Citation: Thede, L., (June 15, 2009) "Informatics: Electronic Records and Organizational Culture" OJIN: The Online Journal of Issues in Nursing Vol. 14 No. 3. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Informatics/Electronic -Records-Organizational-Culture.aspx Healthcare is changing. We hear this from many sources. One change that you have probably already seen is the use of the computer for at least some documentation of care. However, at this writing, there are very few healthcare agencies that are already paperless, which is the ultimate goal of the move to electronic records. Thus most of us are involved in situations in which we, willingly or unwillingly, are doing some documentation on the computer while still maintaining paper records, printed reports, or both. In reality, the technology to make all of our healthcare agencies paperless exists today. This prompts the question: why have we not moved more rapidly in this direction? The usual answers relate to the lack of resources, both time and money. However, a more important reason, although also a more hidden reason, has to do with organizational culture, which is defined informally, as "the way we do things around here" (Deal & Kennedy, 1982, p. 4). Anyone who has ever tried to implement a new system has found that the most difficult part of the implementation is not software, but "peopleware," i.e., "us"! We often resist the new way of doing things, attributing this resistance to a poorly designed system or our own temperamental shortcomings. We assume that the new system is value neutral (Hodas, 1993). Although occasionally this resistance is a result of poorly designed systems, even good systems are often slow to be accepted. Mr. Hodas, in his 1993 article, described the difficulty in getting teachers to accept a new technology, and noted that "schools (read healthcare organizations) are themselves a technology." They are a way of behaving towards a specific goal, usually a tacit one, in which we abide by certain behaviors and values without fully understanding them. These behaviors preserve authority and maintain certain practices and values while minimizing or eliminating others. In healthcare we have optimized our agencies to the mission we believe society has assigned to us. The 1999 Institute of Medicine (IQM) report To Err is Human has brought to our attention the high incidence and unfavorable outcomes of medical errors. Greater use of informatics, which for many users means entering into and retrieving data from computers, is often promoted as one of the methods to decrease these errors. It is assumed that our organizations, desiring to provide excellent patient care, will adopt this rational, deductive approach by using electronic records to reduce the number of medical errors. This assumption misses the point that organizations do not always behave in a rational manner. We all seek our own perpetuity, whether of the organization or our place in it. Hence, we may experience the introduction of electronic charting as not just a challenge, but rather a disruption of our work. Given that these systems will, indeed must, create changes in work flow, this is not an irrational response. As a result our behaviors are often aimed at relieving the pressure created by these changes, rather than advancing a rational approach to solve a defined problem. The change from paper to electronic documentation appears to those outside of nursing, who too often may be administrators or information technology (IT) specialists, as an improvement. For clinicians, however, the introduction of the electronic record too often means disrupting our values and habits to accommodate this new technology. Healthcare organizations have clearly defined lines of power, authority, and flow of information. They remain hierarchical organizations in regard to this power, authority and flow of information. …


Ground Motion Prediction Equations (GMPEs) are empirical relationships which are used for determining the peak ground response at a particular distance from an earthquake source. They relate the peak ground responses as a function of earthquake source type, distance from the source, local site conditions where the data are recorded and finally the depth and magnitude of the earthquake. In this article, a new prediction algorithm, called Conic Multivariate Adaptive Regression Splines (CMARS), is employed on an available dataset for deriving a new GMPE. CMARS is based on a special continuous optimization technique, conic quadratic programming. These convex optimization problems are very well-structured, resembling linear programs and, hence, permitting the use of interior point methods. The CMARS method is performed on the strong ground motion database of Turkey. Results are compared with three other GMPEs. CMARS is found to be effective for ground motion prediction purposes.


— The absence of reliable, high-performance affordable turbine-blades is an obstacle to the commercialisation of tidal-stream energy. This paper describes a novel, but commercially proven, manufacturing process for composites that can address this challenge and discusses the merits and limitations of the resulting blades. The process uses a ceramic, heated mould to process epoxy powder and glass fibre into blades and offers advantages over alternative techniques. The paper also outlines a sensor system for blades that reduces maintenance costs and increases reliability. Together, these technologies are set to play an important role in creating a new European industry – the production of tidal stream turbines. The research is being funded through the Smart Efficient Affordable Marine Energy Technology Exploitation using Composites (SEA ME TEC) project, within Horizon 2020 SME Instrument framework.


Bleomycin labeled with @@Co was used as a tumor-localizing agent in 132 patients. In pa tients with pulmonary tumors the primary to causation concentrated radioactivity in 52 of the 54 appropriate cases; out of the 22 dm1catty known metastases, 19 were visible on the scan; 40 unknown metastases especially in hilus and mediastinum were found by this method and subsequently confirmed. In 22 patients with malignant lymphomas, 18 out of 22 known pathologic lymph glands above the diaphragm were visible on the scan; below the diaphragm the results of scanning in lymph glands and spleen were disappointing, probably because of the disturbing concentration of radioactivity in the kidneys, the bladder, the liver, and some times the gut. In 25 patients with various other tumors, 16 out of 22 known localizations above the diaphragm were visible; 2 were uneertain and 4 negative. Below the diaphragm the results were usually negative. In 24 patients with be nign lesions, uptake of 57Co-bleomycin was visi ble on the scintigram in 4 patients with cavi tating pulmonary tuberculosis, in 2 with pulmonary infections, in 1 with Caplan lesions of rheumatoid arthritis in the lung, and in 1 with sinusitis ethmoidalis. The significance of these results is discussed.


The Well Containment Screening Tool (WCST) focuses on well integrity evaluation after well control incident. The WCST favors a greater wall thickness and, hence, a narrower cementing annulus, potentially increasing the risk of cement loss. We develop a structured and systematic physical model to simulate and track formation damage. A simulation process is conducted to assess the sensitivity of zonal isolation risk as design parameters are changed. In this paper, a physical model involving wellbore, casing and cement fluid is developed to understand the interaction between cement fluid and the formation. Two failure metrics are defined that provide a comprehensive understanding of the zonal isolation risk. Quantitative risk assessment is implemented with Monte Carlo simulation to assess the risk of zonal isolation problems when design parameters are changed. Models of production casing and intermediate casing are studied to verify the generality of this analysis. Taking both failure metrics into consideration, sensitivity analysis for models of production casing and intermediate casing present common observations regarding changes of design parameters. Our analysis suggests that minor increases (within 0.05") in casing thickness, due to increased outer diameter, has little influence on the risk of cement loss, as does slight decreases in mean open hole diameter (within 0.05"). To verify the generality of this approach, in addition to casing and wellbore parameters, the sensitivity to cement fluid flowrate is analyzed. We find that risk is not significantly affected by small increase of flowrate (e.g. from 40 to 100 gpm). This paper applies a novel quantitative risk analysis to assess the influence of different design parameters on zonal isolation problems. This approach, if well implemented, can help to assess the impact of changes in design parameters (e.g., casing length and depth, mud density and cement fluid density, etc.) on drilling safety. It can also help to inform drilling decisions by providing forecasts of zonal isolation risk for particular geological condition.


A method for predicting XPS C1s binding energies in polymers has been developed previously [1]. The calculation uses partial atomic charges determined quantum chemically (by the semi-empirical AM1 Method), which are found to provide a linear correlation with the binding energies corrected by the so-called Madelung intramolecular potential. We used this method successfully for interpreting XPS spectra of partially degraded fluoropolymers [2]. In the current contribution we investigate the possibility of developing a similar equation to describe siliconcontaining polymers that are medically and technologically important, and also some nanoparticles based on organo-silicon compounds.


Vehicle location based services and tracking system available in Nairobi city mainly focus on private car owners, fleet management for various organization and cargo tracking. On the other hand, public service vehicles (PSV) have not attracted much attention of the car tracking companies. Public transport in Nairobi city is generally characterized by a lot of chaos; these ranges from poor management of the vehicles, traffic congestion, reckless driving and unreliable service provision. PSV owners have been victims of rogue operators who do not submit their full revenues thus greatly reducing their profit margins thus escalating their business running costs. The main objective of the project was to develop a customized location based service that caters for the needs of the public transport sector in Nairobi city. The project demonstrates development of a prototype open source solution for management of public transport in Nairobi. The solution uses GPS, web GIS and GPRS technologies for real time transmission of coordinates from the tracking device to the central database server and finally rendering on the web page. The development process of the system entailed the analysis of existing systems in the city, system design and development, evaluation and implementation. OpenGTS (Open GPS Tracking System) platform for tracking was adopted and customised to the needs of public transport in Nairobi.The research provides a cheap solution for effective management of public service vehicles by preventing vehicle misuse. The final solution comprises of a web based application, android application and customized query interface. The web based application provides graphical visualization and the customized queries while the android application used by the vehicle operator to update non spatial the database.


Abstract We report on impedance measurements of nano- and microcrystalline composites of the Li ion conductor Li2O and the ionic insulator B2O3 as well as their interpretation in the frame of percolation models. In the experimental part, besides the dc conductivity and its dependence on composition and temperature (i.e. its activation energy) also the ac conductivity and its dependence on composition, temperature and frequency (i.e. the conductivity exponent) are presented. Striking differences between the nanocrystalline and the corresponding microcrystalline composites were found. Deviations of the ac from the dc results can be explained by the fact that the experiments probe ion dynamics on different time and thus length scales. In the theoretical part, a continuum percolation model, a brick-layer type bond percolation approach and a Voronoi construction are alternatively used to model the dc behaviour. Based merely on the largely different volume fractions of the interfaces between ionic conductor and insulator grains in the nano- and microcrystalline composites, good overall agreement with the experimental dc results is obtained. The high critical insulator content above which the experimental conductivity vanishes in the nanocrystalline composites suggests the presence of an additional Li diffusion passageway of nanometer length in the interface between nanocrystalline insulator grains.


This paper presents two new results on multiple-input multiple-output (MIMO) Gaussian broadcast channels with confidential messages. First, the MIMO Gaussian wiretap channel is revisited. A matrix characterization of the capacity-equivocation region is provided, which extends the previous result on the secrecy capacity to the more general imperfect secrecy setting. Next, the MIMO Gaussian broadcast channel with two receivers and three independent messages: a common message intended for both receivers, and two confidential messages each intended for one of the receivers but needing to be kept asymptotically perfectly secret from the other, is considered. A precise characterization of the capacity region is provided, generalizing the previous results which considered only two out of three possible messages.


Face forgery by deepfake is widely spread over the internet and has raised severe societal concerns. Recently, how to detect such forgery contents has become a hot research topic and many deepfake detection methods have been proposed. Most of them model deepfake detection as a vanilla binary classification problem, i.e, first use a backbone network to extract a global feature and then feed it into a binary classifier (real/fake). But since the difference between the real and fake images in this task is often subtle and local, we argue this vanilla solution is not optimal. In this paper, we instead formulate deepfake detection as a fine-grained classification problem and propose a new multi-attentional deepfake detection network. Specifically, it consists of three key components: 1) multiple spatial attention heads to make the network attend to different local parts; 2) textural feature enhancement block to zoom in the subtle artifacts in shallow features; 3) aggregate the low-level textural feature and high-level semantic features guided by the attention maps. Moreover, to address the learning difficulty of this network, we further introduce a new regional independence loss and an attention guided data augmentation strategy. Through extensive experiments on different datasets, we demonstrate the superiority of our method over the vanilla binary classifier counterparts, and achieve state-of-the-art performance. The models will be released recently at https://github.com/yoctta/multiple-attention.


Hormonal and reproductive factors modulate bioavailable estrogen to influence endometrial cancer risk. Estrogen affects the microsatellite status of tumors, but the relation between these estrogen-related factors and microsatellite instability (MSI) status of endometrial tumors is not known. We evaluated associations between hormonal and reproductive factors and risks of microsatellite stable (MSS) and MSI endometrial cancer among postmenopausal women (MSS cases = 258, MSI cases = 103, and controls = 742) in a population-based case–control study in Alberta, Canada (2002–2006). Polytomous logistic regression was used to estimate ORs and 95% confidence intervals (95% CI). We observed a significant trend in risk reduction for MSI (Ptrend = 0.005) but not MSS (Ptrend = 0.23) cancer with oral contraceptive use; with 5-year use or more, the risk reduction was stronger for MSI (OR = 0.42; 95% CI, 0.23–0.77) than for MSS cancer (OR = 0.80; 95% CI, 0.54–1.17; Pheterogeneity = 0.05). For more recent use (<30 years), the risk reduction was stronger for MSI (OR = 0.36; 95% CI, 0.19–0.69) than for MSS cancer (OR = 0.77; 95% CI, 0.51–1.15; Pheterogeneity = 0.032). No differential risk associations were observed for menopausal hormone use, parity and age at menarche, menopause or first pregnancy. We found limited evidence for statistical heterogeneity of associations of endometrial cancer risk with hormonal and reproductive factors by MSI status, except with oral contraceptive use. This finding suggests a potential role for the MMR system in the reduction of endometrial cancer risk associated with oral contraceptive use, although the exact mechanism is unclear. This study shows for the first time that oral contraceptive use is associated with a reduced risk for MSI but not for MSS endometrial cancer. Cancer Epidemiol Biomarkers Prev; 22(7); 1325–31. ©2013 AACR.


INTRODUCTIONPublic education in the United States may be on the verge of radical reform. The impetus for sweeping change is provided by the persistence of severe problems of a systemic nature which show no hint of fading away. Ongoing financial troubles and unstable labor relations that undermine the provision of educational services, decaying buildings and facilities that no longer meet educational needs, and an array of social problems that overwhelm school personnel are just some of the major issues confronting public schools. There is also growing public concern over the quality of education children receive, based on the widespread perception that standards have fallen and that too many public schools are failing to meet their intellectual needs. In many communities, public schools have become the schools of last resort for those who cannot afford the option of private schools, while those with means do whatever possible to avoid them.During the 1980s, several national reports drew attention to what was perceived as a precipitous deterioration in the standards and quality of education in the U.S. (Business--Higher Education Forum, 1983; The College Board, 1983; Education Commission of the States, 1983; Gross & Gross, 1985; National Commission on Excellence in Education, 1983). These reports attempted to link educational decline, as measured by school performance and student achievement on the Scholastic Aptitude Test (SAT) and other standardized tests, to the poor performance of the U.S. economy and the reduced competitiveness of American products on the international market. Increasingly, the whole system of public education, including its administrative apparatus, has come under attack. Typically, it has been accused of being inefficient, top-heavy, and preoccupied with rules and regulations rather than focused on providing quality education. Teachers, students, and parents have also received a share of the blame for school failure and the "rising tide of mediocrity that threatens our very future as a Nation and a people" (Gross & Gross, p. 5).For these reasons and others, the time may now be ripe for radical reform of public education. Under the rubric of a variety of privatization proposals, several advocates for reform have stated as their goal nothing less than the complete dismantling of public education. The proposals for reform vary in form and content and in the extent to which they alter or transform the existing system. However, regardless of how the ideas are packaged, the current crop of reform proposals are unified by a common belief in the marketplace as the preeminent regulator and guarantor of educational quality. Under the guise of increasing consumer accountability, the conservative critics of public education are pushing for privatization as the medicine that will cure the many ills that beset public schools in the U.S.Given this nation's long history of support for public education, one might be tempted to believe that any effort to undermine the extensive system of public education in the United States would be doomed to failure. The U.S. was, after all, the first Western industrialized nation to establish public schools. Moreover, communities across the country increasingly are looking toward their public schools for solutions to a growing list of social problems. Whether the issue is drugs or the environment, violence or sexually transmitted diseases--more often than not, the search for solutions involves turning to the public schools to find ways to influence popular attitudes on matters of critical social importance. Hence, rather then becoming expendable, in many respects U.S. society is becoming increasingly dependent upon public schools as one of the few remaining viable social institutions that can be relied upon to address a variety of social issues.Yet, despite this reality, large segments of society now appear willing to radically transform public education and replace it with new models, many of which are largely undefined and untested. …


We have carried out light-curve and time-series analysis of a sample of 16 pulsating red giants (PRGs) in the globular cluster ω Cen, using observations from the ASAS-SN database, and the AAVSO software package VS tar . Of the 16 stars, 1 was classified by ASAS-SN as Mira (M), 5 as semiregular (SR), and 10 as "long secondary period" (LSP), i.e. the dominant period was an LSP. We have determined pulsation periods (P) for all of them, secondary pulsation periods for 3, possible secondary pulsation periods for 4, and LSPs for 8. This confirms that LSPs are common in Population II stars. In the context of a recent model for LSPs, this implies that many Population II PRGs had planetary companions which accreted gas and dust to become brown dwarfs or low-mass stars, now enshrouded by dust. In this model, the LSP is the orbital period of the hypothetical companion. The amplitudes of the pulsation periods vary by up to a factor of 3.4 on a median time scale of 18 pulsation periods, for reasons unknown. The ratios of LSP/P cluster around 4 and 8, presumably depending on whether P is a fundamental mode or first overtone period. We have augmented our sample with a few stars from the literature to plot period-luminosity relations. Sequences for LSPs, fundamental, and first-overtone pulsation periods are visible. Our results show that the complex variability of the PRGs in ω Cen is similar to that of red giants in other stellar systems, and in the field. In Appendix 1, we give results for a few red giants in NGC 6712, which we obtained as a prelude to the ω Cen project.


BACKGROUND
Data on complications of pregnancy associated with antiretroviral therapy are limited. Some small studies have demonstrated an increased preterm delivery rate, but a recent retrospective United States multisite study did not concur with these findings. Our objective was to investigate whether antiretroviral therapy was associated with adverse pregnancy outcome at a single site.

METHODS
Using prospectively gathered data, women were identified who were determined to be human immunodeficiency virus positive before or during pregnancy who sought care at our prenatal clinic and who gave birth at the University of Miami/Jackson Memorial Medical Center from 1990 through 2002. The outcome measures were preterm delivery, low birth weight, and stillbirth.

RESULTS
The cohort included 999 women who received antiretroviral therapy during pregnancy (monotherapy in 492, combination therapy without a protease inhibitor [PI] in 373, and combination therapy with a PI in 134) and 338 women who did not receive therapy. After adjustment for possible confounders, only combination therapy with a PI was associated with an increased risk of preterm delivery, compared with any other combination (odds ratio, 1.8 [95% confidence interval, 1.1-3.0]). There were no differences in rates of low birth weight and stillbirth, regardless of therapy.

CONCLUSION
Compared with monotherapy and combination therapy without a PI, only combination therapy with a PI was associated with an increased risk of preterm delivery.


Background: Many intracranial hemorrhage (ICH) patients are emergently transferred to tertiary neurosurgical centers by helicopter emergency medical services (HEMS), yet no guidelines exist for HEMS use in acute ICH. The American Stroke Association (ASA) publishes guidelines for neurosurgical intervention in ICH patients. Additionally, high ICH scores have been shown to predict lethal ICHs. We hypothesized that an algorithm including ASA guideline criteria and ICH score would identify patients for whom HEMS transportation might be appropriate. Objectives: To determine, in ICH patients transferred by HEMS, (1) the sensitivity of ASA guidelines for predicting emergent neurosurgical intervention, and (2) the ability of an ICH score ≥4 to predict early mortality and failure to receive intervention. Methods: We conducted a retrospective chart review of ICH patients transported by HEMS to one tertiary care center between September 2008 and February 2011. We reviewed medical records and brain CTs from the hospital of first presentation to calculate ICH scores and to evaluate for the seven ASA guideline criteria: GCS score ≤8, herniation, intraventricular hemorrhage, hydrocephalus, brainstem compression, lobar clot >30 mL within 1 cm of the paranchymal surface, and cerebellar hemorrhage. We reviewed tertiary center records for neurosurgical interventions and in-hospital mortality. Results: Review of 137 patient records identified 86 patients with an ICH and an available initial brain CT. All patients who received an emergent intervention met at least one of the criteria (sensitivity 100%), while 16 (18.6%) patients transferred by HEMS met no ASA criteria. No patient with an ICH score of ≥4 (n=19) received an emergent neurosurgical intervention, and only one such patient survived to hospital discharge. Comparison of this group to all others produced a hazard ratio of 5.86. Thirty-five (40.7%) patients had either no ASA criteria or an ICH score ≥4. Conclusions: The ASA guidelines have high sensitivity for detecting those patients who will receive emergent neurosurgical intervention after transfer, while patients with ICH scores of ≥4 almost uniformly have lethal hemorrhages and do not undergo emergent intervention. An algorithm including the presence of at least one of the seven ASA ICH neurosurgical intervention criteria and an ICH score


This research examined career priority patterns among samples of managerial and professional women in Bulgaria, Canada, Norway, and Singapore. Data were collected using questionnaires. Women in all four countries shared similar career priority patterns, endorsing patterns that combined both career and family.


Abstract Carbon capture and storage by mineralization is a potential method for storing anthropogenic CO2 emissions, and is based on the reaction between Mg silicate and CO2 to form Mg carbonate. The conglomerates of the Barzaman Formation exposed in the eastern United Arab Emirates represent an excellent natural analogue of this process. These conglomerates were deposited as a series of alluvial fans along the western margin of the Hajar Mountains, part of the Oman-UAE Ophiolite, and are composed largely of ultramafic and lesser-mafic clasts. The clasts and matrix have been extensively altered to dolomite during diagenetic processes. Analysis and interpretation of rock textures provide evidence for the various factors that influenced the diagenetic processes and shed light on the silicate–carbonate transformation process. All the reactions have taken place in the near-surface environment; the silicate–carbonate conversion reaction is exothermic and occurs spontaneously at near-ambient pressure and temperature, probably no greater than 50 °C. Estimates of the amount of CO2 stored in this way can be obtained from considerations of outcrop area, formation thickness and percentage of dolomite replacement, and show that c. 150 billion tonnes (equivalent to about 4 years of worldwide CO2 emissions at current rates) are stored.


Abstract This study focuses on nominal pluralization in Sign Language of the Netherlands (NGT). The aim is to offer a comprehensive description of nominal pluralization processes in the language, based on both corpus data and elicited data, taking into account potential phonological restrictions. The results reveal that NGT nouns can undergo several pluralization processes, the main ones being simple reduplication (i.e., repeating the noun sign at one location) and sideward reduplication (i.e., repeating the noun sign while moving the hand sideward). The choice of pluralization process depends on phonological properties of the base noun: (i) nouns that are body-anchored or involve a complex movement undergo simple reduplication; (ii) nouns articulated at the lateral side of the signing space undergo sideward reduplication; (iii) nouns articulated on the midsagittal plane can undergo both simple and sideward reduplication. Strikingly, the data show considerable variation, and all types of nouns can be zero-marked, that is, plural marking on the noun is not obligatory. The results further suggest that all nouns can undergo at least one type of reduplication. Thus, while phonological properties of the base noun influence the type of reduplication, they do not block reduplication altogether. Plural reduplication in NGT is therefore less constrained than has been reported for other sign languages, where certain noun types cannot undergo reduplication. This shows that reduplication – despite being iconically motivated – is subject to language-specific grammatical constraints.


In December 2000, the Object Management Group (OMG) called for a proposal of a smart transducer interface. In response, a new standard has been proposed that comprises a time-triggered transport service within the distributed smart transducer subsystem and a well-defined interface to a CORBA environment. This smart transducer standard has been adopted by the OMG in January 2002. The smart transducer interface and the time-triggered transport service have been implemented in the time-triggered fieldbus protocol TTP/A. This paper examines the strengths and weaknesses of the smart transducer interface and presents two case studies. The first case study describes a demonstrator with a robot arm that is instrumented by smart transducers and a TTP/A fieldbus. The second case study is an autonomous mobile robot instrumented by a TTP/A cluster that orientates itself via a set of heterogenous sensors and decides, based on this sensor data, which way to go.


Background Cancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (e.g., fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety). Objectives The aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (e.g., insurance), and social isolation, with symptom burden in cancer survivors. Methods This secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies–Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic. Results Non-Hispanic White survivors (n = 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors (n = 168) and non-Hispanic survivors of other races (n = 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races. Discussion These findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.


Abstract: Species interactions have been recently depicted as networks, in which each species is connected to one or more other species in binary interaction matrices. Forty networks of epiphytic orchid and host tree species were assessed in Brazilian gallery forests. The nestedness of the networks was estimated with the NODF index and the significance was tested with null models. The phylogenetic structure of the network was also assessed, by searching for phylogenetic signals in the number of interactions and in the similarity of interacting species. In total, 105 orchid species and 132 host tree species were sampled. A nested pattern in all orchid–host tree networks was found. However, phylogenetic signals were not observed. The results support that the host specificity of orchids is small and most of the interactions occur among generalist orchids and generalist host trees. While the concept of species-specificity can thus be rejected, the extreme alternative – that interacting orchids and host trees are not a random subset of the regional species pool – can be dismissed as well. However, factors other than phylogenetic history may structure interaction networks of epiphytic orchids and host trees.


Sponges are among the less-studied benthic invertebrates as regards their extinction risk and conservation status. Herein, we evaluate the regional conservation status of sponges in the Aegean ecoregion (Eastern Mediterranean Sea), using the IUCN Red List criteria. We examined 20 sponge taxa falling into three categories: i) threatened species listed in Annex II of the Barcelona Convention, ii) bath sponge species (Annex III of the Barcelona Convention), and iii) Aegean endemics. The regional geographic range of the examined taxa was depicted on detailed distribution maps, based mostly on recent observations by the authors and literature data. When possible, population trends were estimated based on historical data, and threats were identified. The suggested regional conservation status of the examined sponge species is as follows: i) nine species were characterised as 'Data Deficient (DD)' due to limited available information; ii) seven species were assigned to the 'Least Concern (LC)' category; iii) the four harvested bath sponge species were assigned to the Endangered (EN) category, based on their population decline in the Aegean region during the past decades. The present evaluation, besides providing scientific data for the regional protection and management of sponge populations, can form a basis for wider assessment and consequent conservation of Porifera.


textabstractIntroduction The following examines the application of Islamic family law with regard to custody and custody rights in the Gaza city sharī'a courts.1 Four objectives are pursued in the paper. First, it identifies areas of gender asymmetry in the legal code, which distinguishes female-oriented physical care of the ward (hadāna) from male-oriented guardianship (wilāya). Second, while examining the strategies adopted by men and women in claiming (or refraining from claiming) custody rights, the paper identifies areas of tension between the textually prescribed custody rights and their highly differentiated social construction. Thirdly, in fulfilling these objectives, it demonstrates the ways in which judges deal with various aspects of custody, and how, in the process, a knowledge of social norms overshadows the text; it will argue that today's judges are still loyal to the heritage of Islamic jurisprudence, which asserts the concepts of fairness, consideration of the context, and protection of the weak. Finally, the conduct of judges is elaborated with reference to the notion of ijtihād (independent reasoning) in the contemporary application of Islamic family law. An illustrative case is presented to argue these points.


Background: This study is aimed at comparing the early diagnostic accuracy of maternal blood white blood cell (WBC) count, C-reactive protein (CRP) and procalcitonin in predicting early onset neonatal sepsis (EONS) among early preterm premature rupture of membrane (PPROM) pregnancies. Methods: A total of 57 consecutive pregnancies, complicated with PPROM, between 24 and 34 gestational weeks were recruited to the study at Suleymaniye Maternity Education and Research Hospital, Istanbul, Turkey between January 2012 and January 2013. All patients were hospitalized and followed up with expectant management. Maternal blood WBC count, CRP and procalcitonin levels were measured in the first 12 h of membrane rupture. EONS was diagnosed using clinical and laboratory findings, and obstetric and neonatal outcomes were noted. Results: The cutoff value for maternal blood CRP was ≥9.49 mg/dl. This value predicted EONS with 77.8% sensitivity, 80.0% specificity, 77.8% positive predictive value (PPV) and 80.0% negative predictive value (NPV). The cutoff value for maternal blood procalcitonin was 0.071 ng/ml. This value predicted EONS with 85.2% sensitivity, 86.7% specificity, 85.2% PPV and 86.7% NPV. Conclusion: Maternal blood procalcitonin levels were superior to maternal blood CRP and WBC count in predicting EONS. Consequently, the maternal blood procalcitonin level is a clinically useful, non-invasive and reliable biomarker in antenatal prediction of EONS.


PURPOSE
Geographic access to inpatient care at the Veterans Affairs (VA) Health Care System is challenging for many veterans with chronic obstructive pulmonary disease (COPD) given relatively few VA hospitals nationwide. Veterans with lengthy travel distances may obtain non-VA care, particularly those dually enrolled in Medicare. Our primary objective was to assess whether distance from VA patients' residence to the nearest VA and non-VA hospitals was associated with 30-day all-cause readmission and the system where patients were readmitted (VA or Medicare).

METHODS
Using VA and Medicare administrative data, we identified 21,273 patients hospitalized for COPD between October 2008 and September 2011 and dually enrolled in VA and fee-for-service Medicare. Outcome variables were dichotomous measures denoting readmission for any cause within 30 days following discharge and whether the readmission occurred in a non-VA hospital through Medicare. Distance to the nearest hospital was defined as the number of miles between patients' residence ZIP code and the ZIP code of the nearest VA and non-VA hospital accepting Medicare, respectively. Probit models with sample selection were applied to examine the relationship between hospital distance and outcome measures.

FINDINGS
Respective distances to the nearest VA and non-VA hospital were not associated with 30-day all-cause readmission. Greater distance to the nearest VA hospital was associated with a greater conditional probability of choosing non-VA hospitals for readmission.

CONCLUSIONS
COPD patients with poor geographic access to VA hospitals did not forgo subsequent inpatient care following their index hospitalization, but they were more likely to seek non-VA substitutes.


In 1810, the French state embarked on a project to systematically register all artworks that had been confiscated since the revolution inside and outside France and declared national property. The extent of the collections of this highly heterogeneous group of objects now accumulated in the French museums since 1793 and the almost entire absence of any prior catalogues certainly presented a challenge. The result leads us to the intersection between art and economic history, where the history of European taste and the market converge, that is, in the price of European art in Paris around 1800. Although the so-called Inventaire Napoleon clearly incorporated and expanded older trends and forms for cataloguing art collections, its morphology differed distinctly from previously existing European museum inventories. The Inventaire Napoleon was accordingly ambivalent: it was an instrument of careful description, classification, and location of thousands of works of art:  4400 paintings, 1808 ancient statues and 61 vases, over 6500 drawings and other art objects registered in a total of 17 folio volumes. At the same time, it represented a listing of symbolic and financial assets in the context of national affirmation and a state treasury under great duress. The fact that these assets were also a mirror of cultural historical values makes the "price" column of the Inventaire Napoleon especially fascinating in retrospect. This catalogue was to be about art as capital.


As Israel's control of the Occupied Palestinian Territory nears its fiftieth anniversary, The Writing on the Wall offers a critical perspective on the international law of occupation. Advocating a normative and functional approach to occupation and to the question of when it exists, it analyzes the application of humanitarian and human rights law, pointing to the risk of using the law of occupation in its current version to legitimize new variations of conquest and colonialism. The book points to the need for reconsidering the law of occupation in light of changing forms of control, such as those evident in Gaza. Although the Israeli occupation is a main focal point, the book broadens its compass to look at other cases, such as Iraq, Northern Cyprus, and Western Sahara, highlighting the role that international law plays in all of these cases.... Download ebook, read file pdf Rethinking the International Law of Occupation


The journey from dust particle to planetesimal involves physical processes acting on scales ranging from micrometers (the sticking and restructuring of aggregates) to hundreds of astronomical units (the size of the turbulent protoplanetary nebula). Considering these processes simultaneously is essential when studying planetesimal formation. We develop a novel, global, semi-analytical model for the evolution of the mass-dominating dust particles in a turbulent protoplanetary disk that takes into account the evolution of the dust surface density while preserving the essential characteristics of the porous coagulation process. This panoptic model is used to study the growth from submicron to planetesimal sizes in disks around Sun-like stars. For highly porous ices, unaffected by collisional fragmentation and erosion, rapid growth to planetesimal sizes is possible in a zone stretching out to ${\sim}10\mathrm{~AU}$ for massive disks. When porous coagulation is limited by erosive collisions, the formation of planetesimals through direct coagulation is not possible, but the creation of a large population of aggregates with Stokes numbers close to unity might trigger the streaming instability (SI). However, we find that reaching conditions necessary for SI is difficult and limited to dust-rich disks, (very) cold disks, or disks with weak turbulence. Behind the snow-line, porosity-driven aggregation of icy grains results in rapid (${\sim}10^{4}\mathrm{~yr}$) formation of planetesimals. If erosive collisions prevent this, SI might be triggered for specific disk conditions. The numerical approach introduced in this work is ideally suited for studying planetesimal formation and pebble delivery simultaneously and will help build a coherent picture of the start of the planet formation process.


The invention concerns a polymeric antimicrobial composition, a method of producing the same and the uses thereof. The ionomer composition comprises an amine functional polymer compound reacted with silver halide, optionally together with a stabilizing component, such as an organic substance carrying a sulfonamide functional group. The ionomer composition can be obtained by reacting together (i) at least one polyamine and silver halide and optionally at least one organic stabilizer substance or; (ii) at least one polyamine, at least one non-halide silver salt or silver complex, hydrogen halide and/or alkaline metal halide salt and optionally at least one organic stabilizer substance. The present ionomer composition is suitable for use as an antimicrobial coating, antimicrobial finish, antimicrobial additive and as antimicrobial component for formation of new antimicrobial materials.


Titanium dental implants are medical devices used to restore the function entailed with the loss of one or several teeth. To obtain successful function over long periods, the dental implants must be sufficiently anchored in the bone to withstand the forces induced by for example chewing. Two important factors for obtaining high anchorage strength are i) the chemical composition of the material and ii) the implant design at all length scales. Topographical features on different length scales induce for example nucleation sites for collagen and minerals, cell attachment and biomechanical stimulation necessary to prevent bone resorption and eventually to gain bone. The design of nucleation sites at the titanium surface to stimulate bone growth is at the heart of the project presented in this thesis. The aim of the work is to in detail characterize the implant surface and design chemically as well as topographically modified surfaces by complementary experimental studies including electrochemical characterization and biomechanical models. The present thesis is based on three main topics of importance for dental implants: i) Surface topography measured with scanning electron microscopy and atomic force microscopy, ii) Biomechanical modelling and iii) Electronic properties of the surface oxide film investigated using impedance spectroscopy and cyclic voltammetry. Theoretical finite element studies have shown that the micro-topography of a surface can be designed to induce optimal biomechanical stimulation for bone formation. However, currently used topographical characterization methods for describing dental implant surfaces are insufficient to characterize the topography in the required detail to design such surfaces. In the present thesis, a method to investigate and describe the microto nanosized surface topographies is presented. In this method, complementary analysis techniques are used in combination with overlapping analysis areas and data filtering in order to obtain information from surface features in a wide range of length scales. Theoretical models have also been developed with the aim of evaluating the ability of microand nanoscaled surface features to induce retention strength with bone. By combining the characterization method and the theoretical models, an integrated characterization method is presented which can be used to design biomechanically optimized implant surfaces with suitable surface topography. Various modification techniques are used to alter the surface topography and as a secondary effect, the electronic properties of the oxide film will be altered. The effects on the biological response induced by changes in topography and electronic properties separately are therefore difficult to distinguish. The present thesis includes a study where the electronic properties of the surface oxide film were deliberately changed without significant changes in surface topography. The results show that the electronic properties of the oxide film have larger effects on the cellular attachment and apatite nucleation than a small change in topography and that a less insulating oxide film is preferable for titanium dental implants. The knowledge obtained from the biomechanical models and the electronic investigation was used to design well-characterized nanostructured surfaces created by coating titanium discs with titanium dioxide nanoparticles of different morphology and size. The bioactivity of the coated samples was evaluated by apatite formation and the results show that the coated samples induce earlier apatite nucleation and form thicker apatite layers than the uncoated reference. The results obtained and presented in this thesis suggest that dental implants should have roughness at different length scales in combination with formation of a thin defect rich oxide. Such an implant is still to be designed and tested under realistic conditions.


We are at the beginning of the multicore era. Computers will have increasingly many cores (processors), but there is still no good programming framework for these architectures, and thus no simple and unified way for machine learning to take advantage of the potential speed up. In this paper, we develop a broadly applicable parallel programming method, one that is easily applied to many different learning algorithms. Our work is in distinct contrast to the tradition in machine learning of designing (often ingenious) ways to speed up a single algorithm at a time. Specifically, we show that algorithms that fit the Statistical Query model [15] can be written in a certain "summation form," which allows them to be easily parallelized on multicore computers. We adapt Google's map-reduce [7] paradigm to demonstrate this parallel speed up technique on a variety of learning algorithms including locally weighted linear regression (LWLR), k-means, logistic regression (LR), naive Bayes (NB), SVM, ICA, PCA, gaussian discriminant analysis (GDA), EM, and backpropagation (NN). Our experimental results show basically linear speedup with an increasing number of processors.


[Abstract]: In the search to find the solution to the 'one best way' to provide a conduit for contact between organizations and their customers, call centers represent a recent incarnation of the principles of scientific management developed in the first decades of the last century.

This paper seeks to apply another iconic legacy of twentieth century management theory, Tuckman's four-stage model of group development devised in 1965, to organizations which didn't exist when the original idea was first postulated.

How relevant are the 'forming', storming', norming, and 'performing' stages of progression to an environment renowned for constant changes to group membership? In his 1977 revision of the four-stage model with Jensen, Tuckman acknowledged the limited capacity of the theory to account for transient participation in groups.

This paper reports the findings of research which provides evidence that Tuckman's model describes accurately the patterns of behaviour demonstrated by groups of newly selected call center workers completing their initial induction training in an Australian, semi-government, call center.

Call centers provide a contemporary context for the application of Taylorist management principles, symbolic of practice more readily associated with the industrial revolution than with 'modern' organizations. Tuckman's 1965 model has a similar resonance for call centers today.


Introduction For many years midportion Achilles tendinopathy was known to be difficult to treat. Recent advances using immunohistochemical analyses of tissue specimens have clarified the neural patterns in this condition, and new treatment approaches focusing on the blood vessel and nerve rich ventral side of the Achilles have shown good clinical results. Material 125 tendons from 103 patients (66 males, and 37 females). Methods Ultrasound (US)+Doppler (CD)-guided scraping in local anaesthesia. Clinical and US+DP follow-ups. Results Follow-ups at 18 months (mean) showed good clinical results in 111/125 tendons, VAS from 73 to 3. US follow-ups have shown a thinner tendon with improved structure. Discussion Surgical scraping treatment on the blood vessel and nerve rich ventral side of the Achilles midportion has a high potential to reduce tendon pain and also to improve tendon structure and decrease tendon thickness. Our group have on-going studies using a new tool to investigate tendon structure, ultrasound tissue characterisation (UTC), to try to properly evaluate the tendon effects of this procedure. The potentials in the soft tissues on the ventral side of the Achilles are in focus for intensive research. References Alfredson H. Br J Sports Med 2011;45:407–410 Lind et al. KSSTA 2006;14:1327–1332 Willberg et al. KSSTA 2014 [in press]


Background Conflict is a significant and recurrent problem in most modern healthcare systems. Given its ubiquity, effective techniques to manage or resolve conflict safely are required.
Objective This review focuses on conflict resolution interventions for improvement of patient safety through understanding and applying/teaching conflict resolution skills that critically depend on communication and improvement of staff members' ability to voice their concerns.
Methods We used the Population-Intervention-Comparator-Outcome model to outline our methodology. Relevant English language sources for both published and unpublished papers up to February 2018 were sourced across five electronic databases: the Cochrane Library, EMBASE, MEDLINE, SCOPUS and Web of Science.
The activity theater (OT) condition is the most unpredictable and unstable work environment where two corresponding doctors share duty regarding one patient. Before, sedation was viewed as behind the scene claim to fame, where anesthesiologist was considered as one of the specialist's help who oversees sedation. Enormous advancement in the field of sedation gradually changed the situation of anesthesiologist from specialist' associate to a free master. This change requested regard and affirmation of one another's information and capacity. In the creating nations, the job of an anesthesiologist in the fruitful result of medical procedure isn't recognized by the overall population. Indeed, even on the expert point of view, the specialist is considered as the essential doctor and anesthesiologist is accepted as an advisor, who is approached to take part in the peri-usable consideration of the patient. Absence of acknowledgment of the pretended by anesthesiologist both inside and outside the working room (OR), absence of gratefulness from the specialist and helpless social cooperation with the patient brings down confidence of an anesthesiologist. Contrast in data, feeling, qualities, experience and interests between a specialist and anesthesiologist may emerge while working in high-pressure conditions like ORs which may trigger conflict.Conflict can extend from a minor contradiction to character conflicts and some of the time physical confrontations. Quality of patient consideration relies upon powerful collaboration for which multidisciplinary correspondence is a basic part, and any interruption in the correspondence may prompt wasteful patient care. Hence, a decent expert connection between the specialist and anesthesiologist is significant for the great patient result and to bring down proficient burnout.The current article audits the different reasons for struggle among specialist and anesthesiologist, their goal and how to stay away from clashes and keep up sound working relationship in ORs as everybody has an option to be treated with poise and regard in the working environment.
As the creators note, "clashes are inescapable." Conflicts might be as basic as contradictions with respect to planning cases in the working, continuing against the standard of care for NPO times as represented by the creators, first case. Another regular expected wellspring of contention as outlined by the creators' subsequent case is the need to drop an elective technique identified with an intense, intercurrent ailment or the requirement for additional work-up. Other increasingly perplexing and now and again incognito situations that may likewise prompt clash incorporate irreconcilable circumstances related with motivations from the pharmaceutical or gear industry or uncontrolled recruiting or advancement rehearses identified with bias, nepotism, or segregation.
Given the expanded acknowledgment of the expected pessimistic effect of such issues on tolerant security and staff prosperity, the requirement for compelling moderation of institutional dangers has expanded. In the United States, The Joint Commission requires characterized institutional strategies tending to problematic conduct. As troublesome conduct isn't restricted to the clinical staff so such approaches must be worldwide and incorporate problematic practices by clinical staff, partnered wellbeing, nursing, bolster staff, and organization. Strategies and methodology likewise fill in as "preconflict" direction. The wide appropriation of arrangements and strategies combined with successful training and on-going re-implementation assists with advancing proficient conduct and build up an institutional culture. As supported by the creators, there are a few solid and steady records to help in the advancement of such rules including those from the American Society of Anesthesiologists.
Attri et al. have plainly and compactly sketched out a portion of the expected reasons for strife just as the starter ventures for struggle resolution.While these are probably going to be viable in most of cases, the medical clinic should likewise have set up the components to manage doctors who are recurrent guilty parties or those whose essential offense is of such a size (physical collaborations) that prompt mediation is required. Doctor officials and clinical staff officials wind up routinely went up against with the consequences of "heightened clashes." Effective arrangements and systems systematize the common qualities and desires for the organization. Powerful post peace making requires exacting consistence with broadly spread, deliberately built, and consensually created approaches. This confines the potential for misuse and keeps up a culture based on shared qualities.
Results After removal of duplicates, 1485 studies were screened. Six articles met the inclusion criteria with a total sample size of 286 healthcare worker participants. Three training programmes were identified among the included studies: (A) crisis resource management training; (B) the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training; and (C) the two-challenge rule (a component of TeamSTEPPS), and two studies manipulating wider team behaviours. Outcomes reported included participant reaction and observer rating of conflict resolution, speaking up or advocacy-inquiry behaviours. Study results were inconsistent in showing benefits of interventions.
Conclusion The evidence for training to improve conflict resolution in the clinical environment is sparse. Novel methods that seek to influence wider team behaviours may complement traditional interventions directed at individuals.


This paper attempts to tune any controller without the knowledge of mathematical model for the system to be controlled. For that purpose, the optimization algorithm of MATLAB / Nonlinear Control Design Blockset (NCD) is adapted for On-line tuning for controller parameters. To present the methodology, a PID controller is verified with the physical plant using the engine speed control System where the problem of maintaining the engine idle speed at a reference value with the applied load is studied. A Proportional Integral Derivative (PID) Controller is used to solve this problem, but to get the best controller parameters the (NCD) Blockset is used for tuning the PID parameters. Simulation shows promising results in the idle speed response by comparing NCD tuning results with the trial and error results. The analytical results are carried out MATLAB / SIMULINK.


The corneal endothelium in 12 cases of keratoconus was examined with the clinical specular microscope. There appeared to be an increase in cellular pleomorphism with many cells considerably smaller than normal distributed throughout the endothelial cell population. There were also many large, elongated cells whose long axis showed a definite tendency to assume a similar directional orientation. The long axis of these cells seemed oriented toward the apex of the cone, and the cells appeared to have been stretched by the ectatic process. Many endothelial cells contained dark intracellular structures. Their significance is unknown. The single cornea in this series with a history of acute hydrops contained a localized area in which the endothelial cells were seven to ten times larger than normal. This suggests that rupture of the endothelium and Descemet's membrane, responsible for the acute edematous process, occurs at this site, and that the adjacent cells enlarged to fill the defect.


Purpose We examined locoregional recurrence (LRR) in patients with breast invasive ductal carcinoma (IDC) receiving total mastectomy (TM) under propofol-based paravertebral block-regional anesthesia (PB-RA) versus sevoflurane-based inhalational general anesthesia (INHA-GA) without propofol. All-cause death and distant metastasis were secondary endpoints. Patients and Methods Patients with breast IDC receiving TM were recruited through propensity score matching and categorized into INHA-GA with sevoflurane and PB-RA with propofol groups. Cox regression analysis was performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results In the multivariate Cox regression analysis, the adjusted HR (aHR; 95% CI) of LRR for the PB-RA with propofol group was 0.52 (0.28–0.96) compared with the INHA-GA with sevoflurane group. The aHRs of LRR for differentiation grade II, grade III, the American Joint Committee on Cancer clinical stage II, stage III, pathological tumor (pT) stage 2, pT stage 3–4, pathological nodal (pN) stage 1, and pN stage 2–3 were 1.16 (1.04–2.08), 1.28 (1.07–2.12), 3.71 (1.82–7.59), 4.67 (1.65–13.18), 1.09 (1.02–1.21), 1.17 (1.03–2.16), 1.10 (1.03–1.33), and 1.22 (1.06–2.41), respectively, compared with differentiation grade I, clinical stage I, pT1, and pN0. The aHR of LRR for adjuvant RT was 0.88 (0.64–0.94) compared with that for no adjuvant RT. Conclusion PB-RA with propofol might be beneficial for reducing LRR in women with breast IDC receiving TM compared with INHA-GA without propofol.


To analyze the effects of fabrication and alignment errors on optical systems with complex apertures such as a segmented telescope, a visual basic routine (VBR) is developed using CODE V's COM interface. One of the eminent features of this VBR is its graphical user interface (GUI). The GUI facilitates the user to model different types of segmentations quickly and precisely. The input parameters describe the basic shapes of the segments (polygon or sector), the chamfers at their corners, and the gaps between them. Fabrication errors (i.e. surface errors and alignment errors such as decenters and tilts for each segment) can also be introduced easily and effectively through the GUI. Geometrical and diffraction-based analyses can then be performed to study and analyze the effects of these errors on the imaging quality of the optical system. Results of tolerance analysis are presented for a test system, which require a very stringent tolerance to be placed on the discrepancy among the radii of curvature for different segments. In short, the VBR is a user friendly and a flexible tool with its application scope in designing complex aperture optical systems.


While surgery is currently the treatment of choice for endometriosis, recurrence remains a serious problem, and its prevention is an unmet clinical need. SLIT, a secreted protein that functions through the Roundabout (ROBO) receptor as a repellent for axon guidance and neuronal migration, has been recently found to induce tumor angiogenesis. We investigated the potential role of SLIT/ROBO1 in ovarian endometriomas and examined their predictive value in recurrence based on tissue samples from 43 patients with recurrence and 45 without recurrence. Microvascular density counts were evaluated by CD34 immunohistochemistry, and statistical analyses were performed to evaluate the effect of SLIT/Robo1 on recurrence risk after adjustment for other risk factors. We found that SLIT expression was positively correlated with microvascular density in ectopic endometrium and that its expression was higher in ectopic endometrium than control endometrium. Both SLIT and Robo1 expression were higher in recurrent cases than in non-recurrent cases. Higher immunoreactivity to SLIT, along with the presence of adhesion, PR-B, and nuclear factor-kappaB, was identified to be a risk factor for recurrence, with a sensitivity of 86% and a specificity of 87%. Therefore, increased SLIT immunoreactivity is likely an important constituent factor for recurrence of ovarian endometriomas, possibly through promoting angiogenesis in ectopic endometrium. Thus, the SLIT/ROBO1 system may be a potential target for reducing the risk of recurrence.


Abstract : The EPA's proposed Drift Reduction Technology DRT low-speed wind tunnel evaluation protocol was tested across a series of modified ASAE reference nozzles. Both droplet size and deposition and flux volume measurements were made downwind from the nozzles operating in the tunnel at airspeeds of 1 m/s and 2.5 m/s, following the prescribed protocol. Overall, the data followed anticipated trends with a few unanticipated results observed, which could be addressed in future iterations of the protocol. There were some difficulties meeting the proposed protocol data quality requirements. Refined quality requirements would address this with no detrimental effect to the overall data set. Major concerns, at this point, are the feasibility of the overall protocol as well as the applicability of the final collected data. The protocol was tailored such that the collected data would directly input into a dispersion model most likely WTDISP. However, not having access to such a model puts into question the validity and practicality of the protocol in its present form. Given the time requirements, which require approximately nine times that of the high speed protocol 90 min versus 10 min, unpublished data, there is a definite need to modify the existing protocol to insure equitable implementation of the overall DRT program.


The activity of dopamine-beta-hydroxylase (D beta H) in the serum was measured in patients with quadriplegia and in healthy subjects. We assume that the plasma D beta H levels reflect sympathetic tone. Quadriplegics had significantly lower D beta H levels at rest. After head-up tilting a significant decrease in D beta H levels occurred in patients with spinal cord injury suggesting failure of the sympathetic nervous system. However, a considerable overlap exists between normals and quadriplegics, making this test of limited value in the assessment of autonomic function in individual subjects.


Nitrogen lasers have been used for many years to make dye solutions lase. A nitrogen laser, which transverse electrical discharge in gas at atmospheric pressure has been built in our laboratory. It has been characterized and applied to pump different dyes: Rhodamine 6G, Coumarin 440, DOTCI, and pyranine in simple "on axis" geometric configuration. It has been shown that pyranine can lase in the absence of any optical external mirror cavity, this happens at very low threshold, and in different solvents. Dyes under consideration can be grouped into two major classes according to their lasing behavior independently on their concentration in the solvent: Rhodamine 6G and DOTCI can lase both axially or transversally and Coumarin 440 and pyranine can lase only axially. Other intriguing features have been observed that span from simultaneous multiple beam generation, to super fluorescence and to distribute axial pumping of dye solutions. A preliminary basis for understanding and controlling such processes is the spatial energy distribution and the energy density of the beam.


IncreTable is a mixed-reality tabletop game inspired by The Incredible Machine. Users can combine real and virtual game pieces in order to solve puzzles in the game. Game actions include placing virtual domino blocks with digital pens, controlling a virtual car by modifying the virtual terrain through a depth camera interface, and controlling real robots to topple over real and virtual dominoes.


A park is a desirable feature when people are purchasing a property. Buyers are ready to pay more for properties surrounded by natural amenities, such as a pleasant park. However, if a park is perceived as unsafe by local residents, then it may have a negative effect on housing prices. The aim of this study is to investigate the importance of urban parks in Stockholm, capital of Sweden, and to find evidence of whether people in Stockholm are willing to pay extra for parks when purchasing an apartment. This study hypothesized that people's willingness to pay for urban parks and green spaces is affected by crime. The methodology had two stages. An extensive field work was performed in a selected number of parks to help characterize the parks in Stockholm. This was later followed by the analysis of 2008's apartment sales using hedonic modelling combined with Geographic Information System (GIS) techniques. Results suggest that the effect of parks vary by park type. An aggregated measure of parks lower apartment prices but the effect turns out to be positive in some cases, or insignificant, when parks are broken down by types. For instance, parks with cultural features, forest feeling, skating and features of national interest increase apartment prices. However, if park have ball games, marina, boating facilities, skate board facilities and frequent social events – these features tend to reduce property values. These findings support the idea that the impact of park on property value depends on the type of park. Contrary to was expected, the park impact on prices does not seem to be affected by seasonal variations (e.g., summer versus winter), only individual months seem to affect prices. More interestingly, crime affects the quality of parks and, in its turn, the relationship between parks and prices. Results show that parks that originally show a positive impact on prices may affect prices negatively if they have relatively high rates of violence and vandalism. The study finalizes with a discussion these results and their implication for future research.


B cell receptor (BCR) signals play a critical role in the pathogenesis of chronic lymphocytic leukemia (CLL), but their role in regulating CLL cell proliferation has still not been firmly established. Unlike normal B cells, CLL cells do not proliferate in vitro upon engagement of the BCR, suggesting that CLL cell proliferation is regulated by other signals from the microenvironment, such as those provided by Toll-like receptor (TLR) ligands or T cells. However, the rapid reduction in the percentage of proliferating CLL cells in patients treated with a BTK or SYK inhibitor suggests that the BCR may be more directly involved, at least in a subset of cases.
 To further address this issue, we investigated the expression of cell cycle regulatory proteins in human and Eμ-TCL1-derived murine CLL cells stimulated with immobilized anti-IgM or cognate antigen, respectively. In both cases, BCR stimulation induced the expression of the positive cell cycle regulators MYC, CCND1, CCND2 and CDK4, consistent with G1 cell cycle entry, but also induced the expression of the negative regulators CDKN1A, CDKN2A and CDKN2B, which block cell cycle progression. Since combined deficiency of these negative regulators occurs in approximately one quarter of Richter syndrome cases because of deletion of the CDKN2A/CDKN2B locus and inactivating genetic lesions of the CDKN1A regulator TP53, we introduced these defects by CRISPR/Cas9 in autoreactive murine Eμ-TCL1 leukemia cells and investigated the effects on leukemia behavior. Adoptive transfer experiments showed that combined targeting of TP53, CDKN2A and CDKN2B results in accelerated leukemia growth and morphological changes consistent with Richter's transformation, including more diffuse infiltration, larger and more pleomorphic cells, and a higher proliferation rate. Moreover, in vitro experiments showed that cells with combined TP53/CDKN2A/2B deficiency had acquired the capacity for spontaneous proliferation, in contrast to control, TP53- or CDKN2A/2B-targeted cells which died after a couple of weeks in culture. Nucleotide sequencing of the TP53/CDKN2A/2B-targeted cells showed complete disappearance of the wild type alleles, suggesting that biallelic loss of all three genes is required for spontaneous growth in vitro. Combined disruption of TP53, CDKN2A and CDKN2B in two other autoreactive Eμ-TCL1 leukemias yielded the same results.
 To determine whether the spontaneous in vitro proliferation is dependent on BCR signals, the TP53/CDKN2A/2B-deficient cells were transfected with Cas9 ribonucleoprotein complexes targeting the IgM heavy chain constant region (IGHM) gene or were treated with the BCR inhibitors ibrutinib, idelalisib and fostamatinib. Disruption of the IGHM gene or treatment with a BCR inhibitor resulted in almost complete block of proliferation. In contrast, knockdown of the TLR-adaptor protein MyD88 had no effect. Considering that T cells were not present in the culture conditions, these experiments establish that proliferation of Eμ-TCL1 leukemia cells with biallelic TP53/CDKN2A/2B disruption is BCR-dependent but independent of costimulatory signals.
 To validate these findings in a human setting, we performed experiments with two recently established Richter syndrome patient-derived xenografts, one with biallelic inactivation/deletion of TP53, CDKN2A and CDKN2B (RS9737), and one with wild type TP53, CDKN2A and CDKN2B (RS1316). BrdU incorporation experiments showed that only RS9737 cells proliferate in vitro following BCR stimulation, whereas both RS9737 and RS1316 cells proliferate following stimulation with CpG + IL-15 or CD40L + IL-4 + IL-21.
 Finally, we tested the activity of combined treatment with a BCR inhibitor and the CDK4/6 inhibitor palbociclib against the murine and human TP53/CDKN2A/2B-deficient Richter syndrome models. Combined treatment showed synergistic activity in vitro and significantly prolonged mouse survival in vivo compared to single agent treatment (n = 10 mice/group, P<0.001).
 In conclusion, these data provide evidence that BCR signals are directly involved in regulating CLL cell proliferation and suggest that frequently co-occurring genetic lesions in TP53 and CDKN2A/2B contribute to Richter transformation by allowing for BCR dependent/costimulatory signal independent proliferation, which can be therapeutically targeted with a BCR and CDK4/6 inhibitor combination.

 Deaglio: Verastem: Research Funding; Heidelberg Pharma: Research Funding. Laurenti:Gilead: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees. Efremov:Janssen-Cilag International: Speakers Bureau.


The effects of drought are vast, but loss statistics often do not reflect the impacts on the tourism and recreation sector, which for many places is one of the most critical economic drivers. This is concerning because drought events are common across the globe, with varying frequency, duration, and intensity, and are therefore unavoidable. Over the years, drought conditions have been at record levels in many regions, causing deep societal and economic impacts. However, little research has been conducted on connections between tourism/recreation and drought, revealing a distinct disconnect between the tourism/recreation sector and drought management. To bridge this gap in the current understanding of, and approaches to, managing drought in the tourism/recreation sector, we present an interdisciplinary conceptual framework that integrates tourism/recreation into the drought management process to ensure sustainable economic development and community vitality. The model presented here promotes understanding of critical interactions through a bottom-up stakeholder engagement process balanced with formal top-down management approaches.


This paper expands the conventional model of responsible party government to take into account the effect of trans-national constraints on nationally elected governments. It starts by systematically comparing the closed model of national party government with that of a governing party subject to the constraints of a world of interdependence. European Union constraints concurrently exert a denationalizing influence through the Council, a multinational effect through the European Parliament, and an aspiring economic technocracy. Interdependence is increased in institutions of a wider Europe or global in scope, and trans-national influences of markets and non-state crime can operate without any formal institution being accountable or in control. As an alternative to electorates rotating their choice between a succession of parties that fail to meet national preference, the conclusion proposes a learning model by which parties and voters may adapt expectations to meet the constraints of interdependence.


The double aorta is very rare. Only two cases are described in the literature. More frequent is a duplication artifact which is misinterpreted as being the image of a double aorta. This is caused by a refraction artifact which results from the difference in the velocity of sound between muscle tissue and fat tissue. Furthermore, a fat depot between parts of the rectus abdominis muscle has a prism-like effect. In most cases, this artifact can be avoided by lateral shifting of the transducer.


Preterm birth is the leading cause of worldwide neonatal mortality. It follows a pathologically accelerated form of the normal processes that govern cervical softening and dilation. Softening and dilation occur due to changes in cervical collagen crosslinking, which can be measured non-invasively by changes in tissue fluorescence and impedance. We present a novel device designed specifically to take fluorescence and impedance measurements throughout pregnancy, with the end goal of fusing and trending these measurements to form an early diagnosis of preterm labor.


: Nine cases of pseudomembranous colitis (PMC) were observed during a 20-month period. All patients had received, or were taking, antibiotics, in five cases lincomycin. The clinical syndrome of PMC occurred in two patients after a major gastrointestinal operation, in two after fracture of the neck of the femur, and in the remaining five, after administration of antibiotics for inflammatory diseases. The clinical syndrome was characterized by an acute onset of profuse diarrhea, pyrexia, abdominal pain, dehydration, and in four patients confusion or hypotension. The diagnosis was made on the basis of rectosigmoidoscopy and histology. No attempt was made to isolate Cl. difficile or to identify neutralizable fecal toxin. All patients received metronidazole at a dose of 1.5 gr. daily with a good response. Eight patients recovered fully. Only one died.


Acute myeloid leukemia (AML), the most prevalent acute leukemia in adults, is an aggressive hematological malignancy arising in hematopoietic stem and progenitor cells. With the exception of a few specific AML subtypes, the mainstays of treatment have not significantly changed over the last 20 years, and are still based on standard cytotoxic chemotherapy. As a result, clinical outcome remains poor for the majority of patients, with overall long term survival in the region of 20-30%. Recent successes in characterizing the genetic landscape of AML have highlighted that, despite its heterogeneity, many cases of AML carry recurrent mutations in genes encoding epigenetic regulators. Transcriptional dysregulation and altered epigenetic function have therefore emerged as exciting areas in AML research and it is becoming increasingly clear that epigenetic dysfunction is central to leukemogenesis in AML. This has subsequently paved the way for the development of epigenetically targeted therapies. In this review, we will discuss the most recent advances in our understanding of the role of epigenetic dysregulation in AML pathobiology. We will particularly focus on those altered epigenetic programs that have been shown to be central to the development and maintenance of AML in preclinical models. We will discuss the recent development of therapeutics specifically targeting these key epigenetic programs in AML, describe their mechanism of action and present their current clinical development. Finally, we will discuss the opportunities presented by epigenetically targeted therapy in AML and will highlight future challenges ahead for the AML community, to ensure that these novel therapeutics are optimally translated into clinical practice and result in clinical improvement for AML patients.


The human promyeloic leukemia cell line HL-60 can be triggered in culture to differentiate into several cell types of the myeloid lineage in response to a variety of chemical stimuli. We used this cell system in order to investigate the changes in glucocorticoid receptors which occur concomitantly with such cellular differentiations. Neutrophilic granulocytes obtained by the addition of dimethyl sulfoxide or retinoic acid to the culture medium showed only slight changes in cellular glucocorticoid receptor levels and receptor-specific mRNA as compared to undifferentiated control cells. Monocytic cells induced by incubation with dihydroxy-vitamin D3 had a moderate increase in receptor hormone-binding activity. However, differentiation toward macrophages by exposure to phorbol ester resulted in a 5- to 6- fold increase in both cellular hormone-binding capacity and immunochemically cross-reacting receptor protein. An even greater increase in glucocorticoid receptor-specific mRNA was observed. These data suggest that the receptor is regulated at the mRNA level and that de novo receptor synthesis occurs during macrophage differentiation, thus making these cells potentially more susceptible to glucocorticoid-induced effects.


OBJECTIVE
To compare serum markers of oxidative stress with diabetic retinopathy severity

RESEARCH DESIGN AND METHODS
This cross-sectional study compared patients with types 1 and 2 diabetes with control subjects in western New York and Pennsylvania. Retinopathy severity was graded from funduscopic fields based on the Early Treatment of Diabetic Retinopathy Study. Serum samples were analyzed for thiobarbituric acid-reacting substances (TBARS), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities, creatinine, HbA1, and triglycerides. Appropriate analysis of covariance models were performed.

RESULTS
TBARS (P = 0.019), triglyceride (P = 0.004), and glucose and HbA1 (both P<0.001) levels were elevated in diabetic patients compared with those in control subjects. SOD (P = 0.003) and GSH-Px (P = 0.046) levels were lower in diabetic patients than in control subjects. No correlation existed between SOD levels and either glucose or HbA1 levels. No significant associations existed between levels of TBARS, SOD, or GSH-Px and severity of diabetic retinopathy There was a significant association between poorer visual acuity and worse retinopathy (P = 0.009), which was only partly explained by macular edema.

CONCLUSIONS
Increased levels of TBARS and decreased levels of SOD and GSH-Px were found in diabetic patients compared with those in control subjects, but no significant associations were found between the levels of these substances and severity of retinopathy When duration and type of diabetes and serum HbA1 levels were taken into account, only visual acuity remained associated with more severe retinopathy.


Twenty-eight 10-week-old pigs were inoculated intratracheally with 1 × 105 colour-changing units/ml Mycoplasma hyopneumoniae strain 232, and another 32 pigs were not inoculated but were divided into 12 direct-contact pigs and 20 indirect-contact pigs. Thirty-five days later, the inoculated pigs were inoculated intranasally with 1 × 102·4 tcid50 of porcine reproductive and respiratory syndrome virus (prrsv) strain mn 30-100. Viraemia, seroconversion and the transmission of prrsv in the M hyopneumoniae-infected pigs were then assessed for four months. Three groups of 10 age-matched gilts were introduced as sentinels into the experimental barn on days 28, 56 and 84 after the prrsv infection. The persistence of prrsv was evaluated in both the experimentally and naturally infected pigs, which were slaughtered 120, 135 and 150 days after the infection. The period of viraemia and the extent of seroconversion were similar to those observed in studies of pigs infected only with prrsv, suggesting that under the conditions of the study M hyopneumoniae did not affect these features of the disease. A delayed pattern in the seroconversion and proportion of pcr-positive pigs was observed in the direct and indirect contact groups, and the persistence of prrsv in tissues was confirmed by pcr at 120 and 150 days after infection only in the directly inoculated pigs and not in the direct- or indirect-contact groups of pigs.


Peniculistoma mytili and Mytilophilus pacificae are placed in the pleuronematid scuticociliate family Peniculistomatidae based on morphology and ecological preference for the mantle cavity of mytiloid bivalves. We tested this placement with sequences of the small subunit rRNA (SSUrRNA) and cytochrome c oxidase subunit 1 (cox1) genes. These species are very closely related sister taxa with no distinct genetic difference in the SSUrRNA sequence but about 21% genetic difference for cox1, supporting their placement together but separation as distinct taxa. Using infection frequencies, M. pacificae, like its sister species P. mytili, does not interact with Ancistrum spp., co‐inhabitants of the mantle cavity. On the basis of these ecological similarities, the fossil record of host mussels, and features of morphology and stomatogenesis of these two ciliates, we argue that M. pacificae derived from a Peniculistoma‐like ancestor after divergence of the two host mussels. Our phylogenetic analyses of pleuronematid ciliates includes the SSUrRNA gene sequence of Sulcigera comosa, a Histiobalantium‐like ciliate from Lake Baikal. We conclude: (i) that the pleuronematids are a monophyletic group; (ii) that the genus Pleuronema is paraphyletic; and (iii) that S. comosa is a Histiobalantium species. We transfer S. comosa to Histiobalantium and propose a new combination Histiobalantium comosa n. comb.


The results of diagnostic laparoscopy in 42 patients are reviewed. A histological diagnosis was achieved in 23 of 26 cases of suspected intraperitoneal disease (15 cases of malignant disease, 4 cases of peritoneal or intra-abdominal tuberculosis and 4 cases of benign hepatic lesions in which percutaneous biopsy had failed to obtain a representative specimen). In 10 patients with abdominal trauma the source of the problem was identified, and in 2 of these successful conservative management was undertaken on the basis of the laparoscopic findings. In 6 patients with abdominal pain of unknown cause no lesion could be identified, and the procedure was abandoned in 2 patients because of dense intraperitoneal adhesions. There was no associated mortality and the morbidity rate was 0,5%.


Background: Focal atrial tachycardias are tachycardias characterized by a radial spread of activation from a discrete area of the atrial myocardium. They account for 10-15% of supraventricular tachycardias and are generally poorly responsive to pharmacological treatment. The pathophysiologic substrate of these arrhythmias remains poorly understood. Computational studies suggest that a certain degree of intercellular uncoupling and anisotropy are important prerequisites for the development of focal arrhythmias. The anisotropy and intercellular uncoupling could promote focal arrhythmias by minimizing the suppressive effect of the surrounding atrial muscle on the pacemaking process in the focus. This hypothesis would be in agreement with the fact that fractionated electrograms, a marker of anisotropy and reduced intercellular coupling, are often recorded at the site of earliest activated site. Reduced intercellular coupling could be induced by factors enhancing the amount of intracardiac connective tissue, such as advancing age or cardiac disease states. Indeed, focal inflammatory processes have been reported in atrial specimens resected from patients with focal tachycardia undergoing arrhythmia surgery. Methods: In a group of patients with paroxysmal and permanent atrial fibrillation we sought to assess whether there is a link between inflammation and the occurrence of atrial arrhythmia. We therefore analyzed different inflammatory markers (C-reactive protein and interleukin-6 and 8) in the systemic and pulmonary circulation as well as in the heart in these patients. In addition, we assessed the extent of intercellular uncoupling in the vicinity of tachycardia origin in patients with focal atrial tachycardia. We also assessed the impact of electrogram fractionation on the method of activation time determination, by comparing different methods for estimating activation time with regard to the appearance of the resultant activation maps and the location of the foci. We also assessed the observer variability in the estimation of activation time during mapping of these tachycardias. Results: There was no evidence of elevated circulatory levels of inflammatory markers in patients with paroxysmal atrial fibrillation. However, patients with permanent atrial fibrillation had increased levels of inflammatory markers (interleukin-8) in the systemic circulation but not in the pulmonary circulation or in the heart. In patients with focal atrial tachycardia, a higher degree of electrogram fractionation existed in the region surrounding the earliest activation site and activated within the first 15 ms as compared with the remaining atrium. Moreover, within this region, from the periphery towards the earliest activated site, there was a gradual increase in electrogram fractionation as well as a gradual decrease in the peak-to-peak voltage. When comparing different methods for estimating local activation time we found that different methods can generate activation maps with different appearances and foci with different locations. However, regardless of the method of activation time determination, the foci tend to cluster within relatively large areas of low-amplitude fractionated electrograms. In addition we found significant observer variability in the estimation of the local activation time. Conclusion: Patients with paroxysmal atrial fibrillation (and probably focal atrial tachycardia) do not have elevated levels of inflammatory markers. The increased levels of interleukin-8 in the systemic circulation suggest a link between long-lasting arrhythmia and inflammation. A relatively wide area of increased electrogram fractionation exists around the site of origin of focal atrial tachycardia. These findings suggest a sizeable atrial region with particular electrophysiological proprieties and raise the possibility of an anatomical substrate of the tachycardia. Increased electrogram fractionation can impact the process of activation determination, as suggested by the fact that different methods compute foci with different locations. In addition, there is significant observer variability in the estimation of local activation time in these patient.


Automation of analysis routines for designing packages has lead to the development of the Virtual Packaging System. Through computer automation, the time required to do virtual testing of product designs can be greatly reduced. Using commercially available software, a customized interface was developed to automate the virtual analysis of bottle geometry. The customized interface guides the analyst through the process while automating the geometry healing, meshing, solution, and reporting steps. The analyst is free to focus on the physical parameters of the design problem rather than the non-value-added steps of setting up analytical solutions. The automated solution results in significant productivity gains while improving repeatability and reliability of the analysis.


Emerging data suggests that synthetic lethal interactions between mutated oncogenes/tumor suppressor genes and molecules involved in DNA damage signaling and repair can be therapeutically exploited to preferentially kill tumor cells. In this review, we discuss the concept of synthetic lethality, and describe several recent examples in which this concept was successfully implemented to target tumor cells in culture, in mouse models, and in human cancer patients.


This paper studies conditions where messages endlessly circulate in a system of IEEE 1588-2008 clocks. The study is based on two independent analysis techniques. One uses a discrete event simulation environment for describing the operation of the best master clock (BMC) algorithm in IEEE 1588-2008. The second uses a model checking tool. We discuss several cases illustrating conditions under which circulating messages occur and the effectiveness of measures to squelch these messages. This paper demonstrates that one or more of the squelching mechanisms must be implemented.