Aim: Candidemia is a life-threatening infection that has been reported to be associated with poorer outcomes in trauma patients. The present study aimed to investigate the epidemiology of candidemia in non-burn patients with polytrauma. Material and Methods: We conducted a retrospective, single-center, observational study of polytrauma patients with candidemia admitted to the surgical intensive care units of a university hospital in Turkey between 2013 and 2017 on. Results: The incidence of candidemia was 127 episodes per 1000 intensive care unit admissions in polytrauma patients. Nonalbicans Candida species accounted for 75.5% of all candidemia episodes. C. parapsilosis (51.05%) was the predominant species, followed by C. albicans (24.52%) and C. tropicalis (12.21%). The highest crude mortality rate (72%) was observed in patients with C. parapsilosis candidemia. In multivariate analyses, who had undergone prior gastrointestinal surgery were 7.1 times more likely to have C. parapsilosis candidemia than those with other strains. Conclusion: Our study, remarkable, demonstrated a high incidence of Candidemia had in polytrauma patients, and non-albicans Candida species were the most frequently isolated candida species. According to our study findings, a prior history of gastrointestinal surgery may help predict C. parapsilosis, as the causative agent of candidemia in polytrauma patients. However, since our study was observational and limited to such a small number of patients, the results obtained should be applied with caution.


Independent protection layers (IPLs) used to mitigate the most severe consequences are analyzed for three chemical processes. The IPLs are categorized by type, function, and design. An analysis of management systems that are in place to ensure the integrity of the IPLs is also included. Categorizations for all three plants revealed similar results and suggest that the results extend across the chemical industry. The data show that the chemical plants depend much more heavily on IPLs that prevent an incident rather than respond to an incident once hazardous material is released. The survey also found that there is a significant reliance on administrative safeguards to achieve an acceptable level of risk. Recommendations are made on how administrative safeguards can adapt these systems to improve their robustness. © 2011 American Institute of Chemical Engineers Process Saf Prog, 2011


A DC 75 kA power supply system was constructed to test the SC (superconducting) R&D (research and development) cables and magnets for the Large Helical Device (LHD). It consists of three 25 kA unit banks. A unit bank has two double-star-rectifier connections with the inter-phase reactors. A digital feedback control method is applied to the automatic current regulation (ACR) in each unit bank. For shortening the dead time of the feedback process, a new algorithm of a digital phase controller for the ACR is investigated. A Bode diagram of the feedback process is directly measured. It is confirmed that the dead time of the feedback process is reduced to one sixth, and that the feedback gain of PID (proportional, integral and differential) compensation is improved by a factor of two from the original method. >


Covalent organic frameworks (COFs) are a promising class of adsorption and separation materials that can meet the needs of ecological sustainability, such as the removal of carbon dioxide and organic dyes. The two synthesized (3,3)-connected triazine-based COFs demonstrate high specific surface area and good thermal and chemical stability. COFZ1 shows good CO2 adsorption selectivities for different CO2 and N2 volume percentage systems at 273 K and 1 bar, with an ideal adsorbed solution theory (IAST) CO2 selectivity (i.e., separation factor) of 35.09 for the simulated flue gas component and a CO2 adsorption capacity of 24.21 cm3 g-1. In the aqueous dye solutions, both COFs present good adsorption performance for the selected dyes, and the maximum adsorption capacities of COFZ1 for methylene blue (MB) and gentian violet (GV) reach 510 and 564 mg g-1, respectively. Each of the two COFs shows a high anti-interference performance and excellent recyclability. The adsorption capacities of two COFs for RhB (Rhodamine B), MB, and GV hardly vary with pH values and salt concentrations. The adsorption behaviors of the two COFs for dyes follow Langmuir isothermal adsorption and quasi-secondary kinetic adsorption, approaching monolayer adsorption and chemisorption.


As school choice is an increasingly common feature of OECD education systems, the regulation of publicly funded private schools has become a salient concern for researchers and policy makers alike. Focussing on three areas of regulation – selective admission, add-on tuition fees and for-profit ownership – this paper provides a review of the theoretical and empirical literature concerning their effects on equity and educational effectiveness. It also offers an overview of different countries' approaches to the funding of private education and the methodological challenges involved in their empirical evaluation. The available evidence confirms that the funding of private schools has yielded widely different results across educational systems and suggests that regulatory frameworks are an important factor shaping these outcomes. Selective admission and substantial add-on tuition fees in particular are likely to exacerbate social segregation and can undermine schools' incentives to compete on the basis of educational quality. The evidence on subsidised for-profit schools is equally divergent across countries but evidence points to the importance of rigorous accreditation processes and clear conditions concerning selectivity and fees to guide allocation of public funds. Although important questions are yet to be conclusively addressed, including the interaction of different regulatory devices and their effect on specific student groups, the existing literature suggests that private school regulation can make an important contribution to the equity and effectiveness of school choice programmes.


The detection of buried targets in shallow water is a tough task in the presence of sea-bottom reverberation. Because both target echo and reverberation are caused by the transmitted signal, they are mixed together in both time domain and frequency domain, which makes traditional signal processing methods inefficient. Blind Source Separation (BSS) is expected to isolate the reverberation from the target echo. However, the feasibility should be proved before separation. In this paper, a method based on spatial correlation is proposed to determine whether reverberation and target echo can be separated as different sources. Then, considering the nonstationarity of the reverberation, SONS (Second Order Nonstationary Source Separation) is applied to separate the original received signals. The sea experiment result shows that BSS is not only feasible but also valid to separate target echo and reverberation, and the target echo after BSS is of higher SRR which makes further process more credible.


This article uses key notions of the discourse theory of Laclau and Mouffe to analyze the identity of the media professional. Within their post-structural framework, this identity is seen as over-determined, contingent and constructed but at the same time subjected to a hegemonic articulation, based on four nodal points: objectivity, autonomy, management of resources and employee-employer relations. Combined with a theoretical discussion on the (counter-)hegemonic articulations, this allows for the field of discursivity that surrounds the identity of the media professional to be (re)constructed, resulting in four dimensions that offer potential points of identification. This field of discursivity is then used and put to the test as a series of sensitizing concepts for the analysis of the seven phone-in broadcasts the program Ter Zake (on VRT - the North Belgian public broadcasting company) has organized, illustrating both the contingency of the identity of the media professional and the rigidity of the hegemonic articulation.


To avoid fabric deformations due to plastic deformations, it is vital to predict how the fabric will behave under load in advance. This was the starting idea for the conducted research. The basic physical and mechanical properties of plain-weave fabric samples with the same density of warp and weft and in various angles were investigated in this paper. A comparison of the experimental and computational modulus of elasticity was performed. Based on the experimental results, a mathematical model and the corresponding mathematical equations of the stress-strain curve for the examined fabric samples were set up. Finally, a statistical analysis of the models and an evaluation of the parameters and representative indicators of the mathematical models have been implemented. The experimental values of the stress-strain curves are well described by all three of the chosen models. Still, mathematical model number three M3 is best suited and can be used with great accuracy in the theoretical calculation of breaking force and elongation for the selected type of fabric.


The integration of wind power (WP) into power systems has led to concerns on the adequacy of primary frequency control. Such concerns have currently arisen in interconnections with high penetration of WP and may appear in other systems where high penetration of WP is planned. This paper proposes a method for predicting the level of WP penetration that may lead to primary frequency control inadequacy, considering a empirically-validated model of primary frequency control, worst-case scenario conditions and no frequency response from WP machines. The NORDEL interconnection is considered as a case study.


Treatment for opioid use disorders is highly effective yet unavailable in many rural areas. "Somewhere to Go: Ensuring Access to Medication-Assisted Treatment in Rural Maryland" is a Robert Wood Johnson Funded Clinical Scholars project intended to expand the use of tele-health medication-based treatment for opioid use disorders services directly to rural areas in need. We demonstrated that a University-based substance use treatment team can successfully collaborate with a geographically distant rural substance use treatment clinic to provide medication-based treatment for opioid use disorders using a HIPPA compliant telehealth strategy. We provide an overview of the implementation strategies our team used to expand overall access in different locales throughout the State of Maryland and beyond. We describe implementation results of a tele-health medication-based treatment program for opioid use disorders that focuses on implementation successes and how to identify and overcome implementation challenges and barriers. Implementation of a telemedicine approach can be challenging, but careful consideration and forethought can map a successful path to program development, operation and sustainability.


State abstractions are often used to reduce the complexity of model-based reinforcement learning when only limited quantities of data are available. However, choosing the appropriate level of abstraction is an important problem in practice. Existing approaches have theoretical guarantees only under strong assumptions on the domain or asymptotically large amounts of data, but in this paper we propose a simple algorithm based on statistical hypothesis testing that comes with a finite-sample guarantee under assumptions on candidate abstractions. Our algorithm trades off the low approximation error of finer abstractions against the low estimation error of coarser abstractions, resulting in a loss bound that depends only on the quality of the best available abstraction and is polynomial in planning horizon.


Delay line oscillators based on photonic components, such as the optoelectronic oscillator (OEO), offer the potential for realization of phase noise levels orders of magnitude lower than achievable by conventional microwave sources. Fibre optic-based delay lines can realize the large delay required for low phase noise systems whilst simultaneously achieving insertion loss levels that can be compensated by available microwave and photonic amplification technologies. However, the long fibre is vulnerable to environmental perturbations such as mechanical vibrations and variations in ambient temperature, which result in short term fluctuations and thermally induced drift of the oscillation frequency. The phase shifter used conventionally to adjust the frequency of an OEO to enable phase lock has a finite range that is insufficient to compensate the delay change resulting from operational temperature ranges. A solution to continuous tuning without mode-hopping and to compensation of thermally induced frequency drift without loss of lock of a time delay oscillator is proposed. The basic concept is to introduce a tuning mechanism that works with Cartesian co-ordinates on the complex plane and to avoid explicit use of polar co-ordinates. Consequently, the transmission of the tuning component may traverse the unit circle in either direction multiple times without range limitation to the phase. Thereby tuning by mode-hopping is avoided and expedients to stabilisation, such as the use of tunable lasers within a control loop or precision temperature stabilisation measures are not required. The concept is verified by Simulink simulations. The method has been experimentally tested successfully using a prototype OEO phase locked to a system reference. Solid lock was maintained even when the OEO was placed in an oven and cycled over a temperature range from ambient to 80 °C.


The Chicago Women's Liberation Union, hereafter Union or CWLU, was a feminist union that operated in Chicago, Illinois, from 1969 to 1977 and was the first and largest union, at the time of its operation, focused on women's issues. The Union organized women with the self-proclaimed collective goal of achieving liberation from sexism and inequality. Within the larger CWLU, smaller groups and chapters formed to address issues such as abortion [8], rape, child care, and reproductive health, among others. During CWLU's eight years of operation, the activists circulated petitions, held demonstrations, and visited high schools to raise public awareness of women's issues. The CWLU created educational opportunities for women in response to apparent sexism in the US and connected them to social groups to further the women's liberation movement and women's reproductive health awareness in the United States.


College mental services have come a long way since the early attempts, nearly 60 years ago, to meet the needs of students in emotional conflict, and this book edited by Dana Farnsworth and Graham Blaine is an excellent documentation for this progress. It is estimated that more than 200 colleges now provide a significant mental health service and that 15% to 20% of the students suffer from emotional difficulties, serious enough to diminish their effectiveness. All the authors come from the Boston region and they deal with the important aspects of student mental health; ambiguity regarding loyalty to students-patients and to the institution, the conditions under which research may be conducted, background of student activists and changing sexual mores. "Students Who Say 'No,' " is a chapter by Robert Coles, sexual morality is described by Dana Farnsworth, and drug abuse by Preston Munter. There is a chapter on depression by Paul


This action research examines the impact that self-video recordings of oral task-based activities
have on the development and/or improvement of students' speaking skills. The
study was conducted in an eight-week period during which the participants wrote a script
for a cooking TV, videoed their rehearsals in order to receive teacher feedback. Finally they
made a final live presentation of the TV show during which a recipe was followed while
they explained its steps and gave tips...


Zinc has received a great deal of importance in crop production especially in a rice-wheat cropping system during the last few years, because of the report of widespread occurrence of its deficiency from different parts of the country limiting crop production. Significant response of rice-wheat to Zn fertilization has also been reported by different investigators from almost all the parts of India. The main reasons for the occurrence of Zn deficiency is the adoption of intensive cropping programme with high yielding varieties and modern agro techniques like use of high analysis chemical fertilizers, use of pesticides with the simultaneous very limited use of on-farm inputs like organic manures, crop residues etc.
Zinc is one of the important essential micronutrients for plants. The problem seems to be more acute for ricewheat as around half of the total rice-wheat area found to be severely affected by Zn deficiency. Zinc plays an important role in different plant metabolism processes like development of cell wall, respiration, photosynthesis, enzyme activity, auxin and protein synthesis, and other bio-chemical functions etc. amongst all the micronutrients Zn deficiency continues to be one of the key factors in determining the crop production in India and other countries of the World. Various factors associated with Zn deficiency are acid sandy soils low in total zinc, neutral or alkaline soils having higher amount of fine clay, silt and available phosphorus, organic soils etc.
Intensive cultivation and growing of exhaustive crops have made the soil deficient in macro as well as in micronutrients. Now a day the use of only nitrogenous and phosphatic fertilizers also create nutrient imbalances particularly of Zn in soils. Although the requirement of micronutrients is very low, its effect on crop yield is, however, very significant.
The favourable rice-wheat environment is found mainly in the western part of the rice-wheat belt, where wheat is the dominant crop in Pakistan, the northwestern Indian states of Punjab and Haryana, and western Uttar Pradesh. The less favourable rice-wheat environment occurs in the eastern part of the Indo-Gangetic belt, where rice is the dominant crop in Bangladesh, West Bengal, the northern parts of Bihar and Uttar Pradesh and the Terai region of Nepal.
Geographically, the favourable rice-wheat environments in the Indo-Gangetic plains are located in the western part, where winter environmental conditions are suited for wheat, irrigation infra structure is good, marketing facilities are available, and both rice and wheat yields are high. The less favourable rice-wheat environments occur in the eastern part and are associated with partially irrigated and rain fed systems, and a shorter growing period for wheat. More detailed agroclimatic analysis would provide an in-depth understanding of the environmental constraints (e.g. Draught stress and flood proneness) for geographical targeting of varietal and crop management strategies in both the favourable and less favourable rice-wheat environments.


Pregnancy in association with dilated cardimyopathy is considered to be a rare entity. The incidence is unknown. The dilated cardiomyopathies (DCM) are defined as diseases of the cardiac muscle without a known cause. Three pregnancies with DCM are reported. In this article the possible hazzards of pregnancy and DCM are discussed, including a review of the literature concerning to diagnosis and management is present.


The Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) study aims to delineate the independent and interaction effects of genomic (genetic and epigenetic) and psychological–environmental (maternally perceived racial discrimination, mental health, and parenting behavior) factors on blood pressure (BP) among African American mother–child dyads over time. The purpose of this article is to describe the two-step genetic and epigenetic approach that will be executed to explore Gene × Environment interactions on BP using a longitudinal cohort design. Procedure for the single collection of DNA at Time 1 includes the use of the Oragene 500-format saliva sample collection tube, which provides enough DNA for both the Illumina Multi-Ethnic Genotyping and 850K EPIC methylation analyses. BP readings, height, weight, percentage of body fat, and percentage of body water will be measured on all participants every 6 months for 2 years for a total of 4 time points. Genomic data analyses to be completed include multivariate modeling, assessment of population admixture and structure, and extended analyses including Bonferroni correction, false discovery rate methods, Monte Carlo approach, EIGENSTRAT methods, and so on, to determine relationships among both main and interaction effects of genetic, epigenetic, and psychological environmental factors on BP.


Abstract Acoustic call sequences are important components of vocal repertoires for many animal species. Bottlenose dolphins (Tursiops truncatus) produce a wide variety of vocalizations, in different behavioural contexts, including some conspicuous vocal sequences – the 'bray series'. The occurrence of brays is still insufficiently documented, contextually and geographically, and the specific functions of these multi-unit emissions are yet to be understood. Here, acoustic emissions produced by bottlenose dolphins in the Sado estuary, Portugal, were used to provide a structural characterization of the discrete elements that compose the bray series. Information theory techniques were applied to analyse bray sequences and explore the complexity of these calls. Log-frequency analysis, based on bout criterion interval, confirmed the bout structure of the bray series. A first-order Markov model revealed a distinct pattern of emission for the bray series' elements, with uneven transitions between elements. The order in these sequential emissions was not random and consecutive decreases in higher order entropy values support the notion of a well-defined structure in the bray series. The key features of animal signal sequences here portrayed suggest the presence of relevant information content and highlight the complexity of the bottlenose dolphin's acoustic repertoire.


A model-based fault detection algorithm assuming uncertain process parameters is used for detecting poorly operating λ-tuned control loops. The a priori information obtained from λ-tuning is used to create an observer as residual generator. The observer has integral action which makes it possible to obtain a tight fault detection threshold. A linear optimization approach is used for finding the parameters in the threshold


We study the effects of differences in local financial development within an integrated financial market. We construct a new indicator of financial development by estimating a regional effect on the probability that, ceteris paribus, a household is shut off from the credit market. By using this indicator, we find that financial development enhances the probability an individual starts his own business, favors entry of new firms, increases competition, and promotes growth. As predicted by theory, these effects are weaker for larger firms, which can more easily raise funds outside of the local area. These effects are present even when we instrument our indicator with the structure of the local banking markets in 1936, which, because of regulatory reasons, affected the supply of credit in the following 50 years. Overall, the results suggest local financial development is an important determinant of the economic success of an area even in an environment where there are no frictions to capital movements.


Processing of biological data sequences by mapping into numerical signals is a commonly used technique. The operators such as de-noising filter, smoothing filter and certain algorithm could be used iteratively. Little is known about the consistency of analysis results with different mapping strategies in this situation. Meanwhile, due to the errors and noises in acquisition of data, the stability of analysis results should never be neglected. In this paper, we provide a method for analyzing the consistency between different mappings under iterations of operator. We define different concepts of mapping equivalence. We show the necessary and sufficient condition for consistency under iteration of affine operator. We present a few theoretical results on the equivalent mappings on the concept of Fatou and Julia Set. We give the definition of stability under iteration of operator and show the stability issue can be viewed as a special case of mapping equivalence. We also establish the connection of stability to Fatou and Julia set. Finally, we present experimental results on human gene AD169 sequence and rhodopsin gene sequence under one of the widely used mappings and illustrate the equivalent mapping for a smoothing filter.


The efficacy of a gut microbiota control was investigated for patients with atopic asthma. 45 patients with atopic asthma were included in the study. The results of our clinical and lab tests, pulmonary function tests and the lactulose hydrogen breath tests have been presented to evaluate small intestine bacterial overgrowth (SIBO). Under the standard SIBO's therapy (long-acting beta-agonists, inhaled glucocorticoids), the first group (15 patients) had being tested with Rifaximin for the SIBO therapy during 7 days. The second group (15 patients) had been tested with Rifaximin and with a succeeding probiotics therapy for three months (B. bifidum, B. longum, B. infantis, L. rhamnosus). SIBO was diagnosed for 30 (67%) patients. We have detected a higher IgE level (P<0.01), a higher eosinophils level (P<0.001) in sputum and more significant decrease of FEV1 (P<0.01) in SIBO(+). The IgE level in patients was decreased (P<0.01) after the complex SIBO therapy both for the Rifaximin therapy group (P<0.05) and for the Rifaximin + Probiotic therapy group (P<0.05). A dramatic decrease of the IgE level (P<0.05) had been induced by probiotics and it was confirmed by the control testing results with a high statistical accuracy for the observed groups of patients. We did not detect any changes for the patients without SIBO (P=0.46), those who had been treated with a standard therapy. A decrease in the number of patient hospitalization was defined by the treatment with probiotics after SIBO therapy (P<0.05). So, SIBO is a significant factor aggravating the atopic asthma in patients. The gut microflora correction with probiotics therapy has been accompanied by a statistical reliability improvement for the immune response and spirometry, as well as by a decrease in the number of hospitalizations for these patients during the year.


Dual-frequency operation of antennas has become a necessity for many applications in recent wireless communication systems, such as GPS, GSM services operating at two different frequency bands, and services of PCS and IMT-2000 applications. Although there are various techniques to achieve dual-band operation from various types of microstrip antennas, there is no efficient design tool that has been incorporated with a suitable optimization algorithm. In this paper, the cavity-model based simulation tool along with the genetic optimization algorithm is presented for the design of dual-band microstrip antennas, using multiple slots in the patch or multiple shorting strips between the patch and the ground plane. Since this approach is based on the cavity model, the multiport approach is efficiently employed to analyze the effects of the slots and shorting strips on the input impedance. Then, the optimization of the positions of slots and shorting strips is performed via a genetic optimization algorithm, to achieve an acceptable antenna operation over the desired frequency bands. The antennas designed by this efficient design procedure were realized experimentally, and the results are compared. In addition, these results are also compared to the results obtained by the commercial electromagnetic simulation tool, the FEM-based software HFSS by ANSOFT.


Currently, environmental research on pollinator decline does not trigger broad protection of pollinators in particular in agricultural landscapes. Prevailing environmental recommendations, e.g. seeding wildflower strips in and between fields, don't take farmers' interests into account. Farmers prefer income from the entire area and they regard wildflowers as weeds potentially spreading their seeds all over the field. Whereas the new agricultural Farming with Alternative Pollinators (FAP) approach uses marketable plants for habitat enhancement and avoids spread of weeds. FAP triggers farmers' motivation to enhance habitats in fields based on evidence of increased income. FAP measures the impact of enhanced habitats (25 % of the field) on the diversity of pollinators and predators and on the total net income in comparison to control fields having the main crop on 100 % of the field. Pilot projects in Uzbekistan with cucumber and sour cherry as main crops and in Morocco with cucumber as main crop proved high increase of yields of the main crop and higher income per surface based on higher diversity and abundance of pollinators and predators in FAP-fields. In total income from FAP fields was more than double in comparison to control. The incentive of large income gain makes FAP scalable. FAP obviates the need to reward farmers for pollinator-friendly practices. As insect species highly differ in Central Asia and North Africa the approach proved replicability. Trials on more crops are recommended. In case they demonstrate substantial income increases as well, FAP might have high potential to protect pollinators and simultaneously enhance food security. Currently, the increase of horticulture production is mainly based on increase of area, whereas FAP increases the productivity per ha. Thus FAP might reduce the loss of forests and rangelands for establishment of additional fields and orchards. FAP is applicable also in low income countries, which cannot afford subsidies as e.g. the European Union pays.


'China's growing assertiveness, America's declining deterrent capability, and Taiwan's growing jumpiness, not least as it watches Hong Kong, have all made a stumble into catastrophic conflict across the Taiwan Strait more likely than for decades. Brendan Taylor credibly argues this is only avoidable - however unattractive "muddling through" might be to purists on all sides - by urgently building more robust crisis-management mechanisms. A sober and compelling analysis which policymakers will ignore at their peril.' Gareth Evans, Former Australian Minister for Foreign Affairs and President Emeritus of the International Crisis Group 'The cross-Strait balance of power is shifting, raising the risk of inadvertent and catastrophic great-power conflict. Brendan Taylor's identification of this window of vulnerability and proposals for crisis-management advance our understanding of one of the most vexing national security problems of the next decade.' Dr Mira Rapp-Hooper, Council on Foreign Relations 'This is certainly a timely book addressing Taiwan's forthcoming security challenges. Brendan Taylor provides an insightful and thought-provoking analysis regarding the threats Taiwan is facing and at the same time offers valuable suggestions in terms of how to manage this imminent crisis. This is worth reading by all interests.' Andrew N.D. Yang, Former Minister of National Defense, Republic of China, Taiwan Taiwan's position looks increasingly precarious, and tensions threaten to grow into a major strategic crisis. Chinese President Xi Jinping has made reunification with Taiwan a central pillar of his vision for China, and has ramped up diplomatic and economic pressure on Taiwan. Its inhabitants are increasingly estranged from the mainland, and Tsai Ing-wen's administration refuses to conduct relations with China on Beijing's terms. Taiwan could take on renewed strategic significance amid the backdrop of the deepening rivalry between China and the United States, and find itself at the centre of a Cold War-style superpower confrontation. While Washington's support and military power has historically guaranteed Taiwan's security, this is no longer a certainty. This Adelphi book argues that China's military modernisation has changed the cross-strait military balance, and the ability of the US to prevail in a conflict over Taiwan may have evaporated by 2030. As China feels increasingly empowered to retake Taiwan, there is significant potential for escalation, particularly given the ambiguity of Beijing's 'red lines' on Taiwan. Neither Beijing, Taipei nor Washington want such a conflict, but each is challenging the uneasy status quo. Taylor calls for the introduction of a narrower set of formal crisis-management mechanisms designed to navigate a major Taiwan crisis.


For more than 25 years, researchers harbored three basic assumptions about the scholastic press: a) that school officials have shown little respect for student journalists' First Amendment rights; b) that student journalists are too deferential to school authorities; and c) that the student press tends to avoid controversial topics.Researchers expected to find that the situation had worsened after the Supreme Court's 1988 Hazelwood School District v. Kuhlmeier decision, which allowed school officials to censor school-sponsored publications that are not public forums and to muzzle the speech of faculty members. Research following the ruling suggested that was not the case, however.Post-Hazelwood researchers found that high school principals and publications advisers did not see much change in the amount of student-newspaper censorship following the ruling. Critics of such research, however, say that these results are based upon arguably biased reports. They also suggest that unpublished prohibitions on content, pressure on student journalists, intimidation and student deference often negate the need for overt censorship. Phillips surmised the following from her pre-and post-Hazelwood study of North Carolina high schools:In all schools, advisers exert subtle pressure and, in practice, most of them are censors by the definition applied in this study: both cutting controversial material and instituting a policy or atmosphere of intimidation that causes students to refrain from printing certain materials in the school newspaper. Clearly, persistent student editor deference to such authority has a stultifying effect on the student press.(1)Post-Hazelwood researchers usually have studied only censorship and have been unable to determine if self-censorship is a problem for the scholastic press. Neither have they determined why press freedom did not suffer after the Hazelwood ruling. Their research points out the need for a reassessment of the extent of press freedom at U.S. public high schools. It also identifies a need to study factors associated with scholastic press freedom.Previous studiesStudies before 1969 often found that scholastic press freedom was limited by the whims of school officials.(2) But in 1969, the Supreme Court stated in Tinker v. Des Moines Independent Community School District that students did not lose their First Amendment rights while at school, if they were not disruptive. Because of that ruling, lower courts upheld student press freedom in a number of cases. Research conducted in the decade following the Tinker decision, however, found that the decision had not led to much of an increase in student press freedom.(3)While supporters of the scholastic press expected an increase in prior restraint to take place because of the Hazelwood ruling, researchers conducting surveys in three states shortly after the ruling concluded that few advisers or principals anticipated changes in their publications.(4) Several national studies of principals and advisers in the early years of the Hazelwood era seemed to confirm that the ruling had little impact on scholastic press freedom.(5)In the one reported study that included opinions of students, Crow found that Texas high school principals and student editors were in substantial agreement concerning the extent of prior restraint that had occurred at the school. Principals' and editors' responses to opinion questions about press freedom, however, were significantly different.(6)While research following the Hazelwood ruling called into question basic assumptions about the extent to which student press freedom existed, researchers' findings also were challenged. The Student Press Law Center, for example, reported that the number of requests for its assistance increased 143 percent from 1988 through 1992. It stated that "[m]uch of the increase is believed to be the result of the U.S. Supreme Court's 1988 decision in Hazelwood School District v. …


This study provides an empirical investigation on the effect of the social-cultural environment; local community literacy levels, support from local communities, language, and corruption levels on the performance of donor-funded health projects in Kenya. Empirical evidence indicatesthat most donor-funded health projects in Kenya experience time and cost overruns as well as quality issues. This study investigated a population of 69 donor-funded health projects that were initiated between 2008 and 2018 and were ongoing during the study period. A census study was conducted to ensure efficiency, representativeness, reliability, and flexibility since the population was small. The study adopted explanatory and descriptive research designs. Regression results indicated that language, support from the local communities, and the level of literacy in the local communities had positive relationships with the performance of donor-funded health projects in Kenya with coefficients of 0.021, 0.045, and 0.042 respectively. These factors were significant at a 5 percent significance level with p-values of 0.018, 0.019, and 0.047 respectively. Corruption levels had a negative relationship with the performance of donor-funded health projects in Kenya with a coefficient of - 0.031 that was significant at a 5 percent significance level with a p-value of 0.013. The study recommends that the government develops policies and frameworks that will help projects to minimize the negative effects of the social-cultural environment and enhance the positive effects, and that all decision-makers and other donor-funded health project stakeholders devise policies and strategies for controlling the effect of the social-cultural environment on the donor-funded health projects.


This paper aims to establish connections between the for Memory is a process that works through the identification of social references within a spatial framework, without physical marks necessarily found in the tangible present. Nonetheless, these references subsist in representations from the past and continue to influence current urban realities. A city is an evolving structure containing different artifacts that relate directly to their importance to a given social group. Usually, but not exclusively, such places have strong historical and memorial significance and are recognized as heritage. Thus, as spaces evolve, inhabitants' emotional bonds are sometimes at odds with the interactions of other actors. These dual interactions generate rivalries and controversies about uses and perceptions of the space. Traces left on the collective memory by violent urbanization processes can be identified by understanding the city through such intangible experiences. Using these principles -notably that forgetting is not equivalent to the destruction of a mnemonic device- we analyze the spatial and social experiences of controversial memories in two different cultural contexts; the Historic Center of Mexico City (Mexico) and the Gulou area of Beijing (China). The Mexican case study looks at a dominant discourse of urban heritage focused on tangible heritage conservation, which has often ignored the importance of local social memories. The Chinese case study scrutinizes the community�s memories in the context of rapid and radical transformation led by the local government�s urban policies and regulations.


ABSTRACT Welcoming 60,000 Southeast Asian refugees in the 1979–80 period has become a celebrated part of Canada's history, but the eventual integration of these refugees into Canadian society has received insufficient attention. This study provides a comprehensive overview of Vietnamese refugees' economic outcomes over the three decades after their arrival. This study also explores how regional contexts contributed to shaping economic outcomes. Based on analyses of multi-year census data, this study finds that adult Vietnamese refugees arrived with little human capital, but they had high employment rates, and over time they closed their initial large earnings gap with other immigrants. Childhood Vietnamese refugees out-performed other childhood immigrants and similar-aged Canadian-born individuals in educational attainment and earnings when they reached adulthood. The geographic region of residence was associated with some large variations in refugees' socioeconomic outcomes; and regional differences in refugees' human capital characteristics, ethnic enclave, and economic conditions played varying roles depending on the outcome measure and length of residence.


One of the main challenges in photonics is the integration of ultrafast coherent sources in silicon compatible platforms at the nanoscale [1]. Generally, the emission of ultra-short pulses is achieved by synchronizing the cavity modes of the system via external active components, such as, e.g., Q-switch or saturable absorbers. Consequently, the required optical setups are complex and difficult to integrate on-chip. To address these difficulties, we propose a novel type of integrated source based on the spontaneous synchronization of several near-field nanolasers. We design our near-field lasers by considering the nonlinear amplification of non-radiating Anapole modes [2]. Anapoles represent an intriguing non-conventional state of radiation, whose excitation is responsible for the formation of scattering suppression states in dielectric nanostructures [3]. Due to their inherent near-field emission properties, an ensemble of anapole-based nanolasers represent an ideal candidate to investigate and tailor spontaneous synchronization phenomena in a silicon-compatible framework. Additionally, their mutual non-linear interaction can be precisely controlled within standard nanofabrication tolerances.


The effect of an applied magnetic field on the growth patterns of Zn electrodeposits on filter paper was investigated using an optical microscope and an atom force microscope. It was found that the concentration of electrolyte and the fibre of filter paper influenced strongly the morphology of Zn electrodeposits obtained in unsaturated electrolyte. No evidence indicated that the magnetic field affected the morphology of electrodeposits obtained in unsaturated electrolyte. The branches of Zn electrodeposits obtained in saturated electrolyte grew in two layers, and the thin layer that adhered to the filter paper grew faster than the thick layer. In the case of saturated electrolyte, the 0.40T magnetic field made the branched electrodeposits grow into a spiral pattern. On the basis of these experimental results and the related theories, it was proposed that the magnetic field influenced the morphologies of the branched Zn electrodeposits grown on filter paper through the Hall effect.


The fruit fly Drosophila melanogaster is an excellent model system for studies of genes controlling development and disease. However, its applicability to physiological systems is less clear because of metabolic differences between insects and mammals. Insulin signaling has been studied in mammals because of relevance to diabetes and other diseases but there are many parallels between mammalian and insect pathways. For example, deletion of Drosophila Insulin-Like Peptides resulted in 'diabetic' flies with elevated circulating sugar levels. Whether this situation reflects failure of sugar uptake into peripheral tissues as seen in mammals is unclear and depends upon whether flies harbor the machinery to mount mammalian-like insulin-dependent sugar uptake responses. Here we asked whether Drosophila fat cells are competent to respond to insulin with mammalian-like regulated trafficking of sugar transporters. Transgenic Drosophila expressing human glucose transporter-4 (GLUT4), the sugar transporter expressed primarily in insulin-responsive tissues, were generated. After expression in fat bodies, GLUT4 intracellular trafficking and localization were monitored by confocal and total internal reflection fluorescence microscopy (TIRFM). We found that fat body cells responded to insulin with increased GLUT4 trafficking and translocation to the plasma membrane. While the amplitude of these responses was relatively weak in animals reared on a standard diet, it was greatly enhanced in animals reared on sugar-restricted diets, suggesting that flies fed standard diets are insulin resistant. Our findings demonstrate that flies are competent to mobilize translocation of sugar transporters to the cell surface in response to insulin. They suggest that Drosophila fat cells are primed for a response to insulin and that these pathways are down-regulated when animals are exposed to constant, high levels of sugar. Finally, these studies are the first to use TIRFM to monitor insulin-signaling pathways in Drosophila, demonstrating the utility of TIRFM of tagged sugar transporters to monitor signaling pathways in insects.


This thesis consists of two parts where Indoor Environmental Quality is studied in the first part by analyzing polycyclic aromatic hydrocarbons (PAHs) and biological contamination levels in floor dust inside an educational building and dwellings within the capital city of Jordan (Amman). Exposure, dose and health risk assessments of PAHs were also performed. The second part investigates particle distribution of accumulation and coarse particles as well as workers'/students' exposure to coarse particles inside an educational workshop. For the first part of the thesis, floor dust samples were taken from the living room and the entrance area inside eight houses as well as from four offices, two lecture rooms, two corridors and two areas of a workshop inside a university building. For the second part, the inhaled deposited dose of coarse particles inside an educational workshop was estimated. The total PAHs concentrations at the living rooms ranged from around 64165422 ng/g and at the entrance area from 2419266 ng/g. Half of the dwellings had higher total PAHs concentrations at the living rooms than at the entrance area. Our findings indicated that both outdoor and indoor sources contributed to high PAHs concentrations. Based on the answers of the occupants of the dwellings, the main sources of indoor PAHs included indoor smoking, cooking activities, heating system and traffic, correlating with the results from other studies. However, more studies are needed to make a confirm conclusion regarding the specific source(s) of PAHs in household floor dust. The total PAHs concentrations inside the educational building varied from around 7145246 ng/g. The PAHs concentrations inside offices, where tobacco smoking took place, were higher than those observed inside lecture rooms and the workshop area. This finding indicated that exposure to tobacco smoking inside poorly ventilated and small indoor environments can be seriously harmful. Especially important was the fact that our results revealed that Jordanian occupants inside residential and occupational environments were less exposed to toxic PAHs via dust ingestion than occupants in similar indoor environments in Europe and Asia. The bacterial and fungal concentrations varied significantly among and within the studied environments indoors, indicating that that the origin of bio-contaminants differs depending on the locations within the city. In addition to occupancy, human's activities and outdoor sources, environmental conditions, are also responsible for the increase of bacterial and fungal concentrations indoors. Inside the workshop area, the highest mean and maxima PN0.3-1 (PM0.3-1) and PN1-10 (PM1-10) concentrations were detected during welding activities. The variation in the accumulation mode and coarse mode aerosol concentrations could be attributed to the type of activity (i.e. specific source) and the particle loss rate (i.e. dry deposition and removal via ventilation). During an 8-hour exposure to particles produced during welding and other activities, the total estimated inhaled deposited dose would be less than 750 μg. The mass regional deposition was: ~ 53% in the alveolar region, ~ 29% in the tracheobronchial and ~ 18% in the head/throat region. The results obtained for the inhaled deposited dose could be used in epidemiological studies and in the creation of risk assessment models during welding or related processes.


Fundamental studies of mass transfer and kinetics are essential for a detailed understanding of the characteristics and the mechanisms of biosorptions. In this study, the modified mass transfer factor models were used to assess the rates of global, external and internal mass transfer for the biosorption of oil and grease (O&G) from agro-food industrial effluent (AFIE) by Serratia marcescens SA30. Using a packed-bed column reactor to run the experiments at different O&G concentrations, this study finds that the global mass transfer rate increases exponentially accompanied with the sudden increase of the cell surface sorption. The influence of concentration on the external mass transfer is very remarkable due to the effects of driving force and biomass growth can lead to a rapid movement of O&G molecules from the bulk water to extracellular precipitation. The resistance to mass transfer could be dependent on intracellular accumulation at the beginning and then on film mass transfer at the final stage of biosorption of O&G by Serratia marcescens SA30. This study would provide a green and sustainable pathway for removing O&G from AFIE.


Acute pancreatitis is a relatively common and potentially fatal condition, but the presenting symptoms are non-specific and diagnosis relies largely on the measurement of amylase activity by the hospital clinical laboratory. In this work we develop a point of care test for pancreatitis measuring concentration of secretory phospholipase A2 group IB (sPLA2-IB). Novel antibodies for sPLA2-IB were raised and used to design an ELISA and a lateral flow device (LFD) for the point of care measurement of sPLA2-IB concentration, which was compared to pancreatic amylase activity, lipase activity, and sPLA2-IB activity in 153 serum samples. 98 of these samples were obtained from the pathology unit of a major hospital and classified retrospectively according to presence or absence of pancreatitis, and the remaining 55 were obtained from commercial sources to serve as high lipase (n = 20), CA19-9 positive (n = 15), and healthy (n = 20) controls. sPLA2-IB concentration correlated well with the serum activity of both amylase and lipase, and performed at least as well as either markers in the differentiation of pancreatitis from controls.


Constructed response questions - in which students must use their own language in order to explain a phenomenon - create more meaningful opportunities for instructors to identify their students' learning obstacles than multiple choice questions. However, the realities of typical large-enrollment undergraduate classes restrict the options faculty have for moving towards more learner-focused instruction. We are exploring the use of computerized lexical analysis of students' writing in large enrollment undergraduate biology and geology courses. We have created libraries that categorize student responses with ≫ 90% accuracy. These categories can be used to predict expert ratings of student responses with accuracy approaching inter-rater reliability among expert raters. These techniques also provide insight into students' use of analogical thinking, a fundamental part of scientific modeling. These techniques have potential for improving assessment practices across STEM disciplines.


Neuroblastoma is the most common extracranial solid tumor in the pediatric population. Sorafenib (Nexavar), a multikinase inhibitor, blocks cell proliferation and induces apoptosis in certain types of cancers. Here, we tested antitumor effects of sorafenib (≤ 10 µM) on four human neuroblastoma cell lines, CHLA255, CHLA171, CHLA90 and SK-N-AS. Sorafenib inhibited cell proliferation and induced apoptosis of neuroblastoma tumor cells in a dose-dependent manner. Sorafenib inhibited phosphorylation of Signal Transducer and Activator of Transcription 3 (STAT3) proteins at Tyr705 in these cells, associated with inhibition of phosphorylated JAK2, an upstream kinase that mediates STAT3 phosphorylation. Expression of a constitutively-activated STAT3 mutant (pSTAT3-C) partially blocked the antitumor effects of sorafenib on neuroblastoma cells. Sorafenib also inhibited the phosphorylation of STAT3 induced by IL-6 and sphingosine-1-phosphate (S1P), a recently identified regulator for STAT3, in these tumor cells. Moreover, sorafenib downregulated phosphorylation of MAPK (p44/42) in neuroblastoma cells, consistent with inhibition of their upstream regulators MEK1/2. Sorafenib inhibited expression of cyclin E, cyclin D1/D2/D3, key regulators for cell cycle, and the antiapoptotic proteins Mcl-1 and survivin. Finally, sorafenib suppressed the growth of human neuroblastoma cells in a mouse xenograft model. Taken together, these findings suggest the potential use of sorafenib for the treatment of pediatric neuroblastomas.


Preparation conditions and platelet storage for transfusion may cause platelet activation, which contributes to decreased ability of stored platelet to function and survive in vivo after transfusion compared with that seen with freshly prepared platelets. Using flowcytometry, we investigated platelet membrane expression of CD62P, CD63 in platelet stored for up to 3 days under standard blood banking conditions. Leukocyte reduction of platelet before transfusion is a routine procedure in many blood transfusion centers to prevent leukocyte side-effects. Twenty-four platelet units prepared by platelet-rich plasma were processed by in-line leukdepletion using an LRP10SE-Pall filter. The filtered and unfiltered platelet concentrates were compared during storage for CD62P, CD63 markers and pH. During storage for up to 3 days, leukdepleted platelet units displayed no significant pH difference in comparison with routine platelet preparation (P>0.05). During storage for up to 3 days (1, 3 days) leukdepleted platelet units displayed a decrease in the CD62P and CD63 expressions as compared with routine platelet preparation (P<0.05). There has been concern that filtration of platelet concentrates might activate platelets through direct contact with the filter. On the other hand, prestorage filtration removal of leukocyte might actually decrease platelet activation and preserve platelet function. This data has shown no platelet activation after filtration and measurement of CD62P and CD63 expressions; moreover, these markers can act as a useful in vitro mean to determine the quality of platelet components. In fact, the present research aimed at studying the effect of prestorage filtration on platelet activation in platelet concentrates.


Overview
Female Perpetrated Sexual Abuse (FPSA) remains a largely under-studied and poorly understood phenomenon, despite its growing prevalence. Traditional gender constructions in relation to victimisation and perpetration as 'gendered', may be stifling its recognition, and the recognition of those affected. Survivor's perspectives on disclosure are crucial, given its known under-reporting, and how many people feel silenced. As research on FPSA is in its relative infancy, understanding the process of disclosing is particularly important in influencing professional and social change, and progression.
Method
Fourteen participants of equal gender distribution, who self identified as having been sexually abused in childhood by a female, were recruited online. The study was advertised via online survivor communities, survivor charities and forums supporting survivors. Participants were directed to a website designed by the Researcher outlining the study in its entirety. Participants then offered their consent to participation and contacted the researcher via the website. Telephone interviews were arranged and conducted with participants meeting eligibility, using a qualitative semi-structured interview protocol. Interviews were transcribed and systematically analysed using a qualitative methodology applying an Inductive Thematic Analysis approach (Braun & Clarke, 2006).
Results
Four super-ordinate themes relating to participants disclosing sexual abuse by a female were discussed, with one being a central and over-arching theme 'Perceptions of Gender and Disclosure', which influenced the three further themes;
Perceptions of Gender and Disclosure; consisting of 'social attitudes', 'gender roles', 'barrier to recognition' and 'barrier to disclosure'
o Decisions to Disclose; consisting of 'relationship with the perpetrator', 'making sense of the experience', effects of abuse' and 'readiness'
o Process of Disclosure; consisting of 'experiences of services', 'contexts of disclosing' and 'nature of disclosure'
o Experiences of Disclosure; consisting of 'perceived professional responses' and 'impact of perceived professional responses'.
Conclusions
Constructions of gender and narrow views of 'perpetration' and 'victimisation' appear to be stifling personal, professional and social recognition of FPSA. This lack of awareness and perceived cultural denial may be silencing survivors, and restricting their ability to disclose and process their experiences. The impact of gender appears to be two-fold and future research would benefit from exploring disclosure of FPSA for males and females exclusively, as their experiences and needs may greatly differ. The value of involving survivors in educating professionals and in widening awareness is discussed.


Abstract We used the process-oriented niche model CLIMEX to estimate the potential global distribution of serrated tussock under projected future climates. Serrated tussock is a drought-tolerant, wind- and human-dispersed grass of South American origin that has invaded pastures in Australia, Europe, New Zealand, and South Africa. The likely effect of climate change on its potential global distribution was assessed by applying six climate-change scenarios to a previously developed model. The projections of climatic suitability under the current climate revealed considerable scope for spread, with the most suitable areas occurring adjacent to existing naturalized populations in Australia, New Zealand, and Western Europe. Under future climates, projected to the 2080s, the land area suitable for serrated tussock contracts globally between 20 and 27%. Changes in projected potential area under the six scenarios were very similar in all geographical regions apart from North America and New Zealand, where the projections range from little change or contraction under the National Center for Atmospheric Research (NCAR) and Centre for Climate Research (MIROC) global climate models (GCMs) to expansion under the Commonwealth Scientific and Industrial Research Organisation (CSIRO) GCM. Elsewhere, contractions occur in Australia, Asia, South America, and Africa under all six future climate scenarios. By contrast, for Europe, the area climatically suitable for serrated tussock increases under all six scenarios (average increase 47%) through expansions into eastern European countries that are currently unsuitable and through increases in the suitable area in England, Ireland, and Denmark. Since pastoralism is a dominant land use in these regions of Europe, a prudent biosecurity strategy would be to contain the nascent foci of serrated tussock in southern France, along the west coast of Italy, and in the United Kingdom. This strategy could consist of a set of policies to limit human-assisted dispersal of the species' seeds and to reduce wind-borne spread through cultural control of the plant. Nomenclature: Serrated tussock, Nassella trichotoma (Nees) Hack. ex Arechav.


BACKGROUND/AIM
The yearly cost of sports injuries, which affects Swedish society, is estimated to 3 billion SEK (460 million USD). Injuries in ice hockey represent at least 270 million SEK (42 million USD). Despite the high number of injuries, mouth and face guards are rarely used in Swedish ice hockey. The major aim of this study was to examine the attitudes of mouth and face guards in two ice hockey clubs in Sweden (one elite and one division 3 club). A second purpose was to determine why some players use mouth and face guards, while others do not. A third goal was to present a material that ice hockey clubs could use for further discussions.

MATERIALS AND METHOD
A phenomenographic analysis of focus groups interviews.

RESULTS
The phenomenographic analysis of the data resulted in 12 categories. Within each category, issues, activities and engagement of the participants were described. Further, similarities and differences in the discussions between the elite club and the division 3 club were described. The following categories were found to engage the participants the most: 'Ice hockey is a high-velocity collision sport in which injuries are expected', 'Attitudes towards personal protection guards' and 'Suggested measures'.

CONCLUSIONS
The participants were aware of the risk of playing ice hockey, but they know little about the consequences of a dental injury. Although ice hockey players wish to protect themselves, they refuse to accept just any mouth or face guard. Through the discussions about reducing dental and jaw injuries by routine use of protection devices, many reform proposals were presented that could be useful in future discussions.


Nonlinear regression is used to estimate optimal parameter values in models of groundwater flow to ensure that differences between predicted and observed heads and flows do not result from nonoptimal parameter values. Parameter estimates can be affected, however, by observations that disproportionately influence the regression, such as outliers that exert undue leverage on the objective function. Certain statistics developed for linear regression can be used to detect influential observations in nonlinear regression if the models are approximately linear. This paper discusses the application of Cook's D, which measures the effect of omitting a single observation on a set of estimated parameter values, and the statistical parameter DFBETAS, which quantifies the influence of an observation on each parameter. The influence statistics were used to (1) identify the influential observations in the calibration of a three‐dimensional, groundwater flow model of a fractured‐rock aquifer through nonlinear regression, and (2) quantify the effect of omitting influential observations on the set of estimated parameter values. Comparison of the spatial distribution of Cook's D with plots of model sensitivity shows that influential observations correspond to areas where the model heads are most sensitive to certain parameters, and where predicted groundwater flow rates are largest. Five of the six discharge observations were identified as influential, indicating that reliable measurements of groundwater flow rates are valuable data in model calibration. DFBETAS are computed and examined for an alternative model of the aquifer system to identify a parameterization error in the model design that resulted in overestimation of the effect of anisotropy on horizontal hydraulic conductivity.


In this article we propose algorithms that address the two basic problems encountered in generating continuous-tone images by ray tracing: speed and aliasing. We examine previous approaches to the problem and then propose a scheme based on the coherency of an auxiliary data structure imposed on the original object domain. After investigating both simple spatial enumeration and a hybrid octree approach, we developed 3DDDA, a 3D line generator for efficient traversing of both structures. 3DDDA provides an order of magnitude improvement in processing speed compared to other known ray-tracing methods. Processing time is found to be virtually independent of the number of objects involved in the scene. For large numbers of objects, this method actully becomes faster than scan-line methods. To remove jags from edges, a scheme for identifying edge orientation and distance from pixel center to true edge has been implemented. The time required for antialiasing depends on the total length of the edges encountered, but it is normally only a fractional addition to the time needed to produce the scene without antialiasing.


Local and regional governments represent the nearest form of government to the people and their fundamental role in addressing citizens' needs is acknowledged worldwide. In line with the subsidiarity principle, the responsibility of the public good and service delivery is primarily upon the territorial administrations closer to the citizens, with the main advantage of offering more suitable and better tailored solutions at local level. In a context of scarce resources and tight budget constraints exacerbated by the ongoing economic crisis, the achievement of these goals is limited and needs to be pursued in an efficient and effective way. Accordingly, the development of tools to evaluate the performance of local and regional government is required, as well as measures to monitor the progress of the task achievement and instruments to support over time the decisional process, in the interest of all the involved shareholders, specially policy makers and citizens, international and civil society organizations. This dissertation contributes to the knowledge on basic service delivery and public expenditure analysis at sub-national level. Particularly, it deals with the provision of both general and specific services, namely the education and water sector ones. From a methodological point of view, innovative methods are proposed to evaluate the service supply and public spending in terms of efficiency and effectiveness. To show the potentiality of the suggested tools, empirical applications are proposed covering two EU countries, Belgium and Italy, which are interesting study cases for their common and peculiar features and provide complementary insights. In Chapter 2, we propose the innovative use of a composite indicator to measure the multidimensional aspects of the local public provision, encompassing several commonly acknowledged municipal tasks, and to investigate the relationship with the local government size, as the decentralization of public activities to the municipalities calls for a more enhanced service provision analysis at the local level. We suggest a robust conditional version of a directional distance Benefitof- the-Doubt approach with weight restrictions based on the municipal expenditure composition. Specifically, we deal with the presence of undesirable municipal service indicators and with the heterogeneity among the municipalities in their political preferences, priority public activities and operating environment characteristics. To illustrate the applicability of the suggested method, we show the construction of the municipal service provision composite indicator for 307 Flemish municipalities over the year 2006-2011. As a focus on a particular service, in Chapter 3 the environmental efficiency of 96 Tuscan (Italian) wastewater treatment plants (WWTPs) is investigated taking into account the quality of the outgoing water in terms of pollutant. In this regard, the presence of the residual nitrogen in the outgoing
 treated water is considered as undesirable output. The efficiency analysis is performed by applying a novel integrated
 AHP/non-radial directional distance function approach. The
 obtained results are then used to identify the efficiency explanatory variables: among them, the facilities' capacity, the
 percentage of wastewater discharged by the industrial and
 agricultural activities and the level of compliance with the
 pollutant concentration threshold set by the legislator have a
 significant impact on the WWTP performance.
 In Chapter 4, a Data Envelopment Analysis model is used
 to study the efficiency of Tuscan municipalities' public expenditure.
 Five strategic functions of Tuscan municipalities are first considered carrying out a non-aggregate analysis;
 then the overall expenditure composition of each municipality
 and the global spending efficiency are analysed by a proposed
 composite indicator. The main determinants affecting
 the municipalities' efficiency are further investigated. In particular, the obtained results may be consistently included in
 the long-standing debate on the municipal size, proving that
 the bigger the municipality, the greater its level of public expenditure efficiency. In Chapter 5, we explore whether investment in public school infrastructure affects students' achievement. We use data on extra funding to public high schools after the 2012 Northern Italy earthquake and apply a quasi-experimental design and an instrumental variable strategy. We find that spending on school infrastructure increases standardized test scores in mathematics and Italian language, and the effect is stronger for lower-achieving students and in mathematics. These results provide evidence in favour of a positive impact of capital spending in improving the learning environment and performances
 of high school students.


Fuzzy set theory was presented for the first time by Professor Lotfi A. Zadeh from Berkeley University in 1965. In conventional binary logic a statement can be true or false, and there is no place for even a little uncertainty in this judgment. An element either belongs to a set or does not. We call these kinds of sets crisp sets. In practice we often experience those real situations that are represented by crisp sets as impossible to describe accurately. A two-valued logic assumes that precise symbols must be employed, and it is therefore not applicable to the real existence. If the information demanded by a system is lacking, the future state of such a system may not be known completely. One of the instruments used to handle the vagueness in the real-world situations is fuzzy set theory, which has been frequently applied in a wide range of areas like, e.g., dynamic systems, militaries, medicine and other domains. Another theory, which copes with the problem of imprecision, is known as rough set theory. It was proposed by Professor Zdzislaw Pawlak in Warsaw in the 1980ties. Whereas imprecision is expressed in the category of a membership degree in fuzzy set theory, this is a matter of the set approximation in rough set theory. Due to the definition of a rough set formulated by means of the decision attribute value, two approximate sets of the rough set are determined. These contain sure and possible members of the universe considered, in which the rough set has been defined. One of the objectives of this study is to apply some classical methods of fuzzy set theory to medicine in order to estimate the survival length of gastric cancer patients. We have decided to test the action of fuzzy controllers of the Mamdani and Sugeno type. Two clinical markers, playing roles of the independent variables, have been included in the algorithm as the base information assisting the survival prognosis. Since the model results have been convergent to the expected experimental values then we will intend to make some extensions of the model concerning the larger number of independent variables. We have also utilized rough set classification, to verify the types of operations. These items are discussed in the thesis in conformity with the physicians' wishes to support results of statistical investigations. The current research is funded by the scientific grant obtained from Blekinge Research Board.


Background : Serum osmolality is often measured in laboratory by cryoscopic technique, which is the reference method. However, in clinical setting, routine measurement of serum osmolality is not always feasible at bedside. In normal subjects, sodium, potassium glucose, and urea are the primary circulating solutes. If no other solutes are present in serum at high millimolar concentrations, then these solute concentrations can be used to predict in the measured osmolality. The osmolal gap (OG) is the difference between measured osmolality and the calculated osmolality. The major
use of OG is to screen for the possible presence of exogenous toxic substances and to screen for cases of alcohol intoxication. However, many equations for the calculation of have been proposed. The purpose of this study is to compare the calculated osmolality using various formulae with the measured osmolality in order to determine which calculated formula fit best with actual measured osmolality. Materials and Methods : Serum osmolality results which was done during the period of January 2015 to December 2015 were extracted from the laboratory information system (LIS). Serum osmolality that was performed simultaneously with renal and Iier function tests, serum electrolytes and plasma glucose were included for the study. Serum osmolality measured for patients with the history of drug abuse and poisoning were excluded from the study. 405 serum osmolality results were chosen for the study and were divided into two groups. Group 1 included 205 data with normal serum osmolality, renal, liver function tests and plasma glucose level less than 7.8 mmol/L. For the second group (n = 200), data with low serum osmolality (n=90) and high serum osmolality (n=80) and normal serum osmolality (n=30) were included. The first group data were to identify which equation correlated well with the measured osmolalit and the second group data to study the performance of equation that correlated well with the measured osmolality. Results Of the 19 formulae studied only four were identified as optimal by having the mean OG<2 mOsm/kg. The Smithline-Gardner formula (2Na+ Glu + BUN) showed the smallest osmolal gap with the mean bias of 0.3 mOsm/kg. This formula was observed to be the best fit betwe n measured and calculated smolality. The DorwartChalmers formula which has been incorporated in many autoanalysers for calculation of osmolality equation underestimates the osmolality compared to the measured osmolality and gave inferior results. Conclusion: Based on our results, we recommend Smithline-Gardner formula to be used by clinicians and laboratories for the calculation of osmolal gap, on the basis that (i) OG gap is close to zero, (ii) it is simple, easy to calculate at bedside for hospitalised patients and (iii) can be easily incorporated in the Laboratory Information System (LIS). Keywords: measured osmolality; calculated osmolality; osmolal gap; regression analysis.


: Whole-body X irradiation with doses of 0.155 and 0.310 C/kg was shown to modify in different ways the activating effects of noradrenaline and serotonin, as well as a biphase effect of dopamine (5.10(-8)--1.5.10(-3) M) on Na,K-pump of neuronal membranes. The resulting effect was a function of a combination of radiation doses and neurotransmitter concentrations and thus showed different modes of interaction between neurotransmitter and ion-transport systems of brain cells in radiation sickness. The authors discuss possible molecular mechanisms of radiation modification of the functional interaction between the neurotransmitter and the active ion-transport systems in nerve cells.


: Various methods of separation and identification of major equine leukocyte populations and subpopulations were used. The purity of T and B lymphocytes separated in Sephadex anti-equine F(ab')2 columns was 87% to 99% and 83% of 97%, respectively. The purity of T lymphocytes separated in nylon-wool columns was 89% to 98%. Preparations of B lymphocytes separated in glass-bead columns were 68% to 79% pure. The presence (or absence) of surface immunoglobulin by immunofluorescence was the most consistent and reliable method for the identification of B or T lymphocytes, respectively. However, the erythrocyte-antibody-complement-rosette method for the identification of B cells and the erythrocyte-rosette method for the identification of T cells were not suitable. Monocytes were separated by the adherence method, and the purity, as identified by the latex particle ingestion procedure, was 70% to 78%. Electron microscopy of monocytes stained by peroxidase activity did not identify these cells. The purity of neutrophils obtained by the Ficoll-Hypaque separation method was 95% to 97%. The merits and usefulness of these methods were discussed.


In order to investigate the electrical behaviour of a high power gas discharge within a volume equal to those of the plasmaburner of a large calibre electrothermal gun experimental investigations with a firing simulator were performed. After giving the initial design parameters which are defined by those of the large calibre ET-gun, the paper presents the mechanical set-up of the large calibre firing simulator. 25 firing experiments with different initial parameters were performed. The results of three characteristic experiments are presented. By the discussion of these results the influence of the initial parameters on the electrical behaviour of the gas discharge within the plasmaburner is shown. A similiar behaviour can be expected when firing the large calibre ET-Gun with the pre-optimized initial parameters obtained from the experiments with the simulator.


The Coronavirus scare that emanated from Wuhan, China in December of 2019 is an epidemic of testing. There is no proof that a virus is being detected by the test and there is absolutely no concern about whether there are a significant number of false positives on the test. What is being published in medical journals is not science, every paper has the goal of enhancing the panic by interpreting the data only in ways that benefit the viral theory, even when the data is confusing or contradictory. In other words, the medical papers are propaganda.


The rare relict ponderosa pine (Pinus ponderosa C. Lawson) mixed-conifer forests of northern California's Whiskeytown National Recreation Area (WNRA), USA, present a classic example of fire exclusion. Altered fire regimes in this biologically unique area have been documented, but the resulting changes in forest composition and structure have not previously been described. A fully randomized, park-wide sampling of relict forest structure at WNRA reveals a high degree of topographic variability in tree species composition, but strikingly similar changes in recent structural development. A distinct cohort of encroachment trees initiated approximately 64 yr to 67 yr ago with little age variation (2 yr SE), with distinct strata now distinguishing the relict and encroachment cohorts. Over the past five decades, the average periodic annual basal area growth of relict trees has remained at a virtual constant of 24 cm2 to 27 cm2 per tree. In contrast, the annual basal area increment of encroachment trees has been steadily increasing, from 3 cm2 per tree in 1955 to 16 cm2 per tree in 2005. Whereas relict trees are comprised primarily of pine species (76%), they represent just 17% of encroachment trees. In contrast, white fir, Douglas-fir (Pseudotsuga menziesii [Mirb.] Franco.), and tanoak (Lithocarpus densiflorus [Hook. & Arn.] Rehder) are rare among relicts (16%) but are the most predominant species among encroachment trees (64%). This study's findings should inform the planning of restoration activities to reduce threats to relict forests at the WNRA as well as similar forests in the southeastern Klamath Mountains.


Challenges around collecting and processing quality data have hampered progress in data-driven dialogue models. Previous approaches are moving away from costly, resource-intensive lab settings, where collection is slow but where the data is deemed of high quality. The advent of crowd-sourcing platforms, such as Amazon Mechanical Turk, has provided researchers with an alternative cost-effective and rapid way to collect data. However, the collection of fluid, natural spoken or textual interaction can be challenging, particularly between two crowd-sourced workers. In this study, we compare the performance of dialogue models for the same interaction task but collected in two different settings: in the lab vs. crowd-sourced. We find that fewer lab dialogues are needed to reach similar accuracy, less than half the amount of lab data as crowd-sourced data. We discuss the advantages and disadvantages of each data collection method.


In this paper, we present a large-scale study of repetitiveness of code changes in software evolution. We collected a large data set of 2,841 Java projects, with 1.7 billion source lines of code (SLOC) at the latest revisions, 1.8 million code change revisions (0.4 million fixes), 6.2 million changed files, and 2.5 billion changed SLOCs. A change is considered repeated within or cross-project if it matches another change having occurred in the history of the project or another project, respectively. We report the following important findings. First, repetitiveness of changes could be as high as 70-100% at small sizes and decreases exponentially as size increases. Second, repetitiveness is higher and more stable in the cross-project setting than in the within-project one. Third, fixing changes repeat similarly to general changes. Importantly, learning code changes and recommending them in software evolution is beneficial with accuracy for top-1 recommendation of over 30% and top-3 of nearly 35%. Repeated fixing changes could also be useful for automatic program repair.


This reference provides safety information on approximately 120 solvents in common usage. It takes account of the UK's new Chemical Hazards Information and Packaging (CHIP) Regulations, published August 1993, by using the required new datasheet format (which incorporates an ecotoxicity section) and including the new risk phrases for individual chemicals. The publication is indexed by chemical name and synonym. Every "safety sheet" provides the following information, in two facing pages: name; CAS registry number; synonyms; composition; hazard information; first aid measures; accidental release measures; handling and storage; exposure controls and personal protection; physical and chemical properties; stability and reactivity; toxicological information; ecological information; disposal considerations; transport information; and regulations. The sheets can be used to: identify hazards of chemicals in the work environment; follow essential first aid steps; identify precautions to be taken during use or disposal; find remedial action to be taken in case of accidental release; and gain knowledge of the ecological effects of specific chemicals.


An econometric geospatial benefit model for nontornadic thunderstorm wind casualty reduction is developed for meteorological radar network planning. Regression analyses on 22 years (1998–2019) of storm event and warning data show, likely for the first time, a clear dependence of nontornadic severe thunderstorm warning performance on radar coverage. Furthermore, nontornadic thunderstorm wind casualty rates are observed to be negatively correlated with better warning performance. In combination, these statistical relationships form the basis of a cost model that can be differenced between radar network configurations to generate geospatial benefit density maps. This model, applied to the current contiguous U.S. weather radar network, yields a benefit estimate of $207 million (M) yr−1 relative to no radar coverage at all. The remaining benefit pool with respect to enhanced radar coverage and scan update rate is about $36M yr−1. Aggregating these nontornadic thunderstorm wind results with estimates from earlier tornado and flash flood cost reduction models yields a total benefit of $1.12 billion yr−1 for the present-day radars and a remaining radar-based benefit pool of $778M yr−1.


"This book amounts to an intellectual autobiography...These pieces are thus a statement of what I have thought about early Americans during nearly seventy years in their company," writes historian Edmund S. Morgan in the introduction to this landmark collection. The Genuine Article gathers together twenty-five of Morgan's finest essays over forty years, commenting brilliantly on everything from Jamestown to James Madison. In revealing the private lives of "Those Sexy Puritans" and "The Price of Honor" on Southern plantations, The Genuine Article details the daily lives of early Americans, along with "The Great Political Fiction" that continues to this day. As one of our most celebrated historians, Morgan's characteristic insight and penetrating wisdom are not to be missed in this extraordinarily rich portrait of early America and its Founding Fathers.


Abstract. The Basque Country Mesonet measures more than 130 000 observations daily from its 85 Automatic Weather Stations (AWS). It becomes clear that automated software is an indispensable tool for quality assurance (QA) of this mesoscale surface observing network. This work describes a set of experimental semi-automatic quality control (QC) routines that is applied at Euskalmet data center. It has paid special attention to level validation design and associated flags, as well as to the system outputs, which are used by meteorologist and maintenance staff.


In this brief, a new coefficient relationship is proposed for the design of variable fractional-delay (VFD) finite-impulse response (FIR) filters by the weighted least-squares (WLS) method so that the number of filter coefficients to be designed can approximately be halved. To reduce the computational cost, closed-form expressions for the elements of related vectors and matrices are derived. Several design examples are presented, and the comparisons show that the overall performance of the proposed method is comparable with that of the conventional method; however, the number of filter coefficients to be designed for the proposed method is about half of that in the conventional method.


A game theoretic treatment is introduced to explore the role of nutrition of the gut bacterial microflora as a potential pro-biotic therapy. Rational design of functional foods and nutraceuticals has far reaching public health and therapeutic benefits. Understanding ecological dynamics and how phenotypic manipulations of microbe-microbe interactions of the gut microbiota can provide direct health benefit is currently a fundamental question in bioengineering and more widely in the food, diet and health industries. This work considers a hypothetical adjustment of the microbiome by introducing a transgenic bacterial species that contributes to increased exposure of omega 3 fats in the gut by converting them from the omega 6 fats, dominant in the Western diet. The ratio of the two fats circulating in blood are risk markers, indicators of metabolic syndrome and related conditions. In this work, we consider nutritional exposure to a pro-biotic, a live culture of transgenic bacteria contributing omega 3 fats from omega 6 in the diet. Maintaining a long-term co-existence between native (indigenous) and transgenic bacteria is a challenge. Game theory is the appropriate tool for handling this conflict. The long-term co-existence is guaranteed if the two strains engage in the Snowdrift game. Our game theoretic treatment provides the basis of a model mechanism for prophylactic nutritional therapy for metabolic syndrome by the transgenic bacteria, providing support of indigenous gut microbiota and additional supplementation of a pro-biotic.


A VOC monitoring was carried out inside and outside a multi-storey car park in order to characterize the emission profile of vehicular traffic source in an indoor environment. BTEX, and in particular toluene, were the most abundant compounds in all monitored sites, with different compositions between indoor parking areas and outdoor sites. The motor vehicle exhaust and gasoline vapor emission in these enclosed parking garages were characterized by diffusion or degradation phenomena different from those that occur in urban areas as the BTEX compositions, their ratios and their reactivity with OH and with NO3 radicals demonstrate. In detail, xylenes/BTEX and ethylbenzene/BTEX ratios in indoor environments were twice than those in outdoor ones, while toluene/BTEX ratio resulted half than that obtained in outdoor sites. In this work, BTEX concentrations depend both on number of vehicles, on vehicular characteristics (age, emission control technology, fuel quality etc.) and on factors related to the characteristics of parking facilities (volume of the monitored areas, indoor or open facilities, ventilation systems, size and maintenance). However, it was found that the external contribution (intrusion of pollutants from outdoor and from the other floors) and the influence of mixing air (removal of pollutants by ventilation and air exchange) on BTEX concentrations were not significant if inside the multi-storey car park there was a strong source (due to the number of vehicles) such happened in the first and second floors and along the ramp that connected them.


Fault identification and location in optical networks is hampered by a multitude of factors: the redundancy and the lack of coordination (internetworking) of the managements at the different layers (WDM, SDH/SONET, ATM, IP); the large number of alarms a single failure can trigger; the difficulty in detecting some failures; and the resulting need to cope with missing or false alarms. Moreover, the problem of multiple fault location is NP-complete, so that the processing time may become an issue for large meshed optical networks. We propose an algorithm for locating multiple failures at the physical layer of a WDM network. They can be either hard failures, that is, unexpected events that suddenly interrupt the established channels; or soft failures, that is, events that progressively degrade the quality of transmission; or both, hard failures are detected at the WDM layer. Soft failures can sometimes be detected at the optical layer if proper testing equipment is deployed, but often require performance monitoring at a higher layer (SDH, ATM, or IP). Both types of failures, and both types of error monitoring, are incorporated in our algorithm, which is based on a classification and abstraction of the components of the optical layer and of the upper layer. Our algorithm does not rely on timestamps nor on failure probabilities, which are difficult to estimate and to use in practice. Moreover, our algorithm also handles missing and false alarms. The nonpolynomial computational complexity of the problem is pushed ahead into a precomputational phase, which is done off-line, when the optical channels are set up or cleared down. This results in fast on-line location of the failing components upon reception of the ringing alarms.


In this paper, I investigate the theoretical status of noun phrases without nouns, i.e. noun phrases that do not contain a noun or pronoun, but only words that otherwise occur as modifiers of nouns. I investigate six possible analyses for such noun phrases: (1) that they are elliptical, (2) that the apparent modifiers are nouns, (3) that the apparent modifiers are heads, (4) that the determiner is the head, (5) that they are headless, (6) that all noun phrases are headless. Although the answers vary depending on the language investigated, I argue that the last hypothesis is generally the most plausible one.


Our aim was to compare the biomechanical properties of suturing methods to determine a better method for the repair of lacerated skeletal muscle. We tested Kessler stitches and the combination of Mason-Allen and perimeter stitches. Individual stitches were placed in the muscle belly of quadriceps femoris from a pig cadaver and were tensioned mechanically. The maximum loads and strains were measured and failure modes recorded. The mean load and strain for the Kessler stitches were significantly less than those for combination stitches. All five Kessler stitches tore out longitudinally from the muscle. All five combination stitches did not fail but successfully elongated. Our study has shown that the better method of repair for suturing muscle is the use of combination stitches.


Gypsum crystals 0.5-3.5 m loong occurring in the Middle Miocene (Badenian) gypsum deposits in the birthern margin of the Carpathian Foredeep, are the largest mineral crystals in Poland, and represent some of the largeest natural crystals in Europe. The crystals spectacular giant intergrowth in similar to the contact 'swallow-tail' {101} twins known form other Cenozoic deposits. The intergrowths are arranged in a palisade manner and occur in a distinct stratigraphic horizon, several metres thick, that is traceable for a distance of approximately 500 km from the Czech Republic in the west to the western Ukraine in the east. In Poland its best exposures are near Busko in the Nida river valley, south of the Holy Cross Mountains, where countless gypsum crystals are 1-1.5 m in length specimens larger than 2.5 m are rare, and only one crystal approaching 3.5 m of length has been documented. This unique specimen, exposed at Bogucice-Skalki, is the largest known mineral crystal in Poland.


This paper presents a fully integrated application specific integrated circuit (ASIC) sensor for the recording of multiple bio-electric signals. It consists of an analog front-end circuit with tunable bandwidth and programmable gain, a 6-input 8-bit successive approximation register analog to digital converter (SAR ADC), and a reconfigurable digital core. The ASIC is fabricated in a 0.18-μm 1P6M CMOS technology, occupies an area of 1.5 × 3.0 mm2, and totally consumes a current of 16.7 μA from a 1.2 V supply. Incorporated with the ASIC, an Intelligent Electrode can be dynamically configured for on-site measurement of different bio-signals. A 2-wire data transmission protocol is also integrated on chip. It enables the serial connection over a group of Intelligent Electrodes, thus minimizes the number of connecting cables. A wearable healthcare system is built upon a printed Active Cable and a scalable number of Intelligent Electrodes. The system allows synchronous processing of maximum 14-channel bio-signals. The ASIC performance has been successfully verified in in-vivo bio-electric recording experiments.


It is pointed out that in ferromagnetic metals a contribution to the Hall voltage arises when a nonzero spin current exists, which is generally the case in the presence of a charge current. This contribution is independent of any scattering effects and exists down to zero temperature. The sign of the resulting Hall coefficient may be either equal or opposite to the one of the ordinary Hall coefficient depending on the band filling. This effect seems to have been left out in previous analyses of the Hall effect in ferromagnetic metals.


Intra-species variation in specific leaf area (SLA) and leaf area (LA) provides mechanistic insight into the persistence and function of plants, including their likely success under climate change and their suitability for revegetation. We measured SLA and LA in 101 Australian populations of the perennial shrub Dodonaea viscosa (L.) Jacq. subsp. angustissima (narrow-leaf hop-bush) (Sapindaceae). Populations were located across about a 1000 km north–south gradient, with climate grading from arid desert to mesic Mediterranean. We also measured leaves from 11 populations across an elevational gradient (300–800 m asl), where aridity and temperature decrease with elevation. We used regression and principal component analyses to relate leaf traits to the abiotic environment. SLA displayed clinal variation, increasing from north to south and correlated with latitude and the first principal component of joint environmental variables. Both SLA and LA correlated positively with most climatic and edaphic variables. Across latitude, LA showed more variability than SLA. Changes in leaf density and thickness may have caused the relative stability of SLA. Only LA decreased with elevation. The absence of a SLA response to elevation could be a consequence of abiotic conditions that favour low SLA at both ends of the elevational gradient. We demonstrated that the widely distributed narrow-leaf hop-bush shows considerable variability in LA and SLA, which allows it to persist in a broad environmental envelope. As this shrub is widely used for revegetation in Australia, South America and the Asia-Pacific region, our results are consistent with the notion that seed used to revegetate mesic environments could be sourced from more arid areas to increase seed suitability to future climate change.


BACKGROUND
Gastrooesophageal reflux disease is a common disorder, its most significant pathophysiological mechanism being a dysfunction of the lower oesophageal sphincter.

MATERIALS AND METHODS
On the basis of our own experience and relevant literature, we present a novel method of treating this disease by means of strengthening the lower oesophageal sphincter by endoscopic suture.

RESULTS AND INTERPRETATION
The commercially available Bard EndoCinch endosuture device was attached to a normal gastroscope and was used to fasten a Prolene thread in a fold of the gastric mucosa approximately one centimetre below the lower oesophageal sphincter. By tying two mucosal folds together, a plication was obtained. Usually, two or three complications were made. The procedure was performed on patients only mildly sedated and typically took 20 to 40 minutes. The method is suitable for patients with moderate or severe reflux disease with hiatal hernias less than 3 cm and may be an alternative to continuous proton pump inhibitor treatment or fundoplication. Contraindications are few, and complications limited. Controlled studies or treatment protocols should be initiated.