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EnglishGolfer Name must be 4 to 16 characters in length, only letters and numbers allowed. Golfer Name can contain no spaces.

my mother cooks a delicious food

Ultimo aggiornamento 2014-04-22
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Golfer Name must be 4 to 16 characters in length, only letters and numbers allowed. Golfer Name can contain no spaces.

Golfer Name must be 4 to 16 characters in length, only letters and numbers allowed. Golfer Name can contain no spaces.

Ultimo aggiornamento 2014-02-09
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Chapter I Political Science: The Discipline Robert E. Goodin Hans-Dieter Klingemann RETROSPECTIVES are, by their nature, inherently selective. Many fascinating observations are contained within the wide- ranging surveys which constitute the New Handbook of Political Science. Many more emerge from reading across all of its chapters, collectively. But, inevitably, the coverage is incomplete and, equally inevitably, somewhat idiosyncratic. All authors are forced to leave out much of merit, often simply because it does not fit their chosen narrative structure. The New Handbook's contributors tell a large part of the story of what has been happening in political science in the last two decades, but none would pretend to have told the whole story. It is the task of this introductory chapter to set those chapters in a larger disciplinary context and to pull out some of their more interesting common threads. Just as the coverage of each of the following chapters is inevitably selective, that of this overview of the overviews is, inevitably, all the more so. Of the several themes and subthemes which emerge, looking across these chapters as a whole, we shall focus upon one in particular. The New Handbook provides striking evidence of the professional maturation of political science as a discipline. This development has two sides to it. On the one side, there is increasing differentiation, with more and more sophisticated work being done within subdisciplines (and, indeed, within sub-specialities within subdisciplines). On the other side, there is increasing integration across all the separate subdisciplines. Of the two, increasing differentiation and specialization is the more familiar story, integration the more surprising one. But dearly it is the case that there is, nowadays, an increasing openness to and curiosity about what is happening in adjacent subdisciplines. An increasingly shared -3- overarching intellectual agenda across most all of the subdisciplines makes it possible for theoretical innovations to travel across subdisciplinary boundaries. An increasingly shared methodological tool-kit makes such interchange easy. All of this is facilitated, in turn, by an increasing band of synthesizers of the discipline, often intellectually firmly rooted in one particular subdiscipline but capable of speaking to many subdisciplines in terms which they find powerfully engaging. Among the many things which strike us, reading across the chapters of the New Handbook as a Whole, these are the ones that strike us most forcefully and which we will elaborate upon in this chapter. I Political science as a discipline A central claim of this chapter is that political science, as a discipline, has become increasingly mature and professionalized.1 As an important preliminary to that discussion, we must address, necessarily briefly, a few threshold questions. What is it for political science to constitute a discipline? What is politics? In what sense can the study of politics aspire to the status of a science? A The nature of a discipline Inured as we are to speaking of the subdivisions of academic learning as "disciplines" it pays to reflect upon the broader implications of that phrase. According to the Concise Oxford English Dictionary a discipline is variously defined as: "a branch of instruction; mental and moral training, adversity as effecting this; military training, drill . . .; order maintained among schoolboys, soldiers, prisoners, etc.; system of rules for conduct; control exercised over members of church; chastisement; (Ecclesiastical) mortification by penance." The last dictionary definition would seem to have only marginal application to academic disciplines, but most of the others have clear counterparts. An academic "discipline" may enjoy minimal scope to "punish," at least in the most literal senses ( Foucault 1977). Still, the community of ____________________ 1 Once "professionalized" might have equated, readily and narrowly, to "Americanized." But as alluded to in our Preface and as is evident from New Handbook contributors' affiliations, the profession itself is becoming more internationalized, both in its personnel and in its professional concerns. -4- scholars which collectively constitutes a discipline does exercise a strict supervisory function--both over those working within it and, most especially, over those aspiring to do so. The "order maintained" is not quite the same as that over soldiers or schoolboys, nor is the training strictly akin to military drill. Nonetheless, there is a strong sense (shifting over time) of what is and what is not "good" work within the discipline, and there is a certain amount of almost rote learning involved in "mastering" a discipline. All the standard terms used to describe academic disciplines hark back to much the same imagery. Many, for example, prefer to think of political analysis as more of an "art" or "craft" than a "science," strictly speaking ( Wildavsky 1979). But on that analogy the craft of politics can then only be mastered in the same manner in which all craft knowledge is acquired, by apprenticing oneself (in academic craftwork, "studying under") a recognized "master" Others like to speak of politics, as well as the academic study thereof, as a "vocation" ( Weber 1919/1946) or a "calling".2 But, tellingly, it is a vocation rather than an avocation, a job rather than a hobby; and as in the core religious meaning so too in the academic one, the "calling'' in question is to service of some higher power (be it an academic community or the Lord). Most of us, finally, talk of academic disciplines as "professions." In Dwight Waldo ( 1975: 123) delightful phrase "sciences know, professions profess." What scientists profess, however, are articles of the collective faith. Any way we look at them, then, disciplines are construed at least in large part as stern taskmasters. But the same received disciplinary traditions and practices which so powerfully mould and constrain us are at one and the same time powerfully enabling. The framework provided by the structure of a discipline's traditions both focuses research and facilitates collaboration, unintentional as well as intentional. A shared disciplinary framework makes it possible for mere journeymen to stand, productively, on the shoulders of giants. It also makes it possible for giants to build, productively, on the contributions of legions of more ordinarily gifted practitioners.3 Discipline, academic or otherwise, is thus a classic instance of a useful self-binding mechanism. Subjecting oneself to the discipline of a discipline--or in the case of Dogan's (below: chap. 3) hybrid scholars, of several--is conducive to more and indisputably better work, both individually ____________________ 2 Both Berger Invitation to Sociology ( 1963) and Medawar Advice to a Young Scientist ( 1989: esp. chap. 2) verge on this. Much the finest work in this genre remains F. M. Cornford justly celebrated Microcosmographia Academia ( 1908). 3 For powerful evidence of the way that certain discoveries are "on the cards" at some point in time, consider the cases of "multiple discoveries" discussed in Merton ( 1973). -5- and collectively. That is as true for the "chiefs" as the "indians" of the discipline, as true for the "Young Turks" as the "greybeards." Branches of academic learning are "professions" as well as disciplines. "Professional" connotes, first of all, a relatively high-status occupational grade; and the organization of national and international "professional associations" doubtless has to do, in no small part, with securing the status and indeed salaries of academics thus organized. But the term "professional'' also, and more importantly, indicates a certain attitude toward one's work. A profession is a self-organizing community, oriented toward certain well-defined tasks or functions. A professional community is characterized by, and to a large extent defined in terms of, certain self-imposed standards and norms. Incoming members of the profession are socialized into those standards and norms, ongoing members are evaluated in terms of them. These professional standards and norms not only form the basis for evaluation of professionals by one another; they are "internalized," with professionals themselves taking a "critical reflective attitude" toward their own performances in light of them.4 The specific standards and norms vary from profession to profession, of course. But across all professions there is a sense of "minimal professional competence," captured by the ritual of "qualifying examinations" for intending political scientists in North American post-graduate training programs. And across all professions there is a notion of particular "role responsibilities" attaching to membership in a profession. The professional ethics of academics do not touch on issues of life and death in quite the same way as those of doctors or lawyers, perhaps. But virtually all academic professions have increasingly formal codes of ethics, touching largely on matters to do with integrity in the conduct and promulgation of research; and all professionals are expected to adhere to them faithfully ( APSA 1991). One of our themes in this chapter is the increasing "professionalism" within political science as a whole. By this we mean, firstly, that there is increasing agreement to a "common core" which can be taken to define "minimal professional competence" within the profession. Secondly, there is an increasing tendency to judge work, one's own even more than others', in terms of increasingly high standards of professional excellence. While the minimal standards are largely shared ones, the higher aspirations are many and varied. But as in medicine so too in political science, each sub-speciality within the larger profession has its own internal stan ____________________ 4 In much the same way Hart ( 1961) depicts the norms of legal systems, more generally, being internalized. On the nature of professions and members orientation toward them, see Hughes ( 1958) and Parsons ( 1968). -6- dards of excellence, by which each member of that fraction of the profession is properly judged. And in political science just as in medicine, there is some broad sense across the profession as a whole as to how all the subspecialities sit together to form a coherent larger whole. B What is politics? The foregoing observations, by and large, pertain to academic disciplines quite generally. Disciplines are differentiated one from another in many ways, principally among them by their substantive concerns and by the methodologies that they have made their own. Although there are, as we shall argue, a number of useful "tricks" in political science's tool-kit which are shared by most members of most of its subdisciplines, Alker (below: chap. 35) is undeniably correct in saying that political science does not have--much less define itself in terms of--a single big methodological device all its own, the way that many disciplines do. Rather, political science as a discipline is defined by its substantive concerns, by its fixation on "politics" in all its myriad forms. "Politics" might best be characterized as the constrained use of social power. Following on from that, the study of politics--whether by academics or practical politicians--might be characterized, in turn, as the study of the nature and source of those constraints and the techniques for the use of social power within those constraints.5 When defining politics in terms of power, we follow many before us.6 "Power" is, by now, well known to be a fraught conceptual field.7 Respectful though we are of its complexities, we decline to let ourselves get bogged down in them. Dahl ( 1957) old neo-Weberian definition still serves well enough. In those terms, X has power over Y insofar as: (i) X is able, in one way or another, to get Y to do something (ii) that is more to X's liking, and (iii) which Y would not otherwise have done. Where our analysis departs from tradition is in defining politics in terms of the constrained use of power. To our way of thinking, unconstrained power is force, pure and simple. It is not a political power play at all, except perhaps in some degenerate, limiting-case sense. Pure force, literally ____________________ 5 This in turn gives rise to the dual foci of the discipline, identified by Almond (below: chap. 2), on "the properties of political institutions and the criteria we use to evaluate them." 6 Notable among them: Weber ( 1922/ 1978); Lassweil ( 1950; Lasswell and Kaplan 1950), Dahl ( 1963) and Duverger ( 1964/ 1966). We, like them, focus specifically on "social" power, the power of people over other people. 7 To classic texts such as Russell ( 1938), Jouvenel ( 1945/ 1948) and Dahl ( 1957; 1961b; 1963) have recently been added Lukes ( 1974), Barry ( 1989: esp. chaps. 8-11) and Morriss ( 1987). -7- speaking, is more the province of physics (or its social analogues: military science and the martial arts) than of politics.8 It is the constraints under which political actors operate, and strategic maneuvering that they occasion and that occurs within them, that seems to us to constitute the essence of politics.9 It is the analysis of those constraints--where they come from, how they operate, how political agents might operate within them--that seems to us to lie at the heart of the study of politics.10 We talk, broadly, about the use of social power (rather than, more narrowly, about its "exercise") as a gesture toward the multitude of ways in which political agents might maneuver within such constraints. We mean the term to cover intentional acts as well as unintended consequences of purposeful action ( Merton 1936). We mean it to cover covert manipulatory politics as well as overt power plays ( Schattschneider 1960; Goodin 1980; Riker 1986). We mean it to cover passive as well as active workings of power, internalized norms as well as external threats ( Bachrach and Baratz 1963; Lukes 1974). The infamous "law of anticipated reactions" non-decisions and the hegemonic shaping of people's preferences ( Laclau and Mouffe 1985) must all be accommodated in any decently expansive sense of the political. One further comment on concepts. In defining politics (and the study of it) as we do, we explicitly depart from the purely distributional tradition of Lasswell ( 1950) classic formulation of "politics" as "who gets what, when and how''11 Perhaps it is true that all political acts ultimately have distributional consequences; and perhaps it is even true that therein lies most of our interest in the phenomenon. But in terms of the meaning of the act to the actor, many political acts are at least in the first instance distinctly non- distributional. And even in the final analysis, much of the social significance--objective as well as subjective--of certain political interactions might never be reducible to crass questions of dividing up the social pie. Distributive, regulative, redistributive ( Lowi 1964) and identity ( Sandel 1982) politics may all have their own distinctive styles. ____________________ 10 In saying this, we are following (loosely) Crick 1962. 11 Or Easton ( 1965) of politics as the authoritative allocation of values--at least insofar as that is construed, first and foremost, as a matter of the allocation of"valued things" in a society. 8 Thus, an absolute dictator in quest of complete, unconstrained power would rightly be said to be engaged in an (inevitably futile) attempt to transcend politics. 9 Consider the following analogy drawn from a cognate discipline. Philosophers talk in terms of "strong" considerations, "compelling" arguments, and such like ( Nozick 1981: 4-6). But consider an argument such that if we did believe it we would die: that is about as compelling as an argument can get; but winning a point by means of such an argument seems the antithesis of real philosophical disputation, the essence of which is give-and-take. By the same token, the very essence of politics is strategic maneuvering ( Riker 1986); and irresistible forces, insofar as they leave no scope for such maneuvering, are the antithesis of politics (however successful they are at getting others to do what you want). -8- Distributional struggles are characterized, in welfare economists' terms, as squabbles over where we sit on the Paretian frontier; but getting to the Paretian frontier is itself a tricky problem, involving a lot of politicking of quite a different sort which is often distinctively non-distributional, at least in the first instance. Important though it undeniably is that our understanding of politics should be attuned to distributive struggles, then, it is equally important that it not be committed in advance to analyzing all else exclusively in terms of them. C The several sciences of politics Much ink has been sprit over the question of whether, or in what sense, the study of politics is or is not truly a science. The answer largely depends upon how much one tries to load into the term "science." We prefer a minimalist definition of science as being just "systematic enquiry, building toward an ever more highly-differentiated set of ordered propositions about the empirical world.''12 In those deliberately spartan terms, there is little reason to think that the study of politics cannot aspire to be scientific. Many, of course, mean much more than that by the term. A logical positivist might cast the aspirations of science in terms of finding some set of "covering laws" so strong that even a single counter-example would suffice to falsify them. Clearly, that sets the aspirations of science much too high ever to be attained in the study of politics. The truths of political science, systematic though they may be, are and seem inevitably destined to remain essentially probabilistic in form. The "always" and "never" of the logical positivist's covering laws find no purchase in the political world, where things are only ever "more or less likely" to happen. The reason is not merely that our explanatory model is incomplete, not merely that there are other factors in play which we have not yet managed to factor in. That will inevitably be true, too, of course. But the deeper source of such errors in the positivist model of political science lies in a misconstrual of the nature of its subject. A covering law model may (or may not: that is another issue) work well enough for billiard balls subject to the sorts of forces presupposed by models of Newtonian mechanics: there all actions can be said to be caused, and the causes can be exhaustively traced to forces acting externally upon the "actors." But human beings, while they are undeniably subject to certain causal forces as well, are also in ____________________ 12 After the fashion o

pagi hari

Ultimo aggiornamento 2014-10-29
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googl1 00:00:00,100 --> 00:00:01,600 Previously on criminal minds... 2 00:00:01,700 --> 00:00:03,400 Elle, 2 weeks of pure heaven. 3 00:00:03,500 --> 00:00:04,600 Do not call me for anything. 4 00:00:04,700 --> 00:00:06,300 Have a great time. You all deserve a break. 5 00:00:06,400 --> 00:00:07,500 Welcome to paradise. 6 00:00:07,600 --> 00:00:09,000 Your resort is beautiful. 7 00:00:09,100 --> 00:00:12,000 A man said there had been a murder in room 19. 8 00:00:12,100 --> 00:00:13,000 Get down! Aah! 9 00:00:13,100 --> 00:00:14,500 Who are you?! 10 00:00:14,600 --> 00:00:15,800 Where is the victim's head? 11 00:00:15,900 --> 00:00:16,900 I'm here on vacation. 12 00:00:17,000 --> 00:00:18,600 From jamaica. Someone sent you a head? 13 00:00:18,600 --> 00:00:20,300 Morgan and elle are in jamaica right now. 14 00:00:20,400 --> 00:00:21,500 Agent greenaway wasn't even here 15 00:00:21,600 --> 00:00:22,600 When this man was killed. 16 00:00:22,600 --> 00:00:23,700 How did he know where we were? 17 00:00:23,800 --> 00:00:25,500 A man came to the door with something 18 00:00:25,600 --> 00:00:26,500 He said you would need right away. 19 00:00:26,600 --> 00:00:27,700 He came to the door? 20 00:00:27,700 --> 00:00:29,100 I was playing a game yesterday. 21 00:00:29,200 --> 00:00:31,500 The hacker could have gotten into my computer first. 22 00:00:31,600 --> 00:00:34,100 I have far less protection on my own laptop. 23 00:00:34,200 --> 00:00:35,500 How could you be that stupid? 24 00:00:35,600 --> 00:00:37,000 I found him. You what? 25 00:00:37,100 --> 00:00:38,100 I know who he is, the hacker, 26 00:00:38,100 --> 00:00:39,100 His name's geist. 27 00:00:39,200 --> 00:00:40,500 Now you're on a quest. 28 00:00:40,600 --> 00:00:42,200 A young girl's life depends 29 00:00:42,300 --> 00:00:43,800 On the successful completion of it. 30 00:00:43,900 --> 00:00:46,100 Aah! Aah! 31 00:00:46,200 --> 00:00:48,900 The one rule is, only the members of your team 32 00:00:49,000 --> 00:00:50,500 May participate in the quest. 33 00:00:51,800 --> 00:00:52,800 He's given us all the clues 34 00:00:52,800 --> 00:00:54,700 Needed to complete this quest, 35 00:00:54,800 --> 00:00:56,300 Including this book code. 36 00:00:56,400 --> 00:00:58,900 Each one of these sets of numbers represents a particular word. 37 00:00:58,900 --> 00:01:00,200 From what book? 38 00:01:00,200 --> 00:01:02,200 Jj, get some reporters here as soon as possible. 39 00:01:02,200 --> 00:01:04,100 Didn't he say that we had to keep this under the team? 40 00:01:04,200 --> 00:01:05,500 We're looking for this man... 41 00:01:05,500 --> 00:01:08,400 No, no, no, no, i said no outsiders. 42 00:01:08,500 --> 00:01:10,000 I'm awake. 43 00:01:10,100 --> 00:01:11,300 Anderson, take greenaway home. 44 00:01:11,400 --> 00:01:12,900 Yes, sir. Get some sleep. 45 00:01:13,000 --> 00:01:15,400 I told you, it was one rule. 46 00:01:15,500 --> 00:01:16,600 One rule! 47 00:01:21,200 --> 00:01:22,900 "The defects and faults of the mind 48 00:01:22,900 --> 00:01:25,200 "Are like wounds in the body. 49 00:01:25,200 --> 00:01:26,300 "After all imaginable care has been taken 50 00:01:26,400 --> 00:01:28,700 "To heal them up, 51 00:01:28,700 --> 00:01:32,400 Still there will be a scar left behind." 52 00:01:32,400 --> 00:01:35,000 French writer francois la rochefoucauld. 53 00:01:41,400 --> 00:01:42,500 Sir, i thought you'd want to know. 54 00:01:42,500 --> 00:01:44,700 We identified the girl in the video... 55 00:01:44,800 --> 00:01:46,400 Rebecca bryant. 56 00:01:46,400 --> 00:01:48,500 Leave it on the desk. 57 00:02:07,000 --> 00:02:09,400 Reid, how many books do you think are published in a year? 58 00:02:09,400 --> 00:02:10,600 In the whole world? 59 00:02:10,600 --> 00:02:11,700 Thousands. 60 00:02:11,800 --> 00:02:14,400 Great, and all we gotta do is find one. 61 00:02:16,100 --> 00:02:17,800 You know, i can see this unsub 62 00:02:17,800 --> 00:02:19,000 Gettin' our phone numbers and addresses 63 00:02:19,000 --> 00:02:20,000 From the bureau personnel files, 64 00:02:20,100 --> 00:02:21,400 But come on, man, 65 00:02:21,500 --> 00:02:23,700 It really says in there that gideon digs nellie fox? 66 00:02:23,800 --> 00:02:25,700 Or that jj collects butterflies? 67 00:02:25,700 --> 00:02:27,600 I didn't even know these things about us. 68 00:02:27,700 --> 00:02:29,200 "Ever would it be night, 69 00:02:29,200 --> 00:02:31,900 But always clear day to any man's sight." 70 00:02:31,900 --> 00:02:34,800 Reid, not again with the poem from the music box, please. 71 00:02:34,800 --> 00:02:35,900 There's something familiar about it. 72 00:02:36,000 --> 00:02:38,800 I think i've heard it somewhere before. 73 00:02:38,900 --> 00:02:40,400 Thought you had a photographic memory. 74 00:02:40,400 --> 00:02:41,700 Eidetic memory, 75 00:02:41,800 --> 00:02:43,100 And that's primarily related to things i read. 76 00:02:43,200 --> 00:02:45,100 Like i said, this is something i think i've heard. 77 00:02:45,200 --> 00:02:46,200 Which leaves us... 78 00:02:46,300 --> 00:02:47,200 Nowhere, that's where it leaves is. 79 00:02:47,300 --> 00:02:48,300 Not necessarily. 80 00:02:48,400 --> 00:02:49,400 How would we proceed 81 00:02:49,500 --> 00:02:52,000 If we didn't have all these clues? 82 00:02:52,100 --> 00:02:53,500 What's the first thing we'd look at? 83 00:02:53,600 --> 00:02:54,900 Victimology. 84 00:02:54,900 --> 00:02:56,500 Why this particular victim in this particular place 85 00:02:56,600 --> 00:02:57,600 At this particular time? 86 00:02:57,600 --> 00:02:59,100 We have a victim, don't we? 87 00:02:59,200 --> 00:03:01,200 Rebecca bryant. 88 00:03:01,300 --> 00:03:03,400 Missin' out of south boston, virginia. 89 00:03:03,400 --> 00:03:05,300 You can get there in a few hours if you hurry. 90 00:03:05,400 --> 00:03:07,900 Take jj. Find out everything there is to know about this girl. 91 00:03:07,900 --> 00:03:08,900 You go it. 92 00:03:08,900 --> 00:03:10,000 Been lettin' him lead us around 93 00:03:10,100 --> 00:03:11,000 Like he's somethin' more than he is. 94 00:03:11,100 --> 00:03:12,600 He's just another unsub. 95 00:03:12,600 --> 00:03:13,800 Let's start puttin' together a profile. 96 00:03:13,900 --> 00:03:15,300 What you want me to do? 97 00:03:15,400 --> 00:03:16,500 Just keep workin' on this. 98 00:03:16,500 --> 00:03:18,100 If anybody can put it together, you can. 99 00:03:40,600 --> 00:03:42,400 Please help me. 100 00:03:48,000 --> 00:03:49,000 Anderson?e translit

peedback

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gAssessment of menopausal status, including premature ovarian failure Assessing ovarian status, including follicle development, ovarian reserve, and ovarian responsiveness, as part of an evaluation for infertility and assisted reproduction protocols such as in vitro fertilization Assessing ovarian function in patients with polycystic ovarian syndrome Evaluation of infants with ambiguous genitalia and other intersex conditions Evaluating testicular function in infants and children Diagnosing and monitoring patients with antimullerian hormone-secreting ovarian granulosa cell tumors Method Name Immunometric Assay Reporting Name Antimullerian Hormone, S Aliases Mullerian inhibiting factor (MIF) Mullerian-inhibiting hormone (MIH) Mullerian-inhibiting substance (MIS) Specimen Type Serum Specimen Required Container/Tube: Preferred: Red top Acceptable: Serum gel Specimen Volume: 0.2 mL Specimen Minimum Volume 0.1 mL Reject Due To Hemolysis Mild OK; Gross reject acceptable to 1,000 mg/dL Lipemia Mild OK, Gross needs to be spun Icterus Mild OK, interpret with caution; Gross reject Other NA Specimen Stability Information Specimen Type Temperature Time Serum Refrigerated (preferred) 7 days Frozen 90 days Clinical Information Antimullerian hormone (AMH), also known as mullerian-inhibiting substance, is a dimeric glycoprotein hormone belonging to the transforming growth factor-beta family. It is produced by Sertoli cells of the testis in males and by ovarian granulosa cells in females. Expression during male fetal development prevents the mullerian ducts from developing into the uterus and other mullerian structures, resulting in normal development of the male reproductive tract. In the absence of AMH, the mullerian ducts and structures develop into the female reproductive tract. AMH is also expressed in the follicles of females of reproductive age and inhibits the transition of follicles from primordial to primary stages. Follicular AMH production begins during the primary stage, peaks in the preantral and small antral stages, and then decreases to undetectable concentrations as follicles grow larger. AMH serum concentrations are elevated in males under 2 years old and then progressively decrease until puberty, when there is a sharp decline. By contrast, AMH concentrations are low in female children until puberty. Concentrations then decline slowly over the reproductive lifespan as the size of the pool of remaining microscopic follicles decreases. AMH concentrations are frequently below the detection limit of current assays after natural or premature menopause. Because of the gender differences in AMH concentrations, its changes in circulating concentrations with sexual development, and its specificity for Sertoli and granulosa cells, measurement of AMH has utility in the assessment of gender, gonadal function, fertility, and as a gonadal tumor marker. Since AMH is produced continuously in the granulosa cells of small follicles during the menstrual cycle, it is superior to the episodically released gonadotropins and ovarian steroids as a marker of ovarian reserve. Furthermore, AMH concentrations are unaffected by pregnancy or use of oral or vaginal estrogen- or progestin-based contraceptives. Studies in fertility clinics have shown that females with higher concentrations of AMH have a better response to ovarian stimulation and tend to produce more retrievable oocytes than females with low or undetectable AMH. Females at risk of ovarian hyperstimulation syndrome after gonadotropin administration can have significantly elevated AMH concentrations. Polycystic ovarian syndrome can elevate serum AMH concentrations because it is associated with the presence of large numbers of small follicles. AMH measurements are commonly used to evaluate testicular presence and function in infants with intersex conditions or ambiguous genitalia, and to distinguish between cryptorchidism (testicles present but not palpable) and anorchia (testicles absent) in males. In minimally virilized phenotypic females, AMH helps differentiate between gonadal and nongonadal causes of virilization. Serum AMH concentrations are increased in some patients with ovarian granulosa cell tumors, which comprise approximately 10%[ERROR] of ovarian tumors. AMH, along with related tests including inhibin A and B (#81049 Inhibin A, Tumor Marker, Serum; #88722 Inhibin B, Serum, #86336 Inhibin A and B, Tumor Marker, Serum), estradiol (#81816 Estradiol, Serum), and CA-125 (#9289 Cancer Antigen 125 (CA 125), Serum), can be useful for diagnosing and monitoring these patients. Reference Values Males 12 years: 0.7-19 ng/mL Females 45 years: <1.0 ng/mL Interpretation Menopausal women or women with premature ovarian failure of any cause, including after cancer chemotherapy, have very low antimullerian hormone (AMH) levels, often below the current assay detection limit of 0.25 ng/mL. While the optimal AMH concentrations for predicting response to in vitro fertilization are still being established, it is accepted that AMH concentrations in the perimenopausal to menopausal range (0-0.6 ng/mL) indicate minimal to absent ovarian reserve. Depending on patient age, ovarian stimulation is likely to fail in such patients and most fertility specialists would recommend going the donor oocyte route. By contrast, if serum AMH concentrations exceed 3 ng/mL, hyper-response to ovarian stimulation may result. For these patients, a minimal stimulation would be recommended. In patients with polycystic ovarian syndrome, AMH concentrations may be 2 to 5 fold higher than age-appropriate reference range values. Such high levels predict anovulatory and irregular cycles. In children with intersex conditions, an AMH result above the normal female range is predictive of the presence of testicular tissue, while an undetectable value suggests its absence. In boys with cryptorchidism, a measurable AMH concentration is predictive of undescended testes, while an undetectable value is highly suggestive of anorchia or functional failure of the abnormally sited gonad. Granulosa cell tumors of the ovary may secrete AMH, inhibin A, and inhibin B. Elevated levels of any of these markers can indicate the presence of such a neoplasm in a woman with an ovarian mass. Levels should fall with successful treatment. Rising levels indicate tumor recurrence/progression. Cautions Like all laboratory tests, antimullerian hormone (AMH) measurement alone is seldom sufficient for diagnosis and results should be interpreted in the light of clinical findings and other relevant test results, such as ovarian ultrasonography (in fertility applications, this would include an antral follicle count), abdominal or testicular ultrasound (intersex/testicular function applications) and measurements of sex steroids (estradiol, testosterone, progesterone), follicle-stimulating hormone (FSH), inhibin B (for fertility), and inhibin A and B (for tumor workup). Elevated AMH is not specific for malignancy, and the assay should not be used exclusively to diagnose or exclude an AMH-secreting ovarian tumor. This assay demonstrates no cross reactivity with transforming growth factor beta-1, activin A, inhibin A or B, luteinizing hormone alpha or beta, FSH, thyroid-stimulating hormone, or insulin-like growth factor-1. However, although unlikely, there might be cytokines that have not been evaluated for cross reactivity that do cross react, resulting in false-elevations. As with other immunoassays, the AMH assay can be susceptible to false-low results at extremely high analyte concentrations (hooking effect) or in the hypothetical scenario of the presence of anti-AMH autoantibodies in a patient serum specimen. Heterophilic antibody interferences that are not blocked by the assay’s blocking regents may also rarely occur, causing typically false-high results. If test results are incongruent with the clinical picture, the laboratory should be contacted.

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Ultimo aggiornamento 2013-04-16
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