Competition in the business world effects the use of information technology. To achieve competitive advantage in the global competition, PT Pan Brothers, Tbk. should establish an integrated information system based on ERP (Enterprise Resource Planning). With the ERP system, information will be accurate and up-todate to support strategic decision making. It takes conscientious planning in building the ERP system. Management information systems development projects have a very important role. One determining component is how to choose and use appropriate information systems development method. SDLC (system development life cycle) is growing very rapidly along with the development of information technology. It is necessary to choose the right SDLC in building an integrated system based on ERP. Each SDLC models has advantages and disadvantages. SDLC models will only be optimal if used according to the situation and conditions. Waterfall model provides clear deliverables and milestones, good documentation, easy to understand, easy to implement, emphasizes on good procedural workmanship (precoding design). Some of its weaknesses are difficult to integrate risk management, high cost change documents, high administrative costs, often late completion thus. To avoid them, there should be a well-planned project management and steps properly so it can be on time and will not exceed budget.


We propose several efficient preprocessing techniques for Unconstrained Quadratic Binary Optimization (QUBO), including the direct use of enhanced versions of known basic techniques (e.g., implications derived from first and second order derivatives and from roof–duality), and the integrated use (e.g., by probing and by consensus) of the basic techniques. The application of these techniques is implemented using a natural network flow model of QUBO. The use of the proposed preprocessing techniques provides: (i) a lower bound of the minimum of the objective function, (ii) the values of some of the variables in some or every optimum, (iii) binary relations (equations, inequalities, or non-equalities) between the values of certain pairs of variables in some or every optimum, and (iv) the decomposition (if possible) of the original problem into several smaller pairwise independent QUBO problems. Extensive computational experience showing the efficiency of the proposed techniques is presented. Substantial problem simplifications, improving considerably the existing techniques, are demonstrated on benchmark problems as well as on randomly generated ones. In particular, it is shown that 100% data reduction is achieved using the proposed preprocessing techniques for MAX-CUT graphs derived from VLSI design, MAX-Clique in c-fat graphs derived from fault diagnosis, and minimum vertex cover problems in random planar graphs of up to 500 000 vertices. Acknowledgements: The third author was partially financially supported by the Portuguese FCT and by the FSE in the context of the III Quadro Comunitário de Apoio.


AIMS
We sought to investigate the effect of adenosine pretreatment on the incidence of myonecrosis after non-urgent percutaneous coronary intervention (PCI).

METHODS AND RESULTS
This was a prospective, randomized, open-label study. Patients who were scheduled for non-urgent PCI in de novo native coronary arteries were eligible. All patients were pretreated with aspirin and clopidogrel. Myonecrosis was measured by creatine kinase-myocardial band (CK-MB) elevation after PCI. A total of 62 patients were randomized into the adenosine (n = 31) or standard (n = 31) group. The adenosine group received 50 microg adenosine bolus before wiring of each lesion, whereas the standard group did not. Post-PCI myonecrosis occurred more frequently in the standard group (39 vs. 13%, OR 0.23, 95% CI 0.05-0.95, P = 0.020). After adjustment for drug-eluting stent implantation, multi-vessel stenting, and elevated baseline troponin, the OR was 0.19 (95% CI 0.05-0.72, P = 0.017). The median peak values of CK-MB in the adenosine and standard groups were 2 and 4 microg/L, respectively (P = 0.033). The adjusted difference was 1.95 microg/L (95% CI 0.13-3.77, P = 0.037). The incidences of myocardial infarction (>3 x CK-MB) were 6 and 16% in the adenosine and standard groups, respectively (OR 0.36; 95% CI 0.03-2.46, P = 0.229).

CONCLUSION
Pretreatment with 50 microg of adenosine decreases the incidence of myonecrosis after non-urgent PCI compared with that without pretreatment.


There are potentially seven hepatitis viruses in existence. Because hepatitis C and G do not fully explain the previous syndrome of non-A, non-B hepatitis, it is likely that at least one additional blood-borne hepatitis virus has yet to be identified. The consequences of the chronic hepatitis syndrome in the United States and around the world will be significant in coming decades. More patients with end-stage liver disease, portal hypertension, and hepatocellular carcinoma may be expected. The implication for surgeons is that there will be more patients with hepatitis. More importantly, the risk of hepatitis as an occupational infection will be with the current generation of surgeons for the rest of their careers. Effective hepatitis B vaccination and application of uniform practices for avoiding blood exposure and percutaneous injury become the hallmark in preventing the occupational transmission of these viruses.


The first well-defined lutetacyclopentadienes are synthesised from pentamethylcyclopentadienyl lithium (Cp*Li), 1,4-dilithio-1,3-butadienes, and LuCl3. The lutetacyclopentadiene shows excellent reactivity towards some small molecules, such as pivalaldehyde, Se, carbon dioxide, and isonitrile to efficiently construct 3-, 5-, 7-, 8-, and 9-membered rare-earth metallacycles. Both monoinsertion and double-insertion of two Lu-Csp2 bonds are observed. Specially, the reaction between lutetacyclopentadiene and isonitrile afforded [3,5,5]-fused metallacycles. The distinguished reactivity can be attributed to the highly ionic character and the cooperative reactivity of two Lu-Csp2 bonds.


In the digital era, the use of the internet is a necessity. The role of social media should be utilized as well as a means of cheap promotion for hospitals. This quantitative study aims to examine the effect of internal marketing on social media, the effect of internal marketing on the interest of patient visits, and the effect of social media on the interest of patient visit Kambang Hospital in Jambi. The respondents involved in this study were all employees in Kambang Hospital, totaling 251 people. Moreover, the questionnaire was distributed by utilizing the google doc application so that the data was immediately tabulated. Additionally, the results of the study were tested using the Smart PLS 2.0 application. As 181 (72%) respondents responded the questionnaires on 13 indicators of internal marketing (IM) variable, 4 indicators of social media (SM) variable and 4 indicators of patient visit interest (PTI) variable. In brief, the results of the study proved that; 1) there was the significant effect of IM on the Constitutional Court, 2) there was the significant effect of IM on SM, 3) there was the significant effect of SM on the Constitutional Court, and 4) there was indirect effect of IM on PTI through SM by using significant Sobel test calculations. This indicated that internal marketing can affect the interest of patient visits through the use of social media.


Abstract:The first women religious came to this country almost three centuries ago beginning what would become a journey of epic transformations, creating a powerful narrative of adaptation and survival, crossing a myriad of boundaries and barriers both physical and cultural. In some ways it is multiple narratives—reflecting and re-visioning changes across time and culture in the United States. In the long nineteenth century (through 1920), the sisters' story is one of growth, risk taking, entrepreneurship, travel and adventure as well as one of poverty, suffering, bigotry, exploitation, and compromise. In the post-1920s era, their story became one of standardization, rigidity, massive institution-building, and diminishment as well as one of educational achievement, professionalism, social justice, modernization, gender awareness, and global outreach. Subsequently, by the early decades of the twenty-first century, sisters continue to adapt to the changing times, expanding their influence and presence within the larger national context and in the global milieu with fewer sisters, but a burgeoning global network. This analysis is not meant to be comprehensive in scope—it is impossible to discuss almost three centuries in one essay. However, I hope to discuss important milestones and themes that are embedded in the history and activities of American Catholic sisters in this expansive timeframe. My intent is to create, discuss, and analyze the larger context that defined and shaped the experience of Catholic sisters in the United States for almost three centuries. And, to provide nuance and analysis about their work, influence, and impact from their early institution-building in the nineteenth and early twentieth century to—most notably in the twentieth century—their focus and influence on social justice and transnationalism.


This study aimed to investigate the relationships between the different levels and degrees of incomplete spinal cord injury (iSCI) evaluated with magnetic resonance imaging (MRI) and the results of non-invasive electromyography (mcsEMG), motor-evoked potentials (MEP), and electroneurography (ENG). With a focus on patients with injuries at four different levels, C3–C5, C6–Th1, Th3–Th6, and Th7–L1, this research delved into the intricate interplay of spinal circuits and functional recovery. The study uses MEP, EMG, and ENG assessments to unveil the correlations between the MEP amplitudes and the MRI injury scores. We analysed data from 85 iSCI patients (American Spinal Injury Association—ASIA scale; ASIA C = 24, and D = 61). We compared the MRI and diagnostic neurophysiological test results performed within 1–2 months after the injury. A control group of 80 healthy volunteers was examined to establish reference values for the clinical and neurophysiological recordings. To assess the structural integrity of spinal white and grey matter on the transverse plane reconstructed from the sagittal readings, a scoring system ranging from 0 to 4 was established. The spinal cord was divided into two halves (left and right) according to the midline, and each half was further divided into two quadrants. Each quadrant was assessed separately. MEP and EMG were used to assess conduction in the corticospinal tract and the contraction properties of motor units in key muscles: abductor pollicis brevis (APB), rectus abdominis (RA), rectus femoris (RF), and extensor digitorum brevis muscles (EXT). We also used electroneurography (ENG) to assess peripheral nerve conduction and to find out whether the changes in this system significantly affect patients' scores and their neurophysiological status. The study revealed consistent positive correlations in iSCI patients between the bilateral decrease of the spinal half injury MRI scores and a decrease of the transcranially-evoked MEP amplitudes, highlighting the complex relationship between neural pathways and functional outcomes. Positive correlations are notably pronounced in the C3–C5, C6–Th1, and Th3–Th6 subgroups (mostly rs 0.5 and above with p < 0.05), while Th7–L1 presents distinct patterns (rs less than 0.5 and p being statistically insignificant) potentially influenced by unique structural compensation mechanisms. We also revealed statistically significant relationships between the decrease of the cumulative mcsEMG and MEP amplitudes and the cumulative ENG scores. These insights shed light on the multifaceted interactions between spinal cord injury levels, structural damage, neurophysiological measures, and motor function outcomes. Further research is warranted to unravel the intricate mechanisms driving these correlations and their implications for enhancing functional recovery and the rehabilitation algorithms in patients with iSCI.


Aims of research. A surface of revolution is generated by rotation of a plane curve z = f(x) about an axis Oz called the axis of rotation. This paper provides information on hyperboloids of revolution surfaces and their classification. Their geometric modeling, linear and materially nonlinear analysis are worked out. Methods. Hyperboloids of revolution middle surface is plotted using the software MathCAD. The linear and materially nonlinear numerical analyses of thin shells of the shape of an hyperboloid of revolution surfaces on stress-strain state is given in this paper, using the finite elements method in a computer software R-FEM, the material which we use in our model is concrete with isotopic nonlinear 2D/3D stress-strain curve for materially nonlinear analysis and linear stress-strain curve for linear analyses. Comparison is done with the result of the finite elements linear analysis of their strain-stress results. Results. That displacements in the investigated shells subject to self-weight, wind load with materially nonlinear analysis are bigger than which done by linear analysis, in the other side the displacements is similarity subjected to free vibration load case. Based on these results, conclusions are made for the whole paper.


This paper discusses design and implementation of a quaternion-based attitude control system for the short-duration mission of suborbital modules using cold-gas thrusters. The quaternion-based controller generates a command torque for each channel, and a pulse-width pulse-frequency (PWPF) modulator determines the required fire signals for the thrusters. The system performance is examined through both numerical and hardware-in-the-loop simulations.


Part 1: Theoretical Perspectives Section. New Directions in Loss Research, Miller and Omarzu. Blockades to Finding Meaning and Control, Thompson. Disillusionment and the Creation of Value, Janoff-Bulman and Berg. Exploring Loss through Autoethnographic Inquiry, Ellis. A Case for Hope in Pain, Loss, and Suffering, Snyder. Trauma and Grief, Stroebe, Schut, and Stroebe. Part 2: Close Relationship Losses Section. The Dissolution of Close Relationships, Sprecher and Fehr. Fatal Attractions, Felmlee. Loss in the Experience of Multiracial Couples, Rosenblatt and Tubbs. Curbing Loss in Illness and Disability, Lyons and Sullivan. Passion Lost and Found, Cunningham, Barbee and Druen. Part 3: Losses Faced by Survivors and Caretakers Section. Implications of Communal Relationships Theory for Understanding Loss among Family Caregivers, Williamson andShaffer. Brain Injury, Chwalisz, Loss Experienced in Chronic Pain and Illness, Kelley. Facilitating Recovery from Suicidal Bereavement, Range. Mental Health Professionals'Responses to Loss and Trauma, Solomon, Ram and Neria. Breaking the Cycle of Genocidal Violence, Staub. Part 4: Losses Related to Social Identity. The Experience of Loss in Sport, LLavallee, Grove, Gordon and Ford. What is Lost by Not Losing, Miller. Homelessness and Loss, Morse. Coping with Threat from Intimate Sources, Nuris and Gaylord. Loss of Collective Identity, Liiceanu. Job Loss, Price, Friedland and Vinokur. Part 5: Synthesizing Commentaries on Loss Theory and Research Section. Why There Must Be a Psychology of Loss, Harvey and Weber. Commentary, Neimeyer. Commentary, Weiss.


Abstract Background Depressive episodes experienced in unipolar (UD) and bipolar (BD) disorders are characterized by anhedonia and have been associated with abnormalities in reward processes related to reward valuation and error prediction. It remains however unclear whether these deficits are associated with familial vulnerability to mood disorders. Methods In a functional magnetic resonance imaging study, we evaluated differences in the expected value (EV) and reward prediction error (RPE) signals in ventral striatum (VS) and prefrontal cortex between three groups of monozygotic twins: affected twins in remission for either UD or BD (n = 53), their high-risk unaffected co-twins (n = 34), and low-risk twins with no family history of mood disorders (n = 25). Results Compared to low-risk twins, affected twins showed lower EV signal bilaterally in the frontal poles and lower RPE signal bilaterally in the VS, left frontal pole and superior frontal gyrus. The high-risk group did not show a significant change in the EV or RPE signals in frontostriatal regions, yet both reward signals were consistently lower compared with low-risk twins in all regions where the affected twins showed significant reductions. Conclusion Our findings strengthen the notion that reduced valuation of expected rewards and reduced error-dependent reward learning may underpin core symptom of depression such as loss of interest in rewarding activities. The trend reduction in reward-related signals in unaffected co-twins warrants further investigation of this effect in larger samples and prospective follow-up to confirm possible association with increased familial vulnerability to mood disorders.


This paper sets forth a model of knowledge-based regional development conceived as a set of multi-linear dynamics, based on alternative technological paradigms. Utilizing longitudinal data from a Swedish region, and international comparisons, four stages of development are identified: Inception, Implementation, Consolidation and Renewal. Innovation policy is created 'bottom-up' as an outcome of 'collective entrepreneurship' through collaboration among business, government and academic actors - the 'triple helix'. The key event is the creation of an entrepreneurial university, whether from an existing academic base or a new foundation, which takes initiatives together with government and industry to create a support structure for firm formation and regional growth. The result of these initiatives is a self-sustaining dynamic in which the role of academia and government appears to recede as industrial actors come to the fore and a lineage of firms is created. Nevertheless, as one technological paradigm is exhausted and another one is needed as the base for new economic activity, the role of academia and government comes to the fore again in creating the conditions for the next wave of innovation.


The Cache River basin located in southern Illinois has characteristics that are unique in the State of Illinois and the nation, with its diverse physical, chemical, and biological features that produced a great diversity of natural communities. Because of these unique characteristics, the Cache River basin contains some high quality bottomland hardwood forests and wetlands that have been recognized nationally and internationally. However, changes in land-use practices and hydraulic modifications during the last century have significantly threatened the ecological integrity of some of these valuable habitats and wetlands. To sustain their value and importance, these habitats need restoration and protection. One of the key goals of resource managers working in the area is to restore the Cache River's natural hydrology to a level that can sustain a viable ecology throughout the river corridor. To evaluate the results of different restoration measures, the Cache River Joint Venture Partnership needed reliable hydrologic and hydraulic models. The Illinois State Water Survey developed calibrated hydrologic and hydraulic models and evaluated the hydrology under current conditions and under various restoration scenarios. Results then were compared to the reference/base condition. The reference/base condition refers to the condition when the hydrology of the Lower Cache River was controlled on the east end by Karnak Levee with two 48-inch gated culverts that prevented flow from Post Creek Cutoff into the Lower Cache River and by in-channel weirs at Route 37 and "Diehl Dam" located west of Long Reach Road. The top elevation for "Diehl Dam" was set at 328.4 feet above mean sea level. After analyzing all the scenarios considered with different combinations of flooding conditions, structural changes, and boundary conditions, the study conclusions can be summarized as follows: 1) The current condition exposes the Lower Cache River corridor, especially the eastern portion, including the community of Karnak, to more flooding during major floods, such as 100-year or greater floods from the Upper Cache and Ohio Rivers. However, the current condition improves flood drainage for some parts of the area during more frequent 1-, 2-, and 5-year floods. iv 2) Installing the East Outlet Structure with stop logs and three or more 72-inch culverts will lower flood elevations from the reference/base condition for the portion of the river east of Karnak Road Bridge, including the community of Karnak, because of increased outlet capacity of the larger culverts. 3) Moving "Diehl Dam" 2,800 feet from its current location under current conditions will increase the area flooded by the 100-year flood by only 8 acres. The additional acres flooded are distributed in small increments throughout the Lower Cache River floodplain. Water levels in the stream channel between current and proposed locations will be higher than the current condition during lowand moderate-flow conditions. 4) Partially reconnecting the Lower Cache River with the Upper Cache River by diverting some flow from the Upper Cache to the Lower Cache River will not increase flood elevations from the reference/base condition during major floods such as a 100-year flood but will raise flood elevations during more frequent 1and 2-year floods. During lowand moderate-flow conditions, reconnection will create slow-moving westerly flow in the Lower Cache River and will not cause flooding.


IntroductionThis paper frames the contours of the recent and ongoing expansion in U.S.-India security ties. Then it briefly sketches the trajectory of the Naxalite insurgency through its first two phases and then focuses on the factors that made its third phase-from 2004 to the present-such a serious security challenge. The paper highlights the unique domestic factors that allowed the Naxalite rebellion's rise to the status of India's most significant internal security challenge from 2007 to 2010. It also identifies those domestic factors that enabled effective counterinsurgency actions beginning in 2011 and effective containment of the threat by 2014. After indicating the kinds of bilateral security assistance offered by the United States to India in recent years, the paper indicates the limited appeal of outside assistance to India in the domestic counterinsurgency arena and assesses why India's self-selected counterinsurgency partnership limitations remain firmly in place. It concludes with some lessons learned for U.S. policymakers in terms of the opportunities and limitations for working with India in matters of domestic insurgency, advising that these limitations make sense on many levels. It also asserts that India's limitations should be respected in Washington and Honolulu to avoid backlash from New Delhi. Any such backlash might threaten far more important U.S.-India bilateral interests in which shared maritime and other strategic interests seem to increasingly diverge with those of China and in areas of mutual benefit from global counterterrorism cooperation.The analysis in this paper is based on 3 years of author research into the unique features of the Naxalite insurgency in India. The research includes field interviews conducted on three visits to India during 2014 and 2015, one of which featured time in Kolkata and West Bengal.Expanding U.S.-India Security Framework, with LimitsGrowing for more than a decade, bilateral defense and security cooperation between the United States and India began accelerating quickly in 2014 and continued into 2016. Much of this acceleration, although not all of it, owed to the tone and tenor of the Indian government of Prime Minister Narendra Modi, elected and seated in 2014. Modi's government, which is Indian nationalist with a dynamic economic, diplomatic, and security agenda, followed a decade-long Indian National Congress (INC) government that had become sclerotic in its dealings with the United States and other global partners from 2009 to 2013. The INC government set the table for U.S.-India defense and security cooperation during the mid-2000s, demonstrating a broadbased Indian commitment to improved bilateral relations with the United States after decades of limited transactions. But the nationalist government of Prime Minister Modi has been driving it forward vigorously.The ongoing acceleration in broad Indo-American relations has taken many forms, including high diplomacy. Prime Minister Modi made visiting the United States a priority, traveling to America within 4 months of his May 2014 accession to the position of prime minister. Modi then made President Barack Obama the first ever U.S. President bestowed the high honor as chief guest at India's Republic Day Parade in January 2015. During this visit, Obama and Modi signed a historic Joint U.S.-India Strategic Vision for the Asia-Pacific and Indian Ocean Region.1 Modi made a third informal visit to the United States in September 2015, using this historically rapid return to enhance economic relations between the national private and public sectors.2 The United States has committed to a wide array of economic projects in India featuring public-private innovation, deeper financial cooperation and inclusive digital networks, "smart city" development in selected Indian cities, and support for increasing economic connectivity between India and the states of South and Southeast Asia.3The acceleration of broad bilateral ties has been showcased by the steady increase in defense and security cooperation between the two countries. …


Abstract The structure and impact of thermally induced secondary motions in stably stratified channel flows with two-dimensional surface temperature inhomogeneities is studied using direct numerical simulation (DNS). Starting from a configuration with only spanwise varying surface temperature, where the streamwise direction is homogeneous (Bon & Meyers, J. Fluid Mech., 2022, pp. 1–38), we study cases where the periodic temperature strip length $l_x/h$ (with $h$ the half-channel height) assumes finite values. The patch width ($l_y/h =\{{\rm \pi} /4, {\rm \pi}/8$}) and length are varied at fixed stability and two different Reynolds numbers. Results indicate that for the investigated patch widths, the streamwise development of the secondary flows depends on the patch aspect ratio ($a=l_x/l_y$), while they reach a fully developed state after approximately $25l_y$. The strength of the secondary motions, and their impact on momentum and heat transfer through the dispersive fluxes, is strongly reduced as the length of the temperature strips decreases, and becomes negligible when $a\lesssim 1$. We demonstrate that upward dispersive and turbulent heat transport in locally unstably stratified regions above the high-temperature patches lead to reduced overall downward heat transfer. Comparison to local Monin–Obukhov similarity theory (MOST) reveals that scaled velocity and temperature gradients in homogeneous stably stratified channel flow at $Re_\tau =550$ agree reasonably well with empirical correlations obtained from meteorological data. For thermally heterogeneous cases with strips of finite length, the similarity functions only collapse higher above the surface, where dispersive fluxes are negligible. Lastly, we show that mean profiles of all simulations collapse when using outer-layer scaling based on displacement thickness.


In the field of remote sensing, we often utilize oriented bounding boxes (OBB) to bound the objects. This approach significantly reduces the overlap among dense detection boxes and minimizes the inclusion of background content within the bounding boxes. To enhance the detection accuracy of oriented objects, we propose a unique loss function based on edge gradients, inspired by the similarity measurement function used in template matching task. During this process, we address the issues of non-differentiability of the function and the semantic alignment between gradient vectors in ground truth (GT) boxes and predicted boxes (PB). Experimental results show that our proposed loss function achieves $0.6\%$ mAP improvement compared to the commonly used Smooth L1 loss in the baseline algorithm. Additionally, we design an edge-based self-attention module to encourage the detection network to focus more on the object edges. Leveraging these two innovations, we achieve a mAP increase of 1.3% on the DOTA dataset.


Abstract The present study seeks to accomplish three goals: to shed light on the problem of reason in Husserl's co-inherited philosophical project, to elucidate his transcendental critique of reason, and to present Husserl's idea of reason in its distinctive features. A historical excursus first provides a frame to understand the necessity of a critique of reason, its proper subject-matter, and its function for the project of genuine philosophy. In particular, this historical reflection identifies the form that a critique must assume in order to fulfil its philosophical-scientific task. The focus is then directed at Husserl's methodological recalibration of the problem of reason. Husserl's 'prinzipielle Kritik' is elucidated in his transcendental reassessment of the headings 'reason' and 'unreason,' and is thought in connection to the concept of Selbstbesinnung. Lastly, Husserl's idea of reason is reconstructed in relation to, and in disambiguation from, the concepts of self-evidence, logos, synthesis, fulfilment, positing, etc. Reason, as teleological rule and structural form of transcendental subjectivity, is clarified in its dependence on, and irreducibility to, the problems of constitution and in light of the question of its objective/subjective character.


In this study, we quantify the value of physical showrooms to online competitors by investigating how the presence and absence of local showrooms impact customers' search and purchase behaviors with online competitors. By using an exogenous event of a large retailer's offline market exit and a unique dataset that captures customers' online browsing and purchasing activities before and after the event, we empirically examine the changes in online search and sales made by customers who lived within neighborhoods where local showrooms closed. We devise several search-oriented measures to complement the conventional sales-based measures in order to quantify the value of a showroom more completely. Using a difference-in-difference approach, we do not find a significant impact on online competitors' sales when a neighboring showroom closes. However, we observe a significant increase in customers' online search intensity as well as an increase of direct navigations to Amazon in the absence of local showrooms. We discuss a wide range of implications both for online and offline retailers based on our results.


An essential forensic capability is to infer the sequence of actions performed by a suspect in the commission of a crime. Unfortunately, for cyber investigations, user activity timeline reconstruction remains an open research challenge, currently requiring manual identification of datable artifacts/logs and heuristic-based temporal inference. In this paper, we propose a memory forensics capability to address this challenge. We present Timeliner, a forensics technique capable of automatically inferring the timeline of user actions on an Android device across all apps, from a single memory image acquired from the device. Timeliner is inspired by the observation that Android app Activity launches leave behind key self-identifying data structures. More importantly, this collection of data structures can be temporally ordered, owing to the predictable manner in which they were allocated and distributed in memory. Based on these observations, Timeliner is designed to (1) identify and recover these residual data structures, (2) infer the user-induced transitions between their corresponding Activities, and (3) reconstruct the devicewide, cross-app Activity timeline. Timeliner is designed to leverage the memory image of Android's centralized ActivityManager service. Hence, it is able to sequence Activity launches across all apps — even those which have terminated. Our evaluation shows that Timeliner can reveal substantial evidence (up to an hour) across a variety of apps on different Android platforms.


Good questions! While a liquid diet probably wouldn't affect the way your digestive system works, you would still need to ensure that you are receiving plenty of calories and nutrients. Discussing this issue with a health care provider, such as a gastroenterologist or nutritionist, may be good steps if a liquid diet is something you want or think you need to pursue. Also, Reader #1, check out the related Q&As for more information about food allergies.


With the increasing popularity of portable wireless computers, mechanisms to efficiently transmit information to such {\em clients}\, are of significant interest. The environment under consideration is {\em asymmetric}\, in that the information server has much more bandwidth available, as compared to the clients. In such environments, often it is not possible (or not desirable) for the clients to send explicit requests to the server. It has been proposed that in such systems the server should broadcast the data periodically. One challenge in implementing this solution is to determine the {\em schedule}\, for broadcasting the data, such that the wait encountered by the clients is minimized. A {\em broadcast schedule}\, determines what is broadcast by the server and when. In this report, we present three algorithms for determining broadcast schedules that minimize the wait time. Simulation results are presented to demonstrate that our algorithms perform well. Variations of our algorithms for environments subject to errors, and systems where different clients may listen to different number of broadcast channels are also considered.


A divergent, short, and novel total synthesis of 1,6,8a-tri-epi-castanospermine (7) and 1-deoxy-6,8a-di-epi-castanospermine (8) has been developed via a common precursor, 15, obtained from D-mannitol derived β-lactam. The key step involves a one pot cascade sequence of trimethyl sulfoxonium ylide based cyclization of epoxy sulfonamide 14via epoxide ring opening, one carbon homologation followed by intramolecular cyclization.


1) This study was conducted in order to examine whether abdominal draw-in maneuver (ADIM) with isometric shoulder flexion, extension, adduction, and abduction selectively contracted deep abdominal muscles. This study's subjects were 13 males 17 females. In order to evaluate the comparison of effects of ADIM and ADIM with isometric shoulder flexion, extension, adduction and abduction, measurements were made on transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) using a real-time ultrasonic diagnostic imaging system. Each position was repetitively measured three times with a real-time ultrasonic diagnostic imaging system and their mean values were used for analysis. The ADIM with isometric shoulder flexion, extension, adduction and abduction significantly increased the thickness of TrA relative to the ADIM only (p<.05). The ADIM with isometric shoulder abduction significantly increased the thickness of IO compared to the ADIM only (p<.05). The ADIM with isometric shoulder extension and abduction significantly decreased the thickness of EO compared to the ADIM only and the ADIM with isometric shoulder extension significantly decreased the thickness of EO relative to the ADIM with isometric shoulder adduction (p<.05). ADIM with isometric shoulder abduction is an effective method to selectively strengthen deep abdominal muscles and therefore may be employed as an intervention for trunk stabilization.


Biclustering refers to simultaneous clustering of objects and their features. Use of biclustering is gaining momentum in areas such as text mining, gene expression analysis and collaborative filtering. Due to requirements for high performance in large scale data processing applications such as Collaborative filtering in E-commerce systems and large scale genome-wide gene expression analysis in microarray experiments, a high performance prallel/distributed solution for biclustering problem is highly desirable. Recently, Ahmad et al [1] showed that Bipartite Spectral Partitioning, which is a popular technique for biclustering, can be reformulated as a graph drawing problem where objective is to minimize Hall's energy of the bipartite graph representation of the input data. They showed that optimal solution to this problem is achieved when nodes are placed at the barycenter of their neighbors. In this paper, we provide a parallel algorithm for biclustering based on this formulation. We show that parallel energy minimization using barycenter heuristic is embarrassingly parallel. The challenge is to design a bicluster identification algorithm which is scalable as well as accurate. We show that our parallel implementation is not just extremely scalable, it is comparable in accuracy as well with serial implementation. We have evaluated proposed parallel biclustering algorithm with large synthetic data sets on upto 256 processors. Experimental evaluation shows large superlinear speedups, scalability and high level of accuracy.


From among 428 Nepalese schoolchildren hair samples of 102 children with clinical features of tinea capitis, obtained by the sterile hairbrush method, were examined by mycological techniques. Age varied between 4-16 years. Itching was experienced by 96.1% sample subjects and hair loss by 32.4%. Of the 102, 11 (10.8%) were positive for Trichophyton violaceum (TV), 6 being from urban areas, the rest from rural areas. Amongst the 11 patients, 7 (63.6%) were girls and rest boys. Statistical associations were observed between the place of haircut and isolation of the organism (chi2 = 15.2, p <0.01). Statistical association was also present between frequency of bathing and isolation of organism. Sharing of combs was associated with the culture-positive subjects. The prevalence of tinea capitis in the urban and rural children was 2.3% and 3.0%, respectively. The only isolated organism was TV. An association of the isolation of TV was found with risk factors such as family members, sharing of combs, frequency of bathing with the organism. Hair loss was more common in the urban children. Discouragement of sharing combs, increased frequency of hair washing, and use of uncontaminated hair cutting instruments are recommended.


This research examines the effect of village fund management toward poverty alleviation in Pasaman Regency, West Sumatra. The data of the research were obtained from the Social Service and Regional Government of Pasaman Regency in 2016-2018. The sample of this research is 37 villages at Pasaman regency in 12 sub-districts. The research was conducted using the panel data regression method. The results showed that each policy area of village fund use in Pasaman Regency was able to reduce poverty simultaneously. Partially from the four research variables, it was found that community development and infrastructure development policies were able to influence the reduction of poverty in Pasaman Regency


A negative current in the scrape-off region beyond the separatrix of a diverted Tokamak can improve its MHD stability. By utilizing a strong thermionic emitter a current of up to 25% of the plasma current can be driven in the scrape-off region. If the thermionic current is emitted at only one end of the open field lines, a current will flow in the absence of a potential bias. The heat to maintain the electron emission that drives the scrape-off current would be supplied by the plasma outflow and no additional power is needed


Abstract. Climate change has multiple direct and indirect potentially synergistic effects on Baltic Sea species, organism communities, and on ecosystem functioning, through physical and biogeochemical environmental characteristics of the sea. Associated indirect and secondary effects on species interactions, trophic dynamics and ecosystem function are expected to be significant. Evidence on effects of climate are compiled from and reviewed for field studies, experimental work, as well as modelling studies primarily from published literature after 2010. The responses vary within and between species groups, even between sibling species. Such subtle differences, as well as secondary feedbacks and altered trophic pathways, make projections difficult. Some common patterns arise from the wealth of recent studies, however. It is likely that the combined effects of increased external nutrient loads, stratification and internal loading will improve the conditions for cyanobacterial blooms in large parts of the Baltic. In the northernmost areas the increasing allochtonous DOM may further complicate the picture by increasing heterotrophy and by decreasing food web efficiency. This effect may, however, be counteracted by the intensification of the bacteria-flagellate-microzooplankton-mesozooplankton link, which may change the system from a bottom-up controlled one to a top-down controlled one. In deep benthic communities, continued eutrophication may promote higher sedimentation of organic matter and increase zoobenthic biomasses, but eventually increasing stratification and hypoxia/anoxia will disrupt benthic-pelagic coupling, leading to reduced benthic biomass. In the photic benthic systems warmer winters with less ice and nutrient increase enhances eutrophication. The projected salinity decline suppresses marine species, and temperature increase overgrowth of perennial macroalgae by annual filamentous alga throughout the growing-season, and major changes in the marine entire ecosystem are expected. The changes in environmental conditions probably also lead to increased establishment of non-indigenous species, potentially affecting food web dynamics in large areas of the Baltic Sea. However, several modelling studies have concluded that nutrient reductions according to the Baltic Sea Action Plan of Helsinki Commission may be a stronger driver for ecosystem functions in the Baltic Sea than climate change. Such studies highlight the importance of studying the Baltic Sea as an interlinked socio-ecological system. Knowledge gaps include uncertainties in projecting the future salinity level as well as stratification under different climate forcings. This weakens our ability to project how overall biodiversity, pelagic productivity, fish populations, and macroalgal communities may change in the future. Experimental work must be better integrated into studies of food web dynamics, to get a more comprehensive view of the responses of the pelagic and benthic systems to climate change, from bacteria to fish. Few studies have holistically investigated the shallow water ecosystems holistically. There are complex climate-induced interactions and multiple feedbacks between algae, grazers and their predators, that are poorly known, as are the effects of non-native invasive species. Finally, both 2D species distribution models and 3D ecosystem models could benefit from better integration of approaches including physical, chemical and biological parameters.


Aim: To investigate whether sexual dimorphism can be established by odontometric study of permanent maxillary canine teeth as well as inter-canine width in north Indian population. Study Design: The study was carried out at department of oral and maxillofacial pathology, King George's Medical University, Lucknow, India on students and patients reporting at OPD. Out of total 180 subjects examined 90 subjects were female and 90 were male. Impressions of the upper arch were made using alginate and casts poured in dental stone. The mesiodistal diameter (MD) of the crown of permanent maxillary canine both on right and left sides and inter-canine width were measured. From these measurements, maxillary canine index was calculated. The percentage of sexual dimorphism (SD) was assessed for all the parameters. Results: In the present study, the MD of maxillary canine for both right (P = 0.001) and left side (P = 0.005) was significantly higher among male subjects than females, Similar observation was found for inter-canine width too (P = 0.0001). However, the maxillary canine index for right and left was almost similar (P > 0.05) for both male and female subjects. The SD in right and left MDs of maxillary canine was 4.2% and 3.6% respectively. For, inter-canine width it was maximum (13.7%). However, SD in right and left canine index showed negative values (−2.1% and -0.9% respectively). Conclusion: There was SD in MD and inter-canine width of permanent maxillary canine teeth. SD was more on right permanent maxillary canine teeth than left permanent maxillary canine.


A new technique has been developed which makes it possible to stack two or more similar shots from different depths in such a fashion that "ghost" energy may be eliminated over a very wide frequency range without significant signal distortion. The method requires knowledge only of the relative moveout between primary and ghosted energy from one shot to the next, and requires that the ghosts from each shot have similar character. By combining shots to obtain a ghost-free seismogram, and subsequently obtaining a statistical estimate of the optimum linear filter for changing the ghost-free record into one of the original shots, it is possible to obtain an estimate of the impulse response of the near-surface layering, i.e., the cause of the ghosts. The method is described in terms of its application to synthetic examples. Examples of its application to actual seismic data illustrate its practical effectiveness. End_of_Article - Last_Page 1776------------


The method presented in the paper enables to determine the isochromatic fringes of fractional order. To analyse the isochromatic patterns obtained by using of the wbite light the monochromatic filters have been appiied. The method was experimentally examined on the test specimen. The limit of application of the method bas been determined.


Residential and commercial buildings account for almost 40 % of total U.S. energy consumption and U.S. carbon dioxide emissions (Pew Center, 2009). Nearly all of the greenhouse gas (GHG) emissions from the residential and commercial sectors can be attributed to energy use in buildings, making high performance energy efficient buildings central to addressing diminishing resources and transitioning to a green economy. However, energy efficiency in buildings receives inadequate attention because first least cost decision-making as opposed to life cycle cost analysis (Romm, 1999). When life cycle analysis is used, it typically captures only the 'hard' financial cost benefits of operational energy and maintenance savings, but rarely includes environmental capital or human capital savings. This thesis proposes an empirical approach to triple bottom line calculations that integrates the economic, environmental and human cost benefits to accelerate investments in high performance building technologies. The development of a new methodology for capital expenditures in investments in the built environment can provide compelling arguments for decision makers and encourage the widespread adoption of high performance building technologies. In the first bottom line, this research quantifies the 'financial' or capital costs and benefits of high performance building investments, by broadening the category of associated benefits beyond energy savings from an investment (Birkenfeld et al., 2011). Traditionally, building investment decisions are made using a value engineering approach, which is driven by the agenda of cost reduction rather than valuing the benefit of different alternatives. Using net present value (NPV) and return on investment (ROI) indices, well-known in financial practices, the first bottom line calculation in this thesis moves away from a 'first least cost' to a life cycle approach to account for multiple non-energy financial benefits that can directly be quantified for the building decision maker. To advance a second bottom line that can be translated into Corporate Sustainability Reporting, the thesis provides a methodology for capturing the environmental benefits of reducing electricity demand related to carbon, air quality and water resources. These calculations are based on three levels of information - electricity fuel sources and power plant quality, the respective air pollution and water consumption consequences, and emerging valuation incentives for pollution reduction. The methodology focuses on critical greenhouse gases CO2, CH4; SOx, NOx, as well as particulates and water use, for three global scenarios – an emerging economy such as India, a country with mid-level sustainability goals such as the US, and a leading economy with low carbon growth goals such as the EU - in order to represent the range of environmental impacts of electric energy use. The capital saved by avoiding the environmental impacts of electricity use based on fuel source and mix can thus be added to each kilowatt-hour of electricity saved in a second bottom line calculation. To advance the third bottom line, this thesis engages a methodology for measuring and quantifying human benefits from building investments based on ongoing development of CMU CBPD's BIDS toolkit. The methodology is built on the field and laboratory research findings that link high performance building design decisions to human health and individual and organizational productivity. This thesis advances an approach to handling the third bottom line calculations, including an approach to establishing baselines, applying a broad base of laboratory and field findings. Given first cost data from vendors, first bottom line simple paybacks for 12 energy retrofit measures ranges from 2-20 years - with energy and facility management savings. When the environmental benefits are included, simple paybacks were accelerated to 1.5-18 years. Most strikingly, when human benefits are included - from reduced headaches and absenteeism to improved task performance or productivity - paybacks for investments in energy efficiency in US offices are often less than 1 year. To support the validity and reliability of results, both quantitative and qualitative methods were used to validate how Triple Bottom Line (TBL) cost benefits might impact and shift decision-making patterns from a least-first-cost approach to an approach that includes TBL information. Field testing of the potential influence on decision makers to move beyond first-cost decision-making to support investments in high performance, energy efficient technologies revealed the positive impact of Triple Bottom Line accounting for decision makers (p<0.05). The introduction of triple bottom line accounting for decision-makers in the built environment may be the most critical catalyst for investments in building energy improvements.


Abstract Objective To examine the effect of obesity on maternal and neonatal outcomes in women diagnosed with gestational diabetes mellitus (GDM) and managed with diet only, glyburide, or insulin. Study Design Women with singleton gestations enrolled for outpatient services diagnosed with GDM and without history of pregnancy-related hypertension at enrollment or in a prior pregnancy were identified in a database. Women with GDM controlled by diet only (n = 3918), glyburide (n = 873), or insulin without prior exposure to oral hypoglycemic agents (n = 2229) were included. Pregnancy outcomes were compared for obese versus nonobese women within each treatment group and also compared across treatment groups within the obese and nonobese populations. Results Within each treatment group, obesity was associated with higher rates of cesarean delivery, pregnancy-related hypertension, macrosomia, and hyperbilirubinemia (all p < 0.05). Higher rates of pregnancy-related hypertension and hyperbilirubinemia were observed in women receiving glyburide. Conclusion Obesity adversely affects pregnancy outcome in women with GDM. Higher rates of pregnancy-related hypertension and hyperbilirubinemia were observed in pregnant women receiving glyburide.


Psoriasis vulgaris is a multifactorial, heterogeneous disease that is associated with problems in skin image and feelings of shame and stigmatization. The aim of this study was to analyze psychopathological traits in patients with psoriasis and a comparative group. A total of 254 dermatological patients participated in the study: 124 patients with confirmed diagnoses of psoriasis vulgaris and 130 patients with melanocytic and non-melanocytic nevi on covered parts of the body. Psychometrically mensural and standardized instruments were used in the study: list of general data, appendix of disease data, Beck Depression Inventory test, State-Trait Anxiety Inventory, Measure of psychological stress and Eysenck's Personal Questionnaire. There is a significant statistical difference in the result of psychometric tests between the study groups. Patients with psoriasis have more severe symptoms of depression, more physical symptoms of anxiety and higher results on the anxiety scale as a state and as a trait p=0.000. Eysenck's personal questionnaire showed higher results on the psychoticism scale p=0.000 and lower results on the extraversion scale p=0.035 among psoriatic patients.


The present study tested the proposition that social class and employment status would differentially affect attributions of responsibility and blame concerning positive and negative economic outcomes. The hypothesis here is that subjects will not blame a person who fails to get a job after taking a retraining program. The hypothesis is based upon the assumption that individuals on the lower rung of the economic ladder are aware of the external circumstances operating against economic security. As predicted, the person experiencing failure was neither held responsible nor blamed for his outcome. Also social class and employment status affected perceptions of the reasons for the successful outcome.


A new way to carry out numerical cellular telephone simulation in the presence of the head is presented. Here, two finite-difference time-domain (FDTD) simulations with different spatial and time resolutions are sequentially combined to perform a dual-grid FDTD (DG-FDTD) simulation. The DG-FDTD approach has the significant advantages to remain stable along the computation and to be easy to implement in a typical FDTD code. When compared with classical FDTD analysis, the DG-FDTD approach exhibits a reduction in computation time and memory requirements by a factor of 2.3 and 3.2, respectively, while providing accurate results both in near-field and far-field radiation.


Background In current French military operations, it is not uncommon for the military nurses (MNs) to be required to support soldiers alone in isolated areas. At a time when advanced practice nurses in the civilian sector develop extended skills, we asked MNs about their willingness to be trained in point-of-care ultrasound (POCUS).Methods We conducted a web-based survey from 1 November 2018 to 1 December 2018, including all MNs deployed in the Barkhane operation. The questionnaire, sent by e-mail, aimed to describe the willingness of MNs to be trained in POCUS. Their opinion on the usefulness of this training, the situations and ultrasound targets that seemed most profitable to them were also studied.Results 30 questionnaires out of 34 were completed. On average, MNs had 7.4 years of practice and had already carried out three military operations. Three MNs reported having been trained in POCUS and six had already performed POCUS on the field. 96% of the untrained MNs wanted to be trained. Twenty-nine (96%) MNs felt that there was added value in knowing how to perform POCUS, especially in operations and in isolated posts without a military physician (MP). Focused assessment with sonography for trauma, pleural and urinary tract ultrasound were the targets considered most useful to them, in that order.Conclusion MNs are interested in learning POCUS. A training course before their departure on mission for simple and quick acquisition targets would be easy to implement and probably beneficial for the patient, the MN and the MP.


Time Warp synchronized parallel discrete event simulators are organized to operate asynchronously and aggressively without explicit synchronization between the concurrently executing simulators. In place of an explicit synchronization mechanism, the concurrent simulators maintain a common virtual clock model and implement a rollback/recovery mechanism to restore causal order when out-of-order events are detected. When the critical path of execution of the simulation is balanced across these parallel simulators, this can result in a highly effective, lightweight synchronization mechanism. However, imbalances in the workload across the parallel simulators can result in excessive rollback at some nodes and ultimately result in an overall slowing of the simulation as prematurely computed and transmitted events are processed. On small shared memory multi-core systems, a lowest time-stamp first scheduling policy can effectively balance the workload. However, on larger many-core chips, conventional load balancing and workload migration will once again become necessary. Fortunately, emerging many-core chips contain some interesting features that can potentially be exploited to improve the performance of parallel simulations. For example, the Intel Single-chip Cloud Computer (SCC) provides mechanisms that a running application can use to adjust the frequency/voltage of different regions (called islands) of the chip. These islands are network and processing core centric and thus, in a Time Warp simulation, one can increase the frequency of the cores executing threads on the critical path (those experiencing infrequent rollback) and decrease the frequency of the cores executing threads off the critical path (those experiencing excessive rollback). This paper investigates the run-time control and adjustment of core frequency in an AMD Phenom II X6 multi-core processor to explore and demonstrate that the dynamic run-time control of core frequency can sometimes improve the performance of a Time Warp synchronized parallel simulation.


With the evolution of Information Communication Technology, libraries in the industrialized nations have experienced significant changes in information glut and these have facilitated the growth of "libraries without walls" This paper looks at the development of virtual libraries in Nigeria, its roles and addresses how it can help educational development in the country. A proposal for an ideal national virtual library system for the enhancement of national development is put forward, problems that would likely confront such proposal are examined and possible solutions are proffered. The Information Technologist Vol. 2(2) 2005: 77-87


In this study, Response surface methodology (RSM) was applied to optimize the yield of crude methanolic extract of Mitragyna speciosa leaves using Ultrasound-assisted extraction (UAE). The crude methanolic extract and its fractions were quantified in terms of total phenolic content and total flavonoid content, along with characterized using Fourier-transform infrared and Gas chromatography–mass spectrometry. The results showed the maximum yield of 49.72% at the optimal conditions (temperature, 34 °C; time, 25 min; and volume of solvent, 166 mL). The recovery crude methanolic extract for TPC and TFC were 137.3 ± 15.7 mg GAE/g and 90.3 ± 15.3 mg RE/g, respectively.


In stochastic programming, the consideration of uncertainty might lead to large scale problems. In these problems, computational resources might fall short of the requirements for solving these problems, especially concerning memory capacity. Decomposition techniques help to clear this obstacle, by producing a set of smaller subproblems at the cost of additional computation time for coordination due to the iterative of the resolution algorithm. However, one way to mitigate the effect of the increased computational time derived from the decomposition is to solve the subproblems in parallel or distributed systems. This paper compares the performance of two different Benders decomposition techniques for linear stochastic problems when executed in two different computational grids (one using singlecore computers and the other using dual-core computers). Decomposition methods that create less task-dependency take better advantage of computer resources available in the grid, thus compensating a small increase in the overall computational weight. In particular, the proposed method called "complete-scenario decomposition" requires a larger total CPU time (the sum of all individual CPU times in the grid) compared to traditional Benders decomposition; however, the computational overhead is compensated by a better grid performance, so the proposed method yields shorter execution times as measured by the user.


AbstractDiethylamine-modified phosphorus-containing polymer has been used as adsorbent for the preconcentration of traces amounts of Cu(II), and Zn(II). 4-(2-thiazolylazo) resorcinol was used as a chelating agent. The analytes were determined by FAAS. Various parameters such as: pH, volume of ligand, volume of elution, and eluent concentration affecting on the extraction efficiency of the polymer has been evaluated by Placket–Burman design to explore the important variables. Further were optimized by central 23+ star orthogonal composite design. The limits of detection for Cu(II) and Zn(II) were 2.1 and 6.3 μg/L, respectively. The accuracy of proposed method was checked by the analysis of TMDA 64.2 certified reference material. The method was applied to determine Cu and Zn in natural water samples.


Purpose: This study was done to develop and test the effectiveness in late school-aged children of a healthy lifestyle education program for cancer prevention. Methods: Participants were 26 students in the sixth grade of N elementary school in J City (experimental group) and 25 students in the sixth grade of D elementary school with same educational conditions (control group). The research design was a nonequivalent control group pretest-posttest design. Data collection and execution of the study were carried out from March 10 to May 19, 2011. For the experimental treatment, 7 weekly sessions of the healthy lifestyle education program for cancer prevention were given by the researcher. Posttest was done immediately following the conclusion of the program and 4 weeks later. Frequencies, percentages, χ 2 -test, t-test, repeated measures ANOVA and paired t-test with SPSS WIN 18.0 were used to analyze the data. Results: Perceived barriers, perceived self-efficacy, activity related effect and family support significantly influenced cancer prevention knowledge and increases in healthy life styles. Conclusion: Results indicate that, as this program for cancer prevention was effective in increasing healthy lifestyle practices in these children, there is a need to further develop, test and implement programs in all schools.


Traditional non-blind image deblurring algorithms always use maximum a posterior(MAP). MAP estimates involving natural image priors can reduce the ripples effectively in contrast to maximum likelihood(ML). However, they have been found lacking in terms of restoration performance. Based on this issue, we utilize MAP with KL penalty to replace traditional MAP. We develop an image reconstruction algorithm that minimizes the KL divergence between the reference distribution and the prior distribution. The approximate KL penalty can restrain over-smooth caused by MAP. We use three groups of images and Harris corner detection to prove our method. The experimental results show that our algorithm of non-blind image restoration can effectively reduce the ringing effect and exhibit the state-of-the-art deblurring results.


TREM-like Transcript 2 (TLT2) is a transmembrane receptor expressed on B cells, macrophages and neutrophils in the mouse and human. As of yet, an endogenous ligand has not been identified and the function of TLT2 remains to be elucidated. Because neutrophils are a primary mediator of the host innate immune response to bacterial infection, the analysis of factors that control neutrophil function is of great interest. Preliminary evidence suggests that TLT2 potentiates multiple neutrophil functions, including the respiratory burst and chemotaxis. Using a chemiluminescence system, it was shown that TLT2 ligation increases the primary phase of the respiratory burst by 20-25% in response to the bacterial peptide FMLP, although there is a slight inhibitory delay during the initial phase of the response. Transwell assays have been used to determine the effect that α-TLT2 mAb has on murine neutrophil chemotaxis. In vitro data demonstrate that TLT2 ligation increases migration 1.5-2.5 times in response to different chemotactic stimuli, such as FMLP, IL-8, and MIP-2. Importantly, α-TLT2 mAb treatment potentiates chemotaxis in response to agonists that signal via G-protein coupled receptors, but not in response to agonists that signal via tyrosine kinase-dependent pathways (e.g. G-CSF). These data suggest that TLT2 ligation effectively potentiates multiple neutrophil functional responses.


The objective of the study: to analyze the frequency and patterns of drug resistance of Mycobacterium tuberculosis (MTB) according to the results of microbiological tests of surgical specimens of the patients who underwent surgery due to tuberculosis, and to compare them with the results of sputum tests done in the pre-operative period. Subjects and methods. The data of surgical specimens from 170 patients operated due to tuberculosis were analyzed. The surgical specimens were sent for histological and microbiological tests (detection of MTB DNA and rifampicin resistance by GeneXpert, culture on solid media with drug sensitivity testing). Results. The molecular genetic testing of surgical specimens by GeneXpert was highly effective for detection of rifampicin resistance; in 97.8% of cases, there was a match with the results of sputum culture with consecutive DST performed before the surgery. Molecular genetic tests of surgical specimens allowed detecting MTB DNA in 66.1% of patients in whom no MTB or MTB DNA was detected in sputum and bronchial washings prior to the surgery, and of them in 28.2% of cases, rifampicin resistance was detected, which was unknown before the surgery. These data allowed prescribing adequate chemotherapy immediately after surgery.


Through the recent examples of diphtheria in the former Soviet Union, plague in India, and trends in pneumonia mortality in the United States, the author, in this article, illustrates issues in emerging infectious diseases. The Centers for Disease Control's plan, Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States, is summarized. Initial efforts to implement this plan are described, with particular focus on the development of Emerging Infections Programs, which are conducting epidemiologic and laboratory projects on several infectious diseases, including invasive bacterial diseases, unexplained deaths, foodborne diseases, and ehrlichiosis in four population-based sites in the United States.


Throughout its history, the United States has been the beneficiary of a worldwide in-migration of entrepreneurial talent. This article surveys finance, one of the many sectors in which immigrants made a conspicuous impact. Part I demonstrates the dominant role of immigrants in forming public financial policies from 1775 to 1817. Part II surveys 12 merchant and investment banking firms founded during the nineteenth century by individual immigrants or family groups, and traces their histories until 1914. Part III suggests, from this small sample, a series of hypotheses and tentative conclusions about their experiences and influence. Part IV compares the financial environment of the nineteenth century with that of the late twentieth and early twenty-first centuries. The article ends with a supporting appendix that describes 19 additional immigrants or immigrant families and their firms.


Introduction Worldwide, measles still kills 400 people every day, more than 90% of them being under-fives. Three out of four deaths happen in India, The objectives of my work are to describe the epidemiology of measles in Karnataka and to identify ways to improve measles control in the state. Methodology I collated and tabulated weekly surveillance reports and outbreak investigation line lists for 4 years. I synthesised the spatio-temporal distribution of measles cases and outbreaks in the state. Through logistic regression multivariate analysis, specified the contextual demographic and socio-cultural determinants of measles outbreaks and vaccination coverage in the state of Karnataka. Findings Measles surveillance data from 2006 to 2009 reveal that measles is indeed endemic in Karnataka, with frequent outbreaks. The notification rate of measles is 10.94 cases per 100 000 population per year. Seasonality of notified measles cases characteristically increases between November and April and decreases from May to October. There were 163 confirmed outbreaks in the state in the 4 years under study. Measles outbreaks were happening consistently in the northern part of the state and sporadically in the southern part: The duration of these outbreaks from the date of appearance of rash in a first case to last case was ranged from 7 days to 120 days with median of 39 days. Discussion Significant reduction in measles incidence and outbreaks can be attained only by adding a second dose to the routine vaccination scheme in the whole state and by conducting catch-up campaigns in northern Karnataka.


In this work, we measure the Raman scattering cross sections (RSCSs) of the carbon—carbon (CC) stretching vibrational modes of canthaxanthin in benzene, acetone, n-heptane, cyclohexane, and m-xylene. It is found that the absolute RSCS of CC stretching mode of canthaxanthin reaches a value of 10−24 cm2·molecule−1·sr−1 at 8×10−5 M, which is 6 orders of magnitude larger than general RSCS (10−30 cm2·molecule−1·sr−1), and the RSCSs of canthaxanthin in various solvents are very different due to the hydrogen bond. A theoretical interpretation of the magnetic experimental results is given, which is introduced in a qualitative nonlinear model of coherent weakly damped electron—lattice vibration in the structural order of polyene chains. In addition, the optimal structure and the bond length alternation (BLA) parameter of canthaxanthin are calculated using quantum chemistry calculation (at the b3lyp/6–31g (d, p) level of theory). The theoretical calculations are in good agreement with the experimental results. Furthermore, the combination of Raman spectroscopy and the quantum chemistry calculation study would be a quite suitable method of studying the structures and the properties of the π-conjugated systems.


Recently, tele-operation of the robot is needed with getting force information. To realize tele-operation with force feedback, high accuracy force control is essential. However, torsional vibration of multi-mass resonant system is a serious problem to operate robots. Vibration suppression in motion control system is important problem in industry applications. In this paper, the system that is 3-mass resonant system is considered. This paper proposes a bilateral control of 3-mass resonant system. The resonance control is implemented to the system to reduce vibration. Also, the inverse system is implemented to reject load disturbance. A load disturbance is estimated by load disturbance observer. The estimation method does not need parameter identification. The determination method of pole placement is discussed. The viability of the proposed method is confirmed by some experiments.


This paper provides an overview of best practice for the role of physiotherapy in managing back pain and neck pain, based mainly on evidence-based guidelines and systematic reviews. More up-to-date relevant primary research is also highlighted. A stepped approach is recommended in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits. Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy may be offered. This should be based on an active management approach, such as exercise therapy. Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Barriers to recovery need to be explored. Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.


This study examined the micro-pacing strategies during a distance freestyle cross-country (XC) skiing competition. Nine female and 10 male highly trained XC skiers wore a GNSS device during a FIS-sanctioned race. The course was ~4900 m; women completed two-laps; men completed three-laps. The course was divided into uphill (S1, S3, S5, S7), downhill (S2, S4, S6, S8), and flat (S9) sections for analyses. Statistical parametric mapping was used to determine the course positions (clusters) where total race time or section time was significantly associated with instantaneous skiing speed. Total race time was associated with instantaneous skiing speed during a cluster in S1 on lap 2 for both sexes (t ≥ 5.899, p ≤ 0.008). The two longest uphill sections (S1; S5) and the flat section (S9) contained clusters where section times were related to instantaneous skiing speed for both sexes (p < 0.05). The fastest woman gained 6.9 s on the slowest woman during a cluster in S1 on lap 1 and 7.3 s during a cluster in S9 on lap 1. The fastest man gained 51.7 s on the slowest man over all clusters in S5 over the 3 laps combined. Compared to skiers with longer total race times, skiers with shorter race times skied with faster instantaneous speeds in some clusters of the uphill sections, as well as on the flat section of the course. This study also identified different relative micro-pacing strategies for women and men during freestyle distance XC skiing races. Finally, statistical parametric mapping analyses can help to identify individual strengths and weaknesses for guiding training programs and optimise competition pacing strategies.


Treatment guidelines recognize the importance of achieving and maintaining asthma control. This study was designed to assess the prevalence of asthma control in a representative U.S. population. A survey regarding asthma and associated symptoms was sent to a representative national sample of 134,401 households managed by the National Family Opinion WorldGroup from May to July 2007. Subjects ≥18 years with current asthma were identified and completed the Asthma Control Test (ACT), a brief validated self-administered survey that assesses asthma control. Subjects with an ACT score of >19 have been defined as having well-controlled asthma (WCA) and those with a score of ≤19 were defined as having not welt-controlled asthma (NWCA). The prevalence of WCA was identified for the total population as well as subjects who currently were only using albuterol to control asthma symptoms. In addition, the frequency of past asthma exacerbations was studied and correlated with ACT. Surveys were returned by 81,505 households (61% return rate). A total of 10,139 adults self-reported having asthma and completed the ACT. Forty-one percent of these had NWCA and 39% of the subjects using albuterol as the only asthma medication had NWCA. Fifty-eight percent of subjects with NWCA in the total population had an asthma-related exacerbation (asthma-related oral corticosteroid use, emergency department, or hospitalization) in the previous year compared with 24% of subjects with WCA. This large representative national asthma sample using a validated asthma control instrument identified >40% of subjects with NWCA. In addition, subjects using albuterol monotherapy, who would be expected to have mild asthma and thus be well controlled, had a similar high prevalence of NWCA.


In the current scenario of human life, use of Internet is an integral part of human being. Internet users are rapidly increasing worldwide. Use of internet is directly or indirectly affecting the life of human being as there are several advantages and disadvantages for using the services of internet especially for the online shopping, reading, searching articles, watching movies, net surfing, etc. In the present work, a real case study of domain of Indian people is considered and questionnaire for Internet Addiction Test is prepared and statistical analysis is used to find out some of important observations related to human being which are using the internet services. Although in India, rate of internet users is very poor however Internet Addiction Test shows some significant results which minimize the loneliness of human being due to vast use of social networking sites. A model is also proposed by the use of most popular object-oriented modeling platform independent language known as the Unified Modeling Language. One can easily develop the software code through proposed model by the use of any object-oriented programming language. Systematic steps are represented through model for minimization of loneliness of people which is converted into happiness by the use of the social networking websites. The proposed model is also validated by generation of valid test cases through Finite State Machine.


Training a bipedal character to play basketball and interact with objects, or a quadruped character to move in various locomotion modes, are difficult tasks due to the fast and complex contacts happening during the motion. In this paper, we propose a novel framework to learn fast and dynamic character interactions that involve multiple contacts between the body and an object, another character and the environment, from a rich, unstructured motion capture database. We use one-on-one basketball play and character interactions with the environment as examples. To achieve this task, we propose a novel feature called local motion phase, that can help neural networks to learn asynchronous movements of each bone and its interaction with external objects such as a ball or an environment. We also propose a novel generative scheme to reproduce a wide variation of movements from abstract control signals given by a gamepad, which can be useful for changing the style of the motion under the same context. Our scheme is useful for animating contact-rich, complex interactions for real-time applications such as computer games.


: A device for determining red cell deformability is described. The studies have demonstrated that in normal subjects the red cell deformability is sufficiently high and the cells penetrate through a filter with pore diameter of 5 microns, whereas in the patients with chronic renal insufficiency this parameter is reduced (p less than 0.001).


Stream programming based on the synchronous data flow (SDF) model naturally exposes data, task and pipeline parallelism. Statically scheduling stream programs for homogeneous architectures has been an area of extensive research. With graphic processing units (GPUs) now emerging as general purpose co-processors, scheduling and distribution of these stream programs onto heterogeneous architectures (having both GPUs and CPUs) provides for challenging research. Exploiting this abundant parallelism in hardware, and providing a scalable solution is a hard problem. In this paper we describe a coarse-grained software pipelined scheduling algorithm for stream programs which statically schedules a stream graph onto heterogeneous architectures. We formulate the problem of partitioning the work between the CPU cores and the GPU as a model-checking problem. The partitioning process takes into account the costs of the required buffer layout transformations associated with the partitioning and the distribution of the stream graph. The solution trace result from the model checking provides a map for the distribution of actors across different processors/-cores. This solution is then divided into stages, and then a coarse grained software-pipelined code is generated. We use CUDA streams to map these programs synergistically onto the CPU and GPUs. We use a performance model for data transfers to determine the optimal number of CUDA streams on GPUs. Our software-pipelined schedule yields a speedup of upto 55.86X and a geometric mean speedup of 9.62X over a single threaded CPU.


Shunt and series-coupling techniques for quadrature generation are applied to CMOS relaxation oscillators. The 2.4GHz quadrature oscillators are designed and simulated in a UMC 0.18µm CMOS process. The shunt-coupled oscillator consumes a current of 12mA from a supply of 1.8V and achieves a phase noise of −99.4dBc/Hz @ 1MHz offset. The series-coupled oscillator consumes a current of 16mA from the 1.8V supply and achieves a phase noise of −98.3dBc/Hz @ 1MHz offset. For a systematic mismatch of 1%, the quadrature phase error of the shunt-coupled and series-coupled circuits are 0.55° and 0.1° respectively.


Scope and definition Hypothermia is defined as a lowering of the temperature of the human body below the arbitrarily chosen level of 35°C (95'F). The temperature lowering may be accidental or therapeutic, generalized or localized. Local therapeutic hypothermia is exemplified by cooling the heart or brain in major surgery, and by local cooling of the stomach in the management of bleeding. Accidental lowering of the temperature of peripheral parts of the body often happens in cold weather, and affects distal parts of limbs, the nose and ears. More severe degrees of tissue damage amount to frostbite. Lowering of the whole body temperature is employed in vascular, cardiac and brain surgery in an attempt to prolong the viability of essential organs deprived of blood supply. This article is concerned with generalized hypothermia occurring 'spontaneously'. It is conventional to record central body temperatures in the rectum, although oesophageal readings would be preferable.


The work is aimed at the disordersin the development of preschool younger school age children. The objective was to explain thein causes and possible conseguences bz which these disorders can be appear and to stress the role of the familz, familz education and the role of the school during children education. Further objective was to determine the mistakes which we as parents and schoolmasters are making and which have decisive significance duringthe form of the personalitz of young people and their moral development.


In this issue of Clinical Infectious Diseases, Ohmit and colleagues report the results of an assessment of influenza vaccine effectiveness during the 2010–2011 influenza season, using a nonrandomized, prospectively followed cohort [1]. This intriguing study had 2 surprising findings. Remarkably, the rate of polymerase chain reaction–documented influenza illness was not substantially different between those subjects who received influenza vaccine and those who did not, and the study was unable to demonstrate statistically significant vaccine effectiveness even after adjustment for age and the presence of high-risk conditions. The second surprising finding is that receipt of influenza vaccination in a previous season may have impacted the effectiveness of the vaccine in the current season. The population under study was predominantly young healthy adults and children with a low frequency of chronic health conditions, the types of subjects that typically mount the best immune responses to vaccine. In addition, there was a close antigenic match between the vaccine and circulating viruses. As we are currently struggling through one of the most vigorous influenza seasons in recent memory, the apparent failure of influenza vaccine under optimal conditions seen in this study is indeed troubling. Influenza vaccines are unique among currently licensed vaccines in that the continuous antigenic evolution of the virus requires frequent updating, reformulation, and annual administration of the vaccine. Thus, each year's influenza season essentially represents a test of a new vaccine against a new virus. Partly for this reason, there has been substantial interest for developing systems to monitor the performance of influenza vaccines on an annual basis. Prospective, randomized controlled trials are the method that is least susceptible to bias as the assignment of vaccinated or unvaccinated groups is made randomly. Organizing such trials on an annual basis would be quite challenging, however. Alternatively, several large networks have been developed that monitor vaccine effectiveness using a test-negative casecontrol design. In these studies, selected persons seeking care for acute respiratory illness are tested using a sensitive and specific test for influenza, and the vaccination histories of those testing positive are compared to those testing negative. The selection of cases based on a prespecified case definition and diagnostic testing without knowledge of vaccine history may eliminate some of the biases inherent in otherobservational studies [2], but the assessment is typically limited to medically attended outcomes. Because the majority of influenza infections do not result in a medical visit, this provides a somewhat incomplete assessment of the impact of vaccination. The innovative prospective surveillance approach used by Ohmit and colleagues allowed the investigators to assess effectiveness against both medically attended and nonmedically attended illnesses, similar to the outcomes typically assessed in randomized trials. However, the result of this study was strikingly different than that reported in recent randomized trials conducted by the same investigators in which inactivated vaccine efficacies of 68%–75% were reported, even though the vaccine and circulating viruses were antigenically mismatched [3, 4]. The Michigan group was also a major contributor to the recent assessment of effectiveness against medically attended illness performed during the same 2010– 2011 influenza season as the current report, but showing substantial vaccine effectiveness of 60% [5]. Understanding the reasons for these widely varying results is a critically important component of the effort to improve our control of influenza. Inactivated influenza vaccines are generally believed to provide "nonsterilizing" immunity—that is, vaccination does not necessarily prevent infection, but it reduces the likelihood that infection Received 28 January 2013; accepted 29 January 2013; electronically published 14 February 2013. Correspondence: John J. Treanor, MD, University of Rochester, Medical Center, Rm 3-6209, 601 Elmwood Ave, Rochester, NY 14642 (firstname.lastname@example.com). Clinical Infectious Diseases 2013;56(10):1370–2 © The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. firstname.lastname@example.com. DOI: 10.1093/cid/cit064


Received: September 4, 2014 Revised: September 14, 2014 Accepted: September 15, 2014 Objectives: The purpose of this study is to investigate the clinical trial research trends in regards to the neurofeedback training (NFT) in Korean journals. Methods: We researched articles published in Korean journals from 2000 up to 2013 and were related to the NFT. We searched six electronic databases to find relevant articles, using the term 'neurofeedback'. Results: 1) 6 single group comparative studies and 31 randomized controlled trials were found. 2) Healthy volunteers and students were most frequently studied with neurofeedback training. Other studies included attention deficit hyperactivity disorder (ADHD), Poststroke, panic disorder, premenstrual dysphoric disorder (PDD), temporomendibular disorder (TMD), and obesity. NFT interventions were attempted in diverse training protocols and assessed with many different outcome measurements. 3) Most studies showed effective results after NFT. Conclusions: NFT is increasingly studied and used in various clinical fields. Also, there have been efforts to adopt NFT in Korean medical clinics and researches, and more rigorous and innovative studies are needed in the future.


Mathematical modeling is very important to describe the dynamic behavior of biological and biomedical systems. The SIR model is the most common mathematical model of epidemics. An epidemic occurs if the number of people infected with a disease is increasing in a population. A numerical discretization for an SIR epidemic model is discussed, where the incidence rate is assumed to be Beddington-DeAngelis type. In particular, we reconsider a SIR epidemic model with Non Linear incidence and treatment rate derived by (Dubey et al. 2015) [1]. We applied Euler method to discretize this model. This discretization leads to a numerical scheme which can be considered as a discrete system. Then we analyzed the dynamics of the obtained discrete system. We developed the model with the focus on the concentration of the basic reproduction number and related stability analysis for the disease-free and endemic equilibrium points. Finally, We have performed numerical simulations to illustrate the disease behavior. Keywords— discrete SIR model, Beddington-DeAngelis type nonlinear incidence rate, Euler method, basic reproduction number, stability. Received: March 7, 2020. Revised: September 30, 2020. Accepted: October 12, 2020. Published: October 24, 2020.


In multi-user MIMO broadcast systems, utilize the simple zero-forcing receiver on top of the TDMA scheduling can obtain good performance. In [7], a TDMA scheduling strategy which based on the maximum capacity criterion has been proposed, but the author does not analysis the system performance theoretically for arbitrary finite number of users. In this paper, we focus on the 2×2 multi-user MIMO broadcast scenario and give an approximate closed-form expression for the scheduling strategy which proposed in [7]. Simulation results show that the expression we deduced can accurate characterize the system capacity under different SNR regions for arbitrary finite number of users.


Parents often have strong opinions about their children's schools, and they're not always shy about expressing them. Josh Starr describes his own experiences with vocal parents who opposed district policies and explains that school and district leaders would do well to seek out opinions from the less vocal parents.


Out of 127 gastric cancer cases with a synchronous liver metastases, the relationship between the prognosis and the nuclear DNA contents in the primary and liver metastatic foci has been investigated in 10 relatively noncurative patients who had received a combined gastrectomy and hepatectomy. In 3 out of 5 long-term survival cases, low ploidy patterns were seen in both foci, whereas in 1 out of 5 short-term survival cases, a multiplicity was observed, i.e., a low ploidy in the primary focus and a high ploidy in the liver. In the other 4 short-term survival cases, high ploidy patterns were noted in both foci.


Using measured the rock drill law carries on the soil erosion to the highway of construction slide slope to carry on the monitor along the Hailin-Yabuli road of national highway 301 in Heilongjiang province, according to the project soil erosion characteristic, the harm degree and the preventing and controlling goal, proposed the corresponding side slope protective measure, establishes take the project protection and the vegetation protection as a body synthesis protection system, the effective preventing and controlling highway slide slope causes soil erosion.


Abstract:There are many and varied views on the role of the management consultant. Roles range from the functional perspective to variations of the critical perspective. Despite these many perspectives, there is low consensus and a poor under-standing of what the consultant actually does. Adding to the mix is that there is even poorer understanding of how the implementation of a new concept af-fects the consultant's role. Consequently, the authors will look at what role a management consultant take when working with new knowledge, and how this role is viewed from the perspective of the consultant, managers and employee in the client organization: a Swedish MNC. The research issue was examined through the authors' own model, which was tested through in-depth interviews with management consultant, managers and employee within the case company. Interview material was complemented through participant observations. Data was then analyzed as authors tried to understand the informants through an emic research perspective. The study shows that the role of the management consultant varies depending on who is asked. The perspective ranges from the functional perspective on management consulting to the critical perspective, even if no informant can be said to argue that the management consultant belong to only one of the two perspectives. What is more, the study indicates that the closeness (relationship) of the client and the management consultant as well as the knowledge used by the consultant determines the consultant's role. The authors suggest that further research should focus on how knowledge de-termines the role of the consultant, the effect of closeness between client and consultant and finally how implementation of new knowledge affects the view of the management consultant's role.KEYWORDS: management consultants, management consultants' role, functional perspec-tive, critical perspective, tacit knowledge, explicit knowledge, knowledge management, client-consultant relationship & reforms.


This article examines the circumstances in which fraud will vitiate consent to sex for the purposes of Australian rape law. It begins by summarising the Australian common law position on fraud in rape law, before discussing the relevant legislative provisions and recent case law in the various Australian jurisdictions. It is argued that the common features of legal approaches to this issue in the Australian States and Territories raise potentially serious problems of vagueness and overbreadth. Three possible responses are then examined. The article concludes that the most promising immediate response lies in a purposive judicial attitude to interpreting and applying the statutory framework, rather than further legislative reform or systematic reading down of the relevant provisions.


relation between postmenopausal use of oestrogen and risk of breast cancer, which has been reported to depend on dose and duration when conjugated equine oestrogens are given.34 At present, though, there are no data linking oestradiol implants with an increased risk of breast cancer.' Drs J H Tobias and T J Chambers have observed that in vitro supraphysiological oestradiol concentrations increased bone resorption in the rat.6 A cross sectional study suggests that in vivo oestradiol implants increase bone mass in humans.7 Drs Jean Ginsburg and Paul Hardiman dispute that the phenomenon of decreasing efficacy with successive implants is a form of tachyphylaxis,5 but according to the definition from Webster's Medical Dictionary that they provide we think that our description of this phenomenon as tachyphylaxis is appropriate. The clinical sequence of events comprises attempts to overcome the return of symptoms (diminished response) by reimplanting oestradiol (a physiologically active substance) at higher dose or decreased intervals, or both (later increments in a sequence of applications). Drs Ginsburg and Hardiman also disagree with our recommended management of patients with supraphysiological oestradiol concentrations and describe our approach of withholding further oestrogen as "unnecessary." They suggest prescribing vaginal oestriol until a more physiological oestradiol concentration is achieved, but the reference they cite to justify this approach relates to the benefits of vaginal oestriol in previously untreated postmenopausal women,9 which is a completely different situation from the one that we described. Thus we regard their use of this reference as inappropriate. In a minority ofwomen with supraphysiological oestradiol concentrations and extremely severe symptoms we have tried transdermal oestradiol 100 ig or 200 [tg a day with only small benefits (unpublished data). This transdermal preparation results in much higher plasma oestrogen concentrations than does vaginal oestriol; thus we fail to understand why vaginal oestriol should be effective. We agree fully with the comments of Drs Peter Wardle and Robert Fox regarding "longlasting" implants and the need for protection against endometrial hyperstimulation. ' Fairly short periods of unopposed oestrogen stimulation, up to three years, may increase the risk of endometrial cancer sixfold for 15 or more years after the oestrogen is withdrawn." We did not discuss this problem in our paper because we have collected a series of these patients and the results will be published later. 2 KEVIN F GANGAR