The billions so far laid out on direct-to-consumer ads for prescription drugs have mostly failed to deliver. Yet the successes of a few companies show that failure is hardly inevitable. On August 17, 1997, executives around northern New Jersey's "drug corridor"--where most of the international pharmaceutical companies have their headquarters--mobilized for action. For on that day, the US Food and Drug Administration issued temporary guidelines that, for the first time, permitted the drug makers to specify the uses of their prescription remedies in their radio and television advertisements. The ruling was a major advance for consumer involvement in health care and represented a breakthrough in the industry's ability to use direct-to-consumer (DTC) marketing to reach Out to a vast, untapped consumer segment. Reach out the industry did. By the time the new regulations became permanent, in August 1999, medications and proprietary remedies had broken into the top five categories of ad spending, along with heavyweights such as cars, retailing, movies, and financial services. Last year, pharmaceutical companies were expected to spend $2 billion on TV, print, radio, and outdoor DTC ads, up from $1.2 billion in 1998. As a group, those companies are now boosting their DTC expenditures by 25 to 35 percent annually (Exhibit 1). This media onslaught has yielded some extraordinary results. Schering-Plough's anti-allergy drug Claritin, for example, with $1.9 billion in US sales, is now a household name. But the real news is that most pharmaceutical companies have had trouble executing their DTC strategies, and overall industry results have been mixed at best. Consumers are frequently confused; ad campaigns have sometimes angered and alienated doctors; and many of the industry's biggest names are struggling as they try to add an entirely new approach by marketing directly to consumers. Nonetheless, many senior pharmaceutical executives believe that drug companies can find dramatic new sources of value through DTC marketing, which (in addition to TV and radio commercials) includes print advertising, promotional efforts, public relations, and Internet communications. [1] There is a powerful logic to this optimistic view. An aging population, easy access to medical information, and the current skepticism about health care systems have increasingly made consumers--not the trusted family physician--the arbiters of what prescription medications they take. This trend will probably gain momentum. Drug makers are likely to find the consumer increasingly at the center of their strategic thinking as they search harder and harder for blockbuster drugs that can generate the revenues needed to sustain their high market multiples. One place where they will certainly focus is developing remedies for the largely unmet medical needs of aging baby boomers. Between 1996 and 1999, AstraZeneca,[2] Pfizer, and Schering-Plough increased their DTC spending by at least $100 million each, and Merck added $50 million (Exhibit 2). In a few cases, DTC represents the lion's share of the marketing mix. Estimates suggest that at least half of the marketing expenditures of three drugs--not only Claritin but also Prilosec, which relieves gastrointestinal distress, and the hair loss treatment Propecia--are directed at consumers rather than professional health care providers. As much as 83 percent of Propecia's budget, and 69 percent of Claritin's, may be allocated to consumer advertising. [3] But marketing to professionals still dwarfs DTC spending by a ratio of 10:1 in almost all therapeutic areas, and companies have found it difficult to decide when DTC makes most sense as part of their marketing mix. In the first half of last year, only 7 of the top 20 pharma companies were supporting more than two products with DTC campaigns, and just 6 supported more than three products at a significant level. In only five therapeutic areas--allergies, arthritis, contraceptives, diabetes, and HIV--were three or more products marketed directly to consumers. …


The description of the biological effects of ionizing radiation requires a good knowledge of the dose deposition processes at both the cellular and molecular scales. However, experimental studies on the energy deposition specificity of sub-keV electrons, produced by most radiations, including high-energy photons and heavy ions, are scarce. Soft X-rays (0.2-2 keV) are here used to probe the physical and physico-chemical events occurring upon exposure of liquid water to sub-keV electrons. Liquid water samples were irradiated with a monochromatic photon beam at the SOLEIL synchrotron. Hydroxyl radical quantification was conducted through HO• scavenging using benzoate to form fluorescent hydroxybenzoate. The yields of HO• radicals exhibit a minimum around 1.5 keV, in good agreement with indirect observation. Moreover, they are relatively independent of the benzoate concentration in the range investigated, which corresponds to scavenging times of 170 ns to 170 ps. These results provide evidence that sub-keV electrons behave as high linear energy transfer particles, since they are able to deposit tens to hundreds of electronvolts in nanometric volumes.


BACKGROUND
 Early efforts to incorporate telemedicine into Emergency Medicine focused on connecting remote treatment clinics to larger emergency departments (EDs) and providing remote consultation services to EDs with limited resources. Owing to continued ED overcrowding, some EDs have used telemedicine to increase the number of providers during surges of patient visits and offer scheduled "home" face-to-face, on-screen encounters. In this study, we used remote on-screen telemedicine providers in the "screening-in-triage" role.

 OBJECTIVE
 This study aimed to compare the efficiency and patient safety of in-person screening and telescreening.

 METHODS
 This cohort study, matched for days and proximate hours, compared the performance of real-time remote telescreening and in-person screening at a single urban academic ED over 22 weeks in the spring and summer of 2016. The study involved 337 standard screening hours and 315 telescreening hours. The primary outcome measure was patients screened per hour. Additional outcomes were rates of patients who left without being seen, rates of analgesia ordered by the screener, and proportion of patients with chest pain receiving or prescribed a standard set of tests and medications.

 RESULTS
 In-person screeners evaluated 1933 patients over 337 hours (5.7 patients per hour), whereas telescreeners evaluated 1497 patients over 315 hours (4.9 patients per hour; difference=0.8; 95% CI 0.5-1.2). Split analysis revealed that for the final 3 weeks of the evaluation, the patient-per-hour rate differential was neither clinically relevant nor statistically discernable (difference=0.2; 95% CI –0.7 to 1.2). There were fewer patients who left without being seen during in-person screening than during telescreening (2.6% vs 3.8%; difference=–1.2; 95% CI –2.4 to 0.0). However, compared to prior year-, date-, and time-matched data on weekdays from 1 am to 3 am, a period previously void of provider screening, telescreening decreased the rate of patients LWBS from 25.1% to 4.5% (difference=20.7%; 95% CI 10.1-31.2). Analgesia was ordered more frequently by telescreeners than by in-person screeners (51.2% vs 31.6%; difference=19.6%; 95% CI 12.1-27.1). There was no difference in standard care received by patients with chest pain between telescreening and in-person screening (29.4% vs 22.4%; difference=7.0%; 95% CI –3.4 to 17.4).

 CONCLUSIONS
 Although the efficiency of telescreening, as measured by the rate of patients seen per hour, was lower early in the study period, telescreening achieved the same level of efficiency as in-person screening by the end of the pilot study. Adding telescreening during 1-3 am on weekdays dramatically decreased the number of patients who left without being seen compared to historic data. Telescreening was an effective and safe way for this ED to expand the hours in which patients were screened by a health care provider in triage.


Misleading advertisements, such as for ring tones, being a typical example of an unfair commercial practice have over the past years caused substantial harm to European consumers and society. This is particularly so because in many cases the enforcement response given a legal breach is slow or does not happen at all. A discrepancy can be observed between mala fide and bona fide traders. While the latter inadvertently breach the law, rogue traders' interests lie in the short-term profit generated by illegal activity. They do not mind changing sectors and try to hide, abusing current loopholes in the legal system. The gap between both types of traders is arguably increasing and so are the profits of the mala fide traders, not least due to new technologies that facilitate their operations; most prominently the Internet. This paper deals with the efficient design of enforcement mechanisms addressing misleading advertising laws. Enforcement is crucial to induce individuals to law-abiding behaviour. Here, it is approached from the deterrence perspective. The UCP directive leaves national legislators with considerable discretion regarding the enforcement and the provisions, and institutions involved in the countries thus vary and not in all countries the optimal balance might have been struck yet. This article's goal is to add to the knowledge on design requirements for optimal enforcement solutions, particularly in terms of players that need to be involved. The two mentioned types of traders calculate with differently high benefits. Thus they are to be deterred by different means which calls for a differentiated approach in legal responses and institutions involved. Path dependency explains why no one-size-fits-all solution is available for all European Member States, and the paper aims at providing a set of design requirements that can be adapted to the respective legal system.


Abstract. Title of the paper: Development of body weight in rabbits (Oryctolagus cuniculus) after embryo transfer of reciprocal nuclear combinations to a neutral line of recipients. Ihe article describes differences in the development of body weight ofthe Fl-generations in the rabbit, which oecured after embryo transfer from reciprocal nuclear combinations to a neutral line of reeipients. These differences can be explained as expression of maternal cyto-plasmatical and / or imprinting-effects. The two races – Deutsche Riesen and Farbzwerge –, which are extremly different in body weight were used for the reciprocal crosses. The neutral reeipients were a commercial breed "Zika". Results show a significant higher litter weight of the offspring which descended from the heavier mother race. On the 84th day of life exists no differences in weight between the crosses. Differences were within the crosses between the females and males and between the crosses reciprocal different. Causes for the reciprocal sexdimorphism can be A: extrachromosomal respectively cytoplasmatic factors or B: a sex-linked and a sex-influenced heredity, which coinside and are regulated by imprinting


In its last days, the Obama Administration imposed sanctions on Syrian military officials in response to reports that President Bashar al-Assad's regime used industrial chlorine as a weapon against its own people in 2014 and 2015. The Treasury Department on Jan. 12 announced it is freezing any U.S. assets of 18 individuals, including military personnel tied to chlorine gas attacks in Aleppo and other locations in Syria. The action marked the first time the U.S. has sanctioned specific officials in connection with Damascus's violation of the Chemical Weapons Convention and a U.N. Security Council resolution. "The Syrian regime's use of chemical weapons against its own people is a heinous act that violates the long-standing global norm against the production and use of chemical weapons," says Adam J. Szubin, acting Treasury undersecretary for terrorism and financial intelligence. A U.N. investigation confirmed that Syria's military used chlorine barrel bombs on civilians in


The mechanism of chaperonins is still under intense investigation. Earlier studies by others and us on the bacterial chaperonin GroEL points to an active role of chaperonins in unfolding the target protein during initial binding. Here, a natural eukaryotic chaperonin system [tail-less complex polypeptide 1 (TCP-1) ring complex (TRiC) and its target protein actin] was investigated to determine if the active participation of the chaperonin in the folding process is evolutionary-conserved. Using fluorescence resonance energy transfer (FRET) measurements on four distinct doubly fluorescein-labeled variants of actin, we have obtained a fairly detailed map of the structural rearrangements that occur during the TRiC-actin interaction. The results clearly show that TRiC has an active role in rearranging the bound actin molecule. The target is stretched as a consequence of binding to TRiC and further rearranged in a second step as a consequence of ATP binding; i.e., the mechanism of chaperonins is conserved during evolution.


AIM
We conducted a genome-wide association study on angiotensin-converting enzyme inhibitor-induced cough and used our dataset to replicate candidate genes identified in previous studies.

PATIENTS & METHODS
A total of 124 patients and 1345 treated controls were genotyped using Illumina arrays. The genome-wide significance level was set to p < 5 × 10-8.

RESULTS
We identified nearly genome-wide significant associations in CLASP1, PDE11A, KCNMB2, TGFA, SLC38A6 and MMP16. The strongest association was with rs62151109 in CLASP1 (odds ratio: 3.97; p = 9.44 × 10-8). All top hits except two were located in intronic or noncoding DNA regions. None of the candidate genes were significantly associated in our study.

CONCLUSION
Angiotensin-converting enzyme inhibitor-induced cough is potentially associated with genes that are independent of bradykinin pathways.


BACKGROUND
The aim of this experimental study was to investigate the effects of melatonin and phospholipid on adhesion formation and the correlation with vascular endothelial growth factor (VEGF) expression in rats.

METHODS
Sixty Wistar-Albino rats were divided into four groups as sham, control and two study groups, each including 15 rats. In the sham group, laparotomy was the only procedure. Left lower parietal peritoneum was abraded after laparotomy and serosal defects formed on the cecum, ileum and right uterine horn in the study and control groups. Ringer lactate was then applied to the control group, while melatonin and phospholipid suspension were applied separately in the two study groups. Relaparotomy was performed in all groups on the 15th day to score and evaluate the adhesion formation.

RESULTS
Adhesion formation was significantly lower in the sham, melatonin and phospholipid groups than in the control group (p<0.05). VEGF staining was significantly higher in the control group with adhesion areas compared to the other groups (p<0.05). When VEGF staining was compared, there was no significant difference between VEGF- stained and normal areas in the melatonin and phospholipid groups.

CONCLUSION
Melatonin and phospholipid decreased the adhesion formation in an experimental adhesion model in rats. There is a correlation between adhesion severity and VEGF expression.


The quality of ripe mango fruits depends on maturity stage at harvest, which is usually assessed by visible criteria or from estimates of the age of fruit. The present study deals with the potential of chlorophyll fluorescence as a nondestructive method to assess the degree of fruit maturity regardless of fruit growing conditions. Chlorophyll fluorescence parameters were measured along with respiration rates of fruits still attached to the tree. At the same harvest stage, based on the fruit age or the thermal time sum (degree-days) method, physical and biochemical measurements related to fruit maturity and quality were made. Shaded fruits had a significantly greener flesh color, as well as a lower fruit density and flesh dry matter content, than well-exposed fruits, showing that fruits at the top of the canopy were more mature than fruits within the canopy, which were still in a growth phase. Additionally, chlorophyll fluorescence parameters, F(o), F(m), and F(v), were significantly lower for fruits taken from the top of the canopy than for those from within the canopy. The unique relationship observed between chlorophyll fluorescence parameters and fruit maturity, estimated by internal carbon dioxide content, on fruit still attached to trees is independent of growing conditions, such as the position of the fruit in the canopy and carbohydrate supply. The chlorophyll fluorescence method evaluates maturity much more accurately than the degree-day method and, moreover, nondestructively provides values for individual fruits before harvest.


Thin films have become important for basic studies in physics and in many other fields. The immense interest in basic properties of thin films is due to considerable variations in their properties compared to those of the bulk material. Studies of the optical, electrical and magnetic properties, investigations of structural disorder and phase transition and of various surface phenomena are very much interest in research areas. The results obtained by research on basic studies are useful for the technical application of thin films. Thin films have greater deviations in their behavior corresponding to their original bulk materials. Because of small thickness certain physical features are observed such as optical interference, electronic tunneling through an insulating layer, high resistivity, low temperature coefficient of resistance, increase in optical magnetic fields and optical temperatures of superconductors. Material properties of indium zinc oxide thin films and all the techniques used to deposit thin films are summarized with an elaborative account along with our results.


Abstract. Ice wedges are widespread periglacial features in the landscape of Adventdalen, Svalbard. The networks of ice wedges have created areas with well-developed polygonal terrains in the lowest fluvial terraces in this valley. We have examined the sedimentological characteristics of the northern and southern banks of the Advent river for palaeoenvironmental purposes. The base of two sedimentary sections reported radiocarbon dates of 3.3 and 3.9 ka BP, respectively. The northern site is constituted by three very different lithostratigraphical units, which suggests that their formation should be related to different environmental and climate conditions. By contrast, the southern section shows a rather homogeneous composition, with no significant variations in grain size and organic matter content. In both cases the uppermost sediments are constituted by a thick aeolian deposit. According to our data, warmer climate conditions may have prevailed during the mid Holocene until 3.3 ka BP with widespread peat formation in the valley bottom. Subsequently, a period with alternating soil formation and aeolian sedimentation took place from 3 to 2.5 ka BP, probably due to increasing climatic severity. During the last millennium a long-term cooling trend has favoured aeolian deposition in the lowest part of Adventdalen.


Numerous methods have recently emerged for fabricating cellular lattice structures with unit cells that can be repeated to create 3D space filling systems with very high interconnected pore fractions. These lattice structures possess exceptional mechanical strength resulting in highly efficient load supporting systems when configured as the cores of sandwich panels. These same structures also provide interesting possibilities for cross flow heat exchange. In this scenario, heat is transported from a locally heated facesheet through the lattice structure by conduction and is dissipated by a cross flow that propagates through the low flow resistant pore passages. The combination of efficient thermal conduction along the lattice trusses and low flow resistance through the pore channels results in highly efficient cross flow heat exchange. Recent research is investigating the use of hollow truss structures that enable their simultaneous use as heat pipes which significantly increases the efficiency of heat transport through the lattice and their mechanical strength. The relationships between heat transfer, frictional flow losses and topology of the lattice structure are discussed and opportunities for future developments identified.


Ménière's disease is a disorder of the inner ear that causes attacks of vertigo and hearing loss, tinnitus, aural fullness in the involved ear. Over the past 4 decades, the Equilibrium Committee of the AAO-HNS has issued guidelines for diagnostic criteria, with the latest version being published in 1995. These criteria were reviewed in 2015 by the Equilibrium Committee, and revisions were approved at the recent meeting of the committee at the 2015 AAO-HNSF Annual Meeting. The following commentary outlines the amended and approved criteria.


Objective: Previous studies suggest that gender affects the adaptive responses of the heart to some forms of cardiac overload. It is unknown whether gender influences left ventricular (LV) remodeling after myocardial infarction (MI). Methods: We performed transthoracic echocardiographic-Doppler examinations in age-matched male (n = 17) and female (n = 16) rats before, and 1 and 6 weeks after transmural MI or sham surgery. Results: Following large MI (male = 45 ± 1% LV circumference vs. female = 48 ± 4%, p = NS), both male and female rats developed progressive LV dilatation. Infarctions caused a similar degree of global and regional LV systolic dysfunction in males and females. Male rats had significant increases in the thickness of the noninfarcted posterior wall by 6 weeks after MI. However, posterior wall thickness did not change in the infarcted female rats. Average myocyte diameter in the noninfarcted region of the heart was also greater in male than female MI rats. The combination of increased cavity size with little change in wall thickness resulted in a greater decline in relative wall thickness in the female rats compared to the males. Male rats with MI showed progressively restricted LV diastolic filling as assessed by transmitral Doppler recordings. Female rats had less of an increase in the ratio of early to late transmitral velocities and less of an increase in the E wave deceleration rate after MI. Conclusions: Female rats showed a different pattern of LV remodeling than males with less of an increase in thickness of the noninfarcted portions of the left ventricle than males, but comparable LV cavity enlargement and systolic dysfunction. Despite similar infarct size, females developed less pronounced abnormalities of LV diastolic filling. We hypothesize that the gender-related differences in postinfarction LV remodeling may contribute to the different LV filling patterns, and might ultimately relate to differences in clinical outcome.


OBJECTIVE: The study was performed to evaluate in silico binding ability of lutein and rosmarinic acid (RA) with the envelope domain III (EDIII) proteins of the four serotypes of dengue virus (DENV), enlightening potential antiviral activity of the two compounds. MATERIALS AND METHODS: EDIII protein structures for the four DENV serotypes were retrieved from RCSB Protein data bank (PDB) and used as receptors. Four ligands of lutein and four of RA were selected from the ZINC database and used for computational molecular docking and ligand interaction analysis with the four receptors using bioinformatics tools like AutoDock Vina and Molecular Operating Environment (MOE) software. RESULTS: The EDIII of the four serotypes demonstrated significant interaction with ligands of lutein and RA. RA ligand ZINC899870, particularly presented best-binding energy values of 6.4, -7.0, and 6.9 kcal/mol with EDIII of serotype DENV-1, DENV-2, and DENV-4 respectively. Whereas, lutein ligand, ZINC14879959 presented best-binding energy value of 7.9 kcal/mol for EDIII of serotype DENV-3. From the results predicted by MOE, the hydroxyl (OH) of 3, 4-dihydroxyphenyl group of RA ligand ZINC899870 is actively involved in interaction with all four serotypes. CONCLUSION: RA is a competent candidate for further evaluation of potential in vitro antiviral activity that can be effective in conferring protection against the four serotypes of DENV.


International collaboration among researchers is a far from linear and straightforward process. Scientometric studies provide a good way of understanding why and how international research collaboration occurs and what are its costs and benefits. Our study investigates patterns of international scientific collaboration in a specific field: wine related research. We test a gravity model that accounts for geographical, cultural, commercial, technological, structural and institutional differences among a group of Old World (OW) and New World (NW) producers and consumers. Our findings confirm the problems imposed by geographical and technological distance on international research collaboration. Furthermore, they show that similarity in trade patterns has a positive impact on international scientific collaboration. We also find that international research collaboration is more likely among peers, in other words, among wine producing countries that belong to the same group, e.g. OW producers or newcomers to the wine industry, Proximity, International scientific collaboration, Wine industry, Gravity model, Scientometrics; Emerging countries Acknowledgements Funding from Fondazione Cassa di Risparmio di Torino (CRT) is gratefully acknowledged.


To the Editor.— The primary and myeloma-associated forms of systemic amyloidosis are frequently associated with cutaneous manifestations, ie, purpuric lesions due to amyloid in vessel walls, or smooth waxy papules, plaques, and nodules due to dermal amyloid deposits. 1,2 Alopecia is less common but may occur as part of the clinical spectrum of established disease or, rarely, as a sign of occult amyloidosis. 3,4 We report a patient whose diffuse alopecia led to the diagnosis of primary systemic amyloidosis. The histopathologic changes in serial biopsy specimens demonstrate that amyloid inhibits anagen restoration of hair follicles, perhaps by vascular impairment. Report of a Case.— A 59-year-old, asymptomatic, white woman presented with a 4-month history of diffuse scalp alopecia (Fig 1), generalized thinning of body hair, and easy bruisability. Physical examination revealed a greater than 50% reduction in scalp hair density, positive hair pulls, increased hair part widths, and microscopically normal hair


Political theology as a branch of Islamic political thought and understanding, based on the methodology of ijtihad, social and political issues related to the administration of the country and includes the commands, decrees and guidelines in relation to different areas of the system, politics and community. The mission of the jurisprudence of collective identity is responsible for shaping the social and political life. One of the most important examples of political jurisprudence is "enjoined" and "denied" to achieve the goals of Islamic rule. On the other hand rule "enjoined" and "denied" are the best strategy for achieving political jurisprudence and Islamic rule. Nevertheless, Samanbkhshy "political theology" and "enjoined" and "denied" require the intellectual foundations of the process of "theory" and "Nzamsazy" politically correct in the light of understanding and insight, which is why in Article 109 constitution of the Islamic Republic of Iran is one of the preferred qualities of leadership "politically correct vision".


Over the last several years, microseismic (MS) monitoring has quickly grown as a technology to map various reservoir processes. Imaging hydraulic fracture stimulations is the most common application especially within North America. As indicated in the introduction to this special section, initial interest in MS was primarily in the engineering community. As the method was pushed forward by the engineers, geophysicists within operating companies began to get pulled in to support the engineering projects. As application of the method gathered steam, interest expanded in the geophysical community and into academia as seen by the growth of research consortia looking at the technique. While MS is a seismic technique, it is sufficiently novel that most geophysicists are largely uninformed about technology challenges. Nevertheless, over the last few years the geophysical community has been both educating itself and taking stewardship of the technology. MS remains a unique geophysical technology although the tech...


OBJECTIVES
The aim of this study was to evaluate the efficacy of greater occipital nerve (GON) block in the treatment of migraine patients.

METHODS
This study included 28 patients diagnosed with migraine between 2014 and 2015. The GON block procedure was applied by administering 1.5 ml of 2% lidocaine 2 cm lateral and 2 cm inferior to the external occipital protuberance. The patients were evaluated in respect of VAS scores, attack frequency, attack duration and the need for analgesia before the procedure. These parameters were evaluated again at 1 week, 1 month and 3 months after the procedure.

RESULTS
The mean age of the patients was 42.21±10.13 years. The mean VAS score was 9.28±0.72 before the procedure and 2.96±2.16 at 1 week, 2.60±1.96 at 1 month and 1.75±1.37 at 3 months. The frequency of attacks was 9.42±4.51 before the procedure and, 5.42±3.30 at 1 month and 3.57±3.14 at 3 months.

CONCLUSION
GON block with 1.5 ml of 2% lidocaine is a safe, simple and effective treatment method for migraine headache.


Context. Accurate transition probabilities for forbidden lines are important diagnostic parameters for low-density astrophysical plasmas. In this paper we present experimental atomic data for forbidden [Fe II] transitions that are observed as strong features in astrophysical spectra. Aims. We measure lifetimes for the 3d(6)((3)G)4s a (4)G(11/2) and 3d(6)((3)D)4s b (4)D(1/2) metastable levels in Fe II and experimental transition probabilities for the forbidden transitions 3d(7) a (4)F(7/2,9/2)-3d(6)((3)G)4s a (4)G(11/2). Methods. The lifetimes were measured at the ion storage ring facility CRYRING using a laser probing technique. Astrophysical branching fractions were obtained from spectra of Eta Carinae, obtained with the Space Telescope Imaging Spectrograph onboard the Hubble Space Telescope. The lifetimes and branching fractions were combined to yield absolute transition probabilities. Results. The lifetimes of the a (4)G(11/2) and the b (4)D(1/2) levels have been measured and have the following values, tau = 0.75 +/- 0.10 s and tau = 0.54 +/- 0.03 s respectively. Furthermore, we have determined the transition probabilities for two forbidden transitions of a (4)F(7/2,9/2)-a (4)G(11/2) at 4243.97 and 4346.85 angstrom. Both the lifetimes and the transition probabilities are compared to calculated values in the literature.


Background: The combination of crescent periareolar mastopexy with breast augmenta  tion is a well-described technique for the cosmetic improvement of breast ptosis classified as grades I and II, according to the Regnault grade scale. The aim of this study is to discuss the results obtained by the authors using a combination technique where the center of the round implants was positioned below the nipple projection. Methods: Grade I ptosis was corrected in certain patients by a combination of crescent periareolar mastopexy with breast augmentation using round-shaped, high-profile silicone gel implants. Each patient comple ted a questionnaire and rated the results obtained as poor, satisfactory, or good. Results: Were studied 128 patients who received silicone implants (average volume, 308 mL). The observed reoperations and complications rates were 9.4% and 8.6%, respectively. Eigh tyone (63.3%) patients responded to the questionnaire, and 58% considered the result good, 35.8% considered it satisfactory, and 6.2% considered it poor. Conclusions: This study showed that this combination of techniques yields good results and low complication rates.


Heparan sulfate proteoglycans are proteins with long, unbranched heparan sulfate (HS) polysaccharide chains attached to them. They are found on cell surfaces and in basement membranes where they exert their action by interacting with a wide range of enzymes and signaling molecules and are thereby involved in a range of various processes both during embryonic development and in adult physiology.A great part of the biological functionality of proteoglycans can be directly related to the polysaccharide part. HS chains display very variable sulfation patterns where highly sulfated regions are responsible for a large part of the biological activity. The biosynthesis of HS is a complex process in which a number of enzymes are involved. Better comprehension of how this process is regulated could reveal clues to how formation of HS sulfation patterns occurs, and thereby how HS functionality is controlled.This thesis is focusing on regulation of one of the enzymes responsible for HS sulfation, glucosaminyl N-deacetylase/N-sulfotransferase (NDST), in an attempt to understand these mechanisms better. Different aspects of NDST regulation were studied in three projects:I) "Heparin/heparan sulfate biosynthesis: Processive formation of N-sulfated domains", where the sulfate donor PAPS is shown to influence the manner in which NDST modifies the substrate, affecting the domain structure of the polysaccharide.II) "Heparan sulfate biosynthesis: Characterization of an NDST1 splice variant", where a splice variant of NDST1 which appears to influence NDST1 protein levels and affect HS structure is described.III) "Heparan sulfate biosynthesis in zebrafish: Five NDST genes with distinct expression patterns during embryonic development", in which five zebrafish NDSTs were cloned and shown to be expressed in a temporally and spatially regulated manner.


Current therapies for treatment of myeloid leukemia do not eliminate leukemia stem cells (LSC), leading to disease relapse. In this study, we supplemented mice with eicosapentaenoic acid (EPA, C20:5), a polyunsaturated omega-3 fatty acid, at pharmacologic levels, to examine whether the endogenous metabolite, cyclopentenone prostaglandin delta-12 PGJ3 (Δ12-PGJ3), was effective in targeting LSCs in experimental leukemia. EPA supplementation for 8 weeks resulted in enhanced endogenous production of Δ12-PGJ3 that was blocked by indomethacin, a cyclooxygenase (COX) inhibitor. Using a murine model of chronic myelogenous leukemia (CML) induced by bone marrow transplantation of BCR-ABL–expressing hematopoietic stem cells, mice supplemented with EPA showed a decrease in the LSC population, and reduced splenomegaly and leukocytosis, when compared with mice on an oleic acid diet. Supplementation of CML mice carrying the T315I mutation (in BCR-ABL) with EPA resulted in a similar effect. Indomethacin blocked the EPA effect and increased the severity of BCR-ABL–induced CML and decreased apoptosis. Δ12-PGJ3 rescued indomethacin-treated BCR-ABL mice and decreased LSCs. Inhibition of hematopoietic-prostaglandin D synthase (H-PGDS) by HQL-79 in EPA-supplemented CML mice also blocked the effect of EPA. In addition, EPA supplementation was effective in a murine model of acute myeloid leukemia. EPA-supplemented mice exhibited a decrease in leukemia burden and a decrease in the LSC colony-forming unit (LSC-CFU). The decrease in LSCs was confirmed through serial transplantation assays in all disease models. The results support a chemopreventive role for EPA in myeloid leukemia, which is dependent on the ability to efficiently convert EPA to endogenous COX-derived prostanoids, including Δ12-PGJ3. Cancer Prev Res; 8(10); 989–99. ©2015 AACR.


Objective: In dental treatments, use of carriers for targeted antibiotic delivery would be optimal to efficiently decrease microbial count. In this study, gentamicin was loaded into polylactic co-glycolic acid (PLGA) microspheres and its release pattern was evaluated for 20 days. Methods: In this experimental study, PLGA microspheres loaded with gentamycin were produced by the W/O/W method. The correct morphology of loaded microspheres was ensured using scanning electron microscopy (SEM). The rate of drug release from polymeric microspheres into the phosphate buffered saline (PBS) solution was measured during a 20-day period using spectroscopy. Data were analyzed using one-way ANOVA. Results: SEM micrographs showed that the produced microspheres had smooth and nonporous surfaces and 30-micron diameter. Assessment of the pattern of drug release from the PLGA microspheres loaded with gentamycin revealed a burst release on day six followed by a stable pattern of release until day 20. Conclusion: Considering the biocompatibility of PLGA and optimal pattern of drug release, PLGA microspheres loaded with gentamicin can be successfully used for infection control and reduction of microbial count in dental treatments.


The objective of the study is to identify how micro-enterprises can be integrated into local value
chains by using the so-called "value chain approach". The "value chain approach" has become a
relatively popular approach among donor agencies and NGOs engaged in Private Sector
Development in recent years, being based on insights from studies on global value chains.
The study includes investigation into the following points:
1) Which business linkages exist among micro-enterprises and with enterprises of different sizes
and sectors, and how are they related to the upgrading process of micro-enterprises?
2) What influence does the legal status of micro-enterprises have on the development of business
linkages and on the upgrading process?
3) How can the development of business linkages and the upgrading process (and, therefore, the
integration into value chains) be supported and enhanced within the framework of PSD?
The empirical study was conducted in Uganda. It includes a combination of qualitative and
quantitative approaches: (1) a questionnaire-based survey among micro-entrepreneurs, and
(2) expert or key informant interviews, using a semi-structured interview guideline.
The study provides an assessment of the relevance and applicability of the "value chain approach"
to micro-enterprises and local value chains in the context of a developing country characterised
by low levels of industrialisation, as well as policy recommendations for practitioners (from public
and private sectors, as well as donor community, NGOs and civil society). Furthermore, the study
highlights the importance of the issue of informality of micro- and small-scale enterprises. (author's abstract)


A Benefit Function Transfer obtains estimates of Willingness-to-Pay (WTP) for the evaluation of a given policy at a site by combining existing information from different study sites. This has the advantage that more efficient estimates are obtained, but it relies on the assumption that the heterogeneity between sites is appropriately captured in the Benefit Transfer model. A more expensive alternative to estimate WTP is to analyse only data from the policy site in question while ignoring information from other sites. We make use of the fact that these two choices can be viewed as a model selection problem and extend the set of models to allow for the hypothesis that the benefit function is only applicable to a subset of sites. We show how Bayesian Model Averaging (BMA) techniques can be used to optimally combine information from all models. The Bayesian algorithm searches for the set of sites that can form the basis for estimating a Benefit function and reveals whether such information can be transferred to new sites for which only a small dataset is available. We illustrate the method with a sample of 42 forests from U.K. and Ireland. We find that BMA benefit function transfer produces reliable estimates and can increase about 8 times the information content of a small sample when the forest is 'poolable'.


We propose a novel framework to localize and label affective objects and actions in images through a combination of text, visual and gaze-based analysis. Human gaze provides useful cues to infer locations and interactions of affective objects. While concepts (labels) associated with an image can be determined from its caption, we demonstrate localization of these concepts upon learning from a statistical affect model for world concepts. The affect model is derived from non-invasively acquired fixation patterns on labeled images, and guides localization of affective objects (faces, reptiles) and actions (look, read) from fixations in unlabeled images. Experimental results obtained on a database of 500 images confirm the effectiveness and promise of the proposed approach.


The knowledge and control of the structural and morphological properties of nanocrystalline silicon is a fundamental requisite for its proper application in photovoltaics. To this purpose, nanocrystalline silicon films grown by Low Energy Plasma Enhanced Chemical Vapour Deposition (LEPECVD) technique on different kinds of substrates were submitted to a systematic characterization using Raman spectroscopy, X-ray diffraction (XRD) and high-resolution transmission electron microscopy (HRTEM). The results showed that the nature of the film substrate induces deep changes in the structural properties of the deposited films. The importance of a Raman in–depth analysis for an accurate determination of the sample structure has been also demonstrated.


Eosinophil cationic protein (ECP) in sputum may be used to estimate the severity of bronchial inflammation and obstruction in asthmatics as well as to monitor asthma drug therapy. For this purpose, standardized processing of sputum is important. The aim of our study was to determine whether time and temperature influence the ECP concentration in the sputum of asthmatics. The samples of induced sputum obtained from 12 patients with stable asthma were homogenized using ultrasonification, and centrifuged. Supernatants were evenly divided and stored for 1, 6, 24 or 72 h at either 4 or 25 degrees C, then frozen at -80 degrees C. The ECP concentrations were determined using fluoroimmunoassay and compared with the immediately frozen samples. After storing at 4 degrees C, the ECP levels at the four time points were 101.2, 96.0, 98.2 and 90.6% of the initial concentration, respectively. When sputum specimens were stored at 25 degrees C, ECP levels decreased to 96.1, 94.4, 90.7 and 87.7%, respectively. The influence of time on ECP concentrations in sputa was statistically significant (p=0.02). A significant temperature effect was found when comparing the specimens stored at 4 degrees C with those at 25 degrees C (p=0.03). Looking at individual time points, a significant decrease in ECP concentration was only seen at 25 degrees C after 24 and 72 h. We conclude that eosinophilic cationic protein in the sputum of asthmatics decreases in a time- and temperature-dependent process. If sputa cannot be processed after obtaining the specimens, they should be stored in a refrigerator at 4 degrees C, until eosinophilic cationic protein is measured.


A low entropy pyramidal image data structure suited for lossless coding and progressive transmission is proposed in this work. The new coder, called the progressively predictive pyramid (PPP) is based on the well-known Laplacian pyramid. By introducing inter-resolution predictors into the original Laplacian pyramid, we show that the entropy level in the original pyramid can be reduced significantly. To take full advantage of progressive transmission, a scheme is introduced to create the predictor adaptively, thus eliminating the need to transmit the predictor and reducing the coding overheads. A method for designing the predictor is presented. Numerical results show that PPP is superior to traditional approaches to pyramid generation in the sense that the pyramids generated by PPP always have significantly lower entropy values.


About 95% of swamp tupelo (Nyssa sylvatica var. biflora (Walt.) Sarg.) and sweetgum (Liquidambar styraciflua L.) seedlings survived continuous root flooding for more than two years, whereas none of the swamp chestnut oak (Quercus michauxii Nutt.) and cherrybark oak (Q. falcata var. pagodifolia Ell.) seedlings survived one year of flooding. Death of oak seedlings occurred in phases associated with periods of major vegetative growth, e.g., after bud burst in spring, after summer stem elongation, and during the winter deciduous stage, suggesting that stored reserves and sources were inadequate to maintain the seedlings when vegetative sinks were forming. Additional evidence that flooding induced a source deficiency in oak was that leaves of flooded oak were 65 to 75% smaller than leaves of nonflooded oak. Flooded swamp tupelo seedlings had a normal leaf size and patchy stomatal opening compared with nonflooded seedlings. Flooding caused increases in alcohol dehydrogenase (ADH) specific activity in taproot cambial tissues and increases in starch concentrations of swamp tupelo seedlings that were reversed when seedlings were removed from flooding. Flooding had little effect on soluble sugar concentrations in swamp tupelo or sweetgum. In the long-term flood-dry-flood treatment, in which all species had survivors, upper canopy leaf photosynthetic rates were higher in all species during the dry period than in nonflooded controls, whereas their starch and soluble sugars concentrations were similar to those of nonflooded controls. Based on seedling survival and the sink-source relationships, the order of flood tolerance was: swamp tupelo > sweetgum > swamp chestnut oak > cherrybark oak.


The mechanism responsible for the formation of recrystallization texture is still disputed although recrystallization texture has long been a subject of research. This is mainly related to the complexity of recrystallization itself .The mechanism of recrystallization microtexture Cold-rolling low carbon sheet steel based on CSP was investigated by the electron back scatter diffraction(EBSD) was investigated. In addition, the origin of nuclei with specific orientations was studied. The results showed that the formation of recrystallization texture is explained by oriented nucleation and the nucleis show around 50% frequency of 15–60°misorientation with their surrounding deformed matrices. Deformed γ-fibre texture components increase more rapidly during the early stage of recrystallization. In contrast, the deformed α-fibre components, such as {001}<110> components disappear rather rapidly early stage of recrystallization and {112}<110> components increases rapidly late stage of recrystallization and grains growth. By microcosmic orientation distribution analyse find that the new {011}<100> grains are nucleated within shear bands in the deformed {111}<112> grains, New {111}<112> grains are nucleated within deformed {111}<110> grains and new {111}<110> grains originated in the deformed {111}<112> grains .


We present an integrated land use modelling framework (ILM) to analyze impacts of climate change and CAP reform as well as farm adaptation using economic, biotic and abiotic indicators at field, farm and landscape scales. The IML is applied on the two contrasting landscapes in the Austrian MACSUR regional pilot study. The scenarios cover climate and policy changes until 2040. The anticipated policy changes lead to declines in farm gross margins by -36% and -5% in the two landscapes, respectively. In contrast, climate change leads to higher gross margins, where farms can reach pre-reform levels on average. Environmental impacts such as removing of landscape elements and increasing fertilization can be moderated by an agri-environmental program, but the opportunity costs of program participation may increase.


It is now widely accepted that microbial residues are a significant source for soil organic matter (SOM) formation. This material must be stabilised in soil in order to persist. A potential mechanism for stabilisation of organic materials in soil is co-precipitation with metal oxyhydroxides (Fe and Al), which, however, may be affected by redox transitions. We thus evaluated the mineralisation of 14C-labelled bacterial residues (Escherichia coli cells and cell envelope fragments) and their co-precipitates with Fe or Al oxyhydroxide under different redox conditions in a laboratory incubation experiment. The co-precipitates or untreated microbial residues (control) were mixed with soil and incubated in sealed vessels under either fully aerobic or under oxygen-limited conditions for up to 345 days. To achieve oxygen limitation, incubation was conducted under an N2 atmosphere for the first 100 days. The redox potential was further decreased by waterlogging the samples (from day 100) and by substrate and nutrient additions (from day 290), to increase electron acceptor consumption by the soil microbes. Mineralisation of the microbial residues was quantified by liquid scintillation counting. The data were fitted to different types of models, depending on the experimental phase. Co-precipitation with Fe and Al oxyhydroxides decreased mineralisation of both intact cells and cell envelope fragments significantly, indicating strong protection of biomass and its fragments. Mineralisation of intact cells was slightly faster than that of cell envelope fragments, indicating higher recalcitrance of the latter material, which therefore may be enriched in SOM. Strongly reducing conditions resulted reductive dissolution of Fe oxyhydroxide and thus in a loss of the stabilising effect of the co-precipitation. We conclude that co-precipitation with and incrustation of organic material by Fe and Al oxyhydroxides provide significant stabilisation of microbial residues. However, environmental conditions, e.g. the redox potential, modify the extent of this stabilisation. Fitting the mineralisation data to the models indicated that initially mainly pool sizes were affected by the factors studied, whereas later in the experiment the rate constants were more sensitive. The results improved significantly our understanding how organic materials, in particular microbial residues, are stabilised in soil.


The molecular biology of lymphatics is only rudimentary owing to the long-standing absence of specific markers, and scanty is the information regarding bladder lymphatic vessels. By using mice with a reporter gene for nuclear factor kappaB (NF-kappaB) activity (kappaB-lacZ) in combination with immunohistochemical staining with a specific lymphatic marker (LYVE-1), we show, for the first time, that NF-kappaB is constitutively active in lymphatic endothelium in the urinary bladder, uterus, intestine, heart, and airways. Tie2-lacZ mice confirmed that the structures observed in kappaB-lacZ mice were not blood vessels. In addition, acute instillation of lipopolysaccharide (LPS) or tumor necrosis factor alpha (TNF-alpha) into the kappaB-lacZ mouse bladder revealed the capacity of this transgenic in reporting inducible NF-kappaB activity. Our findings demonstrate an overriding constitutive NF-kappaB activity in the lymphatic system. They also provide a working model for detecting lymphatic vessels and evoke testable hypotheses regarding the role of lymphatic vessels in health and disease.


We previously developed a cross-sectional echocardiographic technique for quantitatively mapping the endocardial surface of the left ventricle and on which regions of abnormal wall motion can be superimposed in their correct spatial distribution. This endocardial mapping technique (EMT) provides a measure of the left ventricular endocardial surface area (ESA in cm2), the area of abnormal wall motion (AWM in cm2), and the overall percent dysfunction (%AWM) as a measure of the functional "infarct size." To test this approach, we compared the EMT measurements with the actual endocardial surface area (in cm2) and pathologic infarct size (both percent infarct by volume and percent endocardial surface overlying infarct) measured at later autopsy in 20 adults (14 men, six women) ranging in age from 47 to 76 years (mean 64 +/- 9.6 years). The median interval from echocardiographic study to death was 19 days (range 1 to 269 days). Patients were divided into two groups based on the age of their infarcts at the time of death: (1) recent (infarct age less than 14 days; mean age 5.3 +/- 4.6 days) and (2) old (infarct age greater than 6 months; mean age 3.6 +/- 3 years). When the left ventricular endocardial surface area at autopsy was compared with the EMT-derived ESA, a close correlation was found (EMT area = 1.17 X autopsy area + 20.4; r = .94, p = .0001), with the systematic difference in the measurements accounted for by systolic arrest, loss of distending pressure, and specimen shrinkage. The echocardiographic measure of infarct size (%AWM) correlated well with the autopsy percent infarction by volume (%AWM = 1.1 X infarct volume + 5.5; r = .82, p = .0001). Similarly, a good correlation was found for the percent abnormal wall motion and the autopsy percent endocardial surface area overlying infarction (%AWM = 0.89 X infarct area - 0.9; r = .89, p = .0001). When the data were examined in relation to the age of the myocardial infarct, the echocardiographic %AWM appeared to overestimate the autopsy infarct size (by percent infarct volume) in the recent infarct group (n = 6), and underestimate the extent in the old infarct group (n = 13). The findings suggest that the EMT will provide a useful quantitative measure of left ventricular endocardial surface area and the extent of ischemic/infarct-related dysfunction.


Little is known about the reproductive biology of corals from the Philippines, despite this archipelago being at the center of coral reef biodiversity. Here, we report on the reproductive biology of a branching poritid species provisionally identified as Porites cf. cylindrica in the Bolinao-Anda reef complex (BARC), northwestern Philippines. Histological examination and ex situ planulation observations reveal P.cf. cylindrica colonies to be gonochoric brooders that release actively swimming zooxanthellate larvae. Planulation appeared to occur throughout the year and there was significant lunar periodicity in planular release. The mean peak of release occurred from the 25th to 29th lunar day or just before the new moon, while peak in diel timing in planulation occurred during daytime between 08:00–11:00 h. Elsewhere in the Pacific, Porites cylindrica colonies are reported to broadcast spawn. If our species identification is correct, then this is the first report of brooding in P. cylindrica. Although there are no apparent morphological differences between the coral in this study and P. cylindrica reported from other sites, an alternative explanation for our findings is that our provisionally identified Porites cf. cylindrica is a different species. If so, our findings further highlight how difficulties with species identification in corals can influence our understanding of geographical variation in reproductive biology.


The ancients considered aesthetics to be a property of an object, like function or pleasure, a property that manifested itself in the harmonious proportions of the dimensions. This roughly summarized philosophical background indicates that aesthetics in bridge design can be assessed, above all, from the point of view of form and shape, on one hand, and from that of functionalism and efficiency, on the other. Bridge design is essentially an engineering problem. Safety, construction process, and economy, among other things, play decisive roles. Unfortunately, the aesthetic aspect is often neglected, and few significant contributions have been made toward the advancement of bridge aesthetics. The recommendations given in this paper derive mainly from consideration of view expressed by authors in the basis of experience and literature. The problem becomes of increasing importance with the greater efforts now being made to bring the road system of Poland up to the standards required for modern transport.


Implementation of any policy involves negotiation between multiple actors, and is therefore susceptible to a dynamic systems modelling approach. In this paper, we make an attempt to develop a family of dynamic systems models of policy implementation in such a multi-actor world by translating an existing, semi-quantitative, application of two theoretical approaches, Contextual Interaction Theory (CIT) and Participatory Action Research (PAR), into a quantitative dynamic framework. We explore various alternative actor-based dynamic systems for this proposed Participatory Contextual Interaction Theory (PCIT), including linear, piecewise linear, and strongly nonlinear models. Analytical results are supplemented with results of numerical simulations. One of the goals of the modelling exercise is to advance the actor dynamics module in the APoLUS land use cellular automata model; illustrative examples of the incorporation of actor dynamics models developed in the present paper into the computation of APoLUS transition potentials are provided.


A convenient way to analyze blood-oxygen-level-dependent functional magnetic resonance imaging data consists of modeling the whole brain as a stationary, linear system characterized by its transfer function: the hemodynamic response function (HRF). HRF estimation, though of the greatest interest, is still under investigation, for the problem is ill-conditioned. In this paper, we recall the most general Bayesian model for HRF estimation and show how it can beneficially be translated in terms of Bayesian graphical models, leading to 1) a clear and efficient representation of all structural and functional relationships entailed by the model, and 2) a straightforward numerical scheme to approximate the joint posterior distribution, allowing for estimation of the HRF, as well as all other model parameters. We finally apply this novel technique on both simulations and real data.


Rentable is a web application that is developed for the rental market in Ireland, targeting both Landlords and Tenants. At the core of the application, it allows tenants to search for properties available to rent, and landlords to post properties for rent.

Tenants can increase the efficiency of their property search by creating different watchlists and adding properties to the current active list by clicking an icon on the image of the property. Tenants can then go back through various watchlists to compare properties they are interested in and refine their choices.

The search is a standard filtered search. Users can narrow down their search by specifying the desired attributed such as county, town, the minimum and max rent, bedrooms and bathrooms. The search results only show the matched properties (if any).

Currently in Ireland, there is a huge shortage in properties available to rent. The landlord will be inundated with applications. A possible solution to this is the tenant search which is available to landlords in this application. Tenants will set their property preferences, and the landlord can select one of their active adverts and do a search for tenants whose preferences match or are like the property specs. This streamlines the tenant search for landlords (and tenants), as the landlord will only get relevant tenant results.

A crucial element in this application is the ability to start a tenancy. This is essentially like a friend's system that you will see in social media sites. Only the landlord can initiate the tenancy request, and once registered the tenancy can be managed.

The management tools include a expense tracker for properties. Landlords can log an expense associated with one of their properties by entering some details such as title, cost, category, and date. Once logged, this data is used to generate various chart. Each property has its own unique chart, and then each landlord has a chart with the aggregated data from all properties. Benefits of this would be, a permanent record of expenses, without the worry of keeping track of receipts, and landlords can spot areas where they can potentially reduce expenses, and as a result make more money.

Other features in this application include a private messaging system, an expense claimer for tenants so they can recoup outlay on their rental property, a feedback system, where tenants can air grievances, and inform the landlord on how the tenancy is going.


In response to the global Covid-19 pandemic, universities across the world moved coursework online andfrequently used Zoom videotelephony software to replicate the experience of learning in a classroom. While this platform supported certain aspects of the traditional classroom, such as immediacy of responses and the facilitation of social interactions, learning via Zoom also differed in various ways from the familiar classroom experience. Although there has been considerable research on online learning, most studies focused on an asynchronous design and interaction. Thus, the understanding of learning within synchronous, video-mediatedplatforms, such as Zoom, is nascent. In this study, the data was derivedfrom a focus group with eight university students from the United States that was conducted over Zoom. Using content analysis, the transcripts of the focus group's interaction yielded four themes: Zoom Challenges, Zoom Benefits, Faculty Proficiency, and Student Learning Experiences. Cameras, a distinguishing feature of Zoom, could strengthen engagement, yet they also heighten anxiety for some andfatigue for most users. However, when those challenges were mitigated and the benefits harnessed by faculty informed about how to support student learning, students experienced a deepened sense of connection to their peers, the faculty, and their learning. Family science educators who recognize the strengths and limitations of this platform have the opportunity to teach more effectively and support their students' socio-emotional learning and well-being. © 2022, Grand Canyon University. All rights reserved.


Based mainly on the findings in eight patients and their families, a new syndrome is presented, consisting of multiple symmetrical lentigines and (mainly) left-sided obstructive cardiomyopathy, with associated growth retardation and at times slight intellectual impairment. The hypothesis is presented that the pathogenesis of the disorder is an extensive dysfunction of pigmentary and other elements of neural crest origin, and the signs and symptoms of the syndrome can be explained satis factorily by this. It is suggested that the obstructive cardiomyopathy is related to this defect, either primarily (because the neural crest contributes to heart structures) or secondarily (through the lentigines), and it is concluded that the disorder, which evidence suggests to be at least often dominantly inherited in an autosomal manner, has variable manifestations and, possibly, penetrance. Cases with lentigines, but without obstructive cardiomyopathy and, conversely, cases with obstructive cardiomyopathy but without lentigines, as well as some other clinical syndromes, may be pathogenetically related to the new syndrome. The hypothesis concerning the origin of the syndrome, which is supported by a number of hitherto unrelated observations, appears to be testable by biochemical studies of affected persons and by a careful investigation of their melanocytes and their melanosomes (see, e.g., Mishima, 1966) in normal and pigmented skin, and by detailed studies of the outflow cardiac tracts, their structure and metabolism.


The cable TV plant is a broad bandwidth channel into the home and community that has been used primarily for the distribution of television. As the plant is upgraded, there is an opportunity to use it for the transport of high-speed digital signals. While the downstream channel is relatively easy to exploit, the topology and physical characteristics of the upstream channel present new challenges at both the physical and the media access layers. We present a media access protocol that efficiently transfers data on this channel. A primary goal of the design is to keep that portion of the protocol resident in the station as simple as possible. Thus, we use centralized control located in the cable head-end. A station wishing to transmit sends a request to the head-end using a contention channel. The head-end acknowledges the request and then schedules the request, informing the station, by means of a grant message, exactly when to transmit. The protocol performs efficiently under a wide range of conditions, and is robust in the presence of channel errors.


The bone effects of oral dosages of calcium chloride with or without supplementary sodium fluoride were assessed in antiorthostatically suspended mice. Two calcium dosages were used to replace half (3.1 mM) or all(6.3 mM) of the dietary calcium lost due to reduced food intake by the suspended mice. Two groups of 6.3 mM CaCl2-treated mice were additionally treated with 0.25 or 2.5 mM NaF. The results indicate that supplementation of the mouse drinking water with calcium salts prevents bone changes induced by short-term suspension, while calcium salts in combination with fluoride are less effective as fluoride dosage increases. However, the calcium supplements change the relationship between the femur mechanical properties and the mineral composition of the bone. Because of this, it appears that oral calcium supplements are effective through a mechanism other than simple dietary supplementation and may indicate a dependence of bone consistency on systemic and local fluid conditions.


OBJECTIVES
To estimate Australian health-care costs in the year of first occurrence and subsequent years for major diabetes-related complications using administrative health-care data.

METHODS
The costs were estimated using administrative information on hospital services and primary health-care services financed through Australia's national health insurance system Medicare. Data were available for 70,340 patients with diabetes in Western Australia (mean duration of 4.5 years of follow-up). Multiple regression analysis was used to estimate inpatient and primary care costs.

RESULTS
For a man aged 60 years, the average costs in the year the event first occurred were: amputation $20,416 (95% CI 18,670-22,411); nonfatal myocardial infarction (MI) $11,660 (10,931-12,450); nonfatal stroke $14,012 (12,849-15,183); ischaemic heart disease $12,577 (12,026-13,123); heart failure $15,530 (13,965-17,009); renal failure $28,661 (22,989-34,202); and chronic leg ulcer $15,413 (13,089-18,123). The costs in subsequent years for a man aged 60 years range from 14% for nonfatal MI to 106% for renal failure, of event costs.

CONCLUSIONS
Estimates of the health-care costs associated with diabetes-related complications can be used in modeling the long-term costs of diabetes and in evaluating the cost-effectiveness of improving care.


Depending on the mechanical and thermal energy introduced to a dry sliding interface, the near-surface regions of the mated bodies may undergo plastic deformation. In this work, we use "differential EBSD tomography" to highlight changes to the microstructure near tribological fcc alloy surfaces, allowing us to detect subtle differences in lattice orientation and small distances in grain boundary migration. The analysis approach compares electron backscatter diffraction images generated from large-scale molecular dynamics simulations with their undeformed counterparts via a simple image analysis filter. We use our visualization method to discuss the acting microstructural mechanisms in a load- and time-resolved fashion, focusing on sliding conditions that lead to twinning, partial lattice rotation, and grain boundary dominated processes. Extracting and laterally averaging the color saturation value of the generated tomographs allows us to produce quantitative time- and depth-resolved maps that give a good overview of the progress and severity of near-surface deformation. Corresponding maps of the lateral standard deviation in the color saturation show evidence of homogenization processes occurring in the tribologically loaded microstructure, frequently leading to the formation of a well-defined separation between deformed and undeformed regions. When integrated into a computational materials engineering framework, our approach could help optimize material design for tribological and other deformation problems.


Innovation is crucial for all organisations to thrive and survive. Its importance is well recognised in both practice and in academia. Innovation-based initiatives such as research and development, and design constitute the core competencies of many contemporary organisations. In the domain of academia, innovation is well researched in relation to what constitutes innovation and the different forms that innovations take. Innovation is also well researched from many perspectives such as processes and systems, leadership and group dynamics, and at different levels (e.g. organisational, group and individual). Whilst there is a substantial amount of literature on innovation at the individual level, such as motivation and skills, there are still paucities at the intrapersonal level, specifically higher-order thinking dispositions. The role of cognition and intellect in innovation are generally well established however the subject matter of dispositions such as higher-order thinking and their relationship with innovation remains an area that may provide opportunities to gain further insight into factors that contribute to innovation. In addition, there is a growing recognition and acceptance from scholars that an evaluation of the 'whole-person' (e.g. cognitive and dispositional factors) provides for a better explanation of behaviours and potentially organisational outcomes. From a practitioner perspective, higher-order thinking dispositions are crucial because they help to predict typical performance rather than maximal performance. Typical performance is crucial in organisation as ideas for innovation can occur at any time and involve multiple stages (e.g., conception, prototyping, and implementation). Individuals with higher-order thinking dispositions are arguably predisposed to conceive, recognise, act upon and further develop new ideas. Innovation behaviour, in turn, facilitates organisational performance, competitiveness, and enables organisations to not only adapt to change but also potentially shape change. This longitudinal study involved 202 participants. The hypotheses and an overall model based on the hypotheses were tested using partial least squares analysis. The major findings are as follows: i) the relationship between each of the five higher-order thinking dispositions and creativity is partially mediated by job-related learning; ii) the relationship between job-related learning and innovation is partially mediated by creativity; iii) when the five higher-order thinking dispositions are used concurrently to predict job-related learning, multiple perspective-taking is the only significant predictor; iv) when the five higher-order thinking dispositions and job-related learning are used concurrently to predict creativity, job-related learning is the strongest predictor whilst systems thinking and multiple perspective-taking are also significant predictors; and v) when the five higher-order thinking dispositions, job-related learning and creativity are used concurrently to predict innovation, creativity is the strongest predictor whilst job-related learning and multiple perspective-taking are also significant predictors. This study contributes to theory by extending our knowledge on innovation behaviour from a dispositional perspective, and supports the argument that both dispositional and cognitive elements are drivers of innovative behaviour. In addition, the findings also highlight the need for organisations to adjust their HR policies to recruit, select and develop those with higher-order thinking dispositions for innovation-based organisational outcomes.


With the introduction of battery-powered and embedded smart cameras, it has become viable to install many spatially-distributed cameras interconnected by wireless links. However, there are many problems that need to be solved to build scalable, battery-powered wireless smart-camera networks (Wi-SCaNs). These problems include the limited processing power, memory, energy and bandwidth. Limited resources necessitate light-weight algorithms to be implemented and run on the embedded cameras, and also careful choice of when and what data to transfer. We present a wireless embedded smart camera system, wherein each camera platform consists of a camera board and a wireless mote, and cameras communicate in a peer-to-peer manner over wireless links. Light-weight background subtraction and tracking algorithms are implemented and run on camera boards. Cameras exchange data to track objects consistently, and also to update locations of lost objects. Since frequent transfer of large-sized data requires more power and incurs more communication delay, transferring all captured frames to a server should be avoided. Another challenge is the limited local memory for storage in camera motes. Thus, instead of transferring or saving every frame or every trajectory, there should be a mechanism to detect events of interest. In the presented system, events of interest can be defined beforehand, and simpler events can be combined in a sequence to define semantically higher-level and composite events. Moreover, event scenarios can span multiple camera views, which make the definition of more complex events possible. Cameras communicate with each other about the portions of a scenario to detect an event that spans different camera views. We present examples of label transfer for consistent tracking, and of updating the location of occluded or lost objects from other cameras by wirelessly exchanging small-sized packets. We also show examples of detecting different composite and spatio-temporal event scenarios spanning multiple camera views. All the processing is performed on the camera boards.


We measured surface elevations, stage of annual peak flooding, and sedimentation along 10 toposequences across coastal ecosystems on the Yukon-Kuskokwim (Y-K) Delta in western Alaska during 1994-1998 to assess some of the physical processes affecting ecosystem distribution. An ecotype was assigned to each of 566 points, and differences in elevations among 24 ecotypes were analyzed within individual toposequences and across the 40 X 40-km study area. Elevations of vegetated ecotypes along the longest toposequence rose only ~ 1 m over a distance of 7.5 km, and mean elevations of most ecotypes across the study area were within 0.5 m of mean higher-high water (1.47 m), During 1994 to 1998, monitoring of annual peak stage using crest gauges revealed flooding from the highest fall storm surge reached 2.58 m (1.11 m above mean higher-high tide). In each year, only the highest surface was unaffected by flooding. Mean annual sedimentation rates for the various ecotypes were 8.0 mm/y on tidal flats, 1.4 to 3.8 mm/y on the active floodplain, 0.1-0.2 mm/y on the inactive floodplain, and 0 mm/y on the abandoned floodplain. If sea levels in the Bering Sea rise ~0.5 m by 2100, as predicted by some on a global basis, large portions of the coastal margin of the delta could be regularly inundated by water during high tides, and even the highest ecotypes could be affected by storm surges. Predicting the extent of future inundation is difficult, however, because of the changes in the ground surface elevation through sedimentation, organic matter accumulation, and permafrost development.


This paper firstly discusses the necessity of conducting personal knowledge management in the web 2.0 technology environment. On this basis, the author describes the content and characteristics of Twitter, the concepts of personal knowledge management and its processes, and elaborates the features of Twitter's application in personal knowledge management. And then from the view of practical operation, the paper focuses on the three major procedures of applying Twitter to personal knowledge management, which are the building-up of personal knowledge base, the sharing and exchanging of knowledge, and the practical application of knowledge, Finally it summarizes the essential points of conducting Twitter-based personal knowledge management.


Creativity is a loaded concept, which we seem to assign unconditional merit. The danger in this
arises when the allure and momentum of creative processes obscure underlying project agendas. If
we consider designed images, products, and environments to be part of the broader cultural setting,

then designers are accountable for the paradigms that we enable through our work. As systems-
oriented designers, we cannot hide behind the agendas of our clients; rather, we must view each

project as a powerful act of cultural meaning making, in which we share creative agency. In this
paper, we will briefly examine how changes taking place within the field of design may ultimately
influence what we construct as our experienced realities, and also how the positioning of creative
practices within a socio-economic system can determine how they are employed in cultural
production.


OBJECTIVE
To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI).

MATERIALS AND METHODS
One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables.

RESULTS
Mean follow-ups were 32 +/- 12 months (range 12-55) for TVT and 31 +/- 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5%) patients showed a VLPP > 60 cm H2O and 50 (34.5%) patients had a VLPP < or = 60 cm H2O. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H2O and 72% for those with VLPP < or = 60 cm H2O (p < 0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82% vs. 68.9% p < 0.172); VLPP < or = 60 cm H2O (68% vs. 76% p < 0.528).

CONCLUSIONS
When patients were stratified for preoperative VLPP (< or = or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.


Failure to induce oral tolerance may result in food allergy. Hydrolysed cow's milk‐based infant formulas are recommended in subjects with a high risk of developing allergic disease. Presentation of T cell epitopes is a prerequisite to generate regulatory T cells that could contribute to oral tolerance.


Introduction: Third molars are the most common teeth that may follow an abortive eruption path and become impacted as a result of pathology, anatomical structures or insufficient osseous space posterior to the second molars. Aims and Objectives: The present study evaluated (1) the distribution of the impaction of mandibular third molar; (2) the distribution of the patterns of impaction radiographically; and (3) the gender distribution for pattern of impaction. Materials and Methods: This hospital-based retrospective study was conducted over a course of 6 months in the Department of Oral Medicine and Radiology and presents the analysis of 122 panoramic radiographs of patients between the age group of 18-30 years. They were interpreted and assessed for the impaction of mandibular third molars. Statistical analysis was done by Chi-square test. Results: Bilateral impaction of mandibular third molar is more common than unilateral in both the sexes, with mesioangular being the most common pattern. In males, mesioangular pattern was followed by horizontal, whereas in females it was followed by vertical. Conclusion: The present study provides useful data regarding the radiographic status of impacted mandibular third molars in patients.


To understand the differential effects of altitudinal gradient on soil inorganic nitrogen concentration and associated ammonia-oxidizingbacteria (AOB) and archaea (AOA), intact soil cores from a primary coniferous forest were in situ incubated in an alpine forest at a 3582-m altitude (A1) and transplanted to subalpine forests at a 3298-m altitude (A2) and 3023-m altitude (A3) on the eastern Tibetan Plateau. Transplant cooled the soil temperature of A2 but warmed the A3 soil temperature. Both AOA and AOB were found at the three altitudes. Compared to A1, A2 had greater AOA and AOB abundance, but A3 showed lower AOA abundance in organic soil. The AOA abundance was negatively correlated with ammonium concentration at all three altitudes, but AOB showed the reverse trend. Our results suggested that the soil nitrogen process responded differentially to soil core transplanting at different altitudes.


Geopolitical risk is a driver of just about every type of investment portfolio. However, in practice, most geopolitical research published by investment firms is not informed by international relations theory, giving it a less rigorous, editorial flavor. This article is an attempt to address the latter shortcoming by providing a theoretically grounded framework for analyzing geopolitical risk in an investment context. The first half of the article presents a qualitative framework for analyzing geopolitical risk. The framework uses conceptual tools from international relations theory that can be easily adapted to portfolio management. The second half of the article explores the analysis of geopolitical risk from a quantitative standpoint. The focus of this section is the application of game-theoretic, machine learning, and algorithmic techniques to the study of international relations. The last section of the article briefly addresses the topic of portfolio construction and provides a simple framework for incorporating geopolitical views into the portfolio selection process. TOPICS: Risk management, global markets, portfolio management/multi-asset allocation, big data/machine learning Key Findings ▪ Analyses of geopolitical risk in an investment context are most effective when formulated in a clear and precisely expressed conceptual framework. ▪ Considerations of geopolitical risk often act as defeaters, overriding potentially compelling market-related reasons for or against a particular investment. ▪ Quantitative approaches to analyzing geopolitical risk are most useful in the analysis and simulation of the structural relationships between global actors.


The wellbeing of Indigenous youth living in Canada's northern communities continues to lag behind the rest of the Canadian population. To a large extent, these health inequities are perpetuated by processes of colonisation that significantly impact the social determinants of health in Canada's Indigenous north. The purpose of this article is to review the history of colonisation and its impacts on the wellbeing of Indigenous youth in Canada's north, as well as processes of resilience that have helped Indigenous youth live healthy lives despite social challenges. Academic articles published between 2000 and 2016 outlining resilience from Indigenous perspectives are reviewed in the contexts of Canada's Indigenous north. Analysis focuses on what insights about resilience emerge from Indigenous communities, particularly as they related to the health inequities of circumpolar regions. The concept of Âhkameyimo is discussed and how systems of Indigenous knowledge offer important insights into resilience in general, and can be utilised in health promotion, education, and prevention programs targeting Indigenous youth in northern Canada. We conclude that attention should be turned toward issues of social justice and health equity that are desperately needed in order to create healthy environments whereby Indigenous youth within northern Canadian communities can be assisted to flourish.


In April 2015, North J of the Federal Court of Australia made a finding of unconscionable conduct against Advanced Medical Institute, a promoter and provider of erectile dysfunction treatment, in a case concerning unfair contract terms (Australian Competition and Consumer Commission vACN 117 372 915 Pty Ltd (in liq) (formerly Advanced Medical Institute Pty Ltd) [2015] FCA 368). The contract required a minimum 12-month commitment, with costs exceeding treatments available from general practitioners, and made refunds available only after all possible treatment plans were exhausted which included penile injections. This column analyses that case, particularly in respect to the consumer law standards of practice under which it was litigated. Those standards refer to patients as "consumers" yet North J made extensive reference to the Good Medical Practice: A Code of Conduct for Doctors in Australia, a text which refers to "patients", as evidence of what constitutes appropriate professional conduct or practice for the health profession. This column considers whether legislative and judicial categorisation of patients (a class of people presumptively suffering, sick and vulnerable) as "consumers" undermines the formal and informal protections accorded to patients under normative systems of medical ethics such as those represented by the Code. The case, it is argued, also illuminates the contemporary tensions between the ethical, legal and human rights standards required of doctors in their treatment of patients and the commercial interests of businesses.


The environmental impacts of the Kabd Landfill on the soil and groundwater in Kuwait were evaluated. Physical and chemical analyses were carried out on thirty pairs of surface, subsurface soil and five groundwater samples. The groundwater samples are collected from boreholes nearby and downstream of the landfill while the soil samples collected along six profiles. The groundwater samples were geochemically analyzed to determine the total dissolved solids, cations, anions and heavy metals, particularly Iron (Fe), Copper (Cu), zinc (Zn), Cadmium (Cd), Nickel (Ni), Chromium (Cr) and Aluminum (Al), Lithium (Li), Boron (B), Fluoride (F) and Vanadium (V). The soil samples were geochemically analyzed to determine concentration of Cadmium (Cd), Lead (Pb), Nickel (Ni), Iron (Fe), Aluminum (Al) and organics. The results show that the soil and groundwater are contaminated with high TDS, Na, Ca, Mg, Cl, SO4 and heavy metals, especially Ni, Cd, Cu, Al, V and F. The heavy metal concentrations in both the soil and groundwater samples are compared to the World Health Organization (WHO) standard permissible limits. The results revealed that the Zn, Li, B and Fe metals are below the WHO limits for consumption. The soil lithology, natures of dumping, the depth of quarry and the depth to the groundwater level play roles in leachate generation and groundwater contaminations. Such leachate may be originated from the capillary fringe water, moisture content and rising water table, due to its close level at the bottom of the waste disposal site. The organic strength of the soil was reduced due to waste decomposition and continuous gas flaring. Re-designing of sanitary landfills to prevent leachate from getting to the groundwater and adoption of clean technology for a sustainable land management program for reclamation is recommended.


Social indicators and demographic rates are often arrayed over time by age. The patterns of rates by age at one point in time may not reflect the effects associated with aging, which are more properly studied in cohorts. Cohort succession, aging, and period-specific historical events provide accounts of social and demographic change. Because cohort membership can be defined by age at a particular period, the statistical partitioning of age from period and cohort effects focuses attention on identifying restrictions. When applying statistical models to social data, identification issues are ubiquitous, so some of the debates that vexed the formative literature on age–period– cohort models can now be understood in a larger context. Four new articles on age–period–cohort modeling call attention to the multilevel nature of the problem and draw on advances in methods including nonparametric smoothing, fixed and random effects, and identification in structural or causal models.


Eye tracking and hand motion (or mouse) tracking are complementary techniques to study the dynamics underlying
human cognition. Eye tracking provides information about attention, reasoning, mental imagery, but figuring out the dynamics of cognition is hard. On the other hand, hand movement reveals the hidden states of high-level cognition as a continuous trajectory, but the detailed process is difficult to infer. Here, we use both eye and hand tracking while the subject watches a video drama and plays a multimodal memory game (MMG), a memory recall task designed to investigate the mechanism of recalling the contents of dramas. Our experimental results show that eye tracking and mouse tacking provide complementary information on cognitive processes. In particular, we found that, when humans make difficult decisions, they tend to ask 'Is the
distractor wrong?', rather than 'Is the decision right?'.


The existing hypotheses and paradigms about the structure of the Earth's crust and its parts, where igneous rocks are present, do not always show facial connections of rocks and explain the reasons for their formation, as well as the genetic connection of ore deposits. These issues can be solved with the help of paleovolcanic reconstruction of the territory. This paper explains the stages of formation of paleovolcanic structre in aid for their reconstruction. Such structures represent the main units of territories with existence of igneous rocks. Examples of reconstruction of certain territories of Kazakhstan and Egypt are given. These structures are tensely related to large metallic ore deposits of Mo, Cu, Zn, Au, Ag, Ni, Co, etc. These structures have various ages of formation and degree of development. Paleovolcanic structure has many similar features to recent well-preserved structures. Our model reset on the lithostatigraphic study of contributing units around oldest complexes and their geochronological sequence, spatial distribution and pattern fault systems and dykes. These researches have not only theoretical interest for science, but also practical. Reconstruction of such structures allows to allocate the most prospective areas for search the overlapped endogenous mineralization (porphyry copper-gold, copper-sulphide, poly-metallic deposits, etc.).


Periodontitis is a chronic inflammatory disorder affecting nearly 50% of adults in the United States. If left untreated, it can lead to the destruction of both soft and mineralized tissues that constitute the periodontium. Clinical management, including but not limited to flap debridement and/or curettage, as well as regenerative-based strategies with periodontal membranes associated or not with grafting materials, has been used with distinct levels of success. Unquestionably, no single implantable biomaterial can consistently guide the coordinated growth and development of multiple tissue types, especially in very large periodontal defects. With the global aging population, it is extremely important to find novel biomaterials, particularly bioactive membranes and/or scaffolds, for guided tissue (GTR) and bone regeneration (GBR) to aid in the reestablishment of the health and function of distinct periodontal tissues. This chapter offers an update on the evolution of biomaterials (i.e. membranes and bioactive scaffolds) as well as material-based strategies applied in periodontal regeneration. The authors start by providing a brief summary of the histological characteristics and functions of the periodontium and its main pathological condition, namely periodontitis. Next, a review of commercially available GTR/GBR membranes is given, followed by a critical appraisal of the most recent advances in the development of bioactive materials that enhance the chance for clinical success of periodontal tissue regeneration.


When looking at the small craft industry especially at small motor boats and compare them to cars, the set up is quite similar if not simpler in the boat building industry. But looking at the turn over of the factories it is quite obvious that the car industry has a much grater capacity to produce. One of the main reasons for this is that a car is counted as a necessity wiliest a boat is thought as a luxury. This means that the demand for car will always be more than that for a boat but there is still a massive demand for pleasure craft. The way that most boats are manufactured is quite predated when you compare it to the way in witch cars are manufactured robotics has not yet taken any place in the industry whilst is has been the excepted norm for many years in the car industry. The production line has been relatively new development in the small craft and has not been taken up by number of small craft producers. The main drive behind this project is to find out how much the small craft industry can develop by looking at the car industry and seeing what aspects can be taken over and used efficiently to improve the production methods of pleasure craft.


Aims Guidelines are often written by experts without heed to real-life use. This is especially problematic for emergency guidelines of infrequent use often out of hours by staff with varying skill mix. A guideline for safe infusion of concentrated potassium solution was required that was usable across all wards and specialties in a UK children's hospital. Using improvement methodology we modified one created by experts using video simulation. Methods The guideline was modified after each PDSA cycle of table top simulation with target users, the doctors and nurses of all skill mixes in their wards. Participants were pre briefed. The nurse role-played from a written scenario and the doctor asked to produce a prescription with the guideline and salient information. Video was used to further understand the process. An independent observer collected pre-defined measures at each simulation, these included: time taken to prescribe, whether key information was sought by the prescriber and ability to produce a correct prescription. Structural feedback were taken from all participants for their views on the usability and suggestions for improvement for the guideline. Results The guideline was modified after studying the measures and user suggestions at each simulation. Additional useful information was gained from video study not apparent by direct observation. Modifications made included font size, diagrams, didactic wording, simplification of calculations and table layouts. After five simulation cycles the time taken to prescribe a correct prescription reduced from 22 min to 7 min (figure). Secondary effect included culture change of involving users in guideline development and a better understanding of the microsystems of our hospital. Conclusion Simulation can test and improve complex guidelines especially those rarely used in real life regardless of skill mix and hierarchy. Video review adds to information that participants were unaware of or not able to verbalise. Of note, it is time consuming, each simulation and debrief takes upwards of an hour.


Purpose Diallyl sulfide (DAS), one of the organo-sulfur secondary metabolites in garlic, has been shown to inhibit the proliferation of cancer cells. The present study aimed to evaluate the mechanism of DAS in the prevention of benzo[a]pyrene (BaP)-induced lung cancer in a murine model. Materials and Methods The mice were exposed to 50 mg/kg of BaP twice a week for 4 weeks in order to induce lung carcinoma. Pretreatment of mice with DAS (100 mg/kg) was started 2 weeks before BaP exposure and further continued for 21 weeks. The effect of DAS and BaP was evaluated by studying various parameters in the serum and tissues of the treated or untreated BaP-exposed mice. Results The histopathological findings demonstrated that DAS prevented the progression of malignant lung cancer and metastasis in the liver. A significant drop was observed in BaP-induced tumor marker enzymes (ADA, AHH, γ-GT, LDH) in the serum of the mice treated with DAS. Moreover, DAS treatment resulted in the recovery of antioxidant enzymes, SOD and CAT, in BaP-exposed mice. The induction of apoptosis and the destruction of cellular ROS were detected in cancer cells from the mice pre-treated with DAS. The immunohistochemical analysis revealed the up-regulation of fatty acid synthase (FASN) in the lungs and liver tissues of BaP-exposed mice and the treatment with DAS inhibited FASN expression. Conclusion The findings of the present study indicated that DAS-induced apoptosis is strongly associated with the downregulation of FASN in tumor tissues. To the best of our knowledge, this is the first study that describes the role of FASN in BaP-induced lung carcinogenesis.


Observation of damage evolution is of great importance to the understanding of the failure process of rock materials. High-speed DIC system is constructed and used to observe the strain field evolution of the granodiorite disc in Brazilian test. The strain fields at different load levels are analyzed based on the stain abnormality indicator (SAI) which is the ratio of the strain measured in experiment to the strain from theoretical solution in an isotropy and elastic model. SAI could be used to indicate the damage in the specimen. The process of damage and failure of the specimen in Brazilian disc test is quantitatively analyzed and deeply discussed according to the strain fields and the statistics of SAI. Experimental results in this paper show that the failure process of the disc specimen in Brazilian test is not simple crack propagation under tensile load, but a complicated damage evolution procedure.