Co morbidity and dual diagnosis Essay Example | Topics and Well Written Essays - 2000 words

Co morbidity and dual diagnosis - Essay Example We look into 3 studies each of which provide evidence of one hypothesis or another. In the end we conclude that cannabis aggravates already susceptible people's condition who are young users and predominantly male and pushes them into a symptomatic stage of psychosis, rather than causing psychosis in an otherwise normal individual. It has been demonstrated by many a studies that substance abuse is more prevalent in patients with psychotic disorders than in the general population. What is of debate is whether substance abuse precedes psychotic disorders like schizophrenia and is a risk factor for the disease or whether it is just the fact that people with the disorders tend to misuse the drugs. Alcohol and cannabis are the most commonly abused drugs in the general population as well as in people with mental disabilities. Since the middle of the 20th century, the use of mental state altering drugs has increased. Cannabis use has been on the rise and although many attempts have been made to associate or disassociate it from disorders linked with it, researchers are still debating the full impact cannabis use might have on the public. It is imperative that agreement be achieved on the effects of cannabis so that policies and restriction on community use and definitive treatments can be provided to the affected peo ple. The exact relation between cannabis use an... The recent cause of concern is the fact that multiple studies are pointing the finger at the hypothesis that cannabis use leads to schizophrenia. Hickman M et al (2007) in their study have tried to estimate long term patterns of cannabis use in the general population and attempted to and estimate and observe if the schizophrenia rates follow the same pattern. This pattern, if could to be present, they believe could demonstrate that cannabis usage has a direct relationship with schizophrenia as has been proposed by numerous old studies. "Trends in cannabis use were estimated from a national survey, and the incidence of schizophrenia was derived from surveys in three cities. A difference equation cohort model was fitted against estimates of schizophrenia incidence, trends in cannabis exposure and assumptions on association between cannabis and schizophrenia. The model projects trends in schizophrenia incidence, prevalence and attributable fraction of cannabis induced schizophrenia" (Hickman M et al, 2007). Hickman M et al has shown that over the past few decades cannabis use has gradually, but steadily increased in the young age groups of the society. He argues that if there was a casual relationship between cannabis use and schizophrenia prevalence, then the incidence and prevalence of disease should also show an upwards trend in the younger generation (assuming that all other factors remain constant). But recent studies of epidemiology according to Hickman (2007) suggest that schizophrenia's incidence and prevalenc e is in a downward trend. Their projections for the future also show a downward or a trend. This pattern contradicts the theory of casual

The Piazza of San Marco Essay Example | Topics and Well Written Essays - 1500 words

The Piazza of San Marco - Essay Example The essay "The Piazza of San Marco" explores The Piazza of San Marco, the heart of Venice. This is where the famous Grand Canal, the largest canal in Venice takes its beginning from and where the most popular sights are located. The square is very old and has its roots as far back as in the ninth century. It was created then as a small space in front of the Saint Mark’s Basilica, and later, in 1777, it was extended and preserved its size up to nowadays. As we are to compare the condition of the Piazza in the Renaissance (approximately in the year 1500) and nowadays we should mark that, according to the information above, the square remained in its original size at the time of making the map of Jacobo de Barbari and the painting by Gentile Bellini. Nevertheless, i should be mentioned that in the painting of another artist, Giovanni Antonio Canal, square has the same look as in the modern times. To add more, it is notable that the square isn’t actually a square, it is a t rapezoid (Imboden).Regarding the general composition, the location of the buildings haven’t changed over centuries, but the details have. The architectural dominant of the Piazza is the Doge’s Palace, a building that used to serve as a residence for Venetian Doges. The palace is built in Italian gothic style. The first building appeared at that place back in the ninth century and looked as a fortress. In 976 this building was burned as a result of the rebellion, and later rebuilt in 1106. The major part of the modern palace.

Modified Radical Mastectomy for Contralateral Breast Cancer

Modified Radical Mastectomy for Contralateral Breast Cancer Abstract Breast cancer is the most common malignancy in women worldwide. With improving survival figures and early breast cancer detection, treatment related long term adverse effects of radiotherapy have become a concern. Contralateral breast cancer due to scatter radiation from during radiotherapy of diseased breast is one of them. This prospective clinical study was conducted to measure the dose received by the contralateral breast and compare the different techniques which influence this dose. It was found that in post mastectomy patients, treatment with telecobalt medial tangential field contribute more dose to contralateral breast compared to supraclavicular field and lateral tangential fields. The mean dose received by contralateral breast during irradiation of chest wall was 168.29 cGy which 3.36 percentage of the prescribed dose. Key Words; contralateral breast dose, breast malignancy, thermoluminescent disc, scattered radiation Introduction Breast cancer is the most common malignancy among the women worldwide. [1] With improved survival figures due to early breast cancer detection and multimodality treatment, long term adverse effects in the form of second malignancy of contralateral breast (CLB) has become a concern. In patients getting radiotherapy to the affected breast, CLB also receives radiation in the form of scattered radiation due to scattered from primary. Second malignancy is a late sequel of radiation appearing at an interval of 10-15 years. [2, 3, 4, 5, 6, 7] Since breast is highly radiosensitive structure this dose to CLB is a major concern especially in younger women and patients with longer life expectancy. Although radiation induced malignancy is a stochastic effect but the intensity increases linearly with increase in dose. [8] Studies have measured CLB dose on phantom and patients and have observed that the dose to CLB is more for medial tangential (MT) than supraclavicular field (SCL) field and later al tangential (LT) field. In our centre 22% of female patients are suffering from breast cancer and majority of them belong to low socio economic status and presented with advanced disease. In the present study we measure the dose to CLB in patients receiving radiotherapy following modified radical mastectomy (MRM). The radiation dose to CLB were measured with the help of CaSO4: Dy thermoluminescent discs (TLD). The TLD are highly sensitivity and can measure even very small doses. Materials and methods Measurement of CLB was done in 25 patients undergoing for EBRT by cobalt teletherapy machine (THERATRON 780 C and E) following MRM. Precalibrated TLD (9mmÃâ€"13mm) were placed on the surface of CLB. Total three discs were placed one at the nipple and other vertically on either side of nipple 3 cm apart. We tried our best to place the TLD on the same position each time. Skin tattooing was done to demarcate the exact position at the first sitting and this was used subsequently to replicate the position. After delivery of radiation dose for a particular field the discs were removed and another set of three discs were placed for next reading. In this way total six discs were used daily, three for SCL field and three for MT or LT field as MT and LT fields were treated on alternate days and SCL field was treated daily. For MT and LT fields breast cone was used for half beam block. Total dose delivered was 50 Gy in 25 fractions, 2 Gy per fraction, 5 fractions per week in 5 weeks. The expos ed TLD were stored in radiation free zone and the readings were taken after 24 hours and within 7 days after exposure because after seven days the TLD start to loose electrons. The scattered dose received by TLD were measured on NUCLEONIX TL 10091 TLD reader. After one set of measurement, the discs were annealed by heating 400 degree celcius and then used for next measurement. For each patient, measurements were carried out at first week, third week and last week, total three times during the course of treatment. Statistical Analysis Mean dose calculation received by CLB. Total dose received by CLB, this was calculated by multiplication of mean dose to number of fractions. The percentage of radiation dose received by CLB with respect to the prescribed dose to diseased breast (Total doseÃâ€" 100 / prescribed dose to diseased breast). We also stratified data based on gantry angle at which EBRT was delivered (≠¤50 degree and > 50 degree). The statistical software SPSS version 20.0 was used for the data analysis. Results The age wise distribution of patients and the mean dose received by CLB is shown in table 1. 19 out of 25 patients in our study were 50 years or younger. 52% patients had left sided breast cancer. Table 2 shows the contribution of SCL, MT and LT field dose with the gantry angle at which the radiation dose was delivered. Total dose received by CLB varies from 1.22% to 5.82% of the prescribed dose of 50 Gy to the affected breast. Mean total dose received by CLB was 105.55 cGy with MT field followed by SCL field, (33.96 cGy) and LT field {(28.97 cGy) as shown in table 2. This data shows that the maximum contribution of dose to CLB was with MT field followed by SCL field and LT field. Mean dose with all three fields received by CLB was 168.48 cGy with SD  ±62.23 which corresponds to 3.36% of prescribed dose to affected breast. 11 patients were treated on cobalt unit with gantry angle ≠¤ 50 degree having 3.00% contribution of CLB dose (table 3). 14 patients treated with gantry angl e > 50 degree had 3.79% contribution of CLB dose (p=0.199). The mean, median and range were 3.66, 3.34 and 4.60 respectively. Discussion It is well known that exposure to ionizing radiation causes carcinogenesis in healthy tissues. Although it is a stochastic effect having no threshold dose but the intensity increases with increase in radiation dose. CLB must be considered as an organ at risk during radiotherapy planning for treatment of cancer breast. Many previous studies conducted to calculate the dose received by CLB, were based on patients, phantom or treatment planning system. Boice et al analyzed the record of 41109 patients of cancer breast and they found the mean CLB dose was 2.82 Gy. [9] They also hypothesized that there was increased relative risk of CLB malignancy due to exposure to ionization given to diseased breast. The relative risk was 1.19 for all patients, however the relative risk was more (1.49) for younger patients who were less than 45 years old. In our study, the maximum dose received by CLB in women below 40 years which was 3.93 percentage (196.437 cGy) of prescribed dose. The minimal dose was received in patients who were above 60 years of age {(1.96 %) (97.875 cGy)}. The possible reason could be the increased laxity of breast tissues in older women cause more lateral shifting of CLB away from the radiation at the time of exposure. Half beam block technique is routinely used while irradiating the breast with tangential beams. [10, 11] Kelly et al measured CLB dose on Alderson Rando phantom using TLD with four different techniques of breast cancer treatment using 6 MV photon beam on linear accelerator. [12] The used half beam block with asymmetrical jaws, custom blocks and symmetrical collimator jaw. Another technique used was isocentric method with non divergent posterior border. They observed highest dose to CLB in MT field with wedge. In our study radiation was delivered using half beam block with breast cone. The dose to CLB was maximum with MT field because in half block beam, the breast cone is placed near to surface of breast which cause increased dose due to secondary collimator scattering. Bhatnagar et al compared dose to CLB during EBRT to chest wall irradiation using conventional tangential technique and intensity modulated radiotherapy (IMRT). [13] They observed 20 percentage reduction of dose to CLB using IMRT. According to a study by Chougule, the average contralateral nipple dose was 152.5-254.75 cGy and the percentage was 3.05-6.05% for a dose of 5000 cGy in 25 fractions for post mastectomy breast cancer. [14] In our study, the measured mean contralateral nipple dose on was 171.88 cGy (55.5-303.80 cGy) which accounts to 3.47% (1.11%-6.07%) of prescribed dose (table 2). Dose to CLB were higher for dose calculated at the level of nipple as compared to dose received by whole CLB. This may be due to TLD at level of nipple being closest to the radiation source. According to Rankel et al with high gantry angle the beam will be closer to the surface leading higher dose to the CLB. [15] In this study, it was found that with gantry angle >50 °, more dose was delivered to the CLB though the difference is not statistically significant (p=0.199). Conclusion In our patient cohort, higher inadvertent CLB dose was delivered in younger patients with MT field; overall, dose being 3.36 percentage of prescribed dose.

Classical Philosophers Essay -- essays research papers

Classical Philosophy The golden age of Greece was an age of thinking, of knowledge, and of the arts. Some of the greatest minds of any time projected their ideas upon the masses. They were called philosophers. These were men whose minds developed some of the most abstract and revolutionary ideas of the time. Some of them were put to death for their ideas and their beliefs and became martyrs for their cause. During this age, three philosophers in particular stood out from the rest. Socrates Socrates was the first of the three great philosophers. Before devoting his life to his teachings and philosophies, he was a stonemason and also served as a soldier of some distinction during the Peloponnesian war. He never wrote any of his teachings down, and he preferred to speak about his beliefs and philosophies. He also involved himself with the political workings of Athens. He spent most of his life in discussion with young aristocratic men, unrelentingly questioning their blind confidence in popular opinion, but he never offered them any outlined abstract teaching. He merely conversed and questioned their beliefs. Also, unlike other Sophists of the time, he refused to accept pay for his teachings. Because he had no texts written by himself on his beliefs, we turn to his followers for information on his beliefs. Plato documents many of Socrates’ conversations with the youth of Athens in his book, Plato’s Republic. In 405 BC Socrates was convicted (wrongly I might add) of corrupting the youth of Athens, interfering with the religion of the city, and for his intervention into politics. There is a text called `Apology’, which documents his unsuccessful defense speech before the Athenian jury. In 399 BC, surrounded by friends and disciples, he drank hemlock (a poison made from the plant with the same name) and died gracefully. Socrates’ beliefs were not only revolutionary, but also controversial. He spoke with disdain about the gods, and refuted the notion that ‘good’ is doing whatever pleases them. Many texts document his beliefs and morals. Most informative of these are in Plato’s Republic. The best known out of all of his ideas were ideas about virtue, and doing what is right and good. Plato Plato was the next great philosopher, chronologically. It should be noted that Plato’s real name was Aristocles, and that Plato was a nickname, roughly translated to mean... ...e city. Here he started his own academy, known as the Lyceum, and here he began to teach Alexander. (Note: This is where the chain ended. Alexander did not become a philosopher, and did not teach anyone else) Not long after Aristotle returned to Athens, the Athenian people revolted against Macedonian rule. Due to his political position (some would describe it as betrayal) and to avoid being executed, he fled to the island of Euboea, where he died soon afterwards.   Ã‚  Ã‚  Ã‚  Ã‚  Aristotle’s works were modern for the time. He had distinguished dolphins and whales from fish, created a classification system quite similar to the one in place today, and formed many astronomical ideas, which were not far from the truth. It should also be noted that in medieval times, he gained a great many followers after some of his preserved works were found, and the disciples of the late philosopher generally believed his works as absolute truth.   Ã‚  Ã‚  Ã‚  Ã‚  These philosophers made a great impact, even thousands of years after their lives. We still look to their works for answers, and there are systems they themselves created that are still being put into use today. Classical Philosophers Essay -- essays research papers Classical Philosophy The golden age of Greece was an age of thinking, of knowledge, and of the arts. Some of the greatest minds of any time projected their ideas upon the masses. They were called philosophers. These were men whose minds developed some of the most abstract and revolutionary ideas of the time. Some of them were put to death for their ideas and their beliefs and became martyrs for their cause. During this age, three philosophers in particular stood out from the rest. Socrates Socrates was the first of the three great philosophers. Before devoting his life to his teachings and philosophies, he was a stonemason and also served as a soldier of some distinction during the Peloponnesian war. He never wrote any of his teachings down, and he preferred to speak about his beliefs and philosophies. He also involved himself with the political workings of Athens. He spent most of his life in discussion with young aristocratic men, unrelentingly questioning their blind confidence in popular opinion, but he never offered them any outlined abstract teaching. He merely conversed and questioned their beliefs. Also, unlike other Sophists of the time, he refused to accept pay for his teachings. Because he had no texts written by himself on his beliefs, we turn to his followers for information on his beliefs. Plato documents many of Socrates’ conversations with the youth of Athens in his book, Plato’s Republic. In 405 BC Socrates was convicted (wrongly I might add) of corrupting the youth of Athens, interfering with the religion of the city, and for his intervention into politics. There is a text called `Apology’, which documents his unsuccessful defense speech before the Athenian jury. In 399 BC, surrounded by friends and disciples, he drank hemlock (a poison made from the plant with the same name) and died gracefully. Socrates’ beliefs were not only revolutionary, but also controversial. He spoke with disdain about the gods, and refuted the notion that ‘good’ is doing whatever pleases them. Many texts document his beliefs and morals. Most informative of these are in Plato’s Republic. The best known out of all of his ideas were ideas about virtue, and doing what is right and good. Plato Plato was the next great philosopher, chronologically. It should be noted that Plato’s real name was Aristocles, and that Plato was a nickname, roughly translated to mean... ...e city. Here he started his own academy, known as the Lyceum, and here he began to teach Alexander. (Note: This is where the chain ended. Alexander did not become a philosopher, and did not teach anyone else) Not long after Aristotle returned to Athens, the Athenian people revolted against Macedonian rule. Due to his political position (some would describe it as betrayal) and to avoid being executed, he fled to the island of Euboea, where he died soon afterwards.   Ã‚  Ã‚  Ã‚  Ã‚  Aristotle’s works were modern for the time. He had distinguished dolphins and whales from fish, created a classification system quite similar to the one in place today, and formed many astronomical ideas, which were not far from the truth. It should also be noted that in medieval times, he gained a great many followers after some of his preserved works were found, and the disciples of the late philosopher generally believed his works as absolute truth.   Ã‚  Ã‚  Ã‚  Ã‚  These philosophers made a great impact, even thousands of years after their lives. We still look to their works for answers, and there are systems they themselves created that are still being put into use today.

Negative effect of Computer on Children Essay

Topic sentence: Regular use of computer can have negative effect on children. Cause 1: Danger of headache and vision problem * exposer to screen bright light * effect on vision and head Cause 2: long use of computer deprived children from outdoor activities -gain weight and obesity Cause 3: Use of computer may lead children to topics that are beyond their imagination -unreal world -world created by technology In conclusion, excessive use of computer may cause overweight, headache, and vision problem. Regular use of computer can have some negative effects on children. First, children who use the computer for a long time may be at the danger for developing headache and vision problem. According to Anttila (2002), â€Å"It is often observed to tense and tender in children with headache.†(p.17).Second, most of children gain weight when they use computer for a long time because they are deprived from outdoor activities. In addition, Burke, Beilin, Durkin, Hougton and Cameron (2006) reveals that â€Å"television viewing and computer use are widely considered to contribute to the current increase in overweight and obesity in children †¦to fatness in most reported studies.†(Television, computer use, physical activity, diet and fitness in Australian adolescents, p.1) One of the most serious negative effects of computer on children is the exposure to topics that are beyond their understanding .Furthermore, Peter Mansbride points out that â€Å"the simplicity of the past is gone, replaced by a realism easily created by the latest technology† (The bloody bad games, para.1).In conclusion, excessive use of computer may cause overweight, headache, and vision problem. References 1. Tornoe,B.&Skov,L.(2012) Computer animated relaxation therapy in children between 7 and 13 years with tension-type headache: A pilot study.37(1),35- 44,10p. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=71671677&site=ehost-live&scope=site 2. Burke,V.,Beilin,L.Durkin,K.stritzke,W.G.K.,Houghton,S.&Camron , C.A. (2006) Television, computer use, physical activity, diet and fatness in Australian adolescents.1(4)248-225,8p. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=23220041&site=ehost-live&scope=site 3. Mansbridge,P.(2003)The bloody bad games,116(50)20-20.2/3p. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=11642732&site=ehost-live&scope=site

Persuasive Essay- Ipads in Kindergarten Essay

In 2011, ten years after Maine began issuing laptops to all seventh graders, the Auburn School System launched an initiative to provide an iPad 2 for each of its students entering kindergarten. At a cost of roughly $200,000- representing a 5% increase in the school budget (Opinions Divided†¦) some taxpayers were less than pleased- calling it a complete waste of money. But in Auburn- and schools around the country- trends are emerging and showing the iPad to be a powerful learning tool and a necessary investment in our children’s future. For over a decade, Maine has been at the forefront of integrating technology into public schools and there is no reason to stop now. Despite the high cost to institute this program, Auburn should continue to provide iPads to students entering kindergarten. Auburn is not alone in providing iPads to kindergarteners. In fact, kindergarten students in Maine, Tennessee, and South Carolina have received iPads to supplement their teacher’s instruction. While the iPad cannot replace the human interaction of a teacher, it is a great addition to the classroom, at a time when the teacher to student ratio keeps getting larger and larger. Laura Shaw, principal of Sherwood Heights School recently said, â€Å"When you have eighteen kids in the classroom and you see ten kids, hands raised up, the teacher does her best to get around. But sometimes with the iPads and certain apps the kids get immediate feedback. They know what they’ve done is correct and they can move on, or they know ‘Oh, I need to ask for help,’† (Porter). For example, a child can play â€Å"Feed the Hippos Hot Peppers. † In this app the child counts aloud while feeding the hippo. The teacher can adjust the app difficulty to â€Å"count† or â€Å"add† peppers, depending on the child’s capabilities. When the child answers the problem correctly, the iPad responds with a round of applause; an immediate cue to the child that they were correct (Lemeshow). Initially, Auburn Schools split the children into two groups when first issuing the iPads in 2011. Half of the children received iPads during the first week of school, the other half received their iPads in mid-November; effectively creating a control group to gage learning. Although the study lasted just 9 weeks, the results were promising. When tested, students who received their iPads in the first week of school scored higher in 9 out of 10 areas, compared with children who did not. One area in particular really stood out: recognizing sounds and writing letters. Kindergartners with iPads gained 13. 72 points, compared to an 11. 58-point gain for students who did not have iPads. That difference is significant, said Mike Muir, the Multiple Pathways leader for Auburn schools (Auburn Report: iPads). When pupils use iPads, more learning does not seem like a far stretch. With 100’s of learning apps available for download, teachers are able to customize the iPad and tailor the lesson to the individual child’s needs. This way, advanced children can reach their highest potential without becoming bored while the rest of the class catches up. On the other side, if one or two children are struggling, the rest of the class can move on, while the child receives the help she needs. Sherwood Heights Elementary School kindergarten teacher Susan Lemeshow called the iPads â€Å"one of the most powerful teaching tools I’ve ever used. †¦ I can put her on one book, her on a different level book,† she said of two girls in her class. Pupils are doing the same lesson, â€Å"but at the level they need,† she said (Report Say Giving†¦). So what is the problem? Those who oppose the program site the cost- around $800 per student entering kindergarten- as a major issue and wonder if a kindergartener is responsible enough to handle such an expensive piece of equipment. Others worry children may not learn to read and write properly. Auburn hopes the high level of testing done in the beginning of the school year will line them up for educational grants to relieve taxpayers of the burden from having to foot the bill. At the end of the year, the school system will also be able to compare this year’s kindergarten to previous years, with hopes of even better results. Regarding concerns of the students learning to write, it is important for people to understand that children are not using the iPads all day. The use of iPads is balanced. Students are still using crayons, markers, and traditional books. They are still learning how to hold pencils or crayons, and how to write (3 Auburn Teachers†¦). The iPads are a â€Å"center-based† activity with the children using them in 15-minute increments 2 to 3 times per day. Each iPad has a protective case, and students are not allowed to bring them home (Lemeshow). Providing iPads to students as an educational tool is invaluable. With the iPads children have become excited about learning. â€Å"We are seeing high levels of student motivation, engagement and learning in the iPad classrooms,† said Sue Dorris, Principal of East Auburn School (NooNoo). Children born in today’s world grow up bombarded by technology in every aspect of their lives- except school- so an iPad as a learning tool is appealing to them. It really gets their attention and keeps them engaged. The results are more learning and better test scores. With technology always evolving, newer apps, and programs, the possibilities really are endless. Auburn’s plan is to purchase and iPad for each new pupil entering kindergarten. The iPad will stay with the student from kindergarten through 6th grade. With this plan Auburn hopes to have an iPad in the hands of every elementary student in the district by 2017. If every student is equipped with an iPad, the world of digital text books emerges- which could amount to huge savings. In this digital world, it is not really a question of if we can afford this; but more a question of if we can afford not to? Works Cited Lemeshow, Susan. Telephone interview. 27 Apr. 2012. NooNoo, Stephen, ed. â€Å"Kindergarten iPad Initiative Reveals Modest Literacy Gains. † T. H. E. Journal. 1105 Media, Inc. , 2012. Web. 29 Apr. 2012. . Porter, Tim. â€Å"A School System in Maine Gives iPads to Kindergartners. † Voice of America. N. p. , 23 Nov. 2011. Web. 28 Apr. 2012. . Washuk, Bonnie. â€Å"Auburn Report: iPads Help Kindergartners’ Learn. † McClatchy – Tribune Business News (Feb. 2012): n. pag. ProQuest Central K12. Web. 28 Apr. 2012. . – – -. â€Å"Opinions Divided Over iPads for Auburn Kindergartners. † Sun Journal [Lewiston, Maine] 8 Apr. 2011, Lewiston-Auburn ed. : n. pag. Sun Journal. Web. 28 Apr. 2012. . – – -. â€Å"Report Says Giving iPads to Auburn Kindergartners Increases Test Scores. † Bangor Daily News 16 Feb. 2012: n. pag. BangorDailyNews. Com. Web. 28 Apr. 2012. . – – -. â€Å"3 Auburn Teachers Give iPads High Grade. † Sun Journal [Lewiston, Me. ] 20 Oct. 2011.