requirements of local anatomy and biomechanics are strictly mastered and the operation risks are fully evaluated in combination with imaging, the better fixation effect can be achieved. The operation has less trauma, fewer complications and simple operation, which is believed to have a wider application potential. Due to the limited sample size and follow-up time, no clinical control was set up, the results of the study still need to be further verified by prospective trials.


This volume contains the papers presented at the first international workshop on Logics for Component Configuration (LoCoCo 2010) which was associated with the International Conference on Theory and Applications of Satisfiability Testing (SAT 2010) as part of the Federated Logic Conference (FLoC 2010), and which took place on July 10, 2010 in Edinburgh, UK.
Modern software distributions are based on the notion of components, which denote units of independent development and deployment. Components provide the necessary flexibility when organizing a complex software distribution, but also are a challenge when it comes to selecting components from a large repository of possible choices, and configuring these components according to user needs, resource constraints, and interdependencies with other components. Representing and solving configuration problems is a hot topic of great importance for many application domains. Some well-known examples of complex systems of components are Free and Open Source software distributions like GNU/Linux, or Eclipse plugins. The LoCoCo workshop has a focus on logic-based methods for specifying and solving complex configuration problems for software components. The goal was to bring together both researchers and practitioners active in the area of component configuration of software systems, using different modeling and solving techniques, such as constraint and logic programing, description logics, satisfiability and its extensions.


It is well known that small‐scale variations in electron density in the natural ionosphere can disturb electromagnetic signals. These electron‐density irregularities can cause rapid variations in the amplitude and phase of propagating signals, referred to as scintillation. UHF radars that operate in the polar region can experience scintillation anytime of the day or night. The occurrence of polar region scintillation is a complicated function of the physics of the ionosphere and the geometry of the line of sight. The severity of the scintillation is a strong function of time in the 11 year solar cycle and the geomagnetic activity (as quantified by Kp). This paper considers the detection performance during track acquisition of UHF radars that must perform a wide‐volume search while operating during various levels of scintillation disturbance that are likely to occur during the 11 year solar cycle. Under conditions of strong fading, ionospheric scintillation is the primary source of amplitude and phase variations, dominating the effect of target radar cross section fluctuations. The impact on the performance of the commonly used two‐step sequential detection process for track acquisition can be improved by considering ionospheric scintillation in the radar design. The cost of ignoring ionospheric scintillation in the design process is demonstrated through examples. In the examples the design parameters for a two‐step sequential detector are found using a constrained optimization procedure for cases with and without ionospheric scintillation. Cases are also shown where mismatched (to the prevailing ionospheric conditions) parameter sets are used instead of the optimal parameters.


A giant placental chorioangioma was diagnosed in a fetus at 22 weeks of gestation by prenatal ultrasound screening and color Doppler imaging. Although no signs of fetal hydrops and cardiac decompensation were observed, the situation of the fetus deteriorated rapidly and in utero fetal death occurred at 26 weeks, attributed to bleeding from ruptured sinusoids within the tumor. Prenatal diagnosis of chorioangioma and treatment modalities are discussed.


Purpose: To study the distribution of coronary artery stenosis among breast cancer (BC) subjects; to assess any correlation between radiotherapy (RT) and the location of stenosis. Methods: A population based Swedish BC cohort diagnosed 1970-2003 was linked to registers of coronary angiography 1990-2004 and yielded 199 subjects with BC followed by a coronary angiography. The right coronary artery (RCA), the left artery descendens (LAD), and the left circumflex artery, were divided into multiple segments according to the American Heart Association classification. The segments were graded 0-5, where grade 0 was a vessel without any stenosis, grade 1-4 increasing grade of stenosis, and grade 5 was occlusion. Stenoses with at least 70 % diameter narrowing (i.e. grade 3-5) were considered as clinically significant. Hotspot segments for exposure to radiation were defined a priori. RT targets and regimens were categorized as high risk or low risk, regarding radiation to these hotspot segments. Left breast/chest wall was considered high risk for segments 7+8+10 (mid and distal LAD). Due to the radiation technique, the left internal mammary chain (IMC) was regarded as high risk for segments 1+2 (proximal RCA) and 7+8+10 during 1970-1994, and thereafter only for segments 7+8+10. Right IMC was deemed high risk for segments 1+2. Other RT targets and no RT were considered low risk. When comparing left sided BC to right sided, we used conditional logistic regression. In the analysis of hot spot segments, a generalized linear mixed model was used. Associations between RT and coronary artery stenosis were expressed as odds ratios (OR) and 95 % confidence intervals (CI). Results: Mean age at diagnosis of BC was 58.2 years (yr) and left sided BC was slightly more common than right sided, 55 % vs. 45 %. Median follow-up period between BC and coronary angiography was 10.3 yr. The majority of the women with BC had low risk disease, T1-2N0. Sixty-two percent (123/199) of the BC subjects received RT and twenty-nine percent (58/199) were irradiated to the IMC. Adjuvant chemotherapy and endocrine therapy was seldom used, only received by 9 % and 17 % of the subjects, respectively. For left vs. right sided BC, the OR for grade 1-5 stenosis in segments 7+8+10 was 1.44 (CI = 0.95-2.18), grade 3-5 (OR = 2.18; CI = 1.16-4.09), and grade 4-5 (OR = 2.91; CI = 1.24-6.83). When restricting the comparison to left vs. right sided RT treated BC, larger differences emerged. The OR for grade 1-5 stenosis in segments 7+8+10 was 2.04 (CI = 1.18-3.55), grade 3-5 (OR = 4.38; CI = 1.64-11.7), and grade 4-5 (OR = 7.22; CI = 1.64-31.8). For high risk RT vs. low risk, the OR for grade 1-5 stenosis in the hotspot segments was 1.85 (CI = 1.17-2.93), grade 2-5 (OR = 1.33; CI = 0.83-2.13), and grade 3-5 (OR = 1.90; CI = 1.11-3.24). Conclusion: We found a clear and statistically significant increase of coronary artery stenosis in the mid and distal LAD among irradiated left sided breast cancer and an association between RT targets a priori defined as high risk for cardiac exposure and coronary stenosis in hotspot segments for radiation. We found no other plausible explanation than the target area for the RT. Our results therefore suggest that effort should be made to avoid radiation dose to the coronary arteries. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-11-02.


Background Microcalcifications (MCs) are tiny deposits of calcium in breast soft tissue. They serve as key diagnostic radiological features for localization of malignancy. Approximately 30% of early invasive breast cancers have fine, granular MCs detectable on mammography; however, their role in breast cancer tumorigenesis is currently unknown. The purpose of this study was to investigate the relationship between mammographic MCs and breast cancer pathology. Methods : A retrospective chart review was performed for 882 women treated for breast cancer between 2000–2010 at St. Michael9s Hospital. Demographic information (age and menopausal status), tumor pathology (size, histology, grade, nodal status and lymphovascular invasion), hormonal status (ER and PR), HER-2 overexpression and presence of MCs were collected for breast cancer patients. Chi-square tests were performed for categorical variables and t-tests were performed for continuous variables. All tests were two-sided and p-values less than 0.05 were considered statistically significant. Results : A total of 826 patient charts were included; 56 (6.4%) patients had metastatic carcinoma and were excluded from analysis. Only 37.0% (326/882) of the patients presented with mammographic MCs. Patients were more likely to have MCs if they were HER-2 positive (51%) as opposed to being HER-2 negative (33.4%) (p=0.001). There was a significant association between MCs and being perimenopausal with a mean age of 50 (65.2%) (p=0.012). Patients with invasive ductal carcinomas (39.7%) were more likely to present with MCs than were patients with other tumor histology (p=0.001). There was a positive correlation between MCs and tumor grade (p=0.051), with grade III tumors (41.85%) presenting with the most MCs, followed by grade II (37.95%) and grade I (29.8%). There was no significant association between mean age, mean tumor size, ER and PR status with the presence of MCs. Conclusion : This is the largest study that suggests the appearance of MCs on mammograms is strongly associated with HER-2 overexpression, invasive ductal carcinoma and perimenopausal status. Since HER-2 is implicated in mediating aggressive tumor growth and metastasis, future studies should investigate the molecular pathways underlying HER-2 overexpression and MC development. This would help better understand the role of MCs in breast cancer tumorigenesis. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-08-04.


In this paper the author discusses and defends a theory of consciousness inspired by Franz Brentano, according to which every conscious experience involves a certain kind of immediate awareness of itself. All conscious experience is in a certain fundamental sense 'self-intimating'—it constitutively involves awareness of that very awareness. The author calls this 'the awareness of awareness thesis', and she calls the phenomenon that it concerns 'awareness of awareness' ( AOA for short). The author attempts to give a substantive description of what AOA consists in in two ways, first, by listing some of its positive features, and second, by comparing it and contrasting it with introspection. The idea is that there are many different ways we can be aware of our experiences, introspection being one way, AOA being another, distinct way. By clarifying the distinction between AOA and introspection, we can get a better grasp of both phenomena.


INTRODUCTION
Dengue is a public health problem. However, the efficacy of typical control programs is not well-established.

OBJECTIVE
The efficacy of social mobilization was assessed for its role in public empowerment in the improvement of dengue control measures.

MATERIALS AND METHODS
A community trial was conducted in Comuna Norte, a section of the city of Bucaramanga,Santander. Four high-incidence neighborhoods were selected--two received empowerment training and two served as controls. During 1,968 home visits, information was collected concerning knowledge and practices of dengue control, and information was provided concerning dengue and mosquito larval habitats of the vector. At local schools, dengue control information was provided for 2,455 students. The intervention included training of 155 community leaders and tracking of prevention and control activities. Findings were compared between post-intervention and controls by χ² test, with a significance level of p<0.05.

RESULTS
At the home visits, 80.7% of respondents were female. with a mean age of 39.1 and 5.8 years schooling. In comparing the intervention neighborhoods with the controls, differences in knowledge about dengue were as follows: symptoms of bodily pain (χ²=21.0, p<0.001) and abdominal pain (χ²=5.1, p=0.024), reproduction cycle of the mosquito vector (χ²=11.5, p<0.001), knowledge of mosquitos characteristics (χ²=7.1, p=0.008). In washing practices batteries (χ²=7.2, p=0.007), spraying (χ²=7.0, p<0.008), use of bednets (χ²=49.8, p<0.001), consulting a physician (χ²=8.2, p=0.004), participate in meetings (χ²=29.6, p<0.001), prevention methods (χ²=10.4, p=0.013), willingness to lead anti-mosquito campaigns (χ²=6.8, p= 0.009) and to get help for programs (χ²=5.8, p=0.016). There was a decrease in the proportion of households with larvae from 20.0% to 15.9% in both groups. The difference in prevalence of dengue one year after initiation of the program was not significant--4.8% in the intervention group and 6.7% in control (χ²=3.4, p=0.065).

CONCLUSION
The social mobilization was effective for improving actions of empowerment, control, but not dengue prevention.


A survey was undertaken in 3 French departments of the Pays de Loire from January 1, 1986 to December 31, 1986. Among the 32,876 neonate (NN) population, the authors studied the 2,753 NN who were hospitalized and a control group of 1,458 NN representative of the population of 30,123 NN who were not hospitalized. Socioeconomic patterns of mothers, of their pregnancies and deliveries were studied in both groups. The control group was compared with the data obtained in 1981 at the national level and in 1982 at the local level. This group was used as a reference for the study of hospitalized NN. Intrauterine growth retardation rate was 2.4%, prematurity rate 4.6% of live births, very premature rate (as defined by a gestational age less than 32 weeks) was 0.45% of births. Among the group of hospitalized NN, which represent 8.5% of the general population, the NN were regrouped according to Cullen's classification and their care load estimated according to the Omega score. Thus 2 subgroups were defined: the 2,298 ordinarily hospitalized (Cullen's classes I and II) and the 455 severely sick NN (classes III and IV) i.e. 1.3% of births. One third of the severely ill NN were very prematures. The 2 other thirds presented with respiratory (24%), infectious (24%), malformative (19%) or neurological (13%) diseases. Lengths of stay and Omega scores varied according to the causes for hospitalizations and were inversely correlated with gestational ages (p less than 0.001). Neonatal mortality was 3.3 p. 1,000 births and rate of stillbirths 6.5 p. 1,000.


The blades with integral shrouds have been used widely in industry. The blades are brought together via the contact of shroud interfaces. Because the angle of shroud interface can alter the damping of the interfaces and the coupling effect among the blades, knowing how to design the shroud angle is important. In this work, the theoretical shroud model was first verified experimentally, and then used to investigate the effect of shroud angle on the resonant responses excited by wake flow. The results show that a small shroud angle is superior than large shroud angle to minimize the resonant vibration. However, a critical static interface preload should be selected to avoid the weak coupling effect.Copyright © 1990 by ASME


OBJECTIVE: To establish a stable animal model for glucocorticoid-induced avascular necrosis of femoral head in mouse. METHODS: Adult Mus musc ulus var abino mouses were randomly divided into two groups: Group A was treated with a combination of lipopolysaccharide (10mg/kg) and methylprednisolone (30mg/kg), into femoral head muscles. In addition to taking supplements Medrol (tablets dissolve in water) 4 mg /one (13mg / kg) divided in 10 consecutive days. Group B was injected normal saline (NaCl 0,9%) as a control. Resuls were collected at 3, 5, and 7 weeks after the last injection of chemicals.  Histopathological changes in the femoral heads were observed by light transmission electron microscope at the end of seven weeks after the injection. The percentage of trabecular bone area and empty lacunae and microvascular density were measured. Cell cycle and the necrosis of bone marrow cells were analyzed by PI staining method and floww cytometry. RESULTS: Listlessness, blepharal hyperemia, less activity and reduced diet were found in the mouse of groups A after injected with lipopolysaccharide at 3-first day. At 3,5  weeks after the final injection, the body weight of groups A was increased. After that to after the final injection, the body weight of mouse was constant. Bone morphology no difference in expression levels observed with the eye at 7 weeks. The signs of Histopathological changes includes surface crack head crest bone cartilage and increase the size of cells in the hypertrophic cartilage were observed at 7 weeks in group A.The percentages of empty lacunae were (5,87  2,49)% at 5 weeks and upto (21,58  8,10)% at 7 weeks. This ratio may differ significantly between group A and group B. Appears fibrosis and degenerative cartilage cells of the femoral head. Dead cells in the bone marrow at the time of 3 weeks promoting apoptosis markers in tissue structure in the period of 5 weeks and 7 weeks. CONCLUSION: Methylprednisolone combined with lipopolysaccharide can induce typical mouse model for early avascular necrosis of femoral head.


We are told by one of the contributing authors that 'King Henry VIII died of syphilis, having never produced a surviving male heir for his throne', which would have puzzled Edward VI, his son and successor. Who was responsible for this error? According to this book we should look beyond the individual author and consider the ways in which system defects allowed such a mistake to occur; the two academic editors, the proofreader, the production editor, the copy editor and the publisher should all be considered along with the way a book is produced. Analysis of the error should result in self-reflection and changes to the system so that errors are less likely to occur in the future. Naming, blaming and shaming should be avoided. People should view mistakes as learning opportunities. Indeed, very little learning occurs without some mistakes being made.

Over the past decade much attention has been paid to medical errors, with a focus on the activities of clinicians. Little attention has been given to managerial or executive errors, though these can have far greater impact. Managerial errors are often, unlike medical errors, distant from the adverse impact and their effect is therefore more difficult to detect and attribute. Management Mistakes in Healthcare starts to redress the balance. Edited and written by healthcare executives in the US, it is aimed principally at colleagues in that country. While the underlying messages are equally applicable outside the US, the focus on profits, market share and other financial goals means the non-American reader needs to translate the material for health systems that have other drivers and aims.

The book covers the whole field—defining mistakes; classifying and interpreting them; how mistakes evolve; techniques for identifying and disclosing errors; the relationship between clinical and managerial mistakes; and preventing and correcting errors. In addition to chapters considering each of these areas, seven case studies illustrate the issues raised. Two experienced British commentators reflect on the material from a non-US perspective.

Of all the issues raised, the definition of an error is perhaps the most critical. One reason why managerial errors can be hard to recognize is the need to consider acts of omission as much as acts of commission. In addition, standards of performance are less clear than in clinical work. And as with medical errors, what constitutes an error will depend to some extent on the particular circumstances and the perspective adopted. The authors provide a helpful typology with seven types of error—legal; organizational; financial; political; professional; ethical; social; and psychological. While intentional wrongdoing is rightly excluded (as something that needs dealing with in line with other criminal activity), there remains the question of defining managerial negligence. The authors suggest four criteria that all have to be fulfilled for an act to be deemed negligent: the decision taken is one that a reasonable person would consider risky; a bad outcome occurs; risky behaviour is the proximate cause; and a reasonable person would have foreseen the consequences. So, unintended and unforeseeable bad outcomes would not be deemed an error.

While this book is a useful contribution to our thinking about managerial errors, it raises many questions. First, locating the primary responsibility for errors on the system rather than the individual can be taken too far. Presumably there are situations where, despite an excellent organization, individuals fall short of expectations and harm occurs? Always blaming the organization has a suggestion of political correctness about it. While there are good reasons from patients' and payers' points of view to adopt no-fault approaches when bad outcomes occur, there is the danger of creating, in the words of one of the authors, a 'no-fault paradise'.

Second, if too much attention is focused on the consequences of managers' actions, there is a danger of 'defensive management' similar to 'defensive medicine'. Excessive risk avoidance by managers may harm organizations and be to the detriment of patients. It may also mean that managers working in high-risk areas of healthcare (such as medium secure psychiatric facilities) where 'mistakes' are more likely in view of the patients served, will be unfairly criticized. Some means of risk adjustment (similar to that used in comparing clinicians' performance) is needed if we are to avoid creating areas of healthcare provision that deter managers from entering.

Third, there is a close and complex interrelation between managerial and medical errors. Distinguishing between them can be tricky. One American example will be familiar to managers in the British NHS—the impossibility of appointing an additional consultant to reduce waiting times if the existing consultants block the move because they want to protect their personal income. Are the persistent long waiting times (a managerial failing) the fault of the managers, the clinicians or simply 'the system'? Managers will understandably resent being held responsible for a failing that is not of their making. They are also painfully aware that clinicians can blame them for medical errors: the poor clinical outcome was the result of the managers depriving us of sufficient staff, expensive drugs, etc. This approach can also be used effectively by clinicians to resist changes and challenges to professional boundaries. Shroud-waving remains a potent weapon.

Despite these and other loose ends, this book is a welcome first attempt to redress the balance and start examining managerial errors in the way medical errors have been scrutinized of late. The fact there are areas of ambiguity and uncertainty simply confirms the need for more attention to be paid to this topic.


Expression of epidermal growth factor receptor (EGF-R) antisense RNA results in a drastic reduction of EGF-R levels in the human carcinoma KB cell line and induces a reversion of their transformed phenotype (Moroni, M. C., Willingham, M. C., and Beguinot, L. (1992) J. Biol. Chem. 267, 2714-2722). We used parental and EGF-R antisense KB clones as a genetic system to study, in the same cell line, the role of transforming growth factor α (TGF-α) in the establishment and maintenance of the transformed phenotype. KB cells produce TGF-α mRNA, and their conditioned medium is able to sustain growth of antisense cells, mimicking the effect of exogenous EGF or TGF-α. In antisense cells there is a marked reduction of TGF-α mRNA steady-state levels. In addition, the decrease in TGF-α parallels the levels of residual EGF-R in the various antisense clones, indicating a direct correlation between receptors and growth factor levels. The addition of exogenous TGF-α (10 ng/ml) to antisense clones induces TGF-α levels. The half-life of TGF-α mRNA is 40-60 min in antisense cells and more than 8 h in parental KB cells, as determined by actinomycin D decay curves. This result indicates a predominant regulation of TGF-α mRNA at the post-transcriptional level. Nuclear run-on experiments show that there is only a marginal effect at the transcriptional level. We conclude that the autocrine loop responsible for the transformed phenotype of the human carcinoma KB cell line is dependent on both elevated levels of EGF-R and the presence of TGF-α. In addition, TGF-α is able to induce its own mRNA via a signal due to activation of the EGF-R acting predominantly at the post-transcriptional level.


Residency programs in the combined specialty of Internal Medicine-Pediatrics (Med-Peds) are not offered in the military graduate medical education system despite existing in the civilian sector for over 50 years. This residency consists of 4 years of training and results in the development of board-certified internists and pediatricians who can care for patients from infancy to death. This versatility, combined with an emphasis on the transition from childhood to adulthood, would be valuable to the Military Health System. Med-Peds physicians could serve in a variety of settings depending on the needs of the military: in the outpatient clinic, in the hospital, or in an operational setting. Specifically, Med-Peds doctors could operate as critical care extenders in austere or operational environments to patients of all ages. This could improve outcomes of pediatric casualties in war because of specific training in both medical and pediatric intensive care units. Med-Peds physicians would integrate seamlessly into the Military Health System to work alongside family medicine doctors, internists, and pediatricians to provide high-quality primary care to service members; this may also allow for the increased flexibility of the medical corps. As there are already military residency programs in pediatrics and internal medicine, the required infrastructure for such a training program exists. The addition of this residency may also lead to more interest in military medicine from prospective applicants to medical school. This essay uses personal experience to explain how the addition of this specialty to the military would benefit the medical mission domestically and abroad.


Ischemic stroke is a devastating CNS insult with few clinical cures. Poor understanding of underlying mechanistic network is the primary limitation to develop novel curative therapies. Extracellular accumulation of granzyme B subsequent ischemia promotes neurodegeneration. Inhibition of granzyme B can be one of the potent strategies to mitigate neuronal damage. In present study, we investigated the effect of murine Serpina3n and human (homolog) SERPINA3 against cerebral ischemia through granzyme B inactivation. Recombinant Serpina3n/SERPINA3 were expressed by transfected 293 T cells, and eluted proteins were examined for postischemic influence both in vitro and in vivo. During in vitro test, Serpina3n was found effective enough to inhibit granzyme B, while SERPINA3 was ineffectual to counter cytotoxic protease. Treatment of hypoxic culture with recombinant Serpina3n/SERPINA3 significantly increased cell viability in dosage-dependent manner, recorded maximum at the highest concentration (4 mM). Infarct volume analysis confirmed that 50 mg/kg dosage of exogenous Serpina3n was adequate to reduce disease severity, while SERPINA3 lacked behind in analeptic effect. Immunohistochemical test, western blot analysis, and protease activity assay's results illustrated successful diffusion of applied protein to the ischemic lesion and reactivity with the target protease. Taken together, our findings demonstrate therapeutic potential of Serpina3n by interfering granzyme B-mediated neuronal death subsequent cerebral ischemia.


Change is the norm, fierce competition is the driver, and lean thinking is the latest call to action. Information Technology (IT) has finally come into its own, now viewed as a value provider as opposed to a cost drain. With the stakes so high, IT organizations are faced with an extraordinary combination of pressures to deliver value to their organizations in terms of added revenues, avoided costs, lower taxes, higher productivity, less employee turnover, less risk exposure, etc. Competitive advantage is now linked to an organization's ability to rapidly deploy IT solutions, and to change those systems as the business need evolves. IT projects must not only deliver high quality products faster, better, and cheaper (traditionally the responsibility of the project manager), they are also under intense scrutiny to positively impact the bottom line (increasingly, the joint responsibility of the project manager, project sponsor, and the business analyst).