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Substance use disorders (SUDs) are moderately to highly heritable and are in part cross-transmitted genetically, as observed in twin and family studies. We performed exome-focused genotyping to examine the cross-transmission of four SUDs: alcohol use disorder (AUD, n = 4487); nicotine use disorder (NUD, n = 4394); cannabis use disorder (CUD, n = 954); and nonmedical prescription opioid use disorder (NMPOUD, n = 346) within a large nationally representative sample (n = 36,309), the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). All diagnoses were based on in-person structured psychiatric interview (AUDADIS-5). SUD cases were compared alone and together to 3959 "super controls" who had neither a SUD nor a psychiatric disorder using an exome-focused array assaying 363,496 SNPs, yielding a representative view of within-disorder and cross-disorder genetic influences on SUDs. The 29 top susceptibility genes for one or more SUDs overlapped highly with genes previously implicated by GWAS of SUD. Polygenic scores (PGS) were computed within the European ancestry (EA) component of the sample (n = 12,505) using summary statistics from each of four clinically distinct SUDs compared to the 3959 "super controls" but then used for two distinctly different purposes: to predict SUD severity (mild, moderate, or severe) and to predict each of the other 3 SUDs. Our findings based on PGS highlight shared and unshared genetic contributions to the pathogenesis of SUDs, confirming the strong cross-inheritance of AUD and NUD as well as the distinctiveness of inheritance of opioid use disorder.

Purpose: This research serves the purpose of dealing with different types of Human Subjective Biases in Performance Management System by interview-based analysis and content analysis depending upon inputs from renowned HR professionals and then to determine if HR Analytics can help the HR practitioners in objective-decision making rather than intuition in PMS.Design/Methodology/Approach: Focused-Group-Interview approach is followed here to acquire in-depth information about Subjectivity Bias Elimination in Employee Appraisal Process and how the same can be mitigated with the help of People Analytics. Findings: This research will reveal the truth of erroneous subjective judgments based on instincts and how HR Analytics can help the HR practitioners in objective decision making rather than intuition in PMS. Originality/ Value: This research identifies factors leading to Subjectivity Bias in Employee Appraisal Process. It suggests updated criteria for HR professionals to mitigate subjectivity bias in Employee Appraisal Process with help of People Analytics.

Background Little is known about the sociodemographic profiles, the intensity of drinking, the severity of alcohol use disorder (AUD), and psychopathology among individuals with specific patterns of concurrent alcohol and drug use and AUD and other drug use disorders (DUDs) comorbidity. Methods Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. We examined sociodemographic correlates and psychopathology among individuals with specific patterns of concurrent use of alcohol and drug and AUD-DUD comorbidity relative to alcohol use or AUD only, respectively, using multinomial logistic regression. We also examined whether concurrent alcohol and drug use and AUD-DUD comorbidity increased the intensity of drinking and severity of AUD, respectively. Results The majority (62.0%) of past-year drinkers used only alcohol. The 12-month prevalence of AUD only was 53.5%. Individuals with concurrent use of alcohol and drugs and AUD-DUD comorbidity were more likely to be men, younger, never/previously married, with lower education and income (odds ratios (ORs) ≥ 1.2). Concurrent use of alcohol and drugs and AUD- DUD comorbidity groups were more likely to experience psychopathology than the alcohol use only and AUD only groups, respectively (ORs ≥ 1.3). The intensity of drinking was greater among the concurrent use groups relative to the alcohol use only group, while the severity of AUD was greater among AUD-DUD comorbidity groups relative to the AUD only group. Conclusions Research on consequences and treatment outcome of concurrent use of alcohol and drugs and AUD-DUD comorbidity is warranted to inform the development of more effective prevention/intervention programs.

Objective The objective of this study was to present current information on the prevalence, correlates, comorbidity and quality of life among men and women with cannabis use disorder (CUD). Methods In 2012–2013, 36,309 respondents ≥ 18 years old participated in face-to-face interviews in the National Epidemiologic Survey on Alcohol and Related Conditions-III. Results Prevalence of 12-month CUD was greater among men (3.5%) than women (1.7%). Women experienced shorter duration from onset of cannabis use to onset of CUD than men (mean = 5.8 years, men; mean = 4.7 years, women). In both men and women, prevalences of CUD were greater among young adults, Blacks, and those with lower income and greater among Native American women relative to White women. CUD was highly comorbid with other substance use disorders, PTSD, ASPD and borderline and schizotypal PDs for men and women. Quality of life for individuals with CUD was low regardless of gender. Conclusions DSM-5 CUD among men and women is highly prevalent, comorbid and characterized by low quality of life. Results highlighted the need for integrated treatment of CUD and comorbid disorders and the urgency of identifying and implementing effective prevention and intervention approaches, especially for those sociodemographic subgroups for which both men and women are at greater risk for the disorder.

This study presents nationally representative data on the prevalence, correlates, psychiatric comorbidity and treatment (including pharmacological and nonpharmacological) among electronic nicotine delivery system (ENDS) users.Face-to-face interviews in the National Epidemiologic Survey on Alcohol and Related Conditions-III.Prevalences of 12-month and lifetime ENDS use were 3.8% (SE=0.14) and 5.4% (SE=0.17). Odds of ENDS use were greater among men than women, regardless of timeframe. Rates were lower among Blacks, Hispanics and Asians/Pacific Islanders relative to Whites. Odds of 12-month and lifetime ENDS use was also higher among younger (65years) than older (≥65years) individuals and higher among individuals with high school education relative to these with some college education. Odds of 12-month and lifetime ENDS use was also higher among individuals with incomes$70,000.00 compared with those with incomes≥$70,000.00 and higher among the previously married relative to those who were currently married. Associations between 12-month ENDS use and severe nicotine use disorder were strong, whereas associations with other substance use disorders and borderline and antisocial personality disorders were modest (AORs=1.3-2.6). Rates of treatment seeking to cut down or quit tobacco or nicotine use (12-month, 25.0% (SE=1.6); lifetime, 24.4% (SE=1.4)) were low.ENDS use is substantially comorbid, especially with nicotine use disorder. Virtually all ENDS users smoked cigarettes. Research is needed to understand their role in smoking cessation, adverse effects on bodily systems and their potential for addiction and comorbidity.

Interictal epileptiform discharges (IEDs) are a hallmark of focal epilepsies. Most previous studies have focused on whether IED events increase seizure likelihood or, on the contrary, act as a protective mechanism. Here, we study instead whether IED events themselves can be predicted based on measured ongoing neural activity. We examined local field potentials (LFPs) and multi-unit activity (MUA) recorded via intracortical 10 × 10 (4 × 4 mm) arrays implanted in two patients with pharmacologically resistant seizures. Seizures in one patient (P1) were characterized by low-voltage fast-activity (LVFA), and IEDs occurred as isolated (100 - 200 ms) spike-wave events. In the other patient (P2), seizures were characterized by complex spike-wave discharges (2 - 3 Hz) and IEDs consisted of bursts of ~ 2 - 3 spike-wave discharges each lasting ~ 300 - 500 ms. We used extreme gradient boosting (XGBoost) classifiers for IED prediction. Inputs to the classifiers consisted of LFP power spectra; In addition, counts of MUA (1-ms and 100-ms time bins) and envelope, as well as leading eigenvalues/eigenvectors of MUA correlation matrices were used as features. Features were computed from moving short-time windows (1 second) immediately preceding IED events (0.3 - 0.5 preictal gap). Classifiers allowed successful IED prediction in both patients, with better results in the case of IED occurring in the LVFA case (area under ROC curve: 0.86). In comparison, LFP features performed comparatively for P1 datasets, while MUA appeared not predictive in the case of P2. Our preliminary results suggest that features of ongoing activity, predictive of upcoming IED events, can be identified based on intracortical recordings, and warrant further investigation in larger datasets. We expect this type of prediction analyses to contribute to a better understanding of the mechanisms underlying the generation of IED events and their contribution to seizure onset.

Background The objective of this study was to present 12-month and lifetime prevalence, correlates, comorbidity, treatment and disability of DSM-5 bipolar I disorder. Methods Nationally representative U.S. adult sample (N = 36,309), the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions - III. Results Prevalences of 12-month and lifetime DSM-5 bipolar I disorder were 1.5% and 2.1% and did not differ between men (1.6% and 2.2%) and women (1.5% and 2.0%). Prevalences of bipolar I disorder were greater among Native Americans, and lower among Blacks, Hispanics and Asians/Pacific Islanders than whites. Rates were also lower among younger than older individuals, those previously married than currently married and with lower education and income relative to higher education and income. Bipolar I disorder was more strongly related to borderline and schizotypal personality disorders (adjusted odds ratios (AORS) = 2.2-4.7)), than to anxiety disorders (AORs = 1.3-2.9), and substance use disorders (AORs = 1.3-2.1) overall and among men and women. Quality of life was lower among individuals with bipolar I disorder relative to those without the disorder. Treatment rates among individuals with bipolar I disorder were low in the total sample (46%, SE = 2.63), among men (36.7%, SE = 3.82) and among women (55.8%, SE = 3.32). Conclusions Bipolar I disorder continues to be common disabling and highly comorbid disorder among men and women, contributing substantially to low quality of life and burden of disease in our society.

Objective The authors present 12-month and lifetime prevalence, correlates, psychiatric comorbidity, and treatment of nonmedical prescription opioid use (NMPOU) and DSM-5 NMPOU disorder (NMPOUD). Methods Data were derived from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) (N = 36,309). Results Prevalences of 12-month and lifetime NMPOU were 4.1% and 11.3%, exceeding rates in the 2001-2002 NESARC (1.8%, 4.7%). Twelve-month and lifetime rates of DSM-5 NMPOUD were 0.9% and 2.1%. NESARC-III DSM-IV NMPOUD rates (0.8%, 2.9%) were greater than those observed in the 2001-2002 NESARC (0.4% and 1.4%). Rates of NMPOU were greater among men, but no sex differential was observed for NMPOUD. Prevalences of NMPOU and NMPOUD were generally greater among 18- to 64-year-old individuals, whites, and Native Americans, and individuals with lower socioeconomic status. Associations were observed between 12-month and lifetime NMPOU and NMPOUD and other drug use disorders, posttraumatic stress disorder, and borderline, schizotypal, and antisocial personality disorders; persistent depression and major depressive disorder (for NMPOU); and bipolar I disorder (for NMPOUD). Only 5.5% and 17.7% of individuals with 12-month NMPOU and NMPOUD were ever treated. Conclusions NMPOU and NMPOUD have considerably increased over the past decade, are associated with a broad array of risk factors and comorbidities, and largely go untreated in the United States. More information on the determinants, characteristics, and outcomes of NMPOU and NMPOUD is needed to support evidence-based interventions and prevention.

To present nationally representative information on the prevalence, correlates, psychiatric comorbidity, and treatment of DSM-5 nicotine use disorder (NUD) and the public health burden of US cigarette consumption among adults with NUD and other psychiatric disorders.Using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309), we conducted weighted cross-tabulations and multivariate logistic regression analyses to estimate prevalences and examine comorbidity of NUD.Prevalences of 12-month and lifetime DSM-5 NUD were 20.0% and 27.9%, respectively. Nicotine use disorder was more frequent among men, non-Hispanic whites, younger individuals, the previously married, those with less education and lower incomes, and those residing in rural areas. Adjusting for sociodemographic characteristics and additional psychiatric comorbidity, 12-month NUD and lifetime NUD were significantly associated with other substance use and antisocial personality disorders (odds ratios [ORs] = 1.5-5.1, 12-month; 1.5-5.6, lifetime). Twelve-month severe NUD was generally associated with major depressive, bipolar I, bipolar II, panic, generalized anxiety, posttraumatic stress, and schizotypal, borderline, and antisocial personality disorders (ORs = 1.3-2.5). Individuals with current NUD and at least 1 psychiatric disorder comprised 11.1% of US adults but smoked 53.6% of total cigarettes consumed. Treatment was utilized by 20.3% of respondents with 12-month and 18.8% with lifetime NUD.Findings underscore the need to address nicotine use in clinical settings. Recognition of psychiatrically vulnerable subpopulations may inform etiologic research, prevention, and treatment of NUD.

To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD). Face-to-face interviews with 36,309 adults in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with

To present nationally representative data on changes in the prevalences of 12-month cocaine use, cocaine use disorder (CocUD) and 12-month CocUD among 12-month cocaine users between 2001 and 2002 and 2012–2013. Data were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012–2013 NESARC-III. Between 2001 and 2002 and 2012–2013, prevalences of 12-month cocaine use and DSM-IV CocUD significantly increased and 12-month CocUD among 12-month users significantly decreased. Increases in risk of cocaine use were seen across nearly all sociodemographic subgroups while increases in CocUD were observed among women, those in the oldest age group, Whites, individuals with the lowest incomes and highest education, and those residing in urban areas. Prevalence of CocUD among users significantly declined overall and among men, individuals aged 30–44 years old, the never-married, respondents with incomes between $20,000 and $34,000, and those residing in the Midwest. Increases in coca cultivation in Colombia in recent years together with increases in the purity of cocaine entering the U.S. portend more significant increases in the rates of cocaine use and CocUD in the U.S. along with increases in cocaine-related morbidity and mortality. The results of this study support the continued monitoring of cocaine use and CocUD in the U.S., especially in view of the narrowing of the gender gap and shifts in race-ethnic, age and socioeconomic differentials seen between 2001 and 2002 and 2012–2013.

We used the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), a nationally representative sample of US adults (n = 34,653), to estimate the prevalence and correlates of HIV testing and HIV status. The diagnostic interview used was the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version. We found that in 2012-2013, the prevalence of a history of HIV testing was 53.0% among females and 47.0% among males. Among individuals tested, the prevalence of HIV was 1.06%, resulting in a known estimated prevalence of 0.54% in the full sample. In adjusted results, being non-white, aged 30-44, having college, being non-heterosexual, having history of unprotected sex or history of childhood sexual abuse and lower mental health-related quality of life increased the odds of having been tested, whereas being foreign-born, 45 years or older, family income ≥$20,000, being unemployed or a student, living in a rural setting and older age at first sex lowered those odds. Among those tested, being 30-64, being non-heterosexual, having history of unprotected sex or having a sexually transmitted disease in the last year was associated with greater odds of being HIV+. Having some college decreased those odds. In the adjusted results all psychiatric disorders were associated with increased rates of HIV testing, but only a lifetime history of drug use disorder and antisocial personality disorders were associated with HIV status among those tested. Despite CDC recommendations, only about half of US adults have ever been tested for HIV, interfering with efforts to eradicate HIV infection.

Background Documenting changes in alcohol consumption is critical for assessing future health service and alcohol treatment needs, evaluating efforts to modify drinking behavior and understanding the impact of shifting demographics and social norms. For the period since 2000, published data on drinking trends have been scarce and inconsistent. Methods Using data from two large, nationally representative surveys of U.S. adults (2001–2002 and 2012–2013) that contained virtually identical questions on consumption, we assessed differences by period in the prevalence of drinking, volume of intake, frequency of drinking and prevalence of ≥monthly heavy episodic drinking (HED) and determined whether changes in consumption were consistent across beverage types and in population subgroups. Results Between 2001–2002 and 2012–2013, the prevalence of drinking increased, as did volume and frequency of drinking and prevalence of ≥monthly HED among drinkers. Increases were greater for women than men for all measures and smaller among the formerly married for consumption among drinkers. The increase in overall drinking prevalence was magnified among all race-ethnic minorities, whereas the increase in ≥monthly HED was magnified only among Blacks (all relative to Whites). Conclusions Our findings are suggestive of a “wetter” drinking climate in 2012–2013 than in 2001–2002, indicating the need for continued and expanded efforts to prevent chronic and episodic heavy alcohol consumption. Given the across-the-board increases in alcohol consumption in recent years, policy efforts that address drinking at the population level are supported, even if specific drinking behaviors and subgroups of drinkers are additionally targeted for individualized approaches.

The purpose of this study was to assess the procedural validity of the substance disorder modules of the lay-administered Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Version (AUDADIS-5) through clinician re-appraisal re-interviews.The study employed a test-retest design among 712 respondents from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). A clinician-administered, semi-structured interview, the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5) was used as the re-appraisal. Kappa coeffients indicated concordance of the AUDADIS-5 and PRISM-5 for DSM-5 substance use disorder diagnoses, while intraclass correlation coefficients (ICC) indicated concordance on dimensional scales indicating the DSM-5 criteria count for each disorder.With few exceptions, concordance of the AUDADIS-5 and the PRISM-5 for DSM-5 diagnoses of substance use disorders ranged from fair to good (κ=0.40-0.72). Concordance on dimensional scales was excellent (ICC≥0.75) for the majority of DSM-5 SUD diagnoses, and fair to good (ICC=0.43-0.72) for most of the rest.As indicated by concordance with a semi-structured clinician-administered re-appraisal, the procedural validity of the AUDADIS-5 DSM-5 substance use disorder diagnoses found in this study indicates that these AUDADIS-5 diagnoses are useful tools in epidemiologic studies. The considerably stronger concordance of the AUDADIS-5 and PRISM-5 dimensional DSM-5 SUD measures supports a current movement to place more emphasis on dimensional measures of psychopathology, and suggests that such measures may be more informative than binary diagnoses for research, and possibly for clinical purposes as well.

This paper serves the purpose of presentation of a general view of the current applications of fuzzy logic in medicine and bioinformatics. Using fuzzy logic, we particularly review medical aspects. We then recall the geometrical interpretation of fuzzy sets as points in a fuzzy hypercube and present two concrete illustrations in medicine (drug addictions) and in bioinformatics (comparison of genomes). DOI: http://dx.doi.org/10.3329/bjsir.v49i3.22127 Bangladesh J. Sci. Ind. Res. 49(3), 137-146, 2014

Objective To present information on predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime DSM-5 cannabis use disorder (CUD). Method Face-to-face survey of a representative sample of the adult US general population (n = 36,309). Results Treatment rates for CUD were low in this general population survey (13.7%). Severity of CUD and comorbidity of other lifetime drug use disorders were significant predictors of lifetime treatment utilization for CUD. Preference for self-reliance, minimizing problems, fear of stigma, and financial and structural issues were among the most frequently endorsed reasons for respondents not seeking treatment when they perceived the need for treatment among individuals with lifetime CUD, regardless of whether they eventually utilized treatment at some time in their lives. Conclusions Given the rising prevalence of CUD in the US over the past decade and currently low treatment rates for CUD, increased provision for services for CUD appears critically needed, especially those that screen for and treat, when present, other drug use disorders. Programs to reduce stigma and financial barriers are needed, as well as programs to increase awareness among the general public, health care professionals about the nature and seriousness of CUD, and the availability and effectiveness of treatment for this disorder.

Importance Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, andDSM-IValcohol use disorder (AUD) represents a major gap in public health information. Objective To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-monthDSM-IVAUD, 12-monthDSM-IVAUD among 12-month alcohol users, and 12-monthDSM-IVAUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013. Design, Setting, and Participants The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016. Main Outcomes and Measures Twelve-month alcohol use, high-risk drinking, andDSM-IVAUD. Results The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, andDSM-IVAUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), andDSM-IVAUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, andDSM-IVAUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-monthDSM-IVAUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-monthDSM-IVAUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%). Conclusions and Relevance Increases in alcohol use, high-risk drinking, andDSM-IVAUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.

Armed conflict is frequently assumed to be a contributor to the global HIV epidemic, but existing evidence is sparse. We examined the relationship between armed conflict between 2002 and 2008 and HIV disability life years (DALYs) in 2010 among WHO Member States. Using partial least squares analysis we also examined moderation of the armed conflict-HIV link by two susceptibility constructs (background risk, substance use) and one vulnerability mediator (numbers of refugees, people on ART, and total HIV spending). Background risk directly impacted HIV DALYs (p < 0.05), substance use moderated the conflict-HIV relationship (p < 0.01). The vulnerability construct mediated the conflict-HIV association (p < 0.01). Findings underscore the need to align HIV prevention/intervention efforts with pre-existing HIV burden and reduce the impact of natural disasters on the populace in conflict-affected states. Integration of substance prevention/harm reduction programs within national HIV responses, attention to most-at-risk populations and increased surveillance/treatment of drug resistant HIV and TB is warranted.

OBJECTIVE To present current, nationally representative US findings on prevalence, correlates, psychiatric comorbidity, disability, and treatment of DSM-5 antisocial personality disorder (ASPD) and adulthood antisocial behavioral syndrome without conduct disorder before 15 years of age (AABS). METHOD Face-to-face interviews were conducted with respondents (N = 36,309) in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. DSM-5 alcohol, nicotine, and specific drug use disorders and selected mood, anxiety, trauma-related, eating, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. RESULTS Prevalences of ASPD and AABS were 4.3% and 20.3%, respectively, and were highest among male, white, Native American, younger, and unmarried respondents, those with high school or less education, lower incomes, and Western residence. Both antisocial syndromes were significantly associated with 12-month and lifetime substance use, dysthymia/persistent depressive, bipolar I, posttraumatic stress, and borderline and schizotypal personality disorders (odds ratios [ORs] = 1.2-7.0). ASPD was additionally associated with 12-month agoraphobia and lifetime generalized anxiety disorder (ORs = 1.3-1.6); AABS, with 12-month and lifetime major depressive and 12-month generalized anxiety disorders (ORs = 1.2-1.3). Both were associated with significant disability (P < .001 to .01). Most antisocial survey respondents were untreated. CONCLUSIONS One in 4 US adults exhibits syndromal antisocial behavior, with similar sociodemographic and psychiatric correlates and disability regardless of whether onset occurred before 15 years of age, illustrating the clinical and public health significance of both ASPD and AABS. In addition to laying groundwork for estimates of social and economic costs, and further etiologic and nosologic research, these findings highlight the urgency of effectively preventing and treating antisocial syndromes, including investigation of whether treatment for comorbidity hastens symptomatic remission and improves quality-of-life outcomes.

The diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for substance abuse and dependence are commonly used in clinical work and research studies, but whether abuse and dependence represent two different syndromes has been debated. The purpose of this article is to investigate the relationship of substance abuse and dependence for cannabis, cocaine, stimulants and sedatives among lifetime users of these substances in the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey conducted in 2001-2002.The multiple indicators multiple causes (MIMIC) model addresses three sets of relationships: those between (1) diagnostic criteria and latent factors, (2) latent factors and covariates, and (3) criteria and covariates. This approach allows for the detection of and compensation for noninvariance of the measurement of criteria across subgroups.Compared with one-factor models, two-factor models (factors roughly corresponding to abuse and dependence) fit significantly better across all substances, with abuse and dependence factors highly correlated. The MIMIC model indicated that race/ethnicity, age, income, and marital status showed some differential relationships across substance groups, although most covariates showed similar associations to dependence and abuse factors. Noninvariance of criteria measurement by demographic covariates was most pronounced for cannabis abuse and dependence criteria.The general relationship of abuse to dependence was consistent across substances. Results were equivocal on the value of retaining separate factors; therefore, investigating the relationships of specific genetic variants and treatment outcomes to dimensional indicators of abuse, dependence, and measures combining these criteria is warranted. Measurement of cannabis abuse and dependence criteria appears most affected by demographic characteristics.

OBJECTIVE To present nationally representative findings on the prospective relationships between overweight and obesity and DSM-IV substance use, mood, and anxiety disorders. METHOD A nationally representative sample of 34,653 US adults was interviewed in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. The target population was the civilian population residing in households and group quarters, with gathered data adjusted to be representative of the civilian population of the United States on the basis of the 2000 Decennial Census. The main outcome measures were the incidence of DSM-IV substance use, mood, and anxiety disorders and changes in body mass index status during the 3-year follow-up period. RESULTS Regression analyses that controlled for a wide array of covariates showed that overweight and obese women were at increased risk (P < .05) for incident major depressive disorder during the follow-up period (adjusted OR [AOR] = 1.3 [95% CI, 1.02-1.56] and AOR = 1.2 [95% CI, 1.02-1.51], respectively). Overweight men and obese men were at decreased risk (P < .05) of incident drug abuse and alcohol dependence (AOR = 0.7 [95% CI, 0.44-0.96] and AOR = 0.7 [95% CI, 0.52-0.97]), respectively. Obese women had a decreased risk (P < .05) of incident alcohol abuse and drug dependence (AOR = 0.6 [95% CI, 0.45-0.88] and AOR = 0.4 [95% CI, 0.21-0.91], respectively). Men with drug dependence and women with specific phobia had a decreased risk (P < .05) of becoming overweight or obese during the follow-up period (AOR = 0.4 [95% CI, 0.19-0.99] and AOR = 0.8 [95% CI, 0.66-0.95], respectively). CONCLUSIONS Increased risk of major depressive disorder among overweight and obese women could be attributed to stigma and greater body dissatisfaction among women in Western cultures. Overweight and obesity may serve as protective factors against developing incident substance use disorders, possibly due to shared neural functions in the brain underlying addictions to numerous substances. Results are discussed in terms of their clinical implications, including the need to update treatment guidelines for the management of overweight, obesity, and major depressive disorder.

Schizotypal personality disorder (SPD) is a serious psychiatric disorder, the essential feature of which is a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships and cognitive or perceptual distortions and eccentricities.1 Schizotypal personality disorder has been associated with severe reductions in quality of life,2 functional impairment,3,4 and high rates of comorbidity with many substance use, mood, anxiety, psychotic, and other personality disorders.5–14 For Clinical Use ♦ Although schizotypal personality disorder (SPD) is more prevalent among men than women, it is associated with significant disability and is highly comorbid with Axis I and II disorders in both sexes. ♦ Managing male and female patients with SPD may require different treatment strategies due to the sex-specific pattern of co-occurring psychiatric disorders. ♦ Patients with SPD, as well as those with borderline, dependent, and avoidant personality disorders, should be carefully monitored for psychotic episodes and for development of schizophrenia. Schizotypal personality disorder is becoming increasingly important in its own right as a significant personality disorder and as a disorder that may provide important insights into the origins of schizophrenia.15,16 The cognitive-perceptual and interpersonal disturbances, together with disorganized speech and behavior, of SPD have been viewed as a premorbid or prodromal stage of this major psychotic disorder.17–19 This view is supported by the increased frequency of SPD in families of patients diagnosed with schizophrenia and in the adopted-away offspring of mothers with schizophrenia spectrum disorder20–25 and by an increasing use of SPD criteria in the development of structured prodromal screening criteria for schizophrenia.26–28 Despite considerable research devoted to identifying individuals predisposed to schizophrenia, very little is known about the prevalence, correlates, disability, and comorbidity of SPD in large general population samples. Earlier community surveys were geographically restricted to states, and usually cities, in addition to being limited by small sample sizes (N = 133 to 799).3,29–39 Others preselected individuals from larger general population samples based on responses to personality disorder screening scales or psychopathology in general, further limiting the sample sizes on which the prevalence estimates were based.34,40–42 Although 1 larger general population survey (N = 2053),43 compromised by a low response rate (57%), together with 4 other smaller studies34,35,39,40 have provided basic sociodemographic data on SPD (sex, age, marital status, urbanicity), none were large enough to provide detailed information on characteristics such as race-ethnicity or socioeconomic status. Moreover, only 1 prior epidemiologic study39 has examined disability and comorbidity of SPD with other Axis I and II disorders. To fill this gap in the personality disorder literature, the major objective of this study was to present current, comprehensive, and detailed information on the prevalence, correlates, disability, and comorbidity of SPD in the United States using the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).44 The Wave 2 NESARC covered DSM-IV alcohol and specific drug use disorders as well as mood and anxiety disorders assessed in the 2001–2002 Wave 1 NESARC,45,46 in addition to SPD and borderline and narcissistic personality disorders, and posttraumatic stress disorder. The remaining DSM-IV personality disorders (avoidant, dependent, obsessive-compulsive, paranoid, schizoid, histrionic, and antisocial) were assessed in the Wave 1 NESARC. The sample size and high response rate of the Wave 2 NESARC allow for reliable and precise estimation of lifetime prevalence of SPD, especially among important sociodemographic subgroups of the population. The sample size also enabled the examination of comorbidity of SPD with specific Axis I and II disorders with control for both sociodemographic characteristics and additional psychiatric disorders, thereby allowing the determination of the unique relationship of each specific disorder to SPD. The importance of controlling for other disorders that are highly comorbid with one another represents an advance in our understanding of comorbidity recently highlighted in the epidemiologic literature.47,48 This study also provides information on mental disability associated with SPD. All analyses of prevalences, correlates, disability, and comorbidity were conducted separately for men and women. Because so little is known about the relationship between SPD and schizophrenia in large general population samples, the association of SPD with the occurrence of schizophrenia or psychotic episode was examined. If SPD reflects the phenotypic expression of a genetic predisposition to schizophrenia, it would be expected that SPD would be highly and significantly associated with this diagnosis. Associations of other DSM-IV personality disorders with schizophrenia or psychotic episode, some of which have been shown to have greater prevalences in relatives of probands with schizophrenia compared with relatives of controls, are also assessed in this study.

Three dimensional CFD simulations of the moderator flow in the calandria vessel of a heavy water reactor are performed using the PHOENICS CFD code. The model includes the entire calandria vessel consisting of three shells, calandria tubes and inlet and outlet nozzle openings. The computational model prepared in PHOENICS consists of (a) standard k-∊ turbulence model, (b) PARSOL technique for handling curved objects in cartesian grids and (c) Boussinesq formulation for handling variable density flows. PHOENICS is validated by applying it to three different flow cases. The flow pattern in the calandria vessel under normal operating conditions is obtained through simulation. The effect of the presence of calandria tubes and heat generation on moderator flow pattern is studied. The simulation is also performed for various heat loads and moderator mass flow rates. The maximum temperature achieved by the moderator flow under various heat loads and moderator mass flow rates is obtained.

In natural circulation loops, the driving force is usually low as it depends on the riser height which is generally of the order of a few meters. The heat transport capability of natural circulation loops (NCLs) is directly proportional to the flow rate it can generate. With low driving force, the straightforward way to enhance the flow is to reduce the frictional losses. A simple way to do this is to increase the loop diameter which can be easily adopted in pressure tube designs such as the AHWR and the natural circulation boilers employed in fossil-fuelled power plants. Further, the loop diameter also plays an important role on the stability behavior. An extensive experimental and theoretical investigation of the effect of loop diameter on the steady state and stability behavior of single- and two-phase natural circulation loops have been carried out and the results of this study are presented in this paper.

Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century.To present nationally representative information on the past-year prevalence rates of marijuana use, marijuana use disorder, and marijuana use disorder among marijuana users in the US adult general population and whether this has changed between 2001-2002 and 2012-2013.Face-to-face interviews conducted in surveys of 2 nationally representative samples of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions (data collected April 2001-April 2002; N = 43,093) and the National Epidemiologic Survey on Alcohol and Related Conditions-III (data collected April 2012-June 2013; N = 36,309). Data were analyzed March through May 2015.Past-year marijuana use and DSM-IV marijuana use disorder (abuse or dependence).The past-year prevalence of marijuana use was 4.1% (SE, 0.15) in 2001-2002 and 9.5% (SE, 0.27) in 2012-2013, a significant increase (P .05). Significant increases were also found across demographic subgroups (sex, age, race/ethnicity, education, marital status, income, urban/rural, and region). The past-year prevalence of DSM-IV marijuana use disorder was 1.5% (0.08) in 2001-2002 and 2.9% (SE, 0.13) in 2012-2013 (P .05). With few exceptions, increases in the prevalence of marijuana use disorder between 2001-2002 and 2012-2013 were also statistically significant (P .05) across demographic subgroups. However, the prevalence of marijuana use disorder among marijuana users decreased significantly from 2001-2002 (35.6%; SE, 1.37) to 2012-2013 (30.6%; SE, 1.04).The prevalence of marijuana use more than doubled between 2001-2002 and 2012-2013, and there was a large increase in marijuana use disorders during that time. While not all marijuana users experience problems, nearly 3 of 10 marijuana users manifested a marijuana use disorder in 2012-2013. Because the risk for marijuana use disorder did not increase among users, the increase in prevalence of marijuana use disorder is owing to an increase in prevalence of users in the US adult population. Given changing laws and attitudes toward marijuana, a balanced presentation of the likelihood of adverse consequences of marijuana use to policy makers, professionals, and the public is needed.

INTRODUCTION To better understand the impact of the state-level tobacco environment (eg, tobacco control policies, attitudes towards smoking) on cigarette smoking, we examined whether the relationship of state tobacco environments to smoking is modified by individual-level vulnerability factors. METHODS In a nationally representative sample of US adults (N = 34 638), past-year smoking and heavy smoking were examined. State-level tobacco environment was defined by tobacco-related control policies and attitudes, ranging from permissive to restrictive; individual vulnerability was defined by childhood maltreatment and/or parental substance problems. Additive interaction tested differences in state-level tobacco environment effects on smoking and heavy smoking by individual-level vulnerability. RESULTS Significant interactions (P values < .01) indicated that the state tobacco environment had the strongest relationship to smoking outcomes among individuals with greatest individual vulnerability. For example, among respondents with childhood maltreatment and parental substance problems, those in states with permissive tobacco environments had 13.3% greater prevalence of smoking than those in restrictive states. Among respondents with neither individual-level risk factor, those in permissive states had 2.8% greater prevalence than those in restrictive states (interaction P value = .0002). CONCLUSIONS Further restricting states' smoking environments could help reduce the prevalence of smoking and heavy smoking, particularly among those at increased individual risk in the general population. IMPLICATIONS This study shows that the protective effect of restrictive state-level tobacco environments on smoking or heavy smoking was stronger among those especially vulnerable due to individual-level risk factors (parental substance problems, childhood maltreatment). Thus, public health campaigns to influence attitudes towards smoking or legislation to strengthen tobacco control could have a broad effect, particularly impacting those with vulnerability to smoking, which may help decrease smoking prevalence and reduce the massive public health burden of tobacco-related morbidity and mortality.

Little is known about sex-specific risk for nonmedical prescription opioid use (NMPOU) and DSM-5 nonmedical prescription opioid use disorder (NMPOUD). The objective of the present study was to present prevalence, correlates, psychiatric comorbidity, treatment and disability of NMPOU and DSM-5 NMPOUD among men and women.Nationally representative sample of the U.S.Prevalences of 12-month and lifetime NMPOU were greater among men (4.4%, 13.0%) than women (3.9%, 9.8%), while corresponding rates of DSM-5 NMPOUD did not differ between men (0.9%, 2.2%) and women (0.9%, 1.9%). Regardless of time frame and sex, NMPOU and NMPOUD generally decreased with age and were lower among Blacks, Asians/Pacific Islanders and Hispanics, and respondents with lower socioeconomic status. Among men with NMPOU, rates were lower among respondents in the Northeast and South and among those previously married (lifetime). Across time frames and gender, NMPOU and NMPOUD were generally associated with other substance use disorders, posttraumatic stress and borderline, schizotypal and antisocial personality disorders, but associated with major depressive disorder, persistent depression and bipolar I disorder only among men. Disability increased with NMPOU frequency and NMPOUD severity. Only 7.6% and 8.2% of men and women with NMPOU ever received treatment, while 26.8% and 31.1% ever received treatment for NMPOUD.NMPOU and NMPOUD are highly disabling, associated with a broad array of sex-specific and shared correlates and comorbidities and largely go untreated in the U.S. Valid assessment tools are needed that include gender as a stratification variable to identify NMPOU and NMPOUD.

Objectives. We addressed regular drinking before sex and its associated risk factors. Methods. From the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative adult US sample (fielded 2004–2005), we determined the 12-month prevalence of regularly drinking alcohol before sexual activity. Among 17 491 sexually active drinkers, we determined the sociodemographic, psychiatric, and substance use correlates of regularly drinking before sex. Results. Regular presex drinking’s 12-month prevalence was 1.8%. Significant bivariate sociodemographic correlates were age, gender, race/ethnicity, education, family income, marital status, and employment status. Generalized anxiety disorder and alcohol dependence were associated with significantly increased odds of being a regular presex drinker after controlling for covariates. Conclusions. We estimate that 4.3 million American adults are regular presex drinkers. Future research should examine this public health issue at the population level, with particular focus on pathways that link it to psychopathology.

Importance National epidemiologic information from recently collected data on the newDSM-5classification of alcohol use disorder (AUD) using a reliable, valid, and uniform data source is needed. Objective To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, associated disability, and treatment ofDSM-5AUD diagnoses overall and according to severity level (mild, moderate, or severe). Design, Setting, and Participants We conducted face-to-face interviews with a representative US noninstitutionalized civilian adult (≥18 years) sample (N = 36 309) as the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 through June 2013 and analyzed in October 2014. Main Outcomes and Measures Twelve-month and lifetime prevalences of AUD. Results Twelve-month and lifetime prevalences of AUD were 13.9% and 29.1%, respectively. Prevalence was generally highest for men (17.6% and 36.0%, respectively), white (14.0% and 32.6%, respectively) and Native American (19.2% and 43.4%, respectively), respondents, and younger (26.7% and 37.0%, respectively) and previously married (11.4% and 27.1%, respectively) or never married (25.0% and 35.5%, respectively) adults. Prevalence of 12-month and lifetime severe AUD was greatest among respondents with the lowest income level (1.8% and 1.5%, respectively). Significant disability was associated with 12-month and lifetime AUD and increased with the severity of AUD. Only 19.8% of respondents with lifetime AUD were ever treated. Significant associations were found between 12-month and lifetime AUD and other substance use disorders, major depressive and bipolar I disorders, and antisocial and borderline personality disorders across all levels of AUD severity, with odds ratios ranging from 1.2 (95% CI, 1.08-1.36) to 6.4 (95% CI, 5.76-7.22). Associations between AUD and panic disorder, specific phobia, and generalized anxiety disorder were modest (odds ratios ranged from 1.2 (95% CI, 1.01-1.43) to 1.4 (95% CI, 1.13-1.67) across most levels of AUD severity. Conclusions and Relevance Alcohol use disorder defined byDSM-5criteria is a highly prevalent, highly comorbid, disabling disorder that often goes untreated in the United States. The NESARC-III data indicate an urgent need to educate the public and policy makers about AUD and its treatment alternatives, to destigmatize the disorder, and to encourage those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment.

The purpose of this study was to examine prevalences and concordances between Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and Fifth Edition (DSM-5) substance use disorders (SUDs) in a newly completed U.S. epidemiologic survey.The National Epidemiologic Survey on Alcohol and Related Conditions-III surveyed 36,309 civilian, noninstitutionalized adults. SUDs were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Concordances between DSM-IV and DSM-5 disorders were assessed using kappa statistics.Prevalences of past-year substance-specific DSM-5 disorders (2+ criteria) were modestly higher than those of DSM-IV dependence and abuse combined for alcohol, sedatives/tranquilizers, opioids, and heroin, but lower for cannabis, cocaine, and stimulants. Lifetime prevalences were lower under DSM-5. Prevalences were similar between moderate to severe (4+ criteria) DSM-5 disorders and dependence, whereas prevalences of DSM-5 disorders at 3+ criteria (DSM-5 [3+]) were higher, particularly for cannabis. Past-year concordances were excellent for DSM-IV dependence and abuse combined versus any DSM-5 and DSM-IV dependence versus DSM-5 moderate to severe disorders; lifetime concordances were fair to excellent. Past-year concordances between DSM-IV and DSM-5 (3+) were generally similar to or modestly higher than those with any DSM-5 disorder; lifetime concordances were mostly lower.Findings are consistent with those informing the development of DSM-5. Future research should examine differences in patterns between past-year and lifetime disorders, particularly for cannabis. Other questions warranting investigation include whether different combinations of the same numbers of criteria carry different clinical or nosologic implications, whether changes innosology yield changes in treatment demand, and whether changes in characteristics of individuals with DSM-5 SUDs dictate modifications to screening and intervention.

The objective of this study was to compare the current prevalence and co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol and drug use disorders and mood, anxiety, and personality disorders among whites, blacks, Native Americans, Asians, and Hispanics in a large representative sample of the US population. Striking mental health disparities were observed in the prevalences of psychiatric disorders, especially among Native Americans. Disparities in psychiatric comorbidity differed from those associated with prevalence. Most significantly, the association between alcohol disorders and personality disorders was significantly greater among Asians relative to whites, blacks, and Native Americans, despite lower prevalences of these disorders among Asians. Taken together, the results of this study highlight the need of future studies that help unravel the risk factors underlying the disparities in both prevalence and comorbidity of psychiatric disorders observed among race-ethnic groups in the United States.

BACKGROUND: Drinking and driving has been identified as one of the most important contributors of motor vehicle fatalities. This paper addressed the existing gap in our public health knowledge regarding the current prevalence of driving after drinking and how this has changed over the past decade. METHODS: Prevalence rates of drinking and driving in 2001–2002, and changes in those prevalence rates between 1991–1992 and 2001–2002, were examined in two large nationally representative surveys of the U.S. population. RESULTS: Overall, the prevalence of driving after drinking was 2.9 percent in 2001–2002, representing approximately six million U.S. adults. This rate was about three-quarters of the rate observed in 1991–1992 (3.7 percent), reflecting a 22-percent reduction. Generally, the male–female differentials in the rate of driving after drinking decreased over the past decade. However, the sex ratios increased substantially for underaged youth over the past decade, reflecting the sharp decrease in prevalence of driving after drinking among 18- to 20-year-old women. Constant and emerging subgroups at high risk for drinking and driving included Whites, Native Americans, males, underaged young adults, and 21- to 25-year-olds. CONCLUSIONS: The results of this study highlighted the need to continue to monitor prevalence and changes in driving after drinking. Results are discussed in the context of strengthening existing prevention and intervention efforts and developing new programs with the sociodemographic differentials observed in this study in mind.

A mismatch between demand and supply for bandwidth is common in transport carrier networks. This mismatch is generally a result of the disparity between a carrier's capacity buildout and its anticipated customer demand. A carrier with temporary bandwidth deficit or lack of presence in a geographical region and a carrier with surplus capacity in the right locations can be brought together by the emerging bandwidth exchange technology. Bandwidth exchange offers a win-win solution, in which the carrier with a deficit avoids losing revenue by buying capacity from the carrier with surplus, and the latter makes additional revenue by retail sale of its excess capacity. While the concept of real-time purchase and exchange of bandwidth has attracted a lot of attention, many technical challenges stand in the way of making it a reality. The purpose of this article is to provide an engineering framework for enabling real-time bandwidth exchange with committed quality of service and service level agreement among transport carriers. Special emphasis is given to identifying the architectural requirements and the enabling infrastructure necessary for building a viable bandwidth exchange that can be used for creating revenue out of surplus stranded capacity. Indepth analysis of cross-carrier service level agreement specification, capacity publication, route design, and service provisioning are also provided in the article.

Tissue factor (TF) is known to be the key element in the initiation of the extrinsic pathway of the coagulation cascade and appears to be a critical determinant of atherosclerotic plaque thrombogenicity. TF is needed to produce thrombin from prothrombin. In the extrinsic pathway, TF activates factor Vll. TF is expressed mainly on subendothelial tissues, but TF expression may be induced on endothelial cells by inflammatory mediators such as tumor necrosis factor-alpha (TNF-alpha). Subendothelial TF is responsible for initiating fibrin formation at sites of vascular injury, bloodborne TF may be an important contributor to propagation of the developing thrombus. It has been postulated that the blood-borne TF initiates the thrombogenic stimulus, leading to the formation of larger and more stable thrombus. TF may attach to cellular receptors, which in turn affect the production and release of inflammatory mediators. Baseline plasma TF activity has been demonstrated as an independent predictor for cardiovascular death in patients with acute myocardial infarction. TF is expressed by macrophage-derived foam cells in atherosclerotic plaques. TF levels were higher in atheroma from patients with unstable angina than with stable angina. These results suggest that high levels of TF exposed upon plaque rupture trigger atherothrombosis. Inhibition of TF would be expected to reduce thrombosis associated with a variety of diseases. TF pathway is a potential target for new therapeutic agents that can decrease TF activity, such as active site-inactivated factor VIIa, recombinant TF inhibitor and antibodies against TF or peptides interfering with TF-FVIIa complex activity. Significant clinical forms of atherosclerosis, such as sudden death, myocardial infarction, and stroke have common pathogenesis. The occlusion of the vessel lumen is the result from atherosclerotic plaque rupture/erosion that initiate thrombus formation. This thrombus has complex structure and contains predominantly fibrin in addition to platelets, suggesting an important role for the coagulation cascade in plaque thrombus formation. Tissue factor (TF) is known to be the key element in the initiation of the extrinsic pathway of the coagulation cascade and appears to be a critical determinant of atherosclerotic plaque thrombogenicity.

We report a giant enhancement of Spin Hall (SH) shift even for normal incidence in an exotic optical system, an inhomogeneous anisotropic medium having complex spatially varying birefringent structure. The spatial variation of birefringence is obtained by changing the three dimensional orientation of liquid crystal by modulating the pixels with user-controlled greyscale value. This polarization dependent spatial variation (in a plane transverse to the direction of propagation of light) of the transmitted light beam (for incident fundamental Gaussian beam lacking any intrinsic angular momentum) through such inhomogeneous anisotropic medium was recorded using an Eigenvalue calibrated Stokes- Mueller imaging system. Giant SH shift was manifested as distinctly different spatial distribution of the recorded output Stokes vector elements for two orthogonal (left and right) input circular polarization states. We unravel the reason for such large enhancement of SH shift by performing rigorous three dimensional analysis of polarization evolution in such complex anisotropic medium. The theoretical analysis revealed that generation of large magnitude of transverse energy flow (quantified via the Poynting vector evolution inside the medium) originating from Spin Orbit Interaction (SOI) in the inhomogeneous birefringent medium leads to the observation of such a large spin dependent deflection of the trajectory of light beam.

This paper describes an architecture and analyzes the performance of dynamic provisioning of lightpaths in an optical network. In dynamic provisioning, a lightpath is set up in real-time without rearranging the working and protection routes of existing lightpaths, and without the knowledge of future lightpath provisioning events. This paper develops a general model of the physical topology of the optical network, and outlines routing approaches for dynamic provisioning of lightpaths. It analyzes via simulations the performance of dynamically provisioned unprotected, 1+1 protected and mesh-restored lightpaths. The analysis of the efficiency of network utilization of dynamic provisioning focuses on the spare capacity needed for protection, and in particular focuses on the impact of sharing of wavelength channels for mesh-restored lightpaths. The main conclusion from the performance studies is that significant capacity gains are achieved with sharing of wavelength-channels for mesh-restored lightpaths with dynamic provisioning even for sparse topologies, and even at moderate loads.

The road to the acquisition of the USNS Impeccable (T-AGOS 23) has seen a few uncommon and challenging twists and turns, resulting in delays and disruption to the program. The saga began in 1993, when the original shipbuilder, facing financial difficulties, filed for Chapter XI bankruptcy protection. For two more years the program was stalled before the Navy was able to warrant the work that had been done up to that point. In 1995 the contract was reassigned to another shipbuilder to complete the vessel and obtain the necessary certificates to comply with all the applicable requirements of the American Bureau of Shipping (ABS). This unprecedented approach put the Navy in the unique situation of being responsible for two of the most controversial issues in a ship construction process, i.e., detail design and equipment warranties. This paper gives the status of the program, discusses how various technical issues and production demands are being addressed, and describes the future hurdles that need to be overcome before delivery of the vessel.

The Internet Engineering Task Force (IETF) is currently in the process of overhauling the architecture of the Internet to meet new challenges and support new applications. One of the most important components of that venture is the enhancement of the Internet service model from a classless best effort service architecture to an integrated services architecture supporting a multitude of classes and types of services. This paper presents the design, implementation, and experiences with a protocol architecture for the integrated services Internet. It is based on the emerging standards for resource reservation in the Internet, namely, the RSVP protocol and the associated service specifications defined by the IETF. Our architecture represents a major functional enhancement to the traditional TCP/IP protocol stack. It is scalable in terms of performance and number of network sessions, and supports a wide variety of network interfaces ranging from legacy LAN interfaces, such as Token Ring and Ethernet, to high-speed ATM interfaces. The paper also describes the implementation of this architecture on the IBM AIX platform and our experiences with the system. We then present a performance analysis of the system which quantifies the overheads imposed by all components of the QoS support, such as traffic policing, traffic shaping, and buffer management.

Cellular digital packet data (CDPD) is a data network designed to meet growing mobile data transmission needs. CDPD networks can stand alone or overlay on the cellular voice system by drawing radio resources from the pool of unused or free cellular analog voice channels. Detection as to whether a channel is free or occupied is mechanized through channel sniffers. Once the CDPD network seizes a channel, it continues to use the channel as long as it is free and leaves the channel within 40 ms of initiation of any voice activity on the channel-the CDPD network then hops to another free channel, if available. CDPD follows slotted nonpersistent digital-sense multiple access with collision detection (DSMA/CD). In addition, it performs channel-error detection and channel-error recovery. We investigate several aspects of the CDPD network, namely, the: (1) effect of CDPD on cellular voice and (2) the delay-throughput performance due to DSMA/CD with error detection.

One of the major attractions of asynchronous transfer mode (ATM) networks for transporting bursty video traffic is its ability to exploit the multiplexing gains of packet switching while providing quality of service guarantees. Unfortunately, most of the multiplexing mechanisms proposed in the literature fail to exploit the multiplexing gains of ATM. We propose a multirate service mechanism that allows a session to be served at different rates at different times. Applications generating bursty data, such as variable bit-rate (VBR) video, can take advantage of multirate service by requesting a high rate of service for brief periods of bursty arrivals and a much lower rate of service for all other times. Consequently, the applications can improve their delay performance without reserving a high bandwidth for the entire duration of the sessions. Furthermore, the scheduler can multiplex the peaks and the lulls in service rates of different sessions and improve the utilization of the system. Using MPEG video traces from a number of applications, we show that multirate servers outperform single-rate PGPS (packet-by-packet generalized processor sharing) servers and CBR (constant bit-rate) servers in terms of number of connections admitted, while providing the same level of service guarantees. We also investigate the performance of multirate service when service quality need not be guaranteed. We refer to this as predictive service. We propose a measurement-based admission control procedure for predictive service, and show that it helps increase the size of the admissible region even further.

Context Clinical experience and factor analytic studies suggest that some psychiatric disorders may be more closely related to one another, as indicated by the frequency of their co-occurrence, which may have etiologic and treatment implications. Objective To construct a virtual space of common psychiatric disorders, spanned by factors reflecting major psychopathologic dimensions, and locate psychiatric disorders in that space, as well as to examine whether the location of disorders at baseline predicts the prevalence and incidence of disorders at 3-year follow-up. Design, Setting, and Patients A total of 34 653 individuals participated in waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Main Outcome Measures The distance between disorders at wave 1, calculated using the loadings of the factors spanning the space of disorders as coordinates. This distance was correlated with the adjusted odds ratios for age, sex, and race/ethnicity of the prevalence and incidence of Axis I disorders in wave 2, with the aim of determining whether smaller distances between disorders at wave 1 predicts higher disorder prevalence and incidence at wave 2. Results A model with 3 correlated factors provided an excellent fit (Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.98, root mean square error of approximation = 0.008) for the structure of common psychiatric disorders and was used to span the space of disorders. Distances ranged from 0.070 (between drug abuse and alcohol dependence) to 1.032 (between drug abuse and dysthymia). The correlation of distance between disorders in wave 1 with adjusted odds ratios of prevalence in wave 2 was −0.56. The correlation of distance in wave 1 with adjusted odds ratios of incidence in wave 2 was −0.57. Conclusions Mapping psychiatric disorders can be used to quantify the distances among disorders. Proximity in turn can be used to predict prospectively the incidence and prevalence of Axis I disorders.