Health Effects of Snus
Transcript of Health Effects of Snus
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Nhaetn hoohcts lo sius------a e`thraturh rhv`hw lo Swhk`sn jl`st siuoo li strlfh
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AutnlrMuaimnua Cnhi
JTN stukhit
Suphrv`slrKr. Jart`i Staostrj
K`v`s`li lo Slc`ae Jhk`c`ih aik Melgae Nhaetn,Khpartjhit lo Cljjui`ty Jhk`c`ih,
Jaej Xi`vhrs`ty Nlsp`tae
@ithriat `liae Jasthrs Trlmrajjh `i Tuge `c
Nhae tn
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CLI[HI[S
AGS[WAC[............................................................................................................................................. 3AGGWH_@A[@LI..................................................................................................................................... ;
1. @I[WLKXC[@LI................................................................................................................................ 87. TXWTLSH........................................................................................................................................... =3. JH[NLKS.......................................................................................................................................... =;. WHSXE[S............................................................................................................................................ >8. K@SCXSS@LI................................................................................................................................... 1;?. CLICEXS@LIS............................................................................................................................... 1=
ACFIL]EHKMHJHI[...................................................................................................................... 1>ATTHIK@^............................................................................................................................................ 10G@GE@LMWATNP................................................................................................................................... 73
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AGS[WAC[
LGBHC[@_HS- [nh a`j lo tn`s stuky `s tl `ivhst`math tnh hoohcts lo sjlfhehss tlgaccl li strlfh.Mht rhsuets olr outurh Jhta-Aiaeys`s.
GACFMWLXIK- Sjlfhehss tlgaccl ush `s `icrhas`im. @ts cark`lvascuear hoohcts arh ilt wheeuikhrstllk. [nh rhsuets lo k`oohrhit rhsharcn arh clivhrsh.
JH[NLKS- E`thraturh rhv`hw clvhrhk ghtwhhi 1004 aik 744=. [rak`t`liae e`thraturh rhv`hw(Jatr`x Jhtnlks) was appe`hk.
WHSXE[S- Clnlrt stuk`hs supplrt tnat sius cai ra`sh tnh prhvaehich lo strlfh aik cash-clitrlestuk`hs wn`eh crlss-shct`liae stuk`hs aik a sjaee sajpeh s`zh raiklj`zhk clitrleehk tr`ae (WC[)mavhuichrta`i rhsuets.
CLICEXS@LIS- Eacf lo `iolrjat`li orlj mllk khs`mi WC[ aik clnlrt stuk`hs. ]hee khs`mihk(akhquath sajpeh s`zh aik r`mlrlus aeelcat`li clichaejhit) raiklj`zhk ce`i`cae tr`aes aik whee
khs`mihk clnlrt stuk`hs ihhk tl gh `jpehjhithk.
Fhy wlrks2 sius, jl`st siuoo, cnhw`im tlgaccl, sjlfhehss tlgaccl (S[), sjlfh-orhh tlgaccl(SO[), strlfh, nyphrthis`li, nyphre`phj`a, nyphrmeychj`a
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AGGWH_@A[@LI
ACS Ajhr`cai Caichr Slc`htyCNK clrliary nhart k`shash
C@ clio`khich `ithrvae
CTS-@ Caichr Trhvhit`li Stuky @CTS-@@ Caichr Trhvhit`li Stuky @@
KGT k`astle`c gellk prhssurh
HCM hehctrlcark`lmraj
NKE n`mn khis`ty e`plprlth`iNLJA nljhlstat`c jlkhe asshssjhit
JhtSy jhtagle`c syikrljhJLI@CA Juet`iat`liae JLI@tlr`im lo trhiks aik khthrj`iaits `i CArk`lvascuear k`shashIIF ;-(jhtnyei`trlsaj`ih)-1-(3-pyr`kye)-1-gutailih)
IW[ i`clt`ih rhpeachjhit tnhrapy
LM[[ lrae meuclsh tlehraich thstLW lkks rat`l
TA@-1 peasj`ilmhi act`vatlr `in`g`tlr typh 1
WC[ raiklj`zhk clitrleehk tr`ae
WW rheat`vh r`sfSGT systle`c gellk prhssurh
S[ sjlfhehss tlgaccl
tTA t`ssuh peasj`ilmhi act`vatlr_@T _asthrgltthi @ithrvhit`li Trlmrajjh
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1. @I[WLKXC[@LI
Sjlfhehss tlgaccl `s a typh lo tlgaccl clisujhk lraeey. Xie`fh sjlfh c`marhtths, sjlfhehss
tlgaccl `s ilt gurihk kur`im lrae clisujpt`li. Sius `s lih typh lo sjlfhehss tlgaccl. @t cljhs `i
tnh olrj lo a jl`st plwkhrhk pasth aik `s ja`iey jaiuoacturhk aik clisujhk `i Scaik`iav`a
(hsphc`aeey `i Swhkhi aik Ilrway). Sius was `itrlkuchk tl Ilrtnhri Hurlph `i tnh 1?44s. Aothr
jaiy Swhk`sn phlpeh hj`mrathk tl Ilrtn Ajhr`ca ghtwhhi tnh 1>;4s aik tnh 1034s, sius was aesl
hxpaikhk tl Ilrtn Ajhr`ca (1). [nh iujghr lo phlpeh us`im sjlfhehss tlgaccl (S[), nas `icrhashk
snarpey lvhr tnh past 3 khcakhs `i tnh XS.
A typ`cae plrt`li (ghtwhhi >jm aik 1;jm phr plucn) lo sius clita`is tnh sajh ajluit lo i`clt`ih
as twl c`marhtths. Sius aesl clita`is slk`uj, e`clr`ch, i`trlsaj`ihs aik pleli`uj (1, 7). [nh jlst
usuae way tl ush sius `s tl peach `t ghihatn tnh upphr e`p (`i Scaik`iav`a) lr tnh elwhr e`p (`i tnh XS),
aik fhhp `t tnhrh olr a t`jh vary im orlj a ohw j`iuths tl shvhrae nlurs. [nh g`lelm`cae jhcnai`sjs
tnrlumn wn`cn sius caushs strlfh aik ltnhr cark`lvascuear k`shashs arh currhitey khgathk. ]n`cn
`imrhk`hits (i`clt`ih, slk`uj, e`clr`ch, htc.) arh tnh ja`i caushs `s st`ee ai uislevhk tlp`c.
Nyphrthis`li, nyphrmeychj`a aik nyphre`phj`a/nyphrcnlehsthrlehj`a arh whee filwi `ikhphikhit
r`sf oactlrs lo strlfh, as whee as atr`ae o`gr`eeat`li aik shruj nljlcysth`ih ehvhe htc (3-?). [n`s tnhs`s
atthjpts tl hstage`sn a rheat`lisn`p ghtwhhi strlfh r`sf oactlrs sucn as nyphrthis`li, nyphrmeychj`a aiknyphre`phj`a/nyphrcnlehsthrlehj`a aik tnh ush lo sius us`im e`thraturh rhv`hw as a rhsharcn jhtnlk.
[nh jhtnlklelmy ushk `s khscr`ghk `i khta`e `i Shct`li 3 lo tn`s tnhs`s.
Sjlfhehss tlgaccl lr sius arh lih lo jaiy ways cea`jhk gy hxphrts wn`cn cai nhep sjlfhrs qu`t
sjlf`im. @i i`clt`ih rhpeachjhit tnhrapy (IW[), tnrhh jhtnlks arh hjpelyhk2 cnhw`im muj
(i`clt`ih muj), gaikamh (i`clt`ih patcn) aik sjlfhehss tlgaccl (sius). Sljh paphrs rhv`hwhk olr
tn`s tnhs`s navh `ik`cathk tnat sius cai peay ai `jplrtait rleh `i tnh prlchss lo rhkuc`im tnh prhvaehich
lo sjlf`im. [n`s was gashk li tnh kata tnat, `i Swhkhi, ehss phlpeh sjlfh tnai ltnhr Hurlphai
cluitr`hs. Acclrk`im tl tnh o`ik`ims, tnhrh arh il k`oohrhichs `i ltnhr oactlrs wn`cn cnaimhk tnh
sjlf`im nag`t (cnl`ch lo us`im sjlfhehss tlgaccl aik c`marhtths) ghtwhhi Swhkhi aik ltnhr Hurlphai
cluitr`hs hxchpt li tnh rhmueat`lis `i tnh saehs lo sius. Nlwhvhr, clitrary tl tnh aglvh o`ik`ims aik
acclrk`im tl rhchit slurchs, tnhrh navh ghhi jlrh jaeh sius ushrs `i Ilrway tnai O`ieaik, gut tnh
prhvaehich lo sjlf`im ajlim Ilrwhm`ai jhi `s st`ee n`mnhr tnai O`ii`sn jhi, hvhi tnlumn sius `s
gaiihk `i O`ieaik (prhvaehich lo sjlf`im snluek gh n`mnhr `i O`ieaik w`tn tnh gaii`im lo sius
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oleelw`im tnh armujhit tnat sius rhkuchs tnh prhvaehich lo sjlf`im) aik ilt `i Ilrway (=). [n`s
uikhrj`ihs o`ik`ims tnat sius rhkuchs tnh prhvaehich lo sjlf`im. A paphr nas aesl `ik`cathk tnat
tnrhh lut lo olur Swhk`sn jhi navh qu`t sjlf`im w`tnluttnh nhep lo sius(7).
[nh Hurlphai Xi`li (HX) gaiihk tnh saeh lo sius `i 1007. @i 1008, wnhi Swhkhi bl`ihk tnh
HX, tnh gai was st`ee `jpehjhithk w`tn tnh hxchpt`li lo Swhkhi (>). Oleelw`im tn`s, khgaths ghtwhhisius supplrthrs aik lgbhctlrs arh st`ee ml`im li.
Stuk`hs li siusaik `ts hoohct li strlfh aik ltnhr cark`lvascuear k`shashs navh m`vhi j`xhk s`miaes.
Clnlrt stuk`hsnavh snlwi tnat sius cai ra`sh tnh prhvaehich lo strlfh lr `icrhash strlfh r`sf oactlrs,
gut cash clitrle stuk`hs aik crlss-shct`liae stuk`hs navh snlwi uichrta`i rhsuets. Sljh stuk`hs
snlwhk tnat tnh clio`khich `ithrvae (C@) lo tnh rheat`vh r`sf (WW) lr lkks rat`l (LW) lo strlfh `i sius
ushrs cljparhk tl ili sius ushrs cai clvhr 1.4 (0), wn`cn jhais tnat sius klhs ilt clitr`guth tl tnh
r`sf lo strlfh aik cark`lvascuear k`shashs. [n`s cai caush clious`li tl tnh puge`c aglut tnh hoohct lo
sius li tnh r`sf lo strlfh aik ltnhr cark`lvascuear k`shashs. [nh k`oohrhich ghtwhhi prlsphct`vh
(WC[/clnlrt) stuk`hs aik rhtrlsphct (cash-clitrle/crlss-shct`liae) stuk`hs jay gh kuh tl tnh k`oohrhich
lo tnh stat`st`cae plwhr lo k`oohrhit typhs lo stuk`hs.
[l e`j`t tnh w`ktn lo tnh clio`khich `ithrvae, lih jhtnlk `s tl khs`mi a g`mmhr clnlrt stuky `i tnh
outurh6 ailtnhr w`khey ushk jhtnlk `s tl kl a Jhta-aiaeys`s tl cljg`ih tnh rhsuets lo shvhrae stuk`hs.
[l clikuct a Jhta-aiaeys`s, tnh o`rst stamh `s tl `iceukh sljh cr`thr`a aik hxceukh chrta`i stuk`hs. Kuh
tl ja`iey t`jh aik clsts clistra`its, tnh o`rst stamh, e`thraturh rhv`hw as a jhtnlk was oluik tl gh tnh
jlst su`tageh olr tnh cnlshi rhsharcn quhst`li. [nh rhsuets gashk li e`thraturh rhv`hw cai gh mrluiks
olr ourtnhr rhsharcn `i tnh outurh sucn as jhta-aiaeys`s lr whee khs`mihk clnlrt stuky. [nh ja`i
purplsh lo tn`s e`thraturh rhv`hw `s tl o`ik `o tnhrh arh k`oohrhichs ghtwhhi var`lus typhs lo stuk`hs,
nhich tnh ja`i lgbhct`vh `s tl cljparh tnh k`oohrhichs ghtwhhi var`lus typhs lo stuk`hs. Khta`es lo
tnh jhtnlk ushk olr tn`s rhsharcn arh khscr`ghk `i tnh shct`li 3.
[nh rhsuets lo tnh aiaeys`s arh prhshithk `i Shct`li ; w`tn a olcushk k`scuss`li li hacn typh lo stuky
ushk olr tnh aiaeys`s. @i Shct`li 8, tnh k`scuss`li s gashk li aiaeyz`im aee tnh rhsuets aik `s a
sujjary lo tnh olcushk k`scuss`lis lo Shct`li ;. Shct`li 8 aesl `iceukhs sljh rhcljjhikat`lis li
nlw tl `jprlvh outurh stuk`hs gashk li tnh aiaeys`s klih `i tn`s tnhs`s.
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7. TXWTLSH
[nh purplsh lo tn`s e`thraturh rhv`hw `s tl o`ik `o sius (aesl filwi as Swhk`sn siuoo lr Swhk`sn
sjlfhehss tlgaccl) s a r`sf oactlr lo strlfh. @i tn`s tnhs`s, trak`t`liae e`thraturh rhv`hw was appe`hk as
a rhsharcn jhtnlk as a o`rst stamh aik oluikat`li aiaeys`s olr outurh Jhta-Aiaeys`s.
3. JH[NLKS
Acclrk`im tl currhit rhsharcn, tnh hoohct lo sius li strlfh aik ltnhr cark`lvascuear k`shashs `s ilt
cehar. A e`thraturh rhv`hw lo currhit rhsharcn paphrs nas ghhi klih nhrh tl hjpnas`zh tn`s.
[nh e`thraturh rhv`hw olr tn`s rhsharcn clvhrhk ai 1>-yhar phr`lk, orlj 1004 tl Buih 744=. [nh
sharcn olr rhehvait e`thraturh `iceukh tnh ush lo ai hehctrli`c katagash2TugJhk. [nh fhywlrks, "sius
(siuoo)", "strlfh", "nyphrthis`li", "e`p`k", "gellk meuclsh" aik "arrnytnj`a" whrh ushk tl sharcn
rheathk paphrs `i TugJhk. Jlrh lr`m`iae rhsharcn paphrs whrh oluikhk gy a jaiuae sharcn orlj
g`ge`lmrapn`hs lo `khit`o`hk art`cehs orlj TugJhk (hsphc`aeey orlj tnh rhv`hws), w`tn sphc`ae atthit`li
tl ehak`im ce`i`cae bluriaes `i tn`s arha (Ajhr`cai bluriae lo puge`c nhaetn, Scaik`iav`ai bluriae lo
puge`c nhaetn, aikstrlfh, htc.). Liey hjp`r`cae hp`khj`lelm`cae stuk`hs whrh `iceukhk.
Hp`khj`lelm`cae stuk`hs w`tn rhplrt li nujai aik cark`lvascuear k`shash lutcljhs aik/lr
`ithrjhk`ath lutcljhs (h.m. gellk prhssurh, e`p`k ehvhe, aik gellk sumar) whrh `iceukhk. Wheathk
rhv`hws whrh aesl `iceukhk. Ai`jae rhsharcnhs whrh hxceukhk. A tltae lo =0 paphrs whrh hxaj`ihk,
lo wn`cn 1> paphrs (; rhv`hw paphrs aik 1; lr`m`iae rhsharcn paphrs) jht tnh cr`thr`a.
Xs`im Jatr`x Jhtnlks (a tlle wn`cn ushs jatr`x tl nhep rhv`hwhrs lr rhakhrs tl mht, lrmai`zh aik
cljparh tnh `iolrjat`li orlj shvhrae stuky paphrs qu`cfey aik has`ey. Jatr`x Jhtnlk `iceuk`im olur
parts2 sharcn`im, lrmai`z`im, rhv`hw`im, syitnhs`z`im) (14), hacn lo tnh paphrs was hvaeuathk `iaschik`im cnrlilelm`cae lrkhr us`im a structurhk agstract`im olrj w`tn chrta`i [lp`cs sucn as bluriae
`khit`o`cat`li, purplsh, kho`i`t`li lo `ikhphikhit aik khphikhit var`agehs, jhtnlklelm`cae khs`mi,
sajpe`im khs`mi, iujghr lo sugbhcts, kata slurchs, vae`k`ty aik rhe`ag`e`ty lo kata cleehct`li, rhsuets, htc.
Gltn jablr jai`ohstat`lis lo atnhrltnrljglt`c k`shashs, jylcark`ae `ioarct`li navh vhry s`j`earr`sf oactlrs w`tn strlfh. As tnhrh `s a eacf lo rhsharcn paphrs li tnh hoohct lo sjlfehss tlgaccl
clisujpt`li li strlfh, tnh hoohcts li jylcark`ae `ioarct`li lo sjlfhehss tlgaccl clisujpt`li w`ee gh
ushk tl rhprhshit hoohcts li strlfh `i tn`s paphr.
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;. WHSXE[S
Orlj tnh e`thraturh rhv`hw, h`mnthhi paphrs whrh rhtr`hvhk wn`cn `iceukhk olur rhv`hw paphrs aik
olurthhi lr`m`iae rhsharcn paphrs. Ajlim tnh lr`m`iae paphrs, lih lo tnhj was a raiklj`zhk
clitrleehk tr`ae (Aeehi SS ht ae)6 tnrhh whrh clnlrt stuk`hs6 lih ihsthk cash-clitrle stuky6 s`x cash-
clitrle stuk`hs6 aik tnrhh crlss-shct`liae stuk`hs. Jlst lo tnh rhsharcn paphrs olcushk li
cark`lvascuear k`shashs. Liey lih rhsharcn paphr was k`rhctey rheathk tl strlfh.
;.1. Waiklj`zhk ce`i`cae tr`aes (WC[)2 1 paphr
Aeehi's raiklj`zhk clitrleehk tr`ae (11) atthjpthk tl `ivhst`math tnh hoohcts lo i`clt`ih muj
rhpeachjhit (IW[) `i sjlfhehss tlgaccl chssat`li li cark`lvascuear r`sf oactlrs. Nhart rath, gellk
prhssurh, wh`mnt, aik oast`im e`plprlth`i prlo`ehs whrh cnhcfhk `i tn`s tr`ae aik tnh rhsuet snlwhk tnat
tnhrh was il k`oohrhich li cark`lvascuear r`sf oactlrs ghtwhhi tnh sjlfhehss tlgaccl ushr aik ili ushr
mrlup. @i tn`s stuky, tnh rhsharcnhrs ushk tnh klugeh-ge`ik jhtnlk. [n`s was ilt vhry hasy as tnh
sugbhcts cluek sljht`jhs `khit`oy wnhtnhr tnh muj clita`ihk i`clt`ih.
[nh sugbhcts whrh rhcru`thk orlj akvhrt`shjhits `i cajpus aik elcae ihwspaphrs. [nh`r
sjlfhehss tlgaccl clisujpt`li nag`ts aik tnh`r jhk`cae n`stlry whrh rhplrthk gy tnh sugbhcts
tnhjshevhs. [nhrh whrh chrta`iey r sfs tnat tnh sajpeh sugbhcts k`k ilt rhprhshit tnh plpueat`li kuh
tl tnh oact tnat tnhsh part`c`paits j`mnt navh ghhi jlrh clichrihk aglut tnh`r nhaetn. [nhsh phlpeh
usuaeey navh a nhaetn`hr e`ohstyeh tnai tnh phlpeh wnl whrh ilt w`ee`im part`c`pait tn`s stuky.
K`oohrhit e`ohstyehs cai clita`i jaiy clioluik`im oactlrs tnat cai `ioeuhich tnh rhsuet lo tnh stuky.
Sheo rhplrthk kata arh aesl filwi tl navh elw ehvhe lo accurac`hs. @t `s k`oo`cuet tl crlss cnhcf tnh
sheo-rhplrthk kata, hsphc`aeey li tnh`r nag`t lo tlgaccl ush2 aetnlumn sljh eag thsts whrh clikucthk tl
vhr`oy tnh kata.
;.7. Clnlrt stuk`hs2 3 paphrs
Ajlim tnh tnrhh clnlrt stuk`hs, twl lo tnhj (Gle`ikhr M ht ae, Ilrghrm J ht ae) (17, 13) olcushk li
cark`lvascuear k`shash (C_K) aik sjlfhehss tlgaccl ush, aik ailtnhr (Nhiehy SB ht ae) (1;) olcushk
ilt liey li cark`lvascuear k`shash gut li tnh jlrtae`ty lo shvhrae k`oohrhit k`shashs aik sjlfhehss
tlgaccl clisujpt`li.
Nhiehy's paphr jhit`lihk twl earmh prlsphct`vh stuk`hs2 CTS-@ (Caichr Trhvhit`li Stuky @) aik
CTS-@@ (Caichr Trhvhit`li Stuky @@). CTS-@ (starthk `i 1080) aik CTS-@@ (starthk `i 10>7) arh twl
prlsphct`vh clnlrt stuk`hs rui gy tnh Ajhr`cai Caichr Slc`hty (ACS). @i CTS-@, currhit sjlfhehss
tlgaccl clisujpt`li was stat`st`caeey aik s`mi`o`caitey e`ifhk w`tn khatn orlj clrliary nhart k`shash
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(CNK), strlfh, aik rhsp`ratlry k`shashs. K`mhst`vh aik mhi`tlur`iary systhjs whrh aesl aoohcthk, gut
tnhrh was il e`if w`tn khatn orlj caichr. @i CTS-@@, ush lo sjlfhehss tlgaccl prlkucts was
s`mi`o`caitey asslc`athk w`tn khatn orlj CNK, strlfh, aik caichr sucn as euim caichr aik c`rrnls`s.
Olueks aik Wajstrlj (18) quhst`lihk tn`s paphr ghcaush tnhy oluik tnat ih`tnhr lo tnh twl stuk`hs
oluik a s`mi`o`cait `icrhash `i tnh r`sf lo khatn orlj lrae caichr gut ratnhr oluik tnh `icrhashk r`sf loeuim caichr (`i CTS-@@) aik ltnhr rhsp`ratlry systhj k`shashs (`i CTS-@) w`tn sjlfhehss tlgaccl. [nh
jhcnai`sjs lo euim caichr aik rhsp`ratlry k`shashs w`tn tnh ush lo sjlfhehss tlgaccl `i tnh jlutn,
aik tnh rhsuet`im kata vae`k`ty lo tnhsh twl stuk`hs whrh quhst`lihk, s`ich tnhrh was il e`if w`tn lrae
cav`ty caichr wn`cn was wnat jlst rhsharcnhrs hxphcthk. Eathr, Nhiehy aik [nui rhpe`hk (1?) tnat
sjlfhehss tlgaccl ushrs navh a n`mnhr cnaich lo mhtt`im euim caichr lr rhsp`ratlry k`shash ghcaush lo
tnh prhshich lo ;-(jhtnyei`trlsaj`ih)-1-(3-pyr`kye)-1-gutailih) (IIF). IIF `s a tlgaccl
sphc`o`c i`trlsaj`ihs, wn`cn `s aesl a strlim, systhj`c euim carc`ilmhi.
Gle`ikhr's paphr (17) jhit`lihk tnat sjlfhehss tlgaccl ushrs aik sjlfhrs w`ee navh a n`mnhr cnaich
lo ky`im orlj cark`lvascuear k`shashs tnai ili-ushrs. [n`s was acclrk`im tl a crlss-shct`liae stuky
(10=;) oleelwhk gy a earmh clnlrt stuky (10=;-10>8) gashk li jaeh Swhk`sn clistruct`li wlrfhrs.
Aetnlumn tnh r`sf olr sjlfhehss tlgaccl ushrs `s elwhr tnai olr sjlfhrs, tnh hxchss r`sf jay st`ee
supplrt tnat taf`im act`li tl avl`k sius clisujpt`li caiilt gh `milrhk. [nh kata was lgta`ihk orlj
tnh Swhk`sn Clistruct`li @ikustry's Lrmai`zat`li olr ]lrf`im Hiv`rlijhit Saohty aik Nhaetn, aik
orlj a quhst`liia`rh. @i tn`s stuky, sugbhcts whrh `i tnh sup`ih pls`t`li (eay klwi) wn`eh nav`im tnh`r
gellk prhssurh cnhcfhk. Xsuaeey, tnh gellk prhssurh rhak`im wluek gh n`mnhr `i tnh sup`ih pls`t`li
tnai tnh s`tt`im pls`t`li (1=).
Ilrghrm stuk`hk tnh rleh lo jhtagle`c syikrljh (JhtSy), `iceukhs lghs`ty, `jpa`rhk meuclsh
rhmueat`li, kyse`p`khj`a, aik nyphrthis`li htc., `i cark`lvascuear k`shashs wnhi us`im sjlfhehss
tlgaccl (13). [nh rhsharcn kata was gashk li a plpueat`li-gashk elim`tuk`iae clnlrt stuky, a sugsht
lo tnh _asthrgltthi @ithrvhit`li Trlmrajjh (_@T) `i Ilrtnhri Swhkhi, ghtwhhi 100; aik 744;.
Whsharcnhrs oluik tnat tnh jhtagle`c syikrljh `s rheathk tl n`mn clisujpt`li lo sius.
;.3. Ihsthk cash-clitrle stuk`hs2 1 paphr
[n`s rhsharcn paphr `s k`rhctey rheathk tl strlfh, aik `t `s aesl tnh liey ihsthk cash-clitrle stuky `i
tn`s rhv`hw. [nh purplsh lo Aspeuik's paphr (1>) was tl cnhcf `o tnh ush lo siuoo `icrhashk tnh r sf lo
strlfh `i jhi. [nh kata was gashk li ]NL JLI@CA (Juet`iat`liae JLI@tlr`im lo trhiks aik
khthrj`iaits `i CArk`lvascuear k`shash, 10>?-1000) `i ilrtnhri Swhkhi aik tnh _asthrgltthi
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@ithrvhit`li Trlmrajjh (_@T, 10>8-7444) wn`cn `s aesl gashk `i tnh ilrtnhri Swhkhi rhm`li. [nhrh
whrh >7= rhsharcn sugbhcts, 7=? cashs aik 881 clitrles, lo wn`cn iharey lih cash jatcn twl clitrles.
[n`s stuky supplrts tnat sjlf`im `s a r`sf oactlr lo strlfh. Gut olr sius ush, tnh kata snlwhk tnat tnh
clio`khich `ithrvae lo lkks rat`l `s 4.?4-7.77 `i aee ilis-sjlf`im siuoo ushrs aik 4.3= tl 7.0; `i
ilisjlf`im siuoo ushrs wnl nak ihvhr ghhi sjlfhrs. Gltn lo tnh lkks rat`l clvhrhk 1.4.Cljparhk tl a cash-clitrle stuky, `i a ihsthk-cash clitrle stuky, kata `s cleehcthk gholrh tnh
lccurrhich lo ai hvhit. A ihsthk-cash clitrle stuky cai rhkuch rhcaee g`as aik thjplrae ajg`mu`ty.
[nhrh `s nlwhvhr a krawgacf `i tn`s typh lo stuky. Ili-k`shashk phrslis shehcthk orlj tnh clitrles
jay ilt gh oueey rhprhshitat`vh lo tnh lr`m`iae clnlrt kuh tl khatns aik oa`eurh tl oleelw-up tnh cashs.
[nh autnlr aesl jhit`lihk tnat sljh part`c`paits rhplrthk n`stlry lo `scnhj`c nhart k`shash, gut il
rhehvait kata was rheathk tl `t, sucn as HCMs lo tnh part`c`paits. S`ich rhehvait kata was ilt rhclrkhk,
tnh stuky elst sljh cark`ac var`agehs sucn as atr`ae o`gr`eeat`li, wn`cn cai gh clioluik`im oactlrs olr
tn`s stuky. [nh j`ss`im kata rheathk tl nhart k`shashs jay j`sehak tn`s stuky.
;.;. Cash-clitrle stuk`hs2 ? paphrs
Cljparhk tl ltnhr rhsharcn jhtnlks, cash-clitrle stuky `s tnh jlst w`khey ushk. S`x paphrs whrh
oluik acclrk`im tl tnh sharcn cr`thr`a2 Nuntasaar` (1 paphr), Gle`ikhr (3 paphrs, 7 lo tnhj kl ilt
supplrt tnat sius clisujpt`li ra`shs tnh r`sf lo cark`lvascuear k`shashs, wn`eh lih supplrthk), Nhrmhis
(1 paphr).
Aesl gashk li tnh kata orlj ]NL JLI@CA, Aspeuik aik Nuntasaar` ht ae clikucthk a cash-
clitrle stuky (10) aik oluik tnat siuoo ush w`ee ilt `icrhash tnh r`sf lo jylcark`ae `ioarct`li,
hsphc`aeey aothr akbustjhit olr juet`peh cark`lvascuear r`sf oactlrs. [nh lkks rat`l was 4.8> (08% C@
4.38-4.0;) olr rhmuear siuoo ushrs. @t was assujhk `i tnh`r paphr, tnat i`clt`ih j`mnt ilt gh ai
`jplrtait clitr`gutlr tl `scnhj`c nhart k`shash `i sjlfhrs as sius ushrs navh n`mnhr clt`i`ih ehvhes
tnai sjlfhrs [nhrholrh, tnh `icrhashk cnaichs lo sjlfhrs mhtt`im jylcark`ae `ioarct`li j`mnt gh kuh
tl ltnhr rhaslis aik ilt bust orlj tnh hoohct lo i`clt`ih.
Gle`ikhr's twl cash-clitrle stuk`hs (gltn puge`snhk `i 100=) aesl `ik`cathk tnat siuoo ushrs jay ilt
navh a n`mnhr r`sf lo jylcark`ae `ioarct`li tnai ili tlgaccl ushrs. Lih paphr (74) cljparhk gellk
prhssurh, nhart rath, lxymhi clisujpt`li ghtwhhi sjlfhehss tlgaccl ushrs, ili tlgaccl ushrs, aik
sjlfh ushrs at rhst aik at sug-jax`jae hxhrc sh. [n`s stuky snlwhk tnat tnhrh was il s`mi`o cait
k`oohrhich ghtwhhi sjlfhehss tlgaccl ushrs aik ili tlgaccl ushrs. Gut tnh stuky aesl jhit`lihk tnat
i`clt`ih orlj siuoo cai aoohct tnh autlilj`c ihrvlus systhj. Nhich tnh hoohct lo sjlfhehss tlgaccl
li cark`lvascuear k`shash `s ilt sl cehar. Ailtnhr paphr (71) cljparhk `it`ja jhk`a tn`cfihss `i tnh
carlt`k arthry ghtwhhi sjlfhehss tlgaccl ushrs aik ili tlgaccl ushrs. [nh kata orlj tnh stuky
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snlwhk tnat tnh clio`khich `ithrvae lo lkks rat`l ghtwhhi sjlfhehss tlgaccl ushrs aik ili-tlgaccl
ushrs `s clvhr 1.4. [nh krawgacf lo tnh twl stuk`hs `s tnat tnh kata whrh lgta`ihk orlj a sheo-
rhplrthk quhst`liia`rh wn`cn jay navh 'rhcaee g`as'. [nh sugbhcts jay aesl cnaimh tnh`r tlgaccl nag`t
aothr tnhy part`c`pathk `i tn`s stuky.
@i ailtnhr paphr gy Gle`ikhr, puge`snhk `i 100> (77), us`im 7;-nlur gellk prhssurh jli`tlr`im, astrlim pls`t`vh rheat`lisn`p was oluik ghtwhhi gellk prhssurh `icrhash aik clt`i`ih (jablr i`clt`ih
jhtagle`th) `i sjlfhehss tlgaccl ushrs, wnhrhas ai `ivhrsh rheat`lisn`p was oluik `i sjlfhrs,
`ik`cat`im akk`t`liae aik jlrh cljpehx `ioeuhichs li vascuear tlih `i sjlfhrs tnai tnh `ioeuhich lo
i`clt`ih `i sjlfhehss tlgaccl ushrs. Cljpar`im tnh olrjhr twl cash-clitrle stuk`hs rui gy Gle`ikhr,
wh cai shh tnat tnh rhsuet lo tn`s cash-clitrle stuky `s ilt clis`sthit w`tn tnh olrjhr twl cash-stuk`hs
Lih lo tnh rhaslis cluek gh as Nhrmhis jhit`lihk `i n`s paphr (73), tnat tnh `iolrjat`li li tlgaccl
clisujpt`li was orlj part`c`paits' sheo-rhplrt. [n`s jay navh caushk sljh j`sceass`o`cat`li `i tnh
stuky as tlgaccl ush `s jlrh cljjli ajlim ili-rhsplikhrs. Sl, `t `s ilt uiusuae tnat n`s rhsharcn
paphr puge`snhk `i 7448 snlwhk tnat tnhrh was il hv`khich tl supplrt tnat sjlfhehss tlgaccl
`icrhashk tnh r`sf lo jylcark`ae `ioarct`li.
;.8. Crlss-shct`liae stuk`hs2 3 paphrs
S`hmhe's stuky (7;) jhasurhk systle`c/k`astle`c gellk prhssurh (SGT/KGT), puesh, wn`th gellk chee
cluit, tltae aik NKE-cnlehsthrle, i`clt`ih, clt`i`ih, aik shruj caooh`ih ehvhes, tl o`ik `o tnhrh was a
rheat`lisn`p ghtwhhi sjlfhehss tlgaccl clisujpt`li aik cark`lvascuear k`shashs orlj shvhrae
prlohss`liae gashgaee thaj peayhrs. N`s stuky snlwhk tnat sjlfhehss tlgaccl ushrs k`k ilt k`oohr
orlj ili-tlgaccl ushrs `i akbusthk ehvhes lo systle`c aik k`astle`c gellk prhssurh, puesh, aik tltae lr
NKE-cnlehsthrle. Gut sjlfhehss tlgaccl ushrs nak n`mnhr jhai shruj clt`i`ih ehvhes. [n`s stuky
aesl rhvhaehk tnat n`mnhr k`astle`c gellk prhssurhs whrh asslc`athk w`tn n`mnhr jhai shruj i`clt`ih
ehvhes. Oleelw`im tn`s stuky, a cliceus`li tnat sjlfhehss tlgaccl clisujpt`li nas il s`mi`o`cait
clitr`gut`li gut jay navh a jlkhst hoohct li cark`lvascuear r`sf oactlrs `i yluim splrts jhi was
krawi.
[nh ltnhr twl crlss-shct`liae stuk`hs (He`assli ht ae 1008, aik Thrssli ht ae 7444) olcushk li
sjlfhehss tlgaccl clisujpt`li aik meuclsh jhtagle`sj. @i He`assli's stuky (78), part`c`paits whrh
m`vhi tnh 'lrae meuclsh tlehraich thst' (LM[[) tl stuky tnh`r meuclsh jhtagle`sj. [nh part`c`paits
whrh aesl cnhcfhk olr tnh`r t`ssuh peasj`ilmhi act`vatlr (tTA) act`v`ty aik peasj`ilmhi act`vatlr
`in`g`tlr typh 1 (TA@-1) act`v`ty tl khthrj`ih tnh ehvhe lo o`gr`ileys`s. @t snlwhk tnat tnhrh was il
rheat`lisn`p ghtwhhi sjlfhehss tlgaccl clisujpt`li aik `ikhphikhit oactlrs lo cark`lvascuear
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k`shashs, sucn as o`gr`ilmhi, o`gr`ileys`s, meuclsh tlehraich, aik `isue`i ehvhe.
Li tnh clitrary, Thrssli's stuky (7?), snlwhk tnat currhit jl`st siuoo ushrs navh a n`mnhr r`sf lo
[yph @@ k`aghths, aik elwhr `isue`i rhsplish aik rhs`staich gut ilt `jpa`rhk meuclsh tlehraich ajlim
olrjhr siuoo ushrs, cljparhk w`tn tnh ili-tlgaccl ushrs. @i tn`s stuky, tnh part`c`paits whrh aesl
m`vhi tnh 'lrae meuclsh tlehraich thst' (LM[[) tl stuky tnh`r meuclsh jhtagle`sj aik 'nljhlstat`cjlkhe asshssjhit' (NLJA) tl cnhcf tnh`r `isue`i rhs`staich. @i snlrt, siuoo ush acclrk`im tl tn`s
stuky clitr`guths tl tnh `jpa`rjhit lo meuclsh jhtagle`sj.
[nhsh o`othhi stuk`hs aglvh olcushk li shvhrae khphikhit var`agehs2 gellk prhssurh/nhart rath
`icrhas`im, kyse`p`khj`a/nyphrcnlehsthrlehj`a, meuclsh jhtagle`sj/`isue`i ehvhe/Meuclsh `itlehraich
& k`aghths, wn`th gellk chee cluit, o`gr`ileyt`c systhj, wh`mnt, lxymhi clisujpt`li, `it`ja jhk`a
tn`cfihss, htc.
[nh olurthhi stuk`hs arh rhv`hwhk olr tnh`r `jpacts li k`oohrhit asphcts ghelw.
1.Gellk prhssurh aik nhart rath2
A tltae lo shvhi paphrs whrh rheathk tl gellk prhssurh, aik olcushk li h`tnhr snlrt-thrj lr elim-
thrj hoohct. Aetnlumn tnh jablr`ty lo stuk`hs whrh jlrh olcushk li tnh "acuth" hoohcts ratnhr tnai
cnrli`c aik elim-thrj hoohcts, tnhrh arh st`ee sljh rhsharcn rhsuets li elim-thrj hoohct. @i lih stuky,
7;-nlur ajgueatlry gellk prhssurh was jli`tlrhk6 wn`eh ltnhrs bust jhasurhk gellk prhssurh shvhrae
t`jhs a kay. 7; nlurs jli`tlr im wluek m`vh a n`mnhr cnaich tl rhsharcnhrs tl o`ik aiy hehvat`li lo
gellk prhssurh aik nhart rath. (Shh [ageh 7)
S`hmhe ht ae.'s stuky olcushk li a mrlup lo Ajhr`cai prlohss`liae gashgaee peayhrs. [nh stuky
sugbhcts hxhrc`shk rhmuearey, aik arh nhaetn`hr tnai tnh mhihrae plpueat`li. [nh`r pnys`cae clik`t`li
jay he`j`iath tnh akvhrsh hoohcts lo sjlfhehss tlgaccl. As jhit`lihk gholrh, tnh jhtnlklelmy
khs`mi lo Aeehi ht ae.'s stuky clita`ihk sljh whafihsshs.
7.Nyphrcnlehsthrlehj`a2
O`vh paphrs whrh rheathk tl gellk cnlehsthrle, aik olcushk li h`tnhr snlrt-thrj lr elim-thrj
aoohct`li. (shh tageh 3)
Ilrghrm's lih clnlrt stuky snlwhk tnat tnhrh was a rheat`lisn`p ghtwhhi kyse`p`khj`a aik
sjlfhehss tlgaccl ush. @i ltnhr stuk`hs, tnh iujghr lo sugbhcts lo stuky was h`tnhr tll sjaee, lr tnh
khs`mi nak sljh krawgacfs.
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3. Meuclsh jhtagle`sj / @isue`i ehvhe / K`aghths2
Olur paphrs whrh rheathk tl gellk meuclsh, aik olcushk li h`tnhr snlrt-thrj lr elim-thrj aoohct`li.
(shh tageh ;)
Ilrghrm's clnlrt stuky aik Thrssli's crlss-shct`liae stuky snlwhk tnat sjlfhehss tlgaccl
clisujpt`li rheaths tl meuclsh jhtagle`sj aik `isue`i shcrht`li. @i Thrsslis stuky, tnh prhvaehich
lo [yph @@ k`aghths `icrhashk `i currhit nhavy sius ushrs w`tnlut prhv`lus sjlf`im cljparhk tl ili-
sius ushrs, wn`cn `ik`cathk tnat nhavy sius clisujpt`li cai `icrhash tnh r`sf lo [yph @@ k`aghths.
Ailtnhr paphr gy Ilrghrm `ik`cathk tnat n`mn klsh lo sius clisujpt`li cai ehak tl jhtagle`c
syikrljh (JhtSy), wn`cn aesl jhais shvhrae s`imeh r`sf oactlrs lo cark`lvascuear k`shashs, `iceuk`im
strlfh.
;.Atnhrlscehrls`s (@it`ja jhk`a tn`cfihss)2
Gle`ikhr's lih cash-clitrle stuky snlwhk tnat tnhrh was il stat`st`cae s`mi`o`cait `icrhash ajlim
sjlfhehss tlgaccl ushrs.
8.O`gr`ileyt`c systhj2
He`assli's lih crlss-shct`liae stuky k`k ilt snlw aiy s`mi`o`cait cnaimh ajlim sjlfhehss tlgaccl
ushrs.
?. ]n`th gellk chee cluit, lxymhi clisujpt`li, wh`mnt, htc.
S`hmhe's crlss-shct`liae stuky snlwhk tnat tnh cluit lo ehuflcyth nak il rheat`lisn`p w`tn sjlfhehss
tlgaccl ush.
@i Gle`ikhr's cash-clitrle stuky li a mrlup lo o`rhjhi, tnh rhsharcnhrs oluik tnat tnhrh was il
k`oohrhich lo jax`jae wlrfelak lr jax`jae lxymhi uptafh ghtwhhi sjlfhehss tlgaccl ushrs aik ili-
ushrs.
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8. K@SCXSS@LI
[nh jhtnlklelmy ushk `i a rhsharcn `s `jplrtait. ]nhi S`r W`cnark Klee aik Trlo. Grakolrk N`ee
clikucthk tnh`r rhsharcn tl o`ik tnh e`if ghtwhhi sjlf`im aik euim caichr `i tnh 1084s, tnhy cljparhk
tnh prlplrt`li lo sjlfh ushrs `i euim caichr pat`hits aik tnh ili-pat`hits (cash-clitrle stuky). [nhi
tnhy cljparhk tnh rheathk r`sf lo euim caichr ghtwhhi sjlf`im klctlrs aik ili-sjlf`im klctlrs
(clnlrt stuky). [nhy oluik tnat tnh r`sf `icrhashk wnhi tnhrh `s clisujpt`li lo jlrh c`marhtths aik,
rhkuct`li `i r`sfs wnhi sjlf`im chashk (7=, 7>).
Kuh tl tnh eacf lo chrta`i rhslurchs `i tnh sius rhsharcn clnlrt aik cash clitrle stuk`hs, tnhrh `s a
eacf lo `iolrjat`li `i us`im k`oohrhit ways tl prlvh `o sius s rheathk tl strlfh lr ilt. [nhrholrh, `t `s
ilt hasy tl cliceukh tnat sius `s iharey narjehss. [nh quhst`li `s ilt wn`cn `s tnh ehss hv`e. - Hvhi
tnlumn `t j`mnt gh ehss kaimhrlus tnai c`marhtths, `t wluek gh ghtthr tl avl`k gltn tlgaccl prlkucts.
As w`tn aiy rhv`hws, `t `s plss`geh tnat sljh puge`snhk stuk`hs jay navh ghhi j`sshk lut, aik tn`s
rhv`hw k`k ilt `iceukh stuk`hs wn`cn whrh ilt puge`snhk.
As wh filw, acclrk`im tl tnh ce`i`cae hv`khich ehvhe ceass`o`cat`li, whee khs`mihk raiklj`zhk
ce`i`cae tr`ae (WC[) s tnh shclik ehvhe hv`khich, oleelw`im systhjat`c rhv`hw. Aik whee khs`mihk
clnlrt, cash-clitrle, crlss-shct`liae stuk`hs arh tnh olurtn ehvhe hv`khich, gut clnlrt stuky nas jlrh
plwhr tnai cash-clitrle lr crlss-shct`liae stuk`hs. Clicatl ht ae.'s paphr snlwhk tnat whee-khs`mihk
lgshrvat`liae stuk`hs (clnlrt lr cashclitrle stuky) kl ilt systhjat`caeey lvhrhst`jath tnh jami`tukh
cljparhk w`tn tnlsh `i raiklj`zhk clitrleehk tr`aes (70), wn`cn jhais tnat aee whee khs`mihk stuk`hs
navh s`j`ear plwhr. [n`s lp`i`li was qu`th ui`quh, aik was cnaeehimhk gy Tlclcf ht ae. `i ailtnhr
paphr (34).
Orlj tnh aglvh o`othhi lr`m`iae rhsharcn stuk`hs, wh cai o`ik tnat tnh `jpact lo sius orlj currhit
rhsharcnhs nas ghhi clitrlvhrs`ae. [nrhh clnlrt stuk`hs `ik`cathk tnat sjlfhehss tlgaccl was rheathk
tl tnh `icrhash lo prhvaehich lo cark`lvascuear k`shashs. Gut orlj tnh cash-clitrle stuk`hs, liey lih
supplrthk tn`s nypltnhs`s, wn`eh ltnhrs snlwhk tnat tnhrh was il rheat`lisn`p ghtwhhi sjlfhehss
tlgaccl clisujpt`li aik tnh cark`lvascuear r`sf oactlrs.
Sajpeh s`zh `s ailtnhr `jplrtait `ssuh. As wh filw, a whee-khs`mihk stuky w`tn hilumn sajpeh
s`zh cai rhkuch gltn tnh systhjat`c hrrlr aik raiklj hrrlr. A mllk plpueat`li s`zh lo sajpeh
khphiks li juet`peh var`agehs acclrk`im tl k`oohrhit typh lo cljpar`sli. WC[ `s tnh ghst typhs lo
stuky gut tnhy ihhk tl gh khs`mihk carhoueey. ]h liey mht lih sjaee sajpeh s`zh lo WC[, aik `t nas
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e`tteh stat`st`cae plwhr. @i tn`s rhv`hw, sljh stuk`hs cljparhk prlplrt`lis (h.m. tnh iujghr lo phlpeh
w`tn cark`lvascuear k`shashs) ghtwhhi sius mrlup aik clitrle mrlups, aik sljh cljparhk jhais
(h.m. gellk prhssurh) ajlim tnh sajh way. [l cljparh h tnhr twl prlplrt lis lr twl jhais, a
j`i`juj s`zh lo sajpeh `s rhqu`rhk.
7. Ltnhr @iolrjat`li2
(1) Whsharcn shr`ae orlj tnh ]NL-JLI@CA prlbhct2
Sljh kata whrh lgta`ihk orlj ]NL-JLI@CA (Juet`iat`liae JLI@tlr`im lo trhiks aik
khthrj`iaits `i CArk`lvascuear k`shash) prlbhct, wn`cn was clikucthk `i sljh ilrtn Swhk`sn rhm`lis.
Whsharcn paphrs orlj Trlo. Aspeuik's rhsharcn mrlup lothi ushk kata orlj tn`s prlbhct. Lih lo tnh
rhsharcn paphrs was a ihsthk cash-clitrle stuky, aik ltnhrs whrh h`tnhr khs`mihk as cash-clitrle stuk`hs
lr crlss-shct`liae stuk`hs. Ilih lo tnhsh paphrs, nlwhvhr snlwhk aiy rheat`lisn`p ghtwhhi
cark`lvascuear k`shashs aik sjlfhehss tlgaccl ush. [nh liey lih ihsthk cash-clitrle stuky `ik`cathk
tnat rhsharcnhrs oluik sljh cljpe`cathk `iolrjat`li wnhrh sjlfhehss tlgaccl clisujpt`li cluek gh a
oactlr `i `itrlkuc`im tnh ush lo c`marhtths. [n`s pnhiljhili e`ifs sjlfhehss tlgaccl ush tl tnh
`icrhash r`sf lo strlfh v`a tnh prlmrhss`li lo sjlfhehss tlgaccl clisujpt`li tl ush lo c`marhtths.
(7) Gle`ikhr' rhsharcn shr`ae2
Kr. Gle`ikhr cljpehthk nhr TnK tnhs`s paphrs li sjlfhehss tlgaccl wn`cn whrh jlstey rheathk tl
cark`lvascuear k`shashs, arluik thi yhars aml. [wl lo nhr paphrs (cash-clitrle stuk`hs) snlwhk tnat
tnhrh was il s`mi`o`cait cnaimh ajlim sjlfhehss tlgaccl ushrs cljparhk tl ili-ushrs. [nh ltnhr
twl paphrs (lih cash-clitrle stuky aik lih clnlrt stuky) `ik`cathk tnat tnhrh whrh sljh rheat`lisn`p
ghtwhhi cark`lvascuear k`shashs (lr r`sf oactlrs) aik sjlfhehss tlgaccl ush.
3. Sjlfhehss tlgaccl aik sjlfh chssat`li2
Sljh paphrs pl`ithk lut tnat tnh ush lo sius `s a fhy jhtnlk `i rhkuc`im tnh prhvaehich lo sjlf`im
gashk li tnh kata tnat, `i Swhkhi, ehss phlpeh sjlfh tnai ltnhr Hurlphai cluitr`hs. @t was assujhk
tnat tnhrh was il k`oohrhich `i tnh oactlrs wn`cn `ioeuhich tnh cnl`ch lo ush lo sjlfhehss tlgaccl aik
c`marhtths ghtwhhi Swhkhi aik ltnhr Hurlphai Xi`li cluitr`hs hxchpt olr tnh rhmueat`li `i tnh saehs lo
sius. Gut `o wh cljparh tnh kata lo us`im sius aik c`marhtths `i Ilrway aik O`ieaik, wh cai shh tnat
gltn tnh clisujpt`li lo sius aik c`marhtths `i Ilrway `s st`ee n`mnhr tnai `i O`ieaik (=). Ilrway `s a
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1?
ili-HX cluitry aik tnhrh `s il gai li sius. Nhich wh caiilt has`ey bujp tl tnh cliceus`li tnat sius
rhkuchs tnh prhvaehich lo c`marhtth ush,
A phrsli jay aesl cnllsh tl ush sius `isthak lo c`marhtths as s/nh jay gh jlrh nhaetn clisc`lus
wn`cn jay `i turi `ik`cath tnat tnh phrsli jay navh a nhaetn`hr e`ohstyeh (k`ht, hxhrc`sh htc). [n`s jay
sfhw tnh rhsuets tnat sius as a cnl`ch lo tlgaccl ush cai rhkuch tnh prhvaehich lo cark`lvascuear
k`shashs wnhi a nhaetny e`ohstyeh aerhaky clitr`guths tl tnh khcrhash lo cark`lvascuear k`shashs `i
mhihrae.
;. Ourtnhr sthps li nhaetn nazarks lo sjlfhehss tlgaccl rhsharcn2
S`ich tnhrh `s a currhit eacf lo `iolrjat`li `i tn`s o`hek, ourtnhr act`li ihhks tl gh `jpehjhithk tl
lgta`i jlrh ushoue kata, sucn as tnh ush lo systhjat`c rhv`hws aik appey`im whee khs`mihk elim`tuk`iae
stuk`hs. ]hee-khs`mihk cash-clitrle stuk`hs cai gr`im jlrh `ikhphikhit var`agehs (clioluik`im
oactlrs), tnhi whee-khs`mihk clnlrt stuk`hs lr WC[ hsphc`aeey `i jhasur`im tnh rheat`lisn`p ghtwhhi
sjlfhehss tlgaccl aik strlfh.
[nh oleelw`im `s a summhst`li li tnh `jpehjhitat`li lo ourtnhr rhsharcn.
(1) Khs`mi mllk WC[, clnlrt stuky, lr (ihsthk) cash-clitrle stuky tl rhkuch clioluik`im oactlrs aik
g`as as jucn as plss`geh.
(7) Lgta`i hilumn sajpehs, aik accurath rhclrks.
(3) Olcus li s`j`ear mrlup `i lih stuky (h.m. jaeh klctlrs htc.)
(;) Cljg`ih k`oohrhit mrlup stuk`hs us`im jhta-aiaeys`s as a rhsharcn jhtnlk
]`tn tnh aglvh sthps, wh jay gh ageh tl o`iaeey kraw a cliceus`li li wnhtnhr Swhk`sn jl`st siuoo
(sius) aoohcts cark`lvascuear k`shashs aik rhkuch tnh prhvaehich lo sjlf`im. Whsuets oleelw`im tn`s
jhtnlk cai clitr`guth tl ourtnhr ple`cy jaf`im li tn`s `ssuh.
IL[H2 [n`s rhsharcn jhtnlk cai aesl gh appe`hk tl ailtnhr plpuear nhaetn `ssuh, nazarkshehctrljamiht`c rak`at`li orlj cheepnlih lr ]`O` khv`chs.
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1=
?. CLICEXS@LIS
Acclrk`im tl prhshit rhsharcn, wnhtnhr sius `s rheathk tl tnh `icrhash lo r`sf lo strlfh `s st`ee khgathk.
Clnlrt stuk`hs supplrt tnat sius cai ra`sh tnh prhvaehich lo strlfh aik cash-clitrle stuk`hswn`eh
crlss-shct`liae stuk`hs aik a sjaee sajpeh s`zh WC[ mavh uichrta`i rhsuets. [nh r`sf lo strlfh aik
cark`lvascuear k`shashs orlj tnh ush lo sius s st`ee ilt cehar. [nh e`thraturh rhv`hw klih `i tn`s tnhs`s
snlws tnat rhsuets li wnhtnhr sius cai rhkuch tnh prhvaehich lo sjlf`im aik wnhtnhr rhpeachjhit lo
sjlfh c`marhtths w`tn sius cai gh ai hoohct`vh jhtnlk tl rhkuch tnh r`sf lo strlfh `s `icliceus`vh.
Oleelw`im tnh `icliceus`vh rhsuets, @ wluek summhst tnat `t `s ghtthr tl avl`k gltn clisujpt`li lo sius
aik c`marhtths. [nh quhst`li `s ilt wn`cn `s tnh ehss hv`e as `icliceus`vh rhsuets jhais tnat jlrh
stuk`hs ihhk tl gh clikucthk tl clio`rj tnat sius rhkuchs tnh prhvaehich lo sjlf`im aik tnh rhkuct`li
lo r`sf lo strlfh aik cark`lvascuear k`shashs cljparhk tl sjlfh c`marhtths. Nhich, at tn`s m`vhi
pl`it, `t wluek gh ghtthr tl avl`k gltn tlgaccl prlkucts.
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1>
ACFIL]EHKMHJHI[
[n`s stuky was supplrthk gy jy suphrv`slr Kr. Jart`i Staostrj wnl nas m`vhi jh `ivaeuageh
`istruct`lis aik hicluramhjhit.
@ wluek e`fh tl tnaif jy o`rst suphrv`slr Kr. Jar`a Wlsvaee wnl mavh jh tnh `kha tl clikuct tn`srhsharcn li sius. Aesl a g`m tnaif ylu tl tnh thaj lo JTN prlmraj. [n`s prlmraj aeelwhk jh tl
mht tl tnh clrh lo puge`c nhaetn aik rhsharcn o`hek.
@ wluek aesl e`fh tl tnaif jy parhits aik jy o`aich olr tnh`r clistait aik `ihxnaust`geh supplrt.
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10
ATTHIK@^
[ageh 12 Whsuets lo shehcthk paphrs
Stuky Cluitry # lo Sugbhcts Mhikhr Amh (Jhk`ai Amh*) Whsuets
WC[2Aeehi (1008) Xi`thk Staths 174 Jaeh 1>-?8 [r`meychr`khs (p:4.431), ]h`mnt (p:4.433)6 Ltnhr var`agehs navh il s`
k`oohrhich
Clnlrt stuk`hs2Gle`ikhr (100;) Swhkhi 13843? Jaeh 38-?8 WW lo C_K2 1.;(08%C@2 1.7-1.?) V38-8;yr2 7.1(08% C@2 1.8-7.0) 6 8
1.1(08% C@2 1.4-1.;)ZNhiehy (7448)* Xi`thk Staths CTS-@2==;4=
(S[ushr/iliushr2 ==;8/?0??7)6
CTS-@@211;>40
(S[ushr/iliushr2 337=/111,;>7)
Jaeh CTS @283/?7(ili-ushr/ushr)6
CTS @@2
8?/8=/?7(ili-ushr/ushr/olrjhr-
ushr)
CTS @2 NW lo CNK2 1.17 (08%C@2 1.43-1.77)6 NW lo strlfh2 1.;? (08%1.31-1.?;).
CTS @@2 NW lo CNK2 1.7? (08%C@2 1.4>-1.;=)6 NW lo strlfh2 1.;4 (08%
1.14-1.=0)
Ilrghrm (744?) Swhkhi ;4=77 j/o 34, ;4, 84, ?4 LW 1.? (08%C@2 1.7?-7.18)
Ihsthk cash-clit rle stuky2Aspeuik (7443) Swhkhi >7= Jaeh 78-=; Ili-sjlf`im siuoo ushrs2 LW 1.1? (08%C@2 4.?4-7.77)6 Siuoo ushrs
ihvhr ghhi sjlfhrs2 LW 1.48 (08%C@2 4.3=-7.0;)
Cash-clitr le stuk`hs2
He`assli (1001) Swhkhi 8> Jaeh 74.=-70.1 _ar`agehs (gellk meuclsh, shruj NKE, shruj EKE, EKE/NKE) navh i
s`mi`o`cait k`oohrhich
Gle`ikhr (100=) Swhkhi 1;; Jaeh 38-?4 _l7 jax & Jax wlrfelak (p54.441)6 NW & SGT at 104] (T54.48)6 var`agehs navh il s`mi`o`cait k`oohrhich
Gle`ikhr (100=) Swhkhi 1;3 Jaeh 38-?4 _ar`agehs (NKE, EKE, tr`meychr`khs, it`ja jhk`a tn`cfihss lo r`mnt c
arthry) navh il s`mi`o`cait k`oohrhich
Gle`ikhr (100>) Swhkhi 138 Jaeh 38-?4 7;n & kayt`jh jhai SGT (p54.48)6 Ltnhr var`agehs navh il s`mi`o`cai
k`oohrhichNuntasaar`
(1000)
Swhkhi 13=; Jaeh 78-?; Currhit siuoo ushrs, il currhit sjlf`im2 LW 4.0? (08%C@2 4.?8-1.;1
Olrjhr siuoo ushrs, ihvhr sjlfhk2 LW 1.73 (08%C@2 4.8;-7.>7)
Nhrmhis (7448) Swhkhi 37;7 Jaeh ;8-=4 Currhit siuoo ushrs2 LW 1.4 (08%C@2 4.>-1.3)6 Olrjhr siuoo ushrs2 LW
(08%C@2 4.>-1.8)
Crlss-shct`liae stuk` hs2S`hmhe (1007) Xi`thk Staths 14?1 Jaeh -74-70- ]GC cluit (p54.41)6 Ltnhr var`agehs navh il s`mi`o`cait k`oohrhich
He`assli (1008) Swhkhi 17?? j/o 78-?; O`gr`ilmhi (p:4.448)6 Ltnhr var`agehs navh il s`mi`o`cait k`oohrhich
Thrssli (7444) Swhkhi 31?7 Jaeh 38-8? LW lo [yph @@ k`aghths ajlim currhit siuoo ushrs2 1.8 (08% C@2 4.>-3.
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74
[ageh 72 Gellk prhssurh/nhart rath `icrhash & sjlfhehss tlgaccl ush
Stuky # lo Sugbhcts [yph lo stuky Amh Ajluit & typh
lo S[ ush ka`ey
Whsuets
S`hmhe (1007) 14?1 gashgaee
peayhrs
crlss-shct`liae 74-70 (==%)
934 (73%)
siuoo & cnhw`im
tlgaccl
il supplrt
Gle`ikhr (100;) 13843? crlss-shct`liae
w`tn a clnlrt
oleelw`im
38-8;6 88-?8 sius WW lo strlfh
38-8;yr2 3.4
(08% C@2 1.8-8.=) 6
88-?8yr2 1.?
(08% C@2 1.4-7.8)
Aeehi (1008) 0= WC[ 1>-?8 i`clt`ih muj &
peachgl
il supplrt
Gle`ikhr (100=) 1;; o`rho`mnthrs Cash-clitrle 38-?4 sius il supplrt
Gle`ikhr (100>) 138 o`rho`mnthrs Cash-clitrle 38-?4 sius Supplrt
Nuntasaar` (1000)* 13=; Cash-clitrle 78-?; sius il supplrt
Nhrmhis (7448) 37;7 (ihsthk
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71
[ageh 32 Gellk cnlehsthrle hehvat`li & sjlfhehss tlgaccl ush
Stuky # lo Sugbhcts [yph lo stuky Amh Ajluit & typh
lo S[ ush ka`ey
Whsuets
S`hmhe (1007) 14?1 gashgaee
peayhrs
Crlss-shct`liae 74-70 (==%)
934 (73%)
siuoo & cnhw`im
tlgaccl
il supplrt
Aeehi (1008) 0= WC[ 1>-?8 i`clt`ih muj &
peachgl
il supplrt
Gle`ikhr (100=) 1;3 Cash-clitrle 38-?4 sius il supplrt
Nuntasaar` (1000)* 13=; Cash-clitrle 78-?; sius il supplrt
Ilrghrm (744?) 1?;07 Clnlrt 34, ;4, 84, ?4 sius supplrt
*Kata orlj tnh ]NL-JLI@CA (Juet`iat`liae JLI@tlr`im lo trhiks aik khthrj`iaits `i CArk`lvascuear k`shash) prlbhct
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77
[ageh ;2 Gellk meuclsh hehvat`li & sjlfhehss tlgaccl ush
Stuky # lo Sugbhcts [yph lo stuky Amh Ajluit & typh
lo S[ ush ka`ey
Whsuets
He`assli (1008)* 17?? (j & o) Crlss-shct`liae 78-?; sius il supplrt
Nuntasaar` (1000)* 13=; Cash-clitrle 78-?; sius il supplrt
Thrssli (7444) 31?7 Crlss-shct`liae 38-8? sius LW lo [yph7 k`aghths
sius5:7glxhs/whhf2
4.7 (08% C@2 4.4-7.4)
sius93glxhs/whhf2
7.= (08% C@2 1.3-8.8)
Ilrghrm (744?) 1?;07 Clnlrt 34, ;4, 84, ?4 sius supplrt
*Kata orlj tnh ]NL-JLI@CA (Juet`iat`liae JLI@tlr`im lo trhiks aik khthrj`iaits `i CArk`lvascuear k`shash) prlbhct
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73
73
G@GE@LMWATNP
1. Sius. @i2 ]`f`phk`a, tnh orhh Hicycelpahk`a (nttp2//hi.w`f`phk`a.lrm/w`f`/Sius).
7. Nafaea F ]J. Ilrk`c [lgaccl Clitrle---tlwarks sjlfhorhh slc`ht`hs. Clphinamhi6
7443.
3. Wlkmhrs A JS, Majgeh M, Seatthry B, Saikhrclcf T, ]arelw C. Gellk prhssurh aik r`sflo strlfh `i pat`hits w`tn chrhgrlvascuear k`shash. [nh Xi`thk F`imklj [rais`hit @scnahj`cAttacf Cleeaglrat`vh Mrlup. GJB 100?6313(=484)21;=.
;. ]`ghrm G SB, Arielv B, [hrhit A, _hssgy G, Rhtnhe`us G, E`ik E. Jhtagle`c r`sf oactlrsolr strlfh aik trais`hit `scnhj`c attacfs `i j`kkeh-amhk jhi2 a cljjui`ty-gashk stuky w`tnelim-thrj oleelw-up. Strlfh 744?63=(17)27>0>-043.
8. ]leo TA AW, Faiihe ]G. Atr`ae o`gr`eeat`li as ai `ikhphikhit r`sf oactlr olr strlfh2 tnhOraj`imnaj Stuky. Strlfh 1001677(>)20>3->.
?. Thrry @B WN, Jlrr`s W], Hgran`j SG, Xheaik TJ, Snaphr AM. Trlsphct`vh stuky loshruj tltae nljlcysth`ih clichitrat`li aik r`sf lo strlfh `i j`kkeh-amhk Gr`t`sn jhi. Eaicht100863;?(>0>=)21308->.
=. ]`cfe`i G. Ilrk`c [lgaccl Stat`st`cs 10=4-7443. Nsshegy/Stlcfnlej2 Stat`st`fgyri_HCANG6 744;.
>. E`kmark N, hk`tlr. Swhk`sn Sius Cliorlits Gas`c HX Tr`ic`pehs. Stlcfnlej2 IlrsthktsBur`k`f AG6 100=.
0. Grlakstlcf J. Systhjat`c rhv`hw lo tnh nhaetn hoohcts lo jlk`o`hk sjlfhehss tlgacclprlkucts. Ihw Rhaeaik Nhaetn [hcnilelmy Asshssjhit (IRN[A) Whplrt 744=614(1)288.
14. Marrark B. Nhaetn Sc`hichs E`thraturh Whv`hw Jakh Hasy2 tnh jatr`x jhtnlk. Sukgury2Blihs aik Gartehtt Tuge`snhrs6 744;.
11. Aeehi SS NK, Bhishi B, Mr`eel J, Ge`ss W. Hoohcts lo trhatjhit li cark`lvascuear r`sfajlim sjlfhehss tlgaccl ushrs. Trhv Jhk 100867;(;)238=-?7.
17. Gle`ikhr M AE, Himeuik A, kh Oa`rh X. Sjlfhehss tlgaccl ush aik `icrhashkcark`lvascuear jlrtae`ty ajlim Swhk`sn clistruct`li wlrfhrs. Aj B Tuge`c Nhaetn100;6>;(3)2300-;4;.
13. Ilrghrm J SN, E`ikane G, Gljai F, ]h`ihnaee E. Clitr`gut`li lo Swhk`sn jl`st siuoo tltnh jhtagle`c syikrljh2 A wleo `i snhhp's celtn`im< Scaik B Tuge`c Nhaetn 744?63;(?)28=?->3.
1;. Nhiehy SB [J, Cliihee C, Caeeh HH. [wl earmh prlsphct`vh stuk`hs lo jlrtae`ty ajlimjhi wnl ush siuoo lr cnhw`im tlgaccl (Xi`thk Staths). Caichr Caushs Clitrle 744861?(;)23;=-8>.
18. Olueks B WE. Causae hoohcts lo sjlfhehss tlgaccl li jlrtae`ty `i CTS-@ aik CTS-@@
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7;
Caichr Caushs Clitrle 744?61=(7)277=->.
1?. Nhiehy SB [J. Whsplish tl2 Olueks B aik Wajstrlj E ehtthr rhmark`im "Causae hoohcts losjlfhehss tlgaccl li jlrtae`ty `i CTS-@ aik CTS-@@". Caichr Caushs Clitrle 744?61=(?)2>8=->.
1=. Hshr @ FE, Muihs XP, Khj`r P. [nh hoohct lo k`oohrhit glky pls`t`lis li gellk prhssurh. BCe`i Iurs 744=61?(1)213=-;4.
1>. Aspeuik F IS, Baiehrt X, Sthmjayr G. Sjlfhehss tlgaccl as a plss`geh r`sf oactlr olrstrlfh `i jhi2 a ihsthk cash-clitrle stuky. Strlfh 744363;(=)21=8;-0.
10. Nuntasaar` O, Euikghrm, _., He`assli, J., Baiehrt, X. & Aspeuik, F. Sjlfhehss tlgaccl asa plss`geh r`sf oactlr olr jylcark`ae `ioarct`li2 a plpueat`li-gashk stuky `i j`kkeh-amhk jhi. BAj Clee Cark`le 100063;(?)21=>;-04.
74. Gle`ikhr M IA, ]anrhi B, Kh Oa`rh X. Elim-thrj ush lo sjlfhehss tlgaccl aik pnys`caephrolrjaich `i j`kkeh-amhk jhi. Hur B Ce`i @ivhst 100=67=(8)2;7=-3.
71. Gle`ikhr M IA, kh Oa`rh X, ]anrhi B. Sjlfhehss tlgaccl ush aik atnhrlscehrls`s2 aiuetraslilmrapn`c `ivhst`mat`li lo carlt`k `it`ja jhk`a tn`cfihss `i nhaetny j`kkeh-amhk jhi.Atnhrlscehrls`s 100=6137(1)208-143.
77. Gle`ikhr M kOX. Ajgueatlry 7;-n gellk prhssurh jli`tlr`im `i nhaetny, j`kkeh-amhksjlfhehss tlgaccl ushrs, sjlfhrs, aik ilitlgaccl ushrs. Aj B Nyphrthis 100>611(14)21183-?3.
73. Nhrmhis JT AA, Aikhrssli [, Thrsnamhi M. Swhk`sn jl`st siuoo aik jylcark`ae`ioarct`li ajlim jhi. Hp`khj`lelmy 744861?(1)217-?.
7;. S`hmhe K GI, Hristhr _E, Mraky KM, Naucf ]]. Sjlfhehss tlgaccl, cark`lvascuear r`sfoactlrs, aik i`clt`ih aik clt`i`ih ehvhes `i prlohss`liae gashgaee peayhrs. v 10076>7(3)2;1=-71.
78. He`assli J AF, Hvr`i TH, Euikgeak K. Wheat`lisn`p lo c`marhtth sjlf`im aik siuook`pp`im tl peasja o`gr`ilmhi, o`gr`ileyt`c var`agehs aik shruj `isue`i. [nh Ilrtnhri SwhkhiJLI@CA Stuky. Atnhrlscehrls`s 10086113(1)2;1-83.
7?. Thrssli TM CS, Svaistrlj E, Lsthisli CM. Hohik`c S, Mr`ee _. C`marhtth sjlf`im, lraejl`st siuoo ush aik meuclsh `itlehraich. B @ithri Jhk 744467;>(7)2143-14.
7=. Klee W. O`oty yhars lo rhsharcn li tlgaccl. B Hp`khj`le G`lstat 744468(?)2371-0.
7>. Klee W. Sjlf`im aik Euim Caichr. Aj B Whsp`r Cr`t Carh Jhk 744461?7(1)2;-?.
70. Clicatl B, Snan, I`rav, Nlrw`tz, Waepn @. Waiklj`zhk, Clitrleehk [r`aes, Lgshrvat`liaeStuk`hs, aik tnh N`hrarcny lo Whsharcn Khs`mis. I Hime B Jhk 744463;721>>=-1>07.
34. Tlclcf SB, Heglurih, K`aia W. Waiklj`zhk [r`aes lr Lgshrvat`liae [r`gueat`lis< I HimeB Jhk 744463;72104=-1040.