Half Of Term Research Articles

Mortality in Switzerland in 2021.

ObjectiveTo analyze mortality trends in Switzerland in 2021, the second year of the COVID-19 pandemic.MethodsUsing data from the Swiss Federal Statistical Office, we compared mortality in Switzerland in 2021 with that of previous years in terms of standardized weekly deaths, standardized (annual) mortality rates (overall and stratified by age and sex) and life expectancy. The latter is a well-known demographic concept defining the average lifespan of a hypothetical cohort living and dying according to the mortality rates of a given year.ResultsAfter a favorable first half of the year and a fairly standard second half in terms of mortality in Switzerland, the year 2021 ended with a wave of deaths of moderate intensity related to the 5th wave of COVID-19. Overall, and after a notable increase in mortality in 2020 (+9.2%, 95%CI: +8.0%; +10.3%, compared to 2019, and +5.1%, 95%CI: +4.3%; +6.0%, compared to 2015–19), the pre-pandemic mortality level was approximately recovered in 2021 (+0.8%, 95%CI: -0.3%; +0.8%, compared to 2019, and -2.9%, 95%CI: -3.7%; -2.2%, compared to 2015–19). Life expectancy, after declining by 10 months for men and 6 months for women in 2020 (i.e. men would have lost 10 months and women 6 months had they lived their entire lives with COVID-19 as it was in 2020), returned in 2021 to 2019 levels for women (85.6 years) and regained 2018 levels for men (81.6 years, still -0.3 years from 2019). The age group responsible for the small remaining loss for men was the 50–70 age group, which had similar mortality in 2020 and 2021.ConclusionsThe second year of the COVID-19 pandemic in Switzerland was characterized by an approximate return to pre-pandemic mortality levels, with a faster recovery for women than for men with respect to 2020.

Can children use the A‐not a test?

Sensory scientists have adapted several sensory methods to fit children's cognitive abilities. Although several discrimination methods have been reported with children, the A-not-A test has not been studied yet. The aims of this work were to: (i) evaluate the feasibility of using the A-Not-A test with school-aged children, and (ii) compare how the framing of the question (overall differences vs. differences in liking) may influence the results. A total of 126 children were involved in the study. They participated in three sessions, each composed of a familiarization task with a visual stimuli and sample tasting with one of three dairy products (vanilla milk desserts, chocolate-flavored milk, and vanilla-flavored yogurt). Half of the children evaluated the samples in terms of overall differences and the other half in terms of differences in liking. Results from the familiarization step showed that children correctly identified the visual reference in the A-not-A test regardless of how the question was framed, suggesting that they were able to understand the methodology. In the case of tasting samples, children were significantly more likely to correctly identify the reference in two of the three studied dairy products, when the question was based on liking, as compared to the framing based on overall differences. Practical Applications Results from the present work showed that 8–13 year-old children were able to understand the A-Not-A test and use it to differentiate visual stimuli and tasted samples. However, the framing of the task had a significant effect on their performance. Framing the A-not-A task based on liking may show a higher ability to discriminate samples and provide more accurate results.

Informational Determinants of Large-Area Hurricane Evacuations

Abstract This study reports on two experiments to investigate the informational determinants of hurricane evacuation decisions (temporal and spatial). Whereas most observational and experimental studies in this domain address the public’s response to forecast information, this study addresses emergency management decisions. Using a subject sample of emergency managers and other public safety leaders, contrasted with a more typical university subject pool, this study presents an experimental design that overcomes the counterfactual problem present in all prior published experiments, by relying on an actual storm (Hurricane Rita) with a known outcome. Several methodological advancements are presented, including the use of an established numeracy instrument, integration of advanced hydrodynamic forecasts, and use of a loss aversion frame to improve generalizability. Results indicate that the availability of additional forecast information (e.g., wind speed, forecast tracks) significantly increases the probability and improves the timing of early voluntary evacuation. However, we observe that more numerate subjects are less likely to avoid relying upon forecast information that is characterized by probability (e.g., the uncertainty in the forecast track, sometimes referred to as the “cone of uncertainty”). Consequently, more numerate emergency managers are almost twice as likely as less numerate ones to provide additional evacuation time to their coastal communities, and they do so by longer than a typical workday (8.8 h). Results also indicate that subjects knowingly overevacuate large populations when making spatial mandatory evacuation orders. However, results indicate that numeracy mitigates this effect by more than half in terms of the population subject to mandatory evacuation.

Pulmonary hypertension in late onset neonatal sepsis using functional echocardiography: a prospective study.

Pulmonary hypertension (PH) in the newborn period is associated with significant morbidity and mortality. Sepsis has been identified as an independent risk factor for PH in newborns. Data on the proportion and severity of PH in association with neonatal sepsis are scarce. This study was aimed to measure the pulmonary artery systolic pressure (PASP) in neonates with late onset sepsis (LOS) and to estimate the proportion of PH in neonatal sepsis using functional echocardiography (FnECHO). This prospective observational study was conducted at a tertiary neonatal intensive care unit (NICU). All neonates admitted in the NICU with suspected LOS underwent FnECHO within 6 hours of onset of clinical signs and PASP was recorded. Pulmonary hypertension was defined as PASP of > 35mmHg. PASP of neonates with positive culture results (proven LOS) was compared with that of gestational age-matched stable controls without sepsis. Thirty three neonates with proven LOS were analysed (study group). Sixteen neonates (49%) in the study group had PH. Mean PASP of the study group was significantly higher than that of the control group (35.3 ± 10.13mmHg and 12.58 ± 3.92mmHg, respectively; P < 0.0001). None of the neonates in the control group had PH. Pulmonary artery pressure was higher in neonates with late onset neonatal sepsis as compared to that of stable babies without sepsis. Pulmonary hypertension was seen in nearly half of term as well as preterm neonates with late onset sepsis.

Simplifying Hyperbilirubinemia Risk Estimation.

Jaundice impacts more than half of term and late preterm newborns in the first week of life. Although in most cases, jaundice is benign, the consequences of severe hyperbilirubinemia are debilitating; thus, identification of newborns likely to exceed bilirubin treatment thresholds is needed. The American Academy of Pediatrics (AAP) recommends stratification of predischarge total serum bilirubin (TSB) levels by using the Bhutani Nomogram to help determine the appropriate timing of newborn follow-up. A separate nomogram is then used to determine if an infant meets criteria for phototherapy.1Kuzniewicz et al2 aim to simplify the process and more precisely determine when a newborn requires outpatient follow-up for jaundice with a simple equation. Starting with a retrospective cohort study of a diverse sample of 148 162 newborns born at ≥35 weeks’ gestation at 11 Kaiser Permanente Northern California facilities from 2012 to 2017, the researchers identified newborns whose TSB measurements did not exceed phototherapy levels and did not receive phototherapy during the birth hospitalization. Using the newborn’s last TSB value before hospital discharge (predischarge TSB), the authors calculated the difference between the predischarge total serum bilirubin and the corresponding American Academy of Pediatrics phototherapy threshold (in milligrams/deciliter) (Δ-TSB). Newborns who required phototherapy after discharge were identified. The authors compared the ability of the Δ-TSB model to predict postdischarge TSB above phototherapy thresholds to the Bhutani Nomogram. Examining additional variables, they also compared a more complicated Δ-TSB-Plus model. Although all 3 models performed well for those at highest and lowest risk of subsequent severe hyperbilirubinemia, both Δ-TSB and Δ-TSB-Plus models differentiated newborns in the intermediate zones better than the Bhutani Nomogram. Forty-four percent of newborns in Bhutani’s high-intermediate risk zone (who would have follow-up recommended within 48 hours) had a Δ-TSB between −4 and −5 mg/dL. In these newborns, the risk of ever having a subsequent TSB measurement greater than the AAP threshold was only 1.6%, suggesting follow-up within 48 hours might not be indicated.The Δ-TSB measurements used in this study relied on clinician discretion in follow-up; therefore, the predictive accuracy of the Δ-TSB models may be inflated because of differential verification bias as the authors mention. Only TSB measurements were included, but many hospitals and clinics use transcutaneous bilirubinometry.3 Although one can extrapolate the Δ-TSB for low bilirubin levels, the additional uncertainty involved when transcutaneous bilirubin measurements are used to approximate TSB levels has the potential to impact effective implementation of the Δ-TSB risk prediction approach.4 The 2004 AAP bilirubin thresholds were used in this study, but some clinicians caring for the patients studied may have followed other recommendations. For example, if the Northern California Neonatal Consortium criteria were used,5 some newborns may not have received a TSB assessment. Because nearly half of treated newborns were provided home phototherapy, we suspect their bilirubin levels were close to AAP thresholds. Clinicians may want to understand which newborns returned with bilirubin levels nearing or exceeding exchange thresholds and if they were predictable6; these data were not provided. Given the wide range of gestational ages in the AAP phototherapy risk strata (35–38 weeks; >38 weeks), a more delineated approach by gestational age and sex would be helpful because we know lower gestational age and male sex contribute to a higher risk of hyperbilirubinemia.7,8 An implementation study across different health systems will improve the generalizability of the Δ-TSB strategy.Despite any limitations, this study could have significant impact on the experience of care for new families and curb health care overuse. Currently, the AAP Bright Futures Guidelines recommend timing the initial newborn posthospitalization continuing care visit within 3 to 5 days after birth and 48 to 72 hours after discharge. This recommendation is based primarily on concern for jaundice and feeding problems leading to excessive weight loss.9 Implementation of a Δ-TSB approach has the potential to simplify postdischarge phototherapy risk estimation and might decrease unnecessary health care visits and extra hospital days for newborns previously stratified to the high-intermediate and low-intermediate risk zones on the Bhutani Nomogram. Select newborns could be discharged at 24 hours rather than 48 hours given this new evidence supporting an enhanced understanding of bilirubin trajectories. Some newborns with intermediate risk could safely defer in-person follow-up through weekends, holidays, and inclement weather days, whereas others may avoid daily outpatient bilirubin sampling with more optimally timed follow-up. This research also highlights, with large numbers, how truly low risk some newborns are for developing significant hyperbilirubinemia. With increasing adoption of telemedicine,10 those newborns who are also at low risk of feeding problems could be safely cared for in their homes.We thank Arthur Jaffe, MD, for reviewing and editing this commentary.

Performance comparison of partitioned primary hybrid excited linear flux switching machine

To avoid the problem of crowded primary and rising temperature of permanent magnet (PM), the design of partitioned primary hybrid excited linear flux switching machine (PP-HLFSM) positions the armature, and field excitation coil winding on separate part of the mover. This article examines the performance analysis of different structures of unaligned structure of PP-HLFSM and compared the proposed designs by reducing the usage of PM to half in terms of volume from 25,920 mm3 to 12,960 mm3, for both concentrated and toroidal winding structure leading toward cost effectiveness. This article scales down the cost of proposed designs for elevator long stroke application. Based on finite element analysis (FEA) and boundary element analysis, the electromagnetic performance of the machine is studied in detail. Single variable optimization is implemented to optimize both the proposed structures. Analysis includes flux linkages, flux strengthening, average force characteristics, force–velocity and power–velocity curves, copper losses, iron losses, efficiency, thrust force density and power density, and demagnetization analysis. Comparison of conventional structure with proposed designs are made in terms of flux, thrust force, losses, efficiency, power density, demagnetization of PMs, and thermal analysis, along with 3D FEA analysis. Finally, the proposed structures are analytically validated.

Collection and Reporting of Indigenous Status Information in Cancer Registries Around the World.

PURPOSEWorldwide, Indigenous people often have disproportionally worse health and lower life expectancy than their non-Indigenous counterparts. Despite the impact of cancer on life expectancy, little is known about the burden of cancer for Indigenous people primarily because of the paucity of data. We investigated the collection and reporting of Indigenous status information among a global sample of population-based cancer registries (PBCRs).PARTICIPANTS AND METHODSAn online survey was e-mailed to eligible registries using set inclusion criteria. Respondents were asked questions on the collection, reporting, and quality assessment of Indigenous status in their registers.RESULTSEighty-three PBCRs from 25 countries were included. Of these, 66% reported that their registry collected Indigenous status data, although the quality of this variable had been assessed in less than half in terms of completeness (38%) and accuracy (47%). Two thirds of PBCRs who collected Indigenous status data (67%), from nine of 25 countries responded that cancer statistics for Indigenous people were reported using registry data. Key barriers to the collection of Indigenous status information included the lack of data collection at the point of care (79%), lack of transfer of Indigenous status to the cancer registry (46%), inadequate information systems (43%), and legislative limitations (32%). Important variations existed among world regions, although the lack of Indigenous status data collection at the point of care was commonly reported across all regions.CONCLUSIONHigh-quality data collection is lacking for Indigenous peoples in many countries. To ensure the design and implementation of cancer control activities required to reduce disparities for Indigenous populations, health information systems, including cancer registries, need to be strengthened, and this must be done in dialogue with Indigenous leaders.

Evaluation of the Visibility and Artifacts of Seven Common Fiducials for Image-guided Radiation Therapy

The implantation of high-contrast fiducial markers in or near low-contrast gastrointestinal tumors improves the accuracy of stereotactic body radiation therapy (SBRT) delivery. The purpose of this work was to evaluate the visibility and artifacts of several commercially available fiducial markers in CT simulation, CT-on-Rails, and cone-beam CT (CBCT) images for IGRT. Seven of the most commonly used fiducials in SBRT were selected from four of the most prominent vendors. The fiducials varied in material composition (gold, platinum, carbon), shape (cylinder, coil, notched), diameter (0.28-1.0 mm), and length (3.0-20.0 mm) as summarized in the Table below. Each fiducial was placed within 4 mm of bolus located within a 13 cm thick virtual water phantom. Each fiducial was then imaged with a CT scanner used for simulation, and a CT-on-Rails scanner and an onboard CBCT system used for treatment set-up. Image acquisition parameters were set according to clinical protocols with slice thickness ranging from 2-3 mm, voxel sizes from 0.91-0.98 mm, and tube potential between 120-125 kVp. Fiducial visibility was evaluated in terms of contrast (ΔHU) and the Michelson visibility metric (V). Artifacts were quantified in terms of the relative streak artifacts level (rSAL) and the relative standard deviation (rStdDev) with larger values indicating more severe artifacts. The rSAL metric quantifies streak artifacts in terms of the image total variation relative to a uniform reference image. Maximum contrast and artifacts were observed for the 0.75 mm diameter platinum fiducial for all three imaging systems. Minimum contrast and median artifacts (rSAL) were observed for the smallest diameter gold fiducials. The carbon fiducial produced the least severe image artifacts while also ranking in the upper half in terms of Michelson contrast. Quantitative results for CBCT are presented in the Table. Similar results were observed for the simulation CT and CT-on-Rails systems. Qualitatively, fiducial contrast and artifacts were correlated with the quantitative image quality metrics. Visibility and artifacts were assessed for seven commercial fiducials. Visibility and artifacts were greatest for the largest diameter platinum fiducial evaluated. Carbon fiducials, which are MRI compatible and the preferred option for proton therapy, are a promising option for photon beam RT due to the least severe artifacts and superior contrast compared to two popular gold fiducials.Abstract 3716; Table 1FiducialContrastArtifactsMaterial, shape, diameter x length mm2ΔHUVrStdDevrSALPt, coil, 0.75 x 547981.07.52.7Au, cylinder, 0.43 x 517100.73.50.9Au, coil, 0.35 x 1013790.52.40.5Pt, coil, 0.35 x 1013240.42.00.4C, cylinder, 1.0 x 39980.51.60.3Au, notched, 0.28 x 109460.22.30.5Au, notched, 0.28 x 208650.22.60.5 Open table in a new tab

Three opportunities for standardization: A literature review of the variation among pharmacists' patient care services terminology.

Variation describing pharmacists' patient care services exist, and this variation contributes to the prevalent misunderstanding of pharmacists' roles. In contrast, standard phraseology is a critical practice among highly reliable organizations and a way to reduce variation and confusion. This work aims to identify and define pharmacists' patient care service terms to identify redundancies and opportunities for standardization. Between May to August 2018, terms and definitions were searched via PubMed, Google Scholar and statements/policies of professional pharmacy organizations. Two references per term were sought to provide an "early definition" and a "contemporary definition." Only literature published in English was included, and data gathered from each citation included the date published, the term's definition, and characterization of the reference's source as either a regulatory or professional body. A five-person expert panel used an iterative technique to revise and verify the list of included terms and subsequent literature review results. Terms were then searched in the National Library of Medicine's Medical Subject Heading Database (MeSH) in July, 2019. There are fifteen commonly misunderstood terms that refer to the patient care services provided by pharmacists. The appearance of these terms in the literature spanned nearly five decades. Nearly half of terms appeared first in regulatory, law or policy documents; of these, two terms had contemporary definitions appearing in the professional literature that differed from their early regulatory definition. Three opportunities to improve standardization include: (1) Implementation of standardized phraseology systems similar to nursing's Clinical Care Classification System; (2) Academics' adherence to standardized MeSH terms; and (3) Clarification of pharmacy education accreditation standards. Numerous terms are used to describe pharmacists' patient care services, with many definitions of terms overlapping in several key components. The profession has made concerted efforts to consolidate and standardize terminology in the past, but more opportunities exist.

Treatment outcomes and recurrence following standard cold forceps polypectomy for diminutive polyps.

The recurrence rate after standard cold forceps polypectomy (CFP) of diminutive polyps of≤5mm has not been fully determined. The aim of this study was to analyze the long-term follow-up results and recurrence rate after CFP of diminutive polyps. We retrospectively reviewed the medical records of 884 (738 men; age 53years) asymptomatic subjects who underwent surveillance colonoscopy after CFP of 1-2 diminutive adenomatous polyps. Cumulative recurrence at the CFP site and risk factors for recurrence were analyzed. Overall recurrence over 59.7months was 17% after CFP of 1111 diminutive polyps. The rate of definite recurrence was 4%, and probable recurrence was 13%. Recurrence as advanced adenoma was 0.5% (5/1111). The cumulative probabilities of recurrence at 3, 5, and 7years after CFP were 10.0, 16.0, and 21.1%, respectively. Multivariate analysis revealed that polyp 4-5mm in size and right colonic polyp were risk factors for recurrence (hazard ratio [HR] 1.37; 95% confidence interval [CI] 1.01-1.86 and HR 1.49; 95% CI 1.08-2.04, respectively). The recurrence rate for 10 endoscopists who performed at least 50 CFPs ranged from 11.0 to 25.2%; the probability of recurrence in those in the top half in terms of recurrence rate was 1.6-fold higher than that of those in the bottom half (95% CI 1.17-2.19). Although recurrence may develop after standard CFP of diminutive polyps, recurrence as advanced adenoma is rare. Large polyp size, right colon polyp, and endoscopist are risk factors for recurrence after standard CFP.

Half and half nail.

A 10-year-old boy presented with brown-colored nails since the previous 3 months. He was a diagnosed case of chronic renal failure. The patient denied any history of nail trauma. He also denied history of any drug intake before the development of the lesion. Physical and developmental milestones were normal. Hematological investigations showed raised erythrocyte sedimentation rate with deranged renal function. On nail examination all the 20 nails showed two distinct transverse bands with a brownish red band on the distal part of his nails and proximal white part of the nails having smooth surface and normal nail folds obscuring the lunula [Figure 1]. The demarcation line between the two transverse bands did not disappear on pressure. On the basis of clinical findings, a diagnosis of half and half nails was made. Figure 1 All the 20 nails showed distinct transverse band with the distal brownish red area and proximal white area of the nail plate Half and half nail (brown arcs) is also known as Lindsay's nail, in which proximal portion of the nail is white and the distal half (20-60%) is reddish brown. Although it was first described by Bean[1] in 1963, Lindsay[2] was the first to coin the term half and half nail in 1967. Baran and Gioanni[3] were the first to correlate the half and half nail with renal disease and azotemia in 1968. It usually shows a sharp demarcation line between the two portions, which usually remains parallel to the distal free margin of the nail. There is no correlation between severity of azotemia and the distal band length. It is a rare but special clinical finding seen in chronic renal failure with a prevalence of 15-50%. It can also be seen in yellow nail syndrome, Crohn's disease, Kawasaki's disease, Behcet's disease, cirrhosis, hyperthyroidism, zinc deficiency, citrullinemia, pellagra, HIV infection, and even in healthy persons.[4] The exact pathophysiology of half and half nails is not well understood. The proposed theory is that an increase in capillary density along with capillary wall thickening is responsible for the development of the half and half nail rather than an increase in melanocytes.[5] Treatment is only cosmetic as this is a benign condition that requires only counseling and reassurance. The transition band usually remains unchanged even after dialysis but disappears completely after successful renal transplantation. It usually takes 2-3 weeks for disappearance.[4]

Maternal administration of busulfan before in utero transplantation of human hematopoietic stem cells enhances engraftments in sheep

In utero transplantation (IUT) of human hematopoietic stem cells has been conducted in sheep, which are used as large animal models of human hematopoietic reconstitution and models for clinical IUT; however, the levels of engraftment have generally been low. Busulfan (BU), a myeloablative agent, is often administered to patients before hematopoietic stem cells transplantation to improve the engraftment. In this study, hematopoietic activity was evaluated in adult sheep after administering BU at different doses. Next, pregnant ewes were administered BU, and dams as well as their fetuses were evaluated, as BU readily crosses the sheep placenta. Then, the BU dose with the desired outcomes was selected and administered to pregnant ewes at 2 or 6 days before performing IUT using human cord blood CD34(+) cells. The engraftment was evaluated in recipients that underwent IUT in the presence or absence of BU. As a result, hematopoietic activity was safely and transiently suppressed in adult sheep treated with 5 to 7.5 mg/kg BU. BU crossed the sheep placenta, and fetal sheep were indeed conditioned by administering 3 mg/kg BU to pregnant ewes. Engraftment of human CD34(+) cells in fetal recipients was enhanced when IUT was carried out 6 days post-BU. Up to 3.3% engraftment levels (in terms of bone marrow colony-forming units) were achieved with the IUT of 0.72 to 2.4 million CD34(+) cells when BU was used. BU can be administered to pregnant ewes to effectively condition the fetal recipient for IUT with enhanced engraftment of donor cells.

Long term follow-up of a randomised controlled trial of services for urinary symptoms

BackgroundGiven the extent and priority of urinary symptoms there is little evidence available to inform service provision in relation to the long term effects of interventions. This study aims to determine the long term (6 year) clinical effectiveness and costs of a new continence nurse led service compared to standard care for urinary symptoms.MethodsA long term follow-up study of a 2-arm, non-blinded randomised controlled trial that recruited from a community based population between 1998-2000 in Leicestershire and Rutland UK was undertaken. 3746 men and women aged 40 years and over were followed up from the original trial. The continence nurse practitioner (CNP) intervention comprised a continence service provided by specially trained nurses delivering evidence-based interventions using pre-determined care pathways. The standard care (SC) arm comprised access to existing primary care including General Practitioner and continence advisory services in the area. Primary outcome: Improvement in one or more symptom. Secondary outcomes included: a) Leicester Impact scale; b) patient perception of problem; c) number of symptoms alleviated and cost-effectiveness; all were recorded at long term follow-up (average 6 years) post-randomisation.ResultsOverall at long-term follow-up (average 6 years) significantly more individuals in the CNP group (72%) had improved (i.e had fewer symptoms) compared to those in the SC group (67%) (difference of 5% 95% (CI = 0.6 to 9;p = 0.02)).ConclusionThe differences in outcome between the two randomised groups shown immediately post treatment had decreased by half in terms of symptom improvement at long term follow-up. Although the difference was statistically significant, the clinical significance may not be, although the direction of the difference favoured the new CNP service.

Influence of Graphic Format on Comprehension of Risk Information among American Indians

Presentation of risk information influences patients' ability to interpret health care options. Little is known about this relationship between risk presentation and interpretation among American Indians. Three hundred American Indian employees on a western American Indian reservation were invited to complete an anonymous written survey. All surveys included a vignette presenting baseline risk information about a hypothetical cancer and possible benefits of 2 prevention plans. Risk interpretation was assessed by correct answers to 3 questions evaluating the risk reduction associated with the plans. Numeric information was the same in all surveys, but framing varied; half expressed prevention benefits in terms of relative risk reduction and half in terms of absolute risk reduction. All surveys used text to describe the benefits of the 2 plans, but half included a graphic image. Surveys were distributed randomly. Responses were analyzed using binary logistic regression with the robust variance estimator to account for clustering of outcomes within participant. Use of a graphic image was associated with higher odds of correctly answering 3 risk interpretation questions (odds ratio = 2.5, 95% confidence interval = 1.5-4.0, P < 0.001) compared to the text-only format. These findings were similar to those of previous studies carried out in the general population. Neither framing information as relative compared to absolute risk nor the interaction between graphic image and relative risk presentation was associated with risk interpretation. One type of graphic image was associated with increased understanding of risk in a small sample of American Indian adults. The authors recommend further investigation of the effectiveness of other types of graphic displays for conveying health risk information to this population.

Financial Development in India – Status and Challenges

Financial markets in India have come a long way in the past decade and half in terms of economic reforms. India has emerged as a leader in Asia in terms of financial deepening. Development has been uneven in different parts of the financial sector, ranging from a virtual reinvention of equity trading to hardly noticeable in corporate debt markets. International portfolio flows have affected the financial sector in general with the effective level of capital account convertibility well above that reflected in the de jure restrictions, and changes here have been cautious. The regulatory structure is fragmented though with ongoing efforts at greater coordination and unification. Regulatory capacity, too, has fallen behind industry growth. The recent global crisis has underlined the importance of systemic risks, the interconnectedness of markets, the risks with large financial conglomerates and the need of macro-prudential monitoring. At the same time, the developments in UK have strengthened criticism of a unified regulatory structure and a shift to greater principle-based regulation. Some of India’s key developmental challenges lie in the areas of institutional and business environment, elements outside the direct control of financial policy makers.

Low cost and reliable anonymity protocols in P2P reputation systems

In peer-to-peer (P2P) reputation systems, each peer’s trustworthiness is evaluated based on its pseudonym’s rating values given by other peers. Since it is assumed that each peer has a long lived pseudonym, all the transactions conducted by the same peer may be linked by its pseudonym. Therefore, one of the fundamental challenges in P2P reputation systems is to protect peers’ identity privacy. In this paper, we present two independent anonymity protocols to achieve all the peers’ anonymity by changing pseudonym with the help of a trusted third party (TTP) server. Compared with RuP (Reputation using Pseudonym), an existing representative scheme, our protocols reduce the server’s cost in two different ways. First, we propose a protocol using blind signature scheme as in RuP. The protocol improves the blind signature scheme and assessment of macro-node values, and reduces the server’s cost by half in terms of encryption and decryption operations and message overhead. Second, we propose another protocol, group-confusion protocol, to further reduce the server’s cost.

Structure optimization of BiLinear Recurrent Neural Networks and its application to Ethernet network traffic prediction

The BiLinear Recurrent Neural Network (BLRNN) based on the bilinear polynomial has been successfully applied to several nonlinear time series prediction problems. In order to obtain faster convergence in training the BLRNN, two procedures are applied to the network: (i) a structure simplification procedure whereby the multiplications for bilinear components in the BLRNN are reduced and (ii) a pruning procedure entailing application of a genetic algorithm. A structurally optimized BLRNN is thereby obtained. The computational complexity of the optimized BLRNN is reduced by about half in terms of the number of weights while preserving its generalization ability. Experiments on application of the structurally optimized BLRNN to a network traffic prediction problem are conducted on a real-world Ethernet network traffic data set. Results show that the optimized BLRNN-based prediction scheme can reduce the training time by roughly half when compared with the original BLRNN while preserving the prediction accuracy of the latter in terms of Normalized Mean Square Error (NMSE).

Evaluation of chelating ion-exchange resins for separating Cr(III) from industrial effluents

In this study two chelating resins containing iminodiacetic acid groups (Amberlite IRC 748 and Diaion CR 11) and a chelating resin based on sulfonic and diphosphonic acid groups (Diphonix) were investigated in order to separate Cr(III) from industrial effluents produced in hard and decorative electroplating. Samples of two industrial plants were characterized during a period of about one year and a half in terms of the metals content (Cr, Cu, Na, Ca, Fe and Ni), Total Suspended Solids (TSS), Total Dissolved Solids (TDS), Chemical Oxygen Demand (COD) and pH. Some of the physical properties of the resins, namely the moisture content, apparent density, intraparticle porosity and the particle size distribution were also evaluated. To quantify the sorption capacity of the resins, batch experiments were performed using synthetic solutions of Cr(III), as well as solutions of Fe in the case of Diphonix. The Langmuir and Langmuir–Freundlich isotherms enabled a good description of the ion-exchange equilibrium data, and the maximum sorption capacity determined for Amberlite and Diaion was 3.6 mequiv./g dry resin. For Diphonix that parameter was 3.4 mequiv./g dry resin. The Diphonix resin exhibits a high selectivity for transition metals (Fe, Ni) over the chromium trivalent. Therefore, it was screened as the most suitable for selectively removing those metal impurities from chromium electroplating effluents. For this resin, the sorption capacity is strongly dependent on the initial pH of the solution. Though, high regeneration efficiencies of Diphonix for stripping Cr(III) were found by using a mixture of NaOH/H 2O 2. The mathematical model tested for describing the dynamics of the process allowed a good fitting to the experimental data and enabled the estimation of effective pore diffusivity of Cr(III). The saturations of Diphonix with industrial effluents demonstrated that the breakthrough capacity of the resin is affected by the presence of other species in solution, such as Fe and Ni. Nevertheless, these effluents may be treated with this resin, being possible to separate Cr(III) from other transition metallic ions in solution.

Changing of the guard

About a year ago, I was asked to consider taking on the role of Editor-in-Chief for Biopolymers-Peptide Science. I welcomed this opportunity and with this first issue of 2009 start in this role. I look forward to expanding the visibility of the American Peptide Society and our journal. Before discussing my vision for the journal, I would like to offer thanks to those who have worked diligently to ensure its success. Lila Gierasch, the past Editor-in-Chief, has devoted considerable effort to establish Biopolymers-Peptide Science as one of the choice journals for reporting advances in peptide science. Her vision has encompassed everything from moderating scientific content, increasing our presence on the Web, to contributing to the redesign of the journal's cover. One highlight of Lila's tenure was to publish an issue composed of contributions from young investigators to highlight the work of the next generation of peptide scientists. I hope to continue this trend in the future. Although Lila is stepping down as Editor, she will continue to contribute to the journal and remain committed to its success. In addition to Lila, others have played key roles in the journal including the current associate editors, Claudio Toniolo, Sylvie Blondelle, Yuji Kobayashi, and Charles Deber. In addition to ensuring fair and timely reviews of submitted manuscripts, the associate editors have helped define the evolution of the journal. Through the efforts of all who have contributed, I have been handed an excellent opportunity upon which to build. Our journal currently enjoys a wide international readership and maintains a healthy prominence in the biochemical and chemical communities. Of over 300 journals that serve these communities, Biopolymers-Peptide Science ranks in the top one half in terms of impact factor. As Editor-in-Chief, I am committed to increasing our journal's prominence. Most of my efforts will initially be centered on expanding the readership of the journal and increasing the submissions of both original research articles and reviews. How can we expand readership? Although there are many ways one can envision accomplishing this, bringing the journal to the attention of researchers in scientific disciplines that have not traditionally identified themselves as peptide chemists is a good place to start. For example, materials scientists are increasingly using peptides in the design of novel materials. However, many of these researchers are unaware of Biopolymers-Peptide Science and the science communicated within its covers that may help them design better materials. Materials science represents only one discipline that the journal can impact and I welcome suggestions from you, my colleagues, for others. How can we increase submissions? Expanding the readership to include those in new fields should naturally lead to new submissions by these researchers. However, the journal will make a concerted effort to contact leaders in fields outside of our immediate peptide community to submit high impact reviews that broaden its scope. Providing a balance between original research articles and reviews makes interesting journal content and increases visibility. In addition, the journal will encourage submissions from researchers outside the US. Although Italy and Japan continue to heavily contribute to the journal, largely through the efforts of our associate editors, traditionally excellent peptide communities in other countries continue to be underrepresented. Targeting these communities should increase both readership and submissions. I included here only a few ideas that I believe are feasible and can result in increased visibility of both our Society and our journal; I encourage other suggestions that will accomplish the same. Although I and the other editors will work for the continued success of the journal, its future actually rests in your hands. I encourage you to communicate your exciting scientific results through the journal, actively promote the journal to your colleagues and make excellent suggestions that define its future. I leave you with this vision. Biopolymers-Peptide Science will be the premier international forum showcasing advances in peptide research. The journal will communicate significant progress within the peptide community and other disciplines that are newly discovering the power of peptides. The journal strives to build knowledge, promote communication, and facilitate innovative ideas that expand the science of peptides. I look forward to serving our journal. Joel Schneider Editor-in-Chief

Is there an obstetric July phenomenon?

Objective To estimate whether variations in intrapartum management and complications exist with regard to the time of delivery within the academic year. Methods The delivery records of 7814 patients were separated by both term half year and quarter. Statistical comparisons were made using χ 2 tests of association ( P < .05) with respect to the academic time of the year and perineal trauma (third- or fourth-degree tear), episiotomy usage, cesarean delivery, postpartum hemorrhage, chorioamnionitis, shoulder dystocia, neonatal intensive care unit admission, 1- or 5-minute Apgar scores less than 7, and low umbilical cord pH. Results There were 4082 deliveries in the first half and 3732 in the second half of the year from April 1996 through March 1999. The first half-year overall cesarean rate was higher (15.8% versus 14.3%, P < .03). Primary cesarean rates were similar. No other differences were found by term half year. More perineal trauma was noted in the fourth quarter (first 3.3%, second 4.5%, third 3.7%, fourth 5.5%, P < .037). Episiotomy usage was higher in both the first and fourth quarters (13.0%, 11.3%, 10.6%, and 14.8%, P < .002). More cases of chorioamnionitis occurred in the fourth quarter (first 3.4%, second 3.1 %, third 2.6%, fourth 4.0%, P < .038, third versus fourth quarter). Chorioamnionitis occurred more frequently in July (July 5.0% versus August–June 3.1%, P < .005). There were no other clinically significant differences. Neonatal outcomes were not affected by academic time of year. Conclusion Although small differences in outcome exist with respect to the academic time of the year, the timing of these differences indicates that there is not a “July phenomenon” in obstetrics at our institution.