Beach nourishment restores beaches and enhances both their recreational value and their utility in shore protection. Increasing population in coastal areas and competition for land use has reduced the availability of terrestrial borrow pits while older sand pits have been exhausted. This situation has driven the search for borrow or mining sites offshore. Presently, almost all the marine sand mining along the Atlantic and Gulf coasts of the U.S. is to obtain material for publicly funded, beach nourishment. Much of this activity is in waters subject to federal jurisdiction. The demand for construction aggregate in metropolitan and developing coastal areas suggests that there might be an additional demand on offshore sand resources. Marine sand mining, as any type of dredging, disrupts habitat and can disturb transitory fishes and marine mammals. By altering the configuration of the sea floor, sand mining modifies wave transformation and, possibly, nearshore currents. Removing a large quantity of offshore sand and placing it in the nearshore zone alters habitat and sediment-transport processes. For over a decade, there has been a series of studies concerned with the potential environmental consequences of offshore sand mining and subsequent beach nourishment. A more recent set of projects developed and tested a suite of protocols for monitoring dredged and nourished areas. The field study testing the draft monitoring protocol was conducted in the active, sand-mining region of Sandbridge Shoal, offshore of Virginia Beach, Virginia. Results indicate that repopulation of dredged areas is enhanced by leaving patches of undisturbed bottom within the dredged region. No negative impacts on macrobenthos or demersal fishes were noted. Changes in wave transformation resulting from modifying the bottom topography are relatively small and, as the sand-mining sites tend to be in waters greater than 10 m deep, usually only occur during storms. In some instances, dredging shoals may decrease inshore wave height by diminishing the concentration of wave rays caused by refraction on the shoal. Shore-based radar may offer advantages for monitoring waves in the near shore. Agencies involved with individual sand-mining programs should consider participating in consortia managing local, coastal observing systems. Location and elevation/depth (x,y,z) data with sufficient metadata is the basic dataset necessary for determining and monitoring changes in the shore and seafloor surface. The data can be acquired as profiles or, especially in nearshore regions, swath-bathymetry surfaces. Profiles should be spaced to capture changes in topography. On-shore and off-shore measurements should be synoptic or nearly so. Although there are valid and strong scientific and management reasons for implementing a standardized, minimum monitoring protocol for marine sand mining, there appears to be little will for such a program. The obvious problem is cost coupled with the question "who pays?" Costs continue beyond the actual monitoring project. If data are in an electronic format, someone must maintain the computer system and the web site. In the case of beach nourishment projects, although the locality or agency sponsoring the project would carry the immediate expenses, eventually the cost would work down to the tax payer. For commercial mining of construction aggregate, the cost would wind up with the "end user." There are additional problems. The question "why monitor?" must be answered. If the data are collected solely to satisfy a monitoring requirement and are stored, unused the exercise cannot be justified. Widely and easily accessible monitoring data would help determine common factors contributing to the performance of sand mining and beach nourishment projects and would be beneficial in improving the predictive models.


Recently there has been much work on selective sampling, an online active learning setting, in which algorithms work in rounds. On each round an algorithm receives an input and makes a prediction. Then, it can decide whether to query a label, and if so to update its model, otherwise the input is discarded. Most of this work is focused on the stationary case, where it is assumed that there is a fixed target model, and the performance of the algorithm is compared to a fixed model. However, in many real-world applications, such as spam prediction, the best target function may drift over time, or have shifts from time to time. We develop a novel selective sampling algorithm for the drifting setting, analyze it under no assumptions on the mechanism generating the sequence of instances, and derive new mistake bounds that depend on the amount of drift in the problem. Simulations on synthetic and real-world datasets demonstrate the superiority of our algorithms as a selective sampling algorithm in the drifting setting.


Arsenic is a metalloid, a known poison as well as carcinogen that occurs naturally in earth,s crust. It is found in most of the environmental media such as air, soil and water. It enters the body through ingestion, inhalation and per cutaneous route. Health hazards of arsenic toxicity can occur as acute and chronic forms. Recently arsenicosis has emerged as a public health problem in many countries of South East Asian region. DOI: 10.3126/jcmsn.v6i3.4079 Journal of College of Medical Sciences-Nepal , 2010, Vol. 6, No. 3 pp.58-63


Based on fieldwork conducted between 2008 and 2011, this article explores the role of roads in enabling and limiting the movement of people and goods in Tajikistan's Eastern Pamirs. The article focuses on the Pamir Highway and a newly established trade route linking Tajikistan with China. Besides materially facilitating mobility, both roads serve as trajectories for opportunities, but often also signify the lack of such to those who live along them. This article thus seeks to analyse the shifting roles of roads against the backdrop of past and present state dispensations, shifting ideologies and newly emerging economic practices. By emphasising roads as both enabling and limiting spatial entities shaped by materiality, politics and economics, this article argues, on the one hand, that roads are important factors in directing and accelerating the mobility of people and goods and, on the other, that roads are also symbols of immobility inasmuch as they set limitations on the movement of people.


The evolution of continuous time recurrent neural networks is increasingly being employed to evolve nervous systems for autonomous agents. Nonetheless, the picture of populations engaged in hill-climbing rugged fitness landscapes poses a problem of becoming trapped on a local hilltop. Developments in evolutionary theory and molecular biology have pointed to the importance of selective neutrality. The neutral theory claims that the great majority of evolutionary changes are caused not by Darwinian selection but by random drift of selectively neutral or nearly neutral mutants. However, with a few exceptions neutrality has generally been ignored in artificial evolution. This paper addresses the distribution of fitness effects of new mutations when evolving dynamical systems and provides evidence of an improved evolutionary search process when incorporating nearly-neutral drift. This is one of the most fundamental problems in artificial evolution, because it lies at the heart of maintaining a constant-innovative property.


We have developed fast IC process simulation technique based on an empirical resist and etch models to compute the silicon image of designs as large as a full ULSI chip. The simulated silicon image is used to verify the correct electrical operation of the chip and its compliance to semiconductor manufacturing rules. This significantly reduces the manufacturing and development turn-aroundtime (TAT) by decreasing the number of costly and timeconsuming manufacturing test cycles. The basis of these techniques is a fast edge-based optical and process simulator. An edge-movement algorithm is used to compute the displacements of edge fragments in the original design, yielding an approximation to the silicon image. In this paper we will demonstrate the need for Silicon DRC, describe the simulation and image computation algorithms, and illustrate the usefulness of the technique on real circuits.


The Yellow River is well-known for its highest sediment contents of all rivers in the world. Due to the huge sediment to the coast, the Yellow river delta is the youngest land of China, and still in a state of continuous dynamic change. The evolution of the coastline of Yellow River delta is closely related to the environment change of the flow and sediment in the Yellow River estuary. In recent 10 years, environment of flow and sediment in the Yellow River estuary has been changed a lot. At first, in 1996, the riverway into the sea had been artificially changed; secondly, since 1999, Water resources unified collocation has been carried out in the whole basin; and thirdly, since 2002, water and sediment regulation has been carried out in the downstream of Yellow river. Change of flow and sediment condition resulted in change of coastline, land area, land cover and environment. The environment evolution of the Yellow River delta chiefly lies on the change of the coastline. As a kind of monitoring method, remote sensing technology are combined with geographic information system (GIS), which is a very useful tool for studying the dynamic change monitoring. Under this background, the study on the recent evolution of the coastline there through the integration of remote sensing and GIS can not only provide the foundation to evolution analysis but also serve for the sustainable development of the delta. In this paper, multi-phase and many kinds of remote sensing images are used to monitor the coastline change that happened in the Yellow River estuary since 1999. The directly extracted information from these images include coastline, land area and their increase or decrease between each two periods along time series. Furthermore, the relation between the changes and the main affecting factors are also analyzed. Based on the ten years of hydrological data, the flow and sediment feature of the Lijin station that is the last one along the Yellow River from 1996 to 2006 by month was analyzed. Then the relation between it and changes of coastline, land area, land use are analyzed. The result shows that: though the land area of the Yellow River estuary decreased sometimes, the general of it in recent years increased especially after 2003. It is nearly related to the changes of flow and sediment condition. It is clear that these changes are favorable but it is far from the perfect.


INTRODUCTION: Children in out-of-home care have high, unrecognized, and unmet health needs. The combination of exposure to abuse and neglect and a background of social disadvantage place them at significant risk for poor health, which affects their physical, developmental, and emotional health. OBJECTIVE: The aim of this study was to screen children in out-of-home care for unidentified health problems and recommend appropriate health interventions. METHODS: A health screening clinic for children in out-of-home care was established in a tertiary children's hospital in 2005 in collaboration with social services. Working within a multidisciplinary framework, the children had a comprehensive physical, developmental, and behavioral health screen. Recommendations were made to social services for appropriate health care. RESULTS: Of the 122 children screened, 24% had incomplete immunizations, 20% had visual problems, 30% had dental problems, and 26% had hearing loss, 45% of the children under 5 years of age had speech delay, 60% failed the developmental screen, and 54% had significant behavioral and emotional problems. CONCLUSIONS: Children in out-of-home care are a vulnerable group of the child population who experience unacceptable levels of poor health. Comprehensive health screens are important for identifying previously undetected health problems and recommending appropriate health interventions.


Dynamics in wildlife populations emerge from the interactions between individuals and their environment. Constraints between individual nutrition and food availability are therefore fundamental to understanding how species adapt to environmental variability and to identify mechanisms controlling population-level processes. Brown bears (Ursus arctos) exhibit a wide variety of life history traits across its distribution that may be a consequence of differences in their diet. Amount and quality of nutritional resources influence individual energy storage and this plays a central role in female reproductive success. Using energetic simulations models I integrated existing knowledge of energetics and nutrition to explore how the interactions among the ecology and physiology of brown bears, and the nutritional quality of the bear's habitat influence body mass and thus reproductive success. The model simulates the transfer of energy and protein from the environment to the individual, accounting for allocation in maintenance, growth and reproduction. Results reveal that: lean tissue and high protein foods play a fundamental role in reproductive success of bears. The relationship between protein available early in the season and energy available late in the season determine the allocation of nutrients in growth and reproduction and thus influence life history traits such as body size. Minimum levels of fat reserves necessary to support reproduction during hibernation varied from 19% to 33% of the total body mass depending on the number of cubs and length of lactation. However, when nutritional environments are poor (resource limiting) lactating bears require higher levels of denning body fat to support lactation after den emergence. Interactions between the digestive tract capacity of bears and food resource quality limit mass gain in bears and thus female reproductive success. Results reveal that brown bear populations in Alberta are restricted by the nutritional quality of its environment. This has two management consequences for Alberta's threatened population: (1) it limits the carrying capacity of bears resulting in small population sizes; and (2) rate of population recovery will be slower than what has been observed in other populations such as the Greater Yellowstone Ecosystem. This study provides insight into how nutritional factors control reproductive success in brown bears how this ultimately affects population processes.


Earthen materials and rammed earth architecture concepts are becoming more and more popular among architects due to their applicability in various climates and low-cost construction technique. However, the use of flat earthen roofs in today's architecture is rare, although there is historical evidence for the vernacular use of earthen materials in roof assemblies. The first examples for vernacular earthen flat roofs are found in Anatolia, Catalhoyuk. Flat earthen roofs used in vernacular, Anatolian buildings should be studied because a lack of maintenance has resulted in these vernacular Anatolian earthen buildings being on the verge of extinction today. There is a lack of literature research about the construction materials and techniques used in this traditional construction process. The aim of this study is to compile and present the knowledge behind this traditional flat earthen roof technique. In this study, initially, the flat earthen roofs used in vernacular Anatolian Architecture are analyzed via an extensive literature review. It has been found that in different districts of Anatolia, different types of vernacular flat earthen roofs together with different material layers and construction techniques exist. Site studies were carried out in Kemaliye.* During these site studies, six flat earthen roofs present in Kemaliye and in neighboring towns constructed via traditional construction techniques were analyzed and interviews were carried out with seven local foremen. Then, based on the information gathered, these traditional flat earthen roofs were classified into four types according to their material layers and construction techniques. Finally, preservation problems for flat earthen roofs are discussed.


This study offers new insights for policymakers to reduce income inequality, thus ensuring economic growth which greatly benefits the poor segment of population and directing financial sector to provide easy access to financial resources for lower income group at cheaper cost Bound test was applied to examine the long-run and short-run relationships based on the sample period beginning from 1970 until 2016 The results confirmed the existence of a long-run relationship between the variables Financial development in Malaysia, Indonesia and Thailand had successfully reduced income inequality, however, a different effect was recorded in the Philippines where income distribution was worsened Furthermore, economic growth brought positive effect to income distribution in Malaysia and Indonesia, but not for Thailand and the Philippines Inflation, trade openness and foreign direct investment, provided mixed results for all countries Among the policies recommendation for this paper are there should be more easy accessibility for entrepreneurs to reach the wide range of financial services including conventional and Islamic financial products, the expansion of capital market, as well as giving proper attention to the financial sector Besides, granting the access to capital markets for low income groups or underprivileged individuals might be helpful to them either by developing entrepreneurial skill or involvement in productive activities and receive better salaries This policy will give insight to the policymakers to strengthen their financial institutions, especially during the pandemic of Covid-19 © 2021, Econjournals All rights reserved


At present, the medical management of inflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis, are focused on topical, locally active antiinflammatories and systemic immunosuppressives, which are thought to exert their targeted effects in the gastrointestinal mucosa. There is a paucity of controlled trials assessing the impact of mind, central nervous system (CNS), and neuromodulation on the overly active immune response in the intestinal mucosa. Patients and their physicians have long been aware of a strong association between attitude, stress, and flares of their IBD. Although reports to date remain mostly anecdotal, the degree to which mind-body influences and stress impact levels of local inflammation deserves closer attention with the aim of identifying contributing mechanisms, which may highlight new therapeutic interventions, as well as assist in identifying particular subsets of patients that may respond to novel forms of adjunctive treatments for IBD, including hypnosis, meditation, neuropeptide receptor modulation, and cortisol-releasing factor (CRF) modulation.


The web technologies of the present time together with the diverse plethora of digital applications for mobile technologies offer unique opportunities to design mobile and flexible Personal Learning Environments (PLE). Even though the concept of PLE doesn't have a widely established single definition, the common factor seems to be the potential for offering new ways of using digital technology for student-centred learning, and are typically described as a collection of different applications, usually web based and collaborative ("social"), which aims at foster self-regulated and collaborative learning. A PLE should offer the learners possibilities toLearn with other peopleControl their learning resourcesManage the activities they participate inIntegrate their learningIn 2010, Mid Sweden University decided on an educational strategy for the coming years 2011 –2017, in which e-learning was established as one of two main areas for strategic development. E-learning should be a part of the educational activities carried out on campus as well as a part of the courses given on distance. An important part within the framework of the strategy was that Mid Sweden University should have a presence on the Internet that could be understood as a "digital campus" or an "e-campus".The "e-campus-project" started in 2013 with the ambition to build an e-campus for students. This digital environment would be organized around the existing student administrative tool "The Student Portal". Together with a new personalised interface the portal would be developed towards potential integration with other learning resources and learning support services located on the university websites, including the university library services, as well as the learning management system Moodle and GoogleApps licensed to the university. Functions for personalised schedules, possibilities to access transcripts of learning achievements and functions for course registration as well as resources for booking rooms for group work should be easily accessible. Students should have the possibility to easily communicate with each other and with their teachers via group or programme sites and messaging systems.Also, based on the increasing adoption of smartphones and iPads, the demand for mobile access to this new environment was obvious. The new environment should therefore have a responsive interface.In conclusion, the possibilities to transform the existing environment into a PLE is present and vital.The poster presentation aims at further the discussion on the concept of PLEs and the different solutions for digital learning environments among universities by presenting the key elements of the personalised and responsive interface in this still ongoing project. The poster gives an overview of what functionality is present in the digital environment and what possibilities exist in the coming steps of the continued development.


Micro-optical devices embedded in transparent materials are usually manufactured focusing a pulsed laser in bulk fused silica. Under this condition, pulsewidth becomes the most important parameter that rules the size of the inscriptions. Ultrafast pulses (pico- and femtosecond pulses) avoid thermal effects and the results present a high efficiency. Nevertheless, nanosecond lasers are more available due the reduced costs. Therefore, a study of the optical behavior of embedded elements micromachined by nanosecond pulses is required. In this study, we show that this regime of pulses can still be used for engraving diffractive optical elements in transparent materials, regardless of the thermal damage. A Fresnel zone plate and a far-field beam shaper have been manufactured as an example of the functionality of these devices.


AbstractDespite great advances in forensic sciences in the last decades, our knowledge of the pathophysiology of ligature strangulation is still largely based on old writings from the 19th and beginning of the 20th century. The study of filmed hangings by the Working Group on Human Asphyxia has contributed to a better understanding of the agonal responses to strangulation by hanging, and judo-related studies have given some insight into the pathophysiology of manual strangulation, but the pathophysiology of ligature strangulation has remained largely unexplored so far. Three nonlethal strangulations filmed by an autoerotic practitioner are here presented. In these 3 ligature strangulations, the 35-year-old man is sitting on a chair. A pair of pajama pants is rolled once around his neck, with the extremities of the pants falling down on each side of his chest. The man is pulling the extremities of the pants with both hands to apply compression on his neck. After losing consciousness, he ceases to pull on the ligature, and the pants slowly loosen around the neck. A few seconds later, he regains consciousness and gets up from the chair. In the 3 nonlethal ligature strangulations presented in this study, the loss of consciousness occurred in 11 seconds. The loss of consciousness was closely followed by the onset of convulsions (7–11 seconds). These results are compared with the early agonal responses documented in filmed hangings and judo studies.


mTORC1 links nutrient availability to autophagy by phosphorylating multiple components of an autophagy regulatory complex. High nutrient availability stimulates the mammalian target of rapamycin complex 1 (mTORC1) to coordinately activate anabolic processes, such as protein synthesis, while inhibiting the cellular catabolism of autophagy. Positive regulation of protein synthesis through the mTORC1 substrates p70 ribosomal S6 kinase (p70S6K) and eukaryotic initiation factor 4E binding protein 1 (4E-BP1) has been well characterized. The complementary inhibitory mechanism in which mTORC1 phosphorylates the autophagy regulatory complex containing unc-51-like kinase 1 (ULK1), the mammalian Atg13 protein, and focal adhesion kinase interacting protein of 200 kD (FIP200) has also been elucidated.


Canine and human rabies cases were confirmed in Bali in late November 2008, following several months of reported outbreaks of unusual dog biting episodes and several human deaths, with clinical signs consistent with rabies. Bali had been historically free of rabies, although the disease is endemic in many other parts of Indonesia. This incursion provides a unique case study into the local spread of rabies in a naive population with no prior public awareness of the disease and the possibility of eradicating rabies from Bali before it becomes endemic. Careful study of the risk factors which were present at the time of incursion should help both Indonesia and Australia anticipate, prepare for and hopefully prevent further incursions elsewhere.


The present specification discloses an integrated purification technique for purifying recombinant intracellular protein (GFP) from intact E. coli cells using preparative PAGE column. Under the influence of electric fields, the negatively charged GFP was drifted out from cells without the need of cell disruption process. The electrophoresed cells were observed under SEM and some on the membrane of cells were observed. GFP was then separated from other host cells host protein along polyacrylamide gel and finally eluted electrophoretically from the gel. The invention has successfully recovered the GFP with purity and yeild 95% and 82%, respectively in 100 min operation.


We discuss the Brauer–Manin obstruction on del Pezzo surfaces of degree 4. We outline a detailed algorithm for computing the obstruction and provide associated programs in Magma . This is illustrated with the computation of an example with an irreducible cubic factor in the singular locus of the defining pencil of quadrics (in contrast to previous examples, which had at worst quadratic irreducible factors). We exploit the relationship with the Tate–Shafarevich group to give new types of examples of X [2], for families of curves of genus 2 of the form y 2 = f ( x ), where f ( x ) is a quintic containing an irreducible cubic factor.


ABSTRACT Mahjabin, T.; Pattiaratchi, C., and Hetzel, Y., 2016. Factors influencing the occurrence of Dense Shelf Water Cascades in Australia. In: Vila-Concejo, A.; Bruce, E.; Kennedy, D.M., and McCarroll, R.J. (eds.), Proceedings of the 14th International Coastal Symposium (Sydney, Australia). Journal of Coastal Research, Special Issue, No. 75, pp. 527–531. Coconut Creek (Florida), ISSN 0749-0208. Transport of inshore waters and suspended material off the continental shelf by Dense Shelf Water Cascades (DSWC) has important ecological and biogeochemical implications in Australian waters. Because of high rates of evaporation, denser saline water occurs in the shallow coastal regions around Australia, setting up horizontal density gradients that can drive DSWC. Ocean glider data available from the Integrated Marine Observing System (IMOS), which is operated by the Australian National Facility for Ocean Gliders (ANFOG) located at the University of Western Australia, were used to measure cross-shelf density profiles under varying wind and tide conditions for seven contrasting regions around the entire continent. Overall 97 sets of spatial and temporal resolution data from year 2008 to 2015 collected by the ocean gliders and analysed with a subset presented here. Data from 19 transects covering the years 2012 to 2015 for the Pilbara region of Western Australia, indicated that cascades occur during the autumn and winter due to cooling of the coastal waters which already have higher salinity due to evaporation during the summer months. The cross-shelf density gradient in this continental shelf was found to be maximum in July with a value of 14.23×10−6 kg m−4.


Opportunistic networks is one of the fast developing research areas in mobile communications. Under opportunistic networks, mobile nodes try to communicate with other nodes without any prior information and knowledge about the network topology. Furthermore, network topologies are dynamic and can rapidly change. In addition, communication under opportunistic networks is erratic, thus routes between a source node and a destination node sometimes might not exist. These issues would make classical routing approaches insufficient and unusable for opportunistic networks. In this paper, two routing approaches for opportunistic networks are proposed. The first approach is flooding. Under flooding, it is possible to reach a destination node with the minimum number of hops and minimum delay but with maximum network traffic. The second approach is selective flooding.The aim of selective flooding is to decrease network traffic by randomly selecting neighbor nodes and routing traffic through them. This paper explains these two approaches and compares their performance through various simulations.


This Letter reports all-optically tunable and highly indistinguishable single Raman photons from a driven single quantum dot spin. The frequency, linewidth, and lifetime of the Raman photons are tunable by varying the driving field power and detuning. Under continuous-wave excitation, subnatural linewidth single photons from off-resonant Raman scattering show an indistinguishability of 0.98(3). Under π pulse excitation, spin- and time-tagged Raman fluorescence photons show an almost vanishing multiphoton emission probability of 0.01(2) and a two-photon quantum interference visibility of 0.95(3). Lastly, Hong-Ou-Mandel interference is demonstrated between two single photons emitted from remote, independent quantum dots with an unprecedented visibility of 0.87(4).


Opioid receptor can be classified as p., 8, and K-opioid receptor that widely expressed in the CNS. The development of selective receptor agonist and cloning of each receptor have contributed greatly to our increasing knowledge of the neuropharmacological profile of each opioid receptor type. This review focuses on the functional interaction among these opioid receptor types that contribute to opioid dependence especially in psychological dependence. Several lines of evidence provide arguments to support substantial roles for p-opioid receptors and the possible involvement of 8-opioid receptors in the development of physical and psychological dependence on morphine. Many studies have pointed to the mesolimbic dopaminergic system projecting from the ventral tegmental area to the nucleus accumbens as a critical site for the initiation of psychological dependence on opioids. It is important to note as the broad existence of opposing interaction between p/8-, and K-receptors in the central nervous system. The activation of Kopioid receptors leads to the suppression of unpleasant p.- or 8-mediated side effects such as withdrawal and rewarding effect. Considering the functional interaction among opioid receptor types, the co-administration of morphine-like compounds with K-receptor agonists lead suppressing the side effects of p-opioid receptor agonist that benefit for the pain management. Key words : Opioid receptor - receptor types - psychological dependence - morphine


The abundance and hatching success of Acartia bifilosa resting eggs in subtidal sediments of the Urdaibai estuary was analysed in the context of a study on the spatial and temporal dynamics of this species. Two sediment cores of 20 to 30 cm depth were obtained at two sites of the middle zone, where the accumulation of mud and organic particles is favoured. Laboratory incubations were performed to determine the hatching success of eggs and identify newborns. Resting egg abundance was around 107 eggs m -2 , and was higher at the site where the A. bifilosa population maintains an optimal position in the water column. The lower egg abundance in upper layers, as corresponds to winter, was associated with the seasonal dynamics of planktonic populations. On average, the hatching success was >50% at both sites. The lack of significant differences in the hatching success according to sediment depth suggests that eggs remain viable after being buried for a long-time in anoxic conditions. This enables us to infer that the benthic egg bank of A. bifilosa in this estuary is a safe source of recruits into the planktonic population, and plays a crucial role in recuperationand maintenance of the population.


Meiobenthic community structure was investigated at different spatial scales (from 100 metres to centimetres) on and adjacent to a group of coral-topped sandy mounds in the bathyal north-east Atlantic (Darwin Mounds, Rockall Trough) and related to the environmental conditions in the area, mainly differences in sediment organic carbon content and presence of biogenic structures. Meiobenthos abundances were similar to those observed in other deep-sea sites, with nematodes representing at least 94% of the total community. The dominant nematode genera were Microlaimus, followed by Sabatieria, Richtersia, Rhynchonema and Trefusia, together with typical deep-sea genera (e.g. Halalaimus and Acantholaimus). Multivariate analysis of nematode generic relative abundances at the different stations indicated that there was no significant influence on distribution resulting from large scale topographic and biogeochemical conditions around the mounds. The same genera were associated with dead tests of the xenophyophore Syringammina fragilissima and in the surrounding sediments. The vertical distribution of nematodes on and adjacent to the mound showed some unusual features, as the deeper layers of the sediments were inhabited by stilbonematids. These genera harbour ectosymbiotic, chemoautotrophic bacteria and have not previously been recorded from the deep sea. The occurrence of stilbonematids in notable numbers in the subsurface layers of the sediments in the vicinity of the Darwin Mounds provides evidence for the occurrence of anoxic microenvironments.


Hepatitis E is an important global public health problem of enterically transmitted hepatitis. There are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E. Transmission of HEV occurs mainly by the fecal-oral route. There are four major genotypes of HEV. HEV genotypes 1 and 2 are mainly restricted to humans, whereas genotypes 3 and 4 are zoonotic transmission. The common laboratory testing for HEV infection includes IgM and IgG anti-HEV antibodies, as well as HEV RNA and HEV antigens detection. This article reviews the information on basic knowledge of HEV, epidemiology, transmissions, pathogenesis, treatment, preventions and the laboratory diagnosis of HEV infection.


INTRODUCTION
Atopic dermatitis (AD) is a disease that mainly affects the pediatric population involving chronic and repetitive inflammatory skin manifestations. Its evolution is known as atopic march, which is characterized by the occurrence of respiratory and food allergies.

AIM
To carry out a classical review of the state-of-theart scientific literature regarding the effect of probiotics on the treatment of children with AD.

METHODS
Searches were conducted in Medline and Lilacs through the portals PubMed (http://www.ncbi.nlm. nih.gov/pubmed/) and SciELO (http://www.scielo.br). There was a selection of the available publications in the period from 2001 to 2011, using the keywords atopic dermatitis and probiotics (in English and in Portuguese).

RESULTS
After applying the inclusion and exclusion criterias, we selected 12 case-control studies which were conducted in four European countries and Australia. The methodological quality of the studies was assessed according to the STROBE recommendations. Assessment of agreement among researches in classifying the quality of the articles showed excellent agreement (k = 1.00, 95%) with a total of 9 papers at B level. The majority of the studies (75%) indicated a beneficial biological effect of probiotics on AD, including protection against infections, enhancement of the immune response, inflammation reduction and changes in gut the flora. The remaining studies showed no beneficial effects according to the outcomes of interest.

CONCLUSION
The majority of the studies in the scientific literature in this review showed improvements in some inflammatory parameters and in intestinal microbiota and not exactly, changes in clinical parameters. However, the biological effects observed in most of them suggest the possibility of benefits of the use of probiotics as an adjuvant in the treatment of AD.


Currently, no tool is available that precisely identifies and quantifies all 48 species of Pseudo-nitzschia simultaneously. In the present study, we used massively parallel sequencing-based technology with genus-specific Pseudo-nitzschia primers to investigate the distribution and population dynamics of the genus in Tokyo Bay, Japan. Furthermore, we attempted to quantify the abundance of each species using both relative abundance data detected in the massively parallel sequencing-based survey, and cell count data, obtained by light microscopy. Several species of Pseudo-nitzschia were detected continuously from July 10 to September 9, 2016 in the sampling location. Cell densities ranged from 2–300 cells mL−1 (sample no.=10). Fourteen operational taxonomic units (OTUs) attributable to Pseudonitzschia were detected, and 99.9% of sequences detected by massively parallel sequencing belonged to the genus. Each of the most abundant OTUs comprised a single species, and were identified, in decreasing order of abundance, as P. multistriata (Takano) Takano, P. pungens (Grunow ex Cleve) Hasle, P. fraudulenta (Cleve) Hasle, P. multiseries (Hasle) Hasle, and P. galaxiae Lundholm & Moestrup. Species identification was possible in 9 of the 14 OTUs detected, of which several were detected in Tokyo Bay for the first time. The cell abundance ranges of the five most abundant species were estimated as 1,976–246,395, 0.03–52,999, 5–42,820, 4–24,617, and 0.03–1,007 cells L−1, respectively. The detection limit was 0.03 cells L−1.


Carbon/Carbon(C/C) composites have attractive mechanical properties such as superior specific strength and high elastic modulus at high temperature exceeding 2000°C in an inert atmosphere. However, mainly due to lack of knowledge of design criteria, C/C composites have not been used in primary heat resistant structures. For example, almost no unified explanation has been given about the fracture behavior of C/C composites. The objective of this paper is to examine the adequacy of the linear elastic fracture mechanics(LEFM) as the fracture criterion of notched C/C composites. Thus the LEFM was tried to be applied to fracture behavior in tensile tests of double-edge-notched and compact tension specimens and in four-point bending tests of single-edge-notched specimens. It was found that the results of three kinds of fracture tests can be consistently and rationally explained in terms of the LEFM concept with the aid of R-curve behavior if the pre-crack length is long enough to be able to neglect the notch tip radius. From fractographic observation it was found that R curve behavior of C/C composites was mainly attributed to the fiber-bridging effect near the notch tip.


Piaget's concept of equilibration--and its current status--has been briefly reviewed. Two fundamental and essentially related issues were identified: the question of conformity between cognitive structures and their referent external reality and, from a cognitive viewpoint, the description of a "growing self-regulatory adaptive system." These issues were reconsidered in relation to, and elaborated on the basis of, relevant ideas mainly from philosophy, cybernetics, and artificial intelligence. A model of a cognitive homeostatic system was developed from an innate subsystem to a learning-based control hierarchy that additionally involves a naturomorphic cognitive subsystem and an abstract cognitive subsystem. The process of equilibration of cognitive structures was approached in terms of the information processing characteristics of these two cognitive subsystems and their inherent sources of error, and the theoretical requirements for ensuring conformity between cognitive structures and their external referents have been indicated. The model, which takes into account these requirements, constitutes a systematic description of a learning based "growing self-regulating adaptive system."


Repetitive low level image processing transformations can be performed at high speeds by SIMD arrays, DSP and dedicated VLSI devices. These strategies cannot be adppted with more complex and time consuming data dependent algorithms. A flexible and programmable component must be used, and the use of many such devices in parallel, using dynamic load balancing techniques, is necessary to enable acceptable execution performance to be obtained. The transputer is a powerful new microprocessor with unique on chip communications facilities. Together with the new parallel programming language, occam, the transputer was specifically designed for parallel processing applications. Large transputer networks can be used for computationally intensive applications. This work has investigated the use of transputers for performing image processing algorithms of all three levels of complexity. Techniques were devised and implemented for the execution of low, medium and high levels of image processing algorithms on a multi-transputer network. A software architecture using SUPPLY and DEMAND processes was designed, and dynamic work load balancing was achieved, operating on a ternary tree network of up to 32 transputers. Some 80 image processing algorithms were successfully implemented within the software architecture. In particular, the more complex operation of Feature Extraction was achieved using the multi-transputer system. The Features extracted, involving Convex Hull, Convex Hull Deficiencies, Areas and Perimeters, and Shape Factors were used to build a Feature Vector. The use of this Feature Vector in Scene Interpretation, to realise Learn and Recognise functions has been investigated. The results of the work clearly show that while the system proposed is not as effective at executing repetitive, data intensive transformations as methods mentioned earlier, it can execute more complex Feature Extraction and Scene Interpretation algorithms efficiently. An Efficiency of 85% was achieved for Convex Hull formation, using 32 transputers.


Transcriptional activation by nuclear receptors (NRs) involves the concerted action of coactivators, chromatin components, and the basal transcription machinery. Crucial NR coactivators, which target primarily the conserved ligand-regulated activation (AF-2) domain, include p160 family members, such as TIF2, as well as p160-associated coactivators, such as CBP/p300. Because these coactivators possess intrinsic histone acetyltransferase activity, they are believed to function mainly by regulating chromatin-dependent transcriptional activation. Recent evidence suggests the existence of an additional NR coactivator complex, referred to as the thyroid hormone receptor-associated protein (TRAP) complex, which may function more directly as a bridging complex to the basal transcription machinery. TRAP220, the 220-kDa NR-binding subunit of the complex, has been identified in independent studies using both biochemical and genetic approaches. In light of the functional differences identified between p160 and TRAP coactivator complexes in NR activation, we have attempted to compare interaction and functional characteristics of TIF 2 and TRAP220. Our findings imply that competition between the NR-binding subunits of distinct coactivator complexes may act as a putative regulatory step in establishing either a sequential activation cascade or the formation of independent coactivator complexes.


An automated model-image fitting algorithm is proposed in this paper for generating facade texture image from pictures taken by smartphones or tablet PCs. The facade texture generation requires tremendous labour work and thus, has been the bottleneck of 3D photo-realistic city modelling. With advanced developments of the micro electro mechanical system (MEMS), camera, global positioning system (GPS), and gyroscope (G-sensors) can all be integrated into a smartphone or a table PC. These sensors bring the possibility of direct-georeferencing for the pictures taken by smartphones or tablet PCs. Since the accuracy of these sensors cannot compared to the surveying instruments, the image position and orientation derived from these sensors are not capable of photogrammetric measurements. This paper adopted the least-squares model-image fitting (LSMIF) algorithm to iteratively improve the image's exterior orientation. The image position from GPS and the image orientation from gyroscope are treated as the initial values. By fitting the projection of the wireframe model to the extracted edge pixels on image, the image exterior orientation elements are solved when the optimal fitting achieved. With the exact exterior orientation elements, the wireframe model of the building can be correctly projected on the image and, therefore, the facade texture image can be extracted from the picture.


A flexible electronics sensor for large area sensing was developed using a screen printing technology with the thixotropy sol-gel materials to form the microstructure patterns on two polyimide (PI) sheets. A flexible sensor is 150times150 mm2, including posts, resistances, bumps, and electrode traces. The space between the top electrode and the resistance layer provided a buffer distance for large bending. Experimental results show that array microstructures have good morphological profiles at a screen speed of 10 mm/s, a squeegee pressure of 213 kPa, and a separation speed of 0.4 mm/s using the print-print mode. A membrane with a bump protrusion had a large displacement and a quick sensitive response because the bump provided a concentrated force of von Mises stress on the membrane center. For printing thick structures, diffusion effects and dimensional shrinkages can be reduced when a paste material with a higher viscosity is used. The results exhibit a potential for using in the flexible sensing and higher temperatures. In additional, the fabrication is the low cost and potential higher throughput in flexible electronics applications.


Forty-three patients were reoperated in the early postoperative period. In 27 of them the cause of early relaparotomy was postoperative intestinal obstruction. In 20 of these 27 patients the cause of postoperative obstruction were adhesive lesions. Of the 43 reoperated patients 31 showed distinct clinical signs and symptoms of postoperative obstruction. In 12 patients early diagnostic laparoscopy was performed due to unclear symptomatology. This allowed to obtain detailed information and to reduce the period of dynamic observation, to lessen postoperative risk, to avoid unnecessary relaparotomy.


This article is being retracted from Bioscience Reports at the request of several listed co-authors who claim to have had no involvement in the paper and that they were unaware of its submission and publication. The corresponding author has been contacted with regards to the retraction and has not responded to the Journal's queries or the concerns raised. Several listed co-authors wish to retract the article and the Editorial Board agree with the Retraction.


We examined the relationship of summer mortality to reproductive events for suspension-cultured mussels Mytilus edulis L. in the Magdalen Islands. Parameters associated with gametogenesis and spawning were followed along with the timing and intensity of mortality from mid-June to mid-September 1991. For mussels maintained in a shallow lagoon (the usual mussel culture site), summer mortality began in late July as a major spawning event was ending and as summer temperatures peaked (>20°C). Mussels from this group showed low energetic contents after spawning and during the period of highest mortality, glycogen content decreased rapidly and shell growth ceased. Thus, mussels weakened by a major spawning were at the same time submitted to stressful temperatures. Summer mortalities were observed until the end of the experimental period (mid-September) even though surviving mussels seemed to have improved their condition in late August (when glycogen content, tissue mass and shell length had increased). By mid-September approximately 65% of the mussels had been lost. In contrast, no summer mortality was observed for mussels from the same stock that were maintained at 16 m depth in the open sea. These mussels were exposed to lower temperatures and spawned less extensively than those in the lagoon. They had no major spawning in late July and were never completely empty of gametes. Our results suggest that suspension-cultured mussels in Magdalen Islands lagoons pay a high reproductive cost in terms of survival when a major spawning is completed during a period of stressful environmental conditions, such as high water temperatures.


During the production and quality control of heat treatment, especially during drastic cooling operations, avoiding heat-related distortions is critical if relatively stringent geometrical requirements stipulated by industrial manufacturing specifications are to be achieved. Therefore, specialized distortion minimization procedures are often used, which includes: the use of clamps and spreaders for fixturing workpieces in a designated position, and/or to controlling the flow direction and flux of coolants as they impinge on to the cooling workpiece surface. In addition, some assistive devices are required to implement designed movement of workpieces during the quenching process in order to meet the technical requirements of workpieces undergoing heat treatment. Quenching apparatuses are also used to fix workpieces to avoid any possible damage due to unexpected mutual contact or collision between them, and more importantly to ensure uniform heating and reasonable quenching of workpieces. On many occasions, some specially designed accessories are also considered as quenching apparatus to form a complete set with available heating or cooling equipment. Therefore, the quenching apparatuses are discussed in this paper for their role and function both in heat treatment production and especially for controlling quenching distortion. The main principles of the apparatus design are briefly described, and some apparatuses for typical heat treatment purposes are introduced, such as core rods, quenching machines, fixtures for press quenching, copying mould for quenching of aluminum alloy structural components, and apparatuses for induction hardening, and the use of quenchant flow tunnels. The management and the development trends of quenching apparatus are also briefly discussed. Characterization by digital technology, CFD, and computer control quenching apparatus has already become an important part of modern heat treatment production, and the synchronous increases of both production cost and heat treatment quality has been achieved. The popularization of the use quenching apparatuses implies that the fundamental solution to heat treatment distortion, which is based on effective movement constraints of workpiece upon quenching, suggests the programming cooling of workpiece and the reasonable design of quenchant flow tunnel for hardening is approaching. In the meantime, quenching apparatus design is becoming less empirical by increasing the use of established quenching theory and technology.


Sephacryl S-300 gel filtration of animal sera is used to demonstrate that there are at least 2 components that promote the 'spreading' of cells in culture. A morphometric technique is described to quantitate the spreading process. For a number of cell strains and established cell lines the more quantitatively significant spreading factor is not fibronectin. Rather it is a component with fibronectin and seems to cause spreading via a different mechanism from that stimulated by fibronectin. Thus fibronectin will cause spreading in the absence of protein synthesis, whereas the smaller component requires protein synthesis. The kinetics of spreading are also different at all concentrations of the factors that are effective. By comparing the spreading promoted by whole sera with that promoted by separate serum fractions following chromatography we conclude that under normal conditions plasma fibronectin plays little part in initial cell spreading. This view is supported by the fact that fibronectin-depleted serum will stimulate cell spreading.


The RAD6 gene of Saccharomyces cerevisiae encodes a ubiquitin-conjugating (E2) enzyme and is required for the repair of damaged DNA, mutagenesis, and sporulation. Here, we report our studies on the regulation of RAD6 gene expression after UV damage, during the mitotic cell cycle, in meiosis, and following heat shock and starvation. RAD6 mRNA levels became elevated in cells exposed to UV light, and at all UV doses the increase in mRNA levels was rapid and occurred within 30 min after exposure to UV. RAD6 mRNA levels also increased in sporulating MATa/MAT alpha cells, and the period of maximal accumulation of RAD6 mRNA during meiosis is coincident with the time during which recombination occurs. However, RAD6 mRNA levels showed no periodic fluctuation in the mitotic cell cycle, were not elevated upon heat shock, and fell in cells in the stationary phase of growth. These observations suggest that RAD6 activity is required throughout the cell cycle rather than being restricted to a specific stage, and that during meiosis, high levels of RAD6 activity may be needed at a stage coincident with genetic recombination. The observation that RAD6 transcription is not induced by heat and starvation, treatments that activate stress responses, suggests that the primary role of RAD6 is in the repair of damaged DNA rather than in adapting cells to stress situations.


1. Washed cellular suspensions of pneumonic lungs, previously preserved with chloroform and toluene, contain a protease or proteolytic ferment, derived chiefly from the leucocytes of the exudate. 2. This protease is able to convert horse fibrin to a non-coagulable split product. In a pH range of 4.0 to 8.0 the digestion is slight at the most acid end. With decrease in acidity there is a gradual rise in activity to pH 6.0, and then a sharp increase up to the maximum digestion at pH 8.0. Judging from the amino nitrogen determinations, the most complete splitting occurs at pH 7.0. The degree of autolysis occurring in the pneumonic lung cellular suspension controls suggests that the active enzyme is identical with that causing the digestion of the fibrin. 3. Washed cellular suspensions of normal lungs, previously preserved with chloroform and toluene, contain a proteolytic enzyme which is active in a moderately acid medium (pH 4.0) and essentially inactive in less acid, neutral, and slightly alkaline media.


The study examined effect of occupational hazards on poverty status of cassava processors in the study area. Specifically, the study profiled the cassava processors based on their poverty status and determined the factors influencing it. It identifies the general processing activities, the occupational hazard associated with cassava processing and safety measures used.
A multistage sampling technique was applied. Three local governments areas (LGAs) were purposively selected based on large cassava producers and processors in the area. Two wards each from the LGAs, forms the second stage and the processors were selected using. In all, 215 cassava processors from the study area were used for the study. Data obtained were analyzed using descriptive statistics and Ordinary least square regression analysis. The result showed that the mean age of the cassava processors is 48 years. It also revealed that majority of the cassava processor in the study area were women (86.51%) and married (77.21%). The mean household size in the study area was7 persons and it implies that the cassava processors had fairly large household size. The average years spent in school was 7 years. The regression analysis result revealed that poverty status of the cassava processors is influenced by household size (5%), work experience (10%), cost of treatment for eye irritation (5%) and general cut (1%). Inhalation of smoke ranked highest among the occupation hazard identified while the least rank in this category was damage done to the lungs due to inhaled smoke. The use of sun hats/ caps to prevent excessive heat ranked highest amongst the safety measure adopted to combat the occupational hazard.  It was recommended that extension agent should further enlighten and orientate the processors on the importance of using safety guards such as foot wear so as to prevent snake bite, use of modern methods of processing cassava that will minimize or eradicate the identified hazards in the study area.


A method for manufacturing an excellent sandmold by adjusting the pressure value or the blowout time of a first compressed air. In the method, foundry sand is squeezed by moving a squeeze means to a pattern plate side after the foundry sand is blown into a molding space demarcated by at least the pattern plate, a flask, and the squeeze means by supplying a second compressed air onto the upper surface of the foundry sand held in a sand blowing device while floatingly moving the foundry sand near a sand blowout port held in the sand blowing device by blowing the first compressed air near the sand blowout port of the sand blowing device positioned above the molding space and holding the foundry sand. The blowout time of the first compressed air can be decreased or increased based on the results obtained by measuring a movement distance to the pattern plate side of the squeeze means when the squeeze of the foundry sand in the molding space is completed and calculating a difference between the measured value and a target value.


Direct Laser Metal Deposition (DLMD) is an emerging technique in the group of Material Accretion Manufacturing (MAM) processes because of the possibility to fabricate and to repair a wide range of metal components with a complex geometry, starting from metal powders. DLMD is a technology which combines computer aided design, laser cladding and rapid prototyping. Fully dense metallic parts can be directly obtained through melting coaxially fed powders with a laser. The success of this technology in the die and tool industry depends on the parts quality to be achieved. An accurate control of the parameters such as laser power, spot diameter, scanning speed and powder mass flow rate is fundamental to obtain the required geometric dimensions and material properties. In this work, the performance of the DLMD process was examined in terms of hardness, porosity, microstructure, and composition. A fitting equipment was built and used for the experiments together with a CO2 laser machine with a maximum power of 3 kW. The material used for experimental tests was Colmonoy 227-F, a Nickel alloy specially designed for glass container mould protection and restoration.


Development of interpersonal relationships is a fundamental human motivation, and behaviors facilitating social bonding are prized. Some individuals experience enhanced reward from alcohol in social contexts and may be at heightened risk for developing and maintaining problematic drinking. There has been little systematic research conducted in group settings, though, and no prior studies have tried to link genetic variation to alcohol's socially reinforcing effects. This research investigated whether the rewarding effects of alcohol in a group setting are associated with genetic variation implicated in the development of alcohol use disorders. Specifically, this study tested the moderating influence of genes encoding the dopamine D2 and D4 receptors, the serotonin transporter, and the alpha receptor for gamma-aminobutryic acid (GABAA) on the effects of alcohol on social bonding. Social drinkers (N=427; males=50.12%) were assembled into three-person unacquainted groups, and given a moderate dose of alcohol, placebo, or a non-alcohol (control) beverage, which they consumed over 36-min. To assess social bonding, participants completed the Perceived Group Reinforcement Scale immediately after the group drinking period. In addition, their social interaction was video-recorded, and the duration of facial behaviors was systematically coded using the Facial Action Coding System. After applying the Bonferroni correction to control for false positives in multiple genotype comparisons, there was one significant gene x environment interaction. Results showed that carriers of at least one copy of the 7-repeat allele of the DRD4 VNTR reported higher perceived social bonding in the alcohol, relative to placebo or control conditions, whereas alcohol did not affect ratings of 7-absent allele carriers. Findings indicate that carriers of the 7-repeat allele were especially sensitive to alcohol's effects on social bonding. These data converge with other recent gene-environment interaction findings implicating the DRD4 polymorphism in the development of alcohol use disorders, and results suggest a specific pathway by which social factors may increase risk for problematic drinking among 7-repeat carriers.


Governance of food systems is a poorly understood determinant of food security. Much scholarship on food systems governance is non-empirical, while existing research is often case study-based and theoretically and methodologically incommensurable. This frustrates aggregation of evidence and generalisation. We undertook a systematic review of methods used in food systems governance research with a view to identifying a core set of indicators for future research. We gathered literature through a structured consultation and sampling from recent reviews. Indicators were identified and classified according to the levels and sectors they investigate. We found a concentration of indicators in food production at local to national levels and a sparseness in distribution and consumption. Unsurprisingly, many indicators of institutional structure were found, while agency-related indicators are moderately represented. We call for piloting and validation of these indicators and for methodological development to fill gaps identified. These efforts are expected to support a more consolidated future evidence base and eventual meta-analysis.


Data streams are infinite and continuous, so it's difficult to treat the data streams by using existing DBMS. The CEP engine which is one solution for data streams processing detect complex events from real-time data streams using continuous query method. Through this method, we can detect interesting data and process them effectively. And we think that the selective processing of data streams in mobile terminal likes sensor-gateway becomes more important. In this paper, we describe the role of mobile CEP engines and the results of Vesper Android performance test which is the current developed mobile CEP. And based on the experiment results, we discuss the research directions of future mobile CEP engines.


Purpose
This study aims to investigate applications of Six Sigma methodology in Malaysian private hospitals. It measures Six Sigma initiatives of the private hospitals based on demographics such as gender, position and working experience.

Design/methodology/approach
The present study measures Six Sigma initiatives of private hospitals and used stratified random sampling to collect data from eight selected hospitals in Peninsular Malaysia. The respondents of the study include doctors, nurses, pharmacists and medical laboratory technologists. In this study, 520 questionnaires were distributed to respondents who are working in Malaysian private hospitals. In total, 251 responses were received (48.27 per cent response rate). The descriptive analysis, independent samples t-test and one-way ANOVA were undertaken using SPSS version 23.

Findings
The findings of this study indicate that male respondents have better perception on four aspects of Six Sigma applications such as process improvement tools, process improvement methods, manage quality improvement activities and formal planning process compared to female respondents. The research findings also indicate that doctors have better perception regarding process improvement tools to measure quality improvement process, leadership to continuous improvement processes, training in process improvement tools for employees' skill improvement compared to nurses, pharmacists, medical laboratory technologists.

Research limitations/implications
The present research focussed solely on the Malaysian private hospitals, and thus the results might not be applicable to other countries. This study focussed on Six Sigma initiatives of private hospitals in Malaysia, while the future research may consider investigating the difference or conformance between private and public hospitals on Six Sigma initiatives and its relationship with quality performance. In addition, present study findings are expected to provide guidelines to enhance the applications of Six Sigma methodology in private hospitals in Malaysia as well as other countries.

Originality/value
This research provides theoretical and practical contributions for the Six Sigma initiatives in private hospitals. Most of the past studies of Six Sigma initiatives are centred on manufacturing sector, but few empirical studies have been conducted on the health-care organisation. Thus, findings of the present study on the health-care sector contribute to the on-going pursuit of knowledge in the area of Six Sigma by using the strength of related theories and parent disciplines.


Human- plant relation is tightly attached on life of human beings. From the beginning of civilization, people used many plants and their products for different purpose to adopt with their environment. The essential and valuable materials including plant species are gathered, used, saved and always remain hunger for knowledge yet now. They developed different kinds of ceremonies and rituals and include valuable materials and plants within it to protect and remains as indigenous knowledge in particular communities and groups. In this context, I want to raise the issue of material culture to search why people used plants in their rituals with reference to a plant species the Jhakro the Magars inhabitant of Baglung district, western Nepal. The research was carried out by using descriptive and exploratory research design. Observation, interview and group discussion were used in the field for primary data collection. The Magars are rich in their rituals among them death and kul pujane rituals are significant for cohesive and solidarity of the group; within these rituals a shrub plant species with special type of smell remains in central position for purity and soul. They believed that in death ritual all the polluted activities are purified and in kul pujane Jhakro acts as purity as well as help to join their ancestors with them. Unfortunately, they are unknown of the materialistic meaning of it due to lack of transferring knowledge. In etic aspect, this plant has important medicinal properties and the Magar preserved by keeping it in important rituals within their community. Keywords: Ritual; Jhakro; the Magars; ethno-botany; ancestors DOI: 10.3126/dsaj.v4i0.4522 Dhaulagiri Journal of Sociology and Anthropology Vol.4 2010 pp.223-234


Background We aimed to investigate the influence of sleep disturbance on the 10-year risk of myocardial infarction (MI) in men aged 25–64 years in Russia. Materials and Methods Within the framework of the WHO program "MONICA-psychosocial" a representative sample of men aged 25–64 years was surveyed in 1994 (657 persons). Sleep disturbance were measured at baseline using the MONICA—psychosocial scale. Incidence new MI cases were ascertained using systematic surveillance the 10-year follow-up. Cox—proportional regression model was used for an estimation of RR. Results Two thirds of the subjects who experienced their first MI referred to their sleep as "sleep disturbances". The 10-year RR of MI in men aged 25–64 years was 2.8 times higher (p<0.05) in those whose sleep was described as "poor" vs those with "good" sleep. RR of MI in men aged 25–44 years was 9.25 times higher (p<0.0001) in those whose sleep was described as "poor" vs those with "good" sleep. In the 45–64 year age group these differences were insignificant. RR of MI in men with sleep disturbances was higher in widowers, divorced men, with low social support level men, men with only primary education, working class men, and pensioners. Conclusion The results demonstrate that sleep disturbances present a social problem and contribute to the risk of MI in young men.


Mullite reinforced composites were produced by the injection molding technique to develop environmentally friendly friction materials for automotive applications. In order to examine the effect of mullite content on the friction and wear properties, two different specimens containing 10wt% and 30wt% of mullite were respectively fabricated and wear-tested by using the plate-on-disc type sliding friction and wear test machine. The sliding friction and wear test demonstrated that both specimens show similar tendencies at different sliding speeds under a low load of 2.9N. In comparison with common glass fiber reinforced composites, both of the mullite reinforced composites exhibited a lower wear rate at room temperature.


This study aimed to determine the targeted efficacy of trastuzumab (Herceptin) on human epidermal growth factor receptor 2 (HER-2)-overexpressing metastatic esophageal cancer in an orthotopic mouse model. HER-2 overexpression and amplification of human esophageal primary and metastatic tumors were shown with HER-2–fluorescence in situ hybridization analysis and HER-2 immunostaining. Following orthotopic implantation with the HER-2–overexpressing OE19 human esophageal cancer cell line, mice were treated with trastuzumab. Sequential magnetic resonance imaging was used to monitor primary tumor and metastasis during treatment. After six weeks, a significant inhibition of primary tumor development was imaged in trastuzumab-treated animals in comparison with the control group. Trastuzumab treatment also led to a reduction of lymphatic metastasis. Thus, HER-2 targeted therapy with trastuzumab resulted in a significant primary tumor growth reduction as well as a decrease of lymph node metastases in the orthotopic model of metastatic esophageal carcinoma. The results of the present study suggest the clinical use of trastuzumab for HER-2–overexpressing esophageal cancer, which is a significant fraction of the patient population. Treatment of this highly treatment-resistant disease with trastuzumab in the adjuvant setting to prevent lymph node metastasis after primary tumor resection is suggested by the data in this report. Mol Cancer Ther; 9(7); 2037–45. ©2010 AACR.


We consider supervisory control of nonlinear systems which are implemented on digital networks. In particular, two candidate controllers are orchestrated by a supervisor to stabilize the origin of the plant by following a dwell time logic, i.e. evaluating a control-mode switching rule at instants which are at least spaced by some dwell time interval. The plant, the controllers and the supervisor communicate via a network and the transmissions are triggered by a mechanism at the discrete sampling instants, which leads to periodic event-triggered control. Thus, there are possibly two kinds of events generated at the sampling instants: the control-mode switching event to activate another control law and the transmission event to update the control input. We propose a systematic design procedure for periodic event-triggered supervisory control for nonlinear systems. We start from a supervisory control scheme which robustly stabilizes the system in the absence of the network. We then implement it over the network and design event-triggering rules to preserve its stability properties. In particular, for each candidate controller, we provide a lower bound for the control-mode dwell time, design criterion to generate transmission events and present an explicit bound on the maximum sampling period with which the triggering rules are evaluated, to ensure stability of the whole system. We show that there exist relationships among the control-mode dwell time, a parameter used to define the transmission event-triggering condition and the bound of the sampling period. An example is given to illustrate the results.


A new approach was used to experimentally dry and warm a Mediterranean shrubland. By means of automatically sliding curtains, the drought period was extended by excluding rain over the two growing seasons (spring and autumn), and passive warming was created by avoiding infra-red dissipation at night over the whole year. The aim of the study was to test how a future extended drought period and an increase in temperatures could affect the photosynthetic and water use strategies of two co-occurring Mediterranean shrubs, Erica multiflora and Globularia alypum, which are common species of the dry coastal shrublands. The shoot water potential, leaf gas exchange rates and chlorophyll a fluorescence of plants was monitored seasonally during two years (1999–2001). In addition we measured the photosynthetic response curves to light and CO2 in autumn 2001 and the foliar N concentration and leaf C and N stable isotopes in summer 1999 and 2000. Droughted plants of both shrub species showed lower shoot water potentials, transpiration rates and stomatal conductances than control plants, although there was a high seasonal variability. Drought treatment reduced significantly the overall leaf net photosynthetic rates of E. multiflora, but not of G. alypum. Droughted plants of E. multiflora also showed lower leaf net photosynthetic rates in response to light and CO2 and lower carboxylation efficiency than controls, but there was no significant effect of drought on its overall photosystem II (PSII) photochemical efficiency. Although warming treatment did not affect the leaf net photosynthetic rates of the two species overall the study, it increased significantly the carboxylation efficiency and leaf net photosynthetic rates of G. alypum plants in response to CO2 levels in autumn 2001. In addition, warming treatment increased the potential photochemical efficiency of PSII (Fv/Fm) of both species (but especially of G. alypum) at predawn or midday and mainly in autumn and winter. Thus, the results suggest that drier conditions might decrease the annual productivity of these Mediterranean shrubs, particularly of E. multiflora, and that future warming could alleviate the present low temperature constraints of the photosynthetic performance of the two studied species, but especially of G. alypum, during the colder seasons. Ultimately, drier and warmer conditions in the near future may change the competitive relationship among these species in such Mediterranean ecosystems.


BACKGROUND
Voluntary dehydration is a condition where humans do not drink appropriately in the presence of an adequate fluid supply. This may adversely affect their physical and intellectual performance. The present study aimed to describe the prevalence of voluntary dehydration among elementary school children of different ethnicities and countries of birth.

METHODS
Four hundred and twenty-nine elementary school children, aged 8-10 years, from four subpopulations (Israeli-born Jewish and Bedouin-Arab children, and immigrant children who recently arrived to Israel from Eastern Europe and from Ethiopia) were studied. The level of dehydration was determined by noontime urine osmolality, from samples taken over 1 week in mid-summer. Urine osmolality <500 mOsmol kg(-1) H(2)O was considered to be an appropriate level of hydration.

RESULTS
Mean urine osmolality was 862 +/- 211 mOsmol kg(-1) H(2)O. Osmolality above 800 mOsmol kg(-1) H(2)O was detected in 67.5% of the urine samples; among these, 25% were above 1000 mOsmol kg(-1) H(2)O. The most dehydrated group was that of Israeli-born Jewish children, whereas the Bedouin-Arab children were the least dehydrated.

CONCLUSIONS
A high proportion of children who reside in a hot and arid environment were found to be in a state of moderate to severe dehydration. Bedouin ethnicity was associated with better hydration, whereas Israeli-born Jews were most severely dehydrated. Educational intervention programmes promoting water intake should start in early childhood and continue throughout life.


The earliest interactive computer graphics terminals were closely coupled to their central computers and placed heavy loads upon them for resource allocation. Two marked trends in the evolution of terminals have been a reduction of central computer load and exploitation of the increasing performance/cost ratio for terminal equipment. The trends have led to graphics terminals that operate on a stand-alone basis. The history of these trends is traced and particularly illustrated by the cases of the fully interactive, refreshed CRT GRAPHIC 21 and the simply interactive, storage CRT GRAPHIC 101 terminals.


Scatter factor/hepatocyte growth factor (SF/HGF) is a pleiotropic cytokine that has been implicated in glioma invasion and angiogenesis. The SF/HGF receptor, MET, has been found to be expressed in neoplastic astrocytes as well as in endothelial cells of the tumor vasculature. Both SF/HGF and MET expression have also been described to correlate with the malignancy grade of human gliomas . However, most glioblastoma cell lines lack SF/HGF expression, raising the question of the cellular origin of SF/HGF in vivo. Using in situ hybridization, we analyzed glioblastomas, anaplastic astrocytomas, diffuse astrocytomas, pilocytic astrocytomas, and normal brain for the expression of SF/HGF mRNA. We detected strong SF/HGF expression by the majority of the tumor cells and by vascular endothelial cells in all glioblastoma specimens analyzed. Combined use of in situ hybridization with e uorescence immunohistochemistry cone rmed the astrocytic origin of the SF/HGF-expressing cells. In contrast, CD68-immunoreactive microglia/macrophages, as well as vascular smooth muscle cells reactive to a -smooth muscle actin, lacked SF/HGF expression. In anaplastic, diffuse, and pilocytic astrocytomas, SF/HGF expression was cone ned to a subset of tumor cells, and signals were less intense than in glioblastomas. In addition, we detected SF/HGF mRNA in cortical neurons. SF/HGF expression was not up regulated around necroses or at tumor margins. MET immunoreactivity was observed in GFAP-expressing astrocytic tumor cells and endothelial cells as well as in a subset of microglia/macrophages. We conclude that in vivo, both autocrine and paracrine stimulation of tumor cells and endothelium through the SF/HGF-MET system are likely to contribute to tumor invasion and angiogenesis. Lack of SF/HGF expression by most cultured glioblastoma cells is not representative of the in vivo situation and most likely represents a culture artifact. Neuro-Oncol


ABSTRACT Limited data are available on Chryseobacterium spp. leading to an evaluation of the patient demographics and susceptibility patterns for Chryseobacterium spp. collected in the first 5 years of the SENTRY Antimicrobial Surveillance Program (1997 to 2001). Fifty isolates (24 Chryseobacterium meningosepticum, 20 Chryseobacterium indologenes, two Chryseobacterium gleum, and 4 Chryseobacterium spp. isolates) were collected. The highest Chryseobacterium prevalence was detected among the elderly. The most active antimicrobials were the newer quinolones (garenoxacin, gatifloxacin, and levofloxacin, each with a MIC at which 90 percent of the isolates are inhibited [MIC90] of 1 μg/ml and 98.0% susceptibility) followed by rifampin (MIC90, 2 μg/ml and 85.7% susceptibility). Trimethoprim-sulfamethoxazole, ciprofloxacin, and piperacillin-tazobactam also showed reasonable activity; vancomycin showed poor potency.


ABSTRACT Selected forage sweet potato cultivars (Ipomoea batatas Lam) have superior forage characteristics, have high rates of regeneration after harvest, are able to smother weeds and can tolerate diseases and moisture stress. However, little information is documented on their feeding value. The study objective was to determine nutrient intake, digestibility and rumen fermentation characteristics of sheep fed on four selected forage sweet potato cultivars (K158, Marooko, Mugande and Wagabolige). Cultivars did not influence intake of dry matter (DM) (93.8–98.1), organic matter (OM) (82.0–85.6), neutral detergent fibre (NDF) (37.6–38.8 g/kg W0.75) and metabolizable energy (0.94–0.99 MJ/kg W0.75); digestibility of DM (740.3–744.1) and OM (747.0–751.7 g/kg DM) and intake of digestible DM (69.8–72.6) and OM (61.3–64.4 g per kg W0.75); rumen pH (6.80–6.86), molar percentages of acetate (68.34–69.59), propionate (21.35–22.58), butyrate (7.43–7.57) and acetate to propionate ratio (3.03–3.20). Cultivars influenced intake of crude protein (CP) (10.7–16.9) and acid detergent fibre (ADF) (25.9–28.5 g/kg W0.75). Digestibility of CP (655.7–821.1), NDF (594.1–712.8) and ADF (477.0–483.7 g/kg DM); intake of digestible CP (7.0–13.9) and NDF (22.4–27.7 g per kg W0.75) were also influenced by cultivar. CP and NDF digestibility differed among all four cultivars with Morooko and K158 having the highest CP and NDF digestibility, respectively. Sheep fed on K158 and Wagabolige ingested similar quantities of digestible CP (11.6–11.8 g per kg W0.75), which was lower than in Marooko (13.9 g per kg W0.75). The four cultivars provided superior feeds to sheep which classify them as high quality forages. Hence they have the potential to improve livestock production in Kenya.


A unique aqueous silica removal process using naturally occurring diatoms for water reuse and desalination is described. Several strains of brackish water diatoms have been isolated and tested. Among them Pseudostaurosira and Nitzschia species showed promise. Reverse osmosis (RO) concentrate samples from two full-scale advanced water purification facilities and one brackish groundwater RO plant in Southern California have been successfully treated by this process. This new photobiological process could remove aqueous silica, as well as phosphate, ammonia, nitrate, calcium, iron and manganese very effectively. Under non-optimized conditions, 95% of 78 mg·L −1 reactive silica in an RO concentrate sample could be removed within 72 hours. In most cases, addition of nutrients was not necessary because the RO concentrate typically contains sufficient concentrations of macronutrients derived from the source water (i.e., treated wastewater and brackish groundwater). Preliminary characterization of organics indicated that there was no major generation of dissolved organics, which could potentially foul membranes in the subsequent RO process. This new algal process has a strong potential for its application in desalination and water reuse in the United States and around the world.


The Food & Drug Administration recently granted accelerated approval to dasatinib (Sprycel, Bristol-Myers Squibb) for the treatment of adults in all phases of chronic myeloid leukemia (CML) with resistance or intolerance to prior therapy—including imatinib (Gleevec, Novartis). The FDA also granted full approval to dasatinib for the treatment of adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) with resistance or intolerance to prior therapy. Dasatinib, considered an orphan drug for each of these indications, is currently available in retail pharmacies.


: Ion flotation includes removing of ions from solution by adding chemical reagents such as collectors in the presence of air bubbles. In this study, removal of Zn(II) cations was studied from low concentration synthetic wastewater by ion flotation. Sodium dodecyl sulfate (SDS) and ethylhexadecyldimethylammonium bromide (EHDABr) were used as collectors and methyl isobutyl carbonyl (MIBC) and Dowfroth250 as frothers. To investigate the effective parameters, the experimental design was performed supporting by DX7 software. Two-level factorial method was used. Sixteen experiments including 6-level variables were designed. The tests were conducted in Hallimond tube. The results showed that the optimal conditions for the removal of Zn(II) ions were: pH=3, SDS= 300 ppm, Dowfroth250= 90 ppm and air flow rate= 1.8 ml/min. Optimal results were evaluated in a mechanical flotation cell. In optimal condition, recovery of Zn(II) ions and water were more than 92% and 8.65% after 10 min, respectively. This study showed that the use of ion flotation is a very effective method for Zn(II) ions removal from industrial wastewaters.


Purpose of review Although lipid-lowering treatment with statins, ezetimibe, and PCSK9 inhibitors is a very successful strategy to prevent cardiovascular events, there is a need for further drug developments. Not all patients respond sufficiently to the available therapy (very high baseline values, intolerance). Furthermore, patients may be characterized by dyslipidemias not accessible to available drugs such as patients with homozygous familial hypercholesterolemia, chylomicronemia syndrome, or elevated lipoprotein(a). A number of drugs are being developed to close these gaps. Recent findings The focus is on new antibodies, antisense oligonucleotides, and small molecules that address different aspects of lipid metabolism. Many of these developments are promising as they decrease LDL-cholesterol and/or non-HDL-cholesterol and/or triglycerides and/or lipoprotein(a) in patients who so far cannot be treated sufficiently. These drugs are currently in different stages of development and being tested in clinical trials. Summary Some of the new lipid-lowering drugs have a very promising profile. However, eventually phase 3 and outcome trials will be required to prove the usefulness of these compounds in clinical practice. Furthermore, it is unlikely that they will change the primary lipidological approach (statin and ezetimibe) even if they prove successful.


Very high level programming languages (higher than PL/I, Algol 60, etc.) attempt to free the programmer from providing details and let him concentrate on the algorithm for the problem at hand. The importance of very high level programming languages is further emphasized by decreasing machine costs, increased programming costs and the desire to have programs that are well structured, easy to understand and prove correct. Very high level languages provide powerful control structures and data structures that allow the problem to be specified in a natural manner. In this dissertation, we propose several ways of raising the level of a language. The different types of for iteration statements are consolidated into one general for statement. This, along with a new type, the domain of an array, provides us with an easy way of processing arrays; nested iteration statements are no longer necessary. The syntactic list and array generators and the concept of overloading make programming more flexible. The current notion that a data type is a set of values together with basic operations on that set leads us to conclude that formal parameter types need not be explicitly stated. Given a formal parameter X with operations $z_{1}, z_{2},\ldots, z_{n}$ being performed on it within the procedure, one should be able to supply, as an actual parameter in a call, a variable of any type that has the operations $z_{1}, z_{2},\ldots, z_{n}$ defined on it. For example, this concept allows us to write one procedure that finds the maximum value of the elements of an array of any dimension and any element or index type. Grids are arrays that can have any shape. Grid elements need not be contiguous i.e. grids can have holes in them. For example, grids can be trapezoidal, parabolic, rectangular with a hole or pyramid-like. Programs written using grids are more general than those written using arrays and/or functions to simulate non-array shapes. To alter an existing program to work for another grid shape one need only modify the grid declaration suitably, leaving the rest of the program intact. Programs are smaller, semantically clearer and have a more natural problem representation. Grids may be used to represent sparse matrices. Data security is achieved by allowing parts of grids pass as parameters to be readd only or completely masked out. Grids have been implemented as an extension to Fortran. Using Pascal as the base language, we show by series of examples from numerical analysis, data processing, engineering etc., how the above concepts raise the level of a programming language and how they blend together naturally and systematically. Efficient ways of implementing them are also discussed.


This book has two main aims. First, it aims to offer the readers an advanced introduction to L2 speech fluency, to research conducted in this area, to theoretical frameworks that inform this body of research, and to methodological principles that are used to investigate and measure L2 speech fluency. The second aim of the book is to place fluency in a broader perspective, in which it can best be understood by teachers, assessors and language professionals. We will evaluate a range of external factors affecting speech performance across teaching, testing and real-world communication, including task demands, language assessment constraints, and pragmatic interactional factors affecting fluent communication. This book therefore aims to provide a unifying account of L2 fluency across different sub-disciplines of applied linguistics, to discuss how these different research disciplines can complement each other, and to emphasise the need for a more collaborative approach to researching L2 speech fluency.


We propose Super-resolution Neural Operator (SRNO), a deep operator learning framework that can resolve high-resolution (HR) images at arbitrary scales from the low-resolution (LR) counterparts. Treating the LR-HR image pairs as continuous functions approximated with different grid sizes, SRNO learns the mapping between the corresponding function spaces. From the perspective of approximation theory, SRNO first embeds the LR input into a higher-dimensional latent representation space, trying to capture sufficient basis functions, and then iteratively approximates the implicit image function with a kernel integral mechanism, followed by a final dimensionality reduction step to generate the RGB representation at the target coordinates. The key characteristics distinguishing SRNO from prior continuous SR works are: 1) the kernel integral in each layer is efficiently implemented via the Galerkin-type attention, which possesses non-local properties in the spatial domain and therefore benefits the grid-free continuum; and 2) the multilayer attention architecture allows for the dynamic latent basis update, which is crucial for SR problems to "hallucinate" high-frequency information from the LR image. Experiments show that SRNO outperforms existing continuous SR methods in terms of both accuracy and running time. Our code is at https://github.com/2y7c3/Super-Resolution-Neural-Operator.


The popularity of the internet has caused a massive increase in the amount of web pages. The information explosion has led to a growing challenge for information retrieval systems. Document clustering becomes an important process for helping the information retrieval systems organize this vast amount of data. It is believed that grouping similar documents together into clusters will help the users find relevant information quicker, and will allow them to focus their search in the appropriate direction. Feature selection is an important task in data analysis. It is useful to limit redundancy of features, promote comprehensibility, and find clusters (or structures) hidden in high dimensional data. This paper addresses the problems of document mining related with web page clustering and classification. using the Principle component Analysis for Feature Vector Selection. Singular Value Decomposition is used to find the similarity measure and Multilayer neural network used to improve the performance of the clustering algorithm. We illustrate and discuss the system performance by experimental evaluation results.


AKD Rolled Steel Bundling is automatic equipment which is suitable to bundle and pack the clavate or tubular steel. It is developed by Technical Garden Company affiliated University of Science and Technology Liaoning. The design of this type equipment involves multitudinous domain knowledge such as Hydraulic transmission, Electrical Control and Machinery. Therefore, an advanced design technology for virtual prototype is introduced into it. A comprehensive test is carried out on the virtual machine model without the physical prototype.


Microstructure can have a significant effect on the resistance to intergranular stress corrosion cracking. Certain grain boundaries are susceptible to corrosion while others have high resistance and may form crack bridging ligaments as the crack deviates around them. To investigate the mechanics of crack bridging, 3D computational model has been previously developed. An extension to the model, to include stress corrosion crack growth kinetics is presented in this paper. An analysis of the effects of resistant grain boundary fraction demonstrates that the bridging ligaments can significantly retard short crack propagation rates. Increasing the fraction of resistant boundaries is shown to improve microstructure resistance by reducing the crack propagation rate.


Important new developments within practical theology and, in particular, within pastoral theology have taken place over the past decades. In terms of a post-foundational practical theology, this article endeavours from a hermeneutical perspective to explore overlaps between various domains of sciences. As part of a re-described spiritual embodied anthropology, it is claimed that the mind-body dualism is outdated and that the roots of human corporeality are to be rediscovered. The article investigates the effect of an emphasis on the biological for a pastoral anthropology in terms of its implications for one's concept of God, one's view on personal identity, the affirmation of being relation-orientated, and the importance of context. Taking these perspectives to the marketplace, the article considers the meaning of the spirituality of an embodied soul at work. In formulating these perspectives, the emphasis is on an engagement with the other and his/her world.


With electronic book (ebook) sales and readership rising, are ebooks positioned to replace print books? This study examines the preference for ebooks and print books in the contexts of reading purpose, reading situation, and contextual variables such as age, gender, education level, race/ethnicity, income, community type, and Internet use. Additionally, this study aims to identify factors that contribute to ebook adoption. The results of this study support the notion that ebooks have firmly established a place in people's lives, but are not yet positioned to take over all the roles of print books. Both print books and ebooks have unique attributes and serve irreplaceable functions in meeting people's reading needs, which may vary by individual demographic, contextual, and situational factors.


The Quality and Outcomes Framework (QOF) for UK general practice is one of the largest health-related pay-for-performance (P4P) schemes in the world.1 In 2004, the scheme initially had a positive impact on quality of care, primarily achieved via establishment of procedural baselines in the clinical management of incentivised (mostly chronic) diseases. It reduced between-practice variation in care delivery while also improving disease registers, recording of clinical activities, and adoption of electronic medical record systems, leading to an explosion in general practice data and research.1,2

Despite some successes, recent years have seen accelerated debate concerning the removal of QOF. One major criticism is that QOF does not incentivise person-centred care for people with complex conditions,2,3 who require individualised support. This is not captured in the vast majority of indicators, which are based on clinical guidelines.

For example, continuity of care — a critical function of primary care — is valued by patients and associated with improved experience, outcomes, adherence, and preventive medicine, and it may be associated with reduced hospital admissions, death rates, and cost of secondary care/hospitalisation.4 It can be considered a marker of a holistic approach, which is considered essential for the increasing numbers of people with multimorbidity and complex healthcare needs.5 Yet it is currently in decline,6 was reduced after the introduction of QOF,7 and is not being captured by QOF.

In an environment of increasing patient complexity and a drive towards person centeredness, QOF — with its current focus on process indicators — is perceived by many as increasingly anachronistic. A recent systematic review summarised that 'QOF is unlikely to advance progress towards the vision of the Five Year Forward View for …