Introduction: Cancer is the second leading cause of death in the United States (U.S.), after cardiovascular disease. Although there has been a continuous decline in cancer mortality rates in the U.S. over the past two decades, the Appalachian region, which extends through 13 states and 420 counties in the southeastern part of the U.S., has seen a lower decline in cancer mortality. From 1980-2014, cancer deaths decreased by almost 45%, but cancer mortality rates in rural Appalachia was 36% higher than for urban non-Appalachian counties. In terms of cancer-specific, although breast cancer mortality rates have also decreased significantly nationally, a lesser decline was seen in Appalachian counties (17.5%), compared with non-Appalachian counties (30.5%). Similarly, in all 13 Appalachian states, lung cancer mortality rates exceed national rates. Tennessee (TN) is one of the largest and most diverse states in Appalachia in terms of race/ethnicity, income, and location compared to similar largely rural states in the region like Kentucky and West Virginia. Objective: This study explores cancer incidence trends by demographic factors in northeast Tennessee. Methods: We extracted and examined electronic medical records for 322 cancer patients diagnosed with any of the top five cancers (breast, leukemias, lung, lymphoma, and prostate) between January and June 31, 2017, in a major oncological clinic in northeast TN, which attracts low-income individuals and Medicare patients. Variables included gender, race, marital status, tobacco use, and Zip codes. Descriptive statistics was used to examine the distribution, and the Spearman’s rank-order correlation to assess the relationship between demographic factors and cancer type. Results: Preliminary results showed that among women diagnosed with the top five cancers, the proportion of breast cancer (52.1%) was relatively higher than other cancers like lung (15.5%), leukemias (13.6%), multiple myeloma (9.9%) and lung (8.9%). The percentage of cancer diagnosed among men was leukemias (29.2%), lung (27.1%), prostate (21.9%), and lymphoma (21.9%). Findings further revealed a significant positive correlation of 0.396 (p =p= <0.001). Conclusions: This exploratory study examined the trends of cancer incidence in northeast Appalachia TN. Consistent with national trends, breast cancer continued to be the leading cancer diagnosed among women. However, the positive relationship between age and smoking appears to reflect that tobacco and nicotine use is associated with the likelihood to be diagnosed with any of the top five cancers. In addition, because the region is underserved and yet understudied, it is important to continue to evaluate cancer patterns as well as behavioral risk factors to identify areas for effective intervention.

This project is an examination of the communication and publishing implications of producing an e-zine delivered to readers via e-mail with print-magazine style presentation, and then supporting it with a website.Several communication issues are raised, such as the potential for reaching international audiences for little or no additional effort and cost. The very structure of the publishing environment is opened to question by this style of communicating and the model preferred by the publisher is constantly open to review - particularly when the potential to direct influence of the audience on the final product is taken into account.This project has indicated some avenues for maximising the potential for this style of web publishing down a number of paths, including that of becoming a true multi-media production. At the same time it has raised many questions on the future of publishing, the internet, and the world wide web, while highlighting the relative infancy of the sector.

The presence and seasonal variability of human and veterinary pharmaceuticals in surface water (raw water) and treated water samples from two drinking water facilities in Southern Ontario was investigated. Water samples were collected at monthly intervals for one year to characterize the seasonal variability of these contaminants. The presence of these compounds in raw water samples collected from groundwater wells, which were potentially under the influence of surface water, was also examined. All samples were extracted by solid phase extraction (SPE) techniques and analyzed by liquid chromatography coupled with tandem mass spectrometry (LC-ESI-MS/MS). The compounds detected represented different therapeutic classes, including antibiotics, lipid regulating agents and anti-inflammatory drugs. The concentrations detected for most compounds were in the low ng/L range, with one compound being detected close to 1 μg/L. In general, human pharmaceuticals (i.e. gemfibrozil, ibuprofen and carbamazepine) were detected in raw and treated water samples, while the antibiotics were not detected after treatment. Seasonal variability was observed in the concentrations and compounds detected, which could be partially explained by changes in surface water hydrology and sources of contamination. The results demonstrate that the application of conventional treatment technologies were not very effective in reducing some of these compounds from a drinking water facility. In contrast, a second drinking water facility using additional treatment technologies, including ozonation and granular activated carbon (GAC) filters, could reduce the concentrations of these contaminants. Although, the presence of these contaminants in surface water represents a potential risk, the results suggest that appropriate treatment can minimize exposure to at least some of these emerging contaminants.

The presence and seasonal variability of human and veterinary pharmaceuticals in surface water (raw water) and treated water samples from two drinking water facilities in Southern Ontario was investigated. Water samples were collected at monthly intervals for one year to characterize the seasonal variability of these contaminants. The presence of these compounds in raw water samples collected from groundwater wells, which were potentially under the influence of surface water, was also examined. All samples were extracted by solid phase extraction (SPE) techniques and analyzed by liquid chromatography coupled with tandem mass spectrometry (LC-ESI-MS/MS). The compounds detected represented different therapeutic classes, including antibiotics, lipid regulating agents and anti-inflammatory drugs. The concentrations detected for most compounds were in the low ng/L range, with one compound being detected close to 1 μg/L. In general, human pharmaceuticals (i.e. gemfibrozil, ibuprofen and carbamazepine) were detected in raw and treated water samples, while the antibiotics were not detected after treatment. Seasonal variability was observed in the concentrations and compounds detected, which could be partially explained by changes in surface water hydrology and sources of contamination. The results demonstrate that the application of conventional treatment technologies were not very effective in reducing some of these compounds from a drinking water facility. In contrast, a second drinking water facility using additional treatment technologies, including ozonation and granular activated carbon (GAC) filters, could reduce the concentrations of these contaminants. Although, the presence of these contaminants in surface water represents a potential risk, the results suggest that appropriate treatment can minimize exposure to at least some of these emerging contaminants.

Participating in an auction and winning items by placing bids has been in practice since at least 500 B.C. Auctions have evolved since then and anyone can now participate in one online and buy items ranging from clothes, electronics, automobiles and homes using online auction websites, such as eBay. A Reverse Auction varies from the traditional style of Auction where items or services are won by placing successive higher bids until the auction ends. The study of Reverse Auction was first introduced to Texas A & M University in 2004 and continues today, using a SQL based web system. This current research provides a detailed statistical analysis of the fourth case study in this long running work. This fourth case study involved the participation of five bidders who had no prior experience in Reverse Auctions. A Microsoft Access database system and ASP web based user interface was developed and used to conduct these initial studies. However, due to the limited capability of the Access system to handle more than a limited number of connections or bidders, a Microsoft SQL database and web system was developed in 2006 and has been used in all subsequent studies. Case studies have involved up to ten participants. The results from the fourth case study show that a Reverse Auction can result in an increase in the average cost of the job to the owner. Also, there is evidence of game play amongst the bidders and against the purchaser that causes their profits to rise as they gain proficiency in the game. This behavior has been termed as 'tacit collision', but it is considered a byproduct of the system and not illegal behavior. This study analyzes the fourth study data to investigate if the behavior termed "tacit collusion" is evident in the bidding data. This analysis is completed by performing a detailed statistical analysis of the bidding data. Analysis of the profit percentages illustrates the different stages of the game play amongst the bidders. This game play behavior is illustrated by plotting average number of bids to the profit made by each bidder. The data clearly suggests that the players became efficient in their bidding strategy, although some bidders are more efficient than others. This observation negates the common conception that Reverse Auctions will result in lowering average costs for the owners. The individual data of bidders for bids and profit reveal why some players were able to obtain higher than average results and why the others were not. This study can be taken further by analyzing the patterns of the successful and unsuccessful players to determine what causes them to gain or lose profits.

Species of Phalaenopsis Blume (Orchidaceae) are found throughout tropical Asia, namely South China, Indochina, India, Southeast Asia, and Australia. This genus is comprised of approximately 66 species according to the latest classification. Most of them possess commercial value. Thousands of Phalaenopsis cultivars have been grown for commercial goals. Although this orchid is very beautiful and popular throughout the world, studies on the molecular systematics and phylogenetic relationships among these orchids are still deficient. Phylogenetic trees inferred from the internal transcribed spacers 1 and 2 (ITS1+ITS2) region of nuclear ribosomal DNA (nrDNA) and chloroplast DNAs (cpDNAs), including the intron of trnL, the IGS of trnL-trnF, and the IGS of atpB-rbcL, were used to clarify the phylogenetics and evolutionary trends of the genus Phalaenopsis (Orchidaceae). Molecular data are provided to clarify the latest systematics of the genus Phalaenopsis as suggested by Christenson (2001). He treated the genera of Doritis and Kingidium as synonyms of the genus Phalaenopsis and divided it into the five subgenera of Proboscidioides, Aphyllae, Parishianae, Polychilos, and Phalaenopsis. The results concurred that the genera Doritis and Kingidium should be treated as synonyms of the genus Phalaenopsis as suggested by Christenson (2001). The subgenera of Aphyllae and Parishianae were both shown to be monophyletic groups, and to be highly clustered with the subgenus Proboscidioides and two sections (including sections Esmeralda and Deliciosae) of the subgenus Phalaenopsis, which have the same morphological characters of four pollinia as well as similar biogeographies. Furthermore, neither the subgenus Phalaenopsis nor Polychilos was found to be a monophyletic group in this study. In addition, the phylogenetic tree indicates that Phalaenopsis is monophyletic and does not support the existing subgeneric and sectional classification. The phylogenetic tree of the genus Phalaenopsis is basically congruent with the geographical distributions of this genus. Based on the tree, two major clades were separated within the genus Phalaenopsis. The first clade, having four pollinia, included sections Proboscidiodes, Parishianae, and Esmeralda, of which are distributed in South China, India, and Indochina. The second clade, bearing two pollinia, included the sections Phalaenopsis, Polychilos, and Fuscatae, of which are distributed in Malaysia, Indonesia, and the Philippines. In addition, the biogeography of the genus Phalaenopsis is congruent with the historical geology of the distribution regions of this genus as well. According to molecular evidences, biogeography, historical geology, and the evolutionary trend of pollinia number of orchid, evolutionary trends of the genus Phalaenopsis were deduced. The subgenus Aphyllae was suggested to be the origin of Phalaenopsis and South China was suggested to be the origin center of Phalaenopsis. In addition, there were two dispersal pathways of Phalaenopsis from the origin center to Southeast Asia. In one pathway, Phalaenopsis species dispersed from South China to Southeast Asia, in particular the Philippines, using Indochina, older lands of the Philippines (Mindoro, Palawan, Zamboanga, etc.) as steppingstones, from which the subgenus Phalaenopsis developed. In the other pathway, Phalaenopsis species dispersed from South China to Southeast Asia, in particular Indonesia and Malaysia, using the Malay Peninsula as a steppingstone, from which the subgenus Polychilos developed. Furthermore, molecular data and geological dating were used to estimate the substitution rates of DNA from the genus Phalaenopsis based on the hypothesis of the molecular clock. The substitution rates of both ITS and cpDNA data from the genus Phalaenopsis were 2.4~4.7 x 10-9 and 3.9~7.8 x 10¡V10 substitutions/site/year, respectively. The substitution rates of ITS data of the genus Phalaenopsis are approximately six times those of cpDNA. Based on the substitution rates, the divergence time among most of the P. lueddemanniana complex was estimated to have been during the Pleistocene. The section Deliciosae separated from the section Stauroglottis at 21~10.5 Mya. Furthermore, the phylogenetics of the close species of Phalaenopsis will be evaluated based on molecular data, involving three groups of close Phalaenopsis species, namely the P. amabilis complex, P. sumatrana complex, and P. violacea complex. For the first complex, the internal transcribed spacer 1 and 2 (ITS1+ITS2) regions of nuclear ribosomal DNA (nrDNA) were applied to evaluate the phylogenetics of the P. amabilis complex, namely P. amabilis, P. amabilis subsp. moluccana, P. amabilis subsp. rosenstromii, P. aphrodite, P. aphrodite subsp. formosana, and P. sanderiana. Based on molecular data, each of species/subspecies from the P. amabilis complex with the exception of P. aphrodite and its subspecies could be separated from each other. Phalaenopsis aphrodite from different locations and its subspecies could not be separated from each other, but all of them were separable from different populations/subspecies of P. amabilis. In addition, P. sanderiana was nested within both P. amabilis and its subspecies. These results do not support P. sanderiana being treated as a separate species from P. amabilis. In addition, I suggest that P. aphrodite is the origin of the P. amabilis complex and originated in the Philippines. Phalaenopsis amabilis and P. sanderiana descended from P. aphrodite (or its ancestor). Based on the phylogenetic tree, evolutionary trends of the P. amabilis complex were suggested. Within evolutionary trends of P. amabilis complex, two different lineages with different dispersal pathways were suggested. First, P. aphrodite, dispersed into Palawan and evolved to be P. amabilis, thereafter further dispersing into Borneo and Sumatra. Second, P. aphrodite dispersed into southern Mindanao and evolved into P. sanderiana, thereafter further dispersing into Sulawesi and New Guinea, from which P. amabilis subsp. moluccana and P. amabilis subsp. rosenstromii developed, respectively. For the second complex, the phylogenetic relationship of the P. sumatrana complex, namely P. sumatrana, P. corningiana, and P. zebrina, was detected based on the ITS1 and ITS2 regions of nrDNA, the intron of trnL, and the IGS of atpB-rbcL of cpDNA. The P. sumatrana complex includes the two species of P. sumatrana and P. corningiana, as well as a problem species, P. zebrina, according to the concepts of Sweet (1980) and Christenson (2001). Based on the phylogenetic tree inferred from the ITS sequence, accessions of P. sumatrana cannot be separated from those of P. corningiana. Furthermore, accessions of P. zebrina can be separated from those of both P. sumatrana and P. corningiana. In addition, analyses of both sequences of the trnL intron and atpB-rbcL IGS of cpDNA apparently cannot discriminate among these three species of the P. sumatrana complex. Based on the molecular data of this study, plants of P. zebrina might be treated as a separate species from both P. sumatrana and P. corningiana. In the evolutionary trend of the P. sumatrana complex, plants of P. zebrina were deduced to be the relative origin group of the P. sumatrana complex based on the phylogenetic tree and biogeography. In addition, plants of both P. sumatrana and P. corningiana might have descended from plants of P. zebrina. For the third complex, the phylogenetic trees inferred from the internal transcribed spacer 1 and 2 (ITS1+ITS2) regions of nuclear ribosomal DNA (nrDNA), the intron of trnL, and the intergenic spacer of atpB-rbcL of chloroplast DNA (cpDNA) were used to clarify the phylogenetic relationships of the P. violacea complex. The complex includes the two species of P. violacea and P. bellina, according to the concept of Christenson (2001). Based on the phylogenetic tree inferred from the ITS sequence, P. bellina could not be separated from most populations from P. violacea with the exception of the population distributed on Mentawai Is., Indonesia. In addition, analyses of both the intron of trnL and the IGS of atpB-rbcL of cpDNA apparently could not discriminate among the three species of the P. sumatrana complex. Based on the morphological characters, P. violacea from Mentawai Is. bears a long floral rachis and was separable from the other groups of the P. violacea complex. Therefore, the results in this study have a trend to treat the population of Mentawai Is. of the P. violacea complex as a separate species from P. violacea. In the evolutionary trend of the P. violacea complex, Mentawai plants of this complex might be descended from those of Sumatra/the Malay Peninsula according to the phylogenetic analysis and biogeography.

To obtain better well performance and improved production from shale gas reservoirs, it is important to understand the behavior of shale gas wells and to identify different flow regions in them over a period of time. It is also important to understand best fracture and stimulation practice to increase productivity of wells. These objectives require that accurate production analysis be performed. For accurate production analysis, it is important to analyze the production behavior of wells, and field production data should be interpreted in such a way that it will identify well parameters. This can be done by performing a detailed analysis on a number of wells over whole reservoirs. This study is an approach that will lead to identifying different flow regions in shale gas wells that include linear and bilinear flow. Important field parameters can be calculated from those observations to help improve future performance. The detailed plots of several wells in this study show some good numbers for linear and bilinear flow, and some unique observations were made. The purpose of this work is to also manage the large amount of data in such a way that they can be used with ease for future studies. A program was developed to automate the analysis and generation of different plots. The program can also be used to perform the simple calculations to calculate different parameters. The goal was to develop a friendly user interface that would facilitate reservoir analysis. Examples were shown for each flow period, i.e. linear and bilinear flow. Different plots were generated (e.g; Bob Plot (square root of time plot) and Fourth Root of Time Plot, that will help in measuring slopes and thus reservoir parameters such as fracture permeability and drainage area. Different unique cases were also observed that show a different behavior of well in one type of plot from another.

Breastfeeding trends in the United States have varied considerably since the early 1900s. Medical and federal surveys representing comprehensive data on breastfeeding rates of American women show an inconsistency in breastfeeding trends over the course of the past 110 years. Some decades report a growth in breastfeeding rates of infants newborn to 6 months, whereas other decades report a decline. This report examines breastfeeding trends from the early 1900s to present day to suggest which factors have played a role in the decline and rise of breastfeeding in the United States. / text

Background: Inflammatory breast cancer (IBC) is a rare form of breast cancer associated with a poor prognosis. This study describes the incidence, survival, and management of IBC in the province of Ontario. Methods: We conducted a retrospective, population-based, cohort study using data systems held at the Division of Cancer Care and Epidemiology at Queen’s University in Kingston, Ontario. Using the Ontario Cancer Registry (OCR), we identified all primary, pathologically confirmed cases of breast cancer. IBC cases were identified using the unique histology code ‘85303’. OCR records were linked to Statistics Canada data, Canadian Institutes of Health Information (CIHI) records of surgical procedures, and cancer centre records detailing radiotherapy and chemotherapy administration. We calculated age-adjusted incidence rates of IBC for cases diagnosed between 1984 and 2005. Using the Kaplan Meier product-limit method and log-rank statistics we compared overall survival for IBC and non-IBC, and assessed temporal and regional variations in IBC survival. We described the management of IBC for patients diagnosed between 1984 and 2004, and assessed variations over time and across cancer centres. Results: Age-adjusted incidence rates of IBC increased from 0.57/105 women-years in 1984-1987 to 1.15/105 women-years in 2003-2005 (p<0.0001). 10-year survival was 21.5% for IBC compared to 61.7% for non-IBC (p<0.0001). For IBC, 10-year survival increased from 12.0% (95% CI: 8.3–16.3) for those diagnosed between 1984-1994 to 24.0% (95% CI: 20.1–28.2) for those diagnosed between 1995-2005. The utilization of combined mastectomy and postoperative radiotherapy increased from 28.9% in 1984-1994 to 46.1% in 1995-2004 (p<0.0001). We observed no statistically significant difference in the utilization of chemotherapy over time. Differences in the utilization of combined mastectomy and postoperative radiotherapy were observed across cancer centres (29.8% at centre C vs. 54.7% at centre A, p<0.0001). We also observed wide variations in the estimates of survival across cancer centres. Discussion: Rates of IBC have increased over time in Ontario and we observed an improvement in the long-term survival. Management has shifted over time towards increased use of mastectomy and postoperative radiotherapy. Additional prognostic information is needed to determine how variations in practice may be related to variations in outcome. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-09-24 16:15:10.068

Approved for public release; distribution is unlimited. / MBA Professional Report / The purpose of this MBA Project is to investigate and provide an analysis of the prominent factors that affecr the United States Foreign Military Sales (FMS) program. This project was conducted with the sponsorship and assistance of the Naval Postgraduate School's Acquisition Research Institute, Financial Management and International programs. The overall goal of this project is three-fold: 1) to identify the purpose of the United States FMS program and its processes 2) to identify, define and evaluate historical economic, political, social and industrial changes and trends that affect FMS worldwide allocation and support and 3) to apply these findings to a specific country (Taiwan) to make a prediction of future participation and support. The role of arms sales in world politics has grown tremendously since the end of World War II and more specifically since the passage of new arms laws in 1979. The importance of FMS is increasingly evident in the foreign policies of both supplier and recipient nations, in international politics, competition and relations. Arms sales have become in recent years a crucial dimension of international affairs. This paper examines several trends in military equipment, services and training exchanges and investigates their potential impact on the future conflicts. The nature of FMS is complex. This research plans to identify and analyze trends relating to socio-political, economic, and industrial and technological changes associated with FMS spending. This discussion then applies these findings to Taiwan as a case study and expands on the customer's experience with FMS. The intent of this paper is to increase the reader's knowledge of FMS, pinpoint trends in the program and use FMS to Taiwan as a point of comparison to increase comprehension of this extremely complex and not well-understood program.