Journal articles on the topic 'Log book variables'

Consider a sequence U1, U2, · ·· of i.i.d. uniform (0, 1)-random variables. For fixed α ∈ (0, 1), let U(n, K) denote the [Kα]th order statistic of the subsample Un+1, · ··, Un+K, and set . Book and Truax (1976) proved the following analogue of the Erdös-Rényi (1970) strong law of large numbers: for α < u < 1 and C = C(α, u) such that −1/C = αlog(u/α)+ (1 – α)log((l – u)/(1 –α)), it holds almost surely that In view of the Deheuvels–Devroye (1983) improvements of the original Erdös-Rényi law, we determine the lim inf and lim sup of where K = [C log N]. This improves (∗), showing that it holds with a best-possible convergence rate of order O(log log N/log N). Using the quantile transformation the result can be extended to a general i.i.d. sequence X1, X2, · ·· with d.f. F satisfying a strict monotonicity condition.

Consider a sequence U 1, U 2 , · ·· of i.i.d. uniform (0, 1)-random variables. For fixed α ∈ (0, 1), let U(n, K) denote the [Kα]th order statistic of the subsample Un +1, · ··, Un +K , and set . Book and Truax (1976) proved the following analogue of the Erdös-Rényi (1970) strong law of large numbers: for α &lt; u &lt; 1 and C = C(α, u) such that −1/C = αlog(u/α)+ (1 – α)log((l – u)/(1 –α)), it holds almost surely that In view of the Deheuvels–Devroye (1983) improvements of the original Erdös-Rényi law, we determine the lim inf and lim sup of where K = [C log N]. This improves (∗), showing that it holds with a best-possible convergence rate of order O(log log N/log N). Using the quantile transformation the result can be extended to a general i.i.d. sequence X 1, X 2, · ·· with d.f. F satisfying a strict monotonicity condition.

This study aims to determine the effect of profitability, dividend policy, firm size, and debt policy on firm value in the Manufacturing sector of the food and beverage sub-sector listed on the Indonesia Stock Exchange (IDX) in 2014-2020. The ratios used in this study include Price to Book Value (PBV), Return on Equity (ROE), Dividend Payout Ratio (DPR), Log Total Assets, and Debt to Equity Ratio (DER). This study used 10 companies as research samples with 7 years of observation, resulting in 70 observations. This research uses Eviews version 10 program with panel data analysis method. The method used in sampling in this study, namely purposive sampling technique. The results showed that simultaneously profitability (ROE), Dividend Policy (DPR), Firm Size (Log Total Assets), and Debt Policy (DER) variables had an effect on firm value, and partially Profitability (ROE) and Debt Policy (DER) variables. has a positive and significant effect on firm value. Then the Dividend Policy (DPR) has a negative and significant effect on firm value. While Firm size (Log Total Assets) has no effect on firm value in the company

The purpose of this studyis to find out how the influence of earnings per share (EPS) and price book value (PBV) simultaneously and parcial to stock prices in retail industry listed on the Stock Exchange Indonesia period 2013-2016. The ojek this analysis is the retail industry listed on the stock exchange indonesia period 2013-2016. Sampel used in this research is as many as 8 retail industry listed on the Stock Exchange Indonesia period 2013-2016. The method used is qualitative and quantitative method. . The analytical tool used in this research is multiple linear regression analysis, the classical assumption test (normality, multicolinearity, hetoroscedasicity, and autocorrelation) and coefficient of determination. Based on the results of multiple linear regression analysis showed the equation Log Y= 2.244 + Log 0,528EPS Log 0,018PBV + e , with F test value of 5,153. Value t test for earning per share (EPS) of 3,159 and the value of T test for price book value (PBV) of 0,113. Rated R Square 26,2%, while the remaining 73,8% explained other factors beyond the study models. And the R value of 0,512. The conclusion of this research indicates that simultaneously independent variable earnings per share (EPS) and price book value (PBV) have an effect on stock price variable. The parcial price (PBV) has no significant effect on stock price dependent and earnings per share (EPS) have a significant effect on stock price variables.

This formula can be informally read as follows: the ith messagemi brings us log(1=pi) "bits of information" (whatever this means), and appears with frequency pi, so H is the expected amount of information provided by one random message (one sample of the random variable). Moreover, we can construct an optimal uniquely decodable code that requires about H (at most H + 1, to be exact) bits per message on average, and it encodes the ith message by approximately log(1=pi) bits, following the natural idea to use short codewords for frequent messages. This fits well the informal reading of the formula given above, and it is tempting to say that the ith message "contains log(1=pi) bits of information." Shannon himself succumbed to this temptation [46, p. 399] when he wrote about entropy estimates and considers Basic English and James Joyces's book "Finnegan's Wake" as two extreme examples of high and low redundancy in English texts. But, strictly speaking, one can speak only of entropies of random variables, not of their individual values, and "Finnegan's Wake" is not a random variable, just a specific string. Can we define the amount of information in individual objects?

Individuals who invest stocks in a market with excess volatility generally end up selling or holding the stocks at losses. The purpose of this study was to examine individual herding as it related to three comprehensible stock characteristics, market capitalization, price-to-book ratio, and industry affiliation. The target population was the individual investors who traded in Taiwan Stock Exchange in 2016. Data were collected through subscription. Based on Lakonishok, Shleifer, and Vishny's measure, individual herding was significant. The three stock characteristics were separately and as a whole related to individual herding. The findings confirmed sell-herding higher than buy-herding, more serious herding in high market capitalization stocks, and broad industry herding. The findings also extended knowledge to comparable herding levels with 8 to 10 years ago, more linearity between log market capitalization and log odds of herd occurrence, and less herding in P/B ratio stocks with other independent variables controlled.

AbstractIntroductionThe International Physical Activity Questionnaire (IPAQ) was developed to measure health-related physical activity (PA) in populations. The short version of the IPAQ has been tested extensively and is now used in many international studies. The present study aimed to explore the validity characteristics of the long-version IPAQ.Subjects and methodsForty-six voluntary healthy male and female subjects (age, mean±standard deviation: 40.7±10.3 years) participated in the study. PA indicators derived from the long, self-administered IPAQ were compared with data from an activity monitor and a PA log book for concurrent validity, and with aerobic fitness, body mass index (BMI) and percentage body fat for construct validity.ResultsStrong positive relationships were observed between the activity monitor data and the IPAQ data for total PA (ρ = 0.55, P < 0.001) and vigorous PA (ρ = 0.71, P < 0.001), but a weaker relationship for moderate PA (ρ = 0.21, P = 0.051). Calculated MET-h day−1 from the PA log book was significantly correlated with MET-h day−1 from the IPAQ (ρ = 0.67, P < 0.001). A weak correlation was observed between IPAQ data for total PA and both aerobic fitness (ρ = 0.21, P = 0.051) and BMI (ρ = 0.25, P = 0.009). No significant correlation was observed between percentage body fat and IPAQ variables. Bland–Altman analysis suggested that the inability of activity monitors to detect certain types of activities might introduce a source of error in criterion validation studies.ConclusionsThe long, self-administered IPAQ questionnaire has acceptable validity when assessing levels and patterns of PA in healthy adults.

This study aims to examine the equity risk incentives relationship with corporate tax aggressiveness. This study uses four proxies to measure corporate tax aggressiveness variables, namely Cash Effectives Tax Rate (CETR), Tax Shelter, Unrecognized Tax Benefits (UTB), and Discretionary Book Tax Differences (DTAX). The equity risk incentives variable is measured using the annual natural total log of compensation of the key management. The study population was manufacturing companies listed on the Indonesia Stock Exchange from 2013 to 2017. The study samples were determined by purposive sampling method so that samples for each CETR, Shelter, UTB and DTAX were obtained were 235, 180, 210 and 205 companies. Based on panel data regression analysis, the results show that 1) Equity Risk Incentive is negatively related to Cash Effectives Tax Rate but not significant, 2) Equity Risk Incentive is positively related to Tax Shelter but not significant, 3) Equity Risk Incentive is negatively related to Unrecognized Tax Benefits not significant, and 4) Equity Risk Incentive is positively related to the Discretionary Book Tax Differences but not significant. The conclusion of this study is that equity risk incentives are not positively related significantly with corporate tax aggressiveness so the hypothesis is rejected.Keywords: Equity Risk Incentives; Tax Aggressiveness

Background: Perinatal asphyxia is a severe problem which causes serious problem in neonates in developing countries. This study is aimed to determine magnitude of perinatal asphyxia and its associated factors. Methods: A cross-sectional study design was conducted among neonates admitted over a period of 4 years on 740 samples. Systematic sampling method was employed to get required samples from log book. Epi-data 3.1 is used for data entry and the entered data was exported to SPSS Version 23 for analysis. Bivariable and multiple variable logistic regressions analysis were applied to see the association between dependent and independent variables. Finally, P-value <.05 at 95% CI was declared statistically significant. Results: The main significant factor associated to perinatal asphyxia were prolonged labor ( P = .04, AOR = 1.68 95%CI: [1.00, 2.80]), being primipara ( P = .003, AOR = 2.06, 95%CI: [1.28, 3.30]), Small for Gestational Age (SGA) ( P = .001, AOR = 4.35, 95%CI: [1.85, 10.19]), Large for Gestational Age ( P = .001, AOR = 16.75, 95%CI: [3.82, 73.33]) and mode of delivery. Conclusion: The magnitude of perinatal asphyxia was 18%. Prolonged labor, parity, birth size, mode of delivery, and APGAR score at 1st minute were significantly associated with perinatal asphyxia. So, Nurses, Midwives, Medical Doctors, and health extension workers have to engage and contribute to on how to decrease the magnitude of perinatal asphyxia.

Today, there is a great deal of pressure on companies from public authorities, investors, and civil society to introduce more diversity. This criterion is the subject of binding regulations in various countries, to strengthen the presence of women in the management and governance of companies. Our study aims to investigate the results of governance mechanisms, especially board of directors ‘characteristics, on a bank’s performance. Specifically, we are examining how certain governance practices, such as gender diversity on the board and the CEO's dual role, affect a bank's performance. Indeed, these boards’ attributes are proven to reduce agency conflicts and enhance control mechanisms to serve in the best manner shareholders and contribute the better banks' performance. For our empirical methodology, we used panel data with a sample of 66 French banks observed during the period 2014-2018. The findings revealed a positive and statistically significant relationship between gender diversity and performance, as measured by the variable return on equity. We also discovered that director independence has a positive effect on performance. We observed a positive and significant effect on the bank's performance as a result of the CEO's duality. For control variables used: size and debt, the relationship with bank performance is positive with the size variable calculated as the log Book value of Total Assets. But the impact is negative between debt and banks' performance with low significance.

Purpose: The aim of our paper is twofold. First, we examine the predictive ability of log book-market, dividend-price, earnings-price and dividend-earnings ratios on the most recent data set of the strongest securities in the UK economy; unlike the majority of the studies in this data set, our analysis is not limited on returns but further investigates dividend and earnings growth predictability under the presence of the most recent global financial recession. Second, we exploit the long-run equilibrium relationship in two systems, [p_t,d_t,e_t] and [p_t,b_t,e_t] and examine the predictive ability of our newly formed variables, namely 〖pde〗_t and 〖pbe〗_t. Design/methodology/approach: In this study, we examine the most recent data set of Financial Times Stock Exchange 100 (FTSE 100) and analyze it based on the formation of size portfolios. The main focus is placed on the index’s returns, dividend and earnings growth rates and the predictive ability of the four financial ratios we have selected following their reputation as strong predictors. We also formulate two extra ratios based on their long-run equilibrium relationship. Finding: Our study’s main findings can be summarized as following. First, we retrieve evidence that in-sample return predictability is evident in the medium and large-sized portfolios and is better captured by 〖pde〗_t at 35% and 47% equivalently. Second, forecasts on dividend growth are even more linked to the size criterion we employ. Third, in-sample regressions of continuously compounded earnings growth rate show that most predictive benefits are obtained by 〖dp〗_t in the medium portfolio with an R^2 of 45%. Research limitations/implications: A first constraint is the forecasters we employ; we have used the most indicative ones due to their popularity in similar data sets but there are other macroeconomic variables such as spreads and interest rates that could be tested in future research. Also, we could examine the sensitivity of our results on whether we use nominal, excess or real returns and then, attempt to alter our data’s frequency so as to address the seasonality effect observed mainly in dividends and earnings. Originality/value: We believe that our paper contributes to the ongoing debate of the traits that make return predictable and the information included in either dividends or earnings to explain that predictability. Finally, the novelty of this paper lies in the links it tries to retrieve among market capitalization value and predictability in a market whose predictive components have not been entirely explored. Our paper may prove informative to investors focused on short-term forecasting and interested in the effects of size in portfolio formation.

Over the years, the South Asian countries were facing the dilemma of twin’s deficits because they had failed to generate sufficient revenues to finance their budget. Consequently, they were continuously relying on both domestic and external debt to bridge these deficits which had put a severe implication on their economic growth. Their financial position continued to deteriorate and undermined all the efforts of the governments made to stimulate economic growth. The governments in these countries failed to generate enough revenues through internal sources. Therefore, the deficits were normally fiancé through external sources. The paper examined whether the external debt was a blessing or course to the economic growth of South Asian countries i.e. Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. For this purpose 30 years of panel data of these countries from 1990 to 2019 had been taken. Fixed effect model and Panel Autoregressive Distributive Lag (ARDL) Approach had been applied to examine the short-run and long-run association among the variables. The natural log of GDP per capita was used as a proxy for economic growth. The other variables were external debt, initial GDP, foreign direct investment, trade openness, investment, and secondary school investment rate. The outcomes of the study indicated that that external debt had a negative impact on economic growth both in the short-run and long-run. This revealed that external debt had not been utilized effectively and productively. The study suggested that effort would be made to manage the external debt and reduced the twin's deficits to minimize the harmful impact of external debt on the economy. Keywords: South Asian, External Debt, ARDL, Fixed Effect Model, Economic Growth.

Economic growth of an economy is defined as the steady state path through which the productivity of an economy is improved and increases the levels of national output and income. The government consumption expenditures and investment play a key role in the process of investigating the macroeconomic performance of an economy and determinants of economic growth. The countries which grow quickly, invest a substantial fraction of their GDP for consumption expenditures as well for the sources which encourage private investment. The objective of this study to calculate the volatility in economics growth in Pakistan. The annual time series data are used from 1975 to 2014 from WDI, Economics survey of Pakistan and Hand Book of Statistics. GARCH model has been used to measure volatility of all variables. The empirical results of the study confirmed that the volatility of the different variables (volatility of inflation, volatility of interest rate, volatility of political instability, volatility of GDP, and volatility of foreign direct investment) significant affect the government consumption expenditures and private investment in the economy of Pakistan. The study analyzed data by using the autoregressive distributive lag model which is mainly used in time series data Econometrics to estimate the non-stationary models with mix order of integration. The estimated results of the study evaluated that volatility of the inflation lead to uncertainty which is also suggested by the Able (1980) and negatively affect the economy consumption expenditures as well as private investment in the economy of Pakistan. Because uncertainty directly affects the cost of capital as well as reduce private investor confidence.

Financial statements are one important instrument in supporting the sustainability of a company, because financial statements have a role in the process of measuring and evaluating the performance of a company. Financial statements must be of high quality before being submitted to users of financial statements because users of financial statement information require reports that are complete, transparent, and presented on time. The financial statements aim to provide information about the company's financial position, performance and cash flow that is beneficial for most users of financial statements in the context of making economic decisions and shows management's responsibility in the use of company resources. The auditor's timeliness in completing the audit report will affect the timeliness of the publication to the public. The length of time (number of days) from the date of closing the book to the date stated on the audit report is called the audit report lag. The purpose of this study was to obtain empirical evidence about the effect of Profitability, Leverage, Firm Size, Firm Reputation and Outsider Ownership influence on Audit Report Lag. This research was conducted at manufacturing companies listed on the Indonesia Stock Exchange (IDX) with a research period of 2014-2018. The method used is explanatory research, which explains the position of the variables studied and tests the effect of one or several variables on one or several other variables. The results showed that firm size had a significant negative effect on audit report lag, leverage variable does not have a significant negative effect on audit report lag, profitability has no negative effect on audit report lag, Public Accounting Firm (KAP) has no negative influence on audit report lag and institutional ownership does not have a negative effect on audit report lag.

This study examined trends and influences of variables in the 100 most recent applications of Section 5(2) of the Mental Health Act 1983 in a major teaching hospital in England. Case notes, section-forms, log-books and computerised records were scrutinised. Sixty-four per cent of the cases were converted to Section 2(28%) or Section 3(36%), the remainder were rescinded or lapsed. No demographic, illness characteristic or grade of doctor significantly effected conversion or lapse rate of Section 5(2). The clinical implications of a high rate of non-conversion of Section 5(2) is clear. Non-psychotic patients may be less likely to be regarded for further Sections when detained under Section 5(4) before detention under Section 5(2), yet no single factor determines the outcome of emergency detention.

This study aims to determine and analyze the effect of profitability, solvency, liquidity, entity size, and KAP size on audit report lag (ARL). ARL is the length of time it takes from closing the books until the independent auditor's report is signed by KAP. The research population is trade, service and investment sector entities listed on the Indonesia Stock Exchange for the period 2017-2019. Non-probability sampling technique with purposive sampling method with a total of 51 entities. The data analysis technique is multiple regression analysis. The results show that profitability has a significant negative effect on audit report lag, meaning that high profitability will shorten the length of audit reporting time. Solvency, liquidity, entity size, and KAP size variables have no effect on audit report lag.

One of the classic issues in business administration is whether managers can maximize profit. Thus, this article aims to identify the causal factors regarding the maximization of companies’ market value to subsidize decision-makers. The sample was extracted from the Capital IQ database and formed of nonfinancial public companies from Germany, France, and England, considering the period from 1999 to 2019, with quarterly frequency. The study finds theoretical support from market-to-book decomposition concepts as in Rhodes-Kropf, Robinson, and Viswanathan (2005), and uses the classical theory decision model with hypotheses proposed by Lindenberg and Ross (1981), Hirschey and Wirchem (1984), Habib and Ljungqvist (2005), Hertzel and Li (2010), and Belenzon (2012). The research adopted a t-1 period lag in the independent variables in relation to the dependent variable to demonstrate the result of actions of independent variables in the dependent variable in subsequent periods. Subsequently, correlation and regression analyses were performed with panel data. The results show that the management of tangible and intangible assets, goodwill, revenue, Ebitda, return on assets, research and development, advertising, Capex, and return on equity contribute to increasing the companies’ market value, and they can be maximized through good management. Therefore, because these variables are manageable, it is possible to infer that managers are in the position to maximize companies’ market value.

IntroductionParametric survival models are used to develop injury risk curves (IRCs) from impact tests using postmortem human surrogates (PMHS). Through the consideration of different output variables, input parameters and censoring, different IRCs could be created. The purpose of this study was to demonstrate the feasibility of the Brier Score Metric (BSM) to determine the optimal IRCs and derive them from lower leg impact tests.MethodsTwo series of tests of axial impacts to PMHS foot–ankle complex were used in the study. The first series used the metrics of force, time and rate, and covariates of age, posture, stature, device and presence of a boot. Also demonstrated were different censoring schemes: right and exact/uncensored (RC-UC) or right and uncensored/left (RC-UC-LC). The second series involved only one metric, force, and covariates age, sex and weight. It contained interval censored (IC) data demonstrating different censoring schemes: RC-IC-UC, RC-IC-LC and RC-IC-UC-LC.ResultsFor each test set combination, optimal IRCs were chosen based on metric–covariate combination that had the lowest BSM value. These optimal IRCs are shown along with 95% CIs and other measures of interval quality. Forces were greater for UC than LC data sets, at the same risk levels (10% used in North Atlantic Treaty Organisation (NATO)). All data and IRCs are presented.ConclusionsThis study demonstrates a novel approach to examining which metrics and covariates create the best parametric survival analysis-based IRCs to describe human tolerance, the first step in describing lower leg injury criteria under axial loading to the plantar surface of the foot.

Background: Early-initiation of breastfeeding is putting the newborns to the breast within the first hour of life. It is the first critical time they contact their mother outside of the womb. The current study aimed to assess the early initiation of breastfeeding in the study setting. Objectives: To assess the level of early initiation of breastfeeding and its associated factors among mothers who had a baby of less than the age of 24 months in Jeju Woreda, Arsi Zone, Oromia, Ethiopia, 2019. Methods: A community-based cross-sectional study conducted involving 487 mothers from September 18 to October 09, 2019. A multistage sampling technique was employed. First, the setting stratification done in urban and rural settings. Second, ten kebeles selected from both strata. The study participants identified by systematic random sampling technique using kebele log-books registration list as a scheme. The collected data were entered into Epi Info version 7.1.5.0 and exported to SPSS version 21.0.0.0 to analyze. Bivariate and multivariate logistic regression used to determine relations between independent factors and early initiation of breastfeeding. Nine variables became eligible for multivariate analysis at a p - value less than 0.05 in bivariate. The final analyses done the significance of association decided using AOR with its 95% CI, and p - value at less than 0.05. Results: A 97% response rate achieved in this study. The prevalence of early breastfeeding initiation was 74.5%. In multivariate analysis variables namely, mothers whose age category was 35 years and above (AOR = 2.34, 95% CI: (1.07, 5.11)), Pre-lacteal feeding (AOR = 0.37 95% CI (0.17, 0.79)), postpartum advice (AOR = 1.72, 95% CI (1.01, 2.95)) had a significant association. Conclusion and recommendations: The prevalence of early breastfeeding initiation was (74.5%). The finding was low compared to the world health organization recommendation. A working towards discouraging pre-lacteal feeding and strengthening postnatal advice and focusing on ways to better reach young mothers were the recommendations to bring the prevalence in the study area to the recommended level.

There is a large amount of documented weather information all over the world, including Asia (e.g., old diaries, log books, etc.). The ultimate goal of this study is to reconstruct historical weather by deriving total cloud cover (TCC) from historically documented weather records and to assimilate them using a general circulation model and a data assimilation scheme. Two experiments are performed using the Global Spectral Model and an ensemble Kalman filter: 1) a reanalysis data experiment and 2) a ground observation data experiment, for 18 synthesized observation stations in Japan according to the Historical Weather Data Base. By assuming that weather records can be converted into three TCC categories, the synthetic observation data of daily TCC are created from reanalysis data, with a large observation error of 30%, and by classifying ground observation data into the three categories. Compared with the simulation without assimilation of any observation, the results of the reanalysis data experiment show improvements, not only in TCC but also in other meteorological variables (e.g., humidity, precipitation, precipitable water, wind, and pressure). For specific humidity at 2 m above the surface, the monthly averaged root-mean-square error is reduced by 18%–22% downstream of the assimilated region. The results of the ground observation data experiment are not as successful as a result of additional error sources, indicating the bias needs to be handled correctly. By showing improvements with the loosely classified cloud information, the feasibility of the developed model to be applied for historical weather reconstruction is confirmed.

Purpose This paper aims to analyse the risk and excess returns of the Spanish real estate investment trusts (S-REITs) using various methods, though focusing primarily on the Fama-French three-factor (FF3) model, over the period from 2007Q3 to 2017Q2. Design/methodology/approach The autoregressive distributed lag model is used for the empirical analysis to test long-term stable relationships between variables. Findings The findings indicate that the FF3 model is suitable for the S-REITs market, better explaining the S-REITs’ returns variation than the traditional single-index capital asset pricing model (CAPM) and the Carhart four-factor model. The empirical evidence is reasonably consistent with the FF3 model; the values for the market, size and value are highly statistically significant over the analysis period, with 68.7% variation in S-REITs’ returns explained by the model. In the long run, the market factor has less explanatory power than the size and value factors; the positive long-term multiplier of the size factor indicates that small S-REIT companies have higher returns, along with higher risk, while the negative multiplier of the value indicator suggests that S-REITs portfolios prefer to allocate growth REITs with low book-to-market ratios. The empirical findings from a modified FF3 model, which additionally incorporates Spain’s gross domestic product (GDP) growth rate, two consumer price index (CPI) macro-factors and three dummy variables, indicates that GDP growth rate and CPI also affect S-REITs’ yields, while investment funds with capital calls have a small influence on S-REITs’ returns. Practical implications The regression results of the standard and extended FF3 model can help researchers understand S-REITs’ risk and return through a general stock pattern. Potential investors are given more information to consider the new Spanish investment vehicle before making a decision. Originality/value The paper uses standard techniques but applies them for the first time to the S-REIT market.

383 Background: The ability to risk stratify patient’s post-nephrectomy is critical to select candidates for surveillance and adjuvant therapy. Whether transcriptomic information adds value to current prognostic information is unclear. Methods: Data from confirmed clear cell renal cell carcinoma (ccRCC) used in the TCGA Pan-RCC analysis was downloaded from cBioportal and GDC bioportal. Clinicopathologic variables were used to calculate the integrated staging system, SSIGN (stage, size, grade, and necrosis). The 16 gene recurrence score (RS) signature was generated as described in Rini 2015 using the TCGA data with log TPM normalization. The RS was stratified into high and low risk groups by median. SSIGN was divided into low (0-1) intermediate (2-4) and high ( > = 5) risk groups. RS and SSIGN prognostic significance were evaluated using disease recurrence as an end point, censoring by death. Results: SSIGN and recurrence scores (RS) were calculated for 369 (71.2%) of 518 available TCGA subjects with non-metastatic clear cell renal carcinoma. On multivariable analysis, the RS (continuous variable) was independently associated with disease-free status (HR 1.18 [95%CI (1.02-1.37)], p = 0.031) for each 10 point increase in RS) after adjusting for SSIGN. Categorizing SSIGN into low, intermediate and high-risk groups showed 3.9%, 18.5% and 39.8% 3-year recurrence rates. Stratifying SSIGN risk groups by RS scores we found an RS to further risk stratify the SSIGN intermediate risk group (HR 1.60 [95%CI 1.21-2.12], p < 0.001]). The AUC for at 3 years for SSIGN in the intermediate risk group was 0.68, for RS was 0.74 and the combination was 0.78 (with boot-strapping for optimism adjustment). At 3 years, patients with SSIGN intermediate risk disease (n = 135) with low RS had 3-year recurrence rate of 7.1% compared to 31.0% for those with high RS scores. Conclusions: Transcriptomic recurrence scores can risk stratify intermediate SSIGN clinical risk patients. Patients with intermediate risk disease but a high RS score had poorer outcomes similar to clinically high risk patients. Transcriptomic signatures may add value to existing clinicopathologic variables in ccRCC and clinical implementation is warranted.

Background. Undernutrition is a major public health problem in HIV patients in sub-Saharan Africa. To address the problem of malnutrition, the Ethiopian Ministry of Health implemented a therapeutic feeding program, which is the provision of nutritional treatment, care, and support for undernourished individuals. However, little is known about the outcome of a therapeutic feeding program. Therefore, this study aimed to assess nutritional recovery and its predictors among undernourished HIV patients enrolled in a therapeutic feeding program in Northwest Ethiopia. Methods. An institutional-based retrospective cohort study was conducted among 376 randomly selected adult undernourished HIV patients enrolled in the therapeutic feeding program from July 2010 to January 2017 at Finote-Selam General Hospital. Data were collected by reviewing patients’ charts, follow-up cards, and undernutrition treatment registration books using a pretested structured checklist. The main outcome variable was nutritional recovery, defined based on body mass index. Bivariable and multivariable log-binomial regression models were used to identify the predictors of nutritional recovery. Result. From total undernourished HIV patients enrolled in the therapeutic feeding program, 61.2% were recovered with a median recovery time of 12 weeks (IQR 9–17 weeks) for moderate acute malnutrition and 25 weeks (IQR 22–31 weeks) for severe acute malnutrition. Rural residence (adjusted risk ratio (ARR) = 0.53, 95% CI: 0.27–0.85), no formal education (ARR = 0.24, 95% CI: 0.13–0.54), poor ART adherence level (ARR = 0.14, 95% CI; 0.08–0.32), and WHO clinical stage III or IV (ARR = 0.38, 95% CI; 0.17–0.59) decrease the probability of nutritional recovery. Conclusion. Nutritional supplementation plays a critical role in the nutritional care and treatment of malnourished patients. Healthcare providers should give more attention to persons with poor adherence levels, advanced WHO clinical stage, rural residence, and low educational status. Future prospective follow-up studies should be performed to assess important variables such as family income, food sharing at the household level, and distance to health institutions.

This study investigates the asymmetric cointegration and causal relationships between economic growth, carbon emissions, and energy consumption in the next eleven (11) countries over the period 1972–2013. The nonlinear autoregressive distributed lag (NARDL) bounds testing approach and nonpragmatic Granger causality tests are employed. This research’s empirical results have entrenched vital relationships that have significant policy implications. We affirm nonlinear cointegration among the variables in Bangladesh, Iran, Turkey, and Vietnam. The long-run asymmetric effect outcomes indicate a definite boom in economic growth, significantly increases carbon emission in Turkey, and a decline in Vietnam. Additionally, a positive shock to energy consumption significantly increases the carbon emission in Bangladesh, Iran, and Turkey, but a decrease in emissions in Vietnam. Findings from the Wald test reveal a long-run asymmetric effect between carbon emission and economic growth in Bangladesh, Iran, and Vietnam, and for Iran, an asymmetric short-run impact. Long-run and short-run asymmetric effects between carbon emission and energy consumption in Bangladesh and Iran. In terms of asymmetric causality results, bidirectional causality between carbon emission and economic growth was noted in Bangladesh and Turkey, and a unidirectional causality from economic growth to carbon emission in Egypt and South Korea. Energy consumption causes carbon emission in Bangladesh, Egypt, Pakistan, South Korea, and not vice versa. We determined a bidirectional asymmetric causality relationship between carbon emission and energy consumption in Vietnam and a unidirectional causality link from carbon emissions to Turkey’s energy consumption.

Purpose The Oman economy is dominated by production and export of petroleum products and an overdependence on oil revenue, which may have contributed to the continuance of the “resource curse” phenomenon. The purpose of this research is to examine the co-integration of oil with macroeconomic indicators of Oman and of suggesting some policy reform measures to trim down overdependence on oil. Design/methodology/approach The authors culled out data from the annual reports published by the Central Bank of Oman from 1975 to 2016. Considering oil price and oil export volume as regressors, the long-term integration with other macroeconomic indicators was examined by using the bound test. Further, auto regressive distributed lag (ARDL) model was also derived to check the impact of these cross-sectional relations. Findings Oil price is observed to have a strong long-term significant relation with all the macroeconomic variables used in this study. However, the volumes of oil exports do not appear to have significant influence on GDP and consumption but do naturally sway other variables. This indicates that less elasticity of consumption to the flow of macro income, because the consumption in the Omani economy is driven by perceived future income. Oil export revenue is not seems to be much impacting on the real sector as the deficits are funded by the government through compensatory spending. Oil prices and oil exports have exhibited a strong long-term integration with variables such as gross domestic savings (GDS), credit to government (C2G), credit to private (C2P), demand deposits (DD) and time deposits (TD). This hints that oil boom does constitute the key source of funding of the financial sector of Oman. Research limitations/implications This study offers a generalized submission to support the real sector of Oman to lead out of a resource curse through diversification. The study however does not provide industrial groupings to assess the impact of fluctuations in oil prices. Originality/value This research has confirmed the existence of “resource movement” effect and “spending effect” in Oman economy. The nation needs to take radical measures to come out of this phenomenon. For addressing this we have suggested the modified version of Shumpeterian model of creative destruction. In this model we call for demolishing the oil dependent structure with a diversification structure. The new move can bring more positive effect on real and financial sectors of the economy.

196 Background: Prostate cancer is the most common non-cutaneous cancer in Canadian men; over 24,000 will be newly diagnosed and 4,300 will die from it in 2010. Estimating an individual's risk of disease spreading across the capsule and probability of recurrence with different treatment modalities is common practice in prostate cancer management and often drive the choice or extent of treatment options. A strong predictor of recurrence and organ confined disease is tumor grade. The literature recognizes differences in grading prostate cancer between genitourinary and non-specialized pathologists; we previously reported a 30% change in risk category (Low, GS 2-6; Int., GS 7; High, GS 8-10). However, this report was based on data from 2003/2004. A repeat audit was necessary given Gleason grading practice changes following the 2005 ISUP Consensus Conference. Methods: Log books from 2009/10 where our Genitourinary Pathologists (GUP) reviewed prostate needle core biopsies were used to identify cases; a retrospective chart review was completed. The following variables were extracted: 1° Gleason score; 2° Gleason score; number of sites; % Gleason 4/5 pattern (overall); perineural invasion (present/absent); extracapsular extension (present/absent). Descriptive statistics were used to summarize the results. Results: The charts of 132 patients having a GUP biopsy review were extracted. Seventeen percent (22/132) of cases changed risk category. Of the 47 low risk cases, 23% (11/47) were up-graded in risk category (21% by 1 category; 2% by 2 categories). Of the 46 intermediate risk cases, 15% (7/46) were up-graded and 2% (1/46) were down-graded. Of the 39 high risk cases, only 8% (3/39) were down-graded by 1 risk category. Comparatively, there was a 43% reduction in risk category change between 2003/04 (30%) and 2009/10 (17%). Conclusions: Despite this reduction, a clinically significant proportion of patients changed pathologic risk category upon GUP review. Thus, it is recommended that prostate cancer pathology be routinely reviewed by a GUP as a best practice to optimize management and quality of care. Strategies are still needed to address disparities in pathologic grading and represent a potential area for further investigation. No significant financial relationships to disclose.

Tujuan dari penelitian ini adalah menambah literatur terkait analisis gerak tendangan shooting menggunakan punggung kaki pada atlet sepakbola dengan pembahasan ringkas, jelas dan terperinci. Lalu dibentuk dalam sebuah ringkasan singkat mencakup tentang informasi topik artikel beserta aspek-aspek yang berpengaruh dalam topik tersebut. Buku dan jurnal dalam penelitian ini menjadi sumber data dengan dibantu jurnal dan buku yang relevan lainnya. Sumber data dirujuk dari Google Scholar, ResearchGate, Academia.edu, Pubmed dan beberapa sumber artikel jurnal yang relevan dijadikan sebagai referensi. Sumber data diperoleh dari publikasi nasional maupun internasional dengan kriteria tahun 2007 hingga 2021 terkait materi analisis gerak, biomekanika, hubungan-perbandingan, dan mekanisme tendangan dalam olahraga Sepakbola. Teknik instep kick dipengaruhi power dan akurasi yang berkesinambungan dengan beberapa faktor seperti tumpuan kaki, core stability, kekuatan otot tungkai, fleksibilitas, daya tahan otot, koordinasi neuromuscular, keseimbangan, serta konsentrasi dan fokus pada sasaran. Begitu juga dengan memperhatikan terkait sikap tubuh keseluruhan (posisi kaki tumpu, gerakan kaki), ayunan, posisi togok, sikap tangan, Kontak antara bagian kaki dengan bagian bola, pandangan mata, dan Follow through. Pada teknik ini pun terdapat keterkaitan dengan tulang, otot dan sendi yang mampu mempengaruhi hasil teknik instep kick. Penelitian selanjutnya diharapkan dapat mempelajari bentuk program latihan atau mengkaji lebih rinci terkait variabel yang mempengaruhinya. Instep kick motion analysis at football athletes in performance improvement Abstract. The purpose of this study is to add to the literature related to the analysis of the motion of shooting kicks using the instep of football athletes with a concise, clear and detailed discussion. Then it is formed in a brief summary covering information on the topic of the article along with aspects that influence the topic. Books and journals in this study become data sources with the help of other relevant journals and books. The data sources are referenced from Google Scholar, ResearchGate, Academia.edu, Pubmed and several sources of relevant journal articles as references. Data sources are obtained from national and international publications with criteria for 2007 to 2021 related to motion analysis, biomechanics, relationship-comparison, and kick mechanisms in soccer. The instep kick technique is influenced by continuous power and accuracy with several factors such as foot support, core stability, leg muscle strength, flexibility, muscle endurance, neuromuscular coordination, balance, and concentration and focus on the target. Likewise, by paying attention to the overall body posture (pedal position, foot movement), swing, togok position, hand attitude, contact between the foot and the ball, eye gaze, and follow through. In this technique there are also links with bones, muscles and joints that can affect the results of the instep kick technique. Further research can study the form of the exercise program or examine in more detail the variables that influence it.

Background and Aims: Dukan diet, a popular diet with high content of protein and carbohydrate and fat restriction has been widely used for weight loss. We aimed to compare the effects of the Dukan diet with traditional low-calorie diet in nutritional, laboratory and vascular parameters in obese subjects. Methods and Results: Obese subjects classes I or II of both genders, aging 19 to 65 years were allocated into two groups: Traditional low-calorie diet (n=17) and Dukan Diet (n=17). Anthropometric, laboratory and vascular evaluations were performed at baseline, 3, 6 and 12 months. Body composition was evaluated by bioelectric impedance and endothelial function by flow-mediated dilation of the brachial artery, at same times. After 12 months, it was verified that Dukan diet was more effective (p<0.05) than traditional diet for: weight loss (-10.6 vs -2.9 kg), body mass index (-3.7 vs -1.1 kg/m2), waist circumference (-11.2 vs -2.1 cm), fat (-5.7 vs -2.0 kg) and lean mass (-4.8 vs 0.8 kg) and basal metabolic rate (-152 vs -28 cal). In Dukan diet group, improvement (p<0.05 vs baseline) was observed in triglyceride levels (172.40 to 111.90 mg/dL) and insulin resistance, based on HOMA-IR index (4.98 to 3.26). The glomerular filtration rate decreased in this group after 3 months (132.50 to 113.80 mL/min) and no changes in flow-mediated dilation were observed throughout the study with both diets. Conclusion: Dukan diet was more effective than traditional diet for weight loss and laboratory parameters and without changes in endothelial function, in the 12-months follow-up of obese subjects. Introduction Low-carbohydrate diets have been one of the most recently used dietary therapies in patients with diabetes and obesity in clinical studies(1). Among them, in addition to carbohydrate restriction, fat restriction and high protein concentration, as in the Diet Dukan, has been widely used by the general population, aiming at weight loss. The Dukan diet is designed to reduce carbohydrate and fat intake in the first phase of the diet, with exclusive intake of protein, followed by another Three phases, with progressive and slow reintroduction of other nutrients such as fiber, carbohydrates and fats. In recent years, there has been increasing interest in the effectiveness of very low carbohydrate diets, called ketogenic diets, in the effectiveness of weight loss in order to combat obesity and cardiovascular disease risk(2). In this diet, ketone bodies are formed and they are used as an alternative energy source in the absence of glucose. Ketogenic diet promotes weight loss reducing appetite, increasing satiety and thermogenesis, due to the high protein consumption(3) affect hormones that control appetite, such as ghrelin and leptin(4) reduces lipogenesis and increases lipolysis(5,6) and gluconeogenesis(7). Replacing carbohydrates by proteins in the diet have been the aim of several studies but with inconsistent results. High protein intake has positive effects on weight loss, acting on satiety, body composition, lipid profile and glucose homeostasis. Furthermore, it increases thermogenesis, energy expenditure(8) and the elevation in the amino acid level in the plasma acts on the satiety center, decreasing appetite, since amino acids also stimulate insulin secretion resulting in decreased or maintained blood glucose levels(9). Few studies have been published with Dukan diet. Freeman et al. were the first to publish an article with the Dukan Diet in 2014, describing adverse effects in one patient undergoing this diet(10). Nouvenne et al. reviewed studies about the influence of popular diets on kidney stone formation risk. In this article, the authors suggest that in the Dukan diet, due to the high consumption of animal protein, urinary calcium can increase and the citrate urinary excretion can decrease, increasing the risk of kidney stone formation(11). In 2015, Wyka et al. evaluated dietary consumption in women adopting the Dukan-diet, based on the menu consumed in each of 4 phases of diet. They observed weight loss of around 15 kg after 8 to 10 weeks of diet and higher intake of proteins, mainly of animal origin, high consumption of potassium, iron and vitamins A, D and B2 and reduced consumption of carbohydrates, vitamin C and folates. They suggest that this diet may be harmful to health if adopted for a long time, developing of kidney and liver disease, osteoporosis and cardiovascular disease(12). Considering that the Dukan Diet is widely disseminated and it is used by the population in general for weight loss and few scientific studies are found in the literature, we propose to evaluate the nutritional, laboratory parameters related to cardiovascular disease, comparing this diet with traditional hypocaloric diet in obese individuals. Methods Study design This study was a clinical trial with nutritional intervention, for one year. Patients were recruited from the Lipids, Atherosclerosis and Vascular Biology Division of the Universidade Federal de São Paulo (UNIFESP). The study conforms to the ethical guidelines and approval was obtained from the ethics committee and it was registered in the Brazilian Registry of Clinical Trials. All participants provided written informed consent and received no monetary incentive. A total of 40 subjects were initially recruited and the participants were followed up clinically by a cardiologist and nutritionist during the 12-month period with monthly visits. Of the 40 participants who started the study, 34 completed the 12-month follow-up, whose data are presented in this study. The inclusion criteria were: both genders, aging 19-65 years old, obesity grade I or II (body mass index between 30 kg/m² and 39.9 kg/m²), stable body weight in the previous 3 months and desire to lose weight. The main exclusion criteria were: patients in primary or secondary prevention of coronary heart disease with low-density lipoprotein cholesterol (LDL-C) levels greater than 190 mg/dL and triglycerides greater than 400 mg/dL; diabetes mellitus; untreated hypothyroidism; psychiatric and hepatic disease; chronic renal failure; cardiac and respiratory insufficiency; systemic infections; use of antidepressants, corticoids, diuretics and diabetes medications; bariatric surgery, cancer and failure to accept the conditions necessary to conduct the research. Two groups were constituted: Traditional low-calorie diet (TD): n=17, 14 females and 3 males, 45±11 years old, 90±11 Kg body weight and body mass index (BMI) 34±2Kg/m2; High protein/Low carbohydrate diet-Dukan Diet (DD): n=17, 10 females and 7 males, 38±11 years old, 95±9 Kg of body weight and BMI 34±2 Kg/m2. The TD group received orientations according to the Food Guideline for the Brazilian Population, with 1 500–1 800 calories/day. They were stimulated to improve healthy eating habits increasing the consumption of natural foods without preservatives, such as vegetables and fruits rich in fiber and antioxidants. Daily consumption of fruits and vegetables at meals was recommended; carry out the fractionation of the meals throughout the day, avoiding prolonged fasting. Hydration and regular physical activity were recommended, according to healthier life habits(13). The DD group followed the high-protein/low-carbohydrate diet as proposed by Dukan Diet, available at https://www.dietadukan.com.br and received an illustrated book about this diet(14). This diet is structured in four phases: two for weight loss (1st and 2nd phases) and two for weight maintenance (3rd and 4th phases): 1st stage - Attack: For 5 consecutive days, it is allowed to consume only proteins with lean meats, eggs, light cheese and milk, 1.5 tablespoons of oat bran per day and light physical activity for 20 minutes. 2nd stage - Cruise: This phase is maintained until the desired weight loss. The vegetables are introduced alternating with the pure protein day (first stage). It is recommended 2 tablespoons of oat bran per day and light physical activity for 30 minutes. 3rd phase - Consolidation: The time of this phase is equivalent to 10 days per kg of lost weight. In this stage carbohydrates and lipids are introduced by a controlled and moderate way, being divided in two parts: in the first part, corresponding to half of the period to be followed, is allowed: 1 fruit, 2 slices of bread (50 g) or 1 spoon of farinaceous per day and 1 gala dinner per week. In the second part, it is allowed 2 fruits, 4 slices of bread (100 g) or 2 spoons of farinaceous per day and 2 gala dinners per week. This phase has one rule: make one day of the week with pure protein (first stage) and it is recommended 2.5 tablespoons of oat bran per day and light physical activity for 35 minutes. 4th phase - Stabilization: In this phase, three rules must to be followed: one day a week it should follow up the pure protein diet, the daily consumption of 3 tablespoons of oat bran and at least 40 minutes of daily walking. From this phase, the participants followed up the low calorie diet. The adherence of the participants was monitored by the interview with the nutritionist and qualitative evaluation of ketone bodies in the urine, using Labtest UriAction 10 reagent strips. At baseline, 3, 6 and 12 months, the following evaluations were performed: nutritional assessment determining anthropometry, blood samples were collected for laboratory tests. Endothelial function was evaluated in fasting and 2-hours post prandial situations. In the periods between the predetermined visits, the participants were followed up by the nutritionist monthly and by telephone contact whenever requested and with medical attention whenever necessary. Nutritional evaluation Nutritional assessment was performed by anthropometric determinations of weight, height, BMI, abdominal circumference and bioelectric impedance (BIA). BIA was carried out using the Biodynamics Model 450 TBW® apparatus, with portable plethysmograph and patients were instructed according to the manufacturer's instruction(15). Laboratory parameters Peripheral blood samples were collected for dosages of total cholesterol and fractions, triglycerides, glucoses, insulin, iron, ferritin, ALT, AST, urea, creatinine, hemoglobin and hematocrit. Biochemical parameters were determined through the automated colorimetric enzymatic method in Cobas Mira® (Roche, Switzerland) and LDL-c was estimated by the Friedewald equation. Serum insulin concentration was determined by immunofluorometry and the insulin resistance calculated by the HOMA-IR – Homeostasis Model Assessment Insulin Resistance, and values ≥ 2.5 values were considered as presence of insulin resistance(16). Glomerular Filtration Rate (GFR) was estimated by the Cockroft-Gault equation adapted to obese patients(17). Endothelial function Endothelial function was assessed by Endothelial-dependent flow-mediated dilation (FMD) of the brachial artery(18), using an ultrasound system (Sonos5500; Hewlett-Packard-Phillips, Palo Alto, CA), equipped with vascular software for two-dimensional imaging, color and spectral Doppler ultrasound modes, internal electrocardiogram monitor and linear-array transducer with a frequency range from 7.5 to 12.0 MHz. FMD evaluation was performed in two stages: fasted at least 6 hours and 2 hours after the consumption of a small meal, according to each diet. These meals were consisted of 374.04 calories, 36g proteins, 16g carbohydrates and 18g lipids in the DD and in TD, it was composed by 361.20 calories, 24g of protein, 41g of carbohydrates and 11g of lipids. Statistical Analysis The variables were expressed as mean and standard deviation. The distribution of the date normality was analyzed by the Kolmogorov-Smirmov (KS) test. When they did not present normal distribution, a logarithm [log(Y)] transformation was performed prior to analysis. The comparison between the variables of two groups was performed using Student's t-test for independent numerical variables and Fisher's exact test for categorical variables. Comparisons between more than two groups were performed by analysis of variance (ANOVA) for repeated measures, followed by the Tukey test, if differences were found. For the sample power calculation, the Statistical Software, Statistica Ultimate Academic, version 12.7, Concurrent Network was used. Values of p ≤ 0.05 were considered for statistical significance and analysis was performed using the software [GraphPadPrism 4.0 (GraphPad Software, San Diego, CA, USA)]. Results Participants’ characteristics At the beginning of the study, the groups were matched for age, gender, weight and BMI. At 3 months, all participants of DD group (100%) were in phase 2; at 6 months, 13 participants (76.4%) were in phase 3 and 4 (23.5%) in phase 2; and at 12 months, all (100%) were already in phase 4. The TD group followed the same recommendation during the 12 months. The qualitative evaluation of the presence of ketone bodies in the urine of the DD group participants, which were still in phase 2, was positive in 94% at 3rd month and 80% at the 6th month. The following adverse effects have been reported during the course of the study: weakness, fatigue, dizziness, lack of concentration, irritability, constipation, ketone breath and social life impairment. These symptoms were of low intensity and transient, especially in the early stages of the DD diet. These adverse effects were not causes for withdrawal from the study. Anthropometry The changes in body weight, BMI, waist abdominal circumference and BMR were more effective in DD than TD group during all follow-up evaluations. The changes after 12 months in relation to baseline of the anthropometric parameters in the DD and DT groups respectively were: Weight loss (-10.6 Kg, p<0.0001 and – 2.9 Kg, p<0.0001), BMI (-3.7 Kg/m2, p<0.0001 and -1.1 Kg/m2, p<0.0001), waist abdominal circumference (-11.2 cm, p<0.0001 and -2.1 cm, p=0.0008) and BMR (-152 cal, p<0.0001 and -28 cal, p=0.0198). After 12 months, the participants of DD group reached the overweight level but the TD group was still within the obesity range. Reductions were observed in both groups, in fat mass (-5.7 Kg, p<0.0001 and -2.0 Kg, p<0.0001), and in lean mass (-4.8 Kg, p<0.0001 and -0.8 Kg, p=0.0196, in DD and DT group, respectively). Laboratory parameters and endothelial function In TD group, there was only hematocrit reduction after 6 months (p=0.0103) and glucose level after 3 months (p=0.0021) compared to baseline. In DD group, laboratory alterations occurred in relation to hemoglobin, hematocrit, triglycerides, insulin, HOMA-IR and GFR. It was observed an improvement in the triglycerides levels (172.40 ± 62.36 mg/dL and 111.90 ± 43.22 mg/dL, p=0.0001) and insulin resistance determined by HOMA-IR at all times of study (4.98 ± 3.03 and 3.26 ± 2.03, p=0.0008) at baseline and 12 months, respectively. GFR was reduced only after 3 months (132.50 ± 31.13 and 113.80 ± 24.25 mL/min, p=0.0063) in the DD group. No differences were observed in endothelial function in the two study groups, in both fasting and postprandial. Discussion This study demonstrated higher weight loss in the Dukan diet group, compared to the traditional low calorie diet. The effect of weight loss in the DD group was persistent and remained until 6th month, but in 12 months it was observed a gain around 3.41 ± 0.21 Kg. The DD is performed in phases, with severe restriction until the 3rd phase and at about the 6th month; carbohydrates and a gala meal are reintroduced, promoting a weight gain. Sacks et al. observed that regardless of the nutritional composition of the diet, obese participants that had a weight loss, after 12 months of treatment, they can gain weight, but with a reduction of approximately 11.4% of the initial weight(19). We observed that participants of TD group also presented significant weight reduction, suggesting the effectiveness of the close follow up with nutritionist and physician. Abdominal circumference is an indirect parameter of fat mass corresponding to visceral fat that is associated with a higher risk for cardiovascular diseases. In our data, we observed a reduction in waist circumference in both groups after 12 months. Moreno et al. comparing ketogenic diet with standard diet in a group of obese patients found an important reduction in abdominal circumference with partial recovery after 24 months(20). Although DEXA Scan is considered the gold standard for body composition determination, BIA is a non-invasive and relatively inexpensive method and widely used(21). A significant reduction in the relative values of body fat was observed at 3 and 6 months in the DD group and only after 3 months in the TD. Increase in percent of lean mass was observed in the DD group at 3 and 6 months, but this increase does not represent a gain of lean mass, since the relative increase is a result of the reduction of body weight, promoting a relative increase in the values of lean mass. The loss of lean mass in the DD group may be due to the low caloric intake of the diet, as Chaston et al. (2007) pointed out that diet with low-calorie diet promote marked weight loss, but there is a decline in lean mass resulting from this process(22) . In our study, in spite of consuming a large amount of protein, this nutrient alone is not enough to promote the maintenance of lean mass and exercise stimulation is still necessary, which did not happen in this study, since the participants were all sedentary. In obese individuals, weight gain after marked loss is common, with reduction in basal metabolic rate(23). Several studies have observed this phenomenon during rapid weight loss(24) and diets with low carbohydrate intake are among the factors that influence metabolic adaptation. Some studies suggest that low amounts of carbohydrate (<45%) decrease the basal metabolic rate during and after weight loss. This type of diet can promote fat mass loss and preservation of lean mass during weight loss, reducing the basal metabolic rate. Reduction in BMR was observed in both groups, but in the DD group, the reduction occurred at all times in relation to baseline whereas in TD group the reduction was greater only after 6 months of intervention. Improvement in insulin resistance and triglycerides were observed only in the DD group. Individuals with insulin resistance have greater difficulty to metabolize carbohydrates, diverting a greater amount of dietary carbohydrates to the liver, where much of it is converted to fat (lipogenesis), rather than being oxidized in energy in the skeletal muscle. For this reason, very low carbohydrate diets applied in obese individuals, in addition to leading to weight loss also improves glycemic and lipid control. The effects of the very prolonged ketogenic diet are still poorly investigated and for this reason this diet should only be used for a limited period (from 3 weeks to a few months) to stimulate fat loss, improve metabolism, and then adjusting a transition to a normal diet(25). No changes in levels of total cholesterol, HDL-c and LDL-c were observed in any group. However, only in the DD group there was a significant reduction in TG level. In general, diets with reduced carbohydrates and high levels of proteins and fats increase LDL-c and TG levels showing beneficial effects of the ketogenic diet on cardiovascular risk factors. Most studies show that reducing carbohydrates can bring significant benefits in reducing total cholesterol, increases in HDL-c and reduction of triglycerides in the blood. HMG-CoA reductase, a key enzyme in the synthesis of endogenous cholesterol is activated by insulin, so that a reduction in blood glucose and hence insulin levels, leads to lower cholesterol synthesis. Thus, a reduction in dietary carbohydrate associated with adequate cholesterol consumption leads to inhibition of cholesterol biosynthesis(26). When insulin is elevated, lipolysis is reduced and lipogenesis is increased, resulting in overproduction of VLDL containing TG, formation of small and dense LDL particles and reduction of HDL. Low concentrations of glucose and insulin also reduce the expression of the carbohydrate-sensitive response element binding protein (ChREBP) transcription factor, and expression of the binding protein of the sterol regulatory element (SREBP-1c), responsible for the synthesis of fatty acids, as well as their incorporation into triglycerides and phospholipids, activating the main lipogenic enzymes, reducing hepatic lipogenesis and VLDL production(27). When we evaluated the GFR, a reduction only in DD group was observed at 3 months of intervention, but still in normal reference levels. Our results did not show significant changes in serum creatinine levels, but GFR decrease in DD group. Carbohydrate-restricted diets have higher amounts of protein may affect glomerular filtration leading to progressive loss of renal function(28). In the study conducted by Brinkworfh et al. (2010), renal function was evaluated in 68 obese individuals without renal dysfunction who consumed two similar hypocaloric diets for one year, one with carbohydrate reduction and another with high carbohydrate content, and observed that creatinine serum levels and the GFR did not change in any of the dietary groups(29). In general, endothelial function improves after weight loss in obese individuals(30). However, associations between changes in endothelial function with anthropometric and biochemical parameters are still controversial(31). We observed that the endothelial function did not present a significant difference in the two study groups, both in fasting and in the 2 hours postprandial. Volek et al. (2009) observed that low-carbohydrate diet improves postprandial vascular function compared to a low-fat diet in overweight individuals with moderate hypertriglyceridemia(32). Low-carbohydrate diets, may improve vascular function in individuals with metabolic adaptations(32) and carbohydrate-restricted diets may induce benefits in endothelial function in the presence of insulin resistance, since impaired insulin action may be related to endothelial dysfunction. In our study, the meal offered for postprandial evaluation was not high in fat, but correspond to the diet proposed in each group. According to Nicholls et al. (2006), a single carbohydrate-restricted meal does not alter endothelial function(33) and this may be the reason we did not observe a change in endothelial function in the DD group in this study. Conclusion Comparing the nutritional and laboratory effects of traditional and hyper-protein diets with carbohydrate reduction, we can conclude that Dukan diet was more effective than traditional diet for weight loss, as well as for laboratory parameters and without changes in endothelial function, in the 12-months follow-up of obese subjects. Conflict of interest No conflict of interest. Acknowledgement Patricia Naomi Sakae had a scholarship from CAPES – Brazil. References Gogebakan O.; Kohl A.; Osterhoff MA.; van Baak MA.; Jebb SA.; Papadaki A.; et al. Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: the diet, obesity, and genes (DiOGenes) study: a randomized, controlled trial. Circulation. 2011, 124(25), 2829-2838. Merino J.; Kones R.; Ferre R.; Plana N.; Girona J.; Aragones G.; et al. Low-carbohydrate, high-protein, high-fat diet alters small peripheral artery reactivity in metabolic syndrome patients. Clin Investig Arterioscler. 2014, 26(2), 58-65. Krieger JW.; Sitren HS.; Daniels MJ.; Langkamp-Henken B. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1. Am J Clin Nutr. 2006, 83(2), 260-274. Samaha FF.; Iqbal N.; Seshadri P.; Chicano KL.; Daily DA.; McGrory J.; et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003, 348(21), 2074-2081. Paoli A.; Rubini A.; Volek JS.; Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013, 67(8), 789-796. Nordmann AJ.; Nordmann A.; Briel M.; Keller U.; Yancy WS, Jr.; Brehm BJ.; et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006, 166(3), 285-293. Veech RL. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids. 2004, 70(3), 309-319. Feinman RD.; Fine EJ. Nonequilibrium thermodynamics and energy efficiency in weight loss diets. Theor Biol Med Model. 2007, 4, 27. Veldhorst MA.; Westerterp-Plantenga MS.; Westerterp KR. Gluconeogenesis and energy expenditure after a high-protein, carbohydrate-free diet. Am J Clin Nutr. 2009, 90(3), 519-526. Freeman TF.; Willis B.; Krywko DM. Acute intractable vomiting and severe ketoacidosis secondary to the Dukan Diet(c). J Emerg Med. 2014, 47(4), e109-112. Nouvenne A.; Ticinesi A.; Morelli I.; Guida L.; Borghi L.; Meschi T. Fad diets and their effect on urinary stone formation. Transl Androl Urol. 2014, 3(3), 303-12. Wyka J.; Malczyk E.; Misiarz M.; Zolotenka-Synowiec M.; Calyniuk B.; Baczynska S. Assessment of food intakes for women adopting the high protein Dukan diet. Rocz Panstw Zakl Hig. 2015, 66(2), 137-42. Ministério da Saúde. Guia alimentar para a população brasileira: Promovendo a alimentação saudável. Brasília; 2006. Dukan P. O Método Dukan Ilustrado 1a edição ed. Rio de Janeiro; 2013. Heyward V Stolarczyk L. Métodos de dobras cutâneas. In: Heyward VV.; Stolarczyk LM. Avaliação da composição corporal aplicada. São Paulo; 2000. Sakae PN.; Ihara SS.; Ribeiro DA.; de Carvalho L.; Parise ER. Insulin resistance is associated with DNA damage in peripheral blood cells in non-diabetic patients with genotype 1 chronic hepatitis C. Free Radic Res. 2013, 47(9), 750-756. Salazar DE.; Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988, 84(6), 1053-1060. Fonseca HA.; Fonseca FA.; Monteiro AM.; Bianco HT.; Boschcov P.; Brandao SA.; et al. Obesity modulates the immune response to oxidized LDL in hypertensive patients. Cell Biochem Biophys. 2013, 67(3), 1451-1460. Sacks FM.; Bray GA.; Carey VJ.; Smith SR.; Ryan DH.; Anton SD.; et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009, 360(9), 859-873. Moreno B.; Crujeiras AB.; Bellido D.; Sajoux I.; Casanueva FF. Obesity treatment by very low-calorie-ketogenic diet at two years: reduction in visceral fat and on the burden of disease. Endocrine. 2016, 54(3), 681-690. Matthie JR. Bioimpedance measurements of human body composition: critical analysis and outlook. Expert Rev Med Devices. 2008, 5(2), 239-261. Chaston TB.; Dixon JB.; O'Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond). 2007, 31(5), 743-50. Muller MJ.; Bosy-Westphal A. Adaptive thermogenesis with weight loss in humans. Obesity (Silver Spring). 2013, 21(2), 218-228. Camps SG.; Verhoef SP.; Westerterp KR. Weight loss, weight maintenance, and adaptive thermogenesis. Am J Clin Nutr. 2013, 97(5), 990-994. Paoli A.; Bianco A.; Grimaldi KA.; Lodi A.; Bosco G. Long term successful weight loss with a combination biphasic ketogenic Mediterranean diet and Mediterranean diet maintenance protocol. Nutrients. 2013, 5(12), 5205-5217. Paoli A. Ketogenic diet for obesity: friend or foe? Int J Environ Res Public Health. 2014, 11(2), 2092-2107. Volek JS.; Fernandez ML.; Feinman RD.; Phinney SD. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res. 2008, 47(5), 307-318. Crowe TC. Safety of low-carbohydrate diets. Obes Rev. 2005, 6(3), 235-245. Brinkworth GD.; Buckley JD.; Noakes M.; Clifton PM. Renal function following long-term weight loss in individuals with abdominal obesity on a very-low-carbohydrate diet vs high-carbohydrate diet. J Am Diet Assoc. 2010, 110(4), 633-638. Mavri A.; Poredos P.; Suran D.; Gaborit B.; Juhan-Vague I. Effect of diet-induced weight loss on endothelial dysfunction: early improvement after the first week of dieting. Heart Vessels. 2011, 26(1), 31-38. Hamdy O.; Ledbury S.; Mullooly C.; Jarema C.; Porter S.; Ovalle K.; et al. Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care. 2003, 26(7), 2119-2125. Volek JS.; Ballard KD.; Silvestre R.; Judelson DA.; Quann EE.; Forsythe CE.; et al. Effects of dietary carbohydrate restriction versus low-fat diet on flow-mediated dilation. Metabolism. 2009, 58(12), 1769-1777. Nicholls SJ.; Lundman P.; Harmer JA.; Cutri B.; Griffiths KA.; Rye KA.; et al. Consumption of saturated fat impairs the anti-inflammatory properties of high-density lipoproteins and endothelial function. J Am Coll Cardiol. 2006, 48(4), 715-720.

Stealth assessment has been successfully embedded in educational games to measure students’ learning in an unobtrusive and supportive way. This study explored the possibility of applying stealth assessment in a digital reading platform and sought to identify potential in-system indicators of students’ digital learning outcomes. Utilizing the user log data from third- to fifth-grade students ( n = 573) who read an interactive Word Knowledge E-Book, we examined various user log variables and their associations with word knowledge and strategic reading outcomes. Descriptive analysis provided a depiction of the real-time reading processes and behaviors in which students engaged while digitally reading. Multiple regression analysis with classroom fixed effects demonstrated that user log variables relevant to answering questions and making decisions (i.e., percentage of embedded questions answered correctly; number of attempts to answer the questions; and making implausible decisions) were significantly associated with students’ word knowledge and strategic reading outcomes. Variables indicating reading time and frequency, however, were not significantly associated with these outcomes. This study highlights the potential of interactive e-books as another digital learning environment to establish stealth assessment, which may allow researchers and educators to track students’ reading processes and predict reading outcomes while supporting digital learning.

This research focuses on who controls shareholder’s wealth maximization and how does this affect firm’s performance in publicly quoted non-financial companies in Nigeria. The shareholder fund was the dependent while explanatory variables were firm size (proxied by log of turnover), retained earning (representing management control) and dividend payment (representing measure of shareholders control). The data used for this study were obtained from the Nigerian Stock Exchange [NSE] fact book and the annual reports of the six sampled companies from Food/ Beverages and tobacco sub-sector for twenty years (1986-2005) to constitute pooled data of 120 observations. Using auto-regression technique for correcting serial auto-correlation in time series data, the results converge at ten iterations. Results showed that all the independent variables provide good explanation for the model. It was observed that firm size (log of turnover) and retained earnings had positive relationships and statistically significant impacts on the shareholders fund while dividend payment had negative relationship. The results show that turnover and retained earnings are of more significance in the control of shareholders wealth than the dividend payment. Thus, we can conclude that the management of the organizations under the present study is in major control of shareholders wealth maximization objective and impact on the firm performance. Implication is that selecting high quality management for the organizations would help in achieving shareholders wealth maximization objective in organizations.

Abstract Background Mother to child human immune virus (HIV) transmission is the passage of HIV from mother to her child during pregnancy, labor, delivery or breast-feeding. The objective of this study was to identify determinants of mother to child HIV transmission among HIV exposed infants who were born from HIV positive mothers at Governmental health centers of East Gojjam Zone, Northwestern Ethiopia, 2019. Methods A case–control study was conducted on 210(42 cases and 168 controls) from April 1 to 30/ 2019. All cases were included in the study. Controls were selected by simple random sampling. Secondary data were extracted by using checklists from the document of 8 health centers ART register book, antenatal care (ANC) follow up register book, PMTCT service registration log book charts and infant dried blood sample (DBS) tally sheets. After Bivariable logistic regression analysis, all variables with p-value $$\le$$ ≤ 0.25 were entered into multivariable logistic regression and p value < 0.05 considered as significantly associated with the outcome variable. Results HIV exposed infants who were being rural dweller versus (vs) those infants who were being urban dweller [adjusted odds ratio (AOR) = 3.73; 95% CI; 1.27–10.69], have no history of antenatal care follow up of HIV exposed infants’ HIV positive mothers versus (vs) those mothers who have been having history of ANC follow up [ AOR = 5.0;95%CI; 2.02–12.16] and initial CD4 count of HIV infants’ mothers $$\le 350$$ ≤ 350 vs those mothers whose CD4 > 350 [AOR = 2.7;95%CI;1.35–5.52] were significantly associated with HIV infection. Conclusion Mother to child HIV transmission was significantly associated with history of ANC follow up of exposed infants’ mothers and initial CD4 counts of mothers. Strong effort should be made to further increase the ANC service utilization of HIV positive pregnant women.

Abstract Background Reflection is an essential feature of the learning process in all medical education and training fields. While writing the logbooks has been considered to improve learners’ reflection in several disciplines, it is unknown whether writing reflective logbooks improves the learning perception of dermatology residents. Therefore, this study was carried out to assess the role of the reflective logbook in improving the residents’ perception of reflective learning in the dermatology residency program. Methods This cross-sectional study was conducted on 32 dermatology residents from year two (R2) to year four (R4) enrolled in different hospitals in Riyadh, Saudi Arabia. A baseline electronic survey was emailed to all residents before and after implementing the reflective logbook for six months. The survey included 28 close-ended questions assessing their point of view on a Likert scale, and responses varied from agreeing to disagreeing strongly. Frequencies and proportions were generated for the categorical variables such as sex and level of residency. The graphs were generated to assess the proportion of residents correctly responding to the knowledge questions. The data were analyzed using SPSS version 23. Results Almost 80% of dermatology residents considered reflection as an important element of their learning, and 47% of the residents agreed that a reflective log book increases understanding in medical education. About 44% of the residents agreed that the reflective logbook assisted in their learning, and about 19% strongly agreed on the same. However, only 37.5% agreed that logbooks helped them acquire theoretical knowledge, and 9.4% and 18.8% agreed that they helped them acquire practical and research skills, respectively. Almost 68% of the residents had support in writing the logbook, and 34.4% agreed that logbooks helped them address their patient’s needs and enhance their diagnostic skills. Conclusion The study findings revealed that dermatology residents perceived reflection and writing a reflective logbook as important and potentially beneficial. However, knowing the importance of reflection and what reflection means was not optimal. Not all dermatology residents were aware of the reflection and reflective logbooks as tools for reflective learning. Thereby warranting regular workshops or fostering continuous medical education on the importance of reflection.

Purpose This paper aims to explore how Sharia principles could impact capital structure determinants and speed of adjustment of Islamic banks (IBs) compared to conventional banks (CBs) in the Gulf Cooperation Council countries (GCC). Design/methodology/approach This study applies the autoregressive distributed lag (ARDL) approach for a sample of 69 banks listed on GCC stock markets over the period 2009–2018. Findings Regression results indicate that tangibility and bank size are positively related to book leverage of both IBs and CBs, whereas profitability, liquidity and risk are negatively related. For growth opportunities, the results show opposing effect on book leverage of IBs and CBs, regarding macroeconomic variables, the authors find that gross domestic product and financial development are negatively related to book leverage of both IBs and CBs, whereas oil price change is positively related. Moreover, the authors find that IBs slowly adjust their capital structure toward the desired leverage ratio than CBs. In sum, the capital structure of IBs appears to be driven by similar factors to those previously found in the corporate finance literature. Research limitations/implications This research contributes to the theory in re-validating capital structure theories on IBs. It helps understand the capital structure of IBs in comparison with CBs. It highlights some areas where further research on topics related to capital structure of IBs is needed. Practical implications The paper can contribute to policymakers and governance function in understanding the choice of capital structure for IBs within the bound of Sharia requirement in different economic climate through its relation with the macroeconomic variables. Practically, the directors and managers can predict the best capital structure to be achieved by IBs in ensuring their performance is at par, in their quest of additional capital. Originality/value This paper offers some insights on the determinants of capital structure by investigating IBs and CBs. It explores the implication of relevant Islamic principles on capital structure. Moreover, it analyses the determinants of capital structure using ARDL method that permits to identify the short-run and long-run relationships between capital structure and its main determinants.

Objective: to characterize the profile of women with leg ulcers resulting from sickle cell disease treated at a public health institution in Brazil. Method: historical cohort study conducted in the outpatient sector with a sample of women with sickle cell disease and leg ulcer, followed from 1998 to 2014. The data were extracted from the medical record and included sociodemographic, clinical and ulcer-related variables, and underwent descriptive statistical analysis. Results: of the 17 women, 64.7% were cured, 58.8% were aged between 30 and 39 years, 64.7% declared themselves brown, 70.6% were without partners, 41.2% had incomplete elementary education, 52, 9% had an income of 2 to 3 minimum wages, 70.6% were eutrophic and 82.4% used vitamin supplements. Women had a total of 29 ulcers, 52.9% had a single ulcer, 41.4% were located in the malleolar region, 55.17% were between 2 and 36 months, all classified as stage 3. The treatment was with coverings and Unna’s boot. Conclusion: the women received care from specialist nurses and most were cured with up to eight months of follow-up, which required a nursing consultation, including clinical evaluation, topical treatment and application of compression therapy.

Measuring human quality and well-being by the human development index (HDI) is very challenging as it is a composite index of many socio-economic variables. However, a simple index called literate life expectancy (LLE) by combining life expectancy and literacy only can be used as an alternative measure, which is less data intensive than HDI. LLE is the average life expectancy that a person lives under literate state. Length of life in literate state has many positive implications on social, economic and political aspects of life. In this paper an attempt has been made to construct LLE for Omani population with its gender differentials. The data for the study were extracted from the 2015 Statistical Year Book and the 2010 Population and Census report of Oman published by the National Centre for Statistics & Information. Despite socioeconomic progress, levels of education among women in Oman are not the same as men. The analysis shows the remarkable differences in the LLE between men and women for almost all age groups. The Omani female population is much lag behind in literate life expectancy than the Omani male population. The results underscore the need to take necessary steps for reducing gender gap in LLE in Oman.

Abstract Introduction Dental Readiness Classifications (DRCs) enable the Military Health System to prioritize dental care in garrison, minimizing dental emergencies and mission degradation during deployments. Over half (52.4%) of 2008 military recruits presented with high-priority urgent needs classified as DRC3 upon initial dental examination and 18.1% required extensive treatment, needing 7 or more restorations, in order to achieve operational dental readiness. The purpose of this study is to identify risk indicators for urgent and extensive dental treatment needs in current U.S. Air Force (USAF) recruits so that Dental Corps leadership can target interventions to maximize oral health, prioritize resources, and reduce health expenditures in this patient population. Materials and Methods A secondary data analysis was performed of deidentified survey and clinical exam data from the 2018 to 2019 USAF Recruit Oral Health Surveillance study conducted at Lackland Air Force Base from February 2018 to February 2019. Select demographic and self-reported variables were analyzed with two outcome variables: urgent (DRC3) and urgent and extensive (DRC3 + 7) dental treatment needs. Univariate log binomial regression was performed to determine relative risk of DRC3 and DRC3 + 7 by independent variable. The Uniformed Services University of the Health Sciences institutional review board approved the study as an exempt protocol. Results Among the 1,335 recruits studied, the overall prevalence of urgent dental needs was 21.5%, whereas 5.5% of participants had both urgent and extensive needs. The study group included participants who were mostly male (69%), were non-Hispanic white (60%), aged 17 to 19 years (48%), were high school educated (47%), had private dental insurance coverage (50%) and self-reported: no need for dental care in the past year (65%), excellent or good condition of teeth (63%), were toothbrushing more than once a day (58%), and had daily consumption of one to three servings of sugary beverages (62%) and foods (69%). Statistically significant differences in relative risk for DRC3 were found for all independent variables except gender and education level. Risk indicators significant for DRC3 and DRC3 + 7 were aged 25 to 29 years; Other and Black race/ethnicity; Medicaid insurance; uninsured; self-reported fair, poor, or unsure current condition of teeth; and past year needed care but did not go (P &lt; .05). The majority of DRC3 and DRC3 + 7 cases were in the small subset of recruits who self-reported fair, poor, or unknown current condition of teeth or need for dental care in the past year without a dental visit. Conclusions Among USAF recruits, oral health disparities are observed in certain groups. The study findings can inform targeted utilization of resources and interventions to efficiently optimize oral health and operational dental readiness and decrease dental expenditures. Additionally, a two-question screening tool is proposed to facilitate priority assignment for dental examination during boot camp. This tool has the potential to correctly identify nearly 90% of those with urgent and extensive dental treatment needs at half the typical workload.

Purpose The purpose of this study is to determine the Turkish housing price and rent dynamics among seven big cities with a unique monthly data set over 2003–2019. The secondary purpose is to examine bubble dynamics within the price convergence framework through alternative tests. Design/methodology/approach The paper conducts two autoregressive distributed lag (ARDL) cointegration estimates for housing prices and rents and applies conditional error correction model to investigate the long-run drivers of the Turkish housing market. The authors compare ARDL cointegration in-sample forecasts and discounted cash flow (DCF) estimates with actual prices to determine the timing, magnitude and collapse period(s) of bubbles within the price convergence framework. In particular, the generalized sup augmented Dickey–Fuller (GSADF) approach time stamps multiple explosive price behaviors. Findings The ARDL results confirm the theory of investment value by addressing mortgage rates, the price-to-rent ratio and rents as the fundamental factors of house prices. The price-to-rent ratio offers a comparison mechanism among houses deciding to buy a new house in which rents increase monthly real estate investment returns, and mortgage rates act as the discount rate. One key finding is that these dynamics have a greater impact on house prices than mortgage rates. Furthermore, the ARDL, DCF and GSADF findings exhibit temporal overvaluations rather than bubble signals, implying that housing price appreciations, including explosive behaviors, are consistent with fundamental advances. Originality/value This paper is considered to be innovative in determining housing market dynamics through two different ARDL estimates for the Turkish housing price index and rents in real terms as dependent variables. The authors compare the boom and collapse periods of the real housing price index and its fundamentals via the GSADF test. A final key feature of this research is its extensive data set, with 11 different regressors between 2003 and 2019.

IntroductionI spent five days on the Arizona Utah border, photographing Monument Valley and the surrounding areas as part of a group of eight undertaking a landscape photography workshop under the direction of a Navajo guide. Observing where our guide was taking us, and watching and talking to other tourist photographers, I was reminded of John Urry’s concept of the “tourist gaze” and the idea that tourists see destinations in terms of the promotional images they are familiar with (Urry 1). It seemed that tourists re-created images drawn from the popular imaginary, inserting themselves into familiar narratives of place. The goal of the research was to look specifically at the tourist gaze, that is, the way that tourists see view destinations and then represent that vision in their images. Circle of Representation Urry explained the tourist gaze as a particular way of seeing the world as a series of images created by the tourism industry; images which were then consumed or collected through tourist photography. He saw this as constituting a “closed circle of representation” where the images employed by the tourism industry to attract tourists to particular destinations were reproduced in tourists’ own holiday snaps, and as more tourists sought out these locations, they were increasingly used to represent the destination. Susan Sontag saw travel employed as “a strategy for accumulating photographs” (9) suggesting that the images were the culmination of the journey. Urry also saw the end point of tourism as travellers to a destination “demonstrating that they have really been there by showing their version of the images that they had seen originally before they set off” (140).Talking to the guide, my group, and other tourists about the images we were recording, and reviewing images tagged Monument Valley on Instagram revealed that digital and network technologies had altered tourists’ photographic practices. Tourist impressions of destinations come from a wide range of popular culture sources. They have, even on smartphones, fairly sophisticated tools for creating images; and they have diverse networks for distributing their images. Increasingly, the images that tourists see as representative of Monument Valley came from popular culture and social media, and not simply from tourism promotions. People are posting their travel images online, and are in turn looking to posts from others in their search for travel information (Akehurst 55). The current circle of representation in tourist photography is not simply a process of capturing promotional imagery, but an interaction between tourists that draws upon films, television, and other popular culture forms. Tourist photographs are less a matter of “consuming places” (Urry 259) and more an identity performance through which they create ongoing personal narratives of place by inserting themselves into pre-existing stories about the destination and circulating the new narratives.Jenkins analysed brochures on Australia available to potential tourists in Vancouver, Canada, and determined that the key photographic images used to promote Australia were Uluru and the Sydney Opera House, followed by sandy beaches alongside tropical blue waters. Interviews with Canadian backpackers travelling around Australia, and an examination of the images these backpackers took with the disposable cameras they were given, found a correlation between the brochure images and the personal photographs. Jenkins concluded that the results supported Urry’s theory of a closed circle of representation, in that the images from the brochures were “tracked down and recaptured, and the resulting photographs displayed upon return home by the backpackers as evidence of the trip” (Jenkins 324).Garrod randomly selected 25 tourists along the seafront of Aberystwyth, Wales, and gave them a single-use camera, a brief socio-demographic questionnaire, a photo log, and a reply-paid envelope in which they could return these items. The tourists were asked to take 12 photos and log the reason they took each photograph and what they tried to capture in terms of their visit to Aberystwyth. Nine females and four males returned their cameras, providing 164 photographs, which were compared with 70 postcards depicting Aberystwyth. While an initial comparison revealed similarities in the content of tourist photographs and the picture postcards of the town, Garrod’s analysis revealed two main differences: postcards featured wide angle or panoramic views, while tourist photos tended to be close up or detail shots and postcards included natural features, particularly bodies of water, while tourist photographs were more often of buildings and man-made structures. Garrod concluded that the relationship between tourism industry images and tourist photographs “might be more subtle and complex than simply for the two protagonists in the relationship to mimic one other” (356).MethodIdentifying a tourist’s motivation for taking a particular photograph, the source of inspiration for the image, and the details of what the photographer was attempting to capture involves the consideration of a range of variables, many of which cannot be controlled. The ability of the photographer and the sophistication of their equipment will have an impact on the type of images captured; for example this may explain the absence of panoramas in Aberystwyth tourist photos. The length of the stay and the level of familiarity with the location may also have an impact; on a first visit a tourist may look for the major landmarks and on subsequent visits photograph the smaller details. The personal history of the tourist, the meaning the location has for them, their reasons for visiting and their mood at the time, will all influence their selection of photo subjects. Giving tourists a camera and then asking them to photograph the destination may influence the choice of subject and the care taken with composition, however this does ensure a direct link between the tourist opinions gathered and the images analysed. An approach that depends on seeing the images taken independently by the tourists who were interviewed has logistical problems that significantly reduce sample size.Fourteen randomly selected tourists at the visitors centre in Monument Valley, a random sampling of 500 Instagram images hash tagged Monument Valley, and photographs taken by seven photographers in the author’s group were studied by the author. The tourists were asked what they wanted to take photographs of while in Monument Valley, and why of those particular subjects. The images taken by these tourists were not available for analysis for logistical reasons, and 500 Instagram images tagged #MonumentValley were collected as generally representative of tourist images. Members of the photography workshop group were all serious amateur photographers with digital SLR cameras, interchangeable lenses, and tripods. Motivations, decisions and the evaluation of images were discussed with this group, and their images reviewed in terms of the extent to which the image was felt to be representative of the location.Monument ValleyMonument Valley can be considered a mythic space in that it is a real place that has taken on mythic meanings that go beyond physical characteristics and lived experiences (Slotkin 11). Located on the Navajo Tribal Park on the Arizona Utah border, it is known by the Navajo as Tse'Bii'Ndzisgaii or “Valley of the Rocks.” Monument Valley is emblematic of the Wild West, the frontier beyond which civilization vanishes, a mythology originally derived from the Western Films of director John Ford. Ford's film, Stagecoach, was shot in Monument Valley and Ford returned nine times to shoot Westerns here, even when films (such as The Searchers, set in Texas) were not set in Arizona or Utah. The spectacular desert scenery with its towering rock formations combine epic grandeur with brutal conditions, providing an appropriate backdrop for dramatic oppositions: civilization versus barbarity, community versus wilderness, freedom versus domestication. The mythological meanings attached to Monument Valley were extended in the films, novels, television programs, and advertising that followed. Footage of Monument Valley is used to represent a blend of freedom and danger in 2001: A Space Odyssey, Easy Rider, Thelma & Louise, Marlborough and Chevrolet advertising, the television series Airwolf and episodes of Doctor Who. Monument Valley was the culmination of Forrest Gump's exhaustive run, and the setting for music videos by Kanye West, Madonna and Michael Jackson, each drawing on the themes of alienation and the displacement of the hero. While Westerns are on one level uniquely American, they are consistent with widely known romantic myths and stories, and the universal narratives evoked by Monument Valley have appeal far outside the USA. The iconic images of Monument Valley have been circulated well beyond tourist informational material, permeating a breadth of popular culture forms.Photographing the ValleyPhotography is intrinsically linked with tourism, fulfilling a number of roles. Travel can have as its purpose the collection of images, and as such, photography can function to structure the travel experience, and to evaluate its success (Schroeder; Sontag). Recognisable images of the location provide evidence that travel was undertaken, places were visited, and the traveller has experienced some form of authentic or exotic experience (Chalfen 435). Sharing images is an essential part of the process. The various roles of photography are to an extent dependent on having a shared mental image of what photographs from the travel location would look like. This mental image is derived, in part, from tourism sources such as postcards, brochures, and websites, but also from popular culture, and increasingly from photographs taken by other tourists. Travel images are shared online on sites such as Trip Advisor and Virtual Tourist, as well as travel blogs and photo sharing sites like Flickr and Instagram. People who post images online are likely to look to the same sites to search for travel information from others (Akehurst 55), reinforcing specific images as representative of the place and the experience.At the beginning of our photography-based tour we were asked which locations we wanted to photograph. There was a general consensus, with people looking for vistas and panoramas, “golden hour” light on the rock formations of buttes and mesas, sunrises and sunsets with silhouetted landscape forms, and close-ups of shadow patterns and textures. Our guide added that one day had been set aside for the iconic images, which were described as the “Forest Gump” shot from Highway 163, the Mittens at sunrise, John Ford Point (as most recently seen in The Lone Ranger movie posters), and the vista from Artist’s Point or North Window. When I asked tourists at the visitor information centre the same question about the images they wanted to capture, the responses were uniform with all of them saying the view of The Mittens, which was immediately before them. Seventy-eight percent (N=11) said that they were after a general panorama with the distinctive landforms, and Highway 163 was named by 57 percent (N=8). Few gave more than these three sites. Forty-two percent (N=6) described the John Ford Point image with the Navajo rider as a goal, and the same number said they would like to take some sunrise or sunset images. Twenty-eight percent (N=4) were looking to take images of themselves or their friends and family, with the distinctive landscape as a backdrop. There was a high level of consistency between the images described by the guide as “iconic” and the photographs that tourists wished to capture.Categorising five hundred Instagram images with the hashtag Monument Valley revealed 195 pictures (39 percent) of the Mittens, 58 of which were taken at sunrise or sunset. There were 88 images (18 percent) taken of Highway 163. John Ford Point featured in 26 images (five percent) of images and Artist’s Point was the location in 20 (four percent). Seventy-nine photographs (16 percent) were of other landmarks such as the Three Sisters, Elephant Butte, and Rain God Mesa, all visible from the self-drive circuit. Landmarks which could only be visited accompanied by a Navajo guide, accounted for 48 (nine percent) of the Instagram images. There were 16 images (three percent) of people, meals, and cars without any recognisable landmarks in the frame. The remaining 28 images (five percent) were of landmarks in the Southwest, but not in Monument Valley, although they were tagged as such.As expected, the photography tour group had a fairly wide range of images, which included close-ups of rocks, images of juniper trees, and images taken in places that were accessible only with a high clearance vehicle and a Navajo guide, such as the Totem Pole and Yei Bi Chei, the Valley of the Gods, and the slickrock formations of Mystery Valley. However, in the images selected at the end of the workshop as representative of their experience of Monument Valley, all participants included the iconic images of Highway 163, the Mittens, and the Artist’s Point vista.Very few images were of the Navajo people. Tourists are requested not to photograph the Navajo unless they were at a sign-posted location where a mechanism was available for paying for the privilege. Here the Navajo posed in traditional dress, engaged in customary activities, or as foreground interest in the desert landscape. The few tourists availing themselves of these opportunities seemed self-conscious, hurriedly taking the snap and paying the fee. Gillespie explains this as the effect of the “reverse gaze” where the photographed positions the photographer “as an ignorant and superficial tourist” (349). At the time, only one of the iconic images was featured on one of the official tourist sites, with the Mittens forming the banner image on the Visit Utah Monument Valley page. The Visit Arizona Monument Valley page had a single image (of the Ear of the Wind natural arch), and the Navajo Nation Parks and Recreation Monument Valley page also had a single image, that of the Three Sisters formation.Image and MeaningThe dominant subject in both tourist and tourism industry images is the Mittens. This image is also prominent in popular culture beginning with John Ford's film Stagecoach, through to Kanye West’s Bound 2 music video. This suggests that there is a closed circle of representation in tourist photography, with visitors capturing the images they have previously seen as representative of the destination. However, there may be an additional, more prosaic, explanation. The Mittens can be photographed from the terrace at the visitors centre, from the rooms at the View Hotel, or they can be captured from the car park, meaning that tourists do not have to leave their cars to attach this image to their travel narrative. The second most photographed landscape was that of Highway 163, an image that can be taken without even having to pay the fee and enter the Navajo Park.Garrod’s study of tourist and professional images of Aberystwyth noted that tourists did not have photographs taken from the top of the hill, and while no explanation for this was given, it could be that ease of access was a consideration. While the number of visitors to America’s national parks and recreation areas is increasing each year, the amount of time each visitor spends at the attraction is in decline. The average visit to Yosemite lasts just under five hours, visitors stay for just under two hours in Saguaro National Park in Arizona, and at the Grand Canyon National Park, most visitors spend just 17 minutes looking at the magnificent landscape (Bernstein; de Graaf). In Yosemite National Park many visitors “simply rolled by slowly in their cars, taking photos out the windows” (de Graaf np). So, ease of access to locations familiar from popular culture images is a factor in tourist representations of their destinations.Our photography tour group stayed five days in Monument Valley and travelled further afield to locations only accessible with a Navajo guide, however the images selected as representative of Monument Valley were of the same easily reached landmarks. This suggests that the process around the perpetuation of iconic tourist images is more complex than simple ease of access, or first impressions.What is apparent in looking at both the Instagram images and those photographs selected as representative by the tour group, is that what is depicted is not necessarily contemporary tourist experience, but rather a way of seeing the experience in terms of personal and cultural stories. Photography involves the selection, structuring and shaping of what is to be captured (Urry 260), so that the image is as much the representation of a perception, as a snapshot of experienced reality. In a guide to photographing the southwest of the USA, Matrés regrets the greater restrictions on movement and the increased commercialisation in Monument Valley (170), which reduce the possibility of photographing under good light conditions, and of capturing images without tourist buses, sales booths, and consequent crowds. However, almost all of the photographs studied avoided these. Photographers seemed to have expended considerable effort to produce an idealised image of a Western landscape that would have been familiar to John Ford, as the photographs were not of a commercialised, crowded tourist destination. When someone paid the horseman to ride out to the end of John Ford Point, groups of tourists would walk out too, fussing over the horse, however having people in the image led to those on the photography tour rejecting the image as representative of Monument Valley. For the most part, the landscape images highlighted the isolation and remoteness, depicting the frontier beyond which civilization ceases to exist.ConclusionPhotography is one of the performances through which people establish personal realities (Crang 245), and the reality for Monument Valley tourists is that it is still a remote destination. It is in the driest and least populated part of the US, and receives only 350,000 visitors a year compared, with the five million people who visit the nearby Grand Canyon. On a prosaic level, tourist photographs verify that the location was visited (Sontag 9), so the images must be able to be readily associated with the destination. They are evidence that the tourist has experienced some form of authentic, exotic, place (Chalfen 435), and so must depict scenes that differ from the everyday landscape. They also play a role in constructing an identity based in being a particular type of tourist, so they need to contribute to the narrative constructed from a blend of mythologies, memories and experiences. The circle of representation in tourist images is still closed, though it has broadened to constitute a narrative derived from a range of sources. By capturing the iconic landmarks of Monument Valley framed to emphasise the grandeur and isolation, tourists insert themselves into a narrative that includes John Wayne and Kanye West at the edge of civilization.References2001: A Space Odyssey. Dir. Stanley Kubrick. Metro-Goldwyn-Mayer, 1968.Airwolf. Dir. Donald P. Bellisario, CBS, 1984–1986.Akehurst, Gary. “User Generated Content: The Use of Blogs for Tourism Organisations and Tourism Consumers.” Service Business 3.1 (2009): 51-61.Bernstein, Danny. “The Numbers behind National Park Visitation.” National Parks Traveller, 2010. 5 Aug. 2016 <http://www.nationalparkstraveler.com/2010/04/numbers-behind-national-park-visitation/>.Kanye West. Bound 2. Nick Knight Good Music, 2013.Chalfen, Richard M. “Photography’s Role in Tourism: Some Unexplored Relationships.” Annals of Tourism Research 6.4 (1979): 435–447Crang, Mike. “Knowing, Tourism and Practices of Vision.” Leisure/Tourism Geographies: Practices and Geographical Knowledge. Ed. David Crouch. London: Routledge, 1999. 238–56.De Graaf, John. “Finding Time for Our Parks.” Earth Island Journal, 2016. 5 Aug. 2016 <http://www.earthisland.org/journal/index.php/eij/article/finding_time_for_our_parks/>.Doctor Who. Sydney Newman, C. E. Webber, Donald Wilson. BBC One, 1963–present.Easy Rider. Dir. Dennis Hopper. Columbia Pictures, 1969.Garrod, Brian. “Understanding the Relationship between Tourism Destination Imagery and Tourist Photography.” Journal of Travel Research 47.3 (2009): 346-358Gillespie, Alex. "Tourist Photography and the Reverse Gaze." Ethos 34.3 (2006): 343-366.Jenkins, Olivia. “Photography and Travel Brochures: The Circle of Representation.” Tourism Geographies 5.3 (2003): 305-328.Matrés, Laurent. Photographing the Southwest. Alta Loma, CA: Graphie Publishers, 2006.Schroeder, Jonathan E. Visual Consumption. London: Routledge, 2002.Slotkin, Richard. The Fatal Environment: The Myth of the Frontier in the Age of Industrialization, 1800-1890. Norman, OK: University of Oklahoma Press, 1998. Sontag, Susan. On Photography. London: Penguin Books, 1977 Stagecoach. Dir. John Ford. United Artists, 1937.The Searchers. Dir. John Ford. Warner Bros, 1956.Thelma & Louise. Dir. Ridley Scott. Metro-Goldwyn-Mayer, 1991.Urry, John. The Tourist Gaze: Leisure and Travel in Contemporary Societies. London: Sage, 1992.