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The article discusses the use of machine learning (ML) and automated machine learning (AutoML) in clinical medicine. It highlights the challenges faced by healthcare professionals in adopting ML due to technical complexities and the potential solution of partnering with vendors. AutoML is presented as a solution that streamlines the ML analysis process, making it accessible to users with limited programming skills. The article emphasizes the potential of AutoML to accelerate innovation and improve patient outcomes in various medical domains. It also acknowledges the limitations and challenges associated with integrating AutoML into healthcare, including performance variability and ethical concerns. The need for ongoing dialogue, increased investment in education, and a principled approach to deployment is advocated to fully leverage AutoML's transformative potential in patient care. [Extracted from the article]

Introduction: The presence of inflammation is a key hallmark of cancer and, plays an important role in disease progression and survival in colorectal cancer (CRC). Calprotectin detected in the faeces is a sensitive measure of colonic inflammation. The role of FC as a diagnostic test that may categorise patients by risk of neoplasia is poorly defined. This systematic review and meta-analysis aims to characterise the relationship between elevations of FC and colorectal neoplasia.Methods: A systematic review was performed using the keywords (MESH terms) and a statistical and meta-analysis was performed.Results: A total of 35 studies are included in this review. CRC patients are more likely than controls to have an elevated FC OR 5.19, 95% CI 3.12-8.62, p < 0.001 with a heterogeneity (I2 = 27%). No tumour characteristics significantly correlated with FC, only stage of CRC shows signs that it may potentially correlate with FC.Conclusion: FC levels are significantly higher in CRC, with high sensitivity. Its low specificity prevents it from being used to diagnose or screen for CRC. [ABSTRACT FROM AUTHOR]

Aim: Although the relationship between colorectal neoplasia and inflammation is well described, the role of faecal calprotectin (FC) in clinical practice to diagnose or screen patients for colorectal neoplasia is less defined. This prospective study characterizes the relationship between FC and colorectal neoplasia in patients within the faecal occult blood testing (FOBT) positive patients in the Scottish Bowel Screening Programme. Methods: All FOBT positive patients attending for colonoscopy between February 2016 and July 2017 were invited to participate. Patients provided a stool sample for FC before commencing bowel preparation. All demographics and endoscopic findings were collected prospectively. Results: In all, 352 patients were included. 210 patients had FC > 50 µg. Colorectal cancer (CRC) patients had a higher median FC (138.5 μg/g, P < 0.05), in comparison to those without CRC, and 13/14 had an FC > 50 µg/g (93%). FC had a high sensitivity (92.8%) and negative predictive value (99.3%) for CRC, but with a low specificity (41.7%) and positive predictive value (6.2%). FC sensitivity increased sequentially as neoplasms progressed from non‐advanced to malignant neoplasia (48.6% non‐advanced adenoma vs. 92.9% CRC). However, no significant relationship was observed between FC and non‐cancer neoplasia. Conclusion: In an FOBT positive screening population, FC was strongly associated with CRC (sensitivity 92.8%, specificity 41.7% for CRC, at 50 µg/g). However, although sensitive for the detection of CRC, FC failed to show sufficient sensitivity or specificity for the detection of non‐cancer neoplasia. Based on these results we cannot recommend routine use of FC in a bowel screening population to detect cancer per se, but it is apparent that, with further optimization, faecal assessments including quantification of haemoglobin and inflammation could form part of a risk assessment tool aimed at refining the selection of patients for colonoscopy in both symptomatic and screening populations. [ABSTRACT FROM AUTHOR]

Background and Objective: Studies with nonsignificant results are less likely to be published or published in lower impact factor journals. To determine whether a similar phenomenon occurs in pain literature, we explored impact factor bias in peer‐reviewed pain journals. Methods: A PubMed search involving randomized controlled trials in pain journals during 2012 through 2018 was performed. The primary outcome was the publication impact factor. Exclusion criteria included commentaries, editorials, meta‐analyses, reviews, and animal studies. The average impact factor for each journal was determined. The primary independent variable was a study with a positive outcome. Results: Of the 9 journals evaluated, 1108 articles met our inclusion criteria and were included in our analysis. The quartiles for the impact factor for the journals included were 2.5, 2.9, and 3.6. A multivariate analysis identified sample size greater than 100, description of a sample size calculation, presence of a stated hypothesis, and presence of sponsorship funding as independent predictors of publication in a journal with greater impact factor. In contrast, positive results were not associated with publication in a greater impact factor journal, even when forced into the model, P = 0.49. Conclusions: After adjusting for study factors associated with publication, there is no evidence of impact factor bias within the pain literature. The lack of impact factor bias in the pain literature is a positive finding for the field and should benefit scientific development and the clinical care of patients. [ABSTRACT FROM AUTHOR]

Cortical interneurons (cINs) are substantially affected in Schizophrenia (SCZ) and enriched for SCZ heritability during development. To understand SCZ-specific changes in these cells during development, we isolated migratory cINs from cIN spheres derived from 5 healthy control (HC) and 5 SCZ induced pluripotent stem cell lines (iPSCs). Transcriptome analyses show dysregulation in extracellular matrix pathways as the major disturbances in SCZ migratory cINs, whereas sphere cINs show dysregulation in immune pathways. This result suggests the importance of using homogeneous cell populations to identify stage-specific abnormalities and provides a platform to further study the biology of schizophrenia pathogenesis during early development. [ABSTRACT FROM AUTHOR]

Summary: Background: A critical aspect of liver transplantation in hepatitis B patients is to prevent graft reinfection with hepatitis B virus. The use of hepatitis B immune globulin after transplant was a significant milestone, which allowed prolonged graft and patient survival by controlling hepatitis B reinfection in liver grafts. The development of anti‐viral treatments with oral nucleos(t)ide analogues, led to a further reduction in graft reinfection and improvement in patient survival. The combination of the aforementioned two therapies has been widely used in hepatitis B‐associated liver transplants. Aims: To address the post‐transplant management of hepatitis B and provide updates on preventing graft reinfection. Methods: We performed a literature search on Ovid and PubMed for randomised controlled trials or cohort studies in English, which investigated the effectiveness of hepatitis B immune globulin and anti‐viral therapy on hepatitis B‐associated transplants (1/2000‐1/2020). Studies that met pre‐established criteria were reviewed. Results: Based on currently available evidence, an algorithm for post‐transplant management with anti‐viral therapy is proposed. Also, the management of recipients who received grafts from hepatitis B core antibody‐positive donors is discussed. Conclusions: The development of hepatitis B immune globulin and anti‐viral treatments led to substantial improvement in graft and patient survival. The prevention of hepatitis B graft reinfection is complex and involves a broad interdisciplinary team. [ABSTRACT FROM AUTHOR]

The article discusses factors contributing to medical error in South Korean health care facilities and provides solution to improve Korean medicine. Factors that lead to medical error include professional authority and stature, and lack of data on error reporting. Solutions recommended include effective medical leadership, improving data and information sharing system among hospitals, and promoting culture of medical innovation and patient safety.

Abstract Over the last 15 years there has been a change in how we understand the impact of the interaction between the tumour and the host on cancer outcomes. From the simplistic view that the make-up of tumours cells largely determines their aggressiveness to a more complex view that the interaction between the products of tumour and host cell signal transduction pathways is crucial in determining whether the tumour cell is eliminated or survives in the host. Of the host cells, those with an immune/inflammatory function are most well documented to inhibit or promote tumour cell proliferation and dissemination. It is only in the last few years that there has been greater recognition of the impact of intracellular, cellular and systemic immune/inflammatory phenotypes on patient outcomes independent of current tumour staging and that these phenotypes are useful in informing oncological research and practice. In the present review we will examine the importance of inflammatory phenotypes at the intra-cellular, cellular and systemic levels on outcomes in patients with gastrointestinal cancer with focus on colorectal cancer. Based on these phenotypes we will examine and discuss the prospects for therapeutic intervention. Highlights • The development and progression of colorectal cancer is heterogenous in nature. • Tumourogenesis occurs via systemic, cellular and intracellar mechanisms. • NF-κB and JAK-STAT signalling pathways represent key signalling cascades. • Components of signalling pathways are promising therapeutic targets. [ABSTRACT FROM AUTHOR]

Cells depend on the asymmetric distribution of their components for homeostasis, differentiation and movement. In no other cell type is this requirement more critical than in the neuron where complex structures are generated during process growth and elaboration and cargo is transported over distances several thousand times the cell body diameter. Microtubules act both as dynamic structural elements and as tracks for intracellular transport. Microtubules are mosaic polymers containing multiple tubulin isoforms functionalized with abundant posttranslational modifications that are asymmetrically distributed in neurons. An increasing body of evidence supports the hypothesis that the combinatorial information expressed through tubulin genetic and chemical diversity controls microtubule dynamics, mechanics and interactions with microtubule effectors and thus constitutes a ‘tubulin code’. Here we give a brief overview of tubulin isoform usage and posttranslational modifications in the neuron, and highlight recent progress in understanding the molecular mechanisms of the tubulin code. [ABSTRACT FROM AUTHOR]

In the search for improved materials for photoelectrochemical water splitting, it has become important to identify new classes of semiconductor materials that may serve as improved photocathodes. To this end, p-type AgRhO2 has been synthesized and tested as a photocathode for water splitting. The AgRhO2 photocathode is found to exhibit excellent photocatalytic capability for reducing protons to H2 across a wide range of pH values with nearly 100% faradaic efficiency and good photostability. Polycrystalline AgRhO2 electrodes exhibit strong preferred c-axis orientation, resulting in anisotropic conductivity, evident from resistivity measurements. AgRhO2 photocathodes are found to provide improved performance and photostability when compared to prior work using a p-CuRhO2 electrode. Enhanced performance is in part attributed to the unusual degree of c-axis orientation found in this material. In addition, there is a significantly lower kinetic barrier for H2 production at the AgRhO2 interface. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including vehicular cloud computing (VCC), the use of shareable keyword search scheme, and the protocol for the safe dissemination and analysis of vehicle traffic data in VCC.

Background: The range of hospital charges for similar diagnoses show tremendous variability across U.S. hospitals. This charge variability remains unexplained.Objective: We aimed to describe hospital charge variability in the U.S. and examine its relationship to local health factors.Design: This was a descriptive study of the 2011 Medicare Inpatient Charge data summarizing inpatient hospital charges billed to Medicare. This data was evaluated using 29 county-level measures of health status, health behavior, clinical access and quality, built environment, and socioeconomic status in a clustered, multivariate linear regression.Participants: 2871 U.S. hospitals registered with Medicare and with at least ten discharges for diagnosis-related groups (DRGs) of six common inpatient conditions.Main Measure: Inpatient hospital charges were assessed.Key Results: No community health measures were associated with hospital charges. The one notable exception associated with higher charges was higher rates of uninsured status ($344.84 higher charges for every one-percentage point increase in prevalence (p < 0.001)). One variable was associated with lower hospital charges: the percentage of children living in poverty [$309.30 lower charges for every one-percentage point increase in prevalence (p < 0.001)].Conclusions: Overall, hospital charges lacked an association with population health measures, and their variability remains largely unexplained. However, the association of higher charges with uninsured status raises concerns about hospitals' price-setting strategies, such as price discrimination and cost-shifting strategies that expose vulnerable populations to great financial risks. [ABSTRACT FROM AUTHOR]

The resurgence of interest in hydrogen-related technologies has stimulated new studies aimed at advancing lesser-developed water-splitting processes, such as solar thermochemical hydrogen production (STCH). Progress in STCH has been largely hindered by a lack of new materials able to efficiently split water at a rate comparable to ceria under identical experimental conditions. BaCe0.25Mn0.75O3 (BCM) recently demonstrated enhanced hydrogen production over ceria and has the potential to further our understanding of two-step thermochemical cycles. A significant feature of the 12R hexagonal perovskite structure of BCM is the tendency to, in part, form a 6H polytype at high temperatures and reducing environments (i.e., during the first step of the thermochemical cycle), which may serve to mitigate degradation of the complex oxide. An analogous compound, namely BaNb0.25Mn0.75O3 (BNM) with a 12R structure was synthesized and displays nearly complete conversion to the 6H structure under identical reaction conditions as BCM. The structure of the BNM-6H polytype was determined from Rietveld refinement of synchrotron powder X-ray diffraction data and is presented within the context of the previously established BCM-6H structure. [ABSTRACT FROM AUTHOR]

Public companies in the United States must comply with both federal securities law and state corporate law. This division of labor is premised on the assumption that there is a meaningful distinction between securities and corporate law. The most common view is that securities law is characterized by its use of disclosure, while corporate law sets forth substantive requirements. Critics respond that securities law is really just a federal version of corporate law. They argue that the federal policy of investor protection justifies preempting state corporate law to address corporate mismanagement. While investor protection concerns have been invoked as a reason for unifying corporate and securities law, this Article contends that corporate and securities law can be distinguished based on the type of protection they provide to investors. Both corporate and securities law serve to protect investors, but they do so at two different phases of the investment process. First, when purchasing or selling a stock, a trading investor is vulnerable to transacting at an unfair price. Second, during the period when an investor owns a stock, he is vulnerable to new corporate misconduct that reduces the value of the company. Simply put, securities law protects investors as traders while corporate law protects investors as owners. Distinguishing between trading and ownership protection provides a strong basis for regulating securities and corporate law in different ways. Securities law is uniform and mandatory because investors have a common interest in fair valuation when trading. Corporate law is diverse and enabling because the ownership interests of investors are more difficult to reconcile. [ABSTRACT FROM AUTHOR]

Background: Tumour budding has been reported to reflect invasiveness, metastasis and unfavourable prognosis in colorectal cancer. The aim of the study was to examine the relationship between tumour budding and clinicopathological characteristics, tumour microenvironment and survival in patients with primary operable colorectal cancer.Methods: A total of 303 patients from a prospective data set of patients with primary operable colorectal cancer were included in the study. The presence of budding was determined through assessment of all tumour-containing H&E slides and the number of tumour buds was counted using a 10 high-powered field method. Routine pathologic sections were used to assess: tumour necrosis, the tumour inflammatory cell infiltrate using Klintrup-Makinen (KM) grade and tumour stroma percentage (TSP) combined as the Glasgow Microenvironment Score (GMS).Results: High-grade tumour budding was present in 39% of all tumours and in 28% of node-negative tumours respectively. High-grade budding was significantly associated with T stage (P<0.001), N stage (P<0.001), TNM stage (P<0.001), serosal involvement (P<0.001), venous invasion (P<0.005), KM grade (P=0.022), high tumour stroma (P<0.001) and GMS (P<0.001). Tumour budding was associated with reduced cancer-specific survival (CSS) (HR=4.03; 95% confidence interval (CI), 2.50-6.52; P<0.001), independent of age (HR=1.47; 95% CI, 1.13-1.90; P=0.004), TNM stage (HR=1.52; 95% CI, 1.02-2.25; P=0.040), venous invasion (HR=1.73; 95% CI, 1.13-2.64; P=0.012) and GMS (HR=1.54; 95% CI, 1.15-2.07; P=0.004).Conclusions: The presence of tumour budding was associated with elements of the tumour microenvironment and was an independent adverse prognostic factor in patients with primary operable colorectal cancer. Specifically high tumour budding stratifies effectively the prognostic value of tumour stage, venous invasion and GMS. Taken together, tumour budding should be assessed routinely in patients with primary operable colorectal cancer. [ABSTRACT FROM AUTHOR]

Clinically relevant postoperative pancreatic fistula (CR-POPF) is a significant contributor to morbidity after pancreatectomy. Somatostatin analogues have shown variable efficacy in the prevention of CR-POPF. Lanreotide is a somatostatin analogue ideally suited for perioperative use due to its long half-life and favorable side effect profile. We conducted a phase II single-arm trial of a single dose of preoperative lanreotide (120 mg) in patients undergoing either pancreaticoduodenectomy (PD) or distal pancreatectomy (DP). The primary outcome was development of CR-POPF or intra-abdominal abscess. Secondary outcomes included biochemical leak and overall morbidity. A total of 98 patients completed the study. Sixty-two underwent PD (63.3%) and 36 underwent DP (36.7%). The primary outcome was observed in eight (8%) patients in the overall cohort, one from the DP group and seven from the PD group. Biochemical leak was detected in 12 (12.2%) patients in the overall cohort. Twenty-seven (27.5%) patients developed complications, of which 14 (14.2%) were major complications. Drug-related adverse events were limited to mild skin reactions in two (2%) patients. Patients who received preoperative lanreotide developed CR-POPF at rates significantly lower than historical controls or published literature. This provides strong justification for a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Mutations in the X-linked retinitis pigmentosa GTPase regulator (RPGR) gene are a major cause of retinitis pigmentosa, a blinding retinal disease resulting from photoreceptor degeneration. A photoreceptor specific ORF15 variant of RPGR (RPGRORF15), carrying multiple Glu-Gly tandem repeats and a C-terminal basic domain of unknown function, localizes to the connecting cilium where it is thought to regulate cargo trafficking. Here we show that tubulin tyrosine ligase like-5 (TTLL5) glutamylates RPGRORF15 in its Glu- Gly-rich repetitive region containing motifs homologous to the α-tubulin C-terminal tail. The RPGRORF15 C-terminal basic domain binds to the noncatalytic cofactor interaction domain unique to TTLL5 among TTLL family glutamylases and targets TTLL5 to glutamylate RPGR. Only TTLL5 and not other TTLL family glutamylases interacts with RPGRORF15 when expressed transiently in cells. Consistent with this, a Ttll5 mutant mouse displays a complete loss of RPGR glutamylation without marked changes in tubulin glutamylation levels. The Ttll5 mutant mouse develops slow photoreceptor degeneration with early mislocalization of cone opsins, features resembling those of Rpgr-null mice. Moreover TTLL5 disease mutants that cause human retinal dystrophy show impaired glutamylation of RPGRORF15. Thus, RPGRORF15 is a novel glutamylation substrate, and this posttranslational modification is critical for its function in photoreceptors. Our study uncovers the pathogenic mechanism whereby absence of RPGRORF15 glutamylation leads to retinal pathology in patients with TTLL5 gene mutations and connects these two genes into a common disease pathway. [ABSTRACT FROM AUTHOR]

Background: Mismatch repair-deficient (dMMR) colorectal cancer (CRC) is associated with a conspicuous local immune infiltrate; however, its relationship with systemic inflammatory responses remains to be determined. The present study aims to examine the relationships and prognostic value of assessment of the local and systemic environment in the context of MMR status in patients with CRC.Methods: The relationship between MMR status, determined using immunohistochemistry, and the local inflammatory cell infiltrate, differential white cell count, neutrophil : platelet score (NPS), neutrophil : lymphocyte ratio and modified Glasgow Prognostic Score (mGPS), and cancer-specific survival was examined in 228 patients undergoing resection of stage I-III CRC.Results: Thirty-five patients (15%) had dMMR CRC. Mismatch repair deficiency was associated with a higher density of CD3(+), CD8(+) and CD45R0(+) T lymphocytes within the cancer cell nests and an elevated mGPS (mGPS2: 23% vs 9%, P=0.007) and NPS (NPS2: 19% vs 3%, P=0.001). CD3(+) density (P<0.001), mGPS (P=0.01) and NPS (P=0.042) were associated with survival independent of MMR status (P=0.367) and stratified 5-year survival of patients with MMR-competent CRC from 94% to 67%, 83% to 46% and 78% to 60% respectively.Conclusions: Mismatch repair deficiency was associated with local and systemic environments, and in comparison with their assessment, dMMR had relatively poor prognostic value in patients with primary operable CRC. In addition to MMR status, local and systemic inflammatory responses should be assessed in these patients. [ABSTRACT FROM AUTHOR]

Recent analysis of single-cell transcriptomic data has revealed a surprising organization of the transcriptional variability pervasive across individual neurons. In response to distinct combinations of synaptic input-type, a new organization of neuronal subtypes emerged based on transcriptional states that were aligned along a gradient of correlated gene expression. Individual neurons traverse across these transcriptional states in response to cellular inputs. However, the regulatory network interactions driving these changes remain unclear. Here we present a novel fuzzy logic-based approach to infer quantitative gene regulatory network models from highly variable single-cell gene expression data. Our approach involves developing an a priori regulatory network that is then trained against in vivo single-cell gene expression data in order to identify causal gene interactions and corresponding quantitative model parameters. Simulations of the inferred gene regulatory network response to experimentally observed stimuli levels mirrored the pattern and quantitative range of gene expression across individual neurons remarkably well. In addition, the network identification results revealed that distinct regulatory interactions, coupled with differences in the regulatory network stimuli, drive the variable gene expression patterns observed across the neuronal subtypes. We also identified a key difference between the neuronal subtype-specific networks with respect to negative feedback regulation, with the catecholaminergic subtype network lacking such interactions. Furthermore, by varying regulatory network stimuli over a wide range, we identified several cases in which divergent neuronal subtypes could be driven towards similar transcriptional states by distinct stimuli operating on subtype-specific regulatory networks. Based on these results, we conclude that heterogenous single-cell gene expression profiles should be interpreted through a regulatory network modeling perspective in order to separate the contributions of network interactions from those of cellular inputs. [ABSTRACT FROM AUTHOR]

The article discusses the economic impact of securities fraud to the inflation of the price investors pay for the stock as well as the integrity of public stock markets in the U.S. It examines the regulatory structure governing the publicly traded corporation. It also cites the influence of securities laws to the public markets.

The article discusses the legal aspects of bondholders and various securities class action proceedings which took place in America between 1996 and 2005, focusing on common stock and securities fraud laws in the U.S. According to the article, the most prominent case where bondholders achieved a recovery through America's securities laws involved the WorldCom Inc. telecommunications firm and accounting fraud litigation in 2002. U.S. corporate laws and fiduciary duties are also examined.

Abstract: A mild, redox neutral photocatalytic method for alkene hydrothiolation is reported. Utilizing visible-light activation, catalytic radical initiation is achieved with the transition metal complex Ru(bpy)3Cl2, enabling rapid access to a diverse set of thiol–ene coupled products in excellent yield. On the basis of a strong observed background reaction in some cases, we have developed a solvent-free, Lewis acid-promoted tandem amidation–hydrothiolation sequence, providing thiomorpholin-3-ones in a one-pot operation from commercially available materials. [Copyright &y& Elsevier]

Radar observations of human activities have a variety of applications in security, defense, and rescue operations. Range-Doppler signatures of human motions are a useful tool for retrieving information on observed activities but require an understanding of the scattering processes involved to enable interpretation. This paper presents a study of human Doppler signatures using simulations, in particular focusing on the impact of the polarization to enable an understanding of any advantages in the use of polarimetric radar. The simulation model utilized is based on an approximate scattering approach combined with a 12-cylinder description of the human body. A comparison with single polarization co-pol measurements is used to show that the model provides reasonable first-order predictions of human signatures. Further simulations for polarimetric signatures illustrate the differing contributions of individual body parts to micro-Doppler returns and suggest that multi-polarization measurements can be useful in future micro-Doppler radar systems for human observation. [ABSTRACT FROM AUTHOR]

Researchers tend to agree that an increasing quantity of data has caused the complexity and difficulty for information discovery, management, and reuse. An essential factor relates to the increasing channels (i.e., Internet, social media, etc.) for information sharing. Finding information, especially those meaningful or useful one, that meets ultimate goal (or task) of user becomes harder then it is used to be. In this research, issues concerning the use of user-generated contents for individual search support are investigated. In order to make efficient use of user-generated contents, an intelligent state machine, as a hybridization of graph model (Document Graph) and petri-net model (Document Sensitive Petri-Net), is proposed. It is utilized to clarify the vague usage scenario between user-generated contents, such as discussions, posts, etc., and to identify correlations and experiences within them. As a practical contribution, an interactive search algorithm that generates potential solutions for individual is implemented. The feasibility of this research is demonstrated by a series of experiments and empirical studies with around 350,000 user-generated contents (i.e., documents) collected from the Internet and 200 users. [ABSTRACT FROM AUTHOR]

Cloud computing delivers almost all of its services including software, user's data, system resources, processes and their computation over the Internet. Cloud computing consists of three main classes; Software as a Service, Infrastructure as a Service and Platform as a Service. Using Software as a Service (SaaS), users are able to rent application software and databases which they then install onto their computer in the traditional way. In the Enterprise Resource Planning (ERP) system, the system service environment changed so as to allow the application of the SaaS in the cloud computing environment. This change was implemented in order to provide the ERP system service to users in a cheaper, more convenient and efficient form through the Internet as opposed to having to set up their own computer. Recently many SaaS ERP packages are available on the Internet. For this reason, it is very difficult for users to find the SaaS ERP package that would best suit their requirements. The QoS (Quality of Service) model can provide a solution to this problem. However, according to recent research, not only quality attributes' identification for SaaS ERP, but also a process for finding and recommending software in the cloud computing environment, has proved to be lacking. In this paper, we propose a QoS model for SaaS ERP. The proposed QoS model consists of 6 criteria; Functionality, Reliability, Usability, Efficiency, Maintainability and Business. Using this QoS model, we propose a Multi Criteria Decision Making (MCDM) system that finds the best fit for the SaaS ERP in the cloud computing environment and makes recommendations to users in priority order. In order to organize the quality clusters, we organized an expert group and got their opinion to organize the quality clusters using Social Network Group. Social Networks can be used efficiently to get opinion by various types of expert groups. In order to establish the priority, we used pairwise comparisons to calculate the priority weights of each quality attribute while accounting for their interrelation. Finally, using the quality network model and priority weights, this study evaluated three types of SaaS ERPs. Our results show how to find the most suitable SaaS ERPs according to their correlation with the criteria and to recommend a SaaS ERP package which best suits users' needs. [ABSTRACT FROM AUTHOR]

The article presents a study which examined four variables, including self-efficacy, depression, and life satisfaction, of Korean adults in professional nursing facilities to improve nursing treatments. It states that the study made used of tests to measure the variables which include Standard Life Satisfaction Instrument, Korean Simple Depression Scale, and Self-Efficacy Instrument. Moreover, the study showed that Korean adults in the facilities maintain a significant level of well-being.

Securities class actions are often criticized as wasteful strike suits that target temporary fluctuations in the stock prices of otherwise healthy companies. The securities class actions brought by investors of Enron and WorldCom, companies that fell into bankruptcy in the wake of fraud, resulted in the recovery of billions of dollars in permanent shareholder losses and provide a powerful counterexample to this critique. An issuer's bankruptcy may affect how judges and parties perceive securities class actions and their merits, yet little is known about the subset of cases where the company is bankrupt. This is the first extensive empirical study of securities class actions and bankrupt companies. It examines 1,466 securities class actions filed from 1996 to 2004, of which 234 (16 percent) involved companies that were in bankruptcy proceedings while the class action was pending. The study tests two hypotheses. First, securities class actions involving bankrupt companies ("bankruptcy cases") are more likely to have actual merit than securities class actions involving companies not in bankruptcy ("nonbankruptcy cases"). Second, bankruptcy cases are more likely to be perceived as having merit than nonbankruptcy cases, regardless of their actual merit. The study finds stronger support for the second hypothesis than for the first, suggesting that judges and parties use bankruptcy as a heuristic for merit. Even when controlling for various indicia of merit, bankruptcy cases are more likely to be successful in terms of dismissal rates, significant settlements, and third-party settlements than nonbankruptcy cases. These results are evidence that judges use heuristics not only to dismiss cases but also to avoid dismissing cases. Securities class actions cannot be adequately understood without examining the subset of cases with a bankrupt issuer. The perception that securities class actions merely harass healthy companies should be revised in light of the significant number of bankruptcy cases in which shareholders have a greater need for a securities fraud remedy. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing liver resection for colorectal cancer liver metastasis (CRCLM) are often treated with chemotherapy before surgery. However, the associations between chemotherapy, liver injury, perioperative outcomes, and other confounding factors remain unclear. This study investigates the effect of preoperative chemotherapy for CRCLM on nontumoral liver histology and perioperative outcomes in a contemporary cohort. Study Design: Five hundred six patients underwent hepatic resection for CRCLM between April 2003 and March 2007. Histologic evaluation of nontumoral liver parenchyma for sinusoidal dilatation, steatosis, and steatohepatitis was performed in 384 cases for which tissue was available. Patient factors, tumor characteristics, chemotherapy regimens, histology of nontumoral liver, and perioperative morbidity were analyzed. Results: Two hundred fifty patients (65%) received preoperative chemotherapy for a median duration of 24 weeks. Irinotecan, increased body mass index (BMI), and diabetes mellitus (DM) were associated with hepatic steatosis and steatohepatitis. Sinusoidal dilatation was not associated with chemotherapy or any clinicopathologic factors. Perioperative blood transfusion was independently associated with an increased risk of any complication. Major postoperative complications were independently associated with major (≥3 segments) resections (57%) and perioperative blood transfusion. The use of any preoperative chemotherapy decreased the odds of major complications. Liver-related complications were independently associated with major resection and blood transfusion, but not with chemotherapy. Three postoperative deaths (0.8%) occurred, all in patients who were not treated with chemotherapy and had no evidence of liver injury. Conclusions: With appropriate patient selection, liver resection for CRCLM can be safely performed in patients treated with preoperative chemotherapy. [ABSTRACT FROM AUTHOR]

Though the Securities and Exchange Commission (SEC) is the primary securities enforcer, multiple enforcers are active in enforcing the securities laws. Some scholars argue that enforcement should be centralized to eliminate or control enforcers with incentives to overenforce, while others contend that competition checks the SEC from a tendency to underenforce. The debate is characterized by a focus on whether the system produces an optimal quantity of enforcement. This Article assesses the centralization debate through a different lens, emphasizing differences in the quality of enforcement, particularly the values that influence and are expressed by enforcement. To frame the discussion, it draws a distinction between two categories of enforcement: rule-enforcement and principle- enforcement. Rule-enforcement is less costly and controversial than principle-enforcement because special rules tend to reflect the technical requirements of an administrative regime while general principles can reflect a wider range of values. Enforcers differ in their approach in taking on the cost and controversy of principle-enforcement. Industry enforcers are likely to interpret principles narrowly based on industry values. Regulatory enforcers such as the SEC may find it difficult to adequately enforce principles because of the pressure of implementing consistent regulatory policy. Public-values enforcers such as federal prosecutors and state attorneys general are willing to enforce principles in light of social values but may overreach because of political ambition. Entrepreneurial enforcers such as class action attorneys are most willing to invest in principle-enforcement but also have a tendency to bring questionable cases for profit. The choice between a centralized and decentralized enforcement system is fundamentally a choice between a one-dimensional and multidimensional conception of the values relevant to securities enforcement. Proposals to centralize securities enforcement are motivated by a desire to eliminate the conflicts that can arise between enforcement approaches that reflect different values. The cost of such centralization is that the advantages diverse enforcers bring to the table will be eliminated. This Article concludes that a decentralized system is best justified by recognizing the particular strengths of different enforcers rather than focusing on whether an optimal amount of enforcement is produced. [ABSTRACT FROM AUTHOR]

Statistics of radio frequency interference (RFI) observed in the band 1398–1422 MHz during an airborne campaign in the United States are reported for use in analysis and forecasting of L-band RFI for microwave radiometry. The observations were conducted from September to October 2008, and included approximately 92 h of flight time, of which approximately 20 h of “transit” or dedicated RFI observing flights are used in compiling the statistics presented. The observations used include outbound and return flights from Colorado to Maryland, as well as RFI surveys over large cities. The Passive Active L-Band Sensor (PALS) radiometer of NASA Jet Propulsion Laboratory augmented by three dedicated RFI observing systems was used in these observations. The complete system as well as the associated RFI characterization approaches are described, along with the resulting RFI statistical information and examinations of specific RFI sources. The results show that RFI in the protected L-band spectrum is common over North America, although the resulting interference when extrapolated to satellite observations will appear as “low-level” corruption that will be difficult to detect for traditional radiometer systems. [ABSTRACT FROM AUTHOR]

Purpose: Diagnostic imaging is effective for evaluating patients suspected of having hepatocellular carcinoma (HCC). Although the diagnosis can be established with imaging alone, diagnostic biopsy may be useful for patients with tumors measuring 1 to 2 cm. To date, biopsy and imaging use among patients with HCC has not been evaluated in the general community. Patients and Methods: This cohort study used Surveillance, Epidemiology, and End Results (SEER) -Medicare data (2002- 2005) evaluating biopsy, imaging modalities (ultrasound, computed tomography [CT] scan, and/or magnetic resonance imaging [MRI]), and HCC risk factors. Results: Of 3,696 patients, 1,197 (32.4%) underwent one or more biopsies, with no change in yearly biopsy rate (trend test, P = .64). Patients with tumors > 5 cm were most likely to receive biopsies (35.3%), with increasing rates of biopsy for larger tumors (P = .001). Patients who received biopsies underwent more imaging than those who did not (P < .001) and were more likely to have an HCC risk factor. Tumor size > 5 cm in the setting of a concurrent HCC risk factor increased the odds of biopsy. In 47.8% of patients, the diagnostic sequence was not consistent with contemporary evidence-based guidelines. Conclusions: Despite widespread availability and use of CT scan and MRI, one third of HCC patients undergo biopsy, suggesting a problem with the performance and/or quality of diagnostic imaging or that providers do not believe imaging alone is sufficient to establish the diagnosis. Understanding factors that drive biopsy use may help improve the care of patients with HCC. [ABSTRACT FROM AUTHOR]

Securities regulation has traditionally focused on encouraging truthful disclosure that facilitates the accurate pricing of securities. A typical securities fraud claim under the primary antifraud provision, Rule 10b-5, must thus point to a misrepresentation or omission that is material to investors. At the same time, it is undeniable that Rule 10b-5 has been extended to conduct that does not fit this traditional conception of fraud, most notably insider trading. This Article shows that such deviations have become more common as Rule 10b-5 has increasingly become concerned with the problem of unjust enrichment. In numerous areas, the courts have applied Rule 10b-5 to deceptive conduct that is not directed at the market or investors but unjustly enriches some individual. Surprisingly, the unjust enrichment principle has functioned not only as an expander of liability but also as a limit. More and more, securities fraud class actions directed at market-distorting misrepresentations may only proceed if insiders have been enriched by the misrepresentation. The rise of the unjust enrichment principle demonstrates that securities regulation is not only concerned with the economic value of market efficiency but also is significantly influenced by public values. Securities regulation is guided by an evolving principle that sets some limits on the ability to extract wrongful gains from the securities markets. Though unjust enrichment is undeniably a concern of Rule 10b-5, it should be a second-order concern subordinate to the first-order concern of efficient markets. [ABSTRACT FROM AUTHOR]

HIV is a chronic illness that requires strict adherence to medication regimens. This study attempts to examine the patterns of highly active antiretroviral therapy adherence relative to religious beliefs in a population of perinatally HIV-infected adolescents. Eligible subjects included perinatally HIV-infected youth aged 14-22 years who knew their HIV status. Assessment tools included an antiretroviral adherence form, a standardized depression questionnaire, and a religious observance questionnaire. All of these forms were completed at the time of study enrollment. Twenty subjects met entry criteria and were enrolled. Subjects who had excellent adherence had significantly higher religious belief scores than those who had poor adherence (3.46±0.46 vs. 2.34±0.69, p<0.05). Those with excellent adherence also had higher religious practice scores than those with poor adherence (2.66±1.02 vs. 2.23±1.45, p=0.46). Beck Depression Inventory (BDI)-II depression score was also lower in those with excellent adherence versus those with poor adherence (4.64±3.41 vs. 8.86±9.77, p=0.39). Physicians may be able to consider spirituality as a factor that may influence medication adherence in pediatric HIV patients. As perinatally HIV-infected youth age into adulthood, future studies will be needed to explore the ongoing intimate relationship between a patient's religious views and their compliance to medical regimens. [ABSTRACT FROM AUTHOR]

Background: The incidence of hepatocellular carcinoma (HCC) is rising and radiofrequency ablation (RFA) appears to be increasingly used. The nationwide use and impact of RFA have not been well characterized. Study Design: We performed an historical cohort study of US patients 18 years old and older, with a diagnosis of HCC (n = 22,103) using the national Surveillance, Epidemiology, and End Results (SEER) limited-use database (1998 to 2005). Main outcomes measures were receipt of different therapeutic interventions (ablation, RFA, resection, or transplantation) and adjusted 1- and 2-year survivals. Results: A total of 4,924 (22%) patients underwent any intervention, with a 93% increase over the 8-year study period (trend test, p < 0.001). RFA accounted for 43% of this increase. Despite increased use of therapeutic interventions, 1- and 2-year survival rates did not improve over time for patients in the study cohort (48% and 34%, 52% and 37%, 50% and 36%; in 1998, 2002, and 2004, respectively; p = 0.31). Among patients with solitary lesions, adjusted 1- and 2-year survivals remained stable over time after transplantation (97% and 94%, 95% and 89%, 94% and 86% in 1998, 2002, and 2004, respectively; p = 0.99) and RFA (86% and 64%, 76% and 54%, in 2002 and 2004, respectively; p = 0.97), but improved after resection (83% and 71%, 91% and 84%, 97% and 94% in 1998, 2002, and 2004, respectively; p = 0.03). Conclusions: Use of interventions for the treatment of HCC, and specifically RFA, have markedly increased over time. Because increased use of RFA among patients with potentially resectable disease is likely to occur, and because of a lack of high-level evidence supporting expanded indications, continued evaluation of the indications for RFA and subsequent outcomes among US patients is warranted. [Copyright &y& Elsevier]

Background Although the haemodynamic effects of oxygen in healthy subjects are well documented, there have been no well-controlled studies of the effects of oxygen in patients with heart failure (HF). Aims To non-invasively evaluate haemodynamic and neurohumoral effects of oxygen in patients with HF at rest. Methods and results 13 men with heart failure and left ventricular systolic dysfunction (LVSD) were randomised in a double-blind, placebo-controlled, crossover trial to receive medical air or oxygen (40% and high concentration via Hudson non-rebreathing mask). Haemodynamic measurements were made with applanation tonometry, impedance cardiography and venous occlusion plethysmography. Plasma C-terminal B-type natriuretic peptide and A-type natriuretic peptide were measured. Data were analysed with paired t tests. Cardiac output fell by -0.58 (0.62) …l/min on high-flow oxygen compared with -0.02 (0.58) …l/min on air, p=0.031. Oxygen caused a reduction in heart rate (-4.02 (4.21) vs 0.41 (5.35) …beats/min, respectively, p=0.021) and a trend towards increased systemic vascular resistance (875 (1174) vs 235 (321) …dyne/s/m5, p=0.050). Oxygen led to a paradoxical increase in forearm blood flow (0.513 (0.391) vs 0.024 (0.246) …ml/min/100 ml forearm volume on air, p=0.01). Natriuretic peptides were unchanged with oxygen. Conclusions High-concentration inhaled oxygen has significant haemodynamic effects in patients with LVSD and mild HF. Such effects may be detrimental in patients with decompensated HF. [ABSTRACT FROM AUTHOR]

This Article questions the prevailing view that securities-fraud actions suffer from a circularity problem. Because shareholder plaintiffs are owners of the defendant corporation, it is commonly argued that shareholder compensation is a payment from shareholders to themselves with substantial transaction costs in the form of attorney fees. But shareholder compensation is no more circular than a dividend, which is a cash payment to shareholders from the company they own with substantial transaction costs in the form of taxes. In fact, shareholder compensation is less circular than a dividend because it is a transfer to shareholders who purchased stock when the price was inflated by fraud from those who did not. Shareholder compensation serves an important loss-spreading function that is facilitated by the insurance market. Shareholder compensation may also capture some of the benefits of paying dividends, such as signaling and reducing agency costs, though it may do so more effectively if companies could resolve securities-fraud actions by paying a preemptive dividend. [ABSTRACT FROM AUTHOR]

While external barriers such as language, culture, and worldview are often recognized by the church in its mission, the invisible, but very real internal barriers which exist in the hearts of the members, are often overlooked. The story in Acts 10 which has often been called "The conversion of Cornelius" could just as well be known as "The conversion of Peter." The study will use this pericope and the parallel narrative of Saul and Ananias in Acts 9 in order to uncover the hidden internal barriers and make recommendations for the present witness of the church. [ABSTRACT FROM AUTHOR]

The lysosomal storage disorder Fabry disease is characterized by excessive globotriaosylceramide (Gb3) accumulation in major organs such as the heart and kidney. Defective lysosomal α-galactosidase A (Gla) is responsible for excessive Gb3 accumulation, and one cell sensitive to the effects of Gb3 accumulation is vascular endothelium. Endothelial dysfunction is associated with Fabry disease and excessive cellular Gb3. We previously demonstrated that excessive vascular Gb3 in a mouse model of Fabry disease, the Gla-knockout (Gla-/0) mouse, results in abnormal vascular function, which includes abnormal endothelium-dependent contractions, a vascular phenomenon known to involve cyclooxygenase (COX). Therefore, we hypothesized that the vasculopathy in the Gla knockout mouse may be due to a vasoactive COX-derived product. To test this hypothesis, vascular reactivity experiments were performed in aortic rings from wild-type (Gla-/0) and Gla-/0 mice in the presence and absence of specific and nonspecific COX inhibitors. Specific inhibition of COX1 or COX2 in endothelium-intact rings from Gla-/0mice decreased overall phenylephrine contractility com- pared with untreated Gla-/0 rings, whereas COX inhibitors had no effect on contractility in endothelium-denuded rings. Nonspecific inhibition of COX with indomethacin (10 μmol/l) or COX1 inhibition with valeryl salicylate (3 mmol/l) improved endothelial function in rings from Gla-/0 mice, but COX2 inhibition with NS-398 (1μmol/l) further increased endothelial dysfunction in rings from Gla-/0 mice. These results suggest that, in the Gla-/0 mice, COX1 and COX2 activity are increased and localized in the endothelium, producing vasopressor and vasorelaxant products, which contribute to the Fabry-related vasculopathy. [ABSTRACT FROM AUTHOR]

1. Fabry disease results from an X-linked mutation in the lysosomal α-galactosidase A (Gla) gene. Defective Gla results in multi-organ accumulation of neutral glycosphingolipids (GSLs), especially in the vascular endothelium, with the major GSL accumulated being globotriaosylceramide (Gb3). Excessive endothelial Gb3 accumulation is associated with increased thrombosis, atherogenesis and endothelial dysfunction. However, the mechanism(s) by which endothelial dysfunction occurs is unclear. The purpose of the present study was to further characterize the vasculopathy associated with a murine model of Fabry disease. 2. Vascular reactivity was performed in vessels from wild-type (Gla+/0) and Gla-knockout (Gla−/0) mice. Conscious blood pressure and heart rate were measured in Gla+/0 and Gla−/0 mice by telemetry. 3. The present study demonstrates that vascular smooth muscle (VSM) contractions to phenylephrine and serotonin, but not to U46619, were blunted in Gla−/0 mice. Endothelium-dependent contraction and receptor-mediated endothelium-dependent relaxation to acetylcholine were significantly attenuated in vessels from Gla−/0 mice. However, receptor-independent endothelium-dependent relaxation to the calcium ionophore ionomycin remained intact in vessels from Gla−/0 mice. Furthermore, VSM reactivity was normal in aortas from Gla−/0 mice in the absence of endothelium. These changes in vascular function were observed without changes in whole-animal blood pressure or heart rate. 4. These results suggest that the vasculopathy associated with Fabry disease is localized to the endothelium, despite the accumulation of GSLs throughout the vasculature. [ABSTRACT FROM AUTHOR]

A continuing medical education (CME) examination from the American College of Gastroenterology (ACG) on topics like in-hospital mortality for early liver transplant patients with Budd-Chiari syndrome is presented.

Simple Summary: Pronounced differences across individuals (interpatient variability) and cell–cell heterogeneity within a tumor (intratumoral heterogeneity) severely hinder effective brain tumor treatment. To overcome these challenges, a personalized precision medicine approach that considers the uniqueness of an individual patient's tumor and its cellular composition is required. A systems biology approach is needed to develop a multiscale understanding of the mechanistic drivers of disease etiology and progression to realize this vision. A systems-level understanding of disease characteristics can facilitate precise patient stratification into clinically meaningful subtypes and inform on potential druggable targets that can enhance treatment. Here, we synthesize and review various methodologies that can be integrated into a framework designed to achieve a personalized precision medicine approach for treating brain tumors. Finally, we provide a practical example in the context of analyzing an individual glioblastoma (GBM) patient at various stages of disease progression. Brain tumors are among the most lethal tumors. Glioblastoma, the most frequent primary brain tumor in adults, has a median survival time of approximately 15 months after diagnosis or a five-year survival rate of 10%; the recurrence rate is nearly 90%. Unfortunately, this prognosis has not improved for several decades. The lack of progress in the treatment of brain tumors has been attributed to their high rate of primary therapy resistance. Challenges such as pronounced inter-patient variability, intratumoral heterogeneity, and drug delivery across the blood–brain barrier hinder progress. A comprehensive, multiscale understanding of the disease, from the molecular to the whole tumor level, is needed to address the intratumor heterogeneity resulting from the coexistence of a diversity of neoplastic and non-neoplastic cell types in the tumor tissue. By contrast, inter-patient variability must be addressed by subtyping brain tumors to stratify patients and identify the best-matched drug(s) and therapies for a particular patient or cohort of patients. Accomplishing these diverse tasks will require a new framework, one involving a systems perspective in assessing the immense complexity of brain tumors. This would in turn entail a shift in how clinical medicine interfaces with the rapidly advancing high-throughput (HTP) technologies that have enabled the omics-scale profiling of molecular features of brain tumors from the single-cell to the tissue level. However, several gaps must be closed before such a framework can fulfill the promise of precision and personalized medicine for brain tumors. Ultimately, the goal is to integrate seamlessly multiscale systems analyses of patient tumors and clinical medicine. Accomplishing this goal would facilitate the rational design of therapeutic strategies matched to the characteristics of patients and their tumors. Here, we discuss some of the technologies, methodologies, and computational tools that will facilitate the realization of this vision to practice. [ABSTRACT FROM AUTHOR]

We have found a striking difference between the modes of action of amdinocillin (mecillinam) and compound A22, both of which inhibit cell elongation. This was made possible by employment of a new method using an Escherichia coli peptidoglycan (PG)-recycling mutant, lacking ampD, to analyze PG degradation during cell elongation and septation. Using this method, we have found that A22, which is known to prevent MreB function, strongly inhibited PG synthesis during elongation. In contrast, treatment of elongating cells with amdinocillin, which inhibits penicillin-binding protein 2 (PBP2), allowed PG glycan synthesis to proceed at a nearly normal rate with concomitant rapid degradation of the new glycan strands. By treating cells with A22 to inhibit sidewall synthesis, the method could also be applied to study septum synthesis. To our surprise, over 30% of newly synthesized septal PG was degraded during septation. Thus, excess PG sufficient to form at least one additional pole was being synthesized and rapidly degraded during septation. We propose that during cell division, rapid removal of the excess PG serves to separate the new poles of the daughter cells. We have also employed this new method to demonstrate that PBP2 and RodA are required for the synthesis of glycan strands during elongation and that the periplasmic amidases that aid in cell separation are minor players, cleaving only one-sixth of the PG that is turned over by the lytic transglycosylases. [ABSTRACT FROM AUTHOR]

The phenomenon of peptidoglycan recycling is reviewed. Gram-negative bacteria such as Escherichia coli break down and reuse over 60% of the peptidoglycan of their side wall each generation. Recycling of newly made peptidoglycan during septum synthesis occurs at an even faster rate. Nine enzymes, one permease, and one periplasmic binding protein in E. coli that appear to have as their sole function the recovery of degradation products from peptidoglycan, thereby making them available for the cell to resynthesize more peptidoglycan or to use as an energy source, have been identified. It is shown that all of the amino acids and amino sugars of peptidoglycan are recycled. The discovery and properties of the individual proteins and the pathways involved are presented. In addition, the possible role of various peptidoglycan degradation products in the induction of β-lactamase is discussed. [ABSTRACT FROM AUTHOR]

Although the securities industry is primarily regulated by specific rules, it is also governed by general principles. When conduct violates a rule, the regulatory response is obvious-enforce the rule. The issue is more difficult when conduct does not violate a rule but violates a principle. A regulator can excuse the conduct on the ground that the law is unclear and prohibit the conduct going forward through rulemaking. Or, the regulator can punish the conduct through what I call a "principles-based" enforcement action. Since 2002, there has been a surge of principles-based enforcement actions, provoking criticism that regulators are engaging in "Regulation by Enforcement." This Article compares these regulatory tools and proposes criteria to guide regulators in choosing between them in communicating legal norms to the regulated. These approaches represent two paradigms that must coexist but can also compete. Rulemaking reflects the mentality that securities regulation is a technical enterprise that should be left to experts who have created a comprehensive, efficient administrative scheme. Principles-based enforcement actions reflect the demand that regulators punish conduct that violates principles reflecting public values. For the most part, the regulated prefer a predictable regulatory regime, which rulemaking provides, whereas the public prefers decisive responses, which principles-based enforcement actions provide. Based on these preferences, public choice theory would contend that regulators are more likely to address arguable misconduct by aggressively enforcing principles when public influence is high, while utilizing rulemaking when the regulated are influential. But this account is too simplistic-although the relative strength of interest groups can affect the incentives of regulators, their choices are subject to significant constraints. For example, a regulator cannot credibly bring a principles-based enforcement action without uncovering specific evidence of misconduct. Even if regulators are so constrained, they should counter the perception that their choices are made to appease interest groups by considering the circumstances in which principles-based enforcement is appropriate. In doing so, regulators should take into account both the need for a predictable regulatory regime and the need to punish conduct that violates principles. They should consider: (1) whether the principle being enforced is well established or novel, (2) whether the application of the principle is consistent with existing rules, (3) whether there is compelling evidence establishing the misconduct, and (4) whether the conduct caused foreseeable public harm. [ABSTRACT FROM AUTHOR]

Blood transfusion is often necessary in patients undergoing liver resection. Because of the risks associated with allogeneic blood products, preoperative autologous blood donation has been advocated, but its benefit with respect to perioperative outcome remains unclear. This study compares perioperative outcome in patients transfused only with autologous blood to a matched cohort receiving only allogeneic blood. All patients subjected to hepatic resection and given only perioperative autologous red cell transfusions were identified from a prospective database of 2,123 patients and reviewed retrospectively. This group was matched to patients transfused only with a comparable number of allogeneic red cell units and to a control group that received no blood products. All patients in the autologous or allogeneic group received either 1 or 2 U. Matching was based on age, comorbidity, extent of hepatic resection, and estimated blood loss. Matched pair analysis was performed using the paired t test, McNemar and Stuart-Maxwell tests. From December 1991 to May 2003, 124 patients undergoing hepatic resection received perioperative autologous blood only, for which optimal matching was possible in 104. The groups were similar with respect to age, comorbidities, and blood loss; the proportions receiving preoperative chemotherapy, requiring a major resection (>or=3 segments) or a complex procedure (concomitant major procedure in addition to the principal hepatic resection) were also similar. There were no differences between the autologous and allogeneic groups in length of hospitalization, complications, and operative mortality. In patients undergoing hepatic resection, autologous blood transfusion did not demonstrably improve perioperative outcome when compared to a matched cohort of patients receiving a similar number of allogeneic units. [ABSTRACT FROM AUTHOR]

The ethnic-cultural (re)naissance in Chile is currently undergoing an expansion as well as a diversification along lines of minority cultures and gender differentiations. Since the explosion onto the Chilean literary landscape of the bilingual poet Leonel Lienlaf in 1989, Mapuche-Huilliche writers have come into the spotlight of academia, state, and popular culture critics. Younger generations of Huilliche poets are distinguishing themselves through a hybrid, reflexive, and literary expressiveness. In opposition to the poetry that is tied to indigenous cultural institutions, orality, and traditional rural forms of existence, these poets thrive and strive for a pluricultural and complex way of living and expressing themselves. This work explores a selection of poets and their individual circumstances in an attempt to delineate the differences within and between these poets and the more traditional ones, and suggest a greater cultural change that is coming about in south Chile. [ABSTRACT FROM AUTHOR]