Negotiating for Goods and Services

Can a negotiation protocol be both fair and “envy-free” when more than two agents are involved? The authors consider how envy-free apportioning is more difficult than fair apportioning, but both can help to manage critical resources. They discuss an envy-free protocol and agent-based Web auctions

Successful clinical outcome in complicated monochorionic twins: case series

Monochorionic twins have some unique complications like twin-to-twin transfusion syndrome (TTTS), twin anemia polycythemia sequence (TAPS), twin reverse arterial perfusion syndrome (TRAP) and conjoined twins which are otherwise not seen in dichorionic twins. In this case series, we report 3 cases of monochorionic twins who had complications. Our first case had monochorionic twin with a pump fetus and a TRAP. The second case had TTTS stage I and after spontaneous preterm premature rupture of membranes at 32 weeks, delivered both fetuses vaginally at an interval of about 3 hours. Our third case had TTTS stage II and she underwent selective fetoscopic laser photocoagulation of intertwin anastomotic vessels at about 25 weeks and subsequently multiple episodes of amnioreduction till 31 weeks when she underwent emergency caesarean delivery. Our study highlights the need for constant vigilance in patients with monochorionic twins to look for complications like TTTS and TRAP

The role of reinvestment in performance of simulated laparoscopic surgery under time pressure

Free Communications: Verbal and Poster - Motor Learning and ControlOBJECTIVE: To examine the impact of ‘reinvestment’ on laparoscopic performance under a common intra-operative stressor, time pressure. Background Study of the breakdown of performance under stress has been gaining momentum in the motor skill learning domain as well as domains like aviation and anesthesia, but this has not been the case in the domain of surgery until recently. Research on intra-operative stressors has focused on external factors without considering individual differences in the ability to cope with stress. One individual difference that is implicated in adverse effects of stress on performance is ‘reinvestment’, the propensity for conscious monitoring and control of movements. METHODS: Thirty-one medical students were divided into high and low reinvestment groups based on their scores on the Movement Specific Reinvestment Scale. Participants were first trained to proficiency on a peg transfer task and then tested on the same task in a control and time pressure condition. In the control condition, participants were simply asked to do their best, as they had in training. In the time pressure condition, participants were informed that operating surgeons sometimes are required to perform under time constraints and they should try to complete the task faster than their best time in training (of which they were informed).Outcome measures included generic performance and process measures. Stress levels were assessed using heart rate and the State Trait Anxiety Inventory (STAI). RESULTS: High and low reinvesters demonstrated increased anxiety levels from control to time pressure conditions as indicated by their STAI scores, although no differences in heart rate were found. Low reinvesters performed significantly faster when under time pressure, whereas high reinvesters showed no change in performance times. Low reinvesters tended to display greater performance efficiency (shorter path lengths, fewer hand movements) than high reinvesters. Conclusion Trained medical students with a high individual propensity to consciously monitor and control their movements (high reinvesters) displayed less capability (than low reinvesters) to meet the demands imposed by time pressure during a laparoscopic task. The finding implies that the propensity for reinvestment may have a moderating effect on laparoscopic performance under time pressure.published_or_final_versionThe 2012 Conference of the North American Society for the Psychology of Sport and Physical Activity (NASPSPA 2012), Honolulu, HI., 7-9 June 2012. In Journal of Sport and Exercise Psychology, 2012, v. 34 suppl., p. S10

Silencing of midgut aminopeptidase N of Spodoptera litura by double-stranded RNA establishes its role as Bacillus thuringiensis toxin receptor

Insecticidal crystal proteins of Bacillus thuringiensis bind to receptors in the midgut of susceptible insects leading to pore formation and death of the insect. The identity of the receptor is not clearly established. Recently a direct interaction between a cloned and heterologously expressed aminopeptidase (slapn) from Spodoptera litura and the Cry1C protein was demonstrated by immunofluorescence and in vitro ligand blot interaction. Here we show that administration of slapn double-stranded RNA to S. litura larvae reduces its expression. As a consequence of the reduced expression, a corresponding decrease in the sensitivity of these larvae to Cry1C toxin was observed. The gene silencing was retained during the insect's moulting and development and transmitted to the subsequent generation albeit with a reduced effect. These results directly implicate larval midgut aminopeptidase N as receptor for Bacillus thuringiensis insecticidal proteins

Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis

Objectives To determine whether an entirely electronic system can be used to capture both patient-reported outcomes (electronic Patient-Reported Outcome Measures, ePROMs) as well as clinician-validated diagnostic and complexity data in an elective surgical orthopaedic outpatient setting. To examine patients' experience of this system and factors impacting their experience. Design Retrospective analysis of prospectively collected data. Setting Single centre series. Outpatient clinics at an elective foot and ankle unit in the UK. Participants All new adult patients attending elective orthopaedic outpatient clinics over a 32-month period. Interventions All patients were invited to complete ePROMs prior to attending their outpatient appointment. At their appointment, those patients who had not completed ePROMs were offered the opportunity to complete it on a tablet device with technical support. Matched diagnostic and complexity data were captured by the treating consultant during the appointment. Outcome measures Capture rates of patient-reported and clinician-reported data. All information and technology (IT) failures, language and disability barriers were captured. Patients were asked to rate their experience of using ePROMs. The scoring systems used included EQ-5D-5L, the Manchester-Oxford Foot Questionnaire (MOxFQ) and the Visual Analogue Scale (VAS) pain score. Results Out of 2534 new patients, 2176 (85.9%) completed ePROMs, of whom 1090 (50.09%) completed ePROMs at home/work prior to their appointment. 31.5% used a mobile (smartphone/tablet) device. Clinician-reported data were captured on 2491 patients (98.3%). The mean patient experience score of using Patient-Reported Outcome Measures (PROMs) was 8.55±1.85 out of 10 and 666 patients (30.61%) left comments. Of patients leaving comments, 214 (32.13%) felt ePROMs did not adequately capture their symptoms and these patients had significantly lower patient experience scores (p<0.001). Conclusions This study demonstrates the successful implementation of technology into a service improvement programme. Excellent capture rates of ePROMs and clinician-validated diagnostic data can be achieved within a National Health Service setting

Microlensing of Globular Clusters as a Probe of Galactic Structure

The spatial distribution of compact dark matter in our Galaxy can be determined in a few years of monitoring Galactic globular clusters for microlensing. Globular clusters are the only dense fields of stars distributed throughout the three-dimensional halo and hence are uniquely suited to probe its structure. The microlensing optical depths towards different clusters have varying contributions from the thin disk, thick disk, bulge, and halo of the Galaxy. Although measuring individual optical depths to all the clusters is a daunting task, we show that interesting Galactic structure information can be extracted with as few as $40$--$120$ events in total for the entire globular cluster system (observable with 2--5 years of monitoring). The globular cluster microlensing is particularly sensitive to the core radius of the halo mass distribution and to the scale length, surface mass density, and radial scale height variations of the thin disk.Comment: 14 pages, 1 figure. Submitted to ApJ Letters. Uses aastex macro

Bacterial Endophthalmitis

Endophthalmitis is an ocular inflammation involving vitreous cavity along with the retinal and uveal components of the eye mostly due to infectious agent. The source of infection could be exogenous or endogenous. Exogenous endophthalmitis results from direct inoculation as a complication of ocular surgery, foreign bodies or penetrating ocular trauma, while endogenous endophthalmitis results from haematogenous spread of organisms from a distant source of infection. Endophthalmitis often results in partial or complete loss of vision despite aggressive therapeutic and surgical intervention and hence it is considered as a medical emergency. Diagnosis of infectious agent is critical in the management of these agents. Intravitreal antimicrobial therapy along with anti-inflammatory agents is the key ingredient for successful management of endophthalmitis, while surgical procedures like vitrectomy become necessary in severe endophthalmitis cases. This is a brief review regarding classification, etiological agents causing endophthalmitis, diagnosis and therapeutic challenges of endophthalmitis that will help in improving the visual outcome

Analysis of United Kingdom Off-Highway Construction Machinery Market and Its Consumers Using New-Sales Data

The off-highway construction machinery market and its consumers have attracted minimal previous research. This study addresses that void by analyzing annual United Kingdom (UK) (volume/portfolio) new-sales data for the 10 most popular products within that market, 1990–2010 inclusive. Graphical, descriptive statistical, Pearson-correlational, autocorrelational, and elementary modeling are employed to identify contrasts in sales regarding (1) high- and low-volume items; (2) growth trends and significant recessionary effects on volumes; (3) a demand change point circa 1997, since when annual product portfolio has changed little; and (4) product associations in consumer demand. Significant association is demonstrated between demand and construction output, especially with the value of new housing. Subsequently, consumption of wheeled loaders is modeled using construction volume, and demand for mini and crawler excavators is modeled using new-housing data. Time series trends for these machinery types are presented and forecast through 2015. The primary contribution of this study is a deeper understanding of the UK new-machinery market and the predilections of its consumers over the last two decades (to present)

Spinal disease in myeloma: cohort analysis at a specialist spinal surgery centre indicates benefit of early surgical augmentation or bracing

BACKGROUND: Multiple myeloma osteolytic disease affecting the spine results in vertebral compression fractures. These are painful, result in kyphosis, and impact respiratory function and quality of life. We explore the impact of time to presentation on the efficacy of spinal treatment modalities. METHODS: We retrospectively reviewed 183 patients with spinal myeloma presenting to our service over a 2 year period. RESULTS: Median time from multiple myeloma diagnosis to presentation at our centre was 195 days. Eighty-four patients (45.9 %) were treated with balloon kyphoplasty and the remainder with a thoracolumbar-sacral orthosis as per our published protocol. Patients presenting earlier than 195 days from diagnosis had significant improvements in patient reported outcome measures: EuroQol 5-Dimensions (p < 0.001), Oswestry Disability Index (p < 0.001), and Visual Analogue Pain Score (p < 0.001) at follow-up, regardless of treatment. Patients presenting after 195 days, however, only experienced benefit following balloon kyphoplasty, with no significant benefit from non-operative management. CONCLUSION: Vertebral augmentation and thoracolumbar bracing improve patient reported outcome scores in patients with spinal myeloma. However, delay in treatment negatively impacts clinical outcome, particularly if managed non-operatively. It is important to screen and treat patients with MM and back pain early to prevent deformity and improve quality of life