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Aims To provide a pathophysiological basis for distinguishing metabolic variants of the frailty phenotype in older adults with type 2 diabetes. Methods We have made an in-depth review of the possible mechanisms in diabetes, ageing and frailty that will alter allow us to describe phenotypic changes which might assist in predicting responses to particular glucose-lowering therapy. Results Our review has enable us to describe with some confidence a sarcopenic obese phenotype and an anorexic malnourished phenotype. Conclusions By identifying these two phenotypes we can predict which would be most responsive to certain classes of therapy and where therapies may be ill-advised. This represents the first novel approach in this area. Further work is being planned to develop this hypothesis. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; ••: ••-••.

Design of appropriate interaction and human–machine interfaces for the handover of control between vehicle automation and human driver is critical to the success of automated vehicles. Problems in this interfacing between the vehicle and driver have led, in some cases, to collisions and fatalities. In this project, Operator Event Sequence Diagrams (OESDs) were used to design the handover activities to and from vehicle automation. Previous work undertaken in driving simulators has shown that the OESDs can be used to anticipate the likely activities of drivers during the handover of vehicle control. Three such studies showed that there was a strong correlation between the activities drivers represented in OESDs and those observed from videos of drivers in the handover process, in driving simulators. For the current study, OESDs were constructed during the design of the interaction and interfaces for the handover of control to and from vehicle automation. Videos of drivers during the handover were taken on motorways in the UK and compared with the predictions from the OESDs. As before, there were strong correlations between those activities anticipated in the OESDs and those observed during the handover of vehicle control from automation to the human driver. This means that OESDs can be used with some confidence as part of the vehicle automation design process, although validity generalisation remains an important goal for future research.

Objective To evaluate the effect of practice duration on accuracy, retention, and confidence when learning how to tie basic surgical knots. Study design Prospective study. Sample population Fifteen first-year veterinary students. Methods Students were randomly assigned to a 2-week practice (TWP) or an 8-week practice (EWP) to learn how to tie surgeon's, strangle, and miller's knots. Students' knot-tying accuracy and confidence were evaluated immediately after training, at an intermediate time point (2-6 weeks postpractice), and at 12 weeks postpractice. Results Students who had been trained during an extended period tied the strangle knot correctly more often at all assessments (P = .025). The ability of students trained for 2 weeks to tie the strangle knot correctly decreased over time (P = .028). These students lost some confidence (P = .03) and repositioned suture more frequently (P = .03) while constructing the strangle knot at the final time point compared with students trained for 8 weeks. Students who completed TWP felt more confident at placing surgeon's knots than friction knots at the final assessment period (P = .0164 miller's knot, P = .0056 strangle knot), whereas confidence did not differ between knot types for students who completed EWP. All students felt less confident with their knot-tying skills at 12 weeks postpractice. Conclusion Training for 8 weeks rather than for 2 weeks resulted in superior knot tying skills. Students' confidence decreased 12 weeks after training. Clinical significance Prolonged distributed practice is recommended to train students for more complex tasks such as placement of a strangle knot.

In this article, we empirically examine whether the relationship between risk aversion and self-reported risk mitigating behavior is similar to the relationship between risk aversion and an objective measure of risk mitigating behavior. Despite higher levels of risk mitigation in the self-reported measure relative to the objective measure, we find risk aversion is similarly correlated with both measures of wildfire risk mitigation. These results provide some confidence in the use of self-reported behaviors in examinations of risk preferences and risky behaviors, even if the self-reports understate objective behavioral measures.

Background Cardiac arrests, although rare in Paediatrics, are extremely high-pressure, high-stakes situations. Identifying any reversible causes, commonly referred to as the 4Hs and 4Ts, is an important step in the management of cardiac arrest. Ascertaining the cause more quickly has the potential to improve our currently poor outcomes. Aim To evaluate how quickly and accurately healthcare professionals can recall the reversible causes of cardiac arrests and their ability to narrate the management of each of these. Methods Using a standardised proforma, 38 APLS providers (nurses, APNPs, junior doctors and consultants) were asked to recall the 8 reversible causes of cardiac arrest whilst being timed. Next, they were asked to describe management of each. Participants were told this was a competition and therefore asked not to discuss with others. Results Only 12 of the participants were able to recall all 8 reversible causes with their times ranging from 16 to 95 seconds. There was little correlation between seniority or experience of cardiac arrests with ability to recall all 8 causes; half of those able to recall all causes were foundation or ST1–3 level doctors. The order of recall was also recorded. Despite hypoxia and hypokalaemia being the most common causes, tamponade was the most commonly recalled (86.6%) in this survey. Qualitative data showed that overall participants were able to manage hypoxia, hypovolemia, and hypothermia with some confidence but were less able to describe management of the remaining causes. Conclusion Healthcare professionals are not always able to recall all reversible causes, and as such there is potential for delay in cause identification in emergency situations. A simple aide-memoire has the potential to improve speed of identification of cause of arrest and possibly save lives and improve outcomes. This is being developed to trial locally.

International audience; Processes and techniques used for assessing the safety of a complex system are well-addressed by safety standards. These standards usually recommend to decompose the assessment process into different stages of analysis, so called tiered safety assessment. Each analysis stage should be performed by applying recommended assessment techniques. To provide confidence in the correctness of the whole analysis, some verification techniques, usually traceability checking, are applied between two stages. Even if the traceability provides some confidence in the correctness of the decomposition, the following problems remains How to model the system behaviours at each stage of safety assessment? How to efficiently use these stages during the design process? What is the formal relationship between these modelling stages? To tackle these problems, we propose a way to specify, formalize and implement the relations between assessment stages. The proposal and its pros & cons are illustrated on a Remotely Piloted Aircraft System (RPAS) use-case.; Les procédés et techniques utilisables pour évaluer la sécurité des systèmes complexes sont bien définis par les normes de sécurité. Ces normes recommande généralement de décomposer le processus d’évaluation en différents étapes de l’analyse, dite «évaluation à plusieurs niveaux de la sécurité». Chaque étape d'analyse doit être effectuée en appliquant les techniques d’évaluation recommandées. Pour donner confiance à l’exactitude de l’ensemble de l’analyse, certains techniques de vérification, généralement la vérification de la traçabilité, sont appliquées entre deux étapes. Même si la traçabilité procure une certaine confiance dans la correction de la décomposition, les problèmes suivants demeurent: Comment modéliser les comportements du système à chaque étape de l'évaluation de la sécurité? Comment utiliser efficacement ces étapes au cours du processus de conception? Quel est la relation formelle entre ces étapes de modélisation? Pour résoudre ces problèmes, nous proposer un moyen de spécifier, formaliser et mettre en œuvre les relations entre les étapes d'analyse. La proposition et ses avantages et inconvénients sont illustrés sur un cas d'étude de système d'aéronef piloté à distance (RPAS).

The existence of fuzzy priorities is here grounded on a recent proposal for fuzzy-linguistic preference structures (Franco, Knowledge-Based Systems 70 (2014) 203), where the outcome of the decision ordering-process is a fuzzy weight for every decision object. Hence, a procedure is needed for ranking such fuzzy priorities. Here a ranking methodology is suggested based on the core and support of fuzzy weights, which represent the priority intensity for decision objects. In this way, the available evidence is evaluated according to its relative importance, allowing the inclusion of human-expert knowledge, where an automatic search is performed by computing the robustness/stability of the solution, identifying some confidence bounds for the estimated degrees of importance. As a result, building on the linguistic preference statements of experts, the system recommends informative and robust ranking-solutions.

The Global Optimiser used by Whittle Consulting has gone through three major versions to date. The first was based on the Milawa optimisation algorithm; it worked, but had many shortcomings. The second, known internally as ProberA, had a different approach to optimisation in that it used a series of random starting points and found the nearest local NPV maximum to each. It did this a sufficient number of times to give us some confidence that the best result found was close to optimal. ProberB was an enhanced version of ProberA, with the ability to handle a wider range of constraints, particularly with regard to limits on the differences in depth between adjacent areas of a pit. ProberB has been used successfully for some time now. It has produced excellent Life of Project schedules for a wide range of very large mining complexes. However, like any piece of software, it has its limitations. For example, it only copes directly with three steps—mining, processing, and blending.

The volume of data being currently generated poses various challenges for machine learning. One of these challenges is the fact that just a small portion of the data can be manually labeled by human experts. Semi-supervised learning addresses this problem by handling unlabeled data alongside labeled ones. However, if only a small quantity of labeled examples is available, the performance of the classification can be unsatisfactory. Algorithms such as co-training and tri-training use multiple views or multiple learning algorithms to improve the classification of unlabeled instances through simple majority agreement. Also, there are approaches that use less trivial voting processes such as weighted majority voting. Nevertheless, these solutions require some confidence level on the label in order to use it for training. Hence, not all information is used, i.e., information associated with lower confidence level is disregarded completely. We propose an approach called social-training, which uses all information available in the semi-supervised learning task. For this, a classifier ensemble that encapsulates multiple heterogeneous classifiers generates labels for the instances. Social-training then aggregates these results into a single label by means of social choice functions that work with rank aggregation. Our results show that working with full ranking is able to reduce the classification error for some UCI data sets.

The further refinement and re-assessment of human–elephant conflict (HEC) mitigation methods that has occurred since 2003 can be summarized into biological, physical, and governance categories. The most important distinction is between those measures applied against animals and used within the conflict zone, which are mostly used in the shorter term (except some fencing), and those measures working with people in the longer term, which rely heavily on official policy and administration often situated beyond the conflict zone. Effective HEC mitigation is difficult to understand and problematic to implement; it remains a complex package of apparently disparate measures that have to be used in combination and flexibly, at different scales, for both animals and people. Future HEC mitigation will be as much an art as a science, but since we now have a solid research foundation, we can proceed with some confidence to address the inherent sociopolitical difficulties.

This chapter reports the findings from an investigation exploring the hidden inequalities that employees with Asperger Syndrome experience in the workplace, providing new knowledge for those concerned with diversity and inclusion including HR specialists and line managers. Rich descriptions of AS characteristics raise awareness of how skills can be best utilised and accommodated and how at the same time these characteristics can also create hidden inequalities. These discussions also seek to build some confidence in AS individuals that their unique blend of skills is valuable in contemporary organisations and in roles which hitherto neither they nor HR specialists may have considered.

Background Skills in aseptic technique are essential competencies for preventing infection; yet, aseptic technique is a difficult concept to master. During urinary catheter insertion, failure to properly adhere to strict aseptic technique has been linked to infections and sepsis. This pilot study used simulation to identify the most common breaches in aseptic technique during urinary catheter insertion. Methods Baccalaureate nursing students with prior documentation of competency were recruited to demonstrate performance of urinary catheterization on a task trainer. The procedure was recorded, and breaches in technique were identified through review of the digital recordings. Results Data were available for 13 participants. Participants ranged in age from 21 to 43 years (mean, 26.6). Ten participants (77%) were female and three (23%) were male. The participants' mean self-rating of confidence was 3.6 on a 5-point scale (range, 3-5), indicating some confidence in performing the skill. Examination of the video recorded data showed that 10 participants (77%) breached aseptic technique in at least one category and in some instances several categories. The most common breach was cleansing the meatus; seven participants (54%) performed it incorrectly. Conclusions One-time competency validation using a simulator is not enough to ensure skill mastery or retention. Urinary catheter insertion is a high-risk skill and therefore should be afforded ample time to practice. Innovative approaches to ensure skill mastery, including urinary catheterization and other skills requiring sterile techniques, are needed.

Evaluation of medical students during the surgical clerkship is controversial. Performance is often based on subjective scoring, whereas objective knowledge is based on written examinations. Whether these measures correspond or are relevant to assess student performance is unknown. We hypothesized that student evaluations correlate with performance on the National Board Of Medical Examiners (NBME) examination.Data were collected from the 2011-2012 academic year. Medical students underwent a ward evaluation using a seven-point Likert scale assessing six educational competencies. Students also undertook the NBME examination, where performance was recorded as a percentile score adjusted to national standards.A total of 129 medical students were studied. Scores on the NBME ranged from the 52nd to the 96th percentile with an average in the 75th percentile (±9). Clerkship scores ranged from 3.2-7.0 with a mean of 5.7 (±0.8). There was a strong positive association between higher NBME scores and higher clerkship evaluations shown by a Pearson correlation coefficient of 0.47 (P0.001). Students clustered with below average ward evaluations (3.0-4.0) were in the 69.5th percentile of NBME scores, whereas students clustered with above average ward evaluations (6.0-7.0) were in the 79.2th percentile (P0.001).A strong positive relationship exists between subjective ward evaluations and NBME performance. These data may afford some confidence to surgical faculty and surgical resident ability to accurately evaluate medical students during clinical clerkships. Understanding factors in student performance may help in improving the surgical clerkship experience.

Aim Musculoskeletal symptoms are a common cause for presentation of children and adolescents to health-care settings. Junior doctors report lack of confidence in assessment of the paediatric musculoskeletal system. Our aim was to assess the confidence of junior medical officers (JMOs) working in the emergency department (ED) with paediatric musculoskeletal assessment and determine if a readily available teaching module would improve confidence. Methods JMOs rostered to the paediatric ED were surveyed regarding their confidence in paediatric musculoskeletal assessment at the start and end of their ED rotation. A subgroup of these JMOs received formal teaching on paediatric musculoskeletal assessment using the paediatric gait, arm, leg and spine examination as part of their protected teaching time during their rotation. Results Forty-three JMOs were considered in the final analysis. Of those, 27 received teaching (intervention group), and 16 received no teaching (non-intervention group). In the intervention subgroup, there was a trend towards an increase in confidence in paediatric musculoskeletal assessment with the commonest response prior to the teaching intervention being ‘some confidence’ (11/27 41%) and the commonest response after teaching being ‘fairly confident’ (14/27 52%) without achieving statistical significance (P = 0.068). Of the JMOs in the intervention group, 26/27 (96%) found the teaching session useful, and 25/27 (93%) considered it relevant to their future practice. Conclusions A clinical examination teaching intervention resulted in a trend towards an increase in confidence for JMOs in paediatric musculoskeletal assessment. Formal evaluation of a teaching module was feasible within the ED.

In actuality, for example, the review of the National Science Foundation and the blind peer review of doctoral dissertation in China, the evaluation experts are requested to provide two types of information such as the performance of the evaluation objects and the familiarity with the evaluation areas (called confidence levels). However, existing information aggregation research achievements cannot be used to fusion the two types information described above effectively. In this paper, we focus on the information aggregation issue in the situation where there are confidence levels of the aggregated arguments under intuitionistic fuzzy environment. Firstly, we develop some confidence intuitionistic fuzzy weighted aggregation operators, such as the confidence intuitionistic fuzzy weighted averaging (CIFWA) operator and the confidence intuitionistic fuzzy weighted geometric (CIFWG) operator. Then, based on the Einstein operations, we proposed the confidence intuitionistic fuzzy Einstein weighted averaging (CIFEWA) operator and the confidence intuitionistic fuzzy Einstein weighted geometric (CIFEWG) operator. Finally, a practical example about the review of the doctoral dissertation in Chinese universities is provided to illustrate the developed intuitionistic fuzzy information aggregation operators.

We discuss to what extent disease transmission models provide reliable predictions. The concept of prediction is delineated as it is understood by modellers, and illustrated by some classic and recent examples. A precondition for a model to provide valid predictions is that the assumptions underlying it correspond to the reality, but such correspondence is always limited—all models are simplifications of reality. A central tenet of the modelling enterprise is what we may call the ‘robustness thesis': a model whose assumptions approximately correspond to reality will make predictions that are approximately valid. To examine which of the predictions made by a model are trustworthy, it is essential to examine the outcomes of different models. Thus, if a highly simplified model makes a prediction, and if the same or a very similar prediction is made by a more elaborate model that includes some mechanisms or details that the first model did not, then we gain some confidence that the prediction is robust. An important benefit derived from mathematical modelling activity is that it demands transparency and accuracy regarding our assumptions, thus enabling us to test our understanding of the disease epidemiology by comparing model results and observed patterns. Models can also assist in decision-making by making projections regarding important issues such as intervention-induced changes in the spread of disease.

The main objective of this paper is to provide a practical test for checking system reachability under process faults. Taking into account the unappealing phenomenon of faults, it is assumed that the knowledge about them is limited, i.e. they are known up to some confidence interval. Thus, the main objective of this paper is to provide a computational algorithm that can be used for settling such a robust reachability challenge. For that purpose, very useful mathematical tools are recalled, which are called P- and block P-matrices. Subsequently, a new tool is developed, which is able to check if a given matrix is P- or block P-one. The proposed approach is characterized by low computational burden comparing to those presented in the literature. Based on it, a new reachability test is developed for systems under process faults. The final part of this paper shows experimental results, which clearly expose the effectiveness of the proposed approach.

To identify a fossil mammal or to describe a new species, paleontologists like to have good specimens of the skull, especially the jaws and teeth. However, when they want to know what an animal looks like, they need to have more of the skeleton. Unfortunately, it is rare to have both skull and limb bones of the same individual, and it may be some time before scientists can reconstruct the body with some confidence. Paleontologists can apply the tools used commonly by forensic anthropologists to reconstruct stature and body proportions from individual bones to give a better picture of the size and proportions of the australopithecines and early Homo. The bodies of early hominins did not evolve as quickly as had been believed.

Purpose: Clinicians rely on a large amount of medical knowledge when performing clinical work. In clinical environment, clinical organizations must exploit effective methods of seeking and recommending appropriate medical knowledge in order to help clinicians perform their work. Method: Aiming at supporting medical knowledge search more accurately and realistically, this paper proposes a collaboration-based medical knowledge recommendation approach. In particular, the proposed approach generates clinician trust profile based on the measure of trust factors implicitly from clinicians' past rating behaviors on knowledge items. And then the generated clinician trust profile is incorporated into collaborative filtering techniques to improve the quality of medical knowledge recommendation, to solve the information-overload problem by suggesting knowledge items of interest to clinicians. Results: Two case studies are conducted at Zhejiang Huzhou Central Hospital of China. One case study is about the drug recommendation hold in the endocrinology department of the hospital. The experimental dataset records 16 clinicians' drug prescribing tracks in six months. This case study shows a proof-of-concept of the proposed approach. The other case study addresses the problem of radiological computed tomography (CT)-scan report recommendation. In particular, 30 pieces of CT-scan examinational reports about cerebral hemorrhage patients are collected from electronic medical record systems of the hospital, and are evaluated and rated by 19 radiologists of the radiology department and 7 clinicians of the neurology department, respectively. This case study provides some confidence the proposed approach will scale up. Conclusion: The experimental results show that the proposed approach performs well in recommending medical knowledge items of interest to clinicians, which indicates that the proposed approach is feasible in clinical practice.

A survey was developed to benchmark the affective sustainability characteristics of an incoming cohort of students in a Polytechnic in New Zealand, with the intention to monitor changes in these attributes as the students experience higher education over subsequent years. The survey contained a number of research instruments as we were interested in exploring how best to record these attributes. This article reports on the comparative efficacy of four of these instruments in describing the affective characteristics of the students. All the instruments depended on respondents’ self‐reporting in the absence of researchers or interviewers. The results do encourage us to have some confidence that students’ sustainability characteristics may be researched using a variety of survey‐based research instruments, and particular confidence in ongoing use of the Revised New Ecological Paradigm (NEP) scale.

There is strong evidence to support the clinical use of low-intensity pulsed ultrasound (LIPUS) to augment fracture healing. A previous experimental study showed that ultrasound can propagate in the joint space of a single human cadaveric knee. A full experimental investigation of this propagation is not possible due to poor reproducibility, the scarcity of human cadaveric tissues and the practical difficulties in making ultrasound measurements in the knee. The aim of the present work is to investigate whether a computer simulation (Wave2000 Pro®; Cyberlogic Inc., New York, NY, USA) can give a good representation of the experimental model. The simulations provided a good agreement with the experimental data, giving some confidence in the application of this computer simulation method as a means of determining whether ultrasound can propagate through different anatomical regions where bone is present. (E-mail: hcs8dw@leeds.ac.uk )

Objectives: Spinal cord stimulation devices control energy by generating either constant voltage (CV) pulses or constant current (CC) pulses. This study aimed to investigate: 1) whether patients feel differences between CV and CC stimulation; 2) if patients prefer CV or CC stimulation. Methods: Fourteen patients blinded to the type of pulse generation received 20 randomized pairs of 15-sec pulse trains (CC-CV, CV-CC, CV-CV, or CC-CC). Patients identified whether the pairs were the same or different, and if they preferred the first or second train. Results: There was no difference in charge-per-pulse input between CV and CC modes. Patients performed at chance level in identifying identical pairs (55.7 ± 24.1% correct, 10 trials), and slightly better in identifying different pairs (67.1 ± 25.2% correct, 10 trials). No patients correctly identified all pairs. Patients were categorized based on their performance in this task. Only three patients fell into a category where preference could be established with some confidence with respect to the group averages. Two of these patients preferred CV, while one patient preferred CC. Conclusion: The lack of patient ability to discriminate in this preliminary investigation suggests that patient preference for a stimulation type should not be the key determining factor in choosing a spinal cord stimulation system.

Debate on the major changes faced in the past decade by Italy’s manufacturing industry, is traditionally fairly rich. No final opinion has yet been formulated to lead the way forward, also due to sometimes conflicting economic indicators. The article seeks to provide an overall and integrated review of these indicators, with a focus on productivity and competitiveness, especially given the latest revisions made by the National Institute of Statistics (ISTAT). The authors suggest that hard data have often resulted in an underestimation of Italian industry performance and that the indicators are likely to be further revised. Starting with the widening gap between constant and current prices Italy’s share on the world export market, we suggest that the incomplete adjustment of deflators for quality improvement tend to undervalue what is termed as an industrial and then productivity upgrading. This detail is not a negligible factor when called to evaluate the outlook for Italian enterprises beyond the current recession. Our analysis yields some confidence on the opportunity to further sustain an industrial model that, while fairly unconventional among the OECD countries, is not necessarily outdated.

This article describes the use of a performed persona as a device in cross-cultural design activities. The device serves to elicit knowledge and manage expectations in the context of participatory design workshops to explore the purpose and function of a tool for tracing the supply chain of ethical goods from producer to consumer. The use of the method with the staff of a wine producer in Chile is analyzed and the benefits and challenges identified in using the form live in workshops. The authors conclude that the device offers potential but also requires some confidence and skill to invoke.

Temporary brittle bone disease is the name given to a syndrome first reported in 1990, in which fractures occur in infants in the first year of life. The fractures include rib fractures and metaphyseal fractures which are mostly asymptomatic. The radiological features of this disorder mimic those often ascribed to typical non-accidental injury. The subject has been controversial, some authors suggesting that the disorder does not exist. This study reports five infants with typical features of temporary brittle bone disease in whom all or most of the fractures took place while in hospital. A non-accidental cause can be eliminated with some confidence, and these cases provide evidence in support of the existence of temporary brittle bone disease.

A catchment area-based sample of patients recruited for an eating disorder treatment trial was compared with patients from the same geographical area seen in the 12 months before and after the trial. The three samples were very similar. The research sample was representative of the usual clinic sample from which it had been selected and thus the results could be extrapolated with some confidence to other similar clinical settings. It is concluded that whilst treatment trials, by their very nature, have explicit and implicit inclusion and exclusion criteria with appropriate designs they can be usefully representative.

Udgivelsesdato: 2009 For centuries tumors have been described which today with some confidence can be diagnosed as craniopharyngiomas. It was not until 1904 Erdheim described what he called 'hypophysial duct tumors', and which Cushing later gave the name craniopharyngioma. The first operation for this neoplasm took place in 1909. It soon became evident that the outcome of surgery was rather dismal with high mortality and morbidity rates-even after corticosteroid therapy became available around 1950. Radiotherapy was introduced and later refined as radiosurgery. This paper presents a short survey of the accumulation of knowledge of craniopharyngiomas.

Six different methods to calculate the Strain Index (SI) scores for jobs with multiple forces/tasks were developed. Exposure data of 733 subjects from 12 different worksites were used to calculate these SI scores. Results show that using different SI computation methods could result in different SI scores, hence different risk level classifications. However, some simpler methods generated SI scores were comparable to the more complicated composite SI method. Despite differences in the scores between the six different SI computation methods, Spearman rank-order correlation coefficients of 0.61-0.97 were found between the methods. With some confidence, ergonomic practitioners may use simpler methods, depending on their specificity requirement in job evaluations and available resources. Some SI computation methods may tend to over-estimate job risk levels, while others may tend to under-estimate job risk levels, due to different ways used in obtaining the various SI parameters and computations.

The paper presents the Fun Toolkit (v3), a survey instrument that has been devised to assist researchers and developers to gather opinions about technology from children. In presenting the toolkit, the paper provides a reflective look at several studies where the toolkit has been validated and considers how the Fun Toolkit should be used as well as discussing how, and in what way, the instruments contained within it should be employed. This consideration of use is one of the novel contributions of the paper. The second major contribution is the discussion based around software appeal; in which the fit between the Fun Toolkit and usability and engagement is explored. The paper concludes that the Fun Toolkit is useful, that it can be used with some confidence to gather opinions from children and that it has the potential for use for other user experiences.

In the USA, the big push against acute leukaemia in the 1950s, led by the National Cancer Institute (NCI), had led to network of interconnected centres, experimentally testing models of the disease and trialling drug regimes in a programme that, by the early 1960s, included patients who had survived over five years since diagnosis. As we saw in the last chapter, with the major breakthrough using combination therapy in 1964, acute leukaemia began to look curable for some children (Freireich et al., 1964). A number of these cooperative groups launched chemotherapy trials for children with solid tumours alongside those for leukaemia, and published reports of incremental or dramatic increases in survival lengths and rates of cure for many of the most virulent cancers affecting children through the 1960s.1 By the end of that decade, researchers and clinicians could state with some confidence that childhood cancer research in the USA was well organised and delivering improved outcomes for patients suffering many of the paediatric malignancies.

Coming to the end of writing up your research you deal with some of those so what questions in relation to your PhD. At this point, you have shown that you are able to design a research program at postgraduate research level and carry it out, but there is more to do. You will discuss the new knowledge that you have generated with some confidence, showing its significance really has been as you suggested at the outset, and has a place in the wider literature in the field under study.

In the Baltic and the North Sea area the collection of sidescan sonar data began in the early 1970s. Although positioning systems at that time were much less accurate than today, such analogue data archives are a valuable source of comparison for estimating spatial and temporal changes in sediment patterns. This paper describes how geographic information systems (GIS) and remote sensing methods are being applied for more accurate positioning and geometric correction of analogue sidescan sonar profiles geo-referenced by the DECCA navigation system (DNS). A 20 km(2) area in the North Sea, where even after 25 years a complicated sediment pattern has only changed slightly, was selected for the comparison. Data from two sidescan sonar surveys, one from 1977 and the other from 2002, were available. The 2002 data, acquired with a positioning accuracy of estimated 25 in, were mosaicked using modern digital processing techniques. This dataset was used to estimate positioning errors in the analogue sidescan sonar profiles of 1977. After the application of a geo-referencing method of,rubber sheeting' based on an irregular network of ground control points to generate a mosaic of the analogue profiles, positioning errors of 211 m in the E-W and 98 in in the N-S directions were obtained. The positioning error of the DNS calculated from equations provided by the DECCAN Navigator Company for this area, was as large as 200 m for the 'purple' station transmission, 197 m for the 'green', and 66 m for the 'red' one. Consequently, we conclude that the observed positioning errors were mainly caused by systematic deviations of the DNS rather than simplifications used in our methodology. Since such large errors can be corrected locally with some confidence, analogue sidescan profiles geo-referenced by DNS can be used as a significant source of information after digital image processing at appropriate map scales. (c) 2006 Elsevier Ltd. All rights reserved.

Thyroid hormone (TH) is essential for normal brain development; therefore, any environmental chemical that interferes sufficiently with thyroid function, TH metabolism, or TH action may exert adverse effects on brain development. Important known differences in aspects of thyroid endocrinology between the fetus, infant, and adult allow us to identify age-dependent vulnerabilities to thyroid toxicants with some confidence. These differences include the size of the hormone pool stored in the thyroid gland at different ages as well as the age-dependent sensitivity to mild TH insufficiency. Several recent studies that describe risk assessments of the environmental contaminant, ammonium perchlorate, provide good examples of conclusions based on the selective consideration of these known aspects of the thyroid system. Specifically, authors who consider age-dependent differences in thyroid endocrinology suggest that safe levels of perchlorate should be set at relatively low levels (low parts per billion). In contrast, authors who do not consider these known age-dependent differences in thyroid endocrinology recommend safe levels of perchlorate at high (hundreds) parts per billion to parts per million. Emerging evidence indicates that a variety of high production volume chemicals can directly interact with the TH receptor. As testing paradigms are designed by regulatory agencies, these age-dependent differences in thyroid endocrinology must be considered.

The utility of stable oxygen isotope analysis for demonstrating human migration has been developed and demonstrated on archaeological human populations. The application of this approach to tracking human movement has seldom been applied within forensic science. This paper gives results from a stable oxygen isotope assessment of extant modern human and horse enamel δ18O values recovered from tooth enamel. The human and horses were all constrained to known geographic locales for the period of tooth formation and compared to UK and global precipitation values for δ18O. It was found that human and horse values track one another and horse can be used with some confidence as a human proxy. UK values were constrained geographically and outlier values to the UK were identified between Iceland and the Sudan. For application within the realm of forensic science more research is required to understand the regionalized contribution of hydrology to a catchment and the potentially confounding contribution of mi...

A language of formal proteins, the κ-calculus, is introduced. Interactions are modeled at the domain level, bonds are represented by means of shared names, and reactions are required to satisfy a causality requirement of monotonicity.An example of a simplified signalling pathway is introduced to illustrate how standard biological events can be expressed in our protein language. A more comprehensive example, the lactose operon, is also developed, bringing some confidence in the formalism considered as a modeling language.Then a finer-grained concurrent model, the mκ-calculus, is considered, where interactions have to be at most binary. We show how to embed the coarser-grained language in the latter, a property which we call self-assembly.Finally we show how the finer-grained language can itself be encoded in π-calculus, a standard foundational language for concurrency theory.

Asia Pacific, with its huge variety of markets and appetite for power, telecom, infrastructure, and other types of project finance, has reflected a wide range of credit loss experiences recently, each with lessons to be learned. As usual, equity has borne the brunt. As a result, some sponsors have left the scene but other, new ones have stepped in. Meanwhile, from a debt provider9s point of view, only in the submarine cable asset class has material provisioning been necessary. There is thus reason for some confidence when structuring new project finance business in the region going forwards.

We made this report with a view to clarifying the effects of group counseling with visual aids for railway workers enjoying improved health conducted as a part of prevention activities for lifestyle-related diseases such as diabetes. We employed the use of visual aids including slides, samples of blood and the measurement of vascular age on diabetes, and carried out group counseling to improve the interest, knowledge and realization of diabetes and lifestyle. This group counseling was carried out both with and without visual aids. A comparative study of the immediate effects mediated by the use or absence of visual aids was conducted. The workers who accepted our study and cooperated with us totaled 1054 (the average age was 43 +/- 11.2). We divided them at random into the object group and comparative control group and two months later we were able to analyze 190 people among them who could be traced and followed up. As a result of using visual aids, the workers showed much more interest and realization of diabetes and their lifestyles (p < 0.05), and a lower learning decline than the group without visual aids in retention of this knowledge. On the other hand, we have not yet seen improvement in the physical data through group counseling. It is possible that the medical examination data taken beforehand for the object group and the comparative control group were both within the normal range, or the follow-up period was short at only two months after the group counseling was conducted. We conclude that the use of visual aids could lead to a change in consciousness among workers having some confidence in their health as the result of group counseling.

While electricity distributor works are exempt from compliance with AS/NZS 3000 under most circumstances, all of the electrical installations connected to the network do have to comply. AS/NZS 3000 requires automatic disconnection under both over current and earth fault conditions. Compliance with automatic disconnection under earth fault conditions is often measured by earth fault loop impedance, but this is only part of the picture. In any fault current analysis there needs to be some confidence in the impedance of the upstream network. The designers, contractors and inspectors are using assumptions to assess their compliance in a self regulated industry, and some of these assumptions may not be valid. This paper discusses the confidence limits and the impact on contractors and installers complying with AS/NZS 3000.

Online Material: Specifications for the standard earthquake simulator input and output files. An earthquake simulator is a computer program that simulates a long sequence of earthquakes, which may range from tens of thousands of years up to millions of years. Different simulator codes have different input requirements, but in general the inputs to a simulator program include the fault system geometry, fault slip rates, rake angles, friction parameters, initial stress state, and elastic parameters. The output from a simulator program is a list of events, each of which is characterized by time, location, magnitude, rupture area, mean slip, stress change, and, optionally, a map that shows the distribution of slip over the fault surface. It is challenging to demonstrate that an earthquake simulator program is reliable, in the sense that it produces a simulated history whose statistical properties are similar to the properties of real earthquake sequences. The Southern California Earthquake Center (SCEC) Earthquake Simulator Comparison Project addresses this challenge by comparing the results from five different earthquake simulators with each other and, to the extent possible, with what is known about real earthquakes (Tullis et al. , 2012a). The five simulators are independently developed, so agreement among the simulators can provide some confidence in their reliability. To carry out the comparison, it is necessary for each simulator code to receive precisely the same inputs. It is also necessary for each simulator code to generate output in the same format, so that output from all the codes can be analyzed by the same set of statistical tools. We have achieved this by designing standard file formats for transferring data into and out of simulator codes. Although the standard files are formatted as ASCII text and are human‐readable, they are intended primarily for transferring data from one computer program to another. …

Experimental measurements and simulations of a granular flow system have been compared in detail. Positron emission particle tracking (PEPT) was used to study the motion of glass beads in a vertical axis mixer with slowly rotating flat blades. Unlike conventional techniques which are restricted to measuring the flow at the surface or a transparent wall, PEPT revealed the motion of material throughout the entire bed. The flow produced was three dimensional with vortices, and is more complicated than other granular flows that have been described previously. Discrete element method (DEM) was employed to simulate the same system using various sets of parameters for the bed material. As there are extensive three-dimensional flow data from both the experiment and the simulations, it has been possible to make comprehensive quantitative comparisons. This enabled the accuracy of the sets of assumptions for the DEM simulations to be examined. The simulations predicted the overall motion of the bed well. However no one set of assumptions was best, but that different sets predicted the detailed motion more accurately in different parts of the bed. None the less, it is evident that DEM models can now be used with some confidence to explore mixer design and performance.

One of the obstacles to applying neural networks in industry is a lack of confidence in model predictions. Although neural networks are very powerful and flexible for mapping non-linear relationships between the input and output, it is often the lack of assurance in their prediction which prevents their use in engineering applications. Recently, there has been increased interest in tackling this lack of confidence by adding some confidence bounds on predictions. In this paper a methodology of establishing the confidence bound using an ensemble of neural network models will be presented. There are several other advantages of using an ensemble neural network model instead of a single neural network, among these being the improvement of the overall prediction accuracy, the smoothness of the response surface and generalisation ability. The ensemble modelling approach will be demonstrated by an example application to mechanical property prediction for steel products. Initial results are promising, with the confidence bound consistent with metallurgical experience.

The research described in this paper uses panel data recently made available from the Australian federal government's Business Longitudinal Survey. The objective is to devise a convenient means for reliably classifying manufacturing SMEs as to their most likely future development pathway on the basis of measured values for key enterprise age, size and growth variables. Some success is reported in employing relatively simple logistic regression modelling to replicate the author's previous assignment of manufacturing SMEs to certain dominant development pathways over time using more cumbersome exploratory cluster analysis. This success is, however, limited to distinguishing high growth SMEs from other concerns. Nevertheless, the logistic regression models presented should allow other researchers and also policy-makers with the necessary data to identify with some confidence and relative ease the high growth manufacturing SMEs of greatest economic significance.

This paper looks at the performance of plain, longitudinally and transversely grooved journal bearings. An experimental apparatus was created to test the performance, in terms of frictional torque under static and dynamic loading, of each of the three bearing types, to try and understand whether grooving created a different film thickness. The tests were carried out for various combinations of load and speed. The results showed an agreement between theoretical and experimental values that gave some confidence in the experimental methods, and showed the frictional torques between the plain and longitudinally grooved bearings to be similar at all loads, and at lower rather than higher speeds, while those of the transversely grooved bearing differed from the others.

While new cytochrome P450 (CYP450) enzymes continue to be identified, it is now possible to predict with some confidence the total number of human CYP450 enzymes. This review is an update of the CYP450 superfamily of drug metabolising enzymes. It comprises a brief history of CYP450 research, outlines the standard P450 nomenclature system, and describes CYP450 multiplicity, structure and function. J Pharm Pract Res 2008; 38: 55-7.

Tests are reported on two thickness of square hollow cross-section mild steel tubes under lateral quasi-static and dynamic loading at two spans and under fully-clamped and simply-supported end conditions. The overall purpose was to understand the collapse mechanism and the relationship between energy absorption and tube deflection. The dynamic tests were carried out at impact velocities upto 6 m/s using a cylindrical steel indentor. The finite element code DYNA3D was used to conduct numerical simulations based on the experiment setup. Overall, the numerical simulations predicted the deformed shape of the tube well and gave accurate estimates of the force and velocity time histories of the simply supported tubes. The difference in both the mode of deformation and the energy absorption rate between the quasi-static and these relatively low velocity dynamic tests was quite small and the quasi-static results could therefore be used with some confidence to approximate the dynamic response.

You’ve crossed the halfway point! Congratulations. You now have four gizmos under your belt and you’re about ready to begin building the fifth. Hopefully at this point you’re starting to gain some confidence in your hardware skills. Patience is always a good idea when building gizmos, and so is carefully observing where components are inserted and where the wires go that are used to connect everything.

Optical second-harmonic and sum-frequency generation at surfaces and interfaces is discussed and recent work reviewed. Examples from well-characterized interfaces are emphasized and particular attention is paid to spectroscopic studies which have recently become simpler due to the availability of tuneable broad band laser sources. It is shown that the techniques are now well understood at the phenomenological level and, although theoretical calculations are proving to be difficult, interfaces not accessible to conventional surface techniques can now be studied with some confidence.

This paper addresses one of the most significant changes that is taking place with respect to the food and beverage area in hotels, that of contracting out operations to external operators, whether individual restaurateurs or branded restaurant chain names. This development is widely regretted by many traditionalists but represents a reality in north America and, increasingly, in the United Kingdom as well. This paper considers the current situation in north America and the UK and reports the findings of a survey of individual hoteliers and corporate interests in both localities. The survey sought information on current attitudes to contracting out within the hotel industry and mixed responses are reported here. What can be reported with some confidence is that this practice will continue to grow in both locations.

This study aimed to assess the dietary advice practice of UK and New Zealand (NZ) adult gastroenterologists in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).A questionnaire regarding dietary advice practice was emailed or mailed to all members of the British Society of Gastroenterology (n=983) and the NZ Society of Gastroenterology (n=54).363 questionnaires were returned in the UK (response rate 37%) and 51 in NZ (94%). More respondents gave specific dietary advice to more than 25% of their patients on IBS than IBD (84% vs 27% UK, 90% vs 55% NZ; p=0.001 for both) and gave advice about dietary exclusions to more than 25% of patients on IBS than IBD (61% vs 13% UK, 77% vs 14% NZ; p0.001 for both). They were most likely to provide dietary advice to patients with small bowel Crohn's disease, difficult to control IBD, diarrhoea predominant IBS and difficult to control IBS. The majority of respondents agreed strongly or a little that dietary exclusion was effective in the treatment of IBS, compared to the minority in IBD (71% vs 39% UK, 84% vs 43% p0.05 for both).UK and NZ gastroenterologists give dietary advice more commonly to IBS than IBD patients. The majority of gastroenterologists have some confidence in the use of dietary exclusion in IBS, the converse is true in IBD. However, the advice given is largely empiric and mostly comprises the exclusion of fibre, dairy and wheat.

Barnett expresses concerns about a potential bias in our article (Hwang et al. 2011) related to use of a fixed study period based on the date of delivery: on average a shorter duration of gestation among stillbirths compared to live births in combination with seasonal variation of exposure. We acknowledge the complexity of assessing effects of exposure with seasonal variation on the risk of stillbirth and thank Barnett for his suggestion to avoid a possible bias, which he with his colleagues illustrated through simulations of a retrospective cohort study (Strand et al. 2011). We reanalyzed the data, excluding case and control subjects following Barnett’s suggestion to quantify the “fixed cohort bias.” This led to loss of approximately 4.7% (4,480/102,575) of the subjects. The point estimates were similar with those from the original analyses, but some confidence intervals became wider (Table 1). This shows that the role of the fixed cohort bias was minimal in our study. Table 1 Adjusted ORs (95% CIs) for stillbirth by average pollutant concentrations, by trimester and for the whole pregnancy (single pollutant models), following Barnett’s suggestion to address the “fixed cohort bias.”