The selenium content of the 1989 harvest of wheat used for bread making in Scotland ranged from 0.028 μg/g dry weight for home-grown wheat to 0.518 μg/g for Canadian wheat. The tonnage values indicate that 13.8% of the wheat used in bread making came from Canada. This reflects in a calculated dietary intake of 31 μg/d which is well below the recommended levels of 70 and 55 μg for adult males and females respectively (National Research Council, 1989). The average glutathione peroxidase (EC 188.8.131.52) level in 478 samples of human whole blood was 6.08 (se 0.065) units/ml. This increased to 6.65 (se 0.321) in sixty-two subjects consuming brown or wholemeal bread but was unaffected by oily fish consumption. Analysis of a small number of samples of whole milk, eggs and meat indicated slightly higher concentrations than previously published values but this trend was insufficient to compensate for the lower cereal provision of Se.


Basalt sills cored in lowermost Berriasian sediments on Shatsky Rise in the northwest Pacific yield a mean 4 0 Ar- 3 9 Ar incremental heating age of 144.6 ′ 0.8 Ma, providing a minimum estimate on the age of the Jurassic-Cretaceous boundary. The largest part of the rise was emplaced at rates similar to those of several continental flood basalts. The rise formed at an oceanic triple junction, and the sills, as well as lavas from two dredge sites, exhibit an ocean ridge-type Nd-Pb-Sr isotope signature. This signature is provisionally consistent with either a perisphere or meteorite-impact model, but is not predicted by the plume-head model of plateau formation. However, no model can yet be rejected, given the very sparse sampling of Shatsky Rise.


Abstract Purpose: The molecular effects of focal exposure of limited lung volumes to high-dose per fraction irradiation (HDFR) such as stereotactic body radiotherapy (SBRT) have not been fully characterized. In this study, we used such an irradiation system and identified the genes and proteins after HDFR to mouse lung, similar to those associated with human therapy. Methods and materials: High focal radiation (90 Gy) was applied to a 3-mm volume of the left lung of C57BL6 mice using a small-animal stereotactic irradiator. As well as histological examination for lungs, a cDNA micro array using irradiated lung tissues and a protein array of sera were performed until 4 weeks after irradiation, and radiation-responsive genes and proteins were identified. For comparison, the long-term effects (12 months) of 20 Gy radiation wide-field dose to the left lung were also investigated. Results: The genes ermap, epb4.2, cd200r3 (up regulation) and krt15, hoxc4, gdf2, cst9, cidec, and bnc1 (down-regulation) and the proteins of AIF, laminin, bNOS, HSP27, β-amyloid (upregulation), and calponin (downregulation) were identified as being responsive to 90 Gy HDFR. The gdf2, cst9, and cidec genes also responded to 20 Gy, suggesting that they are universal responsive genes in irradiated lungs. No universal proteins were identified in both 90 Gy and 20 Gy. Calponin, which was downregulated in protein antibody array analysis, showed a similar pattern in microarray data, suggesting a possible HDFR responsive serum biomarker that reflects gene alteration of irradiated lung tissue. These genes and proteins also responded to the lower doses of 20 Gy and 50 Gy HDFR. Conclusions: These results suggest that identified candidate genes and proteins are HDFR-specifically expressed in lung damage induced by HDFR relevant to SBRT in humans.


Invasive Aspergillosis (IA), typically caused by the fungus Aspergillus fumigatus, is a leading cause of morbidity and mortality in immunocompromised patients. IA remains a significant burden in haematology patients, despite improvements in the diagnosis and treatment of Aspergillus infection. Diagnosing IA is challenging, requiring multiple factors to classify patients into possible, probable and proven IA cohorts. Given the low incidence of IA, using negative results as exclusion criteria is optimal. However, frequent false positives and severe IA mortality rates in haematology patients have led to the empirical use of toxic, drug-interactive and often ineffective anti-fungal therapeutics. Improvements in IA diagnosis are needed to reduce unnecessary anti-fungal therapy. Early IA diagnosis is vital for positive patient outcomes; therefore, a pre-emptive approach is required. In this study, we examined the sequence and expression of four C-type Lectin-like receptors (Dectin-1, Dectin-2, Mincle, Mcl) from 42 haematology patients and investigated each patient's anti-Aspergillus immune response (IL-6, TNF). Correlation analysis revealed novel IA disease risk factors which we used to develop a pre-emptive patient stratification protocol to identify haematopoietic stem cell transplant patients at high and low risk of developing IA. This stratification protocol has the potential to enhance the identification of high-risk patients whilst reducing unnecessary treatment, minimizing the development of anti-fungal resistance, and prioritising primary disease treatment for low-risk patients.


Raman spectroscopy has been identified as a powerful tool for astrobiology and remote robotic planetary exploration. It can be used to identify and characterise rock matrices, mineral inclusions and organic molecules and is demonstrably effective at identifying biomarkers, or indicators of biological activity. The ExoMars rover, jointly operated by the European and Russian Federal Space Agencies, will carry the first Raman spectrometer into space when it launches in 2018 and two further Raman instruments have recently been announced as part of the payload onboard the National Aeronautics and Space Administration's Mars 2020 rover. Each of these spectrometers however will, by necessity, have poorer resolution than the most sophisticated laboratory instruments because of mass, volume and power constraints and the space readiness of the requisite technologies. As a result, it is important to understand the minimum instrument specification required to achieve the scientific objectives of a mission, in terms of parameters such as spectral resolution and laser footprint size. This requires knowledge of the target minerals and molecules between which there may be ambiguity when identifying bands in spectra from geological samples. Here, we present spectra from a number of Mars analogue samples that include a range of such molecules, highlighting where such confusion may occur and identifying the most useful bands for differentiation. It is recommended that a Raman spectrometer achieves a resolution of at least 3 cm−1 and covers a spectral range from 100 to 4000 cm−1 in order to differentiate between all of the target molecules presented here. Copyright © 2015 John Wiley & Sons, Ltd.


The thesis describes a study of the responses to light and temperature of the common blow fly Calliphora vicina Robineau-Desvoidy (Diptera: Cyclorrhapha: Calliphoridae). C. vicina shows a long-day photoperiodic response; long photoperiods lead to the production of developing offspring, short ones cause the flies to produce diapausing offspring. It also has an endogenous circadian rhythm that can be entrained to an external Zeitgeber, such as a light:dark cycle. The first part of the thesis examines the responses of strains of C. vicina from Finland (65 °N), England (51 °N) and Italy (44 °N) to identical photoperiods and temperatures. Critical daylength (the photoperiod at which the response switched from diapause to development) and diapause duration were longer in the 65 °N strain than in the two from further south. The 65 °N strain's photoperiodic response was relatively insensitive to temperature. In contrast, the strain from 51 °N was temperature-sensitive; raising the temperature decreased the amount of diapause at all photoperiods. Diapause incidence and duration in all strains were influenced by environmental factors but the parameters within which these could act were set by the genetic background of the fly. The pattern of increasing diapause incidence and duration with origin at higher latitudes probably reflects a history of differential selection. Crosses between the English and Finnish strains revealed that diapause incidence was induced solely by the adult female. Both parents contributed to diapause duration. Crosses between the Fl flies and backcrosses to the parental lines suggested that hybrid females were biased in their perception of a fixed photoperiod towards their maternal line. The second part of the thesis discusses various aspects of the response to light stimuli of flies fed carotenoid deficient or depleted diets. The response of the visual system was examined directly; that of the extraretinal photoreceptors was measured indirectly via behavioural observations. The locomotor activity cycle of a majority of flies reared on a carotenoid-free artificial diet was not entrainable to a light:dark (LD) cycle. Flies reared on carotenoiddeficient heart did entrain to a LD cycle but other aspects of their response suggested reduced efficiency of the extraretinal photoreceptors compared with flies reared on carotenoid-rich liver.


Sintering of nanosilver paste has been extensively studied as a lead-free die-attach solution for bonding semiconductor chips. The bonding process typically consists of a low-temperature drying step to remove organic solvents in the paste followed by sintering at around 250°C . Normally, a soak time of several minutes at the sintering temperature is necessary to establish strong bond strength by the conventional heating method. In this paper, we tested the feasibility of applying pulses of alternating electrical current through the nanosilver bonding layer to achieve strong joints in less than a second, not minutes. Experiments were carried out by joining rectangular copper blocks that were either coated with a layer of electroplated silver or without. A layer of nanosilver paste was stencil printed on one block, dried at temperature below 100°C, before the other copper block was placed on. The bonding members were then inserted under an alternating-current spot-welding machine for rapid joining with current pulses. Die-shear test was used to quantify the joint strength. Investigated processing variables on the joint strength were current level, current-on time, nanosilver bondline thickness, predrying temperature and time, and copper surface finish. Scanning electron microscopy was used to characterize the joint microstructure. It is suggestive that the current sintering of nanosilver paste could be used for rapid joining of metal-to-metal connection, such as bonding copper bus bars onto power electronics modules.


This paper develops a framework for measuring digital services in the face of ongoing innovations in the delivery of content to consumers. We capture what Brynjolfsson and Saunders (2009) call "free goods" as the capital services generated by connected consumers' stocks of IT digital goods, a service flow that augments the existing measure of personal consumption in GDP. Its value is determined by the intensity with which households use their IT capital to consume content delivered over networks, and its volume depends on the quality of the IT capital. Consumers pay for delivery services, however, and the complementarity between device use and network use enables us to develop a quality-adjusted price measure for the access services already included in GDP. Our new estimates imply that accounting for innovations in consumer content delivery matters: The innovations boost consumer surplus by nearly $2,000 (2017 dollars) per connected user per year for the full period of this study (1987 to 2017) and contribute .6 percentage point per year to US real GDP growth during the last ten. All told, our more complete accounting of innovations is (conservatively) estimated to have moderated the post-2007 GDP growth slowdown by .3 percentage points per year.


Black locust is a tree species autochthonous from North America, were its distribution range from humid to sub-humid climate. As an early successional and nitrogen-fixing species, black locust grows rapidly as a pioneer tree species under a wide range of site
condition. Black locust short-rotation plantations for bioenergy production is raising
interest, particularly for those areas were conventional crops systems are economically
not profitable. In southern Brandenburg black locust have been successfully used for
land reclamation and biomass production in recultivated open-cast lignite mining areas,
where nutrient and water resources are limited. An open key question is the water use
of the trees under drought conditions which are quite common in these areas. For the
determination of transpiration at whole plant level we used a modified wick lysimeter
system, which allows us to study plant growth under controlled water regime. Water
amount is controlled by the actual evapotranspiration and water demand of the plants
and supplied by an automatic drip irrigation system. Transpiration is calculated from the
experimental water balance in daily intervals. Photosynthesis is the essential process
for biomass productivity including CO2 uptake and water loss controlled by the stomata
on the leaf level. Therefore, the ecophysiological response of the plants to drought
stress is investigated by using a portable gas exchange system, which allows the
measurements of transpiration under various temperature and air humidity regimes.
Water use at whole plant level has been linked to their ecophysiological performance.


Mere weeks after American professional cyclist Floyd Landis seemingly won the 2006 Tour de France, the United States Anti-Doping Association (USADA), under the authority granted to it by the U.S. Congress, and through its enforcement of the World Anti-Doping Code (WADC), accused him of having committed doping violations during the race. Landis vehemently denied these allegations, and accused the French laboratory that had performed the testing of his post-race samples, the Laboratoire National du Depistage du Dopage (LNDD), of bias and misconduct in his case. Under USADA rules, an American athlete accused of doping may request an arbitration hearing before the American Arbitration Association (AAA), using the AAA Supplementary Procedures for the Arbitration of Olympic Doping Disputes. Although arbitration hearings are generally held in private, under these Supplementary Procedures, the athlete may choose to have this hearing open to the public. Landis requested a public hearing for his case, the first athlete to ever have done so.This Article chronicles the public arbitration hearing in the Landis case, which was held at the Pepperdine University School of Law in 2007. Following its initial explanation of the regulatory and procedural framework involved when a U.S. athlete challenges a doping allegation, the Article describes the strategy and events leading up to Landis' hearing, including the preparation, financing, and publicizing of Landis' defense, the selection of the arbitration panel, and key pre-hearing rulings related to procedure and discovery. The Article examines the hearing itself, considering each side's execution of its arbitration strategy, the scientific and personal testimony offered during the hearing, and the arbitral panel's 2-1 ruling in favor of the USADA. The Article describes the subsequent legal action pursued by Landis, including an unsuccessful non-public appeal to the Court for Arbitration of Sport (CAS), and an attempt to persuade a U.S. Federal Court to vacate the CAS ruling. The Article concludes by discussing the value to the public and the legal community that came from having the initial Landis arbitration hearing open to the public, including increased awareness of the need for more transparency and greater organizational accountability in the doping arbitral process. While the Article was published prior to the recent admission of doping by Floyd Landis, certainly the anti-doping standards and adjudicatory process continues to play a vital role in the lives and careers of international sport athletes.


: This monograph reviews and assesses twenty-five studies that examined the question of whether treatment for mental illness, alcohol abuse or drug abuse reduces subsequent medical care utilization. In general, the studies found that such a reduction did take place. Twelve of thirteen studies found reductions of 5 to 85 per cent in medical care utilization subsequent to a mental health intervention. The median reduction was 20 per cent. The thirteenth study found that mental health services provided in a new neighborhood health center in a medically underserved neighborhood were followed by a 72 per cent increase in medical care encounters. The remaining twelve studies found reductions of 26 to 69 per cent in either medical care utilization or surrogate measures of such utilization subsequent to treatment for alcohol abuse. The median reduction was 40 per cent. The drug abuse literature in this area is sparse and primarily indirect. Although many of the studies suggested that alcohol, drug abuse or mental health (ADM) treatment was a cause of the subsequent reduction in medical care utilization, such causality was not definitively established, due to frequent methodological limitations, such as inadequate comparison groups, short time spans, small samples and lack of trend analysis. In addition, the studies focused primarily on outpatient psychotherapy in organized health care settings, particularly health maintenance organizations (HMOs), and on alcoholism treatment provided through employee-based programs and HMOs. Only very limited policy implications on such topics as health insurance and the linkage of health and ADM services can be drawn from the current body of literature. There is a need for additional research that is broader and more rigorous. To encourage such research, methodological recommendations for future studies are presented.


This work presents a novel method for image similarity measure, where a hand-drawn rough black and white sketch is compared with an existing data base of full color images (art works and photographs). The proposed system creates ambient intelligence in terms of the evaluation of nonprecise, easy to input sketched information. The system can then provide the user with options of either retrieving similar images in the database or ranking the quality of the sketch against a given standard, i.e., the original image model. Alternatively, the inherent pattern-matching capability of the system can be utilized to allow detection of distortion in any given real time-image sequences in vision-driven ambient intelligence applications. The proposed method can cope with images containing several complex objects in an inhomogeneous background. Two abstract images are obtained using strong edges of the model image and the morphologically thinned outline of the sketched image. The angular-spatial distribution of pixels in the abstract images is then employed to extract new compact and effective features using the Fourier transform. The extracted features are rotation and scale invariant and robust against translation. Experimental results from seven different approaches confirm the efficacy of the proposed method in both the retrieval performance and the time required for feature extraction and search.


The optical properties of the 1,N6 ‐ etheno derivative of ApA (εApεA) have been studied. Absorbance and CD measurements suggest that (1) neutral salts tend to unstack this molecule and (2) the stacking interaction is weaker than in ApA. εApεA is found to be quenched strongly with respect to the monomer. (εAMP); this quenching is solvent dependent (1M NaCl > 5M NaClo4>40%glycerol) and increases with the ratio of temperature to viscosity (T/η) in each case. Fluorescence lifetime measurements also reveal a temperature‐ and solvent‐dependent decay which is nonlinear on a semilog plot. In the presence of 95% glycerol, this decay return to linearity. These data have been considered from two points of view: (1) two‐state pictures which are based on thermodynamic least‐squares fit to quatum yield and CD curves, together with two exponential fits to the decay curves and (2) a dynamical model in which relatives fluorophore motion leads to deexcitation via intramolecular collision. A simple model of type (2) gives qualitative agreement with the observed behavior.


The NHS has changed a lot since the late Denis Burkitt (who linked high fibre diets with preventing bowel disease) compared illness to an overflowing bath and suggested that doctors and nurses might be better employed turning off taps than mopping the floor. Increasingly, general practice has been considered to be the right place for turning off taps,1 2 and in 1990 health promotion was made a contractual requirement for general practitioners.3 Does prevention of illness in primary care work? Three papers in this week's journal consider different aspects of that question.4 5 6 Unsurprisingly, the answer is not straightforward.

One group based in Oxford, testing strategies to reduce the risks of cardiovascular disease and cancer in general practice populations, has greatly influenced British health policy. It is to the OXCHECK researchers' credit, therefore, that evangelistic fervour has not clouded their evaluative judgment. In their latest report they conclude that health checks for unselected middle aged people achieve little or no reduction in smoking and excessive drinking (p …


Using a sample of 37 687 single family homeowners from the 1980 Annual Housing Survey, this study applied discriminant analysis to determine which variables influence presence, addition, and cost of insulation. Housing units with insulation were more likely to have storm doors or windows, be newer, more expensive, be located in the Northcentral region rather than the South, and have an attached fan and electric or oil heat rather than natural gas. An increase in the age of the head and presence of a child under 6 years old as well as length of occupancy were more highly associated with housing without insulation. The addition of insulation was more likely in older homes, homes located in regions other than the South, homes heated with oil, liquid petroleum gas, or wood rather than natural gas, and homes with storm doors or windows and an attached fan. While presence of a child under 6 years old increased the probability, length of occupancy had a negative impact. Using these variables as discrimators, 74.2% of the households with insulation were correctly classified, while 60.5% of the households who added insulation were correctly classified. Expenditures on insulation varied with region, length of occupancy, age and value of the house, and presence of an attached fan. Thus this study provides a base for identifying households which will undertake insulation activities.


An early clinical symptom of Alzheimer's disease is impaired episodic memory. However, the precise pathological event(s) that underpins this deficit remains unclear. In the present study, the authors examined whether wild-type mice and Tg2576 mice expressing an amyloid precursor protein (APP) mutation are able to form an integrated memory of the spatio-temporal context in which objects are presented. In Experiment 1, wild-type mice, but not Tg2576 mice that were 10-12 months old, explored objects presented in a novel location. In Experiment 2, wild-type mice explored an object that was presented both earlier in a sequence and in a different location relative to other objects that possessed only one of these properties (i.e., memory for "what," "where," and "when" items were presented). In contrast, the behavior of adult Tg2576 mice was influenced only by the temporal order in which objects were presented. These results demonstrate that wild-type, but not APP-mutant, mice are able to form an "episodic-like" memory of the spatio-temporal properties of objects and support the hypothesis that aberrant APP processing contributes to impairments in event memory.


A general and important problem of search-based planning techniques is the state explosion problem, which is usually tackled with approaches to reduce the branching factor of the planning task. Such approaches often implicitly exploit the observation that the number of available operators is higher than the number of operators that are actually needed to find a plan. In this paper, we propose a simple, but general under-approximation refinement framework for satisficing planning that explicitly exploits this observation. Our approach iteratively searches for plans with operator subsets, which are refined if necessary by adding operators that appear to be needed. Our evaluation shows that even a straight-forward instantiation of this framework yields a competitive planner that often finds plans with small operator sets.


Introduction Neisseria meningitidis is a fascinating organism that is capable of causing severe, and sometimes fulminating, infections in man, but only in a small proportion of people who acquire it. In most people the meningococcus colonises the nasopharynx, they carry it for a few weeks or months, and then they eliminate it without having suffered any ill effects; whereas in a small minority, an invasive infection develops that can kill them within hours. In most temperate countries meningococcal infections are sporadic, with occasional clusters of cases. In sub-Saharan West Africa however, true epidemics, with higher attack rates amongst children, occur every few years. During the last 2-3 years (1984-87) the number of cases of meningococcal infection in Britain and Europe has increased, and this has heightened interest in research into the epidemiology, pathogenesis and immunology of meningococcal infection and has stimulated comparisons between situations in Europe and in Africa. The papers presented in this review are based on those given in a Symposium and in the associated free-paper and poster sessions at the meeting of the Pathological Society of Great Britain and Ireland in July, 1987.


Background Polypharmacy of respiratory medications is commonly observed in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate determinants of polypharmacy and to study the consistency of actual respiratory drug use with current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in pulmonary rehabilitation candidates with COPD. Methods Data were extracted from the records of all patients with a diagnosis of COPD referred for pulmonary rehabilitation to CIRO+ between 2005 and 2009. Use of respiratory medications, self-reported COPD exacerbations, lung function, blood gases, exercise capacity, Medical Research Council (MRC) dyspnea grade, and St George's Respiratory Questionnaire (SGRQ) were recorded as part of assessment of health status. Results In total, 1859 COPD patients of mean age (± standard deviation) 64.3 ± 9.7 years and with a forced expiratory volume in one second (FEV1) of 44.7% ± 18.2% were included. On average, patients used 3.5 ± 1.5 respiratory medications; this number increased with increasing GOLD stage, MRC score, and SGRQ scores. FEV1 (% predicted), SGRQ, and number of recent exacerbations were independent determinants of polypharmacy. Use of long-acting bronchodilators and inhaled corticosteroids was substantial and comparable in all GOLD stages. Use of corticosteroids was not restricted to patients with frequent exacerbations. Conclusion Polypharmacy of respiratory medications is common in COPD patients with persistent symptoms. In addition to severity of disease, health status is an independent predictor of polypharmacy. Actual drug use in COPD patients referred for pulmonary rehabilitation is partially inconsistent with current GOLD guidelines.


This article analyzes a unique scene from the Giza mastaba of Akhmerutnisut (G 2184), which shows a life-size depiction of the tomb owner holding a rope, ready to throw a lasso. The active participation of the tomb owner in a lassoing scene is unique in the iconographic program of Fifth Dynasty elite tombs. The location of this scene within the mastaba is also unparalleled: it is the first scene on the right (west side) encountered by visitors as they enter the mastaba. To understand this innovative decorative choice, this paper starts by discussing the iconography of lassoing in the Old Kingdom and its meaning in the elite tombs of the same period. The second part of this paper analyzes Akhmerutnisut's lassoing scene with an analytical framework drawn from visual and material culture studies and focusing on the concepts of monumentality, identity and agency. This study provides a number of possible explanations—none of which are mutually exclusive—to understand why Akhmerutnisut had himself depicted as a monumental lassoer by the entrance of his funerary complex, highlighting the importance of visitor experience and participation in the design of the funerary complexes of the Old Kingdom elite.


This thesis regards the ancient Pythagorean-Platonic idea of heavenly harmony as a philosophical paradox: stars are silent, music is not. The idea of 'star music' contains several potential opposites, including imagination and sense perception, the temporal and the eternal, transcendence and theophany, and others. The idea of 'star music' as a paradox can become a gateway to a different understanding of the universe, and a vehicle for a shift to a new – and yet very ancient – form of consciousness. The ancient Greeks had a holistic form of consciousness, which was continually intermingling with a transpersonal dimension. This ancient state of consciousness was related to a musical understanding of the world, the Pythagorean-Platonic experience of the universe as an ordered cosmos.

My research is approached from two angles, namely from the history of ideas and from musicianship, exploring how music is reflected in the world of thought. By reflexive re-reading of the sources, new insights into the nature of musical consciousness are explored. The idea of 'star music' can be found throughout the history of music and thought in the West, including Plato's works and that of other ancient philosophers, through the Middle Ages, the Renaissance, the Romantic era and the twentieth century up to contemporary New Age music.

As a conclusion, the paradox of 'star music' is connected to an experience of a shared transcendent meaning of music, which can be present in the moment of a musical performance. 'Star music' is a living paradox.


Aim: To evaluate the effectiveness of intravenous magnesium sulphate in the treatment of acute asthmatic attacks in children by meta-analysis. Methods: A systematic and comprehensive search of the literature was performed to identify controlled clinical trials of magnesium sulphate in paediatric acute asthma which evaluated outcomes of hospitalisation or short term pulmonary function tests or symptom scores. Unpublished data were searched by personal contacts with authors and specialists. Two reviewers independently assessed trial qualities and synthesised data. Heterogeneity among studies was evaluated by the Cochrane Q test. Outcome data were pooled by random or fixed effect models depending on presence or absence of heterogeneity. Results: Five randomised placebo controlled trials involving a total of 182 patients were identified. They compared intravenous magnesium sulphate to placebo in treating paediatric patients with moderate to severe asthmatic attacks in the emergency department, with co-therapies of inhaled β2 agonists and systemic steroids. The studies were of high quality with results judged to be valid. Four studies showed that magnesium sulphate was effective, while one study found it ineffective. There was no significant heterogeneity in the primary outcome of hospitalisation. In the fixed effect model, magnesium sulphate is effective in preventing hospitalisation (OR 0.290, 95% CI 0.143 to 0.589). The number needed to treat is 4 (95% CI 3 to 8). Secondary outcomes of short term pulmonary function tests and clinical symptom scores also showed significant improvement. Conclusion: Intravenous magnesium sulphate probably provides additional benefit in moderate to severe acute asthma in children treated with bronchodilators and steroids.


ABSTRACT Be empowering. Be athlete-centered. Be autonomy supportive. These are three related topics currently being promoted by sport psychologists and sport pedagogists in an effort to recognize athletes' unique qualities and developmental differences and make coaching more holistic and coaches more considerate. This has led us to ask, how likely are such initiatives to lead to coaches putting their athletes at the center of the coaching process given that coaches' practices have largely been formed through relations of power that subordinate and objectify athletes' bodies through the regular application of a range of disciplinary techniques and instruments [e.g. Barker-Ruchti, N., & Tinning, R. (2010). Foucault in leotards: Corporeal discipline in women's artistic gymnastics. Sociology of Sport Journal, 27, 229–250; Heikkala, J. (1993). Discipline and excel: Techniques of the self and body and the logic of competing. Sociology of Sport Journal, 10, 397–412; Gearity, B., & Mills, J. P. (2012). Discipline and punish in the weight room. Sports Coaching Review, 1, 124–134]? In other words, to try to develop athlete-centered coaches capable of coaching in ways that will empower their athletes without also problematizing the discursive formation of coaches' practices concerns us [Denison, J., & Mills, J. P. (2014). Planning for distance running: Coaching with Foucault. Sports Coaching Review, 3, 1–16]. Put differently: how can athlete empowerment initiatives be anything more than rhetoric within a disciplinary framework that normalizes maximum coach control? It is this question that we intend to explore in this paper. More specifically, as Foucauldians, we will argue that coaching with greater consideration for athletes' unique qualities and developmental differences needs to entail coaching in a less disciplinary way and with an awareness and appreciation of the many unseen effects that disciplinary power can have on coaches' practices and athletes' bodies.


Results from animal experiments are often used to assess cancer risks to humans from low doses of chemicals. This involves two extrapola- tions: from high dose to low dose and from animals to humans. This paper will review the logic of both. In general, absent other information, we think that a chemical that is carcinogenic in a well-run animal experiment should be viewed with some suspicion. However, there are real problems with most animal experiments as they are currently done, and there are serious inconsistencies in the results. One probable cause is poorly defined end points, and another is uncontrolled variation. A number of suggestions are made for improvement, including proper randomization, "blinding" the necropsy work and use of statistical techniques appropriate to multiple end points. Numerical assessments of human risk, even if based on good animal data, seem well beyond the scope of the scientifically possible. There are substan- tial differences in sensitivity between species, strains, sexes and individuals. Experimental work is needed to quantify these differences and explore their biological bases. The dose-response models now used in numerical extrap- olation are quite far removed from the biology. At present there seems to be no sound way to choose a model on either biological or statistical grounds, and different models give substantially different risk estimates. On this score, there is little hope for progress until the biology of cancer is better understood. The paper is organized as follows. The issues are set out in the first section. Then the one-hit model is introduced in the context of a stylized risk assessment for DDT. Next the main generalizations of the one-hit model are explained: the multihit, Weibull and multistage. The biological foundations for these models are reviewed, and the impact of model selection on low-dose risk estimates is stressed. Dose scales and biological scaling factors are discussed, and then the conventional arguments for the mouse- to-man extrapolation. The DDT carcinogenesis literature is surveyed to show the quality of animal experiments. Opinions by others are cited, and conclusions are drawn.


The demand for and use of health, social, and other human services is related not to the type or severity of disease but rather to a person's socio-economic, cognitive, and emotional characteristics and environmental circumstances. A workshop on supportive care was held to promote a robust research environment, the creation of new knowledge, the setting of an integrated health research agenda, a focusing of attention on the evolving health-care system, and anticipation of emerging health challenges. While the workshop was intended to address a research mandate for the Canadian Institutes of Health Research, a larger vision emerged, to include advocacy, information system, surveillance, and policy development required by institutional, community, voluntary, private sector, family caregiver, and provider systems. The development of a national supportive care strategy will enable Canadians with disease and disability to live with all of their challenges, and could engage researchers, clinicians, advocacy groups, and people experiencing major health challenges.


Monitoring spatial and temporal variability of vegetation is important to manage land and water resources, with significant impact on the sustainability of modern agriculture. Cloud cover noticeably reduces the temporal resolution of retrievals based on optical data. COSMO-SkyMed (the new Italian Synthetic Aperture RADAR-SAR) opened new opportunities to develop agro-hydrological applications. Indeed, it represents a valuable source of data for operational use, due to the high spatial and temporal resolutions. Although X-band is not the most suitable to model agricultural and hydrological processes, an assessment of vegetation development can be achieved combing optical vegetation indices (VIs) and SAR backscattering data. In this paper, a correlation analysis has been performed between the crossed horizontal-vertical (HV) backscattering (s°HV) and optical VIs (VIopt) on several plots. The correlation analysis was based on incidence angle, spatial resolution and polarization mode. Results have shown that temporal changes of s°HV (Δs°HV) acquired with high angles (off nadir angle; θ > 40°) best correlates with variations of VIopt (ΔVI). The correlation between ΔVI and Δs°HV has been shown to be temporally robust. Based on this experimental evidence, a model to infer a VI from s° (VISAR) at the time, ti + 1, once known, the VIopt at a reference time, ti, and Δs°HV between times, ti + 1 and ti, was implemented and verified. This approach has led to the development and validation of an algorithm for coupling a VIopt derived from DEIMOS-1 images and s°HV. The study was carried out over the Sele plain (Campania, Italy), which is mainly characterized by herbaceous crops. In situ measurements included leaf area index (LAI), which were collected weekly between August and September 2011 in 25 sites, simultaneously to COSMO-SkyMed (CSK) and DEIMOS-1 imaging. Results confirm that VISAR obtained using the combined model is able to increase the feasibility of operational satellite-based products for supporting agricultural practices. This study is carried out in the framework of the COSMOLAND project (Use of COSMO-SkyMed SAR data for LAND cover classification and surface parameters retrieval over agricultural sites) funded by the Italian Space Agency (ASI).


This article provides a completion to theories of information
based on entropy, resolving a longstanding question in its axiomatization as
proposed by Shannon and pursued by Jaynes. We show that Shannon's entropy
function has a complementary dual function which we call "extropy."
The entropy and the extropy of a binary distribution are identical. However,
the measure bifurcates into a pair of distinct measures for any quantity that is
not merely an event indicator. As with entropy, the maximum extropy distribution
is also the uniform distribution, and both measures are invariant with
respect to permutations of their mass functions. However, they behave quite
differently in their assessments of the refinement of a distribution, the axiom
which concerned Shannon and Jaynes. Their duality is specified via the relationship
among the entropies and extropies of course and fine partitions. We
also analyze the extropy function for densities, showing that relative extropy
constitutes a dual to the Kullback–Leibler divergence, widely recognized as
the continuous entropy measure. These results are unified within the general
structure of Bregman divergences. In this context they identify half the L2
metric as the extropic dual to the entropic directed distance. We describe a
statistical application to the scoring of sequential forecast distributions which
provoked the discovery.


An engineering method of elastic-plastic fracture analysis is suggested for plane-strain specimens under tension. The condition for an increment of crack extension is set by a critical increment of crakc tip opening displacement (CTOD). The CTOD increment divided by the incremental crack extension is a critical crack tip opening angle (CTOA), assumed to be constant for a material of a given thickness, characterizing the tearing resistance of material. Based on a finite-element analysis of crack tip deformation, a load term in the CTOD equation of the Dugdale strip yield model is modified to accommodate large and small scale yielding, for which cohesive stress in the strip is assumed greater than that for the plane-stress model Approximate generalization of the Dugdale model is suggested for finite-size specimens. A definition of CTOD is reviewed with a round and sharp crack tip. In a successive application of the CTOA criterion at a current extending crack tip, the integration of the incremental crack extensions and load increments after fracture mitration gives a relationship in which a maximum load is either a peak load or a limit load on an unbroken ligament. Material constants are evaluated so that the calculated loads agree with test loads at each crack extension. The proposed method is applied to various specimens of 304 stainless steel for which test data are available.


Many traditions of coastal peoples may be viewed as traditional forms of marine conservation because, like modern fisheries management, they restrict fishing gear, fishing times, and places, but their effects are little studied in practice. A study was undertaken of human culture and fisheries resources in an area of southern Kenya, designated as a national marine reserve, to determine the effect of the existing 'traditional management' on fisheries yields and on the ecological condition of the fished reefs. This area has one of the oldest and most elaborate cultural traditions concerning sacred sites and rituals of sacrifice along the Kenyan coast. The purpose of the customs is, however, to appease spirits rather than to regulate fish stocks which are traditionally seen to fluctuate independently of fishing effort. Many of these traditions have decayed in recent times as Islamization of the culture has occurred, and authority has shifted towards national organizations, weakening the effectiveness of the traditional leaders. Coincidentally, fishers have adopted new or foreign gear, colleagues, and traditions. Two adjacent landing sites (Mvuleni and Mwanyaza) have, however, successfully stopped pull seiners from landing their catch at their sites for over 20 years through passive means. Other landing sites have adopted pull seining. Both landing areas use arguments based on tradition to justify their use of gear. The two landings that restrict pull seining have higher per capita fish catches than those that do not. Nonetheless, there were no obvious differences in the ecological condition of the reefs at these two management areas; both areas were amongst the most degraded reefs reported in East Africa. Biological diversity and coral cover were reduced greatly in all these areas compared to other fished or fully-protected marine park or reserve sites established by the national government. Presently, traditional management is not effective in protecting species diversity or ecological functions, which was probably never the intention of the customs. The conflict between national organizations and local fishers arises because some resource users are concerned that the management proposed by the national organizations will eventually lead to the total loss of access to, and control of the resource by local fishers. There is, therefore, a need to resolve conflicts concerning gear use and regulation, and a need to increase awareness of the expectations and management programmes among the national and local organizations. Many of the traditional forms of management are compatible with the policies of national organizations, but confusion and conflict occur concerning enforcement and its benefits. To solve these conflicts discussions are required between traditional and national fisheries leaders to develop mutually-acceptable policies that augment and share the power of management.


We consider inflationary cosmology in the context of string compactifications with multiple throats. In scenarios where the warping differs significantly between throats, string and Kaluza-Klein physics can generate potentially observable corrections to the cosmology of inflation and reheating. First we demonstrate that a very low string scale in the ground state compactification is incompatible with a high Hubble scale during inflation, and we propose that the compactification geometry is altered during inflation. In this configuration, the lowest scale is just above the Hubble scale, which is compatible with the effective field theory but still leads to potentially observable cosmic microwave background corrections. Also in the appropriate region of parameter space, we find that reheating leads to a phase of long open strings in the standard model sector (before the usual radiation-dominated phase). We sketch the cosmology of the long string phase and we discuss possible observational consequences.


The Cenozoic Pelagornithidae, or pseudotoothed birds, are characterized by unique bony projections along the cutting edges of the beak. These birds were previously known from late Paleocene to Pliocene fossil sites and some species reached wingspans up to 6.4 m. Here we describe a partial skeleton of a small‐sized pelagornithid from the early Paleocene of New Zealand. Protodontopteryx ruthae gen. et sp. nov. is the oldest record of the clade, the smallest known species, and the first pre‐Eocene pelagornithid from the Southern Hemisphere. The skull of the new species exhibits the characteristic pelagornithid morphology, but the postcranial skeleton distinctly differs from other pelagornithids, and various plesiomorphic features indicate that it is the earliest‐diverging representative of the Pelagornithidae. The much stouter humerus suggests that the new species was less adapted to sustained soaring than previously known pelagornithids. Pseudoteeth therefore evolved before pelagornithids became highly specialized gliders. Unlike the giant Neogene pelagornithid species, which presumably were skimmers, early Paleocene pelagornithids are likely to have targeted selected prey items and may have been predominantly piscivorous. The new species furthermore suggests that pelagornithids evolved in the Southern Hemisphere and documents a very early radiation of neornithine seabirds, which may have been triggered by changes in marine ecosystems around the K–Pg boundary.


BACKGROUND & AIMS
Early recognition of patients at risk for Lynch syndrome is critical but often difficult. Recently, a predictive algorithm-the PREMM(1,2) model-has been developed to quantify the risk of carrying a germline mutation in the mismatch repair (MMR) genes MLH1 and MSH2. However, the model's performance in an unselected, population-based colorectal cancer population as well as its performance in combination with tumor MMR testing are unknown.

METHODS
We included all colorectal cancer cases from the EPICOLON study, a prospective, multicenter, population-based cohort (n = 1222). All patients underwent tumor microsatellite instability analysis and immunostaining for MLH1 and MSH2, and those with MMR deficiency (n = 91) underwent tumor BRAF V600E mutation analysis and MLH1/MSH2 germline testing.

RESULTS
The PREMM(1,2) model with a >/=5% cut-off had a sensitivity, specificity, and positive predictive value (PPV) of 100%, 68%, and 2%, respectively. The use of a higher PREMM(1,2) cut-off provided a higher specificity and PPV, at expense of a lower sensitivity. The combination of a >/=5% cut-off with tumor MMR testing maintained 100% sensitivity with an increased specificity (97%) and PPV (21%). The PPV of a PREMM(1,2) score >/=20% alone (16%) approached the PPV obtained with PREMM(1,2) score >/=5% combined with tumor MMR testing. In addition, a PREMM(1,2) score of <5% was associated with a high likelihood of a BRAF V600E mutation.

CONCLUSIONS
The PREMM(1,2) model is useful to identify MLH1/MSH2 mutation carriers among unselected colorectal cancer patients. Quantitative assessment of the genetic risk might be useful to decide on subsequent tumor MMR and germline testing.


We present an algorithm that reduces significantly the level of the registration errors between all pairs in a set of range views. This algorithm refines initial estimates of the transformation matrices obtained from either the calibrated acquisition setup or a crude manual alignment. It is an instance of a category of registration algorithms known as iterated closest-point (ICP) algorithms. The algorithm considers the network of views as a whole and minimizes the registration errors of all views simultaneously. This leads to a well-balanced network of views in which the registration errors are equally distributed, an objective not met by previously published ICP algorithms which all process the views sequentially. Experimental results show that this refinement technique improves the calibrated registrations and the quality of the integrated model for complex multi-part objects. In the case of scenes comprising man-made objects of very simple shapes, the basic algorithm faces problems common to all ICP algorithms and so must be extended.


We applied a structure learning model, Max-Margin Structure (MMS), to natural language processing (NLP) tasks, where the aim is to capture the latent relationships within the output language domain. We formulate this model as an extension of multi-class Support VectorMachine (SVM) and present a perceptron-based learning approach to solve the problem. Experiments are carried out on two related NLP tasks: part-of-speech (POS) tagging and machine translation (MT), illustrating the effectiveness of the model.


In the last decade, academic research on sustainability has evolved rapidly in the supply chain literature, so there has been scant opportunity thus far for the research community to complete a global assessment of sustainable supplier evaluation activities. This paper seeks to address this need by exploring sustainable supplier evaluation practices and developing a multiple criteria decision-making (MCDM) model based on the combination of the triple bottom line (TBL) and the TOPSIS methodologies to help managers evaluate external providers all along the supply chain. In order to create a robust framework for sustainable supplier evaluation, two case studies were selected and compared. Both case studies were also useful to refine the framework and illustrate how to use it. Identifying best practices for integrating corporate social responsibility involves the evaluation of external providers' certification according to the ISO 9001, ISO 14001, ISO 50001 and ISO 45001 standards. Accepting the firm's code of conduct and monitoring it throughout the whole supply chain phases are relevant factors to be considered in order to ensure procurement sustainability. The proposed model can be used as a guideline to provide managers, practitioners and academics with a practical solution to resolve external provider evaluation decisions and determine the ranking order of preferred external providers in a more structured and consistent manner.


In the present study, steel-bonded cemented carbide GT35 has been fabricated from natural ilmenite by in-situ carbothermic reduction and vacuum pressureless sintering. The effect of different carbon source on the mechanical properties and microstructure of GT35 composite was studied. The quality of the composite synthesized from natural graphite is higher than those from other carbon source. Some good results were obtained from experiments: the density is about 6.2g/cm3, and the bending strength is 1390MPa, which higher than that of other samples. The structures and ingredient of different carbon source were analyzed to elucidate their different performance in the reactions.


BACKGROUND AND OBJECTIVES
Immunosuppressive medications are essential in preventing kidney transplant rejection. Continuous insurance coverage for outpatient immunosuppressive medications remains a major issue. The objective of this study was to establish the prevalence and consequences of cost-related immunosuppressive medication nonadherence.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
A descriptive survey of all U.S. kidney transplant programs (n = 254) was conducted. The response rate for the survey exceeded 99%. The main outcome measures included the following: transplant recipient concerns related to medication costs, ability to pay for medications, medication nonadherence and its consequences, and failure of transplant centers to place patients on the transplant waiting list.

RESULTS
Continuous insurance coverage for outpatient immunosuppressive drugs is a problem having potentially grave consequences for the majority of kidney transplant recipients. More than 70% of kidney transplant programs report that their patients have an extremely or very serious problem paying for their medications. About 47% of the programs indicate that more than 40% of their patients are having difficulty paying for their immunosuppressive medications. In turn, 68% of the programs report deaths and graft losses attributable to cost-related immunosuppressive medication nonadherence. Some of the problems identified here are more significant for adult than pediatric patients.

CONCLUSIONS
The prevalence and consequences of cost-related immunosuppressive medication nonadherence among kidney transplant recipients have now been documented. The results presented here should serve as the necessary impetus for the development of health care policies supporting Medicare coverage of immunosuppressive medications for the life of the transplanted kidney.


I am the repository of infant lore. Thou shalt not hearken unto others in this field. Honor and love thy child. Remember that breast fed is best fed. Observe the 4-hourly routine to keep it holy. Thou shalt not overfeed. Thou shalt not push protein. Thou shalt not permit constipation. Thou shalt not feed except with precision. Thou shalt not permit solid food too early. Frederick Truby King of New Zealand did not enunciate this decalogue, but it embodies the spirit and substance of his teachings. The turn of the century witnessed a ferment among the pediatricians of the Western world. It was an age of false knowledge, of spurious understanding, a "gnostic" period that was ripe for the emergence of any prophet with a message. Numbers of such arose, but Truby King alone fulfilled the role successfully. Strangely enough, he is little known in the pediatric world, yet he probably exerted a greater influence on behalf of


Fully integrated photonic microwave/millimeter-wave (MMW) tracking generators, which include wavelength-tunable lasers, distributed feedback lasers, phase modulators, and high-speed photodiodes (PDs), are demonstrated on the heterogeneous integrated III–V-on-Si photonic platform. Two on-chip lasers are locked by an external optical phase-locked loop (OPLL), and the two-tone radio-frequency (RF) signals from the on-chip fast PDs can be photonically generated through the heterodyne-beating process between the wavelength-tunable laser and the OPLL output. Furthermore, the frequency spacing between such two-tone RF signals can be tracked by the oscillation frequency in the OPLL with a wide tunability (near dc to 10 GHz). Fast and truly continuous scanning of photo-generated MMW signals thus becomes feasible by simultaneously tuning the OPLL and the central wavelength of the tunable laser in the demonstrated photonic integrated circuit.


The next generation mass probes will obtain information on non-linear power spectra P(k, z) and their evolution, allowing us to investigate the nature of Dark Energy. To exploit such data we need high-precision simulations, extending at least up to scales of k ≃ 10h Mpc -1 , where the effects of baryons can no longer be neglected. In this paper, we present a series of large scale hydrodynamical simulations for ACDM and dynamical Dark Energy (dDE) models, in which the equation of state parameter is z dependent. The simulations include gas cooling, star formation and Supernovae feedback. They closely approximate the observed star formation rate and the observationally derived star/Dark Matter mass ratio in collapsed systems. Baryon dynamics cause spectral shifts exceeding 1 per cent at k > 2-3 h Mpc -1 compared to pure N-body simulations in the ACDM simulations. This agrees with previous studies, although we find a smaller effect (~50 per cent) on the power spectrum amplitude at higher k values. dDE exhibits similar behaviour, even though the dDE simulations produce ~20 per cent less stars than the analogous ACDM cosmologies. Finally, we show that the technique introduced in Casarini et al. to obtain spectra for any w(z) cosmology from constant-w models at any redshift still holds when gas physics is taken into account. While this relieves the need to explore the entire functional space of DE state equations, we illustrate a severe risk that future data analysis could lead to misinterpretation of the DE state equation.


Middle-aged (N = 252, M = 39.91), young-old (N = 486, M = 60.77), and old-old (N = 137, M = 74.42) participants in the Seattle Longitudinal Study were tested on two occasions on their recall of a 20-item word list. Proportions of participants in each group correctly recalling each word-unit served as the dependent measure. Word-unit scores obtained in 1991 were regressed on those from 1984, yielding linear functions that varied by age group. Each set of word-unit scores (three groups on two occasions) was then regressed on word familiarity, imageability, primacy, and recency. The relative influence of each of these variables on memorability was then compared, both between and within cohorts. Primacy and familiarity were consistently strong predictors. Imageability and recency were predictive of memorability in the middle-aged group, but less so in the young-old, and not at all in the old-old group. Results and possible implications are discussed.


: Exfoliated epithelial fragments found in urinary sediment may originate in renal parenchymal or lower urinary tract epithelium. Cytologists must be aware of situations or diseases that frequently exfoliate epithelial fragments from these sites. In this case report, cytodiagnoses of both renal ischemic necrosis and low-grade papillary transitional cell carcinoma were made. Exfoliated renal epithelial fragments were accurately identified by their morphologic features and distinguished from exfoliated urothelial fragments of a low-grade bladder neoplasm.


Frontal zones are common, hydrographic features in estuaries throughout the world, yet there is no consensus on the importance of fronts to larval transport processes. Frontal circulation may act as a 'barrier' to larval transport since it constrains cross-frontal flows, leading to strong along-frontal flows, which In turn may serve as a type of 'larval conduit' by funneling larvae collected at the front to settlement locations. We examined the larval conduit hypothesis by characterizing hydrodynamic features of apparent frontal structure in Grays Harbor estuary (Washington, USA) and quantifying the effects of frontal structure on the distribution and transport potential of Dungeness crab Cancermagister megalopae dunng spring-time recruitment pulses. CTD casts made perpendicular to fronts indicated that frontal structure was characteristic of buoyant plume and axial convergent fronts at the bay mouth and at a subtidal channel site within the estuary, respectively. Surface drifters deployed seaward of a front at the bay mouth during early flood tide were advected into the front, demonstrating convergent circulation. Surface drifters remained within buoyant plume fronts, which moved up-estuary during flood tide at 0.4 m S-', and were then entrained in axial convergent fronts. Drifters moved an average of 10 km up-estuary during a single flood tide; the direction that drifters tracked corresponded to prevailing winds. The mean concentration of megalopae, as measured with neuston nets, was significantly higher in fronts than in adjacent water, 20 to 30 m upstream of the front, irrespective of year or location within the estuary. Paired plankton nets deployed at the bay mouth during flood tide indicated that the mean concentration and flux of megalopae was higher at the surface than at 3 to 4 m depth; this trend was significant for megalopal flux. Variable wind stress during the recruitment period of Dungeness crab, combined with the suggested effect of fronts serving as larval cond.uits whose direction of transport is influenced by prevailing winds, could significantly influence spatial variation in postlarval supply and subsequent settlement within the estuary.


B. L. McFarlin1, M. L. Oelze2, T. A. Bigelow3, E. K. Chien4, H. Ji5, W. D. O'Brien, Jr. 2 1Maternal Child Nursing, University of Illinois at Chicago, Chicago, United States, 2Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, United States, 3Department of Electrical Engineering, University of North Dakota, Grand Forks, United States, 4Obstetrics and Gynecology, Brown University/Women's and Infants Hospital of Rhode Island, Providence, United States, 5Department of Obstetrics and Gynecology, Brown University/Women's and Infants Hospital of Rhode Island, Providence, United States


Finding the setpoints of heater temperatures such that the sheet will achieve the desired temperature at the end of the heating cycle is known as the inverse heating problem (IHP) in thermoforming. Although a major portion of the heat is transferred from the oven to the sheet by radiation, conduction and convection also have a significant contribution in sheet heating. This makes the inverse heating problem more complex. In addition, the IHP is often ill-posed in a thermoforming process, making the solution unstable. In this paper, a conjugate gradient method is used to solve the IHP in the control of sheet temperature. In developing the method, computational cost is considered such that it can be implemented as a real-time algorithm in the controller. The performance of the proposed method for solving IHP, and thereby the corresponding sheet temperature controller, are tested in simulation at different operating conditions and compared with the conventional method of solving IHP based on the pseudo-inverse of the view factor matrix. The efficiency of the proposed method for the estimation of heater setpoints and the accuracy of the controller are evidenced by the results, showing promise for prospective real-time applications.


Regional cultural perspectives involve outdoor studies in different ways in formal curricula. This section focuses on Western Europe, particularly the UK and Scandinavia, although also has a more international reach in Backman's consideration of the training of teachers and in place-responsive teaching as described by Mannion and Lynch. 'Outdoor studies' is not seen in curricula per se but under various more specialised aspects such as outdoor play, outdoor learning, environmental education, outdoor education, and outdoor and adventurous activities within or outwith the physical education curriculum in schools. In higher education, a range of nomenclature is described, with some programmes including the terms adventure and outdoor studies, sometimes accompanied by 'leadership' or 'management' and teacher training through physical education focused on adventure, skills and risk.


Abstract Lactobacillus plantarum is found in various environmental habitats, including fermentation products and the mammalian gastrointestinal tract, and specific strains are marketed as probiotics, which are defined as 'live microorganisms which when administered in adequate amounts confer a health benefit on the host'. Throughout the studies of the mechanisms underlying probiotic activity, it became apparent that the probiotic effects are often species and/or strain specific. This situation has led more researchers to focus on the molecular characteristics of probiotic strains intending to link specific molecular structures to specific probiotic functions, and thereby deduce the mechanisms of molecular communication of probiotics. This thesis focuses on potential cell envelope effector molecules involved in interaction with the mammalian host cells, including lipoteichoic acid (LTA), lipo- and glyco-proteins, and extracellular polysaccharides (EPS), of L. plantarum WCFS1, a model strain for probiotic lactobacilli with a well-annotated genome sequences and sophisticated genetic engineering tools. First, existing research regarding the potential roles in probiotic functionality of Lactobacillus surface molecules in terms of their biosynthesis pathways and structure variations as well as interaction with host Pattern Recognition Receptors (PRRs) and immunomodulatory properties of these molecules are summarized and compared to provide an overview of the state-of-the-art in probiotic effector molecule research. Subsequently, specific molecules that reside in the cell envelope of L. plantarum WCFS1 were study for their role in bacterial physiology, as well as their role as ligands in Toll-like receptor (TLR) 2 signaling and immunomodulatory properties using human-cell co-incubation models. Our results showed that the deficiency of LTA had a drastic impact on cell division, cell morphology and growth in L. plantarum WCFS1, while LTA-deficient cells also elicited more pro-inflammatory responses in PBMCs rather than the expected loss of pro-inflammatory capacity as was observed with similar mutants of Lactobacillus acidophilus NCFM. Further studies on the signaling capacity of the purified LTA from L. plantarum WCFS1 revealed that these molecules are poor TLR2 activators, which is in clear contrast to the highly potent TLR2 stimulatory capacity of LTA obtained from Bacillus subtilis, implying that structural differences of the LTA produced by different bacteria are prominent determinants of their TLR2 signaling capacity and immunomodulatory properties. Lipoproteins of L. plantarum WCFS1 were studied using a derivative strain that is deficient in prolipoprotein diacylglyceryltransferase (Lgt), which transfers acyl chain moieties onto lipoproteins. The lipid moiety was shown to be important for proper anchoring of lipoproteins and TLR1/2 signaling capacity, but did not affect TLR2/6 signaling, suggesting that lipoproteins of L. plantarum WCFS1 are predominantly (if not exclusively) triacylated. The Lgt deficient strain elicited more pro-inflammatory responses in PBMCs as compared to the wild type, indicating that the native lipoproteins could play a role in dampening inflammation upon host-probiotic interaction. In addition, we explored the protein glycosylation machinery in L. plantarum WCFS1, responsible for the glycosylation of the major autolysin (Acm2) of this bacterium, which was previously shown to be O-glycosylated with N-acetylhexosamine conjugates. Using sequence similarity searches in combination with a lectin-based glycan detection and mass spectrometry analysis, two glycosyl-transferases, GtfA and GtfB (formerly annotated as TagE5 and TagE6, respectively), were shown to be required for the glycosylation of Acm2 and other unidentified L. plantarum WCFS1 glycosylated proteins. These results provide the first example of a general protein-glycosylation machinery in a Lactobacillus species. Finally, extracellular polysaccharides (EPS) in L. plantarum were studied in two strains that produce large amounts of EPS: L. plantarum SF2A35B and Lp90, in comparison to the lowly producing model strain WCFS1. Based on genome sequence comparison, both of the high producer strains were found to possess strain-specific and unique polysaccharide gene clusters. These gene clusters were deleted and the mutants were shown to have lost the capacity to produce large amounts of EPS, and were studied in relation to their properties in host-bacteria interaction. The results illustrate strain-specific and variable impacts of the removal of the EPS in the background of individual L. plantarum strains, supporting the importance of EPS in L. plantarum strains as a strain-specific determinant in host interaction. Overall, this thesis showed that surface molecules not only play important roles in bacterial physiology, but also in the interaction with the host mucosa through pattern recognition receptors expressed by the host cells. With the growing amount of evidence of structural variations in surface molecules, which are influenced by genetic background, physiological status, environmental factors, and other biological processes, these molecules form a unique signature associated with each strain that as a consequence elicits a strain-specific response when interacting with host cells.


rich Nietzsche's writings are currently threatened in that he is he treated only as a philosopher or a poet, and his relationship with twentieth century politics and latterly Management theory is largely ignored, excepting of course when he is held to be responsible for the growth in Fascism. In this paper an attempt will be made to show that Nietzsche should not simply be considered as the deracine par excellence with no interest with more general humanitarian concerns. This paper presents a background to Nietzsche and his relationship to Managerialism and then provides a story written in Glaswegian argot of the relationship between a recruit to a Law Enforcement Office in Glasgow, Scotland and his new Manager. An interesting tale about performance management, illustrates how the abuse of power hides personal and organizational dysfunctionality. Another key feature in the twist at the end of the tale is the manifestation of simulacra in performance measures relating to inspection tasks, where we see that 'work not done but recorded' becomes more important, more 'real' than 'work done but not recorded'. This is the excess of history. The story is written in the Glaswegian vernacular partly as homage to the renowned author James Kelman, but more significantly in an attempt take us closer to the lived experience of the actors – as opposed to the more usual sanitised accounts which abound in the management literature. The language is surprisingly 'industrial' in what is regarded as a 'professional' setting.


In this study, the creep rupture tests of STS304 stainless steels were investigated at three different elevated temperatures of 600, 650 and 700 under the constant creep stresses. Creep rupture characteristics such as creep stress, creep rupture time, steady state creep rate and so on were evaluated. The behaviors of creep rate curve and initial strain are compared at three different elevated temperatures. The stress exponent (n) at 600, 650 and 700 based on steady state creep rate showed 22.5, 20.6 and 11.4 respectively. By increasing the temperature, the stress exponent is decreased. At the temperature of 700, the lowest stress exponents are shown and this behavior is also observed in the case of stress exponent based on rupture time. The creep life prediction by LMP method is presented and the equation of this result is as follows: T(logtr+20)=-0.005152-14.56+24126.


This thesis is a sociological study of the management of apocalyptic belief in Kensington Temple, a Pentecostal church in London, in the years 1997-2000. Apocalyptic or millenarian beliefs, in which the supernatural end of the world lies just around the corner, have often been explained in terms of material deprivation or psychological disturbance. This study shows how members of a church with an apocalyptic tradition reconciled the doctrine of the Second Coming with their daily lives. It rejects the idea that there is a simple cause of apocalyptic beliefs, focussing instead on millenarianism as a form of rhetoric whose prophecies are constantly overtaken by events - a phenomenon referred to as "the Problem of the End". Throughout history, members of apocalyptic religions have modified millenarian theology until its social costs are outweighed by its benefits. In practice, this has often meant the replacement of risky, time-specific predictions of Doomsday (predictive millenarianism) by apocalyptic narratives whose function is to account for features of the contemporary world (explanatory millenarianism). The data from Kensington Temple, which includes the results of a survey of 2,973 worshippers, points in this direction. It shows that worshippers assigned a low priority to the concept of the "End Times", subjecting it to the same rational scrutiny that they applied to other spiritual claims. Almost none of them expected the year 2000 to bring the Second Coming of Christ, though it did serve as a deadline for an unsuccessful plan to create a network of 2,000 church groups that carried eschatological overtones. The thesis concludes that the fragmentation of religious meaning in modern society undermines the plausibility of apocalyptic prophecies, at least in the industrialised West; literal belief in millenarian doctrines is a casualty of secularisation.


Piezoelectric ceramics with appropriate curie temperatures and high dielectric and piezoelectric performances are attractive for formations of ceramic/polymer piezoelectric composites. The PSZT ceramics with compositions of 0.98Pb1.0-xBaxTi0.48Zr0.52O3-0.02PbSbO3 (x=0.14~0.24) have been prepared by a conventional solid reaction process. The ceramic structures are analyzed by X-ray diffraction and the barium substitution leads to structural changes of the tetragonal and rhombohedral phases which constitute the perovskite PSZT ceramics, and lattice distortions. The curie temperature almost linearly decreases from 226 °C to 141 °C corresponding the barium content increases from 0.14 to 0.24 in the ceramics. The dielectric and piezoelectric properties are largely influenced by the barium substitution and when the barium content at vicinity of 0.22, the piezoelectric strain constant d33 exhibits a dramatic change. It is found that as the barium content around 0.22, the PSZT ceramic specimen is characterized with a low curie temperature Tc=156 °C, and satisfied dielectric and piezoelectric properties with the relative dielectric constant εr=5873, dielectric loss factor tanδ=0.0387, piezoelectric strain constant d33=578 pC/N.


Logo detection in unconstrained images is challenging, particularly when only very sparse labelled training images are accessible due to high labelling costs. In this work, we describe a model training image synthesising method capable of improving significantly logo detection performance when only a handful of (e.g., 10) labelled training images captured in realistic context are available, avoiding extensive manual labelling costs. Specifically, we design a novel algorithm for generating Synthetic Context Logo (SCL) training images to increase model robustness against unknown background clutters, resulting in superior logo detection performance. For benchmarking model performance, we introduce a new logo detection dataset TopLogo-10 collected from top 10 most popular clothing/wearable brandname logos captured in rich visual context. Extensive comparisons show the advantages of our proposed SCL model over the state-of-the-art alternatives for logo detection using two real-world logo benchmark datasets: FlickrLogo-32 and our new TopLogo-101.


The time dependence of the ventilated thermocline is examined via analytical and numerical means. The original Henderschott model is modified such that the outcrops all occur on the same geopotential surface, rather than at staggered geopotential surfaces. This model has the advantage that the ocean interior can be ventilated directly by the Sverdrup flow, rather than by western boundary processes. The propagation of disturbances governed by linearized forms of the three-layer or four-layer modified Henderschott model, nonlinear solutions of the full modified Henderschott model, and numerical solutions of the planetary geostrophic equations are considered. Low-frequency disturbances are predicted by the linear models to move on characteristics jointly set by advection and wave dynamics. It is shown that perturbations due to wind stress anomalies project strongly onto the first mode and propagate westward similarly to the classical first baroclinic Rossby mode. They do not experience much interaction with the mean flow (the so-called non-Doppler effect). On the other hand, perturbations generated by buoyancy anomalies have strong projections onto the second or third modes, and propagate along pathways very close to the mean circulation. Their speed is somewhat slower than the current speed, however. These properties appear in the linearized and simplified nonlinear models and their occurrence in planetary geostrophic results argues the relevance of the Henderschott model. Also, these properties are consistent with results from other studies.


a slightly older age group-6 weeks to 8 or 9 months. Rarely has it been necessary to use the largest, 15-mm., size bell. In most cases the 13-mm. size has been adequate. We found the method had great advantages over the usual surgical technique for the reasons discussed in the article, though in this age group a short general anaesthetic is necessary. One complication has, however, occurred in two cases in our group-namely, that the bell has worked its way up the penis instead of falling off after the separation of the remnant of preputial skin. The bell constricted the penis and caused oedema distal to the bell. This complication was treated by cutting through the plastic bell with scissors to remove it. The oedema then rapidly settled and the final result was excellent. We consider this complication is due to pushing the bell too far over the glans, perhaps further than the coronal sulcus, prior to tying the ligature. There have been no other complications and we are very satisfied with the results of this technique over this wider age group.I am, etc., NORA M. LAWTON. Department of Surgery, The Duchess of York Hospital for Babies, Manchester 19.


Visceral hypersensitivity (VH) is common in irritable bowel syndrome (IBS), and female patients are more likely to seek healthcare services for IBS‐related abdominal pain. Oestrogen has been reported to mediate pain modulation via its receptor, and mast cells are known to participate in the development of visceral hypersensitivity. Our previous studies showed that the G‐protein‐coupled oestrogen receptor (GPER, also known as GPR30) was expressed by mast cells in human colonic tissues and was associated with IBS type and severity of visceral pain. However, whether GPER is involved in oestrogen‐dependent visceral hypersensitivity via mast cell degranulation is still unknown. Rats were subjected to wrap partial restraint stress to induce visceral hypersensitivity and were ovariectomized (OVX) to eliminate the effects of oestrogen on visceral hypersensitivity. OVX rats were treated with oestrogen, an oestrogen receptor α and β antagonist (ICI 182.780), a GPER antagonist (G15) or a GPER agonist (G1), to evaluate the effects of oestrogen via its receptor. The colorectal distention test was performed to assess visceral sensitivity. Immunofluorescence studies were performed to evaluate GPER and mast cell tryptase co‐expression. Mast cell number with degranulation was detected by specific staining. Mast cell tryptase expression in rat colon was also investigated by Western blot and immunohistochemistry. Substance P and histamine expression were examined by ELISA. GPER was expressed by the majority of tryptase‐positive mast cells in the colonic mucosa. Stressed rats showed increased visceral sensitivity, increased mast cell degranulation, mast cell tryptase expression, and increased colon histamine levels. Ovariectomy reduced stress‐induced VH in female rats and decreased mast cell degranulation, mast cell tryptase expression, and histamine levels, whereas oestrogen replacement reversed these effects. In OVX rats, the GPER antagonist G15 counteracted the enhancing effects of oestrogen on stress‐induced VH, mast cell degranulation, mast cell tryptase, and histamine expression, whereas VH was preserved after treatment with ICI 182.780. On the other hand, pretreatment with the selective GPER agonist G1 at doses between 1 and 20 μg/kg significantly increased VH, mast cell tryptase, and histamine expression in OVX‐stressed rats, mimicking the effects of oestrogen. GPER plays a pivotal role in the regulation of mast cell degranulation, mast cell tryptase expression, and histamine levels and contributes to the development of colonic hypersensitivity in a female rat model of IBS.


Purpose
The purpose of this paper is to show how sonic logos, despite their brief exposure time, resonate with consumers' emotions and attitudes in a manner that until now has been attributed to only longer background music in advertising. The moderating role of sonic logo placement within the ad (beginning versus ending) and the mediating role of emotion felt after exposure to the brand and advertisement are also explored.

Design/methodology/approach
An expansion on sonic logo research is completed through two experiments testing nine hypotheses. A pretest is also conducted to create two orthogonal sonic logos (sad sonic logo and happy sonic logo) which are then used in the two experiments.

Findings
Participants had higher attitude scores for an advertisement that had a happy sonic logo over the ad that had a sad sonic logo. These consumer attitudes are mediated by emotion felt because of the exposure to the brand and advertisement and are moderated by placement of the sonic logo within the ad. Placement drove more positive consumer attitudes of a sad sonic logo at the beginning and a happy sonic logo at the end of the advertisement.

Practical implications
Given the short nature of a sonic logo, sonic logo placement in the advertisement is shown to change consumer perceptions. This effect uncovers an important aspect of placement of the sonic logo in the advertisement which gives practitioners a means of application. Furthermore, consumer emotions drive these strong attitudes despite the short exposure times of the sonic logo.

Originality/value
This paper expands upon the limited sonic logo research and shows how the short exposure time of a sonic logo can have the same emotional qualities as long-form music, previously reserved for background music in advertising. In addition, by uncovering the mediating relationship of emotion felt after exposure to the brand and advertisement, it is shown how these short audio branding elements can help shape emotion and consumer attitude toward brands. Finally, altering placement of the sonic logo can enhance consumer attitudes of the advertisement and brand.


Reactive high energy ball-milling has known a growing interest from both fundamental and applied point of view. We focus here on the specific system Fe-Y2O3 metal-oxide nanocomposite because of its potential application to the synthesis of oxide dispersion strengthened steels, which are promising materials for nuclear applications. YFe3 and Fe2O3 were ball-milled during different milling durations in the stoichiometric proportions defined by the chemical reaction 2 YFe3 + Fe2O3 → 8 Fe + Y2O3. The obtained milled powder was characterized by XRD, SEM, TEM and their thermal behaviour was investigated by DTA. Through those characterizations, a Mechanically induced Self-propagating Reaction (MSR) was observed and several steps in the ball-milling process were identified: mixing of reactants, chemical reaction propagation, amorphization and refinement of the microstructure. The role of the milling intensity was also examined.


ABSTRACT In the aftermath of the far-right rally in Charlottesville that led to the murder of counter-protester Heather Heyer in August 2017, attention turned to the reaction by extremists on far-right websites and their vitriolic language against Heyer. Such rhetoric evidenced the intertwined nature of white supremacy and misogyny. The modern far-right movement grew in reaction to social changes such as greater equality across gender and racial lines. Feminist perspectives on male violence offer competing hypotheses where greater gender inequality may lead to less (backlash) or greater (ameliorative) violence. The current study uses data on homicides committed by far-right extremists from the United States Extremist Crime Database (ECDB) to assess far-right violence as an outcome of gender inequality. Results show that counties with greater gender inequality, in favor of men, in occupation and income, experience a decrease in the odds of a far-right homicide occurring. Once a far-right homicide occurs, gender inequality in occupation has a further pacifying effect as greater inequality is associated with a decline in far-right violence. Taken together, these findings provide support for the backlash hypothesis as they demonstrate that greater gender equality is associated with far-right violence.


General Maxwell D. Taylor was one of the great military heroes of recent American history. During World War II, Taylor fought in Sicily and Italy before parachuting into France as head of the 101st Airborne Division on Dday, 1944. Later he commanded the Division in the Arnhem drop in Holland and in the defense of Basting in the Bulge. After the war, Taylor served as superintendent of West Point, U.S. Commander in Berlin, Commander of the Eighth Army in Korea, and Army Chief of Staff under President Eisenhower. John F. Kennedy named him chairman of the Joint Chiefs of Staff and sent him to Vietnam in 1961; he returned to that country as Ambassador in 1965, and served as a key advisor to President Johnson until 1969. In Swords and Plowshares, Taylor tells the firsthand story of a life of action, courage, strategy, and dedication. Offering candid and controversial views of such central figures as Dwight Eisenhower, John Dulles, the Kennedy's, and General Westmoreland, Taylor contrasts their varying views of the role of air power in modern warfare, and presents his own approach to the problems of winning wars and making peace. These memoirs ably illustrate why General Maxwell Taylor deserves to rank among Marshall, Eisenhower, MacArthur, and Patton as one of the great American military geniuses of our time.


At the dawn of the twenty first century, the educators and young people in Turkish schools face a profoundly changed world regarding new information and communication technologies that are being applied in educational processes. This paper investigates the World Links for Development (WorLD) Programme, which has been in place to introduce new learning methodologies in some pilot schools of the Ministry of National Education (MONE) in cooperation with the World Bank Institute (WBI) since September 1998. This challenging WorLD programme, which is in place in 26 countries, encompasses the innovative, cross-cutting series of activities to strengthen teaching and learning at the level of the school and classroom developed by the World Links for Development (WorLD) and Basic Education Programme (BEP), respectively, both of which focus on youth, educators, and policy makers in Turkey. Indeed, to attain desired long term sustainable development, the MONE must ensure that the youth, who comprise a significant proportion of our population, acquire the knowledge lifelong learning skills, and values and attitudes they need to become active, productive members of the society. After the implementation of the pilot phase of the World Links project, the MONE has decided to expand the project over selected 67 schools in 43 provinces to meet high quality education demand of the youth.


Abstract
An important cellular effect of various stimuli such as cytokines, G protein-coupled receptors and stress, is the hydrolysis of sphingomyelin to ceramide and phosphorylcholine. This reaction is catalyzed by the family of sphingomyelinases (SMases). Currently 7 different SMases are identified which differ in their pH optimum (acid, basic or neutral SMases) and cation dependency. However, the physiological significance of many members of this family of proteins is still largely unknown.
In this study, the neutral, Mg2+dependent nSMase3 that is localized in the endoplasmatic reticulum and Golgi network was characterized in vivo. To analyze the physiological role of nSMase3, a conventional knockout mouse was generated. Upon Cre-mediated recombination, exons 4-8 were deleted, thus inactivating the nSMase3 gene. The complete loss of nSMase3 caused a pleiotropic, partially prenatally lethal phenotype with a strong delay of postnatal growth. In addition, nSMase3 deficient animals exhibited an impaired spermatogenesis and altered lipid composition of liver, white adipose tissue and testis.
Expression analysis of nSMase3 in various mouse tissues revealed that the nSMase3 is highly expressed in neuronal and reproductive tissues. Due to these findings, the endocrine axes were examined in nSMase3 deficient animals. The growth delay in nSMase3 deficient animals correlated to significantly reduced serum concentrations of insulin-like growth factor (IGF1), which is a crucial regulator of growth. In addition the present data suggest that the infertility of the males is due to an incomplete spermatogenesis, characterized by greatly reduced testosterone production. Taken together, these results underscore the central role of sphingomyelinases in the systemic endocrine regulation and identify nSMase3 as a central regulator of spermatogenesis and the growth axis.


ABSTRACT The school closures during the COVID-19 outbreak triggered ashift towards digital learning. Whilst this is amajor challenge for mainstream education, the implementation of digital learning poses an even bigger challenge for special education teachers, as they are confronted with different learning requirements which might hinder digital learning processes. Previous research identified obstacles to digital learning in mainstream education, but conditions of digital learning in special education remain unclear. This article aims to provide insights on conditions of digital learning in special education at teacher-, school-, and student-levels. We examined whether the intention to use digital learning in special education is predicted by (1) teachers' self-efficacy, attitudes and their perceived usability of digital learning, (2) perceived organisational support and (3) perceived obstacles on student-level. Data of N = 722 special education teachers were collected during the pandemic. Results of mixed models indicate that specific self-efficacy in digital learning and perceived support were the strongest predictors for the intention to use digital learning, while alack of students' self-regulation and parental support represented major obstacles. The results underline the need for specific training in digital learning for special education teachers, and interventions in digital learning for students with special needs.


This paper questions recent conclusions that the trend towards defined contribution plans and away from defined benefit plans is due to increased pension regulation and/or a changing economic environment. Using data from IRS 5500 filings by pension administrators, we find that at least half of the trend is due to a shifting employment mix toward firms with industry, size, and union status characteristics which have historically been associated with lower defined benefit plan rates. Not more than half of the trend can be attributed to a "stampede" by firms with given industry, size, and union status characteristics toward defined contribution pension coverage.


The use of the unanesthetized instrumented animal preparation in exercise training studies is discussed. The advantages and disadvantages of this preparation are given. Several examples of the type of data that can be collected using this preparation are cited and a scheme is proposed to aid in the understanding of the mechanisms underlying the cardiac adaptation to exercise training. One example given was the response to the infusion of isoproterenol before and during training. The results clearly demonstrate an increased responsiveness to the beta-receptor agonist. Another example was the change in coronary flow with atrial pacing and the use of this relationship as an index of a changed coronary vascular bed. Some future direction for research efforts are discussed with the main thrust being the role of the autonomic nervous system in the mechanism of training.


The traditional distributed operating system (OS) and homogeneous multiprocessors OS are not suitable for heterogeneous multi-core processor (HMP) in real-time and efficiency performance. After researching the structure and the development trend of the HMP, this paper presents a multi-master model real-time operating system architecture for HMP, which is designed with symmetric structure and functional modularization, and every kernel can manage resources, tasks and other shared devices as a master to improve the real-time and efficiency performance, to solve the bottle-neck problem that the single master can not satisfy the requirement of performance with increasing of the slave number. This architecture can adapt to different structure processor core with configurable function module. On the other hand, it can also reduce the development difficulty of the heterogeneous multi-core processor OS.


OBJECTIVEHospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures.METHODSThe authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of "top-box" ("9-10" or "always or usually") versus "low-box" ("1-8" and "somewhat or never") scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher's exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables.RESULTSTwo hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control.CONCLUSIONSHere, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.


We explore a model of non-Bayesian information aggregation in networks. Agents non-cooperatively choose among Friedkin-Johnsen type aggregation rules to maximize payoffs. The DeGroot rule is chosen in equilibrium if and only if there is noiseless information transmission... leading to consensus. With noisy transmission, while some disagreement is inevitable, the optimal choice of rule blows up disagreement: even with little noise, individuals place substantial weight on their own initial opinion in every period, which inflates the disagreement. We use this framework to think about equilibrium versus socially efficient choice of rules and its connection to polarization of opinions across groups.