Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding:long-term randomised pragmatic trial in primary care

Background: Heavy menstrual bleeding (HMB) is a common, chronic problem affecting women and health services. However, long-term evidence on treatment in primary care is lacking. Aim: To assess the effectiveness of commencing the levonorgestrel-releasing intrauterine system (LNG-IUS) or usual medical treatments for women presenting with HMB in general practice. Design and setting: A pragmatic, multicentre, parallel, open-label, long term, randomised controlled trial in 63 primary care practices across the English Midlands. Method: In total, 571 women aged 25–50 years, with HMB were randomised to LNG-IUS or usual medical treatment (tranexamic/mefenamic acid, combined oestrogen–progestogen, or progesterone alone). The primary outcome was the patient reported Menorrhagia Multi-Attribute Scale (MMAS, measuring effect of HMB on practical difficulties, social life, psychological and physical health, and work and family life; scores from 0 to 100). Secondary outcomes included surgical intervention (endometrial ablation/hysterectomy), general quality of life, sexual activity, and safety. Results: At 5 years post-randomisation, 424 (74%) women provided data. While the difference between LNG-IUS and usual treatment groups was not significant (3.9 points; 95% confidence interval = −0.6 to 8.3; P = 0.09), MMAS scores improved significantly in both groups from baseline (mean increase, 44.9 and 43.4 points, respectively; P<0.001 for both comparisons). Rates of surgical intervention were low in both groups (surgery-free survival was 80% and 77%; hazard ratio 0.90; 95% CI = 0.62 to 1.31; P = 0.6). There was no difference in generic quality of life, sexual activity scores, or serious adverse events. Conclusion: Large improvements in symptom relief across both groups show treatment for HMB can be successfully initiated with long-term benefit and with only modest need for surgery.

Vertical Handoff Target Selection in a Heterogeneous Wireless Network Using Fuzzy ELECTRE

Global connectivity is on the verge of becoming a reality to provide high-speed, high-quality, and reliable communication channels for mobile devices at anytime, anywhere in the world. In a heterogeneous wireless environment, one of the key ingredients to provide efficient and ubiquitous computing with guaranteed quality and continuity of service is the design of intelligent handoff algorithms. Traditional single-metric handoff decision algorithms, such as Received Signal Strength (RSS), are not efficient and intelligent enough to minimize the number of unnecessary handoffs, decision delays, call-dropping and blocking probabilities. This research presents a novel approach for of a Multi Attribute Decision Making (MADM) model based on an integrated fuzzy approach for target network selection.

Land cover classification of Samoylov Island and Landsat subpixel water cover of Lena River Delta, Siberia, with links to ESRI grid files

Ignoring small-scale heterogeneities in Arctic land cover may bias estimates of water, heat and carbon fluxes in large-scale climate and ecosystem models. We investigated subpixel-scale heterogeneity in CHRIS/PROBA and Landsat-7 ETM+ satellite imagery over ice-wedge polygonal tundra in the Lena Delta of Siberia, and the associated implications for evapotranspiration (ET) estimation. Field measurements were combined with aerial and satellite data to link fine-scale (0.3 m resolution) with coarse-scale (upto 30 m resolution) land cover data. A large portion of the total wet tundra (80%) and water body area (30%) appeared in the form of patches less than 0.1 ha in size, which could not be resolved with satellite data. Wet tundra and small water bodies represented about half of the total ET in summer. Their contribution was reduced to 20% in fall, during which ET rates from dry tundra were highest instead. Inclusion of subpixel-scale water bodies increased the total water surface area of the Lena Delta from 13% to 20%. The actual land/water proportions within each composite satellite pixel was best captured with Landsat data using a statistical downscaling approach, which is recommended for reliable large-scale modelling of water, heat and carbon exchange from permafrost landscapes.

The capacities of institutions for the integration of ecosystem services in coastal strategic planning: The case of Jiaozhou Bay

This paper explains how the practice of integrating ecosystem-service thinking (i.e., ecological benefits for human beings) and institutions (i.e., organisations, policy rules) is essential for coastal spatial planning. Adopting an integrated perspective on ecosystem services (ESs) both helps understand a wide range of possible services and, at the same time, attune institution to local resource patterns. The objective of this paper is to identify the extent to which ESs are integrated in a specific coastal strategic planning case. A subsequent objective is to understand whether institutions are capable of managing ESs in terms of uncovering institutional strengths and weaknesses that may exist in taking ESs into account in existing institutional practices. These two questions are addressed through the application of a content analysis method and a multi-level analysis framework on formal institutions. Jiaozhou Bay in China is used as an illustrative case. The results show that some ESs have been implicitly acknowledged, but by no means the whole range. This partial ES implementation could result from any of four institutional weaknesses in the strategic plans of Jiaozhou Bay, namely a dominant market oriented interest, fragmented institutional structures for managing ESs, limited ES assessment, and a lack of integrated reflection of the social value of ESs in decision-making. Finally, generalizations of multi-level institutional settings on ES integration, such as an inter-organisational fragmentation and a limited use of ES assessment in operation, are made together with other international case studies. Meanwhile, the comparison highlights the influences of extensive market-oriented incentives and governments' exclusive responsibilities on ES governance in the Chinese context.

‘Never Let Me Down Again’1: Loyal customer attitudes towards ticket distribution channels for live music events: a netnographic exploration of the US leg of the Depeche Mode 2005–2006 World Tour

Ticket distribution channels for live music events have been revolutionised through the increased take-up of internet technologies, and the music supply-chain has evolved into a multi-channel value network. The assumption that this creates increased consumer autonomy and improved service quality is explored here through a case-study of the ticket pre-sale for the US leg of the Depeche Mode 2005–06 World Tour, which utilises an innovative virtual channel strategy, promoted as a service to loyal fans. A multi-method analysis, adopting Kozinets' (2002) Kozinets, R. V. 2002. The field behind the screen: using netnography for marketing research in online communities. Journal of Marketing Research, 39: 61–72. [CrossRef], [Web of Science ®] netnography methodology, is employed to map responses of the band's serious fan base on an internet message board (IMB) throughout the tour pre-sale. The analysis focuses on concerns of pricing, ethics, scope of the offer, use of technology, service quality and perceived brand performance fit of channel partners. Findings indicate that fans behaviour is unpredictable in response to channel partners' performance, and that such offers need careful management to avoid alienation of loyal consumers.

Franz Liszt’s Piano Sonata in B Minor: Precedents for an Analytical Evolution

Franz Liszt has all too often been discarded as the virtuosic showman, despite the fact that his several of works have often gained great praise and attracted scholarly engagement. However, one also finds striking development of formal design and tonal harmony in many of the works for his principal composition medium, the piano. This paper seeks to explore the practical application of James A. Hepokoski and Warren Darcy’s 'Sonata Theory' upon Liszt’s magnum opus for the instrument, the Sonata in B Minor.

I shall first consider the historical analyses placed upon the work that deal with structural design, as it pertains to the paradigm of Classical sonata-form. Previous research reveals two main theoretical camps; those in favour of a multi-movement analysis (with conflicting hypotheses therein) and those in favour of a single movement sonata-form. An understanding of these historical conceptions of the piece allows one to then highlight areas of conflict and offer a new solution.

Finally, I shall use Sonata Theory to survey the Sonata in B Minor’s landscape in a new light. The title ‘Sonata’ has clear generic implications, many of which are met by Liszt; 'Sonata Theory' provides a model with which to outline the compositional deformations employed by the composer and the implications of this practice. In particular, I offer new perspectives on the validity of the double-function form, insight into the rhetorical layout of a rotational discourse, and propose a nuanced analysis befitting of this striking work.

Avvägning mellan arbetsmiljö och effektivitet med hjälp av multikriterieanalys : Hur komplettering av kundtjänst påverkar kundnöjdhet och effektivitet

A public organization has a section for customer service which is responsible of order entry from customers concerning errands within real estate and business equipment, cleaning, transport operations and handicap appliance. According to the co-ordinators in hospitals within the organisation the customers are requesting for staff to talk to physically, meaning a person to speak with face to face. The customers experiencing that it’s sometimes difficult to call customer service or use the web form, which is the only communication paths in the current situation. Proposed changes presented claim that a complement to customer service with local service centers in every hospital. The purpose of this study is to evaluate a change proposition by weigh between efficiency and working environment, this by using multi-criteria analysis. To achieve the goal a decision model is designed in the decision tool DecideIT. The aim of the study is to recommend decision makers to choose one of the options based on as rational grounds as possible. The result of the study showed that the preferred alternative is not to supplement customer service with local service centers. For the most part, the result depending on the survey (represented result from working environment criteria) which showed that the majority of customers do not request a person to speak with face to face at all.

JChord : An Android application helping people learn guitar chords

Nowadays, a lot of interesting and useful and imaginative applications are springing to Android software market. And for guitar fans, some related apps bring great connivence to them, like a guitar tuner can save people from carrying a entity tuner all the time, some apps can simulate a real guitar, and some apps provide some simple lessons allowing people to learn some basic things. But these apps which can teach people, they can't really “monitor ” people, that is, they just give some instructions and hope people would follow them. So my project is to design an app which can detect if users are playing wrong and right real-timely. Guitar chords are always the first for new guitar beginners to learn, and a chord is a set of notes combined together in a regulated way ( get from the music theory having millions of developing ), and 'pitch' is the term for determining if the note different from other notes or noise, so the problem here is to manage the multi-pitch analysis in real time. And it's necessary to know some basics of digital signal processing ( DSP ) because digital signals are always more convenient for computers to analyze compared to analog signals. Then I found an audio processing Java library – TarsosDSP, and try to apply it to my Android project.

Lageroptimering med hjälp av multikriterieanalys : En fallstudie hos KUBALs centrallager

This thesis deals with control of stock in an inventory, focusing on inventory placement. The purpose of this thesis is to reduce the transport distance within the main stock house while gathering inventory. This will be achieved by reconstructing the inventory placement in consideration with how frequently the inventories get picked and mass of the inventory. In particular, the literature and the data that is collected from the company´s business system have laid the foundation for the thesis. In general, interviews and observations also contributed to the data collection. To fulfill the aim and to produce arbitrary results, two issues have been developed regarding which attributes that should determine the position of the inventory in the stock house and how to obtain a more effective inventory structure? The authors have jointly produced a result of suggestions for future inventory placement in terms of picking frequency and weight. Initially a situation analysis was conducted to identify known problems with the inventory´s placement and storage systems. The problems that were identified were that the inventory placement has no consideration regarding picking frequency. To determine the most frequent picked inventory an ABC analysis was conducted. All of the inventories were spread out throughout the whole stock house. To take in account, the additional criterion, which was weight, a multi-criteria analysis was performed in combination with the ABC analysis. The results of the combined analysis provided that the basis for drawing up concepts for future inventory placement. The proposal includes optimized inventory placements in different zones of the most frequently picked inventory with weight as an additional criterion.