The purpose of this study was to evaluate the triple channel correction acquisition (TCCA) method for radiochromic film dosimetry performed with a flatbed scanner. The study had two parts: a fundamental and a clinical examination. In the fundamental examination, we evaluated the accuracy of calibration curves for Gafchromic EBT2 (EBT2). The films were calibrated using a field-by-field method with 13 dose steps. Seven calibration curves obtained by TCCA were compared with those produced by a single channel acquisition (SCA) method. For the clinical examination, we compared relative dose distributions obtained by TCCA and SCA for four cases of intensity-modulated radiation therapy (IMRT) and intensity-modulated arc therapy (IMAT). The fundamental examination showed that the consistency of the calibration curves was better for TCCA than for SCA, particularly for the dose range between 0.25 Gy and 1.00 Gy. The clinical examination showed that the dose differences between the measured and calculated doses in high-gradient regions were smaller with TCCA than with SCA. The average pass rates in gamma analysis for the TCCA and SCA methods were 97.2 ± 0.8% (n = 20) and 93.0 ± 1.2% (n = 20), respectively. In conclusion, TCCA can acquire accurate average dose values when creating the calibration curve. The potential advantage of TCCA for EBT2 film dosimetry was seen in high-gradient regions in clinically relevant IMRT and IMAT cases. TCCA is useful to verify dose distribution.


Irreversible congenital heart block (CHB) and the transient rash of neonatal lupus are strongly associated with maternal antibodies to SSA/Ro and SSB/La proteins; however, the precise mechanism by which these antibodies mediate organ-specific injury is not yet defined. Culturing of keratinocytes has provided critical insights. Accordingly, successful culturing of human fetal cardiac myocytes at high yield would constitute a powerful tool to directly examine conditions that promote expression of the target autoantigens. To accomplish this aim, fetal cardiac myocytes from 18- to 22-wk abortuses were established in culture using a novel technique in which cells were isolated after perfusion of the aorta with collagenase in a Langendorff apparatus. After preplating to decrease fibroblast contamination, cardiocytes were grown in flasks and slide chambers. Staining with monoclonal anti-sarcomeric α-actinin revealed the expected striations typical of cardiac myocytes in 70-90% of the cells after 4 d in culture. Furthermore, the cells were observed to beat at rates varying between 25-75 beats per minute (bpm) after the addition of 1.8 mM CaCl2. An average yield of 45-60 × 106 cells was obtained from a 3- to 5-g heart. Cellular localization of SSA/Ro and SSB/La by indirect immunofluorescence and demonstration of mRNA expression by reverse transcriptase polymerase chain reaction supports the feasibility of cultured cardiac myocytes for the study of congenital heart block. In contrast to the increased expression of SSA/Ro reported for keratinocytes, incubation of cultured human cardiac myocytes with either 17β-estradiol or progesterone did not alter mRNA expression or cellular localization of 48 kD SSB/La, 52 kD SSA/Ro, or 60 kD SSA/Ro. In summary, we describe a novel method to successfully culture human fetal cardiac myocytes that should provide a valuable resource for investigation of the molecular mechanism(s) contributing to the development of congenital heart block. Differential constitutive and estradiol-induced expression of 52 and 60 kD SSA/Ro in human cardiac myocytes compared with keratinocytes may be a factor contributing to the marked discordance of clinically detectable injury in these two target tissues.


Abstract:
 Bird habitat on the island of Tinian, Mariana Islands, has been substantially altered, and only around 5% of the island has native forest today. The modern bird fauna is likely to be a subset of the original avifauna where only species tolerant to native forest loss and human disturbance have survived. Avian surveys were conducted on the island in 2008 by the U.S. Fish and Wildlife Service to provide current densities and abundances of the remaining species, and assess population trends using data collected from previous surveys. During the three surveys (1982, 1996, and 2008), 18 species were detected, and abundances and trends were assessed for 11 species. Five of the nine native species and one alien bird have increased since 1982. Three native birds—Mariana Fruit-Dove (Ptilinopus roseicapilla), Micronesian Honeyeater (Myzomela rubratra), and Tinian Monarch (Monarcha takatsukasae)—have decreased since 1982. Trends for the remaining two birds (one native and one alien) were considered relatively stable. Only five birds, including the Tinian Monarch, showed significant differences among regions of Tinian by year. Increased development on Tinian may result in increases in habitat clearing and expansion of human-dominated habitats, and declines in some bird populations would likely continue or be exacerbated with these actions. Expanded development activities on Tinian would also mean increased cargo movement between Guam and Tinian, elevating the probability of transporting the Brown Tree Snake (Boiga irregularis) to Tinian, which would lead to precipitous decreases and extinctions.


The tobacco industry is a major political and legal force in the state of Washington through campaign contributions, lobbying, and filing lawsuits. The tobacco industry has become a major source of campaign contributions to legislative candidates. In the 1985-86 legislative session, the tobacco industry contributed $31,100 to legislative candidates. Contributions reached a peak during the 1989-90 legislative session when the tobacco industry contributed $119,059 to legislative candidates. During the current 1995-1996 election cycle, the tobacco industry has contributed $69,573 to legislative candidates between January 1, 1995 to September 30, 1996. Tobacco industry contributions to legislative candidates is expected to exceed the 1993-1994 amount of $70,524. During the 1993-1994 legislative session, the combined contributions of Philip Morris, RJ Reynolds, and the Tobacco Institute ranked eighth among top contributors to legislative campaigns in Washington. In the past few election cycles, there has been a significant shift in tobacco industry contributions away from the Democratic party and towards the Republican party in Washington. During the 1989-90 election cycle, 47 percent of tobacco industry contributions to legislators, legislative candidates, political parties and party controlled committees went to the Republican party. Contributions to Republicans increased to 60 percent in the 1991-1992 election cycle and 66 percent in the 1993-1994 election cycle. Between January 1, 1995 and September 30, 1996, the tobacco industry contributions to the Republican party has increased to 83 percent. The tobacco industry makes significant contributions to legislative leaders. House Speaker Clyde Ballard has received $11,880 in tobacco industry contributions since 1986, more than any other current legislator. All Republican House Leaders have received tobacco industry contributions and generally had more pro-tobacco industry policy scores. In the Senate, where the Democrats held a one vote majority during the 1995-1996 session, Majority Leader Sid Snyder received $3,600 from the tobacco industry throughout his career. Valoria Loveland, the Democratic Caucus Chair, received $1,600 in tobacco industry contributions during the 1995-1996 electoral cycle. In addition to providing campaign contributions, the tobacco industry is active in lobbying members of the legislature and the administration. In 1993 and 1994, the tobacco industry spent $643,188. The trend suggests that the tobacco industry will exceed that amount during the 1995-1996 session. In 1995, the tobacco industry spent $368,660 in lobbying expenditures, an increase in the rate of lobbying expenditures over the previous election cycle. The tobacco industry became an especially active lobby in 1991 and 1992, after a number of local smoke free and youth access ordinances were passed in Washington cities and counties. A statistical relationship exists between tobacco industry campaign contributions and state legislative behavior. The more money a legislator receives, the less likely he or she is to support tobacco control efforts. The tobacco industry also tends to contribute more money to legislators that have supported the industry in the past. Besides campaign contributions and lobbying, the tobacco industry has used legal tactics to slow down tobacco control activity in the state of Washington. Legal action by the tobacco industry has 1) lead the city of Puyallup to rescind a smoke-free restaurant ordinance, 2) forced the Department of Labor and Industries to defend their clean indoor air regulations in Superior court, and 3) has created an atmosphere of intimidation among organizations associated with Project ASSIST. Despite the highest tobacco tax in the nation, none of the money raised from tobacco taxes has been earmarked for tobacco prevention or cessation programs. The state of Washington is among 19 states and counties that is suing the tobacco industry in order to recover health and medical costs associated with tobacco related illnesses.


BACKGROUND
Although recommendations to prevent COVID-19 healthcare-associated infections (HAIs) have been proposed, data on their effectivity are currently limited.

OBJECTIVE
The aim was to evaluate the effectivity of a program of control and prevention of COVID-19 in an academic general hospital in Spain.

METHODS
We captured the number of COVID-19 cases and the type of contact that occurred in hospitalized patients and healthcare personnel (HCP). To evaluate the impact of the continuous use of a surgical mask among HCP, the number of patients with COVID-19 HAIs and accumulated incidence of HCP with COVID-19 was compared between the preintervention and intervention periods.

RESULTS
Two hundred fifty-two patients with COVID-19 have been admitted to the hospital. Seven of them had an HAI origin (6 in the preintervention period and 1 in the intervention period). One hundred forty-two HCP were infected with SARS-CoV-2. Of them, 22 (15.5%) were attributed to healthcare (2 in the emergency department and none in the critical care departments), and 120 (84.5%) were attributed to social relations in the workplace or during their non-work-related personal interactions. The accumulated incidence during the preintervention period was 22.3 for every 1000 HCP and 8.2 for every 1000 HCP during the intervention period. The relative risk was 0.37 (95% confidence interval, 0.25 to 0.55) and the attributable risk was -0.014 (95% confidence interval, -0.020 to -0.009).

CONCLUSIONS
A program of control and prevention of HAIs complemented with the recommendation for the continuous use of a surgical mask in the workplace and social environments of HCP effectively decreased the risk of COVID-19 HAIs in admitted patients and HCP.


INTRODUCTIONThe family is, among other things, a community based on everyday practices in which adults, generally the parents, are responsible for organizing the minors' environment. Spanish Civil Law, in Article 155 which is currently suspended, establishes the basic principle that all members of the family, both adults and children, should contribute to its sustenance as far as possible. This basic principle of supportive contribution to the needs of family life lays the basis for an approach to upbringing and implies a model of relations far removed from other social coexistence models.The type and amount of said cooperation differs, depending particularly on age and on other factors, such as work or health. Today, there is no longer any doubt about the effectiveness of cooperation in the family context: "everyday domestic agreements, together with the ideas and feelings accompanying them, constitute specific forms of exploring and anchoring questions about the rights and obligations implied by membership of any social or family group" (Goodnow, 1996, 33).This family organizational principle has been changing so that the greater the value placed on the offspring and the way parents interact with them, the less children are involved in household chores. Various studies have shown that, among all domestic tasks, childrearing practices are those which are more positively valued by both men and women (Gager, 1998; Kroska, 2003). At the same time, other studies show that, although the time employed in housework has decreased with respect to past decades, the time spent on childcare has increased. Parents enjoy spending time with their children and frequently organize their leisure time in keeping with their children's interests (Doucet, 1995; Kitterod, 2002).In this context, we define housework as unpaid work which contributes to the well-being of the members of the family group and to the maintenance of the home. Housework can be divided into three fundamental categories:1. Household work: includes those tasks relative to household management, housecleaning, food preparation, transportation, representation and relations outside the home, as well as home repair and maintenance.2. Care of children and other dependent family members: includes all activities derived from the care of these, such as feeding, dressing, purchasing their clothing, taking them to doctor's appointments, administering medication, transportation and accompaniment, among others.3. Emotional labor: makes reference to those activities which permit the improvement of affective well-being and provides emotional support to others. This assumes that said concept includes activities such as giving support, listening attentively, helping to find solutions for problems, being empathetic and so on.Research has been carried out on the amount of time invested by children in household tasks, as well as on the type of work they most commonly do. In their review of these studies, Shelton and John (1996) conclude that while the majority of children do some domestic tasks, their participation is occasional and limited. Blair (1 992), (as cited in Coltrane, 2000), confirms that in families with school-aged children, children do a mean of 5.9 hours of housework per week. Similarly, Greenstein (1996) concluded in his study that children contribute three hours per week to housework. The time invested and types of tasks undertaken by children are mediated by a broad range of factors, but their immediate social interaction context undoubtedly plays a decisive role. In this immediate social context, the ideal representations sustained by parents are key aspects in this matter.Likewise, this participation has been found to vary according to family structure, parents' gender ideology, mother's employment status, and age and gender of children. Thus, the frequency and number of hours per week devoted to housework increases with age (Coltrane, 2000; White and Brinkerhoff, 1981 ; Maganto, Bartau and Etxebarrfa, 2003; Shelton and John, 1996). …


The paper describes a demand-side response scheme
consisting of computer-controlled switches operated at end-users premises to shift loads targeting a homogenized national demand profile. The paper presents further simulation of the economic model corresponding to the above described scheme representing an incentive-based demand response. In the simulation the impact of these programs on load shape and peak load magnitudes, financial benefit to users as well as reduction of energy consumption are shown. The results demonstrated more
homogenized load curves at lesser peak load magnitudes and
reduced energy cost.


SUMMARY This paper investigates the kinematics and the optimization of a generic robotic structure composed by N serial rotary joints and actuated with a mono-directional tendon system. In the first part of the paper, the specific case that brought us to develop this study is introduced; the main motivations and the scenario with its specific constraints and design choices have been described. Since a complete and detailed analysis of an n-R serial structure with this kind of characteristics could not be found in the literature, the study of the kinematics and the parameter optimization of such a structure is treated as generally as possible, in order to make the procedure and the results applicable for any similar structure. Finally, in the last part, through the introduction of specific constraints and the definition of the parameters, the general analysis has been applied to the specific case of study: the preliminary study of a finger exoskeleton for an astronaut suit.


This document reports on the current state-of-the-art of integrating the KEEP Transfer Tool Framework as a use case for the Planets Interoperability Framework. The remit of this work is to implement the already developed experimentation platform of the IF with the transfer workflows required by the TTF. In order to gauge the applicability of the integration, UPHEC produced a feasibility study which was largely based on a focus group consultation with the lead developers of the Planets IF at the British Library. The results of the focus group and feasibility study, which are summarised in this document, showed that integration is possible provided that certain preconditions are met. The focus group also generated a product-based plan for the integration of Media Transfer tools within Planets IF, which serves as a roadmap for completing the individual requirements that constitute the TTF. The remainder of this report comprises four sections: Section 2 provides an overview of the Planets IF and the KEEP TTF. In doing so, the level of convergence between the capabilities of the IF and the requirements of the TTF are highlighted through a crosstabulation matrix. Section 3 includes a summary of the feasibility study findings and introduces the constraints posed to the TTF by technical and legal implications. Section 4 reports on current progress based on the abovementioned product-based plan. This work brings together not only components developed in Planets, but also products of the KEEP project itself. For ease of reference, we have mapped these elements on the product-based plan. Section 5 concludes this report by outlining the future actions necessary to complete the prototypes of the Transfer Tool Framework.


Several tobacco control measures are in place that aim to reduce the availability, accessibility and/or visibility of tobacco products at points of sale (POS). In response to a debate in the Dutch Parliament in October 2013, the Secretary of State for Health, Welfare and Sport agreed to review evidence on the impact of two of these measures, i.e., reducing the number of points of sale and restricting the display of tobacco products at points of sale. Special attention should be paid to tobacco vending machines. These data aim to support and facilitate a balanced discussion of different policy alternatives. This report synthesises data from a systematic review of research findings and information from grey literature and experts in a number of European countries to obtain a picture of the impact of the two measures.


Non-resonant, electron-impact, vibro-electronic excitation cross sections, involving vibrationally excited N2 molecules, to the mixed valence-Rydberg b,c,o Πu and ′ b , ′ c , ′ e Σu + singlet states are presented. These cross sections are calculated using the so-called similarity approach, accounting for the vibronic coupling among excited states, and compared with the experiments and different theoretical calculations. New cross sections for the electron-impact resonant vibrational excitation of CO2 molecule are calculated, for the symmetric stretching mode, as a function of the incident electron energy and for the transitions (υi ,0,0)→ (υ f ,0,0) with υi = 0,1,2 and for some selected value of υ f in the interval υi ≤υ f ≤10. A resonance potential curve and associated widths are calculated using the R-matrix method. Rate coefficients, calculated by assuming a Maxwellian electron energy distribution function, are also presented for the same (υi ,0,0)→ (υ f ,0,0) transitions. Electron-impact cross sections and rate coefficients for resonant vibrational excitations involving the diatomic species N2, NO, CO, O2 and H2, for multi-quantic and mono-quantic transitions, are reviewed along with the cross sections and rates for the process of the dissociative electron attachment to H2 molecule, involving a Rydberg excited resonant state of the ion.


A growing number of visualization tools are now publicly released on the Web. While this has many benefits, such as reaching more users without any installation time or procedure, it is often unclear how those tools are being used. The most common method to remotely observe usage is remote logging through a web server. Analyzing recorded logs has already been successful to improve the usability of tools, assess the performance of users and even to enrich the user interface with histories or logs visualizations. However, from our own practice of recording and analyzing logs, we have found a lack of methodology to support this process and use the results consistently. This workshop aims at bringing the visualization community together to share their practice on logging mechanisms, methods, logs reporting, analysis, visualization, and the underlying infrastructure to support logging on the server side and on the client side. Expected benefits include raising awareness on the potentials of logging for visualization, providing shared tools and methods to instrument visualizations, show how logging can improve visualization and interaction techniques, and scale to large number of users and sessions.


This paper presents the efforts carried out at Research Institute for Fruit Growing between 2020-2021, in order to assess the strawberry behaviour to the hydric and biocenotic stress to improve the water and nutrients use and to build precision driven technologies that can be transferred to the farmers. Thirteen strawberry cultivars and three promising hybrids were evaluated in the field in order to evaluate the response to the fertirrigation regime, the chlorophyll fluorescence and the photosynthetic potential. We also focus on the behavior of the cultivars to the major pest and diseases, forecasts using warning modules, and an innovative mobile application and warning algorithms elaborated on the computer, and productivity potential into the first year of fructification. The ratio between the main macro-elements N 12.5: P 18.0: K 1.0: Mg 1.5 aiming to provid a very good nutrition to the strawberry plants and preparation for the cold season. The varietal sensitivity index to diseases (VSI%) of the newly introduced cultivars, ranged between 0.48 at 'Dona' cultivar and 2.53 at 'Mira' cultivar but no more than 5.00 at 'Elsanta' cultivar. The average fruit weight ranged between 18.5 g at 'Daroyal' and 27.5 at 'Alba' cultivars. So, in this group, the productivity potential ranged between 451 to 1100 g /plant.


The subject of the State becomes more and more topical in the context of building and development of the post-industrial civilization and the growing economic integration, resulting from the process of deepening economic globalization, on one hand, and the growing political fragmentation, on the other, in the post-bipolar world. In the same time there is a considerable cognitive deficit and there are a lot of unlit questions of theoretical, methodological and practical nature related to the cyclic civilizational dynamics and the relation Civilization (local and global) - State - Region (within State). The objective of the present article is the tracing of this interdependence.


Seafood is a common vehicle for the transmission of infections and intoxications. The main concerns in the UK are scombroid fish poisoning, viral infections (associated with bivalve molluscs) and bacterial infections (associated with crustaceans). Paralytic shellfish poisoning (PSP) and red whelk poisoning occur sporadically, and ciguatera has started to appear associated with imported fish. The appearance in coastal waters of marine algae associated with diarrheic shellfish poisoning (DSP) has increased the likelihood of outbreaks of this toxic syndrome. The dinoflagellates causing neurotoxic shellfish poisoning and amnesic shellfish poisoning have not been detected in UK fishing waters but the fluctuating distribution of algal populations makes their appearance a possibility. The Food Hygiene Laboratory and the Torry research station of the Ministry of Agriculture, Fisheries and Food provide a reference service for scombrotoxin, ciguatera, DSP, PSP and red whelk poisoning in the UK.


The ongoing realisation of the enlargement of the Western alliance will create a new challenge for the
future of the Treaty on Conventional Forces in Europe (CFE). At present Russia strictly opposes the
enlargement and has rejected any compromise. Russian diplomats have demanded that the weapons of
the East-Central European countries should be counted as part of the NATO group ceilings if these
countries join the Western alliance. They have indicated that Russia could withdraw from the treaty if
this is not done. From the Russian point of view, it seems to be a political circumvention of the CFE
Treaty if East-Central European countries accede to NATO without changing their CFE group of states
membership. With its new proposal on the modernisation of the CFE Treaty on 23 April 1996 in
Vienna, the Russian Federation underlined its principal rejection of the enlargement and increased the
political pressure on the West because it could use its opposition to enlargement as an instrument to
block the modernisation of CFE.
On the other hand NATO countries argue that from the point of international law the enlargement
would have no effect on the treaty. However, there is an admission that the consequences for the treaty
could only be evaluated if new members were actually to join the alliance. Within NATO there is in
general a broad consensus to offer Russia some kind of compensation. What is still a matter of dispute
is the time, nature and extent of the appropriate Western accommodations because the moment and
extent of enlargement have not yet been decided.
In spite of the fact that there is no movement in the central question, one can see a slight rapprochement
between the sides on a subordinate level. During the CFE Review Conference all participants
agreed to the Russian request to start immediately negotiations "aimed at improving the operation of
the Treaty in a changing environment". The "scope and parameters" for these talks "should be defined
as a matter of priority" and a "progress report" should be presented at the OSCE Lisbon Summit, including
"recommendations on the way ahead". In its new proposal Russia has also hinted at certain
possibilities for compromise. It is no longer demanding a renegotiation of the CFE Treaty, a "supplementary
agreement" would suffice, and it is being suggested that there would be no need for a formal
ratification of adjustment measures. These are very important steps to reduce the fears of many CFE
member states that negotiations on adaptation and modernisation could be a slippery road to the relaxation
of the treaty requirements. Finally, the ceilings for the newly proposed alliance sufficiency rule
are being left open, which signals a preparedness to be flexible in negotiations.
Cooperative security policy for Europe and the CFE Treaty can only survive if both sides are prepared
for a fair compromise. But a compromise requires a clear understanding of what is at stake and of what
both sides want for their security. In this context it is not good policy for Russia simply to say no to
the enlargement of NATO, because this would mean abandoning any chance of influencing the price
the West must pay for it. Secondly, Russia needs to make a clear decision on the question of what it
seeks to obtain from NATO. Also, NATO must answer specific questions: will NATO enlargement
stop after the accession of the Visegrad states, or will it be an open process? The answer will have a
profound impact on possible solutions. The paradox of the present situation is that neither side has yet
made its position clear enough for the other side to be able to decide on its own negotiating strategy.


Importance There has been an increased interest in measuring parathyroid hormone (PTH) levels as an early predictive marker for the development of hypocalcemia after total thyroidectomy. However, significant variation exists in the timing, type of assay, and thresholds of PTH in the literature. Objective We performed a systematic review to examine the utility of PTH levels in predicting temporary postthyroidectomy hypocalcemia. Evidence Review A systematic literature review of studies published prior to May 25, 2016 was performed within PubMed, EMBASE, SCOPUS, and Cochrane databases using the following terms and keywords: "thyroidectomy," "parathyroid hormone," and "hypocalcaemia," "calcium," or "calcitriol." Each candidate full-text publication was reviewed by 2 independent reviewers and selected for data extraction if the study examined the prognostic significance of PTH obtained within 24 hours after thyroidectomy to predict hypocalcaemia. Studies were excluded if calcium supplementation was used routinely or based on a PTH level. Study characteristics, PTH parameters used to predict hypocalcemia, and their respective accuracies were summarized. Findings The initial search yielded 2417 abstracts. Sixty-nine studies, comprising 9163 patients, were included. Overall, for an absolute PTH threshold, the median accuracy, sensitivity, and specificity were 86%, 85%, and 86%, respectively. For a percentage change over time the median accuracy, sensitivity, and specificity were 89%, 88%, and 90%, respectively. Conclusions and Relevance The existing literature regarding PTH levels to predict postthyroidectomy hypocalcemia is extremely heterogeneous. A single PTH threshold is not a reliable measure of hypocalcemia. Additional prospective studies controlled for timing of laboratory draws and a priori defined PTH thresholds need to be performed to ascertain the true prognostic significance of PTH in predicting postthyroidectomy hypocalcaemia.


The German Innovation Policy is based on two strategic elements: innovation policy tries to build up innovation infrastructures mainly related to the generation of new knowledge with the help of big science associations. Simultaneously, innovation policy follows mission-oriented objectives (focusing on key technologies) and strives to improve knowledge diffusion (increasing the share of commercialised knowledge). Due to the German Federalism, both strategic elements are located on a federal and Lander level. Therefore, on regional and central level policymakers struggle with similar problems. In particular, the mission-oriented approach suffers from serious knowledge deficits and there is a political failure to pick the 'winners'. In addition, the mix of joint decision and finance schemes and autonomous decision structures on federal and regional levels cause inefficiencies, because not all responsibilities are efficiently allocated. A lack of transparency also exists, because the support schemes and instruments are too complex. Therefore, the division of labour between the federal state and the Lander beyond the infrastructure policy can be improved.


: One of the results of the 49th Bavarian Physician's Conference was that in 1996 the Bavarian Statutory Health Care Administration (Kassenarztliche Vereinigung Bayerns, KVB) and the Bavarian Medical Association (Bayerische Landesarztekammer, BLAK) jointly suggested a project for the development and verification of a security infrastructure for the online transmission of medical patient data. This Project, the so-called "Health Care Professionals Protocol" (HCP-Protokoll), was designed to establish the first consensus standard for a secure and probably open system to be used in the health care system operating under the constraints of the diverse and heterogeneous IT-infrastructure in Bavaria, with a view towards utilization in all of Germany. In January 1997, the HCP-Protocol was accepted as the strategic mainline project for telematics applications in medicine by the State of Bavaria and endowed with more than 1.3 million DM in the framework of "Bavaria Online II". In the meantime, various national organizations of the German medical community as well as important industrial partners have expressed support for this initiative. Mention in the Roland-Berger study "Telematics in Health Care, Perspectives of Telemedicine in Germany", designation as an "exemplary scenario" in the final report of the Working Group 7 of the Forum Info 2000 "Telematics Applications in Health Care", as well as integration of the new German health professional card, make the HCP-Protocol the most promising candidate for a de facto standard in the security infrastructure for all participants in health care telecommunication in Germany. Since the middle of 1998, an expert group under the guidance of the joint "Projektburo Telemedizin" of the KVB and BLAK has been working on the definition of this protocol, taking into consideration the current legal framework of the German medical profession (Berufsordnung), the German signature law (SigG), and the national data security laws (BDSG), as well as today's technical possibilities and existing components. The results of this definition will be published at the first opportunity (sometime during the first half of 1999) and then placed into public domain, so that any solution provider can reference this source to create secure and mutually interoperable application programs for health care professionals in Germany.


EXECUTIVE SUMMARY The U.S. healthcare system continues to experience high costs and suboptimal health outcomes that are largely influenced by social determinants of health. National policies such as the Affordable Care Act and value-based payment reforms incentivize healthcare systems to engage in strategies to improve population health. Healthcare systems are increasingly expanding or developing new partnerships with community-based organizations to support these efforts. We conducted a systematic review of peer-reviewed literature in the United States to identify examples of hospital–community partnerships; the main purposes or goals of partnerships; study designs used to assess partnerships; and potential outcomes (e.g., process- or health-related) associated with partnerships. Using robust keyword searches and a thorough reference review, we identified 37 articles published between January 2008 and December 2019 for inclusion. Most studies employed descriptive study designs (n = 21); health needs assessments were the most common partnership focus (n = 15); and community/social service (n = 21) and public health organizations (n = 15) were the most common partner types. Qualitative findings suggest hospital–community partnerships hold promise for breaking down silos, improving communication across sectors, and ensuring appropriate interventions for specific populations. Few studies in this review reported quantitative findings. In those that did, results were mixed, with the strongest support for improvements in measures of hospitalizations. This review provides an initial synthesis of hospital partnerships to address population health and presents valuable insights to hospital administrators, particularly those leading population health efforts.


The squamous cell carcinoma (SCC) of the auricle was one of the common tumors of not only skin but also ear. SCC of the auricle was described to be the carcinoma of old age with some predisposing factors and keloid was known to be one of the predisposing factors for malignant tumors. Keloid and radium needle therapy were risk factors, latter the major, independently from each other and were reported to conclude in SCC depending on the duration for the keloid and the dose for the radium needle therapy. The increased age with the long duration of these predisposing factors should have to be kept in mind in every situation when these treatment modalities had been planned to. Surgical interventions should always be the first choice in the treatment of not only the carcinomas but also in keloids in selected cases.


An adsorptive process for the defluoridation of drinking water was performed using a hybrid nanocomposite of hydrous titanium oxide@polypyrrole (HTiO2@PPy), as a scavenger. The adsorbent was successfully fabricated via facile in situ chemical oxidative polymerization of pyrrole monomer in aqueous media in which HTiO2 nanoparticles were suspended. The developed adsorbent was characterized using various spectro-analytical techniques viz. BET, FTIR, FE-SEM, STEM, EDX, TGA and ZETA SIZER. Relatively high BET surface area (98.17 m2 g−1) and pHpzc (∼8.4) values were obtained for HTiO2@PPy. The synergistic effect of both the counterparts (PPy and HTiO2) of the nanocomposite rapidly enhanced the F− adsorption process. A noteworthy rapid fluoride uptake best described by the pseudo-second-order kinetic model was observed (equilibrium attainment within 5–30 min). The Langmuir model best described the isotherm data with a maximum adsorption capacity of 31.93 mg g−1 at 25 °C and pH 6.5 (±0.2). Thermodynamic and activation parameters provided evidence of the spontaneous, endothermic and physical nature of the adsorption process. The selectivity of HTiO2@PPy for F− sorption was significant in the presence of Cl−, NO3−, HCO3−, SO42− and PO43− co-existing ions and noteworthy reusability for up to three regeneration cycles was achieved. Electrostatic interactions and ion-exchange were proposed to be the possible underlying mechanisms for the adsorption of F− by HTiO2@PPy nanocomposite. Thus, HTiO2@PPy is anticipated to serve as an efficient scavenger for the defluoridation of drinking water.


In this study, it is aimed to examine the relationships between the well-being, spiritual intelligence and attitudes of adolescents living in Turkey towards violence. The sample of the study consists of 466 high school students (194 girls, 272 boys) aged between 14 and 19, selected using the convenience sampling method. In the study, "Scale for Spiritual Intelligence", "Five-Dimensional Well-being for Adolescents (EPOCH) Scale" and "Attitude towards Violence Scale for Adolescents" and demographic information form were used as measurement tools. Hierarchical regression analysis was used to test the predictiveness of adolescents' well-being and spiritual intelligence on their attitudes towards violence. According to the findings obtained from the research, there is a moderately negative and significant relationship between attitude towards violence and well-being. It is seen that there is a low negative and significant relationship between attitude towards violence and spiritual intelligence. It was identified that there is a moderate positive and significant relationship between well-being and spiritual intelligence scores. The well- being variable explaining 32% of the attitude scores towards violence was first included in the staged multiple regression analysis performed. And in the second stage, the spiritual intelligence variable, which contributes 2% to the explained variance, was also included. When the total variance explained is examined, it is seen that the variables of well-being and spiritual intelligence together explain 34% of the total variance in the attitude scores towards violence. This finding shows us that the change in well-being and spiritual intelligence scores predicts the change in the scores of the attitude towards violence.


Transferring knowledge among various environments is important for efficiently learning multiple tasks online. Most existing methods directly use the previously learned models or previously learned optimal policies to learn new tasks. However, these methods may be inefficient when the underlying models or optimal policies are substantially different across tasks. In this paper, we propose Template Learning (TempLe), a PAC-MDP method for multi-task reinforcement learning that could be applied to tasks with varying state/action space without prior knowledge of inter-task mappings. TempLe gains sample efficiency by extracting similarities of the transition dynamics across tasks even when their underlying models or optimal policies have limited commonalities. We present two algorithms for an ``online'' and a ``finite-model'' setting respectively. We prove that our proposed TempLe algorithms achieve much lower sample complexity than single-task learners or state-of-the-art multi-task methods. We show via systematically designed experiments that our TempLe method universally outperforms the state-of-the-art multi-task methods (PAC-MDP or not) in various settings and regimes.


The implicit LU-SGS solver has been implemented in the code Edge to accelerate the convergence to steady state. Edge is a ow solver for unstructured grids based on a dual grid and edgebased formulation. LU-SGS has been combined with the line-implicit technique to improve convergence on the very anisotropic grids necessary for the boundary layers. LU-SGS works in parallel and gives better linear scaling with respect to the number of processors, than the explicit scheme. The ordering techniques investigated have shown that node numbering does inuence the convergence and that the native orderings from Delaunay and advancing front generation were among the best tested. LU-SGS for 2D Eu-ler and line-implicit LU-SGS for 2D RANS are two to three times faster than the explicit and line-implicit Runge-Kutta respectively. 3D cases show less acceleration and need a deeper study.


Machine learning is a branch of Artificial Intelligence(AI) which is heavily used in the field of data science. It has a strong potential in health-related data analysis for automated disease prediction. The work focuses on three different machine learning techniques, i.e., DBSCAN, K-Means, and Affinity Propagation to compare their prediction accuracy and computational complexity. The study concentrates on liver disease-related health care data set and uses the Silhouette coefficient for comparative performance measurement of the three techniques mentioned above. The Silhouette coefficient determines prediction accuracy giving K-Means as the optimal method. The overall results will then be analyzed on the basis of prediction accuracy and computational complexity to determine the best technique for prediction of liver diseases using unsupervised machine learning.


The aim of the research was to detect the variations in structure and composition of the ectomycorrhizal fungal communities in several cork oak stands that differed in lithologic substrate (granitic, basaltic, trachytic) and management systems. This survey was carried out in order to implement generalizable models of the dynamics of ectomycorrhizal communities in ecosystems dominated by cork oak trees. Overall of nine cork oak stands,
representative of 75% of the natural cork oak stands, 40% of the grazed and 60% ploughed that occur in Sardinia were investigated. Two transects were delimited in each
cork oak stand and soil samples were collected to study the ectomycorrhizal community in spring and autumn respectively. In total 82.333 ectomycorrhizal tips were isolated and 185 Operative Taxonomic Units (OTUs) were characterized based on morpho-anatomic analysis. 149 of them were identified on the basis genetic analysis. Both structure and composition of the ectomycorrhizal community were significantly influenced by the sampling season, management system and lithologic substrate: particularly the structure was influenced by the management system and season, whereas the composition in the OTUs by the management and lithologic substrate. The latest result have allowed to individuate guilds of fugal species that characterize the cork oak stands investigated.


I Â ntroduction:Â Antipsychotic drugs have an important role in psychiatric treatment. Their side effects such as drug induced Parkinsonism, which has been a historical challenge for patients and physicians, account a major cause of treatment rejection by the patients. Drug induced Parkinsonism is the second cause of Parkinson syndrome. The aim of this study was to evaluate antipsychotic induced Parkinsonism in patients with schizophrenia. Material and Methods:Â This cross sectional descriptive study was done in the year 1999 in Noor and Shariaty Hospitals of Isfahan. 200 patients with schizophrenia, affected with Parkinsonism complication, were investigated. Variables were sex, age, dosage and group of drug, duration of treatment, Parkinsonism criteria and simultaneous anti cholinergic prescription. Data was gathered in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. Results:Â 122 men and 78 women were studied. 26.5 of patients had drug induced Parkinsonism, which was mostly seen in women (32 versus 22.9 in men), higher age (10-19 years: 0, 50 years and higher: 33), and when anticholinergic was not used simultaneously (35.7 versus 25 in anticholinergic users group). Prevalence of Parkinsonism, in high, medium, and low drug potentials was 28.7, 29.4 and 19.2, respectively. Differences in all of the above groups were not significant. Prevalence increased in dosage of less than 100mg (chlorpromazine equivalent dosage) versus 101-300mg (p>0.05), and in 3-6 months after onset of treatment (p<0.05). The most prevalence criterion was rigidity (84.9). Parkinsonism was diagnosed in 11.76 of patients using atypical drug (clozapin). Conclusion:Â Anti psychotic induced Parkinsonism increased in higher ages, women and when anticholinergic was not used simultaneously. This side effect was found in all groups even with clozapin. It had a greater prevalence in the beginning of treatment but decreased with treatment continuation and anticholinergic prescription. Future studies particularly on the atypical groups are suggested.


Using algorithmic complexity theory methods, we propose a robust computational definitions for open-ended evolution (OEE) and adaptability of computable dynamical systems. With this framework, we show that decidability imposes absolute limits to the growth of complexity on computable dynamical systems up to a logarithm of a logarithmic term. Conversely, systems that exhibit open-ended evolution must be undecidable and have irreducible behaviour through the evolution of the system. Complexity is assessed in terms of three measures: sophistication, coarse sophistication and busy beaver logical depth.


Abstract: As we scale down each process generation the degree of control we have on device parameters decreases. We are left to contend with a great deal of variability in process and environmental parameters. Process variation impacts dopant concentration, channel length, oxide thickness and other device parameters. Temperature variation too affects several parameters, amongst them are the threshold voltage and carrier mobility. All of these variations can either be margined for during design or compensated for dynamically. In this paper the technique of adaptive body bias is successfully applied to compensate for the variation in design so that the circuit operates at no more than 10 percent of the optimal pvt (process voltage temperature) point while minimizing leakage.


Due to massive growth of World Wide Web, search engines have become crucial tools for navigation of web pages. In order to provide fast and powerful search facility, search engine maintains indexes for documents and its contents on the web by downloading web pages for processing in iterative manner. Web indexes are created and managed by web crawlers which work as a module of search engines and traverse the web in systematic manner for indexing its contents. A web crawling is a process which fetches data from various servers. It is a time taking process as it gathers data from various servers. Hence, to speed up the searching process in search engines the crawling should be fast enough. The aim of the proposed system is to enhance the speed of crawling process and CPU usage by use of multi-core concept.


In the mechanistic pavement design, it is common practice that the coarse and fine grained materials are modelled as linear elastic materials. The main reason for this is to use a simple set of parameters to represent each layer which in this case are the elastic modulus and Poisson ratio. However, it is well known that the unbound coarse granular materials and the fine grained subgrade materials behave nonlinearly under the traffic loading. The Australian mechanistic empirical design method (AUSTROADS) uses a simplified approach to account for the nonlinear behaviour of the unbound coarse and fine grained materials. In this paper the Austroads quasi-linear analysis is compared with the exact nonlinear analysis to examine the validity of this approach. The Austroads quasi-linear analysis provided better solutions than the linear elastic analysis without sublayering, however, it needs some adjustment to provide better match with the exact nonlinear analysis solution.


Sera from 17 of 18 adult volunteers challenged with a virulent serotype 1 rotavirus strain (D) were examined for prechallenge antibody levels against several well-defined rotavirus VP7 and VP4 neutralization epitopes by a competitive epitope-blocking immunoassay (EBA) in order to determine whether correlates of resistance to diarrheal illness could be identified. The presence of prechallenge serum antibody at a titer of greater than or equal to 1:20 that blocked the binding of a serotype 1 VP7-specific monoclonal antibody (designated 2C9) that maps to amino acid residue 94 in antigenic site A on the serotype 1 VP7 was significantly associated with resistance to illness or shedding (P less than 0.001) or illness and shedding (P less than 0.01) following challenge with the serotype 1 virus. In addition, an EBA antibody titer of greater than or equal to 1:20 in prechallenge serum against a serotype 3 VP7-specific epitope (defined by monoclonal antibody 954/159) that maps to amino acid 94 on the serotype 3 VP7 was also significantly associated with resistance to illness or shedding (P = 0.02), with a trend for protection against illness and shedding. A trend was also noted between the presence of EBA antibody against a cross-reactive VP4 epitope common to many human rotavirus strains, including the challenge virus, or a rhesus monkey rotavirus strain-specific VP4 antigenic site, and resistance to illness or shedding. These data confirm that the presence of serum antibody correlates with resistance to rotavirus illness or shedding but, in addition, demonstrate the association of antibody to a specific epitope with resistance to illness or shedding. These data also suggest that antigenic site A on the rotavirus VP7, composed of amino acids 87 to 96, may be involved in the formation of a major protective epitope. Further study of the role of this epitope in the development of homotypic and heterotypic immunity to rotaviruses following natural or vaccine-induced infection may be important in the development of strategies for control of rotavirus diarrheal disease.


Clinical risk management is a key area in terms of healthcare quality, especially within intensive-care settings and in the case of pediatric patients. The objective of this review is to assess the impact of tools for clinical risk management in pediatric intensive-care settings. Pubmed and Web of Science were queried to carry out a systematic review, using the PICO methodology (June 2019). Primary studies of applicative experiences of clinical risk management that had impacts in pediatric intensive care units were included. A total of 1178 articles were reviewed and 20 were included. Reactive risk management tools were used in 10 studies; proactive tools in 7; both reactive and proactive tools in 3. Sixteen studies out of 20 concerned drugs; other topics included: transition from hospital to primary care, hand hygiene, organizational aspects, human milk administration. Seven studies (35%) reported organizational impacts; Ten studies (50%) reported clinical and organizational impacts; Three studies (15%) reported organizational, clinical and economic impacts. The introduction of clinical risk management tools resulted in changes within the setting considered; combined use of reactive and proactive methodologies was highlighted in various studies, as well as an increasing focus on proactive tools, both drawing a growing trend over time.


Abstract A common critique of organic farming is that it is very tillage intensive, and therefore deleterious to soil quality. However, little information is available on the tillage practices currently employed by organic farmers, as well as organic farmers' attitudes toward reduced tillage (RT). To address these knowledge gaps, a detailed written survey of Michigan organic field crop and vegetable farmers was conducted to investigate their current tillage practices, as well as their perceptions of the barriers and benefits to adoption of RT. Respondents reported a wide range in tillage frequency and intensity, both across and within production of specific crops, with operations split evenly between field preparation and cultivation. Compared with field crop growers, vegetable growers were generally smaller scale and relied more heavily on a limited set of tillage (e.g., rototiller) and cultivation tools. Interest in adoption of RT practices among respondents was low to moderate with median Likert scale ratings (0–7 scale with 0 representing no interest and 7 extreme interest) of 4 or less for all forms of RT. Vegetable growers were most interested in permanent beds, rotational tillage and strip tillage, whereas field crop growers were most interested in rotational tillage and strip tillage. The greatest perceived benefits to adoption of RT were improved soil quality and fuel savings. Both groups ranked weeds, impacts on yields, residue management and crop establishment as high barriers to RT adoption. Vegetable growers also cited lack of scale appropriate equipment as a major barrier. Survey results suggest that future research efforts should focus on overcoming key barriers to adoption, such as weed management and access to low-cost adaptable RT equipment rather than reiterating relatively well-known soil quality benefits. Our results also suggest that promotion of incremental reductions in the frequency and intensity of tillage operations on organic farms may be more realistic and equally valuable compared with promotion of more extreme forms of RT such as no-till.


Humphreys and Forde (H&F) propose that greater within- category structural similarity makes living things more difficult to name. However, recent studies show that normal subjects find it easier to name living than nonliving things when these are matched across category for potential artefacts. Additionally, at the level of single pixels, visual overlap appears to be greater for nonliving things.


Testicular cancer is a disease that particularly occurs to young men. The survival rate of this type of cancer is high in comparison to that of other types of cancer. After treatment there is a follow up trajectory which includes a lot of check-ups for recurrences and long term effects of treatment. After this trajectory there still is a higher than usual risk on recurrences and long term effects, though.
Because of the intensity of the follow up trajectory, for both the patient and the involved health care providers, the University Medical Center of Groningen (UMCG) wondered if a web-based shared care system could help to improve this process. When the general practitioners, the general practitioner and the medical specialists would use this system, it could create a triangular relationship between them. This could improve the follow up. Webbased shared care systems are systems which could stimulate the contact between patients and health care providers and enhance the efficiency in the care processes.
Because of this a research has been done which tries to answer the following question: "What do current webbased shared care systems in healthcare look like and which functions of these systems are also appropriate to implement in a webbased shared care system for the follow up trajectory of testicular cancer patients?" To answer this question two sub questions have been formulated:
1. How are existing webbased shared care systems for other disorders organized considering the possibilities of information, communication and participation?
2. What do future users see as desirable and/or important functionalities for a webbased shared care system for testicular cancer patients? Sub question one is answered by performing an inventory research. There are twenty one existing webbased shared care systems which have been analyzed based on resources from the internet and questionnaires which were sent to developers and other persons that were directly involved. The systems have been analyzed by checking for eighteen prewritten functionalities. It appeared that the functionalities 'Monitoring symptoms in the system', 'asking questions to the health care provider through the system' and 'General information about the disease' are the most popular. The method that is most used for logging on is with a username and a password. A little less common is the use of DigiD code.
To answer sub question 2 an explorative research has been performed. The researchers have tried to analyze the needs of prospective users regarding the content of the webbased shared care system by interviewing nine patients, five general practitioners and five medical specialists. These interviews showed that a lot of the eighteen prewritten functionalities are desirable for them. It also appeared that the provision of information and communication in the follow up period was not always sufficient as it stands now. A webbased shared care system could perhaps solve these problems. The security of the system is an important thing to keep in mind for the development of the system.
This research is limited by the fact that not for every system that was analyzed a questionnaire was filled in and that this information did not always match with the information found on the internet. Another limitation is the fact that the seven features of Van der Vaart et al are not completely applicable for testicular cancer. The division of the main categories information, communication and participation can be considered a strong point since it creates a clear structure for the report. The multiple choice questions have perhaps been designed a bit too much from a patient's perspective and perhaps some possible features are missing. This last point has been countered by allowing respondents to come up with extra features. The selected respondents could perhaps be biased since the selection process for our care providers has been done for a great extent by our external principal and since the interviewed patients were all members of the patient's organization. Because the patients are all members of the patient's organization, they are really committed to improve the healthcare around their disease, which can be seen as a strong point. A final strong point is the fact that the questions were answered from multiple perspectives. One can conclude that a webbased shared care system is a valuable addition in the follow up trajectory for testicular cancer patients. There are no systems for other disorders available which have all the functionalities that are preferred by prospective users in a web-based shared care system for the follow up for testicular cancer patients. It is however known which functionalities are preferable in such system.


Positioning multiple sensors for acquisition of a given environment is one of the fundamental research areas in various fields, such as military scouting, computer vision, and robotics. In this paper, we propose a new model for the problem of sensor deployment. Deploying and configuring a set of given sensors on a synthetically generated 3-D terrain have multiple objectives on conflicting attributes: maximizing the visibility of the given terrain, maximizing the stealth of the sensors, and minimizing the cost of the sensors used. Since they are utility-independent, these complementary and conflicting objectives are modeled by a multiplicative total utility function, based on multiattribute utility theory. The total utility function proposed in this paper can also be adapted for various military scouting missions with different characteristics.


A single-body point absorber system is analysed to improve its power absorption at a finite water depth.  The proposed wave energy converter consists of a single floating body coupled to a direct-drive power take-off system placed on the seabed. The structure of a cylindrical buoy with large draft is changed by a single body composed of three structures rigidly coupled, reducing its volume and improving its frequency-dependent hydrostatic parameters that are obtained through a numerical analysis tool called NEMOH. The undamped natural frequency of the oscillating system is tuned to a specified wave period and the performance of the WEC system is obtained assuming a linear Power Take-Off system. In time domain, the performance of the WEC device is carried-out under a regular (sinusoidal) and irregular incident wave profile. Comparing the performance of the WEC system using the cylindrical and the proposed buoy outcomes that the system with the proposed buoy is able to absorb more energy from incident waves with a wider frequency range, whereas the oscillating system is kept as simple as possible.


Purpose of review Haemophilus ducreyi, the causative agent of the sexually transmitted infection chancroid, is primarily a pathogen of human skin. During infection, H. ducreyi thrives extracellularly in a milieu of professional phagocytes and other antibacterial components of the innate and adaptive immune responses. This review summarizes our understanding of the interplay between this pathogen and its host that leads to development and persistence of disease. Recent findings H. ducreyi expresses key virulence mechanisms to resist host defenses. The secreted LspA proteins are tyrosine-phosphorylated by host kinases, which may contribute to their antiphagocytic effector function. The serum resistance and adherence functions of DsrA map to separate domains of this multifunctional virulence factor. An influx transporter protects H. ducreyi from killing by the antimicrobial peptide LL37. Regulatory genes have been identified that may coordinate virulence factor expression during disease. Dendritic cells and natural killer cells respond to H. ducreyi and may be involved in determining the differential outcomes of infection observed in humans. Summary A human model of H. ducreyi infection has provided insights into virulence mechanisms that allow this human-specific pathogen to survive immune pressures. Components of the human innate immune system may also determine the ultimate fate of H. ducreyi infection by driving either clearance of the organism or an ineffective response that allows disease progression.


It was a busy week aboard the International Space Station as Expedition 56 Commander Drew Feustel and Flight Engineer Ricky Arnold of NASA, along with Flight Engineer and Soyuz Commander Oleg Artemyev of the Russian space agency Roscosmos returned to Earth. With their departure comes the start of Expedition 57 and a new space station commander.


Abstract. Recent work demonstrates that phase displacements within horizontal fractures large with respect to the spatial correlation length of the aperture field lead to a satiared condition that constrains the relative permeability to be less than one. We use" effective meda theory to develop a conceptual model for satiafed relative permeability, then comparepredictionsto existing experimental measurements, and numerical solutions of the Reynolds equation on the measured aperture field within the flowing phase. The close agreement among all results and data show that for the experiments considered here, in-plane tortuosity induced by the entrapped phase is the dominant factor controlling satiated relative permeability. We also find that for this data set, each factor in the conceptual model displays an approximate power law dependence on the satiated saturation of the fraciure.


In the last fifteen years, judicial claims to secure health services as a matter of right have become an important phenomenon in a number of countries including South Africa, India, Brazil, Colombia, Argentina, and Costa Rica. Little systematic empirical information is available with respect to the impact on health financing of such litigation. However, a multi-disciplinary research project coordinated by the Chr. Michelsen Institute provides some preliminary findings.


In Australia, Smart Meters automatically provide electricity suppliers with half-hour energy use data for each customer. This data can be used to classify customers into different categories. To this end, electricity supplier AGL provided MISG participants with data from 772 anonymous Victorian customers, collected between 2011-07-16 and 2012-01-30, and the corresponding series of half-hour temperature readings for Melbourne. The goals were to identify a small number of load profiles that could be used to classify customers, and to identify which customers have significant cooling loads and which customers have significant heating loads. For each customer there was a time series of 9552 half-hour periods, which made the dimensionality of the problem too high for cluster analysis of the entire sample data. Therefore analysis proceeded in two phases. First, the data were explored using various methods of data visualisation, including time series plots, scatterplots and heatmaps of electricity use against temperature and time, Fourier series analysis and load duration curves. Exploration suggested that some automatic data-selection rules would be useful, for example to eliminate premises with long periods of zero electricity, presumably due to vacancy. Based on the data exploration, summary statistics were chosen that would represent each customer, and these were used in the next phase, cluster analysis. Second, three approaches were used for clustering: self-organising maps, agglomerative clustering, and K-means clustering. Each of these methods produced interpretable clusters indicating different types of customer. Agglomerative clustering with complete linkage was good for picking out small very distinctive clusters, and Ward's linkage also performed well provided sufficient clusters were allowed. Computational limitations mean these two techniques cannot be directly used on very large samples---AGL has hundreds of thousands of customers. However, the cluster centroids from a pilot study, such as the sample provided to MISG, could be used as initial estimates for feeding into K-means clustering, providing the twin benefits of interpretable clusters and computational efficiency.

 References Chicco, G. (2009) Support vector clustering of electrical load pattern data. IEEE Transactions on Power Systems, 24: 1619–1628. doi:10.1109/TPWRS.2009.2023009 Chicco, G. (2010) Clustering methods for electrical load pattern classification. In: 8th World Energy System Conference (WESC 2010), Targoviste, Romania, 1–3 July 2010. pp. 5–13 doi:10.1016/j.energy.2011.12.031 De Silva, D., Yu, X., Alahakoon, D., Holmes, D. (2011) Incremental pattern characterization learning and forecasting for electricity consumption using smart meters. In Industrial Electronics (ISIE), 2011 IEEE International Symposium on (pp. 807–812). http://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=05984262 Flath, C., Nicolay, D., Conte, T., Dinther, C., Filipova-Neumann L. (2012) Cluster Analysis of Smart Metering Data. Business Information Systems Engineering 4: 31–39. http://aisel.aisnet.org/bise/vol4/iss1/5 Gullo, F., Ponti, G., Tagarelli, A., liritano S., Ruffolo, M., Labate D., (2009), Low-voltage electricity customer profiling based on load data clustering, IDEAS 2009, pp. 330–333. doi:10.1145/1620432.1620472 Kim, Y. I., Kang, S. J., Ko, J. M., Choi, S. H. (2011a). A study for clustering method to generate Typical Load Profiles for Smart Grid. Power Electronics and ECCE Asia (ICPE and ECCE), 2011 IEEE 8th International Conference on. pp. 1102–1109. http://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=05984262 Kim, Y. I., Ko, J. M., Choi, S. H. (2011b). Methods for generating TLPs (typical load profiles) for smart grid-based energy programs. In Computational Intelligence Applications In Smart Grid (CIASG), 2011 IEEE Symposium on (pp. 1–6). doi:10.1109/CIASG.2011.5953331 Murtagh, F. (1995) Interpreting the Kohonen Self-organizating feature map using contiguity-constrained clustering. Pattern Recognition Letters, 16:399–408. doi:10.1016/0167-8655(94)00113-H Ward, J. H. Jr (1963) Hierarchical grouping to optimize an objective function. Journal of the American Statistical Association, 58: 236–244. doi:10.1080/01621459.1963.10500845


The continuously widening variety of Wireless Sensor Networks (WSNs) applications requires node this is certainly precise which needs efficient and error free localization practices. Localization methods created in past times are totally centered on really good computation this is certainly numerical of network variables for example transmission range, propagation form, transmitted or received power, delivering or arrival time, connection information etc. These variables are susceptible towards ecological presence and circumstance of hurdles in environment. As wireless sensor companies tend to be ubiquitous in general, localization is a factor this is certainly essential to be fixed. Localization of a node that is unknown be identified through a collection of research nodes. In this work, we provide a novel hybrid localization strategy, which determines the location this is certainly exact of an unknown node through the mixture of both range free and range based practices.


Background: Attention deficit hyperactivity disorder
(ADHD) was long considered to be limited to children and adolescents, but it is
now known that ADHD symptoms may persist into adulthood. It is plausible that
the etiology of ADHD is not one-dimensional, but instead involves various
neuroanatomical and neurochemical systems, with the causes of the main abnormalities
believed to be catecholaminergic. Iodine-123-labeled meta-iodobenzylguanidine (123I-MIBG)
is a physiological analogue of norepinephrine (NE). To the best of our
knowledge, there are no reports about the abnormalities of MIBG scintigraphy in
patients with ADHD. The cases presented are male adult patients with different
comorbid psychiatric disorders. Case presentation: The cases presented are male
adult patients with different psychiatric disorders. Case 1 was a 52-year-old
male residential construction foreman, who had been diagnosed with acute schizophrenia-like psychotic disorder. 123I-MIBG planar and SPECTs of the studies were performed at 20 min (early phase) and 3 h
(late phase) after intravenous injection of 111 MBq. Planar images were
processed to determine the heart (H) to mediastinum (M) ratio (H/M). The early
and late H/M ratios were 1.22 and 1.07, respectively. Case 2 was a 52-year-old
male civil servant who was diagnosed with adjustment disorder. The early and
late H/M ratios were 1.98 and 2.08, respectively. Conclusion: Clinical studies
make it clear that symptoms of ADHD are more heterogenous and subtle in adults
than children. Adult ADHD is significantly commorbid with wide range of other
12-month disorders. MIBG imaging can be useful to diagnose patients with
preexisting psychiatric disorders and ADHD. It might be possible to diagnose
objectively though the psychiatric statuses resemble or coexist with other
psychiatric disorders. Needless to say, further research is important.


Populations of organisms that are chronically exposed to high levels of chemical contaminants may not suffer the same sublethal or lethal effects as naive populations, a phenomenon called resistance. Atlantic tomcod (Microgadus tomcod) from the Hudson River, New York, are exposed to high concentrations of polycyclic aromatic hydrocarbons (PAHs) and bioaccumulate polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs). They have developed resistance to PCBs and PCDDs but not to PAHs. Resistance is largely heritable and manifests at early-life-stage toxic end points and in inducibility of cytochrome P4501A (CYP1A) mRNA expression. Because CYP1A induction is activated by the aryl hydrocarbon receptor (AHR) pathway, as are most toxic responses to these compounds, we sought to determine the geographic extent of resistance to CYP1A mRNA induction by PCBs in the Hudson River tomcod population. Samples of young-of-the-year tomcod were collected from seven locales in the Hudson River, extending from the Battery at river mile 1 (RM 1) to RM 90, and from the Miramichi River, New Brunswick, Canada. Laboratory-reared offspring of tomcod adults from Newark Bay, in the western portion of the Hudson River estuary, were also used in this study. Fish were partially depurated in clean water and intraperitoneally injected with 10 ppm coplanar PCB-77, 10 ppm benzo[a]pyrene (BaP), or corn oil vehicle, and levels of CYP1A mRNA were determined. CYP1A was significantly inducible by treatment with BaP in tomcod from the Miramichi River, from laboratory-spawned offspring of Newark Bay origin, and from all Hudson River sites spanning 90 miles of river. In contrast, only tomcod from the Miramichi River displayed significantly induced CYP1A mRNA expression when treated with PCB-77. Our results suggest that the population of tomcod from throughout the Hudson River estuary has developed resistance to CYP1A inducibility and probably other toxicities mediated by the AHR pathway. Tomcod from the Hudson River may represent the most geographically expansive population of vertebrates with resistance to chemical pollutants that has been characterized.


We report an investigation of the effects of low-temperature annealing on the electrical properties of amorphous indium gallium zinc oxide (a-IGZO) thin-film transistors (TFTs). X-ray photoelectron spectroscopy was used to characterize the charge carrier concentration, which is related to the density of oxygen vacancies. The field-effect mobility was found to decrease as a function of the charge carrier concentration, owing to the presence of band-tail states. By employing the transmission line method, we show that the contact resistance did not significantly contribute to the changes in device performance after annealing. In addition, using low-frequency noise analyses, we found that the trap density decreased by a factor of 10 following annealing at 120 °C. The switching operation and on/off ratio of the a-IGZO TFTs improved considerably after low-temperature annealing.


When entering a virtual world, the users expect an experience that feels natural. Huge progress has been made with regards to motion, vision, physical interactivity, whereas interactivity with non-playable character stays behind. This live-demo introduces a method that leads to more aware, expressive and lively agents that can answer their own needs and interact with the player. Notably, the live-demo covers the use of an emotional component and the addition of a layer of communication (speech) to allow more immersive and interactive Als in VR.


Background: Posterior malleolus fractures are associated with poorer functional outcomes compared to simpler malleolar fractures. Traditional teaching states that if a posterior malleolus fracture involves less than 25% of the distal tibia, it can be managed without fixation. Current literature has shown that fixation should not be based on the size of the posterior fragment but rather on the fracture pattern, instability and awareness that reduction and fixation is biomechanically advantageous. We hypothesised that current management of ankle fractures with posterior malleolus involvement in South Africa is not evidence-based and is suboptimal. We sought to assess the training, experience and decision-making of surgeons and trainees who are involved in the management of ankle fractures. Another aim was to develop evidence-based algorithms for the management of posterior malleolus and complex ankle fractures.
Methods: An email survey consisting of questions related to the management of ankle fractures was sent to specialists, registrars and medical officers who voluntarily completed an online survey.
Results: A total of 103 out of 456 emails sent drew responses to the survey. Responses included 28% from consultants, 54% from registrars and 18% from medical officers. Forty-six per cent of responders believed that posterior malleolus fractures can be managed non-operatively if less than 20% of the tibial plafond is involved. Only 49% would CT scan a posterior malleolus prior to operating. Thirty-eight per cent of the responders were not familiar or comfortable with the posterior-lateral approach used for fixation of the posterior malleolus directly.
Conclusion: Understanding of ankle fractures has progressed. A significant proportion of responders to the survey are not following best practice and current literature. Posterior malleolus fractures are not benign and have poorer outcomes compared to bi-malleolar or lateral malleolus ankle fractures. All patients with posterior malleolus fractures should receive pre-operative CT scan. All posterior malleolar fractures that can be held with a plate or screws should be fixed.
Level of evidence: Level 5


There are at least 2.7 million individuals in the United States, most of them in their 40s and 50s, who are chronically infected with hepatitis C virus (HCV). As these infected individuals get older, about 20% will develop cirrhosis, and a significant fraction of those with cirrhosis (about 1 in 10) will then develop serious decompensated liver disease or hepatocellular carcinoma. Currently, HCV is the primary cause of death in 8000 to 12 000 people every year; the virus is also the primary reason for liver transplantation in the United States. Although the number of new cases of HCV infection has been dropping steadily since the introduction of improved blood-supply screening, the "age wave" of existing chronic HCV in baby boomers is expected to contribute to a substantial rise in morbidity, mortality, and costs over the next 2 decades. Although it is difficult to predict which HCV-infected patients will progress to serious liver disease, the availability of a combination drug regimen (peginterferon alfa plus ribavirin) that essentially "cures" the disease in more than half of treated patients now provides clinicians and pharmacists in managed care settings with the tools needed to diminish the impact of the anticipated wave of liver disease. This article reviews the epidemiology, natural history, clinical and economic burden, and screening and treatment options for HCV.


Resistance to organizational change as a facet of psychological resistance of an individual is a widespread phenomenon through which countries, organizations and individuals suffer significant losses. The increasing amount of articles and scientific papers researching the phenomenon of change resistance published for the past 50 year serves as an indicator that the problem of people resisting the implementation of change has not yet been fully studied. Yet the relevance of the issue is far from decreasing as companies keep sustaining considerable losses with the desired changes failing to be implemented as suggested by multiple studies. We believe there is an insufficiently researched aspect of this issue. The purpose of the article is to establish a clear connection between resistance to organizational change and psychological resistance. We believe that such a connection attesting to change resistance being a psychological phenomenon will shift the focus of future research from the organizational or managerial standpoint to viewing change resistance in a psychological dimension. A thorough analysis of previously conducted studies serves as a basis for revealing commonalities between the reason for change resistance and psychological resistance. A chart representing own classification of the reasons for change resistance and psychological resistance illustrating the similarities of the two phenomena can be found in the article. The present study further explores the connections of various strengths that can be seen between the two phenomena and proposes a summary spreadsheet demonstrating the research findings. The article concluded a comparative classification of the reasons for PR and RC appearance, it was stated the connections differ in terms of strengths and permanence.


In this paper, with the milling processing of aluminum-alloy thin-walled parts as the research object, using software AdvantEdge, a milling simulation model is developed to study milling parameters affect on the cutting force, heat and catenation. It is found that by adjusting the ratio of milling parameters, the effects of cutting forces and heat can turn to the favorable direction of workpiece. In addition, we combine numerical simulation with experiments to explore the law of optimization of process parameters. It is discovered that the method of improving the milling speed and reducing the cutting depth properly can ensure the milling efficiency and the quality of the workpiece, providing a scientific insight for achieving high-quality, low-cost and efficient thin-walled parts manufacturing.


As most urologists know, new federal standards have been established to ensure the privacy of patients' health information as part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. In my September 2002 article, I presented limited information on HIPAA and its impact on physicians' practices, including the standards for the electronic transmission of health care transactions and the rules associated with implementation.


Chronic spinal cord injury (SCI) causes major disruption of ejaculatory function in men. Ejaculation is a reflex and the spinal generator for ejaculatory reflexes in the rat has been located in the lumbosacral spinal cord. The effects of SCI on the rat spinal ejaculation generator and ejaculatory reflexes remain understudied. The first goal of the current study was to establish the effects of chronic SCI on the function of the spinal ejaculation generator. Male rats received a contusion injury of the spinal cord at spinal level T6–T7. Ejaculatory reflexes elicited by electrical stimulation of the dorsal penile nerve (DPN) were evaluated in injured and control rats at 4–6 weeks following SCI. SCI males demonstrated significant reductions in bursting of the bulbocavernosus muscle (BCM), an indicator for expulsion phase of ejaculation, and in seminal vesicle pressure (SVP) increases, an indicator for the emission phase of ejaculation, following DPN stimulation. Thus, contusion SCI resulted in long-term impairment of ejaculatory reflexes.The D3 agonist 7-hydroxy-2-(di-N-propylamino) tetralin (7OHDPAT) facilitates ejaculation in spinal cord intact rats, thus the second goal of the current study was to test whether subcutaneous infusions of 7OHDPAT can facilitate ejaculatory reflexes in rats with chronic SCI. Male rats received a contusion injury at T6–T7 and effects of systemic administration of 7OHDPAT (1 mg/kg) were tested 4–5 weeks following injury. Results showed that 7OHDPAT administration facilitated ejaculatory reflexes in SCI males with or without DPN stimulation, provided that supraspinal inputs to the lumbar cord were severed by transection just prior to evaluating the reflex. Thus, 7OHDPAT administration in SCI males was able to overcome the detrimental effects of SCI on ejaculatory reflexes.


Reinforcement learning (RL) has demonstrated promising results in transferring learned policies from simulation to real-world environments. However, inconsistencies and discrepancies between the two environments cause a negative transfer. The phenomenon is commonly known as the "reality gap." The reality gap prevents learned policies from generalizing to the physical environment. This paper aims to evaluate techniques to improve sim2real learning and bridge the reality gap using RL. For this research, a 3-DOF Stewart Platform was built virtually and physically. The goal of the platform was to guide and balance the marble towards the center of the Stewart platform. Custom API was created to induce noise, manipulate in-game physics, dynamics, and lighting conditions, and perform domain randomization to improve generalization. Two RL algorithms; Q-Learning and Actor-Critic were implemented to train the agent and to evaluate the performance in bridging the reality gap. This paper outlines the techniques utilized to create noise, domain randomization, perform training, results, and observations. Overall, the obtained results show the effectiveness of domain randomization and inducing noise during the agents' learning process. Additionally, the findings provide valuable insights into implementing sim2real RL algorithms to bridge the reality gap.


Although interpersonal violence, such as stalking, is prevalent among college students, the factors that predict and contribute to a culture of campus violence are still obscure. Parallel to the established link between rape myth acceptance and rape perpetration, research has emphasized the ways in which stalking myth acceptance, societal attitudes, and false beliefs about stalking, normalize and perpetuate its occurrence (Lippman, 2015; McKeon, McEwan, & Leubbers, 2015). To further understand this dynamic, we examined the relationship between demographic variables, stalking myth acceptance (SMA), and stalking perpetration (SP) in a convenience sample of college students. Statistical analyses indicated that gender and sexual orientation were significant predictors of SMA. Moreover, SMA, gender, and sexual orientation significantly predicted SP. A better understanding of the relationship between demographic variables, attitudes, and stalking perpetration illuminates the need for targeted efforts to change social norms that have traditionally normalized and perpetuated campus violence.


Soil degradation is a major threat for farmers of semi-arid north-central Namibia. Soil conservation practices can be promoted by the development of soil quality (SQ) evaluation toolboxes that provide ways to evaluate soil degradation. However, such toolboxes must be adapted to local conditions to reach farmers. Based on qualitative (interviews and soil descriptions) and quantitative (laboratory analyses) data, we developed a set of SQ indicators relevant for our study area that integrates farmers' field experiences (FFEs) and technical knowledge. We suggest using participatory mapping to delineate soil units (Oshikwanyama soil units, KwSUs) based on FFEs, which highlight mostly soil properties that integrate long-term productivity and soil hydrological characteristics (i.e. internal SQ). The actual SQ evaluation of a location depends on the KwSU described and is thereafter assessed by field soil texture (i.e. chemical fertility potential) and by soil colour shade (i.e. SOC status). This three-level information aims to reveal SQ improvement potential by comparing, for any location, (a) estimated clay content against median clay content (specific to KwSU) and (b) soil organic status against calculated optimal values (depends on clay content). The combination of farmers' and technical assessment cumulates advantages of both systems of knowledge, namely the integrated long-term knowledge of the farmers and a shortand medium-term SQ status assessment. The toolbox is a suggestion for evaluating SQ and aims to help farmers, rural development planners and researchers from all fields of studies understanding SQ issues in north-central Namibia. This suggested SQ toolbox is adapted to a restricted area of north-central Namibia, but similar tools could be developed in most areas where small-scale agriculture prevails.


There are often large gaps between providing information on legal rights and the actual use of that information in women's daily lives. Clinical psychologists from the Arab Renaissance for Democracy and Development - Legal Aid devised joint psychosocial legal awareness training sessions to empower women through culturally sensitive assertiveness skills training, so they could make better practical use of legal rights information. Training of trainers sessions were held with Family Guidance Awareness Center lawyers and social workers, who conducted an anecdotal study with women from the community of Zarqa, Jordan to verify two different methods. The first method involved conducting both legal awareness and a psychosocial session on the same day. The second method, utilised modules, both legal and psychosocial, spread over the course of two days. Quotes from participants strongly suggest that women are able to make better use of legal information if provided with a supportive, skills based psychosocial session as an adjunct, it also suggested that it is likely that longer information and longer psychosocial training sessions (method 2) result in the best outcomes, so long as there is a sufficient break between sessions to overcome fatigue. However, before more widespread implementation of these methods, we recommend more longitudinal research, specifically focused on testing for unintended negative consequences, seeing how well changes can be generalised to fit into women's everyday lives, and how well they last over time.


Current literature suggests that physical educators play a critical role in creating a classroom environment that intrinsically motivates learners to be physically active. According to Self-Determination Theory (SDT), this can be achieved through meeting learners' basic psychological needs (BPNs; i.e., autonomy, competency, and relatedness). As these needs are met, it is more likely learners will intrinsically regulate their desire to be physically active. SDT psychological needs, constructs, associated pedagogical practices, and their relations to motivational regulations have been studied extensively in primary and secondary physical education (PE) settings. However, minimal research has been conducted to analyze these relationships in university settings. Therefore, the purpose of this study was to describe university basic instruction program (BIP) instructors' planning and teaching practices associated with student BPNs in their lessons. Specifically, the research questions were (a) What are university students' perceptions of autonomy, competency, and relatedness at the beginning and end of a BIP course and (b) What teaching practices appear to facilitate BPNs for these university students? This study utilized a mixed methods design to describe students' BPNs and motivational regulations (e.g., amotivation, extrinsic, and intrinsic motivation) as they participated in two BIP courses. Participants for this research were two BIP instructors and their students in a conditioning and beginning swimming course, respectively, taught during a summer session at a major university in the Southeastern United States. Motivational regulations were assessed using a modified version of the Perceived Locus of Causality Scale and BPNs using a modified Basic Psychological Needs Scale. Additionally, teaching strategies consistent with enhancing self-determined motivation were examined using field observation and instructor and student interviews. Quantitative data were analyzed using means and standard deviations and qualitative data using inductive analysis and constant comparison. Qualitative data analysis revealed several themes surrounding student BPNs: these included integrating BPNs, linking self-determined motivation and constructivism, intentional interaction, and the desire to be valued. Instructional implications and future researcher recommendations were detailed.


Associations between psychopathology and poor sleep have been well established by previous research. This has been motivated by the drive to uncover and undo pathology.
An alternative approach offered by positive psychology considers whether those who have good sleep quality (SQ) show high levels of subjective well-being (SWB). Evidence is
limited, but recent findings have linked good sleep with constructs that are central to SWB, including trait gratitude; how orientated people are to the positive things around them.

Aims:
The main aim of this thesis is to examine the effect of a gratitude intervention on SQ. A secondary aim is to explore the relationships between SQ, SWB and pre-sleep cognitions.

Design:
A total of 300 participants took part in the cross-sectional study. These were classified as having high (n = 138) and low SQ (n = 162) according to the Sleep Impairment Index (SII). Groups were compared on measures of Satisfaction With Life (SWLS), gratitude (GQ-6) and pre-sleep cognitions (SST:60). Hypotheses were guided by
the one piece of research that has previously explored these constructs. Individuals with low SQ were then invited to participate in a novel intervention study (N = 51). Participants were randomized into a self-guided Three Good Things in Life gratitude intervention (n = 25) or events listing control intervention condition (n = 26) that ran across 7 days. Repeated measures analysis of variance was used to assess change in SQ and pre-sleep cognitions between baseline and follow-up. Hierarchical linear modelling (HLM) was used to explore daily measurements of sleep and affect.

Results:
Results supported previous work in finding positive relationships between high SQ and measures of SWB, including
trait gratitude. Those completing the gratitude intervention reported significantly improved SQ according to the Pittsburgh Sleep Quality Index (PSQI), compared to the control condition. A higher proportion of participants in the gratitude intervention fell on or below the clinical threshold of >5 on the PSQI after the intervention (n = 11), compared to those in the control intervention condition (n = 3). The effect of intervention on presleep
cognitions between baseline and follow-up was approaching significance. No significant mediational influences were found using HLM. Conclusions: This research demonstrates the relationship between SWB and gratitude in relation to SQ and the outcome of the intervention suggests that it could be employed to improve public health in relation to sleep.