There is an insufficient number of specialty developmental-behavioral pediatrics (DBP) physicians, despite nearly 25% of children and adolescents having a developmental, learning, behavioral, or emotional problem. In the nearly 20 years since becoming a board-certified subspecialty, the definition of DBP clinical practice remains somewhat unclear. This lack of clarity likely contributes to recruitment challenges and workforce issues, and limited visibility of DBP among parents, other professionals, payors, and administrators. Defining DBP is therefore an important step in the survival and growth of the field. In this paper, we describe the methodology used to develop this definition along with the origins of DBP, the persistent challenges to defining its scope, what training in DBP involves, and what distinguishes DBP from other overlapping fields of medicine. We propose the following definition of DBP: developmental-behavioral pediatrics (DBP) is a board-certified, medical subspecialty that cares for children with complex and severe DBP problems by recognizing the multifaceted influences on the development and behavior of children and addressing them through systems-based practice and a neurodevelopmental, strength-based approach that optimizes functioning. Developmental behavioral pediatricians care for children from birth through young adulthood along a continuum including those suspected of, at risk for, or known to have developmental and behavioral disorders.


ABSTRACT The social sciences speak of violence through its meaning, performances, manifestations and representations; however, the inner workings of violence are less explored. In order to suggest a different mode of seeing violence, I explore the inner workings of violence through the pleasures of and fun among Shi'i volunteer combatants. I apply Walter Benjamin's motion of pure means to explain how violence becomes self-referential and non-representational via combat-zone ethnography amongst Iraqi Shi'i militants who fought against ISIS in Iraq. I address the fine line between pleasure and fun in order to highlight the inner workings of violence during combat and to encourage a fresh bottom-up anthropological perspective in assessing the parameters of the persistence and resilience of volunteer combatants. My approach advocates moving beyond recruitment and ideological interpolation by questioning the allure of combat through an ontological framework that includes combatants' perspectives and narratives.


In this paper, I argue that the emerging research strategy of political ecology needs to incorporate an active nature into its analysis of the commodification of natural resources and the politics of resource control. I make reference to earlier work among small rancher-farmers in Cucurpe, Sonora, where the nature of the crucial resources themselves--arable land, grazing land, and irrigation water--determined local agrarian politics as much or more as transnational market demand and Mexican federal agrarian policies. Then I examine water control in Arizona during the past century. I contend that one of the best ways to pursue political ecology is to focus upon the historical dialectic that determines how and why certain natural resources are converted into commodities at particular places and times and how commodity production transforms, and is transformed by, local ecosystems and local societies. Finally, I concur with anthropologist Thomas McGuire that this analysis must be resolutely empirical rather than based upon a priori models or assumptions.


Since approximately 1966, the majority of North American parishes and schools have engaged in an experiment to make "more relevant" the music used at Masses and other liturgical gatherings attended by significant numbers of young Catholics (ages below thirty). Despite this almost universal attempt at improving the response of young Catholics to Catholic worship by the use of musical styles variously described as "lite rock" and "sacro-pop," Catholic demographics have stagnated. According to the 2009 Kenedy directory, the growth of the Catholic population in the year 2008 was only 1.5 percent. Pew Research Center's Forum on Religion & Public Life reports (1) that nine percent of the adult United States population, or about twenty-eight million Americans, were raised Catholic but are now Protestant or unaffiliated with any church. Evangelical churches have been using "contemporary" services with their youth for several decades. Recent research by evangelicals (2) shows that over 60 percent of their young people leave their churches after high school. Beyond this historical data, current Catholic church practice in youth ministry appears to be moving even further in the direction of institutionalizing "sacro-pop" and the use of rock bands at youth-oriented Masses. The Life Teen movement, in particular, encourages what they call "vibrant" music in youth-oriented Liturgy. (3) They publish a two-dollar newsprint songbook called Choose Christ (hereafter CC) that contains music they recommend for such worship services and Masses. Most of the music contained therein is published by Oregon Catholic Press (hereafter OCP). Accompaniments, arrangements, and Nashville-quality CDs of the productions are available at significantly higher costs. The purposes of my study, which involved listening to almost all, and examining each, of the songs in the 2009 version of this songbook, are to determine if there are common musical and theological characteristics of the melodies, accompaniment, and lyrics of these songs and what those characteristics may be. Beyond that initial objective, I wished to determine if those common characteristics have any relationship to those traditional Catholic and Protestant styles of music that have sustained churches and ecclesial communities in the past, and whether the differences between the music might help explain the recently observed low retention of the young by both communions. THEOLOGICAL CHARACTERISTICS OF THE CATHOLIC RR STYLE The Life Teen music philosophy (4) emphasizes the resemblance between the music recommended by the movement and the music commonly listened to by teens and young adults: Teens listen to a great deal of music everyday. Although some of it may be objectionable, it is all produced very well and has incredible sound quality. To inculturate the liturgy for teens, a Youth Mass uses musical instruments that teens are used to hearing on a daily basis. The tone is still prayerful as teens respond by participating and actually singing at Mass. Thus, the style of music is identical to the rock-and-roll (hence RR) heard continually by the youth, but the RR is "baptized" by what the composers consider to be Christian or Catholic texts. On the OCP "Spirit and Song" website, RR composers frequently write about the composition process. They also give YouTube interviews on the subject, so we can generalize about how Catholic RR comes into existence. There are two starting points customarily used: 1) the composer "gets" a chord progression, with or without a melody, and then finds a text to set; (5) 2) the composer sees a short text from the liturgy or scripture, creates a rhythmic pattern and chord progression that matches it, and then finishes off the song with melody and additional words. The additional words are usually the composer's own, since the scriptural or liturgical text, if any, does not fit the composed music. …


The choice of social welfare function is the benchmark for the moral success or failure of economic policies. Yet most analysis of government policy making assumes that there is universal agreement regarding the society for whom welfare is to be maximized. This article argues that policy makers need to examine government policies through five dimensions of social choice: horizontal utility, vertical utility, group utility, generational utility, and universal utility. The two key issues that must be examined are who counts and over what time frame. In this article, the authors demonstrate that changing the definition of society over time and space dramatically changes the choice of moral economic policies. From a biblical perspective, Christians are commanded to make choices consistent with loving their neighbor as themselves while treating everyone in the world, both now and in the future, as their neighbor. Brian K. Strow and Claudia W. Strow, "Social Choice in Five Dimensions," Journal of Markets and Morality 17, no.1 (Spring 2014): 65-84. Click here to discuss this article at Journaltalk.


An attempt is made to predict the pitting strength of cast iron and copper alloy materials from their compressive yield or compressive proof strength for a reliability of 99% at 107 load cycles. The compressive yield or compressive proof strength is related to the tensile strength of ductile cast iron and copper alloy materials by a proportionality factor. Two proportionality factors are used for brittle cast iron materials. The pitting strength formulation incorporates a nominal design factor at 99% reliability which is estimated from a probabilistic model based on the lognormal probability density function. Pitting strength estimates from the predictions are compared with those of American Gear Manufacturers Association (AGMA) estimates and data from other sources. The predicted values for gray cast irons had variances in the range of -11.28% to 25%. Ductile cast iron pitting strength estimates deviated from those of AGMA by -30.28% to 1.73% and 16.76% to 36.34% for Austempered ductile irons. The variances obtained for cast bronze were from 11.17% and 14.73%, but the sample size was small. These variances appear to be reasonable due to the many factors that can influence pitting resistance. Since pitting strength data for many grades of cast iron and copper alloys are not available (especially in the public domain), they may be estimated by the expressions developed in this study for initial design sizing. Also, the pitting strength of new cast iron and copper alloy materials could likewise be estimated for initial design sizing. This will eliminate long and costly contact fatigue testing at the initial design phases, which of course is necessary for design validation.


Functional logic languages combine lazy (demand-driven) evaluation strategies from functional programming with non-deterministic computations from logic programming. To provide a strategy-independent semantics, most languages are based on the call-time choice semantics where parameters are passed as values. From an implementation point of view, the call-time choice semantics fits well with sharing performed by lazy languages. On the other hand, there are also situations where it is intended to pass non-deterministic arguments as sets of values in order to exploit the power of non-deterministic programming. This alternative parameter passing model is known under the name "plural" arguments. In this paper, we show how both mechanisms can be integrated in a single language. In particular, we present a novel technique to implement plural arguments in a call-time choice language so that existing implementations of contemporary functional logic languages can be easily re-used to implement plural parameter passing.


Background: Numerous studies have addressed biomechanical characteristics of circular external fixation of long bones. The objective of the present study was to evaluate stabilization of a simulated foot model using external fixation with either calcaneal tensioned stopper wires or half-pins. Methods: Fixation configurations of the calcaneus included two parallel wires, two wires crossing at either 30° or 45°, a 4-mm- and 5-mm-diameter single half-pin, or two half-pins inserted at a cross-angle of either 45° or 90°. All frames were tested in axial compression, anteroposterior (AP) bending, and mediolateral (ML) bending. Results: An increase in wire cross-angle improved the axial and AP bending stabilization but had no influence on ML bending. Utilization of a single calcaneal half-pin instead of two cross-wires resulted in a considerable reduction in ML bending stabilization. Frame configurations with two half-pins substantially improved axial and ML bending stabilization. Due to the medial location of the metatarsal wire stopper, an increase in half-pin cross-angle significantly improved ML bending stiffness under lateral foot loading. Under the medial foot loading, however, the half-pin cross-angle had no effect on ML bending stabilization. Replacement of cross-wires with two half-pins significantly improved the AP bending stiffness only when the half-pin cross-angle was reduced to 45°. In all modes of two half-pin frame loading, the half-pin diameter had a substantial effect on foot stabilization. Conclusions: Although the wire cross-angle, half-pin cross-angle, and half-pin diameter affect the stability of foot circular external fixation, the influence of these mechanical parameters on foot stabilization is dependent on the mode and location of loading. Clinical Relevance: The results of the present mechanical testing can be utilized as a useful guideline for the optimization of circular external fixation of the foot.


Educational inequalities in mortality are large in Central and Eastern Europe. Mortality levels are particularly high among low educated men as well as women in the Czech Republic. However, differences in male mortality by educational attainment exceed those of females. Two mortality patterns are apparent when dividing the Czech classification of education into four categories—basic, vocational, secondary, and university. Males with basic education experience much higher mortality when compared to their higher educated counterparts. An anomaly in the mortality gradient is observed among women when comparing basic and vocational education. Women with basic education show a rather lower mortality level compared to their vocational counterparts. Three scenar- ios show how the shifts toward a higher education could contribute to the change in mortality level using temporary life expectancies between ages 30 and 80 for males and females: (a) population structure by sex, age, and education remains the same as from the census 2011; (b) 60% of males having the basic education move into the next higher category (vocational) and 60% of women with basic and vocational education move into the secondary education; and (3) sex age education‐specific mortality rates will be shifted upwards by one level.


The efficiency of interior orientation parameters (IOPs) and exterior orientation parameters (EOPs) of the Satellite Pour l'Observation de la Terre 5 (SPOT-5) has been investigated with respect to georeferencing accuracy. A couple of SPOT-5 high-resolution geometric panchromatic level-1A stereoimages with 5-m ground sampling distance covering Zonguldak (Turkey) test field were used for this purpose using orientation parameters provided by metadata files. Ground control points are obtained by Global Positioning System observations. For the purpose of establishing geometric relationship between image and ground coordinate systems, an orbit-attitude parametric model has been used considering imaging geometry of sensor and ephemeris data of satellite. Adjustment consisting of the Gauss-Helmert model was performed in pre- and bundle-adjustment steps. Analyses show that the most efficient parameters are IOPs defined by look angles while EOPs are not significant on the accuracy. The validation of the EOPs and the correlation among IOPs and EOPs are also statistically analyzed. Different variations of point distribution and EOP configurations were preferred, achieving the georeferencing accuracies as ~ ±1 m and ~ ± 5 m at control and check points, respectively. All computations are performed via the developed program package called GeoSpot in Matlab platform.


Background Ischemia-reperfusion injury after liver transplantation (LT) impairs graft function and affects prognosis of recipients. Isoglycyrrhizinate magnesium (Iso) is a hepatoprotective drug usually used after liver injury. In this study, we intended to explore whether Iso alone have protective effect after ischemia-reperfusion injury in a rat model of liver transplantation. We also aimed to study whether Iso could enhance the hepatoprotective effect of FK506 (tacrolimus) and underlying mechanism. Methods Rats after LT were treated with different concentration of FK506 with or without, Iso or lower-dose FK506 plus Iso. Alanine transaminase, aspartate transaminase, and albumin level were measured after 48 hours, 72 hours, and 7 days. A cell ischemic/reperfusion model was established to further study the mechanism of hepatoprotective effect of FK506 and Iso. Results Iso treatment alone had no effect on liver grafts after LT, but lower-dose FK506 + Iso was better for maintenance of liver function than lower-dose FK506 alone at 48 hours, 72 hours, and 7 days after LT. In terms of mechanism, FK506 induced autophagy which resulted in significantly reduced apoptosis and maintained proliferative potential. However, autophagy induced by FK506 also lead to high-mobility group box (HMGB) 1 release from nuclei, resulting in hepatocyte injury through triggering of p38 phosphorylation and chemokine release. Iso effectively inhibited the release of HMGB1 and downstream inflammatory cytokines. Conclusions Iso could inhibit release of HMGB1 by FK506 and enhance the hepatoprotective effect of FK506 in rat LT. Combining Iso with FK506 would be promising for the patients after LT.


Emerging research concerns about the authenticated cloud service with high performance of security and assuring trust for distributed clients in a smart city. Cloud services are deployed by the third-party or web-based service providers. Thus, security and trust would be considered for every layer of cloud architecture. The principle objective of cloud service providers is to deliver better services with assurance of trust about clients' information. Cloud's users recurrently face different security challenges about the use of sharable resources. It is really difficult for Cloud Service Provider for adapting varieties of security policies to sustain their enterprises' goodwill. To make an optimistic decision that would be better suitable to provide a trusted cloud service for users' in smart city. Statistical method known as Multivariate Normal Distribution is used to select different attributes of different security entities for developing the proposed model. Finally, fuzzy multi objective decision making and Bio-Inspired Bat algorithm are applied to achieve the objective.


A set of equations governing oxygen diffusion and consumption in soils has been developed to include microbial and plant-root sinks. The dependent variable is the transformed oxygen concentration, which is the difference between the gaseous concentration and a scaled value of the aqueous oxygen concentration at the root-soil interface. The results show how, as the air-filled porosity decreases, the reduced oxygen flux causes the depth of extinction to decrease. The results also show how the depth of extinction at a particular value of soil water content decreases with increasing temperature, due to increased microbial respiration. The critical value of water content at which the oxygen concentration goes to extinction at a finite depth was compared with alternative calculations with only a microbial sink. By ignoring the feedback of oxygen concentration on root uptake, the alternative calculations yielded substantially higher critical values of water content at all temperatures. Two soil oxygen diffusion coefficient functions from the literature were compared and shown to give significantly different critical values of water content for fine-textured soils, one more realistic than the other. A single relationship between the extinction depth and the ratio of the water content to the critical value was shown to apply for all temperatures and soil textures. The oxygen profiles were used along with a function relating redox potential to oxygen concentration to generate redox potential profiles. This application of the model could be useful in explaining soil biochemical processes in soils. For one such process, denitrification, the depth at which a critical oxygen concentration is reached was calculated as a function of the air-filled porosity and temperature of the soil. The implications of the critical value of soil water content in terms of water-filled pore space and matric potential are discussed in relation to the diffusion coefficient functions and recent literature. Journal compilation


The article is devoted to special features of X-ray examining of patients suffering from acute abdomen pain and X-ray paradigma of some intestine diseases as a cause of partial bowel obstruction. Own clinical data are presented. Long-term experience of our X-ray department is summarized. The possibilities of X-ray examining of abdomen with and without contrast in patients with partial bowel obstruction are described.


BACKGROUND
ACTION, a 24-week, prospective, randomized, parallel-group, double-blind study in patients with severe Alzheimer's disease (AD), demonstrated significant efficacy of 13.3 mg/24 h versus 4.6 mg/24 h rivastigmine patch on the Severe Impairment Battery (SIB) and Alzheimer's Disease Cooperative Study-Activities of Daily Living scale-Severe Impairment Version (ADCS-ADL-SIV). Overall, 61% of the study population received at least 1 dose of concomitant memantine, regardless of dose or duration. This retrospective analysis investigated the effects of concomitant memantine on the efficacy, safety and tolerability of 13.3 mg/24 h versus 4.6 mg/24 h rivastigmine patch.

METHODS
Patients were stratified according to whether or not they received at least one dose of concomitant memantine during the double-blind phase. Changes from baseline on the SIB and ADCS-ADL-SIV were compared using analysis of covariance (ANCOVA) with treatment, pooled center, memantine usage and treatment-by-memantine as factors, and baseline as a covariate. Safety and tolerability were assessed.

RESULTS
Memantine-treated patients were younger than those not receiving memantine (mean 75.9 and 78.8 years, respectively), with a lower screening Mini-Mental State Examination (8.6 and 9.2, respectively). ANCOVA confirmed there was no significant interaction (p>0.1) between study treatment and memantine use on the SIB or ADCS-ADL-SIV. The incidence of adverse events was: 71.4%, 13.3 mg/24 h patch with memantine; 79.7%, 13.3 mg/24 h patch alone; 74.7%, 4.6 mg/24 h patch with memantine; and 71.1%, 4.6 mg/24 h patch alone.

CONCLUSION
These data suggest benefit of 13.3 mg/24 h versus 4.6 mg/24 h rivastigmine patch, regardless of concomitant memantine use. The incidence of adverse events with highdose patch was similar in memantine-treated patients and those not receiving memantine.


1. IntroductionThe research into the history of polar exploration is mainly focused on the evolution of science and its institutionalisation. Social conditions of the members of German polar expeditions have not been the subject of scholarly research. In the official records of the expeditions one can rarely find references to social factors. Such comments were often deliberately avoided.My PhD-Project is based on sources such as unpublished logbooks, diaries and letters. The dissertation also considers the question of how social conditions contributed to the success or failure of an expedition - or if they were not that crucial at all. References to foreign expeditions shall supply additional material for comparative studies.Three expeditions are chosen in this paper:A. The Antarctic expedition 1901/03, led by Erich von DrygalskiB. The Antarctic expedition 1911/12, led by Wilhelm FilchnerC. The Arctic expedition 1930/31, led by Alfred WegenerThe time of the two first expeditions presented here is the period of the German Kaiserreich. In the following text, some aspects of these two expeditions are directly compared. The third expedition is in the period of the Weimarer Republik, with significant different boundary conditions, is treated separately.4. SummaryIn this presentation only a few factors and events can be discussed. The three expeditions were very different in their characteristics. The scientific outcome of all three expeditions was very satisfactory.The particular burden was caused by the extreme climate and hostile surrounding.Concerns about the social life, hierarchy and authority were an important issue, much more important than today. On the one hand, Filchner was an army officer. He tried to solve the problems in a military manner. Using guidelines of the army and neglecting the personal problems of his crew often conflicts were intensified instead of solved. On the other hand, Drygalski encouraged the collaboration between officers, scientists and the crew. He formed teams for specials tasks with people who complemented each other in a natural way. Wegener was respected not only for his convincing scientific competence but also for his close relationship to his crewmembers. His death was a big loss.In my PhD thesis I investigate German expeditions up to 1939. Afterwards methods and the character of polar research changed significantly. In the 1950 financing was easier because of high military and political interests, also the logistics and equipment were very much improved


Social media Instagram become a platform that give chance for business actors, because Instagram is the most popular social media used in Indonesia. One of fashion industries in Indonesia, Rubylicious, take this opportunity to market the products through social media Instagram. Rubylicious embrace one of influencers in Instagram; Ayudia Bing Slamet as its endorser for Rubylicious brand. This research was conducted to analyze the indicators of celebrity endorsement (credibility, attractiveness, familiarity, & match-up congruence), attitude towards brand, brand image, to purchase intention. The research methodology used for this study is a case study with survey research method. Convenience sampling technique derived from non-probability sampling techniques are used for sample selection. The sample of this research is 175, from people who know the existance of Rubylicious and Ayudia Bing Slamet. Statistical software SPSS and AMOS is used to analyze the data. The research has implications for Rubylicious and other marketers; they can consider some factors needed of celebrity to endorsement strategy. The limitation of this research is some of answers less contributed to explain respondents' perception clearly.


This paper explores the situated nature of the epistemological values of a social science discipline as it finds expression in a particular department. Although it explores Becher and Trowler's anthropological conception of disciplinary 'territories' and 'tribes' ([1989]/2001) it finds deeper resonances in Trowler's more recent notion of 'teaching and learning regimes' (2009). It begins to identify some of the regimes that characterise one Political Science department but discovers that these are unstable and diverse, suggesting that, in practice, there are very few unifying 'tribal' values or uncontested 'territorial' practices at work in this context. The study offers these observations on the basis of an ethnographic account of one intellectual community doing the work of inducting first-year students into a new discipline. It has a particular focus on lecturers' perceptions of the resources and capabilities of beginning students, describing some of the lecturers' frustrations with early students' literacy practices. These are metaphorically represented by the idea of 'taxi rank analysis', that is, many new students' tendency to emotive opinions based in experiential, local knowledge rather than the more guarded, grounded analyses of academic Political Science. Finally, the study considers some of the implications these descriptions could have for more responsive teaching and learning regimes in the social sciences. Some examples are offered in the departmental narratives recorded in this study. Keywords: Academic literacies; epistemology; disciplinary tribes and territories; teaching and learning regimes; teaching the social sciences


Abstract This study examines the accounting information uncertainty effects on corporate credit risk from the perspective of real earnings management (RM) activities by investigating 9565 American bond observations from year 2001 to 2008. The main results show that the volatilities of RM activities significantly and positively affect corporate bond yield spreads when well-known bond spread determinant variables are controlled. In addition, the results are robust to alternative model specifications, including the suspect firm analyses, another less ambiguous measure of abnormal cash flows from operations, and abnormal production cost analyses in manufacturing industry or with control of the input price variation. This research also finds that the positive effects of RM volatilities become weaker if a firm has a lower credit rating. Finally, our results remain hold with considering endogeneity issues and analyst characteristic variables and for another estimation period of RM volatilities.


The thermodynamic and kinetic properties of Fe-Cu alloys are studied by ab initio calculations, in the framework of a multiscale modeling of precipitation kinetics. The configuration energies at various compositions, the solute migration and binding energies, as well as the vacancy formation and binding energies are computed. The effects of the local copper distribution on the migration barriers are considered. We show that a simple diffusion model with effective interactions on a rigid lattice, which includes a description of the saddle-point configurations, captures the main features of the energetic landscapes explored by the vacancy during its diffusion in dilute and concentrated configurations.


For more than thirty-five years and through five editions, Mountaineering: The Freedom of the Hills has been the "bible" of the climbing world. An essential teaching tool and resource for novice to advanced mountaineers, it is the standard text for climbing courses throughout the United States and abroad. Freedom is the best-selling mountaineering book of all time, with over 500,000 copies sold. Completely updated and revised, the 6th edition reflects the rapid changes in mountaineering that have accompanied its increased popularity, the development of new techniques, and the introduction of new and improved equipment. It redefines the basics with the latest information on climbing and outdoor fundamentals; rock, snow, ice, and alpine climbing; emergency prevention and response; and the mountain environment. Included in the 6th edition are expanded treatments of belaying, leading and protecting on rock, glacier travel and crevasse rescue, and wilderness travel.


Abstract Throughout the United States, urban food systems are in suboptimal states that are not operating efficiently or equitably and thus do not support food security for all. Creating transformation to a more sustainable and desirable state first requires acknowledging the different values of diverse groups within a city. Then these diverse values can be used to explore pluralistic pathways to futures that maximize benefits for multiple stakeholders. We demonstrate how integrating visioning and Q-methodology can achieve an inclusive understanding of values as priorities for such a food system. Applied in Flint, Michigan, a post-industrial Rust Belt city, this approach can shape the planning process for cities experiencing food insecurity. Qualitative analysis of data from a visioning workshop resulted in sixteen values as priorities for a sustainable and desirable food system. Values as priorities were then ranked in a Q-sort activity, from which three unique groups of ranking patterns emerged, each of which can be interpreted as a vision for a better future. The three visions were a food system with healthy foods that residents are willing to travel for; a food system with convenient, fresh food options for those who cannot travel; and a food system that maintains the community's food traditions. Our novel mixed methods approach empowers communities by giving them a voice in the planning process but also allows decision makers to create transformation pathways that more accurately reflect the needs of the various subsets of community members who hold diverse visions and priorities.


Abstract. Four summer seasons of nitrogen oxide (NO) concentrations were obtained at the South Pole (SP) during the Sulfur Chemistry in the Antarctic Troposphere (ISCAT) program (1998 and 2000) and the Antarctic Tropospheric Chemistry Investigation (ANTCI) in (2003, 2005, 2006–2007). Together, analyses of the data collected from these studies provide insight into the large- to small-scale meteorology that sets the stage for extremes in NO and the significant variability that occurs day to day, within seasons, and year to year. In addition, these observations reveal the interplay between physical and chemical processes at work in the stable boundary layer of the high Antarctic plateau. We found a systematic evolution of the large-scale wind system over the ice sheet from winter to summer that controls the surface boundary layer and its effect on NO: initially in early spring (Days 280–310) the transport of warm air and clouds over West Antarctica dominates the environment over the SP; in late spring (Days 310–340), the winds at 300 hPa exhibit a bimodal behavior alternating between northwest and southeast quadrants, which is of significance to NO; in early summer (Days 340–375), the flow aloft is dominated by winds from the Weddell Sea; and finally, during late spring, winds aloft from the southeast are strongly associated with clear skies, shallow stable boundary layers, and light surface winds from the east – it is under these conditions that the highest NO occurs. Examination of the winds at 300 hPa from 1961 to 2013 shows that this seasonal pattern has not changed significantly, although the last twenty years have seen an increasing trend in easterly surface winds at the SP. What has also changed is the persistence of the ozone hole, often into early summer. With lower total ozone column density and higher sun elevation, the highest actinic flux responsible for the photolysis of snow nitrate now occurs in late spring under the shallow boundary layer conditions optimum for high accumulation of NO. This may occur via the non-linear HOX–NOx chemistry proposed after the first ISCAT field programs and NOx recycling to the surface where quantum yields may be large under the low-snow-accumulation regime of the Antarctic plateau. During the 2003 field program a sodar made direct measurements of the stable boundary layer depth (BLD), a key factor in explaining the chemistry of the high NO concentrations. Because direct measurements were not available in the other years, we developed an estimator for BLD using direct observations obtained in 2003 and step-wise linear regression with meteorological data from a 22 m tower (that was tested against independent data obtained in 1993). These data were then used with assumptions about the column abundance of NO to estimate surface fluxes of NOx. These results agreed in magnitude with results at Concordia Station and confirmed significant daily, intraseasonal and interannual variability in NO and its flux from the snow surface. Finally, we found that synoptic to mesoscale eddies governed the boundary layer circulation and accumulation pathways for NO at the SP rather than katabatic forcing. It was the small-scale features of the circulation including the transition from cloudy to clear conditions that set the stage for short-term extremes in NO, whereas larger-scale features were associated with more moderate concentrations.


Objective To investigate changes in blood glucose level after steroid injection in patients with type 2 diabetes mellitus (DM) and factors affecting those changes. Methods We retrospectively studied 51 patients with type 2 DM who underwent steroid injection for shoulder and back pain. Mean fasting blood sugar (FBS) levels for 7 days before steroid injection was used as the baseline blood glucose level, which was compared with FBS levels for 14 days after steroid injection. We compared the differences in blood glucose changes between HbA1c >7% and HbA1c ≤7% groups and those between insulin and non-insulin treated groups. Demographic data, injection site, and steroid dose were analyzed. Results Compared to baseline, blood glucose significantly (p=0.012) elevated 1 day after steroid injection but not 2 days after injection. In the HbA1c >7% and insulin groups, blood glucose was significantly increased 1 day after injection compared to that in the HbA1c ≤7% (p=0.011) and non-insulin (p=0.024) groups, respectively. Higher HbA1c level before injection was significantly (p=0.003) associated with the degree of blood glucose increase 1 day after injection. No significant differences were noted in the degree of blood glucose increase according to injection site or steroid dose. Conclusion Higher HbA1c level was associated with greater elevation in blood glucose 1 day after steroid injection. Careful monitoring of blood glucose is required on the first day after steroid injection in patients with poorly controlled DM.


In this descriptive study, the author examined the relation of work stress, hardiness, and burnout among 113 full-time hospital staff nurses. It was hypothesized that among hospital staff nurses: 1) the greater personality hardiness, the less job stress; and 2) the greater personality hardiness, the less burnout. Instruments used were Personal Views Survey, Nursing Stress Scale, and Tedium Burnout Scale. Promoting hardiness through nursing staff development programs may help manage stress and reduce burnout in the healthcare setting.


Arterial hypertension, insulin resistance, diabetes mellitus are associated with obesity. However exact mechanisms of this association have not been determined yet. Biologically active substances produced by adipose tissue participate in pathogenesis of cardiovascular diseases and complications. In this review we present data on the role of adiponectin -- adipocytokine with unique antiatherogenic, antiinflammatory, and insulin sensitizing properties. Hypoadiponectinemia is considered to be potentially modifiable cardiovascular risk factor and novel therapeutic target. Therapy with PPAR gamma agonists, blockers of renin-angiotensin and sympathetic nervous systems is associated with elevation of concentration of adiponectin.


This paper describes the setting up of a training programme in psychodynamic psychotherapy in Perth, 'the most isolated city in the world'. Previous attempts to do so have petered out after a short period of time. It had certainly never been possible to develop a training programme. Initially a study group of interested health professionals was formed in 1984 which met to study certain texts at fortnightly meetings and participated in workshops conducted by the supervisors who visited from Sydney, 3,400 km away. At the end of that year the study group was changed into the Association for Psychodynamic Psychotherapy of Western Australia. The foundation members were also the first training group. The training programme consisted of fortnightly meetings concerned with intragroup issues, administrative matters and with the didactic programme: this consisted of seminars being conducted as part of a training programme in Sydney which were recorded on videotape and flown to Perth. As the 3-year training progressed we also added additional topics of our own. On the alternative fortnight the members split into small groups for peer supervision of audiotape recordings of sessions with the patient being supervised. In addition there were supervision workshops conducted by the visiting supervisors from Sydney. The paper also discusses the logistical problems of conducting such a training as well as transference and countertransference issues that arose within the group of trainees as well as with the supervisors who were so far away.


With penetrating insight Combs-Schilling illuminates the remarkable survival of one of the world's oldest monarchies, still ruling after 1200 years. The author unravels the paradox of this ancient yet progressive institution that has weathered invasion, economic collapse, and colonial assult. The pillars of stability for which political analysts typicaly search - military strength, bureaucratic control, and commerical prosperity - have often been absent in Morocco, sometimes for centuries. How then has the monarchy stood firm? In this remarkable book, Combs-Schilling argues that the answer is to be found in the distinctive forms of ritual practice developed during times of great crises. Unique among Islamic governments, the Moroccan monarchy became cnetral to the popular celebrations of the most sacred rituals of Islam, cloaking itself in their sanctity. Combs-schilling breaks new ground in thinking about ritual. The author explores the consequences of the replication and reinforcement of Morocco's national ceremonies in viallages and homes and the metaphorical equivalence thereby built. The author outlines how ritual metaphors simultaneously fuse the monarchy with the hallowed prophets of Islam and the mundane structures of family life. In elucidating the forcefulness of ritual embodiment the book challenges anthropological theory. It demonstrates that rituals created realities by inscribing them deeply within the individual's body and mind. Rituals use eros and physical substance to build imaginative abstractions. Performances of exquisite beauty and grace make the monarchy intrinsic to definitions of male and female, to experience of birth, intercourse, death, and to the ultimate longing to break death's bonds. Combs-Schilling creates a model for national political analysis that takes meaning as well as strategic power into account. The author applies the anthropological analysis of rituals to new arenas - the nation-state and the world political economy - without ever losing sight of the individual and the flow of daily life. The book clarifies a distinctive form of nationalism that expands the boundaries articulated by Anderson in Imagined Territories. Rituals rather than territory or administration came to define the Moroccan monarchy and the Moroccan nation under Western assault, and enabled them to survive. For the novice, the book provides an unusual and compelling entry into Islamic culture and history. Yet it is provocative for the expert in its reinterpretation of the strategic dimensions of Muhammad's marriages and the political potency of the rituals of Islam where power, sacrifice, and sexual identity converge. By revealing the link between national ceremony and individual identity, the author calls into question the popular view that sharply divides East and West and suggests commonalities in the structures of political-sexual power that are built into societies that operate within the cultural contexts of the world's three monotheistic faiths: Islam, Judaism, and Christianity.


©2016 Frontline Medical Communications. Background Reproductive-age women who are undergoing cancer treatment are at risk for heavy menstrual bleeding, unintended pregnancy, and have a contraindication to estrogen-containing products.The incidence of vaginal bleeding and contraception use is not known. Objective To describe clinical practices regarding menstrual suppression, estimate the incidence of vaginal bleeding complaints, and investigate contraceptive counseling and provision in women undergoing chemotherapy. Methods We performed a chart review using ICD-9 codes to identify women aged 14-40 years who received chemotherapy at our institution during July 2008-June 2013. Electronic medical records were examined for menstrual suppression therapy, contraception counseling, and abnormal vaginal bleeding. Results We identified 137 women for this study. 24 (18%) received prophylactic menstrual suppression counseling, of whom 17 (71%) initiated treatment, primarily with combined oral contraceptives, all prescribed by hematologist-oncologists. During the first 6 months of chemotherapy, 36 women (26%) complained of abnormal vaginal bleeding, including 10 women who were on prophylactic treatment. 19 women noted moderate to severe bleeding. 11 (12%) women received contraceptive counseling before chemotherapy, all from hematologist-oncologists; 86 women (63%) initiated chemotherapy without a documented contraceptive method. Limitations Data were generated from billing codes, so all eligible women may not have been included. Conclusions Reproductive-age women undergoing chemotherapy may not receive adequate contraception and menstrual suppression counseling. We encourage consulting gynecologists, especially family planning specialists, at the time of cancer diagnosis to support women with decisions about menstrual suppression and contraception.


Evaluating Public Relations advises PR practitioners at all levels how to demonstrate clearly and objectively the impact that their work has to their clients and managers. The authors draw on both their practical and academic experience to discuss a diverse range of evaluation methods and strategies, illustrated throughout with many award winning case studies and interviews. Fully revised and updated, the second edition of this invaluable book allows practitioners to more closely monitor and evaluate their campaigns and helps them develop more robust campaign strategies. This edition includes new information on: online evaluation; measuring relationships; practitioner culture; evaluation procedures and structures; payment by results; econometrics; word of mouth. Covering both theory and practice, Evaluating Public Relations is an essential handbook for both students and experienced practitioners.


OPTIMASI NANOENKAPSULASI ASAP CAIR TEMPURUNG KELAPA DENGAN RESPONSE SURFACE METHODOLOGY DAN KARAKTERISASI NANOKAPSUL [Optimization of Coconut Shell Liquid Smoke Nanoencapsulation using Response Surface Methodology and Nanocapsules Characterization] Dego Yusa Ali 1) , Purnama Darmadji 2) * dan Yudi Pranoto 2) 1) Jurusan Teknologi Industri Pertanian, Fakultas Teknologi Pertanian, Universitas Jambi, Jambi 2) Jurusan Teknologi Pangan dan Hasil Pertanian, Fakultas Teknologi Pertanian, Universitas Gadjah Mada, Yogyakarta Diterima 15 November 2013 / Disetujui 07 Februari 2014 ABSTRACT Liquid smoke is impractical and easy to deteriorate, thus needs to be protected against deterioration. Spray drying technique is widely used to encapsule bioactive compounds. This study aims to determine the optimum encapsulant ratio and spray drying process to produce nanocapsule of liqud smoke. Nanocapsules production began with the mixing of encapsulant (chitosan and maltodextrin) and the liquid smoke and then agitated until dissolved. The solution of nanoparticles was heated in a water bath at 45°C for 5 minutes and homogenized using a homogenizer at 4000 rpm for 1 min. The nanoparticle solutions was spray dried at various temperatures and feed flow rates. Optimization is accomplished by using Response Surface Methodology (RSM), and the parameters to be optimized were chitosan concentration, inlet air temperature and feed flow rate of the spray dryer based on total phenolic content. Samples were analyzed for viscosity, pH, phenols staining, total phenolic, total carbonil, total acidity content, encapsulation efficiency, morphology profiles, and particle size distribution. The results showed that the nanoparticles solution of liquid smoke had a pH ranged between 2.55-2.64 total soluble solids ranged between 14-14.8°Brix and viscosity ranged between 8.7-14.9 centipoise (cP). The total phenolic content of the nanocapsules ranged from 1.38 to 2.32% with an efficiency ranged from 22.25 to 37.44%, and water content ranged from 9.56 to 10.73% (dry basis). The optimum conditions for the highest value of total phenolic content were 0.12% chitosan concentration, 140.65°C inlet air temperature and feed flow rate at 5.29 mL/min. The results suggested that nanocapsules had spherical and wrinkle shape with an average size of nanocapsules of 29.16 nm.


Since manually labeling training data is slow and expensive, recent industrial and scientific research efforts have turned to weaker or noisier forms of supervision sources. However, existing weak supervision approaches fail to model multi-resolution sources for sequential data, like video, that can assign labels to individual elements or collections of elements in a sequence. A key challenge in weak supervision is estimating the unknown accuracies and correlations of these sources without using labeled data. Multi-resolution sources exacerbate this challenge due to complex correlations and sample complexity that scales in the length of the sequence. We propose Dugong, the first framework to model multi-resolution weak supervision sources with complex correlations to assign probabilistic labels to training data. Theoretically, we prove that Dugong, under mild conditions, can uniquely recover the unobserved accuracy and correlation parameters and use parameter sharing to improve sample complexity. Our method assigns clinician-validated labels to population-scale biomedical video repositories, helping outperform traditional supervision by 36.8 F1 points and addressing a key use case where machine learning has been severely limited by the lack of expert labeled data. On average, Dugong improves over traditional supervision by 16.0 F1 points and existing weak supervision approaches by 24.2 F1 points across several video and sensor classification tasks.


Aldehyde oxidase (EC 184.108.40.206) is a xenobiotic metabolizing enzyme that catalyzes a variety of organic aldehydes and N-heterocyclic compounds. However, its precise pathophysiological function in humans, other than its xenobiotic metabolism, remains unknown. In order to gain a better understanding of the role of this enzyme, it is important to know its exact localization in human tissues. In this study, we investigated the distribution of aldehyde oxidase at the cellular level in a variety of human tissues by immunohistochemistry. The enzyme was found to be widespread in respiratory, digestive, urogenital, and endocrine tissues, though we also observed a cell-specific localization in the various tissues studied. In the respiratory system, it was particularly abundant in epithelial cells from the trachea and bronchium, as well as alveolar cells. In the digestive system, aldehyde oxidase was observed in surface epithelia of the small and large intestines, in addition to hepatic cells. Furthermore, the proximal, distal, and collecting tubules of the kidney were immunostained with various intensities, while glomerulus tissues were not. In epididymus and prostate tissues, staining was observed in the ductuli epididymidis and glandular epithelia. Moreover, the adrenal gland, cortex, and notably the zona reticularis, showed strong immunostaining. This prevalent tissue distribution of aldehyde oxidase in humans suggests some additional pathophysiological functions besides xenobiotic metabolism. Accordingly, some possible roles are discussed.


OBJECTIVE
The purpose of this study is to reassess the projected rate of Electronic Health Record (EHR) diffusion and examine how the federal government's efforts to promote the use of EHR technology have influenced physicians' willingness to adopt such systems. The study recreates and extends the analyses conducted by Ford et al. (1) The two periods examined come before and after the U.S. Federal Government's concerted activity to promote EHR adoption.

DESIGN
Meta-analysis and bass modeling are used to compare EHR diffusion rates for two distinct periods of government activity. Very low levels of government activity to promote EHR diffusion marked the first period, before 2004. In 2004, the President of the United States called for a "Universal EHR Adoption" by 2014 (10 yrs), creating the major wave of activity and increased awareness of how EHRs will impact physicians' practices.

MEASUREMENT
EHR adoption parameters--external and internal coefficients of influence--are estimated using bass diffusion models and future adoption rates are projected.

RESULTS
Comparing the EHR adoption rates before and after 2004 (2001-2004 and 2001-2007 respectively) indicate the physicians' resistance to adoption has increased during the second period. Based on current levels of adoption, less than half the physicians working in small practices will have implemented an EHR by 2014 (47.3%).

CONCLUSIONS
The external forces driving EHR diffusion have grown in importance since 2004 relative to physicians' internal motivation to adopt such systems. Several national forces are likely contributing to the slowing pace of EHR diffusion.


Electrocardiography is a commonly applied method of measuring the electrical activity of the heart. The standard 12-lead electrocardiogram (ECG) provides sufficient information to allow various heart conditions to be diagnosed. Despite its relative ease of use, the standard ECG procedure could benefit from a reduction of leads which may allow for continuous monitoring, for example via a wearable device. In this study, we first investigated the use of variational autoencoders (VAEs) to assess what the most representative leads of the standard 12-lead system are. As the VAE learns to compress the ECG data, it focuses on the parts of the input that is important for the reconstruction. This information is then used to assess which leads are the most useful for a reconstruction task in general. Precordial leads V2, V3 and V4 are shown to contain the most information in the 12-lead ECG data. We then investigated the use of a convolutional neural network (CNN) architecture capable of learning patient-specific models to accurately impute 11 missing ECG signals from a single available lead. Our design is unconventional in that it keeps a two-dimensional structure throughout the fully connected layers. We show that this design outperforms the traditional one-dimensional structure and that these architectures can be affected by the presence of symptoms in recorded heart signals.


This article examines the economics of groundwater irrigation and shallow tubewell (STW) ownership decision making, using farm-level data collected from 324 households in Nepal. STW irrigation generated a significant positive effect on rice yield and farmers' incomes. Based on a probit model, the farm size, land fragmentation, access to electricity, and access to credit were found to significantly influence farmers' decisions to own STWs. Although the water market benefited poor farmers, it is too small and monopolistic. Policy reforms needed to make groundwater accessible to the poor majority include effective credit programs, investments in rural electrification, and public sector support for promoting suitable pumping technologies.


Background: Prostate cancer is the most common form of non‐skin cancer and the second leading cause of cancer deaths within the United States. The five year survival rate has increased from 69% to 99% over the last 25 years for the local and regional disease, but has remained fairly low (approximately 34%) for the advanced disease. Current research is aimed at finding complementary or alternative treatments that will specifically target components of signal transduction, cell‐cycle and apoptosis pathways to induce cell death, with little or no toxic‐side effects to the patient. In this study we investigated the effect of genistein on expression levels of genes involved in these pathways. Genistein (4, 5, 7‐trihydroxy‐isoflavone) is a major isoflavone micronutrient constituent of soy that has been shown to inhibit growth proliferation and induce apoptosis in cancer cells. Methods: The mechanism of genistein‐induced cell death and potential molecular targets for genistein in LNCaP prostate cancer cells were investigated using several techniques. The chemosensitivity of genistein towards prostate cancer cells was investigated using the ATP and MTS assays and apoptosis induction was determined using apoptosis indicator assays and caspase assays. Expression levels of several molecular targets were also determined using cDNA microarray and RT‐PCR analysis. Results: Our results revealed that genistein induces cell death in a time and dose‐dependent manner and regulates expression levels of several genes involved in carcinogenesis and immunogenicity. Several cell cycle genes were down‐regulated including the mitotic kinesins, cyclins and cyclin dependent kinases, indicating that genistein is able to halt cell cycle progression through the regulation of genes involved in this process. Several members of the Bcl‐2 family which are involved in apoptosis were also affected and a number of genes involved in immunogenicity were upregulated including DefB1 and HLA membrane receptors. Conclusion: The results of this study provide evidence of genistein9s ability to inhibit cancer cell proliferation and induce apoptosis which indicates its potential as an adjuvant in chemotherapy and immunotherapy. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):C85.


Objectives To report the implementation of a trigger review method (TRM) in primary care, with a particular focus on its impact on patient safety-related findings. Design Cross-sectional structured review of random samples (n=25) of electronic records of 'high-risk' patient groups conducted twice per year (each for a retrospective review period of 3 months). Setting 274 general practices in two regions of Scotland. Intervention Contractual incentivisation of TRM implementation. Main outcome measures Practice participation rate; characteristics of patient safety incidents (PSIs), for example, their prevalence, type, perceived severity and preventability; and actions or intended actions undertaken during and after trigger reviews. Results 274 of 318 eligible practices (86.2%) returned 536 TRM Summary Reports, which outlined findings from reviews of 13 351 electronic patient records. 1887 (14.1%) PSIs were recorded, with a mean of 3.5 (536/1887) per Summary Report (SD±1.6). Of these, 830 (44.0%) were judged to have caused mild to moderate harm, with 262 (13.9%) cases resulting in more severe harm. A total of 852 PSIs (46.2%) were rated as preventable or potentially preventable. In 459 Summary Reports (85.6%), reviewers indicated implementing one or more improvement actions during the actual TRM process; and 2177 actions after completion of the TRM process (mean 4.1 (SD±3.3) actions per review). Conclusions The great majority of clinician reviewers 'successfully' applied the TRM, uncovering important but previously undetected PSIs, which prompted care teams to take action during and after the trigger reviews. The method and data generated have the potential to drive improvements in related care processes at the practice, regional and national health system level. TRM arguably increased 'ownership' of the safety challenge and clinician engagement in implementing their solutions to specific problems identified. Our results suggest that the TRM has potential as a feasible, pragmatic approach to improving primary care safety and quality.


Early experimental research on induced aggression aimed to set the direct relation between aversive stimulation and aggressive behavior. The generality of the phenomenon was evaluated with variations in the subjects' species and in the inducting stimuli. Seminal studies on induced aggression were published in the Journal of the Experimental Analysis of Behavior (JEAB). The objectives of the present study were systematically present the temporal distribution of publications on induced aggression in JEAB and describe the studies' methodological aspects. The terms "aggress*", "fight*", and "attack*" were searched in the Wiley Online Library database, and selecting criteria were applied. Fiftyeight articles were analyzed. The global representativeness of publications about induced aggression in JEAB is 1.1%. Between 1962 and 1981, there were regular publications about induced aggression in the journal, representing 2.8% of the publications in JEAB in the referred period. During this interval, a first period of publications was marked by investigations involving the exposition of rats and squirrel monkeys to electric shock, which would result in fighting and biting aggressive responses, respectively; a second period was marked by studies involving the exposition of pigeons to schedules of reinforcement, resulting in aggressive pecking responses. The publication pattern of induced aggression on JEAB is in agreement with previous indications regarding the temporal distribution of general publications on induced aggression. Limitations of the present work are discussed, and suggestions for additional research are provided.


Inexpensive, consumer-friendly digital video cameras are fueling the explosion of online video sites. Video cameras are even embedded in cell phones, music players, and a variety of other consumer devices. Video can be shared online with a single click-more than 20 hours of video are being uploaded to the internet every minute. These developments are making it easier than ever to create, view, and remix digital video-and students are already doing it in their free time. So why not use digital video to engage students and bring lessons to life with sound and motion? By watching, analyzing, and creating videos, students can visualize fractals, calculate the speed of sound, demonstrate critical thinking about historic events, and much, much more. Teaching with Digital Video approaches digital video use by subject, showing educators how to effectively use digital video in four core curriculum areas: science, social studies, English language arts, and math. After explaining the unique advantages of digital video for each subject, the authors provide sample activities that can be used in the classroom. To aid implementation, each activity is presented in three parts: the content, aligned with standards including the NETS-S; the technology, which provides tips for using digital video; and the pedagogy, with instructional strategies that take advantage of video's unique capabilities. In addition, the authors cover the tools and techniques needed to acquire, create, and communicate with digital video.


Atrial aneurysms are rare entities that can be congenital or acquired. Those involving the free wall or atrial appendage are even rarer. There are only 49 cases reported in the literature involving the left atrium and 8 in the right atrium until 2002. The most common clinical presentation is the appearance of recurring or incessant atrial arrhythmias. In addition, systemic embolization may occur as an imminent life-threatening event. We present the case of a female teenager who suffered from an embolic stroke during an atrial fibrillation. She had a giant aneurysm of the left atrial appendage that was successfully removed. Images from computed tomography, and of the aneurysm during the surgical intervention are shown.


Here the authors demonstrate an oven‐free and mold‐free heating route to convert preceramic polymers to silicon carbide using carbon nanomaterials as susceptors. Silicon carbide is prized for its high thermal stability and low density and could be produced via slow oven heating of polycarbosilane (PCS). The authors show that addition of multiwalled carbon nanotubes (MWCNT) as susceptors to polycarbosilane results in rapid and volumetric heating upon exposure to microwaves and radio frequency. The authors assess microwave heating of polycarbosilane‐MWCNT composites; this process is capable of reaching pyrolysis temperatures, and the resulting crystal structure is cubic (β‐SiC). Dielectric properties of these composites in the radio frequency range is measured. The authors cure these composites using RF, and thermogravimetric data shows that the extent of cure for these samples is around 95%. The applicability of this study for 3D printing silicon carbides by successive iterations of layer deposition and rapid RF curing is demonstrated. The fly measurements of dielectric values of the 3D printing ink at different temperature while curing it is performed. The authors have also shown that these volumetric heating methods can rapidly cure polycarbosilane fibers to make silicon carbide fibers without melting them before crosslinking.


Increased use of drugs is associated with a number of factors including high sensation seeking and sexual minority status (through group-specific minority stress). We sought to examine how personality traits like sensation seeking may influence drug abuse among sexual minority individuals. Participants were 217 emerging adults (Mage = 20.23, SD = 0.85) recruited from Amazon Mechanical Turk (MTurk). Of these participants, 67.7% identified as heterosexual, 9.7% as gay or lesbian, 21.2% as bisexual, and 1.4% indicated other sexual orientations. Sensation seeking and drug abuse were self-reported using the Brief Sensation Seeking Scale and the Drug Abuse Screening Test, respectively. A preliminary multiple analysis of variance indicated no significant mean differences for these variables as a function of sex or sexual orientation. Next, sexual minority status, Brief Sensation Seeking Scale scores, sex and their interactions were entered into a linear regression predicting Drug Abuse Screening Test scores. Results revealed a significant moderation, such that the positive relationship between Brief Sensation Seeking Scale total scores and Drug Abuse Screening Test total scores was stronger for sexual minorities (β = 0.14, P = 0.00) compared to heterosexuals (β = 0.04, P = 0.04), controlling for sex. These results demonstrate, while sensation seeking and sexual minority status may selectively indicate risk for drug use, sexual minorities high in sensation seeking may be at especially high risk for problems related to drug abuse. More research examining the addiction etiology of sexual minority individuals would inform targeted interventions for this population.


Chimeric polioviruses have been made in which regions of the type 1 Sabin strain corresponding to antigenic sites 2, 3 and 4 have been replaced by the corresponding regions of the type 3 Sabin strain. Manipulation of one site or a component of it generally did not affect the reactions of the others, suggesting that they form independent structural features. The extent to which the inserted site expressed the antigenic properties of type 3 could be assessed by reaction with polyclonal or monoclonal antibodies, or by immunogenicity. Site 2 could be expressed on infectious virus and site 3 on heated non-infectious virus (C antigen), but not on the native virion. The results are consistent with the view that sites consisting of a continuous sequence of amino acids may be presented on chimeras, whereas more complex sites, such as site 4 or site 3 of the native virion, are transferred less readily from type 3 to type 1.


The reasons for the reduction in response of a multidetector radiation counting system when operated at high count-rates were examined and a convenient method of correction which is accurate to within +or-1% up to 0.6*105 counts per second was established. In its application the method uses the observed count-rates from each detector at the time of measurement and previously determined values of critical time intervals of the electronic system. The detected signals establish these intervals in which further signals occurring within them are lost from the response. These further signals can also cause the loss of the signals establishing the intervals. The correction is of particular value when high-sensitivity whole-body counters are used to measure the activity of administered isotopes in metabolic studies.


The growing need and market demand for point of care (POC) systems to improve patient's quality of life are driving the development of wireless nanotechnology based smart systems for diagnosis and treatment of various chronic and life threatening diseases. POC diagnostics for neurological, metabolic, and cardiovascular disorders require constant long term untethered monitoring of individuals. Given the uncertainty associated with location and time at which immediate diagnosis and treatment may be required, constant vigilance and monitoring are the only practical solutions. What is needed is for a remote cyber-enabled health care smart system incorporating novel ideas from nanotechnology, low power embedded systems, wireless networking, and cloud computing to fundamentally advance. To meet this goal, we present e-Nanoflex platform, which is capable of monitoring patient health wherever they may be and communicating the data in real time to a physician or a hospital. Unlike state-of-the-art systems that are either local sensor systems or rely on custom relaying devices, e-Nanoflex is a highly nonintrusive and inexpensive end-to-end cyber-physical system. Using nanostructured sensors, e-Nanoflex provides nearly invisible monitoring of physiological conditions. It relies on smartphones to filter, compress, and relay geo-tagged data. Further, it ties to a backend cloud infrastructure for data storage, data dissemination, and abnormality detection using machine learning techniques. e-Nanoflex is a complete end-to-end system for physiological sensing and geo-tagged data dissemination to hospitals and caregivers. It is intended as a basic platform that can support any nanostructure based flexible sensor to monitor a variety of conditions such as body temperature, respiration air flow, oxygen consumption, bioelectric signals, pulse oximetry, muscle activity, and neural activity. Additionally, to address the cost of manufacturing sensors, e-Nanoflex uses a low cost production technique based on roll to roll gravure printing. We show the efficacy of our platform through a case study that involves acquiring electrocardiogram signals using gold nano-electrodes fabricated on a flexible substrate.


Purpose
There has been a substantial realization of the importance of community engagement (CE) for social enterprise (SE) missions. However, the emerging literature on CE in social enterprises is riddled with theoretical inconsistencies and there is universal lack of studies in this direction. For the sake of advancing the field, the purpose of this paper is to identify and analyze the elements of CE in SEs. Further, a comprehensive preliminary model is developed integrating the five fundamental dimensions of CE in SE setting.

Design/methodology/approach
The paper is based on the critical analysis of the extant literature across disciplines to identify the relevant themes that can affect the CE in SEs.

Findings
The paper develops a preliminary social enterprise community engagement model (SE-CEM), which results from a broad literature analysis. The proposed model attempts to offer a comprehensive perspective outlining the institutional, organizational, individual, community and process dimensions likely to predict engagement success in SE context.

Originality/value
This paper pioneers in presenting a holistic approach to understanding the dimensions that constitute CE in SEs. The SE-CEM incorporates the determinants of CE in social entrepreneurship (S-ENT) context to direct a future research agenda. The preliminary model can further be developed and empirically tested by researchers. Moreover, practitioners can also gain benefits from the model and promote S-ENT.


The complexity and intelligence of energy systems has increased in the recent years, whereas using Multi-agents system (MAS) technology has been recommended by IEEE for developing software solutions for modeling, controlling, and simulating their behaviors. Available MAS solutions for energy systems are generally designed for resolving specific problems by proposing ad-hoc solutions, without considering interoperability and reusability. We propose a methodology, based on the Model-Driven Engineering (MDE) technique, for developing MAS solutions for energy systems. Our methodology uses the Common Information Model standard (CIM), recommended by IEEE, and the existing Platform Independent agent metamodel PIM4Agents. Our proposal allows modeling MAS solutions for power engineering applications, by means of a platform independent model that abstracts developers from existing agent-oriented methodologies and platforms. Applying model transformations, the generated models can be transformed and executed within several agent platforms such as JACK and JADE. The proposal has been partially validated by means of a well-known test case.


The Enewetak windward reef flat is composed of two petrographically distinct pavement types, neither of which appears to reflect the composition of the contemporary surficial biological community. Stratigraphic, petrographic, and radiocarbon analyses indicate a rapid build-up of reef structure followed by a period of erosion. The results are most consistent with a sea level that (1) reached the present level by about 4000 yr B.P. (or earlier), (2) was more than 1 m higher than at present during the period 3500 to 2000 yr B.P., and (3) fell to the present level within the past 2,000 yr.


Ten years ago, a review in the journal Public Health set out an agenda for public health research in heart failure by identifying six areas where major gaps remained in knowledge (at that time).1 One of the six issues was titled "Are women getting a fair deal?", calling attention to how research into cardiovascular diseases was noteworthy for the extent to which women were under-represented or excluded. The authors attributed this situation to an underlying belief that cardiovascular disease is primarily a male problem.

This belief was in fact a prejudice resulting from the confusion between absolute and relative measures! It is true that the incidence of cardiovascular diseases, particularly coronary heart disease and heart failure, is higher in men, particularly at younger ages. However, they are still a major cause of death and disability among women, more frequent than breast cancer and other diseases seen as major problems of women's health.

Is there gender bias in heart failure?

There certainly is gender bias in recruitment to randomised studies of the efficacy of interventions in heart failure, both pharmacological therapy and devices and surgical therapy. In large part this bias is related to the fact that left ventricular systolic dysfunction is often …


We improve the lower bounds on Klarner's constant, which describes the exponential growth rate of the number of polyominoes (connected subsets of grid squares) with a given number of squares. We achieve this by analyzing polyominoes on a different surface, a so-called $\textit{twisted cylinder}$ by the transfer matrix method. A bijective representation of the "states'' of partial solutions is crucial for allowing a compact representation of the successive iteration vectors for the transfer matrix method.


The aim of this thesis was to evaluate international sport horse data for use in genetic evaluations both within populations and between populations. An initial review showed that most sport horse producing breed organisations have created young horse testing schemes. Due to moderate to high heritabilities and highly positive genetic correlations with competition results later in life these tests are good tools for selection and suitable for use in genetic evaluations. Efficiency in testing and selection could be improved by including both sexes in young horse tests where this is not yet done, and by shortening tests, where long test periods are practised. Genetic connectedness among populations is an essential prerequisite for any kind of assessments of data between them. Genetic connectedness among the five investigated sport horse populations in this thesis is at such a level that it would be feasible to use their national breeding values based on young horse data in international genetic evaluations for estimation of genetic correlations among similar phenotypic traits. This is possible if correct and internationally unique IDs of horses can be established. Genetic correlations were estimated between phenotypically similar traits tested in Danish Warmblood (DWB) and Swedish Warmblood (SWB). They were highly positive for performance traits and reliabilities for the corresponding breeding values generally became higher when using information from both countries. Thus, mutual use of nationally calculated EBVs was considered possible when stallions are evaluated for use across countries. Moreover a joint genetic evaluation using MACE would be feasible and beneficial for both DWB and SWB. To evaluate how foreign genetic material should be handled in national genetic evaluations, the influence of foreign stallions on the SWB and its genetic evaluation was studied. Origin of stallions has had significant effects on the genetic improvement of jumping traits in SWB. Inclusion of genetic groups in the genetic evaluation resulted in hardly any re-ranking, but less reliable breeding values; hence it was not recommended as a standard procedure. Complete pedigrees of foreign stallions proved to be much more important than genetic grouping to avoid bias in their EBVs.


We evaluated the anxiolytic and antidepressant effects of the aqueous extract of the bark of Tapinanthus dodoneifolius (TAE) (Danser) (25, 50, and 100 mg/kg), using open field, elevated plus maze, and forced swimming tests. Effect of TAE was compared to standard drugs diazepam (2 mg/kg) and imipramine (10 mg/kg). Additionally, the same doses of TAE were evaluated on rat's memory using Y-maze task. Results showed a significant (; 100 mg/kg) increase in the percentage of open arm entry and the time spent in the open arms in the elevated plus maze, suggesting an anxiolytic activity of the extract. In a dose-dependant manner, TAE at 25 mg/kg significantly () decreased the number of lines crossed and the rearing behavior in the open field test, suggesting its possible sedative activity. In the forced swimming test, the immobility time of the animal was significantly reduced () by TAE (100 mg/kg), compared to control, and this effect was quite comparable to that of imipramine. In the Y-maze paradigm, TAE at 50 mg/kg caused a significant increase in the spontaneous alternations but with a significant decrease in exploratory behavioral pattern. Taking these results together, TAE improved the spatial memory and showed anxiolytic, antidepressant, and sedative activities. The present results support the anxiolytic and antidepressant activities of TAE and, to our knowledge, for the first time, demonstrate its enhancing effect on memory.


When evaluating a network topology, occasionally data structures cannot be segmented into absolute, heterogeneous groups. There may be a spectrum to the dataset that does not allow for this hard clustering approach and may need to segment using fuzzy/overlapping communities or cliques. Even to this degree, when group members can belong to multiple cliques, there leaves an ever present layer of doubt, noise, and outliers caused by the overlapping clustering algorithms. These imperfections can either be corrected by an expert user to enhance the clustering algorithm or to preserve their own mental models of the communities. Presented is a visualization that models overlapping community membership and provides an interactive interface to facilitate a quick and efficient means of both sorting through large network topologies and preserving the user's mental model of the structure.


1,4-Dihydroxy-7,8-dihydro-5H-benzo[a]cycloheptene-5,9(6H)- dione (7) was synthesised from hydroquinone and glutaric acid chloride via an acylation reaction. The reaction of dione (7) with bromine followed by treatment with NEt3 gave homonaphthazarin 8 as well as the brominated derivatives 9 and 10. Reduction of 1,4-dimethoxy-7,8-dihydro-5H-benzo[a]cycloheptene-5,9(6H)-dione (16) with LiAlH4 gave 2 isomeric alcohols, 17 and 18. Reaction of these alcohols with SOCl2 followed by HCl elimination with NEt3 afforded dimethoxybenzocycloheptatriene 19 as the sole product. For the synthesis of the isomeric cycloheptatriene 20, the double bond in 19 was isomerised with KOt-Bu.


The response of desamino-D-arginine vasopressin (DDAVP) was investigated in 32 enuretic children in a double-blind clinical study. The 15 children treated with DDAVP showed a significant reduction in the incidence of bed wetting--from 18.7 +/- 6.5 to 6.5 +/- 9.2 wet nights per 30 days. In 6 children bed wetting stopped entirely, in 6 there was a satisfactory response, and in 3 the response was marginal or there was none. When DDAVP was stopped most children reverted to their earlier bedwetting habits (15.7 +/- 8.9 nights a month). Response to DDAVP was significantly better in children aged more than 10 years (mean age for the entire group). The administration of DDAVP was not associated with any appreciable change in morning urine osmolalities. No adverse effects were noted. It is concluded that DDAVP is effective in nocturnal enuresis, particularly in older children. It is suggested that the cessation of bed wetting may, in part, reflect functional properties of DDAVP rather than antidiuresis.


Accurate 3D surface reconstruction of our environment has become essential for an unlimited number of emerging applications. In the past few years, Unmanned Aerial Systems (UAS) are evolving as low-cost and flexible platforms for geospatial data collection that could meet the needs of aforementioned application and overcome limitations of traditional airborne and terrestrial mobile mapping systems. Due to their payload restrictions, these systems usually include consumer-grade imaging and positioning sensor which will negatively impact the quality of the collected geospatial data and reconstructed surfaces. Therefore, new surface reconstruction surfaces are needed to mitigate the impact of using low-cost sensors on the final products. To date, different approaches have been proposed to for 3D surface construction using overlapping images collected by imaging sensor mounted on moving platforms. In these approaches, 3D surfaces are mainly reconstructed based on dense matching techniques. However, generated 3D point clouds might not accurately represent the scanned surfaces due to point density variations and edge preservation problems. In order to resolve these problems, a new region-based 3D surface renostruction trchnique is introduced in this paper. This approach aims to generate a 3D photo-realistic model of individually scanned surfaces within the captured images. This approach is initiated by a Semi-Global dense Matching procedure is carried out to generate a 3D point cloud from the scanned area within the collected images. The generated point cloud is then segmented to extract individual planar surfaces. Finally, a novel region-based texturing technique is implemented for photorealistic reconstruction of the extracted planar surfaces. Experimental results using images collected by a camera mounted on a low-cost UAS demonstrate the feasibility of the proposed approach for photorealistic 3D surface reconstruction. * Corresponding author


Using such methods as questionnaire survey and experimental study, a study has been made on the effects of yoga on female college students' body shape, the quality of physical function, mental health and so on. Methods: The study sampled 25 2009 female students in Handan College who have selected the yoga course. These students will do yoga practice for 6 months. The body shape, body function and mental health will be tested before and after the exercise. The results show that: such four indicators as body weight, waist circumference, thigh circumference and upper arm circumference; such 6 indicators as vital capacity, heart rate, VO2, sit-ups, step test, and Sit and Reach and such indicators as mental health self-assessment questionnaire (SCL--90), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) have been improved significantly compared to those before practice. Conclusion: Through yoga practice, female college students can improve their physical health, balance physical and mental condition, and relieve stress, enhancing the quality of physical function and mental health.


Pb, Sr, and Nd isotope data for Cenozoic basalts in eastern Australia indicate that mantle isotope signatures of Pacific Ocean mid-oceanic ridge basalts (MORB) type characterize the lava-field basalts (55–14 Ma) in southeastern Australia, whereas mantle isotope signatures of Indian Ocean MORB type characterize younger basalts (6–0 Ma) from northeastern Australia. This discovery further constrains the secular distribution of major asthenospheric mantle reservoirs represented by the Pacific and Indian Oceans MORB sources during and following the breakup of eastern Gondwana and tracks, for the first time, the locus of the boundary of the two reservoirs beneath the Australian continent. These new data fill the gap between previous Indian Ocean MORB–Pacific Ocean MORB boundary locations determined from backarc basin basalts in the southwestern Pacific Ocean and ocean-floor basalts in the Southern Ocean. We propose that the Indian Ocean MORB source is a long-term asthenospheric reservoir beneath most of eastern Gondwana and that the westward migration of the Pacific Ocean MORB source may have been associated with the opening of the Tasman Sea (ca. 85–60 Ma) along a broad front southeast of the Australian continent.


Objectives The interleukin-6 (IL-6) inhibitor satralizumab is an established treatment for neuromyelitis optica spectrum disorder (NMOSD). Although IL-6 inhibitors are generally well-tolerated, serious infections, including sepsis, can occur. In this study, we compared the sepsis characteristics in NMOSD patients administered satralizumab (NMOSD-satralizumab) to those in rheumatoid arthritis patients administered tocilizumab (RA-tocilizumab), another IL-6 inhibitor. Methods We examined adverse event reports from the Japanese Pharmaceuticals and Medical Devices Agency regarding NMOSD-satralizumab from August 2020 to March 2022 and RA-tocilizumab from April 2008 to November 2019 (term 1) and to March 2022 (term 2). Results We identified 6 sepsis cases in NMOSD-satralizumab, of which 5 (83%) developed from urinary tract infections (UTIs). Although data were unavailable for two patients, three cases had urologic complications in addition to recognized risk factors for serious infections, such as an older age, corticosteroid use, obesity, diabetes mellitus and motor disability. Urosepsis was relatively infrequent in RA-tocilizumab (term 1: 24.2%, term 2: 20.1%). Discussion Safe satralizumab use requires risk factor assessment to minimize the incidence of severe infections. Management of UTIs is also recommended.


Emission and absorption properties of indocyanine green (ICG) in Intralipid solution have been investigated. The study is focused on relatively low ICG concentration at a range of 0 to 20 microM. A diffusion model was used to analyze the emission properties of ICG solution at different concentrations. In the low-concentration region, the emission strength increases with the concentration of ICG, while in the high-concentration region, the emission decreases with the concentration. In general, a maximum of emission strength exists and its position (concentration) depends on the wavelength of the excitation light, the distance between the source and the detector, and the sample geometry and size. A so-called "inner-cell-effect" and re-absorption of emission photons are found to contribute to the decay of emission strength. Also, in the concentration range of 0 to 2 microM, ICG solution always has a higher absorption coefficient at wavelength 830 nm than that at 660 nm, which is quite different from the ICG in water case.


Abstract Deviating from the mainstream analyses of the AKP that see the rise of AKP to power as a result of the struggle between "center" and "periphery," this study is an attempt to analyze and understand the modalities of inclusion and accommodation of Turkish Islamism into the sociopolitical structure of Turkey. Therefore, it specially focuses on three interwoven processes: the articulation of Turkish Islamism with the Turkish Islamic synthesis; permanent enlargement of the religious field; and articulation between neoliberalism and Turkish Islamism. Its main argument is that among others, these processes have not only largely transformed Turkish Islamism but also opened a huge sociopolitical space for the rise of the AKP to power.


This year's Nuclear Medicine Annual provides a number of well updated, clearly written reviews describing recent advantages on a number of different subjects within the interesting field of nuclear medicine. The articles are well illustrated and they all provide extensive current reference lists. But none of the articles contains any short summary that could be of importance for providing a quick introduction to a subject the reader may not be so familiar with. The book can be recommended both to physicians working within the area of nuclear medicine, and to those interested in the various topics, even if not especially interested in nuclear medicine. The first chapter givesan updated review of radio labeled antibodies and their potential use in colorectal adenocarcinomas and ovarian carcinomas. This chapter is critical about other imaging techniques including CT and MR imaging whereas it describes immune scintigraphy in an uncritical way. All theoretical advantages and possibilities with that technique are described as if they were already clinically shown to be true, and no limitations of the technique are discussed. The clinical utility of the technique, which has theoretically been promising for decades but has not yet found its proper role, will probably benefit from constructive criticism rather than from too much enthusiasm. SPECT perfusion brain scan findings in a number of dementias, including Alzheimer's disease, are well described, and the results are compared and complemented with those seen with other imaging techniques in a balanced way. The tremendous developments of the imaging techniques allowing evaluation of various infections are well described, and there are extensive chapters about the diagnostic applications of radioaerosols in the evaluation of pulmonary diseases and the advantages and disadvantages of myocardial perfusion imaging. The possible benefit that patients with AIDS can derive from nuclear medicine imaging are provided in the chapter about nuclear medicine in HIV-related diseases, which also gives a short but good overview of the epidemiology, pathogenesis and virology of the diseases. There is also a section about the use of other radiologic techniques in the diagnosis of AIDS and AIDS-related complications. The book ends with 2 shorter chapters, the first about divideddose administration of 1 for thyroid remnant ablation after surgery for thyroid cancer. The recommendations given are clear, and although as yet of more importance for the U.S. medical system, they may find applicability with decreasing economy in many other countries. Consequently, this chapter uses mCi instead of MBq, reflecting that it is written for an American audience. The last chapter is a very interesting description of the adrenergic nervous system of the heart as revealed by scintigraphic methods.


Loss of p53 in antigen-stimulated T cells enables their proliferation in response to interleukin-2. To become fully activated, T cells receive antigen-specific signals through their T cell receptors (TCRs) and coreceptors by interacting with antigen-presenting cells (APCs). Cytokines, such as interleukin-2 (IL-2), generate a third signal that then stimulates T cell proliferation. Understanding the mechanism by which only antigen-exposed T cells, but not bystander cells, proliferate in response to IL-2 could help in designing therapies to prevent inappropriate immune responses. Watanabe et al. found that, whereas T cells from both wild-type mice and mice deficient in the tumor suppressor protein p53 proliferated similarly in response to costimulation with antigen-loaded APCs and IL-2, only the p53-deficient T cells proliferated in response to IL-2 alone. Flow cytometric and biochemical analyses showed that there were no differences in the amounts of IL-2 receptor subunits or in the extent of IL-2 signaling between wild-type and p53-deficient T cells. Compared with wild-type T cells, p53-deficient T cells showed increased DNA synthesis and enhanced cell division when costimulated with antigen-loaded APCs and IL-2. Stimulation of wild-type T cells through the TCR alone led to a transient increase, but then a substantial decrease in p53 abundance, whereas stimulation of T cells with IL-2 alone did not reduce p53 abundance. In addition, stimulation of wild-type T cells through the TCR, but not the IL-2 receptor, increased the mRNA and protein abundance of Mdm2, an E3 ubiquitin ligase that targets p53 for degradation. Exposure of wild-type T cells to the Mdm2 inhibitor Nutlin3a prevented the loss of p53 and blocked proliferation in response to antigen-loaded APCs and IL-2. When wild-type mouse CD4+ T cells that had been exposed to antigen in vivo were isolated and stimulated with antigen in vitro, their proliferation was blocked by Nutlin3a. Together, these data suggest that p53 acts in T cells to block inappropriate proliferation in response to IL-2 until the cells receive antigen-specific signals. M. Watanabe, K. D. Moon, M. S. Vacchio, K. S. Hathcock, R. J. Hodes, Downmodulation of tumor suppressor p53 by T cell receptor signaling is critical for antigen-specific CD4+ T cell responses. Immunity 40, 1–11 (2014). [PubMed] M. A. Fray, S. C. Bunnell, p53 keeps bystanders at the gates. Immunity 40, 633–635 (2014). [PubMed]


It is compulsory for final-year undergraduate engineering students to take a senior design class, commonly known as the senior capstone design project. This project is set up to help students deeply understand and apply what they have learned since beginning their quest for a bachelor's degree in science. Capstone preparation involves many elements including the contribution of faculty members and academic programs that give students the technical and management skills needed to establish a career in engineering. Moreover, the capstone usually requires funding, which often comes from the industry sector. The engineering faculty at King Abdulaziz University (KAU) encourages students to complete this course showing high-quality levels of achievement. The university's mechanical engineering department led the effort in organizing the senior design project course, which meets the Accreditation Board for Engineering and Technology (ABET) requirements. This paper presents an overview of a program that promises an outstanding engineering capstone experience for two KAU engineering colleges in Rabigh and Jeddah, Saudi Arabia. This paper delineates the process, leadership skills, ABET involvement and evaluation. The capstone project presented here has provided overall satisfaction from both faculty members and students. Moreover, course management improvements led to a more cost-efficient program.


This paper examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as "restitution" and narratives common within the context of drug services such as "recovery" can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as "junkies" and associated with criminality. They are positioned as drug-seeking and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make is it challenging to generate "companion" stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person's self-identity is invested in narratives of recovery and opioid use symbolises their addicted past or because for practitioners, this population is a clinical risk with the potential for drug seeking behaviours.