Statistical analysis of spectral data: A methodology for designing an intelligent monitoring system for the diabetic foot

Early detection of (pre-)signs of ulceration on a diabetic foot is valuable for clinical practice. Hyperspectral imaging is a promising technique for detection and classification of such (pre-)signs. However, the number of the spectral bands should be limited to avoid overfitting, which is critical for pixel classification with hyperspectral image data. The goal was to design a detector/classifier based on spectral imaging (SI) with a small number of optical bandpass filters. The performance and stability of the design were also investigated. The selection of the bandpass filters boils down to a feature selection problem. A dataset was built, containing reflectance spectra of 227 skin spots from 64 patients, measured with a spectrometer. Each skin spot was annotated manually by clinicians as "healthy" or a specific (pre-)sign of ulceration. Statistical analysis on the data set showed the number of required filters is between 3 and 7, depending on additional constraints on the filter set. The stability analysis revealed that shot noise was the most critical factor affecting the classification performance. It indicated that this impact could be avoided in future SI systems with a camera sensor whose saturation level is higher than 106, or by postimage processing.

IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes

Recommendations - 1 To identify a person with diabetes at risk for foot ulceration, examine the feet annually to seek evidence for signs or symptoms of peripheral neuropathy and peripheral artery disease. (GRADE strength of recommendation: strong; Quality of evidence: low) - 2 In a person with diabetes who has peripheral neuropathy, screen for a history of foot ulceration or lower-extremity amputation, peripheral artery disease, foot deformity, pre-ulcerative signs on the foot, poor foot hygiene and ill-fitting or inadequate footwear. (Strong; Low) - 3 Treat any pre-ulcerative sign on the foot of a patient with diabetes. This includes removing callus, protecting blisters and draining when necessary, treating ingrown or thickened toe nails, treating haemorrhage when necessary and prescribing antifungal treatment for fungal infections. (Strong; Low) - 4 To protect their feet, instruct an at-risk patient with diabetes not to walk barefoot, in socks only, or in thin-soled standard slippers, whether at home or when outside. (Strong; Low) - 5 Instruct an at-risk patient with diabetes to daily inspect their feet and the inside of their shoes, daily wash their feet (with careful drying particularly between the toes), avoid using chemical agents or plasters to remove callus or corns, use emollients to lubricate dry skin and cut toe nails straight across. (Weak; Low) - 6 Instruct an at-risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non-plantar, or a recurrent non-plantar foot ulcer. When a foot deformity or a pre-ulcerative sign is present, consider prescribing therapeutic shoes, custom-made insoles or toe orthosis. (Strong; Low) - 7 To prevent a recurrent plantar foot ulcer in an at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressure-relieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) - 8 To prevent a first foot ulcer in an at-risk patient with diabetes, provide education aimed at improving foot care knowledge and behaviour, as well as encouraging the patient to adhere to this foot care advice. (Weak; Low) - 9 To prevent a recurrent foot ulcer in an at-risk patient with diabetes, provide integrated foot care, which includes professional foot treatment, adequate footwear and education. This should be repeated or re-evaluated once every 1 to 3 months as necessary. (Strong; Low) - 10 Instruct a high-risk patient with diabetes to monitor foot skin temperature at home to prevent a first or recurrent plantar foot ulcer. This aims at identifying the early signs of inflammation, followed by action taken by the patient and care provider to resolve the cause of inflammation. (Weak; Moderate) - 11 Consider digital flexor tenotomy to prevent a toe ulcer when conservative treatment fails in a high-risk patient with diabetes, hammertoes and either a pre-ulcerative sign or an ulcer on the distal toe. (Weak; Low) - 12 Consider Achilles tendon lengthening, joint arthroplasty, single or pan metatarsal head resection, or osteotomy to prevent a recurrent foot ulcer when conservative treatment fails in a high-risk patient with diabetes and a plantar forefoot ulcer. (Weak; Low) - 13 Do not use a nerve decompression procedure in an effort to prevent a foot ulcer in an at-risk patient with diabetes, in preference to accepted standards of good quality care. (Weak; Low)

Salaisen evankelistan salaliitto : Uusin keskustelu Klemens Aleksandrialaisen kirjeestä Theodorokselle

This thesis is an assessment of the hoax hypothesis, mainly propagated in Stephen C. Carlson's 2005 monograph "The Gospel Hoax: Morton Smith's Invention of Secret Mark", which suggests that professor Morton Smith (1915-1991) forged Clement of Alexandria's letter to Theodore. This letter Smith claimed to have discovered as an 18th century copy in the monastery of Mar Saba in 1958. The Introduction narrates the discovery story of Morton Smith and traces the manuscript's whereabouts up to its apparent disappearance in 1990 following with a brief history of scholarship of the MS and some methodological considerations. Chapters 2 and 3 deal with the arguments for the hoax (mainly by Stephen C. Carlson) and against it (mainly Scott G. Brown). Chapter 2 looks at the MS in its physical aspects, and chapter 3 assesses its subject matter. I conclude that some of the details fit reasonably well with the hoax hypothesis, but on the whole the arguments against it are more persuasive. Especially Carlson's use of QDE-analysis (Questioned Document Examination) has many problems. Comparing the handwriting of Clement's letter to Morton Smith's handwriting I conclude that there are some "repeated differences" between them suggesting that Smith is not the writer of the disputed letter. Clement's letter to Theodore derives most likely from antiquity though the exact details of its character are not discussed in length in this thesis. In Chapter 4 I take a special look at Stephen C. Carlson's arguments which propose that Morton Smith hid clues of his identity to the MS and the materials surrounding it. Comparing these alleged clues to known pseudoscientific works I conclude that Carlson utilizes here methods normally reserved for building a conspiracy theory; thus Carlson's hoax hypothesis has serious methodological flaws in respect to these hidden clues. I construct a model of these questionable methods titled "a boisterous pseudohistorical method" that contains three parts: 1) beginning with a question that from the beginning implicitly contains the answer, 2) considering everything will do as evidence for the conspiracy theory, and 3) abandoning probability and thinking literally that everything is connected. I propose that Stephen C. Carlson utilizes these pseudoscientific methods in his unearthing of Morton Smith's "clues". Chapter 5 looks briefly at the literary genre I title "textual puzzle -thriller". Because even biblical scholarship follows the signs of the times, I propose Carlson's hoax hypothesis has its literary equivalents in fiction in titles like Dan Brown's "Da Vinci Code" and in academic works in titles like John Dart's "Decoding Mark". All of these are interested in solving textual puzzles, even though the methodological choices are not acceptable for scholarship. Thus the hoax hypothesis as a whole is alternatively either unpersuasive or plain bad science.

Construction of stability multipliers for non-linear feedback systems

This paper is concerned with the analysis of the absolute stability of a non-linear autonomous system which consists of a single non-linearity belonging to a particular class, in an otherwise linear feedback loop. It is motivated from the earlier Popovlike frequency-domain criteria using the ' multiplier ' eoncept and involves the construction of ' stability multipliers' with prescribed phase characteristics. A few computer-based methods by which this problem can be solved are indicated and it is shown that this constitutes a stop-by-step procedure for testing the stability properties of a given system.

Quitty: Using technology to persuade smokers to quit

Health is an important topic in HCI research with an increasing amount of health risks surrounding individuals and society at large. It is well known that smoking cigarettes can have serious health implications. The importance of this problem motivates investigation into the use of technology to encourage behavior change. Our study was designed to gather empirical knowledge about the role a "quitting app" can play in persuading people to quit smoking. Our purpose-built app Quitty introduces different content types from different content sources to study how they are perceived and motivate health behavior change. Findings from our field study show that tailored content and push-messages are considered the most important for persuading people to stop smoking. Based on our empirical findings, we propose six guidelines on how to design mobile applications to persuade smokers to quit.

Ministers as strategic political leaders? : Strategic political steering after NPM reforms in Finland

This study explores strategic political steering after the New Public Management (NPM) reforms, with emphasis on the new role assigned to Government ministers in Finland. In the NPM model, politicians concentrate on broad, principal issues, while agencies have discretion within the limits set by politicians. In Finland, strategic steering was introduced with Management by Results (MBR), but the actual tools for strategic political steering have been the Government Programme, the Government Strategy Portfolio (GSP) and Frame Budgeting. This study addresses these tools as means of strategic steering conducted by the Cabinet and individual ministers within their respective ministries. The time frame of the study includes the two Lipponen Cabinets between 1995 and 2003. Interviews with fourteen ministers as well as with fourteen top officials were conducted. In addition, administrative reform documents and documents related to strategic steering tools were analysed. The empirical conclusions of the study can be summarised as follows: There were few signs of strategic political steering in the Lipponen Cabinets. Although the Government Programmes of both Cabinets introduced strategic thinking, the strategic guidelines set forth at the beginning of the Programme were not linked to the GSP or to Frame Budgeting. The GSP could be characterised as the collected strategic agendas of each ministry, while there was neither the will nor the courage among Cabinet members to prioritise the projects and to make selections. The Cabinet used Frame Budgeting mainly in the sense of spending limits, not in making strategic allocation decisions. As for the GSP at the departmental level, projects were suggested by top officials, and ministers only approved the suggested list. Frame Budgeting at the departmental level proved to be the most interesting strategic steering tool from ministers viewpoint: they actively participated in defining which issues would need extra financing. Because the chances for extra financing were minimal, ministers had an effect only on a marginal share of the budget. At the departmental level, the study shows that strategic plans were considered the domain of officials. As for strategies concerning specific substances, there was variation in the interest shown by the ministers. A few ministers emphasised the importance of strategic work and led strategy processes. In most cases, however, officials led the process while ministers offered comments on the drafts of strategy documents. The results of this study together with experiences reported in other countries and local politics show that political decision-makers have difficulty operating at the strategic level. The conclusion is that politicians do not have sufficient incentive to perform the strategic role implied by the NPM type of reforms. Overall, the empirical results of the study indicate the power of politics over management reforms.

The Vexing Case of Igor Shafarevich, a Russian Political Thinker

The Russian mathematician, academician and former dissident Igor Shafarevich (b. 1923) is commonly mentioned in Western scholarly studies on perestroika and post-perestroika-era Russian politics as one of the most notable anti-Semites and extreme nationalists of the country. This notoriety owes to Shafarevich’s old samizdat article Russophobia, which was published in 1988. The scandal surrounding Russophobia came to a head when the president of The National Academy of Sciences in the United States asked Shafarevich, its honorary member, to resign. Nothing like this had ever happened in the academy’s history. The present dissertation discusses Shafarevich’s political activities, his texts and ideas as well as their reception. Particular attention is given to Russophobia, whose detailed examination proves very clearly that its reputation as an anti-Semitic text is groundless. The reasons for Russophobia’s hasty but fierce condemnation were many, but only one was that when the Soviet system began to tumble, it was commonly assumed that a vigorous rise in anti-Semitism and extreme nationalism in the Soviet Union/Russia would be just a matter of time. Many observers were highly sensitised to detecting its signs and symptoms. The dissertation also shows that most of those to write the first criticisms of Russophobia and to liken Shafarevich to the ideologues of Nazi Germany were the same people he had criticised in Russophobia for their deterministic view of history and irrational manner of connecting things for the purpose of fanning the flames of distrust between Russia’s Jews and Russians. In retrospect, it is fairly evident that Shafarevich actually managed to effectively “neutralise” the message of many of those obsessed with the Jews among his Russian contemporaries and contributed to the fact that anti-Jewish sentiments have been a great deal less popular in post-communist Russia than so many had feared and expected. The thesis also thoroughly discusses Shafarevich’s other texts and activities before Russophobia’s appearance and after it. In the 1970s, Shafarevich was one of the best-known dissidents in the Soviet Union. He worked together with academician Andrei Sakharov in a dissidents’ unofficial human rights committee and co-operated closely with Aleksandr Solzhenitsyn before Solzhenitsyn’s exile. Then, during the chaotic years of perestroika, Shafarevich defended the basic rights of ordinary citizens and warned that the hype concerning democracy could become counterproductive if the most palpable result of the reforms was the disappearance of citizens’ basic security and elementary social justice. One of the conclusions of the thesis is that even if the world around Shafarevich has changed considerably, his views have remained essentially the same since the late 1960s and early 1970s.

How childcare providers interpret "reasonable suspicion" of child abuse

- Background Childcare providers are often “first responders” for suspected child abuse, and how they understand the concept of “reasonable suspicion” will influence their decisions regarding which warning signs warrant reporting. - Objective The purpose of this study was to investigate how childcare providers interpret the threshold for reporting suspected abuse, and to consider the implications of these findings for professional training and development. - Method A convenience sample of 355 childcare providers completed the Reasonable Suspicion of Child Abuse survey to quantify what likelihood of child abuse constitutes “reasonable suspicion.” Responses were examined for internal consistency, evidence of a group standard, and associations with professional and personal demographics. - Results On a Rank Order Scale, responses for what constitutes “reasonable suspicion” ranged from requiring that abuse be “the” most likely cause (8 %) of an injury, to the second most likely (9 %), third (18 %), fourth (18 %), to even the seventh (8 %) or eighth (5 %) most likely cause of an injury. On a numerical probability scale, 21 % of respondents indicated that “abuse” would need to be ≥83 % likely before reasonable suspicion existed; 40 % stated that a likelihood between 53–82 % was needed; 27 % identified the necessary likelihood between 33–52 %; and 12 % set a threshold between 1–32 %. - Conclusions The present finding that no consensus exists for interpreting “reasonable suspicion” suggests that a broadly accepted interpretive framework is needed in order to help prepare childcare providers to know when to report suspected abuse.

'SABAM v scarlet: Evidence of an emerging backlash against corporate copyright lobbies in Europe?

The symbols, signs, and traces of copyright and related intellectual property laws that appear on everyday texts, objects, and artifacts have multiplied exponentially over the past 15 years. Digital spaces have revolutionized access to content and transformed the ways in which content is porous and malleable. In this volume, contributors focus on copyright as it relates to culture. The editors argue that what «counts» as property must be understood as shifting terrain deeply influenced by historical, economic, cultural, religious, and digital perspectives. Key themes addressed include issues of how: • Culture is framed, defined, and/or identified in conversations about intellectual property; • The humanities and other related disciplines are implicated in intellectual property issues; • The humanities will continue to rub up against copyright (e.g., issues of authorship, authorial agency, ownership of texts); • Different cultures and bodies of literature approach intellectual property, and how competing dynasties and marginalized voices exist beyond the dominant U.S. copyright paradigm. Offering a transnational and interdisciplinary perspective, Cultures of Copyright offers readers – scholars, researchers, practitioners, theorists, and others – key considerations to contemplate in terms of how we understand copyright’s past and how we chart its futures.

Dominating search: Google before the law

For many, particularly in the Anglophone world and Western Europe, it may be obvious that Google has a monopoly over online search and advertising and that this is an undesirable state of affairs, due to Google's ability to mediate information flows online. The baffling question may be why governments and regulators are doing little to nothing about this situation, given the increasingly pivotal importance of the internet and free flowing communications in our lives. However, the law concerning monopolies, namely antitrust or competition law, works in what may be seen as a less intuitive way by the general public. Monopolies themselves are not illegal. Conduct that is unlawful, i.e. abuses of that market power, is defined by a complex set of rules and revolves principally around economic harm suffered due to anticompetitive behavior. However the effect of information monopolies over search, such as Google’s, is more than just economic, yet competition law does not address this. Furthermore, Google’s collection and analysis of user data and its portfolio of related services make it difficult for others to compete. Such a situation may also explain why Google’s established search rivals, Bing and Yahoo, have not managed to provide services that are as effective or popular as Google’s own (on this issue see also the texts by Dirk Lewandowski and Astrid Mager in this reader). Users, however, are not entirely powerless. Google's business model rests, at least partially, on them – especially the data collected about them. If they stop using Google, then Google is nothing.

N-syndecan and HB-GAM in neural migration and differentiation : Modulation of growth factor activity in brain

The juvenile sea squirt wanders through the sea searching for a suitable rock or hunk of coral to cling to and make its home for life. For this task it has a rudimentary nervous system. When it finds its spot and takes root, it doesn't need its brain any more so it eats it. It's rather like getting tenure. Daniel C. Dennett (from Consciousness Explained, 1991) The little sea squirt needs its brain for a task that is very simple and short. When the task is completed, the sea squirt starts a new life in a vegetative state, after having a nourishing meal. The little brain is more tightly structured than our massive primate brains. The number of neurons is exact, no leeway in neural proliferation is tolerated. Each neuroblast migrates exactly to the correct position, and only a certain number of connections with the right companions is allowed. In comparison, growth of a mammalian brain is a merry mess. The reason is obvious: Squirt brain needs to perform only a few, predictable functions, before becoming waste. The more mobile and complex mammals engage their brains in tasks requiring quick adaptation and plasticity in a constantly changing environment. Although the regulation of nervous system development varies between species, many regulatory elements remain the same. For example, all multicellular animals possess a collection of proteoglycans (PG); proteins with attached, complex sugar chains called glycosaminoglycans (GAG). In development, PGs participate in the organization of the animal body, like in the construction of parts of the nervous system. The PGs capture water with their GAG chains, forming a biochemically active gel at the surface of the cell, and in the extracellular matrix (ECM). In the nervous system, this gel traps inside it different molecules: growth factors and ECM-associated proteins. They regulate the proliferation of neural stem cells (NSC), guide the migration of neurons, and coordinate the formation of neuronal connections. In this work I have followed the role of two molecules contributing to the complexity of mammalian brain development. N-syndecan is a transmembrane heparan sulfate proteoglycan (HSPG) with cell signaling functions. Heparin-binding growth-associated molecule (HB-GAM) is an ECM-associated protein with high expression in the perinatal nervous system, and high affinity to HS and heparin. N-syndecan is a receptor for several growth factors and for HB-GAM. HB-GAM induces specific signaling via N-syndecan, activating c-Src, calcium/calmodulin-dependent serine protein kinase (CASK) and cortactin. By studying the gene knockouts of HB-GAM and N-syndecan in mice, I have found that HB-GAM and N-syndecan are involved as a receptor-ligand-pair in neural migration and differentiation. HB-GAM competes with the growth factors fibriblast growth factor (FGF)-2 and heparin-binding epidermal growth factor (HB-EGF) in HS-binding, causing NSCs to stop proliferation and to differentiate, and affects HB-EGF-induced EGF receptor (EGFR) signaling in neural cells during migration. N-syndecan signaling affects the motility of young neurons, by boosting EGFR-mediated cell migration. In addition, these two receptors form a complex at the surface of the neurons, probably creating a motility-regulating structure.

G20 host Australia faces hard truths of multinational profit shifting

The G20 Finance Ministers have the opportunity this weekend to endorse the initial recommendations of the OECD on how to address the global problem of multinational tax avoidance. The work of the OECD on the issue to date is substantial. Most notable is the adoption by many nations, including Australia, of the Common Reporting Standard for the automatic exchange of tax information. This standard will allow significant inroads to be made into tax avoidance, particularly by individuals sheltering money offshore. This is the first step in an ambitious tax reform program. There is a long way to go if we are to end the issue now known as Base Erosion and Profit Shifting (BEPS). This week’s release of the first of the OECD recommendations contains some positive signs that further advances will be made. It also recognises some hard truths.

Not all corporate tax avoiders will be snared by new rules

Hockey’s budget announcement of two major tax integrity measures was flagged before the budget was handed down, but even that came as no surprise. Integrity, or lack thereof, in our tax system is a hot topic and an easy target for a Treasurer looking to sell a federal budget. The first of the proposed changes is to our GST regime. No-one likes hearing that they will be paying more tax. But, the charging of GST on supplies of digital products and services in Australia by an off-shore supplier will at least make sense to the general public. With the inherent unfairness in the current system and a revenue raising prediction of A$350 million over the next four years, most are likely to accept the logic of such a measure. The second of the proposed changes are new laws to be included in Australia’s general anti-avoidance provision. New laws, which will apply from 1 January 2016, are aimed at multinational companies engaged in aggressive tax practices. The proposed anti-avoidance law is designed to stop multinationals that artificially avoid a taxable presence in Australia. It is difficult to see how this strategy of addressing specific behaviour through what is considered a general provision will work. And, it is these changes that are already causing confusion.

Assessing taxpayer response to legislative changes: A case study of ‘in-house’ fringe benefits rules

On 22 October 2012, the Australian Federal Government announced the removal of the $1,000 in-house fringe benefits concession when used as part of a salary packaging arrangement. At the time of the announcement, the Federal Government predicted that the removal of the concession would contribute additional tax revenue of $445 million over the following four years as well as an increase of GST payments to the States and Territories. However, anecdotal evidence at the same time indicated that the Australian employer response was to immediately stop providing employees with such in-house fringe benefits via salary sacrificing arrangements. Data presented in this article, collected from a combination of interviews with tax managers of four Australian entities as well as a review of the published archival data, confirms that the abolition of the $1,000 in-house fringe benefits concession was perceived as a negative change, whereby employees were considered the ‘big losers’ despite assertions by the Federal Government to the contrary. Using a conceptual map of tax rule change developed by Oats and Sadler, this article seeks to understand the reasons for this fringe benefits tax change and taxpayer response. In particular, the economic and political factors, and the responses of the relevant taxpayers (employers) are explored. Drawing on behavioural economic concepts, the actions, attitudes and response of employers to the rule change are also examined. The research findings suggest that the decision by Australian employers to cease providing the in-house fringe benefits as part of a salary-packaging arrangement after the legislative amendment was impacted by more than simple rational behaviour.

Implications of high level pseudogene transcription in Mycobacterium leprae

Background: The Mycobacterium leprae genome has less than 50% coding capacity and 1,133 pseudogenes. Preliminary evidence suggests that some pseudogenes are expressed. Therefore, defining pseudogene transcriptional and translational potentials of this genome should increase our understanding of their impact on M. leprae physiology. Results: Gene expression analysis identified transcripts from 49% of all M. leprae genes including 57% of all ORFs and 43% of all pseudogenes in the genome. Transcribed pseudogenes were randomly distributed throughout the chromosome. Factors resulting in pseudogene transcription included: 1) co-orientation of transcribed pseudogenes with transcribed ORFs within or exclusive of operon-like structures; 2) the paucity of intrinsic stem-loop transcriptional terminators between transcribed ORFs and downstream pseudogenes; and 3) predicted pseudogene promoters. Mechanisms for translational ``silencing'' of pseudogene transcripts included the lack of both translational start codons and strong Shine-Dalgarno (SD) sequences. Transcribed pseudogenes also contained multiple ``in-frame'' stop codons and high Ka/Ks ratios, compared to that of homologs in M. tuberculosis and ORFs in M. leprae. A pseudogene transcript containing an active promoter, strong SD site, a start codon, but containing two in frame stop codons yielded a protein product when expressed in E. coli. Conclusion: Approximately half of M. leprae's transcriptome consists of inactive gene products consuming energy and resources without potential benefit to M. leprae. Presently it is unclear what additional detrimental affect(s) this large number of inactive mRNAs has on the functional capability of this organism. Translation of these pseudogenes may play an important role in overall energy consumption and resultant pathophysiological characteristics of M. leprae. However, this study also demonstrated that multiple translational ``silencing'' mechanisms are present, reducing additional energy and resource expenditure required for protein production from the vast majority of these transcripts.