Journal articles on the topic 'Grid dip meter'

In order to keep track of the operational state of power grids, the world’s largest sensor system, smart grid, was built by deploying hundreds of millions of smart meters. Such a system makes it possible to discover and make quick response to any hidden threat to the entire power grid. Non-technical losses (NTLs) have always been a major concern for their consequent security risks as well as immeasurable revenue loss. However, various causes of NTL may have different characteristics reflected in the data. Accurately capturing these anomalies faced with such a large scale of collected data records is rather tricky as a result. In this paper, we proposed a new methodology of detecting abnormal electricity consumptions. We did a transformation of the collected time-series data which turns it into an image representation that could well reflect users’ relatively long term consumption behaviors. Inspired by the excellent neural network architecture used for objective detection in computer vision, we designed our deep learning model that takes the transformed images as input and yields joint features inferred from the multiple aspects the input provides. Considering the limited amount of labeled samples, especially the abnormal ones, we used our model in a semi-supervised fashion that was brought about in recent years. The model is tested on samples which are verified by on-field inspections and our method showed significant improvement for NTL detection compared with the state-of-the-art methods.

The German Smart Meter Gateway (SMGW) infrastructure enables digital access to metering data and distributed energy resources by external parties. There are, however, various restrictions in order to guarantee the privacy of consumers, and strong security requirements. Furthermore, in the current state of development, there are still several challenges to overcome in order to implement demand side management (DSM) measures. In this paper, we present a prototype enabling DSM measures within the SMGW infrastructure, using the smart grid traffic light concept. The prototype implements an automated decentralized energy management system (EMS) that optimally controls an electric vehicle charging station. In the development of this prototype, we did not only evaluate five of the seven available SMGW devices, but also push the limits of the infrastructure itself. The experiments demonstrated the successful implementation of the intended DSM measure by the EMS. Even though there are technical guidelines standardizing the functionality of SMGWs, our evaluation shows that there are substantial differences between the individual SMGW devices.

AbstractWater levels were measured in boreholes spaced along the entire length of Bench Glacier, Alaska, USA, for a period in excess of 2 years. Instrumented boreholes were arranged as nine pairs along the center line of the glacier and an orthogonal grid of 16 boreholes in a 3600 m2 region at the center of the ablation area. Diurnal fluctuations of the water levels were found to be restricted to the late melt season. Pairs of boreholes spaced along the length of the ablation area often exhibited similar fluctuations and diurnal changes in water levels. Three distinct and independent types of diurnal fluctuations in water level were observed in clusters of boreholes within the grid of boreholes. Head gradients suggest water did not flow between clusters, and a single tunnel connecting the boreholes could not explain the observed pattern of diurnal water-level fluctuations. Inter-borehole and borehole-cluster connectivity suggests the cross-glacier width of influence of a segment of the drainage system connected to a borehole was limited to tens of meters. A drainage configuration whereby boreholes are connected to a somewhat distant tunnel by drainage pipes of differing lengths, often hundreds of meters, is shown with a numerical test to be a plausible explanation for the observed borehole behavior.

AbstractDiagrids represent one of the emerging structural systems employed worldwide for the construction of high-rise buildings. Their potential relies on the peculiar architectural effect and their great lateral stiffness. Because of the modular nature of the diagrid triangular element, optimization processes are usually carried out to assess the best arrangement of the external diagonals in order to enhance the structural performance while using the lowest amount of structural material. In this contribution, we make use for the first time of the desirability function approach to investigate the optimal geometry of the dia-grid system. A 168-meter tall building, with four different floor shapes, is analyzed, and the inclination of the external diagonals is varied between 35° and 84°. The desirability function approach is applied to find the most desirable geometry to limit both the lateral and torsional deformability, the amount of employed material as well as the construction complexity of the building. A sensitivity analysis is also carried out to investigate the influence of the individual desirability weight on the obtained optimal geometry. The effect of the building height is finally evaluated, through the investigation of sets of 124-, 210- and 252-meter tall diagrid structures.

Caricin Grad, Justiniana Prima, urban planning, fortification, settlement, aerial photography, geophysical surveys, LiDAR, photogrammetry, excavations, GIS. Thanks to the application of modern non-destructive sensing and detection methods, in recent years a series of new data on urban planning in Caricin Grad was obtained. For the most part, the current research programme studies the Upper Town?s northern plateau, wooded until recently and hence the only previously unexplored unit of the city. In the course of this programme, the classical research method - the excavations started in 2009 - is for the first time combined with the systematic application of airborne and terrestrial sensing and detection techniques. The analysis of historic aerial photographs and topographic plans proved to be very useful as well. Along with them, LiDAR-derived DTMs, photogrammetric DEMs, different geophysical and orthophotographic plans are stored in the GIS database for Caricin Grad and the Leskovac Basin. In this way almost 80 percent of the plateau area was defined, and the obtained plan is hypothetical only to a small extent, which particularly refers to the unexcavated northern rampart of the Upper Town. Each source provided relevant information for the reconstruction of both the rampart and the settlement, which points to the value of a holistic approach to documentation from various dates. The first source to be studied were archival aerial photographs of Caricin Grad from 1938 and 1947 (Figs. 1, 2.1). The latter one was originally processed by Aleksandar Deroko and Svetozar Radojci}, who drew the plan of the town after it, labelling the unexplored Upper Town?s northern plateau as ?a probable habitation area?. The route of the northern rampart was aslo rather precisely determined by the authors (Fig. 2.2). Recently, these photographs were rectified and georeferenced in the GIS. The 1938 shot reveals the position of some towers as well, and it is also indicative of the way of construction of certain buildings. From the spatial layout of whitish zones, originating from mortar scattered along the slope, it can be deduced which buildings were constructed in opus mixtum - the horreum and the so-called Building with Pillars east of it. Traces of mortar can be observed along the route of the rampart too. These archival images are particularly important because they record the topography of the site before it was filled with heaps of earth from the excavations. The topographic mappings of this area were conducted in 1981 and 2006 (Fig. 3). The first plan was drawn after an airborne stereophotogrammetric survey of Caricin Grad, and in 2006, after the wood was cut down, this whole area was surveyed with the total station, with a density of nine points per square meter. This survey also resulted in a 3D terrain model (Fig. 3.2) indicating the layout of the buildings, which was to be proved by geophysical surveys and archaeological excavations. In the course of the Serbian-French reaearch programme, in 2007 geomagnetic surveys were carried out by Alain Kermorvan of the University of Tours. Thanks to the application of this method the remains of collapsed stone structures could be observed, and in 2015, in cooperation with the Roman-Germanic Central Museum, Mainz, and the Ludwig Boltzmann Institute from Vienna, the middle and eastern parts of the plateau were scanned with GPR (Fig. 4.2). Precise plans of the buildings were obtained in the areas in which LiDAR scanning and photogrammetric and geomagnetic surveys failed to produce clear images. Within the framework of the ArchaeoLandscapes Europe project, in 2011 we managed to organise an airborne LiDAR survey of the wider area of Caricin Grad. With its density of some 20 points per square meter, this scanning proved to be crucial for our comprehension of the town. The standard DTM provided numerous important data, especially its version calculated in the focal statistics function of the ArcGIS software package (Fig. 5. 1-2). These models show not only the route of the Upper Town?s northern rampart, the position of its towers and the layout of the buildings, but also the line of the Outer Town?s western rampart. Visible only in the DTM, this entirely new aspect of the Caricin Grad fortification has been attested by the excavations. Highly important plans of the town, and of the northern plateau of the Upper Town in particular, were obtained by UAV photogrammetric surveys. The first drone survey was conducted in 2014 within the scope of the same project. It resulted in a cloud with up to 1,600 points per square meter (Fig. 6.1-2). Unlike the LiDAR technology, photogrammetry cannot penetrate vegetation; therefore the preliminary clearing of the ground proved to be a most important step. After the 2015 campaign was finished, the excavation area in the Upper Town was documented again in the same manner. Regular photogrammetric surveys make possible the control of the works and reliable visual monitoring of the progress of exploration (Fig. 9). After the wood was cut down in 2006 and enormous heaps of earth from twentieth-century excavations and restoration works were carefully removed by machinery in 2008 and 2010, without disturbing the original layers of debris, wide excavations could begin. At first only the humus layer was removed from fifteen-meter squares, which was followed by technical drawing. In 2009 and 2010 we did not explore the debris or the cultural layers (Fig. 7.1-2). The additional two squares were opened and documented in the same fashion in 2011, when previously recorded buildings 11 and 15C were explored in detail, together with the part of the corridor between them where a bread oven was found. These buildings were oriented south-north, cascading along the mild slope towards the northern rampart of the Upper Town. Fragments of pithoi and carbonised fruits were found in the buildings, allowing for an economic interpretation. Judging by coinfinds, the buildings ended in fire after the year 602. Some of the buildings on the northern plateau were oriented differently, following the route of the northern rampart of the Acropolis in the east-west direction. In 2012 building 18 was excavated, leaning on the rampart. Rectangular in plan and some 12 by 7.5 meters large, it had a storey and a 7 by 5.5 meters spacious paved atrium in the west. Parallel to building 18 is building 20, the only one on the northern plateau constructed in opus mixtum. The two buildings are separated by a four-meter-wide street, running from east to west. This street, corridor 4, was partly cut in the rock. In some sections it had a substructure of fragmented debris. Building 20 has been carefully excavated for several years now. After the initial documenting, the surface layer of debris was removed, but not the collapsed structures with characteristic construction details; to the east of the building a collapsed wall was uncovered, containing as many as eight successive rows of stone and brick. Beneath these layers are the occupation ones, so far investigated only to a small extent. Building 20 is rectangular in plan, covering 25 by 12.5 meters. In its central axis there is a row of masonry pillars, dividing the building into two naves. On its western side there was a vestibule with a pair of doors matching the main entrances to the building. In the back of the vestibule, between these entrances and in axis with the pillars, there was a staircase. Adetailed analysis of these features led us to conclude that building 20 was a horreum, the first such edifice to be discovered in Caricin Grad. Taking into account the details of its ground plan, pillars, parts of collapsed walls and especially arches, it will be possible to reconstruct the original form of the horreum. Judging by the existing estimate, although somewhat rough, it was 13.5 meters high. It could be observed that in its later phases the horreum was partitioned into several rooms, and some of its entrances were walled up. In the vestibule only these later occupation phases were documented, as the original brick pavement was removed from its northern part. This was followed by a significant accumulation of cultural layers, which were sealed by the debris stratum. South of the horreum there is a spacious courtyard connected with the western street of the Upper Town. The Upper Town?s northern rampart has never been graphically reconstructed, despite the fact that Aleksandar Deroko and Svetozar Radojci} published its accurate (although schematic) ground plan as early as 1950 (Fig. 2.2). This part of the town has gradually been left out of the research focus, mainly due to the vegetation growth. Upon employing all the methods described above, however, it is possible to undertake such an effort. The ideal reconstruction suggested here includes the rampart route, the disposition and the form of the towers, and the possible locations of the posterns. The line of the rampart can be traced following the trenches left by the locals dismantling the walls. Only the section of the northwestern rampart in front of the western postern of the Acropolis cannot be presented, being still covered by massive earth deposits. On the other hand, the recently discovered western rampart of the Outer Town can be traced to its full length in the LiDAR-derived DTM. Its form can be easily reconstructed on the basis of the results of the 2012 excavations and the section of the same rampart uncovered east of the main fortifications in 1955-56 (Fig. 8). Having studied the microtopography of the terrain, we were able to determine the position of a number of towers. They were clearly indicated by bumps, regularly distributed along the northern and northeastern sections of the rampart. The position of the tower below the Acropolis? western postern could be easily determined as well, unlike the position of the tower opposite to the horseshoe-shaped one of the Acropolis fortification. Yet, it is hard to imagine that a hundred-meter-long section of the rampart was left unprotected. The rectangular shape of the towers is suggested because almost all the towers of the town?s outer fortification were constructed in that way. On the other hand, at present we cannot exclude the possibility that some towers were different, horseshoe-shaped in plan, like the ones on the Acropolis rampart. The disposition of the towers along the northeastern rampart of the Upper Town, in the area where the northern street presumably met the fortification, is not clear. This part of the site still lies under massive heaps of earth, and even the 1938 and 1947 aerial photographs are not indicative enough in this regard. However, the tower(s) might have been erected there, not only because the eighty-meter-long stretch of the rampart would be left without protection in an opposite scenario, but because it is likely that the northern street ended in a gate, or at least a postern. It is already known that some of the posterns on the Caric in Grad fortifications were defended by towers. The average distance between the towers of the town?s main fortification extends from 20 meters on the southern to 40 meters on the western rampart of the Lower Town; in our reconstruction the average interval on the Upper Town?s northern rampart is 44 meters. Another argument is that this gate might have connected the Upper and the Outer Towns. The position of the second postern is determined thanks to a depression in the terrain following the axis of another communication route in the Upper Town, leading from corridor 4 and running towards the north along the rows of buildings. Finally, the 3.8 meter width of the rampart in the section adjoining the northern tower of the Upper Town?s eastern gate may only indicate a staircase, the last reconstructed fortification element. On the plateau stretching between the northern ramparts of the Acropolis and the Upper Town fortifications a settlement developed with its radially distributed rows of buildings cascading down the slope. In the eastern part of the plateau there is the horreum, adjoined from the east by another building - the storage called Building with Pillars. Larger than the other buildings and constructed in opus mixtum, the two buildings follow the route of the Upper Town?s northern street, all of which indicates that they belong to the initial construction phase. One should not exclude the possibility that this part of the town was originally conceived as an economic district with storages and similar edifices. By all appearances, the original concept was soon abandoned. Already at the time of Justinian a settlement of numerous smaller buildings was created. With their walls of stone and wattle and daub, the buildings were roofed with tiles. Yet one should underscore that this construction phase, although less sophisticated than the first one, was accomplished according to a previously prepared plan; the spread of the buildings speaks to that effect. Shortly afterwards, if not at the same time, buildings were erected along the outer face of the Acropolis rampart - a clear indication of abandoning urban planning (Fig. 9). Public space was turned into private, in spite of the legal proscriptions of that time. During the last phase of the town?s life the buildings described, whether public or private, were partitioned into small rooms, often with fireplaces and with some of their entrances walled up. Just like the edifices constructed in opus mixtum, some of the more modest buildings from the second construction phase were used to store food - namely buildings 11 and 15C. The plan of this part of the site points to an organised settlement, most probably inhabited by persons servicing a significant clergy and administration. On the other hand, except for some houses - such as building 18 - small buildings along the Acropolis fortification, facing the main street, corridor 4, might have served as shops and workshops. Traces of furnaces, slag and bone working were also encountered in this area. The parallel application of classical research methods and modern techniques of sensing and detection enabled the reconstruction of the northern rampart and the urban matrix of the Upper Town?s northern plateau. Until recently among the least known parts of the town, this unit can now be regarded as one of the best defined. This is important not only for our understanding of Caricin Grad (Justiniana Prima), but also for the study of Early Byzantine urban planning in general.

In Exp. 1, 10 female subjects each twisted six jar lids vs a torque meter with a bare hand, rubber gripper and a cotton cloth. The torques of 3.17 Nm for the 48 mm dia, 5.02 for the 67 mm dia, and 6.04 for the 86 mm dia lids differed significantly. Torques of 4.04 for the cotton cloth in the hand, 4.85 for the bare hand and 5.36 for the rubber gripper also varied significantly. The 4.66 Nm for non-knurled was not significantly different from the 4.84 for knurled. Exp. 2 replicated Exp. 1 with 5 of the 6 lids for 29 visitors to a University Open House. The results were compatible with Experiment 1. Torque exertable on a lid can be predicted well from grip strength, lid radius and the gripping material (rubber, bare hand or cloth).

Studies on soil phosphorus (P) of low productivity cultivated pastures in Cerrado (Brazilian Savanna) areas and surveys on other possible problems related to P are scarce. The spatial variability of soil phosphorus content of a Rhodic Ferralsol was studied in a low productivity pasture of Brachiaria brizantha (BB) grown for 10 years, without fertilizer application, in an experimental area at Planaltina (GO), Brazil. Soil samplings were performed on a regular grid of 10 by 10 meters, with 98 sampling points before (between tussocks and under tussocks) and after the establishment of the experiment (after fertilizing). On the same grid, forage plants were collected and separated into fractions for N and P content analyses. Soil available phosphate was determined by the resin method (Pr) and complemented by the 32P isotopic exchange kinetics analysis. Descriptive statistical and geostatistical analyses were utilized to describe the spatial variability. The Pr content on soil samples under tussocks presented mean and median values 45% larger than in soil samples taken between tussocks. The higher variation is probably related to the greater concentration of BB roots, soil organic matter content and soil P recycled through the plants tussocks. The spatial variability of Pr in this soil was high especially after fertilizer application. This variable did not present spatial dependence for the regular 10 m sampling. The generated knowledge on P variability of soils under low productivity cultivated pastures revealed problems related to the sampling methodology traditionally utilized and to P application.

Background Chronic inflammatory demyelinating polyneuropathy (CIDP) can be successfully treated with immunoglobulin either intravenously (IVIG) or subcutaneously (SCIG). Measurement of plasma immunoglobulin G levels (P-IgG) and its correlation to clinical improvement has shown conflicting results. This study aims to clarify whether changes in P-IgG are related to clinical development in patients with CIDP treated with IVIG or SCIG. Methods Patients from five previous studies treated with either IVIG or SCIG with evaluation at baseline and re-evaluation after two or 10/12 weeks, respectively were included. At evaluation and re-evaluation, the following tests were done: combined isokinetic muscle strength (cIKS), grip strength, 9-hole-peg test (9-HPT), 40-meter-walk test (40-MWT), clinical examination of muscle strength score by the Medical Research Council (MRC) and measurement of plasma immunoglobulin G (P-IgG). Results Fifty-five patients were included in the IVIG group and 41 in the SCIG group. There was no correlation between the changes in P-IgG and cIKS in neither the IVIG group (r = 0.137, p = 0.32) nor the SCIG group (r = − 0.048, p = 0.77). Similarly, no correlations could be demonstrated between P-IgG and grip strength, 9-HPT, 40-MWT or MRC. Conclusions In patients with CIDP receiving SCIG or IVIG, changes in P-IgG during treatment did not correlate with changes in muscle strength or other motor performance skills.

ObjectiveTo assess the ability of functional measures to detect disease progression in dysferlinopathy over 6 months and 1 year.MethodsOne hundred ninety-three patients with dysferlinopathy were recruited to the Jain Foundation's International Clinical Outcome Study for Dysferlinopathy. Baseline, 6-month, and 1-year assessments included adapted North Star Ambulatory Assessment (a-NSAA), Motor Function Measure (MFM-20), timed function tests, 6-minute walk test (6MWT), Brooke scale, Jebsen test, manual muscle testing, and hand-held dynamometry. Patients also completed the ACTIVLIM questionnaire. Change in each measure over 6 months and 1 year was calculated and compared between disease severity (ambulant [mild, moderate, or severe based on a-NSAA score] or nonambulant [unable to complete a 10-meter walk]) and clinical diagnosis.ResultsThe functional a-NSAA test was the most sensitive to deterioration for ambulant patients overall. The a-NSAA score was the most sensitive test in the mild and moderate groups, while the 6MWT was most sensitive in the severe group. The 10-meter walk test was the only test showing significant change across all ambulant severity groups. In nonambulant patients, the MFM domain 3, wrist flexion strength, and pinch grip were most sensitive. Progression rates did not differ by clinical diagnosis. Power calculations determined that 46 moderately affected patients are required to determine clinical effectiveness for a hypothetical 1-year clinical trial based on the a-NSAA as a clinical endpoint.ConclusionCertain functional outcome measures can detect changes over 6 months and 1 year in dysferlinopathy and potentially be useful in monitoring progression in clinical trials.ClinicalTrials.gov identifier:NCT01676077.

Zusammenfassung und zukünftige EntwicklungenDie große Bedeutung der Methoden mit synthetischen Substraten für die Hämostaseologie ist unbestritten. Viele Parameter können damit einfach und zuverlässig bestimmt werden.Frühere Störfaktoren der Teste, z.B. Unspezifität und schlechte Löslichkeit der Substrate, Fibrinbildung, Instabilität der Enzyme und Substrate, sind eliminiert. Trotzdem wird die größte Anzahl der Gerinnungsanalysen heute noch mit Koagulometer-Methoden durchgeführt. Dagegen werden Parameter, die neu entdeckt wurden (z.B. Protein C), oder deren klinische Bedeutung früher unbekannt war (AT III), überwiegend mit den neuen Methoden bestimmt. Die Ursache für das Überdauern der Koagulo-meter-Methoden ist sicher die für das allgemeine Gerinnungslabor ungewohnte Technologie, für die häufig auch nicht die notwendige apparative Ausstattung vorhanden ist.Die immer noch höheren Kosten der photometrischen Teste spielen ebenfalls eine berechtigte Rolle. Dieser Punkt wäre sicher zu beeinflussen mit der Durchführung der Basisanalysen, wie Quick-Wert, APTT und Fibrinogen, sowie häufig bestimmter Spezialparameter, wie AT III, Protein C und Plasminogen, an Photometern und Automaten, mit denen auch klinisch-chemische Parameter analysiert werden. Die leichte Durchführbarkeit der Methoden an Geräten des klinisch-chemischen Labors, speziell an Automaten, die für klinisch-chemische Methoden konzipiert wurden, führt aber auch zu organisatorischen Problemen und Kompetenzfragen.Man kann heute mit einiger Sicherheit annehmen, daß die Methoden mit chromogenen Substraten die Koagulo-meter-Methoden zukünftig stark zurückdrängen werden, falls nicht ganz neue Prinzipien für hämostaseologi-sche Analysen gefunden werden, wofür es derzeit keinerlei Anzeichen gibt.Eine sicher nicht aufzuhaltende Entwicklung wird die Durchführung chromogener Substratmethoden mit Hilfe der sogenannten »Trockenchemie« sein. Die Trockenchemieverfahren haben für zahlreiche klinisch-chemische Parameter bereits einen so hohen Grad an Zuverlässigkeit und Präzision erreicht, daß man sich dieser Methodik trotz großer anfänglicher Skepsis nicht mehr verschließen kann. Dieses zwar noch recht teure Verfahren ist für schnell durchzuführende Einzelanalysen sehr gut geeignet (64, 75). Sicher wird das Verfahren in Zukunft auch für größere Analysenserien einsetzbar sein.Ebenso ist es nur noch eine Frage der Zeit, bis der Quick-Wert aus einer kapillären Blutprobe innerhalb weniger Minuten mit einem Teststreifen bestimmt werden kann. Damit zeichnet sich ab, daß die Kontrolle der oralen Antikoagulanzientherapie in der Praxis des niedergelassenen Arztes zuverlässiger durchführbar sein wird. Hohe Qualität der Teststreifen vorausgesetzt, werden auch die Quick-Werte verschiedener Laboratorien weniger Differenzen untereinander aufweisen.Allerdings wird sich bei der Erweiterung der »Trockenchemie« auf Gerinnungsparameter dann für die Hämostaseologie die gleiche Frage wie für die Klinische Chemie stellen, nämlich inwieweit durch das trockenchemische Verfahren eine Dezentralisierung der Analytik einsetzt und damit die Kontrolle durch einen speziell ausgebildeten Hämostaseologen entfällt. Diese zukünftige Entwicklung sollte ein weiteres Argument für eine intensive hämostaseologische Ausbildung der Ärzte sein.

Wolf E, Wanke R, Schenck E, Hermanns W, Brem G. Effects of growth hormone overproduction on grip strength of transgenic mice. Eur J Endocrinol 1995;133:735–40. ISSN 0804–4643 Growth hormone (GH) is used by athletes like bodybuilders to increase muscle strength and weight gain. On the other hand, chronic hypersecretion of GH in active acromegaly may result in outwardly hypertrophied but functionally weaker muscles. As a model for studying long-term effects of GH on muscle strength, we analysed transgenic mice (TM) carrying rat phosphoenolpyruvate carboxykinasebovine GH (PEPCKbGH) fusion genes, which are expressed in liver and kidney but not in skeletal muscle. Circulating GH levels in TM ranged between 0.5 and 3 μg/ml, resulting in increased (p <0.001) body weight (wt) as well as increased (p <0.01) weights of forelimb and hindlimb muscles. However, muscle weight/body wt ratios of TM were 16–20% smaller than in controls (p<0.05), Forelimb grip strength of hemizygous TM (16 males, 132 ± 45 days old, body wt = 56.8 ± 8.3 g; 32 females, 146 ± 38 days old, body wt = 54.9 ± 6.1 g) and non-transgenic controls (28 males, 127 ± days old, body wt = 40.5±2.9 g; 33 females, 126 ±47 days old, body wt = 32.1 ± 3.6 g) was determined using an automated grip strength meter. Data were computed by analysis of variance, taking into account effects of group, sex and age. Least-squares means estimated for the grip strength (N) of male TM (1.91) and controls (1.92) were significantly (p<0.05) greater than those of female TM (1.78) and controls (1.61). A significant difference between groups was only seen in females (p <0.01). Least-squares means estimated for grip strength/body wt ratios (N/10 g) of male (0.34) and female TM (0.33) were 29% and 35% lower than those of male (0.48) and female controls (0.51), respectively (p <0.001). In summary, long-term elevated GH levels in TM increased muscle weight less efficiently than body weight, and muscle strength did not increase proportionally with muscle weight. Eckhard Wolf, Lehrstuhl für Molekulare Tierzucht und Haustiergenetik, Ludwig-Maximilians-Universität München, Würmtalstraβe 221, 81375 München, Germany

Abstract Functional performance measures (grip strength, Short Physical Performance Battery (SPPB), and 3-meter gait speed) represent underlying disease progression and predict mortality. However, there is little information regarding whether these measures assessed at 2-months post-hip fracture predict long-term mortality (10-year follow-up). To address this gap, a longitudinal analysis of Baltimore Hip Studies-7 cohort, with mortality verified by National Death Index, was conducted. Mean difference in 2-month functional performance measures (n=242, men n=121, female n=121) among those who survived and did not survive over 10 years was determined using t-test. Prediction of mortality by these measures, overall and by sex, was estimated using cox proportional hazard models, for which Hazard ratios (HR) with 95% confidence intervals (CI) were estimated. We found that, gait speed [0.47(standard deviation,SD=0.39) versus 0.31(SD=0.27)] and SPPB score [4.89(SD=3.31) versus 2.83(SD=2.24)] were significantly higher at 2 months among those surviving compared to those who did not. Adjusting for covariates, functional performance predicted long-term mortality in men and women. Increase in gait speed by 0.1m/s predicted 15% decrease in mortality for men [HR=0.85(0.55-0.96)] and 17% for women [HR=0.83 (0.74-0.93)]. Increase in SPPB by 1 unit predicted decrease in mortality by 14% for men [HR=0.86(0.77-0.95)] and 17% for women [HR=0.83(0.74-0.93). Increase in grip strength by 1 kg predicted 5% decrease in mortality for men [HR=0.94(0.92-0.97)] and 9% for women [HR=0.90(0.86-0.95)]. Functional performance measured at 2-months post-hip fracture predicted long-term mortality. Those with poor functional performance at 2-months can be referred for further assessment to optimize their care to promote survival.

Advanced smart grid technologies enable energy prosumers to trade surplus energy from their distributed renewable energy sources with other peer prosumers through peer-to-peer (P2P) energy trading. In many previous works, P2P energy trading was facilitated by blockchain technology through blockchain’s distributive nature and capacity to run smart contracts. However, the feature that all the data and transactions on a blockchain are visible to all blockchain nodes may significantly threaten the privacy of the parties participating in P2P energy trading. There are many previous works that have attempted to mitigate this problem. However, all these works focused on the anonymity of participants but did not protect the data and transactions. To address this issue, we propose a P2P energy trading system on a blockchain where all bids are encrypted and peer matching is performed on the encrypted bids by a functional encryption-based smart contract. The system guarantees that the information encoded in the encrypted bids is protected, but the peer matching transactions are performed by the nodes in a publicly verifiable manner through smart contracts. We verify the feasibility of the proposed system by implementing a prototype composed of smart meters, a distribution system operator (DSO) server, and private Ethereum blockchain.

Aim. To evaluate the effectiveness of electrical muscle stimulation (EMS) in patients with the complicated early postoperative period after cardiac surgery.Methods. 61 patients (44 men and 17 women) aged 52-70 years with the complicated early postoperative period after cardiac surgery were included in the study. The complications included prolonged length of stay in the intensive care unit and prolonged mechanical ventilation. The initial muscle performance of the lower extremities was measured with the carpal and isokinetic dynamometer in all patients. The six-minute walk test was performed in all patients after they had been transferred to the department of cardiac surgery.Results. Patients in the study group had reduced lower extremity muscle strength at baseline, compared with the control group. After the EMS sessions, the study group patients demonstrated pronounced improvements in muscle performance as compared to the control group. Both knee-joint extension values increased during the isometric contraction as compared to those in the control group (38.8% and 40.0% versus 8.1% and 8.4%, p <0.001), similarly to right knee-joint flexion (23.7% versus 10.1%, p = 0.008), left ankle joint (18.6 versus 4.3%, p = 0.010), right-hand grip strength (18.3 versus 11.1%, p = 0.042). In addition, the six-minute walk test results improved in the EMS group (119.72% (293 meters) and 87.13% (315 meters)) as compared to the control group (p = 0.079).Conclusion. The EMS sessions did not affect the clinical status of cardiac surgical patients with the complicated postoperative period. Moreover, it appeared to be beneficial in terms of the improved lower extremity muscle strength that was more pronounced in the study group than in the control group. Therefore, the effects of EMS on the clinical status of these patients require the further investigation.

Abstract Cognitive function and physical function are associated however less is known about task complexity and how individual tasks relate to one another. This project seeks to describe the relationship between cognition and physical function measures across 22 tasks ranging in task complexity and difficulty. Data are from the baseline visits of a new longitudinal study, Brain Networks and Mobility Function (B-NET) Study, mean age: 76.0±4.2 years; 55% women, and 90% Caucasian. We hypothesize there would be a set of “complex” tasks that would intersect both cognitive and physical function abilities such as the Four Square Step Test or Dual Task. We conducted principal components analysis on data from the first 110 participants to describe what factors could be identified across cognition and physical function measures. Seven factors, explaining 73% of the variability, were identified: 1) a complex physical function (postural sway on foam, expanded Short Physical Performance Battery, 400 meter walk, Four Square Step Test, Dual Task), 2) physical strength (grip strength and leg press), 3) visual recall (Brief Visuospatial Memory Test- immediate and delayed), 4) Craft story recall (immediate and delayed), 5) global cognition & fluency (MoCA, category and word fluency) 6) auditory recall (Auditory Verbal Learning Test- immediate and delayed), and 7) executive function (Trail Making Test A & B). We did not identify factors that intersected both physical and cognitive tasks. These results may help to inform measurement selection in future studies that seek to evaluate components of function among older adults.

Abstract Purpose Various implants have been described for ulnar head replacement (UHR) or for total replacement of the distal radioulnar joint (DRUJ). Many series are small and few reports on mid- or long-term results. This study is primarily aimed to report on the midterm results after ulnar head only and total DRUJ replacement using the uHead in the treatment of painful disorders of the DRUJ. The secondary aim of the study was to eventually assess the combination of UHR and total wrist arthroplasty (TWA). Materials and Methods We included 20 consecutive patients in whom an UHR with the uHead was performed at our institution between February 2005 and March 2017. There were 6 men and 14 women with mean age of 59 years (range: 36–80 years). The mean follow-up time was 5 years (range: 2–15 years). Data were recorded prospectively before operation and at follow-up examinations and entered in a registry. The patients were followed-up at 3 and 6 weeks and 3, 6, and 12 months postoperatively and thereafter annually. In five cases, the uHead was implanted simultaneously with a Remotion TWA. In four cases, a Remotion TWA had been implanted previously. Kaplan–Meier survival analysis was used to estimate the cumulative probability of remaining free of revision. A nonparametric Wilcoxon's signed-rank test was used for comparing data not normally distributed (qDASH [quick disabilities of the hand, shoulder, and arm] scores), and the paired parametric Student's t-test was used for normally distributed data (pain and visual analogue scale [VAS] scores, range of motion, and grip strength). Significance was set at a p-value of less than 0.05. Results Pain, grip strength, and the function improved significantly. Pain after surgery decreased with 50 points on the VAS score scale of 100, from 66 (mean), preoperatively (range: 16–97) to 16 (mean; range: 0–51), postoperatively, while grip strength nearly doubled from 12 KgF (mean; range: 4–22), before to 21 KgF (mean; range: 6–36), after the surgery. Patients function measured with qDASH scores improved from 56 (mean; range: 36–75), preoperatively to 19 (mean; range: 4–47), postoperatively. Wrist extension, flexion, and ulnar and radial deviation did not change to a clinically or statistically significant extend, neither did supination nor pronation improved after surgery. While three UHRs were revised early because of pain problems and/or unsatisfactory forearm rotation in two cases and infection in one, 17 had an uncomplicated postoperative course and these patients were satisfied with the results of the surgery at all the follow-ups. Due to limited number of cases, the calculation of significance in comparing combined cases with UHR only cases was abandoned. Conclusion Ulnar head arthroplasty (uHead) showed significant improvement in pain, grip strength, and the function of the patients with a painful disability of the DRUJ, without impairment on mobility on the midterm follow-up. The overall implant survival over the time and the complication rate was acceptable.

690 Background: Multiple inflammatory markers have been evaluated in predicting preoperative risk in patient’s undergoing curative nephrectomy for Clear cell renal cell carcinoma. We propose that ratio of C-Reactive Protein to albumin (CA-ratio) would prove to be a good prognostic indicator for assessment of overall survival and comparable to established nomograms in clear call RCC. Methods: Patients that underwent nephrectomy for localized clear cell RCC between 2007 and 2016 were retrospectively identified. The optimal threshold for individual biomarkers among the panel was determined using grid search methodology, receiver operating characteristic (ROC) analysis, and sensitivity-specificity trade-off analysis. Prognostic value of CA-ratio was analyzed using the Kaplan-Meier method and Cox proportional regression models. ROC and chi-square analyses were performed to compare the predictive ability of CA-ratio to SSIGN, and UISS. Results: Among the 433 clear cell RCC patients treated with nephrectomy, mean age at surgery was 58.4±12, and mean BMI was 30.6±6.8. 158 (36.5%) had CA-ratio < 0.1, while 164 (37.9%) were between 0.1-0.2, and 111 (25.6%) were 0.2+. Pathological T-stage was distributed as follows: T1: 294 (67.9%), T2: 29 (6.7%), T3: 106 (24.5%), and T4: 4 (0.9%). Overall, 60 (13.9%) patients died before end of the follow-up. Area under the curve (AUC) for CA-ratio was 0.72, comparable to SSIGN (AUC 0.73, p = 0.12). On multivariate COX proportional hazards analysis, patients with ratio 0.2 or more were more likely to die compared to patients with ratio < 0.1 [HR:3.45 95%CI:1.68-7.10, p = < 0.001], while adjusting for T-stage, grade, necrosis, and age. Conclusions: CA-ratio is an cost-effective , independent and significant predictor of overall survival in clear cell RCC with accuracy at least as good as other established prognostic tools including SSIGN and UISS. [Table: see text]

When they were first conceived, solar cooling systems were designed to be cost-effective and environmentally safe alternatives for the majority of the developing nations that are characterised by their hot climates in contrast with the traditional air conditioning systems powered by electricity that is produced from fossil fuel resources. Nevertheless, developments in photovoltaic (PV) and air-conditioning technologies have impacted on the prospects of solar cooling systems. This study examined two different options: a coupled PV and air conditioner system and a solar cooling system (absorption chillers where thermal energy is provided by solar collectors) for a specific developing country located in the Eastern Mediterranean region whose climate is hot and dry (Jordan). The cooling system comprised a pair of cooled multistage compression, both of which were 700 kW, while the PV system’s size was 2.1 MWp, the utility grid connection was a 0.4 kV 50 Hz net meter (2 m) and it was anticipated that 3300 MWh/year would be generated. The solar cooling system operated at a maximum coefficient of performance (COP) of 0.79 and had an actual recorded COP of 0.32 on the site; when the electricity tariff of $0.1/kWh was considered, the respective levelised cost of energy (LCOE) values were $0.9/kWh and $2.35/kWh respectively. The findings indicate that the initial costs for the solar thermal cooling system and the PV system were approximately $3.150M and $3M, respectively. The current value of future cash payments when discounts of 6% per year were applied to the payments for the combination of PV and air conditioning was about $9,745,000, whereas the solar thermal cooling system will not reach the breakeven point at negative $1,730,000. It is clear the absorption chiller did not display economic feasibility, whereas the value for the coupled PV and air-conditioning systems was under $0.05/kWh. In addition to the extensive maintenance needs, the reduced COP and the practicality and feasibility of the solar thermal cooling systems mean these kinds of technologies are under significant pressure to remain competitive when faced with the development of new air conditioning and PV technologies.

A B S T R A C TIntroduction. Old age is related to geriatric syndrome where there are several healthproblems that often occur related to a decrease in body function and an increase inthe inflammatory process. Decrease in muscle mass, muscle strength and physicalperformance will lead to a condition of sarcopenia and frailty syndrome in the elderly.The importance of prevention so that sarcopenia does not occur in the elderly byevaluating the factors that can cause it, one of which is controlling nutritional factors(macro and micro nutrients), such as in research, namely omega-3 macronutrients.The purpose of this study was to determine the correlation between serum omega-3levels with muscle mass, muscle strength, and physical performance in the elderlycommunity at Moehammad Hoesin Hospital Palembang. Methods. This research isan observational analytic study with a cross-sectional approach which wasconducted at the Integrated Geriatric Clinic Internal Medicine RSMH Palembangfrom November 2019 to November 2020. A sample of 21 people aged> 60 years wasexamined for muscle mass, muscle strength, physical performance and omega-levels. 3 serums. All data processing and analysis in this study used SPSS version25 for Windows. Results. Of the 21 subjects, it was found that women were 19people (90.5%) and 2 men (9.5%). The mean value of muscle mass was 37.65 ± 5.7,hand grip strength was 24.04 ± 5 kg, and walking speed was 6.72 ± 1.8 seconds per6 meters. There were 11 subjects with low serum omega-3 levels of 485.25 ± 110.19mg. There was a significant relationship between serum omega-3 levels and musclemass (p = 0.041) with moderate correlation strength (r = 0.448). Conclusion: Musclemass has a significant relationship with serum omega-3 levels in the elderly withmoderate strength. Meanwhile, muscle strength and physical performance did nothave a significant relationship.

Abstract Background: Sickle cell disease (SCD) is one of the world's most common inherited diseases, due to a point mutation in hemoglobin that leads to the polymerization of hemoglobin S, giving red blood cells (RBCs) their sickle shape. The hallmarks of SCD are hemolysis and vaso-occlusion. Vaso-occlusive crises (VOC) frequently occur in response to inflammatory and hypoxic conditions such as infections, surgery, etc. Pain is a major defining characteristic of SCD starting early in life and continuing throughout adulthood. VOC-induced pain can be chronic or episodic and unpredictable, requiring frequent hospitalizations and analgesics. Opioids, predominantly morphine, have been the mainstay treatment for pain management of SCD but pose a serious challenge attributed to the many adverse side effects, including tolerance, respiratory depression, sedation, nausea, constipation, pruritus, and dependence. Given that analgesics characteristically used to treat pain appear to be relatively ineffective in alleviating pain associated with SCD as well as display their own dose-limiting adverse effects, there exists a requisite need for superior pharmacological agents in its treatment. Here we reveal that the bivalent ligand MCC22, is highly effective as an analgesic in a murine model of SCD. MCC22 (MW=1255) contains both mu agonist and chemokine CCR5 antagonist pharmacophores that are linked through a 22-atom-spacer. It was designed specifically to target the mu opiate receptor (MOR)-CCR5 heteromer, as there is evidence for crosstalk between MOR and CCR5 in cultured cells that reduces the efficacy of opioid analgesics employed in SCD. Intrathecal (i.t.) MCC22 was potent in reducing the mechanical and heat hyperalgesia in Complete Freund's Adjuvant (CFA) and lipopolysaccharide (LPS) inflammatory pain assays. ED50s for the i.t. administration were 0.019 and 0.015 pmol/mouse, respectively. MCC22 when given intraperitoneally (i.p.) to LPS pretreated mice had an ED50 of 5.6 µmol/kg. We next investigated whether MCC22 would be effective in alleviating pain in SCD mice. Methods:Townes transgenic humanized mice expressing sickle hemoglobin (HbSS / HbAS) and normal human hemoglobin (HbAA) controls (4-12 weeks of age, 20-25g) were used in this study. Mice were characterized for hyperalgesia by quantifying cutaneous mechanical sensitivity of the hind paw and forelimb grip force. Mechanical sensitivity of the hind paw was evaluated by determining the frequency of withdrawal responses and paw withdrawal threshold. The frequency of paw withdrawal evoked by a standard von Frey monofilament with a bending force of 9.3 mN applied to the plantar surface of the hind paws was determined from 10 trials on each paw. Withdrawal threshold was determined using an electronic von Frey anesthesiometer pressed against the plantar surface with increasing force until withdrawal occurred. To assess deep tissue hyperalgesia, the tensile force of peak forelimb exertion was measured using a computerized grip force meter. To evaluate the analgesic effects of MCC22, paw withdrawal frequency was determined before and at various times after administration of 8.0 µmol/kg i.p. Results: Pain Characterization: HbSS sickle mice exhibited robust mechanical hyperalgesia as shown by a significant increase in paw withdrawal frequency compared to HbAS and HbAA controls (Figure1A, p<0.001). Paw withdrawal frequency in HbAS mice was also greater than those for HbAA mice (p<0.001), but less than HbSS mice. HbSS mice had lower mechanical withdrawal thresholds compared to both HbAS and HbAA mice (Figure 1B, p<0.001), while HbAS did not differ from HbAA mice. HbSS and HbAS mice also displayed lower forelimb grip force compared to HbAA mice (Figure 1C, p<0.001), although grip force in HbSS was lower than HbAS mice (p<0.001). Administration of MCC22 (8.0 µmol/kg i.p.) reduced hyperalgesia within 30 minutes as evidenced by a decrease in paw withdrawal frequency in both HbSS and HbAS mice (Figure 1D, p<0.001). Conclusions: Hyperalgesia was demonstrated in both HbAS and HbSS mice. MCC22 potently attenuated mechanical hyperalgesia in these SCD mice. The use of bivalent ligands that target heteromers involved in signaling pain may offer novel and effective treatments for pain in patients with SCD. We speculate that an analgesic with potential anti-inflammatory and mu-agonist activity may provide a novel approach to sickle pain. Figure 1. Figure 1. Disclosures Belcher: CSL Behring: Research Funding; Seattle Genetics: Research Funding; Biogen Idec: Research Funding. Vercellotti:Biogen Idec: Research Funding; CSL Behring: Research Funding; Cydan: Research Funding; Seattle Genetics: Research Funding.

The increasing number of elderly and elderly life expectancy is a challenge for health workers. Decreased cardiac endurance, muscle strength and increased incidence of inflammation will occur in the elderly as we get older. health cardio exercises series-I is an aerobic exercise that has moderate intensity and is carried out for 30 minutes, research is needed to analyze the effect on cardiac endurance, muscle strength and decrease plasma TNF-? levels in the elderly. Research design with experimental method, pre-test and post-test design approach. The study was conducted for 4 weeks on 25 samples which were divided into 3 groups of frequency of health cardio exercises series-I to measure endurance of the heart. A 6-minute road test and muscle strength were used for hand grip strength dynamometer, test back and leg dynamometer. Measurement of plasma TNF-? levels is carried out using the Elisa method. The data was then analyzed using paired t-test to see differences before and after health cardio exercises series-I. The results showed health cardio exercises series-I performed 3x / mg can increase the heart's endurance compared to the frequency of 4x / mg and 5x / mg (-16.11 vs 15.62 vs -47.62 meters). health cardio exercises series-I frequency of 3x / mg and 4x / mg can increase back muscle strength (p-value = 0.019, p <0.05) and the frequency of 5x / mg can increase the strength of attractive shoulder muscles. (p-value = 0.033, p <0.05). Health cardio exercises series-I performed 3x / mg, 4x / mg and 5x / mg did not have a significant effect on plasma TNF-? protein expression in the elderly (0.506 vs 0.856 vs. 0.382, p <0.05). It is suggested that the elderly can do I-1 series heart exercise with a frequency of 3x / mg to increase the heart's lung endurance and back muscle strength, a health cardio exercises series-I 4x / mg series to increase muscle strength of the back back, a series of health cardio exercises series-I frequency of 5x / mg to increase attractive shoulder muscle strength.

The increasing number of elderly and elderly life expectancy is a challenge for health workers. Decreased cardiac endurance, muscle strength and increased incidence of inflammation will occur in the elderly as we get older. health cardio exercises series-I is an aerobic exercise that has moderate intensity and is carried out for 30 minutes, research is needed to analyze the effect on cardiac endurance, muscle strength and decrease plasma TNF-α levels in the elderly. Research design with experimental method, pre-test and posttest design approach. The study was conducted for 4 weeks on 25 samples which were divided into 3 groups of frequency of health cardio exercises series-I to measure endurance of the heart. A 6-minute road test and muscle strength were used for hand grip strength dynamometer, test back and leg dynamometer. Measurement of plasma TNF-α levels is carried out using the Elisa method. The data was then analyzed using paired t-test to see differences before and after health cardio exercises series-I. The results showed health cardio exercises series-I performed 3x / mg can increase the heart's endurance compared to the frequency of 4x / mg and 5x / mg (-16.11 vs 15.62 vs -47.62 meters). health cardio exercises series-I frequency of 3x / mg and 4x / mg can increase back muscle strength (pvalue= 0.019, p <0.05) and the frequency of 5x /mg can increase the strength of attractive shoulder muscles. (p-value=0.033, p<0.05). Health cardio exercises series-I performed 3x / mg, 4x / mg and 5x / mg did not have a significant effect on plasma TNF-α protein expression in the elderly (0.506 vs 0.856 vs. 0.382, p<0.05). It is suggested that the elderly can do I-1 series heart exercise with a frequency of 3x / mg to increase the heart's lung endurance and back muscle strength, a health cardio exercises series-I 4x / mg series to increase muscle strength of the back back, a series of health cardio exercises series-I frequency of 5x / mg to increase attractive shoulder muscle strength.

The Church of St. Stephan, in this paper, belonged to a medieval residential complex above the confluence of the River Piva and the River Tara, in the extreme northeast of the present-day Republic of Montenegro. The central part of the complex consisted of Soko-grad, a castle with the court of the prominent, aristocratic, Kosaca family, which, at the end of the 14th century, right until the Turkish conquests in the sixties and seventies of the 15th century, ruled the regions later known as Hercegovina. At the foot of the castle, on Scepan polje, is the suburb with the Church of St. Stephan the endowment of the grand duke, Sandalj Hranic (+1345). At the foot of the northern slope, beneath the castle, in the area of Zagradja, is another church erected by the grand duke's successor, Herzeg Stefan Vukcic Kosaca (+1465). After the Turkish conquest, the complex of the Soko castle with its suburb was destroyed and the churches became deserted and were never renewed. The ruins of St. Stephan were discovered, investigated and then conserved from 1971-973, however, the results of this research have not been published until now. In reviewing the results obtained in the course of the archaeological excavations, it is possible, in a considerable measure, to comprehend the position and former appearance of the Church of St. Stephan and establish roughly, the time when it came into being. This was the largest church erected in the regions governed by the powerful, Kosaca noble family, during the 15th century. The total length of the church exceeded 25 metres and its width was approximately ten metres. In the preserved body of the construction, of which the remaining walls rise to a height of four metres one may see three basic stages of building. A narthex was later erected beside the church, and subsequently a small parakklesion was added, on the northern side. The original church had a single nave, a cruciform base and a gently, horseshoe-shaped apsis, facing east, flanked by rectangular choirs. The interior of the church, with two pairs of small pilasters, was articulated in three bays of almost equal dimensions. The altar, encompassing the apsis and the eastern bay, was separated from the naos by a constructed altar partition-wall, the essential appearance of which can be assumed on the basis of whatever was found. The entire surface of the constructed iconostasis was covered with frescoes. The floor of the naos was a step lower than the floor of the altar. Flooring made of mortar, like in the altar area also existed in the choirs. As opposed to these spaces, in the central and western bays, the floor was made of large, hewn stone slabs. The finds discovered in the debris, offered an abundance of data about the upper, now collapsed, structures of the church, and about the stonemasonry that decorated this building. The church did not have a dome but all three bays were topped by a single vault of carved calcareous stone, reinforced by two arches, resting on the pilasters. We may assume that the roof structure was of the Gothic type, and ribbed at the base. Above the choirs were lower semi-spherical vaults, perpendicular in relation to the longitudinal axis of the church. They were covered by gabled roofs that ended in triangular frontons on the northern and southern fa?ade, like the main vault on the eastern side above the altar apsis. The roof of the church was made of lead. A belfry, of unique construction, existed on the western side of the original church. It stood about one meter in front of the western wall and was linked by a vaulted passage to the main body of the building. All these parts were structurally inter-connected, indicating that they were built at the same time. The position and appearance of the original church windows can almost certainly be determined according to the preserved traces on the remaining sections of the walls, and the finds of the relevant stonemasonry. In the interior of the naos, along the southern wall of the western bay was the grave of the donor of the church of St. Stephan, Grand Duke Sandalj Hranic. This was the traditional position where the donor was buried, according to the custom or rather, the rule that had been practiced for centuries in the countries of the Byzantine Orthodox Christian world, and particularly in the Serbian lands. The duke's grave, marked by a stele in the form of a massive low coffin on a pedestal, was prepared while the church was being built given that it would have been impossible to install this large monolith that weighed approximately 2.5 tons in the church, later. Generally speaking, the donor's grave in the church of St. Stephan, is eloquent testimony of the donor's aspirations and beliefs. Besides the undoubtedly local feature of a funerary monument in the form of a stele, all its other characteristics emulate earlier models from the region of the Serbian lands. In front of the original church, at a later stage, which apparently followed soon after, a spacious narthex with a rectangular base was added on. Pylons of the belfry substructure were fitted into its eastern wall, which seems to have made that wall much thicker than the other walls of the narthex. This later erected narthex was not vaulted, which we concluded after analysing the preserved walls and the finds in the debris. Apparently, it had a flat ceiling construction, supported by massive beams that rested on consoles along the length of the northern and southern walls. The side entrances when the narthex was built were of the same dimensions as its western portal. However later, before installing the stone doorposts, both these entrances were narrowed down on their western, lateral sides, while the southern portal, in a later phase, was completely walled up. In the course of exploration, no reliable data was discovered regarding the position of the windows in the narthex. One can only assume that monophoric windows existed on the lateral walls, one or two on each side, similar to the monophores in the western bay. Apart from the narthex, another, later construction was observed next to the original church. On its northern side, along the western bay and the lateral side of the choir, a parakklesion, that is, a small funerary chapel was added on, in the middle of which a large stele once stood, of which now only fragments exist. The entire interior of the church of St. Stephan was deco-rated with frescoes. Rather small fragments of the wall painting were discovered in the debris, not only of the original church but also of the narthex, as well as of the northern funerary chapel. It was observed that they were all of the same quality, painted on mortar of a uniform texture which suggests that all the painting was done as soon as the additional buildings were finished. On the discovered fragments, one can recognise the dark blue back-ground of the former compositions, and the borders painted in cynober. On several fragments, there were preserved sections of or whole letters from Serbian Cyrillic texts. On several fragments that may have originated from the aureoles or parts of robes, traces of gold leaf were visible, which would indicate the splendour and representativeness of the frescoes that decorated the endowment of the grand duke, Sandalj Hranic. With the shape of the foundation of a single-nave church, divided into three bays and with rectangular choir spaces, the church of St. Stephan continued the tradition of the early Rascia school of Serbian architecture (13th beginning of 14th century), which represented a significant novelty at the time when it appeared. In Serbia, in the last decades of the 14th and the beginning of the 15th century, the predominant plan of the churches, the triconche, was based on the Holy Mount models. The decision by the donor, the grand duke Sandalj, to give his endowment the features of the earlier, Rascia heritage, in the times when the Serbian territories had been broken up and were exposed to pressure from external enemies, undoubtedly had a deeper significance. By relying on the earlier tradition, which is also reflected in the dedication of the church to St. Stephan, the patron saint of the state and of the Nemanjic dynasty, the donor expressed the aspiration to consolidate his authority more firmly in the regions that had previously formed part of the Serbian state. By erecting an endowment, and a funerary church that he wished to be his eternal resting-place, Sandalj was also demonstrating that he ranked among his predecessors, the Serbian rulers and nobility. One can see this from the choice of the traditional burial position, along the southern wall of the western bay, as well as from the tomb he had prepared for himself during his lifetime. Apart from the basic idea and plan of the church based on the Rascia tradition, the features of its architecture also exhibit other influences. Of crucial importance here was the choice of builders, who undoubtedly came from the coastal area, which is reflected both in the structural solutions, as well as in the decorative stonework. However, local master-craftsman undoubtedly took part in this achievement. One can see this particularly when observing the stonework which, besides some admittedly rather rare, better-carved pieces, consists of a great deal of carving by less experienced artisans. The assumptions about the origin of the architecture and the builders are substantiated by observing the preserved traces of the frescoes, which show that the decoration of St. Stephan's and the adjacent narthex was also entrusted to one of the coastal painters. Perhaps it was the well-known Dubrovnik painter Dzivan Ugrinovic, who is known to have been commissioned by the grand duke Sandalj in 1429. There is no direct or reliable record of the date when the endowment of the grand duke Sandalj Hranic or its later annexes were built. The stylistic analysis of the stonework makes it possible only roughly to attribute it to the first half of the 15th century. The year 1435 provides a slightly narrower span of time, which is the time of Sandalj's funeral, when it would appear that the church of St. Stephan was already finished. The data mentioned earlier regarding the engagement of builders from Dubrovnik and the possible later decoration, enables us to date it more exactly. Therefore, we may assume that the church itself was erected before the end of the second decade of the 15Lj century. The additional construction of the narthex may have followed soon after the completion of the church itself, as indicated by the stylistically uniform stonework. If we accept the possibility that the church was decorated at the end of the third decade of the 15S century, and that this was finished both in the church and the narthex at the same time the year 1429 would be the terminus ante quem for the completion of the additional construction. The Kosaca endowment, erected beside the Soko castle, offers new evidence about this prominent, noble or ruling family, and particularly about their religious affiliation. Historians, almost as a rule consider the Kosaca family to have been Bogumils, or people whose religious convictions were not particularly firm. Such views were based on the fact that Sandalj Hranic, the grand duke of Rusaga Bosanskog (of the Bosnian kingdom) and his successor, the duke and subsequently the herzeg, Stefan Vukcic, were tolerant towards the Bogumils and were often surrounded by people who upheld such religious beliefs, which was the political reality of the times in which they lived and functioned. On the other hand, the enemies of the Kosaca family made use of this to depict them to the Western and Eastern Christians as heretics, which was not without consequences. The distorted view of their religious conviction not only accompanied them during their lifetime but persists even today, not only in historiography but in present-day politics, as well, particularly after the recent wars in ex-Yugoslavia. The origin of the Kosaca family is connected with the region of the Upper Drina, that is to say, the region that had always been a part of the Nemanjic state, where there were no Bogumils, nor could there be. As owners of part of what had always been the Serbian lands, which went to Bosnia after the tragic division between Ban Tvrtko and Prince Lazar, the consequences of which are still felt today, the Kosaca very soon became independent rulers of this territory, forming a specific territory that later came to be known as Herzegovina. Another element that also bears weight in this respect is the fact that, in contrast to central Bosnia where the Bogumil heresy was influential, the population in the Kosaca lands was Orthodox Christian, with a certain number of Catholics in the western parts. The fact that the regions they ruled were nominally within the Bosnian kingdom, where the ruling class were predominantly Bogumils for a long time did not have any fundamental bearing on their religious affiliation. Significant records have been preserved of their unconcealed Orthodox Christian orientation. Without going into the details of this complex circle of problems, which requires a separate study, especially after the more recent discoveries and facts that have come to light, we shall dwell only on some facts. During the rule of Grand Duke Sandalj and his successor, Herzeg Stefan, which lasted almost seventy years, a whole series of Orthodox Christian churches were erected. During the first half of the 15th century, a kind of renaissance of the Rascia school of architecture came about in this area. In the words of V.J. Djuric, the endowments of the Kosaca family 'are different from the average buildings of their time by virtue of their size sometimes the unusual solutions, and the great beauty of form and proportions'. The wealth of the family and the continual relations with aitists from the southern Adriatic coastal cities imbued their architecture with buoyancy and significance. The western stylistic features of the churches of the Kosaca, and the Gothic language of the stonemasons, reveal the centres where these master craftsmen had learned their trade. With the erection of the endowment in the 'ruling seat' beneath Mt. Soko and the churches intended as their final resting-places, the Kosaca distinguished themselves as the last continuers of the Nemanjic tradition of earlier centuries, in the time that preceded the final Turkish conquest of the Serbian lands. The memory of their work is preserved in the church of St. Stephan and the nearby church at Zagradja, as well as in the rains of the Soko castle, which still lies waiting to be researched.

Abstract Introduction: Treatment of lymphoma, while subtype specific, often includes curative intent combination chemotherapy. There is little evidence on which to base treatment decisions for older patients, and oncologists often rely on their clinical impression and the patient's chronologic age to make treatment decisions. Objective measures may be more accurate and reproducible in predicting eligibility for combination chemotherapy; however their utility in the clinical setting is still under investigation. Objective: The objectives of this pilot study were to assess the feasibility of applying the Hurria (Hurria et al. JCO 2011) and CRASH (Extermann et al. Cancer 2012) chemotherapy toxicity risk stratification measures, as well as physical performance tests, during busy outpatient clinics, and their ability to potentially predict chemotherapy toxicity. Methods: This is a prospective, single centre pilot feasibility study in patients 70 years of age or older, with lymphoma, planned for definitive systemic chemotherapy. Patients completed geriatric tools (eg. Hurria and CRASH questionnaires, gait speed test and grip strength, CSHA Clinical Frailty Scale and Charlson Comorbidity Index) at baseline. Physical performance tests were repeated with each treatment cycle and data were collected on toxicities, hospital admissions, as well as change in treatment cycles or dosing. Primary outcomes were feasibility and time needed to complete the measures; secondary outcomes were correlation between chemotherapy toxicity and geriatric assessment results, and other patient characteristics (stage and ECOG status). Results: Thirty patients have been enrolled to date (out of a target of 30), and 29 have completed all follow-up assessments, with a median age of 77 yrs (range 69-90) for the whole group, and 59% being male. Diagnosis was diffuse large B cell lymphoma in most (59%), followed by CLL (17%), indolent lymphoma (10%), and other (14%). Chemotherapy treatments most commonly included RCHOP (59%), and bendamustine and rituximab (24%). Aggressive histology pts received G-CSF as 1° prophylaxis. The chemotherapy was dose reduced by the treating physician at cycle 1 in 8 patients (28%), and during the course of treatment in 3 pts (10%). Using the Hurria risk stratification score, 7 pts (24%) were low, 17 (59%) were intermediate and 5 (17%) high risk for chemotherapy toxicity. Similarly, the CRASH scoring identified 2 pts (7%) as low, 11 (38%) as medium-low, 14 (48%) as medium-high and 2 (7%) as high risk. The median amount of time needed to complete the Hurria tool was 2 min (1-5 min) vs. 20 min (5-30min) for the CRASH score. Fourteen pts (48%) experienced CTCAE grade 3-5 toxicity, for a total of 25 severe AEs. The most common gr ≥3 AEs was febrile neutropenia (4 pts), anemia and thrombocytopenia (3pts each); other severe AEs, such as upper GI bleed, PE and DVT, rapid atrial fibrillation, and hyponatremia occurred in one pt each. Dose delays occurred in 9 pts (31%) and 5 pts (17%) required hospitalization due to toxicity. The CSHA frailty score and grip strength worsened throughout treatment and had not recovered by the 1 month visit post-treatment, while the 6 meter walk time did not significantly vary over time during treatment (Figure 1). On univariate analysis, the CSHA frailty score and grip strength changes over time, and the Hurria risk score at baseline were significantly associated with any adverse event, while only the CSHA frailty score and Hurria risk score were associated with Grade 3 or higher events (Tables 1 and 2). On multivariate analysis, the CSHA Frailty score and Hurria risk score retained significance for any AE, however when adjusted for CSHA Frailty, the Hurria score was no longer a significant predictor. Conclusion: When perceived fit older patients are treated with full-dose systemic chemotherapy, the rate of toxicity is high. The Hurria tool, takes a short time to administer, and while not previously tested in lymphoma patients, appears to predict toxicity. The CSHA Frailty was the most robust predictor of chemotherapy toxicity in our patient population, and is a very simple measure to administer. The results of this pilot has led us to recommend routine use of these tools in all older lymphoma patients undergoing systemic chemotherapy at our centre, with the aim of further testing their ability to predict chemotherapy toxicity and treatment outcomes, as well as help plan co-interventions. Disclosures Kuruvilla: Abbvie: Consultancy; Princess Margaret Cancer Foundation: Research Funding; Leukemia and Lymphoma Society Canada: Research Funding; Lundbeck: Honoraria; BMS: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Amgen: Honoraria; Roche: Consultancy, Honoraria, Research Funding; Karyopharm: Honoraria; Merck: Consultancy, Honoraria; Celgene: Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Gilead: Consultancy, Honoraria. Crump:Jansen-Ortho: Consultancy; F. Hoffmann-La Roche Ltd: Consultancy; Servier Canada: Consultancy.

Abstract Introduction: Among patients with diffuse large B-cell lymphoma (DLBCL), it is well documented that for unknown reasons men have shorter progression-free and overall survival than women. Recently, a specialized subset of CD4+ T-cells, called regulatory T-cells (T-regs), which can suppress the effector functions of cytotoxic CD8+ T-cells, has been proposed to have a role in controlling tumor progression. While elevated T-regs in animal models of cancer can block anti-tumor responses and thereby enhance tumor growth, paradoxically, high T-regs are associated with improved survival in humans with DLBCL. To our knowledge, the relationship between T-regs and gender has not been investigated. Since T-regs constitutively express FoxP3, a transcription factor of the forkhead family, we used this marker to retrospectively study the number and density of FoxP3+ T-regs in tissue sections from both male and female patients with DLBCL, and to compare their effects on survival. Methods: Tumor microarrays of DLBCL containing three 1 mm diameter cores per patient were immunohistochemically stained for FoxP3 and CD4. We enumerated tumor infiltrating FoxP3+ lymphocytes by counting positive nuclei that crossed the lines of a 1 mm2 10×10 grid in a 10× ocular that was combined with a 40× objective in a BX41 Olympus microscope. The mean FoxP3 T-regs per field and the ratio of FoxP3 T-regs to total CD4+ T-cells were compared between 34 men and 48 women with de novo, non-AIDS related DLBCL. The median values were used as cut-offs for total FoxP3 counts and for FoxP3/CD4 ratios. We analyzed survival differences between “high” and “low” groups by using Kaplan-Meier curves and Logrank tests. Cox regression analyses were used to compare mortality after adjusting for age and staging. Results: Men had lower values than women both for mean total FoxP3 counts (7.05 vs 8.15, p=0.636) and for mean FoxP3/CD4 ratios (0.31 vs 0.51, p=0.183). Differences between genders in the proportion above the overall median (“high” group) were statistically significant when comparing total FoxP3 counts (32.4% in men vs. 60.4% in women, p=0.012) and FoxP3/CD4 ratios (35.3% vs. 58.3%, p=0.040). Using gender-specific cut-offs, higher FoxP3/CD4 ratios were associated with worse overall survival in men (Figure 1, p=0.052), but improved overall survival in women (Figure 2, p=0.047). The crude hazard ratio comparing groups with gender-specific “high” vs. “low” FoxP3/CD4 ratios was 3.99 (p=0.077) in men and 0.33 (p=0.061) in women. Adjusting for age did not result in significant changes, but adjusting for stage at diagnosis shifted the hazard ratios toward the null (1.06, p=0.947 in men and 0.45, p=0.218 in women). In men, those in the “high” FOXP3/CD4 ratio group appeared more likely to have stage 3 or 4 disease at diagnosis compared to the “low” group (66.7% vs 36.8%, p=0.139). This was not seen in women (33.3% vs 38.9%, p=0.718). Conclusions: More T-regs infiltrated DLBCL in women than in men. This is difficult to explain, but could be a clue to the relationship between survival and gender in DLBCL. Paradoxically, high T-regs predicted worse overall survival in men, but better overall survival in women. Also, stage 3 or 4 disease at diagnosis was associated with high T-regs in men but not in women. To confirm the significance of these findings, a larger sample size and prospective study design will be needed. Figure 1 Survival in Men with DLBCL by FoxP3/CD4
 p=0.052 Figure 1. Survival in Men with DLBCL by FoxP3/CD4
 p=0.052 Figure 2 Survival in Women with DLBCL by FoxP3/CD4
 p=0.048 Figure 2. Survival in Women with DLBCL by FoxP3/CD4
 p=0.048

Colossus of Rhodes: Where It Stood and How It Was Made The author, just as Ursula Vedder, who has expressed the same opinion recently, has been long sure that the place where the Colossus of Rhodes was located was the acropolis of the town of Rhodes. The paper includes also some arguments that have not been presented by the German scholar. At first, some source information concerning the Colossus has been briefly summarized. For instance, the expression in APV, 171 (Overbeck 1543), ou gar hyper pelagos monon anthesan alla kai en ga, may be understood as confirming its location in the acropolis: “it stood not only close to the sea, but also on the earth.” In fact, there it would have loomed over the land and the sea, and, as big as it was, it could be seen from a distance. The text by Philo of Byzantium is not credible, as it was written quite late. Then the problem has been analyzed critically. As regards the legend of Colossus bestriding the entrance to the harbor, one may add to the already listed counterarguments that for static reasons a piece of sculpture shaped that way would have needed a third footing attached to the sea bottom at the harbor entrance, which would have made the ships’ access to the harbor difficult. Besides, such a pose of a god would have seemed a little indecent. A hypothesis that situates the Colossus at the end of a pier in the Mandraki Bay, preferred by many scholars, also has its weak points. Placed there, the construction site would have been too small, particularly that construction took at least twelve years, and it would have been difficult to move building materials along the narrow and long pier which under such circumstances could not be used as part of the harbor. According to Strabo (XIV, 2, 5) the harbor was accessible only to authorized personnel. Was it then a good location for a work of art intended to glorify the people of Rhodes? Even if the Colossus had been accessible there, it would have been visible only in a shortened perspective, in frog’s eye view. Still, the most important was the problem of proper display of the statue. Placed on the pier, it would have to turn its back either to the town, or to the sea, and in both cases connotations would have been unwelcome. Such details were essential for ancient Greeks. For static and constructional reasons, one must also reject a hypothesis that the Colossus put his palm over the eyes, as if examining the horizon. If it is true that the relics of the statue remained for several hundred years intact, they would have blocked access to the harbor since most probably they would have fallen into the sea. Besides, would the iron elements have resisted corrosion well enough to be recognizable? Placed on the pier, the Colossus would have been invisible to the crews of ships approaching the town from the west and the same would have been true had it been situated at the present location of the palace of the Great Masters of the Knights Hospitaller. The placement of the statue in the sanctuary of Helios at the present corner of Sofouli and Khimaras streets is also improbable, since the area is really small and the Colossus would not have made a prominent component of the town skyline. Hence, the acropolis must have been the most convenient place, just as in other Greek towns, particularly in Athens where it was the site of the city patron’s worship. Some scholars argue that the temple in the acropolis was dedicated to Apollo, but when the Colossus was constructed Apollo was commonly identified with Helios who was the most important patron of the island. The statue, with his face turned to the east – the town and the sea – might have stood near that temple (ill. 1-2), towering over it. From the west, the steep rock of the acropolis practically made it impossible to watch the Colossus from the western shore, while from the sea it was visible only as a silhouette, an orientation point for the approaching ships (ill. 3), particularly if it was gilded like the statue of Athena Promachos in Athens. This can actually be the origin of the legend that the Colossus of Rhodes was also a lighthouse. Situated in the acropolis, the statue would have been visible both from the town and the sea on both sides of the island. If the damaged Colossus remained intact for centuries, it was because removing it from the acropolis was much more difficult than removing from the wharf. The noun “colossus” originally meant “something towering” (cf. Colossae and Colophon, towns upon hills). The other part of the paper focuses on the technology of construction. Some scholars were too eager to draw from Philo’s description conclusions about the Colossus’ structure and the building methods applied. If the statue had stood at the end of the pier, most likely it would not have been hilled up since the area was too small. Due to the pressure of dirt, boarding such an embankment (A. Gabriel’s claim) would have required 40-45 meter long struts for which there was no room. Moreover, with each subsequent raising of the embankment the struts would have to be multiplied and made much longer, which would have been both costly and technologically challenging. With each new layer of dirt, founding furnaces would have to be removed (as, according to Gabriel, they were located on the embankment) and then put back. A high embankment would have required the use of gigantic ladders, unstable and dangerous. What is more, it would have made it impossible to control the form of the work in progress. All that would have been irrational, while ancient Greeks do not really deserve such a charge. In the author’s opinion, the Colossus was erected within a wooden scaffolding. Founding particular elements of the statue on site was rather unlikely. An external dirt coat would not have helped since there was no clay core inside it, which would have made the alloy’s cooling speed radically unequal. Partial casting is also unlikely as it would have required a 1:1 model (30-35 meters high). Had the model been smaller, errors in calculating detailed measurements would have been inevitable. The author believes that the Colossus of Rhodes was made of hammered bronze sheets riveted to the inner metal skeleton. Such a technique made vertical transportation easier and allowed the constructors to correct the process of montage by bending the sheets whenever necessary. It cannot be excluded that the heads of the rivets and lines of contact between the sheets were masked with solders that did not require much alloy, although in higher sections of the statue the wind would have cooled it quite rapidly. The noun “colossus” did not originally imply a gigantic size but only a slightly archaic look of the sculpture so that the Colossus of Rhodes might have been somewhat similar to very ancient and artistically primitive stiff statues of Helios. On the other hand, it might have alluded to the mythic Telchins who were the first to make statues of gods. (For static reasons, contrapposto was out of the question in the statues of that size, besides it would have been impossible to fill its interior with stones.) Another aspect of making the Colossus look archaic was the use of a modified technique of sphyrelaton. In the author’s opinion, the base of the statue and maybe its higher parts as well, up to the level of ankles, contained carefully sized and braced blocks of stone. They were drilled through to hold the lower ends of the metal internal skeleton made according to the schema of a spatial grid, perhaps used on that occasion for the first time in history. Such a fixture protected the Colossus from the wind pressure so effectively that it remained standing for dozens of years, being vulnerable to earthquakes. The fallen Colossus must have looked like a debris of rods and tin, while the stones from the fixture could be seen in the “abyss” (Plinius), below the level of the ankles, where the structure was actually bent (it must have been bent there rather than at the level of the knees, since looking inside the ruin was easy: the ankles were situated about two meters above the base.) The third footing point might have been camouflaged with some attribute (a spear or a torch). It cannot be excluded that originally Chares had been planning a statue half the final size, similar to the previously known colossal pieces of sculpture, but the pride of the people of Rhodes, emulating Athenians, made them want a Colossus twice as big (Sextus Empiricus, pros mathem., VII, 107 n.). Making the statue look archaic and using an old technology plus some innovations allowed Chares to make their extravagant wish come true. The archaic look might have been achieved thanks to a reference to some old statue of Helios, which perhaps could be found in the neighboring temple. The torso might have been topped with the head, cast separately, although the trouble with placing it so high makes one doubt it.

Background: Hypomethylating agents (HMAs) can confer transfusion independence and prolong overall survival (OS) in patients with myelodysplastic syndromes (MDS), but response rates are < 50% and depend on sustained administration. In Ontario, 33% of higher risk MDS patients receive < 4 cycles AZA and have very short survival. Identifying the patients unsuitable for HMAs and the factors predictive of overall survival (OS)/leukemia free survival (LFS) would be of value. MDS-CAN, the national MDS registry prospectively evaluates patient-related factors in addition to disease factors in MDS, MDS/MPN, and oligoblastic AML patients. Objective: Determine the factors predictive of OS/LFS and the completion of ≥ 4 cycles of HMA, with particular focus on frailty and comorbidity. Methods: All patients who had received HMAs (azacytidine (AZA), decitabine, guadecitabine, ASTX727) were eligible. Frailty was assessed using the Rockwood clinical frailty scale (CFS) and the frailty index (FI) comprised of 42 deficits we previously developed. The MDS-FI was calculated using baseline measurements of comorbidities, laboratory values, Lawton Brody instrumental activities of daily living (LB-IADL), quality of life (EQ-5D), and 3 physical fitness tests. Patients who had ≤ 13 missing variables on the MDS-FI were included. Kaplan-Meier (KM) OS curves were calculated from treatment start date to death or last follow up. Univariable and multivariable analysis was done to identify significant predictors of OS, LFS and the receipt of ≥ 4 cycles of HMA. Results: There were 422 patients treated with an HMA (94% AZA). FI scores could be calculated in 188 patients and CFS in 169 patients. Among the 188 patients, the median age at HMA start was 73 years old (IQR 67, 79), time from diagnosis was 10 months (IQR 2, 28), 66% of patients were high/intermediate-2 risk IPSS, and 72% were high/very high risk IPSS-R. 40% were transfusion dependent, 30% had poor/very poor cytogenetics, and 10% had oligoblastic AML. Median number of HMA cycles was 7 and 76% completed ≥ 4 cycles. The median follow up was 12 months (IQR 7, 25). 19% of patients developed AML. Actuarial median OS was 17 months (95% CI: 13-20) with 50% of deaths due to AML or progressive disease. The MDS-FI score was grouped into categories of 1, 2, and 3 (scores ≤0.2, 0.2-3, and >3, respectively), with a median score of 0.3 (IQR 0.2, 0.3). The median scores for the clinical frailty scale (CFS), Charlson comorbidity index (CCI), and MDS-specific comorbidity index (CI) were 3 (IQR 2, 4), 1 (IQR 0, 2), and 0 (IQR 0, 2) respectively. 21% of patients had cardiac comorbidity(s), 53% had ≥ 1 disability (LB-IADL), and 76% had ≥ 1 impaired symptoms or function on the EQ5D, the most common being usual activities (45%) and pain/discomfort (44%). On physical testing, 56%, 30% and 88% had partial or full deficits in grip strength, 4 meter walk and the 10x chair stand tests compared with age/sex matched reference standards. Those who completed ≥ 4 cycles of AZA compared with those that did not were more likely to be younger (73 vs 78 years old, p=0.002), have lower risk disease (IPSS-R very low/low/intermediate: 29 versus 13%, p=0.044), have lower comorbidity (MDS-CI score: 0 vs 1, p=0.006), lower frailty scores (CFS: 2 versus 3, p=0.008) and performed better on grip strength (31 vs 26 kg, p=0.021) and the 10x chair stand test (28 vs 30s, p=0.045). Predictive factors from univariate analysis are presented on Table 1. There was a trend towards receiving fewer HMA cycles if patients fell within higher FI categories (8 vs 7 vs 5 cycles, p=NS). OS declined with increasing FI categories (p=0.002, Fig 1a). In subgroup analysis by IPSS or IPSS-R score, the FI further stratified the OS of patients with IPSS high/intermediate-2 (p=0.001, Fig 1b) and IPSS-R very high/high risk groups (p=0.002, Fig 1c). The best multivariate model for OS included IPSS (p=0.001), LDH (p=0.001), and MDS-CI (p<0.001). Multivariate predictors of LFS included LDH (p=0.024) and IPSS (p=0.042). IPSS-R (p=0.011), MDS-CI (p=0.007) and grip strength (p=0.007) were independent predictors of receiving ≥4 cycles of HMA. Conclusions: Frailty and comorbidity provide important prognostic information for clinical outcomes in MDS patients receiving hypomethylating agents. The evaluation of patient characteristics in addition to disease parameters should be an integral part of clinical decision-making. Disclosures Wells: Alexion: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding. Rockwood:Alzheimer Society of Canada: Research Funding; Lundbeck: Membership on an entity's Board of Directors or advisory committees; Canadian consortium on neurodegeneration in aging and nutricia: Membership on an entity's Board of Directors or advisory committees; Foundation Family Fund: Research Funding; Pfizer: Research Funding; Capital Health research support: Research Funding; Sanofi: Research Funding; CIHR: Research Funding; Nova Scotia Health research foundation: Research Funding. Geddes:Celgene: Honoraria, Research Funding; Alexion: Honoraria, Research Funding; Novartis: Honoraria, Research Funding. Sabloff:Actinium Pharmaceuticals, Inc: Membership on an entity's Board of Directors or advisory committees; Sanofi Canada: Research Funding; Astellas Pharma Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; ASTX: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees. Keating:Sanofi: Membership on an entity's Board of Directors or advisory committees; Hoffman La Roche: Membership on an entity's Board of Directors or advisory committees; Shire: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy; Novartis: Honoraria; Celgene: Membership on an entity's Board of Directors or advisory committees. Leber:Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene Corporation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz: Honoraria, Membership on an entity's Board of Directors or advisory committees; Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Leitch:Celgene Corporation: Honoraria, Research Funding; Otsuka: Honoraria; Novartis: Honoraria, Research Funding, Speakers Bureau; Alexion: Research Funding; AbbVie: Research Funding. Yee:Takeda: Membership on an entity's Board of Directors or advisory committees; Merck: Research Funding; Astellas: Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium: Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Astex: Research Funding; Hoffman La Roche: Research Funding; MedImmune: Research Funding. St-Hilaire:Teva: Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Finn:Sanofi: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria; Ipsen: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Lundbeck: Membership on an entity's Board of Directors or advisory committees; Merck: Research Funding; Astra Zeneca: Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Boehringer Ingelheim: Research Funding; Alexion: Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Storring:Novartis: Honoraria, Research Funding; Abbvie: Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees. Nevill:Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees; Paladin Labs: Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Otsuka: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Shamy:Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees; Abbie: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees. Banerji:Roche: Honoraria, Licensing fee, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; LLSC: Research Funding; Research Manitoba: Research Funding; CCMF: Research Funding; CancerCare Manitoba/University of Manitoba: Employment; CAPhO: Honoraria; BIOGEN: Other: Licensing fee; Dana-Farber Cancer Institute: Other: Licencing fee; Abbvie: Consultancy, Honoraria; CIHR: Research Funding; Gilead: Consultancy, Honoraria, Research Funding; Astra-Zeneca: Consultancy, Honoraria. Delage:Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding. Buckstein:Celgene: Consultancy, Honoraria, Research Funding; Takeda: Research Funding.

Den sicheren Kommunikationskanal des Smart Meter Gateways so effektiv wie möglich nutzen. Mit diesem Vorhaben beschäftigen sich viele Energieversorger und Messstellenbetreiber. Mit der „Controllable Local Systems“-Schnittstelle stellt das Smart Meter Gateway hierfür einen universell nutzbaren Proxy-Kanal zur Verfügung, über den die unterschiedlichsten Anwendungen integriert werden können. Das Potenzial hat auch die Thüringer Mess- und Zählerwesen Service GmbH erkannt und bindet so auf dem Weg zum Smart Grid Anlagen und Anwendungen an die sichere Infrastruktur an.

Die Sagemcom Dr. Neuhaus GmbH, Spezialist für Smart Metering, Smart Grid und M2M-Kommunikation, wartet wie sieben weitere Hersteller von Smart Meter Gateways auf die Zertifizierung ihrer Geräte durch das BSI. Die Hamburger tun das mit relativer Gelassenheit, weil sie sich für den Startschuss zum Rollout intelligenter Messgeräte gut gewappnet fühlen. Worin der Optimismus im Detail wurzelt, erläuterte Dr. Holger Graetz, Director Sales & Marketing, gegenüber der BWK-Redaktion.

Background: Intravenous vitamin C therapy has been associated with reduced mortality in patients with sepsis. Of potential concern with this therapy are falsely elevated point-of-care (POC) blood glucose values vs laboratory analyzed (LA) readings. The purpose of this study was to compare POC and LA blood glucose measurements in patients receiving intravenous vitamin C therapy. Methods: All adults (≥18 years old) admitted from January 2017 to December 2018 who received at least two doses of intravenous vitamin C and had at least one paired blood glucose collection were eligible for inclusion. The primary endpoint was the accuracy in paired blood glucose values determined using the International Organization for Standardization (ISO) 15197:2013 criteria. Paired values were assessed for clinical impact using the Parkes consensus error grid analysis. A subgroup analysis was conducted to determine the impact of impaired renal function on outcomes. Results: Fourteen patients were included for analysis with 46 paired blood glucose levels. Compliance with ISO15197:2013 criteria was met in 34 (73.9%) paired values, which did not meet the minimum criteria for accuracy. Subgroup analysis showed that the paired values from patients with impaired renal function did not meet the minimum requirements for compliance, while those from patients without impaired renal function did. The Parkes error grid showed that the variation in POC measurements likely had minimal clinical impact. Conclusions: Our study suggests that most patients receiving vitamin C for sepsis may still be monitored at POC with the glucose meter used in our study with minimal clinical impact.

Introduction: There is growing literature supporting the significance of frailty in a broad array of cardiovascular diseases. To our knowledge, there are no studies specifically examining the application of frailty assessment to an advanced heart failure population. Methods: Forty consecutive elderly (>65 yrs of age) subjects were enrolled from the heart failure clinic at Montefiore Medical Center, if they had advanced heart failure as defined by: LVEF < 35%, NYHA Class 3 or 4, and a 6 minute walk (6mwt) < 300 meters. At baseline, subjects were assessed for frailty with the Fried Frailty Index, which consists of 5 components: hand grip strength (HGS), 15 meter walk time (WT), weight loss, low physical activity and exhaustion. Each component is assigned a score of 0 or 1 and summed for the total score: 0 = not frail, 1-2 = intermediately frail, ≥3 = frail. Subjects were prospectively followed at 3 month intervals for mortality or heart failure related hospitalizations. Results: Follow-up was available for 38 subjects at a median length of 437 days (range: 12-549). At baseline, the mean age of the cohort was 74±7 yrs, LVEF 27±7%, and 6mwt 189±80m. None of the patients tested were not frail, 32% (12) were intermediately frail, and 68% (26) were frail. More patients in the frail group (N=7) expired during follow up then those in the intermediately frail group (N=1) although this did not reach statistically significance (Figure; 1). Since there was a limited spectrum of frailty in this cohort, HGS and WT were assessed as continuous measures for association with outcomes. Both objective tools demonstrated a strong trend towards mortality (p=0.08). There was no association between the composite or individual score and hospitalizations. Conclusions: In this pilot study of frailty assessment in advanced heart failure, the objective tools of WT and HGS tended to be associated with mortality. These preliminary results warrant further investigation.

Background: At present, it is unclear whether older, obese persons with or without sarcopenia respond differently to training. Furthermore, there are no differentiated recommendations for resistance training for this special target group. Objectives: The objectives are to investigate the changes in the physical parameters of older, obese men caused by training and to reappraise the modalities of resistance training for older persons. Design: Pre-test-post-test design. Participants: The participants were 33 physically inactive and obese older men (≥ 65 years, BMI ≥ 30 kg/m2), with-out severe diseases. Subjects were divided into two groups: NSAR (no or presarcopenia, n= 15) or SAR (sarcopenia, n= 18). Intervention: The intervention consisted of progressive resistance training, twice a week for 16 weeks with finally 80-85% of maximum strength and three sets with 8-12 repetitions. The training contained six exercises for the major muscle groups. Measurements: Sarcopenia was assessed using the Short Physical Performance Battery (SPPB), hand-grip strength, skeletal muscle mass index (SMI), and gait speed over a 6-meter walkway. Furthermore, the maximum dynamic strength (1 RM) was assessed. Results: At baseline, the NSAR group had significantly better values in SMI, SPPB score, hand-grip strength, and 1 RM. After training, the results in both groups displayed an increase in 1 RM at the lower limbs (NSAR 18%, SAR 38%) and the upper limbs (NSAR 12%, SAR 14%). Also, the SPPB score (NSAR 11%, SAR 15%) and the 6-m-gait speed (NSAR 5%, SAR 10%) increased. The SAR group was able to increase their right hand-grip strength by 12%, whereas the NSAR group maintained their initial high strength values. SMI did not change in both groups. Conclusions: Both groups show improvements after resistance training with slightly more benefits for men with sarcopenia. Results of this study can be used to define specific training regimens for N(SAR) subjects.

Fred Huijgen schreef in 2002 in het Tijdschrift voor Arbeidsvraagstukken (TvA) een column met de titel 'ICT en Arbeid. Herhaling van zetten' (Huijgen, 2002). En zo is het maar net! We zien die herhaling van zetten opnieuw. Het is bijna grappig om in discussies, ook van wetenschappers, te lezen over het nieuwe verschijnsel van 'polarisatie' van functies. Er is kennelijk weinig historisch bewustzijn. TvA publiceert al vanaf de jaren tachtig over de kwalitatieve structuur van de werkgelegenheid (degradatie, regradatie, polarisatie) (Huijgen c.s.) en over winnaars en verliezers op de arbeidsmarkt (De Grip c.s.). Om de verbreiding van informatietechnologie, micro-elektronica en robots in de jaren tachtig in goede banen te leiden was er een hausse in activiteiten van met name de overheid (advies, onderzoek, subsidies functie- en arbeidsplaatsverbetering, wetgeving 'welzijn bij de arbeid') en de vakbonden (voorlichting, scholing, Steunpunt Technologie, technologieovereenkomsten, werknemersplannen). Ook de Sociaal-Economische Raad (SER) pakte die uitdaging aan met het project 'Stuur- en regeltaken' om de arbeidsorganisatie en de kwaliteit van de arbeid in goede banen te leiden bij de overgang van analoge besturing (wanden met meters in controlekamers) naar digitale besturing (enkele beeldschermen). De SER had zoiets ook in een eerdere periode van automatisering in de jaren zestig gedaan met projecten 'Werkstructurering' (taakroulatie en taakverrijking) en projecten 'Werkoverleg'. Voor de lezers van dit tijdschrift is het wellicht interessant om te weten dat organisatiesocioloog Cor Lammers daarbij was betrokken vanuit het toenmalige Nederlands Instituut voor Praeventieve Geneeskunde.

Background: While some studies report muscle strength is associated with mortality, independent of aerobic physical activity (PA), in older people, there are less data in women and lack of studies adjusting the association for objective measures of PA and physical performance. We prospectively examined this association in 5,061 multiethnic (White, 48.2%; Black, 34.0%; Hispanic, 17.9%) women ages 63-99 (mean 78.3) with complete information for analysis in the Objective Physical Activity and Cardiovascular Health Study. Methods: Quartile categories of dominant hand grip strength (<14, 14-18, 18.1-22.5, >22.5 kg) and EPESE categories of time to complete five consecutive unassisted chair stands (>16.6, 16.6-13.7, 13.6-11.2, <11.2 sec) were the muscle strength exposure measures. Primary covariables included age, race-ethnicity, current smoking, BMI, and number of comorbidities. Accelerometer measured moderate-to-vigorous PA (MVPA) and total sedentary time, and gait speed during a self-paced 8 meter walk test were further assessed as confounding factors. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: There were 306 (5.5%) all-cause deaths during a mean 3.3 year follow-up. Adjusting for primary covariables, significant inverse trends in mortality were observed across categories of grip strength, HR (95% CI) = 1.00 (ref), 0.70 (0.53, 0.93), 0.77 (0.56, 1.05), 0.59 (0.41, 0.87), trend p = .007, and chair stands, 1.00, 0.82 (0.62, 1.09), 0.76 (0.55, 1.04), 0.53 (0.36, 0.77), trend p <.001. Further adjustment for MVPA attenuated these associations which remained statistically significant, 1.00, 0.72, 0.81, 0.66, trend p = .032, and 1.00, 0.91, 0.88, 0.65, trend p = .033, respectively. Similarly, adding sedentary time or gait speed to the primary covariables did not eliminate significance of the inverse mortality trends with either muscle strength measure. Adjusting for primary covariables, each 1-standard deviation (6.2 sec) faster chair stand time was associated with 12% lower mortality risk (p = .004), which was attenuated to 8% risk reduction (p = .04) when further controlling for MVPA. Adjusting for primary covariables and MVPA, each 1-standard deviation (6.8 kg) increment in grip strength was associated with 13% lower mortality risk (p = .04), and this inverse association was generally consistent across subgroups defined by age (interaction p = .78), race-ethnicity (p = .19), and BMI (p = .88). Controlling for gait speed opposed to MVPA resulted in consistent findings. Conclusions: Higher muscular strength is associated with lower mortality in older women, independent of device-measured MVPA and sedentary time, and measured gait speed, an indicator of aerobic fitness. If results are confirmed, in addition to guideline recommendations regarding aerobic PA, promoting skeletal muscle strength is an important component of aging well.

The process of modernisation can be understood to have contributed to a radical loss of collective and individual orientation, by depriving geography of identity, and replacing ‘place’ by ‘space’. "Space", writes Klapp, "robs identity. Place, on the other hand, nurtures it, tells you who you are" (28). If the replacement of place by space is an achievement of modernity, the replacement of space by time can be considered a postmodern hallmark. The fact is that cultures are now bounded as entities more in time than in space, and "time depth now prevails over field depth" (Virilio 24). It is, in other words, the unfolding of time that reflects change more immediately than does spatial distance. In fact space itself is now defined by time. The 200-year development course of the meter as the unit of length, for example, displays an interesting parallel to the space-time transition. In 1793 the French government decided the unit of length to be 10-7 of the earth's quadrant passing through Paris and to be called meter. It became clear in further examinations that the earth's quadrant had been miscalculated, but this discovery did not stop the use of the unit. Initially referred to as "meter of the archives", the unit was announced in 1799 to be based on a measurement of a meridian between Dunkirk and Barcelona, embodied by a rectangular platinum bar with polished parallel ends. This bar, which was supposed to equal one ten-millionth (10-7) part of the quadrant of the earth, went on to serve as the international standard of length throughout the 19th century. In 1872, the length was set as the official definition of meter by the International Commission of the Meter, even though it was admitted that "its relationship to a quadrant of the earth was tenuous and of little consequence anyway"1. The original bar was then replaced by another platinum-iridium line tool which was christened "the international prototype meter" and its 'copies' were distributed between member countries of the International Metric Convention in 1889. This definition was to serve as the reference of length until the mid-twentieth century. In 1960, following decades of deliberation, meter was redefined in the Eleventh General Conference on Weights and Measures as "1,659,763.73 vacuum wavelengths of light resulting from unperturbed atomic energy level transition 2p10 - 5d5 of the krypton isotope having an atomic weight of 86". This is an interesting development, because now the concept of length is removed from a geographical reference like the distance between Dunkirk and Barcelona to a 'virtual', non-geographical space like the distance between the peaks of the sine waves of a certain type of light. Finally in 1983 the meter was redefined once again. This time the definition refers directly to time as the unit for measuring space. The meter is defined currently as "the length of the path travelled by light in vacuum during a time interval of 1/299,792,458 of a second". A fast glance at this history reveals the absence of 'real' reference for what we have come to accept as the 'standard' unit, and the unstable nature of this unit. More intriguingly, the course of development of this definition portrays the gradual progression of reference from geographic place to virtual space and from there to time. Shrinking Time If the modern question of identity concerned locality and spatial reference, what informs the question of identity in the postmodern condition is primarily defined by temporal locatedness and virtual geography or even virtual space. This progression then causes speed to inevitably inform the issue of identification reference. The speed of environmental change is gradually approaching a point where identity could lack a reference, a precedence with which to identify oneself. The conflict is fundamental: if self-identification has traditionally always already implied a reference in time, then acceleration is inherently the enemy of identity, by continuously curtailing the ‘stuff’ identity is made of. It is not a coincidence perhaps that the concerns of social sciences have gradually moved from being able to predict the future to being content with simply explaining the present, as the high speed of change leaves little room for the luxury of prediction. If the modern question of identity concerned locality and spatial reference, what informs the question of identity in the postmodern condition is primarily defined by temporal locatedness and virtual geography or even virtual space. This progression then causes speed to inevitably inform the issue of identification reference. The speed of environmental change is gradually approaching a point where identity could lack a reference, a precedence with which to identify oneself. The conflict is fundamental: if self-identification has traditionally always already implied a reference in time, then acceleration is inherently the enemy of identity, by continuously curtailing the ‘stuff’ identity is made of. It is not a coincidence perhaps that the concerns of social sciences have gradually moved from being able to predict the future to being content with simply explaining the present, as the high speed of change leaves little room for the luxury of prediction. If we describe the postmodern condition as a condition where ‘the critical referential distance’ of identity approaches zero (the contraction of time), then the increase in speed of change can, theoretically at least, lead to a reversal of the orders of reference (see above). This may in fact be conceptualised as a reversal in the order of signification, so that the signifier precedes the signified. Though extremely important for a theory of posthuman identity, the possibility and implications of such reversal are not within the scope of the present paper. Presently applicable, however, is the more-or-less current postmodern predicament, within which self-identification seems to be running short of reference. To imagine a system of meaning wherein the act of self-identification (as traditionally done by humans) is unfeasible is to imagine a constant state of flux, a seamless ocean of meaning, a state traditionally considered pathological and diagnosed schizoid: a "smooth space," which is "in principle infinite, open, and unlimited in every direction"; and which "has neither top nor bottom nor centre" (Deleuze & Guattari 476). It is not difficult to realise that the ‘self’ native to this environment cannot be the human self we are familiar with. In the words of Gergen, the postmodern self resides in "a continuous state of construction and reconstruction", a fluid landscape where "each reality of self gives way to reflexive questioning, irony, and ultimately the playful probing of yet another reality", a reality where "the centre fails to hold" (6). While such conception of a posthuman to come may appear fantastic, the undeniable fact is that the postmodern condition is constantly expanding its reach, erasing boundaries, transforming nations, and dissolving temporal horizons. "Here as elsewhere, in our ordinary everyday life", writes Virilio, "we are passing from the extensive time of history to the intensive time of an instantaneity without history made possible by the technologies of the hour" (24-5). Conclusion As the progression of speed renders space and time as constituents of human reality less inflexible, it becomes imperative for any new theory of identity to accommodate a conception of ‘identity’ ultimately unconstrained by these grids. Such theoretical argument, however, needs to be accompanied by serious political considerations. Despite the specific philosophical perspective endorsed through the language of this paper, and while accepting Bauman’s suggestion that "identity is a name given to the sought escape from uncertainty" (82), I would insist nonetheless that political and clinical concerns demand certain concepts-to-work-with, certain constructions meant to ‘translate’ Being into the human reality. True, such translation spells ‘violence’, but the fact is that in a final analysis violence appears as the ‘other’ name for being, and any semiotic construction of the world always already exists through a systemised (if partial) negation of Being. That is to say, a philosophical appreciation of the void behind the term "identity" does not necessarily render a conceptualisation of identity futile. The challenge, however, may lie in gradually freeing the concept, so as to move as far as possible from positivistic reification towards the least rigid conceptualisations permitted within the current discourse of a given era. Currently, for example, the notions of change and fluidity championed by postmodern thinkers may provide useful metaphors towards such liberation of the working concept. Footnotes The information on the history of the meter is from the National Institute of Standards and Technology of the Government of the United States, through the Manufacturing Engineering Lab Web Site: http://www.mel.nist.gov. References Bauman, Z. Life in Fragments: Essays in Postmodern Morality. Cambridge: Blackwell, 1995. Deleuze, G., and F. Guattari. Anti-Oedipus: Capitalism and Schizophrenia. Trans. Robert Hurley, Mark Seem, and Helen Lane. New York: Viking, 1977. Gergen, K. J. The Saturated Self: Dilemmas of Identity in Contemporary Life. New York: Basic Books, 1991. Klapp, O. E. Collective Search for Identity. New York: Holt, Reinhart, and Winston, 1969. Fraser, J. T. "An Embarrassment of Proper Times: A Foreword." Time: Modern and Postmodern Experience. By Helga Nowotny. Cambridge, UK: Polity Press, 1994. Virilio, P. Polar Inertia. Trans. Patrick Camiller. London: Sage Publications, 2000. Citation reference for this article MLA style: Sadeq Rahimi. "Identities without a Reference: Towards a Theory of Posthuman Identity." M/C: A Journal of Media and Culture 3.3 (2000). [your date of access] <http://www.api-network.com/mc/0006/identity.php>. Chicago style: Sadeq Rahimi, "Identities without a Reference: Towards a Theory of Posthuman Identity," M/C: A Journal of Media and Culture 3, no. 3 (2000), <http://www.api-network.com/mc/0006/identity.php> ([your date of access]). APA style: Sadeq Rahimi. (2000) Identities without a reference: towards a theory of posthuman identity. M/C: A Journal of Media and Culture 3(3). <http://www.api-network.com/mc/0006/identity.php> ([your date of access]).

Abstract Background Weight loss (WL) has been considered as a prognostic factor in heart failure with reduced ejection fraction (HFrEF). However, the prognosis and associated factors of WL in heart failure with preserved ejection fraction (HFpEF) have remained unclear. Purpose This study aimed to examine the prevalence, prognosis, and clinical characteristics of worse prognosis based on the identified WL after discharge in HFpEF. Methods The study was conducted as a part of a multicenter cohort study (Flagship). The cohort study enrolled ambulatory HF who hospitalized due to acute HF or exacerbation of chronic HF. Patients with severe cognitive, psychological disorders or readmitted within 6-month after discharge were excluded in the study. WL was defined as ≥5% weight loss in 6-month after discharge and HFpEF was defined as left ventricular ejection fraction (LVEF) ≥50% at discharge. Age, gender, etiology, prior HF hospitalization, New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-proBNP), anemia (hemoglobin; male <13g/dL, female <12g/dL), serum albumin, Geriatric Depression Scale, hand grip strength and comorbidities were collected at discharge. Patients were stratified according to their body mass index (BMI) at discharge as non-obese (BMI <25) or obese (BMI ≥25). We analyzed the association between WL and HF rehospitalization from 6 month to 2 years after discharge using Kaplan-Meier curve analysis and Cox regression analysis adjusted for age and gender, and clinical characteristics associated to worse prognosis in WL using logistic regression analysis adjusted for potential confounders in HFpEF. Results A total of 619 patients with HFpEF were included in the analysis. The prevalence of WL was 12.9% in 482 non-obese and 15.3% in 137 obese patients. During 2 years, 72 patients were readmitted for HF (non-obese: 48, obese: 24). WL in non-obese independently associated with poor prognosis (hazard ratio: 2.2: 95% confidence interval: 1.13–4.25) after adjustment for age and sex, while WL in obese patients did not. Logistic regression analysis chose age (odds ratio 1.02 per 1 year; 1.00–1.05), anemia (2.14; 1.32–3.48), and BNP ≥200pg/mL or NT-proBNP ≥900pg/mL (1.83; 1.18–2.86) as independent associated factors for worse prognosis of WL in non-obese patients. Conclusion In HFpEF, WL in early after discharge in non-obese elderly patients may be a prognostic indicator for HF rehospitalization. HF management including WL prevention along with controlling anemia is likely to improve prognosis in this population. Kaplan Meier survival curves Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): A Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science

In Eskom Holdings SOC Ltd v Masinda1 (‘Masinda’) teams from the appellant removed various illegal connections to the national electricity reticulation grid. The removal was animated by a concern for the well-being of those people living in homes with illegal connections and to prevent damage to their property as a result of these dangerous connections.2 While the exact reasons for the removal of the illegal connections were not clearly articulated in the appellant’s submissions, it appears that the connections constituted an immediate danger to the public because the equipment were too small; it did not meet the prescribed quality standards; and it was not installed by an authorised contractor.3 The respondent argued that she used the electricity in her home by drawing supply through a prepaid meter and that this supply constituted an incident of her occupation. She successfully sought the restoration ante omnia of the electricity supply to her home in the Eastern Cape Division of the High Court, Mtatha.4 On appeal Leach JA reasoned that it could not have been the intention of the court a quo to order the restoration ante omnia of a connection ‘that was unlawful and a danger to the public.’ Restoration ante omnia that ‘complied with the necessary requirements of safety’ would not only have required the appellant to do something more than restoring the property to its former state,5 but also extended the purpose of the spoliation remedy to include the ‘reconstituted equivalent’6 of the specified property.7 However, if the court a quo intended the restoration ante omnia of an unlawful and dangerous electricity supply,8 the further difficulty would be that the order would be directing the appellant to ‘commit an illegality’ which itself would be sufficient for a court to refuse the spoliation remedy.9 Finally, Leach JA reasoned that the mere existence of an electricity reticulation supply in the respondent’s home is insufficient to afford her a right that qualified as an incident of her occupation.10 He therefore upheld the appeal11 and dismissed the respondents ‘terse’ claim as ‘misplaced’ and ‘insufficient’.12 In this article I provide a critical comment on the Masinda judgment. I seek to do so by providing a brief exposition of the importance of having access to and being able to stop unlawful interfere with your access to electricity in part 2. In part 3 I set out the requirements, features and application of the mandament van spolie. This is followed in part 4 with an analysis of the growing jurisprudence (comprising two high court judgments that predate democracy and two judgments from the Supreme Court of Appeal in the past decade) where the mandament van spolie was used to seek restoration ante omnia of electricity use.

We (I, Robert Lawrence and, in a rare display of unity, all my online avatars and agents)hereby render and proclaim thisMANIFESTO OF PIECES AND BITS IN SERVICE OF CONTRADICTIONAL AESTHETICSWe start with the simple premise that art has the job of telling us who we are, and that through the modern age doing this job while KEEPING UP with accelerating cultural change has necessitated the invention of something we might call the avant-garde. Along the way there has been an on-again-off-again affair between said avant-garde and technology. We are now in a new phase of the new and the technology under consideration is the Internet.The recent hyperventilating about the term postInternet reflects the artworld’s overdue recognition of the effect of the Internet on the culture at large, and on art as a cultural practice, a market, and a historical process.I propose that we cannot fully understand what the Internet is doing to us through a consideration of what happens on the screen, nor by considering what happens in the physical space we occupy either before or behind the screen. Rather we must critically and creatively fathom the flow of cultural practice between and across these realms. This requires Hybrid art combining both physical and Internet forms.I do not mean to imply that single discipline-based art cannot communicate complexity, but I believe that Internet culture introduces complexities that can only be approached through hybrid practices. And this is especially critical for an art that, in doing the job of “telling us who we are”, wants to address the contradictory ways we now form and promote, or conceal and revise, our multiple identities through online social media profiles inconsistent with our fleshly selves.We need a different way of talking about identity. A history of identity:In the ancient world, individual identity as we understand it did not exist.The renaissance invented the individual.Modernism prioritized and alienated him (sic).Post-Modernism fragmented him/her.The Internet hyper-circulates and amplifies all these modalities, exploding the possibilities of identity.While reducing us to demographic market targets, the Web facilitates mass indulgence in perversely individual interests. The now common act of creating an “online profile” is a regular reiteration of the simple fact that identity is an open-ended hypothesis. We can now live double, or extravagantly multiple, virtual lives. The “me meme” is a ceaseless morph. This is a profound change in how identity was understood just a decade ago. Other historical transformations of identity happened over centuries. This latest and most radical change has occurred in the click of a mouse. Selfhood is now imbued with new complexity, fluidity and amplified contradictions.To fully understand what is actually happening to us, we need an art that engages the variant contracts of the physical and the virtual. We need a Hybrid art that addresses variant temporal and spatial modes of the physical and virtual. We need an art that offers articulations through the ubiquitous web in concert with the distinct perspectives that a physical gallery experience uniquely offers: engagement and removal, reflection and transference. Art that tells us who we are today calls for an aesthetics of contradiction. — Ro Lawrence (and all avatars) 2011, revised 2013, 2015, 2018. The manifesto above grew from an artistic practice beginning in 1998 as I started producing a website for every project that I made in traditional media. The Internet work does not just document or promote the project, nor is it “Netart” in the common sense of creative work restricted to a browser window. All of my efforts with the Internet are directly linked to my projects in traditional media and the web components offer parallel aesthetic voices that augment or overtly contradict the reading suggested by the traditional visual components of each project.This hybrid work grew out of a previous decade of transmedia work in video installation and sculpture, where I would create physical contexts for silent video as a way to remove the video image from the seamless flow of broadcast culture. A video image can signify very differently in a physical context that separates it from the flow of mass media and rather reconnects it to lived physical culture. A significant part of the aesthetic pleasure of this kind of work comes from nuances of dissonance arising from contradictory ways viewers had learned to read the object world and the ways we were then still learning to read the electronic image world. This video installation work was about “relocating” the electronic image, but I was also “locating” the electronic image in another sense, within the boundaries of geographic and cultural location. Linking all my projects to specific geographic locations set up contrasts with the spatial ubiquity of electronic media. In 1998 I amplified this contrast with my addition of extensive Internet components with each installation I made.The Way Things Grow (1998) began as an installation of sculptures combining video with segments of birch trees. Each piece in the gallery was linked to a specific geographic location within driving distance of the gallery exhibiting the work. In the years just before this piece I had moved from a practice of text-augmented video installations to the point where I had reduced the text to small printed handouts that featured absurd Scripts for Performance. These text handouts that viewers could take with them suggested that the work was to be completed by the viewer later outside the gallery. This to-be-continued dynamic was the genesis of a serial form in work going forward from then on. Thematic and narrative elements in the work were serialized via possible actions viewers would perform after leaving the gallery. In the installation for The Way Things Grow, there was no text in the gallery at all to suggest interpretations of this series of video sculptures. Even the titles offered no direct textual help. Rather than telling the viewers something about the work before them in the gallery, the title of each piece led the viewer away from the gallery toward serial actions in the specific geographic locations the works referred to. Each piece was titled with an Internet address.Figure 1: Lawrence, Robert, The Way Things Grow, video Installation with web components at http://www.h-e-r-e.com/grow.html, 1998.When people went to the web site for each piece they found only a black page referencing a physical horizon with a long line of text that they could scroll to right for meters. Unlike the determinedly embodied work in the gallery, the web components were disembodied texts floating in a black void, but texts about very specific physical locations.Figure 2: Lawrence, Robert, The Way Things Grow, partial view of webpage at http://www.h-e-r-e.com/growth_variant4.html, 1998.The texts began with the exact longitude and latitude of a geographical site in some way related to birch trees. ... A particularly old or large tree... a factory that turned birch trees into popsicle sticks and medical tongue depressors... etc. The website texts included directions to the site, and absurd scripts for performance. In this way the Internet component transformed the suite of sculptures in the gallery to a series of virtual, and possibly actual, events beyond the gallery. These potential narratives that viewers were invited into comprised an open-ended serial structure. The gallery work was formal, minimal, essentialist. On the web it was social, locative, deconstructive. In both locations, it was located. Here follows an excerpt from the website. GROWTH VARIANT #25: North 44:57:58 by West 93:15:56. On the south side of the Hennepin County Government Center is a park with 9 birch trees. These are urban birches, and they display random scratchings, as well as proclamations of affection expressed with pairs of initials and a “+” –both with and without encircling heart symbols. RECOMMENDED PERFORMANCE: Visit these urban birches once each month. Photograph all changes in their bark made by humans. After 20 years compile a document entitled, "Human Mark Making on Urban Birches, a Visual Study of Specific Universalities". Bring it into the Hennepin County Government Center and ask that it be placed in the archives.An Acre of Art (2000) was a collaborative project with sculptor Mark Knierim. Like The Way Things Grow, this new work, commissioned by the Minneapolis Art Institute, played out in the gallery, in a specific geographic location, and online. In the Art Institute was a gallery installation combining sculptures with absurd combinations of physical rural culture fitting contradictorily into an urban "high art" context. One of the pieces, entitled Landscape (2000), was an 18’ chicken coop faced with a gold picture frame. Inside were two bard rock hens and an iMac. The computer was programmed to stream to the Internet live video from the coop, the world’s first video chicken cam. As a work unfolding across a long stretch of time, the web cam video was a serial narrative without determined division into episodes. The gallery works also referenced a specific acre of agricultural land an hour from the Institute. Here we planted a row of dwarf corn at a diagonal to the mid-western American rural geometric grid of farmland. Visitors to the rural site could sit on “rural art furniture,” contemplate the corn growing, and occasionally witness absurd performances. The third stream of the piece was an extensive website, which playfully theorized the rural/urban/art trialectic. Each of the three locations of the work was exploited to provide a richer transmedia interpretation of the project’s themes than any one venue or medium could. Location Sequence is a serial installation begun in 1999. Each installation has completely different physical elements. The only consistent physical element is 72 segments of a 72” collapsible carpenter's ruler evenly spaced to wrap around the gallery walls. Each of the 72 segments of the ruler displays an Internet web address. Reversing the notion of the Internet as a place of rapid change compared to a more enduring physical world, in this case the Internet components do not change with each new episode of the work, while the physical components transform with each new installation. Thematically, all aspects of the work deal with various shades of meaning of the term "location." Beginning/Middle/End is a 30-year conceptual serial begun in 2002, presenting a series of site-specific actions, objects, or interventions combined with corresponding web pages that collectively negotiate concepts related to time, location, and narrative. Realizing a 30-year project via the web in this manner is a self-conscious contradiction of the culture of the instantaneous that the Internet manifests and propagates.The installation documented here was completed for a one-night event in 2002 with Szilage Gallery in St Petersburg, Florida. Bricks moulded with the URLs for three web sites were placed in a historic brick road with the intention that they would remain there through a historical time frame. The URLs were also projected in light on a creek parallel to the brick road and seen only for several hours. The corresponding web site components speculate on temporal/narrative structures crossing with geographic features, natural and manufactured.Figure 3: Lawrence, Robert, Beginning/Middle/End, site-specific installation with website in conjunction with 30-year series, http://www.h-e-r-e.com/beginning.html, 2002-32.The most recent instalment was done as part of Conflux Festival in 2014 in collaboration with painter Ld Lawrence. White shapes appeared in various public spaces in downtown Manhattan. Upon closer inspection people realized that they were not painted tags or stickers, but magnetic sheets that could be moved or removed. An optical scan tag hidden on the back of each shape directed to a website which encouraged people to move the objects to other locations and send a geo-located photo to the web site to trace the shape's motion through the world. The work online could trace the serial narrative of the physical installation components following the installation during Conflux Festival. Figure 4: Lawrence, Robert w/Lawrence, Ld, Gravity Ace on the Move, site-specific installation with geo-tracking website at http://www.h-e-r-e.com/gravityace/. Completed for Conflux Festival NYC, 2014, as part of Beginning/Middle/End.Dad's Boots (2003) was a multi-sited sculpture/performance. Three different physical manifestations of the work were installed at the same time in three locations: Shirakawa-go Art Festival in Japan; the Phipps Art Center in Hudson, Wisconsin; and at the Tampa Museum of Art in Florida. Physical components of the work included silent video projection, digital photography, computer key caps, and my father's boots. Each of these three different installations referred back to one web site. Because all these shows were up at the same time, the work was a distributed synchronous serial. In each installation space the title of the work was displayed as an Internet address. At the website was a series of popup texts suggesting performances focused, however absurdly, on reassessing paternal relationships.Figure 5: Lawrence, Robert, Dad’s Boots, simultaneous gallery installation in Florida, Wisconsin and Japan, with website, 2003. Coincidently, beginning the same time as my transmedia physical/Internet art practice, since 1998 I have had a secret other-life as a tango dancer. I came to this practice drawn by the music and the attraction of an after-dark subculture that ran by different rules than the rest of life. While my life as a tanguero was most certainly an escape strategy, I quickly began to see that although tango was different from the rest of the world, it was indeed a part of this world. It had a place and a time and a history. Further, it was a fascinating history about the interplays of power, class, wealth, race, and desire. Figure 6: Lawrence, Robert, Tango Intervention, site-specific dance interventions with extensive web components, 2007-12.As Marta Savigliano points out in Tango and the Political Economy of Passion, “Tango is a practice already ready for struggle. It knows about taking sides, positions, risks. It has the experience of domination/resistance from within. …Tango is a language of decolonization. So pick and choose. Improvise... let your feet do the thinking. Be comfortable in your restlessness. Tango” (17). The realization that tango, my sensual escape from critical thought, was actually political came just about the time I was beginning to understand the essential dynamic of contradiction between the physical and Internet streams of my work. Tango Intervention began in 2007. I have now, as of 2018, done tango interventions in over 40 cities. Overall, the project can be seen as a serial performance of contradictions. In each case the physical dance interventions are manifestations of sensual fantasy in public space, and the Internet components recontextualize the public actions as site-specific performances with a political edge, revealing a hidden history or current social situation related to the political economy of tango. These themes are further developed in a series of related digital prints and videos shown here in various formats and contexts.In Tango Panopticon (2009), a “spin off” from the Tango Intervention series, the hidden social issue was the growing video surveillance of public space. The first Tango Panopticon production was Mayday 2009 with people dancing tango under public video surveillance in 15 cities. Mayday 2010 was Tango Panopticon 2.0, with tangointervention.org streaming live cell phone video from 16 simultaneous dance interventions on 4 continents. The public encountered the interventions as a sensual reclaiming of public space. Contradictorily, on the web Tango Panopticon 2.0 became a distributed worldwide action against the growing spectre of video surveillance and the increasing control of public commons. Each intervention team was automatically located on an online map when they started streaming video. Visitors to the website could choose an action from the list of cities or click on the map pins to choose which live video to load into the grid of 6 streaming signals. Visitors to the physical intervention sites could download our free open source software and stream their own videos to tangointervention.org.Figure 7: Lawrence, Robert, Tango Panopticon 2.0, worldwide synchronous dance intervention with live streaming video and extensive web components, 2010.Tango Panopticon also has a life as a serial installation, initially installed as part of the annual conference of “Digital Resources for Humanities and the Arts” at Brunel University, London. All shots in the grid of videos are swish pans from close-ups of surveillance cameras to tango interveners dancing under their gaze. Each ongoing installation in the series physically adapts to the site, and with each installation more lines of video frames are added until the images become too small to read.Figure 8: Lawrence, Robert, Tango Panopticon 2.0 (For Osvaldo), video installation based on worldwide dance intervention series with live streaming video, 2011.My new work Equivalence (in development) is quite didactic in its contradictions between the online and gallery components. A series of square prints of clouds in a gallery are titled with web addresses that open with other cloud images and then fade into randomly loading excerpts from the CIA torture manual used at Guantanamo Bay Detention Center.Figure 9: Lawrence, Robert, Eauivalence, digital prints, excerpts from CIA Guantanamo Detention Center torture manual, work-in-progress.The gallery images recall Stieglitz’s Equivalents photographs from the early 20th century. Made in the 1920s to 30s, the Equivalents comprise a pivotal change in photographic history, from the early pictorial movement in which photography tried to imitate painting, and a new artistic approach that embraced features distinct to the photographic medium. Stieglitz’s Equivalents merged photographic realism with abstraction and symbolist undertones of transcendent spirituality. Many of the 20th century masters of photography, from Ansel Adams to Minor White, acknowledged the profound influence these photographs had on them. Several images from the Equivalents series were the first photographic art to be acquired by a major art museum in the US, the Boston Museum of Fine Arts.My series Equivalence serves as the latest episode in a serial art history narrative. Since the “Pictures Generation” movement in the 1970s, photography has cannibalized its history, but perhaps no photographic body of work has been as quoted as Stieglitz’s Equivalents. A partial list includes: John Baldessari’s series Blowing Cigar Smoke to Match Clouds That Are the Same(1973), William Eggleston’s series Wedgwood Blue (1979), John Pfahl’s smoke stack series (1982-89), George Legrady’s Equivalents II(1993), Vik Muniz’sEquivalents(1997), Lisa Oppenheim (2012), and most recently, Berndnaut Smilde’s Nimbus Series, begun in 2012. Over the course of more than four decades each of these series has presented a unique vision, but all rest on Stieglitz’s shoulders. From that position they make choices about how to operate relative the original Equivalents, ranging from Baldessari and Muniz’s phenomenological playfulness to Eggleston and Smilde’s neo-essentialist approach.My series Equivalence follows along in this serial modernist image franchise. What distinguishes it is that it does not take a single position relative to other Equivalents tribute works. Rather, it exploits its gallery/Internet transmediality to simultaneously assume two contradictory positions. The dissonance of this positioning is one of my main points with the work, and it is in some ways resonant with the contradictions concerning photographic abstraction and representation that Stieglitz engaged in the original Equivalents series almost a century ago.While hanging on the walls of a gallery, Equivalence suggests the same metaphysical intentions as Stieglitz’s Equivalents. Simultaneously, in its manifestation on the Internet, my Equivalence series transcends its implied transcendence and claims a very specific time and place –a small brutal encampment on the island of Cuba where the United States abandoned any remaining claim to moral authority. In this illegal prison, forgotten lives drag on invisibly, outside of time, like untold serial narratives without resolution and without justice.Partially to balance the political insistence of Equivalence, I am also working on another series that operates with very different modalities. Following up on the live streaming technology that I developed for my Tango Panopticon public intervention series, I have started Horizon (In Development).Figure 10: Lawrence, Robert, Horizon, worldwide synchronous horizon interventions with live streaming video to Internet, work-in-progress.In Horizon I again use live cell phone video, this time streamed to an infinitely wide web page from live actions around the world done in direct engagement with the horizon line. The performances will begin and automatically come online live at noon in their respective time zone, each added to the growing horizontal line of moving images. As the actions complete, the streamed footage will begin endlessly looping. The project will also stream live during the event to galleries, and then HD footage from the events will be edited and incorporated into video installations. Leading up to this major event day, I will have a series of smaller instalments of the piece, with either live or recorded video. The first of these preliminary versions was completed during the Live Performers Workshop in Rome. Horizon continues to develop, leading to the worldwide synchronous event in 2020.Certainly, artists have always worked in series. However, exploiting the unique temporal dimensions of the Internet, a series of works can develop episodically as a serial work. If that work unfolds with contradictory thematics in its embodied and online forms, it reaches further toward an understanding of the complexities of postInternet culture and identity. ReferencesSaviligliano, Marta. Tango and the Political Economy of Passion. Boulder: Westview Press, 1995.