A Fuzzy Approximation Scheme for Sequential Learning in Pattern Recognition

An adaptive learning scheme, based on a fuzzy approximation to the gradient descent method for training a pattern classifier using unlabeled samples, is described. The objective function defined for the fuzzy ISODATA clustering procedure is used as the loss function for computing the gradient. Learning is based on simultaneous fuzzy decisionmaking and estimation. It uses conditional fuzzy measures on unlabeled samples. An exponential membership function is assumed for each class, and the parameters constituting these membership functions are estimated, using the gradient, in a recursive fashion. The induced possibility of occurrence of each class is useful for estimation and is computed using 1) the membership of the new sample in that class and 2) the previously computed average possibility of occurrence of the same class. An inductive entropy measure is defined in terms of induced possibility distribution to measure the extent of learning. The method is illustrated with relevant examples.

Workplace belongingness, psychological distress and resilience in emergency service workers

- Objective Ambulance personnel provide emergency medical services to the community, often attending to highly challenging and traumatic scenes in complex and chaotic circumstances. Currently the assessment of predictors of psychological well-being remains limited. The current study investigated whether workplace belongingness was significant in predicting psychological distress as well as the presence of resilience in ambulance personnel whilst controlling for more routinely examined factors. - Method Australian ambulance officers (N = 740) completed a survey battery including the Kessler 10 (Kessler & Mroczek, 1994), Brief Resilience Scale (Smith et al., 2008) and Psychological Sense of Organisational Membership (Cockshaw & Shochet, 2010) scale. - Results Controlling for more commonly examined factors such as severity of trauma exposure and length of service, hierarchical multiple regression analyses demonstrated that workplace belongingness was significantly associated with reduced distress levels and enhanced resilience levels. - Conclusions Results suggest that strategies to enhance a sense of workplace belongingness in emergency service organisations could promote the well-being of emergency workers despite routine exposure to potentially traumatic events.

Meillä ei ole ikuisia ystäviä eikä ikuisia vihollisia. Ikuisia ovat meidän omat etumme. : Suomen suhteet Kiinan kansantasavaltaan 1949 - 1989

"We have neither Eternal Friends nor Eternal Enemies. We have only Eternal Interests .Finland's Relations with China 1949-1989 The study focuses on the relations between Finland and the People s Republic of China from 1949-1989 and examines how a small country became embroiled in international politics, and how, at the same time, international politics affected Finnish-Chinese relations and Finland s China policy formulation. The study can be divided into three sections: relations during the early years, 1949-1960, before the Chinese and Soviet rift became public; the relations during the passive period during the 1960s and 1970s; and the impact of China s Open Door policy on Finland s China policy from 1978-1989. The diplomatically challenging events around Tiananmen Square and the reactions which followed in Finland bring the study to a close. Finland was among the first Western countries to recognise the People s Republic and to establish diplomatic relations with her, thereby giving Finland an excellent position from which to further develop good relations. Finland was also the first Western country to sign a trade agreement with China. These two factors meant that Finland was able to enjoy a special status with China during the 1950s. The special status was further strengthened by the systematic support of the government of Finland for China's UN membership. The solid reputation earned in the 1950s had to carry Finland all the way through to the 1980s. For the two decades in between, during the passive policy period of the 1960s and 1970s, relations between Finland and the Soviet Union also determined the state of foreign relations with China. Interestingly, however, it appeared that President Urho Kekkonen was encouraged by Ambassador Joel Toivola to envisage a more proactive policy towards China, but the Cultural Revolution cut short any such plan for nearly twenty years. Because of the Soviet Union, Finland held on to her passive China policy, even though no such message was ever received from the Soviet Union. In fact, closer relationships between Finland and China were encouraged through diplomatic channels. It was not until the presidency of Mauno Koivisto that the first high-level ministerial visit was made to China when, in 1984, Foreign Minister Paavo Väyrynen visited the People s Republic. Finnish-Chinese relations were lifted to a new level. Foreign Minister Väyrynen, however, was forced to remove the prejudices of the Chinese. In 1985, when the Speaker of the Finnish Parliament, Erkki Pystynen visited China he also discovered that Finland s passive China policy had caused misunderstandings amongst the Chinese politicians. The number of exchanges escalated in the wake of the ground-breaking visit by Foreign Minister Väyrynen: Prime Minister Kalevi Sorsa visited China in 1986 and President Koivisto did so in 1988. President Koivisto stuck to practical, China-friendly policies: his correspondence with Li Peng, the attitude taken by the Finnish government after the Tiananmen Square events and the subsequent choices made by his administration all pointed to a new era in relations with China.

Ranskan rooli ja asema läntisessä liittoutumassa neljännen ja viidennen tasavallan vaihtumakohdassa 1956-1958

The study discusses the position of France as the United States’ ally in NATO in 1956-1958. The concrete position of France and the role that it was envisioned to have are being treated from the point of view of three participants of the Cold War: France, the United States and the Soviet Union. How did these different parties perceive the question and did these views change when the French Fourth Republic turned into the Fifth in 1958? The study is based on published French and American documents of Foreign Affairs. Because of problems with accessibility to the Soviet archival sources, the study uses reports on France-NATO relations of Pravda newspaper, the official organ of the Communist Party of the USSR, to provide information about how the Soviet side saw the question. Due to the nature and use of source material, and the chronological structure of the work, the study belongs methodologically to the research field of History of International Relations. As distinct from political scientists’ field of research, more prone to theorize, the study is characteristically a historical research, a work based on qualitative method and original sources that aims at creating a coherent narrative of the views expressed during the period covered by the study. France’s road to a full membership of NATO is being treated on the basis of research literature, after which discussions about France’s position in the Western Alliance are being chronologically traced for the period of last years of the Fourth Republic and the immediate months of coming back to power of Charles de Gaulle. Right from the spring of 1956 there can be seen aspirations of France, on one hand, to maintain her freedom of action inside the Western Alliance and, on the other, to widen the dialogue between the allies. The decision on France’s own nuclear deterrent was made already during the Fourth Republic, when it was thought to become part of NATO’s common defence. This was to change with de Gaulle. The USA felt that France still fancied herself as a great power and that she could not participate in full in NATO’s common defence because of her colonies. The Soviet Union saw the concrete position of France in the Alliance as in complete dependence on the USA, but her desired role was expressed largely in “Gaullist” terms. The expressions used by the General and the Soviet propaganda were close to each other, but the Soviet Union could not support de Gaulle without endangering the position of the French Communist Party. Between the Fourth and Fifth Republics no great rupture in content took place concerning the views of France’s role and position in the Western Alliance. The questions posed by de Gaulle had been expressed during the whole period of Fourth Republic’s existence. Instead, along with the General the weight and rhetoric of these questions saw a great change. Already in the early phase the Americans saw it possible that with de Gaulle, France would try to change her role. The rupture took place in the form of expression, rather than in its content.

Nonverbal predication in Erzya : Studies on morphosyntactic variation and part of speech distinctions

This dissertation consists of four articles and an introduction. The five parts address the same topic, nonverbal predication in Erzya, from different perspectives. The work is at the same time linguistic typology and Uralic studies. The findings based on a large corpus of empirical Erzya data, which was collected using several different methods and included recordings of the spoken language, made it possible for the present study to apply, then test and finally discuss the previous theories based on cross-linguistic data. Erzya makes use of multiple predication patterns which vary from totally analytic to the morphologically very complex. Nonverbal predicate clause types are classified on the basis of propositional acts in clauses denoting class-membership, identity, property and location. The predicates of these clauses are nouns, adjectives and locational expressions, respectively. The following three predication strategies in Erzya nonverbal predication can be identified: i. the zero-copula construction, ii. the predicative suffix construction and iii. the copula construction. It has been suggested that verbs and nouns cannot be clearly distinguished on morphological grounds when functioning as predicates in Erzya. This study shows that even though predicativity must not be considered a sufficient tool for defining parts of speech in any language, the Erzya lexical classes of adjective, noun and verb can be distinguished from each other also in predicate position. The relative frequency and degree of obligation for using the predicative suffix construction decreases when moving left to right on the scale verb adjective/locative noun ( identificational statement). The predicative suffix is the main pattern in the present tense over the whole domain of nonverbal predication in Standard Erzya, but if it is replaced it is most likely to be with a zero-copula construction in a nominal predication. This study exploits the theory of (a)symmetry for the first time in order to describe verbal vs. nonverbal predication. It is shown that the asymmetry of paradigms and constructions differentiates the lexical classes. Asymmetrical structures are motivated by functional level asymmetry. Variation in predication as such adds to the complexity of the grammar. When symmetric structures are employed, the functional complexity of grammar decreases, even though morphological complexity increases. The genre affects the employment of predication strategies in Erzya. There are differences in the relative frequency of the patterns, and some patterns are totally lacking from some of the data. The clearest difference is that the past tense predicative suffix construction occurs relatively frequently in Standard Erzya, while it occurs infrequently in the other data. Also, the predicative suffixes of the present tense are used more regularly in written Standard Erzya than in any other genre. The genre also affects the incidence of the translative in uľ(ń)ems copula constructions. In translations from Russian to Erzya the translative case is employed relatively frequently in comparison to other data. This study reveals differences between the two Mordvinic languages Erzya and Moksha. The predicative suffixes (bound person markers) of the present tense are used more regularly in Moksha in all kinds of nonverbal predicate clauses compared to Erzya. It should further be observed that identificational statements are encoded with a predicative suffix in Moksha, but seldom in Erzya. Erzya clauses are more frequently encoded using zero-constructions, displaying agreement in number only.

Kasvatus- ja valmennustyylien yhteys juniorijääkiekkoilijoiden suoriutumisstrategioihin, tyytyväisyyteen ja joukkueen koheesioon

This thesis focused on the roles of parenting styles (including parental norm-breaking attitudes and parents perceptions of players coach-athlete relationship), players achievement strategies, perceptions of coaching behaviours, coaches own perceptions, and perceptions of team leaders, in explaining player satisfaction and team cohesion. Five studies based on the same data provided by the Finnish Ice Hockey Association (FIHA) were carried out. The sample sizes were as follows: players, 1,018; parents, 979; coaches, 35; and team leaders, 57. Questionnaires and self-report questionnaires were used to collect data. The results revealed that: (1) family-parenting styles provided a basis for adolescents achievement strategies and influenced whether the sons played fairly or engaged in rule breaking. Democratic parenting was associated with the adolescents high level of mastery-oriented behaviour, low level of task-irrelevant behaviour, and low level of norm-breaking behaviour. The adaptive achievement strategies enhanced player satisfaction. (2) Democratic parenting styles influenced parents perception of the coach-athlete relationship, which was further associated with a coaching style that also influenced how the child experienced his own cohesion within the team. (3) The adolescents tended to reflect the similarity in leadership behaviours between home and sport from both democratic and autocratic backgrounds. In particular, the compensating combination of non-demanding styles at home and a high level of support by a positive coach was associated with high team cohesion. (4) The stress factor changed the dynamics of the parenting behaviour. (5) Players ratings, coaches ratings, and the ratings of team leaders all differed upon coaching behaviours and team cohesion. Only the players ratings were associated with cohesion high with positive coaching and low with autocratic coaching. The developmental age and the long-lasting membership on an ice hockey team made positive coaching acceptable for all players. Sixteen year-olds from all families rated high team cohesion with positive coaching. Parenting styles were associated with adolescent ice hockey players achievement strategies, norm breaking, and satisfaction. The combination of parenting and coaching was associated with cohesion rated by players. The staff s experiences of coaching and its effects on cohesion differed from the players experiences. These results contribute to understanding links between parenting styles, achievement strategies, norm breaking, and satisfaction, as well as parenting styles, coaching behaviour and cohesion. This work has importance for parents, coaches, sport organizations, and teachers.

Kehittävän kuntoutuksen mahdollisuudet. : Tutkimus Aslak -kuntoutuksen työkytkennän ja asiakkuuden rakentumisesta.

The possibilities of developmental rehabilitation. A study on the construction of work relatedness and the customer in Aslak rehabilitation The challenge of work-related rehabilitation is to anticipate the factors threatening work ability and to affect them. The purpose of this study was to analyze how work-related rehabilitation is constructed in practice and what are the challenges and, at the same time, the possibilities of an innovative transformation of rehabilitation when trying to achive this goal. The theoretical basis is cultural-historical activity theory and developmental work research. Based on a historical analysis, I studied rehabilitation activity empirically using the data gathered from one Aslak programme (Aslak = occupationally oriented medical rehabilitation) over two years. I described and analysed the construction of Aslak using ethnographic data and interviews. The data includes audio- and video-recordings of the Aslak course, fieldnotes, documents and other materials used in the course. The study aimed to reveal rehabilitation practices from different perspectives carried out by different stakeholders and participants in the Aslak course. It focused on the Aslak trajectory produced by a multiorganizational subject. I analyzed the rehabilitation activity using the method of ethnographic analysis of infrastructure. The method of analyzing the construction of the object of rehabilititation the customer was a membership categorization analysis (MCD) based on the ethnomethodological research tradition. I analyzed the meanings denoting customers given by different parties during one Aslak process and the relations between the meanings. Based on this analysis, I studied the disturbances, ruptures, and innovations in the rehabilitation activity. The results of the study show that the infrastructure of Aslak has different basic ideas. Aslak is constructed most explicitly on the infrastructure of medical rehabilitation. The second layer has been provided with some tools of identifying and preventing well-defined occupation-specific load factors. However, it has failed to perform a new structure, as Aslak has encountered, at the same time, rapid changes in working life. The study identified some promising markers representing new kinds of work-related rehabilitation ideas, but they proved to be incomplete and fragile. As a consequence of the multilayered infrastructure, the contents of the Aslak course were split into fragmented phases and disconnected themes, which were blocked in by the master idea of medical orientation. Its relationship to work remained weak and obscure. The categorizations of customers in Aslak were manifold and contradictory. According to the results, the possibilities for transforming work-related rehabilitation lie both in changing the orientation to the customer to be more relevant to changing working life and forging the infrastructural innovations related to this change. The results showed that a new work-relatedeness would be difficult but possible to construct. What is needed is the construction of an infrastructure that will support a coherent master idea of work-related rehabilitation over the entire trajectory of a process. A shared idea of a rehabilitation object must be constructed in close collaboration between different stakeholders, such as Kela (the Social Insurance Institution of Finland), occupational health services, work organizations, and rehabilitation institutes. Key words: Aslak rehabilitation, work-related rehabilitation, development of rehabilitation, customer of rehabilitation, developmental work research, analysis of infrastructure, membership category analysis

Labor Regulations and Unionization Trends: Comparative Analysis of Latin American Countries

This paper discusses the influences of labor regulations on unionization rates through the comparative analysis of Argentina, Chile and Mexico, expecting to contribute to the understanding of the determinants of unionization in Latin America. These regulations, though only one of the factors determining unionization levels, have a crucial role, their influence being at least threefold: they define entitlements to and exclusions from the right to unionize, affect union recruitment strategies and, by generating incentives and disincentives, contribute to shape individual membership decisions. After discussing historical aspects of unionization in the three countries, the analysis centers successively in two periods in which the countries compared showed both similarities and contrasts relevant to the analysis of unionization trends. In the first, the comparison is between Argentina (1976-83) and Chile (1973-89), both under military regimes that had much in common, but with contrasting unionization trends. In the second, the focus is in Argentina (1991-2001) and Mexico (1984-2000), where the reforms implemented to liberalize the economy and ensuing social-economic and labor market transformations were similar, but unionization trends differed. It is argued that, in each case, the divergent behavior of unionization, in spite of the similar economic and sociopolitical contexts, may at least partly be attributed to differences in key labor institutions.

A new option for diabetes

Mr Sweets is a recently retired 67-year-old gentleman (95 kg, 170 cm) living with type 2 diabetes mellitus (T2DM} for a number of years. His blood pressure and cholesterol were high, but are being managed by perindopril and atorvastatin prescribed by his doctor.

Ryhmäidentiteetin mittaaminen verkkoroolipelissä World of Warcraft

The objective of the study was to explore the dimensions of group identity in the guilds of World of Warcraft. Previous research shows that social interaction has an important role in playing games for many players. Social identities are an important aspect of self-concept and since group related cues are more salient than personal clues in computer-mediated communication, the social gaming experience was approached through group identity. In the study a new scale will be developed to measure the group identity in games. Secondary goal is to study how different guild attributes affect the group identity and third goal is to explore the connection between group identity and gaming experience and amount of play. Subjects were 1203 guild members and 106 players not in a guild. The data was gathered by an Internet survey which measured group identity with nine scales, gaming experience with three scales and guild attributes with four scales. Also various background data was gathered. The construct of group identity was analyzed with explorative factor analysis. The typical experiences of group identity was analyzed with cluster analysis and effects of guild attributes with multivariate analysis of covariance. As a result of the study a new scale was developed which measured group identity on six dimensions: self-stereotyping, public and private evaluation, importance, interconnection of self and others and awareness of content. Group identity was experienced strongest in elder middle-sized guilds that had formal rules and that emphasized social interaction. The players with strong group identity had more positive gaming experience and played World of Warcraft more per week than the players who were not in a guild or identified to guild weakly. This result encourages game developers to produce environments that enhance group identity as it seems to increase the enjoyment in games. As a whole this study proposes that group identity in guilds is constructed from the same elements as in traditional groups. If this is truly the case, guild membership may have similar positive effects on individual’s mental well-being as traditional positively evaluated group memberships have.

Tyrosine kinase inhibitors (nibs)

Traditional chemotherapy involves cytotoxic agents that indiscriminately target all rapidly-dividing cells. This can lead to significant side effects as healthy cells are also targeted.

Sense of Community in Web Environment

The study of social phenomena in the World Wide Web has been rather fragmentary, andthere is no coherent, reseach-based theory about sense of community in Web environment. Sense of community means part of one's self-concept that has to do with perceiving oneself belonging to, and feeling affinity to a certain social grouping. The present study aimed to find evidence for sense of community in Web environment, and specifically find out what the most critical psychological factors of sense of community would be. Based on known characteristics of real life communities and sense of community, and few occational studies of Web-communities, it was hypothesized that the following factors would be the most critical ones and that they could be grouped as prerequisites, facilitators and consequences of sense of community: awareness and social presence (prerequisites), criteria for membership and borders, common purpose, social interaction and reciprocity, norms and conformity, common history (facilitators), trust and accountability (consequences). In addition to critical factors, the present study aimed to find out if this kind of grouping would be valid. Furthermore, the effect of Web-community members' background variables to sense of community was of interest. In order to answer the questions, an online-questionnaire was created and tested. It included propositions that reflect factors that precede, facilitate and follow the sense of community in Web environment. A factor analysis was calculated to find out the critical factors and analyses of variance were calculated to see if the grouping to prerequisites, facilitators and consequences was right and how the background variables would affect the sense of community in Web environment. The results indicated that the psychological structure of sense of community in Web environment could not be presented with critical variables grouped as prerequisites, facilitators and consequences. Most factors did facilitate the sense of community, but based on this data it could not be argued that some of the factors chronologically precedesense of community and some follow it. Instead, the factor analysis revealed that the most critical factors in sense of community in Web environment are 1) reciprocal involvement, 2) basic trust for others, 3) similarity and common purpose of members, and 4) shared history of members. The most influencing background variables were the member's own participation activity (indicated with reading and writing messages) and the phase in membership lifecycle (from visitor to leader). The more the member participated and the further in membership life cycle he was, the more he felt sense of community. There are many descreptions of sense of community, but the present study was one of the first to actually measure the phenomenon in Web environment, and that gained well documented, valid results based on large data, proving that sense of community in Web environment is possible, and clarifying its psychological structure, thus enhancing the understanding of sense of community in Web environment. Keywords: sense of community, Web-community, psychology of the Internet

Käsityöläisyyden kuva kultasepän ammatissa : Käsityöläisyys Suomen Kultaseppien Liiton lehdessä 1990-luvun lopussa

The aim of this study is to survey the meaning of craftmanship in goldsmith occupation. The image of craftmanship is built theoretically as well as researcher's own practical experience. The study describes a dialogue between self-employed goldsmith s everyday work and trade union's opinion. Suomen Kultaseppien Liitto (The Goldsmith Assosiation of Finland) was chosen forthe trade union, because it is the biggest, the oldest and the most influential on the occupational area. The research data are volumes 1995 - 1998 of occupational membership journal of Suomen Kultaseppien Liitto. The data analyzed with Adapted Content Analysis and Grounded Theory. The professional occupation of goldsmiths, the role of craftmanship and the future of the occupation are discussed. Additionally, the relationship between the Suomen Kultaseppien Liitto and occupational culture and profession of goldsmiths was studied. Craft and craftmanship is most often discussed in articles related to tradition and education.Craftmanship is understood very idealistically, with little meaning in practical life. St. Eligius and the skill and art of goldsmiths in St Petersburg are raised to symbols of craftmanship. The occupational image is broken and a clear conflict between education and occupation is visible. Education produces artist-craftsmen, while handicraft workers are required in industry, and retailers or specially trained store assistant in business. Computer-aided design and manufacture render handicraft workmanship unnecessary. In a pessimistic view, the future possibilities of the goldsmith occupational profession are dim, because the artist-craftsmen are bound to lose to fast-paced machines. On the other hand, people involved in goldsmith education see the future light, designer-goldsmiths developing the occupational to new dimensions. Suomen Kultaseppien Liitto represents goldsmiths in public. The union, however is governed by non-artisan goldsmiths. The union stresses business attitudes and enterpreneurship, and has succeeded in protecting the privileges of retailers and industry. Goldsmiths profession is seen in the research data as a combination of precious-metal industry, jewellery and watch stores, anda goldsmith shop is considered a specialized giftstore. The goldsmiths occupation is not a profession, and the Suomen Kultaseppien Liitto is not a trade union for artist and craftmen. Accordingly, part of the representative authority of the union could be transferred from the Association to Taidekäsityöläiset Taiko ry, a member of organization of Ornamo. Results of this study show the importance of defining the images of the goldsmith occupational profession and the trade union. The results could be applied to goldsmith education to examine what would be the optimal education and training for present employment opportunities. The important background theories has been the theories of Habermas and Lévi-Strauss.

Estimation of fuzzy memberships from histograms

Based on the conclusions drawn in the bijective transformation between possibility and probability, a method is proposed to estimate the fuzzy membership function for pattern recognition purposes. A rational function approximation to the probability density function is obtained from the histogram of a finite (and sometimes very small) number of samples. This function is normalized such that the highest ordinate is one. The parameters representing the rational function are used for classifying the pattern samples based on a max-min decision rule. The method is illustrated with examples.

Restorative treatment practices and dentist-related factors

This study aimed at elucidating real-life aspects of restorative treatment practices. In addition, dentists' views and perceptions of and variation in restorative treatment practices with respect to dentist-related factors were evaluated. Reasons for placement and replacement of restoration, material selection, posterior restoration longevity, and the use of local anesthesia were assessed on two cross-sectional data sets. Data from the Helsinki Public Dental Service (PDS) included details on 3057 restorations performed by dentists (n=134) during routine clinical work in 2001. The other PDS data from Vantaa were based on 205 patient records of young adults containing information on 1969 restorations investigated retrospectively from 1994-1996 backwards; 51 dentists performed the restorations. In addition, dentists’ self-reported use of local anesthesia and estimates of restoration longevity were investigated by means of a nationwide questionnaire sent to 592 general dental practitioners selected by systematic sampling from the membership list of the Finnish Dental Association in 2004. All data sets included some background information on dentists such as gender, year of birth or graduation, and working sector. In PDS in 2001, primary caries was the reason for placement of restoration more often among patients aged under 19 years than among older patients (p<0.001). Among patients over 36 years of age, replacements represented the majority. Regarding dentist-related factors, replacements of restorations were made by younger dentists more frequently than by older dentists (p<0.001). In PDS in 1994-1996, the replacement rate of posterior restorations was greater among female dentists than among male dentists (p=0.01), especially for amalgams (p=0.008). The mean age of replaced posterior restoration among young adults was 8.9 (SD 5.2) years for amalgam and 2.4 (SD 1.4) years for tooth-colored restorations, the actual replacement rate for all existing posterior restorations being 7% in PDS in 1994-1996. Of all restorative materials used, a clear majority (69%) were composites in PDS in 2001. Local anesthesia was used in 48% of cases and more frequently for older patients (55%) than for patients aged under 13 years (35%) (p<0.001). Younger dentists more often used local anesthesia for primary restoration than did the older dentists (p<0.001), especially for primary teeth (p=0.005). Working sector had an impact on dentists’ self-reported use of local anesthesia and estimates of restoration longevity; public sector dentists reported using local anesthesia more frequently than private sector dentists for Class II (p=0.04) and for Class III restorations (p=0.01). Private sector dentists gave longer estimates of posterior composite longevity than public sector dentists (p=0.001). In conclusion, restorative treatment practices seem to vary according to patient age and also dentist-related factors. Replacements of restorations are common for adults. For children, clear underuse of local anesthesia prevails.