This thesis explores the concept of equity and proposes methods to make it operational in decision-making focused on promoting sustainability. The conceptual approach developed in the research draws on the recognition that the two notions of equity and sustainability are tightly intertwined in the sustainable development debate. As George (1999) claimed, sustainable development is founded on and fully embodied by intra-generational and inter-generational equity, which might be described as transactions of rights between and across generations, respectively. In spite of this, the implications on equity are still poorly addressed in strategic decisions.
This led to the identification of the three main objectives of this research.

The first objective is to understand the extent to which sustainability issues are addressed in current practice, focusing on Strategic Environmental Assessment (SEA) experiences of spatial planning and Oil & Gas development. To this purpose, a framework is developed to analyse the degree of consideration of sustainability principles in SEA, and demonstrate its application to a sample of SEA of Italian urban plans. This framework links Gibson's (2006) sustainability principles to a number of guidance criteria and eventually to review questions, giving particular emphasis to the key concepts of intra- and inter-generational equity. The framework was applied to review the Environmental Report of a sample of urban plans of major Italian cities. The results of this review shows that, even if sustainability is commonly considered as a pivotal concept, there is still work to be done in order to effectively integrate sustainability principles into SEA. Regarding the proposed framework, the review confirms the significance of clarifying equity concerns in the light of sustainability in view of operationalizing intra- and inter-generational equity in decision-making.

The second objective is to identify criteria and indicators to measure intra- and inter-generational equity, against which present state and future trends can be assessed. A conceptual framework for identifying the different implications related to the use of different values and perceptions on equity is built. Subsequently, a set of equity perspectives to guide the assessment of strategic actions through the lens of intra- and inter-generational equity is proposed and discussed. This set includes four equity perspectives, compatible with each other with covered significant sustainability issues, and minimizing conflict, namely opportunity, distributional fairness, distributional fairness across generations and justice for an imperfect world.
The review of equity perspectives allows identifying a set of equity criteria that might be useful in focusing assessment on crucial and integrative sustainability issues. These criteria are reasonably inclusive of essential general intra- and inter-generational equity considerations that account for sustainability over space and time.
However, criteria need to be specific to the context of analysis. This is addressed in this study by selecting a specific sector of investigation that offered significant insights for dealing with sustainability in decision-making. The attention was directed to the Oil & Gas sector for the scope of challenges and positive chances posed to sustainability. For this purpose, the research work specifically fleshes out how current SEA of Oil & Gas sector practice addresses sustainability.
A framework for reviewing SEA practice helped to explore to what extent current SEA for the Oil & Gas sector contributes, procedurally and substantively, to sustainability oriented decisions. 11 case studies related to both off-shore and on-shore Oil & Gas developments are reviewed against this framework. The results show that case studies were more oriented to analyse opportunities derived from Oil & Gas development without fleshing out other potential developmental alternatives. Additionally, even if the SEA reports claim to pursuit a common strategic intent to equally share benefit derived from Oil & Gas development, they do not generally provide a means to tackle this aspect. This part of the investigation allowed also to support the identification and selection of aspects, elements, suggestions and best practise that would assist in defining contest-specific equity criteria and indicators for decision-making in the Oil & Gas sector.

This leads to the third objective of the thesis: testing the applicability of the proposed methods to a case study, dealing with complex decisions at strategic level. A case study on Oil & Gas development in the Basilicata region (Southern Italy) was selected: the Val d'Agri oil field, Western Europe's biggest onshore oil field. Scenario storylines, representing interactions among environmental, social and economic concerns, are constructed and applied against the framework. Specifically, short-term and medium-long term scenarios are developed by varying geographical scopes, ranging from the regional scale to two nested local areas surrounding the Oil & Gas activities.
Scenarios are then assessed against the set of intra- and inter-generational criteria identified by selecting appropriate indicators adapted to context and available data. Indicators are valued according to a quali-quantitative analysis that assisted in examining and comparing trade-off between human and environmental systems under the different scenarios.
The results helped to identify opportunity and risk of different scenarios at strategic level. None of the scenarios provided "the best solution" in term of aggregated equity scores or perfect win-win solutions for each equity perspective. In the long-term, none of the territorial levels (local and regional) seemed to acquire significant increase in equity benefits, not even one at expenses of each other. According to the assumptions, this might suggest that incremental benefits of Oil & Gas development are concentrated outside the three level considered. Nevertheless, the case study shows that approaching to decision with more attention to a sustainable management of the environment and involving institutions at different levels might be a key role in achieving more wide-spread and long-term positive results.

However, scenarios presented possible significant trends in equity criteria, which were affected by restraints in data collected, as well as, simplifications and approximations in analysis. In this exercise, it was assumed that all equity criteria within each temporal dimension receive equal weights and that all three geographical levels were equally weighted too. Introducing participatory mechanisms might be useful for supporting interpretations of implications potentially affecting generations at different temporal and territorial scale, satisfying possible needs of other equity criteria, and establishing priorities in perspectives on equity adopted. In this sense, the equity framework proposed might be a suitable tool for supporting and guiding deliberative processes. Analogously, the spatio-temporal decision matrix, framed through the lens of equity for assessing scenarios against equity criteria, might represent a simple yet flexible framework for analysing and discussing concurrently temporal and spatial implications of plausible storylines.


In 1988, as part of commitment to maintain and improve the quality of beaches and nearshore waters along Barbados' densely populated south and west coasts, the Government of Barbados commissioned Reid Crowther International to carry out feasibility studies and the detailed engineering design of a public sewage collection, treatment and outfall scheme for the south coast. The studies and designs were completed in 1990 and the Government is now negotiating with the Inter-American Development Bank for funding to pay for the construction of the project.

The paper describes project background, estimation of design flows and loads, and treatment plant/outfall design including the detailed marine studies undertaken for the project. Interesting aspects of the sewage collection system design, including the proposed use of "No-Dig" trenchless sewer technology and the project's environmental impact assessment are also described.


This analysis examines the intersections of migration and neoliberal immigration policy in Canada through a political economy lens. It looks particularly at the increasing phenomenon of human smuggling and it asks how the emergence of neoliberalism has shaped Canadian immigration policy and how has this impacted working peoples' lives and forced them to become migrants. Canada increasingly treats migrants with suspicion and seeks to prevent the less "profitable" ones from entering. Today's policies are the result of a historical process of entrenching a North-South divide as some sort of unavoidable truth, and the fruits of the global North as requiring protection from "needy" and "lazy" poor in the global South. It is this paradigm which the following analysis seeks to problematize and deconstruct by examining the historical roots of the North-South divide.


Implementing open source cloud platform as an enterprise solution and develop a tool to manage the entire ecosystem The fundamental idea behind my thesis work is to use open source technologies and build a fully workable enterprise solution. Another part was to develop a management tool for the entire ecosystem , which can be deployed on web servers for the admins and users to use. In the very beginning I researched on different open source cloud platforms. Tried deploying them in small scale . I also looked into some professional cloud service providers, like Amazon AWS and Rackspace Cloud . I found Amazon is the pioneer among the cloud providers who are serving infrastructure as a service and Rackspace Cloud in the second position on the number of cloud users basis . So, there most complete open source solution with Amazon AWS cloud is Eucalyptus cloud ecosystem . I used Eucalyptus to deploy the cloud infrastructure. To make deploying cloud infrastructure easier on small scale I also wrote a script , which will setup a Eucalyptus cloud infrastructure with just few commands. Another part of my thesis was to develop a cloud management tool. I developed a new tool using a very popular open source python library Boto that is used to manage Amazon EC2 and S3 services. This report contains all the steps taken to deploy the cloud platform, challenges and the steps taken to resolve issues and also discuss about the cloud management tool.


Cell adhesion is essential for the regulation of many cellular functions. The adhesion molecule plays a critical role as a fundamental substance in various processes of reproduction such as trophoblast-endometrial interaction. Our understanding of the physiology of adhesion molecules will be helpful for clinical application of these molecules in the treatment and assessment of disorders of many processes of reproduction. We will briefly review integrins, cadherins, and laminin, which were the principal subjects of discussion in this conference.


Axisymmetric spacetimes with a conformal symmetry are studied and it is shown that, if there is no further conformal symmetry, the axial Killing vector and the conformal Killing vector must commute. As a direct consequence, in con-formally stationary and axisymmetric spacetimes, no restriction is made by assuming that the axial symmetry and the conformal timelike symmetry commute. Furthermore, we prove that in axisymmetric spacetimes with another symmetry (such as stationary and axisymmetric or cylindrically symmetric spacetimes) and a conformal symmetry, the commutator of the axial Killing vector with the two others mush vanish or else the symmetry is larger than that originally considered. The results are completely general and do not depend on Einstein's equations or any particular matter content.


A 32-year-old primigravida woman received an epidural anesthetic at 38 weeks of gestation for an elective caesarean delivery. She had for the past 10 years an intrathecal baclofen infusion pump to relieve spastic tetraparesis secondary to perinatal cerebral anoxia. She otherwise also suffered from sickle cell disease complicated by several vaso-occlusive crisis during pregnancy and a recent history of thromboembolic disease. A recent CT scan showed the intrathecal catheter entering the L3-L4 interspace and extending proximally to the thoracic region. For the caesarean delivery, an epidural catheter was sited using ultrasound in the L4-L5 interspace. Motor block and analgesia was obtained with a tested sensitive level never rising above T9. The patient was informed of the clinical situation and eventual risk of converting to general anesthesia if too uncomfortable during the caesarean section. Despite this she wished to forgo a general anesthesia if possible. It was decided to proceed with the caesarean delivery under epidural anesthesia. The caesarean section was uneventful, and no complications occurred in the post-natal period. Neuraxial anesthesia may be favored over general anesthesia for patients with sickle cell disease, but epidural local anesthetic spread may be unpredictable following interventions involving the epidural space as illustrated by this case report.


As conveners that bring various stakeholders into the same physical space, firms can powerfully influence the course of pandemics such as coronavirus disease 2019. Even when operating under government orders and health guidelines, firms have considerable discretion to keep their establishments open or closed during a pandemic. We examine the role of social learning in the exercise of this discretion at the establishment level. In particular, we evaluate how the closure decisions of chain establishments, which are associated with national brands, affect those of proximate, same-industry community establishments, which are independently owned or managed. We conduct these analyses using cell phone location tracking data on daily visits to 230,403 U.S.-based community establishments that are colocated with chain establishments affiliated with 319 national brands. We disentangle the effects of social learning from confounding factors by using an instrumental variables strategy that relies on local variation in community establishments' exposure to closure decisions made by brands at the national level. Our results suggest that closing decisions of community establishments are affected by the decisions made by chain establishments; a community establishment is 3.5% more likely to be open on a given day if the proportion of nearby open chain establishments increases by one standard deviation. This paper was accepted by Olav Sorenson, organizations.


Using a Dietetic Care Process (DCP) can lead to improved application of evidence-based guidelines and critical thinking in dietetics. One aim of the project Improvement of Education and Competences in Dietetics (IMPECD) is to develop a unified DCP for international educational purposes. Therefore, a comparison of European DCPs was needed.A concise literature search and semi-structured interviews with experts representing the full EFAD (European Federation of the Associations of Dietitians) member states were conducted from June to October 2017.16 out of 23 EFAD member states responded (70%) from which 13 indicated to use a DCP. Eight different DCPs were found, with four to six core steps and three graphical representations. In one country the use of a dietetic process is indicated by law. The DCPs have more similarities than differences as they follow the same principles. Differences in language or form may not limit the improvement in collaboration and international exchange in dietetic practice. These results provide a good basis for the development of a unified DCP for educational purposes.


INTRODUCTION
Diallyl disulphide is an organo-sulphur compound which is present in garlic and responsible for the characteristic odor of garlic. It is known for its anticancer and invitro membrane stabilizing properties.

AIM
The main aim was to evaluate the haematopoietic, antioxidant and membrane stabilizing property of diallyl disulfide in irradiated mice.

MATERIALS AND METHODS
Mice were grouped into 6 groups as control, drug control, radiation control and drug pre-treatment groups (i.e. drug administration + radiation group) The mice were fed orally for 15 consecutive days and on the 15(th) day, one hour after drug administration, the mice were irradiated with 6Gy electron beam radiation. The changes in blood cell count, total antioxidant levels, malondialdehyde and reduced glutathione levels were determined. The immunomodulatory response of DADS to the radiological effects was determined by the estimation of IL-6 levels.

RESULTS
A significant improvement in pre-drug treatment group when compared to control groups in the haemoglobin, red blood cell count, white blood cell count, haematocrit and platelet counts was observed. There is an increased level of interleukin-6 in the drug treated groups compared to the radiation control. An increase in the malondialdehyde levels and decrease in the glutathione levels in the irradiated group indicate increased lipid peroxidation and oxidative stress, whereas, there is a significant reduction in the malondialdehyde levels and increased glutathione levels in the drug pre-treatment groups showing membrane stabilization.

CONCLUSION
Thus DADS proves to be an effective haematopoietic and antioxidative agent to counter radiation induced haematopoietic suppression and oxidative stress.


This study documents an educational field experiment evaluating the effects of picture books on primary students' mathematical achievement and their dispositions towards mathematics. The study involved 136 primary grade students from one elementary school in the southeastern region of the United States. The student population had an overrepresentation of students from minority backgrounds (91%), low socioeconomic status (93%) and English Language Learners (47%). During the 18-week treatment period, teacher participants from the treatment group received bi-weekly collaborative professional development regarding the use of picture books in mathematics instruction. The teachers in the control group followed their district's mathematics curriculum. To determine the effect of picture books on students' mathematics achievement STAR gain scores and chapter tests were compared. This analysis revealed that students could learn mathematics when picture books were used. In fact, students in the treatment group demonstrated statistically significant mathematical achievement gains on the STAR assessment (p < .05). Compared to the increase from pretest to posttest in the control group, the increase in the treatment group was 40% larger. Similarly, kindergarten students in the treatment group demonstrated statistically significant higher mathematical achievement on all chapter tests (p <.01), yet a null treatment effect was found for first and second grade students as measured by chapter tests. Analysis of STAR gain scores (first and second grade) revealed no significant treatment between subgroups based on gender, ethnicity, or ELL status. However, the kindergarten chapter test data by subgroup revealed that the treatment had no effect by gender, higher effects for Black students as compared to Hispanic students, and that non-ELL students in both the treatment and control group had higher achievement than ELL students. To determine if there was a relationship between students' mathematical dispositions and the use of picture books in mathematics instruction, students' selfreported disposition towards mathematics were recorded daily during six of the 18 weeks. The analysis comparing the treatment and control groups' dispositions revealed that all students had relatively high dispositions towards mathematics and that the use of picture books did not significantly impact students' positive dispositions towards mathematics.


Following the methodology developed in our previous papers (Unayama and Ohno, 2017a and 2017b), we construct household income and expenditure data that are consistent with macro data, or national accounts, yet are based on micro data. We improve the methodology and update to the latest data of the 2014 National Survey of Family Income and Expenditure (NSFIE). According to the constructed data, the decreasing trend in the macro savings rate has been induced by the elderly. We further observe that while consumption has been stable over birth cohorts, disposable income has become lower for later generations. This trend was brought by the lower interest income associated with the zero interest policy and the lower public pension income. Since the lower public pension benefits are a result of population aging given the pay-as-you-go finance system, the lower savings rate is regarded as a result of population aging.


The modern methods for the calculation of the electronic structures of alkenes are examined. The photoelectron spectra of alkenes are analysed and the relation between the properties of molecules and their orbital structure is discussed on the basis of experimental data and quantum-chemical calculations. The corresponding structural parameters of alkenes are systematically compared with their reactivities. The ionisation energies of alkenes are presented. The bibliography includes 86 references.


Many managers are unaware of the strategic advantages and cost savings possible through systems analysis as applied to material, energy, and water use in building design and operation. This technical note provides whole-systems strategies for improving resource efficiency in industrial and commercial buildings. Green building, sustainability, environmental concerns, and resource efficiency are among the topics covered. The note explains systems thinking and integrated, multidisciplinary methods that can stimulate innovation in both the equipment (technical) systems that make up facilities and the human (organizational) systems involved in the design-build-operate process. Identifying and using key leverage points and systemic synergies can dramatically increase the performance of buildings and the groups of people who make and run them. In practice, these approaches have saved money, reduced environmental impacts, improved worker health and productivity, attracted new employees, greatly decreased operating costs, and, in some cases, even decreased capital costs while adding little or nothing to initial costs.


The scholarship on post-Soviet de facto states has structurally focused on issues related to their contested status, and has long assumed that these entities are transient phenomena. In this article I propose a path towards a new research agenda on post-Soviet de facto states based on two main arguments. Firstly, scholars researching post-Soviet de facto states should start from the working assumption that these entities will continue to exist in the current configuration for the foreseeable future, and proceed in their integration with the patron. Secondly, they should seek new terms of comparison beyond contested territories and conflict regions, and they should apply the same terminology to these entities and ask at least some of the same research questions as they would do when studying uncontested territories.


Byttneria pilosa is locally known as Harijora, and used by the native hill-tract people of Bangladesh for the treatment of rheumatalgia, snake bite, syphilis, fractured bones, elephantiasis and an antidote for poisoning. The present study was carried out to determine the possible anti-inflammatory, analgesic, neuropharmacological and anti-diarrhoeal activity of the methanol extract of B. pilosa leaves (MEBPL) through in vitro, in vivo and in silico approaches. In the anti-inflammatory study, evaluated by membrane stabilizing and protein denaturation methods, MEBPL showed a significant and dose dependent inhibition. The analgesic effect of MEBPL tested by inducing acetic acid and formalin revealed significant inhibition of pain in both tests. During the anxiolytic evaluation, the extract exhibited a significant and dose-dependent reduction of anxiety-like behaviour in mice. Similarly, mice treated with MEBPL demonstrated dose-dependent reduction in locomotion effect in the open field test and increased sedative effect in the thiopental sodium induced sleeping test. MEBPL also showed good anti-diarrheal activity in both castor oil induced diarrheal and intestinal motility tests. Besides, a previously isolated compound (beta-sitosterol) exhibited good binding affinity in docking and drug-likeliness properties in ADME/T studies. Overall, B. pilosa is a biologically active plant and could be a potential source of drug leads, which warrants further advanced study.


The metabolic syndrome is a cluster of risk factors for atherosclerosis. Although a universally accepted definition is still lacking because available classifications present slightly different diagnostic criteria, the metabolic syndrome is now recognized as a serious public health problem that affects up to 45% of the population > 50 years of age in the United States and (cid:1) 20 to 25% of the adult population in Europe. To diagnose the metabolic syndrome, the concomitant presence of at least three components, among them visceral obesity defined by the measurement of the waist circumference, elevated blood pressure, hyperglycemia, hypertriglyceridemia, or reduced high-density lipoprotein cholesterol levels, is required. The concomitant presence of these risk factors, and thus the presence of the metabolic syndrome, is associated with inflammatory and hypercoagulable states that through increased levels of coagulation factors, reduction in fibrinolysis, endothelial dysfunction, and platelet hyperreactivity may predispose patients to develop cardiovascular events. Several studies have consistently shown that patients with the metabolic syndrome are at significantly increased risk of diabetes, coronary artery disease, and ischemic stroke. A few recent studies suggest that the metabolic syndrome may also play a role in the pathogenesis of venous thromboembolism, but this latter finding needs confirmation by large clinical studies.


In 1858 Governor James Douglas proclaimed British Columbia a colony at Fort Langley before an audience of Hudson's Bay Company officials, workers, and Indigenous leaders. The Proclamation dissolved the Hudson's Bay Company trading monopoly and, while claiming to protect Indigenous lands, actually asserted British ownership of their territory. In the present, Fort Langley National Historic Site holds regular re-enactments of the Proclamation through their educational programs targeting local schools. The script for these re-enactments, authored by Parks Canada staff, allows schoolchildren to role-play a scenario in which James Douglas proclaims British Columbia a colony to protect Indigenous lands, without explicitly staging the negative consequences for Indigenous peoples that the claiming of those lands caused.I link these two events, the 1858 Proclamation and the present-day re-enactments, by comparing the script's content to its historical and contemporary context. I conclude that the Proclamation re-enactments become performances of recolonization when Parks Canada deceptively presents its own wry civility (Daniel Coleman). The 1858 Proclamation's embedded civility, and its repetition and reformation in the contemporary script, the production process, and the surrounding social structure, allows colonial ideology to be physicalized, invested, and passed on to and through children at the Fort Langley National Historic Site.


Distributed m-healthcare cloud computing system significantly facilitates efficient patient treatment for medical consultation by sharing personal health information among healthcare providers. However, it brings about the challenge of keeping both the data confidentiality and patients' identity privacy simultaneously. Many existing access control and anonymous authentication schemes cannot be straightforwardly exploited. To solve the problem, in this paper, a novel authorized accessible privacy model (AAPM) is established. Patients can authorize physicians by setting an access tree supporting flexible threshold predicates. Then, based on it, by devising a new technique of attribute-based designated verifier signature, a patient self-controllable multi-level privacy-preserving cooperative authentication scheme (PSMPA) realizing three levels of security and privacy requirement in distributed mhealthcare cloud computing system is proposed. The directly authorized physicians, the indirectly authorized physicians and the unauthorized persons in medical consultation can respectively decipher the personal health information and/or verify patients' identities by satisfying the access tree with their own attribute sets. Finally, the formal security proof and simulation results illustrate our scheme can resist various kinds of attacks and far outperforms the previous ones in terms of computational, communication and storage overhead.


ABSTRACT: Edible oil is oxidized during processing and storage via autoxidation and photosensitized oxidation, in which triplet oxygen (3O2) and singlet oxygen (1O2) react with the oil, respectively. Autoxidation of oils requires radical forms of acylglycerols, whereas photosensitized oxidation does not require lipid radicals since 1O2 reacts directly with double bonds. Lipid hydroperoxides formed by 3O2 are conjugated dienes, whereas 1O2 produces both conjugated and nonconjugated dienes. The hydroperoxides are decomposed to produce off-flavor compounds and the oil quality decreases. Autoxidation of oil is accelerated by the presence of free fatty acids, mono- and diacylglycerols, metals such as iron, and thermally oxidized compounds. Chlorophylls and phenolic compounds decrease the autoxidation of oil in the dark, and carotenoids, tocopherols, and phospholipids demonstrate both antioxidant and prooxidant activity depending on the oil system. In photosensitized oxidation chlorophyll acts as a photosensitizer for the formation of 1O2; however, carotenoids and tocopherols decrease the oxidation through 1O2 quenching. Temperature, light, oxygen concentration, oil processing, and fatty acid composition also affect the oxidative stability of edible oil.


Importance
National guidelines balance risks and benefits of population-level cancer screening among adults with average risk. Older adults are not recommended to receive routine screening, but many continue to be screened (ie, are overscreened).

Objective
To assess the prevalence of overscreening for colorectal, cervical, and breast cancers among older adults as well as differences in overscreening by metropolitan status.

Design, Setting, and Participants
The cross-sectional study examined responses to a telephone survey of 176 348 community-dwelling adults. Participants were included if they met age and sex criteria, and they were excluded from each cancer-specific subsample if they had a history of that cancer. Data came from the 2018 Behavioral Risk Factor Surveillance System, administered by the US Centers for Disease Control and Prevention.

Exposures
Metropolitan status, according to whether participants lived in a metropolitan statistical area.

Main Outcomes and Measures
Overscreening was assessed using US Preventive Services Task Force definitions, ie, whether participants self-reported having a screening after the recommended upper age limit for colorectal (75 years), cervical (65 years), or breast (74 years) cancer.

Results
Of 176 348 participants (155 411 [88.1%] women; mean [SE] age, 75.0 [0.04] years; 150 871 [85.6%] non-Hispanic white; 60 456 [34.3%] with nonmetropolitan residence) the cancer-specific subsamples contained 20 937 [11.9%] men and 34 244 [19.4%] women for colorectal cancer, 82 811 [47.0%] women for cervical cancer, and 38 356 [21.8%] women for breast cancer. Overall, 9461 men (59.3%; 95% CI, 57.6%-61.1%) were overscreened for colorectal cancer; 14 463 women (56.2%; 95% CI, 54.7%-57.6%), for colorectal cancer; 31 988 women (45.8%; 95% CI, 44.9%-46.7%), for cervical cancer; and 26 198 women (74.1%; 95% CI, 73.0%-75.3%), for breast cancer. Overscreening was more common in metropolitan than nonmetropolitan areas for colorectal cancer among women (adjusted odds ratio [aOR], 1.23; 95% CI, 1.08-1.39), cervical cancer (aOR, 1.20; 95% CI, 1.11-1.29), and breast cancer (aOR, 1.36; 95% CI, 1.17-1.57). Overscreening for cervical and breast cancers was also associated with having a usual source of care compared with not (eg, cervical cancer: aOR, 1.87; 95% CI, 1.56-2.25; breast cancer: aOR, 2.08; 95% CI, 1.58-2.76), good, very good, or excellent self-reported health compared with fair or poor self-reported health (eg, cervical cancer: aOR, 1.21; 95% CI, 1.11-1.32; breast cancer: aOR, 1.47; 95% CI, 1.28-1.69), an educational attainment greater than a high school diploma compared with a high school diploma or less (eg, cervical cancer: aOR, 1.14; 95% CI, 1.06-1.23; breast cancer: aOR, 1.30; 95% CI, 1.16-1.46), and being married or living as married compared with other marital status (eg, cervical cancer: OR, 1.36; 95% CI, 1.26-1.46; breast cancer: OR, 1.54; 95% CI, 1.34-1.77).

Conclusions and Relevance
In this study, overscreening for cancer among older adults was high, particularly for women living in metropolitan areas. Overscreening could be associated with health care access and patient-clinician relationships. Additional research on why overscreening persists and how to reduce overscreening is needed to minimize risks associated with cancer screening among older adults.


Introduction Vascular calcification is highly correlated with cardiovascular disease mortality, often seen in type II diabetes and attributed to over 422 million cases worldwide. It is now widely accepted that VC is an active process with similarities to bone ossification, occurring within the smooth muscle cell (SMC) layer, involving the transition of SMCs from the cell cycle into a senescent phenotype, activation of osteogenic transcription factors and the loss of mineralisation inhibitors. Recent evidence demonstrates the beneficial role of Sirtuin 1 (SIRT1), an NAD+ -dependant deacetylase, in insulin sensitivity and glucose homeostasis, and suggests a link between smooth muscle cell senescence, hyperglycaemia and SIRT1 downregulation. The current study aims to investigate the therapeutic role of SIRT1 activation for the prevention of vascular calcification. Methods Human coronary artery SMCs (hCASMCs) were incubated in high (25 mM) glucose to reflect a diabetic milieu and compared to low glucose (5 mM) and osteogenic media containing β-glycerophosphate and calcium chloride. SIRT1 was inhibited by Sirtinol and activated by SRT1720. Cellular calcification was confirmed via alizarin red staining, alkaline phosphatase activity, qPCR and western blot analysis. B-galactosidase staining and qPCR confirmed cellular senescence. SIRT1 levels within diabetic patients was confirmed via ELISA of diabetic serum and correlated with tissue histology. Results hCASMCs, cultured in high glucose osteogenic conditions in the presence of SRT1720, showed a significant decrease in ALP activity (p<0.05) at day 4, which was sustained until day 7. A 3-fold reduction in alizarin red staining was observed (p<0.05), alongside a decline in the osteogenic transcription factor RUNX2 mRNA expression to a tenth of its control levels (p<0.05), and a reduction in RUNX2 protein by a half. Additionally, calcification associated senescence within hCASMCs was shown to significantly decline with the addition of SRT1720 (p<0.05) with P16 expression also shown to be decreased by tenfold (p<0.05). Conversely, SIRT1 inhibition via Sirtinol significantly increased ALP activity (p<0.05) with an increase in alizarin red staining by day 21 in both osteogenic and control treatments (p<0.05). RUNX2 activity was significantly increased at mRNA level (p<0.001) and at protein level, with downstream osteocalcin significantly increased (p<0.01). Sirtinol increased X-Gal staining by 20% (p<0.01) alongside P16 expression (p<0.05), the results of which are confirmed with corresponding SIRT1 siRNA knockdown. Conclusions SIRT1 activation via small a molecule activator attenuates deposition of a calcified matrix in hCASMCs grown in diabetic conditions, via the downregulation of the RUNX2 transcription factor and subsequent downstream calcifying markers. These data suggest an essential role of SIRT1 in the protection against vascular calcification, which may be compromised within diabetic patients.


Previous work (Reynolds and Gross 1992) has demonstrated that mate choice enables female guppies, Poecilia reticulata, to obtain heritable benefits ('good genes') for their offspring. It is not yet known whether males also signal their functional fertility, that is, their viability as fathers, to female guppies. Our study tested the hypothesis that a male's behaviour reveals characteristics of his ejaculate. We uncovered a strong correlation between display rate and sperm number in male guppies derived from two wild Trinidadian populations. This result indicates that information on the functional fertility of potential mates is available to females. However, our investigation also found a significant relationship between the frequency of sneaky mating and sperm number. Female guppies in wild populations, particularly those experiencing a high predation regime, are constantly subjected to sneaky mating attempts. As the males responsible for these sneaky matings have highest reserves of sperm they may have the capacity to undermine female choice. The implications of these findings for sperm competition are discussed.


The objective of this study is to find effective and economical cement grout system for preventing corrosive gas. In this paper, in order to resist the corrosion of the cement sheath by acid gas, a new corrosion resistant agent denoted as FH-1 has been added into the cement grout. A series of cement blocks formed by cement system with different additives quantities have been obtained. The permeability, compression strength and corroding depth of these cement blocks have been investigated. The microstructure of cement blocks has been analyzed by scanning electron microscope (SEM) and the mechanism of corrosion resistant of FH-1 has been discussed. The FH-1 shows excellent resistance to corrosion against CO2, and H2S gas.Therefore the optimal corrosion resistant cement grout systems were obtained.


Degradation models play an important role in Blind super-resolution (SR). The classical degradation model, which mainly involves blur degradation, is too simple to simulate real-world scenarios. The recently proposed practical degradation model includes a full spectrum of degradation types, but only considers complex cases that use all degradation types in the degradation process, while ignoring many important corner cases that are common in the real world. To address this problem, we propose a unified gated degradation model to generate a broad set of degradation cases using a random gate controller. Based on the gated degradation model, we propose simple baseline networks that can effectively handle non-blind, classical, practical degradation cases as well as many other corner cases. To fairly evaluate the performance of our baseline networks against state-of-the-art methods and understand their limits, we introduce the performance upper bound of an SR network for every degradation type. Our empirical analysis shows that with the unified gated degradation model, the proposed baselines can achieve much better performance than existing methods in quantitative and qualitative results, which are close to the performance upper bounds.


David Attenborough reveals a secret universe - it is teeming with life and is all around us, yet we never see it. It is the world of the very small, and it is a world of sex, drugs and violence. Here David shows us not just bugs, beetles and creepy-crawlies, but scorpions and centipedes, mites and mantids, spiders and dragonflies. And not just life in the undergrowth, but the dramatic battles between predator and prey that are happening in the corner of your living room and in your larder. See magnificent spectacles: swarming antler moths; millions of desert locusts; a mountain of locusts. For every pound of humans on Earth, there are 300 pounds of insects.


"Green" multiferroic BaTiO3/FeBSi composite films were grown by pulsed laser deposition and ion beam sputtering on general Pt/Ti/SiO2/Si substrates. Room temperature X-ray diffraction and Raman scattering show that the crystal structures of BaTiO3 and FeBSi are tetragonal and amorphous, respectively, and no additional or intermediate phase peaks appears in the composite films. A cross-sectional scanning electron microscopy image clearly demonstrates a 2-2 type structure with sharp interface between the top FeBSi layer and bottom BaTiO3 layer. The magnetic properties of the top FeBSi are obviously modified by the bottom BaTiO3. The composite films show obvious ferroelectric feature.


Adaptive compression methods have been a key component of many proposed subband (or wavelet) image coding techniques. This paper deals with a particular type of adaptive subband image coding where we focus on the image coder's ability to adjust itself "on the fly" to the spatially varying statistical nature of image contents. This backward adaptation is distinguished from more frequently used forward adaptation in that forward adaptation selects the best operating parameters from a predesigned set and thus uses considerable amount of side information in order for the encoder and the decoder to operate with the same parameters. Specifically, we present backward adaptive quantization using a new context-based classification technique which classifies each subband coefficient based on the surrounding quantized coefficients. We couple this classification with online parametric adaptation of the quantizer applied to each class. A simple uniform threshold quantizer is employed as the baseline quantizer for which adaptation is achieved. Our subband image coder based on the proposed adaptive classification quantization idea exhibits excellent rate-distortion performance, in particular at very low rates. For popular test images, it is comparable or superior to most of the state-of-the-art coders in the literature.


By taking sets of utility functions as a primitive description of agents, we define an ordering over the measurability classes of assumptions on utility functions. Cardinal and ordinal assumptions constitute two types of measurability classes, but several standard assumptions lie strictly between these extremes. We apply the ordering to arguments for the convexity of preferences and show that diminishing marginal utility, which implies convexity, is an example of a compromise between cardinality and ordinality. Moreover, Arrow's (1951) explanation of convexity, proposed as an ordinal theory, in fact relies on utility functions that lie in the cardinal measurement class. In addition, we show that transitivity and order-density (but not completeness) fully characterize the ordinal preferences that can be induced from sets of utility functions. Finally, we derive a more general cardinality theorem for additively separable preferences.


The red oaks (Quercus section Lobatae) include important timber species, but we know little about their gene pools. Red oak species can be difficult to identify, possibly because of extensive interspecific hybridization, although most evidence of this is morphological. We used 15 microsatellite loci to examine the genetic composition of a red oak community in 20.6 ha of an Indiana old-growth forest. The community included northern red oak (Quercus rubra L.), Shumard oak (Quercus shumardii Buckl.), and pin oak (Quercus palustris Muenchh.). Species were identified using whole-tree silvic characters, the approach most often implemented by foresters. We found high genetic diversity within species but limited genetic differences between species. Phenetic clustering showed that Q. rubra and Q. shumardii were more genetically similar than either was to Q. palustris, but a neighbor-joining tree revealed that individuals of the different species did not resolve into single-species clusters. We identified four mixed-species subpopulations using Structure, a computer program based on Monte Carlo simulation. The three largest groups are consistent with the following biological interpretations: (i) pure Q. rubra, (ii) Q. rubra, Q. shumardii, and their hybrids, and (iii) Q. rubra, Q. shumardii, Q. palustris, and their hybrids. We discuss the implications of these findings for the whole-tree silvic approach to selection and for management of the red oak gene pool.


Out of a panel of seven monoclonal antibodies with affinity for human lymphoid cells, three were shown to prevent cytotoxic T cell activity, whereas none affected natural killer cell activity when applied without complement. Anti-OKT3 and anti-Leu-2a, with affinity for all T cells and the cytotoxic/suppressive subset, respectively were both shown to inhibit T killing by their interaction with the effector cell. For anti- OKT3, the inhibition remained after free antibody was washed away. Anti- Leu-2a, in contrast, induced a rapidly reversible inhibition. Using a single cell assay, anti-OKT3 was shown to reduce the lytic ability without affecting target cell binding, whereas anti-Leu-2a prevented the effectors from binding target cells.


: Forcipomyia taiwana, an important vexing pest, influences the development of the industry of Taiwan tourism and the quality of country life. Using human-attractant method to investigate the blood-sucking behavior of Forcipomyia taiwana in three districts in Taichung, it revealed that female F. taiwana only exhibits blood-sucking behavior in daytime, not in nighttime. The blooding-sucking behavior of female F. taiwana was affected by some factors, i.e., season and atmospheric factors. During 2008 to 2010, our study revealed that blood-sucking behavior commenced from 7:00 to 8:00 in the spring equinox, the summer solstice and the autumnal equinox, but from 8:00 to 9:00 in the winter solstice. However, regardless of any seasons, it revealed that blood-sucking behavior reached the acme between 13:00 and 15:00, and then descending. In those four seasons, the summer solstice had longer lighting and higher temperature, the average sucking activity was around 12 hours, on the contrary, the winter solstice had shorter lighting and lower temperature, the average sucking activity bridled to around 8 hours whilst it retrenched to 11 hours in the spring equinox and the autumnal equinox. To analyze the correlation between blood-sucking behavior and atmospheric factors, it revealed that female blood-sucking behavior was correlated positively to temperature and lighting but negatively to humidity. In addition, our study also showed that there is no blood-sucking behavior under 18ºC.


Cancer genome sequencing has identified dozens of mutations with a putative role in lymphomagenesis and leukemogenesis. Validation of driver mutations responsible for B cell neoplasms is complicated by the volume of mutations worthy of investigation and by the complex ways that multiple mutations arising from different stages of B cell development can cooperate. Forward and reverse genetic strategies in mice can provide complementary validation of human driver genes and in some cases comparative genomics of these models with human tumors has directed the identification of new drivers in human malignancies. We review a collection of forward genetic screens performed using insertional mutagenesis, chemical mutagenesis and exome sequencing and discuss how the high coverage of subclonal mutations in insertional mutagenesis screens can identify cooperating mutations at rates not possible using human tumor genomes. We also compare a set of independently conducted screens from Pax5 mutant mice that converge upon a common set of mutations observed in human acute lymphoblastic leukemia (ALL). We also discuss reverse genetic models and screens that use CRISPR-Cas, ORFs and shRNAs to provide high throughput in vivo proof of oncogenic function, with an emphasis on models using adoptive transfer of ex vivo cultured cells. Finally, we summarize mouse models that offer temporal regulation of candidate genes in an in vivo setting to demonstrate the potential of their encoded proteins as therapeutic targets.


Based on qualitative, multisited research, this article examines the impacts of short- and long-term international migration to the Middle East and the West on the Mar Thoma Syrian Christian demonination of Kerala. Migrants and their foreign-born children have new demands and expectations, and significant financial contributions have led to adjustments in the orientation and functioning of the denomination and its clergy. Large-scale emigration has also had indirect effects. International networks and the economic affluence of the population, along with a rise in social problems caused by migration and consumerism, have led to the rise of evangelical and charismatic transdenominational churches in Kerala that challenge the functioning of established Christian denominations such as the Mar Thoma. Church leaders have been trying to bring about changes to address these developments, but are constrained by the tradition, structure, and the mission of the churches. I draw on theories of organizational religious change and theories of transnationalism to explain the process of social change in Kerala, also addressing some limitations of these theories.


Turkey's democracy has been consolidated by the inclusion of the religiouslyoriented into mainstream politics. This was facilitated by the increasing secularization of the Turks that made support for a radical religious revival less likely, and the increasing moderation of the worldviews of the religious groups themselves. The Refah Partisi (Prosperity Party, RP)' obtained the plurality of votes in Turkey's December 1995 general elections. In June 1996, the RP and the center-right secular True Path Party (TPP) formed a coalition government, and the RP's leader, Necmettin Erbakan, became prime minister for the first two years of the coalition. These developments caused consternation among many in Turkey, but, unlike the situation in Algeria, the military did not lift a finger to prevent them. Everybody, including the military, accepted the legitimacy of a government led by Erbakan. How has this uneasy marriage between democracy and Islam in Turkey been possible? In order to address this issue, we need to look at the relationship between Islam and democracy in Turkey from a historical perspective. Bernard Lewis has found some aspects of Islam incompatible with liberal democracy.2 Lewis has observed, however, that of the 46 states which were members of the Islamic Conference in 1993, only one, the Turkish Republic, could be described as a democracy in Western terms.3 Earlier, Lewis had expressed a guarded optimism about the future of democracy in Turkey: Twice before, in the course of their history, the Turks have set an example and served as a model for others-under the Ottomans, of militant Islam; under Kemal Ataturk, of secular patriotism. If they succeed in their present endeavor to create, without loss of character and identity, a liberal economy, an open society, and a liberal democratic polity, they may once again serve as a model to many other peoples.4 To use Juan J. Linz's terminology, in Turkey democracy has become the "only game in town;"5 no group with political influence and/or power, including the military and a great majority of the religiously oriented groups, would prefer an authoritarian regime to a democracy.6 Islam, on the other hand, has been integrated into Turkey's democracy in a myriad ways, while constitutional and legal secularism have been kept intact. Religious orders, movements, and sects have had representatives in the secular political parties as well as in the RP. On the other hand, Turkey's 1982 constitution, not unlike the previous 1961 constitution, stipulates that Turkey is a secular state and that this particular provision in the constitution cannot be repealed. The Constitutional Court can be activated by the president and by the political parties if these constitutional provisions are violated. In 1971, for example, the Court banned the Milli Nizam Partisi (National Order Party, NOP), also formed by Erbakan in the previous year, for using religion for political purposes. Ultimately, the military constitutes the major deterrent to the establishment of an Islamic state in Turkey. The consolidation of democracy in Turkey, including the successful inclusion of the religiously oriented groups, has been a consequence of an interactive relationship between Islam and democracy. In the 19th century, Islam was given short shrift as a source for public policymaking while some key ideas of democracy were allowed to flourish. From 1923, when the Republic was founded, until the mid-1940s, democracy itself was gradually established. While people's religious feelings were respected, Islamists, defined here as those who wish to see Islam play a greater role in the society and/or the polity, were not permitted to have their own political organizations. From the mid-1940s to the present, as democracy became consolidated, Islamists have been increasingly reincorporated into the political system. This was helped by a gradual change of attitude on the part of the bulk of the Islamists from an anti-regime stance to a pro-regime one. …


Clefting of the lip and palate is the most frequent craniofacial malformation that occurs in newborn babies. The greatest immediate challenge facing a neonate with a cleft is to take nourishment. In developing countries and particularly in rural areas, palatal obturators and other aids that can assist in feeding are not easily available or accessible. The aim of this study was to develop, evaluate and report on the cleft seal, a simple and inexpensive device that is used with a feeding bottle to promote nourishment of a neonate with a cleft palate. The cleft seal is made of either silicone or thermoform plastic and consists of a spoon-like projection attached to a circular washer. The latter fits snugly between the teat base and collar of the feeding bottle, while the spoon-like projection forms a canopy over the teat and separates the nasal cavity from the mouth during feeding. Closure of the cleft emulates the natural feeding process and favours normal orofacial development. Results from this study indicate that there is an increase in nutritional intake over a shorter feeding time when using the cleft seal. Parents also report an absence of nasal regurgitation. The greatest advantage of the cleft seal lies in its negligible cost and ease of use, which can enable distribution and application in remote neonatal centres, where nursing and parental care givers are often at a loss as to what to do when faced with a newborn with a cleft palate.


Cloud services require the allocation of scarce resources to multiple user requests (jobs) in a setting that facilitates preemption and migration while respecting resource and timing constraints. This gives rise to the following variants of the classical \em resource allocation problem (RAP). The input is a set J of jobs and a set M of homogeneous hosts, each has available amount of some resource. A job is associated with a release time, a due date, a weight and a given length, as well as its resource requirement. A feasible schedule is an allocation of the resource to a subset of the jobs, satisfying the job release times/due dates as well as the resource constraints. We consider two essential objectives: \em throughput maximization (MaxT), which seeks a maximum weight subset of the jobs that can be feasibly scheduled on the hosts in M , and \em resource minimization (MinM), that is finding the minimum number of (homogeneous) hosts needed to feasibly schedule all jobs. Both problems are known to be NP-hard. We address these fundamental problems, which have been studied previously in the \em non-preemptive model, and develop novel techniques for tackling them. In the full version of the paper, we present an $Ømega(1)$-approximation algorithm for MaxT, assuming there is sufficient slack for each job to be completed in its time window. For MinM, we study a more general setting with d resources and derive an $O(łog d)$-approximation for any fixed $d \geq 1$, under the assumption that time windows are not too small. This assumption can be removed, leading to a slightly worse ratio of $O(łog dłog^* T)$, where T is the maximum due date of any job.


There are numerous process integration schemes currently in place for the implementation of 3D-IC. Via first, via middle, via last along with back end of line (BEOL), front end of line (FEOL) and other variations of these approaches. This work will explore the role of wafer bonding, both permanent and temporary, in the fabrication of 3D-IC. Additionally, the materials and process flows used for these processes will be examined in detail.


Front-end Instruction delivery accounts for a significant fraction of the energy consumed in a dynamic superscalar processor. The Issue queue in these processors serves two crucial roles: it bridges the front and back ends of the processor and serves as the window of instructions for the out-of-order engine. A mismatch between the front end producer rate and back end consumer rate, and between the supplied instruction window from the front end, and the required instruction window to exploit the level of application parallelism, results in additional front-end energy, and Increases the issue queue utilization. While the former increases overall processor energy consumption, the latter aggravates the issue queue hot spot problem. We propose a complementary combination of fetch gating and issue queue adaptation to address both of these issues. We introduce an issue-centric fetch gating scheme based on issue queue utilization and application parallelism characteristics. Our scheme attempts to provide an instruction window size that matches the current parallelism characteristics of the application while maintaining enough queue entries to avoid back-end starvation. Compared to a conventional fetch gating scheme based on flow-rate matching, we demonstrate 20% better overall energy-delay with a 44% additional reduction in issue queue energy. We identify Icache energy savings as the largest contributor to the overall savings and quantify the sources of savings in this structure. We then couple this issue-driven fetch gating approach with an issue queue adaptation scheme based on queue utilization. While the fetch gating scheme provides a window of issue queue instructions appropriate to the level of program parallelism, the Issue queue adaptation approach shuts down the remaining underutilized issue queue entries. Used in tandem, these complementary techniques yield a 20% greater issue queue energy savings than the addition of the savings from each technique applied in isolation. The result of this combined approach is a 6% overall energy-delay savings coupled with a 54% reduction in issue queue energy.


A series of analogue and derivatives of heterocyclic bearing nitrogen, oxygen and oxazole moieties constitutes the core structure of a several biological active compounds. Oxazole containing heterocyclic compounds plays an important role in medicinal chemistry and exhibit wide range of biological activities. Benzoxazole Nucleus have been reported various types of biological activities such as Antidepressant, Antibacterial, Antifungal, Antiinflammatory, Analgesic and Anticancer.


The endocannabinoids anandamide and 2-arachidonoylglycerol mimic Delta9-tetrahydrocannabinol, the chemical component responsible for the psychoactive properties of Cannabis sativa, by binding to both type 1 and type 2 cannabinoid receptors. Endocannabinoids exert several actions, both centrally and peripherally, and are synthesized or hydrolyzed by specific enzymes. In this review, the elements that constitute the endocannabinoid system (ECS) are described, with the aim of describing their interplay with other components of reproductive endocrinology, both in females and males. In particular, the interaction of the ECS with sex hormones and cytokines,1 generating an endocannabinoid/hormone/cytokine array responsible for the control of human fertility, is discussed. The data for endocannabinoids suggest that these molecules can be proposed as novel lipid hormones (lipokines) that are critically involved in reproductive events.


Mobile systems for mapping and terrain classification are often tested on datasets of intact environments only. The behavior of the algorithms in unstructured environments is mostly unknown. In safety, security and rescue environments, the robots have to handle much rougher terrain. Therefore, there is a need for 3D test data that also contains disaster scenarios. During the Response Robot Evaluation Exercise in March 2010 in Disaster City, College Station, Texas (USA), a comprehensive dataset was recorded containing the data of a 3D laser range finder, a GPS receiver, an IMU and a color camera. We tested our algorithms (for terrain classification and 3D mapping) with the dataset, and will make the data available to give other researchers the chance to do the same. We believe that this captured data of this well known location provides a valuable dataset for the USAR robotics community, increasing chances of getting more comparable results.


The Tiger (Panthera tigiris tigiris) is an iconic, charismatic and umbrella species of certain terrestrial ecosystems. Globally the species faces very serious threats through habitat loss, and human-tiger conflicts like poaching and illegal trade of its body parts. There is clear need for policy-makers and conservationists to give greater attention to conservation strategy, if the species is to be saved in the wild. The iconic status of the tiger in terrestrial ecosystems, means success in its conservation has wide implications for the survival of other species. This study aimed to assess and review the efforts made by the Government of Nepal and its achievements in terms of conserving the tiger population and its prey-base. We assess the status of the species with reference to the Global Tiger Recovery program (GTRP) and the progress made by the Government of Nepal. The study was carried out in the lowlands of Nepal, the Terai Arc Landscape (TAL), an important tiger landscape compromising six protected area of Nepal and nine protected areas in India. However, this paper covers only the Nepal part. The TAL (Nepal part) extends from Bagmati River in the east to Mahakali River in the west. There are six tiger bearing protected areas in the TAL, and Chitwan National Park supports the largest tiger population, one of the very few protected areas with more than 100 tigers. This study was largely based on review of literature, as well as informal interviews of the field staff involved in tiger conservation activities, protected area managers, and policy makers. Information was collected during the nation-wide tiger survey conducted from January to June 2013. Results showed that the tiger population increased by 63% in four years from 2009 (from 121 in 2009 to 198 in 2013). The increase in tiger population in that area of Nepal is an indication of positive progress in terms of the GTRP objectives while some challenges associated to human-tiger conflicts remains. Results suggest that despite the significant gain in tiger populations, policy-makers need to pay even greater attention to safeguarding tiger habitat, addressing human-tiger conflict and combating poaching and illegal trade of tiger body parts on a perpetual basis. The study further suggested that engagement of local communities in tiger conservation is an essential requirement in reducing human-tiger conflicts, strengthening trust in wildlife conservation and ensuring that conservation benefits accrue to the communities and tigers. Effective law enforcement is equally imperative in ensuring long-term survival of the species.


Uncontrolled lymphoproliferation is a characteristic feature of lymphomas and leukemias. Nonmalignant lymphoproliferative diseases are also observed in humans as well as in lpr (lymphoproliferation) and gld (generalized lymphadenopathy) mice. The discoveries that spontaneous mutations of Fas (APO-1/CD95) or its ligand (FasL) were associated with the lpr and gld phenotypes led to a satisfying explanation as to how deficiency of a pivotal lymphocyte apoptotic pathway (Fas–FasL) caused accumulation of activated lymphocytes in the peripheral immune system 1. A second important consequence of the failure to delete activated cells of the immune system is systemic autoimmunity—which can be explained by the persistence of potentially self-reactive T cells and, most likely, antigen-presenting cells in the peripheral immune system 2.

The remarkable strides made in defining the cellular biochemistry of apoptosis over the last 5 years have led to several predictions of protein function that, most definitively, could be tested by gene targeting in mice. Early predictions were that deletion of components of the Fas signal transduction pathway would lead to a phenotype similar to lpr. Deletions of Fas-associated death domain (FADD) or caspase-8 were lethal in the embryo due to impaired cardiac development, and were therefore uninformative regarding mature T cell function 34. However, FADD-deficient T cells in recombination activating gene (RAG)-1−/− mice or transgenic mice expressing a dominant negative FADD protein were completely resistant to Fas-mediated apoptosis, as expected, but demonstrated reduced T cell proliferation rather than lymphoproliferation and autoimmunity 56.

The results of the studies by Alam et al. 7 and Kennedy et al. 8 in this issue provide a potential explanation for the contrasting effects of Fas versus FADD deficiency. Both studies report that, in addition to the well-defined role of upstream caspases in initiating the proteolytic cascade required for the inactivation and packaging of cellular constituents in apoptosis, caspases are necessary for proliferation of primary human T cells in vitro. This conclusion was based on two major observations: (a) T cell proliferation was inhibited by cell-permeable caspase inhibitors, and (b) caspases were cleaved within hours after CD3 engagement. Although these data are compelling, some caveats should be noted. Most commercially available irreversible caspase inhibitors are not absolutely specific for any individual caspase, so that precise intracellular targets cannot be certain 9. Could these inhibitors be exerting a "toxic" effect on primary T cells, thus accounting for their lack of proliferation? Alam et al. 7 have made considerable efforts to exclude this possibility: caspase-3 cleavage was observed in activated T cells that were sorted on the basis of failure to bind annexin V, a marker of early cell death. These authors also used cell-permeable fluorescent caspase substrates to avoid artefactual activation of caspases arising from mechanical disruption of the cell, which complicated the interpretation of previous studies 1011.

Key to understanding the significance of the observations reported by Alam et al. 7 and Kennedy et al. 8 is the identification of the earliest upstream "initiator" caspase, most likely caspase-8, that is activated after CD3 ligation as well as the substrates of this caspase. In its pro-form, caspase-8 exists as an inactive 56-kD precursor that is recruited to a death receptor from the cytosol to form the DISC (death-inducing signaling complex) through the adapter protein FADD. Caspase-8 is sequentially cleaved into 41/43- (large subunit) and 12-kD (small subunit) intermediates followed by 26- and 18- (large subunit) and 10- and 2-kD (small subunit) products 12. In neither study reported in this issue were the catalytically active fragments (18 and 10 kD) clearly demonstrated within the first day after T cell activation, although the presence of the ∼26-kD peptide implies cleavage of the large subunit. In contrast to these studies, Scaffidi et al. 13 observed that there was very little recruitment of FADD or caspase-8 to form a DISC within the first day after mitogen activation of T cells, and that catalytically active fragments of caspase-8 were not detected. These contrasting findings raise the question as to whether other caspases and/or Fas binding proteins could be responsible for promoting T cell proliferation.

Peripheral blood–derived T cells are a heterogeneous population that includes different functional subsets as well as cells with varying life histories (naive, recently activated, and memory cells). Could anti-CD3 provide a restimulation (death) signal to a subpopulation of previously activated T cells? Failure to detect caspase-3 activation in the study by Kennedy et al. 8 would argue against this, as does a subset analysis by Alam et al. 7. However, the two studies differ significantly with regard to the extent of caspase activation and its consequences. Whereas Kennedy et al. 8 did not observe caspase 3 activation within 24 h after activation, Alam et al. 7 detected cleavage of caspase-3, -6, and -7 as well as selective proteolysis of the substrates poly(ADP-ribose) polymerase (PARP) and lamin B in cells analyzed 16 h to 4 d after activation. Cleavage of the DNA repair enzyme, PARP, and a structural component of the nuclear membrane, lamin B, are striking findings and raise obvious questions about cell viability.

The similarities between several of the morphologic features of mitosis and apoptosis, such as dissolution of the nuclear membrane and chromatin condensation, suggested that apoptosis can be likened to a "mitotic catastrophe" under certain conditions 14. Therefore, it would not be surprising to find similarities between some of the biochemical pathways involved in these two opposing cell fates. During cell division, the nuclear membrane to which lamins are attached becomes vesiculated and dispersed within the cytosol. Whereas cleavage of lamins has not previously been reported in this context, it is well known that lamins are phosphorylated, a posttranslational modification that is associated with depolymerization of the lamina into soluble oligomeric units 1516. Similarly, cleavage (and inactivation) of PARP during T cell proliferation would not be expected to have any immediate deleterious consequences, as PARP-deficient mice have an apparently normal immune system 17.

Caspases do not function solely to inactivate proteins. The first caspase identified, IL-1β–converting enzyme (ICE/caspase-1), cleaves IL-1β and IL-18 into their active proinflammatory cytokines 18. It is likely that caspase-4, -5, and -11 play similar roles 19. In the context of apoptosis, many cleavage events also result in enzyme activation. Apart from their own autocatalytic conversion into active proteases, caspases cleave inhibitory proteins such as inhibitor of caspase-activated DNase (ICAD)/DNA fragmentation factor of 45 kD (DFF45) to release an active DNase, and they cleave proteins within the bcl-2 family to promote proapoptotic effects and regulatory proteins such as gelsolin to render this protein constitutively active for actin degradation. Therefore, these activities define two functional categories, one related to promotion of inflammation and the other to the promotion of apoptosis. In addition, a significant number of caspase substrates have been identified for which the functional significance remains unclear 919. These substrates include kinases (c-Jun NH2-terminal kinases [JNKs], PITSLRE kinase, protein kinase C-δ, p21-activated kinase 2 [PAK2K]), many of which have pleiotropic functions. For example, JNK activation may cause T cell proliferation or apoptosis, depending on the duration of JNK expression 20. Taken together with the reports in this issue 78, a third category of caspase function, cell proliferation, can now be proposed.

Several questions remain to be addressed. If caspase-8 cleavage is required for T cell proliferation, how do Fas-deficient mice or humans 2122 develop massive lymphadenopathy and autoimmunity? One possibility is that other death receptors such as TNF-R or DR3 that use the same signal transduction pathways as Fas activate upstream caspases so as to costimulate T cells in a similar fashion to Fas. Other questions will need to be addressed, such as how does "high dose" anti-CD3 lead to caspase-3 activation? Is this achieved through increased transcription of autocrine FasL and/or other "death" ligands, as suggested by Kennedy et al. 8? Why don't transgenic mice that overexpress crm A (a cowpox-encoded protein that potently inhibits caspase-1 and -8) have a defect in T cell proliferation 6? Answers to these questions will be illuminating.


Abstract Kochia is a troublesome weed throughout the western United States. Although glyphosate effectively controls kochia, poor control was observed in several no-till fields in Kansas. The objectives of this research were to evaluate kochia populations response to glyphosate and examine the mechanism that causes differential response to glyphosate. Glyphosate was applied at 0, 54, 109, 218, 435, 870, 1305, 1740, 3480, and 5220 g ae ha−1 on 10 kochia populations. In general, kochia populations differed in their response to glyphosate. At 21 d after treatment, injury from glyphosate applied at 870 g ha−1 range from 4 to 91%. In addition, glyphosate rate required to cause 50% visible injury (GR50) ranged from 470 to 2149 g ha−1. Differences in glyphosate absorption and translocation and kochia mineral content were not sufficient to explain differential kochia response to glyphosate. Nomenclature: Glyphosate; kochia, Kochia scoparia (L.) Schrad.


Context: The effects of physical activity (PA) on improvement of glycemia may differ between prediabetic individuals defined by oral glucose tolerance test vs glycated hemoglobin (HbA1c). Objective: We studied the association between PA and improvement of glycemia in individuals with prediabetes defined by glucose vs HbA1c criteria. Design, Setting, and Participants: From the Whitehall II study, 957 participants with prediabetes defined by isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), or both and 457 with prediabetes defined by HbA1c were included. Main Outcome Measures: The associations of PA with concomitant changes in glucose-related outcomes during 5 years of follow-up were analyzed. A recursive partitioning analysis was performed to study heterogeneity in the association between baseline PA and the probability of reversion to normoglycemia. Results: After 5 years of follow-up, 405 (42%) individuals with glucose-defined prediabetes reverted to normal glucose tolerance (NGT). A 5-year increase in moderate-to-vigorous-intensity PA was associated with improvements in insulin sensitivity and β-cell function, but PA was not generally associated with reversion to NGT. Only among women ≥50 years with i-IFG or i-IGT, higher amounts of PA were associated with higher probability of reversion to NGT. In HbA1c-defined prediabetes, only 20 individuals (4.4%) reverted to normoglycemia, and PA was not associated with improvement in glycemic markers. Conclusions: PA may be particularly important for reversion to normoglycemia among older women with i-IFG or i-IGT. Individuals with prediabetes identified by HbA1c have a low probability of reversion to normoglycemia, and their changes in glycemia are not related to PA.


Background and Objectives: Fenofibrate, a PPAR-α agonist, has been demonstrated to reduce the progression of diabetic retinopathy (DR) and the need for laser treatment in a FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study. However, in the subgroup of patients without pre-existing DR, there was no significant difference in the progression of DR between the fenofibrate group and the placebo group. In this study, we aim to investigate whether fenofibrate can decrease the risk of incident DR in a population-based cohort study of type 2 diabetic patients in Taiwan. Materials and Methods: A total of 32,253 type 2 diabetic patients without previous retinopathy were retrieved from 892,419 patients in 2001–2002. They were then divided into two groups based on whether they were exposed to fenofibrate or not. The patients were followed until a diagnosis of diabetic retinopathy was made or until the year 2008. Results: With a follow-up period of 6.8 ± 1.5 years and 5.4 ± 2.6 years for 2500 fenofibrate users and 29,753 non-users, respectively, the Cox proportional hazard regression analysis revealed that the hazard ratio (HR) of new onset retinopathy was 0.57 (95% CI 0.57–0.62, p < 0.001). After adjusting for hypertension; the Charlson comorbidity index (CCI); and medications such as angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), anticoagulants, gemfibrozil, statins, and hypoglycemic agents, the adjusted HR was 0.75 (95% CI 0.68–0.82, p < 0.001). The need for laser treatment has an HR and adjusted HR of 0.59 (95% CI 0.49–0.71, p < 0.001) and 0.67 (95% CI 0.56–0.81, p < 0.001), respectively. Conclusion: Our study showed that the long-term and regular use of fenofibrate may decrease the risk of incident retinopathy and the need for laser treatment in type 2 diabetic patients. Since there are limitations associated with our study, further investigations are necessary to confirm such an association.


Space-time code is a kind of antifading techniques discussed drastically in recent years. The paper focuses on the field of space-time block coding antiinterference technique. After introducing the fundamental concept of interference cancellation and the two-step interference cancellation method used usually, the paper submits a new arithmetic, which is unselective repeated feedback interference cancellation (URF-IC) arithmetic. The arithmetic can achieve the performance of two-step interference cancellation technique while its complexity of operation is lower.


Environmental education and its effective integration into the teaching process of comprehensive subjects in curriculum documents is one of the priority but common educational aims that are embodied in the National Programme of Education Development (NPED) in the Czech Republic. In the same time it represents an integration element of all taught subjects from the curriculum at Grammar as well as Secondary Schools. One of the modules of the project UNDP (United National Development Programme) entitled "The sustainable development – creation of conditions" that had been solved in the Czech Republic in 1998-2000 dealt with specific problems of environmental education at Secondary Schools and in teachers' preparation. In the frame of the above quoted project there was made a comparative analysis of teachers` study curriculum.


The use and appropriation of digital information and communication technologies by Mapuche communicators and activists has turned into a new process of political and identity innovation in the context of the Chilean–Mapuche intercultural and interethnic conflict. This study aims to understand the Mapuche intercultural dialogue. Based on a corpus of semi-structured interviews with Mapuche communicators, we interpret and analyze their discourses in relation to the dissemination and/or analysis of the indigenous digital informative media. The results are built upon the valorization and recognition of the mediations that the Mapuche agents develop around their own e-communication praxis. This interpretation derives from applying theoretical–conceptual categories which have enabled us to address technological, technopolitical, (inter)cultural, and communicative dimensions regarding the Mapuche e-communication work.


Sprague-Dawley rats were used to study the influence of local application of antagonists of D1 and D2 receptors (SCH 23390 and raclopride, respectively) on neuronal responses in globus pallidus evoked by somatosensory cortex stimulation. SCH 23390 was found to produce a short-latency inhibition in response to cortical stimulation and to block the long-latency inhibition. Raclopride application suppressed the short-latency inhibition and revealed the long-latency inhibition in response to cortical stimulation. It is suggested that the observed phenomena are based on the modulation of GABA releasing in stria-pallidar terminals by endogenous dopamine.


Traumatic brain injury (TBI) is seen by the insurance industry and many health care providers as an "event." Once treated and provided with a brief period of rehabilitation, the perception exists that patients with a TBI require little further treatment and face no lasting effects on the central nervous system or other organ systems. In fact, TBI is a chronic disease process, one that fits the World Health Organization definition as having one or more of the following characteristics: it is permanent, caused by non-reversible pathological alterations, requires special training of the patient for rehabilitation, and/or may require a long period of observation, supervision, or care. TBI increases long-term mortality and reduces life expectancy. It is associated with increased incidences of seizures, sleep disorders, neurodegenerative diseases, neuroendocrine dysregulation, and psychiatric diseases, as well as non-neurological disorders such as sexual dysfunction, bladder and bowel incontinence, and systemic metabolic dysregulation that may arise and/or persist for months to years post-injury. The purpose of this article is to encourage the classification of TBI as the beginning of an ongoing, perhaps lifelong process, that impacts multiple organ systems and may be disease causative and accelerative. Our intent is not to discourage patients with TBI or their families and caregivers, but rather to emphasize that TBI should be managed as a chronic disease and defined as such by health care and insurance providers. Furthermore, if the chronic nature of TBI is recognized by government and private funding agencies, research can be directed at discovering therapies that may interrupt the disease processes months or even years after the initiating event.


Objective To investigate the association between dietary protein sources in early adulthood and risk of breast cancer. Design Prospective cohort study. Setting Health professionals in the United States. Participants 88 803 premenopausal women from the Nurses' Health Study II who completed a questionnaire on diet in 1991. Main outcome measure Incident cases of invasive breast carcinoma, identified through self report and confirmed by pathology report. Results We documented 2830 cases of breast cancer during 20 years of follow-up. Higher intake of total red meat was associated with an increased risk of breast cancer overall (relative risk 1.22, 95% confidence interval 1.06 to 1.40; Ptrend=0.01, for highest fifth v lowest fifth of intake). However, higher intakes of poultry, fish, eggs, legumes, and nuts were not related to breast cancer overall. When the association was evaluated by menopausal status, higher intake of poultry was associated with a lower risk of breast cancer in postmenopausal women (0.73, 0.58 to 0.91; Ptrend=0.02, for highest fifth v lowest fifth of intake) but not in premenopausal women (0.93, 0.78 to 1.11; Ptrend=0.60, for highest fifth v lowest fifth of intake). In estimating the effects of exchanging different protein sources, substituting one serving/day of legumes for one serving/day of red meat was associated with a 15% lower risk of breast cancer among all women (0.85, 0.73 to 0.98) and a 19% lower risk among premenopausal women (0.81, 0.66 to 0.99). Also, substituting one serving/day of poultry for one serving/day of red meat was associated with a 17% lower risk of breast cancer overall (0.83, 0.72 to 0.96) and a 24% lower risk of postmenopausal breast cancer (0.76, 0.59 to 0.99). Furthermore, substituting one serving/day of combined legumes, nuts, poultry, and fish for one serving/day of red meat was associated with a 14% lower risk of breast cancer overall (0.86, 0.78 to 0.94) and premenopausal breast cancer (0.86, 0.76 to 0.98). Conclusion Higher red meat intake in early adulthood may be a risk factor for breast cancer, and replacing red meat with a combination of legumes, poultry, nuts and fish may reduce the risk of breast cancer.


1407_50The tandem betatron is a compact, high-current induction accelerator that has the capability to accelerate electrons to an energy of order one gigavolt. Based upon the operating principle of a conventional betatron, the tandem betatron employs two synchronized induction cores operating 180 degrees out of phase. Embedded within the cores are the vacuum chambers, and these are connected by linear transport sections to allow for moving the beam back and forth between the two betatrons. The 180 degree phase shift between the core fluxes permits the circumvention of the flux swing constraint that limits the maximum energy gain of a conventional betatron. By transporting the beam between the synchronized cores, an electron can access more than one acceleration cycle, and thereby continue to gain energy. This added degree of freedom also permits a significant decrease in the size of the magnet system. Biasing coils provide independent control of the confining magnetic field. Provided that efficient beam switching can be performed, it appears feasible that a one gigavolt electron beam can be generated and confined. At this energy, a high current electron beam circulating in a one meter radius orbit could provide a very intense source of short wavelength ((lambda) < 10 nm) synchrotron radiation. This has direct application to the emerging field of x-ray lithography. At more modest energies (10 MeV-30 MeV) a compact tandem betatron could be employed in the fields of medical radiation therapy, industrial radiography, and materials processing.


This paper investigates runtime monitoring of perception systems. Perception is a critical component of high-integrity applications of robotics and autonomous systems, such as self-driving cars. In these applications, failure of perception systems may put human life at risk, and a broad adoption of these technologies requires the development of methodologies to guarantee and monitor safe operation. Despite the paramount importance of perception, currently there is no formal approach for system-level perception monitoring. In this paper, we formalize the problem of runtime fault detection and identification in perception systems and present a framework to model diagnostic information using a diagnostic graph. We then provide a set of deterministic, probabilistic, and learning-based algorithms that use diagnostic graphs to perform fault detection and identification. Moreover, we investigate fundamental limits and provide deterministic and probabilistic guarantees on the fault detection and identification results. We conclude the paper with an extensive experimental evaluation, which recreates several realistic failure modes in the LGSVL open-source autonomous driving simulator, and applies the proposed system monitors to a state-of-the-art autonomous driving software stack (Baidu's Apollo Auto). The results show that the proposed system monitors outperform baselines, have the potential of preventing accidents in realistic autonomous driving scenarios, and incur a negligible computational overhead.


The photovoltaic system within the "Politehnica" of University of Timisoara, Romania has a surface of the PV cells of 16.06 m2 and a total surface of the panels of 18.30 m2. In the period April 2011 - February 2012 it worked with an average efficiency of 12.66% and with an annual energy efficiency of 1267.5 kWh/kWp. The installations injects electrical energy in the public grid. The PV system is used for educational practical applications for Master degree students in Solar Energy, for realization of dissertation theses and for public dissemination of information on solar energy. An assessment of the performances of the system based on measured data is provided in this communication. The results are useful for solar energy users interested in installing PV systems in the region.


The COVID-19 pandemic has catalysed numerous changes worldwide in healthcare systems and service delivery practices, many relying on biomedical technologies including digital health The rapid development and widespread adoption of these changes has led to many being reported on extensively in grey literature and public media, but not yet in the conventional scientific peer reviewed literature In particular, digital health contributions have received much attention but the main topics of reporting have been prominent public perception issues, with technical aspects being largely ignored This perspective paper therefore responds to the need for a systematic contextualisation framework to describe digital health contributions to the current COVID-19 pandemic situation The framework recommends four focus areas or "dimensions" for contextual settings: clinical processes, health system, stakeholder and technology Two examples are used to motivate these dimensions: mobile phone tracking, and telehealth consultations It is suggested that use of the framework in presenting digital health innovations more broadly and in context using these example cases, will convey a more informative understanding of the nature of such contributions now and in the post-COVID-19 period


Using the Wiener-Hopf method, for the model with arithmetic distributions of waiting times Ti and claims Zi in ordinary renewal process, an exact non-ruin probabilities for an insurance company in terms of the factorization of the symbol of the discrete Feller-Lundberg equation, are obtained. The delayed stationary process is introduced and generating function for delay is given. It is proved that the stationary renewal process in arithmetic case is ordinary if and only if, when the inter-arrival times have the shifted geometrical distribution. A formula for exact non-ruin probabilities in delayed stationary process is obtained. Illustrative examples when the distributions of Ti and Zi are shifted geometrical or negative binomial with positive integer power are considered. In these cases the symbol of the equation is rational functions what allows us to obtain the factorization in explicit form.


Given a closed Riemannian manifold and a pair of multi-curves in it, we give a formula relating the linking number of the later to the spectral theory of the Laplace operator acting on differential one forms. As an application, we compute the linking number of any two multi-geodesics of the flat torus of dimension 3, generalising a result of P. Dehornoy.


Background. Evidence suggests adherence to clinical guidelines for pelvic inflammatory disease (PID) diagnosis and management is suboptimal. We systematically reviewed the literature for studies describing strategies to improve the adherence to PID clinical guidelines. Methods. The databases MEDLINE and EMBASE, and reference lists of review articles were searched from January 2000 to April 2012. Only studies with a control group were included. Results. An interrupted time-series study and two randomised controlled trials (RCTs) were included. The interrupted time-series found that following a multifaceted patient and practitioner intervention (practice protocol, provision of antibiotics on-site, written instructions for patients, and active followup), more patients received the recommended antibiotics and attended for followup. One RCT found a patient video on PID self-care did not improve medication compliance and followup. Another RCT found an abbreviated PID treatment guideline for health-practitioners improved their management of PID in hypothetical case scenarios but not their diagnosis of PID. Conclusion. There is limited research on what strategies can improve practitioner and patient adherence to PID diagnosis and management guidelines. Interventions that make managing PID more convenient, such as summary guidelines and provision of treatment on-site, appear to lead to better adherence but further empirical evidence is necessary.


This qualitative descriptive study employed a mixed methods approach to investigate research conducted by Canadian researchers who involve children in their studies. Data collected from a questionnaire completed by thirty researchers across Canada were contextualized through seven interviews, with the goal of compiling a description of the research designs and the mechanisms of engagement used to involve children. A thematic analysis was conducted in order to explore the research designs used, how beliefs about children and childhood shape research design, and ethical and reflective practices used in research involving children. Overall, findings indicate that a wide range of research designs and mechanisms of engagement are used. Implications for practice emerging from this study suggest that researchers should choose a design approach to best suit the study's purpose, and that deliberate and continuous reflection in design practices and implementation can promote ethical practice when conducting research involving children.


Introduction Directly active antivirals (DAA's) are highly effective agents which are ensuring the cure of the majority of Hepatitis C (HCV) patients with all forms of severity of disease. High rates of co-morbidities and polypharmacy in this patient group means thorough drug-drug interaction (DDI) checks are essential. EASL Recommendations on Treatment of Hepatitis C 2016 recognises that numerous and complex DDI are possible with the use of DAAs. Therefore it is recommended that co-medicines are assessed for potential DDI prior to and during treatment. Clinical pharmacists are a key member of the multidisciplinary team to perform this task to ensure safe and effective treatment. We set out to evaluate the incidence of DDIs in the UK and its impact on treatment. Method We performed a retrospective evaluation of HCV patients receiving hepatitis C therapy with DAAs seen across 17 UK centres from August 2015 until April 2016. Data were collected on demographics, HCV genotype (GT), choice of DAA and additional monitoring required. The Liverpool hep-druginteractions.org website was used to evaluate presence and severity of potential DDIs. Results 975 patients were identified of which 684/975 (70%) were male and median 53 (23-89) years old. 608/975 (62%) were HCV GT 1, 50/975 (5%) were GT 2, 237/975 (24%) were GT 3, 65/975 (7%) were GT 4. 564/975 (58%) were cirrhotic. The HCV regimens chosen based on local policies are listed in table 1. 3808 co-medicines were identified in 804/975 (82%) of patients (median of 5.5 medicines/patient). Of the co-medications prescribed: 26% were CNS drugs, 19% cardiac drugs, 12% gastric drugs, 5% HIV drugs and 4.5% opioid substitution therapies. There were 702 interactions identified. Of these 678 (96%) were amber DDIs (close monitoring/dosage adjustment required), with 24 (4%) were red (do not co-administer). Abstract PWE-078 Table 1 HCV regimen Number (%) of patients Sofosbuvir/ledipasvir +/- ribavirin 558 (57) Sofosbuvir/daclatasvir +/- ribavirin 136 (14) Sofosbuvir/pegIFN/ribavirin 109 (11) Ombitasvir/paritaprevir/ritonavir/dasabuvir+/-ribavirin 104 (10) Sofosbuvir + ribavirin 45 (5) Ombitasvir/paritaprevir/ritonavir +/- ribavirin 20 (2) Simeprevir +pegIFN + ribavirin 3 (1) Conclusion This study has shown that although polypharmacy is common in this cohort of patients, this does not preclude cost effective HCV treatment options. The expertise of the clinical pharmacist is essential to ensure accurate screening and advice on managing DDIs to ensure optimal treatment outcomes. Disclosure of Interest None Declared


Home care provider networks can help agencies serve more people more effectively. Before joining a health care provider network, however, agencies must analyze several factors and find partners who share the same business and health care philosophies. Using the guidelines in this article, agencies can be confident of better decisions for their businesses.


Objective: Protein–energy malnutrition (PEM) is an important prognostic factor in patients with cirrhosis. Energy malnutrition (EM) is de�ned by the Japanese Society of Gastroenterology Guidelines for cirrhosis as a non-protein respiratory quotient <0.85, a % arm circumference (%AC) <95%, or a free fatty acid (FFA) value >660 μEq/L. The parameters associated with EM are di�cult to measure in all patients. In this study, we evaluated simple indicators of EM. Methods: This retrospective study included 295 patients with chronic liver diseases (CLDs) in whom serum FFA values or %AC were measured at the Department of Gastroenterology at the Municipal Hospital of Kofu. We examined the characteristics of the patients with EM. Results: EM was observed in 36% of patients with CLDs without a late-evening snack (LES). The frequency of EM was high in patients with Child–Pugh grade B or C, γ-GTP level ≥ 100 U/ml, AST level ≥ 27 IU/l, and ALT level ≥ 27 IU/l in males, and Child–Pugh grade B or C, γ-GTP ≥ 84 U/ml, AST ≥ 24 IU/l, and ALT ≥ 28IU/l in females. Among the three indicators of Child–Pugh grade B or C, increased γ-GTP levels, and increased transaminase values, EM was observed in 16%, 35%, 59%, and 57% of patients who were positive for 0, 1, 2, or 3 of the indicators. The frequency of EM in patients with Child-Pugh grade A was high for increased γ-GTP, AST, and ALT levels. Among the two indicators of increased γ-GTP, and transaminase levels, 16%, 32%, and 67% of patients were positive for 0, 1, or 2 of the indicators. Conclusion: Child-Pugh grade, transaminase values, and γ-GTP levels were useful indicators of EM in patients with CLDs. We should evaluate positively the presence of EM in cases with poor liver function, high transaminase concentrations, or high γ-GTP levels.


We report empirical results on factors that influence human default reasoning, both in feature-inheritance type problems and in problems that specify information about exceptions to default rules. These factors include similarity between instances that are reasoned about and whether the classes of the instances are naturallyoccurring or classes of artifacts. While in classical deductive logic, a problem's 'correct answer' is defined by the problem's formal structure, we argue that the case is different for default reasoning. The identification of factors that influence people's default inferences can contribute to more robust theories of default reasoning that include principles of relevance.