As the post-marketing surveillance of cefpodoxime proxetil (Banan), MICs of cefpodoxime (CPDX, an active form of Banan) against 1090 clinical isolates of 22 species from 15 medical institutions all over Japan from June 2000 to March 2001 were measured using the broth microdilution method approved by the Japanese Society of Chemotherapy and compared with those of oral cephem antibacterials, cefaclor, cefdinir, cefditoren, and cefcapene. In this study, remarkable change in the activity of CPDX was observed in Streptococcus pneumoniae and Haemophilus influenzae compared with the susceptibility in the studies before Banan was launched. This cause is considered to be the increase in the incidence of the following resistant strains: penicillin-intermediate S. pneumoniae (47.3%), penicillin-resistant S. pneumoniae (PRSP, 15.1%), and beta-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae (24.0%), which were scarcely isolated in 1989 when Banan was launched. Other tested drugs also exhibited low activity against these resistant strains. However, CPDX showed comparatively good activity with MIC90 of 2 micrograms/mL against PRSP. Against methicillin-susceptible Staphylococcus spp., Streptococcus pyogenes, Streptococcus agalactiae, and Moraxella catarrhalis, CPDX also showed comparatively good activity with MIC90 of < or = 4 micrograms/mL, which was almost equal to that in the studies before its marketing. Against quinolones-resistant Neisseria gonorrhoeae, CPDX showed excellent activity with MIC90 of 0.5 microgram/mL. Against members of the family Enterobacteriaceae except for Citrobacter freundii, Enterobacter spp., Proteus vulgaris, and Morganella morganii, CPDX showed good activity. However, in Escherichia coli, Klebsiella spp. Proteus spp., and Providencia spp., there are some high-resistant strains to all tested drugs including CPDX. Against Peptostreptococcus spp., MIC90 of CPDX was 8 micrograms/mL and its MIC range was widely distributed from 0.03 to 32 micrograms/mL, which were similar to those in the studies before its marketing. In this study, CPDX showed the decrease in the activity against several species as did other drugs tested, but against most of species tested, CPDX maintained good activity. Furthermore, it is necessary to pay much attention to the trend of resistant strains.


The use of electroconvulsive therapy (ECT) in U.S. state hospitals has markedly decreased in the past 20 years. During this time ECT technique has reached a high level of sophistication. We examine whether ECT still has a place and can be effectively used in a modern state hospital. We conclude that approximately 1% of state hospital patients are candidates for ECT and that patients with major depression, mania, schizoaffective disorder, and schizophrenia may benefit from such treatment. The relative youth and good physical health of state hospital patients referred for ECT reduces the risk of the procedure in this setting. Most of our patients were on civil commitment but retained the capacity to consent to treatment. We discuss the use of inpatient continuation ECT and the treatment of protracted psychotic excitement as issues relevant to state hospitals.


A meta-analysis was conducted on 61 treatment outcome trials for post-traumatic stress disorder (PTSD). Conditions included drug therapies (TCAs, carbamazepine, MAOIs, SSRIs, and BDZs), psychological therapies (behaviour therapy, Eye-Movement Desensitization and Reprocessing (EMDR), relaxation training, hypnotherapy, and dynamic therapy), and control conditions (pill placebo, wait-list controls, supportive psychotherapies, and non-saccade EMDR control). Psychological therapies had significantly lower drop-out rates than pharmacotherapies (14% versus 32%), with attrition being uniformly low across all psychological therapies. In terms of symptom reduction, psychological therapies were more effective than drug therapies, and both were more effective than controls. Among the drug therapies, the SSRIs and carbamazepine had the greatest effect sizes, although the latter was based upon a single trial. Among the psychological therapies, behaviour therapy and EMDR were most effective, and generally equally so. The most effective psychological therapies and drug therapies were generally equally effective. Differences across treatment conditions were generally evident across symptom domains, with little matching of symptom domain to treatment type. However, SSRIs had some advantage over psychological therapies in treating depression. Follow-up results were not available for most treatments, but available data indicates that treatment effects for behaviour therapy and EMDR are maintained at 15-week follow-up. © 1998 John Wiley & Sons, Ltd.


The antinuclear antibody (ANA) is a defining feature of the connective tissue autoimmune disorders. ANAs are a class of antibodies that bind to cellular components in the nucleus including proteins, DNA, RNA, and nucleic acid-protein complexes. First described in 1948, ANA identification has been the foundation of diagnosis for connective tissue autoimmune disorders including systemic lupus erythematosus (SLE), Sjogren's syndrome, and polymyositis/dermatomyositis. Although 20-30% of the average population has detectable levels of ANAs, increased titers are characteristic of individuals with connective tissue disorders. Thus, the sensitivity and specificity of methods used to detect ANAs are key to diagnosis.


ABSTRACT CS6 is a widely expressed colonization factor of enterotoxigenic Escherichia coli (ETEC). To date, CS6 has not been well characterized in its native state. Here, we purified CS6 for the first time from an ETEC clinical isolate. Purified CS6 was composed of two structural subunits, CssA and CssB, which were present in equal amounts and tightly linked through noncovalent, detergent-stable association. The CssA subunit was poorly immunogenic, whereas CssB was highly immunogenic. Although the predicted molecular mass of CssA is 15 kDa, the purified CssA has an effective molecular mass of 18.5 kDa due to fatty acid modification. When purified CS6 was screened for its ability to bind with different extracellular matrix proteins, fibronectin (Fn) was found to interact with CS6 as well as CssA in a dose-dependent and saturable manner. This interaction was inhibited both by a synthetic peptide corresponding to the C-terminal hydrophilic, surface-exposed region of CssA (positions 112 to 126) and by the antibody derived against this region. Enzyme-linked immunosorbent assay results showed that CssA interacted with the 70-kDa N-terminal domain of Fn. The modifications on CssA probably do not play a role in Fn binding. Preincubation of INT 407 cells with CssA, but not CssB, inhibited ETEC binding to these cells. The results suggested that CS6-expressing ETEC binds to Fn of INT 407 cells through the C-terminal region of CssA. Purified CS6 was found to colocalize with Fn along the junctions of INT 407 cells. Based on the results obtained, we propose that CS6-expressing ETEC binds to the intestinal cells through Fn for colonization.


BACKGROUND: The primary objective of this study was to assess the clinical usefulness of a point-of-care device which measures hemoglobin noninvasively (SpHb) in a group of critically ill participants with dark skin pigmentation. METHODS: One hundred forty-six adult and pediatric participants from a multidisciplinary intensive care unit had intermittent readings of noninvasive hemoglobin measurements performed at a minimum of 4 hourly intervals. A total of 371 readings were analyzed. Concurrent blood samples were taken to assess hemoglobin levels using point-of-care blood gas analyzer, as well as sent to a central laboratory where hemoglobin was measured using the sodium lauryl sulfate method. Bland-Altman plots were constructed to assess the agreement between results from the 2 point-of-care devices with the reference standard (laboratory hemoglobin). RESULTS: SpHb exhibited significant bias when compared to laboratory hemoglobin, while blood gas hemoglobin did not. Mean bias for SpHb was +1.64 with limits of agreement of −1.03 to 4.31 compared to blood gas hemoglobin which showed a bias of 0.26 and limits of agreement of −0.84 to 1.37. The magnitude of the bias for SpHb increased with increasing mean hemoglobin levels. Of all the additional study variables assessed for effect on the bias, only Acute Physiology and Chronic Health Evaluation II score in adult patients (P < .0001) and mean arterial blood pressure (P = .001) had an effect. Skin pigmentation did not have any effect on the magnitude of bias. CONCLUSIONS: Noninvasive Hemoglobin measurement is a promising tool in dark-skinned critically ill patients with low hemoglobin levels, but requires further refinements for it to have clinical usefulness.


Sulfur dioxide (SO2) in biological systems is an important gaseous signal molecule and plays important roles in physiological activities. It can be endogenously produced by enzymes in mitochondria during oxidation of sulphur-containing molecules. Thus, the development of probes for sulfur dioxide detection in biological environment is necessary. Here, a new near-infrared fluorescent probe (Rh-TPA) with multiple fluorescence emission was constructed and applied for SO2 derivative detection. Rh-TPA was constructed via conjugation of a rhodamine analogue with a triphenylamine group. Rh-TPA exhibited a major emission peak at 740 nm and a shoulder peak at 810 nm. After interacting with SO2 derivatives, the conjugated system dissociated into two smaller chromophores with two emission peaks (520 nm and 570 nm) in the visible region. The probe showed negligible cytotoxicity, as demonstrated by the MTT results. Biological imaging application experiments indicated that the probe can be used to image SO2 derivatives in HeLa cells and living zebrafish.


Stimulation of aldosterone synthesis by angiotensin II (AII) is associated with depolarization of the cell membrane. Since the potential difference of adrenocortical cells is dependent on membrane permeability to potassium ions, the effects of agents which hyperpolarize the cell (by increasing permeability to K+) on the control of aldosterone synthesis were investigated further. Basal and AII-stimulated aldosterone synthesis was increased by 20-70% in cells incubated with 1 or 10 nM of the potassium ionophore valinomycin; higher concentrations markedly inhibited AII-stimulated synthesis. Cromakalim, a potential antihypertensive drug which facilitates the opening of K+ channels in smooth muscle cells, stimulated basal aldosterone synthesis at 2 microM but had no effect at 40 microM. AII-stimulated aldosterone synthesis was not affected by cromakalim except at 40 microM, which was inhibitory. The inhibitory effects of cromakalim, unlike those of valinomycin, were not reversible. Aldosterone synthesis from added hydroxycholesterol and pregnenolone (but not from deoxycorticosterone and corticosterone) was significantly inhibited by 40 microM cromakalim. Potassium efflux from cells preloaded with 43K was unaffected by low concentrations of valinomycin, but was markedly increased by concentrations which inhibited AII-stimulated aldosterone production. Small decreases and increases in 43K efflux, caused by 1 and 40 microM cromakalim respectively, corresponded with increases and decreases in basal aldosterone production; cromakalim did not affect 43K efflux from AII-stimulated cells. We suggest that increasing adrenocortical cell membrane permeability to K+ reduces steroidogenesis, but that valinomycin and cromakalim have other actions which complicate the relationship between 43K efflux and aldosterone production. Cromakalim appears to inhibit 21-hydroxylase activity in the biosynthetic pathway and may also affect 3 beta-hydroxysteroid dehydrogenase activity.


Background: Low back pain is one of the most important causes of disability among people around the world. Although only 2-5% of low back pain disorders resulting from herniation of lumbar intervertebral discs but surgery for lumbar disc herniation is a common procedure. The aim of this study was to determine the relation between some bio-psycho-social variables and treatment outcomes in patients who undergo first time single-level lumbar discectomy. Methods: This is a prospective observational analytic study comprised 100 patients (age range 18-73 years) underwent single-level lumbar disc surgery. The patients who met our inclusion criteria and were willing to participate in the study were recruited from the neurosurgery ward of Logman and Imam Khomaini hospitals in Tehran, Iran, between October 2015 and March 2016. The patient completed SF-36 quality of life Questionnaires before, one and two months after surgery. Results: In comparison to standard values, before the surgery patients had significantly lower baseline SF-36 (36-Item Short Form Survey) Questionnaire value in all 8 domains. The role limitations due to physical health had greatest impact on quality of life. At the eight weeks' follow-up SF-36 scores showed significant improvement in both physical and mental scales. Age had no significant impact on mental scales of weeks' Questionnaire but in age less than 30 years there was a positive relation between the patient's age at surgery and physical aspects of quality of life. Although there was no significant difference in physical aspects of SF-36 Questionnaire between males and females but males had a significantly higher mean mental health score than females after surgery. Smokers had lower value of mental scales of SF-36 Questionnaire than in nonsmokers. Conclusion: The result of this study showed that surgery for lumbar disc herniation had a great impact on both physical and mental scales of SF-36 Questionnaire two months after surgery. Factors such as age, sex, smoking and psychological factors can play the role of predictor for patient's outcomes after lumbar disc surgery. Abstract


This study aimed to demonstrate that congenital diaphragmatic hernia (CDH) results in vascular abnormalities that are directly associated with the severity of pulmonary hypoplasia and hypertension. These events increase right ventricle (RV) afterload and may adversely affect disease management and patient survival. Our objective was to investigate cardiac function, specifically right ventricular changes, immediately after birth and relate them to myocardial histological findings in a CDH model. Pregnant New Zealand rabbits underwent the surgical procedure at 25 days of gestation (n=14). CDH was created in one fetus per horn (n=16), and the other fetuses were used as controls (n=20). At term (30 days), fetuses were removed, immediately dried and weighed before undergoing four-parameter echocardiography. The lungs and the heart were removed, weighed, and histologically analyzed. CDH animals had smaller total lung weight (P<0.005), left lung weight (P<0.005), and lung-to-body ratio (P<0.005). Echocardiography revealed a smaller left-to-right ventricle ratio (LV/RV, P<0.005) and larger diastolic right ventricle size (DRVS, P<0.007). Histologic analysis revealed a larger number of myocytes undergoing mitotic division (186 vs 132, P<0.05) in CDH hearts. Immediate RV dilation of CDH hearts is related to myocyte mitosis increase. This information may aid the design of future strategies to address pulmonary hypertension in CDH.


This dataset consists of Result of NOT for the 95 on-farm field trial sites x 2 varieties (Hybrid and OPV) x 6 treatments (Control, PK, NK, NP, NPK, NPK+S+Ca+Mg+Zn+B). The dataset is divided into eight sheets; Metadata, Variable, Sites information, Timing Parameters, Yield Parameters, Grain Yield Data Summary and Data History. 'Metadata' give summary description of the dataset. 'Variables' give the name, unit, description and method of determination of the variables in the dataset. 'Site information' gives description of the study and sampling sites. 'Timing Parameters' contain the data for various agronomic timing activities and management history of the sites. 'Yield Parameters' contain yield harvesting parameters (yield) of OPV and Hybrid set of trials. 'Grain Yield Data summary' gives the summary statistics of grain yield across the six treatments for both OPV and Hybrid set of trials.'Data History' describe the historical changes and exchange in the raw dataset. More details can be requested.


The paper gives a detailed account of the structure and function of the mouth parts of Phryganea striata L., followed by a comparative study of these structures throughout the order Trichoptera. Observations on the feeding of caddis flies are reviewed. Consideration is given to homologies and phylogeny. In Phryganea the head is produced ventrally into a proboscis to which all parts of the mouth complex contribute. A detailed account is given of external and internal structure, musculature, and nervous system of the head and mouth parts. The central area of the anterior surface of the head capsule is interpreted as a frontoclypeus because of the origin of muscles to the foregut. The elongate labrum covers a sclerotized groove or sitophore. Mandibles are reduced to small lobes. The cardines and stipites of the maxillae contribute to the base of the proboscis. The single maxillary lobe is interpreted as a lacinia on grounds of musculature. The distinctive protrusible haustellum is regarded as derived from the hypopharynx. It is traversed by a common salivary duct, provided with a muscular valve. The anterior surface of the haustellum is covered with a system of channels which converge to the sitophore. These channels are formed by cuticular outgrowths arranged in lines and drawn out into filaments which roof the channels thus formed. These outgrowths, which are named pectinate hairs, differ in form according to their position on the haustellum. The labium forms part of the base of the proboscis. There is no ligula. Extension of the proboscis is brought about both by muscle action on sclerites and increased blood pressure affecting the flexible areas of cuticle. Relaxation results from reduction in blood pressure, and contraction of retractor muscles. The haustellum functions as an organ for taking up liquids. A direct drinking and a lapping attitude are described. The comparative study includes observations on fifty-three species, which are representative of each of the thirteen families found in Britain. All species examined have a protrusible haustellum, and are capable of drinking. The most highly developed condition is seen in the Phryganeidae and Limnephilidae. A channelled haustellum is also found in the Sericostomatidae, Beraeidae, Molannidae, Odontoceridae, Leptoceridae and Polycentropidae. A simple granulose haustellar surface, devoid of channels, is present in the Hydropsychidae, Psychomyidae, Philopotamidae, Rhyacophilidae and Hydroptilidae. The mandibles are of doubtful function. They are largest in the Hydropsychidae and Rhyacophilidae, and most reduced in Limnephilidae. Small lobes, which are thought to represent the ligula of the labium, are seen in the Philopotamidae, Hydropsychidae, Psychomyidae and Polycentropidae. These differing conditions of the mouth parts are shown to accord with views on the phylogeny of the Trichoptera, which are derived from other data. An account is given of published descriptions of modified mouth parts in some exotic species. The nature of these modifications is discussed. Published observations on the feeding of caddis flies are reviewed. It is concluded that using the haustellum to drink nectar and water is a normal activity of caddis flies.


The purpose of this study was to better understand the number and types of social needs experienced by Medicaid beneficiaries with type 2 diabetes, and how their social needs are associated with key health indicators. Also examined were factors that influence patients' interest in navigation services for health and social needs to inform future interventions and service delivery. The study expands upon prior research, much of which has focused on only one social need (e.g., food insecurity) or one health outcome. The hypothesis was that among individuals with type 2 diabetes, those with a greater number of social needs would report more health-related problems and be more interested in receiving social needs navigation services. Participants completed a cross-sectional survey by phone (n = 95) or online (n = 14). Most (85%) reported having at least one social need (M = 2.5, SD = 2.2), most commonly not having enough money for unexpected expenses (68%) or necessities like food, shelter and clothing (31%), medical costs (24%), and utilities (23%). Results supported our comprehensive conceptual model. Having more social needs was associated with greater perceived stress, diabetes distress, problems with sleep and executive and cognitive functioning, less frequent diabetes self-care activities, more days of poor mental health and activity limitations, worse self-reported health and more hospitalisations. Number of social needs also was positively associated with interest in having a social needs navigator. Social needs were not associated with days of poor physical health, BMI, self-reported A1C or smoking status. Social needs were associated with a wide range of indicators of poor health and well-being. Participants with the greatest social need burden were most open to intervention.


A series of (mercaptoaroyl)amino acids and related compounds was synthesized and tested for ability to inhibit angiotensin converting enzyme (ACE). The most active compound was N-(3-chloro-2-mercaptobenzoyl)-N-cyclopentylglycine, having an in vitro I50 = 0.28 microM. Substitution of the aromatic 3-position by small polar groups enhanced ACE inhibitory activity, whereas bulky groups diminished it. Alteration of the beta relationship between the mercaptan and amide carbonyl or masking of the thiol by acylation reduced activity. Replacement of the thiol by nitro, hydroxy, or carboxy gave compounds lacking ACE inhibitory activity.


Problem. An understanding of Israel's history is crucial to a Christian view of history, including its morals and values, and is a foundation stone of most conservative Christians including Seventh-day Adventists and their religious educational philosophy. There is a vital need for a curriculum that provides reasonable answers to the most frequently asked questions about Israel's early history and builds a solid base for the Christian/Adventist faith. The purpose of this study was to meet this need by empirically developing a curriculum for religion majors in Seventh-day Adventist colleges. Issues discussed include the Philosophical Background and Importance of History; the Role of Biblical Hermeneutics; Archaeology and the Bible; the Patriarchal Period; Abraham and Middle Bronze Customs, the Thirteenth and Fifteenth Centuries Exodus Debate; and Israelite Conquest/Settlement. Method. The instructional product development methods of Baker and Schutz and Naden were employed in this research. Instructional specifications were established through non-ambiguous behavioral objectives after the need for the product had been established. Criteria for the evaluation of these objectives were based on current literature related to the topic. Strategies for the positive modification of affect were included. The curriculum was prepared in the form of ten, 50-minute class periods. Mastery was set at 80/80 which means that at least 80 percent of the participants would score at least 80 percent on each of the twenty-three behavioral objectives. Religion majors were the designated subjects through which the empirical development was conducted. The product was first presented to small groups. The group size was increased as the product was modified and as the groups achieved higher levels of mastery. The curriculum was considered to be presentation ready when mastery was reached by a larger group (33), the results of which could be statistically analyzed. Modification of affect was measured by means of a Likert-scale instrument. Results. After developing the curriculum, the instruction was presented to thirty-three subjects. Mastery at the predetermined level was achieved on all of the behavioral objectives. Modification of affect suggested that students were significantly motivated by the instruction to further study the archaeologically based issues on the history of ancient Israel. Conclusion. In academic circles, conflict continues over the historicity of the Bible in general and of Israel in particular. These questions carry over into general society and congregational life. Because SDA colleges lacked an empirically developed curriculum for teaching these issues related to the history of ancient Israel, this product could be utilized in a college instruction in religion/religious education classes.


Meeting places form a vital link in the process of partner choice, in which preferences, norms and opportunities to meet partners play a role. Using the 2003 Fertility and Family Survey (Onderzoek Gezinsvorming) for the Netherlands, we find that the partner market is segmented by relationship career, education, age, religion and geography. Public places are popular among youngsters, the lower educated, Catholics and the rural population. So-called 'closed' places are meeting places for the higher educated, partners in the repartnering market, young adults, the re-reformed and city dwellers. Those meeting in private settings tend to have a lower level of education, to be Muslim, and to have grown up abroad.


Abstract Currently, many authors in public and academic discourse speak of an increasing "social divide" that threatens social cohesion. There has been a broad discussion on social cohesion in social sciences ever since: Different conceptions could be ideally classified in a scheme with a more rational (Weber, Parsons) and a more emotional pole (Durkheim, Tönnies). I explore this tension by following an affective turn in conceptions of social cohesion. Therefore, I focus on the concept of solidarity as representing the rational model of cohesion and the concept of affinity standing for the affective one. The affective turn brings about a twofold shift in the understanding of the central processes of social cohesion: from collectivity to connectivity and from rationality to affectivity. Still, this shift runs the danger of throwing out the baby with the bathwater. Cohesion must neither be understood as exclusively reyling upon on either rational or affective processes. I propose to overcome this dichotomy by employing Hemming´s concept of "affective solidarity". Rationaliy and affectivity must be understood as being mutually effective, the former modulating the latter, the latter energizing the former.


Background Central venous line insertion is a common procedure performed in the intensive care unit and ultrasound guidance technique is widely practised currently. Despite the use of ultrasound, complications still persist. As exact needle location is often difficult to confirm with the conventional two dimension ultrasound. A novel real time needle guidance ultrasound approach allows the visualisation of the needle and tracks the needle during insertion.
Objective To compare between the conventional ultrasound and novel real time needle guidance ultrasound technique for insertion of central venous line into the internal jugular vein.
Methods This prospective, randomized controlled trial involved patients who underwent central venous line insertion in the intensive care unit of UMMC from Feb until Oct 2016. Participants were the doctors in anaesthesia who performed internal jugular vein cannulation via out of plane method using either the novel real time needle guidance ultrasound approach or conventional ultrasound. The primary outcome was to determine the performance time between the two techniques and the success rate. Participant" s satisfaction and complication rate were also evaluated.
Results Since the performance time was not distributed normally, it is described as median (inter- quartile range, IQR). The median performance time for the novel real-time needle guidance and conventional ultrasound approach were 25.50(22) seconds and 15.00(17) seconds respectively. The p-value was 0.01 and therefore clinically significant. 100% of the operators were satisfied with the conventional method compared to only 88% for the novel real time needle guidance ultrasound method with a p- value of 0.012, which is clinically significant.
Conclusions: Internal jugular vem cannulation using the conventional ultrasound guidance approach needed a shorter perfonnance time and had a higher satisfaction rate among the operators compared to the novel real-time needle guidance ultrasound approach.


Background Nonpulsatile pulmonary blood flow in Fontan circulation results in pulmonary vascular disease, but the potential relationships between pulmonary vascular resistance index (PVRI) and Fontan failure have not been studied. The objective was to determine whether the absence of subpulmonary ventricle in the Fontan circulation would make patients more vulnerable to even low-level elevations in PVRI, and when coupled with low cardiac index, this would identify patients at increased risk of Fontan failure. Methods and Results Two hundred sixty-one adult Fontan patients underwent cardiac catheterization; age 26±3 years, men 146 (56%), atriopulmonary Fontan 144 (55%). Patients were divided into 2 groups: those with high PVRI (>2 WU·m2) and low cardiac index <2.5 L min−1 m−2 (group 1, n=70, 30%), and those with normal PVRI and normal cardiac index (group 2, n=182, 70%). Fontan failure was defined by the composite of all-cause mortality, listing for heart transplantation, or initiation of palliative care. There were 68 (26%) cases of Fontan failure during a mean follow-up of 8.6±2.4 years. When compared with group 2, freedom from Fontan failure was significantly lower in group 1: 66% versus 89% at 5 years. The combination of high PVRI and low cardiac index was an independent risk factor for Fontan failure (hazard ratio, 1.84; 95% confidence interval, 1.09–2.85). Conclusions When coupled with low cardiac index, even mild elevations in PVRI identify patients at high risk of Fontan failure. This suggests that pulmonary vascular disease is a key mechanism underlying Fontan failure and supports further studies to understand the pathophysiology and target treatments to pulmonary vascular tone in this population.


Objective To review the literature on usage of the levonorgestrel intrauterine system (LNG IUS) in women with fibroids or adenomyosis in an attempt to develop a pragmatic approach when faced with enlarged uteri. Data sources Computerised searches of MEDLINE and EMBASE up to December 2000. Some of the information was obtained from references listed in the primary sources and references already known to the authors. Study selection Studies and case reports were excluded if they did not specifically provide information about LNG IUS usage in women with fibroids and adenomyosis. Data extraction and synthesis After perusal, each relevant publication was summarised and appraised in terms of whether it contained information relevant to the stated objective. Discussion This area is sparsely researched, as there were no randomised-controlled studies. One large contraceptive study suggests the LNG IUS has a protective effect from the complications of uterine fibroids and smaller case studies suggest it is also useful in women with symptomatic fibroids. However, there is also evidence of an increased risk of expulsion and there may be a place for initial adjunctive medical treatment to minimise this risk. An observational study and isolated reports of women with adenomyosis report significant symptomatic relief in these women. Conclusion Available data refute the notion that uterine enlargement is a contraindication to insertion of the LNG IUS, but there appear to be reasons for a cautious approach when dealing with pathological uteri.


Animal cultivation and dairying assume an imperative job in the rural economy of India. It is a necessary subordinate to crop production. Dairy cooperatives and private dairies are assuming significant job to improve the milk production in various districts of India. Growth of milk production is formed by socio-economic, innovative, and institutional components, which act both on the demand and the inventory sides. The demand-related economic factors which impact milk production incorporate per capita income, populace growth, urbanization, cost of milk, and its substitutes, income-use versatility, and utilization pattern. The special trait of the Indian dairy industry is that heft of milk production in our nation is dealt with by little milk producers who are unskilled and insensible of economic parts of milk production brave is a safe path and eventual fate of our neural development and turned into a business endeavor. It can contribute generously to a farmer's income. His method for looking to the challenging has not been changed from auxiliary to business. This issue truly lessen the production possibilities of animals, particularly cross breeds as they sand progressively defenseless to ailments, hardships, and contingencies impossible to miss to the Indian atmosphere. Be that as it may, there is little proof accessible on how much the farmers and the country lose because of animal infections. The reproductive capacity the animal, a significant worry in its economic misfortunes to farmers' an incentive in dairy farming, is as often as possible identified with periparturient occasions as unwanted health identified with occasions during this period may result in tremendous economic misfortunes to farmers. Before the finish of development in dairy makes gigantic demands for vitality, protein is with the end goal that it happens at the most productive time of a lactating animal. Tamil Nadu is one of the states with a decent potential for milk production, and the private dairies are giving great and healthy rivalry. Dairy cooperatives and private dairies have not just given an organized system to milk marketing to the rural family units, yet also gave the essential specialized information sources like arrangement of manual semen injection, health administrations, and different data sources. Hence, the present study has been done to give an overview of the economic contribution of Milk Production in Tamil Nadu, and the study is completely based on the secondary sources of data collections.


Research on work aggression or anger has typically focused on supervisors and co-workers as the instigators of aggression; however, aggressive customers are also likely and may have unique consequences for the employee. We explore this phenomenon with a sample of 198 call center employees at two work sites. The employees reported that customer verbal aggression occurred 10 times a day, on average, though this varied by race and negative affectivity. Using LISREL, our data indicated that both the frequency and stress appraisal of customer aggression positively related to emotional exhaustion, and this burnout dimension mediated the relationship of stress appraisal with absences. Stress appraisal also influenced employees' emotion regulation strategies with their most recent hostile caller. Employees who felt more threatened by customer aggression used surface acting or vented emotions, while those who were less threatened used deep acting. Job autonomy helped explain who found these events more stressful, and implications of these results are discussed. Copyright © 2004 John Wiley & Sons, Ltd.


Abstract Despite the design of various challenge levels in online games, exactly how these challenges increase customer loyalty to online games has seldom been examined. This study investigates how such challenges increase customer loyalty to online games. The study sample comprises 2,861 online gamers. Structural equation modeling is performed. Analytical results indicate that the relationship between challenge and loyalty intensifies when customers perceive that overcoming challenges takes a long time. Results of this study contribute to efforts to determine how challenges and challenge-related perceptions impact customer loyalty to online games.


A new method of driving series arrays of non-hysteretic Josephson junctions using optoelectronically generated pulses to synthesize a variable output voltage is described. Electrical pulses from a photodiode are coupled to the array, and the mean output voltage after filtering is proportional to the pulse repetition frequency with fundamental accuracy. Numerical simulations of the behaviour of the Josephson junctions have been carried out, and these results have been verified by experiment. This technique can be easily extended by using two photodiodes with opposite bias polarities in order to synthesize bipolar alternating or direct voltages.


IMPORTANCE
Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear.

OBJECTIVE
To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery.

EVIDENCE REVIEW
A MEDLINE and EMBASE search was conducted for English-language studies published from January 1, 1980, through April 13, 2012. Titles and abstracts were screened in a standardized manner by 2 reviewers. Studies selected for inclusion had to use a measure of hospital or surgeon experience as a predictor variable and had to report postoperative outcomes as dependent response variables. Included studies were reviewed with regard to methodologic quality, and study results were extracted.

FINDINGS
Sixty-three studies were reviewed. Significant heterogeneity was detected in exposure definitions, outcome measures, and risk adjustment, with the greatest heterogeneity seen in appendectomy studies. Various exposure levels were examined: hospital level in 48 (68%) studies, surgeon level in 11 (17%), and both in 9 (14%). Nineteen percent of studies did not adjust for confounding, and 57% did not adjust for sample clustering. The most consistent methods and reproducible results were seen in the pediatric cardiac surgical literature. Forty-nine studies (78%) showed positive correlation between experience and most primary outcomes, but differences in outcomes and exposure definitions made comparisons between studies difficult. In general, hospital-level factors tended to correlate with outcomes for high-complexity procedures, whereas surgeon-level factors tended to correlate with outcomes for more common procedures.

CONCLUSIONS AND RELEVANCE
Data on experience-related outcomes in children's surgery are limited in number and vary widely in methodologic quality. Future studies should seek both to standardize definitions, making results more applicable, and to differentiate procedures affected by surgeon experience from those more affected by hospital resources and system-level variables.


Diallyl sulfide (DAS) is a principal thioether of garlic (Allium sativum) accounting, in part, for the flavor and fragrance of this herb. Previous studies have shown that DAS is a potent inhibitor of experimentally induced colon cancer in mice. Metabolic studies of other garlic-derived substances suggested that DAS could prevent tumorigenicity of other hepatic activated carcinogens. The present study was designed to determine whether DAS could inhibit the DNA-damaging and tumorigenic effects of N-nitrosomethylbenzylamine in rat esophagus. A dose of 200 mg/kg of DAS given p.o. 3 h prior to N-nitrosomethylbenzylamine administration was found to inhibit the carcinogen-induced nuclear toxicity by 64% to 56% at the two doses (3 and 5 mg/kg) of NMBA tested. These results suggested that the compound was potentially anticarcinogenic. In the carcinogenicity experiment it was found that DAS totally inhibited tumor formation in rats treated with a carcinogenic dose of NMBA (100% inhibition of papilloma and squamous cell carcinoma incidence, P less than 0.0001). Additionally DAS was found to substantially reduce hepatic microsomal metabolism of the carcinogen. These data demonstrate that DAS is unique in its anticarcinogenic activity. It strongly suppresses the tumorigenic effects of potent, metabolically activated monoalkylating carcinogens in the gastrointestinal tract.


some of their former contents. Hair shampoo bottles are popular, and urines from these may interfere with the normal test reaction. We have used Pregnosticon since 1963 and tested more than 405 000 urines with this reagent. The overall accuracy of the test, based on the clinical diagnosis for 52 606 women, is 98-7% with an accuracy of 98-1-100% between 21 batches. Analysis of the results shows that a positive result in the absence of clinical evidence of pregnancy might be expected once in 2600 tests. As information accumulates about the incidence of menstrual and very early abortions the probability that these false positives are correct must also be considered. In a recent comparative study between a slide test (Pregnosticon Neoplano Duoc-


A new 7.0 T asymmetric active shield superconducting magnet for Penning traps is proposed in this work. The magnet has two field regions whose homogeneity is better than 0.5 ppm. Linear and nonlinear methods are used for the asymmetric electromagnetic optimization. Stress analysis, mechanical design and a quench protection system design are also introduced in this paper.


A growing number of natural and/or synthetic peptides with cell membrane penetrating capability have been identified and described in the past years. These molecules have been considered promising tools for delivering bioactive compounds into various cell types. Although the mechanism of uptake is still unclear, it is reasonable to assume that the relative contribute of each proposed mechanism could differ for the same peptide, depending on experimental protocol and cargo molecule composition. In this work we try to connect the capability to interact with model lipid membrane and structural and chemical characteristics of CPPs in order to obtain a biophysical classification that predicts the behavior of CPP-cargo molecules in cell systems. Indeed, the binding with cell membrane is one of the primary step in the interaction of CPPs with cells, and consequently the studies on model membrane could become important for understanding peptide-membrane interaction on a molecular level, explaining how CPPs may translocate a membrane without destroying it and how this interactions come into play in shuttling CPPs via different routes with different efficiency. We analyzed by CD and fluorescence spectroscopies the binding properties of six different CPPs (kFGF, Nle54-Antp and Tat derived peptides, and oligoarginine peptides containing 6, 8 or 10 residues) in absence or presence of the same cargo peptide (the 392-401pTyr396 fragment of HS1 protein). The phospholipid binding properties were correlated to the conformational and chemical characteristics of peptides, as well as to the cell penetrating properties of the CPP-cargo conjugates. Results show that even if certain physico-chemical properties (conformation, positive charge) govern CPP capability to interact with the model membrane, these cannot fully explain cell-permeability properties.


Commentators have examined the international law aspects of the new Canadian UGC exception, including its compliance with the Berne Convention and the WTO TRIPS Agreement. One issue that has not been considered much is whether this exception would serve as an ideal model for other jurisdictions that are undertaking digital copyright reform. Written for the Symposium on User-Generated Content under Canadian Copyright Law, this article uses Hong Kong as a case study to illustrate why the Canadian UGC exception, with appropriate modifications, can be — and should be — transplanted abroad.This article begins by discussing the efforts by the Hong Kong government to transplant copyright laws from abroad and its recent public consultation on the treatment of parody under the copyright regime. It further examines the benefits and drawbacks of legal transplants. Using the U.S. Digital Millennium Copyright Act of 1998 as a point of comparison, the article argues that the Canadian UGC exception would provide a timely and attractive model for legal transplant.This article then discusses specifically the UGC exception proposal I submitted to the Hong Kong government based on the Canadian model. Focusing on two key aspects of legal transplant — modeling and adaptation — the article identifies the key objections to the transplant of the Canadian UGC exception to Hong Kong, in particular those relating to the compliance with the TRIPS Agreement.The article concludes by recounting the Hong Kong government's report on the recent consultation, including its preliminary analysis of introducing a UGC exception into the Copyright Ordinance. Although this article strongly disagrees with this analysis, this Part takes seriously the government's international compliance concerns and offers seven additional modifications to further adapt the proposed transplant.


This case study describes the interactional competence of one U.S. Spanish heritage language learner (HLL), during a five-week study abroad program in Spain that included service-learning. Data were drawn primarily from audiotapes, reflection essays, and an exit interview. The audiotapes included "Mía's" conversations at the service-learning site, a summer camp for young children. The three resource categories in Young's (2019) model of Practice Theory of identity, linguistic, and interactional resources facilitated the analysis of Mía's intercultural competence.
 The qualitative analysis describes, first, Mía's resources during discursive practices with children and peer teachers at the camp, reflecting the construction of her identity as an educator. Second, we examine possible connections between Mía's resources and her Spanish learning history. We show that the linguistic and interactional resources observed in her interactions are congruent with her HLL background, as seen in her lexical choices and flexibility interacting with diverse interlocutors. These findings of one HLL's linguistic activity shed light on her interactional competence in this context, thus contributing to the literature on HLL s in study abroad.


Temperate and high latitude terrestrial ecosystems have high thermal variability, and the ectotherms that inhabit these regions must have thermal tolerances that mirror these temperatures. However, the thermal limits of many high-latitude arachnids are unknown, as well as any underlying mechanisms of seasonal plasticity for any arachnid. The objective of my thesis is to measure the thermal tolerances of temperate, Arctic, and sub-Arctic arachnids, and identify if they have thermal plasticity, either seasonally or following acclimation. I collected the highlatitude pseudoscorpion Wyochernes asiaticus streamside from the Yukon Territory, where besides large thermal variability, they are also inundated with spring flooding. I also collected a variety of wolf spiders (Genus Pardosa) in the Yukon, Greenland, and Norway, where they are abundant and active on the tundra in the Arctic summer. In the lab, half of the of the air-exposed and low oxygen water-submerged pseudoscorpions survived for 17 days; showing that they are likely adapted to seasonal flooding. The pseudoscorpions and spiders I collected in the summer have thermal tolerances (the low and high temperatures at which activity stops) that range from 6°C in both pseudoscorpions and spiders, to 37.8°C (in pseudoscorpions) and 45°C (in spiders). Following 4°C-acclimation, the spiders did not show an ecologically significant change in their thermal tolerance breadths (Tbr, the difference between their lowand high-temperature tolerance), potentially because their Tbr is large enough to remain active during summer temperatures. I collected the temperate and freeze-tolerant red velvet mite in late fall, midwinter, and early spring to compare their lower lethal temperature, and potential mechanisms associated with cold-tolerance. In mid-winter, the hemolymph osmolality and glycerol content increases, and water content decreases: all likely cryoprotectant mechanisms. Temperate red velvet mites show seasonal acclimatization resulting in freeze-tolerance, the first evidence of freeze-tolerance in microarthropods.


By applying nonlinear dynamics to the dense storage of information, we demonstrate how a single nonlinear dynamical element can store M items, where M is variable and can be large. This provides the capability for naturally storing data in different bases or in different alphabets and can be used to implement multilevel logic. Further we show how this method of storing information can serve as a preprocessing tool for (exact or inexact) pattern matching searches. Since our scheme involves just a single procedural step, it is naturally set up for parallel implementation and can be realized with hardware currently employed for chaos-based computing architectures.


Proline has been grafted onto silica supports in a single step by reacting trans-4-hydroxy-L-proline with chloropropyl tethers, without the use of protecting groups for the proline amine and carboxylic acid functional groups. The resulting catalysts have been characterised to show that grafting is through reaction with the 4-hydroxy group. The catalysts have been tested in an asymmetric aldol reaction, and shown to be both more active and more enantioselective than equivalent catalysts prepared using a protection/deprotection route for the proline grafting step.


As an American College of Sports Medicine (ACSM) initiative known as Exercise Is Medicine (EIM) is becoming more and more popular globally, FIT Taijipao has
 been proposed as a new approach to exercise. FIT Taijipao has been introduced as an individualized and dynamic exercise. The purpose of this study was to
 examine the effects of FIT Taijipao on Heart Rate (HR) at different speeds including peak (YANG) and minimum (YIN) points every three months across 15
 months of continuous FIT Taijipao exercise, concluding with a follow-up retention test to examine the effects of an 18-month detraining. The participant
 of the case study was recruited in a college-wide mind & health program. A 48-year-old sedentary Asian female volunteered for this pilot longitudinal
 study. The participant performed FIT Taijipao on a treadmill two to three times per week in the exercise lab. A Polar HR Monitor (M400 + H10 chest unit)
 was used to record HR data. According to FIT Taijipao guidelines, HR Average per 200m was used for data analysis. The Borg Rating of Perceived Exertion
 (RPE) scale was used to monitor the participant's subjective effort and controlled to be no higher than 15. YANG Speed (peak) is attained as RPE reaches
 15 or less when HR reaches 145 bpm. The running speed was adjusted according to FIT Taijipao established speed profile. Weekly HR average of YANG (peak)
 speed decreased by 25.3 bpm (146.3 to 121.0 bpm) after first 3 months of FIT Taijipao; Weekly HR average at the same speed continuously decreased to 117.3,
 120.0, 116.0, and 116.3 bpm at 4.5 mph speed. YANG (peak) speed increased gradually from 4.5 mph, to 5.7, 6.0, 6.1, 6.3, and 6.3 mph every three months.
 After 18 months of detraining, a retention FIT Taijipao test was done to examine the HR change. Weekly HR average at 6.3 mph was 160.6 bpm, and the lap
 average speed was 5.7 mph when HR was around 145 bpm. The RPE reported was 13. This case study illustrates that regular FIT Taijipao leads to a decreased
 HR, a useful index for exercise intensity and cardio-respiratory fitness. The participant enjoyed FIT Taijipao, a 40-45 minutes run. FIT Taijipao has a
 great potential to help general population to gain the benefits of exercise and physical activity without being over stressed.


Currently cryopreservation offers the best means of preserving bone tissue for allografts. At -196 degrees C all enzyme activity is halted and tissue preservation is unlimited. Perfect sterilization, adapted cryoprotection and controlled freezing and thawing are now part of the well-controlled process of bone preservation in bone banks. At implantation, the mechanical properties of cryopreserved bone is as good as or better than fresh bone, although the diaphyseal cortical bone is more fragile. Anatomic and physiologic reconstruction of the graft area is a major factor in graft resistance. It takes approximately three weeks for vessels to penetrate cancellous allografts and at least one month for total revascularization. The delay may reach several years for cortical bone. The immune response of the host is determined by the antigenic properties of the leukocytes in the bone marrow as well as the blood vessels and nerves. The protein-mineral complex itself has little antigenic effect. A certain number of non-specific immune reactions result from transfusions almost always performed with bone grafting. At the present time, there is no artificial material capable of providing a mechanically acceptable substitute for allograft bone in limb reconstruction. Allograft bone currently stocked in bone banks provides a biologically and clinically acceptable means of reconstruction after major bone loss. Other factors such as public acceptance and administrative authorizations will also play an important role in the future of massive reconstruction with bone allografts.


Background The healing potential of damaged articular cartilage is limited. The NeoCart is a tissue-engineered collagen matrix seeded with autogenous chondrocytes designed for the repair of hyaline articular cartilage. Hypothesis The NeoCart implant is well tolerated in the human knee. Study Design Case series; Level of evidence, 4. Methods Eight patients (treatment group) with full-thickness cartilage injury were treated with the NeoCart and evaluated prospectively. Autogenous chondrocytes provided by arthroscopic biopsy were seeded into a 3-dimensional type I collagen scaffold. The seeded scaffold was subjected to a tissue-engineering protocol including treatment with a bioreactor. Implantation of the prepared cartilage tissue patch was performed via miniarthrotomy and secured with a collagen bioadhesive. Evaluations through 24 months postoperatively included the subjective International Knee Documentation Committee questionnaire, visual analog scale, range of motion, and cartilage-sensitive magnetic resonance imaging (MRI), including quantitative T2 mapping. Results Pain scores after NeoCart implantation were significantly lower than baseline at 12 and 24 months after the procedure (P < .05). Improved function and motion were also noted at 24 months. Six patients had 67% to 100% defect fill at 24 months with MRI evaluation. One patient had moderate (33%-66%) defect fill, and another patient had poor (less than 33%) defect fill. Partial stratification of T2 values was observed for 2 patients at 12 months and 4 patients at 24 months. No patients experienced arthrofibrosis or implant hypertrophy. Conclusion Pain was significantly reduced 12 and 24 months after NeoCart treatment. Trends toward improved function and motion were observed 24 months after implantation. The MRI indicated implant stability and peripheral integration, defect fill without overgrowth, progressive maturation, and more organized cartilage formation.


Introduction Differences in breast cancer survival by race and ethnicity are often assumed to be a fairly recent phenomenon, and are hypothesized to have arisen due to gaps in receipt of screening or therapy. The emergence of these differences in calendar time have implications for identification of their origin. We sought to determine whether breast cancer survival differences by race or ethnicity arose in tandem with the advent of screening or therapeutic advances. Materials and methods A cohort of women diagnosed with invasive breast cancer from 1975–2009 in 18 population-based registries were followed for five-year breast cancer cause-specific survival. Differences in survival according to race/ethnicity and estrogen receptor status were quantified in Cox proportional hazards models, with estimation of hazard ratios (HR), 95% confidence intervals (CI), and absolute risk differences. For 2010, we also assessed differences in survival by breast cancer subtypes defined by hormone receptor and Her2/neu status. Results Among over 930,000 women, initial differences in five-year breast cancer-specific survival by race became apparent among 1975–1979 diagnoses and continued to be evident, with stronger disparities apparent in those of Black vs. White Non-Hispanic (WNH) race and among estrogen-receptor positive vs. negative disease. Within breast cancer subtype, all included race/ethnic groups experienced disparate survival in comparison with WNH women for triple-negative disease. Black women had a consistent gap in absolute survival of .10-.12, compared with WNH women, from 1975–1979 through all included time periods, such that 5- year survival of Black women diagnosed in 2005–09 lagged more than 20 years behind that of WNH women. Discussion Survival differed by race for diagnoses that predate the introduction of mammographic screening and most therapeutic advances. Absolute differences in survival by race and ethnicity have remained almost constant over 40 years of observation, suggesting early origins for some contributors.


The importance and role of reverse supply chain in gaining competitive advantage has been recognized especially in recent years. However the high costs of implementing and installing these chains works as an impediment for managers. Collaboration as a key to success in supply chains can be a way to decrease the costs and make reverse supply chains economically attractive. This paper proposes a conceptual model for collaboration between reverse supply chains in accordance with VMI in forward supply chains. Firstly a conceptual model is defined by introducing members and assumptions needed for that. Then a collaborative process for collection and routing between members of these chains and a heuristic method using modified tabu search for finding the best routs are defined. Finally an example is solved for some separate reverse supply chains once in the case of isolated chains and then for the collaboration between them in the suggested form of this paper.


The rapid growth and development of the mutual fund industry throughout the world stimulated vast contemporary studies focusing on a wide range of issues predominantly of microeconomic character, such as fund performance, timing ability, fees and fund flows, thus leaving determinants and attributes of mutual fund industry development beyond their research. The rare relevant studies predict that development of the mutual fund industry depends on a number of factors among which the predominant role belongs to development of the economic and financial systems, and quality of governance and regulatory basis. One essential condition of validity of this prediction is that it is based upon a sample of developed economies, thus leaving a space for the likelihood that under condition of developing or middle-income economies some expectations may substantially deviate from the predication. This paper aims to reevaluate the significance of the impact of individual macro- and microeconomic factors, which were identified in previous studies, on size of asset under management in the sample of high- and middle-income economies of Central and Eastern Europe by means of regressing the total size of the mutual fund industry and size of its separate components, such as equity, fixed income and money market asset management over a number of independent variables. The obtained results indicate that out of a wide range of factors, the high explanatory power of which was stressed by earlier studies, only a small group of them turned out to be significant in our research. In particular, it was found that the size of the CEE mutual fund industry in general and the sizes of its particular segments respond positively on increase of country openness to trade and capital inflows, development and stability of local financial and capital markets, improvement of quality of governance and regulatory basis. Also some controversial evidence was obtained on the role of change in government indebtedness for explaining the size of the mutual fund industry – in general, there is a significantly positive impact of a decrease of central government debt on the size of CEE asset management, however its sign is not consistent across all subcategories of funds. Although the chosen sample does not cover as large a number of countries as previous studies, it provides brief insight into the CEE mutual fund industry, documenting important country and regional characteristics.


eICG/AIME (UMR 5253 CNRS), Universite Montpellier II, 34095 Montpellier Cedex 5, France Tin nitride thin films have been reported as promising negative electrode materials for lithium-ion solid-state microbatteries. However, the reaction mechanism of this material has not been thoroughly investigated in the literature. To that purpose, a detailed electrochemical investigation of radio-frequency-sputtered tin nitride electrodes of two compositions 1:1 and 3:4 is presented for several layer thicknesses. The as-prepared thin films have been characterized by Rutherford backscattering spectrometry, inductively coupled plasma optical emission spectrometry, scanning electron microscopy, X-ray diffraction, and transmission electron microscopy. The electrochemical results point out that the conversion mechanism of tin nitride most probably differs from the conversion mechanism usually observed for other oxide and nitride conversion electrode materials. The electrochemical data show that more than 6 Li per Sn atom can be reversibly exchanged by this material, whereas only about 4 are expected. Moreover, the electrochemical performance of the material is discussed, such as electrode cycle life, and a method for improving the cycle life is presented. Finally, thicker films have been characterized by Mossbauer spectroscopy. This technique opens a new route toward


Human monocytes express functional IL-2 receptors (IL-2R) and are directly activated by IL-2 to exert effector and secretory functions. In this study, we show that IL-4 selectively suppressed, in a dose-dependent manner, IL-2-induced monocyte tumoricidal activity, without affecting IFN-gamma-dependent cytotoxicity. This effect was specific because a neutralizing anti-IL-4 mAb completely restored IL-2-activated cytolysis. Furthermore, IL-4 effectively blocked the secretion of proinflammatory cytokines by IL-2-stimulated monocytes. Binding studies with biotin-conjugated IL-2 demonstrated that monocyte stimulation with IL-2 increased IL-2 binding to the cell surface, and that treatment with IL-4 inhibited this augmentation, providing a possible explanation for the decreased responsiveness of monocytes to IL-2 in the presence of IL-4. However, IL-4 suppressive effects could not be ascribed to the down-regulation of the individual components of the IL-2R complex. In fact, co-treatment of monocytes with IL-2 and IL-4 increased the expression of IL-2R gamma chain above the levels induced by IL-2 alone, whereas it did not significantly affect the expression of IL-2R beta chain. Thus, the inhibition of IL-2 binding by IL-4 may be due to the recruitment of the gamma chain into the IL-4-IL-4R system, making it unavailable for participation in the formation of IL-2 binding sites. These findings provide the first evidence of the ability of IL-4 to suppress IL-2-mediated activation of human monocytes and suggest that IL-4 may play an important role in vivo as an inhibitory signal that controls the response of monocytes to IL-2.


Inspired by a recent line of work in online algorithms with predictions, we study the constrained adversary model that utilizes predictions from a different perspective. Prior works mostly focused on designing simultaneously robust and consistent algorithms, without making assumptions on the quality of the predictions. In contrary, our model assumes the adversarial instance is consistent with the predictions and aim to design algorithms that have best worst-case performance against all such instances. We revisit classical online selection problems under the constrained adversary model. For the single item selection problem, we design an optimal algorithm in the adversarial arrival model and an improved algorithm in the random arrival model (a.k.a., the secretary problem). For the online edge-weighted bipartite matching problem, we extend the classical Water-filling and Ranking algorithms and achieve improved competitive ratios.


ABSTRACT As the number of Veterans enrolled in the Veterans Health Administration (VHA) and at risk for needing Long Term Services and Supports increases, VHA is shifting from institutional to Home and Community Based Services, such as the Veteran-Directed Care (VDC) program. VDC is a multi-sector program implemented as a collaboration between individual VHA medical centers (VAMCs) and Aging and Disability Network Agencies (ADNAs), entities that sit outside the VHA. Factors that affect establishment of effective multi-sector programs such as VDC are poorly understood, limiting ability to effectively deliver and scale programs. We conducted a qualitative study to describe factors affecting the interorganizational implementation context of VDC. Using constructs from the Consolidated Framework for Implementation Research (CFIR), we interviewed VDC coordinators from seven different VAMC-ADNA partnerships that initiated the VDC program between 2017 and 2018. We identified eight CFIR determinants which manifested similarly for the VAMCs and ADNAs: evidence strength and quality, relative advantage, adaptability, tension for change, access to knowledge and information, self-efficacy; engaging, and champions. We identified three CFIR determinants that varied dramatically across VAMCs and ADNAs: available resources, implementation climate, and relative priority. Our results suggest that interorganizational context plays a critical and dynamic role within multi-sector collaborations.


Abundance, growth rates and nutrient limitation of the heterotrophic bacteria present in the reef water column and reef cavity water were measured on a fringing reef at Curacao (Nether- lands Antilles). Bacterial in situ growth rates were measured using dialysis bags. Nutrient limitation was measured using bioassays with different amendments of inorganic nutrients (nitrate, ammonium, phosphate) and dissolved organic carbon (glucose). Cell sizes were measured in the reef water col- umn and over an intra-cavity gradient inside reef cavities, from the cavity center to the wall of the cavity. Bacterial abundance was lower in cavities, while growth rates were on average 3.6 times higher than in open reef water. The bacterial community in open reef water was limited in its growth by all nutrients, in contrast to cavity water, in which bacteria were limited by phosphate. Cell volumes decreased significantly from open reef water towards the cavity wall. Results suggest that conditions in cavities have a positive effect on bacterial growth. Growth limitation by N is alleviated through enhanced mineralization in cavities. Through rapid exchange with the ambient water, cavities enrich the overlying reef water with inorganic N.


Objective: Identification of causes of death by verbal autopsy which can be conveniently used by peripheral health workers. Methods: All the deaths in children under the age of five years in one year study period were recorded. The cause of death was ascertained using the standard verbal autopsy procedure. Results: In the study period, 446 live births and 56 deaths in under-five children were reported. The neonatal, infant and under five mortality rates were 49.4, 83.0, 125.6 per thousand live births respectively. The main causes of infant deaths were birth asphyxia, diarrhoea, pneumonia, prematurity (including LBW) and malnutrition. The deaths in children of 1-5 years age group were mainly due to diarrhoea, malnutrition, pneumonia and meningitis. Conclusion: Most of the death in children under the age of five years is preventable, if issues like promotion of institutional deliveries, strengthening of referral system, early recognition of danger signs, strengthening of RCH program.


Abstract. An assessment of the reproductive impacts of maintenance systems, stable-pasture keeping and natural pasture, on Hucul horses was undertaken during the period 1990–2010. During the period covered by the analysis, much higher reproductive results were obtained in natural breeding systems. During the same period (1990–2010), pregnancy levels of 82.2 %, fertility of 80.44 %, sterility of 17.76 % including prolificacy of 77.45 % were attained under guided breeding systems. The corresponding figures for natural breeding were 93.50 %, 90.25 %, 6.50 % and 85.56 %, respectively. On farm, where reproductive guided breeding system was practiced, the best breeding results were obtained by mating mares with stallions from Hroby line while the least were with stallions from Gurgul line. However, in stables where reproduction was devoid of human interference the Hroby and Goral lines were most benefitting. A decline in pregnancy and fecundity accompanied by an increase in sterility were observed on both breeding facilities.


Abstract The aim of this study was mapping, visualizing and determining subject trends in the field of information retrieval using author co-citation network based on articles indexed in Scopus from 2005- 2018. This scientometric study was performed using co-citation analysis. Research population includes all articles indexed in Scopus in the field of information retrieval from 2005 to 2018. Therefore, 35018 papers were retrieved in this field. VOSviewer was used to analyze the author co-citation. The study indicated that a total of 604757 authors were co-cited, 212328 journals were cited. Also highly cited articles and sources were determined. Amongst countries, United States, China, United Kingdom, Germany and Canada ranked one to five, respectively. Computer science was a pioneer with regard to interdisciplinary area in IR. It is noteworthy that visualization of author co-citation in field of IR determined ten clusters, namely knowledge and information science, computer science, electronics, information retrieval, information seeking behavior, psychology, multimedia information retrieval, software engineering, ophthalmology and surgery.


. The transition from the traditional to the innovative paradigm of teaching places the new demands to a teacher of music art in accordance with the models of a professional, worked out by a society. The understanding of the concepts of "innovation", "identity" made it possible to consider the essence of the teacher's innovative pedagogical activity. We have developed the concept of "pedagogically-innovative identity of the teacher of musical art" and specified the factors of the formation of the pedagogically-innovative identity. There have been specified the factors for the formation of the pedagogically innovative identity as an integrated quality of a teacher of music art. There have been ana-lized the peculiarities of the innovative pedagogical technologies in music education. The content of the technology for the formation of the innovative identity of the future teachers of music art in the professional training process in the higher educational institution has been considered. The organization and the implementation of the coordinative influence defined by the certain educational methods, ways, and means. The expediency of using the didactic approaches in the process of the formation of the innovative identity of the future teachers of music. The stages for the realization of the pedagogical technology for the formation of the innovative identity of the future teachers of music art have been specified. An example of an instruction card to organize the individual academic activities with students has been presented. The author has provided the system of teaching methods, forms, means and ways, which includes three blocks. there is a meaningful analysis for the technology of the formation of the innovative identity of the future teachers of music.


relative work ratio (t AD /t DD) relative work ratio (t AD /t DD) (As described in Subsection 5.3, each number in the shaded portion of the table is a ratio of the AD–generated derivative value D AD to the DD–generated derivative value D DD. In experiment 1, the blank entries indicate derivatives that were computed to be zero by both D AD and D DD. In experiment 2, each " * " indicates a ratio having a highly suspect D DD value.) Non-geometric Sensitivities exp # flow case flow type grid size M α Re M α Re M α Re 1 1 Algorithmic Sensitivities flow case flow type grid size VIS2 VIS4 VIS2 VIS4 VIS2 VIS4 6 4 T,BL 97x25x17 .9972 flow case flow type grid size K A+ K A+ K A+ 7 4 T,BL 97x25x17 .9980. flow case flow type grid size c tip x tip,LE z tip,LE c tip x tip,LE ztip,LE c tip x tip,LE z tip,LE


Background : Owing to the growing interest in biofuels, the concept of a biorefinery where biomass is converted to a variety of useful products is gaining ground. We here present how distillery waste is combined with a by-product from a sugar production, molasses, to form a medium for the growth of Lactobacillus plantarum with yields and biomass densities comparable with conventional industrial media. Such approach enables a cost-effective utilization of the problematic wastewater from ethanol and a by-product from sugar production. It is the first approach that attempts to find low-cost media for the production of Lactobacillus plantarum biomass. Results : This study suggests that sieved wheat stillage enriched by adding 1.77 g/l yeast extract and 10% molasses (v/v), with NH 4 OH used for pH adjustment, may be used as a media for large-scale cultivation of L. plantarum. Such composition of the medium permits a high density of lactic acid bacteria (1.6 x 10 10 cfu/ml) to be achieved. Conclusions : The use of a fermentation medium consisting of distillery wastewater and molasses to obtain value-added products (such as LAB biomass and lactic acid) is a possible step for classical ethanol production to move towards a biorefinery model production in which all by and waste products are utilized to increase produced values and reduce waste production. This enables a cost-effective utilization of the problematic wastewater from ethanol and sugar production.


Speech is normally accompanied or supplemented with different gestures such as eyebrow movements and head movements. These movements seem to be of great importance in face-to-face communication. In this study we were studying the visual correlates to focal accent in read speech. We were especially interested in the timing of the non-verbal events in relation to the speech signal and thereby the segmental flow. It was found that the head movements were highly correlated to the focused word of the utterance. The head movements were either down and forward or up and back.


Ground-based augmentation systems (GBAS) improve the positioning accuracy of aircraft through differential correction techniques during the approach process and enable aircraft to achieve higher services through various monitoring algorithms. Many errors need to be eliminated during navigation. Tropospheric delay is one of the most critical errors in a GBAS. Under normal atmospheric conditions, most of the tropospheric delays can be eliminated by using the difference method and TC model. However, these methods are not applicable under anomalous atmospheric conditions, and abnormal atmospheric conditions have been observed by both the International Civil Aviation Organization (ICAO) and Single European Sky Air Traffic Management Research (SESAR). Anomalous atmospheric conditions pose a great threat to aircraft safety. An integrity monitoring approach may be taken, or the threat may be incorporated into the normal model and overbounded by the protection levels. This paper focuses on non-nominal anomalies in different regions and in different seasons. We found that the maximum residual tropospheric delay caused by non-nominal anomalies exceeds 35 cm. In addition, the frequency of and the maximum residual tropospheric delay caused by the simultaneous occurrence of duct anomalies and non-nominal anomalies are studied here. We found that the maximum frequency of non-nominal and duct anomalies occurring simultaneously exceeds 70%. Finally, this paper used the previously developed overbound method to overbound the two kinds of tropospheric anomalies using data from Dongying Airport. We found that the impact of duct anomalies on the protection levels is greater than that of non-nominal anomalies at Dongying Airport.


In this paper we propose the first calibration exercise based on quantization methods. Pricing and calibration are typically difficult tasks to accomplish: pricing should be fast and accurate, otherwise calibration cannot be performed efficiently. We apply in a local volatility context the recursive marginal quantization methodology to the pricing of vanilla and barrier options. A successful calibration of the Quadratic Normal Volatility model is performed in order to show the potentiality of the method in a concrete example, while a numerical exercise on barrier options shows that quantization overcomes Monte-Carlo methods.


As for UV-induced DNA damage, which may induce skin cancer in animals and growth inhibition in plants, there are two types of photoproducts, namely cis-sin cyclobutane pyrimidine dimers (CPD) and pyrimidine-pyrimidone (6-4) photoproducts. When they are to be repaired, base-flipping occurs, and they bind to enzymes. However, this process remains relatively unknown at a molecular level. We analyze conformation and interaction energy changes upon base-flipping using classical molecular dynamics (CMD) simulations and ab initio electronic structure calculations. CMD simulations starting with a CPD in the flipped-in and flipped-out states showed that both states were unchanged for 500 ns, indicating the flipped-in and flipped-out processes do not occur spontaneously (without any help of the enzyme) after photo-damage. To deeply understand the reasons, we investigated interaction energy changes among bases upon structure changes during the flipped-in and flipped-out processes using Parallel Cascade Selection-MD (PaCS-MD) simulations at 400 K, followed by a fragment molecular orbital (FMO) method. The total inter-fragment interaction energy (IFIE) between CPD and other bases at the flipped-in state is estimated to be −60.08 kcal/mol. In particular, four bases strongly interact with CPD with interaction energies being −10.96, −13.70, −21.52, and −14.46 kcal/mol each. On the other hand, the total IFIE at the obtained flipped-out state increased to −10.40 kcal/mol by partly losing hydrogen bonds and π-π stacking interactions, respectively. These results clearly indicate that the base-flipping process of DNA lesions occurs with the help of external forces like interactions with appropriate enzymes such as photolyases.


Dynamic type-checking and object-oriented programming often go hand-in-hand; scripting languages such as Python, Ruby, and JavaScript all embrace object-oriented (OO) programming. When scripts written in such languages grow and evolve into large programs, the lack of a static type discipline reduces maintainability. A programmer may thus wish to migrate parts of such scripts to a sister language with a static type system. Unfortunately, existing type systems neither support the flexible OO composition mechanisms found in scripting languages nor accommodate sound interopera-tion with untyped code. In this paper, we present the design of a gradual typing system that supports sound interaction between statically-and dynamically-typed units of class-based code. The type system uses row polymorphism for classes and thus supports mixin-based OO composition. To protect migration of mix-ins from typed to untyped components, the system employs a novel form of contracts that partially seal classes. The design comes with a theorem that guarantees the soundness of the type system even in the presence of untyped components. blame theorem (proof technique) * Supported in part by two NSF grants, the DARPA CRASH program, and a grant from the Mozilla Foundation. Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. To copy otherwise, to republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. The popularity of untyped programming languages such as Python, Ruby, or JavaScript has stimulated work on combining static and dynamic type-checking. The idea is now popularly called gradual typing [27]. At this point, gradual typing is available for functional programming languages such as Racket [33, 34], for object-oriented languages such as Ruby [12] or Thorn [38], and for Visual Basic [23] on the .NET platform. Proposals for gradual typing also exist for JavaScript [19] and Perl [31]. Formal models have validated soundness for gradual type systems, allowing seamless in-teroperation between sister languages [22, 27, 32]. (define drracket-frame% (size-pref-mixin (searchable-text-mixin (searchable-mixin (status-line-mixin (text-mixin (editor-mixin (standard-menus-mixin frame%)))))))) Figure 1. Abbreviated code with a chain of mixins Unfortunately, no existing gradual type system supports the full range of object-oriented styles found in scripting languages. These untyped languages tend to support flexible mechanisms for class composition, …


Large-scale data integration efforts to support clinical and biological research can be greatly facilitated by the adoption of standards for the representation and exchange of data. As part of a large project to design the necessary architecture for multi-institutional sharing of disparate biomedical data, we explored the potential of the HL7 reference information model (RIM) for representing the data stored in a local academic clinical data warehouse. A necessary first step in information exchange with such a warehouse is the development and utilization of tools for transforming between local data schemes and standards-based conceptual data models. We describe our initial efforts at mapping clinical concepts from a relational data warehouse to the HL7 RIM.


Abstract. Speleothem δ18O and δ13C signals enable climate reconstructions at high resolution. However, scarce decadal and seasonally resolved speleothem records are often difficult to interpret in terms of climate due to the multitude of factors that affect the proxy signals. In this paper, a fast-growing (up to 2 mm yr−1) seasonally laminated speleothem from the Han-sur-Lesse cave (Belgium) is analyzed for its δ18O and δ13C values, layer thickness and changes in calcite aspect. The studied record covers the period between AD 2001 and 1479 as indicated by layer counting and confirmed by 20 U / Th ages. The Proserpine proxies are seasonally biased and document drier (and colder) winters on multidecadal scales. Higher δ13C signals reflect increased prior calcite precipitation (PCP) and lower soil activity during drier (and colder) winters. Thinner layers and darker calcite relate to slower growth and exist during drier (and colder) winter periods. Exceptionally dry (and cold) winter periods occur from 1565 to 1610, at 1730, from 1770 to 1800, from 1810 to 1860, and from 1880 to 1895 and correspond to exceptionally cold periods in historical and instrumental records as well as European winter temperature reconstructions. More relative climate variations, during which the four measured proxies vary independently and display lower amplitude variations, occur between 1479 and 1565, between 1610 and 1730, and between 1730 and 1770. The winters during the first and last periods are interpreted as relatively wetter (and warmer) and correspond to warmer periods in historical data and in winter temperature reconstructions in Europe. The winters in the period between 1610 and 1730 are interpreted as relatively drier (and cooler) and correspond to generally colder conditions in Europe. Interpretation of the seasonal variations in δ18O and δ13C signals differs from that on a decadal and multidecadal scale. Seasonal δ18O variations reflect cave air temperature variations and suggest a 2.5 °C seasonality in cave air temperature during the two relatively wetter (and warmer) winter periods (1479–1565 and 1730–1770), which corresponds to the cave air temperature seasonality observed today. Between 1610 and 1730, the δ18O values suggest a 1.5 °C seasonality in cave air temperature, indicating colder summer temperatures during this drier (and cooler) interval. The δ13C seasonality is driven by PCP and suggests generally lower PCP seasonal effects between 1479 and 1810 compared to today. A short interval of increased PCP seasonality occurs between 1600 and 1660, and reflects increased PCP in summer due to decreased winter recharge.


Abstract A hypothesis is presented that states that tumor viruses produce their transforming action on cells, at least in part, by the production of endogenous polypeptide growth-stimulatory factors. Cells transformed by murine sarcoma viruses have been found to have reduced or absent cell surface receptors for epidermal growth factor (EGF), as compared to the untransformed parental cells and to cells transformed by other viruses. Sarcoma virus-transformed cells are shown to release a family of polypeptide growth factors into the supernatant fluids in cell cultures. These factors, with molecular weights of approximately 25,000, 12,000, and 7,000, stimulate cell division and compete for EGF receptors. The new sarcoma growth factors are not produced by untransformed cells or by DNA virus-transformed cells. Sarcoma growth factors induce normal fibroblasts to grow in soft agar and to express some of the phenotypic properties of transformed cells; these effects are dependent on the continued presence of the factor. A human fibrosarcoma was found that had normal levels of EGF receptors, but no apparent multiplication-stimulating activity (MSA) receptors. Since normal fibroblasts have MSA receptors, it was decided to test whether the receptor-negative cell was producing a related growth factor. In this case a family of related growth polypeptides was found that interacted with MSA receptors, but not with EGF receptors, and stimulated cell division in cells of various species. The activities of both the sarcoma growth factors and the MSA-related human fibrosarcoma growth factors are heat stable, protease sensitive, and sensitive to disulfide reducing agents. The endogenous production of polypeptide growth factors by cells that are able to respond to their own products may represent a general mechanism for cell transformation.


Backprojected images offer compact and accurate storage of three-dimensional (3-D) positron emission tomography (PET) data and so are potentially very suited to high-resolution 3-D PET scanners. However, there are very few methods available for correcting backprojected images for the effects of scatter and random events. Scatter correction methods usually involve experimental measurement of scatter response functions or accurate simulations, and are thus limited by the accuracy of the model used. In contrast, the approach proposed here uniquely adapts a general form of a combined scatter and random response function. This method inherently does not rely upon accurate determination of the scatter and random response functions but does, however, rely upon knowledge of the attenuating object's outline. The technique is able to adapt to different imaging situations and account for detector scatter, and in particular is readily implemented in backprojection space. The method has been implemented for a small-volume HIDAC (II) PET scanner.


In this tutorial we describe our methods for preparing detergent-extracted cytoskeletons for observation by high resolution scanning (SEM) and scanning transmission (STEM) electron microscopy. We both discuss the theoretical background and provide practical procedures for each of the following steps: cell culture on Formvar-coated gold grids; prefixation with aldehydes or protein crosslinking reagents (homobifunctional N-hydroxy-succinimide esters); extraction with Triton X-100 or Brij 58 detergent in microtubule stabilizing buffer; postfixation in formaldehyde and glutaraldehyde; dehydration; critical point and freeze drying; sputter coating with 1-2 nm of platinum or tungsten; and examination by SEM and both normal and inverted contrast STEM. These methods produce cytoskeletal preparations in which filaments as fine as 7 nm are preserved and can be observed by scanning electron microscopy.


Chicken antibody alone does not bind to Staphylococcus aureus or protein A-Sepharose. Immune complexes containing chicken antibodies do bind, however, showing protein A-binding sites exist on the molecules. Binding does not occur via the antigen contained in the complex. Complexes formed in far antigen excess also bind, suggesting that an induced conformational change in the Fc region of the immunoglobulin occurs but only a fraction of the total chicken antibody is reactive.


Angus × Simmental steers (n = 210; initial BW 314 ± 11 kg) were separated into heavy and light BW blocks and allotted evenly by BW to 6 treatments (3 heavy and 2 light pens per treatment) to determine the effect of supplemental vitamin D3: 0 IU (no D), 250,000 IU for 165 d (long-term D), or 5 × 106 IU for 10 d (short-term D) on performance, carcass traits, vitamin D metabolites, and meat tenderness in steers fed either 0 (NZ) or 8.38 mg/kg zilpaterol hydrochloride (ZH) daily for 21 d. Placebo or ZH was added to the diet 24 d, and short-term D was added 13 d before slaughter. Vitamin D3, ZH, and placebo were all removed from the diet 3 d before slaughter. Steers fed ZH tended to have improved overall G:F compared with steers not fed ZH (P < 0.09). Overall performance was not affected by long-term D, with or without ZH (P = 0.11) compared with no D, with or without ZH. Shortterm D decreased final BW, ADG, and G:F (P = 0.04) compared with no D, when ZH was not fed. Zilpaterol hydrochloride increased HCW, dressing percentage, and LM area (P < 0.01); and decreased fat thickness, yield grade, and marbling (P < 0.03). Carcass traits were not impacted by long-term D without ZH (P > 0.13), but long-term D with ZH decreased percentage KPH (P < 0.02). Compared with no D, short-term D tended to decrease HCW (P < 0.07), decreased fat thickness (P < 0.01), and tended to increase dressing percentage (P < 0.10) when ZH was not fed, yet did not impact carcass traits when ZH was fed (P < 0.13). Feeding ZH tended to decrease (P < 0.09) LM 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]. The long-term D treatment increased LM vitamin D3 and 25-hydroxyvitamin D3 (25OHD3) 18and 5-fold, respectively, when ZH was not fed (P < 0.04) and increased LM 25OHD3 by 4-fold when ZH was fed (P < 0.01). Short-term D increased LM vitamin D3 and 25OHD3 by 52and 9-fold, respectively, when ZH was not fed (P < 0.01), and by 24and 9-fold, respectively, when ZH was fed (P < 0.01). Also, shortterm D increased LM 1,25(OH)2D3 by 2-fold (P < 0.04) when ZH was fed. Warner-Bratzler shear force (WBSF) was greater for ZH steaks than non-ZH steaks at 7, 14, and 21 d postmortem aging (P < 0.01). Vitamin D did not reduce WBSF (P = 0.18). When ZH was fed, long-term D tended to increase WBSF in steaks aged 21 d (P = 0.06). In conclusion, ZH improved carcass leanness and decreased tenderness, and vitamin D feeding increased vitamin D3 metabolites in LM, but did not improve tenderness in steers fed ZH.


There is currently a lack of consensus on which anticoagulant therapy contraindications should be considered "absolute" and which should be considered "relative". Guidelines do not clearly identify absolute and relative contraindications to anticoagulant therapy. Recent guidelines on AF of the European Society of Cardiology underline the relevance of several factors and their use in scores, leaving anyway space to the clinical judgment of the physician. A high bleeding risk score should generally not result per se in a contraindication to anticoagulant therapy. Rather, bleeding risk factors should be identified and treatable factors corrected. A combined use of a more hierarchical classification of the different bleeding risk factors and the risk scores probably represents the best approach to maximize the benefit of anticoagulant therapy in various clinical settings.


This thesis discusses a case study that explores the impact on educators' teaching practices, particularly their assumptions and beliefs about teaching and self-efficacy, as a result of their participation in an educational development programme designed to prepare college educators to develop and teach online and hybrid courses. The philosophical worldview adopted in this study is closely aligned to the constructivist perspective. It draws upon the conceptions of teaching literature, Bandura's theory of self-efficacy (1977; 1986; 1997) and Mezirow's (1978) theory of transformational learning as a conceptual framework. The data were collected through an online survey of 34 participants, face-to-face interviews with 18 participants and documentary evidence review of 6 participants, and was analysed using Braun and Clarke's (2006) thematic analysis approach. The findings suggest that the knowledge and experience that college educators acquire when participating in educational development for online teaching produce a positive increase in technological and pedagogical knowledge and understanding of accessibility for some educators. This new understanding, in turn, results in changes to both online and face-to-face teaching practices of educators. The results also indicate that for some educators, participation in an educational development programme for online teaching encouraged more student-centred teaching approaches and helped to dispel misconceptions about the lower quality and value of online learning. Participation in educational development for online teaching was also found to increase some educators' technical and pedagogical confidence, although a few participants experienced an initial decline in self-efficacy. Finally, the results reveal that educators perceived their participation in the educational development programme for online teaching to have a positive impact on the learning experience of their students.


The United States plays a key role in global food security by producing and exporting agricultural products. Groundwater irrigation is increasingly important in agricultural production, nearly tripling since records began in 1950. Increased reliance on groundwater and prolonged unsustainable pumping of aquifers has led to groundwater depletion in many areas. In this study, we ask: How much groundwater depletion is embedded in the domestic transfers and international agricultural exports of the United States? How much do domestic and international agricultural commodity fluxes rely on unsustainable groundwater use? To address these questions, we quantify the amount of nonrenewable groundwater that is incorporated into agricultural commodities produced in the United States and transferred both within the country and exported internationally. We find that 26.3 km 3 of nonrenewable groundwater was transferred domestically in 2002 and 2.7 km 3 was sent abroad. In 2012, 34.8 km 3 was transferred domestically and 3.7 km 3 was exported. This indicates an increase of 32% in domestic transfers and 38% in international exports. In 2002, we find that 1,491,126 kt (340 billion USD) of agricultural products reliant on nonrenewable groundwater were domestically transferred, while 119,048 kt (47 billion USD) were exported. In 2012, the mass transfer of agricultural goods reliant on unsustainable groundwater decreased, but their value in national and international supply chains increased by 54% and 31%, respectively. Our results underscore the importance of the long‐term risks posed to global agricultural supply chains from reliance on unsustainable groundwater use.


We contribute to recent efforts in relating two approaches to automatic synthesis, namely, automated planning and discrete reactive synthesis. First, we develop a declarative characterization of the standard "fairness" assumption on environments in non-deterministic planning, and show that strong-cyclic plans are correct solution concepts for fair environments. This complements, and arguably completes, the existing foundational work on non-deterministic planning, which focuses on characterizing (and computing) plans enjoying special "structural" properties, namely loopy but closed policy structures. Second, we provide an encoding suitable for reactive synthesis that avoids the naive exponential state space blowup. To do so, special care has to be taken to specify the fairness assumption on the environment in a succinct manner.