Objective Patient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred. Setting and participants We used the Arksey and O'Malley scoping review method. Searches were conducted in MEDLINE, Embase, ProQuest Medical, other key databases and grey literature for studies reported in English from January 2000 to April 2016. We defined a patient navigator as a person or process creating a connection or link between a person needing primary care and a primary care provider. Our target population was people without a regular source of, affiliation or connection with primary care. Studies were included if they reported on participants who were connected to primary care by patient navigation and attended or made an appointment with a primary care provider. Data analysis involved descriptive numerical summaries and content analysis. Results Twenty studies were included in the final scoping review. Most studies referred to 'patient navigator' or 'navigation' as the mechanism of connection to primary care. As such, we grouped the components according to Freeman's nine-principle framework of patient navigation. Seventeen studies included elements of patient-centred care: informed and involved patient, receptive and responsive health professionals and a coordinated, supportive healthcare environment. Conclusions Patient navigators may assist to connect people requiring primary care to appropriate providers and extend the concept of patient-centred care across different healthcare settings. Navigation requires further study to determine impact and cost-effectiveness and explore the experience of patients and their families.


Study design: A single case study design Background: Scheuermann's Disease is the developmental disorder of spine in which wedge shaped vertebrae of thoracic spine are found which leads to excessive curvature and postural abnormality that causes stiffness and pain in upper back and later compromise of respiratory functions and disability occurs. Objectives: To investigate the effect of spinal mobilization, breathing exercise and home exercises in an adolescent with Scheuermann's Disease. Methods: This study was done on a 17 years old boy with the complaint of severe low back pain. An exercise program was given for 45 min for 8 weeks which included postural correction, strengthening and breathing retraining with chest expansion exercises. The changes in pain was evaluated by NRPS, muscle strength by MMT, Cobb's angle by X-ray and functional ability was assessed by Roland Morris Disability Questionnaire Results: Results of the study showed that patients improved with his pain, muscle strength, and functional abilities. Dyspnea of the patient also improved with breathing retarining. Conclusion: From this study it is concluded that spinal mobilization and breathing retraining with chest expansion and practicing these at home helps to relieve pain and reduce disability in patients with Scheuermann's disease.


We develop a model of a small region with durable housing, endogenous home maintenance, and disaster expectations, in which hurricane strike damage is a function of maintenance decisions. The model implies that declining areas (relative to growing areas) have a less well-maintained housing stock, with several associated predictions on the effects of hurricanes. First, in declining areas, initial hurricane damage to the housing stock is greater, causing substantial job losses, out-migration, and supply-driven wage increases. Second, recovery in declining areas is less complete because for some locations in the area, the asset value of destroyed homes is less than the replacement cost. Areas with a history of hurricane strikes undertake higher levels of maintenance, making them more resilient to the effects of hurricanes. Empirical evidence supports each of these predictions, and results are notably robust to the exclusion of Hurricane Katrina in 2005.


This thesis describes the occurrence of microbial and chemical contaminants in swimming pools and the investigation of an alternative disinfection technology, UVOX Redox® that could reduce reliance on chlorine and the formation of chlorinated disinfection byproducts (DBPs) in swimming pools. This technology was effective in inactivation of chlorine resistant microorganisms, represented by Bacillus subtilis spores, and in combination with chlorine generated lower concentrations of chlorinated DBPs compared to chlorination alone. It enhanced the removal of pharmaceuticals and personal care products (PPCPs), which were frequently present in indoor, outdoor and spa pools. Carbamazepine and 1H-benzotriazole were the most frequently detected PPCPs, while hydrochlorothiazide and 4-methylbenzylidene camphor were detected at the highest concentration. An investigation of seven different swimming pool facilities showed that clinically relevant fungi were omnipresent. Floors at the sites where the pool visitors converge, such as the exit leading to shower rooms, showed the highest fungal concentrations. The distribution of fungi inside the swimming pool facilities highlighted potential transmission pathways and a possible risk of fungal infections. Future swimming pool water guidance should include raising awareness among swimmers, pool operators and managers about hygienic behaviour and better hygiene measures, and application of alternative disinfection technologies such as UVOX.


The principle objective of this paper is to study the accuracy and efficiency of two-way performance nesting techniques for structured grids between a coarse grid and a fine grid for 2D shallow water models using explicit finite difference scheme. This model consists of a higher- resolution (fine grid) model with nested 3:1 embedded in a low-resolution (coarse grid) model on which covers the entire domain. The formulation of the mesh nesting algorithm of the structure grid model allows flexibility in deciding the number of meshes and the ratio of grid resolution between adjacent meshes. The two- way nesting is satisfied with an interpolating of the coarse grid domain to provide boundary conditions for the fine grid region and by updating the variables on the fine grid is suit- ably averaged onto the coarse grid in order to drive the coarse grid model. Comparing the results of a fine grid and a coarse grid shows the two- way nesting technique to be working efficiently over different periods of time and these results indicate good performance of the nesting technique.


Context. The complexity of the common-envelope phase and of magnetic stellar wind braking currently limits our understanding of close binary evolution. Because of their intrinsically simple structure, observational population studies of white dwarf plus main sequence (WDMS) binaries can potentially test theoretical models and constrain their parameters. Aims. The Sloan Digital Sky Survey (SDSS) has provided a large and homogeneously selected sample of WDMS binaries, which we characterise in terms of orbital and stellar parameters. Methods. We have obtained radial velocity information for 385 WDMS binaries from follow-up spectroscopy and for an additional 861 systems from the SDSS subspectra. Radial velocity variations identify 191 of these WDMS binaries as post common-envelope binaries (PCEBs). Orbital periods of 58 PCEBs were subsequently measured, predominantly from time-resolved spectroscopy, bringing the total number of SDSS PCEBs with orbital parameters to 79. Observational biases inherent to this PCEB sample were evaluated through extensive Monte Carlo simulations. Results. We find that 21-24% of all SDSS WDMS binaries have undergone common-envelope evolution, which is in good agreement with published binary population models and high-resolution HST imaging of WDMS binaries unresolved from the ground. The bias-corrected orbital period distribution of PCEBs ranges from 1.9 h to 4.3 d and approximately follows a normal distribution in log (Porb), peaking at ∼10.3 h. There is no observational evidence for a significant population of PCEBs with periods in the range of days to weeks. Conclusions. The large and homogeneous sample of SDSS WDMS binaries provides the means to test fundamental predictions of binary population models, hence to observationally constrain the evolution of all close compact binaries. © 2011 ESO.


Abstract Drawing on recent interdisciplinary, multidimensional research on civic and religious education in northern Europe, this article explores disciplinary epistemological economies in an era of mounting discontent with the narrowness of mono-disciplinary analyses of complex social and educational issues. It is argued in the article that under conditions of sufficient world complexity, interdisciplinarity provides for a more cogent scholarly approach to educational structures and phenomena than either of the logics of mono-, multi- and transdisciplinarity—the main extant alternatives. It is shown in both conceptual and empirical terms that these alternatives cannot accommodate social and educational diversity, complexity and sprawl other than thinly, hence should mainly be endorsed by universities and research funders for other than epistemological reasons or when there is agreement that the object subjected to analysis is correspondingly thin and isolated. As education in and of itself is a remarkably complex social phenomenon and field of study, it is concluded that interdisciplinary environments may typically be expected to provide a stronger potential for assessing and understanding it.


Extra–pair mating has been proposed as a source of sexual selection responsible for secondary sexual traits that are common among socially monogamous birds, although supporting evidence is scant. In the socially monogamous yellow warbler, males are larger than females, and unlike females, have extensive reddish streaking on their breasts. Using DNA fingerprinting we show that within–pair parentage was positively related to male size, and that extra–pair mating success was positively related to the amount of streaking on the breast. To our knowledge, this is the first intraspecific evidence of an association between a male plumage ornament and gains of extra–pair paternity that is apparently independent of age. This study confirms that extra–pair mating can be an important mechanism of sexual selection even when the most successful sires are commonly cuckolded, and refutes a previous hypothesis that the variation in plumage and behaviour among male yellow warblers is an example of alternative, equally successful, evolutionarily stable strategies (ESS). More generally, the demonstrated independence of within–pair and extra–pair success and their associated traits indicates that where animals have multiple secondary sexual traits, different traits may be selected by different mechanisms that contribute to total reproductive success.


The bearing capacity of layered soil studies was carried out with various approaches such as experimental, theoretical, numerical, and combination of them. This work is focused on the settlement and bearing capacity of shallow foundations subjected to the vertical load placed on the surface of layered soils. The experimental part was performed by manufacturing soil cubic container (570 mm x 570 mm x 570 mm).  A model square footing of width 60 mm was placed at the surface of the soil bed. The relative density of sand was constant at 60%, and the clay was prepared with a density of 19.2 (kN/m3) and water content of 14.6%. PLAXIS 3D FEM was used to simulate the experimental tests and performing a parametric study. The results showed that there was a good agreement between experimental work and corresponding numerical results. The value of the bearing capacity was obtained from load-settlement curve. The bearing capacity of layered soil showed higher value for footing resting on clay over sand soil. It was found that an increase in the ultimate bearing capacity regarding the clay over sand with increasing in first layer thickness ratio; while, a decrease has been indicated for the sand over clay. The critical depth was found at H = (2-3m), and the failure pattern was not unique for layered soil.


This paper questions the notion of good contexts for translators and describes an experiment which tests the usefulness of two specific kinds of contexts in a translation task, namely (1) contexts that provide conceptual information about a term, and (2) contexts that provide linguistic information about the collocational profile of this term. In the experiment, trainee translators are asked to use several types of resources, including a set of pre-annotated contexts of various types, and to identify the contexts that they consider to be the most relevant for their task. We present the first results of this experiment, which confirm our general assumption about the usefulness of such rich contexts and indicate some differences regarding the use of contexts in the source and target language. This study takes place in the CRISTAL project whose aim is to retrieve from bilingual comparable corpora the contexts that are the most relevant for translation and to provide them to users through a CAT tool.


With the current expansion of offshore oil activities in Arctic regions, there is an urgent need to establish the potential effects of oil-related compounds on Arctic organisms. The scallop Chiamys islandica is distributed throughout the sub-Arctic and has been proposed as a sentinel species for this region. In addition, the temperate scallop Pecten maximus occurs in regions of oil activity and, with increasing sea temperatures, the limit of its distribution may extend further into sub-Arctic regions. P. maximus also accumulates contaminants to a greater extent than the current temperate sentinel Mytilus edulis. A hierarchical approach, similar to that adopted to assess vertebrate immune function, was used to determine immunocompetence in the Arctic scallop C. islandica and the temperate scallop P. maximus following exposure to oil and oil-related compounds. The Arctic scallop C. islandica demonstrated a reduced immunocompetence following both dispersed and acute oil exposure. Immunomodulation in the scallops exposed to low levels of dispersed oil appeared to be reversible following removal of the contaminant stress (Chapter 3). However, a simulated oil spill resulted in mortalities and it remains unclear if the organisms are able to recover from the substantial immune suppression observed (Chapter 4). A component of crude oil and the most abundant PAH in aquatic ecosystems, phenanthrene suppressed immune function in P. maximus. These results indicated a link between PAH-induced oxidative stress and the subsequent inhibition in haemocyte immune function (Chapter 5). However, the ability of scallop haemocytes to recognise and respond to a pathogen-associated molecular pattern was not affected by phenanthrene exposure (Chapter 6). The immune parameters used in this research were shown to be sensitive, reliable markers of immunocompetence that can be directly linked to host resistance (Chapter 7). These immune parameters were also used to assess the sublethal effects of drilling wastes associated with offshore oil production (Chapter 8), indicating their potential as ecotoxicological monitoring tools.


Lubricant distribution and recovery for near contact and contact recording conditions are experimentally investigated using thermal fly-height control (TFC) sliders. Contact between the protruded center pad and the disk lubricant causes a thickness modulation (rippling) together with lubricant depletion that grows with contact duration. Slider dynamics and lubricant rippling evolve quickly in the first few revolutions of contact and rippling frequencies are strongly correlated with the slider air bearing frequencies. Peculiar cases where suppressed "stable" slider dynamics occur for TFC heater power beyond the touchdown power correspond to negligible lubricant rippling and this condition may be sustained for fairly long durations in some tests. Experiments with different lubricant types (ZTMD, Z-tetraol+A20H, Z-dol+A20H) and different lubricant thicknesses show that a larger depletion is observed for the thicker lubricant of each type at a given TFC heater power. Lubricants with lower bonded fraction show shorter recovery time after the slider is unloaded. From the current experiments it is extrapolated that Z-dol+A20H (30% bonded) lubricant recovers in a time scale of a few hours, while Z-tetraol+A20H (60% bonded) lubricant of comparable thickness takes a few days, and ZTMD (75% bonded) takes weeks to fully recover.


"Ulcosilvanil" (Romanian registered mark), administered in duodenal and gastric ulcer patients, leads to a constant and long-lasting inhibition of gastric acid secretion, consequently to disappearance of subjective symptoms as well as to radiologically and endoscopically proved healing of the crater. The high percentage and the quick ulcer healing by "Ulcosilvanil", as compared with antacid and anticholinergic therapy or with H2-receptor blocking agents, prove the outstanding therapeutical value of the former.


Acetylcholine modulates neuronal activity in the brain with different responses in activity depending on the region of the brain. Our study was focused on the cholinergic modulation of excitatory synaptic transmission in the monkey anterior cingulate cortex (ACC) and lateral prefrontal cortex (LPFC), with specific focus on the effects of carbachol, a cholinergic agonist, on spontaneous excitatory postsynaptic currents (sEPSCs) and on the expression the muscarinic cholinergic type II (M2) receptor in these regions. We used electrophysiology to analyze the effects of carbachol on sEPSC of layer 3 (LIII) pyramidal neurons from each area. We used confocal microscopy to study the M2 colocalization with axon terminals labeled with vesicular glutamate transporter 1 (VGLUT1) in the ACC and LPFC, and the colocalization of M2 with specific axon terminals from the amygdala labeled with tracer and terminating in the ACC. Results from the electrophysiological experiments showed that both the ACC and LPFC L3 neurons responded to carbachol by decreasing the frequency of sEPSCs. Cells from the LPFC showed a decrease in sEPSC frequency after 4 minutes in carbachol, an earlier timepoint than ACC neurons, which showed a decrease in sEPSCs frequency after 6 minutes in carbachol. In the confocal studies, M2 expression and colocalization with VGLUT1 terminals in the ACC and LPFC were observed. However, we observed a greater total area of M2 expression in the ACC versus the LPFC in layer 1. We found


Objective The chronic obstructive pulmonary disease (COPD) integrated care pathway (ICP) programme was designed and implemented to ensure that the care for patients with COPD is comprehensive and integrated across different care settings from primary care to acute hospital and home. We evaluated the effectiveness of the ICP programme for patients with COPD. Design, setting and participants A retrospective propensity score matched cohort study was conducted comparing differences between programme enrolees and propensity-matched non-enrolees in a Regional Health System in Singapore. Data on patients diagnosed with COPD who enrolled in the programme (n=95) and patients who did not enrol (n=6330) were extracted from the COPD registry and hospital administrative databases. Enrolees and non-enrolees were propensity score matched. Outcome measures The risk of COPD hospitalisations and COPD hospital bed days savings were compared between the groups using a difference-in-difference strategy and generalised estimating equation approach. Adherence with recommended care elements for the COPD-ICP group was measured quarterly at baseline and during a 2-year follow-up period. Results Compared with non-enrolees, COPD hospitalisation risk for ICP programme enrolees was significantly lower in year 2 (incidence rate ratio (IRR): 0.73; 95% CI 0.54 to 1.00). Similarly, COPD hospital bed days was significantly lower for enrolees in year 2 (IRR: 0.78; 95% CI 0.64 to 0.95). ICP programme patients had sustained improvements in compliance with all recommended care elements for patients with COPD. The overall all-or-none care bundle compliance rate had improved from 28% to 54%. Conclusion The study concluded that the COPD-ICP programme was associated with reductions in COPD hospitalisation risk and COPD health utilisation in a 2-year follow-up period.


This book explores the purpose and politics of the field. The contributors to this volume argue that for too long, inclusiveness has substituted for methodology in American studies scholarship. The ten original essays collected here call for a robust comparativism that is attuned theoretically to questions of both space and time. "States of Emergency" asks readers to engage in a thought experiment: imagine that you have an object you want to study - Which methodologies will contextualize and explain your selection? What political goals are embedded in your inquiry? This thought experiment is taken up by contributors who consider an array of objects - the weather, cigarettes, archival material, AIDS, the enemy, extinct species, and torture. The essayists recalibrate the metrics of time and space usually used to measure these questions. In the process, each contributes to a project that redefines the object of American studies, reading its history as well as its future across, against, even outside the established grain of interdisciplinary practice.


This paper provides an overview of the construction of subjectivity from an analytical- binding perspective. It explains how the inter-subjectivity of each individual is the result of interplay between inter-subjectivity and trans-subjectivity. It also explains how violence becomes part of the children's identity when they grow up in a violent environment, at family or school, making them to reproduce the same kind of environment in the future.


Inflation, or the general increase in prices, is the result of many unobserved adjustments. Only a fraction of prices change in a month. Some of those prices haven't changed for over a year while others changed last month. Some are rising or falling faster than others. Some goods are on sale while others are not. These dynamics matter a lot in themselves as they describe pricing behaviour. But they also matter for economic theory forming the foundation of how these prices, and hence inflation, are predicted and forecast. We used a never-before analysed dataset of consumer goods prices to decompose inflation into the fraction of price changes (extensive margin), both increases and decreases, and the magnitude of those price changes (intensive margin). We found the following properties of pricing dynamics in South Africa. First, the average fraction or prices changing from 2009 to 2015 is 27.8 per cent, while the median change is only 12.5 per cent. The average fraction of prices changing per month can vary anywhere between 37 and 18 per cent. There is also substantial heterogeneity between products and over months. Second, the average magnitude of price changes 0.83 per cent, or just under 10 per cent annualised. Multiplying the extensive and intensive margins mean that monthly inflation averages 0.25 per cent, or 3.0 per cent annualised. Third, the variance in monthly inflation is explained mainly by the extensive margin, or the fraction of prices changing. This suggests that inflation in South Africa is state-dependent, rather than time-dependent. Fourth, the variance of inflation is mainly due to price increases (explains 70%). Fifth, sales prices account for only around four per cent of prices but help lower inflation from 4.8 per cent annualised to 3 per cent.


Clinical experience indicates that the methods of intracoronary thrombolysis are not standardized. Although overall reperfusion rates of 75-80% have been achieved, clinical application at individual centers reflects variations in thrombolytic agents used, dosage, infusion rates, technique of administration and use of adjunctive measures, as well as variation in rates of successful recanalization. Analysis of results as a function of differences in approach suggests that certain procedural factors may influence reperfusion rates. Within the range of total dosage and infusion rates used, higher dosage levels and infusion rates appear to be associated with higher rates of reperfusion. Experimental and preliminary clinical results also suggest that subselective infusion may be associated with higher response rates than ostial infusion of thrombolytic agents. However, additional studies are needed to define the optimal methods of intracoronary thrombolytic therapy.


Two-phase, capillary-fed cooling devices are appealing thermal management technologies due to their potential for high heat transfer performance and ease of system-level integration. While existing evaporative wicking structures such as copper inverse opals (CIOs) and copper wire meshes (CWMs) have shown promise for achieving target heat dissipation rates of 100 Wcm−2 or greater, the reliability of these structures for long-term device operation and optimal capillary-driven boiling performance has not received much attention. To ensure proper functionality of the evaporator wick, the microporous copper structures must retain a hydrophilic contact angle during device operation. Surface oxidation of the copper is a critical degradation mechanism that must be addressed to preserve the integrity of the wick. In this study, we systematically investigate the contact angle change of untreated copper and various copper oxides under different conditions. To avoid the formation of hydrophobic Cu2O, we pre-oxidize the copper micro porous wick to form hydrophilic cupric oxide CuO and study the effect of various thermal and chemical oxidation recipes on the hydrophilicity and morphology of the resulting structures. A chemical oxidation formula is implemented for the creation of a stable superhydrophilic surface at a low temperature (70°C) for copper inverse opals (CIOs) (5 μm pore size) and copper wire meshes (CWMs) (76 μm pore opening). The recipe has been optimized to create nano CuO needles with a length of < 100 nm and keep the necks (∼1 μm diameter) open for better capillary wicking of the working fluid. The findings of this study potentially benefit the development of copper-based capillary-fed cooling devices.


Computer viruses uses a few different techniques, with various intentions, toinfect files. However, what most of them have in common is that they wantto avoid detection by anti-malware software. To not get detected and stay unnoticed,virus creators have developed several methods for this. Anti-malwaresoftware is constantly trying to counter these methods of virus infections withtheir own detection-techniques. In this paper we have analyzed the differenttypes of viruses and their infection techniques, and tried to determined whichworks the best to avoid detection. In the experiments we have done we havesimulated executing the viruses at the same time as an anti-malware softwarewas running. Our conclusion is that metamorphic viruses uses the best methodsto stay unnoticed by anti-malware software's detection techniques.


ABSTRACT This article investigates the empirical ground for transfer thinking about the practical aesthetic school subjects (PAS). We investigate the conceptual framework and methodological possibilities and constraints concerning transfer from the PAS to other domains, and analyse the transfer arguments in arts and crafts and physical education (PE) within the context of the Nordic countries specifically. We find that there is not much research about how educational objectives, content, and teaching and working methods, assessment forms, learning processes and learning outcomes are linked together. Accordingly, the transfer from one school subject to other subjects or domains is challenging to justify. We outline an alternative perspective on transfer in PAS in general, and in arts and crafts and PE specifically that could be investigated more carefully to further the development of a more robust knowledge field.


The type, shape and distribution of carbide take directly effect on the mechanical properties of high chromium castings. Vanadium is able to stabilize the structure of carbide in high chromium cast iron, meanwhile the hardness of carbide containing vanadium can reaches about 2800HV. In some cases, vanadium can also refine the microstructure. Rare-earth is able to change the shape of carbide in cast iron, refine the grain size of ferrite and improve the mechanical properties of castings. In this experiment, intention of adding vanadium and rare-earth is modification of mechanical properties with the proper heat treatment technology. With the help of SEM, the characteristics of carbide, such as shape, distribution and quantity can be observed and mechanical properties have been improved for better wear-resistance.


An adenocarcinoma arising from the rectosigmoid area. It is more frequently seen in populations with a Western type diet and in patients with a history of chronic inflammatory bowel disease. Signs and symptoms include intestinal bleeding, anemia, and change in bowel habits. According to the degree of cellular differentiation, rectosigmoid adenocarcinomas are divided into well, moderately, and poorly differentiated. Histologic variants include mucinous adenocarcinoma, signet ring cell carcinoma, medullary carcinoma, serrated adenocarcinoma, cribriform comedo-type adenocarcinoma, and micropapillary adenocarcinoma.


The budding of Nipah virus, a deadly member of the Henipavirus genus within the Paramyxoviridae, has been thought to be independent of the host ESCRT pathway, which is critical for the budding of many enveloped viruses. This conclusion was based on the budding properties of the virus matrix protein in the absence of other virus components. Here, we find that the virus C protein, which was previously investigated for its role in antagonism of innate immunity, recruits the ESCRT pathway to promote efficient virus release. Inhibition of ESCRT or depletion of the ESCRT factor Tsg101 abrogates the C enhancement of matrix budding and impairs live Nipah virus release. Further, despite the low sequence homology of the C proteins of known henipaviruses, they all enhance the budding of their cognate matrix proteins, suggesting a conserved and previously unknown function for the henipavirus C proteins.


BACKGROUND
Brain metastasis and carcinomatous meningitis from gynecological tumors are an uncommon event, usually related to choriocarcinoma, ovarian and cervical cancer.

CASE
A 74-year-old woman was diagnosed with locally advanced vulvar squamous carcinoma. Initial therapy consisted of multiagent chemotherapy and vulvar, pelvis and groin irradiation. The patient subsequently developed widely spread metastatic disease including brain and meningeal metastases.

CONCLUSION
The rising incidence of central nervous system metastasis in the last two decades is probably associated with treatment-related improvement in life expectancy. To our knowledge, this is the first case reported of brain metastases and meningeal carcinomatosis associated with vulvar squamous cell carcinoma.


Changes in serum and intrapancreatic enzyme content and protein synthesis in pancreas were studied in acute oedematous pancreatitis (AOP). Male Wistar rats (n 111) were divided into 2 groups, controls with a sham operation and those with AOP. Serum amylase levels rose immediately after the procedure causing AOP and then fell gradually, while serum lipase and ribonuclease levels remained higher than control values over 48h. (p<0.05,0.01). Serum deoxyribonuclease (DNase) II levels were unchanged. Intrapancreatic enzyme levels were scarcely affected by AOP. 3H-leucine uptake into pancreatic tissue of rats with AOP was decreased throughout the study (p < 0.001), but some protein synthesis continued. Intrapancreatic enzyme contents are maintained despite diffusion into the blood because the pancreas retain its ability to synthesize enzymes.


Management control systems may differ markedly from organization to organization. However, the trend within many of today's organizations is to include new perspectives in their formal management control and accounting systems. This ongoing transformation of management control systems is partly driven by the notion that intangibles play an increasingly important role in an organization's value creation process and thereby has to be visualized to a greater extent than hitherto. Nowadays, customers, suppliers and other stakeholders are frequently incorporated into the value creation process of organizations. Together with the growing importance of other intangible resources, such as leadership, employee competence and internal business processes, this approach promotes a highly complex picture of the organizational value creation process. The aim of this paper is to analyze organizational value creation from a management control perspective and, based on a longitudinal case study of a Swedish bank, discuss possible key features of a management control system that enables organizations to understand and allocate attention to the value creation of the firm.


Developing effective communication and symptom assessment skills is an important component of palliative care training for advance practice nurses (APNs) and other health care providers. The purpose of this project was to develop and pilot test a three-station palliative care Observed Structured Clinical Examination (OSCE) for APN students and physician fellows. Three stations included discussing goals of care, breaking bad news, and assessing delirium. Measures included the Interpersonal Skills Tool, Station Checklists, the OSCE Evaluation Tool, and a focus group to solicit learners' perspectives about the experience. Findings showed that learners evaluated the exercise as appropriate for their level of training and that standardized patients were convincing and provided helpful feedback. Learner self-evaluation means were significantly lower than those of standardized patient or faculty, and faculty raters demonstrated low interrater reliability. Initial evaluation suggests a three-station palliative care OSCE exercise is effective for multidisciplinary learners, although additional refinement is necessary.


THE ACROPOLIS AT KAMINALJUYÚ: A STUDY IN LATE CLASSIC OCCUPATION Kelleigh W. Cole Department of Anthropology Master of Arts The Late Classic Period at Kaminaljuyú is one of the most poorly understood periods of occupation, possibly because the artifacts and architecture lack the ornate decoration found in earlier periods. One of the largest and best preserved areas of the site is located in the Parque Arqueológico de Kaminaljuyú in Zone 7 of Guatemala City. A major focal point of architecture at Kaminaljuyú is the Acropolis, which has been the focus of various excavations, particularly the work of Gustavo Espinoza from 1958 to 1962. Despite this research, much of the important documentation and artifacts recovered from these excavations have been lost. In 2003, Brigham Young University and colleagues from the Universidad Del Valle in Guatemala City conducted excavations near the Acropolis and Palangana in order to collect additional artifacts and create a chronology of the structures found at the park. The team also focused on studying architecture and remapping the area, hoping to recover information vital to interpreting the construction and function of the buildings found there, with a particular focus on the relationship between the occupants of Kaminaljuyú and the people living at Teotihuacán. Using ceramics collected from the Brigham Young University/ Universidad Del Valle excavations, this thesis will focus on the Late Classic period of Kaminaljuyú in order to determine the function of the Acropolis during this period. A discussion of the status of the ancient inhabitants of the Acropolis will also be included. This thesis will provide the reader with a description of Late Classic ceramics and building phases. These findings will be explained in terms of the function of the Acropolis and the status of its residents during that period. The ultimate goal of this work is to illustrate that the Acropolis was used as a residential zone during the Late Classic Period. I will also argue that the people who lived near the Acropolis probably achieved an elevated status compared to residents of other parts of Kaminaljuyú, but lacked many of the luxury goods commonly associated with elites in Mesoamerica.


We report on the study of the interband pairing interaction in the two-band superconductor MgB2 by tunneling spectroscopy using thin film tunnel junctions. The films were deposited in situ by an approach comprising a conventional planar B sputter gun and a special homemade Mg evaporator providing a high vapor pressure. For the tunneling experiments sandwich-type crossed-strip tunnel junctions with a native MgB2 oxide as the potential barrier and Al, In or Pb counterelectrodes were prepared. Voltage-dependent differential conductance measurements revealed estimates of the barrier thickness and height of 1.5 nm and 1.6 eV, respectively, and allowed us to determine the phonon-induced structures in the tunneling density of states of the phonon-mediated superconductor MgB2. The analysis of the reduced density of states using the standard single-band Eliashberg equations yielded an effective electron-phonon spectral function accounting for the smaller energy gap. A further analysis involving ab-initio LDA calculations and the two-band Eliashberg equations revealed that the dominant feature in the effective spectral function, a strong peak at 58 meV, was mainly due to the interband pairing interaction.


Regression testing assures the quality of modified service-oriented business applications against unintended changes. However, a typical regression test suite is large in size. Earlier execution of those test cases that may detect failures is attractive. Many existing prioritization techniques order test cases according to their respective coverage of program statements in a previous version of the application. On the other hand, industrial service-oriented business applications are typically written in orchestration languages such as WS-BPEL and integrated with workflow steps and web services via XPath and WSDL. Faults in these artifacts may cause the application to extract wrong data from messages, leading to failures in service compositions. Surprisingly, current regression testing research hardly considers these artifacts. We propose a multilevel coverage model to capture the business process, XPath, and WSDL from the perspective of regression testing. We develop a family of test case prioritization techniques atop the model. Empirical results show that our techniques can achieve significantly higher rates of fault detection than existing techniques.


Some of the most interesting Islamic interlacing patterns involve ten-pointed stars or ten-petalled rosettes. These motifs have local ten-fold symmetry, yet they are often included as part of a plane periodic pattern, which can have no overall fiveor ten-fold symmetries. Instead of using these motifs in periodic patterns, can we incorporate them in patterns based in some way on Penrose tilings (which have many local five-fold symmetries)?


Case studies and recent economic theory are used to show why gaining and defending competitive advantage through innovative use of information technology has proved to be difficult. The principle lines of research in strategic and competitive information systems are surveyed. It is concluded that innovations can confer advantage if they leverage resources available to the innovator or to the innovator's cooperating group but not to competitors.<<ETX>>


Background: Many of the established skin diseases give rise to psychiatric disorders notably psoriasis and vitiligo. In Bangladesh, no study has yet been reported on psychiatric morbidity among psoriasis and vitiligo patients. Objectives: The objective of the study was to see the psychiatric morbidities in two chronic skin diseases, psoriasis and vitiligo, in Bangladesh. Methods: This was a cross sectional, analytical and comparative study. It was conducted to see whether psychiatric morbidity was higher among patients with psoriasis than that of vitiligo. Specific types of psychiatric disorders were identified by consultant psychiatrist assigned as per criteria of (Diagnostic and Statistical Manual for Mental and Behavioural Disorders-Fourth Edition)DSM-IV among 50 patients with psoriasis and same number of patients with vitiligo and were compared. Study places were the Departments of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) in Dhaka city. Results: Among the two dermatological conditions, psychiatric disorders were found 25 (50%) in psoriatic patients and 12 (24%) that in vitiligo patients. The proportion of major depressive disorders (MDD) was higher among psoriasis patients 15(30.0%) compared to vitiligo patients 04(8.0%). However, no statistical difference was found between two groups of patients in terms of anxiety disorders (8% in psoriasis and 12% in vitiligo patients). In patients with psoriasis, MDD was found highest (30.0%) followed by anxiety disorders (8.0%), adjustment disorder (4.0%) and somatoform disorder not otherwise specified (2.0%). Whereas, among the vitiligo patients, anxiety disorder was found highest (12.0%) followed by MDD (8.0%). The Present study showed significant association of psychiatric morbidities in these two dermatological diseases (psoriasis and vitiligo) with the variables of the study population. Conclusion: It has been found in Bangladesh that the psychiatric morbidity is higher among the patients with psoriasis than vitiligo. Key words: Psoriasis; Vitiligo; Psychiatric morbidity DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8636 BSMMU J 2011; 4(2):88-93


An estuary is a semi-enclosed coastal body of water which has a free connection with the open sea and within which sea water is measurably diluted with fresh water derived from land drainage. Examples are the Western Scheldt River Estuary and the Chesapeake Bay. Within these environments complex patterns of velocity and suspended sediments are observed in the transversal plane (across-estuary and vertical), and sediments are trapped laterally (across-estuary). The transverse structure of velocity is relevant to the transport of salt, sediment, contaminants, oxygen and other material. High sediment concentrations affect water quality, ecology and wildlife, and may cause siltation of navigation channels and harbors. This work aims at a fundamental understanding of the transverse distributions of estuarine velocity and suspended sediment. The thesis provides two-dimensional (cross-sectional) analytical models to identify the effect of individual forcing mechanisms on the transverse distribution of velocity and suspended sediment in tidally-dominated estuaries. The models are based on the shallow water equations and sediment mass balance. Considered are the residual and the semi-diurnal tidal components of the along-estuary, across-estuary and vertical velocity and of the suspended sediment concentration. The models apply to partially to well-mixed tidal estuaries, relatively uniform along-channel conditions and weakly to moderately nonlinear flow. Horizontal density gradients are prescribed based on numerical or observational data. The analytical flows are decomposed into components induced by individual mechanisms. Considered are tides, horizontal residual density gradients, river discharge, stokes return flow, wind, the earth's rotation, tidal variations in the across-channel density gradient and channel curvature. In addition, two tidally rectified along-channel residual flow mechanisms are considered, which result from net advection of along-channel tidal momentum by the Coriolis-induced transverse tidal flow and by the density-induced transverse tidal flow, respectively. The models were validated against observations in the James River and Chesapeake Bay, and against a three-dimensional numerical model for various estuarine conditions. An important finding is that the residual across-channel density gradient is crucial for the lateral distribution and trapping of sediment in many estuarine cross-sections. The gradient tends to trap sediments in fresher areas of the cross-section. Tidal variations in the across-channel density gradient were found to cause a double circulation pattern in the transverse tidal flow during slack tides. The gradient also affects along-channel residual velocity via density-induced tidal rectification. This rectification component features landward currents in the channel and seaward currents over the slopes, and is particularly effective in deeper water. Coriolis-induced tidal rectification was found to induce residual flows that are up-estuary to the right and down-estuary to the left of an estuarine channel (looking up-estuary in the northern hemisphere). The process fundamentally changes the transverse structure of along-channel residual flow for stronger tides or steeper channels, as the flow becomes internally asymmetric. For weaker tides, along-channel residual flows are typically dominated by a gravitational circulation, i.e., landward flow in the channel and seaward flow over the shoals, or river flow. Stokes return flow, which resembles river flow, is particularly important for strong tides in shallow water


Ruminant utilization of poor-quality feeds is governed by rates of digestion and of passage through the rumen. The passage rate of feed material determines the quantity of bypass nutrients and the efficiency of synthesis of microbial protein in the rumen, making modelling of passage rate important. Artificial neural networks were used to develop models of liquid and solid passage rates. Studies that reported fractional passage rates, along with class and body mass of ruminants, were included in the dataset. Factors that affect rates of passage in all the studies were identified, which included animal and feed factors. The dataset was composed of observations of domestic and wild ruminants of variable body mass (1.5 to 1238 kg) from 74 studies and 17 ruminant species from various climatic regions. Observations were randomly divided into two data subsets: 75% for training and 25% for validation. Developed models accounted for 66 and 82% of the variation in prediction of passage rates for solid and liquid, respectively. On validation with an independent dataset, these models attained 42 and 64% of precision in predicting passage rates for solid and liquid, respectively. Liquid and solid prediction passage rate models had no linear and mean bias in prediction. This study developed better prediction models for solid and liquid passage rates for ruminants fed on a variety of diets and/or feeds from different climatic regions. Keywords : Artificial neural networks, intake, mean retention time, prediction equation, rumen


An important set of applications, from diverse domains such as cosmological simulations, data mining, and computer graphics, involve repeated, depth-first traversal of trees. As these applications operate over massive data sets, it is often necessary to distribute the trees to process all of the data. In this paper, we introduce SPIRIT, a framework to ease the writing of distributed tree applications. SPIRIT automates the challenging tasks of tree distribution, optimizing communication and parallelizing independent computations. The common algorithmic pattern in tree traversals is exploited to effectively schedule parallel computations and improve locality. As a result, we identify systematic ways of exploiting pipeline parallelism in these applications and show how this parallelism can be complemented by selective application of data parallelism to provide greater speed-ups without requiring excessive data replication. SPIRIT is packaged into a set of application programming interfaces (APIs) that developers can use to create scalable applications. Evaluation of SPIRIT on various tree traversal algorithms shows a scalable system. We also find that SPIRIT implementations perform substantially less communication and achieve significant performance improvements over implementations in other distributed graph systems, and are competitive against state-of-the-art, hand-tuned, application-specific implementations.


Reach redirection is an illusion-based virtual reality (VR) interaction technique where a user's virtual hand is shifted during a reach in order to guide their real hand to a physical location. Prior works have not considered the underlying sensorimotor processes driving redirection. In this work, we propose adapting a sensorimotor model for goal-directed reach to obtain a model for visually-redirected reach, specifically by incorporating redirection as a sensory bias in the state estimate used by a minimum jerk motion controller. We validate and then leverage this model to develop a Model Predictive Control (MPC) approach for reach redirection, enabling the real-time generation of spatial warping according to desired optimization criteria (e.g., redirection goals) and constraints (e.g., sensory thresholds). We illustrate this approach with two example criteria – redirection to a desired point and redirection along a desired path – and compare our approach against existing techniques in a user evaluation.


To pursue innovation, design engineers need to continuously exploit the knowledge in their design domain and explore other relevant knowledge around the domain. While many methods and tools have been developed to retrieve knowledge within a given design domain, e.g., flying cars, knowledge discovery beyond the domain for innovation remains a challenge, and relevant methods are under-developed. Herein, we introduce a methodology to use a technology knowledge graph (TKG), which covers sematic-level knowledge in all technology fields defined in the international patent classification system, to retrieve the existing engineering knowledge in a domain and discover engineering concepts around the domain for future design considerations and innovation. We demonstrate the TKG-based methodology by applying it to explore the future designs of flying cars, an emerging domain with high uncertainty despite growing prospects.


Staphylococcus aureus is a formidable pathogen capable of causing infections in different sites of the body in a variety of vertebrate animals, including humans and livestock. A major contribution to the success of S. aureus as a pathogen is the plethora of virulence factors that manipulate the host's innate and adaptive immune responses. Many of these immune modulating virulence factors are secreted toxins, cofactors for activating host zymogens, and exoenzymes. Secreted toxins such as pore-forming toxins and superantigens are highly inflammatory and can cause leukocyte cell death by cytolysis and clonal deletion, respectively. Coagulases and staphylokinases are cofactors that hijack the host's coagulation system. Exoenzymes, including nucleases and proteases, cleave and inactivate various immune defense and surveillance molecules, such as complement factors, antimicrobial peptides, and surface receptors that are important for leukocyte chemotaxis. Additionally, some of these secreted toxins and exoenzymes can cause disruption of endothelial and epithelial barriers through cell lysis and cleavage of junction proteins. A unique feature when examining the repertoire of S. aureus secreted virulence factors is the apparent functional redundancy exhibited by the majority of the toxins and exoenzymes. However, closer examination of each virulence factor revealed that each has unique properties that have important functional consequences. This chapter provides a brief overview of our current understanding of the major secreted virulence factors critical for S. aureus pathogenesis.


Some problems of real and stochastic analysis arising from applications quasi-periodic solutions of Hamiltonian evolution equations scaling limits for lattice gas models multivariate distributions with Gaussian conditional structure the minimal projection from L1 onto Pi-n proofs and proofs of the Eckart-Young theorem an analytic semigroup associated to a degenerate evolution equation degenerate nonlinear parabolic problems - the influence of probability theory an application of measure theory to perfect competition dilations of Hilbert-Schmidt class operator-valued measures and applications transient solution of the M/M/1 queueing system via randomization a characterization of Hida measure new results in the simplex method in linear programming an estimate of the semi stable measure of small balls in Banach spaces nonsquare constants of Orlicz spaces recursive multiple Wiener expansion for nonlinear filtering of diffusion processes a Berry-Esseen type estimate for Hilbert space valued U-statistics and on Bootstrapping Von Mises statistics on the strong form of the Faber theorem nonlinear filtering theory for stochastic reaction-diffusion equations an operator characterization of oscillatory harmonizable processes operator algebraic aspects for sufficiency nonlinear parabolic equations, Favard classes and regularity.


AIMS
To update pretest probabilities (PTP) for obstructive coronary artery disease (CAD ≥ 50%) across age, sex, and clinical symptom strata, using coronary computed tomography angiography (CTA) in a large contemporary population of patients with stable chest pain referred to non-invasive testing.

METHODS AND RESULTS
We included patients enrolled in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial and randomized to CTA. Exclusively level III-certified readers, blinded to demographic and clinical data, assessed the prevalence of CAD ≥ 50% in a central core lab. After comparing the recent European Society of Cardiology-Diamond and Forrester PTP (ESC-DF) with the actual observed prevalence of CAD ≥ 50%, we created a new PTP set by replacing the ESC-DF PTP with the observed prevalence of CAD ≥ 50% across strata of age, sex, and type of angina. In 4415 patients (48.3% men; 60.5 ± 8.2 years; 78% atypical angina; 11% typical angina; 11% non-anginal chest pain), the observed prevalence of CAD ≥ 50% was 13.9%, only one-third of the average ESC-DF PTP (40.6; P < 0.001 for difference). The PTP in the new set ranged 2-48% and were consistently lower than the ESC-DF PTP across all age, sex, and angina type categories. Initially, 4284/4415 (97%) patients were classified as intermediate-probability by the ESC-DF (PTP 15-85%); using the PROMISE-PTP, 50.2% of these patients were reclassified to the low PTP category (PTP < 15%).

CONCLUSION
The ESC-DF PTP overestimate vastly the actual prevalence of CAD ≥ 50%. A new set of PTP, derived from results of non-invasive testing, may substantially reduce the need for non-invasive tests in stable chest pain.


The amperometric biosensor for ethanol determination based on alcohol oxidase immobilised by the method of electrochemical polymerization has been developed. The industrial screen-printed platinum electrodes were used as transducers for creation of amperometric alcohol biosensor. Optimal conditions for electrochemical deposition of an active membrane with alcohol oxidase has been determined. Biosensors are characterised by good reproducibility and operational stability with minimal detection limit of ethanol 8 x 10(-5) M. The good correlation of results for ethanol detection in wine and during wine fermentation by using the developed amperometric biosensor with the data obtained by the standard methods was shown (r = 0.995).


C.K. Chow and C.N. Liu (1968) introduced the notion of three dependence to approximate a kth-order probability distribution. More recently, A.K.C. Wong and C.C. Wang (1977) proposed a different product approximation. The present authors show that the tree dependence approximation suggested by Chow and Liu can be derived by minimizing an upper bound of the Bayes error rate under certain assumptions. They also show that the method proposed by Wong and Wang does not necessarily lead to fewer misclassifications, because it is a special case of such a minimization procedure. >


To the Editor.— During the past two decades, colchicine has been shown to be effective in treating a wide variety of inflammatory disorders, including the cutaneous lesions of Behcet's disease. 1 As there is no clear-cut distinction between recurrent oral ulcers or so-called aphthous stomatitis and the mucosal involvement in Behcet's disease, 2 we used colchicine therapy in four cases of protracted aphthous stomatitis. Report of Cases.—Case 1.— A 32-year-old woman had a long history of recurrent ulceration of the mouth during every menstrual period. Following a prodromal phase of soreness and burning sensation for one to two days, two or three small aphthous ulcers appeared, causing pain for ten days. Oral colchicine, 0.6 mg/day, was administered for a month, with no recurrence of the ulcers during the subsequent menstrual period. However, the patient complained of nausea after one month of therapy, so we limited administration of the


For simplified processing, micro parts are handled as linked parts. The length of the frame structure of these linked parts can change during a multi-stage production process especially when forming is included. Hence, the positions of individual parts are not constant within the linkage. An individual referencing of the parts becomes necessary in each production step. In this paper, a visual high-speed on-line part referencing system is presented and analyzed. Especially, the trade-off between the highest possible feed velocity and the demand of high accuracy in micro production is taken into account. In addition to this general characterization application related testing with stepwise positioning is performed.


In this paper, we develop and validate a method to identify computationally efficient site- and patient-specific models of ultrasound thermal therapies from MR thermal images. The models of the specific absorption rate of the transduced energy and the temperature response of the therapy target are identified in the reduced basis of proper orthogonal decomposition of thermal images, acquired in response to a mild thermal test excitation. The method permits dynamic reidentification of the treatment models during the therapy by recursively utilizing newly acquired images. Such adaptation is particularly important during high-temperature therapies, which are known to substantially and rapidly change tissue properties and blood perfusion. The developed theory was validated for the case of focused ultrasound heating of a tissue phantom. The experimental and computational results indicate that the developed approach produces accurate low-dimensional treatment models despite temporal and spatial noises in MR images and slow image acquisition rate.


I hypothesis that there is a correlation between the failure of Indigenous politics to achieve its goals and the sway of what Thomas Paine refers to as the false doctrine of Christian dogma. Unremitting evangelism and Christian hegemony has led to silencing or compromising authentic grassroots voices of too many Indigenous people. High conversion rates have weakened opportunities for resistance to colonialism and the loss of vital traditional values. (I suggest that a similar problem may relate to the failure of contemporary black politics.) It is important at this critical time for human civilization to reflect carefully on the influence of dominant worldview assumptions as relates both to the tragic problems facing Indigenous Peoples as well as to the broader consequences globally of having dismissed Indigenous understandings about the world. Overcoming the problems of religious hegemony does not require wholesale rejection. It includes possibilities for a complementary relationship between Indigenous spiritual understanding and alternative interpretations of Biblical Gospel that have existed for centuries. Moving to a different location is a simple process, though it often takes courage. One merely decides what to take and what to leave behind. What man makes, whether computers or religions, requires consumers to critically and intuitively consider both positive and negative potential outcomes. We must engage dialectically about likely universal truths and those that we invent about how best to live in flowing balance. All of us, Indigenous as well as those far removed from their Indigenous ancestors, however, can learn to again trust in the laws of Nature on which Indigenous worldviews are based.


Neutron stars formed in Type II supernovae are likely to be initially obscured by late-time fallback. Although much of the late-time fallback is quickly accreted via neutrino cooling, some material remains on the neutron star, forming an atmosphere that slowly accretes through photon emission. In this paper, we derive structure equations of the fallback atmosphere and present results of one-dimensional simulations of that fallback. The atmosphere remaining after neutrino cooling (Lν) becomes unimportant (Lν≲LEdd, e−, the Compton Eddington limit) is only a fraction of the total mass accreted (≲10-8 Macc=10−9 M☉). Recombined iron dominates the opacity in the outer regions, leading to an opacity 103-104 times higher than that of electron scattering alone. The resultant photon emission of the remnant atmosphere is limited to ≲10−3LEdd, e−. The late-time evolution of this system leads to the formation of a photon-driven wind from the accretion of the inner portion of the atmosphere, leaving, for most cases, a bare neutron star on timescales shorter than 1 yr. The degenerate remnant of 1987A may not be a black hole. Instead, the fallback material may have already accreted or blown off in the accretion-driven wind. If the neutron star has either a low magnetic field or a low rotational spin frequency, we would not expect to see the neutron star remnant of 1987A.


CONTEXT
Results from an analysis of 1998 Demographic and Health Survey (DHS) data from Kenya, where the approval rate of family planning is 90%, have cast doubt on the assumption that spousal discussion improves knowledge of partner's attitude toward family planning. However, it is not known whether this finding also applies to contexts more typical of Sub-Saharan Africa, where approval is not as high.

METHODS
DHS data from 21 Sub-Saharan African countries were used to assess the relationship between spousal discussion and correct reporting of partner's attitude toward family planning. Multivariate analyses of data from Chad were conducted to further examine this relationship in a setting where contraceptive approval was not high.

RESULTS
In every country, the proportion of women correctly reporting their spouse's disapproval of contraception was smaller among those who had discussed family planning with their husband than among those who had never done so. However, in an analysis of Chad data that included women who did not know their husband's attitude toward contraception, proportions of women correctly citing their husband's attitude were larger if discussion had occurred than if it had not, regardless of the husband's actual approval status. In multivariate analyses of Chad data that controlled for women's demographic characteristics, discussion was positively associated with correct reporting of husband's approval, but negatively associated with correct reporting of his disapproval.

CONCLUSIONS
Partner discussion does not necessarily mean an increase in knowledge of a partner's contraceptive attitudes. Therefore, anticipated reductions in unmet need for contraception through improvements in spousal discussion may be overstated.


High efficiency and linearity are indispensable requirements of power amplifiers. Unfortunately they are difficult to obtain simultaneously, since high efficiency PAs are nonlinear and linear PAs may have low efficiency. In order to satisfy the efficiency and linearity requirements, designers preferred to prioritize the efficiency of PAs in the design process and to later recover the linearity using external linearization techniques or architectures. Among the linearization techniques proposed in the literature, digital predistortion (DPD) has drawn the most attention of the industrial and academic sectors because it can provide a good compromise between linearity performance and implementation complexity. This thesis investigates digital predistortion techniques to suppress nonlinear distortion in radio transmitters.

The first part of this thesis provides a short introduction to the behavioral modeling of PAs, which includes a review of the most commonly known behavioral models, parameter estimation techniques, and performance evaluation criteria.

The second part provides an introduction to digital predistortion linearization and reviews different parameter identification techniques for digital predistorters. A variant to the indirect learning architecture (ILA), which is the most commonly used parameter identification technique, is proposed to simplify the DPD synthesis. The concept of iterative learning control (ILC) for the linearization of PAs is introduced and a new parameter identification technique based on ILC is proposed.

The third and final part of this thesis focuses on the linearization of dual-input transmitter architectures. Such architectures, which are currently attracting large research interest in the PA hardware community can offer greater efficiency and linearity than conventional PAs. The varactor-based dynamic load modulation PA architecture and dual-input Doherty PAs are discussed. A review of different linearization schemes especially designed for these kind of architectures is presented. Finally the linearization of dual-input Doherty PAs is discussed and a new linearization scheme that provides better linearity performance than existing schemes has been proposed.
The improved linearity performance achieved through the techniques and methods developed in this thesis can enable a better utilization of the potential performance of existing and emerging highly efficiency PAs, and are therefore expected to have an impact in future wireless communication systems.


Rutting is one of the main forms of distresses in thin flexible pavement structures, often associated with accumulation of permanent deformation in unbound granular layers and subgrade soils under traffic loading. Realistic prediction of surface rutting requires models that can reliably capture the cumulative plastic deformation of pavement unbound layers under repeated loads. This study presents an evaluation of three models that incorporate the time-hardening concept for prediction of permanent deformation of silty sand subgrade materials. A series of multistage repeated load triaxial (RLT) tests, in which the material underwent a wide range of continuous stress conditions, were carried out on two silty sand subgrades. The RLT tests were conducted at four different moisture contents in which pore suctions were measured throughout the test. In the modelling of the permanent deformations, the effective stress approach was used taking into account the effects of soil suctions. The material parameters of the predictive models were optimised using the RLT test data and the effect of moisture content (matric suction) on the permanent deformation characteristics of the materials and the predictive model parameters were investigated. Generally, it was observed that the modified models that are based on the shakedown approach performed reasonably well in capturing the permanent deformation behaviour of the selected subgrade materials with minor discrepancies between the models. This indicates that using multistage RLT tests can be an efficient approach for characterising the permanent deformation behaviour of subgrade soils.


Linking changes in amino acid sequences to the evolution of transcription regulatory domains is often complicated by the low sequence complexity and high mutation rates of intrinsically disordered protein regions. For the Hox transcription factor Ultrabithorax (Ubx), conserved motifs distributed throughout the protein sequence enable direct comparison of specific protein regions, despite variations in the length and composition of the intervening sequences. In cell culture, the strength of transcription activation by Drosophila melanogaster Ubx correlates with the presence of a predicted helix within its activation domain. Curiously, this helix is not preserved in species more divergent than flies, suggesting the nature of transcription activation may have evolved. To determine whether this helix contributes to Drosophila Ubx function in vivo, wild-type and mutant proteins were ectopically expressed in the developing wing and the phenotypes evaluated. Helix mutations alter Drosophila Ubx activity in the developing wing, demonstrating its functional importance in vivo. The locations of activation domains in Ubx orthologues were identified by testing the ability of truncation mutants to activate transcription in yeast one-hybrid assays. In Ubx orthologues representing 540 million years of evolution, the ability to activate transcription varies substantially. The sequence and the location of the activation domains also differ. Consequently, analogous regions of Ubx orthologues change function over time, and may activate transcription in one species, but have no activity, or even inhibit transcription activation in another species. Unlike homeodomain-DNA binding, the nature of transcription activation by Ubx has substantially evolved.


Introduction The aim of this study was to examine the impact the EU Directive for the Prevention of Sharps injuries had on the incidence of needlestick injuries (NSI) in Ireland. Methods A five-year retrospective study prior to, and after the introduction of these regulations, was conducted. Secondary data from the Occupational Health Department's annual NSI reports were used. The population studied were healthcare workers who reported a NSI from 2013 to 2017. Results The incidence of NSI varied from 157 in 2017 to 207 in 2014. 'Miscellaneous needles' was the category which caused the most NSI (23%). 'Disposable needles with syringes' accounted for 20% of all NSI before the legislation; this figure was reduced to 12-15% after the regulations were introduced. Conclusion The EU regulations did not reduce the incidence of NSI. A lower incidence of NSI was reported from 'disposable needles with syringes' after the implementation of the regulations.


late rickets or osteomalacia adhered to a chapati-free diet for 7 weeks, substituting unleavened bread of lower extraction. All 10 subjects showed prompt evidence of biochemical healing with subsequent biochemical relapse on resuming a normal diet. On the other hand, while 37 out of a sample of 66 Pakistani and Indian children resident in Glasgow, between 9 to 16 years of age, showed biochemical, radiological, or clinical evidence of late rickets, only one of a sample of 23 children taking vitamin D supplements showed a minimal depression of serum calcium. Similarly, a survey of the small Pakistani community in Stornoway, where atmospheric pollution is minimal, showed no biochemical evidence of rickets or osteomalacia in 42 subjects who were examined. In order to further elucidate the role of vitamin D deficiency, a competitive protein binding assay for 25-hydroxycholecalciferol (25HCC) was developed. It was found that normal Asians had 25HCC levels less than half those of Caucasians, while Asians with florid rickets had undetectable levels (limit of detectability 0 8 ng/ml). It seems probable, therefore, that the high dietary phytate content combined with vitamin D deficiency is responsible for the marked prevalence of rickets and osteomalacia among Asian immigrants. A possible unifying hypothesis was presented for discussion.


The author compares two replication schemes designed to provide high availability in an efficient manner: HA-NFS and ARM. Both schemes use the primary copy method for replica control. Both schemes were designed with the goal of minimizing the overheads during failure-free operation. In a primary copy scheme these overheads primarily consist of updating the secondary replicas. The two schemes were designed for different applications; ARM for providing high availability in a Shared Nothing database system, HA-NFS for providing high availability in an NFS file server environment. They also differ in that the HA-NFS scheme uses dual-ported disks to provide high availability, the ARM scheme uses replication over a network. In spite of the seemingly major differences, the schemes have the same key conceptual idea viz. propagating updates asynchronously to remote replicas. In addition to this idea, HA-NFS uses an unusual hardware arrangement in the form of dual-ported disks to further lower the overhead of updating secondary replicas.<<ETX>>


The design of mooring systems in West of Africa is often dominated by squall events. These are episodes of rapidly increasing wind speeds accompanied with sudden and significant wind direction changes. The response of weathervaning systems (offloading tankers moored to an export system or turret moored FPSO's) to such transient and violent environments is very complex and the subject of an on-going joint industry project. One important parameter in numerical simulations of weathervaning units to squall events is the yaw motion damping model. There is quite a large body of references and insights in yaw damping under steady environmental conditions but hardly any when it comes to responses in squall owing to the transient nature of the event and to its complexity.
 Field measurements of the yaw motions of a turret moored unit offshore Angola with concurrent on-board wind measurements are presented. Both quantities are sampled at 1-minute intervals. Time series of aft and fore drafts are also available on a daily basis. These measurements span one decade. A systematic scan of the wind speed time series has been performed to identify, based on the World Meteorological Organization definition, all squall events passing through the asset. The main particulars of the turret-moored FPSO are described along with its station-keeping system and the associated horizontal slow drift motion response time scales.
 Systematic analysis of measured yaw motions and velocities has been performed seeking correlations with the hull loading condition at the time of the squall event, its heading prior to the squall and the squall maximum speed and direction range. The main objective of these analyses is to provide factual information that can be used to firm up the yaw damping models used for mooring analyses in squall-prone areas.


Nationalization was particularly important in the early 1930s in Germany. The state took over a large industrial concern, large commercial banks, and other minor firms. In the mid-1930s, the Nazi regime transferred public ownership to the private sector. In doing so, they went against the mainstream trends in western capitalistic countries, none of which systematically reprivatized firms during the 1930s. Privatization was used as a political tool to enhance support for the government and for the Nazi Party. In addition, growing financial restrictions because of the cost of the rearmament programme provided additional motivations for privatization.


Religious orientation and psychological functioning were investigated in an analog study with 83 participants. After completing the Religious Orientation Scale (Allport & Ross, 1967), participants read a continuous narrative with three scenarios in which they first committed a dishonest act, and then felt compelled to confess what they had done. The final scenario contained a manipulation of grace or no-grace, in which half of the participants were forgiven for their act and half were not. Following each scenario, participants were tested for feelings of guilt and related behavioral and emotional responses. Intrinsically religious participants were more prone to guilt, more likely to confess their wrongdoing, and more likely to forgive themselves than extrinsically religious subjects. Guilt was found to have a mediating effect between intrinsic religiousness and some, but not all, outcome variables. The potentially beneficial consequences of guilt are discussed.


A 25-T cryogen-free superconducting magnet (25T-CSM) is being developed at the High Field Laboratory for Superconducting Materials, Institute for Materials Research, Tohoku University. In the case of a cryogen-free superconducting magnet, the coil temperature rises during a sweep of an operating current due to ac losses. Hence, the ac loss estimation is very important for the cooling design. The critical current density and the magnetization of Gd123 tapes at 4.2 K were measured in order to estimate the ac loss of a Gd123 insert of the 25T-CSM. The ac loss is actually the hysteresis loss, which are calculated from the Jc properties taking the magnetic field distribution in the Gd123 coil into account. Regarding the effect of tape stacking (or winding) in a pancake coil, the slab approximation can be used for hysteresis loss calculation. In the case of slab model, the full penetration field at the center of the tape becomes higher than the maximum applied magnetic field in the most part of the coil. As a result, the hysteresis loss increases with increasing a magnetic field when the magnet energizes. The hysteresis losses assuming the slab model, however, show an opposite field dependence to those calculated from the strip model without the stacking effect. Hence, the ac loss of 5 W is estimated when the magnet energizes to 25.5 T within 60 min.


Studies investigating fat as a fuel for exercise have found that increasing free fatty acids during exercise tends to spare muscle glycogen due to increased utilization of free fatty acids for energy, which in turn can enhance the capacity for endurance exercise. Medium-chain triglycerides do not delay gastric emptying or absorption. They are broken down by lipase in the stomach and duodenum to glycerol and medium-chain fatty acids (MCFA). Since MCFAs are metabolized as quickly as glucose, it has been speculated that they might provide an alternative carbon source for the muscle during prolonged exercise. While the majority of studies investigating the role of medium-chain triglycerides and exercise have found no sparing effect of muscle glycogen after consumption of medium-chain triglycerides, two recent studies have presented conflicting results. This review will investigate the speculated role of medium-chain triglycerides as an alternative fuel source for exercising muscles and will discuss the possibility that medium-chain triglycerides preserve muscle glycogen during exercise.


A tale about duty and desire, conflict and reconciliation in the lives of the diaspora, is molded in Chitra Banerjee Divakaruni's The Mistress of Spices . The present paper demonstrates the unevenness in the diasporic life showing the difficulty of the diasporic community, in a cross-cultural ambience, to reconcile with the conflicting entities of their life. Divakaruni epitomizes the spices, appearing emblematic throughout the novel, as the treasure of India, "a mythic place of desire in the diasporic imagination." This research focuses on how the author depicts an altruistic character like Tilo, who struggles to harmonize herself with the shifting priorities of her life. Her ambivalent soul sways between her egalitarian sense of duty and bodily desire for love. In the midst of turmoil, Tilo settles her mind to "acknowledge the suffering" of all, substantiating that "the smell of charred flesh is the same everywhere." Finally, the paper concludes with showing how pertaining to "a double consciousness," the characters, negotiating with the nuances of their inheritance, grow up cosmopolitan, that is "vernacular" in nature, allowing "the local, parochial, rooted, culturally specific" one to live together with the one who is "transnational" and "transcendent."


Bacterial cellulose-silk sericin (BC-SS) biomaterials enhance the in vitro proliferation of skin cells, forecasting an ability to accelerate wound healing. In a previous study, fibroblasts aligned along the stripes of microstructured BC-SS (mBC-SS), whereas randomly distributed on smooth BC-SS (rBC-SS). Therefore, we hypothesized that in vivo , collagens produced by fibroblasts and pivotal for wound contraction could follow the alignment of these cells, which would prevent excessive fibrosis and scaring. The current work reports the in vivo evaluation of rBC-SS2 and mBC-SS2 in full-thickness wounds. Overall, improved healing rates were obtained with the composites than with pure BC. Especially, mBC-SS2 induced complete wound closure with hair growth at day 14. Early infiltration of inflammatory cells, fibroblasts, and keratinocytes with the composites led to faster re-epithelialization, vascularization, and wound contraction. Interestingly, mBC-SS2 prevented the excessive wound contraction responsible for hypertrophied neo-tissue formation upon application of rBC-SS2, enhancing healing while containing fibrosis and scar formation.


The case "Guerrilha do Araguaia" is well known in Brazil in the view of the disappearances of oppositors to the military regime occurred between 1972 and 1974 , in the region known as Araguaia. Despite the efforts made by the families of the victims to seek responsibility and redress, few progress has been done. In 1995, Brazil recognized its responsibilities for the deaths and established a Commission to provide compensation to the families of the victims. The Amnesty Law prevented the State to initiate the criminal proceedings related to the responsibilities of those involved in the disappearances, torture and killings. On December 2010, the Inter-American Court of Human Rights decided that Brazil is responsible for the enforced disappearances in the Araguaia's region and, following its previous jurisprudence, determined that the State initiate adequate investigation and criminal proceedings related to the facts that amount to crimes against the humanity. In the view of the determination of criminal responsibilities on the "Guerrilha do Araguaia"'s case, this article will examine the grounds of criminal liability of the alleged offenders under the international criminal law as well as under the Brazilian domestic law, analysing the limitations that arise from both jurisdictions.


BACKGROUND
Laparoscopic removal of axillary lymph nodes is possible and affords an excellent view of all structures, allowing preservation of vessels and nerves. The technique uses pediatric trocars and a lifting device to maintain the newly created axillary space.

OBJECTIVE
To prove that a newly developed technique of balloon axilloscopy can be performed using only one 10-mm and two 5-mm standard trocars and constant carbon dioxide flow to preserve the axillary space and that preservation of all nerves and vessels is possible with this approach.

DESIGN
Prospective study on 4 fresh-frozen human cadavers and 7 live porcine models.

SETTING
A hospital department of minimal surgery access and a university department of anatomy.

RESULTS
The balloon dissection consistently revealed and preserved the nerves and vessels, and exposure and dissection of the first rib could similarly be accomplished. An alternative route to the apex of the axilla has been developed--between the pectoralis minor and pectoralis major muscles--after their careful separation. The axillary content of surgical interest (lymph nodes) is easily separated from the other anatomical elements and is simply dissected under complete visualization and preservation of all vital axillary structures.

CONCLUSIONS
Balloon axilloscopy was easy to perform, provided the surgeon with constant visualization of vital anatomical structures, and allowed easy separation and dissection of the axillary lymph nodes and the first rib. As a technical aid prior to a conventional axillary dissection, or as part of a pure endoscopic procedure in the axilla, balloon axilloscopy is 100% reliable in identifying the long thoracic nerve and moving it out of the way, separating the lymph nodes from it and from the intercostobrachial nerve and axillary vein and artery, rendering the whole dissection process safer for both the surgeon and the patient.


A variogram-based two-point geostatistical approach was applied to generate a geological model of a petroleum reservoir. The geology consists of a sandstone formation with uniformly inclined rock strata of equal dip angle structurally trapped by surrounding faults. Data exploration of electrical well logs using univariate/bivariate statistical tests and data transformation tools demonstrated the data to be statistically suitable for ordinary kriging and sequential Gaussian simulation. Three directions were defined as part of the variogram and the data were interpolated resulting in a 3D subsurface representation. Validation included performing a leave-one-out cross-validation for each well and statistical comparison of multiple realizations generated from a computed stochastic model. The results display a reliable geological model which indicate a direct causation of the continuity trends from the bedding attitude of the regional fault trap.


© Cambridge University Press 2016. The ambition in producing this volume was to examine the nature and extent of relations between the European Union and China beyond the scope of trade and investment. While there is no doubt that this relationship continues to be dominated by economic concerns, the preceding chapters have demonstrated the multifaceted character of the cooperation between the two powers and the value in probing deeper into the various security dimensions of this relationship. Seeking to identify a security perspective in the context of a predominantly economic partnership is not a contradiction. Indeed, these two aspects of EU-China relations can be seen as two sides of the same coin: precisely because the EU and China are such significant trading partners, both also have an inherent interest in various kinds of cooperation that can help to underpin their mutual security (Gartzke 2007). Or, to put it differently, the fact that Europe and China perceive each other as trading partners - and not as adversaries - also makes it easier to consider cooperation across a range of security domains. From such a starting point, EU-China security cooperation is not a utopian concept or a normative agenda, but an empirical question - a question that requires the kind of detailed analysis across a range of relevant areas that the contributions to this volume have provided. Building on these foundations, the purpose of this concluding chapter is threefold. First, to bring together the individual analyses and aggregate them, as much as possible, into a comprehensive picture. Second, the wider context influencing EU-China security relations will be brought into focus, including issues such as the potential for differences among EU member states and the role of third countries as impacting on this relationship in the context of global security. Finally, based on the preceding analysis and discussion, the chapter will provide an overall assessment of the current state and future prospects of EU-China security relations. Security Cooperation between the EU and China - Toward Convergence? The contributions to this volume have systematically analyzed EU-China security relations across a range of traditional and nontraditional dimensions of security. The guiding questions, as established in our introductory chapter, concerned the degree to which one can observe convergence between the two sides with respect to both the perceptions of threats facing the polity/society as well as the domestic policy response in addressing such threats.


This thesis considers the application of statistical exploratory methods and modelling techniques to sports data. Key to this investigation is the analysis of home advantage and the factors which drive it. The review of literature has shown that much conjecture has been made about the cause of home advantage, but little statistical investigation has been pursued into this area. Building on the model for association football goal counts discussed in Dixon and Coles (1997), reparameterisation to reflect time and team dependent home advantage was explored, alongside the effect of cards on home advantage. Covariate analysis was performed using parametric and semi-parametric models in an attempt to better interpret home advantage by analysing regularly hypothesised causal relationships. Over and under dispersion in goal counts may be the result of variation in team skill or the lack thereof. Censoring and threshold mixture models were explored to try and capture any over or under dispersion, with the aim of creating a more flexible model. As an aside, weighted likelihood based changepoint methods were also explored as a method of considering the reduction in information about the threshold position carried by observations far from the threshold position. Finally, a brief but insightful analysis of changes of performance in golf was carried out. The research contained within can be used to inform statistical models for sports results and impact betting strategies based upon such models.


New wave therapies such as Acceptance and Commitment Therapy aim to cultivate people's psychological flexibility in order for them to live a satisfying life. Psychological flexibility has also a role in promoting mental health, which may mediate the relationship with life satisfaction. The aim of this study was to determine whether mental health mediates the effect of psychological flexibility on life satisfaction. A convenience sample of 140 adults (32 males, M = 36.50 years, SD = 12.22; 107 females, M = 38.46 years, SD = 12.81; and a 45-year-old person of unknown gender) completed an online questionnaire assessing psychological flexibility, mental health and life satisfaction. Three of the four hypothesized components of psychological flexibility (experiential acceptance, cognitive alternatives and cognitive control) contributed to the latent construct of psychological flexibility, but cognitive defusion failed to contribute. Psychological flexibility had a direct, positive effect on life satisfaction and the hypothesis that mental health would mediate this relationship was supported. The results suggest that psychological flexibility is important for one's mental health and that both are integral to life satisfaction. The results also support a continued focus on third-wave therapies in cultivating psychological flexibility.


DESIGNING A FACE DETECTION CAPTCHA Adam C. Day Completely Automated Tests for Telling Computers and Humans Apart (CAPTCHAs) are quickly becoming a standard for security in every online interface that could be the subject to spam or other exploitation. The majority of today's CAPTCHA technologies rely on text-based images, which present the user with a string of distorted characters and asks the user to type out the characters. The problem with CAPTCHAs is that they are often difficult to solve and can generally be successfully defeated using techniques such as segmentation and optical character recognition. We introduce an image face recognition based CAPTCHA which presents the user with a series of distorted images and the question of deciding which of these images contain a human face. The user is required to click on all presented face images in order to successfully pass the CAPTCHA. The concept relies on the strength of the human ability to detect a face even amongst heavy distortion as well as the inaccuracies and short-comings of face recognition software. The CAPTCHA application was designed with a web interface and deployed on West Virginia University's Computer Science 101 attendance website. To test the success of the CAPTCHA, data for human success rates was compared alongside facial recognition software which attempted to solve the CAPTCHA. The results of the data gathered during testing not only prove the feasibility of face recognition based CAPTCHAs in general, but also provide valuable data regarding human versus computer recognition rates under varying types of image distortion.


The results of amputating an entire lower extremity with the corresponding half of the pelvis for malignant disease in 50 patients seen before the end of December, 1954, are reviewed for the purpose of assessing the therapeutic value of the operation and identifying the factors that affect immediate surgical mortality. No hospital deaths occurred, but in 1955 a hospital death followed operation. It resulted from pulmonary embolism on the seventh post-operative day. This extremely low mortality is ascribed to the relatively short duration of the operative procedure (which averaged 21/4 hours), to the general supportive care given to the patient, and to the replacement of lost blood. A tracheal tube was used by the anesthesiologist in every case. The surgeon must avoid seeding the wound with tumor cells, and transabdominal biopsies of tumors of the os coxae during exploratory laparotomy or through the incision made at the time of hemipelvectomy are strongly condemned. The life expectancy of the patient depended on the type of diseases that necessitated operation, and the best post-operative survival rate was in the group of patients with chondrosarcoma.


Automatic meter reading (AMR) is an application implemented by power utilities which is becoming increasingly important in the utilities sector. It could be included in the more general environment of demand side management, which satisfies the need for more improved communications. AMR offers a better financial return due to the inclusion of other applications. Although there are several international standards which address AMR, most deployments are currently using proprietary systems. This fact may reflect that current standards do not fully cover this area. Since the power network reaches all energy meters, a convenient way to deploy AMR is to use the power lines as a transmission medium. The present-day situation is that there is mounting pressure to deploy AMR systems in a bid to provide better management of the energy demand in a bid to reduce global warming and create a more sustainable electrical system in our environmentally conscious society. This paper is focused on analyzing different standards and specifications related to AMR over powerline communications (PLC). Furthermore, two of them are chosen, implemented, and simulated using the OPNET modeler. The main goal of the implemented applications is to obtain comparative results of the two most known standard applications in AMR over PLC.


Background: Observing musicians may offer illuminating parallels with surgical training, with several similarities between the two professions. Both utilize fine motor skills and are vocations, which involve in what can often be a stressful environment. As pressures on time within surgical training increase and learning opportunities decrease, understanding how to assist surgical trainees to reach the highest levels of achievement and become autonomous learners becomes increasingly important. Self-regulated learning (SRL) is a framework for lifelong learning used by musicians. It refers to self-generated ideas and thoughts that are planned and adapted to achieve personal goals. Within this dynamic framework adapted for medical education are four interacting cyclical processes: planning (goal setting); learning (learning styles and strategies); assessment (self-assessment alongside external feedback) and adjustment (selfevaluation and adaptation). SRL is not actively taught within surgical training but is fundamental to musicians. Therefore, this study sets out to identify approaches to SRL used by musicians to identify techniques that may be transferable to surgical training to assist surgical trainees in becoming independent learners and to maximize learning opportunities. Methods: Semi-structured interviews were performed with four expert cellists and data were analysed with six steps of thematic analysis. Results: Several themes emerged from the data that fell within the predefined phases of the SRL framework, including listening and strategy. The former highlighted the importance of critically listening to one's self, and to peers, teachers and critics. A pivotal master teacher was described by all as instrumental in the process of becoming independent learners. Two learning strategies were identified that may be transferable to surgical training: the use of video and audio recording analysis and the concept of instrument-free planning time, when the musicians spend time studying the musical score and planning bowings and fingerings before attempting to play. Conclusion: This study serves to generate ideas of how to integrate the teaching of SRL within surgical training to assist surgical trainees to reach higher levels of learning. Both learning strategies identified could be applied to surgical training, and indeed educators could be trained on how best to teach SRL amongst surgical trainees.