textabstractThis thesis focuses on two issues: 1) the clinical value of gastric exercise tonometry (GET), and
2) the development of reliable prolonged tonometry, including postprandial measurement,
and its potential in patients suspected of gastrointestinal ischemia.

Including GET in the analysis of patients with solitary celiac artery stenosis had major
clinical impact. The GET results enabled us to distinguish between patients with and without
gastric ischemia. The clinical improvement after vascular treatment in ischemic patients was
sustained for up to 4 years, and compares favorably to earlier reports. These results put the
single vessel splanchnic syndrome on the map as a clinical entity.

The ability of GET to separate ischemic form non-ischemic patients proved beneficial in the
large cohort of patients with both single-and multi-vessel splanchnic stenoses as well. Similar to the single-vessel patients, GET identified patients with gastrointestinal ischemia, subsequent treatment resulted in good results on mid-term follow-up. The single-and multi-vessel
patients differed significantly in patient characteristics, clinical presentation, morbidity and
mortality (before and after treatment). This leads to the notion that the chronic splanchnic
syndrome (CSS) has to be divided into two different entities, with different diagnostic and
therapeutic approach, urgency, and goals of treatment.

Prolonged tonometry, including postprandial measurements, proved feasible in healthy subjects when in vitro tested standard meals were taken and high dose acid suppression was
administered. From this study 'normal' values were obtained. Using these normal values in
a cohort of patients, the accuracy for ischemia detection of prolonged tonometry showed
acceptable results. Careful and prospective studies are clearly needed to confirm these first
results before prolonged tonometry can be advocated in patients suspected for CSS.


Cinema and opera have become intertwined in a variety of powerful and unusual ways. Vocal Apparitions tells the story of this fascinating intersection, interprets how it occurred, and explores what happens when opera is projected onto the medium of film. Michal Grover-Friedlander finds striking affinities between film and opera--from Lon Chaney's classic silent film, The Phantom of the Opera, to the Marx Brothers' A Night at the Opera to Fellini's E la nave va. One of the guiding questions of this book is what occurs when what is aesthetically essential about one medium is transposed into the aesthetic field of the other. For example, Grover-Friedlander's comparison of an opera by Poulenc and a Rossellini film, both based on Cocteau's play The Human Voice, shows the relation of the vocal and the visual to be surprisingly affected by the choice of the medium. Her analysis of the Marx Brothers' A Night at the Opera demonstrates how, as a response to opera's infatuation with death, cinema comically acts out a correction of opera's fate. Grover-Friedlander argues that filmed operas such as Zeffirelli's Otello and Friedrich's Falstaff show the impossibility of a direct transformation of the operatic into the cinematic. Paradoxically, cinema at times can be more operatic than opera itself, thus capturing something essential that escapes opera's self-understanding. A remarkable look at how cinema has been haunted--and transformed--by opera, Vocal Apparitions reveals something original and important about each medium.


A new slip-line field model and its associated hodograph of rounded-edge cutting tool were developed for orthogonal micro-cutting operation using matrix technique. The new model considers the existence of dead metal zone in front of the rounded-edge cutting tool. The ploughing forces, chip up-curl radii, chip thicknesses, primary shear zone thicknesses and lengths of bottom side of the dead metal zone are obtained by solving the model depending on the experimental resultant force data. The effects of cutting edge radius, uncut chip thickness, cutting speed and rake angle on these outputs are specified.


Water purity was assessed at the site of a deep oil seepage near Cape Gorevoy Utes (Central Baikal). Polycyclic aromatic hydrocarbons (PAHs) and n-alkanes were determined in different types of oil-containing samples collected at this section of Lake Baikal. The set of studied samples included: (i) samples of water from the surface water layer; (ii) samples of water from different depths; (iii) oil on the water surface; (iv) oil from a sediment core. In the surface water layer and the water column, the total concentration of n-alkanes ranged from 0.2 to 5.3 µg/L and did not exceed the 0.1 maximum permissible concentration (MPCfish = 50 µg/L) established for hydrocarbons in water bodies of fishery importance. PAHs with carcinogenic properties were less than 0.1 ng/L. The total concentration of PAHs found in the water column did not exceed 110 ng/L; toxic equivalent (TEQ) values ranged from 0.001 to 0.110 ng/L. The distribution of petroleum hydrocarbons from the seepage site was limited, and water pollution was localised. The low level of water pollution is associated with natural mechanisms in the Baikal ecosystem. Microbiological community and phytoplankton make a decisive contribution to the purity of Baikal water, and oil fractionation during deep discharge contributes to the bioavailability of petroleum hydrocarbons.


This study examines the determinants of firm profitability for 114 firms listed on the Nigerian Stock Exchange (NSE) from 1998 to 2012, using the system Generalized Method of Moments (GMM). The results show that lagged profitability exerts significant positive effect on contemporaneous firm profitability. However, short-term leverage, inflation rate, interest rate and financial risk have significant negative effects on firm profitability. The study therefore suggests, among other recommendations, that the cost of borrowing to the real sector of the economy should be reduced in order to minimize costs of production, enhance productivity and profitability while necessary macroeconomic policies should be put in place by the government to curb inflationary pressure in the economy.

JEL Classification: B21, C23, L25


We study the correlations between timing and X-ray spectral properties in the low-mass X-ray binary 4U 0614+09 using a large (265 ks) data set obtained with the Rossi X-Ray Timing Explorer. We find strong quasi-periodic oscillations (QPOs) of the X-ray flux, like the kilohertz QPOs in many other X-ray binaries with accreting neutron stars, with frequencies ranging from 1329 Hz down to 418 Hz and perhaps as low as 153 Hz. We report the highest frequency QPO yet from any low-mass X-ray binary at 1329 ± 4 Hz, which has implications for neutron star structure. This QPO has a 3.5 σ single-trial significance; for an estimated 40 trials the significance is 2.4 σ. Besides the kilohertz QPOs, the Fourier power spectra show four additional components: high-frequency noise (HFN), described by a broken power law with a break frequency between 0.7 and 45 Hz, very low frequency noise (VLFN), which is fitted as a power law below 1 Hz, and two broad Lorentzians with centroid frequencies varying from 6 to 38 Hz and from 97 to 158 Hz, respectively. We find strong correlations between the frequencies of the kilohertz QPOs, the frequency of the 6-38 Hz broad Lorentzian, the break frequency of the HFN, the strength of both the HFN and the VLFN, and the position of the source in the hard X-ray color versus intensity diagram. The frequency of the 97-158 Hz Lorentzian does not correlate with these parameters. We also find that the relation between power density and break frequency of the HFN is similar to that established for black hole candidates in the low state. We suggest that the changing mass accretion rate is responsible for the correlated changes in all these parameters.


The findings of a literature review of topics related to the anchorage of headed reinforcement are presented. The topics are grouped in three broad categories: conventional anchorage of reinforcement, anchorage of headed reinforcement, and a review of strut-and-tie modeling (STM). The review of conventional anchorage focuses on the mechanics of bond and code provisions for development length. A review of hooked bar anchorage is also included. The review of headed reinforcement includes historical background, a survey of commercially available products, a summary of the published research on headed reinforcement and related topics such as deeply embedded anchor bolts and the bearing capacity of rigid plates, and a review of pertinent code provisions. The review of STM includes an historical background, an overview of the STM design process, a review of code provisions, and a summary of selected research.


The purpose of these experiments was to employ video microscopy to identify early pathological changes after orthotopic liver transplantation in the rat. Liver transplantation was performed using the cuff technique. Survival was greater than 90% when livers were stored for 1 hr in Ringer's solution prior to transplantation (survival conditions), whereas all rats died following storage of grafts for 4 hr in cold Euro-Collins solution (nonsur-vival conditions). Postoperatively, each recipient animal was anesthetized, the abdomen was opened, and the liver was placed on the stage of an inverted fluorescence microscope equipped with a low-light ISIT video camera. Precautions were taken to prevent the liver surface from drying. The fluorescent dyes fluorescein sodium (1.0 μmol/kg), acridine orange (2.5 μmol/kg), and propidium iodide (1 μmol/kg) were injected intravenously to label hepatocytes, polymorphonuclear leukocytes, and the nuclei of irreversibly damaged cells, respectively. In livers from untransplanted rats, movement of labeled leukocytes through the hepatic sinusoids was smooth and rapid (velocity, 500–550 μn/sec) and margination (adhesion) of cells was minimal (less than 1%). After transplantation, however, velocity was diminished 2–3-fold, and margination was increased to 10% of leukocytes in survival groups and to 40% in nonsurvival groups 4 hr postoperatively. In the nonsurvival groups, irreversible cell death detected by propidium iodide fluorescence was minimal 15 min after transplantation—however, massive cell damage was detected 4 hr postoperatively. In addition, serum transaminases and necrosis were higher at 4 hr than 15 min postoperatively. Taken together, these data demonstrate that leukocyte margination increases following orthotopic liver transplantation and is followed rapidly by cell death. These events likely play a role in the mechanism of early graft failure following transplantation.


The isoscaling behavior in the reaction system of 58,64Ni + 9Be has been studied by using the heavy-ion phase-space exploration(HIPSE) model. The extracted isoscaling parameters α and β for both heavy and light fragments for HIPSE model calculations are in good agreement with recent experimental data. The investigation shows that the parameters in the HIPSE model have some effect on the isoscaling parameter. The isoscaling parameters for hot and cold fragments have been extracted.


© Elizabeth Holt and Rebecca Clift 2007 and Cambridge University Press, 2009. Research on so-called 'direct reported speech' (henceforth simply 'reported speech') in interaction has hitherto overwhelmingly focused on the most common context for its occurrence, namely story-telling, whether in mundane talk (see, inter alia, the collection in Lucy, 1993 andHolt, 1996, 2000) or in various institutional contexts (e.g. Buttny, 1997; Holt, 1999; Clayman, this volume; Galatolo, this volume; Rae and Kerby, this volume; and Wooffitt, this volume). There are occasions in mundane talk, however, in which reported speech is not used in the service of a more extended story but, as in the following, is deployed fleetingly by a speaker in the course of an exchange with another (arrowed) (see also Couper-Kuhlen, this volume): [Rahman:B:2:JV(14):4] In (1), Jenny and Vera have been talking about Vera's son Bill, his wife Jean, and their children. Vera's report of what she said to Jean at line 7, and its response from Bill, neither launches an extended story-telling, nor forms an element of an ongoing story. It is offered as a response to an assessment from Jenny, 'All they need now is a little girl to complete it', and in turn gets laughter from her, endorsed by Vera's own laughter at line 10. Jenny's jocular inquiry at lines 11–12 subsequently provides a wry commentary on what Vera has reported.


The reactivity of protein bound iron-sulfur clusters with nitric oxide (NO) is well documented, but little is known about the actual mechanism of cluster nitrosylation. Here, we report studies of members of the Wbl family of [4Fe-4S] containing proteins, which play key roles in regulating developmental processes in actinomycetes, including Streptomyces and Mycobacteria, and have been shown to be NO responsive. Streptomyces coelicolor WhiD and Mycobacterium tuberculosis WhiB1 react extremely rapidly with NO in a multiphasic reaction involving, remarkably, 8 NO molecules per [4Fe-4S] cluster. The reaction is 10(4)-fold faster than that observed with O(2) and is by far the most rapid iron-sulfur cluster nitrosylation reaction reported to date. An overall stoichiometry of [Fe(4)S(4)(Cys)(4)](2-) + 8NO → 2[Fe(I)(2)(NO)(4)(Cys)(2)](0) + S(2-) + 3S(0) has been established by determination of the sulfur products and their oxidation states. Kinetic analysis leads to a four-step mechanism that accounts for the observed NO dependence. DFT calculations suggest the possibility that the nitrosylation product is a novel cluster [Fe(I)(4)(NO)(8)(Cys)(4)](0) derived by dimerization of a pair of Roussin's red ester (RRE) complexes.


In this study, several aspects of Saxion spin-offs have been analysed, the numbers, workplaces, location, migration, gender issues, different economic sectors and survival rates. The main question underlying all these analyses was what the impact of Saxion as university of applied sciences is on the regional economy of the two regions in which it is located. From the literature, the concept of an entrepreneurial ecosystem, as explanatory factor for the observations that in certain regions more graduates or staff members start their own business and that such an ecosystem helps small fledgling businesses to survive and grow is an interesting concept. Unfortunately, the theoretical foundations are still not fully crystallized, therefore measuring the actual influence of such entrepreneurial ecosystems is still a difficult exercise. In this study, Saxion spin-offs from two regions, Twente and the Cleantech Region, have been analysed, and several differences in terms of number of spin-offs, employment, migration patterns and survival rates have been identified. Since the spin-offs are from the same university of applied sciences, with the same policy regarding support of entrepreneurship and both regions are located outside of the economic core regions of the country, it appears as if the strength of the regional context, the regional entrepreneurial ecosystem and the business opportunities it provides is a factor in explaining why there are more spin-offs in Twente (even when controlling for the larger size of the Saxion campus in this region). If one assumes that the strength of the entrepreneurial ecosystem is stronger in Twente (among others because of existing business networks, the availability of a world class research university, the University of Twente and a business support organization like Novel-T), it would explain why spin-offs located in this region on average offer more workplaces, and have a higher survival rate than in the Cleantech Region. Gender differences related to entrepreneurship are present in Saxion spin-offs, female graduates and staff members are much less likely to start a spin-off company than their male counterparts. When females do start, their spin-offs are on average much smaller in terms of workplaces offered. Their businesses have on average an equal survival rate than those started by a male entrepreneur. Findings from the literature on the subject and the numbers found in this study suggest that there is a need for specific programs in Saxion targeting females, to at least think about starting their own business. Also, specific mentoring programs for spin-offs with female entrepreneurs may help to let these businesses grow and increase their regional economic impact. Saxion spin-offs can be found in many different sectors, something understandable given the broad spectrum of study programs in Saxion. Even though most spin-offs remain micro sized businesses, certain economic sectors seem to offer better scalable business models, especially in sectors such as industry, information and communication technology businesses and business support services. The number as well as employment in the more innovative and internationally competitive topsectors is much higher in the region Twente than in the Cleantech Region, possibly another consequence of the – apparently – stronger regional entrepreneurial ecosystem in Twente. An often-stated argument for regional economic development is that investing in spin-off companies will help to create workplaces in the region, since companies are not very likely to move. In this study, the data on migration of spin-offs have been compared with the migration of graduates, based on the HBO-monitor survey. It is not possible to one-on-one compare the two datasets, as the migration of spin-offs is calculated for the first five years of their existence and the HBO-monitor is held around one and a half year after graduation. Still, w


The triacylglycerol/sterol condition index was applied to larval lobster populations in the vicinity of Georges Bank in the Gulf of Maine, This index is related to larval size by an increasing power function which explains around 40 % of the variation. The poor fit can be explained by the uneven increase in triacylglycerol levels during development within each moult stage. Increased pigmentation is not related to larval condition, as measured by lipid storage, and masks the increased yellowish hue of lipids as development proceeds. The larval triacylglycerol/sterol index appears to undergo a diurnal cycle in Stage III and [V lobsters, with lowest values at midday and highest values after dark. This pattern cannot be explained by nocturnal feeding, which leaves the possibilities that satiated larvae descend below the surface metre during daylight and are therefore underrepresented in our collections by being more vertically diffuse, and/or that healthy well-fed larvae would be more likely to detect the trawl and escape during daylight. Few Stage I and II lobster larvae were found in the vicinity of Georges Bank with a condition index less than 0.1, which is the level laboratory studies indicate approaches the 'point-of-no-return'. The condition of all developmental stages was found to be better in individuals located off Georges Bank. This is not ecologically significant in the case of the first 2 stages because such a small proportion of the population was actually located off the bank. It is not resolved how the third and fourth stages arrive off Georges Bank, since shoal water hatching is the norm, but their lipid reserves are significantly greater than identical developmental stages located on the bank. Finally, the density of Stage IV larvae in the adjacent surface waters over the Gulf of Maine is twice that found over Georges Bank. This suggests that the lobster has evolved a life cycle in offshore waters in which larvae are hatched in shoal waters over the banks but the last 2 planktonic/pelagic stages either seek or are transported to, and by Stage IV thrive in, the warmer stratified layer over the deeper waters of the Gulf of Maine.


This thesis examines the treatment of fidelity rebates as one of the most
controversial topics in EU competition law. The controversy arose from the lack of
clarity as to how to distinguish between rebates that constitute a legitimate business
practice and those that might have anti-competitive effects, as the same type of rebates
could be pro-competitive or anti-competitive depending on their effects on competition.
Regardless of their ambiguous effect, the EU Courts deemed fidelity rebates as an
unlawful abuse of a dominant position. Many have questioned the strict approach
adopted by the EU Court over the years. As a reaction, the European Commission
undertook a modernisation of the EU competition law regime, pressing for the adoption
of an 'effects-based' approach based on careful examination of a company's behaviour
and an application of an 'as efficient competitor' (AEC) test in order to distinguish
between anti-competitive conduct and legitimate competition. In recent years, the
application of the AEC test in relation to the anti-competitive effects of fidelity rebates
has been raised as a central issue in the Intel and the Post Danmark II judgements. Both
judgements failed to clarify whether the test should be a part of the legal standard and
highlighted the uncertain doctrine in this area, leading to a renewed debate on the
appropriate legal standard to distinguish lawful from exclusionary fidelity rebates. To
that extent, the case law of the EU Courts and the economic theory of rebates is
explored in order to provide an interpretation of the law and to clarify the appropriate
treatment of fidelity rebates. The critical discussion of the case law is centred on the
idea as to whether the standard needs to reflect economic analysis and particularly, the
AEC test. The recent US case law regarding fidelity rebates is also studied in order to
provide clarity on this question. This thesis demonstrates that the application of a pricecost
test as a tool to distinguish anti-competitive from pro-competitive fidelity rebates
cannot be based on the current state of both US and EU case law and of the modern
economic literature.


The discovery of fullerenes in 1985 has ushered in an explosive growth in the applications of engineered nanomaterials and consumer products. Nanotechnology and engineered nanomaterials (ENMs) are being incorporated into a range of commercial products such as consumer electronics, cosmetics, imaging and sensors. Nanomaterials offer new possibilities for the development of novel sensing and monitoring technologies. Nanosensors can be classified under two main categories: (i) Nanotechnology-enabled sensors or sensors that are themselves nanoscale or have nanoscale materials or components, and (ii) Nanoproperty-quantifiable sensors or sensors that are used to measure nanoscale properties. The first category can eventually result in lower material cost, reduced weight and energy consumption. The second category can enhance our understanding of the potential toxic effects of emerging pollutants from nanomaterials including fullerenes, dendrimers, and carbon nanotubes. Despite the enormous literatures and reviews on Category I sensors, there are few sensors to measure nanoscale properties or sensors belonging to Category II. This class of nanosensors is an area of critical interest to nanotoxicology, detection and risk assessment, as well as for monitoring of environmental and/or biological exposure. This article discusses emerging fields of nanotoxicology and nanomonitoring including the challenges of characterizing engineered nanomaterials and the potentials of combining existing analytical techniques with conventional cytotoxicity methods. Two case studies are provided for development of Category II nanosensors for fullerene nanoparticles and quantum dots. One highlights the uniqueness of a portable, dissolved oxygen electrochemical sensor arrays capable of detecting the ENMs as well as provide rapid nanotoxicological information. This review has shown that addressing the complex and critical issues surrounding the environmental transformation and toxicity of ENMs must be accompanied by the creation of new approaches or further developments of existing instrumentation.


The compromise effect denotes the finding that brands gain share when they become the intermediate rather than extreme option in a choice set. Despite the robustness and importance of this phenomenon, choice modelers have neglected to incorporate the compromise effect in formal choice models and to test whether such models outperform the standard value maximization model. In this article, the authors suggest four context-dependent choice models that can conceptually capture the compromise effect. Although the models are motivated by theory from economics and behavioral decision research, they differ with respect to the particular mechanism that underlies the compromise effect (e.g., contextual concavity versus loss aversion). Using two empirical applications, the authors (1) contrast the alternative models and show that incorporating the compromise effect by modeling the local choice context leads to superior predictions and fit compared with the traditional value maximization model and a stronger (naive) model that adjusts for possible biases in utility measurement, (2) generalize the compromise effect by demonstrating that it systematically affects choice in larger sets of products and attributes than has been previously shown, (3) show the theoretical and empirical equivalence of loss aversion and local (contextual) concavity and (4) demonstrate the superiority of models that use a single reference point over "tournament models" in which each option serves as a reference point. They discuss the theoretical and practical implications of this research as well as the ability of the proposed models to predict other behavioral context effects.


Primary penile melanomas are exceedingly rare (less than 1% of primary penile cancers), 221 cases being reported to date in PubMed indexed medical literature. More than half of the cases occur on the gland, usually in older people than on cutaneous counterpart and have unfavourable prognosis mainly due to the belated diagnosis. We report the case of a 77 years old male diagnosed with a pigmented ulcerated nodular melanoma of the gland with maximal thickness of 4.5 mm, mitotic index 8 mitoses/mm2 and vascular emboli. No lymph node enlargements or distant metastases were identified at presentation. Six months after the diagnosis the patient was well, free of disease. Clinically, penile melanomas may be mistaken for several lesions such as squamous carcinoma, penile nevi, pyogenic granuloma, Kaposi sarcoma. Histopathologic diagnosis is usually straight forward except for highly pleomorphic tumors; discrimination between primary penile tumor and penile metastatic melanoma is the most delicate problem of differential diagnosis. The treatment is not standardized; surgical wide excision or partial/total penectomy completed with sentinel lymph node biopsy are the most frequent methods of treatment; multi-agent chemotherapy and/or high-dose interferon alpha 2b therapy are recommended for patients with locally un-controllable disease and/or metastases.


The bacterially fermented mistletoe preparation Iscador, used in cancer therapy for 30 years, and the recently prepared unfermented preparation, have been tested on rat hepatoma tissue culture (HTC) cells and human leukemia Molt 4 cells. As observed by phase-contrast microscopy, treatment of HTC cells with fermented or unfermented Iscador, at a concentration corresponding to 1 mg of fresh plant per milliliter culture, led to rapid lysis of cellular membranes. At a lower concentration, 0.1 mg/ml, unfermented Iscador led to the formation of polynucleated cells. On Molt 4 cells, fermented Iscador also produced cytolysis but after a longer time of action. Unfermented Iscador showed a much stronger cytotoxic effect on these cells than on HTC cells. Fermented Iscador was slightly more potent than unfermented Iscador in inhibiting the growth of HTC cells, but on Molt 4 cells fermented Iscador was less active than unfermented Iscador. DNA synthesis, measured by [3H]thymidine incorporation in HTC and Molt 4 cells, was inhibited by fermented and unfermented Iscador with the same type of differences of action as on cell growth. Fermented Iscador contained a low amount of lectins, approximately 100 ng/ml, while unfermented Iscador contained about 10 times more. A purified mistletoe lectin produced effects on HTC and Molt 4 cells similar to those of unfermented preparations. HTC cells were 100 times less sensitive to this lectin than Molt 4 cells. These results are discussed in relation to the known biological effects of lectins.


China is currently experiencing a rising demand for water, combined with limited funding availability for water project procurement. Consequently, local Chinese governments have sought procurement solutions by experimenting with public private partnerships (PPPs). However, the legal risk in PPPs, particularly in the water sector, remains high. Legal risk refers to risk arising from the legal and regulatory systems surrounding PPPs. Past research have identified legal risk in PPP projects in China as critical, however the stages at which they are significant have not been studied. This paper examines the legal risk associated with PPPs in the water sector in China and measures the degree of risk across three key stages; 1) Procurement, 2) Construction and 3) Operation. The interrelationship between legal risk at these three stages is also investigated. The significance of the risk was measured by determining the probability and severity of the risk. Correlation analysis was used to investigate the relationship between legal risks across the three stages. Our findings are that legal risk is present at all three stages, at close to moderate levels, with risk significance greatest at the operational stage. Moreover, while no correlation was identified for legal risk at the operational stage with those of earlier stages, it was found that legal issues arising during the procurement stage significantly exacerbated any further legal issues that emerged during the construction stage of water projects. The findings from this study will be significant in providing practitioners with the information to manage this risk at different stages of PPP projects.


The deployment of building integrated photovoltaics in the urban environment represents an opportunity for energy production and use at source. It also has a positive impact on expanding the market for photovoltaics resulting in reduction in cell and systems costs. An example of such a system is the subject of this paper. The operation of the photovoltaic facade installed at Southampton University is constantly monitored. In addition to system energy yields, the mismatch losses, notably at low irradiance levels and during periods of shading, were measured and evaluated. The determination of the operational characteristic of each string in the array is critical in identifying the interactions that may occur between strings, and the resultant degrading effect on system performance. The results indicate that the original design configuration of the strings of the array, determined as the optimal from theoretical and conventional principles, is not the most efficient. After optimisation of the connection characteristics of the 24 strings in the array, an increase of 8% in system efficiency was achieved.


This thesis contributes to economic research in two sub-fields of behavioral economics: asset pricing under risk and gift-exchange.

The first essay, "Risk, Information and Asset Pricing: An Experiment," investigates how providing non-fundamental information in experimental asset market affects market pricing process. The information points to potential arbitrage opportunity in the market if market prices are different from the intrinsic values, which is expected to speed up market price convergence to intrinsic values. In contrast, persistent under-pricing is observed in all experimental sessions. Providing non-fundamental information introduces price rigidity that disrupts the information diffusion process. As a result, share prices are anchored around levels that reflect different market appetite towards risk in different experimental sessions.

The second essay, "Giving According to The Rules: A Study of Monetary Gift Exchange in China," explores the features of the social institution of monetary gift exchange for Chinese weddings using a survey study. Results show that the size of giving depends on the nature and quality of relationship, and gift history. The size of gift as a proportion of average social disposable income tends to decrease over time, which implies that monetary gift exchange does not intensify the status competition. Monetary gift exchange also tends to maintain the balance of giving as the size of return gifts as a proportion of average city-wise disposable income is often similar to the size of initial gifts received in the past.

Keywords: behavioral economics, risk, information, asset pricing, experiment; monetary gift exchange, reciprocity, social norms, status competition.


This paper presented a robust PID controller design for time delay system. This controller will be utilizing the gain-phase margin method; a specification-oriented parameter region in the parameter plane that characterizes all admissible controller coefficients sets can be obtained. Tuning of a PID controller refers to the tuning of its various parameters (P, I and D) to achieve an optimized value of the desired response. The basic requirements of the output will be the stability, desired rise time, peak time and overshoot. A compromise between the performances of the system with Ziegler-Nichols method is also included. Here we are measuring the plant response with and without delay condition with respect to original reference signal. Small modeling error is encountered and it is gradually detuned to a PID controller.


Although the potential of asynchronous discussion to support learning is widely recognized, student engagement remains problematic. Often, for example, students simply refuse to participate. Consequently the rich promise of asynchronous learning networks for supporting students' learning can prove hard to achieve.After reviewing strategies for encouraging student participation in discussions in Asynchronous Learning Networks (ALN), we present a study that investigates how these strategies influenced students' perceptions and use of the discussion area. We identify and explore factors that encouraged and inhibited student participation in asynchronous discussion, and evaluate student postings to an asynchronous discussion group by content analysis.The results question received wisdom about some of the pedagogic techniques advocated in the literature.Instead, results support the view that the major factors for stimulating student participation in asynchronous discussion are tutor enthusiasm and expertise. It appears that the tutor may be the root cause of engagement in discussions, an important conclusion, given that to date, the tutor's role has remained relatively unexamined. We also note that participation in asynchronous discussion is inhibited when students allocate a low priority to participation, as may occur when participation is not assessed.Content analysis of an asynchronous discussion in this study reveals that contributions were not strongly interactive and that students were simply 'playing the game' of assessment, making postings that earned marks but rarely contributing otherwise. Thus the use of assessment to encourage students' contributions appears to be only a superficial success; it seems likely that giving credit for postings changes behavior without necessarily improving learning. This finding has significant implications for curriculum design.


We have provided an overview of state-of-the-art ROI coding techniques applied to medical images. These techniques are classified according to the image type they apply to; thus the first class includes ROI coding schemes developed for two-dimensional (2-D) still medical images whereas the second class consists of ROI coding in the case of volumetric images. In the third class, a prototype ROI encoder for compression of angiogram video sequences is presented. ROI coding preserves image quality in diagnostically critical regions by performing advanced image compression, enabling better image examination and addressing issues regarding image handling and transmission in telemedicine systems. The mapping of the ROI from the spatial domain to the wavelet domain is dependent on the used wavelet filters and it is simplified for rectangular and circular regions. Therefore, ROI coding is considered quite important in distributed and networked electronic healthcare.


Rumour stance classification is a task that involves identifying the attitude of Twitter users towards the truthfulness of the rumour they are discussing. Stance classification is considered to be an important step towards rumour verification, therefore performing well in this task is expected to be useful in debunking false rumours. In this work we classify a set of Twitter posts discussing rumours into either supporting, denying, questioning or commenting on the underlying rumours. We propose an LSTM-based sequential model that, through modelling the conversational structure of tweets, obtains state-of-theart accuracy on the SemEval-2017 RumourEval dataset.


Controlled sex‐, stage‐ and tissue‐specific expression of antipathogen effector molecules is important for genetic engineering strategies to control mosquito‐borne diseases. Adult female salivary glands are involved in pathogen transmission to human hosts and are target sites for expression of antipathogen effector molecules. The Aedes aegypti 30K a and 30K b genes are expressed exclusively in adult female salivary glands and are transcribed divergently from start sites separated by 263 nucleotides. The intergenic, 5′‐ and 3′‐end untranslated regions of both genes are sufficient to express simultaneously two different transgene products in the distal‐lateral lobes of the female salivary glands. An antidengue effector gene, membranes no protein (Mnp), driven by the 30K b promoter, expresses an inverted‐repeat RNA with sequences derived from the premembrane protein‐encoding region of the dengue virus serotype 2 genome and reduces significantly the prevalence and mean intensities of viral infection in mosquito salivary glands and saliva.


Moving and manipulating bio-particles and fluids on the microscale is central to many lab-on-a-chip applications. Techniques for pumping fluids which use electric fields have shown promise using both DC and AC voltages. AC techniques, however, require the use of integrated metal electrodes which have a low resistance but can suffer from unwanted chemical reactions even at low potentials. In this paper we introduce the use of carbon MEMS technology (C-MEMS), a fabrication method which produces 3D conductive polymeric structures. Results are presented of the fabrication of an innovative design of 3D AC-electroosmotic micropump and preliminary experimental measurements which demonstrate the potential of both the technology and the design.


The field of Information Science is constantly changing. Therefore, information scientists are required to regularly review-and if necessary-redefine its fundamental building blocks. This article is one of a group of four articles, which resulted from a Critical Delphi study conducted in 2003-2005. The study, "Knowledge Map of Information Science," was aimed at exploring the foundations of information science. The international panel was composed of 57 leading scholars from 16 countries, who represent (almost) all the major subfields and important aspects of the field. This particular article documents 130 definitions of data, information, and knowledge formulated by 45 scholars, and maps the major conceptual approaches for defining these three key concepts.


Vitamin D is thought to protect the cardiovascular system, although its role is not completely clear. The beneficial effect may occur by vascular calcification inhibition through blockage of both inflammatory cytokines and adhesion molecules. Moreover, calcitriol is a renin negative regulator, interfering in renin-angiotensin-aldosterone system (RAAS) and limiting the production of angiotensin II, an inflammatory and atherogenic cytokine implicated in the development of atheromatous plaques. Epidemiological studies showed an association between osteoporosis and atherosclerosis, which suggests the existence of common underlying mechanisms. We aimed to analyse the relationship between vitamin D serum levels, the severity of atherosclerosis and bone mineral density (BMD) and to explore the importance of both arterial blood pressure and inflammation as mediators of the relationship between vitamin D and atherogenesis. Patients who underwent carotid endarterectomy in the Vascular Surgery Department of Hospital de Santa Maria were included. A structured clinical protocol was applied to those who agreed to participate and many important personal data (age; gender; traditional cardiovascular risk factors; date of the surgery; personal and family history of bone fractures, osteoporosis and other relevant diseases; patient's medication) were recorded, as well as many variables, like calcidiol, degree of carotid stenosis, BMD (obtained by dual-energy X-ray absorptiometry), mean arterial pressure (MAP) and C-reactive protein (CRP). The correlations between calcidiol and both degree of stenosis and BMD were not statistically significant. There were no cross-sectional association between MAP and serum calcidiol or the percentage of stenosis and the latter and BMD levels were not significantly different in patients with and without sufficient/adequate vitamin D levels. Despite the existing evidence that vitamin D has a protective role in cardiovascular system through many pathways, our results do not substantiate that premise. Mean arterial blood pressure and C-reactive protein didn't correlate with both vitamin D and percentage of stenosis. It is important to have in mind that this study had some limitations (like sample dimension, the cross-sectional design and the exclusion of many confounders). Nevertheless we highlight the importance of vitamin D in cardiovascular system, encouraging the reflection about points that could strengthen the results of future projects.


Digitalization has changed the world. The digital revolution has promoted the Internet, and more recently mobile network infrastructure, as the technological backbone of our society. Digital technologies have become more integrated across all sectors of our economy and society, and create novel possibilities for economic growth. Today, customers are more and more interested in value-added services, compared to the basic products of the past. Novel digital services, as well as the use of mobile services, has increased both at-work and during free time. However, it is important to understand the needs and expectations of the end users and develop future services with them. This paper focuses on pointing out the importance of user involvement and co-design in digital service development and providing insights on transformation caused by the digital revolution. Experiences and effects of user involvement and co-design are introduced with details via two case studies from the traditional retail domain.


Unhealthy diets are commonly associated with increased disability-adjusted life years (DALYs) from noncommunicable diseases. The association between DALYs and dietary patterns can be quantified with individual longitudinal data. This assessment, however, is often based on dietary data collected once at cohort entry, therefore reflecting the impact of "old" dietary habits on morbidity and mortality. To overcome this limitation, we tested the association of contemporary diets with DALYs. First, we defined contemporary dietary patterns consumed in Switzerland with the national nutrition survey menuCH (2014–2015). Second, we identified individuals who consumed similar diets in the NRP–MONICA census-linked cohort (1977–2015). In this cohort, individual data on disease and mortality were used to calculate the DALYs-dietary patterns association using a mixed regression model. A total of 58,771 DALYs from NCDs were recorded in a mean follow-up time of 25.5 years. After multivariable adjustments, the "Swiss traditional" pattern was not associated with an increase in DALYs compared to the "Prudent" pattern. However, individuals following a "Western" pattern had, on average 0.29 DALYs (95% CI 0.02, 0.56) more than those following a "Prudent" pattern, equating to a loss of healthy life of more than three months. These data highlight the feasibility of quantifying the impact of contemporary diets on DALYs without the establishment of new cohorts or the use of nationally aggregated data.


Introduction The objective of this study was to evaluate the contributions of Art Education for sexual health promotion of adolescents in the context of urban social vulnerability, through the process of consciousness and empowerment. Methods Community-based participatory research developed with 21 adolescents who were participating in a governmental program of Art Education and resocialization located in a Brazilian poor community. Data were collected in five months by Fetterman's method of Empowerment Evaluation through weekly group meetings and participant observation by critical friends. Data analysis was supported by Freire's concepts of Critical Consciousness with a qualitative approach to data categorization. Results Adolescents oriented their needs and priorities of health into two main themes and their categories: 1) Community: health care, diseases, trafficking, violence, drugs and leisure; 2) Adolescence: body, mind, friendships, dating, sex and fun. The Art Education activities - visual, audiovisual and dance - were articulated with reflections about these subjects and showed the power of community relationships in sexual health promotion of adolescents. Some changes were observed after reevaluation of the process and involved the triad: individual, community and program. A predominantly negative view of the neighbourhood was becoming a vision full of possibilities, examples and personal empowerment for health and wisely choices. Conclusion This research proposed a model of Adolescent Health Promotion Based on Art Education and Community-Centred. The group walked towards intransitive consciousness, for the transitive-naive and critical, featuring an awareness process that began with the seizure of a health reality initially considered fateful and immutable, past the living situations that favoured the questioning of this reality and culminated with the perception of the possibilities of change and self-determination for change.


We showed by experiments that a number of plants is able to germinate under water and that the seedlings are able to establish themselves at the river-bank. This applies not only to alpine and subalpine waterborne plants like Kernera saxatilis or Cymbalaria muralis, to species of the riparian Vegetation like Rumex stenophyllus, Leonurus marrubiastrum, Artemisia anniia, Epilobium parviflorum, but also to ruderal species of dryer habitats like Anthriscus cerefolium, Bromus tectorum or Hordeum murinum. Subhydric germination gives no recognizable benefit to the last group of species. But it is possible that this attribute is more often to be found with them than believed till now.


ABSTRACT Scholars and policymakers often make noticeable distinctions between acts of terrorism and mass shooting incidents. In order to assess if these distinctions are generally accurate, we identity four key criteria from standard international and domestic definitions of terrorism. The criteria include: a political, religious, ideological, or social motivation; intent to reach a larger audience; the motivation not involving personal monetary gain; and the manifestation of an 'enemy/other'. We analyze 105 mass shooting events in the United States from 1982 through October 2018 to assess whether they meet these criteria and find that 41 (39%) incidents meet all four criteria and another 45 (43%) incidents meet three of the criteria to be classified as acts of terrorism. Thus, we contend that mass shooting incidents fit the standard definitions of terrorism to a greater degree than is often reported by government officials, academics, and media outlets. We contend that researchers must be more persistent in investigating the motivations behind mass shooting events in order to accurately label and counter them.


Abstract The efficiency and effectiveness of judicial systems has become one of the main points of interest in public sector administration, due to the beneficial effects of an efficient judicial system on economic growth and firm competition. This is particularly relevant in Italy where judicial proceedings are extremely long-lasting due to the huge (in)efficiency of courts and to the presence of bottlenecks that affect the efficient management of court activity. This paper attempts to measure the relative technical efficiency of Italian first instance courts in the period 2010–2011 by applying a non-parametric frontier and distinguishing between managerial (in)efficiency and (in)efficiency due to the non-discretionary caseload. Our findings show that, while the presence of bottlenecks in the caseload plays a role in the level of court inefficiency, this effect is relatively small compared with the inefficiency due to the lack of managerial ability to efficiently manage both the backlog and increases in filings. Furthermore, this outcome is more relevant in the South rather than in the North of the country. Finally, our empirical findings are robust to an alternative estimator and sample variation.


WiMAX is intended for fourth generation wireless mobile communications where a group of users are provided with a connection and a fixed length queue. In present literature traffic of such network is analyzed based on the generator matrix of the Markov Arrival Process (MAP). In this paper a simple analytical technique of the two dimensional Markov chain is used to obtain the trajectory of the congestion of the network as a function of a traffic parameter. Finally, a two state phase dependent arrival process is considered to evaluate probability states. The entire analysis is kept independent of modulation and coding schemes.


SIR,-Dr. J. V. Morris in his interesting article on mongolism in a twin (Journal, November 2, p. 1038) states that only 14 cases have been reported in the British literature since 1876, and he describes an additional case. He quotes Morris and MacGillivray' as saying that mongolism in one of twins is not so rare in British literature as had been suggested. Dr. J. S. Happel, of Alresford, has kindly reminded me of twins born at home and transferred to the Royal Hampshire County Hospital, Winchester, on April 3, 1957. The second twin, a male, was clearly a mongol, markedly jaundiced, cyanosed, and breathless due to a pronounced heart defect, having bilateral cataracts, and weighing 3 lb. 15 oz. (1.8 kg.). He did surprisingly well, and at 5 months weighed 11 lb. 4 oz. (5.1 kg.), when he contracted an upper respiratory infection and died within a few days. The other twin was also a male and weighed 6 lb. 11 oz. (3 kg.) at birth. He is quite normal and now thriving and well. There were two placentas. The mother was aged 36, and was delivered of a normal child in 1954 and again in 1955. She had a miscarriage in 1956. No history of twinning in her own family or in her husband's family can be traced. Drs. Nicholson and Keay2 state that among dizygous pairs the great majority are discordant for mongolism, and they go on to report mongolism in both monozygous twins of opposite sex which they describe as unique in the literature. -I am, etc.,


Adoptive transfer of antigen-specific T cells has been most effective in treating cytomegalovirus (CMV) disease and Epstein-Barr virus (EBV)-associated lymphoproliferative disease (LPD). Both of these diseases develop only during periods of acute immune suppression, and both involve highly immunogenic infected cells, and thus respond well to T cell therapies. In contrast, tumours that develop in the presence of a competent immune system evolve complex immune evasion strategies to avoid and subvert T cell-mediated killing. Therefore, even T cells that display potent cytotoxic activity against tumour cells in vitro may not be effective in vivo without altering the tumour:T cell balance in favour of the T cell. This review discusses several new areas of research aimed at improving adoptive T cell therapy for the treatment of cancer, including the genetic modification of antigen-specific T cells to allow them to perform better in vivo, and conditioning the host to improve in vivo expansion and function of transferred cells.


: The conscious narrative studies of narratives emerged from the critical research of the Russians structuralists in the mid-twentieth century. This research pushed the critic Todorov to define narratives as naratology (the science of the narrative) which tries to identify the internal structures in the narrative, distinguish its characteristics, and reveal the relations which connect them together. This research is concerned with narrative structure and narrative discourse, which serve as bases for literariness and poetic quality. It should be noted that the central objective of these two terms is to emphasize on qualitative features of narrative art. Critical approaches agree that the study of narrative art must be start with the narrative structure and its internal structures and features. This is so because narrative structures are associated with practical applications and try to bring about a narrative text according to narrative conventions. So, Narratives belong to an independent particular literary genre with its own norms.


This research reports on a qualitative survey of hotel guest loyalty. The approach was unusual in several ways: It sought to measure loyalty in the general population of hotel users rather than selecting a population already known to be loyal, and instead of trying to identify personality traits in the guests' psychology that might be important, or ranking features of the hotel that might be determining factors, guests were simply asked what the term hotel loyalty meant to them. This approach has the advantage of not being influenced by any particular theory or restricted by the scope of the questions asked. The outcome of the analysis of their responses is a model of hotel loyalty created directly from the guests' own perceptions of loyalty. The model shows that "loyalty" is actually a dynamic concept balancing seven elements already found in previous research and involves an unstated or implied contract between the guest and the hotel. It also suggests that many of the determinants commonly held to influence loyalty are, in fact, not relevant.


Context • Balneotherapy is one of the most commonly used nonpharmacological interventions for osteoarthritis (OA), but its mechanism of action in relieving pain and stiffness and in improving physical function is not well understood. Studies have found that therapy provokes a series of neuroendocrinal reactions with anti-inflammatory and analgesic effects. Sphingosine-1-phosphate (S1P), a bioactive lipid, has been implicated as an important mediator in the maintenance of physiological processes (eg, vascular barrier integrity) and in pathophysiologic processes such as inflammatory conditions. Accordingly, targeting S1P and S1P receptors may offer a potential therapy for arthritis. Objective • The aims of the present study were to determine whether (1) balneotherapy modified the circulating levels of S1P as well as some inflammatory parameters and stress markers, in patients with OA; and (2) to assess the relationship of those parameters to therapeutic efficacy. Design • This study was designed as an uncontrolled longitudinal study. Setting • The study took place at the Bolu Physical Therapy and Rehabilitation Hospital (Bolu, Turkey). Participants • Forty patients who suffered from general OA in at least 3 positions on the body, one of which could be the vertebral column, and who fulfilled the American College of Rheumatology Classification criteria and the Kellgren-Moore radiologic criteria, were enrolled in the intervention group in the study. Intervention • During balneotherapy, the participants were fully immersed in warm thermo-mineral water for 20 min at a temperature of 38°C to 40°C. A total of 15 immersions were performed in a period of 15 d. Outcome Measures • A baseline clinical evaluation of participants' pain, stiffness, and physical function was carried out using the Western Ontario and McMaster Universities questionnaire. Baseline serum levels of S1P, cyclooxygenase 2 (COX-2), matrix metalloproteinase 3 (MMP-3), and heat shock protein 70 (HSP-70) were measured using enzyme-linked immunosorbent assays and high-sensitivity C-reactive protein, with an immunoturbidimetric assay. The clinical evaluations and the biochemical measurements were repeated after completion of the balneotherapy period. Results • Balneotherapy caused a significant reduction in circulating levels of S1P and high-density lipoprotein and a limited increase in HSP-70 levels, in addition to a reduction in pain and stiffness and an improvement in physical function. In the Spearman's correlation analysis, S1P was found to be positively associated with serum levels of HSP-70, COX-2, and MMP-3. Conclusion • Balneotherapy modulated serum S1P levels in patients with OA. The effect of S1P modulation on the clinical outcome of patients with OA should be further investigated.


Insole pressure sensors capture the different forces exercised over the different parts of the sole when performing tasks standing up. Using data analysis and machine learning techniques, common patterns and strategies from different users to execute different tasks can be extracted. In this paper, we present the evaluation results of the impact that clinically diagnosed osteoarthritis of the knee at early stages has on insole pressure sensors while walking at normal speeds focusing on the effects caused at points, where knee forces tend to peak for normal users. From the different parts of the foot affected at high knee force moments, the forefoot pressure distribution and the heel to forefoot weight reallocation strategies have shown to provide better correlations with the user's perceived pain in the knee for OA users with mild knee pain. This paper shows how the time differences and variabilities from two sensors located in the metatarsal zone while walking provide a simple mechanism to detect different strategies used by users suffering OA of the knee from control users with no knee pain. The weight dynamic reallocation at the midfoot, when moving forward from heel to forefoot, has also shown to positively correlate with the perceived knee pain. The major asymmetries between pressure patterns in both feet while walking at normal speeds are also captured. Based on the described features, automatic evaluation self-management rehabilitation tools could be implemented to continuously monitor and provide personalized feedback for OA patients with mild knee pain to facilitate user adherence to individualized OA rehabilitation.


Lewis's distrust of scientific laws for history, rather than undercutting his practice of literary history, existed alongside a basic, cautionary trust in representing the past. His methods of history writing included offering an overall plot, developing characters and corporate quasi-characters, and making analogies with the present to increase readerly sympathy (or antipathy) with long-gone cultures. Despite his strong rhetorical tendency to generalize, Lewis did not place absolute faith in his historical narratives. They were made to be argued with, supplemented, and even over-turned. The article pays particular attention to three documents from Lewis's career as a literary historian: 1) his 1945 essay, "Addison"; 2) his two-day address in 1956 to the Cambridge Zoological Laboratory, "Imagination and Thought in the Middle Ages"; and 3) the opening introduction to his monumental English Literature in the Sixteenth Century, Excluding Drama. Likewise, it examines his overall attitude toward historiography, which requires a theological structure to position his suspended middle of historical and ethical judgments. Additional


Abstract Background: The use of laboratory tests has been increasing in recent years due to various factors affecting laboratories, physicians, legal aspects, or patients themselves. Methods: The efficacy of laboratory tests must be evaluated on the basis of the clinical benefits that they provide in terms of prevention, diagnosis, follow-up, or treatment; with the aim of optimizing health results in general. Results: There are techniques that can be used to determine the clinical validity of the efficacy, effectiveness, and safety of treatment or preventive measures performed on individuals with abnormal tests, as well as providing an economic evaluation of the process. Once the test is incorporated into clinical service, it must be evaluated by retrospective audits in test utilization. To improve the use of laboratory tests, many strategies have been devised that incorporate clinical practice guidelines (CPGs), the conduct of professionals and the patients, and organization of the process. We discuss the importance of the involvement of health professionals. Conclusions: Strategies in relation to CPGs, conduct of professionals, conduct of patients, or organization of health care processes improve the use of tests in relation to clinical processes. Laboratory professionals have the appropriate knowledge and can improve the quality and efficacy of health care. Clin Chem Lab Med 2009;47:1461–5.


A novel method based on steady state fluorescence measurements is introduced for measuring the activation energy of the number average degree of polymerization (NADP). Pyrene (Py) was used as a fluorescence probe for real time monitoring of free-radical polymerization (FRP) of methyl methacrylate (MMA). In situ FRP experiments were performed at various temperatures. Positive activation energy for NADP was measured and found to be 9.2 kcal/mol.


The effect of aminoacylation on the conformation of yeast tRNA(Phe) was investigated by high-resolution (300 MHz) proton nuclear magnetic resonance (NMR) spectroscopy. Resonances in the low-field (-11 to -15 ppm) region of the spectra are due to ring NH protons of Watson-Crick base pairs, and to a very high degree of approximation (within 0.05 ppm) the low-field spectra of tRNA(Phe) and phenylalanyl-tRNA(Phe) are identical. From this observation and analysis of the low-field NMR spectra we conclude that the secondary structures of the two tRNAs are identical with respect to base-pairing schemes and interbase distances in the helical region (0.1-0.2 A). Several tertiary structural features, including conformation of the dihydro-U loop, conformation of the minor loop, relative orientations of the acceptor and the TPsiC stems, dihydro-U and anticodon stems, and probably conformation of the anticodon loop are shown to be the same in tRNA(Phe) and phenylalanyl-tRNA(Phe). Our results leave little remaining opportunity for changes in tertiary structure that would not have been observed by the NMR method.


Exploring ways to understand the boundary of a problematic situation is fundamental to intervention. The boundary draws a difference between what is relevant and what is not relevant for the problem situation. In other words, it points out what it is and is not the system. Boundary Critique Theory, has used the notion of boundary to built ways to examine and reflect critically about the intervention process. It has developed ways to manage situations such as conflict, exclusion and the generation of reasonable discourse among the participants. These developments use ideas from sources such as critical theory, pragmatic philosophy, sociology, biology and cybernetics. This paper contributes to the range of theories informing Boundary Critique by adding a framework of Boundary Games. The framework is based on Wittgenstein's Language Games and Relevance Theory (a theory from Language Pragmatics). It shows new ways to reflect on the actions and language on a setting. Particularly, it proposes six possible "moves", intentions or games in relation to the boundary. The framework implies a shift in how the boundary is usually managed in Boundary Critique, from a boundary that shapes our actions towards a boundary that is shaped by every action.


National geographical state is on spatial-related national state regarding social nature, politics, economy and culture of a nation. The reliability of national geographical state is a crucial issue which will affect the correctness of a national strategic decision and planning. Reliable monitoring of national geographical state is thus a new research direction scientifically and with an urgent demand by the country. In this paper, the research on reliable dynamic monitoring of national geographical state is proposed, including basic concepts, general research framework, key technologies and theories, and core problems to be solved. The proposed key technologies and theories for reliable geographical state monitoring include reliable analysis and quality control of dynamic monitoring, spatial-temporal dynamic modeling, integrated space-air-ground monitoring system, geographical grid-based representation of non-spatial data, change detection, dynamic update and consistency maintenance of spatial-temporal data, reliable analysis, reliable data mining, reliable decision-making, cloud computing framework, geo-visualization and techniques of GNSS and handheld devices for monitoring data capture.


Genetic screens in Drosophila have lead to the discovery of many genes important for patterning and signal transduction in diverse organisms. Traditionally, the phenotypic effects of loss-of-function mutations are analyzed. As an alternative way to link genes and function, I have developed a versatile misexpression screen in Drosophila, the first such screen in higher eukaryotes. The screen identifies genes that, when over- or misexpressed in a pattern of interest, give a specific phenotype or modulate an existing mutant phenotype. It is based on Gal4 transactivation of a mobile enhancer and promoter that "targets" random endogenous genes for expression. The modular design of the screen allows directed expression in any temporal or spatial pattern. When activated in the developing eye, 4% of target inserts gave dominant phenotypes. One insertion was in the gene encoding Ras GTPase-activating protein; its overexpression phenotype was strongly enhanced by a mutation in Ras1. Thus, biologically relevant phenotypes and genetic interactions are identified using this method. The screen is a powerful new tool for developmental genetics; similar approaches can also be developed for other organisms.


Headmasters as leaders are responsible for the advancement of the organization of their schools. To commit their duties, they deal with more human than technical aspects. They have to use an emotional approach to making rapports with their subordinates in order to cooperate with them productively and emotionally. Effective competencies the headmasters should possess are building ties, collaboration and cooperation, and team ability. The team members should also make a cooperation through a healthy interaction, the interaction which enables them to make an in-debth, open debate, tested against others' critical opinions. They keywords in such a successful interaction is an emotional intelligence such as self-intelligence, empathy, and communication.


This chapter examines computer misuse, a collective term for a number of criminal offences committed by means of a computer, often through access to the internet, including computer hacking (unauthorized access), denial-of-service attacks, and the creation and distribution of computer viruses and other malware. It first discusses hacking, focusing on employee hackers and external hackers, and then looks at the political debate surrounding the UK's Computer Misuse Act 1990, and extradition centred on the cases of hackers Gary McKinnon and Laurie Love. The chapter also considers 'digital criminal damage' associated with the creation and distribution of computer viruses, along with cases of web defacement and mail-bombing.


The hepatic metabolism of an externally added hydroperoxide, t-butyl hydroperoxide, results in substantial decreases in CoASH and acetyl-CoA and a concomitant increase in CoA-disulfides. The principal CoA-disulfide which is formed under these conditions was identified as CoASSG, the mixed disulfide of coenzyme A and glutathione; CoASSCoA levels were unchanged. The perturbation in the coenzyme A system was absent when the hydroperoxide was infused into livers from rats maintained on a selenium-deficient diet. In these livers. Se-dependent glutathione peroxidase is lowered to less than 5% of control levels; the observed effects can be attributed to flux through Se-dependent GSH peroxidase.


Background: Acne is a very common and disfiguring disease that more or less severely affects the majority of adolescents and, to some extent, also adults. The importance of emotional stress in the onset or worsening particularly of skin diseases has long been a subject of study and debate, and it has been shown that stress stimuli may lead to behavioral changes and biological modifications within the muscular, neurovegetative and psychoneuroendocrinal as well as the immune system. The aim of this study was to investigate whether acne may have psychosomatic genesis and may be based on stress, personality, mood, and the activation of the hypothalamic-pituitaryadrenocortical axis. Patients and Methods: In order to establish whether stress is a causal factor or only a consequence of the disease, four tests were used to reveal the presence and possible influence of specific stressing events as a concomitant primary or secondary cause of onset or progression. The study population consisted of 33 patients (29 women and 4 men, with a mean age of 27.87 ± 7.3 (range 19–47) years). Results: Paykel's scale of stressing events showed that the majority of the patient group (67%) reported a relationship between the onset of acne and the occurrence of a stressing event. This was particularly true for recent stressing events, mainly those associated with emotional life (30%) and education (37%). The Minnesota Multiphasic Personality Inventory (MMPI) provided an average personality profile highlighting the fact that acne particularly develops in people with depressed (depression scale mean score 75.41 ± 15.59) and conformist (masculinity/femininity scale mean score 42.23 ± 15.53) personality traits. Zung's test indicated that the mood of the subjects was partly depressed (63.6%), and finally the Questionario per la Tipizzazione della Aggressivita (QTA) revealed a tendency to aggressiveness (particularly resentment and irritability) within the sample.


Normal brain function depends on normal neuronal metabolism, which is closely related to systemic homeostasis of metabolites, such as glucose, electrolytes, amino acids and ammonia. "Metabolic encephalopathy" indicates diffuse brain dysfunction caused by various systemic derangements. Electroencephalogram (EEG) is widely used to evaluate metabolic encephalopathy since 1937, when Berger first observed slow brain activity induced by hypoglycemia. EEG is most useful in differentiating organic from psychiatric conditions, identifying epileptogenicity, and providing information about the degree of cortical or subcortical dysfunction. In metabolic encephalopathy, EEG evolution generally correlates well with the severity of encephalopathy. However, EEG has little specificity in differentiating etiologies in metabolic encephalopathy. For example, though triphasic waves are most frequently mentioned in hepatic encephalopathy, they can also be seen in uremic encephalopathy, or even in aged psychiatric patients treated with lithium. Spike-and-waves may appear in hyper- or hypo-glycemia, uremic encephalopathy, or vitamin deficiencies, etc. Common principles of EEG changes in metabolic encephalopathy are (1) varied degrees of slowing, (2) assorted mixtures of epileptic discharge, (3) high incidence of triphasic waves, and (4), as a rule, reversibility after treatment of underlying causes. There are some exceptions to the above descriptions in specific metabolic disorders and EEG manifestations are highly individualized.


Bromo and extra terminal (BET) proteins (BRD2, BRD3, BRD4, and BRDT) are transcriptional regulators required for efficient expression of several growth promoting and antiapoptotic genes as well as for cell-cycle progression. BET proteins are recruited on transcriptionally active chromatin via their two N-terminal bromodomains (BRD), a protein interaction module that specifically recognizes acetylated lysine residues in histones H3 and H4. Inhibition of the BET-histone interaction results in transcriptional downregulation of a number of oncogenes, providing a novel pharmacologic strategy for the treatment of cancer. Here, we present a potent and highly selective dihydroquinazoline-2-one inhibitor, PFI-1, which efficiently blocks the interaction of BET BRDs with acetylated histone tails. Cocrystal structures showed that PFI-1 acts as an acetyl-lysine (Kac) mimetic inhibitor efficiently occupying the Kac binding site in BRD4 and BRD2. PFI-1 has antiproliferative effects on leukemic cell lines and efficiently abrogates their clonogenic growth. Exposure of sensitive cell lines with PFI-1 results in G1 cell-cycle arrest, downregulation of MYC expression, as well as induction of apoptosis and induces differentiation of primary leukemic blasts. Intriguingly, cells exposed to PFI-1 showed significant downregulation of Aurora B kinase, thus attenuating phosphorylation of the Aurora substrate H3S10, providing an alternative strategy for the specific inhibition of this well-established oncology target.


The process of converting gray images or videos to color ones by adding colors to them and transforming them from one-dimension to three-dimension is called colorization. This process is often used to make the image appear more visually appealing. The main problem with the colorization process is the lack of knowledge of the true colors of the objects in the picture when it is captured. For that, there is no a unique solution. In the current work, the colorization of gray images is proposed based on the utilization of the YCbCr color space. Reference image (color image) is selected for transferring the color to a gray image. Both color and gray images are transferred to YCbCr color space. Then, the Y value of the gray image is combined with the Cb and Cr values of the reference image, based on the Euclidian distance between them. The quality of the resulted image was measured based on several quality measures, which indicated very good results. The proposed algorithm is simple, efficient, and fast.


The compact steep spectrum and gigahertz peaked spectrum sources are widely believed to be young radio sources, with ages<10 6 yr. If the activity in the nucleus is fuelled by the supply of gas, one might find evidence of this gas by studying the structural and polarization characteristics of CSS sources as these evolve through this gas. We present polarization observations of a sample of CSS sources, and combine our results with those available in the literature, to show that CSS sources are more asymmetric in the polarization of the outer lobes compared with the more extended ones. We suggest that this could be possibly due to interaction of the jets with infalling material, which fuels the radio source. We also investigate possible dependence of the polarization asymmetry of the lobes on redshift, since this might be aected by more interactions and mergers in the past. No such dependence is found for the CSS sources, suggesting that the environments on the CSS scales are similar at dierent redshifts. However, the polarization asymmetry of the oppositely-directed lobes is larger at higher redshifts for the more extended sources, possibly reflecting the higher incidence of interactions in the past.


The effects of taxes have been discussed in almost every decision context in the extant literature, but the relationship between taxes and auditing has amazingly merited little attention. We explore the relationship between audit effort, audit quality and taxes from the perspective of both auditors and the public using an analytical research model. The analysis provides evidence that even symmetric taxes significantly influence audit effort and audit quality when auditors' risk aversion is considered. While taxes do not influence audit effort monotonically, audit quality generally increases with decreasing tax rates. Hence, taxes may interfere with legislators' efforts to improve audit quality. Additionally, we show that high quality audits should be a matter of public concern because the public is damaged whenever a party unfairly remains untaxed. Therefore, a socially optimal amount of audit effort exists. We derive a mandate- and auditor-specific liability limitation to achieve a socially optimal level of audit effort.


It was hypothesized that, with regard to subsurface flow from the cathedral Peak VI catchment: (a) a defined change in the slope of the hydrograph during a prolonged almost rain free period reflects the onset of outflow from a particular water storage zone of the catchment; (b) reliable soil (upper vadose zone) drainage curve data can help to interpret outflow from that particular water storage zone. To test the hypothesis, measured hydrograph and soil water data from previous studies in the Cathedral Peak VI catchment were used. Drainage curves were derived for the main soils during the rain free autumn periods of four years 1991 to 1994 and the relevant hydrograph were subdivided into appropriate logical regions. The contribution of the soils (upper vadose zone) to streamflow was estimated using the soil drainage curves from selected sites together with the areas of the catchment that they represented. The estimations were compared to estimations done using data from measured streamflow values for the equivalent periods of the hydrographs. The results obtained by the two estimates were as follows, with measurement year, then hydrograph and soil drainage curve estimates (m 3 ), respectively: 1991, 24841, 20061; 1992, 39048, 16528; 1993, 29967, 28448; 1994, 15703, 20809. Apart from the results for 1992, for which a logical explanation is provided, it is concluded that the hypothesis is valid.


The primary goal of the oil and gas well cementing is zonal isolation. During the production life of a well, the cement experiences various severe conditions affecting its permeability. These conditions include cracking, debonding, and shear failure which can be worsened by pressure fluctuations during hydraulic fracturing operations. Any of these conditions by forming micro-cracks within the cement or micro-annuli at the casing/cement or cement/rock interfaces create cement permeabilities far beyond the intrinsic permeability of the intact cement sheath. Recently, some studies have been devoted to improving the overall mechanical behavior of the cement by adding carbon nanotubes and carbon nano-fibers. Although these nano-additives offer considerably high strength and modulus, the high costs of these materials persuade us to find alternatives at relatively low costs, such as, graphite nanoplatelets (GNPs). Our preliminary laboratory studies show the effectiveness of GNPs in the enhancement of durability characteristics of the prepared nanocomposite cement paste by improving its compressive strength, ductility and toughness resistance. Considering the importance of dispersion of nanoadditives within the cementitious matrix, we physically or chemically manipulate the surface properties of GNPs to prevent the agglomeration of nanoparticles.


A novel fiber-optic flow velocity sensor based on a twin-core fiber Michelson interferometer has been proposed and demonstrated. The sensor only is a segment of twin-core fiber acting as cylinder cantilever beam. The force exerted on the cylinder by the slow flow speeds of order mm/s of the fluid with unknown velocity bends the fiber, which corresponds to the shift of the phase of the twin-core in-fiber integrated Michelson interferometer.


A series of novel deoxycholic acid (DCA) derivatives containing aliphatic diamine and aminoalcohol or morpholine moieties at the C3 position were synthesized by 3,26-epoxide ring-opening reactions. These compounds were investigated for their cytotoxicity in four human tumor cell lines and murine macrophages and for inhibitory activity against macrophage-mediated NO synthesis in vitro. Obtained data revealed that: (i) all amine-containing substituents significantly increased the cytotoxicity of the novel compounds (IC502–10 = 1.0–36.0 μM) in comparison with DCA (IC50DCA ≥ 82.9 μM); (ii) aminoalcohol moieties were more preferable than diamine moieties due to the fact they imparted better selectivity for tumor cells of the novel derivatives; (iii) the susceptibility of tested cell lines to derivatives diminished in the following order: HuTu-80 (duodenal carcinoma) ≈ HepG2 (hepatocarcinoma) > KB-3-1 (cervical carcinoma) > RAW264.7 (macrophages) > A549 (lung carcinoma); (iv) compounds 8 and 9, bearing aminoethanol and aminopropanol moieties, respectively, exhibited high cytotoxic selectivity indexes (SIHuTu-80 = 7.9 and 8.3, respectively) and good drug-likeness parameters; (v) the novel compounds do not display anti-NO activity. Mechanistic study revealed that compound 9 induces ROS-dependent cell death by activation of intrinsic caspase-dependent apoptosis and cytodestructive autophagy in HuTu-80 cells and vitamin D receptor can be considered as its primary target.


We have observed the presence of erythropoietic bursts containing eosinophils and their precursors in methylcellulose culture of human peripheral blood and marrow nucleated cells in the presence of erythropoietin and medium conditioned by phytohemagglutinin-stimulated leukocytes (PHA-LCM). It was possible to identify these bursts (colonies) in situ in methylcellulose culture on the basis of their unique red and black colors. Transmission electron microscopy revealed that the constituent erythroid and eosinophilic cells lay intermixed with each other, and through close intercellular connections formed compact colonies and bursts consisting of several sub-colonies. Differential counts of individual erythro-eosinophil colonies (EEo colonies) revealed only a small percentage of blast cells in most of the colonies. Replating experiments of single EEo colonies yielded only eosinophilic colonies and clusters and erythroid colonies. The clonal nature of the EEo colonies was documented by analysis of Y-chromatin-positive cells in individual EEo colonies derived from cocultures of male and female peripheral blood mononuclear cells. Comparison of conditioned media indicated that PHA-LCM is the best stimulator for EEo colonies. These studies suggest that the differentiation capabilities of the progenitors for EEo colonies are restricted to erythroid and eosinophilic differentiation.


The elastic behavior of the demand consumption jointly used with other available resources such as distributed generation (DG) can play a crucial role for the success of smart grids. The intensive use of Distributed Energy Resources (DER) and the technical and contractual constraints result in large-scale non linear optimization problems that require computational intelligence methods to be solved. This paper proposes a Particle Swarm Optimization (PSO) based methodology to support the minimization of the operation costs of a virtual power player that manages the resources in a distribution network and the network itself. Resources include the DER available in the considered time period and the energy that can be bought from external energy suppliers. Network constraints are considered. The proposed approach uses Gaussian mutation of the strategic parameters and contextual self-parameterization of the maximum and minimum particle velocities. The case study considers a real 937 bus distribution network, with 20310 consumers and 548 distributed generators. The obtained solutions are compared with a deterministic approach and with PSO without mutation and Evolutionary PSO, both using self-parameterization.


The Internet of Things (IoT) represents a new paradigm in the Internet history and in the way people interact with everyday objects. Academics and several industry segments have been working over the past years to make this vision possible. It is estimated that there will be dozens or hundreds of devices simultaneously connected to the user's network (e.g., in their home) in the next years, which can make the discovery and interaction with smart object more complicated to IoT users increasingly. This work proposes a smart objects discovery approach using image recognition, which aims to make this task quicker and more selective from an user perspective. An initial assessment has shown that the proposed mechanism can reduce the discovery time in a scenario with several devices, and additionally ensure a good level of user satisfaction.


Persons with Chronic Obstructive Pulmonary Disease (COPD) demonstrate reduced physical activity (PA) levels compared to healthy age-matched controls. Regular PA is associated with positive health outcomes. Inactivity leads to deconditioning, which leads to increased symptoms and a further reduction of PA. This results in a downward spiral of deconditioning and inactivity.

Pulmonary rehabilitation (PR) is known to improve exercise capacity; however, these benefits decline to pre-rehabilitation values after 1-2 years when patients do not continue to exercise after completing the programme. Furthermore, the effect of PR on PA is less consistent, and positive effects disappear rather quickly.

The overall aim of the thesis was to improve and/or maintain PA in patients with COPD after PR.

In chapter 1 a literature review was performed showing that suffering from COPD has a substantial negative effect on the duration and amount of PA but less on the intensity. There seems to be a relation between PA and the severity of the disease (as classified by the GOLD criteria), but this correlation is moderate at most.

In chapter 2 the barriers and enablers to physical activity according to patients were studied. Fatigue, lack of motivation and weather conditions greatly influence engagement in PA in patients with COPD.

The thesis continues in chapter 3 with a study that looks at older adults in general and their ICT use. A computer and e-mail are often used by older adults, whereas the use of a smartphone or a tablet is conceivably lower. Increased age, a lower degree of education, being a non-Western immigrant, a lower income, less arthrosis of the hands, and a lower physical functioning significantly predicted lower ICT use in older adults. It appears that it is not the degree of physical restrictions but rather the degree of adaptability to these restrictions that influence the use of ICT.

Chapter 4 describes the development of an eHealth intervention to address the overall aim of this thesis. Several pilot studies were conducted to ensure usability and accuracy of the measurement. The final product consists of two components: 1) a smartphone application and 2) a website for the healthcare professional (HCP). The application provides feedback on PA measured by the accelerometer embedded in the smartphone. Patients are persuaded to obtain their personalized PA goal. The HCP can monitor their patients' PA via the website and is able to adjust each patient's PA goal and send motivating group or individual text messages.

In chapters 5 and 6 this intervention was evaluated through efficacy testing in a randomized controlled trial and by examining the experiences of those who received the intervention.

The eHealth intervention did not affect PA, physical capacity, health related quality of life, or BMI. PA, lung function, and mastery significantly decreased over time. Surprisingly, exercise capacity remained unchanged over the one-year duration of the study.

Not all prerequisites were met to ensure the usability and successful implementation of the intervention in practice. The thesis provides several recommendations for practice and future research to address this inefficacy.


A hermeneutic phenomenological study was carried out to explore the difficulties and challenges of being a first-time mother in a rural area in Indonesia. The purposes of the present study were to provide health care providers with a greater understanding of the difficulties and the challenges of early motherhood. The thirteen Indonesian women who participated in this study described their experiences of first-time motherhood during early motherhood. Data were collected through semi structured conversational interviews. Three majors difficulties and challenges were identified: (1) being a new mother is not easy (2) a new mother is not as free as she was before and (3) trying to be a good mother. These challenges have offered insight, information and understanding into the experiences of Indonesian women with early motherhood. Also, this study will give a richer and deeper understanding of the needs of women during this period and about their feelings on the mothering role, which is useful for health care providers and others, who are concerned about this issue.


Abstract Moving fluids are capable of transporting a large amount of heat over long distances in sedimentary basins, but the effects are often ignored when modelling the thermal evolution of sedimentary basins. If significant, the passage of these heated fluids through the sediment pile will leave a thermal signature which can be measured at the present-day using palaeotemperature determinants such as vitrinite reflectance and apatite fission track analysis (AFTA™). The interpretation of palaeotemperature-depth profiles, particularly the slope of a palaeotemperature-depth profile, i.e. the palaeogeothermal gradient, allows fluid-induced temperature profiles to be distinguished from those due to simple conduction of basal heat flow. Steady-state systems, typified by large-scale lateral fluid flow in foreland basins or where low-temperature hydrothermal circulation systems occur associated with intrusions and thick volcanic piles, are characterized by dog-length geothermal gradients, with high-interval gradients near the surface, above the shallowest aquifer, and lower interval gradients beneath an aquifer. It is argued that the classic occurrence of near vertical vitrinite reflectance-depth profiles observed in many ancient foreland basins can result from this mechanism. Thermal effects of transient fluid flow are most easily observed at the present-day, where they are characterized by low or negative geothermal gradients beneath aquifers in active geothermal systems, and the same criterion enables their recognition in ancient situations. Similarly, shallow-level igneous intrusion into porous and permeable sediments can produce observable thermal signatures further from the intrusion than will result from simple conduction, but which can be readily explained by movement of fluids heated by the intrusion. Complex steady-state profiles that may be difficult to distinguish from transient profiles without additional geological data may arise where multiple aquifers are separated by aquitards. The thermal consequences of fluid flow in two of these situations, a foreland basin and igneous intrusion into porous sediments, are illustrated by examples of thermal history reconstruction from the Pliocene Papua New Guinea Fold Belt and the Canning Basin of Australia, respectively.


This paper describes the computational aspects of the beam Finite Element formulation recently developed by the authors to simulate the nonlinear response of structural members subjected to shear and torsion, accounting for cross-section warping. The paper focuses on an efficient consistent solution algorithm that by-passes the iterative procedure required in force-based and mixed Finite Elements and makes the model easy to be implemented in a standard code. Moreover, it proposes a new non-iterative technique to condense out the stress components derived by the three-dimensional constitutive response and not directly included in the fiber section formulation. The efficiency and accuracy of the proposed numerical model are validated by simulating the response of steel and reinforced concrete structural members.


Summary.  When a bleeding complication occurs during therapy with heparin or vitamin K antagonists, there is an option to give a specific antidote. Several new anticoagulants have been developed that are likely to have some risk of bleeding complications, for which no specific antidotes are available. Interestingly, it is unknown how often the use of an antidote is necessary in clinical practice. We investigated 1877 patients treated for venous thromboembolism included in three large clinical trials, of which 181 (9.6%) had a total of 225 adjudicated bleeding episodes; 46 hemorrhages being designated as major. Some form of antidote was given to 26 (14.4%) patients with a hemorrhage. Of the patients with at least one major hemorrhage, 19 (41.3%) received an antidote. Vitamin K was given to 23 (1.2%) patients, one (0.05%) patient received protamin sulfate and seven (0.4%) patients received fresh frozen plasma. The use of antidotes was comparable for initial and long‐term treatment. Antidotes were statistically significantly more frequently given in Canada as compared to other participating countries. Vitamin K was more frequently given in case of a higher international normalized ratio value. Although antidotes against anticoagulant treatment are widely available, our analysis shows that in only a very small number of patients a direct, or slow‐acting antidote to reverse the anticoagulant effect was used.


This study investigated the impact of unemployment on economic growth in Nigeria (1981- 2015) adopting the Ordinary Least Square technique (OLS), Augmented Dickey-Fuller test, Co-integration, Vector Error Correction Mechanism (VECM) and the Granger Causality tests. The regression results revealed that unemployment and inflation have negative and insignificant impact on economic growth, while government expenditure has a significant positive impact on economic growth in Nigeria. The computed R-squared implied that about 95% of the systematic variation in economic growth is explained by the unemployment, government expenditure and inflation and indicated that the model has a good fit. The result from the Johansen Co-Integration test revealed a long-run co-movement between the dependent variable, economic growth and the three independent variables, unemployment, government expenditure and inflation. The vector error correction coefficient for LNRGDP meets the apriori expectation of a negatively singed coefficient and this implied that 3.7976% of the errors are corrected in the long-run and as such there is a convergence. Granger Pairwise causality test result revealed that government expenditure granger causes real GDP at 5% level of significance, while none of the other variables granger caused the other. Hence, the study recommended that the activities of the government in promoting economic growth in the country should be geared towards promoting employment for the people, particularly in areas of agriculture, small and medium scale businesses and also, government expenditure in the economy should be increased as it brings about economic growth and would result in increased employment rate in the long-run.


BACKGROUND
Data on the development and outcomes of effective interventions to address aberrant opioid-related behavior (AB) in patients with cancer are lacking. Our outpatient supportive care clinic developed and implemented a specialized interdisciplinary team approach to manage patients with AB. The purpose of this study was to report clinical outcomes of this novel intervention.

MATERIALS AND METHODS
The medical records of 30 consecutive patients with evidence of AB who received the intervention and a random control group of 70 patients without evidence of AB between January 1, 2015, and August 31, 2016, were reviewed.

RESULTS
At baseline, pain intensity (p = .002) and opioid dose (p = .001) were significantly higher among patients with AB. During the course of the study, the median number of ABs per month significantly decreased from three preintervention to 0.4 postintervention (p < .0001). The median morphine equivalent daily dose decreased from 165 mg/day at the first intervention visit to 112 mg/day at the last follow-up (p = .018), although pain intensity did not significantly change (p = .984). "Request for opioid medication refills in the clinic earlier than the expected time" was the AB with the highest frequency prior to the intervention and the greatest improvement during the study period. Younger age (p < .0001) and higher Edmonton Symptom Assessment System anxiety score (p = .005) were independent predictors of the presence of AB.

CONCLUSION
The intervention was associated with a reduction in the frequency of AB and opioid utilization among patients with cancer receiving chronic opioid therapy. More research is needed to further characterize the clinical effectiveness of this intervention.

IMPLICATIONS FOR PRACTICE
There are currently no well-defined and evidence-based strategies to manage cancer patients on chronic opioid therapy who demonstrate aberrant opioid-related behavior. The findings of this study offer a promising starting point for the creation of a standardized strategy for clinicians and provides valuable information to guide their practice regarding these patients. The study results will also help clinicians to better understand the types and frequencies of the most common aberrant behaviors observed among patients with cancer who are receiving chronic opioid therapy. This will enhance the process of timely patient identification, management, or referral to the appropriate specialist teams.