The Family's Doctor Program (FDP) is a policy toward the organization of Primary
Health Care in Niteroi since 1992. During the 22 years of its implementation, the
program was characterized by a set of health actions focused on family and care by a
team, composed of doctor and nursing technician. However, since 2006 some changes are
perceived in the composition of the teams and on program coverage. Besides the federal
incentives, it is believed that local variables may have contributed for an approximation
of FDP to the model recommended in national level. The objective of the research was to
analyze the trajectory of the implementation of FDP in Niteroi with emphasis on elements
of continuities and changes in the 2000s. It was realized an exploratory case study with
qualitative approach. The research techniques used were the documentary analysis and
semi-structured interviews. The subjects studied were: municipal managers of health,
program coordinators, supervisors and doctors, presidents of associations of residents and
professor involved in the program implementation. The interviews were realized in the
period between May to October 2014. For analysis of empirical findings were used the
thematic content analysis whose categorization was based on two dimensions: the context
and the institutional framework of the FDP. The analysis of the trajectory of
implementation of FDP allows identify continuities and changes in various organizational
and operational aspects of the program. The policy's focus remains being the care to
portion of the population that lacks basic services, expanding the coverage of the teams
that have extended their composition, which raises some questions about the maintenance
of your original model. As explanations for the continuity of the program in the 2000s, it
were standing out the historical trajectory of public health in the city, the symbolic value
of the program for the city and the creation of a network of governmental and non
governmental organizations that support the policy in the municipality. Among the
factors that explain the changes, it were emphasized the change in team co-ordination of
the program, the socioeconomic conditions, the labor market in the city and its
surroundings, the alignment of the health ministry's prepositions and the federal
incentives. It can be concluded that the understanding of these factors can also contribute
to the comprehension of the municipality's health network.


A fast-locking clock multiplying delay-locked loop (MDLL) for fractional-ratio frequency multiplication is presented. A new phase detecting controller (PDC) has been adopted to resolve the long locking time problem of conventional MDLLs. The proposed FMDLL was implemented in 65-nm CMOS process and occupies an active area of 0.015 mm2. It operates over a frequency range of 2.0-4.0 GHz with a frequency multiplication factor of N/M, where N = 4, 5, 8, 10 and M = 1, 2, 3. It achieves a peak-to-peak output clock jitter of 13.5 ps at 4 GHz while reducing locking time of about 75%.


Of two natural product phytotoxins, maculosins-1 and -2, produced by Alternaria alternata on spotted knapweed (Centaurea maculosa), only maculosin-2 appeared active against intact knapweed plants. Furthermore, unlike host specific maculosin-1, maculosin-2 exhibited phytotoxicity to a wide range of weedy plants including Canada thistle (Cirsium arvense), hound's tongue (Cynoglossum officinale), yellow starthistle (Centaurea solstitialis), Russian knapweed (Centaurea repens), rush skeletonweed (Chondrilla juncea), dandelion (Taraxacum officinale), broad-leaved plantain (Plantago major), lamb's-quarters (Chenopodium album), redroot pigweed (Amaranthus retroflexus), whitetop or hoary cress (Cardaria draba), common mallow (Malva neglecta), sulfur (erect) cinquefoil (Potentilla recta), and leafy spurge (Euphorbia esula). As such, maculosin-2 and its synthetic analogs are good candidates for development as target specific post-emergence herbicides. One measure of herbicidal activity is detection in the etiolated wheat coleoptile (Triticum aestivum L. cv Wakeland) bioassay. In common with greenhouse tests on whole knapweed plants, maculosin-1 (cyclo-TyrPro) and pyriculamide (cyclo-3-NO2-TyrPro) were inactive. Similarly, analogs with protected hydroxyl groups: cyclo-Tyr(Me)Pro; cyclo-Tyr(Et)Pro; cyclo-Tyr(Pr)Pro, and cyclo Tyr(Bu)Pro, significantly inhibited (P < 0.01) wheat coleoptiles. The heavy atom derivatives: cyclo-4-Cl-PhePro; cyclo-4-Br-PhePro and cyclo-4-I-PhePro were also inhibitory. The maculosin-2 (cyclo-PhePro); cyclo-TICPro, cyclo-1-NALPro and cyclo-2-NALPro were significantly active (P < 0.01) against coleoptiles. The wheat coleoptile bioassay is a fast, reliable, convenient method for screening herbicidal activity of maculosin analogs.


An assessment of the performance of a wetland dominated by opportunistic weeds in removing nutrients from a secondary sewage effluent was carried out at Thredbo in Kosciusko National Park. Water quality sampling of the inflow and outflow showed a reduction in turbidity, pH and conductivity with passage through the wetland. Dissolved oxygen levels also decreased. In summer 1982, the phosphorus toad of 1.8 kg P day-1 was reduced by 44% as wastewater moved through the wetland, and the nitrogen load of 6.4 kg N day-1 by 65%. Winter retentions were 10% and 14% of inflowing loads, respectively. In 1983 there was a net release of phosphorus and reduced retention of nitrogen. This was regarded as being a result of physical disturbance of the wetland. Vegetation downstream of the effluent inflow was dominated by the opportunistic weeds Epilobium sarmantaceum and Rumex crispus. Upstream, Carex gaudichaudiana and Baeckea gunniana dominated. Marked seasonal changes in vigour and biomass were recorded. Plants, but not sediments, downstream of the inflow contained more nutrients than those upstream. Seed bank analysis showed more seeds downstream than upstream. A moist treatment promoted more seed germination than a flooded treatment. E. sarmantaceum and to a lesser extent R. crispus dominated in each treatment. In an effort to promote greater water retention and replacement of the weed species, channels in the wetland have been blocked with gravel and planted with Phragmites australis and Schoenoplectus validus.


Governments the world over are focused on the challenges of delivery in global and increasingly more complex contexts. Developed as well as developing countries are confronted with the challenges of delivery and development in different ways. In the expanding search for innovative solutions to global and local challenges, effective delivery is seen as critical to generating the kind of development that includes not only economic growth but social progress. Sen (1999:3) argues:


As the element of clothing, color plays an important role since it always forms a first impression of clothing aesthetic experience and is also a key factor to affect the evaluation of consumers on clothing in fast fashion consumption environment. The aim of current study is to explore the influence of clothing color combination on the aesthetic evaluation. In this study, clothing pictures with four contrasts (30°, 60°, 90° and 120°) in hue combined in bi-color and tri-color was evaluated by 40 participants. The results indicate that the stronger the color contrast, the less beautiful the clothing it is no matter in bi-color or tri-color combinations. We also found that the scores rated for bi-color combinations are higher than those for tri-color combinations, suggesting that bi-color combinations were more beautiful compared to tri-color combinations. Furthermore, in the process of aesthetic response to clothing color combinations, the reaction times spent making a judgment for tri-color combinations were shorter than that for bi-color combinations, that is to say, the number of color combinations has an effect on the difficulty of the color aesthetic evaluation.


With the rapid growth of the ASIC design size and complexity,traditional verification approaches can hardly meet the emerging requirements.A new ASIC verification approach based on FPGAs can shorten the development cycle efficiently,implement verification more quickly and completely and satisfy the requirements of ASIC verification better.This paper discusses the reconfigurable interconnection structure of prototype systems,presents a partitioning algorithm,and gives the corresponding implementation.


In a recent ward round, the Chief of the Surgical Service of the University of Virginia Hospital remarked, "Since the advent of chemotherapy, the sections of textbooks dealing with the diagnosis of infection must be rewritten." With the widespread use of chemotherapy in any illness remotely suggesting infection, few patients fail to receive one of the newer chemotherapeutic remedies. It is the almost universal experience of physicians in the larger reference institutions that an increasing number of patients are seen in whom the classical symptoms of disease are masked or modified by previous chemotherapy. The correct diagnosis of disease, or the proper evaluation of progression or regression of pathologic processes, even after the diagnosis has been established, has become much more difficult. The roentgenologist, therefore, since he interprets pathologic changes as depicted on his films, must assume more and more responsibility with respect to the proper treatment of the patient,


The essay deals with the issues of reception of English literature by Russian literary criticism; it analyzes polemically pointed evaluations of The Newcomes (1853–1855) by two leading Russian critics of the 1850s – 1860s – Nikolay Chernyshevsky and Alexander Druzhinin. To look at their reviews of the novel is worthwhile as it leads to a better understanding of both Russian literary process of the period and Russian reception of English literature in the middle of the 19th century. While examining these reviews, it is necessary to remember that this novel occupies quite an important place in the creative work of Thackeray and has many peculiarities at such levels of its structure as genre, plot, narrative, character-making, irony. The novel belongs to the after Vanity Fair period of Thackeray's oeuvre with its own aesthetics which just in The Newcomes gets its final look. The novel pictures the life of the English upper classes with the help of chronicle and panoramic methods of plot-making; direct satire, keenest irony and invective do not work here as they work in Vanity Fair. It is precisely this 'otherness' of The Newcomes, in comparison with the most famous novel by Thackeray, that becomes the matter of the opposite estimates of this novel by two Russian critics: at one extreme, Chernyshevsky who, though noting some strong plot-making and narrative positions in the novel, criticizes the writer for poor conceptuality of the novel, the petty themes raised, the hero's unimpressiveness, procrastination and slowness of the narrative; at the other extreme, the benevolent view of Druzhinin who reveals some important facets of the novel's artistic originality. He does not assess the novel from the ideological positions which are, in many respects, the products of the first Russian 'thaw' after the period of political reaction of the regime of Nicholas I and which determine the position of Chernyshevsky. Since Druzhinin had been taken by Chernyshevsky as his ideological rival and the founder of 'art for art's sake' conception, his review was a severe polemical answer to Druzhinin's review published earlier. That is one of the main reasons why such a profound literary critic as Chernyshevsky did not notice or did not want to notice many merits of The Newcomes which are stressed in the essay. It is shown in the essay that, while writing his review of The Newcomes, Chernyshevsky was thinking more about Russian literary situation than Thackeray's novel itself and the literary process in England in the middle of the 19th century.


The utility model relates to a straw particle combustion furnace and belongs to the field of combustion furnaces. The utility model aims to solve the defects of the prior straw particle combustion furnace like incomplete combustion, low energy utilization rate and easy formation of tar and smoke and provides a straw particle combustion furnace which has the advantages of complete consumption, practical use and convenience and can be used for central heating and heated brick bed. The straw particle combustion furnace comprises a furnace body and an air blower as well as a furnace platform, an inner oven, a cover plate, a lower air cavity, a lower air pipe, an outer air cavity, a middle air pipe and a smoke discharge flue, wherein the inner oven is positioned in the furnace body formed by the cover plate; the outer air cavity is formed in a space between the inner oven and the cover plate; one end of the lower air pipe and the other end of the lower air pipe connected with the air blower are positioned at the lower air cavity at the bottom part of the inner stove; one end of the middle air pipe is connected with the air blower, and the other end thereof is positioned at the outer air cavity.


Good fundamental analysis can identify the numerous opportunities that currently exist in the global credit markets. Investing where growth is high and where balance sheets are healthy can be critical. Exposure, directly or through multinationals, to the solid growth of emerging markets can offer an attractive opportunity.


Over half a century ago, heart specialists – there were no board certified cardiologists yet – began to report unusual phenotypes like very long QT intervals or extraordinary left ventricular hypertrophy that ran in families and caused sudden death in the young. In the 1980s and 90s, linkage analysis in large families identified the first disease genes, landmark discoveries that have been critical for understanding basic physiologic and pathophysiologic processes in the heart, counselling families, defining penetrance that is so often incomplete, and identifying phenotype positive patients in whom coding region variants in these first disease genes were absent. In those patients, disease pathways defined by early rigorous linkage-based studies implicated new candidate genes for mediating these cardiovascular genetic phenotypes. So, for example, once beta-myosin heavy chain mutations were identified in hypertrophic cardiomyopathy (HCM), genes encoding other contractile proteins became logical candidates; similarly, ion channel genes or modifiers were candidates in channelopathies and desmosomal proteins in arrhythmogenic right ventricular cardiomyopathy (ARVC). As a result, we now have long lists of disease genes for major cardiovascular genetic diseases, and dramatic improvements in sequencing costs and efficiencies have enabled widespread application of panel-based sequencing. While these advances have improved care of affected patients and their families, two papers in the current issue of Circulation highlight potential flaws in the logic that underlies increasing use of these panels across large patient populations.,


It is over ten years since the beginning of the evaluation of vocational colleges launched by the education ministry in 2003.The findings of the investigation include administrative tendency,digressions of values,monotony of evaluation,and lack of introspective motivations.So the countermeasures are discussed as strategies for a complete system in support of a sound and dynamic evaluation.


ABSTRACT We extend Chebyshev's inequality to a random vector with a singular covariance matrix. Then we consider the case of a multivariate normal distribution for this generalization.


Thirty genotypes of Dolichos bean (Lablab purpureus) were evaluated to study the genetic variability on yield, yield-contributing and related characters. The highest and lowest coefficient of variation was observed for single podded clusters per plant and protein content respectively. Little or no difference between the phenotypic and genotypic coefficients of variability in the expression of various horticultural traits studied for protein content, days to 50% flowering, days to first pod set, pod length, pod weight, weight of 10 green pods and days to maturity. Phenotypic coefficient of variation was high for the single podded clusters per plant. Days to 50% flowering, pod length, width of pod, weight of 10 green pods accounted for the higher heritability and higher genetic advance. Significant positive phenotypic correlations were observed between yield other yield components including days to first pod set, days to 50% flowering, number of pods per plant, weight of 10 green pods and length of pod. The genotypes used in the study are of diverse nature and can be used in the breeding programme for development of superior genotypes in Dolichos bean.

 Key words: Dolichos bean, correlation, genetic advance, genetic variability, heritability.


BACKGROUND: Acute massive pulmonary embolism(PE) is a life-threatening condition with high mortality. Survival depands on rapid recanalization of the pulmonary arterial occlusion and reduction of the right ventricular(RV) afterload. The standard medical management for patients with massive PE is systemic thrombolysis using a tissue plasminogen activator(t-PA) or a novel modified t-PA,monteplase. However,systemic thrombolysis is associated with hemorrhagic risk and some patients cannot receive systemic thrombolysis due to contraindications. Catheter directed thrombolysis (CDT) is an alternative therapy for patients with massive PE with contraindications to systemic thrombolysis,and this method is considered to be much less invasive than the open surgery. PURPOSE: The purpuse of this study was to assess the efficacy and safety of CDT with monteplase. METHODS AND RESULTS: Between July 2005 and May 2011,38 PE patients(21 females and 17 males, mean age 67 years) were treated using the PIT(pulse-infusion thromb...


28 Neurotransmitters can have diverse effects that occur over multiple timescales often making the 29 consequences of neurotransmission difficult to predict. To explore the consequences of this diversity 30 we used the buccal ganglion of Aplysia to examine the effects of GABA release by a single interneuron, 31 B40, on the intrinsic properties and motor output of the radula closure neuron B8. B40 induces a 32 picrotoxin sensitive fast IPSP lasting milliseconds in B8 and a slow EPSP lasting seconds. We found that 33 the excitatory effects of this slow EPSP are also mediated by GABA. Together, these two GABAergic 34 actions structure B8 firing in a pattern characteristic of ingestive programs. Furthermore, we found that 35 repeated B40 stimulation induces a persistent increase in B8 excitability which was occluded in the 36 presence of the GABA B receptor agonist baclofen, suggesting that GABA affects B8 excitability over 37 multiple timescales. The phasing of B8 activity during the feeding motor programs determines the 38 nature of the behavior elicited during that motor program. The persistent increase in B8 excitability 39 induced by B40 biased the activity of B8 during feeding motor programs causing the motor programs to 40 become more ingestive in nature. Thus, a single transmitter released from a single interneuron can 41 have consequences for motor output that are expressed over multiple timescales. Importantly, despite 42 the differences in their signs and temporal characteristics the 3 actions of B40 are coherent in that they 43 promote B8 firing patterns that are characteristic of ingestive motor outputs. 44


The purposes of surgical treatment for fracture-dislocations of cervical spine are stabilization of cervical spine and the expectation of recovery of neurological functions. We prefer the anterior interbody fusion for these cases after pre-operative reduction of cervical spine achieved by means of skull traction. However, in old cases it is very difficult to reduce the injured spine by means of skull traction. In addition, because of neck pain, restriction of mobility of cervical spine and possibility of delayed myelopathy it is desired to do anterior interbody fusion in reduced position.We have treated 7 cases of such old fracture-dislocations of middle or lower cervical spine. All cases had neck pain, restriction of mobility of cervical spine and mild neuological symptoms. We performed anterior interbody fusion in these 7 cases and the results were excellent.


It is found that the temperature sensitivity of a fiber polarimeter can be significantly reduced by UV irradiation of the fiber. A stress-relief model is proposed to explain the mechanism, which is proposed to be a consequence of the breakage of oxygen-deficient bonds (wrong bonds) in the glass network through single-photon or multiphoton absorption, with a subsequent relaxation of the tensile stresses in the fiber core.


This paper aims to show the differences between the U.S. stock exchange performance (notably Dow Jones Industrial) and the U.S. real economy situation. In order to highlight discrepancies, we move on from the standard Price/Earnings analysis and we look, instead, at several macroeconomic variables - such as inventories and durable goods - in order to retrieve a synthetic index that can possibly identify the imbalance between real economy and stock exchange information. Since the real estate industry represents one of the most important economic features in the present economic scenario, the former part of the paper focuses on the description of the house market weaknesses, while the latter build up the econometric model. The comparison between S&P 500 Index and the synthetic index allows us to show when and for how long the stock exchange has underperformed or overperformed the real economic trend.


Actinomycosis is a rare infection caused by Actinomyces spp, a gram-positive germ of saprophytic nature, located in the mouth, genital tract and lower gastrointestinal tract. Its diagnosis is difficult because of its low frequency and variable clinical presentation. We report the case of a 28-year-old female, 34½ weeks pregnant, who presented a pelvic and hypogastric mass accompanied by abdominal pain. One day before admission, the contraction-like pain in the right iliac fossa intensified. The patient underwent a cesarean section and a full-term product was obtained. This surgery was followed by hysterectomy and resection of an abdominal wall tumor as well as en bloc resection of the vesical dome plus appendectomy. The pathology report informed actinomycosis. We focus on the presentation in a pregnant woman with a preterm and live product, as well as the signs and symptoms that help consider this diagnosis.


The role of explicit knowledge in the teaching and learning of a second language has been the subject of much research. Little of this, however, has taken place within the context of the Modern Foreign Languages in secondary school classrooms in the UK. In this study, we investigate the relationship between knowing and using the perfect tense in French in a small-scale project carried out over two years, involving a small group of learners.


Objetctive To explore the effect of dorlar and nitrous oxide analgesia on pregnant women and fetus. Methods 100 cases treated with dorlar and analgesia of nitrous were used as the study group and 100 cases with no treatment were used as control group. The effect of analgesia, the mode of delivery, labor stages, postpartum haemorrhage and neonatal asphyxia were compared between the two groups. Results The analgesia rate in study group and control group was 96% and 5%, respectively. The difference was statistically significant (P0.01). The rate of operation was 13% in study group which was significantly lower than that of control group (34%) (P0.05). The whole labor process was (9.16±3.86) hours in study group which was significantly less time than that of control group, (13.45 ±4.55) hours. The differences of postpartum haemorrhage and neonatal asphyxia between the two groups were not statistically significant (P0.05). Conclusion Using dorlar and nitrous oxide analgesia during labor will be an all-sided service model of labor. It can improve the effectiveness of labor and is safe to the mother and baby.


This paper presents a multi-perspective (i.e., four camera views) multi-modal (i.e., thermal infrared and color) video based system for robust and real-time 3D tracking of important body parts.The multi-perspective characteristics of the system provides 3Dtrajectory of the body parts, while the multi-modal characteristics of the system provides robustness and reliability of feature detection and tracking. The application context for this research is that of intelligent vehicles and driver assistance systems. Experimental results demonstrate effectiveness of the proposed system.


The article describes the mechanisms of development of musical abilities with age-appropriate students in terms of children folklore ensemble, suggests the ways to maintain interest to the folk song, presents the techniques of work with voice and breathing apparatus.


In this paper, a new method to reduce the quantization error in time measurement technique is proposed for a SPAD readout circuit. Initially, we developed a novel readout method to enhance the readout dynamic range of pixel based on a single photon avalanche photodiode by using a double readout technique based on time and amplitude measurements without decreasing the fill factor. In this paper we describe the contribution of the proposed method applied to time measurement technique in reducing the quantization error simply by using a multiple time resolution. It is important to notice that the main advantage of this method is the ability to apply it to all Active Pixel Sensor (APS).


This thesis research contends that the focused and practiced acquisition of a mindful attitude to visual arts-making offers innovative possibilities of thought and engagement. The interaction with phenomena within the classroom is hermeneutically interpreted and influenced by selected elements of Deleuzian theory enabling insights into creative processes.


The author presents the basic concepts of qualitative reasoning (QR) and then looks at what one needs to do to use it for control. In QR, physical problems are treated as a general domain and the ideas of forces and other physical phenomena are incorporated into the problem solving structure itself. It is suggested that, in order to reason about control within this framework, the framework needs to include feedback and learning capabilities and to relax some of its assumptions.<<ETX>>


In the light of A.A. Friedman's conceptual analysis of the World of events as a mathematical model of the physical reality in his book "The World as Space and Time", a priory, innate interconnection of events belonging to one and the same moment of time, which can condition the space-time metric, is considered with a summary review of its astronomical observations by N.A.Kozyrev's method.


The invention discloses a kind of high performance pigments ink and preparation method thereof, belongs to fine chemistry industry and new high-tech material technical field.The paint ink comprises at least following component:Multifunctional polyurethane oligomer, reaction monomers, light trigger, nano dye, related auxiliaries (diluent, bactericide) and deionized water.Paint ink prepared by the present invention is different from normal ink, the introducing of multifunctional water-soluble polyurethane oligomeric body makes ink have fluency, dispersion stabilization good, the advantages that fastness is high after solidification, cured film is soft, color clear, high glossiness, available on the flexible materials such as textile, non-woven fabrics, paper pattern it is ink-jet printed.


The cathedral at Le Puy is an emblematic monument of the western Middle Ages. The aim of this paper is a reinterpretation of its wall-paintings as spatial markers of a topography surrounded by an ecclesiological and liturgical discourse, translated by images and inscriptions, and deeply linked to the cathedral's various statuses, as a cathedral and as a pilgrimage place.


In geothermal energy production, reservoir permeability exhibits various degrees of enhancement or degradation with time. These changes are generally attributed to various multiphysics processes such as chemical alteration (dissolution and precipitation), thermal and poroelastic deformation of fractures or the rock matrix, or inelastic failures such as hydrofracking or hydroshearing. If permeability is dependent upon the deformation state of the solid matrix, then a strong feedback is present in the governing differential equations. Few codes are equipped to handle the fully-coupled ThermalHydrological-Mechanical (THM) problems in geothermal reservoir simulation. Therefore, separate codes equipped to handle separate differential equations are often loosely coupled to model THM processes. While previous efforts have investigated numerical coupling procedures in geochemical transport [13], it is not clear what degree of numerical coupling is required to accurately capture the feedback required for permeability enhancement phenomena. In this work, we compare various levels of coupling for modeling Engineered Geothermal System (EGS) well stimulation. Specifically, we address a flow/stress feedback whereby permeability changes as a function of effective stress [8]. The simulations are performed using FEHM


Shipboard polarized lidar for upper seawater column sounding through sea surface was designed. The lidar was designed to obtain the vertical profiles of hydro-optical properties and to locate of subsurface high-scattering layers and some different inhomogeneities. The source of the linearly polarized light sounding pulses is YAP:Nd Q-switched laser with SHG. Two identical photo-receiving devices are used to register waveforms of the two orthogonal-polarized components of echo-signal power. Field experiments with the use of the device were carried out at the several areas of the Atlantic Ocean. Subsurface high-scattering layers were detected during the field experiments.


In this paper we present our ongoing work on integrating large-scale terminological information into NLP tools. We focus on the problem of selecting and generating a set of suitable terms from the resources, based on deletion, modification and addition rules. We propose a general framework in which the raw data of the resources are first loaded into a knowledge base (KB). The selection and generation rules are then defined in a declarative way using query templates in the query language of the KB system. We illustrate the use of this framework to select and generate term sets from a UMLS dataset.


It is generally accepted that school science teaching lacks relevance to the outside world; the low popularity of the science at University compared to the arts is probably partly due to this neglect. This paper discusses the development of an AO-level course for use in 6th form general studies. This Science in Society course is that proposed by the association of Science Education and is suitable for both Science and Arts students. The possible course content is discussed.


A number of studies have recently demonstrated that catalyst microstructure and defect engineering are important to enhance reaction rates, but rigorous microstructure optimization studies are lacking. Kinetic rate prediction requires models that resolve catalyst sites and their coupling arising from surface diffusion, spatial arrangement of multifunctional sites, and lateral interactions. Modeling these effects requires kinetic Monte Carlo (KMC) simulation. The computational demand of KMC simulation makes direct microstructure optimization infeasible. To overcome this challenge, we parametrize the KMC data (reaction rate) using an active learning approach to capture complex structural dependencies among sites at negligible computational cost. We apply our method to a prototype chemistry over bifunctional materials, a case study reminiscent of the ammonia decomposition reaction on defected NiPt (core/shell) structures. We demonstrate that machine learning can effectively develop surrogate models for syste...


This paper proves a simple and general theorem on resource-allocation mechanisms that achieve Pareto efficiency. We say that a mechanism (game form) is normal if at any action profile, an agent who obtains his endowments neither pays nor receives a positive amount. In the context of auctions, this simply means that losers receive no bill. We prove that for any normal mechanism, if its Nash equilibrium allocations are Pareto efficient for all preference profiles, then the equilibrium allocations are necessarily in the core. The result holds for a large class of allocation problems in which monetary transfers are feasible and the consumption space is discrete except for the space of transfers. Examples include auctions with any number of objects, economies with indivisible public goods, marriage problems, and coalition formation. Journal of Economic Literature Classification Numbers: C71, C72, C78, D51, D60, D71, D82.


The present invention, the monomer (A), relates to copolymers obtained by polymerizing (B) and (C), wherein (A) is a monomer represented by formula (I), In the formula, B is different from the A R represents hydrogen or methyl, m is 1 to 500; n is 1 to 500, Wherein the sum of m + n is an 2 to 1000; (B) represents an ethylenically unsaturated monomer having an aromatic group; and, (C) represents an ethylenically unsaturated monomer having an alkyl group. The copolymers of the present invention are used as dispersants for pigments.


Eighteen years of seasonal 10‐member ensemble simulations have been performed with observed sea surface temperature (SST) to assess the ability of dynamical models to predict seasonal‐interannual climate variations during boreal summer. In addition, test cases have been designed to assess the role in climate trends, predictability of land initial conditions, systematic errors of precipitation and radiation fluxes at the land surface, and increasing CO2. The model reproduces a global warming trend in surface temperature similar to that observed. This appears to be attributable to the influence of SST. However, surface flux replacement and atmospheric initialization can reduce the SST‐driven trend even while improving the spatial pattern of surface air temperature. The results also show that land surface interaction has an effect both on surface temperature and the higher levels of the troposphere. However, realistically increasing CO2 concentrations have little impact in these seasonal simulations.


Ginzburg-Landau equations for superconductors with both $s$- and $d$-wave coupling in the presence of nonmagnetic impurities are derived from the Gorkov equation microscopically. The impurity effects on the critical temperature of the mixed $s+d$ symmetry superconductor, as well as the coexistent phase, are explored by using these derived equations.


Objective:To discuss the diagnosis methods of CT and MRI in intracranial germinoma.Methods:Some patients used routine axial CT scanning at the baseline of OM line,with a collimation of 5 mm and interslice gap of 5 mm,other patients were scanned in skull base with coronal scannings.For MRI scanning,all the patients were examined with plain and enhanced scanning.Plain scanning patients used spin echo sequences for T2-weighted images and spin echo sequences for T1-weighted images in axial,sagittaland corornal planes;enhanced scanning patients were injected with Uro grafin(0.5 mmol/kg) into ulnar vein.Results:For 38 patients with cranial CT scan,11 leisions located in sella area reveal circular or oval high density imaging with clear border.For 38 patients with MRI scanning,24 lesions located in pineal and sella area show irregular ones with intermediate signal intensity on T1WI and T2WI and intermediate enhancement on enhanced scans.Conclusion:CT and MRI can be effectively combined diagnosis of intracranial germ cell tumors.


The most fundamental structure of the chromosome is nucleosome, which forms "beads-on-a-string" structure with the width of 11 nm. The nucleosomal array is folded into higher-order structures with the help of linker histones, non-histone chromosomal proteins and histone-tails. This study analyzed the structure of reconstituted chromatin using S. pombe (fission yeast) core histones. Histone H2B of fission yeast has less lysine residues than that of higher eukaryotes and no linker histone gene has been found in the genome. To examine how the structural property of yeast chromatin differs from that of higher eukaryotes, fission yeast core histones were purified and used in chromatin reconstitution. In low salt buffer (50 mM NaCl), yeast and HeLa nucleosomal arrays showed similar "beads-on-a-string" structures. How ever, in higher salt buffer (100 and 200 mM NaCl), HeLa nucleosomal arrays formed aggregates, while yeast nucleosomal arrays did not. Hyper-acetylated HeLa nucleosomal array also failed to form aggregates in higher salt conditions. Similar to HeLa nucleosomes, yeast nucleosomal array also formed a thicker fiber structures upon the addition of linker histone H1. These results suggest that the yeast nucleosomal array possesses similar structural properties to the hyper-acetylated nucleosomal array of higher eukaryotes, possibly due to the comparable electric charge in the tail regions.


Encouraging the use of renewable energy is crucial for meeting our energy needs, but it requires bulk storage to be practical. One potential solution is underground hydrogen storage, which could provide a consistent supply of clean energy for the world. Depleted hydrocarbon reservoirs may be a viable storage option for this purpose, given their existing infrastructure. However, ensuring wellbore integrity is a major challenge when storing hydrogen in such reservoirs. To test the feasibility of this approach, a core holder to replicate wellbore conditions having a 12" long, 4" diameter core sample that has a concentric two-inch drilled hole is used in this study. A one-inch perforated pipe, as the casing, is placed inside the 2" hole, and the cement will be placed between the pipe and the core. 72 hours after pouring the cement between the core and the pipe, hydrogen is injected into the sandstone from the casing through the cement. A CT scanner was then used to detect any leakage channels or cracks in the cement that could compromise the integrity of the storage system. One end of the cemented annulus is connected to a Data Acquisition system via transducers to detect any leakage. This new method could offer a promising alternative for underground hydrogen storage in depleted hydrocarbon reservoirs to detect leakage and ensure well integrity.

 Hydrogen is seen as a key element in the energy transition towards a more sustainable and low-carbon future as it is a clean energy carrier which makes it an ideal fuel for a low-carbon energy system. Hydrogen can be used in a wide range of applications, including transportation, electricity generation, heating, and industrial processes. The production of hydrogen using renewable energy sources, such as solar or wind power, can help decarbonize the energy system. In addition, hydrogen can be used to replace fossil fuels in a wide range of applications, including transportation and industrial processes (Bechara et al., 2022).
 Hydrogen can be stored for long periods of time, making it an important energy storage medium for intermittent renewable energy sources like solar and wind power. This can help balance the grid and ensure that energy is available when it is needed (Canbaz et al., 2021). Salt caverns, aquifers, and depleted hydrocarbon reservoirs can be used to store large quantities of hydrogen for a long period of time. Depleted hydrocarbon reservoirs are the most suited as hydrogen can be produced and transported in a similar way to natural gas, and existing gas infrastructure can be repurposed for hydrogen use. This could help speed up the adoption of hydrogen as an energy carrier, as it can be distributed through existing pipelines and infrastructure (Al-Hadrami et al., 2022).


The consequences of preterm birth are a major public health concern with high rates of ensuing multisystem morbidity, and uncertain biological mechanisms. Common genetic variation may mediate vulnerability to the insult of prematurity and provide opportunities to predict and modify risk.


WHO termed obesity as "New world syndrome" and hypertension as "Silent killer" by observing its consequences and it's increasing prevalence for the past few decades. This study was under taken to observe the prevalence of obesity and hypertension among urban working women in southern India by enrolling 120 working women in an educational institution, located at the centre of the city. Well structured questionnaire was developed and distributed to all the women to elicit their socio economic details, life style pattern and food habits. Their weight, height and blood pressure were recorded. Among the selected women obesity was prevalent among 80.2 per cent and the prevalence of hypertension was observed to be 48 per cent. The blood pressure was noticed to increases with increase in body weight of the individuals. The results stress the need of timely preventive measures for these new endemic disorders to reduce the burden of many chronic morbidity. Coronary artery disease occurs almost a decade earlier in South Asians as compared to western counterparts. Coronary artery disease and diabetes are preceded by constellation of risk factors which include abdominal obesity, hypertension, dyslipidaemia, prediabetes and sedentary lifestyle as shown in various epidemiological and observational studies. For the past few decades, the prevalence of obesity and hypertension is increasing rapidly due to life style transition. (Walia et al., 2014). Various studies revealed that it is more prevalent in urban areas when compared to rural areas and females are more prone to these risk factors than males. obesity can be seen as the first wave of a defined cluster of non communicable diseases called "New World Syndrome," creating an enormous socioeconomic and public health burden in poorer countries (Pednekar et al.,2008) The problem is more acute among the non-poor than the poor in urban India. Hypertension is directly associated with risks of several types of cardiovascular diseases and according to WHO (2005), it was increased by 30 times among urban community people (Gouda & Prusty., 2014) Urbanization and the adaptation of the westernized lifestyle is one of the reasons for a rapid epidemiological transition. Thus, the growing demand which now appears before the health sector is to address this rising urban epidemic and hence this study was undertaken with the objective to study the prevalence of obesity and hypertension in urban working women who are more likely to susceptible to these epidemic transitions. Methodology 120 women working in an educational institution located at the centre of city, those who were interested in participating in the study were selected for this study. Well structured questionnaire was developed with three parts to elicit the information on socio economic details, lifestyle pattern and food habits and distributed to selected women. Body weight was measured using a portable weighing balance. The scale was zeroed before weighing and light clothing was allowed to be worn. The height was measured for all the participants using a portable stadiometer. Using Weight and height BMI was calculated to all the participants. The blood pressure of all the women was measured using Standard sphygmomanometer with the help of a medical practitioner. The blood pressure was measured in both the arms. An average of three readings taken with the time gap of 2-3mts was recorded as the individual's blood pressure. The arm with the higher pressure was used to make the three measurements. Results and Discussions The results and discussions of the study are given below. The socio economic status of the selected urban working women is given in Table-I Table -I Socio economic status of the selected urban working women S . No. Particulars Number Per cent


Atmospheric ozone remains depleted which in turn leads to the increase of UV-B radiation reaching the surface of the earth and in the same time more and more nitrogen will be imported into the terrestrial ecosystems through nitrogen deposition. These two factors will operate simultaneously. The photosynthetic and physiological responses of deciduous broad leaved species Swida hemsleyi occurring commonly at 1350-3700 m a.s.l. subjected to enhanced UV-B and to nitrogen supply were studied. The experimental design included two levels of UV-B treatments (ambient UV-B, 11.02 KJ m(-2) day(-1) and enhanced UV-B, 14.33 KJ m(-2) day(-1)) and two nitrogen levels (without supplemental nitrogen supply and with supplemental nitrogen supply). An experiment was conducted in open semi-field condition in Maoxian Ecological Station of Chinese Academy of Sciences, Sichuan province, China at 1820 in a.s.l. Enhanced UV-B caused a marked decline in growth parameters, net photosynthetic rate, stomatal conductance to water vapour, chlorophyll pigments, whereas it induced an increase in rate of reactive oxygen species (ROS) production and ROS accumulation and malondialdehyde (MDA) content. Enhanced UV-B also induced an increase in leaf thickness and antioxidant compounds content, such as carotenoids and proline content. On the other hand, nitrogen supply caused an increase in some growth parameters, chlorophyll pigments and antioxidant compounds, and reduced ROS accumulation. However, nitrogen supply did not affect MDA content under enhanced UV-B, though it increased antioxidant compounds content and reduced the rate of ROS production and ROS accumulation. These results implied that enhanced UV-B brought harmful effects on Swida hemsleyi seedlings and supplemental nitrogen supply could alleviate the adverse effects of UV-B radiation on plants to some extent.


Climate change and industrial agricultural practices pose threats to the future of Kansas agriculture. To inform the debate about sustainable agriculture that must soon occur, we seek to illuminate the factors involved in the decision making of farmers in Kansas. Drawing from Actor–Network Theory, we consider how farmers' participation in the industrial agricultural network shapes their decisions, defines the types of knowledge and skills that are valued by farmers and others in the network, transforms what it means to be a Kansas grain farmer, and entrenches unsustainable production practices.


Cardiac sympathetic nervous system abnormality can predict sudden cardiac death due to arrhythmia. However, it is unknown whether the sympathetic nerve abnormality is related to the origin of tachyarrhythmia. We hypothesized that such a relationship exists and tested it by uptake of iodine-123 metaiodobenzylguanidine (123I-MIBG) in 184 patients (mean •} standard deviation, age : 52.7 •} 18.8 years, 106 males) with a history of paroxysmal palpitation. Patients with organic heart disease or left ventricular dysfunction were excluded. Cardiac sympathetic nerve abnormality was assessed from the heart l mediastinum (H / M) later index and washout ratio (WR). Sustained ventricular tachycardia (VT) in 46 patients and sustained supraventricular tachycardia (SVT) in 103 patients were diagnosed by ECG during onset of arrhythmia or by electrophysiologic tests employing programmed cardiac stimulation. The tachyarrhythmia was not proven in 35 patients (Control groups). The H I M index was significantly lower and WR significantly higher in tachyarrhythmia groups compared to controls (H I M index : 2.75 •} 0.55 in VT group, 3.01 •} 0.78 in SVT group vs. 3.34 •} 0.48 in control group, p < 0.001 and p < 0.05, WR : 39.6 •} 12.1% in VT group, 38.1 •} 8.5% in SVT group vs. 34.2 •} 6.8% in Control group, p < 0.05 in each). The mean H / M index was lower in the VT group than the SVT group (p < 0.05). Cardiac sympathetic nerve abnormality thus predicts the origin of tachyarrhythmia, and we propose 123I -MIBG scintigraphy as an important tool to discriminate the life-threatening tachyarrhythmia from benign episodes in patients with a history of palpitation.


Each chapter of this manual introduces numerous Suru compound verbs, explains their structures, and illustrates usage in sentences and dialogues.


To synthesize evidence relating to comparisons between patient‐generated blood glucose records and meter memory in diabetes and to identify any predictors of agreement.


In the experience of Aschoff, 1 Kaufman 2 and others, hemangiomas of the vertebral column have been encountered rarely. In 1927, however, Makrycostas 3 was able to describe 12 cases which he collected during the routine autopsy work of Erdheim's laboratory. He stated the opinion that the uncommon occurrence of compression of the spinal cord with such lesions probably explains the infrequency of reports of the condition in the literature. No neurologic manifestations were recorded in the 12 cases which he described. He observed that vertebral hemangiomas are most common in late adult life, are irregular in their distribution, are most frequently multiple and are ordinarily discovered in the lower dorsal and lumbar vertebrae. In 1928 Topfer 4 more than confirmed the impression of Makrycostas that hemangiomas of the vertebral column are not so much a pathologic as a clinical rarity. He sagittally sectioned the vertebral columns of 2,154 cadavers


This paper presents a novel three-dimensional alternating current electroosmosis (ACEO) micropump with high power density. ACEO is a phenomenon to generate a flow of a liquid such as water by applying an AC voltage to the liquid. Using a specific configuration, a net flow due to ACEO becomes unidirectional and an ACEO micropump can be constructed. Many ACEO micropumps have been proposed; however, most of them are of the planar type, and their output power per device volume is not sufficiently high for applications such as micro fluid power sources for micro total analysis systems, lab-on-a-chips, biomedical microelectromechanical systems (bio-MEMSs), soft microactuators, and soft microrobots. To achieve a higher output power density, in this study, we proposed an ACEO micropump using an array of plate-cylinder electrodes, which is called PC-ACEO-MP. To induce unidirectional flow efficiently, a square pole-slit electrodes ACEO micropump called SS-ACEO-MP has been proposed using asymmetrical pillar-shaped electrodes. PC-ACEO-MP is an extension of SS-ACEO-MP with a three-dimensional structure. First, the finite element method simulations were performed and the results showed that PC-ACEO-MP has the potential to realize high output power with a 1 cm3 effective pump volume using large numbers of plate-cylinder electrodes connected in parallel and in series. Second, a fabrication method using MEMS fabrication process, including electroplating, was proposed and developed for a micro-holed electrode plate that forms parallel cylinder electrodes. The validity of the proposed process was confirmed by fabricating large models and micro-models of the micro-holed electrode plate. The diameter and number of microholes were 10 μm and 36 100, respectively, for the large models and 3 μm and 65 500, respectively, for the micro models. Finally, PC-ACEO-MPs were constructed and their promising pumping characteristics were clarified through experiments using deionized water. The estimated power density was approximately 400 times higher than that of the former high output power ACEO micropump.


The new nonlinear transformer time domain model for analysis of transient process is presented.The correctness and practicability of the model are verified by test.


Transfer point location problem in which demand points are weighted and their coordinates are uniformly distributed for the case of minimax objective and planar topology has been introduced recently. In the real problems, such as disaster cases, different points of an area might be demand locations with different possibility degrees. Thus, developing a more applicable model is critical for these problems. In this paper, a new transfer point location problem is proposed in which demands are weighted in fuzzy form and have possibilistic coordinates. To formulate the problem, a new possibilistic model is developed which leads to construct the general model based on experts' viewpoints. The proposed model is formulated as a fuzzy unconstrained nonlinear programming in which decision variables are obtained as fuzzy numbers. Subject to the complexity of the developed model, a new Fuzzy Logic Controller (FLC) is designed based on the derived fuzzy decision variables to infer the optimum or near optimum values for all decision variables. Finally, a numerical example is applied to demonstrate the efficiency and efficacy of the developed FLC. © 2014 World Academic Press, UK. All rights reserved.


A novel class AB operational transconductance amplifier (OTA) topology is proposed, based on a class AB flipped voltage follower. The OTA has class AB behavior, with current boosting both for the load and the compensation capacitors. It has a high gain of (gmr0)4, obtained using a two‐stage structure with cascoded stages, and is a two‐stage Miller‐compensated amplifier employing multipath to remove the positive zero. It has close to rail‐to‐rail output swing (limited by cascoding) and very low common‐mode gain thanks to a replica technique (allowing the use of low‐power common‐mode feedback [CMFB] loops). Ninety‐two decibels of gain and 176 dB of common‐mode rejection ratio (CMRR) without CMFB are achieved using a 40‐nm complementary metal‐oxide semiconductor (CMOS) process. The OTA is used to design a low‐power sample‐and‐hold amplifier (SHA) operating at 5 MSps, a typical application for CMOS OTAs, which has been chosen to verify the proposed circuit's performance and to show that the OTA is robust in Monte Carlo simulations under process variations and mismatches in an actual application.


This report describes a breakthrough in a project to design minor groove binders to recognize any sequence of DNA. A key goal is to invent synthetic chemistry for compound preparation to recognize an adjacent GG sequence that has been difficult to target. After trying several unsuccessful compound designs, an N-alkyl-benzodiimidazole structure was selected to provide two H-bond acceptors for the adjacent GG-NH groups. Flanking thiophenes provide a preorganized structure with strong affinity, DB2831, and the structure is terminated by phenyl-amidines. The binding experimental results for DB2831 with a target AAAGGTTT sequence were successful and include a high ΔTm, biosensor SPR with a KD of 4 nM, a similar KD from fluorescence titrations and supporting competition mass spectrometry. MD analysis of DB2831 bound to an AAAGGTTT site reveals that the two unprotonated N of the benzodiimidazole group form strong H-bonds (based on distance) with the two central G-NH while the central –CH of the benzodiimidazole is close to the –C
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Created by potrace 1.16, written by Peter Selinger 2001-2019
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 O of a C base. These three interactions account for the strong preference of DB2831 for a -GG- sequence. Surprisingly, a complex with one dynamic, interfacial water is favored with 75% occupancy.


Emerging threats to hardware Intellectual Property (IP) confidentiality due to the horizontal business model have come in the form of piracy, reverse engineering, and extraction of design secrets. These threats have led to the development of promising IP protection solutions, which include logic locking and hardware obfuscation. While logic locking has been mainly developed for protecting confidentiality of hardware IPs, it may also provide other security benefits that extend beyond IP theft and into defending design integrity against malicious design modifications, referred to as hardware Trojan attacks. Hardware Trojan attacks are realized through insertion of stealthy malicious logic in a design, often activated under rare conditions, so as to evade detection. Existing countermeasures against Trojan attacks primarily focus on detection of an attack through targeted verification approach or its prevention through design solutions. In this paper, we present an investigation on the role of state-of-the-art logic locking methods for protecting against hardware Trojan attacks. We discuss beneficial attributes of logic locking that can contribute to Trojan prevention and significant reduction in its efficacy. We introduce metrics to describe and quantify these phenomena. Through extensive experimental validation and practical Trojan insertion, we show that on average effective logic locking can offer around 87% reduction in Trojan activation success and around 1000x increase in Trojan activation probability of those successfully inserted.


FIELD: pharmaceutics. SUBSTANCE: group of inventions refers to pharmaceutics and concerns a medical agent containing a combination of N-acetyl-L-cysteine, selenium in the form of selenomethionine and melatonin. Described product can be used for treating carcinoma, dermatological diseases, chronic obstructive pulmonary disease (COPD), amyloidosis, endometriosis and bacterial infections caused by E.coli., for cosmetic treatment of skin, as well as an antibacterial agent with medical device adapted for use in contact with body fluids. EFFECT: group of inventions provides a synergetic effect at preservation of N-acetyl-L-cysteine, favorable effect on treating COPD, endometriosis, amyloidosis, dermatological diseases and skin states, such as vitiligo, psoriasis, alopecia, seborrheic dermatitis, as well as improved oral absorption. 12 cl, 9 dwg, 1 tbl, 5 ex


SYLLABUS OF POINTS DECIDED. The statutes of Kentucky against empiricism are constitutional. Whether a school of medicine from which a party holds a diploma is a reputable medical college, is a question alone and exclusively for the State Board of Health to decide. Mandamus will not lie to compel the said Board to decide a particular way. Their act is quasi-judicial and is not subject to mandamus. On the merits, held that the American School of Osteopathy at Kirksville, Mo., from which the plaintiff holds a diploma, is not a reputable medical college; and that the State Board of Health is right in refusing to allow the plaintiff to practice osteopathy in this state. The evidence analyzed and the law reviewed. Historic review of kindred quack schools of mysterious healing. This is a suit in equity by the plaintiff, Harry Nelson, against the State Board of Health of Kentucky, to


SUMMARY  Increasing evidence suggests a role for environmental chemicals in the promotion of Type 2 diabetes. This review summarizes epidemiologic studies of environmental chemical exposures reported to be associated with Type 2 diabetes and insulin resistance. Chemicals are classified as having moderate, limited and insufficient degrees of evidence in support of a diabetes-promoting effect. Moderate evidence exists for diabetogenic effects of inorganic arsenic and persistent organic pollutants, including organochlorines, dioxins and polychlorinated biphenyls. Limited evidence supports a role for environmental tobacco smoke and ambient air pollution. Insufficient evidence is available regarding the potential effects of bisphenol A, phthalates, organophosphates and pyrethroids; most studies of such short-lived pollutants have been cross-sectional and do not demonstrate causality.


The main goal of the current study is to ascertain the impact that social media platforms have on electoral strategy, communication tactics, and electoral outcomes in the specific context of the 2023 municipal elections in Tirana, Albania. The purpose of this study is to analyze the official usage data on Facebook and Instagram of Erion Veliaj, the current mayor of Tirana and a candidate associated with the Socialist Party. The temporal scope of the investigation encompasses the period spanning from April 1 to June 1, 2023. The main objective of this study is to investigate the possible impact of widespread use of social networks as a means of political communication on election results, as well as the manner in which this platform influences voter engagement with political candidates. The hypothesis posited in this study suggests that the extensive utilization of social media platforms by political candidates during the municipal elections in Albania in 2023 yielded a favorable effect on public participation in political discussions, hence exerting an influence on the electoral results. The research question under examination are as follows: What were the methods implemented by candidate Erion Veliaj in leveraging social media during the municipal election campaign of 2023? What is the relationship between social media engagement, as measured by quantitative metrics like likes, shares, follower growth rate, and engagement rate, and the electoral success of candidates in the 2023 Municipal Elections in Tirana, Albania? The study used a mixed-methods approach, which combines qualitative and quantitative methodologies, to investigate the correlation between the candidate's patterns of interaction, content tactics across different platforms, and the outcomes of the election. This comprehensive study aims to gain a thorough understanding of the substantial role of social media as a medium for political communication and its positive impact on electoral outcomes.

Received: 20 July 2023 / Accepted: 5 October 2023 / Published: 5 November 2023


Driving is a high-risk adventure and a highly complex task; yet anyone with a driver's licence might perform daily. The driving task is characterised by requiring competence and control to cope wit ...


This paper is the third in a series where we describe the space of all embedded minimal surfaces of fixed genus in a fixed (but arbitrary) closed 3-manifold. In [CM3]–[CM5] we describe the case where the surfaces are topologically disks on any fixed small scale. Although the focus of this paper, general planar domains, is more in line with [CM6], we will prove a result here (namely, Corollary III.3.5 below) which is needed in [CM5] even for the case of disks. Roughly speaking, there are two main themes in this paper. The first is that stability leads to improved curvature estimates. This allows us to find large graphical regions. These graphical regions lead to two possibilities:


The aim of this study is to create and assemble the system with customizing/building Linux kernel and environments to be compatible and efficient on mini-ITX computer. The objective of the study is to create/customizing lightweight operating system using GNU/Linux to be used on computer to be used on vehicle. The system would also optimize the size and functionalities most probably would be implemented on car computer system.Keywords: mini-ATX, CarPC, Linux, Ubuntu, Qt, QML


Silver nanoparticles have some particular physical and chemical characteristics,and have a wide application prospect in the fields of catalysis,optics,biomedicine,etc.This review described a brief overview of the research progress of bacteria,yeasts,fungi and antinomycetes in the biosynthesis of silver nanoparticles,especially focused on microorganism species,synthesis method and mechanism.The future development of silver nanoparticles was forecasted.


There is no need for me to labour the issue of the internal tensions which undoubtedly exist within the so-called last discourse of the Fourth Gospel (John 13:1-17:26). The most immediately recognised of these is the apparent decision to finish the discourse and to leave the setting of the upper room in 14:30-31, a passage which links beautifully with the first verse of the passion narrative in 18: 1, but which inexplicably leads to the allegory on the true vine (15: 1-11) and much elsewithout any indication of a time, place or situation for the material which runs from 15:1-16:33. In fact, a similar ending can be found in 16:32-33:


This paper investigates a novel approach of digital image watermarking based on BCH error correction code in Discrete Cosine Transformation (DCT) domain. In the proposed technique, the watermark is encoded through BCH error correction code before embedding process, then it is embedded into the Discrete Cosine Transformation (DCT) coefficients of cover image. The proposed algorithm also employs lookup table method to find the best positions in the frequency domains for watermark insertion. The significant feature of this method is the reduction of time required in the process embedding of information, security and ability to correct the error caused by different attacks. Experimental results show the superiority of the proposed approach against the existing approaches. Keywords—Digital Watermarking, Discrete Cosine Transformation, Error Correction Codes, BCH code, Look Up Table


Successful transfer of knowledge between two organizations is of particular importance for outsourcing relationships and even more so for relationships within IT/IS domain where the relationship often needs to be rapidly redefined or terminated. Transferring knowledge in IT/IS outsourcing relationships requires empowering of both teams of outsourcer and service provider towards achieving knowledge transfer goals set by outsourcing organization. We focus on the Transfer Team which consists of knowledge keepers (service provider) and receivers (outsourcer) and propose a framework for piloting knowledge transfer initiative in IT outsourcing set-up. To empower the outsourcing Transfer Team we propose two tools to support the process: Transfer Profiler and Transfer Instruments Catalogue. Swiss financial institution used an approach based on this framework and tools for knowledge transfer pilots in their outsourcing transfer initiative. We describe this framework and the related tools as well as offer first lessons learned from using them in the field.


chema Therapy is an approach that was initially used to treat personality disorders. However, over time, studies have shown that its use could also be extended to acute disorders. One way to investigate its effectiveness is by using the Young's Schema Questionnaire (YSQ), which investigates the Early Maladaptive Schemas (EMSs) of individuals. Through a Systematic Review of articles published from 2003 to 2019, this article proposes the investigation of interventions in Schema Therapy using the YSQ- Long Version (YSQ-L3). The bases investigated were SCOPUS, Pubmed and Psycinfo. Interventions were found in personality, mood and personality disorders. The studies were carried out both on individuals individually and in groups, but most of them were mixed. In all studies there was a decrease in psychopathological symptoms and EMSs. This denotes the importance of instrument validation studies and adaptation of protocols based on Schema Therapy for use in Brazil.


The stereoscopic 3D industry almost seems to have exploded overnight. We have a growing number of stereoscopic 3D (S-3D) movie theaters, the S-3D gaming industry is taking off thanks to efforts by the S-3D manufacturers (e.g. iZ3D, TDVision Corp, etc.), leading names like James Cameron, Ubisoft, Electronic Arts Korea and additionally by the efforts of the Meant To Be Seen (MTBS) membership. Yet the more things change, the more things stay the same. What does the S-3D industry need to do to make stereoscopic 3D a success for the masses? What lessons can the past teach us to help move us along?


The application of scanning tunnelling microscopy (STM) to semiconductor surfaces is reviewed. After a brief description of theoretical models for STM the experimental requirements are summarized. STM results will be shown and discussed for clean semiconductor surfaces (Si(111), Si(100), Si(110), high-index faces of Si, Ge and GaAs). Examples will be given for the more important reconstructions of these surfaces and for temperature dependent phase transitions, e.g., for the high-temperature transition of Si(111) and for the low-temperature c transition of Si(100). The properties of steps will be described for Si(111) and Si(100). The study of adsorption and growth processes is one of the main fields in current STM work on semiconductors and representative examples will be given for homoepitaxy, heteroepitaxy, cross-sectional studies, metal adsorption and adsorption of small molecules which give rise to surface reactions. Finally, more recent applications such as manipulation of semiconductor surfaces, ballistic-electron emission, potentiometry and electrochemistry will briefly be reviewed.


The helicopter and trained paramedics operating in the rural areas of Arizona in 1969 and 1970 in a multidimensional role as an airborne force to provide definitive treatment and reduce patient transport time for highway accidents (the evacuation mission) and as a deterrent force to reduce traffic accident potential (the highway surveillance mission) were demonstrated and evaluated. When they were used in patrol and surveillance operations, there was a statistically significant reduction in driver behavior characteristics that are accident-related. The helicopter must be evaluated with regard to its total operating capability of performing medical evacuation, patrol and surveillance, and general law enforcement. It cannot be economically justified when used to perform only 1 type of mission.


Second virial coefficients have been determined for carbon disulphide, methyl chloride, acetone, and methanol over the temperature range of 50-150° with some additional results at lower temperatures. Similar work has been conducted on the selected mixtures methyl chloride-carbon disulphide, methyl chloride-acetone, acetone-carbon disulphide, and methyl chloride-argon. Methanol, exceptionally, shows very significant third virial contributions in the sub-atmospheric pressure range. A comparison is made with recent models pertaining to molecular interactions between unlike molecules possessing dipolar and quadrupolar contributions to the intermolecular forces.


We report on our latest research in the field of nanostructured optical components fabricated using stack and draw technique. The concept of nanostructuring is based on the idea that the macroscopic optical properties of the system can be controlled by introduction of subwavelength elements. In some geometries even a single nanoinclusion can significantly change the performance of the device, in others incorporation of large amount of subwavelength elements justifies the usage of effective medium theory. Here, we demonstrate that nanostructurization through stack-and-draw method leads to development of fibres with carefully design birefringence and allows fabrication of elements of arbitrary effective index profiles. On the basis of Energy-dispersive X-ray spectroscopy measurements we also discuss the impact of selective diffusion process on optical properties of considered systems and show that this mechanism can be treated either as an opportunity to extend the dispersion engineering flexibility in optical elements or as a limitation which introduces the uncertainty of the final dispersion profile of the nanostructured components.


Objective: In recent years, the presence of precore/core region mutations were uncovered by the examination of Hepatitis B Virus (HBV) deoxyribonucleic acid (DNA) that is isolated from patient samples with anti-HBe seroconversion without viral replication loss. In this study, the frequency of precore/core mutations were investigated on serum samples obtained from chronic hepatitis B patients. Methods: From a total of 100 samples 69 anti-HBe and HBV DNA positive, and 31 HBeAg and HBV DNA positive samples were analyzed in the study to determine the mutations with the INNO-LIPA method at the Serology laboratory. Statistical analyses were bone with, SPSS v11.5 and chi-square and variance analysis (ANOVA) tests were conducted. Results: The precore mutations were detected in 68, while the core promoter mutations were present in 57 samples. Mutations were detected at the precore region in 11 out of 31 HBeAg positive (35%), and 57 out of 69 anti-HBe positive samples (83%). Likewise, the core promoter region was affected in 10 of 31 HBeAg (32%), and 47 out of 69 anti-HBe positive samples (68%). Both precore and core promoter mutations were substantially higher in the anti-HBe positive group (p<0.05). Conclusion: As a result, since precore/core mutations were prevalent in samples obtained from the study group, it is our opinion that careful attention must be paid to such mutations during the diagnosis and treatment phases of chronic hepatitis B patients.


The Disney Channel has been playing to air from video servers since November I, 1996. Twenty-four hours a day, seven days a week, all programming and promotional materials play to air from a pair of redundant video servers under the control of an automation system. Living with video servers is becoming a reality for all broadcasters. Whether servers are used facility-wise or only in isolated areas, broadcast engineers must understand how to use them effectively and be aware of their particular failure modes. Experience with computer operating systems and modern computer networking techniques is not only helpful, it is essential. The Disney/ABC Cable Group's Network Operation Center (NOC) in Burbank, CA., was built in the summer of 1996. The NOC went into operation in November 1996, with the origination of the Disney Channel from a new all-digital facility with ITU-R 601 digital component video and four channels of AES/EBU digital audio. Many rules have changed in moving from the analog VTR world to the digital server world. Simultaneous introduction of a digital facility, automated network playback system, and video servers taught the Disney engineering staff many lessons. In this paper, we intend to relate our experiences to help others plan and understand the coming change to server-based facilities.


Nanosized lanthanide-doped TiO_2 samples with different Ti/Ln(Ln=La,Ce,Pr,Nd,and Sm) atomic ratios were prepared by sol-gel method using tetrabutyl titanate and lanthanide nitrate as precursors,and were characterized by fluorescence and UV-vis diffuse reflection spectroscopy.Unique fluorescence properties were observed from Sm-doped TiO_2 nanoparticles and the intensity of peaks in the emission spectra varied with the doping concentration.Compared with undoped TiO_2,the absorption edges of Ce-doped samples were red-shifted remarkably and those of other lanthanide ions doped samples were blue-shifted.


A new species belonging to the new genus of the tribe Agapanthiini is described from South Korea under the name Coreocalamobius parantennatus gen. et sp. nov. This new genus is close to Pseudocalamobius KRAATZ, 1879 by the sexual features of tegmen and abdominal sternites 4 and 5, but can be easily distinguished from the latter by its short antennae, narrower body with effaced hu- meri and degenerated hind wing.


Evans, P. B. 1975 "Multiple hierarchies and organizational control." Administrative Science Quarterly 20:250-259. Glassman, Robert 1973 "Persistence and loose coupling in living systems." Behavioral Science 18:83-98. Kaufman, Herbert 1976 Are Government Organizations Immortal? Washington, DC: Brookings. March, James G., and Richard Cyert 1963 A Behavioral Theory of the Firm. Englewood Cliffs, NJ: Prentice-Hall. Merton, Robert 1940 "Bureaucratic structure and personality." Social Forces 17:560-568. Rubin, Irene 1977 "Financial Retrenchment and Organizational Change." Ph.D. Dissertation, University of Chicago. Simon, H. A. 1962 "The Architecture of Complexity." Proceedings of the American Philosophical Society 106:467-482. 1973 "The organization of complex systems." Pages 1-28 in Howard Pattee (ed.), Hierarchy Theory: The Challenge of Complex Systems. New York: George Braziller. Thompson, James. 1967 Organizations in Action. New York: McGraw-Hill. Tullock, Gordon 1965 The Politics of Bureaucracy. Washington, DC: Public Affairs Press. Weick, Karl 1976 "Educational organizations as loosely coupled systems." Administrative Science Quarterly 21 (March):1-19.


The aim of this study is to see if there are significant relationships between different variables of physical condition and academic performance. Most literature shows that a relationship does exist, mainly emphasizing maximal oxygen consumption and academic performance. With regard to the other variables, more differences can be found. A total of 79 students participated in the study from the island of Majorca (Spain), ranging in age from 12.5 to 14.5 years. Students passed fitness tests, which were compared with their academic results. The results show a significant positive relationship between BMI and hand grip strength and significant negative relationships between BMI and note and between BMI and maximal oxygen consumption. No significant relationships have been found, however, between maximal oxygen consumption and note. Assessment of the importance of physical condition and therefore physical education in academic performance is of interest in order to implement the necessary hours of Physical Education. Furthermore, this subject should be characterised further in terms of its relation to the issue of health.


The reproductive season was studied in clam Cyclina sinensis in coastal Dalian by means of histological section and fatness.The results showed that the clam was characterized by the typical characteristic of bivalves in gonadal development,and the reproductive cycle was divided into 5 stages: proliferation stage, growing stage,maturation stage,spawning stage and spent stage.The microscopic and histological character of each stage was described in this article.The gonadal maturation of the clam took one year in Dalian coast.The spawning occurred from mid-July to late August,the peak being from late July to mid-August when the water temperature was about 24.0-26.8 ℃.The maximal fatness index was about 8.07% in August,and the minimal about 5.27% in December.


This essay considers the personal political ramifications of the refusal to make a confession, twice enacted in J. M. Coetzee's Disgrace . Professor David Lurie refuses officially to apologize for sexually abusing a student; and, later, his daughter Lucy, the victim of a gang rape, refuses to lay charges or speak of what has happened. In a context informed by the recent experience of the Truth and Reconciliation Commission hearings, the novel thus raises the question of what it is to come to terms with a history of terror and subjection, both for the perpetrator and for the victim. It proposes, as an alternative to a Christianized confession, a secular atonement - in effect, a physical abjection, a dogged acceptance of humiliation - the forms of which are conventionally feminine, or at least emasculating. The essay examines the gender significations of this abjective alternative, especially in a situation where an ethic of unstinting love requires the elision and/or subjection of the body of the woman.


This is the age of customer service, and those involved with the provision of customer service are finding the focus group interview to be an efficient technique for assessing quality of service. This paper explains the rationale and method of the focus group interview and demonstrates how focus group interviews were used to gauge student-user opinions of service quality in Purdue University's library system. The relationship of this qualitative research technique to quantitative techniques is discussed.


A major concern of chemical evolution research1 4 is to find an answer to the question: How were proteins originally formed on Earth before the appearance of life? A widely held view stimulated by the speculations of Oparin,5 Haldane,6 Bernal,7 and Urey8 is that the formation of polypeptides occurred via two essential steps, a-amino acid synthesis initiated by the action of natural high-energy sources on the components of a reducing atmosphere, followed by polycondensations in the oceans or on land. The results of a dozen years of simulation experiments1-4 appear to support this view. Experiments in which high-energy radiations were applied to reduced mixtures of gases have yielded many of the 20 a-amino acids commonly found in proteins. The pioneering research of M\iller9 showed that glycine, alanine, aspartic acid, and glutamic acid were among the products obtained by passing electric discharges through a refluxing mixture of hydrogen, methane, ammonia, and water. Extensions of these studies by Abelson10 and others'-4 showed that a-amino acid synthesis could be effected by almost any source of high energy so long as the starting mixture contained water and was reducing. Since mechanism studies by Miller9 indicated that aldehydes and hydrogen cyanide were transient intermediates during the course of the reaction, it was concluded that the a-amino acids were formed by the well-known Strecker route involving hydrolysis of aminoacetonitriles arising from the interactions of aldehydes, hydrogen cyanide, and ammonia.


The study examines students' perceptions on the thesis mentoringprocess regarding their nonverbal communication patterns in the English studyprogram, FKIP of Halu Oleo University. The scope and focus are kinesics,proxemics, oculesics, chronemics, paralanguage, and physical appearance.Thisstudy apply a qualitative approach. The data obtained employing interview anddocumentation are then analyzed by Miles and Huberman's theory using reduction,reporting, and verification. The subjects of the study are eight graduated studentsand two students in the mentoring process. The study results shows that the sixtypes of nonverbal which are most likely to be experienced more often andinfluentially are 'kinesics', which is like the supervisor's attitude serving thestudents. Other nonverbal types continue to take on roles but are not as influentialas kinesics. This study reveals that the importance of communication is able toincrease student attention and motivation in constructing ideas gained from theirsupervisors when the communication process is going well and vice versa.


Abstract Herein, we report the complete chloroplast genome of Tilia mongolica Maxim. from Tiliaceae. The chloroplast genome of T. mongolica is 162,804 bp, with a large single copy region of 91,255 bp, small single copy region of 20,355 bp, and two inverted-repeat regions of 25,597 bp. The chloroplast genome contains 130 genes, including 85 protein-coding, 8 rRNA, and 37 tRNA. The total GC content is 36.46%. The phylogenetic analysis of T. mongolica showed a relatively close relationship with Tilia taishanensis.


This paper presents a general procedure for determining the optimal MPEG coding strategy in terms of the selection of macroblock coding modes and quantizer scales. The two processes of coding mode decision and rate control are intimately related to each other and should be determined jointly in order to achieve optimal coding performance. We formulate the constrained optimization problem and present solutions based upon rate- distortion characteristics, or R(D) curves, for all the macroblocks that compose the picture being coded. Distortion of the entire picture is assumed to be decomposable and expressible as a function of individual macroblock distortions, with this being the objective function to minimize. The determination of the optimal solution is complicated by the MPEG differential encoding of motion vectors and dc coefficients, which introduces dependencies that carry over from macroblock to macroblock for a duration equal to the slice length. Once the upper bound in performance is calculated, it can be used to assess how well practical sub-optimum methods perform.


This paper presents the nonlinear dynamical post-buckling analysis of an uncertain cylindrical shell. The proposed approach is adapted to the dynami cal analysis of geometrically nonlinear structures subjected to a stochastic ground-bas ed motion in the presence of both system parameter uncertainties and model uncertainties. T he structure is modeled by a large finite element model using 3D elasticity theory. The groundbased motion is represented by a Gaussian centered non-stationary second-order stocha tic process. Then, a reducedorder basis is constructed using the POD (Proper Orthogonal Decomposition) analysis of a nonlinear static reference response combined with selecte d lin ar eigenmodes of vibrations. The mean reduced-order nonlinear computational model is th en explicitly constructed. A positive-definite operator involving the nonlinear sti ffness of the structure is defined, allowing the nonparametric probabilistic approach to be used for constructing the uncertain nonlinear reduced-order computational model. The dispersion parameter controlling the level of stiffness uncertainty is a scalar which has been previously ident ified experimentally in a nonlinear static context. Finally, the instantaneous spec tral density power of the dynamical response is analyzed in order to quantify the influence of bot h geometrical nonlinearities and random uncertainties on the stochastic dynamical response .


In this paper,analyzed the advantage of the intelligent material using on artillery rocket,established the model of the extended--range artillery rocket.According to established the exterior ballistic model of this artillery rocket ,a simulation software is programmed and calculated the exterior ballistic.The model as well as the simulation resulta gives an important guidance to advanced study of self--adapt ammunition.


Background: Complementary and Alternative Medicine (CAM) is a common practice worldwide and there is a broadening interest among Saudi population in its curative potential. This study aimed to determine the gender differences of Saudi population in the use of Complementary and Alternative Medicine based on individual practice and beliefs.

Aim: To determine the purpose, beliefs, and commonly used modalities in CAM among the indigenous community in Riyadh, Saudi Arabia.

Methodology: This is a cross-sectional study conducted in Riyadh region of Saudi Arabia. Data were collected from 740 respondents by a pre-tested questionnaire after obtaining ethics approval. Statistical analysis was performed by SPSS software version 25.0.

Result: Sixty-one (28.6%) males prefer the use of CAM over modern medicine compared to 205 (38.9%) females. One hundred and twenty-one (56.8%) and 297 (56.4.%) of males and females, belief that CAM can cure diseases what Modern Medicine still struggle with. Two hundred and forty-two (45.9%) females and 79 (37.1%) males use CAM for treatment respectively. Ninety males (42%) use CAM based on cultural reasons:

However: Two hundred and twenty-five (42.7%) females use CAM based on their belief on its scientific evidence.

Conclusion: Females prefer CAM use more than males. Both genders use CAM mainly for treatment. Herbs are the most common types of CAM for both males and females. The source of getting CAM products is family and friends both genders. The use of CAM is based on cultural reasons for males, scientific evidence forms the base of CAM use for females.


With the Reformation, philosophers sought to establish a new way of thinking independent of religion. Borrowing principles popularized religious reformers: the right of conscience, the utter transcendence of God, the sinfulness of the world, they constructed a new metaphysics that highlighted the mystery of God and the complete intelligibility of 'rational man.' From this history an understanding of our religious situation is distilled. The chapters of this work develop for the reader the intellectual structure of religion and show how its language, imagery and ritual function. They argue that if religion no longer presents a challenge, it is because we think of it in terms of the 'new metaphysics.' To recapture the reality, we must join our contemporaries who are attacking the premises of classical modern philosophy and so experience ourselves afresh.


The raw material of agricultural biomass is tracked during whole first supply chain.The residue of the agricultural biomass is tracked during whole second supply chain.The amount using the fuel with carbon intensity level for determining to be produced from the raw material based on the residue in second supply chain.


This Update reviews several important papers from the gastroenterology literature published during 2002. My recommendations reflect both the best available evidence and today's cost-constrained practice environments. The papers are grouped into four categories: Barrett esophagus, Helicobacter pylori, hepatology, and inflammatory bowel disease. Barrett Esophagus I will consider the literature on screening or surveillance for Barrett esophagus. In programs designed to screen for Barrett esophagus, members of the general population who are believed to be at increased risk (usually those with gastroesophageal reflux, although, as we will see, the at-risk population may be larger) undergo endoscopic evaluation once to establish or exclude the disease. Surveillance programs are used only in patients with Barrett esophagus; these programs require periodic endoscopic evaluations, including biopsies, to look for dysplasia or early adenocarcinoma. Surveillance for Barrett Esophagus Appears To Be Associated with Better Outcomes in Esophageal Cancer, but a Randomized, Controlled Trial Is Needed Corley DA, Levin TR, Habel LA, et al. Surveillance and survival in Barrett's adenocarcinomas: a population-based study. Gastroenterology. 2002; 122:633-40. [PMID: 11874995] The authors of this paper, from the Northern California Kaiser Permanente group, compared the long-term outcomes of esophageal cancer in patients with Barrett esophagus who had undergone surveillance and those who had not. Five hundred eighty-nine patients had adenocarcinoma of the esophagus or gastric cardia, but only 135 (23%) had documented Barrett esophagus. Furthermore, only 23 of these 135 (17%) had received a diagnosis of Barrett esophagus more than 6 months before cancer was discovered. In the remaining patients, the diagnosis of Barrett esophagus was first established when the tumor was resected. Of the 23 patients with previously diagnosed Barrett esophagus, 15 received a diagnosis of esophageal cancer during a surveillance procedure. These 15 patients had less advanced cancer than those whose cancer was discovered by other means. Survival was much better in the surveillance patients. Eleven (73%) were alive at the end of follow-up (mean, 6.1 years) compared with none of the 8 patients who had cancer diagnosed after symptom development (P = 0.001). The 15 surveillance patients were approximately 10 years younger than the 8 who had cancer diagnosed without surveillance (61.4 vs. 72.6 years; P = 0.02), and this age difference could have accounted for some of the difference in survival. An epidemiologic study can only show an association between an intervention and an outcome. As the authors correctly pointed out, the design of their study did not permit them to conclude that surveillance is efficacious. Several biases could make an ineffective surveillance intervention seem beneficial. These include selection (individuals who agree to be screened are more health-conscious in general), lead time (the apparent longer survival is due only to an earlier diagnosis and not to a change in prognosis), and length time (surveillance identifies slower-growing cancer because faster-growing tumors are diagnosed between surveillance procedures). Thus, only a randomized, controlled trial (RCT) that compares the esophageal cancer death rate in patients assigned to surveillance or to no surveillance can establish the efficacy of the more aggressive approach. Do We Need More Extensive Screening Programs To Identify Barrett Esophagus? Dulai GS, Guha S, Kahn KL, et al. Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: a systematic review. Gastroenterology. 2002; 122:26-33. [PMID: 11781277] In this paper, researchers from the University of California, Los Angeles, performed a systematic review and meta-analysis of the literature to determine the percentage of patients who had surgery for adenocarcinoma of the esophagus and who had a previous diagnosis of Barrett esophagus. They included observational studies from 1966 to 2000 that reported both the number of adenocarcinomas resected and the number of patients with preexisting Barrett esophagus. Twelve papers involving 1503 patients met the inclusion criteria. The authors estimated that 5% of patients who had adenocarcinoma of the esophagus had a previous diagnosis of Barrett esophagus. (This observation reinforces the previous paper's finding that most patients with esophageal adenocarcinoma do not have a previous diagnosis of Barrett esophagus.) The authors concluded that we need to develop more effective screening programs to identify patients with Barrett esophagus. However, as was previously noted, we need to prove that surveillance of patients with Barrett esophagus will reduce the death rate from esophageal adenocarcinoma, before we undertake more widespread screening. Barrett Metaplasia Is Common in Asymptomatic Veterans Gerson LB, Shetler K, Triadafilopoulos G. Prevalence of Barrett's esophagus in asymptomatic individuals. Gastroenterology. 2002; 123:461-7. [PMID: 12145799] Gerson and colleagues determined the prevalence of Barrett esophagus among asymptomatic veterans of the U.S. armed forces. They asked persons who were scheduled for screening flexible sigmoidoscopy if they would also consent to upper endoscopy; 110 agreed to do so. The results were provocative. Twenty-seven patients (25%) had Barrett esophagus; all but 8 had short-segment disease, which may be a less threatening variant. An additional 19 patients (17%) had normal-appearing mucosa but microscopic evidence of intestinal metaplasia on random biopsy. The authors concluded that Barrett esophagus is common in U.S. veterans. The study was not sufficiently powered to elucidate the contribution of specific risk factors, such as alcohol and tobacco exposure. Resource Utilization and Barrett Esophagus Although most patients who have adenocarcinoma of the esophagus do not have a previous diagnosis of Barrett esophagus, it is widely believed that esophageal adenocarcinoma is preceded by this metaplastic change. Therefore, it is tempting to advocate screening for Barrett esophagus in patients with gastroesophageal reflux or perhaps even in the general population. However, screening for Barrett esophagus is not clearly justified. First, esophageal adenocarcinoma is still relatively rare compared with types of cancer for which screening has been introduced (colon, breast, prostate). Second, although many believe that all cases of esophageal adenocarcinoma arise in the setting of Barrett esophagus, many patients with this cancer have no evidence of Barrett esophagus. Perhaps in these cases cancer simply replaces Barrett esophagus, but we cannot exclude the possibility that the latter disorder was never present. Third, surveillance in patients with Barrett esophagus identifies only one case of cancer per 200 patient-years of surveillance; these cases are not all curable or destined to cause morbidity if untreated. The added issues of length-time and lead-time biases also make screening and surveillance more problematic. (In other words, discovering cancer during surveillance does not automatically translate into a cancer death prevented.) When we also consider the relatively high cost of the screening tools (endoscopy and biopsy), the case for screening or surveillance for Barrett esophagus is quite weak. We first need to measure the benefits of screening and surveillance, which will require RCTs with controls who do not receive either. Helicobacter pylori Eradication of Helicobacter pylori Does Not Worsen Reflux Moayyedi P, Bardhan C, Young L, et al. Helicobacter pylori eradication does not exacerbate reflux symptoms in gastroesophageal reflux disease. Gastroenterology. 2001; 121:1120-6. [PMID: 11677204] Because Helicobacter pylori causes chronic gastritis that leads to reduced acid secretion, some physicians have expressed concern that treatment of H. pylori infection will lead to greater acid secretion and more symptomatic heartburn. Others have warned that the long-term use of proton-pump inhibitors could worsen gastric mucosal atrophy in H. pyloriinfected individuals. To assess the interaction between H. pylori and reflux, Moayyedi and colleagues studied 190 H. pyloripositive patients with symptoms of heartburn but without endoscopic evidence of severe esophagitis. Patients were randomly assigned to receive either H. pylori eradication therapy or placebo. All patients took omeprazole for 8 weeks. Eradication therapy was successful in 83% of 93 patients (as assessed by a urea breath test), and 13% of the 97 placebo recipients became H. pylori negative. Ten months after omeprazole was stopped, the symptomatic reflux relapse rates were the same in both groups (83%). The time to the first symptomatic relapse was also the same (P > 0.2 [log-rank test]). Thus, treatment of H. pylori infection did not affect the subsequent incidence of reflux. The same investigative group made a similar observation in H. pyloripositive patients with nonulcer dyspepsia who were randomly assigned to antibiotics or placebo (1). Only approximately 25% of each group developed reflux symptoms. This incidence rate was probably lower than that in patients with gastroesophageal reflux disease in the more current study because the primary underlying disease was nonulcer dyspepsia rather than reflux. These articles appear to refute the suggestion that H. pylori eradication therapy worsens reflux. Therefore, H. pyloripositive patients with reflux can take eradication therapy without concern that it will aggravate their reflux symptoms. H. pylori Infection Should Be Treated before Long-Term Therapy with Nonsteroidal Anti-Inflammatory Drugs Is Started Chan FK, To KF, Wu JC, et al. Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial. Lancet. 2002; 359:9-13. [P