One of the primary observational data sets of sea level is represented by the tide gauge record. We propose a new method to estimate variability on decadal time scales from tide gauge data by using a state space formulation, which couples the direct observations to a predefined state space model by using a Kalman filter. The model consists of a time-varying trend and seasonal cycle, and variability induced by several physical processes, such as wind, atmospheric pressure changes and teleconnection patterns. This model has two advantages over the classical least-squares method that uses regression to explain variations due to known processes: a seasonal cycle with time-varying phase and amplitude can be estimated, and the trend is allowed to vary over time. This time-varying trend consists of a secular trend and low-frequency variability that is not explained by any other term in the model. As a test case, we have used tide gauge data from stations around the North Sea over the period 1980–2013. We compare a model that only estimates a trend with two models that also remove intra-annual variability: one by means of time series of wind stress and sea level pressure, and one by using a two-dimensional hydrodynamic model. The last two models explain a large part of the variability, which significantly improves the accuracy of the estimated time-varying trend. The best results are obtained with the hydrodynamic model. We find a consistent low-frequency sea level signal in the North Sea, which can be linked to a steric signal over the northeastern part of the Atlantic.


Recently, enormous datasets have made power dissipation and area usage lie at the heart of designs for artificial neural networks (ANNs). Considering the significant role of activation functions in neurons and the growth of hardware-based neural networks like memristive neural networks, this work proposes a novel design for a hyperbolic tangent activation function (Tanh) to be used in memristive-based neuromorphic architectures. The purpose of implementing a CMOS-based design for Tanh is to decrease power dissipation and area usage. This design also increases the overall speed of computation in ANNs, while keeping the accuracy in an acceptable range. The proposed design is one of the first analog designs for the hyperbolic tangent and its performance is analyzed by using two well-known datsets, including the Modified National Institute of Standards and Technology (MNIST) and Fashion-MNIST. The direct implementation of the proposed design for Tanh is proposed and investigated via software and hardware modeling.


months three patients with severe hyperthyroidism accompanied by hypercalcaemia. In two of these anorexia and vomiting were conspicuous symptoms. This caused some puzzlement and was responsible for considerable delay in diagnosis. Thus in the only two cases I have seen of vomiting with hyperthyroidism hypercalcaemia was present, and I have always assumed since then that this combination should prompt a request for a serum calcium determination. It would be interesting to know if any such determinations were made in the case of the patients described. P H SANDERSON Medical Unit, St Mary's Hospital, London W2


Environmental issues have received increasing attention recently. Compared to solvent borne polyurethane (PU), waterborne PU requires relatively little solvent dosage. Therefore, waterborne PU is used to replace traditional solvent borne PU to satisfy environmental and economic requirements. Chitosan is a material that has been discussed widely in recent years because of its exceptional antimicrobial performance, biocompatibility, bioactivity, and biodegradability. This study primarily uses a prepolymer mixing process to synthesize m-TMXDI based waterborne PU with different ratios of aqueous chitosan and chain extenders (ethylenediamine; EDA). Modification reactions are conducted and waterborne PU modified by aqueous chitosan is synthesized. Through this experimental method, emulsions modified by different compositional proportions of aqueous chitosan to EDA were tested. For material determination, FTIR, NMR, and XPS were used to conduct chemical structure determination and GPC molecular weight tests. Regarding membrane properties, a contact angle meter analyzed the hydrophility of the membrane and the antimicrobial performance of the prepared waterborne PU membrane against Staphylococcus aureus and Escherichia coli. The test results showed the following characteristics: (1) The terminal NCO group of the waterborne PU (WPU) was bonded with the terminal amino group(-NH2) of chitosan, and (2) as the proportion of aqueous chitosan added increased, improvements were observed regarding molecular weight, hydrophility, and antimicrobial performance.


Abstract In oxic waters, dissolved Fe exists dominantly as Fe(III) complexes with strongly coordinating, siderophore-like ligands. In this study, we have determined an equilibrium Fe isotope fractionation of 0.6‰ (Δ56Fe) between inorganic Fe(III) and Fe(III) siderophore complexes using the siderophore desferrioxamine B as a model compound. The 57Fe tracer experiments show that the Fe isotopes of the siderophores exchange readily with dissolved inorganic Fe. The results indicate that organic ligands are likely to be important in the generation of Fe isotope signatures in oxic environments. For example, the isotopic composition of marine Fe-Mn nodules may largely be due to the presence of strongly coordinating ligands.


This article draws attention to the relation between Husserl's 'talk of Being' in the transcendental reduction in Ideas I (1913) and Heidegger's re-orientation of Husserl's idea of transcendental phenomenology towards 'the question of the meaning of Being' and its relation to Dasein in Being and Time (1927). It argues that Heidegger's selection of 'death' as an 'object' for phenomenological elucidation challenges both the confines and the suppositions of Husserl's 'talk of Being' in the reduction as the sole possibility for transcendental phenomenology. It also argues that Heidegger's distinction between 'authentic' and 'inauthentic' talk about death in Being and Time radically challenges Husserl's distinction between 'authentic and inauthentic thinking' espoused in the Logical Investigations (1900–01). This is why Husserl is correct to see, much to his disappointment and incomprehension, both overt and covert criticisms of his philosophical position in Being and Time by its author. Yet despite Husserl's misgivings about Heidegger's phenomenological credentials, Being and Time is a work in phenomenology because it is founded in the experience of finitude and it provides a conception of philosophy that is capable of subsuming Husserl's reduction under its own grander conception of transcendental phenomenology as 'fundamental ontology'.


For many women, labour and childbirth is a time of excitement and anticipation alongside uncertainty, anxiety, fear and pain. The memories and experiences of childbirth remain with the woman throughout her life. Clearly, the support and care they receive during this period is critical. The study aims to assess quality of nursing care offered during intrapartum and postpartum periods,  patient satisfaction with care and  to find the relationship between maternal satisfaction and some variables example, maternal age, education, duration of labor and reproductive history. A descriptive study was carried out from 22 April, 2013 through 15 February, 2014. A purposive sample of (200) postpartum women, delivered at the maternity teaching  hospital. A questionnaire was comprised of two parts: socio-demographic characteristics and History of pregnancy and Women's views of birth Labor Satisfaction Questionnaire (WQBLS4). Data were collected through interview and analyzed through the application of descriptive and inferential statistical approaches by statisitical package for social sciences  (SPSS)  (17.0) program. ANOVA (F) test was used in the statistical assessment and the figure of p<0.05 was considered as the statistically significant. The study findings, indicate that women were satisfied regarding their expectations of the childbirth process, length and holding their baby, support from husband and their relative, in addition they were strongly satisfied with items related to professional support, environment and general satisfaction. The study concludes  that the main factors identified as influencing satisfaction and dissatisfaction were, caregivers and client interaction, the characteristics of the setting, the involvement of clients in the caring process, the nurses' perception of client characteristics, the outcome of labour for both mother and baby.

 Key words: Satisfaction, nursing care, labour.


We introduce an interesting interpretation of the ROC Curve that, subsequently, opens a new research paradigm. We define the "Diagnostician Operating Choice" (DOC) Curve to be the set of all (True Positive Probability/True Negative Probability) or ("skill in diseased population"/"skill in non-diseased population" when considered from the diagnostician's perspective) options made available to a particular radiologist when interpreting a particular diagnostic technology. The DOC Curve is, thus, the choice set presented to the diagnostician by their interaction with the technology. This new paradigm calls for tools that can measure the particular choice set of any particular individual radiologist interpreting a particular technology when applied in a particular clinical setting. Fundamental requirements for this paradigm are for the DOC Curve to be unique to individuals and constant across similar experimental conditions. To investigate constancy, we analyzed data from a reading study of 10 radiologists. Each radiologist interpreted the same set of 148 screening mammograms twice using a modified version of BI-RADS. ROC Curves for each radiologist were computed and compared between the two reading occasions with the CORROC2 program. None of the areas were statistically significantly different (p<0.05), providing confirmation (but not proof) of constancy across the two reading conditions. The DOC Curve paradigm suggests new areas of research focusing on the behavior in individuals interacting with technology. A clear need is for more efficient estimation of individual DOC Curves based on limited case sets. Paradoxically, the answer to this last problem might lie in using large population-based ("MRMC") studies to develop highly efficient and externally validated standardized testing tools for assessment of the individual.


Today the industry cluster in developing countries comes to the bottleneck which is "big but not strong" because of excessive reliance on cost competition and lack of innovation ability. Therefore, industry cluster in space does not mean the economic competitive, the innovation network is the source of competitive advantage in the cluster. Gradually, how to promote the innovation network of industry cluster in developing countries becomes an urgent problem to explore and solve. In this paper, we review the knowledge network in the industry cluster and the weighted complex network, analyze the mechanism of cluster innovation, and at last give the tactics in order to create continuous momentum for the cluster innovation. The conclusion of this paper has some significance as reference for those policy-makers who try to improve industry cluster innovation.


Abstract Pseudomonas aeruginosa was isolated in low rates from stool specimens of outpatients and inpatients (7% versus 12%) but in higher rates from chlorinated and nonchlorinated water sources (15% versus 44%), respectively in Jordan. The same biotype was recognized among 90% of P. aeruginosa isolates from patient's stools and water sources using specific biochemical profiles. Three serogroups belonging to 01, 06 and 011 accounted for the majority of these isolates in water (66%) and stools (78%), respectively. All P. aeruginosa isolates from water were highly susceptible (87%-100%) to piperacillin-tazobactam, amikacin, gentamicin, imipenem, aztreonam, ceftazidime and ciprofloxacin, whereas the isolates from stool were slightly less susceptible (81%-98%) to these antimicrobials. P. aeruginosa isolates from water and stool sources were almost equally highly resistant to tetracycline (86%-89%) and carbenicillin (88%-89%), respectively. One common small plasmid (15.4 kb) was detected in 14/25 (56%) of multidrug-resistant P. aeruginosa isolates from both water and stool. This study demonstrates certain common epidemiological characteristics including antimicrobial resistance pattern, biotypes and serotypes among P. aeruginosa isolates from patient's stools and drinking water sources in Jordan.


Dealing with latent constructs (loaded by reflective and congeneric measures) cross-culturally compared means studying how these unobserved variables vary, and/or covary each other, after controlling for possibly disturbing cultural forces. This yields to the so-called 'measurement invariance' matter that refers to the extent to which data collected by the same multi-item measurement instrument (i.e., self-reported questionnaire of items underlying common latent constructs) are comparable across different cultural environments. As a matter of fact, it would be unthinkable exploring latent variables heterogeneity (e.g., latent means; latent levels of deviations from the means (i.e., latent variances), latent levels of shared variation from the respective means (i.e., latent covariances), levels of magnitude of structural path coefficients with regard to causal relations among latent variables) across different populations without controlling for cultural bias in the underlying measures. Furthermore, it would be unrealistic to assess this latter correction without using a framework that is able to take into account all these potential cultural biases across populations simultaneously. Since the real world 'acts' in a simultaneous way as well. As a consequence, I, as researcher, may want to control for cultural forces hypothesizing they are all acting at the same time throughout groups of comparison and therefore examining if they are inflating or suppressing my new estimations with hierarchical nested constraints on the original estimated parameters. Multi Sample Structural Equation Modeling-based Confirmatory Factor Analysis (MS-SEM-based CFA) still represents a dominant and flexible statistical framework to work out this potential cultural bias in a simultaneous way. With this dissertation I wanted to make an attempt to introduce new viewpoints on measurement invariance handled under covariance-based SEM framework by means of a consumer behavior modeling application on functional food choices.


For the first time, 2-aminobenzimidazole (2-ABI) was tested as a corrosion inhibitor for copper in 3 wt% NaCl solution at 25 °C using cyclic voltammetry (CV), chronopotentiometry, electrochemical impedance spectroscopy (EIS), and potentiodynamic curve (PD) techniques. The EIS measurements indicated that the corrosion of Cu in the presence of 2-ABI followed kinetic- and diffusion-controlled processes. After 100 h of immersion, the potentiodynamic curves showed that 2-ABI acts as a mixed-type inhibitor, with a predominant action on the anodic corrosion reaction. ATR-FTIR confirmed the adsorption of 2-ABI on the Cu surface, which resulted in increased hydrophobicity of the copper surface and reduced its surface roughness.


With the development of multimedia technology and digital devices, it is very easier to recapture image of high quality from LCD screens and the use of such recapture image in authentication can be harmful. An attacker may choose to recapture a forged image in order to hide imperfections and to increase its authenticity. To do forensic analysis of such images for evidence is very important. So detection of recapture images from set of images is very important in this case. In this paper we did survey of various recapture image detection algorithms with their pros and cons. Also we studied various features like aliasing, blurriness etc. of recaptured images, which can differentiate recapture image from original one.


In this paper we consider the design of a robust timing synchronization algorithm for pilot-aided OFDM systems in high-mobility fading environments. We first analyze the impact of both mobility and timing errors on the performance of a pilot-aided OFDM system for frequency selective fading channels, by deriving an expression for channel estimation error variance. The analysis will show that, even for high levels of mobility, a pilot-aided channel estimator is considerably sensitive to timing errors, due to the impact of rotations in different bases. We then show how this sensitivity can be utilized to design a robust timing synchronization algorithm for mobile OFDM systems, without relying on synchronization training information. Theoretical results are then confirmed by simulating the performance of an OFDM system in high delay and Doppler spread fading environments. Finally, we show how the proposed mathematical framework and algorithm can be used to address timing synchronization in the presence of a frequency offset as well. The analysis of this paper is the extension of the derivations of Part I [8], the accompanying paper on the design of a robust timing synchronizer for low-mobility OFDM systems.


—Convolution-augmented transformers (Conformers) are recently proposed in various speech-domain applications, such as automatic speech recognition (ASR) and speech separa- tion, as they can capture both local and global dependencies. In this paper, we propose a conformer-based metric generative ad- versarial network (CMGAN) for speech enhancement (SE) in the time-frequency (TF) domain. The generator encodes the magni- tude and complex spectrogram information using two-stage conformer blocks to model both time and frequency dependencies. The decoder then decouples the estimation into a magnitude mask decoder branch to filter out unwanted distortions and a complex refinement branch to further improve the magnitude estimation and implicitly enhance the phase information. Additionally, we include a metric discriminator to alleviate metric mismatch by optimizing the generator with respect to a corresponding evaluation score. Objective and subjective evaluations illustrate that CMGAN is able to show superior performance compared to state-of-the-art methods in three speech enhancement tasks (denoising, dereverberation and super-resolution). For instance, quantitative denoising analysis on Voice Bank+DEMAND dataset indicates that CMGAN outperforms various previous models with a margin, i.e., PESQ of 3.41 and SSNR of 11.10 dB.


Securing a network from the attackers is a challenging task at present as many users involve in variety of computer networks. To protect any individual host in a network or the entire network, some security system must be implemented. In this case, the Intrusion Detection System (IDS) is essential to protect the network from the intruders. The IDS have to deal with a lot of network packets with different characteristics. A signature-based IDS is a potential tool to understand former attacks and to define suitable method to conquest it in variety of applications. Data Mining techniques are used in the process of knowledge discovery for many domains' problems. Feature Selection plays a vital role for a large number of datasets. This paper discusses on the classification of attacks in the network with the assistance of the proposed Optimized Intrusion Detection Classification technique. In this proposed technique, the DBN hidden layers weights are optimized by using evolutionary Genetic algorithm. This GA is utilized to enhance the classification accuracy by applying the hidden layers of Restricted Boltzmann Machine (RBM). The comparative results show that the proposed classifier gives the improved accuracy, specificity, precision, Sensitivity, and reduced false positive rate, miss rate.


Pathways regulated by Phosphotidylinositide-3-kinase (PI3K) have emerged as important mediators of cell proliferation and survival. When altered, several components of this pathway have been identified to contribute towards a wide range of human malignancies. PI3K has been implicated in the development of several EBV-associated malignancies of both lymphoid and epithelial origin. These include Burkitt's lymphoma, Hodgkin's disease and nasopharyngeal carcinoma. Although progress has been made in dissecting the pathways regulated by PI3K, the key components contributing to lymphocyte transformation have not been fully characterised. This study sought to investigate downstream targets of PI3K in lymphocytes in order to further our understanding of the contribution of PI3K signalling to lymphocyte proliferation and survival, particularly within the context of EBV-associated B-cell lymphomas. Initial work in this study revealed that a component of the mammalian ribosome, S6-ribosomal protein, is a major target for PI3K activation in transformed lymphocytes. In order to study PI3K and EBV regulated proteins on a larger scale, the technology of two-dimensional electrophoresis (2DE) was employed. The use of 2DE in combination with a PI3K inhibitor did not allow the identification of PI3K regulated proteins. However, three EBV regulated proteins were detected in the B-lymphocyte nucleus using this technology. The technology was further developed to study the post-translational modifications of DNA bound transcription factors. This detected multiple isoforms of the cAMP-response element binding protein (CREB), signal transducers and activators of transcription 1 (STAT1) and forkhead box O (FOXO) transcription factors in the nuclei of EBV immortalized lymphocytes. More detailed analysis of the PI3K regulated pro-apoptotic transcription factor, FOXO1, revealed that this protein is downregulated in EBV positive cells at both the transcriptional and translational levels. This downregulation was shown to directly correlate with the protein expression of a known target gene activated by FOXO1, Bcl-6, and to inversely correlate with protein levels of Cyclin D2, a target transcriptionally repressed by FOXO1. Further investigations into the mechanisms by which EBV downregulates FOXO1 implicated a role for two EBV encoded proteins, Latent membrane protein-1 (LMP1) and LMP2A in the downregulation of both FOXO1, and its target gene, Bcl-6. In conclusion, this work has explored the use of antibody detection and proteomic techniques for the identification and analysis of nuclear proteins and transcription factors regulated by PI3K and EBV. Together, these investigations have deepened our understanding of the molecular changes that occur in lymphocytes in response to EBV infection, and how EBV may influence malignancy.


ABSTRACT The purpose of this study was to evaluate the immunomodulatory activity of Spirulina, a bluegreen alga used as a food supplement. The effects of Spirulina on the secretion of three cytokines from unstimulated and stimulated human peripheral blood mononuclear cells (PBMC) were examined. In resting PBMC, Spirulina stimulated secretion of interleukin (IL)-1beta, IL-4, and interferon (IFN)-gamma to nearly 2.0, 3.3, and 13.6 times basal levels, respectively. Spirulina induced levels of IFN-gamma (229 +/- 104 pg/ml) that were comparable to those seen after phytohemagglutinin (PHA) stimulation (476 +/- 121 pg/ml). However, it was much less mitogenic than PHA (13.1 +/- 6.9 pg/ml) with respect to the induction of IL-4 secretion (0.34 +/- 0.1 pg/ml). In PHA-stimulated cells, Spirulina enhanced secretion of IL-1beta, IL-4, and IFN-beta by 2.9, 4.0., and 1.6 times, respectively. Although Spirulina stimulates several cytokines, it is clearly more effective in the generation of a Thl-type response. This in vitro study offers additional data for consideration of the potential therapeutic benefits of Spirulina.


Automatic facial micro-expression (ME) analysis is a growing field of research that has gained much attention in the last five years. With many recent works testing on limited data, there is a need to spur better approaches that are both robust and effective. This paper summarises the 2nd Facial Micro-Expression Grand Challenge (MEGC 2019) held in conjunction with the 14th IEEE Conference on Automatic Face and Gesture Recognition (FG) 2019. In this workshop, we proposed challenges for two micro-expression (ME) tasks— spotting and recognition, with the aim of encouraging rigorous evaluation and development of new robust techniques that can accommodate data captured across a variety of settings. In this paper, we outline the evaluation protocols for the two challenge tasks, the datasets involved, and an analysis of the best performing works from the participating teams, together with a summary of results. Finally, we highlight some possible future directions.


Providing a convenient mechanism for accessing the Internet, smartphones have led to the rapid growth of Social Networking Services (SNSs) such as Twitter and have served as a major platform for SNSs. Nowadays, people are able to check conveniently the SNS messages posted by their friends and followers via their smartphones. As a consequence, people are exposed to spoilers of TV programs that they follow. So far, there are two previous works that explored the detection of spoilers in texts, not SNS: (1) keyword matching method and (2) machine-learning method based on Latent Dirichlet Allocation (LDA). The keyword matching method evaluates most tweets as spoilers; hence its poor recall performance. The other method based on LDA, although successful on large text, works poorly on short segments of text such as those found on Twitter and evaluates most tweets as non-spoilers. This paper presents four features that are significant in the classification of spoiler tweets. Using those features, we classified spoiler tweets pertaining to a reality TV show ("Dancing with the Stars"). We experimentally compared our method with previous methods, with our method achieving substantially higher precision compared to the keyword matching and LDA-based methods while maintaining comparable recalls.


Background: Spermidine has recently received major attention for its potential therapeutic benefits in the context of neurodegeneration, cancer, and aging. However, it is unclear whether concentration dependencies of spermidine exist, to differentially enhance autophagic flux. Moreover, the relationship between low or high autophagy activity relative to basal neuronal autophagy flux and subsequent protein clearance as well as cellular toxicity has remained largely unclear. Methods: Here, we used high-resolution imaging and biochemical techniques to investigate the effects of a low and of a high concentration of spermidine on autophagic flux, neuronal toxicity, and protein clearance in in vitro models of paraquat (PQ) induced neuronal toxicity and amyloid precursor protein (APP) overexpression, as well as in an in vivo model of PQ-induced rodent brain injury. Results: Our results reveal that spermidine induces autophagic flux in a concentration-dependent manner, however the detectable change in the autophagy response critically depends on the specificity and sensitivity of the method employed. By using correlative imaging techniques through Super-Resolution Structured Illumination Microscopy (SR-SIM) and Focused Ion Beam Scanning Electron Microscopy (FIB-SEM), we demonstrate that spermidine at a low concentration induces autophagosome formation capable of large volume clearance. In addition, we provide evidence of distinct, context-dependent protective roles of spermidine in models of Alzheimer's disease. In an in vitro environment, a low concentration of spermidine protected against PQ-induced toxicity, while both low and high concentrations provided protection against cytotoxicity induced by APP overexpression. In the in vivo scenario, we demonstrate brain region-specific susceptibility to PQ-induced neuronal toxicity, with the hippocampus being highly susceptible compared to the cortex. Regardless of this, spermidine administered at both low and high dosages protected against paraquat-induced toxicity. Conclusions: Taken together, our results demonstrate that firstly, administration of spermidine may present a favourable therapeutic strategy for the treatment of Alzheimer's disease and secondly, that concentration and dosage-dependent precision autophagy flux screening may be more critical for optimal autophagy and cell death control than previously thought.


Objectives: To describe and compare published reference charts of amniotic fluid index (AFI), in order to assess the impact of different normal values on clinical management of pregnancy at relevant gestational age. Methods: A PUBMED search was performed in order to identify all the studies published between 1985 and 2016 whose only aim was to create amniotic fluid index normal values in singleton pregnancies. The search, by using the MESH terms ''amniotic fluid index'', ''reference values'' and ''ultrasound'' yielded 77 possible citations. After screening of titles and abstracts, full texts of eligible papers were assessed. Only 19 studies with the primary objective of creating AFI normal charts in the second and third trimester, using either a cross-sectional or longitudinal design, were included in the review. The discrepancy between AFI cut-off values for 5th, 50th and 95th centiles, at clinically relevant gestational age (GA) (28, 32, 36, 40 weeks) were expressed in percentage of the difference between the lowest and the highest AFI value, divided by the highest. Results: The comparison between reference charts showed wide inconsistencies for cut off values of 5th, 50th and 95th centile at relevant GA. There were large variations between studies. For the 50th centile the variation was up to 45%, while differences above 40% were observed for the 95th centile. Despite the clinical relevance, the cut off for the 5th centile showed the greatest differences. For example at 32 weeks the 5th centile in the published studies ranged from 60 to 140mm; in the whole window differences above 60% were common and maximum differences were 68%. Conclusions: Large differences exist in current AFI normal reference charts at clinically relevant gestational ages. The variability between cut off values may lead to different clinical management. Therefore, an attempt to standardise AFI reference values is urgently needed.


In this paper we investigate, through a randomized controlled trial design, the impact of a personalized text messaging intervention designed to encourage college freshmen to refile their Free Application for Federal Student Aid (FAFSA) and maintain their financial aid for sophomore year. The intervention produced large and positive effects among freshmen at community colleges where text recipients were almost 14 percentage points more likely to remain continuously enrolled through the Spring of sophomore year. By contrast, the intervention did not improve sophomore year persistence among freshmen at four-year institutions among whom the rate of persistence was already high.


It is acknowledged that traditional approaches to human rights can have and have had a negative impact in the field of environmental protection. But the emphasis in human rights on controlling the abuse of power and its capacity to equip social movements with a language of protest and a platform for change shows the potential for mutually beneficial connections between the two fields. The use made by environmental activists of various human rights that are to be found in international and regional laws is considered, as well as the way new social movements in the environmental arena have deployed the language of rights to promote their goals. It is concluded that a mutually reciprocal relationship between the two fields is both possible and – given the threat of climate change – essential.


The Forsmark Nuclear Plant is one of the largest in Sweden and produces around one sixth of the total electrical energy in the country. It is situated on the east coast of Sweden in the Uppland region. Nuclear waste has to be properly handled every year and Forsmark is one site proposed for long-term storage of all spent fuel from Swedish nuclear power reactors. This potential high-level repository (a low-level one already exists in the area) will be based on the KBS-3 design process, which consists of 6000 iron-copper capsules where the waste will be stored for 30 years and finally buried 500 m down, isolated from the environment for100.000 years.Before using the disposal site, numerous investigations must be done in the area so the risks are reduced as much as possible. These investigations include drilling of cored boreholes down to 1000 m depth. In this study the KFM01A borehole (figure 1.1) was used with different shot points to analyze possible anisotropy in the subsurface. The anisotropy in rocks can be due to different mechanisms as crystal and mineral grain alignment, crack and pore space alignment and thin layer anisotropy (Rowlands J. et al., 1993). For this purpose a shear wave splitting analysis was done in an attempt to determine both orientation and density of fractures.Shear wave splitting has shown to be a very effective method detecting fractures, providing an unique ability to measure anisotropic seismic attributes that are sensitive to fractures (James E. Gaiser, 2004). This can be useful in many domains as in oil companies to improve reservoir management (James E. Gaiser, 2004) or as an imaging tool in fracture-controlled geothermal reservoirs, to monitor fluid pressure in the cracks and changes in crack density (Tang Chuanhai, 2005). Shear wave splitting studies have also been done in seismology for crustal studies (Rowlands J. et al., 1993).When shear waves enter anisotropic medias they split in two approximately orthogonal components, where the faster and slower components will travel parallel and perpendicular to the fracture planes respectively. The time delay will depend of the amount of anisotropy and the path length. Different methods can be used to evaluate the anisotropy; polarization diagrams (Crampin et al., 1986), linear moveout plots of the horizontal components (Li et al.,1988).The procedure described by Li et al. (1988) are the techniques that are used in the present study.The fractures orientation is also analyzed and compared with the general stress components in the area using well bore information from previous studies, as well as the general tectonic characteristics of the zone.


«Smart tourism» has gained momentum in research fostered by the revolution of the latest generation of information and communication technologies and has rapidly become a leading stream of literature. The concept has permeated governments and the business sphere and has been accompanied by the quest for developing smart devices, services and tourist destinations. However, experiences as the main focus of smartness development in tourism and destinations have received comparably little attention in the smart discourse. Smart destinations, as new ecosystems backed by concrete geographical contexts, facilitate the co-creation of a rich, technology-based, smart tourism experience (STE). Yet, a clear definition and examination of the dimensions of what constitutes a smart tourism experience is still to be developed. This paper aims to discuss the main core precedent constructs of STEs, namely: a) technology enhanced experiences and b) smart destinations, to underpin a holistic definition of a smart tourism experience. Based on an in-depth literature review, a novel conceptual model for this concept is developed and an agenda for further research is proposed drawing on the identified key themes and dimensions of this construct. By mapping out smart tourism experiences and providing real examples, this research contributes to the theoretical foundations of smart tourism and tourist experiences.


The paper aims at measuring both the relationship and reciprocal effect between strategic agility along with its dimensions (agility of sensing, agility of decisionmaking, agility of practice), on one hand, and competitive intelligence along with its dimensions (market intelligence, competitor intelligence, technology intelligence), on the other hand. Korek mobile communications company in Iraq is used as the field of the study. Questionnaire has been used as a tool for collecting data to achieve the aims of the paper. There are (43) forms distributed to the managers at the company's headquarters, and all the forms retrieved have been found valid for statistical analysis. In this context, the analysis adopts a number of statistical methods (like: correlation coefficient, simple linear regression coefficient). The study concludes that there is a correlation relationship with significant statistical significance between strategic agility and competitive intelligence, and the presence of a positive reciprocal effect with significant statistical significance between strategic agility and competitive intelligence. Finally, a set of recommendations, based on the given conclusions, has been suggested. one of these recommendation is the focus on the sustainability of strengthening the relationship between strategic agility and competitive intelligence due to the importance of such sustainability and the positive reflection on the organization's performance as well as enhancing the mutual effect between strategic agility and competitive intelligence via focusing on achieving compatibility and compatibility between the sub-dimensions of the two variables.


Abstract The transnational character of the literate musical community in the United States created an environment in which language barriers, ideological biases, and other potential sources of misunderstanding caused print items to change shape quickly as they were transferred from one reader to the next. The aesthetic controversy between William Henry Fry and Richard Storrs Willis surrounding the 1853 premiere of Fry's Santa Claus: Christmas Symphony provides a rich case in point. The controversy at times seemed to draw from a parallel debate in Europe, often called "The War of the Romantics," which concerned the future of symphonic composition and music's capacity for representation. At others, the controversy seemed to diverge from its European counterpart as central concepts were articulated in new intellectual contexts. The vagaries of print culture help explain these discrepancies. This article outlines the central arguments of the debate, situates them within their transatlantic contexts, and examines how print culture played a significant role in the controversy's unfolding as early as 1839, fifteen years before it took place. More broadly, it constructs a new framework for examining the function and meaning of nineteenth-century music periodicals by illustrating how an antislavery newspaper became an unlikely voice in a debate over program music.


Critical systems heuristics (CSH) is a framework for reflective professional practice organised around the central tool of boundary critique. This paper, written jointly by the original developer, Werner Ulrich, and Martin Reynolds, an experienced practitioner of CSH, offers a systematic introduction to the idea and use of boundary critique. Its core concepts are explained in detail and their use is illustrated by means of two case studies from the domain of environmental planning and management. A particular focus is on working constructively with tensions between opposing perspectives as they arise in many situations of professional intervention. These include tensions such as 'situation' versus 'system', 'is' versus 'ought' judgements, concerns of 'those involved' versus 'those affected but not involved', stakeholders' 'stakes' versus 'stakeholding issues', and others. Accordingly, boundary critique is presented as a participatory process of unfolding and questioning boundary judgements rather than as an expert-driven process of boundary setting. The paper concludes with a discussion of some essential skills and considerations regarding the practice of boundary critique.


Recent rapid development of both networking and cloud computing technologies is transforming the Internet from an infrastructure for data transportation to a general platform for service provisioning upon which a wide spectrum of cloud computing applications can be deployed. Such transform requires networking and cloud computing to be integrated in the next generation Internet, which calls for federated management of both networking and computing resources for service provisioning. The Service-Oriented Architecture (SOA), which has been widely adopted in cloud computing through the IaaS, PaaS, and SaaS paradigms, has been applied in networking to enable the Network-as-a-Service (NaaS) paradigm. The NaaS in networking together with IaaS in cloud computing offers a promising approach toward converged network-Cloud service provisioning in the next generation Internet. A key challenge to achieve high performance converged network-cloud services lies in composition of network and Cloud services with end-to-end performance guarantee. In this chapter, we present our recent research progress in Quality of Service (QoS)-aware network- cloud service composition, including system model and problem formulation for network-cloud service composition and our proposal of an efficient algorithm to solve this problem. We also report the experimental results for evaluating the performance of the proposed algorithm in this chapter.


Endonucleolytic removal of 5'-leader sequences from tRNA precursor transcripts (pre-tRNAs) by RNase P is essential for protein synthesis. Beyond RNA-based RNase P enzymes, protein-only versions of the enzyme exert this function in various Eukarya (there termed PRORPs) and in some bacteria (Aquifex aeolicus and close relatives); both enzyme types belong to distinct subgroups of the PIN domain metallonuclease superfamily. Homologs of Aquifex RNase P (HARPs) are also expressed in some other bacteria and many archaea, where they coexist with RNA-based RNase P and do not represent the main RNase P activity. Here we solved the structure of the bacterial HARP from Halorhodospira halophila by cryo-EM revealing a novel screw-like dodecameric assembly. Biochemical experiments demonstrate that oligomerization is required for RNase P activity of HARPs. We propose that the tRNA substrate binds to an extended spike-helix (SH) domain that protrudes from the screw-like assembly to position the 5'-end in close proximity to the active site of the neighboring dimer subunit. The structure suggests that eukaryotic PRORPs and prokaryotic HARPs recognize the same structural elements of pre-tRNAs (tRNA elbow region and cleavage site). Our analysis thus delivers the structural and mechanistic basis for pre-tRNA processing by the prokaryotic HARP system.


A new zero voltage and zero current switching (ZVZCS) full bridge DC-DC converter with transformer isolation is proposed for arc welding machines. The proposed DC-DC converter uses an auxiliary transformer to obtain ZCS for the leading leg, which provides load current control capability even under short circuit conditions. The power rating of the auxiliary transformer is /spl sim/10% or more of the main transformer. The operation is verified by experiments.


Physical systems typically evolve continuously whereas modern controllers and signal processing devices invariably operate in discrete time. Hence sampling arises as a cornerstone problem in essentially all aspects of modern systems science. This paper reviews various aspects of sampling of signals and systems. We argue that careful consideration must be given to sampling to obtain meaningful results when interconnecting a physical system to a computer for the purpose of data storage, signal processing, or control. We also take the opportunity to dispel several common misconceptions about sampling and sampled-data systems.


BACKGROUND
This study concerns clinical characteristics and survival of renal cell carcinoma (RCC) patients in University Malaya Medical Centre (UMMC), as well as the prognostic significance of presenting symptoms.

MATERIALS AND METHODS
The clinical characteristics, presenting symptoms and survival of RCC patients (n=151) treated at UMMC from 2003-2012 were analysed. Symptoms evaluated were macrohaematuria, flank pain, palpable abdominal mass, fever, lethargy, loss of weight, anaemia, elevated ALP, hypoalbuminemia and thrombocytosis. Univariate and multivariate Cox regression analyses were performed to determine the prognostic significance of these presenting symptoms. Kaplan Meier and log rank tests were employed for survival analysis.

RESULTS
The 2002 TNM staging was a prognostic factor (p<0.001) but Fuhrman grading was not significantly correlated with survival (p=0.088). At presentation, 76.8% of the patients were symptomatic. Generally, symptomatic tumours had a worse survival prognosis compared to asymptomatic cases (p=0.009; HR 4.74). All symptoms significantly affect disease specific survival except frank haematuria and loin pain on univariate Cox regression analysis. On multivariate analysis adjusted for stage, only clinically palpable abdominal mass remained statistically significant (p=0.027). The mean tumour size of palpable abdominal masses, 9.5±4.3cm, was larger than non palpable masses, 5.3±2.7cm (p<0.001).

CONCLUSIONS
This is the first report which includes survival information of RCC patients from Malaysia. Here the TNM stage and a palpable abdominal mass were independent predictors for survival. Further investigations using a multicentre cohort to analyse mortality and survival rates may aid in improving management of these patients.


Objectives: The objective of this study was to determine whether a 5-module self-paced computerized educational program improves residents' skills in assessing and managing youth presenting to the emergency department in acute psychiatric distress. Methods: The evaluation used a quasi-experimental posttest-only design assessing both knowledge of the educational context of the program and self-rated pretest knowledge of program content with 32 residents recruited from 1 medical center in Cleveland, Ohio. Results: About half of the respondents were female (48%); almost two thirds were white (65%), and few were trained in psychiatric assessment of children/adolescents. On average, residents had significantly higher scores on the posttest compared with the self-rated pretest (6.4 ± 1.1 vs 3.8 ± 2.3; P < 0.001), an effect size of 1.32. Residents responded positively to the modules and rated them highly on educational content (4.2 ± 0.5 on a 5-point scale) and satisfaction with clinical applicability (8.2 ± 1.2 on a 10-point scale) and found the program easy to navigate (8.5 ± 1.9 on a 10-point scale). Conclusions: A brief, self-administered, Web-based training program shows promise for improving residents' knowledge about suicidal behaviors in youth.


There are aspects of New Product Development (NPD) business processes that pose particularly difficult challenges to Organizational Learning systems. Short product and process life cycles compress the available time window for recouping the expenses associated with product development. Cross-functional collaboration in product development organizations requires the merging of knowledge from diverse disciplinary and personal skills-based perspectives. Cross-institutional collaboration leads a requirement for knowledge to be combined from participants across multiple collaborating organizations. Transient existence in teams and high turnover results in a reduction in organizational knowledge unless there is a repository for knowledge rather than a dependence on knowledge which is situated in the minds of individuals. High rates of change in turbulent industries, such as electronics, motivates participants in NPD processes to effectively overcome these Organizational Learning challenges. The potential payoff includes time saved by not repeating mistakes and reuse of knowledge that leads to successful products and processes. IS research has paid little attention to NPD processes despite the fact that some IS appears to have the potential to have an impact in that area. Recent research completed by these researchers in Analog Devices Inc identified Organizational Learning challenges encountered by engineering teams in product development. This paper will report on these challenges and will describe how systems were developed to support organizational learning to support the product development process.


PURPOSE
We previously reported a beneficial effect of benfluorex (BFL) on oral glucose tolerance test (OGTT) and visceral fat mass in an open-label study conducted in 60 HIV-infected patients. The objective of this study was to assess whether administration of BFL compared to placebo (PBO) improves insulin resistance (IR) in HIV+ patients with HAART- induced lipodystrophy.

METHOD
22 HIV-infected patients with IR or impaired glucose tolerance were double-blind randomly assigned to receive BFL 3 tablets/day or PBO for 24 weeks. Efficacy assessments included OGTT, abdominal computed tomography, and the measurement of fasting lipids.

RESULTS
Change of median insulin AUC was -53.0 microIU/mL (IQR, -126.0 to -12.7) in the BFL group vs. +33.6 microIU/mL (IQR, 7.0 to 115.6) (p = .01) in PBO group. Weight decreased significantly in the BFL group (-2 kg +/- 2.6; IQR, -6.8 to 2.0) compared to the PBO group (0.8 kg +/- 1.7; IQR, -2.0 to 0.5) (p = .02). No significant changes in visceral or subcutaneous fat mass and plasma lipid level were observed between the two groups.

CONCLUSION
Added to antiretroviral therapy, a 6-month therapy with BFL improved insulin sensitivity but is not sufficient to reduce significantly visceral fat mass.


The accuracy-based XCS classifier system has been shown to solve typical data mining problems in a machine-learning competitive way. However, successful applications in multistep problems, modeled by a Markov decision process, were restricted to very small problems. Until now, the temporal difference learning technique in XCS was based on deterministic updates. However, since a prediction is actually generated by a set of rules in XCS and Learning Classifier Systems in general, gradient-based update methods are applicable. The extension of XCS to gradient-based update methods results in a classifier system that is more robust and more parameter independent, solving large and difficult maze problems reliably. Additionally, the extension to gradient methods highlights the relation of XCS to other function approximation methods in reinforcement learning.


Swidden being a widespread form of land use in the tropics comprehensively defining it become a difficult task. Its characteristics embrace different types of topography, demographic feature, ethnic and ecological diversities. It also varies in terms of cropping pattern, frequency of land use, tools and methods of practice. It is argued that the institutions governing swidden are static in nature and do not adapt to the requirements of the changing ecological and social needs. This necessitates understanding what characterise institutions in a traditional swiddening society, and hence, changes in these characteristics to appreciate whether swidden is a static form of agriculture or changing over the time and space. There are a few aspects, which underscore the institutional face of swidden. Though, population growth plays a crucial role in swiddening system, it is not a necessary condition that the changes in agricultural institutions are guided by the population factor alone. There are also other forms of institutions to understand whether the swidden system of production is static or not. These include, land -use choices vis-a-vis property right structures and labour sharing arrangements, forms of integration with market, changing technology. They depict the economic interface with institutions. Development and changes in the customs and norms are a few of the analytically complex and notable in stitutional changes in swidden. Considering these factors, we attempt to understand the institutional changes observed in the swidden system. Based on the field survey in five swiddening villages of Orissa, we find varying characteristics of changes in the above discussed institutions that call for a comprehensive understanding of the development processes.


Blended learning (BL) has been increasing in popularity and demand and has developed as a common practice in institutions of higher learning. Therefore, this study develops a model to evaluate the critical predictors that determine students' acceptance and deployment of BL in institutions of higher education based on the theory of planned behavior (TPB).,The empirical analysis entails data collected from 1,811 responses from an online survey questionnaire from students in Malaysian universities, colleges and polytechnics. Partial least square–structural equation modeling (PLS–SEM) was employed for data analysis.,The results reveal that the attitude, subjective norm, perceived behavioral control and self-efficacy were found to influence students' intention to accept BL. Moreover, results suggest that the intention of students to accept BL approach is significantly influenced by actual BL deployment.,Data were collected from students in universities, colleges and polytechnics only. Besides, this research is one of the limited studies that explored BL deployment in a Malaysian perspective.,Findings from this research not only add scientific evidence to BL literature but also provide a better understanding of the predictors that may motivate or discourage learners to deploy BL in institutions of higher learning.,Respectively, findings from this study aid students to acquire and apply knowledge on how to effectively improve BL initiatives in learning activities.,This study is one of the fewer studies that investigate students' behavioral intentions toward BL deployment in Malaysia. Additionally, this study contributes to the understanding of the predictors that influence students' intention to accept and deploy BL in their respective institutions.


Purpose. Candida spp. are the most common causes of fungemia. Rapid and accurate diagnostic methods are very important for appropriate management of candidemia. At present, blood culture is the essential diagnostic test despite having a long detection time and low sensitivity rate. We aimed to investigate the ways to shorten the turnaround time from blood culture collection to final identification in candidemia. Methodology. Sixty clinical bloodstream isolates of Candida were included, and Plus Aerobic/F, Peds Plus/F and Mycosis IC/Fbottles were used with a BACTEC 9240 blood culture instrument. Germ tube production, carbohydrate assimilation (API 20C AUX) and peptide nucleic acid fluorescent in situ hybridization yeast traffic light tests were performed directly from positive‐signalled bottles. Results. Time to positivity of blood cultures was affected by species of Candida, fungal load and bottle type. Candida tropicalis had the shortest and Candida glabrata had the longest time to positivity. Mycosis IC/F culture bottle had a significant superiority in the isolation of yeasts, especially for C. glabrata and if there was a low fungal load in the bottle. Direct germ tube test had 90% sensitivity and 97.6% specificity for Candida albicans in two hours after signalling. The compliance between direct and classical assimilation tests was 98.3%. Sensitivity and specificity of peptide nucleic acid fluorescent in situ hybridization were 100%. Conclusion. We think that it is possible to shorten the turnaround time for the identification of Candida in blood culture even with currently available methods.


Clinical guidelines can improve the quality of care in multiple trauma. In our Department of Trauma Surgery a specific guideline is available paper-based as a set of flowcharts. This format is appropriate for the use by experienced physicians but insufficient for electronic support of learning, workflow and process optimization. A formal and logically consistent version represented with a standardized meta-model is necessary for automatic processing. In our project we transferred the paper-based into an electronic format and analyzed the structure with respect to formal errors. Several errors were detected in 7 error categories. The errors were corrected to reach a formal and logically consistent process model. In a second step the clinical content of the guideline was revised interactively using a process modeling tool. Our study reveals that guideline development should be assisted by process modeling tools, which check the content in comparison to a meta-model. The meta-model itself could support the domain experts in formulating their knowledge systematically. To assure sustainability of guideline development a representation independent of specific applications or specific provider is necessary. Then clinical guidelines could be used for training, process optimization and workflow management additionally.


Representative data in terms of a set of selected samples is of interest for various machine learning applications, e.g. dimensionality reduction and classification. The best-known techniques probably still are k-Nearest Neighbors (kNN) and its variants. Recently, richer representations have become popular. Examples are methods based on l1-regularized least squares (Sparse Representation (SR)) or l2-regularized least squares (Collaborative Representation (CR)), or on l1-constrained least squares (Local Linear Embedding (LLE)). We propose Iterative Nearest Neighbors (INN). This is a novel sparse representation that combines the power of SR and LLE with the computational simplicity of kNN. We test our method in terms of dimensionality reduction and classification, using standard benchmarks such as faces (AR), traffic signs (GTSRB), and PASCAL VOC 2007. INN performs better than NN and comparable with CR and SR, while being orders of magnitude faster than the latter.


Purpose of review Evidence-based medicine and guidelines directing the diagnosis and treatment of patients are changing. General recommendations are moving towards an individual focus, where technology evolution allows identification of specific patterns and where 'one size fits all' no longer has a place. Recent findings Emerging innovations on health technology include useful tools for individualizing patients' specific conditions and follow-up. There are several preventive initiatives that aim to reduce allergic disease development, but they have no generalizable and definitive results as yet. Both omics and molecular diagnosis have provided the basis for differentiating clusters of patients, both allowing prediction of severity and also indicating appropriate management. Here we discuss examples contributing to some specific conditions we are now facing. Summary Precision medicine encompasses a personalized care of the patient, the prediction of a successful treatment, the potential prevention of a disease and its progression when present and the important active participation of the patient in the planning and guidance of the approach and management. Technology and medical innovations like omics and molecular diagnosis help for discriminating specific phenotypes/endotypes and the correct individualized interventions. The great challenge for implementing precision medicine will be the possibility of providing those advances to everyone at affordable costs. Conclusion Technology and innovations in medicine are aimed to help all patients globally, providing evidence for particular conditions that need to be personally considered, involving the patient's decision while treating, predicting and preventing disease. Our aim should be to have precision medicine available everywhere at any time.


Abstract. We present a dataset of global soil NO emissions comprising gridded monthly data and the corresponding 3-hourly weight factors, suitable for atmospheric chemistry modelling. Data are provided globally at 0.5° × 0.5° degrees horizontal resolution, and with monthly time resolution over the period 2000–2018. Emissions are provided as total values and also with separate data for soil NO emissions from background biome values, and those induced by fertilizers/manure, pulsing effects, and atmospheric deposition, so that users can include, exclude or modify each component if wanted. This paper presents the emission algorithms and their data-sources, some comments on the availability of soil NO emissions in other inventories (and how to avoid double-counting), and finally some preliminary modelling results and comparison with observed data. This dataset was constructed as part of the Copernicus Atmosphere Monitoring Service (CAMS), with the dataset referred to as CAMS-GLOB-SOIL v2.2. These data are available through the Copernicus Atmosphere Data Store (ADS) system, (https://doi.org/10.24380/kz2r-fe18, last access June 2021, Simpson 2021a) or through the Emissions of atmospheric Compounds and Compilation of Ancillary Data (ECCAD) system (https://eccad.aeris-data.fr/, last access June 2021). For review purposes, ECCAD has set up an anonymous repository where a subset of the CAMS-GLOB-SOIL v2.2 data can be accessed directly (https://eccad.aeris-data.fr/essd-surf-emis-cams-soil/, Last access July 2021, Simpson 2021b).


Most orthopedic surgeons focused only on examining the knee when they see a patient with anterior knee pain (AKP) in the office. This approach is a great mistake because other important etiological factors distant from the knee can be responsible for the pain. Therefore, the entire lower extremity should be examined. AKP is basically a clinical diagnosis, with imaging studies used to confirm the clinical impression. The AKP patient is experiencing chronic pain, and therefore, the evaluation should include psychological factors, which are important in patients with chronic pain. Addressing the whole patient helps to identify potentially modifiable factors so an appropriate therapeutic program can be developed to achieve the best outcomes.


The following letter presents an adaptive path planning algorithm for cooperative localization in the maritime environment. It considers the scenario where an Autonomous Surface Vehicle (ASV) acts as a Communication and Navigation Aid (CNA) to support Autonomous Underwater Vehicles (AUVs) with range measurements. As AUVs have no access to GPS while submerged, range measurements can bind the otherwise continuously growing navigational error. This can be done by methods such as range-only Extended Kalman Filter (EKF). In such methods, the resulting uncertainty and positional error depends on the geometry between transmitter (CNA) and receiver (AUV). This letter proposes a planning algorithm that combines priority based expansion of a search tree with random sampling-based exploration to position the CNA at strategic positions to transmit ranging messages at optimal times to reduce the uncertainty and error at the AUVs' position. The approach is validated and shows an increased confidence for AUVs' localization in simulated environments as well as real experiments using a dataset gathered from AUV Sirius.


Online activities no longer represent a new or emerging aspect of the collegiate experience. College students are "wired." They are actively engaged with social media sites such as Facebook, Instagram, and Twitter; they participate regularly in online gaming activities; and they own devices like smart phones and tablets that facilitate their online participation. According to a Pew Research Center study, the eighteen to twenty-four age group is highly wired, reporting over 80% of four-year undergraduates and graduate students as having social networking sites. Indeed, virtual spaces now constitute an integral and common aspect of the daily lives of many college stu-


This paper estimates the change in net (of subsidy) financial burden ("the price of responsibility") and in welfare that would be experienced by a large nationally representative sample of the "non-poor" uninsured if they were to purchase Silver or Bronze plans on the ACA exchanges. The sample is the set of full-year uninsured persons represented in the Current Population Survey for the pre-ACA period with incomes above 138 percent of the federal poverty level. The estimated change in financial burden compares out-of-pocket payments by income stratum in the pre-ACA period with the sum of premiums (net of subsidy) and expected cost sharing (net of subsidy) for benchmark Silver and Bronze plans, under various assumptions about the extent of increased spending associated with obtaining coverage. In addition to changes in the financial burden, our welfare estimates incorporate the value of additional care consumed and the change in risk premiums for changes in exposure to out-of-pocket payments associated with coverage, under various assumptions about risk aversion. We find that the average financial burden will increase for all income levels once insured. Subsidy-eligible persons with incomes below 250 percent of the poverty threshold likely experience welfare improvements that offset the higher financial burden, depending on assumptions about risk aversion and the value of additional consumption of medical care. However, even under the most optimistic assumptions, close to half of the formerly uninsured (especially those with higher incomes) experience both higher financial burden and lower estimated welfare; indicating a positive "price of responsibility" for complying with the individual mandate. The percentage of the sample with estimated welfare increases is close to matching observed take-up rates by the previously uninsured in the exchanges.


This report provides a primer on the complex pricing system that has evolved in the United States to deal with milk production, its assembly (collection), and its distribution to alternative users. All the various government and private institutions making up the system are expected to work together to ensure that the public gets the milk it wants, while dairy farmers get the economic returns needed to provide the milk. The major institutions are the Federal milk price support program and milk marketing orders, the Northeast Interstate Dairy Compact, State regulations, dairy cooperatives, and milk and dairy product futures and options markets. Our goal is to provide a primer on milk pricing that can serve as a steppingstone to other, more detailed works for those so inclined.


The author, a high school physics teacher, describes the process of teaching with the commercial video game Portal 2. He gives his story from inception, through setbacks, to eventually teaching a semester of laboratories using the Portal 2 Puzzle Maker, a tool which allows for the easy conception and construction of levels. He describes how his students used the Puzzle Maker as a laboratory tool to build and analyze virtual experiments that followed real-world laws of physics. Finally, he concludes with a discussion on the current and future status of video games in education.


Background:
Pain severity after ear surgery is usually at its worst during the first few hours after surgery. The greater auricular nerve is the major sensory branch of the cervical plexus and is readily amenable to blockade as it lies superficially passing over the sternocleidomastoid muscle. Dexamethasone as an adjuvant is known to prolong analgesia
Aims and Objectives
To compare the efficacy of combination of bupivacaine 0.25% (9.5ml) with dexamethasone 2mg (0.5ml) versus bupivacaine 0.25% (9.5ml) with normal saline (0.5ml) in greater auricular nerve block for Duration of analgesia and Requirement of rescue analgesia postoperatively.
Methodology:
Prospective double blind randomized controlled trial .50 patients aged 18-65 years, ASA status I / II posted for mastoid surgery were randomly allocated into two groups. Both groups received routine general anaesthesia. Intra operatively, analgesia was maintained with boluses of IV fentanyl 25µg each if required. At the end of surgery, just before extubation the nerve was identified using anatomical landmarks and blocked blindly with the drugs chosen depending on the group. The patients were extubated after complete reversal of neuromuscular blockade.
Results:
Demographic data and type of surgery were similar in both the groups. There was a significant difference for duration of analgesia between the two groups (p<0.01).
Conclusion:
Dexamethasone as an adjuvant to bupivacaine in greater auricular nerve block significantly increases the duration of analgesia and reduces the need for rescue analgesics without any complications.


Background: Heterotopic pregnancy is the co- existence of intrauterine and extrauterine gestation at the same time. The condition is life threatening when the ectopic pregnancy ruptures and it is unrecognized.
Objective: To report the first successfully managed case of heterotopic pregnancy in a woman without obvious risk factors in our centre.
Design: Case report.
Setting: University of Port Harcourt Teaching Hospital, Port Harcourt.
Result: A multiparous 30 - year old lady who had heterotopic pregnancy with natural conception and salpingectomy for the ruptured ectopic component delivered a live baby at term . Management of the ectopic pregnancy with viable intrauterine pregnancy delivered at term.
Conclusion: Heterotopic pregnancy though rare, is possible in our women without known risk factors. Medical practitioners should have a high index of suspicion when a parous woman presents with lower abdominal pain in the first trimester of pregnancy. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 201-203


Imagined speech is a relatively new electroencephalography (EEG) neuro-paradigm, which has seen little use in Brain-Computer Interface (BCI) applications. Imagined speech can be used to allow physically impaired patients to communicate and to use smart devices by imagining desired commands and then detecting and executing those commands in a smart device. The goal of this research is to verify previous classification attempts made and then design a new, more efficient neural network that is noticeably less complex (fewer number of layers) that still achieves a comparable classification accuracy. The classifiers are designed to distinguish between EEG signal patterns corresponding to imagined speech of different vowels and words. This research uses a dataset that consists of 15 subjects imagining saying the five main vowels (a, e, i, o, u) and six different words. Two previous studies on imagined speech classifications are verified as those studies used the same dataset used here. The replicated results are compared. The main goal of this study is to take the proposed convolutional neural network (CNN) model from one of the replicated studies and make it much more simpler and less complex, while attempting to retain a similar accuracy. The pre-processing of data is described and a new CNN classifier with three different transfer learning methods is described and used to classify EEG signals. Classification accuracy is used as the performance metric. The new proposed CNN, which uses half as many layers and less complex pre-processing methods, achieved a considerably lower accuracy, but still managed to outperform the initial model proposed by the authors of the dataset by a considerable margin. It is recommended that further studies investigating classifying imagined speech should use more data and more powerful machine learning techniques. Transfer learning proved beneficial and should be used to improve the effectiveness of neural networks.


The excavation and support problem of deep foundation pit is very interested by construction engineers with the development of the high buildings in cities and exploration utilization of the underground pace. Stability and economy are the most important problems in deep foundation pit support. This paper mainly studied on stability and economy of steel sheet pile support structure. The steel sheet pile support technique was fully introduced and analyzed here, using a combined method of theoretical guidance, calculation analysis, engineering application with finite element program simulation and market investigation.


To determine the mode of inheritance of hypertrophic cardiomyopathy 193 first degree relatives (parents, siblings, and offspring) of 50 patients with hypertrophic cardiomyopathy were assessed by clinical examination, electrocardiography, M mode and cross sectional echocardiography, and necropsy when available. Thirty nine (20%) first degree relatives had hypertrophic cardiomyopathy--37% of parents, 25% of siblings, and 8% of offspring. Eight (23%) of 35 affected relatives diagnosed by echocardiography had normal clinical and electrocardiographic findings. In the total study group 43% of the male population and 30% of the female population were affected. This difference is statistically significant. In 28/50 families there was familial occurrence of hypertrophic cardiomyopathy. Familial occurrence was demonstrated in 17 of 18 families in which five or more family members were assessed. In 15 families the pattern of inheritance was consistent with an autosomal dominant trait; in the other 13 the affected members were identified in a single generation and the pattern of inheritance could not be determined.


BACKGROUND
Bisphosphonate therapy has been shown to preserve the osteonecrotic femoral head in experimental and short-term clinical studies. However, a lack of new bone formation within the preserved femoral head due to the inhibition of bone remodeling is a concern. The purpose of this investigation was to determine if combined therapy consisting of ibandronate and bone morphogenetic protein-2 (BMP-2) can preserve the shape of the femoral head and stimulate new bone formation in an immature animal model of ischemic osteonecrosis.

METHODS
Ischemic osteonecrosis was surgically induced in immature pigs. Four groups were studied: normal, treated with saline solution, treated with ibandronate, and treated with both ibandronate and BMP-2 (the ibandronate + BMP-2 group). The animals were killed eight weeks after surgery. Radiographic, histological, and histomorphometric assessments were performed.

RESULTS
Radiographic assessment showed better preservation of the femoral head shape-i.e., a 54% (CI [95% confidence interval]: 22%, 86%) higher mean epiphyseal quotient-in the ibandronate + BMP-2 group than in the saline group. Histological assessment showed increased trabecular bone in the ibandronate + BMP-2 group as compared with that in the saline group. The mean values for trabecular bone volume, thickness, and number and for osteoblast surface were an average of 400% (CI: 242%, 558%), 212% (CI: 166%, 259%), 71% (CI: 6%, 137%), and 2402% (CI: 2113%, 2693%) higher, respectively, in the ibandronate + BMP-2 group than in the saline group. The osteoclast number was significantly reduced in the ibandronate + BMP-2 group compared with that in the saline group (-59% [CI: -75%, -42%]). The mean osteoblast surface value in the ibandronate + BMP-2 group was significantly higher (2567% [CI: 2258%, 2877%]) than that in the ibandronate group. Heterotopic ossifications were present in the capsule of the hip joint in the ibandronate + BMP-2 group.

CONCLUSIONS
A combination of ibandronate and BMP-2 decreased femoral head deformity while stimulating bone formation in an immature animal model of ischemic osteonecrosis.


Background: As part of the ongoing professionalisation of patient organisations and the expansion of their activities, their need for financial resources keeps increasing. This need is often met by pharmaceutical companies. In order to make this financial support more transparent, the pharmaceutical industry has responded with voluntary commitments to greater transparency. The LBI-HTA conducted a systematic analysis of the published data in 2014 and is aiming to continue the consistent monitoring of these payments. The research question underlying this third update of the systematic analysis was, to what extent patient initiatives in Austria received financial support from pharmaceutical companies in the year 2018. Method: Again, the websites of all PHARMIG member companies (as of September 2019) were examined for information regarding financial support for patient organisations in the year 2018. The collected data was thereafter grouped according to pharma companies, patient organisations and fields of diseases. Result: 49 out of 113 PHARMIG member companies have declared financial contributions to patient organisations for the year 2018. An attempt to verify this information on the websites of patient organisations was of limited success. A total sum of € 1.657.087 in grants to patient initiatives was reported by the PHARMIG member companies. Most grants (around 85% of all financial contributions) were given to initiatives in the nine fields of Oncology & Haematology, Neurology, Haemophilia, Pulmonology, Rare Diseases, Dermatology, Gastroenterology, Rheumatology, and HIV/AIDS. By far the biggest contribution to a single organisation was again given to the Austrian Haemophilia Society with € 161.516; the Austrian Crohn's Colitis Association came in second with € 118.855. Following a significant decline in 2016, the declared total has risen by almost +45%. The number of disclosures doubled compared to 2014 (2014: 24 out of 115 PHARMIG companies declared donations to patient initiatives, 2018: 49 out of 113). Conclusions: The pharmaceutical companies in Austria have taken an important first step towards greater transparency, but a second step, an improved implementation needs to follow. To further advance transparency, consistent monitoring by a critical public is required.


Abstract Purpose: To report our initial experience of robot-assisted vesicovaginal fistula (VVF) repair. Materials and methods: Data from all patients who underwent robot-assisted VVF repair from August 2015 to October 2018 were analyzed. Preoperative data included age, BMI, smoking status, alcohol consumption, etiology of fistula and location and size of fistula. Operative data was operation time and the use of tissue interposition. Postoperative data included time to follow up, complications and reoperations. Results: A total of 13 patients underwent robot-assisted VVF repair and 15 operations were performed as 2 patients required a repeated procedure. The mean age was 45.0 ± 14.5 years (±SD) and operative time was 138.3 ± 58.9 min (±SD). The mean time to follow up was 18.3 ± 16.1 weeks (±SD). Postoperative complications were reported by one patient and was Clavien-Dindo I. Relapse of fistula was found in two patients who had a successful reoperation with repeated robotic-assisted surgery. An interposition flap was used in a single patient. The overall success rate was 84.6% after primary surgery (11 out of 13) and 100% after repeated procedure (2 out of 2). Conclusions: In this initial small series, we found that robot-assisted VVF repair is a safe procedure with results comparable to transvaginal repair. This procedure has a high success rate and few complications without using interposed tissue.


[1] We used a Lunar Reconnaissance Orbiter Camera (LROC) global monochrome Wide-angle Camera (WAC) mosaic to conduct a survey of the Moon to search for previously unidentified pyroclastic deposits. Promising locations were examined in detail using LROC multispectral WAC mosaics, high-resolution LROC Narrow Angle Camera (NAC) images, and Clementine multispectral (ultraviolet-visible or UVVIS) data. Out of 47 potential deposits chosen for closer examination, 12 were selected as probable newly identified pyroclastic deposits. Potential pyroclastic deposits were generally found in settings similar to previously identified deposits, including areas within or near mare deposits adjacent to highlands, within floor-fractured craters, and along fissures in mare deposits. However, a significant new finding is the discovery of localized pyroclastic deposits within floor-fractured craters Anderson E and F on the lunar farside, isolated from other known similar deposits. Our search confirms that most major regional and localized low-albedo pyroclastic deposits have been identified on the Moon down to ∼100 m/pix resolution, and that additional newly identified deposits are likely to be either isolated small deposits or additional portions of discontinuous, patchy deposits.


Underwater impulsive sounds may affect the behavior of harbor porpoises within a certain distance from the sound source. To determine the 50% threshold received sound exposure level (SEL) of an impulsive sound that causes a brief behavioral response (a sudden change in swimming speed and/ or direction, similar to a startle response) in harbor porpoises, a male harbor porpoise was exposed once every 3 min to a single impulsive sound: a synthetic exponential pulse with a 5 ms time constant, reproduced by an underwater loudspeaker in a pool (resulting in a signal duration of 10 ms). The sound was transmitted at seven source levels, which were expected to cause brief responses in 10 to 90% of exposures. During each transmission, the harbor porpoise's behavior was observed, and the presence or absence of a brief response was recorded. A 50% brief response rate was observed at a received SEL of 92 dB re 1 µPa2 s, and a zeroto-peak sound pressure level of 122 dB re 1 µPa. The present study suggests that a single impulsive sound as used in this study does not cause a brief response in harbor porpoises at SELs below around 65 dB re 1 µPa2 s. The duration and spectrum of impulsive sounds change with distance to the sound source, and such changes may affect the responses of wild harbor porpoises.


M acrophage-derived foam cell formation, a hallmark of the progression of atherosclerosis, begins with recruitment of monocytes into the subendothelial space of affected blood vessels. In the cytokine-rich subendothelial microenvironment, monocytes differentiate into macrophages with concomitant expression of proteins that mediate the uptake of modified lipoproteins and retention of cholesterol in the cells. Among the genes upregulated during foam cell formation are scavenger (CD36, MSRA, CD68) and phagocytic (phosphatidyl-serine receptor, Fcγ, SRB1, ATP-binding cassette transporter [ABCA1]) receptors that mediate uptake of oxidized low-density lipoprotein (OxLDL), nuclear receptors (peroxisome proliferator-activated receptor [PPAR] and CCAAT/enhancer binding protein [CEBP]) that regulate expression of the receptors involved in LDL uptake, and genes involved in eicasanoid (eg, hydroxyeicosatetraenoic acids, leukotrienes) biosynthesis that activate the aforementioned nuclear receptors. Plasminogen (Plg) is synthesized primarily by the liver and circulates in the blood at 1 to 2 μmol/L. Plg is converted to an active serine protease, plasmin, by Plg activators, a transition that is influenced by interaction of Plg with C-terminal lysines of extracellular matrix and cell-surface Plg receptors (Plg-Rs). Hence, blockade of Plg with lysine analogs such as tranexamic acid or antibodies directed at the C-terminal lysine region of Plg-Rs blocks the interaction of Plg with cells and dampens plas-min generation. 5 Beyond the extracellular proteolytic functions of Plg, 6 its interaction with cells can trigger intracellular signaling.


A novel self-contained, electro-hydraulic cylinder drive capable of passive load-holding, four-quadrant operations, and energy recovery was presented recently and implemented successfully. This solution improved greatly the energy efficiency and motion control in comparison to state-of-the-art, valve-controlled systems typically used in mobile or offshore applications. The passive load-holding function was realized by two pilot-operated check valves placed on the cylinder ports, where their pilot pressure is selected by a dedicated on/off electro valve. These valves can maintain the actuator position without consuming energy, as demonstrated on a single-boom crane. However, a reduced drop of about 1 mm was observed in the actuator position when the load-holding valves are disengaged to enable the piston motion using closed-loop position control. Such a sudden variation in the piston position that is triggered by switching the load-holding valves can increase up to 4 mm when open-loop position control is chosen. For these reasons, this research paper proposes an improved control strategy for disengaging the passive load-holding functionality smoothly (i.e., by removing this unwanted drop of the piston). A two-step pressure control strategy is used to switch the pilot-operated check valves. The proposed experimental validation of this method eliminates the piston position's drop highlighted before and improves the motion control, mainly when operating the crane in open-loop. Theses outcomes benefit those systems where the kinematics amplifies the piston motion significantly (e.g., in aerial platforms) increasing, therefore, the operational safety.


Thought Experiments of Economic Surplus: Science and Economy in Ernst Mach's Epistemology. Thought experiments are an important element in Ernst Mach's epistemology: They facilitate amplifying our knowledge by experimenting with thoughts; they thus exceed the empirical experience and suspend the quest for immediate utility. In an economical perspective, Mach suggested that thought experiments depended on the production of an economic surplus based on the division of labor relieving the struggle for survival of the individual. Thus, as frequently emphasized, in Mach's epistemology, not only the 'economy of thought' is an important feature; instead, also the socioeconomic conditions of science play a decisive role. The paper discusses the mental and social economic aspects of experimental thinking in Mach's epistemology and examines those within the contemporary evolutionary, physiological, and economic contexts.


When an alloy such as Ni-W is liquid phase sintered, heavy solid W particles sedimentate to the bottom of the container, provided that their volume fraction is less than a critical value. The sintering process evolves typically in two stages, diffusion-driven macrosegregation sedimentation followed by true sedimentation. During sedimentation, the overall solid volume fraction decreases concurrently with elimination of liquid concentration gradient. However, in the second stage of true sedimentation, the average solid volume fraction in the mushy zone increases with time, and oddly, no concentration gradient is necessary in the liquid zone. In this work, we propose that the true sedimentation results from particle rearrangement for higher packing efficiency.


The value of the addition of f8-blockers to coronary vasodilator therapy in the treatment of patients with unstable angina at rest is controversial. We conducted a double-blind, randomized, placebo-controlled 4 week trial of propranolol in 81 patients with unstable angina, 39 of whom were assigned to placebo and 42 ofwhom received propranolol in a dose of at least 160 mg daily. All patients were also treated with coronary vasodilators, including 80 mg nifedipine daily and long-acting nitrates. The incidences of cardiac death, myocardial infarction, and requirement for bypass surgery or coronary angioplasty did not differ between the two groups (propranolol = 16; placebo = 18). The propranolol group had a lower cumulative probability of experiencing recurrent resting angina than the placebo group (p = .0 13), and over the first 4 days of the trial the mean number of clinical episodes of angina (propranolol 0.9 + 0.2, placebo 1.8 ± 0.3, p = .036), duration of angina (propranolol 15.1 + 4.3 min, placebo 38.1 + 8.4, p = .014), and nitroglycerin requirement (propranolol 1.1 + 0.3 tablets, placebo 3.5 + 0.8, p = .003) were also fewer. Continuous electrocardiographic recording for ischemic ST segment changes revealed fewer daily ischemic episodes in the propranolol group (2.0 + 0.5) than in the placebo group (3.8 + 0.7, p = .03), and a shorter duration of ischemia (propranolol 43 + 10 min, placebo 104 + 28 min, p =.039). Thus propranolol, in patients with unstable angina, in the presence of nitrates and nifedipine is not detrimental and reduces the frequency and duration of symptomatic and silent ischemic episodes. Circulation 73, No. 2, 331-337, 1986. THE EFFICACY of /3-blockers in the treatment of patients with stable, demand-related angina has been demonstrated.'-' Their use is controversial, however, in patients with resting angina. Although the negative inotropic and chronotropic properties of fl-blockers are theoretically advantageous in the treatment of myocardial ischemia, the primary pathophysiologic event in From the Division of Cardiology, Department of Medicine, Francis Scott Key Medical Center and The Johns Hopkins Hospital, Baltimore. Dr. Gottlieb was supported in part by a Research Fellowship Award from the American Heart Association, Maryland Affiliate. Computational assistance was received from CLINFO, sponsored by a grant (5 MOl RR 35-20) from the National Institutes of Health. Address for correspondence: Sidney 0. Gottlieb, M.D., Director, Cardiac Catheterization Laboratory, Division of Cardiology, B-1 South, Francis Scott Key Medical Center, The Johns Hopkins Medical Institutions, 4940 Eastern Ave., Baltimore, MD 21224. Received Aug. 6, 1985; revision accepted Nov. 7, 1985. Presented in part at the 57th Scientific Sessions of the American Heart Association, November 12-15, 1984, Miami Beach. Vol. 73, No. 2, February 1986 these patients is often a reduction in coronary flow caused by coronary vasoconstriction and/or platelet aggregation.45 Vasoconstriction is known to occur in atherosclerotic portions of coronary arteries,65 and to be potentiated by fl-blockade.6 W" Coronary vasodilator therapy, consisting of nitrates and often nifedipine, is generally used in the therapy of resting anginal2'and these drugs may prevent the potential undesirable effects of fl-blockade. Conversely, treatment with vasodilators alone may in some instances produce a significant reflex sympathetic tachycardia that may increase myocardial oxygen demand and therefore be detrimental in patients with high-grade coronary artery stenoses.16 Thus, patients with fixed atherosclerotic coronary disease and resting angina in whom coronary spasm may be superimposed on obstructive lesions may benefit from the anti-ischemic effects of 331 by gest on Sptem er 5, 2017 http://ciajournals.org/ D ow nladed from


A recently proposed formulation of the stochastic planning and control problem as one of parameter estimation for suitable artificial statistical models has led to the adoption of inference algorithms for this notoriously hard problem. At the algorithmic level, the focus has been on developing Expectation-Maximization (EM) algorithms. For example, Toussaint et al (2006) uses EM with optimal smoothing in the E step to solve finite state-space Markov Decision Processes. In this paper, we extend this EM approach in two directions. First, we derive a non-trivial EM algorithm for linear Gaussian models where the reward function is represented by a mixture of Gaussians, as opposed to the less flexible classical single quadratic function. Second, in order to treat arbitrary continuous state-space models, we present an EM algorithm with particle smoothing. However, by making the crucial observation that the stochastic control problem can be reinterpreted as one of trans-dimensional inference, we are able to propose a novel reversible jump Markov chain Monte Carlo (MCMC) algorithm that is more efficient than its smoothing counterparts. Moreover, this observation also enables us to design an alternative full Bayesian approach for policy search, which can be implemented using a single MCMC run.


In what way do the corporatist and authoritarian legacies that modelled some Latin American labor institutions influence the opportunities for and restrictions on organizing workers in a new context? To what extent did institutional designs, together with other economic and political factors, influence the characteristics that currently distinguish the union organizations in the countries of the region? Taking into consideration the existence of a broader debate about the consequences of globalization and political democratization for unions, the contribution of historical institutionalism and previous research, in this Article I compare the institutional and organizational dynamics of unions in four countries with authoritarian legacies and corporatist traditions (Argentina, Brazil, Chile and Mexico). The Article argues that in spite of these shared traditions, the differences in the institutional designs — which have scarcely been considered in the specialized literature — have historically imposed distinctive features on the associational power of workers and unions. These features not only persist to the present day, but also translate into dissimilar trajectories of the labor movement and opportunities for organizing workers in the last decade.


A new treatment paradigm for pulmonary arterial hypertension (PAH) has emerged, heralded by the recently published results of the AMBITION study in a recent issue of the New England Journal of Medicine .1 While the practice of combination therapy is not new, this has previously been implemented in a sequential fashion. The AMBITION study is the first study comparing the use of upfront combination therapy in patients with treatment-naive incident PAH who were randomised to therapy with ambrisentan plus tadalafil versus ambrisentan or tadalafil monotherapy. The results were initially presented at the European Respiratory Society meeting in September 2014 with the primary publication in the New England Journal of Medicine in August 2015.1

The primary efficacy endpoint of the AMBITION study was time to first clinical failure (TTCF) defined as either death, hospitalisation for worsening PAH, disease progression (>15% decline in 6 min walk test (MWT) from baseline with WHO functional class III or IV symptoms) or unsatisfactory clinical response (WHO functional class III symptoms while in the study for at least 6 months with a decrease in 6 MWT distance from baseline). The latter three events were all adjudicated and multiple secondary endpoints, including change in the 6 min walk distance, were also evaluated. There were 610 patients enrolled in the study of whom 500 constituted the primary analysis set (PAS).1 The other 105 patients were excluded from the PAS after a protocol amendment aimed at excluding those patients with risk factors for left ventricular diastolic dysfunction. Patients were randomised in a 2:1:1 fashion to upfront combination therapy or monotherapy with ambrisentan or tadalafil. The study demonstrated unequivocally that upfront combination therapy was indeed superior to monotherapy with either single agent based on the selected end points of the study. The HR for TTCF for combination therapy compared with the …


Plasma measurements by electrostatic probes are influenced by the spacecraft-plasma interaction, including the photoelectrons emitted by the spacecraft. Such effects get particularly important in tenuous plasmas with large Debye lengths. We have used the particle-in-cell code package SPIS to study the close environment of the Rosetta spacecraft, and the impact of the spacecraft-plasma interaction on the electrostatic potential at the position of the Langmuir probes onboard. The simulations show that in the solar wind, photoemission has a bigger impact than wake formation. Spacecraft potential estimates based on Langmuir probe data in the solar wind need to be compensated for these effects when the spacecraft attitude varies. The SPIS simulations are validated by comparison to an independent code.


Business influential Michael Porter theorized that standards based solutions are more cost-effective and efficient than proprietary alternatives when there is little "differentiating value" seen by the end user. Intel's aggressive adoption of 300 mm standards in wafer manufacturing and automated test equipment (ATE) automation standards in test manufacturing validates this premise. These standards have provided rapid, cost-effective factory integration and have enabled greater investment in manufacturing innovation. There are similar opportunities for ATE operating system (OS) software standards. This paper elaborates on the history and successes of ATE automation standards at Intel and future directions for ATE OS software standards in the industry


Alzheimer's disease (AD) is a neurodegenerative disorder marked by cognitive and behavioral impairment that significantly interferes with social and occupational functioning. AD is progressive and fatal dementia of unknown cause characterized by loss of cognitive and physical functioning, commonly with behavior or cognitive symptoms. Cognitive decline is gradual and includes memory loss, aphasia, apraxia, agnosia, disorientation, and impaired executive function. physicians will often play a major role in diagnosing and treating dementia and related disorders in the community. Accurate treatment of cognitive symptoms is important. Accordingly, we reviewed the available pharmacotherapy in the clinical management of cognitive symptoms of dementia.