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We examine whether delays in the expected release of annual earnings have implications for the future auditor-client relationship. Managers have strong incentives to release earnings on schedule, and auditors play an important role in helping their clients avoid costly earnings announcement delays. We find an increased likelihood of subsequent auditor-client realignments after earnings announcement delays. We further find that clients changing auditors realign with audit firms that better meet their earnings announcement timing demands, without finding evidence of a significant compromise in the reliability of the financial statement numbers in the earnings announcement. Our results help inform regulatory concerns about audit market concentration and how audit firm turnover has the potential to impact the auditor-client dynamic. While it is possible that auditor turnover could lead to a power imbalance where clients gain leverage in the relationship, our results suggest otherwise.

Early results using injectable autologous chondrocyte implantation (ACI) for the treatment of full thickness acetabular cartilage defects have been promising. However, so far there is no information on radiological results after injectable ACI using spheroids. The purpose of this sturdy was to (1) investigate the quality of tissue repair on MRI and (2) investigate the correlation between the MRI results and clinical results at a minimum follow-up of 24 months after third generation ACI in full thickness acetabular cartilage defects. It was hypothesized that ACI shows good MRI results in patients with large full thickness acetabular cartilage defects 24 months after surgery. It was also hypothesized that there is a correlation between postoperative clinical and MRI morphological results at a minimum follow-up of 24 months. Retrospective case series. Patients with ACI for full thickness acetabular cartilage defects > 2 cm2 were evaluated by preoperative and postoperative clinical scoring tools including the modified Harris Hip Score (mHHS), the International Hip Outcome Tool (iHOT-33), and the Subjective Hip Value (SHV) as well as a high resolution indirect arthro-MRI 24 months after surgery utilizing an identical imaging protocol for all patients. The magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used to classify the repair tissue on MRI. Demographic patient data was evaluated for influencing factors for pre- and postoperative clinical as well as radiological results. Thirty six consecutive patients (5 women/31 men, average age 32.9 years) had undergone two stage ACI procedure. The average size of the cartilage defect was 5.0 (2–6) cm2. The average follow-up was 29.9 (24–42) months. Four patients were not available for the final follow-up (follow-up rate 89%). The postoperative average MOCART score was 82.2 (± 14.2). MOCART score showed medium correlation of the item defect fill and the postoperative mHHS (r = 0.384, p = 0.043). There was no correlation of the other items or the total score with postoperative results. The patients showed significant improvement in the outcome measurements between preoperative and postoperative in the mHHS, the iHOT-33, and the SHV. Despite the large acetabular cartilage defects included in this study, ACI showed good MRI results with complete defect fill in 87.5% after a minimum 24-month follow-up. Statistically significant correlation of MRI and clinical results could only be seen with the item defect fill. Further research with longer follow-up is needed to evaluate the long-term results of ACI in acetabular cartilage defects.

SYNOPSIS This study examines the effect of audit completeness at the annual earnings announcement date on audit quality and auditor/client retention decisions. The vast majority of companies now release earnings before the year-end audit is complete while, historically, companies would release earnings on or after the date of audit completion. Management's decision to release earnings when the audit is less complete can adversely impact audit quality and has negative implications for the overall auditor/client dynamic. We find that audits that are less complete at the earnings announcement date are associated with a higher likelihood of financial statement misstatements in audit areas that are typically performed toward the end of audit fieldwork. We also find a higher likelihood of auditor turnover during the following year. Taken together, the results suggest lower financial reporting/audit quality and higher auditor turnover for companies that release earnings when the audit is less complete. Data Availability: The data used are publicly available from the sources cited in the text.

Over two-thirds of United States public companies now announce annual earnings prior to (versus with, or after) audit completion. We expect this practice has potential to increase pressure in auditor/client negotiations over post-announcement audit adjustments. In a controlled experiment with audit partners and senior managers, we find, in the presence of today’s typical level of audit committee engagement, auditors are significantly more likely to accept aggressive financial reporting when earnings have been released (versus drafted). Further, we test and find this effect is mitigated with strong audit committee effectiveness (i.e., including ideal, but achievable, characteristics typically currently lacking in today’s average committees). Our process-model tests find the joint effects are mediated by auditors’ directional goals such that in the absence of strong audit committees, released earnings increases auditors’ directional goals, leading to lower judgment quality. Our study provides evidence on the importance of investing in high-quality audit committees in promoting high-quality financial reporting.

This study sought to address the disagreement in literature regarding the "golden hour" in trauma by using the Relative Mortality Analysis to overcome previous studies' limitations in accounting for acuity when evaluating the impact of prehospital time on mortality.The previous studies that failed to support the "golden hour" suffered from limitations in their efforts to account for the confounding effects of patient acuity on the relationship between prehospital time and mortality in their trauma populations. The Relative Mortality Analysis was designed to directly address these limitations using a novel acuity stratification approach, based on patients' probability of survival (PoS), a comprehensive triage metric calculated using Trauma and Injury Severity Score methodology. For this analysis, the population selection and analysis methods of these previous studies were compared to the Relative Mortality Analysis on how they capture the relationship between prehospital time and mortality in the University of Virginia (UVA) Trauma Center population.The methods of the previous studies that failed to support the "golden hour" also failed to do so when applied to the UVA Trauma Center population. However, when applied to the same population, the Relative Mortality Analysis identified a subgroup, 9.9% (with a PoS 23%-91%), of the 5,063 patient population with significantly lower mortality when transported to the hospital within 1 hour, supporting the "golden hour."These results suggest that previous studies failed to support the "golden hour" not due to a lack of patients significantly impacted by prehospital time within their trauma populations, but instead due to limitations in their efforts to account for patient acuity. As a result, these studies inappropriately rejected the "golden hour," leading to the current disagreement in literature regarding the relationship between prehospital time and trauma patient mortality. The Relative Mortality Analysis was shown to overcome the limitations of these studies and demonstrated that the "golden hour" was significant for patients who were not low acuity (PoS91%) or severely high acuity (PoS23%).

This study examines the relation between audit personnel salaries and office-level audit quality. We measure audit personnel salaries at the associate, senior, and manager ranks for Big 4 audit offices from 2004 to 2013, using unique individual-auditor-level data obtained from the U.S. Department of Labor. We find that offices that pay lower salaries have a higher percentage of clients that experience restatements. In related analyses, we also find lower levels of audit quality when audit employees are paid less, relative to other lines of service in accounting firms. Finally, we document positive and significant associations between salary and fees, suggesting that audit offices pass some of the cost of higher labor onto their clients. Overall, our findings provide important initial evidence on the role of audit salary and its relation to audit quality and audit fees.

A hypertrophic AIIS has been identified as a cause for extraarticular hip impingement and is classified according to Hetsroni using 3D-CT reconstructions. The role of the conventional AP pelvis X-ray, which is the first standard imaging step for the evaluation of hip pain, has not been investigated yet. AP pelvis X-rays and 3D-CT reconstructions of patients were evaluated regarding their morphology of the AIIS. The conventional X-rays were categorized into three groups according to the projection of the AIIS: above (A) or below (B) the acetabular sourcil or even exceeding the anterior acetabular rim (C). They were compared to the morphologic types in the 3D-CT reconstruction (Hetsroni type I-III). Ninety patients with an equal distribution of type A, B or C projection in the AP pelvis were evaluated and compared to the morphology in the 3D-CT reconstruction. The projection of the AIIS below the acetabular sourcil (B + C) showed only moderate sensitivity (0.76) and specificity (0.64) for a hypertrophic AIIS (Hetsroni type II + III), but if the AIIS exceeds the anterior rim, all cases showed a hypertrophic AIIS in the 3D-CT reconstructions (Hetsroni type II + III). Distinct differentiation of the AIIS morphology in the AP pelvis is not possible, but the projection of the AIIS below the anterior acetabular rim represented a hypertrophic AIIS in all cases and should, therefore, be critically investigated for a relevant AIIS impingement.

Journal of synchrotron radiation 27(1), 60 - 66 (2020). doi:10.1107/S1600577519014048, A new Rococo 2 X-ray fluorescence detector was implemented into the cryogenic sample environment at the Hard X-ray Micro/Nano-Probe beamline P06 at PETRA III, DESY, Hamburg, Germany. A four sensor-field cloverleaf design is optimized for the investigation of planar samples and operates in a backscattering geometry resulting in a large solid angle of up to 1.1 steradian. The detector, coupled with the Xspress 3 pulse processor, enables measurements at high count rates of up to 106 counts per second per sensor. The measured energy resolution of ∼129 eV (Mn Kα at 10000 counts s−1) is only minimally impaired at the highest count rates. The resulting high detection sensitivity allows for an accurate determination of trace element distributions such as in thin frozen hydrated biological specimens. First proof-of-principle measurements using continuous-movement 2D scans of frozen hydrated HeLa cells as a model system are reported to demonstrate the potential of the new detection system., Published by Wiley-Blackwell, [S.l.]

Ineffective internal controls over financial reporting often relates to a lack of qualified personnel with sufficient accounting and technical expertise. In this study, we examine whether firms respond to internal control failures by increasing their demand for specific accounting and finance skills. Using unique data containing an extensive collection of job postings, we document significant increases in firms’ demand for employees with financial skills following the disclosure of an internal control weakness. This demand effect is more pronounced among jobs requiring accounting skills or accounting software knowledge, but also extends to non-accounting personnel that interface with accounting functions, suggesting an important role for all firm personnel in remediating internal control failures. We also find that increased financial skill demand is associated with a higher likelihood of internal control remediation, especially for firms with restatements. We also provide additional evidence consistent with increased financial skill demand relating to the disclosure of a material weaknesses rather than a proactive firm response to internal control issues. Overall, our findings shed new light on how firms internally respond to ineffective internal controls by increasing their demand for financial skills in their workforce.

Acetabular cartilage lesions are frequently seen in young patients with hip pain and have been identified as an important prognostic factor. New therapies have complemented abrasion and microfracture procedures. The aim of the study is to evaluate the early outcome of patients with arthroscopic injectable autologous chondrocyte transplantations (ACT) for full thickness acetabular cartilage defects.A two-step procedure ACT was performed in patients with full thickness acetabular cartilage defects measuring ≥2 cm(2). The patients were closely followed with clinical examination, pre- and postoperative scores until the latest available follow-up of 3, 6, 12, and 24 months.20 consecutive cases (4 female, 16 male, mean age 33 years) were included. No patients were lost at final follow-up. The average defect size was 5.05 (range 2-6) cm(2). The average follow-up was 12.05 (range 6-24) months. Three months postoperatively the preoperative scores improved significantly from a mean mHHS of 63-81 points (p = 0.009), iHOT33 of 44-66 % (p = 0.028) and subjective hip assessment (Subjective Hip Value, SHV) of 60-87 % (p = 0.007). After 12 months the results improved significantly to a mean mHHS of 93 points (p = 0.017), an iHOT33 of 79 % (p = 0.007) and an SHV of 82 % (p = 0.048) compared with the preoperative scores.The injectable matrix associated ACT is a reliable procedure, yielding promising early results with a significant increase of all scores evaluated in patients with full thickness acetabular cartilage defects.

We comment on the Securities and Exchange Commission’s (the “Commission”) proposed Amendments to the Accelerated Filer and Large Accelerated Filer Definitions. We provide comments and analysis relating primarily to the Request for Comments in Sections II.E and III.D of the proposed Amendments (“Proposal”). Our comments relate to the provisions of the Proposal that would eliminate internal control audits required under Section 404(b) of the Sarbanes-Oxley Act for companies with annual revenue less than $100 million. Part I provides comment on the central premise of the Proposal. Part II provides comments on various aspects of the Commission’s economic analysis. Although it might be socially desirable to encourage investment, and research and development, we believe there are ways to do so without sacrificing oversight.

We examine how third party verification of internal controls over financial reporting (ICFR) affects bank supervision by exploiting a change in size thresholds for required FDICIA-related internal control audits. We document that affected banks have higher reported levels of non-performing loans after the removal of internal control audit requirements compared to unaffected banks. This increase in non-performing loans is not accompanied by increases in past due loans, indicating more forthcoming reporting by management rather than operational deterioration. Furthermore, we find that the effects are concentrated in periods of heightened regulatory scrutiny and in banks with less stringent oversight in the pre-period. Examiners increase the length of targeted examinations and downgrade regulatory ratings, indicating an increase in stringency after the elimination of third-party verification of internal controls over financial reporting. Our findings suggest that third-party verification of internal controls is an imperfect substitute for bank supervision and efforts to rely upon externally generated assurance may heighten bank risk.

This paper is about an innovative multiphase generator concept without a winding overhang. It gives an overview of the system and specifies the characteristics of the concept. Suggestions for the design of the short-circuit ring are included as well as feasible variants of a multiphase transformer to connect the multiphase generator to the grid. Additionally, the behaviour of the system at rated operation is presented.

Sepsis is a dysregulated systemic response to infection that causes organ dysfunction. It is the leading cause of in-hospital mortality and is responsible for the longest, most expensive, hospital stays in the United States. Prognostic modeling of sepsis has demonstrated potential for improving treatment and outcomes for critical care patients. However, the majority of previous models have relied on an outdated definition of sepsis based on systemic inflammatory response syndrome (SIRS). Therefore, this study sought to build predictive models of sepsis using the most recent definition of sepsis, Sepsis-3. A total of three classification methods, including logistic regression (LR), support vector machines (SVM), and logistic model trees (LMT), were used to predict onset of sepsis in adult Intensive Care Unit (ICU) patients using vital signs and blood culture results. For patients who did not develop sepsis, predictor values were selected from a random 48-hour time window during the patient's ICU stay. For those who developed sepsis, a random time was selected for the patient within 48 to 6 hours prior to onset of sepsis, and the predictor values with the closest preceding time were extracted. The LMT produced superior classification performance compared with the LR and SVM. The wide time window used for data extraction improves the clinical utility of the models relative to those built in previous work. However, while the models showed similar sensitivity and specificity to previous models using the Sepsis-3 definition, they each showed a high false positive rate.

We address whether SOX 404(b) internal control audits under two auditing standards regimes and SOX 404(a) management assessments are associated with improved internal control system quality, an important and largely unstudied potential benefit. In 2013, the PCAOB disclosed that 15 percent of inspected control audits were ineffective, suggesting that the current control auditing standard may not be sufficient to induce implementation of high-quality control systems. We use an indirect measure of internal control system quality—future unaudited accruals quality—to proxy for internal control quality because sustained internal control improvements should be exhibited in future quarterly financial reports unaltered by contemporaneous financial statement audits. We find that internal control audits initially provided internal control quality benefits. After the 2007 auditing standards change, internal control quality deteriorated for ICFR audited versus unaudited firms. Finally, we find limited evidence that management assessments affect internal control quality. Results indicate that recent PCAOB concerns may have merit. Data Availability: Data are publicly available from the sources identified in the text.

This study examines the role of the external audit in management's decision about the amount of GAAP financial statement information to disclose in the annual earnings announcement. The earnings announcement is a key disclosure provided by public companies. Yet, there is no requirement that earnings announcements contain audited GAAP numbers; in fact, recent trends indicate that a majority of companies release earnings before the completion of year-end audit fieldwork. I predict and find that companies that wait until the audit is more complete at the earnings announcement date and receive higher quality audits provide more detailed balance sheet, cash flow statement, and overall GAAP disclosures. I also provide evidence that complete audits and higher quality audits impact the information content of the earnings announcement. The combined results indicate that audit completeness and quality help facilitate more detailed earnings announcement disclosures and have implications for the equity market. Data Availability: Data are publicly available from sources identified in the text.

While the shareholder benefits of audits are well documented, evidence on whether audits can facilitate opportunistic behavior by corporate insiders is scarce. In this paper, we examine whether the audit process facilitates one particular form of opportunism: informed trading by corporate insiders. We focus our analysis on insider trading around the audit report date. We find an increase in trading around the audit report date and that the increase is abnormally large for firms that subsequently report modified opinions. The abnormal increase in trading is concentrated among officers and non-audit committee independent directors, and most pronounced in first-time modified opinions and modified opinions in years where financial results are subsequently restated. These trades are highly opportunistic: they predict restatements, and as a consequence, we show they avoid significant losses. Collectively, our findings provide novel evidence that insiders appear to exploit private information about the audit process––a process ostensibly designed to protect shareholders––for opportunistic gain.

Electrical and optogenetic methods for brain stimulation are widely used in rodents for manipulating behavior and analyzing functional connectivities in neuronal circuits. High-resolution in vivo imaging of the global, brain-wide, activation patterns induced by these stimulations has remained challenging, in particular in awake behaving mice. We here mapped brain activation patterns in awake, intracranially self-stimulating mice using a novel protocol for single-photon emission computed tomography (SPECT) imaging of regional cerebral blood flow (rCBF). Mice were implanted with either electrodes for electrical stimulation of the medial forebrain bundle (mfb-microstim) or with optical fibers for blue-light stimulation of channelrhodopsin-2 expressing neurons in the ventral tegmental area (vta-optostim). After training for self-stimulation by current or light application, respectively, mice were implanted with jugular vein catheters and intravenously injected with the flow tracer 99 m-technetium hexamethylpropyleneamine oxime (99mTc-HMPAO) during seven to ten minutes of intracranial self-stimulation or ongoing behavior without stimulation. The 99mTc-brain distributions were mapped in anesthetized animals after stimulation using multipinhole SPECT. Upon self-stimulation rCBF strongly increased at the electrode tip in mfb-microstim mice. In vta-optostim mice peak activations were found outside the stimulation site. Partly overlapping brain-wide networks of activations and deactivations were found in both groups. When testing all self-stimulating mice against all controls highly significant activations were found in the rostromedial nucleus accumbens shell. SPECT-imaging of rCBF using intravenous tracer-injection during ongoing behavior is a new tool for imaging regional brain activation patterns in awake behaving rodents providing higher spatial and temporal resolutions than 18 F-2-fluoro-2-dexoyglucose positron emission tomography.

We document a growing disparity in earnings disclosure mechanisms. Firms are increasingly disclosing earnings announcements (EA) concurrently with the 10-K filing instead of first issuing a ‘stand-alone’ EA. Firm adoption of concurrent EA/10-Ks is associated with lower investor sophistication, greater impediments to producing timely and reliable earnings information, and greater industry-level concurrent reporting. Concurrent EA/10-Ks differ from stand-alone EAs in that investors anticipate more information in the EA, disclosures are preempted by industry peer EAs, the market reaction is muted even when controlling for EA timing, and post-earnings-announcement drift is greater.

Successful new product development is of crucial importance for the survival of enterprises and for creating and securing competitive positions. In R&D performance in new product development is generally affected by interpersonal leadership. Empowering leadership, specifically, is suitable for this context, as the need for autonomy and achievement, as well as the cooperation of the followers, are taken into account through the support of the leader. However, so far no moderating effects of the context have been examined. Therefore, the present study examined the influence of the contextual factors of strategic, structural, and cultural orientation on the relations between empowering leadership and new product development performance in R&D. Additionally, a wide range of leadership behaviors with transformational and transactional leadership is taken into account in this study. Empowering leadership is assumed to have the highest impact on the R&D context. The moderating effects of the context were investigated in a quantitative design with 116 leaders and 371 respective followers from 32 R&D departments of various branches of industrial enterprises. The results confirmed a main effect of empowering leadership on new product development performance. Additionally, moderation analyses showed moderating effects on strategic and cultural orientation, while structural orientation had no moderating effect. It can be concluded that empowering leadership has a positive effect on new product development performance; nevertheless, the context in which leadership is practiced has to be considered.

Nowadays the system of public health is constructed in such a manner so that its main objective is the recovery of an already sick person, while prediction and prevention receive little attention. Meanwhile the development of these aspects of medicine can lead to the ability to control morbidity among the population, to identify chronic and genetic diseases in the early stages of development, and thus to prevent their further progression. This will reduce traditionally high costs of sick people treatment and the number of disabled population, and improve the quality and duration of life. The elaboration of new fields of science that are working on the study and interpretation of data obtained during laboratory and clinical research, creation of new methods for diagnosis, prognosis and treatment, provides an opportunity now to implement a new strategy, called PPPM, and gets promising results, which should lead to further development of an existing medicine.

SUMMARY We examine the impact of PCAOB Auditing Standard No. 5 (AS5) and the economic recession on risk characteristics and degree of auditor/client misalignment in the publicly traded client portfolios of Big 4 firms. AS5 and the economic recession both likely resulted in an increase in audit firm personnel capacity as well as a decline in current and future revenue prospects, leading to concerns that the Big 4 firms may pursue clients that present greater risk to the portfolio. We find that the overall portfolio in 2009 presents greater financial risk, attributable to the impact of the recession on continuing clients. A net decrease in audit and auditor business risks is also attributable to continuing clients over this period, as increases for new clients are offset by reductions due to departing clients. Overall, the results, which should be of interest to regulators, indicate that Big 4 firms continued to balance their portfolio with risk in mind. Data Availability: Data are publicly available from sources identified in the paper.

This study examines the relationship between audit personnel salaries and office-level audit quality. Audit personnel are a key input in the audit process and expectations of personnel have been increasing since the inception of the PCAOB. Despite these increased expectations and workloads, audit salaries have remained relatively flat over the past decade. Using salary data collected from H1-b visa applications obtained via the Freedom of Information Act, we measure audit personnel salaries at the Associate, Senior and Manager ranks for local Big 4 audit offices during the years 2004 to 2013. We first examine the determinants of audit personnel salaries finding that some individuals are willing to trade-off higher salaries for the opportunity to work for offices that are local market leaders and have a history of performing high quality audits. We next examine the relationship between audit personnel salaries and office level audit quality finding a negative association. That is, offices that pay lower salaries to its rank-and-file employees tend to have a higher percentage of clients that experience restatements. Finally, we examine the ability of audit offices to pass the costs of audit labor onto their clients. We document positive and significant associations between salary and fees, suggesting that audit offices pass the cost of labor onto their clients. Overall, our findings provide initial evidence on the role of audit salary and its impact on audit quality and audit fees.

A high sensitivity multi-channel far infrared laser diagnostics with switchable interferometry and polarimetry operation modes for the advanced neutral beam-driven C-2U field-reversed configuration (FRC) plasmas is described. The interferometer achieved superior resolution of 1 × 1016 m−2 at >1.5 MHz bandwidth, illustrated by measurement of small amplitude high frequency fluctuations. The polarimetry achieved 0.04° instrument resolution and 0.1° actual resolution in the challenging high density gradient environment with >0.5 MHz bandwidth, making it suitable for weak internal magnetic field measurements in the C-2U plasmas, where the maximum Faraday rotation angle is less than 1°. The polarimetry resolution data is analyzed, and high resolution Faraday rotation data in C-2U is presented together with direct evidences of field reversal in FRC magnetic structure obtained for the first time by a non-perturbative method.

A number of rammed earth projects constructed in recent years in Germany and abroad testify to the high level of architectural interest in this material, not only in our country. Rammed earth has been “rediscovered”, in particular by young architects, due to its unique materiality and fascinating and individual surface aesthetics. In connection with the realisation of two rammed earth projects realised in Thuringia, Germany, in 2003/2004 some questions arose concerning the process of moisture transfer and changes in strength properties during construction. The earthen building standards detail only very rough estimates of drying times for rammed earth walls. The idea arose to develop a test programme for investigating the aspect of drying time with regard to the change in material strength in rammed earth walls, as well as for elaborating general aspects of testing procedures for rammed earth in standards. The paper presents results of a laboratory programme that attempts to approach this very complex problem. A series of test specimens were produced and the unconfined compressive strength was determined after different drying times varying from 7 to 90 days. The moisture content of the test specimens also was varied: at OMC (Proctor test) and above and below the OMC., Una serie de proyectos de tierra apisonada construidos en los últimos años en Alemania y en el extranjero dan testimonio del alto nivel de interés arquitectónico en este material, no solo en nuestro país. La tierra apisonada ha sido “redescubierta”, en particular por los arquitectos jóvenes, debido a su materialidad única y fascinante y la estética singular de su superficie. En relación con la realización de dos proyectos de tierra apisonada realizados en Turingia, Alemania, en el período 2003/2004 surgieron algunas preguntas sobre el proceso de transferencia de la humedad y los cambios en las propiedades de resistencia durante la construcción. Las normas de construcción de tierra indican solamente estimaciones muy aproximadas de los tiempos de secado para muros de tierra apisonada. Surgió la idea de desarrollar un programa de pruebas para investigar el aspecto del tiempo de secado con respecto al cambio en la resistencia del material en muros de tierra apisonada, así como para establecer los aspectos generales de los procedimientos de ensayo de tierra apisonada en las normas. El documento presenta los resultados de un programa de laboratorio que intenta abordar este complejo problema. Se elaboró una serie de muestras de análisis y se determinó la resistencia a la compresión no confinada después de diferentes tiempos de secado que variaban de 7 a 90 días. El contenido de humedad de las muestras también era variado: en el método abierto de coordinación (prueba Proctor) y por encima y por debajo de la OMC.

BACKGROUND: Cytoreductive peritonectomy with hyperthermic intraoperative chemotherapy (HIPEC) is an established therapy for patients with gastrointestinal, gynaecological metastasised peritoneal carcinomatosis as well as primary peritoneal carcinomatous tumours. METHODS: On the basis of a literature review and our personal experience, selection criteria for peritonectomy are discussed. RESULTS: Computed tomography (CT) scans and diagnostic laparoscopy are not sufficient for the diagnosis of peritoneal carcinomatosis. The combination of fluorodeoxyglucose positron emission tomography (FDG-PET) and CT seems to be the most reliable diagnostic imaging method. In our institution, all patients undergo PET / CT prior to peritonectomy. CONCLUSION: The PET / CT scan may play an important role in forecasting the operability of patients with peritoneal carcinomatosis.

Introduction The radiological assessment of osteoarthritis of the knee joint in longitudinal studies is usually performed with established classifications. It is disadvantageous that these features are always combined to describe a certain stage of the disease, even though they can develop independently. Methods A german score based on a publication by Scott et al. (1993) was designed. At first 100 X-ray series of knees were evaluated using the Jager & Wirth, the Kellgren & Lawrence classification and the point score. Six observers then evaluated 200 anonymised radiographs of knee joints twice within 3 months. Results The most reliable criteria for the inter-observer reliancy were medial osteophytes, medial joint-line narrowing, patella osteophytes and chondrocalcinosis. At least 4 out of 6 observers had a high match in these criteria. The reproducability of most of the individual radiographic features was good, with a higher level of orthopaedic training resulting in a higher consistency of the score. Discussion A certain level of orthopaedic training is necessary for consistent results. The main focus of the score will be less the daily routine assessment of radiographs of the knee joint, but more the scientific assessment of radiographic progression of osteoarthritis in longitudinal studies.

Histopathological examination of synovial specimens can contribute to the diagnosis of chronic joint diseases. A so-called synovitis score has been introduced as a standardised grading system, based on the semi-quantitative evaluation of the three determining features of chronic synovitis: enlargement of synovial lining, density of synovial stroma and inflammatory infiltrate, giving a score between 0 and 9. The present study examines the reliability of this procedure by comparison with exact measurements using computer-assisted image analysis (CAIA). Seventy-one synovial specimens from patients with osteoarthritis (OA, n=22), psoriatic arthritis (PsA, n=7), rheumatoid arthritis (RA, n=35) and from a control group (Co, n=7) were evaluated using both the synovitis score and CAIA. The measurements were transformed to semi-quantitative values analogous to the synovitis score. The differences between the transformed CAIA scores and the pathologist's scores were 0 or +/-1 in 40 cases, whereas in 31 cases the difference was greater than 1 (correlation coefficient r=0.725). The CAIA scores differed significantly between Co and RA cases (p=0.000) as well as between OA and RA (p=0.000). We conclude that the synovitis score was validated by CAIA and can be regarded a reliable grading system that contributes to the diagnostic procedure of chronic joint inflammation.

An analysis of the regulations of herbicide use for weed control in non-agricultural/urban amenity areas, including actual pesticide use, was carried out as a joint survey of seven European countries: Denmark, Finland, Germany, Latvia, the Netherlands, Sweden and United Kingdom. Herbicides constitute the major part of the pesticides used in urban amenity areas. Herbicide use on hard surfaces is the largest in terms of volume and potential contamination of surface and groundwater. The aim of the study was to investigate the differences in political interest and public debate on the 'use of pesticides in public urban amenity areas', regulations within each country at national, regional and local levels, possible use of alternative weed control methods and the amounts of pesticides used on urban amenity areas. A comparative analysis revealed major differences in political interest, regulations and availability of statistics on pesticide use. Denmark, Sweden, the Netherlands and Germany have, or have had, a strong public and political interest for reducing the use of herbicides to control weeds in urban amenity areas and also have very strict regulations. The UK is currently undergoing a period of increasing awareness and strengthening regulation, while Latvia and Finland do not have specific regulations for weed control in urban amenity areas or on hard surfaces. Statistics on pesticide/herbicide use on urban amenity areas were only available in Denmark and the Netherlands. Developing this kind of information base reveals the differences in herbicide use, regulations and policies in European countries and may enhance the transfer of knowledge on sustainable weed control across countries.

Conventional field-reversed configurations (FRC) face notable stability and confinement concerns, which can be ameliorated by introducing and maintaining a significant fast ion population in the system. This is the conjecture first introduced by Norman Rostoker multiple decades ago and adopted as the central design tenet in Tri Alpha Energy’s advanced beam driven FRC concept. In fact, studying the physics of such neutral beam (NB) driven FRCs over the past decade, considerable improvements were made in confinement and stability. Next to NB injection, the addition of axially streaming plasma guns, magnetic end plugs, as well as advanced surface conditioning lead to dramatic reductions in turbulence driven losses and greatly improved stability. In turn, fast ion confinement improved significantly and allowed for the build-up of a dominant fast particle population. This recently led to the breakthrough of sustaining an advanced beam driven FRC, thereby demonstrating successful maintenance of trapped magnetic flux, plasma dimensions and total pressure inventory for times much longer than all characteristic system time scales and only limited by hardware and electric supply constraints.

We show that the conventional disclosure strategy, in which a ‘stand-alone’ earnings announcement pre-empts the SEC-mandated filing (e.g. 10-K), has been steadily disappearing over time and is instead being replaced by a concurrent earnings announcement, in which the earnings announcement and the 10-K filing are released on the same day. We document that the prevalence of concurrent earnings announcements has increased significantly over time. Importantly for investors, we find that concurrent earnings announcements are less timely and less decision useful than stand-alone earnings announcements. Specifically, we document that concurrent earnings announcements are associated with attenuated market reactions to and greater anticipation of earnings news by investors compared to stand-alone earnings announcements. Finally, we find that firms with greater impediments to producing timely earnings information are more likely to have switched from a stand-alone to a concurrent strategy. Collectively, we document a distinct divide in the marketplace, with a growing number of firms switching to the less decision useful practice of concurrent earnings announcements, relative to stand-alone earnings announcements.

Background: Topotecan is an active drug in small-cell lung cancer (SCLC). In our previous study, a combination of topotecan with cisplatin was associated with a median overall survival of 7.6 or 8.7 months, depending on the duration of treatment. We have replaced cisplatin by carboplatin in this trial, with the objective of creating a more convenient schedule for our patients. Furthermore, we have also compared the standard 5-day schedule with an experimental 3-day schedule. Patients and methods: A total of 100 patients with metastatic disease were included. Patients were randomly assigned to receive either topotecan 0.75 mg/m2, days 1–5, and carboplatin AUC 5, day 5 (arm A) or topotecan 1.25 mg/m2, days 1–3, and carboplatin AUC 5, day 3 (arm B). Six cycles were given at a 3-week interval. Results: A total of 91 patients were assessable for response. The response during therapy was 86.9% in arm A and 80.0% in arm B. Median survival in arm A was 11.8 months and in arm B 11.6 months (P = 0.37). Conclusions: The combination of topotecan and carboplatin is active in extensive-disease SCLC. Toxicity and median survival were comparable in both arms. Three days of treatment seems to be similar to the 5-day regimen.

In recent years, large mumps outbreaks, involving mainly adolescents and young adults, have re-emerged in several countries. We investigated a large mumps outbreak, evaluated the association between mumps clinical severity (complications, hospitalization) and vaccination status (number of previous measles, mumps and rubella - MMR vaccine doses), and assessed vaccine effectiveness. The first mumps cases emerged in an ultra-orthodox boys' school in Jerusalem and were epidemiologically linked to the mumps outbreak in New York. Overall, 3130 mumps cases were notified in the Jerusalem district during September 2009-August 2011 (median age 13y, 64% males). Most cases were reported from community clinics. Patients with systemic symptoms and/or complications (419, 13.4%) were either hospitalized (n = 79) or treated in an emergency medical center (n = 340). The main complications included orchitis (3.8% males> age 12y) and meningoencephalitis (0.5%). The mumps virus genotype was G5. The distribution of previous MMR vaccine doses (n = 0,1,2) was: 24.8%, 28.3% and 46.9%, respectively. The number of previous vaccine doses was inversely associated with clinical severity. Adjusted values for MMR vaccine effectiveness against complications were estimated as 52.1% (95% CI -4 -78%) for one vaccine dose and 62.7% (95% CI 25.7-81.3%) for 2 doses. The outbreak was characterized by predominance of male students; the majority of whom had been previously vaccinated. The reported complication rate was relatively low. Vaccination status was associated with age and disease severity. The combination of limited mumps vaccine effectiveness and the specific school setting (dense learning and living conditions) probably contributed to the disease spread.

Normothermic, nonpulsatile cardiopulmonary bypass (CPB) impairs systemic and splanchnic oxygen transport and increases gastrointestinal permeability. It is an important therapeutic goal to avoid splanchnic dysoxia during CPB. Small-dose prostacyclin therapy improves splanchnic oxygen transport and microcirculation in septic patients. In this study, we sought to determine if during cardiac surgery, the prostacyclin analog epoprostenol improves the balance of systemic and splanchnic oxygen transport. Eighteen patients undergoing cardiac valve replacement were randomized to receive either epoprostenol (3 ng x kg(-1) x min(-1)) or placebo during, and for 1 hour after, surgery. Systemic and splanchnic oxygen delivery, consumption, and extraction and arterial, mixed venous, and hepato-venous lactate concentrations were measured before, during, and after CPB. Gastrointestinal permeability was measured 1 day before and 1 day after surgery using the triple sugar permeability test. During CPB, the epoprostenol group had decreased systemic oxygen consumption and splanchnic oxygen extraction (P = 0.024). These effects were not present 1 hour after the end of epoprostenol infusion. The study was not adequately powered to determine whether epoprostenol altered the trend towards increased lactate metabolism and increased postoperative gastrointestinal permeability, nor could we demonstrate any differences between groups in clinically relevant end-points. In conclusion, these findings suggest that during normothermic CPB, small-dose epoprostenol therapy may reduce systemic oxygen consumption and splanchnic oxygen extraction.

Background It has been suspected that synthetic colloids may interfere with leukocyte adhesion by down-regulation of endothelial cell adhesion molecules. Although inhibition of endothelial inflammation might reduce leukocyte-related tissue injury, the same mechanism may be detrimental for host defense during severe infection. Regarding the widespread use of colloids, the authors performed a laboratory investigation to determine the mechanisms by which synthetic colloids interfere with leukocyte-endothelial interactions. Methods Adhesion molecule expression on native and cytokine-activated endothelium from umbilical veins was measured after pretreatment with gelatin and various preparations of dextran or hydroxyethyl starch. Inhibition of neutrophil adhesion to activated endothelium was examined in a flow chamber by perfusion of untreated and colloid-treated neutrophils over colloid-pretreated endothelium at 2 dyn/cm. Comparisons were made between untreated controls, colloid-pretreated endothelium, and colloid-cotreated neutrophils. Results Intercellular adhesion molecule 1, vascular cell adhesion molecule 1, E-selectin, and P-selectin were not attenuated by any colloid. Accordingly, colloid pretreatment of endothelium alone did not reduce neutrophil adhesion. In contrast, when neutrophils were cotreated by addition of colloids to the perfusate immediately before perfusion, adhesion decreased by 31-51% (P < 0.05) regardless of the colloid type. As indicated by the twofold increased rolling fractions, this reduction was due to an inhibition of neutrophil integrins. Conclusions This study shows that synthetic colloids inhibit neutrophil adhesion by a neutrophil-dependent mechanism rather than interfering with endothelial cell activation. This suggests that inhibition of leukocyte sequestration by volume support is a common and transient phenomenon depending on the colloid concentration in plasma.

Photocatalytic oxidation (PCO) is a promising technology for purification of biological pretreated wastewater or destruction of non-biodegradable compounds. For this reason PCO has been investigated as a last step of purification of biologically pre-treated paper-mill effluents. The influence of the parameters pH, TiO2-modification, TiO2-concentration, catalyst re-use, concentration of substances to be oxidised (wastewater quality) has been determined. The TOC of the biologically pretreated wasterwater was up to 55 mg L-1. This wastewater was treated with a previously presented aerated cascade photoreactor which was modified for batch experiments. A high specific oxidation rate of up to 0.76 g TOC m-2 h-1 as well as a complete TOC mineralization has been achieved after the optimisation of the process parameters. The complete destruction of recalcitrant compounds will offer the opportunity to reuse the wastewater in the production process. The increase of the BOD5/TOC ratio after a short irradiation period indicates the transformation of recalcitrant organic compounds to better biodegradable intermediates. The use of PCO as a pre-treatment step for the enhancement of the biodegradability of wastewater, containing recalcitrant or inhibitory compounds is an alternative to a long and energy-intensive total pollutant mineralization.

Based on results from bench-scale flow-film-reactors (FFR) and aerated cascade photoreactors, a solar catalytic pilot plant has been built at the site of a textile factory. This plant has an illuminated surface area of 50 m2 and is designed for the treatment of 1 m3 h-1 of wastewater. The preliminary results are presented and compared with a bench-scale FFR using textile wastewater and dichloroacetic acid. Equivalent degradation kinetics were obtained and it was demonstrated that the solar catalytic technology is able to remove recalcitrant compounds and color. However, on-site optimization is still necessary for wastewater reuse and for an economic application.

Die photoakustische Infrarotspektrometrie gilt als Goldstandard zur zeitgenauen Messung von Spurenkonzentrationen von Narkosegasen in der Raumluft. Zur Sicherstellung der Messprazision empfiehlt der Hersteller des Gasmonitors die vierteljahrliche bis jahrliche Kalibrierung. Wir untersuchten, ob zertifizierte Prufgase als Alternative zur kommerziell angebotenen Kalibrierung geeignet sind. Hierzu wurde ein Multigas-Monitor Typ 1302 (Bruel & Kjaer, Naerum, Danemark) an Druckflaschen angeschlossen, die Prufgase mit Analysenzertifikat enthielten. Uber ein T-Stuck mit Durchflussmessgerat war gewahrleistet, dass wahrend der Kalibrierungsphase keine Raumluft eindrang. Zur Nullpunktkalibrierung diente hochreiner Stickstoff, der kein Infrarotlicht absorbiert. Fur Des-, En-, Iso-, Sevofluran und Halothan betrugen die Referenzwerte 41,6–51,1 ml/m3 (ppm) in synthetischer Luft. Wegen Uberschneidung der Infrarotabsorptionsspektren halogenierter Kohlenwasserstoffe mit im Operationssaal gebrauchlichen Alkoholen wurde eine Querempfindlichkeitskompensation mit Isopropanol (107,0 ppm) vorgenommen. Fur N2O wurde eine 2-Punkt-Kalibrierung mit 96,2 und 979,0 ppm sowie Querempfindlichkeitskompensation mit CO2 mit Nafionschlauchen durchgefuhrt, die Fehlbestimmungen durch molekulare Relaxationsphanomene verhindern. Die Abweichung vom Sollwert betrug initial fur volatile Anasthetika 0–2,0% und stieg nach 18 Monaten auf bis zu 4,9% an. Fur N2O ergaben sich 4,2% bzw. 2,7% Abweichung. Somit erreichten wir durch unser Kalibrierungsverfahren prazise Messwerte mit geringer Anderung uber 18 Monate. Die Vorteile liegen u. a. in der Moglichkeit, die Genauigkeit des Gerates selbststandig uberprufen zu konnen, so dass individuell uber die Notwendigkeit der erneuten Kalibrierung entschieden werden kann. Die Kosten (Prufgase, Flaschenmiete, Arbeitszeit) und logistischen Aspekte (Lagerung und Gultigkeitsdauer der Prufgase) mussen im Einzelfall gegen die Kosten der kommerziellen Kalibrierung aufgewogen werden.

Study objective To determine the applicability and reliability of a screening questionnaire to detect patients at high-risk of latex allergy; to assess the importance of other allergies such as profilin allergies (pollinosis) for presence of latex sensitization; and to determine the clinical effectiveness of preemptive avoidance of latex exposure in high-risk patients. Design Prospective, clinical trial. Setting Operative theater of a university hospital. Patients 95 adult patients. Interventions Patients were preoperatively screened and classified for present latex allergy (high-risk and low-risk group) according to a specially designed screening questionnaire. Anesthesia and surgery in the high-risk group were performed strictly avoiding latex-containing materials. The low-risk group (other allergies including pollinosis) received routine treatment, without latex-avoidance. Effects of latex avoidance or exposure were evaluated by measuring specific IgE titers perioperatively. Measurements and main results According to the questionnaire, 45 patients at high risk were defined. Validity of classification of high-risk patients is supported by significantly higher total IgE and latex and grass profilin specific IgE compared to the low-risk group. There were no significant differences in other profilin-specific IgEs. In one case of severe anaphylactic reaction a drop of latex-specific IgE during surgery could be observed. Conclusion The questionnaire allowed the identification of most patients at high risk for latex allergy. In isolated pollinosis no changes in any specific IgE levels were detectable. Strict avoidance of perioperative latex exposure in high-risk patients increases safety during anesthesia and surgery.

This report describes problems arising after an arthroscopic meniscal refixation using the biodegradable Clearfix screw system (Innovasive Devices, Marlborough, MA). A serious problem arose in the form of migration of a meniscal screw that had been inserted in accordance with the manufacturer's instructions. Dislocation of the screw led to pain on the medial aspect of the knee joint and irritation of the infrapatellar branch of the saphenous nerve. The case reported here is a first analysis of the potential complications associated with the use of this meniscal refixation system.

Background: In patients with acute renal failure, the pharmacokinetics of meropenem depend on the operational characteristics of the renal replacement therapy. Dosage recommendations are based on the correlation of plasma levels with pharmacodynamic requirements. Methods: Eight critically ill patients with acute renal failure were treated by continuous veno-venous hemofiltration with a filtrate flow of 1,600 ml/h and received 500 mg of meropenem every 12 h. Plasma and hemofiltrate concentrations of meropenem at steady state were determined by HPLC. Results: Peak levels in plasma amounted to 39.5 ± 10.5 mg/l (mean ± SD) and trough levels were 2.4 ± 1.5 mg/l. The minimal inhibitory concentration (MIC) for susceptible bacteria (4 mg/l) was covered for 40% of the dosing interval or longer in all patients. The MIC for intermediately susceptible organisms (8 mg/l) was covered for 33% in 6 of the 8 patients. The elimination half-life was prolonged to 3.63 ± 0.77 h. The sieving coefficient of meropenem was 0.91 ± 0.10 and the recovery in hemofiltrate amounted to 30.9 ± 11.5% of the dose. Conclusions: A dosage of 500 mg twice daily provides appropriate serum levels for the treatment of infections caused by susceptible bacteria. A higher dosage is adequate for infections by intermediately susceptible bacteria or for renal replacement therapies with markedly higher filtrate flow rates.

Der hohe Stellenwert der transosophagealen Echokardiographie (TEE) in der perioperativen Medizin ist unumstritten. Die TEE gestattet eine direkte bildgebende Darstellung von pathologischen Veranderungen des Herzens. Daher ist die TEE das Verfahren der Wahl zur Diagnose und Graduierung von Herzklappenerkrankungen. Uber die direkte bildliche Darstellung hinaus erlaubt die TEE eine objektivierbare hamodynamische Beurteilung der Klappen- und Ventrikelfunktion. Durch Messung von Blutflussgeschwindigkeiten werden Druckgradienten uber stenotischen Klappen ermittelt. Unter Anwendung der Kontinuitatsgleichung oder der Planimetrie lassen sich Klappenoffnungsflachen bestimmen. Bei einer Klappeninsuffizienz wird der Schweregrad mittels color flow, continuous oder pulsed-wave Doppler abgeschatzt. Chirurgische Patienten sind intraoperativ mitunter grosen Schwankungen von Blutdruck, Volumenstatus und Beatmungsdruck ausgesetzt. Mittels TEE werden die Auswirkungen dieser hamodynamisch wirksamen Parameter auf die Funktion von Herzklappen erkannt. Gegenstand aktueller klinischer Studien ist daher die Untersuchung der Interaktionen zwischen Hamodynamik und Klappenfunktion mit dem Ziel, eine Verbesserung des anasthesiologischen Managements und perioperativen Verlaufs bei Patienten mit Klappenerkrankungen herbeizufuhren.