BACKGROUND
Advanced penile squamous cell carcinoma (pSCC) is a rare and aggressive malignancy with limited success of immune-checkpoint inhibitors (ICIs). Approximately half of pSCC cases are associated with human papillomavirus (HPV) infection.

METHODS
Evaluation was done retrospectively of the landscape of somatic alterations and ICI-related biomarkers in pSCC by using the Caris Life Sciences data set with the aim to establish signatures for HPV-dependent oncogenesis. The pSCC tumors were analyzed by using next-generation sequencing (NGS) of DNA and RNA. Programmed death ligand 1 (PD-L1) expression was evaluated by immunohistochemistry (IHC). Microsatellite instability (MSI) was tested by fragment analysis, IHC (SP142; ≥1%), and NGS. Tumor mutational burden (TMB)-high was defined as ≥10 mutations/Mb. HPV16/18 status was determined by using whole-exome sequencing (WES) when available. Significance was adjusted for multiple comparisons (q value < .05).

RESULTS
NGS of the overall cohort (N = 108) revealed TP53 (46%), CDKN2A (26%), and PIK3CA (25%) to be the most common mutations. Overall, 51% of tumors were PD-L1+, 10.7% had high TMB, and 1.1% had mismatch repair-deficient (dMMR)/MSI-high status. Twenty-nine patients had their HPV status made available by WES (HPV16/18+, n = 13; HPV16/18-, n = 16). KMT2C mutations (33% vs. 0%) and FGF3 amplifications (30.8% vs. 0%) were specific to HPV16/18+ tumors, whereas CDKN2A mutations (0% vs. 37.5%) were exclusive to HPV16/18- tumors. TMB-high was exclusively found in the HPV16/18+ group (30.8%). The two groups had comparable PD-L1 and dMMR/MSI-H status.

CONCLUSIONS
In a large and comprehensive NGS-based evaluation of somatic alterations in pSCC, HPV16/18+ versus HPV16/18- pSCCs were molecularly distinct tumors. Our finding that TMB-high is exclusive to HPV16/18+ tumors requires confirmation in larger data sets.

PLAIN LANGUAGE SUMMARY
Penile squamous cell carcinoma (pSCC) is a rare and aggressive malignancy in the advanced setting, with poor prognosis and little success with immune-checkpoint inhibitors (ICIs) in an unselected patient approach. Human papillomavirus (HPV) infection is a known risk factor for pSCC; its impact on genomic tumor profiling is less defined. Using next-generation sequencing, we explored the genetic landscape and ICI-related biomarkers of pSCC and HPV-driven oncogenic molecular signatures. Our results indicate that HPV-positive and HPV-negative pSCCs are molecularly distinct tumors. Increased tumor mutational burden is associated with HPV-positive tumors, and could serve as a biomarker for predicting therapeutic response to ICI-based therapies. Our results support the growing literature indicating that HPV status in pSCC can be used to guide patient stratification in ICI-based clinical trials.


: Homogeneous (as judged by data from gel filtration, ultracentrifugation, polyacrylamide gel electrophoresis with and without sodium dodecyl sulfate (SDS), and isoelectric focusing) beta-xylosidase showing beta-D-xylosidase, beta-D-glucosidase, beta-D-galactosidase, and alpha-L-arabinosidase activities has been isolated from the hemicellulase preparation of the microscopic fungus Aspergillus niger 15 by ethanol fractionation and chromatography on Sephadex G-50, cellulose DE-52, and Sephadexes SP C-50 and G-200. The specific activity of the enzyme toward p-nitrophenyl-beta-D-xylopyranoside (p-NPX) increased 199-fold and was equal to 35.2 units/mg of protein; the activity yield was 43%. The sedimentation coefficient was equal to 10.6 S, and the molecular weight was 253,000 according to the gel filtration data and 122,000 according to the data from SDS electrophoresis. The isoelectric point was at pH 4.9. An amino acid analysis has shown that dicarboxylic and hydrophobic amino acids prevail in the enzyme. beta-Xylosidase had no carbohydrate component, and p-chloromercuribenzoate inhibited its activity. The temperature optimum of beta-xylosidase activity toward p-NPX was at 70 degrees C, and the pH optimum was 3.8-4.0. The enzyme was stable at pH 3 to 8 and did not lose its activity for 1 h at temperatures up to 50 degrees C. D-Xylose was found to be a competitive inhibitor of the beta-D-xylosidase activity of the enzyme with Ki = 2.9 mM. beta-Xylosidase showed transglycosylase activity.


Data are lacking regarding the association of alcohol consumption with a broad range of other cancer risk factors. Objectives: (i) to assess which sociodemographic, lifestyle and dietary factors were associated with alcohol consumption; (ii) to identify profiles of alcohol consumers by beverage type; (iii) to estimate the number of cancer risk factors accumulated on the individual level according to alcohol consumption. Alcohol and dietary intakes were assessed by six 24 hr records among 29,566 adults of the NutriNet‐Santé cohort. Factors associated with alcohol consumption (nondrinkers (reference)/< 10 g/day/≥ 10 g/day) were assessed by polytomic multivariate logistic regression stratified by gender. Among alcohol consumers, percentages of alcohol brought by each beverage type were compared across sociodemographic and lifestyle characteristics using Kruskal‐Wallis rank tests. Several factors were associated with alcohol consumption ≥ 10 g/day in both genders: older age (pmen = 0.02, pwomen < 0.0001), smoking (pmen&women < 0.0001), higher socioprofessional category (pmen&women < 0.0001), higher income (pmen = 0.003, pwomen < 0.0001) and less healthy dietary intakes. Profiles of subjects varied across alcoholic beverage types. Men with history of cardiovascular disease (p = 0.0002) or depression (p = 0.03) and women with history of cirrhosis (p < 0.0001) consumed less alcohol. In women, personal history of cancer was associated with a lower proportion of moderate alcohol users only (< 10 g/day, p = 0.04). In both genders, higher alcohol drinkers clustered more cancer risk factors (median = 5, apart from alcohol) than nondrinkers (median = 4), p < 0.0001. The multiplicity of deleterious lifestyle behaviors combined with alcohol drinking must be taken into account in cancer prevention efforts. Gender‐specific medical advice for people with personal or family history of alcohol‐related diseases, including cancer, should be strengthened.


In this paper, we prove the global existence of weak solutions to the non-isothermal nematic liquid crystal system on $\mathbb T^2$, based on a new approximate system which is different from the classical Ginzburg-Landau approximation. Local energy inequalities are employed to recover the estimates on the second order spacial derivatives of the director fields locally in time, which cannot be derived from the basic energy balance. It is shown that these weak solutions conserve the total energy and while the kinetic and potential energies transfer to the heat energy precisely. Furthermore, it is also established that these weak solutions have at most finite many singular times at which the energy concentration occurs, and as a result, the temperature must increase suddenly at each singular time on some part of $\mathbb T^2$.


: In this paper a finite-time flocking of multi-agent system with input saturation is investigated. By introducing a new control protocol, it is show that speed and position of agents with double-integrator dynamics converge to the speed and position of leader in finite time. It is assumed that the graph between the agents is connected and that at least one agent is informed of the leader speed and position. It is shown that the agents do not collide under this control protocol and the graph remains connected. Further, conditions are provided by which the control signal level remains less than the limiting saturation range.


The configuration of a distributed storage system typically includes, among other parameters, the set of servers and their roles in the replication protocol. Although mechanisms for changing the configuration at runtime exist, it is usually left to system administrators to manually determine the "best" configuration and periodically reconfigure the system, often by trial and error. This paper describes a new workload-driven optimization framework that dynamically determines the optimal configuration at run-time. We focus on optimizing leader and quorum based replication schemes and divide the framework into three optimization tiers, dynamically optimizing different configuration aspects: 1) leader placement, 2) roles of different servers in the replication protocol, and 3) replica locations. We showcase our optimization framework by applying it to a large-scale distributed storage system used internally in Google and demonstrate that most client applications significantly benefit from using our framework, reducing average operation latency by up to 94%.


Background and objective: Many authors have emphasized the difficulty of choosing suitable replacement teeth for edentulous patients and arranging these teeth in a natural way. In dentures, mesiodistal width of anterior teeth is the most important factor, because complete denture will not be able to provide a real appearance if artificial teeth are too small. For obtaining proper occlusion, maxillary and mandibular teeth must be proportional in size.. The purpose of this study is to determine correlation between the average mesiodistal width of posterior teeth and anterior teeth.
Materials and methods: The sample consisted of 40 pairs of study casts of both jaws with normal occlusion (50% male and 50% female; aged 18-26). The mesiodistal width was measured directly on plaster models by use of a digital caliper (Mitutoyo, Tokyo, Japan) at the widest level of proximal contact area of the teeth. Measurements were repeated 1 day and 1 week later. Data was analyzed using SPSS 10 (Statistical Package for Social Sciences SPSS Inc., Chicago, IL). Mean and standard deviation values were calculated for each variable. Comparisons between female and male samples were made for each variable using Student's t-test.
Results: The mean value for the mesiodistal width ratio of upper anterior to posterior sextant was calculated for female and male samples (1.38 ± 0.1 and 1.36 ± 0.07m respectively). The mean ratio for mesiodistal width of lower anterior to posterior sextant was calculated for female and male samples (1.00 ± 0.05 and 1.02 ± 0.05, respectively).
Conclusions: the ratio of mesiodistal width of anterior teeth to posterior teeth can be used as a guideline for choosing correct artificial teeth for partially edentulous patients.


Abstract Decapod crustaceans bearing major claws with long, slender fingers armed with pectinate (comblike) denticles have been described in six genera arrayed within three families (Polychelidae, Nephropidae, and Ctenochelidae) in three infraorders (Palinura, Astacidea, and Anomura, respectively). Only one or a few genera in each infraorder exhibit this claw form. The pectinate claw form is confidently interpreted as having evolved independently in four lineages: once in the Polychelidae, once in the Ctenochelidae, and twice in the Nephropidae. Three of the lineages are known from both the fossil record and modern seas; the polychelid form is known only from Jurassic rocks. Convergence in this claw form developed to the extent that isolated fossil claws (i.e., claws without associated bodies) have commonly been misidentified at high taxonomic levels. The fossil record confirms what seems intuitively reasonable: that claw morphology is prone to convergence and should not, by itself, be given a high degree of taxonomic importance.


With the advent of ubiquitous computing there are two design parameters of wireless communication devices that become very important: power efficiency and production cost. Compressive sensing enables the receiver in such devices to sample below the Shannon-Nyquist sampling rate, which may lead to a decrease in the two design parameters. This paper investigates the use of Compressive Sensing (CS) in a general Code Division Multiple Access (CDMA) receiver. We show that when using spread spectrum codes in the signal domain, the CS measurement matrix may be simplified. This measurement scheme, named Compressive Spread Spectrum (CSS), allows for a simple, effective receiver design. Furthermore, we numerically evaluate the proposed receiver in terms of bit error rate under different signal to noise ratio conditions and compare it with other receiver structures. These numerical experiments show that though the bit error rate performance is degraded by the subsampling in the CS-enabled receivers, this may be remedied by including quantization in the receiver model. We also study the computational complexity of the proposed receiver design under different sparsity and measurement ratios. Our work shows that it is possible to subsample a CDMA signal using CSS and that in one example the CSS receiver outperforms the classical receiver.


This article lays out and defends the role of political parties in cultivating a democratic ethos among citizens. It argues that citizens' commitment to the democratic idea of self-rule requires positive conviction of the worth of collective political agency, and suggests that this conviction draws on three main sources, characterised as normative, motivational and executive. The article shows theoretically why parties are able to cultivate all three sources in a way no other political actor can match, thus constituting a unique and indispensable mode of civic engagement. Moreover, it proposes that the widely noted shortcomings of parties in contemporary democracy leave this basic capacity unimpaired, indeed that certain important developments herald renewed opportunities.


A boy discovers a bizarre-looking creature while out collecting bottle-tops at a beach. Having guessed that it is lost, he tries to find out who owns it or where it belongs, but the problem is met with indifference by everyone else, who barely notices its presence. Each is unhelpful in their own way; strangers, friends, parents are all unwilling to entertain this uninvited interruption to day-to-day life. In spite of his better judgement, the boy feels sorry for this hapless creature, and attempts to find out where it belongs.


Pandemics cause chaotic situations in supply chains (SC) around the globe, which can lead towards survivability challenges. The ongoing COVID-19 pandemic is an unprecedented humanitarian crisis that has severely affected global business dynamics. Similar vulnerabilities have been caused by other outbreaks in the past. In these terms, prevention strategies against propagating disruptions require vigilant goal conceptualization and roadmaps. In this respect, there is a need to explore supply chain operation management strategies to overcome the challenges that emerge due to COVID-19-like situations. Therefore, this review is aimed at exploring such challenges and developing strategies for sustainability, and viability perspectives for SCs, through a structured literature review (SLR) approach. Moreover, this study investigated the impacts of previous epidemic outbreaks on SCs, to identify the research objectives, methodological approaches, and implications for SCs. The study also explored the impacts of epidemic outbreaks on the business environment, in terms of effective resource allocation, supply and demand disruptions, and transportation network optimization, through operations management techniques. Furthermore, this article structured a framework that emphasizes the integration of Industry 4.0 technologies, resilience strategies, and sustainability to overcome SC challenges during pandemics. Finally, future research avenues were identified by including a research agenda for experts and practitioners to develop new pathways to get out of the crisis.


Background/context HILS have been using video debriefing in simulation since our centre opened, yet have noticed a variability of faculty success in using it. In an attempt to uncover best practise, the technical team set out to document the effective use of bookmarks in video debriefing during a 15 day mandatory simulation course for Junior Doctors. Description of innovation or topic The Technical Team recorded the following: The number of total bookmarks made per scenario The number of bookmarks actually used in each debriefing Whether the use of the video bookmark was successful or not Comments on communication between technician and debriefer Improvements/outcomes (anticipated or recorded) With immediate effect, there were obvious techniques which resulted in differences between the debriefing of scenarios such as Whether bookmarks where identified with number, time or text description Whether bookmarks were used from printed paper or from onscreen menus When the data is analysed, we also expect to find An increase in the number of 'good' bookmarks used over time from individual debriefers No correlation between number of bookmarks made, and bookmarks used Take home messages There are subtle improvements that can be made to improve the effectiveness of using video in a debriefing There is a wide variation in the use of video debriefing1 Reference http://icenetblog.royalcollege.ca/2015/02/10/effective-debriefing-tips-for-simulation-based-medical-education/


Terrorism financing is one of the most complex problems the democratic world is facing today. The transfer of funds to support terrorist activities has created enormous challenges across the world. This has fuelled several inter-religious and nationalist hate, and as such has put many nations into war with terrorist organisations. The main objective of this study is to review the sources of terrorist financing. The paper relies on secondary data that were drawn from various books, journals, as well as from institutional materials relevant to the issues raised. It concludes that terrorists are exploiting established financial systems at the global level to move their finances, and that informal systems remain the biggest challenge to thwart terrorist activities.


The relationship between tunicates and the uncultivated cyanobacterium Prochloron didemni has long provided a model symbiosis. P. didemni is required for survival of animals such as Lissoclinum patella and also makes secondary metabolites of pharmaceutical interest. Here, we present the metagenomes, chemistry, and microbiomes of four related L. patella tunicate samples from a wide geographical range of the tropical Pacific. The remarkably similar P. didemni genomes are the most complex so far assembled from uncultivated organisms. Although P. didemni has not been stably cultivated and comprises a single strain in each sample, a complete set of metabolic genes indicates that the bacteria are likely capable of reproducing outside the host. The sequences reveal notable peculiarities of the photosynthetic apparatus and explain the basis of nutrient exchange underlying the symbiosis. P. didemni likely profoundly influences the lipid composition of the animals by synthesizing sterols and an unusual lipid with biofuel potential. In addition, L. patella also harbors a great variety of other bacterial groups that contribute nutritional and secondary metabolic products to the symbiosis. These bacteria possess an enormous genetic potential to synthesize new secondary metabolites. For example, an antitumor candidate molecule, patellazole, is not encoded in the genome of Prochloron and was linked to other bacteria from the microbiome. This study unveils the complex L. patella microbiome and its impact on primary and secondary metabolism, revealing a remarkable versatility in creating and exchanging small molecules.


Netosis and abzyme activity are the significant components of the innate immunity. Spontaneous and induced netosis, various types of proteolytic and oxidoreductase abzyme activity in patients with COPD and BA were determined in this study. NETs were determined by both light and fluorescence microscopy using a previously developed staining method. As a result of the work, an increase of the induced netosis was found in patients with COPD, relative to patients with BA. A significant increase in the IgA peroxidase activity was found in patients with BA relative to patients with COPD. Data on hyaluronidase, catalase, elastase, dipeptidyl dipeptidase-4-similar activity were obtained. A correlation between the peroxidase and catalase activity of IgA in patients with BA was found.


Patients with chronic prostatitis have an increased number of white blood cells in expressed prostatic secretion. Two groups can be separated, one is characterized by uropathogenic bacteria in expressed prostatic secretion and recurrent urinary tract infections, chronic bacterial prostatitis. In this group an immune response to the bacteria has been demonstrated. Patients belonging to the other group, non-bacterial prostatitis, have similar symptoms. Many harbour Gram-positive bacteria in a high number, often Staphylococcus epidermidis in expressed prostatic secretion. This bacteria is usually not considered in prostatitis in spite of extreme high numbers. The etiology of non-bacterial inflammations is thus unknown. Forty-three per cent of the patients with chronic prostatitis had Gram-positive bacteria and 13% had Gram-negative in expressed prostatic secretion. Forty-four per cent of patients referred with symptoms of prostatitis did not have any aerobic bacteria at the prostatic level in sufficient number for the diagnosis bacterial prostatitis according to Meares and Stamey and form thus a third group. Antibiotic treatment of patients with non-bacterial prostatitis reduced symptoms but also changed the bacterial flora in urethral and prostatic secretion in such a way that uropathogens were found after treatment. In a group of patients an immunologic response to Staph. epidermidis was searched for by measuring complement components (C3c, C4c) as well as ceruloplasmin in serum and immunoglobulins (IgA, IgG) in seminal plasma. A specific ELISA method to estimate antibodies in serum against Staph. epidermidis was tested. No specific pattern separated patients from controls or patients with Gram-negative bacteria from patients with Gram-positive bacteria. Staphylococcus saprophyticus in cultures from men with prostatitis were more frequent in the third quarter of the year. The bacteria seemed to appear during or after antibiotic treatment but disappeared spontaneously during a follow-up period of six months. Treatment with the surfactant sodium pentosanpolysulphate, a heparinoid, given orally to patients with chronic prostatitis reduced concomitant pain in muscles and joints. The possibility of an altered host factor function in the polymorphonuclear leucocytes of patients with chronic non-bacterial prostatitis colonized with Staph. epidermidis was investigated. Chemotaxis, phagocytosis and intracellular killing were reduced in vitro and may to a part explain the bacteriological findings. Careful evaluations must thus be performed of earlier neglected factors to reach better knowledge of the chronic prostatitis.


We use the Nernst effect to delineate the boundary of the pseudogap phase in the temperature-doping phase diagram of hole-doped cuprate superconductors. New data for the Nernst coefficient ν(T) of YBa2Cu3Oy (YBCO), La1.8−xEu0.2SrxCuO4 (Eu-LSCO), and La1.6−xNd0.4SrxCuO4 (Nd-LSCO) are presented and compared with previously published data on YBCO, Eu-LSCO, Nd-LSCO, and La2−xSrxCuO4 (LSCO). The temperature Tν at which ν/T deviates from its high-temperature linear behavior is found to coincide with the temperature at which the resistivity ρ(T) deviates from its linear-T dependence, which we take as the definition of the pseudogap temperature T★—in agreement with the temperature at which the antinodal spectral gap detected in angle-resolved photoemission spectroscopy (ARPES) opens. We track T★ as a function of doping and find that it decreases linearly vs p in all four materials, having the same value in the three LSCO-based cuprates, irrespective of their different crystal structures. At low p,T★ is higher than the onset temperature of the various orders observed in underdoped cuprates, suggesting that these orders are secondary instabilities of the pseudogap phase. A linear extrapolation of T★(p) to p=0 yields T★(p→0)≃TN(0), the Neel temperature for the onset of antiferromagnetic order at p=0, suggesting that there is a link between pseudogap and antiferromagnetism. With increasing p,T★(p) extrapolates linearly to zero at p≃pc2, the critical doping below which superconductivity emerges at high doping, suggesting that the conditions which favor pseudogap formation also favor pairing. We also use the Nernst effect to investigate how far superconducting fluctuations extend above the critical temperature Tc, as a function of doping, and find that a narrow fluctuation regime tracks Tc, and not T★. This confirms that the pseudogap phase is not a form of precursor superconductivity, and fluctuations in the phase of the superconducting order parameter are not what causes Tc to fall on the underdoped side of the Tc dome.


Abstract Water issues in the western United States include a long history of struggle, controversy and politics. Collaboration and compromise are required to achieve desirable outcomes in water quality and water rights. Collective Currents is an interactive art installation, developed collaboratively by a computer engineer and a multimedia artist, that explores the idea of cooperative experience in both literal and conceptual ways and creates an environment that makes reference to and engages the viewer to think about our ability to understand and solve environmental issues, specifically water quality and conservation, through collaboration.


In this paper, an efficient force-recovery algorithm is presented for a novel planar photoelastic tactile transducer. A distributed-force profile input to the tactile sensor developed in our laboratory generates stress in the photoelastic layer of the transducer, making it birefringent. Circularly polarized light input to the transducer is elliptically polarized at the output due to phase-lead created in the stressed photoelastic layer. The algorithm presented recovers the phase-lead distribution and correlates it to the input force profile. Since this distribution is a linear function of the force profile, the solution of the inverse-tactile problem is significantly simplified. The paper presents the analytical basis of the algorithm as well as the numerical technique used in its solution.


UNLABELLED
OBJECT.: To date, experience of globus pallidus internus (GPi) deep brain stimulation (DBS) in the treatment of Huntington's disease (HD) has been limited to a small number of case reports. The aim of this study was to analyze long-term motor outcome of a cohort of HD patients treated with GPi DBS.

METHODS
Seven patients with pharmacologically resistant chorea and functional impairment were included in a prospective open-label study from 2008 to 2011. The main outcome measure was the motor section of the Unified Huntington's Disease Rating Scale. The primary end point was reduction of chorea.

RESULTS
Patients underwent MRI-guided bilateral GPi implantation. The median duration of follow-up was 3 years. A significant reduction of chorea was observed in all patients, with sustained therapeutic effect; the mean improvement on the chorea subscore was 58.34% at the 12-month follow-up visit (p = 0.018) and 59.8% at the 3-year visit (p = 0.040). Bradykinesia and dystonia showed a nonsignificant trend toward progressive worsening related to disease evolution and partly to DBS. The frequency of stimulation was 130 Hz for all patients. DBS-induced bradykinesia was managed by pulse-width reduction or bipolar settings. Levodopa mildly improved bradykinesia in 4 patients. Regular off-stimulation tests confirmed a persistent therapeutic effect of DBS on chorea.

CONCLUSIONS
GPi DBS may provide sustained chorea improvement in selected HD patients with pharmacologically resistant chorea, with transient benefit in physical aspects of quality of life before progression of behavioral and cognitive disorders. DBS therapy did not improve dystonia or bradykinesia. Further studies including quality of life measures are needed to evaluate the impact of DBS in the long-term outcome of HD.


Author(s): Moncloa, Fe; Erbstein, Nancy; Subramaniam, Aarti; Diaz-Carrasco, Claudia | Abstract: This practitioner brief offers an overview of the findings and recommendations that emerged from a 2-year qualitative study that draws on observations of thirteen organizations in California serving Latinx youth and the perspectives of seventeen youth development professionals and fifty-three Latinx and diverse youth.This brief offers some key guiding principles related to each of the four dimensions of youth development organizations: conceptual framework, organizational infrastructure, program elements, and program and community relationship.


This volume presents a framework designed to help international development partners consider the relevance of political economy issues for their programmatic support to decentralization and local government reform. The intention is neither to advocate decentralization in general or in any particular form, nor to presume or privilege any particular decentralization objective. Instead, the purpose is to document the potential value of better understanding how (primarily national and intergovernmental) political and institutional dynamics do or could affect the scope for realizing decentralization reforms aligned with commonly advocated service delivery, governance, and poverty reduction goals. The underlying premise is that systematic analysis of these issues can productively complement the dominantly technical diagnostic work typically carried out by development partners. Specifically, development partners can benefit from better understanding the practical significance of motives that drive politicians and bureaucrats to support or oppose reform at various stages of the decentralization process, from making an initial reform decision to detailed design and implementation. In addition, the authors address how these incentives can weaken, strengthen, or shift in response to changes in political and economic conditions that arise after reform begins. A general approach to conducting political economy of decentralization analysis is outlined, recognizing the need to tailor such analysis to the particular country context. This volume is based on literature reviews and knowledge derived from selected country experiences.


The measurement and evaluation of sheet metal surface characteristics is of increasing importance, due to the significant functional impact on finishing processes like forming and varnishing. For a comprehensive and useful description of textured topographies including nonstatistical characteristics, a simple profile evaluation based on 2D roughness parameters is no longer sufficient. The introduction of area-imaging white light confocal microscopy offers, in contrast to tactile profiling methods of comparable accuracy, the clear advantage of contact-free and extremely fast 3D data capture. The capabilities and benefits of this technology in interaction with sophisticated 3D area analysis methods are demonstrated by measurement examples of sheet metal and roller surfaces. A newly-developed mobile confocal measurement system for direct roller measurements is introduced.


From June 2009 to February 2010, the Health Protection Agency hosted a clinical network including regular teleconferences, with the aim of sharing clinical experiences of the international participants about pandemic influenza. The minutes of the teleconferences over a two month period were analysed to identify clinical themes. A systematic literature search was then undertaken to identify peer-reviewed publications that either supported or refuted these themes. Observations relating to patient demographics, clinical features and clinical management were supported by published literature. Younger adults and children were more likely to be infected, but young adults were more likely to require intensive care. Obesity, pregnancy and asthma were confirmed as risk factors for severe influenza illness. Extra-pulmonary organ dysfunction was common, often requiring specific interventions. The benefit of certain ventilatory and non-ventilatory interventions remains unclear, although they were frequently used. This global clinical networking model facilitated the real-time exchange of valuable clinical information and provided the basis for clinical practice notes.


Sleepiness has been recognized as a causal factor in many round-the-clock industries. While individuals can subjectively express their momentary sleepiness level, sleepiness-related contextual factors (CF) can influence their perception of sleepiness and cognitive performance. In this paper, the self-reported sleepiness value (vSRS) was improved by transforming it into a kernel density estimate and the assignment of the class's score is done using a likelihood ratio test (IvSRS). We integrated multiple CF and IvSRS to model sleepiness using a Bayesian network (BN). The BN produced a single probability estimate calculated based on the prior and posterior probability of the CF and IvSRS. The results showed IvSRS performed better (p < 0.05) in classifying sleepiness to three states, compared to non-modified vSRS. Considering each CF and IvSRS as stand alone indicators, integrating all these information under a BN significantly improved the systems performance (p ≤ 0.05). In addition to being able to function well in the event of missing vSRS, the proposed system has a prediction horizon of 12 h, with F1-measure > 78%.


The problem investigated concerns the robust estimation of fundamental period, only on the basis of representative speech pressure waveforms. The work has involved the design and development of a set of algorithms. The main intended application is in pattern processing acoustic and cochlear implant hearing aids. Essentially the task is to infer from the acoustic evidence available the points in time at which vocal fold closures occur. Its accomplishments both gives fundamental period information on a cycle-bycycle basis and provides information concerning whether voicing is present. The task of detecting the point of closure of the vocal folds is formulated as a pattern recognition problem, and the pattern recognition technique employed uses the multi-layer perceptron (MLP). The first system configurations investigated were based on a pre processing of the speech pressure waveform by a wide-band filterbank analyzer. This gave an input to the classifier which consisted of a set of adjacent time frames from the output of the filterbank. The output from the classifier was defined as being in one of two classes. In the first there is a period epoch marker at a given output frame, in the second there is not. This first classifier was trained to generate an output which signified the presence of a vocal fold closure at the centre of its input window. The fundamental periods between successive vocal-fold closures defined by these epoch markers, are given the name Tx. The labelling of both training and test data was performed semi-automatically by means of an algorithm that makes use of the output of a laryngograph. Developments of this first approach were then explored. These were primarily directed towards methods for reducing the training time for the MLP and improving the time resolution of the fundamental period estimates. Different pre-processing stages were investigated and these included direct operation on the speech pressure waveform and the use of a simplified auditory filterbank. Methods to reduce the computation load required for practical implementation were examined and these resulted in a system using a low-order filterbank together with a smaller MLP network. The last configuration was of practical interest because it had a processing load small enough to 2 be run in real-time on a portable DSP system. A real-time system was implemented in conjunction with Mr. John Walliker. First patient results using this system are reported following perceptual assessments made by Dr. Andrew Faulkner. A number of objective assessment techniques were developed and used to permit quantitative comparisons between fundamental period estimation algorithms to be carried out. These involved both quantitative comparisons between frequency contours and between time excitation epoch markers. Using these comparisons, various different configurations of the MLP-Tx algorithm were evaluated over a wide range of speakers and environmental conditions. The performance of the MLP-Tx algorithm was also compared against that of established fundamental frequency estimation algorithms, and its performance in competing noise was found to be better than that obtainable by the use of the peak-picking approach previously employed.


The popularity of "mobile wallets" (or "mobile payment" platforms) is one of the most prominent trends in the mobile commerce (m-commerce) era. However, like most mobile applications (apps), mobile wallet apps usually suffer from low repeat usage rates. Most extant research on mobile users' app usage behavior focuses on the early stage of app usage, such as app download and adoption intentions, and researchers know little about what makes a mobile payment app successful in engaging users, maintaining user base, and achieving favorable economic outcomes. In addition, extant research on mobile users' experience, engagement and usage are based primarily on subjective survey responses, and there has been a lack of empirical investigation on users' actual behavior. To bridge these research gaps, this dissertation empirically examines multiple stages during users' app usage with individual-level tap stream data from a hybrid mobile wallet app. The first essay explores three intersections: first, it considers jointly users' acquisition and retention processes with the mobile wallet app; it also examines the relationship between acquisition and retention; and third, it analyzes the effects of vii marketing and operational factors on the previous two processes. Results of the analysis suggest that while an aggressive "onboarding" promotion at "born" stage has a positive effect on user acquisition, it does not have any effect on subsequent retention. In addition, this dissertation finds a negative duration dependence on both acquisition and retention compounded by a negative correlation between the two processes. This negative duration indicates an unfavorable situation, which suggests the ineffectiveness of current marketing promotion strategies in gaining loyal users for the mobile wallet app. The second essay examines user experience and user engagement with the mobile wallet app during multiple usage sessions. Measuring user experience and engagement with observable user actions based on individual-level tap stream data, the essay investigates the effecs of user experience and firms' marketing efforts on user engagement and purchase decisions. The results reveal an intermediate role of user engagement between user experience and purchase decisions. Surprisingly, the negative experience of technical failure does not always discourage users in engaging with the app or making purchases. Through empirical exploration and novel findings on mobile users' app usage pattern, and through new determinations of the effects of marketing in the context of the emerging mobile payment, this dissertation contributes substantively to the literature of mobile marketing.


Diabetes mellitus is a metabolic disorder in the endocrine system. This dreadful disease is found in all parts of the world and becoming a serious threat of mankind health. There are lots of chemical agents available to control and to treat diabetic patients, but total recovery from diabetes has not been reported up to this date. In addition to adverse effects, drug treatments are not always satisfactory in maintaining euglycemia and avoiding late stage diabetic complications. Alternative to these synthetic agents, plants provided a potential source of hypoglycemic drugs and are widely used in several traditional systems of medicine to prevent diabetes. Several medicinal plants have been investigated for their beneficial effect in different type of diabetes. Other alternative therapies such as dietary supplements, acupuncture, hydrotherapy, and yoga therapies less likely to have the side effects of conventional approaches for diabetes.


Fiber metal laminates (FMLs), a new type of material for use in airframes, are composed of thin plies of metals and fiber-reinforced polymers (FRP). One drawback of conventional composite materials containing only FRP plies is their susceptibility to suffer internal damage due to low-velocity impact while showing little evidence of damage on the surface. Research reported in Part 1, and its companion Part 2, evaluated the resistance of a specific type of FML, glass-reinforced aluminum (Glare), to low-velocity impact. The experiments, a review of previous impact tests, the test program carried out in this project, and its results are discussed. The work confirmed that some consequences of impact on Glare are similar to the damage modes found in FRP composites such as delaminations, fiber breakage, and, ultimately, penetration of the material. On the other hand, in contrast to FRP composites, impact dents are formed that would reveal the impact during visual component inspections. Additionally, it was determined that Glare-5-2/1 laminates had the highest relative impact resistance of those tested.


Importance
In preterm infants, mechanical ventilation (MV) is associated with adverse pulmonary and neurodevelopmental outcomes. Multiple randomized clinical trials over the past 2 decades have shown the effectiveness of early noninvasive ventilation (NIV) in decreasing the use of MV in preterm infants. The epidemiologic factors associated with respiratory support in US preterm infants and any temporal changes after these trials is unknown.

Objective
To evaluate temporal changes in MV and noninvasive respiratory support in US preterm infants.

Design, Setting, and Participants
In a cohort design, 2 large national data sets (Pediatrix Clinical Data Warehouse for the clinical cohort and National Inpatient Sample for the national cohort) were used to collect data on preterm infants (<35 weeks' gestation) without congenital anomalies who received active intensive care and were discharged home or died in the birth hospital from January 1, 2008, to December 31, 2018. Data analysis was conducted from December 10, 2019, to December 16, 2020.

Exposure
Discharge year.

Main Outcome and Measures
In the clinical cohort, detailed respiratory support data were generated, including days of MV and NIV modalities, and temporal trends were evaluated using multivariable modified Poisson or negative binomial regression models with discharge year as a continuous variable. In the national cohort, observed and expected national MV use were calculated.

Results
Among 259 311 infants (47.2% female) in 359 neonatal intensive care units in the clinical cohort, decreases were noted in the use (from 29.4% of infants in 2008 to 18.5% in 2018, relative risk for annual change, 0.96; 95% CI, 0.95-0.96) and duration (mean days, from 10.3 in 2008 to 9.7 in 2018; rate ratio for annual change, 0.98; 95% CI, 0.97-0.98) of MV. Noninvasive ventilation use increased from 57.9% of infants in 2008 to 67.4% in 2018 (adjusted relative risk for annual change, 1.02; 95% CI, 1.02-1.03), and mean NIV duration increased by 3.2 days (95% CI, 2.9-3.6 days). With increased use of continuous positive airway pressure and nasal intermittent positive-pressure ventilation as the main factors in the increase, the mean duration of respiratory support increased from 13.8 to 15.4 days (adjusted rate ratio for annual change, 1.03; 95% CI, 1.02-1.04) from 2008 to 2018. Among 1 169 441 infants in the national cohort, MV use decreased from 22.0% in 2008 to 18.5% in 2018, with an estimated 29 700 fewer ventilated infants and 142 000 fewer days of MV than expected during this period.

Conclusions and Relevance
These findings suggest that preterm respiratory support changed significantly from 2008 to 2018, with decreased use and duration of MV, increased use and duration of NIV, and an overall increase in respiratory support duration.


: Prior work has successfully described how low and high-performing dyads of students differ in terms of their visual synchronization (e.g., Barron, 2000; Jermann, Mullins, Nuessli & Dillenbourg, 2011). But there is far less work analyzing the diversity of ways that successful groups of students use to achieve visual coordination. The goal of this paper is to illustrate how well-coordinated groups establish and sustain joint visual attention by unpacking their different strategies and behaviors. Our data was collected in a dual eye-tracking setup where dyads of students (N=54) had to interact with a Tangible User Interface (TUI). We selected two groups of students displaying high levels of joint visual attention and compared them using cross-recurrence graphs displaying moments of joint attention from the eye-tracking data, speech data, and by qualitatively analyzing videos generated for that purpose. We found that greater insights can be found by augmenting cross-recurrence graphs with spatial and verbal data, and that high levels of joint visual attention can hide a free-rider effect (Salomon & Globerson, 1989). We conclude by discussing implications for automatically analyzing students' interactions using dual eye-trackers.


We present Assembler3 a software tool that allows users to perform 3D parametric manipulations on 2D laser cutting plans. Assembler3 achieves this by semi-automatically converting 2D laser cutting plans to 3D, where users modify their models using available 3D tools (kyub), before converting them back to 2D. In our user study, this workflow allowed users to modify models 10x faster than using the traditional approach of editing 2D cutting plans directly. Assembler3 converts models to 3D in 5 steps: (1) plate detection, (2) joint detection, (3) material thickness detection, (4) joint matching based on hashed joint "signatures", and (5) interactive reconstruction. In our technical evaluation, Assembler3 was able to reconstruct 100 of 105 models. Once 3D-reconstructed, we expect users to store and share their models in 3D, which can simplify collaboration and thereby empower the laser cutting community to create models of higher complexity.


The red gum lerp psyllid (RGLP) (Glycaspis brimblecombei) is a newly established foliar pest on red gum eucalyptus trees (Eucalyptus camaldulensis) in California, U.S. (Gill 1998). Since its initial detection in southern California in 1998, RGLP has quickly spread throughout California and has infested eucalyptus as far north as the San Francisco Bay area and south to San Diego (Brennan et al. 1999). Heavy populations of RGLP have resulted in extensive defoliation that has stressed trees, making them susceptible to nutritional stress, disease, and invasion from other insects (Brennan et al. 1999; Garrison 1999). The RGLP nymph constructs a protective sugary covering (lerp) that protects it from predators and prevents pesticides from making contact through conventional foliar spraying. Applying systemic materials may be an effective approach in controlling this new pest. Koehler and Campbell (1968) were among the first to implement systemic applications of pesticide to control foliage pests of shade trees. Costonis (1981) and Gardner (1986) have reviewed the efficiency and benefits of pesticide micro-injection, and recently Stanton et al. (1999) reported significantly reduced lace bug damage on green hawthorn (Crataegus viridis) via trunk and soil injection of systemic pesticides. Systemtic pesticide field trials were initiated utilizing the J.J. Mauget method of micro-injection in eucalyptus trees in July 1999. Three treatments were tested: single treatments of oxydemeton-methyl, imidacloprid, and a combination of both. The objective was to determine the efficacy rate of performance and residual activity of micro-injected treatments of oxydemeton-methyl, imidacloprid, and a combination of both materials against RGLP nymphs.


It may seem redundant to address Sport as a development trigger but, sometimes, redundancy is necessary for someone to be heard. The commanding voices of Philosophy in the XXth century take sciences as trivial, by expressing the notion that Science has nothing to do with the ontological and metaphysical statutes of men. What is at stake is too much important, as the attack is not aimed at Sciences, organizations and institutions, nor at the people, but rather against Reason itself. We found ourselves immersed in irrationalities and superstitions in the most primitive form of belief. Worldwide there are three times more astrologists than there are physics. In Portugal, also in Sport, there are numberless stand-coaches and pseudo-writers, which all speak and write about exercise and appear as public opinion makers, stating banalities that discredit Sport and its professionals. In western science, what is axiomatic is not merely the concept of progress, but rather the concept of constant and unlimited progress. And we take for granted this lack of limits… Indeed, it seems …… In fact, it is a deeply enigmatic assumption, taking into account the metaphysical meaning of the term. And it is from these assumptions that we must analyse the role of Sport and Exercise. Biological life may be increased in duration, but death will come: and the challenge is therefore the quality of an extended life. In Sport and exercise, progress has more than a technical relevance, it has an ontological relevance: the enhancement of a life cycle. Sport is, therefore, an immeasurable asset and holds opportunity to induce peace and be a promoter of several social causes. Sport is one of the possible, perhaps the main, cultural objectification and historical form of movement. This is only possible by valuing the fundamental character of the body in motion, because it is upon it that the sports body is installed and merges. Even giving it a fundamental meaning, it has not yet found its value due to the failure in the evaluation of its return, whether educational, social, health, economic or structural. The importance of Sport and its institutions cannot be measured, as much as some state so, by performance indicators in an international setting (this leads to unfair, unproportioned comparisons among sports with different density and international coverage). A message that, unfortunately, has passed to general society, involving risks to lower even more the national sport involvement is: resources must be mainly focused in the few sports with international merit. With time, this will end up in an overall failure of national Sport, and subsequently a progressive underfinancing of the Sport will appear. Every organization that deal with Sport cannot deviate from what is its main mission, to organize, promote and spread the Sport for a permanent and constant demonstration that what is done and how it's done fully respect the high public interest and, ultimately, serves the people. This role is also that of Science.


The aim of this paper is to make a detour through the notion of information (e.g., Adriaans, van Benthem, 2008) in order to explore whether it can bring useful insights concerning the regulation of algorithms and machine learning from a data protection law perspective.

The notion of information is central both to data protection law (which defines personal data as "any information relating to an identified or identifiable natural person"), and to algorithms/machine learning, which are predicated upon the possibility of extracting information from data, pursuant to the canonical DIKW (data, information, knowledge, wisdom) pyramid, as first conceptualized by Ackoff (1989). It is this centrality that gives the impressions that algorithms and machine learning processes are just yet another data processing operation to be regulated. However, current debates around the data protection law-oriented regulation of algorithms show that there are still broad interrogations concerning the protection afforded thereby (see Bygrave, 2017; Wachter, Mittelstadt, Floridi, 2017). More radical critics argue that data protection is simply ill-suited for such regulatory purpose (see de Vries, 2016; Gurses, van Hoboken, 2017).

This contribution echoes this last strand of criticism insofar as it argues that the under-explored meaning of information might account for such inadequacy. Albeit mobilized by both practices (data protection law and machine learning), it seems that information and its meaning are taken for granted, and in so doing justify the regulatory reach of data protection in the first place. Yet, as it transpires from debates in data protection law (see Bygrave, 2014; Hallinan and De Hert, 2016), the meaning of personal data and information (which is a core component of the latter) are far from being clear. Furthermore, the present conceptual exploration shows that the meaning of information as it is deployed in algorithms/machine learning is in any case dissimilar therefrom. Therefore, in unpacking how both practices frame and mobilise different notions of information, this contribution aims at showing that data protection law may not necessarily be the most adequate framework for regulating algorithms and machine learning; and possibly at showing some alternative way(s) forward.


Clearfil DC Bond (DC) is a new single-step, dual-cure bonding agent. In this study, the shear bond strengths of a core build-up composite to dentin used with four bonding systems [DC, Unifil Core Self-Etching Bond (UC), Clearfil SE Bond (SE) and Cleafil tri-S Bond (TS)] were measured. The bonding ability after 7 days of storage and in vitro durability following 20,000 thermocycles were also evaluated. The bond strength of DC did not differ significantly from those of other bonding systems after 24 hours of storage. Another dual-cure bonding system, UC, showed a significant reduction of bond strength after 7 days of storage. On the other hand, the bond strength of TS, a light-cured bonding system with a similar composition to DC, was reduced significantly following 20,000 thermocycles. SE, a two-step light-cure bonding system in the same series as DC, provided superior bond strength under all conditions. Although DC showed a slightly lower bond strength than SE, there was no significant difference between DC and SE under all conditions. Consequently, DC may be a useful and effective bonding system for multiple composite resin restorations.


The reason for this contribution is need for analysis and evaluation of the support of adding value to food products in framework of the Rural Development Programme (sub-measure I.1.3.1) in the context of the preparation of new documents for the new programming period 2014 - 2020. Application of research results is the first step to modification of rules for the RDP granting aid for the programming period 2014 - 2020 in order to be efficient and targeted at food industry in the new conditions. From a methodological point of view the solution is based on counterfactual analysis and identifies the main effects for the food industry using economic indicators. Results show that the supported businesses consolidated their economic position to a certain extent. The investment support has positive impact on financial stability because participants had smaller decrease of profitability than nonparticipants in the period 2007 - 2010. The investment support increases labour productivity. But due to the higher depreciation, as the consequence of investments in fixed assets, the overall effects on economic results are slightly reduced. The author gratefully acknowledge the support of the Ministry of Agriculture – the support came from the institutional support of the Institute of Agricultural Economics and Information (internal research project no. 1262 – "Economic performance of the Czech food processing sector with focus on small and medium enterprises in the context of the measures Rural Development Programme").


There has been renewed interest into affective symptoms and psychological approaches to schizophrenia and other psychosis, yet no in-depth investigation as to the course, consequences or indeed psychological causes of depression in a phase specific manner in the important first episode. Our understanding of risk and aetiological processes in psychotic illness will only advance once we accurately identify the "end phenotype" of psychotic illness. This series of studies investigates the course of depression in first episode psychosis, its significance in terms of suicidal thinking, and relation to both diagnosis and other symptom domains. Depression in the acute and post psychotic phases is explored, through the importance of the awareness and appraisal of positive symptoms, and diagnosis itself. Significant findings include a pervasive nature of depression throughout the course of first episode psychosis, the predictive nature of prodromal depression and the high prevalence of suicidal acts. Appeasement and engagement with voices, subordination to persecutors and the (ineffective) use of safety behaviours drive a position of entrapment, demoralization and a lack of control. In addition negative illness appraisals are stable and may vary between cultural groups. Implications are explored, in terms of clinical practice, aetiological pathways, potential treatments and intervention strategies


This work proposes a method of handling the difficulties generated by sparse and noisy sensorial output from a small quantity of ultrasonic sensors in order to develop a low cost SLAM system. A pre-processing step of detecting faulty sensors was implemented by applying PCA on the available data in order to extract more reliable baseline features through the Hough Transform. Furthermore, we analyze the influence of odometry errors and failures in the localization of a differential driven mobile robot. This method is suitable for indoor and orthogonal shaped environments, especially for medium and short term tasks, such as exploration, rescue and inspection. The experimental results demonstrate the accuracy and robustness to noise and sensorial failures.


Background: Genus "Sansevieria" has been traditionally used for the treatment of various ailments in African countries since a long time. In particular, Sansevieria trifasciata is used for the treatment of inflammatory conditions and sold as a crude drug in the market to treat victims of snakebite in South Africa and tropical America. Therefore, the present study aimed to investigate the presence of phytochemicals, total phenolic content, antioxidant as well as antidiabetic activity of ethanol extract and fractions of Sansevieria cylindrica leaves.
Methods and findings: Phytochemical analysis of hexane, chloroform, methanol and aqueous fractions Sansevieria cylindrica leaves confirmed the presence of steroids, flavonoids, saponins, tannins, and phenolic acids. Methanol fraction was found to show maximum phenolic content. Ethanol extract and its methanol fraction showed significant antioxidant and antidiabetic activity. They inhibited 80.5% and 83.6% respectively DPPH free radical at 100 μg/ml concentration. In addition, methanol fraction exhibited 57.9% inhibition of glucose-6- phosphatase enzyme at 100 μM concentration.
Conclusion: Our study confirmed the traditional uses of Sansevieria cylindrica plants for the treatment of various diseases.


Current cognitive models of reading assume that word recognition involves the 9bottom-up9 assembly of perceived low-level visual features into letters, letter combinations, and words. This rather inefficient strategy, however, is incompatible with neurophysiological theories of Bayesian-like predictive neural computations during perception. Here we propose that prior knowledge of the words in a language is used to 9explain away9 redundant and highly expected parts of the percept. As a result, subsequent processing stages operate upon an optimized representation highlighting information relevant for word identification, i.e., the orthographic prediction error. We demonstrate empirically that the orthographic prediction error accounts for word recognition behavior. We then report neurophysiological data showing that this informationally optimized orthographic prediction error is processed around 200 ms after word-onset in the occipital cortex. The remarkable efficiency of reading, thus, is achieved by optimizing the mental representation of the visual percept, based on prior visual-orthographic knowledge.


Fourier transform infrared (FTIR) spectroscopy has been used to examine the conformationally sensitive amide I' bands of calmodulin and troponin C. These are observed to undergo a sequence of spectroscopic changes which reflect conformational rearrangements that take place when Ca2+ is bound. Calmodulin and troponin C show similar though not identical changes on Ca2+ binding, and the effect of Mg2+ on troponin C is quite different from that of Ca2+. Both proteins show absorption maxima in the amide I' region at 1644 cm-1 which is significantly lower in frequency than has been generally observed for proteins that contain a high percentage of alpha-helix. It is proposed that an unusually high proportion of the helices in the structures of these proteins are distorted from the normal alpha-helical configuration such that the carbonyl stretching frequencies are lowered. It is further proposed that the shift to lower frequency is due to backbone carbonyl groups in the distorted helices that form strong hydrogen bonds with solvent molecules. A decrease in intensity at 1654 cm-1, the normal frequency assignment for alpha-helical structure, is observed as Ca2+ binds to calmodulin and troponin C. This suggests that Ca2+ binding results in a net decrease in "normal" alpha-helix conformation. There is a corresponding increase in intensity of the band at 1644 cm-1, possibly due to an increase in distorted helix content, allowing for a net increase in helix consistent with circular dichroism estimates of the Ca2+-dependent changes in helix content in calmodulin.


Thrombotic thrombocytopenic purpura (TTP) is a rare disorder of blood clotting associated with plasma deficiencies in von Willebrand factor cleaving protease (VWF-CP). The resulting increase in VWF activity leads to excessive microvascular clotting, reduced numbers of circulating platelets, and anemia as a result of physical fibrin-related damage to erythrocytes. Compromised circulation may lead to central nervous system symptoms and kidney failure, and the condition is life-threatening if not recognized and treated immediately [1]. Thrombocytopenia, microangiopathic hemolytic anemia, fever, acute renal dysfunction, and neurological dysfunction are the symptoms that constitute the classical diagnostic pentad for TTP.

The use of therapeutic plasmapheresis has reduced the TTP-related mortality rate from around 80% to 10% [2]. The underlying causes of acquired TTP include hematopoietic stem cell transplantation, pregnancy and oral contraceptives, medications such as antiplatelet agents and quinine, and autoimmune disorders [1].

There are few case reports of secondary TTP induced by Sjogren's syndrome (SS) [3–8]. In these reports, thrombocytopenia and multiple organ dysfunctions were ameliorated after therapeutic plasmapheresis with or without steroid therapy. However, we now present the case of a patient diagnosed with SS-related TTP, exhibiting only three (thrombocytopenia, microangiopathic hemolytic anemia, and neurological dysfunction) of the typical diagnostic symptoms. The 41-year old woman showed a poor response to plasmapheresis and steroids, but was rescued by cyclophosphamide pulse therapy. We also review the literature concerning therapeutic strategies for TTP.

A 41-year-old single woman was admitted exhibiting dulled responsiveness and unexplained mental changes over 2 days. Her speech was slow, irrelevant and incoherent in content, and she exhibited amnesia and generalized malaise and weakness. No other symptoms were identified, and there was no recent history of trauma. The patient had a prior diagnosis of hypertension, which had been controlled for 5 years with atenolol (100 mg daily), and had a baseline blood pressure of around 125/85 mm Hg. There were no indications of the use of other medications (including herbal and health foods), and no recent history of travel or contact with animals.

The neurologic examination was normal initially, indicating an intact cranial nerve system, full muscle power, and negative meningeal and Babinski signs. A brain magnetic resonance image disclosed neither intracranial hemorrhage nor a space-occupying lesion. Electroencephalography revealed only mild diffuse cortical dysfunction. Only a mild increase in total protein was detected in the cerebrospinal fluid study.

However, by her tenth day in the hospital the pa tient's consciousness level deteriorated to E2V1M4 (Glasgow Coma Scale: eyes open in response to pain, no verbal response, flexion/withdrawal to pain), and ecchymosis appeared bilaterally over the extremities. A blood examination showed anemia (hemoglobin 5.7 g/dl), thrombocytopenia (platelets 12 000/µl), elevated lactate dehydrogenase (LDH 2810 U/l), and fragmented red blood cells in a peripheral blood smear. The prothrombin time (PT) and activated partial thromboplastin time (APTT) were 13.9 s and 31.6 s, respectively. Blood urea nitrogen was 9.96 mmol/l, serum creatinine was 53.38 µmol/l, and Coombs test was negative. The combination of thrombocytopenia, microangiopathic hemolytic anemia, and acute consciousness impairment of unknown origin caused us to suspect TTP. Daily plasmapheresis therapy was initiated on hospital day 11. This treatment restored the level of consciousness, but the platelet count and LDH levels continued to worsen. Beginning on hospital day 14, methylprednisolone (40 mg, q6h) was administered in conjunction with plasmapheresis, but the platelet level remained below 20 000/µl, and LDH remained above 2000 U/l. At the same time, tests for the anti-nuclear antibodies anti-Ro and anti-La were positive. Under the diagnosis of SS, we began on hospital day 18 to administer intravenous cyclophosphamide (600 mg) followed by oral cyclophosphamide (50 mg, twice daily). The platelet count was elevated on hospital day 20 and gradually increased to 168 000/µl on hospital day 41. LDH also returned to a normal range within a few days (Figure 1 and Table I).

Figure 1

Response of platelet counts and serum lactate dehydrogenase to treatment

Table I

Laboratory data of this patient

Tracing back the history, the patient reported experiencing dry eyes and dry mouth for more than 3 months. Combined with a positive Schirmer's test, salivary scintigraphy and presence of anti-Ro and anti-La, the profile was compatible with SS (Table I). Neither the disintegrin and metalloprotease with thrombospondin type 1 motif, member 13 (ADAMTS13) activity nor autoantibody test was available in our hospital, and although the ADAMTS13 test was available at the National Taiwan University Hospital, the procedure was refused by the patient's family due to cost considerations.

The patient was discharged and the condition was controlled with cyclophosphamide and prednisolone. The platelet count at the 3-month follow-up after discharge was within normal limits.

The mechanistic basis for idiopathic TTP was identified in 1998 when Furlan et al. [9] and Tsai and Lian [10] independently described an IgG-antibody-evoked reduction in VWF-CP. The resulting elevation in plasma VWF levels leads to consumptive thrombocytopenia and microangiopathic hemolytic anemia (MAHA), and impaired microvascular circulation can bring on neurological symptoms and acute renal failure [11]. A congenital form of TTP was described in 2001 by Levy et al. [12], who identified mutations in the ADAMTS13 gene that codes for VWF-CP. An ADAMTS13 gene knock-out mouse model was described in 2005 by Motto et al. [13]; it revealed that despite undetectable levels of VWF cleaving protease activity, these mice did not develop thrombocytopenia or MAHA unless exposed to Shiga toxin. This provided the first indication that individuals with a congenital ADAMTS13 deficiency may not develop TTP unless exposed to some other triggering event, e.g., infection or pregnancy [14]. Key laboratory findings are the typical peripheral blood smear showing fragmented erythrocytes and thrombocytopenia and anemia with markedly raised serum LDH and normal coagulation parameters, which rule out disseminated intravascular coagulation [7].

Non-idiopathic TTP may be associated with a variety of drugs, infectious agents including HIV, pregnancy, or underlying malignancy [1]. The TTP may also be associated with autoimmune disorders. Systemic lupus erythematosus is the most frequently encountered autoimmune disease associated with TTP, usually occurring in patients with previously diagnosed lupus [15, 16]. Isolated case reports of TTP in patients with scleroderma, rheumatoid arthritis, mixed connective tissue disease, or dermatomyositis have also been reported [11]. In most reported cases there is no evidence that drugs given to treat an autoimmune condition could have triggered the TTP. Reported cases of thrombocytopenia in response to heparin [17], trastuzumab infusion [18], and I125 radiotherapy [19] highlight the importance of considering and investigating potential drug-related thrombocytopenia during diagnosis.

Our patient presented with only three features of the diagnostic pentad of TTP (thrombocytopenia, microangiopathic hemolytic anemia, and neurological dysfunction, without fever or renal dysfunction), but this is common in as many as 70% of TTP cases [20]. As no other cause of TTP was identified after careful evaluation, we conclude that TTP can be added to the list of hematological manifestations associated with SS. This association is apparently very rare, and a review of the literature reveals only six additional cases of TTP associated with SS. These cases are similar in many respects (Table II) but show variability in the extent of hemolysis, the severity of thrombocytopenia, and renal damage. For each patient, fresh plasma exchange (1800 ml) was administered for 6 days beginning on hospital day 11. Plasma exchange treatment was efficacious in three of these cases.

Table II

Comparison of reported patients with thrombotic thrombocytopenic purpura and Sjogren's syndrome

Plasmapheresis has been the first-line therapy for TTP since 1991 and is the only therapy for TTP with proven efficacy in prospective randomized controlled trials [21]. In this process excess VWFs and antibodies against ADAMTS13 are removed from the patient's circulation. Furthermore, the infusion of donor plasma is a source for new ADAMTS13 activity [22]. Corticosteroids are often used in cases of poor response to plasma exchange [23]; however, the additional benefit of corticosteroids has not yet been demonstrated in randomized controlled trials. There is also no consensus in the literature regarding the dose of steroids that should be administered. In refractory or relapsing forms of TTP, sporadic success has been reported with other immune-modulating agents such as vincristine, cyclophosphamide, cyclosporine A, and azathioprine [24, 25]. Rituximab, a monoclonal antibody against the CD20 antigen on B-lymphocytes, depletes the B-cell clone producing ADAMTS13 inhibitory antibodies and has emerged as a new and promising therapy in TTP [26].

This case is the first example of the use of cyclophosphamide to treat the first episode of TTP in an SS patient showing a poor response to plasmapheresis. Whether TTP can be envisaged as an autoimmune disorder remains open; however, in such autoimmune disease-related cases of TTP, cyclophosphamide provides an alternative therapeutic strategy for those patients with a poor response to plasma exchange therapy.


Cross-modal retrieval has received increasing attentions for efficient retrieval across different modalities, and hashing technique has made significant progress recently due to its low storage cost and high query speed. However, most existing cross-modal hashing works still face the challenges of narrowing down the semantic gap between different modalities and training with imbalanced multi-modal data. This article presents an efficient Adversarial Tri-Fusion Hashing Network (ATFH-N) for cross-modal retrieval, which lies among the early attempts to incorporate adversarial learning for working with imbalanced multi-modal data. Specifically, a triple fusion network associated with zero padding operation is proposed to adapt either balanced or imbalanced multi-modal training data. At the same time, an adversarial training mechanism is leveraged to maximally bridge the semantic gap of the common representations between balanced and imbalanced data. Further, a label prediction network is utilized to guide the feature learning process and promote hash code learning, while additionally embedding the manifold structure to preserve both inter-modal and intra-modal similarities. Through the joint exploitation of the above, the underlying semantic structure of multimedia data can be well preserved in Hamming space, which can benefit various cross-modal retrieval tasks. Extensive experiments on three benchmark datasets show that the proposed ATFH-N method yields the comparable performance in balanced scenario and brings substantial improvements over the state-of-the-art methods in imbalanced scenarios.


Wakes behind scientific spacecraft caused by supersonic drifting ions is common in collisionless plasmas. Such wakes change the local plasma conditions and disturb in situ observations of the geophysical plasma parameters. We concentrate on observations of the electric field with double-probe instruments. Sometimes the wake effects are caused by the spacecraft body, are minor and easy to detect, and can be compensated for in a reasonable way. We show an example from the Cluster spacecraft in the solar wind. Sometimes the effects are caused by an electrostatic structure around a positively charged spacecraft causing an enhanced wake and major effects on the local plasma. Here observations of the geophysical electric field with the double-probe technique becomes impossible. Rather, the wake can be used to detect the presence of cold positive ions. Together with other instruments, also the cold ion flux can be estimated. We discuss such examples from the Cluster spacecraft in the magnetospheric lobes. For an intermediate range of parameters, when the drift energy of the ions is comparable to the equivalent charge of the spacecraft, also the charged wire booms of a double-probe instrument must be taken into account to extract useful information from the observations. We show an example from the MMS spacecraft near the magnetopause. With understanding of the physics causing wakes behind spacecraft, the local effects can sometimes be compensated for. When this is not possible, sometimes entirely new geophysical parameters can be estimated. An example is the flux of cold positive ions, constituting a major part of the mass outflow from planet Earth, using electric and magnetic field instruments on a spacecraft charged due to photoionization


ABSTRACT More than 50% of U.S. adults do not engage in sufficient physical activity to meet current recommendations, making physical activity change and maintenance a priority for health promotion throughout adulthood. Among married partners, change in physical activity of one partner often is concordant with change of activity of the other. The primary purpose of this study was to examine two couple-focused interventions that capitalize on the co-occurrence of health behavior change within couples to promote physical activity in older adults. In this study, partners (N = 31 couples) participated together in assessment and intervention activities, and were randomized together into one of two couple-focused conditions. In one condition (concurrent), standard goal-setting techniques were extended to a couple-focused design with each partner setting daily step goals and monitoring her or his own progress. In the other condition (combined), partners collaborated to set and monitor shared daily step goals. Physical activity was assessed with accelerometers pre- and post-intervention. Post-intervention, average weekly physical activity increased by 58 min (p < 0.001), and average body mass index (BMI) decreased by 0.50 kg/m2 (p = 0.001), from pre-intervention measures. Similar levels of change in weekly physical activity and in BMI were detected in both intervention groups. Furthermore, participants demonstrated high adherence to the intervention protocol. Results suggest that couple-focused physical activity interventions can be effective in eliciting increases in physical activity among older adults. Further research is needed to uncover interpersonal mechanisms that maximize physical activity promotion and maintenance within couples over time.


Abstract: The proper screw rotor cutting process is essential to obtain a precise rotor profile; however, it is a costly and high hazard if studied in a practical method. This study introduces an analytical screw cutting method to ensure the cutting process is running well and acquire the expected rotor profile. Two distinct cutter types, a cutter with a single curve and multiple inserts cutting edge, were applied. The analytical screw cutting method was developed according to the cutter-workpiece engagement model. The result reveals that the analytical screw cutting model using various cutters can generate identical simulated profiles and close to the original rotor profile. In addition, the virtual machining verification using VERICUT software was conducted to evaluate the proposed method. Conclusively, the analytical screw cutting method is reliable and realistic to be applied in screw rotor milling.


The present study was set up to evaluate to what extent multilingual study groups can be considered homogeneous. A series of interviews were conducted to investigate the metacommunicative awareness of 101 children. We compared children who had learned an additional language in a formal context (abbreviated LLE, i.e. Language Learning Experience) to those who had not (abbreviated nLLE, i.e. without a Language Learning Experience). The primary outcome measure consisted of the reactions to an imaginary situation of communication. The results of the current study suggest that LLE children were more inclined to carry out the exchange than the nLLE children. Studying the same outcome measure, no such difference was identified when comparing monolingual to multilingual children. These findings indicate that with regard to the present tasks, the presence or absence of LLE may be a more relevant factor than mono- or multilingualism.


The ongoing global financial crisis is forcing many employers, from General Motors to local general stores, to take a hard look at the costs of the compensation packages they offer employees. For public school systems, this will entail a consideration of fringe benefit costs, which in recent years have become an increasingly important component of teacher compensation. During the 2005-06 school year, the most recent year for which U.S. Department of Education data are available, the nation's public schools spent $187 billion in salaries and $59 billion in benefits for instructional personnel. Total benefits added about 32 percent to salaries, up from 25 percent in 1999-2000. The increase reflects the well-known rise in health insurance costs, but it also appears to include growing costs of retirement benefits, which have received much less attention. Conventional wisdom holds that teacher pensions (along with other public pensions) are more costly than private retirement benefits, for reasons dating to an earlier era of low teacher salaries over lifelong careers. In spite of dissent from this view by some researchers (see sidebar), in this case we find that conventional wisdom is right: the cost of retirement benefits for teachers is higher than for private-sector professionals. To track changes in retirement costs and compare employer contributions to retirement for public school teachers with those for private-sector professionals, we draw on recent data from a major employer survey conducted by the U.S. Department of Labor. These data show that the rate of employer contributions to retirement benefits for public school teachers in 2008 is substantially higher than for private professionals: 14.6 percent of earnings for teachers vs. 10.4 percent for private professionals. Moreover, the gap has widened over the four years the data have been available. Between March 2004 and September 2008, the difference more than doubled, rising from 1.9 to 4.2 percentage points (see Figure 1). There are several reasons one might expect employer contributions to retirement to be higher for teachers. First, nearly all teachers are covered by traditional defined benefit (DB) pension plans, in which employees receive a regular retirement check based on a legislatively determined formula. These plans have, over the years, come to offer retirement at relatively young ages, at a rate that replaces a substantial portion of final salary. U.S. Department of Education data show a median retirement age for public school teachers of 58 years, compared to about 62 for the labor force as a whole. A teacher in her mid-50s who has worked for 30 years under a typical teacher pension plan will be entitled to an annuity at retirement of between 60 and 75 percent of her final salary. In nearly all plans this annuity has some sort of cost-of-living adjustment. One does not generally observe comparable retirement plans for professionals and lower-tier managers in the private sector, since most employers have replaced traditional DB plans with defined contribution (DC) or similar 401(k)-type plans, in which the employer and employee contribute to a retirement account that belongs to the employee. Nor do those traditional DB plans that remain typically reward retirement at such early ages; they more nearly resemble Social Security, where eligibility is age 62 for early retirement, and 66 and rising for normal retirement. The Survey Data Our analysis draws on data from the National Compensation Survey (NCS), an employer survey developed by the Bureau of Labor Statistics (BLS). The NCS survey is designed to measure employer costs for wages and salaries and fringe benefits across a wide range of occupations and industries in the public and private sectors. Although the BLS has been reporting quarterly fringe-benefit cost data for various public and private employee groups for more than a decade, only since March 2004 has the bureau broken out these fringe-benefit cost data for public school K-12 teachers. …


This work demonstrates the effects of through‐plane motion due to respiration on contrast and sharpness of liver lesions in MRI. The effects of slice coverage with and without such respiratory motion is also reported. This work is comprised of two parts: a theoretical prediction of liver‐lesion contrast and blur with and without respiration and an experimental validation using gel phantoms of the predicted results. Both theory and experiment show a loss of contrast, increasing with amplitude of the peak‐to‐peak motion. The loss of contrast for a 5‐mm lesion at normal respiration of 15 mm peak‐to‐peak superior‐inferior motion is ≈ 10% with a low order sorted respiratory ordered phase encoding acquisition and ≈ 50% for an unsorted acquisition. Lesion blur is greatest for the low order sorted acquisition while the unsorted and high sort acquisitions maintain edge definition. Breath‐hold imaging is potentially superior to nonbreath‐hold imaging in liver lesion contrast and edge definition, but is more sensitive to inadequate slice coverage.


Abstract BACKGROUND. Functional connection between the stomatognathic system and the acoustic-vestibular apparatus is approached with interest in topical studies, in an attempt to elucidate in depth the cause-effect relationship between pathology and symptom. The temporomandibular joint disorder may be accompanied by a series of otological symptoms such as otalgia, tinnitus and vertigo. For this reason, for a correct diagnosis, a complex clinical examination is required both on the acousticvestibular analyzer and on neighbouring structures. MATERIAL AND METHODS. We conducted a clinical study, on a group of 97 patients diagnosed with temporomandibular joint disorder (TMJD) and treated for this pathology. All patients included in the study were evaluated by the dentist and the ENT specialist. The patients were treated at the dental clinic and then returned to the ENT clinic two months after completion of the treatment for re-examination, recording changes in otologic symptoms in order to obtain the results of the study. RESULTS. Of the 97 patients with TMJD, 58 also associated otic symptomatology (otalgia – 74.13%, tinnitus – 53.45%, vertigo – 43.10%). The evaluation done two months after treatment of the temporomandibular joint disorder revealed a significant remission of otalgia (decrease in Mean VAS from 6.05 to 2.49), followed by vertigo (from 5.08 to 2.52) and by tinnitus (from 4.84 to 3.84). Important changes also occurred in the results of the vestibular assessments. CONCLUSION. The most common otological symptom of patients with TMJD is auricular pain. Otalgia, tinnitus and vertigo can be improved by dental treatment of the temporomandibular dysfunction, auricular pain having the highest rate of remission.


Nano-hydroxyapatite/polyamide66/chitosan composite (n-HA/PA66/CS) was prepared by a co-precipitation method, and was characterized by TG/DTG, TEM, IR, XRD and Universal mechanical testing machine. TEM test showed that some rod like crystals were formed and distributed uniformly into polymer matrix, with a size of about Φ30nm×80nm. IR and XRD analysis showed that some chemical bonds and electrostatic interaction existed between n-HA and polymers. TG/DTG curves indicated that the composites possessed a talent of high heat-resistance. The compressive strength of composite changed with different content of three compounds, the maximum compressive strength of composite (70MPa) could be acquired.


A type of metal-dielectric multilayered structures is investigated theoretically and experimentally for achieving optical transparency with a high electrical conductivity. The structure in our demonstrated case comprises of two coupled metal-dielectric-metal planar optical resonators with metal-layer thicknesses near to its skin depth. Simulations show that the maximum transmittance for visible light can easily reach 90% for silver-based structures. Experimentally, the sample fabricated exhibits a transmission window with a bandwidth of 150 nm and a maximum transmittance of 76% around 643 nm wavelength at normal incidence. Its sheet resistance is measured to be less than 10Ω/□, much smaller than that of common indium-tin-oxide films. Transparent conductors functioning for blue light and even for the whole visible light are also shown to be theoretically possible. Owing to their simple fabrication procedure as well as design flexibility, such a layered structure can serve as a compelling alternative as transparent conductors for optoelectronic devices, especially for liquid-crystal displays and light-emitting diodes.


Background: Further reductions in malaria incidence as more countries approach malaria elimination require the identification and treatment of asymptomatic individuals who carry mosquito-infective Plasmodium gametocytes that are responsible for furthering malaria transmission. Assessing the relationship between total parasitemia and gametocytemia in field surveys can provide insight as to whether detection of low-density, asymptomatic Plasmodium falciparum infections using sensitive molecular methods can sufficiently detect the majority of infected individuals who are potentially capable of onward transmission. Methods: In a cross-sectional survey of 1,354 healthy children and adults in three communities in western Kenya across a gradient of malaria transmission (Ajigo, Webuye, and Kapsisywa-Kipsamoite), we screened for asymptomatic P. falciparum infections by rapid diagnostic tests, blood smear, and quantitative PCR of dried blood spots targeting the varATS gene in genomic DNA. A multiplex quantitative reverse-transcriptase PCR assay targeting female and male gametocyte genes ( pfs25 , pfs230p ), a gene with a transcriptional pattern restricted to asexual blood-stages ( piesp2 ), and human GAPDH was also developed to determine total parasite and gametocyte densities among parasitemic individuals. Results: The prevalence of varATS -detectable asymptomatic infections was greatest in Ajigo (42%), followed by Webuye (10%). Only two infections were detected in Kapsisywa. No infections were detected in Kipsamoite. Across all communities, children aged 11-15 years account for the greatest proportion total and sub-microscopic asymptomatic infections. In younger age groups, the majority of infections were detectable by microscopy, while 68% of asymptomatically infected adults (>21 years old) had sub-microscopic parasitemia. Piesp2 -derived parasite densities correlated poorly with microscopy-determined parasite densities in patent infections relative to varATS -based detection. In general, both male and female gametocytemia increased with increasing varATS - derived total parasitemia. A substantial proportion (41.7%) of individuals with potential for onward transmission had qPCR-estimated parasite densities below the limit of microscopic detection but above the detectable limit of


We investigate the complete stability for multistable delayed neural networks. A new formulation modified from the previous studies on multistable networks is developed to derive componentwise dynamical property. An iteration argument is then constructed to conclude that every solution of the network converges to a single equilibrium as time tends to infinity. The existence of 3n equilibria and 2n positively invariant sets for the n-neuron system remains valid under the new formulation. The theory is demonstrated by a numerical illustration.


Our work addresses the problem of accurately 3D localising specific types of road fixtures, such as manhole covers. The surveying task for manholes has to be done for millions of kilometres of road. We propose an efficient pipeline that starts from images captured by vans, which are then used to detect, recognise and localise the manholes. Challenges come from frequent occlusions, regular changes in illumination conditions, substantial viewpoint variance, and the fact that the actual manhole covers are far less similar than one might expect. We combine 2D and 3D techniques and demonstrate high performance for large amounts of image data. To our knowledge this is the first published work for manhole mapping based solely on computer vision techniques and GPS.


A classification of disseminated sclerosis summing up many years of follow up of 750 patients is proposed. According to this classification, the cerebral, spinal and cerebrospinal forms are distinguished. The cerebral form includes hyperkinetic and ocular disease varieties. Both childhood disseminated sclerosis and disease variety with a late debut are distinguished. Rare cases of familial disseminated sclerosis are marked. Acute disseminated sclerosis is considered only as a stage of chronic disease development.


This report considers the evidence relating to cancer risk associated with exposure to low doses of low linear energy transfer radiation, and particularly doses below current recommended limits for protection of radiation workers and the general public. The focus is on evidence regarding linearity of the dose–response relationship for all cancers considered as a group, but not necessarily individually, at low doses [the so-called linear, non-threshold (LNT) hypothesis]. It looks at the possibility of establishing a universal threshold dose below which there is no risk of radiation-related cancer. The report is organised by scientific discipline, beginning with epidemiological studies of exposed human populations. Extrapolation of risk estimates based on observations at moderate to high doses continues to be the primary basis for estimation of radiation-related risk at low doses and dose rates. The fundamental role of radiation-induced DNA damage in the induction of mutations and chromosome aberrations provides a framework for the analysis of risks at low radiation doses and low-dose-rate exposures. Although cells have a vast array of damage response mechanisms, these mechanisms are not foolproof, and it is clear that damaged or altered cells are capable of escaping these pathways and propagating. Cellular consequences of radiation-induced damage include chromosome aberrations and somatic cell mutations. Current understanding of mechanisms and quantitative data on dose and time–dose relationships support the LNT hypothesis. Emerging results with regard to radiation-related adaptive responses, genomic instability, and bystander effects suggest that the risk of low-level exposure to ionising radiation is uncertain, and a simple extrapolation from high-dose effects may not be wholly justified in all instances. However, although there are intrinsic uncertainties at low doses and low dose rates, direct epidemiological measures of radiation cancer risk necessarily reflect all mechanistic contributions including those from induced genomic instability, bystander effects, and, in some cases, adaptive responses, and therefore may provide insights about these contributions. Experimental approaches using animal models support the view that the response for early initiating events is likely to correspond to that for the induction of cytogenetic damage. On this basis, mechanistic arguments support a linear response in the low-dose region. Quantitative analyses of dose responses for tumourigenesis and for life shortening in laboratory animals also support this prediction. These studies also support a dose and dose rate effectiveness factor (DDREF) in the range of about 2 when data ICRP Publication 99


Background and purpose : Despite many studies on the main mechanisms of the function of L-carnitine, some processes of its supplementation effects on lipid metabolism in healthy humans are still unknown. Therefore, this study was conducted to determine the effects of short-term oral supplementation of L-carnitine on lipid and blood lactate metabolisms in endurance exercise performance. Materials and methods : Twenty healthy exercised men participated in this single blind clinical trial. Subjects were selectively divided into the two supplemented (n = 10) and placebo (n = 10) groups. The supplement group received 3 g of L-carnitine tartrate dissolved in 200 ml of water plus 6 drops of lemon juice while the placebo group received only 200 ml of water plus 6 drops of lemon juice, 90 minutes before performing the protocol outlined by Conconi. Blood samples were drawn from the arm vein at 90 minutes before, immediately after and 30 minutes of rest after the exercise and their free fatty acid and blood lactate and concentrations were measured using standard kits. Results : In the experimental group, significant difference was observed in free fatty acid, blood lactate  and distance traveled concentrations. Moreover, in the control group, the dependent variables showed no significant changes due to placebo (P<0/05). Conclusion : The results of the present study showed that supplementation of L-carnitine improved effective endurance performance by reducing blood lactate. However, no significant effect was observed on triglyceride.


Because of the limited understanding of effective HRM activities in
SME?s the clear relevance of the topic both from an academic point of
view and from the standpoint of owners/ directors of such companies
and because of the importance of SME?s in our economies the
university of Twente decided to start a research programme on HRM in
Dutch SME?s with the help of Saxion Hogeschool Deventer. The longterm
goal is to try and find configurations of hr-policies and practices
that work for different classes of SME?s. This paper is however the first step towards this long term goal and as such it seeks to develop a theoretical framework on HR-policies and practices in SME?s. The research question is to find out what the current role and position is of the HR-department in the Dutch SME?s. To do this a theoretical model was developed and operationalised into a preliminary questionnaire to see if configurations could be found in
this kind of companies. With this questionnaire a pilot survey study
was conducted. The pilot survey did not produce the results expected,
mainly because it proved difficult to get the right population, but the effort did help in getting a better understanding of the topic.
With this newfound insight the questionnaire and research model can
be improved so a further use in large scale quantitative research is
possible.


Bacterial pneumonia is responsible for high mortality in surgical intensive care patients which is partly attributable to a high incidence of gram-negative bacillary pneumonia. In these patients alterations to epithelial cell surfaces promote colonization of the oropharynx by gram-negative bacilli. The alterations are directly related to the severity of the patients' underlying disease and not to the hospital environment. Prospective studies on prophylactic administration of antibiotics to decrease the incidence of nosocomial pneumonia are reviewed. In these studies antibiotic have been administered either locally in the respiratory tract or systemically by the i.v. route. In both cases a moderate decrease in the incidence of pneumonia was observed, but selection of resistant bacteria occurred. Pneumonia appearing despite antibiotic prophylaxis was difficult to treat and had a high mortality. Therefore, local or intravenous antibiotic administration for routine prophylaxis of pneumonia seems to do more harm than good in patients from intensive care units.