Prognosis in Duke's B colorectal carcinoma: the Jass classification revisited.

OBJECTIVE: To assess whether Jass staging enhances prognostic prediction in Dukes' B colorectal carcinoma. DESIGN: A historical cohort observational study. SETTING: A university tertiary care centre, Switzerland. SUBJECTS: 108 consecutive patients. INTERVENTIONS: Curative resection of Dukes' B colorectal carcinoma between January 1985 and December 1988, Patients with familial adenomatous polyposis; hereditary non-polyposis colorectal cancer; Crohns' disease; ulcerative colitis and synchronous and recurrent tumours were excluded. A comparable group of 155 consecutive patients with Dukes' C carcinoma were included for reference purposes. MAIN OUTCOME MEASURES: Disease free and overall survival for Dukes' B and overall survival for Dukes' C tumours. RESULTS: Dukes' B tumours in Jass group III or with an infiltrated margin had a significantly worse disease-free survival (p = 0.001 and 0.0001, respectively) and those with infiltrated margins had a significantly worse overall survival (p = 0.002). Overall survival among those with Dukes' B Jass III and Dukes' B with infiltrated margins was no better than overall survival among all patients with Dukes' C tumours. CONCLUSION: Jass staging and the nature of the margin of invasion allow patients undergoing curative surgery for Dukes' B colorectal carcinoma to be separated into prognostic groups. A group of patients with Dukes' B tumours whose prognosis is inseparable from those with Dukes' C tumours can be identified, the nature of the margin of invasion being used to classify a larger number of patients.

Notch 1-deficient common lymphoid precursors adopt a B cell fate in the thymus.

We have recently reported that Notch 1, a member of the Notch multigene family, is essential for the development of murine T cells. Using a mouse model in which Notch 1 is inactivated in bone marrow (BM) precursors we have shown that B cells instead of T cells are found in the thymus of BM chimeras. However, it is not clear whether these B cells develop by default from a common lymphoid precursor due to the absence of Notch 1 signaling, or whether they arise as a result of perturbed migration of BM-derived B cells and/or altered homeostasis of normal resident thymic B cells. In this report we show that Notch 1-deficient thymic B cells resemble BM B cells in phenotype and turnover kinetics and are located predominantly in the medulla and corticomedullary junction. Peripheral blood lymphocyte analysis shows no evidence of recirculating Notch1(-/)- BM B cells. Furthermore, lack of T cell development is not due to a failure of Notch1(-/)- precursors to home to the thymus, as even after intrathymic reconstitution with BM cells, B cells instead of T cells develop from Notch 1-deficient precursors. Taken together, these results provide evidence for de novo ectopic B cell development in the thymus, and support the hypothesis that in the absence of Notch 1 common lymphoid precursors adopt the default cell fate and develop into B cells instead.

07014-005 Maple River Watershed Final Report

The proposed project will include the construction of a sanitary sewer collection system and a community gravel filter wastewater treatment system in the unsewered community of Maple River Junction in Carroll County. The system will be built to include approximately 1,150 feet of 4-inch sanitary sewer main, 3,540 feet of 4-inch service main an approximately 35 septic tanks. Some existing 4-inch PVC sewer piping as well as existing septic tanks in good condition will continue to be used in order to control capital costs.

06010-005 Holiday Lake Watershed Final Report

Holiday Lake is included in the Walnut Creek watershed, which is listed on the 303(d) list of impaired water bodies. Research indicates that the causes of impairment are sedimentation and habitat alterations. To improve water quality, the goals of this project are to reduce the sediment delivery into Holiday Lake by 50% and assist in educating watershed residents about cost-effective ways to control sediment and nutrient contaminates. The best management practices will be installed to filter the water, reducing sediment and chemical loading into the lake. When all practices are installed, nearly 100% of the lake’s drainage area will be controlled.

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, February 2016

B-1 Medicaid Reports -- The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report Report name IAMM1800-R001--Medically Needy by County - No Spenddown and With Spenddown; IAMM1800-R002--Total Medically Needy, All Other Medicaid, and Grand Total by County; IAMM2200-R002--Monthly Expenditures by Category of Service; IAMM2200-R003--Fiscal YTD Expenditures by Category of Service; IAMM3800-R001--ICF & ICF-MR Vendor Payments by County; IAMM4400-R001--Monthly Expenditures by Eligibility Program; IAMM4400-R002--Monthly Expenditures by Category of Service by Program; IAMM4600-R002--Elderly Waiver Summary by County.

Investigation of AASHTOWare Pavement ME Design/DARWin-ME Performance Prediction Models for Iowa Pavement Analysis and Design, 2015

The Mechanistic-Empirical Pavement Design Guide (MEPDG) was developed under National Cooperative Highway Research Program (NCHRP) Project 1-37A as a novel mechanistic-empirical procedure for the analysis and design of pavements. The MEPDG was subsequently supported by AASHTO’s DARWin-ME and most recently marketed as AASHTOWare Pavement ME Design software as of February 2013. Although the core design process and computational engine have remained the same over the years, some enhancements to the pavement performance prediction models have been implemented along with other documented changes as the MEPDG transitioned to AASHTOWare Pavement ME Design software. Preliminary studies were carried out to determine possible differences between AASHTOWare Pavement ME Design, MEPDG (version 1.1), and DARWin-ME (version 1.1) performance predictions for new jointed plain concrete pavement (JPCP), new hot mix asphalt (HMA), and HMA over JPCP systems. Differences were indeed observed between the pavement performance predictions produced by these different software versions. Further investigation was needed to verify these differences and to evaluate whether identified local calibration factors from the latest MEPDG (version 1.1) were acceptable for use with the latest version (version 2.1.24) of AASHTOWare Pavement ME Design at the time this research was conducted. Therefore, the primary objective of this research was to examine AASHTOWare Pavement ME Design performance predictions using previously identified MEPDG calibration factors (through InTrans Project 11-401) and, if needed, refine the local calibration coefficients of AASHTOWare Pavement ME Design pavement performance predictions for Iowa pavement systems using linear and nonlinear optimization procedures. A total of 130 representative sections across Iowa consisting of JPCP, new HMA, and HMA over JPCP sections were used. The local calibration results of AASHTOWare Pavement ME Design are presented and compared with national and locally calibrated MEPDG models.

Alcohol and cannabis use as risk factors for injury--a case-crossover analysis in a Swiss hospital emergency department.

BACKGROUND: There is sufficient and consistent evidence that alcohol use is a causal risk factor for injury. For cannabis use, however, there is conflicting evidence; a detrimental dose-response effect of cannabis use on psychomotor and other relevant skills has been found in experimental laboratory studies, while a protective effect of cannabis use has also been found in epidemiological studies. METHODS: Implementation of a case-crossover design study, with a representative sample of injured patients (N = 486; 332 men; 154 women) from the Emergency Department (ED) of the Lausanne University Hospital, which received treatment for different categories of injuries of varying aetiology. RESULTS: Alcohol use in the six hours prior to injury was associated with a relative risk of 3.00 (C.I.: 1.78, 5.04) compared with no alcohol use, a dose-response relationship also was found. Cannabis use was inversely related to risk of injury (RR: 0.33; C.I.: 0.12, 0.92), also in a dose-response like manner. However, the sample size for people who had used cannabis was small. Simultaneous use of alcohol and cannabis did not show significantly elevated risk. CONCLUSION: The most surprising result of our study was the inverse relationship between cannabis use and injury. Possible explanations and underlying mechanisms, such as use in safer environments or more compensatory behavior among cannabis users, were discussed.

Decompression scenarios in a new underground transportation system

BACKGROUND: The risks of a public exposure to a sudden decompression, until now, have been related to civil aviation and, at a lesser extent, to diving activities. However, engineers are currently planning the use of low pressure environments for underground transportation. This method has been proposed for the future Swissmetro, a high-speed underground train designed for inter-urban linking in Switzerland. HYPOTHESIS: The use of a low pressure environment in an underground public transportation system must be considered carefully regarding the decompression risks. Indeed, due to the enclosed environment, both decompression kinetics and safety measures may differ from aviation decompression cases. METHOD: A theoretical study of decompression risks has been conducted at an early stage of the Swissmetro project. A three-compartment theoretical model, based on the physics of fluids, has been implemented with flow processing software (Ithink 5.0). Simulations have been conducted in order to analyze "decompression scenarios" for a wide range of parameters, relevant in the context of the Swissmetro main study. RESULTS: Simulation results cover a wide range from slow to explosive decompression, depending on the simulation parameters. Not surprisingly, the leaking orifice area has a tremendous impact on barotraumatic effects, while the tunnel pressure may significantly affect both hypoxic and barotraumatic effects. Calculations have also shown that reducing the free space around the vehicle may mitigate significantly an accidental decompression. CONCLUSION: Numeric simulations are relevant to assess decompression risks in the future Swissmetro system. The decompression model has proven to be useful in assisting both design choices and safety management.

Suurien tahtimoottorien tilaustoimitusprosessin kehittäminen

Työn tavoitteena on ideoida keinoja, joilla tehottomasti toimivaa tilaustoimitusprosessia voidaan kehittää. Ideoidut kehittämistoimet pohjautuvat tilaustoimitusprosessin toimivuutta selvittävään tutkimukseen ja niillä tavoitellaan kohdeyrityksessä valmistettavien suurien tahtikoneiden tilaustoimitusprosessin korkeampaa tuottavuutta ja laaduntuottokykyä, lyhyempiä läpäisyaikoja sekä pienempää keskeneräisen tuotannon määrää. Työssä keskitytään kehittämään tilaustoimitusprosessin alkupään vaiheiden eli tilauskohtaisen suunnittelun ja projektinhoidon epästandardeja toimintatapoja sekä puutteellisia työvälineitä. Työn tutkimusvaiheessa selvitetään tilaustoimitusprosessinnykytila prosessiin osallistuvia henkilöitä haastattelemalla, tutkimalla toteutuneita toimitusaika- ja nimikerakenteita sekä esiintyneitä laatupoikkeamia. Näin pyritään löytämään nykyisen toimintamallin ongelmakohdat, joihin kehittämisen painopistealue asetetaan. Tutkimusvaiheeseen kuuluu myös kirjallisuustutkimus, jossa paneudutaan tilaustoimitusprosessin toimintaan yleisellä tasolla sekä kartoitetaan niitä tekijöitä, jotka vaikuttavat tilaustoimitusprosessin tehokkuuteen. Lisäksi kirjallisuustutkimuksessa perehdytään yksittäistuotantoon liittyvään teoriaan ja erilaisiin tapoihin organisoida sen toimintaa. Tutkimusvaiheen jälkeen esitellään tutkimukseen pohjautuvat toimenpide-ehdotukset kohdeyrityksen tilaustoimitusprosessin tehokkuuden parantamiseksi.Ehdotettuja toimintaa tehostavia keinoja ovat simultaanisuunnittelu, erilaistensuunnittelun ja tuotannon yhteistyötä tukevien tietojärjestelmien rakentaminen,DFMA-analyysin käyttöönotto, tuotteiden rakenteiden tehokas modulointi sekä mallirakenne yrityksen heikoimmin vakioidulle tuotteelle. Ennen kehitystoimien aloittamista yrityksen toimistoprosessin toimivuutta ehdotetaan lisäksi tarkasteltavan työntutkimuksen keinoin.

Error en el posicionamiento indoor en dispositivos mo¿viles

Location information is becoming increasingly necessary as every new smartphone incorporates a GPS (Global Positioning System) which allows the development of various applications based on it. However, it is not possible to properly receive the GPS signal in indoor environments. For this reason, new indoor positioning systems are being developed.As indoors is a very challenging scenario, it is necessary to study the precision of the obtained location information in order to determine if these new positioning techniques are suitable for indoor positioning.

Agendi Modus; Yrittäjyyskasvatusta Etelä-Karjalassa. Yrittäjyys, koulut ja yrittäjyyskasvatuksenhanketoiminta

Julkaisu on kuvaus Agendi Modus - yrittäjyyskasvatushankkeesta, joka toteutettiin Etelä- Karjalassa vuosina 2004-2007. Samalla se on hankkeeseen osallistuneiden kokemuksista tehty vaikuttavuuden arviointiraportti. Agendi Modus-hanke oli Lappeenrannan teknillisen yliopiston Koulutus ja kehittämiskeskuksen kouluille ja yrityksille suunnattu projekti. Hankkeen tavoitteet olivat 1. pedagogisen muutoksen tuottaminen, 2. oppimisympäristöjen kehittäminen ja 3. yrittäjämäistä koulutyötä tukevan koulun kulttuurin ja johtamisen muutoksen tuottaminen. Julkaisusta käy ilmi, että hankevoi oppia yhdessä asiakkaidensa eli hankkeen yhteistyötahojen kanssa. Raportin toisessa osassa tuodaan esille muutamia yrittäjyyskasvatuksen näkökulmia. Lukija voi myös pohtia, tulisiko yrittäjyyskasvatuksen koulutuskokonaisuus rakentua kuten Agendi Moduksessa, eli esitellen aihealuetta sekäyleisesti että perehtyen sen eri olemuspuoliin. Julkaisun keskeisimmät huomiot ovat että A) hanke, joka kuuntelee asiakastaan, tuottaa sen tarvitsemia tuotteita, B) pitkäkestoinen koulutusprosessi tarjoaa mahdollisuuden ymmärtää yrittäjyyskasvatuksen metodologiaa ja pedagogiaa ja tukee aihealueen didaktiikan kokeilemista, C) on tärkeää kouluttaa sekä työyhteisöjä että näiden yksittäisiä toimijoita, D) eri osallistujilla on omanlaistaan osaamista yrittäjyyskasvatuksessa, koska kukin on valinnut erityyppistä koulutuksista itselleen soveltuvimpia, E) näyttää siltä, että noin puolet koulutuksiin osallistuneista käyttää yrittäjyyskasvatusta opetuksensa käyttöteoriana, F) oppimisympäristöjen kehittäminen on vähäisempää kuin yrittäjyyskasvatuksen käyttö oman opetuksen osana, G) hankkeen jälkeen osallistujilla on laaja ymmärrys yrittäjyyskasvatusta suosivasta oppimiskulttuurista, mutta vain harvat kokevat luovansa yrittäjämäistä koulukulttuuria. Jos uutta aihealueen hanketta suunnitellaan, se voisi keskittyä tätä hanketta tarkemmin koulukulttuurin muuttamiseen, jonka lisäksi toiminta-ajatuksissa kannattaisi huomioida oppimisen, teknologian ja yrittäjyyden strategiat.

Project Success through Effective Decisions: Case Studies on Project Goal Setting, Success Evaluation and Managerial Decision Making

The objective of the thesis is to structure and model the factors that contribute to and can be used in evaluating project success. The purpose of this thesis is to enhance the understanding of three research topics. The goal setting process, success evaluation and decision-making process are studied in the context of a project, business unitand its business environment. To achieve the objective three research questionsare posed. These are 1) how to set measurable project goals, 2) how to evaluateproject success and 3) how to affect project success with managerial decisions.The main theoretical contribution comes from deriving a synthesis of these research topics which have mostly been discussed apart from each other in prior research. The research strategy of the study has features from at least the constructive, nomothetical, and decision-oriented research approaches. This strategy guides the theoretical and empirical part of the study. Relevant concepts and a framework are composed on the basis of the prior research contributions within the problem area. A literature review is used to derive constructs of factors withinthe framework. They are related to project goal setting, success evaluation, and decision making. On the basis of this, the case study method is applied to complement the framework. The empirical data includes one product development program, three construction projects, as well as one organization development, hardware/software, and marketing project in their contexts. In two of the case studiesthe analytic hierarchy process is used to formulate a hierarchical model that returns a numerical evaluation of the degree of project success. It has its origin in the solution idea which in turn has its foundation in the notion of projectsuccess. The achieved results are condensed in the form of a process model thatintegrates project goal setting, success evaluation and decision making. The process of project goal setting is analysed as a part of an open system that includes a project, the business unit and its competitive environment. Four main constructs of factors are suggested. First, the project characteristics and requirements are clarified. The second and the third construct comprise the components of client/market segment attractiveness and sources of competitive advantage. Together they determine the competitive position of a business unit. Fourth, the relevant goals and the situation of a business unit are clarified to stress their contribution to the project goals. Empirical evidence is gained on the exploitation of increased knowledge and on the reaction to changes in the business environment during a project to ensure project success. The relevance of a successful project to a company or a business unit tends to increase the higher the reference level of project goals is set. However, normal performance or sometimes performance below this normal level is intentionally accepted. Success measures make project success quantifiable. There are result-oriented, process-oriented and resource-oriented success measures. The study also links result measurements to enablers that portray the key processes. The success measures can be classified into success domains determining the areas on which success is assessed. Empiricalevidence is gained on six success domains: strategy, project implementation, product, stakeholder relationships, learning situation and company functions. However, some project goals, like safety, can be assessed using success measures that belong to two success domains. For example a safety index is used for assessing occupational safety during a project, which is related to project implementation. Product safety requirements, in turn, are connected to the product characteristics and thus to the product-related success domain. Strategic success measures can be used to weave the project phases together. Empirical evidence on their static nature is gained. In order-oriented projects the project phases are oftencontractually divided into different suppliers or contractors. A project from the supplier's perspective can represent only a part of the ¿whole project¿ viewed from the client's perspective. Therefore static success measures are mostly used within the contractually agreed project scope and duration. Proof is also acquired on the dynamic use of operational success measures. They help to focus on the key issues during each project phase. Furthermore, it is shown that the original success domains and success measures, their weights and target values can change dynamically. New success measures can replace the old ones to correspond better with the emphasis of the particular project phase. This adjustment concentrates on the key decision milestones. As a conclusion, the study suggests a combination of static and dynamic success measures. Their linkage to an incentive system can make the project management proactive, enable fast feedback and enhancethe motivation of the personnel. It is argued that the sequence of effective decisions is closely linked to the dynamic control of project success. According to the used definition, effective decisions aim at adequate decision quality and decision implementation. The findings support that project managers construct and use a chain of key decision milestones to evaluate and affect success during aproject. These milestones can be seen as a part of the business processes. Different managers prioritise the key decision milestones to a varying degree. Divergent managerial perspectives, power, responsibilities and involvement during a project offer some explanation for this. Finally, the study introduces the use ofHard Gate and Soft Gate decision milestones. The managers may use the former milestones to provide decision support on result measurements and ad hoc critical conditions. In the latter milestones they may make intermediate success evaluation also on the basis of other types of success measures, like process and resource measures.

La enseñanza de estrategias de resolución de problemas matemáticos en la ESO: un ejemplo concreto

Within this article is included a description and justification of a didactical sequence to improve the learning of problem solving strategies of Secondary Education students. The design of the didactical sequence is guided by four principles: a) to context the activities and problems to solve in students’ every day practices; b) to use teaching methods that show the problem solving processes; c) to design didactical materials in order to guide strategies such as selection, organisation and control; d) to facilitate the co-operative learning of problem solving strategies.

Error en el posicionamiento indoor en dispositivos móviles

Location information is becoming increasingly necessary as every new smartphone incorporates a GPS (Global Positioning System) which allows the development of various applications based on it. However, it is not possible to properly receive the GPS signal in indoor environments. For this reason, new indoor positioning systems are being developed. As indoors is a very challenging scenario, it is necessary to study the precision of the obtained location information in order to determine if these new positioning techniques are suitable for indoor positioning.

Copy number variations and cognitive phenotypes in unselected populations

IMPORTANCE: The association of copy number variations (CNVs), differing numbers of copies of genetic sequence at locations in the genome, with phenotypes such as intellectual disability has been almost exclusively evaluated using clinically ascertained cohorts. The contribution of these genetic variants to cognitive phenotypes in the general population remains unclear. OBJECTIVE: To investigate the clinical features conferred by CNVs associated with known syndromes in adult carriers without clinical preselection and to assess the genome-wide consequences of rare CNVs (frequency ≤0.05%; size ≥250 kilobase pairs [kb]) on carriers' educational attainment and intellectual disability prevalence in the general population. DESIGN, SETTING, AND PARTICIPANTS: The population biobank of Estonia contains 52,000 participants enrolled from 2002 through 2010. General practitioners examined participants and filled out a questionnaire of health- and lifestyle-related questions, as well as reported diagnoses. Copy number variant analysis was conducted on a random sample of 7877 individuals and genotype-phenotype associations with education and disease traits were evaluated. Our results were replicated on a high-functioning group of 993 Estonians and 3 geographically distinct populations in the United Kingdom, the United States, and Italy. MAIN OUTCOMES AND MEASURES: Phenotypes of genomic disorders in the general population, prevalence of autosomal CNVs, and association of these variants with educational attainment (from less than primary school through scientific degree) and prevalence of intellectual disability. RESULTS: Of the 7877 in the Estonian cohort, we identified 56 carriers of CNVs associated with known syndromes. Their phenotypes, including cognitive and psychiatric problems, epilepsy, neuropathies, obesity, and congenital malformations are similar to those described for carriers of identical rearrangements ascertained in clinical cohorts. A genome-wide evaluation of rare autosomal CNVs (frequency, ≤0.05%; ≥250 kb) identified 831 carriers (10.5%) of the screened general population. Eleven of 216 (5.1%) carriers of a deletion of at least 250 kb (odds ratio [OR], 3.16; 95% CI, 1.51-5.98; P = 1.5e-03) and 6 of 102 (5.9%) carriers of a duplication of at least 1 Mb (OR, 3.67; 95% CI, 1.29-8.54; P = .008) had an intellectual disability compared with 114 of 6819 (1.7%) in the Estonian cohort. The mean education attainment was 3.81 (P = 1.06e-04) among 248 (≥250 kb) deletion carriers and 3.69 (P = 5.024e-05) among 115 duplication carriers (≥1 Mb). Of the deletion carriers, 33.5% did not graduate from high school (OR, 1.48; 95% CI, 1.12-1.95; P = .005) and 39.1% of duplication carriers did not graduate high school (OR, 1.89; 95% CI, 1.27-2.8; P = 1.6e-03). Evidence for an association between rare CNVs and lower educational attainment was supported by analyses of cohorts of adults from Italy and the United States and adolescents from the United Kingdom. CONCLUSIONS AND RELEVANCE: Known pathogenic CNVs in unselected, but assumed to be healthy, adult populations may be associated with unrecognized clinical sequelae. Additionally, individually rare but collectively common intermediate-size CNVs may be negatively associated with educational attainment. Replication of these findings in additional population groups is warranted given the potential implications of this observation for genomics research, clinical care, and public health.