This thesis concerns the role of middle managers in strategic change in the NHS. It addresses a research gap identified by Dopson and Stewart (1990) who called for more empirical studies of the role of middle managers in specific contexts and highlighted the public sector as being of particular interest. It reports qualitative research carried out across 5 successive case studies in the NHS.

The contextual backdrop to the study is one of competing tensions around the role of the middle manager, both generally in organisations and specifically in NHS trusts. On the one hand, it is argued that the role of the middle manager is one of diminishing importance. On the other, it is argued that the role of middle managers is one that should be enhanced. Both sets of commentaries tend towards the speculative and lack an empirical foundation. In the NHS such tensions are reflected in government policy. An enhanced middle manager role is encouraged through the development of a general management ethos. Simultaneously there have been attacks upon middle managers from the Minister for Health in the past Conservative Government and the present Labour Government.

Theoretically, a typology of involvement of middle managers upon strategic change developed by Floyd and Wooldridge (1992, 1994, 1997) is brought to bear as a conceptual lens with which to view the role of middle managers in strategic change in the NHS. Using this typology the role of middle managers is found mainly to be with the implementation of strategic change, rather than other roles, such as 'synthesising information', 'facilitating adaptability' or 'championing alternatives', although there are some illustrations of a role for middle managers beyond implementation of strategy.

Despite their main role remaining within the implementation of deliberate strategy, the case studies illustrate that there is a possibility for an enhanced middle manager role in strategic change within this. However, Floyd and Wooldridge's typology does not sufficiently distinguish between the differing influence that middle managers may enjoy within the implementation of deliberate strategy. Therefore, one suggestion is that further constructs for the influence of middle managers upon strategic change be developed.

It is also noted that middle managers operate under significant constraints that impact upon the possibility of taking up an enhanced role, within the implementation of deliberate strategy and in roles outside this. Principal amongst these constraints is the presence of significant medical group power and the influence of central government intervention. Therefore, middle managers' influence may be limited, on the one hand, to that which converges with the strategy set out by executive management that in turn has been driven by government prescription. On the other, it is likely to be limited mainly to that of the administrative domain rather than the medical domain or where influence is exerted upon the medical domain to changes with which the medical group is agreeable.

The empirical findings also illustrate that any enhanced role for middle managers, within the constraints of government policy and medical group power, may require the presence of certain conditions. Firstly, where strategic change allows for emergence as well as deliberateness, then middle manager may exert more influence upon strategic change. Secondly, they may exert more influence upon strategic change, where it is not solely conceived in top-down rational planning terms, but where is combined with a political element of strategic change. As a result the formulation and implementation of strategic change are likely to be intertwined rather than separate and sequential. This may allow for more involvement of middle managers in the strategic change process. Finally, in order that middle managers can take up the potential for an enhanced role under these conditions, there may need to be some investment in organisation and management development and organisational structures that facilitate boundary-spanning opportunities for middle managers.

NB. This ethesis has been created by scanning the typescript original and may contain inaccuracies. In case of difficulty, please refer to the original text.


chapter Abstract The electrocaloric effect describes a reversible temperature change in dielectric materials submitted to an applied electric field. Adiabatic polarization raises their temperature, and adiabatic depolarization lowers it, analogous to temperature changes that occur when a gas is compressed or expanded. For refrigerator application, the reverse Brayton cycle is currently the most promising for practical implementation. The electrocaloric effect provides a large material efficiency. However, existing refrigerator prototypes lack from the absence of efficient heat switches for thermal linkage to the load and the heat sink. Cooling power densities of a few W/cm 2 and temperature spans in the order of 20 K (in regeneration systems) are achievable at a cycle time of 100 ms.


For decades, corporate social responsibility (CSR) has been an area at the heart of business research. The aspects of CSR that researchers have been focusing on have grown exponentially. Most research efforts have dwelled on its positive effects, including good behavioural changes, promising financial performance, social investment and development, and environmental preservation and protection. On the other hand, several scholars have questioned the credibility of CSR and its link to unethical financial conduct, particularly earnings management. This review paper uses a systematic literature review to conduct bibliometric analysis, content analysis, and thematic analysis in order to identify trends and outcomes of CSR reporting and earnings management research. The literature review search is guided by PRISMA and analyses 152 Scopus-indexed articles between 2005 and 2021. As a result, this paper reveals the most influential authors and articles, leading journals and countries, and research cluster networks. This review also outlines the theoretical perspectives and future direction of CSR and earnings management research. In addition, this review paper provides critical and beneficial insights for stakeholders and researchers.


Introduction: Type 2 diabetes is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency and hyperglycemia. The prevalence of type 2 diabetes was studied in different blood types and the risk diet factors among the different blood types determined. Objective: To determine the prevalence of type 2 diabetes in the different blood types (A, AB, B and O). Method: A total sample size of 302 was randomly selected from two Kenyan populations. Their fasting blood glucose level and two hour post-glucose load blood glucose were determined and recorded under blood types. The participants also made a 24hour recall of their diet intake from which the protein, milk, PUFA, carbohydrate and meat intake estimates were correlated to fasting glucose level. Results: There were more diabetic cases in blood type B among the Luo community (3.1% of N=32) followed by blood type A among the Kalenjins (2.0% of N=50) and then blood type O in both communities (Luo, 1.3% of N=77 and Kalenjin, 1.6% of N=64). There was a positive correlation between fat intake and diabetes in blood type B (r=0.588, p= 0.000) using the fasting plasma glucose level. There was a significant positive correlation in the amount of fish intake and diabetes in blood type AB (r=0.841, p=0.036). There was a significant positive correlation between meat intake and elevated fasting blood sugar level in blood type B(r=0.424, p= 0.016). Conclusion: Blood types A and O are at a higher risk of being diabetic due to the high cases of impaired glucose metabolism. People with blood type B are at a higher risk of developing diabetes type 2 if they consumed a lot of meat and fat. It is recommended therefore that they should manage their diet intake very closely to avoid foods that predispose them to elevated blood sugar levels. Corresponding Author: Kiplamai Festus, 1Kenyatta UniversityKenya: P. O Box 43844-00100 Nairobi: Tel: +254722310973 Email: firstname.lastname@example.com


The usage of muonic x-rays to study elemental properties like nuclear radii ranges back to the seventies. This triggered the pioneering work at the Paul Scherrer Institute (PSI), during the eighties on the Muon-induced x-ray emission (MIXE) technique for a non-destructive assessment of elemental compositions. In recent years, this method has seen a rebirth, improvement, and adoption at most muon facilities around the world. Hereby, the PSI offers unique capabilities with its high-rate continuous muon beam at the Swiss Muon Source (SμS). We report here the decision-making, construction, and commissioning of a dedicated MIXE spectrometer at PSI, the GermanIum Array for Non-destructive Testing (GIANT) setup. Multiple campaigns highlighted the outstanding capabilities of MIXE at PSI, e.g., resolving down to 1 at. % elemental concentrations with as little as 1 h data taking, measuring isotopic ratios for elements from iron to lead, and characterizing gamma rays induced by muon nuclear capture. On-target beam spots were characterized with a dedicated charged particle tracker to be symmetric to 5% with an average σ = 22.80(25) and 14.41(8) mm for 25 and 45 MeV/ c, respectively. Advanced analysis of the high-purity germanium signals further allows us to improve energy and timing resolutions to ∼1 keV and 20 ns at 1 MeV, respectively. Within the GIANT setup, an average detector has a photopeak efficiency of [Formula: see text]% and an energy resolution of [Formula: see text] at E = 1000 keV. The overall performance of the GIANT setup at SμS allowed us to start a rich user program with archaeological samples, Li-ion battery research, and collaboration with the industry. Future improvements will include a simulation-based analysis and a higher degree of automation, e.g., automatic scans of a series of muon momenta and automatic sample changing.


The Borrowdale Volcanic Group of northern England hosts Late Ordovician arthropod trackways that are frequently cited as the earliest unequivocal evidence for animal life on land, and provides a key geological locality for our understanding of myriapod evolution and terrestrialization. Original fieldwork at the site has identified four additional bedding surfaces that yield 121 new trackways (of a total 158 known individuals), permitting better sedimentological and paleoecological contextualization of the trackways. Contrary to published claims, none of the trackways occur in sandstones but are invariably preserved on dacitic tuff bedding planes. Trackway morphology comprises either short straight segments with discernable footprint impressions (Diplichnites), long looping traces suggesting dragging and footprint amalgamation (Diplopodichnus), or transitional forms. Morphometric comparison of the Diplopodichnus with fossil and recent mortichnia (death traces) suggests they record immediate pre-mortem locomotion of dying myriapods, and modern analogue reveals mechanisms by which abundant volcanic ash would have elevated arthropod mortality rates. Sedimentary structures including wave ripples, bedding sags and detached large- scale ball-and-pillow structures, show that the tuffs were deposited subaqueously. One instance where trackways intermittently traverse 3-5 cm tracts of subaerially-exposed wave-ripple crestlines attests that the tracemakers were capable of surviving out of water over limited distances. The low diversity ichnofauna has greater similarity with other Cambrian and Ordovician sites, recording semi-subaqueous pioneer tracemakers, than it does with the earliest fully-terrestrial ichnofaunas from the Silurian and Devonian.


Stress-activated protein kinase/c-Jun kinase (SAPK/JNK) is thought to be necessary for preimplantation embryonic development (Maekawa et al., 2005). However, media increases SAPK/JNK phosphorylation and these levels negatively correlate with embryonic development (Wang et al., 2005). Culture-induced stress could confuse analysis of the role of SAPK in development. In this study, we tested how SAPK/JNK inhibitors influence embryonic development in optimal and non-optimal media and define the contribution of cell survival and proliferation to the embryonic response to these media. SAPK/JNK inhibitors retard embryonic development in suboptimal Ham's F10, but improve development in optimal potassium (K+) simplex optimized media (KSOM) +AA. In KSOM + amino acids (KSOM+AA), two SAPK/JNK inhibitors increase the rate of cavitation and hatching. These data suggest that (i) SAPK/JNK mediates the response to culture stress, not normal preimplantation embryonic development and (ii) SAPK/JNK inhibitors may be useful in ameliorating embryo stress caused by culture. To define the effects of media, we assayed the contribution of cell survival and proliferation and the differences in total cell number of cultured embryos. Embryos cultured from E3.5+24 h in the suboptimal medium (Ham's F10) induced significant but small increases in TdT (terminal deoxynucleotidyl transferase)-mediated dUDP nick-end labelling (TUNEL) positive cells. Bromodeoxyuridine (BrdU) incorporation in suboptimal Ham's F10 was significantly lower than in optimal KSOM+AA, suggesting that cell cycle arrest also contributes to slower increase in cell number in stressful media. This is the first report where TUNEL and BrdU were both assayed to define the relative contribution of cell cycle/S phase commitment and apoptosis to lessened cell number increase during embryo culture.


BACKGROUND
Endovascular repair of abdominal aortic aneurysm was originally developed for patients who were considered to be physically ineligible for open surgical repair. Data are lacking on the question of whether endovascular repair reduces the rate of death among these patients.

METHODS
From 1999 through 2004 at 33 hospitals in the United Kingdom, we randomly assigned 404 patients with large abdominal aortic aneurysms (> or = 5.5 cm in diameter) who were considered to be physically ineligible for open repair to undergo either endovascular repair or no repair; 197 patients were assigned to undergo endovascular repair, and 207 were assigned to have no intervention. Patients were followed for rates of death, graft-related complications and reinterventions, and costs until the end of 2009. Cox regression was used to compare outcomes in the two groups.

RESULTS
The 30-day operative mortality was 7.3% in the endovascular-repair group. The overall rate of aneurysm rupture in the no-intervention group was 12.4 (95% confidence interval [CI], 9.6 to 16.2) per 100 person-years. Aneurysm-related mortality was lower in the endovascular-repair group (adjusted hazard ratio, 0.53; 95% CI, 0.32 to 0.89; P=0.02). This advantage did not result in any benefit in terms of total mortality (adjusted hazard ratio, 0.99; 95% CI, 0.78 to 1.27; P=0.97). A total of 48% of patients who survived endovascular repair had graft-related complications, and 27% required reintervention within the first 6 years. During 8 years of follow-up, endovascular repair was considerably more expensive than no repair (cost difference, 9,826 pounds sterling [U.S. $14,867]; 95% CI, 7,638 to 12,013 [11,556 to 18,176]).

CONCLUSIONS
In this randomized trial involving patients who were physically ineligible for open repair, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower rate of aneurysm-related mortality than no repair. However, endovascular repair was not associated with a reduction in the rate of death from any cause. The rates of graft-related complications and reinterventions were higher with endovascular repair, and it was more costly. (Current Controlled Trials number, ISRCTN55703451.)


Self-patterning presents an appealing alternative to lithography for the production of arrays of nanoscale ferroelectric capacitors for use in high density non-volatile memory devices. Recently a self-patterning method, based on the use of the instability of ultrathin films during hightemperature treatments, was used to fabricate nanosized ferroelectrics. This paper reports the use of the method for the preparation of PZT nanoislands on different single crystalline substrates - SrTiO3, MgO and LaAlO3. Moreover, a multi-step deposition procedure in order to control lateral the dimension of the crystals was introduced. The nanostructures obtained were studied by atomic force microscopy, scanning electron microscopy and X-ray diffraction.


Flow is the new "next generation" version of RefWorks. Instead of storing PDFs on your computer, you can now store them "in the cloud" along with your citations. Users can also fully allow collaboration on their bibliographies within the U. of Denver.


A steady layered organic-inorganic perovskite hybrid containing Fe3+ was prepared in the air with phenosafranine as organic sheets, the Fe(CN)63- as inorganic sheets. We utilized the Fe(CN)63- as inorganic sheets of perovskite hybrids, which may help to stabilize the unusual metal-deficient layered structures. The results of X-ray diffractometry (XRD) and scanning electron microscopy (SEM) show that the hybrid is typical layered perovskite structure. The hybrid was mixed with paraffin to form a hybrid paste for the hybrid paste electrode. Electrochemical characteristics of carbon paste electrode (CPE) modified by hybrid were investigated with cyclic voltammetry. The modified electrode can accelerate the electron-transfer to improve the electrochemical reaction reversibility and be use for the determination of chemicals. The interactions between sodium nitrite (NaNO2), sodium bromide (NaBr), hydroxylammonium chloride (NH2OH·HCl), hydroquinone (C6H6O2) with hybrid were studied. The modified electrode exhibits good electrochemical activity. The hybrid can be used as electrochemical materials.


BACKGROUND
Sensory conflict may be a factor in simulator sickness (SS) given that visual input is often inconsistent with other sensory inputs. It was predicted that an expanding optical flow pattern would lead to more sensory conflict, and subsequently more SS than a contracting pattern.

METHODS
There were 16 individuals who participated in the experiment (6 men, 10 women, mean age = 24.4 yrs). Subjects viewed a steadily expanding pattern of blue squares displayed on a computer monitor. In a second condition the pattern steadily contracted. Subjects completed the Simulator Sickness Questionnaire (SSQ) designed by Kennedy and colleagues both before and after a trial (5 min exposure to optic flow). A total SSQ score and three SSQ sub-scores (nausea, oculomotor, and disorientation) were obtained.

RESULTS
Mean post-treatment total SSQ scores (mean=28) in the expanding condition were higher than those obtained in the contracting condition (mean=17). Nausea and oculomotor SSQ sub-scores were also higher in the expanding condition compared with the contracting condition.

CONCLUSIONS
Experience with expanding flow patterns that result during forward self-motion, and the sensory inputs that usually accompany them, have resulted in a central nervous system expectancy about what the appropriate inputs should be during forward self-motion. Less experience with backwards self-motion (and contracting patterns) may result in a lower level of expectation regarding what the appropriate sensory inputs should be for contracting flow patterns. This lower level of neural expectancy may subsequently lead to less sensory conflict and less SS generated by contracting flow patterns.


The nature of Puritanism in America and the role of emotion in religion is the subject of this important and useful collection of five religious orations, discussed and appraised by Professor White for students of Puritanism and rhetoric. The five orations presented here consist of three by Jonathan Edwards, Future Punishment, Distinguishing Marks, and The Nature of the Affections; one by Charles Chauncy, Enthusiasm Described and Caution d Against; and one by Ebenezer Gay, Natural Religion, as Distinguished from Revealed. In the first or introductory part of the book, Professor White discusses in considerable detail the broader implications of the confrontation between rationalists and revivalists in New England, represented by the following orations, during this most important upheaval in the Colonies prior to the Revolution. The orations themselves are arranged to represent the force and counterforce of reason versus emotionalism and the precarious balance maintained momentarily and, eventually, lost. And in the third part of the book Professor White provides critical analysis and suggested appraisal for further interpretation and inquiry."


BACKGROUND
Scoliosis causes impairment of the respiratory and cardiovascular systems. Traditional pulmonary function tests only examine patients under static conditions. The aim of our study was to investigate the correlation between radiographic parameters and dynamic cardiopulmonary capacity in patients with idiopathic scoliosis.

METHODS
Forty patients with idiopathic scoliosis were included in this prospective study from January 2014 to February 2016. The patients underwent full radiographic assessment of deformity, pulmonary function testing, and cardiopulmonary bicycle ergometer testing. The impact of the severity of thoracic curvature and kyphosis on pulmonary function and physical capacity was investigated.

RESULTS
Thirty-three female patients with a mean age of 15.5 years (range, 11 to 35 years) and coronal thoracic curvature of 49.4° (range, 24° to 76°) and 7 male subjects with a mean age of 15.9 years (range, 13 to 18 years) and coronal thoracic curvature of 47.1°(range, 22° to 80°) were included. No correlation was found between coronal thoracic curvature and pulmonary function test results in the female patients. Female patients with a thoracic curve of ≥60° had lower blood oxygen saturation at maximal exercise in the cardiopulmonary exercise test (p = 0.032). Female patients with a thoracic curve of ≥50° had a higher respiratory rate (p = 0.041) and ventilation volume per minute (p = 0.046) and lower breathing reserve at maximal exercise (p = 0.038). Thoracic kyphosis in female patients was positively correlated with pulmonary function, as shown by the forced expiratory volume in 1 second (r = 0.456, p = 0.01), forced vital capacity (r = 0.366, p = 0.043), vital capacity (r = 0.525, p = 0.006), and total lung capacity (r = 0.388, p = 0.031), as well as with tidal volume (r = 0.401, p = 0.025) in cardiopulmonary exercise testing. Female patients who engaged in regular exercise had better peak oxygen intake normalized by body weight (p < 0.001), peak oxygen intake normalized by the predicted value (p = 0.003), maximum heart rate (p = 0.020), and heart rate reserve (p = 0.014).

CONCLUSIONS
Overall exercise tolerance was not correlated with the magnitude of the thoracic curve and kyphosis. Some parameters of ventilatory function and pulmonary gas exchange worsened as thoracic curvature increased or kyphosis decreased. Exercise capacity was better in patients who engaged in regular aerobic exercise, and physical activity is recommended for patients with idiopathic scoliosis.

LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Gluconobacter suboxydans IFO 3290 was immobilized by adsorption on ceramic honeycomb monolith and continuous production of free gluconic acid from glucose was performed in an aerated reactor. The effects of reactor residence time, aeration rate, and glucose concentration were investigated on the gluconic acid yield. Observation of SEM photographs revealed that the cells were adsorbed with a high density not only on the outer surface of the support but also on the inner surface of large pores. From measurement of the number of the adsorbed cells, it was elucidated that the biofilm comprised a monolayer or bilayer of the cells. Maximum specific rate of growth was estimated for the free and adsorbed cells, and the adsorbed cells were found to grow at a fast rate compared with the free cells. In the continuous fermentation performed for one month at the glucose concentration of 100 kg/m3, reactor residence time of 3.5 h and aeration rate of 900 cm3/min, the activity of the adsorbed cells was appreciably stable. The high productivity of 26.3 kg/(m3‐reactor · h) was attained with the gluconic acid yield of 84.6% and glucose conversion of 94%.


Aims: To evaluate the efficacy of repeated bevacizumab injection in rotational conjunctival flap surgery versus rotational conjunctival flap with adjunctive mitomycin C (MMC) or rotational conjunctival flap alone. Materials and Methods: Ninety eyes of 90 patients who underwent primary pterygium surgery with rotational flap were evaluated. Patients were randomly assigned to undergo conjunctival rotational flap alone (Group A) or conjunctival rotational flap with either 0.02% MMC application (Group B) or adjunctive subconjunctival 2.5 mg/0.1 ml bevacizumab injection (Group C). Each group consisted of 30 eyes. Recurrence rates at 9 months were evaluated. Results: There were no statistically significant differences in mean size of the pterygium across the limbus in terms of length (P > 0.5). The recurrence rates at 9 months were 26.6% (n = 8) in Group A, 13.3% (n = 4) in Group B, and 10% (n = 3) in Group C. The recurrence rates in Group B and C were significantly lower than in Group A (P =0.1806). The recurrence rates were similar in Group B and C (P > 0.05). Conclusions: Subconjunctival bevacizumab injection may decrease the recurrence rate of primary pterygium surgery with rotational conjunctival flap. Further studies with a larger population and longer follow-up period are needed to supplement this study.


This paper proposes a non-parametric optimization criterion for the static portfolio selection problem in the mean-variance-skewness-kurtosis space. Following the work of Briec et al. (2004-a and 2004-b), a shortage function is defined in the four-moment space that looks simultaneously for possible improvements in the expected portfolio return, variance, skewness and kurtosis directions. This new approach allows us to solve for multiple competing and often conflicting asset allocation objectives within a mean-variance-skewness-kurtosis framework. The global optimality is here guaranteed for the resulting optimal portfolios. We also establish a link to a proper indirect four-moment utility function. An empirical application on funds of hedge funds serves to provide a three-dimensional representation of the primal non-convex mean-variance-skewness-kurtosis efficient portfolio set and to illustrate the computational tractabilty of the approach.


Silica nanoparticles, usually synthesized via Stober reactions in the presence of a suitable amount of an ammonia catalyst, are frequently used in the fabrication of self-cleaning surfaces. However, to achieve superhydrophobicity, the nanosilica-modified surfaces need to be further functionalized with low-surface-energy materials. Here, we report the preparation of polymethylsiloxane nanoparticles in a facile way, i.e., the hydrolysis of trichloromethylsilane in toluene under ambient conditions in the absence of a catalyst. The resulting gel-like solution can be applied to substrate surfaces by the convenient method of spraying. Wood slides were used as substrates, and the spray-coated wood without any further surface elaboration became extremely superhydrophobic. Notably, it was observed that the superhydrophobicity of the coated wood is mechanically stable against repeated finger rubbing because of the macroscale and microscale roughness of the wood surfaces that serve as a barrier against mechanical damage.


Let k be a p-adic field. Split reductive groups over k can be described up to k-isomorphism by a based root datum alone, but other groups, called rational forms of the split group, involve an action of the Galois group of k. The Galois action on the based root datum is shared by members of an inner class of k-groups, in which one k--isomorphism class is quasi-split. Other forms of the inner class can be called pure or impure, depending on the Galois action. Every form of an adjoint group is pure, but only the quasi-split forms of simply connected groups are pure. A p-adic Local Langlands correspondence would assign an L-packet, consisting of finitely many admissible representations of a p-adic group, to each Langlands parameter. To identify particular representations, data extending a Langlands parameter is needed to make "completed Langlands parameters." Data extending a Langlands parameter has been utilized by Lusztig and others to complete portions of a Langlands classification for pure forms of reductive p-adic groups, and in applications such as endoscopy and the trace formula, where an entire L-packet of representations contributes at once. We consider a candidate for completed Langlands parameters to classify representations of arbitrary rational forms, and use it to extend a classification of certain supercuspidal representations by DeBacker and Reeder to include the impure forms.


Teamwork and team incentives are increasingly prevalent in modern organizations. Performance measures used to evaluate individuals' contributions to teamwork are often non-verifiable. We study a principal-multi-agent model of relational (self-enforcing) contracts in which the optimal contract resembles a bonus pool. It specifies a minimum joint bonus floor the principal is required to pay out to the agents, and gives the principal discretion to use non-verifiable performance measures to both increase the size of the pool and to allocate the pool to the agents. The joint bonus floor is useful because of its role in motivating the agents to mutually monitor each other by facilitating a strategic complementarity in their payoffs. In an extension section, we introduce a verifiable team performance measure that is a noisy version of the individual non-verifiable measures, and show that the verifiable measure is either ignored or used to create a conditional bonus floor.


Future generations do not exist, and are not determinate in their make-up. The moral significance of future generations cannot be accounted for on the basis of a purely individualistic ethic. Yet future generations are morally significant. The Person-Affecting Principle, that (roughly) only acts which are likely to affect particular individuals are morally significant, must be augmented in such a way as to take into account the moral significance of Homo sapiens, a holistic entity which certainly does exist. Recent contributions to Environmental Values by Alan Carter and Ernest Partridge are criticised (but not entirely rejected).


Abstract Ontologies and rules are usually loosely coupled in knowledge representation formalisms. In fact, ontologies use open-world reasoning, while the leading semantics for rules use non-monotonic, closed-world reasoning. One exception is the tightly coupled framework of Minimal Knowledge and Negation as Failure (MKNF), which allows statements about individuals to be jointly derived via entailment from ontology and inferences from rules. Nonetheless, the practical usefulness of MKNF has not always been clear, although recent work has formalized a general resolution-based method for querying MKNF when rules are taken to have the well-founded semantics, and the ontology is modeled by a general oracle. That work leaves open what algorithms should be used to relate the entailments of the ontology and the inferences of rules. In this paper we provide such algorithms, and describe the implementation of a query-driven system, CDF-Rules, for hybrid knowledge bases combining both (non-monotonic) rules under the well-founded semantics and a (monotonic) ontology, represented by the Coherent Description Framework Type-1 ( $\mathcal{ALCQ}$ ) theory.


Underground communication is a hot and difficult research all the time, there are a lot of techniques about it. This paper according to the characteristics of collision-free, Existence of multi-path wireless channel and multiple access interference in the mines, we propose an improved non-woven technology, frequency hopping sequence collision zone technology, this is the innovation of this paper and the key part. In the article, the collision-zone hopping the structure based on an improved interleaving process is given in detail. Finally, the mathematical proof and algorithm design model program.


International law has developed what many might consider a constitutional understanding of individual civil rights that individuals can claim vis-à-vis their own governments. This article discusses the development of aspects of international law relating to civil rights and argues that if this body of law is meaningful, we should see evidence of links between acceptance of international legal obligation and domestic practices. Recognizing that external forms of enforcement of civil rights is unlikely (because doing so is not generally in the interest of potential "enforcers"), I argue that international civil rights treaties will have their greatest effect where stakeholders—local citizens—have the motive and the means to demand treaty compliance. This is most likely to be the case not in stable autocracies, where such demands are likely to be crushed, nor in stable democracies, where the motive to mobilize is attenuated due to rights saturation, but in transitional countries where the expected value of mobilization is maximized. Thus, I test the hypothesis that the International Covenant on Civil and Political Rights is likely to have its greatest positive effects in transitional countries—those that have had some fleeting experience with democratic governance. This proposition is tested quantitatively with indicators for freedom of religious practice and fair trials. The proposition is weakly supported by extremely stringent statistical models that control for the endogeneity of the treaty commitments, country- and year-fixed effects, and other obvious influences on civil rights practices. I conclude that the "International Bill of Rights" has the power to influence the direction of rights practices in fluid political situations, but it cannot magically transform autocracies into liberal guarantors of civil liberties. Still, these effects are important and are the most we can expect from scraps of paper that the international community has been reluctant to enforce.


The "Stub-End Type" Residential Area is a special community, which is characterized by its position that is located in the end of a direction in a city and the single direction, from which its residents go out. After seeing its location, surroundings et cetera and its advantages, we found that such settlement has not been rationally and orderly made the best use of by using the external conditions. On the contrary, serious problems and disadvantages have emerged conspicuously. In this paper, by citing an example of the southern settlements in Jinan, combined with the factors of its geographical location, natural surroundings and geological conditions, we'll talk about the motives for "Stub-End Type" Spatial Development and relevant solutions and means from a professional point of view to have healthy and harmonious development of Stub-End Type Residential Area.


Titanium is a strong, corrosion resistant metal with low mass density, making it ideal for various purposes, including aviation and medical applications. In the present work, the elastic properties of titanium have been investigated using the first principles Exact Muffin-Tin Orbitals method. The focus of our study is the anisotropic elasticity of single-crystal and cold-rolled titanium. Both types of titanium are used in industrial applications because of their special mechanical properties compared to randomly ordered polycrystalline alloys. Single crystals have better creep resistance compared to polycrystalline metals, while cold-rolled ones, on the other hand, possess more strength. Here cold-rolled titanium is investigated for the first time using ab initio calculations. Single-crystal results are obtained directly from first principles total energy calculations, whereas the elasticity of the cold-rolled structure is estimated from the single-crystal data. The elasticity of cold-rolled titanium has previously been investigated only experimentally, and thus the present computational approach provides new insight and valuable complementary information, not only for cold-rolled titanium, but also for more complex structures. Our results are found to be in good agreement with experimental findings and therefore serve as a starting point for investigating the elasticity of titanium alloys, which, using our method, can be accomplished as easily as the pure titanium case.


Background: We encountered 15 patients with a newly recognized clinical phenomenon that we term orthostatic myoclonus. We conducted a retrospective chart review to better understand the clinical context and importance of this phenomenon. Objective: To describe the clinical picture of orthostatic myoclonus. Methods: The Mayo Clinic Rochester Movement Disorders Laboratory database was searched for all patients diagnosed electrophysiologically with orthostatic myoclonus (2002 through 2006). Medical records and laboratory data of all patients were retrospectively reviewed. Results: Fifteen patients with orthostatic myoclonus were identified, all seniors (64 to 81 years). Seven of the patients had a CNS degenerative disorder and two had a systemic illness known to be associated with myoclonus. In the remaining six patients no known CNS disorder contributed to the phenomenon. The onset of orthostatic myoclonus was accompanied by complaints of leg jerking or observed leg jerking in 13 of 15 patients during upright posture. An insidious deterioration of gait that was often described as "apraxia" or "gait initiation difficulty" accompanied the myoclonus in 13 of 15 patients. Clinicians frequently suspected normal pressure hydrocephalus or orthostatic tremor syndrome. Surface EMG studies revealed short duration myoclonic bursts that occurred predominately with the assumption of an upright posture. Some patients improved on clonazepam. Conclusions: Orthostatic myoclonus is a unique clinical and physiologic phenomenon that accompanies a slowly progressive and eventually disabling gait disorder in the elderly. This phenomenon often arises in the company of more widespread CNS disease.


OBJECTIVES
Despite considerable progress in intensive care management of the acute respiratory distress syndrome (ARDS), little is known about health-related quality of life in long-term survivors. In addition, intensive care treatment can be extremely stressful, and many survivors of ARDS report adverse experiences such as respiratory distress, anxiety, or pain during intensive care unit (ICU) treatment. This study was performed to assess health-related quality of life in survivors of ARDS and to test the hypothesis that adverse experiences during ICU treatment result in posttraumatic stress disorder (PTSD) and negative effects on health-related quality of life.

DESIGN
Retrospective, cohort, case-controlled analyses.

SETTING
A 12-bed multidisciplinary ICU of a tertiary care university hospital, capable of providing extracorporeal life support for adults with severe ARDS.

PATIENTS
We studied 80 patients who were admitted to our hospital from 1985 to 1995 and who survived an episode of ARDS. ARDS was defined according to the criteria of the American-European Consensus Conference on ARDS.

INTERVENTIONS
Health-related quality of life was measured using the Health Status Questionnaire of the self-administered Medical Outcomes Study Short Form Survey that consists of 36 questions (SF-36) and the German version of the Post Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10), a self-report scale for the diagnosis of posttraumatic stress disorder based on the Diagnostic and Statistical Manual (Third Edition) criteria (American Psychiatric Association). The number of adverse experiences (anxiety, respiratory distress, pain, and nightmares) during intensive care was evaluated by means of a structured questionnaire. For each patient with ARDS, three age- and gender-comparable controls were randomly selected from databases providing normal values for the SF-36 and PTSS-10 scores in populations at risk for posttraumatic stress disorder.

MEASUREMENTS AND MAIN RESULTS
Survivors of ARDS showed statistically significant impairments in all eight health dimensions of the SF-36 when compared with normal controls (median reduction 21.3%, p < .006) with maximal impairments in physical function (median reduction 28.9%, p = .000) and a 38% higher frequency of chronic pain (p = .0001). Three of 34 patients reporting none, or one, adverse experience had evidence of posttraumatic stress disorder vs. 19 of 46 patients remembering multiple traumatic episodes (p = .007). Patients reporting multiple adverse experiences described the lowest health-related quality of life, with maximal impairments in psychosocial functioning (p < .005) and only small limitations in physical function.

CONCLUSIONS
Long-term survivors of ARDS describe a good overall health-related quality of life. Major impairments in mental health domains of health-related quality of life are associated with the development of posttraumatic stress disorder and are a possible result of traumatic experiences during ICU therapy.


With the success of the 3D deep learning models, various perception technologies for autonomous driving have been developed in the LiDAR domain. While these models perform well in the trained source domain, they struggle in unseen domains with a domain gap. In this paper, we propose a single domain generalization method for LiDAR semantic segmentation (DGLSS) that aims to ensure good performance not only in the source domain but also in the unseen domain by learning only on the source domain. We mainly focus on generalizing from a dense source domain and target the domain shift from different LiDAR sensor configurations and scene distributions. To this end, we augment the domain to simulate the unseen domains by randomly subsampling the LiDAR scans. With the augmented domain, we introduce two constraints for generalizable representation learning: sparsity invariant feature consistency (SIFC) and semantic correlation consistency (SCC). The SIFC aligns sparse internal features of the source domain with the augmented domain based on the feature affinity. For SCC, we constrain the correlation between class prototypes to be similar for every LiDAR scan. We also establish a standardized training and evaluation setting for DGLSS. With the proposed evaluation setting, our method showed improved performance in the unseen domains compared to other baselines. Even without access to the target domain, our method performed better than the domain adaptation method. The code is available at https://github.com/gzgzys9887/DGLSS.


Empirically, compensation systems generate substantial effort despite weak monetary incentives. We consider reciprocal motivations as a source of incentives. We solve for the optimal contract in the basic principal-agent problem and show that reciprocal motivations and explicit performance-based pay are substitutes. A firm endogenously determines the mix of the two sources of incentives to best induce effort from the agent. Analyzing extended versions of the model allows us to examine how organizational structure impacts the effectiveness of reciprocity and to derive specific empirical predictions. We use the UKWERS workplace compensation data set to confirm the predictions of our extended model. JEL Code: D82, J33, M52.


The original blog post can be found at the Bitmovin Techblog and has been updated here to focus on and highlight research aspects.


This paper presents a computationally efficient application-specific integrated circuit (ASIC) implementation for the decoding of space-time block codes (STBCs) . Alternative methods of evaluating the originally proposed maximum-likelihood decision metrics are explored at the algorithm and architectural level. At the algorithm level, unique decoding techniques are developed that result in computation savings of as much as 65%. At the architectural level, a low-computation symmetrical approach for the implementation of the proposed algorithm is presented. The proposed ASIC architecture offers considerable computation reductions leading to substantial power and area savings compared to a direct implementation of the original algorithm. The proposed architecture was realized in an ASIC referred to as the ST block decoder ASIC. The chip was fabricated using 0.18-/spl mu/m CMOS technology and occupies a core area of 0.25 mm/sup 2/. The ASIC architecture is highly scalable and can implement 2 /spl times/ 2, 8 /spl times/ 3, and 8 /spl times/ 4 STBCs with modulation formats ranging from binary-phase shift keying (BPSK) to 16 quadrature amplitude modulation (QAM), and can operate at any symbol rate up to 20 Mbaud. Depending on the mode of operation, the decoder power consumption ranges from 0.54 mW for 2 /spl times/ 2 BPSK systems to 1.89 mW for 8 /spl times/ 4 16-QAM systems.


Water resource scarcity has been increasingly becoming a threat to wheat (Triticum aestivum L.) production in North China Plain. Thus, a water-saving irrigation strategy should be urgently developed. We conducted a 2-yr field experiment to examine the effects of supplemental irrigation (SI) on the photosynthetic characteristics and water use efficiency (WUE) of wheat. This study employed two SI strategies: A quota SI using 60 mm water at jointing and anthesis stages (W1) and soil moisture testing SI (W2), which brings the target relative soil water content of 0-40 cm soil layer to 70% field capacity at jointing and anthesis stages. A non-irrigated treatment (W0) was used as control. Results showed that W2 significantly improved the water uptake in 80-160 cm soil layer compared with W1. Moreover, flag leaf photosynthetic rate, stomatal conductance, and transpiration 14-28 d after anthesis were highest in W2 successively followed by W1 and W0, and the difference was significant. Dry matter (DM) at maturity, DM accumulation post-anthesis and its contribution ratio to grain were significantly higher in W2 than in the other treatments. 13CO2 labeling results indicated that W2 promoted δ13C-photosynthate accumulation in grain. In 2012-2013 growing season, the grain yield increased by 56.05% and 5.74% and WUE increased by 26.17% and 6.34% in W2 compared with those in W0 and W1, respectively. In 2013-2014 growing season, the grain yield increased by 41.82% and 5.90% and WUE increased by 28.24% and 13.03% in W2 compared with those in W0 and W1, respectively. Therefore, W2 is a high-yield and water-saving treatment.


The UK apparel retail market is characterised by transient intra-seasonal style trends and unpredictable and demanding consumers. From a commercial perspective, the market has also been marked by increasing concentration, offer homogenization, price deflation, corporate merger and acquisition activity and by the aggressive entry of foreign competitors. As a consequence, UK apparel retailers have historically faced a dual challenge: Firstly, how to create product development, marketing and distribution strategies aligning their products and brands with dynamic consumer preferences and perceptions; and secondly how to synchronize corporate assets and competence to create infrastructures for the execution of those strategies in pursuit of commercial growth. Against this background, this paper identifies the core competences required of participants within the apparel retail market and illustrates the diversification opportunities accrued by their acquisition. These are explored using the example of Next PLC, a historically successful participant within the UK apparel market. Applying historic commercial data since 1982 and contemporary media commentary to the core competence and diversification literature, this paper will show how apparel retailers may diversify by focusing on competences in branding, product development, retail channel and format, internationalisation and business support. Alongside the key findings, a model representing the diversification opportunities of an apparel retailer will be presented.


Background Rheumatoid arthritis (RA) is a chronic inflammatory disease largely driven by immune complexes and their interaction with FcγRs on synovial macrophages. In RA, joint destruction has been associated with high levels of cholesterol (LDL) which become oxidised (oxLDL) within the inflamed synovium. Apolipoprotein E (ApoE) regulates LDL levels and its absence strongly elevates LDL in the serum. In this study we investigated the role of ApoE in inflammation and joint destruction during antigen-induced arthritis (AIA). Materials and methods Experimental arthritis was induced by injection of mBSA into the right knee joint of ApoE-/- and wild type (WT) mice previously immunised with mBSA/CFA. Joint swelling was measured by 99m Technecium (99mTc) uptake and expressed as a ratio of the uptake in the right (injected) and left (non injected) knee joint. Serum mBSA antibody titer was measured by ELISA. WT BM-MΦ were stimulated for 24 hours in vitro with or without 50 µg/ml oxLDL and the FcγRs mRNA expression was measured by qPCR. Joint inflammation and damage were measured by histology using an arbitrary scale from 0 to 3. Results ApoE-/- mice showed significantly less joint swelling at day 1, 3 and 7 after AIA induction compared to WT controls (21%, 17%, 18% lower, respectively). Serum mBSA antibody levels (total IgG, IgG1, IgG2a and IgG2b) were comparable between WT and ApoE-/-mice. LDL serum levels were significantly higher in ApoE-/- mice and LDL/oxLDL was found within synovial macrophages. At day 21, histology showed less inflammatory cells within the synovium and joint cavity (22% and 44% lower, respectively) in the ApoE-/- mice compared to WT controls. WT BM-MΦ stimulated with oxLDL displayed a significant down-regulation of mRNA levels of FcγR I and FcγR II when compared to their non stimulated controls (1,7 and 2,3 fold change, respectively). Joint destruction was significantly reduced in the ApoE-/- mice, as indicated by the reduction of chondrocyte death (32% reduction) and bone erosion (25% reduction from 1.5±0.2 to 1.1±0.1). Conclusions ApoE stimulates joint destruction during AIA by lowering LDL/oxLDL levels, thereby promoting Fcγ- mediated macrophage activation within the synovium.


Despite orders of magnitude difference in atmospheric reactivity and great diversity in biological functioning, little is known about monoterpene speciation in tropical forests. Here we report vertically resolved ambient air mixing ratios for 12 monoterpenes in a central Amazon rainforest including observations of the highly reactive cis‐β‐ocimene (160 ppt), trans‐β‐ocimene (79 ppt), and terpinolene (32 ppt) which accounted for an estimated 21% of total monoterpene composition yet 55% of the upper canopy monoterpene ozonolysis rate. All 12 monoterpenes showed a mixing ratio peak in the upper canopy, with three demonstrating subcanopy peaks in 7 of 11 profiles. Leaf level emissions of highly reactive monoterpenes accounted for up to 1.9% of photosynthesis confirming light‐dependent emissions across several Amazon tree genera. These results suggest that highly reactive monoterpenes play important antioxidant roles during photosynthesis in plants and serve as near‐canopy sources of secondary organic aerosol precursors through atmospheric photooxidation via ozonolysis.


Carbazole, a commonly used hole-transporter for organic electronics, has been modified with an imidazolium cation and a hexafluorophosphate counter-anion to give an ionic hole-transporter. It has been applied as one of the hosts in a host–guest blue light-emitting electrochemical cell (LEC) with the neutral blue emitter FIrPic. We have obtained efficient and bright blue LECs with an electroluminescence maximum at 474 nm and efficacy of 5 cd A−1 at a luminance of 420 cd m−2, thereby demonstrating the potential of the ionic organic charge-transporters and of the host–guest architecture for LECs.


The aim of this study was to test the effects of salt stress on nitrogen metabolism and ion balance in rice plants. The contents of inorganic ions, total amino acids, and NO3 – in the stressed seedlings were then measured. The expressions of some critical genes involved in nitrogen metabolism were also assayed to test their roles in the regulation of nitrogen metabolism during adaptation of rice to salt stress. The results showed that when seedlings were subjected to salt stress for 4 h, in roots, salt stress strongly stimulated the accumulations of Na+ and Cl–, and reduced K+ content; however, in leaves, only at 5 days these changes were observed. This confirmed that the response of root to salt stress was more sensitive than that of leaf. When seedlings were subjected to salt stress for 4 h, salt stress strongly stimulated the expression of OsGS1;1, OsNADH-GOGAT, OsAS, OsGS1;3, OsGDH1, OsGDH2, OsGDH3 in both leaves and roots of rice, after this time point their expression decreased. Namely, at 5 days most of genes involved in NH4 + assimilation were downregulated by salt stress, which might be the response to NO3 – change. Salt stress did not reduce NO3 – contents in both roots and leaves at 4 h, whereas at 5 days salt stress mightily decreased the NO3 – contents. The deficiencies of NO3 – in both roots and leaves can cause a large downregulation of OsNR1 and the subsequent reduction of NH4 + production. This event might immediately induce the downregulations of the genes involved in NH4 + assimilation.


Christianity as a religion is not anti-political, but as in other segments of its existence, it overcomes politics and human organizations, for the Lord tells us that 'My Empire is not of this world' (Jn 18:36). Moral, which is so important for Christ's faith, invites people to accept authority and comply to civil obedience. Everything can be misused, or misunderstood, however, the general moral significance of the State is needed to limit evil and to maintain good for everyone when it comes to social relations between people. The State, as a system of legal regulation that manages interpersonal relations in one community, exists in various forms, almost as much as mankind. Unfortunately, Christianity wasn't well understood from its very beginning in the country where it appears – Roman empire, because of suspicion that it's anti-state and anarchist, even thought that is far from truth. It took some time until the State realized the meaning of St. Paul's words: 'Let everyone put himself under the authority of the higher powers, because there is no power which is not of God, and all powers are ordered by God' (Rom 13:1), these words apply that Christians can be good citizens only if a common language is found. However, Church has, at certain times even after gaining the freedom, brought a wreath of martyrdom because of State's prosecution. History shows us that the systems that fought against the Church, actually fought against God, and the one who fights against God is always defeated in the end.
Keywords: Church, Yugoslavia, Communism, suffering


This work present a new methodology based on time series and CORINE Land Cover products for identifying the main land processes acting on the territory. Seasonality parameters derived from NDVI obtained from Terra satellite were computed using TIMESAT software. These seasonality parameters include amplitude of the season, base value, length of season, maximum value, left and right derivative and small and large integrated values. In general, among all these seasonality parameters, the maximum value of the season and its large integrated value resulted the most appropriate parameters for identifying land processes. However, thus processes occurring within the same CORINE levell, were not well identified. Therefore, the proposed methodology has been proved as a useful approach for identifying the main land processes occurring in the surface. The integration with multispectral/hyperspectral and thermal imagery could help to improve surface classification.


In this paper, we study the framework of two-player Stackelberg games played on graphs in which Player 0 announces a strategy and Player 1 responds rationally with a strategy that is an optimal response. While it is usually assumed that Player 1 has a single objective, we consider here the new setting where he has several. In this context, after responding with his strategy, Player 1 gets a payoff in the form of a vector of Booleans corresponding to his satisfied objectives. Rationality of Player 1 is encoded by the fact that his response must produce a Pareto-optimal payoff given the strategy of Player 0. We study the Stackelberg-Pareto Synthesis problem which asks whether Player 0 can announce a strategy which satisfies his objective, whatever the rational response of Player 1. For games in which objectives are either all parity or all reachability objectives, we show that this problem is fixed-parameter tractable and NEXPTIME-complete. This problem is already NP-complete in the simple case of reachability objectives and graphs that are trees.


Big data offers the knowledge required for healthcare providers to streamline customer service processes that customize healthcare and create best practices for communicating with clients or patients. A more detailed and customized experience can be offered to customers. But there are many challenges that healthcare organizations are facing. The research aims to study big data challenges in the healthcare sector. A literature review is performed to discover big data problems in healthcare. A questionnaire is utilized for the survey research in the hospitals. Target populations are the staff who are working in the hospitals. For analysis, exploratory factor analysis is being performed. All the challenges are grouped into five factors. All the parameters are satisfied for the study.
(*The paper was presented at the 2nd Conference on Business Data Analytics: Innovation in emerging trends in management data analytics. Apeejay School of Management, Dwarka, Delhi, India. November 2021)


This study examined the relationship between owning a pet and experiencing food insecurity in low-income households using self-administered surveys (N=392) and in-depth interviews (N=15). The study found that low-income pet owners were not at greater risk for being food insecure. In fact, having a pet associated with better food security than when people did not own a pet. The cross-sectional design limits causal explanation. It is possible that people who are very food insecure choose not to accept stray animals into their homes or do not adopt or re-home animals from shelters or family members (typically how owners acquired pets). However, another explanation supported by the interviews is that having a pet or pets activates or motivates people to manage their food needs and to work harder at keeping food on the table and in the bowl. Owners may be activated or motivated to do things such as go to the pantry and manage the household finances so that they can continue to care for their pets. Moreover, having a pet provides emotional and social support benefits, particularly for older adults and those with disabilities. Pets give a sense of routine and for dog owners, motivate physical exercise. However, owners did share their human food when they did not have pet-food. Other potential deleterious impacts were grief following the death of beloved pets and financial concerns about current and future veterinary care.


This paper is based on a pilot qualitative research study examining the nature and extent of social capital available to older (aged 60+) British South Asian women living in the north of England. A main argument is that South Asian's women's experiences of growing older have been overlooked within social gerontology and the sociology of ageing. In particular, the interrelationship of racism, sexism, and ageism remains under theorised. One outcome of this neglect is a lack of theoretical insight into the cumulative effect of life-course inequalities on older South Asian women's quality of life. The paper builds on the recognition that older women are not a homogenous group but instead have different resources and capital available to them and face different forms of disadvantage and discrimination. The aims of the paper are three-fold. First, to examine how social capital influences and is influenced by personal and social injustices and inequalities, encountered across the life course and in later life. Second, to consider how gender, migrant, and ethnic identities and roles shape South Asian women's opportunities to develop familial, friendship, and community networks in later life. Third, to problematise the concept of social capital and explore its capacity to explain the experiences of South Asian women, as they grow older.


A reversible (also called lossless, distortion-free, or invertible) visible watermarking scheme is proposed to satisfy the applications, in which the visible watermark is expected to combat copyright piracy but can be removed to losslessly recover the original image. We transparently reveal the watermark image by overlapping it on a user-specified region of the host image through adaptively adjusting the pixel values beneath the watermark, depending on the human visual system-based scaling factors. In order to achieve reversibility, a reconstruction/recovery packet, which is utilized to restore the watermarked area, is reversibly inserted into non-visibly-watermarked region. The packet is established according to the difference image between the original image and its approximate version instead of its visibly watermarked version so as to alleviate its overhead. For the generation of the approximation, we develop a simple prediction technique that makes use of the unaltered neighboring pixels as auxiliary information. The recovery packet is uniquely encoded before hiding so that the original watermark pattern can be reconstructed based on the encoded packet. In this way, the image recovery process is carried out without needing the availability of the watermark. In addition, our method adopts data compression for further reduction in the recovery packet size and improvement in embedding capacity. The experimental results demonstrate the superiority of the proposed scheme compared to the existing methods.


In the article an urgent problem of legal sources is researched. In the context of this general problem the issue of acts of the Constitutional Court is singled out which is one of the most complicated questions actively discussed in scientific circles. Taking into account that in the countries of civil law traditions, where the doctrine of positive law virtually prevails, the acts of the organs of constitutional justice are assessed differently. Taking into regard peculiarities of the status of the Constitutional Court of the Republic of Lithuania, it is suggested to correspondingly consider the acts of the Constitutional Court in the system of legal sources. The article holds that the character of acts of organs of constitutional review is also determined by specificity of constitutional norms. The author thinks that those acts of the Constitutional Court according to which legal norms are recognised as conflicting with the Constitution are to be ascribed, without any doubts, to the sources of constitutional law.


Tax Liability Side Equivalence (tax LSE) claims that the statutory incidence of a tax is irrelevant for its economic incidence. In gift-exchange labor markets, firms provide a gift to workers by paying high wages, and workers reciprocate by providing high efforts. Tax LSE is theoretically predicted to hold in gift-exchange markets if workers' effort choices exclusively depend on the net wage, but breaks down if they partially depend on the gross wage paid to workers. We experimentally test tax LSE in a gift-exchange market and find that it holds surprisingly well.


Daytime ensemble of khaki green cotton twill consisting of:

A) Sun dress. Street-length, sleeveless, with deep rounded neckline. Skirt gathered into natural waist with attached narrow tie belt and bow of matching fabric. Center back zipper with hook & eye at back neckline and inner petersham of white grosgrain ribbon. Unlined.
Designer's label at left side seam: "Adele Simpson"

B) Cropped, bolero or shrug jacket of matching fabric. Embellished all-over with silver stitching "loops", the center of each loop having a circular paillette of reflective silver material. Single snap closure and single hook &loop at base of center front opening which crosses to fasten. Short sleeves. Deep V neckline in front. Lined in cream net.
Designer's label at center back neckline: "Adele Simpson"


: The paper summarized an experience of pronoran (piribedil) treatment of 516 patients with Parkinson's disease (primary parkinsonism) conducted in the district outpatient clinics of 7 Moscow administrative areas. In 84 cases, the medication was used as a monotherapy and in 432--in combination with levodopa-contained drug madopar. An improvement of patient's state, with reducing of bradikinesia, tremor and rigidity, was achieved in 73.0 +/- 20.4% of the patients. Combined therapy allowed decreasing of madopar dosage in 58.5 +/- 16.7% of the patients. Pronoran (piribedil) is well tolerated. The authors recommend it for the treatment of outpatients with Parkinson's disease.


It is well known that GaAs power FET occasionally shows thermal runaway. There are some explanations about this effect, such as increase of leakage current and lowering the potential barrier of the gate as the increase of temperature. We found such effect is closely related to the gate orientation for the first time. Based on this characteristics of GaAs FET, we demonstrate temperature compensation technique of GaAs power amplifier just by rotating the gate orientation of the FET.


© 2003 Giga Research, a wholly owned subsidiary of Forrester Research, Inc. All rights reserved. Reproduction or redistribution in any form without the prior permission of Forrester Research, Inc. is expressly prohibited. This information is provided on an "as is" basis and without express or implied warranties. Although this information is believed to be accurate at the time of publication, Forrester Research, Inc. cannot and does not warrant the accuracy, completeness or suitability of this information or that the information is correct. Giga research is provided as general background and is not intended as legal or financial advice. Forrester Research, Inc. cannot and does not provide legal or financial advice. Readers are advised to consult their attorney or qualified financial advisor for legal and/or financial advice related to this information. © 2003 Giga Research, a wholly owned subsidiary of Forrester Research, Inc. Copyright and Material Usage Guidelines August 5, 2003


Internet protocol TV (IPTV) is a system to deliver TV content to customers by using IP. It has been deployed worldwide by many IPTV service provides, including AT&T, BT, etc. In addition to the core video services provided by the traditional cable TV and satellite TV systems, IPTV provides much richer user interactions and enables additional value added services. This paper presents a prototype for such kind of service: uninterrupted recording and real time media content indexing service for IPTV platforms. While electronic program guides (EPG) list the TV programs that will be broadcast in the future and allow the users to schedule recording for shows that they are interested in, our prototype empowers the users to search and browse any moment of all recent broadcast content for certain channels. Based on the business interest and requirements, this service can be realized in either a centralized architecture (on the network side) or a distributed one (on the individual client side). The developed user interface can be seamlessly integrated on IPTV platforms, and it has been successfully demonstrated on the set top box (STB).


Tryptophan, a precursor of important molecules such as serotonin, melatonin and niacin, is an essential amino acid for dogs. In pigs, tryptophan supplementation has been shown to induce a significant increase in food intake. The aim of the present study was to assess whether long-term tryptophan supplementation increases voluntary food intake in dogs and to observe whether this was accompanied by a change in serum ghrelin. In the present study, sixteen adult Beagle dogs were used, with four male and four female dogs fed diets supplemented with tryptophan (1 g/dog per d) during 81 d (Trp) and four male and four female dogs that were not supplemented (control). A voluntary food intake test was performed during 5 d following the supplementation period. The Trp group tended to show a higher food intake during the voluntary food intake test (58.0 (SE 5.37) v. 77.5 (SE 3.65) g/kg metabolic weight per d; P = 0.074). No significant differences were found for serum ghrelin concentrations.


Abstract The limited information provided by peer-to-peer (P2P) lending platforms often is not sufficient for lenders to determine if a borrower is trustworthy and able to repay the loan. Using a unique dataset from a P2P lending platform, which allows lenders to seek information directly from borrowers and borrowers to respond to the questions and comments, we examine the impact of lender-borrower communication on funding outcomes and loan performance. Our results show that not only the amount but also the content of such direct communication matters. Specifically, the number of lender comments is negatively associated with funding success, while the number of borrower responses is positively associated with funding success, although only comments help reduce the final interest rate. The role of the communication is even stronger for listings with poor credit grades. Moreover, lenders are influenced by other lenders' (positive or negative) comments and the quality of the information disclosed in borrower responses can affect funding outcomes. Loan performance (e.g., default ratio), however, cannot be predicted based on the amount of lender borrower communication. This research broadens and deepens our understanding of the roles of information disclosure, social influence, information quality, and trust in economic exchanges in online settings.


[1] We have developed the three-dimensional global University of Maryland Chemical Transport Model (UMD-CTM), which can operate on a uniform horizontal grid or operate with a stretched-grid feature that allows transport and chemistry to be computed with mesoscale resolution in a region of interest. The model is suitable for computing photochemical air quality over a specific region, as well as addressing interregional and intercontinental transport issues. The model contains options for a uniform grid or a stretched-grid advection scheme and contains a fast chemical solver and schemes for convective transport, eddy diffusion, emissions, dry deposition, wet scavenging, and stratospheric influx. The model was run on a uniform grid for a full year, and results were evaluated with a variety of surface, airborne, balloon-borne, and satellite observations from many regions of the world. The evaluation was quantified by means of an evaluation index, which compares the model versus observation differences with the variance in the measurements. For most species no systematic biases were found in the results. Results of a simulation with the stretched-grid version of the model are reported in part 2 of this series of papers [Park et al., 2004].


Lyme neuroborreliosis (LNB) in children is a challenging diagnosis based on clinical manifestations and laboratory findings. The aim of this study was to investigate whether herpes simplex virus (HSV) 1 or 2, varicella zoster virus (VZV), enterovirus or tick-borne encephalitis virus (TBEV) could be identified in cerebrospinal fluid (CSF) or serum from children being evaluated for LNB, in order to elucidate whether such infectious diseases may be missed by the clinician. Methods: Ninety-nine pediatric patients (n = 99) were retrospectively included from a previous study on LNB in southeast of Sweden. They had been diagnosed as "Possible LNB" or "Not determined" due to negative Borrelia antibody index in CSF. Routine polymerase chain reaction (PCR) methods were used for detection of herpes viral RNA or enteroviral DNA in CSF. An ELISA assay was used for detection of anti-TBEV antibodies (IgM and IgG) in serum. Results: One patient showed elevated anti-TBEV IgM and IgG antibodies in serum, indicating a current TBE infection. No positive PCR reactions for HSV 1 or 2, VZV or enterovirus were detected in CSF from any of the patients. In conclusion, our results suggest that undiagnosed herpes- or enteroviral infections are unlikely to explain CNS symptoms in children being evaluated for LNB, whereas missed TBE infections may occur. TBEV serology should be included when evaluating children for LNB in TBE endemic areas.


The fungus, Alternaria sonchi is considered to be a potential agent for the biocontrol of perennial sowthistle (Sonchus arvensis). A new chlorinated xanthone, methyl 8-hydroxy-3-methyl-4-chloro-9-oxo-9H-xanthene-1-carboxylate (1) and a new benzophenone derivative, 5-chloromoniliphenone (2), were isolated together with eleven structurally related compounds (3–13) from the solid culture of the fungus, which is used for the production of bioherbicidal inoculum of A. sonchi. Their structures were determined by spectroscopic (mostly by NMR and MS) methods. Alternethanoxins A and B, which were reported in A. sonchi earlier, were re-identified as moniliphenone and pinselin, respectively. The isolated compounds were tested for phytotoxic, antimicrobial, insecticidal, cytotoxic and esterase-inhibition activities. They did not demonstrate high phytotoxicity (lesions up to 2.5 mm in diameter/length at a concentration of 2 mg/mL) when tested on leaf disks/segments of perennial sowthistle (Sonchus arvensis) and couch grass (Elytrigia repens). They did not possess acute toxicity to Paramecium caudatum, and showed moderate to low cytotoxicity (IC50 > 25 µg/mL) for U937 and K562 tumor cell lines. However, chloromonilicin and methyl 3,8-dihydroxy-6-methyl-4-chloro-9-oxo-9H-xanthene-1-carboxylate (4) were shown to have antimicrobial properties with MIC 0.5–5 µg/disc. Compound 4 and chloromonilinic acid B were found to have contact insecticidal activity to wheat aphid (Schizaphis graminum) at 1 mg/mL. Compounds 2 and methyl 3,8-dihydroxy-6-methyl-9-oxo-9H-xanthene-1-carboxylate displayed selective carboxylesterase inhibition activity at concentration of 100 µg/mL. Therefore, the waste solid substrate for production of A. sonchi spores can be re-utilized for the isolation of a number of valuable natural products.


In this chapter we share research findings from our collaborative research project 'PASAR: Participatory Arts and Social Action in Research' (http://fass.open.ac.uk/research/projects/pasar), which combines participatory action research methods of participatory theatre and walking methods in order to understand the way in which racialized migrant women challenge their exclusion and subjugation in the context of the UK. The situation of migrant families in the UK is currently characterized by the 'hostile environment' policies. This policy 'is a sprawling web of immigration controls embedded in the heart of our public services and communities. The Government requires employers, landlords, private sector workers, NHS staff and other public servants to check a person's immigration status before they can offer them a job, housing, healthcare or other support.' (Liberty 2018:5). The currently hegemonic political discourse, views migrants as outsiders to the nation and challenges their right to access welfare. Migrant families are cast as outsiders to citizenship, challenging the social and cultural cohesion of the nation. Indeed, UK immigration policies render it difficult for migrant families to secure their social and economic reproduction. Against this backdrop, the research explores how racialized migrant families develop their subjugated knowledges to claim belonging and participate in the society they live in. In this presentation, we share the key methodological findings, challenges and benefits of working with a PAR approach for co-producing transformatory knowledge with migrant families and advocacy organizations. In line with the aims of this book, we reflect on the transformatory potential of research and knowledge for the common good through 'alternative collaborative system of co-researchers and co-learners engaged in dialogue with civil society and social movements'


: The authors analyse the results of endoscopic colonomicroscopy at various magnifications in 250 patients. A study of dye absorption in different histological types of colonic tumor made it possible to establish that chromocolonoscopy is an effective method in diagnosing and differentiating some types of tumors and hyperplastic changes in the mucosa of the colon. Adenomas with severe dysplasia of the glandular epithelium, and tumors with a structure of an adenocarcinoma do not readily accept vital staining.


With limited coverage of wireless networks and frequent roaming of mobile users, providing a seamless communication service poses a technical challenge. In our previous research, we presented a supernode system architecture that employs the delay-tolerant network (DTN) concept to provide seamless communications for roaming users over interconnected heterogeneous wireless networks. Mobile ad hoc networks (MANETs) are considered a key component of the supernode system for services over an area not covered by other wireless networks. Within the super node system, a dominating-set routing technique is proposed to improve message delivery over MANETs and to achieve better resource utilization. The performance of the dominating-set routing technique depends on estimation accuracy of the probability of a future contact between nodes. This paper studies how node mobility can be modeled and used to better estimate the probability of a contact. We derive a distribution for the node-to-node intermeeting time and present numerical results to demonstrate that the distribution can be used to improve the dominating-set routing technique performance. Moreover, we investigate how the distribution can be employed to relax the constraints of selecting the dominating-set members in order to improve the system resource utilization.


In a 1‐year follow‐up study, the effects of amniocentesis for genetic diagnosis upon 22 infants and their mothers were assessed. The infants were tested at 1 year of age on the Bayley Infant Scale of Mental and Motor Development. No deviations from normal mental or motor development were found. The mothers were interviewed at the same time, in order to better understand the emotional aspects of the experience. Women between ages 35‐39 with no previously affected child tended to accept amniocentesis easily, as an appropriate part of prenatal care. Mothers with a previous defective child tended to have more painful emotional reactions, including higher anxiety over the test and more conflict about a possible abortion. They needed more intensive and extended counseling. We suggest that the issue of abortion is important, even if manageable by most women, and that a chance to discuss it may be significant.


The programming of efficient parallel software typically requires extensive experimentation with program prototypes. To facilitate such experimentation, any programming system that supports rapid prototyping of parallel programs should provide high-level language primitives with which programs can be explicitly, statically, or dynamically tuned with respect to performance and reliability. Such language primitives should be able to refer conveniently to the information about the executing program and the parallel hardware required for tuning. Such information may include monitoring data about the current or previous program or even hints regarding appropriate tuning decisions. Language primitives and an associated programming system for program tuning are presented. The primitives and system have been implemented, and have been tested with several parallel applications on a network of Unix workstations. >


Automatically identifying that a certain page in a set of documents is printed with a different printer than the rest of the documents can give an important clue for a possible forgery attempt. Different printers vary in their produced printing quality, which is especially noticeable at the edges of printed characters. In this paper, a system using the difference in edge roughness to distinguish laser printed ages from inkjet printed pages is presented. Several feature extraction methods have been developed and evaluated for that purpose. In contrast to previous work, this system uses unsupervised anomaly detection to detect documents printed by a different printing technique than the majority of the documents among a set. This approach has the advantage that no prior training using genuine documents has to be done. Furthermore, we created a dataset featuring 1200 document images from different domains (invoices, contracts, scientific papers) printed by 7 different inkjet and 13 laser printers. Results show that the presented feature extraction method achieves the best outlier rank score in comparison to state-of-the-art features.


Computational imaging systems algorithmically post-process acquisition images either to reveal physical quantities of interest or to increase image quality, e.g., deblurring. Designing a computational imaging system requires co-design of optics and algorithms, and recently Deep Lens systems have been proposed in which both components are end-to-end designed using data-driven end-to-end training. However, progress on this exciting concept has so far been hampered by the lack of differentiable forward simulations for complex optical design spaces. Here, we introduce dO (DiffOptics) to provide derivative insights into the design pipeline to chain variable parameters and their gradients to an error metric through differential ray tracing. However, straightforward back-propagation of many millions of rays requires unaffordable device memory, and is not resolved by prior works. dO alleviates this issue using two customized memory-efficient techniques: differentiable ray-surface intersection and adjoint back-propagation. Broad application examples demonstrate the versatility and flexibility of dO, including classical lens designs in asphere, double-Gauss, and freeform, reverse engineering for metrology, and joint designs of optics-network in computational imaging applications. We believe dO enables a radically new approach to computational imaging system designs and relevant research domains.


This study investigated the solution of the rigidity and structural vibration for system of linear guideway type based on ANSYS workbench. By comparing the results derived from the simulation of the model and the corresponding theoretical results, the validity of the theoretical solution can be verified. The analysis includes the system rigidity and the natural vibration frequency in the direction of vertical slider (Vertical), rolling (Rolling) and swing (Pitching), the structural vibration frequency for system of linear guideway type is carried out, the model is built according the true dimensions, what is more, the rollers are not necessary replaced by springs, because there is not so much difficulties by using ANSYS workbench and more accurate results can be obtained in this way. Two different types of simulation are carried out, and the simulation results show that different geometric sizes of slider, which mean different numbers of rollers, will change the resonance frequencies and mode shapes, and more rollers can enhance the stiffness of the LGT model, then reduce the possibility of resonance happening.


This study investigates the cortical abnormalities of early emotion perception in patients with major depressive disorder (MDD) and bipolar disorder (BD) using gamma oscillations. Twenty-three MDD patients, twenty-five BD patients, and twenty-four normal controls were enrolled and their event-related magnetoencephalographic responses were recorded during implicit emotional tasks. Our results demonstrated abnormal gamma activity within 100 ms in the emotion-related regions (amygdala, orbitofrontal (OFC) cortex, anterior insula (AI), and superior temporal pole) in the MDD patients, suggesting that these patients may have dysfunctions or negativity biases in perceptual binding of emotional features at very early stage. Decreased left superior medial frontal cortex (smFC) responses to happy faces in the MDD patients were correlated with their serious level of depression symptoms, indicating that decreased smFC activity perhaps underlies irregular positive emotion processing in depressed patients. In the BD patients, we showed abnormal activation in visual regions (inferior/middle occipital and middle temporal cortices) which responded to emotional faces within 100 ms, supporting that the BD patients may hyperactively respond to emotional features in perceptual binding. The discriminant function of gamma activation in the left smFC, right medial OFC, right AI/inferior OFC, and the right precentral cortex accurately classified 89.6% of patients as unipolar/bipolar disorders.


True gynecomastia is a benign proliferation of the glandular tissue of the male breast. In general, management is conservative, however if there is development of fibrosis after the inflammatory phase, surgery is recommended. The present article describes a case of true gynecomastia with symmetrical enlargement of the breasts since adolescence. In light of this diagnosis, corrective surgery was performed with tumescent anesthesia and exeresis in block of the mammary gland.


This thesis contributes to our understanding of executive compensation schemes in the United Kingdom (UK). On one hand, the study focuses on the effectiveness of long-term incentive plans (LTIPS) which has come under scrutiny in the recent past. On the other hand, it tests within various settings whether compensation contracts are designed optimally. It also looks in detail at the contractual features of long-term incentives which have received little attention in the literature to date.
The first empirical chapter analyses the effect of firm performance on Chief Executive Officer/ Chief Financial Officer (CEO/CFO) pay by employing a sample of non-financial FTSE 350 firms during 2010-2014. We test this association by differentiating between the impacts of short-term and long-term performance on short and long-term compensation. The short and long-term compensation components consist of cash (salary and bonus), equity (performance share plan, share option, matching plan and others) and total realized pay (salary, bonus and total equity vested) of CEO and CFO compensation. We also explore the effectiveness of LTIPs awarded to executives by examining the impact of different numbers, amounts and types of long-term plans on the long-term pay-performance responsiveness. The results indicate that CEO long-term pay, total realized pay and total remuneration are determined by a firm's three-year performance. These results also hold true for CFO but the relationship is not as strong as that for CEO. Also, for CEOs and CFOs, companies that use three or four separate LTIP plans award higher realized pay and total remuneration than companies that do not award any LTIP. However, for CEOs, companies that operate one, two or three plans in a compensation package, align the interests of CEOs with those of the shareholders. Basic plans in compensation packages tend to increase the pay-performance responsiveness. Within these LTIPs, the more valuable the grants are, the stronger the pay-performance relationship becomes. However, for CFOs, greater number or amounts of LTIPs correspond to higher total compensation and realized pay and greater pay-performance responsiveness. These findings suggest that higher grants encourage greater CFO effort, leading to higher equity vesting because of the attainment of performance targets. For CFO, the pay-performance responsiveness differs in number and amount of long-term incentives awarded than that of CEO. Finally, these findings remain consistent with the use of market adjusted TSR, further strengthening the conclusion of the research question.
Next, we analyse the influences on and the effects of the choice of performance measure in CEO compensation contracts, for a sample of 3400 plans from 2007 to 2015. We investigate the link between the choice of performance measure and the volatility of earnings per share (EPS) and total shareholder return (TSR), taking into account four different performance categories, in that a firm may use either EPS or TSR, both, or neither. This allows us to utilize a comprehensive cross-section of plans and accounts for when both EPS and TSR are jointly employed. We find that EPS in combination with TSR is the most common performance metric employed by firms. The findings show that firms with higher EPS volatility and lower TSR volatility are more likely to choose TSR as a performance measure and that firms with higher EPS volatility are less likely to choose EPS alone; we argue that these results are in line with optimal contracting theory. Our results are robust to controlling for plan types, industry and time fixed effects. We control for the effect of the identity of the advising compensation consultant and also for industry on the category of performance measure, and find that some consultants, and some industries, have marked preferences for one measure over another. This, we argue, is an evidence of institutional isomorphism.
The final empirical chapter analyses the effect of common shock on the selection of relative performance evaluation (RPE) based plan in the construction of CEO compensation packages. The results indicate that firms implement RPE based measures exclusively when a performance measure contains significant shocks which are common amongst peer companies and are consistent with the predictions of agency theory. These results are robust after controlling for the identity of the remuneration consultant and alternate proxies for common risk, for example, r-square and correlation. We provide a novel analysis of the breakdown of RPE characteristics, namely, different peer choices, threshold targets, and the equity vesting pertaining to these threshold targets by industry in compensation contracts as set by the firms. The findings reveal that firms are very distinct in their peer group selection and the choice of performance targets. Furthermore, we assess the relationship between common risk and the characteristics of the RPE. We identify that firms facing greater common risk tend to employ tougher performance targets in the shape of wider target spread and a lower percentage of equity vesting at the median and upper quartile threshold targets, where target spread is the difference between median and maximum performance required for equity vesting. Finally, we find that vesting percentages vary in characteristics of RPE.


In this paper we describe new ways to realise micro-channels. The used technologies are based on a novel thick-film photoplastic, the SU-8. This photoresist has outstanding properties, allowing the realisation of high aspect ratio microstructures. It is a simple and low-cost fabrication process. The micro channels developed in this work will be used for the realisation of thermal flow-sensors.


The important yarn quality parameters, like evenness, imperfection, hairiness, strength and breaking elongation percentage, of blow-room blended cotton melange yarn have been studied using Taguchi experimental design. The impacts of process parameters, such as shade depth (%), twist multiplier and ring frame spindle speed, have been studied in presence of two unavoidable and uncontrolled noise parameters. The experimental results show that the melange yarn quality parameters are significantly affected by shade depth and ring frame spindle speed. A ranking of the three controlled parameters and the percentage contribution of each of these parameters have also been evaluated. The shade depth is found most dominating factor affecting cotton melange yarn quality. The set of optimum parameters that correspond to the highest S/N ratio of evenness, imperfections, hairiness, strength and breaking elongation percentage have also been determined.


A 44 year old diabetic woman presented with diplopia and bilateral ptosis and mild exophthalmos. The patient was clinically euthyroid, the baseline thyroid function tests were normal, but the thyroid stimulating hormone response to thyrotrophin releasing hormone was flat. Computed tomographic scan and magnetic resonance imaging of the orbits showed left medial and inferior rectus muscle thickening, more prominent on the left side, consistent with Graves' disease. The tensilon stimulation test resulted in resolution of the ptosis and partial improvement of the ophthalmoplegia. The single fibre electromyography was consistent with a defect in neuromuscular transmission. However, forced duction test was normal and anti-acetylcholine receptor antibodies were undetectable. Significant improvement of the extraocular muscle function and resolution of the right ptosis had resulted from anticholinesterase therapy. These findings and the clinical response to therapy were consistent with concomitant euthyroid Graves' ophthalmopathy and ocular myasthenia gravis. Coexistent isolated ocular myasthenia gravis and Graves' ophthalmopathy is rare and should be considered in patients with findings of ocular myasthenia and extraocular muscle dysfunction.


Sir .—We would like to congratulate Gerber et al 1 on their careful collection of data comparing BID and TID penicillin therapies for group A β-hemolytic streptococcal pharyngitis. However, the analysis of those data was incomplete and it therefore misled the authors into making improper conclusions. Their data showed a difference in failure rates of 28% vs 18% in favor of TID therapy. However, this difference was not statistically significant by the χ 2 test ( P =.21), and the authors concluded that the investigation suggested "that oral penicillin V given twice daily is as effective as penicillin V given three times daily." The P value cited here only indicates the likelihood of type I or α error: the probability of accepting two forms of therapy as different when, in fact, they are the same. That is, these data do not permit the conclusion that the two treatments are different, for


BACKGROUND
The World Health Organization classified coronavirus disease-19 (COVID-19) as a pandemic and recommends strict restrictions regarding most aspects of daily activities.

OBJECTIVES
To evaluate whether the pandemic has changed the prenatal care and pregnancy outcome in pregnant women without COVID-19.

METHODS
The authors conducted a cross-sectional study to describe changes in outpatient clinic visits and to compare the rates of cesarean and instrumental deliveries between two periods of time: March-April 2020 (during the COVID-19 outbreak) with March-April of the preceding year, 2019.

RESULTS
During the COVID-19 outbreak, visits to obstetric triage, gynecologic triage, high-risk clinic, and ultrasound units decreased by 36.4%, 34.7%, 32.8%, and 18.1%, respectively. The medical center experienced a 17.8% drop in the total number of births (610 births) compared with March and April 2019 (742 births). During the outbreak women were more likely to be nulliparous (33.3% vs. 27.6%, P = 0.02) and present with hypertensive disorders during pregnancy (7.5% vs. 4%, P = 0.005) or gestational diabetes (13% vs. 10%, P = 0.03). More epidural analgesia was used (83.1% vs. 77.1%, P = 0.006). There were more operative vaginal deliveries during the outbreak (16.7% vs. 6.8%, P = 0.01). All other maternal and neonatal outcomes were comparable between the two periods.

CONCLUSIONS
The medical facility experienced a major decline in all aspects of the routine obstetrics activities during the time of the pandemic. The higher rate of operative vaginal deliveries among nulliparous may be associated with the pandemic effect on the rate of high-risk patients.