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Surgery remains the only known treatment option for rectal prolapse. Although over 100 abdominal and perineal procedures are available, there is no consensus as to which intervention is best suited for an individual. This retrospective cohort study describes the patient- and disease-related factors involved in making surgical recommendations around rectal prolapse in a single surgeon experience.91 consecutive patients ≥18 years old diagnosed with external and/or high-grade internal rectal prolapse were assessed and were prospectively entered into an IRB approved registry. Information on patient symptoms, comorbidities, exam findings, surgeon judgment, and patient preference was collected. Treatment recommendations (abdominal, perineal, or no operation) were analyzed and compared.Surgical intervention was recommended to 93% of patients. Of those, 66% were recommended robotic abdominal procedures: 75%, robotic ventral mesh rectopexies; 16%, resection rectopexies; and 9%, suture rectopexies. On univariate analysis, patients with older age, higher ASA scores, presence of cardiopulmonary morbidity, pain as a primary rectal prolapse symptom, rectal prolapse always descended, and surgeon concern for frailty and general anesthesia were associated with recommendations for perineal operations (p0.05 for all). However, on multivariate analysis, only age and concern over prolonged anesthesia remained correlated with a recommendation for perineal surgery. Of patients80 years of age, 15% were recommended an abdominal approach.With multiple options available for the treatment of rectal prolapse, treatment recommendations remain surgeon-dependent and may be influenced by many factors. In our practice, robotic ventral mesh rectopexy was the most commonly recommended operation and was offered to carefully selected patients of advanced age. Although robotic surgery and ventral mesh rectopexy may not be accessible to all patients and surgeons, this represents a single surgeon's practice bias. This study reinforces the importance of perineal procedures for higher-risk individuals.

Ultrafast charge carrier migration through all the layers of a nanojunction is observed and quantified., Metal oxide semiconductor junctions are central to most electronic and optoelectronic devices, but ultrafast measurements of carrier transport have been limited to device-average measurements. Here, charge transport and recombination kinetics in each layer of a Ni-TiO2-Si junction is measured using the element specificity of broadband extreme ultraviolet (XUV) ultrafast pulses. After silicon photoexcitation, holes are inferred to transport from Si to Ni ballistically in ~100 fs, resulting in characteristic spectral shifts in the XUV edges. Meanwhile, the electrons remain on Si. After picoseconds, the transient hole population on Ni is observed to back-diffuse through the TiO2, shifting the Ti spectrum to a higher oxidation state, followed by electron-hole recombination at the Si-TiO2 interface and in the Si bulk. Electrical properties, such as the hole diffusion constant in TiO2 and the initial hole mobility in Si, are fit from these transient spectra and match well with values reported previously.

Indoor air quality is a major contributor to the quality of people’s lives. Notwithstanding pollutants that are becoming increasingly prevalent from new building materials, furnishings and consumer products, CO2 density in educational buildings has been identified as a significant issue affecting students’ performance. This paper presents the results of monitored CO2 levels in differing educational facilities in north-east China during the winter period when windows have remained typically always closed to minimise heat loss. The negative impacts of CO2 density is demonstrated to affect students’ decision-making capabilities, and also the relevant Chinese building regulations related to the requirements of indoor air exchange have been reviewed. Finally, this research proffers practical solutions to improve indoor air quality, specifically related to CO2 density in educational buildings.

Purpose There is a clear consensus that improving energy efficiency of existing housing stock is necessary to meet the UK’s legally binding carbon emission targets by 2050. The purpose of this paper is to assess the energy saving potentials from building retrofit using an end-terrace house, similar houses represent about 30 per cent of the existing building stock in the UK. Design/methodology/approach The Salford Energy House – a unique pre-1919 Victorian end-terrace house built within an environmental chamber – was used. Retrofit modelling analysis was carried out using IESVE – a dynamic thermal simulation tool. The retrofitted model was also evaluated using future projected climate data (CIBSE latest release) to examine energy demands and overheating. Findings Findings show that improving building fabric thermal characteristics can reduce space heating demands substantially. Heating modes, set point preferences and infiltration level all have strong impact on heating demands. Space heating demand savings can be as much as 77 per cent when the property facades were upgraded to the similar requirements of Passivhaus standards. The research implicates that, for dwelling retrofit practices, a whole house holistic approach should be the preferred option to improve energy efficiency. With future climate scenarios where temperatures are potentially elevated, the heating demands can be potentially reduced as much as 27 per cent. Practical implications The likelihood of overheating in dwellings after a deep retrofit due to future elevated temperatures becomes apparent. Therefore, mitigation of overheating risk becomes a necessity for future domestic housing stock retrofit planning and policy making. Originality/value The research presented in this paper highlights the effectiveness of various retrofit measures individually as well as holistically, also the implications on energy demands and the likelihood of overheating in dwellings under future climate scenarios.

Veverimer is a polymer being developed as a potential treatment for metabolic acidosis in patients with chronic kidney disease. Veverimer selectively binds and removes hydrochloric acid from the gastrointestinal tract, resulting in an increase in serum bicarbonate. Veverimer is not systemically absorbed, so potential drug-drug interactions (DDIs) are limited to effects on the absorption of other oral drugs through binding to veverimer in the gastrointestinal tract or increases in gastric pH caused by veverimer binding to hydrochloric acid. In in vitro binding experiments using a panel of 16 test drugs, no positively charged, neutral or zwitterionic drugs bound to veverimer. Three negatively charged drugs (furosemide, aspirin, ethacrynic acid) bound to veverimer; however, this binding was reduced or eliminated in the presence of normal physiological concentrations (100-170 mM) of chloride. Veverimer increased gastric pH in vivo by 1.5-3 pH units. This pH elevation peaked within 1 hour and had returned to baseline after 1.5-3 hours. Omeprazole did not alter the effect of veverimer on gastric pH. The clinical relevance of in vitro binding and the transient increase in gastric pH was evaluated in human DDI studies using two drugs with the most binding to veverimer (furosemide, aspirin) and two additional drugs with pH-dependent solubility effecting absorption (dabigatran, warfarin). None of the four drugs showed clinically meaningful DDI with veverimer in human studies. Based on the physicochemical characteristics of veverimer and results from in vitro and human studies, veverimer is unlikely to have significant DDIs. Significance Statement Patients with chronic kidney disease, who are usually on many drugs, are vulnerable to drug-drug interactions (DDIs). The potential for DDIs with veverimer was evaluated based on the known site of action and physicochemical structure of the polymer, which restricts the compound to the gastrointestinal tract. Based on the findings from in vitro and human studies, we conclude that veverimer is unlikely to have clinically significant DDIs.

Subjective indicators of age add to our understanding of the aging process beyond the role of chronological age. We examined whether financial stress contributes to subjective age as rated by others and the self. The participants ( N = 228), aged 26–75, were from a Boston area satellite of the Midlife in the United States (MIDUS) longitudinal study. Participants reported how old they felt and how old they thought they looked, and observers assessed the participants’ age based on photographs (other-look age), at two occasions, an average of 10 years apart. Financial stress was measured at Time 1. Controlling for income, general stress, health, and attractiveness, participants who reported higher levels of financial stress were perceived as older than their actual age to a greater extent and showed larger increases in other-look age over time. We consider the results on accelerated aging of appearance with regard to their implications for interpersonal interactions and in relation to health.

This study explores the efficacy of using musical activities to enhance the character aspect of education of preschoolers in a Taiwanese school setting. The Taiwanese educational authority stipulates that character development activities should focus on the core values of caring, respect, courage, honesty, responsibility, and cooperation. Educational programs utilize musical activities to instill these understandings in children. This research used in-depth interviews with five qualified early childcare teachers who are responsible for caring for children aged 5 to 6 years old. Data derived from these interviews with teachers who participated in this study revealed six significant themes concerning the benefits of integrating musical activities into the curriculum to enhance children’s interest in character development. These themes are: “Caring for Others”; “Valuing Courage”; “Cooperation”; “Respect”; “Responsibility”; and “Honesty.” Overall, teachers reported that positive changes in students’ social interactions and behavior are fostered when the six core personal character values are incorporated into classroom instruction. Furthermore, when musical activities are combined with character development, children are better equipped to proactively address problems in their daily lives.

Background Recovery-oriented models of care are evidence based and have been shown to improve patient satisfaction and outcomes as well as decrease the percentage of readmissions to inpatient psychiatric units. Methods This quality improvement project was implemented on a 16-bed inpatient adult mental health unit in a Veterans Affairs Medical Center. Percentages of readmissions were compared throughout the course of implementation of the recovery model. Readmissions during the months of July-September were tabulated over 3 subsequent years and compared readmission percentages before recovery implementation, during the early stage of recovery implementation, and finally, during ongoing recovery implementation. Results A decrease in readmission percentages was seen with implementation of recovery-oriented care when comparing the same 3-month period over 3 years. Conclusion After implementation of recovery-oriented care measures, there was a decrease in percentage of readmissions to the unit. In addition, this decrease was sustained and was shown to improve over time as recovery-oriented programming was further developed on the unit. These data suggest that Veterans Affairs Medical Centers should consider adding tools and procedures to successfully implement recovery programming on inpatient units and efforts should include direct involvement of patients in their own recovery journey, revision of policies and procedures to reflect the importance of recovery, thorough training of frontline staff regarding recovery principles, and transfer of recovery information directly from inpatient units to outpatient providers.

Background: Management of venous thromboembolism (VTE) in patients with central nervous system (CNS) malignancies is challenging as there is an increased risk of recurrent VTE and intracranial hemorrhage (ICH). Low molecular weight heparins (LMWH) have historically been the standard of care for treatment of cancer-associated thrombosis (CAT). Current guidelines recommend direct oral anticoagulants (DOACs) for CAT treatment, but patients with CNS malignancies have limited representation in the supporting clinical trials. This multicenter, retrospective cohort study evaluated the safety and efficacy of DOACs compared to LMWH for CAT in patients with primary brain tumors or secondary brain metastases. Patients/Methods: In this multicenter, retrospective cohort study, adult patients with a diagnosis of primary brain tumor or secondary brain metastases who received either a DOAC or LMWH for CAT were evaluated. The primary outcome was the incidence of any bleeding event within a 6-month period following the initiation of anticoagulation. Secondary outcomes included incidence of recurrent VTE events, major bleeding, clinically relevant non-major bleeding (CRNMB), and minor bleeding, within a 6-month period following the initiation of anticoagulation. Patients were excluded if their indication for anticoagulation was stroke, non-cancer-associated VTE, or VTE prophylaxis, were on LMWH for one week or less while bridging to warfarin, or received a diagnosis of VTE at an outside hospital. All bleeding events were defined by the International Society on Thrombosis and Haemostasis (ISTH) criteria. Primary and secondary outcomes were analyzed using Fisher's exact test for categorical variables and Wilcoxon rank-sum tests for non-parametric continuous variables. Results: Between January 1, 2012 to October 9, 2019, one-hundred eleven patients met inclusion criteria. Of the patients who met inclusion criteria, 26 (23.4%) patients had primary brain tumors and 85 (76.6%) patients had secondary brain metastases. Bleeding events occurred in 7 of 55 patients (12.7%) in the DOAC group compared to 13 of 56 (23.2%) patients in the LMWH group (RR 0.55, 95% CI 0.24-1.27). Recurrent VTE events occurred in 3 of 55 (5.5%) patients in the DOAC group compared to 3 of 56 (5.4%) patients in the LMWH group (RR 1.02, 95% CI 0.21-4.83). Major bleeding occurred in 3 of 55 (5.5%) patients in the DOAC group, compared to 4 of 56 (7.1%) patients in the LMWH group (RR 0.76, 95% CI 0.18-3.26). There were no differences in the rates of CRNMB and rates of minor bleeding between groups. Conclusion: In this multicenter retrospective cohort study, therapeutic anticoagulation with DOACs showed no significant difference in bleeding events or recurrent VTE events when compared to LMWH, in patients with primary brain tumors or secondary brain metastases. We conclude that DOACs may be potentially safe and efficacious for VTE treatment in patients with primary brain tumors or secondary brain metastases. As prescribing practices are expected to continue to shift towards DOACs, this study provides preliminary evidence of the safety of DOACs in this high-bleeding risk patient population. Disclosures No relevant conflicts of interest to declare.

AIMS Most research into reasons for smoking among adults with serious mental illness (SMI) has focused on reasons related to SMI symptoms. The current study reports reasons for smoking and barriers to cessation that are both related and unrelated to SMI symptoms among adults with SMI. METHODS Four focus groups were conducted among current smokers receiving outpatient care for a psychotic disorder in 2017 (N = 24). Participants were asked why they currently smoke and their barriers to quitting smoking. RESULTS Smoking as a coping mechanism and to self-medicate SMI symptoms were reasons for current smoking and barriers to cessation. Avoidance of other unhealthy behaviors, routine, and enjoyment emerged as reasons for smoking and barriers to cessation that were unrelated to mental illness. CONCLUSION Consideration of factors that are both related and unrelated to SMI symptoms in smoking cessation interventions and brief cessation counseling may improve cessation success in this population.

ObjectiveWe investigated genome-wide changes in gene expression and chromatin remodelling induced by tumour necrosis factor (TNF) in fibroblast-like synoviocytes (FLS) and macrophages to better understand the contribution of FLS to the pathogenesis of rheumatoid arthritis (RA).MethodsFLS were purified from patients with RA and CD14+ human monocyte-derived macrophages were obtained from healthy donors. RNA-sequencing, histone 3 lysine 27 acetylation (H3K27ac), chromatin immunoprecipitation-sequencing (ChIP-seq) and assay for transposable accessible chromatin by high throughput sequencing (ATAC-seq) were performed in control and TNF-stimulated cells.ResultsWe discovered 280 TNF-inducible arthritogenic genes which are transiently expressed and subsequently repressed in macrophages, but in RA, FLS are expressed with prolonged kinetics that parallel the unremitting kinetics of RA synovitis. 80 out of these 280 fibroblast-sustained genes (FSGs) that escape repression in FLS relative to macrophages were desensitised (tolerised) in macrophages. Epigenomic analysis revealed persistent H3K27 acetylation and increased chromatin accessibility in regulatory elements associated with FSGs in TNF-stimulated FLS. The accessible regulatory elements of FSGs were enriched in binding motifs for nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), interferon-regulatory factors (IRFs) and activating protein-1 (AP-1). Inhibition of bromodomain and extra-terminal motif (BET) proteins, which interact with histone acetylation, suppressed sustained induction of FSGs by TNF.ConclusionOur genome-wide analysis has identified the escape of genes from transcriptional repression in FLS as a novel mechanism potentially contributing to the chronic unremitting synovitis observed in RA. Our finding that TNF induces sustained chromatin activation in regulatory elements of the genes that escape repression in RA FLS suggests that altering or targeting chromatin states in FLS (eg, with inhibitors of BET proteins) is an attractive therapeutic strategy.

Copyright © 2018 American Chemical Society. Small polaron formation limits the mobility and lifetimes of photoexcited carriers in metal oxides. As the ligand field strength increases, the carrier mobility decreases, but the effect on the photoexcited small polaron formation is still unknown. Extreme ultraviolet transient absorption spectroscopy is employed to measure small polaron formation rates and probabilities in goethite (α-FeOOH) crystalline nanorods at pump photon energies from 2.2 to 3.1 eV. The measured polaron formation time increases with excitation photon energy from 70 ± 10 fs at 2.2 eV to 350 ± 30 fs at 2.6 eV, whereas the polaron formation probability (85 ± 10%) remains constant. By comparison to hematite (α-Fe2O3), an oxide analogue, the role of ligand composition and metal center density in small polaron formation time is discussed. This work suggests that incorporating small changes in ligands and crystal structure could enable the control of photoexcited small polaron formation in metal oxides.

A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Master of Public Policy, University of Regina. v, 114 p. Indigenous and western qualitative research methods are used to examine whether there is a the relationship between Métis perspectives to increase the Métis Nation - Saskatchewan (MN-S) citizenship registry and the implementation of good governance. Good governance was operationalized by conducting a literature review that identified five universal principles of good governance in the literature. An analysis of the MN-S governance documents was completed using the universal principles of good governance. The study shows that in semi-structured conversations with Métis people about increasing the Métis citizenship registry, broader principles of governance were always implicated. It is incumbent upon the MN-S and other Métis governance organizations to cultivate good governance practices in keeping with the expectations of Métis citizenry and to meet demands for greater sophistication and skill in negotiating with the Canadian state in the rapidly changing Métis public policy landscape. The study concludes that while the experience of Métis people with colonization has been punctuated with systemic racism and marginalization through public policies, in contemporary times, Saskatchewan Métis must participate in the process of self-determination to ensure that Métis governance organizations such as the MN-S are legitimate representatives. This study also has implications for a policy on reconciliation, as the field research demonstrates that Métis perspectives invoke a much broader scope for articulating a policy on reconciliation than the current state-Indigenous dichotomy articulated by the Government of Canada. Student yes

Background With access to surgical care, >90% of today's infants with congenital heart disease (CHD) will reach adulthood. During childhood, survivors accrue a wealth of health care experience and develop strategies for navigating life with a chronic disease. Methods Seeking to learn from this individualized process, we invited adults with complex CHD to participate in narrative analysis-an established qualitative research method for studying how individuals derive meaning from their personal stories. Audio recordings of 2-4 hour free-form interviews were transcribed and iteratively analyzed to identify common themes and detect similarities or differences in language, viewpoint and interpretation. Recruitment continued until saturation was reached (n = 10). Results While each narrative was unique, CHD had a pervasive effect on the autobiography of all participants. Seven themes were discussed consistently: (1) parental/sibling relationships, (2) physical limitations, (3) embarrassment/denial, (4) memories of pediatric health care, (5) transition to adult care, (6) education and career choices, and (7) relationship and reproductive choices. While some of the recalled experiences were negative, all participants also spoke positively about the effect of CHD on their lives. Conclusions Adults with CHD provide the voices of expert witnesses; illuminating how the pediatric journey influences their identity, choices, personal relationships and adult health care interactions. These narratives could inform and improve the contemporary care of children with heart disease.

Background The purpose of this study was to estimate the unmet burden of surgically correctable congenital anomalies in African low- and middle-income countries (LMICs). Methods We conducted a chart review of children operated for cryptorchidism, isolated cleft lip, hypospadias, bladder exstrophy and anorectal malformation at an Ethiopian referral hospital between January 2012 and July 2016 and a scoping review of the literature describing the management of congenital anomalies in African LMICs. Procedure numbers and age at surgery were collected to estimate mean surgical delays by country and extrapolate surgical backlog. The unmet surgical need was derived from incidence-based disease estimates, established disability weights, and actual surgical volumes. Results The chart review yielded 210 procedures in 207 patients from Ethiopia. The scoping review generated 42 data sets, extracted from 36 publications, encompassing: Benin, Egypt, Ghana, Ivory Coast, Kenya, Nigeria, Madagascar, Malawi, Togo, Uganda, Zambia, and Zimbabwe. The largest national surgical backlog was noted in Nigeria for cryptorchidism (209,260 cases) and cleft lip (4154 cases), and Ethiopia for hypospadias (20,188 cases), bladder exstrophy (575 cases) and anorectal malformation (1349 cases). Conclusion These data support the need for upscaling pediatric surgical capacity in LMICs to address the significant surgical delay, surgical backlog, and unmet prevalent need. Type of study Retrospective study and review article Level of evidence III

Purpose: Decisions to continue or suspend therapy with immune checkpoint inhibitors are commonly guided by tumor dynamics seen on serial imaging. However, immunotherapy responses are uniquely challenging to interpret because tumors often shrink slowly or can appear transiently enlarged due to inflammation. We hypothesized that monitoring tumor cell death in real time by quantifying changes in circulating tumor DNA (ctDNA) levels could enable early assessment of immunotherapy efficacy. Experimental Design: We compared longitudinal changes in ctDNA levels with changes in radiographic tumor size and with survival outcomes in 28 patients with metastatic non–small cell lung cancer (NSCLC) receiving immune checkpoint inhibitor therapy. CtDNA was quantified by determining the allele fraction of cancer-associated somatic mutations in plasma using a multigene next-generation sequencing assay. We defined a ctDNA response as a >50% decrease in mutant allele fraction from baseline, with a second confirmatory measurement. Results: Strong agreement was observed between ctDNA response and radiographic response (Cohen's kappa, 0.753). Median time to initial response among patients who achieved responses in both categories was 24.5 days by ctDNA versus 72.5 days by imaging. Time on treatment was significantly longer for ctDNA responders versus nonresponders (median, 205.5 vs. 69 days; P < 0.001). A ctDNA response was associated with superior progression-free survival [hazard ratio (HR), 0.29; 95% CI, 0.09–0.89; P = 0.03], and superior overall survival (HR, 0.17; 95% CI, 0.05–0.62; P = 0.007). Conclusions: A drop in ctDNA level is an early marker of therapeutic efficacy and predicts prolonged survival in patients treated with immune checkpoint inhibitors for NSCLC. Clin Cancer Res; 24(8); 1872–80. ©2018 AACR.

The introduction of Quranic and Fardhu Ain courses (Kelas Al-Quran dan Fardhu Ain (KAFA) by the Department of Islamic Development Malaysia (Jabatan Kemajuan Islam Malaysia (JAKIM) is an effort to produce a generation that is moulded by the teachings of Al-Quran and Al-Sunnah. However, there are specific ḥadīths quoted in the textbook that require further attentive verification. This study seeks to verify the status of the ḥadīth mentioned in the ‘Aqīdah textbook in the eyes of the Ahlussunnah Wal Jama’ah scholars. This is because ‘Aqīda his the most important subject in Islamic studies.This research is a qualitative research which uses data analysis method, where allthe data and information obtained will be analysed using descriptive method. The method of takhrijal-ḥādīth will be applied to verify the status of the ḥadīths. This study reveals that there are six ḥadīths mentioned in the ‘Aqīdah textbook and the status of 3 of them are problematic. The origin of one of these ḥadīths isunknown while two of them are not properly narrated. This study also suggests the establishment of a committee or panel that is comprised of ḥadīth scholars/experts from the local universities in order to makesureall ḥādīths mentioned in the textbooks would adhere to the prescribed standards.

Integrative medicine and palliative medicine share many tenets. This chapter reviews integrative approaches to the most common symptoms needing palliation among geriatric patients at the end of life, including pain, nausea and vomiting, constipation, dyspnea, and fatigue. Several palliative care approaches to communication about patient goals and advance care planning for a time when the patient is unable to make decisions are described. Resources to support advance care planning are provided. Finally, issues that need to be addressed by either primary care geriatrics or in consultation with palliative care in the last weeks, days, and hours of life are described.

Flipped learning has an almost 20-year history. However, the research is as ambiguous as it has been since its inception. This pedagogical model lacks consistent results. One key component that does have an impact, but not the only factor, has been an active or dynamic component included into the learning environment. The goal of this study was to examine the impact of active learning environments compared to traditional learning environments on student learning assessments. Using non-parametric analyses, the findings in this study did demonstrate that an active learning environment increased scores on student learning assessments. This, like previous studies, demonstrated inconsistent results in that not each assessment was statistically significant. Because this model keeps appearing in the research, further studies need to address the issues to hone the model to be consistent across the research.

Background Post-thrombotic syndrome (PTS) occurs in 20-50% of patients following proximal deep vein thrombosis (DVT), despite anticoagulation treatment. The International Society on Thrombosis and Haemostasis recommends using the Villalta scale to standardize the diagnosis of PTS and to quantify its severity. However, many investigators use the Venous Clinical Severity Score (VCSS) to assess PTS. Different to the Villalta score, the VCSS was developed as a measure for chronic venous disease and not PTS specifically. The aim of the study was to determine which of Villalta and VCSS best captures clinically important PTS and PTS severity by analyzing the relationship of each to QoL scores in the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial study population. Methods A secondary analysis of the ATTRACT randomized controlled clinical trial was conducted. 621 ATTRACT patients with symptomatic proximal DVT are included in this analysis. Correlations of the Villalta and VCSS scores with QoL scores (Short-Form Health Survey-36 physical component score/mental component score [SF-36 PCS/MCS]; the Venous Insufficiency Epidemiological and Economic Study-QoL/Symptoms [VEINES-QoL/Sym] questionnaire) were examined at study visits. The correlation of the random intercept (mean scores) and random slope (rate of change of the scores) between the Villalta, VCSS and the VEINES-QoL/Sym scores was assessed using a multivariate longitudinal model. Results The mean age at enrolment was 51 years of age, 78% were white, 62% were male, the mean BMI was 32 kg/m2, 57% had iliofemoral DVT, 19% had a previous ipsilateral DVT and 93% were taking one or more anticoagulation therapies prior to randomization. The median (range) correlation coefficients across all follow-up visits for the Villalta scale and VEINES-QOL and the Villalta scale and VEINES-Sym were -0.73 (0.51, -0.73) and -0.75 (-0.50, -0.76), respectively. The median (range) correlation coefficients for the Villalta scale and the SF-36 PCS or the SF-36 MCS across all follow-up visits were -0.51 (-0.35, -0.54) and -0.31 (-0.21, -0.38), respectively. In all correlation analyses between the Villalta scale and QoL measures, correlations at baseline were the weakest, and then increased until 6 months, after which the correlation coefficients remained relatively constant. The median correlation coefficient (range) across all follow-up visits for VCSS and VEINES-QOL and for VCSS and VEINES-Sym were -0.39 (-0.37, -0.39) and -0.41 (-0.36, -0.41), respectively. The median correlation (range) between VCSS and SF-36 PCS and for VCSS and MCS were -0.32 (-0.31, -0.32) and -0.12 (-0.12, -0.14), respectively. The magnitude of the correlations remained relatively constant from 6 months to 24 months follow-up visits. The Villalta scale had a strong negative correlation with VEINES-QoL and VEINES-Sym, a moderate negative correlation with SF-36 PCS, and a weak negative correlation with SF-36 MCS. Conversely, the VCSS had a weak negative correlation with VEINES-QoL, VEINES-Sym and SF-36 PCS, and a very weak negative correlation with SF-36 MCS. Adjustment for age, sex, ethnicity, race, extent of DVT and previous ipsilateral DVT did not change our findings. Each pair of disease severity scales and QoL scales were analyzed as a multivariate outcome in a multivariate longitudinal model. A random intercept (mean scores) and random slope (rate of change of the scores) were present in all these multivariate longitudinal models. The impact of covariates (i.e. age, sex and BMI) was also examined. The Villalta score and VCSS score have a positive correlation between their random intercept and random slope. This suggests that patients with a higher average Villalta score also tend to have a higher average VCSS score (correlation is 0.74 and 0.69 if adjusted). Those that have a higher rate of change in Villalta score over time tend to have a higher rate of change in VCSS (correlation is 0.72 and 0.84 if adjusted). The impact from covariate adjustment by age, sex and BMI was minor. Conclusion For all measures, the Villalta scale has a substantially higher correlation with QOL than the VCSS. Our findings support the use of the Villalta scale to assess PTS in preference to VCSS, as it better captures the impact of PTS on patient reported QoL, a key consideration in patients with chronic PTS.

Downregulation of Rpd3, a homologue of mammalian Histone Deacetylase 1 (HDAC1), extends lifespan in Drosophila melanogaster. Once revealed that long-lived fruit flies exhibit limited cardiac decline, we investigated whether Rpd3 downregulation would improve stress resistance and/or lifespan when targeted in the heart. Contested against three different stressors (oxidation, starvation and heat), heart-specific Rpd3 downregulation significantly enhanced stress resistance in flies. However, these higher levels of resistance were not observed when Rpd3 downregulation was targeted in other tissues or when other long-lived flies were tested in the heart-specific manner. Interestingly, the expressions of anti-aging genes such as sod2, foxo and Thor, were systemically increased as a consequence of heart-specific Rpd3 downregulation. Showing higher resistance to oxidative stress, the heart-specific Rpd3 downregulation concurrently exhibited improved cardiac functions, demonstrating an increased heart rate, decreased heart failure and accelerated heart recovery. Conversely, Rpd3 upregulation in cardiac tissue reduced systemic resistance against heat stress with decreased heart function, also specifying phosphorylated Rpd3 levels as a significant modulator. Continual downregulation of Rpd3 throughout aging increased lifespan, implicating that Rpd3 deacetylase in the heart plays a significant role in cardiac function and longevity to systemically modulate the fly's response to the environment.

Purpose– The purpose of this study is to investigate the perception of knowledge workers on practice of knowledge management (POKM) as an organizational knowledge sharing enabler in an information technology shared services company to understand issues faced and provide recommendations on different technological characteristics of the system.Design/methodology/approach– The initial stage of the research involved a preliminary review of the existing knowledge management-related documents. This was followed by a top management interview to understand the organization’s business goals and knowledge management (KM) expectations. A total of 70 knowledge workers took part in the research activity. Twenty-five participants from nine departments took part in the preliminary interview, and 52 successful survey forms were collected from a total of 70 respondents. The entire investigation took close to nine months. Data compilation and research result analysis took about three months to complete.Findings– The outcomes of the research show that the quality of POKM is stable, easy to use and organization of the content is rated as good. However, POKM has poor response time and search capability. The content is found to be difficult to locate in the POKM but most participants agree that knowledge stored in the POKM is helpful, can be accessed anytime and anywhere and useful for their day-to-day job. As for the user interface, POKM is not very pleasant to use with a weak set of functions and features. For user satisfaction toward POKM, it is shown that users are not satisfied with the efficiency and effectiveness of the systems. However, employees generally are satisfied with the ease of access, download and reuse of knowledge contains in POKM. In term of perceived POKM benefits, users agree that POKM is an enabler for acquiring new knowledge and innovative ideas, managing and storing knowledge and accomplishing tasks more efficiently. Lastly, knowledge users agree that POKM functions enable knowledge networking, sharing and creation in the organization.Originality/value– POKM was launched and implemented for close to 10 years; however, the organization has failed to achieve some of the goals such as knowledge sharing among employees, creation of new skills and knowledge, measuring knowledge sharing activities and knowledge sharing strategy. The importance of this study is to understand and highlight the technological perspective of POKM from the knowledge workers. Findings will summarize issues faced by the case company for further action and remedy. The outcomes of the study also provide a comprehensive view and guideline to organizations who are interested to implement a KM system.

Background: Infants have been screened for developmental dysplasia of the hip (DDH) since the 1960s. However, changes to the national screening programme in 2008 have reduced the surveillance of DDH following the removal of the 8-month infant hip check, leaving only the 6–8 week hip check as standard. Aim: The study was to ascertain if parents/carers could be effective screeners in the detection of infant DDH using a self-check guide. Design and setting: A self-check guide for DDH was developed to enlist parents as screeners. The guide highlights common signs used to alert to the possibility of DDH or hip dislocation. It was disseminated during 2008–13 by the Royal Berkshire NHS Foundation Trust in West Berkshire, through maternity services and health centres. Results: Of those infants referred to our clinic as a result of parental screening, 73% were ‘abnormal’; of these, 33% went on to treatment with splintage. The mean age of infants was 5.36 months, and 20% of positive findings were in infants aged 7 months or over at the time seen. None went on to have open surgery. These patients represented 5–10% of the overall group of DDH-positive patients. If left undiagnosed, they may have gone on to late presentation requiring surgery as a child, or undiagnosed acetabular dysplasia and possible surgical treatment in relatively early adulthood. Conclusion: Given the right guidance, parents could assist in detecting DDH in their infant.

This comparative research paper contrasts the use of interactive whiteboards (IWB) and older models of teaching (OMT) to examine the effect of both upon children's learning attitude and their learning outcomes. This article extends the existing literature by addressing three key questions: 1.What are the reported advantages and disadvantages of integrating IWB into musical teaching and teaching without this technology? 2. How does each of these models of teaching perform in the music classroom when assessed using a standardized measurement? 3. Are there any significant differences in children's learning attitudes and learning outcomes when comparing these two models for teaching music in preschools? This study was conducted across two preschool classrooms in a regional daycare center in Taiwan. Classes were held as a ‘one off’ 50 minute lesson for the purposes of the experiment. One classroom used IWB and the other used older training methods. The research method entailed observational analysis of children's musical activity and a Likert Scale checklist was utilized to measure children's attitude towards music learning and their level of musical achievement. The participants included two head teachers, fourteen children, and five aides spread across both classrooms. Additional data were collected at the conclusion of the lesson via in depth interviews with the two classroom teachers. These interviews were intended to elicit evidence of perceived attitudinal change and validation of learning efficacy. The program of music activities used in this study offered multiple opportunities for children to improve their attitudes in the classroom while also acquiring musical skills and theory. The findings of this research showed that children are able to increase their own level of engagement and reach a high level of achievement during individual and peer play in a structured setting that is overseen by a professional. IWB and traditional methods of teaching both proved effective: it was the teacher's pedagogy, rather than technology per se, that brought about the benefits.

Objective During the course of rheumatoid arthritis (RA), fibroblast-like synoviocytes (FLS) are chronically exposed to an inflammatory milieu. The purpose of this study was to test the hypothesis that prolonged exposure of FLS to tumor necrosis factor α (TNFα) augments inflammatory responses to secondary stimuli (priming effect). Methods FLS obtained from RA patients were exposed to TNFα for 3 days and were then stimulated with interferons (IFNs). Expression of IFN target genes was measured by real-time quantitative reverse transcription–polymerase chain reaction analysis and enzyme-linked immunosorbent assay. Total STAT-1 protein and IFN-mediated STAT-1 activation were evaluated by Western blotting. Total histone levels, histone acetylation, and NF-κB p65 and RNA polymerase II (Pol II) recruitment were measured at the CXCL10 promoter (encodes IFNγ-inducible 10-kd protein [IP-10]) by chromatin immunoprecipitation assays. Results Prolonged pre-exposure of FLS to TNFα enhanced the magnitude and extended the kinetics of CXCL10/IP-10, CXCL9, and CXCL11 production upon subsequent IFN stimulation. This phenotype was retained over a period of days, even after the removal of TNFα. Prolonged TNFα exposure decreased histone levels, increased acetylation of the remaining histones, and heightened recruitment of NF-κB p65 and Pol II to the CXCL10 promoter. In parallel, an increase in intracellular STAT-1 led to amplification of IFN-induced STAT-1 activation. Conclusion Our study reveals a novel pathogenic function of TNFα, namely, prolonged and gene-specific priming of FLS for enhanced transcription of inflammatory chemokine genes due to the priming of chromatin, the sustained activation of NF-κB, and the amplification of STAT-1 activation downstream of IFNs. These data also suggest that FLS gain an “inflammatory memory” upon prolonged exposure to TNFα.

The distributive shock chapter reviews the definition, classification, epidemiology, pathophysiology, clinical manifestations, and therapeutic goals of shock. It examines the cardiovascular factors and mechanisms leading to impaired oxygen delivery and its effect on the pathogenesis of shock. It reviews the compensatory mechanisms in shock that cause symptoms and organ manifestations in patients with acute circulatory failure. This chapter also discusses the limitations and benefits of different monitoring modalities during shock management including central venous pressure, mixed venous oxygen saturation, and echocardiography. Finally, it considers therapeutic goals and treatments to restore perfusion to reverse the shock state.

New York City (NYC) is pioneering green infrastructure with the use of bioswales and other engineered soil-based habitats to provide stormwater infiltration and other ecosystem functions. In addition to avoiding the environmental and financial costs of expanding traditional built infrastructure, green infrastructure is thought to generate cobenefits in the form of diverse ecological processes performed by its plant and microbial communities. Yet, although plant communities in these habitats are closely managed, we lack basic knowledge about how engineered ecosystems impact the distribution and functioning of soil bacteria. We sequenced amplicons of the 16S ribosomal subunit, as well as seven genes associated with functional pathways, generated from both total (DNA-based) and expressed (RNA) soil communities in the Bronx, NYC, NY, in order to test whether bioswale soils host characteristic bacterial communities with evidence for enriched microbial functioning, compared to nonengineered soils in park lawns and tree pits. Bioswales had distinct, phylogenetically diverse bacterial communities, including taxa associated with nutrient cycling and metabolism of hydrocarbons and other pollutants. Bioswale soils also had a significantly greater diversity of genes involved in several functional pathways, including carbon fixation ( cbbL-R [ cbbL gene, red-like subunit] and apsA ), nitrogen cycling ( noxZ and amoA ), and contaminant degradation ( bphA ); conversely, no functional genes were significantly more abundant in nonengineered soils. These results provide preliminary evidence that urban land management can shape the diversity and activity of soil communities, with positive consequences for genetic resources underlying valuable ecological functions, including biogeochemical cycling and degradation of common urban pollutants. IMPORTANCE Management of urban soil biodiversity by favoring taxa associated with decontamination or other microbial metabolic processes is a powerful prospect, but it first requires an understanding of how engineered soil habitats shape patterns of microbial diversity. This research adds to our understanding of urban microbial biogeography by providing data on soil bacteria in bioswales, which had relatively diverse and compositionally distinct communities compared to park and tree pit soils. Bioswales also contained comparatively diverse pools of genes related to carbon sequestration, nitrogen cycling, and contaminant degradation, suggesting that engineered soils may serve as effective reservoirs of functional microbial biodiversity. We also examined both total (DNA-based) and expressed (RNA) communities, revealing that total bacterial communities (the exclusive targets in the vast majority of soil studies) were poor predictors of expressed community diversity, pointing to the value of quantifying RNA, especially when ecological functioning is considered.

The student accommodation sector in now the best-performing asset in the UK and US property markets\ud and this is projected to further accelerate, with building refurbishment of existing student accommodations being the preferred method to satisfy growing demand. However, there are no published research studies on refurbishment projects within the student accommodation sector. Refurbishment is an emergent trend to upgrade existing stock to ensure that buildings meet rising energy efficiency demands.\ud Moreover, it is widely affirmed that greenhouse gases contribute to climate change and notably\ud the built environment is a significant contributor, both through its construction and during its operation and use. This paper demonstrates through a comparative case study approach, how greenhouse gases levels can be effectively measured during refurbishment works. There are multiple metrics used for\ud quantification/assessment of greenhouse gases performance and this paper aims to make well-argued recommendations for their best use. Four student accommodation refurbishment projects are presented to compare and contrast differing emission datasets. The results dictate that project cost and duration cannot alone be used to gauge greenhouse gases emissions; more too, in the instance of student accommodation refurbishment, gross internal floor area and the number of rooms offers a more predictable indicator. It is recommended that refurbishment developers reflect on these recommendations when reporting the primary energy and GHG performance of their refurbishment works. Best practice from this research may be adopted into domestic buildings refurbishment projects.

We use transient XUV spectroscopy to measure the carrier and phonon dynamics for each atomic-species in a semiconductor or semiconductor heterojunction, giving the technique potential for table-top photovoltaic device characterization. First, the electron populations, phonon populations, and their scattering pathways are measured in the $\Delta$ , L, and r valleys of Si(100) from femtoseconds to hundreds of picosecond. Second, the Si(100) is coated with Ti0 2 and Ni to form a metal-insulator-semiconductor (MIS) junction. The Si L23, Ni M23, and Ti M23 edges are probed using XUV radiation from 20 eV to 150 eV, measuring the photoexcited charge-transfer, equilibration, and lattice dynamics for each component of the MIS junction.

© 2018 Author(s). The thermalization of hot carriers and phonons gives direct insight into the scattering processes that mediate electrical and thermal transport. Obtaining the scattering rates for both hot carriers and phonons currently requires multiple measurements with incommensurate timescales. Here, transient extreme-ultraviolet (XUV) spectroscopy on the silicon 2p core level at 100 eV is used to measure hot carrier and phonon thermalization in Si(100) from tens of femtoseconds to 200 ps, following photoexcitation of the indirect transition to the Δ valley at 800 nm. The ground state XUV spectrum is first theoretically predicted using a combination of a single plasmon pole model and the Bethe-Salpeter equation with density functional theory. The excited state spectrum is predicted by incorporating the electronic effects of photo-induced state-filling, broadening, and band-gap renormalization into the ground state XUV spectrum. A time-dependent lattice deformation and expansion is also required to describe the excited state spectrum. The kinetics of these structural components match the kinetics of phonons excited from the electron-phonon and phonon-phonon scattering processes following photoexcitation. Separating the contributions of electronic and structural effects on the transient XUV spectra allows the carrier population, the population of phonons involved in inter- and intra-valley electron-phonon scattering, and the population of phonons involved in phonon-phonon scattering to be quantified as a function of delay time.

Research works on TAM, TAM2, TAM3 and UTAUT has always focused on cognitive aspect of technology acceptance in the past two decades. Acceptance of technologies such as eCommerce, Mobile and ERP that considered emotion and affect are still less. This creates a gap in the technology acceptance research, which consider the role of affect into technology acceptance model. This study considers the role of affect of a knowledge worker that work in Multimedia Super Corridor (MSC)-status organizations in Malaysia on their behavioural intention to use knowledge sharing tools (KS tools) in their day-to-day tasks. Hence, Affective Technology Acceptance (A.T.A) model has been proposed. The behavioural intention on the acceptance of KS tools will be hypothesize in the Affective Technology Acceptance (A.T.A) model. Positive (PA) and Negative (NA) affect as the role of affect construct were introduce in this model to investigate its influence on KS tools usefulness and ease of use among employees in Multimedia Super Corridor organizations. The findings of this study highlighted that NA has no impact on perceive usefulness. The findings also showed that PA has very significant positive influence on PU, PEOU and BI with impact on PEOU being the greatest.

The mechanisms for increased cardiovascular risk in patients with Psoriasis (PsO) are unknown. Activated platelets adhere to damaged endothelium and secrete pro-inflammatory cytokines thus promoting atherosclerosis. The contribution of platelets to promote endothelial activation in PsO has not been

Lower extremity revascularization is performed to improve morbidity and quality of life in symptomatic peripheral artery disease (PAD). Unfortunately, thrombotic and bleeding complications are not infrequent in the perioperative period. Prior data from our group demonstrated the association between

An effective communication process is an important element in distributing information to various project teams. The previous study demonstrates the importance of communication in the project management process in order to encourage project delivery processes successfully. Unfortunately, the issue of communication still dominates Industrialization Building System (IBS) because the project development process are still based on traditional methods. This research aims to explore the cause of communication challenges between construction players in managing IBS projects. The research methodology implemented for this paper was a semi-structured interview approach used to investigate the communication problem. Five experienced project managers were chosen from across the industry. The findings of this study are valuable for improving the communication level of project teams, which will indirectly increase the level of the IBS project delivery process and strengthen team integration on IBS projects in Malaysia.