Cocaine abuse is problematic, directly and indirectly impacting the lives of millions, and yet existing therapies are inadequate and usually ineffective. A cocaine vaccine would be a promising alternative therapeutic option, but efficacy is hampered by variable production of anticocaine antibodies. Thus, new tactics and strategies for boosting cocaine vaccine immunogenicity must be explored. Flagellin is a bacterial protein that stimulates the innate immune response via binding to extracellular Toll-like receptor 5 (TLR5) and also via interaction with intracellular NOD-like receptor C4 (NLRC4), leading to production of pro-inflammatory cytokines. Reasoning that flagellin could serve as both carrier and adjuvant, we modified recombinant flagellin protein to display a cocaine hapten termed GNE. The resulting conjugates exhibited dose-dependent stimulation of anti-GNE antibody production. Moreover, when adjuvanted with alum, but not with liposomal MPLA, GNE-FliC was found to be better than our benchmark GNE-KLH. This work represents a new avenue for exploration in the use of hapten-flagellin conjugates to elicit antihapten immune responses.


In the first part of the thesis, the solvability of stochastic differential equations with reflecting boundary conditions is studied. Such equations arise in singular stochastic control problems as a way for determining the optimal strategies. The stochastic differential equations represent homogeneous one-dimensional diffusions while the boundaries are given by c`adl`ag functions. Pathwise solutions are constructed under mild assumptions on the coefficients of the equations. In particular, the solutions are derived as the diffusions' scale functions composed with appropriately time-changed reflected Brownian motions. Several probabilistic properties are addressed and analysed.
In the second part of the thesis, piecewise diffusion approximations of Levy processes are studied. Such approximating processes have been called Itˆo semi-diffusions. While keeping the statistical fit to Levy processes, this class of processes has the analytical tractability of Ito diffusions. At a given time grid, their distribution is the same as the one of the underlying Levy processes. At times outside the grid, they evolve like homogeneous diffusions. The analysis identifies conditions under which Itˆo semi-diffusions can be used as an alternative to Levy processes for modelling financial asset prices. In particular, for a sequence of Itˆo semi-diffusions determined by a given Levy process, conditions for the convergence of their finite-dimensional distributions to the ones of the Levy process are established. Furthermore, for a single Ito semi-diffusion, conditions for the existence of pricing measures are established.


Trust concept is an important requirement for sustained interactions between peers, and to deal with malicious peers in P2P file sharing systems. Traditional security mechanisms and services are unable to protect against malicious behaviors, therefore trust and reputation management is considered an appropriate solution that can provide a protection against such threat. In this paper, we focused on the advantage of some existing trust models to formulate a new model that solves problems raised in the previous models. We also considered the partially decentralized ( PD ) peer-2-peer (P2P) architecture to execute the proposed model. Finally , we construct a C# based simulator to test proposed model on the partially decentralized P2P file sharing network. Simulation results show that the model is able to identify malicious peers effectively and isolate them from the system (sharing files), hence reducing the amount of inauthentic uploads and increasing peers' satisfaction.


We investigate the formation of jellyfish galaxies using radiation-hydrodynamic simulations of gas-rich dwarf galaxies with a multiphase interstellar medium (ISM). We find that the ram-pressure-stripped (RPS) ISM is the dominant source of molecular clumps in the near wake within 10 kpc from the galactic plane, while in situ formation is the major channel for dense gas in the distant tail of the gas-rich galaxy. Only 20% of the molecular clumps in the near wake originate from the intracluster medium (ICM); however, the fraction reaches 50% in the clumps located at 80 kpc from the galactic center since the cooling time of the RPS gas tends to be short owing to the ISM–ICM mixing (≲10 Myr). The tail region exhibits a star formation rate of 0.001–0.01 M ⊙ yr−1, and most of the tail stars are born in the stripped wake within 10 kpc from the galactic plane. These stars induce bright Hα blobs in the tail, while Hα tails fainter than 6 × 1038 erg s−1 kpc−2 are mostly formed via collisional radiation and heating due to mixing. We also find that the stripped tails have intermediate X-ray-to-Hα surface brightness ratios (1.5 ≲ F X/F Hα ≲ 20), compared to the ISM (≲1.5) or pure ICM (≫20). Our results suggest that jellyfish features emerge when the ISM from gas-rich galaxies is stripped by strong ram pressure, mixes with the ICM, and enhances the cooling in the tail.


We theoretically study the topological properties of the tight-binding model on the breathing kagome lattice with antisymmetric spin-orbit coupling (SOC) between nearest neighbors. We show that the system hosts nontrivial topological phases even without second-nearest-neighbor hopping, and that the weakly dispersing band of the kagome lattice can become topological. The main results are presented in the form of phase diagrams, where the Z2 topological index is shown as a function of SOC (intrinsically allowed and Rashba) and lattice trimerization. In addition, exact diagonalization is compared with effective low-energy theories around the high-symmetry points. We find that the weakly dispersing band has a very robust topological property associated with it. Moreover, the Rashba SOC can produce a topological phase rather than hinder it, in contrast to the honeycomb lattice. Finally, we consider the case of a fully spin polarized (ferromagnetic) system, breaking time-reversal symmetry. We find a phase diagram that includes systems with finite Chern numbers. In this case too, the weakly dispersing band is topologically robust to trimerization.


This present work deals with the effects of injection parameters such as pilot-main injection mass ratio and dwell time on combustion, performance, and emission characteristics of a diesel engine. A single cylinder diesel engine is used in this research work with the flexibilities to modify different variables via open electronic control unit. Biodiesel mix (BDM) used in the present work is derived from waste feedstocks of used cooking oil and chicken fat. Throughout the experiment, engine load and speed were maintained constantly at 4.51 brake mean effective pressure and 1500 rpm, respectively. Different pilot mass ratios (10%, 20%, and 30%) and dwell times (20° crank angle (CA), 30° CA, and 40° CA) were tested and results were compared with conventional mode combustion. The results indicated that the pilot injections helped to reduce the ignition lag period and also shortened the combustion duration. The highest brake thermal efficiency of 34.78% was identified with the lowest pilot mass of 10%. According to the results, increased dwell time decreased the oxides of nitrogen emissions but increased the hydrocarbon emissions. The experiment revealed that BDM made of waste feedstocks could be an effective alternative for engine applications with optimized engine operating conditions.


A new chaotic communication scheme based on generalized chaotic synchronization (GCS) and hash function transpositions is presented. The communication scheme has nonsymmetric secrete keys and its ability is similar to traditional digital signatures, i.e. a receiver can convince himself whether or not the sender's message contents have been modified. As a direct application of the scheme, a GCS system is designed by using Chen's chaotic circuit and is studied in some detail. The numerical simulation shows that this Chen GCS system has high security and is fast and reliable for secure lnternet communications.


PurposeThis paper aims to develop and apply a service design method that allows for stronger recognition and integration of human activities into the front-end stages of the service design process.Design/methodology/approachFollowing a discussion of different service design perspectives and activity theory, the paper develops a method called activity-set mapping (ActS). ActS is applied to an exploratory service design project to demonstrate its use.FindingsThree broad perspectives on service design are suggested: (1) the dyadic interaction, (2) the systemic interaction and (3) the customer activity perspectives. The ActS method draws on the latter perspective and focuses on the study of human activity sets. The application of ActS shows that the method can help identify and visualize sets of activities.Research limitations/implicationsThe ActS method opens new avenues for service design by zooming in on the micro level and capturing the set of activities linked to a desired goal achievement. However, the method is limited to activities reported by research participants and may exclude unconscious activities. Further research is needed to validate and refine the method.Practical implicationsThe ActS method will help service designers explore activities in which humans engage to achieve a desired goal/end state.Originality/valueThe concept of "human activity set" is new to service research and opens analytical opportunities for service design. The ActS method contributes a visualization tool for identifying activity sets and uncovering the benefits, sacrifices and frequency of activities.


In the wake of failed coups and political challenges by ultra-conservatives, leaders in the emergent Russian federation face the difficult task of introducing sweeping economic, political, and social changes without provoking a return to Soviet ideology. Russian citizens are uncertain about the benefits of adjusting to a market-based economy, and their social infrastructure is inadequate to cope with new expectations for self-direction and individual responsibilities. At the core of the change process are nearly 75 years of deep-rooted socialist doctrine and a rigid sociopolitical hierarchy through which monopoly power over resources and the means of production were controlled. Until recently, only a select body of the Supreme Soviet or its appointees had authority to make substantive decisions. Today, however, Russia is attempting to transform its economy, which involves repositioning companies as market-driven enterprises. Consequently, managers are being given greater authority and responsibility for organizational performance. Changes in managerial values are a significant element in the socioeconomic transformation in Russia.


Four lactating cows, each fitted with a rumen cannula and duodenal and ileal t-cannulae, were used to measure flow and digestion of nitrogenous compounds in the digestive tract. Dietary dry matter contained 17% crude protein and 50:50 forage:concentrate. Treatments were: 1) corn silage-soybean meal; 2) corn silage-heated soybean meal; 3) ammonia-treated corn silage-soybean meal; and 4) ammonia-treated corn silage-heated soybean meal. Flow of organic matter to the duodenum was overestimated when lanthanum or chromium ethylene-diaminetetraacetate was used as an indigestible marker. This resulted in low estimates of ruminal digestion of organic matter and high estimates of nitrogen flow to the duodenum. However, calculations using lanthanum or lignin as markers yielded similar organic matter flow to ileum and feces. With acid-detergent lignin as a marker, estimates of dietary nitrogen degraded in the rumen were: corn silage-heated soybean meal, 55.0% ammonia-treated corn silage-heated soybean meal, 58.8%; ammonia-treated corn silage-soybean meal, 63.3%; and corn silage-soybean meal, 66.0%. Digestion in the small intestine of nonammonia nitrogen was equal for all treatments suggesting that availability of heated soybean meal in the intestine was not different, although ruminal degradability tended to be lower. Feeding diets containing nonprotein nitrogen did not decrease available nitrogen at the duodenum.


The sensitivity of the cochlear amplifier to changes in operating conditions Yi Wang Frequency selectivity is one of the most important functions of the mammalian hearing organ – the cochlea. The interaction of fluid mass and organ of Corti compliance sets a traveling wave along the basilar membrane (BM), which is longitudinally tuned to different frequencies. Beyond this passive tuning process, cochlear amplification locally enhances the vibration of the best frequency peak by factors of hundreds to boost the frequency selectivity and sensitivity of the cochlea. This amplification is achieved by a positive feedback loop between BM motion and outer hair cell (OHC) electrical-mechanical response. However, this active mechanism is vulnerable to damage and cannot be fully recovered in vivo. As the instruments of cochlear amplification, the frequency response of BM and OHCs are of great importance to understand cochlear tuning process. This thesis used animal models, aimed to understand cochlear tuning and investigate possibilities to manipulate the cochlear amplifier, by testing the cochlear amplifier's sensitivity to operating conditions. The first project tested whether the cochlear amplification can adjust to a lower endocochlear potential (EP), which controls OHC electromechanical force by providing part of the voltage source to drive OHC transduction current. To investigate this possibility, we use intraperitoneal (IP) and intravenous (IV) injection of furosemide to reversibly reduce EP, while monitoring the EP and cochlear amplification simultaneously. Cochlear amplification was monitored by measuring the local cochlear microphonic (LCM) and distortion product emission (DPOAE). With IV injection, the cochlear amplification observed in LCM could attain nearly full or even full recovery with reduced EP. This showed the cochlea has an ability to adjust to diminished operating condition. Furthermore, the cochlear amplifier and EP recovered with different time courses: cochlear amplification just started to recover after the EP was nearly fully recovered and stabilized. Using a Boltzmann model and the 2nd harmonic of the LCM to estimate the mechanoelectric transducer channel operating point, we found that the recovery of cochlear amplification occurred with re-centering of the operating point. The second project studied the physiological and anatomical effects of perfusing the cochlea with a viscous fluid, for better understanding cochlear fluid mechanics. Perilymphatic perfusion was applied with artificial perilymph and viscous sodium hyaluronate (Healon, HA) in four different concentrations. Using compound action potential (CAP) thresholds as an indicator of cochlear condition, our results and analysis indicated that the cochlea can sustain, without a significant CAP threshold shift, up to a 1.5 Pa shear stress. Histology of the cochleae perfused with higher shear stress showed the Reissner's membrane was torn. These data also indicated that the cochlea mechanics remains normal within increased perilymphatic fluid viscosity up to an increase of a factor of 50. Beside these findings, a temporary CAP threshold shift was observed, perhaps due to the presence and then clearance of viscous fluid within the cochlea, or to a temporary position shift of the organ of Corti. The last project was to test the effect of OHC intracellular Cl concentration on cochlear amplification. Chloride is known to enable the electromotility of the OHC by binding its motor protein, prestin. By locally perfusing high chloride perilymph and the chloride ionophore tributyltin, this study investigated whether increasing intracellular chloride concentration can restore cochlear sensitivity in a cochlea that was slightly damaged. This had been shown by others in guinea pig. However, we did not observe recovery in several attempts in gerbil, and did not pursue this study.


There is an ongoing tension in the American public education system between the values of excellence, equity, and a sustained commitment to efficiency. Accountability has emerged as a framework in education reform that promises to promote and balance all three values. Yet, this frame is often contested due to disagreements over the role of incentives and penalties in achieving desirable change, and concerns that the proposed mechanisms will have significant unintended consequences that outweigh potential benefits. More fundamentally, there is widespread disagreement over how to quantify excellence and equity, if it is even possible to do so. Accountability rhetoric echoes a broader turn toward data-driven decision-making and resource allocation across sectors. As a tool of power, accountability processes shift authority and control away from professional educators and toward policymakers, bureaucrats, and test makers. The construct of accountability is predicated on several assumptions. First, it privileges quantification and statistical analysis as ways of knowing and is built on a long history of standardized testing and data collection. Second, it takes learning to be both measurable and the product of instruction, an empiricist perspective descended from John Locke and the doctrine that knowledge is derived primarily from experience. Third, it holds that schools, rather than families, neighborhoods, communities, or society at large, are fundamentally responsible for student performance. This premise lacks a solid evidentiary basis and is closely related to the ideology of meritocracy. Finally, efforts to achieve accountability presume that market-based solutions can effectively protect the interests of society's most vulnerable, another controversial assumption. The accountability movement reflects the application of free market economics to public education, a legacy of the Chicago School of Economics in the post-World War II era. As a set of policies it was instantiated in the Elementary and Secondary Education Act (ESEA) of 1965, reauthorized as the No Child Left Behind Act (NCLB) of 2002, and reinforced by the Every Student Succeeds Act (ESSA) of 2015. Teaching and learning are increasingly measured and quantified to enable analysis of the relationship between inputs (e.g., funding) and outputs (e.g., student performance). As has been true in other sectors when data-driven surveillance and assessment practices are introduced, outcomes are not always as expected. It is unclear whether this data push will promote equality of opportunity, merely document inequality, or perhaps even increase racial and socioeconomic segregation. Furthermore, little is understood about the costs of increased assessment on the health and success of students and teachers, externalities that are rarely measured or considered in the march to accountability. States will need to generate stakeholder buy-in and think carefully about the metrics they include in their accountability formulas in order to balance mandates for accountability, the benefits that accrue to students from preserving teacher autonomy and professionalism, the social good of equal opportunity, and public calls for transparency and innovation.


: Ten mares, 5 resistant and 5 susceptible to bacterial endometritis, were examined for differences pertaining to the efficiency of phagocytosis of bacteria by neutrophils in the uterus. An assay for chemiluminescence was used to evaluate various schemes of opsonization and relate them to phagocytic rate. 123I-labelled albumin was used to measure protein migration to the inoculated uterus. Neutrophil numbers moving to the uterine lumen were determined. Before inoculation resistant mares were found to have substances in their uterine secretions that opsonized bacteria, resulting in effective phagocytosis. In contrast, uterine contents of susceptible mares were not effective in opsonization. The addition of serum to uterine washings significantly enhanced opsonization of bacteria in both groups. In response to intrauterine challenge with pathogenic streptococci, no differences were observed between resistant and susceptible mares in the migration of serum protein or neutrophil numbers to the site of contamination. Following inoculation, the ability of the uterine contents to opsonize bacteria was similar between groups. Clinical observations after inoculation confirmed that mares were resistant or susceptible to endometritis.


Nearly 10% of students enrolled in public schools in the U.S. are identified as English Language Learners (ELLs). The population of ELL students is expected to continue to rise, therefore research about ELLs is both timely and essential. An increasing body of literature addresses the experience and outcomes of ELLs in the context of both K-12 and postsecondary education. Most studies, however, focus on California, Texas, Florida, and New York (Aguilar, 2010; Callahan et al., 2023; Flores, Batalova & Fix, 2012) presenting a need for more research to make state-by-state comparisons especially from rural states that have become new destinations for many immigrant families. This study seeks to understand the postsecondary enrollment trends of ELL students in Arkansas. Using administrative data from the Arkansas Department of Education and the National Student Clearinghouse, we found that ELLs in Arkansas are less likely to attend postsecondary institutions compared to native English speakers. Results vary by urbanicity and socioeconomic status. Similar themes appear when analyzing the types of postsecondary institutions that ELLs enrolled in after high school graduation. We conclude our analysis by providing discussions and policy recommendations based on the results.


Two transition metal complexes [L2M] {M = FeII (2), MnII (3)} of the novel [N,N,S] scorpionate ligand L = [PhB(pz)2(CH2SMe)]– have been synthesized and characterized by X-ray crystallography, magnetic measurements, cyclic voltammetry, and various spectroscopic techniques. In the solid state, both complexes 2 and 3 possess a distorted octahedral ligand sphere, but adopt different configurations (2: cis; 3: trans). According to X-ray diffraction data, Mossbauer spectroscopy, and SQUID measurements, compound 2 exists as low-spin complex in the solid state at temperatures T ≤ 20 °C (μeff ≈ 0.5 μB). Upon heating, the magnetic moment μeff increases continuously to a value of 1.8 μB at 90 °C, which indicates a temperature dependent high-spin  low-spin transition above room temp. Solutions of 2 in CDCl3 showed paramagnetic behavior at 25 °C (μeff = 3.1 μB; Evans NMR method). Cyclic voltammetry (CH2Cl2, [Bu4N][PF6]; vs. FcH/FcH+) on 2 reveals a reversible FeII/FeIII redox transition at E1/2 = –0.16 V. Density functional theory (B3LYP-D/def2-TZVPP//B3LYP-D/SVP level) has been used to evaluate relative energies of the cis and trans isomers of 2 in their high-spin and low-spin states. Theoretical and experimental investigations have been extended to the related literature-known homoleptic FeII complexes [{PhB(pz)3}2Fe], [{PhB(pz)(CH2SMe)2}2Fe], and [{PhB(CH2SMe)3}2Fe]. The following order of ligand-field strengths has been established: [PhB(CH2SMe)3]– < [PhB(pz)(CH2SMe)2]– < [PhB(pz)2(CH2SMe)]– < [PhB(pz)3]–. The only significant deviation from this systematic behavior became evident for the unexpectedly low solution magnetic moment of [{PhB(CH2SMe)3}2Fe], which finds no parallel in the solid state. Computed spin-state splittings for the entire series of complexes, however, confirm the trend in solution magnetic moments and we relate the disaccording experimental observations to the presence of a second stereoisomer in crystals of [{PhB(CH2SMe)3}2Fe] which increases the paramagnetism of solid-state samples of this complex.


Background: Periodontal diseases are microbial induced chronic inflammatory conditions characterized by infiltration of leukocytes, loss of connective tissue, alveolar bone resorption, and formation of periodontal pockets. In response to periodontal pathogens, the leukocytes (PMN) elaborate destructive oxidants, proteinases and other factors. The balance between these factors, the antioxidants and endogenously synthesized antiproteinases determine the extent of periodontal damage. Diabetes mellitus is a metabolic disorder. Most of the complications of diabetes are due to hyperglycemia. Persons with diabetes are at a greater risk for periodontal disease Malnutrition is characterized by marked tissue depletion of antioxidant nutrients and impaired acute phase protein response to infections resulting in impaired healing. Diabetes mellitus also alters the micronutrient levels. Malnutrition is characterized by marked tissue depletion of antioxidant nutrients and impaired acute phase protein response to infections resulting in impaired healing. Malnutrition, which usually involves concomitant deficiencies of several essential macro and micro nutrients, therefore, has the potential to adversely influence the prognosis of periodontal infections. Objectives:This study has been conducted to evaluate and compare the serum levels of vitamin C, zinc and copper in diabetic and healthy individuals with periodontitis. Materials and Methods: In this case control study 60 subjects inclusive of both sexes were selected and divided into 3 groups of 20 each. Group 1 comprised of 20 subjects with type 2 diabetes mellitus and periodontal disease, Group 2 comprised of 20 healthy subjects with periodontal disease. And Group 3 comprised of 20 healthy subjects without periodontal disease. Venous blood samples were collected and centrifuged at 3000rpm for 15 minutes and the superanatant serum is collected to measure the vitamin C, zinc and copper levels. The vitamin C levels of clinical samples were measured using spectrophotometric quantitation (dinitrophenyl hydrazine method) and zinc and copper levels were measured using atomic absorption spectrophotometry. Results: The results showed that the levels of vitamin C and zinc decreased and copper levels increased in diabetic patients with periodontits compared to healthy individuals with periodontitis. Conclusion: It may be reasonable to suggest vitamin and/or mineral supplements for patients whose nutrition might be inadequate. Future research should focus on an evaluation of which nutrients may help to prevent the onset and progression of periodontal disease


We study the optimal intervention policy to stop projects in a relational contract between a principal and a policymaker. The policymaker is privately informed about his ability and privately chooses how much effort to exert. Before a project is completed, the principal receives a signal about its outcome and can intervene to stop it. Intervention may prevent a bad outcome, but no intervention leads to better learning about the policymaker's ability. In the benchmarks with observable effort or observable ability, optimal intervention follows a threshold rule. With unobservable effort and ability, the optimal policy switches between intervention and no intervention. (JEL D78, D82, D86)


The protection of information leads to protection of individual privacy for everyone. This protection is performed using encryption. Many types of encryption may be utilized while the simplest one is the covering of information. In this paper, three novel algorithms have been presented for covering the information and for increasing the security. The degree of these security algorithms depends on three keys; MD5 core code, MD5 iteration , and mode of data hashing. The strengths of this work are the simplicity of the design and taken a long time for attack recovering the hashing data. Where, the sequence length for our proposed algorithms related to the MD5 output sequence length will be increased from 100% for 8-bit core code to 256% for scenarios E and F, while 1024% for scenario G with processing time is 20 nsec and 60 nsec depend on the scenarios. While the bit rate of the information data in transmitted data stream bits are different from 64-to- 32 bits for each transmitted stream bits depending on the scenario that selected. In this context, the maximum expected throughput is 806.596 Mbps. The implementation of algorithm circuits is built by using Xilinx Spartan 3-xc3s1400a-4fg484.


OBJECTIVE
A major new survey program, the Medicare Beneficiary Health Status Registry (MBHSR), has been proposed to improve the monitoring of the health status of Medicare beneficiaries. The MBHSR would collect data by mail with telephone follow up of nonrespondents to permit economical assessment of a total Registry of approximately 200,000 Medicare beneficiaries, approximately 54,000 of whom would be surveyed in any given year. (Surveys would be conducted of samples of new enrollees who would be reinterviewed every five years.)

METHOD
To assess the feasibility of that approach, a field test was conducted with a probability sample (n = 1,922) that comprised approximately equal numbers of new Medicare enrollees (aged, 65) and current beneficiaries (age range, 76-80). The field test was designed to assess the quality of the data that this design would produce.

FINDINGS
Results indicate that the proposed design of the MBHSR could achieve response rates of approximately 80% among both age cohorts using a survey instrument that took 30 minutes to complete. Internal reliability of Activities of Daily Living, Instrumental Activities of Daily Living, Mobility, Mental Health Index, General Health, and Prostate Symptomatology scales ranged from 0.77 to 0.93. When measurements were repeated approximately 30 days after the initial survey, moderate to high levels of cross temporal correlation (range, 0.64-0.96) were found for most indexes, with the exception of prostate symptomatology. In addition, an earlier comparison of survey responses in the MBHSR field test to Medicare payment records indicated that the MBHSR field test obtained highly accurate reports of most of the major surgeries that were recorded in Medicare claims files.

CONCLUSION
The design proposed for the MBHSR is feasible. If implemented, it should produce acceptably high rates of response and data quality.


IOT basically comprises of physical articles that are installed with sensors, actuators, processing gadgets and information correspondence abilities. These are connected to systems for information transportation. Envision a situation where patient's restorative profile, indispensable parameters, and dialysis machine info are caught with the assistance of medicinal gadgets connected to his body. The patient does not need to move from office to office to get treatment. Or maybe, he can complete his dialysis the assistance of a versatile home machine intended for the reason. Information assembled from this gadget is broke down and put away, and the accumulation from different sensors and restorative gadgets settles on educated choices in convenient way. Parental figures can screen the patient from any area and react properly, in light of the caution got. Propelled treatment of this nature can radically enhance a patient's personal satisfaction. The current headways in innovation and the accessibility of the Web make it conceivable to interface different gadgets that can speak with each other and share information. The Web of Things (IoT) is another idea that permits clients to interface different sensors and savvy gadgets to gather continuous information from nature. The model named as 'k-Social insurance' makes utilization of 4 layers; the sensor layer, the system layer, the Web layer and the administrations layer. All layers collaborate with each other viably and proficiently to give a stage to getting to patients' wellbeing information utilizing advanced mobile phones. The quick development of electronic gadgets, advanced mobile phones and tablets which can be imparted physically or remotely has turned into the principal device of day by day life. The up and coming era of associated world is Web of Things (IoT) which interfaces gadgets, sensors, machines, vehicles and other "things".


Current crop production systems in Zimbabwe are vulnerable, especially in drought years, as the country is now and again affected by the El Nino phenomenon. The majority of the population live in drought-stricken areas with infertile soil where poverty is a major problem. Agricultural strategies should aim to achieve the multiple goals of the farmers, which include household food security, increased cash incomes, increased crop diversity, and an improvement in soil fertility. The AFCD is making plans to collaborate with others to promote the adoption, through participatory approaches, of sustainable farming systems in the communal areas of the country. These systems emphasise the improvement of farm management skills in order to use fertilizer more efficiently, to control pests and diseases, and soil and water conservation. This paper describes the underlying principles for the development of sustainable farming systems and the ACFD's experience with agroforestry trees like castor oil, jatropha, and pigeon peas, that minimise the risk of soil degradation and provide other benefits.
 Transactions of the Zimbabwe Scientific Association Volume 72 (Supplement) 1998, pp. 66-68


Three syndromes of multiple endocrine neoplasia (MEN) have been identified to date: MEN--I, IIa and IIb. They involve various combinations of endocrine neoplasia and occur mostly in young patients. Predisposition transmission mechanism is autosomal-dominant with total penetration and variable expressiveness. Patients' families should undergo screening which involves identification of biochemical markers and cytogenetic examination. This would allow identification of subjects at high risk for cancer and improvement of early diagnosis.


In this paper, we develop deep spatio-temporal neural networks to sequentially count vehicles from low quality videos captured by city cameras (citycams). Citycam videos have low resolution, low frame rate, high occlusion and large perspective, making most existing methods lose their efficacy. To overcome limitations of existing methods and incorporate the temporal information of traffic video, we design a novel FCN-rLSTM network to jointly estimate vehicle density and vehicle count by connecting fully convolutional neural networks (FCN) with long short term memory networks (LSTM) in a residual learning fashion. Such design leverages the strengths of FCN for pixel-level prediction and the strengths of LSTM for learning complex temporal dynamics. The residual learning connection reformulates the vehicle count regression as learning residual functions with reference to the sum of densities in each frame, which significantly accelerates the training of networks. To preserve feature map resolution, we propose a Hyper-Atrous combination to integrate atrous convolution in FCN and combine feature maps of different convolution layers. FCN-rLSTM enables refined feature representation and a novel end-to-end trainable mapping from pixels to vehicle count. We extensively evaluated the proposed method on different counting tasks with three datasets, with experimental results demonstrating their effectiveness and robustness. In particular, FCN-rLSTM reduces the mean absolute error (MAE) from 5.31 to 4.21 on TRANCOS; and reduces the MAE from 2.74 to 1.53 on WebCamT. Training process is accelerated by 5 times on average.


Using content coding analysis, the current study examines sex-role portrayals in Austrian television advertisements. 129 Austrian advertisements were recorded in May 2005, and subsequently analyzed by employing established coding categories. The findings indicate that gender stereotypes in Austrian television advertisements exist in some aspects. For instance, women are underrepresented both as central characters and narrating voiceovers. Men, on the other hand, often play a dominant role and promote masculine products. However, this study also presents results that go against the grain to traditional gender stereotyping, as males and females are found to be equally represented in dependent roles, as well as in occupational and domestic settings.


Managers may unwittingly hamper employee empowerment when their own work styles encourage codependent behaviors among staff. Identifying and understanding the different ways in which people respond to others in the workplace can enhance management and employee growth.


We evaluate the probability of observing consistent results and the relationships between the required sample size and the effect size for a confirmatory multiregional trial. Three methods are evaluated, including two methods (methods 1 and 2) already proposed by the Ministry of Health, Labor and Welfare in 2007 and a new method proposed to confirm the ratio of one region to the other regions of the true treatment effect in a multiregional trial. We discuss method 1 and a new method with a survival endpoint and method 2 with a normal endpoint using numeric equations and simulations. We show that the probability of observing consistent results is not related to the effect size and the conditional probability is slightly superior to the unconditional one in both method 1 and the new method. We conclude that the probability of observing consistent results with the new method decreases according to the increase of the number of regions in method 1 previously proposed. Nonetheless, the slight difference between the new method and method 1 was observed in a small proportion of patients, which is less than 20%.


A method for ballistic trajectory detection based on multiscale morphological reconstruction is presented. The morphological gray reconstruction algorithm is used for background estimation, and the image is binarized to extract suspicious objects in single frame firstly. Then according to the shell's agglomeration characteristics, the multiscale morphological binary reconstruction could be applied for eliminating false targets. Finally, ballistic trajectory is identified based on the shell's dynamic characteristics by multi-frame data fusion. Our simulation results show that the multiscale morphological reconstruction has excellent practical value for ballistic trajectory detection in image sequences.


Colonialism is not only enforced through violence but facilitated also by economic, religious and social strategies and inducements. Amongst these, love has been exploited as a tool of empire to construct alliances, procure compliance and disguise the conquest of peoples and territories. Love has also, however, been the basis for an ethics and politics that contests imperialism. Friendship, affinity and amorous relations between coloniser and colonised enables a resistance to the ambitions of colonial occupation and rule. In this article, the work of the London-based artist, Yinka Shonibare, is used to examine the operation of love in the colonial context. Focusing especially on his 2007 installation  Jardin d'Amour the bifurcation of love into an imperialist strategy on the one hand and an anti-colonial ethics on the other is challenged. Instead, love is conceived as a process of exposure and hybridisation that transforms lover and beloved by introducing otherness into the heart of the subject. Drawing on French philosopher Jean-Luc Nancy's analysis of shattered love, it is suggested that each instance of love involves both violence and caress: each performance of love is an intrusion of otherness that inaugurates the subject as an always multiple and heterogeneous being.


Rationale: Research exploring the effects of the widely used recreational drug Ecstasy or MDMA (3,4-Methylenedioxymethamphetamine) has produced some evidence that this substance may be associated with neurotoxic changes (in animals and humans) and with possible psychiatric sequalae. However, few large-scale surveys have been carried out in the general population.
Aims: The aim of this doctorate programme of research was to explore in-depth the psychological well-being of two large non-clinical samples of ecstasy polydrug users
and identify factors associated with increased risk of developing psychological problems following ecstasy use.
Method: The research project consists of two cross-sectional studies. In the first study, 768 questionnaires were analysed; participants were allocated into 5 groups according to their history of drug use: Non-drug users (N=126), Alcohol/tobacco users (ISM 17),
Cannabis/alcohol/tobacco users (N=71), Light ecstasy users who had consumed ecstasy less than 20 times in their lifetime (N=52), and Heavy ecstasy users who had consumed ecstasy more than 20 times in their lifetime (N=45). The UEL Drug use questionnaire was used to assess drug use; Psychological well-being was assessed by the SCL-90, with 25 additional positive-feelings items and 5 MDMA side-effects items.
Ecstasy users were also asked to report whether they had ever experienced sideeffects following ecstasy use.
In the second study, 501 participants were divided into 4 sub-groups: Alcohol/tobacco users (1X1=123), Polydrug no-ecstasy users (N=102), Light ecstasy users who had taken
ecstasy for less than 20 times in their lifetime (N=116) and Heavy ecstasy users who had taken ecstasy for more than 20 times in their lifetime (N=160). Drug use and ecstasy dependence were assessed using a modified version of the UEL Drug use questionnaire and psychological well-being was assessed using the BSI (Brief Symptoms Inventory). Additional items were used to explore positive feelings (N=20)sexual functioning, (N=4) and cognitive failures (N=5). A more detailed demographic questionnaire was also used in order to identify pre-existing mental heath disorders in the family.
Results/Discussion: In line with other studies, the present data demonstrated a link between ecstasy polydrug use and some psychiatric symptoms. Findings from both studies suggest that ecstasy use might be particularly related to increases in anxiety, somatization and anger/hostility symptoms. However, the work presented here also highlighted the complexity of the subject matter and the limitations of using theoretical approaches to studying this drug that are based on notions of unidirectional causality of
psychopathology. Study Two highlighted three main predictors of psychiatric symptoms following ecstasy use: presence of mental illness in the immediate family, perceived dependence on ecstasy and perceived stress. In contrast, moderate cannabis use was identified as a possible protective factor against increased anger and somatization symptoms following ecstasy use. Finally, this thesis provides evidence that responses to ecstasy polydrug use may differ by gender. Specifically, it was proposed that
psychological problems might be more likely to precede drug use in females, but follow drug use in males.
Conclusions: It is suggested that a better understanding of these (and other possible) risk factors for ecstasy-related psychopathology are vitally important for the development of effective prevention and/or harm reduction strategies, and for the processes of diagnosis, treatment and management of drug-related mental health problems.


The article, which is mostly based on a survey of 82 letters written by Sadeq Hedayat to his closest friend, Hasan Shahid Noura'i and compiled in an annotated volume, is an attempt to discover new factors which might have contributed to Hedayat's depressive state of mind. According to the author, although Hedayat's melancholy and pessimistic world view are abundantly reflected in most of his short stories, the newly published letters shed more light on the psyche and personality of this most celebrated and influential of Iran's modern writers. The author suggests that it was not only the impact of generally depressive social and political conditions in Iran, but also Hedayat's own inner demons that gradually drove him to ever deepening state of depression.
Hedayat's fascination with death and his suicidal tendencies were already evident in his early writings beginning with Ensan va Heyvan [Man and Beast], Ruba'iyyat-e Khayyam and Zendeh be Gur [Buried Alive]. However, it is in these published letters, the author believes, that Hedayat's deep feelings of despair and ennui are revealed. The daily routine of a nearly solitary life, and the hardship of living in a barely furnished and poorly ventilated room in his father's home, all seem to have deepened Hedayat's innate cynicism. His short and cursory involvement in Iranian leftist politics merely increased his revulsion towards politicians and politics, Iranian style.
The letters also reveal, according to the author, that Hedayat's mistrust and low esteem of Iranians as a whole did not spare a number of celebrated Iranian writers and intellectuals of his time. In a language often blunt and at times scathing, he berates some of his contemporaries, including Mohammad Ali Jamalzadeh, Mojtaba Minovi and Bijan Jalali, for their perceived follies and foibles.


This paper deals with an explorative research into the use of emerging technologies for teaching and learning. An important stimulus for this research is the skills gap. The rapid changing demand puts a lot of pressure on education and the promise is that technology might help to solve the problem. The expectation is that indeed the next generation of technologies will affect education more profoundly, because of the increase and the vast integration of these technologies in our society at large. Engineering education has been reluctant in accepting technologies for learning, but the speed of change needs to be acknowledged and education cannot continue to say that the demand for new skills is a world we do not know yet. The exploration starts with an assessment about what kind of technologies are at stake and what their contribution might be for education. Recent research and reports are used to value the educational technological developments; representatives from industry and education have been interviewed and a small number of experiments are being executed to gather further knowledge and experience. At the time of writing these experiments are ongoing, but we allow to zoom in on Virtual Reality (VR) as one of the most promising technologies. The focus in this research is on the perceived value for education and therefor the exploration is very much related to the triangle perspective of student – teacher – organization as interrelated stakeholders and decisive for the usability of technology. The guiding questions are: what is the perceived value for the students; what is the value for the teacher and what are the consequences for the organization? The one thing that emerges is that engineering education needs to be much more proactive to master the question about technology in teaching and learning. This ongoing exploration is an initiative of the 4TU Centre for Engineering Education which is part of the 4TU Federation being an alliance of the four technical universities in the Netherlands EMERGING TECHNOLOGIES IN ENGINEERING EDUCATION: CAN WE MAKE IT WORK?. Available from: https://www.researchgate.net/publication/317958875_EMERGING_TECHNOLOGIES_IN_ENGINEERING_EDUCATION_CAN_WE_MAKE_IT_WORK [accessed Oct 2, 2017].


Four techniques are compared for the geometric calibration of flash light positions in a dome illumination device for digital photography: (1) the shadow cast by a vertical pin onto graph paper; (2) the illuminance distribution on white paper; (3) the reflections from a billiard ball; (4) a multi-image photogrammetric technique. The precision of the coordinates obtained by the four techniques is analysed, and the consequent effect on the accuracy with which surface normals can be determined. Calibrated test objects are used to guide the metrology of the 3D digitisation of cultural heritage objects. A case study is included for the performance of the dome with an object from ancient Egypt in the Petrie Museum.


Amaranthus cruentus, Corchorus olitorius and Vigna unguiculata are traditional leafy vegetables with potential to improve nutritional security of vulnerable people. The promotion of these crops is partly hindered by the lack of agronomic information. The effect of plant spacing on growth, physiology and yield of these three leafy vegetables was evaluated under commercial-scale production at Roodeplaat, Pretoria over two summer seasons, 2011/12 and 2012/13. A randomised complete block design was used with plant density (100 000, 66 666 and 50 000 plants ha−1) as a factor. Chlorophyll content index (CCI), chlorophyll fluorescence, stomatal conductance, leaf number, leaf area index (LAI) and biomass were measured in situ. Planting at 100 000 plants ha−1 resulted in lower (P < 0.05) LAI, CCI and biomass per plant for A. cruentus and C. olitorius. Total yield of A. cruentus, C. olitorius and V. unguiculata was higher (P < 0.05) at 100 000 plants ha−1 relative to 50 000 and 66 666 plants ha−1. For A. cruentus and C. olitorius, higher leaf attributes (CCI, plant height, leaf number, biomass per plant and LAI) were obtained and this indicated that traditional leafy vegetables can be produced commercially under lower densities using a drip irrigation system. Using 66 666 plants ha−1 is suitable for commercial production of A. cruentus and C. olitorius, whereas 50 000 plants ha−1 may be recommended under low water availability. For V. unguiculata 100 000 plants ha−1 is recommended.


This thesis deals with various aspects of the structure and dynamics of colloidal hard spheres. A general introduction on colloids as experimental realization of hard spheres is presented in Chapter 1. The basic principles of confocal microscopy, the main technique used in this thesis, as well as its advantages over conventional microscopy are discussed in Chapter 2.

Chapter 3 describes the synthesis and characterization of monodisperse crosslinked polymethyl methacrylate (PMMA) latex particles consisting of a fluorescent core and a large nonfluorescent shell. Since only the fluorescent cores are visible, quantitative confocal microscopy studies in three dimensions (3D) and on a single-particle level are feasible. In addition, we demonstrate that the properties of the core and the shell(s) can be controlled independently, which allows the preparation of different composite PMMA particles.

The behavior of crosslinked PMMA particles in the good solvents tetrahydrofurane, chloroform and toluene is explored in Chapter 4 using light scattering and confocal microscopy. We find that the particles almost instantaneously swell, up to more than 7 times their volume in a poor solvent like hexane. Furthermore, it is likely that the particles are charged in tetrahydrofurane, whereas signs of attractions are found in toluene.

In Chapter 5, we use a fast (spinning disc) confocal microscope to acquire 3D snapshots of an equilibrium hard sphere fluid at various densities. The available volume to insert another sphere and the surface area of that volume are determined. Applying exact relations between geometry and thermodynamics, we directly obtain the pressure, the chemical and the free energy density from microscopy images only.

Chapter 6 deals with the 3D analysis of the crystal-fluid interface of colloidal hard spheres. We vary the growth rate of the crystal by adjusting the mass density of the solvent with respect to the mass density of the particles and determine the number density profiles and in-plane bond-order profiles normal to the interfacial plane. We find that the interfacial width increases from about 8 particle diameters close to mass density matching, to 15 diameters for the largest mass density difference studied.

In Chapter 7 we show that both structure and dynamics are significantly affected by the presence of a wall. Whereas in bulk (i.e. far away from a wall) the system forms a glass, hexagonal order is clearly observed at a wall. Moreover, we show that the system at the wall exhibits a reentrant melting transition upon increasing volume fraction. The reentrant melting transition is accompanied by an increase in the mean squared displacement. Surprisingly, the ordered phase at a wall has a hexatic character rather than crystalline.

The correlation between local structure and mobility is addressed in Chapter 8 by introducing the topological lifetime, being the average time that a particle spends having the same coordination number. Subsequently, we show that defective particles exhibit shorter lifetimes than sixfold coordinated particles, which directly implies that the mobility generally increases near defects.

In Chapter 9 we compare the structures of 'monodisperse polyhedral colloids' and equivalent spherical particles. We find that the polyhedral shape significantly increases the degree of polycrystallinity. Furthermore, within single domains of the polyhedral colloids the inherent shape-induced geometrical frustration leads to a hexatic-like structure of the polyhedral colloids.


The way Bugis people adapt to nature has been contained in the book of Lontara', which is called Kutika. Kutika's scriptwriting background was full of philosophies and religious influences when the script was created. The philosophical calculation time shows how Buginese humans talk to nature, read signs, and treat nature as an equal element, not as an object. This philosophical triggered the writer to see it from ecophenomenology by Saras Dewi and Heidegger's perspective. This research applies a philological approach with a critical edition method to translate the manuscript, then linking text analysis with ecophenomenology. Through the eco-phenomenology approach, local concepts in the Kutika text regarding the use of natural pesticides (biopesticides) can be described. Eco-phenomenology views humans and nature as equal entities. This is in line with the Bugis perspective, which views pests not as the enemy but as friends who should be fed first. Lontara' Kutika shows that since hundreds of years ago, the Bugis people have had modern agriculture techniques with their local knowledge. The knowledge that is considered ancient is needed as an alternative to solve environmental problems today.


9098 Background: Routine follow-up after curative treatment for early breast cancer exists to monitor for local recurrence and provide support for patients. Hospital visits can be stressful for patients and evidence indicates most recurrences are first identified by the patient. The value of resource-intense clinical follow-up is constantly being questioned. Many believe that time spent seeing essentially well-women is not clinically beneficial or an efficient use of time.

METHODS
This pilot study tested the feasibility and acceptability of a new supportive model of follow-up using quality-of-life (QOL) questionnaires plus qualitative diary evaluations. All patients attended four half day patient education workshops with course evaluations, followed by randomised to open access (OA) or hospital follow up (HFU). QOL including Hospital Anxiety and Depression Score (HADS), EORTC QLQ-C30 and BR23 were performed at baseline and 6 months, with further results awaited for 12, 18 and 24 months.

RESULTS
106 women were recruited to the pilot study. 53 were randomised to HFU and 53 to OA. Multivariate analyses of covariance (MANCOVA) tests were conducted on all QOL data. Age was included as a covariate. Follow-up ANCOVAs on individual function and symptom outcomes were also conducted. The MANCOVA analyses indicated no statistically significant differences in change scores between HFU and OA groups, or between patients of different ages, on any of the three questionnaires. In all cases the effect of group had a greater effect on change (baseline-6 months) scores than the effect of age. Univariate ANCOVA tests and descriptive analyses showed performance improvement in many of the individual function and symptom scales in the OA group.

CONCLUSIONS
While open access patients showed greater mean improvements in more scales than patients seen in clinic, follow-up method does not appear to significantly affect overall outcomes on any of the three questionnaires. As an influencing factor, the patients' age is less significant than the assigned group. This new model is feasible and acceptable. It is being adopted as standard across the Yorkshire Cancer Network.


We propose a holistic framework based on state-of-the-art methods in Machine Learning and Optimization to prescribe influenza vaccine composition that are specific to a region, or a country based on historical data concerning the rates of circulation of predominant viruses. First, we develop a tensor completion formulation to predict rates of circulation of viruses for the next season based on historical data. Then, taking into account the uncertainty in the predicted rates of circulation of predominant viruses, we propose a novel robust prescriptive framework for selecting suitable strains for each subtypes of the flu virus: Influenza A (H1N1 and H3N2) and B viruses for production. Finally, we train optimal regression trees to predict efficacy of the prescribed vaccine in terms of both morbidity and mortality rates using a set of weighted distances between the vaccine-strain and the actual circulating viruses during a flu season for each subtypes of the flu virus. Through numerical experiments, we show that our proposed vaccine compositions could potentially lower morbidity by 11-14% and mortality by 8-11% over vaccine compositions proposed by World Health Organization (WHO) for Northern hemisphere, and lower morbidity by 8-10% and mortality by 6-9% over vaccine compositions proposed by U.S Food and Drug Administration (FDA) for USA, and finally, lower morbidity by 10-12% and mortality by 9-11% over vaccine compositions proposed by European Medicines Agency (EMA) for Europe.


The following thesis concerns itself with a collection of 64 stone sculptures commonly known as seated human figure bowls. This prehistoric stone carving tradition from the Strait of Georgia/Puget Sound and Fraser/Thompson river regions was reviewed with an eye towards addressing three fundamental issues. These were: i) to provide a thorough, up to date overview of the subject, including a history of the research conducted, descriptive information and a current catalogue of the collection; ii) to construct a bowl typology in an attempt to bring some spatio-temporal order to the data, and; iii) to investigate elements of meaning/function in the seated human figure bowl form using morphological, archaeological and ethnographic information. Through library research and the study of museum collections, the goals of this thesis were successfully achieved. A current and complete catalogue now exists for these carvings. The typological analysis establishes three bowl types as well as a hypothetical evolutionary sequence for the tradition. Many issues of temporal and spatial dynamics are highlighted for further research. The hypothesis that these objects were generalised objects of shamanistic power or, "medicine bowls", is offered and justified through various lines of morphological, archaeological and ethnographic evidence.


Abstract This paper evaluates an attempt by the author to operationalise the theory of reflective practice within the context of initial teacher education. Whilst an integral element of many teacher education programmes, the problematic of 'how' to reflect on practice remains a concern. In response, and taking inspiration from the work of Deleuze and Guattari, specifically their critique of representational thought and common understandings of text, the author experiments with a method for reflecting called implicated reading. The method involves the reading of students' lived experiences as beginning teachers (recorded in written form), against a variety of other texts. The author draws on interview data to analyse and discuss the merits of the approach. The paper concludes that the method of implicated reading has the potential to unsettle the common tendency to focus on meaning and interpretation when reflecting on events and experiences. It is argued that the student teachers involved in the project instead begin to experience reflection as a process of connectivity, rethinking pedagogy as a result.


After the projections undertaken by the National Institute of Statistics, the number of the non-autonomous elderly will increase to 762,000 (optimistic scenario) or 1,185,000 (pessimistic scenario) in 2020 from 666,800 in 1990. It is noteworthy that the starting point of dependency occurs mainly between the ages of 80 and 85. This means that the number of depending elderly will accelerate sharply its growth after the year 2020. For the time being, the non-autonomous elderly people are generally cared about by their own families. However, in the future, new collective behaviors, in particular the higher female participation rate to economic activity may change fundamentally the issue. How to find a sufficient amount of resources to cover the care provided to the very old? The emergency of the question, due to the upcoming arrival of the baby boom cohorts at retirement age, is not perceived in France for the time being.


The decision to report criminal victimizations to the police is an important determinant of the capacity of the criminal justice system to fulfill its mandate. This report analyzes the individual-level determinants of crime reporting, using data generated by the 1973 National Crime Survey conducted by the Bureau of the Census. It examines the impact of three characteristics of victimizations upon their reporting probability: the attributes of their victims, the nature of victim-offender relationships, and the seriousness of the offense. Only the latter appears to be of major significance, although youthful victims are substantially less likely than their elders to report their experiences to the police. The reasons that nonreporters give for their inaction appear to be quite rational, reflecting the probability that anything will come of their cooperation.


The goal of this research was to evaluate the effect of the Masgutova Neurosensorimotor Reflex Integration (MNRI) therapy modality in improving the behavioral, cognitive, and physical functioning of individuals diagnosed with Autism Spectrum Disorder (ASD). Our research group utilized the MNRI therapy modality based on knowledge of the neurophysiology of reflexes, clinical observations, and studies of reflex pathologies which can be key to improving neurodevelopment in children diagnosed with ASD. The MNRI program uses specific strategies and techniques which access innate natural resources – reflex circuit pathways of the nervous system aimed at supporting maturation within their neuro-sensorymotor patterns. Symptoms of children with ASD are reflected in their lack of sensory-motor integration, poor social interaction and language development, repetitive behaviors and actions, and hyperactive and anxiety disorders. The current study involved three groups: the Study Group of children (n=524) diagnosed with ASD that received the MNRI program, and two control groups that did not receive the MNRI treatment program – Control Group 1: 94 children diagnosed with ASD (total n=618) and Control Group 2: 683 children with neurotypical development. A Reflex Assessment was given to all children before and after the study period. Statistical analysis revealed that a large spectrum of reflex patterns (86.67% or 26 of 30 patterns) were dysfunctional or pathological in children diagnosed with ASD compared to those with neurotypical development [5]. Based on this specific data, the MNRI program utilized techniques and exercises that targeted the restoration of reflex circuit components and protection functions of the children with ASD. A Reflex Assessment completed prior to and after the MNRI intervention (duration – 6 hours daily, 48 hours total) demonstrated a statistically significant (p<0.05) improvement in 83.3% of the reflex patterns of children with ASD in the Study Group. Further qualitative analysis confirms that children in the Study Group also showed improvement in the level of sensory-motor integration, communication, physical and cognitive functioning, particularly, in such areas such as: postural control, motor coordination, balance, tactile sensitivity, behavioral control, state of "presence" and self-awareness, and other abilities and skills, observed by their therapists, parents, and sometimes even themselves. Based on the data from the current study, MNRI intervention appears to have a beneficial effect on children with autism with 80% of the study participants demonstrating improved sensory-motor integration as well as physical, behavioral, emotional, and cognitive development.


OBJECTIVE
To evaluate 4 rapid supravital stains and 3 preparation techniques for use in the intraoperative diagnosis of intracranial lesions.

ANIMALS
10 dogs and 1 cat euthanatized for intracranial lesions.

PROCEDURE
Specimens were taken from lesions and slides prepared, using 3 techniques: touch impression, medium-pressure impression, or smear preparation. Preparations were then stained with 4 stains: modified Wright stain, May-Grünwald-Giemsa, toluidine blue, and zynostain and examined in a blinded randomized fashion. Cytologic diagnosis was compared with histopathologic diagnosis and classified on the basis of identification of the pathologic process and specific diagnosis into the following categories: complete correlation, partial correlation, or no correlation.

RESULTS
An overall diagnostic accuracy of 81% (107/132) was achieved on the basis of a combination of partial and complete correlation. Of the stains examined, modified Wright stain appeared to be most accurate, with complete correlation in 17 of 33 (52%) specimens and partial correlation in 12 of 33 (36%) specimens. Of the preparation methods, touch preparation and smear preparation provided the most accurate results, with an overall diagnostic accuracy of 82% (36/44) for both methods. However, smear preparations appeared to be of greater diagnostic value, with fewer nondiagnostic specimens, compared with touch preparations.

CONCLUSIONS AND CLINICAL RELEVANCE
Cytologic preparations provide a useful diagnostic tool for the intraoperative diagnosis of intracranial lesions. All stains examined yielded promising results, the most accurate of which appeared to be the modified Wright stain. The smear preparation appeared to be the preparation method of greatest diagnostic value.


Masaru Emoto carried out very interesting experiments with water at critical point for freezing. He claimed that words expressing emotions have effect on the crystals formed in the process. Emoto reports that words with positive emotional contents produce beautiful crystals and those with negative emotional content generate ugly ones. Also music and even pictures are reported to have similar effect. Emoto had also experimented with rice in water and claims that the words with positive emotions content induce a metabolic process known as fermentation whereas those with negative emotional content tend to induce rottening. The experiments can be certainly criticized and people calling themselves skeptics have reacted violently to these claims. TGD inspired theory of consciousness and quantum biology suggests the presence of just this kind of effects and therefore one can make the working hypothesis that the effects are real, and see what the TGD based explanation for them could be. I will consider here the working hypothesis that the effects are real, and develop an explanation  based on TGD inspired quantum biology. The basic ingredients of the model are following: magnetic body (MB) carrying dark matter as h eff / h = n phases of ordinary matter; communications between MB and biological body (BB) using dark photons able to transform to ordinary photons identifiable as bio-photons; the special properties of water explained in TGD framework by assuming dark component of water implying that criticality for freezing involves also quantum criticality, and the realization of genetic code and counterparts of the basic bio-molecules as dark proton sequences and as 3-chords consisting of light or sound providing a universal language allowing universal manner to express emotions in terms of bio-harmony realized as music of light or sound. The entanglement of water sample and the subject person (with MBs included) realized as flux tube connections would give rise to a larger conscious entity expressing emotions via language realized in terms of basic biomolecules in a universal manner by utilizing genetic code realized in terms of both dark proton sequences and music of light of light and sound.


Hans Kelsen identified three possible relationships between the international and domestic legal orders. Dualism understands the international and domestic legal orders as separate and independent. Monism describes a single and comprehensive legal order but can operate with either domestic law or international law as a higher order law. Like many domestic legal orders, that of the United States has never fully worked out which of these three options specifies the status of international law in its domestic legal order. While the text of the United States Constitution suggests a form of monism in which international law is automatically part of the domestic legal order, the structure of the Constitution does not permit such automatic incorporation. In a 2008 decision, the U.S. Supreme Court articulated a theory that borders on dualism. The Court's decision makes sense of some recent U.S. practice, but it cannot be reconciled with either the text or the structure of the U.S. Constitution. Moreover, as a consequence of the Supreme Court's decision, the United States is in danger of re-enacting the de facto primacy of domestic law that the Constitution's Framers sought to address by according constitutional supremacy to treaty law.


In this work we have analyzed soil samples from Oxisols collected from two traditional communities, one formed by Guarany Indians at South of Brazil and other by African descendants on North of Rio de Janeiro State, Brazil. The content and fractional composition of humus was investigated and the isolated humic acids (HAs) were characterized by elemental composition, 13C solid-state nuclear magnetic resonance, and high-performance size exclusion chromatography. The bioactivity of HAs was evaluated considering the effects on root growth of maize seedlings. Chemical properties from adjacent soils under native forest were used as control samples. The local field sites matching the traditional cropping requirements, were characterized by higher soil chemical fertility and soil organic matter hydrophobicity, as compared to the land plots considered as inadequate by rural peasants. The HAs from cropped soils revealed significant differences in respect to content, hydrophobicity, biostimulation and molecular dimension. Although all humic extracts promoted, both, root growth and the stimulation of lateral root emergence over control, the HAs from preferential local sites, revealed a larger bioactivity response on root stimulation even at lower concentration. The assessment of soil quality issued by local farmers, showed a valuable fitting with bio-chemical fertility indicators and SOM hydrophobicity.


Perpetually exposed to geographical or emotional exile, the human being never finishes discovering himself. Each exile is the beginning of a new adventure in which chance holds the reins. In this thesis, I will analyze the writing of the exile of three French-speaking immigrants who have settled in Canada for some time. Born elsewhere than in Canada, the three FrenchCanadian writers reflected on their status, what they would have become if they did not immigrate to this country from their respective countries torn apart by the war, dictatorship or even cultural oppression. The search for a stable life and security prevailed throughout their travels and the first moments in the new country. More pragmatic than idealistic, they all knew that the task would not be easy once arrived at their destination. As a result, under the pressure of circumstances, they agreed to transform themselves. The project is significant, but sometimes their cultural and spiritual beliefs resurface. It is obvious they still have part of their roots connected to their origin countries. However, my analysis also looks at the difference in the female experience of emigration that differs substantially from the male experience. This difference, which represents a big problem, is often overlooked. According to my thesis, I will try to illustrate the different experiences the three writers lived in their journey. The point is to understand the hardship they overcame and how their identities are challenged. Would it be easier to go away and live an American life, or die to put an end to the suffering? The first writer is Dany Laferrière, who is originally from Haiti. I focus over two of his novels, the first one is Chronique de la dérive douce and the second is L' Énigme du retour. I also use some of his other novels that are communicating with the two novels I am working on. Then the second writer is Kim Thuy who is from Vietnam. I will focus on two of her novels, Vi and Ru. These two novels complete each other. The author begins the story of exile with the Ru and finishes the journey with Vi. Finally, the third writer Ying Chen is from China. I'm going to focus on two of her novels which are Les lettres chinoises and L'Ingratitude.


Background. While New York Times and Vogue described Lund and the southernmost region in Sweden as an undiscovered pearl waiting to be explored, the local tourism office of Lund asked tourists to go to visit places outside Lund. This is not due to a huge and steady flow of tourists visiting the city of Lund. Lund is one of the oldest town in Scandinavia, with a rich and fascinating history.Aim. This paper aims at discussing the citizen initiative to place market the city of Lund.Main approach. Destination Lund can be seen as a 'bottom-up' response by residents in 2016 to the politically controlled local tourism office's attempts to involve residents in 'top-down' activities and dismantling of the city brand. A unique material has been collected through participating observation.Key arguments/findings. By using smart tourism technologies and the fact that many of the members are experienced travellers, a set of downloadable material for smart phones and tablets in several languages have been developed: maps, guides, films and useful links. All material is free of charge on the Facebook page and at the blog. The local tourism office run by the municipality oppose – and even combat – these efforts, as they want the tourists to come to their office and buy their printed products; their focus is on the surrounding countryside.The digital map of sights and attractions, practical information (ATMs, toilets, bike stations etc.) has been a virtual success. The biking tour around the battlefield of the Battle of Lund has been highlighted by the Swedish Tourism Association. Moreover, some busloads of tourists have arrived to Lund.Conclusion. Several lessons can be learned from Lund. The locals are the best ambassadors for a place; Kotler is right indeed. Know-how and enthusiasm can achieve more in place marketing than the official tourism office with a budget. Moreover, the third sector can play an important role in place marketing activities. A key to successful place marketing lays in a good product and to master marketing through social media.


Background: Health caregivers in Intensive Care Units (ICUs) in developed countries have documented accounts of futile care for patients admitted into the Intensive Care Unit (ICU). But, evidence gaps exist in medical literature from developing countries on futility. While costs of establishing and running ICUs are astronomical in resource-poor countries, administration of medically futile care can further compound problems for ICU patients, family caregivers, health caregivers and hospital establishments. We sought and analysed the opinions of anaesthetists working in ICUs, highlighting the concept of medically futile care as perceived by health caregivers in low-middle income ICUs.
Materials & Methods: Using a phenomenological framework, this study involved face-to-face in-depth interviews conducted with 15 resident doctors working in two ICUs of a tertiary health institution in South-East Nigeria. Transcripts were analysed using Interpretive Phenomenological Analysis (IPA).
Results: Five core themes emerged: unnecessary procedures and interventions; intrinsic and extrinsic factors of medically futile care; family caregiver influences; negative notions of medical futility; ICU outcomes. One participant was of the view that not intervening medically might be best for some patients admitted into the ICU. Other participants described cases where patients received care which participants considered futile, noted possible causes of futile treatments and proffered strategies to correct such situations.
Conclusion: The surveyed doctors commonly view care to be futile in low-resource ICUs. Several factors are implicated including lack of goals in patient care, poor communication, lack of specialist training in intensive care and lack of protocols. Medical futility, in the opinion of these doctors, may contribute substantially to the challenges of running an ICU. This calls for multiple strategies for its reduction so as to ensure efficient use of scarce resources and improved outcomes in ICUs located in resource-limited settings.


Sales occupation is one of the most frequent in the job market, and selection of successful salespeople is typically among the highest priorities of their companies. Research aimed at explaining sales performance shows that traditional psychometric predictors are limited in achieving this goal. Common constructs that are typically related to work behaviour, such as abilities or personality traits, typically show non-significant or low relations with sales performance. Taking that into an account, we developed a new measure for assessing one's propensity for selling, based on motivational constructs that underlie successful sales job. In the first study, we developed an initial set of items and assessed its content validity using a sample of sales professionals. In the second study, we assessed the scale's dimensionality, divergent and predictive validity. A sample of 99 contact centre agents were asked to describe themselves using newly developed items and measures of personality and explicit motives. Besides psychometric measures, the data on agents' objective sales performance was provided by their employer. First, a unidimensional, three-item solution was shown to be the most appropriate in the exploratory factor analysis of initially developed items. Second, an aggregated result of these three items, representing a total scale score, showed to be largely independent of personality and explicit motives measures. Third, propensity to selling, compared to personality and motives measures, showed to be the most important predictor in explaining the variance of objective sales performance. The scale was labelled Propensity to Selling Scale, and its theoretical and practical implications were further discussed.


Proctectomy is often recommended when Crohn's proctitis becomes refractory to medical therapy. However, some surgeons offer a temporary diverting stoma in an effort to avoid a permanent stoma. The long-term efficacy of this approach is not well-established. Our aim was to determine the long-term effectiveness of fecal diversion in patients with refractory Crohn's proctitis.

 This retrospective study included all patients with Crohn's proctitis who underwent formation of a diverting ileostomy or colostomy for refractory disease from, 1998 to, 2019 in Mayo Clinic Rochester MN. Outcomes were disease recurrence, rate of stoma closure, and proctectomy. Univariate comparisons among categorical variables were performed with Pearson's Chi-square and continuous variables using the student t-test. The cumulative probability of stoma closure was performed with a Kaplan Meier log-rank analysis. Multivariable analysis of risk factors for proctectomy and permanent stoma was achieved with logistic regression.

 Ninety-seven patients (55.7% female) were included. Ileostomy was the most common stoma type (88.7%, n=86), and colostomy was (11.3%, n=11) (Table.1). Median follow-up was, 4 years (range, 0–14). Active Crohn's at follow-up was reported in, 68.1%. Only, 41.2% of patients underwent attempt at stoma reversal, and, 42.3% required a proctectomy (median, 19.5 months after diversion). At last follow-up, 29.9% were stoma-free, 42.3% had a new permanent stoma, and, 27.8% had the original diverting stoma (Fig.1). The multivariable predictors of proctectomy and permanent stoma were the recurrence of active CD after diversion and the need for other CD-related surgery following stoma creation (Table.2). The limitations of the study are its small sample size and its retrospective nature. The cumulative probability of stoma closure was performed with a Kaplan Meier log-rank analysis (Fig.2).

 Diversion is effective at alleviating symptoms of Crohn's proctitis in selected patients but does not significantly change disease outcome. Only a small number can avoid a long-term stoma.


One of the main bottlenecks in abalone aquaculture is maintaining individuals during the weaning stage, when the natural diet changes from diatoms (postlarvae) to macroalgae (juvenile). During this period, abalone pass through profound morphological and physiological changes, which suitable nutrient requirements must sustain. An inadequate diet can result in adverse effects such as late metamorphosis, starvation, slow growth and even death during this phase. Two strategies have been proposed to increase the growth and survival rates of weaning abalone: (i) extending feeding with benthic diatoms and (ii) abalone hybridization via interspecific crosses. To evaluate the efficiency of the two strategies, we assessed the growth and survival rates of postlarvae of pure red abalone (Haliotis rufescens) and a hybrid obtained by crossing red abalone females with green abalone (H. fulgens) males. Both crosses were supplied with six different diets consisting of either one macroalgae mono-diet (Macrocystis pyrifera or Ulva ohnoi) or a mixture with Navicula incerta. Overall, cross-specific diets achieved better growth rates, suggesting that each cross may need specific food items (nutrients) during weaning. Moreover, pure red abalone generally showed the highest growth rates, while the hybrid abalone showed the highest survival rates with most tested diets. Hence, hybrids appear to be better at withstanding stressful conditions, and their use in aquaculture could reduce losses and increase commercial production.


The thermoregulatory function of brown adipose tissue (BAT) is due to the tissue-specific expression of uncoupling protein 1 (UCP1) which is thought to have evolved in early mammals. We report that a CpG island close to the UCP1 transcription start site is highly conserved in all 29 vertebrates examined apart from the mouse and xenopus. Using methylation sensitive restriction digest and bisulfite mapping we show that the CpG island in both the bovine and human is largely un-methylated and is not related to differences in UCP1 expression between white and BAT. Tissue-specific expression of UCP1 has been proposed to be regulated by a conserved 5′ distal enhancer which has been reported to be absent in marsupials. We demonstrate that the enhancer, is also absent in five eutherians as well as marsupials, monotremes, amphibians, and fish, is present in pigs despite UCP1 having become a pseudogene, and that absence of the enhancer element does not relate to BAT-specific UCP1 expression. We identify an additional putative 5′ regulatory unit which is conserved in 14 eutherian species but absent in other eutherians and vertebrates, but again unrelated to UCP1 expression. We conclude that despite clear evidence of conservation of regulatory elements in the UCP1 5′ untranslated region, this does not appear to be related to species or tissues-specific expression of UCP1.


The new method dynamic proprioceptive correction using a medical loading costume was included into complex therapy in patients with late-stage residual stroke. Application of the costume promoted normalization of complex locomotor acts of walking by correcting proprioceptive pulsation resulted from the system of elastic draughts. Thus, a new motor stereotype was forced upon the patients. Clinical observation, computer analysis of the motor potential, spectrum of heart rhythm variabilities before and after therapy, and psychological testing were performed in 120 patients with motor disorders (pareses, paralyses) resulted from acute cerebral circulatory disorders. A steady-state clinical effect (p < 0.05) was found in 71.9% of the patients after 15 sessions of therapy. The patients became to walk independently, a possibility to self-attendance appeared, their speech became better. Lateralization of a damage and preservation of both the most significant homeostatic vasomotor mechanisms and the cerebral mechanisms of preparation of a movement with the minimal manifestations of emotional-affective disorders were shown to have impact on the patients' rehabilitation and on the early clinical features of pyramidal defect.


Appalachia, a region that spans 420 counties in 13 states from New York to Mississippi, has a greater proportion of residents with low socioeconomic status (SES), including lower household incomes, higher unemployment, and deficits in education compared to the United States (U.S.) as a whole. These factors contribute to disparities such as access to quality healthcare and an increased cancer burden. Cervical cancer incidence and mortality rates in Appalachia are significantly higher than among other women in the U.S. In order to understand and intervene on cancer health disparities, the Centers for Population Health and Health Disparities (CPHHD) initiative developed and tested a multi-level socio-ecological framework (Warnecke model) which included social, behavioral, environmental and biological variables as contributing and interacting factors. The Ohio State University Comprehensive Cancer Center9s CPHHD (P50CA015632) used this framework to better understand why cervical cancer disparities exist and to attempt to reduce the cervical cancer burden within Appalachian Ohio. Four studies, that spanned the Warnecke model levels of influence, were conducted to address important factors causing cervical cancer: 1) the genetic contributions to invasive cervical cancer; 2) the influence of social networks on smoking behaviors; 3) the biological effects of stress on immunity to the HPV vaccine; 4) and the effects of a multi-level intervention on uptake of the HPV vaccine among adolescent girls. The results of each study were examined on a multi-level basis and then the significant factors from each study were included in an overall multi-level model to explain the disparity of cervical cancer in Appalachian Ohio. In all, a total of 1340 participants were included in these studies. Results from the multi-level models from each study revealed that 1) the interaction of individual risk factors and genetic mechanisms is related to cervical cancer in non-smokers; 2) in terms of tobacco use, individual factors such as age and depression as well as an individual9s social network and social influence and social cohesion are relevant factors; 3) poverty, discrimination, social cohesion, neighborhood disadvantage, social support, age, SES, and depression were associated with the immune response to the HPV vaccine; and 4) the interplay of institutional structures such as healthcare systems and families, social influences, as well as SES were associated with HPV vaccine uptake among adolescent girls. Taken together, these results suggest that upstream (poverty, discrimination, health care systems, families, social cohesion, social networks, social support, social influences, and neighborhood factors) as well as downstream factors (tobacco use, age, SES, education, depression, genetics and immune function) together contribute to cervical cancer disparities in Appalachian Ohio. Interventions must now be developed and implemented across these multiple levels to reduce disparities. Citation Format: Electra D. Paskett, Ryan Baltic, Cecilia R. DeGraffinreid, Mary Ellen Wewers, Mack T. Ruffin, IV, Christopher M. Weghorst, Thomas J. Knobloch, Mira L. Katz, Cathy M. Tatum, Michael L. Pennell, Bo Lu, Erinn M. Hade, Amy K. Ferketich. Multi-level research designs for understanding the determinants of cervical cancer disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR03.


This paper examines the short-and long-run relationships between visitor arrivals to Fiji, real disposable incomes, and own-hotel price and substitute hotel price for the period 1970-2000, using the bounds testing approach to cointegration and error correction models. The paper's main contribution is that it generates bounds F-statistic critical values specific to the study's sample size (31 observations) and finds that critical values are 35.5% higher than those reported in Pesaran et al. (2001) for 1000 observations and 17.1% higher than those reported in Pesaran and Pesaran (1997) for 500 observations for a model with 4 regressors and an intercept. In the light of this, we tabulate critical values for sample sizes ranging from 30 observations to 80 observations, which will be usefull for future researchers using the bounds testing approach to cointegration.


Abstract:  Railroads have been using wayside inspection technologies for many years to improve the safety and efficiency of operations. There has been a recent proliferation of new, more sophisticated, but also more costly inspection systems that are capable of detecting a wide range of subtle defects before a problem has actually occurred. This new class of "predictive" wayside detection systems, as compared with the older "reactive" technologies, requires a different deployment strategy. The higher cost of these new technologies means that it is particularly important for railroads to maximize the benefit they derive from the investment. This article presents a network optimization model that selects cost‐effective installation sites for wayside defect detection systems over a railroad network. The objective is to maximize the total inspection benefits possible under any given investment budget. We develop solution techniques based on Lagrangian relaxation to effectively solve the problem. The article also presents case studies with empirical data to illustrate the technique. The computational results show that the problem can be solved efficiently, and that the model has the capability of being applied to full‐scale railroad networks at regional or national levels. There are a variety of ways that railroads can use this model to help them more efficiently invest in wayside inspection technology so as to maximize the safety and economic benefits of these technologies.


Because of their deep roots and high water demand, alfalfa (Medicago sativa L.) hay crops can reduce water available to crops following in the rotation. Recharging the soil water profile after alfalfa is, therefore, a high priority in dryland cropping systems. The objective of this study was to investigate effects of alfalfa crop termination date (late June, early August, and in spring immediately before spring wheat seeding) and method (herbicides, tillage, and herbicides plus tillage) on soil water conservation, and establishment, yield, and water use efficiency (WUE) of following spring wheat (Triticum aestivum L.) crop. Experiments were conducted over 5 site-years in a subhumid region of western Canada. Herbicide termination resulted in greater total water recharge and a faster rate of water recharge than treatments involving tillage. Greater efficiency of soil water recharge for herbicide termination after the first hay harvest (late June) appeared to cause deep water percolation at one site. Delaying termination until after the second hay harvest (early August) did not reduce soil water availability at spring seeding of the following wheat crop, hut increased reliance on overwinter soil water recharge. Delaying herbicide treatment until spring reduced water at seeding and wheat yields in some cases. Compared with treatments involving tillage, herbicide treatments resulted in higher levels of groundcover (i.e., greater soil erosion control), higher WUE, and higher grain yields. Herbicide termination after the second hay harvest produced the most favorable overall outcome; better than the traditional approach of tillage after the first hay harvest.


Crystalline TiO2 particles with a diameter of 300nm were obtained from aqueous TiOCl2 solution with 0.67M Ti4+ concentration, diluted by TiCl4 solution using the homogeneous spontaneous precipitation process. Dispersion stability of rutile TiO2 powder with acicular typed primary particles has been investigated in both aqueous and organic media. In this paper, we focus on the TiO2 suspension stability in aqueous and organic media using a recently developed optical analyzer(Turbiscan) and Zeta potential analyzer. The surface potentials of TiO2 particles were greatly modified by dispersion medium and valance of the ionic species, which governs the colloidal behavior of TiO2 particles virtually.


Epistaxis is a common problem that may range in severity from a minor nuisance to hemodynamically significant bleeding. Vascular anatomy allows for predictable identification of suspicious bleeding sites. Historically, packing was the workhorse of management, but, currently, more directed interventions have become available. These modalities may result in improvements in both cost-effectiveness and patient comfort.


Fibrin appears to be a multi-potential component of atherogenesis, intervening at virtually all stages of lesion development. Fibrin and microthrombus deposition on normal intima is associated with endothelial disruption and intimal oedema, and oedema is a primary characteristic of early proliferative lesions. Fibrin strands on or in the intima encourage smooth muscle cell (SMC) migration and proliferation, and contribute to the growth of plaques. Fibrin also provides a continuing source of fibrin degradation products (FDP), and these have mitogenic activity which will sustain SMC proliferation in growing plaques, and act as chemoattractants for blood leucocytes. Accumulation of the lipid core in fibrous plaques may also be influenced by fibrin which appears to bind the lipoprotein Lp(a) with high affinity, thereby immobilizing its lipid moiety within the lesion.


ofenzyme activity to develop a strategy for early diagnosis of acute myocardial infarction. We enrolled 103 patients with suspected myocardial infarction, of whom 43 were confirmed to have had a myocardial infarction based on clinical history, characteristic evolution of electrocardiographic changes over 24-26 hours, and raised activity of creatine kinase and its MB isoenzyme (>5% of total creatine kinase activity over 24 hours. In the light of Dr Mullen's letter we reanalysed our database with specific reference to electrocardiographic changes at time of presentation. Of the 43 patients who were confirmed to have a myocardial infarction, 30 (69%) had electrocardiographic abnormalities suggestive of infarction or ischaemia. Of these electrocardiograms 20 were diagnostic of acute myocardial infarction (ST elevation >1 mm in standard leads or >2 mm in precordial leads), and the remaining 10 showed ST segment depression (seven) or T wave inversion (three). Of the remaining 13 patients, six had electrocardiographic evidence of left bundle branch system block and seven patients had a normal electrocardiogram. We support Dr Timmis's view that the electrocardiography, in conjunction with clinical history, is the earliest and most useful investigation for diagnosing acute myocardial infarction and need for thrombolytic treatment. Timed sequential estimation of enzyme activities, however, do have a role in the diagnosis or exclusion of acute myocardial infarction. Of the 23 patients with non-diagnostic electrocardiograms all had change in activity of the MB isoenzyme ofgreater than eight units 12 hours after admission. Whether these patients would benefit from thrombolytic treatment is unclear, and we will have to await the results of ongoing clinical trials that are examining this question. Dr Timmis seems to contradict himself when he states in his article that "at Newham patients with regional ST elevation presenting within 24 hours after the onset of continuous chest pain are given thrombolytic therapy" and then in his reply to Dr Mullen's letter that the benefits of thrombolytic therapy after 12 hours or more are considerably diminished.3 That the benefits of late thrombolysis are diminished is well supported and would equally apply to patients who present late (with electrocardiographic diagnosis) or in whom disease is diagnosed late (with equivocal electrocardiographic changes but diagnostic cardiac enzyme activities). We disagree with Dr Mullen regarding the sensitivity of log slopes of creatine kinase activity, especially if the initial creatine kinase activities are raised, and have recently presented our experience with this method.5


Leriche syndrome results from thrombotic occlusion of the abdominal aorta immediately above the site of its bifurcation. Impotence in leriche syndrome is caused due to proximal obstruction, commonly involving isolated common iliac, internal iliac, internal pudendal or dorsalis penis artery. The symptoms of Leriche syndrome include intermittent and bilateral claudication, pallor, coldness and fatigue in lower extremities. Data regarding psychiatric morbidity in Leriche syndrome is unavailable. We hereby report the case of Leriche syndrome, presenting to psychiatry outpatient department with depressive disorder and erectile dysfunction (ED) with focus on dilemmas faced in the diagnosis and management in psychiatry.