Conducting polymers are new materials that can be used as low-voltage actuators and active flexure joints, scaling down to the microscale; however, many devices based on these actuators are limited because they can only operate when submerged in an electrolyte. Conducting polymer trilayer actuators are laminated structures with a wide range of potential applications as they are capable of operating both in air and liquid environments, but their dynamic behavior is not yet fully understood. With the view to developing a comprehensive dynamic model of trilayer actuators, this paper presents the experimentally obtained frequency response of the actuator displacement, as measured using a laser displacement sensor. A model of the resonant frequency is also presented and then comprehensively validated using actuators of various geometry and loading. This model can be used to: 1) estimate properties of the trilayer actuator from experimental measurements; 2) quantify and optimize an actuator's dynamic behavior as a function of geometry; and 3) facilitate the use of these actuators as a component in practical applications, such as force and motion control systems.


Coarse-grained, polymict, deposits, draping hillslopes at high elevations on ocean island volcanoes, have been variously interpreted as sourced either from sea-level highstands or from tsunamis; their origin is thus controversial. A detailed facies analysis of coarse-grained, fossiliferous sediments located at Agaete, on the north-west coast of Gran Canaria, has been undertaken. Previously interpreted as the result of a sea-level highstand, these deposits have recently been re-interpreted as sourced from a tsunami; itself triggered by a volcano flank failure. The Agaete Fossiliferous Conglomerates occur at several locations in the Barranco de Agaete, up to 188m apsl. and 2 kilometres inland from the coast. They comprise seven facies, all of which are variably graded, matrix- and clast-supported, range from ~0.3 to 2 m thick, and contain a diverse assemblage of volcanic clasts, large beachrock boulders and a shallow marine fauna. All the facies have sharp, erosional bases. A facies at one site contains large palaeosol rip-up clasts up to 1.5 m across and at its base truncates plant roots. The upper facies of the conglomerates are all finer-grained, reverse-graded, clast-supported and better-sorted than the lower facies of the group. At one location the upper conglomerates comprise prograding beds that are interpreted as alluvial. The lower facies of the conglomerates are interpreted as primary tsunami deposits, whereas the upper facies are interpreted as tsunami deposits that have been reworked. The alternative, marine highstand, interpretation of the coarse-grained deposits is discounted on the basis of (i) an absence of supporting geomorphological features such as a marine terrace and/or a wave cut platform; (ii) the composition of the sediments; (iii) diagenetic features; (iv) distance from the coast; and (v) elevation of the deposits. Gran Canaria is in its erosional post-shield stage of development and the north-western coastline has experienced 40-50 m of tectonic uplift over the past 1.75Ma. Thus uplift of highstand deposits cannot account for the occurrence of the Agaete sediments at elevations of up to 188 m apsl. The Guimar lateral collapse event on the neighbouring island of Tenerife, dated at around 0.8Ma BP, is presented as the most likely tsunami source.


Calorie restriction extends life span in organisms ranging from yeast to mammals. Nisoli et al. find that when mice are subjected to calorie restriction, endothelial nitric oxide synthase (eNOS) expression and 3′,5′-cyclic guanosine monophosphate formation are increased. This change is accompanied by mitochondrial biogenesis, increased oxygen consumption, adenosine triphosphate production, and expression of sirtuin 1, a protein previously implicated in mediating the effects of calorie restriction on life span. These effects are strongly attenuated in mutant mice lacking eNOS. Thus, NO may play a role in the processes induced by calorie restriction and in life-span expansion in mammals. E. Nisoli, C. Tonello, A. Cardile, V. Cozzi, R. Bracale, L. Tedesco, S. Falcone, A. Valerio, O. Cantoni, E. Clementi, S. Moncada, M. O. Carruba, Calorie restriction promotes mitochondrial biogenesis by inducing the expression of eNOS. Science 310, 314-317 (2005). [Abstract] [Full Text]


Objectives: This study intended to examine the effectiveness of mindfulness-based cognitive therapy on moderating maladaptive schemas and affective control in students suffering from learning disabilities. Methods: This experimental research was conducted using pretest-posttest and a control group. The population included all the female students who were studying in the Koohdasht's middle schools (academic year: 2012-2013). The sample included 40 female students suffering from learning disabilities who had been randomly selected out of Koohdasht's middle school students after identification and a structured clinical interview and they were put into experimental and control groups (20 students each group). For data collection, Affective Control Scale and Young Schema Questionnaire were used. Results: The results of multivariate covariance analysis showed that mindfulness-based cognitive therapy has significantly decreased maladaptive schemas, depression, anxiety, and anger in subjects (p<0.001). Discussion: This finding represents important implications regarding education and mental health improvement in exceptional students. Therefore, it is recommended to use this therapeutic package in schools and clinics as a supplement to other therapies in order to decrease negative emotions and to prevent formation of maladaptive schemas in these students.


This paper discusses U.S. energy policy and the associated evolution of energy supply, energy demand, energy prices and the industrial organization of the domestic energy industries during the period 1991 through 2000. This period covers the last two years of the George H. W. Bush administration and the entire Clinton administration. The paper begins with a background discussion of energy supply, consumption and energy policy prior to the 1990s. It then provides an overview of the evolution of energy markets and energy policy during the 1990s. This discussion is followed by a more detailed discussion of supply, demand and public policies affecting the primary sources of energy supply and demand during the 1990s: petroleum, natural gas, electricity, coal, nuclear energy, renewable energy and energy efficiency.


Issues surrounding migration, both legal and illegal, have fascinated social scientists for decades. Unfortunately, widespread focus on migration in academia has not been accompanied by innovative perspectives. Indeed, research on migration tends to be dominated by economic models and group perspectives such as the classic ''cost-benefit analysis'' and ''social network theories.'' For Ali Nobil Ahmad, the quantitative, group-focused, and rational choice models employed by researchers of migration are useful, but incomplete. In Masculinity, Sexuality and Illegal Migration, he argues for the importance of analyzing the individual-level drives that impact migration. After summarizing the strengths and weaknesses of conventional theories of migration including social capital theory and transnationalism, Ahmad applies a psychodynamic approach to the study of migration practices and argues that both masculinity and sexuality play important roles in illegal migration practices of Pakistani men. The writing is both articulate and engaging. The personal interviews conducted by the author and reprinted (in part) in the text allow the reader to delve into the mind of the Pakistani migrant and discover how various psychological drives push them toward a path of migration. Of particular interest is the interplay between gender and sexuality/desire in prompting the motivation to migrate. Though the majority of the book focuses on individual men, Ahmad contextualizes the individual by commenting on historical, social, and legal forces that influence migration. In many ways, then, the author helps to fill a gap in the migration literature by providing a more complete picture of migration practices. In summation, this is a must read for any scholar interested in a novel approach to the study of migration and the application of psychoanalytic theory to the investigation of migration practices. Further, the commentary on where migration studies currently stand and its future makes this book appropriate for those who have no prior knowledge of research on migration.


This study provides an insight in the analytical estimation of the electric field along the surface of a stress grading system (SGS) in the end-winding region of an electrical machine. An analytical approach is derived for the field grading materials (FGMs) having power-law electric-field-dependent conductivity. Despite some limitations, the introduced model can be used for the preliminary analysis of SGS with specific geometric and dielectric parameters, both during sinus and pulsed voltage condition. The analytical considerations are verified with finite element simulations for 15 markedly different nonlinear FGMs, which were previously reported in the applications related to the medium voltage rotating electrical machines.


Majority of pharmaceuticals are small molecule organic compounds. Their structures are most effectively described and communicated using the graphical language of organic chemistry. A few years ago we decided to harness this powerful language to create new educational tools that could serve well for data mining and as catalysts for discovery. The results were the Top 200 drug posters, which we have posted online for everyone to enjoy and update yearly. This article details the origin and motivation for our design and highlights the value of this graphical format by presenting and analyzing a new pharmaceutical structure montage (poster) focused on US FDA approved drugs in 2011.


Purpose: The purpose of this research note is to systematically document the extent that researchers who publish in American Speech-Language-Hearing Association (ASHA) journals search for and include unpublished literature in their meta-analyses and test for publication bias.Method: This research note searched all ASHA peer-reviewed journals for published meta-analyses and reviewed all qualifying articles for characteristics related to the acknowledgement and assessment of publication bias.Results: Of meta-analyses published in ASHA journals, 75% discuss publication in some form; however, less than 50% test for publication bias. Further, only 38% (n = 11) interpreted the findings of these tests.Conclusion: Findings reveal that more attention is needed to the presence and impact of publication bias. This research note concludes with 5 recommendations for addressing publication bias.Supplemental Material S1. Summary of common publication bias tests. Chow, J. C. (2018). Prevalence of publication bias tests in speech, language, and hearing research. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2018_JSLHR-L-18-0098


The sensorimotor cortex activity measured by scalp EEG shows coherence with electromyogram (EMG) activity within the 15- to 35-Hz frequency band (β-band) during weak to moderate intensity of isometric voluntary contraction. This coupling is known to change its frequency band to the 35- to 60-Hz band (γ-band) during strong contraction. This study aimed to examine whether such contraction level-related modulation of corticomuscular coupling differs between muscles with different muscle compositions and functions. In 11 healthy young adults, we quantified the coherence between EEG over the sensorimotor cortex and rectified EMG during tonic isometric voluntary contraction at 10-70% of maximal voluntary contraction of the tibialis anterior (TA) and soleus (SOL) muscles, respectively. In the TA, the EEG-EMG coherence shifted from the β-band to the γ-band with increasing contraction level. Indeed, the magnitude of β-band EEG-EMG coherence was significantly decreased, whereas that of γ-band coherence was significantly increased, when the contraction level was above 60% of maximal voluntary contraction. In contrast to the TA, the SOL showed no such frequency changes of EEG-EMG coherence with alterations in the contraction levels. In other words, the maximal peak of EEG-EMG coherence in the SOL existed within the β-band, irrespective of the contraction levels. These findings suggest that the central nervous system regulates the frequency of corticomuscular coupling to exert the desired levels of muscle force and, notably, that the applicable rhythmicity of the coupling for performing strong contractions differs between muscles, depending on the physiological muscle compositions and functions of the contracting muscle.


This dissertation presents a picture of the complexities and contradictions in the daily lives of people in the Seacoast area of New Hampshire who identify as, or are identified as, lesbian, gay, bisexual, transgender, queer, questioning and allied people (LGBTQQA). The focus of this study is the "Create Our Destiny" conference, a social change project. Philosophically, I viewed this project through a Postmodern feminist lens, and methodologically I used a grounded theory approach. This dissertation is divided into three sections. Within section one, I present more detailed descriptions of my philosophical and methodological approaches, a description of the geographical and political context in which the study was set, and definitions of terms. There were three distinct stages to this research project---the planning process, the conference, and the follow-up interviews---and my role varied, from participant, to observer, to interviewer. Recognition of the challenges and ethical dilemmas inherent in conducting qualitative research, especially when one is working with participants who are marginalized, is an important part of this study. Along with a detailed description of the "Create Our Destiny" conference (chapter 4), section two contains the bulk of the participants' experiences and insights presented in my dissertation. Clear patterns emerged from the participants' stories about coming out (chapter 5), labels (chapter 6), and gender identity issues (chapter 7), particularly the underlying tension between seeking a sense of belonging while maintaining one's personal sense of integrity. The third and final section is where I present my research findings. Ultimately, this study shows that people in the Seacoast want to be "fully and wholly" themselves, or as I re-present their interests in chapter eight, to strive toward singularity. In this dissertation, I argue that striving towards singularity requires grappling with unexamined codes and principles, such as compulsory heterosexuality and gender duality, through selfawareness and reflexivity. In chapter nine, I present practical suggestions that can be used to operationalize the theoretical suggestions developed and/or supported by my work.


Perceptions of physical attractiveness vary across cultural groups, particularly for female body size and shape. It has been hypothesized that visual media propagates Western "thin ideals." However, because cross-cultural studies typically consider groups highly differentiated on a number of factors, identifying the causal factors has thus far been impossible. In the present research, we conducted "naturalistic" and controlled experiments to test the influence of media access on female body ideals in a remote region of Nicaragua by sampling from villages with and without regular TV access. We found that greater TV consumption remained a significant predictor of preferences for slimmer, curvier female figures after controlling for a range of other factors in an ethnically balanced sample of 299 individuals (150 female, aged 15-79) across 7 villages. Within-individual analyses in 1 village over 3 years also showed an association between increased TV consumption and preferences for slimmer figures among some participants. Finally, an experimental study in 2 low-media locations demonstrates that exposure to media images of fashion models can directly impact participants' body size ideals. We provide the first converging cross-sectional, longitudinal, and experimental evidence from field-based research, that media exposure can drive changes in perceptions of female attractiveness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Height distribution of ionospheric plasma parameters in the F2-region is closely related to height distribution of the main thermospheric parameters. Therefore, they can be extracted from ionospheric observations solving an inverse problem of aeronomy. A self-consistent approach to the Ne(h) modeling at the F2-region heights has been applied to solve the problem. Using routine incoherent scatter radar observations (Ne(h), Te(h), Ti(h), Vi(h) profiles) the method yields a self-consistent set of main aeronomic parameters responsible for the F2-region formation. The list of derived parameters includes: neutral temperature profile Tn(h) depending on the exospheric temperature Tex, the temperature at 120 km T120 and the shape-parameter S, which determine the temperature profile, concentration of neutral species [O], [O2], [N2], vertical plasma drift W, which may be converted to the meridional thermospheric wind Vnx, total solar EUV flux and ion composition (O+, O2 +, NO+, N2 +, N+) as a result of Ne(h) fitting. Therefore, the method gives a complete description of the upper atmosphere condition in the vicinity of incoherent scatter facility for the periods of observation. Analysis of all available EISCAT (CP-1, CP-2) observations has shown wide deviations from MSIS-86 model predictions for geomagnetically disturbed conditions while the retrieved parameters are close to the model ones for quiet periods. The approach turns out to be very useful for physical analyses of the F2-layer disturbance mechanisms giving a complete picture of the phenomenon in question. Limitations and problems related to method application are discussed. Under existing conditions when thermospheric observations are not conducted currently the proposed method may be considered a real tool for thermosphere investigation and monitoring at least for the periods of ISR observations.


OBJECTIVE
To estimate allele frequencies of the hyperkalaemic periodic paralysis (HYPP), lethal white foal syndrome (LWFS), glycogen branching enzyme deficiency (GBED), hereditary equine regional dermal asthenia (HERDA), and type 1 polysaccharide storage myopathy (PSSM) genes in elite performance subgroups of American Quarter Horses (AQHs).

DESIGN
Prospective genetic survey.

ANIMALS
651 elite performance AQHs, 200 control AQHs, and 180 control American Paint Horses (APHs).

PROCEDURES
Elite performance AQHs successful in 7 competitive disciplines (barrel racing, cutting, halter, racing, reining, western pleasure, and working cow horse) were geno- typed for 5 disease-causing alleles. Age-matched control AQHs and APHs were used to establish comparative whole-breed estimates of allele frequencies.

RESULTS
Highest allele frequencies among control AQHs were for type 1 PSSM (0.055) and GBED (0.054), whereas HERDA (0.021) and HYPP (0.008) were less prevalent. Control APHs uniquely harbored LWFS (0.107) and had high prevalence of HYPP (0.025), relative to AQHs. Halter horse subgroups had significantly greater allele frequencies for HYPP (0.299) and PSSM (0.155). Glycogen branching enzyme deficiency, HERDA, and PSSM were found broadly throughout subgroups; cutting subgroups were distinct for HERDA (0.142), and western pleasure subgroups were distinct for GBED (0.132). Racing and barrel racing subgroups had the lowest frequencies of the 5 disease genes.

CONCLUSIONS AND CLINICAL RELEVANCE
Accurate estimates of disease-causing alleles in AQHs and APHs may guide use of diagnostic genetic testing, aid management of genetic diseases, and help minimize production of affected foals.


We consider a partially asymmetric exclusion process (PASEP) on a finite number of sites with open and directed boundary conditions. Its partition function was calculated by Blythe, Evans, Colaiori, and Essler. It is known to be a generating function of permutation tableaux by the combinatorial interpretation of Corteel and Williams. We prove bijectively two new combinatorial interpretations. The first one is in terms of weighted Motzkin paths called Laguerre histories and is obtained by refining a bijection of Foata and Zeilberger. Secondly we show that this partition function is the generating function of permutations with respect to right-to-left minima, right-to-left maxima, ascents, and 31-2 patterns, by refining a bijection of Francon and Viennot. Then we give a new formula for the partition function which generalizes the one of Blythe & al. It is proved in two combinatorial ways. The first proof is an enumeration of lattice paths which are known to be a solution of the Matrix Ansatz of Derrida & al. The second proof relies on a previous enumeration of rook placements, which appear in the combinatorial interpretation of a related normal ordering problem. We also obtain a closed formula for the moments of Al-Salam-Chihara polynomials.


Background: Ventilator associated pneumonia (VAP) is a major cause of poor outcome among patients in the intensive care units (ICU) world-wide. We sought to determine the factors associated with development of VAP and its prognosis among patients admitted to different ICUs of a Tertiary Care Hospital in India. Methodology: We did a matched case control study during October 2009 to May 2011 among patients, ≥18 years with mechanical ventilation. Patients who developed pneumonia after 48 h of ventilation were selected in the case group and those who did not develop pneumonia constituted the control group. Patients' history, clinical and laboratory findings were recorded and analyzed. Results: There were 52 patients included in each group. Among cases, early onset ventilator associated pneumonia (EVAP) occurred in 27 (51.9%) and late onset ventilator associated pneumonia (LVAP) in 25 (48.1%). Drug resistant organisms contributed to 76.9% of VAP. Bacteremia (P = 0.002), prior use of steroid/immunosuppressant (P = 0.004) and re-intubations (P = 0.021) were associated with the occurrence of VAP. The association of Acinetobacter (P = 0.025) and Pseudomonas (P = 0.047) for LVAP was found to be statistically significant. Duration of mechanical ventilation (P = 0.001), ICU stay (P = 0.049) and requirement for tracheostomy (P = 0.043) were significantly higher in VAP. Among each case and control groups, 19 (36.5%) expired. Conclusion: We found a higher proportion of LVAP compared with EVAP and a higher proportion of drug resistant organisms among LVAP, especially Pseudomonas and Acinetobacter. Drug resistant Pseudomonas was associated with higher mortality.


Planning scenarios involving user pre-specified items present themselves frequently in recommender system domains. Although next-item and next-basket recommendation has been a focus of prior research, multiple consecutive item or basket approaches are needed for planning. No prior work has leveraged pre-specified future reference items to improve this type of challenging consecutive prediction task at inference time. PLAN-BERT is the first to accommodate this general planning scenario. It does so by contributing novel modifications that take inspiration from the masked training and contextual embedding of self-attention models. To test the model, we use the domain of student academic degree planning, in which students' past course histories and future pre-specified courses of interest are used to fill in the remainder of their curriculum. Our offline analyses consist of 15 million historic course enrollments at 20 institutions and an online evaluation conducted at one of the institutions. Our results show that PLAN-BERT outperforms existing models including BERT, BiLSTM, and a UserKNN baseline, with small numbers of future reference items substantially improving accuracy. Significant results from our online evaluation show PLAN-BERT to be strongest in students' perceptions of personalization.


Anticipating multimedia file requests via caching at the small cell base stations (SBSs) of a cellular network has emerged as a promising technique for optimizing the quality of service (QoS) of wireless user equipments (UEs). However, developing efficient caching strategies must properly account for specific small cell constraints, such as backhaul congestion and limited storage capacity. In this paper, we address the problem of devising a user-cell association, in which the SBSs exploit caching capabilities to overcome the backhaul capacity limitations and enhance the users' QoS. In the proposed approach, the SBSs individually decide on which UEs to service based on both content availability and on the data rates they can deliver, given the interference and backhaul capacity limitations. We formulate the problem as a one-to-many matching game between SBSs and UEs. To solve this game, we propose a distributed algorithm, based on the deferred acceptance scheme, that enables the players (i.e., UEs and SBSs) to self-organize into a stable matching, in a reasonable number of algorithm iterations. Simulation results show that the proposed cell association scheme yields significant gains, reaching up to 21% improvement compared to a traditional cell association techniques with no caching considerations.


Baby RD was born at term, weighing 4.78 kg (98–99.6th centile) by emergency caesarean section for fetal distress and thick meconium. She was born in poor condition (Apgar 5 and 7) and required ventilation breaths. She developed signs of meconium aspiration soon after birth and needed 48h continuous positive airway pressure support. She was discharged from NICU on day 5 to the ward to continue antibiotics. Her C-reactive protein (CRP) peaked at 49 on day 2 and remained between 12 and 17 during week 1. Although clinically well and with no other evidence of infection, her CRP started rising on day 10 (CRP 27) and peaked at day 25 (CRP 69). Her repeated infection screen including viral PCR was negative. Antibiotics and topical antifungal were continued for suspected infection. It was also noted she had a rising calcium from day 10 (corrected Ca 3.1 mmol/l), peaking at 4.42 mmol/l at day 22. On day 22 she was noted to have faint indurated purplish bruising to the back, buttock and thigh. Dermatology review supported a clinical diagnosis of subcutaneous fat necrosis (SFCN) of newborn. Baby RD had no phenotypic features of William syndrome. PTH (<1 pmol/L) was appropriately suppressed, with normal 25-OH-vitamin D. However, 1, 25 (OH)2 vitamin D was significantly raised at 179 pmol/l (48–110). As she was clinically well, hypercalcaemia was initially managed with intravenous hydration with little effect. She was then given a single dose of IV pamidronate 0.5 mg/kg, which achieved significant reduction in corrected calcium to 3.1 mmol/l in 72 h. SFCN is a rare disorder producing characteristic purple or bluish nodules over the trunk, buttocks, thigh, arms and cheeks following a complicated delivery. Diagnosed clinically, it usually resolves within 3–6 months without medical intervention. Cases have been reported with severe hypercalcaemia hypothesised to be due to increased macrophage production of 1, 25(OH)2 vitamin D. The persistently elevated CRP is expected to reflect the inflammatory component of SFCN. The authors wish to highlight that marked hypercalcaemia is a rare complication of SFCN, there is an effective response to pamidronate and to emphasise the associated elevated CRP which caused prolonged antibiotic treatment and hospital stay.


Summary Background Over the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than 1 year. Material/Methods Patients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index. Results Mean VAS that was 8.7±1.1 before the procedure was determined to be 3.4±1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1±10.2 in the beginning, they went down to 33.9±14.9 at the end of 2 years. The percent of those stating "good" and "excellent" satisfaction was 66% (23 persons) on the last follow-up. Conclusions While it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.


This paper details the attack on RC6 which was announced in a report published in the proceedings of the second AES candidate conference (March 1999). Based on an observation on the RC6 statistics, we show how to distinguish RC6 from a random permutation and to recover the secret extended key for a fair number of rounds.


Objective: Coronary artery disease (CAD) has become a global epidemic affecting all occupation. Teachers are suspected to be at occupation stress; however the risk of developing CAD among them is not studied in Saudi Arabia. This study was conducted to investigate the current situation of CAD and prevalence of its risk factors among school teachers in Almadinah Almunawwarah. The findings will help in understanding the extent of the problem of CAD and its risk it poses among school teachers in KSA.
Methods: A cross-sectional study was conducted during the academic year 2015 in Almadinah Almunawwarah city. A sample of 210 teachers was randomly selected out of 10,341 Saudi male teachers following a common cluster-sampling scheme (30 schools × 7 teachers). Data included CAD, and its classical risk factors were collected from participating teachers at their schools in a specially designed questionnaire by a trained paramedic. Univariate and multivariate logistic regression was done to identify associated risk factors.
Results: The prevalence of CAD among school teachers in this study was 6.7%. Prevalence of diabetes (30%), obesity (43.8%), hypertension 37.7%, and hyperlipidemia 27.6% was higher. Multivariate regression model shows, the risk of CAD was 6 times higher among obese and it increases by 2 times with addition of one risk factor. To explore the current situation of CAD and the prevalence of its risk factors among school teachers in Almadinah Almunawwarah.
 Conclusion: This study demonstrated a high prevalence of cardiovascular risk factors among Saudi male teachers. Promotion of healthy life styles by physical activities, healthy diet and keeping schools free from smoking could be useful.


We present theoretical analysis on why and how rechargeable metal–air type batteries can be made significantly safer and more practical by utilizing CO2/oxalate conversions instead of O2/peroxide or O2/hydroxide ones, in the positive electrode. Metal–air batteries, such as the Li–air one, may have very large energy densities, comparable to that of gasoline, theoretically allowing for long range all-electric vehicles. There are, however, still significant challenges, especially related to the safety of their underlying chemistries, the robustness of their recharging and the need of supplying high purity O2 from air to the battery. We point out that the CO2/oxalate reversible electrochemical conversion is a viable alternative of the O2-based ones, allowing for similarly high energy density and almost identical voltage, while being much safer through the elimination of aggressive oxidant peroxides and the use of thermally stable, non-oxidative and environmentally benign oxalates instead.


This paper uses a natural policy experiment to estimate how changes in the costs of engaging in criminal activity may influence adolescents? decisions in crime participation and school attendance. The study finds that, after an exogenous decrease in the severity of judicial punishment imposed on Colombian adolescents, crime rates in Colombian municipalities increased. This effect appears to be larger in municipalities with a higher proportion of adolescents between 14 and 15 years of age. The study provides suggestive evidence that one possible transmission channel for this effect is a decrease in the effort of the police force to capture teenage suspects. The study also finds that the probability that boys of this same age group attend school decreased following the change in the juvenile justice system. This effect is stronger for boys from homes where the heads of household are less educated.


Net fluid production and pressure data were gathered to estimate the amount of storage space available and the potential for additional oil recovery using -enhanced oil recovery (EOR) in the Phacoides sandstone, McKittrick oilfield, San Joaquin Valley, California. The Phacoides reservoir has produced 61.5 million reservoir barrels of fluid, a volume equivalent to the subsurface capacity of 9.8 million metric tons of . Reservoir pressure changes with fluid production suggest that injecting 1 million metric tons of may raise reservoir pressures by 2 MPa (255 psi). We assume that the sealing capacity of the reservoir for injection is equivalent to the conditions controlling the original hydrocarbon accumulation. If injection pressures exceed this limit, the could leak through the caprock, from aging wellbores or along faults in the reservoir. Faulting has compartmentalized the reservoir into six major blocks with varying degrees of hydraulic communication. Injection wells will be required within each sealed fault block, resulting in additional costs for implementing a carbon capture and sequestration (CCS) project. Through -EOR, an additional 17 million bbl of oil may be recoverable, thereby offsetting the cost of carbon storage. This is equivalent to 1.4 million metric tons of additional storage space. However, assuming that none of the carbon is captured, combustion of this additional oil will add approximately 7 million metric tons of to the atmosphere, negating the available storage space in the reservoir and resulting in a net carbon gain to the atmosphere of 700,000 metric tons.


It is fair to maintain that every world construction, also a "world" of learning such as a tertiary institution, is blueprinted in some form of ideology. The lecture halls at a large university such as the University of Pretoria also speak about this expanding cultural horizon and it is not uncommon to have a class where there are students from Korea, Zimbabwe and Namibia mingling with a range of South African ethnicities. The picture now is very different from the picture of years ago when South African universities were predominantly "white" as a result of the ideological patterns of the time.


Background: There is growing research on Nepali migrant workers, especially on living conditions and occupational health and safety abroad. However, few studied support networks for migrant labourers. Objective of this study is to explore social support and support networks among Nepali migrant workers in the Middle East and Malaysia. Methodology: Study among Nepali men working in the Middle East and Malaysia. Twenty in-depth interviews were conducted and the interviewees were mixed in terms of age, marital status, education, ethnic background and length of stay. Qualitative data were analysed thematically. Results: The participants found that having (pre-)existing circles of friends in the host countries makes migration easier to migrate, and made their lives easier when establishing themselves abroad. Conclusion: The assimilation of migrant workers appears to be easier among those who have existing networks in their place of migration. Social Capital Theory helps explain the importance of these networks.


The quantity of available water resources has been recognized as the key limiting factor for development of most of the arid regions. This paper focuses on the simulation–optimization for conjunctive use of surface water and groundwater on a large scale. In this study, Hetao Irrigation District in China, one of the largest irrigation districts in the Yellow River basin, is selected as a representative study area. The conjunctive management model of water resources is developed by means of dynamically coupling a large-scale hydrological model with an optimal allocation model. A groundwater level is adopted in the coupled model as the constraint condition and the optimal conjunctive utilization quantity of surface water and groundwater is set as the objective function. Finally, the coupled model is applied to calculate the optimal water supply quantity of surface water and groundwater and sustainable utilization scheme of water resources for 2020 and 2030 in Hetao Irrigation District. The modeling results demonstrate the conjunctive management model of water resources is an effective tool for appraising water resources in large-scale arid regions.


Joint pain related to haemophilia affects large numbers of people and has a significant impact on their quality of life. This article reviews evidence about behavioural and psychological aspects of joint pain in haemophilia, and considers that evidence in the context of research on other chronic pain conditions. The aim is to inform initiatives to improve pain self‐management among people with haemophilia (PWH). Reduced pain intensity predicts better physical quality of life, so better pain management should lead to improved physical quality of life. Increased pain acceptance predicts better mental quality of life, so acceptance‐based approaches to self‐management could potentially be adapted for PWH. Pain self‐management interventions could include elements designed to: improve assessment of pain; increase understanding of the difference between acute and chronic pain; improve adherence to clotting factor treatment; improve knowledge and understanding about the benefits and costs of using pain medications; improve judgements about what is excessive use of pain medication; increase motivation to self‐manage pain; reduce negative emotional thinking about pain; and increase pain acceptance. The influence of behavioural and psychological factors related to pain are similar in haemophilia and other chronic pain conditions, so there should be scope for self‐management approaches and interventions developed for other chronic pain conditions to be adapted for haemophilia, provided that careful account is taken of the need to respond promptly to acute bleeding pain by administering clotting factor.


Over the past four decades, decision-makers in Ethiopia have pursued a range of policies and investments to boost agricultural production and productivity, particularly with respect to the food staple crops that are critical to reducing poverty in the country. A central aim of this process has been to increase the availability of improved seed, chemical fertilizers, and extension services for small-scale, resource-poor farmers. While there is some evidence to suggest that the process has led to improvements in both agricultural output and yields, decision-makers still recognize that there is an urgent need for more substantial improvement. This paper attempts to synthesize the lessons learned from Ethiopia's past experiences with providing smallholders with access to seed, fertilizer, and extension services, identify challenges facing the country's continuing efforts to strengthen its input systems and markets, and recommend policy solutions for the future. The paper does so by specifically focusing on three policy "episodes" in Ethiopia's recent history to shed light on the potentially complementary, but often conflicting, roles played by the public and private sectors in the provision of seed, fertilizer, and extension services.


We present imaging experiments in focusing Kerr media using digital holography and digital reverse propagation (DRP) of the wave. For moderate power, the nonlinear DRP algorithm can be used to improve the quality of images over the linear DRP. We discuss the limits of the method at high power, the role of small-scale filaments, and the problem of time-dependent self-phase modulation.


Did Shakespeare read Plato? The evidence suggests that Shakespeare not only read Plato, but also consulted him as though he possessed wisdom of the highest sort. With a focus on comparing the demands on poetry set out in the Republic with both comic and tragic plays, I show that Shakespeare's genius is at least in part due to his uncanny ability to transform Platonic wisdom into fully realized dramatic action. While Shakespeare and Plato may not ultimately agree as to the highest art accessible to man, they importantly agree as to the constitutive elements of the soul that make such arguments both possible and useful for reflection on the biggest issues of political philosophy. Shakespeare is the only sort of poet that would be welcomed back into the city in speech.


Drug development for SSc has been hindered by the relative paucity of validated outcome measures and biomarkers for use in clinical trials. The Scleroderma Clinical Trials Consortium (SCTC) conducted an interactive session at the Scleroderma International Workshop in Cambridge, UK in July 2011 to discuss clinical trial design in SSc. The following issues were discussed: 1) primary outcome for trials of SSc - skin vs. lung vs. composite; 2) ischaemic digital ulcers in SSc - healing vs. repair vs. composite; 3) pulmonary arterial hypertension in SSc; and 4) neglected aspects of SSc - opportunities for study or of lower priority and feasibility. Randomised controlled trials with collection of biospecimens are necessary to assess efficacy of therapeutic agents, validate novel outcome measures, and discover and validate potential biomarkers for each of these areas. Although SSc is a rare, heterogeneous disease, collaborative efforts led by the SCTC and other international networks will ultimately improve the design of clinical trials of promising therapies for SSc.


This book can inspire every pupil to succeed in History at Key Stage 3. "History in Progress" features clearly differentiated tasks that are designed to support and encourage well-structured progression in readers of all ability levels, promoting students to take ownership of their learning. This book targets pupils of all levels with accessible information and stimulating images to motivate them and boost confidence, as well as open ended tasks which offer a greater challenge to more able students. It includes exciting and engaging material that supports key themes from the new Programme of Study. It links past to present, capturing pupils' imagination and brings lessons to life. Key Skills are taught via the Skills Bank, which provides targeted progression across KS3 in preparation of GCSE.This book encourages readers to make connections, reinforcing chronological understanding and enabling pupils to form links between events, countries and time periods. A clear focus is made on chronology and a greater balance of British, European, and World History, to increase the relevance of the subject to the current generation of pupils.


This paper examines the effect of government nursing home policies on institutionalization rates and support for the elderly in the community. We combine data from the National Long Term Care Survey with information on state policies to estimate these effects. We examine two state policies for nursing home care: the ability of some high income elderly to receive Medicaid support, and the price differential between Medicaid and the private market. Both policies strongly affect aggregate nursing home utilization. as well as the composition of nursing home residents. In states with more liberal Medicaid rules. the high income elderly are more likely to use a nursing home. while in states with larger underpayments. the poor suffer reduced access. The marginal source of community care for the institutionalized elderly appears to be support from children or other helpers, rather than living alone. Almost all of the elderly in nursing homes would have lived with children or others had they been in the community. In addition, as the ease of acquiring Medicaid increases or Medicaid payments become more generous, fewer elderly receive substantial day-to-day help from their children.


Low‐level regions of high wind speed known as tip jets have been identified near Cape Farewell, Greenland's southernmost point. These wind systems contribute to this area being the windiest location on the ocean's surface and play an important role in the regional weather and climate. Here we present the first analysis of the wind systems that make the Siberian coast of the northern Bering Sea the windiest location in the North Pacific Ocean during the boreal winter. In particular we show that tips jets characterized by enhanced northeasterly winds occur in the vicinity of the two prominent headlands along the coast, Cape Navarin and Cape Olyutorsky. The advance of sea ice in the region is shown to impact the frequency and location of the high speed winds in the vicinity of these two capes. Furthermore, we show that these jets are associated with the interaction of extra‐tropical cyclones with the high topography of the Koryak Mountain range, situated just inland of the capes. The windstress imparted to the ocean via the tip jets is argued to help drive the formation of dense water in winter in the northern Bering Sea, thus playing an important role in the regional oceanic circulation.


The Cross-track Infrared Sounder (CrIS) aboard the Suomi National Polar-orbiting Partnership (S-NPP) satellite is a spaceborne Fourier transform infrared spectrometer. The study aims to retrieve carbon dioxide (CO2) information (the CO2 profile and column-averaged dry-air mole fraction of XCO2) from June 2018 to December 2019 based on the The National Oceanic and Atmospheric Administration (NOAA)-Unique Combined Atmospheric Processing System (NUCAPS) Cloud-Cleared Radiances (CCRs) via the CrIS. The CCRs products for the CrIS with 2223 channels have been available since 22 May 2018. Characteristics of the CO2 weighting functions inform the choice of multiple channels that are around 15 μm in size that differ by latitude and season to maximize retrieval sensitivity to CO2 and minimize sensitivity to other interfering atmospheric parameters. CO2 was retrieved from these channels using an adopted nonlinear optimization algorithm. The temperature, water vapor, and ozone profiles used in the inversion process were gathered from the European Centre for Medium-Range Weather Forecasts (ECMWF) Reanalysis v5 (ERA5). Validations of CO2 concentrations as retrieved from CrIS showed the following conclusions: (1) The relative error of the retrieved CO2 concentrations, as compared to Civil Aircraft for the Regular Investigation of the atmosphere Based on an Instrument Container (CARIBIC) in situ aircraft measurements, was less than 0.5%, and the root mean square errors (RMSE) were less than 0.7 ppmv (with correlation coefficients of 0.56–0.86); (2) the retrieved XCO2 from June 2018 to December 2019 correlated well with the ground-based Total Carbon Column Observing Network (TCCON) observations, and the differences were within ±0.2 ppmv. Further analysis of the temporal and spatial distribution of the retrieved CO2 at 300 hPa demonstrated a strong seasonal variation of CO2 in 0–60° N in the Northern Hemisphere with the maximum values in June–August and larger amplitudes of seasonal variation in the northeast of Asia and northeastern part of North America. The variations likely occurred due to larger sinks of atmospheric CO2 that are dominated by CO2 uptake in the summer. In the Southern Hemisphere, the CO2 displayed high concentration anomalies in the latitudinal range of 30–60° S in September–November and December–February, which probably occurred due to the lofted smoke plumes from the strong fire seasons in South America and Southern Africa.


Mehmet FIRAT Anadolu University Abstract Continuous Partial Attention is a current concept open to research which, besides multitasking, intensely occupies the agenda of education, communication and cognitive psychology. The purpose of the present study was to determine educators' continuous partial attention. In line with this purpose, the research data were collected from 109 educators in higher education from different age groups and from four different countries with the use of a questionnaire made up of two sections and seven questions. The findings obtained in the study revealed that the educators' Continuous Partial Attention did not significantly differ with respect to their technology use efficacies, their ages or their countries. In addition, it was found out that the educators' Continuous Partial Attention differed statistically significantly depending on the fields they worked in. Based on this, it could be stated that educators working in the field of educational technologies encounter with Continuous Partial Attention more frequently than educators working in other fields. At the end of the study, several suggestions were put forward.


Optimal supply chain design depends on the business context the chain caters for. In this dissertation, we are concerned with attaining and maintaining this alignment between a firm's supply chain portfolio and its business context. Following an introduction in Chapter 1, in Chapter 2 of this dissertation, we analyze the influence of a firm's product types on optimal supply chain design: Academics and practitioners agree that functional products are best delivered via physically efficient supply chains, while innovative products are best delivered via market responsive chains. However, to date, only a few firms have systematically adjusted their supply chain strategies according to this argument. Instead of carrying only one product type, firms deliver a number of both functional and innovative products in parallel complicating the alignment of supply chain portfolios with product portfolios. We address this issue and analyze in detail a firm's optimal supply chain portfolio as a function of its product portfolio. We target the tactical level of decision-making and develop a generic mathematical model to analyze how product portfolios affect the optimal setup of supply chain portfolios. We identify generic problem properties and perform extensive sensitivity analysis to illustrate our findings with numerical examples. Our results indicate that effective supply chain and product portfolio alignment holds the potential for significant cost savings. Because of the large number of factors influencing the optimal set-up, however, profound quantitative analysis is required to exploit the full potential of aligning the supply chain with the product portfolio and to guide implementation. In Chapter 3, we extend our modeling framework and take into account the fact that a firm's products and global business parameters, such as labor rates and transportation costs, evolve over time. Hence, firms need to adapt their supply chain portfolios frequently to stay aligned in the long term. Adapting a well-established supply chain portfolio, however, may involve high costs and expose a firm to unforeseeable risks. We address this issue, differentiating business dynamics into product portfolio dynamics and global business dynamics, and classifying supply chain adaptation into high, medium and low. Building on these classifications, we extend our mathematical model to analyze how much supply chain adaptation a firm actually requires to respond to the business dynamics it faces. Our results indicate that supply chain adaptation may indeed be crucial for a firm to retain its competitiveness. The need for adaptation, however, varies widely across firms: For example, a firm faced with product portfolio commoditization may be required to adapt its entire manufacturing footprint, while a firm with a high product turnover rate may not need to adapt its supply chain portfolio at all. Furthermore, the need for supply chain adaptation is not only determined by the business context in which a firm operates, but can also be manipulated by the firm's product portfolio decisions. Finally, a firm should carefully align its supply chain portfolio with the employed supply chain adaptation strategy to exhaust attainable benefits. In Chapter 4, we widen our scope and develop a step-by-step process to guide sustained alignment between a firm's business context and its supply chain portfolio in practice. Drawing on academic literature, insights from our quantitative models, and extensive interviews with executives from leading firms, we propose and detail four process steps. In the first step we suggest challenging the performance of a firm's current supply chain setup and identifying pressure points to evaluate how acute supply chain realignment is. As a second step we propose and detail a business context analysis to identify what a supply chain lacks and potential areas for realignment. To complement the previous analysis, in a third step, we frame and discuss generic options for long-term supply chain strategy. As a fourth step, we lay out opportunities and pitfalls during the project implementation. We conclude with recommendations on how to stay aligned in the long term. We end the dissertation with a conclusion in Chapter 5.


Amends the Department of Commerce and Related Agencies Appropriations Act, 1999 to prohibit U.S. courts from recognizing, enforcing, or otherwise validating any assertion of rights by an individual (currently, by a designated Cuban national) of a mark, trade name, or commercial name that was used in connection with a business or assets that were confiscated by the Cuban government unless the original owner of such mark or name, or such owner's bona fide successor, has expressly consented. Applies such prohibition only if the individual asserting the rights knew or had reason to know at the time of acquiring the rights asserted that the mark or name was the same or substantially similar to the mark or name used in connection with the business or assets that were confiscated.


Knock your socks off service doesn't just happen. It requires coaching on an ongoing basis. Now, thanks to authors Kristin Anderson and Ron Zemke, supervisors have a practical guide to the day-to-day challenges that arise in training superior customer service people.

This newest Knock Your Socks Off book explains how to help frontline employees hone their skills, maintain the motivation to perform, and meet new situations head-on. The authors present a model for successfully coaching anyone, anywhere, and they show readers how to apply it in familiar coaching situations.

Everyone can appreciate Zemke and Anderson's strategies for handling the toughest coaching problems. And they will learn a most important new skill? teaching employees to be peer coaches, a growing need in the current era of teams and of doing more with less.


Hager, Jr. Carl H. Ph.D. in Engineering, Department of Mechanical and Materials Engineering, Wright State University, 2008. Mechanisms of Nickel-Based Coatings for Fretting Wear Mitigation of Ti6Al4V Interfaces. Fretting wear is an accumulation of damage that occurs at component interfaces that are subjected to high contact stresses coupled with low amplitude oscillation. The key to fretting wear reduction in metallic contacts is the mitigation of galling at the interface, followed by the control of debris production and the rheology of active wear debris. Once the thin surface species of the metallic interfaces is dispersed, adhesion between the contacting nascent surfaces causes the inception of severe surface deformation and material transfer or removal. This is extremely apparent in the fretting wear of aerospace materials such as titanium alloy and nickel alloy contacts. However, the literature suggests that nickel alloy contacts perform very well in sliding and reciprocating wear contacts at elevated temperatures due to the formation of what is often called a 'Glaze' oxide layer. The current state of literature describes the composition of the glaze layer as NiO. The focus of this dissertation was to provide experimentation and analysis of temperature effects on the lubricious tribofilm formation that occurs in nickel contacts. This was accomplished by testing commercially pure nickel coatings and thick nickel oxide surfaces. The enhanced understanding of the fretting performance of nickel oxides aided in the development of nickel graphite based self-lubricating coatings. These coatings were then proved to reduce fretting wear damage within Ti6Al4V mated surfaces over a wide temperature range.


A high yield soybean experiment was conducted to compare the management intensive practices of recent soybean record holder, Kip Cullers, to conventional production practices in 2008 to 2010. Preplant fertilizer applications of poultry litter and mineral fertilizers were compared for their effects on soybean yield and nodulation. While soybean yields increased between 2008 and 2010, preplant treatment differences were inconsistent. Soybean nodule weight, numbers, and size decreased over the three year experiment, but differences between poultry litter and mineral fertilizer applications did not occur. Foliar fertilizers, micronutrient, and irrigation applications were also studied, but did not have significant effects on soybean yield in this experiment. Overall, differences were not observed the high input treatments and conventional practices. To assess if changes have occurred in soybean nodulation capabilities and tolerance to mineral N over time, greenhouse and field experiments were conducted in 2010 and 2011 to survey soybean cultivars released from 1930 to 2002. Results from the field study demonstrate increased soybean yields with increasing cultivar release date, but similar trends in soybean nodulation, total N and leaf ureide concentrations were not observed. These experiments do not support a novel tolerance for N inhibition or loss of nodulation capabilities over time.


In early 1946, Kurds declared an independent republic in north-west Iran. The Mahabad Republic, as it became known, was the first time that the Kurds experienced self-rule in the modern era. Although short-lived, the Republic had a formative influence on the subsequent development of Kurdish nationalist movements in Iran and the wider region. Here, Abbas Vali disputes the conventional view that the Kurdish Republic was the result of a Soviet conspiracy to dismember Iran, a side-effect of the Cold War. Instead he emphasizes the diversity of the internal Iranian and Kurdish factors that led to the formation of the Republic, arguing that the Republic represents the culmination of a new and modern Kurdish national identity. This was an identity which emerged in response to the exclusionary effects of the political and discursive processes and practices of the construction of a modern Iranian nation-state and national identity since the Constitutional Revolution of 1906. With its analysis of the formation and effects of nationalism and ethnic identity, this book is essential reading for anyone interested in the Kurds or the development of national and state identities in the Middle East.


This article assesses the impact of innovation on Roman society. It starts from a critical engagement with past debate about technological progress, which over the past decades has been too strongly focused on economic growth, and a re-appreciation of the literary evidence for innovation, which points to a culture in which technological knowledge and invention were thought to matter. Then, it highlights two areas where the uptake of technology had a direct impact on everyday life: material culture, where the emergence of glass-blowing, a proliferation of metal-working, and innovation in pottery-production changed the nature and amount of artefacts by which people surrounded themselves, and construction, where building techniques using opus caementicium, arches and standardized building materials revolutionized urban and rural landscapes. A concluding discussion highlights the role of integration of the Mediterranean under Roman rule in making innovation possible, and the role of consumer demand in bringing it about.


Peptide-specific antisera were developed to analyze the products encoded by adenovirus type 5 early region 4 (E4) open reading frames 6 and 7. Reading frame 6 previously was shown to encode a 34-kilodalton polypeptide (34K polypeptide) that forms a complex with the early region 1B (E1B)-55K antigen and is required for efficient viral growth in lytic infection. Antisera that were generated recognized the E4-34K protein as well as a family of related polypeptides generated by the fusion of open reading frames 6 and 7. These polypeptides shared amino-terminal sequences with the 34K protein. Short-pulse analysis suggested that the heterogeneity observed with the 6/7 fusion products resulted from differential splicing patterns of related E4 mRNAs. An antiserum directed against the amino terminus of reading frame 6 recognized only the free form of the 34K antigen that was not associated with the E1B-55K protein. This observation allowed the determination of the stability of the free and complexed form of this polypeptide. Pulse-chase analyses demonstrated that both forms of the 34K protein had half-lives greater than 24 h, suggesting that complex formation did not result in stabilization of this gene product. The half-lives of the 6/7 fusion products were approximately 4 h. The 34K protein also was shown to have a nuclear localization within infected cells. Finally, analysis of a mutant carrying deletions in both the E4-34K and E1B-55K polypeptides indicated that the complex formed between these two proteins was a functional unit in lytic infection.


We extend Stochastic Gradient Variational Bayes to perform posterior inference for the weights of Stick-Breaking processes. This development allows us to define a Stick-Breaking Variational Autoencoder (SB-VAE), a Bayesian nonparametric version of the variational autoencoder that has a latent representation with stochastic dimensionality. We experimentally demonstrate that the SB-VAE, and a semisupervised variant, learn highly discriminative latent representations that often outperform the Gaussian VAE's.


I. INTRODUCTION Federal appellate practice is not what is used to be. In the 1970s, oral argument was routinely granted and it was generously sized at thirty minutes per side. After a period of dramatic shrinkage in both frequency and length in the 1980s (1) and 1990s, the role of oral argument has been greatly diminished. It is now the exception rather than the rule. In 2011, only one quarter of all federal appeals were orally argued, (2) down from nearly two-thirds in the early 1980S, (3) and the time allotted in most circuits was limited to fifteen minutes or less. The drastic reduction in the frequency of oral argument and its length has been driven largely by considerations of efficiency as reflected in the universal adoption of case-screening methods that shunt aside the majority of cases to a summary or non-argument calendar. (4) This separate decisional track involves "a significantly lesser degree of personal attention by judges" (5) by placing "primary reliance for the operation of the screening process on a centrally-organized, parajudicially-supervised group of staff attorneys." (6) The federal rule on this issue acknowledges the importance of oral argument, but in practice permits it to be both brief and rare. (7) Procedural efficiency comes with a cost, (8) of course, and the extraordinary reduction in oral argument has diminished its role. (9) The decline of oral argument has been one casualty of the procedural reforms made in response to the crisis of caseload volumes that began in the 1980s. (10) Reduction in oral argument has been described as a response to pressure, taken almost against the courts' own will. (11) The result is a more efficient but more paper-driven bureaucratic process of appellate decisionmaking. There is less input from the lawyers. The values implicit in appellate review are weakened or diluted. (12) Moreover, there is a disturbing appearance of correlation between the decline in frequency of oral argument and the decline in reversal rates in both civil and criminal cases. For example, Judge John Godbold cited data in 1994 showing a decline of one half in the overall federal appellate reversal rate from 1982 to 1993, from 19.9 percent to 10.3 percent, with a significant decline in every category of appeal. (13) By 2011, the reversal rate had fallen further, to 8.9 percent overall and 5.8 percent in criminal cases. (14) Could the decline in reversal rates and the decline in frequency of oral argument be coincidental? They could. Or one might say that better screening procedures have increased the accuracy of appellate decision making to a more "correct" reversal rate than the historic figures. But one might also reasonably suspect that the very same process that shunts the vast majority of cases to the summary calendar is responsible for an institutional readiness to dispose of the cases by affirming the decisions below. Thus, the authors fear, though they are not the first to do so, that "[w]e have lowered our expectations for appellate procedure. We have defined down our appellate values. We all have internalized the postmodern norms of the minimalist procedural paradigm." (15) Oral argument is too central to the appellate process and too valuable to sacrifice on the altar of efficiency. We propose a return to a greater role for oral advocacy. (16) Part I of this article briefly outlines the importance of oral presentation in Western culture, modern communication, and traditional common law argument. Part II collects the federal rule of appellate procedure and corresponding local rules and internal operating procedures that govern the grant, or more often the denial, of oral argument. Part III examines the numerous and varied values of appellate justice that are served by oral argument. Part IV demonstrates the dramatic decline of oral argument since 1970. Finally, the authors propose modest reforms for restoring a greater role for oral argument in the federal courts of appeals. …


For over two decades, international environmental equity – the fair and just sharing of the burdens associated with environmental changes – has been the subject of much debate by philosophers, activists and diplomats concerned about climate change. It has been manifested in many international environmental agreements, notably the Framework Convention on Climate Change and the Kyoto Protocol. The question arises as to whether it is being put into practice in this context. Are the requirements of international environmental equity merely words and principles in international instruments, or are they having a practical effect on the policies of state governments? This article aims to start answering these questions. It examines whether the European Union (EU) and its member states are sharing the burdens of climate change. The article introduces equity in the context of the climate change agreements and looks at some normative and practical considerations. It suggests that Europe has been a leader on international equity in the climate change negotiations over the last decade, and it points to what European states and the EU have done to take on some of the burdens of climate change. Europe's actions are briefly assessed from practical and normative perspectives. Europe is doing more than any other part of the world to address climate change and to share the burdens associated with it. Nevertheless, Europe is not doing as much to address this problem as it can and should do. Both practical and normative imperatives demand more urgent action by Europe to implement climate equity.


A number of deterministic reservoir optimization models are capable of finding optimal basin allocation over multiple time steps simultaneously. This is commonly referred to as Multiple Time Step Optimization (MTO). However, such solutions are predicated on perfect foreknowledge of incoming runoff over the entire simulated period (typically one year), which is not available to reservoir operators in real time, thus creating a gap between the results of MTO-based modeling and their practical use. There is no universally accepted methodology on how the results of MTO should be used to develop practical and easy-to-understand operating rules. This paper offers a simple approach to bridge this gap and suggests additional avenues for further research in this direction.


Background. Bronchiolitis is one of the leading controversial pediatric diseases because of its variations in diagnosis and treatment. Use of diagnostic resources beyond the clinical features is usually unnecessary in its classic presentation. The objective of this study was to evaluate the prevalence of significant abnormalities in radiographic findings performed on infants <24 months of age who were hospitalized through the emergency department with the diagnosis of bronchiolitis, as well as to assess whether clinical variables can accurately identify children with abnormal chest x-ray in order to reduce unnecessary radiation exposure. Methods. From September 2006 to March 2007, infants aged <24 months evaluated and hospitalized through the emergency department of the Hospital San Jose Tec de Monterrey with a diagnosis of bronchiolitis were included in the study. Clinical variables were registered (age, gender, time since onset, oxygen saturation) and laboratory variables as well (leukocytes, lymphocytes, virus identified). Information from the chest x-ray was also obtained. Results. There were 128 patients included; 70% were aged <12 months. Chest x-ray was performed in 122 patients (95.31%) and respiratory virus studies were done in 119 patients (92.96%). There were 69 patients who were positive (57.99%); respiratory syncytial virus was demonstrated in 62 samples (89.85%) and 15 patients (12.29%) showed abnormal chest x-ray (atelectasis/consolidation). No differences were found between patients with and without chest x-ray abnormalities in clinical and laboratory variables. Conclusions. Most patients with bronchiolitis had a normal chest x-ray. Our study suggests that x-rays in children with typical bronchiolitis have limited value.


Abstract Until recent times, there was an incorrect perception in many developing countries, including Ghana, that considerable water resources were available. Faced with increasing population, intensification of agricultural, mining, and industrial activities together with natural events, the demand on both the quantity and quality of Ghana's water resources is now becoming a major concern. The population of Ghana increased from 6.7 million in 1960 to 8.6 million in 1970 to 12.3 million in 1984 to 18.9 million in 2000. The increasing population in Ghana contradicts sharply with the observed decline in rainfall amounts in many parts of the country, the rising temperatures nation-wide, and the pollution of water bodies from both natural and human activities. The freshwater bodies of Ghana are thus vulnerable and must have to be efficiently managed and utilized to sustain the socio-economic growth of the nation. Towards this objective, recommendations and suggestions have been made in terms of a joint participatory approach between local communities and state agencies in addition to suggestions for enactment of policies, education, and enforcement of laws.


Many pooid grasses (Poaceae) harbor Epichloë species (Hypocreales), endophytic fungi that often produce toxic alkaloids which may provide anti‐insect protection for their hosts. Two natural populations of Achnatherum robustum (Vasey) (sleepygrass), in the Lincoln National Forest, Cloudcroft, and Weed (NM, USA), are infected with the endophyte species Epichloë funkii (KD Craven & Schardl) JF White and Epichloë sp. nov. We tested whether: (1) these endophytes affect survival, growth, and development of the insect herbivore Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae) (fall armyworm), (2) larval diets alter adult fecundity (assessed as number of larvae or eggs produced by females and number of spermatophores that males transfer to females when enclosed in pairs within each feeding group), and (3) infections affect leaf consumption in larval no‐choice and choice experiments. Individual larvae were reared on Epichloë infected vs. uninfected clipped leaves from the Cloudcroft and Weed population plants. Overall, armyworm survival was not affected when fed infected sleepygrass from either population. However, larvae that fed on Weed‐infected plants were smaller and had longer development than larvae that fed on uninfected and Cloudcroft‐infected plants. Males fed on Weed‐infected leaves had reduced mating success. Interestingly, pupal mass increased when larvae fed on either the infected leaf types. However, heavier females from both infected diets did not lay more eggs than lighter females from uninfected diets. In a no‐choice test, larvae on Weed‐infected plants diet consumed more leaf biomass than larvae from three other groups. In choice tests, larvae avoided feeding on leaves infected with either of the endophytes relative to uninfected leaves. Thus, the two Epichloë may provide direct protection to sleepygrass from insect herbivory by deterrence. The Weed population endophyte may provide stronger indirect protection than the Cloudcroft endophyte by reducing insect fitness or increasing risks of predation and parasitism through delayed development, even though larvae may consume more leaf biomass.


The causes of segmentation of mid-ocean ridges by long-lived transform boundaries are poorly understood. Large (>200 km) offsets of the Mid-Atlantic Ridge are distributed neither regularly nor randomly, but are mostly clustered in the equatorial region, where they can be traced outside the active transform to South American and African sheared continental margins. This permanent cluster of transforms is located above a long-lived upper mantle thermal minimum. Permanent transforms at 50°–55°N and perhaps at 45°–50°S are associated with mantle secondary thermal minima. A cluster of transforms disrupts the mid-ocean ridge above a mantle thermal minimum at the Australian-Antarctic discordance. Conversely, "hot" stretches of the Mid-Atlantic Ridge are devoid of major transforms. Low magmatic budget and high-strength rheology of cold, thick lithosphere above cold mantle caused the formation of weak and unstable oceanic rift segments during the opening of the equatorial Atlantic and Australian-Antarctic oceans, favoring the development of initial transform clusters and maintaining them as permanent structural and/or geochemical boundaries. Thus, some long-lived transform clusters may be caused ultimately by upper mantle thermal minima, and not vice versa; thermal anomalies created in the mantle by these transforms ("transform cold edge effect") are second-order "rebound" effects.


The elucidation of the biochemical pathway of trichothecene production by Fusarium species has been the focus of our laboratory for a number of years. The complex pathway begins with the sesquiterpene hydrocarbon trichodiene and consists of multiple oxygenation, cyclization, and esterification steps. As is found in a number of other organisms that produce toxic/antibiotic compounds, many of the genes involved in the pathway of trichothecene production in Fusarium are located within a gene cluster. Identified genes within this cluster are two genes encoding P450 oxygenases (TRI11 and TRI4), a sesquiterpene cyclase (TRI5), two acetyltransferases (TRI3 and TRI7), a pump (TRI12), and a gene for transcriptional regulation (TRI6). We have now identified the function of TRI8, a gene located adjacent to TRI7. To determine the function of TRI8, we disrupted the gene in both F. graminearum and F. sporotrichioides, transformed the parental strains, and analyzed transformants. Gene disruption was confirmed by PCR analysis as well as Southern hybridizations. The culture filtrate of F. graminearum mutants produced by genetic disruption of TRI8 accumulated three C-3 acetylated compounds not normally seen in filtrates of the parent strain. We also conducted whole-cell and cell-free feeding experiments using acetylated trichothecenes. The wild-type parental converted the compounds into the deacetylated form whereas the disruptant mutants did not. Heterologous expression of TRI8 and TRI12 in yeast resulted in a strain that could remove the C-3 acetyl group from a number of trichothecenes. Based on these lines of evidence, we have identified that TRI8 encodes an esterase that removes the C-3 acetyl group of F. sporotrichioides and F. graminearum trichothecenes.


Introduction Intervertebral disc (IVD) disease characterized by low back pain is common in both humans and large breed dogs. Inflammatory mediators such as prostaglandin E2 (PGE2) play a key role in IVD degeneration, causing structural changes of the IVD and low back pain. The current conservative and surgical treatment modalities do not reverse IVD degeneration and have certain drawbacks. Long term systemic administration of non-steroidal anti-inflammatory drugs can cause gastro-intestinal side effects. Decompressive surgery is effective in over 80% of the patients, but is rather costly and has a long recovery period. Injectable formulations that enable local sustained release of anti-inflammatory drugs aim at decreasing inflammation and thereby inhibiting degeneration and pain. In vitro, controlled release of celecoxib, a COX-2 inhibitor, from a thermoreversible acetyl-capped PCLA-PEG-PCLA hydrogel inhibited PGE2 production and enhanced matrix production for 28 days in 3D culture of canine nucleus pulposus cells that were subjected to the catabolic effects of TNF-α. In vivo, sustained release of celecoxib by the hydrogel for up to 60 days was shown and safely applied intradiscally in laboratory dogs with naturally occurring IVD degeneration. The aim of the present study is to report the safety and feasibility of intradiscal application in client-owned dogs with low back pain related to IVD degeneration. Material and Methods Client-owned dogs with low back pain were diagnosed by MRI with degenerative lumbosacral stenosis marked by mild to moderate IVD degeneration and protrusion. The dogs were surgical candidates but were offered intradiscal injection. The PCLA-PEG-PCLA thermogel, loaded with 0.013mg/ml celecoxib, was percutaneously injected into the nucleus pulposus of L7-S1 under fluoroscopy guidance. Follow-up consisted of clinical examination, owner questionnaires, and objective gait analysis by measurement of ground reaction forces (GRFs) using force plate analysis (FPA) at 6 weeks, and 3 and 6 months after injection. MRI was repeated after 3 months and included T2- and T1-weighted images and T2-mapping. Results Ten dogs with DLLS were injected with the celecoxib-loaded hydrogel. None of the dogs showed adverse reactions after intradiscal injection. Follow up MRI showed no worsening of the IVD degeneration. Clinical improvement was achieved by reduction of low back pain in 9/10 dogs, as was shown by clinical examination, force plate analysis and owner questionnaires. In 3/10 dogs low back pain recurred at 3 months and they subsequently underwent standard-of-care surgical treatment. Conclusion This study showed the safety and feasibility of intradiscal injections with a thermoresponsive hydrogel loaded with celecoxib. Ongoing studies concentrate on the long term clinical follow up of these patients. Future studies will determine the optimal loading dose of celecoxib for clinical efficacy. In this setup, the dog can be used as a model for the development of novel treatment modalities in both canine and human patients with chronic low back pain.


The game of Mastermind is a constraint optimisation problem. There are two aspects which seem interesting to minimise. The first is the number of guesses needed to discover the secret combination and the second is how many combinations (potential guesses) we evaluate but do not use as guesses. This paper presents a new search algorithm for mastermind which combines hill climbing and heuristics. It makes a similar number of guesses to the two known genetic algorithmbased methods, but is more efficient in terms of the number of combinations evaluated. It may be applicable to related constraint optimisation problems.


Expression patterns of sugars on the mucosal surface of the uterus in pregnant mice were investigated by using 21 kinds of lectins. In the uterine mucosa, the GlcNAc group tended to express a positive reaction before pregnant day 10, but the glucose/mannose group generally expressed a positive reaction after pregnant day 10. On the other hand, the fucose group expressed a negative reaction during all periods in pregnancy. These findings were almost the same on both the mesometrial side and anti-mesometrial side of the uterus. These differences of sugar expression probably reflect the functional change of the mucosa during pregnancy and the alteration of sugar expression may give a chance for pathogens to infect in the uterus with limited periods.


In the title compound, C13H13NO3, the dihedral angle between the phenyl and isoxazole rings is 43.40 (13)°. The ethoxycarbonyl group is rotated out of the plane of the isoxazole ring by 16.2 (13)°.


Abstract The incorporation of the random walk model into stratophenetic analysis marked a turning point by presenting a potential null model for microevolutionary patterns. Random walks are derived from a family of statistical fractals, and their statistics can be reconstructed using appropriate techniques. This paper lays the foundation for the explicit and uniform description of evolutionary mode in stratophenetic series using random walk null models and the information contained within incompletely preserved time series. The method relies upon the iterative analysis of subseries of an original stratophenetic series by measuring the presence of deviations from statistical randomness as the lineage evolves. This measure, and its probability of significance (evaluated using a randomization test), forms the dimensions of a descriptive space for microevolutionary modes. Each stratophenetic series can then be viewed as a journey through this space. Computer simulation of various evolutionary modes demonstrates that different modes, for example stasis and gradualism, have differing trajectories and occupy different regions of the microevolutionary space. The method is applied to two published foraminiferal stratophenetic series, the Mio-Pliocene Globorotalia plesiotumida-tumida punctuated transition and an anagenetic trend in the Late Cretaceous Contusotruncana fornicata-contusa lineage. An anagenetic trend is strongly supported in the latter example, whereas transformation of the Globorotalia species seems to result from the fluctuating effectiveness of constraining processes.


This volume continues the major work published by the JSNT Supplement Series in the area of Greek linguistics of the New Testament, and explores what the editors believe are crucial phases in the application of linguistics to New Testament Greek. The first half of the volume includes essays on such topics as linguistics and literary criticism, linguistics and historical criticism, and linguistics and rhetoric. The second half includes essays dealing with the relations and uses of individual words, but ranges from oral composition to the value of word frequency in determining authorship. Some of these essays review established models of research; others propose new models and criteria of linguistic analysis.


ABSTRACT Outcrops of the lower part of the Cutler Formation near Gateway, Colorado, contain proximal alluvial-fan deposits of two principal lithofacies. The diamictite lithofacies (D) consists of a variety of sharply bounded, massive, muddy beds which are interpreted as deposits of subaerial debris flows. The gravelly sandstone lithofacies (S) consists of amalgamated beds of laminated and cross-bedded conglomeratic sandstones which are interpreted as water-deposited sediments. Clasts in S are rarely larger than 0.5 m in maximum diameter, but clasts in D are commonly much larger (up to 8 m). Both normal and inverse grading are visible in D, but grading is generally not well developed in either lithofacies. Imbrication of clasts, although more pronounced and more consistent in S, is fairly commo in both lithofacies. Four subfacies of diamictite are distinguishable on the basis of clast packing and grading: massive matrix-supported (Dram), graded matrix-supported (Dmg), inversely graded clast-supported (Dci), and massive clast-supported (Dcm). Given the hydrodynamic and rheologic properties of debris flows as reported by previous workers, four debris-flow regimes are postulated on the basis of varying water content and clast interaction. Subfacies Dram and Drag typify deposits of flows having viscous clast interactions; subfacies Dci represents deposits of flows having inertial or colliding clast interactions. Subfacies Dram comprises deposits of flows with demonstrably high yield strengths. Subfacies Dcm represents deposits of flows in which yield strength was insufficient to support most clasts. This classification specifically recognizes turbulence, selective deposition, and bedload transport of clasts as essential characteristics of certain dilute debris flows. It also accommodates as debris-flow deposits some beds which have features usually associated with aqueous deposition, including clast frameworks, channelization, imbrication, and normal grading.


Purpose – The purpose of this paper is to explore enhancing theory development in service research and provide an overview of the five essays on theorizing initiated by the International Network for Service Research workshop, held at Karlstad, Sweden in September 2014. Design/methodology/approach – A collaborative theorizing process which was initiated at the Karlstad, Sweden workshop. Findings – Six (five from the event and the introduction) original and provocative essays that explore different aspects of theorizing in service research. Originality/value – Exploring how a collaborative approach to research can be used.


Lists of words compiled on the basis of their frequency of occurrence in writings of various kinds have long been considered "basic" materials for reading instruction. It is said teachers should use such lists because the child best learns to read if the order of the words presented to him for this purpose is governed by the relative frequency words occur in written materials. Put another way, it is argued that if word A occurs more often in written matter of different types than does word B it then should be presented for a child to learn to read before word B is presented. There is a certain logic to support this procedure. Unknown words that appear frequently in a child's reading material surely pose more of a handicap to his success here than would unknown words that appear infrequently. Consequently, one can agree with Hillerich1 that "most educators accept the need for a basic list."


Given the complex nature of freshwater catchment divides and emerging evidence of high levels of genetic diversity, there is great potential for cryptic species to exist among Australian freshwater amphipod groups. Among the chiltoniid amphipods, two congeneric species, Austrochiltonia australis (Sayce, 1901) and A. subtenuis (Sayce, 1902), have been widely recorded across southern Australia yet are poorly known and contentiously defined. A large fragment of the mitochondrial DNA cytochrome c oxidase I (COI) gene was examined and morphological diversity among populations assessed across the reported geographic range of the two putative species. The results confirmed A. australis and A. subtenuis as morphological and molecular species. In addition, two previously undetected and cryptic species from Tasmania are recognised – sister species to A. subtenuis and A. australis. Working conclusions provide evidence towards a more comprehensive systematic revision of the Chiltoniidae and present species information relevant to conservation and management efforts of Australian river systems. A key is presented to the chiltoniid amphipods of southern Australia.


This chapter introduces the novel applications of deep reservoir computing (RC) systems in cyber-security and wireless communication. The RC systems are a new class of recurrent neural networks (RNNs). Traditional RNNs are very challenging to train due to vanishing/exploding gradients. However, the RC systems are easier to train and have shown similar or even better performances compared with traditional RNNs. It is very essential to study the spatio-temporal correlations in cyber-security and wireless communication domains. Therefore, RC models are good choices to explore the spatio-temporal correlations. In this chapter, we explore the applications and performance of delayed feedback reservoirs (DFRs), and echo state networks (ESNs) in the cyber-security of smart grids and symbol detection in MIMO-OFDM systems, respectively. DFRs and ESNs are two different types of RC models. We also introduce the spiking structure of DFRs as spiking artificial neural networks are more energy efficient and biologically plausible as well.


Using state-of-the-art computational tools in seismology and structural engineering, validated using data from the Mw =6.7 January 1994 Northridge earthquake, we determine the damage to two 18-story steel moment-frame buildings, one existing and one new, located in southern California due to ground motions from two hypothetical magnitude 7.9 earthquakes on the San Andreas Fault. The new building has the same configuration as the existing building but has been redesigned to current building code standards. Two cases are considered: rupture initiating at Parkfield and propagating from north to south, and rupture propagating from south to north and terminating at Parkfield. Severe damage occurs in these buildings at many locations in the region in the north-to-south rupture scenario. Peak velocities of 1 m.s−1 and 2 m.s−1 occur in the Los Angeles Basin and San Fernando Valley, respectively, while the corresponding peak displacements are about 1 m and 2 m, respectively. Peak interstory drifts in the two buildings exceed 0.10 and 0.06 in many areas of the San Fernando Valley and the Los Angeles Basin, respectively. The redesigned building performs significantly better than the existing building; however, its improved design based on the 1997 Uniform Building Code is still not adequate to prevent serious damage. The results from the south-to-north scenario are not as alarming, although damage is serious enough to cause significant business interruption and compromise life safety.


Gastropods often show signs of unsuccessful attacks by predators in the form of healed scars in their shells. As such, fossil gastropods can be taken as providing a record of predation through ge-ological time. However, interpreting the number of such scars has proved to be problematic - would a low number of scars mean a low rate of attack, or a high rate of success, for example? Here we develop a model of scar formation, and formally show that in general these two variables cannot be disambiguated without further information about population structure. Nevertheless, by making the probably reasonable assumptions that the non-predatory death rate is both constant and low, we show that it is possible to use relatively small assemblages of gastropods to produce accurate estimates of both attack and success rates, if the overall death rate can be estimated. We show in addition what sort of information would be required to solve this problem in more general cases. However, it is unlikely that it will be possible to extract the relevant information easily from the fossil record: a variety of important collection and taphonomic biases are likely to intervene to obscure the data that gastropod assemblages may yield.


This note examines the constitutional and social implications of the civil commitment of sexually violent predators in the United States. These commitments are implemented on sexual offenders deemed too dangerous to be placed back into society after serving prison sentences and have been gaining popularity across the United States. Currently, these commitments are considered constitutional in limited circumstances by the Supreme Court, but while these commitments are meant for only the most dangerous and least controllable individuals, the public reaction to sexual offenses increases the possibility these commitments will be misused. As a part of examining this commitment process, this note analyzes the short story, The Yellow Wallpaper, a first hand fictive account of a woman undergoing the rest cure, an eighteenth century medically accepted treatment for women suffering a variety of mental ailments, which isolated women and left them to sleep, eat, and do little else. Today, women look back on this "cure" and wonder how it could have ever been considered an appropriate medical treatment. This story of one woman's confinement to a room as a part of a medically accepted treatment offers a different angle on the situation men face today under changing sexual offender laws and medically accepted treatment programs. By comparing this treatment of women submitted to the rest cure both in The Yellow Wallpaper and in Victorian society to the current constitutional treatment of men submitted to commitment for sexually violent offenses, this note hopes to show how medically accepted treatment regimes with little or no individual treatment are socially and morally dangerous. In the end, there are better alternatives to commitment of sexual offenders that will keep society safe, provide individualized treatment, and uphold constitutional liberties so valued by our society. Perhaps one day, a hundred years from now, society will also look back on the commitment of sexually violent predators as medically inappropriate and wonder how it ever became the socially instituted procedure. 162 WILLIAM AND MARY JOURNAL OF WOMEN AND THE LAW [Vol. 15:161


The Economic Burden of Diabetic Macular Edema in a Working Age and Commercially Insured population Christopher John Wallick Chair of the Supervisory Committee: Professor Sean D. Sullivan Department of Pharmacy INTRODUCTION: Diabetic Macular Edema (DME) is the leading cause of blindness amongst working age adults in most developed countries. Diagnosis and treatment of DME involves many visits to specialists, numerous medications, and great cost. The primary objective of this study was to describe the economic burden of DME in a commercially insured working age population. METHODS: We conducted a retrospective cohort study using enrollment and health care claims information from a large database of commercially insured, working age adults. We matched a cohort of patients with a claim for DME 1:5 to a diabetic control group without DME and reported health care utilization and cost over a 1, 2 and 3 year period. RESULTS: The DME cohort had significantly more comorbidities and a higher Charlson Comorbidity Index (CCI) scores than the matched diabetic control cohort. Health care resource utilization rates were significantly higher in DME patients than diabetic control patients for every category. DME patients had claims for significantly higher counts of emergency, outpatient, and inpatient visits than the diabetic control cohort. The total number of days with a visit to any healthcare provider was on average more than 10 days greater in DME cohort patients than in non-DME diabetic patients (27.01 vs. 16.13 days). Among the DME cohort this represents, on average, a visit to a healthcare provider more than once every 2 weeks over the course of a year. CONCLUSION: We characterized utilization patterns for DME patients and compared them to matched non-DME diabetic patients. We found that DME patients utilized significantly more health care resources and accrued higher costs than the non-DME diabetic patients. DME patients also made more visits to health care professionals. The burden of disease for DME patients is large and may represent a challenge for patients that are trying to attend to family or work. The large and rising cost of treatment only adds burden to patients that are likely already missing work time to visit specialists. DME patients that have nearly 30 days per year with at least one provider visit are likely to have difficult decisions between seeking treatment and taking care of their family or going to work.