Defense Information Systems Agency

The approach which had been being employed to date for dealing with and classifying those aspects related to health and disability have been revised and updated thanks to the World Health Organization (WHO) having drafted the International Classification of Functioning, Disability and Health, which has now been accepted 191 countries after revamping the prior model and reaching a consensus regarding a new international model for describing and measuring health and disability. As background information, it must be recalled that the Classification of Impairments, Disabilities and Handicaps (CIDH) previously in effect was first published by the WHO in 1980. The process of revising this classification has resulted in some changes of far-reaching importance. The change in the name has been aimed at reflecting the wish to replace the negative perspective of impairments, disabilities and handicaps for a more neutral view of structure and function, considering the positive perspectives of activities and of participation. Another new aspect has been that of including a section related to environmental factors in recognition of their importance, given that by interacting with the health condition they may give rise to a disability, or, at the opposite end of the scale, may restore functioning. The data available has enabled the WHO make estimates including that of some 500 million years of life being lost annually due to disabilities related to health problems, which totals over one half of the years lost annually due to premature deaths. The main objective of this new classification is that of providing the conceptual framework by means of unified, standardized language with a view to of the underlying challenges, setting out a valuable instrument of practical use in public health.

Executive Overview The foci of strategic entrepreneurship (SE) are broad and rich, building on research from multiple disciplines such as economics, psychology, and sociology, along with other subdisciplines in management including organizational behavior and organization theory. Herein, we examine the contributions of strategic management and entrepreneurship to SE. Building on a previous model of SE, we develop an input-process-output model to extend our understanding of the SE construct. We examine the resource inputs into SE, such as individual knowledge and skills. In addition, we explore the resource orchestration processes that are important for SE and the outcomes, including creating value for customers, building wealth for stockholders, and creating benefits for other stakeholders, especially for society at large. Individual entrepreneurs also benefit through financial wealth, but other outcomes such as personal satisfaction and fulfillment of personal needs (e.g., self-actualization) may be of equal or even greater importance. Therefore, we incorporate in the model of SE multilevel outcomes that motivate entrepreneurs.

Internationally, the adoption of health information technology is increasing. However, a number of issues have complicated the adoption of electronic health records (EHRs). In addition to adoption issues, it is becoming increasingly recognized that healthcare providers face a variety of usability issues. In this paper, we consider approaches that have been taken to assess both adoption and usability of EHRs in Canada, Denmark and Finland. Although all three countries deploy surveys to assess adoption, the approach and focus of the surveys differs across the countries. In Denmark and Finland, these surveys are dedicated to assessing information technology (IT) usage; while in Canada, questions about IT usage are part of a larger physician survey. Regarding usability, approaches vary considerably. In Finland, the approach includes a national survey about EHR usability. In Canada, ratings of system usability are reported regionally on web sites; while in Denmark, regional study results are reported based on evaluation of commercial products. This paper highlights the need to consider different evaluation approaches internationally.

Abstract— The turnover of brain norepinephrine (NE) and dopamine (DA) was studied in five groups of male Sprague‐Dawley rats under different conditions of alcohol treatment: no treatment, acute treatment while intoxicated, acute treatment subsequent to elimination of alcohol from the blood, alcohol‐dependence while still intoxicated and alcohol‐dependence during a withdrawal syndrome. Turnover was determined from the rate of depletion of brain catecholamine levels after inhibition of tyrosine hydroxylase. In rats given a single dose of alcohol, NE turnover was increased, while DA turnover was unaffected during the few first hours after treatment. After that time the turnover of both NE and DA was reduced. In alcohol‐dependent rats, whether intoxicated or undergoing a withdrawal syndrome, the turnover of NE was increased, while that of DA was decreased. These data suggest that catecholamines may mediate some of the symptoms of the alcohol withdrawal syndrome in the rat.

, 2012, p. 533) has been used to extend the transdiagnostic model articulated by Mansell (2005, p. 141) to focus on the role of IU as a facet of the model that is important to address in treatment. Research suggests that individual differences in IU may compromise resilience and that individuals high in IU are susceptible to increased negative affect. The model extension provides a guide for the treatment of clients presenting with uncertainty in the context of either a single disorder or several comorbid disorders. By applying the extension, the clinician is assisted to explore two facets of IU, "Need for Predictability" and "Uncertainty Arousal."

phenotype and protects axons from degeneration induced by axotomy or mitochondrial dysfunction. SARM1 inhibition post-mitochondrial injury with rotenone allows recovery and rescues axons that already entered the metastable state. We conclude that SARM1 inhibition with small molecules has the potential to treat axonopathies of the central and peripheral nervous systems by preventing axonal degeneration and by allowing functional recovery of a metastable pool of damaged, but viable, axons.

Studies of emotion signaling inform claims about the taxonomic structure, evolutionary origins, and physiological correlates of emotions. Emotion vocalization research has tended to focus on a limited set of emotions: anger, disgust, fear, sadness, surprise, happiness, and for the voice, also tenderness. Here, we examine how well brief vocal bursts can communicate 22 different emotions: 9 negative (Study 1) and 13 positive (Study 2), and whether prototypical vocal bursts convey emotions more reliably than heterogeneous vocal bursts (Study 3). Results show that vocal bursts communicate emotions like anger, fear, and sadness, as well as seldom-studied states like awe, compassion, interest, and embarrassment. Ancillary analyses reveal family-wise patterns of vocal burst expression. Errors in classification were more common within emotion families (e.g., 'self-conscious,' 'pro-social') than between emotion families. The three studies reported highlight the voice as a rich modality for emotion display that can inform fundamental constructs about emotion.

The boundary value problem of the infinite grating of circular cylinders is treated by specializing the new functional equation obtained previously for arbitrary elements. This specifies the problem in terms of a set of algebraic equations which involves only the known scattering coefficients of an isolated cylinder, and certain series of elementary functions. The special results for normal incidence are identically those obtained originally by Ignatowsky who worked with the separation-of-variables solution; as a check we also extend his procedure to arbitrary angles and show that the results can be transformed to those we obtain by the Green's function approach. The equations are used to construct series and closed form approximations for both polarizations, for conducting and dielectric cylinders, for arbitrary angles of incidence. The results are applied to consider multiple scattering or coupling effects for a mode near grazing (Wood anomalies), and for closely spaced scatterers (packing effects). For example, we show that to a first approximation the packing effects for <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">E</tex> perpendicular to the axes merely increase the dipole moment of the isolated cylinder; in this range, the circular cylinder within the grating is equivalent to an isolated elliptic cylinder whose size and shape are independent of angle of incidence. We also obtain simple closed forms for low frequencies which take explicit account of coupling effects up to multipoles of order <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2^{5}</tex> , etc.

Executive Overview Informal firms operate in a shadowy zone where they produce legal goods and services but do not follow legal requirements to register with government authorities. The collective economic activity involving informal firms, their suppliers, and their customers constitutes the informal economy. Although the informal economy accounts for a significant percentage of total commerce in many countries, there has been little management research about it. We outline some key issues and questions involving the informal economy that management researchers could help to answer, forming a potential research agenda in the process.

Necrotizing abdominal wall infections, enteric fistulae, or exposed prosthetic material after ventral hernia repair often results in a loss of abdominal wall integrity. Further surgical reconstruction with prosthetic material is usually contraindicated in the contaminated wound because of the high infection rate necessitating prosthetic removal and further abdominal wall debridement. Consequently, for the past 9 years, we have been using free grafts of autologous fascia lata to replace deficient abdominal wall fascia and muscle in situations where prosthetic material is contraindicated and local tissue rearrangement (i.e., component separation) would be inadequate. Thirty-two patients (mean age 59 years) underwent abdominal wall reconstruction with autologous fascia lata grafts. Indications included exposed mesh (31 percent), enteric fistulae (28 percent), enteric contamination (22 percent), wound infection (13 percent), and immunosuppression alone (6 percent); 31 percent of all patients were immunosuppressed secondary to either a solid organ transplant or a systemic inflammatory disorder. Fascia grafts (mean size 10 x 17 cm) were sutured to the surrounding abdominal wall and covered by local skin flap advancement and/or myocutaneous flap rotation. All abdominal reconstructions were initially successful. Subsequent local abdominal wall complications included cellulitis (n = 3), seroma (n = 2), and skin dehiscence with exposed fascia grafts (n = 7). Five of seven patients with skin dehiscence healed by secondary intention, whereas two had split-thickness skin grafts successfully applied to the granulating fascia. Thigh donor site complications included hematoma (n = 1), skin dehiscence (n = 1), and seroma (n = 2). There have been no cases of lateral knee instability. The average follow-up period is 27 months (range 3 to 106 months). Recurrent hernia has been seen in three patients (9 percent). Interestingly, laparotomy has been performed through an intact fascia lata patch in three patients for unrelated intra-abdominal conditions. In each case, the graft was intact and revascularized, confirming experimental animal data performed in our laboratory. Recurrent hernia has not been observed through the laparotomy site. Our 9-year experience has demonstrated that in the face of large, contaminated abdominal wounds where prosthetic material is contraindicated and local tissue rearrangement would be inadequate, fascia lata autografts are a reliable adjuvant to abdominal wall reconstruction.

BACKGROUND: The use of technology-enhanced patient-reported outcome measures to monitor the symptoms experienced by people with cancer is an effective way to offer timely care. OBJECTIVE: This study aimed to (a) explore the feasibility and acceptability of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy and clinicians involved in their care and (b) assess changes in patient outcomes during implementation of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy in clinical practice. METHODS: A repeated-measures, single-arm, mixed-methods study design was used involving poststudy interviews and completion of patient-reported outcome measures at baseline and end of treatment with 16 patients with lung cancer and 13 clinicians who used this mobile phone-based symptom monitoring system. RESULTS: Only rarely did patients report problems in using the handset and they felt that the system covered all relevant symptoms and helped them to manage their symptoms and effectively communicate with clinicians. Clinical improvements in patient anxiety, drowsiness, and self-care self-efficacy were also observed. Clinicians perceived the use of "real-time" risk algorithms and automated self-care advice provided to patients as positively contributing to clinical care. Reducing the complexity of the system was seen as important to promote its utility. CONCLUSIONS: Although preliminary, these results suggest that monitoring patient symptoms using mobile technology in the context of radiotherapy for lung cancer is feasible and acceptable in clinical practice. IMPLICATIONS FOR PRACTICE: Future research would be most beneficial if the use of this technology was focused on the postradiotherapy phase and expanded the scope of the system to encompass a wider range of supportive care needs.

DNA methyltransferases (DNMTs) are important enzymes involved in epigenetic control of gene expression and represent valuable targets in cancer chemotherapy. A number of nucleoside DNMT inhibitors (DNMTi) have been studied in cancer, including in cancer stem cells, and two of them (azacytidine and decitabine) have been approved for treatment of myelodysplastic syndromes. However, only a few non-nucleoside DNMTi have been identified so far, and even fewer have been validated in cancer. Through a process of hit-to-lead optimization, we report here the discovery of compound 5 as a potent non-nucleoside DNMTi that is also selective toward other AdoMet-dependent protein methyltransferases. Compound 5 was potent at single-digit micromolar concentrations against a panel of cancer cells and was less toxic in peripheral blood mononuclear cells than two other compounds tested. In mouse medulloblastoma stem cells, 5 inhibited cell growth, whereas related compound 2 showed high cell differentiation. To the best of our knowledge, 2 and 5 are the first non-nucleoside DNMTi tested in a cancer stem cell line.

Recent papers have introduced a multiplexing structure for mixing voice and data traffic in an integrated telecommunications system. This structure utilizes a master frame format of a time division statistical multiplex facility. A certain portion of the frame is allocated to voice calls, and data traffic is assigned to the remaining frame capacity. To achieve a high transmission utilization, data are allowed to use any residual voice capacity momentarily available due to statistical variations in the voice traffic. The voice traffic is treated as a loss system and data packets are buffered. In this paper we derive exact analytical expressions for the key system perfomance measures, the probability of loss for voice calls, and the expected waiting time for data packets. Actually, two cases are considered, the one discussed above, called the movable boundary case, and one where the boundary is fixed; i.e., data are not allowed to utilize the residual voice capacity. The computational aspects of calculating actual numbers are discussed in some detail, and results are presented for typical cases.

A review of the scientific literature indicates osmotic priming (osmopriming) as the principal method of seed priming and polyethylene glycol (PEG) as the principal osmotic agent. An analysis of the available data across experiments carried out with different species under varying conditions showed an average 11% increase in percent germination and 36% shorter mean germination time (MGT) in primed vs. unprimed seeds. Moreover, in primed seeds MGT was less dependent on temperature, which is consistent with the effects expected from the treatment. Priming effects are mainly influenced by osmotic potential, temperature and time; major biochemical processes (repair of damaged DNA and RNA, preparation for cell division and increased antioxidant activity) are involved in treatment effects to an extent which is not fully ascertained in literature. A reduction of seed storage life is the major disadvantage of priming and the principal constraint to its diffusion, since dehydration to the initial moisture (drying-back) is needed to allow seed storage. Seed behaviour during drying-back, the role of the raffinose family oligosaccharides in cell membrane integrity and the expression of antioxidant enzymes in germinating seeds need to be further elucidated in a sufficient number of species, to promote a more reliable use of this technique.

Ancient DNA (aDNA) research involves invasive and destructive sampling procedures that are often incompatible with anthropological, anatomical, and bioarcheological analyses requiring intact skeletal remains. The osseous labyrinth inside the petrous bone has been shown to yield higher amounts of endogenous DNA than any other skeletal element; however, accessing this labyrinth in cases of a complete or reconstructed skull involves causing major structural damage to the cranial vault or base. Here, we describe a novel cranial base drilling method (CBDM) for accessing the osseous labyrinth from the cranial base that prevents damaging the surrounding cranial features, making it highly complementary to morphological analyses. We assessed this method by comparing the aDNA results from one petrous bone processed using our novel method to its pair, which was processed using established protocols for sampling disarticulated petrous bones. We show a decrease in endogenous DNA and molecular copy numbers when the drilling method is used; however, we also show that this method produces more endogenous DNA and higher copy numbers than any postcranial bone. Our results demonstrate that this minimally-invasive method reduces the loss of genetic data associated with the use of other skeletal elements and enables the combined craniometric and genetic study of individuals with archeological, cultural, and evolutionary value.

Enantiomerically Pure Synthetic Building Blocks with Four C‐Atoms and Two or Three Functional Groups from β‐Hydroxy‐butanoic, Malic, and Tartaric Acid The pool of chiral, non‐racemic electrophilic building blocks, which are available from simple natural products in both enantiomeric forms is enlarged by the epoxides 3, 5 , and 10 , by the tosylate 12a , and by the aldehydes 18 ( cf. symbols A‐D , 14 , and Scheme 1 ). Key steps of the conversions leading from hydroxyacids to the building blocks are: epoxide‐opening by triethylborohydride ( 1 → 2a ) and tosylate reduction ( 12a → 12b ); the Mitsunobu inversion ( 2a → 4a ); the reduction of ( R, R )‐tartaric ester to ( R )‐malic ester by NBS ( N ‐bromosuccinimide) opening of the benzaldehyde acetal 8 and tin hydride reduction ( 6c → 7c ); the enantiomer enrichment of optically active ethyl β‐hydroxy‐butanoate through the crystalline dinitrobenzoate 21b . Detailed procedures are given for large scale preparations of the key intermediates. The enantiomeric purities of the building blocks are secured by correlations.

The rise of carbon dioxide (CO₂) emissions and the accumulation of non-biodegradable plastics in the environment is leading to an environmental crisis.

BACKGROUND: Recovery from critical illness can be prolonged and can result in a number of significant short- and long-term psychological consequences. These may be associated with the patient's perception of the intensive care experience. AIM: The aims of the study were to assess patients' perceptions of their intensive care unit (ICU) experience and the effect of these on anxiety, depression and post-traumatic stress up to 6 months after discharge. METHOD: One hundred and three participants were recruited from six ICUs from one Critical Care Network in the United Kingdom. A prospective, longitudinal study was designed to assess anxiety, depression, post-traumatic stress symptomatology and patients' perceptions of their intensive care experience. Data were collected on three occasions: after intensive care discharge and before hospital discharge, and 2 months and 6 months later. Measures included the impact of events scale, hospital anxiety and depression scale and intensive care experience questionnaire. RESULTS: Anxiety, depression, avoidance and intrusion scores did not significantly reduce over time. At hospital discharge there was a significant association between patients' perceptions of their intensive care experience and anxiety, depression, avoidance and intrusion scores at hospital discharge. CONCLUSION: Standardised assessment of an intensive care experience is important. It provides information about the patient experience which can inform care practice within ICU, following discharge to the ward and, in the longer term, rehabilitation.

We investigated the effects of recombinant granulocyte colony-stimulating factor (G-CSF) in a canine model of septic shock. Awake 2-yr-old beagles were studied before and after intraperitoneal placement of an Escherichia coli-infected clot. Nine days before and until 3 days after clot placement, animals received daily high-dose (G-CSF (5 microgram/kg body wt; n = 17), low-dose G-CSF (0.1 microgram/kg body wt; n = 17), or a control protein (5 micrograms/kg body wt; n = 20). Survival rate was greater (P < 0.04, Wilcoxon test) in the high-dose G-CSF group (14/17) than in the low-dose G-CSF (10/17) and control (12/20) groups. High-dose G-CSF improved cardiovascular function, as evidenced by increased left ventricular ejection fraction (day 1 after clot; P < 0.001) and mean arterial pressure (day 2; P < 0.02) compared with low-dose G-CSF and control groups. High-dose G-CSF increased (P < 0.001) mean peripheral neutrophils before (-3 days) and after (2 h to 4 days) clot and produced a more rapid (P < 0.001) rise (day 2) and fall (day 4) in mean alveolar neutrophil numbers compared with the low-dose G-CSF and control groups. High-dose G-CSF decreased mean serum endotoxin (2-8 h; P < 0.002) and tumor necrosis factor (2 h; P < 0.02) levels and lowered blood bacteria counts (2-6 h; P < 0.04) compared with the low-dose G-CSF and control groups. Thus, in this canine model, G-CSF sufficient to increase peripheral neutrophils before and during peritonitis and septic shock enhances host defense, reduces cytokine (tumor necrosis factor) levels, and improves cardiovascular function and survival.

Abstract Bei der WITTIG‐Reaktion von 2.5‐Bis‐(triphenylphosphoniomethyl)‐thiophen‐dichlorid mit Thiophen‐2.5‐dialdehyd wurde Poly‐[thienylen‐(2.5)‐äthenamer] mit endständigen Aldehydgruppen erhalten. Durch Reaktion mit 2‐(Triphenylphosphoniomethyl)‐thiophenchlorid läßt sich ein Teil der Aldehydgruppen in Thienyl‐(2)‐vinyl‐Gruppen überführen. Zum Vergleich wurden – ebenfalls mit Hilfe der WITTIG‐Reaktion – Oligomere der allgemeinen Formel R(CHCHR) n H [R = Thienyl‐(2)‐; R = Thienylen‐(2.5)‐] mit n = 1,2,3,4,6 hergestellt. Die Struktur der untersuchten Verbindungen wurde durch UV‐Spektren, sichtbare Spektren, IR‐Spektren und Massenspektren bestätigt. Zur weiteren Charakterisierung wurden Röntgenuntersuchungen herangezogen. Die Oligomeren sowie das Polymere wurden auf ihre elektrische Leitfähigkeit hin untersucht.