Data movement between the memory system and computation units is one of the most critical challenges in designing high performance and energy-efficient computing systems. The high cost of data movement is forcing architects to rethink the fundamental design of computer systems. Recent advances in memory design enable the opportunity for architects to avoid unnecessary datamovement by performing processing-in-memory (PIM), also known as near-data processing (NDP). While PIM can allow many data-intensive applications to avoid moving data from memory to the CPU, it introduces new challenges for system architects and programmers. Our goal in this thesisis to make PIM effective and practical in conventional computing systems. Toward this end, this thesis presents three major directions: (1) examining the suitability of PIM across key workloads, (2) addressing major system challenges for adopting PIM in computing systems, and (3) redesigning applications aware of PIM capability. In line with these three major directions, we propose a seriesof practical mechanisms to reduce processor–memory data movement in modern workloads: First, we comprehensively analyze the energy and performance impact of data movement for several widely-used Google consumer workloads. We find that PIM can significantly reduce datamovement for all of these workloads, by performing part of the computation close to memory. Each workload contains simple primitives and functions that contribute to a significant amount of the overall data movement. We investigate whether these primitives and functions are feasible to implement using PIM, given the limited area and power constraints of consumer devices. Our analysis shows that offloading these primitives to PIM logic, consisting of either simple cores or specialized accelerators, eliminates a large amount of data movement, and significantly reducestotal system energy execution time. Second, we address one of the key system challenges for communication with PIM logic by proposing an efficient cache coherence support for near-data accelerators (NDAs). We find that enforcing coherence with the rest of the system, which is already a major challenge for on-chip accelerators, becomes more difficult for NDAs. This is because (1) the cost of communication between NDAs and CPUs is high, and (2) NDA applications generate a large amount of off-chip datamovement. As a result, as we show in this work, existing coherence mechanisms eliminate most of the benefits of NDAs. Based on our observations, we propose CoNDA, a coherence mechanism that lets an NDA optimistically execute an NDA kernel, under the assumption that the NDA has all necessary coherence permissions. This optimistic execution allows CoNDA to gather information on the memory accesses performed by the NDA and by the rest of the system. CoNDA exploits this information to avoid performing unnecessary coherence requests, and thus, significantly reducesdata movement for coherence. We show that CoNDA significantly improves performance andreduces energy consumption compared to prior coherence mechanisms. Third, we propose a hardware–software co-design approach aware of PIM for edge machinelearning (ML) accelerators to enable energy-efficient and high-performance inference execution. We analyze a commercial Edge TPU (tensor processing unit) using 24 Google edge neural network (NN) models (including CNNs, LSTMs, transducers, and RCNNs), and find that the accelerator suffers from three shortcomings, in terms of computational throughput, energy efficiency, andmemory access handling. We comprehensively study the characteristics of each NN layer in all of the Google edge models, and find that these shortcomings arise from the one-size-fits-all approach of the accelerator, as there is a high amount of heterogeneity in key layer characteristics both across different models and across different layers in the same model. To combat this inefficiency, we propose a new acceleration framework called Mensa. Mensa incorporates multiple heterogeneous ML edge accelerators (including both on-chip and near-data accelerators), each of which caters to the characteristics of a particular subset of models. At runtime, Mensa schedules each layer torun on the best-suited accelerator, accounting for both efficiency and inter-layer dependencies. We show that Mensa significantly improves inference energy and throughput, while reducing hardware cost and improving area efficiency over the Edge TPU and Eyeriss v2, two state-of-the-art edge ML accelerators. Lastly, we propose to redesign emerging modern hybrid databases to be aware of PIM capability, to enable real-time analysis. Hybrid transactional and analytical processing (HTAP) databasesystems can support real-time data analysis without the high costs of synchronizing across separate single-purpose databases. Unfortunately, for many applications that perform a high rate of data updates, state-of-the-art HTAP systems incur significant drops in transactional and/or analyticalthroughput compared to performing only transactions or only analytics in isolation, due to (1) data movement between the CPU and memory, (2) data update propagation, and (3) consistency costs. We propose Polynesia, a hardware–software co-designed system for in-memory HTAP databases. Polynesia (1) divides the HTAP system into transactional and analytical processing islands, (2) implements custom algorithms and hardware to reduce the costs of update propagation and consistency, and (3) exploits processing-in-memory for the analytical islands to alleviate data movement. We show that Polynesia significantly outperforms three state-of-the-art HTAP systems and reduces energy consumption.


This study aims to identify the marketing mix florist board, identify internal factors (strengths and weaknesses) and external factors (opportunities and threats) that faced, developed and recommend appropiate alternative marketing strategies. The research was conducted in June 2013 until the end. The sampling method used in this research is a case study in the Valentine Florist's florist board business. The data were analyzed descriptively. Results showed interest board products offered by various designs and sizes, ranging from size to size 2mx3m 2mx12m and can be combined using fresh flowers. Rental price charged to the consumer products amounted to Rp 100,000 rupiah/board. Product distribution channels carried by employers are only one level. Promotion is done is through the division enterpreneur cards and banners installed on each foot flower display board. Alternative marketing strategies based on the SWOT matrix can be chosen that maintain product image by improving the quality of products and services and maintain consumer trust, maintain exiting markets and seek new market opportunities, utilizing the media campaign to seize market opportunities, offering derivative products of interest apart from board interest to consumers, promote products to consumers continuouly. Keywords: Florist Board Business, Marketing Mix and Marketing Strategy


It is not your imagination. Supreme Court Justices are in the news more than ever, whether they are selling books, testifying before Congress, addressing a Federalist Society, or American Constitution Society event, or just talking to a Muppet on Sesame Street. The number of books about the Court and particular Justices continues to grow. Websites are now devoted to tracking the Justices' movements as they crisscross the country (and the world) speaking to various audiences. Justice Ruth Bader Ginsburg is even promoted on T-shirts as the "Notorious R.B.G.," a riff on the name of famous rap artist Notorious B.I.G. She will soon be the topic of a biopic staring Natalie Portman.That Supreme Court Justices have become celebrities is not news. Indeed, Justices' public statements about same-sex marriage or Bush v. Gore often get extensive coverage, and extrajudicial comments on issues in pending cases sometimes lead to (ignored) calls for judicial recusal. However, until now no one has quantified the increase in the number of publicly reported events and interviews done by Justices overall and which Justices engage most reported extrajudicial speech.Using an original dataset of reported instances of Supreme Court Justice extrajudicial appearances and interviews from 1960 to 2014, I find that the amount of reported extrajudicial speech has increased dramatically, especially in the past decade. From 1960-1969, research identified 193 publicly-reported appearances or interviews by all the Justices combined. This number fell by more than half (to 91) in the 1970s. From 2005-2014 it rose to 783, an eight-and-a-half-fold increase over the 1970s. The data show close to a doubling of the number of reported appearances from the 1970s to the 1980s, from the 1980s to 1990s, and from the 1990s to the 2000s. While a small part of that discrepancy between old and new rates of appearances may be due to research limitations as to older news sources, most of the discrepancy appears due to the great increase in the number of reported public appearances by Justices, driven in part by the swelled number of media outlets looking to interview and report on the Justices.Further, not all Justices are created equal when it comes to Celebrity Justice. John Marshall Harlan, had a mere four reported appearances or interviews from 1960 until he left the Court in 1971. Four Justices had over 175 reported appearances or interviews: Stephen Breyer (224), Ruth Bader Ginsburg (195), Antonin Scalia (186), and Clarence Thomas (179). Dividing the number of appearances by the number of years a Justice was on the Court from 1960 until 2014 yields a "Celebrity Index." In that Index, Justice Sonia Sotomayor is the highest scoring celebrity Justice, with a score of 13.6 annual reported appearances, followed by Justice Breyer, with a score of 11.2. Nine of the top ten Justices in the Index are current Supreme Court Justices. Finally, not all types of appearances are the same. Some Justices are much more likely to give interviews than others. Among current sitting Justices, Justice Sotomayor has given the largest percentage of interviews, and Justice Anthony Kennedy the smallest. This Essay proceeds in three parts. Part I sets out the evidence of the rise of Celebrity Justices and the variations among Justices. Part II discusses methodological concerns. Part III briefly reflects on the normative question whether the rise of the Celebrity Justice is good or bad. I argue that the answer is mixed, but the trend of public appearances and interviews likely will continue to grow in coming years thanks to a drastically changed media landscape and a politicized Court.


Arduino open-source microcontrollers are well known in sensor applications for scientific equipment and for controlling RepRap 3D printers. Recently low-cost open-source gas metal arc weld (GMAW) RepRap 3D printers have been developed. The entry-level welders used have minimal controls and therefore lack any real-time measurement of welder voltage or current. The preliminary work on process optimization of GMAW 3D printers requires a low-cost sensor and data logger system to measure welder current and voltage. This paper reports on the development of a low-cost open-source power measurement sensor system based on Arduino architecture. The sensor system was designed, built, and tested with two entry-level MIG welders. The full bill of materials and open source designs are provided. Voltage and current were measured while making stepwise adjustments to the manual voltage setting on the welder. Three conditions were tested while welding with steel and aluminum wire on steel substrates to assess the role of electrode material, shield gas, and welding velocity. The results showed that the open source sensor circuit performed as designed and could be constructed for <$100 in components representing a significant potential value through lateral scaling and replication in the 3D printing community.


The Routledge Companion to Media and Activism is a wide-ranging collection of 42 original and authoritative essays by leading contributors from a variety of academic disciplines. Introducing and exploring central debates about the diverse relationships between both media and protest, and communication and social change, the book offers readers a reliable and informed guide to understanding how media and activism influence one another. The expert contributors examine the tactics and strategies of protest movements, and how activists organize themselves and each other; they investigate the dilemmas of media coverage and the creation of alternative media spaces and platforms; and they emphasize the importance of creativity and art in social change. Bringing together case studies and contributors from six continents, the collection is organized around themes that address past, present and future developments from around the world. The Routledge Companion to Media and Activism is an essential reference and guide for those who want to understand this vital area.


This paper presents a comparative study of neural network (NN) training. The trained NNs are used as adaptive beamformers of antenna arrays. The training is performed either by a recently developed method called Mutated Boolean PSO (MBPSO) or by a well known beamforming method called Minimum Variance Distortionless Response (MVDR). The training procedure starts by applying the MBPSO and the MVDR to a set of random cases where a linear antenna array receives a signal of interest (SOI) and several interference signals at random directions of arrival (DOA) difierent from each other in the presence of additive Gaussian noise. For each case, the MBPSO and the MVDR are independently applied to estimate respective excitation weights that make the array steer the main lobe towards the DOA of the SOI and form nulls towards the DOA of the interference signals. The lowest possible value of side lobe level (SLL) is additionally required. The weights extracted by the MBPSO and the weights extracted by the MVDR are used to train respectively two difierent NNs. Then, the two trained NNs are independently applied to a new set of cases, where random DOA are chosen for the SOI and the interference signals. Finally, the radiation patterns extracted by the two NNs are compared to each other regarding the steering ability of the main lobe and the nulls as well as the side lobe level. The comparison exhibits the superiority of the NN trained by the MBPSO.


We report the discovery of a pulsar with period P = 136 ms and dispersion measure 308 cm-3 pc in a deep observation of the supernova remnant (SNR) G54.1+0.3 with the Arecibo radio telescope. Timing measurements of the new pulsar, J1930+1852, reveal a characteristic age of P/2 = 2900 yr and a spin-down luminosity of = 1.2 × 1037 ergs s-1. We have subsequently searched archival ASCA X-ray data of this SNR and detect pulsations with a consistent period. These findings ensure that PSR J1930+1852 is the pulsar that powers the "Crab-like" SNR G54.1+0.3. Together with existing Chandra observations of the SNR, we derive an X-ray pulsed fraction (2-10 keV) of ≈27%. We also find that the cooling efficiency of the pulsar wind nebula (PWN) is intermediate between those of the Vela and Crab PWNe: LX(2-10 keV) ~ 0.002. PSR J1930+1852 is a very weak radio source, with a period-averaged flux density at 1180 MHz of 60 μJy. For a distance of 5 kpc, its luminosity, ~1 mJy kpc2, is among the lowest for known young pulsars.


A unique aspect of plant biology is their ability to respond very rapidly to shifts in their ever-changing environment. To do this, plants need to have evolved mechanisms that enable them to sense their environment and to rapidly respond to different stresses and different combinations of stress. The main focus of my thesis has been on plant responses to low temperature. One way in which the plant cell is thought to sense low temperature is via the rigidification of the plasma membrane that occurs when the temperature falls rapidly. I showed that CRMK1, a leucine-rich-repeat-receptor-like kinase, located in the plasma membrane is a key component of the cold sensing machinery. I show that a T-DNA insertion mutant of CRMK1 attenuated the expression of marker cold genes in response to cold stress and decreased the plants ability to acquire freezing tolerance after 3 days of exposure to low temperature. I described a protective mechanism in the thylakoid membranes by which excess electrons, which can accumulate at low temperature and under high light in cold acclimated plants, can be dissipated. In order to properly respond to a changing surroundings cells not only have to sense the fluctuations but they need to communicate this changes to the nucleus and I showed that organelles such as the chloroplasts can act as a sensor of changing temperature and communicate this information to the nucleus to change the expression of cold regulated genes. I presented and identified factors in addition to low temperature that regulate the expression of genes for cold tolerance. I showed that a circadian signal, together with plastid and light signals, influence the expression of nuclear encoded cold tolerance genes (CBF3 and COR15). The response of plants to low temperature also depends on the duration of the cold stress. There are plants, such as over-wintering herbaceous and perennial woody plants, that have to survive and grow for prolonged periods at low temperature and there are those from extreme polar or alpine environments that spend entire life in cold. I provided a comprehensive overview of the biological processes and genes that enable plants to survive and develop the full cold acclimated state during long-term over wintering and growth in the low temperature.


Objectives: Early-phase clinical trials play a pivotal role in drug development. However, limited data are available on outcomes of gastrointestinal (GI) cancer patients enrolled in phase I clinical trials. Here, we evaluated the characteristics associated with survival in GI cancer patients participating in phase I clinical trials and attempted to validate previously established prognostic models. Materials and Methods: All consecutive patients with advanced GI tumors who participated in phase I clinical trials at our institution from January 2007 to December 2013 and received at least 1 dose of the study drug were included. Cox regression models were used to estimate multivariable-adjusted hazard ratio (HR) and 95% confidence interval. Results: In 243 study patients (median age, 62 y [range, 26 to 82 y]; 55% male), treatment included chemotherapy only (14%), targeted therapy (41%), chemotherapy+targeted therapy (42%), and others (2%) for the following disease types: pancreatic (42%), colorectal (34%), gastroesophageal (10%), hepatobiliary (13%), and others (2%). Response rate was 4%, with 38% achieving stable disease and 42% having progressive disease. Median survival was 5.8 months (range, 0.2 to 52.4 mo). Our multivariable Cox regression analyses included the following as predictors of survival: Eastern Cooperative Oncology Group performance score ≥1 (HR=1.76), prior systemic therapies ≥2 (HR=1.63), lactate dehydrogenase >618 IU/L (HR=1.85), sodium >135 mmol/L (HR=0.46), and white blood count >6×109/L (HR=1.5). Our data set was consistent with previous prognostic scores. Conclusions: This is the largest study to assess clinical outcomes in this patient population. Phase I trials provide clinical benefit to patients with advanced GI malignancies and should be recommended as a treatment option in appropriate patients.


Bilingualism in the Russian Expatriate Communities. Baron Sergei Korff at the Universities of Finland, Estonia and the USA Eugene Petrov St Petersburg State University Individuals who are characterised as bilingual usually speak two languages equally well and choose the language depending mainly of the communication situation. Diglossia refers to a situation where different languages are used in a different social context or social class, and this more likely characterises an entire community. This article discusses how bilingualism and a liberal world view guaranteed success to one of the best Russian administrative law specialists, Baron Sergei Korff (1876–1924), as an emigrant in the USA, on the example of his academic biography. Korff's fate was in many ways typical to Russian expatriate researchers, but his success occurred quicker than that of many others. At the beginning of the 20th century many European universities preferred to educate their own students to be the next generation of the academia. It was easier for newcomers to find a place in the more open American universities; however, speaking the language was an unavoidable precondition. There are three clearly differentiable stages in the life story of Korff: the periods of St. Petersburg (1876–1905), Helsinki (1905– 1919) and New York (1919–1924), but the reality was more complicated. After studies at the St. Petersburg law school, Baron Korff worked at the University of Helsinki in 1905–1911. His federal views developed during that time and the works cited to this day were published (e.g., Federalism, 1908). In 1911, he completed his PhD in constitutional law (topic: Russian administrative law) at the University of Tartu / University of Jurjev, however, this did not secure him an academic position. Korff became the director of the Slavonic library of the University of Helsinki. He had to hold lectures in many private institutions of higher education in 1914–1916 (women's courses, commerce courses and lectures at the commerce academy) and, from time to time, he would make an appearance with lecture courses in America. In 1917, he quickly became politically renowned as the assistant to the governor-general of Finland. Up until 1919, Korff participated actively in the Russian emigrant activities in Europe but seeing that the Bolshevik's secured their power, he immigrated to the USA in 1919. After that, since 1919, he already worked as an emigrant at the universities of Georgetown and Columbia in the USA, where he laid much of the foundations for the Russian studies in the USA. Baron Korff's wife was American, and the reasons for his thriving and quick success as an emigrant in the USA were mostly his fluent language skills and the vast knowledge about both the European and American academy.


Experimental compressional wave velocity (Vp) measurements were performed on felsic metasedimentary and igneous lithologies belonging to the Beit Bridge Group, and other amphibolite facies rocks, found in and around the Venetia Kimberlite pipes, which intrude the Central Zone of the Limpopo Belt. Xenoliths of eclogite, granulite, gabbronorite and garnet-quartz, which represent the major crustal and upper mantle lithologies found in the kimberlite host rock were too small for experimental measurements. Compressional wave velocities for these samples were calculated, based on their modal mineralogy and end member mineral compositions. Compressional wave velocities were corrected for in-situ conditions based on estimated equilibration temperatures and pressures, and the resulting velocities were compared with the seismic refraction model of the Limpopo Belt, in order to construct a lithologic column of the crust and upper mantle below the Venetia Mine.


As Hadoop and the surrounding projects & vendors mature, their impact on the data management sector is growing. Amr will talk about his views on how that impact will change over the next five years. How central will Hadoop be to the data center of 2020? What industries will benefit most? Which technologies are at risk of displacement or encroachment?


Methylation of CpG islands in gene promoters results in silencing of those genes. Mutation of a methyl-CpG binding domain protein called MeCP2 that contributes to the maintenance of methylation-mediated gene silencing is associated with a severe neurological disease called Rett syndrome. As
 Klose and Bird
 report in their Perspective, new work published here (
 Chen
 et al .,
 Martinowich
 et al .) and elsewhere demonstrates that MeCP2 normally represses the expression of two genes-
 BDNF in rat and
 Hairy2a in frog-that are crucial for normal development of the nervous system.


Protein expression across human tissues Sequencing the human genome gave new insights into human biology and disease. However, the ultimate goal is to understand the dynamic expression of each of the approximately 20,000 protein-coding genes and the function of each protein. Uhlén et al. now present a map of protein expression across 32 human tissues. They not only measured expression at an RNA level, but also used antibody profiling to precisely localize the corresponding proteins. An interactive website allows exploration of expression patterns across the human body. Science, this issue 10.1126/science.1260419 Transcriptomics and immunohistochemistry map protein expression across 32 human tissues. INTRODUCTION Resolving the molecular details of proteome variation in the different tissues and organs of the human body would greatly increase our knowledge of human biology and disease. Here, we present a map of the human tissue proteome based on quantitative transcriptomics on a tissue and organ level combined with protein profiling using microarray-based immunohistochemistry to achieve spatial localization of proteins down to the single-cell level. We provide a global analysis of the secreted and membrane proteins, as well as an analysis of the expression profiles for all proteins targeted by pharmaceutical drugs and proteins implicated in cancer. RATIONALE We have used an integrative omics approach to study the spatial human proteome. Samples representing all major tissues and organs (n = 44) in the human body have been analyzed based on 24,028 antibodies corresponding to 16,975 protein-encoding genes, complemented with RNA-sequencing data for 32 of the tissues. The antibodies have been used to produce more than 13 million tissue-based immunohistochemistry images, each annotated by pathologists for all sampled tissues. To facilitate integration with other biological resources, all data are available for download and cross-referencing. RESULTS We report a genome-wide analysis of the tissue specificity of RNA and protein expression covering more than 90% of the putative protein-coding genes, complemented with analyses of various subproteomes, such as predicted secreted proteins (n = 3171) and membrane-bound proteins (n = 5570). The analysis shows that almost half of the genes are expressed in all analyzed tissues, which suggests that the gene products are needed in all cells to maintain "housekeeping" functions such as cell growth, energy generation, and basic metabolism. Furthermore, there is enrichment in metabolism among these genes, as 60% of all metabolic enzymes are expressed in all analyzed tissues. The largest number of tissue-enriched genes is found in the testis, followed by the brain and the liver. Analysis of the 618 proteins targeted by clinically approved drugs unexpectedly showed that 30% are expressed in all analyzed tissues. An analysis of metabolic activity based on genome-scale metabolic models (GEMS) revealed liver as the most metabolically active tissue, followed by adipose tissue and skeletal muscle. CONCLUSIONS A freely available interactive resource is presented as part of the Human Protein Atlas portal (www.proteinatlas.org), offering the possibility to explore the tissue-elevated proteomes in tissues and organs and to analyze tissue profiles for specific protein classes. Comprehensive lists of proteins expressed at elevated levels in the different tissues have been compiled to provide a spatial context with localization of the proteins in the subcompartments of each tissue and organ down to the single-cell level. The human tissue–enriched proteins. All tissue-enriched proteins are shown for 13 representative tissues or groups of tissues, stratified according to their predicted subcellular localization. Enriched proteins are mainly intracellular in testis, mainly membrane bound in brain and kidney, and mainly secreted in pancreas and liver. Resolving the molecular details of proteome variation in the different tissues and organs of the human body will greatly increase our knowledge of human biology and disease. Here, we present a map of the human tissue proteome based on an integrated omics approach that involves quantitative transcriptomics at the tissue and organ level, combined with tissue microarray–based immunohistochemistry, to achieve spatial localization of proteins down to the single-cell level. Our tissue-based analysis detected more than 90% of the putative protein-coding genes. We used this approach to explore the human secretome, the membrane proteome, the druggable proteome, the cancer proteome, and the metabolic functions in 32 different tissues and organs. All the data are integrated in an interactive Web-based database that allows exploration of individual proteins, as well as navigation of global expression patterns, in all major tissues and organs in the human body.


Wireless sensor networks are poised to change the way computer systems interact with the physical world. We plan on entrusting sensor systems to collect medical data from patients, monitor the safety of our infrastructure, and control manufacturing processes in our factories. To date, the focus of the sensor network community has been on developing best-effort services. This approach is insufficient for many applications since it does not enable developers to determine if a system's requirements in terms of communication latency, bandwidth utilization, reliability, or energy consumption are met. The focus of this thesis is to develop real-time network support for such critical applications.
The first part of the thesis focuses on developing a power management solution for the radio subsystem which addresses both the problem of idle-listening and power control. In contrast to traditional power management solutions which focus solely on reducing energy consumption, the distinguishing feature of our approach is that it achieves both energy efficiency and real-time communication. A solution to the idle-listening problem is proposed in Energy Efficient Sleep Scheduling based on Application Semantics (ESSAT). The novelty of ESSAT lies in that it takes advantage of the common features of data collection applications to determine when to turn on and off a node's radio without affecting real-time performance. A solution to the power control problem is proposed in Real-time Power Aware-Routing (RPAR). RPAR tunes the transmission power for each packet based on its deadline such that energy is saved without missing packet deadlines.
The main theoretical contribution of this thesis is the development of novel transmission scheduling techniques optimized for data collection applications. This work bridges the gap between wireless sensor networks and real-time scheduling theory, which have traditionally been applied to processor scheduling. The proposed approach has significant advantages over existing design methodologies: (1) it provides predictable performance allowing for the performance of a system to be estimated upon its deployment, (2) it is possible to detect and handle overload conditions through simple rate control mechanisms, and (3) it easily accommodates workload changes. I developed this framework under a realistic interference model by coordinating the activities at the MAC, link, and routing layers.
The last component of this thesis focuses on the development of a real-time patient monitoring system for general hospital units. The system is designed to facilitate the detection of clinical deterioration, which is a key factor in saving lives and reducing healthcare costs. Since patients in general hospital wards are often ambulatory, a key challenge is to achieve high reliability even in the presence of mobility. To support patient mobility, I developed the Dynamic Relay Association Protocol – a simple and effective mechanism for dynamically discovering the right relays for forwarding patient data – and a Radio Mapping Tool – a practical tool for ensuring network coverage in 802.15.4 networks. We show that it is feasible to use low-power and low-cost wireless sensor networks for clinical monitoring through an in-depth clinical study. The study was performed in a step-down cardiac care unit at Barnes-Jewish Hospital. This is the first long-term study of such a patient monitoring system.


The Internet is undergoing substantial changes from a communication and browsing infrastructure to a medium for conducting business and selling a myr-iad of emerging services. The World Wide Web provides a uniform and widely-accepted application interface used by these services to reach multitudes of clients. These changes place the web server at the center of a gradually emerging e-service infrastructure with increasing requirements for service quality, reliability , and security guarantees in an unpredictable and highly dynamic environment. Towards that end, we introduce a web server QoS provisioning architecture for performance diierentiation among classes of clients, performance isolation among independent services , and capacity planning to provide QoS guarantees on request rate and delivered bandwidth. We present a new approach to web server resource management based on web content adaptation. This approach subsumes traditional admission control based techniques and enhances server performance by selectively adapting content in accordance with both load conditions and QoS requirements. Our QoS management solutions can be implemented either in middle-ware transparent to the server or by direct modiica-tion of the server software. We present experimental data to illustrate the practicality of our approach.


In this paper we discuss how to assess the performance of algorithms for optimisation problems in a way that balances solution quality and time. We propose measures of cost-effectiveness for such algorithms. These measures give the gain in solution quality per time unit over a sequence of inputs, and give a basis for deciding which algorithm to use when aiming for best accumulated solution quality for a given time investment over such an input sequence. Cost-effectiveness measures can be defined for both average-case and worst-case performance. We apply these ideas to three problems: maximum matching, graph colouring and Kolmogorov complexity. For the latter, we propose a cost-effectiveness measure for the time-bounded complexity Kτ(x), and argue that it can be used to measure the cost-effectiveness both of finding a short program to output x and of generating x from such a program. Under mild assumptions, we show that (roughly speaking) if the time-bounded complexity Kτ(x) is to be a cost-effective approximation to K(x) then τ(n)=O(n2).


Selecting a sensor technology for a Digital Musical Instrument (DMI) is not obvious specially because it involves a performance context. For this reason, when designing a new DMI, one should be aware of the advantages and drawback of each sensor technology and methodology. In this article, we present a discussion about the Rulers, a DMI based on seven cantilever beams fixed at one end which can be bent, vibrated, or plucked. The instrument has already two sensing versions: one based on IR sensor, another on Hall sensor. We introduce strain gages as a third option for the Rulers, sensor that are widely used in industry for measuring loads and vibration. Our goal was to compare the three sensor technologies according to their measurement function, linearity, resolution, sensitivity and hysteresis and also according to real-time application indicators as: mechanical robustness, stage light sensitivity and temperature sensitivity. Results indicate that while strain gages offer more robust and medium sensitivity solution, the requirements for their use can be an obstacle for novice designers.


Three days before Hurricane Sandy's East Coast landfall, NASA released its first aerial, time-lapse video of the storm. Roughly 22,000 miles above Earth, NOAA's GOES-14 satellite scanned the hurricane's movement across the southern United States. NASA's video, produced through rapid-scanning technology, captured the enormity of the storm, its dynamic cloud structure, and the sharpening of the storm's eye as the continent dimmed under the setting sun. But despite the complicated process of data gathering and transmission that is involved in meteorological satellite sensing and imaging, satellite media often pass as uninterpreted weather reality for popular audiences, offering visual and textual narratives of weather crises that abstract the human from environmental disaster. This essay considers the twentieth-century turn toward uninterpreted and visually centered weather media by analyzing the meteorological satellite movement of the 1960s, contemporary GOES-14 experimental satellite technology, and the narratological and ontological ramifications of the visual satellite data and media that constitute a weather "movie" during storm crises.


This study has developed optimal hedging policies for the multi-purpose Ubonratana Reservoir in northeastern Thailand based on its existing rule curves. The hedging policy was applied whenever the reservoir storage falls below a critical level for each month of the year. The decision variables, i.e. the set of monthly storages defining the critical rule curve that triggers rationing and the rationing ratio, were optimized by genetic algorithm (GA). Both single stage (i.e. with one critical rule curve and one rationing ratio) and two-stage (with two critical rule curves and ratios) of the hedging policy were considered in the optimization. To test the effect of the optimized hedging policies on reservoir performance, simulations were carried out, forced alternatively with the existing rule curves (i.e. without hedging) and the two optimized hedging policies. Performance was summarized in terms of reliability (time- and volume-based) and vulnerability. The results showed that the vulnerability was significantly reduced by using the optimized hedging rules. However, the number of water shortages increased with the optimized rules, causing the time-based reliability to worsen significantly. This should not be of concern since, although the number of shortages increased, the associated shortage quantities on most of these additional occasions were small, leaving the volumetric reliability largely unchanged.


Bawden and Robinson (2009) state: "[t]here is no single generally accepted definition of information overload. The term is usually taken to represent a state of affairs where an individual's efficiency in using information in their work is hampered by the amount of relevant, and potentially useful, information available to them." (pp. 182-183) We concentrate on the subjective dimension of information overload, defining it as: distress associated with the perception that there is too much information. We utilize psychometric scale development procedures to measure information overload and correlate it with demographic and psychological variables. Our poster reports preliminary findings that information overload is correlated significantly with gender (being female); age and year in college (positively); and measures of life satisfaction (negatively).


Island waste management professionals are faced with limited land resources, high energy costs, large seasonal fluctuations in waste volumes, and complex social and political dynamics that stem from their often closely knit societies. These and other factors can discourage typical waste management practices, but they also provide opportunities for island governments and businesses to explore alternative technologies and policies that suit their particular circumstances and that might be environmentally preferable. This critical review discusses the waste management literature on islands to date, including several industrial ecology (IE) studies. Common advantages and disadvantages faced by island waste management challenges are presented from the perspectives of business and municipal management. Waste generation data are presented from more than 40 islands around the world and tested for correlation with economic and geographic parameters and using cluster analysis, with the aim of identifying trends among island types. Poor data quality and comparability are ongoing challenges that underscore the potential benefits of a consistent program of island waste management data collection. Finally, the review explores opportunities for applying IE research to generate useful insights and policies in the areas of material flow analysis, industrial symbiosis, life cycle assessment, and social ecology.


Complex perovskite A(B'B'')O3 ceramics with various degrees of B-site order have been structurally and spectroscopically characterized by means of x-ray diffraction, transmission electron microscopy, and infrared reflectivity. In Ba(Fe1/2Nb1/2)O3 and Pb(Fe1/2Nb1/2)O3, no order could be detected whereas Pb(In1/2Nb1/2)O3, Pb(Mg1/3Nb2/3)O3, and Pb(Sc1/2Ta1/2)O3 (unannealed) all exhibited weak reflections associated with small ordered regions Pb(SC1/2Ta1/2)O3 was also prepared by appropriate heat treatment in the fully ordered form and exhibited strong maxima arising from the ordered superlattice in both electron and x-rav diffraction. The infrared reflectivity (30-4000 cm-1) revealed correlation between the degree of ordering and appearance of the extra mode in the 260-320 cm-1 range assigned to B'-B'' vibrations. Despite an apparently low volume fraction of ''ordered material'' in. ''partially ordered'' samples of Pb(SC1/2Ta1/2)O3, the extra mode was observable. It is suggested that infrared spectroscopy is sensitive to short-range ordering down to the nm range which is proposed to exist in between the small regions of order.


This volume is a collection of five satires from the Reformation period, written between 1517 and 1526. In her Introduction to the work, Rummel explains that the battle between reformers and champions of the old faith was waged on many fronts, not only by preachers thundering from the pulpits, theologians facing each other in acrimonious disputations, and church authorities issuing censures and condemnations.This collection focuses on the impact and importance of a supporting cast of satirists whose ad hoc productions reached a wider audience, in a more visceral manner, than the rational approach which typified scholarly theological arguments. Rummel explains: Satire, a genre that requires finely honed language skills, was the preferred weapon of the humanists, who by and large sympathizes with the reformers.The humanists and reformers were often so closely associated in the reading public's mind that the earliest phase of the Reformation was sometimes interpreted as a quarrel between philogists and theologians, a manifestation of professional jealousies. Thus Erasmus claimed that the debates of his time were the result of antagonism between the faculties of Arts and Theology. Three of the selections contained in the volume represent the Reformers, and two support the Catholics, the Papistsof the title. These satirical essays, circulated widely among educated laypersons, use wit and biting humor to ridicule and discredit their adversaries and belong to a genre which was part of a larger body of sixteenth-century satire. The proliferation of satires became a concern of authorities who moved to suppress what they called hate-mongering.Officials banned the publication of anonymously authored writings, effectively ending the publication of the satires, which were largely published either anonymously or carried only the name of the publisher. As a result, many of the pieces did not survive to the present day, many more are only known to us through obscure references in other literature. This volume brings to light five of these satiric pieces, written in the pivotal period when the Reformation ceased to be a protest and organized itself as a full-fledged movement. The topical issues featured in each satire are brought into historical context by a headnote explaining the circumstances surrounding its publication and giving bibliographical information about the satire's author. The witty style makes this collection entertaining reading and the impact of these writings sheds new light on the history of the Reformation.


Immunoassays are microwell and solid phase based antigen-antibody (Ag/Ab) interactions majorly dependent on immune complex or lattice formation. Most of these assays are aimed at the detection of very minute amount of antigen or antibody. Such biochemical reactions are bound to identify not only the target biomolecule (immunoassay) but also clinically important pathogens (immune detection) because of their remarkable simplicity, specificity and sensitivity. But the existing technology suffers from certain difficulties like affinity and avidity of antigen and antibody, vigorous washing methods, chances of false positive interactions, appropriate probe selection and dependence on carcinogenic (as substrate) or hazardous radioisotopes. An urgent need is being felt to ensure more specific, powerful and versatile platform for robust detection of immune reactions. In this scenario, application of nanomaterials in immunoassays may pave a new horizon for immune based detection. Optically active nanomaterial dependent detection reduces the chance of false positive results as well as chromogen or radioisotope dependence and time and cost incurred for those. In this perspective, the immense potential of biomedical nanodevices in immunoassays is summarized in this article. Moreover, application of gold nanoparticles in all types of biosensor (electrochemical, optical, surface enhanced Raman scattering based and engineered) is also discussed as a specific tool in nano immunosensors.


Banana is an extensively cultivated plant worldwide, mainly for its fruit, while its ancillary product, the banana flower is consumed as a vegetable and is highly recommended for diabetics in the traditional Indian medicine system. This study is based on an investigation of the in vivo antihyperglycaemic activity of Umbelliferone (C1) and Lupeol (C2) isolated from the ethanol extract of banana flower (EF) in alloxan induced diabetic rat model. Diabetic rats which were administered with C1, C2 and EF (100 and 200 mg/kg b. wt.) for 4 weeks showed deterioration in fasting hyperglycaemia and reversal of abnormalities in serum/urine protein, urea and creatinine, when compared to the diabetic control group of rats. The diabetic group of rats fed with EF, C1 and C2 (100 mg/kg b. wt.) once daily, for a period of 28 days resulted in a significant reduction of diabetic symptoms viz., polyphagia, polydipsia, polyuria and urine sugar together with an improved body weight. HbA1c extent was reduced whereas levels of insulin and Hb were increased. Both the extract and compounds wielded positive impacts in diabetic rats by reversal of altered activities of hepatic marker enzymes viz., aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP); glycolytic enzyme (hexokinase); shunt enzyme (glucose-6-phosphate dehydrogenase); gluconeogenic enzymes (glucose-6-phosphatase, fructose-1,6-bisphosphatase, lactate dehydrogenase) and pyruvate kinase. The characteristic diabetic complications such as hypercholesterolemia and hypertriacylglycerolemia also significantly reverted to normal in the serum/liver of diabetic rats. Besides these, the treatment increased the activities of enzymatic and non-enzymatic antioxidants in the serum and liver. The histological observations revealed a marked regeneration of the β-cells in the drug treated diabetic rats. In conclusion, the present study illustrates that EF, C1 and C2 enhances the glycolytic activities, besides increasing the hepatic glucose utilization in diabetic rats by stimulating insulin secretion from the remnant β-cells along with potential enzymatic and non-enzymatic antioxidant activities.


Who is the "sovereign individual" of GM II:2, and what does he have to do with Nietzsche's conceptions of free will, freedom or the self? I shall argue for what would have been, at one time, a fairly unsurprising view, namely, that (1) Nietzsche denies that people ever act freely and that they are ever morally responsible for anything they do; (2) the figure of the "sovereign individual" in no way supports a denial of the first point; and (3) Nietzsche engages in what Charles Stevenson would have called a "persuasive definition" of the language of "freedom" and "free will," radically revising the content of those concepts, but in a way that aims to capitalize on their positive emotive valence and authority for his readers. More precisely, I aim to show that the image of the "sovereign individual" is, in fact, consistent with the reading of Nietzsche as a kind of fatalist, which I have defended at length elsewhere. To show that the image of the "sovereign individual" squares with Nietzsche's fatalism, I distinguish between two different "Deflationary Readings" of the passage. On one such reading, the figure of the "sovereign individual" is wholly ironic, a mocking of the petite bourgeois who thinks his petty commercial undertakings - his ability to make promises and remember his debts - are the highest fruit of creation. On another Deflationary Reading, the "sovereign individual" does indeed represent an ideal of the self, one marked by a kind of self-mastery foreign to less coherent selves (whose momentary impulses pull them this way and that), but such a self, and its self-mastery is, in Nietzschean terms, a fortuitous natural artifact (a bit of "fate"), not an autonomous achievement for which anyone could be responsible. To associate this ideal of the self with the language of "freedom" and "free will" is an exercise in "persuasive definition" by Nietzsche, a rhetorical skill of which he was often the master.


In April 2017, the German television program Plusminus featured a documentary about an alleged new cancer therapy. It started with a suggestive question by the moderator: "What happens, when a substance promises cure but almost no profits?" and featured scientist Claudia Friesen form the University Hospital Ulm in Germany, and German physician Hans‐Jorg Hilscher, who claim that methadone improves the effectiveness of anti‐cancer drugs. The report portrayed methadone as a new miracle drug and conveyed the impression that the pharmaceutical industry is pulling the strings to impede its further development, because it is too cheap and would ruin their profits. The broadcast itself, and much of the media hype that followed, is a case study of how a scientific issue can turn into a conspiracy theory.

> … once a conspiracy theory starts circulating, it is difficult to argue with reason.

In a Stern TV studio interview that followed the Plusminus report, moderator Steffen Hallaschka asked "Why has she still not received the Nobel Prize?" referring to Friesen. "Why is not everyone treated with methadone?" he continues and Hilscher answers by describing the medical and scientific community as a conservative enterprise that does not endorse innovative new treatments. Indeed, the interview portrays Friesen as a victim of a corrupted scientific enterprise: "Meanwhile, I don't even get my basic research funded anymore", Friesen complained. Overall, Stern TV and Plusminus make it look as if big pharma and academia have conspired against these two who stand up for the interests of patients. But even if some media reports were more balanced, the underlying problem is that once a conspiracy theory starts circulating, it is difficult to argue with reason.

Debates in science are, of course, not only common, but essential. Researchers who proposed hypotheses outside the mainstream often brought science ahead—Galileo, Einstein, Darwin, …


Background: Today, there are several diagnostic methods to determine the exact size and nature of periapical lesions. Furthermore, there are studies that described thickening of the mucous membrane of the maxillary sinus (MS) in patients with periapical lesions and demonstrated a causal relation. Aims: This study aims to evaluate the morphological variations of the MS floor (MSF) adjacent to chronic periapical lesions in molars and premolars using cone-beam computed tomography (CBCT). Methods: Twenty-five CBCTs with periapical lesions adjacent to maxillary molars and premolars were evaluated. A total of 50 maxillary sinuses were analyzed (12 males and 13 women) taking into account density changes within the sinus cavity. The thickening of the sinus mucosa and the periapical lesions was measured in a caudal-cephalic direction. The axial and sagittal axis was taken as reference on the sagittal and coronal sections. Statistical Analysis: Chi-square, Fisher exact, and the Mann–Whitney tests were used in this study. Results: A significant association between the size of the periapical lesions (>4 mm) and the presence of MSF affectation was found on sagittal and coronal views (P < 0.001). No significant differences between the presence or absence of periapical lesions and the thickening of the sinus mucosa were found (P = 0.241). The presence of opacification on the MS had no direct associations with the periapical lesions. Conclusions: Maxillary sinus floor affectation was associated with chronic periapical lesions >4 mm. The opacification or thickening of the sinus mucosa was not related with the periapical lesions.


This study explores empirically the price dynamics within two distinct market institutions - a double oral auction, which resembles modern asset markets, and a bilateral exchange market, which represents markets that have existed for centuries. To provide a theoretical basis to our investigation, we test and compare the excess supply model (Walras (1874, 1877, 1889, 1896)) and the excess rent model (Smith (1962, 1965)) in both market institutions. Our approach is unique in that we make use of appropriate demand and supply systems coupled with randomization of the main treatment variable to discriminate between the theories. All previous efforts, including Smith's (1965) seminal experiments, use designs that cannot appropriately parse the models. We report several insights, perhaps most importantly, we consistently reject the Walrasian model in favor of the excess rent model, regardless of market institution. This finding has important implications both positively and normatively.


Modifications to large active rivers to aid navigation, reduce flood risk, improve land drainage or generate hydroelectric power have adversely affected river habitats and the hydrological connectivity between the river and its floodplain. Consideration of natural river processes helps to identify sustainable rehabilitation options within constraints imposed by the need to maintain required river functions and any restrictions imposed by space limitations due to floodplain development. A brief review of rehabilitation opportunities for active lowland rivers constrained by river functions is presented. This approach is used to identify suitable rehabilitation measures for two lowland meandering Slovak rivers, the Morava and Hron, which have been significantly influenced by engineering works. Both rivers differ in hydrological, morphological and ecological characteristics. Previous rehabilitation efforts based on locally targeted ecological and landscape restoration measures have actually exacerbated ecological degradation due to their failure to consider the abiotic processes which control river morphology. For rehabilitating cut-off meanders, full meander integration is recommended as the best solution for lowland rivers, such as the Morava, which actively transport bed material load. On the Hron River, an alternative method for improving the water regime and ecological quality of cut-off meanders is required due to engineering constraints. The study demonstrates the need for an integrated interdisciplinary approach to river restoration.


Barack Obama assumed office at a time when the discourse of American exceptionalism had become dysfunctional in international affairs even though it still had broad appeal among the American people. Obama tried to move beyond exceptionalism and chart a new course for American foreign policy in a series of speeches during 2008 and 2009. There is little evidence that Americans paid much attention to these speeches, but if they had, they likely would have seen them as undermining American strategic interests. Obama might mitigate this dilemma by trying to redefine exceptionalism, focusing on its challenges and responsibilities rather than its gifts, This approach would involve recovering a recessive strain in the history of American public discourse.


Distributed word representations, or word vectors, have recently been applied to many tasks in natural language processing, leading to state-of-the-art performance. A key ingredient to the successful application of these representations is to train them on very large corpora, and use these pre-trained models in downstream tasks. In this paper, we describe how we trained such high quality word representations for 157 languages. We used two sources of data to train these models: the free online encyclopedia Wikipedia and data from the common crawl project. We also introduce three new word analogy datasets to evaluate these word vectors, for French, Hindi and Polish. Finally, we evaluate our pre-trained word vectors on 10 languages for which evaluation datasets exists, showing very strong performance compared to previous models.


This article is evaluative assessing the implementation of the Ezulwini Consensus by the International Conference on the Great Lakes Region (ICGLR). In early April 2012, a mutiny started in the eastern part of the Democratic Republic of the Congo (DRC), resulting in the creation of the rebel group known as the Mouvement du 23 Mars (M23). The spread of M23 constituted a serious threat to peace, security and stability in the entire African Great Lakes region. On the basis of the Ezulwini Consensus, which emphasises that regional organisations in areas of proximity to conflicts should be empowered to take action, the ICGLR resolved to intervene. Through several summits attempting to find a home-grown solution, the ICGLR faced two main challenges in implementing the Ezulwini Consensus. The first was related to the lack of actions and sanctions against member states that violated fundamental principles and the second was related to the lack of neutrality of the chairperson of the ICGLR during the dialogue between the government of the DRC and M23. The intervention of the ICGLR is important, but in such circumstances, it is crucial that member states demonstrate their political will to respect fundamental principles and sanction members that allegedly ignore these principles. In the mediation process, where there is sufficient evidence to indicate that a member state is allegedly providing support to rebel groups that are destabilising another member state, it is important that the ICGLR adopt a policy of requesting such a country to avoid taking the lead in or mediating the conflict. However, when regional organisations in areas of conflict face such challenges, the African Union must take responsibility for comediating or sending African experts to resolve the conflict impartially.


As a toast to success, a drowning of sorrows, a rite of passage, and the fuel for most social activities, alcohol plays a central role in our culture. Alcohol generates nearly $160 billion in US revenues annually and is a major source of tax revenue, making the stakes in the modern debate over its use, misuse, and regulation staggeringly high. Factor in the costs of alcohol-related illness and addiction, alcohol-related deaths, evolving social mores, legal precedents, and increasingly aggressive advertising and marketing and an already controversial subject becomes a heated, vigorous, and complicated battle. Synthesizing the divergent, interdisciplinary perspectives on alcohol sales, regulation, and consumption into a cohesive whole, Social and Economic Control of Alcohol: The 21st Amendment in the 21st Century draws on the expertise of key academic and legal figures to become the seminal volume in this burgeoning field of inquiry. Amidst a rapidly changing milieu of regulations, cultures, and emotions, it objectively re-examines issues surrounding the regulation and sale of alcohol with unparalleled breadth, depth, and unbiased focus. The book examines the foundation and basis for our current regulatory policy and how that foundation has shifted dramatically with changes in the law, marketing, consumer influence, and the impact of alcohol on society. With strong and relevant comparisons to historical studies and evaluations of past legislation, this book presents a critical analysis and definition of concepts and applications regarding alcohol control. Double-blind, peer-reviewed contributions outline specific concerns related to the development of new laws and policies, and consider how those policies may affect individuals, organizations, law, and society in general. Highlighting current findings and trends, this volume allows for a better understanding of the potential correlation and causal relationship between regulation, sales, and consumption patterns.


Soil Maximum Available Water Content (MaxAWC) is a key parameter in Land Surface Models (LSMs). However, being difficult to measure, this parameter is usually unavailable. This study assesses the feasibility of using a fifteen-year (1999–2013) time-series of satellite-derived low resolution observations of Leaf Area Index (LAI) to retrieve MaxAWC for rainfed croplands over France. LAI inter-annual variability is simulated using the CO2-responsive version of the Interactions between Soil, Biosphere and Atmosphere (ISBA) LSM for various values of MaxAWC. Optimal value is then selected by using (1) a simple inverse modelling technique, comparing simulated and observed LAI, (2) a more complex method consisting in integrating observed LAI in ISBA through a Land Data Assimilation System (LDAS) and minimizing LAI analysis increments. The evaluation of the MaxAWC retrievals from both methods is done using simulated annual maximum above-ground biomass (B ag ) and straw cereal grain yield (GY) values from the Agreste French agricultural statistics portal, for 45 administrative units presenting a high proportion of straw cereals. Significant correlations (p-value  ag and GY are found for up to 36 % and 53 % of the administrative units for the inverse modelling and LDAS tuning methods, respectively. It is found that the LDAS tuning experiment gives more realistic values of MaxAWC and maximum B ag than the inverse modelling experiment. Using low resolution LAI observations leads to an underestimation of MaxAWC and maximum Bag in both experiments. Median annual maximum values of disaggregated LAI observations are found to correlate very well with MaxAWC.


A telephone survey was conducted of the 1994-2000 STEP NSF Teaching Scholars in orderto gather demographic information and current employment on the scholars as well as to gain information about the scholars' perceptions of the STEP program structure. The survey also examined the scholars' perceptions of various supports and barriers to the successful completion of the scholars' undergraduate teaching program. The survey responses (109 out of the 127 scholars) were collected and summarized. Eighteen scholars were not contacted due to the fact that their current address and/or telephone numbers were not listed or unknown. The gender representation of the respondents was 69% female and 31% male. Approximately 50% of the scholars were Native American. No other minorities were represented among the scholars completing the surveys. There were nine (9) different tribal affiliations reported among the Native American scholars. A large number of Native American scholars (69%) reported being parents, which was in contrast to the relatively low number of non-minority scholars reporting themselves as parents (22%). When asked to describe barriers encountered while pursuing a higher education degree, the scholars cited financial struggles (48%) most frequently. Among Native American scholars, adjustment to a new environment was also cited quite often (40%). Information pertaining to support systems both formal and informal, was also gathered in the survey. For formal support, 77% of the scholars reported the STEP Project was a helpful campus support. Individual staff (65%) and individual students (51%) was also a highly regarded support systems among the scholars. The informal support systems acknowledged were family (88%), friends (73%), and for Native American scholars, spiritual support (82%). Scholar involvement in professional development opportunities and service projects was assessed via the survey instrument. The majority of scholars indicated that they had been offered the opportunity to participate in professional development opportunities as well as service projects and that these opportunities were beneficial. Participation in service projects was encouraged among the majority of the scholars. The results of the telephone survey of the NSF teaching scholars indicated that the scholars program has been quite influential and successful in supporting these teaching candidates through financial assistance as well as through academic, cultural, and emotional support systems. Thirty-six percent of the graduated scholars are currently involved in an educational program or as a teacher in a school system. It is recommended that continued support from the STEP Program can be modified or shifted to address the needs of the scholars from the information that was gathered from the survey.


The article substantiates the influence of globalization of the world economy on the innovative enterprises management. In this regard, it also considers its impact on a specific feature of structuring the accounting resource. The work is aimed at determining the main areas of structuring the accounting and analytical information in relation to innovation-oriented entities depending on internal and external factors influencing their economies. It resulted in giving reasonable arguments to support the main policies of management accounting segmentation in commercial management system. Examples of management accounting objects within the framework of the proposed segments are presented and new management opportunities for innovative production are introduced. This approach will allow a more accurate assessment of the costs of management objects in relation to the responsibility for arising costs for each management object. At the same time, a part of the accounting techniques are highlighted as typical for the management accounting system of any type of production, and some are individual and mandatory for the innovative type of production.


CONTEXT
Intravenous tissue plasminogen activator (tPA) is known to improve outcomes in ischemic stroke; however, patients receiving long-term chronic warfarin therapy may face an increased risk for intracranial hemorrhage when treated with tPA. Although current guidelines endorse administering intravenous tPA to warfarin-treated patients if their international normalized ratio (INR) is 1.7 or lower, there are few data on safety of intravenous tPA in warfarin-treated patients in clinical practice.

OBJECTIVES
To determine the risk of symptomatic intracranial hemorrhage (sICH) among patients with ischemic stroke treated with intravenous tPA who were receiving warfarin vs those who were not and to determine this risk as a function of INR.

DESIGN, SETTING, AND PATIENTS
Observational study, using data from the American Heart Association Get With The Guidelines-Stroke Registry, of 23,437 patients with ischemic stroke and with INR of 1.7 or lower, treated with intravenous tPA in 1203 registry hospitals from April 2009 through June 2011.

MAIN OUTCOME MEASURE
Symptomatic intracranial hemorrhage. Secondary end points include life-threatening/serious systemic hemorrhage, any tPA complications, and in-hospital mortality.

RESULTS
Overall, 1802 (7.7%) patients with stroke treated with tPA were receiving warfarin (median INR, 1.20; interquartile range [IQR], 1.07-1.40). Warfarin-treated patients were older, had more comorbid conditions, and had more severe strokes. The unadjusted sICH rate in warfarin-treated patients was higher than in non-warfarin-treated patients (5.7% vs 4.6%, P < .001), but these differences were not significantly different after adjustment for baseline clinical factors (adjusted odds ratio [OR], 1.01 [95% CI, 0.82-1.25]). Similarly, there were no significant differences between warfarin-treated and non-warfarin-treated patients for serious systemic hemorrhage (0.9% vs 0.9%; adjusted OR, 0.78 [95% CI, 0.49-1.24]), any tPA complications (10.6% vs 8.4%; adjusted OR, 1.09 [95% CI, 0.93-1.29]), or in-hospital mortality (11.4% vs 7.9%; adjusted OR, 0.94 [95% CI, 0.79-1.13]). Among warfarin-treated patients with INRs of 1.7 or lower, the degree of anticoagulation was not statistically significantly associated with sICH risk (adjusted OR, 1.10 per 0.1-unit increase in INR [95% CI, 1.00-1.20]; P = .06).

CONCLUSION
Among patients with ischemic stroke, the use of intravenous tPA among warfarin-treated patients (INR ≤1.7) was not associated with increased sICH risk compared with non-warfarin-treated patients.


type="main" xml:id="ecin12178-abs-0001"> We analyze whether consumers' quality perception and/or producer investment of New York City restaurants, measured by Zagat scores, responds to newly appearing expert opinion, measured by Michelin scores. Answering this question is of general economic interest as it applies to all markets with information asymmetries. Employing a difference-in-differences approach as well as a propensity score matching approach we find significant Michelin treatment effects on food and decor quality. Based on these changes, we find a Michelin-induced price increase of approximately 30% per Michelin star. To examine whether the improved food and nonfood quality is based on restaurant investments or is merely imagined, we analyze nonfood investments by referring to Wine Spectator wine list awards. Our analysis suggests that Michelin-reviewed restaurants are significantly more likely to invest in their wine list than others. As a result, Michelin reviewed restaurants are more likely to improve food and nonfood (esp. decor) quality leading to significant price increases. However, while restaurants that increase prices only due to decor and service improvements are more likely to go out of business, food improvements appear to secure a restaurant's survival . ( JEL D11, L15, L66)


Ensuring the accuracy and consistency of highly decentralized and discretionary decision making is a core challenge for the administrative state. The widely influential school of "democratic experimentalism" posits that peer review provides a way forward, but systematic evidence remains limited. This Article provides the first empirical study of the feasibility and effects of peer review as a governance mechanism, based on a unique randomized controlled trial conducted with the largest health department in Washington State (Public Health-Seattle and King County). We randomly assigned half of the food safety inspection staff to engage in an intensive peer review process for a 4-month period. Pairs of inspectors jointly visited establishments, separately assessed health code violations, and deliberated about divergences on health code implementation. Our findings are threefold. First, observing identical conditions, inspectors disagreed 60% of the time. These joint inspection results in turn helped to pinpoint challenging code items and to efficiently develop training and guidance documents during weekly sessions. Second, analyzing over 28,000 independently conducted inspections across the peer review and control groups, we find that the intervention caused an increase in violations detected and scored by 17-19%. Third, peer review appeared to decrease variability across inspectors, thereby improving the consistency of inspections. As a result of this trial, King County has now instituted peer review as a standard practice. Our study has rich implications for the feasibility, promise, practice, and pitfalls of peer review, democratic experimentalism, and the administrative state.


We have established and partially characterized a panel of monoclonal antibodies against alpha-DNA polymerase. One of the hybridomas, clone 5F, has been exploited for cell kinetic studies on three colon cancer cell lines, LOVO, SW 620, and SW 403, which are endowed with different growth patterns and differentiation status. By an immunoperoxidase method, we could demonstrate the specific intranuclear localization of alpha-DNA polymerase during the exponential phase of in vitro growth and contrast it with the diffuse distribution of the enzyme throughout the cytoplasm during the resting state. The percentage of intranuclear staining positive cells, evaluated at successive time points of in vitro growth, changed from 75 to 95% (assayed on Days 3 and 7) to 15 to 25% in confluent and resting populations assayed on Days 12 to 14. In agreement with the assumption that the enzyme moves from nucleus to cytoplasm after entering quiescence, alpha-DNA polymerase was still present in the cytoplasm or in the cytoplasmic perinuclear area of cells in resting phase cultures. Comparisons between traditional kinetic parameters (thymidine labeling index and primer-dependent alpha-DNA polymerase) and proliferative state determined by the monoclonal antibody supported the feasibility of this approach to define the proportion of actively proliferating elements in a tumor cell population. Moreover, parallel flow cytometric analysis performed on Days 5 and 14 of continuous culture showed fluctuations of alpha-DNA polymerase content in relation to exponential and steady-state phases, with a significant increase in the amount of alpha-DNA polymerase in actively proliferating populations and a progressive reduction of the enzyme as the cultures entered the resting stage.


The book is a considerably extended and fully revamped edition of the highly successful and frequently cited Foundations of Post-Keynesian Economic Analysis, published in 1992. It provides an exhaustive account of post-Keynesian economics and of the developments that have occurred in post-Keynesian theory and in the world economy over the last twenty years. Topics covered include open-economy issues, the methodological foundations of heterodox economics, consumer theory, firms and pricing, money and credit, effective demand and employment, inflation theory, and growth theories.


City is the manifestation of human culture and civilization. Urban neighborhoods as social spaces play an important role in the lives of citizens. Texture density in neighborhoods, concentration of complex land uses and their proximity to each other are closely associated with sustainable urban forms. Today, with the increase of urban population, we are observing transformation and destruction of urban neighborhoods and a lot of old neighborhoods are being destroyed under the pretext of having timeworn texture and lack of accountability to our urban population. Tehran metropolis is no exception to this. Here we encounter two urban problems: First, uncontrolled urban dispersion and second, a huge amount of buildings which haven't any identification and have formed regardless of their field bed. Compact city is a model of sustainable cities and this is an efficient model to address the phenomenon of urban dispersion. In addition, the model emphasizes the focus on the neighborhood. Nazi Abad neighborhood in Tehran, one of the old quarters of the city that has a compact and outdated texture. In recent years, new buildings are being built in the neighborhood, which were formed regardless of the identity and the dominant pattern in this neighborhood. This had a negative impact on the neighborhood and has tarnished its image. By using descriptive-analytic study as well as field studies on Nazi Abad neighborhood, this paper considers this neighborhood as part of the skeleton of Tehran and aims to solve these urban problems by providing some solutions and identify the patterns in Nazi Abad neighborhood. The contents listed in this article aims to provide key tools for urban planning, urban identity and locations for future designs.


This research is concerned with the question of embodiment and body representation in plays written by African American women playwrights during the twentieth century. It starts with the early 1920s and ends around the turn of the twentyfirst century. This project negotiates issues of bodily manifestations and the evolvement of this manifestation from one decade to the next. My research is divided into an introduction, six chapters, and a conclusion; each chapter is concerned with examining bodily representation in a certain era. Chronologically presented, the chapters attempt to answer how embodiment at the beginning and at the close of the twentieth century differs. Although the better-known playwrights Susan-Lori Parks, Adrienne Kennedy and Ntozake Shange and the lesser-known playwrights Alice Childress, Sonia Sanchez (better known as a poet), and Marita Bonner share a concern with what might be called the "raced body," they also seem to share a certain type of maternal heritage passed from one playwright to another. Therefore, this research contributes to the existing scholarship by, firstly, establishing a literary genealogy between African American women playwrights through their shared interest in the utilisation of the body-in-the-world as a form of resistance. Secondly, I present these playwrights as phenomenologists; through using this political body as a way of experiencing the world and experimenting with it, as a way of being in the world, those playwrights –in both modern and postmodern eras—become interpreters of and experimenters with meaning. Their perpetual commitment to defining the position of African American subject, especially that of African American woman, is entwined with an experimental approach of a black body that lives, registers, interprets, and attempts to re-write the hyphenated body (body-in-the-world).


A report of mammary development in 6-month-old ewe lambs grazing lucerne on a commercial farm in North Otago provided an opportunity to investigate the possibility to use this as a tool to detect oestrogenic lucerne pastures. Of the 36 ewe lambs grazing lucerne at this farm, protruding mammary glands were visible in 19. In contrast, none of the 22 ewe lambs grazing grass had protruding mammary glands. The lucerne-fed ewe lambs also had larger mean teat width than the grassfed ewe lambs (17.9 ± 0.53 mm versus 13.4 ± 0.78 mm respectively. The lucerne-fed animals were returned to grass pasture 4 weeks before the introduction of rams. There was no effect of the earlier 16 weeks of lucerne grazing on the number of fetuses present in ewes near mid-gestation compared with ewes on grass throughout this period. These findings from a commercial farm suggest that oestrogenic lucerne may be detected by monitoring ewe lambs for mammary development. This would enable farmers to manage pre-mating grazing of ewes with minimal risk of lowered ovulation rates.


In this paper, a new formulation model for cellular manufacturing system (CMS) design problem is proposed. The proposed model of this paper considers assembly operations and product structure so that it includes the scheduling problem with the formation of manufacturing cells, simultaneously. Since the proposed model is nonlinear, a linearization method is applied to gain optimal solution when the model is solved using direct implementation of mixed integer programming. A new genetic algorithm (GA) is also proposed to solve the resulted model for large-scale problems. We examine the performance of the proposed method using the direct implementation and the proposed GA method. The results indicate that the proposed GA approach could provide efficient assembly and product structure for real-world size problems.


Introduction:
Cancer chemopreventive agents from natural sources have been actively investigated over the years to seek prevention against cancer. In this study, cocoa polyphenols extract (CPE) was examined to explore its antioxidant and cytotoxicity activities.

Methods:
CPE was analysed for total phenolic content (TPC) and antioxidant activity (DPPH radical scavenging activity and FRAP ferric-reducing antioxidant power assays). In vitro cytotoxicity effect of CPE against HepG2, HT-29, HeLa, MCF-7, MDA-MB-231 and WRL-68 cell lines after 48 h exposure was measured by MTT assay.

Results:
The study showed that CPE had higher total phenolic content (13560.0±420.1 mg GAE/100g dry weight of sample) than vitamin E (p<0.05). CPE exhibited strong antioxidant activity comparable with ascorbic acid in both DPPH (IC50 = 14.73±1.47 μg/ml) and FRAP (2130.33±2.33 μM of FE/1 mg of dry weight of sample). The cytotoxicity study showed that CPE exhibited the highest cytotoxicity effect against MCF-7 with lowest IC50 value (3.00±0.29 mg/ml) compared to other cancer cell lines after 48 h treatment (p<0.05).

Conclusion:
Our results indicate that CPE demonstrated high total phenolic content, free radical scavenging activity, ferric reducing ability and cytotoxicity activity towards HepG2, HT-29, HeLa, A549, MDA-MB- 231 and MCF-7 cancer cell lines. Further isolation of bioactive constituents from CPE should be done to characterise its potential chemopreventive activity as well as to elucidate the mechanism of cancer cell death induced by CPE.


An experimental setup for tomographic inspection of phase objects is presented. The system uses a common-path interferometer consisting of two windows in the input plane and a translating grating as its pupil. In the output, interference of the fields associated with replicated windows is achieved by a proper choice of the windows' spacing with respect to the grating period. With a rotating object in one window and a plane wave in the second one, the phase distribution of each projection is encoded as a corresponding digital image row, which, in turn, constructs a composite interferogram over the plane of a traditional sinogram. Phase stepping of composite interferograms can be achieved by a proper translation of the grating in order to obtain the unwrapped phase distribution as the corresponding sinogram. This sinogram allows tomographic reconstruction of phase slices by standard procedures. Composite interferograms and reconstructions for some transparent samples are shown.


A rapid increase in the RNA levels of the proto-oncogenes c-fos, c-jun, and c-myc was detected after human cytomegalovirus infection. Neither inactivation of viral infectivity with ultraviolet irradiation (with or without psoralen), nor inhibition of translation with cycloheximide or anisomycin adversely affected the enhanced expression of proto-oncogenes, even though these treatments substantially reduced or eliminated the detection of immediate early viral antigens. The increase in the RNA levels of the proto-oncogenes was prevented in the presence of alpha-amanitin or actinomycin D. Thus, expression of these oncogenes appears to be induced by events occurring before the onset of viral protein synthesis, perhaps by the interaction of viral particles with the cell surface.


"A great resource for beginning ethics courses. The book is short and yet it richly embodies the methods of ethical thinking about practical moral problems that are hard for students to learn unless they see them in action. McGinn perspicuously sets out a small set of basic principles and then attacks the problems of our treatment of animals, abortion, sex, censorship, and so on, with a masterful blend of attention to real-life cases and imaginary thought experiments. McGinn hardly claims to have the last word on the complex issues he discusses, and students will find many exciting problems and points to take up." -- Owen Flanagan, Duke University


The abiotic and biotic gradients on mountains have enormous potential to improve our understanding of species distributions, species richness patterns and conservation. Here we describe how abiotic factors change with elevation, how flora and fauna respond to these changes and how elevational species richness patterns have been studied to uncover drivers of biodiversity. There are four main trends in elevational species richness: decreasing richness with increasing elevation, plateaus in richness across low elevations then decreasing with or without a mid-elevation peak and a unimodal pattern with a mid-elevational peak. We discuss the history of elevational richness studies and overview the various hypotheses thought to be important in richness trends, including climatic, spatial, biotic and evolutionary factors.

Key Concepts:

Elevational gradients exhibit complex variation in abiotic conditions over short distances.

Patterns of elevational species richness follow four common patterns: mid-elevation peaks, decreasing, low-elevation plateaus and low plateaus with mid-elevation peaks.

Patterns of elevational species richness vary between taxonomic groups.

A combination of water availability and temperature is often found to be related to elevational species richness patterns.

No consistent support is found for the importance of area or mid-domain effects for elevational species richness patterns.

Support for the various mechanisms underlying elevational richness patterns tends to be related to the ecology and evolutionary history of the taxonomic group of interest.

Elevational gradients are valuable in our task to disentangle the causes behind broad-scale patterns in biodiversity, and in our quest to understand threats to biodiversity with climatic change.

Keywords:

climate;
biotic interactions;
diversity;
elevation;
environmental gradient;
mountains;
precipitation;
productivity;
species–area relationship;
temperature


Introduction: Gingivitis is a relatively innocuous and reversible inflammation of gingiva. If left untreated, it might progress involving the deeper supporting periodontal tissues of the tooth with consequent mobility and tooth loss. Compelling literature has suggested the role of local antibacterial and anti-inflammatory agents as an adjunct to scaling and root planing (gold standard) for treating periodontal diseases. Various herbs such as Nimba (Azadirachta indica A. Juss), Babbula (Vachellia nilotica (L.) P.J.H. Hurter & Mabb.) and turmeric (Curcuma long a L.) have been used for gingivitis since ancient times. Nigella sativa L. (Kalonji) is one such herb known for its remarkable anti-inflammatory, antioxidant and antimicrobial properties and thus has been utilized in the present study. Aim: The aim of the study was to explore the clinical efficacy of different ethanolic solutions of N. sativa in moderate-to-severe gingivitis patients. Materials and Methods: It is a split-mouth clinical study with 24 patients of moderate-to-severe gingivitis from the age group of 25–45 years. Recruited individuals were divided in to group I1, group II1and group III1 (scaling and root planning i.e., control) and group I2, group II2and group III2 (experimental). Three doses of solution 1 (1:3), solution 2 (1:1) and solution 3 (3:1) were administered to the experimental groups for 3 consecutive days. The clinical parameters, i.e., gingival index (GI) and plaque index (PI) were recorded at baseline, 14 days and 28 days in all the individuals. ANOVA test was used in the study for statistical analysis. Results: Intergroup comparison in terms of GI showed statistically significant difference at 14th and 28th day from baseline between I1 &I2,at only 28th day between II1 & II2and insignificant difference between III1 & III2 at all time intervals from baseline. On intragroup comparison, statistically significant reduction in GI in all groups from baseline till 28 days was found, but among experimental groups best result was seen in group III2(P < 0.001; F value 153.75). As far as PI is concerned, intergroup comparison between different groups displayed statistically significant difference from baseline to 14th and 28th day between all groups i.e I1& I2, II1& II2and III1& III2. On intragroup comparison, statistically significant reduction in PI in all control groups i.e I1, II1 & III1was found, but among experimental groups only group III2 provided statistically significant reduction (P < 0.001, F value 30.40). Conclusion: The results of this study indicate that, the ethanolic extract of N. sativa is effective in the treatment of moderate to severe gingivitis.


In Mexico, the service sector has become increasingly important both for gross national product and exports, and the film industry seems to be a relevant sector to explore in the effort to diversify export niches. This sector has a long and varied history, having become very prominent during certain periods (the Golden Age of the 1940s and 1950s) and less so in others, because of the various problems faced (for example between 1995 and 2005). The strengths and weaknesses experienced by the film industry throughout its existence can serve to orient future public policies. Mexico has important productive and creative capacities in the film industry that permit it to produce completely domestic films (domestic preproduction, production and post-production). Its proximity to the United States, the varied national scenery, and the skills of producers, directors, artists, and technicians with years of experience favor Mexico's insertion into certain niches of the international film production chain. Furthermore, Mexico is one of the largest markets in the world for film exhibition, although the Mexican film industry rarely takes advantage of this. Industry production is limited, however, by scant financing, major competition from Hollywood productions, the lack of joint initiatives and partnerships among members of the Mexican industry, weak legal regulation in the industry, the absence of integrated public policies to promote film production, and restrictions on distribution and internationalization. National infrastructure and technology capabilities, as well as training of personnel in new digital technologies, must be strengthened to achieve better results in the film industry. Other countries' experiences have shown that the Mexican film industry could have much greater potential. The dynamism of this sector on a global level, the potential for the creation of a large number of high-quality jobs, and the possibility of Mexico's integration into the global production chain with greater added value, should be strong incentives for solutions to be found to the problems that this industry is facing.


State capture and corruption are widespread phenomena across the globe, but their empirical study is still highly challenging. This paper develops a new conceptual and analytical framework for gauging state capture based on micro-level contractual networks in public procurement. To this end, it first establishes a robust measure of corruption risks in public procurement transactions focusing on relationships between pairs of issuers and suppliers. Second, it searches for clusters of high corruption risk organisations in the full contractual network of issuers and suppliers. These clusters and the density of corrupt links in them suggest state capture. Third, it employs this analytical framework to systematically explore how the radical change in governing elite composition in Hungary in 2009-2012 impacted on patterns of state capture. Findings indicate the feasibility and usefulness of such micro-level approach to corruption and state capture. Better understanding the network structure of corruption and state capture opens new avenues of research and policy advice on anti-corruption efforts, budget deficit, market competition, and democratic contestation.


Database applications have become a core component in control systems and their associated record keeping utilities. Traditional security models attempt to secure systems by isolating core software components and concentrating security efforts against threats specific to those computers or software components. Database security within control systems follows these models by using generally independent systems that rely on one another for proper functionality. The high level of reliance between the two systems creates an expanded threat surface. To understand the scope of a threat surface, all segments of the control system, with an emphasis on entry points, must be examined. The communication link between data and decision layers is the primary attack surface for SQL injection. This paper facilitates understanding what SQL injection is and why it is a significant threat to control system environments.


OBJECT
In previous studies at their laboratory the authors showed that cytidinediphosphocholine (CDP-choline), an intermediate of phosphatidylcholine synthesis, decreases edema formation and blood-brain barrier disruption following traumatic brain injury (TBI). In the present study the authors investigate whether CDP-choline protects hippocampal neurons after controlled cortical impact (CCI)-induced TBI in adult rats.

METHODS
After adult male Sprague-Dawley rats had been anesthetized with halothane, a moderate-grade TBI was induced with the aid of a CCI device set at a velocity of 3 m/second, creating a 2-mm deformation. Sham-operated rats, which underwent craniectomy without impact served as controls. The CDP-choline (100, 200, and 400 mg/kg body weight) or saline was injected into the animals twice (once immediately postinjury and once 6 hours postinjury). Seven days after the injury, the rats were neurologically evaluated and killed, and the number of hippocampal neurons was estimated by examining thionine-stained brain sections. By 7 days postinjury, there was a significant amount of neuronal death in the ipsilateral hippocampus in the CA2 (by 53 +/- 7%, p < 0.05) and CA3 (by 59 +/- 9%, p < 0.05) regions and a contusion (volume 34 +/- 8 mm3) in the ipsilateral cortex compared with sham-operated control animals. Rats subjected to TBI also displayed severe neurological deficit at 7 days postinjury. Treating rats with CDP-choline (200 and 400 mg/kg, intraperitoneally) significantly prevented TBI-induced neuronal loss in the hippocampus, decreased cortical contusion volume, and improved neurological recovery.

CONCLUSIONS
Treatment with CDP-choline decreased brain damage following TBI.


On the 17th August 1998 a severe rainfall event occurred over a widespread area of the City of Wollongong. During this storm, 1 person drowned and an estimated $50 to $100 million damage was caused to the City of Wollongong. Road access to the City was cut by raised water levels and debris flows covering and or scouring road and rail routes for up to 36 hours following this event. A geotechnical team of 3, including the first author, was organised at very short notice during the response phase of the emergency operations on the early morning of the 20th August by the Local Emergency Management Officer of the Wollongong City Council. This team was organised with a Commonwealth Bureau of Meteorology weather forecast in hand of a further deterioration of the weather conditions expected during the next few days. In the weeks after the storm event the team inspected 191 geotechnical problem sites. The team assisted the emergency services by visually inspecting reported cases of slope instability, whilst a separate team looked at flooding and hydrological problems. The geotechnical team also determined action plans for hazard and risk assessment that included referral of sites to relevant authorities, as appropriate. A Hazard Consequence Matrix based Risk Assessment approach, in accordance with the AS/NZS 4360:1995 Risk Management Standard was adopted for the qualitative risk assessment work. A comprehensive database of site, visit, photograph and map information was collated for documentation and future reference.


Background and objectives Patients with liver cirrhosis are more prone to develop reduced bone mineral density (BMD), i.e. hepatic osteodystrophy (HOD). There are few data on the prevalence of HOD in the Indian population and its treatment. We aimed to determine the prevalence of HOD, factors associated with it and the impact of bisphosphonates on BMD in patients with liver cirrhosis. Patients and methods Consecutive patients with liver cirrhosis admitted at Sir Ganga Ram Hospital, New Delhi, between August 2012 and July 2013 were enrolled. Patients with chronic kidney disease, hyperparathyroidism and those on steroids were excluded. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femoral neck. Osteopenia and osteoporosis were defined according to WHO criteria. Ibandronic acid 150 mg per day orally for six months was given to patients with osteoporosis and DEXA scan repeated. Results A total of 215 patients (males 179, 83%) with a mean age of 50.9 ± 11 years were enrolled in this study. Prevalence of HOD was found to be 66% (142/215). On multivariate analysis BMI, TLC, total serum bilirubin and transient elastography values were found to be independently associated with HOD. All the patients with osteoporosis (n = 47) were treated with ibandronic acid as per protocol. Treated patients had significant improvement in DEXA scans after six months as compared to baseline. Conclusions HOD was seen in two-thirds of patients with liver cirrhosis. Higher liver stiffness as determined by transient elastography is significantly associated with HOD. Severity scores of liver disease (CTP and MELD) and etiology of liver cirrhosis did not determine HOD. Ibandronic acid is a safe drug that showed significant improvement in BMD in patients with liver disease along with osteoporosis.