Background: eHealth, a communication and information technology to improve and healthcare, is lagging within the forensic mental healthcare (forensische geestelijke gezondheidszorg, fggz). The fggz is psychiatric care that focuses on transgressive behaviour. The use of eHealth can be increased if the implementation runs smoothly, this happens when the therapist-related, patient-related, contextual and technological factors are taken into account. Little research has been done on the influence of the patient-related factors on the use and implementation of eHealth within the fggz. This research will therefore focus (especially) on these factors. This research will be conducted within the institution Tender of the organization Transfore, which is an instituation that offers ambulant fggz care. Within this organisation the eHealth intervention, Minddistrict, is used.
Method: The study was conducted among all therapists (n = 20) who worked at the Tender. They have been approached by their team leader. The therapists were screened, based on the inclusion criteria. The inclusion criteria were that the therapists treated fggz patients and that they were trained in the use of Minddistrict. The interviews were based on the non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework. Afterwards, the interviews were inductively coded.
Results: Obstructing and stimulating patient-related factors for the use and implementation of eHealth have been found, based on the interviews with the therapists. The obstructive patient factors that emerged were for example, that the therapist did not want to introduce the online treatment program, as they thought that patients did not have the proper abilities to be able to use the online treatment. A related stimulating factor was the ability to work independently at home, because the patient could organize his or her own time. Furthermore, the technology turned out to obstruct the use of the online treatment if the level of the online treatment did not match the skills of the patient. The technology also stimulated the use of eHealth because the technology could add structure to the face-to-face treatment. Lastly, the context of the patients turned out to obstruct the use of eHealth, because of the private barriers of the patients. An example of a private barrier is the absence of rest in the patient's life. In this case the patient would not be able to focus on the treatment. A stimulating contextual factor was the possibility to involve family members in the online treatment.
Discussion: The results show that the main cause for the lagging in the use and the implementation of the online treatment program, is the lack of personalization possibilities of the online treatment program. This causes that the online treatment does not fully connect with the patients. However, there are also barriers that can be attributed to patients who may rely on the estimation of the therapists rather than on their experience, for example the influence of the private barriers of patients. This makes it important to conduct research with patients, for example with interviews, in which patients can give their opinions on the obstructing and stimulating patient-related factors for the use and the implementation of eHealth.


More than 15 million individuals suffer ischemic stroke each year. High levels of serpinf2 (Sf2, a2-plasmin inhibitor, a2-antiplasmin) have been identified as a potential risk factor for human ischemic stroke.

 Methods:
 We examined the integrated effects of sf2 in a thromboembolic MCA stroke model with translational relevance to human disease. Using a blinded observer, neuronal cell death was quantified by TTC staining; hemorrhage and brain swelling were determined by planimetry. Immunohistochemistry was used to assess apoptosis, matrix metalloproteinase 9 expression and breakdown of the blood brain barrier.

 Results:
 Increasing the levels of sf2 caused larger infarctions by comparison to control mice (51% larger, p<0.002). Sf2 administration also markedly worsened brain swelling (p<0.05) but it did not cause hemorrhage. Conversely, when mice were given an sf2 inactivator (sf2-i), it markedly reduced stroke infarct size (95%) by comparison to control (p<0.001) and TPA-treated mice (p<0.001). Treatment of mice with an sf2-I also markedly reduced mortality rates by comparison to TPA-treated mice (p<0.0005) or control mice (p<0.004). The survival effect was dose-dependent: lower doses of the sf2-I were less effective than higher doses (p≤ 0.05) but still reduced mortality by comparison to control and TPA (p≤ 0.01). Microscopic examination of the brains of mice surviving the initial stroke period (> 12 hrs.) showed that sf2-i reduced stroke infarct size by comparison to control mice or TPA treated mice (p<0.001). There was less hemorrhage in sf2-i treated mice than occurred in control mice (p<0.001) or than in those receiving TPA (p<0.01). Inactivation of sf2 markedly reduced brain swelling by comparison to controls (p<0.001) and TPA-treated mice (p<0.05). Sf2-i treated mice showed no significant disability in Rotarod behavioral testing when compared to sham mice without strokes.

 Conclusions:
 Sf2 significantly enhances brain injury in ischemic stroke. Since inactivation of Sf2 prevents disability, hemorrhage and death it may prove to be a safe and effective strategy for treating acute ischemic stroke.


The purpose of this study was to determine the underwriting challenges facing PSV insurance in Kenya. This was in view of the literature review indicating that many PSV insurers had collapsed while others faced imminent collapse. Many general insurers were also reported to be avoiding PSV insurance particularly for 'matatus'. Whereas a lot of studies had been carried out on PSV sector, no specific study examined the underwriting challenges facing PSV insurance in Kenya. The objectives of the study were; to establish the approaches used in underwriting PSV insurance in Kenya and to identify the underwriting challenges facing PSV insurance in Kenya. The literature review covered the basic principles of insurance as they relate to motor insurance, the concept of underwriting as it relates to PSV insurance, regulation of PSV in Kenya and the role of information technology in insurance as presented by various researches, scholars, analysts and authors. The study adopted a cross sectional research design with a population of thirty six (36) general insurance companies underwriting motor insurance. Primary data was collected by use of a questionnaire having structured and open ended questions. Descriptive statistics consisting of frequencies, percentages, arithmetic mean and standard deviation were used. Data was presented by use of tables, bar charts and pie charts. The study concluded that most insurance companies wrote both individual and fleet PSV risks and very few were using accommodation of non-motor business in underwriting PSV risks. Many of the insurance companies that avoided PSV risks attributed this to company policy. The key factors in underwriting PSV risks were vehicle carrying capacity, use of the vehicle and the type of cover. The main contributor to PSV underwriting problems was cited as moral hazard. The key problems in underwriting PSV risks were weak enforcement of traffic laws, lack of industry integrated motor insurance data system, fraudulent claims, weaknesses in regulatory framework and generous judicial awards. Charging of uneconomic premium rates was attributed to stiff competition and undercutting within the industry. The main contributors to fraudulent


OBJECTIVE
The purpose of this study was to evaluate if narrowing and approximation of the alveolar cleft through presurgical alveolar molding followed by gingivoperiosteoplasty (GPP) at the time of lip repair reduces the need for a bone-grafting procedure.

DESIGN
This was a retrospective blind study of patients with unilateral or bilateral alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon. Alveolar bone formation was assessed prior to the eruption of the maxillary lateral incisor or canine by clinical examination, panoramic and periapical radiographs, and/or a dental CT scan. The criterion for bone grafting was inadequate bone stock to permit the eruption and maintenance of the permanent dentition.

SETTING
This study was performed at the Institute of Reconstructive Plastic Surgery by the members of the Cleft Palate Team.

PATIENTS
All patients with unilateral (n = 16) or bilateral (n = 2) alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon from 1985 to 1988 were studied. The control population consisted of all alveolar cleft patients (n = 14) who did not undergo alveolar modeling or GPP during the same time period.

INTERVENTIONS
Presurgical alveolar modeling was performed with an intraoral acrylic molding plate. This plate was modified on a weekly basis to align the alveolar segments and close the alveolar gap. The surgical intervention consisted of a modified Millard GPP.

MAIN OUTCOME MEASURES
The primary study outcome measure was the elimination of the need for a secondary bone graft in patients who underwent presurgical alveolar molding and GPP.

RESULTS
Of the 20 sites in the 18 patients who underwent GPP, 12 sites did not require an alveolar bone graft. Of the 8 sites requiring a bone graft, 4 presented minimal bony defects. All 14 patients in the control group required bone grafts.

CONCLUSIONS
In this series of 20 alveolar cleft sites treated with presurgical orthopedics and GPP, 60% did not need a secondary alveolar bone graft in the mixed dentition.


This paper empirically examines the extent to which loyalty program attributes explain variations in satisfaction with the retail offer. Two dimensions of loyalty program attributes are introduced including hard attributes and soft attributes. Store satisfaction is examined in terms of the elements of the retail offer. The results suggest that emphasis on hard and soft attributes enhance customer satisfaction with a retailers' merchandise, trading format, customer service and customer communication. Additionally, hard attributes have a more significant influence than soft attributes on satisfaction with all elements of the retail offer excluding merchandise.


Achieving sufficient connectivity between populations is essential for persistence, but costs of dispersal may select against individual traits or behaviours that, if present, would improve connectivity. Existing dispersal models tend to ignore the multitude of risks to individuals: while many assess the effect of mortality costs, there is also a risk of failing to find new habitat, especially when the entire inhabitable area remains both small and fragmented. There are few known rules governing whether individuals evolve to disperse more, or less, than what is ideal for population connectivity and persistence. Here we aim to fill this gap, while also noting that evolution might not only produce suboptimal dispersal behaviour: it also influences individual heterogeneity in dispersal. Intuitively, we might expect heterogeneity to improve connectivity, as some individuals will travel far. However, we show that this is only true if dispersal distances on average are quite short; heterogeneity can also lead to reduced connectivity because it can reduce the proportion of the most profitable ('safest') intermediate dispersal distances. In general, our results show that conditions typically associated with conservation concerns (small and fragmented habitats inhabited by a species with a low birth rate) are also ones that are most likely to lead to suboptimal dispersal traits. This prompts the question of assisted dispersal in cases of urgent conservation concern.


Mast cells (MCs) accumulate in a broad range of tumors, including melanomas. While MCs are potent initiators of immunity in infection, and in allergic inflammation, the function of MCs in anti-melanoma immunity is unclear. MCs have the potential to release tumoricidal cytokines and proteases, to activate antigen-presenting cells and to promote anti-tumor adaptive immunity. However, within the immunosuppressive tumor microenvironment (TME), MC activation may promote angiogenesis and contribute to tumor growth. In this review, the relationship between MCs and melanomas is discussed with a focus on the impact of the TME on MC activation.


Compensation systems, such as individualized pay-for-performance (I-PFP) schemes for employees, represent an important approach to aligning employer-employee interests. However, the adoption of I-PFP is much less common in many countries than in the United States. Employing a multilevel analysis of over 4,000 firms in 26 countries, we explore determinants of its adoption. At the country level, we distinguish between cultural and institutional (labor regulation institutions) influences. At the firm level, we distinguish firms that view human resources as strategically important and firms that are foreign owned. On the one hand, our findings indicate that both cultural and institutional effects at the country level significantly influence the adoption of I-PFP. On the other hand, senior managers' agency counts. We find the effect of labor regulation on I-PFP to be mediated by its effects on labor union influence, and we find the effects of culture on I-PFP to be entirely mediated by labor regulation and (country-level) union influence.


Background Food insecurity, occupation, and poverty contribute to the poor nutritional status of Palestine. This review study aimed to analyze the nutritional status in the Palestinian Territory by analyzing published data from 2011 to 2023. Method Searching for relevant publications yielded 67 studies. Based on reviewing these studies, five major themes were identified: low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Results Based on the review of these studies, five major themes were identified, namely, low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Based on the literature, the prevalence rate of exclusive breastfeeding was 24.4% in the Gaza Strip, compared to a national rate of 39.9% in 2020. Smoking, anemia in mothers, diet during pregnancy, and indoor pollution were associated with low birth weight. One-fifth of the boys and girls were stunted by 2 years of age in the Gaza Strip, and girls were more stunted than boys. The prevalence rates of underweight, overweight, and obesity among school children in the West Bank were 7.3%, 14.5%, and 15.7%, respectively. Age, gender, and living area were significant predictors of being overweight among school children. The prevalence rates of overweight and obesity among adults in Palestine were 57.8% and 26.8%, respectively. Obesity is associated with a family history, chronic diseases, and low physical activity among adults. Exclusive breastfeeding was below the WHO recommendations, while significant rates of obesity and overweight were found among children and adults. Iron-deficiency anemia (IDA) among pregnant women and children remains a challenging public health issue, while other micronutrient deficiencies are high among children. Conclusion This review emphasizes the need for multi-sectoral interventions to address malnutrition and nutritional shifts. It identifies gaps and addresses nutrition-related issues in the Palestinian Territory, which can serve as a basis for guiding United Nations agencies and governments in formulating evidence-based policies and strategies for prioritizing nutritional interventions to meet sustainable development goals.


A high-purity Al alloy and a supersaturated Al-0.3wt.% Sc alloy were accumulative roll bonded (ARB) at 200 °C to generate 0.5 mm gauge sheet consisting of 32 alternating layers of Al and Al(Sc). The material was subsequently annealed for 6h at 350 °C. The deformation and annealed microstructures were investigated using transmission electron microscopy (TEM) and electron backscatter diffraction (EBSD). The deformation microstructure composed primarily of lamellar bands of unequal fineness with shear bands and deformation bands being additional substructural features in the Al(Sc) layers. The high strain deformation generated Al layers containing lamellar boundaries separated by a large fraction of high angle grain boundaries, thereby creating the ideal microstructure for continuous recrystallization. Annealing of the as-deformed material generated a hybrid microstructure consisting of alternating layers consisting of ~20 0m grains produced by continuous recrystallization (Al layers) and a lightly recovered substructure (Al(Sc) layers); the latter were highly resistant to recrystallization due to precipitation of nanosized Al3Sc particles during annealing.


There are notable examples of online search improving over hand-coded or learned policies (e.g. AlphaZero) for sequential decision making. It is not clear, however, whether or not policy improvement is guaranteed for many of these approaches, even when given a perfect leaf evaluation function and transition model. Indeed, simple counterexamples show that seemingly reasonable online search procedures can hurt performance compared to the original policy. To address this issue, we introduce the choice function framework for analyzing online search procedures for policy improvement. A choice function specifies the actions to be considered at every node of a search tree, with all other actions being pruned. Our main contribution is to give sufficient conditions for stationary and non-stationary choice functions to guarantee that the value achieved by online search is no worse than the original policy. In addition, we describe a general parametric class of choice functions that satisfy those conditions and present an illustrative use case of the empirical utility of the framework.


The Industrial Design Engineering bachelor studies of the University of Twente are concluded by an individual assignment given by and preferably executed in a company.
The furniture company PT. Indovickers Furnitama in Jakarta, Indonesia, kindly granted the assignment of the design of a new executive desk.
In this report, this company is introduced by describing its profile.
At the end of August 2006, the assignment is started in the company in Jakarta.
The research phase starts with the product analysis, including the documenting of materials and production techniques.
The President – Director and the employees of the Market Division are interviewed, to determine the target group, cost demands, wishes and demands of these users.
The outcome of the questionnaires provides information about the trends and developments in the Indonesian furniture market.
Every user wants to work comfortably behind his desk and therefore the ergonomic aspects are analysed.
All of the information of the analysis is gathered, helped to determine a direction for the design.
The concept generation uses this direction and specification. This concept generation has two partitions: the orientation phase and, after the feedback of the R&D Team, the second phase.
These phases lead to two different concepts: the classical desk and the modern desk.
At the final presentation in Jakarta, these two concepts are presented to the President-Director, R&D Team and manager, and a couple of employees from the Market Division.
They give feedback and they choose the second concept, the modern designed desk, which becomes the definitive concept.
After the stay of two months in Jakarta, the work of the assignment is finished in the Netherlands.
The final concept is specified and a SolidWorks model is produced.
This SolidWorks model is used to get advice from a researcher of aluminium extrusion profiles and lecturers.
The desk has a tabletop from hardened glass. Force calculations are executed to check the strength of this tabletop and the construction.
The production costs and the selling price of the executive desk are calculated and these calculations give a good indication of the sale potential in the market.
The research in this assignment provides conclusions and recommendations, which can be used for the development of a new executive desk series.


The laws of comparison of dynamically similar fluid motions are derived by three different methods based on the same principle and yielding the same or equivalent formulas. This report outlines the three current methods of comparing dynamically similar motions, more especially of fluids, initiated respectively by Newton, Stokes (or Helmholtz), and Rayleigh. These three methods, viz., the integral, the differential, and the dimensional, are enough alike to be studied profitably together. They are treated in succession then compared. (author)


Title Insight into the Beijing genotype Mycobacterium tuberculosis clinical isolates in Myanmar [an abstract of dissertation and a summary of dissertation review] Author(s) Lai Lai San Citation 北海道大学. 博士(獣医学) 甲第13297号 Issue Date 2018-09-25 Doc URL http://hdl.handle.net/2115/72052 Rights(URL) https://creativecommons.org/licenses/by-nc-sa/4.0/ Type theses (doctoral abstract and summary of review) Additional Information There are other files related to this item in HUSCAP. Check the above URL. File Information Lai_Lai_San_abstract.pdf (論文内容の要旨)


The bond orientational correlation function (BCF) of a semiflexible ring polymer on a flat surface is studied theoretically. For a stiff chain, we give an exact analytic form of BCF with perturbation calculations. For a chain sufficiently longer than its persistence length, the conventional exponential decay vanishes and a long-range order along the chain contour appears. We demonstrate that the bond orientational correlation satisfies the scaling properties, and construct an interpolating formula for its universal curve that encompasses the short- and large-distance behaviors. Our analytical findings are confirmed by extensive Langevin dynamics simulations, and are in excellent agreement with recent experimental data obtained from DNA molecules imaged by atomic force microscopy without any fitting parameters.


Introduction: Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, is authorized for the treatment of chronic lymphocytic leukemia (CLL). This study aims to explore the cardiac safety profile of ibrutinib in comparison with obinutuzumab. Methods: A retrospective pharmacovigilance study was conducted on data retrieved from the European pharmacovigilance database (Eudravigilance) from 1 January 2014 to 30 September 2022. To compare the reporting frequency of cardiovascular events among ibrutinib, obinutuzumab, and the combination of both. Results: A total of 2 291 CV cases were retrieved, of which 1965 were related to ibrutinib, 312 to obinutuzumab, and 14 to the combination. Most cases referred to patients aged ≥65 years (N = 1,454; 63.47%) and male (N = 1,497; 65.34%). Most cases were serious (N = 2,131; 93.02%). The most reported events were: atrial fibrillation (N = 913; 31.31%) and haemorrhage (N = 201; 6.89%). A higher reporting frequency of CV events was found when ibrutinib was compared to obinutuzumab (ROR, 3.22; 95% CI, 2.89-3.60) or combination (ROR, 1.77; 95% CI, 1.11-2.83). A lower reporting was observed when obinutuzumab was compared to combination (ROR, 0.55; 95% CI, 0.34-0.88). Discussion: A higher reporting frequency of CV events in patients exposed to ibrutinib in comparison with obinutuzumab was found. Further studies are needed to better explore the safety of ibrutinib.


In August 1995, the first case of porcine dermatitis and nephropathy syndrome was diagnosed in the north-eastern part of Spain; the pig showed characteristic dermal and renal lesions. Between then and January 1996, nine further animals from five different herds were diagnosed; they showed signs of anorexia, depression and, sometimes, pyrexia. Diarrhoea, Glässer's disease, conjunctivitis and gastric ulcers also occurred on the farms where the diagnoses were made. The affected pigs died of renal failure with diffuse fibrinous glomerulonephritis and a systemic necrotising vasculitis. Chronic interstitial nephritis, glomerulosclerosis and scar-like marks on the skin were observed in chronic cases. Other common findings in both acute and chronic cases were a diffuse depletion of lymph node lymphocytes with infiltration by syncytial cells (50 per cent of cases) and interstitial pneumonia. All the animals tested positive for porcine reproductive and respiratory syndrome virus (PRRSV) by serological tests and virus isolation. Serum urea and creatinine concentrations were above normal in the acutely affected animals. The pathogenesis of the condition is unknown but the lesions and immunopathological observations by other authors suggest that a type III hypersensitivity is a possible aetiology. The occurrence of PRRSV in these pigs suggests that the virus might be implicated in the pathogenesis of porcine dermatitis and nephropathy syndrome.


Two brothers diagnosed with ectodermal dysplasia were treated for 5 years during their mixed-dentition periods for problems arising from absence of teeth (oligodontia) and abnormally formed teeth. An individualized approach to restorative and prosthodontic management allowed dynamic and evolving treatment attuned to their concern about their appearance.


Hospitals are under pressure to improve overall quality and operate more economically. Against that background, this design research project aims at optimizing discharge management outcomes by means of improved patient pathways at a gynaecological clinic of a large hospital. Referring to organizational science research that reveals a relevance gap for practice that could be met by prescriptive design research applied as a mode of organizational research, the project investigates how an understanding of patient journeys yield evidence by means of actionable knowledge, and how it be represented and integrated with that of the involved hospital professionals. To that end, the research team conducted in-depth ethnographic research, resulting in various issues along the patient journey, including associated current and potential solutions and new solution ideas. A co-design workshop with hospital staff and patients revealed additional design propositions towards an optimized version of a patient process with regard to satisfaction and quality. The issues point to areas for optimization in the larger systemic context defined by the patient journey. The findings from the co-design workshop indicate that local staff can indeed be enabled to contribute to cross-disciplinary ideation activities. The research contributes to an understanding of design-research-based evidence generation in the hospital context.


ISSN 2463-2872 (Print) ISSN 2463-2880 (Online) Abstract This experiment investigated the effects of Caucasian clover (CC), white clover (WC), perennial ryegrass (RG) and their mixtures on dry matter (DM) yield under dryland and irrigated conditions over 5 years (1st July-30th June) at Lincoln University. Seven mixtures of the three species (three pure, three binary and one ternary) were sown in November 1999, grown with and without irrigation, and grazed by sheep. Total annual DM yield in Years 2-6 (2000/2001-2004/2005) was analysed. Clover-RG mixtures yielded more than the average monoculture yields of their constituent species (over-yielding). This diversity effect was 1.8-7.0 t DM/ha for WC-RG over all 5 years and 2.7-4.6 t DM/ ha for CC-RG in Years 3-6. There was no additional yield benefit from the three-species mixture. Diversity effects were due to synergistic interactions between the clovers and RG, which were similar for CC and WC once established. The interspecific interactions persisted despite changes in botanical composition across irrigation levels and years.


Users issue queries to Search Engines, and try to find the desired information in the results produced. They repeat this process if their information need is not met at the first place. It is crucial to identify the important words in a query that depict the actual information need of the user and will determine the course of a search session. To this end, we propose a sequence-to-sequence based neural architecture that leverages the set of past queries issued by users, and results that were explored by them. Firstly, we employ our model for predicting the words in the current query that are important and would be retained in the next query. Additionally, as a downstream application of our model, we evaluate it on the widely popular task of next query suggestion. We show that our intuitive strategy of capturing information need can yield superior performance at these tasks on two large real-world search log datasets.


INTRODUCTION
The present study was designed to investigate the effect of Essentiale L, a mixture of polyenylphospholipids from soybeans, on oxidative stress in various brain regions, on erythrocytes (RBC) and on RBC membrane composition in ethanol-administered rats.

METHODS
Adult male albino rats of body weight 150-170 g were divided into four groups and administered either isocaloric glucose (5 g/kg body weight/day) or ethanol (6 g/kg body weight/day) through oral gavage. Essentiale L was administered to a set of ethanol-fed rats and the control rats at a dosage of 300 mg/kg body weight/day through oral gavage. The treatment protocol was carried out for 45 days. At the end of the experimental period, the animals were sacrificed, and the biochemical parameters related to the lipid profile, oxidative stress and thiol status were assayed in the brain regions, RBC and RBC membrane.

RESULTS
Ethanol administration resulted in increased levels of lipid peroxidation products in RBC and different brain regions, such as the cortex, cerebellum, striatum, hippocampus and hypothalamus, and depletion of enzymatic and nonenzymatic antioxidants and alterations in oxidised glutathione/glutathione (GSSG/GSH) ratio and thiol groups (protein-bound and total), signifying oxidative stress. Ethanol-treated rats also showed significant alterations in protein content and lipid composition in RBC membranes. Significant differences in the relative proportions of hexose, hexosamine and sialic acid of the membranes were observed. Administration of Essentiale L prevented all the alterations induced by ethanol and returned their levels to near-normal.

CONCLUSION
These findings suggest that Essentiale L, a therapeutic adjunct for liver diseases, also has bioprotective effects on nonhepatic tissues and cells.


In the scramble for the understanding of the nature of dark matter and dark energy, it has recently been suggested that the change of behavior of the missing energy density might be regulated by the change in the equation of state of the background fluid. The Chaplygin Gas (CG) model in cosmology is one of the most profound candidates for this suggestion. This work aims to bring to light a geometric interpretation of the model by re-writing the difierent toy models in terms of exact f(R) gravity solutions that are generally quadratic in the Ricci scalar with appropriate ΛCDM limiting solutions.


Rapid multiplication of turmeric (Curcuma longa) by micropropagation is needed to produce a continuous source of uniformly sized, high-quality, and disease-free plantlets. Three in vitro experiments were conducted to optimize the medium by evaluating nine media and a full factorial combination (matrix) of two plant growth regulators for direct organogenesis of 'Hawaiian Red' turmeric. Two experiments evaluated the media, and the third studied the plant growth regulator matrix. As a result, Driver and Kuniyuki walnut (DKW), Murashige and Skoog (MS), and broadleaf tree basal (BLT) media performed better than woody plant media [Lloyd & McCown woody plant basal medium (L&M), and McCown's woody plant basal salt mixture (McCown)] for shoot and root formation. The multiplication rate was 18 plants per explant in DKW with 1 mg⋅L−1 6-benzylaminopurine (BAP) and 0.1 mg⋅L−1 1-naphthaleneacetic acid (NAA). After transferring the plants to an ex vitro environment, the survival rate was 97%, and 30% higher than previously reported. DKW produced the highest number of plantlets (with shoots and roots), and BLT produced fewer plants with higher biomass. In the MS media, higher BAP to NAA ratio (2.5 to 0.1 mg⋅L−1) produced the most significant number of shoots; however, the lowest concentration of BAP and NAA (0.1 mg⋅L−1 of both) produced the highest number of rooted plantlets. There are two recommendations for tissue culture of 'Hawaiian Red' turmeric. To produce the highest number of plantlets, one should use the higher BAP to NAA ratio (2.5 mg⋅L−1 BAP and 0.1 mg⋅L−1 NAA) for shoot proliferation and then transfer the explants to the root initiation media. However, to reduce the number of subcultures, the explants can be grown in the lowest concentration of both BAP and NAA (0.1 mg⋅L−1) to induce both shoot and root. Although, the number of plantlets (with roots and shoots) will decrease in this method, there is no need for subsequent subcultures and changing of the plant growth regulator combinations.


Background: For several years adaptive designs became more and more popular in the pharmaceutical industry and in particular much attention was brought on adaptive seamless designs. Those designs combine the phase II dose finding trial and the phase III confirmatory trial in a single protocol (with a fixed total sample size). The objective of this paper is to propose some utility-based tools to optimize those designs: first in terms of ratio between phase II and phase III sample sizes, and, second, in patient allocation to doses at the beginning of phase II.
Methods: Design optimization methods are generally based either on Fisher information matrix (D-optimality) or on the variance of some statistics of interest (C-optimality). Instead, we propose to define utility functions associated to sponsors' decision related to choice of dose for the phase III and we propose design optimization metrics based on the expected value of this utility.
Results and Conclusions: After reviewing and discussing several kinds of utility functions, we focused on two of them, that we have assessed through simulations. We concluded that in most of the scenarios simulated, the expected utility was in a sense more sensitive to the timing of the interim analysis (ratio between phase II over total sample size) than on the patients allocation between the doses. This result points out the fact that it might be necessary to enroll a larger number of patients in phase II to allow an accurate identification of the optimal dose.


The abandonment of villages in Northwestern Europe between 1200 and 1400 AD is a much-studied subject. Little is known about the presence of this phenomenon after 1500 AD. In the historic County of Holland (more or less the western part of the Netherlands) evaluation of an old taxation document from 1514 showed that 7,5% of the villages and 15% of the hamlets present in 1514 had disappeared by 2018. Main reason is the slowly rising North Sea. Another cause is the destructive peat industry, which caused a steady and dangerous enlargement of inland lakes. The research also showed that smaller and economically weaker settlements have a higher chance to be left deserted. Cities, and traditional agricultural villages not close to the sea or big lakes, were practically immune to permanent abandonment in the last 500 years.


The Evaluation Office of UN Environment commissioned in 2015 an evaluation study of the Strategic Cooperation Agreements (SCAs) between the European Commission (EC) and UNEP. The SCAs fall under the Thematic Programme for Environment and Sustainable Management of Natural Resources, including Energy (ENRTP) of the European Union (EU) Development Cooperation Instrument (DCI). The evaluation aims to answer the question whether the SCA approach developed under the ENRTP provides an effective way of conducting EC-UNEP programmatic cooperation.


The main purpose of this dissertation is to describe how terminally ill patients experienced their situation, and what their views about the future were. Further, the experiences and attitudes of relatives of such patients, and of health care professionals, were also central. Focus was on existential issues, such as autonomy, meaning, guilt, relations, dignity, and communication. In the first paper, a case based on actual facts was described and analysed. The study showed that in every situation where a decision has to be made, there is often more than one alternative interpretation of the situation and how to act. The studies in the other papers comprised 18 patients in palliative care (diagnosed with advanced cancer and ALS) and 8 close relatives of ALS patients. Moreover, 7 caregivers, formal and informal, were interviewed in a focus group. Data were collected from in-depth interviews with patients and relatives and from focus group interviews with caregivers. The results showed that patients experienced a number of problems concerning existential issues and consider these questions important. The patients diagnosed with cancer wished to be able to discuss existential issues with someone. The ALS patients experienced problems particularly in connection with physical inability. Close relatives of ALS patients need more information about the disease and the process of the disease and have to be supported and viewed as individuals with their own preferences. One practical question is: Who's responsibility is it to try to meet existential needs in palliative care? The results of the focus group study indicate that, depending on the circumstances, several different solutions can be sufficiently satisfactory, and possible ways of handling the problems are suggested. (Less)


Microarrays allow biologists to better understand the interactions between diverse pathologic states at the gene level. However, the amount of data generated by these tools becomes problematic. New techniques are then needed in order to extract valuable information about gene activity in sensitive processes like tumor cells proliferation and metastasi s activity. Recent tools that analyze microarray expression data have exploited correlation-based approach such as clustering analysis. Here wed scribe a novel GA/ANN distributed approach for assessing the importance of genes for sample classification based on expression data. Several different approaches have been exploited and a comparison has been given. The developed system was employed in the classification of ER+/- metastasis recurrence of breast cancer tumors and results were validated using a real life database. Further validation has been carried out using Gene Ontology based tools. Results proved the valuable potentialities and robustness of similar systems.


Cognitive control exertion leads to mental fatigue and has been shown to impart negative effects on subsequent physical performance. Although the mechanisms underlying these effects are not well understood, previous research suggests mental fatigue causes neuromuscular perturbations which may impair physical performance. This study examined the effects of a mentally-fatiguing, cognitive control task on physical performance and muscle activation while performing a resistance exercise task. The study employed a randomized, cross-over design. On Visit 1, participants (N = 10) performed a barbell biceps curl one-rep maximum (1RM) test. On Visits 2/3, participants performed 20 biceps curls at 50% of their 1RM, followed by their respective 10-minute cognitive experimental manipulation (high vs. low cognitive control), and then performed a second set of biceps curls at 50% of their 1RM to failure. Total repetitions performed on the post-manipulation exercise task, and muscle activation (electromyography amplitude) of the biceps, triceps and lumbar erector spinae muscles were recorded. Mental fatigue was significantly greater following the high cognitive control manipulation (d = 1.09). Total repetitions performed following the high (M=24.9) and low cognitive control manipulations (M=25.2) did not differ (p > .05). However, there was a significant increase in muscle activation for the biceps, triceps and lumbar erector spinae during repetitions performed while mentally fatigued that indicate greater involvement of the low-back musculature and co-contraction of the triceps while lifting. Findings suggest mental fatigue may alter motor unit recruitment, reducing the efficiency of movement patterns in ways that may leave people susceptible to injury.Acknowledgments: SSHRC


Author(s): Ellis, Helen | Advisor(s): Klein, Cecelia F. | Abstract: Before the Spanish-led defeat of the Aztecs in 1521, manuscripts were ubiquitous in Mesoamerica. Regrettably very few survive. One of them is the Aztec (Eastern Nahua) Codex Borgia painted in the Late Postclassic period (ca. 1250–1521 CE). Many of its 76 pages include maize imagery in polychrome. The plant appears amid gods of fertility hovering above naked females; associated with Quetzalcoatl, the god of wind; and rendered to look strikingly similar to grass. The questions I address in this dissertation relate to the significance of maize, Quetzalcoatl, and grass depictions. What does maize imagery convey? Why did the Nahua venerate a god of wind? How is maize related both wind and grass?Until now, scholars of the Codex Borgia have generally assumed that it records information used in divination, astronomy, and farming. What has not been considered is the possibility that it reflects scientific information about plants. I contend that maize imagery studied against the scientific record on plant domestication indicates that it does. Scientists have demonstrated that Central Mexicans were brilliant at manipulating plants, and had by approximately 6,000 BCE, through genetic selection, transformed a common grass into the maize plant. The result was a symbiotic relationship between maize and humans. Amerindians cared for the plant, continuing to manipulate it to become the modern crop, ultimately spread throughout the world, completely dependent on humans for reproduction.Scholars have lamented that indigenous people failed to make a record of their scientific achievements. I argue that maize and related images in their extant artifacts reflect those accomplishments. My research strives to shed light on the Codex Borgia, its imagery, and the ways in which indigenous people of Mesoamerica recorded scientific information. Specifically, my dissertation shows with substantial scientific, ethnohistoric, and iconographic evidence that the Nahua understood plant sexuality, that wind was the primary means of plant reproduction, and that the common grass they held in great esteem was the progenitor of maize. My dissertation seeks to establish that the Codex Borgia's imagery shows the cultural importance of maize to the Nahua and that it was rooted in scientific understanding.


This paper uses confidential Census data, specifically the 1990 and 2000 Census Long-Form data, to study the demographic processes underlying the gentrification of low income urban neighborhoods during the 1990's. In contrast to previous studies, the analysis is conducted at the more refined census-tract level with a narrower definition of gentrification and more narrowly defined comparison neighborhoods. The analysis is also richly disaggregated by demographic characteristic, uncovering differential patterns by race, education, age and family structure that would not have emerged in the more aggregate analysis in previous studies. The results provide little evidence of displacement of low-income non-white households in gentrifying neighborhoods. The bulk of the income gains in gentrifying neighborhoods are attributed to white college graduates and black high school graduates. It is the disproportionate in-migration of the former and the disproportionate retention and income gains of the latter that appear to be the main engines of gentrification.


Angiogenesis is the growth of blood vessels from the existing vasculature. A variety of methods have been used to assess angiogenesis. One widely accepted is the Chick Chorioallantoic membrane (CAM) model. Quantification of blood vessels in the CAM model using Stereomicroscope and the Image Analysis software, is one of the easy, reproducible and validated technique, but it is not economical. Hence, there is a need for an alternative technique which has the consistency of the Image analysis method but is cost effective. Thus, the present study was aimed to compare 3 different techniques of CAM model, 2 known and one novel (Drabkin"s method), in determining the angiogenic potential of drugs. 6-day old embryonated White Leghorn eggs were used for the CAM model. The angiogenic potential of 3 standard drugs viz. , VEGF, Erythropoietin and Heparin was assessed using 3 techniques, viz. , Drabkin"s method, Overall quantification of blood vessels (using Stereomicroscope) and Localized quantification of blood vessels (using discs).6-day old embryonated eggs were inoculated with the known drugs respectively, and incubated. Untreated eggs served as the normal control. On day 12, CAM was excised from the eggs and the effect of the drugs on angiogenesis was evaluated by the 3 techniques and compared. All techniques evaluated in the study demonstrated comparable results with significant Pearson"s correlation (r = 0.9877, p <0.0001). Significant correlation between the Drabkin"s method results and both the image analysis methods demonstrated that Drabkin"s method is a relatively cheaper, reproducible and a reliable technique to screen drugs for their angiogenic potential.


Mo modified layers on Ti-6Al-4V alloy were obtained with plasma surface alloying technique. The properties of the Mo-diffusion layers were investigated in this paper. Results show that the Mo-diffusion layers obviously enhance the wear resistance of Ti alloys against a polished 2100 steel counterbody ball under ball-on-disc test condition. With a series of experimental results, a wear model of high wear resistance of modified layers is propounded. The noval wear behavior is a result of absolute elasticity characteristics on the subsurface of Mo modified layers.


The establishment of a government bureaucracy to collect taxes is regarded as one of the essential features of a modern economy. While Britain is considered a pioneer, France has been treated as a laggard because of continued reliance on tax farming. Focusing on the largest tax farm, France's late transition from private to government tax collection is explained in a principal-agent context by the difficulties of monitoring employees and borrowing at low cost in the capital market. Tax farmers continued to earn high returns, absorbing the risk of fluctuating collections, leaving the Crown with lower revenue.


For federated learning systems deployed in the wild, data flaws hosted on local agents are widely witnessed. On one hand, given a large amount (e.g. over 60%) of training data are corrupted by systematic sensor noise and environmental perturbations, the performances of federated model training can be degraded significantly. On the other hand, it is prohibitively expensive for either clients or service providers to set up manual sanitary checks to verify the quality of data instances. In our study, we echo this challenge by proposing a collaborative and privacy-preserving machine teaching method. Specifically, we use a few trusted instances provided by teachers as benign examples in the teaching process. Our collaborative teaching approach seeks jointly the optimal tuning on the distributed training set, such that the model learned from the tuned training set predicts labels of the trusted items correctly. The proposed method couples the process of teaching and learning and thus produces directly a robust prediction model despite the extremely pervasive systematic data corruption. The experimental study on real benchmark data sets demonstrates the validity of our method.


Importance
Warfarin is prescribed to patients with atrial fibrillation (AF) for the prevention of cardioembolic complications. Whether warfarin adversely affects bone health is controversial. The availability of alternate direct oral anticoagulant (DOAC) options now make it possible to evaluate the comparative safety of warfarin in association with fracture risk.

Objective
To test the hypothesis that, among patients with nonvalvular AF, use of DOACs vs warfarin is associated with lower risk of incident fracture.

Design, Setting, and Participants
This comparative effectiveness cohort study used the MarketScan administrative claims databases to identify patients with nonvalvular AF and who were prescribed oral anticoagulants from January 1, 2010, through September 30, 2015. To reduce confounding, patients were matched on age, sex, CHA2DS2-VASc (congestive heart failure, hypertension, age [>65 years = 1 point; >75 years = 2 points], diabetes, and previous stroke/transient ischemic attack [2 points], vascular disease) score, and high-dimensional propensity scores. The final analysis included 167 275 patients with AF. Data were analyzed from February 27, 2019 to September 18, 2019.

Exposures
Warfarin and DOACs (dabigatran etexilate, rivaroxaban, and apixaban).

Main Outcomes and Measures
Incident hip fracture, fracture requiring hospitalization, and all clinical fractures (identified using inpatient or outpatient claims) defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes.

Results
In the study population of 167 275 patients with AF (38.0% women and 62.0% men; mean [SD] age, 68.9 [12.5] years), a total of 817 hip fractures, 2013 hospitalized fractures, and 7294 total fractures occurred during a mean (SD) follow-up of 16.9 (13.7) months. In multivariable-adjusted, propensity score-matched Cox proportional hazards regression models, relative to new users of warfarin, new users of DOACs tended to be at lower risk of fractures requiring hospitalization (hazard ratio [HR], 0.87; 95% CI, 0.79-0.96) and all clinical fractures (HR, 0.93; 95% CI, 0.88-0.98), whereas the association with hip fractures (HR, 0.91; 95% CI, 0.78-1.07) was not statistically significant. When comparing individual DOACs with warfarin, the strongest findings were for apixaban (HR for hip fracture, 0.67 [95% CI, 0.45-0.98]; HR for fractures requiring hospitalization, 0.60 [95% CI, 0.47-0.78]; and HR for all clinical fractures, 0.86 [95% CI, 0.75-0.98]). In subgroup analyses, DOACs appeared more beneficial among patients with AF who also had a diagnosis of osteoporosis than among those without a diagnosis of osteoporosis.

Conclusions and Relevance
In this real-world population of 167 275 patients with AF, use of DOACs-particularly apixaban-compared with warfarin use was associated with lower fracture risk. These associations were more pronounced among patients with a diagnosis of osteoporosis. Given the potential adverse effects of warfarin on bone health, these findings suggest that caution should be used when prescribing warfarin to patients with AF at high risk of fracture.


Abstract In this paper I argue that the ways in which a genealogical idiom brings together multiple scales of space and time is as important to its social, political, or religious efficacy as the particular people, places, and events it incorporates. To illustrate this point, I turn to the unusual patrilineal genealogy of Habib Abdurrahim, a nineteenth-century descendant of the Prophet Muhammad buried in the Indonesian region of Seunagan. Since the late 1950s, Habib Abdurrahim's descendants have cultivated a version of his patriline emphasizing five prominent figures. This constellation of figures, together with the relationships Muslims in Seunagan foster with each of the five, produce configurations of spatial-temporal scale through which local Muslims inscribe themselves as participants in several Islamic pasts: the establishment of Seunagan's customary practice, the Islamization of the Indonesian nation, and Islam's cosmic history. Narrative, social, and ritual practices surrounding Habib Abdurahim's patriline link Muslims in Seunagan to the multiple scales that inhere in the genealogy, encouraging them to see themselves as actors within entwined and unfolding histories of Islamization.


OBJECTIVE
To investigate whether early or regular preventive dental visit (PDV) reduces restorative or emergency dental care and costs for low-income children.

STUDY SETTING
Enrollees during 1998-2012 in the Alabama CHIP program, ALL Kids.

STUDY DESIGN
Retrospective cohort study using claims data for children continuously enrolled in ALL Kids for at least 4 years. Analyses are conducted separately for children 0-4 years, 4-9 years, and >9 years. For 0-4 years, the intervention of interest is whether they have at least one PDV before age 3. For the other two age groups, interventions of interest are if they have regular PDVs during each of the first 3 years, and if they have claims for a sealant in the first 3 years. Outcomes-namely restorative and emergency dental service and costs-are measured in the fourth year. To account for selection into PDV, a high-dimensional propensity scores approach is utilized.

DATA EXTRACTION
Claims data were obtained from ALL Kids.

PRINCIPAL FINDINGS
Only sealants are associated with a reduced likelihood of using restorative and emergency services and costs.

CONCLUSIONS
Whether PDVs without sealants actually reduce restorative/emergency pediatric dental services is questionable. Further research into benefits of PDV is needed.


Adversarial examples have been shown to exist for a variety of deep learning architectures. Deep reinforcement learning has shown promising results on training agent policies directly on raw inputs such as image pixels. In this paper we present a novel study into adversarial attacks on deep reinforcement learning polices. We compare the effectiveness of the attacks using adversarial examples vs. random noise. We present a novel method for reducing the number of times adversarial examples need to be injected for a successful attack, based on the value function. We further explore how re-training on random noise and FGSM perturbations affects the resilience against adversarial examples.


Although liver lesions in the young population are relatively rare, clinicians can benefit from being familiar with a subset of common benign liver lesions which include hepatic adenoma, hepatic hemangioma, and focal nodular hyperplasia. This a case report of a 25-year-old Jehovah's Witness female on chronic oral contraception for polycystic ovarian syndrome who presented with progressive right upper quadrant abdominal pain. Ultrasound and MRI findings were consistent with hepatic adenoma. A description of her clinical work up followed by a brief description of the surgical intervention is discussed. We then elaborate on the clinical characteristics and evidence-based interventions of hepatic adenoma, hepatic hemangioma, and focal nodular hyperplasia.


Abstract: Breast cancer is the fifth cause of cancer death among women worldwide and represents a global health concern due to the lack of effective therapeutic regimens that could be applied to all disease groups. Nowadays, strategies based on pharmacogenomics constitute novel approaches that minimize toxicity while maximizing drug efficacy; this being of high importance in the oncology setting. Besides, genetic profiling of malignant tumors can lead to the development of targeted therapies to be included in effective drug regimens. Advances in molecular diagnostics have revealed that breast cancer is a multifaceted disease, characterized by inter-tumoral and intra-tumoral heterogeneity and, unlike the past, molecular classifications based on the expression of individual biomarkers have led to devising novel therapeutic strategies that improve patient survival. In this review, we report and discuss the molecular classification of breast cancer subtypes, the heterogeneity resource, and the advantages and disadvantages of current drug regimens with consideration of pharmacogenomics in response and resistance to treatment.


The first work package (WP1) contains a critical review and synthesis of human behaviour models ofdrivers of road vehicles, trains and maritime vessels (ships). Based on this review a reference modelof Driver–Vehicle–Environment is developed. A variety of approaches to modeling driver behaviourare possible as options. The literature review covers the more widely cited of these. Generally, thesemight be categorized as either 'Descriptive' models which can only describe the driving task in termsof what the driver has to do or 'Functional' models which are able to explain and predict drivers'performance in demanding situations and drivers' behaviour in typical ones. It seems that theoptimal approach might be a hybrid of several types of models. In recent years, a variety of driversupport and information management systems have been designed and implemented with theobjective of improving safety as well as performance of vehicles. While the crucial issues at atechnical level have been mostly solved, their consequences for driver behaviour remain to be fullyexplained. To reach this goal predictive models of the interaction of the driver with the vehicle andthe environment are necessary. The aim of the European Project AIDE was to integrate all in vehiclesupport and information systems in a harmonized user interface (Saad, 2006). The ITERATE projectwill take this further by developing it into a unified driver model that is also applicable to othertransport domains.The first deliverable in this work package (D1.1) presented a critical review of Driver-Vehicle-Environment (DVE) models and most relevant drivers' parameters and variables to be implementedin such models, in different surface transport modes and in different safety critical situations. Theaim of this deliverable (D1.2), succeeding D1.1 is to describe and detail the Unified Model of Driverbehaviour (UMD), define the environmental parameters to be implemented and their relationshipswith the driver variables. The proposed model will be used to support design and safety assessmentof innovative technologies and make it possible to adapt these technologies to the abilities, needs,driving style and capacity of the individual drivers. The model will also present the environmentalparameters, different road and traffic scenarios with different weather and visibility conditions to besimulated in the test phases. The scenarios of traffic that are independent of the activities carried outby the vehicle and driver will be simulated. The model is simplified in the sense that traffic conditions(density, complexity) are not sensitive to the 'test' driver and vehicle behaviour, but remain fixed in agiven trial. Thus, within the constraints of this pioneering effort, only the behaviour of the test driveris variable, while the environment and vehicle are defined as parameters with fixed values.


Background Hospital pharmacists are expected to play a key role as members of a multidisciplinary therapeutic team, to ascertain the best therapeutic results with respect to limited resources available in all healthcare systems. Purpose To investigate the extent that medication review takes place in everyday clinical practice, the number and type of proposed interventions, as well as identification of barriers to be overcome, so that seamless care, regarding pharmacotherapy, is assured. Material and methods Medication review at the prescription and ward level, by hospital pharmacists, was investigated in 2 (general and terminal patient clinics) hospitals located in the same health region, for a period of 3 months. Benchmarking of all implemented procedures was evaluated by weekly questionnaires. Results In both hospitals, a computerised physician order entry system was available, characterised more by its administrative and less by its clinical value. In both cases, all prescriptions were reviewed by pharmacists, while the average number of medicines/patient was 8. However, the fact that pharmacists do not participate in direct patient care (ward rounds) in combination with limited access to the complete patient record renders medication review time consuming and fragmented. In the general hospital, the absence of any type of feedback, regarding the actual administration at ward level, hinders the intergraded evaluation of pharmacotherapy outcomes. In the case of the end stage patients' hospital, where an extended length of stay is observed along with a higher ratio of pharmacists per hospital beds (1/50 vs 1/200 for the general hospital), a more complete monitoring of medication use is feasible, as interventions take place before transformation of medical instructions into prescriptions. In both cases, the majority (almost 60%) of the hospital pharmacists' interventions concern the dosage form, length of drug administration, incompatibilities and interactions, polypharmacy management and substitution with low cost generic formulations. Conclusion Although medication review should be a high priority, the extent that this happens depends on the initiative/expertise of the hospital pharmacists and the type of institution. Lack of and deficiencies in relevant legislation, infrastructure and collaboration culture are identified as key barriers. Nevertheless, hospital pharmacists are engaged in medicines optimisation, against all odds. No conflict of interest


Background: Patients with diabetes mellitus (DM) are believed to have higher complication rates when undergoing ankle and hindfoot fusions, but data is lacking. The purpose of this study was to compare the postoperative outcomes of major foot and ankle arthrodeses in patients with and without DM. Another goal was to evaluate what effect glycemic control had on the outcomes of patients with diabetes. Methods: A retrospective review of charts from operative years 2005 to 2010 was performed. Inclusion criteria encompassed patients requiring major hindfoot and/or ankle fusion. Exclusion criteria included any patient who did not have at least 6-month followup. Seventy four patients with DM were matched with 74 non-DM patients based on age, gender, and length of surgery. Significance was set at p < 0.05 with associated 95% confidence intervals. Results: The overall complication rate was found to be significantly higher in patients with DM, a history of tobacco use, and peripheral neuropathy. The postoperative infection rate was found to be significantly higher in patients with DM, poor long-term glucose control (Hgb A1c levels greater than or equal to 7%), a history of tobacco use, peripheral artery disease, and peripheral neuropathy. Our rate of noninfectious complications was found to be significantly higher in patients with DM, poor short-term glucose control (a preoperative glucose greater than 200 mg/dL), a history of tobacco use, and previous solid organ transplantation. Patients greater than or equal to 65 years of age were significantly associated with fewer overall complications and postoperative infections. Conclusion: This study confirmed our hypothesis that patients with DM were at increased risk for postoperative complications after foot and/or ankle arthrodesis when compared to patients without DM. A secondary finding of this study demonstrated patients with poor short- and long-term glucose control experienced more complications. Level of Evidence: III, Retrospective Comparative Study


Air travelers ask the question, "How much lithium in a battery am I allowed to bring on board?" We differentiate between two battery types: Lithium metal and lithium-ion. Most lithium metal batteries are non-rechargeable and are used in film cameras. Lithium-ion packs are rechargeable and power laptops, cellular phones and camcorders. Both battery types, including spare packs, are allowed as carryon but cannot exceed the following lithium content: - 2 grams for lithium metal or lithium alloy batteries - 8 grams for lithium-ion batteries Lithium-ion batteries exceeding 8 grams but no more than 25 grams may be carried in carry-on baggage if individually protected to prevent short circuits and are limited to two spare batteries per person.


BACKGROUND AND OBJECTIVE:The additional diagnostic value of endoscopic ultrasound-fine needle aspiration (EUS-FNA) over lymph node (LN) echofeatures alone in evaluating lymphadenopathy is unknown. The objectives of this study are (1) to prospectively evaluate the utility of EUS-FNA in evaluating mediastinal or peri-intestinal lymphadenopathy and to compare its yield to that of echofeatures alone and (2) to determine clinical and endosonographic features predictive of malignant involvement of LNs.METHODS:All consecutive patients who underwent EUS-FNA of a LN over a 22-month period were prospectively evaluated. Reference standard for final diagnosis included: surgery (n = 76), long-term clinical and/or imaging follow-up (n = 74), or death from disease (n = 26).RESULTS:One hundred and eighty-three EUS-FNAs of LNs were performed in 137 patients with no major complications. Locations of the biopsied LNs included 31% subcarinal, 21% celiac, 21% peripancreatic, 13% periesophageal, 4.4% aortopulmonary window, 3.2% perigastric, and 3.3% perirectal. Mean LN size was 20.5 mm (SD ± 11.1) × 13.2 mm (SD ± 7.97). The mean number of EUS-FNA passes was three (range 1–7). The sensitivity, specificity, PPV, and NPV of EUS-FNA of LNs were 98.3%, 100%, 100%, and 98.4%, respectively. EUS-FNA was more accurate compared to LN echofeatures alone (99.4% vs 75.4%, p < 0.001). Mediastinal LNs were 2.77 times less likely to be malignant as compared to other LN locations. In multivariable analysis, the number of LN echofeatures, site of LN, and patient's age were associated with malignant involvement (p = 0.001).CONCLUSIONS:EUS-FNA is superior to LN echofeatures in evaluating lymphadenopathy. Endosonographic LN features alone are particularly unreliable in the mediastinum, necessitating tissue confirmation. EUS-FNA can safely, reliably, and accurately sample mediastinal and peri-intestinal LNs obviating the need for more invasive testing or surgical intervention.


A brief statistical analysis of the pelvic hematomas' evolution in traumas with various localizations is presented in the article. The current published data were made use of to describe the state-of-art for the time being. Finally, problems related with the forensic-medical aspects of the issue are defined, and methods to cope with them are appropriately suggested.


In 2010 for the first time in a UK general election, the candidates for Prime Minster of the three major parties, Gordon Brown for Labour, David Cameron for the Conservatives and Nick Clegg for the Liberal-Democrats, faced each other in a series of three television debates in front of a carefully selected audience supposed to represent the British electorate. After opening statements by each of the candidates—again—carefully selected members of the audience posed—again—carefully selected questions to the panel. This aspect of selection represents the link through which the debates can be defined as the outcome of a journalistic production process. This chapter will start out with a consideration of the rules that governed the debate to establish the role journalists played in shaping its content. The actual content in relation to migration will then be analysed in relation to Britain as a nation state. The chapter concludes by returning to the role of journalists, this time by analysing a particular exchange within the debates. Though Britain's status as a multicultural and multinational state raises specific issues, the argument illustrates a dynamic of wider applicability: current discourses of nation state and migration render the latter as permanent source of crisis for the former.


A major challenge of university faculty and adjunct members in teacher education is the logistics of scheduling and observing remote field experience evaluations of candidates. According to National Educational Technology Standards for Teachers (NETS.T) (2003), observations require an investment of time, scheduling logistics, and trained professionals to observe and analyze evaluation data. The authors of NETS.T (2003) state, "Put another way, observation opportunities are precious and should be designed to make every moment count" (p. 112). Technology, particularly in the form of videoconferencing, is being used to develop and improve the level of communication when observing and evaluating candidates. This mode of delivery is helping to bridge the three themes of transforming identity, collegial relationships, and cultural responsiveness.


This paper demonstrates theoretically and empirically that a greedy algorithm called orthogonal matching pursuit (OMP) can reliably recover a signal with m nonzero entries in dimension d given O(m ln d) random linear measurements of that signal. This is a massive improvement over previous results, which require O(m2) measurements. The new results for OMP are comparable with recent results for another approach called basis pursuit (BP). In some settings, the OMP algorithm is faster and easier to implement, so it is an attractive alternative to BP for signal recovery problems.


Supplemental Digital Content is available in the text. Psychosocial stress is a key contributing factor to the pathogenesis of hypertension and cardiovascular disease. We examined the association of urinary stress hormone levels with incident hypertension and cardiovascular events. This prospective cohort study included 412 adults (age 48–87 years) free of hypertension from the Multi-Ethnic Study of Atherosclerosis with measurements of urinary stress hormones (norepinephrine, epinephrine, dopamine, and cortisol). Multivariable Cox proportional hazard models were used to estimate the adjusted hazard ratio (aHR) of incident hypertension and cardiovascular events according to urinary stress hormone levels. The average age (SD) was 61.2 (9.1) years, and 50% were female. Over a median follow-up of 6.5 years, there was an increased risk of incident hypertension per doubling of norepinephrine (aHR, 1.31 [95% CI, 1.06–1.61]), epinephrine (aHR, 1.21 [95% CI, 1.03–1.41]), dopamine (aHR, 1.28 [95% CI, 1.00–1.64]), and cortisol (aHR, 1.23 [95% CI, 1.04–1.44]). The associations were generally stronger among participants <60 years than those ≥60 years, particularly for dopamine (P-for-interaction, 0.04) and cortisol (P-for-interaction, 0.04). Over a median follow-up of 11.2 years, there was an increased risk of incident cardiovascular events per doubling of cortisol (aHR, 1.90 [95% CI, 1.16–3.09]), but not for catecholamines. In this multiethnic population study, higher urinary stress hormone levels were associated with an increased risk of incident hypertension. Urinary cortisol levels were also associated with an increased risk of incident cardiovascular events. Our findings highlight a potentially important role of stress hormones in the prevention and treatment of hypertension and cardiovascular diseases.


The prognostic significance of excess small bowel gas on a plain abdominal radiograph has been assessed in 75 patients with severe attacks of ulcerative colitis requiring intravenous hydrocortisone. The radiographs were reviewed without knowledge of the subsequent outcome. Small bowel distension was defined as the presence of three or more loops of gas filled small bowel. Forty two patients responded to medical treatment and 33 underwent colectomy. The two groups were comparable for age, sex, and length of history. The surgical group had more extensive disease. Of those who did well on medical therapy, 18 (42.9%) had small bowel distension compared with 24 of 33 (72.7%) who failed medical therapy. The difference was significant (p less than 0.05, odds ratio = 3.55, 95% confidence interval of 2.27-5.87). Of the 24 patients with small bowel distension who came to surgery, five had more than four loops of gas filled small bowel. This degree of distension was not seen in any of the patients settling on medical therapy. Thus the presence of small bowel distension on a plain abdominal radiograph in a patient with severe ulcerative colitis may predict a poor response to medical therapy.


1, 3 dipolar cycloaddition reactions offer a versatile route for the synthesis of multi component heterocyclic molecules. Solvent-free Claisen-Schmidt reactions of cycloalkanones with various substituted benzaldehydes (aryl aldehydes) using solid NaOH (20 mol%) and applying a grinding technique is used to synthesize Quantitative yields of α,AŽÂ¬-bis-(substitutedbenzylidene) cycloalkanones. Using the same technique we could synthesize the corresponding bis-benzylidene- and monobenzylideneacetone derivatives. The derivatives are then subjected to 1,3 dipolar cycloaddition reaction with azomethine ylides to yield the corresponding dispiroheterocycles through a microwave induced solvent free approach.


Applied economists often wish to measure the effects of managerial decisions or policy changes on plant-level productivity patterns. But plant-level data on physical quantities of output, capital, and intermediate inputs are usually unavailable. Therefore, when constructing productivity measures, most analysts proxy these variables with real sales revenues, depreciated capital spending, and real input expenditures. The first part of this paper argues that the resultant productivity indices have little to do with technical efficiency, product quality, or contributions to social welfare. Nonetheless, they are likely to be correlated with policy shocks and managerial decisions in misleading ways. The second part of the paper develops an alternative approach to inference. Using Steven Berry's (1994, RAND Journal) representation of equilibrium in a differentiated product market, we show how to impute each plant's unobserved marginal costs and product quality from its observed revenues and costs, and how to use this mapping to calculate plant-specific welfare-based performance measures. (Bayesian estimation techniques are required because the vector of unknown parameters is under-identified.) The final part of the paper demonstrates our methodology using panel data on Colombian pulp and paper plants.


Background Best practice health and safety concentrates on removing, or reducing, sources of danger to achieve the largest reductions in individuals' risk. However, analyses of personal travel have focused on the risks of different modes. The risks imposed on others by a given mode of travel have received little attention. Using data from two time-periods (2005–2007; 2008–2010) we examined changes in the comparative risk of third-party fatality by sex, age, and travel mode. Methods The main outcome measures were the number of: (1) car driver and cyclist fatalities; and (2) third-party fatalities (e.g., passengers, occupants in other vehicles in multi-vehicle collisions, pedestrians, cyclists) by time spent travelling (fatalities per million hours' use, f/mhu). Data on fatal car and bicycle accidents were extracted from STATS19, the national database of crashes on highways in Britain reported to and by the police. Variables recorded for each crash include details of all vehicles involved, age and gender of occupants, and resulting casualties. Data on time travelled by mode (exposure) was extracted from the National Travel Survey, and was aggregated to the population using mid-year population estimates. Subgroup differences in f/mhu were tested using Poisson regression. Results Fatality rates for drivers (aged 17+) and cyclists (all ages) fell significantly from 0.093 f/mhu (95% CI 0.090–0.097) and 0.475 f/mhu (0.442–0.509) respectively in 2005–2007 to 0.067 f/mhu (0.064–0.070) and 0.323 f/mhu (0.294–0.353) in 2008–2010, reflecting decreases in the number of fatalities (both modes) and increases in usage (cycling). Age-specific rates showed U- and J-shapes for car drivers and cyclists respectively. Fatality rates for drivers aged 17–25 fell significantly from 0.372 f/mhu (0.353–0.392) in 2005–2007 to 0.252 f/mhu (0.234–0.271) in 2008–2010 (p < 0.001). Likewise, fatality rates for drivers aged 70+ decreased from 0.155 f/mhu (0.138–0.174) to 0.131 f/mhu (0.115–0.148) over the same period. Third-party fatalities in car accidents occurred most frequently for young drivers, with rates for men more than double those for women. Third-party fatality rates decreased for male drivers aged 17–25 from 0.807 f/mhu (0.783–0.828) in 2005–2007 to 0.581 f/mhu (0.552–0.611) in 2008–2010, reflecting decreases in the number of non-driver deaths. Risks imposed on third-parties by car drivers were significantly (>30 times) greater than those by cyclists (0.157 (0.152–0.161) versus 0.024 (0.015–0.036) f/mhu in 2005–2007; 0.119 (0.115–0.123) versus 0.014 (0.008–0.023) f/mhu in 2008–2010). Conclusion Official studies comparing risk across travel modes have ignored the wide variation in risk posed to other road users. Third-party fatality rates are considerably lower for crashes involving bicycles than cars.


In this paper, we propose a clock routing algorithm for structured ASICs using predefined yet via-configurable metal wires. Our algorithm has many distinct features implemented to address the specific problems encountered by the tasks of creating tapping points and performing wire snaking. We also present an approach to merging two subtrees without exacerbating the skew of a merged tree. Experimental data show that a delay-balanced clock tree can be constructed using via-configurable routing fabric, with an average skew of 8.1% of clock latency for some benchmark circuits. Such a result is comparable to what can be achieved by a commercial clock tree synthesizer.


This Excel spreadsheet records the applications made for open access article processing charges (APCs) through the Research Councils UK (RCUK) block grant at the University of Cambridge, via the Office of Scholarly Communication, Cambridge University Library between 1 August 2015 and 31 July 2016.


AIM
To summarize the empirical research on assessing quality of life (QOL) in patients with gastric carcinoma.

METHODS
Literature searches were conducted in MedLine from 1966 to February 2004.

RESULTS
Twenty-six studies were identified. QOL was used as an outcome measure in virtually all identified studies, such as those examining the effects of gastric cancer and various medical or surgical treatments in the patients. QOL was assessed mainly with generic measures; the social dimensions of QOL were largely neglected. The lack of gastric cancer-specific QOL measures hampers QOL research up to now. The gastric cancer-specific EORTC-QLQ-STO22 and the FACT-Ga are important additions to the arsenal of disease-specific QOL measures. In most of the studies, the label QOL is used for questionnaires, which only assess symptoms or performance status, or are physician-reported rather than patient-reported outcomes.

CONCLUSION
QOL in patients with gastric cancer deserves more systematic studies, especially as one of the outcome measures in randomized clinical trials. Results of studies that include QOL in patients with gastric cancer should be applied in clinical care, which aims at improving QOL of these patients.


The coating of fertilizers with polymers is an acknowledged strategy for controlling the release of nutrients and their availability in soil. However, its effectiveness in the case of soluble phosphate fertilizers is still uncertain, and information is lacking concerning the chemical properties and structures of such coatings. Here, an oil-based hydrophobic polymer system (polyurethane) is proposed for the control of the release of phosphorus from diammonium phosphate (DAP) granules. This material was systematically characterized, with evaluation of the delivery mechanism and the availability of phosphate in an acid soil. The results indicated that thicker coatings can change the maximum nutrient availability toward longer periods, such as 4.5−7.5 wt % DAP coated, that presented the highest concentrations at 336 h, as compared to 168 h for uncoated DAP. In contrast, DAP treated with 9.0 wt % began to increase the concentration after 168 h until it results in maximum release at 672 h. These effects could be attributed to the homogeneity of the polymer and the porosity. The strategy successfully provided long-term availability of a phosphate source.


The adoption of organic agriculture or livestock involves risk and uncertainty, and to overcome this, well designed schemes are required. Are the current support measures attractive for farmers who wish to convert to organic? At first, this study tries to assess the optimal investment trigger for a new comer into organic dairy sheep farming system and secondly, to evaluate the investment profitability of an existing organic farmer in his attempt to improve his farm. Results indicate that the framework of real options analysis is an appropriate form of analysis if the question of investment profitability is examined under risk and uncertainty and the role of economic subsidies offered to organic farmers is assessed.


The UK National Transmission System (NTS) is a key enabler to decarbonise the gas network in Great Britain (GB) in order to meet the UK government's target of net-zero emissions by 2050. FutureGrid is National Grid's research programme assessing the capability of the transmission system to transport hydrogen. Our goal is to accelerate the decarbonisation of power, industry and heat by delivering a safe supply of energy to all customers both during, and after, the energy transition. FutureGrid will lead to a better understanding of what the technical parameters are around the ultimate role of the NTS in the energy system, and how the transition can be managed. Under FutureGrid, National Grid will construct a NTS hydrogen test facility at DNV's Spadeadam testing and research site. NTS assets, due to be decommissioned in early RIIO2, will be reconstructed to create a test network that can be used to answer some of the fundamental questions around safety and operation of a converted network. Flows of hydrogen/natural gas blends, including 100% hydrogen, will be tested for the first time in GB at transmission pressures. This system will connect to the existing H21 distribution network test facility at Spadeadam to prove a complete beach-to-meter network can be decarbonised, to develop a comprehensive programme for the hydrogen transition. The project will provide a transmission facility which is a key enabler for more advanced hydrogen testing on industrial equipment such as hydrogen separation technology, hydrogen compressors and/or purification of hydrogen for transport. Our paper will detail the current position and aims of the project.


New methods for teaching and controlling contour-tracking tasks based on contact sensing are developed to improve robotic machining. Accurate contact point detection is introduced to estimating a work contour path with high reliability. These teaching methods reduce the effort for task teaching and improve adaptability to handle changes in task specifications without re-teaching. Real-time contour tracking control using this contact sensing to suppress work uncertainties in process is presented. Experimental results for practical grinding tasks using a 6 DOF manipulator validate our methods.<<ETX>>


Abstract
Intensive research into the biological roles of nitric oxide has shown that this tiny molecule is of vital physiological significance in numerous organ systems including the gastrointestinal tract, where nitric oxide has been proposed as an inhibitory enteric neurotransmitter. This paper outlines experiments using retrograde neuronal tracing and enzyme histochemistry in a guinea-pig model which provided the first direct anatomical evidence of a descending nitrergic rectoanal neuronal pathway appropriate to mediating relaxation of the internal anal sphincter during the rectoanal inhibitory reflex. Studies of human tissue showed that the in vitro responses of isolated strips of human rectum were typical of non-sphincter specialized gastrointestinal smooth muscle, that nitric oxide is involved in neurogenic relaxation of the rectum and that nitric oxide synthase immunocytochemistry identified a subpopulation of neurones in the myenteric ganglia and immunoreactive profiles within both layers of the muscularis propria of human rectum. Taken together, these data provide pharmacological and anatomical support for the hypothesis that nitric oxide acts as a functionally important mediator in the innervation of human anorectum.


Introduction: Alcohol abuse has been well recognized as a significant risk factor for severe community-acquired pneumonia (SCAP) with variable data about pneumonia complications. Objective: To study clinical peculiarities and complications of SCAP in alcoholic patients hospitalized in an intensive care unit (ICU). Methods: Retrospective cohort study of SCAP hospitalized in ICU of Sfanta Treime Municipal Hospital, Chisinau, from October 2014 to November 2015. We included 104 patients divided into 2 groups: group A (32 alcoholic patients) and group NA (72 non-alcoholic patients). Results: There was a higher rate of patients younger than 65 years and male gender in group A - 78.1% vs 56.9% in group NA and 75% vs 50%, respectively (p>0.05). Streptococcus pneumoniae was the most common pathogen in both groups. Mental confusion on admission and pleural effusion were more frequently registered in group A: 28.1vs 4.2% and 25% vs 4.2% (p>0.05), respectively. No significant differences in laboratory data were revealed, except hypoalbuminemia in group A - 31.3 % vs 8.3 %. ARDS was diagnosed in 15.6% in group A vs 16.7% in group NA (p>0.05) and septic shock in 43.8% vs 15.3% (p 0.05). Conclusion: In our study mental confusion on admission, pleural effusion, hypoalbuminemia and septic shock were among the main features of severe community-acquired pneumonia in alcoholic patients hospitalized in intensive care unit.


In 1996, against the backdrop of Alberto Fujimori's increasingly corrupt national politics, an older woman in Lima, Peru - part of a group of women street sweepers protesting the privatization of the city's cleaning services - stripped to the waist in full view of the crowd that surrounded her. Lima had just launched a campaign to revitalize its historic districts, and this shockingly transgressive act was just one of a series of events that challenged the norms of order, cleanliness, and beauty that the renewal effort promoted."The City at Its Limits" employs a novel and fluid interweaving of essays and field diary entries as Daniella Gandolfo analyzes the ramifications of this act within the city's conflicted history and across its class divisions. She builds on the work of Georges Bataille to explore the relation between taboo and transgression, while Peruvian novelist and anthropologist Jose Maria Arguedas' writings inspire her to reflect on her return to her native city in movingly intimate detail. With its multiple perspectives - personal, sociological, historical, and theoretical - "The City at Its Limits" is a pioneering work on the cutting edge of ethnography.


Architectural analysis was applied to study branch development of 'Royal Gala' apple trees grafted with dwarfing and non-dwarfing rootstock/interstock combinations, which had been chosen to produce trees with a wide range of vigour. Using AMAPmod methodology, the structure of 3-year-old branches was described at four levels of representation: branch; annual shoot; growth unit; and node. Three types of growth units were distinguished: extension growth unit (vegetative unit with internode extension); vegetative spur with minimal internode extension; and fruiting spur or bourse. The aim of the analysis was to describe exactly how the rootstock/interstock combinations affected the structure building process. The number of extension growth units, vegetative spurs and fruiting spurs per annual shoot changed over the years, but this was not affected by rootstock/interstock combination. Compared with MM.106 rootstock, M.9 rootstock reduced the number of nodes per extension growth unit. In most cases, rootstock/interstock combination had no effect on the linear relationship between extension growth unit length and node number (R(2) = 0.88). Average internode length depended on unit node number, with internodes being shorter for units with fewer nodes. Thus the difference in apple branch size induced by the rootstock/interstock combinations was mainly due to a reduction in the length and number of neoformed nodes produced on extension growth units. As percentage budbreak of axillary buds on extension growth units was not affected by rootstock/interstock combination, differences in numbers of axillary annual shoots per branch were entirely due to differences in the total numbers of nodes extended during the previous year.


Rationale: Regulatory DNA elements in the human genome play important roles in determining the transcriptional abundance and spatiotemporal gene expression during embryonic heart development and somatic cell reprogramming. It is not well known how chromatin marks in regulatory DNA elements are modulated to establish cell type–specific gene expression in the human heart. Objective: We aimed to decipher the cell type–specific epigenetic signatures in regulatory DNA elements and how they modulate heart-specific gene expression. Methods and Results: We profiled genome-wide transcriptional activity and a variety of epigenetic marks in the regulatory DNA elements using massive RNA-seq (n=12) and ChIP-seq (chromatin immunoprecipitation combined with high-throughput sequencing; n=84) in human endothelial cells (CD31+CD144+), cardiac progenitor cells (Sca-1+), fibroblasts (DDR2+), and their respective induced pluripotent stem cells. We uncovered 2 classes of regulatory DNA elements: class I was identified with ubiquitous enhancer (H3K4me1) and promoter (H3K4me3) marks in all cell types, whereas class II was enriched with H3K4me1 and H3K4me3 in a cell type–specific manner. Both class I and class II regulatory elements exhibited stimulatory roles in nearby gene expression in a given cell type. However, class I promoters displayed more dominant regulatory effects on transcriptional abundance regardless of distal enhancers. Transcription factor network analysis indicated that human induced pluripotent stem cells and somatic cells from the heart selected their preferential regulatory elements to maintain cell type–specific gene expression. In addition, we validated the function of these enhancer elements in transgenic mouse embryos and human cells and identified a few enhancers that could possibly regulate the cardiac-specific gene expression. Conclusions: Given that a large number of genetic variants associated with human diseases are located in regulatory DNA elements, our study provides valuable resources for deciphering the epigenetic modulation of regulatory DNA elements that fine-tune spatiotemporal gene expression in human cardiac development and diseases.


The availability of soil in water is needed to run an everyday life, especially for living beings. The availability of groundwater is highly dependent on the good hydrological patterns, whereby if rain occurs with sufficient criteria then groundwater will be available as much as we need, but if the hydrological cycle becomes disrupted as a result of meteorological phenomena such as el nino then it will decrease water content in the soil. El nino phenomenon that occurred in 1997-1998 had a profound influence on the availability of groundwater, especially on the island of Ambon. Based on the analysis of water balance on the island of Ambon in 1997-1998, water deficit (drought) was so significant in the mid to late 1997 and in 1998. This certainly greatly affected the agricultural sector which is very dependent on the availability of water ground. The dynamics of the atmosphere has changed significantly, Both the government and the other correspond institution must anticipate the impact of water shortages on agriculture.


The scaphotrapeziotrapezoid (STT) joint is the second most common site in the wrist affected by degenerative arthritis. STT fusion has been the traditional treatment for patients with isolated STT arthritis but there are concerns about the complication rate and loss of wrist movement post-surgery. The current study presents the results of an interposition arthroplasty using a scaphoid trapezium pyrocarbon implant (STPI, BIOProfile). Ten STPI's were implanted in nine patients (mean age 66, 58-76 years) with isolated STT arthritis. The mean follow-up was 16.4 (3-35) months. Following surgery, VAS pain scores improved significantly and most patients had minimal restrictions in function, with a mean DASH score of 21. The mean wrist flexion-extension arc was 126 degrees and radioulnar deviation was 43 degrees. Mean grip strength was 82% and pinch strength 85% compared to the non-operated side. Patients were highly satisfied with the results of their surgery (mean VAS score 9.1). No surgical complications were encountered and no significant changes in carpal alignment were noted on radiographs. The results of this study suggest that STPI interposition arthroplasty may be a good alternative to STT fusion for isolated STT arthritis.


Excerpt] When direct subordinated employment is disguised as self-employment, it is termed 'bogus'. Work can be contracted in several different ways. The main distinction remains the one between 'employment' and 'self-employment': this is a prominent feature in all European legal systems, built around the concepts of 'subordination' and 'autonomy'. Contracting work can therefore be done in one of two ways: • through a commercial relationship/contract, between one client and a self-employed person or entrepreneur • through a labour contract, between an employer and a worker/employee. No definition of bogus self-employment has yet been agreed at European level. Various definitions have been proposed in several forums. Bogus self-employment refers to self-employed people 'who declare themselves (or are declared) as self-employed simply to reduce tax liabilities, or employers' responsibilities' (OECD, 2000, p. 156). Generally speaking, a person is considered to be in bogus self-employment when the characteristics and activities of self-employment (autonomy, tendering for different clients and so on) are limited or non-existent. Thus, bogus selfemployment contains features of subordinate employment relationships such as: • long-term engagement with a single contractor/work donor/employer • lack of control or autonomy over the organisation of work (working time, for example) • lack of own resources and equipment. However, the person concerned is bound by a commercial contract instead of a labour contract and therefore does not enjoy the protection and social rights provided by labour laws. Bogus self-employment results in a situation of factual subordination and dependence, which is not recognised legally or institutionally recognised in terms of employment and social rights, nor in terms of employers' liability and responsibility towards their employees. Thus, workers must comply with employers' working methods, but are deprived of the various rights associated with employee status (such as severance pay in the case of dismissal, access to unemployment benefits, and health and safety protection) and therefore suffer negative consequences.


Recently joint models for longitudinal and time-to-event data have attracted a lot attention. A full joint likelihood approach using an EM algorithm or Bayesian methods of estimation not only eliminates the bias in naive and twostage methods, but also improves efficiency. However, both the EM algorithm and a Bayesian method are computationally intensive, limiting the utilization of these joint models. We propose to use an estimation procedure based on a penalized joint likelihood generated by Laplace approximation of a joint likelihood and by using a partial likelihood instead of the full likelihood for the event time data. The results of a simulation study show that this penalized likelihood approach performs as well as the corresponding EM algorithm under a variety of scenarios, but only requires a fraction of the computational time. An additional advantage of this approach is that it does not require estimation of the baseline hazard function. The proposed procedure is applied to a data set for evaluating the effect of the longitudinal biomarker PSA on the recurrence of prostate cancer.