Streptococcus pneumoniae is a major cause of human infectious diseases worldwide. Despite this documented evidence, data on pneumococcal disease rates among general populations are scant because of the frequent lack of cultural identification. In this study we propose a model for estimating the burden of pneumococcal pneumonia on hospitalizations. The study was performed by analyzing administrative and clinical data of patients aged 50 years or older, resident in Sicily, and hospitalized, from 2005 to 2012. Demographic information, admission/discharge dates, discharge status, and up to 6 discharge diagnoses coded according to ICD-9 CM were collected for each hospitalized patient. During the 8-year study period, a total of 72 372 hospitalizations with at least one ICD-9 CM diagnosis code suggestive of all-cause pneumonia were recorded. Of these, 1943 (2.7%) hospitalizations had specific ICD-9 CM diagnosis codes for pneumococcal pneumonia. According to the proposed model, 16 541 (22.9%) pneumonia out of all-cause pneumonia was estimated to be attributable to S. pneumoniae. Pneumococcal pneumonia and model-estimated pneumococcal pneumonia had mean hospitalization rates of 13.4 and 113.3/100 000, respectively, with a decreasing temporal trend. The risk of hospitalization for pneumococcal pneumonia was strongly correlated with age (P < 0.001). Our model provides data usable to construct suitable decisional models for the decision-makers and could allow to the responsibles of healthcare facilities to assess the budget impact if they hypothesize to offer vaccination for pneumococcal disease to certain cohorts of subjects aged 50 years or older. In our area, the high estimated hospitalization rates among adults aged ≥65 years suggest the need to implement effective preventive strategies (e.g., vaccination) tailored for these groups.


BACKGROUND
The "post cholecystectomy" syndrome comprises a series of vague symptoms referred by patients subjected to this surgical procedure. These symptoms are unspecific and their association with the operation is dubious.

AIM
To assess the frequency of digestive symptoms among patients subjected to a cholecystectomy ten years ago.

PATIENTS AND METHODS
One hundred patients subjected to a cholecystectomy between 1987 and 1990, were contacted by mail. They were invited to a clinical interview and to an abdominal ultrasound examination.

RESULTS
Two invited patients had died of an acute myocardial infarction. Therefore, 98 patients (78 women), aged 30 to 85 years old, were assessed. Seventy two percent had diverse dyspeptic symptoms, 90% had no food intolerance and 94% had gained weight after the operation. Ninety six percent was satisfied with the surgical results, 3% had severe symptoms due to gastroesophageal reflux or depression. One patient had a residual choledocholithiasis and refused any treatment.

CONCLUSIONS
Cholecystectomy is well tolerated and has good long term results.


Communication antennas, optical mirrors, solar/optical reflectors, etc. often have the shape of parabolic shells or shells of revolution, due to their required focusing, aiming, or reflecting performance. In this paper, the wireless control of free-floating flexible parabolic shells using discrete photostrictive actuators is investigated. Parabolic shell of revolution is considered to be one of the most difficult geometry among all shell and non-shell structures. Because of this, an approximate way to estimate the dynamic behavior and light-induced control forces of a photostrictive coupled parabolic shell is presented. Based on the approximate spherical model, the effects of actuator locations as well as membrane and bending components on the control action are analyzed. The results obtained indicate that the control forces are location dependent. It is also shown by analysis that the membrane control action is much more significant than the bending control action. The validation of the approximate model is done by comparing the light-induced control forces of the photostrictive coupled shells obtained by the approximate equivalent spherical shell model and those obtained by the parabolic shell model. From the comparison, it can be concluded that there is only a slight difference between a spherical shell and a parabola for surface with an F/D (focal length to diameter ratio) of 1.00 or larger.Copyright © 2007 by ASME


Parameters of heat denaturation and intrinsic fluorescence of barnase and its close homologue, binase, in the pH region 2-6 have been determined. Barnase heat denaturation (pH 2.8-5.5) proceeds according to the "all-or-none" principle. Barnase denaturation temperature is lower than that of binase and this difference increases from 2.5 degrees C at pH 5 to 7 degrees C at pH 3. Enthalpy values of barnase and binase denaturation coincide only at pH 4.5-5.5, but as the pH decreases the barnase denaturation enthalpy decreases significantly and in this respect it differs from binase. The fluorescence and CD techniques do not reveal any distinctions in the local environment of aromatic residues in the two proteins, and the obtained difference in the parameters of intrinsic fluorescence is due to fluorescence quenching of the barnase Trp-94 by the His-18 residue, which is absent in binase. Secondary structures of both native and denaturated proteins also do not differ. Some differences have been found in the barnase and binase electrostatic characteristics, revealed in the character of the dipole moment distribution.


Few studies have examined students' liking for physical education activities and factors that influence students' evaluations despite the importance these have for continued engagement in physical activity. This study examined 16,032 ratings of "liking" of 648 physical education lessons reported by students in eight coeducational fourth- and fifth-grade classes during an 8-month period. Mean ratings on activity units ranged from 3.15 to 3.62 on a 4-point scale, indicating that the children liked the activities. However, they liked some units more than others (p < .001), and they preferred skill-related over health-related activities (p < .001). Day of week (p < .53), child's grade (p < .69), and school (p < .56) were not associated with the children's liking scores. Ratings of activities did not change significantly as students gained more experience with a specific instructional unit. Future research is recommended on how students' needs and preferences relate to developing positive attitudes toward phys...


Summary
1.  Ecological specialization is one of the main concepts in ecology and conservation. However, this concept has become highly context-dependent and is now obscured by the great variability of existing definitions and methods used to characterize ecological specialization.

2.  In this study, we clarify this concept by reviewing the strengths and limitations of different approaches commonly used to define and measure ecological specialization. We first show that ecological specialization can either be considered as reflecting species' requirements or species' impacts. We then explain how specialization depends on species-specific characteristics and on local and contingent environmental constraints. We further show why and how ecological specialization should be scaled across spatial and temporal scales, and from individuals to communities.

3.  We then illustrate how this review can be used as a practical toolbox to classify widely used metrics of ecological specialization in applied ecology, depending on the question being addressed, the method used, and the data available.

4.  Synthesis and applications. Clarifying ecological specialization is useful to make explicit connections between several fields of ecology using the niche concept. Defining this concept and its practical metrics is also a crucial step to better formulate predictions of scientific interest in ecology and conservation. Finally, understanding the different facets of ecological specialization should facilitate to investigate the causes and consequences of biotic homogenization and to derive relevant indicators of biodiversity responses to land-use changes.


Considering the negative consequences of stroke disease that dramatically reduce the quality of life of post-stroke patients and their families, it is urgent to offer more effective methods and tools for recovering the survivors in a possible short time. They must be accomplished in a way that preserves dignity and motivates the patient to relearn basic skills that the stroke disease may have impaired like bathing, eating, dressing and walking, shopping, speaking, reading and eventually return to working life. Taking this as a background for consideration, the aim of this paper is to present the research outcomes on the usefulness of the new and innovative rehabilitation pathways basing on Virtual Reality (VR) technologies. Basically, the case studies performed in the rehabilitation centre Technomex from Poland, encompassing the whole stroke patients' rehabilitation procedures with the use of VR were described. Simultaneously, these examples were the base for creating a comprehensive and professional training tool intended mostly for rehabilitators and physiotherapists about using VR technologies in supporting stroke survivors' recovery that is the main objective of the international project titled "Development of Innovative Training


The current scientific interest and fervour in graphene research is fuelled by their potential uses in a variety of fields such as energy storage, electrochemical and biomolecule sensing applications. In particular, many of these require the bulk production of graphene materials, using approaches such as the oxidation of graphite to graphite oxide with chlorate or manganate oxidants in the presence of strong acids. This is followed by its reduction via thermal exfoliation, or through chemical and electrochemical reduction methods. Elemental potassium is a very strong reducing agent with a chemical potential of ca. E = −2.93 V versus the standard hydrogen electrode. Therefore, in this paper we evaluate the effects of the presence of elemental potassium as a strong reductant during the thermal exfoliation of graphite oxides. We employ both the Hofmann (concentrated sulfuric and nitric acids with KClO4) and Hummers (concentrated sulfuric acid with NaNO3 and KMnO4) methods of graphite oxidation, followed by their thermal reduction at 500 °C both in the absence and presence of elemental potassium. Collectively, these treatments invariably result in differences in morphologies, defect densities and the quantities of oxygen-containing groups within these materials, thus affecting their heterogeneous electron transfer rates and electrochemistry. Extensive analyses with scanning electron microscopy (SEM), Raman spectroscopy, high resolution X-ray photoelectron spectroscopy (XPS), energy-dispersive X-ray spectroscopy (EDS), powder X-ray diffraction (XRD), BET surface area analysis, combustible elemental analysis and cyclic voltammetry (CV) are performed to elucidate the different properties and characteristics of our materials. We observed that the elemental potassium-assisted thermal reduction of graphene oxide led to a product with increased heterogeneous electron transfer rates towards the Fe(CN)64−/3− redox probe, despite having more oxygen-containing groups. This is in contrast to prior reports where larger amounts of oxygen groups corresponded to poorer electrochemistry. There were also no significant differences in the density of sp3 defects between the graphene materials. Hence, this improved electrochemistry may be attributed to the formation of stable complexes between potassium and oxygen groups on the graphene surface in a manner we propose to be similar to carboxylic acid salts. These results would therefore have important implications in our understanding of oxygen-containing groups in graphene materials and their influence on their inherent electrochemistry.


Almost immediately after the collapse of the Soviet Union, its newly independent states started reaching out to their neighbors in an attempt to join in the already established alliances and regional groupings of states. Moreover, they sought to recreate some sort of an interstate economic union amongst themselves. While integration with the EU succeeded for some and remains an option for others, regional integration with other post-Soviet states remains mostly a rhetorical exercise. Nonetheless, regionalist imagery still drives these states' foreign policies. Identity construction in the region has emphasized the irreconcilably dualistic nature of such categories as "European" versus "Eurasian." Eurasian regionalism grew out of fear be left alone in the increasingly globalized world. This was accompanied by the politics of envy toward the European Union. Other key movers were China's economic penetration of the region and Russia's attempts to reassert itself both geopolitically and economically. Regionalization was called forth to address political and economic insecurity by means of external branding of the state. Seeking eventual affiliation with the European Union, Ukraine, had spearheaded an openly anti-Russian GUAM (Georgia-Ukraine-Azerbaijan-Moldova) alliance. However, GUAM's construction of identity in explicit opposition to that of Russia's was not positively rewarded with promises of the prospective EU membership. Meanwhile, the "Eurasian" Russia together with Kazakhstan and Belarus has launched the Single Economic Space (SES) project. The idea of creation of a new trading bloc in Eurasia serves as much an anchor of identity as a basis for pragmatic foreign policy. The paper examines regional dimensions of social identity construction in post-Soviet space, focusing on the competing images of "Europe" versus "Eurasia." By looking at the example of the SES, it seeks to clarify the role that regional identities and cultures play in politics of interstate cooperation in Europe and beyond. I argue that development of regional dimension to a national identity is a necessary first step towards the state's wider international integration.


ABSTRACT The wavelet stretch effects in pre-stack migration, which is similar to that of NMO stretch, distort the frequency spectrums and taper the high-frequency components at far offsets. The long-offset migrated results in conventional migration methods are muted, resulting in a loss of effective information about the subsurface investigation. Only short-offset data are used to obtain a high-resolution stacked image. However, long-offsets that correspond to high-incident-angle data are critical to velocity inversion and amplitude versus offset (AVO) analysis when estimating lithology and fluid product. Furthermore, attenuation of seismic waves due to the anelasticity of the subsurface medium will cause dissipation of seismic energy and loss of high frequencies, thus broadening the propagating wavelet and degrading the resolution of imaging. Both the wavelet stretch and the absorption will taper the high-frequency components. We developed a wavelet stretch correction and absorption compensation scheme during the migration process by shrinking the wavelet when applying the imaging condition, which matches the stretch effect caused by migration. The correction factor is derived based on the incidence angle associated with many factors. Moreover, the de-absorption pre-stack time migration (QPSTM) is implemented on the effective Q model that makes the Q modelling become easier. Both the application of synthetic and real data examples demonstrate that the proposed anti-stretch QPSTM can be particularly useful recovering the high-frequency components caused by anelasticity and wavelet stretch, and obtain higher-resolution images.


Protein concentration and acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activities were assayed in the cerebrospinal fluid (CSF) of 26 healthy normal subjects (20–86 years old), 27 patients with dementia of the Alzheimer type (DAT), and 10 patients with dementia of the Alzheimer type with extrapyramidal signs (EDAT). In normal subjects, there was an age‐related increase in CSF protein and AChE activity and a significant correlation (p < 0.001) between CSF protein and BChE activity. In the DAT and EDAT groups, CSF AChE activities (mean ± SD = 17.5 ± 3.6 and 15.3 ± 4.4 nmol/min/ml, respectively) were significantly lower (p < 0.05) than in 13 age‐matched control subjects (21.5 ± 5.6 nmol/min/ml). In contrast, neither CSF protein concentration, BChE activity, nor the ratio of AChE/BChE differed significantly between groups. In patients with DAT, CSF AChE activity was significantly lower (p < 0.05) in subjects with an early onset compared to those with a late onset (16.4 ± 3.4 and 19.7 ± 2.8 nmol/min/ml, respectively), and activity in the latter group did not differ significantly from control values. CSF AChE activity was not related to dementia severity and did not change significantly over an 18‐month period. Although these results confirm a cholinergic deficit in patients with DAT, the considerable overlap of CSF AChE activity between groups and the nonsignificant correlation between AChE activity and dementia severity limit the usefulness of CSF AChE as a diagnostic marker of this disorder.


OBJECTIVE
This study aimed to explore the expression characteristics of CD151 in breast cancer (BC) and to further study its role in the development of BC and potential regulatory mechanisms.

PATIENTS AND METHODS
Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) was used to detect the level of CD151 in 82 pairs of BC tissues and adjacent normal ones, and the relationship between CD151 expression and BC pathological parameters and prognosis was analyzed. CD151 expression in BC cells was further validated using qRT-PCR. The CD151 knockdown model was constructed in BC cell lines including MCF-7 and SKBR3 using the small interference RNA. The cell counting kit-8 (CCK-8) and transwell assay were used to analyze the effect of CD151 on the biological function of BC cells, and finally Western blot was performed to explore its underlying mechanism.

RESULTS
QRT-PCR analysis revealed that CD151 level in BC tissues was strikingly higher than that in normal ones, and the difference was statistically significant. Compared with patients with low CD151 level, patients with high CD151 level had worse tumor stage, lymph node metastasis, and distant metastases. The higher the incidence of metastasis, the lower the overall survival rate. Compared with the negative control group, the ability of cell proliferation or invasion and migration in the CD151 knockdown group was significantly reduced. In addition, Western blot results demonstrated that the levels of proteins in TGF-β1/Smad pathway, including transforming growth factor-β1 (TGF-β1), p-Smad2, p-Smad3, N-cad, Vimentin and MMP-9, were remarkably decreased in cells of si-CD151 group.

CONCLUSIONS
The expression of CD151 in BC was significantly increased, which was found evidently associated with BC stage, lymph node or distant metastasis, and poor prognosis. Meanwhile, CD151 may promote the proliferation and invasion of BC by regulating TGF-β1/Smad pathway.


Insulin dependent diabetes mellitus (IDDM) is an autoimmune disease associated with the presence of different types of autoantibodies. The presence of these antibodies and the corresponding antigens in the circulation leads to the formation of circulating immune complexes (CIC). CIC are known to persist in the blood for long periods of time. Such CIC following deposition in the small blood vessels have the potential to lead to microangiopathy with debilitating clinical consequences. The aim of our pilot study was to investigate whether a correlation exists between CIC and the development of microvascular complications in diabetic children. Isolation of a new glycoprotein complement inhibition factor (CIF) from the parasitic plant Cuscuta europea seed, which appears to bind specifically to complement component C3 has provided an unique tool for the measurement of immune complexes by means of ELISA-type techniques (CIF-ELISA). We studied the levels of CIC (IgG, IgM and IgA) in 58 diabetic children (mean age 12.28±4.04 years, diabetes duration 5.3±3.7 years), 29 of them had vascular complications (group 1) and the other 29 were without vascular complications (group 2). As controls, we studied sera samples from 21 healthy children (mean age 13.54±4.03 years). Sera from the diabetic patients showed statistically significant higher levels of CIC IgG ( p=0.03) than sera from the control group. In sera from group 1 values of CIC IgG showed statistically significant higher levels than controls (0.720±0.31 vs. 0.46±0.045; p=0.011) Sera from 59% of the patients were positive for CIC IgG, 36% for CIC IgM and 9% for CIC IgA. Among 26 patients with microalbuminuria, sera from 17/26 (65%) were positive for CIC IgG, 8/26 (31%) for CIC IgM and 2/26 (8%) for CIC IgA. CIC IgG correlated with HbA1c (r=0.51; p=0.005) and microalbuminuria (r=0.42, p=0.033). CIC IgA correlated with age (r=0.44, p=0.03). CIC IgM correlated with the duration of diabetes (r=0.63, p=0.02). These findings suggest that elevated levels of CIC IgG are associated with the development of early diabetic nephropathy.


This paper assesses the scalability and replicability of smart grid projects, by means of the identification of limitations and barriers faced by these projects. Factors have been identified that impact a project's scalability and replicability by means of a review of demonstration projects. The factors are of technical, economic, regulatory and social acceptance nature, and they describe requirements for scalability and replicability. Data was collected from ongoing European smart grid demonstration projects through the use of an elaborated questionnaire on the identified factors. Which allowed to quantify the status quo to what extent projects have taken these factors into account. Dew to their nature the derived factors can be categorized in technical, economic and regulatory & stakeholder related factor areas The obtained results allowed the identification of barriers, i.e. limitations regarding the scalability and replicability of smart grid projects. In particular projects face barriers regarding the absence of standards, the physical limits of the existing infrastructure, the absence of cost-benefit analyses, the neglect of varying macro-economic factors, stakeholder involvement and from the dependency of projects on regional or national regulatory frameworks and market designs.


Understanding culture and its attitudes and values towards space, place and nature is a critical aspect in determining appropriate approaches to a wide variety of planning actions. Actions such as gaining support for protected areas, designing new developments, and integrating tourism facilities in existing communities all depend on an understanding of cultural norms and values for their success. But understanding the relationship between cultural attitudes and culturally defined space can be difficult, falling prey to the observer's own cultural norms and biases. This project uses a method based on individual interviews and expert observation of physical traces, to develop an understanding of cultural attitudes and values towards land, nature and proxemics. This case study of three cultural groups in Belize compares and contrasts the village patterns and personal landscapes of three villages with widely differing landscapes. About the size of Massachusetts, Belize is home to a diverse population of ethnic groups with widely different cultures and visibly different development patterns. The Garifuna, descendants of African slaves shipwrecked on St. Vincent, inhabit villages on the coast in central Belize. The Mayan villages are predominantly two linguistic types, Mopan or Kechi and inhabit the highlands of southern and southwestern Belize. Many moved to these areas during periods of civil unrest in Guatemala during the 20th century. The third cultural group, the Creole, are descendants of African slaves brought to Belize to work in the logwood trade and on plantations, and include European cultural heritage descending from plantation owner-slave parentage. Creole communities proliferate through the northern and coastal areas of Belize. This study observed the three predominant cultures as expressed in three different villages: Garifuna in the coastal village of Hopkins, Mayan in the southern highlands village of San Jose, and the northern lowlands Creole village of Crooked Tree. Data was collected through participant interviews and expert observation of physical trace during two case study visits made during the month of March in 2007 and 2008 by two teams of students. The data illustrates two critical findings: first, how widely different the living spaces and personal landscapes of three cultures can be, even when located in villages located in close proximity, and secondly, how clues in the personal, home landscapes of community members give valuable clues to their attitudes and values with respect to nature, land and protected areas.


A computer simulation model of the population dynamics of a polygenic system and a pattern of mobile genetic elements (MGEs) under directional truncation selection for a quantitative trait was developed. Modifier MGEs were shown to be rapidly and adaptively fixed (or lost) together with the modified polygenes. Marker MGEs and independent MGE copies were fixed and lost just as rapidly but in a random manner. Using specific marking of initial haploid genomes and direct computing of the mean proportion of identical encounters at each locus in each generation, it was shown that the mean nonselective inbreeding coefficient F(n) dramatically increases in the course of selection, reaching values 0.7-0.9 in 15-20 generations. As a result, adaptive homozygotization of polygenes and modifier MGEs and random homozygotization of marker MGEs, independent MGE copies, and all other genes of the genome occurs. These results confirm the hypothesis on the "champion" polygene pattern advanced earlier to explain the data of selection experiments.


The Geomatics industry is a highly specialised field incorporating advanced technical instrumentation and complex measurement systems which form part of local, national and international Spatial Information Systems. As spatial information forms the basis for many aspects of construction, architecture, planning and development, the knowledge and skills required by the qualified Geomatics professional are varied. The professional surveyor must attain the required academic standard and satisfy professional criteria. The BSc in Geomatics in the Dublin Institute of Technology (DIT) is the only programme in Ireland producing Geomatics professionals. It is accredited by a number of professional bodies including the Society of Chartered Surveyors (SCS) and the Royal Institution of Chartered Surveyors (RICS) and is designed to produce graduates who have academic integrity coupled with real-life problem solving skills thus servicing societal needs. The subject area 'Geodetic Surveying' is taught in each year of the Geomatics Degree Programme and traditionally brings together a number of core surveying principles and practical problem solving skills which are reflected in the summative and formative module assessments. In this exercise the formative assessment element of module SSPL3005 (Geodetic Surveying 3), which is a 5 ECTS (European Credit Transfer System) module delivered to third year students, focused on an industrial simulation exercise as a means of meeting the demands of relevant stakeholders, viz. Students, Academic standards, Professional Bodies and Industry. This simulation exercise emulates the TV show 'The Apprentice' whereby students, operating in teams, had to solve a practical survey problem and present, and defend, their findings on camera before a panel consisting of two course tutors and a chartered surveyor who is the director of a large survey practice. This paper outlines the pedagogical approach of using industrial simulation for survey education and evaluates the methodology employed and the outcomes achieved. It also highlights the challenges in aligning academic curricula and assessment with the professional competencies required by industry.


Communicated by: C. Ojiewo Abstract Cowpea, Vigna unguiculata (L.), is an important grain legume grown in the tropics where it constitutes a valuable source of protein in the diets of millions of people. Some abiotic and biotic stresses adversely affect its productivity. A review of the genetics, genomics and breeding of cowpea is presented in this article. Cowpea breeding programmes have studied intensively qualitative and quantitative genetics of the crop to better enhance its improvement. A number of initiatives including Tropical Legumes projects have contributed to the development of cowpea genomic resources. Recent progress in the development of consensus genetic map containing 37,372 SNPs mapped to 3,280 bins will strengthen cowpea trait discovery pipeline. Several informative markers associated with quantitative trait loci (QTL) related to desirable attributes of cowpea were generated. Cowpea genetic improvement activities aim at the development of drought tolerant, phosphorus use efficient, bacterial blight and virus resistant lines through exploiting available genetic resources as well as deployment of modern breeding tools that will enhance genetic gain when grown by sub-Saharan Africa farmers.


Purpose Failure mode and effects analysis (FMEA) was used to identify potential errors and to enable the implementation of measures to improve the safety of neonatal parenteral nutrition (PN).

Methods FMEA was used to analyze the preparation and dispensing of neonatal PN from the perspective of the pharmacy service in a general hospital. A process diagram was drafted, illustrating the different phases of the neonatal PN process. Next, the failures that could occur in each of these phases were compiled and cataloged, and a questionnaire was developed in which respondents were asked to rate the following aspects of each error: incidence, detectability, and severity. The highest scoring failures were considered high risk and identified as priority areas for improvements to be made.

Results The evaluation process detected a total of 82 possible failures. Among the phases with the highest number of possible errors were transcription of the medical order, formulation of the PN, and preparation of material for the formulation. After the classification of these 82 possible failures and of their relative importance, a checklist was developed to achieve greater control in the error-detection process. FMEA demonstrated that use of the checklist reduced the level of risk and improved the detectability of errors.

Conclusion FMEA was useful for detecting medication errors in the PN preparation process and enabling corrective measures to be taken. A checklist was developed to reduce errors in the most critical aspects of the process.


BACKGROUND AND AIMS
Patients with Ulcerative Colitis (UC) may present as emergencies and require rapid escalation of therapy. This study aimed to assess the mortality, colectomy and readmission risk during and following a first emergency admission with UC.

METHODS
Using Hospital Episode Statistics, subjects aged between 18-60 years, coded with a first emergency admission with UC were identified between 2007-2017. Influences of demographic factors, comorbidity, anti-TNF therapy and provider UC activity on mortality and colectomy were examined.

RESULTS
10,051 subjects (46% female; median age 33-years (IQR 25-44)) were identified. Mortality was 0.2% in-hospital and 0.5% at 12-months, and following colectomy during acute admission was 1.4% in-hospital and 2.1% at 12-months. Females had reduced risk of colectomy during admission (OR 0.73 (95%CI 0.62-0.85)). Comparing the period from 2007-2011 to 2012-2017, the rate of colectomy fell during acute admissions, OR 0.85 (0.72-0.99), p=0.038 and at 12-months after admission OR 0.73 (0.61-0.87). Anti-TNF therapy increased four-fold in acute UC admissions from 2007-2017. Those receiving anti-TNF therapy had a 70% increased risk of colectomy during index admission compared to those not receiving anti-TNF (OR 1.72 (1.29-2.31)). Increased time to colectomy during first admission was associated with female sex (HR 0.84 (0.72-0.98)) and Asian ethnicity (HR 0.61 (0.44-0.85)) while reduced time was associated with increased comorbidity, lower deprivation and high provider volume of colectomies for UC (HR 1.59 (1.31-1.93)).

CONCLUSIONS
Mortality following colectomy was 1.4% in-hospital, 2.1% at 12-months, and no significant change over time was observed. Colectomy during emergency admission for UC was less common in females. Rates of anti-TNF therapy during emergency admission for UC have increased whereas overall colectomy rates have fallen.


Background Tamoxifen is the cornerstone of adjuvant therapy for hormone receptor-positive breast cancer. Despite its efficacy, limited drug sensitivity and endocrine resistance remain the important clinical challenges. The main objective of this study was to investigate fatostatin, which was found to sensitize breast cancer to the antitumour effect of tamoxifen both in vitro and in vivo. Methods Fatostatin-induced ER degradation was detected by immunoprecipitation assay. The antitumour effect of fatostatin and tamoxifen on MCF-7 and T47D cells was assessed by MTT and colony forming assays. Cell cycle arrest was detected by flow cytometric analysis. Apoptosis was detected by annexin V/propidium iodide double staining and TUNEL assay. Autophagy was detected by MDC assay and acridine orange staining. Migration and invasion assays were performed using a Transwell system, and the efficacy of the synergistic use of fatostatin and tamoxifen in vivo was evaluated using an MCF-7 xenograft model in BALB/c nu/nu female mice. Results The synergistic use of fatostatin and tamoxifen significantly suppressed cell viability and invasion, induced cell cycle arrest, and regulated apoptosis and autophagy in MCF-7 and T47D cell lines via PI3K-AKT-mTOR signalling. Additionally, the expression levels of Atg7/12/13, beclin and LC3B increased while p-mTOR and P62 expression levels decreased after treatment with fatostatin and tamoxifen. Tumor growth in the xenograft model was suppressed significantly with the synergistic treatment of fatostatin and tamoxifen. Conclusion Fatostatin could induce ER degradation by K48-linked polyubiquitination, which was the key mechanism contributing to tamoxifen inhibition of PI3K-AKT-mTOR signalling in breast cancer. Fatostatin may have a promising clinical use for ER-positive breast cancer patients.


Textile Designers at the Cutting Edge showcases a selection of textile designs from all over the world, presented in feature interviews with the world's most visionary young designers. Chosen for their contributions to fashion textiles and interior fabrics, the designers describe their output and inspirations in their own words. Whether speaking from style capitals, such as London, Paris, Milan, Madrid, Berlin, Tokyo, and New York, or in less-trafficked cities, today's most forward-thinking textile designers showcase exciting work that signals newdirections in textile practice and the emergence of new textile forms and fiber technologies. The book not only features images of completed designs, but also previously unseen archive material, such as work-in-progress photographs and digital drawings. These unique visuals create a stylish picture of today's textiles, as well as an essential reference guide for those interested in contemporary textile design.


Network Management Systems (NMS) are used to monitor the network and along with Operations Support Systems (OSS) maintain the performance with a focus on guaranteeing sustained QoS to the applications and services. One aspect that is given less importance is the energy consumption of the network elements during the off peak periods. This paper looks at a scenario where the NMS plays an important role in making the network energy efficient by intelligently turning the network elements or their selective ports to sleep mode when they are underutilized. To this end, we propose and evaluate a Bayesian Belief Network (BBN) based Decision Management System (DMS), which provides intelligent decisions to the NMS for it to adaptively alter the operational modes of the network elements, without compromising the performance and QoS constraints. Simulated network has been used to provide the proof of concept followed by discussions on the amount of energy saved and its effect on the network performance.


We present a detailed structural characterization of the interfaces in Fe/MgO/Fe layers grown by molecular-beam epitaxy using aberration-corrected transmission electron microscopy (TEM), scanning TEM, and electron energy-loss spectroscopy. When fabricated into magnetic tunnel junctions, these epitaxial devices exhibit large tunnel magnetoresistance ratios (e.g., 318% at 10 K), though still considerably lower than the values predicted theoretically. The reason for this discrepancy is being debated and has been attributed to the structure of, and defects at the interface, namely, the relative position of the atoms, interface oxidation, strain, and structural asymmetry of the interfaces. In this structural study, we observed that Fe is bound to O at the interfaces. The interfaces are semicoherent and mostly sharp with a minor degree of oxidation. A comparison of the two interfaces shows that the top MgO/Fe interface is rougher.


Abstract : The most accurate clocks are using cesium beam frequency standards as their source of accuracy. The atomic time scale TAI is built from the SI seconds after adopting the definition of its origin. As a practical time scale close to the astronomic time, UTC has been introduced, which is equal to TAI, but kept in close agreement with universal time, by additional or subtraction of leap seconds. UTC and TAI are computed by the BIPM from the time comparison data of laboratory and commercial cesium clocks. The accuracy of comparing clocks all over the world has been: improved significantly by the use of the GPS common view method. This one way method is capable of precision around 8 ns and accuracies of about 30 ns if not deteriorated by Selective Availability measures. A further improvement can be realized by using two-way methods, as demonstrated in several experiments using groundstations at each clock site capable of reception and transmission. This paper addresses the calibration of the groundstations to achieve high accuracy in such two way time comparisons.


With the advent of the Internet, exchanges and the acquisition of information, description and recognition of 3D objects have been as extensive and have become very important in several domains, which require the establishment of methods to develop description and recognition techniques to access intelligently to the contents of these objects. This paper deals for 3D models recognition. Thus under general affine transform we propose an approach based on neural network. The recognition is done by measuring the similarity between a sample of object and its transformed obtained by parameters extracted from neural networks using the euclidean distance.


Contagious itch can be evoked by observing people scratching. Verbal suggestions about to‐be‐received itch can influence itch intensity, as shown by placebo research, but it is unknown whether this extends to contagious itch. The current study aimed to replicate prior findings that listening to scratching and rubbing sounds elicits contagious itch, and to investigate whether suggestions can modulate this process. Healthy participants (n = 140) received positive or negative suggestions about itch in response to the sounds (aimed to decrease or increase expected itch, respectively), or no specific suggestions as a control. Participants listened to a number of audio fragments with scratching and rubbing sounds. The amount of expected itch as well as itch sensation after each audio fragment were measured by self‐report. Suggestions had no effect on the expected itch. Both rubbing and scratching sounds significantly elicited itch in all groups. Scratching sounds induced more itch than rubbing sounds exclusively in the control group. These findings indicate that short suggestions might be not effective enough to modify the expectations of people regarding contagious itch. Furthermore, suggestions modulate contagious itch to some degree, but not in the hypothesized direction. Potential similarities and differences in the neurobiological mechanisms of contagious itch and nocebo effects are discussed.


The European Bus System of the Future (EBSF_2) is a research project funded by the European Union with the aim of developing a new generation of buses across Europe. The goals are to increase the attractiveness and efficiency of buses by testing advanced operational and technological solutions. Among these are more comfortable internal layouts, the implementation of a standard IT architecture, intelligent garage procedures, energy-efficient auxiliaries and green driving assistance systems, all of which are being tested in several demonstrators. This study focuses on the innovative features of the methodology and test process adopted in Ravenna, Italy, where a demonstrator is being used to improve predictive maintenance management. The demonstrator involves maintenance software used to analyse data from CANbus and sensors to assess oil quality, detect potential breakdowns and, on this basis, replace spare parts in advance. The system also detects which substances contribute to poor oil quality. The study describes performance before and during the implementation of the demonstrator in relation to various impact areas: maintenance, operations, fuel consumption, costs, staff training and the efficiency of the intelligent transport system in processing data. The achieved results are reported with the aim of providing advanced knowledge for applications beyond EBSF_2.


Most scholars are understandably preoccupied with the impact of Europeans on native peoples who were passive, unwilling, or resistant participants in that contact. We present in this chapter a different case. The Missouri Riv er tribes, including the Omaha and Ponca, willingly engaged in relations with Euramericans, especially in the fur trade that dominated interaction in this region. The time frame for this study is 1780- 1820, a period when interaction between individual traders and Native Americans was replaced by the dominance of the American Fur Company in organized exploitation of the Missouri River lands and peoples. This involvement later contributed to the well-documented environmental destruction of Plains river systems with dire consequence to Native American subsistence in the late 1800s. The years between 1780 and 1820 saw commerce contribute to the emergence of the Omaha tribe as a major political, economic, military, and cultural force in the area of modern Nebraska. It is thought that lifestyles changed during these dealings with Euramericans to the simultaneous benefit and peril of tribal members. Omaha population decreased during the late 1700s and early 1800s. Epidemics (Trimble, 1989) and trade in toxic lead (Reinhard and Ghazi, 1992) contributed to this decline. Beyond these factors, female health and reproductive success must have played a role in the decline and eventual recovery of the Omaha population. It appears that several factors related to the fur trade resulted in changes in ways of life that adversely affected female health. Trade exposed the Omaha to Euramericans and their diseases. The need to produce furs resulted in greater physical demands on an already heavily taxed population. We suspect that the vitality of Omaha women was compromised, resulting in a decrease in life expectancy and reproductive success. If extrapolations from ethnographic and historical writings are correct, these alterations in life experience should have left recognizable signatures on the skeletons. The comparison of pre


This paper explores the syndrome of dementia and the way in which it affects a person's capacity to make a medical decision. The symptoms of dementia exist along a continuum, meaning that a patient will begin with a mild form of dementia and then progress to a more severe form of this syndrome. This paper argues that although demented patients generally do not have the capacity to make medical decisions, some demented patients, because of the continuum nature of the syndrome, can participate in the planning of their care and, in some cases, participate in the informed consent process. It maintains that the principles of respect for autonomy and dignity, beneficence, and justice provide ethical reasons for involving demented patients in the care when they are capable to do so. Moreover, this paper contends that ageism, sexism, and hypercognitivism are biases that likely affect the way in which physicians view their demented patients, and consequently, the intersectionality of these three biases may play a role in a physician's disregard for an elderly demented patient's involvement in the planning of their care. Finally, the way in which physicians' interpret the idea of "involvement" provides further reasons to explain why physicians sometimes exclude demented patients in participating in decisionmaking. This paper concludes by providing some suggestions for positively involving demented patients in care planning.


Philosophy addresses questions and theories related to morality, society, religion, and the natural and social sciences. Course work in philosophy provides students with an understanding of the methods and traditions of philosophical thought, as well as with opportunities to critically and collaboratively reflect on the nature of the world and the human situation in it. Through readings, discussion, and writing, students examine questions concerning the validity of moral judgments, political ideas, and scientific theories, as well as questions about values and social policy in such areas as law, medicine, environment, and technology. Course work in philosophy significantly strengthens study in other areas.


This paper examines student learning time as a key educational resource. It presents an overview of how different OECD countries allocate instruction time. It also develops a model to understand the effective use of allocated instruction time and examines how different OECD countries compare on this. The paper confirms the value of sufficient instruction time as a key educational resource, but the key conclusion is that what matters the most is the way in which allocated time is used. Student learning time and academic achievement seem to have complex and curvilinear relationship with diminishing returns to scale. The paper also cautions that there should be realistic expectations on how effectively students can learn throughout the school day and year. Accordingly, it suggests that instruction could be organised to better optimise times when students are better able to concentrate. Evidence on lost instruction time in different OECD countries points to areas of potential increased effectiveness within existing time allocations, for example by improving classroom management and matching instruction to better meet students' learning needs.


Introductions: Duration of stay in Emergency Department (ED) is associated with negative outcomes, from increased mortality to increased duration of length of stay as inpatient. This study evaluates the length of duration of stay in ED after admission and the outcomes. Methods: This was a cross sectional observational study conducted at Patan Hospital, a tertiary care teaching hospital of Patan Acedemy of Health Sciences, capital city of Nepal. All the patients presenting to ED and getting admitted from 21 st July to 4 th August 2014 were enrolled in the study. Primary outcome was in hospital mortality, length of hospital stays (days) and secondary outcome was rate of transfer of inpatient to ICU or step down for higher care. Results: There was total 178 admissions form ED during the study period. Length of hospital stay increased with the increased duration spent in ED (p=0.004). The mortality group also had increased duration of stay in ED with mean duration of 23.23 hours. Increased duration of stay in ED after admission was also directly related to increased inpatient higher care transfers and thus prolonged hospital length of stay. Conclusions: Increased duration of stay in ED after admission was associated with increased hospital stay, increased mortality and increased inpatient transfer for higher care. Keywords: boarding time in emergency department,  ICU, outcome  of hospital admission, stay in emergency, persistent trophoblastic disease


The use of graphene electrodes with hydrogenated edges for solid‐state nanopore‐based DNA sequencing is proposed, and molecular dynamics simulations in conjunction with electronic transport calculations are performed to explore the potential merits of this idea. The results of the investigation show that, compared to the unhydrogenated system, edge‐hydrogenated graphene electrodes facilitate the temporary formation of H‐bonds with suitable atomic sites in the translocating DNA molecule. As a consequence, the average conductivity is drastically raised by about 3 orders of magnitude while exhibiting significantly reduced statistical variance. Furthermore, the effect of the distance between opposing electrodes is investigated and two regimes identified: for narrow electrode separation, the mere hindrance due to the presence of protruding hydrogen atoms in the nanopore is deemed more important, while for wider electrode separation, the formation of H‐bonds becomes the dominant effect. Based on these findings, it is concluded that hydrogenation of graphene electrode edges represents a promising approach to reduce the translocation speed of DNA through the nanopore and substantially improve the accuracy of the measurement process for whole‐genome sequencing.


This Paper studies the evolution of sectoral labour concentration in relation to the level of per capita income. We show that various measures of sectoral concentration follow a U-shaped pattern across a wide variety of data sources: countries first diversify, in the sense that labour is spread more equally across sectors, but there exists, relatively late in the development process, a point at which they start to specialize again. We introduce a model with endogenous costs of trading internationally that provides an explanation for this new empirical fact. The model highlights a trade-off between the benefits of diversification in the context of high trading costs, and the benefits of specialization in a Ricardian sense.


SUMMARY Two hundred and four Salmonella enterica serotype Typhi (S. Typhi) isolates were collected from seven Asian countries during 2002–2004. Multidrug-resistant S. Typhi (resistant to ⩾3 antibiotics) was detected in 84 (41·2%) isolates and 142 (69·6%) showed reduced susceptibility to ciprofloxacin (minimum inhibitory concentration=0·125–1·0 mg/l). This study highlights the worsening situation of antimicrobial resistance of S. Typhi in Asia.


Operation of wind turbine generator (WTG) systems in the above-rated region characterised by high wind turbulence intensities invariably induces fatigue stresses on the drive train components. This demands a trade-off between two performance metrics: maximisation of energy harvested from the wind and minimisation of the damage caused by mechanical fatigue. A learning adaptive controller in the form of a self-tuning regulator (STR) for output power levelling and decrementing fatigue loads is presented. The STR incorporates a hybrid controller of a linear quadratic Gaussian (LQG), neurocontroller and a linear parameter estimator (LPE). The main control objective is to regulate the relationship between rotational speed and wind speed by controlling the generator torque and further, the rotational speed. A pitch actuator ensures system operation geared toward maintaining output at rated power. A second-order model and a stochastic wind field model are used to systematically analyse the dynamical relationship between the WTG subsystems. The LQG is used as a basis upon which the performance of the proposed method in the trade-off studies is assessed. Simulation results indicate the proposed control scheme captures the performance and critical reliability loci thereby ensuring the wind turbine operates optimally in mechanically harmless conditions.


The commercialization of RNA‐based agricultural products requires robust ecological risk assessments. Ecological risk is operationally defined as a function of exposure and adverse effects. Information on the environmental fate of RNA‐ based plant‐incorporated protectants is essential to define routes and duration of exposure to potentially sensitive nontarget organisms. Providing these details in problem formulation helps focus the ecological risk assessment on the relevant species of concern. Postharvest plant residue is often considered to be the most significant route of exposure for genetically modified crops to adjacent aquatic environments. Previous studies have shown that DvSnf7 RNA from SmartStax PRO maize dissipates rapidly in both terrestrial and aquatic environments. Although these studies suggest that direct exposure to DvSnf7 RNA is likely to be low, little is known regarding the fate of DvSnf7 RNA produced in plants after entering an aquatic environment. This exposure scenario is relevant to detritivorous aquatic invertebrates that process conditioned maize tissues that enter aquatic environments. To assess potential exposure to shredders, dissipation of DvSnf7 RNA expressed maize tissue was evaluated following immersion in microcosms containing sediment and water. Concentrations of DvSnf7 RNA in the tissue were measured over a duration of 21 d. The DvSnf7 RNA dissipated rapidly from immersed maize tissue and was undetectable in the tissues after 3 d. Concentrations of DvSnf7 RNA found in tissue as well as calculated water column concentrations were below levels known to elicit effects in a highly sensitive surrogate species, supporting the conclusion of minimal risk to aquatic nontarget organisms. Environ Toxicol Chem 2020;39:1032–1040. © 2020 SETAC


This article studies the possibility of detecting dementia in an early stage, using nonrigid registration of MR brain scans in combination with dissimilarity-based pattern recognition techniques. Instead of focussing on the shape of a single brain structure, we take into account the shape differences within the entire brain. Imaging data was obtained from a longitudinal, population based study of the elderly. A set of 29 subjects was identified, who were asymptomatic at the time of scanning, but were diagnosed as having dementia within 0.7 to 5 years after the scan, and a set of 29 age and gender matched healthy controls were selected. Each subject was registered to all other subjects, using a nonrigid registration algorithm. Based on statistics of the deformation field in the brain, a dissimilarity measure was calculated between each pair of subjects, yielding a 58×58 dissimilarity matrix. A kNN classifier was trained on the dissimilarity matrix and the performance was tested in a leave-one-out experiment. A classification accuracy of 81% was attained (spec. 83%, sens. 79%). This demonstrates the potential of whole-brain intersubject dissimilarities to aid in early diagnosis of dementia.


This work is part of an ongoing research study towards an understanding of the complete metabolism of arsenosugars in mammalian organisms when ingesting seaweed, using the North Ronaldsay (NR) sheep as a model organism. We focus on the analysis of only those arsenic species bound to the lipids of the feed (Laminaria digitata), faeces and the tissues of the NR sheep using a novel enzymatic hydrolytic method that is simple and reliable. This rare breed of sheep, found in the remote Orkney Islands in the north of Scotland, live the entire year on the beaches and eat seaweed that is washed ashore (up to 3 kg daily).

Previous studies on arsenic fractionation in muscle, kidney and liver tissues revealed that most of the arsenic is concentrated in the fat fractions of these tissues (muscle fat: 61%; liver fat: 66%; kidney fat: 25%) rather than in the non-lipid fractions. Hence, this study was undertaken in order to determine the arsenic species bound to lipids in the muscle, kidney and faeces of NR sheep and to compare these with the arsenic species bound to the lipids of the L. digitata consumed.

The enzymatic hydrolytic procedure has been successfully employed for the first time to cleave the arsenic species cleanly from the rest of the lipid structure. This makes the arsenic species water soluble and enables their direct determination by high-performance liquid chromatography coupled with inductively coupled plasma mass spectrometry. Dimethylarsinic acid (DMA(V)) and monomethylarsonic acid (MA(V)) were found to be the major hydrolysed arsenic species bound to the kidney and muscle lipids, whereas arsenosugar-1 was found to be the major hydrolysed arsenic species in L. digitata lipids. On the other hand, DMA(V) was found to be the major arsenical obtained after the enzymatic hydrolysis of the faeces lipids. These results seem to suggest that both direct absorption and biotransformation of the absorbed organoarsenicals are the likely reasons for their occurrence and accumulation in the NR sheep tissues. Copyright © 2003 John Wiley & Sons, Ltd.


The understanding of genomic imprinting has made us realize that maternal and paternal contributions to the embryo are different. Disturbances during the imprinting process may lead to different pathologies due to an imbalance of gene expression either maternally or paternally derived. Known epigenetic diseases such as neonatal diabetes, growth retardation or overgrowth syndromes as well as cancer are better understood. It has become clear that environmental factors can be at the origin of such epigenetic changes. Careful analysis and diagnosis of epigenetic diseases are important for patient treatment and outcome.


The organisation of the actin cytoskeleton within eukaryotic cells is controlled by a large variety of actin-binding proteins (ABPs) with roles ranging from nucleation to bundling, severing and capping of actin filaments. The calponins and transgelins are a family of actin-binding/bundling proteins possessing one or more highly conserved motifs (i) calponin homology (CH) domain, and (ii) calponin-like repeat (CLR/ CLIK23 repeat), which have both been implicated in acting-binding. The Saccharomyces cerevisiae gene SCP1 encodes a protein, which shares a high degree of homology with SM22/transgelin. In this study Scp1p was purified and, using a range of biochemical techniques was shown to possess actin-bundling activity. Further analysis by EM revealed the formation of tight bundles of actin in the presence of Scp1p. Although a large number of protein containing CH domains have been shown to bind actin, the CH domain alone is not sufficient to bind actin. Using amino and carboxy terminal (N- and C-term) Scp1p truncated mutants it has been possible to localise the actin-binding domain (ABD) to the C-terminal region containing the CLR/CLIK23 repeat, and to show that the CH domain alone is not able to bind actin. In vivo studies into the localisation of Scp1p have revealed a co-localisation with actin to patches at the cell cortex. Other proteins found at these actin patches include the yeast fimbrin homologue Sac6p, another CH domain-containing protein involved in actin bundling. It has been shown that deletion of the SCP1 gene alone has no adverse affect on actin organisation, whereas a SAC6/SCP1 double knockout displays a more defective actin phenotype than the SAC6 single knockout. The importance of Scp1p in organising the actin cytoskeleton is clearly shown in cells overexpressing Scp1p, which possess a severely disrupted actin cytoskeleton, with the appearance of large clumpy actin patches. Taken together this study shows that Scp1p is an actin-bundling protein, which is involved with Sac6p in the organisation of the yeast cytoskeleton.


Border adjustments are currently discussed to limit the possible adverse impact of climate policies on competitiveness and carbon leakage. We discuss the main choices that will have to be made if the European Union implements such a system alongside with the EU ETS. Although more analysis is required on some issues, on others some design options seem clearly preferable to others. First, the import adjustment should be a requirement to surrender allowances rather than a tax. Second, the general rule to determine the amount of allowances per ton imported should be the product-specific benchmarks that the European Commission is currently elaborating for a different purpose (i.e. to determine the amount of free allowances). Third, this obligation should apply when the exported product is registered at the EU border, and not after the end of the year as is the case for domestic emitters. Fourth, the export adjustment should take the form of a rebate on the amount of allowances a domestic emitter has to surrender. Five, this rebate should equal the above-mentioned product-specific benchmarks, not the emissions of the particular exporting plant or firm. Finally, the adjustment does not have to apply to consumer products but mostly to basic products.


By means of SEM, TEM, UV-VIS optical transmission spectra and photoluminescence spectra tests, hetero-epitaxial defects and optical characteristics of SiCGe layers grown on 6H-SiC substrate were studied. SEM and TEM images have shown that the SiCGe were grown in layer-by-layer mode with APD and DPB defects which were caused by the thermal and lattice mismatches between SiCGe and SiC. Transmission spectra results have shown the calculated band gap of the SiCGe layer was 2.31eV. Room temperature photoluminescence spectra have shown that the peak wavelength and the FWHM of SiCGe layer were closely related to its Ge contents and the hetero-epitaxial defects.


A combination of tetralogy of Fallot( TOF) and total anomalous pulmonary venous return(TAPVR) is rare and results in chronic volume and pressure load of the right side of the heart and underfilling of the left heart. We report a successful 2-staged surgical correction of TOF associated with TAPVR and atrial septal defect. The patient was unsuitable for total primary intracardiac correction because the volume of the left ventricle was considered to be small. First, repair of anomalous pulmonary venous return and palliative right ventricle outflow tract reconstruction were simultaneously performed in 2 months of birth. One year after 1st operation, cardiac catheterization revealed that normalization of left ventricle volume, so 2nd operation was planned. Total correction of ventricular septal defect and right ventricle outflow reconstruction was performed and the patient was discharged on the 21st postoperative day with good hemodynamic status.


Introduction: Surgical safety is a public health concern worldwide. The attitudes and perceptions of the surgical team regarding to the safety of the patient are associated to the safety climate and the prevalence of adverse events. Objective: To evaluate the safety climate perceived by operating room nurses from several Hospitals. Method: This works presents a multicentre cross-sectional study. Data collection was obtained by means of The Safety Attitudes Questionnaire (SAQ), a self-completed questionnaire translated to the Spanish. A convenience sample with voluntary participation was selected. The safety climate was determined through six factors: Teamwork climate, Safety climate, Job satisfaction, Perception of the Unit and Hospital Management, Working conditions and Stress recognition. Results: safety climate perceived by surgical nurses shows mixed values in relation to patient safety. Perception of the management (p = 0.001)and Working condition domain (p = 0.003) are the domains worst valued. The size of the hospitals and Years of professional experience showed statistical differences in several domains. Conclusions: The variation of the safety climate perceived by nurses suggests that there are needs and opportunities for improvement in all its dimensions.


An important recent discovery in the membrane science is the polymeric nanofiber membrane. Membranes have many applications in protein purification, wastewater treatment and fuel cells. One of the versatile technique with the ability of producing cost-effective, highly porous non-woven membranes with large surface area is electrospining. In this study the effect of TiO2 nanoparticles in membrane performance has been investigated. A PES/TiO2 nanofibers membrane has higher flux and permeability than a pristine PES membrane. Also the measurments show that the surface area of the membrane will increase by addition of TiO2 nanoparticles. Moreover, the contact angle was investigated.


PURPOSE Despite being the only hospital to provide comprehensive cervical cancer treatment to many medically underserved Guatemalan women, no assessment of the cervical cancer patient population at the Guatemala Cancer Institute has been performed. To understand the demographics of the patient population, their treatment outcomes, and access to care, we sought to assess treatment compliance of patients with cervical cancer at the Guatemala Cancer Institute and its effects on patient outcomes. METHODS A retrospective chart review was conducted of patients with cervical cancer between 2005 and 2007 and assessed for follow-up through December 2015. Demographics and clinical characteristics were tabulated. A Kaplan-Meier curve to model compliance was generated. RESULTS Ninety-two patients with invasive cancer were analyzed. Most presented with squamous cell carcinoma (73%) and at locally advanced stages (IIB, 51%; IIIB, 33%). Most (75 of 92, 81.5%) initiated treatment after diagnosis, but 18.5% (17 of 92) were lost to follow-up before treatment initiation. For treatment, 97% received external beam radiation, 84% brachytherapy, and 4% concomitant chemotherapy. Nearly 20% of patients were lost to follow-up in the first 6 months and 65% in the first 5 years. Of the 67 patients who completed treatment, only 15 (16% of the initial cohort) were diagnosed with a recurrence. No deaths were recorded. CONCLUSION The low recurrence rate and no documented deaths suggest a correlation with the low compliance rate and poor follow-up. This finding highlights the need to examine more fully the barriers to compliance and access to care among this population to optimize the treatment of cervical cancer.


Biowaste compost is frequently used in German viticulture to improve soil physical characteristics and to replace soil organic matter losses. A monitoring program was carried out to investigate the effect of a mature biowaste compost application on soil biology and soil mineral N dynamics. At four vineyard sites in southern Germany, compost was applied at two different rates in a random block design with four replicates. Soil mineral N, soil microbial biomass and soil respiration were observed over a period of three years. At three of the four investigated sites, the compost application induced a priming effect, leading to mineral N contents of between 87 and 440 kg N ha−1 shortly after the amendment. During the investigation period, the pattern of N mineralization and translocation in all soils otherwise followed common rules which are governed by environmental conditions. Due to the priming effect, the N release from the compost was sufficient to cover the vine's N demand for the first and second year after application at three of the four vineyard sites. In the third year, a mineral N fertilizer application would have been required. High soil mineral N contents as a consequence of the priming effect may be exposed to leaching and denitrification.


A young adult man with neurofibromatosis type 1 (NF1) presented with a several-month history of an increasingly painful mass in the posteroinferior region of the right thigh. Imaging studies (Figure) showed a relatively well-circumscribed mass, 15 cm in length and 7 cm in diameter, arising on a background of very extensive involvement of the peripheral nervous system by plexiform neurofibromas. A biopsy specimen of the mass showed a high-grade (World Health Organization grade IV) malignant peripheral nerve sheath tumor (MPNST). An above-knee amputation was subsequently performed and the MPNST (Figure, inset A) was found to arise in continuity with one of the many preexisting low-grade (World Health Organization grade I) plexiform neurofibromas (Figure, inset B shows an example of such in the leg). For approximately 3.5 years following surgery and radiotherapy, there was no evidence of local tumor recurrence. The patient then was seen with a large left-sided retroperitoneal mass that was histopathologically confirmed to also be an MPNST, possibly a metastasis from the original thigh tumor but more likely a de novo primary tumor. He subsequently underwent several major debulking surgeries, radiotherapy, and rounds of chemotherapy, including palliative doxorubicin, for increasingly disseminated metastatic disease. He died approximately 7 years after his initial presentation.


The author first introduces the typical back-propagation ANN's model and the reasons why we used it in this paper. And then, the author states the random fuzzy theory and gives some useful definition and theorem that were used in the next part. In the last part of this paper, the author gives the new structure and the process of BP model on the random fuzzy theory, which is widely used nowadays.


Traffic streams, sources as well as aggregated traffic flows, often exhibit long-range-dependent (LRD) properties. This paper presents the theoretical foundations to justify that the behavior of traffic in a high-speed computer network can be modeled from a self-similar perspective by limiting its scope of analysis to the network layer, since the most relevant properties of self-similar processes are consistent for use in the formulation of traffic models when performing this specific task.


In this letter we develop a new concept, the negative alpha filter, which we suggest has application for quantitative estimation of surface parameters beneath vegetation using polarimetric synthetic aperture radar (SAR) interferometry (POLInSAR). We first derive the filter and then validate it using simulations of L-band coherent forest scattering. We then show initial results of applying the filter to airborne data from the German Aerospace Center's E-SAR L-band sensor.


Background Neurenteric cysts are the association of an endodermal cyst with a vertebral dysplasia. This congenital malformation can be asymptomatic or manifest itself through respiratory signs due to airway compression. Case report A male newborn, from normal vaginal delivery at 40 weeks of gestation, weighing 4000 g with Apgar score of 8 and 9 at 1 and 5 min was referred to the neonate intensive care unit. The clinical findings showed tachypnea, mild intercostals retraction and there was diminished air-entry on the right side. The chest X-ray showed vertebral anomalies in the midthoracic region, there was an hydric opacity occupying the 2:3 of the right side with deviation of the mediastinum to the left side. The CT scan of the chest revealed butterfly and hemi-vertebrae of the upper thorax. There was a large posterior mediastinal cystic mass partitioned by multiple septa on the inferior right side. On fifth day, the patient underwent a right thoracotomy. A large cystic mass attached to the oesophagus wall was exised, Histopathology favours the diagnosis of neurenteric cyst. Postoperatively outcomes were poor, the operation was complicated by bilateral chylothorax diagnosed on 10 th post-operative day and increasing oxygen needs. The newborn died on the 16 th postoperative day in a severe sepsis. Conlusion Antenatal diagnosis of this malformation is not easy but possible. In post-natal, the radiological approach based on chest x-ray and CT scan, is helpful for establishing the diagnosis and lead to a prompt curative surgery.


Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory illness characterized by polyarthritis of small and large joints which in the course of time may progress to disability. Material and methods: In our prospective study were included 951 patients (females 730, and males 221 respectively) with an average age 51.3 year old, diagnosed with RA in accordance with ACR-EULAR/2010 criteria. The purpose of the paper is to investigate gender, age, group age by gender, level of education, residing place, nationality, religion, social condition, marital status, and vocation in our patients. Statistical processing has been carried out with program SPSS 20.0, SigmaStat 2.03, SigmaPlot 2000, MedCalc and Excel 2010. Most present group age was 40 – 49 year old with difference in distribution based on gender. Results: The largest number of them had completed secondary education, most of them originated from rural areas, were farmers by vocation and housewives. The database created by this survey can serve for building the RA patients' national registry. This registry can serve for further researches and planning the management of RA as a systemic rheumatic disease that has an immense social, economic and health impact. Largest portion of RA patients were farmers and housewives respectively (38% and 32.2% respectively). Vocations such as: retail sellers, workers in administration, education, factory, maintenance, and artisan workers had similar incidence in both genders that ranged from 9.7% to 6.2%, whereas these vocations among males ranged from 11.3% to 2.7%.


Abstract Beta-defensin 126 (DEFB126) coats the entire surface of macaque sperm until sperm become capacitated, and the removal of DEFB126 from over the head of sperm is required for sperm-zona recognition. Viable sperm collected from cervix and the uterine lumen of mated female macaques had DEFB126 coating the entire surface, suggesting that DEFB126 is retained on sperm en route to the oviduct. DEFB126 plays a major role in attachment of sperm to oviductal epithelial cells (OECs). Following treatment to either remove or alter DEFB126, sperm were coincubated with explants of OECs, which were assessed for sperm binding following rinsing to remove superficially attached sperm. Sperm treated with either 1 mM caffeine + 1 mM dibutyryl cyclic adenosine monophosphate (dbcAMP) (induces capacitation and complete release of DEFB126 from sperm), 2 mM caffeine (removes DEFB126 from over the head and midpiece but does not induce capacitation), anti-DEFB126 immunoglobulin, or neuraminidase (cleaves sialic acid from terminal positions on glycosylation sites of DEFB126) resulted in similar and significant levels of inhibition of sperm-OEC binding. Preincubation of OECs with soluble DEFB126 also resulted in significantly reduced sperm-OEC binding. Furthermore, reduced OEC binding capability of sperm lacking DEFB126 could be restored by addition of soluble DEFB126 to the sperm surface prior to incubation with OECs. Finally, purified DEFB126, infused into oviducts in situ, associated primarily with the apical membranes of secretory-type epithelial cells. In summary, treatments of macaque sperm that result in either removal, masking, or alteration of DEFB126 result in loss of sperm-OEC binding that is independent of changes in sperm motility. DEFB126 may be directly involved in the formation of a reservoir of sperm in the oviduct of macaques.


A growing population world might exceed its food supply in the future. Food availability needs an increasing agricultural productivity and production through technology and innovation. European concerns about innovation policies reflected on the Lisbon Agenda include the European program PROPRURAL+ for the Portuguese Azores Islands. The agricultural innovation in the Azores started with the Green Revolution, which increased agricultural production, using seeds, fertilizers, chemical products and agricultural equipment. But much more innovation is needed for the Azores to became a well-sustained and competitive European region in this economic sector. For example, concerning milk, the region is responsible for more than 30% of the national production. But, since the liberalization in EU imposed by the global markets, a crisis in the sector is installed. Dairy producers are now facing many difficulties in trying to enhance the profitability of their farms, by reducing costs and improving efficiency. A characterization of the Azorean agriculture, emphasizing the milk production sector is presented. The specificities and the potential of the region are discussed and some agricultural innovations with IoT technologies are pointed out.


The Galerkin method is used to derive a realistic model of plane Couette flow in terms of partial differential equations governing the space-time dependence of the amplitude of a few cross-stream modes. Numerical simulations show that it reproduces the globally sub-critical behavior typical of this flow. In particular, the statistics of turbulent transients at decay from turbulent to laminar flow displays striking similarities with experimental findings.


Article Information This study was designed to examine the mediating role of meta-cognitions in the relationship between perceived expressed emotions and hallucination proneness in a non-clinical sample. The study sample (n = 432 university students) was selected through a stratified cluster sampling procedure and measures of perceived expressed emotions, metacognitive beliefs and hallucination proneness were administered. Two dimensions of expressed emotion, perceived irritability and perceived intrusion, and two metacognitive beliefs, beliefs about uncontrollability and danger and beliefs about cognitive confidence were found to be associated with hallucination proneness. However, only negative beliefs about uncontrollability of thoughts mediated the relationship between perceived intrusiveness and hallucination proneness. Findings imply the experience of real or perceived parental intrusiveness may activate negative beliefs about thoughts concerning uncontrollability and danger, which in turn, leads to hallucinatory experiences as a coping strategy and contributes to the persistence of real or perceived career intrusiveness.


Background: Anal stenosis results from loss of anoderm with subsequent fibrosis and scarring of underlying tissue. The condition represents a technical challenge in terms of surgical management. It is a serious complication of anorectal surgery, most commonly seen after surgical haemorrhoidectomy. However, stenosis can also occur after perianal circumferential burn due to application of herbal medicine by village doctors.
Objective: This study was conducted to see the outcome of diamond-flap anoplasty for the treatment of moderate to severe anal stenosis.
Patients and interventions: Unilateral diamond flaps anoplasty was performed for moderate to severe anal stenosis. Final anal calibre of 25 to 26 mm was targeted. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis severity, postoperative complications and the time of return to work were recorded.
Results: From July 2012 to January 2017, 18 patients (12 males, 67% and 6 female patients, 33%) with a mean age of 34 years (range, 25-52) were treated. 15 of the patients had a history of previous haemorrhoidectomy and 3 had circumferential perianal chemical burn due to application of herbal medicine by village doctors. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5-15), 25 ± 0.75 mm (range, 24- 26), and 25 ± 1 mm (range, 23-27). The clinical success rate was 98.9%. No severe postoperative complications were observed.
Conclusion: Diamond-flap anoplasty is a highly successful method for the treatment of anal stenosis caused by previous haemorrhoidectomy and perianal circumferential chemical burn by herbal medicine.
J Shaheed Suhrawardy Med Coll 2020; 12(2): 67-71


In the beginning …
Once upon a time …
This is the story of …
That's a good story ….
And they all lived ….
Let me tell you a story ….
Narrative, it seems, is all around us. Bruner (2002) states that we are
'constantly in the process of making narratives' (p.3) and that narrative is so
much part and parcel of life that 'human society cannot run without it'. In
everyday life we recount stories about ourselves and others and in so doing
both represent and construct ourselves. We are the heroes and heroines of our
own stories and occasionally of the stories of others. Our experience, lives and
Selves are storied. In academia narrative has also found a place not only in the
humanities but also the social sciences and even the natural sciences. It would
seem there is no escape from participation in the narrative enterprise - it is a
way of experiencing, relating, thinking and, ultimately, being in the world.
Narrative, as Barthes (1977) said, 'is simply there, like life itself' (p.79).
To be sure, the development of narrative as a theory and method has
brought (or constructed) insights into all manner of things. Narrative, emerging
as it did from an interest in the experience of powerlessness (MacKinnon,
1996), was seen as a means of giving voice to those previously at the margins
and has effectively, and prolifically, expanded our understanding of what it is
like to be marginalised, oppressed, victimised, ignored and silenced. But even
as this is so, it is my contention, contra Barthes, that narrative and the process
of narration (narrativity) as we currently conceive and operationalise it
excludes certain individuals and groups of people, creating people without
narrative. These people are those I shall call the 'narratively dispossessed'. In
the first part of this paper I will seek to outline what I mean by this and work
towards a tentative definition. In the latter part I will attempt to suggest some
ways in which we might try to think about narrative/narrativity somewhat
differently so as to narratively 're-possess' these individuals and groups.


A central theme in internet history since the 1990s is the rise of algorithmic power, enabled through the self-restraint of human governments. Digital platforms were born weak and clumsy. Governments could have stamped them out to enforce traditional territorial boundaries and regulatory categories. They chose not to. Once the digital tornado was unleashed, however, its path was not easily directed. Fledgling innovators in need of protection developed into dominant platforms that transformed many aspects of the world for the better, but also created serious harms through pervasive data collection and automated decision-making. The threats arose from the very attributes that made these digital systems so appealing.

The cycle is now repeating itself. Another broad-based technological shift is empowering market entrants that promise huge gains in both efficiency and freedom. And once again, the deeper challenge is how to regulate their own penchant for algorithmic overreach.

Blockchain and cryptocurrency technologies are today's digital tornado. Like the internet, they are stimulating dramatic levels of investment, startup activity, and media attention, as well as creating massive disruption of industries and passionate visions of societal transformation. As with the internet, this excitement often gets ahead of reality. The internet economy recovered from the dotcom crash of the early 2000s to realize its potential through the growth of social media, cloud computing, and mobile connectivity. The crypto economy seems likely to experience a similar trajectory over time. To succeed at scale, however, blockchain-based networks and services will need address the problem of governance. Immutability, the mechanism that allows these systems to generate trust without central authorities, also creates inherent weaknesses that sometimes turn into catastrophic failures.


The aims of this study were to screen and characterize lactic acid bacteria (LAB) isolated from gastrointestinal (GI) tract of Cemani chicken, one of Indonesian local chicken and to investigate their potential use as probiotics. LAB were isolated from GI tract using MRSA and GYPA media and incubated anaerobically. Selected LAB were determined their probiotic properties with several assays. Identification of selected LAB was based on 16S rDNA sequences, morphological and biochemical characteristics. Ninety five bacteria were isolated and characterized as lactic acid bacteria (Gram positive, catalase negative, non sporeforming and acid producing). Twenty four isolates of LAB demonstrated antimicrobial activity against Escherichia coli JCM 1649 and Salmonella enteritidis B2586, and three selected isolates, i.e. CCM011, CSP004, and CVM002 showed the highest inhibition activity. The isolates had characters of high cell surface hydrophobicity and inter-isolate coaggregation ability of LAB, high survival at low pH, high phytase and protease activity (but no amylase and lipase activity), weak coaggregation with pathogen and no resistance to the examined antibiotics. The isolates were identified based on sequence analysis of 16S rRNA gene as Lactobacillus salivarius, however, each isolate had different profiles of sugar fermentation. Therefore the three LAB isolates had potential application as probiotics for chicken.


Cosmic rays (CRs) have critical impacts in the multiphase interstellar medium (ISM), driving dynamical motions in low-density plasma and modifying the ionization state, temperature, and chemical composition of higher-density atomic and molecular gas. We present a study of CR propagation in inhomogeneously ionized plasma, addressing CR transport issues that arise in the cloudy ISM. Using one-dimensional magnetohydrodynamic (MHD) particle-in-cell simulations that include ion–neutral drag to damp Alfvén waves in a portion of the simulation domain, we self-consistently evolve the kinetic physics of CRs and background gas MHD. By introducing a damping region in our periodic domain, our simulations break translational symmetry and allow the emergence of spatial gradients in the CR distribution function. A spatial gradient opposite to the CR flux forms across the fully ionized region as a result of pitch angle scattering. We connect our results with CR hydrodynamics formulations by computing the wave–particle scattering rates as predicted by quasilinear, fluid, and Fokker–Planck theory. For momenta where the mean free path is short relative to the box size, we find excellent agreement among all scattering rates. However, we also find evidence of a reduced scattering rate for less energetic particles that are subject to the μ = 0 barrier in our simulations. Our work provides a first-principles verification of CR hydrodynamics when particles stream down their pressure gradient and opens a pathway toward comprehensive calibrations of transport coefficients from self-generated Alfvén wave scattering with CRs.


Solar fuel production utilizing carbon dioxide through the process of photocatalysis is an attractive method to sustainably generate energy carriers. Research into photocatalytic CO2 reduction has however been challenged by low conversion. To enable progress, this thesis works through the challenges of benchmarking, to address experimental conditions and results reporting. Starting with a literature survey to identify parameters affecting photoreduction, and assess key terms reported, crucial challenges are isolated. These challenges are limited benchmarking, experimental standardization, and the dual term challenge. Terms are proposed to address critical limitations in data interpretation, and a list is proposed for benchmark-necessary reporting. Two sets of identical experimental condition tests were conducted focusing on gas phase experiments conducted with titanium dioxide-based photocatalysts, with commercially available catalysts, including an anatase TiO2, P25, and Mirkat 211, and modified samples, including doping, structure order, and calcination. To investigate metrics comparisons Mirkat 211 and Au doped TiO2 are explored further for interaction effects and regime identification with the results analyzed three ways: through unitary product formation, photonic yield, and an extended rate normalization. Benchmarking of the Mirkat 211, through single variable experiments, and Au doped TiO2, through a design of experiments, is assessed as compared to the existing literature. In conclusion, the importance of greater context of regimes is emphasized, identification of the importance of the reaction length, irradiance, and catalyst loading experimental variables is ranked, the catalytic versus photonic quantification compared, and recommendations for improving the experimental set up and necessary experimental reporting for photocatalysis are given.


In this workshop, participants will build two styles of models. One style of model is built from sticks, and vinyl tubing. This first model will determine lengths of struts and lines, and will also be extensively labeled to help in building finished tensegrity models. A second style of model will be built from PVC pipe, PVC sleeves, and bungee cord. Additional printed information will be provided to help build the finished tensegrity models. Building physical models [1], [2], [3], and writing about the building process, continues to be my focus. Most recently, I have chosen to build tensegrity models, and to provide clear instructions to help build them from PVC pipes, PVC sleeves, and bungee cords. I have constructed preliminary models from sticks and vinyl tubing, and labeled them extensively in order to assist in the building of the final PVC models. The final models take a considerable amount of time and resources to build. It has been important that the models be durable so they can be handled by students through a number of years, and be of a reasonable size so that they can be seen by 20-30 students in a classroom. Each tensegrity model has an interesting set of spatial properties and is engaging as a physical object.


On-site sanitation facilities, mostly pit latrines are the main points of human excreta disposal in peri-urban low-income settlements in Kenya. Collection, treatment and final disposal of pit latrine faecal sludge, pose a significant management problem and present public health risks. The choice of appropriate faecal sludge treatment technology depends on precise region based data on the sludge characteristics that are often unavailable. The study analysed physiochemical characteristics of faecal sludge sampled at different depths of pit latrines. Twenty-four samples were collected from six pit latrines along the depth strata at 1-m intervals from the surface to 3 m depth. Samples were analysed for chemical oxygen demand (COD), biochemical oxygen demand (BOD), ammonia, total nitrogen and total phosphorus. The mean COD: BOD ratio was 1:5 with a concentration of 112800 and 24600 mg/L, respectively. Concentrations for all parameters were variable and higher in comparison with properties reported in literature. Upper layers had higher concentrations than lower depths. The concentrations of the sludge were 10-100 higher than acceptable limits for in-fluent sludge into municipal wastewater treatment plants. These results show that disposal of pit latrine faecal sludge into the wastewater treatment plants without co-treatment overload the system since treatment plants in use currently have not been designed to handle pit latrine sludge. The properties of faecal sludge analysed indicate that the wastewater treatment plants may not be capable of treating faecal sludge unless co treatment mechanisms are applied. Therefore, influent faecal sludge must be maintained within allowable concentrations; otherwise, the effluents may lead to significant environmental pollution impacts.

 Key words: On-site sanitation, depth strata, faecal sludge disposal, low-income settlements.


Thymomas comprise a group of rare epithelial neoplasms of the anterior mediastinum. Whereas localized disease carries a favorable prognosis, the majority of patients with metastatic thymomas experience progression or recurrence over a 10-year period. Although targeted therapies have become standard of care in many malignancies, no clinically actionable mutations have consistently been identified in metastatic thymomas. Here, we describe a patient with an aggressive thymoma complicated by extensive pleural metastases. Over a 16-year period, she progressed on multiple treatment regimens. To identify additional treatment options, tissue from a pleural metastasis was sent for next-generation sequencing, revealing mutations in BRCA2, tyrosine kinase 2, and SET domain containing 2. Based on supporting evidence for poly (ADP-ribose) polymerase (PARP) inhibition in other BRCA-mutated tumors, the patient was started on the PARP inhibitor olaparib. She derived significant clinical benefit from treatment, with imaging showing overall stabilization of her disease. Here, we review the genotyping results of her tumor and discuss the functional and clinical significance of the mutations in her cancer as well as implications for managing patients with advanced BRCA-mutant thymomas. KEY POINTS: Targeted therapy has yet to enter the standard clinical management of metastatic thymomas.Patients with BRCA2-mutant thymomas may benefit from poly (ADP-ribose) polymerase inhibition.


CONTEXT
The extent of concordance between meta-analyses and large trials on the same topic has been investigated with different protocols. Inconsistent conclusions created confusion regarding the validity of these major tools of clinical evidence.

OBJECTIVE
To evaluate protocols comparing meta-analyses and large trials in order to understand if and why they disagree on the concordance of these 2 clinical research methods.

DESIGN
Systematic comparison of protocol designs, study selection, definitions of agreement, analysis methods, and reported discrepancies between large trials and meta-analyses.

RESULTS
More discrepancies were claimed when large trials were selected from influential journals (which may prefer trials disagreeing with prior evidence) than from already performed meta-analyses (which may target homogeneous trials) and when both primary and secondary (rather than only primary) end points were considered. Depending on how agreement was defined, kappa coefficients varied from 0.22 (low agreement) to 0.72 (excellent agreement). The correlation of treatment effects between large trials and meta-analyses varied from -0.12 to 0.76, but was more similar (0.50-0.76) when only primary end points were considered. When both the magnitude and uncertainty of treatment effects were considered, large trials disagreed with meta-analyses 10% to 23% of the time. Discrepancies were attributed to different disease risks, variable protocols, quality, and publication bias.

CONCLUSIONS
Comparisons of large trials with meta-analyses may reach different conclusions depending on how trials and meta-analyses are selected and how end points and agreement are defined. Scrutiny of these 2 major research methods can enhance our appreciation of both for guiding medical practice.


The design and implementation of a high isolation buffer amplifier is described. The IC uses a 2-gain stage topology with variable maximum output power up to 22 dBm, this being determined by the use of an external bias resistor. It has better than 40 dB of input-output port isolation and operates from 0.5 GHz to 6 GHz. The IC is fabricated on Agilent Technologies' proprietary enhancement-mode GaAs PHEMTs (pseudomorphic high-electron-mobility transistors) process. The enhancement-mode characteristic enables operation with a single supply voltage with high linearity and low noise. With a single 5 V supply, typical gain is 21dB with 40 mA quiescent current consumption. Total die size is 500 /spl mu/m /spl times/ 700 /spl mu/m. The IC is packaged in an 8-lead low-profile 2 mm /spl times/ 2 mm plastic package and features input and output matched ports to 50 ohms impedance. Input and output impedance matching can be further optimized for different frequency bands by the use of a single input inductor and a load inductor at the power supply. Typical uses of the part are for isolating VCO (voltage controlled oscillator) outputs and mixer local oscillator inputs as well as a buffer amplifier for driving passive mixers.


Nikolay Kondratieff is known primarily for his theory of long cycles. However, it is worth recalling that he was among the first who started to investigate the nature of different economic cycles and their systematic interaction. Actually the primary classification of cycles into short, medium and long belongs to Kondratieff. In 1922, in his book The World Economy and its Conjunctures during and after the War Nikolay Kondratieff formulated for the first time the basic tenets of the theory of long cycles (Kondratieff 1922 [2002]). As until that time the economic literature hardly knew any other cycles than the ones with a characteristic period between 7 and 11 years (which were called industrial, commercial, and so on), Kondratieff quite logically called them 'short cycles' (Ibid.: 323). However, already in 1925, in the Long Cycles of Conjuncture (Kondratieff 1925 [1993]: 25–26), he began to call the same cycles as 'medium cycles'. Why? The fact is that in those years Kitchin (1923) discovered some cycles (with a characteristic period between 3 and 4 years) manifested in fluctuations in inventories that could be denoted as truly 'short cycles'. Later, they became known as 'Kitchin cycles'. Due to the fact that the medium-term cycles often have internal ups and downs, a group of scientists in the Harvard School headed by Wesley Mitchell started to consider cycles statistically (not by their logic, but by the presence of recessions, from a recession to another recession, regardless of the point that different recessions may be significantly different as regards their strength and nature). As a result, they also detected some cycles with a period between 3 and 4 years (which to a certain extent coincided with Kitchin cycles).