SV40-transformed mKSA cells (H-2d) readily induce progressively growing tumors in adult syngeneic BALB/c mice while expressing the full complement of H-2d MHC class I antigens. BALB/c mice previously immunized with SV40, soluble SV40 T antigen, or irradiated SV40-transformed syngeneic, allogeneic, or xenogeneic cells reject an mKSA tumor challenge even though these mice have been considered low- or nonresponders to T antigen due to difficulty in demonstrating SV40 T antigen-specific CTL. We have investigated the role of H-2d-restricted CTL in the rejection of SV40 tumors in BALB/c mice. Immunization of BALB/c mice with SV40 induced T antigen-specific CTL which were largely. H-2Ld-restricted. However, following repeated in vitro restimulation with mKSA cells, CTL emerged which recognized a subdominant H-2Kd-restricted epitope corresponding to T antigen residues 499-507. Immunization of BALB/c mice with a recombinant vaccinia virus expressing the T499-507 epitope provided partial protection against a challenge of syngeneic mKSA tumor cells and induced the generation of T499-507-specific CTL. These results indicate that a subdominant H-2Kd-restricted CTL epitope can participate in the rejection of SV40 tumors in BALB/c mice.


Ahstrat t-This paper evaluates electricity two-part tariffs with both efficiency and equity criteria. The efficiency of tariffs is analyzed by studying the relation between price and marginal cost for both customer connection and variable output. The equity of tariffs is addressed by an analysis of cross subsidization. To address these issues, this paper presents a multiproduct cost function that can provide information on output and connection marginal costs for each customer class. Using a 1980 cross section of electric utilities, it is shown that prices are not set in a first-best efficient manner, and least favor the commercial class.


Laparoscopic procedures can be an attractive treatment option for liver resection, with a shortened hospital stay and reduced morbidity compared to open surgery. One of the central challenges of this technique is visualisation of concealed structures within the liver, particularly the vasculature and tumourous tissue. As photoacoustic (PA) imaging can provide contrast for haemoglobin in real time, it may be well suited to guiding laparoscopic procedures in order to avoid inadvertent trauma to vascular structures. In this study, a clinical laparoscopic ultrasound probe was used to receive ultrasound for PA imaging and to obtain co-registered B-mode ultrasound (US) images. Pulsed excitation light was delivered to the tissue via a fibre bundle in dark-field mode. Monte Carlo simulations were performed to optimise the light delivery geometry for imaging targets at depths of 1 cm, 2 cm and 3 cm, and 3D-printed mounts were used to position the fibre bundle relative to the transducer according to the simulation results. The performance of the photoacoustic laparoscope system was evaluated with phantoms and tissue models. The clinical potential of hybrid PA/US imaging to improve the guidance of laparoscopic surgery is discussed.


The case of President Trump's travel ban raises the question of whether the intentions of public officials matter in determining the legitimacy of their actions. In recent years, philosophers and legal scholars have argued that intentions are never directly relevant to the moral permissibility of actions. This permissibility objection can be applied to theories of political legitimacy that make intentions relevant in specifying moral conditions for the exercise of political power. After surveying various ways in which intentions might figure into theories of legitimacy, I present the permissibility objection and then argue that it cannot be sustained in reflective equilibrium. Using examples of discretionary discrimination, including the travel ban, I argue that intentions are relevant to determining the legitimacy of official conduct. I then defend a doctrine of moral taint, which holds that skepticism about the actions of public officials is appropriate when they have previously taken similar actions on the basis of wrongful intentions.


The objective of this paper is to design a multi -agent system architecture for the Sc rum methodology. Scrum is an iterative, incremental framework for software development which is flexible, adaptable and highly productive. An agent is a system situated within and a part of an environment that senses the environment and acts on it, over time, in pursuit of its own agenda and so as to effect what it senses in the future (Franklin and Graesser, 1996). To our knowledge, this is first attempt to include software agents in the Scrum framework. Furthermore, our design covers all the stages of sof tware development. Alternative approaches were only restricted to the analysis and design phases. This Multi -Agent System (MAS) Architecture for Scrum acts as a design blueprint and a baseline architecture that can be realised into a physical implementation by using an appropriate agent development framework. The development of an experimental prototype for the proposed MAS Architecture is in progress. It is expected that this tool will provide support to the development team who will no longer be expected to report, update and manage non-core activities daily.


SUMMARY Oil palm has become an important source of revenue for smallholders in Indonesia, but productivity of smallholder plantations is generally poor. Nutrient limitations have been suggested as an important agronomic constraint to yield. Our research aimed to quantify fertiliser use, soil and tissue nutrient status, and palm growth and yield in a sample of independent smallholder plantations. We selected 49 plantations in Indonesia in two provinces with contrasting soils. For all plantations, we obtained self-reported fertiliser use and yield data, collected soil and tissue samples, and analysed vegetative growth. More than 170 kg N ha−1 year−1 was applied in one site, and P was applied in excess of recommended quantities in both sites, but on average farmers applied less than 100 kg K ha−1 year−1. Soils in the palm circle were poor in N, P and K in 29, 40 and 82% of the plantations, and deficiencies were measured in 57, 61 and 80% of the leaflet samples, respectively. We found statistically significant correlations between tissue nutrient concentrations and vegetative growth, but a large part of the variation in the data remained unaccounted for. Single leaf area was reduced in >80% of the plantations. Average yields were estimated to be 50‒70% of the water-limited potential. Our results demonstrate that widespread nutrient imbalances and deficiencies, especially potassium and phosphorus, occur in smallholder oil palm plantations, due to inadequate and unbalanced fertiliser application practices. These deficiencies may be an important underlying cause of the overall poor productivity, which threatens the economic and environmental sustainability of the smallholder sector.


Book description:
A conservative approach to economic growth has dominated policy circles for close to two decades. This approach holds that the key to restoring economic growth lies in reducing the size and role of government in the market economy through deregulation of the financial sector, privatization, and lower taxes. The contributors to this book argue that the principles of 'trickle down' economics are of dubious validity, and have led to economic stagnation, high unemployment, and increasing inequality. They develop a new perspective on macroeconomic policy, one affirming that egalitarian and democratic economic structures are not only compatible with economic revival, but in fact offer the best hope for sustainable growth of living standards. Their alternative recognizes that markets have an important role to play, but only within the framework of macroeconomic stability, corrections of market failures, and egalitarian rules of the game.


Adipose tissue is an important energy depot and endocrine organ, and the degree of adiposity impacts the host response to infection. However, little is known regarding the mechanisms by which white adipose tissue (WAT) is lost acutely and then restored after the resolution of sepsis. Therefore, the signaling pathways governing protein synthesis, autophagy, apoptosis, and the ubiquitin-proteasome were investigated to identify potential mechanisms mediating the acute (24 h) loss of WAT after cecal ligation and puncture as well as the failure to replenish WAT during recovery (day 10). While whole body fat mass was decreased equally in pair-fed control and septic mice at 5 days after cecal ligation and puncture, fat mass remained 35% lower in septic mice at day 10 During sepsis-recovery, protein synthesis in epididymal WAT was increased compared with control values, and this increase was associated with an elevation in eukaryotic translation initiation factor (eIF)2Bε but no change in mammalian target of rapamycin complex 1 activity (eIF4E-binding protein-1 or S6 kinase 1 phosphorylation). Protein breakdown was increased during sepsis-recovery, as evidenced by the elevation in ubiquitin-proteasome activity. Moreover, indexes of autophagy (light chain 3B-II, autophagy-related protein 5/12, and beclin) were increased during sepsis-recovery and associated with increased AMP-activated kinase-dependent Ser555-phosphorylated Unc-51-like autophagy activating kinase-1. Apoptosis was increased, as suggested by the increased cleavage of caspase-3 and poly(ADP-ribose) polymerase. These changes were associated with increased inflammasome activity (increased NLR family, pyrin domain containing 3; TMS1; and caspase-1 cleavage) and the endoplasmic reticulum stress response (increased eIF2α and activating transcription factor-4) and browning (uncoupling protein-1) in epididymal WAT. Our data suggest that WAT stores remain depleted during recovery from sepsis due to sustained inflammation and elevations in protein and cellular degradation, despite the increase in protein synthesis.


The need for better understanding of the environmental fate and transport of engineered nanoparticles (ENPs) is now a scientific consensus. However, the partially saturated zone, a critical region that links the earth's surface to aquifers, has to date received only minor attention in the context of ENP mobility. We investigate the transport and fate of a representative ENP, silver nanoparticles (Ag-NPs), in partially saturated soil. Here we present a set of column experiments and modelling simulations to examine breakthrough curves (BTCs), retention profiles, and mass balances that characterize Ag-NP transport, and gain insights into retardation mechanisms. Unlike Ag-NP transport in sand columns, where the BTC pattern often resembles that of a conservative tracer, Ag-NP transport in soil columns shows moderate mobility and more complex BTC patterns; these results also emphasize the importance of employing realistic porous media in environmental studies. Overall, Ag-NP mobility decreases in the presence of Ca(NO3)2, and increases when the solution contains humic acid, at higher water saturation levels, or at higher input concentrations of Ag-NPs. In addition, a different pattern was observed for Ag-NP aggregates, indicating nanospecific behaviour. Modelling analysis of Ag-NP transport in partially saturated soil suggests that a two-site kinetic model with a time-dependent retention function quantifies the transport behaviour of Ag-NPs.


Temporomandibular joint dysfunction is one of commonest joint that gets affected in females, studies shows that the altered posture of cervical spine lead to mandibular retrusion and hence in long term leads to Temporomandibular dysfunction, the tightness of sub-occipital muscle leads to pulling of the ligaments around the joint in course causing retrusion or malocclusion. The common symptoms of temporomandibular joint dysfunction includes clicking, reduced mouth opening, headache. Alteration in the function of TMJ leads to poor quality of life of the individual as this joint is involved in basic activities like talking, eating, laughing and kissing. The sub-occipital muscles are the group of muscle extending from spinous process of C2 vertebrae to inferior nuchal line of occipital bone. Tightness of this muscle lead to extension of upper cervical spine and flexion of lower cervical spine. The common causes of temporomandibular dysfunction includes injury to jaw, overuse, inflammatory condition like arthritis and bruxism. Our aim is to find out the efficacy of sub-occipital Myofacial Release versus conventional physiotherapy on functional disability of TMJ. The clinical trial registry-India(CTRI) registration number for this trial is CTRI/2021/05/033493.


Over 100 years of research on the hippocampal formation has led us understand the consequences of lesions in humans, the functional networks, anatomical pathways, neuronal types and their local circuitry, receptors, molecules, intracellular cascades, and some of the physiological mechanisms underlying long‐term spatial and episodic memory. In addition, complex computational models allow us to formulate sophisticated hypotheses; many of them testable with techniques recently developed unthinkable in the past. Although the neurobiology of the cognitive map is starting to be revealed today, we still face a future with many unresolved questions. The aim of this commentary is twofold. First is to point out some of the critical findings in hippocampal formation research and new challenges. Second, to briefly summarize what the anatomy of memory can tell us about how highly processed sensory information from distant cortical areas communicate with different subareas of the entorhinal cortex, dentate gyrus, and hippocampal subfields to integrate and consolidate unique episodic memory traces. © 2015 Wiley Periodicals, Inc.


The differences between the hands of men and women are mainly observed in the difference in the ratio of the lengths of the index and ring fingers (ratio 2d:4d) or in the difference in the proportional ratios of longitudinal and transverse dimensions, identified using classical morphometry methods, which give only indirect ideas about variations in the shape of the hand. The object of this study was digital images of radiographs of the right hands of 50 men and 50 women, on which 20 landmarks were located, the configuration and two-dimensional coordinates of which were studied using geometric morphometry methods. The predominance of the general variability of the hand's shape was associated with a combined multidirectional transformation in the space of the elements of the II-V rays of the hand relative to the longitudinal axis with simultaneous compression or stretching of the shape relative to the transverse axis. At the same time, men have a stretching of the shape of the hand from the IV-V rays and compression from the II-III rays, while women have reverse changes. The relationship between the shape and size of the hand, regardless of gender, is minimal – 5.82% and 3.93% of hand allometry were detected in men and women, respectively. This study shows that the shape of the hand is markedly different in men and women, which indicates a significant sexual dimorphism affecting this trait. Based on the detected sexual differences, it is possible to distinguish the male and female morphological type of the hands.


Adsorption of dioxygen at clean Ni(110) and Ni(100) surfaces gives rise to two prominent features in the O(1s) spectra at 530 and 531 eV due to O2- and O- type species, respectively. Interaction of ammonia with a Ni(100)-O surface where theta(oxygen) < 0.1 ML favors the dissociation of NH3 giving NHn, (n=1, 2) and N(a) species. This is accompanied by a decrease in the intensity of the 531 eV feature. On the other hand. a Ni(100)-O surface where the oxygen species are mainly of the O2- type is unreactive, Coadsorption studies of NH3-O-2 mixtures show that at Ni(110) surfaces the uptake of both oxygen and ammonia increase with the proportion of oxygen in the NH3-O-2 mixture. The surface concentrations of the O- species and the NHn species also increase with the increase in the O-2/NH3 ratio while the slope of the plot of sigma(N) versus sigma(O-) is around unity. The results demonstrate the high surface reactivity of the O- species and its role in the dissociation of ammonia. Based on these observations, the possibility of the formation of a surface complex between ammonia and oxygen (specifically O-) is suggested. Results from vibrational spectroscopic studies of the coadsorption of NH3-O-2 mixtures are consistent with those from core-level spectroscopic studies.


To investigate the characteristics of spherical fragments penetrating LY12 aluminum alloy target, the penetration process of the spherical fragments with different diameters into LY12 aluminum alloy target was simulated by LS-DYNA software. Through numerical simulation, the failure modes of the target and the penetration ability of fragments were analyzed, and also the ballistic limiting velocities were obtained. The results show that the chief failure modes of the target impacted by spherical fragments are petal type failure and plugged failure. The penetration capacity of fragments increase when one has a bigger diameter, and the ballistic limiting velocities are in good agreement with test results.


Electric Vehicle (EV) batteries can be utilized as potential energy storage devices in micro-grids. They can help in micro-grid energy management by storing energy when there is surplus (Grid-To-Vehicle, G2V) and supplying energy back to the grid (Vehicle-To-Grid, V2G) when there is demand for it. Proper infrastructure and control systems have to be developed in order to realize this concept. Architecture for implementing a V2G-G2V system in a micro-grid using level-3 fast charging of EVs is presented in this paper. A micro-grid test system is modeled which has a dc fast charging station for interfacing the EVs. Simulation studies are carried out to demonstrate V2G-G2V power transfer. Test results show active power regulation in the micro-grid by EV batteries through G2V-V2G modes of operation. The charging station design ensures minimal harmonic distortion of grid injected current and the controller gives good dynamic performance in terms of dc bus voltage stability.


ABSTRACT Schools in the United States have historically conducted language policing in favor of standardized American English. The current study examines links between language policies in eight immigrant families in relation to educational language policies of two public elementary schools operating under an English-only policy in Massachusetts. The study places a focus on the agency of children and parents expressed through interviews, while paying attention to the institutional power of schooling. The participating families spoke Cape Verdean Creole, Mandarin, Portuguese, and Spanish as their heritage languages. Two theoretical frameworks informed our findings. Firstly, we use "family language policy" to define language decisions in families as a multifaceted construct. Secondly, we analyze family language beliefs and practices through a "language ideology" lens to unveil power structures influencing them. Our findings showed that the participants' spoken beliefs positioned bilingualism and heritage language maintenance as valuable. However, family language decisions showed an increasing preference for English that inherently aligned with the English-only educational policies and practices and alienated heritage languages. Our study contributes to the existing body of literature on family language policy by adding more nuance to the contextual and fluid nature of language decisions in bilingual families.


Some commentators defend limited shareholder liability for torts and statutory violations as efficient, even though it permits corporations to externalize the costs of risky activity and encourages overinvestment in such activity. Others propose its replacement with pro rata unlimited shareholder liability for corporate torts. Both approaches, however, fail fully to account for qualitative differences among shareholders. Control shareholders, in particular, may have lower information costs, greater influence over managerial decisionmaking, and greater ability to benefit from corporate activity. The paper develops a control-based approach to shareholder liability. It first explores several ways in which differences among shareholders affect the efficiency of shareholder liability rules. For example, a control shareholder can more easily curb managerial risk-aversion and consequently, the presence of such a shareholder will prompt a company to externalize more costs. Further, because a control shareholder can obtain special benefits from corporate activity, the imposition of pro rata liability for tort judgments exceeding corporate assets likely will not fully deter overinvestment in risky activities. The paper then proposes the concept of a control-based shareholder liability regime, which would hold shareholders with a capacity to control corporate activity fully responsible for corporate torts and statutory violations. When compared with the limited liability and pro rata liability regimes, a control-based liability regime is most likely to compel corporations to internalize their costs and to ensure compensation for injured corporate tort plaintiffs. The regime is not without disadvantages. For example, it could overdeter some socially beneficial activities for which insurance is unavailable. Definitively resolving the relative size of such effects requires further empirical investigation of issues such as the significance of litigation and information costs and the value attributable to corporate control. Nonetheless, because a control-based liability regime more explicitly addresses shareholder differences and appears most likely to address limited liability's moral hazard, the paper concludes that such a regime offers a promising alternative.


This work presents the progress in developing an all SiC based power module for use in high frequency and high efficiency applications. Using parallel combinations of 1200V enhancement mode SiC VJFETs (36mm2) and Schottky diodes (23mm2), a total on-resistance of only 10mOhm (2.7m-cm2) was achieved at ID=100A in a commercially available standard module configured as a half-bridge circuit. Careful attention to module layout, gate driver design, and the addition of optimized snubbers resulted in excellent switching waveforms with low total switching losses of 1.25mJ when switching 100A at 150oC.


Abstract The present study is an archaeological and anthropological analysis of a grave pertaining to the Únětice culture and discovered in Holubice, in the Praha-západ district. In the tomb pit the remains of an adult male laid on his right side with his lower limbs sharply bent, had been buried. The skeleton was found to be only partially preserved. Only the frontal bone (os frontale), the major part of the left parietal bone (parietale sin) and a part of the left temporal bone (temporale sin) were preserved. The preserved part of the skull presents signs of a slash trauma including a skull penetration. Even though the bones went through an advanced healing process, the wound had remained open. The nature of the injury indicates that the wound was surgically treated and loose bone fragments were removed. The injury had not been fatal and the individual lived for some time after. The discovered grave is unique not only for its unusual and highly accurately datable grave goods, but above all for standing as proof of the considerable medical knowledge of the people from the Únětice culture.


The law of conservation of flow, which states that an input must either be absorbed or sent on as an output (possibly with modification), is an attractive tool with which to analyze network protocols for security properties. One of its uses is to detect disruptive network elements that launch denial of service attacks by absorbing or discarding packets. Its use requires several assumptions about the protocols being analyzed. We examine the WATCHERS algorithm to detect misbehaving routers. We show that it uses conservation of flow without sufficient verification of its assumptions, and can consequently be defeated. We suggest improvements to make the use of conservation of flow valid.


Alteration of natural river flow regimes is a major threat to freshwater biodiversity. Restoration of natural flow regimes requires an understanding of linked hydrological and ecological processes. In this study, we investigated how annual seasonal flow characteristics and physical habitat attributes could interact to explain yearly changes in brown trout population densities (for 0+ fish, corresponding to the young of the year, and for the >0+ age class) in 112 sites widespread in France. Using an information theoretic approach and general linear modeling, we identified the physical habitat attributes and seasonal hydrological variables which explained 0+ proportion, total, >0+ and 0+ brown trout density dynamics. A decrease in total and 0+ brown trout densities were mainly linked to high water levels in both high and low flows during the emergence period and to a lesser extent, to physical habitat attributes reflecting the river size. 0+ proportions were only linked to the level of low flows, and to a lesser extent to high flows, during the emergence period. Our study demonstrated that seasonality of flow is a main driver of brown trout population dynamics, especially magnitude of high and low flows for the 0+ age class, and should be considered in the definition of environmental flows.


For normal healthy teeth, the percussive energy generated by mastication is attenuated by the periodontal ligament at the healthy bone/natural tooth interface. However, when a natural tooth must be replaced by an implant because of damage or disease, the ligament is lost and the implant will transmit the percussive forces to the bone directly. Studies have evaluated the deformation distribution of the alveolar bone in the vicinity of implants using finite element analysis and photoelasticity. However, finite element analysis requires clinical verification or a determination of material properties, and photoelastic materials generally have material properties and structure quite different from those of actual bone. Therefore, this study examined the deformation distribution around dental implants in cortical/cancellous bone experimentally using sawbone cortical/cancellous bone models. Dental implants were placed in the bone models and the displacement distribution was measured using the digital image correlation method, and the strain distribution was visualized under a compressive load that simulated the occlusion force.


In spite of scientific progress during the last two decades, microsurgery, neuroanesthesiology, and a better knowledge of the pathophysiology of cerebral vasospasm, the outcome of subarachnoid hemorrhage (S.A.H.) patients remains very poor. Each year, 28,000 North Americans are afflicted. Eighteen thousand of these patients will either die or become severely debilitated, a mortality morbidity of 64%. Only one patient out of five may return to the premorbid state. International cooperative studies report that the highest rate of rebleeding occurs during the first 24 hours post S.A.H. There is no rebound phenomenon during the 7th-8th day post S.A.H. Cerebral vasospasm begins during the 2d-4th day post S.A.H. and reaches its peak around the 8th day post bleed. Antifibrinolytics like AMICAR (aminocaproic acid) do not reduce significantly the rebleeding rate. In most of the cases the therapeutic level of these drugs is reached only on the third or fourth day of treatment. Hence antifibrinolytics are inactive during the first crucial seventy two hours. Antifibrinolytics increase the incidence of vasospasm, hydrocephalus, and thromboembolic phenomenon. At Infant Jesus Hospital, Quebec City, S.A.H. patients are operated on early since more than two years. Patients included in this study were admitted between January 1983 and December 1984. One hundred and thirty six patients were operated upon, 22 patients operated on acutely, less than 72 hours post S.A.H. Evaluation of these patients included the Glasgow Coma Scale (G.C.S.), the grade according to Botterell classification, a CT Scan, and angiography. A preoperative evaluation included Botterell classification and G.C.S., a post operative evaluation was performed during the first and seventh post operative days.(ABSTRACT TRUNCATED AT 250 WORDS)


Functionally graded materials (FGMs) with continuous varying properties have absorbed great attention for the purpose of eliminating the mismatch of material properties which may result in cracking. In this paper, three-dimensional finite element method (3D FEM) based on nonhomogeneous elements is used to study the fracture behaviors of a 3D FGM plate. Since real material properties at Gaussian integration points are adopted during forming the element stiffness matrix, the nonhomogeneous material properties can be applied in each element. Moreover, 20-node singular elements are used around the crack front to deal with the singularity of stress fields at the crack front. By this way, the stress intensity factors (SIFs) can be calculated with high efficiency and accuracy. Therefore, compared with the general FEM using homogeneouos elements, the calculating efficiency and accuracy can be increased. Finally, parameter analysis is conducted. It is found that the material nonhomogeneity constant and the crack parameter have significant influences on the SIFs.


Hyponatremic hypertensive syndrome (HHS) is characterized by hypertensive crisis, and hyponatremia secondary to unilateral renal damage with glomerular and tubular dysfunction. Elevated plasma levels of renin in most cases suggest that the stimulation of renin release from the ischemic kidney plays an important pathophysiologic role. Activation of the renin-angiotensin system results in hypertension and causes secondary hyperfiltration, pressure diuresis and sodium loss from contralateral non-damaged kidney. An elevated renin level is a pathognomonic finding in HHS. Potassium deficiency from hyperaldosteronism may further stimulate renin secretion and intensify this vicious circle. We report a female term newborn, who presented with hypertensive crisis on the seventh day after traumatic birth. The first three days of life were uneventful. Initial treatment with captopril resulted in severe hypotension and hemodynamic instability. Lab work revealed hyponatremia, hypokalemia, and elevated peripheral renin activity and aldosterone levels. Complementary sonography and magnetic resonance confirmed right adrenal gland hematoma and several ischemic areas in the upper pole of the right kidney. The diagnosis of HHS secondary to renal ischemia was evoked. HHS is a rare condition in the neonatal period, though still under-recognized. In the neonatal and early infancy period, renovascular disease is the most common cause of secondary hypertension. In this case, there was no sign of vascular disease, the renin-angiotensin system was activated secondary to direct renal ischemia and infarction. The intense renin stimulation and pressure through the contralateral normal kidney results in high pressure natriuresis facilitating a severe volume-depleted state. Although the use of renin-angiotensin system inhibitors is the treatment of choice, it is imperative to re-establish hydration and renal perfusion before starting this antihypertensive medication. We aimed to improve awareness of HHS diagnosis and prompt treatment, to prevent continuous renal damage and other life-threatening complications.


Over recent decades, there has been the substantial rise in the proportion of people engaged in what is termed informal employment, generating a broad trend toward "informalization" of labor market conditions in developing countries, even when economic growth is proceeding. We consider the relationship between the rise of informalization and the corresponding ascendancy of neoliberal policies in developing countries, focusing in particular on how the decline in average per capita GDP growth associated with neoliberalism has fostered informalization. We then explore policy measures for raising the proportion of decent jobs with core social protections in developing countries—which means, as we argue, reversing the process of informalization. We examine policy measures in two areas: raising the rate of economic growth and improving the regulation of labor markets.


A celebration of the female dancers of the Arab world and their impact on the West, this book explains the origins of this ancient art, which has survived in the face of commercialism, religious disapproval and changing times. Focusing on the 19th- and early-20th centuries, the book shows how Arabic dance came to be influenced by Western ideas about art and entertainment. But the influence was two-way. In the heyday of Orientalism, Arabic dance exerted a powerful influence on the Western imagination - on such writers and artists as Flaubert, David Robers and Jean-Leon Gerome, and imitators Colette and Mata Hari. Their fascination was often based on common fantasies about the women of the Middle East. Yet, as the book's illustrations show, this obsession also produced evocative images. At the turn of the century, the genre also had an impact on fashion, theatre and popular entertainment.


During the Selective Laser Melting (SLM) process large temperature gradients can form, generating a mismatch in elastic deformation that can lead to high levels of residual stress within the additively manufactured metallic structure. Rapid melt pool solidification causes SLM processed Ti6Al4V to form a martensitic microstructure with a ductility generally lower than a hot working equivalent. Post-process heat treatments can be applied to SLM components to remove in-built residual stress and improve ductility.
This investigation sought to investigate and understand the root cause of residual stress formation and lower ductility in Ti6Al4V components when processed by SLM, with the aim of ultimately being able to reduce the residual stress and enhance ductility by SLM parameter adjustment. The effect of individual SLM parameters on residual stress was studied by using hole drilling method. Microstructural analysis, tensile, and Vickers hardness testing was used to understand the effect of SLM parameters on mechanical properties of Ti6Al4V components. Experimental study was carried out using a commercial Renishaw AM250 SLM machine and a modified Renishaw SLM125 machine. FEA modelling in ABAQUS with user subroutines DFLUX and USDFLD was used to predict the correlation between SLM parameters, cooling rates and temperature gradients.
The experimental investigation included studying the effect of scanning strategy, layer thickness, rescanning, power and exposure variation keeping energy density constant, and bed pre-heating temperature on residual stress and mechanical properties of SLM Ti6Al4V parts.
Finally an I-Beam geometry was created to identify the geometrical dependence of residual stress in SLM Ti6Al4V components. Stress reduction strategies from the study of individual SLM parameters were strategically applied to high stress regions of the I-Beam geometry to devise techniques for stress reduction across the cross section of a complex geometry.


Individuals with X-linked Adrenoleukodystrophy (X-ALD) may manifest symptoms of their disease following head trauma or neurologic infection. We report a case of adult-onset cerebral ALD in a 21-year-old man, who also had a remote history of head trauma and recent history of neurosyphilis. He presented with a generalized tonic-clonic seizure and left-sided weakness, along with recent weight loss, headaches, and low-grade fevers. Initial workup revealed a positive cerebrospinal fluid VDRL, and no evidence of peripheral neuropathy or endocrinopathy. Frontal lobe biopsies revealed loss of myelin staining by Luxol fast blue and white matter macrophages and T lymphocytes, consistent with a demyelinating or dysmyelinating disease. The diagnosis of X-ALD was made through detection of elevated very long-chain fatty acids. This patient's presentation is highly unusual for someone with X-ALD. The majority of patients present either in childhood with an often-lethal inflammatory cerebral dysmyelinating phenotype, or in adulthood with a non-inflammatory distal axonopathy. Most patients who are asymptomatic during childhood do not go on to develop cerebral ALD in adulthood, especially not without first presenting with peripheral neuropathy or adrenal dysfunction. This patient's head trauma and/or neurosyphilis may have provided the inflammatory trigger for the manifestation of the inflammatory cerebral demyelinating phenotype of X-ALD in adulthood.


This article shows that, after decades of inequality, the 1990s saw sudden and dramatic increases in lending to low income and minority groups. Drawing in part on the work of Williams, Nesiba and McConnell (2005), we argue that government deregulation, industry restructuring and government-insured loans all fueled this growth by increasing the sources of loans to minorities. We further argue that this increased lending had small but perceptible effects on residential segregation. But, the transformation of the home mortgage industry also gave rise to new lenders who were quite unlike the old. We contend that the nature of lending was even more important than the amount: some lenders and types of lending had much more of an impact on residential segregation than did others. Specifically, loans from traditional lenders tended to decrease segregation. Conversely, loans from subprime and manufactured housing lenders that specialized in serving low income and minority markets either had no statistically significant effect on segregation or even increased it.


The National Curriculum handbooks are the official National Curriculum documents for secondary and primary schools. They are the revised blue-print for what every child will be required to learn in school from September 2000.


Objective: To determine trends of new cases per year, stages and five-year survival rate of breast cancer in Srinagarind Hospital during January 2000 and December 2010. Materials and Methods: During January 2000 and December 2010, all new cases of breast cancer in Srinagarind Hospital, Faculty of Medicine, KhonKaen University, Thailand were included in the study. Electronic database of Srinagarind cancer registry was accessed and reviewed. Demographic data and survival time were analyzed using Descriptive statistics and Log-rank test, respectively. Results: There were 3,097 female (98.9%) and 36 male patients (1.1%). The mean age was 50.0 years old. Stage at diagnosis of I, II, III, IV and unknown were 6.5%, 28.5%, 28.2%, 15.5% and 21.3%, respectively. Treatments of breast cancer including surgery, chemotherapy and radiotherapy were 80.0%, 67.5% and 31.1%, respectively. Overall five-year survival rate was 59.1% (95%CI:56.6%-61.8%). The five-year survival of stage I,II,III,IV and unknown were 89.7%(95%CI:83.9%-96.0%), 74.6%(95%CI:70.5%-79.0%), 48.3% (95%CI:43.7%-53.4%), 28.2% (95%CI:22.8%-34.8%), 63.8%(95%CI:56.3%-72.1%), respectively. Conclusion: The  number of new cases per year of breast cancer were increasing in the past decade but  the proportion  of each stage were not difference. The overall five-year survival rate was 59.1%.


Maximum oxidative capacity of skeletal muscle measured by in vivo phosphorus magnetic resonance spectroscopy (31P-MRS) declines with age, and negatively affects whole-body aerobic capacity. However, it remains unclear whether the loss of oxidative capacity is caused by reduced volume and function of mitochondria or limited substrate availability secondary to impaired muscle perfusion. Therefore, we sought to elucidate the role of muscle perfusion on the age-related decline of muscle oxidative capacity and ultimately whole-body aerobic capacity. Muscle oxidative capacity was assessed by 31P-MRS post-exercise phosphocreatine recovery time (τPCr), with higher τPCr reflecting lower oxidative capacity, in 75 healthy participants (48 men, 22–89 years) of the Genetic and Epigenetic Signatures of Translational Aging Laboratory Testing study. Muscle perfusion was characterized as an index of blood volume at rest using a customized diffusion-weighted MRI technique and analysis method developed in our laboratory. Aerobic capacity (peak-VO2) was also measured during a graded treadmill exercise test in the same visit. Muscle oxidative capacity, peak-VO2, and resting muscle perfusion were significantly lower at older ages independent of sex, race, and body mass index (BMI). τPCr was significantly associated with resting muscle perfusion independent of age, sex, race, and BMI (p-value = 0.004, β = −0.34). τPCr was also a significant independent predictor of peak-VO2 and, in a mediation analysis, significantly attenuated the association between muscle perfusion and peak-VO2 (34% reduction for β in perfusion). These findings suggest that the age-associated decline in muscle oxidative capacity is partly due to impaired muscle perfusion and not mitochondrial dysfunction alone. Furthermore, our findings show that part of the decline in whole-body aerobic capacity observed with aging is also due to reduced microvascular blood volume at rest, representing a basal capacity of the microvascular system, which is mediated by muscle oxidative capacity. This finding suggests potential benefit of interventions that target an overall increase in muscle perfusion for the restoration of energetic capacity and mitochondrial function with aging.


REFERENCES 1. Gelb AF, George SC, Silkoff PE, et al. Central and peripheral airway/alveolar sites of exhaled nitric oxide in acute asthma. Thorax 2010;65:619e25. 2. Mahut B, Trinquart L, Le Bourgeois M, et al. Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severity. Allergy 2010;65:636e44. 3. Mahut B, Delclaux C, Tillie-Leblond I, et al. Both inflammation and remodeling influence nitric oxide output in children with refractory asthma. J Allergy Clin Immunol 2004;113:252e6. 4. Puckett JL, Taylor RW, Leu SY, et al. Clinical patterns in asthma based on proximal and distal airway nitric oxide categories. Respir Res 2010;11:47. 5. Delclaux C, Sembach N, Claessens YE, et al. Offline exhaled nitric oxide in emergency department and subsequent acute asthma control. J Asthma 2008;45:867e73.


Migraine headache is widely believed to be associated with cerebral or meningeal vasodilatation. Human evidence for this hypothesis is lacking. 3 Tesla magnetic resonance angiography (3T MRA) allows for repetitive, non-invasive, sensitive assessment of intracranial vasodilatation and blood flow. Nitroglycerine (NTG) can faithfully induce migraine attacks facilitating pathophysiological studies in migraine. Migraineurs (n =3 2) randomly received NTG (IV 0.5kg/kg/min for 20 min; n = 27) or placebo (n = 5; for blinding reasons). Using 3T MRA, we measured: (i) blood flow in the basilar (BA) and internal carotid arteries (ICA) and (ii) diameters of the middle meningeal, external carotid, ICA, middle cerebral, BA and posterior cerebral arteries at three timepoints: (a) at baseline, outside an attack; (b) during infusion of NTG or placebo and (c) during a provoked attack or, if no attack had occurred, at 6 h after infusion. Migraine headache was provoked in 20/27 (74%) migraineurs who received NTG, but in none of the five patients who received placebo. The headache occurred between 1.5 h and 5.5 h after infusion and was unilateral in 18/20 (90%) responders. During NTG (but not placebo) infusion, there was a transient 6.7^30.3% vasodilatation (P_ 0.01) of all blood vessels. During migraine, blood vessel diameters were no different from baseline, nor between headache and non-headache sides. There were no changes in BA and ICA blood flow during either NTG infusion or migraine. In contrast to widespread belief, migraine attacks are not associated with vasodilatation of cerebral or meningeal blood vessels. Future anti-migraine drugs may not require vasoconstrictor action.


This paper discusses an ontological crisis that emerges from the modern life which is inherently related to modern technology, with insights from Heidegger's ontology of technology and my observations in Ladakh. There are two central underlying assumptions in my approach: − "Technological" progress lies at the heart of earning the identity of being a developed country. − The way we relate to objects of knowledge, determines the nature of knowledge. Heidegger shows that what qualifies as science and technology for the minority world today, has not always been the way it was conceived. The validity and truth of modern knowledge is held under profound suspicion because only that which can be measured, calculated, stored, called-upon and challenged to deliver comes into being in this worldview. This tendency pervades every aspect of our lifestyles including mundane acts such as excretion. It is through such mundane acts, that relations with existence as a whole are formed and maintained and progressive knowledge is possible; knowledge which makes sustainability and the good life possible. Key Word: Technology, Excretion, Ladakhi, Heidegger's Ontology of Technology.


Laughter positive emotion, helpful, healthy way to deal with stress. Laughter therapy is a cognitive-behavioral therapy that can make physical, psychological; social relationships healthy improve quality of life. Laughter therapy positive effect on mental health alternative therapy. Laughter therapy does not require special preparations, such as appropriate facilities equipment easily accessible. Laughter reduces stress-producing hormones in the blood, can reduce the effects of stress. Depression is a disorder in which neurotransmitters such as norepinephrine, dopamine, serotonin is reduced brain. Problem mood control circuit of the brain. Laughter can alter dopamine serotonin activity. The endorphins released by laughter can be helpful when people are upset or depressed. Laughter therapy alternative treatment for depression that harms mental health. Examined the effect of laughter therapy on depression was in this study. In the research, it was used as "Pretest-Posttest-Semi-Experimental Design with Follow-Up Test Control Group." The study was conducted by obtaining a work permit from the participants who applied to the Psychology, Psychiatry Clinic in the Beyoğlu district of Istanbul. It was determined randomly which of the centers would be the experimental group the control group. While the study group consisted of 15 participants, the control group consisted of 15 participants. Participation of individuals included in the study was voluntary basis. While the experimental group received a 4-week "Laughter Therapy Practice," the control group received a placebo-like two-session training. Used personal information form Beck Depression Inventory. As a result, the depression levels of the participants who were treated with laughter therapy decreased.


French cuisine is such a staple in our understanding of fine food that we forget the accidents of history that led to its creation. "Accounting for Taste" brings these "accidents" to the surface, illuminating the magic of French cuisine and the mystery behind its historical development. Priscilla Parkhurst Ferguson explains how the food of France became French cuisine. This momentous culinary journey begins with Ancien Regime cookbooks and ends with twenty-first-century cooking programs. It takes us from Careme, the "inventor" of modern French cuisine in the early nineteenth century, to top chefs today, such as Daniel Boulud and Jacques Pepin. Not a history of French cuisine, "Accounting for Taste" focuses on the people, places, and institutions that have made this cuisine what it is today: a privileged vehicle for national identity, a model of cultural ascendancy, and a pivotal site where practice and performance intersect. With sources as various as the novels of Balzac and Proust, interviews with contemporary chefs such as David Bouley and Charlie Trotter, and the film "Babette's Feast," Ferguson maps the cultural field that structures culinary affairs in France and then exports its crucial ingredients. What's more, well beyond food, the intricate connections between cuisine and country, between local practice and national identity, illuminate the concept of culture itself. To Brillat-Savarin's famous dictum-"Animals fill themselves, people eat, intelligent people alone know how to eat"-Priscilla Ferguson adds, and "Accounting for Taste" shows, how the truly intelligent also know "why" they eat the way they do. "Parkhurst Ferguson has her nose in the right place, and an infectious lust for her subject that makes this trawl through the history and cultural significance of French food-from French Revolution to "Babette's Feast" via Balzac's suppers and Proust's madeleines-a satisfying meal of varied courses."-Ian Kelly, "Times" (UK) "


biology depend greatly on the capability of computational applications to analyze the laboratorial results. A comprehensive analysis of an experiment requires typically the simultaneous study of the obtained dataset with data that is available in several distinct public databases. Nevertheless, developing a centralized access to these distributed databases rises up a set of challenges such as: what is the best integration strategy, how to solve nomenclature clashes, how to solve database overlapping data and how to deal with huge datasets. In this paper we present GeNS, a system that uses a simple and yet innovative approach to address several biological data integration issues. Compared with existing systems, the main advantages of GeNS are related to its maintenance simplicity and to its coverage and scalability, in terms of number of supported databases and data types. To support our claims we present the current use of GeNS in two concrete applications. GeNS currently contains more than 140 million of biological relations and it can be publicly downloaded or remotely access through SOAP web services.


Singular regions of the globe harbour a disproportionally large fraction of extant biodiversity. Spatial biodiversity gradients are frequently associated to extant ecological conditions using statistical models, but more rarely to paleo-environmental conditions, especially beyond the Quaternary. On one hand the role of plate tectonics in shaping the extant diversity of lineages is supported by numerous phylogenetic and fossil evidences, and on the other hand the spatial variation of biodiversity across the globe is rarely associated to geodynamic variables. In this study, we propose that plate tectonics explain the current location of hotspots of endemic richness across the globe. As an illustration, we used paleogeographies in a model, which quantifies through time and for each cell the potential dispersal across disconnected habitat patches. Rare events of dispersal across dynamic straits of unsuitable habitats allows species colonisation and that a subsequent absence of gene flow could lead to in-situ speciation. We evaluated whether this process could pinpoint the locations of hotspots of endemic richness computed from the ranges of 181,603 species across 14 taxonomic groups. The significant congruence between the regions highlighted by the model and the endemic richness provides evidences of the contribution of plate tectonics in shaping global biodiversity gradients. Places with high tectonic complexity, predominantly located at the confluence of major lithospheric plates such as the Mediterranean basin, Central America, Madagascar and South East Asia likely provided favourable circumstances for allopatric speciation and the emergence of new species across straits. While our illustration supports the role of plate tectonics, accounting for deep time geological events in spatial models of extant biodiversity is not straightforward. Future research should develop quantitative spatial models of biodiversity including the dynamic of ancient habitats.


Fluorescence photobleaching recovery and immunofluorescence methods have been used to study the lateral mobility and topographical distribution of a major cell surface glycoprotein (CSP). Both endogenous CSP and fluorescent-labeled exogenous CSP bind to the cell surface in a fibrillar pattern and are immobile on the experimental time scale. Azide, vinblastine, and cytochalasin B do not alter the immobility and cell surface distribution of the CSP molecules. Therefore, oxidative phosphorylation and the cytoskeleton do not seem to be responsible for the properties of the bound glycoprotein. The presence of immobile CSP fibrils does not, however, impede the diffusion of a lipid probe, a ganglioside analogue, or various surface antigens. Therefore, the fibrils apparently do not form a "barrier" across the lipid phase of the plasma membrane. In contrast, concanavalin A binds to CSP and is largely immobile in regions rich in CSP. The presence of immobile concanavalin A receptors in areas or on cells lacking CSP indicates that other types of immobile concanavalin A receptors also exist.CSP does not bind to lipid bilayers composed of phosphatidylcholine or oxidized cholesterol. It does bind to dextran-coated bilayers as a diffuse distribution of mobile molecules that can patch after addition of antibodies to CSP. The latter result suggests that CSP molecules do not interact strongly with other CSP molecules under these conditions. Exogenous CSP binds to regions on the cell surface that already bear CSP. In view of the apparent weakness of CSP-CSP interactions on the lipid bilayer, it seems possible that the assembly of CSP fibrils is nucleated by cell surface components in addition to CSP.


This paper presents an experimental study on demountable shear connectors in profiled composite slabs. Overall, three groups of push-off tests were conducted to assess the shear capacity, stiffness and ductility of the shear connectors. In all the specimens, a pair of shear studs were used per trough and were bolted to each side of the flange of a loading beam. Different concrete strength, embedment height of the shear studs and reinforcement cage were considered. Particularly, a joint was made between the pair studs in two groups of specimens when casting and formed two completely separate slabs per half specimen, to evaluate the load transfer between the pair studs. The experimental results showed that the shear capacity and behavior of the demountable connectors in separate slabs and continuous slab were both similar to the welded connectors and could fulfill the 6mm minimum ductility requirement stated in Eurocode 4 if proper embedment height of connector was used. The shear capacities of the tested specimens were compared against the calculated results obtained from the equations used for welded shear connectors in Eurocode 4 and bolted connections in Eurocode 3. Generally, the Eurocodes prediction underestimated the shear capacities of the push-off specimens.


Prognosis of patients with glioblastoma (GBM) remains dismal despite maximal surgical resection followed by aggressive chemo-radiation therapy. Almost every GBM, regardless of genotype, relapses as aggressive recurrent disease. Sensitization of GBM cells to chemo-radiation is expected to extend survival of patients with GBM by enhancing treatment efficacy. The PARP family of enzymes has a pleiotropic role in DNA repair and metabolism and has emerged as an attractive target for sensitization of cancer cells to genotoxic therapies. However, despite promising results from a number of preclinical studies, progress of clinical trials involving PARP inhibitors (PARPI) has been slower in GBM as compared to other malignancies. Preclinical in vivo studies have uncovered limitations of PARPI-mediated targeting of base excision repair, considered to be the likely mechanism of sensitization for temozolomide (TMZ)-resistant GBM. Nevertheless, PARPI remain a promising sensitizing approach for at least a subset of GBM tumors that are inherently sensitive to TMZ. Our PDX preclinical trial has helped delineate MGMT promoter hyper-methylation as a biomarker of the PARPI veliparib-mediated sensitization. In clinical trials, MGMT promoter hyper-methylation now is being studied as a potential predictive biomarker not only for response to TMZ therapy alone, but also PARPI-mediated sensitization of TMZ therapy. Besides the combination approach being investigated, IDH1/2 mutant gliomas associated with 2-hydroxygluterate (2HG)-mediated homologous recombination (HR) defect may potentially benefit from PARPI monotherapy. In this article, we discuss existing results and provide additional data in support of potential alternative mechanisms of sensitization that would help identify potential biomarkers for PARPI-based therapeutic approaches to GBM.


The concept of intention is used in different ways in many regulations of the EU. The Court of Justice of the EU has given a description of intention and accepted dolus eventualis as a form of intention. This article examines several relevant judgments of the Court, especially case C-396/12.These judgments show a double emancipation process. Not only are legal concepts used in the European Union emancipated from those concepts used in the national legal traditions of the Member States. These concepts are also emancipated from the field of law in which they were developed in the Member States.


Chronic undernutrition is characterized by long-term exposure to food of insufficient quality and inadequate quantity, including restricted intake of energy, protein, fat, micronutrients, essential amino acids, vitamins and minerals. Physiologically, in a state of chronic food insufficiency, the human body conserves energy by prioritizing essential metabolic processes resulting in impaired linear growth and delayed reproductive maturation. Consequently, height can theoretically be considered a measure of an individual's cumulative health and nutrition. Therefore, a deviation from the 'normal' height relative to one's age represents a deviation from one's optimal growth and, potentially, the presence of other issues. Similarly, the delayed onset of puberty is another common physiological response to food insufficiency, often accompanying impaired linear growth. Chronic undernutrition can arise from chronic disease, congenital abnormalities and insufficient food intake. In this review, we will explore the hypothesis of CUG during adolescence, given the relationship between impaired linear growth and the delayed onset of puberty in children suffering from chronic undernutrition due to a lack of sufficient quality and quantity of food.


The multiprocessor SoC (MPSoC) revolution is fueled by the need to execute multiple advanced multimedia applications on a single embedded computing platform. At design-time, the applications that will run in parallel and their respective user requirements are unknown. Hence, a run-time manager is needed to match all application needs with the available platform resources and services. Creating such run-time manager requires two decisions. First, one needs to decide what functionality to implement. Second, one has to decide how to implement this functionality in order to meet boundary conditions like e.g. real-time performance. This paper is the first to detail a generic view on MPSoC runtime management functionality and its design space tradeoffs. We substantiate the run-time components and the implementation trade-offs with state-of-the-art solutions and a brief overview of some industrial and academic multiprocessor run-time management examples. We show a clear trend towards more hardware acceleration, a limited distribution of management functionality over the platform and increasing support for adaptive multimedia applications.


This paper provides an implementable and energy efficient solution for the problem of manoeuver control of formations of nano-satellites subject to input-saturation constraints and persistent disturbances. The proposed control scheme is based on a supervisory switching logic which, at any time instant, select the most appropriate controller from a bank of pre-computed candidate predictive regulators. Each candidate controller is tuned for minimal energy control on to a different control horizon. The larger the control horizon, the smaller the energy of the required inputs. An example is provided for showing the effectiveness of the proposed approach.


INTRODUCTION
Robot-assisted partial nephrectomy (RAPN) is increasingly used for the surgical management of renal masses. Aim of this study was to analyze the available literature regarding the outcomes of RAPN compared to those of open partial nephrectomy (OPN).

EVIDENCE ACQUISITION
A literature search was performed up to October 2018 using PubMed, MEDLINE and Embase. Article selection followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles and Population, Intervention, Comparator, Outcomes (PICO) methodology was used. Population (P) was patients with renal masses who underwent RAPN (I). RAPN was compared with OPN (C). Outcomes of interest were perioperative, oncological and functional outcomes of both surgical procedures (O). Inclusion criteria were: randomized controlled studies andobservational cohort studies comparing RAPN versus OPN, which reported at least one outcome of interest.

EVIDENCE SYNTHESIS
Twenty-two manuscripts met our inclusion criteria and were included in the systematic review. RAPN was superior to OPN in terms of complication rate in 11 studies while similar results were observed in 9 studies. Positive surgical margins were similar in 13 studies while RAPN had lower surgical margins in 6 studies. Operative and warm ischemia times were longer in OPN in 13 and 10 studies, respectively. Seventeen and 19 studies showed that estimated blood loss and length of hospital stay were higher in RAPN. Estimated glomerular filtration rate decline and chronic kidney disease upstaging decline were similar in the majority of studies.

CONCLUSIONS
Current evidence demonstrate that RAPN is a reasonable alternative to OPN with regard to oncological and early functional outcomes with a straightforward advantage of improved perioperative morbidity, as expected by minimally invasive techniques. Nevertheless, there is still a great need for well-designed randomized studies with an extended follow-up.


According to Howe (2002), humor originates from perceiving the thoughts of the subject of the humor, implying the involvement of perspective-taking or related mental processes. However, how does the ability to infer the mental states of others, or theory of mind (ToM) operate with the comprehension of humor is yet certain. The current research continued to examine this idea using fMRI, hoping to investigate the underlying neural substrates of those with high and low ToM related ability when processing humor. In fMRI, participants read 64 stories, including ToM-funny, ToM-unfunny, nonsensical-funny, and nonsensical-unfunny conditions. Empathy Quotient is used to assess participants' ToM ability. The results revealed a positive correlation between EQ scores and left ACC under the comparison between ToM conditions and nonsensical conditions. The present study advanced the influences of ToM processing and how it involves cognitive processing, such as story reading or joke comprehension.


Objective To analyse the nutritional status of the adult population in Esmeraldas by means of anthropometric measurements, the input of macro and micronutrients in the diet, and the adequacy estimation of nutrient intake by hispanic Dietary Reference Instakes along with the sex and the age influence. Methods Nutrient intake data were obtained by personal interview with the application of two 24 hour recalls (weekend and weekday). The anthropometric indicators analysed were body mass index, waist circumference and blood pressure. Nutriplato version 2.0 software was used for the two 24-hours food recall surveys data processing, and for the respective calculations of macronutrients, micronutrients and Dietary Reference Intakes. Means and standard deviations were calculated for anthropometry, nutrient intakes and Dietary Reference Instakes. The General Linear Model was applied to identify differences in relation to nutrient intakes considering sex, profession, body mass index, group, origin and day of the week as factors. Results Statistical analysis showed significant differences mainly in carbohydrates, fiber, calcium, phosphorus, iron, sodium, iodine, and vitamin E. Dietary intakes were compared with the Federación Española de Sociedades de Nutrición, Alimentación y Dietética Dietary Reference Intakes requirements and calcium, potassium, iodine, riboflavin, pantothenic acid, biotin, vitamin D, vitamin E, fiber, monounsaturated fatty acids and polyunsaturated fatty acids are below the Dietary Reference Instakes in all ages and gender subgroups. The anthropometric results obtained indicated that 67.0% of the population were overweight and obese, the 87.7% of the adults suffered from prehypertension and the waist circumference indicated that 73.0% of the subjects were established in the range of high risk of cardiovascular disease.


In multi-contrast acquisitions, a critical concern is whether to distribute undersampling uniformly or unequally across contrasts, as scan times and SNR typically vary among sequences. This study investigates a compressive sensing framework in jointly reconstructing multi-contrast data with unequal acceleration rates. Using in-vivo and numerical datasets, the total scan time was fixed and acceleration factors were varied between protocols. The results suggest using lower acceleration rates for protocols with higher-SNR and shorter duration, and higher rates for protocols with lower-SNR and longer duration improves image quality, even in the highly accelerated contrast. The method was also compared to seven state-of-the-art methods from the literature.


In a 15-year case study, we used the multiple streams approach (MSA) and the advocacy coalition framework (ACF) to examine a controversial industry-led proposal for increased harvest of Crown forests in New Brunswick, Canada, in an adversarial policy subsystem. Study participants were queried on their perceptions of policy problems and reasons for community attention, the relationship between science and policy, and whether policy decisions were consistent with scientific understanding. Thematic analysis was used to examine interview data for evidence of Kingdon's MSA and Sabatier's ACF. During public hearings of a Legislative Select Committee on Wood Supply, two competing policy alternatives emerged. The first, put forward by the forest industry coalition, advocated an intensive forest management approach in support of a competitive industry. The second, supported by the conservation coalition, largely made up of scientists and environmental groups, focused on adaptive management, an ecosystem approach, and greater public input. This counterproposal forestalled the industry from placing its proposal on the government 2005 decision agenda. However, in 2014, the government unexpectedly adopted essentially the same industry proposal. Although the MSA provided a better explanation of the factors critical to the 2014 policy change, i.e., a declining provincial economy and a change of key government personnel, the ACF offered a nuanced perspective on the need for a professional forum to facilitate policy-oriented learning across competing coalitions. In 2014, the lack of such a forum and a closed process limited policy alternatives considered by elected officials. Results also emphasize the importance of how legislators choose to interact with experts and scientists, particularly within an adversarial subsystem, especially when a powerful coalition develops ways to limit the access to decision makers by competing coalitions.


Abstract Leptin, a hormone released from the adipose tissue, inhibits food intake and increases energy expenditure. We have found a novel function of leptin as a modulator of sweet taste sensitivity in mice. In lean normal mice, the gustatory nerve responses to sweet stimuli were selectively suppressed depending on plasma leptin level after an intraperitoneal injection of recombinant leptin. Patch-clamp studies using isolated taste cells of lean mice showed that extracellular leptin enhanced K+ currents of sweet-responsive taste cells, which led to membrane hyperpolarization and a reduction of sweetener-induced depolarization. Reverse transcription-polymerase chain reaction (RT-PCR) and in situ hybridization analyses demonstrated specific expression of mRNA of the long-form functional leptin receptor (Ob-Rb) in taste tissue and cells of lean mice. The genetically diabetic db/db mice, which have defects in Ob-Rb, demonstrated neither a suppression of gustatory neural responses to sweeteners nor an increment of whole-cell K+ conductance of taste cells even with high doses of leptin. These results suggest that Ob-Rb is specifically expressed in sweet-responsive taste cells of lean mice and that leptin suppresses sweetener-induced depolarization via activation of K+ channels, leading to a decrease in impulses of sweet-best fibers. The enhanced sweet responses of db/db mice may result from the lack of inhibitory modulation by leptin.


The present paper investigates the effect of certain economic factors on the competitiveness of Greek Wine Enterprises and Unions of Agricultural Cooperatives (UACs). Data on 41 wineries and 10 UACs of Greece was collected for a period of three years (2004-2006). Financial analysis results were used with the help of a fixed effect model-panel data technique- using profitability as dependent variable in order to measure the competitiveness of wineries. The results indicated that the size of the enterprise as well as the square of the capital intensity have a positive influence on the winery's profit.


Abstract. International agreements aimed at reducing sulphur deposition from the atmosphere are now focused on the "critical loads" concept. This provides a distributed link between sources and receptors of acidic oxides and also links the level of reduction with biological recovery. Methods for calculating critical loads include simple classification (Level 0), mass-balance equilibrium models (Level 1) and dynamic hydrochemical models (Level 2). Here, examples of each method are applied to headwater catchments in Plynlimon, mid-Wales. The critical loads derived are compared and the utility of the critical loads concept as a tool for local pollution control and land management is assessed. Differences in critical load methods for soils result from assumptions regarding biological receptors. Surface water critical loads are generally similar under all methods. As a local management tool, the dynamic model is most appropriate although it has a high data requirement. The utility of other methods depends upon detailed maps of soil and vegetation being available at an appropriate scale.


Abstract The aim of this study is to examine the relationship among pre-service science teachers' personality traits, academic self-regulation and teaching self-efficacy by proposing and testing a conceptual model. For the specified purpose, 1794 pre-service science teachers participated in the study. The Teachers' Sense of Efficacy Scale, the NEO Five-Factor Inventory, and the Motivated Strategies for Learning Questionnaire were administered to assess pre-service science teachers' teaching self-efficacy, personality, and academic self-regulation respectively. Results showed that agreeableness, neuroticism, performance approach goals, and use of metacognitive strategies are positively linked to different dimensions of teaching self-efficacy, namely self-efficacy for student engagement, instructional strategies, and classroom management. In general, while agreeableness and neuroticism were found to be positively associated with different facets of self-regulation and teaching self-efficacy, openness was found to be negatively linked to these adaptive outcomes.


The main of this paper, is determining relationship between science and technology performance indicators used by private sector industry based on balanced scorecard. Evaluation of support by development organizations in the Ministry of Industries and Mines of IRAN in empowering the private sector in domains of science and technology includes four dimensions that in the first step, evaluation indices derived based on field studies and ultimately bilateral questionnaires are created. These indicators are grouped into some categories named strategic issues of that field and then between them are drawn conceptual relationship. Next, relationships between each of these issues, by means of statistics concept, are being assessed in the form of a multi-agent structure and ultimately, executive paths are being determined. This research will help managers to understand managing key indicators of success and can identify critical paths and the way to overcome critical situations.


The main purpose of this bachelor thesis is to create a product in the form of a database that can be used for cost estimates of equipment within bio refineries. Through interviews and literature searches the key components and their costs were identified. The database was constructed in Microsoft Excel with different tabs for different categories of components; these tabs are further divided into three parts: one part with costs, one part with calculations and an information part. Most of the part with costs contains the expenses found in scientific papers during the literature study, the calculating part converts different capacities according to user preferences and the currency to euro (€) from 2010 and the information part consists of references and information about what is included in the cost.

The database is a good tool for making cost estimates for bio refineries. The strengths of the database are its ease of use, its capability of handling different currencies at different times and the fact that it covers a large number of components. However, it allows only rough estimates, and therefore cannot be used to make final cost estimates for real life investments. This would require a much more detailed study, as margins can be very small. The type of database generated during this project works best for comparison of different alternative technologies. When costs and profitability for competing technologies are estimated in the database, they are fairly accurate relative to one another even if the estimated costs can differ from the real price. Therefore, this type of database is useful whenever techniques at an early stage of development need be compared with each other.

To test the database a profitability analysis is also performed on a typical bio refinery concept including an investigation of the necessary level of financial support to make it an economically viable technique at different repayment terms. The result is that for a repayment period of 10 years, a financial assistance of 0.081 euro (€)/kWh SNG is needed, for 15 years 0.036 euro (€)/kWh SNG and for 20 years 0.014 euro (€)/kWh SNG is needed. To check if these levels are reasonable, it is compared with the support in Denmark, which is 50 ore/kWh SNG and the payback period for this process with the Danish assistance is 12.7 years. Since companies often strive for a repayment period of 10-20 years it seems like it is a pretty good estimate, but there are still large uncertainties in the assessment of the viability.


By enabling diverse and large-scale transducers, large-area electronics raises the potential for electronic systems to interact much more extensively with the physical world than is possible today. This can substantially expand the scope of applications, both in number and in value. But first, translation into applications requires a base of system functions (instrumentation, computation, power management, communication). These cannot be realized on the desired scale by large-area electronics alone. It is necessary to combine large-area electronics with high-performance, high-efficiency technologies, such as crystalline silicon CMOS, within hybrid systems. Scalable hybrid systems require rethinking the subsystem architectures from the start by considering how the technologies should be interfaced, on both a functional and physical level. To explore platform architectures along with the supporting circuits and devices, we consider as an application driver, a self-powered sheet for high-resolution structural health monitoring (of bridges and buildings). Top-down evaluation of design alternatives within the hybrid design space and pursuit of template architectures exposes circuit functions and device optimizations traditionally overlooked by bottom-up approaches alone.


In 'Visual Pleasure and Narrative Cinema', Laura Mulvey says the gender
inequality that favours men and disadvantages women also structures how
we look. Women are passive objects of the look and men are active agents
of it. Fetishistic scopophilia exaggerates and emphasizes the physical beauty
of a woman so she is pleasurable to look at, but at the same time it reduces
her to a non-threatening fragment, a part-object without subjectivity.
In reference to Marxism and psychoanalysis, this chapter will argue
that contemporary culture, characterized by the predominance of social
networking sites and selfies, produces a particular type of fetishistic look:
a magnifying, dissecting gaze. This mode of looking is an internalized gaze
that compels the individual to work on the body so it more closely resembles
social body ideals. It is not the pleasurable scopophilia described by Mulvey
but a judgmental, disciplining gaze.


Flast v. Cohen, decided by the Supreme Court in 1968, articulated a narrow exception to the general rule that merely being a taxpayer does not provide the necessary standing to challenge an expenditure of government funds alleged to violate the Constitution. Since the time of Flast, the Court has steadily narrowed the exception, retreating from the underlying rationale of the Flast decision—a trend most recently observable in the Court's decision in Arizona School Tuition Organization v. Winn. This Note proposes a new test for taxpayer standing which aims to preserve the doctrine, while remedying some its ills. Under this Note's proposed test, taxpayer standing is appropriate when the following three factors are met: (1) the taxpayer's status as a taxpayer bears a reasonable relationship to the challenged expenditure of government funds in question; (2) it is of practical necessity because the political system is structurally ill-equipped to provide a remedy for those who object to a particular expenditure of government funds alleged to violate the Constitution, or the taxpayer is a member of the class for whom the especial benefit of a constitutional limitation is intended to directly run; and (3) where no other plausible party has standing to challenge the alleged violation, leaving it functionally irremediable.


Accessibility is a concept that has become central to physical planning during the last 50 years; improving accessibility is an aim which has now made its way into mainstream transport planning and policymaking worldwide. Batty (2009) traces the origins of the concept back to the 1920s. It was used in location theory and regional economic planning, becoming important once transport planning began, mainly in North America where it was associated with transport networks and trip distribution patterns. Its conceptual basis dates back further. Hansen (1959), in his classic and much cited exposé, 'How accessibility shapes land use', rolled out our fi rst real defi nition: the potential for interaction (based on the notion of potential traced back to the social physics school in the nineteenth century). In recent decades, the term 'accessibility' has marshalled renewed interest from civil engineering, geography, spatial economics and other academic fi elds to uncover a variety of new measures. This book's purpose is relatively straightforward. It marries advancing approaches in accessibility research and modelling with best practices in accessibility planning and evaluation – to better support integrated transport and landuse policymaking in Europe and the United States. In the 2000s considerable progress has been made along these fronts. These advances have taken diff erent directions. First, there is a continuing trend of more complex and disaggregated accessibility measures, largely in response to recognizing that aggregate measures fail to account for the wide variation in individual behaviour and population groups at diff erent spatial scales. These trends partly result from improvements in techniques to construct locationbased accessibility indicators. These techniques have evolved from simple calculations to complex and detailed methods that use algorithms within a geographic information system (GIS) platform to extract and assemble data from multiple spatial databases at fi ne levels of spatial resolution (e.g., see Chen et al., 2011; Kwan, 2000). Measuring


Svensk Karnbranslehantering AB (SKB) has performed comprehensive investigations of two candidate sites for a final repository for Sweden's spent nuclear fuel. In March 2011 SKB decided to submit licence applications for a final repository at Forsmark. Before selection, SKB stated that the site that offers the best prospects for achieving long-term safety in practice would be selected. Based on experiences previous safety assessments, a number of issues related to long-term safety need to be considered in the context of site comparison. The factors include sensitivity to climate change such as periods of permafrost and glaciations, rock mechanics evolution including the potential for thermally induced spalling and sensitivity to potential future earthquakes, current and future groundwater flow, evolution of groundwater composition and proximity to mineral resources. Each of these factors related to long-term safety for the two candidate sites is assessed in a comparative analysis of site characteristics. The assessment also considers differences in biosphere conditions and in the confidence of the site descriptions. The comparison is concluded by an assessment on how the identified differences would affect the estimated radiological risk from a repository located at either of the sites. The assessment concludes that there are a number of safety related site characteristics for which the analyses do not show any decisive differences in terms of implications on safety, between the sites Forsmark and Laxemar. However, the frequency of water conducting fractures at repository depth is much smaller at Forsmark than at Laxemar. This difference, in turn, affects the future stability of the current favourable groundwater composition, which combined with the much higher flows at Laxemar would, for the current repository design, lead to a breach in the safety functions for the buffer and the canister for many more deposition positions at Laxemar than at Forsmark. Thereby the calculated risk for Forsmark will be considerably lower than that for Laxemar. What decided the choice is that Forsmark is thus mainly that it was judged to offer better prospects for achieving long-term safety in the final repository. Other factors considered included implications regarding repository construction and operation, difference in the footprint of the repository, comparisons regarding environment and health as well as social resources and local support.Copyright © 2011 by ASME


for an Invited Paper for the APR11 Meeting of The American Physical Society Working (And Sparring) With Luis: Some Personal Recollections MOISHE PRIPSTEIN, Physics Division, National Science Foundation Luis Alvarez was the most remarkable physicist I have ever worked with. As a member of his bubble chamber group at the Lawrence Radiation Laboratory in Berkeley and subsequently as a leader of that group for several years, I could appreciate his outstanding attributes as a physicist and his forceful and colorful personality. Each day at the lab seemed exciting. Although he created the largest research group in particle physics in the world at the time, Luis was an ardent foe of group-think, which he characterized as "intellectual phase-lock". He had an uncanny intuition about physics and technology, coupled with an insatiable curiosity about the world around him. He is justly renowned as a member of the Inventors Hall of Fame for his myriad inventions and as a Nobel Laureate in physics for his contributions to particle physics through his development of the hydrogen bubble chamber technique, leading to the discovery of a large number of resonance states. However, it was his wide-ranging curiosity which led him to one of his finest achievements, while working with his son Walter – developing the asteroid impact theory as the explanation of the extinction of the dinosaurs. I will offer some personal recollections of Luis and the group in this period, including some of his other intriguing efforts which illustrate the breadth of his interests, pertaining to the Kennedy assassination and x-raying the pyramids, among them. All in all, a brilliant and most unusual scientist and stimulating colleague.


The movement of people and capital around the world necessitates that we explore the ways in which women interact with food through varying enterprises. Many of these activities are considered "off the books" or part of a shadow or underground economy. This alternative economic space usually involves otherwise law-abiding citizens who seek to provide for their families in ways that fall outside the formal economy. This ethnographic project examines four female street-food vendors of Jacmel, Haiti. This project considers what happens when the underground becomes the primary means of survival. Some could argue that the "informal system" reinforces a traditional patriarchy gender performance, yet the women reveal a system that sustains community and provides food for the masses in a more efficient and effective way than the government-sponsored programs while simultaneously encouraging a sense of agency, support, and a highly developed community networking system.


The technological and scientific advances of nutrigenetic testing imply the future is here, but unfortunately legal protections are not. Nutrigenetics - the newly developing science correlating diet and genotypes - promises an easier way to escape the consequences of unhealthy lifestyles. And many Americans, including cost-conscious employers and insurers, are seeking such high-tech solutions. But enthusiasm for nutrigenetics obfuscates unusual problems surrounding protection of genetic information in a market context. Upon providing genetic material, individuals lose control over who can access results. The ramifications raise considerable liberty issues - from privacy, equal protection to perhaps property rights - and can result in widespread, irreversible damage, such as stigmatization and discrimination against tested individuals and all who share that DNA. Current regulations and safeguards inadequately address problems, failing to sufficiently consider who may obtain the information. To improve protections, courts should recognize individuals' rights to control personal genetic information. Congress should expand legislation to reach nutrigenetic and other lifestyle genetic testing, mandating safeguards preventing harmful disclosure but allowing authorized parties to obtain relevant information. Proposed legislation distinguishing derived from raw genetic information and regulating third-party access can be implemented through a double-masking model, allowing nutrigenetic testing to provide countless benefits to individuals and society.


Background: Many medications used in older adults have strong anticholinergic (ACH) properties, which may increase the risk of falls and fractures. Use of these medications was identified in a population-based Canadian cohort. Objective: To identify the fall and fracture risk associated with ACH medication use. Methods: Data collection and analysis were conducted at baseline, year 5, and year 10. Cross-sectional analyses were performed to examine associations between ACH medication use and falls. Time-dependent Cox regression was used to examine time to first nontraumatic fracture. Finally, change in bone mineral density (BMD) over 10 years was compared in ACH medication users versus nonusers. Results: Strongly ACH medications were used by 618 of 7753 participants (8.0%) at study baseline, 592 (9.5%) at year 5, and 334 (7.7%) at year 10. Unadjusted ACH medication use was associated with falls at baseline (odds ratio = 1.50; 95% CI = 1.14-1.98; P = 0.004), but the association was no longer significant after covariate adjustment. Similar results occurred at years 5 and 10. ACH medication use was associated with increased incident fracture risk before (hazard ratio = 1.22; CI = 1.13-1.32; P < 0.001) but not after covariate adjustment. Mean (SD) change in femoral neck BMD T-score over 10 years, in those using ACH medications at both years 0 and 5, was −0.60 (0.63) in ACH users versus −0.49 (0.45) in nonusers (P = 0.041), but this was not significant after covariate adjustment. Conclusions: ACH medications were not found to be independently associated with an increased risk of falling, fractures, or BMD loss. Rather, factors associated with ACH medication use explained the apparent associations.


Enterprise Resource Planning (ERP) projects have special characteristics that differentiate them from other kinds of software projects. Main difference that affects effort estimation results is high reuse rates of ERP projects. This paper presents our exploratory work to establish an approach to calculate reuse reflective size of ERP projects, which could be a primary input for effort estimation. We explored the usability of COSMIC function points as the base unit and its convertibility to reuse reflective size using reuse levels. We have performed a case study on an SAP Implementation project. We were able to calculate COSMIC size and reuse levels using the documents available for the project. We discuss the results as well as challenges and opportunities in the light of the case study.


Virtual prototyping technology as a key technology for agile manufacturing can deal with multidisciplinary knowledge across different fields. In the complex product development process, the exchange between heterogeneous data in heterogeneous environment is a universal problem encountered, which increases the complexity of collaborative parallel design of virtual prototype. Taking the product models as carriers and the different function requirements as clues, the knowledge structure and expression of product information in various fields was studied. By adopting component object model technology, direct geometry access technology, behavioural modeling technology and parametric design thinking, the interaction among tools in various function units was realized, and the effective integration of information and function in multi-fields was accomplished, the parameter-driven virtual prototype architecture of complex product based on the integration of information and function was created. The feasibility of this architecture has been verified by the actual engineering. This plan provides an effective way to carry out virtual prototype projects for enterprise.


This paper discusses the feasibility of the use of minimum independent prefix set (MIPS) algorithm in a ternary content addressable memory (TCAM) based parallel architecture proposed for high speed packet switching. MIPS algorithm is proposed earlier to transform a forwarding table into one that contains the minimum independent prefix set. In this paper we propose MIPS algorithm to be integrated into a TCAM based parallel IP lookup engine. We first analyze the table compression performance of the MIPS algorithm and demonstrate that it may lead to routing table expansion rather than compression in general. For certain cases on the other hand, MIPS algorithm performs well and is suitable to be used in TCAM based parallel IP lookup engine. We demonstrate that with the adoption of the MIPS algorithm, the overall performance, in terms of throughput, of the IP lookup engine can be enhanced considerably.


Bisimulation minimization is one of the classical means to fight the infamous state space explosion problem in verification. Particularly in stochastic verification, numerical algorithms are applied, which do not scale beyond systems of moderate size. To alleviate this problem, symbolic bisimulation minimization has been used effectively to reduce very large symbolically represented state spaces to moderate size explicit representations. But even this minimization may fail due to time or memory limitations. This paper presents a symbolic algorithm which relies on a hybrid symbolic partition representation. It dynamically converts between two known representations in order to provide a trade-off between memory consumption and runtime. The conversion itself is logarithmic in the partition size. We show how to apply it for the minimization of Markov chains, but the same techniques can be adapted in a straightforward way to other models like labeled transition systems or interactive Markov chains.


Polyunsaturated fatty acid metabolism is governed primarily by two enzymes, prostaglandin H synthase and lipoxygenase. The crystal structure of the metastable product-oxidized purple form of soybean lipoxygenase-3 was determined at 2.0 A resolution. The data reveal that the chromophore corresponds to an iron-peroxide complex, a potential intermediate in the catalyzed reaction. A significant alteration of the iron site accompanies the formation of the complex. The structure, the first for a fatty acid-lipoxygenase complex, also reveals an unexpected mode of binding, and identifies amino acid residues that may play significant roles in catalysis, regio- and stereoselectivity.


Employability must have to be attained in the journey to success in one's career life. Graduates must be equipped with employability skills, knowledge, and personal attributes as the government of Sri Lanka allocates substantial resources for higher education. However, after graduation, a considerable number of graduates in the field of social sciences including management fail to find suitable employment, hence, are forced to accept lower-paying jobs that are not commensurate with their qualifications and some graduates are unemployed or underemployed. In this context, this study examines the level of employment and employability of management graduates of state universities in Sri Lanka, identifies problems and difficulties faced by management graduates in finding suitable jobs in the industry, and proposes policy measures for improving the employability of management undergraduates of state universities in Sri Lanka. Quantitative research method was used to achieve the objectives of the study. Among 10,033 management graduates from 09 state universities, a sample of 1333 students was selected based on a stratified random sampling method. A postal survey with a structured questionnaire was used to collect the data. Descriptive statics were used to analyze the data. The employability level of management graduates is higher than the average level. Nearly, 90% of them are employed or self-employed, but most of them are seeking a new job. The degree, personality, work experience, English proficiency and professional qualifications are the most important reasons for getting their current job. Age and lack of experience are the major constraints faced by graduates in finding a suitable job. The study


Abstract Objective To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic. Design Multicentre randomised controlled trial. Setting 8 acute care hospitals in Canada. Participants 905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up. Intervention Participants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre's usual care. Patients, healthcare providers, and data collectors were aware of patients' group allocations. Outcome adjudicators were blinded to group allocation. Main outcome measures The primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation. Results All 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group: relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval −0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care: relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (−0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation: absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation. Conclusion Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. Trial registration ClinicalTrials.gov NCT04344665.