In nitrogen (N)-limited systems, the potential to sequester carbon depends on the balance between N inputs and losses as well as on how efficiently N is used, yet little is known about responses of these processes to changes in plant species richness, atmospheric CO2 concentration ([CO2]), and N deposition. We examined how plant species richness (1 or 16 species), elevated [CO2] (ambient or 560 ppm), and inorganic N addition (0 or 4 g x m(-2) x yr(-1)) affected ecosystem N losses, specifically leaching of dissolved inorganic N (DIN) and organic N (DON) in a grassland field experiment in Minnesota, USA. We observed greater DIN leaching below 60 cm soil depth in the monoculture plots (on average 1.8 and 3.1 g N x m(-2) x yr(-1) for ambient N and N-fertilized plots respectively) than in the 16-species plots (0.2 g N x m(-2) x yr(-1) for both ambient N and N-fertilized plots), particularly when inorganic N was added. Most likely, loss of complementary resource use and reduced biological N demand in the monoculture plots caused the increase in DIN leaching relative to the high-diversity plots. Elevated [CO2] reduced DIN concentrations under conditions when DIN concentrations were high (i.e., in N-fertilized and monoculture plots). Contrary to the results for DIN, DON leaching was greater in the 16-species plots than in the monoculture plots (on average 0.4 g N x m(-2) x yr(-1) in 16-species plots and 0.2 g N x m(-2) x yr(-1) in monoculture plots). In fact, DON dominated N leaching in the 16-species plots (64% of total N leaching as DON), suggesting that, even with high biological demand for N, substantial amounts of N can be lost as DON. We found no significant main effects of elevated [CO2] on DIN or DON leaching; however, elevated [CO2] reduced the positive effect of inorganic N addition on DON leaching, especially during the second year of observation. Our results suggest that plant species richness, elevated [CO2], and N deposition alter DIN loss primarily through changes in biological N demand. DON losses can be as large as DIN loss but are more sensitive to organic matter production and turnover.


Abstract Background: Treatment for locally recurrent breast cancer poses a significant challenge because the benefits in local control must be weighed against the increased risk of side effects of the treatment. Frequently, patients have been heavily pre-treated with radiation and several types of chemotherapy. Moreover, they often present with large volumes of bulky disease, further complicating management. Hyperthermia can be used to improve the efficacy of radiation, particularly in the setting of recurrent disease. Methods: We reviewed our clinical and dosimetric experience of breast cancer patients who received hyperthermia and radiation for recurrent breast cancer from 2011 to 2017. Thirty-six patients were treated with hyperthermia and radiation. Median follow-up was 11 months. Thirty patients (83.3%) received prior radiotherapy. The most commonly used radiation fraction scheme was 32 Gy in 8 fractions. The median radiation dose at the time of recurrence was 35.5 Gy (range 20–64 Gy). Mild temperature hyperthermia was delivered two times per week. Results: The median repeat radiation volume was 574 cc (range 11–3620 cc). Electrons, conventional photons, and IMRT radiation techniques were used. IMRT was used for large and complex treatment volumes and showed acceptable doses to organs at risk. The overall response rate was 61.1%. Complete response was observed in 17 patients (47.2%), partial response in 5 patients (13.9%), stable disease in 11 patients (30.6%), and progressive disease in 3 patients (8.3%). Twenty-six patients experienced acute grade 1 and 2 toxicities, primarily pain and erythema; and 26 experienced long-term grade 1 and 2 toxicities, mainly hyperpigmentation and lymphedema. Three patients developed new ulcerations that healed with conservative management. One patient developed pulmonary fibrosis resulting in mild dyspnea on exertion. Conclusion: Hyperthermia and radiation provide good local control with a favorable side effect profile. Thermoradiotherapy may be offered to patients with recurrent breast cancer, including those with extensive volumes of disease.


Cotton fabric with excellent antibacterial properties was obtained by treated with polyamide-amine (PAMAM) dendrimers as a carrier and silver nitrate as an antibacterial agent. The antibacterial cotton fabrics were prepared by the methods of one-bath process and two-bath process. Antibacterial activity of cotton fabrics treated by two different methods was good, but the antibacterial durability of cotton fabric treated with two-bath process was better than that treated with one-bath process. After 50 washing cycles, cotton fabric treated with two-bath process still had good antibacterial property and its inhibitory rate to Gram-positive S. aureus and Gram-negative E. coli was over 99 %. It was found that the breaking strength retention of finished cotton fabrics was 85.83 % and the decrease of cotton fabrics' whiteness index was about 15 %.


OBJECTIVE
No studies have compared the response to selective serotonin reuptake inhibitors and atypical antipsychotics in anorexia nervosa. This case study examines such a comparison.

METHOD
This report describes a case of 12-year-old identical twins with anorexia nervosa, one of whom was treated with olanzapine and the other with fluoxetine, while undergoing family therapy.

RESULTS
Twin A treated with fluoxetine went from 75 to 84.4% ideal body weight, while Twin B treated with olanzapine went from 72 to 99.9% ideal body weight over the course of 9 months.

DISCUSSION
This case supports the need for adequately powered, controlled clinical trials to test the efficacy of olanzapine in adolescents presenting with anorexia nervosa.


PURPOSE
To evaluate retrospectively in 64 gastric non-Hodgkin lymphoma (G-NHL) patients the role of some prognostic factors in the therapeutic strategy of this disease.

PATIENTS AND METHODS
Sixty-four primary G-NHL patients (39 males and 25 females; median age: 57 years) were retrospectively evaluated. Treatment consisted of surgery alone (S) in 7 patients, chemotherapy alone (CT) in 15, CT + radiotherapy (RT) in 2, S + RT in 2, S + CT in 19, S + CT + RT in 16. Three patients had no treatment. Forty-four patients received sub-total gastrectomy (21) or total gastrectomy (23), and 20 were not submitted to surgery.

RESULTS
After a median follow-up of 106 months (range 48-201), the four-year disease free survival (DFS) was 56% and overall survival (OS) was 59%. In the univariate analysis, tumor invasion depth (p = 0.007), stage (IIE1 vs IIE2: p = 0.007; I-IIE1 vs IIE2-IV: p = 0.0000009) and treatment (in stage IE-IIE1: p = n.s.; in stage IIE2-IV: p = 0.002) were significantly different. In the multivariate Cox regression model, stage was the only significant variable negatively influencing survival.

CONCLUSIONS
Our study confirms the prognostic value of both the depth of invasion and the disease stage. In patients with early disease stages and disease localized to the gastric wall, a conservative approach can be recommended. No difference was found between the sub-total and total gastrectomy but surgery retains its fundamental role for G-NHL, even in advanced disease. Prospective trials are needed to confirm these results.


BACKGROUND Histoplasmosis is an endemic fungal infection in Peru and HIV coinfection leads to difficult diagnoses and high associated mortality. AIM To describe clinical, epidemiological and clinical outcomes in patients with HIV infection with diagnosis of disseminated histoplasmosis (DH) at Guillermo Almenara Irigoyen National Hospital, Lima, Peru. METHODS Retrospective, descriptive study; information was obtained from the computer registry of patients with HIV infection diagnosed with DH, during the period 1996-2014. Clinical, epidemiological, treatment and outcome characteristics were described. RESULTS We found 27 patients, 25 (92.6%) were male, with a mean age of 36.7 years (± 9.4 years) and 22 (81.5%) had an epidemiological history contact. Sixteen patients (59.3%) had DH as an AIDS defining disease. The median CD4 count was 65 cells/mm3 (IQR 15-92). Only 7 (25.9%) received combination antiretroviral therapy at diagnosis. The most common clinical presentation was fever (66.7%), chronic diarrhea (40.7%) and lymphadenopathy (33.3%). The diagnosis was made mainly by histopathology. Six (22.2%) patiens died in the acute stage of the disease. Seven (25.9%) were initially treated empirically as tuberculosis. CONCLUSION We describe the clinical characteristics of a group of patients who had DH as HIV coinfection and this is still a quasi endemic reality in patients suffering from this pathology.


Increasing prices- and high demand for hydrocarbons worldwide have encouraged oil companies to explore in deeper, more vulnerable- and hasher ocean environments. A consequence of working in such areas is that the requirements of the equipment are rising. Aker Drilling Risers, together with Institut Francais du Petrole, have taken all this into account, and are currently designing their second edition of the clip connector drilling riser. This newly developed riser system is based on a load-sharing-system, were both the peripheral-lines (P-lines) and the main pipe are in tension. With the development, Aker Drilling Risers are interested in a parameter study around the fatigue of P-lines. This master's thesis combines a global and a local Finite Element (FE) Analysis together with Miner's rule to calculate the fatigue life. A local FE model of the connector calculates the hot spot stress in the p-line, and a global analysis calculates the tension variation in the riser pipe. The two analyses are coupled together to create a local stress histogram. It is then summed up by using Miner's rule to calculate the fatigue life. In the first chapter an introduction to the problem and specification around Aker's drilling risers are given. Further the chosen procedure and the theoretical background are shown. This is primarily limited to DNVs main code for the area, DNV-RP-C203; fatigue design of offshore steel structures. The main part is divided in two; first the local analysis in Abaqus is described and different parameters, such as, threads, design, pressure and friction are analyzed. The parametric optimized design is used to calculate a stress transfer function (STF). In the second part an existing analysis from the Gulf of Mexico is used to create the tension variation. The tension variation was connected to the local stress transfer function to create the local stress histogram and then summed up with Miner's rule. A discussion around the results and the procedure are done before the author concludes:With the optimized design, with the new elliptical radius on the box, the structure is well prepared to handle to cyclic stresses for the Gulf of Mexico. With this tension variation, it has a constant operating fatigue life of 740 years.


In this paper, I measure the importance of remittances and financial development for developing countries. I estimate an index of overall financial conditions and use it to determine the relevance of the financial sector as a transmission channel for remittances to affect economic growth. The index brings together information from existing measures, reflecting size, depth and efficiency of the financial sector. It is created by means of an unobserved components model. I show that the more financial development in a country, the smaller becomes the impact of remittances on economic growth and it can even turn negative. For countries with weaker financial markets there is a positive effect, but significant only at the earliest stages of financial development. The effect becomes negative in the third quartile of financial development. These results hold irrespective of the measure of financial development included, but are most profound in case of the created index. This means that estimates based on proxies might be slightly biased. I also show that countries with both low levels of remittances and financial development should first focus on developing the latter, while migrants' transfers become important for growth if the country has a moderate level of financial development.


In recent years, Artificial Neural Networks (ANNs) pruning has become the focal point of many researches, due to the extreme overparametrization of such models. This has urged the scientific world to investigate methods for the simplification of the structure of weights in ANNs, mainly in an effort to reduce time for both training and inference. Frankle and Carbin [1], and later Renda, Frankle, and Carbin [2] introduced and refined an iterative pruning method which is able to effectively prune the network of a great portion of its parameters with little to no loss in performance. On the downside, this method requires a large amount of time for its application, since, for each iteration, the network has to be trained for (almost) the same amount of epochs of the unpruned network. In this work, we show that, for a limited setting, if targeting high overall sparsity rates, this time can be effectively reduced for each iteration, save for the last one, by more than 50%, while yielding a final product (i.e., final pruned network) whose performance is comparable to the ANN obtained using the existing method.


The hereditary features of renal disease have engendered much interest since the turn of the century. Hereditary cystic renal disease, abnormalities in both proximal and distal tubular function, chronic glomerulonephritis, nephrosis, congenital anomalies, and tumors of the genitourinary tract are well documented and were the subject of a recent review by Perkoff. 1 This paper describes a family with persistent microscopic hematuria of glomerular origin without nephritis, deafness, ocular lesions, impairment of renal function, or other congenital anomalies. An unusual structural abnormality, thin glomerular capillary basement membranes, was a constant finding in this kindred and may be the cause of the hematuria. Hematuria is usually considered a serious symptom, and its presence calls for meticulous investigation. The diagnosis of "idiopathic" or "essential" hematuria is a diagnosis of exclusion, and can be made only when no cause for the hematuria is found after exhaustive investigation. The abnormality causing the hematuria can


In continuous casting process, tundish operates as a refining finisher. Different flow modifiers can be used in order to optimize cleanliness of liquid steel. To study the effect of various flow modifiers such as dam, weir, inlet shroud and etc., a three dimensional mathematical model was developed to simulate turbulent flow inside the tundish. The computed flow field was further used to model the transient mass transfer in the melt flowing in the tundish. The residence time distribution (RTD) of particles was determined by mass transfer model. The performance of the model was evaluated by experimental data obtained by a physical model. The verified model was used to evaluate the effect of location and size of different flow modifiers on flow pattern and particles residence time and consequently on tundish performance.


Summer rainfall in the central United States has singular interannual variations of a 3-6-yr period. Identifying the causes of these variations assures improvement in predictions of summer rainfall in the region. A review of previous studies revealed a puzzling situation: the outstanding interannual variations of the summer rainfall in the central United States showed no persistent correlations with known influential interannual variations in the Northern Hemisphere and the El Nino-Southern Oscillation (ENSO). This study was undertaken to identify the cause of this situation and ultimately explain the causes of the observed interannual summer rainfall variations. Its results showed a teleconnection of the ENSO with the summer rainfall in the central United States. The intensity of which has varied over the last 125 years. The teleconnection was active in two epochs, 1871-1916 and 1948-78, and absent in the two epochs 1917-47 and 1979-present. This variation was associated with a multidecadal variation in both sea surface temperature and sea level pressure in the mid- and high-latitude North Pacific. In the epochs of active teleconnection, the circulation in the warm phase of ENSO favored a deformation field in the lower troposphere in the central United States causing wet summers and a reversed circulation in cold phase of ENSO yielding dry summers, a process that partially explains the interannual summer rainfall variations. The result also showed that the variations of the teleconnection were ''in phase'' with the variation in the average surface temperature of the Northern Hemisphere. When the ''abrupt warming'' of the surface temperature developed in 1917-47 and the most recent two decades, the teleconnection broke down. Because of the limitation in data record length, this observed relationship and the persistence of the variation in the teleconnection need further investigations when additional data are available.


BACKGROUND
Burns are one of the most important causes of traumatic death in children worldwide. A pediatric burn center was established in our hospital in August 2009. The aim of this study was to compare patient profiles and data before and after the burn treatment center was established.

METHODS
Burn patients were admitted to the pediatric surgery department between January 2005 and August 2009, and there was no intensive care service in this department. Intensive care service has been provided since August 2009 with the burn center established at our hospital. The 316 cases that were followed-up at the pediatric surgery department in the first period were identified as Group I and the 442 cases that were admitted to the burn center in the second period were identified as Group II. The data of the groups were then compared.

RESULTS
Mean age of the cases was 5.1 years in Group I and 7.7 years in Group II. The total mean body burn percentage was 16.12% in Group I and 17.54% in Group II. Although scalding burns were the most subtype in both groups, flame burns were 2.13 times, electrical burns 3.44 times, flame+inhalation burns 8.33 times, and burns with an over 40% total burn surface area were 2.41 times more common in Group II than in Group I. The mortality rates were 0% in Group I and 2.26% in Group II.

CONCLUSION
Converting to a normal department admitting burn patients in a burn unit format to an actual burn center means more severe cases will be admitted. This requires a patient and attentive process while the burn team struggles with the new patient profile on one hand and has to learn how to overcome with less personal trauma the loss of patients, a feeling it is unfamiliar with, on the other, which is also an actual training process for the entire burn team.


OBJECTIVE
The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) trial demonstrated that glycemic failure rates were significantly lower in youth randomized to metformin plus rosiglitazone treatment than in youth randomized to metformin alone or metformin plus intensive lifestyle intervention. At the end of the study, rosiglitazone was permanently discontinued, and routine diabetes care resumed. Herein, we report postintervention glycemic failure rates in TODAY participants over an additional 36 months of follow-up for the three original treatment arms and describe insulin sensitivity and β-cell function outcomes.

RESEARCH DESIGN AND METHODS
A total of 699 participants were randomized during TODAY, of whom 572 enrolled in the TODAY2 observational follow-up. Glycemic failure was defined as HbA1c ≥8% over a 6-month period, inability to wean from temporary insulin therapy within 3 months after acute metabolic decompensation during TODAY, or sustained HbA1c ≥8% over two consecutive visits during TODAY2. Oral glucose tolerance tests were conducted, and insulin sensitivity, insulinogenic index, and oral disposition index were calculated.

RESULTS
During the 36 months of TODAY2, glycemic failure rates did not differ among participants by original treatment group assignment. Insulin sensitivity and β-cell function deteriorated rapidly during the 36 months of TODAY2 routine diabetes care but did not differ by treatment group assignment.

CONCLUSIONS
The added benefit of preventing glycemic failure by using rosiglitazone as a second agent in youth-onset type 2 diabetes did not persist after its discontinuation. More work is needed to address this rapid progression to avoid long-term diabetes complications.


Super Madi Hydrolectric Project (SMHEP) is located in Kaski District of Nepal. It is a run of river scheme with a installed capacity of 44 MW, net head of 295m and design discharge of 18 m^3⁄s.It has planned to build for the fulfillment to minimize the load-shedding problem of Nepal in the current scenario. This project lies in the lower part of the Higher Himalaya, mainly dominated by high-grade metamorphic rocks like gneiss and schists. Major task involve in this thesis work is to check for proper alignment of existing layout, assessment of stability condition with proper support system. Selection of best alternative alignment of cavern with its best shape and size are also another major work in this thesis. Optimum support estimation for the best alternative has also been done. Conclusion and final recommendations are based on stability condition and degree of rock support requirements. Geological and topographical site condition of headworks restrict for exposed settling basin therefore underground settling basin cavern in the left hill side has been selected. Rock mass in the settling basin area is slightly deformed, foliated micaous and banded gneiss with thin layer of schist. Analysis is based on assumption of ``No significant faults and shear zones across the alignment of settling basin cavern``. Both alternatives with axis orientation of N145E have been selected for the analysis. Shape of the caverns in both alternatives are inverted D. Existing alternative consists of two parallel settling basin caverns with a clear spacing of 9.5 m. Average width and height for both the caverns of existing alternative (Alternative I) are 8.4 m and 15 m whereas for proposed alternative (Alternative II) are 18.3 m and 20 m are respectively. Stress-strength factor plays a vital role for overall stability condition of the cavern. Stress induced problems such as rock bursting and spalling in hard rock whereas squeezing in weak rock is assumed. Some Empirical, Analytical, and Numerical approaches have been used for stability assessment and for designing of proper rock support system. RMR and Q-system of rock mass classification are used to classify the rock masses. Grimstad and Barton (1993) method is used in the analysis of rock bursting problem and squeezing problem. As a Semi-analytical approach ``Hoek and Marionos approach`` has been used for squeezing analysis. Numerical approaches have many benefits over empirical and analytical approaches, specifically in complex geometry like settling basin cavern. Rocscience software for numerical analysis such as Phase^2 and Un-wedge has been used. Generalized Hoek and Brown failure criterion are used to determine the state of stresses, strength factors, and deformations around the periphery of the caverns in Phase^2 . To analyze the wedge failure due to low shear strength of joints, empirical approach suggested by Barton and Bandis is used in the numerical analysis through rocscience software-Unwedge. Comparative study of empirical, analytical, and numerical approaches of analysis have been carried out for assessment of stability conditions. Finally, some recommendations to improve the analysis results have been performed.


This paper proposes a generative method to extract 3D human pose using just a single image. Unlike many existing approaches we assume that accurate foreground background segmentation is not possible and do not use binary silhouettes. A stochastic method is used to search the pose space and the posterior distribution is maximized using Expectation Maximization (EM). It is assumed that some knowledge is known a priori about the position, scale and orientation of the person present and we specifically develop an approach to exploit this. The result is that we can learn a more constrained prior without having to sacrifice its generality to a specific action type. A single prior is learnt using all actions in the Human Eva dataset [9] and we provide quantitative results for images selected across all action categories and subjects, captured from differing viewpoints.


Abstract: Hypertonic saline (HTS) is an osmotic agent that can help patients in the acute phase of severe traumatic brain injury. HTS extracts fluid from swollen cerebral tissue to both control intracranial pressure and diminish the deleterious effects of secondary brain injury. Neuroscience nurses in intensive care and acute care units, who may administer HTS as resuscitation fluid, continuous infusion, or bolus dose, need to be familiar with physiologic actions, potential side effects, and appropriate HTS administration techniques. Neuroscience nurses collaborate with other members of the interdisciplinary team to ensure that HTS is administered safely. Severe traumatic brain injury (TBI) is a major health problem in the United States. There are approximately 50,000 new cases per year, including 17,500 deaths (Narayan et al., 2002). Head injury, which causes significant mortality in all age groups (Bullock et al., 2000), is the leading cause of death in infants and children (Simma, Burger, Falk, Sacher, & Fanconi, 1998). TBI is a contributing factor in more than 60% of all trauma-related deaths (Bullock et al.). The high mortality rate associated with severe TBI probably is in part due to the deleterious effects of secondary brain injury. The primary injury is often followed by secondary events hours and even days later (Bayir, Clark, & Kochanek, 2003). The occurrence of devastating secondary events accounts for the fact that inpatient mortality rates continue at an alarming 25%–33%, even at the best head injury centers in the country (Narayan et al., 2002). In fact, as many as 90% of patients who die from TBI show some evidence of secondary brain injury (Shackford et al., 1998). Hypertonic saline (HTS) is an osmotic agent that may diminish the effects of secondary brain injury in patients with TBI. Given during the acute phase of head trauma care, this treatment is inexpensive and has manageable side effects. It has been determined to be safe and effective in multiple human trials. HTS can be given during resuscitation, via continuous infusion, or as a bolus dose (Doyle, Davis, & Hoyt, 2001). Nursing care for patients receiving HTS includes careful administration and close monitoring of laboratory values and patient status (Johnson & Criddle, 2004). This article provides guidelines for HTS administration and a general plan for nursing care. The recommendations are based on protocols and results reported in previously published studies.


In the present article we are studying the relation between the prefix s?- and the simple verbal basis of the Greek lexicon-grammar in order to find the regularities pertaining to the behavior of the prefix s?-, which will contribute to the semi-automatic enrichment of the electronic dictionary DELAGR. A series of observations on the syntactic structures containing these verbs reveal the fact that prefixation has to be considered in terms of predicative relations and arguments. The article is divided in three parts: 1. presentation of some particularities; 2. description of the inflection of prefixed verbs 3. presentation of data and restraints. In conclusion we are providing some statistic elements concerning the formation of prefixed verbs with s?-.


The work contains the analyses and discussion of the main sources of space radiation specified for interplanetary flights, the dosimetric functionals used for describing the processes of radiation lesions and reparation of the organism in the conditions of the complex radiation impact with a broad charge composition of cosmic rays and a peculiar spatial and temporal dose behavior. It represents the results of calculations of the radiation risks during the flight and the total lifelong radiation risk with taking into account all the delayed unfavorable biological consequences. The main uncertainties in the calculated values of radiation risk leading to its undervaluation are analyzed. In addition, also provided is the range of theoretical and experimental investigations necessary for the adjustment of coefficient values used in the algorithm of radiation risk calculations, as well as in the nomenclature of experiments for estimating the individual resistance of man to the extreme influence and investigations aimed at estimating and increasing the reliability of the operator activity of cosmonauts.


With the deployment of collaborative robots in intelligent manufacturing, object hand-over between humans and robots plays a significant role in human–robot collaborations. In most collaboration studies, human hand-over intentions were usually assumed to be known by the robot, and the research mainly focused on robot motion planning and control during the hand-over process. Several approaches have been developed to control the human–robot hand-over, such as vision-based approach and physical contact-based approach, but their applications in manufacturing environments are limited due to various constraints, such as limited human working ranges and safety concerns. In this paper, we develop a practical approach using a wearable sensory system, which has a natural and simple configuration and can be easily utilized by humans. This approach could make a robot recognize a human's hand-over intentions and enable the human to effectively and naturally control the hand-over process. In addition, the approach could recognize the attribute classes of the objects in the human's hand using the wearable sensing and enable the robot to actively make decisions to ensure that graspable objects are handed over from the human to the robot. Results and evaluations illustrate the effectiveness and advantages of the proposed approach in human–robot hand-over control.


The Cloud relies heavily on resource replication to support the demands of the clients efficiently. Replicated Cloud services are distributed across large geographic areas and are accessible via the Internet. This paper describes MidCloud; an agent‐based middleware that provides Cloud clients with dynamic load balancing and fault tolerance mechanisms for effective utilization of replicated Cloud services and resources. MidCloud can be used to connect clients with multiple replicated Cloud services and provide fast and reliable service delivery from multiple replicas. Several approaches for load balancing and fault tolerance in distributed systems were introduced; however, they require prior knowledge of the environment's operating conditions and/or constant monitoring of these conditions at run time that allows the applications to adjust the load and redistribute the tasks when operational conditions change and when failures occur. These techniques work well when there is no high communication delay. Yet, this is not true in the Cloud, where data storage and computation servers are scattered all over the world and communication delays are usually very high. MidCloud deploys approaches to reduce the negative impact of high and dynamic delays on the Cloud servers and the Internet. The experimental results show the positive effects of using MidCloud to provide efficient load balancing and fault tolerance. Copyright © 2013 John Wiley & Sons, Ltd.


Epistaxis is one of the most frequent emergencies in Otorhinolaryngology and occurs in other disciplines, esp. in Oncology, Traumatology and Pediatrics as well. Even the young otorhinolaryngologist should be basically informed about the diagnostic concepts and therapies available for nosebleeding patients. The specialist should be capable to choose between modern and traditional therapeutical options in order to realise a definitive closure of the bleeding source with maximal comfort for the patient and with preservation of functionally important structures. However, even for the specialized rhinologist it can be difficult to overview the tremendous variety of the different therapies and diagnostical procedures. This article is a compressed review of both the traditional guidelines and the more innovative methods concerning epistaxis. Additionally it deals with the vascular anatomy of the nose and the pathophysiology of epistaxis.


Various politicians and public commentators seek to deny birthright citizenship to children born in the United States to undocumented or temporary migrants. Among their claims, critics of universal birthright citizenship contend that the practice flies in the face of liberal principles, in which both individuals and the state should consent to membership. From this perspective, citizenship through naturalization is valorized, since it rests on the affirmative choice of the immigrant and the clear consent of the state. This chapter proposes a different approach to these debates, one that underscores the principles of inclusion and equality. The argument rests on empirical evidence on how those affected by these debates – foreign-born residents and their U.S.-born children – understand belonging in the United States. Interviews with 182 U.S.-born youth and their immigrant parents born in Mexico, China, and Vietnam show that despite a discourse portraying U.S. citizenship as a civic and political affiliation blind to ascriptive traits, many of those interviewed equate "being American" with racial majority status, affluence, and privilege. For many immigrants, membership through naturalization – the exemplar of citizenship by consent – does not overcome a lingering sense of outsider status. Perhaps surprisingly, birthright citizenship offers an egalitarian promise: it is a color-blind and class-blind path to membership. The Citizenship Clause of Fourteenth Amendment provides constitutional legitimacy for the ideals of inclusion and equality, facilitating immigrant integration and communal membership through citizenship.


Marine soundscapes often differ among habitats; however, relatively little is known about whether soundscapes on naturally occurring habitats differ from soundscapes on human-made structures. To address this knowledge gap, we investigated whether temporal and spectral characteristics of biological sound production differ between natural and artificial offshore reefs. Specifically, we analyzed recordings from 5 week-long hydrophone deployments on 2 natural rocky reefs and 2 artificial reefs on the North Carolina, USA, continental shelf. Analysis of sound pressure levels (SPLs) on hourly and seasonal scales revealed similar temporal patterns between the reef types. These patterns were largely driven by 4 dominant fish vocalizers with seasonal chorusing patterns, including a toadfish Opsanus sp. Despite similar temporal patterns within reef types, soundscape spectral content was more similar within than between reef types, especially during the April deployment, which had the most acoustic activity. Our findings suggest that the soundscapes of shipwreck artificial reefs may differ from the soundscapes of natural rocky reefs, possibly due to differing community composition. As sound plays an important role in the navigation and settlement of many marine species, soundscape differences between natural and artificial habitats could affect ecosystem function through species behavior and interactions.


Stress shielding phenomenon is an important issues in considering the primary stability of the cementless hip arthroplasty. Stress shielding occurs when there is a mismatch in the elastic modulus of two materials perfectly bonded to each other, such as the prosthesis stem and the bone. In this study, influences of different prosthesis stem lengths on stress distribution in cementless THA are examined using finite element method. The calculated stress distribution is discussed with respect to stress shielding and primary stability issues in THA femur cases. Results show that similar pattern in stress distribution for intact and THA femur but differs in magnitudes. The stress level increases from the neck to the middle region and peaks at locations coinciding with the tip of the prosthesis. The maximum stress for intact femur is 55.5 MPa, THA with short stem is defined up to 112 MPa, while with medium and long stem are 204 MPa and 278 MPa, respectively.


The binding of the basement-membrane glycoprotein laminin to glycosaminoglycans (aggregating and non-aggregating subsets of heparan sulphates and dermatan sulphates, as well as heparin, chondroitin sulphates and hyaluronic acid) was studied by affinity chromatography. Partially periodate-oxidized chains of glycosaminoglycans were coupled to adipic acid dihydrazide-substituted agarose. Co-polymeric glycosaminoglycans reveal high affinity for laminin, whereas hyaluronic acid does not. Competitive-release experiments indicate that glycosaminoglycans share a common binding site on the laminin molecule.


The influence of buyer and personal relationship characteristics on agricultural land prices has received little attention in the literature. Recently, Perry and Robison (2001) used a restricted nonlinear specification to model the influence of personal relationships on the implicit prices of land characteristics. In this paper a more flexible alternative model is proposed. An approach to general model specification and model selection is presented. The results indicate that buyer characteristics and personal relationships exert nonuniform effects on the implicit prices of land characteristics. Our results support the hypothesis that social capital affects the terms of trade in the land market. (JEL C14)


Background/Aims—Gastric cancer is one of the most prevalent forms of cancer in East Asia. Point mutation of the p53 gene has been reported in more than 60% of cases of gastric cancer and can lead to genetic instability and uncontrolled cell proliferation. The purpose of this investigation was to evaluate the potential of p53 gene therapy for gastric cancer. Methods—The responses of human gastric cancer cell lines, MKN1, MKN7, MKN28, MKN45, and TMK-1, to recombinant adenoviruses encoding wild type p53 (AdCAp53) were analysed in vitro. The eYcacy of the AdCAp53 treatment for MKN1 and MKN45 subcutaneous tumours in nude mice was assessed in vivo. Results—p53-specific growth inhibition was observed in vitro in two of four gastric cancer cell lines with mutated p53, but not in the wild type p53 cell line. The mechanism of the killing of gastric cancer cells by AdCAp53 was found, by flow cytometric analysis and detection of DNA fragmentation, to be apoptosis. In vivo studies showed that the growth of subcutaneous tumours of p53 mutant MKN1 cells was significantly inhibited by direct injection of AdCAp53, but no significant growth inhibition was detected in the growth of p53 wild type MKN45 tumours. Conclusions—Adenovirus mediated reintroduction of wild type p53 is a potential clinical utility in gene therapy for gastric cancers. (Gut 1999;44:366–371)


The "Red". The imagine of the enemy in the""Nationalist Spain" - This paper examines the multiform nature of the violence that erupted during the Spanish Civil War, with particular emphasis on its symbolic dimension. To this end, its considers the propagandistic construction underpinning the representation of the «enemy» (los rojos) in the so-called Nationalist press during one moment of the war, aftermath of the fighting on the Madrid front and the advance of the Nationalist forces througt northern Spain Parole chiave: Guerra civile spagnola, violenza, propaganda, rappresentazione culturale, nemico, nazionalismo Spanish Civil War, violence, propaganda, cultural representation, enemy, nationalism


The petitioners were parishioners and respectively the partner of 25 years and daughter of the deceased. They sought a faculty for the reservation of gravespaces in order that they might be buried respectively with and alongside his remains. His three children by his former wife and his sister objected on the basis that it would be uncomfortable for them talking to him in his grave in the knowledge that the petitioners were also buried there. The chancellor noted the Christian belief that although mortal remains stay in the grave, the immortal soul of the person who has died is not there, but lives on in Christ. The faculty was granted. [RA]


The Haiti Agroforestry Research Project was a program to encourage Haitian farmers to plant fast growing trees as a cash crop. This project was part of an overall plan by USAID to curb the devastating erosion which was washing the top soil into the sea.


Paper submitted to the AIAA Guidance, Navigation, and Control Conference held at Gaylord National Resort & Convention Center, National Harbor (Maryland), 13-17 of January 2014.


Objective: To assess whether ultrasound measurement of vaginal wall thickness demonstrates intra-observer and inter-observer reliability. Method: Twenty five women had a transvaginal ultrasound scan and measurement of the thickness of tissue between the ultrasound probe and the pelvic organ in relation to the vaginal compartment being assessed. On the anterior vaginal wall this was the bladder and on the posterior vaginal wall, the rectum. This distance was termed vaginal wall thickness (VWT) and represented the thickness of the vaginal wall as well as any fascia between the vaginal wall and the pelvic organ. Measurements were taken at three anatomical sites: the bladder neck, dome of the bladder and the anterior fornix on the anterior wall, and the anorectal junction, rectum and posterior fornix on the posterior wall. The scan was repeated by an independent second operator at the first visit. Women then returned 4 to 6 weeks later and the ultrasound measurements of VWT were repeated. The interobserver and intraobserver measurements were analysed at each of the anatomical sites. Results: The mean difference in measurements between the two observers for the bladder neck measurement was 0.3 (SD: 0.41), bladder dome 0.07 (SD: 0.5) and anterior fornix was 0.3 (SD: 0.3). The mean difference at the anorectal junction was −0.02 (SD: 0.4), rectum −0.02 (SD: 0.4) and posterior fornix 0.2 (SD: 0.2). When comparing interoperator difference between visits 1 and 2. Mean difference for the bladder neck measurement was −0.1 (SD: 0.4), bladder −0.1 (SD: 0.3) and anterior fornix 0.07 (SD: 0.3). The anorectal junction was −1.0 (SD: 0.3), rectum −0.14 (SD: 0.4) and posterior fornix −0.05 (SD: 0.4). Conclusions: VWT showed small differences between operators and between the same operators at different visits. It is therefore a reliable technique.


Abstract We have investigated communication preferences of mammography results in 90 patients through a structured interview approach. About 81% of patients expressed that they wanted to get the results, and 18% expressed that getting the results does not help if they are incomprehensible. In patients who want to get the results, 80% preferred face-to-face interaction with physicians, whereas the others preferred other modes of communication to prevent loss of time. Majority of patients infavor of face-to-face interaction (57%) preferred both the referring physician and the radiologist. Comprehensibility and fast delivery of reports, plus direct communication with radiologists are the requirements in mammography patients while implementing patient-centered radiology.


Sex cord-stromal tumors (SCST) are rare tumors of the ovary that include three main subtypes known as pure stromal tumors, pure sex cord tumors, and mixed sex-cord stromal tumors. This case involves a 25year-old female who presented to the Gynecology outpatient clinic with a two-year history of amenorrhea associated with excessive hair growth since menarche. Ultrasonography revealed a solid left ovarian mass. Histopathology confirmed a diagnosis of SCST not otherwise specified with no cytological atypia. In this case report, we describe the process of managing this patient and a brief literature review on the updates regarding the clinical presentation, molecular changes, and management of SCSTs not otherwise specified.


The purpose of this study was to assess the difference in maximal physiological responses between an acute bout of deep-water running (DWR) and treadmill running (TMR) in young and older adults. Participants were 9 young and 9 older women who performed maximal DWR and TMR tests. Maximal measures included oxygen consumption (VO2max), heart rate (HRmax), ventilation (VE), respiratory-exchange ratio (RER), and blood lactate (BLac). The young women exhibited higher VO2max, HRmax, VE, and BLac than did the older women for both exercise conditions (p < .05). Lower VO2max and HRmax values were observed with DWR for both age groups (p < .05). No significant differences were found for VE, RER, and BLac in either group between exercise conditions, nor a significant interaction between exercise conditions or ages for any of the variables measured. The data suggest that although older adults exhibit lower maximal metabolic responses, differences between DWR and TMR responses occur irrespective of age.


Query enhancement with domain-specific metadata (thesaurus terms) is analyzed for monolingual and bilingual retrieval on the GIRT social science collection. We describe our technique of Entry Vocabulary Modules, which associates query words with thesaurus terms and suggest its use for monolingual as well as bilingual retrieval. Different weighting and merging schemes for adding keywords to queries as well as translation techniques are described. Query enhancement generally improves average precision scores for both monolingual and bilingual retrieval. We take a closer look at individual queries and discuss how the query enhancements (or substitutions in bilingual retrieval) can change retrieval results quite dramatically. A query-by-query analysis provides deeper insight into strengths and weaknesses of strategies and serves as a cautionary reminder that average precision scores don't always tell the whole story.


An important problem in the field of bioinformaties is to identify interactive effects among profiled variables for outcome prediction. In this paper, a simple logistic regression model with pairwise interactions among a set of binary covariates is considered. Modeling the structure of the interactions by a graph, our goal is to recover the interaction graph from independently identically distributed (i.i.d.) samples of the covariates and the outcome. When viewed as a feature selection problem, a simple quantity called influence is proposed as a measure of the marginal effects of the interaction terms on the outcome. For the case when the underlying interaction graph is known to be acyclic, it is shown that a simple algorithm that is based on a maximum-weight spanning tree with respect to the plug-in estimates of the influences not only has strong theoretical performance guarantees, but can also significantly outperform generic feature selection algorithms for recovering the interaction graph from i.i.d. samples of the covariates and the outcome.


Library@HACC: Guides are helpful web pages filled with quality information & resources that can be used to fulfill the research needs for your classes.


Human islet isolation is a cost-/resource-intensive program generating islets for cell therapy in Type 1 diabetes. However, only a third of cadaveric pancreas get to clinical transplantation due to low quality/number of islets. There is a need to identify biomarker(s) that predict the quality of islets, prior to initiating their isolation. Here, we sequenced transcriptome from 18 human islet preparations stratified into three groups (Gr.1: Best quality/transplantable islets, Gr.2: Intermediary quality, Gr.3: Inferior quality/non-transplantable islets) based on routine measurements including islet purity/viability. Machine-learning algorithms involving penalized regression analyses identified 10 long-non-coding(lnc)RNAs significantly different across all group-wise comparisons (Gr1VsGr2, Gr2vsGr3, Gr1vsGr3). Two variants of Metastasis-Associated Lung Adenocarcinoma Transcript-1(MALAT1) lncRNA were common across all comparisons. We confirmed RNA-seq findings in a "validation set" of 75 human islet preparations. Finally, in 19 pancreas samples, we demonstrate that assessing the levels of MALAT1 variants alone (ROC curve AUC: 0.83) offers highest specificity in predicting post-isolation islet quality and improves the predictive potential for clinical islet transplantation when combined with Edmonton Donor Points/Body Mass Index(BMI)/North American Islet Donor Score(NAIDS). We present this resource of islet-quality-stratified lncRNA transcriptome data and identify MALAT1 as a biomarker that significantly enhances current selection methods for clinical (GMP)-grade islet isolation.


Diabetic eye diseases, such as diabetic retinopathy (DR) and diabetic macular edema (DME) are among the leading causes of blindness in developed countries. Anti-VEGF therapies such as, ranibizumab, aflibercept and off-label bevacizumab have become first-line treatment for DME. While randomized controlled trials show significant improvement in vision, these anti-VEGF agents have limited durability leading to a significant treatment burden, as reflected in real-world studies, which generally demonstrate under-treatment and less favorable visual acuity outcomes than observed in prospective trials. Alternative pathways, such as the Tie-2 angiopoietin pathway may address unmet needs, with potential for greater efficacy or durability when compared to anti-VEGF monotherapy. While some Tie-2 angiopoietin therapeutic agents, such as nesvacumab, ARP-1536 or AKB-9778, did not meet primary endpoints in clinical trials, other agents have shown promise. One such agent is faricimab, a bispecific antibody inhibiting both VEGF-A and Ang-2. The phase 3 DME trials (YOSEMITE and RHINE) demonstrated favorable safety, visual, and durability outcomes; patients receiving faricimab injection every 4 months achieved similar visual gains as those receiving aflibercept injection every 2 months. Another agent, AXT107 is a peptide that inhibits VEGFR2 and modifies Ang-2 to behave more similarly to Ang-1, promoting vascular stability. This drug is currently undergoing phase 1/2a trials for safety and bioactivity to be completed in May 2022.


We perform time-resolved spectroscopy on the prompt emission in gamma-ray bursts (GRBs) and identify a thermal, photospheric component peaking at a temperature of a few hundreds keV. This peak does not necessarily coincide with the broad-band (keV–GeV) power peak. We show that this thermal component exhibits a characteristic temporal behavior. We study a sample of 56 long bursts, all strong enough to allow time-resolved spectroscopy. We analyze the evolution of both the temperature and flux of the thermal component in 49 individual time-resolved pulses, for which the temporal coverage is sufficient, and find that the temperature is nearly constant during the first few seconds, after which it decays as a power law with a sample-averaged index of −0.68. The thermal flux first rises with an averaged power-law index of 0.63 after which it decays with an averaged index of −2. The break times are the same to within errors. We find that the ratio of the observed to the emergent thermal flux typically exhibits a monotoneous power-law increase during the entire pulse as well as during complex bursts. Thermal photons carry a significant fraction (∼30% to more than 50%) of the prompt emission energy (in the observed 25–1900 keV energy band), thereby significantly contributing to the high radiative efficiency. Finally, we show here that the thermal emission can be used to study the properties of the photosphere, hence the physical parameters of the GRB fireball.


Rheumatoid arthritis is a progressive, chronic, and degenerative disease that adversely affects the quality of life of individuals. Depending on the individual's symptoms of rheumatoid arthritis, basic and instrumental daily life activities are restricted, and par‐ ticipation of life is adversely affected. Occupational therapy interventions for rheumatoid arthritis rehabilitation include self‐management programs (e.g., arthritis self‐manage‐ ment program, bone up on arthritis, self‐management arthritis treatment physical activ‐ ity), splinting techniques for rheumatoid arthritis, and vocational rehabilitation. In this chapter, updated information about these approaches is brought together and presented to the reader.


PURPOSE/OBJECTIVES
To obtain information about the knowledge and attitudes of oncology nurse practitioners (ONPs) concerning the effect of direct-to-consumer (DTC) advertising of prescription medications on prescribing patterns.

DESIGN
Exploratory survey.

SETTING
Oncology Nursing Society Nurse Practitioner Special Interest Group members in the United States.

SAMPLE
221 of 376 ONPs completed the survey (58%).

METHODS
Researcher-developed 12-question postal survey.

MAIN RESEARCH VARIABLES
Knowledge and attitudes of ONPs on DTC advertising effects on prescribing patterns.

FINDINGS
The findings were similar to those of previous studies of physicians regarding the number of visits when patients requested DTC-advertised medications. Major differences were the positive attitudes of ONPs toward potentially longer patient visits to explain and educate patients regarding medication requests based on DTC advertising and smaller percentages of ONPs who felt "pressured" to prescribe requested medications.

CONCLUSIONS
ONPs have mixed opinions regarding the practice of DTC advertising but do not believe that they are influenced heavily by advertising with regard to prescriptive practices. ONPs consider patient encounters for education purposes as appropriate and include information about requested DTC-advertised medications in their approach to patient care.

IMPLICATIONS FOR NURSING
This is an exploratory survey of a specialty group of ONPs. More research is needed to further explore the practice of DTC advertising and potential influences on the prescribing patterns of ONPs. DTC advertising of prescription medications is increasing; ONPs need to increase their knowledge base about the potential for influences of prescriptive practices.


Randomised controlled studies of the treatment of status epilepticus (SE) are difficult to perform due to ethical reasons. Therefore, the evidence for treatment guidelines is mainly based on observational studies, case series, case reports, and retrospective database analyses. The diversity of approaches used to determine the termination drug in a treatment episode of SE shows that the scientific community has not yet found a global means of defining when and if an antiepileptic drug is successful in terminating SE. More meta-analyses are needed in order to compare the treatment effects in the subtypes of non-convulsive SE because these are only small heterogeneous subdivisions in large database analyses. Furthermore, we propose that future case series, observational studies, or retrospective database analyses should follow certain standards to make them more comparable.


In an effort to identify the key mechanisms controlling biological productivity and food web structure in the Chesapeake Bay estuarine turbidity maxima (ETM), we measured plankton community metabolism on a series of surveys in the upper Chesapeake Bay during the winter and spring of 2007 and 2008. Measured quantities included primary production, bacterial production, planktonic community respiration, and algal pigment concentrations. These measurements revealed a classic minimum in photosynthesis in the vicinity of the ETM. Temporal variability in plankton community metabolism, primary production, respiration, and bacterial production, were highest in the southern oligohaline region down-estuary of the ETM, and appeared to be driven by dynamic bio-physical interactions. Elevated primary production and community respiration in this region were often associated with the presence of mixotrophic dinoflagellates. The dinoflagellate contribution to primary production and respiration appeared to be particularly large as a result of their mixotrophic capabilities, which allow them to obtain energy both autotrophically and heterotrophically. This study suggests that mixotrophic dinoflagellates play a key role in pelagic food web in the oligohaline region of Chesapeake Bay supplying most of the labile organic matter during late winter and spring and also providing a vector for transferring microbial production to mesozooplankton.


This article discusses the psychological problems that may arise following upper extremity traumatic amputation. Members of a health team consisting of surgeon, hand therapist, and counseling psychologist describe their individual and group functions in assisting the patient's recovery.


The well-known black hole X-ray binary GRS 1915+105 is a unique source in the sense that it cannot be classified within the standard picture of black hole binary states. In this work, we study archival XMM-Newton observations taken between 2003 and 2004 of the chi variability class of GRS 1915+105, which corresponds to the hard state in the standard black hole X-ray binary state classification. The crucial point of our study is that by using XMM-Newton data, we can access the variability below 3 keV, an energy range that is not covered with RXTE. We focus on the study of the power spectral shape in the soft and hard X-ray band, in light of our work done with Swift on MAXI J1659-152. In the hard band (above 2.5 keV), power density spectra consist of band-limited noise and quasi-periodic oscillations, corresponding to the power spectral shape seen in the hard or intermediate state, while in the soft band the averaged power density spectrum is consistent with a power-law noise, corresponding to the power spectral shape usually seen in the soft state. The coexisting of two different power spectral shapes in the soft and hard band, where the soft-band power spectrum is dominated by a power-law noise, is consistent with MAXI J1659-152, and confirms the energy dependence of power spectral states. Our additional spectral analysis shows that the disc component does contribute to the soft-band flux. These findings support that the observed black hole power spectral state depends on which spectral component we are looking at, which implies that power spectral analysis is probably a more sensitive method than spectral modelling to trace the emergence of the disc component in the hard or intermediate state.


Food is a social and cultural capital, a symbolic medium through which we express our identity and group membership. Therefore, food culture and habits play a significant role in the processes of migration and acculturation, especially from the transnational perspective. This study, in which six European high-skilled migrants were interviewed in depth, explores how migrants experience acculturation in their diets and how they negotiate the food culture of receiving country, the United Kingdom. The results reveal that in the light of transnational theory, food enables newcomers to stretch their culture over time and space and helps them to accommodate to the new environment. This means participants retain most of their habits while adapting and acquiring new ones, alongside the neophobic and neophilic continuum. Besides, the study also raised a question for further research of migration, belonging and 'European identity', since majority of participants did not identify themselves with the concept of migrant.


Although attempts to develop any viable chemotherapeutic approaches to combat metastatic cancers have largely failed, potential genetic targets to halt metastatic progression continue to be identified. As drugs are developed to address these targets, there is a need for high-throughput systems that accurately reproduce in vivo microenvironments to gauge their efficacy. Accordingly, we have developed a three-dimensional in vitro culture system representative of the environment present upon secondary metastasis to quantitatively measure tumor cell invasion in this setting three-dimensionally. Culturing melanomas of different metastatic capacities within the system showed that each cell type invades the matrix in a manner commensurate to its known metastatic potential in vivo. Moreover, the developed quantitative schemes were put to use to characterize the effect of microenvironmental influences (i.e., matrix components, interstitial cell presence) on planar and vertical melanoma invasion. We propose this novel, quantitative system as a useful tool to assess the effects of pharmacologic and/or microenvironmental influences on tumor cell invasion at a metastatic site. [Mol Cancer Ther 2007;6(2):552–61]


Abstract The aim of this study was to investigate in vitro. antimicrobial and antioxidant activities of the methanol extracts of Cladonia foliacea. Willd. Hudson, Dermatocarpon miniatum.(L.) Mann., Everinia divaricata. (L.) Ach., Evernia prunastri. (L.) Ach., and Neofuscella pulla. (Ach.) Essl. Antioxidant activity was evaluated by two separate methods: scavenging of free radical DPPH and the inhibition of linoleic acid oxidation. Extracts of C. foliacea., E. divaricata., E. prunastri., and N. pulla. did not exert any activity in both assays, whereas those of D. miniatum. provided 50% inhibition at 396.1 µg/ml concentration in the former and gave 49% inhibition in the latter. Total phenolic constituents of extracts from lichen species tested (C. foliacea., D. miniatum., E. divaricata., E. prunastri., and N. pulla.) were 1.7% (w/w), 2.9% (w/w), 3.0% (w/w), 2.6% (w/w), and 1.5% (w/w), respectively (as gallic acid equivalent), implying that the observed activity could be related to the amount of polar phenolics. Extracts were also found to possess antimicrobial activity against some of the bacteria and fungi tested, but no activity was observed against the yeasts.


Background: Different definitions and estimates of over-diagnosis in mammographic screening reflect a substantial need to investigate and understand the complexity of the issue. This modelling study aims to estimate the number of over-diagnosed women, defined as those diagnosed with breast cancer who die from any cause within the lead-time period. Methods: We used numbers from incidence- and death statistics available online and published estimates of lead-time. Postulated cohorts of screened and not screened women aged 50–51 were followed for a period corresponding to ten biennial screening exams during 20 years, and a further ten years, to age 78-79. The increase in breast cancer incidence due to screening was estimated based on lead-time. The proportion of women diagnosed with breast cancer who died within the lead-time period was assessed based on the differences in the cumulative number of breast cancer diagnosed in a non-screened and screened cohort. Results: The proportion of inevitable over-diagnosed women in a screened versus non-screened cohort was 1.9% for England & Wales and 1.8% for Norway. Sensitivity analyses using various assumptions increased the estimates up to a maximum of 4%. Conclusion: The proportion of women with breast cancer diagnosed after participation in a screening program who died within the estimated lead-time period was less than 4%. This inevitable proportion of over-diagnosis should be emphasized in the definition and communication of the issue. Impact: The issue of over-diagnosis is complex and estimates should be interpreted with substantial care.


The change of the over-current protection point of the power switches, caused by slope compensation, is analyzed in detail. It is discovered that the peak current protecting value increases as the duty cycle decreases. As a result, the safety operation of the switches is damaged greatly. A novel solution to improve over-current protection with constant peak current limitation is proposed by inducing synchronous slope compensation into the current limit function instead of the original constant voltage. The design principle and method of the protection circuit based on a UC3846 PWM controller for the interleaved dual-forward converter is presented. Experimental results are given to verify the analysis.


The cost sharing scheme in health delivery is supposed to cater for the quality, affordable and better services for the Patients. The overall study objective was to assess the impact of cost sharing mechanisms in the delivery of healthcare services in Tanzania. The study was conducted in Dare es salaam at Amana Hospital using a sample of 108 participants where 95 were Patients, 3 doctors, 8 nurses, and 2 accountants. In line to the above mentioned subject, the specific objectives were to assess the accessibility, convenience and affordability of healthcare services to the beneficiaries and stakeholders, the performance of healthcare services delivery and to identify the obstacles facing the hospitals in the delivery. The data from the field were collected through questionnaires, and interview. The results revealed that less than 50% was awarded by participants to accessibility, convenience, and affordability of health services to the beneficiaries and stakeholders. Less than 45% was awarded to the performance of cost sharing scheme in health delivery is negative. Obstacles in this study included little participant's awareness about cost sharing, availability of medicines, long distance to the service centres, unfriendly hospital environment and poor hospital attendance. It can be concluded that the implementation of cost sharing scheme in Tanzania lies far from Tanzanians expectation of the said service. The following recommendations are made; Government should sensitize people on the cost sharing scheme. Prices of health services have to be revised to allow most Tanzanians to access it and lastly improving quality of health delivery is necessary to create confidence on patients to make use of them.


On March 11, 2009, President Barack Obama announced that Seattle Police Chief Gil Kerlikowske will be the next director of the Office of National Drug Control Policy (also known as the "Drug Czar"). Chief Kerlikowske's nomination comes as we approach the 40th anniversary of the so-called "war on drugs," which followed the passage of the Controlled Substances Act in 1970. This essay argues that after nearly 40 years, "it is becoming increasingly clear that our current drug control strategy has not worked." It reaches this conclusion after discussing a variety of studies and surveys that detail the amount of money that has been spent by the United States as part of this "war," and the results with regard to drug use in general, use of drugs by young people, and the ease of obtaining drugs, particularly in comparison to other countries that have used different approaches to addressing these issues. It also discusses the significant impact that U.S. drug policy has had on the size and composition of our prison population. The essay calls on the President and the new Drug Czar to change the focus of our nation's drug policy from a punitive approach to one that addresses the problem through the lens of public health. The essay discusses recent surveys and election results and sees an opportunity for politicians to seek fundamental change in our approach to combating drug use. The views of American voters are changing, and they are now more open to reform than they were in the 1980s and 1990s. The essay acknowledges that "[t]here is no magic bullet that can solve the problem of substance abuse." Nevertheless, it contends that "[t]here are ... a number of readily identifiable reforms that can help begin to set us on the right track and build a foundation for more significant improvements in the future." In particular, it suggests shifting funding from programs that have unsuccessfully focused on limiting the supply of drugs to programs that have proven successful at reducing demand. It also proposes removing provisions in federal law that are hampering the government's ability to pursue effective programs. The essay concludes by advocating the creation of a commission to conduct a comprehensive reevaluation of U.S. drug policy in light of what we have learned from other countries and from four decades of our own experience with the current approach.


Describing the existing and quantifying the extent of change in land use for spatially distributed land cover pattern of a selected study site using different machine based algorithms has been a topic of interest from a long time. The main objective of the paper presented here is appraisal of land use/land cover pattern for Varanasi study site using Sentinel-1 images using pixel based Support Vector Machines (SVMs) Polynomial algorithm. SVMs, supervised image classifiers has been particularly appealing in image classification studies with its desirable trait to successfully handle small training data and producing better accuracies than traditional methods. The results indicated an overall accuracy of 97.09% for the Sentinel-1 image classification using SVMs, which confirms the suitability of the microwave imagery like Sentinel-1 for land use/land cover studies.


Background: Oral health is an integral part of the general health of an individual. Children spend a considerable period in schools and teachers are in an enviable position to influence and guide children. School-based oral health education (OHE) is valuable as children are guided when young during the formation of their oral hygiene habits. Aim: This study was undertaken with the objective of assessing the oral health knowledge, attitudes, and practices of primary school teachers. Materials and Methods: This cross-sectional survey was conducted among primary school teachers in Shirur village of Udupi district. A validated questionnaire was used, and a total of 103 teachers were assessed for their knowledge, attitudes, and practices regarding oral hygiene. Statistical Analysis: Data description and statistical analysis were obtained using IBM SPSS Version 21-computer software (IBM Statistical Package for the Social Sciences, SPSS 21.0, Inc., Chicago, USA) in association with Microsoft Excel. Descriptive statistics were obtained, and the mean values and frequency distributions were calculated. Results: All teachers (100%) were unanimous in their agreement that oral health was an integral part of general health and 95.3% (n = 102) agreed on the need for periodic dental check up. A majority (55.8%) of the teachers brushed twice daily and 32.7% of them visited their dentist once every 6 months. All teachers were interested in delivering OHE in schools. Conclusions: School teachers can be effectively used for OHE in schools. There is a need for a comprehensive approach to include OHE in schools through activities such as dental examinations and demonstration of brushing techniques.


Although the risks and protective processes influencing substance use behaviors of adult Latinos have been increasingly examined in the literature, substance abuse among adult Latinas remains a relatively understudied area. This study examined associations between mother-daughter attachment and substance abuse among 158 Latina mothers and their adult daughters (N = 316). Dyads of mothers and daughters were categorized into four groups: (a) mother/daughter both drug or alcohol abusers (Dyad 1), (b) mother abuser and daughter non-abuser (Dyad 2), (c) mother non-abuser and daughter abuser (Dyad 3), and (d) mother/daughter both non-abusers (Dyad 4). Dyad 1 participants reported lower levels of attachment to each other than all other types of dyads. Participants born in the U.S. reported more substance abuse than their non-U.S. born counterparts. Future longitudinal research is recommended to determine the presence of a mother-daughter attachment threshold that, if established early and maintained, may act as a protective mechanism against the intergenerational co-occurrence of substance abuse among adult Latinas.


PHF-tau, a modified form of tau in Alzheimer diseased brains, is composed of proteins of molecular weight 68, 64, and 60 kd. The 68-kd PHF-tau has been reported to be encoded by a tau transcript containing both exons 2 and 3. The 64-kd protein contains exon 2, but not exon 3, and the 60-kd protein contains neither exons 2 nor 3. To study the proportion of different tau isoforms in PHF-tau and normal tau, we raised antibodies to exon 2 (E-2) and exon 3 (E-3). By immunoblots, about 74% of the PHF-tau contained exon 2, and 25% contained exon 3; whereas in normal tau, 82 to 90% contained exon 2, and no more than 5% contained exon 3. Enzyme-linked immunosorbent assays demonstrated that PHF-tau was 38% less reactive with E-2 and 79% more reactive with E-3 than normal tau. Alkaline phosphatase treatment increased the E-2 immunoreactivity of PHF-tau by 120% and normal tau by 38%, but it had no effect on E-3 immunoreactivity. The dephosphorylated PHF-tau and normal tau were similar in E-2 immunoreactivities. Phosphatase treatment of Alzheimer's diseased brain sections increased the number of E-2 immunoreactive neuropil threads and senile plaque neurites but had very little effect on the number of immunoreactive neurofibrillary tangles. The results suggest that PHF-tau contains proportionally more isoforms with E-3 than normal tau; that the E-2 epitope is more phosphorylated in PHF-tau than in normal tau; and that the phosphorylated E-2 epitope of PHF-tau is preferentially located in neurites.


Cotton is remarkable among our major crops in that four species were independently domesticated, two allopolyploids and two diploids. In each case thousands of years of human selection transformed sparsely flowering, perennial shrubs into highly productive crops with seeds bearing the vastly elongated and abundant single-celled hairs that comprise modern cotton fiber. The genetic underpinnings of these transformations are largely unknown, but comparative gene expression profiling experiments have demonstrated up-regulation of profilin accompanying domestication in all three species for which wild forms are known. Profilins are actin monomer binding proteins that are important in cytoskeletal dynamics and in cotton fiber elongation. We show that Gossypium diploids contain six profilin genes (GPRF1–GPRF6), located on four different chromosomes (eight chromosomes in the allopolyploid). All but one profilin (GPRF6) are expressed during cotton fiber development, and both homeologs of GPRF1–GPRF5 are expressed in fibers of the allopolyploids. Remarkably, quantitative RT-PCR and RNAseq data demonstrate that GPRF1–GPRF5 are all up-regulated, in parallel, in the three independently domesticated cottons in comparison with their wild counterparts. This result was additionally supported by iTRAQ proteomic data. In the allopolyploids, there This usage of novel should be fine, since it refers to a novel evolutionary process, not a novel discovery has been novel recruitment of the sixth profilin gene (GPRF6) as a result of domestication. This parallel up-regulation of an entire gene family in multiple species in response to strong directional selection is without precedent and suggests unwitting selection on one or more upstream transcription factors or other proteins that coordinately exercise control over profilin expression.


Research to develop new technologies for increasing the safety of passengers and crew in rail equipment is being directed by the Federal Railroad Administration's (FRA's) Office of Research, Development, and Technology. Crash energy management (CEM) components which can be integrated into the end structure of a locomotive have been developed: a push-back coupler and a deformable anti-climber. These components are designed to inhibit override in the event of a collision. The results of vehicle-to-vehicle override, where the strong underframe of one vehicle, typically a locomotive, impacts the weaker superstructure of the other vehicle, can be devastating. These components are designed to improve crashworthiness for equipped locomotives in a wide range of potential collisions, including collisions with conventional locomotives, conventional cab cars, and freight equipment.
 Concerns have been raised in discussions with industry that push-back couplers may trigger prematurely, and may require replacement due to unintentional activation as a result of loads experienced during service and coupling. Push-back couplers (PBCs) are designed with trigger loads meant to exceed the expected maximum service and coupling loads experienced by conventional couplers. Analytical models are typically used to determine these trigger loads. Two sets of coupling tests have been conducted that validate these models, one with a conventional locomotive equipped with conventional draft gear and coupler, and another with a conventional locomotive retrofit with a PBC. These tests allow a performance comparison of a conventional locomotive with a CEM-equipped locomotive during coupling, as well as confirmation that the PBC does not trigger at speeds below typical coupling speeds. In addition to the two sets of coupling tests, car-to-car compatibility tests of CEM-equipped locomotives, as well as a train-to-train test are also planned. This arrangement of tests allows for evaluation of the CEM-equipped locomotive performance, as well as comparison of measured with simulated locomotive performance in the car-to-car and train-to-train tests.
 The conventional coupling tests and the CEM coupling tests have been conducted, the results of which compared favorably with their pre-test predictions. In the CEM coupling tests, the PBC triggered at a speed well above typical coupling speeds. This paper provides a comparison of the conventional coupling test results with the CEM coupling test results. The next test in the research program is a vehicle-to-vehicle impact test. This paper describes the test preparation, test requirements, and analysis predictions for the vehicle-to-vehicle test. The equipment to be tested, track conditions, test procedures, and measurements to be made are described. A model for predicting the behavior of the impacting vehicles and the CEM system has been developed, along with preliminary predictions for the vehicle-to-vehicle test.


In this manuscript, a solar cavity packed with thermoelectric generator modules is investigated numerically. The hot plate of TEG modules make the inner surface of the cube, and the cold plate is outside of the cavity, under natural convection. The TEG modules are electrically in series. The solution algorithm using the equations of heat transfer and generated power of TEG modules is developed via MATLAB and simulated under various non-concentrated irradiation levels. The generated power variation in solar thermoelectric cavity shows that as the solar irradiance rises, the generated power increases at a growing rate. The radiation varies from 700 to 1200 W/m2, and the generated power increases from 0.2 mW to 10 mW for side TEGs and up to 30 mW for bottom side TEGs. Studying the effect of aperture size shows that, although the generated power of fully open cavity is 2.25 times higher than generated power in 5×5 cm2 aperture size cavity but its efficiency is 50% lower than small aperture cavity. Heat transfer analysis of cavity depicts the 91% of heat transferred by conduction in cube surfaces and, only 6% and 3% of input energy are lost by re-radiation and convection through the aperture, respectively.


The Gascoyne-Murchison region of Western Australia experiences an arid to semi-arid climate with a highly variable temporal and spatial rainfall distribution. The region has around 39.2 million hectares available for pastoral lease and supports predominantly catle and sheep grazing leases. In recent years a number of climate forecasting systems have been available offering rainfall probabilities with different lead times and a forecast period; however, the extent to which these systems are capable of fulfilling the requirements of the local pastoralists is still ambiguous. Issues can range from ensuring forecasts are issued with sufficient lead time to enable key planning or decisions to be revoked or altered, to ensuring forecast language is simple and clear, to negate possible misunderstandings in interpretation. A climate research project sought to provide an objective method to determine which available forecasting systems had the greatest forecasting skill at times of the year relevant to local property management. To aid this climate research project, the study reported here was undertaken with an overall objective of exploring local pastoralists' climate information needs. We also explored how well they understand common climate forecast terms such as 'mean', median' and 'probability', and how they interpret and apply forecast information to decisions. A stratified, proportional random sampling was used for the purpose of deriving the representative sample based on rainfall-enterprise combinations.

In order to provide more time for decision-making than existing operational forecasts that are issued with zero lead time, pastoralists requested that forecasts be issued for May-July and January-March with lead times counting down from 4 to 0 months. We found forecasts of between 20 and 50 mm break-of-season or follow-up rainfall were likely to influence decisions. Eighty percent of pastoralists demonstrated in a test question that they had a poor technical understanding of how to interpret the standard wording of a probabilistic median rainfall forecast. this is worthy of further research to investigate whether inappropriate management decisions are being made because the forecasts are being misunderstood.

We found more than half the respondents regularly access and use weather and climate forecasts or outlook information from a range of sources and almost three-quarters considered climate information or tools useful, with preferred methods for accessing this information by email, faxback service, internet and the Department of Agriculture Western Australia's Pastoral Memo. Despite differences in enterprise types and rainfall seasonality across the region we found seasonal climate forecasting needs were relatively consistent. It became clear that providing basic training and working with pastoralists to help them understand regional climatic drivers, climate terminology and jargon, and the best ways to apply the forecasts to enhance decision-making are important to improve their use of information. Consideration could also be given to engaging a range of producers to write the climate forecasts themselves in the language they use and understand, in consultation with the scientists who prepare the forecasts.


Introduction: Advances in neonatal medicine have led to the early diagnosis and treatment of respiratory diseases, and the recent development of fetal airway surgery. Data on the growth of the trachea and bronchi are not readily available to the anesthesiologist and bronchoscopist in spite of the obvious clinical interest. The aim of this study was to determine the anatomical development of tracheal structures during the fetal periods and to correlate these observations with other fetal biometric parameters to estimate developmental particularities of the fetal airway. Materials and methods: The study was carried out in the department of Anatomy, on 28 human fetuses of known gestational age (GA) from spontaneous abortions or stillbirths, aged 16–37 weeks of gestation which were categorized into second and third ( trimesters. Following parameters were noted prebifurcation length (PL), birfurcation length (BL), bifurcation-to-prebifurcation length ratio (BL/PL), Upper external transverse diameter (UD), Lower external transverse diameter (LD), Circumference (C) of trachea at the level of last tracheal cartilage. Results: The mean and standard deviations were calculated for second and third trimester and values were compared using student t-test. There was significant difference in means for PL, UD and LD between second and third trimesters. The various parameters were correlated with GA using Pearson's correlation test. SPSS version 16 was used for the statistical analysis. No significant correlation was found for LD (r=0.2, p=0.2) and for C (r=0.19, p=0.3). Conclusion: Authors conclude that the tracheal length increases significantly proportional to the GA, but not the diameter.


Modern coextruded production requires new approaches to technology, this is largely due to the wide nomenclature of raw materials, a combination of their application (recipes, multilayer structures) and a wide range of finished products.One of the key modules coextrusion line is gravimetric dosing. Moreover, performance measures dosing systems are not available, but practice shows that the stability of the recipe is the first play technological parameter affecting the underlying trading performance of the performance, cost, and quality.The analysis of the quality criteria for the example of mixing technology coextrusion. The effect of mixing on the quality of physical and mechanical properties of multilayer film products. Defined standard value index characterizes the qualitative mixing multicomponent mixture. Investigated and analyzed the samples for the development of unit testing procedures gravimetric dosing systems multicomponent mixtures.


The supraoptic nucleus (SON) of the hypothalamus is an important integrative brain structure that coordinates responses to perturbations in water balance and regulates maternal physiology through the release of the neuropeptide hormones vasopressin and oxytocin into the circulation. Both dehydration and lactation evoke a dramatic morphological remodeling of the SON, a process known as function-related plasticity. We hypothesize that some of the changes seen in SON remodeling are mediated by differential gene expression, and have thus used microarrays to document global changes in transcript abundance that accompany chronic dehydration in female rats, and in lactation. In situ hybridization analysis has confirmed the differential expression of three of these genes, namely TNF-induced protein 6, gonadotropin-inducible transcription factor 1, and ornithine decarboxylase antizyme inhibitor 1. Comparison of differential gene expression patterns in male and female rats subjected to dehydration and in lactating rats has enabled the identification of common elements that are significantly enriched in gene classes with particular functions. Two of these are related to the requirement for increased protein synthesis and hormone delivery in the physiologically stimulated SON (translation initiation factor activity and endoplasmic reticulum-Golgi intermediate compartment, respectively), whereas others are consistent with the concept of SON morphological plasticity (collagen fibril organization, extracellular matrix organization and biogenesis, extracellular structure organization and biogenesis, and homophilic cell adhesion). We suggest that the genes coordinately regulated in the SON as a consequence of dehydration and lactation form a network that mediates the plastic processes operational in the physiologically activated SON.


Hypoxia (low oxygen) exposure generally leads to decreased reproductive capacity, exhibited by reductions in testicular mass, reproductive hormones, and sperm swimming speed. However, in many fish species, reproduction occurs either periodically or exclusively under hypoxic conditions. In this study we assessed how hypoxia influences sperm performance in the plainfin midshipman (Porichthys notatus Girard, 1854), a species that lives in intertidal nests that become hypoxic during low tides. We exposed sperm from the same male to normoxic or hypoxic conditions and compared sperm characteristics and oxygen consumption between treatments. Sperm exposed to hypoxic water swam faster and consumed more oxygen than sperm swimming in normoxic conditions. Sperm swimming speed was positively related with oxygen consumption. For each male, the percentage of motile spermatozoa did not differ between treatments, suggesting that the same number of sperm were active but their performance was dependent on the dissolved oxy...


Access to markets is argued to have a significant role in development. In order to quantify the access of places to markets, policy makers are showing increasing interest in accessibility indicators (Yoshida and Deichmann 2009). This paper seeks to examine the spatial relationship of access to market in the Kyrgyz Republic using a recent census and household survey in order to identify possible linkages with rates of poverty and other micro (spatial) information. This analysis uses the Market Accessibility Index that measures the potential connectivity of population or expenditures between village/towns and big cities via the transport network. Results show that high Market Accessibility is located near the large cities with a concentration of infrastructure, while low access is more in the rural areas. Future work will use this indicator in economic models to statistical identify its significance with regards to per capita expenditure and poverty.


We introduce an online active exploration algorithm for data-efficiently learning an abstract symbolic model of an environment. Our algorithm is divided into two parts: the first part quickly generates an intermediate Bayesian symbolic model from the data that the agent has collected so far, which the agent can then use along with the second part to guide its future exploration towards regions of the state space that the model is uncertain about. We show that our algorithm outperforms random and greedy exploration policies on two different computer game domains. The first domain is an Asteroids-inspired game with complex dynamics but basic logical structure. The second is the Treasure Game, with simpler dynamics but more complex logical structure.


The requirement of DAG (diacylglycerol) to recruit PKD (protein kinase D) to the TGN (trans-Golgi network) for the targeting of transport carriers to the cell surface, has led us to a search for new components involved in this regulatory pathway. Previous findings reveal that the heterotrimeric Gbetagamma (GTP-binding protein betagamma subunits) act as PKD activators, leading to fission of transport vesicles at the TGN. We have recently shown that PKCeta (protein kinase Ceta) functions as an intermediate member in the vesicle generating pathway. DAG is capable of activating this kinase at the TGN, and at the same time is able to recruit PKD to this organelle in order to interact with PKCeta, allowing phosphorylation of PKD's activation loop. The most qualified candidates for the production of DAG at the TGN are PI-PLCs (phosphatidylinositol-specific phospholipases C), since some members of this family can be directly activated by Gbetagamma, utilizing PtdIns(4,5)P2 as a substrate, to produce the second messengers DAG and InsP3. In the present study we show that betagamma-dependent Golgi fragmentation, PKD1 activation and TGN to plasma membrane transport were affected by a specific PI-PLC inhibitor, U73122 [1-(6-{[17-3-methoxyestra-1,3,5(10)-trien-17-yl]amino}hexyl)-1H-pyrrole-2,5-dione]. In addition, a recently described PI-PLC activator, m-3M3FBS [2,4,6-trimethyl-N-(m-3-trifluoromethylphenyl)benzenesulfonamide], induced vesiculation of the Golgi apparatus as well as PKD1 phosphorylation at its activation loop. Finally, using siRNA (small interfering RNA) to block several PI-PLCs, we were able to identify PLCbeta3 as the sole member of this family involved in the regulation of the formation of transport carriers at the TGN. In conclusion, we demonstrate that fission of transport carriers at the TGN is dependent on PI-PLCs, specifically PLCbeta3, which is necessary to activate PKCeta and PKD in that Golgi compartment, via DAG production.


In Bayesian machine learning, the posterior distribution is typically computationally intractable, hence variational inference is often required. In this approach, an evidence lower bound on the log likelihood of data is maximized during training. Variational Autoencoders (VAE) are one important example where variational inference is utilized. In this tutorial, we derive the variational lower bound loss function of the standard variational autoencoder. We do so in the instance of a gaussian latent prior and gaussian approximate posterior, under which assumptions the Kullback-Leibler term in the variational lower bound has a closed form solution. We derive essentially everything we use along the way; everything from Bayes' theorem to the Kullback-Leibler divergence.


The main purpose of the article is to define the framework in which one can situate Leopold Blaustein's philosophy. The author focuses on the question of the method which is used by Blaustein and he situates it in the historical-philosophical context. The article defends the thesis that Blaustein uses a method which can be labelled as a phenomenologically oriented descriptive psychology that is close to, though not identical with, Edmund Husserl's project as formulated in the first edition of his Logical Investigations and that is connected to Husserl's 1925 lectures on the phenomenological psychology. The article is divided into four parts. In the first part, the author disputes the one-sided classifications of Blaustein's philosophy either as a continuator of the analytical tradition of the Lvov-Warsaw School, or as a mere repetition of Husserl's achievements. In the next part, the author sketches an intellectual biography of Blaustein and on this basis he defines the context in which one has to situate this thought. In this regard, two further parts of the article are devoted to two sources of inspiration for Blaustein. In the third part, a selection of methods and concepts of descriptive psychology are examined, and in the last part of the article, references to Husserl's phenomenology are explored.


Chemical dependence is a leading cause of morbidity and death in the United States. At least 20% of patients seen by primary care physicians in both the outpatient and inpatient setting are chemically dependent. Up to 90% of these patients go undiagnosed by their primary physicians. Chemical dependence is defined as a chronic, progressive illness characterized by the repeated and persistent use of alcohol or drugs despite negative health, family, work, financial, or legal consequences. Primary care physicians are in an ideal position to detect chemical dependence at its earliest stages, when irreversible medical consequences and death are most likely preventable. Alcohol is the most common drug of abuse. Improving the rate of recognition of chemical dependence depends on being familiar with the constellation of physical, mental, and social indicators. Early medical manifestations of alcoholism common in the primary care setting include: gastric complaints, elevated blood pressure, palpitations, traumatic injuries, headaches, impotence, and gout. Early psychosocial manifestations common in both alcohol and drug dependence include anxiety, depression, insomnia, persistent relationship conflicts, work or school problems, and financial or legal problems. Particularly useful laboratory indicators of alcoholism include elevated levels of GGT and MCV, both displaying high specificity, with the GGT level being the most sensitive. Similarly specific laboratory tests for drug dependence are not available. Any patient presenting with any of the above medical, psychosocial, or laboratory manifestations should be screened for chemical dependence. The CAGE questionnaire for alcoholism, a four-question test, is particularly well suited to the primary care setting, where it can be administered in fewer than 60 seconds. The CAGE has demonstrated high sensitivity (in the 80% range) and specificity (approximately 85%) for alcoholism. Comparably convenient instruments do not yet exist for drug dependence, although a 28-item instrument, the DAST (Drug Abuse Screening Test), has demonstrated high sensitivity and specificity for drug abuse.


The chapter leads the reader through the historical development of additive manufactur- ing (AM) techniques until the most recent developments. A tentative taxonomy is added to the historical perspective, in order to better understand the main lines of develop - ment and the potential cross-fertilization opportunities. Some case studies are analyzed in order to provide a clearer picture of the practical applications of AM in architecture engineering and construction (AEC), with a particular attention to the use of AM for final products rather than just prototypes. Eventually, some thoughts are shared as to the impact of AM on AEC beyond the mere cost-effectiveness and well into the poten tial change of paradigms in how architecture can be thought of and further developed embracing the new world of opportunities brought by AM.


Waterless offset doesn't use dampening solution, so it has the advantage of color saturation that the water offset can not reach. Monomer is an important component of the UV waterless offset ink; it has great influence on the performances of ink. Ink samples were made separately by using different monomers. The flow curve, thixotropy crack index, surface tension, gloss, curing speed and other performance parameters of the ink samples were tested, and the influence of different kinds of monomer on the performance of ink was analysised. The results show that the viscosity of monomer affects the viscosity of ink sample directly; six monomers we used have good curing speed; the lowest surface tension can be got when using monomer with single functionality; and six ink samples have large thixotropy. The result of the compound EOEOEA, TPGDA and TMPTA is 0∶3∶7 by using the functionality design principle.