Strategic considerations for construction in the People’s Republic of China: the case of German contractors in the 1990s

The construction industry has been struggling to integrate business strategies that are anticipating the internationalisation and infiltration of international markets. This article attempts to evaluate the China operations of German contractors from a strategic management decision perspective in the period between 1990 and 2000. Existing internationalisation theories have appeared to be inappropriate to explain international construction due to the unique project nature of construction business. The Ownership, Location and Internationalisation (OLI)-paradigm was initially developed to explain international production pattern was revised to form the basis for the evaluation of the Construction contractors’ market activities. The interviews indicate an industry-specific culture that affects how companies approach foreign markets. Some exceptional companies illustrated a higher degree of openness towards a more strategic and consistent approach in terms of the development of overseas markets

3 Derivation and internal validation of a clinical decision rule to guide whole body computed tomography scanning in trauma.

There are no widely accepted validated clinical decision rules for the use of WBCT in trauma. Given the potential risks and costs, there is a clear need for a clinical decision rule (CDR) to safely guide targeted use of WBCT. We aimed to derive a CDR to guide clinical decisions on WBCT utilisation by detecting patients at high and low risk of multi-region trauma.We retrospectively identified consecutive patients who had presented to a major trauma centre with suspected major trauma. Study took place at Aintree University Hospital, Merseyside. After extracting data, we derived a clinical decision rule for detection of multi-region trauma by logistic regression and recursive partitioning. The primary outcome was defined as injuries of AIS≥2 in two or more body regions, while the secondary outcome was the presence of two injuries of AIS≥3 in two or more body regions. This rule was cross-validated on the original sample using bootstrapping.1608 patients were included in the study. The derived model combined a bespoke physiological score with mechanistic and anatomical factors. The physiological score identified the risk of multi-region injury at various cut-offs of age, systolic blood pressure, GCS, heart rate and respiratory rate. Patients were further categorised according to mechanism of injury and clinical findings, and specific physiological scores were applied to each category to determine which patients in these categories required WBCT. 'High risk' injury mechanisms included high falls and unprotected road traffic collisions. Clinical signs of injury were categorised by body region, including the head, chest, abdomen and pelvis (figure 1). The overall sensitivity of the clinical decision rule for the primary objective was 96.0% (95% CI:94.8 to 97.2) while the specificity was36.1% (95% CI:33.3 to 39.0). The negative likelihood ratio was 0.11. For the secondary objective the sensitivity was 98.5%, the negative likelihood ratio 0.04.emermed;34/12/A861-a/F1F1F1Figure 1 CONCLUSION: This study derived a two stage CDR which was highly sensitive for identifying patients at high risk of multiregion injury. A prospective external validation study is now required to further refine and improve this model. This could provide a useful screening tool in the future

Late widespread skeletal metastases from myxoid liposarcoma detected by MRI only

Background Myxoid liposarcoma is the second most commonly occurring sub-type of liposarcomas. In contrast to other soft tissue sarcomas, it is known to have a tendency to spread toward extrapulmonary sites, such as soft tissues, retroperitoneum, and the peritoneal surface. Bony spread, however, is not as common. Case presentation We report an unusual case of diffuse skeletal metastases from myxoid liposarcoma occurring 13 years after treatment of the primary tumour in the left lower limb. The skeletal spread of the disease was demonstrated on MRI only after other imaging modalities (plain radiography, CT and TC99 bone scans) had failed to detect these metastases. Conclusion MRI is an extremely sensitive and specific screening tool in the detection of skeletal involvement in these types of sarcomas, and therefore, should be a part of the staging proces

Chemical and topographical effects on cell differentiation and matrix elasticity in a corneal stromal layer model

Control and maintenance of the keratocyte phenotype is vital to developing in vitro tissue engineered strategies for corneal repair. In this study the influence of topographical and chemical cues on the mechanical, phenotypical and genotypical behaviour of adult human derived corneal stromal (AHDCS) cells in three dimensional (3D) multi-layered organised constructs is examined. Topographical cues are provided via multiple aligned electrospun nanofiber meshes, which are arranged orthogonally throughout the constructs and are capable of aligning individual cells and permitting cell migration between the layers. The influence of chemical cues is examined using different supplements in culture media. A non-destructive indentation technique and optical coherence tomography are used to determine the matrix elasiticity (elastic modulus) and dimensional changes, respectively. These measurements were indicative of changes in cell phenotype from contractile fibroblasts to quiescent keratocytes over the duration of the experiment and corroborated by qPCR. Constructs containing nanofibers have a higher initial modulus, reduced contraction and organised cell orientation compared to those without nanofibers. Cell-seeded constructs cultured in serum-containing media increased in modulus throughout the culture period and underwent significantly more contraction than constructs cultured in serum-free and insulin-containing media. This implies that the growth factors present in serum promote a fibroblast-like phenotype; qPCR data further validates these observations. These results indicate that the synergistic effect of nanofibers and serum-free media plus insulin supplementation provide the most suitable topographical and chemical environment for reverting corneal fibroblasts to a keratocyte phenotype in a 3D construct

Energy Efficient Heart Rate Sensing using a Painted Electrode ECG Wearable

© 2017 IEEE. Many countries are facing burdens on their health care systems due to ageing populations. A promising strategy to address the problem is to allow selected people to remain in their homes and be monitored using recent advances in wearable devices, saving in-hospital resources. With respect to heart monitoring, wearable devices to date have principally used optical techniques by shining light through the skin. However, these techniques are severely hampered by motion artifacts and are limited to heart rate detection. Further, these optical devices consume a large amount of power in order to receive a sufficient signal, resulting in the need for frequent battery recharging. To address these shortcomings we present a new wrist ECG wearable that is similar to the clinical approach for heart monitoring. Our device weighs less than 30 g, and is ultra low power, extending the battery lifetime to over a month to make the device more appropriate for in-home health care applications. The device uses two electrodes activated by the user to measure the voltage across the wrists. The electrodes are made from a flexible ink and can be painted on to the device casing, making it adaptable for different shapes and users. In this paper we show how the ECG sensor can be integrated into an existing IoT wearable and compare the device\u27s accuracy against other common commercial devices

Extended time scales of carbonaceous chondrite aqueous alteration evidenced by a xenolith in L a P az Icefield 02239 ( CM2 )

LaPaz Icefield (LAP) 02239 is a mildly aqueously altered CM2 carbonaceous chondrite that hosts a xenolith from a primitive chondritic parent body. The xenolith contains chondrules and calcium‐ and aluminum‐rich inclusions (CAIs) in a very fine‐grained matrix. The chondrules are comparable in mineralogy and oxygen isotopic composition with those in the CMs, and its CAIs are also mineralogically similar to the CM population apart for being unusually small and abundant. The presence of serpentine demonstrates that the xenolith has been aqueously altered, and its phyllosilicate‐rich matrix has a comparable oxygen isotopic composition to the matrices of CM meteorites. The xenolith's chondrules lack fine‐grained rims, whereas the xenolith itself has a fine‐grained rim that is petrographically and chemically comparable with the rims on coarse grained objects in LAP 02239 and other CM meteorites. These properties show that the xenolith's parent body was formed from similar materials to the CM parent body(ies). Following its lithification by aqueous alteration, a piece of the xenolith's parent body was impact‐ejected, acquired a fine‐grained rim while free‐floating in the protoplanetary disc, then was accreted along with rimmed chondrules and other materials to make the LAP 02239 parent body. Subsequent aqueous processing of the LAP 02239 parent body altered the fine‐grained rims on the xenolith, chondrules, and CAIs. The xenolith shows that the timespan of geological evolution of carbonaceous chondrite parent bodies was sufficiently long for some of them to have been aqueously altered before others had formed

Attitudes and practices regarding resuscitation in emergency departments in Trinidad and Tobago

© 2014, BMJ Publishing Group. All rights reserved. Background: Ethical issues with regard to resuscitation are increasingly important. Understanding how emergency physicians deal with these problems is essential for the development of policies for resuscitative care. Objectives: To identify the knowledge, opinions and practices of emergency physicians employed full time in public hospitals in Trinidad and Tobago, with respect to cardiopulmonary resuscitation. To compare the differences in responses between physicians in training and those who were not. In addition, to compare these responses with those expressed in a similar study in the USA in 2007. Methods: All emergency physicians (120) who fulfilled the eligibility criteria for the study were asked to record anonymous responses to survey questions about ethical issues regarding resuscitation. Results: Of the 98 respondents, most (79.6%) had been practising emergency medicine for ≤5 years and about 38% had had some training in emergency medicine. Most respondents agreed that survival rates for cardiopulmonary resuscitation (CPR) were poor. However, 41.2% of respondents had performed CPR >10 times in the past 3 years despite expected futility. More participants in the US study than in the local study thought that the existence of an advance directive was important in making decisions about CPR and that legal concerns should not, but do, affect CPR decisions in practice. Conclusions: Local emergency physicians are as affected by legal and ethical CPR issues as are US emergency physicians. Education programmes and policies that deal with these concerns would better assist the emergency physician in dealing with them

CD4+ T cell immunity to Salmonella is transient in the circulation

While Salmonella enterica is seen as an archetypal facultative intracellular bacterial pathogen where protection is mediated by CD4+ T cells, identifying circulating protective cells has proved very difficult, inhibiting steps to identify key antigen specificities. Exploiting a mouse model of vaccination, we show that the spleens of C57BL/6 mice vaccinated with live-attenuated Salmonella serovar Typhimurium (S. Typhimurium) strains carried a pool of IFN-γ+ CD4+ T cells that could adoptively transfer protection, but only transiently. Circulating Salmonella-reactive CD4+ T cells expressed the liver-homing chemokine receptor CXCR6, accumulated over time in the liver and assumed phenotypic characteristics associated with tissue-associated T cells. Liver memory CD4+ T cells showed TCR selection bias and their accumulation in the liver could be inhibited by blocking CXCL16. These data showed that the circulation of CD4+ T cells mediating immunity to Salmonella is limited to a brief window after which Salmonella-specific CD4+ T cells migrate to peripheral tissues. Our observations highlight the importance of triggering tissue-specific immunity against systemic infections