Psycho-emotional state is one of the factors effecting human health. Its evaluation allows revealing hidden psychological trauma which can be reason of chronic stress, depression or psychosomatic disorders. Modern techniques of objective psycho-emotional state assessment involve a device which detects electrophysiological parameters of human body connected with emotional reaction and psychological condition. The present study covers development and testing of psycho-emotional state assessment device. The developed implement uses three methods of electrophysiological activity evaluation: electrocardiography, electroencephalography and galvanic skin response detection. The device represents hardware-software complex consisting of nanosensors, measuring unit, lead wires and laptop. Filters are excluded from the measuring circuit due to metrological parameters and noise immunity of implemented nanosensors. This solution minimizes signal distortion and allows measuring signals of 0.3 μV and higher in a wide frequency range (0-10000 Hz) with minimal data loss. In addition, results of preliminary medical studies aimed to find correspondence between different psycho-emotional states and electrophysiological parameters are described. Impact of filters on electrophysiological studies was studied. According to the results conventional filters significantly distort EEG channel information. Further research will be directed to the creation of complete base of electrophysiological parameters related to a particular emotion.


High bush density and cover have negative effects on the environment in general and on livestock production, in particular in savanna rangelands. The study examined the effects of bush control techniques on woody sapling recruitment in the low land savanna region. The study consisted of 21 plots located next to each other on an area of 5.3 ha encroached by Acacia mellifera and Acacia reficiens trees. Seven bush control treatments were assigned randomly to the plots and replicated three times. In the bush clearing plot, woody species were removed at ground level using a handsaw. In the tree thinning; thinning and grazing; thinning and browsing; thinning and fire, and thinning with fire-browsing treatments, trees were thinned to the equivalents of 60% of the density of that of the control plot. Positive changes in sapling densities were observed in the clearing, thinning, and thinning and grazing treatments. In contrast, the control, thinning and browsing, and thinning and fire treatments presented negative changes in densities. A change in sapling density was highest in the cleared plot, whereas it was lowest in the thinning, fire, and browsing treatment. The correlation between changes in sapling densities and new recruitments was highly (p < 0.001) significant in the clearing, thinning, and thinning and grazing treatments thus increased sapling recruitment with the proportion greater for the clearing treatment. The significant correlation induced average sapling recruitment in the control, and low in the thinning with browsing and thinning with fire treatments. The relationship was insignificant in the thinning, fire, and browsing combination treatment and resulted in the lowest rate of saplings' recruitment. Postthinning techniques reduced woody tree recruitment and would sustain open savanna under the continuous management plan.


Ibn Sina's (Avicenna) denotes that one of the most effective methods in medical treatment is listening to music, which clearly illustrates the position of music therapy in medical treatment. This chapter discusses four matters: (i) the concept of music therapy as medical treatment, (ii) the function of music therapy as a method of complementary treatment aimed more towards calming and relieving pain, but not as a total cure for the patient, (iii) the hospitals that applied music therapy as treatment, and (iv) the process of applying music therapy in the medical tradition of the Islamic civilisation. Music here includes instrumental music, the sound of singing, adhan (call to prayer), Quranic recitation, as well as sounds of nature, such as of birds singing and of water from a fountain pool. Among the hospitals that applied such therapy was Bimarastan Fez in Morroco, Bimarastan al-Mansuri at Cairo, Egypt, Bimarastan al-Arghuni at Allepo, Syria, Bimarastan Nur al-Din at Damascus City, and Suleymaniye Sifahanesi.


In the classic model of the arrector pili (AP) muscle, each hair follicle is independently associated with a single AP muscle. Recently, new models have been proposed based on interpretations of serial histological cross-sectional images. The purpose of this study was to confirm the morphology of the AP muscle in relation to the follicular unit (FU) using quantitative threedimensional (3D) reconstruction of serially sectioned images. Skin samples were obtained from the parietal region of the scalp, and processed using routine histological procedures. The serially sectioned slides were stained with Masson's trichrome. All the hairs and hair follicles of the FU exhibited some degree of slanting, with the single AP muscle slanted in the same direction. The distal portion of the AP muscle was divided into branches, as in a bronchial tree. There was branching in the single AP muscle present in the FU, and it was inserted into all the hair follicles of the FU either tightly or loosely. We suggest that the classic anatomy of the AP muscle must be modified with this new model, now confirmed by computer-based 3D reconstruction.


We present a case of inadvertent arterial insertion of a central venous catheter, identified during a pericardiectomy procedure after observing abrupt changes in pressure waveform and confirmed via arterial blood gas analysis and transesophageal echocardiography. Central venous pressure measurement was initially 20 mmHg in supine, and then elevated to 30-40 mmHg in right lateral decubitus, presumably resulting from constrictive physiology of pericarditis. The pressure waveforms, however, abruptly changed from a venous to an arterial waveform during surgery. When visual discrimination between arterial and venous blood regurgitation is unreliable, anesthesiologists should confirm that using all the available methods one has on the scene, especially after at least two unsuccessful attempts or in patients with advanced age or clinical conditions resulting in jugular venous dilation. To prevent arterial catheterization, one should limit the leftward rotation of the head by <40° and consider using ultrasound-guided method after more than two unsuccessful attempts.


The Advanced Knee Arthroscopic Surgery course was first organised in 1995 under the joint auspices of the British Association for Surgery of the Knee and The Royal College of Surgeons of England. This is a two-day course in advanced knee arthroscopic techniques, with lectures, videos and extensive practical sessions. The approach is very much hands-on, using cadavers together with sawbones and model knees. Use is also made of the specimens in the Anatomical Museum of the College. Instruction is given in anterior cruciate ligament reconstruction, meniscal repair and posterior cruciate with posterolateral ligament reconstruction. Since 1995 the course has been held on seven occasions and has been attended by over 100 senior trainees and consultants.


A parallel connected peak-current-mode-controlled (PCMC) switched- mode DC/DC power supply, together with single-wire autonomous current sharing, is proposed and analysed. To avoid the minor alarm of the current limit and reduce the unbalance of current distribution during the transient state, the nature of the fast response of the PCMC is integrated with a current-sharing circuit to adjust automatically the trim signal that exists in conventional DC/DC power converters. A design example of three 150 W (48/5 V, 30 A) full-brick type (2.4/spl times/4.6/spl times/0.5 inch) parallel modules has been constructed and experimental results verify the performance of current sharing.


Background. Physiological hyperinsulinemia in lean human subjects stimulates sympathetic nerve activity and blood flow in skeletal muscle, but the underlying mechanism is unknown. Potential mechanisms include central neural or peripheral actions of insulin. Glucocorticoids may potentially interfere with both such actions and thereby may attenuate sympathoexcitatory and vasodilatory effects of insulin in skeletal muscle. Methods and Results. To determine whether insulin-induced sympathetic activation and vasodilation are attenuated by dexamethasone, we measured muscle sympathetic nerve activity and muscle blood flow during euglycemic hyperinsulinemia before and after short-term administration of this pharmacological agent. Insulin concentrations, which normally doubled sympathetic activity and markedly increased blood flow, had no such stimulatory effect after short-term dexamethasone administration. In contrast, responses to two noninsulin sympathetic stimuli, the Valsalva maneuver and immersion of the hand in ice water, and the vasodilatory response to calf vascular occlusion were not altered by dexamethasone. Conclusions. These results demonstrate a dramatic impairment of insulin-induced sympathetic activation and vasodilation by dexamethasone in lean, healthy humans. This study suggests that dexamethasone administration to lean subjects may offer an experimental model to examine underlying mechanisms that regulate the interplay between cardiovascular, sympathetic, and metabolic effects of insulin. (Circulation 1993;88:388-394)


As evidence-based practice (EBP) continues gaining prominence in the professional literature, at least two overlapping challenges make it difficult for mainstream social workers to accept EBP as the primary mode for practice. Social workers need a robust pool of intervention research on which to base practice decisions. The research must remain current; be well formulated, for instance, conforming to the Consolidated Standards of ReportingTrials guidelines (the gold standard for reporting clear, transparent, and sufficiently detailed conference abstracts and journal articles); and be focused on ascertaining the most appropriate interventions that attain the desired outcomes for specific clients with specific problems (Hopewell et al., 2008; Thyer, 2001). Social workers also need research that values knowledge derived from clinical expertise or practice wisdom. Any apprehension social workers have with adopting the kind of transparent EBP put forward by Gambrill (2007) may be attributed in part to the lack of appreciation for practice wisdom that is hard to observe and quantify as a valid source of evidence. Over the past few years, other professions have found Bayesian analysis useful across many disciplines where data collection is difficult or expensive, most notably medicine and pharmacology. The application of Bayesian analysis to adaptive designs in clinical trials has allowed trials to stop sooner, thus getting patients on an effective medicine or off of a harmful medicine much faster than in the past (see, for instance, Giles et al., 2003, and Krams, Lees, Hacke, & Grieve, 2003). This article introduces Bayesian analysis as a statistical paradigm conducive to addressing the challenges of EBP in social work research and practice. In contrast to classical statistical methods, Bayesian analysis allows researchers to translate practice wisdom into evidence and incorporate data from past and present studies. The article begins with a brief introduction to Bayes's theorem, followed by a discussion and comparison of classical and Bayesian approaches. Finally, we provide a practical example of Bayesian analysis to assess the clinical improvement of youths receiving children's psychosocial rehabilitation (CPSR) from a mental health clinic that specializes in the treatment of youths with severe emotional disturbance (SED). STATISTICAL APPROACHES Classical Statistical Analysis Most statistical analysis done in social work has tended to be in the classical (also called the "frequentist") paradigm. In the frequentist approach to statistics, parameters are assumed to be fixed, unknown quantities. A sample is taken from the population, and inference is generally accomplished through either hypothesis testing or confidence intervals. There are actually several difficulties with frequentist inference, but one problem in particular is that it relies on what is termed the "repeated sampling paradigm," which makes interpretation of results difficult and quite nonintuitive. For instance, suppose interest lies in the proportion of clients therapeutically discharged from a state-supported intensive outpatient treatment program for mental health and substance abuse disorders. We denote this unknown proportion p. The frequentist confidence interval (CI) found in most introductory textbooks is of the form [??] [+ or -] [z.sub.[alpha]/2 [square root of ([??](1 - [??]/n)], where [??] is the estimated proportion of positive responses, found by taking the number of positive responses divided by the sample size n, and [z.sub.[alpha]/2] is the value of the standard normal distribution that leaves (1 - [alpha]/2) * 100 in the upper tail of the distribution. The common value for [alpha] is .05 which leads to a value [z.sub.[alpha]/2] = 1.96. The interpretation of this interval is not the desired one of the "probability" that p in the interval is 95%. Instead, we have to imagine repeating the experiment essentially an infinite number of times and interpreting the interval by saying that 95% of these "repeated sampling" intervals would contain the true parameter p. …


Pelvic bone fractures are very complex and offer challenging situations to orthopedic surgeons. The ideal treatment method for pelvic fractures remains a matter of debate till date. The objective of the present study is to introduce the treatment modalities and clinical outcomes of pelvic fractures at our center in Uzbekistan. For study, 285 patients admitted from February, 2010 to January, 2014 with pelvic injury at the head center of the Republican Research Center of Emergency Medicine of Uzbekistan were enrolled. The age of the patients ranged from 25 years to 55 years. Clinical outcomes were analyzed in 182 patients who were operated and had followed up for at least 6 months. Study population was divided into three groups according to the morphology of fracture and stability of the pelvic ring. Out of 285 patients, surgical treatments were performed in 205 (71.9%) cases. Unstable pelvic fractures were 80 (28.1%). Among the surgically managed patients, transosseous osteosynthesis by external fixator was in 103 (50.2%) cases, osteosynthesis by internal fixation was in 42 (20.5%) cases, and combined osteosynthesis was in 60 (29.3%) cases. Polytraumatized patients were 202 (70.9%). Overall mortality observed was 26 (9.1%). Clinical outcomes were excellent in 114 of the cases (62.4%) and good in 48 (26.4%). Using external fixator, surgical treatment of pelvic fracture showed satisfactory clinical outcome in Uzbekistan region. However, more combination of external fixator and internal fixation was necessary in unstable pelvic fracture compared with stable or partially stable pelvic fracture.


: In F1 and F2 from a cross between two clones of Dileptus anser isolated from natural sources (MT 1 x x MT III; MT = mating type), along with "normal" clones, many clones were observed demonstrating abnormal phenotype with respect to the MT-character. Irregular features of the latter were as follows: a) a delay in maturation; b) temporary reversion to immature or adolescent state, which means instability of maturity state; c) expression of MT I and MT III, rather than MT II as in properly matured clones; d) changes in MT (i.e., MT instability); e) appearance of totally unexpected MTs in terms of the scheme of genetic control of MTs in D. anser previously suggested by Afon'kin and Yudin (1987)--e.g., of all three MTs in F1 from the initial (analysing!) cross. Amazingly, these abnormal D. anser clones closely resembled some selfer-clones of Tetrahymena pigmentosa, previously reported as an example of genetic instability in the ciliate MT system (Simon, 1980; Simon, Orias, 1987).


Purpose of the Study. The purpose of this study was (a) to describe how the concept of salvation develops among Adventist young adults and (b) to examine the perceived influence of mentors and (c) life experiences, especially traumatic experiences, on the development of the concept of salvation and intrinsic religious motivation. Method. This cross-sectional developmental study utilized three instruments: (a) the Salvation Concept Interview, (b) the Life Experience Interview, and (c) the Intrinsic/Extrinsic Religious Motivation Scale. Interviews were conducted with 132 individuals, and the data were analyzed descriptively and quantitatively using Spearman rho correlations and Chisquares. Results and Conclusions. Limited correlations existed between the maturity of salvation concepts and age. The major concepts of salvation were most frequently orthodox. Two-thirds of the subjects expressed assurance of salvation. Salvation concept maturity and intrinsic motivation were positively correlated. Subjects at the low intrinsic level were more egocentric and more unsure of their salvation. Subjects at the medium intrinsic level tended to be more orthodox and to view God as a father-type. Most perceived their fathers as good. Compared with other levels, fewer individuals reported traumatic events. Individuals at the high intrinsic level were more aware of their sinful nature, more dependent on God, and better able to integrate grace and works. Subjects at the very high intrinsic level were the most mature in salvation concepts. They seemed more empowered and were active in their pursuit of God. More individuals at the high and very high intrinsic levels understood salvation within the larger context of the universe and they tended to be relationship-oriented. However, those with childhood trauma did not understand how a relationship with God was connected with salvation. More individuals at these intrinsic levels (69%) had experienced considerable trauma. Interviewees who reported good fathering were more orthodox and understood the gospel better, while those with good mothers understood grace better, and those with good teachers had more understanding of God's personal interest in them. Individuals who reported trauma between ages 14 and 34 tended to be more alienated from the church, whereas those who reported good parenting were the least alienated.


Vertical organic field-effect transistors (VOFETs) with a large current on/off ratio and easy fabrication process are highly desirable for future organic electronics. In this paper, we proposed an ultrathin p-type copper (II) phthalocyanine (CuPc) interfacial layer in reduced graphene oxide (rGO)-based VOFETs. The CuPc interfacial layer was sandwiched between the rGO electrode and the N,N'-dioctyl-3,4,9,10-perylenedicarboximide (PTCDI-C8) organic layer. The introduced CuPc interfacial layer not only decreased the off-current density of the device but also slightly enhanced the on-current density. The threshold voltage of the device was also effectively improved and stabilized at around 0 V. The obtained device exhibited a current on/off ratio exceeding 106, which is the largest value reported for rGO-based VOFETs. The vertical electron mobility of the PTCDI-C8 layer estimated by the space-charge-limited current technique was 1.14 × 10–3 cm2/(V s). However, it was not the main limiting factor for the current density in this device. We totally fabricated 48 devices, and more than 75% could work. Besides, the device was stable with little performance degradation after 1 month. The use of low-cost, solution-processable rGO as work-function-tunable electrode and the application of an ultrathin CuPc interfacial layer in VOFETs may open up opportunities for future organic electronics.


In efficient and economical treatment of wastewaters,the settleability of activated sludge is of prime importance. Efficient settlement in the secondary sedimentation tank is required, both to keep the desired effluent quality and to sustain the necessary amount of microorganisms in the aeration tank. On the other hand, the settleability of microorganisms in the secondary clarifier is very dependent on the physiological and biochemical nature of activated sludge flocs, which are determined by the conditions of the aeration tank. In this research, effects of temperature and pH of aeration basin on settleability of activated sludge were studied. Settleability was measured by zone settling velocity and sludge volume index (SVI). Five different temperatures and four different pH values were operated in the aeration basin. It was found that the settleability of activated sludge is greatly affected by these two parameters.


Extracellular matrix plays a key role in cell growth, survival, and differentiation in a wide array of tissue types through integrin-mediated signaling pathways and its interaction with growth factors. This study investigates the role of extracellular matrix and its interaction with activin-A on in vitro growth and survival of mouse preantral follicles. Preantral follicles isolated from 14-day-old immature mouse ovaries were cultured either 3 dimensionally using basement membrane matrix (growth factor — reduced matrigel) or 2 dimensionally on cover slips coated with a single component of extracellular matrix (fibronectin, collagen, or laminin), on polylysine (negative control), or in standard culture plates in a serum-free culture medium with or without activin-A for 7 days. Follicles cultured in matrigel maintained well their 3-dimensional structure compared to those cultured conventionally. This observation was confirmed by analyzing 3-dimensional images of follicles cultured in matrigel and standard culture plate using confocal microscopy. Furthermore, follicles displayed higher growth and survival rates and exhibited antral space formation as early as day 5 of culture when activin-A was added to matrigel; in contrast, the addition of activin-A had no effect on the growth and survival of follicles cultured on individual extracellular matrix components after 7 days of culture. These data may suggest that 3-dimensional culture with extracellular matrix and activin-A provides a better milieu for in vitro growth and survival of preantral follicles in immature mice.


Opioid analgesics buprenorphine, nubain, and morphine were used in 33 patients suffering from acute postoperative pain on days 1-3 after operations on the lungs, heart and main vessels, abdominal organs. Buprenorphine was used in dose 0.01 mg/kg, nubain in dose 0.3 mg/kg, and morphine in dose 0.3 mg/kg. Effects of opioid analgesics on O2 consumption, carbon dioxide exhalation, minute respiration volume, and total energy metabolism were monitored. Effects of buprenorphine on metabolism and ventilation were the most manifest: it lead to reduction of metabolism by 26.2% and minute respiration volume by 36%. Nubain had no noticeable effect on metabolism or ventilation parameters. Morphine lead to moderately expressed changes in metabolism and ventilation reducing metabolism by 12.5% and minute respiration volume by 10.3%.


The high mobilization activity of neutrophils as a capacity of momentary feed-back reaction to factually any external stimuli, make it possible to use them in var-ious diagnostic systems in vitro. Among them is the automated test system of chemiluminescent detection of functional activity of peripheral blood neutrophils in parallel response to luminol, opsonizing zymosan and different antigens. This approach makes it possible to evaluate the initial and induced activity of phago-cytes and its dynamics in case of adding in vitro to test system of one or another allergen. The application of micro technique of chemiluminescent detection of functional activity of peripheral blood neutrophils revealed the stimulating effect of allergens Aaspergillus fumigatus, Alternaria alternata, Cladosporum herbatum, Candida albicans and Penicillinum notatum. This is an additional evidence of high sensitivity of children with allergic diseases of lungs to fungi and hence one more factor of diagnostics and treatment.


BACKGROUND
Parkinson's disease (PD) primarily results from a severe and selective damage of dopaminergic neurons. The neuropathological hallmark of the disease is the presence of protein inclusions of α-Synuclein (αS) within the surviving neurons. To date, several researchers have been focused on screening for the inhibitors that are able to block, slow down, or reverse αS aggregation, particularly at its early stages.

OBJECTIVES
In this work, we aimed to investigate the effects of a β-Synuclein derived peptide on oligomerization of pathological mutants of αS (A53T, A30P, E46K).

METHOD
The effects of the peptide on aggregation of native and mutant of αS were examined by fluorescence spectroscopy and electron microscopy. The influence of the peptide inhibitor on cell toxicity of aggregation products of αS and its mutants were investigated by MTT assay and flow cytometry.

RESULTS
It was shown that the peptide inhibitor effectively blocks the fibrillation of not only the native αS but also the PD related αS mutants in vitro, suggesting a similar mechanism of oligomerization for native and mutants of αS. The peptide inhibitor greatly diminished the cell toxicity of the aggregation products of native and mutants of αS.

CONCLUSION
Our findings suggest the therapeutic potential of this peptide for treatment of the rare inherited forms of PD.


This paper proposes a voting scheme that protects voters privacy even when the Central Tabulating Facility reveals individual responses. The basic idea is to add random noise to the true opinion by randomizing in a way such that the true vote is chosen with higher probability than the other alternatives. A major part of this paper is to outline the statistical propeties of our proposed protocol. A commitment protocol is also proposed to cope with dishonest voters who do not randomize their votes. The primary result is that the accuracy of the voting result improves as the number of voters increases.


The purpose of this classroom action research to: (1) describe the learning process with a problem-based learning model (PBL) to improve the writing competency of students in class XI MIPA 5 students in SMAN 1 Bantul in the academic year 2019/2020 and (2) knowing the increase in writing competency in student reviewer writing grade XI MIPA 5 SMAN 1 Bantul 2019/2020 school year through a problem based learning model (PBL). The subjects of this study were students of class XI MIPA 5 SMAN 1 Bantul. In the school Year 2019/2020. The setting/location of the study was in SMAN 1 Bantul Yogyakarta. While the research time was for three months from January to March 2020. This class action research was conducted in two cycles. Each cycle consists of four activities, namely: (1) action planning, (2) action implementation, (3) observation, and (4) reflection. The results of this class action research show: (1) The Problem Based Learning Model (PBL) can improve teacher performance in learning, improve student performance in learning, and obtain excellent responses from students; and (2) The implementation of PBL learning models in learning can improve the competency of writing a review of students.


We propose a model in which assets with identical cash flows can trade at different prices. Infinitely-lived agents can establish long positions in a search spot market, or short positions by first borrowing an asset in a search repo market. We show that short-sellers can endogenously concentrate in one asset because of search externalities and the constraint that they must deliver the asset they borrowed. That asset enjoys greater liquidity, measured by search times, and a higher lending fee ("specialness"). Liquidity and specialness translate into price premia that are consistent with no-arbitrage. We derive closed-form solutions for small frictions, and can generate price differentials in line with observed on-the-run premia.


This paper is to study effects of strategic flexibility on knowledge management. Statistical population includes 212 managers and employees in Ghalamchi, the Educational and Cultural Center. Sample size is determined to be 136 using the Morgan table, and the sampling is done through simple random sampling method. Given its objectives, the present study is an applied research classified as descriptive survey in terms of the method employed for gathering data. The questionnaire's reliability measured through Cronbach's alpha is 0.96. Results of data analysis using linear regression show that strategic flexibility has significant effect on the knowledge management. Moreover, it is revealed that strategic flexibility affects aspects of knowledge management significantly so that the strategic flexibility produces the most and least effect on knowledge acquisition (0.515) and knowledge organization respectively.


Using vision for navigation is important for many animals and a common debate is the extent to which spatial performance can be explained by "simple" view-based matching strategies. We discuss, in the context of recent work, how confusion between image-matching algorithms and the broader class of view-based navigation strategies, is hindering the debate around the use of vision in spatial cognition. A proper consideration of view-based matching strategies requires an understanding of the visual information available to a given animal within a particular experiment.


We are Ohio state court judges with actual experience in imposing and/or reviewing criminal felony sentences. We are unaware of any expressed objection by Ohio's judiciary to having more relevant information available to a sentencing court.
 Sentencing discretion is conferred upon trial courts by the General Assembly through its statutory enactments, and the trial courts have full discretion to impose a prison sentence that falls within the prescribed statutory range. With such wide-ranging discretion the database will provide additional information to a sentencing judge, which will result in a more informed sentence.
 Justice requires that judges get it "right." Why prevent useful, relevant, and important information from being considered by trial judges in achieving this goal? Once the criminal sentencing database is in place, for the first time in the state's history all stakeholders, including judges, will have access to relevant information that can inform their sentencing decisions while keeping biases, implicit or otherwise, in check. This will usher in a fairer, more transparent system that we should all support.
 As stewards of the greatest system ever designed to resolve disputes and, therefore, as those empowered to see that justice is achieved, we can't afford to pretend that the problem doesn't exist. We must seize this moment and take this long-overdue step for the betterment of our judicial system and, therefore, our society.


Popular culture – in this case military-themed videogames – has been argued to mould and shape popular understandings of the geopolitics of the 'war on terror'. To date, most attention has been focused on the geopolitical representations of a 'final' popular cultural text or object. Less attention has been paid to how popular understandings of geopolitics and military violence have been constructed and commodified prior to, and 'beyond the screen'. Empirically, the paper examines the marketing campaign of Call of Duty: Modern Warfare 3. Through the use of experiential marketing, I show how the game's launch night incorporated spectacular displays, performances and consumer interactions to sell the pleasures of virtual war by drawing on geopolitical fears of terrorism and military violence within major Western cities. Firstly, I demonstrate how marketing engaged with and transformed urban spaces extending the popular geopolitics of virtual war. Secondly, the paper reveals how experiential marketing targeted and encouraged connections with and between attendees' bodies. Thirdly, I demonstrate how such events promote geopolitical encounters which extend beyond the temporal and the spatial confines of the marketing event itself. Ultimately, the paper reveals how urban fears surrounding the global 'war on terror' were employed to sell the pleasures and geopolitics of virtual war.


Since its inception, the Edmonton Police Service (EPS) Re-integration Program has grown in its capacity, impact, and service to members within EPS. It has also attracted increasing attention among—and emulation by—other first responder communities in the province of Alberta. Most recently, the program was the subject of a featured segment during the joint Canadian Association of Chiefs of Police (CACP) and Mental Health Commission of Canada (MHCC) international conference, "The Mental Health of Police Personnel: What We Know & What We Need to Know and Do", held in February 2017. Based on the strong reception and interest generated among conference delegates, the Journal of CSWB invited the program's architects to develop the following Practice Guideline article, with a view to bringing wider awareness to this unique peer-supported program. The EPS program connects conventional counselling and support resources with aspects of recovery and re-integration that are more closely tied to the equipment and operational realities of first responders.


The size distribution and orientation of massive hemispherical tabulate corals and hemispherical stromatoporoids from the Fossil Hill and Manitoulin Formations on Manitoulin Island (Niagaran and Alexandrian, Ontario), and of hemispherical stromatoporoids in the Flume and Upper Cairn Members of the Miette reef complex (Frasnian, Alberta) and the Jamesville Member of the Manlius Formation (Helderbergian, New York), was determined. In all five sample populations there is no statistically significant difference in the mean size between populations of heads in growth position and those disoriented. The process or processes responsible for disorienting heads evidently did not selectively disorient or remove specific size classes. Such disorientation, associated with little lateral transport of heads, could have been accomplished by infrequent short-lived strong wave and current action (storms), structural or soft substrate instability caused by increasing skeleton size due to growth or bioerosion, or some as ye...


Recent advances have shown the potential for coded computation to impart resilience against slowdowns and failures that occur in distributed computing systems. However, existing coded computation approaches are either unable to support non-linear computations, or can only support a limited subset of non-linear computations while requiring high resource overhead. In this work, we propose a learning-based coded computation framework to overcome the challenges of performing coded computation for general non-linear functions. We show that careful use of machine learning within the coded computation framework can extend the reach of coded computation to imparting resilience to more general non-linear computations. We showcase the applicability of learning-based coded computation to neural network inference, a major workload in production services. Our evaluation results show that learning-based coded computation enables accurate reconstruction of unavailable results from widely deployed neural networks for a variety of inference tasks such as image classification, speech recognition, and object localization. We implement our proposed approach atop an open-source prediction serving system and show its promise in alleviating slowdowns that occur in neural network inference. These results indicate the potential for learning-based approaches to open new doors for the use of coded computation for broader, non-linear computations.


The Dumont dune field in the northern Mojave Desert of California consists of a core of well-developed star dunes flanked by smaller barchan, crescentic-ridge, and linear dunes. Many of the small dunes on the margin of the dune field develop star-dune–like features, such as a central peak and multiple, radiating arms. These incipient star dunes develop in the complex wind regime at Dumont by the merging and modifying of small bed-forms during the seasonal changes in wind directions, but they typically lose their star-dune–like features a few weeks later. The larger, mature star dunes maintain their overall integrity throughout the seasons. Mapping of surface airflow and sedimentary processes on mature and incipient star dunes show that the arm trends correspond to directions of the primary winds over the seasons. For any given time and wind direction, however, each arm behaves as an active transverse, oblique, or longitudinal element. Secondary airflow over star dunes is complex, and the direction of the wind at the surface is markedly different over parts of the dune at a single time and at a high variance with the primary wind direction. Most of the depositional surface of star dunes is covered by wind ripples, with slipfaces commonly confined to the upper portions of the dunes. The strength, direction, and duration of the seasonal primary winds, the size of the dune and its arms, and the secondary airflow all play critical roles in the maintenance and growth of star dunes. A multidirectional primary wind favors star-dune formation, but the persistence of winds from any one direction for a period of time favors some arms over others and, hence, loss of the star-dune features. A "minimum survival size" is necessary for incipient star dunes to maintain their star-dune morphologies from season to season. Secondary airflow favors the maintenance of the arms as well as the accumulation of sand on the bedform, thus allowing for growth. The nature of star-dune surface processes (plus the internal structure revealed in shallow trenches) suggests that the most common deposits of star dunes are low- to moderate-angle wind-ripple laminae arranged in packages or sets separated by gently dipping truncational surfaces. This may explain the rarity with which star-dune deposits are identified in the rock record.


Tokyo—A new program, dubbed Core Research for Evolutional Science and Technology, is intended to give Japanese scientists a free hand to pursue large, ambitious, and somewhat risky projects with a huge potential payoff. Some 54 scientists have received the 5-year grants, worth up to $10 million, in the first wave of what Japan hopes will grow to 250 projects with an annual budget of half a billion dollars. The program is modeled after the Exploratory Research for Advanced Technology program, created 15 years ago by Genya Chiba as a way to break the mold in support for Japanese researchers


We report a case of an unusual hip fracture that involved the intracapsular area and continued vertically to the extracapsular region below the trochanteric line. The division between these two types of fractures is based on the anatomical site, the blood supply and the mechanical forces that act on the hip. This division is important and influences the different surgical techniques to treat these individual fractures. Femoral neck fractures (intracapsular), particularly those with displacement, can disrupt the blood supply to the femoral head and may be associated with an increased incidence of complications, especially non-union and avascular necrosis (AVN) of the femoral head. These fractures are usually treated either by reduction and fixation, or by hemiarthroplasty. Non-union and avascular necrosis following extracapsular fractures are rare. Treatment involves reduction of the fracture and insertion of a dynamic hip screw. The combination of these two types of fractures is extremely rare and creates a surgical problem without any optimal solution. The focus of this case report is placed on the mechanical axis and weight-bearing forces that play a role in the hip and on the optional surgical techniques in such a rare type of fracture in an elderly osteoporotic patient. (Hip International 2002; 1: 43-6).


PURPOSE/OBJECTIVES
To describe the development of a self-efficacy instrument that measures perceived ability to manage symptoms and quality-of-life problems resulting from the diagnosis and treatment of breast cancer.

DESIGN
Items were developed and content validity assessed. A 14-item scale was psychometrically evaluated using internal consistency reliability and several types of construct validity.

SAMPLE
1,127 female breast cancer survivors (BCSs).

METHODS
Written consents were mailed to the research office. Data were collected via mail and telephone.

MAIN RESEARCH VARIABLES
Demographics, symptom bother, communication with healthcare provider, attention function, fear of recurrence, depression, marital satisfaction, fatigue, sexual functioning, trait and state anxiety, and overall well-being.

FINDINGS
Data demonstrated that the breast cancer self-efficacy scale (BCSES) was reliable, with an alpha coefficient of 0.89, inter-item correlations ranging from 0.3-0.6, and item-total correlation coefficients ranging from 0.5-0.73. Three of 14 items were deleted because of redundancy as identified through high (> 0.7) inter-item correlations. Factor analysis revealed that the scale was unidimensional. Predictive validity was supported through testing associations between self-efficacy and theoretically supported quality-of-life variables, including physical, psychological, and social dimensions, as well as overall well-being.

CONCLUSIONS
The BCSES demonstrated high internal consistency reliability, unidimensionality, and excellent content and construct validity. This scale should be integrated into interventions that target self-efficacy for managing symptoms in BCSs.

IMPLICATIONS FOR NURSING
Nurses working with BCSs may use this tool to assess areas in which survivors might need to build confidence to adequately cope with their specific survivorship concerns.

KNOWLEDGE TRANSLATION
The use of the BCSES can inform nurse researchers about the impact of an intervention on self-efficacy in the context of breast cancer survivorship, improving the ability to deliver effective interventions. The scale is brief and easy to administer. Results of this study demonstrate clear psychometric reliability and validity, suggesting that the BCSES should be put to use immediately in interventions targeting the quality of life of BCSs.


Chapter one of this dissertation tries to empirically answer the question of what explains China's foreign reserve holdings. The author finds that some VEC models motivated by modern mercantilism perform better in predicting China's foreign reserves than selected ARIMA models and those based on precautionary demand theories, both with statistical significance. This suggests that previous econometric studies, whose emphasis has been overwhelmingly placed on precautionary motives, might have missed some more important factors in explaining China's reserve holdings. Further structural analyses of these models show that the buildup of reserve stocks by China has a negative (depreciating) effect on its real exchange rate and a positive impact on its export growth. These findings seem to corroborate the conjecture that the recent increase in China's reserve holdings is a part of its export-led development strategy, and they also suggest that such a policy is effective for China.The second chapter studies the impact of trade liberalization on imports, exports, and overall trade balance for a large sample of developing countries, using two recently constructed measures of trade liberalization dates. The authors find strong and consistent evidence that trade liberalization leads to higher imports and exports. However, in contrast to Santos-Paulino and Thirwall (2004), who find a robustly negative impact of trade liberalization on the overall trade balance, the authors find only mixed evidence of such a negative impact. In particular, the authors find little evidence of a statistically significant negative impact using their first measure of liberalization dates, which extends Li (2004). Using a second measure of liberalization dates compiled by Wacziarg and Welch (2003), the authors find some evidence that liberalization worsens the trade balance, but the evidence is not robust across different estimation specifications, and the estimated impact is smaller than that reported by Santos-Paulino and Thirwall (2004).The last chapter empirically tests the proposition that domestic real oil prices can help to forecast real effective exchange rates. For most countries in the sample, little evidence was found to support such a proposition. There were two exceptions, Japan and Norway, who showed some consistent signs in favor of the oil-price exchange rate model. But the statistics favoring the model are mostly insignificant. The author also finds that the relations between oil prices and real exchange rates are not stable over time. The conjecture that the oil-price exchange rate model can produce better forecasts on exchange rates when oil prices are more volatile is not consistent with the pattern seen in the subsample results.


The conditioni broadlv defined by the title of this paper was brought to our notice bv the clinical observation of six children at the Hospital for Sick Children, Great Ormond Street, all of whomn presented the symptoms of wasting, constipation, and regurgitation of undigested food from the cesophaguis. Although the term ' cardiospasm 'was applied to these children for the purposes of the hospital records, the underlving morbid condition which existed at the lower end of the cesophagus remained in most cases obscure. In the hope of reaching a clearer understanding of the pathological basis of these caves. the hospital records were searched, and six additional cases of similar natture were found. Of the total of twelve children with cesoph.ageal obstructio), five have died. With one exception these have come to post-mortem examination, and the pathologist's reports have been available. In addition, radiological evidence has been forthcoming in all buit two cases. To be complete. this article should incluide that form of obstruction met (luring the first two weeks of life due to complete atresia of the Wesophagus. Instances of this condition have been frequenitly recorded, and in 1917 Cautlev )ublished a full review of the subject. The syrmptoms are well defined, and the condition is incompatible with life, so that fturther allusion to this group will not be made. Acquired stenosis such as follow s upon the ingestion of caustics is also excluded from consideration. The study of the cases at our disposal was simplified by grouping them according to the level in the cesophagus at which the obstruction occurred, and we shall consider them in this manner. The first and largest group consists of 10 children who had obstruction at the level of the seventh thoracic vertebra, halfway between the level of the bifurcation of the trachea and the diaphragm. It is to these cases that we wish to draw particular attention, because they fcrnm a clearly defined clinical entity, which is, hoNever, apt to be confused with the condition called ' cardiospasm ' or 'achalasia of the cardia.' The result is that they are often suibmitted to treatment which, although successful in cardiospasm, is injurious to them. In the two remaining cases. the obstruction -%as at the level of the (liaphragm,


Accurate evaluation of mathematics support centres is a complex task, given that such centres should ideally be integrated into the overall learning experience of the student, complementing structures such as lectures and tutorials. As such, a multi-faceted approach should be undertaken in order to best measure the effectiveness of such support, combining quantitative data such as attendance records and analysis of exam results with qualitative data such as anonymous student feedback.
Over the five years of its operation to date, the Maths Learning Centre in Dublin City University has maintained detailed records regarding the use of its drop-in support service. These records serve the dual purpose of allowing more efficient planning of resources by providing an overview of student attendance patterns and common problem areas, while also enabling an analysis of subsequent student performance to be conducted. However, such data provides little information as to the quality of the student experience within the Centre. Therefore, at the end of each academic year, an anonymous questionnaire is given to firstyear service mathematics students to ascertain their opinions and experiences of the Centre. Over the past couple of years, more than four hundred students per year have completed this survey, over half of whom had used the Centre. Here, following a brief overview of our quantitative data, we focus on the survey results and discuss what can be learnt from these. We also consider the responses in the context of records kept and anecdotal evidence to determine the usefulness and reliability of such feedback.


In this thesis, we consider the method of Harris-Soudry-Taylor et al. of attaching 2-dimensional l-adic Galois representations to cuspidal automorphic representations for GL(2) over imaginary quadratic fields. In this process, one lifts an automorphic representation for GL(2) over an imaginary quadratic field to an automorphic representation for GSp(4) over the rationals; the latter automorphic representation has associated a 4-dimensional l-adic Galois representation, which turns out to be induced from a 2-dimensional representation of the absolute Galois group over the imaginary quadratic field. We aim in using this method to transfer level lowering results for GSp(4) over the rationals to level lowering results for GL(2) over an imaginary quadratic field.

Firstly, we study in detail the conductors of irreducible admissible non-supercuspidal and non-generic supercuspidal representations of GSp(4) over a non-archimedean local field, and we obtain a result in the sense of Carayol and Livne on how the conductors degenerate modulo a prime number. In particular, when we have a corresponding mod l Galois representation and an l-adic lift of it, we list all the cases where the conductors differ.

Having this in our machinery, together with an explicit local theta correspondence between irreducible admissible representations of GL(2,L) and irreducible admissible representations of GSp(4,F) (here L is either a degree 2 field extension over F, or L is isomorphic to FxF, with F a non-archimedean local field), we obtain a conditional result on level lowering for automorphic representations of GL(2) over an imaginary quadratic field of prime discriminant. The result is conditional in the sense that we assume a level lowering result for representations of GSp(4) over the rationals.

Finally, we prove a level lowering result by twisting particular automorphic representations over imaginary quadratic fields by grossencharacters.


This article proposes a new active power flow controller for dc–dc multiactive bridge (MAB) converters with minimum current point tracking (MCPT) to minimize conductive losses. Unlike recent efforts in this area, the proposed controller does not require look-up table for implementation nor complex nonlinear converter modeling and is not circuit parameter dependent. The proposed control scheme is also generalized for MAB converters with any number of ports and is derived in per unit form to enable standard implementation for buck/boost/unity-gain operating modes. The proposed MCPT algorithm is based on an innovative adaptive perturb and observe tracking of the minimum current point (MCP) on the MAB converter current characteristic plane. This MCP is tracked while active power regulation is simultaneously achieved based on a new phase shift decoupler to enable direct regulation of individual port active power. Detailed design procedure of the proposed controller is presented and extensive simulation is carried out to validate the effectiveness of the proposed MCPT closed loop controller. Experimental implementation is also provided to substantiate the simulation results.


The advent of large-array superconducting biomagnetometer systems, including sophisticated operating and data processing electronics, has enabled practical patient studies evaluating the potential contribution of magnetoencephalography to clinical medicine. The superimposition of sources localized magnetically onto anatomic images, referred to as magnetic source imaging, has allowed physicians to conduct this evaluation in the content of their customary medical practice. This article summarizes the basic technology of magnetoencephalography and magnetic source imaging and includes brief descriptions of the various applications that are being studied with these new sensor systems, some of which are discussed in subsequent articles.


This paper investigates the mutual relationship between Jordanian practitioners' individualistic/collectivistic cultural orientation and the International Financial Reporting Standards (IFRS). It explores Jordanian accountants' perception of the importance of IFRS, the IFRS-embedded cultural values attributed to those accountants, and whether adopting IFRS has contributed to change their cultural orientation. A three-part questionnaire distributed to 81 Jordanian accountants reveals that their cultural orientation is more collectivistic than individualistic. Moreover, accountants who have practiced only IFRS have a more individualistic orientation than those with long experience with the pre-IFRS standards. As the paper analyses only one cultural dimension (i.e., collectivistic versus individualistic), further research should explore other cultural dimensions, such as power distance, masculinity and uncertainty avoidance, religion and language, and their interrelationships with IFRS. Our findings should be relevant to other countries, especially those with developing or emerging economies, as they strive to improve the effectiveness of their corporate financial information.


To accomplish the scientific objectives of NGST, the observatory must be equipped with instruments suitable for panchromatic observations across the 1-15 mu m spectral region on the faintest detectable objects. A wide-field imaging spectrometer that is efficient in the confusion limit, which may occur in deep field images, will maximize the scientific return and opportunities for serendipity from NGST. An imaging Fourier transform spectrometer (IFTS) supports these requirements in a low-cost, efficient instrument package that functions as an electronically programmable infrared filter with both imaging and spectroscopic capability. The conceptual design of the Integral Field Infrared Spectrograph (IFIRS) is an imaging FTS configured as a 4-port Michelson interferometer. The added ports are obtained by the use of cube-corner retroreflectors. A 4-port design delivers complementary symmetric and antisymmetric interferograms to the primary and secondary focal plane assemblies (FPAs). In this design, the object field of the complementary input is also imaged and superimposed on each image of the primary input. In operation, when observing the sky in the primary input, the secondary input would be fed with a cold blackbody having negligible radiance. The final interferogram is constructed from the difference between the two outputs (which is therefore also immune to common mode noise) while the normalized ratio of the difference to the sum of the two outputs serves to compensate for temporal variations in the object radiance, and may reveal systematic variations due to telescope throughput or detector drifts. The interferometer aperture, field angle, beam waist control, beamsplitter/beamcombiner co-planar alignment, maximum optical frequency and maximum resolution have been traded at a conceptual level of detail. These tradeoffs suggest that a 12 cm beam splitter diameter is sufficient to accept the throughput of an 8 m primary over a 5.'3 x 5.'3 square field of view.


A novel transparent conducting spinel solid solution Cd1+xIn2-2xSnxO4 (0 ≤ x ≤ 0.75 at 1175 °C) between cubic CdIn2O4 and orthorhombic Cd2SnO4 has been discovered. The extent of this solid solution is noteworthy given that bulk phase relations determined in air over the temperature range 800−1175 °C demonstrate that cubic (spinel) Cd2SnO4 is metastable. Reduced samples exhibit exceptional four-point dc conductivities exceeding 3500 S/cm (x = 0.70). The maximum optical gap estimated from diffuse reflectance spectra is ∼3.0 eV for 0 ≤ x ≤ 0.15. The optical gap shows negligible change with reduction, possibly because of combined Moss−Burstein and band-narrowing effects. Abrupt conductivity increases and optical gap decreases at specific compositions, i.e., x = 0.4 and 0.2 respectively, may be indicative of a change in cation distribution between tetrahedral and octahedral sites. Room temperature thermopower measurements indicate the change in conductivity across the solution is a consequence of an increase i...


In this brief paper, we go through the theoretical steps of the spectral clustering on quantum computers by employing the phase estimation and the amplitude amplification algorithms. We discuss circuit designs for each step and show how to obtain the clustering solution from the output state. In addition, we introduce a biased version of the phase estimation algorithm which significantly speeds up the amplitude amplification process. The complexity of the whole process is analyzed: it is shown that when the circuit representation of a data matrix of order $N$ is produced through an ancilla based circuit in which the matrix is written as a sum of $L$ number of Householder matrices; the computational complexity is bounded by $O(2^mLN)$ number of quantum gates. Here, $m$ represents the number of qubits (e.g., 6) involved in the phase register of the phase estimation algorithm.


In 2005, the National Environmental Education and Training Foundation (NEETF) released a summary of a decade's worth of research into environmental literacy among Americans, collected in collaboration with Roper Reports. The report included some disturbing statistics: 45 million Americans think the ocean is a fresh-water source, for example, and only 12% of those surveyed were able to pass a basic quiz on energy awareness. As the report's author laments, "Our years of data from Roper surveys show a persistent pattern of environmental ignorance even among the most educated and influential members of society" (Coyle v). Like most Americans, honors students are often only superficially aware of environmental concerns. Those who have developed some degree of environmental awareness may be praised or derided for "thinking outside the box," but as Amory Lovins, an energy analyst, argues, "There is no box" (qtd. in Brown xi). We are at a tipping point in our human interactions with nature, a crisis that demands we be more attentive than ever to interconnections and systems-thinking and move beyond the compartmentalization of knowledge that is characteristic of many university curricula. For this reason, among others, our recent favorable accreditation review at Kennesaw State University was based in part on our success in promoting global learning and appreciation for diversity across campus. While the institution passed that review with no difficulty, the assessment of programs across campus continues to focus on whether global learning and diversity are being adequately addressed. As an honors director who is also co-directing the new Interdisciplinary Studies Program on our campus, chairing the university-wide Environmental Concerns Committee, and sitting on the President's Climate Commitment Board, I feel an especially urgent need to combine global learning with environmental learning, so two years ago I set out to design a course that would encourage honors students to analyze environmental issues more closely through the lens of world religions and cultures. GOALS AND COURSE DEVELOPMENT The challenge of developing a semester-length course on such a broad topic was intensified by the relative cultural homogeneity of KSU students. My institution is located in the northwest quadrant of the metro Atlanta area, and its 21,000 students come primarily from northwest Georgia and southern Tennessee. Many also come from conservative religious backgrounds, and these students typically consider responding to environmental concerns less important than advancing their positions on specific social issues and maintaining a strong sense of exclusivity. Even those who brand themselves as more broad-minded nurse misconceptions about other religions. As I considered all these factors, I decided to design a course curriculum that would meet our accreditation criteria and also raise the level of environmental literacy among our honors students. Fortunately, I received an internal grant to design the course and in the summer of 2007 spent six weeks in Oxford, England reading everything from scientific literature on global warming to books and articles on environmental philosophy. I emerged with a broader and more informed perspective on the complexities of ameliorating environmental ills. As scholars from Lester Brown, President of the Earth Institute, to the Dalai Lama have observed, aggressive advances in technology must also be accompanied by changes in cultural awareness and practical efforts to live more sustainably. These became the touchstones of my honors seminar, "Spirit and Nature: Religion and Environmental Values," taught as Honors 2290, a lower-level "special topics" course (a general designation for a wide variety of innovative courses offered in the program) for all levels of honors students, from those in our joint-enrollment honors program to college seniors. Of the thirteen students who enrolled, the oldest student in my class was forty-one, the youngest seventeen. …


Endometrial cancer (EC) is the most common neoplasm of the female genital tract. Although immunohistochemical methods have been used for detecting several biomarkers for several cancer types, this method is still underutilized in EC. We conducted this review to identify the currently available published evidence to support the utilization of immunohistochemical for p53 protein overexpression as prognostic and predictive biomarkers of disease outcomes in endometrioid endometrial carcinoma.


Although the small intestine constitutes over 75% of the length and 90% of the mucosal surface of the gastrointestinal tract, small intestine cancer is rare and accounts for only 1% of gastrointestinal malignancies (1, 2). Adenocarcinoma together with carcinoid tumours are the most common histological types of primary malignant tumours of the small bowel but other, including lymphoma and leiomyosarcoma, may less frequently be encountered. Adenocarcinomas are predominantly located in the duodenum. Primary adenocarcinoma of the duodenum is a rare malignant tumor, accounting for 0.30.5% of all gastroenteral malignancies (3, 4). The diagnosis of primary adenocarcinoma of duodenum is often delayed because its symptoms and signs are nonspecific (5). In this work we want to focus on the diagnostic and therapeutic problems of duodenal adenocarcinoma, by a case report.


The longitudinal optical (LO) phonon energy in AlGaN/GaN heterostructures is determined from temperature-dependent Hall effect measurements and also from Infrared (IR) spectroscopy and Raman spectroscopy. The Hall effect measurements on AlGaN/GaN heterostructures grown by MOCVD have been carried out as a function of temperature in the range 1.8-275 K at a fixed magnetic field. The IR and Raman spectroscopy measurements have been carried out at room temperature. The experimental data for the temperature dependence of the Hall mobility were compared with the calculated electron mobility. In the calculations of electron mobility, polar optical phonon scattering, ionized impurity scattering, background impurity scattering, interface roughness, piezoelectric scattering, acoustic phonon scattering and dislocation scattering were taken into account at all temperatures. The result is that at low temperatures interface roughness scattering is the dominant scattering mechanism and at high temperatures polar optical phonon scattering is dominant.


Differential evolution algorithm (differential evolution, DE) is a multi-objective evolutionary algorithm based on groups, which instructs optimization search by swarm intelligence produced by co-operation and competition among individuals within groups. While it can track the dynamics of the current search by the DE specific memory, in order to adjust their search strategy. The strong global convergence and robustness of the characteristics can solve the complex optimization problem which it hardly solves with the mathematical programming methods. This paper presents it to the research of short-term scheduling of hydro plant. Accord to the application of the hydro unit, the results shows that reasonable and effective.


Stroke is a common cause of life-long disability in surviving patients. Despite improvements in neurologic deficits, stroke survivors remain with important limitations on participating in social activities, on reintegrating into family, community and working life which could trigger psychological problems and a decreased quality of life (QoL). An important issue in post-stroke rehabilitation is improvement of patient's quality of life. Introduction: The assessment of the Quality of Life could be an indicator of the effectiveness of the post–stroke rehabilitation. One simple instrument for assessment of Qol is the Quality of Life Scale (QOLS), created by John Flanagan, which has been adapted for use in chronic illness groups, a higher score indicating higher quality of life. An important instrument for improving QoL of stroke patients is combined rehabilitation therapy in a balneoclimacteric resort or in a rehabilitation hospital. This study aimed to monitor the efficacy of these natural therapeutic factors, used in conjunction with classical neurorehabilitation methods in post-stroke patients Material and method: We performed a prospective longitudinal analysis in 50 post-stroke patients which performed rehabilitation treatment: the first group of 20 patients performed only kinesitheraly, massages, occupational therapy during 15 days at Rehabilitation Hospital Cluj, and the second group of 30 patients performed the same treatment during 15 days, in association with with carbonated mineral water baths and walking at Tușnad Spa Complex SA treatment facility in Băile Tușnad. Quality of Life of both group of patients was assessed using the QOL Scale. Results: Both groups showed statistically significant improvements in the QoL as shown by comparing the mean score before and after treatment by the paired T test, with a p value of < 0,05 in both groups. Conclusion: Rehabilitation treatment improve the qualty of life in stroke survivors. The use of natural therapeutic factors (mineral water baths and bioclimate), in conjunction with kinesitherapy, occupational therapy and massotherapy, significantly improved the quality of life in stroke patients.


Because of the large shrinkage of the mortar used for external thermal insulating materials, in order to reduce the shrinkage, the ordinary Portland cement and rapid hardening sulphoaluminate cement is used to make mortar in this paper. The experimental results show that whether added the UEA expensive agent, or without the expensive agent, compounding of ordinary Portland cement and rapid hardening sulphoaluminate cement could significantly reduce the shrinkage of mortar, but the compressive strength and flexural strength of the mortar specimen reduce at the same time, and when the rapid hardening sulphoaluminate cement accounted for 30%, the strength of the specimen is the lowest. Moreover, the setting time of the PO-SAC system is very short, so the research is needed to continue whether this kind of mortar is suitable to engineering application.


Control automation can reduce human workload by automating routine operations such as system reconfiguration and anomaly handling. Humans need assistance in interacting with these automated control agents. We have developed the Distributed Collaboration and Interaction (DCI) system, an environment in which humans and automated control agents work together. Within this environment, we provide personal liaison agents, called Ariel agents, for each human in a group to assist them in performing the duties associated with the roles they perform for that group. We have deployed the DCI system at NASA's Johnson Space Center (JSC) to assist control engineers in performing duties associated with crew water recovery systems. In this paper we describe the water recovery system in the Water Research Facility (WRF) at JSC, the DCI system we developed, and our experiences in deploying DCI for use in the WRF.


Among malignant neoplasms, kidney cancer occupies one of the first places in terms of the growth rate of incidence in Russia. Despite the possibilities of modern diagnostic research methods, the number of patients with common forms of the disease does not decrease. In 5–10% of cases, renal cell carcinoma is complicated by the formation of a tumor clot in the inferior Vena cava (VCI), which requires volume surgery — nephrectomy with thrombectomy, which is the only effective treatment option for this group of patients. Previously, the results of treatment of locally advanced kidney cancer were unsatisfactory due to the high incidence of complications and mortality after extended surgical interventions. However, improving the operation technique requires a re-evaluation of previous representations. Performing a nephrectomy with a VCI thrombectomy is not an easy task and is often associated not only with technical difficulties due to the need for mobilization, control and resection of the inferior Vena cava, but also with the risk of intra — and postoperative complications. The most difficult task is the choice of surgical tactics for descending non-tumor hemorrhagic thrombosis. As a result of long-term tumor obstruction, organized blood clots that are soldered to the intima of the vessel often spread to the common iliac veins and, as a rule, are technically impossible to remove. If the VCI is preserved, a residual hemorrhagic blood clot in the area of its confluence is a potential source of pulmonary embolism (PE), for the prevention of which mechanical plication is used. This maneuver does not lead to the development of clinically significant chronic venous insufficiency of the lower extremities (CVI NC), postoperative VCI or PE thrombosis. Despite the technical complexity of the operation and the difficult course of the postoperative period, surgical treatment of renal cell cancer complicated by tumor thrombosis is certainly justified. This article presents a clinical case of surgical treatment of a patient with renal cell cancer complicated by massive specific (tumor) and non-specific thrombosis in the presence of reduced parenchymalexcretory function of the contralateral kidney and severe cardiac pathology. Goal: to share experience and demonstrate the results of successful surgical treatment of renal cell carcinoma.


This thesis gives a thorough introduction to the infinite graphs known as Bratteli diagrams and their two most common uses — namely as a means of representing AF-algebras in a combinatorial way and as a way of modeling Cantor minimal systems. The thesis is therefore naturally divided into two parts. In the first part, the machinery needed study AF-algebras is introduced, in particular the structure theorem for finite-dimensional C∗-algebras is proved from first principles, and direct limits of finite-dimensional C∗-algebras are constructed. We show how an AF-algebra can be represented by a Bratteli diagram and how information about the AF-algebra may be extracted from its Bratteli diagram. In particular we demonstrate how the ideals of an AF-algebra may be read off its Bratteli diagram and also how the Bratteli diagrams of isomorphic AF-algebras are related. Some classic examples of AF-algebras are given, and their Bratteli diagrams are computed and used to illustrate the general theory. In the second part, ordered Bratteli diagrams are introduced and we construct the associated Cantor minimal systems, known as Bratteli-Vershik systems. The associated dimension groups are also briefly introduced. We give the full proof of the model theorem for Cantor minimal systems.


Objective: The aim of the study was to analyze clinical characteristics of the consecutive sample of patients with atrial fibrillation (AFib) who were admitted to the UHC Zagreb Cardiology Clinic, part of the ESH Excellence centre of hypertension. This cohort is part of the ESH –FA project. Design and method: Consecutive sample of 201 patients with AFib (115 M, 86 F; averaged age 71.6) was enrolled in period 2014–2016. Data were collected from medical records. BP was measured following the ESH/ESC guidelines. Hypertension (HT) was defined as BP >  = 140/90 mmHg and/or antihypertensive drugs treatment, chronic kidney disease (CKD) was defined as eGFR (CKD Epi < 60 ml/min). Results: Average BP values and heart rate were 133.5/80.2 mmHg, 82.2 bpm, and BMI was 31.1 kg/m2, there were 19.6% and 11.5% smokers and ex-smokers, respectively. CHD, cerebrovascular disease, heart failure, valvular disease, PAD, hypothyreosis, and CKD were established in 52.7%, 17.9%, 49.3%, 29.3%, 13.9%, 14.4% and 52.5%, respectively. Family history for CVD was positive in 43.2% patients. Prevalence of HT was 83.5%, and 63.7% were treated, while 20% were newly diagnosed. Only 30.2% HT had BP < 140/90 mmHg. Most frequently used antihypertensive drugs were beta blockers (67.6%), loopD (54.7%), ACEi (50.7%), potassium-sparingD (22.8%) and thiazide-likeD (17.9%). LoopD were prescribed more frequently in patients with CKD than in non-CKD as well as in HF than in non-HF patients. Hypokalemia was noticed in 18.9% patients and was mostly reported in non-HF patients (41.1%); it was associated with overuse of loopD and underuse of potassium-sparingD. First diagnosed, paroxysmal, permanent and persistent AFib were diagnosed in 5.4%, 33.3%, 51.2% and 10.4%, respectively. CHADVASC > 2 was determined in 78.9%; varfarin and NOAC were administered in 64.4% and 35.6% patients, respectively. In patients treated with varfarin INR > 2 was achieved in only 35.4%. Conclusions: Better BP control and anticoagulation with more frequent use of NOACs is needed. Physicians must be aware of high prevalence of CKD in AFib patients and consequent drug dose adjustments.


This paper investigates the dynamic effects of monetary and fiscal policy in a monetary union, which is characterized by asymmetric interest rate transmission. This asymmetry gives rise to intertemporal reversals in the relative effectiveness of policy on member country outputs. The direction and the number of these reversals depend on whether policies are unanticipated or anticipated. We also study the coordination between monetary and fiscal policy in a monetary union. Monetary policy may completely stabilize European output after unanticipated fiscal policy shocks. With anticipated fiscal policy shocks, complete stabilization throughout the overall adjustment process requires monetary policy to be time-inconsistent.


The effectiveness of sodium hypochlorite 2.5%, used to remove of the infected pulp endodontic flora was tested in vitro with three irrigation methods. Root canals of freshly extracted teeth infected were treated as follows: the first group was irrigated with a conventional manual syringe, the 2nd group received a passive ultrasonic irrigation (PUI) and the 3rd group was treated with Nd: YAP. A bacteriological sample was taken on each tooth before and after treatment using sterile paper points, these points were immediately placed in sterile petri dishes containing agar cooked (GSC) blood and incubated anaerobically at 37°C for 48 h. The bacteriological study was performed according to standard molecular biology. Analysis of the results was carried out with the software epi-info3.3.2.le rate is retained signifiance p<0.005. The results showed the superior efficacy of PUI and laser eradication endodontic flora compared to conventional irrigation.


The body's immune system is impressively good at coping with external and internal errors, usually known as bacteria and viruses. The body is able to distinguish the haemoglobin found in blood from the insulin secreted by the pancreas from the vitreous humor contained in the eye from everything else. It must manage to repel innumerable different kinds of invading organisms and yet not attack the body. The question to be answered is can we mimic these mechanisms in the design of our computer systems? This paper gives some details on how the body actually performs this amazing feat and gives some suggestions as to how this might inspire our design of computer systems increasing their reliability-immunotronics.


Abstract. The identification of optimum model parameters may be influenced by temporal or event-specific changes of optimum parameter ranges and the length and information content of calibration data. These effects were studied for the hydrological model WaSiM-ETH in a 170 km2 catchment. Based on a Monte-Carlo simulation including seven model parameters, we investigated temporal and state dependent changes of parameter identifiability using the DYNIA algorithm. The effect of data length was studied using a modified DYNIA approach based on a growing window algorithm. The DYNIA analysis revealed temporal changes of identifiability for the snow melt runoff parameter cmelt, which is only identifiable during winter runoff, and for the drainage density parameter drd. The drd parameter was closely related to observed discharge (or catchment moisture), when re-ordering the time series by discharge. Such dependencies probably result from processes not included in model equations. The growing window analysis shows that more than one year of data did not result in improved identification of model parameters cmelt and drd. Using the re-ordered data series, good identifiability of cmelt was bound to high discharges, while identifiability of drd changed with the addition of further values in descending or ascending order. The methodology revealed structural problems with regard to the parameter drd, which are not yet completely understood and require further investigation.


Objectives: The aim of this study was to compare the canal debridement capabilities of three single file systems, ProTaper, and K-files in oval-shaped canals. Materials and Methods: Seventy-five extracted human mandibular central incisors with oval-shaped root canals were selected. A radiopaque contrast medium (Metapex; Meta Biomed Co. Ltd., Chungcheongbuk-do, Korea) was introduced into the canal systems and the self-adjusting file (SAF), WaveOne, Reciproc, ProTaper, and K-files were used for the instrumentation of the canals. The percentage of removed contrast medium was calculated using pre- and post-operative radiographs. Results: An overall comparison between the groups revealed that the hand file (HF) and SAF groups presented the lowest percentage of removed contrast medium, whereas the WaveOne group showed the highest percentage (P < 0.001). The ProTaper group removed more contrast medium than the SAF and HF groups (P < 0.05). Conclusions: None of the instruments was able to remove the contrast medium completely. WaveOne performed significantly better than other groups.


Although in Italy most Long-Term Care is still provided in kind by unpaid informal caregivers, families are less and less likely to be in the condition to care for a disabled elderly. Given the social and financial implications associated with this trend, there is a growing interest in understanding the determinants of family decisions regarding living arrangements of the elderly, in order to implement effective policy measures aimed at containing costs and to enhance the quality of care. We estimate the effects of various household and individual characteristics on the choice of living care arrangement, considering a representative population sample of the Italian region Emilia Romagna. We exploit detailed information on the health conditions of the elderly person, on household socio-economic status and on family attitudes towards current welfare state services in order to identify the main determinants of the choice between institutionalisation and home care. Our results outline the predominance of disability indicators as opposed to family characteristics, economic variables and public services availability in determining the decision of the family. In an context in which social norms about filial responsibility still tend to consider the elderly institutionalisation with a consistent amount of social stigma, the institutionalisation is strictly influenced by the growing functional or cognitive impairments of the elderly and, to a lower extent, by economic status. Partly different from the international empirical literature, wealthier households have a larger probability to opt for the residential alternative


Methicillin-restitant Staphylococcus aureus (MRSA) is very dangerous bacteria and one of
the most feared nosocomial germs. In this study, acacetin was evaluated against
20 clinical isolates of MRSA, either alone or in combination with antibiotics.
The acacetin exhibited a good activity against isolates MRSA with MICs/MBCs
ranged between 10-80/20-160 μg/mL, for ampicillin 64-1024/128-2048 μg/mL, and for oxacillin 8-32/16-64 μg/mL. The combination of acacetin plus
oxacillin or ampicillin was reduced by ≥4-fold against isolates MRSA tested, evidencing a
synergistic effect as defined by a FICI of ≤0.5. Furthermore, a
time-kill study evaluating the growth of the tested bacteria was completely
attenuated after 2-5 h of treatment with the 1/2 MIC of acacetin,
regardless of whether it was administered alone or with oxacillin (1/2 MIC) or
ampicillin (1/2 MIC). In conclusion, acacetin exerted synergistic effects when
administered with oxacillin or ampicillin and the antibacterial activity and
resistant regulation of acacetin against clinical isolates of MRSA might
be useful in controlling MRSA infections.


In this paper, we will show that, for elliptic problems in heterogeneous media, there exists a local (generalized) finite element basis (AL basis) consisting of $O\big( \big( \log\frac{1}{H}\big) ^{d+1}\big)$ basis functions per nodal point such that the convergence rates of the classical finite element method for Poisson-type problems are preserved. Here H denotes the mesh width of the finite element mesh and d is the spatial dimension. We provide several numerical examples beyond our theory, where even $O(1)$ basis functions per nodal point are sufficient to preserve the convergence rates.


Purpose – This chapter examines how gender, parenthood, and partner's employment are related to individual's employment patterns, analyzing paid work at individual and household levels.

Methodology/approach – Analyses use individual-level data from the Luxembourg Income Study (LIS) wave 5 for 19 countries, for adults aged 25–45. We use logistic regression and a two-stage Heckman sample selection correction procedure to estimate the effects of gender and parenthood on the probabilities of employment and full-time employment.

Findings – The variation between mothers and childless women is larger than that between childless men and childless women; differences in women's employment patterns are driven by gendered parenthood, controlling for women's human capital, partnered status and household income. Fathers and mothers' employment hours in the same household vary cross-nationally.

Mothers' employment behaviors can identify important differences in the strategies countries have pursued to balance work and family life.

Research implications – Important differences between childless women and mothers exist; employment analyses need to recognize the variation in employment hours among women, and how women's hours are related to partners' hours. Further research should consider factors that shape employment cross-nationally, as well as how these relate to differences in wages and occupational gender segregation.

Practical implications – Employment choices of women and mothers must be understood in terms of employment hours, not simply employment, and within the context of partners' employment.

Originality/value of paper – Our chapter clarifies the wide dispersion of employment hours across countries – and how men's and women's employment hours are linked and related to parenthood.


Abstract Raman spectroscopy was assessed for its ability to rapidly identify asbestos phases by submitting the amphiboles anthophyllite, amosite, crocidolite and tremolite to spectroscopic analysis. All the phases were characterized by using XRD, SEM, TEM (CTEM, SAED), AEM and EDS techniques. This study demonstrates that accurate identification of the mineralogical phase can be attained by analysing the position in the Raman spectrum of the bands corresponding to the symmetric stretching modes (vs) and to the antisymmetric stretching modes (vas) of the different Si-O linkages. Raman spectroscopy thus proves to be an effective technique for rapidly distinguishing the different fibrous minerals examined.


In recent years, male students disciplined for sexual harassment have brought Title IX lawsuits against their schools, arguing that they experienced anti-male gender discrimination. Several circuits have allowed these students' reverse-discrimination suits to sidestep the usual barriers erected to throw traditional civil rights suits out of court. Specifically, these courts have allowed these plaintiffs, and these plaintiffs alone, to treat alleged mistreatment of a non-sex-based class as sex discrimination; to ignore strict, judicially-imposed limits on the use of comparators to show discrimination; and to rely on evidence of alleged bias lacking any nexus to an adverse action. This Article traces an emerging trend among lower courts by which Title IX has become a more powerful tool for men accused of sexual harassment than for victims and other members of marginalized groups.

Some courts justify this apparent double standard by arguing that federal enforcement of Title IX creates an actionable climate of anti-male sex discrimination. This backward reasoning suggests that civil rights enforcement is a form of discrimination against dominant groups. As this Article argues, this reasoning is both incorrect and dangerous: If courts continue treating civil rights' agencies work to remedy discrimination as evidence of discrimination against dominant groups, they will frustrate the enforcement and promise of all anti-discrimination statutes.


Public health education is experiencing record growth and transformation. The current emphasis on learning outcomes necessitates attention to creating and evaluating the best curricula and learning methods for helping public health students develop public health competencies. Schools and programs of public health would benefit from active engagement in pedagogical research and additional platforms to support dissemination and implementation of educational research findings. We reviewed current avenues for sharing public health educational research, curricula, and best teaching practices; we identified useful models from other health professions; and we offered suggestions for how the field of public health education can develop communities of learning devoted to supporting pedagogy. Our goal was to help advance an agenda of innovative evidence-based public health education, enabling schools and programs of public health to evaluate and measure success in meeting the current and future needs of the public health profession.


The issues about security of the system and the device are still to be a potential topics in computer technology and networking. The fingerprint image as a kind of human biometric features has been used for over a century and the most widely used for personal recognition in civil, forensic, and commercial areas. In this paper is discussed the latest in trend in fingerprint recognition is viewed from the category of fingerprint images, namely; patent, impressed, and latent. The survey of various research articles indicated that opportunities in the fingerprint identification, particularly the problems in fingerprint image enhancement are topic that potential for researched.


The Relationship Between Gesture and Speech Predicts Who Will Learn to Solve a Chemistry Problem Raedy Ping University of Chicago Elena Zinchenko University of Chicago Samuel Larson University of Chicago Mary-Anne Decatur University of Chicago Susan Goldin-Meadow University of Chicago Abstract: When children explain their answers to tasks that they have yet to master, some produce gestures that include additional information not found in their speech. These children are likely to benefit from instruction in the task. Here we investigate the possibility that different types of gesture-speech relationships might index readiness to learn for adult novice learners. Adults, na¨ive to organic chemistry, were asked to create stereoisomers of molecules, a task that requires mentally transforming and drawing an alternative spatial arrangement of parts of the molecule. Adults whose gestures added correct information to the information conveyed in speech at pretest were more likely to learn on the task than adults whose gestures did not add information or added incorrect information. These findings suggest that, even for adult learners and complex tasks, gesture reveals implicit knowledge about the task at hand and can be used to identify who is ready to learn.


The article starts by identifying the main institutional components of the (elusive) concept of Social Europe: the 'National Social Spaces', i.e. the social protection systems of the member states; the 'EU Social Citizenship Space', i.e. the coordination regime that allows all EU nationals to access the social benefits of other member states when they exercise free movement; the 'Regional Social Spaces', i.e. sub-national and/or trans-regional social policies; and the 'EU Social Policy' proper. Based on such reconceptualisation, the article then revisits the main analytical insights and substantive findings of the volume's contributions, focusing in particular on dynamics of 'social re-bounding' during the crisis, on national implementation processes, on the relevance of 'fits' and 'misfits' for social policy compliance and on issues of democratic control. In the conclusion, some suggestions for future research and for the EU's social agenda are put forward.


PP1 (protein phosphatase 1) is among the most conserved enzymes known, with one or more isoforms present in all sequenced eukaryotic genomes. PP1 dephosphorylates specific serine/threonine phosphoproteins as defined by associated regulatory or targeting subunits. In the present study we performed a PP1-binding screen to find putative PP1 interactors in Arabidopsis thaliana and uncovered a homologue of the ancient PP1 interactor, I-2 (inhibitor-2). Bioinformatic analysis revealed remarkable conservation of three regions of plant I-2 that play key roles in binding to PP1 and regulating its function. The sequence-related properties of plant I-2 were compared across eukaryotes, indicating a lack of I-2 in some species and the emergence points from key motifs during the evolution of this ancient regulator. Biochemical characterization of AtI-2 (Arabidopsis I-2) revealed its ability to inhibit all plant PP1 isoforms and inhibitory dependence requiring the primary interaction motif known as RVXF. Arabidopsis I-2 was shown to be a phosphoprotein in vivo that was enriched in the nucleus. TAP (tandem affinity purification)-tag experiments with plant I-2 showed in vivo association with several Arabidopsis PP1 isoforms and identified other potential I-2 binding proteins.


Federation of Contractor Associations of Nepal (FCAN) has asked the government to amend the law so that bidders quoting the average price would be awarded the contract. The competitive bidding process for awarding construction contracts in Nepal is based on the low bid method. According to this method, the construction firm submitting the lowest bid receives the right to the construction contract. Promoting competition amongst contractors and maintaining transparency are the clear benefits but delays in meeting the contract duration, increment of the final project cost, tendency to compromise quality, and adversarial relationship among contracting parties are the major drawbacks.As alternative of low bid method, some countries are using Average bid method.In this method, contract is awarded to the contractor whose price is closest to the average of all bids submitted. It is assumed that with a fair price they would conform to quality requirements of the project, would complete on time, and would not have adversarial relationships with the consultant of the employer. Awarding tenders to the lowest bidders is the major reason behind lingering construction projects and failure in meeting its standards in Nepal. To avoid such problems, Average bid Award system may be practiced by public agencies for procurement of works in Nepal. DOI: http://dx.doi.org/10.3126/jie.v10i1.10889 Journal of the Institute of Engineering, Vol. 10, No. 1, 2014, pp. 130–139


Our ability to generalize beyond training data to novel, out-of-distribution, image degradations is a hallmark of primate vision. The predictive brain, exemplified by predictive coding networks (PCNs), has become a prominent neuroscience theory of neural computation. Motivated by the recent successes of variational autoencoders (VAEs) in machine learning, we rigorously derive a correspondence between PCNs and VAEs. This motivates us to consider iterative extensions of VAEs (iVAEs) as plausible variational extensions of the PCNs. We further demonstrate that iVAEs generalize to distributional shifts significantly better than both PCNs and VAEs. In addition, we propose a novel measure of recognizability for individual samples which can be tested against human psychophysical data. Overall, we hope this work will spur interest in iVAEs as a promising new direction for modeling in neuroscience.


Specific gravity tests were performed on chromium ore processing residue (COPR), an expansive industrial byproduct of the historical processing of chromite ore, to determine if the complexity and heterogeneity of the particle microstructure may cause erroneous specific gravity results using ASTM D854-06 Method B as the baseline procedure. In complex, reactive industrial residuals such as COPR, specific gravity is an important indicator of the extent of weathering that has occurred. Specific gravity for weathered hard-brown (HB) COPR significantly differs from that of unweathered gray-black (GB) COPR, and laboratory testing can indicate the position of COPR along the GB to HB pathway. The difference between a "true" and an "apparent" specific gravity that accounts for the inclusion of closed pores was determined. Oven-drying of COPR at the ASTM standard temperature of 110±5°C does not cause mineral dehydration to affect specific gravity results. The apparent (avg.=3.146) and true (avg.=3.355) specific gravities of GB COPR are statistically different and should be reported as such. Pre-processing of GB COPR by mechanical grinding is necessary to open intraparticle voids, determined to be 6.2 % by volume, to the atmosphere and thus approach the true specific gravity.


STUDY QUESTION
Are Swedish women age 40-44 years with assumed early menopause 'undertreated' by hormone therapy (HT)?

SUMMARY ANSWER
Many women with probable early menopause discontinue their HT after a short period of time. Thus, they fail to complete the recommended replacement up to age 51-52 years, the average age of menopause.

WHAT IS KNOWN ALREADY
Spontaneous early menopause occurs in ∼5% of women age 40-45 years. Regardless of the cause, women who experience hormonal menopause due to bilateral oophorectomy before the median age of spontaneous menopause are at increased risk of cardiovascular disease, neurological disease, osteoporosis, psychiatric illness and even death.

STUDY DESIGN, SIZE, DURATION
The study is descriptive, and epidemiological and was based on the use of national registers of dispensed drug prescriptions (HT) linking registers from the National Board of Health and Welfare and Statistics Sweden from 1 July 2005 until 31 December 2011.

PARTICIPANTS/MATERIALS, SETTING, METHODS
The study population consisted of 310 404 women, 40-44 years old on 31 December 2005 who were followed from 1 July 2005 until 31 December 2011.

MAIN RESULTS AND THE ROLE OF CHANCE
Only 0.9% of women 40-44 years old started HT during the study period. A majority of these women used HT <1 year.

LIMITATIONS, REASONS FOR CAUTION
We do not know the indications that led to the prescription of HT but assume that early onset of menopause was the main reason. Because of the study design-making a retrospective study of registers-we can only speculate on the reasons for most of the women in this group discontinuing HT. Another limitation of this study is that we have a rather short observation time. However, we have up to now only been able to collect and combine the data since July 2005.

WIDER IMPLICATIONS OF THE FINDINGS
As the occurrence of spontaneous early menopause in women age 40-45 is reported to be ∼5%, the fact that <1% of Swedish women age 40-44 are prescribed HT, and can be shown also to have had the medication dispensed at a pharmacy suggests an unexpectedly low treatment rate. Some women with early menopause may have used combined contraceptives as supplementation therapy, but in Sweden HT is the recommended treatment for early menopause so any such women are not following this recommendation. Women who experience early menopause are at increased risk for overall morbidity and mortality, and can expect to benefit from HT until they have reached at least the median age of spontaneous menopause. It is therefore important to individualize the information given these women and to convey new knowledge in this area to gynaecologists and physicians in general as well as the recommendation that women in this group continue HT at least until the average age for spontaneous menopause is reached.

STUDY FUNDING/COMPETING INTERESTS
No competing interests exist.