Patient-based outcome assessment instruments in acupuncture research.

BACKGROUND: Outcome assessment can support the therapeutic process by providing a way to track symptoms and functionality over time, providing insights to clinicians and patients, as well as offering a common language to discuss patient behavior/functioning. OBJECTIVES: In this article, we examine the patient-based outcome assessment (PBOA) instruments that have been used to determine outcomes in acupuncture clinical research and highlight measures that are feasible, practical, economical, reliable, valid, and responsive to clinical change. The aims of this review were to assess and identify the commonly available PBOA measures, describe a framework for identifying appropriate sets of measures, and address the challenges associated with these measures and acupuncture. Instruments were evaluated in terms of feasibility, practicality, economy, reliability, validity, and responsiveness to clinical change. METHODS: This study was a systematic review. A total of 582 abstracts were reviewed using PubMed (from inception through April 2009). RESULTS: A total of 582 citations were identified. After screening of title/abstract, 212 articles were excluded. From the remaining 370 citations, 258 manuscripts identified explicit PBOA; 112 abstracts did not include any PBOA. The five most common PBOA instruments identified were the Visual Analog Scale, Symptom Diary, Numerical Pain Rating Scales, SF-36, and depression scales such as the Beck Depression Inventory. CONCLUSIONS: The way a questionnaire or scale is administered can have an effect on the outcome. Also, developing and validating outcome measures can be costly and difficult. Therefore, reviewing the literature on existing measures before creating or modifying PBOA instruments can significantly reduce the burden of developing a new measure.

Reified temporal logics: an overview

There are three main approaches to the representation of temporal information in AI literature: the so-called method of temporal arguments that simply extends functions and predicates of first-order language to include time as the additional argument; modal temporal logics which are extensions ofthe propositional or predicate calculus with modal temporal operators; and reified temporal logics which reify standard propositions of some initial language (e.g., the classical first-order or modal logic) as objects denoting propositional terms. The objective of this paper is to provide an overview onthe temporal reified approach by looking closely atsome representative existing systems featuring reified propositions, including those of Allen, McDermott, Shoham, Reichgelt, Galton, and Ma and Knight. We shall demonstrate that, although reified logics might be more complicated in expressing assertions about some given objects with respect to different times, they accord a special status to time and therefore have several distinct advantages in talking about some important issues which would be difficult (if not impossible) to express in other approaches.

What students can tell about lecturers when they are teaching: manifestations of confident and under-confident lecturers

Delivering a lecture requires confidence, a sound knowledge and well developed teaching skills (Cooper and Simonds, 2007, Quinn and Hughes, 2007). However, practitioners who are new to lecturing large groups in higher education may initially lack the confidence to do so which can manifest itself in their verbal and non-verbal cues and the fluency of their teaching skills. This results in the perception that students can identify the confident and non-confident teacher during a lecture (Street, 2007) and so potentially contributing to a lecturer’s level of anxiety prior to, and during, a lecture. Therefore, in the current educational climate of consumerisation, with the increased evaluation of teaching by students, having the ability to deliver high-quality, informed, and interesting lectures assumes greater significance for both lecturers and universities (Carr, 2007; Higher Education Founding Council 2008, Glass et al., 2006). This paper will present both the quantitative and qualitative data from a two-phase mixed method study with 75 nurse lecturers and 62 nursing students in one university in the United Kingdom. The study investigated the notion that lecturing has similarities to acting (Street, 2007). The findings presented here are concerned with how students perceived lecturers’ level of confidence and how lecturers believed they demonstrated confidence. In phase one a specifically designed questionnaire was distributed to both lecturers and students and a response rate of 91% (n=125) was achieved, while in phase two 12 in-depth semi-structured interviews were conducted with lecturers. Results suggested that students in a lecture could identify if the lecturer was confident or not by the way they performed a lecture. Students identified 57 manifestations of non-confidence and lecturers identified 85, while 57 manifestations of confidence were identified by students and 88 by lecturers. Overall, these fell into 12 main converse categories, ranging from body language to the use of space within the room. Both students and lecturers ranked body language, vocal qualities, delivery skills, involving the students and the ability to share knowledge as the most evident manifestations of confidence. Elements like good eye contact, smiling, speaking clearly and being fluent in the use of media recourses where all seen as manifestations confidence, conversely if these were poorly executed then a presentation of under confidence was evident. Furthermore, if the lecturer appeared enthusiastic it was clearly underpinned by the manifestation of a highly confidence lecturer who was secure in their knowledge base and teaching abilities: Some lecturers do appear enthusiastic but others don’t. I think the ones that do know what they are talking about, you can see it in their voice and in their lively body language. I think they are also good at involving the students even. I think the good ones are able to turn boring subjects into lively and interesting ones. (Student 50) Significantly more lecturers than students felt the lecturer should appear confident when lecturing. The lecturers stated it was particularly important to do so when they did not feel confident, because they were concerned with appearing capable. It seems that these students and lecturers perceived that expressive and apparently confident lecturers can make a positive impact on student groups in terms of involvement in lectures; the data also suggested the reverse, for the under confident lecturer. Findings from phase two indicated that these lecturers assumed a persona when lecturing, particularly, but not exclusively, when they were nervous. These lecturers went through a process of assuming and maintaining this persona before and during a lecture as a way of promoting their internal perceptions of confidence but also their outward manifestation of confidence. Although assuming a convincing persona may have a degree of deception about it, providing the knowledge communicated is accurate, the deception may aid rather than hinder learning, because enhances the delivery of a lecture. Therefore, the deception of acting a little more confidently than one feels might be justified when the lecturer knows the knowledge they are communicating is correct, unlike the Dr Fox Effect where the person delivering a lecture is an actor and does not know the subject in any detail or depth and where the deception to be justified (Naftulin, et al., 1973). In conclusion, these students and lecturers perceive that confident and enthusiastic lecturers communicate their passion for the subject in an interesting and meaningful manner through the use of their voice, body, space and interactions in such a way that shows confidence in their knowledge as well as their teaching abilities. If lecturers, therefore, can take a step back to consider how they deliver lectures in apparently confident ways this may increase their ability to engage their students and not only help them being perceived as good lecturers, but also contribute to the genuine act of education.

Environmental variability and biodiversity of megabenthos on the Hebrides Terrace Seamount (Northeast Atlantic)

We present the first remotely operated vehicle investigation of megabenthic communities (1004-1695 m water depth) on the Hebrides Terrace Seamount (Northeast Atlantic). Conductivity-temperature-depth casts showed rapid light attenuation below the summit and an oceanographic regime on the flanks consistent with an internal tide, and high short-term variability in water temperature, salinity, light attenuation, aragonite and oxygen down to 1500 m deep. Minor changes in species composition (3-14%) were explained by changes in depth, substratum and oceanographic stability, whereas environmental variability explained substantially more variation in species richness (40-56%). Two peaks in species richness occurred, the first at 1300-1400 m where cooler Wyville Thomson Overflow Water (WTOW) mixes with subtropical gyre waters and the second at 1500-1600 m where WTOW mixes with subpolar mode waters. Our results suggest that internal tides, substrate heterogeneity and oceanographic interfaces may enhance biological diversity on this and adjacent seamounts in the Rockall Trough.

Questions of 'h' in Northern Ireland: Breathing New Life on the Aspiration Theory

This paper considers existing ideas concerning pronunciation of the letter name for (LNH) in Northern Irish English (NIE). Traditionally, the status of LNH realisation as an ethnic marker has gone unquestioned: Catholics are thought to say [het&Mac186;] while the Protestant norm is assumed to be [etS]. The phonetic difference between these realisations is consistently described as word-initial aspiration versus non-aspiration, with aspiration attributed exclusively to Irish language influence. Here, we show that an explanation based on aspiration alone is phonologically unsatisfying and question whether aspiration is, in fact, an Irish language or ethnically dictated phenomenon. It is further suggested here that the overwhelming stigmatisation of LNH realisation may be responsible for blocking a potential sound change in NIE. While this paper is not intended as a detailed account of ethnolinguistic differences in NI phonology, it engages critically with the over-simplistic and widespread notion that LNH realisation is a result of transfer from the Irish language to the English used by Catholics in Northern Ireland.

An automated machine vision system for the histological grading of cervical intraepithelial neoplasia (CIN)

The histological grading of cervical intraepithelial neoplasia (CIN) remains subjective, resulting in inter- and intra-observer variation and poor reproducibility in the grading of cervical lesions. This study has attempted to develop an objective grading system using automated machine vision. The architectural features of cervical squamous epithelium are quantitatively analysed using a combination of computerized digital image processing and Delaunay triangulation analysis; 230 images digitally captured from cases previously classified by a gynaecological pathologist included normal cervical squamous epithelium (n = 30), koilocytosis (n = 46), CIN 1 (n = 52), CIN 2 (n = 56), and CIN 3 (n=46). Intra- and inter-observer variation had kappa values of 0.502 and 0.415, respectively. A machine vision system was developed in KS400 macro programming language to segment and mark the centres of all nuclei within the epithelium. By object-oriented analysis of image components, the positional information of nuclei was used to construct a Delaunay triangulation mesh. Each mesh was analysed to compute triangle dimensions including the mean triangle area, the mean triangle edge length, and the number of triangles per unit area, giving an individual quantitative profile of measurements for each case. Discriminant analysis of the geometric data revealed the significant discriminatory variables from which a classification score was derived. The scoring system distinguished between normal and CIN 3 in 98.7% of cases and between koilocytosis and CIN 1 in 76.5% of cases, but only 62.3% of the CIN cases were classified into the correct group, with the CIN 2 group showing the highest rate of misclassification. Graphical plots of triangulation data demonstrated the continuum of morphological change from normal squamous epithelium to the highest grade of CIN, with overlapping of the groups originally defined by the pathologists. This study shows that automated location of nuclei in cervical biopsies using computerized image analysis is possible. Analysis of positional information enables quantitative evaluation of architectural features in CIN using Delaunay triangulation meshes, which is effective in the objective classification of CIN. This demonstrates the future potential of automated machine vision systems in diagnostic histopathology. Copyright (C) 2000 John Wiley and Sons, Ltd.

A tentative determination of upwelling influence on the paleo-surficial marine water reservoir effect in southeastern Brazil.

Previous work has suggested that seasonal and inter-annual upwelling of deep, cold, radiocarbon depleted waters from the South Atlantic has caused variations in the reservoir effect (R) through time along the southern coast of Brazil. This work aims to examine the possible upwelling influence on the paleo-reservoir age of Brazilian surficial coastal waters based on paired terrestrial/marine samples obtained from archaeological remains. On the Brazilian coast there are hundreds of shell-middens built up by an ancient culture that lived between 6500 to 1500 years ago, but there are few located on open coast with a known upwelling influence. Three archaeological sites located in a large headland in Arraial do Cabo and Ilha de Cabo Frio, southeastern coast of Brazil with open ocean conditions and a well-known strong and large upwelling of the Malvinas/Falkland current were chosen for this study. The 14C age differences between carbonized seed and marine samples varied from 281 ± 44 to 1083 ± 51 14C yr. There are also significant age differences between carbonized seed samples (977 14C yr) and marine samples (200 and 228 14C yr) from the same archaeological layer that cannot be explained by a reservoir effect or an old-wood effect for charcoal. Therefore the present data from the southeastern Brazilian coast are inconclusive for identifying an upwelling effect on R. To do so it would be necessary to more precisely define the present-pre-bomb R in upwelling regions and to analyze paired marine/terrestrial samples that are contemporaneous beyond doubt.

Radiative rates and electron impact excitation rates for H-like Fe XXVI

Aims. In this paper we report on calculations for energy levels, radiative rates, collision strengths, and effective collision strengths for transitions among the lowest 25 levels of the n $\le$ 5 configurations of H-like Fe XXVI.
Methods. The general-purpose relativistic atomic structure package (GRASP) and Dirac atomic R-matrix code (DARC) are adopted for the calculations.
Results. Radiative rates, oscillator strengths, and line strengths are reported for all electric dipole (E1), magnetic dipole (M1), electric quadrupole (E2), and magnetic quadrupole (M2) transitions among the 25 levels. Furthermore, collision strengths and effective collision strengths are reported for all the 300 transitions among the above 25 levels over a wide energy (temperature) range up to 1500 Ryd (107.7 K). Comparisons are made with earlier available results and the accuracy of the data is assessed.

Marketing secondhand goods in late medieval England

Purpose – The purpose of this paper is to identify the main practitioners, goods, customers and locations of secondhand marketing activities in late medieval England. It questions how important was the economic role played by such markets and what was the interaction with more formal market structures?

Design/methodology/approach – A broad range of evidence was examined, covering the period from 1200 to 1500: regulations, court rolls, wills, manorial accounts, literature, and even archaeology. Such material often provided mere scraps of information about marginal marketing activity and it was important to recognise the severe limitations of the evidence. Nevertheless, a wide survey of the available sources can give us an insight into medieval attitudes towards such trade, as well as reminding us that much marketing activity occurred beyond the reach of the surviving documentation.

Findings – Late medieval England had numerous outlets for secondhand items, from sellers of used clothes and furs who wandered the marketplaces to craftsmen who recycled and mended old materials. Secondhand marketing was an important part of the medieval makeshift economy, serving not only the needs of the lower sectors of society but also those aspiring to a higher status. However, it is unlikely that such trade generated much profit and the traders were often viewed as marginal, suspicious and even fraudulent.

Originality/value – There is a distinct lack of research into the extent of and significance of medieval secondhand marketing, which existed in the shadowy margins of formal markets and is thus poorly represented in the primary sources. A broad-based approach to the evidence can highlight a variety of important issues, which impact upon the understanding of the medieval English economy.

Temperature dependence of the mid-infrared dielectric function of YBCO in the a-b plane: a re-evaluation

The a-b plane dielectric function (epsilon) of c-axis YBa2Cu3O7-delta thin films with T-c > 85 K was measured at lambda = 3.392 mum in the temperature range 85-300 It, using an attenuated total reflectance (ATR) technique based on the excitation of surface plasmons, The results show that \epsilon (r)\ decreases quasi-linearly with increasing temperature, while Ei is invariant to temperature within experimental uncertainties. Typical values are epsilon (ab) = -23 + 16.5i at similar to 295 R and epsilon (ab) = -27 + 15.5i at similar to 90 K. A generalised Drude analysis yields effective scattering rates (1/tau*) that increase with temperature from similar to 1500 to similar to 1900 cm(-1). The temperature dependent rates best fit an equation of the form 1/tau* = a + bT(alpha) with alpha = 1.46 +/- 0.40. The effective plasma frequencies of w(p)* similar to 18,500 cm(-1) are almost independent of temperature. The uniquely detailed temperature dependence of the results confirm and consolidate data obtained by other groups using normal reflectance methods, but contradict our previously published ATR measurements. Technical shortcomings in the earlier work are identified as the source of the discrepancy. (C) 2000 Elsevier Science B.V. All rights reserved.

Constraint rule-based programming of norms for electronic institutions

Norms constitute a powerful coordination mechanism among heterogeneous agents. In this paper, we propose a rule language to specify and explicitly manage the normative positions of agents (permissions, prohibitions and obligations), with which distinct deontic notions and their relationships can be captured. Our rule-based formalism includes constraints for more expressiveness and precision and allows to supplement (and implement) electronic institutions with norms. We also show how some normative aspects are given computational interpretation. © 2008 Springer Science+Business Media, LLC.

A New Irish? Problems of communication in modern Irish media and new speakers.

While the Gaeltacht (Irish speaking) areas of Ireland are geographically isolated from each other and relatively small in area, it is expected that the number of second language Irish speakers throughout the country should ensure the future of the language. Nevertheless, while the official standard grammar has been established for many decades, there is still a tendency in the spoken language to give precedence to regional dialectal variants in schools and the broadcast media which often raises barriers between native speakers themselves and between learners and native speakers.
All pupils in school in the Republic and many in Northern Ireland learn Irish and there has been a great increase in the number of pupils attending immersion Irish language Gaelscoileanna. But concern has been expressed about the phonetic and structural accuracy achieved in schools, all of which contributes to communication breakdown.
This paper discusses how a greater awareness of the link between phoneme and grapheme in Irish and the proposals for the Lárchanúint (Central Dialect) in the 1980s and current discussions on Caighdeán Leathan agus Caighdeán Cúng (Broad and Narrow Standard) would mitigate these concerns.

Radiation retinopathy--clinical, histopathological, ultrastructural and experimental correlations

Clinical, pathological and experimental studies of radiation retinopathy confirm that the primary vascular event is endothelial cell loss and capillary closure. Pericytes are less susceptible, but typically atrophy as the capillaries become non-functional. The immediate effects of radiation reflect interphase and early mitotic death of injured endothelial cells, whereas later changes may be attributed to delayed mitotic death of compromised endothelial cells as they attempt division in the ordinary course of repair and replacement. Capillary occlusion leads to the formation of dilated capillary collaterals which may remain serviceable and competent for years. Microaneurysms develop in acellular and poorly supported capillaries, predominantly on the arterial side of the circulation and adjacent to regions of poorly perfused retina. Alterations in haemodynamics produce large telangiectatic-like channels which, typically develop a thick collagenous adventitia and may become fenestrated. Limited capillary regeneration occurs, usually evident as recanalisation of arterioles or venules by new capillaries. Vitreo-retinal neovascularisation may occur where retinal ischaemia is widespread. Radiation produces an exaggerated vasculopathy in patients with diabetes mellitus, and five month streptozotocin-induced diabetic rats develop a severe ischaemic retinopathy with vitreoretinal neovascularisation when exposed to 1500 cGy of radiation. Later photocoagulation is useful in containing or reversing microvascular incompetence and vasoproliferation in some patients with advanced radiation retinopathy.

Rigorous Specification and Low-Latency Implementation of Technical Market Indicators

Technical market indicators are tools used by technical an- alysts to understand trends in trading markets. Technical (market) indicators are often calculated in real-time, as trading progresses. This paper presents a mathematically- founded framework for calculating technical indicators. Our framework consists of a domain specific language for the un- ambiguous specification of technical indicators, and a run- time system based on Click, for computing the indicators. We argue that our solution enhances the ease of program- ming due to aligning our domain-specific language to the mathematical description of technical indicators, and that it enables executing programs in kernel space for decreased latency, without exposing the system to users’ programming errors.

Promoting multicultural education in the primary classroom:Broadband videoconferencing facilities and digital video

The aim of this study was to explore the impact of interaction (through gathering local field data and engaging in remote reciprocal presentations) on aspects of multicultural awareness. Sixty-six 11-12-year-old Scottish primary school pupils collected data in the field from their local community through questionnaires, interviews, direct observation, digital images and video. From this they distilled a multimedia presentation, delivered by videoconference to a partner school in the USA, who reciprocated. There was some evidence of pre-post project gains in the complexity of the children's perceptions of their community environment, the ethnicity of their community, their own ethnicity, and news images. The children's use of language to define ethnicity also became more complex and their attitudes toward ethnic minorities became more inclusive. The implications for practice, policy and future research were explored. © 2004 Elsevier Ltd. All rights reserved.