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Personal connection and social interaction are vital components of health throughout the lifespan. Loneliness and social isolation among the older adult population impacts both physical and mental health negatively. Analysis of published research demonstrates the importance of considering the use of different social technology platforms to foster opportunities for social support among family and friends. Researchers noted an increased relevance of the need for social technology in residential living facilities with the emergence of the COVID-19 pandemic and social distancing. The study aims to investigate the impact of social technology, via Sherish℠ Connect on older adults’ reported levels of loneliness and social isolation within a residential living facility. The seven participants used Sherish℠ Connect, a television-based photo-sharing application, for a minimum of one month prior to data collection. Data was collected via survey responses and medical records review to determine the effect of the Sherish℠ Connect intervention on participants’ perceived loneliness. Six participants reported using Sherish℠ Connect weekly or daily. All participants reported Sherish℠ Connect provided comfort. Social technology platforms offer an opportunity for social support among family and friends. Sherish℠ Connect, given a larger sample and increased duration of use, has the potential to combat loneliness and social isolation and provide comfort for older adults. Researchers hope this study provides baseline research that inspires additional studies investigating Sherish℠ Connect. The utilization of social technology adds value to occupational therapy intervention for mental health and social participation, particularly during the unprecedented time of COVID-19.

E10 is a blend of 10% bioethanol and 90% gasoline that can be used in the engines of most cars without causing damage. Currently for the E10 blend, Jamaica imports gasoline from Trinidad & Tobago and bioethanol from Brazil because the bioethanol production in Jamaica is at an early stage. However, the country has great potential for bioethanol production. In order to assess the environmental and economic feasibility of bioethanol in Jamaica, this paper presents an economic and environmental life cycle assessment for a case study in Jamaica in two different scenarios. The Baseline Scenario represents the use of E10 in the current conditions in which bioethanol comes from Brazil and gasoline from Trinidad & Tobago. Scenario I represents the use of E10 with bioethanol from Jamaica and gasoline from Trinidad & Tobago. The comparative environmental life cycle assessment revealed that the Baseline Scenario had better results than Scenario I in ten environmental categories. The economic assessment results in Scenario I were 7% higher than in the Baseline Scenario. Hence, the current context (Baseline Scenario) was identified as the scenario with the best economic performance. Therefore, the current situation in Jamaica (Baseline Scenario) scored better results than Scenario I from an environmental and an economical point of views. It is recommended to increase the bagasse cogeneration of Scenario I to lower the environmental impacts. To improve their productivity, it is necessary to improve the Jamaican sugar infrastructure by combining molasses and cane juice to produce bioethanol. Publicado

In a large organization, learning and forgetting may occur at different rates at the various levels of the organization. Recently, it has been shown that a multiple-level learning model works effectively for the accurate measurement and prediction of learning and forgetting in such an organization. Due to a lack of sufficiently detailed data at each organizational level, however, it is often necessary to use the conventional aggregated single-level model to estimate the learning and forgetting of the entire organization. In such an approximation, the potentially different impacts of learning and forgetting at different levels of the organization is not explicitly considered. This paper investigates the accuracy of this single-level approximation. The single-level approximation, of course, cannot be used to explain how the learning and forgetting occur at various levels of an organization. However, numerical experiments based upon the Liberty ships dataset show that the single-level approximation can provide surprisingly good estimates of the organization’s key performance measure, e.g., production time per unit. It can therefore yield good estimates of the learning and forgetting rates aggregated for the entire organization, and these estimates can be used to compare the performance of one organization to another. The single-level approximation is shown to perform particularly well when the data exhibit a large amount of dispersion, the number of units used for fitting is large, the learning occurs slowly, or the forgetting rate is high.

The Seeded and Natural Orographic Wintertime Clouds: The Idaho Experiment (SNOWIE) project aims to study the impacts of cloud seeding on winter orographic clouds. The field campaign took place in Idaho between 7 January and 17 March 2017 and employed a comprehensive suite of instrumentation, including ground-based radars and airborne sensors, to collect in situ and remotely sensed data in and around clouds containing supercooled liquid water before and after seeding with silver iodide aerosol particles. The seeding material was released primarily by an aircraft. It was hypothesized that the dispersal of the seeding material from aircraft would produce zigzag lines of silver iodide as it dispersed downwind. In several cases, unambiguous zigzag lines of reflectivity were detected by radar, and in situ measurements within these lines have been examined to determine the microphysical response of the cloud to seeding. The measurements from SNOWIE aim to address long-standing questions about the efficacy of cloud seeding, starting with documenting the physical chain of events following seeding. The data will also be used to evaluate and improve computer modeling parameterizations, including a new cloud-seeding parameterization designed to further evaluate and quantify the impacts of cloud seeding.

Statement of purpose It is recommended that children over age eight continue to use a booster seat until they fit properly into an adult seatbelt. ‘Boost ‘em in the Back Seat’ is a video intervention informing parents about this recommendation and is empirically supported to increase booster seat use. The present study aimed to evaluate key elements of the video. Methods/Approach Parents participated in one of two study arms: virtual focus groups (3 groups, n = 23) or an online survey (n = 28); both examined knowledge of booster seat recommendations and perceptions of the ‘Boost ‘em in the Back Seat’ video. All participants viewed the video and provided feedback. Qualitative data from both study arms were analyzed using NVIVO software and common theme analysis, and descriptive survey data were analyzed using SPSS. Results Almost half of survey parents (42.9%) were unaware of current booster recommendations. Thematic analysis revealed that parents found the narrative approach of the video impactful. Parents preferred male expert’s perspectives, found some medical language too technical, and had mixed reactions to the realistic crash scene. Parents felt the length of the video (4-minutes) was too long, but felt that the novel information, seeing the incident from the mother’s viewpoint, inclusion of local talent/settings, and the cinematography distinguished the video from others. Conclusions Parents find the ‘Boost ‘em in the Back Seat’ video impactful and provided helpful feedback regarding how the video could be modified such as excluding certain actors, shortening the introduction, and using less technical language. Significance Parent feedback was helpful in determining which elements of the video are essential for persuasive effect. This will inform how to best translate the message to other uses, such as static media or a shorter video, as we continue to work toward improving child occupant protection.

The history of chestnut production in Michigan begins with hobbyists or small farm growers who decided to begin a commercial industry by planting Chinese chestnut seedlings. The American chestnut was never prevalent in Michigan and it was not known how the Chinese chestnut trees would grow and produce in this northern state. Many of these early growers followed protocols predicated on model chestnut farms established in other states such as Ohio and Pennsylvania. Years later, Michigan State University researchers were contacted as growers began to question the lack of chestnut production in their orchards. It was discovered that few of the seedling trees actually produced chestnuts and that the lack of size made the Michigan chestnut less commercially desirable. Being a seedling tree also meant that it took longer for the trees to mature and produce chestnuts. Researchers suggested planting European × Japanese hybrid cultivars that growers on the west coast of North America were growing. Some of these cultivars performed much better than the Chinese chestnut seedling trees and went into production faster and with larger nuts. Once several growers switched or established orchards of European × Japanese hybrid cultivars, yields increased, a cooperative was formed and a commercial chestnut industry quickly developed. Growers can now expect to produce 2,500-5,000 kg chestnuts ha-1. To reach this achievement, several challenges have been encountered. These challenges include chestnut blight, internal kernel breakdown, insect pests, spring frost events, winter injury and death, production of enough nursery stock, harvesting issues, storage rots, marketing avenues, and return on investment. How we dealt with these challenges will be discussed.

Cogeneration from sugarcane bagasse in Jamaica represents a significant opportunity to reduce CO2 emissions and its dependence on a fossil fuel-based energy matrix. Generation of electricity through cogeneration is a huge opportunity in countries where the sugarcane industry is in decline. This article draws on the findings of a case-study on electricity generation through cogeneration in Jamaica to provide some key messages that may be useful for policy-makers and the private sector to make electricity generation by cogeneration a more competitive option the for investors. To this end, this article analyses two scenarios: the first is a Baseline Scenario that assesses the impact of cogeneration technology already installed in a Jamaican sugarcane company where the cogeneration stage produces 2,2 MW; the second one considers that the cogeneration technology is changed to a new biomass based power plant upgrading the cogeneration stage in order to produce 5 MW of power from bagasse. The assessment was carried out by using a complete Life Cycle Assessment, Life Cycle Costing and Social Life Cycle Assessment. The results revealed that generation of electricity from cogeneration derived from bagasse is a suitable alternative adding economic, environmental and social value. Publicado

Eine Augenbeteiligung bei Sarkoidose tritt mit einer Pravalenz bis zu 60 % bei bekannter systemischer Sarkoidose auf und zahlt zu den haufigsten Formen der nichtinfektiosen Uveitis. Bei bekannter pulmonaler Sarkoidose tritt eine Augenbeteiligung in bis zu 80 % der Falle auf. Die Sarkoidose kann sich auch ohne Systemmanifestation nur am Auge zeigen (okulare Sarkoidose). Typischerweise tritt die okulare Sarkoidose in Form einer bilateralen granulomatosen Uveitis auf und kann alle Augenabschnitte betreffen. Neben der akuten anterioren Uveitis findet sich haufig eine chronische intermediare oder posteriore Uveitis. Um eine schwerwiegende Sehbeeintrachtigung bis zur Erblindung zu verhindern, kommt der rechtzeitigen Diagnosestellung und Therapie eine grose Bedeutung zu. Zur Diagnosestellung ist die Kombination aus typischen klinischen Zeichen am Auge (beidseitige granulomatose Veranderungen in allen Augenabschnitten) und typischen Laborparametern (ACE, Lysozym, sIL2R, Thoraxrontgenaufnahme oder Thorax-CT) heranzuziehen, da eine Biopsie mit dem Nachweis nicht verkasender Granulome zur Diagnosesicherung bei rein auf das Auge beschrankten Veranderungen aufgrund eines hohen Risikos nicht durchgefuhrt wird. Therapeutisch ist die okulare Sarkoidose einer Therapie mit lokalen oder systemischen Kortikosteroiden meist gut zuganglich. Bei unzureichendem Ansprechen konnen immunsuppressive Basistherapeutika und Biologika eingesetzt werden.

Expansion joints are important components of bridges that accommodate the movements between deck spans that result from thermal loads, traffic loads, and other environmental factors. Experience shows that joints undergo premature deterioration on a regular basis, which leads to unexpected problems caused by leakage of water and other corrosive chemicals over the components of the superstructure and substructure, which in turn leads to premature deterioration of those components. The Virginia Department of Transportation (DOT) has spent millions of dollars over more than 50 years for repair and replacement of joints. Several types of closed joints have been developed and installed in the past three decades to combat this problem. Jointless details at piers and abutments have also been developed and installed in the past three decades to eliminate the need for joints and the associated deterioration. However, the issue persists. The Virginia DOT’s Structure and Bridge Division has developed a new design for a flexible joint system with bonded and debonded zones. An elastomeric concrete material acts as the load-bearing surface as well as the component that allows free expansion and contraction. This joint system has been installed in selected pilot bridges on secondary roads for observation. The performance of this joint system and the challenges faced in its development are discussed.

Owing to the lack in structural strength while composting certain kinds of organic wastes, 11 co-substrates were tested that are generally locally available in rural areas of northern Tamil Nadu, India. In addition to the classical composting parameters such as carbon/nitrogen ratio, moisture content, dry matter and organic dry matter, a compression test was conducted to evaluate the structural strength and the suitability as bulking agent for composting processes. Additionally, with respect to the climatic conditions in India, the water holding capacity was also evaluated.

Hintergrund Fur die Behandlung des persistierenden zystoiden Makulaodems (CMO) nach Vitrektomie existieren gegenwartig keine einheitlichen Therapiekonzepte. Ziel der vorliegenden retrospektiven, multizentrischen Studie war es, die Wirksamkeit eines Dexamethason-Implantats zur Behandlung des CMO in vitrektomierten Augen zu untersuchen.

The Free and Secure Trade (FAST) program provides participating commercial vehicles with shorter waiting times at the Canada–U.S. border. Prior to 2011, FAST vehicles had access to a dedicated approach lane and inspection booth at the southbound Pacific Highway Crossing (PHC) in Blaine, WA. Non-participating vehicles were restricted to a general purpose approach lane and two general purpose inspection booths. While this configuration had the advantage of rewarding FAST participants with shorter border waiting times, it could result in undesirably high waiting times for non-participants during periods of high demand. A simulation study was conducted to determine if an alternative border configuration could reduce the waiting times of non-participants without notably increasing the waiting times of FAST vehicles. A new border configuration was found to dramatically reduce waiting times for non-participants with only a small increase in waiting times for FAST vehicles. In spring 2012 the southbound PHC was reconfigured to implement the recommendations of the study, thereby enhancing the efficiency of the existing border infrastructure. This paper reviews the concerns with the pre-2011 state of the southbound PHC; the recommendations of the simulation analysis; and the documented results of the subsequent implementation of the new configuration.

Severe freeze events have been identified as a primary limiting factor for the saguaro cactus at high elevations in the southwestern United States. With the observed increase in minimum temperatures, it may be expected that saguaros will expand their elevational range. To better understand the factors influencing potential range expansion, we developed a logistic regression model to help explain saguaro presence along its current uppermost elevation. We find that the occurrence of fire decreases the odds of saguaro presence by 78 percent. While less frequent freeze events could allow saguaros to push their current elevational limit, our model suggests that increased fire activity related to the establishment and spread of invasive species could inhibit this range expansion.

Disubstituted hydroxylamines were synthesized and used to form aluminum–amide complexes. These reagents masked carbonyl groups in situ from nucleophilic addition. The stability and utility of the aluminum–aminals are presented in the context of selectively controlling nucleophilic addition on substrates with multiple carbonyl groups.

Vegetative compatibility (VC) is commonly used to characterize structure and diversity in fungal populations. In the chestnut blight fungus, Cryphonectria parasitica, high VC diversity is hypothesized to be responsible for the failure of hyperparasitic mycoviruses to spread through pathogen populations in North America. To test this hypothesis, we assessed VC diversity at three recovering sites in Michigan where mycoviruses had invaded and compared them with four epidemic population sites where mycoviruses were absent. VC diversity was assessed for samples collected in 1996 and 2009, which allowed us to determine how C. parasitica populations changed with time. Twelve VC types were found in 1996 while 29 were found in 2009; 75% of types overlapped between the sample dates. Sites where mycoviruses were present had unique VC structures with the exception of the recovering population site at County Line where the main VC group was also detected at two epidemic sites. With one exception, epidemic sites contained more VC groups and displayed higher population level diversity than recovering sites. Mating-type analyses of blight populations revealed that two of three recovering populations were significantly skewed for MAT2 suggesting asexual reproduction, while epidemic sites with a long history of blight infection had ratios near 50:50 suggesting sexual reproduction. We propose that selection in the largely asexual C. parasitica populations at two recovering sites favors the most-fit fungal genotype by mycovirus combination and results in reduced diversity relative to the sexually reproducing pathogen populations at epidemic sites.

Lack of trust and rapport with health care providers has been identified in the under-representation of racial/ethnic minorities within clinical trials. Our study used a coach to promote trust among minority patients with advanced cancer.Minority patients with advanced breast, colorectal, lung, or prostate carcinoma were randomly assigned to receive a coach Intervention (CI) or usual care (UC). All patients completed baseline and 6-month telephone interviews to assess demographics, trust in health care providers, attitudes toward clinical trials, and quality of life. Patients randomly assigned to CI were assigned a coach, who made biweekly contacts for 6 months to address general issues, progress or development in cancer care, and available resources. Patients randomly assigned to UC received the standard of care, without this intervention. Clinical trial enrollment was assessed.Over 21 months, we screened 268 patients and enrolled 73 African Americans and two Asian Americans. Patients were randomly assigned to CI (n = 38) or to UC (n = 37). Longitudinal analyses were conducted on 69 patients who completed the 6-month follow-up assessment. Trial enrollment was 16 and 13 patients for the CI and UC groups, respectively. This difference was not significant (P = .351). Higher quality of life (1-point odds ratio on Functional Assessment of Cancer Treatment-General = 1.033, P = .036) and positive attitudes toward trials predicted enrollment. There was no significant difference between these groups in quality of life, attitudes toward clinical trials, perceptions of racism, trust in doctors, or depression.Quality of life and positive attitude toward trials predicted trial enrollment, regardless of assignment to CI or UC.

Treatment with estradiol, the primary estrogen produced by the ovaries, enhances hippocampus-dependent spatial memory and increases levels of hippocampal synaptic proteins in ovariectomized rats. Increasing evidence indicates that the ability of estradiol to impact the brain and behavior is dependent upon its interaction with insulin-like growth factor-1 (IGF-1).The goal of the current experiment was to test the hypothesis that the ability of estradiol to impact hippocampus-dependent memory and levels of hippocampal synaptic proteins is dependent on its interaction with IGF-1.Adult rats were ovariectomized and implanted with estradiol or control capsules and trained on a radial-maze spatial memory task. After training, rats were implanted with intracerebroventricular cannulae attached to osmotic minipumps (flow rate 0.15 μl/h). Half of each hormone treatment group received continuous delivery of JB1 (300 μg/ml), an IGF-1 receptor antagonist, and half received delivery of aCSF vehicle. Rats were tested on trials in the radial-arm maze during which delays were imposed between the fourth and fifth arm choices. Hippocampal levels of synaptic proteins were measured by western blotting.Estradiol treatment resulted in significantly enhanced memory. JB1 blocked that enhancement. Estradiol treatment resulted in significantly increased hippocampal levels of postsynaptic density protein 95 (PSD-95), spinophilin, and synaptophysin. JB1 blocked the estradiol-induced increase of PSD-95 and spinophilin and attenuated the increase of synaptophysin.Results support a role for IGF-1 receptor activity in estradiol-induced enhancement of spatial memory that may be dependent on changes in synapse structure in the hippocampus brought upon by estradiol/IGF-1 interactions.

Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We present a framework for institutional enhancement of minority clinical trial accrual. We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: (1) leadership support; (2) center-wide policy change; (3) infrastructural process control, data analysis, and reporting; and (4) follow-up with clinical investigators. A Protocol Review and Monitoring Committee reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities leads efforts for proportional accrual, supporting the system through data tracking, Web tools, and feedback to investigators. Following implementation in 2005, minority accrual to therapeutic trials increased from 12.0 % in 2005 to 14.0 % in 2010. The “rolling average” minority cancer incidence at the institution during this timeframe was 17.5 %. In addition to therapeutic trial accrual rates, we note significant increase in the number of minorities participating in all trials (therapeutic and nontherapeutic) from 2005 to 2010 (346–552, 60 % increase, p

It has become increasingly common for companies to offer make-to-stock (MTS) and make-to-order (MTO) versions of the same product through different sales channels. To satisfy these two distinct demand streams, one strategy is to produce both the MTS and MTO items in a single “hybrid” facility partially comprised of flexible servers or machines. We develop a multi-server queueing model of this system, where a subset of the servers or machines is dynamically switched between MTS and MTO production via a congestion-based switching policy. We develop analytical formulae for quantifying all major performance measures of the system. We also present a search procedure to find the capacity and inventory control parameters which minimize the total costs of the system while satisfying the customer service constraints. Numerical results are used to illustrate the general behavior of the dynamic hybrid system and to compare its performance to that of a more conventional static hybrid facility with dedicated MTS and MTO servers. For high levels of traffic intensity, the dynamic system is shown to provide superior customer service for both sales channels with lower finished goods inventory levels.

A new reagent, the dimethylaluminum N,O-dimethylhydroxylamine complex, is effective at masking reactive carbonyl groups in situ from nucleophilic addition. This reagent allows chemoselective addition of reducing reagents, Grignard reagents, organolithiums, Wittig reagents, and enolates into substrates with multiple carbonyl groups. Moreover, the trapped carbonyl group, a stable aminal, can be unmasked in situ for additional synthetic manipulations.

OBJECTIVE:Over the last 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. This technical report describes, in detail, the procedures undertaken to develop the recommendations given in the accompanying clinical practice guideline, “Management of Type 2 Diabetes Mellitus in Children and Adolescents,” and provides in-depth information about the rationale for the recommendations and the studies used to make the clinical practice guideline’s recommendations.METHODS:A primary literature search was conducted relating to the treatment of T2DM in children and adolescents, and a secondary literature search was conducted relating to the screening and treatment of T2DM’s comorbidities in children and adolescents. Inclusion criteria were prospectively and unanimously agreed on by members of the committee. An article was eligible for inclusion if it addressed treatment (primary search) or 1 of 4 comorbidities (secondary search) of T2DM, was published in 1990 or later, was written in English, and included an abstract. Only primary research inquiries were considered; review articles were considered if they included primary data or opinion. The research population had to constitute children and/or adolescents with an existing diagnosis of T2DM; studies of adult patients were considered if at least 10% of the study population was younger than 35 years. All retrieved titles, abstracts, and articles were reviewed by the consulting epidemiologist.RESULTS:Thousands of articles were retrieved and considered in both searches on the basis of the aforementioned criteria. From those, in the primary search, 199 abstracts were identified for possible inclusion, 58 of which were retained for systematic review. Five of these studies were classified as grade A studies, 1 as grade B, 20 as grade C, and 32 as grade D. Articles regarding treatment of T2DM selected for inclusion were divided into 4 major subcategories on the basis of type of treatment being discussed: (1) medical treatments (32 studies); (2) nonmedical treatments (9 studies); (3) provider behaviors (8 studies); and (4) social issues (9 studies). From the secondary search, an additional 336 abstracts relating to comorbidities were identified for possible inclusion, of which 26 were retained for systematic review. These articles included the following: 1 systematic review of literature regarding comorbidities of T2DM in adolescents; 5 expert opinions presenting global recommendations not based on evidence; 5 cohort studies reporting natural history of disease and comorbidities; 3 with specific attention to comorbidity patterns in specific ethnic groups (case-control, cohort, and clinical report using adult literature); 3 reporting an association between microalbuminuria and retinopathy (2 case-control, 1 cohort); 3 reporting the prevalence of nephropathy (cohort); 1 reporting peripheral vascular disease (case series); 2 discussing retinopathy (1 case-control, 1 position statement); and 3 addressing hyperlipidemia (American Heart Association position statement on cardiovascular risks; American Diabetes Association consensus statement; case series). A breakdown of grade of recommendation shows no grade A studies, 10 grade B studies, 6 grade C studies, and 10 grade D studies. With regard to screening and treatment recommendations for comorbidities, data in children are scarce, and the available literature is conflicting. Therapeutic recommendations for hypertension, dyslipidemia, retinopathy, microalbuminuria, and depression were summarized from expert guideline documents and are presented in detail in the guideline. The references are provided, but the committee did not independently assess the supporting evidence. Screening tools are provided in the Supplemental Information.

Background In phenylketonuria presymptomatic treatment following newborn screening prevents severe mental and physical impairment. The reasons for subtle impairments of cerebral functions despite early treatment remain unclear. We assessed a broad spectrum of visual functions in early-treated patients with phenylketonuria and evaluated two hypotheses—the dopamine and the long-chain polyunsaturated fatty acids (LCPUFAs) depletion hypotheses. Methods Contrast sensitivity, colour vision, electroretinography, frequency doubling technology campimetry (FDT), and their relation with blood phenylalanine and docosahexaenoic acid levels were assessed in 36 patients with phenylketonuria and 18 age-matched healthy controls. Results Contrast sensitivity was significantly lower and total error scores in colour vision significantly higher in patients than controls. Electroretinography results differed significantly between patients and controls. We found a trend for the effect of phenylalanine-levels on contrast sensitivity and a significant effect on colour vision/FDT results. Docosahexaenoic acid levels in erythrocytes were not associated with visual functions. Conclusion This is the first evaluation of visual functions in phenylketonuria using a comprehensive ophthalmological test battery. We found no evidence supporting the long-chain polyunsaturated fatty acids depletion hypothesis. However, the effect of phenylalanine-levels on visual functions suggests that imbalance between phenylalanine and tyrosine may affect retinal dopamine levels in phenylketonuria. This is supported by the similar patterns of visual functions in patients with phenylketonuria observed in our study and patients with Parkinson's disease.

Electronic service quality, or e-service quality, is the quality experienced by the user of a service delivered over the Web. Over the past several years, researchers have developed many models of e-service quality with the goal of identifying those factors that are most important for customer loyalty. Most of these models focus primarily or exclusively on retail e-commerce Web sites which support the delivery of a physical product to the consumer. Recently, however, “pure” e-service Web sites, namely those that do not involve the sale and delivery of a physical good, have received increasing attention from researchers. This article proposes and validates a quality assessment instrument for a type of pure e-service that has not yet been studied: a Web-based decision support system. Based on a study involving over six hundred subjects, we identify those quality dimensions that affect customer loyalty for a pure e-service of this type.

To date, there is no consensus about the management of persistent cystoid macular edema (CME) following vitrectomy. The aim of this study was to evaluate the efficacy and safety of intravitreal dexamethasone implants for the treatment of postoperative CME following vitrectomy.In this multicenter study we retrospectively reviewed the data of 24 patients (25 eyes) who had been treated with intravitreal dexamethasone (Ozurdex®) for the management of persistent postoperative CME following pars plana vitrectomy. The main outcome measure was central retinal thickness (CRT in µm) as assessed by spectral domain optical coherence tomography (SD-OCT). Secondary outcome measures included change in best corrected visual acuity (BCVA) and the presence of metamorphopsia.All 19 eyes which were postoperatively examined within 4-8 weeks after implantation showed a significant decrease in CRT (mean 564 µm to 315 µm) and a reduction of metamorphopsias. Within the same period of time the BCVA improved in 15 out of 19 eyes (79%) which corresponds to an average visual improvement from 0.69 logMAR to 0.46 logMAR (P 0.0001). In eyes examined after 10-16 weeks a slight increase in the average CRT of 351 µm was observed, whereas the BCVA improved to 0.28 logMAR. After 4 months a decrease in average BCVA was noted. Out of 25 eyes 12 required further dexamethasone implantations between 1 and 4 times within the investigation period. The first repeat injections were performed an average of 7.3 months after the initial treatment.Our results suggest that intravitreal dexamethasone is a safe and effective treatment option for persistent CME following vitrectomy.

Die Gesichtsfelduntersuchung mittels statischer automatischer Perimetrie (SAP) ist die Methode der Wahl zur Funktionsbestimmung beim Glaukom. Dennoch lassen sich damit beginnende Skotome oft nicht darstellen, selbst wenn es bereits zu morphologisch erkennbaren Schaden der Nervenfaserschicht gekommen ist. Dies gilt insbesondere fur Nervenfaserbundeldefekte. Die Mikroperimetrie oder Fundusperimetrie erlaubt eine gezielte Untersuchung der Lichtunterschiedsempfindlichkeit uber spezifischen, zugehorigen Netzhautarealen. Beim Glaukomschaden muss im Gegensatz zur primaren Schadigung der Rezeptoren der Verlauf der Nervenfasern und die dadurch hervorgerufene Lokalisation des hervorgerufenen Funktionsausfalls berucksichtigt werden. Dabei ist der Nachweis einer Funktionsschadigung moglicherweise fruhzeitiger als mit der konventionellen statischen Schwellenperimetrie moglich. Der zusatzliche Aufwand an Kosten und Zeit hat die Verbreitung der Fundusperimetrie bisher eingeschrankt. Aktuelle Entwicklungen konnten neue Perspektiven bieten.

Introduction Computer-based smile esthetic surveys based on slider technology allow more precise control of variables and the possibility of obtaining continuous data. Variations in the perception of smiles from different facial perspectives have not been resolved. The objective of this study was to quantify the ideal and the range of acceptable values for smile variables judged by laypersons from a full-face perspective for comparison with lower-face data. Methods Mirrored and symmetric male and female full faces previously determined by peers to be of average attractiveness were used. Ninety-six laypersons judged these smile variables: smile arc, buccal corridor fill, maxillary gingival display, maxillary midline to face, maxillary to mandibular midline discrepancy, overbite, central incisor gingival margin discrepancy, maxillary anterior gingival height discrepancy, incisal edge discrepancy, and cant. The judges manipulated the variables using adjustable image technology that allowed the variable to morph and appear continuous on a computer monitor. Medians for each smile variable were compiled, and the Fleiss-Cohen weighted kappa statistic was calculated to measure reliability. Multiple randomization tests with adjusted P values were used to compare these data with those for lower-face views. Results Reliability ranged from 0.25 for ideal overbite to 0.60 for upper midline to face, except for upper and lower buccal corridor limits, which each had a kappa value near 0. There were no statistically significant differences between the ratings of male and female raters. The following variables showed statistically and clinically significant differences (>1 mm) when compared with the lower-face view: ideal smile arc, ideal buccal corridor, maximum gingival display, upper to lower midline, and occlusal cant. Although the smile arc values differed because of model lip curvature variations, the principle of tracking the curve of the lower lip was confirmed. For the full-face view, the raters preferred less maximum gingival display, less buccal corridor, more upper to lower midline discrepancy, and less cant of the occlusal plane. Conclusions Reliability was fair to moderate with the exception of the buccal corridor limits. Most variables showed no clinically meaningful differences from the lower-face view. The acceptable range was quite large for most variables. Detailed knowledge of the ideal values of the various variables is important and can be incorporated into orthodontic treatment to produce an optimal esthetic smile.

The bullwhip effect in particular, and supply chain volatility in general, has been the subject of much analytical and empirical investigation by researchers. One goal of this work has been to determine supply chain designs and policies that minimize volatility. Using a system dynamics approach, we use three distinct supply chain volatility metrics to compare the ability of two alternative pipeline inventory management policies to respond to a demand shock. The results indicate that no one policy dominates on all three metrics of supply chain volatility. A simplistic static pipeline policy minimizes the bullwhip effect and lessens the likelihood of on-hand inventory oscillations, while a more sophisticated dynamic pipeline policy may converge more rapidly to the new equilibrium. In addition, simulation results suggest that the dynamic policy provides better customer service through fewer stockouts and backorders.

As the dimensions of the structures of integrated circuits shrink, the influence of particles on device yield becomes increasingly important. According to the cleaning requirements of the International Technology Roadmap for Semiconductors (ITRS) in 2007, particles of 32 nm and larger are believed to be detrimental to devices and thus have to be removed. To remove nano-particles with minimal substrate loss and no damage requires very dilute chemistries and sufficiently gentle physical forces in a cleaning process. In this work the performance of an aerosol spray based cleaning technique is evaluated with regard to the removal efficiency of nano-particles as well as substrate loss and structural damage.

The advances in retinal imaging technologies have led to enormous innovation towards diagnostic in current ophthalmology, enabling the practitioner to detect early retinal changes and to document treatment effects. While, in the past, retinoscopy, visual acuity testing and perimetry played the major role in functional diagnostics, today, laser-based systems like laser scanning imaging systems especially for fluorescein-angiography, optical coherence tomography, electrodiagnostic systems and the analysis of retinal vessels may be used as well. However, the challenge to correlate subjective alterations or clinical changes with visual function, still remains. Micro- or fundus perimetry offers the option to test retinal sensitivity while directly observing the fundus. In this paper, we review the literature encompassing the results of more than 25 years of fundus perimetry, i.e. perimetry under simultaneous visualization of the fundus. During this time, results on known diseases and reproducibility of the technique were published, but a lot of work was also performed on the combination of different examination methods, allowing a synopsis of long-term results and new approaches by combining different methods and improving each of them. The first part of this review attends to improvements of the method. The second part addresses the clinical and diagnostic values. The final part is dedicated to diagnostic and long-term observation of fundus perimetric results beginning with common and rare diseases like age-related macular degeneration, macular holes and diabetic retinopathy, various types of macular dystrophies ending with challenges in conventional perimetry like glaucoma and malingering. Due to the experience and progress in the field of fundus perimetry and retinal imaging, the method has long passed its role of observing and has all the potential for prediction, early detection and treatment-monitoring of macular diseases.

Most recent research on supply chain volatility has focused on one particular dimension of that volatility, namely the amplification of upstream order variability. While not ignoring this aspect of supply chain volatility, we focus on a different but equally critical aspect of volatility: the cyclical oscillation of on-hand and on-order inventories about their target values. We prove that such cyclicality does not require oscillatory or random retailer demand as a prerequisite; the resulting volatility is therefore endogenous rather than simply an amplification of exogenous demand inputs. We also measure the amount of amplification resulting from a step increase in demand. The order amplification is the product of two factors, each of which is clearly linked to either on-hand or on-order inventory. Our results attest that supply chain volatility can arise in the absence of exogenous oscillatory or random demand and suggest strategies for avoiding or minimizing such volatility.

Despite extremely starved conditions, caves contain surprisingly diverse microbial communities. Our research is geared toward understanding what ecosystems drivers are responsible for this high diversity. To asses the effect of rock fabric and mineralogy, we carried out a comparative geomicrobiology study within Carlsbad Cavern, New Mexico, USA. Samples were collected from two different geologic locations within the cave: WF1 in the Massive Member of the Capitan Formation and sF88 in the calcareous siltstones of the Yates Formation. We examined the organic content at each location using liquid chromatography mass spectroscopy and analyzed microbial community structure using molecular phylogenetic analyses. In order to assess whether microbial activity was leading to changes in the bedrock at each location, the samples were also examined by petrology, X-ray diffraction (XRD) and scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX). Our results suggest that on the chemically complex Yates Formation (sF88), the microbial community was significantly more diverse than on the limestone surfaces of the Capitan (WF1), despite a higher total number of cells on the latter. Further, the broader diversity of bacterial species at sF88 reflected a larger range of potential metabolic capabilities, presumably due to opportunities to use ions within the rock as nutrients and for chemolithotrophic energy production. The use of these ions at sF88 is supported by the formation of a corrosion residue, presumably through microbial scavenging activities. Our results suggest that rock fabric and mineralogy may be an important driver of ecosystem function and should be carefully reviewed when carrying out microbial community analysis in cave environments.

For the determination of visual function an objective assessment is essential. Basic ophthalmologic examinations such as measurement of visual acuity and perimetry are dependent on patient statements. If the patient is not being able to provide adequate answers, as is the case for small children or mentally retarded patients, or also if the accuracy of the patient's statements is doubtful or simulation or aggravation is suspected, the denoted function in the evaluation of visual acuity has to be checked on consistency using different examination methods, and the results of objective functional tests, such as electrophysiology and morphological features, have to be taken into account.

Hintergrund Ziel dieser Studie war es, bei Patienten mit Chorioretinopathia centralis serosa (CCS) Netzhautfunktion und -morphologie mittels Fundusperimetrie und OCT zu vergleichen.

Das Microperimeter 1 (MP-1) ermoglicht eine funduskontrollierte statische Schwellenperimetrie des zentralen Gesichtsfelds. Ziel dieser Studie war es, die MP-1-Fundusperimetrie mit der bereits etablierten Scanning-Laser-Ophthalmoskop- (SLO-)Fundusperimetrie hinsichtlich der detektierten Schwellenwerte der Lichtunterschiedsempfindlichkeit (LUE) bei Probanden zu vergleichen. Bei 31 Augen von 31 gesunden Probanden wurde jeweils mit dem MP-1 (Fa. Nidek Technologies, Erlangen) sowie mit dem SLO (Fa. Rodenstock) eine funduskontrollierte statische Perimetrie durchgefuhrt. Im zentralen 21°×12°-Gesichtsfeld wurden in einem rechteckigen 3°-Raster fur 40 korrespondierende Testpunkte die Schwellenwerte der LUE verglichen. Die mittlere LUE betrug am MP-1 19,1±0,5 dB und am SLO 17,2±0,9 dB. Im Durchschnitt lagen die LUE-Schwellenwerte der 40 korrespondierenden Prufpunkte bei der Untersuchung am MP-1 um 1,9±1,3 dB uber denen am SLO. Sowohl das MP-1 als auch das SLO bieten eine reproduzierbare Funktionsanalyse der zentralen Netzhaut bei gleichzeitiger Funduskontrolle. Zum Vergleich von Ergebnissen der MP-1- und SLO-Fundusperimetrie ist ein Korrektionsfaktor von etwa 2 dB anzuwenden.

Purpose To determine differential light threshold values obtained with the Micro Perimeter 1 (MP1) in healthy volunteers and to correlate them with conventional automated static threshold perimetry using the Octopus 101 Perimeter. Design Prospective comparative observational study. Participants Thirty healthy volunteers. Methods In 30 eyes of 30 healthy volunteers, static threshold perimetry was performed with the MP1 Micro Perimeter (Nidek Inc., Italy) and the Octopus 101 (Haag-Streit AG, Switzerland) in the same eye in random order. Main Outcome Measures Differential light threshold values obtained with the MP1 and their difference to differential light threshold values with the Octopus. Differential light sensitivity was compared for 21 matching points in a rectangular test grid using similar examination settings with Goldmann III stimuli, stimulus presentation time of 100 msec, and white background illumination (1.27 cd/m 2 ). Results For the 21 matching locations, mean differential light thresholds with the MP 1 and the Octopus were 15.5±0.8 decibels (dB) (range, 13.0–17.1) and 30.2±1.2 dB (range, 27.7–32.0), respectively. On the average, the Octopus showed higher threshold values for all test locations than the MP1. The mean difference between both examinations was 14.6±1.8 dB for all locations and 14.8±1.7 dB excluding the test locations at the blind spot. With a considerably high grade of variation according to the test point location, the difference between the 2 devices varied from 11.4 to 18.3 dB, showing a vertical asymmetry with a larger difference in the lower part of the visual field. Linear regression of the perimetric results for each test point location, excluding the area of the blind spot and the lower line of the test grid, showed significant correlation ( r = 0.56; P = 0.036). Conclusions The results show that the MP1 provides reproducible threshold values with a systematic difference compared with standard Octopus perimetry of approximately 15 dB. With a larger difference in the lower part of the visual field, differential light sensitivity values in microperimetry with the MP1 are comparable to the threshold values obtained with the Octopus 101 using a correction factor of 11.4 to 18.3 dB according to stimulus location.