Poor management of water and sanitation resources are impediments to achieving the Millennium Development
Goals (MDGs). MDG targets met with high breakdown rate of water points will be meaningless. Much
as coverage of safe water is estimated at 72% in Malawi, nearly 30% are not functional at any given time.
Community based management (CBM) approach is the answer to achieve sustained beneficial outcomes. This
paper aims to provide water professionals with knowledge on how CBM works from Malawi's own experience
using Mpira/Balaka Piped Water Supply Scheme as a case example. Experience-Sharing Workshops, earlier
analyses documented by the Government of Malawi, other recent publications supplemented by author's
own personal experience informed the study. Engaging the communities in all stages of the development
project is seen as practical solution to meet meaningful MDG targets especially in the developing world. In
conclusion, CBM works very well and has multiplier effect on rural development.


This study evaluated fatigue crack growth characteristics, Besides consider compressive residual stress effect and verified the most suitable shot peening velocity. Fatigue crack growth delay effect was compressive residual stress, but over peening did action projecting velocity that accelerate fatigue crack growth rate. X-ray diffraction technique according to crack length direction was applied to fatigue fractured surface. Fracture mechanics parameters could be estimated by the measurement of X-ray parameters, and the fractography observation was performed using a scanning electron microscope (SEM) for fatigue fracture surface. As the shot peening velocity increases, striation width increased. The changes in X-ray material parameters described above are directly related to the process of fatigue until the initiation of fatigue crack and X-ray diffraction pattern is thought that failure prediction with stress distribution is possible.


This article explores the conceptual, methodological, and practical implications of research on state crimes against democracy (SCADs). In contrast to conspiracy theories, which speculate about each suspicious event in isolation, the SCAD construct delineates a general category of criminality and calls for crimes that fit this category to be examined comparatively. Using this approach, an analysis of post—World War II SCADs and suspected SCADs highlights a number of commonalities in SCAD targets, timing, and policy consequences. SCADs often appear where presidential politics and foreign policy intersect. SCADs differ from earlier forms of political corruption in that they frequently involve political, military, and/or economic elites at the very highest levels of the social and political order.The article concludes by suggesting statutory and constitutional reforms to improve SCAD prevention and detection.


We analyze a simple endogenous growth model with environmental interactions. Economic production generates emissions of pollutants whose environmental impact is mitigated by abatement activities financed by government expenditure; environmental quality affects preferences but does not play any productive role. We show that government intervention, by reallocating resources from capital accumulation to environmental preservation activities, allows the economy to achieve a sustainable balanced growth path. Along such a path, softer environmental policy regimes lead to win–win outcomes, fostering economic growth and improving environmental quality. Such a result needs to be interpreted as a long run outcome, but it clearly shows that the compatibility between economic growth and environmental improvement is far from automatic. Indeed, in the long run it could paradoxically be the case that both the economy and the environment benefit from low levels of environmental protection.


This article revisits Francis's vision of politics as one of the highest forms of charity. It argues that Francis's concept of "political charity" goes beyond a mere repetition of classical church social teaching on politics to ground a spirituality for Christian politicians. He does this mainly in two ways: the first is by inscribing the main Christian virtue of love at the heart of political practice; the second is by portraying both politics and economics as Christian vocations to be embraced as noble paths to holiness. Finally, I introduce an African perspective into the discussion for context and illustration.


The importance of intensity resolution in terms of the number of intensity steps needed for speech recognition was assessed for normal-hearing and cochlear implant listeners. In experiment 1, the channel amplitudes extracted from a six-channel continuous interleaved sampling (CIS) processor were quantized into 2, 4, 8, 16, or 32 steps. Consonant recognition was assessed for five cochlear implant listeners, using the Med-El/CIS-link device, as a function of the number of steps in the electrical dynamic range. Results showed that eight steps within the dynamic range are sufficient for reaching asymptotic performance in consonant recognition. These results suggest that amplitude resolution is not a major factor in determining consonant identification. In experiment 2, the relationship between spectral resolution (number of channels) and intensity resolution (number of steps) in normal-hearing listeners was investigated. Speech was filtered through 4-20 frequency bands, synthesized as a linear combination of sine waves with amplitudes extracted from the envelopes of the bandpassed waveforms, and then quantized into 2-32 levels to produce stimuli with varying degrees of intensity resolution. Results showed that the number of steps needed to achieve asymptotic performance was a function of the number of channels and the speech material used. For vowels, asymptotic performance was obtained with four steps, while for consonants, eight steps were needed for most channel conditions, consistent with our findings in experiment 1. For sentences processed though 4 channels, 16 steps were needed to reach asymptotic performance, while for sentences processed through 16 channels, 4 steps were needed. The results with normal-hearing listeners on sentence recognition point to an inverse relationship between spectral resolution and intensity resolution. When spectral resolution is poor (i.e., a small number of channels is available) a relatively fine intensity resolution is needed to achieve high levels of understanding. Conversely, when the intensity resolution is poor, a high degree of spectral resolution is needed to achieve asymptotic performance. The results of this study, taken together with previous findings on the effect of reduced dynamic range, suggest that the performance of cochlear implant subjects is primarily limited by the small number (four to six) of channels received, and not by the small number of intensity steps or reduced dynamic range.


The ALPS ePortfolio project was funded by the Yorkshire and Humber Strategic Health Authority (SHA) to involve students in investigating the use, benefits and requirements of ePorfolios in health and social care education. It was undertaken by the ALPS CETL (www.alps-cetl.ac.uk), which involved 5 universities and 16 health and social-care professions. Sixteen students were employed to work on the project, reviewing ePortfolio use and designing an ideal ePortfolio for health and social care education.

The main project objectives were achieved; the project team identified benefits that could be achieved through ePortfolio use, wrote guidelines for the effective introduction of ePortfolios and agreed on the specification (a list of desired functionalities) for an ideal ePortfolio. In addition, the use of ePortfolios and reflective diaries increased within the student group and various approaches to championing ePortfolios (to both students and staff) were explored. The students enjoyed working as part of a project team alongside the academic staff; feeling that their work was valued and that they gained important skills and experiences from their involvement. The skills reported as being enhanced were in the common competency areas (teamworking, communication and interprofessional working) that the wider ALPS programme has been supporting.

The students identified two key pieces of further work they thought was needed in this area:
• To build the improved ePortfolio based on their specification.
• To integrate ePortfolios more effectively into the courses and the professions

Suggestions for integrating ePortfolios more effectively into their courses included:
• linking it to other key university systems (email and submissions) to encourage daily use
• ensuring that it provided a place where students could save and manage their own material as well as course reflections
• better support and use by staff so that the ePortfolio acted as an interface between students and staff and
• better links between HE and the professions' use of ePortfolios to ease the transition from education to the workplace

Improved linking between the HE and professional use of ePortfolios is an area that the ALPS CETL is in a good position to investigate further, as the CETL has involved collaboration between the universities and 16 health and social care professions. Work in this area could be taken forward by the ALPS ePortfolio network (ALPS 2010) which was set up in Autumn 2010.


This article discusses issues related to custodial sentences. It addresses jurists' arguments
against these sentences on the ground of their inconsistency with the aim of criminal
justice. The article is more concerned with the Muslim jurists' position; hence, it
focuses on examining the consistency of custodial sentences with maqasid al-Shariah to
determine their appropriateness to the enforcement of criminal justice and the safeguard
of public interest. It also assesses the consistency of this concept with the philosophy of
Islamic criminal law and the viability of its application in light of the concept of crime
and punishment. For this purpose, the article defines custodial sentences in contemporary
legislations. It then analyses the concept of imprisonment in the Quran and the Sunnah,
and the practices of the Companions. It also assesses the impacts of custodial sentences
in modern practices with the aim to identify the conditions and parameters for alternatives
to these custodial sentences within the framework of maqasid al-Shariah in general, and
the maqasid of punishments in particular. The article found that although considered as
necessary to establish justice and protect society, custodial sentences are not in line with the
Shariah principals and objectives. It also proposes a number of Maqasidi-driven parameters
that serve as building blocks for the implementation of alternative custodial sentences.


Jim Anderson became CEO of Cincinnati Children's Hospital Medical Center (CCHMC) in 1996, after serving on the Board of Cincinnati Children's for 20 years, including four years as Chairman. A lawyer and manufacturing executive by background, Jim has shepherded Cincinnati Children's to unprecedented levels of excellence in patient care, teaching and research. Cincinnati Children's ranks third among all paediatric hospitals in NIH-funded research, and is among the top 3 or 4 children's academic centres nationwide in scale and quality of teaching and care. A participant in the Robert Wood Johnson/IHI Pursuing Perfection initiative, CCHMC has earned an international reputation for quality, and in 2006 was awarded the McKesson Quest for Quality Prize in recognition of its extraordinary accomplishments. In particular, the AHA recognised Cincinnati Children's exceptional commitment to patient-centredness, and its achievement of stunning results (see table 1). Mr Anderson was interviewed in August 2006 about leadership for quality at Cincinnati Children's.

View this table:

 Table 1

JR: Jim, it's often said that the measure of leadership is results. What results are you most proud of?

JA: I get consistent feedback from throughout the organisation that everyone knows the transformational vision for Cincinnati Children's and the strategy for achieving that vision, and is engaged and enthusiastic about doing their part in getting there. What I'm most proud of is the depth and penetration of that engagement throughout the organisation, in every discipline and unit. That sort of engagement is essential for execution (the most challenging and most important aspect of any strategic plan).

JR: How do you know that engagement is present? Do you measure it somehow?

JA: The feedback loop I rely on comes in two forms: anecdotes and measured performance. I walk around the organisation keeping my senses tuned to …


The current demand of even more powerful and efficient microprocessors, for e.g. deep learning, has led to an ongoing trend of reducing the feature size of the integrated circuits. These processors are patterned with EUV-lithography which enables 7 nm chips [1]. To produce mirrors which satisfy the needed requirements is a challenging task. Not only increasing requirements on the imaging properties, but also new lens shapes, such as aspheres or lenses with free-form surfaces, require innovative production processes. However, these lenses need new deterministic sub-aperture polishing methods that have been established in the past few years. These polishing methods are characterized, by an empirically determined TIF and local stock removal. Such a deterministic polishing method is ion-beam-figuring (IBF). The beam profile of an ion beam is adjusted to a nearly ideal Gaussian shape by various parameters. With the known removal function, a dwell time profile can be generated for each measured error profile. Such a profile is always generated pixel-accurately to the predetermined error profile, with the aim always of minimizing the existing surface structures up to the cut-off frequency of the tool used [2]. The processing success of a correction-polishing run depends decisively on the accuracy of the previously computed dwell-time profile. So the used algorithm to calculate the dwell time has to accurately reflect the reality. But furthermore the machine operator should have no influence on the dwell-time calculation. Conclusively there mustn't be any parameters which have an influence on the calculation result. And lastly it should take a minimum of machining time to get a minimum of remaining error structures. Unfortunately current dwell time algorithm calculations are divergent, user-dependent, tending to create high processing times and need several parameters to bet set. This paper describes an, realistic, convergent and user independent dwell time algorithm. The typical processing times are reduced to about 80 % up to 50 % compared to conventional algorithms (Lucy-Richardson, Van-Cittert …) as used in established machines. To verify its effectiveness a plane surface was machined on an IBF.


The coastline of San Diego County, California, is characterized by steep seacliffs cut into 5 to 115 m high uplifted marine terraces. Over the past few decades, rapid population growth in the area has promoted a substantial increase in cliff-top development, despite a limited understanding of the long-term cliff erosion rates and their controlling factors. Wave erosion at the base of the seacliff is usually assumed to be a basic driving mechanism of coastal cliff retreat. We investigated the influence of waves on seacliff erosion by comparing high-resolution, long-term seacliff erosion rates to wave parameters (height, energy, and power or energy flux) in 10 m of water, the break-point, and at the cliff toe. Seacliff erosion rates range from 3.0 cm/yr in well-lithified Cretaceous sandstone to 43.0 cm/yr in unlithified Pleistocene sands. The wave parameters were calculated using the California Data Information Program (CDIP) Southern California Refraction-Diffraction Model (SCRDM), an empirical relationship for breaking wave height, and a new term we define as relative power at the cliff toe. Directional wave data from offshore South-Central California were used to initialize the model. The distribution of wave power in 10 m of water and at the breakpoint and cliff toe appears to be inversely related to historical seacliff erosion rates at our study sites. As a result, our findings suggest that waves, while an important mechanism of seacliff erosion, are secondary to material properties in the overall retreat of San Diego seacliffs. Along the San Diego coastline, material strength appears to largely determine seacliff stability and the rate and manner of retreat.


The expression of Japanese encephalitis virus (JEV) envelope gene in green cos leaf was a project undertaken at the John Innes Centre during 6 September to 20 October 2018 and is one of the projects of the research training program at the John Innes Centre during long vacation every year since 2010 until now.The summary of this research is as follows. The production of the envelope protein of the JEV in green cos by using the envelope gene expression by 8 epitopes (MEP: multiepitope) of Japanese encephalitis virus vaccine strain SA14-14-2 that provides the highest immune response against JEV. After incorporated the envelope gene into pEAQ-HT and pEAQ-HT-HBcAg-tEL vectors, we cloned genes in Escherichia coli and Agrobacterium tumefaciens, respectively, then expressed the envelope protein of JEV in green cos leaves. The result can be seen in photographs of green cos leaves by both visible light camera and ultraviolet light camera.Further research should include the analysis and identification by chemiluminescence immunoassay and by the Matrix-assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF). Further purification of the envelope protein expression of JEV in green cos that will be benefited for the production of the envelope protein of the JEV plant-based vaccine.Key words: Japanese encephalitis virus, plant-based vaccine, chemiluminescence immunoassay, MALDI-TOF


For professionals working with multilingual children, detecting language deficits in a child's home language can present a challenge. This is largely due to the scarcity of standardized assessments in many children's home languages and missing normative data on multilingual language acquisition. A common approach is to translate existing English language vocabulary measures into other languages. However, this approach does not take into account the cultural and linguistic differences between languages. This pilot study explored whether English and home-language receptive vocabulary skills can be objectively and reliably screened using a tablet application. Preliminary data on monolingual and multilingual vocabulary skills was collected from 139 children aged 6–7 years. A tablet application was designed to assess children's receptive vocabulary in both English and an additional eight languages using a four-choice picture paradigm. Linguistically controlled and pre-recorded target items are presented orally via the tablet in each language and responses are made via the touch screen and are automatically scored. The English version of the test was administered to 67 monolingual and 72 multilingual children, while 38 multilingual children also completed the test in their home language. Test criteria measures, including reliability and concurrent validity showed satisfactory results. These findings suggest that the tablet application could be a useful tool for professionals to screen receptive vocabulary skills in monolingual and multilingual children. Limitations of the first version of the receptive vocabulary screener and future steps are discussed.


Leeches are bloodsucking hermaphroditic parasites that attach to tissues using two muscular suckers, ingest large amounts of blood and may cause severe anaemia in the host. Two four-month-old mixed-breed dogs (one bitch and one male) were referred with anorexia, retching, hypersalivation and bleeding from the oral cavity. On physical examination, two live leeches were detected on the ventral aspect of the tongue of the bitch and one in a similar position in the male. The leeches were gently detached and removed using Adson tissue forceps after applying vinegar over the area. Microcytic hypochromic anaemia was detected in the bitch and mild leukocytosis in the dog. One month after treatment both animals were re-examined and a complete blood count was normal. Given that infestation with leeches as described here is associated with contaminated water, the use of clean and safe drinking water is recommended to avoid such diseases.


In the present study, we investigated whether a robot is able to deceive a human by producing a behavior against him/her prediction. A feeling of being deceived by a robot would be a strong indicator that the human treat the robot as an intentional entity. We conducted a psychological experiment in which a subject played Darumasan ga Koronda, a Japanese children's game, with a robot. A main strategy to deceive a subject was to make his/her mind believe that the robot is stupid so as not to be able to move quickly. The experimental result indicated that unexpected change of a robot behavior gave rise to an impression of being deceived by the robot.


This paper describes the experience of applying the administrative analysis tool to the modernization of public management, more specifically at the 3rd Infancy and Youth Judgeship of Porto Alegre, Brazil. An action-survey was carried with the following goals: to qualify management procedures; to provide more effective service to clients; to standardize the main administrative processes, aiming at the future municipalization of the socio-educational measures to be applied with open sentencing. The experience has suggested that, in spite of strongly bureaucratized state structures, it is possible to employ rationalization techniques for administrative processes in specific sectors of the State, with relevant results for users of the system and a low implementation cost.


Karisa, B. K., Thomson, J., Wang, Z., Bruce, H. L., Plastow, G. S. and Moore, S. S. 2013. Candidate genes and biological pathways associated with carcass quality traits in beef cattle. Can. J. Anim. Sci. 93: 295-306. The objective of this study was to use the candidate gene approach to identify the genes associated with carcass quality traits in beef cattle steers at the University of Alberta Ranch at Kinsella, Canada. This approach involved identifying positional candidate genes and prioritizing them according to their functions into functional candidate genes before performing statistical association analysis. The positional candidate genes and single nucleotide polymorphisms (SNP) were identified from previously reported quantitative trait loci for component traits including body weight, average daily gain, metabolic weight, feed efficiency and energy balance. Positional candidate genes were then prioritized into functional candidate genes according to the associated gene ontology terms and their functions. A total of 116 genes were considered functional candidate genes and 117 functional SNPs were genotyped and used for multiple marker association analysis using ASReml®. Seven SNPs were significantly associated with various carcass quality traits (P=0.005). The significant genes were associated with biological processes such as fat, glucose, protein and steroid metabolism, growth, energy utilization and DNA transcription and translation as inferred from the protein knowledgebase (UniprotKB). Gene network analysis indicated significant involvement of biological processes related to fat and steroid metabolism and regulation of transcription and translation of DNA.


We estimate the amplitude of the source-lens clustering bias and of the intrinsic-alignment bias of weak lensing estimators of the two-point and three-point convergence and cosmic-shear correlation functions. We use a linear galaxy bias model for the galaxy-density correlations, as well as a linear intrinsic-alignment model. For the three-point and four-point density correlations, we use analytical or semi-analytical models, based on a hierarchical ansatz or a combination of one-loop perturbation theory with a halo model. For two-point statistics, we find that the source-lens clustering bias is typically several orders of magnitude below the weak lensing signal, except when we correlate a very low-redshift galaxy ($z_2 \la 0.05$) with a higher redshift galaxy ($z_1 \ga 0.5$), where it can reach $10\%$ of the signal for the shear. For three-point statistics, the source-lens clustering bias is typically of order $10\%$ of the signal, as soon as the three galaxy source redshifts are not identical. The intrinsic-alignment bias is typically about $10\%$ of the signal for both two-point and three-point statistics. Thus, both source-lens clustering bias and intrinsic-alignment bias must be taken into account for three-point estimators aiming at a better than $10\%$ accuracy.


Enterprise Resource Planning systems are the new solution to business systems. These systems provide comprehensive business functionality in an integrated fashion using a state-of-the-art IT architecture. This trend towards enterprise systems in large and mid-sized organizations has a significant impact on IS careers paths. Enterprise systems essentially change fundamental business work processes thus implying that the system that supports these processes, and the design and development of these systems, also changed. Yet, most IS curricula do not provide significant coverage of ERP concepts, nor do they graduate students who are knowledgeable about these systems and the impact that these systems have on industry. This paper identifies opportunities for incorporating the ERP body of knowledge into an IS program. The general spirit of the paper is that of experiential learning. That is, this paper focuses on curriculum that is enriched through the hands-on experience gained by students working on a real ERP system. The paper also discusses related topics such as costs and critical success factors.


The processes of development of information society and knowledge-based economy are followed by structural and institutional changes. As a consequence, the model of employment and relations of production were affected as well. The process of transformation of employment and production's organization model proceeds in many countries. The transformation manifests itself by a tendency of increasing flexibility of the model. The main goal of this article is to investigate, how mentioned tendencies manifest in the model of employment in Lithuania and European Union in recent years (after the year 2000). My investigation shows that in EU countries (especially in Denmark, Sweden, Netherlands, and UK) the model of employment becomes more flexible. The changes in Lithuanian model of employment are less noticeable; its model of employment is composed by "traditional" and "flexible" elements of the forms of employment organization. However, the attitude towards the process of work is changing and it is likely that flexible forms of organization of work will gradually settle in Lithuania as well. These processes are fostered by European Union Employment policy: the flexicurity remains one of underlying its areas, therefore there are developed recommendations for member countries, concerning the flexicurity, and there is allotted support from structural funds for the implementation of the reforms.


Water samples from air conditioning cooling towers receiving different treatment protocols on five large municipal buildings in San Juan, P.R., were assayed for various Legionella spp. and serogroups by using direct immunofluorescence. Several water quality parameters were also measured for each sample. Guinea pigs were inoculated with water samples to confirm pathogenicity and recover viable organisms. Legionella pneumophila serogroups 1 to 6, L. bozemanii, L. micdadei, L. dumoffii, and L. gormanii were observed in at least one of the cooling towers. L. pneumophila was the most abundant species; its density reached 10(5) cells per ml, which is within the range that is considered potentially pathogenic to humans. A significantly higher density of L. pneumophila was observed in the cooling tower water that was not being treated with biocides. Percent respiration (INT) and total cell activity (acridine orange direct count) were inversely correlated with bacterial density. This study demonstrates that Legionella spp. are present in tropical air-conditioning cooling systems and that, without continuous biocide treatment, they may reach densities that present a health risk.


Abstract In order to minimise drag, the front part of most modern glider fuselages is shaped so that laminar flow is preserved to a position close to the wing-to-fuselage junction. Experimental investigations on a full-scale JS1 competition glider however revealed that the laminar boundary layer in fact trips to turbulent flow at the fuselage-to-canopy junction position, increasing drag. This is possibly due to ventilation air leaking from the cockpit to the fuselage surface through the canopy seal, or that the gap is merely too large and therefore trips the boundary layer to turbulent flow. The effect of air leaking from the fuselage-to-canopy gap as well as the size of the gap was thus investigated with the use of computational fluid dynamics. It was found that if air was leaking through this gap the boundary layer would be tripped from laminar to turbulent flow. It was also found that the width of the canopy-to-fuselage gap plays a significant role in the preservation of laminar flow. If the gap is less than 1mm wide, the attached boundary layer is able to negotiate the gap without being tripped to turbulent flow, while if the gap is 3mm and wider, it will be tripped from laminar to turbulent flow. The work shows that aerodynamic drag on a glider can be significantly minimised by completely sealing the fuselage-to-canopy gap and by ensuring a seal gap-width of less than 1mm.


ANOMALIES make operation on the biliary tract a challenge to even the most experienced surgeon. One of the uncommon anomalies is that of congenital absence of the gallbladder. Relatively careful reporting of cases, necropsy and surgical, along with newer concepts of accepted biliary procedures, now allow a rational approach to management. Dixon and Lichtman1were first to report the surgical experience with this anomaly at the Mayo Clinic. In 1945 they added 10 cases to the 50 surgical and necropsy cases already reported in the literature. McIlrath and associates2in 1962 reported 10 more cases found in a review of 26,531 necropsies at this clinic. The total number of cases reported in the literature at that time3,4was about 143. We recently operated on another patient having this anomaly and were stimulated to review the surgical experience at the Mayo Clinic since 1945. From 1945 through 1963,


The mini-Wright peak flow meter (MPFM) has been evaluated, and the results obtained from it show a strong positive correlation (r=0.970) with the Wright's peak flow meter (PFM). MPFM measurements, however, were biased to be about 38 1/min higher than PFM measurements (95% confidence limits 31.01/min to 45.01/min). Between instrument variation was found (F--ratio 3.67 with 9 and 81 degrees of freedom: P less than 0.001). In practice this did not appreciably affect individual measurements greatly as 95% confidence limits on any individual measurements were increased from +/-24 1/min to +/-27 1/min. There was no significant day-to-day variability in measurements obtained with individual instruments. The MPFM is a pocket-sized, simple, cheap, and robust instrument for following changes in ventilatory function. In clinical trails and surveys, however, both the bias in favour of the MPFM compared to the PFM and inter-machine variation must be taken into account. As the manufacturers have altered the scale to remove the bias since this study was performed, it will be important to know whether the original or the modified meter is being used in future studies.


OBJECTIVE
Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. Self-monitoring of ketone bodies by diabetes patients can be done using blood or urine. We compared the two self-monitoring methods and summarized recent developments in the epidemiology and management of DKA.

METHODS
MEDLINE and EMBASE were searched for relevant publications addressing the epidemiology, management and prevention of DKA up to 2009. The current, relevant publications, along with the authors' clinical and professional experience, were used to synthesize this narrative review.

FINDINGS
Despite considerable advances in diabetes therapy, key epidemiological figures related to DKA remained nearly unchanged during the last decades at a global level. Prevention of DKA - especially in sick day management - relies on intensive self-monitoring of blood glucose and subsequent, appropriate therapy adjustments. Self-monitoring of ketone bodies during hyperglycemia can provide important, complementary information on the metabolic state. Both methods for self-monitoring of ketone bodies at home are clinically reliable and there is no published evidence favoring one method with respect to DKA prevention.

CONCLUSIONS
DKA is still a severe complication potentially arising during prolonged hyperglycemic episodes with possibly fatal consequences. Education of patients and their social environment to promote frequent testing - especially during sick days - and to lower their glucose levels, as well as to recognize the early symptoms of hyperglycemia and DKA is of paramount importance in preventing the development of severe DKA. Both methods for self-monitoring of ketone bodies are safe and clinically reliable.


Parasitism of four corixid species in Lough Corrib, western Ireland, by larval watermites of the genera Hydrachna and Eylais was investigated. Differences in abundances of mite species were noted in respect of host species and different sampling localities. Infection parameters were not affected by host size, although host sex seemed to influence Hydrachna parasitism. Partial temporal separation of mites was observed in respect of larval attachment to hosts and emergence of nymphs. The largest nymphs were generally recorded from the largest hosts and from single infections. Intraspecific and interspecific competition was evident among parasites for host nutritive resources and growing space, especially on smaller hosts. The feeding intensity of parasitised Cymatia bonsdorfi was significantly greater than that of unparasitised bugs. Increased feeding by parasitised C. bonsdorfi may have been an attempt to compensate for the effects of nutritional drain by H. conjecta.


Prior studies show stock liquidity improves price informativeness and strengthens governance. Stock price informativeness offers an incentive for managers with equity-based compensation to avoid tax. Strengthening governance, by contrast, reduces tax avoidance if diverting corporate profits for private benefits complements tax avoidance. Using an exogenous shock that drastically increased the liquidity of stocks listed in China, we find robust evidence that higher liquidity significantly increases the overall level of tax avoidance. The increase is more substantial when controlling shareholders own more shares, and when diversion is less complementary to tax avoidance. Liquidity has no significant impact on tax evasion—the most aggressive and risky tax avoidance—and at the higher ends of the tax avoidance distribution. The positive and significant effects are observed only at lower levels of tax avoidance. We attribute the weaker impact of liquidity on aggressive tax avoidance to diversion being more complementary to higher-risk tax avoidance.


We present a relativistic model for the stationary axisymmetric accretion flow of a rotating cloud of non-interacting particles falling onto a Kerr black hole. Based on a ballistic approximation, streamlines are described analytically in terms of timelike geodesics, while a simple numerical scheme is introduced for calculating the density field. A novel approach is presented for describing all of the possible types of orbit by means of a single analytic expression. This model is a useful tool for highlighting purely relativistic signatures in the accretion flow dynamics coming from a strong gravitational field with frame-dragging. In particular, we explore the coupling due to this between the spin of the black hole and the angular momentum of the infalling matter. Moreover, we demonstrate how this analytic solution may be used for benchmarking general relativistic numerical hydrodynamics codes by comparing it against results of smoothed particle hydrodynamics simulations for a collapsar-like setup. These simulations are performed first for a ballistic flow (with zero pressure) and then for a hydrodynamical one where we measure the effects of pressure gradients on the infall, thus exploring the extent of applicability of the ballistic approximation.


Climate change affects water availability and the conditions will be worsened with increasing water demands. The relative performance of GCMs depends on the size of the region, location, and on the variables being analyzed. For this study the model output of HadCM3 GCM was employed for the A2 (Medium- High Emissions) and B2 (Medium-Low Emission) Scenarios. HadCM3 is a coupled atmospheric-ocean GCM developed at Hadley Centre for Climate Prediction and Research, UK. The atmospheric part of HadCM3 has a horizontal resolution of 2.5° latitude x 3.75° longitude, and has 19 vertical levels. HadCM3 is applied in this study because the model is widely applied in climate change impact studies and the model provides daily predictor variables with coverage all over the world includes Malaysia that can be used for the Statistical Downscaling Model (SDSM). In this study, Statistical Downscaling Model (SDSM) was applied using two stations in Kerian, Perak consisted to Kolam Air Bukit Merah and Ladang Sungai Kerian. These stations would be used to evaluate mean daily precipitations, wet days, wet spell length and dry spell length which are related with current situations 1961-1990 and the future projections 2010-2039, 2040-2069 and 2070-2099.The availability of the data for observed situation were serves by National Centre of Environmental Prediction (NCEP) which are provides in 40 years starting from 1961. By providing this evaluation, the results showed the fluctuations every 30 years. Within this projection, it shows the decrement of wet days and wet spell length due to increment of future climate change. Frequency analysis techniques were carried out using two model distribution which are Gumbel and Generalised Extreme Value (GEV). This distribution showed the return periods due to flood monitoring based on 50 and 100 years. With this consideration, SDSM is measured as the workbench to interpret implication of climate change caused by carbon dioxide concentrations in the present and future development.


The tremendous growth of wireless services has created an ever-increasing demand for the radio frequency spectrum. However, most of the spectrum, especially in the sub-6 GHz frequency ranges, have been allocated. Given the observation that a large part of the allocated spectrum remains unused in various locations and at different times, dynamic spectrum access technologies that allow for opportunistic use of the allocated bands when they are idle are being developed. In this paper, we study the spectrum usage in the frequency range of 700 MHz to 2.8 GHz at Salt Lake City, Utah. Our study indicates that several portions of these frequencies are under-utilized, with an average of only 19% usage. Furthermore, we observe that certain frequency bands demonstrate clear usage patterns, e.g., show higher utilization during the daytime compared to night-time, that can be exploited for opportunistic secondary usage of the spectrum. We propose a spectrum prediction system using Long Short-Term Memory (LSTM) neural networks to predict the occupancy of a channel in future time slots. We further introduce an LSTM based Window Selector to find the optimal window of future forecasts that increase the utilization of the network while minimizing the interference caused by the opportunistic user. Our experiments show that the Multivariate LSTM model can be reliably used to guide the choice of the channel for the opportunistic user. The multistep LSTM models can be used to forecast spectrum usage with approximately 96% accuracy on the frequency bands exhibiting discernible usage patterns.


The so called war on terror provides the Bush administration with a unique opportunity to both establish clear guidelines for the interrogation of detainees and to make a forceful statement about American values. How the government chooses to act can promote either an ethical commitment to the norms of civil society, or an attitude analogous to Toby Keith's "American Way," where Keith sings that "you'll be sorry that you messed with the USofA, 'Cuz we'll put a boot in your ass, It's the American Way." No aspect of the war on terrorism more clearly addresses this balance than coercive interrogation. In its recent decision, Hamdan v. Rumsfeld, the procedures governing the Guantanamo Bay Military Commissions were found inadequate by the United States Supreme Court. Though the Court called on the Administration to create adequate procedures and process, the recently enacted Military Commissions Act and the subsequently issued Department of Defense Manual for the Trial of Detainees suggest that the Administration has not fully internalized Hamdan's significance regarding the coercive interrogation of detainees. In seeking the articulation of clear interrogation standards, this article turns to the pages of American history for guidance. In drawing a comparison between the current detainees and African Americans in the Deep South, this historical analysis argues that the same constitutionally based prohibition on the coercive interrogation of African Americans can be extended to the detainees in the war on terror, a currently unprotected class. This historical analogy is accomplished by analyzing a set of cases that I term the Bram-Brown progeny. This watershed progeny of cases show the Supreme Court's willingness to enter the interrogation rooms in the Deep South, mandating the extension of constitutional protections to a then-unprotected class of people. I conclude this analysis by formulating recommendations based on constitutional, criminal, and international law that I posit will both cure the deficiencies identified by the Court in Hamdan and provide a means for the United States to return to its moral stance in the international community.


This software is designed to aid the clinician and the student in the differential diagnosis and treatment of a red eye. The program, consisting of three disks, was designed with HyperCard v. 1.2.5 for the Macintosh computer. Included in the program are objective and subjective findings, diagnostic tests, suggested treatment regimens and any contraindications, follow-up care and prognosis for forty-five etiologies of a red eye. One of the major features of this program allows the clinician to enter subjective and/or objective findings. Given these findings, the computer will provide a list of possible ocular conditions. From this list, the clinician can select one of the possibilities listed in which he/she feels is most appropriate for that particular patient. At this point the program will proceed to a stack of information specific for the selected condition. Once a choice has been made, the clinician always has the freedom of returning back to the list of possible ocular conditions.


Abstract Anaerobic bacteria have been increasingly implicated as important pathogens in animals. To determine the prevalence of anaerobic bacterial infection, the results of anaerobic bacteriologic culture of 599 specimens obtained from dogs and cats hospitalized at the Colorado State University Veterinary Teaching Hospital were reviewed. Obligate anaerobic bacteria were isolated from 35% of properly submitted specimens; Bacteroides spp and Fusobacterium spp were the organisms most commonly isolated. Infections most often containing anaerobes were abscesses, pleuropulmonary infections, and abdominal infections. A complication rate of 28% was observed with anaerobic bacterial infections; failure to initially treat with an effective antibiotic increased the rate of recurrence of infection.


Dr. Balducci has presented a timely and useful overview of bone health in elderly patients undergoing cancer treatment. This topic has important implications, not only within geriatric oncology but also throughout the entire age spectrum. Dr. Balducci's focus on the elderly population is especially relevant, as this group is at particularly high risk for bone complications over the course of cancer therapy. In his review, Dr. Balducci provides an introduction to the physiology of bone reabsorption and formation, and discusses risk factors for the interruptions in usual physiologic homestasis that lead to osteoporosis.


Good security cannot be achieved through technical means alone and a solid understanding of the issues and how to protect one's self is required from users. Whilst many initiatives, programs and strategies have been proposed to improve the level of information security awareness, most have been directed at organizations. Given people's use of technology is primarily focused between the workplace and home; this paper seeks to understand the knowledge and practice relationship between these environments. Through a developed survey, it was identified that the majority of the learning about information security occurred in the workplace, where clear motivations, such as legislation and regulation, existed. Results found that users were more than willing to engage with such awareness raising initiatives. From a comparison of practice between work and home environments, it was found that this knowledge and practice obtained at the workplace was transferred to the home environment. Given this positive transferability of knowledge and the willingness to learn about how to remain secure, an opportunity exists to move away from specific organizational awareness programs and to move towards awareness raising strategies that will develop an all-round individual security culture for users independent of the environment they are operating in.


The encryption process for secure voice communication may degrade the speech quality when it is applied to the speech signals before encoding them through a conventional communication system such as GSM or radio trunking. This is because the encryption process usually includes a randomization of the speech signals, and hence, when the speech is decrypted, it may perceptibly be distorted, so satisfactory speech quality for communication is not achieved. To deal with this, we could apply a speech enhancement method to improve the quality of decrypted speech. However, many speech enhancement methods work by assuming noise is present all the time, so the voice activity detector (VAD) is applied to detect the non-speech period to update the noise estimate. Unfortunately, this assumption is not valid for the decrypted speech. Since the encryption process is applied only when speech is detected, distortions from the secure communication system are characteristically different. They exist when speech is present. Therefore, a noise estimator that is able to update noise even when speech is present is needed. However, most noise estimator techniques only adapt to slow changes of noise to avoid over-estimation of noise, making them unsuitable for this task. In this paper, we propose a speech enhancement technique to improve the quality of speech from secure communication. We use a combination of the Wiener filter and spectral subtraction for the noise estimator, so our method is better at tracking fast changes of noise without over-estimating them. Our experimental results on various communication channels indicate that our method is better than other popular noise estimators and speech enhancement methods.


We propose a simple and effective method for machine translation evaluation which does not require reference translations. Our approach is based on (1) grounding the entity mentions found in each source sentence and candidate translation against a large-scale multilingual knowledge base, and (2) measuring the recall of the grounded entities found in the candidate vs. those found in the source. Our approach achieves the highest correlation with human judgements on 9 out of the 18 language pairs from the WMT19 benchmark for evaluation without references, which is the largest number of wins for a single evaluation method on this task. On 4 language pairs, we also achieve higher correlation with human judgements than BLEU. To foster further research, we release a dataset containing 1.8 million grounded entity mentions across 18 language pairs from the WMT19 metrics track data.


The anti-fibrillatory ED50-values of a series of agents were determined. Upon administration of the agents in this ED50-dose (all agents then being equieffective in their antifibrillatory action) various side effects of each of them were quantitatively measured. The measured side effects were: the negative inotropic and chronotropic action, the conduction retarding, refractory period prolonging, excitability decreasing and ectopic automaticity depressing action. The substrate for these measurements was the isolated perfused rat heart. The series of agents tested consisted of a group possessing a beta-adrenolytic component and a group in which this component was absent. We compared quantitatively the side effects induced by the one group with those induced by the other. Differences were found in their influence on contractility and conductivity but not in their influence on the other parameters. The results obtained do not support the expectation that a beta-adrenolytic component will enlarge the therapeutic range of an antifibrillatory agent.


Characterized by symptoms of urinary frequency, urgency, and urge urinary incontinence, overactive bladder (OAB) is a condition that results from a deficiency in the bladder's ability to store urine and in the onset of involuntary bladder muscle contractions that promote urgency and possibly urine loss.


Two separate 'schools' have offered what are claimed to be general foundations for the subject of non-equilibrium statistical mechanics, based respectively on subdynamics and information theory. These appear to be unrelated, to start from conflicting interpretations of probability, to generate different methodology and to be useful in non-overlapping applications. The present paper is a study of the relation between the work of the two schools. After reviewing them critically in a presentation that unifies the notation used, the connection between them is developed. It is concluded, subject to some provisos, that they are equivalent. It is suggested that the subject could be unified on this basis, and that the methodologies be made more generally available.


ABSTRACT The 'Franklin expedition' of 1845 set out to establish a 'northwest passage' between the Atlantic and Pacific oceans but ended with the deaths of all 129 crewmen in the grimmest of circumstances. The hypothesis that lead poisoning may have contributed to the disaster is examined by re-analysis of the bone-lead content of seven skeletons in order to model statistically the likely variation in lead burden across the whole crew. Comparison of the estimated lead burdens with present-day data that associates lead with cognitive and physical morbidity suggests that a proportion of the crew may have experienced few or no adverse effects whilst those with higher burdens may have suffered some significant debility. It is unclear whether such debility would have been incapacitating or exceptional for the lead-contaminated environment of nineteenth-century Britain. Whilst lead alone may not have caused the disaster, it is proposed that high levels of lead may have interacted with other factors including dietary insufficiencies and individual constitutional differences to render some, but not all, of the crew more vulnerable to debility in the final throes of the expedition.


The structure evolution of all-polymer solar cells based on the blends of poly(3-hexylthiophene) (P3HT) and poly[(9,9-dioctyluorene)-2,7-diyl-alt-(4,7-bis(3-hexylthien-5-yl)-2,1,3-benzothiadiazole)-20,20 0-diyl] (F8TBT) was investigated. The P3HT/F8TBT system exhibits crystallization-driven structure formation similar to the P3HT/phenyl-C61-butyricacidmethylester (PCBM) blend despite the existence of a miscibility gap, which was determined for a blend containing regio-random P3HT. The lamellar crystallization of regio-regular P3HT was not perturbed by the addition of F8TBT. X-ray scattering studies indicate that F8TBT is segregated to the interlamellar amorphous phase, establishing a bulk heterojunction framework with the crystalline lamellae of P3HT. The excess F8TBT is accommodated at the film–substrate interface and at amorphous grain boundaries. The structural studies were correlated with the photovoltaic device performance of blend films that consisted of large P3HT spherulites. These device results emphasize the importance of a mesoscopic F8TBT network that separates the P3HT crystal domains. Our results suggest that the nanostructure formation in P3HT/F8TBT blends is determined by P3HT crystallization, resulting both in a 10 nm crystalline morphology and a F8TBT mesoscopic segregation network, both of which are beneficial for exciton dissociation.


From an analysis of the American health care policies, this article proposes a renewal of our understanding of the "neo-liberal turning point" of the 1970s. It highlights a dimension that is usually ignored in the classical studies of this period: the transformations that occurred in the 1950s and 1960s in the social spaces where ideas and knowledge are produced (mainly the academic space and the space of expertise). Thus it invites us to relativize the impact of the economic and budgetary context of the 1970s, which is generally considered as the trigger of the paradigmatic change. On the other hand, it underlines the interest of introducing some elements of the sociology of knowledge into the analysis of policy change.


We investigate the dynamics of a composite system ([Formula: see text]) consisting of an interacting fermion–antifermion pair in the three-dimensional space–time background generated by a static point source. By considering the interaction between the particles as Dirac oscillator coupling, we analyze the effects of space–time topology on the energy of such a [Formula: see text]. To achieve this, we solve the corresponding form of a two-body Dirac equation (fully-covariant) by assuming the center-of-mass of the particles is at rest and locates at the origin of the spatial geometry. Under this assumption, we arrive at a nonperturbative energy spectrum for the system in question. This spectrum includes spin coupling and depends on the angular deficit parameter [Formula: see text] of the geometric background. This provides a suitable basis to determine the effects of the geometric background on the energy of the [Formula: see text] under consideration. Our results show that such a [Formula: see text] behaves like a single quantum oscillator. Then, we analyze the alterations in the energy levels and discuss the limits of the obtained results. We show that the effects of the geometric background on each energy level are not same and there can be degeneracy in the energy levels for small values of the [Formula: see text].


This paper characterizes optimal monetary policy for a range of alternative economic models in terms of a flexible inflation targeting rule, with a target criterion that depends on the model specification. It shows which forecast horizons should matter, and which variables besides inflation should be taken into account, for each specification. The likely quantitative significance of the various factors considered in the general discussion is then assessed by estimating a small, structural model of the U.S. monetary transmission mechanism with explicit optimizing foundations. An optimal policy rule is computed for the estimated model, and shown to correspond to a multi-stage inflation-forecast targeting procedure. The degree to which actual U.S. policy over the past two decades has conformed to the optimal target criteria is then considered.


Capacitively coupled nitrogen plasma discharges driven by two different exciting radio frequencies of 13.56 MHz, and 40 MHz are investigated. Langmuir probe diagnostics along with optical emission spectroscopy are used for interpreting the discharges. The results of these diagnostics are not shown sufficiently in the literature for 40 MHz even though there are some for 13.56 MHz. The electron density ne and the effective electron temperature Teff are calculated from the measurements of the current – voltage characteristics of the discharges. These calculated parameters are correlated with the vibrational temperatures of the N2 second positive system C3Πu−B3Πg and the N2+ first negative system B2Σu+−X2Σg+ measured via optical emission spectroscopy. The population of the vibrational excitation particles plays a crucial role in the determination of the vibrational temperature which strongly depends on ne and Teff. The transition from collisionless stochastic heating mode to collisional Ohmic heating mode into the bulk plasma appears at lower pressure value for 40 MHz as compared to 13.56 MHz. This effect is observed effectively with increasing the RF input power due to the high energy electrons. It is noted that the vibrational temperatures of N2 and N2+ decreases at high-pressure region (>0.3 Torr for 13.56 MHz and >0.2 Torr for 40 MHz) due to a reduction in the relative population of the vibrationally excited particle. The measurements of the Langmuir probe are very consistent with the results of the optical emission spectroscopy.Capacitively coupled nitrogen plasma discharges driven by two different exciting radio frequencies of 13.56 MHz, and 40 MHz are investigated. Langmuir probe diagnostics along with optical emission spectroscopy are used for interpreting the discharges. The results of these diagnostics are not shown sufficiently in the literature for 40 MHz even though there are some for 13.56 MHz. The electron density ne and the effective electron temperature Teff are calculated from the measurements of the current – voltage characteristics of the discharges. These calculated parameters are correlated with the vibrational temperatures of the N2 second positive system C3Πu−B3Πg and the N2+ first negative system B2Σu+−X2Σg+ measured via optical emission spectroscopy. The population of the vibrational excitation particles plays a crucial role in the determination of the vibrational temperature which strongly depends on ne and Teff. The transition from collisionless stochastic heating mode to collisional Ohmic heating mode int...


Thallusin, a highly biologically active, phytohormone-like and bacterial compound-inducing morphogenesis of the green tide-forming macroalga Ulva (Chlorophyta), was determined in bacteria and algae cultures. A sensitive and selective method was developed for quantification based on ultra-high-performance liquid chromatography coupled with electrospray ionization and a high-resolution mass spectrometer. Upon C18 solid phase extraction of the water samples, thallusin was derivatized with iodomethane to inhibit the formation of Fe–thallusin complexes interfering with the chromatographic separation. The concentration of thallusin was quantified during the relevant phases of the bacterial growth of Maribacter spp., ranging from 0.16 ± 0.01 amol cell−1 (at the peak of the exponential growth phase) to 0.86 ± 0.13 amol cell−1 (late stationary phase), indicating its accumulation in the growth medium. Finally, we directly determined the concentration of thallusin in algal culture to validate our approach for monitoring applications. Detection and quantification limits of 2.5 and 7.4 pmol L−1, respectively, were reached, which allow for quantifying ecologically relevant thallusin concentrations. Our approach will enable the surveying of thallusin in culture and in nature and will thus contribute to the chemical monitoring of aquaculture.


The Automated Universal Tribotester (AUT) represents a fully automated reduced scale brake dynamometer. The setup is based on the pin-on-disc principle, where the specifically designed load unit, on the one hand, guides the pin and on the other hand applies the necessary normal load on the friction contact. Even with highly developed tribometers such as the AUT at IDS, long bedding processes after load changes are necessary for a valid evaluation of wear and emissions. The applied loads in combination with the limited material stiffness of machines result in an inevitable tilting of the pin, which influences the surface dynamics in the friction layer. Only an intelligent adaptive compensation system is capable of measuring and adjusting the specimen's alignment towards the disc during measurements in a way, that a full surface contact can be assured. This paper presents the adaptive system, which is added to the load unit of our fully automated tribometer. It presents the observer model to monitor the specimen's angle in the friction interface, including its application in the overall control loop. Furthermore, the kinematic principle with its self-locking features and the drive concept is presented. Finally, this paper demonstrates the adjustment range and speed performance of the complete adaptive system. The impact of the compensation on characteristic values of friction such as the coefficient of friction, wear and emissions will be presented elsewhere.


The purpose of the paper is to identify the most energy efficient value chains using solid biomass of specially grown energy crops and the most significant parameters affecting their energy efficiency and environmental sustainability. The methodology of Life Cycle Assessment (LCA) was used to determine the energy efficiency of value chains of heat production from energy crops. According to the methodology, the scope of the product system includes the raw material cycle of growing energy crops and the subsystem of transformation with production of thermal energy. Cumulative energy demand and energy yield coefficient were chosen as energy efficiency indicators. The product system was compared with a similar one using natural gas. The non-renewable energy yield coefficient was used to define how many times the energy output was bigger than the input of non-renewable energy. Assessment was conducted for two energy crops: Miscanthus as a typical representative of specially grown grassy energy crops and willow as a typical representative of specially grown woody energy crops. The growing of energy crops in Ukraine for the subsequent production of biofuel in the form of chips and their combustion in biofuel boilers are energetically effective with a maximum transportation distance of 400 km for Miscanthus chips and 180 km for willow chips.


Matthew Rose worked at the Naval Postgraduate School as a graphic designer from February 2002-November 2011. His work for NPS included logos, brochures, business packs, movies/presentations, posters, the CyberSiege video game and many other projects. This material was organized and provided by the artist, for inclusion in the NPS Archive, Calhoun.


Commercial supply chains and donor funded supply chains are driven by distinctive mechanisms and purposes, and the factors that make the operational environment of donor funded supply chains unpredictable, complex and dynamic, differ from those that cause this complexity in a commercial supply chain environment. Although literature contains several theories and frameworks to assist in the design, measurement and management of commercial supply chains, there is a significant research gap related to the formal study of donor funded supply chains. In this research, several examples of donor funded supply chains are investigated in order to systematically compare and highlight the key differences between donor funded supply chains and commercial supply chains.


Abstract Background: One of the most important threats for children's health status is being overweight and obesity, and related causes such as
screen time prevalence. Prevalence of being overweight and obesity in children is associated with health risk consequences in adulthood. Objectives: The purpose of this study was to assess the prevalence of screen time and physical activity in overweight and obese students. Patients and Methods: In this cross sectional descriptive study we randomly selected 302 students, from all districts of Qazvin, who's relative body mass index (RBMIs) were above the 85th percentile. Their screen time and physical activity prevalence were assessed with two separate techniques (self-report and parent-report). Pearson correlation test and regression analysis were done to examine the association between RBMI, screen time and physical activity. Results: Mean screen time in boys was more than girls, in both overweight screen time- self report technique (ST-SRT: 1.93 ± 0.24 vs. 1.26 ± 0.44, ST-PRT: 3.4 ± 0.22 vs. 2.1 ± 0.15) and obese subjects (ST-SRT: 1.88 ± 0.31 vs. 1.37 ± 0.49, ST-PRT: 3.2 ± 0.32 vs. 2.3 ± 0.34) yet overweight subjects had less total screen time than obese individuals (P < 0.05). Pearson correlations with one-tailed test indicated that screen time had a significant association with RBMI. In addition, there was a significant association between the two techniques of screen time and physical activity measurements. The model of regression for screen time and RBMI was significant (F = 45, P = 0.000, R
2
 = 0.42) and screen time explained about 16% of variance in RBMI (B = 0.021, SEB = 0.004, β = 0.325). Conclusions: Our research determined an association between screen time, physical activity and RBMI. Screen time was a prominent predictor of RBMI in children. It is important for health workers to decrease screen time of children to prevent the prevalence of being overweight and obesity.
Keywords: Physical Activity, Sedentary Behavior, Overweight, Obesity


Twenty-seven Hereford steers (227¦3 kg) were offered ad libitum low-quality grass pasture hay containing 4.3 g N/kg DM. These steers were offered one of three maize supplements (nil, 570 g/day crushed maize or 680 g/day whole maize) alone or with one of two nitrogen (N) supplements (1 12 g/day urea: 250 g/day molasses, or 800 g/day pelleted protein meals). The crushed maize, whole maize and protein meal supplements were calculated to be isoenergetic on a metabolisable energy basis, and the urea and protein meal supplements were isonitrogenous.Both urea and protein meal supplements increased the intakes of hay and total digestible organic matter (DOMI), but there was a significant interaction between maize and N supplements such that maize increased hay and DOM intakes when offered alone. Unsupplemented steers ate only 1.98 kg OM of hay/day, whereas N supplemented steers ate 3.96-4.40 kg OM/day, and those supplemented with crushed and whole maize alone ate 2.45 and 2.85 kg OM/day respectively. The intakes of hay by the urea and protein meal supplemented groups were not significantly different.Both N and maize supplements had positive effects on liveweight change (P < 0.01), with N having the largest effect. Steers supplemented with protein meal gained 210 g/day more than those offered urea (P < 0.05), although DOMI was only 110 g/day more, indicating an effect of protein on the efficiency of utilisation of absorbed nutrients.N supplements increased rumen ammonia concentrations from 10¦3.0 mg NH3-N/l in unsupplemented steers to 169¦ 19.3 and 105¦ 19.0 mg NH3-N/l in steers offered urea and protein meal respectively; there was a significant interaction between the form of N supplement and form of maize supplement (P < 0.05). Total volatile fatty acid concentrations in the rumen (65¦ 1.9 mM) did not differ significantly between supplements.Glucose entry rate was positively related to liveweight change and was increased by both the N supplements and whole maize. Glucose entry rate, adjusted for DOMI, was higher in protein meal supplemented steers than those receiving urea or no N supplement (P < 0.01), and these steers had the highest growth rate.Urea pool size, and synthesis rate in the body, were greater in steers given the urea and protein meal supplements (P < 0.05), but there were no significant differences in these measurements between urea and protein meal supplements.


Paradigm of a hospital management must be oriented to quality based on patients perception in order to support growth and development of a hospital in which its improvement can bring patients to be satisfied and put on loyalty.
Aim of this research was to analyze the influence of patients perception about some factors of service quality viewed from aspects : efficacy, accessibility, effectiveness, amenities, technical competency, safety, interpersonal relationship, continuity of care, and timeless toward of patients at Wijaya Kusuma Pavilion of Salatiga Public Hospital.
This was explanatory research using quantitative-qualitative method and cross sectional approach. Subjects were 4 heads of departments and 90 patients suffering chronic diseases.
Data were collected by interview using questionnaires. Quantitative data were analyzed using Chi-Square test and Logistic Regression. Qualitative data were analyzed using Content Analysis.
In term of the sample characteristics, most of the respondents are female (5,66%), and have greater than 30 years of age (79,3%) and high education (88,9%). Furthermore, they have income greater or equal to Rp 3.812.500,- (50,0%), and work in private sector (44,4%). Result of statistical analysis shows that factors of efficacy (P < 0,05), effectiveness (P < 0,01), technical competency (P < 0,01), and continuity of care (P < 0,05) influence loyalty of the patients.

Sumber Utama : www.mikm.undip.ac.id


In the distribution of resources, persons must be respected, or so many philosophers contend. Unfortunately, they often leave it unclear why a certain allocation would respect persons, while another would not. In this paper, we explore what it means to respect persons in the distribution of scarce, life-saving resources. We begin by presenting two kinds of cases. In different age cases, we have a drug that we must use either to save a young person who would live for many more years or an old person who would only live for a few. In different numbers cases, we must save either one person or many persons from certain death. We argue that two familiar accounts of respect for persons―an equal worth account, suggested by Jeff McMahan, and a Kantian account, inspired by the Formula of Humanity―have implausible implications in such cases. We develop a new, "three-tiered" account: one that, we claim, generates results in such cases that accord better with many people's considered judgments than those produced by its rivals.


Previous articles have evaluated the association between IL-23R gene rs7517847 T>G SNP and systemic lupus erythematosus (SLE). Nevertheless, the results of these studies have been inconclusive. The current study is a meta-analysis that assesses the association between IL-23R gene rs7517847 T>G SNP and SLE susceptibility. Literature searches of Medline, Web of Science, and EMBASE databases were performed to recognize all eligible studies published before August, 2016, and the search was updated in July, 2017. The identified studies were independently reviewed by two authors for eligibility based on inclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were applied to assess the strength of association in the allelic model, dominant model, recessive model, heterozygotes contrast, and homozygotes contrast. Because evidence of heterogeneity was detected across the studies, the data was pooled using a random-effects model. A sum of four case-control studies with 1348 SLE patients and 1754 healthy subjects were considered in this study. In the combined analysis, no significant association between the IL-23R gene rs7517847 T>G SNP and SLE disease risk was found in any of the genetic models (dominant model: OR = 0.95, 95% CI = 0.72-1.18; allelic model: OR = 1.08, 95% CI = 0.95-1.21; recessive model: OR = 1.13, 95% CI = 0.80-1.46; TG vs. TT: OR = 0.86, 95% CI = 0.63-1.08; and GG vs. TT: OR = 1.20, 95% CI = 0.81-1.60). Moreover, no publication bias was observed in any genetic models (p> 0.05). First, this study was based on unadjusted ORs. Second, the number of included case-control articles was small. Third, only published English language studies were imported to this meta-analysis. The current meta-analysis suggests that the IL-23R gene rs7517847 T>G SNP might not be related with risk of SLE. More studies are essential to confirm these results. No association was found between the IL-23R gene rs7517847 T>G SNP and SLE risk.


This study incorporated an instrumental embedded case study design to explore how 15 faculty members and an administrator at one Catholic institution of higher education describe their responsibility to promote the academic mission of Ignatian spirituality. Interviews included Jesuit, Catholic, and non-Catholic faculty, and the president of Holy University. It was determined that participants' ability to foster Ignatian spirituality was dependent upon their religious beliefs and a willingness to promote values common to Catholic and Jesuit faith traditions, despite facing multiple challenges to fulfilling the academic mission. A conceptual model developed that demonstrated relationships among academic administrators, faculty, and students, and how the interactions influence the ability to foster Ignatian spirituality and preserve a faith-based identity at Holy University. Additional perspectives from members at Holy University and other Jesuit institutions of higher learning need to be explored to develop a greater understanding of the academic mission of Ignatian spirituality.


Plasmocytoma and Waldenstroem's disease together with some other very rare diseases form the group of paraproteinaemic haemoblastoses. In these cases the plasmocytoma as a neoplasia of the plasma cells is quite likely to define by the sum of the cytomorphological, radiological and immunological findings in form of the plasmocytosis of the bone-marrow, the destructions of the skeleton and the formation of monoclonal immunoglobulins as cardinal symptoms. Waldenstroem's disease, however, becomes more and more a special form of the IgM-forming malignant lymphomas. In its classical expression apart from the formation of lymphomas, hepato-splenomegaly and haemorhages it above all exhibits the excessive formation of a monoclonal, macromolecular immunoglobulin. In this disease the prognosis is in many cases by far more favourable than that one of the plasmocytoma which, apart from its solitary-multiple form of the course, is a disease with high malignity. Cyclophosphamide and sarcolysin are the remedies of choice in the plasmocytoma, procarbazine in waldenstroem's disease. Nowadays, the inclusion of the two diseases into the large spectre of neoplasias of all cells of the immuno-competent system which finally are structurally derived from the immunocyte and are functionally differentiated renders a special way of description unnecessary.


The carnivorous sponge Asbestopluma hypogea, was known only from shallow submarine caves (-15 to -26 m) in the Western Mediterranean Sea and the Adriatic. Herein A. hypogea is reported from outside of caves, on seamounts in the Alboran Sea (-167 m), off the Balearics (-100 m) and north off Sicily (-660 m), and along steep bathyal escarpments in the Strait of Sicily (~700 m). These deeper ROV-based findings of A. hypogea are conform to the typical deep-sea occurrence of the Cladorhizidae.


Daidzein and genistein are isoflavones found in soybean. Genistein is known to exhibit anticarcinogenic activities and inhibit tyrosine kinase activity. However, the underlying molecular mechanisms of the chemopreventive activities of daidzein and its metabolite, equol, are not understood. Here we report that equol inhibits 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced neoplastic transformation of JB6 P+ mouse epidermal cells by targeting the MEK/ERK/p90RSK/activator protein-1 signaling pathway. TPA-induced neoplastic cell transformation was inhibited by equol, but not daidzein, at noncytotoxic concentrations in a dose-dependent manner. Equol dose-dependently attenuated TPA-induced activation of activator protein-1 and c-fos, whereas daidzein did not exert any effect when tested at the same concentrations. The TPA-induced phosphorylation of ERK1/2, p90RSK, and Elk, but not MEK or c-Jun N-terminal kinase, was inhibited by equol but not by daidzein. In vitro kinase assays revealed that equol greatly inhibited MEK1, but not Raf1, kinase activity, and an ex vivo kinase assay also demonstrated that equol suppressed TPA-induced MEK1 kinase activity in JB6 P+ cell lysates. Equol dose-dependently inhibited neoplastic transformation of JB6 P+ cells induced by epidermal growth factor or H-Ras. Both in vitro and ex vivo pull-down assays revealed that equol directly bound with glutathione S-transferase-MEK1 to inhibit MEK1 activity without competing with ATP. These results suggested that the antitumor-promoting effect of equol is due to the inhibition of cell transformation mainly by targeting a MEK signaling pathway. These findings are the first to reveal a molecular basis for the anticancer action of equol and may partially account for the reported chemopreventive effects of soybean.


A selection of Trentin'sdiaries from 2001-2006, some unpublished pages on his political activity in the European Parliament and the elaboration of The Freedom Comes First: these works allow us to enter Bruno Trentin's intellectual laboratory and to follow, from the inside, the editing of the essays and the realization of the volume. Public and private intertwine in a melee with a heavy depression, which demands to "cope with death by accelerating the production of writings that can clarify or conclude my testimony." The notes on the Italian and international situation after September 11th, 2001, the American intervention in Iraq in 2003 and the European Constitution project are significant. The section is completed by some coeval political interventions, including the last article of July 2006 on meritocracy and the affirmation of individual rights.


Over the past decades, the education of students has progressively shifted from the traditional teaching environments to technology-assisted settings. In Taiwan, the preference to provide students with multimedia in environments shared by their peers is gaining acceptance and public attention. Therefore, "Chinese Idioms String Up Puzzle game," a new text reconstruction online program was developed by the Digital Game-Based Learning Laboratory, National Taiwan Normal University in Taiwan to encourage students to use their organizing schemes to learn Chinese Idioms. A survey was conducted to examine participants' anxiety, interest and cognitive load by using this new computer-assisted game. According to the survey, students felt this new program is interesting and would like to play again in the future. For those students who believe anxiety helps their performance, and for those students whose degree of anxiety lowered after completing the test, they tended to have greater interests in playing the game. Findings of the Partial Least Squares (PLS) contribute to an expanded understanding of both psychological anxiety and somatic anxiety influence their cognitive load, whereas both anxieties was not significantly related to their playing interest. In addition, the study results indicated that the higher degree of psychological and somatic anxiety, the greater cognitive load participants had.


Low capital accumulation or savings due to financial shallowness instead of financial deepening is a worrisome situation that needs to be addressed. This is because low capital accumulation will lead to low investment and this would hinder the achievement of one of the Sustainable Development Goals of economic growth and full employment. Data, which were relevant to variables of study like financial deepening and total savings (which was used to capture capital accumulation), and spanning 48 years from 1970 to 2018 were gathered from secondary sources and analyzed using the ARDL model. The result proved that savings accumulation has a long-term positive and significant impact on financial deepening. The paper recommends amongst others that banking habits should be encouraged to every Nigerian so as to increase total savings and hence, capital accumulation.


The REDfly database of Drosophila transcriptional cis-regulatory elements provides the broadest and most comprehensive available resource for experimentally validated cis-regulatory modules and transcription factor binding sites among the metazoa. The third major release of the database extends the utility of REDfly as a powerful tool for both computational and experimental studies of transcription regulation. REDfly v3.0 includes the introduction of new data classes to expand the types of regulatory elements annotated in the database along with a roughly 40% increase in the number of records. A completely redesigned interface improves access for casual and power users alike; among other features it now automatically provides graphical views of the genome, displays images of reporter gene expression and implements improved capabilities for database searching and results filtering. REDfly is freely accessible at http://redfly.ccr.buffalo.edu.


This booklet is intended to guide extension service advisors and institutions who work with small-scale farmers and foresters with an interest in Carbon Finance and Carbon Projects. Its aim is to support setting-up carbon projects which involve small-scale farmers. Their participation allows them to be involved in the development and implementation of the project, influence the design of the project to generate positive impacts for the farmers and increase their knowledge about carbon finance. The definition of a small-scale farmer differs between and within countries. In most cases it is a farmer who cultivates less than one hectare of land and has diverse sources of livelihood. The guide is structured into five sections: first, the background of climate change is explained (1); second, an introduction is given to how the carbon market works (2); this is followed by an explanation of carbon project development and the timeline and project size to take into account for planning (3); four, costs to be expected during the development of carbon projects are summarised, as well as benefits (4); finally, different funds and grants are presented (5). This booklet will need constant updating, as the political framework is changing very fast, causing changes in legislation, as well as actors, funds and regulations. In addition, the available data, research and knowledge for the development of carbon projects is constantly improving which will facilitate their future upgrowth.


This paper is concerned with the stochastic bounded consensus tracking problems of leader—follower multi-agent systems, where the control input of an agent can only use the information measured at the sampling instants from its neighbours or the virtual leader with a time-varying reference state, and the measurements are corrupted by random noises. The probability limit theory and the algebra graph theory are employed to derive the necessary and sufficient conditions guaranteeing the mean square bounded consensus tracking. It is shown that the maximum allowable upper boundary of the sampling period simultaneously depends on the constant feedback gains and the network topology. Furthermore, the effects of the sampling period on the tracking performance are analysed. It turns out that from the view point of the sampling period, there is a trade-off between the tracking speed and the static tracking error. Simulations are provided to demonstrate the effectiveness of the theoretical results.


Most of trials in New Zealand radiata pine (P. radiata) plantations were conducted on Podzol Soils and Mapua sandy loam soils. Few trials were conducted on Allophanic Soils in the country. A better understanding on change in P chemistry and tree growth due to the application of P fertiliser on an Allophanic Soil is important to determine appropriate management practice for the P fertiliser. A glasshouse trial was carried out to investigate changes in the soil available P, the P nutrition, growth of P. radiata seedlings, and to determine relationships of soil plant-available P with plant P on an Allophanic Soil, following the application of three rates of triple superphosphate (TSP) in a glasshouse. The results showed that the application of P fertilizer enhanced the P availability in the soils of radiata seedlings as measured by the Bray-2 P concentrations. The dry matter yield and the P concentrations in needles, stem, and roots of radiata pine increased also with increased rates of triple superphosphate application to a P-deficient Allophanic Soil. Furthermore, P concentration in the new shoot needles had significant logarithmic relationship with Bray-2 P concentration in the soil under the radiata seedlings. This curvilinear relationship suggests that the P concentration of new shoot needles diminishes with an increase in the plant-available P concentration (Bray-2 P) in this high-P fixing Allophanic Soil.


Medical data are an ever-growing source of information generated from the hospitals in the form of patient records. When mined properly, the information hidden in these records is a huge resource bank for medical research. As of now, these data are mostly used only for clinical work. These data often contain hidden patterns and relationships, which can lead to better diagnosis, better medicines, better treatment, and overall, a platform to better understand the mechanisms governing almost all aspects of the medical domain. Unfortunately, discovery of these hidden patterns and relationships often goes unexploited. However, there is on-going research in medical diagnosis which can predict the diseases of the heart, lungs, and various tumours based on the past data collected from the patients. They are mostly limited to domain-specific systems that predict diseases restricted to their area of operation like heart, brain, and various other domains. These are not applicable to the whole medical dataset. The system proposed in this paper uses this vast storage of information so that diagnosis based on these historical data can be made. It focuses on computing the probability of occurrence of a particular ailment from the medical data by mining it using a unique algorithm which increases accuracy of such diagnosis by combining the key points of neural networks, Large Memory Storage, and Retrieval, k-NN, and differential diagnosis all integrated into one single algorithm. The system uses a service-oriented architecture wherein the system components of diagnosis, information portal, and other miscellaneous services are provided. This algorithm can be used in solving a few common problems that are encountered in automated diagnosis these days, which include diagnosis of multiple diseases showing similar symptoms, diagnosis of a person suffering from multiple diseases, receiving faster and more accurate second opinion, and faster identification of trends present in the medical records.


Aim: To assess the myocardial velocities of the mitral annulus, left ventricular lateral wall, and midseptum in healthy children, and to compare these parameters with transmitral and pulmonary venous velocities. Methods and results: We examined 72 children, half being male, who had no systemic or cardiac pathologies. Their mean age was 6.73 ± 5.10 years, with a range from 0.1 to 17.75 years, and a median age of 6.71 years. Each parameter was measured twice, at end inspiration and end expiration. The tissue velocities are similar in males and females (p > 0.05). The longitudinal velocity of the heart in early diastole has a positive correlation with age (p < 0.05; midseptum velocity r = 0.57, left ventricular lateral wall velocity r = 0.56, mitral annulus velocity r = 0.56), and the tissue velocities are not influenced by respiration (p > 0.05). The myocardial velocities of different segments of the left ventricle are not correlated with the transmitral or pulmonary venous flows (p < 0.05). When age is controlled for heart rate, age mainly affects the systolic velocity of the mitral annulus and the early diastolic velocity of the midseptum in longitudinal axis, as well as the early diastolic velocity of the midseptum in transverse axis (p > 0.05 for all, r = 0.34, 0.29, 0.30 respectively). Conclusion: This study, which has determined reference values for tissue velocities in a large healthy group of children, will now set the scene for further studies in children with heart disease.


Advanced techniques for detecting kinase inhibitors are in demand due to limitations of traditional approaches. Here, we used a fluorescence resonance energy transfer (FRET)-based kinase assay, a sensitive fluorescence turn-on biosensing platform, to identify a Polo-like kinase 1 (PLK1) inhibitor. The assay was developed with the Z'-Lyte™ FRET-peptide and PLK1 kinase purified from a baculovirus expression system. Using PLK1 inhibitors, sensitivity and efficiency of this FRET-based PLK1 kinase assay were compared to those of radioisotope-based and immunoblot-based assays. Although the inhibitory activity of BI 2536 against PLK1 kinase in each assay was almost the same, the FRET-based PLK1 kinase assay was much easier, faster, safer, and more convenient than a radioisotope-based assay or an immunoblot-based traditional kinase assay. From our findings, we suggest that a FRET-based PLK1 kinase assay is an advanced tool which overcomes the limitations of previous traditional kinase assays to detect kinase inhibitors for the development of anticancer drugs.


To present information such as causes of accidents and their consequences on the Ghanaian mining industry in the safety literature, classification schemes for incident analysis within the safety literature were studied. Human Factor Analysis and Classification Scheme (HFACS) emerged suitable for incident analysis. Base on its suitability for incident analysis within the Ghanaian Mining Industry (GMI), a derivative of the HFACS, namely HFACS-GMI, was proposed. This research seeks to study the usefulness and the applicability of the HFACS-GMI. Collectively, 56 incident investigation reports were obtained from an open cast gold mine in Ghana and analysed using the HFACS-GMI. Two cases, an equipment damage incident and an injury incident, were used to demonstrate the coding processing in identifying the causal factors. The analysis shows that most mishaps are associated with adverse workplace/operator conditions (151 references), with the physical environment (72.2%) being cited as the major causal code under the tier. Management decision showed a major contribution (74.1%) to mishap under the causal codes. Most cases were attributed to mistake error (57.4%) followed by the contravention (51.1%) of set rules and procedures with the operator's act tiers. Inadequate work standards (27.8%) and failure to ensure competency (24.1%) under the operational process and leadership flaw causal codes, respectively, were identified as the most cited nanocode. Management decision is critical in a mishap and should be given much attention in developing accident prevention strategies. The study has demonstrated that HFACS-GMI is very useful and applicable for incident analysis within the mining industry and is recommended to study causal factors across the mines.


Transient current (IDD) testing has been often cited and investigated as an alternative and/or supplement to quiescent current (IDDQ) testing. In this correspondence, we present a novel integrated method for fault detection and localization using wavelet transform-based IDD waveform analysis. The time-frequency resolution property of wavelet transform helps us detect as well as localize faults in digital CMOS circuits. Experiments performed on measured data from a fabricated 8-bit shift register, and simulation data from more complex circuits show promising results for both detection and localization. Wavelet-based detection method shows better sensitivity than spectral and time-domain methods. Effectiveness of the localization method in presence of complex power supply network, measurement noise, and process variation is also addressed.


Several recent works have emphasised contemporary hierarchical trends within international society. These trends have been most readily demonstrated by the willingness of dominant states, such as the United States, to conduct interventions in support of the promotion of liberal values and political institutions. Yet while many scholars have identified new relations of hierarchy within international society, few have explored what they suggest regarding international society's normative constitution or what factors have given rise to these new hierarchies. The end of colonialism in the 1960's resulted in a fundamental reconstitution of international society. The result of decolonisation was that pluralism, the notion that all states have the equal freedom to constitute their internal socio-political and economic institutions as they see fit, was entrenched as the central constitutive principle of the post-colonial international society.

Contemporary hierarchical trends suggest a transition away from this pluralist constitution, with resultant changes in the processes of inclusion and exclusion and modes of interaction between different members of international society. This thesis aims to explore these processes of reconstitution within international society in the post-Cold War era and explain why Western societies have felt compelled to intervene in particular territories in order to promote liberal values. Utilising sociological theories of risk, particularly the work of Ulrich Beck, this thesis suggests that a new 'liberal social logic of risk' underpins the emergence of new forms of hierarchy and contemporary constitutional transition within international society. New forms of temporally and spatially de-bounded security risks (such as terrorism), and Western attempts at managing these risks through intervention and the imposition of liberal values in so-called 'risky zones', has altered the constitution of international society in a way that gives rise to various hierarchical and anti-pluralist trends.


Introduction: Adnexal tumors are third common neoplasms in female reproductive ages and the fifth cause of death in women.
 Objectives: The aim of the study was to evaluate sonography accuracy in discrimination between adnexal malignancies.
Patients and Methods: This is a retrospective study in women with adnexal masses. Sonography findings were compared with histopathology diagnoses.
 Results: Around 67 masses were involved in the study and accuracy of sonography was 92%.
Conclusion: The accuracy of gray-scale and color Doppler sonography in discrimination between malignant and benign adnexal masses were high and proved to be valuable diagnostic tools.


The world entered the nuclear age in 1945 when the United States first acquired nuclear capability. The United States enjoyed a strategic monopoly but only for a couple of years until the Soviet Union tested its nuclear device in 1949. Since then, the United Kingdom, France, and China joined the exclusive nuclear club, and the threat of nuclear weapons has become one of the most daunting challenges of the world. Almost immediately after the United States developed nuclear weapons in the 1940s, it began to explore a way to destroy an incoming nuclear warhead before it reached its target in the United States in order to negate the dangers of nuclear weapons. Smaller scale threats coming from the Third World or rogue states and possibly terrorist organizations are serious factors to be reckoned with, but the nuclear threat from the Soviets was the backbone of US strategic thinking after WWII and until the late 1980s and early 1990s. During the long history of missile defense, the strategic environment experienced fundamental shifts, the most significant being the end of the Cold War. Nevertheless, the United States has shown rather consistent support for missile defense. Missile defense policy changes were seen but they did not coincide with the rise or fall of the Soviet threat. This is the central research question of this study: how has US missile defense policy been able to survive for decades despite fundamental changes in the security environment? The main interest of this study is the decision making process. Essentially, this study attempts to discover the central force behind US missile defense policy. In this effort, this study proposes three competing perspectives: the security perspective, the bureaucratic politics perspective, and the congressional perspective. Was it the external security factor? Was it the executive branch of the US government? Or was it Congress that brought about the policy decisions? This study argues that new strategic developments play an extremely important role in triggering policy changes, but Congress was instrumental in materializing missile defense policy changes.