From the perspective of the groups formed by listed companies and their subsidiaries, there may be "risk diffusion" effect and "risk neutralization" effect in the debt guarantee of listed companies to their subsidiaries, but it is regrettable that the existing studies have not made a distinction between them. However, under the risk-oriented audit mode in China, the risk level of the auditee directly affects the audit pricing behavior of CPA. In view of this, this paper examines the relationship between debt guarantees and audit pricing of listed companies within the group. The results show that: The debt guarantee for subsidiaries of listed companies within the group improves the audit pricing by enhancing the financial risk and operational risk of listed companies; further research shows that, compared with the debt guarantee of state-owned enterprises and guarantee mode, if the listed company is the debt guarantee of non-state-owned enterprises and joint and several liability, its debt guarantee for subsidiaries will enhance the audit pricing. When the financial level of listed companies is higher, the debt guarantee for subsidiaries will lead to the increase of audit pricing, and good internal control can inhibit the increase of audit pricing caused by the debt guarantee of listed companies. Therefore, this paper argues that listed companies should reasonably choose the way of debt guarantees, and comprehensively study and judge the possible risk points of debt guarantees for subsidiaries, so as to judge whether to guarantee the subsidiaries; the subsidiaries should comprehensively analyze their own resource endowment, financial ability and comprehensive governance ability, so as to prevent the transmission of credit risk to the parent company as far as possible, and curb the group as a whole; auditors should consider the risk points of debt guarantees of listed companies to subsidiaries and the complexity of obtaining audit evidence, and reasonably determine audit fees.The possible contributions of this paper are as follows: (1)From the perspective of group as a whole, studying the relationship between debt guarantees and audit pricing of listed companies within the group can provide a new theoretical explanation for the relationship between debt guarantees and audit pricing of listed companies to subsidiaries. (2)Mining the basic path of debt guarantees for subsidiaries of listed companies to improve audit pricing can reveal the deep logic of listed companies' debt guarantee on subsidiaries' audit pricing. (3)The investigation of cross-sectional characteristics of listed companies, such as the nature of property rights, the way of debt guarantees, the level of financialization and the quality of internal control, can provide important empirical evidence for understanding the constraints between debt guarantees and audit pricing. It is helpful for listed companies to prevent and control the risk of debt guarantees, and provide important decision-making basis for CPA audit pricing.


Pleomorphic carcinoma is a rare variant of pancreatic exocrine carcinoma. The aim of this communication is to reappraise surgical resection of pleomorphic carcinoma of the pancreas. Clinicopathological findings of four Japanese patients with pleomorphic carcinoma of the pancreas were reviewed and compared with those of 24 Japanese patients with adenocarcinoma of the pancreas to clarify possible surgical implications of pleomorphic carcinoma. Of the four patients, three were female and one male, aged 64, 65, 66, and 74 yr, respectively. Two carcinomas were located in the head of the pancreas, one in the body, and the other in the tail. Ultrasonography demonstrated a well defined hypoechoic mass measuring 5–10 cm, with central necrotic area in all of the patients. Computed tomography showed a low density tumor with sharp margin and heterogenous internal structure in all. On angiography, three tumors were hypervascular and another was hypovascular. Extensive vascular encasement was observed in all. Pancreatoduodenectomy was done in two patients and distal pancreatectomy in the other two. Multiple liver metastases occurred 1 month after surgical resection in two patients and local recurrence 1 month in one and 2 months in the other, leading to death either 2 (2 patients) or 3 months (2 patients) after pancreatectomy. Significantly differentiating features of the four pleomorphic carcinomas of the pancreas and the 24 adenocarcinomas of the pancreas were the mean diameter (6.6 ± 1.3 cm vs 3.5 ± 0.3 cm, p= 0.0007), margin of the tumor (expansive in the four pleomorphic carcinomas versus infiltrative in 21 of the 24 adenocarcinomas, p= 0.003) and vascularity on angiography (hypervascular in three of the four pleomorphic carcinomas versus hypovascular in 21 of the 23 adenocarcinomas, p= 0.013). The 1-yr and 3-yr survival rates of the four patients with pleomorphic carcinoma were 0% and 0%, whereas those of the 24 patients with adenocarcinoma of the pancreas were 42% and 13%, respectively (p < 0.0001). These findings suggest that the clinical course of patients with pleomorphic carcinoma of the pancreas is so poor even after surgical resection that pleomorphic carcinoma of the pancreas is not a candidate for pancreatectomy despite its locally expansive growth.


[1] Recent decreases in nitrogen oxide (NOx = NO + NO2) emissions from eastern U.S. power plants and their effects on regional ozone are studied. Using the EPA 1999 National Emission Inventory as a reference emission data set, NOx and sulfur dioxide (SO2) emission rates at selected power plants are updated to their summer 2003 levels using Continuous Emission Monitoring System (CEMS) measurements. The validity of the CEMS data is established by comparison to observations made on the NOAA WP-3 aircraft as part of the 2004 New England Air Quality Study. The impacts of power plant NOx emission decreases on O3 are investigated using the WRF-Chem regional chemical forecast model. Summertime NOx emission rates decreased by approximately 50% between 1999 and 2003 at the subset of power plants studied. The impact of NOx emission reductions on ozone was moderate during summer 2004 because of relatively cool temperatures and frequent synoptic disturbances. Effects in individual plant plumes vary depending on the plant's NOx emission strength, the proximity of other NOx sources, and the availability of volatile organic compounds (VOCs) and sunlight. This study provides insight into the ozone changes that can be anticipated as power plant NOx emission reductions continue to be implemented throughout the United States.


Drilling is one of the main machining processes carried out in the assembly stage of automobile manufacturing and aerospace components. Generally, delamination is considered as a major problem during drilling of composite materials. In this paper, the effects of feed rate, cutting speed and drill point angle on thrust force and delamination factor have been studied by using full factorial design. According to the results, feed rate has the most significant effect on thrust force followed by drill point angle. Moreover, the Half-Normal plot was used to identify which experiment factors have significant effects on the delamination factor; According to the results, feed rate has the most important effect. Acoustic emission signals and wavelet analysis were employed to monitor drilling process and discriminate frequency distributions of different cutting mechanisms. After time-frequency analyzing of AE signals, component 2 (EPC2) with frequency range of 62.5-125 kHz was attributed to matrix cracking and component 5 (EPC5) with frequency range of 250-312.5 kHz and average energy of 32% was attributed to fiber cutting.


Leadership is needed to drive an organization. Leadership is the determining factor in the success of a program in education. It is necessary to underline the success of education is not the work of individuals, but the work of competent cooperation. Therefore, the leader must be able to give influence to his work team (leadership is influence) to work effectively and efficiently. The purpose of this research is to understand more deeply about the characteristics that must exist in a leader so that the leader can play his role optimally and the educational program can run smoothly. This research uses literary study methods in the form of several journals and leadership books. The results of this study show that after understanding the characteristics of an ideal leader, it should be adjusted to the leadership model to be chosen. All attitudes and behaviors of a leader must be able to build trust and confidence with his subordinates, because the leader is the bridge to the achievement of the organization's mission.


This study aimed to evaluate the attitudes of health professionals toward the use of medicinal cannabis as part of the management of patients with cancer. A prospective, cross-sectional study was conducted using an anonymous survey, emailed out to health professionals at a public metropolitan hospital in Australia. One hundred and thirty-five responses were received. 62% of survey respondents reported that patients inquire about medicinal cannabis. More than half of the health professionals stated being insufficiently informed about access to medicinal cannabis (74%), about its evidence base (59%), and about potential drug interactions (65%). Thirty-four percent would recommend medicinal cannabis to their patients with cancer, 20% would not, and 46% were unsure. Comments indicated concerns about lack of clinician knowledge, drug efficacy, side effects and drug interactions. The results show that health professionals feel insufficiently informed about access to, and use of, medicinal cannabis as part of cancer management. More information and education are required for health professionals to consider medicinal cannabis as part of care provided to their patients with cancer.


Objectives: To evaluate the incidence and practical significance of short femur length as an isolated finding at mid-trimester sonography in women who have had Down syndrome screening by the integrated test. Methods: This was a retrospective cohort study of 1262 women booked for antenatal care and delivery at University College London Hospital. All women had integrated testing in late first trimester and a detailed anomaly scan in mid-trimester. Isolated short femur (SF) was characterized as femur length < 5th centile with otherwise normal biometry without any anomalies. All scan reports, screening results and neonatal data were analyzed statistically using SPSS version 11.0 software. Results: Some 5.1% of patients had a short femur and 4.7% had isolated SF. Pregnancies with isolated SF were significantly associated with low PAPP-A levels (P = 0.001). Women with an isolated SF fetus delivered babies with a significantly lower birth weight (P = 0.008) and had a higher rate of SGA (P = 0.004) and LBW (P = 0.04) babies compared to controls. Isolated SF was not associated with gestational hypertension, preterm delivery or low Apgar score. Conclusions: This study demonstrates that short femur, even as an isolated finding at mid-trimester, is associated with fetal growth restriction. The measurement of femur length is part of the routine scan done at 18–22 weeks. We believe that a finding of SF in midtrimester, on the background of a normal Down syndrome screening test and anomaly scan, should be regarded as a predictor for SGA and that these patients warrant frequent antenatal monitoring and serial fetal growth scans in pregnancy.


Biomimetic terpene sensors which have high sensitivity and stability have been fabricated using moleculary imprinted polymer (MIP) technology. Since it is impossible to make a resistive type sensor due to the high resistance of MIP, we improved the sensor by adding conductive polymers. We investigated the sensitivity of resistive type sensors with nano particles depending on the amount of conductive polymers. The MIP membrane contained the methacrylic acid as functional monomer and ethylene glycol dimethacrylate as cross linker, which formed specific cavities originated by the target terpene molecules. The mixture of MIP and the conductive polymer was coated on the patterns of interdigit electrodes on the alumina substrate. The fabricated sensors showed their highest specific sensitivities exposed to 500 ppm target gases : limonene 0.055 at 40% of amount of conductive polymers and geraniol 5.84×10-4 at 20% of amount of conductive polymers. In conclusion, we found that the terpene sensors are affected by the target molecules, functional monomers and the conductive polymers.


Atmospheric pressure plasma (APP) generates highly reactive species that are useful for surface activations. We demonstrate a fast regeneration of iron oxides, that are popular catalysts in various industrial processes, using microwave-driven argon APP under ambient condition. The surface treatment of hematite powder by the APP with a small portion of hydrogen (0.5%) lowers the oxide's reduction temperature. A near-infrared laser is used for localized heating to control the surface temperature. Controlled experiments without plasma confirm the catalytic effect of the plasma. Raman, XRD, SEM, and XPS analyses show that the plasma treatment changed the chemical state of the hematite to that of magnetite without sintering.


In this paper we propose a novel method of connecting laser range finders to a service robot or to an arbitrary sensor network. The developed unit can be connected to two laser range finders and provides a standard Ethernet port. Autonomous computing power enables the unit to carry out data manipulation tasks. Every device in the network will be able to access both the raw measurement data and pre- processed measurements calculated by the smart interface unit. The paper will discuss the technical aspects of the developed unit as well as the implemented novel processing algorithms. These algorithms are specific to tasks many service robots have to carry out. We present a use case where the developed unit has been applied successfully.


The world in which we live and work is a rapidly changing place, and only by looking ahead can we prepare ourselves today for what might happen in the future. An ongoing three-year research project at the universities of Loughborough, Reading and Salford is now at the half-way stage and the three institutions have worked together in a complimentary and collaborative manner in order to fulfil the project objectives and produce some initial preliminary research findings. The objective of the research is to identify and understand the challenges and opportunities confronting the UK construction sector over the next 10 to 20 years and to investigate ways to mitigate and/or exploit them. To date, 24 workshops have been conducted and nearly 70 causal maps and future scenarios produced. In addition, case histories have been developed to reveal the unique contexts of a range of collaborating organisations and what this means for their strategy and competitiveness. A series of system dynamics models have been developed which convert a firm's characteristics into a "competitiveness index", which can then be used to help firms understand and hence be more successful in the unfolding landscape of the construction marketplace.


Polarization sensitivity of semiconductor optical amplifiers (SOAs) with delta-strained quantum-well (QW) structures is investigated. The valence band structures and TE, TM optical gain spectra are calculated for the various delta-strained QW structures. It is shown that the number and location of the delta layers affect the polarization dependence of the delta-strained quantum well SOA signal gains. The optimal delta-strained QW structure for the SOA application is identified and its theoretical verification is provided.


Active magnetic bearings (AMBs) are used in many high speed machinery applications because of their advantages of no contact, no wear, no need for lubrications and ability to operate in high rotational speeds. AMBs represent an alternative solution to traditional mechanical bearing due to their contactless working principle. Touchdown bearings are needed in AMBs to prevent system damage under certain conditions such as sudden impact or sudden change of unbalance. In these conditions, rotor may make contact with touchdown bearings. AMBs may have the capability to accommodate sudden impact without contact though this will require novel design of control strategy for thrust and touchdown bearing. The purpose of this work is to provide platform for
the robust control design research of flexible rotor-AMB touchdown systems. To this end research work concentrates on the design, construction and simulation of magnetic thrust and touchdown system.
The report begins with the identifications of flexible rotor AMB system configuration. In this content accurate rotor system model considering AMB, thrust and touchdown discs was obtained using FEM technique according to Timoshenko beam theory. Design of flexible rotor AMB system requires careful attention towards rotordynamic design aspect such as observability and controllability and it is important that actuator
and sensor location are away from the nodal point. Identification of flexible rotor-AMB system model is achieved in a series of steps. Free-free undamped mode shapes were obtained in this work which predicts the dynamic behaviour of the flexible rotor. The plot of the free-free mode shapes and natural frequencies results have shown that the
system is controllable and observable. Second, Campbell diagram was generated to see the effect of gyroscopic behaviour on the splitting of natural frequencies into forward and backword modes. Campbell diagram results showed satisfactory behaviour of flexible rotor.
The second goal of this work is to acquire technical design, modelling of
electromechanical components and control unit. Magnetic actuator design
specifications were obtained based on magnetic circuit analysis. Unigraphics software was used to carry out detail design and 3D modeling/assembly of electromechanical components. In this context purchase cost estimation was identified based on quotations. Purchase of rotor model components were made outside.
The third goal of a thesis work is to verify the flexible rotor system model using experimental test. Hammer used as a force transducer was used in the test as excitation of the system and accelerometer used to measure response of the system. The experimental result validates the FEM technique because it is in reasonably good agreement with simulation results. The experimental mode shape results showed rotor
will perform well within design speed range.


Speech recognition of foreign accented (non-native or L2) speech remains a challenge to the state-of-the-art. The most common approach to address this scenario involves the collection and transcription of accented speech, and incorporating this into the training data. However, the amount of accented data is dwarfed by the amount of material from native (L1) speakers, limiting the impact of the additional material. In this work, we address this problem via data augmentation. We create modified copies of two accents, Latin American and Asian accented English speech with voice transformation (modifying glottal source and vocal tract parameters), noise addition, and speed modification. We investigate both supervised (where transcription of the accented data is available) and unsupervised approaches to using the accented data and associated augmentations. We find that all augmentations provide improvements, with the largest gains coming from speed modification, then voice transformation and noise addition providing the least improvement. The improvements from training accent specific models with the augmented data are substantial. Improvements from supervised and unsupervised adaptation (or training with soft labels) with the augmented data are relatively minor. Overall, we find speed modification to be a remarkably reliable data augmentation technique for improving recognition of foreign accented speech. Our strategies with associated augmentations provide Word Error Rate (WER) reductions of up to 30% relative over a baseline trained with only the accented data.


Oblique subduction at a high rate of convergence along much of the Middle America Trench results in northwest-directed trench-parallel block motion. Accommodation of this motion along northwest-striking dextral strike-slip faults has been postulated; however, in Nicaragua such faults are not well developed. We suggest instead that this motion is accommodated by bookshelf faulting that includes northeast-striking left-lateral faults. We present earthquake epicenter and focal mechanism data and mapped fracture and fault data consistent with this model. Trenchward migration of the volcanic arc since the Miocene and reactivation of northeast-striking Miocene structures may have led to the development of this arc- and trench-normal fault system.


Malaria is a major public health concern, and any tangible intervention during the pre-elimination phase can result in a significant reduction in infection rates. Recent studies have reported that antigens producing cross-protective immunity can play an important role as vaccines and halt malaria transmission in different endemic regions. In this study, we studied the genetic diversity, natural selection, and discovered novel conserved epitopes of a high molecular weight rhoptry protein 2 (RhopH2) in clinical samples of Plasmodium knowlesi and Plasmodium vivax cross-protective domains, which has been proven to produce cross-protective immunity in both species. We found low levels of nucleotide diversity (P. knowlesi; π ~ 0.0093, SNPs = 49 and P. vivax π ~ 0.0014, SNPs = 23) in P. knowlesi (n = 40) and P. vivax (n = 65) samples in the PkRhopH2 cross-protective domain. Strong purifying selection was observed for both species (P. knowlesi; dS - dN = 2.41, p < 0.009, P. vivax; dS - dN = 1.58, p < 0.050). In silico epitope prediction in P. knowlesi identified 10 potential epitopes, of which 7 epitopes were 100% conserved within clinical samples. Of these epitopes, an epitope with 10 amino acids (QNSKHFKKEK) was found to be fully conserved within all P. knowlesi and P. vivax clinical samples and 80%–90% conservation within simian malaria ortholog species, i.e., P. coatneyi and P. cynomolgi. Phylogenetic analysis of the PkRhopH2 cross-protective domain showed geographical clustering, and three subpopulations of P. knowlesi were identified of which two subpopulations originated from Sarawak, Malaysian Borneo, and one comprised only the laboratory lines from Peninsular Malaysia. This study suggests that RhopH2 could be an excellent target for cross-protective vaccine development with potential for outwitting strain as well as species-specific immunity. However, more detailed studies on genetic diversity using more clinical samples from both species as well as the functional role of antibodies specific to the novel conserved epitope identified in this study can be explored for protection against infection.


Interactive image processing is an important requirement in many industrial applications, such as the inspection of industrial parts within a manufacturing environment, or the processing of images from surveillance cameras. Being able to achieve this quickly and accurately is often essential for the success of such industrial applications. A service-based approach that autonomously launches Image Analysis Services (accessible through a Central Service Manager) onto spare network resources through a Condor system is presented. This allows high throughput analysis of these images in a dynamic resource pool. The Central Service Manager reacts to new tasks submitted to the Image Analysis Services and is able to add new service instances to manage these tasks dynamically. Each service instance here corresponds to a computational resource that is able to execute image processing algorithms. New service instances may be requested by the Central Service Manager from the Condor system, based on the number of tasks that need to be processed. This enables entire image repositories to be acted upon interactively and in parallel, as opposed to the analysis of single images individually. The approach is demonstrated through a campus-wide test bed utilising a Condor system with 90 machines.


Video games not only incorporate representations of landscapes, they are themselves a form of landscape representation that communicates ideas about how the world is and how it should be. Like traditional forms of landscape representation, video games use tricks of perspective and realistic graphics to represent real world places or to create worlds that appear to be real. Through their interactivity, video games also give their players a sense of power and control over the spatial form of the landscape. However, unlike traditional forms of landscape representation, video games offer opportunities to subjectively enter the space of the game and explore the social processes that help to produce the virtual landscape. For instance, many video games highlight the role of labor in the production of landscape. Video games may therefore help their players to understand the taken-for-granted social processes that produce real world landscapes and to explore alternative utopian or dystopian social and spatial arrangements. Nevertheless, video games remain a landscape form of representation because they do not fully reveal the labor of programming and design that goes into their creation. Like traditional landscapes, video game landscapes incorporate the moral ideologies of their producers and therefore limit or direct the kinds of lessons about the real world that players might learn. Video game landscapes may therefore reinforce the dominant ideologies that govern the production of real world landscapes as much as they challenge them.


Oral administration of proteins is a long-recognized method of inducing antigen-specific peripheral immune tolerance. We previously showed that oral administration of myelin basic protein suppresses monophasic experimental autoimmune encephalomyelitis in the Lewis rat when it is given in association with immunization and prior to disease onset. As a potential therapy for human autoimmune disease, it is crucial to determine whether oral tolerance can ameliorate an ongoing immune response. We therefore asked whether oral administration of myelin antigens, after sensitization and disease expression has occurred, could affect immunological, clinical, or pathological features of experimental autoimmune encephalomyelitis. Chronic relapsing experimental autoimmune encephalomyelitis was induced in the Lewis rat and strain 13 guinea pig by immunization with whole guinea pig cord homogenate, complete Freund's adjuvant, and Mycobactevinm tnberculosis. Following recovery from the first attack, animals were orally given bovine myelin, guinea pig myelin, or guinea pig myelin basic protein three times per week for up to 3 months. Animals receiving myelin products orally had decreased severity and frequency of clinical relapses, decreased delayed-type hypersensitivity responses to myelin antigens, diminished inflammation in the central nervous system (CNS), and decreased areas of CNS demyelination. In the rat, guinea pig myelin basic protein was as effective as guinea pig myelin in ameliorating the disease and also resulted in decreased serum anti-myelin basic protein antibody levels. No exacerbation of disease or worsening of pathological findings occurred in the animals given myelin products. These results demonstrate that oral administration of myelin antigens can suppress chronic relapsing experimental autoimmune encephalomyelitis and have direct relevance to


Objectives. The objective of this study was to explore the impact of specific cost formats on individuals' decision making. Methods. Mechanical Turk workers completed a choice based conjoint (CBC) analysis survey designed to examine preferences for three second line agents used to treat diabetes: a sulfonylurea, exenatide, and insulin. Diabetes was chosen because the disease is familiar to the general public and people are generally aware of the importance of controlling blood sugar levels. The CBC survey included five attributes: route of administration, efficacy, risk of low blood sugar, frequency of checking blood sugar levels and cost. We developed seven versions of the CBC survey which were identical except for the cost attribute. We described cost in terms of: Affordability, Monthly Co-pay, Dollar Sign Rating, How Expensive or How Cheap compared to other medications, Monthly Co-pay, Working Hours Equivalent (per month) and Percent of Monthly Income. The resulting part-worth utilities were used to calculate the relative importance of cost and to estimate treatment preferences. Results: Cost had the greatest influence on participants' decisions when framed in terms of Affordability and the lowest influence when framed in terms of How Cheap (compared to other drugs). Sulfonylurea is strongly preferred across Affordability, Percentage of Monthly Income, Monthly Copay and Dollar Sign formats. Exenatide is preferred when cost is described using the How Cheap and How Expensive format. Conclusions. How to frame cost impacts subjects' medical decision remarkably. Patients will be the most costsensitive when cost is framed in terms of affordability, the least cost-sensitive when considering how cheap the medication is compared to others. Further researches are needed to evaluate the impact of presentation of cost on decision making in clinical contexts.


BACKGROUND
A range of surgical and non-surgical techniques have received increasing attention in recent years in an effort to reduce the duration of a course of orthodontic treatment. Various surgical techniques have been used; however, uncertainty exists in relation to the effectiveness of these procedures and the possible adverse effects related to them.

OBJECTIVES
To assess the effects of surgically assisted orthodontics on the duration and outcome of orthodontic treatment.

SEARCH METHODS
We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 10 September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8), MEDLINE via OVID (1946 to 10 September 2014), EMBASE via OVID (1980 to 10 September 2014), LILACS via BIREME (1980 to 10 September 2014), metaRegister of Controlled Trials (to 10 September 2014), ClinicalTrials.gov (to 10 September 2014), and the World Health Organization (WHO) International Clinical Trials Registry Platform (to 10 September 2014). We checked the reference lists of all trials identified for further studies. There were no restrictions regarding language or date of publication in the electronic searches.

SELECTION CRITERIA
Randomised controlled trials (RCTs) evaluating the effect of surgical adjunctive procedures for accelerating tooth movement compared with conventional treatment (no surgical adjunctive procedure).

DATA COLLECTION AND ANALYSIS
At least two review authors independently assessed the risk of bias in the trials and extracted data. We used the fixed-effect model and expressed results as mean differences (MD) with 95% confidence intervals (CI). We investigated heterogeneity with reference to both clinical and methodological factors.

MAIN RESULTS
We included four RCTs involving a total of 57 participants ranging in age from 11 to 33 years. The interventions evaluated were corticotomies to facilitate orthodontic space closure or alignment of an ectopic maxillary canine, with the effect of repeated surgical procedures assessed in one of these studies. The studies did not report directly on the primary outcome as prespecified in our protocol: duration of orthodontic treatment, number of visits during active treatment (scheduled and unscheduled) and duration of visits. The main outcome assessed within the trials was the rate of tooth movement, with periodontal effects assessed in one trial and pain assessed in one trial. A maximum of just three trials with small sample sizes were available for each comparison and outcome. We assessed all of the studies as being at unclear risk of bias.Tooth movement was found to be slightly quicker with surgically assisted orthodontics in comparison with conventional treatment over periods of one month (MD 0.61 mm; 95% CI 0.49 to 0.72; P value < 0.001) and three months (MD 2.03 mm, 95% CI 1.52 to 2.54; P value < 0.001). Our results and conclusions should be interpreted with caution given the small number of included studies. Information on adverse events was sought; however, no data were reported in the included studies.

AUTHORS' CONCLUSIONS
This review found that there is limited research concerning the effectiveness of surgical interventions to accelerate orthodontic treatment, with no studies directly assessing our prespecified primary outcome. The available evidence is of low quality, which indicates that further research is likely to change the estimate of the effect. Based on measured outcomes in the short-term, these procedures do appear to show promise as a means of accelerating tooth movement. It is therefore possible that these procedures may prove useful; however, further prospective research comprising assessment of the entirety of treatment with longer follow-up is required to confirm any possible benefit.


The use of plagiarism avoiding techniques can be helpful to maintain academic integrity, a better learning environment and intellectual honesty. This explored the use of plagiarism avoiding techniques for creating ethical scholarship among research students. It also measured the association between the frequency of using plagiarism avoiding techniques and the satisfaction about knowledge of plagiarism. Data were collected from seven universities through an online self-structured questionnaire. Ordinal logistic regression analysis was used to explore the variance. The association between the frequency of using plagiarism avoiding techniques and satisfaction about knowledge of plagiarism was indicated. Differences were also found on the basis of gender, discipline, level and stage of study.


The primary phase of ADP-induced aggregation of human platelets does not involve appreciable formation of thromboxane A2 or release of granule contents; lack of formation of inositol trisphosphate has also been noted. Because these responses of platelets to ADP differ so markedly from their responses to other aggregating agents, the roles in ADP-induced aggregation of diacylglycerol, protein kinase C, increases in cytosolic [Ca2+], phosphorylation of pleckstrin (47 kDa) and phosphatases 1 and 2a were investigated. Washed human platelets, prelabelled with [14C]5-hydroxytryptamine and suspended in Tyrode solution (2 mM Ca2+, 1 mM Mg2+), were used for comparisons between the aggregation induced by 2-4 microM ADP, in the presence of fibrinogen, and that induced by 0.05 units/ml thrombin. The diacylglycerol kinase inhibitor 6-(2-[(4-fluorophenyl)phenyl-methylene]-1-piperidinylethyl)-7-meth yl-5H-thiazolo[3,2-a]-pyrimidin-5-one (R59022; 25 microM) had no, or only a slight, enhancing effect on ADP-induced aggregation, but potentiated thrombin-induced responses to a much greater extent. 1,2-Dihexanoyl-sn-glycerol or 1-oleoyl-2-acetyl-sn-glycerol (25 microM) added with or 30-90 s before ADP greatly potentiated aggregation without formation of thromboxane; staurosporine, an inhibitor of protein kinase C, reduced this potentiation. Staurosporine (25 nM) did not inhibit ADP-induced aggregation, although it strongly inhibited thrombin-induced aggregation and release of [14C]5-hydroxytryptamine. All these observations indicate little or no dependence of primary ADP-induced aggregation on the formation of diacylglycerol or on the activation of protein kinase C. At 2-4 microM, ADP did not significantly increase the phosphorylation of pleckstrin (studied with platelets prelabelled with [32P]orthophosphate), but 1,2-dihexanoyl-sn-glycerol- induced phosphorylation of pleckstrin was increased by ADP. Surprisingly, the diacylglycerols strongly inhibited the ADP-induced rise in cytosolic [Ca2+] concurrently with potentiation of ADP-induced aggregation; thus the extent of primary aggregation is independent of the level to which cytosolic [Ca2+] rises. Incubation of platelets with 1,2-dihexanoyl-sn-glycerol or 1-oleoyl-2-acetyl-sn-glycerol for several minutes reversed their potentiating effects on aggregation, and inhibition was observed. Incubation of platelets with okadaic acid, an inhibitor of phosphatases 1 and 2a, inhibited ADP- and thrombin-induced aggregation; although the reason for this effect is unknown, it is unlikely to involve inhibition of phospholipase C, since formation of diacylglycerol appears to have little involvement in the primary phase of ADP-induced aggregation.


The fundamental objectives of locating facilities can be summarized into three categories. The first category refers to those designed to cover demand within a specified time or distance. This objective gives rise to location problems which are known as the Location Set Covering Problem (LSCP) and the Maximal Covering Location Problem (MCLP). The LSCP seeks to locate the minimum number of facilities required to 'cover' all demand or population in an area. The MCLP is to locate a predetermined number of facilities to maximize the demand or population that is covered. The second category refers to those designed to minimize maximum distance. This results in a location problem known as the p-center problem which addresses the difficulty of minimizing the maximum distance that a demand or population is from its closet facility given that p facilities are to be located. The third category refers to those designed to minimize the average weighted distance or time. This objective leads to a location problem known as the p-median problem. The p-median problem finds the location of p facilities to minimize the demand weighted average or total distance between demand or population and their closest facility. The p-median problem is a typical combinatorial optimization problem with many practical applications such as location of warehouses, schools, health centers, shops etc. Greedy algorithms are the simplest algorithms to design however it is not easy to understand its capability and limitations. A greedy algorithm solves a global optimization problem by making a sequence of locally optimal decisions. That is a greedy algorithm always chooses the next step of an algorithm that is locally optimal. For example for Facility Location Problem we will consider the facilities for which decisions regarding locally optimal locations will be made. The decisions that are made regarding where to locate successive facilities by a greedy method are permanent. That is the greedy algorithms make permanent decisions about the construction of a solution, based on the restricted consideration such as choosing a location that gives a minimum cost. Greedy algorithms for facility location problems are constructive in principle. They are designed to give solutions of fairly good quality without using much time that is needed to compute better quality solutions by other algorithms. The most natural and simple heuristic for the p- median problem is the greedy algorithm. For the p-median problem to locate facilities, this algorithm picks a most 'cost-effective' facility until every required number of facilities p is located. We propose a modified form of the myopic (greedy) algorithm for the p-median problem. The new algorithm is simple and it gives relatively quality solutions. We demonstrated the importance of the removal of extreme values from a distance matrix before locating the first facility. The modification of the algorithm involves the removal of the extreme or large values from each column of the distance matrix. We then determine the first facility (1-median) after the removal of the extreme values. We revert to the original distance matrix after the first facility (1-median) is located. We then determine the additional facilities using the original distance matrix. We compare the results obtained by the original Myopic algorithm with the modified version using the 400 random problems. The results demonstrate the efficiency and superiority of our new method.


In this paper, we are going to introduce the new technique for measurement of blood flow rate in humans based on LDF (Laser Doppler Flowmetry) technique. We had developed overall embedded system which takes input from laser Doppler blood flow sensor & gives output on personal computer via wireless communication. The structure of the sensor consists of two compartments with a light dependant resistor (LDR) and a laser diode in each. The size & weight of sensor & overall system is very less. The overall system is powered through a dedicated battery & hence power saving arrangement is also provided. Proper blood flow in human body is essential because an adequate amount of blood supply is necessary for the proper functioning of all body organs as blood carries all the nutrients and oxygen that our body needs to stay healthy. Improper blood flow rate is main symptoms of various diseases. The measurement of the blood flow can therefore provide essential information for the judgment of diseases. Since changes in blood flow occurs with the very primary stage of disease, with a fast, reliable blood flow measurement technique, the physicians have a new option for early disease diagnosis. So using this system, we can successfully & easily able to measure human blood flow rate. Major advantage of this technique is this method is noninvasive which means not involving the introduction of instruments into the body[1][2]


This paper presents a snapshot of the Declarative Rulebased Agent Modelling System (DRAMS), which is currently being developed with the goal of providing declarative rule engine functionality to agent-based simulation models. While the incentive for this effort is to allow stakeholders in policy modelling activities to better understand and, hence, to be more deeply involved in modelling and simulation of policy processes, the approach chosen appears to be valuable for many other areas. After a short literature review on similar approaches, the paper briefly outlines the FP7 project OCOPOMO, the context in which DRAMS is developed, in order to underpin some of the requirements and related design decisions presented subsequently. On the basis of this information, the software architecture is described in some detail, followed by a few notes about implementation and user interfaces. Finally, a small "toy" model illustrates the use of DRAMS.


The data on immunological and morphological examinations of 85 lung cancer patients have been compared. Tuberculin sensitization indexes were shown to indicate the strength of antitumor immunity. Relationships between indexes of humoral and cellular immunologic response to tuberculin, on the one hand, and their actual levels in lung cancer patients, on the other, serve as fairly reliable indications of histological pattern of tumor and its extension.


IMPORTANCE
Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed.

OBJECTIVE
To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves.

DESIGN, SETTING, AND PARTICIPANTS
Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves.

MAIN OUTCOMES AND MEASURES
Survival, stroke, and New York Heart Association functional class.

RESULTS
Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008).

CONCLUSIONS AND RELEVANCE
In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.


Unfractionated heparin (UFH) is a sulfated glycosaminoglycan that consists of repeating disaccharides, containing iduronic acid (or glucuronic acid) and glucosamine, exhibiting variable degrees of sulfation. UFHs release tissue factor pathway inhibitor (TFPI) which inhibits the extrinsic pathway of coagulation by inactivating factor Xa and the factor VIIa/TF complex. Most heparins used clinically are derived from porcine intestinal mucosa however, heparins can also be derived from tissues of bovine and ovine origin. Currently there are some concerns about the shortage of the porcine heparins as they are widely used in the manufacturing of the low molecular weight heparins (LMWHs). Moreover, due to cultural and religious reasons in some countries, alternative sources of heparins are needed. Bovine mucosal heparins (BMH) are currently being developed for re-introduction to the US market for both medical and surgical indications. Compared to porcine mucosal heparin (PMH), BMH exhibits a somewhat weaker anti-coagulant activity. In this study, we determined the TFPI antigen level following administration of various dosages of UFHs from different origins. These studies demonstrated that IV administration of equigravemetric dosages of PMH and ovine mucosal heparin (OMH) to non-human primates resulted in comparable TFPI antigen release from endothelial cells. In addition, the levels of TFPI were significantly higher than TFPI antigen levels observed after BMH administration. Potency adjusted dosing resulted in comparable TFPI release profiles for all 3 heparins. Therefore, such dosing may provide uniform levels of anticoagulation for the parenteral indications for UFHs. These observations warrant further clinical validation in specific indications.


In two experiments, we showed that irrelevant numerical information influenced the speed of sentence-picture verification. Participants were asked to verify whether the concept mentioned in a sentence matched the object presented in a subsequent picture. Concurrently, the number word attached to the concept in the sentence and the quantity of objects presented in the picture were manipulated (numerical congruency). The number of objects varied from one to four. In Experiment 1, participants read statements such as three dogs. In Experiment 2, they read sentences such as three dogs were wandering in the street. In both experiments, the verification speed revealed the interaction between response and numerical congruency. The verification times for concept-object match were faster when there was also numerical congruence (compared with incongruence) between the number word and quantity. On the other hand, there was no difference between numerical congruence and incongruence when the concept and object mismatched. The results are interpreted as evidence for the symbol grounding of number words in perceptual representation of small quantities, that is, quantities falling in the subitization range.


We introduce the coolest path problem, which is a mixture of two well-known problems from distinct mathematical fields. One of them is the shortest path problem from combinatorial optimization. The other is the heat conduction problem from the field of partial differential equations. Together, they make up a control problem, where some geometrical object traverses a digraph in an optimal way, with constraints on intermediate or the final state. We discuss some properties of the problem and present numerical solution techniques. We demonstrate that the problem can be formulated as a linear mixed-integer program. Numerical solutions can thus be achieved within one hour for instances with up to 70 nodes in the graph.


The non-pathogenic human parvovirus, adeno-associated virus (AAV) is helper virus-dependent. However, it integrates into the cellular genome in the absence of its helper viruses. Therefore it could become a useful vector for gene therapy. Previous studies and our own results have shown that 40 to 80% of adults are seropositive for AAV and that seroconversion occurs during the first few years of life, but little is known about the route of natural infection with the virus. We used the polymerase chain reaction to detect the AAV-2 genome and identify AAV sequences within peripheral blood leukocytes (PBLs). We could detect AAV in PBLs of two of 55 healthy blood donors, and two of 16 haemophilic patients. AAV DNA replication and viral protein production in PBLs propagated in tissue culture were also examined. AAV DNA replicated very efficiently in the presence of helper adenovirus, but capsid proteins were produced at a lower level and the yield of infectious virus was very low. Our findings prove that in vivo infection of PBLs occurs, and that PBLs could mediate the spread of AAV infection to different body tissues.


In this paper, we propose an instance similarity learning (ISL) method for unsupervised feature representation. Conventional methods assign close instance pairs in the feature space with high similarity, which usually leads to wrong pairwise relationship for large neighborhoods because the Euclidean distance fails to depict the true semantic similarity on the feature manifold. On the contrary, our method mines the feature manifold in an unsupervised manner, through which the semantic similarity among instances is learned in order to obtain discriminative representations. Specifically, we employ the Generative Adversarial Networks (GAN) to mine the underlying feature manifold, where the generated features are applied as the proxies to progressively explore the feature manifold so that the semantic similarity among instances is acquired as reliable pseudo supervision. Extensive experiments on image classification demonstrate the superiority of our method compared with the state-of-the-art methods. The code is available at https://github.com/ZiweiWangTHU/ISL.git.


Host genetic resistance to Norovirus (NoV) has been observed in challenge and outbreak studies in populations from Europe, Asia, and USA. In this study, we have investigated if histo‐blood group antigens can predict susceptibility to diarrhea caused by NoV in Nicaragua, Central America, and if this can be reflected in antibody‐prevalence and titer to NoV among individuals with different histo‐blood group antigen phenotypes. Investigation of 28 individuals infected with NoV and 131 population controls revealed 6% of non‐secretors in the population and nil non‐secretors among patients infected with NoV, suggesting that non‐secretors may be protected against NoV disease in Nicaragua. Surprisingly, 25% of the population was Lewis negative (Lea−b−). NoV infections with genogroup I (GI) and GII occurred irrespective of Lewis genotype, but none of the Lewis a positive (Lea + b−) were infected. The globally dominating GII.4 virus infected individuals of all blood groups except AB (n = 5), while the GI viruses (n = 4) infected only blood type O individuals. Furthermore, O blood types were susceptible to infections with GI.4, GII.4, GII.7, GII.17, and GII.18‐Nica viruses, suggesting that secretors with blood type O are susceptible (OR = 1.52) and non‐secretors resistant. The overall antibody‐prevalence to NoV GII.3 VLP was 62% with the highest prevalence among blood type B carriers (70%) followed by A (68%) and O (62%). All four investigated individuals carrying blood type AB were antibody‐negative. Among secretors, 63% were antibody‐positive compared to 33% among non‐secretors (P = 0.151). This study extends previous knowledge about the histo‐blood group antigens role in NoV disease in a population with different genetic background than North American and European. J. Med. Virol. 81:728–735, 2009 © 2009 Wiley‐Liss, Inc.


We report that a model dye, Re(CO)3(bypy)CO2H, aggregates into clusters on TiO2 nanoparticles regardless of our preparation conditions. Using two-dimensional infrared (2D IR) spectroscopy, we have identified characteristic frequencies of monomers, dimers, and trimers. A comparison of 2D IR spectra in solution versus those deposited on TiO2 shows that the propensity to dimerize in solution leads to higher dimer formation on TiO2, but that dimers are formed even if there are only monomers in solution. Aggregates cannot be washed off with standard protocols and are present even at submonolayer coverages. We observe cross peaks between aggregates of different sizes, primarily dimers and trimers, indicating that clusters consist of microdomains in close proximity. 2D IR spectroscopy is used to draw these conclusions from measurements of vibrational couplings, but if molecules are close enough to be vibrationally coupled, then they are also likely to be electronically coupled, which could alter charge transfer.


The eggshells of communally breeding greater anis Crotophaga major consist of a blue‐green pigmented calcite matrix overlaid by a chalky white layer of vaterite, both of which are polymorphs of calcium carbonate. The white vaterite layer is intact in freshly laid eggs and may function in protecting the eggs from mechanical damage, but it also abrades during incubation to reveal the blue calcite shell underneath. Previous research has shown that this color change serves a visual signaling function: nesting greater anis can discriminate between eggs that are freshly laid and those that have already been incubated, which allows them to reject asynchronous eggs laid by extra‐group parasites. Here we use avian visual modeling and pigment extraction to assess the perceptual and chemical bases of such egg recognition. We found that there was no overlap between the avian perceptual space occupied by ani eggshells with and without vaterite, and that vaterite lacked both of the pigments found in the eggshell's calcite matrix, bililverdin and protoporphyrin. The visual contrast between the unpigmented vaterite and the blue‐pigmented calcite appears to pre‐date the evolution of the signaling function, since the related guira cuckoo Guira guira, also a communal breeder, lays similarly structured and pigmented eggs but does not use the visual contrast as a signal to detect parasitism.


Improved preventive measures, clinical experience and improved laboratorial procedures have resulted in changes in the design of the removable partial denture. More attention is paid to esthetics, support of free-extension dentures and the biological consequences of the design. Possibilities in prosthodontics concerning these aspects are described.


Toyota Motor Corporation's Toyota Production System embraces four very significant components. Just-in-time (JIT) production is a management philosophy aimed at eliminating waste from every aspect of manufacturing and its related activities. The term JIT refers to the production of only what is needed, when it is needed, in just the amount needed. Total quality control is a concept of quality operation of the business with all people in all areas of the company's organisation involved to meet customer needs. Total productive maintenance, on the other hand, is a concept of productive maintenance aimed at achieving overall effectiveness of the production system through the involvement of all the people in the organisation. Finally, computer integrated manufacturing is a concept to integrate the company operations from design, production and distribution to after-sales service and support in the field, through the use of computers and modern information technologies. The effectiveness of TPS has been expressed through simple, unambiguous performance metrics capable of transcending cultural and economic boundaries.


Introduction: Most vaccines are administered by intramuscular injection using a hypodermic needle and syringe. Some limitations of this procedure include reluctance to be immunized because of fear of needlesticks, and concerns associated with the safe disposal of needles after their use. Skin delivery is an alternate route of vaccination that has potential to be painless and could even lead to dose reduction of vaccines. Recently, microneedles have emerged as a novel painless approach for delivery of influenza vaccines via the skin. Areas covered: In this review, we briefly summarize the approaches and devices used for skin vaccination, and then focus on studies of skin immunization with influenza vaccines using microneedles. We discuss both the functional immune response and the nature of this immune response following vaccination with microneedles. Expert opinion: The cutaneous administration of influenza vaccines using microneedles offers several advantages: it is painless, elicits stronger immune responses in preclinical studies and could improve responses in high-risk populations. These dry formulations of vaccines provide enhanced stability, a property of high importance in enabling their rapid global distribution in response to possible outbreaks of pandemic influenza and newly emerging infectious diseases.


The printing market across the globe today is very challenging with many printing companies are striving to sustain their existence in the market. Malaysia printers are not excluded and received the similar pressure. Realizing the affect of this scenario in the long run, this study explored the printing challenges faced by the Malaysia commercial printers and the strategies used to maintain in the market from the management's perspectives. A qualitative with the exploratory research design was used. The data collection was done in two stages. First, a preliminary study was conducted with fifteen companies in order to have a general understanding about the scenario and challenges faced by Malaysia printers. The themes from this stage were then analysed and then collapsed into four main themes: market challenge, technology development, human resources challenges, and quality implementation and enforcement. The themes generated from the first stage were then used to further explore the scenario at four large commercial printing companies that are established. In depth interviews were conducted with twenty-two to investigate whether the companies encountered the challenges and to compare the strategies used to retain in the market. All the participated printing companies highlighted and agreed that the ' (MS) = Main Supervisor (CS) = Co Supervisor global printing challenges impacted their printing businesses. It is recommended that printing companies to smartly utilize their existing resources, keep abreast with the latest technology, aware and adapt to market changes, and improve employees' competency. Practically, this study could help Malaysia commercial printing companies to improve their businesses performances and stay competitive. Additionally, the sustainability strategies identified can be shared and benchmarked by other printers in improving their performance. The findings also could help relevant agencies to review current policies to augment the overall performance of Malaysia printing industries. Theoretically, the findings of this study enrich the existing literature with the current issues or challenges faced and strategies adopted by the Malaysia printers, which is very minimal being empirically studied before. This study focused on large printers, thus, future studies are encouraged to explore on Small and Medium Enterprise (SME) printers who play vital role in Malaysia printing industry.


The current study investigated the development of numerical estimation in 3to 5-year-old children sampled monthly for six months. At each session, children completed a task that assesses verbal number knowledge (Give-N task) and a numerical estimation task that assesses approximate number knowledge (Fast Cards). Results showed that children who acquired the cardinal principle (CP) during the course of the study showed marked improvement on the estimation task. Following CP acquisition, estimation became more accurate overall but also fluctuated widely. We discuss the implications of our findings for number word learning, particularly the mapping between verbal number and the approximate number system (ANS).


Radio-frequency coils play a crucial role in the quest for optimal magnetic resonance (MR) image resolution. Given the growing variety of specialized coils available for neuroradiologic imaging applications, it is critical that radiologists use a coherent strategy for successfully matching these coils to specific imaging situations. First, fundamental concepts of coil design are reviewed. Subsequently, a coil-selection algorithm for neuroimaging applications is described. The algorithm uses the patient's clinical history to derive a region of interest, a desired spatial resolution, and a desired contrast resolution. These factors are then used to impose anatomic coverage and imaging protocol constraints on the set of available coils. Finally, coil selection is further refined according to patient tolerance factors. The following coils are considered for use with a 1.5-T superconducting MR imager; namely, quadrature birdcage head, neurovascular phased-array, and dual single-circular-element coils, as well as investigational coils that have not yet been approved by the U.S. Food and Drug Administration: reduced-volume birdcage end-cap, temporal lobe phased-array, carotid artery phased-array, coils. Rationales are discussed regarding appropriate coil selection for screening whole brain and imaging brainstem, cranial nerves, orbits, cerebral cortex, mesial temporal lobes, and internal auditory canal, and for MR angiography.


Report and presentation completed by students enrolled in CE 5511: Urban Hydrology and Land Development, taught by Dr. John Gulliver in spring 2013.


Improving the yield of rice ( Oryza sativa L) in existing irrigated areas rather than further expansion is more likely to be the main source of growth for the crop in Kenya, especially due to limited land and water resources. In order to achieve this, there is need to identify and adopt solutions that are environmentally more sustainable. That is, the production systems adopted should reduce water consumption and increase productivity. This study evaluated whether the System of Rice Intensification (SRI) could increase water use efficiency and crop productivity relative to the conventional production system of continuous flooding. The effects of SRI on total water input and the growth characteristics of three rice varieties were investigated in a split-plot factorial at the experimental farm of the Mwea Irrigation Scheme of Kenya during the August - December 2009 growing season on vertic clay soils. The production practices of SRI were found to be beneficial to rice growth. SRI gave higher average grain yield (14.85 t/ha) than the conventional production system (8.66 t/ha) at P=0.006, while the average yield across production systems was 15.89 t/ha, 11.26 t/ha and 8.10 t/ha for BW196, NERICA1 and Basmati370 varieties respectively, with P<0.001. There was a 24% saving in irrigation water by SRI, while crop productivity and water use efficiency increased by 71%, 90% respectively due to SRI. Overall, SRI production system gave better yield and productivity results than the conventional flooding system. This was probably as a result of better phenotypic expressions due to the innovative soil-water-crop management practices of SRI that change the environment where rice is grown.


Aims: This study explored how midwives access and use information whilst caring for women with high risk needs in the labour ward. The study focussed on identification of information needs, sources and types of information, use of information and what facilitates and inhibits information access. Background: Social trends and advancing healthcare mean that the complexity of care for the minority of women who are recommended to birth in the labour ward is increasing. The immediacy and unpredictability of this suggests that midwives need to access information whilst with women in order to deliver excellent care. Method and analysis: As midwives are a social group, the principles of ethnography were used. Between October 2011 and March 2012 twenty-one purposively sampled midwife participants were observed providing care to women with high risk needs on the labour ward. Ten of these observed midwives were purposively sampled for interview. The data were analysed with thematic analysis using open and focussed coding. Findings: Midwives identify their information needs through their professional knowledge. Information sources used by midwives include maternity notes, guidelines, equipment, computers and the environment. Verbal information is transmitted through a network of women and colleagues via midwives. Midwives seek different types of information: woman specific, practice based, objective and organisational. Factors that facilitate and inhibit information access are related to the search time, usability, versatility and approachability of the source or channel rather than reliability. There are information proficient characteristics shown by some midwives. Implications for practice and research: The verbal information network could be enhanced to include women in care collaborations. Information proficiency as a potentially learnable skill may be taught to midwives to improve information access. If reliable sources and channels are accessible, usable and approachable it may increase their use. Passive information, information need and information types as areas that may influence practice require further research.


We develop a new framework for learning variational autoencoders and other deep generative models that balances generative and discriminative goals. Our framework optimizes model parameters to maximize a variational lower bound on the likelihood of observed data, subject to a task-specific prediction constraint that prevents model misspecification from leading to inaccurate predictions. We further enforce a consistency constraint, derived naturally from the generative model, that requires predictions on reconstructed data to match those on the original data. We show that these two contributions -- prediction constraints and consistency constraints -- lead to promising image classification performance, especially in the semi-supervised scenario where category labels are sparse but unlabeled data is plentiful. Our approach enables advances in generative modeling to directly boost semi-supervised classification performance, an ability we demonstrate by augmenting deep generative models with latent variables capturing spatial transformations.


Immunohistochemical assessment of 5-bromo-2-deoxyuridine (BrdU) in tissue sections is a widely used method to evaluate cell proliferation in vivo. However, this method requires time-consuming preparation of paraffin sections and laborious counting of BrdU-labeled nuclei on multiple sections. Here, we report the development of a rapid and reliable method to quantitate BrdU incorporation in intestinal and liver tissues using a dot-blot method. In vivo models of colon or liver proliferation were used to analyze the usefulness and reliability of this new method. Mice were killed after BrdU injection, and genomic DNA was isolated from the tissues, denatured, and dot-blotted onto a nitrocellulose membrane. The incorporated BrdU was detected with a BrdU monoclonal antibody, and the signal intensity was densitometrically quantified. Results were compared with BrdU index determined by conventional immunohistochemistry on the same tissue samples. The patterns of colonic BrdU incorporation during fasting and refeeding, measured by the dot-blotting method and the immunohistochemical method, were similar. The BrdU incorporation in the regenerating liver after partial hepatectomy, evaluated by these two different methods, showed a strong correlation (R(2) = 0.91, P < 0.01). In addition, the inhibition of colon proliferation by the phosphoinositol 3-kinase inhibitor wortmannin was demonstrated by this dot-blotting method. In conclusion, the dot-blotting technique described in this report provides an accurate, more efficient, and possibly more reliable method for the assessment of in vivo proliferation compared with conventional immunohistochemical determination of BrdU-labeling index.


Background: Despite the significant roles that school teachers are expected to play in school eye health programmes, their perceptions on their pupils' eye health have not been adequately determined.
Objective: The study aims to ascertain the perceptions of elementary school teachers in Ilorin, Nigeria, of some factors that could influence their pupils' eye health.
Materials and Methods: A knowledge-attitude-practice (K-A-P) survey using structural self-administered questionnaires was conducted from May to July 2005 on 172 consenting teachers. The teachers were selected by proportionate sampling from 6 randomly selected primary schools in Ilorin.
Results: Majority of them (98.8%) rated good eye sight as important or very important to pupils' leaning, and identified good nutrition (84.9%) and adequate lighting (74.4%) as requirements for optimal eye health. During an outbreak of epidemic keratoconjunctivitis among pupils, close to two-thirds of the teachers would send home affected pupils (61.6%). Pupils with defective eyesight would have their parents informed (77.9%) and seated closer to the writing-board (77.7%). Eye injuries had been observed among pupils during recreation (42.4%) and following fights among themselves (51.2%).
Conclusion: Majority of the teachers appeared to have an adequate knowledge of, the correct attitude to and correct practices of, the factors that have positive bearings on their pupils' eye health. Eye care specialists should find it easy to train this pool of qualified teachers for some roles in screening pupils for eye defects and diseases in school eye health programmes.
 Keywords : School health programme, Children eye health, Teachers perceptions Sahel Medical Journal Vol. 10 (3) 2007: pp. 79-83


The extended adaptive multi-rate-wideband (AMR-WB+) is a standard audio codec stipulated by the 3rd Generation Partnership Project (3GPP). It has been experimentally validated by 3GPP that an AMR-WB+ audio codec well outperforms others when encoding speech or audio signals at bitrates below 24 kbps, but at the cost of high computational load, particularly when performing the vector quantization (VQ) of immittance spectral frequency (ISF) coefficients. For this sake, by no means can an AMR-WB+ audio codec implemented on mobile devices meet the energy efficiency requirement. As a solution to this problem, in this paper, we present two high-efficiency triangular inequality elimination (TIE)-based algorithms for VQ codebook search. The first is referred to as the iterative TIE (ITIE) search algorithm, and the other is substantially the combined use of ITIE and the equal-average nearest neighbor search (ENNS) algorithm, both of which are subsequently applied to quantize the vectors of ISF coefficients. Most of the codewords are ruled out herein as the candidates using one-level and two-level rejection criteria, leading to a significantly reduced number of codeword searches but still maintaining the same coding quality. With a full search algorithm as a benchmark, this work shows a reduction in the total number of operations of more than 75.21%, a figure far beyond 60.23% using the TIE algorithm with a dynamic and an intersection mechanism (DI-TIE), 60.85% using ENNS, and 64.88% using the equal-average equal-variance equal-norm nearest neighbor search (EEENNS) algorithm. Moreover, this work can be implemented on handheld devices equipped with multiple sensing components, e.g., smartphones, to provide various multimedia and audio applications, and the energy saving requirement can be achieved as well.


Cases of bullying have been on the rise in secondary schools. The purpose of the study reported on in this paper was to investigate the effects of bullying on academic performance in selected public secondary schools in Dagoretti Division, Nairobi. The specific objectives of the study included: investigation on the types of bullying, factors contributing to bullying in schools, effects of bullying and remedies to bullying. The study used ex-post facto research design and employed simple random sampling technique to sample 120 students. Data were collected using questionnaires. Descriptive statistics were used to analyze the data. Data were presented using tables, histograms and pie charts. The findings revealed that bullying is a serious problem that can dramatically affect the ability of students to progress academically, emotionally and socially. Recommendations of the study included that concerted efforts are required to exhaustively deal with bullying in all schools with comprehensive intervention programs involving all students, parents, teachers, the community and Ministry of Education Science and Technology introduced in all schools to ensure that all students learn in safe and fear-free environments.


Variations in the reverse transcriptase (RT) domain were analyzed to clarify retrotransposon family structure and their evolution in wheat genome. RT-PCR was conducted by using primers based on the conserved RT peptide motifs of plant retrotransposons to amplify the RT domain of retrotransposons in the seedlings of wheat line Pm97034 treated with powdery mildew fungus. High level of heterogeneity was detected in 51 (RT1-51) clones randomly selected and the identity of nucleotide sequence among them ranged from 75.4% to 97.9%. These sequences, in combination with previously identified seven representatives from wheat retrotransposon families (families 1―7), were used to construct a composite phylogenetic tree. Three new families, designated family 8 to family 10, were identified. Famliy 8 formed before divergence of the Pooideae subfamily and was regarged as an ancient retrotransposon family. Some members of family 4 and family 7 had transcriptional activativity, and were present with multiple copies in wheat and its related species.


I report my clinical experience as a trainee. I am doubtful about the usefulness of hospital medical and accident and emergency posts, but obstetric and paediatric posts are highly relevant. There was little experience and teaching in the general practice year about psychiatry and gynaecology. It seems possible that trainees are not seeing enough chronic illness or associated problems, such as obtaining social services, therapy in chronic cases, and correct delegation to practice nurses. These points all suggest that the work of doctors undergoing vocational training should be monitored, at least at present.


The inhibitory properties of beta-2-thienyl-dl-alanine on rat phenylalanine hydroxylase from crude liver and kidney homogenates were assessed in vitro and in vivo, as well as its effects on the intestinal transport of phenylalanine, by using a perfusion procedure in vivo. The apparent K(m) for liver phenylalanine hydroxylase changed from 0.61mm in the absence of the inhibitor to 2.70mm in the presence of 24mm-beta-2-thienyl-dl-alanine, with no significant change in the V(max.). For kidney the corresponding values were 0.50 and 1.60mm respectively. A single dose of beta-2-thienyl-dl-alanine (2mmol/kg) failed to inhibit phenylalanine hydroxylase in either organ. Repeated injections during a 4-day period caused a decline of the enzymic activity to about 40% of controls. Intestinal absorption of phenylalanine when perfused at 0.2-2.0mm concentration was also competitively inhibited by beta-2-thienyl-dl-alanine. Its K(i) value was estimated at 81mm. The limited inhibitory effects of beta-2-thienyl-dl-alanine towards hepatic phenylalanine hydroxylase and phenylalanine intestinal transport, and its rapid metabolism, as suggested by the small elimination of this compound in the urine and its virtual absence from animal tissues, are factors that restrict its potential usefulness as an inducer of phenylketonuria in rats or as an effective blocker of phenylalanine absorption by the gut.


Studies in the Great Barrier Reef Lagoon (GBRL) show that Trichodesmium (Oscillatoria) spp. fix significant amounts of atmospheric nitrogen and that the loads of 'new' nitrogen introduced by Trichodesmium spp. are at least of the same order as those entering via riverine discharge. The elevated growth of other genera of phytoplankton and hence eutrophication in some sections of the GBRL could now be largely driven by the in situ production of this 'new' nitrogen. Trichodesmium is more prolific in the Central GBRL than in the Northern GBRL and there is evidence that the concentrations of Trichodesmium spp. have increased since the 1928-29 Great Barrier: Reef Expedition to Low Isles. It is hypothesised that this increase has resulted from increases in river borne nutrients that would promote N fixation (e.g. phosphorus, iron and dissolved organic matter). It is estimated that the loads of such nutrients have increased several fold since the development of the coastal catchments of Queensland.


The National Exposure Registry (NER) was created as a comprehensive group of data repositories that sought, over time, to relate specific environmental exposures to dioxin, trichloroethylene (TCE), benzene, and trichloroethane (TCA) to registrants' health conditions. Some parts of the NER were well conceived, whereas others were not. The most important design deficiency of the NER was its inability to adequately assess exposure. This was the key missing element and the Achilles heel of the NER program. At least three other important issues were never satisfactorily resolved in the design of the NER. They were unverified self-reporting, appropriate control groups, and the use of biomarkers. The many health effects that were observed to be in excess when compared with national norms might be explained by methodological differences in data analysis and reliance on self-reported nonverified data. Creating and maintaining a population-based chemical exposure registry is a more difficult challenge than creating and maintaining an outcome registry, such as a cancer registry.


The frequency and degree of circulatory insufficiency depending on the stage of the disease are analyzed in 404 patients with chronic glomerulonephritis and 145 patients with chronic pyelonephritis aged 15 to 74 years. When the renal function is still preserved different degrees of circulatory insufficiency are diagnosed in 29.4% of patients. Circulatory insufficiency complicates more often chronic glomerulonephritis than pyelonephritis and is more common in the aged. Latent cardiac insufficiency is more common. In the period of chronic renal insufficiency cardiac decompensation is seen in 78.1% of cases, its frequency is practically the same in glomerulonephritis and pyelonephritis. The mechanisms of development of cardiac insufficiency and the principles of treatment depending on the functional state of the kidneys are discussed.


Synopsis

This case uses Uber Technologies Inc. to engage students in a serious conversation about how a firm both affects its stakeholders and is affected by its stakeholders as well as the role of strategic leadership in the amount of emphasis placed on ethical practices. Uber represents a visible high-growth startup that has received considerable positive and negative attention in the media; however, few people know of the extent of its aggressive management approach. Much of the publicity about Uber is both a direct consequence of and a direct consequence for stakeholder relationships. Students are asked to analyze Uber's approach and offer suggestions for moving forward.

Research methodology

This case was created using secondary data sources. The issues for Uber that led the authors to write this case were not very flattering to Uber, and therefore, the authors decided to use secondary sources. Since Uber and many of its direct competitors were private companies, the authors collected as much financial data as the authors could from publicly available sources. Also, due to the contentious nature of some of the managerial tactics used within Uber, the use of secondary data sources was warranted.

Relevant courses and levels

This case was crafted with senior undergraduate students in strategic management as the primary audience, but is also relevant for MBA-level strategy courses as well. This case touches upon core content in the vast majority of undergraduate strategic management courses with a special emphasis on two concepts underrepresented in most strategic management textbooks, stakeholder theory and ethical decision making.


Changes in human life style have increased the incidence of obesity which has become a risk factor to human health. In Taiwan, the annual production of Citrus grandis [L.] reaches 75 000 tons, while the amount of waste fruits could reach 5%. We propose that abundant phytochemicals present in the wastes can be beneficial to attenuate obesity with hyperlipidemia. An animal Wistar rat model showed that pomelo flesh, peels, carpel (the segmental membrane), as well as the essential oil attenuated obesity as well as hyperlipidemia, and the AMPK-SREBP-PPARS pathway was involved. To further verify the mechanism, a HepG2 cell model was used to test some representative pomelo phytonutrients including limonene (Ln), γ-terpinene (γT), p-synephrine (SP), β-sitosterol (βS), and hesperidin (Hn). Data interestingly revealed it to be a multiple mechanism of anti-lipogenic bioactivity via downregulating the enzymes involved in both the cholesterol and triacylglyceride de novo biosynthesis (in the order of decreasing bioactivity): acetyl CoA carboxylase (Hn, SP, βS, Ln = γT), fatty acid synthase (Ln, γT, SP, βS, Hn), HMG-CoA synthase (Ln, Hn, SP, βS, γT), and HMG-CoA reductase (Hn, Ln, βS, γT, SP), and via upregulation of cholesterol-7α-monooxygenase (CYP7A1) (Hn, βS). In addition, all pomelo fruit parts enhanced the fecal crude lipid and sterol excretion capability. Thus, fruits of C. grandis can serve as a rather promising integrative antihyperlipidemic agent.


Effects of different scatter compensation methods incorporated in fully 3D iterative reconstruction are investigated. The methods are: (i) the inclusion of an `ideal scatter estimate' (ISE); (ii) like (i) but with a noiseless scatter estimate (ISE-NF); (iii) incorporation of scatter in the point spread function during iterative reconstruction (`ideal scatter model', ISM); (iv) no scatter compensation (NSC); (v) ideal scatter rejection (ISR), as can be approximated by using a camera with a perfect energy resolution. The iterative method used was an ordered subset expectation maximization (OS-EM) algorithm. A cylinder containing small cold spheres was used to calculate contrast-to-noise curves. For a brain study, global errors between reconstruction and `true' distributions were calculated. Results show that ISR is superior to all other methods. In all cases considered, ISM is superior to ISE and performs approximately as well as (brain study) or better than (cylinder data) ISE-NF. Both ISM and ISE improve contrast-to-noise curves and reduce global errors, compared with NSC. In the case of ISE, blurring of the scatter estimate with a Gaussian kernel results in slightly reduced errors in brain studies, especially at low count levels. The optimal Gaussian kernel size is strongly dependent on the noise level.


BACKGROUND
The study was designed to determine the mediating neuroanatomy of obsessive-compulsive disorder (OCD).

METHODS
The short half-life tracer oxygen 15-labeled carbon dioxide was used to allow for repeated positron emission tomographic determinations of regional cerebral blood flow on each of eight patients with OCD during a resting and a provoked (symptomatic) state.

RESULTS
Individually tailored provocative stimuli were successful in provoking OCD symptoms, in comparison with paired innocuous stimuli, as measured by self-report on OCD analogue scales (P = .002). Omnibus subtraction images demonstrated a statistically significant increase in relative regional cerebral blood flow during the OCD symptomatic state vs the resting state in right caudate nucleus (P < .006), left anterior cingulate cortex (P < .045), and bilateral orbitofrontal cortex (P < .008); increases in the left thalamus approached but did not reach statistical significance (P = .07).

CONCLUSIONS
These findings are consistent with results of previous functional neuroimaging studies and contemporary neurocircuitry models of OCD. The data further implicate orbitofrontal cortex, caudate nucleus, and anterior cingulate cortex in the pathophysiology of OCD and in mediating OCD symptoms.


Abstract. Ocean-induced melting below ice shelves is one of the dominant drivers for
mass loss from the Antarctic Ice Sheet at present. An appropriate
representation of sub-shelf melt rates is therefore essential for model
simulations of marine-based ice sheet evolution. Continental-scale ice sheet
models often rely on simple melt-parameterizations, in particular for
long-term simulations, when fully coupled ice–ocean interaction becomes
computationally too expensive. Such parameterizations can account for the
influence of the local depth of the ice-shelf draft or its slope on melting.
However, they do not capture the effect of ocean circulation underneath the
ice shelf. Here we present the Potsdam Ice-shelf Cavity mOdel (PICO), which
simulates the vertical overturning circulation in ice-shelf cavities and thus
enables the computation of sub-shelf melt rates consistent with this
circulation. PICO is based on an ocean box model that coarsely resolves ice
shelf cavities and uses a boundary layer melt formulation. We implement it as
a module of the Parallel Ice Sheet Model (PISM) and evaluate its performance
under present-day conditions of the Southern Ocean. We identify a set of
parameters that yield two-dimensional melt rate fields that qualitatively
reproduce the typical pattern of comparably high melting near the grounding
line and lower melting or refreezing towards the calving front. PICO captures
the wide range of melt rates observed for Antarctic ice shelves, with an
average of about 0.1 m a−1 for cold sub-shelf cavities, for
example, underneath Ross or Ronne ice shelves, to 16 m a−1 for
warm cavities such as in the Amundsen Sea region. This makes PICO a
computationally feasible and more physical alternative to melt
parameterizations purely based on ice draft geometry.


Abstract The aim of this study was to investigate the acute effects of p-synephrine ingestion on substrate oxidation during exercise in elite cyclists. Fifteen elite cyclists volunteered to participate in a double blind, crossover, randomized and placebo-controlled experimental trial. During two different trials, participants either ingested a placebo (cellulose) or 3 mg/kg of p-synephrine. After 60 min for substances absorption, participants performed an incremental maximal cycle ergometer test until volitional fatigue (25 W/min). Breath-by-breath gas exchange data was continuously recorded during the entire test to estimate energy expenditure, carbohydrate oxidation, and fat oxidation rates by stoichiometric equations. Heart rate was continuously measured by using a heart rate monitor. The ingestion of p-synephrine had no significant effects on energy expenditure (F = 0.71, P = 0.40) or heart rate (F = 0.66, P = 0.43) during exercise. However, there was a main effect of p-synephrine to increase the rate of fat oxidation over the placebo (F = 5.1, P = 0.04) and the rate of fat oxidation was higher with p-synephrine in the following loads: 45 ± 2%, 51 ± 3%, 62 ± 3%, 67 ± 4%, 79 ± 5% and 85 ± 5% of the maximum wattage obtained in the test (all P < 0.05). The ingestion of p-synephrine did not modify the maximal rate of fat oxidation during the ramp test (mean value; 95%CI =  0.91; 0.79–1.03 vs 1.01; 0.91–1.11 g/min, respectively, P = 0.06) nor the exercise intensity at which maximal fat oxidation was achieved (i.e. Fatmax =  49; 48–53 vs 50; 47–51% Wmax, P = 0.52). Acute p-synephrine ingestion moved the fat oxidation-exercise intensity curve upwards during an incremental cycling test without affecting Fatmax.


Diving medicine is a peculiar specialty. There are physicians and scientists from a wide variety of disciplines with an interest in diving and who all practice 'diving medicine': the study of the complex whole-body physiological changes and interactions upon immersion and emersion. To understand these, the science of physics and molecular gas and fluid movements comes into play. The ultimate goal of practicing diving medicine is to preserve the diver's health, both during and after the dive. Good medicine starts with prevention. For most divers, underwater excursions are not a professional necessity but a hobby; avoidance of risk is generally a much better option than risk mitigation or cure. However, prevention of diving illnesses seems to be even more difficult than treating those illnesses. The papers contained in this issue of DHM are a nice mix of various aspects of PFO that divers are interested in, all of them written by specialist doctors who are avid divers themselves. However, diving medicine should also take advantage of research from the "non-diving" medicine community, and PFO is a prime example. Cardiology and neurology have studied PFO for as long, or even longer than divers have been the subjects of PFO research, and with much greater numbers and resources. Unexplained stroke has been associated with PFO, as has severe migraine with aura. As the association seems to be strong, investigating the effect of PFO closure was a logical step. Devices have been developed and perfected, allowing now for a relatively low-risk procedure to 'solve the PFO problem'. However, as with many things in science, the results have not been as spectacular as hoped for: patients still get recurrences of stroke, still have migraine attacks. The risk-benefit ratio of PFO closure for these non-diving diseases is still debated. For diving, we now face a similar problem. Let there be no doubt that PFO is a pathway through which venous gas emboli (VGE) can arterialize, given sufficiently favourable circumstances (such as: a large quantity of VGE, size of the PFO, straining or provocation manoeuvres inducing increased right atrial pressure, delayed tissue desaturation so that seeding arterial gas emboli (AGE) grow instead of shrink, and there may be other, as yet unknown factors). There is no doubt that closing a PFO, either surgically or using a catheter-delivered device, can reduce the number of VGE becoming AGE. There is also no doubt that the procedure itself carries some health risks which are, at 1% or higher risk of serious complications, an order of magnitude greater than the risk for decompression illness (DCI) in recreational diving. Scientists seek the 'truth', but the truth about how much of a risk PFO represents for divers is not likely to be discovered nor universally accepted. First of all, the exact prevalence of PFO in divers is not known. As it has been pointed out in the recent literature, a contrast echocardiography (be it transthoracic or transoesophageal) or Doppler examination is only reliable if performed according to a strict protocol, taking into account the very many pitfalls yielding false negative results. The optimal procedure for injection of contrast medium was described several years ago, but has not received enough attention. Indeed, it is our and others' experience that many divers presenting with PFO-related DCI symptoms initially are declared "PFO-negative" by eminent, experienced cardiologists! Failing a prospective study, the risks of diving with a right-to left vascular shunt can only be expressed as an 'odds ratio', which is a less accurate measure than is 'relative risk'. The DAN Europe Carotid Doppler Study, started in 2001, is nearing completion and will provide more insight into the actual risks of DCI for recreational divers. The degree of DCI risk reduction from closing a PFO is thus not only dependent on successful closure but also (mostly?) on how the diver manages his/her dive and decompression in order to reduce the incidence of VGE. It has been convincingly shown that conservative dive profiles reduce DCI incidence even in divers with large PFOs, just as PFO closure does not protect completely from DCI if the dive profiles are aggressive. Prospective studies should not only focus on the reduction of DCI incidence after closure, but should take into account the costs and side effects of the procedure, as has been done in the cardiology and neurology studies. Imagine lung transplants becoming a routine operation, costly but with a high success rate; imagine also a longterm smoker suffering from a mild form of obstructive lung disease and exercise-limiting dyspnoea. Which of two options would you recommend: having a lung transplant and continue smoking as before, or quit smoking and observe a progressive improvement of pulmonary and cardiac pathology? As opposed to patients with thrombotic disease and migraine, divers can choose to reduce DCI risk. In fact, all it takes is acceptance that some types of diving carry too high a health risk - whether it is because of a PFO or another 'natural' factor. It would be unethical to promote PFO closure in divers solely on the basis of its efficacy of shunt reduction. Unfortunately, at least one device manufacturer has already done so in the past, citing various publications to specifically target recreational divers. Some technical diving organizations even have recommended preventive PFO closure in order to undertaking high-risk dive training. As scientists, we must not allow ourselves to be drawn into intuitive diver fears and beliefs. Nor should we let ourselves be blinded by the ease and seemingly low risk of the procedure. With proper and objective information provided by their diving medicine specialist, divers could make an informed decision, rather than focus on the simplistic idea that they need 'to get it fixed' in order to continue diving. A significant relationship between PFO and cerebral damage, in the absence of high-risk diving or DCI, has yet to be confirmed. Studying PFO-related DCI provides us with unique opportunities to learn more about the effect of gas bubbles in various tissues, including the central vascular bed and neurological tissue. It may also serve to educate divers that safe diving is something that needs to be learned, not something that can be implanted.


The influence of short and prolonged diet containing silver ions (Ag-diet) on copper metabolism was studied. Two groups of animals were used: one group of adult rats received a Ag-diet for one month (Ag-A1) and another group received a Ag-diet for 6 months from birth (Ag-N6). In Ag-A1 rats, the Ag-diet caused a dramatic decrease of copper status indexes that was manifested as ceruloplasmin-associated copper deficiency. In Ag-N6 rats, copper status indexes decreased only 2-fold as compared to control rats. In rats of both groups, silver entered the bloodstream and accumulated in the liver. Silver was incorporated into ceruloplasmin (Cp), but not SOD1. In the liver, a prolonged Ag-diet caused a decrease of the expression level of genes, associated with copper metabolism. Comparative spectrophotometric analysis of partially purified Cp fractions has shown that Cp from Ag-N6 rats was closer to holo-Cp by specific enzymatic activities and tertiary structure than Cp from Ag-A1 rats. However, Cp of Ag-N6 differs from control holo-Cp and Cp of Ag-A1 in its affinity to DEAE-Sepharose and in its binding properties to lectins. In the bloodstream of Ag-N6, two Cp forms are present as shown in pulse-experiments on rats with the liver isolated from circulation. One of the Cp isoforms is of hepatic origin, and the other is of extrahepatic origin; the latter is characterized by a faster rate of secretion than hepatic Cp. These data allowed us to suggest that the disturbance of holo-Cp formation in the liver was compensated by induction of extrahepatic Cp synthesis. The possible biological importance of these effects is discussed.