ABSTRACT A number of new psychoactive substances (NPS) have been released in the last decade, and the list of NPS continues to grow. This paper reports a retrospective evaluation of the toxicological analyses in 1,445 suspected intoxication cases by psychostimulant, hallucinogen, and dissociative NPS occurring in hospitals across Italy from 2011 to 2019. The objectives of the study were to contribute to the monitoring of the NPS diffusion based on analytically confirmed intoxications, and to evaluate the importance of the clinical toxicological laboratory in the diagnosis of NPS intoxication. For at least one NPS of the considered classes, 246 patients (17.0%) tested positive. Forty-four different NPS were detected and a consistent turnover was observed during the nine-year period, especially regarding cathinones. Among the positive cases, 47.2% tested positive for dissociative NPS, with particular regard to ketamine. Hallucinogens (30.9%) was the second most frequent NPS involved. Stimulants were found in 20% of the positive cases with a considerable presence of cathinones. Findings confirm the dynamism of the NPS phenomenon, underline the importance of awareness of this new public health threat among health care professionals, and highlight the need for analytical confirmation for the identification of the drugs in forensic contexts.


A pedagogically-informed approach to the design of an e-learning system is important since an effective learning system requires teaching activities that match the students' learning requirements. Currently some e-learning systems are based on adaptive educational hypermedia. User modelling is one of the components of adaptive hypermedia. However, currently designed user models are inconsistent in estimating learner's knowledge level, are not pedagogically designed, and do not satisfactorily incorporate the achieved learning of the learner. The paper proposes a competency-based system for recommending study materials from the Web to learners (CBSR), and explores the benefits of a competency model for an improved pedagogical approach to e-learning and a more consistent profile of learners' competences which can persist though their learning life. A competences structure is represented as a directed acyclic graph (DAG), and the paper considers the processing of a competence structure to identify learners' existing/desired competences and provide appropriate study materials from the Web.


While case studies appear frequently in business classrooms as learning exercises, they appear only infrequently in scholarly journals as an accepted basis on which to demonstrate a theory or test a hypothesis. While scholars have contributed much in recent years to improving the rigor and design of business case studies, this research approach may yet be underutilized. The academic approach to the study of law in the US and England draws heavily on the use of case studies; management scholars may benefit from an understanding of the ways in which lawyers construct, analyze, and draw lessons from cases.


In the complex world of today, it is difficult to conceive of a transaction that can operate effectively without good communication. Language, spoken or silent, directs us in countless ways in our daily lives; misinterpretation can lead to chaos. Breakdown of message relays can result in business catastrophes, wars, or marital dissolution. In the microcosm of our bodies, at the cellular level, there exist communication mechanisms with the same capabilities of creating harmony or wreaking havoc. The language of these cell-to-cell interactions is just beginning to be deciphered. We are used to the concept of neurological impulses instructing mass muscle movements with modulating influences coming from the cerebral cortex; the analogy to telephone messages is easy to comprehend. Directional influences that are just as specific operate at a cellular level, where the surface membrane serves as the central telephone exchange receiving and relaying messages. Cell Communication Structures The array of


Natural gas (NG) is an alternative combustible fuel for the transportation sectors due to its clean combustion, small carbon footprint, and, with recent breakthroughs in drilling technologies, increased availability and low cost. Currently, NG is better suited for spark-ignited (SI), as a gasoline replacement in conventional SI engines or as a diesel replacement in diesel engines converted to SI operation. However, the knowledge on the fundamentals of NG flame propagation at conditions representative of modern engines (e.g., at higher compression ratios and/or lean mixtures) is limited. Flame propagation inside an engine can be achieved by replacing the original piston with a see-through one. This study visualized flame activities inside the combustion chamber of an optically-accessible heavy-duty diesel engine retrofitted to NG SI operation to increase the understanding of combustion processes inside such converted engines. Recordings of flame luminosity throughout the combustion period at lean-burn operating conditions indicated that the fully-developed turbulent flame formed from several smaller-scale kernels. These small kernels varied with shapes and locations due to different flow motion around the spark location (including the effect of spark electrodes on the local flow separation), different local temperature, or different energy released in these regions. In addition, the turbulent flame was heavily wrinkled during propagation, despite it was grown from a relatively-circular kernel. Moreover, the intake swirl accelerated the flame propagation process while rotating the turbulent flame during its development. Furthermore, the flame propagation speed reduced dramatically when entering the squish region, while the direction from which the flame first touched the bowl edge changed with individual cycles. The results can help the CFD community to better develop RANS and/or LES simulations of such engines under lean-burn operating conditions.


"Business climate indexes" characterize state economic policies, and are often used to try to influence economic policy debate. However, they are also useful in research as summaries of a large number of state policies that cannot be studied simultaneously. Prior research found that business climate indexes focused on productivity and quality of life do not predict economic growth, while indexes emphasizing taxes and costs of doing business indicate that low‐tax, low‐cost states have faster growth of employment, wages, and output. In this paper, we study the relationship between these two categories of business climate indexes and the promotion of equality or inequality. We do not find that the productivity/quality‐of‐life indexes predict more equitable outcomes, although some of the policies underlying them suggest they might. We do find, however, that the same tax‐and‐cost‐related indexes that are associated with higher economic growth are also associated with increases in inequality.


ABSTRACT During the last years the DRC has made itself known in the world for terrible acts of violence committed by armed men – militia and the regular army – against the civilian population. The voices of the soldiers and combatants have so far been absent in the accounts of this violence. This silence is problematic, both because it makes it harder to understand such violence, but also because it reinforces stereotypes of African warriors as primitive and anarchic, driven by innate violence and tribal hatred. Enquiry into the particular discursive as well as material circumstances of the armed conflict in the DRC, which might better redress the complex and interrelated context in which 'people in uniforms' commit violence, is consequently impeded. The story we recount here emerges from soldiers within the main perpetrator of violence in the DRC today: the Integrated Armed Forces. The soldiers' interview texts challenge the dominant representation of soldiers and combatants in the DRC. The soldiers made sense of the prevalence of violence (in which they too had participated) in several interrelated ways, none of which reflected any expression of 'natural' (if dormant) violent tendencies, hatred or vengefulness for the enemy.


Phytophthora root rot is a destructive soybean disease worldwide, which is caused by the oomycete pathogen Phytophthora sojae (P. sojae). Wall-associated protein kinase (WAK) genes, a family of the receptor-like protein kinase (RLK) genes, play important roles in the plant signaling pathways that regulate stress responses and pathogen resistance. In our study, we found a putative Glycine max wall-associated protein kinase, GmWAK1, which we identified by soybean GmLHP1 RNA-sequencing. The expression of GmWAK1 was significantly increased by P. sojae and salicylic acid (SA). Overexpression of GmWAK1 in soybean significantly improved resistance to P. sojae, and the levels of phenylalanine ammonia-lyase (PAL), SA, and SA-biosynthesis-related genes were markedly higher than in the wild-type (WT) soybean. The activities of enzymatic superoxide dismutase (SOD) and peroxidase (POD) antioxidants in GmWAK1-overexpressing (OE) plants were significantly higher than those in in WT plants treated with P. sojae; reactive oxygen species (ROS) and hydrogen peroxide (H2O2) accumulation was considerably lower in GmWAK1-OE after P. sojae infection. GmWAK1 interacted with annexin-like protein RJ, GmANNRJ4, which improved resistance to P. sojae and increased intracellular free-calcium accumulation. In GmANNRJ4-OE transgenic soybean, the calmodulin-dependent kinase gene GmMPK6 and several pathogenesis-related (PR) genes were constitutively activated. Collectively, these results indicated that GmWAK1 interacts with GmANNRJ4, and GmWAK1 plays a positive role in soybean resistance to P. sojae via a process that might be dependent on SA and involved in alleviating damage caused by oxidative stress.


Narcissism is generally perceived as a growing social phenomenon in our society (Kopelman 1984; Mullins et al. 1984; Nelson 1977), as Lasch puts in his widely cited book "Culture of Narcissism" (1991). Recent technology shifts have yet again started a discussion about the increase of narcistic behaviour in western culture. Among these technology shifts are technologies that enable social interaction in general, and social networking sites in particular (Halavais 2007). In spite of any possible negative connotations of this phenomenon, narcissism can also be seen as a functional and healthy personal strategy for making sense of our increasingly fast and techno-oriented world. According to this argument, narcissism can be considered as a cultural and social entity (Emmons 1987; Mullins et al. 1984). The most specific definition is proposed by Raskin et al. (1981; 1988; 1979) and their development of an empirical method, the Narcissistic Personality Inventory, which measure the level of narcissism. However, most definitions can be summarized as a self-focussed concentration of the attention of an individual.
The practice described as »Self-Googling« can be seen as a form of narcissism, which may help to explain the phenomenon of people searching and browsing the Web for information about themselves. Egosurfing, Egogoogling, Self-Marketing or Vanity Searching are different names for the same "practice of harnessing the Internet's vast data-collection powers to dig up information about oneself," as Glasner (2001) puts it. In addition to using the theory of narcissism to explain the »Self-Googling« phenomenon, however, this practice can also be seen as a social construction of personal reputation in terms of Self-Marketing (Lampel et al. 2007).
To investigate this phenomenon, we have gathered and analysed 1.7 million search engine requests over a time period of 14 months. On the basis of this data we have conducted an in-depth analysis of the search terms used, in combination with the links eventually selected (clicked on) by the user from the search engine result lists. This paper will report on the results of this analysis.
There have been previous attempts to explain and analyse the search behaviour of users, which fall into three distinct categories: (1) those that primarily use transaction-log analysis, (2) those that involve users in a laboratory survey or other experimental setting, and (3) those that examine issues related to or affecting Web searching (Jansen et al. 2006; Spink et al. 2004). Our research methodology and the presented results clearly belong to the first category. However, none of the previous attempts made an explicit differentiation between generic search term keywords and personal names. Only a vague category of "people, places or things" has previously been analysed by Jansen et al. (2006) showing a growth of search terms in that category from 21.5% of all search terms in 2001 to 41.5% in 2002.
This paper addresses this gap in the available research by more specifically comparing search and click-through trends for personalised information resources (Web pages and sites which refer specifically to individual persons, and whose URIs include a version of the person's name) and non-personalised information resources (pages and sites which are not name-specific, and have more generic URIs). In particular, it examines whether generic search terms or personal names as search terms produce a better click-through performance. This throws new light on the »Self-Googling« phenomenon and provides a basis for further research.


We extend the original idea of the residual income model and decompose the firm's cost of equity capital into its two elementary components: The discount rate of normal operating earnings (kNE) and discount rate of residual operating earnings (kRE). The first part of the paper identifies the analytical relation between the firm's cost of capital, kNE and kRE for the un-levered firm in steady state conditions. The second part of the paper empirically tests this relation by exploiting the cross section of firm's operating profitability (RNOA) and enterprise price-to-book ratio (PNOA/NOA). Our findings support the idea that residual earnings are the less risky component of income.


The overall aim of this project was to utilise green chemistry methodology to capture potentially harmful, toxic or valuable compounds from wastewater.
Novel mesoporous materials, Starbon®, prepared from naturally abundant polysaccharides, have demonstrated significant potential as adsorbents for the uptake of a range of dyes and phenols. Through the use of different polysaccharide starting materials (starch and alginic acid) and different preparation temperatures, six materials were produced. The resulting materials were characterised by techniques including: solid-state NMR, nitrogen porosimetry, FT-IR, x-ray photoelectron spectroscopy and electron microscopy. The experimental results revealed that the materials exhibited high efficiency to remove dyes and phenols from aqueous media due to their high mesoporous nature. The adsorption process was described well by the Langmuir, Freundlich and Dubinin-Radushkevich isotherms. Thermodynamic analysis of the results indicated that adsorption was a physical process.
Investigations into the capture of palladium from liquid waste and also greener methods of supported nanoparticle formation were also carried out. Biosorption of palladium by alginic acid and seaweed was highly successful, resulting in nanometer sized palladium deposits within the adsorbent. The catalytic activity of these materials was successfully demonstrated through the use of Heck and Suzuki reactions.
Preliminary work exploring the first use of living plants to recover palladium from water and in situ production of catalytically active palladium nanoparticles also is presented. This novel process eliminates the necessity for nanoparticle extraction from the plant and reduces the number of production steps compared to traditional catalyst palladium on carbon. These plant catalysts have demonstrated high catalytic activity in a range of C-C coupling reactions, outperforming traditionally used palladium catalysts.


An extended depth-first-search (EDFS) algorithm is proposed to solve the multi-constrained path (MCP) problem in quality-of-service (QoS) routing, which is NP-Complete when the number of independent routing constraints is more than one. EDFS solves the general k-constrained MCP problem with pseudo-polynomial time complexity O(m2 middot EN + N2), where E and N are the number of links and nodes of a graph respectively, and m is the maximum number of feasible paths maintained for each destination. This is achieved by deducing potential feasible paths from knowledge of previous explorations, without re-exploring finished nodes and their descendants in the process of the DFS search. One unique property of EDFS is that the tighter the constraints are, the better the performance it can achieve, w.r.t. both time complexity and routing success ratio. Analysis and extensive simulation are conducted to study the performance of EDFS in finding feasible paths that satisfy multiple QoS constraints. The main results show that EDFS is insensitive to the number of constraints, and outperforms other popular MCP algorithms when the routing constraints are tight or moderate. The performance of EDFS is comparable with that of the other algorithms when the constraints are loose


The annual festivals that are central to the south Indian religious tradition are among the largest religious gatherings found anywhere in the world. Most are located at Hindu temples, but some are at Buddhist, Christian, or Islamic centers, and many involve people or symbols from more than one religious tradition. To an outside observer, the many activities of a festival may seem somewhat chaotic, but the participants see the activities as the ritual focus of a distinct religious experience, and frequently testify that it is in the activity of a festival that they find their most profound sense of religious meaning. In spite of their obvious importance in the lives of participants, these festivals have received scant scholarly attention. In this book, Paul Younger offers a fieldwork-based study of fourteen different religious festivals, shedding light on not only their religious, but also their social and political meanings.


Abnormalities of the arterial pulse waveform reflect changes in cardiovascular structure and function. These abnormalities may occur early in the course of essential hypertension, even before the onset of blood pressure elevation. Previous studies of cardiovascular structure and function have relied on invasive intra-arterial cannulation to obtain the arterial pulse wave. We evaluated arterial structure and function using a noninvasive cuff sphygmomanometer in hypertensive (n = 15) and normotensive (n = 36) subjects stratified by genetic risk (family history) for hypertension. Using a simple physical model in which the aorta was assumed to be a T tube and the brachial artery a straight tube, we determined vascular compliance and peripheral resistance by analyzing the brachial artery pulsation signal from a cuff sphygmomanometer. Essential hypertensive subjects tended to have higher peripheral resistance (P = .06) and significantly lower vascular compliance (P = .001) than normotensive subjects. Vascular compliance correlated with simultaneously determined pulse pressure in both groups (n = 51, r = .74, P < .0001). Higher peripheral resistance (P = .07) and lower vascular compliance (P = .04) were already found in still-normotensive offspring of hypertensive parents (ie, normotensive subjects with a positive family history of hypertension) than in normotensive subjects with a negative family history of hypertension. Multivariate analysis demonstrated that both genetic risk for hypertension (P = .030) and blood pressure status (P = .041), although not age (P = .207), were significant predictors of vascular compliance (multiple R = .47, P = .011). However, by two-way ANOVA, genetic risk for hypertension was an even more significant determinant (F = 7.84, P = .007) of compliance than blood pressure status (F = 2.69, P = .089). Antihypertensive therapy with angiotensin-converting enzyme inhibitors (10 days, n = 10) improved vascular compliance (P = .02) and reduced resistance (P = .003) significantly; treatment with calcium channel antagonists (4 weeks, n = 8) tended to improve vascular compliance (P = .07) and significantly reduced peripheral resistance (P = .006). We conclude that arterial vascular compliance abnormalities detected by a noninvasive cuff sphygmomanometer reflect treatment-reversible changes in vascular structure and function. Early changes in vascular compliance in still-normotensive individuals at genetic risk for hypertension may be a heritable pathogenetic feature of this disorder.


Tissue homeostasis requires a balance between cell proliferation and death. Apoptosis and proliferation are linked by cell cycle regulators, and apoptotic stimuli affect both cell proliferation and death. Glucocorticoids induce G1 arrest and apoptosis in transformed lymphoid cells. Decreased expression of the cell cycle components c-myc and cyclin D3 is essential for glucocorticoid-induced growth arrest and death in dividing cells. Other G1 regulators, such as p53, pRb, and E2F, have also been implicated in apoptosis. Mice lacking either p53 or E2F display aberrant cell proliferation and tumor formation, suggesting that these proteins are involved in the elimination of abnormal cells through apoptosis. In contrast, pRb induces G1 arrest and suppresses apoptosis in cultured cells. Mice that lack pRb are nonviable and show ectopic mitosis and massive cell death, suggesting that pRb is an apoptotic suppressor. Further analysis of common components of apoptotic and cell cycle machinery may provide insight into the coordinated regulation of these antagonistic processes.


- This work has been supported by COMPETE: POCI-01-0145-FEDER-007043 and FCT - Fundacao para a Ciencia e Tecnologia within the Project Scope: UID/CEC/00319/2013.


Background Retinopathy of prematurity (ROP) is a cause of treatable blindness in premature babies. Guidelines in the UK recommend babies born at less than 32 weeks gestation or weighing less than 1501 grams are screened to enable the timely provision of treatment of sight threatening ROP. Clinical audit was done to explore the effectiveness of the ROP screening service provided by an ophthalmologist at a teaching hospital. Effectiveness was determined by adherence to guidelines regarding (a) referral to screening programme; (b) appropriate repeat screening and discharge and (c) appropriate and timely treatment. The standard of an effective service was set at 100% adherence to guidelines. Methods Details of all babies who were admitted to the neonatal unit between 01/04/12 and 31/03/13 were collected. The details of the babies admitted were compared to the babies who were recorded by the ophthalmologist to have received screening for ROP and records on the trust intranet. Results According to the guidelines, 151/991 (15.24%) babies were eligible for ROP screening during this time period. 135/151 (89.4%) babies who should receive ROP screening did receive it. Of those that did not receive screening, 16/16 (100%) had a sufficient reason for not receiving screening (too young to screen as inpatient, died or transferred prior to entry). 112/135 (82.96%) received appropriate repeat screening and discharge. Of the 23 who did not, 11 were transferred, 1 died, 1 refused, 5 did not attend and 4 had delayed screening due to transfer in and 1/135 (0.74%) was lost to follow up. 1/151 (0.66%) baby required laser treatment for ROP and this was done at the right time. Conclusion Evaluation demonstrated that the neonatal unit and ROP screening service worked together to adhere to guidelines 100% of the time when factors were within the hospital's control. Although it is difficult to alter factors outside its control, the hospital should work to reduce the number of 'did not attend' babies, by improving knowledge of ROP through patient information leaflets and staff-parent discussion.


University of Medical Sciences absTracT Collaboration between physicians and pharmacists is essential for proper and effective medical care. Medicine is a multifaceted discipline where success is judged by the outcomes of the patient's wellbeing. Incorpo-rating interdisciplinary education within healthcare enhances the cooperation between future medical pro-fessionals. In this comprehensive review, we present the current steps that have been implemented to apply interdisciplinary care as well as interprofessional cooperation possibilities


The maroon clown Premnas biaculeatus is the sole member in the genus Premnas. P. biaculeatus is commonly known as 'Spine-Cheek Anemone fish' because of the presence of a pair of long spines on its pre-operculum. In India, this species is abundant in the coral reef ecosystem of Andaman and Nicobar Islands situated in Bay of Bengal. Their most striking bright red to maroon colouration on entire body and fin, demarcated abruptly with white to golden yellow narrow bands make them as one of the most attractive species among the marine ornamental clown fishes. Most of the salt water ornamental fishes are collected from the wild and hence there is a serious concern in respect of their conservation. Recent studies also showed that wild collected specimens have a dismal survival history in captivity, whereas captivebred clownfish are generally hardier, more disease free, easily adjust to life in aquaria and retain normal colouration. Due to the very high demand of the species in the aquarium fish trade, development of an appropriate technology for its captive production is felt as an alternative means of providing fish for the trade rather than wild collection which may cause depletion of the stocks. In this juncture, a viable technique has been developed in the marine hatchery of CMFRI, Kochi for the captive breeding and juvenile production of P. biaculeatus for the first time in India.


This paper analyzes monetary exchange in a search model allowing for multilateral matches to be formed, according to a standard urn-ballprocess. We consider three physical environments: indivisible goods and money, divisible goods and indivisible money, and divisible goods and money. We compare the results with Kiyotaki and Wright (1993), Trejos and Wright (1995), and Lagos and Wright (2005) respectively. We find that the multilateral matching setting generates very simple and intuitive equilibrium allocations that are similar to those in the other papers, but which have important differences. In particular, surplus maximization can be achieved in this setting, in equilibrium, with a positive money supply. Moreover, with flexible prices and directed search, the first best allocation can be attained through price posting or through auctions with lotteries, but not through auctions without lotteries. Finally, analysis of the case of divisible goods and money can be performed without the assumption of large families (as in Shi (1997)) or the day and night structure of Lagos and Wright (2005).


The purpose of this article is to explore the issue of drug use among police officers and police recruits. Data from two large police agencies were used in this analysis. Results of the two most popular drug screens (urinalysis and hair analysis) in the identification of drug‐involved individuals, who are either currently employed in or applying for law enforcement positions, are presented and discussed. It is found that there is an identifiable group of people in policing which appears to be drug‐involved. It also appears that, at least in some situations, and for rapidly excreted drugs like cocaine, the use of urine may be producing underestimates of these groups. The data support the idea that policing agencies may want to consider using multiple drug‐testing modalities in order to maximize the identification of different drugs, whose characteristics can be an important consideration in interpreting drug test results.


Several types of failures can occur in the GPS satellites that transmit the ranging signals to the users. Among them, a specific type of failure in the signal generation process aboard the satellite may result in an anomalous waveform being transmitted, called an 'evil waveform'. Evil waveforms are GPS signals that have a distorted PRN code modulation waveform. The main impact is a rupture of the symmetry of the cross-correlation peak inside the tracking channel, therefore inducing a different measurement error for two receivers that would not have the same loops architecture. As a consequence, there is a potential for evil waveforms to induce large tracking errors of differential systems if left undetected. This paper aims at providing some insight on the behavior of specific ground monitoring techniques that were proposed for implementation.


BACKGROUND
Many patients presenting in general practice are suffering from stress. Approaches using complementary therapeies are gaining popularity but have not been systematically evaluated.

AIM
To compare the effect of six sessions of therapeutic massage with the use of a relaxation tape on stress, as measured by The General Health Questionnaire (GHQ-30).

DESIGN OF STUDY
Randomised controlled trial.

SETTING
A stress reduction clinic in general practice.

METHOD
There were three treatment groups. Patients in the first group received six sessions of therapeutic massage, which was carried out by a nurse trained in this technique. Patients in the second group were given six sessions using a relaxation tape in the surgery and those in the third group were given a relaxation tape to use at home. The main outcome measures were: the GHQ-30, the Adapted Well Being Index (AWBI); a sleep scale; general practitioner (GP) consultations for any reason in the six weeks before treatment, during treatment, and the six weeks following treatment; and patient satisfaction.

RESULTS
Sixty-nine patients completed the treatment. There were significant improvements across all four outcome measures and all three treatment groups. Following treatment the majority of patients felt far less emotional disturbance, were sleeping better, and consulting their GP less.

CONCLUSION
Despite very strong patient preference for therapeutic massage, it did not show any benefits over either a relaxation tape used in the surgery or a relaxation tape used at home.


AIMS
The aim of this study is to present a contrast media (CM) protocol for the dynamic visualisation of the tricuspid valve (TV) and tricuspid annulus (TA) with CT.

METHODS AND RESULTS
Fifteen patients with no cardiac abnormalities (controls), 15 patients with functional tricuspid regurgitation (FTR) <3+, and 13 patients with FTR ≥3+ underwent a dedicated cardiac CT protocol. Using advanced visualisation, segmentation and analysis software, the annular area, entire annular circumference, its three parts, and annular diameters were measured by two independent, blinded readers. The homogeneity of attenuation in the right heart was 63 HU in the RA and 46 HU in the RV, showing a significant negative correlation with the degree of FTR (r=-0.61, p<0.001). The annular area, entire annulus and diameters were larger in patients with FTR compared to controls (p<0.05). There were significant differences between systole and diastole in controls and patients with FTR <3+ and FTR ≥3+ for the annular area and annulus (p<0.05). The annulus was significantly smaller (all, p<0.05) in 2D compared to 3D (systematic underestimation: 1.0-1.3 mm), the difference decreasing with increasing FTR grades.

CONCLUSIONS
This study introduces an individually tailored CM protocol for optimised visualisation of the TV with CT. We found dynamic changes of the geometry within the cardiac cycle and between 3D and 2D measurements, the latter systematically underestimating the true size of the TA. Use of this CM protocol enables accurate imaging of the dynamic geometry of the TA prior to transcatheter valve repair.


Significant amounts of energy can be saved every year by appropriate building opening ventilation control. Towards this direction, SRC (System of Resistances and Capacitances), a finite element based hydro-thermal building simulation program can be used in order to define the operation schedules of building openings, which achieve energy savings, while preserving thermal comfort in building interiors. SRCmodels buildings as a collection of thermal circuit elements, which when assembled together form a global system. This systemic point of view, allows real time simulations to be performed, temperatures at the building zones to be calculated and thermal effects of the openings' ventilation to be estimated at every simulation time step. These zone temperature calculations and thermal effect estimations are repeated in an iterative algorithm in order to derive the opening operation schedules which comply with imposed energy and comfort constrains. Essentially the operation schedules of the openings are obtained by defining and solving a convex optimization problem at every iteration step. At the end of the iteration process, the schedules which satisfy the energy and comfort criteria, are finally selected. The examined method is tested ona simple one-zone model building. Extensions to multiple zonebuildings of higher complexity are straightforward.


Multiple Sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disorder of the central nervous system (CNS), which mainly affects young adults. Activated T lymphocytes promote the neuro-inflammatory cascade of MS by secreting pro-inflammatory cytokines and play a significant role in its pathogenesis. T lymphocytes may trigger the inflammation, which in turn leads to axonal loss and neurodegeneration observed in the course of MS. Currently, there is no cure for MS, however, one of the most promising neuroprotective research tools consists of the use of bone marrow derived mesenchymal stem cells (MSC). This method promotes immune system regulation and possibly induces neurological repair and re-myelination of the damaged axons. Recent studies have shown that MSC exert an immune regulatory function and induce T regulatory-cell proliferation, therefore, it may serve as a potentially useful treatment for immune-mediated diseases such as MS. In this pilot study a group of MS patients underwent MSC therapy and we assayed the expression of an X-linked transcription factor, FoxP3, as a specific marker of T Regulatory cells in peripheral blood, prior to and after the treatment. Using q RT-PCR for measurement of expression of FoxP3 by peripheral blood mononuclear cells, we found that in all subjects, except for one, the expression of FoxP3 at 6 months after intrathecal injection of MSC was significantly higher than the levels prior to treatment. Such significant enhanced expression of FoxP3 associated with clinical stability. Findings from this pilot study further support the potential of bone marrow derived MSC for treatment of MS patients.


Psychiatric disorders can be characterized as behavioral or mental states that cause significant distress and impaired personal functioning. Such disorders may occur as a single episode or persistent, relapsing, and perhaps leading to suicidal behaviours. The exact causes of psychiatric disorders are hard to determine but easy access to health care services can help to reduce the severity of the states. Inpatient psychiatric hospitalization is not only an expensive mode of treatment but also may represent the quality of health care system. The aim of this study was to investigate the factors associated with repeated hospitalizations among the patients with psychiatric illness, which may help the policy makers to target the high-risk groups in a more focused manner. The count of hospitalizations for psychiatric patients may be zero during a period of time for the huge majority of patients rather than a positive count. A common strategy to handle excessive zeros is to use zero-inflated models or hurdle models. In the field of health services research of mental health, very little literature is available comparing the relative fits of zero-inflated distributions and other count distributions to empirical data. A large linked administrative database consisting of 200,537 patients with psychiatric diagnosis in the years of 2008-2012 was used in this thesis. Various counts regression models were considered for analyzing the hospitalization rate among patients with psychiatric disorders within 3, 6 and 9 months follow-up since index visit date. The covariates for this study consist of sociodemographic and clinical characteristics of the patients. According to the Akaike Information Criteria, Vuong's test and randomized quantile residuals, the hurdle negative binomial model was the best model. Our results showed that hospitalization rate depends on the patients' socio-demographic characteristics and also on disease types. It also showed that having previously visited a general physician served a protective role for psychiatric hospitalization during our study period. Patients who had seen an outpatient psychiatrist were more likely to have a higher number of psychiatric hospitalizations. This may indicate that psychiatrists tend to see patients with more severe illnesses, who require hospital-based care for managing their illness. Having earlier and greater access to outpatient psychiatrist and community-based mental


Web-based learning systems are one of the most interesting topics in the area of the application of computers to education. Collaborative learning, as an important principle in constructivist learning theory, is an important instruction mode for open and distance learning systems. Through collaborative learning, students can greatly improve their creativity, exploration capability, and social cooperation. This paper used an agent-based coordination mechanism to respond to the requirements of an efficient and motivating learning process. This coordination mechanism is based on a Web-based constructivist collaborative learning system, in which students can learn in groups and interact with each other by several kinds of communication modes to achieve their learning objectives efficiently and actively. In this learning system, artificial agents represent an active part in the collaborative learning process; they can partially replace human instructors during the multi-mode interaction of the students.


Information is not available on the extent of population shifts, if any, in synthetic cultivars of smooth bromegrass resulting from seed multiplication in diverse environments, methods of breeder seed synthesis, or seed maturity at harvest. Objectives of our research were to determine effects of two methods of breeder seed syntheses, three diverse locations of seed production, and three seed maturities at harvest upon the population stability of 'Saratoga' smooth bromegrass (Leyss.). Polycross seed was produced in vegetatively established nurseries at Shafter and Tehachapi, Calif., and Prosser, Wash. At each location two breeder seed lots were synthesized using 1) equal parts of pure live seed from each of the 5 parental clones, or 2) portions equivalent to relative seed yields. These lots, plus similar blends produced at Ithaca, N.Y., were used to plant four isolated increase blocks at the three western locations to produce second generation seed harvested at early, optimum, or late maturity. The second generation seed lots, including the original breeder seed blends, were evaluated in a space-planted nursery at Prosser in 1978 and 1979. Four plant characteristics were measured: heading date, anthesis date, plant height, and rhizome spread after 2 years. Plants from second generation seed produced at Shafter tended to be taller with less rhizome spread than those from Prosser or Tehachapi. Otherwise there were no consistent trends to indicate that methods of synthesizing breeder seed or location of production affected the population characteristics. Maturity of seed at harvest had no effect on plant characteristics. Based on these results we concluded that even though the parental clones were significantly different, the Saratoga bromegrass synthetic, and perhaps other bromegrass synthetics, would be very stable under differing management and environmental conditions.


The insulinlike growth factor (IGF) family is believed to be important in endometrial development during the menstrual cycle and in the process of implantation. The mitogenic, differentiative, and antiapoptotic properties of the IGFs and their binding proteins, as well as their spatial and temporal expression in cycling endometrium, suggest that they may participate in endometrial growth, differentiation, apoptosis, and perhaps angiogenesis. IGFBP proteases, which increase IGF bioavailability, have been localized to endometrial stromal cells and to the human cytotrophoblast and likely play important roles in endometrial, decidual, and trophoblast physiology. IGFBP-1 is a major protein product of nonpregnant endometrium during the mid-late secretory phase and occurs in abundance in decidua. Its roles as an IGF-binding protein and as a trophoblast integrin ligand suggest that it may have multiple roles in endometrial development and in interactions between the decidua and the invading trophoblast. Recent evidence suggests that it may have a role in the process of shallow implantation in the clinical disorder of preclampsia. In contrast to knowledge about the roles of IGF peptides, IGFBP proteases, and IGFBPs in normal endometrial development and early human pregnancy, little information is available regarding this family in abnormal endometrial development, in occult endometrial defects, and in uterine receptivity and nonreceptivity.


Scholarly work on the nexus of religion, nationalism, and violence is currently fragmented along disciplinary and theoretical lines. In sociology, history, and anthropology, a macro-culturalist approach reigns; in political science, economics, and international relations, a micro-rationalist approach is dominant. Recent attempts at a synthesis ignore religion or fold it into ethnicity. A coherent synthesis capable of adequately accounting for religious-nationalist violence must not only integrate micro and macro, cultural and strategic approaches; it must also include a meso level of elite conflict and boundary maintenance and treat the religious field as potentially autonomous from the cultural field.


Abstract Leydig cell tumours (LCTs) are rare testicular stromal neoplasms classically presenting with a painless testicular mass or swelling in adults. Symptoms secondary to hypogonadism may occur resulting from the hormonal activity of these tumours. Loss of libido is described in LCTs in conjunction with other symptoms; however, no case has reported this as the sole presenting feature. We describe the case of a 42-year-old man presenting to his General Practitioner with loss of libido and no other features suspicious of testicular cancer. Ultrasound performed due to an unrelated epididymal cyst detected an incidental mass confirmed as a benign LCT following radical orchidectomy. Biochemical markers remained normal throughout and following treatment his libido returned to normal. This case may serve as a reminder for clinicians to maintain a high index of suspicion for testicular neoplasms in patients with features of hypogonadism in the absence of classical features for testicular cancer.


This paper focuses on the module development model for tafaqquh at the mosque in Kubang Pasu, Kedah. The tafaqquh programme has been systematically conducted jointly by JAKIM, the State Islamic Affairs Department and mosques' management committees. The programme has been made successful and effective by the contribution and cooperation of takmir teachers who have been appointed and trained intensively. These takmir teachers play very significant roles in the realisation of the aspiration and the scheme in developing knowledgeable society through the involvement of the mosque. To get the holistic view of the theme and subject of the study, focus is made on several key elements; the history of the development of tafaqquh programme module in the societies of the Malay Archipelago, Islamic education theory which correlates to the National Philosophy of Islamic Education : Studying fiqh method from the current methodology and pedagogy and finally the presentation of the current tafaqquh module of Alternative Islam in Malaysia. The learning of fiqh must be viewed from a broad context and it should be able to have an influence on the life of human beings from all living aspects.The Philosophy of Islamic Education, which is based on al-Quran and al-Sunnah should be able to be implemented realistically. The modification and upgrade of the studying fiqh syllabus in mosques require a drastic approach, besides practical module construction. Through these, it is hoped that the only learning of fiqh through the tafaqquh programme in mosques will progress on par with modernisation and current 'urf awareness in the society.


Spectrum sensing task is known to be one of the most important functionalities of a cognitive radio for dynamic spectrum access networks to be aware of the radio environment. Licensed user (primary user) detection has gained a great deal of interest recently on spectrum sensing strategies whereas unlicensed user (secondary user) detection must be a part of sensing with equal proportion of interest. This paper proposes a novel scheme that enables an efficient and robust spectrum sensing for both primary and secondary users detection. The proposed scheme is based on intentionally adding known noise at the sensing side. Then the sensing detector becomes insensitive to signal and noise types, and thus noise uncertainty problem is diminished. After sensing, the added noise is removed without affecting existing transmission on the channel. Although there have been several spectrum sensing methods, the proposed scheme is the optimal solution for spectrum sensing, to the best of our knowledge. DOI: http://dx.doi.org/10.5755/j01.eee.21.6.13769


Regular serial refraction was used to determine the rate of stabilisation of refraction following routine extracapsular cataract surgery in 85 eyes. Patients were divided into four groups depending on wound closure technique: limbal section closed by interrupted 8-0 virgin silk, 9-0 polydioxanone or 10-0 nylon sutures, and corneal section closed by continuous 10-0 nylon suture. Stabilisation of refraction, sufficient to prescribe satisfactory glasses, occurred at three months except in the interrupted 10-0 nylon group, when stabilisation was delayed to between four and five months. The factors affecting stabilisation and the causes of the differences observed are discussed.


Recent development of autostereoscopic displays demands the synthesis of more virtual views in wider baseline, an inevitable trend for future 3DTV systems. However, current standard file formats, e.g. multi-view coding (MVC) and image plus depth, encounter challenging problems to meet the request. Therefore, we propose a new file format, called reduced depth stereo image (RDSI), which saves the color and depth images of the left view and the disoccluded regions in the right view. Based on RDSI, rendering virtual images from parallel viewpoints along the baseline can be simplified as view interpolation that is not only very efficient but also consistent in disocclusion regions. Through experiments on both simulated and real data, we demonstrate the superior performance with several quantitative assessments for the adopted file format and the rendering algorithm. The results suggest RDSI as a better choice to meet the demands for the online synthesis of many virtual views in wide baseline for advanced autostereoscopic displays.


Aims: Transmission of human T lymphotropic viruses (HTLV) testing performed as routine pretransfusion screening. In Riyadh city the prevalence of HTLV1/2 among healthy volunteers in Riyadh city more than two decades. In addition, no information available related to the HTLV1/2 infections in HIV/AIDS patients. This study first aims to determine the prevalence of HTLV1/2 infections among healthy volunteers in Riyadh city. Second, as HTLV1/2 transmission similar as HIV routes, we assess rates of HTLV1/2 coinfection among patients infected with HIV. Materials and Methods: A retrospective study depends on the data obtained from Riyadh Regional Laboratory (RRL) for 3 years, 2017–2019. The samples enrolled in study consist of 114638 healthy blood donors and 243 patient samples referred to RRL virology samples. In addition, 474 HIV-infected patients were included. All serum samples tested to detect infection with HTLV1/2 by commercial CMIA or enzyme-linked immunosorbent assay kits and any positive results confirmed and differentiated by western blot. Results: Among of 114638 blood donations were tested, only two confirmed HTLV1 positive found from two (0.002%) donors, one of them is Saudi female and the second donor was expatriates. None was positive for anti-HTLV2. The overall HTLV1 prevalence was 1.7/100,000 donations during the 3 years tested. In addition, none of the referred sample was positive for anti-HTLV1/2. In addition, a large number of HIV-positive individual population enrolled none tested positive for HTLV1/2. Conclusions: HTLV seroprevalence is very low among healthy blood donors population in Riyadh city, which reflects the situation in the general population. However, screening for HTLV1/2 blood donors for the first donation from endemic countries donors would keep safe blood donation in Saudi Arabia.


Three experiments explore how sport consumers respond to sponsor advertisements featuring a team that lost a pivotal game. Drawing from social identity and appraisal theories, the authors hypothesize and find that high identifiers experience stronger negative emotions but less identity threat than low identifiers following their favorite team's loss. When an advertisement features the losing team, low identifiers show less favorable evaluations toward the brand, whereas high identifiers report more favorable assessments. The results demonstrate that the tendency to hide and escape from the source of threat (losing team) among low identifiers is evidenced in processing marketing communications, whereas high identifiers display more positive evaluations toward the brand when the advertisement acknowledged the loss. The study findings provide implications for sponsors to consider different messaging strategies depending on the level of team identification with the losing team.


The Andean broken foreland in west-central Argentina, located 400–800 km from the Peru-Chile Trench, is associated with flat subduction linked to collision of the oceanic Juan Fernandez Ridge. While the conditions associated with flat subduction would be expected to produce increases in rock uplift and exhumation, where thrusting and dynamic forces work together, a prevalence of pre-Cenozoic apatite fission track (AFT) cooling ages suggests that there is no such link. The lack of Cenozoic cooling ages is at odds with structural reconstructions and basin studies along the foreland that show several kilometers of exhumation. This paradox can be reconciled by taking into account the thermal effects of flat subduction that removed the mantle wedge, and a significant source of heat flow into the crust. Reinterpretation of published AFT exhumation data (>320 ages) using more realistic lower geothermal gradient values allows for substantial exhumation and explains the lack of Cenozoic exhumation ages across the foreland region.


OBJECTIVES
The purpose of this study was to determine the efficacy and safety of the nicotine patch for smoking cessation in an over-the-counter environment. The years of study were 1994 to 1995.

METHODS
Parallel 6-week trials were conducted: a placebo-controlled trial of no-cost 22-mg, 24-hour nicotine patch therapy and an open label trial of the same therapy with patches purchased by subjects. Participants (n = 958) were 18 years or older, had smoked at least 15 cigarettes daily for at least 6 months, and were enrolled at 3 study sites. The main outcome measure was self-reported smoking abstinence confirmed by expired carbon monoxide measurements.

RESULTS
Smoking cessation rates in the placebo-controlled trial were 16.8% and 9.6% at week 6 and 8.7% and 4.3% at week 24 for the active patch and placebo groups, respectively. Smoking cessation rates in the open label-pay trial were 19.0% and 10.8% at weeks 6 and 24, respectively. A slight increase in adverse cardiovascular events was noted only in the open label-pay group in comparison with the placebo group.

CONCLUSIONS
In an over-the-counter environment, the 22-mg, 24-hour nicotine patch is effective and safe for smoking cessation treatment.


Paula Kelly - PhD Research Fellow at the Centre for the Study of Higher Education, University of Melbourne. E-mail: email@example.com Hamish Coates - Professor - Head of the Chair of Higher Education at the Centre for the Study of Higher Education (CSHE), University of Melbourne. E-mail: email@example.com Ryan Naylor - PhD Senior Lecturer at Victoria University. E-mail: firstname.lastname@example.com Address: Elisabeth Murdoch Building (Building 134), Spencer Road, The University of Melbourne, VIC3010, AustraliaOnline education has grown exponentially over the last few decades, churning through a swarm of acronyms, ambiguities and potentialities. Substantial energy has been invested in producing technology, building academic capability, and understanding learners and markets. Though it feels pervasive, online education is comparatively new in the scheme of higher education, and key education and business models remain in formation. To spur advancement, this paper argues that as online education matures increasing energy must shift from admissions and provision to ensuring each learner"s success. We argue that online education presents new opportunities not just for the mechanics of higher education, but for improving each student"s experience and outcomes. Central to such advancement is a clear picture of study success, cogent perspectives for understanding students, effective strategies for analysing and interpreting huge volumes of data, and more evidence-based academic leadership. The paper investigates each of these areas, provoking what institutions could seek to achieve. higher education, online education, quality of education, student"s experience, evidence-based academic leadership.


A forty-year-old woman suffering from maduromycosis of the right sole is described with a disease history of 17 years. After a contusion and surgery for fibroma she developed an edema on the skin of the right sole, then ulcers with purulent discharge. She was repeatedly treated on an outpatient basis and in hospital by surgeons, phthisiologist, and dermatologist for osteomyelitis, tuberculosis of the bones, and Kaposi's sarcoma without effect. The diagnosis of maduromycosis of the sole was confirmed by laboratory examinations and histologically by detecting Actinomyces elements. Since conservative therapy has proved ineffective, surgical treatment was recommended.


A rare type of diffuse large B-cell lymphoma, intravascular large B-cell lymphoma primarily affects the middle-aged to elderly population, with a slight predominance in men. By the time of presentation, most patients have advanced, disseminated disease, and often the diagnosis is made at autopsy. Patients may present with any of a myriad of symptoms, with any tissue potentially being infiltrated. Central nervous system and cutaneous involvement is common, as is the presence of B symptoms including fever, weight loss, and night sweats. Morphologically, growth of neoplastic cells is restricted to the lumen of small vessels. The cells are large, with 1 or more prominent nucleoli, scant cytoplasm, and frequent mitotic figures, and are commonly positive for cluster of differentiation markers 79a, 20, and 19, as well as MUM1/IRF4 and Bcl-2. Intravascular large B-cell lymphoma is aggressive, and without treatment is rapidly fatal.


The frequency and correlates of earache were studied prospectively among 335 consecutive episodes of acute otitis media with effusion (AOME) diagnosed in a suburban pediatric practice. Earache was severe in 142 (42%) episodes, mild/moderate in 135 (40%), and absent in 58 (17%). The incidence of apparently painless AOME was higher among children less than 2 years old than among older children (25% v 7%). Redness of the completely bulging tympanic membrane was associated with an increased likelihood of earache. Neither gender nor the extent of involvement (one v both ears) was independently related to earache. Earache is not an invariable component of AOME, especially among infants and young children. Detection of all cases of AOME among young children requires a high index of suspicion, even in the apparent absence of earache.


Thirteen patients were analyzed who suffered from chronic infection after total hip replacement. Some of them had had severe soft tissue defects or multiple fistulae for years. Some showed acute, sometimes life-threatening infection after long-standing loosening of the prosthesis. Therapy consisted of radical debridement, installation of a closed suction-irrigation drainage system and if another total hip prosthesis was implanted of a specific antibiotic management, including rifampin. In one case treatment was limited to the achievement of a permanent fistula. The average follow-up time was 4.3 years. With or without total hip reimplantation infections were healed as a rule and the decrease in pain was marked. There was only a partial increase in walking ability. In these severely damaged patients treatment can result in marked amelioration of the quality of life but only exceptionally in normalization.


The paper is based on the search query as made in the State Archives in Cracow, and specifically on the analysis of files of the Cracow Circuit Court covering the years 1918–1945. In both discussed trials whose objective was the separation of spouses these were the husbands who filed the application. They were Catholics with the University educational background and both were the sons of the professors of law the inter-war period. In the first case, supplied with the court reference no.: SOKC 4334 (Cg XI f 713/21) it took the trial almost three years and a half (from 31 May 1921 until 17 September 1924) to be ended, the case being examined in the three instances. The Cracow Circuit Court, after 6 hearing sessions, dismissed the application for the separation. The Appellate Court upheld this decision while the Supreme Court in which the motion for the revision was lodged unexpectedly found the decision justified and adjudicated on the separation of spouses on the basis of the fault that it attributed to both parties. The files of the second trial were supplied with the reference no.: SOKC 797 (I C 1323/34). It took the trial 17 months (from 8 November 1934 until 21 April 1936) to end, after four hearing sessions. The decision amounted to the suspension of legal proceedings. For 3 years that followed the parties did not apply for the resuming of the proceedings. As a result the Cracow Circuit Court issued, on the 18th of March 1941, the "On Behalf of the Law" decision on the discontinuance of the suspended proceedings for the separation, thereby fulfilling the requirement of legalism. These proceedings could be classified among those that were most time consuming, the case being tried in one instance. In view of the fact that divorces were not admitted on the basis of the ABGB, the separation trials as instituted by Catholic spouses in Polonia Minora region were decidedly the most frequent method that was applied to deal with difficult matrimonial issues by married couples.


We study the properties of \begin{document}$ \Phi $\end{document} -irregular sets (sets of points for which the Birkhoff average diverges) in dynamical systems with the shadowing property. We estimate the topological entropy of \begin{document}$ \Phi $\end{document} -irregular set in terms of entropy on chain recurrent classes and prove that \begin{document}$ \Phi $\end{document} -irregular sets of full entropy are typical. We also consider \begin{document}$ \Phi $\end{document} -level sets (sets of points whose Birkhoff average is in a specified interval), relating entropy they carry with the entropy of some ergodic measures. Finally, we study the problem of large deviations considering the level sets with respect to reference measures.


Abstract The depositional environment of the Upper Ordovician Harding Sandstone of central Colorado has been debated since Charles Walcott first described its pteraspidomorph agnathans. Although most previous workers have favored a marine setting for the Harding based on the presence of marine invertebrates and burrows, some have argued for a fluvial or estuarine habitat for these primitive vertebrates. This study presented here is the first regional, comprehensive analysis of the depositional environments and sequence stratigraphy of the Harding Sandstone. The Harding contains deposits from an array of coastal environments, including transition zone, shoreface, bay/lagoon, washover fan, and bayhead delta. Features of these environments suggest that the Harding was deposited on a microtidal coast with low wave energy. Within the study area, two depositional sequences are developed, and each apparently lacks a lowstand systems tract. The Harding contains numerous flooding surfaces, which preclude any attempt to interpret the Harding as a single depositional environment. Flooding surfaces commonly display evidence of stratigraphic condensation, including burrowed firmgrounds, concentrations of pteraspidomorph plates, and dolomitic cementation. Pteraspidomorph remains are associated most commonly with shoreface facies, are uncommon in bay/lagoon facies, and are absent from bayhead-delta facies. Collectively, these occurrences argue for a shallow-marine habitat for these primitive vertebrates.


The recent description of Amoebic Gill Disease (AGD) and Neoparamoeba perurans in Atlantic salmon (Salmo salar) farmed in Chile has necessitated the development of more reliable and sensitive diagnostic tests. Final diagnosis of infection is normally confirmed by histology. However, the correlation between gross gill lesions and histological lesions is generally unclear. In the current study, moderate concordance level (k=0.5319) between gross pathology and histology was observed. The sensitivity and specificity of gross pathology was 77.91% and 71.05%, respectively. Neoparamoeba spp. are considered morphologically indistinguishable therefore by using histopathology limits the capacity to characterise the causative agent and it can be time consuming. We developed a PCR assay to amplify the N. perurans 18S rRNA gene from gill clinical samples of AGD-affected fish. High concordance level (k=0.95) between PCR and histological examination was observed. The sensitivity and specificity of PCR assay was 94.64% and 97.06%, respectively. The PCR-based assay provides a rapid tool that will be useful to the diagnostic routine for AGD in Chile.


6112 Background: Diagnostic imaging is Medicare's most rapidly growing service, and increasing rates of imaging have been documented among cancer patients. Like all interventions in patients with metastatic solid tumors, imaging may contribute to palliation but is unlikely to lead to long-term survival. We sought to determine patterns of imaging use in this population and to compare temporal trends with those observed among patients with curable early-stage disease.

METHODS
We extracted SEER-Medicare claims dated 1999-2007 for patients diagnosed with stage IV breast, colorectal, lung, or prostate cancer in 2000-2005 (n=64,267). High-cost imaging procedures were identified by CPT and/or ICD-9 codes for CT, MRI, PET, and nuclear medicine (NM) studies. Summary statistics were calculated, including percent of patients imaged and number of imaging procedures per patient. Comparable data were generated for patients with stage I-II disease of the same tumor types (n=127,827). Mean rates between groups were compared using the Wilcoxon test. We grouped patients according to year of diagnosis and compared utilization rates for the first and last year of the study period.

RESULTS
Stage IV patients underwent a mean of 2.4 high cost imaging procedures during the 60 day diagnostic period, compared to 0.8 in early stage patients (p<0.0001). Thereafter, stage IV patients underwent 0.7 high cost scans per month (1 scan every 43 days on average). 41% of stage IV patients were imaged in the last month of life. Over time, overall utilization increased in stage IV patients, while use decreased in early stage patients (Table).

CONCLUSIONS
Patients with stage IV solid tumors undergo frequent high cost imaging. Imaging rates in this population are increasing over time, in contrast to the observed decrease in those with curable disease. There is an urgent need for studies to determine whether the benefits of these procedures justify the cost, measured in societal resources as well as patient discomfort and anxiety. [Table: see text].


Critical thinking and application of knowledge to an ambiguous patient care scenario are often difficult skills to cultivate in learners. Use of traditional teaching techniques (e.g. topic discussions and journal clubs) helps to develop these competencies within learners. However, alternative teaching strategies may help develop critical thinking and direct application. Debates have been used in healthcare education for decades with positive results. This paper provides supporting evidence for use of debates in pharmacy education and is designed to serve as a general guide for preceptors interested in implementing debates into the experiential setting. Specifically, the objectives are to: 1) highlight the pedagogical outcomes as reported in the literature, 2) offer practical considerations to implement debates as a teaching tool in experiential education, and 3) encourage future research and scholarship in this area.

Type: Idea Paper


: Twenty-one circadian blood sample profiles were made in heavy brood mares during pregnancy, lactation or the dry, non-pregnant period. The mares were fed forage-rich diets containing different levels of energy and nitrogen (table 1). Each profile consisted of 7 samples taken at 8 a.m., 11 a.m., 3 p.m., 7 p.m., 11 p.m., 4 a.m. and 8 a.m. The animals were fed at 8:30 a.m. The eleven plasma components evaluated were glucose, non-esterified fatty acids, beta-hydroxybutyrate, acetate, alanine, insulin (energy metabolites), urea, total protein (nitrogen metabolites), calcium, inorganic phosphorus and magnesium (mineral metabolites). Profile results are shown in table 2 and figure 1. Glucose, insulin and alanine increased and non-esterified fatty acids, acetate and beta-hydroxybutyrate decreased during the prandial period (between 8 a.m. and 11 a.m.). The glucose and insulin peaks were short, while the other components returned slowly to preprandial values. Acetate and beta-hydroxybutyrate were maximal during the night, while urea increased moderately during the prandial period. Protein concentration did not vary. The effect of feeding on minerals was moderate: there was a slight increase in calcium and magnesium and a decrease in phosphorus. The following differences were related to diet or physiological state (figs. 2, 3, 4): --higher glucose and insulin peaks when concentrate intake was high; --lower circadian variation of non-esterified fatty acids, beta-hydroxybutyrate and acetate in dry, non-pregnant, well-fed mares; --higher acetate levels with a high-forage diet; --more rapid alanine decrease during late pregnancy than in early lactation; --higher circadian variations in minerals during lactation than during pregnancy. The prandial variations of the following factors were significantly correlated (table 3): --glucose and insulin, --acetate and beta-hydroxybutyrate, --beta-hydroxybutyrate and non-esterified fatty acids, --acetate and non-esterified fatty acids. The origin of these variations is discussed. Two factors intervened: 1) exogenous production Very rapid digestion of the concentrate induced an increase in glucose (and thus in insulin) and alanine. The volatile fatty acids produced in the hindgut caused nocturnal peaks of acetate and beta-hydroxybutyrate; 2) a lipogenic phase (which began after mean meal intake) alternating with a lipolytic phase, providing constant coverage of the energy needs. This explains the large post-prandial decreases in non-esterified fatty acids, acetate and beta-hydroxybutyrate.


Up to now the long range filaments have been considered as a balance between Kerr focusing and defocusing by plasma generation in the nonlinear focus. However, it is difficult to apply the above explanation of filamentation in far-field zone. There are basically two main characteristics which remain the same at these distances - the super broad spectrum and the width of the core, while the power in a stable filament drops to the critical value for self-focusing. At such power the plasma and higher-order Kerr terms are too small to prevent self-focusing. We suggest here a new mechanism for stable soliton pulse propagation in far-away zone, where the power of the laser pulse is slightly above the critical one, and the pulse comprises super-broad spectra. For such pulses the diffraction is not paraxial and an initially symmetric Gaussian pulse takes parabolic form at several diffraction lengths . The stable soliton propagation appears as a balance between the divergent parabolic type diffraction of broadband optical pulses and the convergent nonlinear refractive index due to the intensity profile. We investigate more precisely the nonlinear third order polarization, using into account the carrier-to envelope phase. This additional phase transforms the third harmonic term to THz or GHz one, depending on the spectral width of the pulse.


Abstract 275

RUNX1/AML1 gene has been investigated in the pathogenesis of hematopoietic diseases and point mutations of RUNX1 have been frequently detected in patients with MDS or AML. We have found RUNX1 mutations in patients with MDS and MDS-related AML, including therapy-related cases. The mutations were distributed throughout the full length of the RUNX1 protein, and replacement of D171 amino acid in runt homology domain was the most frequent target of mutations in the RUNX1 gene. The D171N mutant showed a loss of normal RUNX1 trans -activation potential and dominant-negative trans -activation suppression, suggesting that this mutant may have some oncogenic potential in addition to the loss of function. In mouse transplantation systems D171N-transduced mice exhibited hyper-proliferative AML with multilineage dysplasia in collaboration with Evi1 overexpression. This impressive result indicated that RUNX1 mutations may be a cause of MDS with a leukemogenic potential. However in human, most of D171-mutated patients were MDS refractory anemia with excess blasts, and EVI1 overexpression was observed in a patient with MDS rapidly progressed to AML. Instead, most of patients with RUNX1 mutations displayed a high expression level of BMI1 , suggesting that mouse phenotypes were not always meets clinical features of the patients with the mutations, partly because gene circumstances in mouse are different from those in human. Thus, biological analysis using human hematopoietic stem cells was considered to be necessary to clarify the molecular mechanisms of the RUNX1 mutations in the pathogenesis of MDS/AML.

To examine the effect of RUNX1 mutants, we transduced the D171N mutant into human CD34+ cells from cord blood cells. In colony forming cell (CFC) assay, the number of burst forming unit-erythroid colonies was significantly decreased, while the number of granulocyte-macrophage colony-forming unit colonies was increased. Most of the D171N-transduced cells expressed myeloid lineage markers. The D171N cells showed replating capacity for 3 replatings, suggesting that they have self-renewal advantage. The presence of progenitors with long-term self-renewal capabilities was confirmed by long-term culture-initiating cell assay. The D171N cells showed a drastic increase in the number of colonies. However, long-term culture in complete cytokine liquid medium showed that the D171N cells grew a little, exhibiting lower proliferation ability than control. The percentage of CD34+ cells increased slightly, but gradually decreased with a maximum around day 35. At this point, although the percentage of CD34+/CD38+ cells did not increase in comparison to control cells, the percentage of CD34+/CD38− cells increased to 4 %. On day 35, a vast majority of the control cells terminally differentiated into mature myeloid cells and monocytes, whereas the D171N cells contained a large number of immature cells and displayed morphological abnormalities in all 3 hematopoietic lineages. Cell cycle analysis revealed that most of the D171N cells accumulated in G1 phase on day 53 when the cells stopped proliferating. These results indicated that the D171N cells had no proliferation ability although the mutant probably gives rise to the multi-lineage dysplasia of hematopoietic cells with increase in the number of blasts that is the main characteristic of MDS.

Because the D171N cells showed low expression level of BMI1 , we next performed stepwise transduction of BMI1 following D171N. In CFC assay, stepwise vector-transduced D171N cells seemed to no longer have colony forming ability, whereas stepwise BMI1-transduced D171N cells displayed an increase in both colony forming ability and replating capacity. Moreover, CD34+ cell population remained in the stepwise BMI1-transduced D171N cells. Furthermore, the cells showed long-term proliferation with a retained CD34+ cell fraction. Morphological findings showed myeloid cell dysplasia with increased blast-like cells.

Taken together, the results of the D171N forced expression demonstrate that the mutation requires collaborating genes for proliferation. EVI1 and BMI1 may add distinct proliferating forces to the D171N cells, reflected in clinical features of MDS patients with their overexpression. Our results support the concept that RUNX1 mutations may become one of the genetic classification categories of myeloid neoplasms.

Disclosures: No relevant conflicts of interest to declare.


Bird-aircraft collisions (hereafter, bird strikes) pose substantial hazards to aviation safety. The most common method employed to objectively quantify bird hazards on airport property is a point-count survey. However, we questioned the adequacy of point counts in prioritizing bird-strike hazards. Our objectives were to 1) quantify relative risk associated with potential bird strikes at Seattle-Tacoma International Airport (SEA) based on data from point counts and a supplemental survey of species time spent within runway protection zones (RPZs) for active runways; and 2) contrast risk based on each survey method against airport-specific bird-strike statistics obtained from the U.S. Federal Aviation Administration (FAA). We defined risk as the product of an index of frequency of use and a damage metric associated with a bird strike. We referenced observational data collected by USDA Wildlife Services biologists (over 50 weeks between 10 June 2003 and 11 June 2004) and assigned 51 species observations to 14 groups based on American Ornithologist's Union classification and bird-strike data obtained from the FAA. Ranks for risk within survey method were similar between surveys for 9 of 14 groups. Waterfowl (excluding Canada geese, Branta canadensis, but including double-crested cormorants, Phalacrocorax auritus), Corvidae, gulls (Laridae), and Canada geese ranked among the top 5 groups for risk in both surveys. Notably, raptors ranked 4th in risk based on the RPZ survey, but 9th based on point-count survey. Strike statistics for SEA indicate that gulls and some passerine species tied for the most strikes/year (1990-2005), followed by ties among raptors, shorebirds (Laridae), and swallows/swifts (Hirundinidae/ Apodidae). Data from the RPZ survey indicate that raptors posed a greater bird-strike risk at SEA than indicated by point-count data. This risk associated with a potential raptor strike was corroborated by strike statistics at SEA.


A mathematical environmental transport model of roadside applied herbicides at the site scale (approximately 100 m) was stochastically applied using a Monte-Carlo technique to simulate the concentrations of 33 herbicides in stormwater runoff. Field surveys, laboratory sorption data, and literature data were used to generate probability distribution functions for model input parameters to allow extrapolation of the model to the regional scale. Predicted concentrations were compared to EPA acute toxicity end points for aquatic organisms to determine the frequency of potentiallytoxic outcomes. Results are presented for three geographical regions in California and two highway geometries. For a given herbicide, frequencies of potential toxicity (FPTs) varied by as much as 36% between region and highway type. Of 33 herbicides modeled, 16 exhibit average FPTs greater than 50% at the maximum herbicide application rate, while 20 exhibit average FPTs less than 50% at the minimum herbicide application rate. Based on these FPTs and current usage statistics, selected herbicides were determined to be more environmentally acceptable than others in terms of acute toxicity and other documented environmental effects. This analysis creates a decision support system that can be used to evaluate the relative water quality impacts of varied herbicide application practices.


For the analysis of enzyme kinetics, a variety of programs exists. These programs apply either algebraic or dynamic parameter estimation, requiring different approaches for data fitting. The choice of approach and computer program is usually subjective, and it is generally assumed that this choice has no influence on the obtained parameter estimates. However, this assumption has not yet been verified comprehensively. Therefore, in this study, five computer programs for progress curve analysis were compared with respect to accuracy and minimum data amount required to obtain accurate parameter estimates. While two of these five computer programs (MS‐Excel, Origin) use algebraic parameter estimation, three computer programs (Encora, ModelMaker, gPROMS) are able to perform dynamic parameter estimation. For this comparison, the industrially important enzyme penicillin amidase (EC 184.108.40.206) was studied, and both experimental and in silico data were used. It was shown that significant differences in the estimated parameter values arise by using different computer programs, especially if the number of data points is low. Therefore, deviations between parameter values reported in the literature could simply be caused by the use of different computer programs.


OBJECTIVE
To check the validation of the precision in measuring arterial pressure (AP) of an automatic non-invasive machine for out-patient monitoring of arterial pressure, the ACP-2200, comparing the sequential with the simultaneous method in line with the criteria of the Association for the Advancement of Medical Instrumentation.

DESIGN
A comparative crossover study.

SETTING
Primary Care. "La Orden" Health Centre, Huelva.

PATIENTS
86 individuals, 42 men and 44 women of all ages, both hypertense and not, and without any antihypertension treatment, with SAP intervals between 99 and 160 mmHg and DAP between 59 and 105 mmHg, selected at random from the on-demand consultations.

MEASUREMENTS AND MAIN RESULTS
Three AP readings were made with a manual apparatus for reference (a mercury sphygmomanometer) and three simultaneously with the ACP-2200 and the manual apparatus placed in a T on the cuff. The AP means obtained were compared and the mean calculated. The standard deviations of the paired differences between the APs obtained with the ACP-2200 and with the manual method, both in the sequential and simultaneous form, as well as Pearson's lineal correlation coefficient, were all calculated. The means of the paired differences and the standard deviations between the automatic and manual apparatuses were, for the SAP, 1.52 +/- 4 (r = 0.96) and 0.66 +/- 3.38 (r = 0.97) (sequential and simultaneous, respectively) and, for the DAP, 0.86 +/- 2.84 (r = 0.98) and 0.64 +/- 1.73 (r = 0.99) (sequential and simultaneous, respectively). All the values of p were inferior to 0.001.

CONCLUSIONS
The ACP-2200 complies with the validation criteria for the two methods used, with the simultaneous method being recommended for use.


The steps involved in marketing and program development include: analyzing competition, identifying and measuring consumer needs, undertaking feasibility studies, determining patient potential, identifying specific market segments, designing services, location, etc., determining services most likely to succeed, deciding on price, and implementing and adjusting programs. The ultimate goal of a good laboratory marketing program is to make a precise determination of what the consumer's needs are and devise strategies to provide them with their needs. For those laboratories wise enough to implement a marketing program, marketing offers a fresh perspective for securing the clinical laboratory's future.


The course of federal employment discrimination litigation is replete with instances of lower federal courts attempting to define and apply broad rules that, usually though not always, have the effect of defeating plaintiffs' claims of discrimination. The same-actor inference, first applied by the Fourth Circuit Court of Appeals 1991, aptly exemplifies this trend. The essence of the same-actor inference is that an individual who harbors discriminatory animus toward a protected class of persons would not knowingly hire a member of that class and then fire that same individual on account of his or her protected status. Since 1991, a circuit split has emerged on the question of who should evaluate the import of same-actor facts in a given case. Several circuits have followed the Fourth Circuit and employ the inference to justify summary judgment, directed verdicts, and judgments notwithstanding the verdict, all in favor of defendant-employers. Other circuits, in contrast, expressly reserve to the jury the decision of how to weigh same-actor facts. The Supreme Court has yet to resolve this split. This Note argues that the history of employment discrimination litigation, the Civil Rights Act of 1991, and public policy considerations require that it be juries, not courts, who determine the import of same-actor facts in a given employment discrimination case.


Train control system requires the high level of safety since these are vital control system to ensure safe operation of the train. According to these reason, safety-related regulations for railway signaling systems are standardized in IEC. In Korea, many attempts are tried to procure the level to meet the international standards, but the efforts are beginning steps. HAZOP study is recommended for hazard analysis at IEC standards, but this method has several unsuitable problems because this method is developed in chemical plant domain. In this paper we recommend mew method of HAZOP, named HAZOP-KR, which would be suitable for analyzing safety of the train control systems. AN example of this method applied to real system is also included.


CASE
Brian is a 6-year-old boy who was diagnosed with autism spectrum disorder (ASD) and global developmental delay at age 2. He has no other health conditions of note. Brian lives with his parents and an older brother, who also has ASD, in a rural area 2 hours from the center where he was diagnosed. Brian has a history of intermittent self-injurious behaviors (head-banging, throwing himself onto the floor, etc.) that regularly result in bruising, intense and lengthy tantrums, and aggression toward family and teachers. Brian will occasionally indicate items that he wants, but otherwise has no functional communication skills. Over the past 18 months, Brian's challenging behaviors have waxed and waned. The regional special education program is not equipped to safely manage his behaviors, and there are no in-home or center-based agencies that provide applied behavior analysis (ABA) available. Brian's developmental pediatrician initiated guanfacine (eventually adding a small dose of aripiprazole) and referred the family to psychology for weekly telehealth behavioral parent training to address behavioral concerns using the Research Units in Behavioral Intervention curriculum.Brian's behavioral problems decreased during the initial weeks of the COVID-19 crisis, when he no longer had to leave home or attend special education. However, as summer continued, his behaviors worsened substantially (regular bruising and tissue damage, numerous after-hours consultations with his psychologist and developmental pediatrician, and one trip to the emergency department). The intensity of Brian's behaviors (maintained primarily by access to tangible items and escape from demands) made progress with behavioral supports slow and discouraging for his parents. Other psychosocial stressors coalesced for the family as well, including employment loss, limited social support because of social distancing requirements, and illness of one of his parents. The developmental pediatrician continued to modify the medication regimen over the summer, transitioning Brian from guanfacine to clonidine and increasing his aripiprazole incrementally (with clear increased benefit); hydroxyzine was also used as needed during the episodes of highest intensity.Despite the availability of best-practice guidelines for children with Brian's presenting concerns, a confluence of barriers (geographic, economic, ABA work force, global pandemic, etc.) present serious questions for his family and care team related to the next steps in Brian's care. Should he attend in-person school in the fall, knowing that the available program may have limited educational benefit and increase his risk of COVID-19 exposure (not to mention self-injury)? Would the potential benefits of cross-country travel to an intensive behavioral treatment program outweigh the associated psychosocial and economic stressors? How else can the virtual care team support this family?


Abstract This study forms the second part of a larger investigation into the offence process characteristics of female sexual offenders (FSOs). In the first part – documented in Gannon, Rose, and Ward (Sexual Abuse: A Journal of Research and Treatment, 20, 352–374, 2008) – we described the development of the Descriptive Model of Female Sexual Offending (DMFSO); an offence process model developed using Grounded Theory methodology to describe the sequence of cognitive, affective, behavioural and contextual factors generating female-perpetrated sexual abuse. The second study described here examines the prevalence of specific pathways characterizing the 22 FSOs originally used to develop the DMFSO. Four individuals could not be assigned to a pathway due to lack of information (18% of the overall sample). However, for the remaining 18 participants, three stable pathways to female sexual offending were identified: Explicit Approach offenders (50%, n=9), who intended to offend, and explicitly planned their offence behaviours accordingly; Directed Avoidant offenders (28%, n=5), who did not intend to offend, but did so under the direction and coercion of a male accomplice; and Implicit Disorganized offenders (22%, n=4), who did not intend to offend (i.e. they engaged in minimal planning), but offended impulsively following severe self-regulatory failure. In this paper, we present the core characteristics defining each pathway, their associated demographic features, and discuss potential treatment implications.


In this paper, the thermal field of underground power cable is solved using two intelligent techniques which are newly introduced for thermal assessment of power cables. A backpropagation neural network (BPNN) and an adaptive neuro-fuzzy inference system (ANFIS) models were developed to predict the cable temperature under geometrical parameter variations. The effect of cable spacing and cable burial depth on cable ampacity is investigated. The two models are trained using an input-output pattern generated using finite element (FE) method, which is extensively used in this field. Furthermore, a portion of the FEgenerated output results, which have not been provided to the models – as input data - in the training phase, were utilized to compare the cable temperature of the three methods (FE, ANN and ANFIS). The results of the two intelligent methods show high agreement with the finite element solution, which confirms that introducing intelligent techniques provides a reliable and simple alternative approach for the thermal field evaluation by avoiding the numerous computational complexities of the numerical methods


Extracellular vesicles (EVs) are lipid-enclosed submicron-sized vesicles that are secreted by all eukaryotic cells. EVs can selectively encapsulate tissue-specific small molecules from parent cells and efficiently deliver them to recipient cells. As signal mediators of intercellular communication, the molecules packaged in EVs play critical roles in the pathophysiology of diseases. In relevant clinical translation, EV contents have been used for cancer diagnosis and treatment monitoring. To further promote EV-based cancer liquid biopsy toward large-scale clinical implementation, the efficient and specific isolation of pure tumor-derived EVs from body fluids is a prerequisite. However, the existing EV isolation methods are unable to address certain technical challenges, such as lengthy procedures, low throughput, low specificity, heavy protein contamination, etc., and thus, new approaches for EV isolation are required. Here, we report a multivalent, long single-stranded aptamer with repeated units for EV enrichment and retrieval. After short incubation of biotin-labeled multivalent aptamers (MAs) with the samples, EVs can be quickly secured by MAs, anchored onto streptavidin-coated microspheres, and further retrieved via digestion of the DNA aptamer. Approximately 45% of EVs can be isolated from the spiked samples in 40 min with a depletion of 84.7% of albumin contamination. In addition, 93.1% of the isolated EVs can be retrieved via DNase-mediated aptamer degradation in 10 min for downstream molecular analyses. Our findings suggest that MAs can efficiently and specifically isolate EVs derived from malignant lymphocytes, and this simple method could facilitate the EV-centered study of acute lymphoblastic leukemia.


The rise in world oil prices, coupled with heightened interest in the abatement of greenhouse gas emissions, led to a sharp increase in biofuels production around the world. Previous authors have devoted considerable attention to the impacts of these policies on a country-by-country basis. However, there are also strong interactions among these programs, as they compete in world markets for feedstocks and ultimately for a limited supply of global land. In this paper, we offer the first global assessment of biofuel programs Ð focusing particularly on the EU and US. We begin with an historical analysis of the period 2001-2006, which also permits us to validate the model. We then conduct an ex ante analysis of mandates in the year 2015. We find that if these mandates are indeed fulfilled the impact on global land use could be substantial, with potentially significant implications for greenhouse gas emissions.


The Gravity Recovery and Climate Experiment (GRACE) satellites provide observations of water storage variation at regional scales. However, when focusing on a region of interest, limited spatial resolution and noise contamination can cause estimation bias and spatial leakage, problems that are exacerbated as the region of interest approaches the GRACE resolution limit of a few hundred km. Reliable estimates of water storage variations in small basins require compromises between competing needs for noise suppression and spatial resolution. The objective of this study was to quantitatively investigate processing methods and their impacts on bias, leakage, GRACE noise reduction, and estimated total error, allowing solution of the trade‐offs. Among the methods tested is a recently developed concentration algorithm called spatiospectral localization, which optimizes the basin shape description, taking into account limited spatial resolution. This method is particularly suited to retrieval of basin‐scale water storage variations and is effective for small basins. To increase confidence in derived methods, water storage variations were calculated for both CSR (Center for Space Research) and GRGS (Groupe de Recherche de Géodésie Spatiale) GRACE products, which employ different processing strategies. The processing techniques were tested on the intensively monitored High Plains Aquifer (450,000 km2 area), where application of the appropriate optimal processing method allowed retrieval of water storage variations over a portion of the aquifer as small as ∼200,000 km2.


A discrete time domain model for the LCC-type parallel resonant converter has been derived. This model has been used to predict the large signal behavior of the converter. The peak component stresses and the dynamic response of the key state variables, as obtained from the large signal analysis, using PRO-MATLAB software are plotted. SPICE results are included to verify the analytical results. Experimental results are also presented to verify the theory.<<ETX>>


The New England "short o" has been discussed in the literature on American dialects a number of times (see Avis 1961; Kurath -- McDavid 1961: 12). Kurath (1964: 150) introduces this phenomenon as follows. He discusses the loss in American English of the original Middle English distinction between monophthongal Q: and diphthongal ou, and writes: Only New England [in the USA] preserves the original [ME] distinction, though to a limited extent. Here the old monophthong survives in checked position as a short and fronted mid-back vowel /e/ as in stone, road, coat /sten, red, ket/, contrasting with up-gliding /o/, as in know, grown (but also, e.g., in no, rode). This so-called "New England short o" is somehow related to regional English folk speech. Avis (1961) further tells us that the heartland of this phenomenon in North America lies, for the USA, in eastern Vermont, New Hampshire, northeastern Massachusetts, and Maine, and in Canada in southwestern New Brunswick. Kurath (1965 [1971]) asks the interesting question: "Is the survival of contrasting vowels in New England to be attributed to English folk speech?" and answers it as follows: "New England usage in this matter probably derives from English folk speech or from a regional type of Standard British English reflecting folk usage." In a much earlier publication (1928 [1971]) he actually appears to give a more geographically detailed answer to the question when he says: "The population of the seaboard of New England had come for the most part from southeastern counties of England"; and "the shortened vowel of coat, whole, and home is recorded for East Anglia." It is definitely tempting to see a connection. This was certainly also the link I was suggesting myself when I wrote (1974) that there was a "clear resemblance" between the two phenomena in East Anglia and New England. Further linguistic evidence in favour of Kurath's linkage to northern East Anglia is as follows. In the case of both East Anglia and New England, the phenomenon of shortening is confined to items descended from Middle English Q:; it never occurs in either area in words such as grown, soul. Both features, moreover, are recessive, and both vary widely in their incidence from word to word, style to style, and speaker to speaker. The East Anglian facts are as follows. The vowel of English labelled by Wells (1982) as the GOAT vowel has, as in New England, maintained two counterparts in the vowel system of the dialects of northern East Anglia, that is Norfolk and northern Suffolk. Paralleling a now vestigial distinction in the front vowel system between the sets of made and maid, corresponding to the distinction between the Middle English monophthong and diphthong, there is in northern East Anglia a similar contrast in the back vowel system which, however, is by no means vestigial (see Trudgill 1998 on why the one distinction has survived longer than the other). The distinction is between /u:/ = [uu], descended from ME Q:, and foul = [eu], descended from ME ou. Thus pairs such as moan-mown, road-rowed, nose-knows, sole-soul are not homophonous. The important thing to notice for our purposes is that the FOOT vowel /u/ was much more frequent in the older East Anglian dialect than in General English (in the sense of Wells 1982). There has been a strong tendency in East Anglia for the /u:/ descended from ME Q: to be shortened to /u/ in closed syllables. Thus road can rhyme with good, and we find pronunciations such as toad, home, stone, whole, coat /tud, hum, stun, kut/. Distribution is unpredictable: /u/ does not occur, at least in current dialects, in foam, load, moan, coal, vote, for example. The extent of this East Anglian "short o" phenomenon is indicated in the work of a number of writers. Kokeritz (1932), for example, writing about the dialects of northern Suffolk, lists the following items as having the same vowel as pull: boast, boat, bone, choke, cloak, clover, coach, coast, coat, don't, folk, goat, hole, home, hope, load, loaf moat, most, oak, oath, oats, over, poach, pole, post, road, rope, smoke, stone, toad, whole, wholly Lowman's records (see Trudgill 1974) also show a large number of examples of the "short o", although (possibly incorrect) transcriptions such as [ston] stone make it unclear as to whether he regards such words as having a vowel identical to that of foot. …