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Objective: An efficient method for measuring maternal milk production is needed. Our objectives were to: (1) validate a milk production rate (MPR) protocol in exclusively breastfeeding mothers; (2) determine MPR change following 48 hours of increased breast emptying; (3) assess agreement between MPR and infant test-weighing; and (4) characterize MPR in early postpartum exclusively breastfeeding mothers. Materials and Methods: N = 23 mothers emptied both breasts hourly over 3 hours (h0, h1, h2, and h3). We estimated steady-state MPR as mean (h2 and h3). Subset A mothers (n = 5) also completed MPR measurements after 48 hours of increased breast emptying. Subset B mothers (n = 16) also test-weighed for 48 hours. We used paired t-test to examine within-participant change in hourly milk yield and MPR; and we used Bland-Altman analysis to compare 24-hour milk production (g/24 hours) measured using test-weight versus MPR. Results are reported as mean ± standard deviation or (±95% limits of agreement). Results: Mothers were 54 ± 14 days postpartum. Paired difference in h3–h2 hourly milk yield was not significantly different (p > 0.05, 3 ± 10 g/hour). In Subset A (n = 5), MPR declined from 50 ± 13 to 43 ± 16 g/hour (p = 0.003) following 48 hours of increased breast emptying. In Study B (n = 16), mean infant test-weighed intake (TW) was 717 ± 119 g/24 hours, and mean MPR was 1,085 ± 300 g/24 hours. Mean difference (MPR-test-weigh) and mean ratio (MPR/test-weigh) significantly increased as MPR increased (p 20 g/24 hours, n = 12), mean MPR = 48 ± 12 g/hour (range, 35–78 g/hour). Conclusion: MPR is a valid measure of current maternal milk production capacity, but is not accurate for evaluating infant intake in exclusively breastfeeding dyads.

The hygiene hypothesis suggests that a reduction in microbial exposure contributes to an impaired immune response later in life and increases the incidence of immune-mediated diseases such as inflammatory bowel diseases (IBD). Thumb sucking and nail biting are two early habits that modulate the oral microbiota composition and antigen load. We hypothesized a lower risk of Crohn’s disease (CD) and ulcerative colitis (UC) in adults with prior thumb sucking and nail biting. 918 IBD cases and their 918 siblings without IBD were asked to fill out a survey containing 32 questions on environmental factors in childhood and early adulthood. Prevalence of thumb sucking and/or nail biting at the usually well-remembered time of (1) school enrollment and (2) coming-of-age ceremonies was the predefined combined risk factor of this study. 65% of the patients were female and 57% suffered from CD. About 49% of IBD patients but only 44% of their siblings reported thumb sucking/nail biting at the time of school enrollment or coming-of-age (p = .007). Sensitivity analysis revealed that this difference was observed in patients with CD (50% versus 41%; RR= 1.22; 95% CI 1.09–1.37, p = .001) but not in patients with UC (49% versus 48%; RR= 1.02; 95% CI 0.90–1.17; p = .83). Contrary to our expectation and challenging the hygiene hypothesis, we found that common oral habits are not protective against IBD. Instead, nail biting at the time of school enrollment and coming-of-age was a statistically significant risk factor for CD in our cohort. Key summary Evidence available before this study: The hygiene hypothesis suggests that a reduction in microbial exposure due to improved health activities has contributed to an immunological imbalance in the intestine and an increased incidence of allergic and autoimmune diseases. A population-based birth cohort study has demonstrated that thumb-sucking and nail biting in children lead to a reduction of the risk of atopic sensitization, asthma, and hay fever. Added value of this study: Contrary to the hypothesis, thumb sucking and nail biting were not associated with a reduced risk of IBD. Instead, thumb sucking and/or nail biting at the usually well-remembered points in time of school enrollment and of religious or secular coming-of-age ceremonies was associated with a higher risk of Crohn’s disease but not of ulcerative colitis. Our data did not support the hygiene hypothesis, one pathogenic concept in the context of IBD.

Background:. Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Various postoperative rehabilitation strategies have been promoted, but the ability to improve patient-reported functional outcome has not been clearly demonstrated. We aim to evaluate outcomes associated with clinic-based, physical therapist-supervised rehabilitation (Formal-PT) compared to surgeon-directed rehabilitation (Home-PT). Methods:. This prospective observational study included patients with operative bimalleolar or trimalleolar ankle fractures with or without dislocation (n = 80) at a Level I trauma center. Patients were prescribed PT per the surgeon's practice pattern. Patient-reported functional outcomes at 6 months and complication rates were compared between groups. Results:. Of the 80 patients, 38 (47.5%) patients received Formal-PT; the remaining received Home-PT. Thirty-four patients (89.5%) attended ≥1 PT session. Number of sessions attended ranged from 1 to 36 (mean = 16). Receipt of Formal-PT did not differ by injury characteristics or demographics. Of patients with private insurance, 57% were prescribed Formal-PT vs 7% of uninsured patients (P = .033). FAAM and Combination SMFA scores at 6 months were similar between groups (Formal-PT: 69.7, 20.1; Home-PT: 70.9, 24.4; P = .868, .454, respectively). Postoperative complications were rare and equivalent between groups. Conclusions:. Comparison of outcomes between patients with operatively treated displaced ankle fractures/dislocations with Formal-PT vs Home-PT showed no difference in SMFA and FAAM scores. These findings suggest patients receiving supervised PT produced a similar outcome to those under routine physician-directed rehabilitation at 6 months. The cost for therapy averaged $2012.96 per patient receiving Formal-PT.

The alcohol industry has developed its own alcohol moderation advertising to combat the rising criticism about the industry's marketing and advertising practices. Today, many brewers and distillers promote “drink responsibly.” This paper attempts to explore what “drink responsibly” means to college students, a target audience who partakes in risky drinking behaviors. The results indicate that these words convey a variety of pro-health and -safety messages, yet don't address other topics, such as being of age. Implications for alcohol marketers, health advocates and public policy makers are presented, and future research directions are offered to stimulate further investigation into these advertising campaigns.

We have previously shown that quantification of CD38 expression using microbeads of specific antibody binding capacity (ABC) improves the prognostic value of CD38 expression in B-cell chronic lymphocytic leukemia, particularly for Binet Stage A patients. Quantification of CD38 expression using beads is expensive, time consuming and could be difficult to implement in a routine clinical laboratory. The calculation of relative median fluorescence (RMF) using the median fluorescence intensities of the test and control samples, is even more simply and cheaply obtained by flow cytometry and could be used as an alternative way of quantifying antigen expression. The present study demonstrates that RMF is an effective prognostic indicator in B-CLL that correlates closely with ABC in predicting disease-specific survival and time to progression for all patients. RMF predicted overall survival and time to progression in all patients (P 30% or > 20% in predicting disease-specific survival in Stage A patients of all ages (CD38 30%: P = 0.0853, CD38 20%: P = 0.0894) and in those under 60 years old (CD38 30%: P = 0.5438, CD38 20%: P = 0.2872). Also, RMF is more effective in predicting time to progression of Binet Stage A patients less than 60 years (P = 0.0143), while percentage CD38 positivity of 30%, 20% or 7% did not achieve statistical significance (P = 0.1103, = 0.0547, = 0.3399, respectively). We suggest that CD38 RMF could be used clinically as an alternative to ABC to identify patients with B-CLL that are likely to progress and require early treatment.

The following study investigates mass media coverage of the consumer privacy issue from 1990–2001 across three media formats: newspapers, consumer magazines, and trade publications. The results indicate that media coverage has increased dramatically in all media formats. Overall, article content has varied relative to the primary privacy domain covered, primary story topic, and the portrayal of the direct marketing industry. Differences were found across media outlets with respect to the source of the privacy problem and the source of the potential solution. Implications and ideas for future research also are presented.

Summary form only given. We have developed and tested two prototype linear transformer drivers (LTDs): LTD III [1], which is a single LTD cavity that generates a peak electrical power of 79 GW, and Mykonos II [2,3], which is a two-cavity 142 GW LTD module. LTD III is driven by 20 bricks, each of which includes an 85-nH gas switch and two 60-nF capacitors. LTD III has been successfully tested on 3,500 shots at a charge voltage of +100 kV / -100 kV. The first 1,500 shots were conducted with UV-illuminated gas switches; the last 2,000, with new three-electrode field-distortion switches. Over the course of the last 2,000 shots, the variation of the output power generated by LTD III was 0.9% (one sigma) and the switch pre-fire rate was 1 in 10,000 switch shots after conditioning. Mykonos II is driven by 72 bricks altogether, 36 in each of the module's two cavities. Each brick includes a 115-nH switch and two 40-nH capacitors. Mykonos II is the first LTD module to drive a water-insulated transmission line. Mykonos has been successfully tested on 1,500 shots at a charge voltage of +90 kV / -90 k V. Over the course of these shots, the variation in the output power was 2.3% (one sigma) and the switch pre-fire rate was 1 in 11,000 switch shots after conditioning. Measured output-pulse parameters of LTD III and Mykonos II are consistent with circuit-model predictions. The results obtained suggest that LTDs are a viable prime-power source for next-generation pulsed-power accelerators.

While this book concentrates on IM for actors, it is beneficial to examine other performance forms to deepen an understanding of the concept of personal and character IM. The phenomenon of a performance IM is not unique to acting. Performers of varying types all connect in some way to those voices in their head.

As mentioned earlier in this book, classical theatre contains its own versions of interior drama that are the theatre’s earliest and most recognized use of IM. From ancient to modern times, the idea of sharing a character’s private thoughts has been used to allow an audience entrance into the inner workings of a character’s true motivations. While never truly labeled IM, the use of these devices has been part of the theatrical lexicon for centuries. We will divide these devices into three categories: apostrophe, soliloquy, and aside. Each method has its own definition and rules.

A measurement and psychometric examination of a set of cognitive tasks was carried out. A critical part of this analysis involved investigation of the stability of latencies and number correct scores over a two-week time period. Relations with standardized test scores and scores on a variety of ability measures were also investigated. Finally, the tenability of considering data from individual paradigms as narrow components of “ g ” and aggregating latencies to form meaningful composites with significant relations with g was investigated. Results indicate moderate to high reliabilities for most of the tasks investigated. Stabilities were found to be low to moderately high. Significant and compelling levels of covariation were achieved from the aggregation of scores, indicating clear promise for the continued investigation of this approach. Findings are discussed in the realm of the critical need for evaluating psychometric and measurement properties of cognitive tasks used in individual differences research.

This study investigated several current coaching practices used in training test-wiseness for analogy items in standardized test batteries. A three-group design was used which included a general test-taking, "encouragement" condition in addition to a no-training control group condition. The specific techniques used in training are described. Scholastic Aptitude Test (SAT) scores were obtained from university admission files to verify that no overall aptitude differences existed in the three conditions. Differences were observed for the coached group relative to the two control groups in terms of overall number of correct responses for the coached item types (analogies). No differences were found for the non-coached item types. Item difficulties for the three groups are also reported which show that several items were indeed made easier for individuals in the coached group. A qualitative analysis of the items made easier by coaching in terms of the training techniques used is given along with an analysis o...

A 6.1-MV, 790-kA laser triggered gas switch (LTGS) is utilized to synchronize the 36-modules of the Z-machine at Sandia National Laboratories. The switch is ∼81-cm in length, 45-cm in diameter, and is immersed in transformer oil. The switch is pulse-charged from a 780-kJ, 6-MV Marx generator in 1.4-µs. Closure of the switch allows energy stored in a 24-nF intermediate-store water capacitor to flow into subsequent pulse-forming stage. The entire system (36-modules) generates a ∼70-TW at the present system operating level, but after near term improvements are complete, this level will increase to ∼100-TW.

You are a designer. You have listened to your collaborators. You have done your research. You have put pen to paper and you have designed. You designed with the audience’s reaction in mind. You designed the premise. You designed the climax. You have designed with the needs of others in mind while allowing your artistic abilities to create bolder, better plans for your contribution. Now, how do you best present them?

For designers and directors alike, the entire production revolves around one collaborator who rarely attends production meetings: the playwright. You have heard it before but, honestly, it all begins and ends with the script: the common ground from which we all create. The deciding factor in most debates and the duty of any member of the production team is to serve the script. The sole reason for everyone devoting the time and effort to any production revolves around the script—or more correctly, around the production team’s interpretation of the script.

This chapter offers ways to assist in dealing with the initial meetings of the production team. The first impressions that you present to your collaborators are difficult to alter. Although we are using examples from our lives working at a university and in professional settings, our experiences can easily translate into any production venue. Our aim throughout is to assist in creating a healthy collaboration. Also, the practical part of this book aims to model an expeditious collaboration and therefore places the director as arbiter of most debates. This should not always be the case.

Thoroughly researching a play is impossible. There are always details you cannot even begin to tackle. Beside the imminent demand of production schedules, there are just too many elements that must be addressed. Even if you are lucky enough to have the assistance of a dramaturg, you can never cover everything.

The production has opened. The response was what you hoped for. You see the production team’s final product and you’ve marveled that this project, begun many weeks ago, has been successfully handed over to its intended audience. You have a few seconds to breathe before the whole process begins anew with a different production team.

The main goal of this paper is to provide design of an underwater robot with actuators utilizing advanced and smart materials such as Shape Memory Alloys (SMA).

Introduction Victims of intimate partner violence against women (IPVAW) often come into contact with various health care professionals, including emergency nurses. Michigan has implemented an ED surveillance system to monitor IPVAW in the state. Methods Twenty-three emergency departments participate in the Michigan Intimate Partner Violence Surveillance System. Female assault and maltreatment victims are identified using International Classification of Diseases Clinical Modification (ICD-9-CM) diagnostic and E codes (External Cause of Injury/Adverse Effects codes). For a 2-year period (1999-2000), patients' charts were reviewed, usually by an emergency nurse, to identify IPVAW victims. Results A total of 3111 female assault and maltreatment victims were identified. Of the 2926 incidents for which physical and/or sexual violence was confirmed by chart review, 1136 (38.8% [95% confidence interval: 37.1% to 40.6%]) involved IPVAW. Discussion A hospital ED surveillance system revealed that more than a third of female assault and maltreatment incidents were attributable to intimate partner violence, with a considerable proportion being young women abused by an ex-boyfriend. Surveillance also identified a need for improved documentation of female assault and maltreatment in ED records. We realized the benefits of using a public health surveillance process to monitor IPVAW incidence, identify high-risk groups, and reduce research costs.

Background: Ileocolonoscopy represents the diagnostic standard in the work-up of patients with inflammatory bowel diseases (IBD). Patients are often reluctant to be colonoscoped because of the invasiveness and pain sensation during colonoscopy. Aims: To compare the usefulness of transabdominal ultrasound (US) and magnetic resonance imaging (MRI) in assessing disease extension and activity in patients with IBD restricted to the terminal ileum and large bowel. Patients and Methods: 61 patients with IBD [37 Crohn's disease (CD) and 24 ulcerative colitis (UC)] were prospectively studied. All patients underwent clinical and laboratory assessment, ileocolonoscopy, transabdominal sonography, and MRI within 5 days. Involved bowel segments were defined as those with bowel wall thickness >3 mm and increased Doppler signal on US or contrast enhancement of the bowel wall on MRI. To compare disease activity endoscopic, MRI and US findings were graded with newly developed scores. Results: The segment-by-segment analysis revealed an overall accuracy of 89% for US and 73% for MRI in identifying active IBD. The accuracy was better in patients with UC than in patients with CD for both US and MRI. The endoscopic activity index (EAI) correlated stronger with the US activity index (r = 0.884) than with the MRI activity index (r = 0.344). The correlation of US and MRI activity indices with EAI was better in patients with UC compared with patients with CD. All three imaging methods showed a significant correlation with clinical disease activity in patients with UC but not in patients with CD. Conclusion: This study provides strong evidence that US should be considered as a first-choice method for follow-up of patients with IBD of the terminal ileum and large bowel.

Controlling of underwater robots require the estimation of unknown hydrodynamic forces and moments and disturbances acting on these vehicles. Using conventional control theory for design and synthesis of the controller seems to be almost impossible when we are dealing with such a nonlinear system. In this paper an artificial neural network based control system of a robot for underwater ship hull cleaning is proposed. The underwater robot has to move on a trajectory specified in terms of desired position according to the hydroacoustic localisation system.

The paper describes a robot system for underwater cleaning and maintenance of ship hulls, drilling platforms or floating docks. It works under water and it is gripped to the steel surface of a hull using the power of magnetic attraction. Its control and hydraulic drives systems are presented in this paper.

Background: lleocolonoscopy still represents the diagnostic gold standard in the work-up of patients with inflammatory bowel diseases (IBD). Because of the necessity to clean the colon extensively and the invasive and often painful procedure, patients are often reluctant to be colonoscoped. The purpose of this study was to evaluate the usefulness of transabdominal ultrasound (US) and magnetic resonance imaging (MR1) to assess disease extension and seventy of the terminal ileum and colon in patients with IBD. Methods: Seventy consecutive patients with confirmed IBD (43 with Crohu's disease and 27 with ulcerative colitis) were included. Patients underwent clinical assessment, laboratory testing, ileocolonoscopy, US, and MRI within 5 consecutive days. Involved bowel segments were defined as those with bowel wall thickness > 3 mm assuming an increased Doppler signal on US or moderate contrast enhancement of the bowel wall on MRI. Endoscopy served as diagnostic gold standard. Severity of disease was graded wath newly developed scores for endoscopic, MRI, and US findings. Results: A segment-by-segment analysis revealed an overall accuracy of 89% for US and 73% for MRI in identifying active IBD lesions. The accuracy was higher in patients with ulcerative colitis (UC) compared to patients with Crohn's disease (CD) for both US and MRI (95% vs. 85% and 81% vs. 67%, respectively). The US activity index showed a strong correlation with the endoscopic activity index (EAI) (r = 0.884, p < 0.0009), whereas the MRI activity index did not correlate with the EA1 (r = 0.344, p = 0.007). Correlation of EAI with US and MRI activity index was better in patients with UC (r = 0.974, p = 0.0009 and r = 0.519, p = 0.009, respectively) than in patients with CD (r = 0.830, p < 0.0009 and r = 0.120, p = 0.482, respective). The extension and severity of inflammation as assessed on US and MRI varied according to location of affected bowel segment. All three imaging methods showed a significant correlation with clinical disease activity index in patients with UC but not in patients with CD. In addition, EA1 and US activity index showed a significant correlation with C-reactive protein in patients with UC. Conclusion: Trausabdominal ultrasound provides a reliable, cheap and safe tool to assess disease extension and activity in patients vath IBD and should be considered as a first-choice method for the follow up of patients with confirmed diagnosis of IBD.