GONOCOCCAL RHINITIS SIR,-It is very gratifving to note the interest evoked by the article by Dr. Kirkland and myself on gonococcal rhinitis in an infant, published in the Journal of February 14th. The case was reported, not for scientific record, but to provoke discussion on a very important but much neglected subject. Admittedly t-he diagnosis was not complete, because no cul ture was made and the gonococcal complement-fixation reaction of the baby's serum was iot determined..: Nevertheless, my thesis is that typical gonococci cannot be mistaken by one experienced in recognizing these organiisms. I agree with Dr. A. Scott, who poinits out in the Journal of March 28th that it is very difficult to culture the gonococcus in the presence of other hardier organisms. I should like to hear from Dr. Assinder his method of culturing the gonococcus in mixed infections, and how he identifies them by fermentation tests in the possible presence of Micrococcus catarrhalis. Quite often have I been able to identify the gonococcus in a smear of prostatic fluid stained by methylene blue, yet have not been able to identify them in culture-owing to the medium being overgrown by staphylococci and diphtheroids. Media rich in trephones, such as Hirschfeld's testicular and Pelouse's calf-brain agar, have all been tried, but without much success. I contend that in a case of mixed infection the identification of an organism from the nose by fermentation tests (as suggested by Dr. Assinder in the Jouirnal of February 2Sth) is not practicable. I should be glad to know of any medium which would inhibit the growth of other organisms and yet promote the growth of the goIiococcus. I suggest that such a medium is urgentli, required, and reseatrch devoted to its isolation should be encouraged in every way possible. The complement-fixation reaction of the baby's serum should have been determined, but it is probable that, as is the case in other early acute gonococcal infections, it would have been negative. Dr. Orpwood Price raises a very important controversial point. In the absence of positive blood reaction and the isolation of the gonococcus by culture, is it justifiable to regard a chronic non-symptomatic prostatitis in the male adult as gonococcal infection merely because the prostatic fluid contains pus? Where there's smoke there's fire! I maintain, therefore, that where there is a history of antecedent gonorrhoea it is safer to treat the patient as suffering from an uncured gonococcal focus than to assure him that he has " nothing to worry about " as is so commonly done, with tragic sequelae. The " certain " diagnosis of chronic latent gonorrhoea presents very great difficulties, especially in married persons where the symptoms are slight or even absent. "Gonococcosis d'emblhe " is, in my opinion, far commoner than suspected. In conclusion, I suggest that when -there is naked-.eye or microscopical evidence of gonococcal infection, medical men should be extremely cautious of pronouncing a patient cured merely because the cultural and serological results are negative. Recently, at the instigation of the author, a Laboratory of Neisserian Research has been established in Sydney, the -main object of whichi is to secure a higher standard of cure in gonorrhoea than has been demanded by the medical profession in the past. In view of the extreme prevalence of latent gonorrhoea (10 per cent. of the adult population) it is lamentable to observe the apathy of the medical profession towards this tremendously important problem. Especially is this so in Australia. Here there are no lectureships in venereology at any of the universities; there are Ino opportunities for post-graduate work in the modern diagnosis and treatment of gonorrhoea and syphilis ; and there is no section o-f the British Medical Association for the study of venereal diseases.-I am, etc., SydneEy, Nexv South Walles, MaIy 7thl. ROBERT V. STORER. FRACTURE OF THE NECK OF THE FEMUR SIR,-In recent numbers of the Journal attention has been drawn to the important question of fractures of the neck of the femur. As regards treatment, I must confess that I have never had any success with the Whitman type of plaster-of-Paris spica, nor can I fully concur in its uncderlying principles. To my mind the essentials in treatment are extension withabduction ;then, correction of the excessive external rotation of the foot. These can surely be best obtained by skeletal traction in such a splint as the Thomas knee splint. WVith faithful attention to detail there is absolutely no reason why full and adequate reduiction -should not be secured; and if it is maintained and the patient is transferred to a walking' calliper splint after some weeks, a good result will be obtained, but not under three years in the case of the "intracapsular" variety. In the nea-r future a book will be published by Constable and Co. which will contain the. details of the methods I advocate. I should be only too pleased to let any reader know particulars earlier, if he-, so requires.-I am, etc., MEURICE SINCLAIR, London, WV., Jtune 9th. \Major R.A.M.C. (ret.).


This paper examines the shortcomings of present tax and social welfare treatment of unskilled temporary workers in the United States. Uncovering systematic overtaxation and undersupport for migrant workers' financial stability, the paper then explores the effect of these policies on immigration outcomes. Informed by empirical research on migration decision-making, this paper argues that current tax and social welfare policies create disincentives for return migration by exacerbating financial insecurity, a main driver of migration in the first place. Further, systematic exclusion from tax benefits and social welfare protection violates migrant workers' internationally recognized right to equal treatment under the law. I present evidence that supporting migrant workers' financial stability, in part by promoting remitting to and saving in home countries, would improve incentives for return migration while simultaneously protecting migrants' rights and dignity. Although a guest worker policy regime that incentivizes return migration while simultaneously respecting migrants' rights has proven elusive, policymakers need not prioritize one goal at the expense of the other. I propose policies that correct the flaws of the current system through targeted tax incentives and provision of social welfare benefits in home countries.


We present an overview of physical processes that drive water circulation within the extended system of coastal embayments in the Toronto Harbour. The different water circulation patterns occur at various spatial and temporal scales, and our article provides context for the various efforts to improve water quality by the Toronto and Region Remedial Action Plan. Velocity profiles and water level measurements showed that the harbour's Helmholtz pumping mode drives a 1-h period oscillation, which can influence flushing of the shallow embayments. This process likely persists year-round and would lead to flushing time-scales of between 1–11 days for these shallow embayments. If this ubiquitous pumping is combined with solar heat fluxes, it partially explains the persistent temperature gradients amongst the shallow embayments. In the larger and deeper (∼10 m) Inner Harbour, the prevailing westerly winds drive most of the mean circulation, with a current entering through the Western Gap and leaving through the Eastern Gap. This wind driven circulation leads to a residence time of water in the Inner Harbour between 7–14 days. In addition, periodic strong and sustained westerly winds can induce frequent upwelling events in Lake Ontario (between 4 to 10 times during the stratified season) that mildly increase the exchange flow and help maintain good water quality by exchange nearshore waters with cleaner hypolimentic waters. The intrusion of cold water into the harbour can also lead to highly variable temperature regimes with sudden drops in temperature that could have negative effects on aquatic organisms.


Background: Despite rapid advances in research on the evaluation of complex interventions, debate on evaluation methods and approaches still mainly revolves around the conventional and mostly outdated positivist–constructivist dichotomy. The lack of a clear conceptual and theoretical framework from which to choose appropriate evaluation approaches and methods means that approaches are often misused by both researchers and practitioners. Research design: Using three case studies, this article shows how different approaches should and should not be used in practice according to levels of nonlinearity. Both the theoretical development and the case studies presented in this article rely heavily on interviews conducted by the author with program management and staff, evaluation managers, heads of evaluation units, and evaluators in several countries across two continents, along with a quantitative survey. Results: This article expands the classic discussion on evaluation approaches, adapting it to current managerial demands, increased complexity, and newly developed methodologies. It suggests an operational tool for categorizing evaluations and then matching evaluation approaches to the circumstances and the evaluation objectives. Conclusion: The findings suggest that approaches which are not congruent with levels of nonlinearity may hinder attempts to accurately evaluate results, causing dissatisfaction of evaluation commissioners from the evaluation process and methods applied. In contrast, analyzing the nonlinear and structural elements of complexity separately allows an extended categorization of evaluation approaches to be matched to the nonlinearity of programs to be evaluated.


When Congress intervenes in amending the Federal Rules of Evidence it displays the very characteristics that Rule 403 is designed to keep out of the courtroom. Indeed, the history surrounding enactment of Rules 413-415 (allowing prior bad act evidence in sexual crimes) and Rule 704(b) (restricting use of expert testimony on the mental state of the defendant) shows that Congress often succumbs to inflamed passions, emotional appeals, and faulty logic when considering evidentiary rules. However, unlike a jury"s display of these traits, which reaches only to the single case before it, congressional interference in the Federal Rules of Evidence results in wide-ranging and long-term detriment to the fairness of America"s system of justice. For these reasons, Congress should refrain from directly involving itself in the Federal Rules of Evidence.


Although various treatment approaches are available for MDD, 30 to 50% of patients fail to respond to those interventions 23 . Identifying pre-treatment biomarkers may give clinicians reliable estimates of whether patients will respond to a treatment. Such biomarkers can guide treatment selection, which may reduce costs relevant to unsuccessful treatments. Neurocognitive tasks are designed to tap into the functioning of critical neural networks that may highlight deficits associated with MDD, which may indicate biomarkers relevant to treatment response. in which deficits may be associated with MDD and which may indicate markers relevant to treatment responses. This study used Attention Network Task (ANT) and Iowa Gambling Task (IGT) to assess critical aspects of attention (alerting, orienting), executive control (conflict detection), and decision making in the context of rewards and punishments. Previous research has revealed that depressed adolescents show impairments in the ANT and IGT compared to their healthy counterparts. The deficits implicated in the task results were hypothesized to be the markers that can potentially predict treatment outcome in depressed adolescents (N = 15). Participants received 16 weeks of interpersonal psychotherapy (IPT-A) treatment. Pre-treatment ANT and IGT scores of treatment responders and nonresponders were compared and correlated with the degree of remission achieved over the course of treatment. Overall for the ANT, conflict detection and alerting did not differentiate responders and non-responders. However, a significant positive correlation was found between orienting score and the degree of treatment response. For the IGT, on the other hand, analyses failed to report any significant group differences.


The Cloud Computing (CC) is a new innovative model of sourcing the information and communication technologies (ICT) services required by firms for supporting their activities, so it is necessary to investigate the level of benefits that CC offers to firms, as well as their determinants. However, limited empirical research has been conducted in this direction. Our paper contributes to filling this research gap. It formulates a set of research hypotheses concerning the effects of firm's 'hard ICT capital', and also some types of firm's 'soft ICT capital', on the benefits offered by CC, having as theoretical foundation the 'resource-based view' theory. These research hypotheses are tested using data collected through a survey from 115 Greek firms, from which CC benefits regression models are estimated. It has been concluded that the sophistication of firm's ICT infrastructure (an overall measure of firm's hard ICT capital) has a positive impact on CC benefits. Furthermore, three of the examined types of soft ICT capital have been found to impact positively CC benefits: the information systems (IS) inter-connection/integration capability, the ICT strategic planning and alignment capability, and the internal relationship between firm's ICT unit and business units. Our findings reveal some aspects of firm's ICT capital that affect the generation of value from this new innovative CC paradigm, which can be useful to CC service providers, and also management and ICT firms' practitioners and consultants. of of appropriate CC leading to the of higher levels of from CC usage.


Neurofibromatosis is the most common single gene disorder to affect the nervous system, with an estimated incidence of 1 in 3000 live births. Neurofibromatosis (NF) may be classified into von Recklinghausen NF (NFI) and bilateral acoustic NF (NFII) based on the distribution of lesions. The most common lesion associated with the von Recklinghausen type is the neurofibroma. Various complications are associated with neurofibromatosis, the most feared of which is malignant change in the neurofibroma. This article describes the study of 7 cases of proven malignant change in neurofibromas with regards to presentation, clinical progress and treatment followed by a review of the present literature.


Torula infection of the central nervous system is a rare disease but one which is of interest to the internist and the syphilologist as well as the neurologist. Clinically, in these cases a diagnosis of tumor or abscess of the brain, tuberculous meningitis, encephalitis or dementia paralytica is made, and frequently the true etiology is not revealed until autopsy is performed. Rusk, in 1912, under the title "Systemic Oidiomycosis," was the first in this country to report a case of torula infection of the central nervous system. His report was antedated in Germany, however, by that of von Hansemann in 1905 and that of Turk in 1907, each of whom reported one case. It remained for Stoddard and Cutler in 1916 to describe the clinical characteristics of this disease and to isolate the causative organism by cultural methods, animal inoculations and histologic sections. They differentiated this condition from other mycotic


Recognition of pre-defined musical patterns in the context of Greek Traditional Music is very useful to researchers in Musicology and Ethnomusicology. This paper presents an efficient method for recognizing isolated musical patterns played by Creek Traditional Clarinet, in a monophonic environment. The Discrete Time Wavelet Transform of the signal is calculated. The highest scales, along with the lowpass residue of the Wavelet Transform, are treated as signals and the spectrogram of each one of them is calculated. The spectrograms are in turn treated as 2-D images. A number of translation and scaling invariant moments are then computed for the resulting images. These moments are used as features, and turn out to cluster around certain points in the corresponding multidimensional feature space, for the various musical patterns. Tree-like structured classification procedure is then adopted for classification. A few clusters correspond to more than one musical pattern. In such case a Dynamic Time Warping procedure is employed to determine the specific pattern.


We studied metabolic abnormalities of postoperative organ failure in 55 patients and classified them into four groups according to the postoperative changes in the arterial blood-ketone body ratio (acetoacetic acid-beta-hydroxybutyric acid) reflecting hepatic mitochondrial redox potential: patients in group A had no decrease below 0.7, patients in group B had a transient decrease to 0.4, patients in group C had a progressive decrease to below 0.4, and patients in group D (terminal stage) had a decrease to below 0.25. All group A and B patients tolerated their operations well; the group C and D patients had multiple organ failure. In groups B, C, and D, plasma concentrations of alanine, proline, phenylalanine, and tyrosine were negatively correlated with the blood--ketone body ratio and the molar ratios between the plasma concentrations of branched-chain amino acids and aromatic amino acids were positively correlated with the blood--ketone body ratio. Hepatic energy deficit associated with decreasing blood-ketone body ratio may be the metabolic basis of postoperative organ failure.


Testosterone therapy is the cornerstone in the care of men with hypogonadism and transgender males. Gel and intramuscular injections are most frequently used and are registered and included in the international guidelines. The specific preparation should be selected according to the patient's preference, cost, availability, and formulation-specific properties. As the majority of men with hypogonadism and transgender males require lifelong treatment with testosterone, it is important to utilize a regimen that is effective, safe, inexpensive, and convenient to use with optimal mimicking of the physiological situation. This systematic review reviews current literature on differences between the three most used testosterone preparations in adult men with hypogonadism and transgender males. Although it appeared hardly any comparative studies have been carried out, there are indications of differences between the preparations, for example, on the stability of testosterone levels, hematocrit, bone mineral density, and patient satisfaction. However, there are no studies on the effects of testosterone replacement on endpoints such as cardiovascular disease in relation to hematocrit or osteoporotic fractures in relation to bone mineral density. The effect of testosterone therapy on health-related quality of life is strongly underexposed in the reviewed studies, while this is a highly relevant outcome measure from a patient perspective. In conclusion, current recommendations on testosterone treatment appear to be based on data primarily from non-randomized clinical studies and observational studies. The availability of reliable comparative data between the different preparations will assist in the process of individual decision-making to choose the most suitable formula.


Mobile agents play a key role in many researches on non-fixed services composition, but threats from potentially malicious hosts become a great obstacle of services composition based on mobile agent technology because an agent on a malicious host is in a white-box attack context. A security framework based on bilinear pairings on elliptic curves using a special digital signature technique and a multi-recipient encryption scheme is proposed. The framework provides following security features: First, verifiability, strong unforgeability and strong identifiability of digital signatures of composition member. Second, prevention of misuse of digital signatures of composition controller. Third, confidentiallity of parameters and result of services conpositon with high efficiency. All these security features relies on the difficulty of solving discrete logarithm problems and gap Diffle-Hellman problems, which are computational infeasible to solve at present.


We recently expressed three major concerns about a 2018 article of El Hage et al. about a claimed effect of the box size in molecular dynamics simulations of hemoglobin. In the response of the authors to our comment, none of these concerns have been addressed, yet the authors maintain their original conclusions. Here, we challenge those conclusions and provide additional data that reestablish our original concerns. In addition, we identified six additional flaws in the response from El Hage et al. as well as a number of technical concerns about the presented simulations and analyses. Taken together, we conclude that there is no basis to support the hypothesis of significant box size effects in MD simulations for the studied systems in the examined range.


Biplane cellules using the N.A.C.A.-M6 airfoil section have been tested in the variable density wind tunnel of the National Advisory Committee for Aeronautics. Three cellules, differing only in the amount of stagger, were tested at two air densities, corresponding to pressures of one atmosphere and of twenty atmospheres. The range of angle of attack was from -2 degrees to +48 degrees. The effect of stagger on the lift and drag, and on the shielding effect of the upper wing by the lower at high angles of attack was determined.


The action of acrylamide on Escherichia coli B was studied: short-term action at high concentrations, long-term action at low doses under the normal conditions of growth and in the process of cell immobilization in polyacrylamide gel. Such a treatment was found to cause considerable structural changes in the cells. Division of the cells was inhibited and they reached giant sizes when grown in media containing 1-2% of acrylamide. The phenomenon might be used for differentiation of living and dead E. coli cells.


The objective of this paper is to present the current status and possibilities of microgrid in Nepal. There are many possibilities of microgrid implementation, interconnecting micro hydro power plants (MHPs). Hybrid microgrids could also be formed interconnecting MHPs with wind turbines or photovoltaic systems. The challenges and benefits of implementing a microgrid are presented in this paper. The paper also presents the case of first pilot microgrid installed in Nepal.


We investigate economic resilience of UK regions before, during and after the 2007/8 global financial crisis. We date business cycle turning points in real output, employment and productivity to assess the resilience dimensions of resistance, recovery and renewal and rank the economic resilience of regions in a resilience scorecard. Our empirical results reveal that the business cycle in productivity has not returned to its pre-recession peak level for Yorkshire and the Humber and the employment level has not recovered in Scotland. The resilience scorecard ranks the South East as the most resilient region with Northern Ireland the least resilient.


Large inequities in health exist between indigenous and non-indigenous populations worldwide. This health divide has also been demonstrated in India, where indigenous groups are officially classified as scheduled tribes (STs). India has one of the largest tribal populations in the world. Tribal communities in general and primitive tribal groups in particular are highly disease prone and their misery is compounded by poverty, illiteracy, ignorance of causes of diseases, hostile environment, poor sanitation, lack of safe drinking water, blind beliefs, etc. As per the estimates of National Family Health Survey-3 (NFHS-3), the likelihood of having received care from a doctor is lowest for ST mothers (only 32.8% compared to India of 50.2%). While many strategies have been attempted over the years to discuss some of the economic, social, and physical factors preventing tribal population to get access to healthcare services, the ultimate outcome has remained far less than the expectations. Considering that these ST groups are culturally and economically heterogeneous, the methods to tackle their health problems should not only be integrated and multi-fold, but also specific to the individual groups as feasibly as possible. Measures like strengthening of the existing human resources, bringing health services within the reach of remote populations, promotion of health awareness, facilitation of community participation using innovative strategies, bringing about a change in the behavior of health care providers, implementation of measures for the empowerment of ethnic groups by carrying out administrative reforms and finally by ensuring the sustainability of all above recommended measures.


Ciliary neurotrophic factor (CNTF) is one of a small number of proteins with neurotrophic activities distinct from nerve growth factor (NGF). CNTF has now been purified and cloned and the primary structure of CNTF from rabbit sciatic nerve has been determined. Biologically active CNTF has been transiently expressed from a rabbit complementary DNA clone. CNTF is a neural effector without significant sequence homologies to any previously reported protein.


Abstract This paper draws on data collected during a longitudinal collaborative project with teachers in England from schools and further education colleges. The project investigated 'Learning to Learn' in partnership with teacher–researchers with a focus on how metacognitive awareness can be improved by enquiring into creative combinations of pedagogy, environment and learners' dispositions. The paper is an attempt to make clear the theoretical underpinnings of our belief that the project teachers were enacting something different, something metacognitive. We present a pragmatic model of metacognition development based on ideas collaboratively produced across the project. The five cycles of development are exemplified from the pedagogic and the professional learning perspective with quotes, vignettes and case study excerpts. We show a catalytic relationship between the pedagogies used by the teachers to develop their students' metacognition and the teachers' own learning and metacognitive knowledge and skilfulness.


General packet radio service (GPRS) is a part of the evaluation path towards 3G. This paper investigates the effect of using adaptive overlapping between adjacent cells on the data sessions within GPRS system. A simulator model was developed to study the behavior of data transmission between a GPRS server and data terminals via air interface. Simulation results show the trustworthiness and validity of the proposed approach even at high offered traffic


Background : The correlation between high blood pressure (BP) and overweight in children is widely acknowledged, although the role of body fat distribution in this association remains to be fully elucidated. The aim of this study was to investigate the role of abdominal (central) and mid-upper arm (peripheral) adiposity in association with BP. Methods : 839 adolescents of both genders took part in the SHARP (Sardinian Hypertensive Adolescent Research Programme) study. BP, waist circumference (WC), mid-upper arm circumference (MUAC), body mass index (BMI) and heart rate were measured. Results : 89 out of 839 subjects were hypertensive (10.6%: 44 males and 45 females. Isolated systolic hypertension: 4.2%; isolated diastolic hypertension: 4.9%; combined systolic and diastolic hypertension: 1.5%). In univariate analysis, WC and MUAC correlated with systolic (p < 0.0001 and p < 0.0007, respectively), but not with diastolic BP. In multiple longitudinal regression analysis, WC and MUAC were the strongest independent predictors of systolic BP over time. Furthermore, a significant increase of systolic BP was observed throughout all age-adjusted quintiles of WC (p < 0.001), while a similar increase was revealed only for the first four quintiles of MUAC (p < 0.001). Higher quintiles of central adiposity were associated with a higher prevalence of elevated systolic BP (p < 0.001), while no similar relationship was detected for MUAC. Conclusions : in adolescence, central and periph eral distribution of body fat is associated with normal systolic BP, irrespective of BMI, with WC alone being correlated to hypertension. Proceedings of the 9 th International Workshop on Neonatology · Cagliari (Italy) · October 23 rd -26 th , 2013 · Learned lessons, changing practice and cutting-edge research


Automation of anti-suffocation system has become a very essential part of safety in automobile. The death of toddlers, disabled people and animals due to suffocation in locked cars has been a significant problem. Hence, there is a requirement for a system which autonomously operates with minimal power consumption and cost to overcome this sort of harm to human life. In this work an attempt has been made to develop a system that works invariably, irrespective of negligence of person handling the car. This system is a prototype vehicle model of how sensors and actuators can be appropriately used as a setup to overcome this problem. The setup consists of a prototype vehicle, with engine cut off and all the doors closed, a temperature sensor, a motion sensor, a microcontroller and actuator and the power supply is provided by a battery. Results indicate that, with the help of sensors and actuators window glass is lowered and circulation of fresh air takes place, temperature inside the car is lowered; this system prevents suffocation by intelligent sensing which works efficiently, this is an economical system without any compromise on its functioning.


Tau Alpha Pi is the national honor society for engineering technology. It is fostering Excellence in Engineering Technology Education. The MET Department just get Tau Alpha Pi chapter approved by TTU's student organization and the goal of this project is to design and create the Tau Alpha Pi Emblem to be placed in front of Lewis Hall. The dimensions for the emblem were received from Tau Alpha Pi national organization. This project will involve 2D and 3D solid model designing, pattern printing and casting a bronze Honor Society Emblem. Our team was able to contact a High Tech Foundry in Arkansas, which has the ability to cast the larger pieces of the Emblem. Our group will be responsible for casting the remaining pieces of the Emblem here at Tennessee Technological University. Nowadays, foundries are using newer, more abstract means of patterning molds for metal casting. Recent developments in additive manufacturing and robotics are being implemented as a replacement for traditional mold making techniques. The construction of the Tau Alpha Pi emblem for display in front of Lewis Hall will utilize these new techniques. Additively manufactured patterns and robotic milled molds will be utilized in the metal casting process. Casting will occur both on Tennessee Tech's campus and off-site at Southern Cast Products in Jonesboro, Arkansas. The manufacturing of the Tau Alpha Pi emblem takes traditional methods and combines them with innovative techniques to produce an accurate, near-net-shape product.


With the approach of anodic oxidation, TiO2/Ti film doped with Cu2+ was produced in H2SO4 electrolyte mixed with CuSO4. The surface morphology and the roughness of the films were studied with atomic force microscopy. The phase composition of the films was studied by X-ray diffraction. The photocatalytic activity of the films was compared through the photocatalytic degradation rate of phenol. The relations of the photocatalytic activity to the concentration of Cu2+, the microstructure and the surface roughness of the film were investigated. The results showed that Cu2+ increased the surface roughness and restrained the growth of crystal. In addition, the phenol in aqueous solution was successfully photodegraded under visible light irradiation by Cu2+-TiO2/Ti film. The composition and structure of the film affected the catalytic activity greatly. Compared with TiO2/Ti film, the recombination rate of e- and h+ of Cu2+-TiO2/Ti film was decreased.


As the number of young people attending college has increased, the diversity of college students' educational backgrounds has also risen. Some students enter introductory courses with math anxiety or gaps in their quantitative training that impede their ability to master or even grasp relevant disciplinary content. Too often professors learn of these anxieties and gaps only during the post mortem of the first midterm. By that time, a good portion of a student's grade is determined and successful recovery may be impossible. During the 2016-17 academic year, the Department of Economics at Carleton College ran a pilot project using the Quantitative Literacy and Reasoning Assessment (QLRA) as a pre-course diagnostic tool. Results show that the QLRA predicts student grades even after controlling for other SAT/ ACT math scores and overall GPA. This finding suggests that quantitative reasoning is an important input into success in Principles of Economics (both Macro and Micro). When the QLRA alone is used to predict success in a course (as defined by either a grade of Cor better, or a grade of Bor better), we find that we could nearly always pick out students who were on the way to sub-par performance. On the other hand, the tool has a fairly high false positive rate; almost half of students identified as "at risk" based on QLRA performance went on to earn a successful grade in the course. In total, we argue that the QLRA may be a useful and inexpensive early-warning device for introductory courses in economics; it may be worth exploring a similar use of the instrument in other disciplinary settings where introductory courses require quantitative reasoning.


From the proton nmr studies of 2-thiocoumarin and coumarin, it is concluded that the relative interproton distances in the two oxygen heteroatom bicyclic systems are similar. The values for the phenyl ring protons do not deviate significantly from the regular hexagonal geometry, unlike bicyclic systems with nitrogens as the heteroatoms, such as diazanaphthalenes. Larger values of the indirect spin-spin couplings within the protons of the ring containing the oxygen heteroatom, compared to the values between the ortho protons in the phenyl rings in coumarin and 2-thiocoumarin, correspond to the olefinic nature of these protons. This is in contrast to results for the nitrogen heterocycles where both the rings are aromatic.


The concept of a virtual semiconductor fab'' requires a focused effort among engineering, physics, chemistry, materials, mathematical and computational sciences. Although widely used by the semiconductor industry, current technology computer-aided design (TCAD) struggles to keep pace with new generations of IC technology. The semiconductor industry needs improved, predictive physically-based modelling and simulation capabilities to decrease cost, improve efficiency, and provide TCAD tools to process developers before production begins. Without the use of more advanced next generation TCAD models, future IC technology development will slow as a result of expensive, time-consuming experimental validation of processes and device performance. This volume brings together researchers from industry, universities and national laboratories to highlight recent advances in TCAD, and to identify critical areas for future emphasis. Both silicon and compound semiconductor process and device performance modelling and featured. Topics include: bulk process modelling; equipment modelling; topography modelling; and characterization and device modelling.


AN INVESTIGATION OF KEY FACTORS IMPACTING FRONT-LINE SERVICE PROVIDERS' EFFORTS TO DELIVER A QUALITY CUSTOMER EXPERIENCE Donna Wells, B.A. Marquette University, 2013 The relevance of competitive differentiation for any business that strives to achieve success is undeniable. An awareness of how to best satisfy the customer is instrumental in helping a company to distinguish itself from the competition. Service firms in particular realize that the customer's perception of service quality can prove to be a valuable asset in the quest for customer satisfaction and retention. In the customer's eyes, evaluation of the service experience as satisfying or less than satisfying is largely dependent upon the treatment extended by frontline employees during the face-to-face service encounter. The aim of this qualitative study was to investigate the important factors that may potentially impact delivery of a high-quality customer experience by the contact personnel who are charged with representing the company's services. This research employs instrumental case study methodology. Subjects were recruited via nonprobability, purposive expert sampling and included managers or supervisors of front-line customer-contact employees representing hotel properties as well as a private, four-year university. All organizations are located within the metropolitan Milwaukee area. Data were collected from nine informants using semi-structured, face-to-face interviews. The gathered information was then transcribed and analyzed to identify significant themes. Recurring themes that surfaced in the scholarly literature review aligned closely with the current study's findings. Findings suggest that attention directed at workplace climate, hiring qualifications, service training, job satisfaction, and reward/recognition programs on the part of management can likely produce employees that are better prepared and more motivated to carry out the responsibilities of their critical front-line service role, thus leading to customer satisfaction. FACTORS IMPACTING FRONT-LINE SERVICE PROVIDERS' ii


25 size calculation is that reasonable chunk sizes must be decided on based only on information from the compressed data available at a given point in the process. Similarly, from previous data, it must be possible to evaluate when to switch from the parallel chunk compression to the serial process that completes compression of each piece. A more general technique accommodates pieces that are not compressed independently, allowing compressors such as the Fast Lossless (FL) to more fully exploit dependencies between spectral bands, which generally allows a higher compression factor to be achieved. This work was done by Matthew A. Klimesh and Aaron B. Kiely of Caltech for NASA's Jet Propulsion Laboratory. Further information is contained in a TSP (see page 1). NPO-48521


Civil Litigation introduces the processes and procedures involved in making and defending civil litigation claims. Following the chronological progression of a civil litigation claim, the volume offers practical guidance on advising clients whilst ensuring that the principles of the Solicitors' Regulation Authority Handbook which includes the Codes of Conduct for firms and for solicitors. This edition includes commentary and detail of the new rules of conduct that were approved by the Legal Services Board in November 2018. A part of the new Handbook (the Handbook) came into force in December 2018—the SRA Transparency Rules—and the remaining sections are expected to be fully in force in April 2019. Diagrams at the beginning of chapters make clear the way in which the litigation procedure works and help with the understanding of the nature of the process as a whole. Examples provide a realistic context for learning, while issues of cost, best practice, and professional conduct are clearly highlighted. Alternative dispute resolution is given appropriate practical emphasis, and references to the Civil Procedure Rules throughout make sure that students are ready for life in practice. This edition has been revised to reflect the most up-to-date law and practice in all aspects of litigation practice. In addition to the chapters highlighted below, there are additional chapters online on injunctions and other equitable remedies, a practical guide to court hearings, instructing counsel, and enforcement of judgments.


Mitochondria are organelles found in the cytoplasm of eukaryotic cells. They are composed of an outer membrane and an inner membrane. The outer membrane faces the cellular cytoplasm, while the inner membrane folds back on itself multiple times, forming inner folds, called cristae. The space between the two membrane layers is called the intermembrane space, and the space within the inner membrane is called the matrix. Subject Cell organelles [3] Mitochondria [4] eukaryotic cells [5] Mitochondrion [6] Topic Theories [7] Processes [8]


Abstract: E.O. Wilson, the noted entomologist at Harvard, "wished" for an authoritative encyclopedia of life that would be freely available on the worldwide Web for the entire world. On May 9th, 2007, The Encyclopedia of Life (EOL) was launched as a multi-institutional initiative whose mission is to create 1.8 million Web sites detailing all the known attributes, history, and behavior, about every known and described species and portraying that information through video, audio, and literature, via the Internet. A major contributor to the Encyclopedia is the Biodiversity Heritage Library that is currently scanning all the core biodiversity literature


Clinically, arteriovenous shunt (AVS) stenosis results in turbulent and pulsatile flow because of high resistance and pressure within a narrowed space inside a stenotic access. Palpation and ultrasound methods are primarily used (first-line examination) to rapidly screen the risk of the degree of stenosis (DOS). Therefore, quantitative hemodynamic analysis involving Doppler ultrasound is performed in patients suffering from AVS stenosis and undergoing long-term hemodialysis. Doppler ultrasound with a center frequency of 7.5 MHz can provide substantial resolution and sensitivity to the measurement of blood flow velocity within a range of depth of 20.0–30.0 mm and a scan diameter of 10.0 mm. A hemodynamic method is used to analyze blood flow through a hemodialysis access in terms of dimensionless numbers. In this study, velocities were measured using Doppler ultrasound at three specific sites in vessels, namely, arterial anastomosis, loop, and venous anastomosis sites. Dimensionless numbers, such as supracritical Reynolds numbers, critical peak Reynolds numbers, and resistive indices, are determined in accordance with parallel conditional expression-based rules to create decision trees for the rapid screening of the DOS at the abovementioned specific sites. For the enrolled subjects, results demonstrate that noninvasive hemodynamic analysis with Doppler ultrasound measurements and parallel decision trees has potential for the efficient screening of the DOS in patients suffering from AVS stenosis and undergoing long-term hemodialysis. Experimental results also indicate that the hit and true-positive rates of the proposed screening method in clinical indication are higher than those of the machine learning method.


Knowledge distillation (KD) is essentially a process of transferring a teacher model's behavior, e.g., network response, to a student model. The network response serves as additional supervision to formulate the machine domain, which uses the data collected from the human domain as a transfer set. Traditional KD methods hold an underlying assumption that the data collected in both human domain and machine domain are both independent and identically distributed (IID). We point out that this naive assumption is unrealistic and there is indeed a transfer gap between the two domains. Although the gap offers the student model external knowledge from the machine domain, the imbalanced teacher knowledge would make us incorrectly estimate how much to transfer from teacher to student per sample on the non-IID transfer set. To tackle this challenge, we propose Inverse Probability Weighting Distillation (IPWD) that estimates the propensity score of a training sample belonging to the machine domain, and assigns its inverse amount to compensate for under-represented samples. Experiments on CIFAR-100 and ImageNet demonstrate the effectiveness of IPWD for both two-stage distillation and one-stage self-distillation.


Intellectual capital, intangible assets of an organization mobilizing the resources it provides long-term life and do not appear in the balance sheet as assets as defi ned, information is based on a new type of capital. Patents and trademarks of the organization has received the organization's reputation, customer loyalty, such as abstract elements, in other words, information, and such assets are shown as are the basis of the capital. These assets, intellectual capital is separated into three basic components. The fi rst, is the human capital and employee organizations of past experience, business skills refers to. Second, structural capital and the organization's culture and structure had settled into the habit of doing business and professionalism includes. Third, the relational or social capital and intellectual capital is the most important component. This type of capital, do business with organizations around the connection with other organizations that is based on. A social network, this mechanism contained in the bonds of members based on their capacity utilization means that they created. Actors within this network mechanism, the organization itself or the units can take an active role. This study, to companies aff ected by the global crisis, the crisis of social capital as a way out of a capacity to off er tips and suggestions for how could be increased. For this reason, study, an alternative approach as a means fi rms can exit from the crisis of social networking mechanism for how confi gurations and relational capital, how and in what form of action needed, the basic problematically respectively.


Donation after circulatory death (DCD) allows expansion of the donor pool. We report on 11 years of Italian experience by comparing the outcome of grafts from DCD and extracorporeal membrane oxygenation (ECMO) prior to death donation (EPD), a new donor category. We studied 58 kidney recipients from DCD or EPD and collected donor/recipient clinical characteristics. Primary non function (PNF) and delayed graft function (DGF) rates, dialysis need, hospitalization duration, and patient and graft survival rates were compared. The estimated glomerular filtration rate (eGFR) was measured throughout the follow-up. Better clinical outcomes were achieved with EPD than with DCD despite similar graft and patient survival rates The total warm ischemia time (WIT) was longer in the DCD group than in the EPD group. Pure WIT was the highest in the class II group. The DGF rate was higher in the DCD group than in the EPD group. PNF rate was similar in the groups. Dialysis need was the greatest and hospitalization the longest in the class II DCD group. eGFR was lower in the class II DCD group than in the EPD group. Our results indicate good clinical outcomes of kidney transplants from DCD despite the long "no-touch period" and show that ECMO in the procurement phase improves graft outcome, suggesting EPD as a source for pool expansion.


High-dimensional MR imaging often requires long data acquisition time, thereby limiting its practical applications. This paper presents a low-rank tensor based method for accelerated high-dimensional MR imaging using sparse sampling. This method represents high-dimensional images as low-rank tensors (or partially separable functions) and uses this mathematical structure for sparse sampling of the data space and for image reconstruction from highly undersampled data. More specifically, the proposed method acquires two datasets with complementary sampling patterns, one for subspace estimation and the other for image reconstruction; image reconstruction from highly undersampled data is accomplished by fitting the measured data with a sparsity constraint on the core tensor and a group sparsity constraint on the spatial coefficients jointly using the alternating direction method of multipliers. The usefulness of the proposed method is demonstrated in MRI applications; it may also have applications beyond MRI.


The consequences of preterm birth (PTB), to the individual and society at large, remain a major financial and personal burden. Babies born at the limits of viability, who survive, often have major neurological impairments, such as cerebral palsy, developmental delay and blindness. The cost of initial hospitalisation is more than $200 000 for each birth but takes no account of future costs once they leave the hospital. The major morbidities associated with extreme prematurity are respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). With advancing gestational age at birth, the financial costs and morbidity associated with these conditions decrease. The major morbidities (RDS, IVH and NEC) are rare by 34 weeks of gestation, with the exception of RDS, which complicates 7% of deliveries at this gestational age. While the vast majority of infants survive the first year of life, the infant mortality rate is markedly increased by three‐ to five‐fold even for the mildly preterm infants, as compared with that of the term infants. Neonates born after 34 completed weeks of gestation rarely have mortality or major morbidity, but the financial costs remain significant ($7000 per case), and efforts to prevent delivery at this gestational age are probably indicated. Economic costs associated with PTB include the cost of initial hospitalisation, the cost of any chronic diseases resulting from the prematurity and social costs including loss of gainful employment by a family member taking care of the infant or child and loss of potential future earnings of the affected child. Antenatal steroids, if given to the mother at least 48 hours prior to a PTB, have shown significant reductions in RDS, IVH and NEC. Efforts to prevent, or avoid, PTB include the use of tocolytic agents which have been shown to prolong gestation for a minimum of 48 hours, or longer in some cases. The range of tocolytic agents used to delay or prevent PTB work through many different pathways, with varying degrees of success. Which tocolytic agent to use depends on many factors including underlying maternal status, gestational age of the fetus and documented efficacy of agent used.


The roles and responsibilities of oncology nurses have rapidly transformed over the past century from general nurses providing bedside comfort care with few technological advances to advanced practice oncology nurses responsible for everything from performing invasive procedures to diagnostic interpretation and screening for cancer prevention. As cancer care continues to evolve, nurses will play a key role in the field of oncology, whether as specialized oncology nurses providing clinical care or as nurse researchers spearheading groundbreaking oncology research.


Understanding how and why liability laws and liability reforms alter the medical treatment decision-making process is central to reforming the current U.S. malpractice liability system. Survey methods serve a valuable role in this process because they measure how malpractice pressure affects physician perceptions of appropriate practices, and thereby capture an important determinant of treatment decisions. Based on analysis of the American Medical Association Socioeconomic Monitoring System survey, we present four findings. First, physicians from states enacting liability reforms that directly reduce malpractice pressure experience lower growth over time in malpractice claims rates and in real malpractice insurance premiums. Second, physicians from reforming states report significant relative declines in the perceived impact of malpractice pressure on practice patterns. Third, individual physicians' personal experiences with the malpractice system are a key determinants of the perceived importance of defensive medicine. Fourth, the impact of individual physicians' claims experience on perceptions is smaller in reforming than in nonreforming states. Taken together, these results suggest that reforms in law affect physicians' attitudes, both by reducing the probability of an encounter with the liability system and by changing the nature of the experience of being sued, for those physicians who defend against malpractice claims.


Feeding cattle with on-pasture supplementation or feedlot diets can increase animal efficiency and system profitability while minimizing environmental impacts. However, cattle system profit margins are relatively small and nutrient supply accounts for most of the costs. This paper introduces a nonlinear profit-maximizing diet formulation problem for beef cattle based on well-established predictive equations. Nonlinearity in predictive equations for nutrient requirements poses methodological challenges in the application of optimization techniques. In contrast to other widely used diet formulation methods, we develop a mathematical model that guarantees an exact solution for maximum profit diet formulations. Our method can efficiently solve an often-impractical nonlinear problem by solving a finite number of linear problems, that is, linear time complexity is achieved through parametric linear programming. Results show the impacts of choosing different objective functions (minimizing cost, maximizing profit and maximizing profit per daily weight gain) and how this may lead to different optimal solutions. In targeting improved ration formulation on feedlot systems, this paper demonstrates how profitability and nutritional constraints can be met as an important part of a sustainable intensification production strategy.


The Department of Biomedical and Health Information Sciences (BHIS) offers course work leading to an online Master of Science in Health Informatics (MSHI). Health Informatics is the science of healthcare-related information, encompassing clinical care and clinical, financial, IT, and enterprise management. A concentration in Health Data Science is available for students pursuing the MSHI who desire additional competencies in health data analytics and data science. BHIS participates in a joint degree program with the College of Pharmacy titled Doctor of Pharmacy/MS In Health Informatics. An online postmaster's IBHE-Approved Certificate in Health Informatics is available for healthcare and IT professionals who already have a master's degree. BHIS also offers the MS in Biomedical Visualization, as well as an online postbaccalaureate certificate in Health Information Management (HIM), and an on-campus and online undergraduate bachelor's degree in HIM.


We have used the NEXTMap Britain digital terrain model (DTM) to determine the lithospheric response to erosional unloading and the contribution of tectonics, in the form of elastic plate flexure, to the Cotswold 'scarp and vale' landscape. The calculations take into account lithology variations and along-strike changes in escarpment retreat. We show that flexural rock uplift as a result of erosional unloading varies spatially and may contribute up to 50% of the relief in the Cotswold region. This is supported by morphometric analysis, of concavity and steepness, for 66 longitudinal river profiles that drain the scarp and dip slope of the escarpment. Viscoelastic plate models suggest that the uplift is initially rapid (up to 8 m ka−1) and essentially complete within 50 ka. These initial rates are compatible with an early post-Anglian incision rate inferred from the Thames terraces. The 'staircase' terrace pattern suggests, however, that there have been a number of denudational isostatic events, each associated with a climate cycle. Finally, the analysis reveals an inherited 'proto-landscape' that has a subdued relief when compared with the modern DTM. Such a relief is consistent with an early extension of the River Thames, through the Vale of Moreton, to the north of the present-day Cotswold Hills.


Adaptation of service compositions is considered a major research challenge for service-based systems. In this paper we describe a proactive approach to support adaptation of service compositions triggered by different types of problems. The approach allows for changes in the composition workflow by replacing a service operation, or a group of operations, by another service operation or a group of dynamically composed operations. The adaptation process is supported by the use of QoS prediction techniques, analysis of dependencies between service operations, and use of groups of service operations in a composition flow instead of isolated operations. A prototype tool has been implemented to illustrate and evaluate the framework. We also present results of experiments that we have conducted to evaluate the work.


H 2 S corrosion of mild steel is a recurrent issue in the oil and gas industry. Many studies related to the corrosion and hydrogen permeation of steel in an H 2 S containing environment have been made during the past decades with the intent of improving the knowledge and the prevention of economic loss. Since H 2 S is also a hydrogen entry promoter, lots of studies are also dedicated to the understanding of H 2 S cracking. Although it is generally accepted to avoid oxygen contamination in such a medium, there is a lack of research concerning its effect on the corrosion and hydrogen charging of steel. In this study, the effect of oxygen on corrosion and hydrogen charging of steels in an H 2 S containing environment is studied using Electrochemical Impedance Spectroscopy (EIS). An equivalent electrical circuit has been built according to SEM observations, literature research and experimental results. Using this equivalent electrical circuit, experimental data was analyzed and the average corrosion rates were deduced and found to be in good agreement with corrosion rates obtained by weight loss measurements. Furthermore, the evolution of fitting parameters (double layer capacity, charge transfer resistance, diffusion impedance, etc.) was found to be in good agreement with the real physical meaning of such parameters in the given conditions. This research contributes to the explanation of the mechanism behind the high corrosion rate observed in an H 2 S environment polluted with traces of oxygen.


Cells of Streptococcus lactis were harvested in the early stationary phase, washed, and resuspended in either skim milk (10% nonfat milk) or buffered distilled water (0.0003 m dipotassium phosphate, pH 7.2). Samples of each suspension were frozen and stored at -20 C for intervals up to 28 days. Colony counts of the frozen culture were made using lactic agar and a "restricted" lactic agar medium (Tryptone reduced to 0.5%) to determine injury and death. Death was determined by the difference in plate counts on lactic agar before and after freezing. Injured cells were determined by the difference in plate counts on the two plating media. Greatest injury of the cells occurred during early stages of frozen storage and decreased with time, and death continuously increased. Injury and death were more pronounced when cells were frozen in water than when frozen in 10% nonfat milk solids. Certain cultures survived better when frozen rapidly, whereas with others survival was greater when freezing was slow. Successive freezing, thawing, and propagation of the culture gradually eliminated cells which showed injury by freezing.


Thermal residual stresses, internal pressure stresses, and acceleration stresses during launch were evaluated and quantified for cryogenic composite fuel tank design. Both failure initiation and progression of graphite/epoxy laminate system (IM7/977-2) [0/90/90/0/0/90]s and graphite/BMI laminate system (IM7/5250-4) [0/90/90/0/0/90]s were investigated using the non-isothermal classical laminate and plate theory (CLPT) and the maximum stress failure criterion. The thermal residual stresses in the transverse direction are the dominant stresses on each ply in the launch stage. After initial ply cracking, through-the-thickness temperature change of a laminate related to fuel leakage as well as a laminate stiffness matrix change was applied to the progressive failure analysis. The fuel leakage-based progressive analysis shows a higher number of initial ply cracking does not necessarily mean a higher chance of matrix cracking in all plies. The graphite/BMI laminate has such an advantage as transverse thermo-mechanical resistance over the graphite/epoxy laminate at an initial exposure to 2538C and 1500 kPa. In terms of complete laminate matrix cracking, however, the graphite/epoxy laminate is more resistant to transferring stresses to other plies than the graphite/BMI laminate.


Campylobacteriosis is one of the most common foodborne diseases worldwide. Two Campylobacter species – C. jejuni and C. coli in poultry and poultry products are considered to be the main source of human campylobacteriosis. Therefore, studying Campylobacter status in poultry flocks is needed to prevent transmission of disease and reduce human risk, health cost, and economic losses. In this study, we adapted and used a Loop-Mediated Isothermal Amplification (LAMP) assay for specific, sensitive, simple and cost-effective rapid detection of C. jejuni and C. coli in the poultry production chain. Amplified LAMP products were detected using a small, low-cost portable commercial blue LED transilluminator and a direct visual detection strategy was demonstrated. By using optimized conditions for amplification a limit of detection (LOD) of 50 CFU/ml was achieved for testing of C. jejuni and C. coli in spiked chicken feces without enrichment. The method took 60–70 min from receiving the samples to the final results (including 30 min for amplification). The optimized LAMP showed a relative accuracy of 98.4%, a specificity of 97.9%, and a sensitivity of 100% in comparison to real-time PCR method. Cohen's kappa index also showed an excellent agreement (0.94) between the two methods. The results showed that the method is specific, sensitive and is suitable to develop for rapid detection of Campylobacter spp. at poultry production.


The task of statistically analysing and understanding high-dimensional financial data sets is one that is increasingly pertinent in an age of burgeoning information. With high frequency measurements and a global investment universe of hundreds of thousands of securities, reducing the dimension of large data sets by projecting them onto a smaller set of dominant underlying factors or components is often a first step. While principal component analysis has been a standard dimension reduction tool for many decades, a theoretically sound measure of the number of components that should be retained has been lacking. Here we show that the effective rank offers a potential model-independent solution to the problem. We demonstrate that the explanatory power of the number of components indicated by the effective rank is remarkably stable for a wide range of global financial market data while the effective rank itself can vary dramatically over time, offering a potential indicator of systemic risk. The results suggest a certain universality to the measure and we provide some theoretical results supporting this view, derive lower bounds for its explanatory power and highlight links to measures of diversification in areas ranging from ecology to quantum mechanics. Our results demonstrate that the time-varying drivers of financial markets do exhibit some persistent structure. We anticipate our results will prompt further investigation of the effective rank in principal component analysis given the latters' wide appeal in diverse fields of research ranging from psychology to atmospheric science. We also hope our results provide some direction to solving related dimensional problems such as in cluster analysis where the longstanding question of how many clusters should be used remains unanswered.


In recent years, we have seen significant steps taken in the development of self-driving cars. Multiple companies are starting to roll out impressive systems that work in a variety of settings. These systems can sometimes give the impression that full self-driving is just around the corner and that we would soon build cars without even a steering wheel. The increase in the level of autonomy and control given to an AI provides an opportunity for new modes of human-vehicle interaction. However, surveys have shown that giving more control to an AI in self-driving cars is accompanied by a degree of uneasiness by passengers. In an attempt to alleviate this issue, recent works have taken a natural language-oriented approach by allowing the passenger to give commands that refer to specific objects in the visual scene. Nevertheless, this is only half the task as the car should also understand the physical destination of the command, which is what we focus on in this paper. We propose an extension in which we annotate the 3D destination that the car needs to reach after executing the given command and evaluate multiple different baselines on predicting this destination location. Additionally, we introduce a model that outperforms the prior works adapted for this particular setting.


Although gypsum is one of synthetic building materials, nowadays it is used as interior coating of walls and ceilings of buildings. Thus, measurement of its radiation shielding properties is vital. The gamma attenuation coefficients of gypsum concretes, produced using different rates of boron, have been measured at gamma energies of 511, 835 and 1275 keV. The measured results have been compared with the results of calculation, which has been done using XCOM computer code. The obtained results have also been compared with the normal type of gypsum concrete, in order to see the effect of boron on the radiation shielding properties.


Despite the growing body of work on the media in Wales, very little exists on the history of commercial television in Wales. This book seeks to address this imbalance by tracing the growth and development of ITV in Wales and assessing its contribution to the life of the nation. ITV has been a powerful force in British broadcasting since its inception in 1955. When commercial television came to Wales for the first time in 1958, it immediately got caught up in with matters of national identity, language and geography. Compared with the BBC, it is a relative newcomer; its growth was slower than that of the BBC and it took until 1962 to complete the network across the UK. Once it had arrived, however, its impact was considerable. The book will provide an historical narrative and critical analysis of independent television (ITV) in Wales from 1958 up until the present day.


Childhood Maltreatment (CM) is an important risk factor for major depressive disorder (MDD). Previous studies using emotional task-state functional magnetic resonance (task-state fMRI) found that altered brain function in prefrontal-limbic regions was the key neuropathological mechanism in adult MDD patients with experience of early-life maltreatment. However, to the best of our knowledge, there is no published study investigating brain function in MDD patients with CM experience using resting-state fMRI (rs-fMRI). In present study, we aimed to detect altered resting-state brain activity in MDD patients with CM experience, and identify significantly activated brain regions, which may provide new insights into the neural mechanism underlying the relationship between MDD and CM experience. The results showed MDD patients with CM experience were associated with increased amplitude of low-frequency fluctuation (ALFF) and altered function connection (FC) in the prefrontal cortex, when compared to MDD patients without CM. Of note, left frontal middle gyrus (LFEG) was found as a specific brain region which differentiates MDD patients with CM from patients without CM. These results suggest that rs-fMRI is a useful method in studying the correlation between MDD and CM experience and altered function of LFEG in resting-state may explain the correlation between MDD and CM experience.


Spatial and temporal distribution of stream macroalgae in streams from southeastern Brazil were assessed for one year. The fluctuations in macroalgal species composition and environmental factors were monitored monthly. The region exhibit a tropical climate, with defined rainy and dry seasons. Nineteen species were found, with a predominance of Chlorophyta (52.7% of the species), followed by Cyanobacteria (26.3%), Ochrophyta and Rhodophyta (10.5% each). Scytonema arcangeli had the highest number of records (63.6%), while Mougeotia capucina occurred in all sampling sites. Community structure had low similarity (20-26%) and the environmental factors showed a weak contribution to the distribution pattern observed. Despite this, the light availability at the stream-bed seems to be a major influence on the macroalgal seasonal dynamics. We suggest that macroalgae communities are predominantly composed of rare species, and this could explain the lack of a clear spatial and temporal variation pattern of these organisms.


Abstract There is a lack of research on the drivers for green cities development in developing countries. This study aims to investigate the key drivers for green cities development in Ghana. To this end, 19 drivers were identified from a comprehensive literature review, and a questionnaire survey was performed with 154 professionals with green cities development experience. In using the exploratory factor analysis and the fuzzy synthetic evaluation, 4 green cities driver criteria were developed viz., health and wellbeing; green attraction and social inclusion; green governance and management; and green environment and materials. Though this study was conducted in Ghana, the lessons could be adapted for promoting green cities development in other countries that share similar characteristics with Ghana. This paper presents the first comprehensive empirical study on the drivers for green cities development in Ghana, contributing to the green cities' development body of knowledge. The findings can help policymakers and practitioners promote widespread green cities development.


Tort and insurance law treat driving as a centrally important activity and treat injuries caused by automobiles as more significant than other injuries. The role of tort and insurance law in privileging injuries from driving, and driving itself, is largely unacknowledged in torts and insurance law scholarship. The Article shows how the negligence regime and automobile insurance regulation together function to actively support driving. They create a most-favored injury status for injuries caused by cars. The interlocking tort liability regime and automobile insurance system create a "choice architecture," to use Cass Sunstein's and Richard Thaler's phrase, that favors and encourages driving. While the hierarchy of injury and encouragement of car use were understandable decades ago, they are unjustifiable today. Given the negative public health, sprawl, environmental, and other consequences of driving, and the importance of insurance to driving, it is time to consider ways that the choice architecture of tort and insurance law could be shifted to discourage driving. Two automobile insurance reforms are ideal candidates: The first is to make the ongoing costs of auto insurance visible to people as they drive, instead of making those costs practically invisible as the current payment structure does. A second way is to encourage usage-based, also known as pay-as-you-drive programs, on a widespread basis. These two steps are likely to reduce the amount of driving, with many positive consequences.


Abstract Molten Salt Fluxes, Polychalcogenide, Polyselenide Na2Ti2Se9 was first discovered in the quaternary system Na/Ti/P/Se, but it can be prepared rationally by dissolving Ti in a Na2Sex flux at 375 °C. The silverish dark red crystals are air-and water-stable. A new method for synthesizing Na4TiSe4 is also reported. Na2Ti2Se9 crystallizes in space group P21, with a = 12.785(4), b = 14.848(4), c = 13.961(4) Å, ß = 94.556(4)°, R1 = 0.0592 and wR2 = 0.1336. The structure is similar to that of KsNaTi6Se27. It contains infinite one dimensional chains which run parallel to the c-axis and contain Ti4+ centers bonded to Se22- and Se2- species. The l/∞[Ti2(Se2)4Se]2- chains pack together in a hexagonal pattern. All of the titanium atoms are surrounded by a pentagonal bipyramid of selenium atoms. The selenium atoms bridge the Ti centers in two different ways. Na2Ti2Se9 is a semiconductor with a band gap, Eg, of ~ 1.02 eV. The Raman spectra are also reported.


With the huge proliferation of sensory applications, the Internet of Things (IoT) is promising connectivity capacity far beyond the conventional computing platforms, with an ultimate goal of connecting all everyday objects. Sensory applications in the marine environment are foreseen to be an integral part of this connected world, forming the Internet of Marine Things (IoMaT). While some efforts that aim to establish network connectivity in such a sparse environment exist, securing these networks is still an unreached goal. This paper introduces a secure Mobile Ad-hoc/Delay Tolerant routing protocol (S-MADNET) for the marine environment over VHF equipment available on the majority of ships. The proposed secure network is designed to use the existing Automatic Identification System (AIS) that ships use for positioning and navigation aid. An IoMaT routing module that forwards marine sensory data using the proposed secure protocol is also presented, taking the AIS system level considerations into account. Furthermore, a new AIS message format with IoMaT support is proposed that accommodates the requirements of the secure routing protocol. Evaluation results show that the proposed S-MADNET routing protocol outperforms its counterparts in terms of packet delivery rates and packet duplication rates, while maintaining data security.


OBJECTIVE
To determine the prevalence and causes of low vision in a large sample of nursing home residents.

METHODS
Twenty-eight nursing homes on the Eastern Shore of Maryland and Delaware were enrolled in a clinical trial to assess the impact of vision restoration/rehabilitation on nursing home residents. Visual acuity was measured using both recognition charts and preferential looking techniques. An ophthalmologist examined all residents with visual acuity worse than 20/40 in the better-seeing eye and determined the primary cause for decreased vision. Results are reported for the better-seeing eye.

RESULTS
Of 2544 eligible residents, 1591 (63%) participated, but 286 residents were unable to respond to visual acuity testing. Of the remaining 1307 residents, 496 (37%) had best-corrected visual acuity worse than 20/40 in the better-seeing eye. Causes were ascribed for 412 subjects. Rates of low vision were similar between African American subjects and white subjects (39% and 38%, respectively; age-adjusted P =.18). Cataract was the leading cause of low vision, responsible for 37% of low vision among white subjects and 54% of low vision among African American subjects. Macular degeneration was responsible for 29% of low vision among white subjects but only 7% among African American subjects. Glaucoma caused low vision in 4% of white subjects and 10% of African American subjects. Refractive error was not a frequent cause of low vision in nursing home residents.

CONCLUSIONS
Low vision is highly prevalent among nursing home residents, with 37% having visual acuity worse than 20/40 in the better-seeing eye. Differences in causes of low vision between African American subjects and white subjects were noted, with African American subjects more likely to have vision loss on the basis of cataract, a readily treated condition. Appropriate interventions for nursing home residents, who face significant obstacles in accessing eye care services, have the potential to improve the quality of life of this at-risk older population.


Livestock farming and meat consumption, especially red meat, both have a severe impact on the Earth's environment and sustainability, causing forest destruction, wildlife extinctions, excessive greenhouse gas emissions, and global climate change. Currently, as a protein source for the world's rapidly expanding middle class populations, increased meat consumption will likely put excessive strain on Earth's well-being, exceeding planetary boundaries of safety. Although God Almighty provided livestock for human benefit, today considerations of protecting the higher objectives (maqasid) of Islamic shariah, the fiqh principle (qawa'id) of reducing harm, and also promoting social equity and physical health, require Muslims to reduce meat consumption and live more simply, like the Prophet (pbuh) and his Companions, who were 'semivegetarians'.
The review of animal sacrifice in Islam, particularly during the annual Eid ul-'adha celebration, confirms that Islam strongly promotes these practices. However, the alternative to sacrificing (fasting for Tamattu' and Qiran pilgrims) should be availed upon wherever possible, not just during Eid ul-'adha. Mujtahids should investigate in which situations, such as following large-scale human calamities or cases of severe environmental harm, Islam may permit the giving of sadaqah or other aid instead of the traditional sacrifice.


Available research is reviewed on the interactions of application variables, herbicides, and species. Objectives of this review are to gain insights into why variation occurs with herbicide performance, how current knowledge might be applied to enhance efficacy and consistency, and research pathways that should foster integration of applicationefikacy models. A historical context is provided on southeastern forestry herbicide applications. Adoptable application technology from agronomy and right-of-way sectors are explored. To enhance consistency and performance, increased rates and optimized timing hold most promise. Optimizing droplet size spectrums and new surfactants also have potential. Multidimensional efficacy functions are needed for the commonly abundant species and often-used tank mixes by rate and timing. Integratable research is the key to advancement.


Making use of deficiencies, inversions and translocations, we have genetically dissected the region 95E to 96F of Drosophila melanogaster. We localized cytologically the loci abnormal spindle (asp: 3-85.2: 96A20-25;96B1-10) and M(3)96C2 (96C1;96C5). We have also found several new phenotypes associated with lesions in the 95E to 97B region: (1) Minute(3)96A (M(3)96A) is a haplo-insufficient phenotype of thin and short bristles presented by individuals deficient for the region 95E6-8;96A1-5. (2) abdominal-one reduced (aor) shows two different phenotypes associated with the distal breakpoint of In(3R)Ubx7L (89E;96A1-7). One is the increase of the Ubx phenotype, but its effect requires the presence of lesions in Ubx. The other phenotype is a drastic reduction or disappearance of the first abdominal segment. Both phenotypes might be due to lesions in the same gene. (3) metaphase arrest (mar) is associated with the breakpoint of the T(Y;3)B197 (96B1-10) and produces a phenotype typical of mitotic mutants with arrest of the cell cycle during prometaphase or metaphase. There is another region localized in 97B which interacts with asp: in a background homozygous for asp, three doses of this region enhance the asp phenotype.


To thrive and stay relevant to the needs of society, botanic gardens need to be able to adapt and change. This is especially the case now that there is such an urgent need to explain the changing world to visitors. There is also a need to accept that their collections and gardens are difficult to change due to their inherent limitations and historical context. This paper seeks to address this issue by providing an overview of one of Europe's oldest botanic gardens, de Hortus Botanicus Amsterdam, as one which has developed a collection policy to provide greater flexibility to shape the organisation while retaining the spirit of place or genius loci. The paper provides a framework to help reconsider the context and content of collection themes and to provide a sustainable basis that best meets the needs of the current organisation. This framework also provides a flexible approach to planning collections in the future.


It is refreshing to read a generally positive and optimistic editorial about borderline personality disorder and its long-term prognosis (Fonagy & Bateman, 2006). It is also reassuring to find the authors speculating about an issue long recognised by users of personality disorder services, that is, the 'reality of iatrogenic harm'. We feel, however, that there is a worrying element to this piece: the almost casual assertion that 'in any case, in the vast majority of cases, borderline personality disorder naturally resolves within 6 years'. We question the validity of this rather astounding statement. One of the studies quoted by the authors as evidence of this (Zanarini et al, 2003) was a naturalistic study that assessed people at four time points (baseline and 2, 4 and 6 years) and did not document what therapy or treatment people received between assessments. It did not suggest, or even try to suggest, that borderline personality disorder 'naturally resolves' within 6 years. Fonagy & Bateman also seem to imply that borderline personality disorder exists as an easily definable, distinct personality disorder, which the authors will know is very rarely, if ever, the case. People with borderline personality disorder often have other personality disorders and Axis I illnesses, as well as related alcohol and drug misuse. The idea that such complex needs will somehow spontaneously remit in 6 years is untenable. What is particularly disturbing about this assertion is its potential political impact and the impact it may have on policy makers, coming as it does from two of the leading authorities on borderline personality disorder within the UK; indeed, from two experts who are closely involved with the development and assessment of new services for personality disorder that are currently being piloted by the Department of Health. Such a statement could be seized by a Whitehall policy advisor and taken as a perfectly adequate reason why services for people with borderline personality disorder do not need to be provided by the National Health Service, as for the vast majority of these people the problems will 'naturally resolve' within 6 years. It is extremely disappointing that two such highly regarded experts in this field should perpetuate such a flagrant and dangerous simplification through the pages of this eminent Journal.


The primary focus of pain research in intellectually disabled individuals is still on pain assessment. Several observational pain assessment scales are available, each with its own characteristics, its own target group and its own validated use. Observational studies report differences in the treatment of intra- and postoperative pain of intellectually disabled children and almost all children with intellectual disability have comorbidities that need to be addressed. The scope of research has started to broaden. In this review we aim to answer the question: Can we integrate validated ways of pain assessment and postoperative pain treatment in intellectually disabled children to develop specific analgesic algorithms? Regrettably there is little knowledge on possible interaction effects and other relevant pharmacological issues. Possible genotype-phenotype associations related to pain in children with Down syndrome have several promises as six possible candidate genes are located on chromosome 21. In conclusion, the pain assessment tools for intellectually disabled children are there. We should now focus on tailoring the pain treatment. To this aim we need to perform pharmacokinetic and pharmacodynamic studies of analgesics and obtain information about the genotype-phenotype relationships for pain. This can lead to the development of specific analgesic algorithms.


The effects of i.v. human atrial natriuretic factor (alpha-hANF [99-126]) was investigated in 5 conscious calves (age 4 months, weight 94 +/- 14kg) with constant fluid (300 ml/h) and sodium intake over a period of 24 hours before and during the 3 hours of experimentation. We administered 200 micrograms, 400 micrograms and 800 micrograms ANF at hourly intervals. Immediately (+2 min) after the i.v. injection the peptide's serum-concentration rose from, basal 13 +/- 3 to 802 +/- 191 (200 micrograms), 1707 +/- 419 (400 micrograms) and 3483 +/- 878 pmol/l (800 micrograms) (p < 0.0001), respectively. Mean arterial pressure decreased from, basal, 108 +/- 18 to 85 +/- 17, 76 +/- 16 and 69 +/- 18 mmHg (p < 0.0001), and central venous pressure decreased from, basal, 5.1 +/- 3 to 1.2 +/- 1, 0.4 +/- 1 and 0.8 +/- 2 mmHg (p < 0.001). Heart rate increased from, basal, 66 +/- 5 to 84 +/- 23, 111 +/- 29 and 114 +/- 13 b/min (p < 0.001). Following the administration of ANF the urine volume decreased from, basal, 261 +/- 145 to 195 +/- 72, 121 +/- 41 and 102 +/- 33 ml/h (p < 0.0041). The urinary sodium excretion rates decreased from, basal, 50 +/- 17 to 30 +/- 13, 22 +/- 10 and 19 +/- 10 mmol/h (p < 0.007), and the potassium excretion rates decreased from, basal, 43 +/- 19 to 39 +/- 16, 26 +/- 11 and 23 +/- 10 mmol/h (p < 0.0047). Endogenous clearance of creatinine (basal: 182 +/- 30 ml/min) did not change (260 +/- 84, 218 +/- 66 and 224 +/- 76 ml/h) following i.v. ANF. Inspite of this marked fluid retention, the hematocrit, expressed as relative change, was increased by 7.5%, 11.8% and 10.4%. In 2 calves we additionally measured an increased whole blood and plasma density possibly indicating increased liquid permeation to an extravascular compartment. Thus, in calves the hemodynamic effects of ANF are comparable to those seen in man. However, the failure of ANF to stimulate diuresis and natriuresis indicates a dissociation of hemodynamic and renal effects of ANF in calves.


Cultural references in source texts are recognized as probably the most troublesome elements of atranslation, raising not only the question of the proper selection of a particular lexical unit but alsothe issue of the cultural competence. Many researchers, linguists, and scientists deal with definition,recognition, classification and translation matters of culture-specific items, yet the consensuscannot be reached. Different definitions, interpretations, and even classifications, which strongly relyupon similar criteria, are offered. Therefore, the analysis of translation strategies used to render culture-specific items in popular science literature are very important and relevant to the overall analysisof cultural realia. Aiming to research translation strategies of CSI in the genre of popular science,Martin Lindstrom's book Brand Sense: build powerful brands through touch, taste, smell, sight, andsound" (2005) and its Lithuanian translation Prekės ženklo jausmas, accomplished by Lina Krutulytė,was chosen. The analysis presented in this article is restricted to the group of common expressionsdenoting CSI, as translation of proper nouns follow the recommendations provided by the LithuanianLanguage State Commission and were found to be less problematic as compared to the group ofcommon expressions. For the analysis of translation strategies used to render culture-specific items,categorization of Davies (2003) was followed. To accomplish the research goals, descriptive, comparativeand quantitative analysis was employed. The obtained results indicate that prevailing translationstrategies used to render common expressions in the popular science book by Martin LindstromBrand Sense were literal translation, localization, preservation, and addition. No examples of omission or creation were observed. The analysis has revealed that the usage of translation strategies wasinconsistent – homogenous and semantically similar CSI were rendered differently, using differenttranslation strategies, thus the target text lacks cohesion and logical approach. DOI: http://dx.doi.org/10.5755/j01.sal.0.29.15129


The  South China Sea is divided into two parts; the northern South China Sea (nSCS) and the southern South China Sea (sSCS), where the nSCS  includes Taiwan, Hong Kong and the Republic of China.  The sSCS region consists of Malaysia, Thailand, Singapore, Brunei, Indonesia, Cambodia, Vietnam and the Philippines. The South China Sea  is a semi-closed system and  is largely influenced by  the western Pacific region especially during monsoon seasons.  By late 2020 countries such as Thailand, Malaysia and Indonesia intend to operate nuclear reactors as an alternative energy source. Some radionuclide produced during their  operation will enter themarine ecosystem through the water cooling process. This will affect most neighboring coastal waters as transboundary pollution. A recent investigation on seafood conducted before the Fukushima, Japan tsunami event by The Hong Kong Observatory clearly shows that artificial radionuclides such as plutonium-239, tritium, strontium-90, carbon-14, iodine-131, cesium-137 and potassium-40 were found at positive concentration levels.  There were no significant differences in Cs-137 activities both in surface and bottom water samples atthe 95% confidence level. The activity of Cs-137 was found to be in the range of 1.47 to 3.36 Bq/m3and 1.69 to 3.32 Bq/m3for both Sabah and Sarawak, respectively.


An adaptive comb filtering method, which was initially investigated by Frazier et al. [5] for the enhancement of degraded speech due to additive noise, is applied for estimating vocal noise generated at the glottis due to pathological changes of the vocal folds. In applying the method, special emphasis is placed on the accurate determination of pitch period durations. The amount of estimated vocal noise is quantified by a novel acoustic measure, normalized noise energy(NNE). Experiments with vowel samples spoken by 64 normal control subjects and 50 patients with glottic cancer have shown that the NNE is useful for the distinction between normal and pathological voice status.


This article uses repeated cross-sectional data for the years 1986 to 1998 to examine how the median and spread in the distribution of wages among workers of different age and gender were affected by the economic growth and contraction in output during this period. It finds that it is mainly the younger cohorts of male and female workers that have reaped the benefits of the growing employment and wages in the formal sector. The growing wage sector has been absorbing many of the young entrants into the labour market but more male workers than female workers. The increases in the median wages of these younger cohorts have been accompanied by a rise in the inequality of earnings. The level as well as the increase in dispersion is also higher for females of younger cohorts than male cohorts. The declines in real wages since the 1997 crisis have been relatively evenly distributed among male and female workers and across different age cohorts, while the impact of the crisis on wage inequality has been mixed.


Thunderstorm formation depends on environmental stability and the existence of electrification mechanisms. Because electrification mechanisms such as the ice-graupel collision process, described with the Relative Diffusional Growth Rate Theory, depends on convection for charge separation, and convection relates to Convective Available Potential Energy (CAPE), the relationship between CAPE and lightning is determined. A Spearman Rank Correlation revealed a small positive correlation between lightning and CAPE, and corresponding p-values indicate this correlation is significant. The evaluation of the relationship between CAPE and lightning lends meaningful insight into thunderstorm formation and electrification, providing an understanding that can enhance severe weather forecasting products.


The call for the growth of successful entrepreneurial activities across the globe raised the need to determine the influencing factors affecting micro-entrepreneurial growth. Hence, this study adopted a cross-sectional survey design to examine determinants of micro-entrepreneurial growth among micro-entrepreneurs. Two hundred and eighty-two micro-entrepreneurs were sampled through snowball and convenience techniques. The findings showed that stepwise multiple regression analysis identified four models in the prediction of micro-entrepreneurial growth. Specifically, operational challenge (β = -.35, p < .001), lack of support, β = -.17, p < .001), workforce challenge (β = .22, p < .001), and personal factors (β = -.21, p < .01) are significant predictors of micro-entrepreneurial growth. The findings were discussed in line with the literature while recommendations in terms of decision-making applications, and provision of developmental programs in assisting rural entrepreneurship for enhancement of growth were suggested.


Au nanoparticles(NPs) mixed with a majority of bone-like, rod, and cube shapes and a minority of irregular spheres, which can generate a wide absorption spectrum of 400 nm–1000 nm and three localized surface plasmon resonance peaks, respectively, at 525, 575, and 775 nm, are introduced into the hole extraction layer poly(3,4-ethylenedioxythiophene):poly(4-styrenesulfonate)(PEDOT:PSS) to improve optical-to-electrical conversion performances in polymer photovoltaic cells. With the doping concentration of Au NPs optimized, the cell performance is significantly improved: the short-circuit current density and power conversion efficiency of the poly(3-hexylthiophene): [6,6]-phenylC60-butyric acid methyl ester cell are increased by 20.54% and 21.2%, reaching 11.15 m A·cm-2and 4.23%. The variations of optical, electrical, and morphology with the incorporation of Au NPs in the cells are analyzed in detail, and our results demonstrate that the cell performance improvement can be attributed to a synergistic reaction, including: 1) both the localized surface plasmon resonance- and scattering-induced absorption enhancement of the active layer, 2) Au doping-induced hole transport/extraction ability enhancement, and 3) large interface roughness-induced efficient exciton dissociation and hole collection.


Plant cells need to monitor the cell wall dynamic to control the wall homeostasis required for a myriad of processes in plants, but the mechanisms underpinning cell wall sensing and signaling in regulating these processes remain largely elusive. Here, we demonstrate that receptor-like kinase FERONIA senses the cell wall pectin polymer to directly activate the ROP6 GTPase signaling pathway that regulates the formation of the cell shape in the Arabidopsis leaf epidermis. The extracellular malectin domain of FER directly interacts with de-methylesterified pectin in vivo and in vitro. Both loss-of-FER mutations and defects in the pectin biosynthesis and de-methylesterification caused changes in pavement cell shape and ROP6 signaling. FER is required for the activation of ROP6 by de-methylesterified pectin, and physically and genetically interacts with the ROP6 activator, RopGEF14. Thus, our findings elucidate a cell wall sensing and signaling mechanism that connects the cell wall to cellular morphogenesis via the cell surface receptor FER.


A major stumbling block for widespread incorporation of simulators into EMT training includes the limited availability of curricula infrastructure linking the key components of skills, scenarios, and measures as well as the expertise required to run such programs. To meet these needs we are developing a training program for first responders that uses mannequin-based simulator technology effectively to fill the identified training need for valid meaningful scenarios that can be integrated into the curriculum and are applicable for a variety of EMT skill levels. The program will provide detailed scenarios, instructions for administering the program, and measures for performance feedback. Each scenario will exercise a combination of task work and cognitive skills and the set of scenarios will span all of the higher-level skills that have been identified as benefiting from targeted training.


Introduction : Recent research has highlighted the need to improve communication with mechanically ventilated patients. There are a number of studies currently evaluating the usefulness of augmentative and alternativen communication methods (AACs), but a significant gap still exists in understanding patients' key needs during the ventilation period. Aims : 1) To determine the perceptions of patients and healthcare staff on the use of AACs. 2) To find out patients' key needs during ventilator treatment, within the context of Ward 118 in the Royal Infirmary of Edinburgh. 3) To use the results of this study to propose larger scale research into adapting a specific electronic device (Predictable) to aid communication. Methods : This qualitative study adopted semi-structured interviews lasting 10–20 minutes with 13 patients and 18 members of healthcare staff and applied thematic analysis in interpreting interview findings. Results : There was a mismatch between patient and staff perceptions on the usefulness of closed yes/no questions and lip reading. Aided AACs, such as picture boards, pen and paper, and sketch boards are also underused. Most patients and staff used a combination of methods rather than any one method alone. This study also found that patients' key needs include addressing discomfort related to the ventilator, bed or breathing, emotional needs, trust building with healthcare staff and the need for more information. Conclusion : This study highlights the need for personalized, patient-centred care to facilitate effective communication with ventilated patients.