Background: Insomnia is one of the most common problems in dialysis patients, and likely to contribute impairment in quality of life, which has a positive correlation with patients' survival. In diabetic patients, morbidity and mortality are substantially higher than in the nondiabetic counterparts, and also the incidence of sleep disturbances. However, there is no means to predict sleep disturbance in the dialysis patients especially in diabetics. To define the prevalence and risk factors for insomnia in diabetic patients on hemodialysis, we undertook a cross-sectional multicenter study. Methods: Eighty-two diabetic patients (50 men/32 women, aged 58.7 ± 9.23 years) on maintenance hemodialysis for more than 6 months from 12 different hospitals were enrolled. The demographic data, subjective symptoms, depression scale, and insomnia were assessed by questionnaires, and lean body mass, BMI, Kt/V, subjective global assessment, nursing assessment score (NAS), and biochemical parameters were examined. Results: The number of patients with and without insomnia were 56 and 26, respectively, which amounted to 68.2% for insomnia. NAS (28.1 ± 3.81 vs. 30.8 ± 2.88, p = 0.002), serum albumin concentration (3.82 ± 0.44 vs. 4.09 ± 0.36 g/dl, p = 0.008), and depression scale (25.2 ± 12.1 vs. 18.9 ± 10.3, p = 0.025) were significantly different between them. Patients with insomnia were older (60.5 ± 9.0 vs. 56. 1 ± 9.60 years, p = 0.053) and felt pain (38.5 vs. 15.3%, p = 0.06) more frequently than those without insomnia. The scale of depression was correlated with NAS (r = –0.455, p < 0.001) and the serum albumin concentration was correlated with NAS (r = 0.337, p = 0.002). NAS, age, and serum albumin concentration were the major risk factors for insomnia in logistic regression analysis. Conclusion: The prevalence of insomnia in diabetic hemodialysis patients was 68.2%. Age, nutritional status, and depression were the major risk factors for sleep disturbance in diabetic patients.


Background Noninvasive physical management is often prescribed for headache and neck pain. Systematic reviews, however, indicate that the evidence of its efficacy is limited. Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing headache and neck/shoulder pain. Methodology/Principal Findings Cluster-randomized controlled trial. All municipal workers of the City of Turin, Italy, were invited to participate. Those who agreed were randomly assigned, according to their departments, to the intervention group (IG) or to the control group and were given diaries for the daily recording of pain episodes for 1 month (baseline). Subsequently, only the IG (119 departments, 923 workers) began the physical and educational program, whereas the control group (117 departments, 990 workers) did not receive any intervention. All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention. The primary outcome was the change in the frequency of headache (expressed as the proportion of subjects with a ≥50% reduction of frequency; responder rate); among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain. Differences between the two groups were evaluated using mixed-effect regression models. The IG showed a higher responder rate [risk ratio, 95% confidence interval (CI)] for headache (1.58; 1.28 to 1.92) and for neck/shoulder pain (1.53; 1.27 to 1.82), and a larger reduction of the days per month (95% CI) with headache (−1.72; −2.40 to −1.04) and with neck/shoulder pain (−2.51; −3.56 to −1.47). Conclusions The program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary-care settings. Further trials are needed to investigate the program effectiveness in a clinical setting, for highly selected patients suffering from specific headache types. Trial Registration ClinicalTrials.gov NCT00551980


We have discovered four X-ray bursts, recorded with the Rossi X-ray Timing Explorer Proportional Counter Array between 2003 September and 2004 April, that we show to originate from the transient magnetar candidate XTE J1810-197. The burst morphologies consist of a short spike or multiple spikes lasting ~1 s each, followed by extended tails of emission where the pulsed flux from XTE J1810-197 is significantly higher. The burst spikes are likely correlated with the pulse maxima, having a chance probability of a random phase distribution of 0.4%. The burst spectra are best fitted to a blackbody with temperatures 4-8 keV, considerably harder than the persistent X-ray emission. During the X-ray tails following these bursts, the temperature rapidly cools as the flux declines, maintaining a constant emitting radius after the initial burst peak. During the brightest X-ray tail, we detect a narrow emission line at 12.6 keV, with an equivalent width of 1.4 keV and a probability of chance occurrence of less than 4 × 10-6. The temporal and spectral characteristics of these bursts closely resemble the bursts seen from 1E 1048.1-5937 and a subset of the bursts detected from 1E 2259+586, thus establishing XTE J1810-197 as a magnetar candidate. The bursts detected from these three objects are sufficiently similar to one another, yet significantly different from those seen from soft gamma repeaters, that they likely represent a new class of bursts from magnetar candidates exclusive (thus far) to the anomalous X-ray pulsar-like sources.


A detailed investigation was carried out to clarify the macrocell and microcell corrosion of horizontally oriented steel bars in concrete. To find an effective way to control corrosion of horizontal bars in concrete, three alternatives, such as the application of a cement paste coat over the steel bars, revibration, and the use of expansive admixture were studied. For this, prism specimens 200 mm in length, 150 mm in width, and 500 mm in depth were made with steel bars at three horizontal levels at 100, 250, and 400 mm from the bottom. The specimens were exposed to artificially-created wetting and drying cycles using natural seawater. Electrochemical and physical evaluations of corrosion, chloride ingress, and SEM investigation on the steel-concrete interfaces were carried out. A porous steel-concrete interface under the bottom half of the steel bar was found. The weaker interface caused early corrosion under the bottom half of the steel bar. Generally, the macro-corrosion cell is formed between the top half (anode) and bottom half (cathode) of the steel bar. A significant amount of micmcell corrosion was found over the bottom half. The application of a cement paste coat over the steel bars before embedding into concrete was found to be an effective way to delay early corrosion under the bottom half of the steel bars. The use of an expansive admixture was also found as another alternative. No improvement of steel-concrete interface was obtained by revibration; revibration creates more corrosion over the steel bars.


The present study aimed at development of planned teaching program for assessing the knowledge of 80 staff nurses in S.S.S.B. Govt. Satellite and Late Sh. Khemraj Katara Govt. Satellite Hospital at Udaipur city, Rajasthan. The method adopted for the present study was evaluative approach, this would help the investigator to evaluate the effect of specific intervention that is "Planned teaching program" on the variable that is "Knowledge" of staff nurses regarding prevention and treatment of Multi drug resistant and Extensively drug resistant TB in selected health centers of Udaipur district, Rajasthan. In this study samples were drawn by using simple random technique method. Data was collected by using structured knowledge questionnaire. From the findings of the study it was found that the pre-test mean knowledge score was 16.66, post-test mean knowledge score was 23.96. The significance of the findings was obtained by using paired "t" test the value of pre-test and post-test of knowledge was 24.48 (P1 is accepted that there is a significant difference between pre-test and post-test of knowledge score. There is a significant association between pre-test knowledge score with selected socio demographic variables such as age in years, gender, religion, marital status, area of residence, educational qualification, working experience and source of information were significant at 0.05 level. Hence, research hypothesis H2 is accepted. The study concluded that there was improvement in the level of knowledge of staff nurses which indicated that the planned teaching programme was effective. The demographic variables of staff nurses significantly associated with the pre-test knowledge score. This will helps the staff nurses to enhance their knowledge.

Keywords: Knowledge, Planned teaching programme, Staff nurse.


This paper presents a novel power conditioning unit (PCU) for variable-speed micro wind turbine applications. It contains a simple generator-side rectifier, galvanic isolation with a simple dc–dc converter, and a single-phase full-bridge inverter at the grid side. Variable-speed micro wind turbines based on a permanent magnet synchronous generator (PMSG) are increasingly used in residential and small commercial buildings, despite their relatively low output voltage. Therefore, they can be used easily for battery charging, while their grid integration requires a PCU with galvanic isolation. Most of available PCUs provide no galvanic isolation, or use relatively complicated topologies or four stage energy conversion for that purpose. The dc–dc converter proposed allows reducing the complexity of the PCU. Steady-state analysis shows that the converter is capable of regulating voltage in a wide range suitable for micro wind turbines, which is supported by experimental results within the input voltage range of 40–400 V. The prototype built for integration of a 1.3-kW PMSG-based micro wind turbine shows good performance over the entire 1:5 range of the given wind turbine output voltage. A study of efficiency and power losses was conducted according to the wind turbine power profile.


ABSTRACT
 The COP-26 United Nations Climate Change meeting, scheduled to be held in Glasgow in 2021, is an important step in the world's attempt to deal with the climate emergency arising from increasing greenhouse gas emissions. Here we look at how society has responded to the Covid-19 emergency and compare it with the response to the climate change emergency, the latter based on our experience of a Royal Society of Edinburgh Inquiry on climate change published nearly ten years ago (RSE, 2011). With reference to Covid-19, civil society's response to the lockdown showed the power of clear political leadership and also the willingness of people to work together. On the negative side, the UK national test and trace system struggled because of a disconnect between national and regional activities. In our climate change report, we identified similar organisational barriers that were impeding a move towards a low-carbon future, especially the lack of responsibilities and powers at a city regional scale. If Scotland is to reduce emissions seriously, the focus needs to be on transport (30% of emissions), heating and agriculture. Without more responsibility and power at a city regional scale, Scotland will not achieve its emissions targets.


Pain following intracranial surgery has historically been undertreated because of the concern that opioids, the analgesics most commonly used to treat moderate‐to‐severe pain, will interfere with the neurologic examination and adversely affect postoperative outcome. Over the past decade, accumulating evidence, primarily in adult patients, has revealed that moderate‐to‐severe pain is common in neurosurgical patients following surgery. Using the neurophysiology of pain as a blueprint, we have highlighted some of the drugs and drug families used in multimodal pain management. This analgesic method minimizes opioid‐induced adverse side effects by maximizing pain control with smaller doses of opioids supplemented with neural blockade and nonopioid analgesics, such nonsteroidal antiinflammatory drugs, local anesthetics, corticosteroids, N‐methyl‐D‐aspartate (NMDA) antagonists, α2‐adrenergic agonists, and/or anticonvulsants (gabapentin and pregabalin).


Beyond the first posttransplant year, 3% of kidney transplants fail annually. In a prospective, multicenter cohort study, we tested the relative impact of early versus late events on risk of long‐term death‐censored graft failure (DCGF). In grafts surviving at least 90 days, early events (acute rejection [AR] and delayed graft function [DGF] before day 90) were recorded; serum creatinine (Cr) at day 90 was defined as baseline. Thereafter, a 25% rise in serum Cr or new‐onset proteinuria triggered graft biopsy (index biopsy, IBx), allowing comparison of risk of DCGF associated with early events (AR, DGF, baseline serum Cr >2.0 mg/dL) to that associated with later events (IBx). Among 3678 patients followed for 4.7 ± 1.9 years, 753 (20%) had IBx at a median of 15.3 months posttransplant. Early AR (HR = 1.77, P < .001) and elevated Cr at Day 90 (HR = 2.56, P < .0001) were associated with increased risk of DCGF; however, later‐onset dysfunction requiring IBx had far greater impact (HR = 13.8, P < .0001). At 90 days, neither clinical characteristics nor early events distinguished those who subsequently did or did not undergo IBx or suffer DCGF. To improve long‐term kidney allograft survival, management paradigms should promote prompt diagnosis and treatment of both early and later events.


This thesis presents an original approach for the concentration of thermo-sensitive solutions: the Sweep Gas Membrane Distillation (SGMD) process. A new membrane contactor with metallic hollow fibers has been designed and allows the distillation process to be operational at low temperature. Heat is generated in the fibers by the Joule effect, rather than being supplied as latent heat in the liquid bulk. The localized generation of heat results in a reduction of temperature polarization phenomena. The stainless-steel hollow fiber membranes have been synthetized with appropriate structural properties and sufficient mechanical strength. The pore surface of the fibers has been made hydrophobic by the deposition of a thin layer of an elastomer. Moreover, a novel and green method is presented to fabricate alumina and stainless-steel hollow fibers. This method is based on ionic gelation of a biopolymer and completely avoids the use of harmful solvents. By a detailed experimental study of the SGMD the influence of different operational parameters on the process performance has been investigated. The improvements in the flux and the separation efficiency using Joule effect have been successfully demonstrated, even in the case of pervaporation.


Client-side project managers face challenges in motivating project organisations to pursue exceptional design and construction performance. One approach to improving the motivation of project organisations is by offering a financial incentive reward for the achievement of voluntary performance standards above the minimum required standard. However, little investigation has been undertaken into the features of a successful incentive system as a part of an overall procurement strategy. In response to a lack of information available to client-side project managers tasked with the initial design of an incentive system, the paper explores motivation under a successful incentive and identifies key learnings for client-side project managers to consider when designing incentives. Our findings are based on the results of a large Australian case study which is interpreted against a conceptual framework based on both economic and psychological perspectives of motivation. The results suggest that motivation towards incentive goals is influenced by the value the project organisations place on the incentive reward as a commercial opportunity to increase their profit margins. However, perhaps more important are the relationship management processes that promote commitment to the project; and pride in the achievement of project goals. In the case study, these processes intensified the direct motivational effect of the incentive reward on offer. The findings also highlight the importance of ensuring that incentive goals and performance measurement processes remain relevant to the organisations throughout a project to continuously encourage motivation under changing project conditions.


Primary cilia are microtubule-based organelles projecting from most epithelial cells in vertebrates, with numerous essential roles in chemo- and mechanosensation. A suite of inherited human conditions are caused by defects in the structure or function of primary cilia, and the study of these so-called 'ciliopathies' offers an insight into the roles of cilia in normal development and disease.
Meckel-Gruber syndrome (MKS) is the most severe ciliopathy, an embryonic lethal condition affecting multiple organ systems. At the opposite end of the ciliopathy phenotypic spectrum, Leber's Congenital Amaurosis (LCA) type 5 is a ciliopathy with a phenotype restricted to the retina. These conditions provide excellent models to study the importance of cilia. The work in this project aims to elucidate the function of the primary cilium, by studying the molecular genetics of these ciliopathies, using a candidate gene approach, and by studying the proteins mutated in these diseases.
Genetic screening identifies C2CD3 as a possible modifier of multi-organ ciliopathies, and suggests that LCA5 is only involved in retinal ciliopathies. Functional work focuses on three poorly-understood ciliopathy proteins: lebercilin, mutated in LCA; and meckelin and MKS1, mutated in MKS. Live-cell imaging and interaction assays suggest a role for lebercilin in bidirectional intraflagellar transport (IFT). Meckelin is shown to interact with nesprin-2, a nuclear scaffold protein, with potential impacts on basal body positioning and non-canonical Wnt signalling. Studies of MKS1 clearly suggest that defects in the interaction between cilia proteins and the proteasome are associated with deregulation of Wnt signalling, which is causative of the ciliopathy disease state.
This work will give insights into gene function and molecular mechanism of disease in complex genetic conditions. The understanding of ciliopathies at the molecular level may result in new therapeutic interventions for such conditions to modify disease progression.


Adolescent stressors coupled with environmental demands, such as pressures to achieve, might lead to negative outcomes for some students. Students who worry about their ability to meet high standards might be more at risk of internalizing problems. The current study investigated the relations among perfectionism, social support, and internalizing problems of middle school students (N = 169). Research has established perfectionism as having maladaptive and adaptive traits. Regression analyses indicated that maladaptive perfectionism was positively related, while adaptive perfectionism was negatively related, to anxiety and depression. Adaptive perfectionists reported significantly higher levels of teacher support than maladaptive perfectionists and nonperfectionists and higher levels of classmate support than nonperfectionists. In addition, classmate support for girls and boys, and teacher support for boys, were found to buffer the relation between maladaptive perfectionism and anxiety and depression. Future research should examine social support and perfectionism and how to best provide support to maladaptive perfectionists.


In this work, a study of hepatocellular carcinoma and normal livers in rats using nuclear magnetic resonance (NMR) based on superconducting quantum interference devices (SQUIDs) was presented. The time domain free induction decay signals, Sy(t), of cancerous liver tissue and control liver tissue of rats were measured to study the respective longitudinal relaxation rate T1-1 . The NMR data were fitted to [1-exp(-TBp/T1)] to derive the longitudinal relaxation times T1 for cancerous liver tissue and control liver tissue. It is found that T1, cancer of cancerous liver tissues is 2.3 times higher than T1, control of control liver tissues. Statistically the data suggest that T1, cancer/T1, control can be used to discriminate cancerous liver tissue from control tissue. Furthermore, differentiating cancerous tissues from control tissues was demonstrated using magnetic fluid phantoms as phantoms for cancerous and control tissues. The SQUID-detected NMR/MRI exhibits potential applications in clinical research.


Divorce has become a key life-course risk that can have significant economic impacts. This article uses a new Australian data source that follows families over a 10-year period to estimate the impact of divorce on income and assets. There have been few longitudinal studies of the impact of divorce on assets and relatively few such studies of its impact on income. The article finds that divorce has a substantial negative impact upon the household income of women in the short term, but by 6 years after divorce income had largely recovered to what it would have been had they remained married. In contrast, men who divorce experience a substantially faster rate of increase in income post-divorce than had they remain married. The analysis of asset data reveals that while the gap between the value of assets of the divorced and non-divorced grows post-divorce, it appears that the growing disparity in assets largely reflects pre-divorce differences in assets. The results in this article clearly demonstrate the critical importance of using longitudinal data to estimate the economic and labour market consequences of divorce. While the economic effects of divorce on Australian women appear to be, on average, relatively short-run, the Australian social security system plays a crucial role in protecting the incomes of women post-divorce, particularly those with children.


The first version of a European spatial development perspective (ESDP) approved by the informal conference of ministers for regional policy and planning in June 1997 includes a proposal for a new "system of indicators". The purpose of this system of indicators is to form the basis for a typology of European regions and for a set of scenarios on the future development of the European space. The need to improve the present standards of spatial analysis within the European Union is clearly demonstrated by the ESDP. Nevertheless, the indicators proposed in the document (geographical location, economic potential, social and spatial integration, land use intensity among others) represent only vague descriptions of spatial characteristics somehow relevant for regional development. Important questions still remain: How could these characteristics be defined in a feasible operational way? Which regional level is most appropriate for this kind of analysis? Is it at all possible to provide the required data for these spatial units? In general, European regional policy as actually applied in the context of the Structural Funds indicates quite different trends: the delineation of promotion areas, especially objective 2 areas and objective 5b areas, is partly based on qualitative criteria; as a consequence, the process of application for regional aid is open to interpretation of these criteria by national and regional governments. According to the principle of subsidiarity, this could be regarded as a positive factor of decision making. On the other hand, the number of promotion areas and programmes seems to expand beyond the EU's possibility to finance them. Therefore the reform of the Structural Funds will have to define new criteria capable of evaluating the need for EU assistance among European regions on a common basis, which must at the same time be able to reflect specific regional characteristics and development potential. The paper gives an overview of the need for and the framework of a new system of indicators.


A novel and generic sol–gel method has been developed for the production of high purity metal oxide nanopowders using sodium alginate. This has been demonstrated successfully employing nickel oxide (NiO) as a model material in this instance. The results of this investigation indicate that the final particle size of ~20 nm can be obtained after calcination of the predried beads at 500°C for 3 h in ambient air. An insight into the calcination process has been obtained using simultaneous thermo-gravimetric analysis and differential scanning calorimetry (TGA/DSC) and high temperature X-ray diffraction (HT-XRD). Powder X-ray diffraction (XRD) confirms that the obtained samples are single phase cubic NiO powders with no trace of impurity. During the phase transformation, NiO + NiO2 have been found to coexist between 250°C and 350°C and a reaction scheme is proposed to account for this. The mean crystallite sizes calculated from XRD analysis using Rietveld refinement method is in good agreement with the morphological features observed using transmission electron microscopy (TEM). The NiO nanopowders produced in this study exhibit negligible strain as indicated using Rietveld refinement procedure. The XRD and TEM analyses indicate that there is a significant influence of calcination temperature and time on the particle size, which increases with increasing temperature and annealing time. This new sol–gel method is a simple, environmentally friendly, and nontoxic route for a large scale production of high purity single phase nanopowders in a cost-effective manner at significantly low temperatures. The process described in this study can yield 200 kg of NiO nanopowders per ton of dried Ni-ALG beads.


We consider the resonant system of amplitude equations for the conformally invariant cubic wave equation on the three-sphere. Using the local bifurcation theory, we characterize all stationary states that bifurcate from the first two eigenmodes. Thanks to the variational formulation of the resonant system and energy conservation, we also determine variational characterization and stability of the bifurcating states. For the lowest eigenmode, we obtain two orbitally stable families of the bifurcating stationary states: one is a constrained maximizer of energy and the other one is a constrained minimizer of the energy, where the constraints are due to other conserved quantities of the resonant system. For the second eigenmode, we obtain two constrained minimizers of the energy, which are also orbitally stable in the time evolution. All other bifurcating states are saddle points of energy under these constraints and their stability in the time evolution is unknown.


For thousands of years, people living in Egypt, China, Greece, Rome, and other parts of the world have been fascinated by shooting stars, which are the light and sound phenomena commonly associated with meteorite impacts. The earliest written record of a meteorite fall is logged by Chinese chroniclers in 687 bce. However, centuries before that, Egyptians had been using "heavenly iron" to make their first iron tools, including a dagger found in King Tutankhamun's tomb that dates back to the 14th century bce. Even though human beings have a long history of observing meteors and utilizing meteorites, we did not start to recognize their true celestial origin until the Age of Enlightenment. In 1794 German physicist and musician Ernst Chladni was the first to summarize the scientific evidence and to demonstrate that these unique objects are indeed from outside of the Earth. After more than two centuries of joint efforts by countless keen amateur, academic, institutional, and commercial collectors, more than 60,000 meteorites have been catalogued and classified in the Meteoritical Bulletin Database. This number is continually growing, and meteorites are found all over the world, especially in dry and sparsely populated regions such as Antarctica and the Sahara Desert. Although there are thousands of individual meteorites, they can be handily classified into three broad groups by simple examinations of the specimens. The most common type is stony meteorite, which is made of mostly silicate rocks. Iron meteorites are the easiest to be preserved for thousands (or even millions) of years on the Earth's surface environments, and they are composed of iron and nickel metals. The stony-irons contain roughly the same amount of metals and silicates, and these spectacular meteorites are the favorites of many collectors and museums.
 After 200 years, meteoritics (the science of meteorites) has grown out of its infancy and become a vibrant area of research today. The general directions of meteoritic studies are: (1) mineralogy, identifying new minerals or mineral phases that rarely or seldom found on the Earth; (2) petrology, studying the igneous and aqueous textures that give meteorites unique appearances, and providing information about geologic processes on the bodies upon which the meteorites originates; (3) geochemistry, characterizing their major, trace elemental, and isotopic compositions, and conducting interplanetary comparisons; and (4) chronology, dating the ages of the initial crystallization and later on impacting disturbances. Meteorites are the only extraterrestrial samples other than Apollo lunar rocks and Hayabusa asteroid samples that we can directly analyze in laboratories. Through the studies of meteorites, we have quested a vast amount of knowledge about the origin of the Solar System, the nature of the molecular cloud, the solar nebula, the nascent Sun and its planetary bodies including the Earth and its Moon, Mars, and many asteroids. In fact, the 4.6-billion-year age of the whole Solar System is solely defined by the oldest age dated in meteorites, which marked the beginning of everything we appreciate today.


Serum N-glycans are promising biomarkers for systemic disease states. Better understanding of the serum N-glycome of patients with resectable periampullary adenocarcinoma may identify novel prognostic markers for this disease. Serum N-glycans in 70 patients with resectable periampullary adenocarcinoma, 15 patients with benign periampullary tumor, and 129 healthy individuals were quantified using ultra performance liquid chromatography. High-sensitivity C-reactive protein (hsCRP) was analyzed for all samples using an immunoturbidimetric method. The N-glycome was compared to clinical and histopathological data, and to the acute phase response as measured by hsCRP. Whole-genome tumor tissue mRNA expression data were used for correlation and enrichment analysis to investigate underlying biological processes giving rise to changes in the serum N-glycome. Significant changes were found in the serum N-glycome of patients with periampullary adenocarcinoma (n = 70) compared to healthy individuals (n = 129). No significant differences were found between patients with benign (n = 15) and malignant periampullary tumors (n = 70). Many alterations in the N-glycome correlated with systemic acute phase response as measured by hsCRP. Enrichment analysis indicated that immunologic pathways of the cancer microenvironment correlate with specific features of the serum N-glycome. Certain glycans were associated with poor overall and disease free survival in patients with pancreatobiliary type of periampullary adenocarcinoma. Our study supports the hypothesis that certain factors secreted by the tumor affect liver and plasma cells to orchestrate the changes in the serum N-glycome observed. The serum N-glycome could potentially reflect modified phenotypes of the host and/or tumor microenvironment. The prognostic impact of the serum N-glycome should be evaluated in larger, prospective studies.


Abstract. As the ability to make predictions regarding uncertainty information
representing natural hazards increases, an important question for those
designing and communicating hazard forecasts is how visualizations of
uncertainty influence understanding amongst the intended, potentially
varied, target audiences. End-users have a wide range of differing expertise
and backgrounds, possibly influencing the decision-making process they
undertake for a given forecast presentation. Our previous, Part 1 study
(Mulder et al., 2023) examined how the presentation of uncertainty
information influenced end-user decision making. Here, we shift the focus to
examine the decisions and reactions of participants with differing areas of expertise
(meteorology, psychology, and graphic-communication students) when presented
with varied hypothetical forecast representations (boxplot, fan plot, or
spaghetti plot with and without median lines) using the same eye-tracking
methods and experiments. Participants made decisions about a fictional
scenario involving the choices between ships of different sizes in the face
of varying ice thickness forecasts. Eye movements to the graph area and key
and how they changed over time (early, intermediate, and later viewing
periods) were examined. More fixations (maintained gaze on one location)
and more fixation time were spent on the graph and key during early and
intermediate periods of viewing, particularly for boxplots and fan plots.
The inclusion of median lines led to less fixations being made on all graph
types during early and intermediate viewing periods. No difference in eye
movement behaviour was found due to expertise; however, those with greater
expertise were more accurate in their decisions, particularly during more
difficult scenarios. Where scientific producers seek to draw users to the
central estimate, an anchoring line can significantly reduce cognitive load,
leading both experts and non-experts to make more rational decisions. When
asking users to consider extreme scenarios or uncertainty, different prior
expertise can lead to significantly different cognitive loads for processing
information, with an impact on one's ability to make appropriate decisions.


Background: African nations experience a significant proportion of the global burden of death and disability. The provision of prehospital emergency care has been shown to partially reduce excess morbidity and mortality. However, access to prehospital care in Africa is still limited. This study sought to identify barriers to access prehospital care in the city of Jimma, Ethiopia.Methods: This is an interview-based qualitative study of key prehospital stakeholders in Jimma, conducted in February 2018. A purposive sample of individuals from the community and local ambulance organizations was selected for interviews. Interviews were conducted in local languages, translated into English, and then coded for consistent themes. Results: All respondents felt that prehospital care was difficult to access and therefore infrequently utilized. This was due to a combination of a limited number of ambulances, the lack of a toll-free emergency number, the lack of a single organized EMS system, a lack of uniform prehospital care protocols, inconsistent and limited training of ambulance crews, public mistrust of the existing system, poor road infrastructure, and limited public understanding of the role of prehospital care. Respondents suggested that establishment of a formalized prehospital care system, investment in infrastructure, establishment of a toll-free emergency number, public awareness campaigns, and more widely available emergency medical training were feasible solutions to these current barriers to access.Conclusion: Multiple barriers to accessing prehospital care were identified in Jimma. Establishing a formalized, well-resourced prehospital system in parallel with improving community capacity and knowledge building were suggested solutions to improve access. Hence, interventions to improve prehospital emergency care delivery should ideally target these identified barriers and proposed solutions.


Rule breaking in organizations has traditionally been seen as deconstructive actions by
angry or self-interested employees. An emerging research area is seeking to highlight a
type of rule breaking behaviour that may bene t organizations. Some authors label this
type of rule breaking \pro social rule breaking" and it refers to when employees break
rules for such reasons as saving time or money for their company, or preserving customer
relations. Instead of antagonizing the rule breaking employee, the pro-social rule breaking
research area opens up for new perspectives on employees' motivations for breaking
rules. The pro-social rule breaking has contributed to the organizational research area
by acknowledging that rule-breaking behaviour occurs frequently in organizations, and
that employees who break rules are motivated by things other than self-interest.
Organizational rules are created by some part of the organization that perceives itself
as having a better grasp of schedules and constraints than the employees who receive
the rules. Dismissing rule breaking behaviour as isolated actions motivated by selfinterest
leads rule-makers to have an incomplete understanding of how their rules are
interpreted at the receiving end. This is of current importance to the IT industry where
many companies are in the process of transitioning from waterfall to agile methodologies.
This thesis is aimed at contributing to the emerging cause of acknowledging rule-breaking
actions as potentially constructive. The report accounts for a multiple case study with
the purpose of investigating how newcomers to organizations learn how to break rules.
The research purpose made it possible for us to discuss rules, rule-interpretations and
communication of rules and rule-breaking with new employees who had recently been
included in the organization's social constructs.
The study nds that employees most often learn how to break rules through socialization,
and mostly through observing other employees deviating from rules. Rules are in many
cases broken because they are found to be inadequate or even misleading in a certain
situations. Employees are reluctant to changing a rule even if it is frequently broken;
they nd that rules are guiding even if broken.The study also concludes that rule breaking is rarely spoken of in organizations. A rulemaker
cannot teach rule breaking without changing the rule receiver's interpretation
of the rule. The interpretation of the rule controls behaviour in relation to the rule.
This phenomena is attributed to a social mechanism which we label \the interpretation
system". The interpretation system is a part of the norms within a group that tell
members how to interpret rules.
By approaching rule breaking as objective researchers we were able to uncover how
employees interpret rules; information which is normally obscured to the rule-designers
within an organization. This is perhaps the most valuable contribution of this thesis.


A feeding trial was conducted to investigate the effects of dietary graded protein levels on the growth, survival, amylase and trypsin activities of large yellow croaker (Pseudosciaena crocea R.) larvae from 12 to 42 days after hatching (DAH). Five approximately isoenergetic microbound diets (16.65 MJ/kg diet) were formulated to contain different protein (47.1%, 52.0%, 57.1%, 62.2% and 67.5%) levels. Frozen copepods, containing 54.5% crude protein (CP), 6.0% crude lipid, 27.2% ash and 6.7% glycogen, were used as a control. Each diet was randomly fed to triplicate groups of larvae with an initial mean body weight of 1.76 ± 0.09 mg (mean ± SD) in 180 L white plastic tanks, and each tank was stocked initially with 3500 larvae. Both the survival and the specific growth rate (SGR) of large yellow croaker larvae significantly increased with increasing dietary protein level up to 57.1%, and decreased thereafter. Frozen copepods resulted in intermediate survival and low SGR compared with the other diets. Whole-body moisture and protein of larvae were not significantly affected by the dietary protein level. In contrast, whole-body lipid of larvae fed diet with 47.1% CP was significantly higher (P<0.05) than those from fish fed the diets containing more than 57.1% CP. Additionally, fish fed the frozen copepods had the lowest whole-body protein and lipid. The amylase-specific activity increased with increasing dietary carbohydrate level during the period of this experiment. However, trypsin activity was not significantly affected by the dietary protein content before 42 DAH, indicating a later onset of trypsin than amylase in the regulation of enzymatic synthesis induced by a dietary substrate.


It is now widely recognized that asphaltene exist in crude oils both as dissolved and particulate matter and that asphatenic crude oils behave as colloidal systems. The objective of this research work is to check if, in porous media and under dynamic conditions, asphaltene also behave as colloids. In this case, their deposition kinetic should obey the classical laws for colloid deposition in porous media. To achieve this, asphaltene deposition kinetics has been investigated as a function of the main controlling parameters such as flow rate, asphaltene aggregation state, resin content and crude origin. The study has been performed, first under well controlled condition using model fluids and porous media, and then under more representative conditions using actual crude oils and outcrop sandstones. The results confirmed that, indeed, the kinetics of asphaltene deposition in porous media obeys the general scaling low of colloid deposition. They allowed us to propose general scaling laws for the deposition kinetics in the form , η is the capture efficiency and γ the shear rate. The exponents s are universal exponents that are characteristic of the deposition regimes while the power law pre-factors A encompass all the specific features of the system considered (asphaltene and porous media). These kinetic laws show that the thickness of the deposit increases rapidly with decreasing shear rate. Accordingly and under favourable conditions, a thick deposit is expected to form during heavy oil extraction from high permeability formations and under low flow rate conditions. Such deposition could then have significant impact on the efficiency of heavy oil recovery. Therefore, its impact on permeability and on flow properties of reservoir fluids needs to be assessed as a part of process optimisation and evaluation. The Colloidal approach provides a new and promising route for asphaltene deposition and associated permeability damage modelling.


This study presents the heuristic evaluation, as a usability inspection method for Human-Robot Interaction (HRI) systems. First, the methodology to engineer a semi-autonomous agricultural robot sprayer is presented, and then findings from heuristic usability evaluation studies that were carried out on a human-robot interface for a semi-autonomous agricultural vineyard robot sprayer. The following research-based heuristics for the design of robot teleoperation were used: Platform architecture and scalability, Error prevention and recovery, Visual design, Information presentation, Robot state awareness, Interaction effectiveness and efficiency, Robot environment/surroundings awareness, and Cognitive factors. In each evaluation study, usability problems were identified, and specific suggestions were documented for HRI usability improvement. In each design iteration, a smaller number of usability issues were identified.. Results of the final heuristic evaluation showed that the system is at a good level of usability and is expected to provide satisfactory services to its typical users.


For the past five years, staff from the Minnesota Department of Health's Minnesota Climate and Health Program have been studying climate data and the potential health effects of climate change in the state. This year they released the "Minnesota Climate and Health Profile Report 2015," which presents a synthesis of their research. This article summarizes key points from that report.


Measured by its capacity to endure, the Prussian nobility was the most successful in the modern history of continental Europe. Throughout the long vicissitudes of its history, this class--the Junkers--displayed a remarkable ability to adapt to new circumstances and maintain its own political power. Robert Berdahl presents a comprehensive interpretation of the tenacity of the Prussian nobles from the late eighteenth century until the revolution of 1848. At one level, he provides a richly detailed economic, social, and political history: the story of how the landowning nobility coped with changes in rural social relations after the emancipation of the serfs in 1807 and of how it survived the agrarian depression of the 1820s by the development of capitalist agriculture. At another level, he shows how the Junkers developed an ideology of conservatism that justified their control of a society that was becoming increasingly bourgeois.The domination of society by members of the nobility was traditionally supported by their experience in governing landed estates and particularly by the imagery of paternalism. Capitalist agriculture undermined the old landlord-peasant relations, but the nobility continued to exploit paternalistic images of domination.Originally published in 1988.The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.


The carcinogenic effects of microorganisms have been discovered in multiple cancer types. In urology, the development of squamous cell carcinoma of the bladder due to the parasitic infection with Schistosoma Mansoni is widely accepted. The oncogenic potential of biofilms has been studied in colorectal cancer and experimental studies have shown that bacteria such as Escherichia coli drive the development of colorectal cancer. Notably, Escherichia coli is responsible for 80% of all urinary tract infections. Recent findings suggest an altered urinary microbiome in patients with bladder cancer compared to healthy subjects. In this case series, we demonstrate our findings of biofilm formation in human bladder cancer tissue. Tissue samples from ten patients that underwent routine Transurethral Resection of Bladder Tumor (TURBT) were obtained from the Danish National Biobank. Pathological tissue was examined for presence of bacterial aggregates by Fluorescence in situ Hybridization. In two of ten patients, analysis showed abundant bacterial aggregation on the surface epithelium. Both positive cases had pT2 urothelial bladder cancer. Our findings suggest that biofilm occurs in urothelial cancer tissue indicating an association between biofilm formation and bladder cancer.


Objective: We investigate experienced joy of use (JoU) and usability using a multimodal methods approach by systematically varying mobile phone interactions. Methods: We combined subjective and objective measures to investigate whether positive emotional experiences and moments of joy during the interaction can be distinguished from neutral and negative emotional experiences. In a study with 30 participants, electroencephalography (EEG), electrocardiography (ECG), electrodermal activity (EDA), facial emotion recognition, and questionnaires were used. Results: There were greater positive experiences in interactions designed to elicit JoU, even under bad usability. We did not observe a difference between the conditions in the EEG indices. However, a higher heart rate and components in the EDA phasic response as well as facial muscle activity associated with anger were linked to good usability combined with no JoU. Conclusion: The multimodal methods approach reveals great potential to investigate JoU and usability in naturalistic scenarios. Application: The developed framework provides a groundwork to evaluate and improve interactions with technology. Thereby, users and their emotional experiences are placed at the centre when designing user interfaces. By detecting moments of joy, this approach can support a better understanding of how technology can be purposefully designed for joyful experiences.


: A study has been made of the binding of fibrinogen to erythrocyte membranes. The amount of fibrinogen bound is found to be proportional to the concentration in the suspending phase (up to 10 g/l) and to be unaffected by other plasma proteins or calcium ions (up to normal concentrations). The binding is also unaffected by temperature (between 4 and 37 degrees C). However it is sensitive to both pH and ionic strength variation. A similar study of the major fibrinogen degradation products (FDP) produced by plasmin shows that these all bind to red cell membranes but by different amounts. A model based on these data is suggested for the positions of the binding regions on the fibrinogen and FDP molecules and is used to explain their influence on rouleaux formation and on the flexibility of the erythrocyte.


Fully supervised deep neural networks for segmentation usually require a massive amount of pixel-level labels which are manually expensive to create. In this work, we develop a multi-task learning method to relax this constraint. We regard the segmentation problem as a sequence of approximation subproblems that are recursively defined and in increasing levels of approximation accuracy. The subproblems are handled by a framework that consists of 1) a segmentation task that learns from pixel-level ground truth segmentation masks of a small fraction of the images, 2) a recursive approximation task that conducts partial object regions learning and data-driven mask evolution starting from partial masks of each object instance, and 3) other problem oriented auxiliary tasks that are trained with sparse annotations and promote the learning of dedicated features. Most training images are only labeled by (rough) partial masks, which do not contain exact object boundaries, rather than by their full segmentation masks. During the training phase, the approximation task learns the statistics of these partial masks, and the partial regions are recursively increased towards object boundaries aided by the learned information from the segmentation task in a fully data-driven fashion. The network is trained on an extremely small amount of precisely segmented images and a large set of coarse labels. Annotations can thus be obtained in a cheap way. We demonstrate the efficiency of our approach in three applications with microscopy images and ultrasound images.


There recently has been an increased interest in examining the relationship between the baseline (control) risk of an adverse outcome and the magnitude of the treatment effect (Brand and Kragt, 1992, Statistics in Medicine 11, 2077-2082; Davey Smith, Song, and Sheldon, 1993, The British Medical Journal 306, 1367-1373; Senn, 1994, Statistics in Medicine 13, 293-294). To facilitate such an examination, we propose a logistic model in which the relationship between the treatment effect, as measured by the log odds ratio, and the baseline risk is specified parametrically. This procedure is founded on a product-binomial likelihood and generates maximum likelihood estimates of the baseline event rates and two parameters characterizing the trend in the treatment effect. We fit this model to data from a meta-analysis involving the treatment of women at risk of preterm labor and contrast our findings with those of an earlier analysis.


In The Valkyries' Loom, Michèle Hayeur Smith examines Viking textiles as evidence of the little-known work of women in the Norse colonies that expanded from Scandinavia across the North Atlantic in the ninth century AD. While previous researchers have overlooked textiles as insignificant artifacts, Hayeur Smith is the first to use them to understand gender and economy in Norse societies of the North Atlantic.This groundbreaking study is based on the author's systematic comparative analysis of the vast textile collections in Iceland, Greenland, Denmark, Scotland, and the Faroe Islands, materials that are largely unknown even to archaeologists and span 1,000 years. Through these garments and fragments, Hayeur Smith provides new insights into how the women of these island nations influenced international trade by producing cloth (vaðmál); how they shaped the development of national identities by creating clothing; and how they helped their communities survive climate change by reengineering clothes during the Little Ice Age. She supplements her analysis by revealing societal attitudes about weaving through the poem "Darraðarljoð" from Njál's Saga, in which the Valkyries—Óðin's female warrior spirits—produce the cloth of history and decide the fates of men and nations.Bringing Norse women and their labor to the forefront of research, Hayeur Smith establishes the foundation for a gendered archaeology of the North Atlantic that has never been attempted before. This monumental and innovative work contributes to global discussions about the hidden roles of women in past societies in preserving tradition and guiding change.


The purpose of the study was to explore students' conceptual frameworks of models of atomic structure and periodic variations, chemical bonding, and molecular shape and polarity, and how these conceptual frameworks influence their quality of explanations and ability to shift among chemical representations. This study employed a purposeful sampling technique and used three diagnostic instruments for conceptual understanding to determine the students' level of content knowledge of the related concepts. Six student interviews were analyzed to portray students' conceptual frameworks in high and low content knowledge (HCK and LCK, respectively) groups. The study's major findings revealed that moving from a high toward a low level of content knowledge, the quality of students' explanations declined, as did their ability to reconcile new information to their existing knowledge frameworks. Three essential concepts – models of atomic structure, effective core charge and principles of electrostatic force, and quantum mechanics descriptions – were identified that may explain students' failure to learn the necessary aspects of molecular geometry and polarity. This study provides empirical evidence of how students' content knowledge influences their understanding about molecular polarity. The findings have implications for college chemistry education with respect to teaching concepts about molecular polarity.


Two finite-element-based, full-field computational methods and algorithms for use in Structural Health Management (SHM) systems are reviewed. Their versatility, robustness, and computational efficiency make them well suited for real-time, large-scale space vehicle, structures, and habitat applications. The methods may be effectively employed to enable real-time processing of sensing information, specifically for identifying three-dimensional deformed structural shapes as well as the internal loads. In addition, they may be used in conjunction with evolutionary algorithms to design optimally distributed sensors. These computational tools have demonstrated substantial promise for utilization in future SHM systems.


Peroxisome proliferator-activated receptor γ co-activator 1α (PGC-1α) promotes mitochondrial biogenesis and slow fiber formation in skeletal muscle. We hypothesized that activation of the p38 mitogen-activated protein kinase (MAPK) pathway in response to increased muscle activity stimulated Pgc-1α gene transcription as part of the mechanisms for skeletal muscle adaptation. Here we report that a single bout of voluntary running induced a transient increase of Pgc-1α mRNA expression in mouse plantaris muscle, concurrent with an activation of the p38 MAPK pathway. Activation of the p38 MAPK pathway in cultured C2C12 myocytes stimulated Pgc-1α promoter activity, which could be blocked by the specific inhibitors of p38, SB203580 and SB202190, or a dominant negative p38. Furthermore, the p38-mediated increase in Pgc-1α promoter activity was enhanced by increased expression of the downstream transcription factor ATF2 and completely blocked by ATF2ΔN, a dominant negative ATF2. Skeletal muscle-specific expression of a constitutively active activator of p38, MKK6E, in transgenic mice resulted in enhanced Pgc-1α and cytochrome oxidase IV protein expression in fast-twitch skeletal muscles. These findings suggest that contractile activity-induced activation of the p38 MAPK pathway promotes Pgc-1α gene expression and skeletal muscle adaptation.


In Reply. —Dr Dickey and Mr Hatlie challenge our estimates of the extent of iatrogenic injury as "sweeping and scientifically invalid" because they are based "solely" on the MPS. Unfortunately, those results were consistent with results from a 1975 California study that showed an adverse event rate of 4.2%. Both undoubtedly underestimated the extent of injury because they relied on information recorded in medical records. As every physician knows, all events are not recorded in the medical record. In addition, neither study measured adverse events in the outpatient setting. A recent study in Australia, using MPS methodology, found an adverse event rate of 16%. 1 We agree with Dickey and Hatlie that the health care system is safe for the vast majority of patients and that health care professionals are dedicated to preventing injuries, points we have made repeatedly to the press and public. We have never questioned the commitment


When a Spine-Leaf topology adopts the Intermediate System to
Intermediate System (IS-IS) routing protocol, the Leaf node receives
Link State Packets (LSPs) from all the other nodes thus having the
entire routing information of the topology. This is usually considered
unnecessary and costly. This document describes a solution to this
problem by utilizing IS-IS's inherent multi-level and area
partition features, which requires that an IS-IS router SHOULD check a
level-1 LSP's area addresses before advertising it to a neighbor.


This paper reviews current approaches to design visualization in the built environment and establishes a gap in theory and practice. While it has been acknowledged for some time that the temporal component is an important aspect of visualisation there has been minimal attempts to integrate this approach into design practice. We articulate an approach to visualization which we term 'temporal context'. This approach has two aspects: (1) the evaluation of designs in terms of spatial sequence and multiple viewpoints over time; (2) perceptual change over time due to changing light and atmospheric conditions. Building on our previous research in the use of video game technology to facilitate design, we evaluate the potential of augmented reality (AR) technology to address temporal context. We describe proposals for two innovative screen based AR systems, which incorporate a multi-camera capture mechanism, a video data base and a unique illumination data capture approach


Almost all previous works on saliency detection have been dedicated to conventional images, however, with the outbreak of panoramic images due to the rapid development of VR or AR technology, it is becoming more challenging, meanwhile valuable for extracting salient contents in panoramic images.
In this paper, we propose a novel bottom-up salient object detection framework for panoramic images. First, we employ a spatial density estimation method to roughly extract object proposal regions, with the help of region growing algorithm. Meanwhile, an eye fixation model is utilized to predict visually attractive parts in the image from the perspective of the human visual search mechanism. Then, the previous results are combined by the maxima normalization to get the coarse saliency map. Finally, a refinement step based on geodesic distance is utilized for post-processing to derive the final saliency map.
To fairly evaluate the performance of the proposed approach, we propose a high-quality dataset of panoramic images (SalPan). Extensive evaluations demonstrate the effectiveness of our proposed method on panoramic images and the superiority of the proposed method against other methods.


The complex hydrodynamics of three-phase (gas-liquid-solid) fluidized beds are not well understood due to complicated phenomena such as particle-particle, liquid-particle and particle-bubble interactions. In the present work both experimental and computational studies have been carried out on two and three dimensional fluidized beds to characterize there hydrodynamic behavior. Air, water and low density solid particles have been used as the gas, liquid and solid phase to analyze the system behaviors. Eulerian multi-phase model has been used to simulate the system by using the commercial CFD code ANSYS Fluent 13.0. Gidaspow and Schiller-Neumann drag models have been used to calculate inter-phase drag force. Two-equation standard k-e model has been used to describe the turbulent quantities. CFD simulation of three-phase fluidized bed systems with a distributor plate is not seen in literature. In the present work fluidized bed with distributor having orifice diameter 0.002 m has been studied. Result obtained from the simulation shows that fluidized bed with distributor has higher values of bed expansion and gas holdup compared to that of fluidized bed without distributor plate. It is also observed that in the bed having distributor the velocity magnitudes of solid particles, the liquid and gas phases are high and more fluctuating than in the bed without distributor. Simulation result obtained from CFD simulation with low density solid material is found agree with the experimental finding.


Neurostimulation techniques for the treatment of primary headache syndromes, particularly for chronic cluster headache (CCH), have received much interest in the recent years. Occipital nerve stimulation (ONS) has yielded favourable clinical results, and is becoming a routine treatment for refractory chronic cluster headache in specialized centres. Meanwhile, other promising techniques, such as spinal cord stimulation (SCS) or sphenopalatine ganglion stimulation, are emerging. This article reviews the current state of clinical research for neurostimulation techniques for chronic cluster headache, and particularly the pros and cons of SCS and ONS.


– There has been a discrepancy between visitors needs of guide service at a bird-watching site in Bali and the guides English competence. This article addresses the language learning needs of the guides and how they are analyzed to construct an English module for the bird-watching guides. The module can hopefully improve the guiding service, enhance the tourists' experience and contribute to the conservation of culture via tourism activities. Observation and interview with 5 officers of the bird village and observations on the village's vicinity revealed their necessities, lack and want in terms of the English learning, in relation to their occupation as guides. Beside knowledge about the heron population, the material also covers insight about Balinese's traditional house, their prayer offerings, and their spiritual philosophy. Each chapter of the module encloses conversation and role-play, grammar focus, pronunciation drill, and reading section. The English material was then judged by the experts in language teaching and in Hinduism.


This thesis is conducted on "The Impact of Government Expenditure on Economic growth in Ethiopia" by using time series data of 1970171 to 2010111, applying Ram's (1986) endogenous growth accounting model. The general objective of the study is to investigate the relationship between the components of government expenditure and economic growth in Ethiopia. Both descriptive and econometric techniques were employed for the purpose of analysis. Descriptive part deals about the general compositions and trends of public spending, the growth patterns of economy, and sectoral composition of national output. Econometric analysis is conducted by using Johansen Maximum Likelihood Estimation procedure. Before estimating the long run model, the time series characteristic of the data is tested using DF and ADF test and found that all the variables are integrated of order one. Then, the cointegration test was conducted and concluded that there is one co integrating equation between variables. The long run estimation result revealed that real government spending on human capital formation is growth promoting; real government consumption is growth retarding and real government physical investment becomes insignificant in explaining growth of real per capita income. Real Private investment and real openness affect the growth of real per capita income positively and significantly. Furthermore, VECM is employed to estimate the short run dynamics. The result revealed that all components of government expenditure do not have significant effect in explaining growth of real per capita income in the short run. Issues of quality, transparency, accountability and capacity building should be well established in public expenditures particularly on huge investment projects to ensure fiscal regulation and management of scarce resources and promotion of sustainable development, an effective channeling of unproductive public funds to productive activities should be implemented.


INTRODUCTION
This article uses alumni survey data from the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine to assess the professional impact of pediatric-trained USU graduates over the course of their careers. We specifically report on the clinical and leadership roles held, career accomplishments, and operational involvement among military pediatricians.

MATERIALS AND METHODS
This study analyzed survey data that were collected from alumni of USU. We used descriptive statistics to report the career achievements and operational experiences among USU graduates who completed training in pediatrics. This study was deemed exempt by the USU Institutional Review Board.

RESULTS
The survey response rate was 49.5% among 2,400 eligible respondents. Out of 1,189 alumni respondents, 110 (9.3%) trained in pediatrics. Among the pediatric-trained USU graduates, 98.2% spent some time as a full-time clinician, 73.6% served as chief of a clinical service, 42.7% held the role of department chair/chief or the equivalent, and 26.3% filled leadership positions in deployed settings. Forty percent of USU-trained military pediatricians deployed to combat areas at least once, and 35.5% participated in at least one peacetime humanitarian mission.

CONCLUSIONS
Our findings contribute to the unique story of military pediatricians who graduated from USU. These uniformed pediatricians participate actively in all realms of military medicine and have demonstrated their versatility through participation in a wide variety of vital functions. Their contributions include the provision of clinical care for both military children and active duty service members, serving in varied leadership positions, engaging in health professions education and other academic pursuits, and participating in operational assignments. Future studies could aim to more fully address the diverse contributions of military pediatricians to the overall mission by including more specific data about career experiences from all uniformed pediatricians.


Plagiarism is a growing concern to educators in the tertiary sector, although currently its appearances in the higher education literature have predominantly been concerned with its prevention and management. This article draws on the poststructuralist theory of consumption developed by Michel de Certeau, to consider plagiarism as a tactic deployed by consumers in their attempts to negotiate the demands of an increasingly commodified tertiary education sector. The article interrogates institutional structures of power through which consumers of tertiary education are attracted, progress and are occasionally excluded, to argue that the tertiary sector's subscription to market ideologies makes educational institutions complicit in the production of a climate in which the illicit appropriation of the work of others is deployed by students as a tactic to achieve educational success. Theorizing plagiarism as a consumptive practice is a necessary step in developing adequate institutional responses to plagiarism designed to facilitate student's negotiation of curriculum, rather than negotiation of institutional strategies.


Venipuncture and intravenous therapy are painfull procedures when hospitalized. The experience of pain in the neonatal period can lead to impaired neurological, attention, and learning development and also behavioral disorders in children. One of the most pleasanttypes of music is the recitation of the Holy Quran is a complementary therapy for relief pain. Although Breastfeeding was effective for reducing pain but not easy to implemented if nurse or health care proffesionals need space room for intervention and far from their mother. So need study further about nonpharmacological treatment contributes to optimal pain management in neonates. This study aimed to determine the effect of the sound of the holy Quran recitation on pain level neonates undergoing the invasive procedure at Perinatology Care Unit on Al Islam Hospital Bandung. This was a quasi-experimental study conducted on 36 neonates, selected with purposive sampling divided into two groups. Pain level was measured with the Neonatal Infant Pain Scale instrument during venipuncture or intravenous procedure. The Study was conducted since desember 2018 until february 2019. The data were analyzed using Mann whitney. The result showed a significant difference in pain level (p= 0.001) between the intervention and the control groups. The find ings indicated that the sound of Holy Quran recitation could help decrease pain level of neonates during invasive procedure.


Abstract Bats are an important group of mammals, frequently foraging in farmland and potentially exposed to pesticides. This statement considers whether the current risk assessment performed for birds and ground dwelling mammals exposed to pesticides is also protective of bats. Three main issues were addressed. Firstly, whether bats are toxicologically more or less sensitive than the most sensitive birds and mammals. Secondly, whether oral exposure of bats to pesticides is greater or lower than in ground dwelling mammals and birds. Thirdly, whether there are other important exposure routes relevant to bats. A large variation in toxicological sensitivity and no relationship between sensitivity of bats and bird or mammal test‐species to pesticides could be found. In addition, bats have unique traits, such as echolocation and torpor which can be adversely affected by exposure to pesticides and which are not covered by the endpoints currently selected for wild mammal risk assessment. The current exposure assessment methodology was used for oral exposure and adapted to bats using bat‐specific parameters. For oral exposure, it was concluded that for most standard risk assessment scenarios the current approach did not cover exposure of bats to pesticide residues in food. Calculations of potential dermal exposure for bats foraging during spraying operations suggest that this may be a very important exposure route. Dermal routes of exposure should be combined with inhalation and oral exposure. Based on the evidence compiled, the Panel concludes that bats are not adequately covered by the current risk assessment approach, and that there is a need to develop a bat‐specific risk assessment scheme. In general, there was scarcity of data to assess the risks for bat exposed to pesticides. Recommendations for research are made, including identification of alternatives to laboratory testing of bats to assess toxicological effects.


Background. In 2017, there were sixty people who identified themselves as lesbian, gay, bisexual and transgender/ transsexual (LGBT) people in Sememi Public Health Center, and seven of them were known to be people living with HIV/AIDS (PLWHA). People who are at high risk for HIV infection, especially the LGBT people and Female Sex Workers, are at even greater risk of developing a number of severe periodontal diseases. Periodontal problems, such as periodontitis, in HIV patients, are more severe and occur more frequently than uninfected patients. However, data on dental visit in Sememi Public Health Center as the primary health center in Sememi district is still limited, and there is still no data regarding periodontal health status among HIV patients.
Objective. The aim of this study is to investigate the relationship between HIV/AIDS and periodontal health status among the population who are at high risk of HIV/AIDS in Sememi Public Health Center area.
Method. This study was conducted with a cross-sectional design. The sample size was determined using a total sampling technique and came up with 30 participants.
Conclusion. Population with a high risk of HIV/AIDS in Sememi Health Center area in Surabaya City has poor periodontal status, due to a large number of bleeding on probing (BOP), periodontal pocket depth, and loss of attachment (LOA). There is no significant difference between BOP results and pocket depth between the HIV and non-HIV groups. But a significant difference was found between LOA in the HIV and non-HIV groups. On the contrary, we found that there is no significant relationship between HIV/AIDS and xerostomia in this study.


Aspen ecosystems are valued because they add biodiversity and ecological value to the landscape. They provide rich and productive habitats and increase aesthetic value. Climate change poses the risk of altering and disrupting these ecosystems, and it may worsen the effects of non-climate stressors. To provide scientific information for land managers facing the challenge of helping aspen ecosystems adapt to climate change, we developed an aspen vulnerability assessment on the Uinta-Wasatch-Cache and Ashley National Forests. Literature-based information and expert elicitation are used to define (a) components of sensitivity and exposure to climate change and (b) the capacity of these ecosystems to adapt to expected changes. Aspen ecosystems benefit from fire and quickly reproduce. Yet, aspen trees are susceptible to drought and heat that is projected to become more frequent and intense in the future. Some aspen-associated plant and animal species may benefit from the expected changes in disturbance regimes and stand structure, while others may experience population reductions or stress as a result of drought and heat. Overall, vulnerability is defined as moderate because although persistence of aspen ecosystems is likely, a dynamic spatial and temporal response to climate change is expected.


This study aimed to analyze the effect of an increased price of broiler meat on the production, consumption, and import of these commodities: Maize, rice, broiler meat, and eggs. The research method employed was the survey method and used both primary and secondary. The commodities analyzed in this study included: Maize, rice, broiler meat, and eggs. The business actors were classified into: (1) Commercial-broiler livestock companies (LSCL), (2) commercial-broiler small-scale farms (SSCL), and (3) other households (OTHR). The determination of the commodities was made based on considerations of production and consumption. The analysis results using multimarket model showed that increased broiler meat price would have opposite effects on production and consumption. An increased price of broiler meat increased the production of broiler meat, and on the contrary decreased consumption of broiler meat. Fulfilling the equilibrium caused the net import to decrease. This was very different from commercial layer. Furthermore, the increase in the price of broiler meat caused the production and consumption of maize to increase. The percentage of production increase which was less than the percentage of consumption increase caused the net import for maize to increase, on the contrary for rice.


Introduction There are controversies regarding inpatient vs outpatient management of placenta praevia. RCOG1 recommends that the care should be tailored according to the need of individual. This retrospective study aimed to establish whether outpatient management of placenta praevia affected the rates and pace of emergency LSCS, gestation at delivery, neonatal unit admissions, and the incidence of post-partum haemorrhage compared to inpatient group. Method Case note review of 100 patients over a 5-year period (July 2008–July 2013) with placenta praevia documented at their 34 weeks scan. Placenta praevia defined as placenta less than 2 cm from internal os. Results 20% (20/100) of patients were admitted from 34 weeks of pregnancy. The emergency LSCS rate amongst inpatients was 30% (6/20) and amongst those who received outpatient management the LSCS rate was 17.5% (12/80). The time interval between onset of bleeding to delivery time amongst the emergency LSCS group ranged from 35minutes to 96 h96hours, with a median interval of around 4 h. The patient who was delivered the fastest (35 min) was not an inpatient. The rates of SCBU admissions, PPH and blood transfusions were similar for both inpatients and outpatients. Conclusion Although the inpatient and outpatient group this study are not matched, there does not appear to be a significant difference in PPH, blood transfusion or neonatal complication rate, although the emergency LSCS was higher amongst inpatients. This could justify outpatient management if the patient is able to access the hospital quickly and has got support at home. Reference Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management, Green-top Guideline No. 27, Royal College of Obstetricians and Gynaecologists, January 2011


The new energy power station in the islands is the central node with the ocean current energy,wind energy, solar energy,energy storage equipment and other types of new energy power generation confluencing,achieved intelligent monitoring and energy management for new energy power in the islands.Refer three layer and two network architecture of smart substation,presents the islands's new energy power monitoring and energy management platform architecture,describes specific function and implementation method of the new energy power station with process layer,spacer layer and energy management layer.Based on the IEC 61850 ( Second Edition ) and IEC 61400-25 standard,the new energy power stations in the islands were standardized modelling,to ensure the platform standard and open.


Background. Following a World Health Assembly call in 2014 to strengthen palliative care, the South African (SA) Department of Health approved this strategy as part of the SA National Policy Framework and Strategy on Palliative Care. In 2016, the University of Cape Town, together with the College of Radiation Oncology of SA, identified the need to integrate palliative care (PC) into the oncology curriculum. In collaboration with the Cancer Association of SA, a research project was developed to introduce a 12-module curriculum at five teaching hospitals. The aim of this research was to evaluate the impact of a 1-year PC course within the training programme for specialist oncologists in SA. Objective. To determine the reaction of oncology registrars and their supervisors to the course to determine changes in knowledge and skills, and to determine the application in oncology practice. Methods. This study was a mixed-method prospective evaluation of an educational intervention. The educational programme used a blended learning method to train and support registrars ( n =32) and facilitators ( n =5) across five universities from August 2017 to September 2018. Evaluation feedback was electronically collected to determine the registrars' reactions to the course materials. Pre and post multiple-choice questions (MCQs) were used to review their knowledge. Focus group discussions (FGDs) were used to explore reactions, change in knowledge and skills and how registrars integrated PC into their daily work. Results. There was an overwhelmingly positive reaction to the PC course by the oncology registrars and their supervisors. The training was found to be feasible, and the topics addressed appropriate. Concerns previously raised by the College of Radiation Oncology of SA regarding the feasibility and appropriateness of the course and material were found to be unsubstantiated. The poor MCQ results can be ascribed to poor sequencing of the execution of the question. However, the MCQs in modules 7 and 8 (symptom management) demonstrated the most significant change in knowledge and skills (symptom management). The FGDs demonstrated a perceived change in knowledge and skills, especially for communication skills and pain and symptom management. The FGDs also indicated that the registrars' approach to PC changed in that they were able to integrate the principles of PC into practice, and now saw PC as an essential component of oncology. Lastly, registrars and their supervisors felt that the course addressed topics that formed part of their daily clinical work. Conclusion. This research supports the view that PC training is an essential component of oncology training in the SA setting. PC forms part of the daily practice of oncologists, and a structured curriculum prepares clinicians to be able to integrate evidence-based PC into the practice of oncology if they receive appropriate training. Supervisors of the oncology training programme and registrars are confident that the training of 12 modules across 1 year is feasible and appropriate.


The welfare-maximizing income tax structure, rate of money creation, and amounts of intergenerational transfers are jointly determined for given rates of government consumption. When government consumption is zero, it is found for the parameter values examined that the income tax structure is progressive, the rate of money change is negative, and positive transfers are made to the old. As government consumption increases, the tax structure's progressivity declines and turns increasingly regressive, the rate of money change rises, and transfers decrease. It is found that the bulk of the increase in government consumption is optimally financed by a cut in transfers.


SUMMARY Recent literature reports thrombotic episodes occurring in patients with HIV infection associated with other abnormalities including neoplasms and infections predisposing to a hypercoagulable state. We report a 47-year-old woman who developed pulmonary thromboembolism in association with HIV infection, pulmonary tuberculosis and breast cancer. She was treated with rifampin, isoniazid, pyrazinamide; heparin, phenprocoumon, zidovudine, lamivudine and efavirenz. Acid fast bacilli were visualized in a sputum smear and three months after, Mycobacterium tuberculosis was isolated from lymph node biopsy during a episode of immune reconstitution. The isolated mycobacteria showed sensitivity to all first-line drugs. HIV infection, breast cancer and pulmonary tuberculosis have several mechanisms that induce hypercoagulable state and can lead to thromboembolic complications. Pulmonary thromboembolism in this patient was a diagnostic challenge because of all the other severe diseases that she experienced at the same time.


Abstract Background: The quality of health education teachers is, in large part, dependent on the education they receive from their teacher preparation program. Purpose: This study assessed institutions of higher education (IHE) teaching practices in school health teacher preparation programs regarding the amount of time spent and content taught related to various health education tools and products (e.g. National Health Education Standards, the Health Education Curriculum Analysis Tool and the School Health Index). Methods: A survey (87 items) that demonstrated validity and reliability was mailed to the population of 225 lead school health education faculty at IHEs that offered school health licensure or certification programs. Results: The response rate was 59.6% (134/225). Faculty who taught how to use a variety of health education materials varied (30.6% to 89.6%), depending on the tools and products. Discussion: A primary responsibility of IHEs should be to help pre-service teachers utilize the tools and products described in this study. Many IHEs do not train their pre-service school health education majors to use these tools and products. Translation to Health Education Practice: Quality school health teacher preparation includes being trained on how to use these tools and products. To improve the quality of education provided by IHEs to pre-service school health education teachers, methods faculty need more training on incorporating these various tools into their curriculum.


Only a few transition managers (mainly consultants) offer unbundled transition advisory services. Most of the firms offering consulting services link their consulting arm with their asset management and/or broker/dealer divisions and bring institutional predispositions, strengths, and weaknesses that favor certain approaches over others. Perhaps most important, transition managers often do not act as a plan fiduciary, but instead act solely in a brokerage capacity. As a consequence, plan sponsors who feel the need for fiduciary advice and expertise should consider a new paradigm whereby the roles of transition fiduciary, and trade execution are bifurcated. Under such a model, plan sponsors need not rely on "firewalls" between the advisory and execution teams, and enjoy unfettered access to the optimal trading strategy and venue (pursuant to fiduciary advice that is "agnostic" with respect to transition methodology and executing broker/dealer).


Life comes from life and is again an absolute entity. In its incorporeal state, life transforms to a different body retaining its self existence. Thus either an addition or subtraction of life remains unaltered. The script of His instructions is embedded in its physical manifestation as a single and total functional unit called Cell formed inside the mother's womb contributed by its parents. The single cell multiplies itself into many units by mitosis molding themselves into a living organism, sheds down the depleted cells by apoptosis but retains their uniqueness and take birth into this world. The newborn grows up in terms of its genetic codification in the given environment and living conditions. Thus life is an ultimate non-material particle and is distinct from molecules or matter and that the supreme lord is the source of both life and matter. Human race among the living organisms is bestowed with a distinctive feature of intellect to understand this reality. Folks on eastern hemisphere paid their gratitude for His blessing and moved in His directions to solve their social, economic and health problems. Many techniques and therapies were developed. Folks on western hemisphere mistook the bestowed intelligence as their own. They developed a diagnostic method of solving problems in terms of why, what and how? They framed a theory of supplementation and started replacing the worn out materials, altering chemical compositions, reconstruction of organs and their replacements. In the present scenario east have lost its supreme intellectuals and their works are not fully understood for lack of complete doctrines and necessary peripherals. The western methods found to be remedial for the existing irregularities without correcting the source and sprouting up new problems making the condition worse. The need of the hour is to synthesize east and west technologies to find a true solution of any problem. In the spectrum of health concern this integrated approach is found fruitful by synchronizing the test results of western technologies with the eastern therapeutic methods. In its simpler version this may be called as "Integrated Approach of Yoga Therapy". In the orbit of health concern, here the study is confined to know the Influence of Yogic Practices on stimulation of Thyroid Gland and its Secretion of Hormones in Hypothyroidism.


Computer security has become an important part of the day today's life. Not only single computer systems but an extensive network of the computer system also requires security. In achieving the safety of the systems, an Intrusion Detection System (IDS) plays a significant role. IDS is a software that monitors the computer network and detects the suspicious activities that occur in the systems or network. The process of intrusion detection includes detecting intrusion. Intrusion is a suspicious activity attempted by the attacker. This paper presents a fuzzy-genetic approach to detecting network intrusion. Paper presents the results of the proposed system in terms of accuracy, execution time, and memory allocation. To implement and measure the performance of the system the KDD99 benchmark dataset is used. The KDD99 dataset is a benchmark dataset that researchers use in various network security researches. Genetic algorithm includes a development and collection that uses a chromosome like data structure and develop the chromosomes using selection, crossover and mutation operators. Fuzzy rule sorts network attack data.


An ab initio study has been performed for the electronic, spectroscopic, and chemical properties of the most stable configuration of the (CdO)n nanoclusters by employing B3LYP-DFT/LanL2DZ method. Different isomers were optimized to obtain structural stability and numerous chemical parameters such as dipole moment, ionization potential, etc. We report here the vibrational frequencies of the most stable configuration of (CdO)n nanoclusters. We found that, the highest vibrational frequencies of each (CdO)n nanoclusters arise from the asymmetrical stretching vibrations while the lower frequencies correspond twisting, bending and the out-of-plane vibrations of Cd and O atoms. Our results show that, the (CdO)2 nanocluster with the ring structure and the smallest HOMO-LUMO gap (HLG = 1.897) has the smallest hardness (ɳ = 0.95) and consequently is expected to has the highest chemical reactivity.


The hitherto poorly known forefin of Chensaurus chaoxianensis (Ichthyosauria) from the Lower Triassic (Spathian) is redescribed on the basis of the holotype and two new specimens. The humerus resembles that of Utatsusaurus hataii but is distinctive in having an emarginated anterior margin. The anteroproximal prominence of the radius is well developed, unlike that of other ichthyosaurs. All three specimens have five metacarpals and many phalanges, but only three carpals, which are identified as the ulnare, intermedium, and fourth distal carpal. These specimens show that delayed mesopodial ossification occurred in ichthyosaurs, at least in an early evolutionary stage. Because delayed mesopodial ossification is common among diapsids and is unknown in Jurassic ichthyosaurs, it was lost during the evolution of the Ichthyosauria. The osteogenic developmental axis appears to have continued into the fourth digit, as in other amniotes. The ossification pattern provides conclusive evidence to support the suggestion that the basal element of the fifth digit in Early Triassic ichthyosaurs is a metacarpal, rather than a carpal.


Long-term care for older people is increasingly turning to consumer-directed approaches. As a case in point, the Hong Kong Government recently implemented a new voucher programme for community-based aged care based on a consumer-directed approach: the Community Care Service Voucher for the Elderly (CCSV). The objectives of this study were to explore the lived experience of professional workers vis-à-vis the new programme and to identify barriers to effective voucher use by older people in Hong Kong. In-depth individual interviews were conducted with 16 professionals who had primary responsibility for the voucher programme for community-based aged care. The interview guide covered five main areas: (a) professional's perception and experience on the voucher programme; (b) the decision-making process around the voucher programme; (c) personal capacities of older people; (d) family support and social networks; and (e) institutional support. Findings indicate several barriers to effective use of the CCSV including: lack of self-awareness of service needs, lower education level, poor health condition, lack of financial resources, lack of family support, inadequate family involvement in decision-making, lack of peer and professional support, lack of available services and poor service accessibility. Suggestions for strengthening the voucher programme include institution of a case management model and public education. Different factors or elements are required to facilitate older people to make sound and informed choices, and a case manager can assist in combining different resources and forms of support towards effective use of the CCSV.


The Contingent Valuation Method can be used to assess the value of products with intangible benefits such as ecological products and so on. Forest eco-tourism product is the symbiosis product of forest ecological environment and tourism industry, which owns the function of increasing foreign exchange as well as carbon solidification and complies with the requirements of developing low-carbon economy. Forest eco-tourism product is a new growth point of forestry industry; however its value is underestimated by market price. This paper designed the survey objects, questionnaire, survey processes of Contingent Valuation Method that is suitable for Heilongjiang Province and the points should be attended during the implementation process, further, the willing expenditure utility function of Forest eco-tourism product is analyzed as well to provide a theoretical basis for the pricing of forest ecological product.


The study employed the World Bank Enterprise survey 2013 for Uganda and quintile method to determine the relationship between firm location, International Standards Organization (ISO) certification and cash inflows of Small and Medium Enterprises (SMEs) in Uganda. The results show that ISO certification and firm location are positively and significantly related to SMEs' cash inflows. It was also realized that other factors such as using email, foreign ownership, access to finance and tax administration are not obstacles to firm's cash inflows. Our findings suggest that creating awareness among entrepreneurs about ISO certification and creating enabling environment for SMEs in Uganda to become ISO certified should be highly considered by Government of Uganda. In addition, the Government of Uganda with Kampala Capital City Authority must develop deliberate policy to enable SMEs get internet connection cheaply and faster. This will ease doing businesses and enable SMEs' cash inflows to grow.

 Key words: Cash inflows, location, International Standards Organization (ISO) certification, Uganda.


Aims: To evaluate a recently developed digital slide and virtual microscope system, and to compare this method with optical microscopy on routine gastrointestinal biopsy specimens in both local and remote access modes. Methods: A fully computer controlled commercial microscope was used. The scanning program included object detection, autofocus, and image compression algorithms. The overall hard disk space for a gastric biopsy was between 30 and 50 MB and the scanning time was between 20 and 40 minutes. Haematoxylin and eosin stained routine gastric (61) and colon (42) biopsy specimens were selected, scanned, and evaluated by two specialists on an optical (OM) and virtual microscope (VM). Results: The overall concordance of VM and OM with the consensus diagnosis was 95.1% and 97%, respectively. Clinically important concordance was 96.1% and 98% for VM and OM, respectively. The two methods showed concordance in 92% of cases and clinically important concordance in 94.1% of cases. The reasons for discordance were image quality (one case), interpretation difference (three cases), and insufficient clinical information (three cases). Remote evaluation of the digital slides through the Internet has the advantages of the previously used static and dynamic telepathology methods. Conclusions: Diagnostic concordance was found between OM and VM. The digital slide and the virtual microscope can be alternative techniques in the computerisation of the histology laboratory and in teleconsultation services after further evaluation of time and storage constraints.


This paper describes work-in-progress on an Interactive Sonification Toolkit which has been developed in order to aid the analysis of general data sets. The toolkit allows the designer to process and scale data sets, then rapidly change the sonification method. The human user can then interact with the data in a fluid manner, continually controlling the position within the set. The interface used by default is the computer mouse, but we also describe plans for multiparametric interfaces which will allow real-time control of many aspects of the data. Early results of interactive sonic analysis of two example domains are described, but extensive user tests are


Software development processes are typically supported by a set of different tools that assist the designer in various phases of development like modeling, verification, source code generation, testing. Tool-chains can be formed by the integration of tools that are related to the subsequent steps of the process. In this paper, we present a tool integration framework which applies metamodel-driven and process-centric design patterns. Motivated by our research activities in various projects, our framework is based on standard process models, which allows the re-use of tool integration patterns as well as automated checking of the conformance of tool-chains to development standards. We make use of the state-of-the-art Rational Jazz platform as a technological basis.