Christian missions : their agents and their results (vol. 1) / by T.W.M. Marshall.

http://books.google.com/books?vid=ISBN0665456816&id=sipohllLjKQC&dq=protestant+missions&a_sbrr=1 View book via Google

Christian missions : their agents and their results (vol. 2) / by T.W.M. Marshall.

http://books.google.com/books?vid=ISBN0665456816&id=sipohllLjKQC&dq=protestant+missions&a_sbrr=1 View book via Google

CT Scan Dosimetric Parameters Routine Monitoring: First Results of Radiation Dose Optimization Strategies Promptly Provided by a Multidisciplinary Team

CONCLUSION Radiation dose reduction, while saving image quality could be easily implemented with this approach. Furthermore, the availability of a dosimetric data archive provides immediate feedbacks, related to the implemented optimization strategies. Background JCI Standards and European Legislation (EURATOM 59/2013) require the implementation of patient radiation protection programs in diagnostic radiology. Aim of this study is to demonstrate the possibility to reduce patients radiation exposure without decreasing image quality, through a multidisciplinary team (MT), which analyzes dosimetric data of diagnostic examinations. Evaluation Data from CT examinations performed with two different scanners (Siemens DefinitionTM and GE LightSpeed UltraTM) between November and December 2013 are considered. CT scanners are configured to automatically send images to DoseWatch© software, which is able to store output parameters (e.g. kVp, mAs, pitch ) and exposure data (e.g. CTDIvol, DLP, SSDE). Data are analyzed and discussed by a MT composed by Medical Physicists and Radiologists, to identify protocols which show critical dosimetric values, then suggest possible improvement actions to be implemented. Furthermore, the large amount of data available allows to monitor diagnostic protocols currently in use and to identify different statistic populations for each of them. Discussion We identified critical values of average CTDIvol for head and facial bones examinations (respectively 61.8 mGy, 151 scans; 61.6 mGy, 72 scans), performed with the GE LightSpeed CTTM. Statistic analysis allowed us to identify the presence of two different populations for head scan, one of which was only 10% of the total number of scans and corresponded to lower exposure values. The MT adopted this protocol as standard. Moreover, the constant output parameters monitoring allowed us to identify unusual values in facial bones exams, due to changes during maintenance service, which the team promptly suggested to correct. This resulted in a substantial dose saving in CTDIvol average values of approximately 15% and 50% for head and facial bones exams, respectively. Diagnostic image quality was deemed suitable for clinical use by radiologists.

Policy-based techniques for self-managing parallel applications

This paper presents an empirical investigation of policy-based self-management techniques for parallel applications executing in loosely-coupled environments. The dynamic and heterogeneous nature of these environments is discussed and the special considerations for parallel applications are identified. An adaptive strategy for the run-time deployment of tasks of parallel applications is presented. The strategy is based on embedding numerous policies which are informed by contextual and environmental inputs. The policies govern various aspects of behaviour, enhancing flexibility so that the goals of efficiency and performance are achieved despite high levels of environmental variability. A prototype self-managing parallel application is used as a vehicle to explore the feasibility and benefits of the strategy. In particular, several aspects of stability are investigated. The implementation and behaviour of three policies are discussed and sample results examined.

Monitoring changes in phytoplankton abundance and composition in the Northwest Atlantic: a comparison of results obtained by Continuous Plankton Recorder sampling and colour satellite imagery

Phytoplankton abundance in the NW Atlantic was measured by continuous plankton recorder (CPR) sampling along tracks between Iceland and the western Scotian Shelf from 1998 to 2006, when sea-surface chlorophyll (SSChl) measurements were also being made by ocean colour satellite imagery using the SeaWiFS sensor. Seasonal and inter-annual changes in phytoplankton abundance were examined using data collected by both techniques, averaged over each of four shelf regions and four deep ocean regions. CPR sampling had gaps (missing months) in all regions and in the four deep ocean regions satellite observations were too sparse between November and February to be of use. Average seasonal cycles of SSChl were similar to those of total diatom abundance in seven regions, to those of the phytoplankton colour index in six regions, but were not similar to those of total dinoflagellate abundance anywhere. Large inter-annual changes in spring bloom dynamics were captured by both samplers in shelf regions. Changes in annual (or 8 months) averages of SSChl did not generally follow those of the CPR indices within regions and multi-year averages of SSChl, and the three CPR indices were generally higher in shelf than in deep ocean regions. Remote sensing and CPR sampling provide complementary ways of monitoring phytoplankton in the ocean: the former has superior temporal and spatial coverage and temporal resolution, and the latter provides better taxonomic information.

Monitoring of a quasi-stationary eddy in the Bay of Biscay by means of satellite, in situ and model results

The presence of a quasi-stationary anticyclonic eddy within the southeastern Bay of Biscay (centred around 44°30′N-4°W) has been reported on various occasions in the bibliography. The analysis made in this study for the period 2003–2010, by using in situ and remote sensing measurements and model results shows that this mesoscale coherent structure is present almost every year from the end of winter-beginning of spring, to the beginning of fall. During this period it remains in an area limited to the east by the Landes Plateau, to the west by Le Danois Bank and Torrelavega canyon and to the northwest by the Jovellanos seamount. All the observations and analysis made in this contribution, suggest that this structure is generated between Capbreton and Torrelavega canyons. Detailed monitoring from in situ and remote sensing data of an anticyclonic quasi-stationary eddy, in 2008, shows the origin of this structure from a warm water current located around 43°42′N-3°30′W in mid-January. This coherent structure is monitored until August around the same area, where it has a marked influence on the Sea Level Anomaly, Sea Surface Temperature and surface Chlorophyll-a concentration. An eddy tracking method, applied to the outputs of a numerical model, shows that the model is able to reproduce this type of eddy, with similar 2D characteristics and lifetimes to that suggested by the observations and previous works. This is the case, for instance, of the simulated MAY04 eddy, which was generated in May 2004 around Torrelavega canyon and remained quasi-stationary in the area for 4 months. The diameter of this eddy ranged from 40 to 60 km, its azimuthal velocity was less than 20 cm s−1, its vertical extension reached 3000–3500 m depth during April and May and it was observed to interact with other coherent structures.

Monitoring of a quasi-stationary eddy in the Bay of Biscay by means of satellite, in situ and model results

The presence of a quasi-stationary anticyclonic eddy within the southeastern Bay of Biscay (centred around 44°30′N-4°W) has been reported on various occasions in the bibliography. The analysis made in this study for the period 2003–2010, by using in situ and remote sensing measurements and model results shows that this mesoscale coherent structure is present almost every year from the end of winter-beginning of spring, to the beginning of fall. During this period it remains in an area limited to the east by the Landes Plateau, to the west by Le Danois Bank and Torrelavega canyon and to the northwest by the Jovellanos seamount. All the observations and analysis made in this contribution, suggest that this structure is generated between Capbreton and Torrelavega canyons. Detailed monitoring from in situ and remote sensing data of an anticyclonic quasi-stationary eddy, in 2008, shows the origin of this structure from a warm water current located around 43°42′N-3°30′W in mid-January. This coherent structure is monitored until August around the same area, where it has a marked influence on the Sea Level Anomaly, Sea Surface Temperature and surface Chlorophyll-a concentration. An eddy tracking method, applied to the outputs of a numerical model, shows that the model is able to reproduce this type of eddy, with similar 2D characteristics and lifetimes to that suggested by the observations and previous works. This is the case, for instance, of the simulated MAY04 eddy, which was generated in May 2004 around Torrelavega canyon and remained quasi-stationary in the area for 4 months. The diameter of this eddy ranged from 40 to 60 km, its azimuthal velocity was less than 20 cm s−1, its vertical extension reached 3000–3500 m depth during April and May and it was observed to interact with other coherent structures.

What is a reasonable time from decision to delivery by Caesarean section? Evidence from 533 deliveries.

Objective To determine how long it takes from the decision to achieve delivery by non-elective caesarean section (DDI), the influence on this interval, and the impact on neonatal condition at birth. Design Twelve months prospective data collection on all non-elective caesarean sections. Methods Prospective collection of data relating to all caesarean sections in 1996 in a major teaching hospital obstetric unit was conducted, without the knowledge of the other clinicians providing clinical care. Details of the indication for section, the day and time of the decision and the interval till delivery were recorded as well as the seniority of the surgeon, and condition of the baby at birth. Results The mean time from decision-to-delivery for 100 emergency intrapartum caesarean sections was 42.9 minutes for fetal distress and 71.1 minutes for 230 without fetal distress (P<0.0001). For 22 'crash' sections the mean time from decision-to-delivery was 27.4 minutes; for 13 urgent antepartum deliveries for fetal reasons it was 124.7 minutes and for 21 with maternal reasons it was 97.4 minutes. The seniority of the surgeon managing the patient did not appear to influence the interval, nor did the time of day or day of the week when the delivery occurred. Intrapartum sections were quicker the more advanced the labour, and general anaesthesia was associated with shorter intervals than regional anaesthesia for emergency caesarean section for fetal distress (P<0.001). Babies born within one hour of the decision tended to be more acidaemic than those born later, irrespective of the indication for delivery. Babies tended to be in better condition when a time from decision-to-delivery was not recorded than those for whom the information had been recorded. Conclusion Fewer than 40% intrapartum deliveries by caesarean section for fetal distress were achieved within 30 minutes of the decision, despite that being the unit standard. There was, however, no evidence to indicate that overall an interval up to 120 minutes was detrimental to the neonate unless the delivery was a 'crash' caesarean section. These data thus do not provide evidence to sustain the recommendation of a standard of 30 minutes for intrapartum delivery by caesarean section.

Exploration of the Kuiper Belt by High-Precision Photometric Stellar Occultations: First Results

We report here the first detection of hectometer-size objects by the method of serendipitous stellar occultation. This method consists of recording the diffraction shadow created when an object crosses the observer's line of sight and occults the disk of a background star. One of our detections is most consistent with an object between Saturn and Uranus. The two other diffraction patterns detected are caused by Kuiper Belt objects beyond 100 AU from the Sun and hence are the farthest known objects in the solar system. These detections show that the Kuiper Belt is much more extended than previously believed and that the outer part of the disk could be composed of smaller objects than the inner part. This gives critical clues to understanding the problem of the formation of the outer planets of the solar system.

A framework for managing uncertain inputs: An axiomization of rewarding

The success postulate in belief revision ensures that new evidence (input) is always trusted. However, admitting uncertain input has been questioned by many researchers. Darwiche and Pearl argued that strengths of evidence should be introduced to determine the outcome of belief change, and provided a preliminary definition towards this thought. In this paper, we start with Darwiche and Pearl’s idea aiming to develop a framework that can capture the influence of the strengths of inputs with some rational assumptions. To achieve this, we first define epistemic states to represent beliefs attached with strength, and then present a set of postulates to describe the change process on epistemic states that is determined by the strengths of input and establish representation theorems to characterize these postulates. As a result, we obtain a unique rewarding operator which is proved to be a merging operator that is in line with many other works. We also investigate existing postulates on belief merging and compare them with our postulates. In addition, we show that from an epistemic state, a corresponding ordinal conditional function by Spohn can be derived and the result of combining two epistemic states is thus reduced to the result of combining two corresponding ordinal conditional functions proposed by Laverny and Lang. Furthermore, when reduced to the belief revision situation, we prove that our results induce all the Darwiche and Pearl’s postulates as well as the Recalcitrance postulate and the Independence postulate.

Thalidomide for managing cancer cachexia [review paper]

Cancer cachexia is a multidimensional syndrome characterised by wasting, loss of weight, loss of appetite, metabolic alterations, fatigue and reduced performance status. A significant number of patients with advanced cancer develop cachexia before death. There is no identified optimum treatment for cancer cachexia. While the exact mechanism of the action of thalidomide is unclear, it is known to have immunomodulatory and anti-inflammatory properties, which are thought to help reduce the weight loss associated with cachexia. Preliminary studies of thalidomide have demonstrated encouraging results. This review aimed to (1) evaluate the effectiveness of thalidomide, and (2) identify and assess adverse effects from thalidomide for cancer cachexia. Electronic searches were undertaken in CENTRAL, MEDLINE, EMBASE, Web of Science and CINAHL (from inception to April 2011). Reference lists from reviewed articles, trial registers, relevant conference documents and thalidomide manufacturers identified additional literature. This review included randomised controlled trials (RCTs) and non-RCTs. Participants were adults diagnosed with advanced or incurable cancer and weight loss or a clinical diagnosis of cachexia who were administered thalidomide. All titles and abstracts retrieved by electronic searching were downloaded to a reference management database. Duplicates were removed and the remaining citations were read by two review authors and checked for eligibility. Studies that were deemed ineligible for inclusion had clear reasons for exclusion documented. Data were extracted independently by two review authors for all eligible studies. While a meta-analysis was planned for this review, this was not possible due to the small number of studies included and high heterogeneity among them. Thus a narrative synthesis of the findings is presented. The literature search revealed a dearth of large, well conducted trials in this area. This has hindered the review authors' ability to make an informed decision about thalidomide for the management of cancer cachexia. At present, there is insufficient evidence to refute or support the use of thalidomide for the management of cachexia in advanced cancer patients. The review authors cannot confirm or refute previous literature on the use of thalidomide for patients with advanced cancer who have cachexia and there is inadequate evidence to recommend it for clinical practice. Additional, well conducted, large RCTs are needed to test thalidomide both singularly and in combination with other treatment modalities to ascertain its true benefit, if any, for this population. Furthermore, one study (out of the three reviewed) highlighted that thalidomide was poorly tolerated and its use needs to be explored further in light of the frailty of this population

Diagnostic accuracy and clinical management by realtime teledermatology. Results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

Diagnostic accuracy and management recommendations of realtime teledermatology consultations using low-cost telemedicine equipment were evaluated. Patients were seen by a dermatologist over a video-link and a diagnosis and treatment plan were recorded. This was followed by a face-to-face consultation on the same day to confirm the earlier diagnosis and management plan. A total of 351 patients with 427 diagnoses participated. Sixty-seven per cent of the diagnoses made over the video-link agreed with the face-to-face diagnosis. Clinical management plans were recorded for 214 patients with 252 diagnoses. For this cohort, 44% of the patients were seen by the same dermatologist at both consultations, while 56% were seen by a different dermatologist. In 64% of cases the same management plan was recommended at both consultations; a sub-optimum treatment plan was recommended in 8% of cases; and in 9% of cases the video-link management plans were judged to be inappropriate. In 20% of cases the dermatologist was unable to recommend a suitable management plan by video-link. There were significant differences in the ability to recommend an optimum management plan by video-link when a different dermatologist made the reference management plan. The results indicate that a high proportion of dermatological conditions can be successfully managed by realtime teledermatology.