Mechanisms that reliably and efficiently guide practitioners to find relevant evidence are urgent for conservation decision‐making in Chilean Patagonia. The objective of this study was to systematically collect, characterize, and synthesize the extensive evidence about conservation knowledge in Chilean Patagonia focusing on the impacts of global change drivers on ecosystems and human–nature relationships, identifying knowledge gaps, and providing policy recommendations. The quality of the evidence was assessed through a predefined level‐of‐evidence hierarchy scale, applied to a sample of the studies reviewed. We compiled ~1000 studies documenting that evidence focusing on terrestrial and marine ecosystems has grown exponentially. For terrestrial ecosystems, most studies have addressed climate change, habitat change, and invasive species; while for marine ecosystems, studies have focused on pollution, invasive species, and habitat change. We identified that an important gap is the study of the social dimensions of conservation, and future efforts should focus on incorporating traditional and local knowledge as this can help point the way to ecosystem conservation. The appraisal of the quality of the evidence showed that ~80% of the sample represented reliable evidence with underlying data and an experimental design. Enhanced efforts to deliver this evidence to decision‐makers in a user‐friendly format for evidence uptake in conservation policy are urgent. In this review, we provide a tool that can help practitioners to find evidence reliably to improve decision‐making for the conservation of ecosystems in Chilean Patagonia.


In this report the phenology of food plants of Barnacle Geese breeding on Gotland (temperate zone) is investigated. Both study seasons (1992 and 1993) were very dry and grass growth was found to be inhibited by the lack of rain, Not all investigated species reacted in the same way to the lack of water. Agrostis stolonfera and Festuca rubra showed a comparable and strong reaction while Puccinellia maritina showed little reaction to the lack of rain. Puccinellia is growing closer to the sea and has probably better access to seawater. A watering experiment on the Festuca dominated vegetation showed that the decrease in production was slowed down when there was extra water.
Not only production, but also nitrogen content of Festuca and Agrostis was decreasing during the season. The nitrogen content of Puccinellia increased during the season. At the end of the season, in the pre-migration period, the nitrogen content of Festuca and Agrostis increased again, after periods with rain. This seems to indicate that growth on this saltmarsh is primarily limited by water and not by nitrogen, as is the case in most arctic breeding areas. When there was sufficient water, nitrogen content was high, even late in the season.
As the nitrogen content on the Festuca dominated vegetation decreased, the grazing pressure on this vegetation type also decreased. On Gotland, goose grazing had a stimulating effect on grass growth through the whole season. The increase in growth could not be accomplished by fertilization through goose droppings alone, as fertilization with droppings showed no effect.
Nitrogen contents of food plants in the moulting period on Gotland were in the same order as those found by others on Spitsbergen (arctic zone). Also the observed total feeding time per day was in the same order as found on Spitsbergen. However, the Gotlandic geese seemed to have a lower digestion efficiency. In this respect the Gotlandic geese might be at a disadvantage on the breeding grounds compared to arctic breeding geese.


An understanding of mortality patterns, and especially the variation in juvenile mortality, is an important component in vertebrate population dynamics. Our study investigates, for the first time, neonate mortality and two levels of spatial behaviour, in a free-ranging fallow deer Dama dama population in southwestern Sweden. In the summers of 2008 and 2009, 36 fawns were marked with radio-collars. Neonate mortality calculated by the Kaplan-Meier method was 23.6%. Mortality caused by predation was low, since only one of eight non-surviving fawns died from predation, probably by red fox Vulpes vulpes. The spatial behaviour of the neonates was examined by habitat selection at home-range level, which in fact is a selection made by the mother, and at bed-site level within that habitat. Compositional analysis revealed a significant preference for arable land, pasture and coniferous forest between 5-15 m high, compared to young forest. Selected bed sites showed significantly lower visibility and higher amount of canopy cover than random sites. Surprisingly, we did not find any relationship between canopy cover and visibility in selected bed sites while it showed a significant and negative relationship at random bed sites. We interpret this finding as while high canopy cover and low visibility covary at the habitat level, fawns seem to select these two bed-site variables independently, perhaps for thermoregulatory reasons. Since there are few predators in our study area and predation pressure is low, this behaviour is not connected to actual survival rates in this area, but would rather be in support of the hypothesis of 'pleiotropy' as thermoregulatory reasons for bed-site selection in neonate fawns might be the most important contemporary selection force in the absence of large predators.


Software maintenance tools for program analysis and refactoring rely on a metamodel capturing the relevant properties of programs. However, what is considered relevant may change when the tools are extended with new analyses, refactorings, and new programming languages. This paper proposes a language independent metamodel and an architecture to construct instances thereof, which is extensible for new analyses, refactorings, and new front-ends of programming languages. Due to the loose coupling between analysis, refactoring, and front-end components, new components can be added independently and reuse existing ones. Two maintenance tools implementing the metamodel and the architecture, VlZZANALYZER and X-DEVELOP, serve as proof of concept.


Glucocorticoids (GCs) are widely used as anti-inflammatory and immunosuppressive drugs. The use of these potent drugs, however, often results in side-effects, such as growth retardation in children. For already many years, this GC-induced growth retardation is suggested to involve impaired action of the components of the growth hormone (GH) - insulin-like growth factor (IGF) system. The components of this system are among the main regulators of postnatal longitudinal bone growth. Longitudinal bone growth is regulated by the growth plates, layers of cartilage (containing cartilage cells, chondrocytes) located at the proximal and distal ends of the long bones. The growth plate is a specialised and organised structure and the chondrocytes in the growth plates follow a tightly controlled program of proliferation and differentiation (resulting in the different zones of the growth plate), which is part of the process of endochondral ossification, resulting in the formation of new bone. This bone formation is responsible for longitudinal bone growth. GC-induced growth retardation involves a mechanism intrinsic to the growth plate. However, not much is known about the molecular mechanism underlying this growth retardation. In my PhD thesis project, I have studied the molecular mechanisms by which GCs bring about their effects on the growth plate, with the main emphasis on the components of the IGF system, using both in vitro and in vivo model systems.
We have treated mice with GCs for a short-term (1 week) and a long-term (4 weeks) period. We detected expression of three components of the IGF system in the growth plate: IGF-I, IGF-II and IGFBP-2 (one of the IGF binding proteins). GC treatment only affected IGF-I expression, after 1 week we could show a down-regulation, in contrast, after 4 weeks of treatment we detected an upregulation of IGF-I expression. Besides these changes in gene expression, changes in the proliferation and differentiation of the growth plate chondrocytes were also detected. The initial decrease in IGF-I could contribute to the GC-induced growth retardation, whereas the subsequent increase could be part of a compensatory mechanism to minimise the GC-induced growth retardation at the longer term.
We have also studied the effects of GCs on angiogenesis and apoptosis in the growth plate, two essential processes for endochondral ossification to occur. In piglets treated with GCs, apoptosis was increased and blood vessel formation was severely disturbed. The GC treatment down-regulated VEGF expression, which is an important growth factor for angiogenesis. We confirmed the down-regulation of VEGF expression by GCs in primary chondrocyte cultures, derived from neonatal piglets. In these same chondrocyte cultures we have studied the effects of GCs on proliferation and gene expression of the IGF system. In this in vitro model system, GCs down-regulated IGFBP-2 expression, at the transcriptional level (as shown by promoter studies).
The obtained data suggest that the IGF system is indeed impaired by GCs at the local level of the growth plate, probably both involving proliferation and differentiation, which is probably part of the molecular mechanism underlying GC-induced growth retardation.


Aluminum casting is widely used in aeronautical, automobile and other industries nowadays. The Cellular Automaton (CA) method was modified to simulate the microstructure evolution of Al alloy casting. Simulated program code was developed and applied into Al casting production. A nucleation model was investigated based upon the experimental data. The solute diffusion in the liquid and solid phases was also considered in developing a grain growth model. With the developed models, not only grain structure but also dendritic microstructure can be predicted during the solidification process. The microstructure simulation of the Al alloy turbine wheel was studied in detail.


A sensitive, specific method for the measurement of uroporphyrinogen decarboxylase(porphyrinogen carboxy-lyase, EC188.8.131.52) in liver homogenates, haemolysates and other tissues is described. Pentacarboxylic porphyrinogen III, prepared from the corresponding porphyrin by reduction with sodium-mercury amalgam, is used as substrate. After oxidation and methyl esterification the reaction product, coproporphyrinogen III, is separated from the substrate and measured by high-performance liquid chromatography, with mesoporphyrin IX as internal standard. The method can readily be adapted for use with any of the other substrates of uroporphyrinogen decarboxylase, including uroporphyrinogens I and III.


In this paper, we study the problem of establishing the accountability and fairness of transparent machine learning models through monotonicity. Although there have been numerous studies on individual monotonicity, pairwise monotonicity is often overlooked in the existing literature. This paper studies transparent neural networks in the presence of three types of monotonicity: individual monotonicity, weak pairwise monotonicity, and strong pairwise monotonicity. As a means of achieving monotonicity while maintaining transparency, we propose the monotonic groves of neural additive models. As a result of empirical examples, we demonstrate that monotonicity is often violated in practice and that monotonic groves of neural additive models are transparent, accountable, and fair.


Isogenic populations of cells exhibit phenotypic variability that has specific physiological consequences. For example, individual bacteria within a population can differ in their sensitivity to an antibiotic, but whether this variability can be regulated or is generally an unavoidable consequence of stochastic fluctuations is unclear. We observed that a bacterial stress response gene, the (p)ppGpp synthetase sasA, exhibits high levels of extrinsic noise in expression, suggestive of a regulatory process. We traced this variability to the convergence of two signaling systems that together control the multisite phosphorylation of a transcription factor, an event largely unexplored in bacteria, This regulatory intersection between a Ser/Thr kinase and a prototypical two component system is crucial for controlling the appearance of outliers, rare cells with unusually high levels of sasA expression. Additionally, by examining the full distributions of gene expression we calculated the contribution of the additional Ser/Thr kinase-dependent phosphorylation in setting the relative abundance of cells with a given a level of SasA. We then created a predictive model for the probability of a given cell surviving antibiotic treatment as a function of sasA expression. Therefore, our data show that multisite phosphorylation can be used to strongly regulate variations in phenotypes across a bacterial population.


The European seas are known to be the recipient of several hundreds of Non-Native Species (NNS) due two main origins: shipping and aquaculture. More than 160 NNS had been recorded along the Normandy coast, which remains low in comparison with the number of marine invertebrate species known in the English Channel (> 3,000). The main sites of introduction are the harbours, especially Le Havre and the oyster cultivation zones. Among these NNS, 56 are present in Normandy and considered invasive along the European coasts, but only ten (one macro-algae and nine invertebrates) are invasive in Normandy. Six examples are illustrate, the molluscs Magallana gigas, Crepidula fornicata, Ensis leei, and Ruditapes philippinarum, the polychaete Ficopomatus enigmaticus and the crab Hemigrapsus sanguineus. The two first species have changed the dynamics and functioning of the coastal ecosystems, while the others have lower impact. In fact, the oyster and the manila clam are now key species for the French economy, while the rapid expansion of the other species change biodiversity in the more colonised sites. The ALEX (ALien Biotic IndEX) proposed by Cinar and Bakir in 2014 for the Mediterranean Sea is used for the first time in Atlantic waters.


Science normally focuses on basic research discoveries and the breaking of technological barriers that can pave the way for medical advances. However, another approach exists for combating disease that generally gets few headlines. This alternative can thwart an enormous number of illnesses and save lives by finding new ways to translate current scientific understanding into practice. The alternative is called prevention. In the developing world, there are many formidable hurdles to improving public health, beginning with the provision of sufficient quantities of safe food and water, sanitation, and basic health care. However, the fact that thousands of lives in the United States and the rest of the developed world will be lost because of the failure to recognize and implement well-known and scientifically documented principles of preventive medicine should be an embarrassment to its citizens.

AIDS prevention is only the latest example of scientifically compelling evidence ignored in favor of political expediency. Approximately a third of new AIDS cases in the United States today can be linked to contaminated hypodermic needles, either by direct use or as a result of indirect exposure of partners or children. Study after study has shown that needle-exchange programs will reduce the incidence of AIDS, a fact acknowledged by the Clinton administration. However, despite expressions of support for science and technology, the president and Congress have recently decided that the federal government will not fund such needle-exchange programs. Peter Lurie, at the University of Michigan, has estimated that with federal support, needle-exchange programs could prevent up to 17,000 infections during President Clinton's term of office. Similar shortsighted, moralistic, and psychosocial arguments as were used to block needle-exchange funding continue to interfere with more aggressive targeting of effective sex education and condoms to our adolescent population so that they can achieve safer sex practices.

As another example of preventive medicine with the potential to save many lives, the development of a new vaccine is rightfully an occasion for great celebration. However, because of missed opportunities by physicians and ineffective education, populations at risk are not getting the vaccines that are already available. A survey of physicians in Massachusetts found that most thought that 85 to 100 percent of their patients were fully vaccinated, but in reality the average was only 61 percent. Despite the existence of an effective vaccine against pneumococcus, which is the most common cause of bacterial pneumonia and middle-ear infections in the United States, implementation is inadequate. It has been estimated that only 15 to 30 percent of the targeted populations, such as the elderly, immunocompromised individuals, and individuals with pulmonary or cardiac conditions, are protected. Surveys of university students indicate similarly inadequate employment of the existing vaccine against hepatitis B.

The rates of infection and death from hospital-related (nosocomial) infection and the fact that antibiotic resistance is spreading in environments where the public expects vigilance to be at its best are further indicators that preventive medicine is underutilized. Roughly 88,000 people in the United States alone die each year as a result of complications from nosocomial infections, a third of which are estimated to be preventable. Vancomycin-resistant enterococci are spreading like wildfire through hospitals in the United States, after first being detected in 1989. There are already standards for reducing the risk of acquisition of a nosocomial infection and the spread of antibiotic resistance that include screening for carriers, isolation of patients who are culture-positive regardless of whether they show symptoms, appropriate use of antimicrobials, hand washing by health care providers before and after all patient contacts, and sterilization of equipment. These seem like no-brainers, yet concerns over discrimination against carriers, the unwillingness of hospitals to establish special isolation rooms for infected populations, and the inability of hospital personnel to maintain the levels of hand washing needed have resulted in steady increases in infections. The spread of antibiotic resistance in hospitals is part of a larger picture in which overuse and misuse of antibiotics threaten to overturn the progress of the last 50 years.

These examples are all ominous warning signs for the future. In the next millennium we must not only strive to open new avenues of scientific knowledge and insight but also to translate this knowledge into concrete results. To have invested in science, achieved understanding of the steps that need to be taken, and then failed to act on that knowledge would be folly of the highest order.


This work describes an inference mechanism applied to AliQAn Question Answering System for Spanish in open domain. AliQAn is based fundamentally on the use of syntactic patterns to identify the possible answers. An inference mechanism is applied to the questions set of economic type. In this way, our system improves the accuracy of this question type from 33% to 57%.


Experimental studies were conducted at elevated pressures and temperatures on the combined solubilities of iron, zinc, and lead sulfides in chloride solutions buffered in pH by a silicate assemblage of quartz monzonite composition plus added muscovite, and buffered in/s2 and/o2 by the assemblage pyrite-pyrrhotite-magnetite. Major controls on base metal concentration are temperature, total chloride, and pressure. Higher temperature and higher chloride concentration favor higher metal solubilities as expected, but the pressure effect is opposite to that generally expected and is of considerable importance to the problem of ore mineral transport. At 500 °C, 0.5 kbar, and 1 m total chloride, Fe, Zn, and Pb solubilities were 8500, 4300, and 8700 ppm, respectively, whereas at 1 kbar they were 4200, 2400, and 2600 ppm, and at 2 kbar, 1700, 800, and 1200 ppm. The experimental results thus indicate that the metals could be carried over long distances on a decreasing pressure gradient so long as the temperature decreases were not sufficient to significantly offset the pressure effect. Such a condition could be approximated by a near-adiabatic transport cooling path. Such a condition is probably common geologically, especially for hydrothermal processes involving fairly deep-seated sources of heat and mineral components.


The site of zinc and lead metallurgy, and sulphuric acid making of Mortagne-du-Nord (France) is a waste landfill where contamination is the main preoccupation. The physical property sensitive to mineralization is electrical resistivity, because of the water content and quality dependance. Geophysical techniques taking into account this property, such as slingram electromagnetic mapping and electrical 2D imaging have been carried out. Surveys at different depths and over a wide area allow to locate mineralized water areas, to identify the water leakage toward river drain, and to locate the clayey alluvial deposits.


Churches today often neglect the study and preaching of biblical prophecy because they consider it a controversial and impractical topic. At the same time, many bemoan the apathy of believers and struggle to encourage people toward holy living. Churches caught in this trap need to consider that the teaching of the Rapture, woven throughout the fabric of the New Testament, addresses these issues and can provide motivation for godliness. No single Bible verse says precisely when the Rapture will take place in relation to the Tribulation or the Second Coming in a way that would settle the issue to everyone's satisfaction. However, this does not mean that the Scriptures do not teach a clear position on this matter, for it does. As we shall see later, the Bible does promise that the church will not enter the time of God's wrath, which is another term for the tribulation. Many biblical passages teach the pretribulational rapture of the church. Many important biblical doctrines are not derived from a single verse, but come from a harmonization of several passages into systematic conclusions. Some truths are directly stated in the Bible, such as the deity of Christ John 1:1; Titus 2:13). Other doctrines, like the Trinity and the incarnate nature of Christ, are the product of harmonizing the many passages that relate to these matters. Taking into account all that the Bible says on these issues, orthodox theologians, over time, concluded that God is a Trinity and that Christ is the God-Man. Similarly, a systematic, literal interpretation of all New Testament passages relating to the Rapture will lead to the pretribulational viewpoint: that, at the Rapture, all living believers will be translated into heaven at least seven years before Christ's Second Coming. This is what I believe the Bible teaches. Foundational Issues Four affirmations provide a biblical framework for the Pretribulational Rapture: They are (1) consistent literal interpretation, (2) Premillennialism, (3) futurism, and (4) a distinction between Israel and the church. These are not mere suppositions, but rather are important biblical doctrines upon which the doctrine of the Rapture is built. Literal Interpretation Consistent literal interpretation is essential to properly understanding what God is saying in the Bible. The dictionary defines literal as " belonging to letters. " Further, it says literal interpretation involves an approach " based on the actual words in their ordinary meaning. .. not going beyond


: Judea and Samaria became a really important element in Israeli right-wing and religious debate following the Six Day War, because the State of Israel began to control it militarily and politically and started settling in this area. Nonetheless, Judea and Samaria had a deeper meaning within Religious Zionist ideology and its main representative Mafdal (NRP). After 1967 Religious Zionists were also influenced by the Messianic ideology, thus biblical territories accelerate Redemption. Hence, the NRP insisted on creating and developing Jewish settlements in Judea and Samaria, both in leftist and rightist governments. The situation has changed since the Oslo Accords and Sharon's disengagement from Gaza. Both were shocking for the Religious Zionism camp, the state was no longer a steady defender of Jewish settlements. In 2008 the Mafdal was absorbed by the newly created Habayit Hayehudi (the Jewish Home) which was treated as a hope for Religious Zionism to restore its former glory. The head of the Jewish Home – Naftali Bennett – called his party a real right-wing camp. He is thought to be a representative of settlers but he also tries to widen his electorate with secular citizens. Habayit Hayehudi is the best example of a party which wants to achieve ideas of Religious Zionism in the new political reality after Oslo. The article will analyze the attitude of the Jewish Home party towards Judea and Samaria and party's ideological course.


Exploring the proposition that in our consumer society, undergraduate students are now denied the opportunity to transform into critical thinking scholars, this case study explores academics' beliefs about the purpose and shape of an ideal undergraduate higher education. Located in one English research-intensive university, research focuses on their perceptions of transformation as a concept, and how it is enabled or denied. Adopting a critical realist approach, the study responds to an absence of work on the effects of marketisation on curricula and pedagogy, and academics' shifting identities in national policy and local practice.

Academics' views link to tensions in a changing higher education system, where managerialisation and marketisation have been compounded by the emergence of a global knowledge economy, massification, a new digital age, and more recently, the global financial crisis and a conservative government. Within this, and setting the context for fourteen in-depth interviews, increasingly influential 'students as consumers' and 'student experience' discourses are explored through critical examination of national and institutional policy documents.

Using a presage-process-product (3P) model, the thesis links academics' aspirations for an ideal undergraduate education which develops knowledge and intellectual approaches grounded within a discipline (product), to elements that 'enable' or 'deny' in curricula and pedagogy (process), and the wider institutional environment, such as academics' roles, student numbers and quality processes (presage). Academics describe the ways in which they negotiate, subvert or overcome these elements. The study uses a suite of concepts including quality discourses, university psychosis, unregulated play, and models of knowledge, curriculum and pedagogy, to visualise tensions surfaced and disentangle the concept of transformation. In proposing a way forward, conclusions note the need for the university to overtly acknowledge trade-offs made, and to consider more deeply the impact of presage and process elements on academics, students, and the undergraduate education aimed for.


Purpose: The aim of our study was to compare the depth of the demarcation line developing in the cornea after the standard Dresden protocol versus the accelerated, pulsed, epithelium-off corneal collagen cross-linking (CXL). Methods: This was a nonrandomized, retrospective case series. Patients with progressive keratoconus were treated with either the standard Dresden protocol (Group 1) or accelerated, epithelium-off CXL using the Avedro (Waltham, MA, USA) device (Group 2). The accelerated CXL protocol involved 18 min of pulsed ultraviolet-A (20 mW/cm2, 7.2 J/cm2, pulsed pro-file: 1 s on, 2 s off). The depth of the demarcation line was measured about 3 months postoperatively. Results: Fifty-nine eyes of 35 subjects were included in the analysis. Group 1 consisted of 19 eyes, and Group 2 of 40 eyes. The mean age of the participants was 22.21 years in Group 1 and 26.55 years in Group 2 (p = 0.184). The mean preoperative K value was 44.89 D in Group 1 and 45.20 D in Group 2 (p = 0.768). The depth of the demarcation line was 322.50 μm in Group 1 and 319.95 μm in Group 2 (p = 0.937). Conclusions: The demarcation line depth was not statistically significantly different between the two protocols. The significance of the demarcation line depth has not been fully clarified in the literature. Our results support the contention that these two techniques may have similar structural outcomes and efficacies in the treatment of keratoconus.


The pharmacist should always provide maximum drug information services to the patients in order that the information they got will not be hesitate with the medicine they will consume. The research has been done related to the profile of the outpatients' satisfaction at Mamajang public health center toward the quality of drug information services. The aim of this research is to know the profile of the outpatients' satisfaction at Mamajang public health center toward the quality of drug information. This research used descriptive method. The data were obtained by collecting the result of the answers from questionnaires with 10 questions than make tabulation, scoring then presented, where the total of samples were got as many as 96 respondents with rating scale Likert namely: satisfied, quite satisfied, not satisfied. Based on the result of the research, it can be inferred that outpatients at Mamajang public health center felt satisfied with the drug information services which is given by crew of public health center in this case on the part of pharmacist itself with percentage 85,24%.


This paper details the first reported integration of two advanced digital microfluidic technologies where 100 µm silicon cubes are transported with ElectroWetting On Dielectric (EWOD) and the droplet then held with EWOD while the silicon cubes are mixed with another liquid using a Surface Acoustic Wave (SAW). Together these two technologies provide a comprehensive lab-on-a-chip combination with well developed functionalities. These include droplet generation, splitting and transportation offered by EWOD with transportation, mixing and biosensing being potentially available with SAW. The fabrication of both EWOD and SAW structures on LiNbO3 substrates used low temperature Ta/Ta2O5/CYTOP layer deposition and patterning technologies, which enabled efficient transportation and mixing functions to be demonstrated.


Abstract In this paper we base our analysis on previous OECD findings and analysis of trade facilitation indicators for assessing relative economic and trade impact of specific trade facilitation measures for the countries of South-Eastern Europe. In the analysis we plan to include all CEFTA-2006 members, except Moldova, and other countries which are part of this region: Bulgaria, Romania and Greece. We plan to construct twelve trade facilitation indicators (TFIs) that correspond to the main policy areas under negotiations at the WTO. The indicators are composed from seventy-eight variables, whose values are drawn from publicly available data. We plan to use these indicators in gravity model in order to estimate the impact of those policy areas on trade volumes between the countries of the region. The use of individual trade facilitation indicators should also enable countries to better assess which trade facilitation measures deserve priority.


Cost-sharing strategies such as hospital tiering will require consumers to make cost-benefit decisions where they have little experience. This responsibility may be further challenged by prevailing consumer perspectives: that health insurance is an open-ended service benefit; that medical treatment decisions should not be influenced by costs; and that consumers are not responsible for the current cost crisis. Although there are steps providers can take to prepare consumers for their new role in cost sharing, health care leaders need to begin moving from a consumer-driven to a citizen-driven approach.


Introduction: Medicaid expansion has allowed more patients to undergo total hip arthroplasty (THA). Given the continued focus on the opioid epidemic, we sought to determine whether patients with Medicaid insurance differed in their postoperative pain and narcotic requirements compared with privately or Medicare-insured patients. Methods: A single-institution database was used to identify adult patients who underwent elective THA between 2016 and 2019. Patients in the Medicaid group received Medicaid insurance, while the non-Medicaid group was insured commercially or through Medicare. Subgroup analysis was done, separating the private pay from Medicare patients. Results: A total of 5,845 cases were identified: 326 Medicaid (5.6%) and 5,519 non-Medicaid (94.4%). Two thousand six hundred thirty-five of the non-Medicaid group were insured by private payors. Medicaid patients were younger (56.1 versus 63.28 versus 57.4 years; P < 0.001, P < 0.05), less likely to be White (39.1% versus 78.2% versus 76.2%; P < 0.001), and more likely to be active smokers (21.6% versus 8.8% versus 10.5%; P < 0.001). Surgical time (113 versus 96 versus 98 mins; P < 0.001) and length of stay (2.7 versus 1.7 versus 1.4 days; P < 0.001) were longer for Medicaid patients, with lower home discharge (86.5% versus 91.8% versus 97.2%; P < 0.001). Total opioid consumption (178 morphine milligram equivalents [MMEs] versus 89 MME versus 82 MME; P < 0.001) and average MME/day in the first 24 hours and 24 to 48 hours (52.3 versus 44.7 versus 44.45; P < 0.001 and 73.8 versus 28.4 versus 29.8; P < 0.001) were higher for Medicaid patients. This paralleled higher pain scores (2.71 versus 2.31 versus 2.38; P < 0.001) and lower Activity Measure for Post-Acute Care scores (18.77 versus 20.98 versus 21.61; P < 0.001). Conclusions: Medicaid patients presenting for THA demonstrated worse postoperative pain and required more opioids than their non-Medicaid counterparts. This highlights the need for preoperative counseling and optimization in this at-risk population. These patients may benefit from multidisciplinary intervention to ensure that pain is controlled while mitigating the risk of continuation to long-term opioid use.


There is an increasing need for a comprehensive institutional understanding pertaining to 4 ecosystem services (ESs) in coastal and marine fields. This paper develops a systematic 5 framework to inform coastal and marine governance about the integration of ES concepts. 6 First, as a theoretical basis, we analyze the generic rules that are part of the Institutional 7 Analysis and Development (IAD) framework. Second, by an extensive literature review, we 8 formulate a set of ES-specific rules and develop an evaluative framework for coastal and 9 marine governance. Third, we examine this evaluative framework in a specific action situation, 10 namely coastal strategic planning concerning Qingdao, China. Results from the literature 11 review and the case study reveal that when designing ES-specific rules for coastal and marine 12 governance, there are several socio-spatial and economic aspects that should be taken into 13 account: (1) conceive of stakeholders as ES users, (2) capture the effect of ecological scaling, 14 (3) understand ES interactions and clarify indirect impacts and causalities, (4) account for ES 15 values, and (5) draw on economic choices for use rights to deal with ES issues. 16


Purpose: Previous studies in the literature have measured an altitude effect for low‐energy brachytherapy seeds; a correction factor applied in addition to PTP to account for the breakdown of Bragg–Gray cavity theory at low energies in well‐type ionization chambers. In clinical practice, many centers use altitude correction factors that are not seed‐model‐specific. The purpose of this work is to present altitude correction factors for several seed models without documented factors in the literature. Methods: An in‐house constructed pressure vessel was used with a well‐type ionization chamber to measure the air‐kerma strength of the IsoAid Advantage (Pd‐103), Theragenics AgX100 (I‐125), and Nucletron selectSeed (I‐125) at a pressure range representative of those encountered worldwide. The TheraSeed 200 (Pd‐103) was also measured for comparison to the originally published correction factor for validation of the experimental process. When correction factors derived in this work were within experimental uncertainties of those published, no new correction factors were proposed. Results: The three seed models measured herein all demonstrated a similar response to change in pressure as previously documented in the literature with the HDR 1000 Plus well‐type ionization chamber. Correction factors of the functional form Symbol, consistent with those previously published, were found to be appropriate for these seed models. A new correction factor is proposed for the Theragenics AgX100 and Nucletron selectSeed (k1 = 0.0417, k2 = 0.479). The IsoAid Advantage, however, agreed to within uncertainty with the published altitude correction factor for the TheraSeed 200; thus the application of the same correction factor is appropriate (k1 = 0.0241, k2 = 0.562). Symbol. No Caption available. Conclusions: This work presents altitude correction factors for three permanent implant brachytherapy seed models in clinical use. This will allow clinics to utilize model‐specific factors, reducing systematic errors in their air‐kerma strength verifications.


Purpose: Treatment of malignant glioma involves concomitant temozolomide and ionizing radiation (IR). Nevertheless, overall patient survival remains poor. This study was designed to evaluate if addition of Ad.Egr–tumor necrosis factor (TNF), a replication defective adenovector encoding a cDNA for TNF-α, to temozolomide and IR can improve overall antiglioma effect. Experimental Design: The efficacy of combination treatment with Ad.Egr-TNF, IR, and temozolomide was assessed in two glioma xenograft models. Animal toxicity and brain histopathology after treatment were also examined. In addition, in an attempt to explain the antitumor interaction between these treatments, the activation status of the transcription factor nuclear factor-κB was examined. Results: Triple therapy (Ad.Egr-TNF, IR, and temozolomide) leads to significantly increased survival in mice bearing glioma xenografts compared with dual treatment. Fifty percent of animals treated with the triple regimen survive for >130 days. Pathologic examination shows that triple therapy leads to a complete response with formation of a collagenous scar. No significant change in myelination pattern is noted after triple therapy, compared with any double treatment. Treatment of intracranial glioma bearing mice with Ad.Egr-TNF and IR leads to cachexia and poor feeding that does not improve, whereas triple therapy results in less toxicity, which improves over 21 days. Both Ad.Egr-TNF and IR activate nuclear factor-κB, and temozolomide inhibits this activity in an inhibitor of κBα (IκBα)–independent manner. Conclusion: This work shows that the addition of adenoviral TNF-α gene delivery to temozolomide and IR significantly improves antiglioma efficacy and illustrates a potential new treatment regimen for use in patients with malignant glioma.


PURPOSE/OBJECTIVES
To evaluate the feasibility of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance during treatment for advanced cancer and to assess initial efficacy of the intervention.

DESIGN
One group pre- and post-test design.

SETTING
Outpatient oncology clinics at a comprehensive cancer center in the midwestern United States.

SAMPLE
30 adults with advanced (recurrent or metastatic) colorectal, lung, prostate, or gynecologic cancer receiving chemotherapy or radiotherapy.

METHODS
Participants completed baseline measures (e.g., demographics, symptom inventory) and received education and training to use an MP3 player loaded with 12 cognitive-behavioral strategies (e.g., relaxation exercises, guided imagery, nature sound recordings). Participants used the strategies as needed for symptom management for two weeks, keeping a log of symptom ratings with each use. Following the two-week intervention, participants completed a second symptom inventory and an evaluation of the intervention.

MAIN RESEARCH VARIABLES
Feasibility, patient-controlled cognitive-behavioral intervention, pain, fatigue, and sleep disturbance.

FINDINGS
Thirty of 43 eligible patients (73%) agreed to participate; of them, 27 (90%) completed the study. Most reported that they enjoyed the intervention, had learned useful skills, and perceived improvement in their symptoms. Symptom scores at two weeks did not differ significantly from baseline; however, significant reductions in pain, fatigue, and sleep disturbance severity were found in ratings made immediately before and after use of a cognitive-behavioral strategy.

CONCLUSIONS
The patient-controlled cognitive-behavioral intervention appears to be feasible for additional study and could reduce day-to-day severity of co-occurring pain, fatigue, and sleep disturbance.

IMPLICATIONS FOR NURSING
A randomized, controlled trial is needed to test efficacy of the intervention for co-occurring pain, fatigue, and sleep disturbance. Meanwhile, based on previous efficacy studies, cognitive-behavioral strategies can be recommended for certain individual symptoms.


The association between psychopathy and crime is established, but the specific components of the personality disorders that most contribute to crime are largely unknown. Drawing on data from 723 confined delinquents in Missouri, the present study delved into the eight subscales of the Psychopathic Personality Inventory–Short Form to empirically assess the specific aspects of the disorder that are most responsible for explaining variation in career delinquency. Blame externalization emerged as the strongest predictor of career delinquency in ordinary least squares regression, logistic regression, and t-test models. Fearlessness and carefree nonplanfulness were also significant in all models. Other features of psychopathy, such as stress immunity, social potency, and coldheartedness were weakly and inconsistently predictive of career delinquency. Implications of these findings for the study of psychopathy and delinquent careers are discussed in this article.


This study presents an optimisation technique for proportional-integral-derivative (PID) controller to achieve maximum-power-point tracking (MPPT) of single-ended primary-inductor converter (SEPIC). A new weight function is developed to optimise the PID parameters based on gradient-descent (GD) method by adding low-pass filter term. The proposed optimisation method does not stick in the local minima, which happens frequently with the traditional weight function used in GD method, where the low-pass filter term suppresses the noise and smooths the iteration process. The prototype of the proposed optimised PID-based SEPIC converter for photovoltaic inverter applications is built using DSP-based TMS320F28335. The performance of the proposed optimised PID-based MPPT scheme is tested in both simulation and experiment at different operating conditions. A performance comparison of the proposed GD method with the conventional GD PID is also made in real-time. It is found that the proposed optimised PID-based SEPIC converter is superior to the conventional GD PID controller in terms of power transfer and efficiency. Furthermore, the proposed optimised PID controller for two-level inverter can achieve a better total harmonic distortion (THD) level as compared to the multi-level inverter frequently used by researchers for the same purpose.


INTRODUCTION
Hydronephrosis, a condition that is mostly congenital, is considered as the most common type of pediatric urinary tract disorder. The aim of this study was the evaluation of the prognosis and outcomes of hydronephrosis in cases of congenital hydronephrosis.

METHODS
In a cross-sectional study, run in a tertiary clinic of pediatric nephrology, from 2015 to 2020, patients with fetal hydronephrosis were selected. Ultrasonography, urinalysis and kidney function tests were ordered for all patients and in the presence of hydronephrosis, repeated ultrasonography, voiding cystourethrography and dimercaptosuccinic acid scan were performed. In cases with evidence of obstruction, a diethylenetriamine pentaacetic acid scan and relative surgical procedures were performed.

RESULTS
Among 141 cases, mean age was 8 ± 1.4 years and 80.9% were male. Partial or complete obstruction in the right and left kidney was found in 16.3 and 24.8% of patients, respectively. The degree of hydronephrosis was mild in 46.1%, moderate in 39%, and severe in 9.2% of the patients. At the last follow-up period, hydronephrosis recovered in 46% of the patients, while 54% experienced persistence or exacerbation of the disease. Meanwhile, 7.1% of patients showed neurogenic bladder, 19.1% urinary tract infection and 22.7% urinary stones.

CONCLUSION
Our study revealed that fetal hydronephrosis ends in complete recovery following birth in 46% of the cases. However, in cases experiencing persistent or exacerbating hydronephrosis, optimized treatment and/or surgical intervention are required.  DOI: 10.52547/ijkd.6516.


In order to avoid selecting decomposition level for quantitative calibration of near infrared spectra in discrete wavelet transform empirically or semi-empirically, a scheme which can be selected optimal decomposition level was proposed. In this scheme, the raw spectral was decomposed by wavelet transform, the approximation coefficients of each decomposition level as input set for partial least square (PLS) to built calibration model, root mean square error of validation (RMSEV) was employed as objective function to find the optimal decomposition level using the validation set, and the approximation coefficients which obtained lowest RMSEV is the optimal decomposition level. The proposed method was demonstrated in determination of moisture in wheat by near infrared spectroscopy.


A 73-year-old woman presented with subarachnoid hemorrhage caused by a ruptured left distal anterior inferior cerebellar artery (AICA) aneurysm. Computed tomography showed a thin subarachnoid hemorrhage in the ambient cistern, and digital subtraction angiography revealed an aneurysm arising from the lateral branch of the left AICA, which was separate from the meatal loop. Endovascular treatment was performed to achieve parent artery occlusion using two Guglielmi detachable coils. Postoperatively, the patient had no complications except for left hearing disturbance, and she was independent in daily life. Endovascular parent artery occlusion for distal AICA aneurysm, especially distal from the meatal loop, can avoid sacrificing the internal auditory artery if the lateral branch of the AICA could be occluded more distally from the meatal loop. Sufficient collateral circulation prevents major infarction, and this strategy may be the first-line treatment choice.


The public has gradually become more dependent on the mass media for their political information as alternative channels of political communication have been marginalized. Political knowledge is not equally distributed, and according to the knowledge gap hypothesis, the gap between the most and least knowledgeable is likely to widen due to the pattern of media consumption, the different content of printed media and TV, and the abilities of the audience as linked to educational differences. Most of the empirical research on the knowledge gap hypothesis has been done in the USA, a media system very different from those of the Nordic countries. The strong tradition of PB TV and the high rate of newspaper consumption make the Norwegian media environment favourable for political knowledge gain, but it may, for the very same reasons, lead to a widening knowledge gap, according to the knowledge gap hypothesis. In the present paper, the impacts of TV and newspaper consumption on the distribution of political knowledge are studied. Two hypotheses are tested: TV exposure as leveller and newspapers exposure as enhancer of the knowledge gap. The empirical analyses are based on the 1997, 2001 and 2005 Norwegian election studies.


Accelerated life testing can be operated in the designing process of a product to predict the lifetime of the product. The design of the product would be improved if the lifetime prediction value is not acceptable. This paper presents a method to predict lifetime of products based on proportional hazards-proportional odds model in accelerated life testing. Proportional hazards-proportional odds model makes proportional hazards model and proportional odds model special cases of it through transformation parameter. A testing system is established to process constant stress accelerated life testing for miniature bulbs under high stress levels and failure time data of the bulbs under each stress level are analyzed using proportional hazards-proportional odds model. Lifetime prediction of the miniature bulbs is presented finally.


The rapid development of mobile communications requires even higher spectral efficiency. Non-orthogonal multiple access (NOMA) has emerged as a promising technology to further increase the access efficiency of wireless networks. Among several NOMA schemes, it has been shown that sparse code multiple access (SCMA) is able to achieve better performance. In this paper, we consider a downlink MIMO-SCMA system over frequency selective fading channels. For optimal detection, the complexity increases exponentially with the product of the number of users, the number of antennas and the channel length. To tackle this challenge, we propose near optimal low-complexity iterative receivers based on factor graph. By introducing auxiliary variables, a stretched factor graph is constructed and a hybrid belief propagation (BP) and expectation propagation (EP) receiver, named stretch-BP-EP, is proposed. Considering the convergence problem of BP algorithm on loopy factor graph, we convexify the Bethe free energy and propose a convergence-guaranteed BP-EP receiver, named conv-BP-EP. We further consider cooperative network and propose two distributed cooperative detection schemes to exploit the diversity gain, namely, belief consensus-based algorithm and the Bregman alternative direction method of multipliers (ADMM)-based method. Simulation results verify the superior performance of the proposed conv-BP-EP receiver compared with other methods. The two proposed distributed cooperative detection schemes can improve the bit error rate performance by exploiting the diversity gain. Moreover, Bregman ADMM method outperforms the belief consensus-based algorithm in noisy inter-user links.


The present paper tries to analyze the training needs for the principals and vice-principals of the Yucatan State secondary schools (Mexico). For this, it has been made a descriptive and qualitative research through the semi-structured interviews implemented to the owner principals. Some of the most important results, show the problem according to access this type of positions, without knowledge and experience to do it successfully, so there is no a specific training for developing a management function as the use of communicative skills or the conflicts resolution.


In the near future, making a correct medical diagnosis will be increasingly supported by artificial intelligence. The development of algorithms that integrate all data from an individual into the diagnostic process calls for a multidisciplinary approach that includes not only healthcare professionals and patients, but also data scientists. Because of the position of the clinical chemist in the current health care process, this medical specialist is naturally suited to initiate the development of self-learning diagnostic algorithms and to take the lead in the process to take big data to the next level and create value for health care.


The authors analyze current and future needs in building adaptive real-time systems and formulate a series of design requirements for their hardware/interconnection, operating system, and application levels that could be satisfied together only in an integrated system design. They describe the major features of the corresponding model. On the operating-system level, novel services are rendered by their own file system, Dragon Slayer. The file system, in order to both meet real-time constraints and provide for high availability in a hazardous environment, allows for replicating, relocating, or deleting of file copies. A distributed implementation of the integrated system design model is currently being completed in order to serve as a distributed real-time testbed. The authors also report on a sensitivity study that shows how promptly the model file system reacts to changing environmental situations (changing request patterns).<<ETX>>


The implementation and design of an integrated anti-theft system, which is being used to prevent from stealing of vehicles. This embedded system mainly based on advanced communication technology known as LTE Release 8. The components are putting together inside the vehicle in a hidden way. A GSM is connected to a microcontroller via SIM card interfaces helps the end-user to control his vehicle by send and receive messages. Once the vehicle is stolen, the owner call to the secret number inside the GSM. The microcontroller will cut off a call and order the GPS to determine the location of the vehicle and sends back an SMS message contains the longitude and latitude. However, a Pi Camera will be triggered to capture the driver picture and sends it back as an MMS all together with the previous message to the vehicle's owner. The main information is transformed through a control processing system on a google map application to trace the vehicle movement. Immediately, the owner based on the received information can send an SMS that has a detailed instruction to order RPi to control the engine ignition system by turning it off at the required location through an embedded system


Mobile phones, i-Mode, WAP, telephone, fax, e-mail, Internet and personal digital assistants (PDAs) are dominating our society - which is fast becoming a Network society characterised by electronic communications. While these developments bring many social and economic benefits, they also pose several social, ethical, political and cultural consequences and challenges.The aim of the IFIP WG 9.2, 9.6/11.7 Summer School, which was held 4-8 August 2003 at Karlstad University - Sweden , was to discuss Risks and Challenges of the Network Society. This report collects the contributions of the participants which were presented and discussed during the Summer School


Post-translational modifications of histone proteins often mediate gene regulation by altering the global and local stability of the nucleosome, the basic gene-packing unit of eukaryotes. We employed semi-synthetic approaches to introduce histone H2B ubiquitylations at K34 (H2BK34ub) and K120 (H2BK120ub) and H3 K79 trimethylation (H3K79me3). With these modified histones, we investigated their effects on the kinetics of transcription elongation by RNA Polymerase II (Pol II) using single-molecule FRET. Pol II pauses at several locations within the nucleosome for a few seconds to minutes, which governs the overall transcription efficiency. We found that H2B ubiquitylations suppress pauses and shorten the pause durations near the nucleosome entry while H3K79me3 shortens the pause durations and increases the rate of RNA elongation near the center of the nucleosome. We also found that H2BK34ub facilitates partial rewrapping of the nucleosome upon Pol II passage. These observations suggest that H2B ubiquitylations promote transcription elongation and help maintain the chromatin structure by inducing and stabilizing nucleosome intermediates and that H3K79me3 facilitates Pol II progression possibly by destabilizing the local structure of the nucleosome. Our results provide the mechanisms of how these modifications coupled by a network of regulatory proteins facilitate transcription in two different regions of the nucleosome and help maintain the chromatin structure during active transcription.


Household carbon footprints account for a large proportion of total emissions. When considering indirect emissions through the consumption of goods and services, a high level of carbon footprint inequality exists both worldwide and within China. Utilizing both provincial level input-output tables and micro-level household survey data, this paper aims to measure Chinese households' indirect carbon footprints, estimate the level of indirect carbon footprint inequalities, and analyze the main drivers of carbon footprint disparities. The main findings are as follows. First, there is widespread inequality in terms of indirect carbon footprints at the individual household level, and the urban-rural disparity has a significant impact on carbon footprint inequalities. Second, inequalities in terms of carbon footprints are higher than those in relation to income and expenditure, with the main source being between-group inequalities. Third, disparities in income, education, living conditions, and asset ownership, as well as urban-rural disparities, are the main factors contributing to carbon footprint differentials. These results imply that the urban rich in China have contributed significantly to emissions growth by means of their daily consumption. With the largest population in the world, the reduction of China's household carbon footprint has significant implications for global carbon emissions mitigation. China's future policies should include consideration of low carbon emissions initiatives, such as a progressive carbon tax, that emphasizes the responsibility of the rich.


This study  accomplished an expedite rising of the native forest fragments scattered among  Eucalyptus spp plantations in a forest property in order to  characterize and to identify the critical points to which  they  are subject, to propose management actions  envisaging their reclamation and  conservation and to propose landscape management actions. The study was developed in  Sao Jorge farm located in  Paraopeba- MG- county. All fragments were analyzed  to collect the following information: vegetation type, area, soil type,  water collection occurrence, forms, neighborhood type, topography, fire-break conservation, height of the canopy,  succession stage, presence of domestic and wild animals, more common tree species, altitude, disturbances and isolation degree. Covering maps, tables, indexes that allowed to analyze the characteristics of the fragments and to prescribe the landscape management were constructed. It concluded that: in the studied landscape the area with native forest covering is superior to the minimum required by law. However, if fragments are subject to border effect   of 50 m, two of them can be extinguished along time. The action of turning the area with native vegetation of the property into a Preservation Area doesn't guarantee its maintenance along time. It is necessary to establish appropriate management techniques to soften the border effect, mainly for the smaller fragments. To protect the smaller fragments of the entropic action and of the border effect it is necessary to promote environmental education, to totally restrict the presence of domestic animals in the area, to implement corridors with vegetation, and to increase the size of the fragments. Managing the landscape correctly the property area with native vegetation will increase from 23,13% to 41,46% and the area with vegetation under border effect will fall from 49,6% to 26,2%.


As Wi-Fi handheld devices providing a variety of data and multimedia services become more widespread, and as the global demand for internet access everywhere rapidly increases, energy-efficient network mobility (NEMO) technology is attracting great attention with respect to the latest research in mobile networking. The previous research relating to energy-efficient networks in mobile networking has focused on routing protocol or topology control. In NEMO, cost-efficient protocol design reduces unnecessary costs because of mobility signalling and packet delivery, and saves limited network bandwidth in both wired and especially wireless, which is one of the important issues of energy efficiency. In this study, the authors propose a cost-efficient proxy router-based NEMO scheme (PR-NEMO) providing efficient mobility management and packet delivery method. In PR-NEMO, a mobile network is formed with a unique ID and the information of mobile network nodes (MNNs) within the mobile network anchored at local mobility anchor (LMA) are distributed to attached mobile access gateway (MAG). The authors analyse the performance of the PR-NEMO with the N-PMIPv6 and the rNEMO in terms of total cost; that is, sum of location update cost and packet-tunnelling cost. Numerical results demonstrate that the PR-NEMO is the most cost-efficient scheme, under various conditions, among the three schemes evaluated.


It's required that mechanical properties of in-service facilities maintain the safety of operation in power plants as well as chemical plants. In this study the four classes of thermally aged 1Cr-1Mo-0.25V specimens were prepared using an artificially accelerated aging method at 630°C. Ultrasonic tests, tensile tests, KIC tests and hardness tests were performed in order to evaluate the degree of the material degradation. The mechanical properties deteriorated as the specimen degraded, but the attenuation coefficient and the harmonic generation level of the ultrasonic signal increased. The non-linear parameter derived from the harmonic generation level is especially sensitive and will be a good parameter to evaluate the material degradation.


Molecular dynamics (MD) simulation, an established method for investigating the internal motions of biomolecules, is applied to thrombin protein, a critical blood coagulation cascade protease with complex, not yet fully understood regulatory mechanisms. Accelerated MD (AMD) is employed to achieve enhanced conformational sampling of more biologically relevant timescales, and nuclear magnetic resonance (NMR) experiments are used to validate and tune AMD parameters. In chapter 1, the thrombin system and its interaction with cofactor thrombomodulin (TM) is introduced. The potential contribution of dynamics to thrombin allostery is discussed, and methods for MD and AMD simulations are described. In chapter 2, the combined use of NMR and AMD to examine the dynamics of thrombin is detailed. AMD generated ensembles are shown to recapitulate NMR residual dipolar couplings (RDCs), observables that report on ms timescale dynamics. The resulting picture of thrombin depicts a stable core surrounded by highly dynamic surface loops. In chapter 3, a computational study comparing isolated thrombin with TM bound forms is reported. Community network analysis identifies two allosteric pathways from the TM binding exosite to the thrombin active site. The presence of the fourth EGF-like domain of TM, known to be essential for thrombin regulation, is shown to establish and strengthen these allosteric pathways. This essential domain is also observed to elicit enhanced dynamics and cross-correlated motion in the distal active site loops. In chapter 4, these analyses are extended to compare apo thrombin with active site inhibitor bound thrombin. Allosteric pathways between the active and TM binding exosite site are again observed and are altered by the presence of inhibitor. Residual local frustration analysis reveals a minimally frustrated thrombin core surrounded by highly frustrated surface loops. The highly frustrated contacts regions show significant overlap with regions undergoing slow timescale dynamics. In chapter 5, overarching implications for a dynamical mechanism to thrombin:TM allostery are discussed. The collective observations of thrombin active site surface loops undergoing concerted, long timescale dynamics in response to TM binding at exosite 1 strongly suggest a dynamic, allosteric mechanism in thrombin regulation


Hastelloy X and stainless steel 304 are alloys widely used in industrial gas turbines components, petrochemical industry and energy generation applications; In the Pressure Vessel and Piping (PVP) industries they are used in nuclear and chemical reactors, pipes and valves applications. Hastelloy X and stainless steel 304 are favored for these types of applications where elevated temperatures are preferred for better systems' efficiencies; they are favored due to its high strength and corrosion resistance at high temperature levels. A common characteristic of these alloys, is its rate-dependent mechanical behavior which difficult the prediction of the material response for design and simulation purposes. Therefore, a precise unified viscoplastic model capable to describe Hastelloy X and stainless steel 304 behaviors under a variety of loading conditions at high temperatures is needed to allow a better and less conservative design of components. Numerous classical unified viscoplastic models have been proposed in literature, to predict the inelastic behavior of metals under extreme environments. Based on Miller and Walker classical unified constitutive models a novel hybrid unified viscoplastic constitutive model is introduced in the present work, to describe the inelastic behavior caused by creep and fatigue effects at high temperature. The presented hybrid model consists of the combination of the best aspects of Miller and Walker model constitutive equations, with the addition of a damage rate equation which provides a description of the damage evolution and rupture prediction capabilities for Hastelloy X and stainless steel 304. A detailed explanation on the meaning of each material constant is provided, along with its impact on the hybrid model behavior. Material constants were calculated using the recently developed Material Constant Heuristic Optimizer (MACHO) software, to ensure the use of the optimal material constants values. This software uses the simulated annealing algorithm to determine the optimal material constants in a global surface, by comparing numerical simulations to an extensive database of experimental data. To validate the capabilities of the proposed hybrid model, numerical simulation results are compared to a broad range of experimental data at different stress levels and strain amplitudes; besides the consideration of two alloys in the present work, would demonstrate the model's capabilities and flexibility to model multiple alloys behavior. Finally a quantitative analysis is provided to determine the percentage error and coefficient of determination between the experimental data and numerical simulation results to estimate the efficiency of the proposed hybrid model.Copyright © 2015 by ASME


Health interventions are increasingly focused on young adolescents, and as a result, discussions with this population have become a popular method in qualitative research. Traditional methods used to engage adults in discussions do not translate well to this population, who may have difficulty conceptualizing abstract thoughts and opinions and communicating them to others. As part of a larger project to develop and evaluate a video game for risk reduction and HIV prevention in young adolescents, we were seeking information and ideas from the priority audience that would help us create authentic story lines and character development in the video game. To accomplish this authenticity, we conducted in-depth interviews and focus groups with young adolescents aged 10 to 15 years and employed three novel methods: Storytelling Using Graphic Illustration, My Life, and Photo Feedback Project. These methods helped provide a thorough understanding of the adolescents' experiences and perspectives regarding their environment and future aspirations, which we translated into active components of the video game intervention. This article describes the processes we used and the valuable data we generated using these three engaging methods. These three activities are effective tools for eliciting meaningful data from young adolescents for the development of health interventions.


A strong need exists to develop new kinds of high-temperature shape-memory alloys. In this study, two series of CoNiGa alloys with different compositions have been studied to investigate their potentials as high-temperature shape-memory alloys, with regard to their microstructure, crystal structure, and martensitic transformation behavior. Optical observations and X-ray diffractions confirmed that single martensite phase was present for low cobalt samples, and dual phases containing martensite and γ phase were present for high cobalt samples. It was also found that CoNiGa alloys in this study exhibit austenitic transformation temperatures higher than 340°C, showing their great potentials for developing as high-temperature shape-memory alloys.


Recent years have seen international and national policy intensification in early childhood education (ECE). This has manifested in multiple ways, including the design and implementation of increasingly prescriptive curricular policies. Against this backdrop some early educators are
 pushing back. Drawing on work from their recent enquiries and doctoral studies, the authors surface less visible pockets of resistance, highlighting actions taken 'under the radar' to respond to such policy demands. 1 Taking the form of a dialogue between two ECE researchers, this paper explores
 the actions of a number of educators who found subversive ways which circumvent, mediate and disrupt demands upon them. These multiple, 'below the surface' subversions and resistances illustrate ethical pedagogical decision-making in action.


Reconnaissance field studies have identified a regional metamorphic complex, at least 200 km long and 25 to 50 km wide, in the eastern Chugach Mountains, southern Alaska. The metamorphic complex was developed within the Cretaceous Valdez Group, a flysch sequence that was accreted to the continental margin during the Late Cretaceous or early Tertiary. The metamorphic complex shows the progressive development from subgreenschist and green-schist facies slate, phyllite, and semischist that is regionally characteristic of the Valdez Group, to biotite-plagioclase-quartz schist (± muscovite, cordierite, andalusite, staurolite, garnet, and sillimanite) in an intermediate zone, and amphibolite facies muscovite-biotite-plagioclase-quartz schist and gneiss (± sillimanite and garnet) in a higher-grade central zone. K-feldspar is characteristically absent in the amphibolite facies schists, but it is present in migmatitic rocks that are common to the central zone. The mineral assemblages and petrographic relations indicate that metamorphism took place under low-pressure intermediate-facies series conditions; partial melting took place at the highest grade of metamorphism. Melting produced granodioritic magmas in migma-titic rocks of the central zone that were emplaced as discrete plutons in both the intermediate zone and peripheral rocks of the complex. The timing of metamorphism as indicated by field relations and K-Ar data is about 50 to 65 m.y. ago and overlaps or is coeval with the emplacement, throughout the Gulf of Alaska region, of early Tertiary plutons that are thought to be anatectic in origin. The distribution of these plutons suggests that a high-temperature low-pressure metamorphic belt, about 1,800 km long, developed along the leading edge of the continental margin in late Paleocene to early Eocene time.


Most studies today agree about the link between visual-attention and oculomotor control during reading: attention seems to affect saccadic programming, that is, the position where the eyes land in a word. In a previous eye movement study (Bellocchi & Ducrot, submitted), it has been showed that fifth grade typical reading children take the direction of attentional scanning (left-to-right) into account, which results in asymmetrical landing-position pattern: this mechanism depends on the discreteness of the stimulus and interestingly, it is less irrepressible in lower reading level children and in children with reading disability. Furthermore, some studies have demonstrated that increasing inter-letter spacing or inter-word spacing improves the legibility of texts, especially for dyslexic children (e.g. Zorzi et al., 2012): is this improvement linked to a bigger inter-letter saliency which produces, in turn, a more precise saccade programming? To explore this question we assessed the eye movements of three groups of children: dyslexic readers, unimpaired reading-level controls, and unimpaired chronological-age controls, using a lateralized bisection task (participants were asked to move their eyes to a position they thought to be the middle of the stimulus) and a lexical decision task. The type of stimulus – bisection task (words vs. non-linguistic stimuli), LDT (words vs. pseudowords) and crowding (spaced vs. unspaced) - in combination with the stimulus presentation side (left vs. right) were manipulated. Main results showed that saccade computation seems to be modulated by crowding, stimulus presentation side and reading level. Results are discussed with respect to current models of oculomotor control in typical and defective reading.


Purpose of reviewThis review focuses on the association between allergic disease and pediatric rhinosinusitis. For this purpose, allergic rhinitis and chronic rhinosinusitis (CRS) were the areas chosen for further discussion. Recent findingsThe role of allergy as a major immunopathologic mechanism causing inflammation in pediatric rhinosinusitis is becoming better defined. However, despite the fact that allergic rhinitis and CRS are characterized by inflammation, there appears to be a distinct difference in the inflammatory response of children and adults with CRS, which may attest to a difference in the pathophysiologic pathways. Local allergic rhinitis, a recently described pathological entity, appears to affect a significant number of patients with a previous diagnosis of nonallergic rhinitis, making this a prevalent entity in patients evaluated with rhinitis. With regard to the relationships between allergy and infectious diseases, it has been reported that basophils are activated in the presence of suboptimal doses of allergens and bacteria and may explain the clinical behavior of allergy exacerbation. SummaryAllergic rhinitis is frequently associated with CRS. The management of CRS should include evaluation of the pediatric patient for allergic disease and the management should be targeted at decreasing the inflammatory response, which will most likely result in better control of the CRS patient.


Additional at the end of the chapter Abstract The community pharmacists (CPs) are legally responsible to hand out a wide range of ready-made prescription medications to patients. Additionally, CPs are also involving in advocating customers who determine to self-medicate. Interestingly, it is also noted that CPs in developed countries like the United Kingdom, Germany, and Canada have performed more than these services. What are the extended community pharmacy services available? What are the barriers and perceptions of these extended services? It is rationale to explore such issues globally since it might have potential to give some possible course of action to CPs to incorporate more values to the contemporary services.


The SACCO movement provides financial services to large numbers of people throughout Kenya. Over the last ten years there has been significant growth and innovation with new services offered to an expanding membership base. However this development has beenaccompanied by various challenges such as an increasing level of risk and concern that theinstitutional capacity of many SACCOs to manage risk has not developed at the same pace.Increasing levels of competition from a more vibrant banking system are set to increase thepotential threat faced by the SACCO movement. These challenges therefore prompted the government to come up with a policy to regulate the Sacco sub sector in order to promote financial soundness in the industry. The Saccos Societies Act 2008 was enacted into law and was operatinalized in 2010 with an aim of regulating all deposit taking Saccos. The purpose of this study was to investigate the effect of the financial regulations on the profitability of Saccos inNyeri Town. The specific objectives of this study included, establishing if capital adequacy requirement has affected profitability of Saccos, to determine the effect of licensing on the profitability of Saccos and to identify whether credit management requirement has affected the profitability of Saccos. The study is considered important to various stakeholders including the government, Saccos, researchers, academic etc. The literature review identified what other researchers have done in the area of financial regulations and performa ce in terms of profitability of Saccos. The study was conceptualized to determine the relationship between the dependent and independent variables and the influence of the intervening variables on the relationship between the dependent and the independent variables. The study consisted of 30 out or 35 Sacco Societies registered in Nyeri town and was conducted on top and middle level managers of Saccos in Nyeri town. The respondents were issued with self-administered questionnaires to collect primary data. The researcher used descriptive research design with stratified random sampling technique for primary data and secondary data was obtained from researched work and articles, economic surveys CBK annual report. Data collected was analyzed by use of descriptive statistics, Statistical Program for Social Sciences (SPSS).


Based on variable structure systems (VSS) theory, this paper presents a new method of estimating the disturbances (or system nonlinearities and any model uncertainties) for continuous-time multi-input multi-output (MIMO) minimum phase (with respect to the relation between the disturbance and the output) dynamical systems. The designed robust method requires only the input and output measurements of the system. Even for MIMO systems under the assumption that the partial states directly affected by the disturbances do not directly appear in the outputs (when it is considered in the state space), the disturbances can still be estimated by applying the proposed formulation. The estimated disturbances are then employed to construct a robust state observer. Further, the estimated disturbances and the state observer are applied to synthesize a controller to place the desired stable poles and to cancel the disturbances. A design example and simulation results are presented to show the practicality and effectivene...


This study provides evidence for an N-acetylmannosamine (manNac) receptor mediating in vivo bacterial adherence of P. aeruginosa to the scarified corneal epithelial surface. Bacteria, whether exposed to the inhibiting sugar or not, did not adhere immediately after inoculation, but required time in contact with the scarified corneal surface to adhere and adherence increased with time. Organisms were observed primarily adherent to the surface of epithelial cells lining the wound and were less frequently seen on areas of denuded stroma. Saturation of binding sites on the bacterial surface by manNac inhibited attachment of the organisms to newly exposed surface membrane receptors. In vivo protection studies showed excellent correlation with quantitative analysis of scanning electron micrographs, in that the number of adherent organisms at the corneal surface at 60 min following scarification and bacterial inoculation was decreased significantly by prior treatment of the bacteria with manNac when compared with PBS or the other monosaccharides. These data were confirmed by quantitative bacterial culture of excised corneas which had been similarly infected in vivo with PBS or manNac treated organisms. Invest Ophthalmol Vis Sci 28:1978-1985,1987


The two most efficient and most recently radiated Afrotropical vectors of human malaria – Anopheles coluzzii and An. gambiae – are identified by single‐locus diagnostic PCR assays based on species‐specific markers in a 4 Mb region on chromosome‐X centromere. Inherently, these diagnostic assays cannot detect interspecific autosomal admixture shown to be extensive at the westernmost and easternmost extremes of the species range. The main aim of this study was to develop novel, easy‐to‐implement tools for genotyping An. coluzzii and An. gambiae‐specific ancestral informative markers (AIMs) identified from the Anopheles gambiae 1000 genomes (Ag1000G) project. First, we took advantage of this large set of data in order to develop a multilocus approach to genotype 26 AIMs on all chromosome arms valid across the species range. Second, we tested the multilocus assay on samples from Guinea Bissau, The Gambia and Senegal, three countries spanning the westernmost hybridization zone, where conventional species diagnostic is problematic due to the putative presence of a novel "hybrid form". The multilocus assay was able to capture patterns of admixture reflecting those revealed by the whole set of AIMs and provided new original data on interspecific admixture in the region. Third, we developed an easy‐to‐use, cost‐effective PCR approach for genotyping two AIMs on chromosome‐3 among those included in the multilocus approach, opening the possibility for advanced identification of species and of admixed specimens during routine large scale entomological surveys, particularly, but not exclusively, at the extremes of the range, where WGS data highlighted unexpected autosomal admixture.


Many middle-school students struggle with decimals and fractions, even if they do not have a mathematical learning disability (MLD). In the present longitudinal study, we examined whether children with MLD have weaker rational number knowledge than children whose difficulty with rational numbers occurs in the absence of MLD. We found that children with MLD failed to accurately name decimals, to correctly rank order decimals and/or fractions, and to identify equivalent ratios (e.g. 0.5 = 1/2); they also 'identified' incorrect equivalents (e.g. 0.05 = 0.50). Children with low math achievement but no MLD accurately named decimals and identified equivalent pairs, but failed to correctly rank order decimals and fractions. Thus failure to accurately name decimals was an indicator of MLD; but accurate naming was no guarantee of rational number knowledge - most children who failed to correctly rank order fractions and decimals tests passed the naming task. Most children who failed the ranking tests at 6th grade also failed at 8th grade. Our findings suggest that a simple task involving naming and rank ordering fractions and decimals may be a useful addition to in-class assessments used to determine children's learning of rational numbers.


Carbon capture and storage (CCS) is one approach being studied by the U.S. Department of Energy to help mitigate global warming. The process involves capturing CO2 emissions from industrial sources and permanently storing them in deep geologic formations (storage reservoirs). However, CCS projects generally target "green field sites," where there is often little characterization data and therefore large uncertainty about the petrophysical properties and other geologic attributes of the storage reservoir. Consequently, ensemble-based approaches are often used to forecast multiple realizations prior to CO2 injection to visualize a range of potential outcomes. In addition, monitoring data during injection operations are used to update the pre-injection forecasts and thereby improve agreement between forecasted and observed behavior. Thus, a system for generating accurate, timely forecasts of pressure buildup and CO2 movement and distribution within the storage reservoir and for updating those forecasts via monitoring measurements becomes crucial. This study proposes a learning-based prediction method that can accurately and rapidly forecast spatial distribution of CO2 concentration and pressure with uncertainty quantification without relying on traditional inverse modeling. The machine learning techniques include dimension reduction, multivariate data analysis, and Bayesian learning. The outcome is expected to provide CO2 storage site operators with an effective tool for timely and informative decision making based on limited simulation and monitoring data.


The dietary supply of folates and their measurement are both affected, potentially, by the instability of some folates. Labile folates appear to be stabilized by binding to folate-binding protein (FBP); this paper reports measurements of that stabilization. The degradation rates of the very labile tetrahydrofolate (H(4)folate) and moderately labile 5-methyltetrahydrofolate (5-CH(3)H(4)folate) were measured with the compounds free or bound to either soluble or immobilized bovine milk FBP. Complexation increased stability from 2- to > 1000-fold, depending on buffer and temperature conditions. H(4)folate at 4 degrees C and pH 6.7 appeared to be quite stable for > 100 d when bound to soluble FBP but had a half-life of < 1 h when free. Stabilization of milk folates may be a role of FBP and would improve the bioavailability of milk folate to newborns and other consumers.


file:///C:/Users/MWF/Downloads/Lee, Daniel Junehee.The 8-bit digital-to-time converter (DTC) to be used for a time-mode successive-approximation register analog-to-digital converter (SAR ADC) with a minimum power consumption and silicon area is presented. The architecture and the drawbacks of a conventional voltage-mode SAR ADC are discussed. The principle of time-mode circuits and benefits of their applications to mixed-signal circuits are explained. The architecture of a time-mode SAR ADC is presented. The need for an area and power-efficient DTC to be used for a time-mode SAR ADC is discussed. The principle of a DTC is explained and prior works on a DTC are reviewed. The principle of a phase interpolator (PI), to be used for a DTC, is explained and prior works on digital PIs are reviewed. The design of the proposed DTC is presented. Each block of the proposed DTC is explained using schematic and layout views. Optimal slope of the input of the PI and the condition for linear phase interpolation are investigated. Simulation results of the proposed DTC designed in TSMC 65 nm 1.0 V CMOS technology are provided. According to simulation results with BSIM4.4 device models only, the time resolution of 0.33 ps, a maximum operation frequency of 2.53 G Hz, the power consumption of 1.38 mW, and peak differential nonlinearity (DNL) and integral nonlinearity (INL) less than 0.14 least significant bit (LSB) and 0.49 LSB, respectively, for a nominal process (TT) and a temperature condition (27 C°) are achieved.


Nickel oxide (NiO) thin films were prepared by electron beam evaporation technique and studied various properties at different annealing temperatures. The surface morphology of the deposited films was characterized by scanning electron microscopy (SEM) and the compositional analysis of the deposited films was studied by energy dispersive spectroscopy (EDAX). The effect of the annealing process on the topography of the prepared NiO thin films was studied by atomic force microscope (AFM) at room temperature. The optical band gap of the as-deposited film was increased to 3.68 eV with the increase of annealing temperature up to 400C, thereafter decreased at higher annealing temperature. Thin film samples annealed at 400C showed decreased resistivity compared to other samples.


■ METHODS: Consecutive patients (N 109), who rec eived statin monotherapy followed by ezetimibe adjunct therapy, were prospectively studied. The expected LDL levels for each patient on statin and on ezetimibe adjunct therapy were calculated. The difference between expected and actual LDL levels on statin and on ezetimibe adjunct therapy was calculated for each patient and subsequently correlated.


BACKGROUND
The effects of hospital-acquired Clostridium difficile infection (CDI) on patient outcomes are incompletely understood. We conducted this study to determine the independent impact of hospital-acquired CDI on in-hospital mortality after adjusting for the time-varying nature of CDI and baseline mortality risk at hospital admission.

METHODS
This retrospective observational study used data from the Ottawa Hospital (Ottawa, Ontario, Canada) data warehouse. Inpatient admissions with a start date after July 1, 2002, and a discharge date before March 31, 2009, were included. Stratified analyses and a Cox multivariate proportional hazards regression model were used to determine if hospital-acquired CDI was associated with time to in-hospital death.

RESULTS
A total of 136 877 admissions were included. Hospital-acquired CDI was identified in 1393 admissions (overall risk per admission, 1.02%; 95% confidence interval [CI], 0.97%-1.06%). The risk of hospital-acquired CDI significantly increased as the baseline mortality risk increased: from 0.2% to 2.6% in the lowest to highest deciles of baseline risk. Hospital-acquired CDI significantly increased the absolute risk of in-hospital death across all deciles of baseline risk (pooled absolute increase, 11%; 95% CI, 9%-13%). Cox regression analysis revealed an average 3-fold increase in the hazard of death associated with hospital-acquired CDI (95% CI, 2.4-3.7); this hazard ratio decreased with increasing baseline mortality risk.

CONCLUSIONS
Hospital-acquired CDI was independently associated with an increased risk of in-hospital death. Across all baseline risk strata, for every 10 patients acquiring the infection, 1 person died.


After many years of neglect, there is a renewed interest in agricultural mechanization in Africa. Since government initiatives to promote mechanization, e.g., by importing and subsidizing tractors, are confronted with major governance challenges, private-sector initiatives offer a promising alternative. This paper analyzes an initiative of the agricultural machinery manufacturer John Deere and its dealership partner AFGRI to promote smallholder mechanization in Zambia through a contractor model. The analysis focuses on the impact of this initiative on smallholder farmers who receive tractor services and on the demand for hired labor. The analysis is based on a survey of 250 smallholders and focus group discussions using Participatory Impact Diagrams. The results of a Propensity Score Matching (PSM) analysis indicate that farmers who access tractor services for land preparation can almost double their income by cultivating a much larger share of the land that they own. The analysis also suggests that the increased income is used for children's education and for purchasing more food, but does not result in increased food diversity. The findings indicate that the demand for hired labor increases due to the expansion of the cultivated area and due to a shift from family labor, including that of children, to hired labor. Questions that require further investigation are identified, including policies and strategies to increase the incentives of tractor owners to provide services to smallholders, to use mechanization more effectively to increase land productivity, and to avoid new forms of dependency of agricultural laborers that may result.


We cloned a cDNA encoding a novel mouse protein, named A-C1, by differential display between two mouse cell lines: embryonic fibroblast C3H10T1/2 and chondrogenic ATDC5. The deduced amino acid sequence of A-C1 consists of 167 amino acids and shows 46% identity with that of a ras-responsive gene, rat Ha-rev107. Northern blot analysis showed a distinct hybridization band of 3.2 kilobases. Expression of A-C1 mRNA was detected in undifferentiated ATDC5 cells and myoblastic C2C12 cells, while none of C3H10T1/2 cells, NIH3T3 fibroblasts, Balb/c 3T3 fibroblasts, osteoblastic MC3T3-E1 cells, and ST2 bone marrow stromal cells expressed A-C1 mRNA in vitro. Moreover, A-C1 mRNA was expressed in skeletal muscle, heart, brain, and bone marrow in adult mice. By in situ hybridization, A-C1 gene expression was localized in hippocampus as well as bone marrow cells. By immunocytochemistry, A-C1 protein was detected in the cytoplasm as well as perinuclear region of the cells. Transfection of A-C1 cDNA into Ha-ras-transformed NIH3T3 cell line caused increase in the number of flat colonies and inhibition of cell growth. Our data indicate that A-C1 is expressed in some specific tissues in vivo and modulates Ha-ras-mediated signaling pathway.


African Americans have a disproportionately higher risk of chronic conditions such as cardiovascular disease (CVD), type 2 diabetes, and hypertension than other ethnic or racial groups. Data regarding CVD-related perceptions and beliefs among African Americans are limited, particularly in the Southwest US. Assessment of current views regarding health and health behaviors is needed to tailor interventions to meet the unique needs of specific populations. We sought to examine knowledge, attitudes, and perceptions of African Americans living in Arizona toward CVD and etiological factors associated with health behaviors and chronic disease development to inform state health agency program development. Transcripts from 14 focus groups (n = 103) were analyzed using Grounded Theory for perceived disease risk, knowledge of CVD risk factors, nutrition, preventative behaviors, and barriers and motivators to behavior change. Participants identified CVD, stroke, and diabetes as leading health concerns among African-Americans but were less certain about the physiological consequences of these diseases. Diet, stress, low physical activity, family history, hypertension, and stroke were described as key CVD risk factors, but overweight and obesity were mentioned rarely. Participants described low socio-economic status and limited access to healthy foods as contributors to disease risk. Focus group members were open to modifying health behaviors if changes incorporated their input and were culturally acceptable. Respondents were 41% male and 59% female with a mean age of 46 years. This study provides insight into CVD and associated disease-related perceptions, knowledge, and attitudes among African Americans in the Southwest and recommendations for interventions to reduce CVD risk.


Abstract Objective: To describe the effect of infection control interventions on the incidence of vancomycin-resistant enterococci (VRE), the utility of pharyngeal cultures for surveillance for VRE colonization, and the cost of barrier precautions. Design: Evaluation of the occurrence of VRE infection or colonization, rates of vancomycin use, results of surveillance cultures before and after interventions, and the cost of increased barrier precautions. Setting: University of Massachusetts Medical Center, a 347-bed tertiary-care teaching hospital with eight intensive-care units, one burn unit, and one bone marrow transplant unit. Participants: Patients in the intensive-care units and staff who were involved with patients colonized or infected with VRE. Methods: Infection control interventions included placement of patients with VRE in private rooms, strict contact isolation, cohorting of patient and nursing staff, prohibiting of equipment sharing, and monitoring of compliance with the vancomycin restriction policy, with hand washing, and of the adequacy of environmental cleaning. Both rectal and pharyngeal cultures were obtained from patients at the beginning of the outbreak, and the utility of pharyngeal cultures was evaluated. The cost of barrier precautions was estimated by comparing the cost of glove and gown use before and after the outbreak began. Results: The interventions decreased the number of new cases of VRE, but total eradication of VRE was not achieved. Compliance with the room-cleaning protocol was 91% (141/155 observations). Hand washing following interaction with patients who were not in isolation was 51%, vs 100% for patients in isolation. Overall, handwashing compliance was 71% (319/449): 56% (130/231) for physicians and 86% (187/218) for nurses (P<.0001). The mean number of doses of vancomycin dispensed per 1,000 patient days decreased from 145 to 114 per 1,000 patient days (P<.001). Compliance with vancomycin-use guidelines was 85%. Forty-six (77%) of 60 surveillance rectal swabs yielded enterococci, as compared to only 4 (11%) of 36 pharyngeal cultures (P<.0001). Expenses on glove and gowns alone increased by over $11,000 per year since the epidemic began. Conclusions: Implementation of the various infection control measures did not eradicate VRE cases from the hospital. Rectal cultures were more useful than pharyngeal cultures for surveillance of VRE. Controlling VRE epidemics can be costly.