Enhancing quality of learning for students has remained a primary target of states and economies around the world. Education systems around the world consider student test scores as objective measures (though with limited explanatory power) to determine the "quality" of student learning. Various strategies are adopted to enhance this matric. One tool that schools use to improve student achievement in the form of test scores has been teacher evaluation. In recent decades, teacher evaluation has come into the spotlight around the world in the current policy debates, reforms, and policy analyses. Therefore, as a significant contribution to the current policy environment, this study explores determinants of student achievement by analyzing data on student background, school traits, teacher evaluation, and country traits. It employs a robust dataset using two surveys i.e., Program for International Student Assessment (PISA) 2009 and Teaching and Learning International Survey (TALIS) 2008. Using Ordinary Least Squares as the analytic model, the study explores relationships between test scores in Mathematics and Science and determinants of student achievement at student, school, and country levels. The study finds mixed results for developmental and high-stakes approaches to teacher evaluation. Powerful associations between determinants of achievement at student, school, and country level suggest that it is important to explore implications of these factors on student achievement in schools.


Fifty-six paramedical personnel in training as Community Health Officers (CHO) and Nurse Tutors were interviewed by a self administered questionnaire as to personal information and what they know and believed about sickle cell haemoglobinopathy. Even after the normal course of lectures on the haemoglobinopathies as given for their training as CHO's, many of them still did not fully understand the topic as shown by mixed up and confusing answers given to questions. As a result of the maturity and exposure as community health workers, they are being proposed for retraining as counsellors with regards to the haemoglobinopathies. From our findings to this study it appears that using a formal lecture schedule would not be adequate in intimating this group with the problems they would likely encounter as CHO's in practice. A training programme should also include organised group discussions designed to detect biases and prejudices and correct them before certification as community health officers.


In this paper 1 , we propose some parallel structures of the word-based nonlinear combine functions in word-based stream cipher, high-speed versions of general (bit-based) nonlinear combine functions. Especially, we propose the high-speed structures of popular four kinds in word-based nonlinear combiners using by PS-WFSR(Parallel-Shifting or ParallelStructured Word-based FSR): m-parallel word-based nonlinear combiner without memory, m-parallel wordbased nonlinear combiner with memories, m-parallel word-based nonlinear filter function, and m-parallel word-based clock-controlled function. In addition, we propose an implementation example of the m-parallel word-based DRAGON stream cipher, and determine its cryptographic security and performance.


Introduction: Adalimumab is an anti-tumour necrosis factor (anti-TNF) monoclonal antibody and an important part of the treatment regime for autoimmune conditions including inflammatory bowel disease. We present a case of adalimumab induced pleuropericarditis and discuss the diagnosis challenges we faced.
Case History: A 22-year-old male presented to the emergency department with 3 days history of headache, malaise, fever and right-sided chest pain. He was diagnosed with ulcerative colitis 8 months ago but failed to respond to mesalazine, requiring high dose steroids to induce disease remission. His mesalazine was stopped after 4 months and he was initiated on adalimumab 2 months prior to the current presentation. At presentation, he had a temperature of 38.7 °C (101.6 °F) but no other physical signs. His inflammatory markers were raised, and the chest x-ray was clear. He was started on empirical intravenous antibiotics on suspicion of the underlying infective process. On day 4 the patient developed a new pleural rub and crepitations on both lung bases. An urgent echocardiogram and computed tomography scan of the thorax abdomen and pelvis revealed pleural effusion and a 1.8 cm diameter pericardial effusion. Extensive investigation including virology screen, autoimmune screen and pleural fluid analysis were normal.
Diagnosis, Management and Outcome: This case was discussed in a multidisciplinary meeting. A diagnosis of pleuropericarditis secondary to adalimumab was made. Adalimumab and antibiotics were stopped, and he was started on a course of oral steroids. The patient responded well to the treatment and his symptoms resolved.
Conclusion: Rare drug toxicity should be part of differential diagnosis, especially in young patients with unusual presentation. An early multidisciplinary approach is crucial for a positive outcome. The patient should be actively involved in decision making to improve long term outcome.


Background To identify parameters based on dual-imaging 18F-AlF-NOTA-octreotide (18F-OC) and 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for predicting the prognosis of neuroendocrine neoplasms (NENs). Materials and Methods Sixty-six patients (age: mean ± standard deviation (SD): 51.8 ± 11.8 years) who underwent both 18F-OC and 18F-FDG PET/CT imaging were enrolled in our retrospective study. The following PET parameters were measured: the maximum standardized uptake value (SUVmax) and the volumetric parameters—18F-OC SSR-derived tumor volume (TV) and somatostatin receptor expression (SRE, TV multiplied by the mean standardized uptake value (SUVmean)) and the 18F-FDG-derived multiple tumor volume (MTV) and tumor lesion glycolysis (TLG). The NETPET grade based on dual-imaging PET images was assessed. Progression-free survival (PFS) was set as an endpoint. Univariate and multivariate survival analyses were performed for PET parameters and clinical tumor data. Results In the univariate survival analyses of clinical information, PFS was significantly associated with age (>45.5 vs ≤45.5, years, P < 0.034) and the presence of bone metastases (P = 0.04). Higher values for the 18F-FDG and 18F-OC volumetric parameters and the NETPET grade were adverse factors for PFS according to the dual-imaging PET parameters. In the multivariate survival analysis, the NETPET grade and SRE were predictors of PFS in NEN patients. Conclusion The NETPET grade is a potential noninvasive prognostic biomarker for NENs.


Databases have become a crucial component in modern information systems. At the same time, they have become the main bottleneck in most systems. Database replication protocols have been proposed to solve the scalability problem by scaling out in a cluster of sites. Current techniques have attained some degree of scalability, however there are two main limitations to existing approaches. Firstly, most solutions adopt a full replication model where all sites store a full copy of the database. The coordination overhead imposed by keeping all replicas consistent allows such approaches to achieve only medium scalability. Secondly, most replication protocols rely on the traditional consistency criterion, 1-copy-serializability, which limits concurrency, and thus scalability of the system. In this paper, we first analyze analytically the performance gains that can be achieved by various partial replication configurations, i.e., configurations where not all sites store all data. From there, we derive a partial replication protocol that provides 1-copy-snapshot isolation as correctness criterion. We have evaluated the protocol with TPC-W and the results show better scalability than full replication.


Entry in many occupations is regulated with the objective to screen out the least able producers and guarantee high quality of output. Unfortunately, the available empirical evidence suggests that in most cases these objectives are not achieved. In this paper we investigate entry into the legal profession in Italy and we document that such a failure is due to the combination of the incomplete anonymity of the entry exam and the intergenerational transmission of business opportunities. We use microdata covering the universe of law school graduates from 2007 to 2013 matched with their careers and earnings up to 5 years after graduation. Variation generated by the random assignment of the entry exam grading commissions allows us to identify the role of family ties in the selection process. We find that connected candidates, i.e. those with relatives already active in the profession, are more likely to pass the exam and eventually earn more, especially those who performed poorly in law school. When we simulate the process of occupational choice assuming family connections did not matter, we find that strong positive selection on ability would emerge.<br>


Deformable user interfaces leverage the physical actions we use intuitively to interact with real objects. It is therefore important to consider a prototype's physical characteristics when conducting research on deformable interactions. To create an authentic product experience, the authors set out to build a prototype that would mimic potential commercialized flexible devices and achieve the realism often lacking in low-fidelity prototypes. In this article, they outline the design and fabrication process to create Bendy, a prototype for studying deformable user interfaces. Their method creates prototypes quickly (one day) and inexpensively (approximately US $70) by using readily available materials. In addition, the process lets other researchers customize physical properties and interaction language to fit their specific purposes. The deformable prototype is composed of three main layers: a flexible plastic, an array of bend sensors connected to a flexible circuit, and a layer of silicone that encloses the sensors and circuit. The authors describe the fabrication process and demonstrate their method with two additional case studies. This article is part of a special issue on fabrication and printing. The Web extra shows the fabrication process, from the circuit design to printing and testing our flexible circuit, to creating the final Bendy prototype and playing Pac-Man using our deformable prototype. The Web extra for this article can be found at http://youtu.be/PJ5ee5gAbm8.


State-of-the-art language models (LMs) represented by long-short term memory recurrent neural networks (LSTM-RNNs) and Transformers are becoming increasingly complex and expensive for practical applications. Low-bit neural network quantization provides a powerful solution to dramatically reduce their model size. Current quantization methods are based on uniform precision and fail to account for the varying performance sensitivity at different parts of LMs to quantization errors. To this end, novel mixed precision neural network LM quantization methods are proposed in this paper. The optimal local precision choices for LSTM-RNN and Transformer based neural LMs are automatically learned using three techniques. The first two approaches are based on quantization sensitivity metrics in the form of either the KL-divergence measured between full precision and quantized LMs, or Hessian trace weighted quantization perturbation that can be approximated efficiently using matrix free techniques. The third approach is based on mixed precision neural architecture search. In order to overcome the difficulty in using gradient descent methods to directly estimate discrete quantized weights, alternating direction methods of multipliers (ADMM) are used to efficiently train quantized LMs. Experiments were conducted on state-of-the-art LF-MMI CNN-TDNN systems featuring speed perturbation, i-Vector and learning hidden unit contribution (LHUC) based speaker adaptation on two tasks: Switchboard telephone speech and AMI meeting transcription. The proposed mixed precision quantization techniques achieved "lossless" quantization on both tasks, by producing model size compression ratios of up to approximately 16 times over the full precision LSTM and Transformer baseline LMs, while incurring no statistically significant word error rate increase.


Abstract Background Attention-deficit/hyperactivity disorder (ADHD) often persists into adolescence and adulthood, but the processes underlying persistence and remission remain poorly understood. We previously found that reaction time variability and event-related potentials of preparation-vigilance processes were impaired in ADHD persisters and represented markers of remission, as ADHD remitters were indistinguishable from controls but differed from persisters. Here, we aimed to further clarify the nature of the cognitive-neurophysiological impairments in ADHD and of markers of remission by examining the finer-grained ex-Gaussian reaction-time distribution and electroencephalographic (EEG) brain-oscillatory measures in ADHD persisters, remitters and controls. Methods A total of 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 age-matched controls were compared on ex-Gaussian (mu, sigma, tau) indices and time-frequency EEG measures of power and phase consistency from a reaction-time task with slow-unrewarded baseline and fast-incentive conditions ('Fast task'). Results Compared to controls, ADHD persisters showed significantly greater mu, sigma, tau, and lower theta power and phase consistency across conditions. Relative to ADHD persisters, remitters showed significantly lower tau and theta power and phase consistency across conditions, as well as lower mu in the fast-incentive condition, with no difference in the baseline condition. Remitters did not significantly differ from controls on any measure. Conclusions We found widespread impairments in ADHD persisters in reaction-time distribution and brain-oscillatory measures. Event-related theta power, theta phase consistency and tau across conditions, as well as mu in the more engaging fast-incentive condition, emerged as novel markers of ADHD remission, potentially representing compensatory mechanisms in individuals with remitted ADHD.


It has previously been reported that the heterogeneity of the geomagnetic field disturbs the currently-
measured free induction decay signal of magnetic resonance sounding (MRS). To overcome the limitation of MRS in a non-homogeneous geomagnetic field, we adapted the spin-echo methodology
usually used at the laboratory scale and in boreholes. We present examples of measurements carried out in a sandy aquifer in southern India. The 15–25 m thick sand deposit overlays a gneissic basement. Two sources of geomagnetic field heterogeneity have been identified at this site, both affecting the geomagnetic field within the sandy aquifer: the gneissic bedrock and an intruded dyke into the bedrock. Spin-echo and free induction decay signals have been recorded at six locations. We found that the groundwater content, the thickness of the saturated aquifer and its transmissivity calculated with free induction decay measurements are underestimated compared to those derived from spin-echo measurements. The closer to the dyke the higher the underestimation. Time-domain electromagnetic measurements indicate that the aquifer is rather homogeneous at the site scale, as suggested by spin-echo results. We also found that a small heterogeneity of the geomagnetic field can go unnoticed, thus leading to an unknown mis-estimate of aquifer properties when using free induction decay measurements. Thus spin-echo measurements can be used to improve the accuracy of aquifer characterization when using MRS in geological contexts where geomagnetic field
heterogeneity exists.


Gold & Stoljar's target article is important because it shows the limitations of neurobiological theories of the mind more powerfully than previous philosophical criticisms, especially those that focus on the subjective nature of experience and those that use considerations from philosophy of language to argue for the holism of the mental. They use less controversial assumptions and clearer arguments, the conclusions of which are applicable to the whole of neuroscience. Their conclusions can be applied to psychiatry to argue that, contrary to many researchers' assumptions, the approaches to both understanding and treating mental disorders must be interdisciplinary.


Vincenzo Tandoi and the imperial Latin satire (Persius, Turnus, Juvenal). The article of F. Bellandi examines five separate studies on the Latin satire of the imperial age by Tandoi and verifies their important results and the effect they have had on the following critics. The first paper is about a difficult passage (44 ss.) of sat. III of Persius (and the myth of Cato Uticensis). The second one analyses the two fragments of Turnus, satirist at the court of the Flavians. The three remaining essays are dedicated to Juvenal (two starting from the relationship between the Satirist and Statius) and consider numerous aspects of the satires 4 and 7 (esp. political thought and practice of mecenatism).


David Rudrum - Living Alone: Solipsism in Heart of Darkness - Philosophy and Literature 29:2
Philosophy and Literature 29.2 (2005) 409-427 Living Alone: Solipsism In Heart Of Darkness
David Rudrum London Metropolitan University ". . . As if I could read the darkness."Philosophical
Investigations, ?635 We live, as we dream -- alone." This, Marlow's most eminently quotable
aphorism, encapsulates a theme central to the outlook of modernism: what Virginia Woolf called
"the loneliness which is the truth about things." This loneliness derives not from the absence of
others -- Marlow is surrounded by friends when he makes this assertion. It is a deeper condition
brought about by recognizing the limits of selfhood, by confronting or being confronted by them.
This condition is central to Marlow's narrative predicament: he attempts to fathom the enigmatic
self that is Kurtz, to understand "the tempestuous anguish of his soul" (HoD, p. 246); he is led, by
this attempt, to question the nature of his own self; and, finally, he tries to relay the impenetrable
essence of both these selves to the "other minds" of his narratees on the yawl Nellie. As we shall
see, Marlow concedes defeat in all three of these struggles. Heart of Darkness, then, is a novel
beset by the limits of subjectivity. It is also a novel which foregrounds the limits of language.
Marlow concludes that we live in isolation from one another after musing on the failure of
language to communicate...


Check here if the organization is not a 509(a)(3) supporting organization and its gross receipts are normally not more than $25,000. A return is not required, but if the organization chooses Group Exemption Number to file a return, be sure to file a complete return. Check if the organization is not required Gross receipts: Add lines 6b, 8b, 9b, and 10b to line 12 to attach Sch. B (Form 990, 990-EZ, or 990-PF).


Background: Perceived risk is commonly conceived as a joint function of the perceived evaluations about the probability estimate of a negative outcome, and the perceived seriousness of the consequences of that negative outcome. Theories typically posit that once people perceive their vulnerability to health risks or outcomes, they form intentions to take preventive actions to reduce their risk. This theoretical proposition is not supported in skin cancer preventative behavior studies, which could be due to improper measurement of perceived risk. Purpose and Methods: The purpose of this manuscript was to assess how risk perception of skin cancer has been conceptualized and measured in the literature to date. Literature retrieval was facilitated through EBSCO, PubMed, PsycInfo, MEDLINE, and ERIC databases. Twenty potentially relevant articles were identified for this review. Results: In the literature, skin cancer risk has been operationalized in two ways: absolute risk and comparative risk. However, these measures have some serious limitations. For example, there is great uncertainty regarding the quality of risk perception measurements (i.e., whether the items used to measure perceived risk are reliable and valid). Future studies are warranted to better understand the significance of using conditional risk measures.


In this work, we present a new framework for person recognition in photo albums that exploits contextual cues at multiple levels, spanning individual persons, individual photos, and photo groups. Through experiments, we show that the information available at each of these distinct contextual levels provides complementary cues as to person identities. At the person level, we leverage clothing and body appearance in addition to facial appearance, and to compensate for instances where the faces are not visible. At the photo level we leverage a learned prior on the joint distribution of identities on the same photo to guide the identity assignments. Going beyond a single photo, we are able to infer natural groupings of photos with shared context in an unsupervised manner. By exploiting this shared contextual information, we are able to reduce the identity search space and exploit higher intra-personal appearance consistency within photo groups. Our new framework enables efficient use of these complementary multi-level contextual cues to improve overall recognition rates on the photo album person recognition task, as demonstrated through state-of-theart results on a challenging public dataset. Our results outperform competing methods by a significant margin, while being computationally efficient and practical in a real world application.


The structure of subjection to different clinical forms of colon cancer and to the morbidity as a whole approximates better the quasi-continued phenotypical model within which the contribution of genetic factors reaches 68-84%, that of incidental medium factors being 16-32%. Genetic study of heterogeneity of colon cancer clinical forms revealed that their pathogenetic community was quite high. However, the origin of colon cancer depends strongly on genetic factors (83.7 +/- 7.3%), in comparison with rectal cancer (67.9 +/- 7.1%). The analysis of colon cancer interrelation with other malignant neoplasms (including specific ones for women--breast and uterus cancer) revealed that the development of another malignant neoplasms was the result of the influence of partially common genes (20-50%) which predetermined the development of colon cancer and other malignant neoplasms. According to the data obtained in this study, the tables of repeated risk have been worked out which may be used for medico-genetic consultation.


An evaluation of the Wesley-Jessen 74% water Durasoft 4 LiteTint soft contact lens was made using 18 lenses on nine subjects and two pairs of control lenses. Five subjects cold disinfected the lenses and four subjects heat disinfected the lenses using Softmate PS regimens. One pair of control lenses was disinfected with each system . The results of the study show that heat disinfection can damage these lenses. Three of five pairs of lenses that were heat disinfected showed discoloration upon completion of the study. This includes one pair of control lenses which were heated once daily for 6 months, the duration of the study. All cold disinfected lenses remained normal. Other results show problems with Durasoft 4 lenses not attributable to the type of disinfection used. These problems include: difficulty in handling and determining whether inside-out or not, discomfort and severe drying symptoms, a rapid decrease in wearing time, and a tendency to accumulate deposits rapidly. Only one subject remained in the study for the 6 month duration. All others left early due to lens discomfort. Each subject was seen on a follow-up schedule and normal clinical methods were used to evaluate symptomology, fitting characteristics, and refractive changes. The results suggest that dehydration in these high water content lenses is the primary problem leading to discomfort.


AIMS AND OBJECTIVES
The aim was to elucidate patients' lived experience of the care pathway of going through open surgery for abdominal aortic aneurysm.

BACKGROUND
Open surgical treatment has a great impact on patients' health-related quality of life both before and after treatment. The transition from being independent and asymptomatic to dependent on nursing care can be difficult. To facilitate this process and provide high-quality care, patients' needs must be better understood.

DESIGN
An exploratory descriptive design was chosen to describe and understand patients' lived experience.

METHOD
Audio-taped interviews were performed three months postoperatively, covering the care pathway before and after surgery. Interviews were analysed with qualitative content analysis.

RESULTS
The informants made a transition from becoming aware of the deadly risk associated with abdominal aortic aneurysm to gradually understanding the physical and emotional impact of the surgical procedure during the recovery process. The experience of not understanding fully the risks of undergoing surgery or its consequences on daily life made the informants unprepared for complications and limitations during the recovery period. Many concerns emerged, with a need for more dialogue and opportunities to understand their own care than those provided by the health care staff.

CONCLUSIONS
To facilitate the transition process, health care staff should consider patients' unpreparedness for the physical and emotional impact that can follow diagnosis and treatment for abdominal aortic aneurysm and recognise the need for dialogue to enhance participation during recovery.

RELEVANCE TO CLINICAL PRACTICE
Throughout the care pathway, patients' need for information and for opportunities to reflect on bodily and emotional reactions to the diagnosis and treatment of abdominal aortic aneurysm should be recognised by nurses and physicians to support patients getting realistic expectations of the consequences of treatment and facilitate participation in decisions concerning care and medical treatment.


Dynamic portfolio analysis looks at the portfolio as a moving object to capture the essentials of a long-short investment management strategy. To see the forest rather than the trees requires simplifying assumptions, here a bare-bones two-parameter structure. One parameter measures the rate of information flow and the other the rate of trading in the portfolio. This framework yields informative results to explain the implementation efficiency of the strategy as well as the balance between the cost of trading and the benefit of trading. More significantly, it establishes a link between cause and effect. These notions can be used to engineer strategies, to analyze strategies, and to optimize the operation of strategies.


There is a strong correlation between bird mass and the likelihood of aircraft damage during a bird–aircraft collision. Thus, the U.S. Federal Aviation Administration (FAA) has established airworthiness standards related to bird mass for engines, airframes, and windshields. Most standards use large (1.8 kg) and medium (1.1 kg) birds as benchmarks (the empennage and certain large turbofan engines use a 3.6-kg bird). There are 20 large (≥1.8 kg) and 16 medium (1.1–1.7 kg) bird species in North America with ≥20 strikes reported for civil aircraft (FAA National Wildlife Strike Database), 1990 to 2018. I analyzed the population changes of these 36 species from 1990 to 2018 in relation to flocking behavior. For the 20 large species, the combined population had a net gain of 27.8 million birds (129% increase). For the 16 medium species, the combined population had a net gain of 6.7 million birds (20% increase). Notably, all 9 species with body mass ≥3.6 kg indicated population increases. In agreement with the increased numbers of birds, the number of strikes involving large and medium birds showed significant (P < 0.01) positive trends from 1990 to 2020 as did strikes involving multiple birds. The threat to aviation safety from large and medium birds, especially flocking species, was much higher in 2018 than in 1990. Although progress is being made to mitigate the risk by management programs to keep large and medium birds away from airport properties, these actions do little to mitigate the threat during climb and approach phases of flight. Enhanced airworthiness standards for aircraft components, bird-detecting radar to provide real-time warnings, and aircraft lighting schemes to improve visibility of aircraft to birds are priority areas of research and development to mitigate these off-airport threats to aviation safety.


While there are very clearly some structural constraints on pronoun interpretation, debate remains as to their extent and proper formulation (Bruening 2014). Since Reinhart 1976 it has commonly been reported that bound-variable pronouns are subject to a c-command requirement. This claim is not universally agreed upon and has recently been challenged by Barker (2012), who argues that bound pronouns must merely fall within the semantic scope of a binding quantifier. In the processing literature, recent results have been advanced in support of c-command (Cunnings et al. 2015, Kush et al. 2015). However, none of these studies separates semantic scope from structural c-command. In this article, we present two self-paced reading studies and one off-line judgment task which show that when we put both c-commanding and non-c-commanding quantifiers on an equal footing with regard to their ability to scope over a pronoun, we nonetheless find a processing difference between the two. Semantically legitimate but non-c-commanded bound variables do not behave like c-commanded bound variables in their search for an antecedent. The results establish that c-command, not scope alone, is relevant for the processing of bound variables. We then explore how these results, combined with other experimental findings, support a view in which the grammar distinguishes between c-commanded and non-c-commanded variable pronouns, the latter perhaps being disguised definite descriptions (Cooper 1979, Evans 1980, Heim 1990, Elbourne 2005).*


Streptomyces are ubiquitous in soil and face a rapidly changing environment. Like other bacteria, they sense and respond to external stimuli via two component systems and Streptomyces species encode a particularly high number of these systems. One of these two component systems is called MtrAB-LpqB and it is highly conserved in the phylum Actinobacteria. Previous work in Mycobacterium tuberculosis, Corynebacterium glutamicum and Streptomyces coelicolor indicates that MtrAB-LpqB is involved in osmosensing and cell cycle progression. To investigate the function of MtrAB-LpqB I attempted to make single gene deletions in the new model organism Streptomyces venezuelae. I also performed chromatin immunoprecipitation and sequencing (ChIP-seq) against MtrA-3xFlag in S. venezuelae and S. coelicolor to identify the regulon of genes under its control. I present evidence that MtrA is essential in S. venezuelae whereas MtrB is dispensable. It was not possible to confirm deletion of lpqB. Deletion of mtrB activates MtrA and leads to the overproduction of cryptic secondary metabolite biosynthetic gene clusters (BGCs). The same effect was achieved by introducing a gain of function MtrA protein into the S. venezuelae wild-type strain. The cryptic BGCs are activated because MtrA binds to target genes spanning 85% of the BGCs in S. venezuelae and S. coelicolor. In Streptomyces, antibiotic production is linked to development and the MtrA regulon overlaps with the master regulator of development, BldD. The results presented here suggest that MtrAB senses external signals and modulates target gene expression to coordinate development with the production of secondary metabolites.


Abstract Aims: This study analyses how Finnish and Norwegian teenagers and parents of teenagers perceive the appropriateness, desirability or harmfulness of different drinking situations. The focus is on whether teenagers and parents perceive the situations similarly or differently. Methods: Our data consist of focus group interviews from Finland and Norway with teenagers aged 14–17 years (n = 8 groups, n = 44 participants) and parents (n = 8 groups, n = 38). Three pictures portraying different drinking situations were presented to the participants, who were asked to describe (1) what kind of situation the picture depicts, (2) whether the way of drinking in the picture was acceptable or not and (3) whether they identified with the situation or not. Findings: Our analysis showed that teenagers and parents defined the situations similarly and applied rather similar criteria when assessing the appropriateness of drinking. The most important criteria related to the amount and the way of drinking, and whether or not children were present in the situation. Regarding the identification with the situations, teenagers seemed to have somewhat stricter attitudes towards intoxication than adults, which can be perceived as a sign of an ongoing trend of decreasing youth drinking. Conclusions: Overall, our analysis suggests that the alcohol worlds of parents and teenagers resembled each other, supporting the notion that the generational gap between parents and teenagers is diminishing.


Objective: Estimation of the glomerular filtration rate (GFR) is essential for identification, evaluation and risk prediction in patients with kidney disease. Estimated GFR (eGFR) is also needed for the correct dosing of drugs eliminated by the kidneys and to identify high-risk individuals in whom coronary angiography or other procedures may lead to kidney failure. Both cystatin C and creatinine are used for the determination of GFR, and we aimed to investigate if eGFR by the two methods differ in cardiology patients. Methods: We compared cystatin C and creatinine (CKD-EPI) eGFR calculated from the same request from a cardiology outpatient unit (n = 2,716), a cardiology ward (n = 980), a coronary care unit (n = 1,464), and an advanced coronary care unit (n = 518) in an observational, cross-sectional study. Results: The median creatinine eGFR results are approximately 10 ml/min/1.73 m2 higher than the median cystatin C eGFR that is up to 90 ml/min/1.73 m2, irrespective of the level of care. Creatinine eGFR resulted in a less advanced eGFR category in the majority of patients with a cystatin C eGFR <60 ml/min/1.73 m2. Conclusions: Our study demonstrates a difference between creatinine and cystatin C eGFR in cardiology patients. It is important to be aware of which marker is used for the reported eGFR to minimize erroneous interpretations of the test results, as this could lead to under- or overmedication. Further studies are needed to determine the best method of estimating the GFR in cardiology units.


SIR,-It is remarkable that over two months elapsed before there was a published comment on Professor Hugh Dudley's leading article on intensive care training (21 February, p 459). We have been reticent in replying because our own proposals for a pilot senior registrar training scheme in the South Western region were being considered by the interfaculty/collegiate liaison group on intensive therapy. We now understand that our scheme has been approved, and we therefore welcome Professor Iain Ledingham's letter (25 April, p 1095), with its emphasis on the importance of encouraging without delay training programmes recommended by the liaison group. There are two main obstacles to achieving this. The first is funding. The liaison group was set up jointly by the Faculty of Anaesthetists, the Royal Colleges of Surgeons ofEngland and Scotland, and the Royal College of Physicians. Its proposals have been accepted by the conference of royal colleges and their faculties. The agreement achieved is remarkable if not unique. It is difficult to believe that the conference cannot persuade the Department of Health and Social Security of the need to fund a small number of posts, unless those who have supported the liaison group publicly are privately hoping that lack of funds will ensure its premature death. The second problem is the anxiety among some anaesthetists that the proposals will undermine their role in intensive care and interfere with the training of anaesthetic registrars and senior registrars. For over 20 years anaesthetists have borne the main burden of intensive care in this country, and they will continue to do so. Trainees in other disciplines, however, also wish to pursue a career in intensive care. Is it essential that they must have completed all three parts ofthe FFARCS examination before being allowed to do so? We think not. The liaison group's proposals and our own South Western training scheme are designed to improve the training of those doctors who wish to have intensive care as a major component of their consultant career, and who include anaesthetists. Furthermore, the presence of a senior registrar in an intensive care unit may actually improve the training of registrars as he or she will be more readily available to teach than many consultants. So far as senior registrars in anaesthesia are concerned, it should be possible to maintain the amount of training in intensive care, even though there may already be a senior registrar on the intensive care unit in a hospital to which the new trainee rotates. In many regions, however, training of senior registrars in intensive care is limited by the demand for training in subspecialties within anaesthesia. It is essential that existing anaesthetic senior registrars continue to receive such1 trainig as many will undertake on call intensive care work as consultants. Many anaesthetists support these proposals. Some who oppose them misunderstand them. A few are unwilling formally to open intensive care training to disciplines other than anaesthesia. The proposals arose out of the need to improve the care of critically ill patients in Britain. It saddens us that parochial concerns may defeat this laudable objective. JoHN F SEARLE


PID (Proportional Integral Derivative) control is a feedback mechanism widely used in industrial control systems, and publisher/subscriber is an asynchronous one-to-many messaging mechanism commonly used in fieldbus protocols. Some fieldbus protocols are extended with IP/Ethernet, and publisher/subscriber messages are mapped to IP multicasts when extending these protocols. Some such protocols map each publisher/subscriber message to an individual IP multicast Group ID. This one-to-one mapping requires a large number of Group IDs if a system has a large number of devices, causing scalability issues on the Ethernet and IP layers. A single large Ethernet has to be divided by IP networks to resolve related scalability issues. However, this causes scalability issues related to IP multicasts. The purpose of this paper is to clarify these issues from the viewpoint of a network layer model. A further study item is to discuss solutions in depth; here, a tunneling technique is shown as a solution. The analysis presented in the paper is applicable to any fieldbus protocol with a one-to-one mapping model between publisher/subscriber messages and IP multicast Group IDs.


This paper addresses stability analysis and stabilization for Takagi-Sugeno (T-S) fuzzy systems with model uncertainties via a so-called fuzzy Lyapunov function, which is a multiple Lyapunov function. The advantage of the fuzzy Lyapunov function is that the controller design is not restricted by a common positive definite matrix (i.e., the common P) to form the quadratic Lyapunov function. Based on the fuzzy Lyapunov function approach and a parallel distributed compensation (PDC) scheme, we provide stabilization conditions for closed-loop fuzzy systems with model uncertainties. Furthermore, we propose a compound search strategy composed of island random optimal algorithms concatenated with the Simplex method to identify the chaotic systems, and to solve the linear matrix inequality (LMI) problem.


Peroxisome proliferator-activated receptors (PPARs) are nuclear receptors (NRs) that regulate genes involved in lipid and glucose metabolism. PPAR activity is regulated by interactions with cofactors and of interest are cofactors with ubiquitin ligase activity. The E6-associated protein (E6-AP) is an E3 ubiquitin ligase that affects the activity of other NRs, although its effects on PPARs have not been examined. E6-AP inhibited the ligand-independent transcriptional activity of PPARα and PPARβ, with marginal effects on PPARγ, and decreased basal mRNA levels of PPARα target genes. Inhibition of PPARα activity required the ubiquitin ligase function of E6-AP, but occurred in a proteasome-independent manner. PPARα interacted with E6-AP, and in mice treated with PPARα agonist clofibrate, mRNA and protein levels of E6-AP were increased in wildtype, but not in PPARα null mice, indicating a PPARα-dependent regulation. These studies suggest coordinate regulation of E6-AP and PPARα, and contribute to our understanding of the role of PPARs in cellular metabolism.


Monitoring physical quantities using acoustic wave devices can be advantageously achieved using the wave characteristic dependence to various parametric perturbations (temperature, stress, and pressure). Surface acoustic wave (SAW) resonators are particularly well suited to such applications as their resonance frequency is directly influenced by these perturbations, modifying both the phase velocity and resonance conditions. Moreover, the intrinsic radio frequency (rf) nature of these devices makes them ideal for wireless applications, mainly exploiting antennas reciprocity and piezoelectric reversibility. In this paper, we present a wireless SAW sensor interrogation unit operating in the 434 MHz centered ISM band--selected as a tradeoff between antenna dimensions and electromagnetic wave penetration in dielectric media--based on the principles of a frequency sweep network analyzer. We particularly focus on the compliance with the ISM standard which reveals complicated by the need for switching from emission to reception modes similarly to radar operation. In this matter, we propose a fully digital rf synthesis chain to develop various interrogation strategies to overcome the corresponding difficulties and comply with the above-mentioned standard. We finally assess the reader interrogation range, accuracy, and dynamics.


Since the pioneering work that was carried out 10 years ago, the generation of highly energetic ion beams from laser-plasma interactions has been investigated in much detail in the regime of target normal sheath acceleration (TNSA). Creation of ion beams with small longitudinal and transverse emittance and energies extending up to tens of MeV fueled visions of compact, laser-driven ion sources for applications such as ion beam therapy of tumors or fast ignition inertial confinement fusion. However, new pathways are of crucial importance to push the current limits of laser-generated ion beams further towards parameters necessary for those applications.
The presented PhD work was intended to develop and explore advanced approaches to high intensity laser-driven ion acceleration that reach beyond TNSA. In this spirit, ion acceleration from two novel target systems was investigated, namely mass-limited microspheres and nm-thin, free-standing diamond-like carbon (DLC) foils. Using such ultrathin foils, a new regime of ion acceleration was found where the laser transfers energy to all electrons located within the focal volume. While for TNSA the accelerating electric field is stationary and ion acceleration is spatially separated from laser absorption into electrons, now a localized longitudinal field enhancement is present that co-propagates with the ions as the accompanying laser pulse pushes the electrons forward. Unprecedented maximum ion energies were obtained, reaching beyond 0.5 GeV for carbon C$^{6+}$ and thus exceeding previous TNSA results by about one order of magnitude. When changing the laser polarization to circular, electron heating and expansion were shown to be efficiently suppressed, resulting for the first time in a phase-stable acceleration that is dominated by the laser radiation pressure which led to the observation of a peaked C$^{6+}$ spectrum. Compared to quasi-monoenergetic ion beam generation within the TNSA regime, a more than 40 times increase in conversion efficiency was achieved. The possibility to manipulate the shape of the ion acceleration front was successfully demonstrated by use of a spherically curved target surface. Finally, the last part of the presented work is devoted to accomplishments in laser development.


Introduction: Spondyloarthropathies (SpAs) are inflammatory diseases with symptoms such as spinal pain, sacroiliac, and peripheral involvement. The prevalence of SpAs is reported from 0.2% to 1.6%. SpAs can cause significant disabilities for patients. Its medical treatment is mainly with non-steroidal anti-inflammatory (NSAIDs) and anti-TNF drugs. Objectives: The primary purpose of this study is to carefully detect the clinical manifestations of patients, demographic characteristics, and the effectiveness of common medications in this disease. Patients and Methods: The present study is a retrospective descriptive study. The statistical population is 101 patients with SpA who have demographic information and items related to clinical conditions, radiographic findings and response to treatment. Results: One hundred one patients with SpA [46 (45.5%) female] with the age of 36.83± 10.45 years were studied. Around 66 patients (64.7%) had ankylosing spondylitis (AS), with the highest prevalence of AS. The most common clinical symptoms in patients were axial and peripheral/ extra-articular symptoms. The response to patients' treatment were 61 patients (60.4%) had responded to the first stage of treatment, since only one patient needed to change the treatment steps in five times. Conclusion: We found, most patients with SpA were young patients. The most common radiological finding was Sacroiliitis. The most common clinical finding was extra-articular manifestations. Peripheral manifestations of the disease in women and axial images in men were common. The highest response to treatment was observed with the combination of indomethacin, sulfasalazine (SSZ) and indomethacin (alone).


Based on the previous study of micro bubble generation using carbon nanotube heating elements with uW power input in static droplet of water, the dynamic characteristic of micro bubble generated by CNTs heater draw us much attention. In this summary, the micro bubble transportation, diameter control in micro channel and the departure of micro bubble from CNTs heater by pulse current stimulation in water tank will be presented. On the one hand, PDMS, after fabricating micro channel on it, will be bonded to the silicon substrate by oxygen plasma to form micro channel device. In our research, we could observe that the movement of vapor bubble along the micro channel by pulse flow or constant flow. The power consumption for bubble generation in micro channel is relative higher than that in static droplet of water, but it keeps staying around 275 uW. Furthermore we also use the injected cool water to control the diameter of the micro bubble. On the other hand, from micro bubble departure in water tank experiment, we observe that the micro bubble has shake response by pulse current input on the CNTs heater, which accelerate the departure of micro bubble. With low power consumption, dynamic transportation and controllable diameter, the micro bubble generated by CNTs heater in micro channel offers a promising future in lots of application, e.g., micro manipulation and micro transportation.


Abstract. Landslides are a ubiquitous hazard in terrestrial environments with slopes,
incurring human fatalities in urban settlements, along transport corridors
and at sites of rural industry. Assessment of landslide risk requires
high-quality landslide databases. Recently, global landslide databases have
shown the extent to which landslides impact on society and identified areas
most at risk. Previous global analysis has focused on rainfall-triggered
landslides over short ∼ 5-year observation periods. This paper presents
spatiotemporal analysis of a global dataset of fatal non-seismic landslides,
covering the period from January 2004 to December 2016. The data show that in
total 55 997 people were killed in
4862 distinct landslide events. The spatial distribution of landslides
is heterogeneous, with Asia representing the dominant geographical area.
There are high levels of interannual variation in the occurrence of
landslides. Although more active years coincide with recognised patterns of
regional rainfall driven by climate anomalies, climate modes (such as El
Niño–Southern Oscillation) cannot yet be related to landsliding,
requiring a landslide dataset of 30+ years. Our analysis demonstrates that
landslide occurrence triggered by human activity is increasing, in particular
in relation to construction, illegal mining and hill cutting. This supports
notions that human disturbance may be more detrimental to future landslide
incidence than climate.


Secondary gelation is an important but overlooked element which has a significant impact on the quality of liquid-core hydrogel beads (LHB). This study firstly searches the optimized extraction conditions of burdock leaf and analyses its functional compounds and antioxidant abilities. Then, we measure loading efficiency, relative hardness, swelling capacity, and outer appearance to evaluate the optimized preparation conditions of LHB loaded with burdock leaf extract (BLE). The results showed that the optimized extraction conditions of burdock leaf were a solid to liquid (95% ethanol) ratio of 1 : 3, and extraction at 80 °C for 90 min. This extraction contained 23.81 mg g−1 dw chlorogenic acids (CGA) and the DPPH scavenging activity was 59.49%. LHB prevented the DPPH scavenging ability of BLE from decreasing during storage. The diameter and swelling capacity of burdock LHB increased, and hardness and loading efficiency decreased with longer gelation times. Relative hardness of the LHB prepared by 1% CaCl2 in the secondary gelation was 5.6-fold higher than that of the control, but there was no significant difference in CGA loading efficiency.


Rural productive cooperatives in Iran are not making use of their full potential. It appears that an important reason for this is the lack of an efficient monitoring and evaluation system to improve decision-making and develop more detailed economic prospects for projects. The current study guided rural productive cooperatives during implementation of an efficient monitoring and evaluation system to improve performance and efficiency. A model was designed to monitor and evaluate the rural productive cooperatives in Golestan province in Iran. For this purpose, 218 respondents were selected from the statistical population comprising all managing directors, members of the boards of directors and inspectors in rural productive cooperatives of Golestan province ( N = 483) and were asked to fill in a researcher-made questionnaire. Data analysis and modeling were performed by confirmatory factor analysis in AMOS. The recommendations for monitoring and evaluation of rural productive cooperatives are presented. Keywords: monitoring, evaluation, rural productive cooperative, Golestan Province.


Healthy young adults demonstrate a group-level, systematic preference for stimuli presented in the left side of space relative to the right ('pseudoneglect') (Bowers & Heilman, 1980). This results in an overestimation of features such as size, brightness, numerosity and spatial frequency in the left hemispace, probably as a result of right cerebral hemisphere dominance for visuospatial attention. This spatial attention asymmetry is reduced in the healthy older population, and can be shifted entirely into right hemispace under certain conditions. Although this rightward shift has been consistently documented in behavioural experiments, there is very little neuroimaging evidence to explain this effect at a neuroanatomical level. In this thesis, I used behavioural methodology and electroencephalography (EEG) to map spatial attention asymmetries in young and older adults. I then use transcranial direct current stimulation (tDCS) to modulate these spatial biases, with the aim of assessing age-related differences in response to tDCS.
In the first of three experiments presented in this thesis, I report in Chapter Two that five different spatial attention tasks provide consistent intra-task measures of spatial bias in young adults across two testing days. There were, however, no inter-task correlations between the five tasks, indicating that pseudoneglect is at least partially driven by task-dependent patterns of neural activity. In Chapter Three, anodal tDCS was applied separately to the left (P5) and right (P6) posterior parietal cortex (PPC) in young and older adults, with an aim to improve the detection of stimuli appearing in the contralateral visual field. There were no age differences in response to tDCS, but there were significant differences depending on baseline performance. Relative to a sham tDCS protocol, tDCS applied to the right PPC resulted in maintained visual detection across both visual fields in adults who were good at the task at baseline. In contrast, left PPC tDCS resulted in reduced detection sensitivity across both visual fields in poor performers. Finally, in Chapter Four, I report a right-hemisphere lateralisation of EEG activity in young adults that was present for long (but not short) landmark task lines. In contrast, older adults demonstrated no lateralised activity for either line length, thus providing novel evidence of an age-related reduction of hemispheric asymmetry in older adults.
The results of this thesis provide evidence of a highly complex set of factors that underlie spatial attention asymmetries in healthy young and older adults.


The article describes the study of rotor-to-wing aerodynamic interaction for the wingtip-mounted coaxial rotors configuration of the tiltrotor aircraft.
The influence of the rotor slipstreams on lift-to-drag ratio characteristic was determined. Obtained results were compared with similar characteristics of the equivalent in thrust conventional single rotor slipstreams impact.
Using the computational aerodynamics methods (panel-vortex method) the flow around the tiltrotor model with the wingtip-mounted single and coaxial rotors has been simulated. A study of the basic model configuration with conventional single rotors, based on the technical characteristics of the AgustaWestland AW609 tiltrotor, was conducted. Further researches were conducted for a modified model where single rotors were replaced with equivalent in thrust coaxial rotors. The influence of the rotor slipstreams on the aerodynamic characteristics of the model for both directions of rotors rotation in coaxial combination is considered. Also, the dependence of the maximum lift-to-drag characteristic due to the coaxial rotor diameters change has been determined.
The results show that the coaxial rotor slipstreams-to-wing aerodynamic interaction effect is the similar to the effect of conventional single rotor, but less intensive. Comparison of the results showed that a tiltrotor equipped with wingtip-mounted single rotors has approximately 20% greater maximum lift-to-drag characteristic than one equipped with coaxial rotors with the same thrust. However, the use of coaxial rotors allows getting higher maximum speed, when conventional single rotors lose the efficiency significantly. Therefore, it is advisable to conduct further research for the possibility of using coaxial rotors for tiltrotor aircrafts.
The research results are presented in graphical form. The obtained data provides a basis for further studies of the described problem, and also will be useful for new tiltrotor design works.


Purpose of review The review is designed to give an overview of the latest developments in research exploring the relationship between sleep and psychosis, with particular attention paid to the evidence for a causal relationship between the two. Recent findings The most interesting avenues currently in pursuit are focused upon sleep spindle deficits which may hallmark an endophenotype; explorations of the continuum of psychotic experiences, and experimental manipulations to explore the evidence for bidirectional causality; inflammatory markers, psychosis and sleep disturbances and finally, treatment approaches for sleep in psychosis and the subsequent impact on positive experiences. Summary Globally, large surveys and tightly controlled sleep deprivation or manipulation experiments provide good evidence for a cause-and-effect relationship between sleep and subclinical psychotic experiences. The evidence for cause-and-effect using a interventionist-causal model is more ambiguous; it would appear treating insomnia improves psychotic experiences in an insomnia cohort but not in a cohort with schizophrenia. This advocates the necessity for mechanism-driven research with dimensional approaches and in depth phenotyping of circadian clock-driven processes and sleep regulating functions. Such an approach would lead to greater insight into the dynamics of sleep changes in healthy and acute psychosis brain states.


Background: Smart devices turned into a basic tool of medical students' academic life. Smart devices are utilized throughout the day for numerous reasons including learning, communication, productivity, entertainment, utilities, social networking and gaming. The objectives of the current study were to determine the use and perceptions of medical students at Majmaah University, Saudi Arabia towards smart devices and its relationship with academic performance. Methods: This was a cross-sectional study to determine the use and perceptions of medical students at Majmaah University, Saudi Arabia towards smart devices. The total enumeration of all eligible students was considered in this study. Data were collected by a questionnaire. Analysis was performed by SPSS. Results: All students (n=174, 100%) use smart devices and 37% use them more than 6 hours per day. 141 (81.0%) students preferred to study using smart devices. Most students utilize smartphones in studying lectures and preparing PBL/CDs 79.3% and 75.3% respectively. Eighty-seven (49.7%) have a good perception towards smart devices. Nine (47.4%) students with high academic performance study less than three hours/day with smart devices. Conclusion: Most students at the College of Medicine, Majmaah University use smart devices, mostly for more than six hours every day. Studying lectures constitute the most use of smart devices. Most students have good perception towards smart devices. There is a significant relation between the number of hours spent on smart devices and academic performance.


In 2002, the National Research Council (NRC) completed an 18-month study entitled Biosolids Applied to Land: Advancing Standards and practices , which made an overarching recommendation to "establish a framework for an approach to implement human health investigations." In response to this recommendation, the Water Environment Research Foundation (WERF) funded two projects. Phase I began in 2006 and WERF published the results in 2007. Phase I developed a draft five-step rapid response investigation protocol to collect data on reports of health effects from neighbors of land application sites.

This project (Phase II) field tested and refined the Phase I draft protocol from May 2009 until November 2010, on 33 complaints from three states. The draft protocol included a health questionnaire to collect data on complaints of alleged health symptoms, nuisance odors, or quality of life effects from neighbors of land application sites of biosolids, manure and other materials, a generator questionnaire to characterize biosolids that were land applied and an applier questionnaire to document methods of application.

The project team tested two site investigation reports which documented the location and described the land application site of concern. The project team also evaluated the health questionnaire using pre-testing, content expert reviews, and cognitive interviews during field testing, to determine if any biases existed within both the structure and organization of the questionnaire, the wording, and order of the questions, or within the methods of administration, such as measurement errors resulting from answers by respondents who misinterpreted or did not understand the meaning of questions. In addition, the project team evaluated the generator and applier questionnaires by pre-testing, content expert reviews, field testing, and by using a focus group of generators and appliers. The project team designed the protocol so that local or state public health departments and state biosolids regulators could apply it accurately, efficiently, and effectively as a component of a future standardized surveillance and "rapid response" investigation system throughout the country. The team of researchers also developed an outreach and implementation communication plan and a guidance document that suggested future research methods, based upon what the research team learned from this project.

This title belongs to WERF Research Report Series .

ISBN: 9781843396147 (eBook)


BACKGROUND AND METHODS: The treatment of substance abuse is an important health service available in all industrialized countries throughout the world. Cost of treatment and its benefit or economic value is an important policy issue. Reduction in health care cost is one alternative way to measure benefits. This paper reviews a series of studies (all from the US) which address the cost-benefit question. Most studies have compared the monthly costs prior to initiation of substance abuse treatment with the costs following initiation. RESULTS FROM STUDIES OF ALCOHOLISM TREATMENT: Many studies have found that, over the time prior to alcoholism treatment initiation, total monthly health care costs increased and costs substantially increased during the 6-12 months prior to treatment. Following treatment initiation, monthly total medical care costs declined and the overall trend was downward, i.e., the slope was negative. In contrast to the use of general health care where women typically utilize more medical care than men, overall medical care costs were found to be similar. Alcoholics of different ages, however, showed distinct medical care costs, i.e., younger patients experienced greater declines in medical care costs following alcoholism treatment initiation. Inpatient treatment is most affected by alcoholism treatment. In some cases, outpatient treatment is actually increased in response to aftercare health care utilization, but at a substantially lower cost than inpatient treatment. If the alcoholism condition can be treated on an outpatient basis, then the total cost of such treatment is obviously lower and the potential for a cost-offset net effect is substantially increased. COST BENEFITS OF DRUG ABUSE TREATMENT: There have been few drug abuse treatment cost-benefit research studies. Early studies found that there was a decline in sickness and medical care utilization associated with initiation of treatment. A recent study found a substantial reduction in total health care costs following initiation of drug abuse treatment. Utilization of inpatient care and its associated costs are most affected by the absence and/or presence of treatment. SUMMARY AND CONCLUSION: This review describes the research findings from a number of cost-offset or cost-benefit studies of alcoholism and drug abuse treatment. In broad terms the findings of this research can be summarized as follows. (i) Untreated alcoholics or drug dependent persons use health care and incur costs at a rate about twice that of their age and gender cohorts. (ii) Once treatment begins, total health care utilization and costs begin to drop, reaching a level that is lower than pre-treatment initiation costs after a two- to four-year period. The conclusion is based on similar findings across different patient populations using a variety of research designs. (iii) There are no apparent gender differences in the utilization and associated costs before and after treatment initiation. (iv) There are age differences that support the value of early intervention. Younger treated substance abuse patients have pre-treatment total cost levels that are lower than pre-treatment levels for older patients. IMPLICATIONS OF HEALTH POLICY: The results of research provide consistent support for the cost benefits of substance abuse treatment. From a health policy perspective, such results are promising if the objective is to demonstrate that treatment investment can pay for all or part of its associated costs through reductions in other health care costs. One can hold a contrary position, i.e., lower future medical care costs for substance abusers could reflect denial of essential care. IMPLICATIONS FOR FURTHER RESEARCH: The studies that have addressed the potential cost offset of substance abuse treatment have been largely based upon overall or aggregate effects across all forms of substance abuse treatment. There have been no studies of the cost offset of specific treatment modalities, though this is what the next generation of studies should do


Wild edible mushrooms, Termitomyces microcarpus are widely consumed in Uganda, partly because of their taste, flavour and because they are believed to have medicinal benefits. This study investigated the nutrient composition of the Termitomyces microcarpus mushrooms and the effect of the mushroom on feed intake, weight gain, serum cholesterol and triglycerides of male albino rats. Semi-dried mushrooms collected from Kyenjojo District in western Uganda were analyzed for nutrient composition using standard procedures. To determine the effect of dietary intake of mushrooms, a completely randomized study design was used with experimental treatments having diets containing 25, 45 and 60% air -dried mushroom flour mixed with the basal feed and 0.5% cholesterol. These were compared to a control diet consisting of only commercial (basal) feed and to a diet containing basal feed and 0.5% cholesterol. The rats were fed on the five diets for ten weeks and were monitored for changes in feed intake and weight at weekly intervals for six weeks and in serum total cholesterol, High Density Lipoprotein (HDL)-cholesterol, Low Density Lipoprotein (LDL)-cholesterol and triglycerides at two weeks intervals for ten weeks. Proximate analysis revealed that the mushrooms contained 25.5% protein, 2.3% fat, 11.2% dietary fibre, 48.37% available carbohydrates and 12.67% water. The mushrooms were also found to contain 61 mg/100g of iron, 156 mg/100g of calcium and a number of other dietary minerals. Dietary inclusion of Termitomyces microcarpus mushrooms significantly reduced the feed intake and weight gain of the rats by up to 36.8 and 29.5%, respectively. The reduction increased with the proportion of dietary mushroom. Inclusion of mushrooms in the diets of rats also lowered their total serum cholesterol, LDL-cholesterol and triglycerides by up to 15.6, 28.3 and 29.9%, respectively. Reduction in serum lipids did not, however, show a clear relation to the quantity of mushrooms in the diet. The reduction in the total serum cholesterol, LDL- cholesterol and triglycerides may be attributed to the high quantities of fibre in the mushrooms. These results suggest that consumption of T. microcarpus mushrooms could contribute to reducing the prevalence of diseases linked to high blood lipids. Key words: Serum cholesterol, mushroom, Termitomyces microcarpus, triglycerides


This paper reports on the recent work carried out to develop and implement a high precision on-line optical measurement system with the aim of providing defect detection and characterisation for ALD coated vapour barrier films produced by a roll-to-roll process. This proof-of-concept system is designed to detect and measure pre-existing defects on the film and define their size, location, form and density. The aim is to be able to detect defects in a thin film Al2O3 layer that are critical to vapour barrier performance, and eventually provide valuable process control information. Such an inspection system must be fast in order to evaluate large areas involved (500 mm width foil) at high magnifications. In addition the flexibility of the foil introduces challenges in terms of dealing with surface deviation away from an ideal plane and vibrations. Our solution is a wavelength scanning interferometer (WSI) combined with two kinematic stages, vertical (for auto-focus) and a traverse stage to provide full coverage of the foil. A porous air-bearing conveyor system is used to hold the foil at a fixed height and improve the flatness of the film relative to the measurement plane. This paper describes the principle and design of the inspection system.


Modeling time headways between vehicles has attracted increasing interest in the traffic flow research field recently, because the corresponding statistics help to reveal the intrinsic interactions governing the vehicle dynamics. However, most previous micro-simulation models cannot yield the observed log-normal distributed headways. This paper designs a new car-following model inspired by the Galton board to reproduce the observed time-headway distributions as well as the complex traffic phenomena. The consistency between the empirical data and the simulation results indicates that this new car-following model provides a reasonable description of the car-following behaviours.


ABSTRACT The role of antibody in protection against human immunodeficiency virus (HIV-1) has been difficult to study in animal models because most primary HIV-1 strains do not infect nonhuman primates. Using a chimeric simian/human immunodeficiency virus (SHIV) based on the envelope of a primary isolate (HIV-89.6), we performed passive-transfer experiments in rhesus macaques to study the role of anti-envelope antibodies in protection. Based on prior in vitro data showing neutralization synergy by antibody combinations, we evaluated HIV immune globulin (HIVIG), and human monoclonal antibodies (MAbs) 2F5 and 2G12 given alone, compared with the double combination 2F5/2G12 and the triple combination HIVIG/2F5/2G12. Antibodies were administered 24 h prior to intravenous challenge with the pathogenic SHIV-89.6PD. Six control monkeys displayed high plasma viremia, rapid CD4+-cell decline, and clinical AIDS within 14 weeks. Of six animals given HIVIG/2F5/2G12, three were completely protected; the remaining three animals became SHIV infected but displayed reduced plasma viremia and near normal CD4+-cell counts. One of three monkeys given 2F5/2G12 exhibited only transient evidence of infection; the other two had marked reductions in viral load. All monkeys that received HIVIG, 2F5, or 2G12 alone became infected and developed high-level plasma viremia. However, compared to controls, monkeys that received HIVIG or MAb 2G12 displayed a less profound drop in CD4+ T cells and a more benign clinical course. These data indicate a general correlation between in vitro neutralization and protection and suggest that a vaccine that elicits neutralizing antibody should have a protective effect against HIV-1 infection or disease.


The purpose of this study is to explore the function and significance of the various representations and manifestations of silence in the poetry of Shelley, Browning, Yeats and Eliot. Attention ranges from specific allusions to the absence of speech and sound, to the role played by punctuation and poetic form. The choice of these poets stems from Shelley's function as an acknowledged, influential precursor to both Browning and Yeats and, as an un-acknowledged, though arguably no less essential, influence on Eliot. The aim is to establish to what extent poetic interaction with silence alters and shifts in the period under study, and to make coherent the development from Shelley to Eliot in their fascination with silence, and its centrality to poetic expression.
 The approach primarily involves close textual analysis of the poetry itself, the objective being to access a new angle of consideration by focusing on each poet's particular relationship with silence, and the extent to which this cumulatively expands into either a coherent philosophy, or a series of recurring themes on the part of the poet. The thesis is also concerned with poetic influence. Theorists who have previously written on silence, such as Steiner and Wagner-Lawlor, are also engaged with, as are critics concerned with the specific poets and epochs addressed (e.g Bloom, Ricks, Keach, O'Neill, and Perry). Chapters look in turn at Shelley's Mont Blanc, considering the role played by silence in the poem's consideration of the relationship between imagination and nature (1); at the same poet's treatment of the relationship between poetry and death (2); at Browning's relationship with the unrealized objective, especially in relation to love (3); at the role of the silent auditor in Browning's dramatic monologues (4); at the relationship between silence and the unknown in Yeats's poetry, and the extent to which he substituted an aesthetic approach for Browning's preoccupation with justice and pragmatism (5); at silence and the fertile nature of the contradictory in Yeats (6); at modernity and language's simultaneous pursuit of, and resistance to, silence in the poetry of Eliot (7). Overall, the thesis demonstrates that to discuss the silence of poetry should be as natural, and as necessary, as to discuss the language of it.


Introduction: Healthliteracyreferstoone'scapabilityofacquisition,interpretation, and comprehension of the primary health care information that is essential for a proper decision-making. The present research aimed to evaluate the level of adults' health literacy in Jahrom in 2015. Methods: The present descriptive and cross-sectional study which was applied in type, conducted on 502 adults (above 18 years of age) who were selected through convenient sampling method in Jahrom. The data collection instrument was a standardized performance health literacy in adults questionnaire. Data were analyzed by SPSS software using independent t-test and one-way ANOVA. Results: Based on the TOFHLA questionnaire, the health literacy of 82.62% of the adult subjects was adequate while that of 17.37% was close to the cut-off point. No statistically significant correlation was observed between health literacy and sex, age, and income. However, health literacy showed to be significantly correlated with education. Conclusion : The present study showed an inadequate level of health literacy among the majority of subjects. Therefore, there is a need to assist those of low health literacy by developing comprehensive plans and easy and comprehensible educational media and materials to improve their health literacy.


At present, the definition of smart cable is still not clear, however, the opinion that using the fiber optical sensing apparatuses as the sensing element of smart cable has formed a consensus in majority of study reports. In order to develop a new type of smart cable based on fiber Bragg grating (FBG), a scheme for fabricating smart cable which is compatible with production process of parallel steel wires cable is put forward. Aiming at the test range requirement, a novelty desensitized encapsulation structure is designed, which ensures the possibility to test steel wire strain of cable by FBG sensor. The single steel wire tension test in laboratory showed the design rationality of desensitized encapsulation structure which was reflected by the favorable linear relationship and repeatability of test results. After finish the on site tension test based on one fabricated smart cable, the proposed scheme feasibility that embedded novelty desensitized encapsulation FBG strain sensor in cable to form a new type of smart cable was verified. Test results showed that the survival rate of sensors in smart cable was high. Meanwhile, there was a clear linear relationship between the output test signal of smart cable and the tension loads and the test repeatability was acceptable as well. Finally, several improvement suggestions relating to the successful application of the proposed scheme about smart cable in actual engineering were also indicated.


Nanoscale materials (such as TiO2, hydroxyapatite nanoparticles) have gained much concern in the coating of implants for cell adhesion and growth to improve the osteoconductivity. However, due to attrition and corrosion, the wear particles would be generated from the joint in living organism, and influence the physiological function of synovial membranes in joint cavity. In this study, the potential cytotoxicity of anatase TiO2 nanoparticles (TiO2 NPs) on rat synovial cell line 364 (RSC-364) was investigated. After treatment with different concentrations of TiO2 NPs (0, 3, 30, 300 microg/ml), the viability of RSC-364 cells were decreased in a dose-dependent manner. TiO2 NPs exposure could disrupt the integrity of cell plasma membrane, leading to the increased leakage of lactate dehydrogenase (LDH) into the culture medium. TiO2 NPs were uptaken by RSC-364 cells. The ultrastructure of RSC-364 cells was changed such as nuclear shrinkage and mitochondrial swelling. The reactive oxygen species (ROS) was over-produced especially in the cells exposed to 30 and 300 microg/ml TiO2 NPs. The activities of endogeneous antioxidant enzymes, superoxide dismutase (SOD) and catalase (CAT), were significantly decreased. The increased lipid peroxidation product (malondialdehyde, MDA) suggests the oxidative damage in cells. The flow cytometry detected that the cell cycle was blocked in G0/G1 phase, inhibiting the cell proliferation. These preliminary results indicate the oxidative stress injury and cytotoxicity of anatase TiO2 NPs on rat synovial cells. The reasonable and safe application of nanomaterials in artificial implants needs further study.


To address the need for a high throughput, non-destructive technique for measuring individual cell mechanical properties, we have developed optical alignment compression (OAC) cytometry. OAC combines hydrodynamic drag in an extensional flow microfluidic device with optical forces created with an inexpensive diode laser to induce measurable deformations between compressed cells. In this, a low-intensity linear optical trap aligns incoming cells with the flow stagnation point allowing hydrodynamic drag to induce deformation during cell-cell interaction. With this novel approach, we measure cell mechanical properties with a throughput that improves significantly on current non-destructive individual cell testing methods.


Abstract:The paper begins by exploring the conceptual links between freedom, rights and democracy, and the institutional arrangements necessary to guarantee civil and political rights and fundamental freedoms in a democracy. It then sets out a procedure for assessing the quality of a country's democracy in four successive steps: defining the appropriate democratic 'goods'; identifying standards of best practice as a benchmark for the attainment of each of these 'goods'; analyzing the typical modes of subversion which may prevent their attainment; and exploring possible agencies of protection against these subversions. After applying each of these steps to the subject of civil and political rights, the paper concludes with a reservation about the limits of purely institutional indicators.


This paper describes an LDMOS power amplifier integrated circuit for W-CDMA applications. The IC was developed with Infineon's Si LDMOS IC technology. The PA IC achieved 28.5 dB gain. When tuned for W-CDMA the IC showed 20 W PEP at IM3 = -30 dBc (two-tone), 400-MHz bandwidth (20%) around 2100 MHz, gain flatness of 0.15 dB/30 MHz, and phase flatness of 1 degree/30 MHz. The PA IC was characterized under all typical modulation formats, and is included in Infineon's product portfolio of power ICs for radio base stations.


We review a recently proposed approach to construct gravitational wave (GW) polarization states of unbound spinning compact binaries. Through this rather simple method, we are able to include corrections due to the dominant order spin-orbit interactions, in the quadrupolar approximation and in a semi-analytic way. We invoke the 1.5 post-Newtonian (PN) accurate quasi-Keplerian parametrization for the radial part of the dynamics and impose its temporal evolution in the PN accurate polarization states equations. Further, we compute 1PN accurate amplitude corrections for the polarization states of non-spinning compact binaries on hyperbolic orbits. As an interesting application, we perform comparisons with previously available results for both the GW signals in the case of non-spinning binaries and the theoretical prediction for the amplitude of the memory effect on the metric after the hyperbolic passage.


Background : Spinal injury is a major cause of morbidity, mortality and long bed occupancy in patients admitted in Mulago Hospital. Several studies have reported different incidence and presentations of spinal injury 1-4. At Mulago hospital, road traffic crushes (RTC) is one of the most common causes of these injuries5. However the magnitude of the problem is unknown and this impacts on planning of services. The main objective was to determine the prevalence and presentation of spinal injury among patients with major trauma admitted at Mulago hospital, Kampala. Method : A Cross-sectional descriptive study was done on 669 patients with major trauma admitted in the Accident and Emergency ward of Mulago Hospital. Newly admitted patients were consecutively enrolled in the study. Data was collected using questionnaires capturing information from relevant history, physical examination and X-ray interpretation. This was done between November 2008 and January 2009. Data was entered into the Epi-data statistical programme and exported to SPSS statistical programme for analysis. Results : Of the 669 patients enrolled, 59 had spinal injury thus giving a prevalence of 8.8%. Most of the patients had Neurological involvement and Frankel A was the most common neurological sign. All patients had X-rays done and fracture was the most common radiological diagnosis and the majority of the respondents had unstable spine. Long bone fractures were the most common associated injury. Conclusions and recommendation : The prevalence of Spinal injury among the trauma patients is 8.8% with Frankel A score being the most common neurological injury, while fractures being the most common radiological diagnosis. There should be measures instituted by the policy makers to prevent spinal injury. The hospital should be fully equipped to manage spinal injury patients before they go back into the community.


The Second Australian National Blood Pressure Study (ANBP2) is a comparative outcome trial being conducted in general practices throughout Australia of ACE inhibitor- and diuretic-based treatment in 6000 hypertensive patients aged 65-84 years. The study is using a prospective randomised open-label design with blinding of endpoint assessments. The primary objective is to determine whether there is any difference in total cardiovascular events (fatal and non-fatal) over a five year treatment period between the two treatment regimens. Eligible hypertensive patients (average sitting blood pressure at the 2nd and 3rd screening visits > 160 mm Hg systolic and/or > 90 mm Hg diastolic) may be either untreated or previously treated and should have no history of recent cardiovascular morbidity or serious intercurrent illness. Patients are randomised to one of the treatment arms with randomisation stratified for practice and for age. Following randomisation each patient's blood pressure is managed by his/her general practitioner according to guidelines relevant to each treatment arm. Over 700 patients have now been randomised with recruitment intended to be complete by the end of 1997.


Background We sought to examine whether neighborhood deprivation is associated with participation in a large population-based health check. Such analyses will help answer the question whether health checks, which are designed to meet the needs of residents in deprived neighborhoods, may increase participation and prove to be more effective in preventing disease. In Europe, no study has previously looked at the association between neighborhood deprivation and participation in a population-based health check. Methods The study population comprised 12,768 persons invited for a health check including screening for ischemic heart disease and lifestyle counseling. The study population was randomly drawn from a population of 179,097 persons living in 73 neighborhoods in Denmark. Data on neighborhood deprivation (percentage with basic education, with low income and not in work) and individual socioeconomic position were retrieved from national administrative registers. Multilevel regression analyses with log links and binary distributions were conducted to obtain relative risks, intraclass correlation coefficients and proportional change in variance. Results Large differences between neighborhoods existed in both deprivation levels and neighborhood health check participation rate (mean 53%; range 35-84%). In multilevel analyses adjusted for age and sex, higher levels of all three indicators of neighborhood deprivation and a deprivation score were associated with lower participation in a dose-response fashion. Persons living in the most deprived neighborhoods had up to 37% decreased probability of participating compared to those living in the least deprived neighborhoods. Inclusion of individual socioeconomic position in the model attenuated the neighborhood deprivation coefficients, but all except for income deprivation remained statistically significant. Conclusion Neighborhood deprivation was associated with participation in a population-based health check in a dose-response manner, in which increasing neighborhood deprivation was associated with decreasing participation. This suggests the need to develop preventive health checks tailored to deprived neighborhoods.


isolated space, impassive from the outside world. In the past, the fetus was believed to grow in the womb regardless of what was happening outside. Later, this protection was shown to be partial. During the 9 months of gestation, the environment that surrounds pregnant women affect the fetus and her/his later life. Fetal programming is a relatively new concept. Since 2008, publications about this topic have increased exponentially, reaching almost 70,000 registers in the last 10 years. This increase comes from the importance of studying intrauterine environment influence on fetal well-being and its relationship to numerous health problems throughout life. Large cohorts and records studying an exposure to extreme starvation, such as the Netherlands or Leningrad siege during World War II, supports the hypothesis of fetal origins of adult disease. It was shown how the exposure to malnutrition in those pregnant women was related to the appearance of diseases in the offspring regardless of individual lifestyle. This fact shows that the human body remains programmed from the perinatal period despite healthy habits. Furthermore, the relationship between low birth weight and development of cardiovascular diseases upholds the fetal programming hypothesis. Subsequent projects confirmed its relationship with other disorders in the postnatal stage, such as the metabolic syndrome, insulin resistance, or diabetes. So, our body is designed to be adapted to the environment, especially in the early stages of development, though sometimes they do not improve the chances of survival, but the opposite of it. The book Fetal programming: Prenatal growth and developmental environment [Programación fetal: ambiente de crecimiento y desarrollo prenatal] synthesizes all the available evidence on prenatal environment and consequences on postnatal health in the short and long term. As cited in this book, pregnancy is a stage characterized by the continuous interaction between mother and fetus, in which genetic, environmental, and behavioral factors can determine the present and the future health of the mother and the newborn. In this way, fetal stages determine postnatal life's health. Exposure to environmental factors, such as stress, anxiety, violence, pollution or communicable diseases, has been shown to induce epigenetic modifications that will be transmitted to the offspring and future generations. Among other topics, this book addresses assisted reproduction techniques, which have increased due to conception difficulties given the social transformations in the last decades. This book discusses possible obstetric complications related with their use. Another important topic addressed by this book is the influence of a mother's lifestyle on fetal and postnatal health. A mother's diet quality and her physical activity are modifiable factors that have been largely studied, which are described in this book. But this publication reports certain behavioral habits that have been less explored and also determine mother's and newborn's health. On the other hand, highly prevalent pathologies, such as preeclampsia, gestational diabetes, or anemia, are also widely described in the book, given their high prevalence and their impact on pregnancy. Something to highlight is the multidisciplinary authorship of this book, which I consider a positive aspect. Researchers from different fields (psychology, medicine, sociology, physiology, anthropology, midwifery, and nursing) and institutions have made their contribution to this book, addressing fetal programming from many perspectives, describing it in all its aspects. The first chapter introduces the fetal programming concept. The second chapter addresses the importance of fetal programming for the development of the metabolic syndrome in adulthood. From third to sixth chapter the relationship between exposure to stressors and psychological alterations during pregnancy and the development of diseases from the prenatal stage to childhood and adulthood are discussed. The seventh chapter describes the physiology of the predisposition to certain diseases determined by the quality of the diet during pregnancy. The eighth chapter reveals the importance of preeclampsia in future obesity development, diabetes, cardiovascular diseases, metabolic syndrome, and other chronic non-communicable diseases in the adulthood. The ninth chapter focuses on short Clínica y Salud (2021) xx(x) xx-xx


Excited states of the neutron-rich N=21 S37 nucleus have been studied using binary grazing reactions produced by the interaction of a 215-MeV beam of S36 ions with a thin Pb208 target. The magnetic spectrometer, PRISMA, and the γ-ray array, CLARA, were used in the measurements. The level scheme of S37 was established to an excitation energy of 4196 keV and a number of new transitions were observed, in particular that corresponding to the decay of the proposed Jπ=(11/2−) level at an excitation energy of 2776 keV. The structure of the state is discussed within the context of state-of-the-art shell-model calculations using the SDPF-U effective interaction; the main component of the wave function corresponds to the coupling of the odd 1f7/2 neutron to the first 2+ state of the S36 core. The electromagnetic decay properties of the state are discussed within the context of a particle-core coupling model and the shell model. The other members of the multiplet of states are also discussed.


What changes in our understanding of the experience of black communities in diaspora when we move beyond the binaries of stillness and motion to engage black life through the lens of stasis? This essay explores a collection of vernacular photos of a black German family in the Third Reich using the concept of stasis to unpack the social, historical, political, and visual tensions that structure these images' depiction of their black German subjects. Viewing these images as complex depictions of stasis (defined not as the cessation of movement but as motion held in suspension and a balancing of multiple forces) offers a generative framework for theorizing the quotidian practices of refusal that constitute black fugitivity.


The European Union faces a problem of uneven implementation of its rules by national authorities. Agreement on common rules at the Community level does not necessarily translate into commitment by national authorities to apply those rules coherently and effectively. In this context, decentralisation of the existing system of State aid control is hardly considered. The issue, however, is not whether it should be decentralised or not but by how much. Theory and practice suggest that complete decentralisation of State aid control would be a recipe for disaster. On the other hand, as the European Union enlarges, as State aid policy becomes more codified, as State aid concepts become clarified by the courts and as State aid rules are modernised to take into account conditions in local markets, the case for some decentralisation becomes stronger. Some decentralisation will also create incentives for compliance with Community rules and reduction of State aid granted for political gains. This article analyses the various aspects of the problem and proposes a feasible division of tasks between the Commission and national State aid authorities.


Despite the impossibility to, under Brazilian law, as a rule, an insured or aggrieved third party seek payment of insurance indemnity directly from a reinsurer, it is recurrent the inclusion of reinsurers as defendants in lawsuits, especially in cases involving the purchase of facultative civil liability insurance. As a result of legislative, jurisprudential, bibliographical and documentary research, this study aims to shed light on the relationships and obligations established by reinsurance agreements and reject this unlawful practice at once. This is done through an initial dive into the insurance relationship and the facultative civil liability insurance and through the review of the particularities of reinsurance and the features that differ it from insurance, to, ultimately, reinforce the initial statement that served as a premise for this work.


Ventricular shunt is a well-established modality in the management of hydrocephalus. However, it can be associated with numerous complications and disastrous consequences. The reported incidence of intra-abdominal complications in infants and children after ventriculoperitoneal (VP) shunt procedures is about 24% and most of these patients present with abdominal signs and/or intracranial sepsis. In this article we report on a 2-year-old boy who presented with swelling in the right inguino-scrotal region. Imaging showed migration of the peritoneal catheter into the right scrotum.


Costa Rego was one of the most respected journalists of his time. He wrote for the main newspaper of the country, the Correio da Manha. In this article I carefully observe Rego's analysis of the actuation of the '1934 Constituent' and its implications. The richness of his point of view comes out of the accurate look he provides of that revolutionary moment. This journalist contested, with obstinacy, the destruction of his own experience as a public personality, defending the liberal project as a political option for Brazil, after the Revolution of 1930.


BACKGROUND
People with type 2 diabetes mellitus are at increased risk from cardiovascular disease. Dietary fish oils are known to reduce triglyceride levels, but their impact on cholesterol levels, glycemic control and vascular outcomes are not well known.

OBJECTIVES
To determine the effects of fish oil supplementation on cardiovascular outcomes, cholesterol levels and glycemic control in people with type 2 diabetes mellitus.

SEARCH STRATEGY
We carried out a comprehensive search of the Cochrane Controlled Trials Register, Medline, Embase, Lilacs, bibliographies of relevant papers and contacted experts for identifying additional trials. Date of last search: September 2000.

SELECTION CRITERIA
All randomized placebo-controlled trials in which fish oil supplementation was the only intervention in people with type 2 diabetes were included. Authors were contacted for missing information.

DATA COLLECTION AND ANALYSIS
Three investigators performed data extraction and quality scoring independently with discrepancies resolved by consensus.

MAIN RESULTS
Eighteen trials including 823 participants followed for a mean of 12 weeks were included. Doses of fish oil used ranged from 3 to 18 g/day. No trials with vascular event or mortality endpoints were identified. The outcomes studied were glycemic control and lipid levels. Meta-analysis of pooled data demonstrated a statistically significant effect of fish oil in lowering triglycerides by 0.56 mmol/l (95% CI -0.71 to -0.40 mmol/l) and raising LDL cholesterol by 0.21 mmol/l (95% CI 0.02 to 0.41 mmol/l). No statistically significant effect was observed for fasting glucose, HbA1c, total or HDL cholesterol. The triglyceride lowering effect and the elevation in LDL cholesterol were most marked in those trials that recruited people with hypertriglyceridemia and used higher doses of fish oil. No adverse effects of the intervention were reported.

REVIEWER'S CONCLUSIONS
Fish oil supplementation in type 2 diabetes lowers triglycerides, may raise LDL cholesterol (especially in hypertriglyceridemic patients on higher doses of fish oil) and has no statistically significant effect on glycemic control. Trials with vascular event or mortality defined endpoints are needed.