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Evaluation of volumetric modulated arc therapy technique for cranio-spinal irradiation: A rando - phantom based dosimetric study Background: In this study, clinical advantages and the dosimetric accuracy of volumetric modulated arc therapy (VMAT) technique for cranio-spinal irradiation (CSI) were investigated and compared with field in field (FinF) and intensity modulated radiotherapy (IMRT) techniques. Materials and Methods: The organs at risk (OARs) and planning target volume (PTV) were generated on the RANDO phantom computerized tomography (CT) image series. The dosevolume parameters for PTVs and OARs were compared for three techniques. Furthermore, the dose distribution inside the RANDO phantom was measured with thermoluminescent dosimeter (TLD) for all three techniques. Comparisons were done between measured and calculated doses of field junctions, targets and OARs. Results: FinF failed to obtain an adequate dose distribution for the upper spine (US), while VMAT and IMRT provided good dose coverage for all parts of the PTV. The most homogeneous dose distribution at the field junctions was obtained with the VMAT. Although heart, thyroid, intestine, lung, liver and testicular maximum doses were lower for the VMAT, the mean doses were higher except for the heart and thyroid. The absolute volume receiving prescription dose was significantly lower for the VMAT. The median differences between the TLD measurements and TPS calculations were 0.27% (7.8, -9.7; p=0.394), -0.28% (8.1, -10.7; p=0.322) and 0.33% (8.4, -12; p=0.338) for the FinF, IMRT and VMAT, respectively. These differences were not found statistically significant for the VMAT technique, as were the other two techniques. Conclusion: We conclude that the VMAT technique is the optimal Linac based CSI treatment in regards to dose coverage, dose homogeneity in field junctions and OAR sparing for higher doses. In addition, the VMAT showed dose distribution accuracy as good as the two other techniques in measurements simulating real clinical situations.

Streaming implementation of video algorithms on a low-power parallel architecture Low-power real-time streaming implementation of many video algorithms is possible using many-core-processor integrated circuit platforms, such as the Coherent Logix hx3100TM processor based on HyperX technology, by structuring the algorithm as a data flow implementation so as to make full use of the inherent parallelism of the architecture. This is illustrated using a 2-D discrete wavelet transform for an image-fusion application. Calculations for different frame sizes are given to show scalability.

In manufacturing of integrated circuits, display panels, disks and the like, sputtering (hereinafter also referred to as sputter) is widely used to form a film on a substrate such as a semiconductor wafer, a glass panel, and a resin disk. Sputter is a film formation technique in which ions collide with the surface of a target, and thereby particles are ejected from the surface and are deposited on a substrate to form a film. The target is fixed to a backing plate. The backing plate is cooled by a cooling means, thereby cooling the target. The backing plate also functions as an electrode that applies a voltage to the target. In order to perform sputter efficiently, a magnetron sputter is widely used in which a magnet is disposed on the back surface of the target. In the magnetron sputter, a voltage is applied to a target to form plasma formed in an area near the target, and the plasma thus formed is confined to the area near the target by a magnetic field, so that the sputter can be performed efficiently. A configuration is proposed in which a shield enclosing the outer circumference of the target is grounded (hereinafter also referred to as ground shield) to serve as an anode whereas the target and the backing plate function as a cathode under application of a voltage (Patent Document 1). In addition, Patent Document 1 discloses that the shield is made of a magnetic material, thereby further confining the plasma to the area near the target.

Minnesota Policy on Pharmacist-Prescribed Contraceptives: Benefits, Limitations, and Opportunities for Improvement Abstract In August 2020, pharmacists were authorized to prescribe contraceptives in Minnesota outside of a collaborative practice agreement. To practice under this new authorization, pharmacists must complete formal contraceptive prescribing training and follow guidelines which include restrictions on patients age and appropriate screening and assessment requirements. Allowing pharmacists to prescribe contraceptives has the potential to extend contraceptive access, decrease overall health care costs, and improve outcomes. However, barriers to the expansion of contraceptive prescribing by pharmacists may prevent widespread adoption of this practice in Minnesota. A key concern among pharmacists is a lack of reimbursement for providing this service. Other states adopting contraceptive prescribing by pharmacists which have not paid for this service have reported limited implementation and discontinuation of this service. To improve contraceptive access to Minnesotans, policymakers should consider expanding provider status to pharmacists and providing reimbursement to pharmacists for contraceptive services. Patients under the age of 18 may only utilize a pharmacist to prescribe contraceptives if there is a prior record of prescribing by another licensed provider. Second, pharmacists may refill contraceptives only after recognizing that the patient had previously visited another clinician. The number of refills that pharmacists can prescribe is not limited by any protocol's restrictions. Third, before prescribing a contraceptive, pharmacists are required to have patients fill out the Minnesota Hormonal Contraceptive Self-Screening Questionnaire and evaluate their responses with them. This survey collects information about the patient's personal data, previous use, adverse reaction, and contraindication to contraceptives, and medical history. 3 Fourth, pharmacists are required to measure the patient's blood pressure and follow the Minnesota Board of Pharmacy Standard Procedures Algorithm for Prescribing of Contraceptives 4 in order to confirm indication, contraindication, or referral for contraceptives. Fifth, pharmacists are required to train patients on contraceptive self-administration, provide them counseling on drug use and management, and release them a written prescription record. The prescription of contraceptives cannot be delegated to another person and needs to be recorded in a written or electronic form. 2 The mandates related to pharmacist prescribing of contraceptives in Minnesota are similar to that enacted by other states (Table 1). At the time of this writing, thirteen states, including Minnesota and the District of Columbia have enacted policies that allow pharmacists to prescribe contraceptives outside of a collaborative practice agreement. 5 Oregon was the first state to implement this regulation in January 2016, followed by California in April 2016. Unlike Minnesota, California does not require contraceptive prescribing training for pharmacists who graduate from a pharmacy school in California in or after 2014. All other states, except Idaho, have defined training requirements for contraceptive pharmacist-prescribing. Oregon is the only state that has the same restrictions on patient age as Minnesota; Colorado, Utah, and West Virginia allow pharmacists to prescribe contraceptives only to patients of 18 years of age or older, while the other states do not have restrictions on patient age. Many other states use protocols for contraceptive pharmacist-prescribing as Minnesota and require patients' selfscreening and blood pressure measurement. However, in addition to not requiring these assessments, some states do not mandate pharmacists to follow a standardized prescribing algorithm or provide patient. 6 Similar to Minnesota, other states' protocols do not mention restrictions on the number of refills that pharmacists can prescribe. Training/ education Benefits of the policy Allowing Minnesota's pharmacists to prescribe contraceptives has the potential to expand access to contraceptive services for patients. Studies have shown that many patients have a higher frequency of visits to community pharmacies than to primary care physicians which makes them a readily accessible source for health care. 24 The accessibility of community pharmacists can benefit patients receiving contraceptive prescriptions and enhance contraceptive adherence. 25 Pharmacists already reported their intention to prescribe contraceptive in their practice. 26 The willingness of pharmacists to provide this service is demonstrated across states that have adopted these policies. A study conducted in one of the earliest states to adopt this service (California) showed that in 2017, 11.1% of community pharmacies provided contraceptive prescribing services. 7 Although an 11% participation rate may seem low, with more than 5,000 community pharmacies in California, 27 this represents more than 500 additional contraceptive prescribing locations previously unable to provide this service. In San Francisco, 21 of 113 community pharmacies in the city provided pharmacist-prescribed contraceptives. 25 In Oregon, the first state to adopt contraceptive prescribing by pharmacies, a survey delivered prior to the policy being enacted showed that 39% of pharmacists planned to provide contraceptive prescribing. 28 Although only 39% of pharmacists planned to provide contraceptive prescribing, this represents a large increase in access for patients who were previously unable to use pharmacies to obtain this service. In addition, the availability of pharmacists to prescribe contraceptives as measured by the receipt of formal training required for the service increased from 19% to 63% of all state zip codes over a 6 month period since the law was established. 18 The results from these states suggest that Minnesota also has the potential for pharmacists in the community to provide contraceptive prescribing, which would increase access to this service. The willingness of pharmacists to provide contraceptive prescribing services has the potential to translate into increased access to contraceptive services for patients. A national survey showed that women facing issues obtaining contraceptive prescriptions have reported a willingness to use pharmacies to obtain contraceptives. 29 Another study that interviewed women who received pharmacist-prescribed contraceptives reported that women were willing to continue to receive this service in pharmacies. 30 This willingness has translated into greater access to this service in states that have expanded prescribing. In Oregon, between 2016 and 2017, pharmacists prescribed 10% of all the new prescriptions for contraceptives administered orally or transdermally to Medicaid enrollees. 31 Contraceptive pharmacist-prescribing does not involve only new prescriptions. A study conducted in Oregon and California estimated that 91% of patients who visited a pharmacy to receive a contraceptive prescription already used contraceptives. 32 In addition to increased access, the policy allowing for pharmacist-prescribed contraceptives can be effective in other aspects (Table 2). Facilitating access to contraceptives can decrease unintended pregnancy, reduce costs, and improve outcomes. 33 In Oregon, the expansion of prescribing to pharmacists has been suggested to translate into 51 avoidable unintended pregnancies and $1.6 million in savings to the state Medicaid program over a two year period since the policy was implemented. 34 It should also be noted that in comparison to a physician appointment, contraceptive prescribing by a pharmacist may be a more costeffective option for patients. 25 In California, many pharmacies waive prescribing fees for patients to increase access to this service. 25 Limitations of the policy While allowing Minnesota pharmacists to prescribe contraceptives has the potential to expand this service to patients, significant challenges abound this policy which may prevent these benefits from being fully recognized. A key barrier to the adoption of contraceptive prescribing by pharmacists is adequate reimbursement for the time spent delivering this service. 6,7,26,35 A study conducted in Oregon reported that pharmacists spend an average of 26 minutes providing contraceptive prescriptions for each patient seen. 18 The time needed to comply with regulatory guidelines associated with prescribing contraceptives may not be commensurate with the reimbursement available to pharmacies for providing this service. In a study that conducted interviews in New Mexico, pharmacists reported uncertainty with the reimbursement associated with this service and believed that they do not receive payment for the majority of the work involved in the provision of contraceptive prescriptions. 35 In some cases, this service may not be paid for at all. A study analyzing 676 separate visits of contraceptive pharmacist-prescribing in California and Oregon reported that 16% of the patients did not have insurance. 32 In addition, pharmacists prescribing contraceptives may require patients to pay a fee. 7,32 A study conducted in New Mexico reported that most of the pharmacists studied think that a fee between $30 and $60 may fairly compensate them for the service they provide. 35 However, this fee may be charged out of pocket for the patients. 25,32 California pharmacists reported that patients may not know that pharmacists charge a fee for contraceptive prescribing and that patients may not be able to pay for it. 25 As a result, the pharmacist's fee charged out of pocket for patients may decrease accessibility to this service. 32 To overcome some of these challenges, pharmacists should align the provision of contraceptive prescribing with business models that provide reimbursement for this service. 6 Pharmacies located in states that reimburse contraceptive prescribing should focus on identifying state-designated payers that pay for this service and building billing and reimbursement agreements with them. 31 Other challenges to the prescribing of contraceptives that may limit the provision of this service include lack of staffing, 6,7,28 time, 6,25,26 space, 25 liability, 36 resistance from physicians, 36 and implementation. Another challenge may be represented by the policy's restriction on age. Minnesota requires patients under the age of 18 to show evidence of a previous contraceptive prescription obtained from another licensed provider. This presents barriers to accessing and scheduling appointments with providers, associated transportation, and other costs that may prevent these patients from obtaining contraceptive prescriptions. 37,38 Perceptions of pharmacist-prescribed contraceptives have been explored in patients under the age of 18. These patients reported that the accessibility of pharmacies and their lack of scheduling requirements makes obtaining contraceptive prescriptions more convenient. Patients also acknowledged that pharmacists are the medication experts and are trained to provide this service. 38 Pharmacies' accessibility and pharmacists' medication expertise may encourage people under the age of 18 to receive pharmacist-prescribed contraceptives and address the high rate of unintended pregnancy reported in this population. 37 Another challenge that prevents the achievement of the benefits of contraceptive pharmacists prescribing is placing limits on a pharmacist's ability to prescribe refills. A study conducted in 2019 reported that pharmacists are more likely to prescribe 6 months or more of contraceptives supply at a time. 39 This practice is supported by the protocol on contraceptive prescribing used in Minnesota, which does not indicate limitations on the number of refills that pharmacists can prescribe. As indicated in the protocol, pharmacists in Minnesota are required to provide the patient with a written record that includes the number of refills approved. 3 Other states allow flexibility in the supply of pharmacist-prescribed contraceptives. Pharmacists practicing in the District of Columbia can prescribe a 12-month supply of contraceptives after proper patients' assessments and screenings are conducted. 11 Allowing pharmacists to prescribe 6 months or more of contraceptive supply has the potential to improve contraceptive adherence and decrease unintended pregnancies and should be supported across states' policies. 39 Expanding access through pharmacist-prescribing places Minnesota pharmacists in a position to ensure safety in the prescribing and use of contraceptives. Patients questioned the safety of contraceptives and reported concerns about their adverse events. 29 Patient hesitancy may discourage them from accessing a pharmacy to obtain contraceptive services. Patients need to be assured that pharmacists are trained to be the experts in managing drugs' uses and that pharmacistprescribed contraceptives are safe. 6 A study conducted in 21 states in the United States reported pharmacists' opinions about the safety of pharmacist-prescribed contraceptives. 40 In this study, the majority of pharmacists rated safety concerns including patients' screening, obtaining records, and contraceptives' adverse reactions and self-administration procedures as very important aspects of the service. The study showed that there was not a significant difference in safety concerns between pharmacist respondents who were allowed or not allowed by their local state policies to prescribe contraceptives. 40 In addition, patients may need to be educated on the training that pharmacists received to prescribe contraceptives. 6 While 11 out of 13 states require specific training for pharmacists prescribing contraceptives, Idaho exempts training for all pharmacists and California exempts training for recent pharmacist graduates of a California school. 6 Even though these two states waive training requirements, the competency of pharmacists in contraceptive use is apparent. In 2016, the American College of Clinical Pharmacy Educational Affairs Committee released guidance on pharmacotherapy content in pharmacy curriculum and assigned a Tier 1 status to contraceptive competency; 41 Tier 1 indicates that "students receive education and training on this topic to prepare them to provide collaborative, patient-centered care on graduation and licensure." To offer this service, pharmacists should demonstrate their abilities to manage contraceptive use and identify potential adverse events and contraindications. A study conducted in Oregon measured the safety of contraceptives prescribed by pharmacists by assessing the percentage of patients receiving these medications when contraindicated; 31 the study results showed that pharmacists abided to the prescribing algorithm and achieved a level of safety comparable to other providers when prescribing contraceptives. 31 Implications of the policy Although the legislation recently passed in Minnesota has the potential to significantly improve access to services for women needing contraceptive services in the state, the policy as enacted may be insufficient to ensure broad adoption by pharmacists. A significant limitation of this policy relates to insufficient reimbursement for the time spent providing this service. Without a specific reimbursement mandate, the time needed to fulfill the additional requirements of the service, the need for support staffing, and the willingness to work this service into existing workflow may be hampered. Adequate reimbursement is needed to support contraceptive access, 18,31 improve outcomes, 18 and promote the sustainability of this service. 28 In Oregon, pharmacists can bill insurance for the service offered when they prescribe contraceptives, in addition to billing for the contraceptive drugs dispensed. 17 Moreover, Oregon reimburses pharmacists for visits related to contraceptive prescribing under Medicaid. 18 Contraceptive pharmacist-prescribing is also covered by Medicaid in California, which reimburses pharmacists approximately $45 per service, 42 and Maryland. 6 Other states are making progresses toward the reimbursement of pharmacists' prescribing services. In 2020, New Mexico passed legislation that mandates insurance plans to provide reimbursement for pharmacists' prescribing services, including contraceptive prescribing, at rates similar to those received by physicians and nurse practitioners. 16,43 In the same year, West Virginia passed legislation that requires insurance plans to provide payment for pharmacists' services including contraceptive prescribing if the service would have been paid if offered by another provider. 22,23 States having policies that do not include payment for contraceptive pharmacist-prescribing reported limited implementation and discontinuation of this service. 26 In addition to adequate reimbursement, giving pharmacist's provider status in federal programs like Medicaid and Medicare may yield additional benefits to contraceptive prescribing uptake by pharmacists. 44 Although few Medicare patients are likely to need contraceptive services, federal policy enactment on issues like provider recognition often leads to broader policy uptake by other insurers. Minnesota should look to states like Oregon, who has been an early adopter with broad access to pharmacist prescribing of oral contraceptives, in developing policies to support reimbursement for this service. This may include exploring payers' reimbursement procedures for health care providers' services and aligning payments for contraceptive pharmacist-prescribing with current reimbursement models. 31 As these services expand, the importance of studies directed at understanding the implementation of these services is important. 31,32 So too are formal evaluations of patient involvement, 18 and the health outcomes associated with this service. 45 Future research comparing states' policies and reimbursement procedures for services that pharmacists offer and bill for as providers is needed to support contraceptive pharmacist-prescribing in Minnesota. Moreover, potential future research comparing outcomes of pharmacist-prescribed contraceptives between states that do and not reimburse pharmacists may provide data to support expanded reimbursement for this service. Although the focus of this paper is on U.S. policies, it is worth mentioning that other countries, such as Canada, also allow pharmacist prescribing of oral contraceptives. 46 The lessons of these other countries present a useful comparison to the Minnesota policy and its implications for patients and pharmacists. Conclusion With the recent passage of state legislation, Minnesota's pharmacists are now authorized to offer contraceptive prescribing. The authorization, similar to those granted by other states, may improve patients' access to contraceptives, decrease overall health costs, and improve outcomes. However, the effectiveness of this policy may be hindered by challenges including lack of staff, time, and payment. Minnesota policymakers should align this new authorization with current reimbursement models to support the sustainability of this service and explore opportunities to improve the patient care. Conflicts of Interest: We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.

ECONOMIC AND ENVIRONMENTAL IMPACTS OF THERMAL INSULATION USED IN DIFFERENT DUCT SIZES In this study, the economic and environmental impacts of insulation material are determined for different sizes of heating, ventilation and air conditioning (HVAC) duct. The optimum insulation thickness (OIT), energy-saving (ES) and payback period (PP) for HVAC duct are estimated using Life cycle cost (LCC) analysis. The analysis considers coal, natural gas (NG), liquefied petroleum gas (LPG), fuel oil (FO), bagasse, rice husk (RH) and geothermal as an energy source and the fiberglass as an insulation material. The results indicate the OIT and PP for an HVAC duct increase with the size of the duct while ES decreases. The maximum value of OIT, ES and minimum value of PP for different sizes and energy sources are determined as 48.27 mm in size A (300 mm) and NG, 84.91% in size E (500 mm) and LPG, and 0.2035 years in size A and NG, respectively. Additionally, the environmental analysis results indicate emission of CO2, CO and SO2 decreases with insulation thickness. The maximum value of CO2 and CO emission is determined for size E and NG i.e. 81.8% and SO2 emission for size E and FO i.e. 76.66%, respectively.

You might think you don’t want anyone controlling your brain. You might think that anyone who did want to control your brain was behaving, you know, invasively. But you’d be wrong — and that’s actually very good news. Most of the reactions in your brain are mediated either electrically or neurochemically — or, really, a combination of the two. But given the right manipulation, light can do it too. The problem was that stimulating the opsins so that they would switch the neurons on and off as desired required threading a fiber-optic cable into the brain and sending pulses of light through it — something even a mouse would rather not sit still for. If there was ever going to be a way to use optogenetics in humans, a more benign method had to be developed. Enter Ed Boyden, associate professor of biological engineering and brain and cognitive sciences at MIT. Boyden knew that one of the limitations of most opsins is that they respond only to green or blue wavelengths, which are pretty much stopped cold by solid objects like the bone and soft tissue that makes up the head. But red light can penetrate scalp and skull — at least a little bit. Boyden’s team thus went scouring through light-sensitive bacteria and found two that produce red-sensitive opsins. Those proteins, however, produce only a very weak photocurrent — not nearly enough to affect brain function. So Boyden’s team — especially grad student Amy Chuong — began tinkering with the proteins, genetically engineering mutants that produced a bigger kick when hit with red light. When these engineered opsins were introduced into the brains of laboratory mice, they were able to shut down or turn on local neural activity with nothing more than a well-aimed beam of red light on the skull. Fantastic — but why exactly would a human being want to go within 10 feet of the technology? A lot of reasons. Epilepsy, for example, is little more than an out-of-control electrical storm in the brain, and optogenetics might offer a quick and painless way to regulate it. Other neurological disorders could similarly be treated in much the way researchers are using transcranial magnetic stimulation as a means to control Parkinson’s disease, depression, migraine headaches and other conditions. The MIT team is also working with investigators at the Friedrich Miescher Institute for Biomedical Research in Switzerland to use the same protein to resensitize cone cells in the retina. If the technique proves successful in mice, in could be used to treat retinitis pigmentosa, which causes blindness by destroying the cones. So, as with so many other scary-sounding advances in medical history, brain control is very bad — but only until it’s very good.

Bio-CNG production potential from locally available biomass Today Mumbai is facing the problem of waste accumulation in different areas and limitation of waste disposal sites. These wastes are dumped in the form of big heaps. The degradation of these waste starts after few days. The process of degradation is aerobic at outer layer and anaerobic at inner layers. Due to these reactions, putrescible gases are come out and causes the health hazard. The Bio-CNG plant gives the best solution for this problem. It uses the vegetable waste as raw material and converts it into a high calorific value fuel. Hence it minimizes the waste accumulation and also solves the problem of energy crisis at the same time. In this study 6kg waste is digested under controlled environment condition n a mesophilic temperature range(30°C-45°C) for 26 days to obtain Biogas. The Biogas so obtained contains CH₄, CO₂, H₂S, and Moisture content. The presence of CO₂, H₂S, and Moisture content in Biogas is considered as impurities as it reduces the calorific value of fuel and hence removed using three scrubber units to obtain the composition of natural gas.These three scrubber units contained Sodalime, Silica gel, and Tri-ethylene glycol to remove CO₂, H₂S and moisture content respectively. The Bio-CNG obtained above contains more than 85% of CH₄ which has high calorific fuel value. These Bio-CNG can be used as automobile fuel, for cooking as well as for power generation. It can also be considered an alternative fuel option against the limited stock of conventional fuels like coal, petroleum etc in future.

The Kansas State Board of Healing Arts, the governing body that regulates the practice of medicine in the state, stripped the medical license of a woman who refused to force a mentally-ill 10 year old to give birth. As Robin Marty reports, Dr. Ann Neuhaus became the target of domestic terror group Operation Rescue after her colleague, Dr. George Tiller, was murdered. Neuhaus assisted Tiller by providing second opinions for mental health exceptions for late-term abortions. Operation Rescue filed a negligence complaint against Neuhaus alleging that her exams were not thorough enough to support her medical conclusions and her follow-up care was inadequate because she did not recommend counseling or hospitalization after each procedure. Neuhaus offered a rebuttal of her own. “To even claim that isn’t medically necessary qualifies as gross incompetence,” said Neuhaus. “Someone’s 10 years old, and they were raped by their uncle and they understand that they’ve got a baby growing in their stomach and they don’t want that. You’re going to send this girl for a brain scan and some blood work and put her in a hospital?” Like other states Kansas has made recent attempts to stack their medical review board with anti-choice advocates like former Operation Rescue attorney Richard Macias. When hearing the case against Dr. Neuhaus, the board offered up their own expert to determine if any breach of the standard of care occurred. Not surprisingly, the witnessed insisted that in no cases is abortion a treatment that could be seen as beneficial to a patient’s mental health, further clouding the waters as to the kind of care girls and women can expect in the state of Kansas. Nuehaus will appeal the ruling. If she loses she will have her license permanently revoked. Related Stories: Are Kansas Officials Enabling Operation Rescue Terror Campaigns? Kansas Admits It Destroyed Documents In Case Against Planned Parenthood Operation Rescue Posts Abortion Patient Information Online Photo from World Cant Wait via flickr.

Recent advances in submicron alignment 300 mm copper-copper thermocompressive face-to-face wafer-to-wafer bonding and integrated infrared, high-speed FIB metrology We report on recent experimental studies performed as part of a 3D integrated circuit (3DIC) production-worthy process module roadmap check for 300 mm wafer-to-wafer (WtW) copper-to-copper thermocompression bonding and face-to-face (F2F) aligning. Specifically, we demonstrate submicron alignment capabilities (3sigma alignment variability ∼ 1 m) post Cu bonding on topography M1V1-to-M2 Cu wafers with no interfacial voids observed and complete Cu interdiffusion, as supported by transmission electron microscopy (TEM) and electron back scatter diffraction (EBSD) data. Also, less than 0.1% clustered voids bonding uniformity were observed on bonded blanket Cu wafers. In addition to bonding quality characterization studies involving scanning acoustic microscopy (SAM) and confocal infra-red (IR) laser scanning microscopy, we report on the development of a prototype integrated IR, highspeed focused-ion-beam (FIB) technique with CAD overlay capabilities that enable the creation of site specific cross-sections and TEM samples to better observe bonding structures of interest.

GeroSim: A simulation framework for gesture driven robotic arm control using Intel RealSense Intel RealSense™ is an exciting new technology from Intel that offers a more immersive and intuitive human-computer interaction (HCI) with hand and head tracking and gesture recognition. Robotics has been an ever evolving area of research and development. Robotics has been extensively used in automation. Several past works have been focused towards developing robots that can respond to human voice, gesture in a more natural ways. However, a simulation framework has never been proposed for gesture driven robotic control. Realistic simulation of robotic arm that can mimic the actual actions of a robot and respond to exactly the same way is essential in designing several applications including automation. This paper provides a unique framework for robotic arm simulation for gesture driven control called GeroSim (Gesture-Robotics-Simulator). The simulation engine is logically bind with internet of things (IoT) to enable remote controlling. Any control mechanism can be added as a plugin to the interface to test the interface viability before adopting real hardware. Proposed work presents a unique scripting language called Geroscript that enables different modalities to control a robot seamlessly. Results shows that the engine can support multiple modalities and can be used for practical design of gesture controlled robotic systems.

Standardized Sampling by the Same Nurse Could Improve the Positive Rate and Consistency of the Throat Swabs to Detect COVID-19 Emerging worldwide pandemic COVID-19 is spreading around the world. At present, the diagnosis of COVID-19 mainly depends on qRT-PCR assay of throat swabs. However, false negative rate of nucleic acid test for SARS-CoV-2 with throat swabs is high, also patients are extreme suffering from throat swabs. The lingual swab is convenient and may achieve the same effect. This study compares the differences between lingual swab and throat swab sampling results, and to analyze whether standard sampling by the same nurse could improve the positive rate and consistency of the swabs comparing with sampling by several nurses. The results showed that the positive rate of throat swabs is significantly increased as that of lingual swabs for the detection of COVID-19. Standard sampling by the same nurse helps to improve the consistency of swabs testing for COVID-19. Funding Statement: This work is supported by the Medical Science Advancement Program of Wuhan University (TFLC2018002). Declaration of Interests: The authors declare that they have no competing financial interests. Ethics Approval Statement: Informed consent was provided by all subjects. All procedures in this study were done in accordance with the ethical standards of the institutional and/or national research committee.

Spontaneous Transomental Hernia A transomental hernia through the greater or lesser omentum is rare, accounting for approximately 4% of internal hernias. Transomental hernias are generally reported in patients aged over fifty. In such instances, acquired transomental hernias are usual, are commonly iatrogenic, and result from surgical interventions or from trauma or peritoneal inflammation. In rare cases, such as the one described in this study, internal hernias through the greater or lesser omentum occur spontaneously as the result of senile atrophy without history of surgery, trauma, or inflammation. A transomental hernia has a high postoperative mortality rate of 30%, and emergency diagnosis and treatment are critical. We report a case of a spontaneous transomental hernia of the small intestine causing intestinal obstruction. An internal hernia with strangulation of the small bowel in the lesser sac was suspected from the image study. After an emergency laparotomy, a transomental hernia was diagnosed. CASE REPORT A 57-year-old man was admitted to the Emergency Department with an acute abdomen. He reported abrupt onset of epigastric pain and bilious vomiting with abdominal distension for at least the preceding 24 hours. The patient could not recall previous, similar pain attacks. He had no prior surgical procedures or history of abdominal trauma. Vital signs were all within normal limits. On physical examination, the abdomen was mildly distended and tympanic on percussion. The abdomen showed epigastric tenderness, but not rebound tenderness, and had audible hyperactive bowel sounds. The patient had no visible abdominal surgical scars. Laboratory tests were unremarkable except for leukocytosis (14.09 10 3 /mL with 88.8% neutrophils). A plain film of the abdomen demonstrated dilated small bowel loops with an air-fluid level in the epigastrium and on the right side of the abdomen, suggesting intestinal obstruction (Fig. 1). A computed tomography (CT) scan of the abdomen revealed dilated, hypo-enhancing small bowel loops with a swirling pattern in the mesenteric vessels surrounded to the right by the gallbladder and liver, to the left by the stomach, and posteriorly by the pancreas (Figs. 2, 3). An internal hernia with strangulation of the small bowel in the lesser sac was suspected. An emergency laparotomy was performed. An approximately 50-cm segment of the jejunum and the proximal ileum in the lesser sac was herniated through a 2.0-cm slit-like defect in the distal part of the gastrocolic ligament (Fig. 4A, B). The incarcerated small bowel loops appeared congested, but did not strangulate. After reduction of small bowel loops, the ischemic signs of the herniated loops recovered. The omentum was divided. The postoperative course was uneventful. The patient was discharged DISCUSSION Internal hernias are protrusions of the viscera through a peritoneal or mesenteric opening, with the herniated viscera remaining within the abdominal cavity. Openings have normal (foramen of Winslow), paranormal (paraduodenal, ileocecal, supravesical fossa), and abnormal (transomental defect) anatomies. Based on autopsy studies, the overall incidence of internal hernias is 0.2%-0.9%. Internal hernias constitute up to 0.6%-5.8% of all intestinal obstructions. Hernia mortality may exceed 45%. A transomental hernia through the greater or lesser omentum is rare, accounting for approximately 1%-4% of internal hernias. Transomental hernias are generally reported in patients aged over fifty. In such instances, acquired transomental hernias are usual, are commonly iatrogenic, and result from surgical interventions (Roux-end-Y gastric bypass, liver transplantation, and small bowel or colon resection) or from trauma or peritoneal in-. In children, congenital transomental hernias are common and occur in males versus females at a ratio of about 2 to 1. In children, disease severity depends on the orifice size and the length of the herniated small bowel loops. In rare cases, such as the one described in this study, internal hernias through the greater or lesser omentum occur spontaneously as the result of senile atrophy without history of surgery, trauma, or inflammation. Yamaguchi classified transomental hernias as type A (peritoneal cavity → greater omentum → peritoneal cavity), B (peritoneal cavity → omental bursa → peritoneal cavity), or C (peritoneal cavity → omental bursa). Type A is slightly more common than type C, and type A is predominant in older patients. Our case was type C. Transomental hernias are difficult to diagnosis. Clinical manifestations are not specific and are similar to acute obstructive syndrome including nausea, vomiting, abdominal pain, distended abdomen, and constipation. Compared with other types of internal hernias, patients with transomental hernias present more frequently with strangulation of the small bowel. In most cases, a gangrenous bowel is present at the exploratory laparotomy. For this reason, transomental hernias have a high postoperative mortality rate of 30%, so emergency diagnosis and treatment are critical. Abdominal CT scans are helpful for diagnosis. Abdominal CT scans may reveal dilated small bowel loops with a "beak sign, " which is a triangular configuration of the transition zone between the proximal dilated bowels and the herniated bowel segments or between dilated, herniated bowel segments and distal, collapsed bowel segments. CT might also reveal a swirling pattern of the mesenteric vessels, engorged mesenteric vessels with a large impact on the surrounding organs and bowel wall thickening. In addition, a transomental hernia should be suspected if the dilated small bowel loops are localized in the lesser sac (i.e., surrounded to the right by the gallbladder and liver, to the left by the stomach, and posteriorly by the pancreas) and the neck of the hernia orifice is seen as mesenteric vessels passing through the omental defect, with abdominal CT scans showing no evidence of loops passing through the foramen of Winslow between the inferior vena cava and the portal triad. However, in most cases, a definitive diagnosis is established intraoperatively. Surgical treatment is the reduction of the herniated intestinal segments. If necrosis, perforation, or irreversible ischemia of the herniated viscera is present, bowel resection is necessary. In sequence, the defect of omentum must be repaired to prevent subsequent herniation. Even without risk factors of previous abdominal surgery, trauma or peritoneal inflammation, the possibility of

The present invention relates to a pendulum mechanism, adapted to be attached to the casing of a clockwork for use together with the clockwork, which operates independently of the clockwork, and which comprises a pivot bearing, a pendulum arm mounted on the bearing for swinging motion, and an electrical drive mechanism for the pendulum comprising a permanent magnet carried by the pendulum adjacent its lower end and cooperating with a coil mounted on a circuit board located below the clockwork casing and carrying the electronics for driving the pendulum. An autonomously operating pendulum arrangement, which can be attached to a crystal-controlled clockwork, is discussed in Haag et al U.S. Pat. No. 4,043,118, assigned to the assignee of the instant application. This known arrangement consists of a pendulum housing adapted to be fastened to the lower side of the clockwork casing and carrying a circuit board on which are mounted the electrical components required to drive the pendulum. The arrangement includes a bearing device for the pendulum arm which bearing device is attached as a separate element to the upper side of the clockwork casing, and a device for suspending the pendulum is provided at the lower side of the pendulum arm. The housing is also provided with a lateral arm on which the bell of a clock-striking system can be mounted. This known arrangement has the disadvantage that the proper functioning of its various components, i.e., the overall pendulum arrangement as well as the associated chime system, can be checked out for proper operation only when all of the separate parts of the pendulum have been assembled on the clockwork casing. There is, in addition, the disadvantage that the pendulum arm is substantially U-shaped and envelopes the clockwork laterally, and this requires a comparatively large amount of space for the swinging motion of the pendulum. The known arrangement, moreover, cannot be used in conjunction with comparatively small pendulum clocks, for example table clocks; and the lateral placement of the bell of the clock-striking system precludes use of the arrangement in small-sized classic clocks. The present invention is intended to obviate these disadvantages of the prior art, and is concerned with a novel autonomous pendulum mechanism which can be connected to the casing of the clockwork in the form of a completely separate assembled structural unit whose functioning can be checked out independently of the clockwork. Moreover, the unitary pendulum mechanism of the present invention is so arranged that a chiming system can be incorporated therein as part of the pendulum unit, so that its proper operation can also be checked out independently of the clockwork.

Molecular control of granulocyte and macrophage production. The four major glycoprotein colony stimulating factors (CSF's) controlling murine granulocyte-macrophage formation and function have been purified to homogeneity and some sequence data obtained. cDNA's for GM-CSF and Multi-CSF have been cloned and the full sequence of the CSF polypeptides deduced. Despite functional similarities between the two molecules, no sequence homology exists between these two regulators. Binding studies using radiolabeling M-CSF, G-CSF and GM-CSF have indicated that relatively low numbers of specific receptors exist for G-CSF and GM-CSF on responding hemopoietic cells although up to 20,000 receptors per cell exist for M-CSF. Despite the few receptors available, biological effects of the CSF's are demonstrable with low receptor occupancy. Interactions between the four CSF's permit the production of granulocytes and macrophages to be finely controlled.

Restoring order to the ordo salutis: Conversion normativity in light of recent critique Given the disparate details of Lukes report on early conversion practices, some scholars have sought to deliver their readers from the difficulty of determining normativity. However, the complication which excites such re-exegesis, at least in terms of the ordo salutis, is often overstated. Indeed, once the intrinsic dependency of conversion-initiations constituent elements is considered, a general (and essential) order emerges. Even the seemingly mutable moment of regeneration is fixed given a concrete set of conditions. Thus, the only controversy remaining concerns the particulars, specifically which conditions initiate regeneration.

Let’s start off with Bravo’s token Jew, Andy Cohen. Andy’s obviously our crush because his job rocks and we want it, but also because we just about melt every time he says “Mazel” on WWHL. And then there’s also Andy Samberg, who’s hot because he’s got the best Jew fro in Hollywood and probably the best sense of humor, too. And he’s best friends with Justin Timberlake, which only ups his hotness factor. Even though at the moment Jake looks like a rabbi (and not the hot kind you had a crush on in Hebrew school), we obviously had to include Mr. Gyllenhaal since he’s an actual, legit member of the tribe. And let’s be real—his hotness makes Jews everywhere look good. And speaking of looking good, um, hi, Zac Efron. Even though Zac was raised as an agnostic his whole life, he’s got Jewish in his blood and that’s good enough for us. Jack Antonoff went to private Jewish school for most of his life and now he’s one third of the band fun. and is in a relationship with Girls’ Lena Dunham. We’d say that’s pretty awesome. We know rapper Drake doesn’t look like a Jew, but his mom is a full-born one and thus so is he. And remember Drizzy’s music video for “HYFR?” That was him reliving his Bar Mitzvah. Seth Cohen being the token jew on ‘The OC’ was not just by chance, guys—Adam is Jewish IRL. Because his name and his hair probably didn’t give that one away, right? Nev Schulman from ‘Catfish”s full name is Yaniv, and his parents came up with it while staying on a kibbutz in Israel. His ridiculous amount of chest hair further proves his Israeli-ness. Yum. Sasha Baron Cohen is not only a Jew (his Mom’s Israeli), but he’s also a Brit, which makes him double hot. Isla Fisher is one lucky gal. Yes, Spider-man is a real-life Jew. We’re amazed too! But what’s more amazing is that this British Jewish actor is dating a shiksa in real life, Emma Stone. All the good ones do, though. Hmph.

Land Conflict Management as an Effort to Secure Serang Regency Government Assets This paper aims to analyze the management of land conflicts that occurred in the assets of the Serang Regency Government as a form of securing their assets. The problem is focused on efforts to solve land disputes or conflicts and the asset security strategies that were carried out. To approach this problem, Fisher's theory of conflict management and Siregar's asset management theory were used. Data were collected through interviews, observation, and literature study and analyzed descriptively qualitatively. This study shows that land asset conflicts occur predominantly between individuals and the Serang Regency Government regarding land grants given for the use of public facilities such as education and health, however without being accompanied by official documents. Settlement of land disputes was carried out through a compromise approach and reaches the court level if no common solution was found. Dispute resolution aims to administratively complete land ownership documents. Physically avoiding illegal land use and legal security related to dispute resolution through the courts to determine the legal ownership of disputed land assets. It can be concluded that Serang Regency Government must fix all land disputes that occur so that the land assets owned can be maximized and do not disturb the socio-political stability in the society.

Rheumatology: the expectations and preferences of patients for their follow-up monitoring care: a qualitative study to determine the dimensions of patient satisfaction. BACKGROUND Patient satisfaction has rarely been defined. It is a multi-dimensional concept and relates to expectations and preferences for care. This paper reports the findings of a study to determine the expectations and preferences of rheumatology patients for their follow-up monitoring care. AIMS AND OBJECTIVES To identify the dimensions of satisfaction important to rheumatology patients in the provision of their care in two locations; primary and secondary. The objectives were to determine the expectations and preferences of this group and to gather data to inform a larger study of patient satisfaction. DESIGN This small qualitative study used semi-structured interviews with a convenient sample of 10 patients; five from each location. METHODS Interviews were recorded and transcribed. Qualitative data analysis revealed a framework and conceptual categories. RESULTS Empathy, specialism, information provision, technical aspects, time, and continuity of care were identified as being important in the provision of care for this group of patients. CONCLUSIONS These categories had already been found in a validated questionnaire and justified the use of this tool in the larger comparative study. RELEVANCE TO CLINICAL PRACTICE Patient satisfaction cannot be accurately assessed unless important categories of care are identified and used in the measurement tool.

Gwinnett County officially borrowed Tuesday more than $35 million to purchase property that could become home to its first-ever MARTA station. The 20-year bonds approved by the Board of Commissioners will be used to acquire about 103 acres at the high-profile OFS Brightwave Solutions site near I-85 and Jimmy Carter Boulevard. The property has been pitched over the years as everything from a casino to a movie production campus, but none of those projects came through. Gwinnett plans to market to property to developers in hopes of spurring new growth in the area, which they believe is one of Gwinnett’s most important corridors. Officials have also suggested that the I-85 and Jimmy Carter area would be an ideal location for a new multimodal transit hub that, if voters approve a March referendum on joining MARTA, would be a potential destination for the transit agency’s inaugural extension into the county. Commission Chairman Charlotte Nash has said that locating a transit hub on the sizable OFS site would not preclude other projects. She envisions an “urban-style mixed-use development” on the property. OFS, which manufactures fiber optic cable, plans to remain on part of the site but has been marketing the rest of the property for several years. Gwinnett and OFS ratified a purchase-sale agreement in May. The deal, which is expected to close this month, would include OFS’ Building 50 — a 422,000 square foot facility that, despite the failure of the much larger movie campus previously proposed by a private developer, is still being used for film production. Officials have said that the revenues collected from the continuance of such projects should cover the county’s expected annual debt service of around $2.5 million on the bonds it issued Tuesday. The county received eight bids for the $35.435 million in bonds and went with the low bidder, chief financial officer Maria Woods said. They will be financed at 3.9 percent interest. The commission vote passed 3-1, which District 4 Commissioner John Heard the lone no vote. District 3 Commissioner Tommy Hunter was not present during the meeting. He deemed the OFS project to be different from several other speculative undertakings that the county has gotten involved in recently. The county has acquired and razed the Olympics-era Stone Mountain Tennis Center and plans to present that site to potential developers as well. Gwinnett is also involved in a sizable mixed-use development on the Infinite Energy Center site and has broken ground on a $60 million “water innovation center” that it hopes will spur business opportunities.

1550-nm combined transmission booster amplifier and receiver preamplifier for satellite to satellite laser communication Satellite-to-satellite laser communication technology underpins high-speed l0-Gbps optical links for the new generation of satellite constellations that will serve as global telecommunications networks. LEO satellite-to-satellite links may extend over distances of >5000 km, necessitating an optical-power budget of ~70 dB to compensate for diffraction-limited opticalbeam divergence. This can be achieved by boosting the transmitted laser diode signal to around 1 W, and by amplifying the received signal by 40 dB. Such performances are attained by terrestrial fiber amplifiers, operating in the telecom 1550- nm wavelength window, which are produced in volume of thousands and are (in relative terms) of low cost. Based on MPBCs large volume production experience of fiber amplifiers and its heritage of space system design and manufacturing, a new product line of Laser Communication Terminals (LCTs) for space is presented. It is designed to be lower cost, exploiting commercial off-the-shelf (COTS) components whenever possible. Most of these fiber-optic components are extensively employed in large terrestrial telecom equipment and are already qualified to telecommunications standards. However, additional tests are required to ensure reliable long-term operation in a space environment. We have subjected the components, both active and passive, to gamma- and proton-radiation tests including total ionization doses of up to 100 kRad, Temperature vacuum cycling over extended temperature range have been performed and are still ongoing. Finally, considering manufacturing costs, we are packaging both the transmission optical booster unit and receiver optical amplification unit in the same housing, in order to co-locate both the transmit and receive functions of the link. These units are compact and stackable and save on the enclosure weight.

Diversity, Dissent and Representation: Lessons From The First Minority Judge in the Israeli Supreme Court This paper seeks to enrich existing empirical research on substantive representation in the judicial system by exploring a case study of the Honorable Justice (retired) Salim Joubran, the first ethnic-minority judge appointed to the Supreme Court of Israel. By employing a dual methodology of qualitative discourse analysis and dissenting quantitative studies, the study investigates when, why and how he dissented in controversial cases, which are defined as cases that resulted in non-unanimous votes. The study shows that a quantitative study on dissenting opinions of a minority judge alone did not provide comprehensive conclusions. The complementary qualitative discourse analysis shows that in cases that challenged state actions that impacted his social group, Joubran employed distinct strategies and reasoning that are akin to feminist judgments approach. Hence, the study adds to existing research on judicial diversity indicating that women and ethnic minorities judges not only share common challenges but might also operate similar reasoning strategies. In light of these insights, the study calls for employing the combined qualitative and quantitative methodology on examining judgments focusing on dissenting opinions of women and ethnic minority judges as it offers a complex understanding of substantive representation and provides answers regarding the socio-legal effects of group affiliation on judgments.

. BACKGROUND Severe obesity due to hypothalamic involvement has major impact on prognosis in long-term survivors of childhood craniopharyngioma. The long-term effects of rehabilitation efforts on weight development and obesity in these patients are not analyzed up to now. PATIENTS AND METHODS 108 patients with childhood craniopharyngioma recruited in HIT Endo before 2001 were included in the study. Long-term weight development (BMI SDS after >10 yrs follow-up) was analyzed in regard to rehabilitation, which was performed in 31 of 108 (29%) patients (one rehabilitation in 4 patients (13%), more than one in 21 patients (68%), 6 patients unknown) in 13 German rehabilitation -clinics. RESULTS 84% of patients underwent rehabilitation in order to reduce hypothalamic obesity (BMI>+2SD), whereas 12% of patients were normal weight. Childhood craniopharyngioma pa-tients with rehabilitation presented with higher BMI at diagnosis (median BMI: +1.32SD; range: -1.08 to +7.00SD) and at last evaluation (median BMI: +4.93SD; range: -0.20 to +13.13SD) when compared with patients without rehabilitation (median BMI at diagnosis: +0.24SD; range: -2.67 to +6.98SD; BMI at evaluation: +2.09SD; range: -1.48 to +10.23SD). A long-term weight reducing effect of rehabilitation was no detectable regardless of degree of obesity, frequency of rehabilitation, and hospital of rehabilitation. CONCLUSION Treatment options for hypothalamic obesity in terms of rehabilitation are limited. Accordingly, strategies for prevention of hypothalamic lesions and psychosocial effects of rehabilitation are currently in focus for improvement of prognosis in childhood craniopharyngioma patients.

A study of association between self feeding practices and nutritional status of infants in a rural population Background: Feeding practices determine the nutritional staus of infants. Infant and young child feeding practices include appropriate breastfeeding and complementary feeding practices. The impact of complementary feeding in the form of proper timing, quantity and quality of food on nutritional status is a matter of study in many research works. But nutrional stautus not only depends on type and amount of food but also on how its fed. Responsive feeding which includes encouraging the chlild to feed himself or herself also improves nutritional status. Objective: To assess the impact of self-feeding practice on nutritional status of children. Materials and Methods: A cross sectional study was done between December 2015 to January 2016 on 200 infants between 9 months to 1 year in field practice area of Sri Siddhartha Medical College Tumkur. Results: Of the 200 infants who were studied, self feeding was initiated early (8 to 10 months) in 158 infants and late (after 10 months) in 42. The prevalence of stunting was significantly less in early self-feeding group (18.98%) compared to late self-feeding group (47.14%) with P value of <0.001. The prevalence of wasting was also found to be significantly less in early self-feeding group (37.9 %) compared to late self-feeding group (66.66%) with P value of <0.001. Conclusion: There is a significant association between early self-feeding practices and better nutritional status of infants. Introduction It has long been recognized that the period from birth to two years of age is a "critical window" for the promotion of optimal growth, health and behavioural development. Infant-feeding practices constitute a major component of child caring practices apart from socio-cultural, economic and demographic factors. Appropriate feeding practices play a crucial role in achieving optimal health outcomes in infancy as well as in later life. In addition to inadequate quantities and diversity of food, nutritionists increasingly recognize an unresponsive feeding style as a crucial impediment to healthy nutrition. Poor infant-feeding practices can lead to stunted growth, delayed motor and mental development, immune incompetence, and increased risk of infectious diseases such as diarrhoea. Guidelines for infant-feeding practices in developing countries to date have focused primarily on their relationship to child malnutrition. Self feeding, whereby the mother feeds her child in response to child cues and psychomotor abilities, is low in some countries and likely contributes to malnutrition. The child's food preferences and practices are initiated very early in life. Educational interventions for families of young children may have immediate nutritional benefit as well as helping to reduce both infectious and chronic disease risks when learned healthful habits and preferences are carried into adulthood [7,. Thus, appropriate management of malnutrition in early childhood can prevent short-and long-term consequences. Hence the present study was conducted with the objective to assess the impact of appropriate self-feeding practice on nutritional status of children. Materials and Methods A prospective cross sectional study was done between December 2015 to January 2016 on 200 infants between 9 months to 1 year in field practice area of Sri Siddhartha Medical College Tumkur. Infants with Low birth weight (< 2.5kg), multiple gestations, Prematurity, Children with significant congenital malformations and infants with chronic illness were excluded from the study. Data on feeding practices was collected by interviewing mothers on a pre-tested semi-structured schedule after due consent. These children were examined and their nutritional status was assessed by anthropometry. The children were divided in to two groups based on when self feeding was initiated, a) early self feeding group (self feeding initiated between 8 to 10 months), b) late self feeding group (self feeding initiated after 10 months). Weight and length of the children at 1 year was plotted on WHO growth charts. Prevalence of wasting (weight for length below 3 rd percentile) and stunting (length for age below 3 rd percentile) were calculated for early and late self feeding groups. The relationship between self feeding practice and nutritional status was analyzed. Results In the present study, 57% of the infants were male and 43% were female. Among them 80% of the children lived in nuclear families and 20% in joint families. 27% of children were born first order, 37% second order, 24% third, 10% fourth and 2% fifth order. None of the children were of the birth order of more than 6. Majority (88%) of the study infants were born in hospital and 12% were born in home among those 10% were conducted by trained dais and 2% by untrained dais. Initiation of self feeding practices in our study showed that majority (79%, n = 158) of the infants started their self feeding between the age of 8-10 months and only 21% (n=42) of them started self feeding after 10 months of age . In our study we found a significant association between early initiation of self-feeding practices and better nutritional status (lesser prevalence of wasting and stunting) by chi-square test. 18.98% of infants in whom self feeding was initiated early (i-e between 8;10 months) had stunting, where as 47.14% infants in whom self feeding was initiated late (after 10 months) had stunting . Our study also showed significant association between initiation of self-feeding practices and wasting among infants. 37.9% of infants in whom self feeding was initiated early (i-e between 8;10 months) had wasting, where as 66.66% infants in whom self feeding was initiated late (after 10 months) had stunting . Discussion In the present study, 57 % of the children studied were Male and 43% were Female. In a study done by Dinesh Kumar et al, 63% of children were male and 36% of the study population were female which is similar in comparison with this study. In the present study 80% were born in hospital. According to NFHS 3 data, 38 to 40 % of total deliveries in our country take place in a health care facility. In a study conducted in rural Karnataka, the deliveries outside a health care facility contributed to 65 % of the deliveries. In a study conducted in urban slums of Mumbai, Das S et al found the incidence of hospital deliveries to be 84 %, which is the same as in our study. In the present study proportion of stunting was 27% which was less compared to 66.1% reported in an earlier survey in Allahabad and also 37.4% from another study done in Allahabad. The proportion of the infants who showed wasting in our study was 44% which is quite on higher side compared to other studies 10.6% and 11.7%. It was observed in a study that poor care was associated with significantly higher Prevalence of stunted and underweight children whereas it did not influence prevalence of wasting amongst children from a study done in Accra. There are not many studies done to evaluate the impact of appropriate self feeding practices and nutritional staus of children. The present study shows that early initiation of self feeding practices helps to enhance the nutritional status of the infants. Conclusion Improvement in child care and feeding practices could positively impact nutritional status of children which can be done by adequate health education to the mothers. It may also be necessary to invest in community level change agents to facilitate the process especially in an already overburdened health system. This study highlights the need to strengthen the ongoing community oriented health education programs, utilize the missed opportunities for improving complementary feeding and self feeding practices by education and imparting information in the urban slum population. Funding: Nil, Conflict of interest: Nil Permission from IRB: Yes

Algorithm for bringing the results of tests of a thermal imaging device to the normalized values of parameters and conditions of sighting at the observation object According to the results of tests of thermal imaging device the IR signature of observation object is restructured into fragments that form its video image. The recognition range for the normalized conditions is determined as the detection range of video image fragments which are replaced by their equivalent test patterns.

C'est la vie: Translating The Office for French Screens The Office (20013) has been widely cited as one of TVs best sitcoms.1 This ostensible tale of office dronedom is unquestionably one of the BBCs most successful comedy exports it has been sold to over 88 countries and adapted in seven foreign territories (the United States, French Canada, Chile, Israel, Brazil, Germany and, of course, France), with a Swedish version set to premiere in 2012 and a Chinese one in production.2 As a case study for the adaptation of AngloSaxon television to the French screen, the example of The Office is particularly interesting. This Gallic adaptation broke new ground for the Office franchise: the better-known American version may have been the first adaptation in March 2005, but the French was the first official foreign-language remake in May 2006. A comparison between the two does seem relevant, given the novelty of both in their respective cultures and quasi-simultaneity. But their success could not be more different: while the US series continues in what is its eighth season, with over 150 episodes thus far, the French series was quietly abandoned after only six episodes, despite its well-known star (Franois Berland, a fixture in French television and film since the late 1970s) and established team of director-screenwriters (Nicholas Charlet and Bruno Lavaine, or Nicholas & Bruno, as they commonly refer to themselves). In this article, then, the American adaptation will serve as a point of comparison for my analysis of the French series, as I examine the circumstances surrounding the very different receptions to the same basic premise of this workplace mockumentary.

Get the biggest daily news stories by email Subscribe Thank you for subscribing We have more newsletters Show me See our privacy notice Could not subscribe, try again later Invalid Email An elderly man who fell ill while voting for the US Presidential election insisted on casting his vote as medics rushed to help him. A voter - who used the Twitter name Hedi Lou Who - said she was waiting to vote for the historic election when the man fell ill with chest pain and breathing difficulties. But instead of waiting calmly for help, the man still insisted on casting his ballot. It comes as record numbers of Americans are voting - highlighting how serious many are taking this election and the decision between Donald Trump or Hillary Clinton. Video Loading Video Unavailable Click to play Tap to play The video will start in 8 Cancel Play now Writing on Twitter, Heidi said: “Older man at polling place having chest pain & trouble breathing, insisted on casting his ballot as the ambulance was called.” Pictures from the scene - thought to be in Virginia - show ambulances at the scene. The condition of the man is not known. Despite trailing in the latest polls, Donald Trump remains confident he will be victorious in the election. The Reuters/Ipsos States of the Nation project gave Hillary Clinton a 90 percent chance of defeating Trump in a poll released on Monday. The Democratic nominee was on track to win 303 Electoral College votes out of the 270 needed, to Trump's 235. Undeterred, Republican Trump maintained that the election result would be as big an upset as the EU referendum in the UK. He told supporters in Raleigh, North Carolina: “I think it’s going to be Brexit plus plus plus.” As the billionaire businessman left the stage You Can’t Always Get What You Want by the Rolling Stones began to play. (Image: AFP/Getty Images) (Image: Jonathan Bachman/Getty Images) However, Trump's sustained and vicious attack on Latinos could deliver the killer blow to his White House bid as polls close. He has campaigned to deport 11 million undocumented immigrants, and branded Mexicans killers, rapists and drug dealers – vowing to build a wall on the border. But as the moment of truth approaches, early votes in battleground states with large Latino populations show record turnouts among them. (Image: AFP/Getty Images) It’s payback from America’s largest minority group against the billionaire, who went way beyond his disgraceful Mexican “rapists” claim, broadening his insults to all Latinos. Announcing his candidacy in June, he said: “You have people coming in and I’m not just saying Mexicans, I’m talking about people that are from all over that are killers and rapists.” He also insisted the Mexican government was sending undocumented criminals over the border. As a result, many polls show Latino voters supporting Clinton by unprecedented margins. They could sink Trump in a number of states essential to the 270 electoral votes needed to win the White House, say analysts. In Nevada, the Latino turnout propelled Democrats in Clark County, the state’s largest population, and Las Vegas, to a record-breaking close on Friday. Early ballots gave Clinton a 72,000-strong lead. Enough, says Nevada political expert Jon Ralston, to win the state for the Democrats. (Image: Getty) Four years earlier, Obama won in Clark County by seven points, with a 71,000 early voting lead. Florida, home to millions of Latinos, had a 49.4% turnout among early voters with ­Democrats leading Republicans by 88,000. According to CNN , Clinton pulled ahead in battlegrounds of New Hampshire and Pennsylvania with a three-point and five-point edge. She was tied with Trump in the key state of North Carolina. But across the States Clinton holds a three-point average lead while an NBC poll put her seven points ahead. Of the 10 legitimate polls Trump leads in only one, which gives him a two-point advantage. (Image: REUTERS) Clinton has been boosted by Sunday’s FBI finding of no criminality in a new batch of emails. Four months ago she was found careless but not criminal in handling classified material on a private email server. The renewal of the probe a fortnight ago led to a huge drop in her ratings. She was neck-and-neck with Trump, after 650,0000 emails were found on the laptop of her aide, Huma Abedin. This was despite accusations of sexual misconduct against him from 12 alleged victims. (Image: REUTERS) The announcement Clinton was in the clear infuriated Trump. He said she was being protected by “a rigged system”, claiming: “You can’t review 650,000 emails in eight days.” But the latest boost is enough to give Clinton a historic win as the first female president, many Republicans fear. Video Loading Video Unavailable Click to play Tap to play The video will start in 8 Cancel Play now Longtime party political ­strategist John Weaver said: “I believe she’s going to win in an electoral landslide and be the most unpopular president in electoral history.” Yesterday the two candidates cut differing paths on the trail. Clinton appeared in Michigan, where earlier this year she lost the Democratic primary to Senator Bernie Sanders of Vermont. President Obama also headed to the Great Lakes State to boost support for her. Earlier, he taunted Trump over staff taking him off Twitter to save embarrassment. He said: “If somebody can’t handle a Twitter account, how can they handle the nuclear codes?” Last night Obama and his First Lady joined Clinton and husband Bill at a rally in Philadelphia, featuring Bruce Springsteen and Jon Bon Jovi.

The sleepy days of summer are coming to an end. In a few weeks children will don their backpacks and step into yellow buses when the Fairfax County Public Schools start on Aug. 28. Back to School season is a hectic time for many Fairfax families. This increase in activity means we all must take extra precautions to keep our children and neighbors safe, especially on the road. Our entire community should be aware during the morning and afternoon school commutes. This time of day will bring a flurry of buses, carpools, cyclists and pedestrians all across the county. Morning commutes will be more crowded as more than 1,700 school buses get back on the road. Drivers should leave a few minutes earlier to allow for more time in their commute. School buses carry thousands of children to school and back every morning and afternoon. Please respect their important role in our community. When a school bus is stopped with red flashing lights, all cars must stop unless they are in another lane divided by a median. So if you are traveling in a two lane roadway that has no median, all cars going both directions have to stop when the bus is loading or unloading. The same goes for a two lane roadway with a center turn lane and a four lane roadway without a median separation. The only time you can continue driving when a bus is stopped is if you are driving on the other side of the median. It is important to also keep in mind that many children will be walking to school and to neighborhood bus stops. Make sure to yield to children crossing the streets, especially near schools. Look out for crossing guards and follow their instructions. Keep your car off the cross walk when stopped. Be prepared to stop for children who may make unexpected movements into roadways. And finally, follow the school zone speed limits when the signs are flashing. Most school zones have a 25 mph speed limit, but they may vary. Parents, please remind your children about street, pedestrian, and bus safety. Try to get to the bus stop early so no one gets hurt while rushing to catch the bus. If you are crossing a roadway, make sure that cars are stopped in both directions before crossing. Teach them to use designated crosswalks if they are available and only approach the bus once it has come to a full stop. If you have young drivers in the family, take time to review the rules about school zones and school buses. Every Fairfax County child has the right to an education. We all must work together to protect that right by making sure students travel safely to and from school. Please help us keep Fairfax County students safe this year.

Genomic coamplification of CDK4/MDM2/FRS2 is associated with very poor prognosis and atypical clinical features in neuroblastoma patients Neuroblastoma (NB) is the most common extracranial malignant tumor of childhood and is characterized by a broad heterogeneity in clinical presentation and evolution. Recent advances in pangenomic analysis of NB have revealed different recurrent chromosomal aberrations. Indeed, it is now well established that the overall genomic profile is important for treatment stratification. In previous studies, 11 genes were shown to be recurrently amplified (ODC1, ALK, GREB1, NTSR2, LIN28B, MDM2, CDK4, MYEOV, CCND1, TERT, and MYC) besides MYCN, with poor survival of NB patients harboring these amplifications being suggested. Genomic profiles of 628 NB samples analyzed by arraycomparative genome hybridization (aCGH) were reexamined to identify gene amplifications other them MYCN amplification. Clinical data were retrospectively collected. We additionally evaluated the association of FRS2 gene expression with NB patient outcome using the public R2 Platform. We found eight NB samples with high grade amplification of one or two loci on chromosome arm 12q. The regional amplifications were located on bands 12q13.3q14.1 and 12q15q21.1 involving the genes CDK4, MDM2, and the potential oncogenic gene FRS2. The CDK4, MDM2, and FRS2 loci were coamplified in 8/8 samples. The 12q amplifications were associated with very poor prognosis and atypical clinical features of NB patients. Further functional and clinical investigations are needed to confirm or refute these associations.

Problem-oriented record. A critical review. After 10 years of experience using the problem-oriented record (POR), Weed proposed that both patient care and clinical education could be improved by changing traditional medical records to a problem-oriented format. The problem-oriented system of record keeping has since been attempted or adopted by many physicians in the United States and abroad. This article will review four aspects of the POR. First, it will define the format of the POR in an ambulatory and ward setting. Second, it will discuss POR implementation. Third, it will attempt to assess the extent to which POR is in use currently. Fourth, it will review the studies that have attempted to evaluate the effectiveness of the POR.

New Jersey's positively pop-punk kings, the Bouncing Souls , aren't just sunshine, riffs and feelings — the band can get political as well. In their latest pop-inflected jam, "Battleground," Greg Attonito and co., lead a charge to mobilize their audience with a clear chorus of "We have to fight for humanity!" and rainbow fists throughout. The new single — which makes its debut in video form here — delivers a strong message of unity in these politically charged times. It's a great track, made greater because the heavy, important message is delivered in a way that most other protest or political tracks aren't: It's fun, light-hearted, inviting and very hummable. Congrats to Bouncing Souls for accomplishing the nearly impossible. With this song out now and proceeds set to benefit NoDAPL , we talked to Attonito about the track's inspiration, life under the Trump umbrella and what's next for the N.J. band. The results of our interview are below. In the meantime, buy or stream the track, and head here if you want more information on the Indigenous Environmental Network. This song is a benefit for the protestors at Standing Rock. What is your reaction to Trump's recent repeal of Obama's executive order to end the DAPL? The executive order was disappointing, but not surprising. I hope it's not as discouraging as it's being made to appear, and I believe various things still need to fall in place for the building of the pipeline to continue. That being said, my heart goes out to all the people who are putting their life energy into protecting the water in South Dakota and so many other water sources that are under threat in the country. Their courage, determination and strength is truly inspiring. They are out there on the front line in the cold for us, so I feel like we all should do whatever we can to help them by contributing, taking action or just talking about it on social media. The lyrics of the song are closely tied to the current political climate, but it seems to be less focused on a particular issue. With all of the insanity going on right now, what cause would you say is extremely important to you, and why? The cause that is most important to me is for people to WAKE THE FUCK UP. I believe a shift in consciousness is priority one. The sooner people become aware that our government has been hijacked and that we have been living in a social and political environment, intentionally designed to control us through fear, the better. The “dark forces” I’m referring to in the song are the ones who are trying to create chaos and fear for people so they can be controlled. There is a new wave of fear coming at us now. Women are on the verge of losing their rights to make choices about their own bodies. This is crazy! It amazes me that more people — especially women — are accepting this, and even supporting it in many cases. People of all races and religions are experiencing threats that should not be tolerated for a second in this day and age. It's plain to see so many of this “administration”’s efforts, are to “normalize” hate and fear under the guise of patriotism. It up to us to not fall into the trap. We have to stay united in our shared humanity and show care for each other, now more than ever. How would you quantify what is going on in America and what do you think the average citizen can do to help? Do things that truly empower your heart and soul, and in turn it will inspire the hearts and souls of others around you. This has a BIG impact, and we can all do it RIGHT NOW. Pay attention to where you spend your money and who profits from the choices you make. Educate yourself on how food is grown, how things are made and where they are made, to the best of your ability. I don’t think we all realize how much power there is in our spending choices. Try a plant-based diet! This one choice will have an immediate positive impact on your health [and] the environment, and you will be helping to topple the government-subsidized meat industry! I encourage people to call their representatives and express themselves about issues that are important to them. Whatever you choose to do or say, take action from your heart and it will be helping to empower hearts everywhere! Did you participate in the Women's March? If so, what sort of feelings did you get? I was unable to attend a march, but I participated that day virtually by helping my wife, Shanti [Wintergate], create a video for a new single she released that day, called “Revolution.” It felt good to be able to help my wife realize her vision about what’s happening in our world right now and say what she wanted to say that day through the song and the video. I was so inspired by the events of that day. I still feel energized by it! 2016 saw the release of your 10th LP, Simplicity . Did this song come from those sessions? The song did not come about during those sessions. The band had all been following the events at Standing Rock for a while, but the spark of inspiration came when a good friend of ours, who is a veteran, organized a trip to Standing Rock to assist the water protectors in December. The song idea was born shortly after that; then we exchanged ideas over the phone and the band mobilized a recording session really quickly. John Seymore, who produced Simplicity , agreed to volunteer his producer efforts, and we were in the studio in a few days. It felt great to be proactive as a group and get behind something we all believe in, instead of allowing all these events to steamroll us into submission. We want to keep that head of steam and momentum going, and do our part if we can, like so many others. The power of the people can change the world. What's next for the Bouncing Souls? What's next for you as a solo artist? The Souls will be continuing to bring good vibes to our world for the next six months on various tours. We are doing a few East Coast dates and West Coast dates, and will be playing some European festival shows in the spring and summer. I haven’t been doing much solo stuff, but I have been working on a family-friendly music project called Play Date for the past few years, and I am excited to be performing live and releasing some new music with that this year. In the big picture, though, I’m most excited about doing my best in every moment to stay centered and share love with the world. I encourage everyone to do the same — it will make a huge impact for all of us.

A transaction-based memory interface is one of the choices for interfacing with a variety of memory and storage devices. The transaction-based memory interface provides design flexibility because a memory controller of a host computer and the coupled memory and storage device communicate with each other via asynchronous messages. The transaction-based memory interface can support higher memory capacity and higher bandwidth for memory devices or storage devices. The transaction-based memory interface can also be used as an interface for input/output (I/O) ports to provide connectivity between various types of electronic devices. Typically, a generic transaction-based interface designed for memory and storage modules provides discrete interfaces for the memory and storage modules. The number of modules that can be coupled to a host computer is determined by the predetermined number of links supported by the interface. FIG. 1 shows an example of such a generic transaction-based interface. The transaction-based interface 110 has a total of n+m interface links including a first set of interface links for memory modules 1-n and a second set of interface links for storage modules 1-m. In a typical system, memory and storage modules reside in a discrete module and operate in a memory address space and a storage address space, respectively.

FRANKLIN, Wis. - The closures of two other food pantries have sent a growing number of hungry people through the door at Jeremiah Missionary Baptist Church in Milwaukee, where food service director Audrey Wilson is scrambling to meet the demand. Other people have come seeking help as their food stamp benefits have been cut, in some cases to as little as $16 a month. Something is better than nothing, Wilson said, but "with $16, they probably only get milk, bread and eggs." Wilson and other anti-hunger advocates gathered Wednesday at a news conference in the Milwaukee suburb of Franklin, where they celebrated a possible end to the partial government shutdown. However, they lamented that Congress still has not passed a farm bill, which historically has funded many food programs. An extension expired Sept. 30, and work on a new bill has languished as lawmakers focused on the 16-day shutdown and a threatened Treasury default. Senate leaders announced a deal to reopen the government Wednesday morning, and Congress approved it late that night. Sherrie Tussler, executive director of Hunger Task Force, said the deal was "great news" because time had been running out for people to apply or renew benefits for next month. But, Tussler said, an end to the shutdown wasn't enough because of the uncertainty surrounding the farm bill, which funds the Supplemental Nutrition Assistance Program. The Senate's version of the bill would cut $400 million per year from the program, while a House bill would cut $4 billion annually. When the shutdown ends, Tussler said, "We can all go, yay! But at the end of today, if that happens, don't say yay. Say, what about the farm bill?" Wilson's church provided nearly 300 people with food last month, but she said it "wiped us out." A call for help brought in donations, including a gift of nearly 2,400 pounds of food from Roundy's Supermarkets. But she said she's not sure what she'll do this month - and next - as the hungry keep coming. An increase in food stamp benefits funded by the federal stimulus package expires at the end of the month. In November, an average family of four will see benefits fall from $668 to $632 a month, about a 5 percent cut. Democratic Reps. Katrina Shankland and Mandela Barnes spoke in support of a farm bill that adequately funds food programs. Shankland, of Stevens Point, said she always considered herself lucky to live in an area with many farms that supply fresh fruit and vegetables. But she spent a week last summer living on food stamps and found that $1.50 per meal put most produce out of reach. "What I found was that I basically had to eat carbs and subsist on that," she said. Barnes, who used food stamps for about six months in 2010 when his hours at the Milwaukee Area Workforce Investment Board were cut, said time for action on a farm bill is running short, and was reminded of a sign he saw recently. "The sign read, 'At some point, the poor will have nothing to eat but the rich,'" he said.

Managing Disagreements in the Management of Short Bowel and Hypoplastic Left Heart Syndrome Background and Objectives. When innovative, not yet fully proven therapies are introduced, physicians may have neither experience nor sufficient data in the medical literature to assist in their decision to discuss them with and/or recommend them to patients. Little is known about how physicians deal with this uncertainty. Moreover, when multiple physicians caring for a single patient have reached different conclusions regarding this new therapy, the potential for disagreement exists that could give rise to ethical issues as well as cause confusion to the patient. To explore these topics, we investigated the attitudes of specialists to therapies for two life-threatening diseases: hypoplastic left heart syndrome (HLHS) and short bowel syndrome. Methods. A forced choice questionnaire was distributed to the heads of neonatology, pediatric cardiology, and pediatric gastroenterology training programs asking about their outcome impressions and treatment recommendations and about the local availability of treatments. In addition, responses from specialists from the same institution were linked in a confidential manner to evaluate the frequency of disagreement within the same institution. Responses were analyzed using 2 and Wilcoxon matched pair analysis as appropriate. Results. The overall rate of response was 79%. In institutions that had both neonatology and pediatric gastroenterology training programs, there was a 59% response rate compared with a 73% response rate from institutions that had both neonatology and cardiology programs. Significant differences were noted among specialists as to who would be involved in discussions of therapeutic options with patients in both HLHS and short bowel syndrome. Differences also were noted in the willingness of specialists to discuss and recommend therapies, in the perceived survival and quality of life by various specialists after transplant and palliative surgery, and in the local availability of various options. The neonatologists and gastroenterologists at the same institution disagreed on responses in 34% of the questions with only 1 of the 25 pairs in full agreement. In contrast, the neonatologists and pediatric cardiologists at the same institution disagreed in only 14% of the questions with 7 of the 28 pairs in full agreement. Conclusions. Substantial disagreement among specialists about new interventions was found. There seem to be fewer differences among specialists when dealing with the more mature therapy, HLHS. Two major ethical issues arise. First, there seems to be no accepted professional standard to which individuals can appeal when determining whether to discuss or recommend new, not-yet-fully-proven technologies. Second, there is the potential for much patient confusion when counseling physicians recommend different options. Colleagues as individuals and specialists as groups should talk to each other before individual discussions with families to ensure that there is a clear understanding of differing beliefs.

The 28-page report HHS released breaks down these numbers into greater detail. And the numbers are probably a little conservative, because some states haven’t submitted final figures and people who registered directly with state offices handling Medicaid or Children’s Health Insurance Program enrollment don’t count toward the total. But most people will focus on the topline numbers, out today. The question is how to judge them. And that comes down to how you think about two separate issues: 1) What counts as an enrollment? HHS counts somebody as enrolled once they have selected an insurance plan. Critics have said enrollment should only count for somebody who has written a check. The administration notes that healthcare.gov doesn’t actually have a payment option. You have to get a bill from the insurer. Most people aren’t going to pay now for a policy that begins January 1, they say, adding that many insurers don’t even ask for payment until December. Critics say it doesn’t matter. Enrollment figures shouldn’t count if no money has changed hands. 2) What’s a realistic baseline? You’re going to hear a lot about an internal HHS projection, later obtained by the Associated Press, suggesting half a million people would sign up for private plans in the first month. The real number is obviously way, way short of that figure—and surely has something to do with problems on the website, which have made the enrollment process slow and cumbersome. But that HHS projection is not gospel. For another baseline, it’s helpful to look exclusively at Massachusetts. I’ve described the situation previously: Of the 36,167 people who eventually enrolled in premium-charging plans from Commonwealth Care, 123 signed up in the first month. That’s right—one hundred and twenty-three, or about 0.3 percent. Over the first two months, the number was a bit larger—2,289. But that’s still just 6.3 percent. The analogy to Obamacare is far from perfect, in that Commonwealth Care didn’t include wealthier people who didn't qualify for subsidies. (In the Massachusetts scheme, they essentially had a separate exchange—and enrollment there began half a year later.) Also, the Massachusetts open enrollment period was twice as long. So it’s reasonable to expect that, with a fully functional website, early enrollment in Obamacare private plans would be higher than those numbers above suggest. But the general point stands. Very few people sign up for insurance in the first few months. Most wait until much later in the game. If you do the math, you’ll see the October Obamacare numbers compare favorably if you compare them to the first month in Massachusetts, but unfavorably if you compare them to the first two months. The low enrollment in the federal website is further confirmation that healthcare.gov has worked very poorly.

Identification of key differentially expressed genes between ER-positive/HER2-negative breast cancer and ER-negative/HER2-negative breast cancer using integrated bioinformatics analysis. Background Treatment strategies for various subtypes of breast cancer (BC) are different based on their distinct molecular characteristics. Therefore, it is very important to identify key differentially expressed genes (DEGs) between ER-positive/HER2-negative BC and ER-negative/HER2-negative BC. Methods Gene expression profiles of GSE22093 and GSE23988 were obtained from the Gene Expression Omnibus database. There were 74 ER-positive/HER2-negative BC tissues and 85 ER-negative/HER2-negative BC tissues in the two profile datasets. DEGs between ER-positive/HER2-negative tissues and ER-negative/HER2-negative BC tissues were identified by the GEO2R tool. The common DEGs among the two datasets were detected with Venn software online. Next, we made use of the Database for Annotation, Visualization and Integrated Discovery to analyze enriched Kyoto Encyclopedia of Gene and Genome (KEGG) pathways and gene ontology terms. Then, the protein-protein interactions (PPIs) of these DEGs were visualized by Cytoscape with the Search Tool for the Retrieval of Interacting Genes. Of the proteins in the PPI network, Molecular Complex Detection plug-in analysis identified nine core upregulated genes and one core downregulated gene. UALCAN and Gene Expression Profiling Interactive Analysis were applied to determine the expression of these 10 genes in BC. Furthermore, for the analysis of overall survival among those genes, the Kaplan-Meier method was implemented. Results Ninety-three common DEGs (63 upregulated and 30 downregulated) were identified. KEGG pathway enrichment analysis showed that upregulated DEGs were particularly enriched in the progesterone-mediated oocyte maturation pathway. In addition, PGR might be a prognostic biomarker for ER-positive/HER2-negative BC. CCND1 is a poor prognostic biomarker for ER-positive/HER2-negative BC and ER-negative/HER2-negative BC. Moreover, TFF1, AGR2 and EGFR might be predictive biomarkers of node metastasis in ER-positive/HER2-negative BC and ER-negative/HER2-negative BC. Conclusions CCND1, AGR2, PGR, TFF1 and EGFR are the key DEGs between ER-positive/HER2-negative BC and ER-negative/HER2-negative BC. Further studies are required to confirm the functions of the identified genes.

The Relationship between Hierarchy Ambiguity and Emotional Cut off among a Sample of Married Female and Male Employees Working at Some Public Hospitals in Amman the present study aimed to explore the relationship between hierarchy ambiguity and emotional cut off among a sample of married female and male employees working in 2 public hospitals in Amman, Jordan. It aimed to explore the levels of hierarchy ambiguity and emotional cut off in accordance with (the duration of the marriage, family income, and academic qualifications). The sample consists from 155 individuals (doctors and nurses) who work in the operation and ICU rooms in public hospitals. The researchers used two scales; the hierarchy ambiguity scale and the emotional cut off scale. It was found that the respondents hierarchy ambiguity and emotional cut off levels are low. It was found that there isnt any statistically significant relationship between hierarchy ambiguity and emotional cut off. It was found that there isnt any statistically significant difference in the respondents hierarchy ambiguity and emotional cut off which can be attributed to the family income and academic qualifications. That doesnt apply to marriage duration. For instance, it was found that there is a significant difference between the respondents emotional cut off levels which can be attributed to the marriage duration for the favor of the ones who have been married for a period that exceeds 5 years. It was found that there isnt any statistically significant difference between the respondents hierarchy ambiguity which can be attributed to the marriage duration.. The inequality-related thoughts are influenced by sexual expectations. The status of the spouse who benefit more and the status of the spouse who benefit less are affected by the marital disputes. It should be noted that marital distress and low marital satisfaction are strongly connected with benefitting less (Le Baron, 2014). Spouses seek enjoying equality in roles and responsibilities in order to settle conflicts. However, spouses must waive some rights and adjust the thoughts related to marital happiness in accordance with the surrounding situations. The unequal relationship creates a tensed atmosphere and increases the probabilities of experiencing depression. The equity theory is an objective theory that is based on one's perceptions about the relationship. It interprets the transformations made to the decision making process due to the financial status of the spouses or the shift from one stage to another (Webster & Rice, 1996). The equivalence between spouses throughout the marital stages change. That's attributed to the acquisition of new characteristics by one or the family. Each marital stage requires meeting certain demands. Meeting such demands shall enable the family member to perform his/her functions. Seeking to meet the sexual role assigned by society shall reduce the capability of the spouse to do his/her functions (Smith & Smith, 2006). Emotional cut off Any defect in the family relationships shall lead to experiencing psychological instability by the family members. Providing inadequate attention by the spouses to addressing this defect shall lead to the loss of respect and positive emotions. It may lead to experiencing emotional cut off. Emotional cut off leads to many disputes between the spouses. That shall threaten the survival of the marital relationship. It shall also reduce the emotional harmony between them ((Al-Shwashreh and Abed Al-Rahman, 2018). Titleman Clarified that the emotional cutoff couldn't be occurred or continued in the presence of one individual; it is a process needs at least two individuals to feel emotionally cutoff. Bowen adds that emotional cut off refers to a method that is used by individuals in order to alienate themselves from their families in order to reduce the emotional burden derived from problems. Kerr suggests that emotional cut off refers to cutting off the relationship with the family due the feelings of distress. Such feelings result from emotional miscommunication. According to Weiss, marriage problems may lead to experiencing distress by the spouse. Such distress is considered similar to the distress experienced by children who stopped being attached to their parent. It usually leads to the separation of adults Emotional cut off is considered an extreme solution for reducing the anxiety resulting from close relationship to a family member causing tension. It is practiced through staying away from that family member or avoiding the tensed situations that involves interacting with him. It shall lead to the emergence of more problems (Sholevar&Schwoeri, 1986). Emotional cut off may be practiced intentionally in order to avoid major conflicts that cause tension. It may be practiced internally or physically. The signs indicating that emotional cut off is being experienced include: separation, isolation, withdrawal, loneliness, and denial for the significance of the relationship. There are factors leading to experiencing emotional cut off. Emotional cut off may be experienced after the passage of numerous years. It may be initiated by a spouse suddenly due to a conflict. That's because the latter spouse believes that the relationship should not continue after the occurrence of this dispute that. Emotional cut off may be initiated by both spouses. The types of emotional cut off are : 1-Primary emotional cut off: This emotional cut off is practiced when one cuts off his relationship with his/her parent(s) In Bowen theory, differentiation is considered the most important factors. It's affected by psychological health and maturity. It affects marital disputes, emotional cut off and signs of failure to adapt among spouses. Internal differentiation manifests through separating ideas and emotions. That is done through achieving a balance between intimacy and autonomy. The couples with low level of differentiation can't be impartial. They also have low autonomy level The second central key in Bowen theory is that both of the spouses represent their families, and develop the relationship when they're being more cognitively balanced, and works as a unit. Every Spouse holds the unresolved psychological issues with his/her family of origin to the marital relationship; so when one of the spouses feels emotionally cutoff, it will accompanied with an anxiety that creates negative behaviors to compensate this obstacle and reach the main goal which is the balance between individuality (the tendency to independency) and togetherness (the need to be belonged and acceptable, this balance creates the inner peace. Maggie Hayes studied the causes of divorce among spouses in middle age years indicated that the majority of the spouses with the husband dominant pattern impeded gaining an acceptable independency, and achieving progress at the academic and career wise. Moreover, in some cases, the husband-wife dominant pattern may increase the probability of the marital violence (Sholevar&Scwoeri, 2003). Especially when it is related to a vocational chronic stress, the likelihood to engage in psychological and physical aggression is higher (Frye&Kerney, 2006).and marital withdrawal following this heavy load times at work (Story&Repetti, 2006). Many societies suffer from emotional cut off, such as: Asian societies. In such societies, the emotional cut off is prevalent. That's attributed to the nature of the dominant culture (Sahebihagh, Khirshidi, Atri&Jafarabadi, 2017). For instance, the culture may set many social determinants. Such determinants emphasize the significance of protecting families, sons and daughters. That leads to increasing the possibilities of experiencing emotional cut off. That's because people in such societies avoid getting divorced to avoid having negative attitudes towards them (Yeitzhak& Peleg, 2011). Walsh suggest that most of the divorce cases among the spouses who have been married for a period of years. The divorce in such marriages is attributed to experiencing many irresolvable disputes. It's also attributed to experiencing emotional separation. Experiencing such separation shall make the spouse refrain from handling his/her responsibilities. Such refrainment shall lead to experiencing emotional cut off and using offensive expressions and expressions that involve criticism. In such a case, each spouse shall have his/her own personal life and start seeking divorce. Jafarizadeh and Afrasiabi aimed to explore the relationship between emotional divorce and personal factors in Behbahan. The simple random sampling method was used. The sample consists from 57 individuals. A survey was used for data collection. It was found that there is a significant relationship between emotional divorce and several personal factors, such as: sex, understanding spouse, spouse expectations, using nice words by spouse, using drugs and understanding spouse situations. It was found that there isn't a significant relationship between emotional divorce and several personal factors, such as: pessimism, occupational differences, misplaced expectations, educational differences, age and forced marriage. Katyal conducted a study in India. He found that psychological exhaustion and burnout levels are higher among the nurses working at public hospitals. Thus, such nurses have higher probabilities to experience psychological problems. That applies especially to the nurses who work at the ICU room (). Alshawashereh and Abdel Rahman aimed to explore the relationship between emotional separation and irrational thoughts among married people. The sample consists from 242 married individuals. Two scales were used. One of them measures irrational thoughts and the other scale measures emotional separation. It was found that there is a positive significant relationship between emotional separation and irrational thoughts among married people. Values of the correlation coefficient, frequencies and percentages were calculated. The present study aimed to shed a light on several aspects of the lives of the married employees working at the operation and ICU rooms in some public hospitals in Amman. It's necessary to understand the factors related to that within an economic and developmental frameworks. Family experience several development stages. These stages are three ones. During the first stage, the newly married couple face many challenges and must handle many responsibilities. Such challenges are related to daily life issues and the spouses' relationships with their families. In case the spouses didn't adjust themselves to meet the new demands and couldn't settle the conflicts with their family members, there shall be high probabilities to experience emotional cut off and then actual divorce. There are many studies that shed a light on emotional cut off worldwide. However, as far as the researchers know, there aren't many studies that shed a light on emotional cut off in Jordan. In addition, there aren't many studies that shed a light on hierarchy ambiguity. That applies especially to the studies that target the employees who work in the medical institutions in general and the employees who work in the public hospitals in particular. Therefore, the present study aimed to explore the relationship between hierarchy ambiguity and emotional cut off among a sample of married female and male employees working in public hospitals in Amman, Jordan. It aimed to identify the levels of hierarchy ambiguity and emotional cut off in accordance with (the duration of the marriage, family income, and academic qualifications) The Study's Questions: The present study aimed to answer the following questions: 1- What's the level of hierarchy ambiguity among the married female and male employees working at public hospitals in Amman? 2- What's the level of emotional cut off among the married female and male employees working at public hospitals in Amman? 3- Is there any statistically significant relationship -at the statistical significance level of (a=05)-between hierarchy ambiguity and emotional cut off among the married female and male employees working at public hospitals in Amman? 4- Is there any statistically significant difference -at the statistical significance level of (a=05)-between the respondents' hierarchy ambiguity levels which can be attributed to (the duration of the marriage, family income, and academic)? 5- Is there any statistically significant difference -at the statistical significance level of (a=05)-between the respondents' emotional cut off levels which can be attributed to (the duration of the marriage, family income, and academic)? Methodology: The Study's Design: The researchers adopted a descriptive approach. A correlative approach wad adopted. These approaches were adopted to explore the relationship between hierarchy ambiguity and emotional cut off among a sample of married female and male employees working in public hospitals in Amman, Jordan. They were adopted to explore the levels of hierarchy ambiguity and emotional cut off in accordance with (the duration of the marriage, family income, and academic qualifications) Journal of Education and Practice www.iiste.org ISSN 2222-1735 (Paper) ISSN 2222-288X (Online) Vol.10, No.36, 2019 Sample: Two public hospitals in Amman were sampled. One of them is located in East Amman, whereas the other is located in West Amman. The present study targeted the whole population. The population consists from all of the married female and male employees (doctors and nurses) working in the operation and ICU rooms in public hospitals in Amman. 160 questionnaire forms were distributed to the employees who work at these rooms. 5 forms were excluded due to missing data. Such missing data include demographic data and variables-related data. 155 forms were retrieved. The response rate is greater than 95%. Thus, the data in 155 forms was analyzed. Regarding the duration of the marriage, 84 respondents have been married for a duration that's less than 5 years. 71 respondents have been married for a duration that's more than 5 years. Regarding the family income, 116 respondents have family income that is less than 1000 JDs. 39 respondents have family income that is more than 1000 JDs. Regarding academic qualifications, 39 respondents have a diploma degree or less. 116 respondents have a BA degree or a higher degree. When distributing the questionnaire forms in hospitals, the researchers complied with ethics. The present study was conducted during (July-October) of 2019. The members of the sample volunteered to participate in the present study. They agreed to participate after illustrating the significance of their participation by the researchers. The researchers distributed the questionnaire forms to the sample during the break period. The members of the sample were informed that their participation in the study is very significant. Each member of the sample filled in the form in private and gave it back to the researchers. The process of filling the form took minutes. After collecting data, it was analyzed statistically through using the SPSS program. The value of Pearson correlation coefficient was calculated to identify the correlation between the hierarchy ambiguity and emotional cut off. Means and standard deviations were calculated to explore the levels of hierarchy ambiguity and emotional cut off in accordance with (the duration of the marriage, family income, and academic qualifications). Table presents the demographic characteristics of data. Data analysis methods: To analyze the collected data, the researcher calculated percentages, frequencies, means and standard deviations. He also calculated the values of the correlation coefficient to explore the relationship between variables. The researcher adopted a descriptive analytical approach for analyzing data. This approach is usually adopted in scientific research for providing a sensory description for objects. It's adopted to determine whether the sensory attributes of objects are accepted or not. It's also adopted to understand and explore variables and their components (Lawless and Heymann, 1999). Instruments The study's instruments are identified below: The hierarchy ambiguity scale: A scale was developed for measuring the hierarchy ambiguity. It was developed after reviewing several scales, such as: the scale of the marital power, the scale for measuring the outcomes of such power (Le Baron & Miller &Yorgason, 2014), the marital decision scale, the decision making and interpersonal control scale (Mason and Smith, 2000). The hierarchy ambiguity scale aimed to measure two dimensions. The first one is the marital decision (12 items). The second dimension is marital influence (19 items /item No. 13 -item No. 31). A three-point Likert scale was adopted. It consists from the following scores: 0 score (i.e. unclear), 1 score (i.e. one of them) and 2 scores (i.e. both of them). 1- The marital decision dimension: It is connected to the one who makes the final decision in various aspects of life. It is represented in items No. (2 3 4 5 6 7 89 10 11 12 1). The scores of this dimension is within the range of. 2- The marital influence dimension: It's one of the strength aspects in the marital hierarchy. It's represented in direct and indirect words and behaviors that the spouse uses in order to change the other spouse. It is represented in items No 13 -31. The scores of this dimension is within the range of. The total scores are within the range of 0-31. The maximum limit is 1 score and the minimum limit is 0 score. The total score of the hierarchy ambiguity that is within the range of 0-33 is low. The total score of the hierarchy ambiguity that is within the range of 43-67 is moderate. The total score of the hierarchy ambiguity that is within the range of 68-100 is high. The emotional cut off scale: This scale was developed to meet the study's goals. It consists from 30 items. It was developed after reviewing the relevant studies (Skowron& Friedlander, 1998) and the emotional separation ((Al-Shwashreh and Abed Al-Rahman, 2017). Statistical criteria for the emotional cut off scale. The emotional cut off scale adopted the five point Likert scale. The latter scale consists from the following categories; strongly agree, agree, neutral, disagree, and strongly disagree. These categories represent the following scores respectively; 5, 4, 3, 2 and 1. The total score of the emotional cut off that is within the range of 1-2.33 is low. The total score of the emotional cut off that is within the range of 2.34-3.67 is moderate. The total score of the emotional cut off that is within the range of 3.68-5 is high. These statistical criteria were set through the following method: (The maximum limit / the minimum limit )/ The number of categories Thus, the interval is 1.33 The study's procedures: Ethical consent: The consent of the institutional review Board (IRB) at Jordan University Hospital was obtained. The consent of the institutional review Board (IRB) at the Jordanian Ministry of Health was obtained. These consents were obtained in order to collect data from the employees who work at the aforementioned hospitals Pilot study Journal of Education and Practice www.iiste.org ISSN 2222-1735 (Paper) ISSN 2222-288X (Online) Vol.10, No.36, 2019 Emotional cut off Measuring validity through experts: The emotional cut off scale was passed to ten university professors who were selected from the University of Jordan. They were also selected from other public and private Jordanian universities. They are specialized in counselling, including family counselling. They were asked to provide their opinions about the relevancy of each item to the study's goals. They were asked to provide their opinions about language, and clarity of items. They were asked to make deletions, additions, and changes. The researchers decided to keep the items that are approved by 80% of the experts. The sample percent applies to the adjustment of statements. Nine statements were deleted based on the experts' opinions. These items are items No. (10 22 27 31 32 33 35 39). Thus, the final version of the scale consists from 30 items. The discriminant functions of each item In order to measure the structural validity of the scale, the values of the correlation coefficient were calculated. That was done after retrieving the questionnaire forms from an exploratory sample. The exploratory sample consists from 30 married female and male employees working in public hospitals. However, the members of the exploratory sample are different from the members of the actual sample. The values of the correlation coefficient represent validity. They are within the range of 0.86-0.34. The table listed below displays these values: Reliability of the emotional cut off scale: In order to measure the reliability of the emotional cut off scale, the total value of the internal consistency coefficient (i.e. Cronbach Alpha coefficient) was calculated. That was done after retrieving the questionnaire forms from an exploratory sample. The exploratory sample consists from 30 married female and male employees working in public hospitals. However, the members of the exploratory sample are different from the members of the actual sample. The total value of the Cronbach Alpha coefficient is 0.95.The values of the Cronbach Alpha coefficient enable the researchers to meet the study's goals. The hierarchy ambiguity scale: Validity of the scale was measured through two methods: Measuring validity through experts: The hierarchy ambiguity scale was passed to ten university professors who were selected from the University of Jordan. They were also selected from other public and private Jordanian universities. They are specialized in counselling, including family counselling. They were asked to provide their opinions about the relevancy of each item to the study's goals. They were asked to provide their opinions about language, and clarity of items. They were asked to make deletions, additions, and changes. The researchers decided to keep the items that are approved by 80% of the experts. The sample percent applies to the adjustment of statements. Nine statements were deleted based on the experts' opinions. In order to measure the structural validity of the scale, the values of the correlation coefficient were calculated. That was done after retrieving the questionnaire forms from an exploratory sample. The exploratory sample consists from 30 married female and male employees working in public hospitals. However, the members of the exploratory sample are different from the members of the actual sample. The values of the correlation coefficient represent validity. They are within the range of 0.75-0.12. The table listed below displays these values: The present study aimed mainly to explore the relationship between hierarchy ambiguity and emotional cut off among a sample of married female and male employees working at public hospitals in Amman. The first and second questions are answered through calculating means and standard deviations. The third question is answered through calculating the values of Pearson correlation coefficient. The fourth question is answered through conducting the three way analysis of variance The study's first question: What's the level of hierarchy ambiguity among the married female and male employees working at public hospitals in Amman? To answer this question, means and standard deviations were calculated. The table below illustrates these values The percentage of the hierarchy ambiguity of taking the marital decision is 3.3. The percentage of the hierarchy ambiguity of marital influence is 24.9. The total percentage of the hierarchy ambiguity is 16.8. All of the latter decisions is low. The study's second question: What's the level of emotional cut off among the married female and male employees working at public hospitals in Amman? To answer this question, means and standard deviations were calculated. The table below illustrates these values Q.3: Is there any statistically significant relationship -at the statistical significance level of (a=05)-between hierarchy ambiguity and emotional cut off among the married female and male employees working at public hospitals in Amman? The values of Pearson correlation coefficient are calculated to answer this question. Table displays the values of Pearson correlation coefficient to identify the relationship between hierarchy ambiguity and emotional cut off among the married female and male employees working at public hospitals in Amman (*)This sign means that the value is statistically significant at the statistical significance level of (a=0.05) (**)This sign means that the value is statistically significant at the statistical significance level of (a=0.01) Through table, it was found that there is a positive statistically significant relationship between emotional cut off from one hand and taking the marital decision and the marital influence from another hand. That was concluded among the married female and male employees working at public hospitals in Amman. It was found that there isn't any statistically significant relationship between hierarchy ambiguity and emotional cut off among the married female and male employees working at public hospitals in Amman. The study's fourth question: Is there any statistically significant difference -at the statistical significance level of (a=05)-between the respondents' hierarchy ambiguity levels which can be attributed to (the duration of the marriage, family income, and academic)? Means and standard deviations are calculated to explore the levels of hierarchy ambiguity in accordance with (the duration of the marriage, family income, and academic qualifications). To identify the statistical significance of those differences, the three way analysis of variance was conducted. The results of the latter analysis are presented in table -It was found that there isn't any statistically significant difference-at the statistical significance level of (a=05)-between the respondents' hierarchy ambiguity levels which can be attributed to the duration of the marriage. That applies to all the areas jointly and separately. -It was found that there isn't any statistically significant difference-at the statistical significance level of (a=05)-between the respondents' hierarchy ambiguity levels which can be attributed to the family income. That applies to all the areas jointly and separately. -It was found that there isn't any statistically significant difference-at the statistical significance level of (a=05)-between the respondents' hierarchy ambiguity levels which can be attributed to the academic qualification of wife.. That applies to all the areas jointly and separately. -It was found that there isn't any statistically significant difference-at the statistical significance level of (a=05)-between the respondents' hierarchy ambiguity levels which can be attributed to the academic qualification of husband. That applies to all the areas jointly and separately. The study's fifth question: Is there any statistically significant difference -at the statistical significance level of (a=05)-between the respondents' emotional cut off levels which can be attributed to (the duration of the marriage, family income, and academic)? Means and standard deviations are calculated to explore the levels of emotional cut off in accordance with (the duration of the marriage, family income, and academic qualifications). Based on the table, it appears that there are difference between the respondents' emotional cut off levels which can be attributed to (the duration of the marriage, family income, and academic qualifications) To identify the statistical significance of those differences, the three way analysis of variance was conducted. The results of the latter analysis are presented in table below Journal of Education and Practice www.iiste.org ISSN 2222-1735 (Paper) ISSN 2222-288X (Online) Vol.10, No.36, 2019 Table : The results of the three-way analysis of variance to explore the statistical significance of the differences between the respondents' emotional cut off levels in accordance with (the duration of the marriage, family income, and academic qualifications) -It was found that there are statistically significant differences-at the statistical significance level of (a=05)-between the respondents' emotional cut off levels which can be attributed to the duration of the marriage. The F value is 5.016. The significance value is 0.027. The latter differences are for the favor of the ones who have been married for a period that exceeds 5 years. -It was found that there isn't any statistically significant difference-at the statistical significance level of (a=05)-between the respondents' emotional cut off levels which can be attributed to the family income. The F value is 1.047. The significance value is 0.308 -It was found that there isn't any statistically significant difference-at the statistical significance level of (a=05)-between the respondents' emotional cut off levels which can be attributed to the academic qualification of wife. The F value is 0.775. The significance value is 0.380 -It was found that there isn't any statistically significant difference-at the statistical significance level of (a=05)-between the respondents' emotional cut off levels which can be attributed to the husband. The F value is 0.070. The significance value is 0.792. Discussion: The present study aimed mainly to explore the relationship between hierarchy ambiguity and emotional cut off among a sample of married female and male employees working in the operation and ICU rooms in public hospitals in Amman. The latter employees include doctors and nurses. Through the study's first question, the researchers aimed to identify the hierarchy ambiguity level of respondents. It was found that hierarchy ambiguity level of respondents is low. The latter result may be attributed to the fact that many respondents have BA degree or a higher degree (74.8% and 69.7%). Having such education shall enable respondents to take, and discuss decisions. Education plays a significant role in differentiation. The latter result is attributed to the fact that most of the respondents' family income is 1000 JDs or less (74.8%). High salaries and disrespect are not associated with the professions that requires dedicating much time leading the employee to delegate their spouses and then experiencing hierarchy ambiguity. Thus, the ones who work in high salary jobs shall not delegate their spouses to take decisions for a long period of time. That is consistent with what's suggested by Al-Udwan and Al-Najar. The latter researchers suggest that hierarchical power is affected by several factors related to situations and capabilities of individuals. The ones who work in tiring and low income jobs experience difficulties in using methods to influence the decision making process performed by their spouses. That's because using such methods shall lead to experiencing more problems and exerting much effort. The clarity in terms of using the marital influence strategies is represented in a percentage of 75.1. Having university degrees shall make both spouses exert much effort to achieve fairness in terms of role and responsibilities. They seek achieving that in a manner that satisfies both spouses. They seek achieving based on fixed and clear foundations without using influence strategies that may indirectly weaken the marital relationship. In fact, spouses seek achieving such fairness through using indirect influence strategies. Such strategies shall make both spouses experience marital happiness and satisfaction (Olson &Defrain, 2003). In addition that one of the most important reasons of hierarchy ambiguity is the ambiguity of the gender role criteria; the Jordanian society is a compenation of congruent nationalities which give the man clearly the right to take the final decisions. Regarding the second question, it aims to shed al light on the level of emotional cut off among the married female and male employees working at public hospitals. It was found that the latter level is low. That may be attributed to the fact that the Jordanian society adopts eastern traditions. Such traditions hinder people from expressing emotional cut off-related issues. The same applies to many Asian countries. In such countries, talking about emotional cut off as something sensitive to talk about. In such countries, answering questions about emotional cut off is considered something socially rude. The latter result is consistent with the result concluded by Shehabihaghet al.. The latter researchers suggest that the emotional cut off level among nurses is low in Iran. The employees in public hospitals enjoy higher job security levels. Their bonus system is fixed. Thus, the employees at public hospitals don't face much work pressure which may negatively marital relationship. Thus, they won't experience the phenomenon of (double income, no sex). The latter phenomenon was addressed by Olson &Defrain. Most of the respondents have a BA degree or a higher degree. That shall make the respondents address the marital daily life issues with more maturity to avoid negative implications. The respondents are concerned much in generating more income. Most of the respondents' family income is 1000 JDs or less (74.8%). Such an income is considered low in comparison to the high cost of living. This category shows a high self-efficacy level as it's suggested by Shehabihagh et al.. Thus, the marital satisfaction of this category is high and the emotional cut off is low. The study shows that the relationship is a negative relationship. When the level of hierarchy ambiguity is low, the likelihood of the anxiety to occur with a psychological and emotional load as a solution to imbalance is low. Regarding the third questions, it sheds a light on hierarchy ambiguity and emotional cut off among the married female and male employees working at public hospitals. It was found that there isn't any significant relationship between hierarchy ambiguity and emotional cut off. The hierarchy ambiguity in the marriage hierarchy is an indicator for the occurrence of marital disputes. Such disputes may lead to experiencing emotional cut off. Differentiation is highly linked with EQ and marital satisfaction (). High EQ level enables one to handle work pressures wisely, and clearly without experiencing hierarchy ambiguity. That shall increase the marital satisfaction and reduce the emotional cut off level. Regarding the fourth question, it aims to explore the differences between the respondents' hierarchy ambiguity levels which can be attributed to (the duration of the marriage, family income, and academic). It was found that there isn't any difference between the respondents' hierarchy ambiguity levels which can be attributed to the duration of the marriage. That's because the spouses with high education are capable to overcome the issues related to the relationship boundaries and determining the one who shall take the decision, and the higher level of education qualified the spouses to deal with the outside interferences from friends and the extended family which represent a reciprocal reason for hierarchy ambiguity, especially at the first and middle age of the marriage. There isn't any significant difference between the respondents' hierarchy ambiguity levels which can be attributed to (the family income). That may be attributed to the fact that all the respondents' spouses are employees. That makes the respondents' spouses accept the income received from healthcare employees in institutions in general and such employees in public institutions in particular. The respondents' spouses are aware about the laws and regulations of healthcare professions. That shall make the respondents' marital decisions balanced, logical and consistent with the family income. Having a working spouse shall reduce how dominant the spouse is. That shall make the spouses understand each other more. The husbands' income and the wives income are close to one another. That shall participate in achieving fairness and equality. It shall Journal of Education and Practice www.iiste.org ISSN 2222-1735 (Paper) ISSN 2222-288X (Online) Vol.10, No.36, 2019 195 participate in reducing the extent of practicing dominance by the spouses.And reducing the predictable psychological and physical violence Thus, the marital relationship shall not be threatened. The spouses' academic qualification are close to one another. Therefore, it's reasonable to have no differences between the respondents' hierarchy ambiguity levels which can be attributed to the academic qualifications. When the spouses' academic qualification are close to one another, they shall not experience a sense of inferiority. Thus, no one shall none of the spouse shall indirectly influence the decision making process made by the other in order to do what he/she desires without making the spouse feel less powerful. When the spouses' academic qualification are close to one another, none of them will need to use power to make the decision by himself/herself nor use strategies to resolve daily issues and marital disputes. There is a significant difference between the respondents' emotional cut off levels which can be attributed to the marriage duration for the favor of the ones who have been married for a period that exceeds 5 years. That's because life is full of happiness during the beginning of the marital life. During this period, both spouses shall perceive each other in a positive manner. Such perception shall make them overcome any issue that may negatively affect their marital life. Today, most of the married people, especially the educated married ones seek adopting a birth planning approach. That's because Jordan is experiencing a bad economic status. It's because many women today are working. It's because children are not treated properly at nurseries. To adopt a birth planning approach, women take birth control pills during the first and the second years of marriage. That's done in order for the spouses to get to know to each other. Thus, the first five years of marriage today are different that the counterpart years in the past in Jordan. In the part, women used to seek giving birth to the greatest number of male children. That's done to meet social demands and avoid feeling insecurity about their feminine identity. Thus, during the first five years of marriage, spouses aren't facing children-related pressures. However, after many years, the spouses will have children. Thus, daily life responsibilities will be maximized. In addition, the spouses will have to take care of their parents, because they have become older. That shall make life full of pressures. Thus, harmony between the spouses will disappear. That shall increase the probabilities of experiencing emotional cut off. The same is suggested through Hilly's theory. The latter theory suggests that family goes through a cycle and transformations which vary from one family to another based on the marriage duration and the presence of songs/daughters. It was found that there isn't any statistically significant difference between the respondents' emotional cut off levels which can be attributed to family income. That's because the employees in the public sector in Jordan realize the amount of income in this sector. Such employees realize that one exerts much effort to be hired in the public sector in order to enjoy high job security level. It's inconsistent with what's suggested by Katyal. The latter researcher suggests that employees in public hospitals have high probabilities of experiencing emotional and psychological problems. That may be attributed to the nature of the work environment at the latter hospitals. The ones who work in the public sector in Jordan enjoy a high job security level and the vacation system is better than the counterpart system of the private sector. It was found that there isn't any statistically significant difference between the respondents' emotional cut off levels which can be attributed to academic qualifications. That's because the husbands' academic qualifications are similar to the wives' academic qualifications. 74.8% of females have BA degree or higher and 69.7% of males have a BA degree or higher. Education plays a significant role in achieving intellectual and emotional harmony between the spouses. Reducing the likelihood of the violence.It also plays a significant role in letting the spouses avoid emotional cut off and separation. Conclusion It was found that the respondents' hierarchy ambiguity and emotional cut off levels are low. The low emotional cut off level of respondents may be attributed to the bad economic situation experienced by Jordan. It may be attributed to the low average income in Jordan. Such bad financial situations shall lead to experiencing marital problems and tensions. Such problems and tensions shall lead eventually to experiencing emotional cut off. After many years of experiencing emotional cut off, the spouses may emotionally separate or get divorced. The low emotional cut off level of respondents may be attributed to the nature of the Jordanian culture. For instance, in such a culture, it's difficult for women to ask for divorced. In addition, in such a culture, divorced women face many difficulties. Therefore, many Jordanian women shall not ask for divorce and thus, they shall experience emotional cut off level. It was found that there is a positive statistically significant relationship between emotional cut off from one hand and taking the marital decision and the marital influence from another hand. That was concluded among the Journal of Education and Practice www.iiste.org ISSN 2222-1735 (Paper) ISSN 2222-288X (Online) Vol.10, No.36, 2019 married female and male employees working at public hospitals in Amman. It was found that there isn't any significant relationship between hierarchy ambiguity and emotional cut off. It was found that there isn't any statistically significant difference in the respondents' hierarchy ambiguity and emotional cut off which can be attributed to the marriage duration, family income and academic qualifications. It was found that there is a significant difference between the respondents' emotional cut off levels which can be attributed to the marriage duration for the favor of the ones who have been married for a period that exceeds 5 years. The researchers recommend conducting longitude studies that target the employees in public and private institutions. Such studies must explore the stages that spouses go through and the way spouses communicate with one another. They must explore whether there are differences between spouses that can be attributed to the marriage duration. Most of the previous studies target employees in public institutions, housewives, and patients in clinics. The researchers recommend exploring marital-related factors that affect the communication between the spouses. Due to the low emotional cut off level of respondents, the researcher believes that measures must be taken by the government and social institutions for promoting knowledge among spouses about the way of maintaining a healthy relationship. The researcher also believes that measures must be taken and policies must be set to improve the financial status of the Jordanian family. That shall lead to promoting harmony and positive feelings among the members of the Jordanian family.

Quantitative description of the absorption spectra of the coenzyme in glycogen phosphorylases based on log-normal distribution curves. The absorption spectra of the coenzyme in glycogen phosphorylase a (GPha), glycogen phosphorylase b (GPhb) and of the latter bound to various effectors and substrates were analysed on the basis of log-normal distribution curves. The results obtained showed that the ionization state of the PLP and GPha environment differs from that of GPhb. This divergence was interpreted in terms of tautomeric equilibria between some forms of the Schiff base of PLP and enzymic Lys-679. The ionic forms are slightly more predominant in GPha than they are in GPhb, so ionic and/or hydrogen-bonding interactions between the aromatic ring of PLP and GPha must be stronger than with GPhb. This confirms the purely structural role of the aromatic ring of the coenzyme. Binding of GPhb to AMP and Mg2+ results in the coenzyme adopting a similar state as in GPha. On the other hand, binding to IMP gives rise to no detectable changes in the tautomeric equilibrium of the coenzyme.

Reflection of temperature ratedependent coupled thermoelastic waves on a non-local elastic half-space Based upon the GreenLindsay (GL) theory of thermoelasticity and the Eringen non-local elasticity theory, we describe the new constitutive relations and the field equations for generalized non-local thermoelastic model. The propagation of harmonically time-dependent thermoelastic plane waves of assigned frequency is studied in a homogeneous, isotropic, non-local infinite elastic solid by employing these equations. Reflection phenomenon of thermoelastic waves at a stress-free thermally insulated or isothermal flat boundary of a non-local thermoelastic solid half-space is also studied in case of incident coupled longitudinal wave. The amplitude ratios of the reflected waves to that of incident wave are determined analytically and numerically by considering an appropriate material. The numerical results are presented graphically to highlight the effects of various parameters of interest.

Profile: Douglas and Pamela Soltis. The power of two. Profile: Douglas and Pamela SoltisPamela and Douglas Soltis have separate appointments at the University of Florida, Gainesville, she at the natural history museum and he in the biology department. But students, grants, courses, publications, talks, even accolades are shared. Early adopters of new techniquesincluding molecular DNA toolsas students in the 1980s, the Soltises have shown how rapid progress can be when two minds focus on a single research program. Doubling up is a main theme in their research as well. In their work on the evolution of flowering plants, the Soltises have shown that two genomes can be better than one. Throughout their joint career, they have studied a genus called Tragopogon, weedy plants with composite flowers that turn into puffballs. Hybridization of closely related Tragopogon species in Washington state has brought together two plant genomes in a single organisma condition called polyploidyyielding new species that are crowding out the parent stock. In addition, using molecular techniques to build a family tree of flowering plants, or angiosperms, the Soltises and their collaborators have determined which plants in the angiosperms are the most ancient. Early genome duplications, they learned, created genetic fodder for the great burst of diversification that followed the first appearance of flowering plants.

Two-stage pancreatic head resection after previous damage control surgery in trauma: two rare case reports. Background This study describes the successful treatment of two clinical settings of grade V pancreaticoduodenal blunt trauma only possible due to the prompt collaboration of a peripheral trauma hospital and a central hepatobiliary and pancreatic unit. Case presentation We reviewed the clinical records of two male patients aged 17 and 47years old who underwent a two-stage pancreaticoduodenectomy after a previous Damage-Control Surgery (DCS). Both patients were transferred to our Hepatobiliopancreatic Unit 2days after immediate DCS with haemostasis, debridement, duodenostomy, gastroenterostomy, external drainage and laparostomy. One day after, they both underwent a two-stage Whipples procedure with external cannulation of the main bile duct and the main pancreatic duct with seized calibre silicone drains through the skin. The reconstructive phase was performed two weeks later. The first patient had an uneventful post-operative course and was discharged on post-operative day 8. The second patient developed a high debt biliary fistula on post-operative day 5 being submitted to a relaparotomy with extensive peritoneal lavage. After conservative measures the fistula underwent a progressive closure in 15days, and the patient was discharged at post-operative day 50 without any limitations. Conclusions Pancreaticoduodenectomy is a life-saving operation in selected grade V pancreaticoduodenal trauma lesions. DCS is a salvage approach, often performed in peripheral hospitals, making an early referral to an hepatobiliopancreatic centre mandatory to achieve survival in these severely injured patients. A two-staged Whipples operation for severe duodenal / pancreatic trauma can be performed safely and may represent a life-saving option under these very unusual circumstances. Background Duodenal and pancreatic injuries are very rare compared with those of other abdominal organs. Isolated duodenal injuries have an estimated 4.3% incidence in all abdominal injuries, and pancreatic trauma occurs in only 3%. By its protected retroperitoneal location, an excessive blunt or penetrating trauma is required to be able to injury both the pancreas and the duodenum. This is the main cause to the high rates of associated abdominal injuries under those circumstances. The most common injury is at the neck of the pancreas, by direct compression against the vertebral column, while less commonly, pancreas head or tail injuries may develop due to blows to the flanks. Hemodynamically unstable patients need to have an immediate surgical exploration, often with a Damage-Control Surgery (DCS), and the reconstructive interventions should be planned at a later stage, when the potentially lethal factors (haemorrhage, shock, peritonitis, acidosis, hypothermia or coagulopathy) are treated efficaciously and the patient is stabilized. However, many complex injuries occur far from differentiated medical centres, and the first approach to these complex patients is made in peripheral hospitals, lacking surgeon and institutional experience, making crucial an early referral collaboration. Under these circumstances pancreaticoduodenectomy is a very uncommon procedure, and a two-stage operation may be considered if the surgeon is dealing with an unstable patient. Moreover, this approach is usually reserved for the most severe injuries of both the head of the pancreas and the duodenal arch, grade 4 or 5 according with the organ injury scale and the American Association for the Surgery of Trauma (Table 1). Here we present two cases of severe blunt duodenal / pancreatic trauma, using this two-stage approach after a previous DCS. Both patients had been managed previously with haemostatic procedures followed by gastroenterostomy before being referred to our institution for definitive surgery. Case presentation First clinical setting A 17-year-old male suffered a severe motorcycle accident with a deep upper abdominal blunt trauma. Soon after the accident he was resuscitated and taken for emergency laparotomy at the nearest Trauma Centre. A massive right-sided retroperitoneal hematoma was detected, with active haemorrhage from a severely disrupted pancreatic head, duodenum and lower biliary tract. An extended Kocher manoeuvre was performed while compressing the hepatoduodenal ligament for haemostasis. At that time a main pancreatic duct disruption was demonstrated, without any evidence of the portal or the superior mesenteric vein involvement. The patient was hypothermic and moderately acidotic, fostering a DCS. After multiple sutures around the avulsion areas, the active bleeding was stopped and a cholecystectomy, complemented with a silicone T-tube drainage of the main bile duct and a gastroenterostomy were performed, as well as a duodenostomy with a Foley catheter. Two large silicone drains were placed and the patient was transferred to Lisbon by plane, with a laparostomy. The patient was admitted in the Intensive Care Unit (ICU) of Curry Cabral Hospital where supportive care was initiated. Improvement of physiological parameters and hemodynamic stability was achieved in 48 h, despite a progressive biliary drainage from the silicone rubber drains. A second surgery was then decided, revealing bile staining throughout the entire peritoneal cavity, revealing slight oedema of the bowel loops without contamination. A Whipple's resection was performed, exposing a main bile duct of around 5 mm diameter and a centred and easily located 3 mm main pancreatic duct: they were both cannulated with seized calibre silicone drains exiting the abdomen through the skin. Before closing the abdomen both catheters were secured to the surrounded parenchyma with a nylon transfixed suture, and the right upper quadrant was drained with two closed suction systems (Fig. 1). The post-operative course was uneventful. Fourteen days later the reconstructive operation was performed without any unusual factors, and a classical Whipple operation was completed after removal of the well-placed silicone endoluminal catheters. Again, the post-operative course was uneventful and the patient was discharged from the hospital at post-operative day 8. Second clinical setting This patient was a 47-year-old male paddle-surfer who suffered a severe deep and blunt trauma in the upper abdomen with his paddle-surf board. He was immediately transported to the nearest emergency room (Trauma Centre of Portimo Hospital), where he was submitted to a first medical evaluation. At that time, he was hemodynamically stable but with severe abdominal tenderness and acute abdomen signs. An abdominal CT scan revealed a haemopneumoperitoneum with distinctive evidence of pancreatic contusion in the uncinated process and duodenal rupture. No main pancreatic duct disruption was shown. He was then sent to emergency surgery and a median laparotomy was performed. There was a 300 cc haemoperitoneum with its origin in the duodenum and the head of the pancreas, but as in the first clinical setting, there was no lesion detected in the portal or the superior mesenteric vein. A more than 75% rupture of the second duodenum was confirmed, with alleged bile duct integrity and a complete main pancreatic duct disruption in the neck (Fig. 2). A DCS was performed, with haemostasis, a duodenostomy with a Foley catheter, a silicone T-tube drainage of the main bile duct (after a normal cholangiography), cholecystectomy and a gastroenterostomy (Fig. 3). Again, two large silicone rubber drains were placed and the patient was transferred by plane to the HPB Unit of Curry Cabral Hospital, with a laparostomy. The patient was admitted in the ICU of Curry Cabral Hospital, obtaining an improvement of physiological parameters and achieving hemodynamic stability in 48 h, once again with a progressive drainage rich in amylase from the silicone rubber drains. As the drainage turned biliary, a second surgery was then decided, confirming bile content throughout all the peritoneal cavity, with considerable oedema of the bowel loops. A Whipple's resection was performed, exposing a main bile duct of around 4 mm diameter and a centred and easily located 3 mm main pancreatic duct with a normal consistency parenchyma. The same surgical protocol was used, cannulating both ducts with seized calibre silicone drains exiting the abdomen through the skin (Fig. 4). Again, both catheters were secured to the surrounded parenchyma with a nylon transfixed suture, and the right upper quadrant was drained with two closed suction drains. The abdomen was then closed. The post-operative course was uneventful. Sixteen days later, the reconstructive operation was performed just as in the previous case, and a classical Whipple was completed after removal of the well-placed silicone endoluminal catheters. The post-operative course was uneventful until the 5th day. At this point, there was progressive abdominal pain and a high debt biliary fistula, both from the drain and the abdominal wall. A relaparotomy was then performed, with extensive peritoneal lavage, confirming an impenetrable and sealed upper abdominal compartment: the suction drains were changed and the laparotomy was closed with separated full-thickness stiches. After conservative measures and serial image control, the fistula underwent a progressive closure in 15 days, and the patient was discharged from the hospital at post-operative day 50. He reported returning to his normal lifestyle without any limitations. Discussion and conclusions Whipple's procedure in trauma-related circumstances is a very unusual procedure. This kind of pancreatic resection was reported for the first time in literature for trauma patients in the 60s. This is due to the very low incidence of duodenal and pancreatic injuries compared to other abdominal organs (respectively 4.3 and 2.0% of all abdominal injuries), and to the very high mortality rate ranging from 20 to 100%. The two cases described were both grade V, making a surgical approach inevitable. Nonoperative management would be inappropriate in these high-grade injuries, as it has been demonstrated in retrospective studies. This is not an absolute truth since non-operative treatment for severe lesions is possible as demonstrated by Wilden in one of the largest retrospective studies. However, in these two cases the presence of both extensive trauma to the head of the pancreas and severe combined pancreaticoduodenal injury justified the operative decision. The clinical and geographic circumstances determined the option of performing DCS as the first approach. This strategy is indicated with acidosis (pH < 7.3), hypothermia (temperature < 35°C) and coagulopathy (non-mechanical bleeding). Due to its rarity, the application of DCS techniques in relation to pancreatic and duodenal injuries is hardly ever described in literature, aiming at preventing further haemorrhage or abdominal contamination with bile and pancreatic juices. Packing combined with adequate pancreatic and duodenal drainage, as in the primary approach of these two cases, was the appropriate DCS technique under those circumstances. The need for total pancreatectomy is exceptional during DCS, under these circumstances. However, it might be considered only as a definitive procedure, if the extent of debridment required left no other choice. This difficult decision might be taken only by a center specialized in pancreatic surgery. Also, attempting a Whipple's resection on a coagulopathic, hypothermic and acidotic patient, is considered very risky, assuming that a higher experience / better outcomes relation is also true in unstable trauma patients. Additionally, the status of the main pancreatic duct as well as the global status of the patient determinate the management of pancreatic injuries. Screening trauma patients for pancreatic injury using CT scan must be cautious since the sensitivity is reported as poor, as in the second clinical case. A careful inspection and a bimanual palpation of the pancreas should be enough to demonstrate a main duct injury, avoiding added risk by other manoeuvres such as intraoperative pancreatography. In most cases described in literature, the second and definite surgery is performed in approximately 48 h, allowing appropriate staff and patient conditions. In the two cases described, however, the second surgery has been precipitated by the aggravation of the abdominal conditions, namely the bile content throughout the whole peritoneal cavity. The high amylase content of the drainage activated the bile leaking from the injured duodenum, and led to a pancreatitis-like reaction and to a considerable oedema of the bowel loops, which, altogether, precluded the immediate reconstruction after pancreaticoduodenectomy. One might argue why deciding to postpone the definitive reconstruction, as it was taking place at an experienced hospital, with an experienced pancreatic team. There is evidence that, performing anastomosis despite the unfavourable presented circumstances is as safe as delaying it into a twostage procedure (38.7% vs 34.2% mortality). Nevertheless, assuming such a high late mortality rate, mostly due to multiple organ failure and sepsis discouraged us to do so, particularly after an open abdomen scenario. The appropriate conditions of both the common hepatic duct and the main pancreatic duct made safe and possible to cannulate both with separate silicon catheters, allowing a total and separated external drainage of bile and pancreatic content. Both drainages were left in place in a good position, allowing local conditions for the final surgical step. The length of time until the anastomotic surgery (15 days) was decided based on the stabilization of the clinical situation of the patient. Although this could be considered a late timing since it might correspond to a high peritoneal inflammatory reaction after a biliary peritonitis, it has been reported that in abdominal sepsis caused by secondary peritonitis, the acute phase proteins synthesis stimulated by cytokines recover to normal values only after day 12 of the post-operative period. The fact that, in both cases, there were no inaccessible exsanguinant lesions involving both the retropancreatic portal nor the superior mesenteric vein, allowed this 15-day delay between the two stages of pancreatoduodenectomy; under those circumstances, that period would have been considered excessive. Moreover, there is no recommendation in literature concerning the timing of the definitive procedure. On the second patient, we repeated the surgical protocol previously used and based on the excellent outcome of the first clinical setting. The significant morbidity (biliary fistula) reported in the second clinical setting may reflect the inappropriate judgement of the optimal local conditions after a pancreatitislike reaction. There are no recommendations found whatsoever, concerning the optimal approach of pancreatic and duodenal grade V injuries due to its rarity. Most publications are based on case reports, like ours, making it difficult to interpret the scarce literature available. Pancreatic and duodenal trauma remains a clinical challenge, with a high mortality rate. Grade V injuries are difficult to deal with, as they occur very rarely, lacking high level evidence based recommendations in the literature. DCS definitely changed the references for these severe cases, but the mortality remains high, with most deaths occurring before a definitive management. Early diagnosis remains problematic, especially following blunt abdominal trauma. The presence of main pancreatic duct injury is one of the major determinants of both morbidity and treatment decisions. Trauma Whipple procedure may be inevitable in the sequence of previous DCS, and it should always be decided after early patient referral to an experienced hepatobiliary and pancreatic centre, avoiding inappropriate aggressive or conservative indications. In conclusion, reconstruction after a pancreaticoduodenectomy for duodenal / pancreatic trauma can be performed safely as a two-staged procedure and may represent a life-saving option under these very unusual circumstances.

A 26-year-old Los Angeles man accused of stabbing to death his girlfriend's son — an 11-year-old student at David Starr Jordan Middle School — pleaded not guilty this week to murder and child abuse charges, officials said. The man, Rineson Adams, was charged with one count each of premeditated murder and child abuse — according to a Los Angeles County Superior Court criminal complaint — and entered his plea on Tuesday. The boy, Jai Lewis, was stabbed multiple times in the chest and neck at around 9 a.m. on Memorial Day at his mother's home in the 200 block of South Carondelet Street in the Westlake District of Los Angeles, police and coroner's officials said. The 11-year-old, whose father lives in Burbank, was pronounced dead at the Children's Hospital Los Angeles at 9:33 a.m. The news shocked the Burbank Unified School District community. In a message to Jordan middle school parents, Principal Stacy Cashman offered her condolences to Jai's family and friends. "We will remember Jai for his great sense of humor and huge smile," she said in the statement. "He will be greatly missed by the Jordan community." Cashman could not be reached for further comment, but school officials said a funeral for Jai was held on Thursday in Los Angeles. It's unclear what prompted the domestic dispute. During the attack, the boy's mother reportedly stabbed her boyfriend in his shoulder in an attempt to stop him from stabbing her son, said Los Angeles Police Sgt. Michael Mabie. Adams has a rap sheet that reaches back almost a decade, including a burglary conviction in 2006, and two convictions for the transportation and sale of a controlled substance. If convicted, Adams faces a maximum of 64 years to life in state prison. Adams is being held in lieu of $1.22 million bail and is due back in court later this month, according to the Los Angeles District Attorney's Office.

The invention relates to sulfonyloxazolamines of the general formula I and to their use as medicaments, and to a process for their preparation, to the intermediates employed in the preparation process and to a process for preparing the intermediates. The sulfonyloxazolamines according to the invention are compounds of the general formula (I) where R1 and R2 independently of one another are H, xe2x80x94R6, xe2x80x94C3-C8-cycloalkyl, xe2x80x94(CH2)nxe2x80x94R7, xe2x80x94(CH2)nxe2x80x94Oxe2x80x94R6, xe2x80x94(CH2)nxe2x80x94NH2, xe2x80x94(CH2)nxe2x80x94NHR6, xe2x80x94(CH2)xe2x80x94N(R6)2, C2-C6-alkenyl or, where appropriate, together form a mononuclear saturated heterocycle having one or two nitrogen, oxygen and/or sulfur atoms, R3 and R4 independently of one another are H, xe2x80x94R6, xe2x80x94CF3, xe2x80x94NO2, xe2x80x94Hal, xe2x80x94OH, xe2x80x94Oxe2x80x94R6, xe2x80x94NH2, xe2x80x94NHxe2x80x94R6 or xe2x80x94N(R6)2, R5 is a 5- or 6-membered, saturated or unsaturated heterocycle having one or two nitrogen, oxygen and/or sulfur atoms which may be mono- or disubstituted by xe2x80x94R6, xe2x80x94CF3, xe2x80x94NO2, xe2x80x94Hal, xe2x80x94OH, xe2x80x94Oxe2x80x94R6, xe2x80x94NH2, xe2x80x94NHxe2x80x94R6 or xe2x80x94N(R6)2, and R6 is C1-C6-alkyl, R7 is R3- and/or R4-substituted phenyl, n is 0 to 2, and physiologically acceptable salts or solvates thereof. Some sulfonyloxazolamines are known from various earlier publications: V. A. Chervonyi et al., Ukr. Khim. Zh. (Russian Ed.) 1991, 57(4), 415-418 or V. A. Chervonyi et al., Zh. Org. Khirm. 1988, 24(2), 453-4 corresponding to V. A. Chervonyi et al., J. Org. Chem. USSR (Engl. transl.) 1988, 24, 401. The latter publication describes, for example, the preparation of 4-tolylsulfonyl-5-dimethylamino-2-phenyl-1,3-oxazole. The invention was based on the object of finding sulfonyloxazolamines with valuable properties. In particular it was important to find pharmacologically active sulfonyloxazolamines. The object is achieved by compounds of the general formula I described hereinbefore and physiologically acceptable salts or solvates thereof. It was found that the compounds of the formula I and their pharmacologically active salts surprisingly have a selective affinity to 5-HT6 receptors, together with good tolerability, and they are therefore 5-HT6 receptor ligands. They exhibit 5-HT6-antagonistic or 5-HT6-agonistic actions. 5-HT6 receptors form a subfamily of 5-HT receptors. The neurotransmitter 5-hydroxytryptamine (5-HT), also known as serotonin, is an important regulating neurotransmitter in the brain, whose actions are assisted by a family of receptors which, at the current level of knowledge, contains 13 G protein-coupled receptors and an ion channel. The group of G protein-coupled receptors also includes the 5-HTG receptors. Some representatives have been cloned and to some extent histologically and biochemically investigated (see, for example, Kohen et al. (1996) J. Neurochem 66, 47-56; Ruart et al. (1993), 193, 268-76). The greatest density of the serotonin 5-HT6 receptors in the brain is found in the olfactory tubercle, in the nucleus accumbens, in the striatum, in the dentate gyrus and in the CA1-3 regions of the hippocampus. These regions are involved to a particular extent in psychiatric disorders such as, for example, schizophrenia or depression. Moreover, it is known from animal experiments that the administration of 5-HT6 antisense oligonucleotides causes a behavioural syndrome which corresponds to that of dopamine agonists. Furthermore, hyperactivity of the dopaminergic neurotransmitter system in schizophrenia (dopamine hypothesis of schizophrenia) is pathophysiologically confirmed. However, dysfunctions of the dopamine system in various forms of depression have been demonstrated. Of the established or alternatively newer therapeutics which are employed in clinical practice for the treatment of these psychiatric disorders, a large number moreover bind to the 5-HT6 receptor. The atypical neuroleptics (e.g. clozapine) and the tricyclic antidepressants (e.g. amitriptyline) may be mentioned here in particular. Moreover, it was found in animal experimental investigations that 5-HT6 receptors in the brain control cholinergic neurotransmission. Cholinergics are employed in disorders with memory disturbances such as, for example, Alzheimer""s disease. For these reasons, it can be concluded that there is an involvement of the 5-HT6 receptor in psychiatric and neurological disorders such as, especially, schizophrenia, depression and Alzheimer""s. The compounds of the formula I and their physiologically acceptable salts are therefore suitable as therapeutic active compounds for disorders of the central nervous system. The compounds of the formula I and physiologically acceptable salts or solvates thereof are particularly suitable for the treatment of psychoses, schizophrenia, manic depression (B. L. Roth et al., J. Pharmacol. Exp. Ther. 1994, 268, 1403-1410), depression (D. R. Sibley et al., Mol. Pharmacol. 1993, 43, 320-327), neurological disorders (A. Bourson et al., J. Pharmacol. Exp. Ther. 1995, 274, 173-180), memory disorders, Parkinson""s disease, amyotrophic lateral sclerosis, Alzheimer""s disease, Huntington""s disease (A. J. Sleight et al., Neurotransmitters 1995, 11, 1-5), bulimia, anorexia nervosa or other eating disorders, compulsive acts or of premenstrual syndrome. Solvates of the compounds of the formula I are understood as meaning adducts of xe2x80x9cinertxe2x80x9d solvent molecules to the compounds of the formula I, which are formed on account of their mutual force of attraction. Solvates are, for example, mono- or dehydrates or alcoholates. For all radicals which occur one or more times it holds true that their meanings are independent of one another. R3 and R4 are preferably and independently of one another methyl, methoxy, chlorine and bromine or hydrogen. is preferably phenyl, o-, m- or p-methylphenyl, o-, m- or p-ethylphenyl, o-, m- or p-propylphenyl, o-, m- or p-isopropylphenyl, o-, m- or p-tert-butylphenyl, o-, m- or p-aminophenyl, o-, m- or p-N,N-dimethylaminophenyl, o-, m- or p-nitrophenyl, o-, m- or p-hydroxyphenyl, o-, m- or p-methoxyphenyl, o-, m- or p-ethoxyphenyl, o-, m-, p-trifluoromethylphenyl, o-, m- or p-fluorophenyl, o-, m- or p-chlorophenyl, o-, m- or p-bromophenyl, furthermore preferably 2,3-, 2,4-, 2,5-, 2,6-, 3,4- or 3,5-dimethylphenyl, 2,3-, 2,4-, 2,5-, 2,6-, 3,4- or 3,5-dihydroxyphenyl, 2,3-, 2,4-, 2,5-, 2,6-, 3,4- or 3,5-difluorophenyl, 2,3-, 2,4-, 2,5-, 2,6-, 3,4- or 3,5-dichlorophenyl, 2,3-, 2,4-, 2,5-, 2,6-, 3,4- or 3,5-dibromophenyl, 2,3-, 2,4-, 2,5-, 2,6-, 3,4- or 3,5-dimethoxyphenyl. Particularly preferred for is phenyl, o- or p-methylphenyl, o- or p-chlorophenyl, p-bromophenyl, p-methoxyphenyl or 2,4-dichlorophenyl. xe2x80x94Hal is fluorine, chlorine or bromine. R1 and R2 together may also form a mononuclear saturated heterocycle having from 1 to 2 N, O and/or S atoms. This heterocycle is preferably tetrahydro-2- or -3-furyl, 1,3-dioxolan-4-yl, tetrahydro-2- or -3-thienyl, 1-, 2- or 3-pyrrolidinyl, tetrahydro-1-, -2- or 4-imidazolyl, tetrahydro-1-, -3- or 4-pyrazolyl, 1-, 2-, 3- or 4-piperidinyl, 1-, 2-, 3- or 4-perhydroazepinyl, 2-, 3- or 4-morpholinyl, tetrahydro-2-, -3- or -4-pyranyl, 1,4-dioxanyl, 1,3-dioxan-2-, -4- or -5-yl, hexahydro-1-, -3- or -4-pyridazinyl, hexahydro-1-, -2-, -4- or -5-pyrimidinyl or 1-, 2- or 3-piperazinyl, 1-Piperidinyl or 4-morpholinyl is particularly preferred. Compounds in which R1 is H are preferred. Furthermore, compounds of the general formula I in which R2 is R6 are preferred. Moreover, R3 and/or R4 are preferably H. R5 is preferably 2-furyl, 2-thienyl or 3- or 4-pyridyl. R6 is linear or branched, and has 1 to 6, preferably 1, 2, 3 or 4, C atoms. R6 is preferably methyl, furthermore ethyl, propyl, butyl, isobutyl, sec-butyl or tert-butyl, in addition also pentyl, 1-, 2- or 3-methylbutyl, 1,1-, 1,2- or 2,2-dimethylpropyl, 1-ethylpropyl or hexyl. Methyl is particularly preferred. Alkenyl is preferably allyl, 2- or 3-butenyl, isobutenyl, sec-butenyl, in addition is preferably 4-pentenyl, isopentenyl or 5-hexenyl. Allyl is particularly preferred for alkenyl. A base of the general formula I can be converted into the associated acid addition salt using an acid, for example by reaction of equivalent amounts of the base and of the acid in an inert solvent such as ethanol and subsequent evaporation. For this reaction, suitable acids are in particular those which yield physiologically acceptable salts. Thus inorganic acids can be used, e.g. sulfuric acid, nitric acid, hydrohalic acids such as hydrochloric acid or hydrobromic acid, phosphoric acids such as orthophosphoric acid, sulfamic acid, in addition organic acids, in particular aliphatic, alicyclic, araliphatic, aromatic or heterocyclic mono- or polybasic carboxylic, sulfonic or sulfuric acids, e.g. formic acid, acetic acid, propionic acid, pivalic acid, diethylacetic acid, malonic acid, succinic acid, pimelic acid, fumaric acid, maleic acid, lactic acid, tartaric acid, malic acid, citric acid, gluconic acid, ascorbic acid, nicotinic acid, isonicotinic acid, methane- or ethanesulfonic acid, p-toluenesulfonic acid, naphthalenemono- and disulfonic acids or lauryl sulfuric acid. Salts with physiologically unacceptable acids, e.g. picrates, can be used for the isolation and/or purification of the compounds of the formula I. The invention further relates to the use of the compounds according to the general formula I and physiologically acceptable salts and solvates thereof for preparing medicaments, in particular for preparing anticonvulsants, nootropics, anti-inflammatories, neuroprotectants and cerebroprotectants and for preparing medicaments for the treatment of diseases of the central nervous system, in particular for the treatment of schizophrenia, depression, pathological anxiety states, epilepsy, pathological memory disorders such as Alzheimer""s disease, neurological disorders, amyotrophic lateral scleroses, Huntington""s disease, disorders of the gastrointestinal tract, functional gastropathy, irritable bowel syndrome, bulimia, anorexia nervosa, compulsive acts (obsessive-compulsive disorder, OCD), premenstrual syndrome, migraine, drug addictions, sleeping disorders and/or for the treatment of head and spinal injuries. The substances according to the invention are as a rule administered here in a dose of preferably between approximately 1 and 500 mg, in particular between 5 and 100 mg, per dose unit. The daily dose is preferably between approximately 0.02 and 10 mg/kg of body weight. The specific dose for each patient, however, depends on all sorts of factors, for example on the efficacy of the specific compound employed, on the age, body weight, general state of health, and sex, on the diet, on the time and route of administration, and on the excretion rate, pharmaceutical combination and severity of the particular disorder to which the therapy applies. Oral administration is preferred. The compounds of the general formula I may also be employed as pesticides. The invention further relates to a pharmaceutical preparation comprising at least one compound according to the general formula I and physiologically acceptable salts and solvates thereof and, where appropriate, vehicles and/or excipients. These preparations can be used as pharmaceuticals in human or veterinary medicine. Possible vehicles are organic or inorganic substances which are suitable for enteral (e.g. oral), or parenteral administration or topical application and do not react with the novel compounds, for example water, vegetable oils, benzyl alcohols, alkylene glycols, polyethylene glycols, glycerol triacetate, gelatin, carbohydrates such as lactose or starch, magnesium stearate, talc or petroleum jelly. Tablets, pills, coated tablets, capsules, powders, granules, syrups, juices or drops, in particular, are used for oral administration, suppositories are used for rectal administration, solutions, preferably oily or aqueous solutions, in addition suspensions, emulsions or implants, are used for parenteral administration, and ointments, creams or powders are used for topical application. The novel compounds can also be lyophilized and the lyophilizates obtained used, for example, for the production of injection preparations. The preparations indicated can be sterilized and/or can contain excipients such as lubricants, preservatives, stabilizers and/or wetting agents, emulsifiers, salts for affecting the osmotic pressure, buffer substances, colourants, flavourings and/or one or more other active compounds, e.g. one or more vitamins. For the subject of the invention, of the therapeutic active compounds of the formula I or their physiologically acceptable salts or solvates, of the use of the compounds of the formula I or their physiologically acceptable salts or solvates as therapeutic active compounds or of the production of a pharmaceutical preparation for the treatment of disorders of the central nervous system, all the more preferred are compounds of the formula I, the more radicals have one of the preferred or particularly preferred meanings mentioned hereinbefore. The invention further relates to the preparation of compounds of the general formula I, where R1R2NH is reacted with compounds of the general formula II or III. The invention also relates to the compounds of the general formula II: where R3 and R4 independently of one another are H, xe2x80x94R6, xe2x80x94CF3, xe2x80x94NO2, xe2x80x94Hal, xe2x80x94OH, xe2x80x94Oxe2x80x94R6, xe2x80x94NH2, xe2x80x94NHxe2x80x94R6 orxe2x80x94N(R6)2, R5 is a 5- or 6-membered, saturated or unsaturated heterocycle having one or two nitrogen, oxygen and/or sulfur atoms which may be mono- or disubstituted by R6, xe2x80x94CF3, xe2x80x94NO2, xe2x80x94Hal, xe2x80x94OH, xe2x80x94Oxe2x80x94R6xe2x80x94NH2, xe2x80x94NHxe2x80x94R6 or xe2x80x94N(R6)2, and R6 is C1-C6-alkyl. The invention also relates to the compounds of the general formula III where R3 and R4 independently of one another are H, xe2x80x94R6, xe2x80x94CF3, xe2x80x94NO2, xe2x80x94Hal, xe2x80x94OH, xe2x80x94Oxe2x80x94R6, xe2x80x94NH2, xe2x80x94NHxe2x80x94R6 or xe2x80x94N(R6)2, R5 is a 5- or 6-membered, saturated or unsaturated heterocycle having one or two nitrogen, oxygen and/or sulfur atoms which may be mono- or disubstituted by R6, xe2x80x94CF3, xe2x80x94NO2, xe2x80x94Hal, xe2x80x94OH, xe2x80x94Oxe2x80x94R6, xe2x80x94NH2, xe2x80x94NHxe2x80x94R6 or xe2x80x94N(R6)2, and R6 is C1-C6-alkyl. The compounds of the general formula I may be synthesized according to the following synthesis scheme (referring to V. A. Chervonyi et al., Ukr. Khim. Zh. (Russ. Ed.) 1991, 57(4), 415-418; V. A. Chervonyi et al., Zh. Org. Khim. 1988, 24(2), 453-4 corresponding to V. A. Chervonyi et al., J. Org. Chem. USSR (Engl. transl.) 1988, 24, 401; F. Weygand et al. Chem. Ber. 1966, 99, 1944-1956; H. Bxc3x6hrme et al. Arch Pharmaz., 1961, 294, 307-311; A. N. Meldrum and G. M. Vad J. Indian Chem. Soc. 1936, 13, 117-118; D. Z. Barczynski and Z. Eckstein Przem Chem., 1978, 57, 176-177; F. Kasper and H. Bxc3x6ttiger Z. Chem. 1987, 27, 710-71): In the synthesis scheme shown beforehand, an amide of the formula R5CONH2 is reacted with chloral resulting in the corresponding xe2x80x9caldehyde ammoniaxe2x80x9d. This is reacted with thionyl chloride resulting in the corresponding tetrachloroethyl derivative. This is subsequently reacted with substituted or unsubstituted sodium benzenesulfinate. This results in a compound of the general formula II or III. Both the compounds of the formula II and the compounds of the formula III react with an amine of the formula R1R2NH with cyclization to give sulfonyloxazolamines of the general formula I. The suitable reaction conditions of the reactions mentioned from the synthesis scheme are known from the references V. A. Chervonyi et al., Ukr. Khim. Zh. (Russ. Ed.) 1991, 57(4), 415-418 or V. A. Chervonyi et al., Zh. Org. Khim. 1988, 24(2), 453-4 corresponding to V. A. Chervonyi et al., J. Org. Chem. USSR (Engl. transl.) 1988, 24, 401, or from standard works such as, for example, Houben-Weyl, Methoden der organischen Chemie [Methods of Organic Chemistry], Georg-Thieme-Verlag, Stuttgart. In this case, use can also be made of variants which are known per se, but not mentioned here in greater detail. The invention also relates to a process for preparing a compound according to the general formula (II), where a) R5xe2x80x94CONH2 is added to chloral, b) the product from a) is chlorinated with thionyl chloride, c) the product from b) is reacted with an alkali metal salt of a compound of the general formula (IV) where R3 and R4 have the meanings listed hereinbefore and Me+ is an alkali metal cation, preferably Na+.

Phase boundary propagation in large LiFePO4 single crystals on delithiation. Large single crystals of LiFePO have been chemically delithiated. The relevance of chemical oxidation in comparison with electrochemical delithiation is discussed. Analyses of the Li content and profiles were done by electron energy loss spectroscopy and secondary ion mass spectrometry. The propagation of the FePO phase growing on the surface of the large single crystal was followed by in situ optical microscopy as a function of time. The kinetics were evaluated in terms of linear irreversible thermodynamics and found to be characterized by an induction period followed by parabolic growth behavior of the FePO phase indicating transport control. The growth rate was shown to depend on the crystallographic orientation. Scanning electron microscopy images showed cracks and a high porosity of the FePO layer due to the significant changes in the molar volumes. The transport was found to be greatly enhanced by the porosity and crack formation and hence greatly enhanced over pure bulk transport, a result which is supposed to be very relevant for battery research if coarse-grained powder is used.

Acute myeloid leukemia induced by MLL-ENL is cured by oncogene ablation despite acquisition of complex genetic abnormalities. Chromosomal translocations involving 11q23 are frequent in infant acute leukemia and give rise to the formation of MLL fusion genes. The mechanism of leukemic transformation by these fusions has been the subject of numerous investigations. However, the dependence of acute leukemia on MLL fusion activity in vivo and the efficacy of targeting this activity to eliminate disease have not been established. We have developed a model for conditional expression of MLL-ENL in hematopoietic progenitor cells, in which expression of the fusion oncogene is turned off by doxycycline. Conditionally immortalized myeloblast cells derived from these progenitors were found to induce leukemia in vivo. Leukemic cells isolated from primary recipient mice were shown to have acquired additional genetic abnormalities and, when transplanted into secondary recipients, induced leukemia with shortened latencies. However, the leukemic cells remained dependent on MLL-ENL expression in vitro and in vivo, and its ablation resulted in regression of established leukemias. This study demonstrates that even genetically complex leukemias can be reversed on inactivation of the initiating MLL fusion and has important implications for the design of novel leukemia therapies.

The story: Malorie (Sandra Bullock) warns two children that they are about to take a raft down a hazardous river and that no matter what happens, they must never remove their blindfolds or something will cause them to die. In a flashback, she is shown to be heavily pregnant. She and sister Jessica (Sarah Paulson) are at the hospital for a check-up when chaos breaks out. It seems that America, too, has been afflicted by the spate of mass suicides happening in other countries. Based on Josh Malerman's 2014 novel of the same name. This post-apocalyptic thriller with supernatural overtones has a clever premise - as in the legend of Medusa, death visits anyone who looks upon the source of evil. But the potential is squandered. Bullock's Malorie is the protagonist in this global pandemic story, which the film makes clear by including her in every scene. The collapse of civilisation seen through her eyes and supporting characters tends to deliver the story exposition around her in clunky, obvious ways. Unfortunately, she offers the blandest point of view in recent movie memory. It is uncertain if something was lost in translating her character from the novel or if both the book and film suffer from underwriting. Malorie does indeed grow as a character, from a pregnant single mother who is protected from harm by a number of supporting characters, to being a protector of two children, when the film flashes forward to the present day. While she is much less passive by the end than she is at the beginning, her internal life remains blank. Dull Narrator Syndrome is not the only problem here. This is a story that hovers somewhere between the Stephen King-style ensemble horror of The Mist (2007) and the high-concept action thrills of this year's A Quiet Place, with bits of the art-house murky grimness of The Road (2009) thrown in, but never quite lands in a comfortable spot of its own. Top-notch talent John Malkovich, Trevante Rhodes and Jacki Weaver are underused in parts that call for single-note performances that support hackneyed apocalypse themes, such as self-interest versus altruism and the power of hope when all seems lost.

In 2012, the UN Human Rights Council asked the UN Working Group on Arbitrary Detention to produce a document spelling out just what it means to say there is a prohibition on arbitrary detention--including in the context of armed conflict. The Working Group has now promulgated its conclusions, in the form of a document that almost certainly will be cited with gusto by those challenging detention systems such as the United States operated in Afghanistan and Iraq in the post-9/11 period. Highlights include a bold claim that non-military judicial review may be required even in connection with ordinary POWs (and certainly so with respect to persons held for the duration of hostilities as the functional equivalent of combatants but without POW status). All the relevant documents, and a handy overview, are provided in this very useful post from Marko Milanovic.

Home » Neurology Procedure » Ventriculoperitoneal Shunt for Hydrocephalus Ventriculoperitoneal Shunt Overview A ventriculoperitoneal shunt (VP) shunt is a device that is used to relieve the pressure from the brain caused by the fluid accumulation. The VP shunting is a surgical procedure that is primarily used for treating hydrocephalus, a condition which occurs when excess cerebrospinal fluid (CSF) gets accumulated in the brain’s ventricles. The CSF acts as a cushion for your brain, which protects it from injury inside the skull. The fluid also acts delivery system for nutrients required by your brain and takes away the waste products. Normally, the CSF flows through these ventricles to the base of the brain and then bathes the brain as well as the spinal cord before being reabsorbed into the blood. If the normal flow gets disrupted, then the fluid accumulation can cause harmful pressure on the brain tissue thereby damages the brain. The VP shunts are surgically placed inside one of the ventricles of the brain for diverting the fluid away from the brain. This in turn helps restore the normal flow of the CSF and also its absorption. Planning your medical trip to India is a very simple process with Spine and Neuro Surgery Hospital India You just need to fill in our enquiry form and one of our executive will contact you soon. +91-9325887033 Call us at the given to contact number for any assistance. Complete information regarding surgery is provided on our website. Ventriculoperitoneal Shunt Procedure This procedure is performed under general anesthesia and will not experience any pain. The patient will be asleep during the entire procedure which takes about 90 minutes. The medical care team will provide you the instructions about the pre-operative food and drink restrictions. Older children and adults are asked to fast for at least eight hours before the surgery. Infants and toddlers are required to stop eating the solid foods six hours before surgery. The hair behind the ear of the patient will be shaved in preparation for the shunting procedure. This is the area where the thin and flexible tubes called as catheters are inserted to drain off the excess fluid. The surgeon will make a small incision behind the ear and drill a small hole in the skull. One catheter is threaded into the brain through this opening and another is placed under the skin behind the ear. This tube is snaked down to the chest and abdomen, this allows excess CSF to drain away into the abdominal cavity where the body absorbs it. The surgeon will attach a tiny pump to both the catheters and place it under the skin behind the ears. When the pressure inside the skull increases, this pump will automatically activate for removing the fluid. The pump, called as a valve is programmable to activate when the fluid increases a predetermined volume. Get Ventriculoperitoneal Shunt for Hydrocephalus in India We offer free assistance to international patients to find best medical treatment in India. We offer low-cost, world-class medical treatment in India, coordinated by a team of experienced service industry professionals Please post a query to know about low cost treatment options at top India hospitals Click Here Ventriculoperitoneal Shunt Recovery The ventriculoperitoneal shunt recovery may take about three to four days. Most patients are able to leave the hospital within seven days post the procedure. As per the NIH (National Institutes of Health), children undergoing this procedure need to lie flat for 24 hours after the initial shunt placement. During hospitalization, the blood pressure and heart rate of the patient will be monitored frequently. Your doctor will administer the preventive antibiotics and ensure that the shunt is working properly before you are given discharge. Check out the Patient Testimonial, where the patient shares about their success stories from treatments through Spine and Neuro Surgery Hospital India Why Ventriculoperitoneal Shunt is necessary? Ventriculoperitoneal shunt is needed to treat hydrocephalus, which is most likely in babies and in older adults. According to the National Institute for Neurological Disorders and Stroke, one out of every 500 children are likely affected by this condition. The excess fluid accumulation around the brain can be caused due to a number of reasons, including: Poor absorption of CSF by the blood vessels Overproduction of CSF Blockages preventing the fluid to flow throughout the brain. Tumors, cysts or the inflammation in the brain hampers the normal flow of CSF, thereby create an unsafe build-up. The symptoms of hydrocephalus are: Headaches, large head size, seizures, loss of previously acquired skill,s irritability, incontinence, memory loss, poor appetite, cognitive delays, impaired vision and poor coordination. Diagnosis of hydrocephalus includes: Imaging tests like magnetic resonance imaging (MRI), ultrasound, computed tomography (CT) scans are used to view the cavities and tissues within the brain. The tests will show if the areas of the brain are filled with more fluid than the normal. Ventriculoperitoneal Shunt Reviews: Is it Effective? Ventriculoperitoneal shunt is safe and successful in reducing the pressure in the brain in most people. Due to advances in medicine and technology, the majority of the patients who undergo this surgery do not experience any complications. VP shunts require to be replaced after several years, especially in the case of small children. An average lifespan for an infant’s shunt is about two years. Adults and older children may not need a shunt replacement for eight or more years. The shunts require frequent monitoring and follow-ups. Ventriculoperitoneal Shunt Cost comparisons Ventriculoperitoneal shunt in India costs only $1,180 which is a fraction of the cost as compared to the rates in other developed countries. India offers the best quality treatment at highly affordable prices. Why to choose India for your Ventriculoperitoneal Shunt? India provides cost effective ventriculoperitoneal shunt as compared to the first world countries. Over the past few years, India has become a favorite medical destination spot for overseas patients looking to undergo quality treatments at affordable rates. The medical services and facilities provided by Indian hospitals are in par with its counterparts. The surgeons in India are experienced and highly skilled to perform better treatments for your medical conditions. What services we offer to our International Patient? Straight forward - simple booking procedure to seek top Medical Treatmentin India. - simple booking procedure to seek top Medical Treatmentin India. Full assistance to get Medical Visa. Low cost - a fraction of the cost of UK/USA surgery. - a fraction of the cost of UK/USA surgery. Low risk - world's highest standards of clinical care & surgery. - world's highest standards of clinical care & surgery. Fast efficient service - immediate treatment with no waiting lists. - immediate treatment with no waiting lists. Full patient support service - 24/7 services. Specialist consultations - scans, clinical investigations & consultations at short notice. Individual time to each patient Patients without insurance are equally benefitted Provides the world’s highest standards of clinical care & surgery. Receive the travelers at the airport Keep track of the additional requirements (if discovered during the treatment) and organize interventions accordingly to strive to ensure that the treatment process does not get disrupted. Handhold the travelers during their shopping/sight-seeing tours - we may or may accompany the travelers, but we coordinate for a smooth and pleasurable experience (at extra cost) In case the patient/attendant are English-constrained, then provide interpreter services Quick response and availability of revert. Visible compassion for the traveler. Patient Testimonial – Ventriculoperitoneal shunt for hydrocephalus done in India for Master. Jack Sloman from UK Master. Jack Sloman from UK It was quite for our entire family when my younger brother was diagnosed with the condition of hydrocephalus. We did our research about which doctor and hospital to choose for his treatment as we consulted all the top doctors in India but it was only after we met the specialists of spine and neuro surgery group that we actually felt like he would be treated with the right hands. The doctors were really considerate and they answered all our queries with patience. They explained about the ventriculoperitoneal shunt in the simplest manner so that we were comfortable with the procedure and understood it before the procedure began. How to plan your medical trip to India? Send us your query and medical reports Get the advised opinion and treatment plan from us within 48 hours from multiple hospitals Choose your preferred hospital and clear your concerns if you have any We will assist you with medical VISA, Vaccination, FRRO, Travel, Accommodation and Logistic Process Arrival arrangements will be done for your pick up at the airport based on your itinerary Treatment will start at the hospital as planned Once the treatment is done, you can fly back Post treatment follow up and consultation will be done by us via email, phone, Skype Tags Ventriculoperitoneal Shunt, Ventriculoperitoneal Shunt india, Ventriculoperitoneal Shunt reviews, low cost Ventriculoperitoneal Shunt

SALEM – The North Shore Workforce Investment Board (WIB) is looking for a few good career coaches.Mary Sarris, WIB executive director, explained that a successful career coach must have the knowledge, skills and tools to enable them to assume a very complex role. A coach must have extensive knowledge of the health labor market and the health education system, well-honed coaching skills, and an ability to guide and lead, she said.According to Sarris, WIB is the lead partner in a Workforce Competitiveness Trust Fund grant, which is providing on-line and face-to-face college preparatory classes, using primarily through an innovative learning strategy entitled the Health Care Learning Network. Career Coaching is a service to be provided through this project to help these students/employees stay on their chosen career path and successfully attain career goals, she said.Interested parties should contact David McDonald at (978) 741-3805, or by checking our Web site at www.northshorewib.com regarding the specific details for submitting a formal proposal.WIB, through the city of Salem as its fiscal agent, is seeking a project coordinator. This individual will be responsible for the project coordination of the Health Care Learning Network – North Shore.The overall goal of the North Shore project is to develop and implement a customized on-line and face-to-face system through which health care workers, specifically certified nurse assistants, can gain the academic skills necessary to go to college and ultimately fill a growing industry need for licensed practical nurses and other allied health occupations. Given that our current educational system does not support adults with this type of customized industry-learning need, this grant will provide resources that put such a system of education in place, Sarris said.According to McDonald, the project coordinator will ensure that all partners, including seven long-term care facilities, are fully engaged in implementing this program model, so that project goals are reached and the grant ends with a system in place to continue its activities well into the future. This individual will coordinate, motivate, and oversee the work of the various project partners.The candidate should possess a bachelor’s degree in a related field and experience in workforce development system. Experience in the long-term health care field is a plus. The position is 32 hours per week. For a more detailed job description, position requirements, and salary information, call McDonald or check the WIB Web site. Resume and cover letter are due by March 12.

Impact of parenting style and upbringing on menstrual stress in adolescent South Indian girls Dysmenorrhea and menstrual problems show that an estimate of over 600 million hours are lost from work every year. School absenteeism or work absenteeism because of major symptoms like dysmenorrhea has ranged from 14% to 51% and this has affected the participation of school going girls in school related activities. About 50% of these students miss school because of dysmenorrhea. Literature review focuses on menstrual symptoms pertaining only to primary premenstrual syndrome and not on mental health of adolescent girls during menstruation. INTRODUCTION Dysmenorrhea and menstrual problems show that an estimate of over 600 million hours are lost from work every year. 2 School absenteeism or work absenteeism because of major symptoms like dysmenorrhea has ranged from 14% to 51% and this has affected the participation of school going girls in school related activities. About 50% of these students miss school because of dysmenorrhea. Literature review focuses on menstrual symptoms pertaining only to primary pre-menstrual syndrome and not on mental health of adolescent girls during menstruation. 1, In developing countries, adolescent girls face health issues due to socio-economic, environmental conditions and gender discrimination. 8 Menstruation related health issues apart from being an economic burden, are also one of the most common causes of absenteeism and poor academic performance among young girls. 8 Menstrual patterns can be affected by age, ethnicity, family history, smoking, physical activity, and dietary habits. Stress can be a major cause or contributor of various menstrual irregularities. 8 Many researchers like Cohen et al deduced various scales to understand stress levels faced by individuals at a given point in time. 9 This study aimed to determine the level of stress in adolescent girls during menstruation using one of these standardised scales. Parents play an important role in the development of their child's mental and physical growth. The type of parenting style has been explained by Baumrind and other researchers, namely, Uninvolved, Authoritative, Authoritarian, Permissive parenting styles. 10,11 Each style of parenting harbours a particular characteristic coping mechanism in the child to various situations in life. 10,11 This study being one of the few studies, looked into the relation between type of parenting style and its influence on menstrual issues in adolescent girls. The objectives of this study were to assess stress levels during menstrual period among adolescent girls in a rural area of Karnataka; to assess the problems faced during menstrual period by adolescent girls in a rural area of Karnataka; to assess the impact of parenting skill on adolescent girls and its effect on menstrual stress. METHODS This was a cross sectional study done on adolescent girls 13 to 19 years of age from two government schools in a rural village of South India, Karnataka. The study commenced after taking permission from respective school principals. The school staffs were informed about the results of the study and were enlightened on the possible interventions for various coping mechanism for stress. Ethical clearance was obtained from the institutional ethical committee. The tool used in this study included four parts. First part includes demographic details of the student, next part looked into the various type of parenting style (uninvolved, authoritarian, authoritative, permissive) using a short version of the PSDQ scale. 10,12 The short version of the PSDQ scale had 24 questions that looked into various parenting styles assessed by children who were the study girls. The third part measured the prevalence of stress as assessed by the perceived stressed scale (PSS). 9 This was a five-point likert scale which ranged from a scoring of never (zero) to almost always (four). High score was indicative of high stress levels. 13 Questions with regard to problems faced during menstrual cycle was assessed using semi-structured, open ended, face validated questionnaire. All (universal sampling) the adolescents girls aged 13-19 years, studying in two government schools located in rural villages in Karnataka and those present on the day of the study were included. Assent/consent was taken from 217 girls who agreed to be part of this study. The study questionnaire was distributed to all the girls after a brief introduction about the questionnaire. The completed questionnaire was collected by the authors. At the end of the session, the children witnessed an infotainment program on life stressors and its impact on mental health. Statistical analysis Data was analyzed using the SPSS versions 16 after it was manually entered in Microsoft excel. Inter-quartile ranges were deduced for the PSS and the PSDQ scale for analysis of stress levels and parenting style respectively. The Pearson's chi-square, Fishers exact and multi nominal regressions was done for significance. RESULTS This study involved 217 girls in the age group 13 to 19 years. Most of the girls were underweight (BMI <18.5) and belonged to the lower middle-class socio-economic status group (BG Prasad classification). 15 Majority of the girl's had both parents in the age group of 31-41 years and most of their parents had completed secondary education. Table 1, among the study participants 54 (24.9%) felt stressed during the days of the menstrual period, 44 (20.3%) responded that they were unable to get sanitary pads freely, 186 (85.7%) regarded their mother as the major source for menstruation related health issues, majority availed sanitary pads from the shop 162 (74.7%) and 24 (11.1%) from anganwadi and 112 (49.3%) did not get support from their family during the time of the menstrual period. The most common problem faced by adolescent girls was described by them was "a samayadhalli thumba ayasa waguthede" (which means "excessive fatigue during menstrual period"). Total (N) varies with each section, because some girls did not or were unable to answer those questions. a=chisquare; b=Fisher's Exact; *statistically significant at =5% and p<0.05. M1: (response: yes); stress was found to be more among girls who were 14 years of age 14 (35%), undernourished 18 (19.4%), parents more than fifty years (father 50% and mother 100%), parents with secondary education (father 24.2% and mother 24.8%) and with occupational skill level two (father 28% and mother 27.3%). M2: (response: no); girls responded that they were not able to get sanitary pads freely and regularly. Girls who were underweight 21 (22.6%), lower socioeconomic class 9 (26.5%) had expressed their inability in availing sanitary pads. Girls with parents of skill level 1 (father 20.5% and mother 19%) had also replied difficulty in receiving sanitary pads. M5: (response: no); stress was found to be more among girls who were 17 years of age 4 (57.1%), overweight 4 (80%), upper class 2 (66.7%), parents more than forty years (father 60.3% and mother 70%), parents with poor educational qualification (father 100% and mother 84%) and with occupational skill level one (father 55.5% and mother 51.6%). M7: Do you face any problems during the menstrual period? Descriptive: "a samayadhalli thumba ayasawaguthede" was a common complain of the girls of the schools which was responded by many And another symptoms pain abdomen stomach pain, general pain Description of stressors faced by adolescent girls during menstruation and responses to various situations during the menstrual cycle. The most common problem faced by adolescent girls was described by them as "a samayadhalli thumba ayasa waguthede" (which means "excessive fatigue during menstrual period"). Total (N) varies with each section, because some girls did not or were unable to answer those questions. a=chisquare; b = Fisher's Exact; *statistically significant at =5% and p<0.05. Total (N) varies with each section, because some girls did not or were unable to answer those questions. a= Chi-square; b = Fisher's exact; *statistically significant at =5% and p < 0.05. M6: (response: no); The level of stress was overall mild 52 (59.8%). Very authoritative 62 (54.4%) type of parenting style was associated with girls who did not receive time to take care of themselves during menstruation. DISCUSSION Menstrual disorders affect health and increase the financial burden on society worldwide. A major gynecologic complaint leading to school absenteeism is dysmenorrhea. 1,3,17 This study looked into menstrual stress levels in adolescent rural girls and the impact parenting had on coping with this stress. Smetana et al looked into parenting styles, dimensions and beliefs. 18 The original authoritative, authoritarian and permissive parenting styles was conceptualized and involved a fourth dimension of uninvolved style. 18 This study looked into which of these parenting styles would affect adolescent girls during the menstrual period. Girls who had very involved parents (34%, p=0.016) felt stressed during menstruation, probably due to their parents over concerned attitude of the same. Very authoritarian (31.5%) parenting styles showed girls to be stressed during menstruation. This style is common in non-western cultures and has a protective effect on adolescents. 18,19 Studies have shown children to have adjustment issues with this parenting style although they are culturally acceptable. 18, This has been tested in this study showing an inverse relation. Very authoritative (54.4%) parenting, showed girls felt that they did not get enough time to take care of themselves during menstruation, the possibility being the need to be more academically inclined during this phase of growing, causing them to neglect menstrual problems. Girls who did not get support from their family during the menstrual period had not authoritative (100%, p=0.001), not authoritarian (100%, p<0.001), not permissive (75%, p=0.015) type of parents, which is a well-adjusted type of parenting style for an Indian culture. The possibility of these girls internalizing and externalizing their problems is the outcome in this type of parenting (authoritarian rule), which is a harsh guilt induction parenting. 18 In this type of parenting, parents wish to know if their adolescents are involved in dangerous activities. 18,23 The overall stress faced by these adolescent girls was mild stress (PSS). 9 The stress level was found to be severe (29.9%) when it came to problems faced during the menstrual period and not getting support from family members during the menstrual period (53.7%). This probably shows that rural adolescent girls have high coping mechanism and are strong willed. It also supports the reasoning of Indian families needing support which could decrease problems on mental health when it comes to menstrual stress. The DASS-21 accessed the association of stress and menstrual signs and showed 47.2% has stress, similar to this study. 24 A study in Pune showed moderate stress in 46.6%, and 43.3% to have low stress and 10.1% to have high stress during menstruation, similar to this study. 25 Agarwal et al showed source of information regarding menstruation was from mothers (41.61%), sisters (12.41%) and friends (13.87%). 26 In this study mothers (85.7%) were the major source of information followed by friends (1.4%) and sisters (0.5%), similar findings were seen by Kamath et al. 27 Main complaints faced in this study participants was fatigue, followed by abdominal discomfort and pain, which compared with a Indian study showed pain abdomen (59.70%) to be the major complain followed by headache (23.57%) and loss of appetite (11.79%). 26 Other studies done in West Bengal (66.9%) and Garhwal (62.75%) stated that dysmenorrhea was the most common complaint faced by adolescent girls. 28,29 This study noticed low utilization of sanitary pads from the anganwadi (11.1%). One study suggested the possibility of poor ASHA social marketing scheme implementation, needing the NRHM+A to market the availability of sanitary pads in Anganwadi by ASHA workers. 30 Girls above 15 years felt they did not receive support from their family and faced problems during the menstrual period, as care in an Indian society mostly goes to the younger child. Girls with low BMI felt stressed (19.4%), faced lesser complaints during the menstrual period (26.9%) leading to the possibility of hormonal imbalances that exists in low nutritional state. Low SES groups had issues in getting sanitary pads freely and regularly (26.5%), inability to take care of themselves (70.6%), faced more problems (73.5%) and got less support from their family (58.8%) during the menstrual period, due to low resources at home and neglect. Another outlook to this could be low income families have parents working double shift to make ends meet leading to inability to spend time with their daughters as they need to sustain the family. Girls who had fathers of an older age group (66.7%), had no time to take care of themselves during the menstrual period, in comparison with girls with fathers of younger age group (50%) (p<0.001), probability of change in paternal parenting style from authoritarian to permissive in a developing country. Girls with fathers educated to graduate level (60%) had daughters who received good support from their family during the menstrual cycle (p=0.041). This could be awareness of parents to be supportive to their daughters during the menstrual period showing a new trend in modern society where fathers are involved in menstrual care. Limitations of this study was post intervention analysis on stress levels could have been done. CONCLUSION Parents play a very important role during the growing phase of an adolescent girl. The communication between parents and children related to menstrual health issues is dependent on educational status, of the parents and their knowledge about menstrual health. Mothers play a vital role and hence it's important that they be armed with appropriate information and knowledge about reproductive health. It is essential for the teachers to impart knowledge on reproductive health. Integrating menstrual hygiene into curriculum, provision of toilets and even supplying sanitary napkin at schools is the need of the hour especially in rural areas of India. Introducing stress management programmes in schools would create a huge impact on adolescents in dealing with not only health related stress but also mental stress. ASHAs along with village health and sanitation committee and local bodies must be oriented towards menstrual hygiene practices and help spread the awareness through IPC. Professional bodies like IAP and NGOs like UNICEF, UNFPA and PHFI should actively promote menstrual hygiene for better practices in the community. Recommendations National programmes focusing on mental health in the NRHM+A scheme is warranted. This study was the first of its kind to see the association of the perceived stress scale with type of parenting skill of the parents and its effect on mental health in the adolescents

A Unified Approach for Classroom and Laboratory Control Systems Education Abstract In this paper, a unified approach for control systems education will be presented. This approach is a friendly software and hardware platform that provides students with the necessary tools for gathering data for system identification, designing controllers, simulating the closed-loop system, and implementing the controller on real-time hardware. The proposed approach has been used in introductory control systems courses and can be easily extended to advanced and research-based courses. Software-based classroom assignments and projects have been presented based on this platform. Moreover, these classroom assignments and projects were smoothly extended to hardware-based labs. The feedback conveyed by students due to the incorporation of this platform into control engineering curricula has been positive. Also, professors have been endorsing the use of this platform as part of teaching control systems engineering.

Efficient algorithm for scheduling parallel applications on hybrid multicore machines with communications delays and energy constraint This paper presents an efficient algorithm with performance guarantee to solve task scheduling problem on hybrid platforms with energy constraint and communication delays. The underlying platform architecture in this work is composed of two types of resources, CPU and GPU, often called hybrid parallel multicore platforms. We focus on finding a generic approach to schedule applications presented by Directed Acyclic Graph (DAG), which minimizes the makespan by considering communication delays and respecting an energy constraint. A twophase algorithm is proposed with a performance guarantee of 6 compared with the optimal solution; the first phase consists in solving the assignment problem to find the type of processor assigned to execute the tasks (CPU or GPU) using a linear program. In the second phase, we calculate the start execution time of each task to generate a feasible schedule. Finally, we test our algorithm on a large number of instances. These tests demonstrate that the proposed algorithm achieves a closetooptimal performance.

High-temperature pressure transducer interface This paper describes a high-temperature (250 degree(s)C) pressure-transducer interface for resistive Wheatstone bridges. The long-term drift of the smart sensor, i.e., the (pressure) sensor plus its interface electronics, will be determined by the drift of the sensor only. A continuous three-signal auto-calibration sequence of the interface electronics keeps the transducer interface virtually free of long-term drift. A patented low-drift pre-amplifier forms an essential element in this system. The high-temperature operation of the transducer interface has been investigated from both an electronic and a packaging point of view. The system has been realized by combining CMOS ASICs with a thick-film packaging technology. The pressure-transducer interface works up to 250 - 275 degree(s)C with 15 - 16 bits accuracy.

The surgical management for isolated scaphotrapeziotrapezoid (STT) osteoarthritis : a systematic review of the literature. We performed a systematic review to find out the safety and efficacy of various procedures for isolated scaphotrapeziotrapezoid osteoarthritis. Eleven articles were included. The most common procedure was arthroplasty with pyrocarbon implant (28%), followed by resection of distal pole of scaphoid with proximal trapezium and trapezoid resection (18%). The other procedures included trapeziectomy with ligament reconstruction and tendon interposition (LRTI) (14%), arthroscopic resection of distal scaphoid (11%), trapezium and trapezoid resection with LRTI (10%) and arthrodesis (10%). Complications were noted in 18 (15%) patients. The most common complication (7.5%) was asymptomatic dorsal intercalated segmental instability (DISI) followed by dislocation of the pyrocarbon implant (3%). Fusion resulted in decreased range of motion and grip strength. The distal scaphoid resection was related to high rate of DISI. Although the pyrocarbon implant has a higher dislocation rate which requires revision surgery, this complication is avoidable with good surgical technique. Arthroplasty with pyrocarbon implant may be the first choice in younger patients.

A 27-year-old Uber driver was stabbed to death over the weekend, the police said. No suspect has been arrested, and rewards were being offered for information leading to an arrest. The company said it was working with the police in their investigation, but drivers have said the company should do more to protect them. Drivers have complained to Business Insider that they often feel unsafe, given that the company does not perform background or identify checks on riders as it does for drivers. Anyone with a credit or debit card can make an account to ride, even with a fake name, Business Insider has confirmed. An Uber driver was fatally stabbed Saturday night in New York City, according to local news reports. Ganiou Gandonou, 27, was found with stab wounds inside his black Toyota Camry at about 9 p.m. in the Bronx, The New York Times reported. After bleeding heavily from his neck, he died at Jacobi Medical Center in the Bronx, according to ABC7. The police have released a video of a person of interest wanted for questioning and were offering a $2,500 reward. An Uber representative told Business Insider that the company was working with law enforcement in its investigation. "This is a horribly tragic incident and our hearts go out to the grieving family," the representative said in an email. "We stand ready to work with law enforcement to assist their investigation in any way possible." Several drivers have told Business Insider they are often fearful for their safety when driving. While traditional taxis in New York have plastic barriers between the front and back seats, Uber cars have no such protection, and customers sometimes ride in the front seat. Do you work or drive for Uber? Got a news tip? Contact this reporter at grapier@businessinsider.com. Uber performs background checks on drivers, but no such process is in place for riders. Uber doesn't verify that passengers have provided their real name, and rides can be purchased anonymously with prepaid debit cards. Business Insider has successfully made accounts with fake names and taken rides on the platform within minutes of signing up. An NYPD spokesperson declined to comment, saying it was an ongoing investigation. The New York Times noted that the driver was working at the time, but both Uber and the NYPD declined to say whether the passenger was a suspect. A local drivers group said it was offering a $3,000 reward for information leading to an arrest. "We are horrified by the death of our fellow for-hire vehicle driver and our thoughts go out to his loved ones. We must continue to do more to protect the safety of for-hire drivers," the Independent Drivers Guild, which represents 70,000 drivers for ride-hailing companies in New York City, said. "We call on anyone who may have witnessed the attack to contact the police so that the culprit may be brought to justice. The Independent Drivers Guild is offering a $3,000 reward for any witness who can provide information that leads to the arrest of the killer and helps police bring them to justice." The driver's widow, Latifatou Acimi, told the New York Post that her husband was a quiet man who worked hard to provide for her and their 2-year-old son. "My husband was a very quiet man, a very hardworking man," Acimi said. "He always said, 'I'm working hard for my son so he doesn't have to.'" "I want to look that person in his face," she said of the killer. "I want to know the reason why he [did] it, because I know for sure he doesn't got any reason. He took the wrong person." Do you work or drive for Uber? Got a news tip? Contact this reporter at grapier@businessinsider.com. Secure contact methods are available here.

Outcome of Repair of Anterior Penile Hypospadias by Snodgrass Technique- A Study of 50 Cases Introduction: Hypospadias is a developmental anomaly characterized by a urethral meatus that opens onto the ventral surface of the penis proximal to the end of the glans. Hypospadias occurs in 1 in 125 live male births. Classically three abnormalities are found in the hypospadias penis: 1) an ectopic opening of the urethral meatus at the ventral surface. 2) A ventral curvature of the penis (Chordee), and 3). A hooded foreskin on the dorsum of the penis with a lack of skin on the ventral due to a V-shaped defect referred to as urethral delta. There are anterior (65%), middle (15%, and posterior penile hypospadias (20%). Objective: The objective of surgical repair of hypospadias is to provide complete straightening of the penis, placing the meatus at the tip of the glans, forming a symmetrical conical-shaped glans, and constructing a urethra uniform in caliver and acceptable skin coverage. Materials and Methods: This is a Cross-sectional variety of descriptive type of observational study conducted in the department of pediatric surgery, Dhaka Medical College & Hospital, Dhaka, Bangladesh, from 1st January 2009 to 30th June 2010. The total number of cases is 50. Patients having anterior penile hypospadias were selected by simple random sampling. The mean age of the patients was 5.22 years (2 to 10 years). Surgical correction was done with the Snodgrass technique. The mean operative time was 90 minutes. Post-operative hospital stay was10 days. Results: Satisfactory results were obtained in 35 (70%) patients, and only 14 (28%) had urethrocutaneous fistula, wound infection 5(10%), and meatal stenosis 2 (4%). The final outcome was evaluated based on urethrocutaneous fistula, meatal stenosis, and cosmesis. Out of 50 patients, 35 (70%) did not have a urethrucutaneous fistula and were cosmetically acceptable. Conclusion: Early detection and correction are essential to minimize the complications and also to lessen the psychological trauma of the patient. For this, a thorough examination of the neonates following delivery in different maternal and child care clinics is mandatory. Early and timely measures also give the best cosmetic and functional results. So we should put all our efforts into achieving this goal.

Bone mineral metabolism in children with juvenile idiopathic arthritis--preliminary report. INTRODUCTION There are very few reports assessing bone mineral mass and its metabolism in the course of juvenile idiopathic arthritis (JIA). STUDY OBJECTIVE To assess the levels of selected serum markers of bone formation (OCN) and resorption (CTx) in JIA children. MATERIAL AND METHODS The study involved 52 children with JIA diagnosed according to the EULAR criteria of 1997, aged 6-18 years. All patients underwent densitometric measurements using dual-energy X-ray absorptiometry (DXA) to assess TBBMD (g/cm2), Spine BMD (g/cm2), Z-score for SBMD, TBBMC (g), and LBM (g). The following parameters were determined in blood serum: the level of osteocalcin (OCN) and C-terminal type I alpha-collagen chain telopeptide (CTx) using the Elecsys 2010 system (N-MID Osteocalcin, Beta-CrossLaps). A gender- and age-matched control group consisted of 16 healthy children. RESULTS The mean concentrations of both osteocalcin (p<0.001) and CTx (p<0.005) were significantly higher in JIA patients as compared to the healthy controls (OCN 113.2+/-54.9 ng/ml vs. 70.2+/-48.3 ng/ml; CTx 1.4+/-0.5 mug/l vs. 1.2 +/-0.45 microg/l). The concentrations of the bone turnover markers were significantly reduced in children with higher degrees of joint destruction compared to those with anatomically normal joints (p<0.05). The mean concentration of CTx showed a significant negative correlation with the TB BMC/LBM Z-score (p<0.05). Reduced bone mass (Z-score for SBMD< -2.0) was found in 23.6% of the affected children. CONCLUSIONS The JIA patients had elevated levels of OCN and CTx compared to the healthy controls. Reduced bone turnover was observed in children with higher degrees of joint destruction.

Feeding dried purple laver (nori) to vitamin B12-deficient rats significantly improves vitamin B12 status To clarify the bioavailability of vitamin B12 in lyophylized purple laver (nori; Porphyra yezoensis), total vitamin B12 and vitamin B12 analogue contents in the laver were determined, and the effects of feeding the laver to vitamin B12-deficient rats were investigated. The amount of total vitamin B12 in the dried purple laver was estimated to be 54.5 and 58.6 (SE 5.3 and 7.5 respectively) G/100 g dry weight by lactobacillus bioassay and chemiluminescent assay with hog intrinsic factor respectively. the purple laver contained five types of biologically active vitamin b12 compounds (cyano-, hydroxo-, sulfito-, adenosyl- and methylcobalamin), in which the vitamin b12 coezymes (adenosyl- and methylcobalamin) comprised about 60 % of the total vitamin b12. when 9-week-old vitamin b12-deficient rats, which excreted substantial amounts of methylmalonic acid (71.7(se 20.2) mol/d) in urine, were fed the diet supplemented with dried purple laver (10 g/kg diet) for 20 d, urinary methylmalonic acid excretion (as an index of vitamin B12 deficiency) became undetectable and hepatic vitamin B12 (especially adenosylcobalamin) levels were significantly increased. These results indicate that vitamin B12 in dried purple laver is bioavailable to rats.

Length sensing and control strategies for the LCGT interferometer The optical readout scheme for the length degrees of freedom of the LCGT interferometer is proposed. The control scheme is compatible both with the broadband and detuned operations of the interferometer. Interferometer simulations using a simulation software Optickle show that the sensing noise couplings caused by the feedback control can be reduced below the target sensitivity of LCGT with the use of feed forward. In order to improve the duty cycle of the detector, a robust lock acquisition scheme using auxiliary lasers will be used. Introduction The second generation interferometric gravitational wave detectors, such as LCGT, advanced LIGO and advanced Virgo are planned to start observations around 2017 to 2018. The ambitious sensitivity goals set by those projects require that the mirrors of the interferometers be controlled with extremely high accuracy and lowest possible disturbance. All of the above mentioned detectors will use an optical configuration called Resonant Sideband Extraction (RSE), where a mirror is placed at the antisymmetric port of the interferometer to modify the spectral shape of the quantum noises. As a result, the number of degrees of freedom (DOFs) to be controlled is increased from the first generation detectors. Moreover, the strong laser power circulating in the interferometer creates optical springs, resulting in opto-mechanical couplings between otherwise independently suspended mirrors. This complicated situation calls for a highly sophisticated design of the interferometer sensing and control system. In this paper, we will explain the signal extraction scheme to be used in LCGT, the next generation gravitational wave detector in Japan. The focus of this paper is on the length sensing and control. However, the control of the mirror orientations is equally important and it shall be explained elsewhere in a separate paper. LCGT interferometer LCGT will be constructed at the underground site of Kamioka mine with the baseline length of 3 km. The seismically quiet environment of the Kamioka site is a great advantage for the stable and low noise operation of sensitive devices like a gravitational wave detector. Another major feature of LCGT is the use of cryogenic sapphire mirrors, cooled down to 20K, to suppress the thermal noises. The optical configuration of LCGT as well as the naming conventions of the various parts of the interferometer are shown in Figure 1. This configuration is called powerrecycled RSE. The basic parameters of the LCGT interferometer are shown in Table 1. These parameters are selected to maximize the scientific output of the gravitational wave observation by optimizing the quantum noise spectrum given practical constraints, such as the maximum cooling power for the mirrors, and the spectra of classical noises. LCGT is planned to be operated both in broadband RSE (BRSE) and detuned RSE (DRSE) configurations. Therefore, the interferometer control scheme has to be able to handle both the operation modes. Figure 2 shows the projected noise curves of thee LCGT interferometer for the two operation modes. There is an output mode cleaner (OMC) at the downstream of the signal recycling cavity (SRC) to remove unwanted light components and only transmit the signal sidebands generated by the differential length change of the arm cavities. The signal sidebands contain the information of gravitational waves. They are converted into the power changes on a photo detector by the DC readout scheme, which is explained later. The power recycling cavity (PRC) and SRC have two mirrors each to fold the beam in a Z-shape. These folding parts serve as telescopes to add extra Gouy phase changes in the cavities. The purpose of the additional Gouy phase is to avoid the degeneracy of the recycling cavities in terms of the higher order optical modes. In order to keep the interferometer at the optimal operation point, there are five length degrees of freedom to be controlled: i) Differential change of the arm cavity lengths (DARM), ii) Common change of the arm cavity lengths (CARM), iii) Differential change of the Michelson arms formed by the BS and the two ITMs (MICH), iv) PRC length (PRCL) and v) SRC length (SRCL). These five DOFs are represented as the linear combinations of the mirror displacements, and called the canonical DOFs in this paper. DARM is the most important DOF, because it contains information of gravitational waves. All other DOFs are collectively called auxiliary DOFs. The purpose of a length sensing and control system is to measure the variations of the canonical DOFs and apply appropriate feedback to minimize the fluctuations. RF Sidebands The main laser of LCGT is phase modulated at two radio frequencies (RFs), called f1 and f2, to generate RF sidebands. An additional amplitude modulation, called f3, is also applied during the lock acquisition. The resonant conditions of the RF sidebands are shown in Figure 1. The f1 sidebands are resonant both in the PRC and SRC, but not in the arm cavities. Therefore, they carry the information of the PRC and SRC, without affected by the arm cavities. Since the f1 sidebands partially transmit through the Michelson part, they are also sensitive to the MICH degree of freedom. The f2 sidebands are resonant only in the PRC. Therefore, they are only sensitive to the change of PRCL. The amplitude modulated sidebands f3 are not resonant in any part of the interferometer, providing stable local oscillator fields for other RF sidebands. The f3 has to be amplitude modulation so that beating against other phase modulated sidebands yields zero-crossing error signals around the optimal operation point of the interferometer. Signal Extraction Ports The light power coming out of the interferometer is detected at mainly three ports: the reflection port (REFL), pick-off port in the PRC (POP) and the anti-symmetric port (AS). REFL is the light coming back to the laser, intercepted by a Faraday isolator. POP is taken at the transmission of the PR2 to sample the light fields circulating in the PRC. The AS port is the transmission of the OMC. The light power fluctuations detected by photo detectors (PDs) at each port are demodulated at various beat frequencies between the RF sidebands and the carrier. Out of many possible combinations of the signal ports, demodulation frequencies and demodulation phases (in-phase or quadrature-phase), we selected the signals shown in the first columns of Table 3 and Table 4 to be used for the feedback control. The choice was made by repeatedly computing the loop noise couplings, explained in section 5, with different combinations of the signal ports to find the best one. Because the f3 sidebands do not resonate in any part of the interferometer, the demodulation of the REFL signal at the beat frequencies of f3 and either f1 or f2 yields robust error signals for the control of PRCL, SRCL and MICH (collectively called the central part). Since those "f3 signals" do not depend on the carrier, they have smaller couplings from CARM than the signals using the carrier. Also the f3 signals are stable during the lock acquisition, when the carrier rapidly changes its magnitude in the arm cavities. Although the f3 signals have the advantages explained above, they can have much worse shot noises than the signals using the carrier. First of all, the modulation has to be strong enough to yield error signals with small shot noise. However it will waste a lot of input laser power unless some advanced modulation techniques are used. At the REFL port, the amount of carrier light strongly depends on the losses inside the interferometer, which is not easily controllable. Since the carrier light is just a source of shot noise for the f3 signals, this gives rise to an uncertainty in the amount of shot noise. Therefore, we only plan to use the f3 signals during the lock acquisition of the interferometer, not in the observation mode. Unlike the other DOFs, a scheme called DC readout is used to obtain the DARM error signal. A small DC offset is applied to DARM to provide a local oscillator field for the DC readout. The relative phase between the local oscillator and the signal sidebands (homodyne angle) is set to 58 for BRSE and 45 for DRSE to optimize the quantum noise level. Constraints The macroscopic lengths of the PRC, SRC and the MICH asymmetry along with the modulation frequencies of the RF sidebands have to be chosen to satisfy the resonant conditions of Figure 1. Also the length of the mode cleaner (MC), which is used to clean the beam profile of the input laser beam, has to be determined to transmit the RF sidebands through it. In addition, various practical constraints are imposed on the choice of those parameters. The constraints on the available space is stringent in under ground experiments like LCGT, where the space is at a premium. In general we want to minimize the lengths of the recycling cavities and the MC. However, the recycling cavities have to accommodate the Z-shaped folding part and the 20 m long thermal radiation shields between BS and ITMs. Therefore, the minimum possible recycling cavity length is about 65 m. Because a short MC has a larger free spectral range (FSR), a too short MC will severely limit the choice of RF sideband frequencies, which have to be integral multiples of the FSR. To strike a balance between the FSR and the tunnel cost, the desirable MC length is in the order of 30 m. Another constraint is that the modulation frequencies have to be in the range of 10 MHz to 50Hz. If the frequency is too high, it is difficult to find a good PD with fast enough response and a reasonably large aperture. If it is too low, the laser noises are not filtered out enough by the pre-mode cleaner cavity. SRCL Linear Range There are many combinations of the macroscopic lengths and modulation frequencies which satisfy the above constraints. In order to determine the final parameter set to be used in the LCGT interferometer, we use the linear range of the SRCL error signal as the figure of merit. The operation mode is switched from BRSE to DRSE by adding an offset to the SRCL error signal. The required detuning of the SRC is 3.5 in terms of one-way phase shift. Therefore the SRCL error signal has to have a large enough linear range to allow this offset. This linear range is roughly determined by the finesse of the coupled cavity formed by the PRC and SRC for the f1 sideband. Since the reflectivities of the PRM and the SRM are already determined by the optimization of the quantum noise shape, we are left with the Michelson reflectivity for the f1 sideband to change the finesse of the coupled cavity. The Michelson reflectivity R m depends on the f1 frequency (f 1 ) and the Michelson asymmetry (l m ) as R m ∝ cos(2f 1 l m /c), where c is the speed of light. Figure 3 shows the shape of SRCL error signals for three cases of R m. When R m is closer to the PRM reflectivity (0.9), the effective reflectivity of the power-recycled Michelson seen from the SRC becomes lower. Therefore, the finesse of the SRC gets smaller, resulting in a wider linear range. In the case of R m = 0, the DRSE operation point (shown by the vertical line at 3.5 ) is almost at the turning point of the error signal. Therefore it is not usable as an error signal. For R m = 0.79, the error signal is linear throughout the plot range, but the slope is smaller, meaning a poor shot noise. Therefore, after an extensive parameter search, we decided to use a parameter set with R m = 0.14, which has a larger slope at the center while the signal is still not flat at 3.5. The selected parameter set is shown in Table 2. The f3 frequency is chosen to transmit the MC and not resonant in any part of the interferometer including its higher order harmonics. Table 3. Sensing matrix for the BRSE mode. Each row corresponds to a signal. AS DC is the DC readout at the AS port. Other signal names consist of a signal port (REFL or POP), demodulation frequency (f1 or f2) and demodulation phase (in-phase (I) or quadrature-phase (Q)). Each row is normalized by the diagonal element. The columns represent the canonical DOFs. The n-th signal is fed back to the n-th DOF. The interferometer response was evaluated at 100 Hz to create this matrix. Interferometer Model In order to calculate the response and the quantum noises of the LCGT interferometer, an interferometer model was constructed with an optical simulation software called Optickle written by Matt Evans. The model uses the parameters selected in the previous section. In order to simulate the imperfections of real optics, 1% asymmetries in the arm cavity finesse and the BS reflectivity are introduced. These asymmetries increase off-diagonal elements in the sensing matrices. They also create residual DC carrier light at the AS port even without the DARM offset, allowing us to set the homodyne angle to a desired value. Control Loop Modeling The sensing matrices computed by the interferometer model for the canonical DOFs are shown in Table 3 and Table 4. Because the off-diagonal elements in the first row of the matrices are non-zero, there are finite couplings from the auxiliary DOFs to the DARM error signal. Sensing noises, most notably shot noise, are noise signals which do not correspond to the real mirror motions. The feedback system tries to cancel out these noises by unnecessarily moving the mirrors. This additional mirror motion is coupled to the DARM error signal through the off-diagonal elements of the sensing matrix. The noise coupling of this mechanism is called loop noise. The loop noise couplings can be modeled using the block diagram shown in Figure 4. The detector matrix D converts a vector of mirror displacements x into a vector of error signals e in the canonical DOFs. Then the sensing noise vector, n s, is added to the error signal vector. D and n s are calculated by the Optickle model. The error signals are filtered by a feedback filter F and fed back to the mirrors through the actuator matrix A, which converts feedback signals in the canonical DOFs to the motion of each mirror. The displacement noises of the mirrors are represented by n d. The DARM error signal is the first element of the error signal vector e. In the absence of gravitational waves, e is written as, where I is the identity matrix. The off-diagonal elements of (I + G) −1 are responsible for the loop noise couplings. Figure 5 shows the loop noise couplings from the auxiliary DOFs to the DARM signal compared with the target sensitivity of LCGT. These noises are calculated by plugging in the shot noise of each signal port to n s of. In this calculation, we assumed simple 1/f 2 shaped feedback filters with 1/f response around the unity gain frequencies (UGFs) to ensure the stability. The UGFs are 200 Hz for DARM, 10 kHz for CARM and 50 Hz for all the other DOFs. Clearly the shot noise couplings from the auxiliary DOFs are larger than the target noise level. Feed forward The loop noise coupling problem can be mitigated by adding a feed forward path F after the feedback filter F. The elements of F are determined by measuring the transfer functions from the actuation of auxiliary DOFs to DARM error signal. The net effect of F is to reduce the off-diagonal elements in the first row of (I + G) −1. The accuracy of the feed forward cancellation depends on the precision of the transfer function measurements. The feed forward gain is defined as the inverse of the error of the transfer function measurements. Thus a 1% error corresponds to a feed forward gain of 100. Since the optical gains of the interferometer varies by the alignment fluctuations, laser power variation and so on, the optimal feed forward filters also change over time. Adaptive optimization of F is planed to be used in LCGT. Figure 6 shows the quantum noise estimates when a feed forward of gain 100 is applied. It is a reasonable assumption, because the feed forward gain of more than 100 have achieved in the first generation interferometers. In this case, all the shot noise couplings from the auxiliary DOFs are well below the target noise level. Photo Detector Noise Another important sensing noise to be considered is the intrinsic noises of photo detectors. A PD always receives some offset signal, either in RF or DC depending on the type of PD. At some ports, these offset signals can be very large. In this case, the dynamic ranges of the PD becomes an issue. Typically, a low-noise fast operational amplifier (op-amp) used for the current to voltage conversion of a PD has a dynamic range of about 200 dB according to the catalog specifications. However, because of the slew rate limit, the actual dynamic range at RF is much smaller. Moreover, in order to minimize the non-linearity of the detector response, we want to use the op-amps at a much smaller signal level than the slew rate limit. Therefore, for the following analysis, we assume the dynamic range to be 160 dB for RF PDs and 190 dB for a DC PD. Once the dynamic range D is specified, the sensing noise, n pd, of a PD, in terms of the equivalent signal light power on the PD, can be expressed as n pd = P ofs /D, where P ofs is the offset signal power for the PD. Then we can simply replace n s in with n pd to calculate the loop noise couplings for the PD noise. Figure 7 shows the calculated PD noise couplings in the case of DRSE. The PD noises are large in the DRSE mode, especially for MICH. It is because the SRC detuning changes the relative phase of the f1 sidebands with the carrier so that they no longer form a pure phase modulation. The result is constant large RF signals on the PDs for the signals using the f1 sidebands. With the use of feed forward, the PD noises can be made below the target noise level. For BRSE (not shown in the figure), the PD noises are well below the target noise even without the feed forward. Displacement noise requirements The displacement noise contributions to the DARM signal can be calculated from by plugging in the displacement noise of each mirror to n d. Conversely, the requirements to the mirror displacement noise can be derived from given a target noise level. This is especially important when feed forward is used, because feed forward is known to enhance the displacement noise couplings. To avoid this, the feed forward signals are cut off at low-frequencies where displacement noises are dominant. Figure 9. A simplified schematic of the green laser pre-lock system. This diagram shows only the pre-lock system for the X-arm. There is a similar system for the Y-arm injected from the SR2. FI: Faraday Isolator. Figure 8 shows the maximum permitted displacement noise for each mirror requiring the contributions to the DARM signal be smaller than the target noise level. In this calculation, feed forward filters without the low-frequency cut off are assumed to show the worst case scenario. The displacement noise estimates shown in the figure are the sum of the seismic and thermal noises. The seismic noise estimates are based on the measured seismic data of very noisy day (during a heavy storm) at the Kamioka site. Except for at several peaks, the expected displacement noises are below the requirements in the observation band, i.e. above 10 Hz. Lock acquisition In order to ensure a high duty cycle during the observation and minimize the turnaround time during the commissioning, a quick and robust lock acquisition scheme is necessary. However, the relatively high finesse of the arm cavities and the complex optical configuration of LCGT make it difficult to achieve this. A high finesse cavity yields an useful error signal only in a small region around the lock point. Even this signal can be distorted by the slow transient response of the cavity if the mirrors are moving fast. Moreover, the high optical power stored in the arm cavities will kick the mirrors when the cavities are close to the resonances, preventing the interferometer from gently settling down to the locked state. To assist the lock acquisition, we plan to use auxiliary lasers to pre-lock the arm cavities. This idea was first developed at the 40 m laboratory in Caltech. Figure 9 shows a conceptual diagram of the auxiliary laser lock system for the X-arm. An auxiliary laser of 1064 nm wavelength is phase locked with the main laser. Then it is frequency doubled by a second harmonic generator (SHG) to 532 nm (green). The green laser beam is injected to the interferometer from the back of the PR2. The coatings on the PR2 and BS are designed to have a high transmissivity at 532 nm while the PR3 has a high reflectivity so that the beam is led only to the X-arm. The arm cavity mirrors also have dichroic coatings to form a low finesse (about 10) cavity for the green light. Because of the low finesse, it is easy to lock the arm cavity with the green laser. A similar system is also prepared for the Y-arm. Once the arm cavities are locked by the green lasers, the frequency offset between the green and the main lasers is adjusted so that the arm cavities are not resonant to the carrier nor any RF sidebands. This ensures that the central part of the interferometer is not disturbed by the arm cavities. Error signals used to control the central part during the lock acquisition should not depend on the carrier. Otherwise, the error signals may be strongly disturbed when the arm cavities are finally brought to the full resonances. Therefore, we will use the beat signals between the f3 sidebands and the other RF sidebands to obtain the error signals during the lock acquisition. From Optickle simulations, it was confirmed that these error signals are not noticeably affected by the arm cavity offset from a carrier resonance. After the central part is locked, the arm cavity offset is slowly reduced by changing the offset frequency between the green and main lasers. During this process, a large amount of optical power builds up in the arm cavities, pushing the mirrors apart. This radiation pressure is compensated by slightly leaning the suspension towers and letting the gravity counter act the radiation pressure. Once the arm cavities reach the full resonance, the control signals are handed off to the observation mode signals: the DC readout for DARM and the RF signals using the carrier for the auxiliary DOFs. Conclusion The length sensing and control scheme for the LCGT interferometer was proposed. Optickle simulations show that the sensing noise couplings caused by the control loops can be mitigated by the use of feed forward. The displacement noise couplings to the gravitational wave signal are confirmed to be less than the target noise level, even with the enhancement by the feed forward. For quick and robust lock acquisition, auxiliary lasers will be used to pre-lock the arm cavities. The control scheme explained here will

Safety-critical model predictive control for stochastic nonlinear system with time delay using MTN Safe planning and control in the networked scenario under communication delays are notoriously challenging. This paper proposes a safety-critical model predictive control (SCMPC) scheme that ensures safety in the dynamic environment while accommodating communication delays. Spatiotemporal encoder-decoder (STED) captures the delay effects and interaction information between participants. In STED, a multi-dimensional Taylor network (MTN) with a concise topological structure decodes the captured interactive information and generates social context with improved computational efficiency. Then based on such a social context, a stochastic control barrier function (SCBF) is deduced to enforce the risk probability to meet the predefined constraints. Given such constructions, an SCMPC scheme is formulated to obtain a robust and real-time control policy. Finally, the numerical simulation demonstrates the effectiveness of the proposed method.

Abstract 5839: Exome sequencing revealed comparable frequencies of RNF43 mutations and BRAF mutations in Middle Eastern colorectal cancer Mutation-induced activation of Wnt- Catenin signaling is a frequent event in CRC. The E3 ubiquitin ligase, RNF43, has been reported to negatively regulate the Wnt signaling pathway. Although, RNF43 mutations are frequently seen in CRC, its role in CRC from Middle Eastern ethnicity remains unclear. Therefore, we conducted this study to assess the frequency of RNF43 mutations, the clinico-pathological and molecular associations in two independent cohorts of Middle Eastern CRC. Exome sequencing was utilized to identify the somatic mutations in RNF43 gene and in known CRC driver genes including APC, TP53, KRAS, BRAF and NRAS among 113 CRC cases of discovery cohort. In validation cohort of 107 CRC cases, Sanger sequencing was employed to detect the mutations in exon 2, 4, 8 and 9 in RNF43 gene while Targeted capture sequencing was conducted to identify the mutations in entire region of APC gene and hotspot regions of KRAS, BRAF, NRAS and TP53 genes. RNF43 somatic mutations were found in 5.9% (13/220) of the entire CRC cohort, which is similar in frequency to BRAF mutations, which were identified in 3.6% (8/220). The mutations in other known driver genes including APC, TP53, KRAS and NRAS were observed in 58.2% (128/220), 50.9% (112/220), 46.4% (102/220) and 2.7% (6/220) cases, respectively, in all 220 tumors examined. However, no significant association between RNF43 mutations and BRAF mutations was seen. RNF43 was found to be inversely correlated to APC and TP53 mutations. Clinico-pathological analysis showed a strong association of RNF43 mutations with right sided and sporadic deficient mismatch repair (dMMR) CRC. No association was identified between RNF43 mutation and other clinico-pathological features such as age, tumor histological subtype, tumor grade or patients prognosis. Multivariate logistic regression analysis revealed that dMMR status (Odds ratio = 5.43; 95% confidence interval = 1.12 - 26.32; p = 0.0356) and wild type APC (Odds ratio = 4.77; 95% confidence interval = 1.51 - 19.77; p = 0.0312) were independent predictors of RNF43 mutation. Our results revealed that RNF43 mutations do occur in CRC from Middle Eastern ethnicity at comparable frequencies with BRAF mutations and represent a distinct molecular subtype which further enhance our understanding of how different mutational subsets of Wnt tumor suppressor genes link to distinct tumor characteristics, which might be considered for treatment strategies for CRC patients. Citation Format: Rong Bu, Abdul K. Siraj, Tariq Masoodi, Sandeep Kumar Parvathareddy, Kaleem Iqbal, Allianah D. Benito, Sarah Siraj, Nabil Siraj, Maha Al Rasheed, Saeeda O. Ahmed, Wael AL-Haqaw, Maria Angelita Sabido, Mark Ranier Diaz, Padmanaban Annaiyappanaidu, Khawla S. Al-Kuraya. Exome sequencing revealed comparable frequencies of RNF43 mutations and BRAF mutations in Middle Eastern colorectal cancer . In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5839.

TEACHING THE LESS-SKILLED COMPREHENDERS BY USING THE FAB FOUR This study investigates how the Fab Four strategy implemented to teach the less-skilled readers in State Institute of Islamic Studies of Ponorogo. The design of this study is qualitative. Twentyseven English department students of the third semester are the subjects of the study. The Fab Four strategy is applied by having the lecturer model four comprehension strategies (summarizing, questioning, predicting, and clarifying) through guided group discussions. Using this strategy, improvements have been noted in students reading comprehension. The result of this study indicates that the Fab Four is a great strategy to teach the less-skilled comprehenders as they are trained to determine important ideas from a reading text while discussing vocabulary, developing ideas and questions, and summarizing information.

The distribution and significance of the VIPergic system in man and other mammals. The finding of a potent vasodilatory activity in extracts of porcine gut led to the discovery of a new biologically active peptide, Vasoactive Intestinal Polypeptide (VIP) (Said and Mutt 1970). At the time it was not realised what this finding meant, VIP being regarded as yet another putative classical hormone of the gut. It was later found that VIP was present also outside the gut in considerable quantities and it is now known to be one of the components of the body's main regulatory system, "the diffuse neuroendocrine system" The painstaking search for VIP as a classical "circulating" hormone was somewhat fruitless but the discovery of large quantities of VIP in both the central and peripheral nervous systems () provided a fresh impetus and reorientated the direction of research towards VIP as a neurotransmitter. There is now increasing circumstantial evidence for a transmitter function for VIP in both the central and peripheral nervous systems. VIP is found in cell bodies and nerve fibres in the brain and in the autonomic nervous system (, ). It is present in the synaptsomal fraction of nerve terminals and its release is K+ induced and Ca++ dependent (). Raised levels of VIP are also found after nerve stimulation, and a number of atropine resistant gut responses, such as gastric relaxation and intestinal vasodilation are indeed mimicked by injections of small quantities of VIP into the local circulation. ().

Pituitary adenylate cyclase activating polypeptide (PACAP) expression in sympathetic preganglionic projection neurons to the superior cervical ganglion. Pituitary adenylate cyclase activating polypeptides (PACAP27 and PACAP38) are members of the VIP/secretin/glucagon family of peptides and have diverse neuroregulatory effects in sympathoadrenal cell development and function. PACAP peptides regulate rat superior cervical ganglion (SCG) neuron catecholamine and neuropeptide Y content and secretion, and promote sympathoneuroblast survival through activation of specific PACAP1 receptor isoforms. In examining the potential sources of PACAP regulating the SCG, PACAP expression was identified in rat preganglionic neurons in the intermediolateral cell column (IML) of the thoracic spinal cord which provide primary afferent projections to this sympathetic ganglion. Thoracic spinal cord segments (T1-4) contained approximately 17 pmol PACAP38 immunoreactivity/g tissue wet weight. Reverse-transcription polymerase chain reaction of cDNA from microdissected thoracic spinal cord using primers specific for rat neuronal proPACAP identified proPACAP mRNA expression in the IML; the results correlated with neurons labeled for proPACAP mRNA by in situ hybridization histochemistry and implicated PACAP biosynthesis in IML neurons. To demonstrate directly proPACAP transcript expression in preganglionic projection neurons to the SCG, the ganglion was decentralized and the sympathetic trunk immersed in fluorogold to identify sympathetic preganglionic neurons by retrograde labeling. Cryosections of spinal cord segments containing preganglionic neuron fluorogold labeled neurons were processed subsequently for in situ hybridization histochemical localization of proPACAP mRNA using a digoxigenin-labeled riboprobe; IML neurons were examined for fluorogold and digoxigenin/alkaline phosphatase product dual labeling. More than half of the preganglionic projection neurons to the SCG expressed PACAP mRNA, consistent with the postulate that PACAP peptides released from a subpopulation of thoracic IML preganglionic neurons may be physiological anterograde modulators of sympathetic SCG function.

LOS ANGELES — A fire department responded to a hospital hazmat spill that forced the closure of the emergency room. CBS Los Angeles reported that an LAFD hazmat crew responded to the Cedars-Sinai Marina del Rey Hospital after a damaged pipe caused a liquid oxygen spill. Fire department officials said a pipe from a 2,000-gallon tank was sheared and most of the oxygen inside spilled out. According to ABC7, the spill created a shoulder-high vapor cloud in the parking lot, causing ambulance tires and portions of walls and streets to freeze slightly. Hospital officials said no one was harmed in the incident, but some patients were transferred by ambulance to another hospital. The hospital’s ambulance bay was also impacted by the spill. The ER reopened about six hours after the spill occurred.

Abstract A75: A radiosensitivity gene signature and PD-L1 expression are predictive of the clinical outcomes of patients with lower-grade glioma in The Cancer Genome Atlas dataset Background: Identifying predictive factors for the clinical outcome of patients with low grade gliomas following radiotherapy could help optimize patient treatments. Here, we investigate the predictive efficacy of both a previously identified 31 gene signature and programmed death ligand-1 (PD-L1) expression. Methods: We identified 516 patients with low grade glioma in The Cancer Genome Atlas dataset and divided them into two clusters: radiosensitive (RS) and radioresistant (RR). Patients were also classified as PD-L1-high or PD-L1-low based on CD274 mRNA expression. Five-year survival rates were compared across patient groups, and differentially expressed genes were identified via a gene enrichment analysis. Results: Patients in the RS group had a higher survival rate than in the RR group, but only when treated with radiotherapy (63% vs. 52%, p = 0.019; univariate analysis). Patients in the RR group who were also PD-L1-high had a lower survival rate than other patients (50% vs. 60%, p = 0.010). Furthermore, a Cox multivariate analysis demonstrated that both belonging to this patient population and expressing wild-type isocitrate dehydrogenase were predictive of lower survival rates (p = 0.048). Differentially expressed genes associated with this group were found to play a role in the immune response, including the T-cell receptor signaling pathway. Conclusions: We validated the predictive value of a 31 gene signature and PD-L1 expression in a dataset of patients with low-grade glioma. Our results suggest that the patient population classified as both RR and PD-L1 high may benefit most from radiotherapy combined with anti-PD1/PD-L1 treatment. This work was supported by a grant from the Ministry of Science, ICT & Future Planning (NRF#2017R1A2B4002710 & & 2017M2A2A7A01018438) to In Ah Kim. Citation Format: Bum Sup Jang, In Ah Kim. A radiosensitivity gene signature and PD-L1 expression are predictive of the clinical outcomes of patients with lower-grade glioma in The Cancer Genome Atlas dataset . In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2017 Oct 1-4; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2018;6(9 Suppl):Abstract nr A75.

The Effect of Glufosinate Ammonium in Three Different Textured Soil Types under Malaysian Tropical Environment Glufosinate ammonium is a broad spectrum, non-selective, contact and organophosphate herbicide which is commonly used in Malaysian oil palm plantations. Research area was one of the oil palm growing areas of Malaysia is located adjacent to the Tasik Chini, Pahang. Farmers use this herbicide to control several types of unwanted plants which could compete with the oil palm for nutrients. Rain water and the sprayed solution are easily adsorbed by soil particles. The glufosinate ammonium sorption was determined by the batch equilibrium technique. The collected soil samples (0-50 cm depth) divided into five groups at 10 cm depth intervals. Glufosinate ammonium adsorption coefficients were correlated with the soil pH, organic matter (OM), clay content, and cation exchange capacity (CEC). Series of glufosinate ammonium standard were as 0.01, 0.1, 0.25, 0.5, 1, 3, 5, and 10 m/mL. The Linear and Freundlich equations were fitted for obtaining the adsorption and desorption isotherms. The result of the analyses showed that adsorption of glufosinate ammonium was correlated to the clay content. The clay fraction of the soil is the main absorbent of the glufosinate ammonium. Desorption from the soil was indicated by the high binding strength of the adsorbed glufosinate ammonium.

Customize the Windows 7 Taskbar! The Windows 7 taskbar can be manipulated and configured to display favourite applications, resized as required and even repositioned to meet your preferences. It might just look, like a strip of colour with a few applications docked into it, but the taskbar can prove extremely useful in finding out a great deal of information – as well as saving you from pressing the reset switch on your PC when you run into trouble! You can access the Taskbar settings by right-clicking your mouse and selecting Properties. On the Taskbar tab you can Lock the taskbar to prevent it from being moved, Auto-hide the taskbar to allow the taskbar to slip out of view when it is not being used, and Use small icons to save space. From this tab you can also access the Notification area and Aero Peek settings. The taskbar location can be changed by dragging the item around your desktop, but it can also be repositioned using the Taskbar location on screen: option. Meanwhile, you might like to resize or lock the taskbar – you can change how much of the screen it takes up by hovering your mouse over the edge of the taskbar, waiting for the two-headed arrow to appear and then left-clicking and dragging the taskbar’s edge to where you want it. Also by right-clicking the taskbar you can Lock the taskbar to retain its current settings. In addition to accessing properties, by right-clicking you can also Start Task Manager, a great way to access the vital tool for closing programs that don’t run correctly. You will probably notice how running applications will have a small icon on the taskbar, and for regularly used software you can ensure that these icons stay where they are. This is done by right-clicking the taskbar icon for the application when running and selecting Pin this program to taskbar, which effectively docks the software. Docked applications can also be previewed by hovering your mouse over them, prompting a small window to appear detailing the current contents of that application. If you were running a video clip in Windows Media Player you would see a smaller representation of the clip. With all of these Windows 7 taskbar settings and features at your command you should be able to configure it to suit your own needs. My own preference is to have as slim a taskbar as possible on the left side of the desktop with auto-hide active in order to maximise my desktop display.

Renewable Energy-Aware Sustainable Cellular Networks with Load Balancing and Energy-Sharing Technique : With the proliferation of cellular networks, the ubiquitous availability of new-generation multimedia devices, and their wide-ranging data applications, telecom network operators are increasingly deploying the number of cellular base stations (BSs) to deal with unprecedented service demand. The rapid and radical deployment of the cellular network significantly exerts energy consumption and carbon footprints to the atmosphere. The ultimate objective of this work is to develop a sustainable and environmentally-friendly cellular infrastructure through compelling utilization of the locally available renewable energy sources (RES) namely solar photovoltaic (PV), wind turbine (WT), and biomass generator (BG). This article addresses the key challenges of envisioning the hybrid solar PV/WT/BG powered macro BSs in Bangladesh considering the dynamic profile of the RES and traffic intensity in the tempo-spatial domain. The optimal system architecture and technical criteria of the proposed system are critically evaluated with the help of HOMER optimization software for both on-grid and off-grid conditions to downsize the electricity generation cost and waste outflows while ensuring the desired quality of experience (QoE) over 20 years duration. Besides, the green energy-sharing mechanism under the off-grid condition and the grid-tied condition has been critically analyzed for optimal use of green energy. Moreover, the heuristic algorithm of the load balancing technique among collocated BSs has been incorporated for elevating the throughput and energy efficiency (EE) as well. The spectral efficiency (SE), energy efficiency, and outage probability performance of the contemplated wireless network are substantially examined using Matlab based MonteCarlo simulation under a wide range of network configurations. Simulation results reveal that the proper load balancing technique pledges zero outage probability with expected system performance whereas energy cooperation policy offers an attractive solution for developing green mobile communications employing better utilization of renewable energy under the proposed hybrid solar PV/WT/BG scheme. Introduction Over the last decade, telecom network operators have been continuously increasing the number of cellular base stations to support the higher number of mobile subscribers and to meet their huge amount of data demand. This rapid and radical deployment of cellular base stations throughout the world has significantly increased energy consumption, resulting in decreasing the fossil fuel reservation and emitting harmful greenhouse gasses. As referred to, cellular base stations are the main parts of the telecom industry which consume around 57% of the total energy. Authors in estimated that the amount of energy consumed by the telecommunication industry was 519 TWh in 2019, and this value is increasing at a yearly rate of 10%. Moreover, the international energy agency reported that global energy is expected to increase by around 27% from 2017 to 2040, which is equivalent to 3743 million tons of oil. As a result, an average of 1.4% per year and around 2-2.5% of worldwide greenhouse gas discharges are caused by the information and communication technology (ICT) sector. It is also estimated that the emission of carbon-dioxide (CO 2 ) will rise around 6% per year and the annual electricity bill for the mobile industry will raise $10 billion. Due to the aforementioned facts, telecom network operators are always trying to find out the alternative source of environment-friendly and cost-effective energy. As a consequence, harvesting energy from the locally available renewable energy sources has become one of the major concerns of academia and researchers. Renewable energy sources such as solar, wind, biomass, hydro, geothermal, etc are reusable and widely available in many places throughout the world. Moreover, a huge amount of energy can be harvested from renewable energy sources with the help of modern technology by minimizing cost. Being inspired by the potential benefits of renewable energy sources, telecom operators are progressively installing cellular BSs powered by the locally available RES. Despite the potential benefits, there are some challenges of harvesting energy from renewable energy sources due to the dynamic nature of RES and its dependency on the condition of weather. Moreover, the use of renewable energy in the telecom industry may cause a shortage or outage of energy that may arise due to the intermittency nature of RES. The shortage or outage of energy is not allowed in the telecom industry which may degrade the continuity of power supply and reliability. However, the reliability of the renewable energy-based supply system can be ensured in the following ways: (i) by integrating the renewable energy sources with the non-renewable energy source, (ii) by integrating different types of renewable energy sources, and (iii) by integrating the renewable energy source or sources with the adequate energy storage devices. Bangladesh is a tropical and fourth rice-producing country in the world which is located between 33 and 39 N latitude and between 124 and 130 E longitude. The main renewable energy sources of the country are solar, wind, hydro, biomass (agriculture residue), geothermal, etc.. As a tropical country, Bangladesh has enough potential to harvest a huge amount of green energy from the sunlight. The average sunlight intensity of the selected location is 4.59 kWh/m 2 /day. Authors in reported that the country can harvest around 70 PWh electrical energy per year with the proper modeling of the solar PV system. In the meantime, the average wind speed of the selected location is 7.48 m/s that is sufficient for harvesting energy by the wind turbine. Additionally, the country has started generating electricity using biomass resources on a small range but most of them are used for cooking and boiler purposes only. As referred to in, Bangladesh has approximately 90.21 million tons of biomass available whose energy potential is 1344.99 PJ equivalent to 373.71 TWh of electrical energy. Reference also mentioned that with the help of modern technology, the country can harvest around 7682 GWh electrical energy from the biomass resources with a total capacity of 1066 MW in 2030. In today's world, energy-efficient cellular networks are highly desirable for developing a sustainable green mobile communication not only for the reduction of energy consumption but also for environmental considerations, such as the reduction of greenhouse gas. It is a collective expression that can be used to explain how much energy a network uses, what the network currently uses the energy for, where the energy comes from, what impact it has on resource depletion, economy and environment, and what a network can do to reduce its consumption of energy and its unwanted consequences. As referred to in, the energy efficiency of the wireless network can be improved by integrating various technologies such as energy-sharing, resource allocation, spectral-sharing, device to device network, load balancing, ultra-dense network, and cell zooming. On the other hand, the sustainability of the network can be ensured by introducing a hybrid supply system and a proper energy co-operation management system. For improving energy efficiency and ensuring long-term sustainability, authors in proposed an energy-aware resource management technique where the heterogeneous networks (HetNets) are progressively powered by a hybrid supply system. However, the energy sustainability and OPEX savings of the cellular network can be attained by enhancing energy efficiency and incorporating a dynamic traffic/energy management system as stated in. The major concern of this work is to develop a hybrid solar PV/WT/BG focused supply system for powering the macrocellular network in Bangladesh considering the dynamic profile of renewable energy sources and traffic intensity. The selected area of this work is Patenga under the Chittagong Division of Bangladesh whose geographical position is 22 15 14" North, 91 48 21" East. To the best knowledge of authors, we are the first to develop the energy efficiency analysis integrating load-balancing scheme and energy cooperation policies for the envisaged green wireless networks. The major contributions of this work are summarized below To determine the optimal system architecture and techno-economic (i.e., energy yields and net present cost evaluation) feasibility of the hybrid solar PV/WT/BG system using HOMER optimization software endeavoring a green cellular network. To evaluate the effectiveness of the energy-sharing mechanism for saving energy by maximum utilization of renewable energy sources. Particularly, we analyzed and developed the inter base station energy-sharing algorithm via a low loss resistive power line for off-grid condition and energy-trading policy with the electrical grid system for the grid-tied system. Based on the heuristic algorithms, we further analyzed the system reliability by means of loss of power supply probability (LPSP) term and energy-saving in terms of sold energy to the grid. To examine the performance of the proposed framework in terms of spectral efficiency, energy efficiency, and outage probability metrics of the user equipment under various system configurations (e.g., channel bandwidth, channel quality indicator) employing extensive Monte-Carlo simulation, taking into account uneven incoming traffic intensity, inter-cell interference, shadow fading, etc. A promising load balancing policy is developed for efficient utilization of resource blocks allocated in a cluster aiming at further energy-saving and enhancing the throughput with guaranteed quality of services (QoS). Afterward, spectral efficiency and outage probability metrics are assessed for different channel quality indicators (CQI) factor (i.e., in the form of physical resource block allocation) and channel bandwidth. To the end, a comprehensive feasibility comparison with other existing frameworks is conducted in the forms of greenness measurement (i.e., atmospheric pollutions) and economic factors for further validation. In addition, the collateral challenges and research opportunities are discussed for future works. The rest of the paper is oriented as follows: Section 2 includes the literature review. Section 3 highlights the system architecture along with the mathematical modeling of the major system components. System implementation and cost modeling are presented in Section 4. The results and discussions of the proposed system are demonstrated in Section 5. Finally, Section 6 concludes this article by summarizing the key outcomes. Literature Review Numerous research works have been conducted to find a long-term sustainable, reliable, and energy-efficient supply system using locally available renewable energy sources. Some of the researchers recommend the combination of different renewable energy sources or non-renewable energy sources with renewable energy sources, while others suggest the integration of the electrical grid system with renewable energy sources or a single renewable energy source with sufficient energy storage devices. Authors in have introduced a stand-alone solar PV powered green cellular base station, along with an adequate battery bank. In these works, the technical criteria and economic feasibility of the stand-alone solar PV system are critically analyzed considering the dynamic profile of the solar intensity. Due to the use of a single energy source, the shortage or outage of energy may arise in the case of a solar PV powered cellular networks. Hence, References proposed the integration of renewable energy sources with the non-renewable energy source such as a solar PV system with diesel generator (DG) system for powering the off-grid cellular network. The key challenges and optimal solutions are critically analyzed by simulating the system under different network configurations using HOMER optimization software. As a result, Huawei technology has already installed a diesel generator focused hybrid system for powering the off-grid cellular network in Africa and the Middle East. The integration of DG with the solar PV system can overcome the single renewable energy source related problems but the transportation of diesel is quite challenging in many places, and the burning of diesel emits toxic CO 2. The combined utilization of different renewable energy sources such as solar PV with wind turbine and solar PV with a biomass generator based supply system has been recommended by the researchers as presented in. The optimal sizing, energy issues, economic issues, and greenhouse gas emissions are thoroughly investigated for developing a green cellular network aiming to minimize the per unit electricity generation cost. Moreover, the authors examined the performance of the wireless network in terms of throughput and energy efficiency taking into account the tempo-spatial variation of traffic intensity. Being inspired by the potentials of renewable energy, Ericsson has developed a wind energy-based hybrid supply system for green-powering the cellular BSs of off-grid areas. In the urban areas of Germany, Nokia Siemens has also established a hybrid solar PV and wind energy focused cellular base stations. Reference, proposed a hybrid solar PV and PEM fuel cell-based supply system. Reference, investigated the technical criteria and economic feasibility of installing renewable energy and hydrogen-based power supply. The key challenges and potential solution of developing a hybrid solar PV and biomass gasifier based supply system for powering the off-grid residential areas in Bangladesh has been examined in. Recently, renewable energy sources are being integrated with the conventional electrical grid system for powering the cellular BSs at the optimal level. The electrical grid system emits a significant amount of greenhouse gas that damages the ozone layer and increases global warming due to the burning of a huge amount of fossil fuel. Authors in recommended a combined utilization of a solar PV system with the electrical grid system for enhancing the system reliability and ensuring the guaranteed continuity of services. Reference examined the potential of different renewable energy sources in Malaysia and proposed three types of integration: (i) solar PV with electrical grid, (ii) solar PV and wind turbine with the electrical grid, and (iii) wind turbine with the electrical grid. In these papers, the optimal criteria and main challenges of utilizing the maximum renewable energy and possible solutions are addressed to minimize the grid pressure and greenhouse gas emissions. Nowadays, modern cellular BSs are inter-connected to share the information to the control server, which will enhance the energy efficiency, spectral efficiency, and throughput performance of the wireless network. A lot of methods have been suggested by the researchers to improve energy efficiency and save energy though it is yet not saturated. A coordinated multipoint (CoMP)-based green cellular network has been proposed in that can substantially improve the spectral efficiency of the network by minimizing the inter-cell interference. However, the authors did not consider the energy efficiency issue. Authors in, proposed a hybrid supply system where all the off-grid BSs are connected through a low resistive line to share the power among the neighboring BSs. In this work, the energy-sharing policy among the BSs and optimal criteria are critically analyzed considering the intermittency nature of renewable energy under different system bandwidth and transmission power. To increase energy efficiency, the infrastructure sharing concept is presented in, where the same radio access network (RAN) will be shared by the multiple network operators. For getting the same benefit, authors in, introduced a smart grid infrastructure sharing mechanism. For improving the energy efficiency, Reference, proposed base station sleep mode provision, Reference, proposed a cell-zooming concept. Although the sleep mode provision and cell zooming technique have many potential benefits, the sleep mode provision is not feasible for populated areas and the implementation of the cell-zooming technique involves a lot of challenges. In this trend, the authors in proposed a distributed user association based load balancing algorithm to balance the load among the neighboring BSs. Reference introduces an empirical load-balancing algorithm that can be used to optimize the range of heterogeneous networks. Therefore, the load balancing techniques are used for redistributing the load among the active BSs and can benefit in various ways including effective application of frequency bands, improvement in coverage for cell-edge users, and percentage increase in overall system throughput performance. In these papers, the idea of load-balancing is employed for increasing the energy efficiency performance under optimal power supply scenarios. However, some of the above models fail to capture the load-dependent power consumption in BSs causing overestimations. Besides, many of them offered either very simple algorithms overlooking the real locations of users, or no algorithm at all. Figure 1 represents the schematic diagram of the proposed hybrid solar PV/WT/BG powered macro cellular network. It is mentioned that base stations are the DC load while some AC loads are also connected to the BSs such as AC lamp and air condition. The system essentially consists of a solar PV panel, wind turbine, biomass generator. For maintaining the continuity of power supply and enhancing the system reliability, a battery bank is connected to the supply system, which delivers backup power during the shortage or outage of RES. Moreover, a converter is needed to convert the AC into DC or vice versa. The mathematical modeling of the major components of the proposed system is presented below: Solar PV Panel Solar PV panels are arrays consist of series/parallel connected multiple solar cells to transform sunlight into electricity. The amount of solar energy generated by the solar PV panel is mostly affected by the location, materials/tilt of the solar panels, and energy-harvesting technology. Moreover, the internet of things (IoT)-based smart monitoring system can be incorporated to control the generated power of the solar PV system. The annual energy produced by the solar PV panel can be determined as follows where R PV is the express rated capacity for solar PV panel (kW), PSH means peak solar hour calculated from the average value, and PV is the panel efficiency. The monthly statistic of sunlight intensity and clearness index of the selected location are illustrated in Figure 2. Wind Turbine The electrical power generated by the wind turbine mainly depends on the speed of the wind, condition of weather, and the height of the turbine above the ground. The amount of power generated by the wind turbine can be estimated as follows where V is the average velocity of wind, C p is the coefficient of the Betz limit, and is monthly air density (kg/m 3 ). The monthly statistic of the wind speed of the selected area is shown in Figure 3. Biomass Generator The amount of energy generated by the biomass generator mostly depends on the average biomass availability (T BM ), the calorific value of the biomass (CV BM ), the efficiency of the biomass generator ( BM ), and BG running hours (t op ). The output power of the BG can be expressed as follows The annual energy generated by the BG can be estimated as follows where 0.248 is the capacity factor that determines the actual electricity generated per day. The average biomass available in the selected area is 9 t/day. The characteristics of the biomass generator are shown in Figure 4. Battery Bank The amount of back power supplied by the energy storage devices mostly depends on battery autonomy (B aut ). B aut determines the number of potential hours that the battery bank can supply without support from the RES and can be expressed as follows where N batt is the number of batteries in the battery bank, V nom is the nominal voltage of a single battery (V), Q nom is the nominal capacity of a single battery (Ah), B SOC min indicates the lower threshold limit of battery discharge and L BS is the average daily BS load in kWh. Moreover, the capacity of the battery bank (B c ) for providing the backup power up to t time can be expressed as follows where P BS is the BS power consumption, B DOD is the dept of discharge of the battery bank, D is the backup days, K b is the battery capacity co-efficient factor (K b = 1.4), and V is the DC bus-bar voltage (48 Volt). Battery lifetime is another important issue that affects the replacement cost of the entire project. The lifetime of the battery bank can be evaluated as follows where Q li f e is the lifetime throughput of a single battery (kWh), Q thp is the annual battery throughput (kWh/year), and B f is the battery float life (year). Electrical Grid Generally, the electrical grid is an interconnected system that is used for supplying power to the load. In this work, the proposed hybrid solar PV/WT/BG system has been connected to the utility grid system for sharing the excess electricity to the grid. Load Profile The proper dimensioning of the hybrid supply system mostly depends on the consumption of power by cellular networks. The total power consumption of a BS as a function of traffic intensity () is shown in Figure 5 and can be represented as follows where ∆ p is the load dependency power gradient, P 0 is the power consumption at idle state, and P sleep is the power consumption at sleep mode. The individual power consumption by the macro cellular BS under 10 MHz bandwidth is presented in Table 1. On the other hand, the key parameters of the BS are summarised in Table 2. Total power (W) 754.8 Table 2. BS power consumpton model parameters. BS Type Macro with RRH 6 20 84 2.8 56 The maximum power consumption of the base station is directly related to the associated loss component that can be determined as follows where DC, MS, and cool respectively represent the loss component of DC-DC regulator, main supply, and cooling system. On the other hand, N TRX is the total number of antennas in a base station and P TX is the maximum transmission power in W. The P BB and P RF are respectively the baseband and RF power consumption for the given 10 MHz transmission bandwidth. Loss of Power Supply Probability Loss of the power supply probability (LPSP) is used to measure the system reliability over the intended project duration. LPSP can be defined as the ratio of supply energy shortage to the total BS demand for a given period that ranges from zero to one. However, LPSP can also be designated as the loss of load probability (LOLP), load coverage rate (LCR), loss of power probability (LOPP) in some literature. Note that a higher value of LPSP signifies lower system reliability. In order to ensure zero outage as well as guaranteed quality of experience, sufficient excess energy should be reserved for backup supply during unexpected energy shortage. In this paper, the optimum design configuration is determined assuming the tangent of the partial derivative of RE supplies including storage devices with desired LPSP. The LPSP of the system can be projected as follows : where loss of the power supply (LSP) identifies the power shortage while the power supply fails to satisfy the load demand (P Tot < P BS ). Here, P Tot = P PV + P WT + P BM + P batt for a given period of time (t T). The higher values of LSP degrade the system reliability whereas the LPSP = 0 indicates the contemplated supply system can fulfill the BS energy demand entirely. Energy-Sharing Model In this subsection, a heuristic green energy-sharing technique has been proposed for ensuring the guaranteed continuity of supply by maximum utilization of renewable energy sources under different cases. In the case of the off-grid condition, the hybrid supply system can share green energy among the neighboring base stations. On the other hand, it can share energy to the electrical grid system for a grid-connected system. For both off-grid and on-grid conditions there arise three different cases which are as follow Case I: Generation is higher than demand (E Gen > E D ) If E Gen > E D, then the harvested green energy is sufficient to fulfill the BS's energy demand, and excess energy is stored in the battery bank for providing backup power and the remaining energy is used for sharing. Here, E Gen refers to the sum of energy generated by renewable energy sources (solar PV, WT, and BG) while E D includes both the energy demand for the base station and associated losses. In this case, there is no need for receiving energy from the other BSs and the loss of the power supply (LPS) will be zero as E Gen > E D. The generated, excess, and shared energy can be expressed as follows : where E Loss involves both the converter and battery losses. For an on-grid condition, it can share energy directly to the electrical grid system while for the off-grid condition, it can share energy to the neighboring needy BSs via a low resistive power line. If R is the resistance of the entire line, then the line losses (E Line ) for the time t can be estimated by the following equation where I is the current flowing through the transmission line, V is the DC 48 volt and P Share is the shared power. Hence, the total shared energy and average energy-saving by the inter BS sharing mechanism can be determined as follows E Share = P Share t r where N is the number of sharing BS, typically 19 for the two-tier configuration, and E BS is the required energy of i th BS. Case II: Generation is equal to demand (E Gen = E D ) If E Gen = E D, then the base station will be served by the generated green energy and backup power will be supplied by the battery bank, hence E Share = 0, and LPS(t) = 0. The reserved capacity of the battery bank (Bc) that is required for supporting the BS energy demand for t (in hours) time can be determined using. Case III: Generation is lower than demand (E Gen < E D ) If E Gen < E D, then the harvested green energy cannot fulfill the BS energy demand entirely. Hence, the BS will receive energy from the electrical grid system (for the grid-tied system) or the neighboring over generated BS (via the low resistive power line for the off-grid interconnected system) as mentioned in case I. In this case, the loss of power supply will arise. The LPS and the total amount of energy needed for the i th BS at time t can be estimated as follows where, E Need = E Grid for grid-tied system and E Need = E Share for off-grid system. For off-grid conditions, all the BSs are interconnected through a low resistive power line. Moreover, all the BSs are sorted according to the generated energy and traffic intensity as follows: where M is the number of the adjacent base station of BS i. Now, if the base station BS i,1 has sufficient excess energy then BS i can receive this green energy in the case of shortage or outage of energy. However, a needy BS i will search all the neighboring BSs to find out the over generated BSs to fulfill the required energy. If the base station BS i takes green energy from the neighboring base station BS i,M, the total amount of energy consumed from the neighboring BSs can be estimated as follows The algorithms of the green energy-sharing model for both off-grid and on-grid conditions are presented in Algorithms 1 and 2 respectively. In this algorithm, B c (t) is the energy stored in the battery bank, and B c (t)=1 indicates that the battery bank is fully charged. Algorithm 1 Algorithm of off-grid energy-sharing for i th base station BS i. Energy Efficiency and Outage Probability The throughput, spectral efficiency, and energy efficiency performance of the macro-cellular network are examined with the help of Matlab-based Monte-Carlo simulations under different network conditions. The key parameters for the Monte-Carlo simulation setup are obtained from. According to Shanon's information capacity theorem, total achievable throughput in a network at time t can be expressed by R total (t) = where N is the number of transmitting BSs, U is the total number of user equipment (UEs) in the network, and SI NR i,k is the received signal-to-interference plus-noise-ratio at k th UE located in base station BS i. In this paper, energy efficiency is defined as the ratio of total network throughput and total power consumed by the network. Thus, the EE metric denoted as for time t can be written as where P BS is the total power consumed in all the BSs at time t and can be calculated by using. The spectral efficiency determines how efficiently a limited frequency can be utilized in wireless communication. Spectral efficiency measures the data rate that can be transmitted over a given system bandwidth. The spectral efficiency of the wireless network can be expressed by the following equation The term 'outage probability' determines the probability of outage of the user equipment in the wireless network and it arises when the required data rate is less than the threshold level of the data rate. We consider that SI NR i,k is the threshold level of SINR for effective communication of UE from class j, then the outage probability of u th UE U u from j th class C j location in i th BS can be expressed as P j,out where Pr{U u ∈ C j } is the probability that user u is from class C j. Load Balancing Algorithm In this subsection, we propose a traffic-aware load balancing algorithm, which has the potential to exchange the peak traffic among the nearby base stations. An example of traffic-guided load balancing is shown in Figure 6. In this load balancing concept, all the nineteen BSs in a two-tier macro cellular network will be sorted according to their arrival of traffic rate. The higher traffic density BS will search the neighboring BSs to find out the lower traffic density BSs to shift the peak load (beyond the threshold value) to the neighboring lower density BS. This shifting of peak load increases the spectral efficiency and decreases the outage probability of the network. The detail of the load balancing algorithm is presented in Algorithm 3. The operation of the algorithm can be divided into two modes: firstly, the base stations are not allowed to shift the core zone load to the neighboring BSs. Secondly, if there is any high traffic density BS and the neighboring BSs can receive the load, the higher traffic density BS will shift the load to minimize the outage probability. Moreover, the amount of load received by the low traffic density BSs depends on their unused resource blocks and renewable energy generation. However, the load balancing has appealed much consideration as a talented way out for higher resource allocation, better system enactment, and reduced operational expenditure as well. Load balancing is an efficient technique for adjusting the load and relieving the congestion among the neighboring BSs. With the introduction of load balancing techniques, a cellular network can gain in different ways, such as the effective exercise of frequency bands, improvement in coverage for cell-edge users, and boost in overall network spectral efficiency and outage probability. Here, th is the threshold level of traffic intensity that can be efficiently carried out by the i-th base station BS i. In the load balancing algorithm, RB (resource block) is the smallest unit of resources that is assigned to the user. It is considered that at least one RB should be allocated for every user. On the other hand, multiple RBs are connected to a single user in the case of higher data demand and higher system bandwidth. Simulation Setup The optimal size and techno-economic feasibility of the proposed system are accomplished using the HOMER optimization software considering the 20 years project duration and 6.75% annual interest rate, which is the annual interest rate of Bangladesh. The architecture of the proposed system in the HOMER platform is shown in Figure 7a,b respectively for the on-grid and off-grid conditions. The seasonal DC and AC load profile of the macro BS under 10 MHz is shown in Figure 8a,b respectively. It is seen that the DC load is time-varying due to the dynamic nature of the traffic intensity. On the other hand, the AC load remains constant due to the continuous use of the AC lamp from 6 p.m. to 6 a.m. For macro with RRH base station, no cooling system is required. The technical parameters and their value for the HOMER simulation setup are presented in Table 3. Cost Modeling In this work, different types of costs can be evaluated using the HOMER optimization software under different network conditions aiming to minimize the net present cost. The net present cost (NPC) of the proposed model as a summation of capital cost (CC), replacement cost (RC), net present cost (NPC), operation and maintenance cost (OMC), fuel cost (FC), and salvage value (SV) can be expressed as follows where the total annualized cost (TAC) and capital recovery factor (CRF) is calculated by and, respectively. where L is the lifetime of the project and i is the annual real interest rate. The salvage value of the system can be calculated by where Rep, Rem, and Comp respectively are the replacement cost, remaining lifetime, and a lifetime of the component. For ensuring guaranteed continuity of services, a significant amount of expressed electricity is required that can be express as follows where E l comprises yearly losses of battery and inverter. The key consideration of this work is to maintain the loss of power supply probability zero by maximum utilization of RES. The main objective function of the hybrid solar PV/WT/BG system along with battery bank can be illustrated as follows minimize NPC (30a) where E BS is the annual BS load consumption as obtained from Table 1 and E batt is the energy afforded by the battery bank. E battmax and E battmin signify the maximum and minimum storage capacity of the energy storage devices. The constraint (30b) guarantees that the energy generated by the RES carries the annual BS consumption. The constraint (30c) represents that the total energy generation containing battery backup can satisfy the BS total energy demand and associated losses such. After fulfilling the BSs' own energy demand, a minimum of 10% of the additional energy is stored in the battery bank (excess electricity) for use in the critical condition and the other 90% energy is allowed for sharing, which is represented in constraint (30d). The constraint (30e) indicates that the battery bank storage capacity should not exceed the maximum limit and not reach below the threshold level. Results and Discussions In this section, the results of the proposed system are critically analyzed considering the following key parameters: (i) optimization criteria, (ii) energy issues, (iii) economic issues, (iv) energy efficiency issues, (v) outage probability, and spectral efficiency via load balancing, (vi) waste issues, and (vii) challenges and opportunities analysis. Moreover, the proposed system has been compared with other supply systems in terms of technical and economic feasibility for justifying the validity of the present one. Optimization Criteria The optimal size of different components of the proposed hybrid solar PV/WT/BG system is summarized in Table 4. The system has been simulated in the HOMER platform taking the dynamic behavior of traffic and renewable energy sources into account. It is identified that a higher value of the component size is required for the grid-tied system due to the higher amount of energy generation by the on-grid system for transferring the higher amount of energy to the electrical grid system which minimizes the capital cost and grid pressure. It is also seen that the optimal size of the components is almost the same concerning the system bandwidth, which implies that the proposed system can fulfill the BS energy requirement under different network conditions without changing the system component on a large scale. Table 4. The optimal size of the hybrid solar PV/WT/BG system. Energy Issues The annual consumed energy (DC and AC load), excess energy, and shared energy for the macrocellular network under 10MHz bandwidth are shown in Figure 9. On the other hand, the individual energy breakdown of the hybrid solar PV/WT/BG system for on-grid and off-grid conditions is presented in Figure 10a,b respectively. The data of this figure have been found considering the dynamic profile of the RES under 10 MHz bandwidth. In both cases, the wind turbine is the highest energy contributor, solar PV panel is the second-highest, and the biomass generator is the lowest energy contributor. Figure 10a also tells us that no energy has been consumed from the electrical grid system for utilizing renewable energy sources at the maximum level. The main objective of the electrical grid system is to sell the excess renewable energy and receive energy back in case of a shortage or outage of RES. The monthly statistic of the power production by the different renewable energy sources and power contribution by the electrical grid system is separately presented in Figures 11 and 12. In line with our speculation, the ideal renewable energy sources i.e., solar PV and wind turbines contribute a higher amount of energy throughout the year. On the other hand, the biomass generator contributes a lesser amount of energy due to the optimal use of renewable energy. The proposed system can minimize the capital cost and carbon contents as the wind turbine generate a higher amount of energy in all conditions. However, the energy generated by the wind turbine requires a minimum amount of wind speed, which is not available throughout the year. During the time of lower wind speed and lower solar intensity, biomass generator provides additional power to maintain the continuity of the power supply. In this way, solar PV, wind turbines, and biomass generators complement each other. An extensive comparison of the annual energy generated by the different sources under various system bandwidth is shown in Figures 13 and 14. The detailed calculation of annual energy generated by the solar PV panel, wind turbine, and biomass generator for 10 MHz bandwidth is given below: As referred to in Table 4, the optimal size of the solar PV panel for the grid-tied system is 2 kW under 10 MHz bandwidth. The annual generated energy is estimated using as follows: 2 kW 4.59 0.9 365 days/year = 3015.63 kWh. Moreover, due to the two-axis tracking mode, this value will be 4324 kWh. The optimal size of the wind turbine is 1 kW and the generated electricity is 8902 kWh as obtain from for the operating time of 7748 h per year. The optimal size of the biomass generator is 1 kW. The running hours of the BG are 2813 h per year (7.707 h per day) and the consumed bio-feedstock is 1.60 tones/year as obtaining from HOMER simulation. Hence, the annual generated power is calculated using as follows: P BG = (1.60 t/year (T BM ) 3411.33 KCal/Kg (CV BM ) 0.30 ( BG ) 1000)/(365 860 7.707 h (t op )) = 0.677 kW. On the other hand, the generated energy is estimated using as follows: E BG = 0.677 kW (P BG ) 365 24 0.248 (capacity factor) = 1472 kWh/year for macro BS, under 10 MHz bandwidth. In a similar process, the annual energy generated by the other system configurations are calculated. Bio-feedstock is the fuel of biomass generators. A higher amount of energy-harvesting from the biomass generator contains a higher volume of bio-feedstock consumption. The amount of bio-feedstock consumed by the hybrid solar PV/WT/BG system under different system bandwidth is presented in Figure 15. It is found that the grid-connected hybrid solar PV/WT/BG system consumed a greater amount of biomass than the off-grid system. More especially, the grid-connected system always generates higher energy than it is necessary. So, there is the provision to transfer the excess energy to the electrical grid system which subsequently minimizes the grid pressure and capital cost by maximum utilization of RES. The total number of battery that is required for both on-grid and off-grid condition is 64: connected as 8 in series and 8 in parallel to support the load demand of the base station during the deficiency of RES. In this work, the "Trojan L16P" battery has been selected due to superior characteristics of charging and discharging rate. HOMER determines the battery bank autonomy 162 h for 10 MHz bandwidth which is calculated using. The annual throughput and autonomy of the battery bank under different network configurations are presented in Figure 16. According to the, the throughput value of the battery is directly proportional while the battery autonomy is inversely proportional to the BS energy demand. Hence, the higher system bandwidth exhibits a lower value of battery autonomy and a higher value of battery throughput. However, the reliability of the renewable energy-focused supply system can be increased by proper modeling of the battery bank and by controlling the charging and discharging rate of the battery bank. On-grid Condition: Figure 17 represents a monthly statistic of energy sold to the electrical grid system using the energy-sharing mechanism. In line with our expectation, the grid-connected hybrid solar PV/WT/BG system can transfer a significant volume of renewable energy to the electrical grid system after fulfilling the required energy demand of the macro BSs. The amount of sold energy for different system bandwidth is demonstrated in Figure 18. It is seen that the curves of both the sold and excess energy are downward in trend because of the higher amount of energy consumed by the BS in higher system bandwidth. It is also remarkable that the sold energy curve stays above the excess energy curve which implies that the proposed system has sufficient generation capacity and a greater amount of energy is transferred to the electrical grid system and a small portion of the energy is used for pack up protection. However, the generated energy can perform three functions: (i) a major portion of the generated energy is essential to fulfill the BS's load requirement, (ii) some amount of excess energy is stored in the battery bank to back up the system in the time of shortage or outage of renewable energy, and (iii) the remaining amount of energy is transferred to the electrical grid system for ensuring the continuity of power supply by maximum utilization of renewable energy sources. Off-grid Condition: For the off-grid condition, we have planned to keep all the BSs connected through a low resistive power line as shown in Figure 19. The purpose of this interconnection is to send excess energy of a BS to the neighboring needy BSs or to receive excess energy from other BSs. The resistance of the power line is found from the American Wire Gauge (AWG) standard conductor size table. The inter-site distance (ISD) is calculated as √ 3 times of cell radius (i.e., √ R) and the cell radius is 1000 m for P TX = 20 W. The total resistance of the transmission line between the two BSs is 5.67. This inter-BS energy-sharing process enhances the continuity of power supply and ensures the optimal use of renewable energy sources. The amount of shared energy and subsequently saved energy for different system bandwidth is presented in Table 5. Numerical results depict that 793.07 kWh energy can be shared annually by applying the inter BS energy-sharing technique, and thus saves around 15.13% energy under 10 MHz bandwidth. Moreover, the performance of the sharing mechanism can be improved by reducing the resistance of the power line as summarized in Table 6. A throughout comparison of transferred energy for the different values of line resistance is illustrated in Figure 20. All the shared energy curves follow a similar pattern of decreasing nature which signifies that a lower value of line resistance can transfer a higher amount of energy. Figure 19. Energy-sharing among the neighboring BS for the off-grid condition. Economic Issues In this subsection, different types of costs that are associated with the hybrid solar PV/WT/BG system are evaluated using HOMER optimization software to develop a cost-effective hybrid supply system. The critical analyses of these types of costs have been carried out considering the dynamic nature of renewable energy sources under different network configurations. The summary of the nominal cash flow of the hybrid solar PV/WT/BG system for the on-grid and off-grid system is sequentially shown in Figures 21 and 22. The summary has been extracted from the HOMER software by simulating the system under 10 MHz bandwidth. It is observed that the battery bank in comparison with other types of components incurs a higher amount of cost for both on-grid and off-grid systems due to the smaller lifetime of the battery as compared to the project duration. It is also observed that the off-grid system involves higher NPC value through a greater amount of excess energy that can be sold to the electrical grid system which subsequently minimizes the net present cost by maximizing renewable energy utilization. An extensive comparison of the net present cost for the different network configurations is demonstrated in Figure 23. All the NPC curves increase linearly with the increment of system bandwidth to cope up with the higher energy demand. Additionally, the NPC curve for the off-grid system rises above the on-grid system which implies that the energy-trading policy to the electrical grid system can significantly minimize the capital cost. In the case of the off-grid system, a small amount of energy can be transferred, if the neighboring base stations are connected through a low resistive power line. The energy-trading policy for both on-grid and off-grid systems are extensively analyzed in this work for maximum utilization of renewable energy sources and enhancing the system reliability. Figure 24 illustrates the quantitative comparison of the per-unit energy generation cost for the proposed system under different network configurations. In line with our expectation, a lower value of energy generation cost is found for the higher system bandwidth. Moreover, the energy generation cost is higher for the off-grid system than the on-grid system due to the higher amount of NPC involvement in the off-grid system as mentioned earlier. Figure 17 shows the monthly statistic of sold energy and Figure 18 shows the sold energy under different system bandwidth. By selling the excess energy to the electrical grid system, the proposed system can return around $7200 per year according to the data found from Figure 18. However, the grid-tied solar PV/WT/BG system can transfer a greater amount of renewable energy to the electrical grid system which will decrease the energy generation cost and grid pressure. Energy Efficiency Issues The throughput and energy efficiency performance of the wireless network under different system bandwidth are respectively shown in Figures 25 and 26. These performance metrics have been evaluated considering the two-tier LTE cellular network with 19 base stations in hexagonal shape as shown in Figure 19. The throughput denotes the number of bits transmitted per second. On the other hand, the term 'energy efficiency' is used to measure the number of bits transmitted per watt, which is expressed as the ratio of total throughput to the total power required by the base station. It is always desirable to develop a system which provides sufficient throughput and energy efficiency performance. Figure 25 depicts that the proposed system has sufficient throughput performance and it is similar to the dynamic traffic intensity profile of Figure 5. Moreover, a better value of throughput performance is found for higher system bandwidth due to the higher amount of energy demand. According to, energy efficiency is directly proportional to the throughput performance of the network. As a consequence, energy efficiency curves increase with the increment of system bandwidth as demonstrated in Figure 26. Outage Probability and Spectral Efficiency via Load Balancing In a cellular network, voice is the major part of the data demand. The maximum number of voice over LTE (VoLTE) users that can be carried by the wireless network depends on various factors such as physical resource blocks (PRBs), channel quality indicator (CQI), system bandwidth (BW), SINR, etc.. The maximum number of the simultaneous users (N su ) that can efficiently be supported by the network is calculated as: (Number of Available PRB)/(Number of PRB per VoLTE call) 20. According to, the number of required resource blocks and carried VoLTE users under different system bandwidth and CQI are summarized in Table 7. However, a base station can support a specific number of users/traffic based on the designed parameters. If the users/ traffic rates increase beyond this value, the performance of the network may decrease. For instance, with the increment of traffic intensity beyond the threshold value, the spectral efficiency of the network decreases, and the outage probability of the network increases. To overcome these problems, load balancing is an efficient technique. By proper modeling and implementing the load balancing technique, the spectral efficiency performance of the wireless network can significantly be improved as shown in Figure 27, where 0% shifted load indicates the spectral efficiency and outage probability of the network without applying the load balancing technique. Figure 27 implies that a 5% shifting of peak load to the neighboring low-density base station can improve the spectral efficiency up to around 4%. An extensive comparison of outage probability of the wireless network for with and without load balancing technique is shown in Figures 28-30 under different network conditions. All the figures have been drawn by shifting the load from 0% to 5%, where shifted load 0% means without load balancing and shifted load greater than 0% means by applying load balancing. Figure 28 represents the outage probability for three different additional users (additional users are 25, 50, and 75) beyond the standard user of CQI = 7 and BW = 10 MHz which is mentioned in Table 7. The outage probability for different CQI is presented in Figure 29 under 10 MHz bandwidth. On the other hand, Figure 30 outlines the outage probability for different system bandwidth under CQI = 7. All the curves follow a similar pattern of the downward trend which implies that balancing the load among the neighboring lower density BSs can significantly reduce the outage probability. To the end, Figure 28 has been drawn to find out the effect of additional users, Figure 29 has been drawn to calculate the effect of CQI, and Figure 30 has been drawn to observe the effect of system bandwidth on the simultaneous users. For all the cases, a better value of probability has been found by applying the load balancing technique. Waste Issues The sustainability of green mobile communication can be enhanced by controlling the waste of the supply system and telecommunication equipment. In this subsection, the waste of the proposed hybrid solar PV/WT/BG system is extensively evaluated for both on-grid and off-grid conditions. On the other hand, the waste of the proposed system is compared with other supply schemes in terms of CO 2 as presented in Section 5.8. As an ideal renewable energy source, solar PV and wind turbines do not contribute to the emission of any carbon contents though a small amount of carbon content is released by the biomass generator due to the processing of biomass. The details of the waste emitted by the biomass generator are presented in Table 8. With the advancement of new technology, this waste can be kept at a negligible range. The negative sign of the emissions in Table 8 implies that a grid-connected solar PV/WT/BG system can significantly minimize the carbon footprints by sharing the excess green energy to the electrical grid system. Moreover, the proposed system can save the environment indirectly by reducing the burning of rice husk (the main source of biomass) for cooking and boiler purposes as shown in Table 9. However, the generation of carbon dioxide is directly related to the operating hours of the biomass generator. The amount of carbon dioxide emitted by the BG as a function of BG running hours is presented in Figure 31. Challenges and Opportunities Analysis The hybrid solar PV/BG/WT-powered green cellular network with energy-sharing and load balancing technique has many potential benefits but the implementation involves a lot of challenges. The key challenges and the possible solutions are listed below: The implementation of a hybrid solar PV/WT/BG system involves a greater amount of wind speed, biomass resources, water, and land, which may not always be available in many countries. As tropical and fourth rice (the main source of biomass) producing country, Bangladesh has enough potential to harvest energy from the solar PV and biomass resources. Besides, the selected location has sufficient wind speed throughout the year. The implementation of a hybrid solar PV/WT/BG system may require the release of a negligible amount of carbon footprints due to the processing of biomass. With the advancement of modern technology, the higher volume of carbon footprints can be confined to a lower value. Moreover, the biomass generator indirectly reduces carbon footprints by minimizing the burning of rice husks in cooking and heating in Bangladesh. The implementation of a hybrid solar PV/WT/BG system includes a huge number of energy storage devices for providing sufficient backup power in case of a shortage or outage of renewable energy sources. This problem can be overcome by integrating the electrical grid system with the hybrid solar PV/WT/BG system or by establishing inter-connection between the BSs via a low resistive power line in the case of off-grid conditions to facilitate sharing of power among the neighboring BSs. The implementation of the inter BSs energy-sharing technique requires to trace the actual energy consumed by the individual BS and energy stored in the storage device. This problem can be overcome by sharing the source and load information to the control unit or control server. The implementation of the load balancing technique also requires to trace the actual incoming traffic rate of the BSs. This problem can be solved by connecting the BSs to the control server where all the BSs will share their information with the control server and subsequently, the control server will sort the BSs according to the traffic density, transmission power, and stored energy. Feasibility Comparison An extensive comparison of optimal system criteria for the different types of hybrid supply schemes is presented in Table 10. These optimal criteria have been derived by simulating the macro-cellular BS under 10 MHz bandwidth considering the average value of solar intensity, wind speed, and available biomass resources of the selected location. From the data, it is concluded that the hybrid solar PV/WT provides better performance and the hybrid solar PV/DG system has poor performance among the different supply schemes. In contrast, our proposed hybrid solar PV/WT/BG system exhibits a satisfactory level of performance. Moreover, the proposed system has a higher green energy generation capacity than other systems which can also transfer a higher amount of energy to the electrical grid system by ensuring the maximum utilization of renewable energy sources. In the end, a hybrid solar PV/WT/BG system is an attractive solution for developing green mobile communication considering the geographical location of Bangladesh. Conclusions The fundamental goal of this work is to develop a sustainable, reliable, and energy-efficient cellular network by utilizing the locally available green energy sources by minimizing a considerable amount of both the net present cost and greenhouse gas emissions. Extensive simulations are carried out to develop effective ways of ensuring maximum utilization of renewable energy and assessing the quantitative benefits of the proposed scheme along with energy-sharing mechanisms and sufficient energy storage devices. It is observed that the optimal use of harvested green energy with a fruitful energy-sharing mechanism has enough potential to fulfill the own energy demand of BSs maintaining the guaranteed continuity of power supply in both off-grid and grid-tied systems. For off-grid conditions, the inter-BSs green energy-sharing mechanism can save energy up to 2%. On the other hand, for the grid-tied system, the energy-sharing facility to the electrical grid can sell an average of 793.07 kWh energy per year, which can reduce the grid pressure and save capital cost around $7194/year. The simulation results show that the energy storage systems can carry the load demand for around 162 h without any external sources, which is enough time to fix the renewable energy sources. Though the hybrid solar PV/WT/BG system releases a small number of carbon footprints, the biomass generator acts as a sustainable waste management system by reducing the burning of biomass (agriculture residue) for cooking and heating purposes. The proposed system exhibits a satisfactory level of throughput, energy efficiency, and spectral efficiency performance that are extensively analyzed considering the tempo-spatial variation of traffic intensity and system BW. Moreover, the spectral efficiency and outage probably of UEs are thoroughly investigated under different system conditions such as different user conditions, different CQI, and different transmission bandwidth. Numerical results demonstrate that the integration of load balancing provides better spectral efficiency and outage probability as compared to those without load balancing condition. In summary, the proposed renewable energy-focused hybrid supply system along with the proper balancing of the load among the neighboring BSs can improve the outage probability of the user equipment and the green energy-sharing mechanism can overcome the loss of power supply probability. Countries like Bangladesh are in dire need of establishing such a hybrid power system to meet the increasing energy demand, save the environment, and ensure continual services to the users. Finally, the hybrid solar PV/WT/BG system is an attractive solution to develop a sustainable green mobile communication in Bangladesh for her position as the tropical and fourth rice-producing (the main source of biomass) country in the world. Conflicts of Interest: The authors declare no conflicts of interest.

Randomized trial of cognitive behavior therapy versus supportive psychotherapy for HIV-related peripheral neuropathic pain. The feasibility and acceptability of cognitive behavior therapy for HIV-related peripheral neuropathic pain was examined and the potential efficacy of the intervention was compared with that of supportive psychotherapy in reducing pain, pain-related interference with functioning, and distress. Sixty-one patients were randomly assigned to receive six weekly sessions of cognitive behavior therapy or supportive psychotherapy. Thirty-three subjects completed the protocol. Both groups showed significant reductions in pain. The cognitive behavior group improved in most domains of pain-related functional interference and distress; the supportive psychotherapy group showed fewer gains. The high dropout rate suggests that psychotherapeutic treatments for HIV-related pain may have limited feasibility and acceptability.

Acute thrombotic thrombocytopenic purpura in Louisiana: Seasonal distribution and evaluation of an ADAMTS13 order screening protocol Thrombotic thrombocytopenic purpura (TTP) is a lifethreatening disorder caused by inactivation of ADAMTS13. It is characterized by thrombocytopenia and microangiopathic hemolytic anemia. Previous studies have produced conflicting data regarding seasonal association of TTP diagnoses. This study evaluated the seasonal distribution of acute TTP in southern Louisiana. Additionally, this study timeline overlapped with the initiation of a new screening protocol for ADAMTS13 testing.

Brad Paisley Lost a Bet to Ludacris ... and It Cost Him Big! Brad Paisley Lost a Bet to Ludacris … and It Cost Him Big Time! Brad Paisley was forced to open up his wallet to fellow 'Rising Star' judge Ludacris after losing a bet -- he had to pay up in the form of a really expensive bottle of cognac. Although it's unclear what the bet was actually about, two things are very clear: the country star lost, and he had to shell out some big bucks to keep up his end of the deal. Paisley shared a video on Instagram with his fans, warning them, "Don't make bets with rappers. They're very expensive." In the clip, the camera pans to the famous red box, with Louis XIII de Rémy Martin looking beautiful and very expensive in its sparkling glass decanter. After a few angles of the costly prize, the video shows Ludacris, who jokes, "Man, you better not have poured Hennessy in this thing." The cognac Paisley bought for the rapper runs for $2,100 -- but he got off easy. The alcohol can run up to $44,000! Yikes! That would have been a pretty brutal loss. According to Paisley's tweet on Saturday, Ludacris was supposed to wear the country star's cowboy hat on 'Rising Star' if he were to lose. "If you ever see @ludacris wearing my cowboy hat on @RisingStarABC you will know he lost the bet I made with him," said the singer. It seems Paisley's winnings would have been less expensive, but possibly more humbling. The 'Whiskey Lullaby' singer is currently the judge on ABC's new show 'Rising Star,' along with the rapper and pop singer Kesha. In addition to his time on the small screen, Paisley is working on a forthcoming new album called 'Moonshine in the Trunk,' which streets Aug. 26. See Brad Paisley as a Little Kid!

Integration of the CYMDIST RT-LAB Platforms for the Real Time Analyze of Distribution Networks Nowadays, one of the main challenges of electrical distribution companies is becoming part of the era of intelligent networks with computer systems developed in parallel with the electrical needs to obtain the entire distribution network simulations and models. The concept of automation must be implemented to carry out the planning, operation, and optimization processes of the behavior of the distribution networks. Thanks to this development, since 2004, the implementation of the simulation and the CYMDIST modeling system in Ecuador's electrical companies has been possible; nevertheless, with certain dynamic limitations in real-time. Therefore, this document presents the development of an interface that integrates the RT-LAB real-time simulation software to the CYMDIST environment, using the 34 node IEEE model. This proposed integration model will allow evaluating and validating the correct communication between the computer packages and examining the behavior of the proposed system under certain test scenarios that guarantee optimal performance by performing a load flow analysis that provides magnitude and angle values both in voltage and current. The results obtained were very close in levels of precision of the model, and it can be appreciated employing the proposed graphical interface. Furthermore, with this investigation, the possibility remains open for future investigations in which it is complemented with more detailed and complex analyzes. Keywords CYMDIST; RT-LAB; simulations; real-time; interface; communication. Manuscript received 12 Oct. 2020; revised 10 Mar. 2021; accepted 11 Apr. 2021. Date of publication 31 Dec. 2021. IJASEIT is licensed under a Creative Commons Attribution-Share Alike 4.0 International License.

Effect of Compost on Soil Properties in Dallas, Texas Compost derived from landscape debris was incorporated into seven different soils in the Dallas, Texas area at variable rates. Treatment levels for each of the 3.34 m2 quadrats were compost depths of approximately 0.0, 2.5, 5.0 and 7.5 cm. Composted plots were evaluated for two years to quantify differences in infiltration rate, moisture content, coefficient of linear extensibility (COLE), pH and salinity relative to control plots. Substantial differences in soil properties between sites barred comparison between sites. However, significant site-specific differences between control and treatments were observed. Infiltration rate was more strongly affected by soil texture, soil mineralogy, and climatic effects than by the addition of compost. Compost incorporation may provide a significant reduction in COLE values, but not necessarily to levels below the very high shrink/swell class. Soil water content significantly increased with elevated levels of compost in the Austin, Eddy, and Brackett soils. Incorporated landscape compost does provide quantifiable benefits to soil physical properties on certain soil series in the Dallas area.

Boris Johnson is a loose cannon, but why don't we let police use the hoses instead? Boris Johnson is a loose cannon, but why don’t we let police use the hoses instead? POLITICIANS, especially those with a blue hue, like to tell us that our hard- earned money is safe in their hands. But it isn’t. Boris Johnson, for example, decided that he would like to build some cycle lanes in London so that adults could ride around the capital on their children’s toys. He was told the scheme would cost £900million and instead of saying: “Don’t be ridiculous, that’s ten times more than it cost to do the same thing in Chicago,” he said: “Sounds reasonable.” And the idiotic project got the green light. Then you have the council in Oxford that thought it was perfectly sensible to spend £10million shrinking two roundabouts. And their opposite numbers in Cambridge who blew half a million on a so-called “ghost round-about” which should have cost two grand tops. And now comes news that when he was Mayor of London, Boris — yup, him again — bought three water cannons at £28,000 a pop, even though it’s illegal for the authorities to actually use machines like this. Then, after they were delivered, someone suggested that it would be a good idea to fit them with CD players and big sound systems. Well yes, it would, because as we know from Apocalypse Now, if you play music loud when you go into battle with the enemy, “it scares the hell out of them”. But no. The music would only be played in the cab. So even though the occupants would have better things to do in the middle of a riot than to sit there listening to a collection of Barry Manilow ballads, Boris decided that it’d be £3,000 well spent. Then, nearly two hundred grand was somehow spent on maintaining these three glorified vans. Which is fairly astonishing given that they haven’t actually been used. The total bill so far for these vehicles has been £320,000 which, as my son — who’s working as a waiter at the moment — has worked out, equates to every penny he’ll pay in tax for the next 100 years. This week it’s been announced that they are to be sold, possibly for scrap, and that at best, they’ll fetch £6,000. I have a better idea, though. Why not let the police use them. At present, when those weird-beard halfwits lie down on the runway at an airport or in the middle lane of the M4, Plod has to sit around filling in forms until the protesters get bored. Or the weed wears off. And when there’s a proper riot it’s even worse, because the police get helmets and a shield and have to just stand there while everyone throws rocks at them. The safety and health diddums brigade say that being sprayed with a jet of water is very horrid and that a protester may fall over. I’ve actually been hit by a water cannon — it was for a television thing, I wasn’t actually putting some turf on Winston Churchill’s statue at the time — and it’s not nice, I admit. You do fall over and it’s very cold. But it’s a very effective way of bringing people to heel without actually breaking bones or filling them full of holes. Plus, we already have the damn things in a garage so it’d cost us nothing. Most importantly though, riots and stupid protests could be ended before they've really begun. I’VE spent the past year or so imagining that the Royal Air Force role in Iraq and Syria is to provide the tea and brass band music, while the Americans and Russians do all the actual flying stuff. However, at the always excellent Millies this week, below, I learned our boys have dropped four times more bombs over there than they did in the entire Afghanistan campaign. Our planes and our drones and our tankers are flying round the clock, providing air cover for whoever happens to be our allies on the ground at the time. I was amazed. And then I was even more amazed to learn that our smart weapons are so clever that pilots can choose which part of a fast-moving pick-up truck they’d like to hit. They can take out the weapon on the back or the engine, which won’t kill the people in the cab. Or they can steer the missile through the driver’s window and up his left nostril. NEW proposals say that husbands who refuse to pay their ex-wives’ divorce settlements should be banned from driving for 12 months. Well, I’m sorry, but I can’t see what one thing has to do with the other. That’d be like banning people from keeping a dog if they park in a disabled parking bay. Wouldn’t it be better to shame them instead? By forcing them to wear their underpants on the outside of their trousers until they cough up. APPARENTLY, there’s a show on television called Real Housewives – and this week, one of its stars went to some red carpet party in half a dress and stopped in front of all the photographers to kiss her pretty, 18-year-old daughter on the lips. And she’s a real housewife, is she? MY closest friend died last weekend after a horribly brief bout of extremely brutal cancer, and straight away his family was plunged into a world no one is ever properly prepared for. What happens to his bank account? How many death certificates do you need? How do you sell his car? Is it legal to keep his shotguns in the house? How are his pension schemes activated? The list goes on and on. And it made me wonder. If you are an old lady, living in a council flat in some Godforsaken hellhole and your husband dies, what do you do? You don’t have an accountant or a financial adviser. You don’t have a computer or Google. You don’t have an army of friends. It’s just you, in a jungle of bureaucracy and red tape and rules. So you have to get on a bus, grieving, and go into town to the Citizens Advice Bureau, which is almost always shut, then trudge home again to an empty flat which is filling up with forms you don’t understand. And Christmas is just a week away. It breaks my heart if I’m honest, so for the first time ever I’m going to make a New Year’s resolution. You go ahead and give up smoking or drinking or eating fat to try to prolong your life. But me? I’m going to sort out what happens when it ends. PRINCE HARRY, who is a young, heterosexual man, has a girlfriend, who is a young, heterosexual woman. Not sure I can add any more to this. BAFTA announced this week that it will no longer give awards to films which don’t feature people from minority groups. Yup. If you want to win a gong for making an outstanding British film, or on your debut as a writer or director, you’d better make sure your movie is about slavery or Aids. Or preferably both. This means Gone With The Wind or Brief Encounter would be excluded. Naturally, this has caused all sorts of normal people to roll their eyes and sag their shoulders and point out that Soviet behaviour like this should have ended when the Berlin Wall came down. But I’ll let you into a little secret. Bafta has been using its liberal views to choose winners for years. The difference is that now, they’ve owned up to it.

Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: A single-center retrospective study. Highlights Respiratory viruses were detected in 32% of Hospital Acquired Pneumonia. Virus/bacteria co-infection was associated with higher length of stay and mortality. We distinguished acute acquired viral infection and long-term viral carriage. Background Respiratory viruses (RVs) are known to constitute a large burden in community-acquired respiratory infections. With regards to nosocomial infections, RVs (excluding herpes simplex virus (HSV) and cytomegalovirus (CMV)) have traditionally been paid little attention, except in hematopoietic stem cell or solid organ transplant recipients. Although hospital-acquired pneumonia (HAP) is the second most common nosocomial infection in the developed countries and is associated with high mortality and morbidity, it has always been seen to be driven by bacteria, with no role of RVs. However, in a recent South Korean study 22.5% of cases of HAP were related to viral infections, and 59.5% to bacterial infections. This finding, showing a non-negligible role of viruses, can be explained by recent improvements in detection methods and needs to be explored further. Indeed, improvements in the sensitivity of detection techniques such as multiplex polymerase chain reaction (mPCR) have greatly enhanced the ability to detect RVs. However, data on the frequency and role of RVs in HAPs and especially their outcome are still scarce. Apart from influenza and respiratory syncytial virus (RSV), other viruses are not usually investigated because of weak evidence of their pathogenicity, lack of available treatment, and the high cost of mPCR tests. Furthermore, the role of viral-bacterial coinfection is still unclear in pneumonia and all of the few investigations using mPCR were conducted on community-acquired pneumonia presenting viral-bacterial coinfection and yielded divergent data on pathogenicity and prognosis [2,. Objectives We retrospectively reviewed all cases of HAP who underwent screening for RVs in patients admitted to or in an intensive care unit (ICU) between 2014 and 2016 in order to estimate the proportion of HAP associated with RVs, bacteria or viral-bacterial coinfection and to compare their impact on prognosis. Study population and data collection The study was conducted at the medical ICU of the Bichat-Claude Bernard Hospital, a teaching tertiary referral hospital in Paris, France. All medical records of patients who underwent mPCR assay for RVs during an ICU stay from May 1, 2014 to April 31, 2016 were retrospectively reviewed. Patients with community-acquired pneumonia or with a diagnosis other than pneumonia were excluded. Only adult patients diagnosed with HAP who underwent screening for RVs at the time of suspected pneumonia were included in the study. When multiple episodes of HAP occurred in the same patient, only the first episode was taken into consideration. Patients included were classified in one of the following four groups according to the microorganisms identified from specimens collected within 72 h after the diagnosis of pneumonia: virus only, bacteria only, virus/bacteria and no pathogens. Of note, the use of mPCR for respiratory virus screening in the ICU of the Bichat-Claude Bernard Hospital is not systematic and is left at physician's discretion. Its use that started in 2013 and was at first limited to immunocompromised patients has progressively expanded over the years. We compared characteristics of those who did not undergo screening for RVs to those who underwent and were included in the study. For this we identified the total number of HAP that occurred during the study period in the ICU using the primary diagnosis coded according to the Tenth Revision of the International Classification of Diseases (ICD10). Clinical, laboratory data including microbiological tests, and radiological findings at diagnosis of HAP data were retrieved from the patients' medical charts. Length of ICU stay after diagnosis of pneumonia and in-hospital mortality were collected and compared between groups. In order to differentiate hospital-acquired viruses from longterm viral shedding in patients with at least one virus found, all available mPCR tests performed during the same hospital stay before HAP diagnosis were retrieved. All definitions are detailed in Supplemental data 1. Laboratory data All patients enrolled in this study underwent bronchoscopy with bronchoalveolar lavage (BAL) or endotracheal aspirate (ETA). Other microbiological evaluations were performed at the physician's discretion. These evaluations may have included one or more sets of blood culture (gram stain and culture), culture and histological examination for the diagnosis of fungus, PCR for diagnosis of cytomegalovirus (CMV) or herpes simplex virus (HSV) in ETA or BAL fluid and screening for RVs on nasopharyngeal swabs or in ETA or BAL fluid. Microorganisms identified from specimens collected within 72 h after the diagnosis of pneumonia were considered as pathogens. Statistical analysis Patient characteristics and outcome are reported as numbers and percentages for categorical variables and as mean and standard deviation (SD) or median and interquartile range (IQR) for continuous variables. Data from the no pathogen group are not displayed. Inhospital and 28-day mortality and median ICU length of stay after HAP diagnosis in patients discharged alive were considered as outcome of interest and compared between the virus only, bacteria only and virus/ bacteria groups. The Kruskal-Wallis test and Fisher's exact test were used, as appropriate, for univariate analysis. There were no missing data. P values less than 0.05 were considered statistically significant. All statistical analyses were conducted using STATA software (V12, ©1996-2014 StataCorp, College Station, Texas, USA). Patient characteristics Among the 999 ICU patients who underwent an mPCR assay to test for RVs during the study period, 95 were considered to have HAP and were included in the study. During the same period, HAP were admitted or occurred in the ICU in 143 patients. Thus, screening for RVs was performed in 66% (95/143) of HAP patients. The characteristics of the 48 HAP patients not tested for RVs were similar to those of the 95 patients described in this study, except for immune status. Patients tested for RVs were more likely to be immunocompromised (47% vs. 19%, p = 0.001). Baseline characteristics are listed in Table 1. Respiratory viral pathogens Overall, 30 RVs were identified in 30 patients (30/95, 32%). None of these patients were infected with more than one type of virus. All viruses were detected from BAL fluid specimens or the ETA. Among the 30 patients, 22 underwent solely bronchoscopy with BAL, 6 underwent both bronchoscopy with BAL and ETA and two only ETA. Eleven patients also had a nasopharyngeal swab. Patients had a median age of 58 years (IQR 52-66), 73% had underlying conditions and 63% were immunocompromised. The median length of hospital stay prior to pneumonia was 17 days (IQR 9-36). Fifteen of the 30 patients with HAP (50%) and at least one RV identified had a mPCR prior to the HAP episode that was performed during the same hospital stay (Fig. 1). The prior mPCR was negative in seven patients (7/15, 47%) who underwent it on average 15 (Standard Deviation (SD) 6.4) days before HAP diagnosis. These patients were considered to have acquired RVs in the hospital. Their characteristics and outcomes are shown in Supplementary Table S1. Five of the cases occurred in ICU ventilated patients and two in non-ventilated patients from a long-term care facility. Identified viruses were RSV (n = 3), parainfluenza (n = 2), metapneumovirus (n = 1) and influenza (n = 1) and 4/7 cases were virus only infection. No grouped cases among these seven patients were identified. On the other hand, eight patients (8/15, 53%) had a prior positive mPCR on average 11 (SD 5.0) days before HAP diagnosis, with the same virus identified at the time of HAP diagnosis. These patients, all immunocompromised, were considered to be long-term carriers, infected in the community. Identified viruses were rhinovirus (n = 6) and influenza (n = 2) and all eight cases were coinfection HAP (viral- bacterial n = 4, viral-HSV-bacterial n = 1, viral-bacterial-Aspergillus n = 1 and viral-HSV n = 2), suggesting a potential role of some RVs in the occurrence of bacterial VAP in immunocompromised patients. Outcomes between groups (Table 1) The in-hospital mortality rate and 28-day mortality rate of all the included patients were 40% (38/95) and 42% (40/95), respectively, with a median (IQR) ICU length of stay after HAP diagnosis of 14 days in patients alive at discharge. Mortality rates were higher in the coinfected (virus/bacteria) group than in both bacteria only and virus only groups but the difference did not reach statistical significance (62% vs. 40% and 35%, p = 0.3 for in-hospital mortality; 62% vs. 42% and 41%, p = 0.45 for 28-day mortality). Discussion In this retrospective study conducted over two years in one teaching tertiary referral hospital in France, RVs were identified in 32% of 95 HAP patients admitted to or in the ICU who underwent respiratory mPCR testing. Influenza virus (27%), rhinovirus (27%) and RSV (17%) were the most commonly identified viruses. Patients concerned by viral HAP were more likely to be immunocompromised than those with bacterial HAP. Patients with virus/bacteria coinfection had a higher mortality, although this did not reach statistical significance, and a longer length of stay in the ICU than both the bacteria only and virus only groups. Our results regarding the proportion and the nature of RVs found are consistent with those presented by Hong et al. in their single-center study of 262 cases of severe HAP in Seoul, South Korea over a two-year period. In that study, 119 (45%) were immunocompromised, 251 (96%) patients were ventilated and RVs were identified in 22.5% of cases with a predominance of RSV, parainfluenza virus and rhinovirus. However, unlike Hong et al., the virus/bacteria group in our study presented a longer ICU length of stay and a trend to higher mortality rates than both the virus only and bacteria only groups. In the Hong et al. study, contrary to our study in which all patients underwent BAL fluid or ETA arguing in favor of their active role, only 41% (107/262) of patients had BAL performed and RVs were diagnosed on BAL fluid testing in 63% (37/59 patients). In community-acquired pneumonia, previous studies have reported the clinical interaction between influenza and S. pneumoniae or S. aureus as a major contributor to influenza mortality [2,. It is becoming clear that similar interactions may occur with other RVs, including RSV, human metapneumovirus, and possibly rhinovirus or parainfluenza virus. However, clinical evidence from prospective studies on the role of coinfection in severity is somewhat conflicting. In our study it should be underlined that all eight HAP cases with long-term shedding of community-acquired viruses involved immunocompromised patients with coinfection with other pathogens. Shedding of rhinoviruses for more than 4 weeks is not uncommon even in immunocompetent individuals and especially in patients with immunodeficiency in whom chronic rhinovirus carriage for as long as 4-12 months has been documented. The significance of rhinovirus detection in respiratory specimens from pneumonia patients is a subject of some debate. Some findings have demonstrated that rhinovirus infection alters the respiratory microbiome and may precipitate secondary bacterial infections in patients with COPD. We found a high rate (50%) of proven nosocomial HAP in patients who underwent a prior RVs screening during their hospital stay. Virus distribution, viral-bacterial coinfection rate, and patient prognosis differed greatly from long-term virus shedding cases. Our findings support the possible nosocomial transmission of various RVs and not only influenza and RSV in debilitated patients who have prolonged hospitalizations, and highlight the need for infection control measurements targeted at health care personnel and family members to control further hospital transmission. Several limitations of our work should, however, be acknowledged. First, this study was single-center and retrospective. Second, during the study period, mPCR testing for RVs was not systematic in the ICU, but was left instead to the clinician's discretion, which may have led to selection bias and to an underestimation of the total number of cases of HAP in admitted patients to the ICU or occurring in the ICU. We tried to overcome this issue by estimating the total number of HAP during the study period and comparing characteristics of patients with HAP who underwent RVs screening and those who did not. The group of patients who underwent RVs screening were more frequently immunocompromised. Third, the 48-h delay traditionally used for the definition of nosocomial cases is derived from data concerning bacteria. This delay may not be appropriate for RVs for which incubation and shedding data are still partial in these populations and can differ from one virus to another. Most authors agree to a median delay for symptoms of 2-7 days for all RVs. We used previous RV tests done before HAP diagnosis when available to try to overcome this issue. Finally, our study design prevented assessment of the pathogenic role of RVs. However, the fact that all RVs were obtained from BAL fluid or ETA argues in favor of their active role. In conclusion, in our setting, RVs were tested for in two-thirds of patients (mostly immunocompromised) admitted with HAP or with HAP that occurred in the ICU, and RVs were identified in 32% of them, of which 43% were respiratory virus/bacterial coinfection. The latter seems to be associated with poorer outcomes compared with bacteria only or virus only pneumonia. RVs found in HAP could be divided in two categories: (i) community-acquired viruses with chronic shedding (i.e. mainly rhinovirus) in immunocompromised patients, associated with other microorganisms at the time of HAP, and (ii) hospitalacquired viruses (RSV, parainfluenza, influenza and human metapneumovirus) in debilitated patients with prolonged hospitalization. Our retrospective data did not demonstrate a causal relationship between viral shedding and outcome, but emphasize the need for further systematic prospective studies to assess the temporality and consequences of both viral infections and viral/bacterial coinfection. Funding The current work received no fund. Competing interest The authors declare no commercial or other association that might pose a conflict of interest. Ethical approval The need for informed consent was waived in view of the retrospective observational nature of the study with no intervention performed. This study was conducted in agreement with French regulations on privacy and data collection and treatment and was approved by the Advisory Committee on Information Processing for Research (CCTIRS, authorization 16.788), the French Data Protection Authority (CNIL, declaration 2003604) and the local ethics committee.

Analytical Evaluation of Mobile In Situ Soil Nitrate Infrared Sensor Designs for Precision Agriculture One approach to improving nitrogen fertilizer use efficiency in crop production is to use infrared (IR) soil nitrate sensors to analyze soil nitrate and then spatially modulate fertilizer application rates. The most commonly used Fourier transform IR (FTIR) spectrometers are sensitive to vibration and hence not suitable for real-time measurements in agricultural fields when mounted on tractors that experience severe vibrations as they are driven across a field. In this paper, we propose IR sensor designs to address the vibration issues currently limiting the use of IR spectroscopy for precision nitrogen fertilizer management in agriculture. We evaluate the performance of different nitrate sensor configurations based on diamond attenuated total reflection (D-ATR) spectrometers, that do not have moving parts and less sensitive to vibrations than FTIRs. We study sensor configurations based on the following infrared light sources: commercially available tunable quantum cascade lasers (QCLs), thermal sources, superluminescent diodes (SLDs), and superlattice light emitting diodes (SLEDs). Performance of the different sensor systems is evaluated and optimized to achieve maximum signal-to-noise ratio (SNR). We also propose a sensing limit variable, S, to characterize different sensor configurations. The work presented in this manuscript provides design options for agricultural nitrate sensors that can be rugged in the field and collect spectral data at fast rates with high SNR.

Genetics of obesity in humans. Considerable attention has focused on deciphering the hypothalamic pathways that mediate the behavioral and metabolic effects of leptin. We and others have identified several single gene defects that disrupt the molecules in the leptin-melanocortin pathway causing severe obesity in humans. In this review, we consider these human monogenic obesity syndromes and discuss how far the characterization of these patients has informed our understanding of the physiological role of leptin and the melanocortins in the regulation of human body weight and neuroendocrine function.

A concert benefiting Pregnancy Resources of Abilene will begin at 6 p.m. Friday in the amphitheater at Abilene Christian University. Tickets are $10 at the door and $7 in advance. SAGERTON — The annual Sagerton Hee Haw will be presented at 8 p.m. Friday and Saturday at the Sagerton Community Center. Dinner will be served from 5:30-7 p.m., with music starting at 7 p.m. A dance featuring the Last Dance Band will be 7-11 p.m. Friday at the 201 Mesquite Event Center, 201 Mesquite St. Tickets are $12 at the door or $10 in advance. Admission is free for children age 11 and younger. Mary Preston will present an organ concert at 4 p.m. Sunday at First Central Presbyterian Church, 400 Orange St. Admission is free. STEPHENVILLE — Bronwen Forbay and Sharon Lavery will present a vocal and piano concert at noon Friday in Clyde H. Wells Auditorium at Tarleton State University. Admission is free. ► A family history discovery day will be open from 9 a.m. to 1 p.m. Saturday at the Church of Jesus Christ of Latter-day Saints, 3325 N. 12th St. Admission is free. For information, call 325-668-4223. ► Cheryl Carpenter will present a program on women's mental health at 11 a.m. Saturday at the south branch of the Abilene Public Library, in the Mall of Abilene. Admission is free. ► SWEETWATER — A dance featuring Men With Hats will begin at 8 p.m. Saturday at VFW Post 2479, 216 Avenger Field Road in Sweetwater. Admission is $10. The venue is temporarily alcohol-free.

Roy Williams is a retired dairy farmer and third-year graduate student in molecular and cellular biology at Dartmouth College. For most people in the U.S., dairy products provide about 600 calories per day, and 1/3 to ½ of our daily protein intake. As a former dairy farmer, I appreciate the challenges in producing the milk that provides for so much of our diet. As a current graduate student in genetics and molecular biology, I also appreciate the incredible advances in science, and the amazing improvements in technology in dairy farming over the last 70 years. Those changes have radically reduced the environmental footprint of dairy farming over the last 70 years. Today, the average American consumes almost as many dairy products as they did 70 years ago – although today, a lot of that milk is consumed as cheese, yogurt and ice cream. Today, U.S. dairy farms need only 8.5 million cows to produce more than twice as much milk as dairy farms did in 1940 with 26 million cows. My rough calculations suggest that the number of acres of land required for grazing, hay and feed for dairy farming today is probably no more than 40% of what was needed in 1940. Crops developed through genetic engineering have played a role in that progress. Contrary to the claims of those whose ideology opposes scientific progress, the consumption of plants developed by genetic engineering have no negative effect on milk quality or safety . Nowhere in the cow, or in you, can parts of plants be found (except, of course, in the digestive tract). When humans, or cows, eat plants, the plants are broken down into tiny molecular-sized fragments in the digestive system, so that the chemical factories in our body (or the cow) can make new fats, sugars, and proteins that we need. Here is an analogy: suppose you want to make a decorative brick wall in your yard. You find where an old building is being demolished, and you get the brick from the demolition crew. When you get home, you find you must carefully clean all the old mortar off, and separate all the bricks, because you cannot lay the bricks neatly into the new wall if they are not separate and clean. When you are done, you have a decorative wall in your yard, regardless of what structure the bricks previously formed. They may have made a prison in their prior form – but now they make a garden wall, not another prison. The “bricks” that make up living things are the same in all species of plants and animals – they are just put together in different ways, just as the same bricks can make a garden wall or a prison. This should be obvious: you eat many different foods, but you do not look like a cow, a corn plant, or some weird mix of what you have eaten all your life. One of the components of every living thing is a chemical known as “DNA”. DNA is a unique material – it is an incredibly thin, long “thread”. (If you took all of the DNA in your body and stretched all the pieces together end-to-end, it would long enough to reach from the Earth to the Sun 450 times.) DNA is much like a very thin strip of paper, so thin that it is only one letter wide. The “genes” are groups of letters on the paper; each group (gene) is thousands of letters long. If you chop up the paper, the individual pieces are not legible – you just have jumble of letters that mean nothing. That is what digestion does to the food you eat, and to what the cow eats. The genes – the genetic information – is lost when the DNA is shredded by the digestive system. Some research reports have claimed that a very tiny amount of small DNA fragments (smaller than is needed for a complete gene) from digested plants can sometimes be found in milk. These tiny fragments in no way represent complete genes, any more than a few bricks stuck together are a prison. What is a “tiny” amount? No genetically modified genes or gene fragments were found in milk, while fragments of a “normal” plant gene were found. Thus, the claim that “GMOs are in your milk” is false – there are no plant genes of any kind in any milk, just some fragments of DNA .

Calculation of initial discharge voltage on insulator surface based on the simulation analysis of distorted electric field The calculation of initial discharge voltage is the difficulty of insulator performance evaluation. Based on the theory of streamer and the finite element simulation analysis of distorted electric field, the gas discharge model of polluted insulator surface is established in this paper. The electric field distribution in the gap of the dry band was calculated, and the impact of environmental factors such as pollution degree, humidity and temperature on the distribution of distorted electric field is studied. The dynamic process of the initial discharge of streamer is analyzed quantitatively by the finite element methods such as space electric field partition quantification and dynamic accumulation, and the calculation method of the initial discharge voltage on insulator surface is proposed. The calculation method of this paper is verified by the surface discharge experiment of polluted insulator. The experimental results show that the calculation method based on the simulation analysis of distorted electric field and considering the environmental factors can accurately quantify the streamer initial discharge voltage on insulators, which can provide useful reference for the operation and maintenance of power transmission and transformation projects.

Use of sildenafil in patients with severe COVID-19 pneumonitis embolism, of larger vessels. 1 These changes contribute to dead-space and shunt, increased pulmonary vascular resistance, and right ventricular (RV) dysfunction, and can be improved by therapies modulating endothelial function. Of these, inhaled nitric oxide (NO) 5 has pulmonary vasodilating, anti-inflammatory, and potential antiviral properties. The phosphodiesterase type 5 inhibitor sildenafil recommendation from the joint task force of the Chinese society of anesthesiology and the Chinese association of anesthesiologists. Anesthesiology 2020; 132: 1307e16. Published correction appears in Anesthesiology 2020; 133: 693 2. Patel 1e3 These changes contribute to dead-space and shunt, increased pulmonary vascular resistance, and right ventricular (RV) dysfunction, 4 and can be improved by therapies modulating endothelial function. Of these, inhaled nitric oxide (NO) 5 has pulmonary vasodilating, antiinflammatory, and potential antiviral properties. 6 The phosphodiesterase type 5 inhibitor sildenafil increases endogenous NO, is well tolerated in patients with lung fibrosis, 7,8 but may worsen shunt in acute respiratory e18 -Correspondence distress syndrome (ARDS). 9 We hypothesised that in patients with COVID-19 ARDS with pulmonary hypertension, RV dysfunction, or both, sildenafil would improve gas exchange. Sildenafil-treated patients with COVID-19 pneumonitis and moderate to severe ARDS were studied between March 1, 2020 and May 31, 2020. The study had ethical approval (A-CLUE 285452, IRAS reference 285452). Oxygenation and carbon dioxide (CO 2 ) clearance were assessed immediately prior, 24 h, 48 h, and 5 days after sildenafil by averaging three blood gas and ventilator parameters to calculate the P:F ratio (PaO 2 :FiO 2 ), oxygenation index, 10 dead space fraction, 11 and ventilatory ratio. 12 Vasoactive drug dose was calculated using norepinephrine equivalents (NE) 13 and the vasoactive-inotropic score (VIS). 14 Initial sildenafil at 12.5 mg three times a day (TDS) was titrated up to 25 mg TDS if tolerated. Patients underwent baseline and follow-up CT scanning (some with dual energy CT pulmonary angiogram , Supplementary material) and detailed echocardiographic assessment (e.g. pulmonary vascular resistance) using the velocity time integral of the pulsed wave Doppler at the RV outflow tract (Supplementary material). We report outcomes with sildenafil in a well characterised cohort of ARDS patients with pulmonary hypertension or RV dysfunction as a result of COVID-19. Although a single sildenafil dose can cause hypotension and deterioration in oxygenation in ARDS (without associated pulmonary hypertension or RV dysfunction), this study suggests sildenafil was well tolerated in COVID-19 ARDS, without deterioration in oxygenation, dead space, or haemodynamics, and improved cardiac biomarkers and echocardiographic features. Several factors further to dosing may explain the potential beneficial effects in this cohort. Pulmonary vascular and RV dysfunction are common in COVID-19 ARDS. Increased cardiac output as a result of reduced pulmonary vascular resistance and improved RV function, as supported by improvement in cardiac biomarkers, may have augmented oxygen delivery. Gas exchange did not deteriorate with sildenafil, suggesting that intrapulmonary shunt or potential ventilation-perfusion mismatch was balanced by beneficial effects (e.g. on cardiac output). The potential for improvement in longer term lung function impairment 15 remains to be seen. This report is of course limited by its retrospective and nonrandomised nature. Despite limitations, our results suggest that sildenafil is safe in carefully selected COVID-19 ARDS patients. Supporting these observations, a recent randomised trial of sildenafil reported reduced hospital stay and need for mechanical ventilation in ward patients with COVID-19 and perfusion deficits on DECTPA (not selected for RV dysfunction). 16 These developments are encouraging given that a pulmonary vasculopathy appears central to the pathophysiology of severe acute COVID-19, and sildenafil therapy merits further exploration in randomised trials. Funding CM is supported by a grant from the National Institute for Health and Care Research, award number 156882. We are compelled to raise several points. Firstly, we would advise caution with the conclusion of the paper that such an approach is safe in terms of postoperative morbidity and mortality, given the lack of power to identify these secondary outcomes. The authors have appropriately powered their study to demonstrate that using ScvO2 to guide RBC transfusion resulted in a more restrictive transfusion strategy. This may be a worthy aim, but it is a process outcome, primarily useful in establishing the feasibility for future large-scale trials. 2 Whilst the authors allude to this in their paper, they also claim that a clinically relevant outcome has been found (i.e. that such a strategy is non-inferior to a more liberal one). Without initially powering the study to examine differences in morbidity and mortality, reporting that it is safe in this respect may result in clinicians inappropriately deploying this approach believing this to be a seemingly definitive assessment of the subject. Declarations of interest We also question the overall utility of ScvO 2 to guide RBC transfusion when the authors report no significant increase in ScvO 2 after administration of RBC transfusion. In principle, ScvO 2 provides a good composite reflection of the systemic oxygen uptake to oxygen delivery ratio. However, a more complex system contributing to tissue oxygenation may well occur, especially in inflammatory states such as sepsis and after exposure to a cardiopulmonary bypass circuit. This could partly explain why three international studies, ProMISE, ARISE, and ProCESS, did not replicate the results of Rivers and colleagues 3 to which the authors refer in their initial rationale for using this measure. 3e6 Lastly, we wonder whether clinically relevant endpoints can be extrapolated in this cohort of patients without reporting the volume of RBCs transfused on the ICU or an understanding of what was administered intraoperatively and after discharge to lower acuity wards. With specific regard to this study, it is interesting to note that whereas group separation may well have initially taken place in terms of delivering a restrictive transfusion regime, mean haemoglobin values in both cohorts remained between 9.0 and 9.6 g dl 1 on Days 1, 2, and 7. Given that the risks associated with transfusion are largely summative and that increased volume transfused may also represent surgical complexity and the preoperative haemoglobin and volume status of the patient, future studies reporting long-term clinical outcomes should likely examine patient blood management throughout the entirety of their perioperative course.

Productivity Improvement on a CNC Lathe by Automatic Loading and Unloading of Throttle Valve Component Industrial Automation is a broad field among other engineering disciplines. The major activities of Automation stem from manufacturing industries and include cycle time improvement, productivity improvement, cost reduction, efficiency im- provement, materials handling, analyze and improve the work methods, to eliminate waste and proper allocation and utiliza- tion of resources. Automation in a manufacturing shop is one of the most challenging tasks, as it has an impact of many interre- lated variables and parameters. A detailed study by large data acquisition and analysis is essential for understanding the trends in productivity improvement. Productivity improvement is achieved through analyzing the current method by eliminating un- necessary movements, reducing cycle time and providing appropriate solutions to various problems during the machining of components to improve productivity. The project titled "Productivity Improvement on a CNC Lathe by Automatic Loading and Unloading of Throttle Valve Component" includes analysis and detailed study of manufacturing process including load- ing and unloading methods of components on a machine. This project involves the use of automation techniques namely pneu- matics automation to increase the productivity and efficiency. Present work aims at improving the productivity of throttle valve components on a CNC turning centre. Here emphasis is placed upon improving the existing time consuming methods. An effort is made to bring down the total cycle time.

This story is about Published May. 2016 Gosselin: How Matt Bush's journey to big-league redemption began with a friend at a Golden Corral Share This Story On... Twitter Facebook Email Texas Rangers Matt Bush attends a news conference before a baseball game against the Toronto Blue Jays, Friday, May 13, 2016 in Arlington, Texas. The Texas Rangers promoted hard-throwing reliever Matt Bush from Double-A Frisco on Friday, making him available for his major league debut seven months after getting out of prison and 12 years after being the No. 1 overall pick. (Max Faulkner/Star-Telegram via AP) MAGS OUT; (FORT WORTH WEEKLY, 360 WEST); INTERNET OUT; MANDATORY CREDIT By Rick Gosselin , Special Contributor Contact Rick Gosselin on Twitter: @RickGosselin9 ARLINGTON -- Globe Life Park is a long way from Frisco. It’s an even longer way from the parking lot of the Golden Corral in Jacksonville, Fla. But that’s where the resurrection of Matt Bush’s baseball career began about a year ago at this time -- a resurrection that culminated Friday night with his recall by the Rangers from Frisco. Matt Bush will not be spoon-fed by the Rangers at the major league level, 'We feel he's ready to pitch' The Rangers needed a live arm for their embattled bullpen and Bush, with a fastball in the mid-90s, got the call despite having thrown only 17 competitive innings over the last five seasons. Those all came at the Double-A level in Frisco this spring. That’s because Bush, the first overall pick of the June 2004 draft, had been out of baseball for the last four years serving prison time for a 2012 drunken driving, hit-and-run conviction. Enter Roy Silver. Or, rather, re-enter Roy Silver. Silver became friends with Bush in the spring of 2009 during Sunday chapels when Bush was in the big-league camp of the Toronto Blue Jays and Silver a camp volunteer. “I was more of a mentor to him,” Silver said. “When he got into the situation in 2012, we stuck it out. We never quit being friends.” Bush’s father reached out to Silver early in Matt’s incarceration and, because he had no phone privileges in prison, the two started corresponding with letters. When Bush left prison to enter a halfway house in Jacksonville in January 2015, Silver would make that 3 ½-hour drive from his home in Clearwater on a monthly basis to have dinner with him at the Golden Corral and check his well-being. Bush needed employment when he moved into the halfway house and Golden Corral provided him that paycheck. “I thought I could help him get a job coaching or scouting,” said Silver, a baseball lifer who had been hired by the Rangers prior to the 2015 season as a special assistant in player development . “I knew it was going to be hard for him to function in society after what he had done. My concern was what is he going to do with his life when he gets out? You want to care about the person before the athlete.” On his visits, Silver would pull his glove out of the trunk and the two would play catch in the parking lot. Catch evolved into long toss. 10 things to know about Rangers' Matt Bush, including prison sentence and 100 mph fastball “It was pretty immediate that I knew his arm was OK,” Silver said, “but I wasn’t really concerned about the physical side as much as I was the mental, emotional and spiritual side. After a couple of visits on my own, about March, I mentioned it to the Rangers. I said, 'Would you guys be interested?' At first it was, 'We'll think about it. How much longer is he in there for?’” By the summer, Silver was driving to Jacksonville twice a month. And he was now bringing his catching gear. Bush would use a concrete parking stopper as his rubber and there was a natural incline from that particular parking spot toward the drain. Silver brought a rubber plate from his days as a youth softball coach and, Voila! -- Bush was once again throwing off a “mound” at the Golden Corral. “He got more in-tune with his baseball shape and it started becoming more and more of a reality,” Silver said. “I had that personal relationship with him and I happened to work for Texas so I asked him if he’d be interest in the Rangers if the Rangers were interested in him. He said, `Sure.’ That was August. I told the Rangers he looks pretty good physically, we’re having good conversations and he’ll be coming out Oct. 30.” On Dec. 18, the Rangers signed Bush to a minor-league contract. Five months later, he was wearing a big-league uniform for the first time in his life. He debuted in the ninth inning in mop-up duty, striking out Josh Donaldson and setting down the 2-3-4 hitters in the Toronto lineup in order. Silver spent eight seasons in the farm system of the Cardinals before becoming a coach and finally a manager, all in the minors. Now he is as much a life coach as a baseball coach for the Rangers, roaming their minor leagues. Sherrington: New Ranger Matt Bush is an unbelievable story, but first, he must stay sober “I always wanted to be a baseball coach,” Silver said. “But we have a lot of people who do that stuff very well. So I concentrate on foul territory. I think a lot can be gained and lost in foul territory, whether it’s the clubhouse, your home, the hotel, the night life... I’ve always been that way with all of my players. If your life is in order off the field, I think you’re going to get more production on the field.” Silver, who employed Josh Hamilton at his baseball academy during that player’s rehabilitation 10 years ago, stood in the back of the room at Bush’s introductory press conference Friday. But he didn’t find the moment rewarding. “What’s rewarding will be 10 years from today and the story has been written a little further,” Silver said. “This is just a paragraph in the beginning of his story. It’s exciting to be a part of this ... but rewarding? No. For him it has to be just another day. “He’s blessed to be able to throw a ball 95-plus miles an hour to be here. But he also knows if he threw the ball 85 miles an hour I would still be in his life.” Listen to Rick Gosselin at 10:50 a.m. Tuesdays on Sportsradio 1310 AM/96.7 FM The Ticket with Norm Hitzges and Donovan Lewis, and follow @RickGosselinDMN on Twitter. 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BASIC (BLI Adenoma Serrated International Classification) classification for colorectal polyp characterization with blue light imaging. BACKGROUND AND STUDY AIM Advanced endoscopic imaging has revolutionized the characterization of lesions during colonoscopy. The aim of this study was to create a new classification for differentiating subcentimetric hyperplastic and adenomatous polyps, and deeply invasive malignant lesions using blue-light imaging (BLI) with high definition, with and without optical magnification, as well as to assess its interobserver concordance. METHODS A video library consisting of 48 videos/still images (with/without optical magnification) from 24 histologically verified polyps/cancer with BLI was prospectively created. In the first step, seven endoscopists with experience in electronic chromoendoscopy reviewed 12 BLI videos/still images with/without magnification representative of the different histotypes, and individually identified possible descriptors. In the second step, these descriptors were categorized and summarized with a modified Delphi methodology. In the third step, the seven endoscopists independently reviewed the remaining 36 videos/still images with/without optical magnification, and the interobserver agreement for the new descriptors was assessed. The interobserver agreement between endoscopists was assessed using Gwet's AC1. RESULTS By reviewing the initial 12 videos/still images, 43 descriptors were proposed. By a modified Delphi process, the endoscopists eventually agreed on summarizing 12 descriptors into three main domains. The main domains identified were: polyp surface (mucus, yes/no; regular/irregular; depressed, yes/no), pit appearance (featureless, yes/no; round/nonround with/without dark spots; homogeneous/heterogeneous distribution with/without focal loss), and vessels (present/absent, lacy, pericryptal, irregular). Interobserver agreement for the polyp surface domain appeared to be almost perfect for mucus (AC1 0.92 with and 0.88 without optical magnification), substantial for the regular/irregular surface (AC1 0.67 with and 0.66 without optical magnification). For the pit appearance domain, interobserver agreement was good for featureless (AC1 0.9 with and 0.8 without optical magnification), and round/nonround (AC1 0.77 with and 0.69 without optical magnification) descriptors, but less consistent for the homogeneity of distribution (AC1 with/without optical magnification 0.58). Agreement was almost perfect for the vessel domain (AC1 0.81-0.85). CONCLUSIONS The new BASIC classification takes into account both morphological features of the polyp, as well as crypt and vessel characteristics. A high concordance among the observers was shown for most of the summarized descriptors. Optical magnification had a beneficial effect in terms of interobserver agreement for most of the descriptors.

Owning your home is part of the great Australian dream. But as soaring prices deny many people that dream – and city dwellers increasingly look for regular short-term rural escapes – there are new ways emerging to build financial security. Enter the side-hustle cottage: a low(er) risk nest egg, income booster and holiday house in one, allowing a buyer to dip their toe in the property market while simultaneously making money as a holiday rental. "Buying in a rural area can be a way to supplement your income while getting a foothold in the market and building an investment portfolio," says Bessie Hassan, head of PR at Finder.com.au. "Sites like Airbnb offer a platform to draw tenants." Here, three women tell how they invested in other people's getaways. Interior designer Simone Mathews, 39, and her builder husband Ben, 40, relocated their family to Gerringong in the NSW Illawarra region to refurbish an old farmhouse. Simone is also about to launch Soul Home, an online guide to help people set up Airbnb businesses. "My husband and I had always loved the idea of buying and creating a holiday property we could share with everyone while providing an income to supplement our main business. The process was definitely a roller coaster. We weren't looking for a place at the time, and not being familiar with Illawarra property, we weren't sure if we were paying a so-called local price or tourist price. We sought a private valuation to assist us with this. Once we'd bought the house, and because we were new to the tourism industry, a lot of hours were spent trawling the internet to find resources to assist us in setting up the property as holiday accommodation. Reaching out to other holiday house owners in the area was invaluable. In creating a luxurious coastal retreat, we wanted to pay homage to the property's original character. The home was once a farmhouse, so we restored and reused as much as we could of the existing property and then added a new spark to bring it into today's world. We renamed the home Soul of Gerringong. Ben is a builder and I'm an interior designer, so the work was completed by us witha team of local tradies. We believed it was important to support them so the Gerringong community, in turn, would support our project. The family's old farmhouse in Gerringong. As with any property, there were lots of discoveries; some good, such as the raked ceilings in the bedrooms that had been hidden by layers of plastered ceilings; some not so good, like the rotted timber frames that resulted in the middle section of the property having to be rebuilt from scratch! Even with our backgrounds and renovating experience, the budget stretched beyond our original forecast. We made the decision to move our whole family from Sydney to Gerringong for 12 months while we renovated and got a feel for the town. We reasoned it would also help us make recommendations for our guests' stays. But we are still here 18 months later, living on another dwelling on our property. Social media allows our property to reach such a wide audience with a very small financial input. I have always marketed the lifestyle of Soul rather than the property itself. In coastal and rural areas, you are buying a lot more value than you would in the city. But, as with anything, the more attention and time you dedicate to your holiday property, the greater the return." , 31, fell in love with a cottage in her hometown of Narrandera, in the NSW Riverina. Thinking it would be ideal for her wedding, she and her partner Mitchell Steel, 33, purchased the property with her father, Gary Powell, 64, and turned it into a boutique country-town retreat. "Buying Tall Trees [below] happened by chance. My sister-in-law was the selling agent and we went along to the open house to support her. "I thought I knew all the beautiful properties in town, so when I arrived to find a gorgeous cottage tucked away behind a leafy garden on the banks of the local canal, I fell in love. My fiancé Mitch and I haven't been in a position to buy property in either Sydney, where I lived for 10 years, or Newcastle, where we live together. We saw Tall Trees as a low-risk opportunity to break into the market. The property had so much potential and charm that we made an offer on the spot. Powell's cottage in her hometown of Narrandera, in the NSW Riverina. As [it was an unexpected purchase], the actual decision wasn't based on too many facts and figures. Dad owns rentals in town, so we already knew returns in Narrandera were strong. The property didn't need any structural work, but because we wanted it to be attractive as boutique accommodation, we updated the place aesthetically. We had a budget of $20,000 – allocated for a fresh coat of paint, polished floors, new bathroom tiles, new tapware and furniture – which we only exceeded by about $2000. With help from Dad, who is a retired farmer and a carpenter by trade, we were able to do most of the work ourselves. We bought furniture from garage sales, thrift stores and Gumtree, and Dad made some, too. We did buy a few new things: a sofa and armchair, the beds and bedding and things like cushions, vases and books. We had maps of the town and sketches of nearby landmarks printed by the local council to put on the walls, and tracked down amazing historical images from the local paper, which we had framed. The cottage is more than 100 years old, so we wanted the style to be classic but still modern. We're really excited for people to be able to enjoy the property, which has a secluded garden, the canal, beautiful views and easy access to town. Social media has played a huge part in promoting Tall Trees. We had three bookings, including a wedding ceremony, from the Instagram account before it was even listed on Airbnb." Hannah Silverton, 28, fell in love with the Byron Bay hinterland at the age of 12, when she was on a family holiday from England. Two years ago, she purchased and refurbished an old Queenslander. Her Bangalow property, Mahalo, offers a quintessential Byron escape. "When you're drinking a coffee in a Sydney cafe on the weekend, you can be sure you'll be among people flicking through the papers and lamenting the cost of buying a home in the city. Whenever I was in the Northern Rivers [region of NSW], I would peek into real estate agents' windows and realise you could get acreage just 10 minutes from the ocean for the same price as a small apartment in Manly, where I was living. The region has tourists passing through it all year round for weddings, as well as a warm climate and a slower pace of life, so it felt like a no-brainer to seize the opportunity while still possible. It came down to 95 per cent instinct and 5 per cent logic. The area's development and expansion over the past two decades has been astronomical, so it has become an increasingly viable place to live and work. What sold me on my property [above] was its walking distance to town as well as the big deck and garden – in my mind, the best of both worlds. But because it was an old Queenslander that had had a number of add-ons over the years, the space lacked flow. I hit the renovation jackpot by finding Ray, a multi-talented, kind and patient local builder, through a friend. Silverton's Bangalow property, Mahalo, offers a quintessential Byron escape. In order to maximise the holiday rental yield, I knew it needed to sleep as many people as the space would allow, so a few creative rearrangements of internal walls managed to turn it from three bedrooms to five. Ray was brilliant at reusing materials such as old doors and timber that had been stored by the past owners. It was a nice way of maintaining some of the house's history while modernising other aspects. Sourcing furniture was probably the most enjoyable aspect of the process for me. I have a pretty clear idea of what I love so once a few signature pieces were found, I shaped an aesthetic around them. I stumbled upon some older pieces of furniture in local antique shops. When I walked in for the first time after the renovations, I welled up a bit because it felt like home, and I had one of those weird moments where you can see your future play out in the front of your eyes. I could just see people making memories in it and knew the big risk of buying remotely and spontaneously was completely the right thing to have done. In every review the same features come up as favourites: the window seat in the master bedroom, the wraparound deck you can dine on all year round, and the bi-fold doors that open up to it and bring the tropical outdoors in. The whole space just has a really good, happy feel."

Removal of Cibacet Blue (CB) by Adsorption onto an Algerian Red Slag This study is based on the implementation of a composite material with absorbent properties for the elimination of organic pollutants.In our case we used the slag (red slag)from the region of Bechar, (South-East of Algeria). Characterization using DRX and Fourier transforms infrared spectrometer(FT-IR), shows that, we were able to prepare adsorbents with very interesting structural and mechanical properties. The effectiveness of obtained adsorbents was evaluated in the removal of Cibacet Blue (CB) dye using the adsorption process. Kinetic resultswith an elimination rate of 83 % show that, the time to equilibrium is influenced by experimental conditions such us, contact time, pH, initial concentration, temperature and adsorbent mass. Pseudo-first order model represent very well our experimental results with adjustment coefficients (R2) close to 1. Modeling of adsorption isotherms of the CB dye on the red slagshows that both models of Langmuir and Freundlich can present our results with acceptable adjustment coefficients (R2> 0.995).

. Scientific productivity in Chile was studied examining a data bank constructed with the publications indexed by the Institute for Scientific Information during 1987 and 1988. The bank excludes meeting abstracts and contains the full title of the published paper, the list of authors, addresses, field, and the nature of collaboration between two or more institutions. The articles were classified in different fields and tabulated according to the institution from which they originated. Although biology remains to be the more productive subject (26.5%) followed by medical sciences (23.9%) and chemistry (12.3%), articles in mathematics and physics continued their increase as in previous years. Using the scientometric indicators published by Braun et al., the impact of the research originated in Chile in biology, physics and mathematics was compared to that attained in Argentina, Brazil, Mexico and Venezuela. The role of the chilean National Research Fund and the output of the financed research projects were also analyzed. The successful results obtained during the first years in which the National Research Fund has been involved in the support of the scientific activity in Chile, confirms the need to strengthen its budget, according to the goals stated in the National Plan for Science and Technology for Development.

Convenient single-step, one tube purification of PCR products for direct sequencing. Structural alterations of the apolipoprotein E (apo E) are known to influence the lipid metabolism. The three most common isoproteins Arg 158) are encoded by three co-dominant alleles (e2, el, e4). Phenotyping is cumbersome and, therefore, several methods for apo E genotyping have been developed. Of these, PCR-RFLP (restriction fragment length polymorphism) is currently most rapid and cost-effective. To detect mutations not affecting restriction sites, direct PCR sequencing of apo E fragments is the method of choice. This, however, requires purification of PCR products, which is routinely accomplished by techniques like gel electrophoresis or chromatography. We have established a new purification method using exonuclease I (exo I) and shrimp alkaline phosphatase (sAP) to degrade excess primers and nucleotides, which are the main factors interfering with dideoxy PCR sequencing. This procedure simply requires the addition of the enzymes to the PCR product, avoiding frequent sample handling and DNA loss through technical manipulation. Human DNA was extracted from 50 iA EDTA blood with Tris-EDTA lysis and proteinase K digestion. The PCR reaction mix (50 ill) was optimized to contain 10 /tl of DNA extract, 30 pmol of the primers F4 and F6, 5 pi of dimethyl sulfoxide (DMSO), 10 pmol of each dNTP, 2 U of Taq polymerase 5 ii\ of 10 X PCR buffer (GeneAMP; Perkin-Elmer). After initial denaturation (95°C 5 min) 35 cycles (95°C 20 sec, 60°C 30 sec, 72 °C 30 sec) of amplification were performed, followed by a final extension (72°C 10 min; DNA Thermal Cycler 480, Perkin-Elmer). 2 jil of PCR product (244 bp) were mixed with 1 U exo I and 1 U sAP (USB, Cleveland, USA) and incubated for 1 h at 37°C. The enzymes were inactivated for 15 min at 72°C. The purified PCR product was diluted to a final volume of 10 /tl for cycle sequencing with 0.5 pmol biotinylated primer F6 (A Taq™ Cycle Sequencing Kit; USB) under the same conditions as for PCR of genomic DNA. For chemiluminescence detection we used the 'Sequenase® Images™ non-isotopic DNA sequence detection kit' (USB). Sequencing data obtained with sAP/exo I purified DNA are at least equal to those after column chromatography and superior to those using unpurified templates (Figure 1). Adjusting the purified DNA solutions for dilution we saw a slightly better efficiency of cycle sequencing in the enzymatically purified DNA.

Automatic Identification of Shrub-Encroached Grassland in the Mongolian Plateau Based on UAS Remote Sensing Recently, the increasing shrub-encroached grassland in the Mongolian Plateau partly indicates grassland quality decline and degradation. Accurate shrub identification and regional difference analysis in shrub-encroached grassland are significant for ecological degradation research. Object-oriented filter (OOF) and digital surface model (DSM)-digital terrain model (DTM) analyses were combined to establish a high-accuracy automatic shrub identification algorithm (CODA), which made full use of remote sensing products by unmanned aircraft systems (UASs). The results show that: The overall accuracy of CODA in the Grain for Green test area is 89.96%, which is higher than that of OOF (84.52%) and DSM-DTM (78.44%), mainly due to the effective elimination of interference factors (such as shrub-like highland, well-grown grassland in terrain-depression area, etc.) by CODA. The accuracy (87.5%) of CODA in the typical steppe test area is lower than that (92.5%) in the desert steppe test area, which may be related to the higher community structure complexity of typical steppe. Besides, the shrub density is smaller, and the regional difference is more massive in the typical steppe test area. The ground sampling distance for best CODA accuracy in the Grain for Green test area is about 15 cm, while it is below 3 cm in the typical and desert steppe test area. Introduction In recent years, the shrub-encroachment phenomenon in natural and artificial grassland in the Mongolian Plateau has been continuously emerging, which indicates to some extent the grassland quality decline and the occurrence of grassland degradation. In addition, the grassland ecosystems of the Mongolian Plateau have undergone unprecedented changes in the past hundred years under the dual effects of climate change and human activities. Especially, overgrazing has weakened the ecological dominance of herbaceous vegetation such as Leymus Chinensis and Artemisia, which has resulted in a continuous expansion of shrubs such as Caragana. This kind of constant development of shrubs has not only changed the original natural community structure but also altered the ecosystem functionality. Furthermore, the production of animal husbandry and livelihoods of herdsmen have been affected or reformed where the shrub-encroachment is more severe. Therefore, identifying shrubs and analyzing the biological mechanism of shrub-encroachment is of great significance for the sustainable development of grassland in the Mongolian Plateau. In most studies of shrubs in grassland, the traditional method is to use portable Global Positioning System (GPS) devices, spectrometers, or other equipment to conduct field investigations on the Background With the development of the UAV industry, unmanned aircraft systems (UASs) have penetrated and affected a variety of ecological research fields. Small UAS (S-UAS), with small-size and easy-to-use characteristics, plays an essential role in passive optical remote sensing. Many scholars have tried to retrieve grassland structure, biomass, and other information based on UAS, which can be summarized as the following two kinds of research methods. One type of technique that some scholars use is optical vegetation indexes (OVIs) or spectral characteristic analysis to quantitatively study grassland ecosystem, in which OVIs have a profound characterization ability for grassland growth. Among many OVIs, the ExG-ExR has been proven to have good results in vegetation extraction, which is applied in many types of research. Another method that some scholars use is image classification, decision tree analysis and other approaches to analyze grassland types qualitatively, in which object-oriented classification technology has a high accuracy of optical remote sensing in grassland. However, these methods depend on the reflectivity of several electromagnetic bands and are often analyzed with only three optical image bands (red, green, and blue). Facing the complex structures of grassland ecosystems, the methods as mentioned above always confuse shrubs with well-growing grass-patches. Besides the digital orthophoto map (DOM), the digital surface model (DSM) is one other of the critical products of UAS remote sensing, where shrubs can always be represented as "bulges" in the DSM. This feature of shrubs brings a new research approach for shrub recognition. Formerly, the DSM has been used to study vegetation identification and classification by scholars, but these applications mainly depend on LiDAR point-cloud products and mainly attribute to the high accuracy of LiDAR products. With the development of UAS, many vegetation analyses based on DSM products by UAS emerges. There are many conductive approaches for forest, cropland, and grassland ecosystem developed with DSM by UAS. For UAS remote sensing, DSM does have some difficulty in the automated processing of steep edges such as buildings and trees: either the UAS is required to collect a large number of UAS images at multiple angles, or manual editing at a later stage is expected, which will undoubtedly considerably increase the time consumption and manpower. Fortunately, shrubs are often scattered or clustered. Besides, unlike buildings and trees with a huge DSM drop in edges, DSM changes relatively smoothly in the shrub area, which is easy to be adequately monitored by UAV. Therefore, DSM is feasible for the extraction of grassland shrubs. In this study, a high-precision automatic algorithm for grassland shrub identification was developed by the combining object-oriented filter and DSM-DTM algorithm (CODA). CODA was designed for using the information of DOM and DSM products of UAS remote sensing as fully as possible. The algorithm was implemented to shrub identification of typical steppe and desert steppe in the Mongolian Plateau and the scale effect of UAS grassland remote sensing was further analyzed by information entropy theory. As a result, the research in this paper will provide technical support for deepening and expanding the research on the mechanism of shrub-encroached grassland and grassland degradation. The Experimental Sites Shrub-encroached grasslands mainly occur in arid or semi-arid areas. In this study, a sample typical steppe area and a sample desert steppe area were selected as the research sites. In addition, the researchers also selected an experimental area of Grain for Green grassland for the development and validation of CODA. Therefore, the experimental sites of shrub-identification in this paper were the Grass for Green Test Area (GGA), the Typical Steppe Test Area (TSA) and the Desert Steppe Test Area (DSA), as shown in Figure 1 The Acquisition of UAS Images The Mavic Pro S-UAS (developed by DJI Technology Co., Ltd., Shenzhen, China) was used to collect UAS images in the GGA, TSA, and DSA. The essential information of UAS images is shown in Table 1. The Mavic Pro was equipped with a 1/2.3 inch complementary metal oxide semiconductor (CMOS) camera (also known as FC220) with a maximum aperture of f/2.2 and a field of view (FOV) The Acquisition of UAS Images The Mavic Pro S-UAS (developed by DJI Technology Co., Ltd., Shenzhen, China) was used to collect UAS images in the GGA, TSA, and DSA. The essential information of UAS images is shown in Table 1. The Mavic Pro was equipped with a 1/2.3 inch complementary metal oxide semiconductor (CMOS) camera (also known as FC220) with a maximum aperture of f/2.2 and a field of view (FOV) of 78.8. To ensure image quality and reflectivity accuracy, the aperture size was fixed to f/2.0, the shutter time was set to 0.1 s, and the ISO was set to 1600. Given the lack of normalization correction in each band of the subsequent processing, to ensure the homogeneity of imageries, all the photos were taken in the morning from 8 to 10 o'clock (there was merely cloud cover in study area at this time also). Additionally, the image was saved in RAW format with 4000 3000 resolution, which stored photos with floating data type. Furthermore, the photo overlay referred to the specification standard for aerial photography in China, which requires an along overlap of no less than 60% and an across overlap of no less than 30%. After photo acquisition, DOMs and DSMs were composed by Pix4d Mapping software with the same sampling distance. Additionally, no ground control points (GCPs) were used, but the GPS and global navigation satellite system (GLONASS) on the Mavic Pro provided enough information for aerial triangulation. The imageries were saved as GeoTiff format with WGS 1984 universal transverse Mercator (UTM) projected coordinate system (Zone: 49N, EPSG: 32649). As a result, the generated DOMs and DSMs had high accuracy: the number of point clouds matching was not less than 20,000 key points per photo, averaging 27,421 key points per photo. The average point cloud densities in the three sites varied from 1017.32 to 1215.66 points per square meter, which contained enough topography information to generate the DSMs. For further accuracy assessment of DSMs and DOMs, at least three points were selected in each image and their location information was obtained by GPS devices. Methods The aim of this research was to automatically identify and count shrubs in shrub-encroached grassland based on the combined object-oriented filter (OOF) and DSM-DTM algorithm (CODA), which was divided into three main processes: Object-oriented filter: The DOM was objectified by multiresolution segmentation algorithm, and the average value of ExG-ExR of each object was calculated as a feature. Hence, the shrubs were extracted by using this feature and threshold classification. DSM-DTM filter: The DTM was retrieved automatically from DSM mainly by a DTM filter (slope based) tool and interpolation tool in System for Automated Geoscientific Analyses (SAGA) firstly, and then the difference between DTM and DSM was obtained. Thus, the shrub area iwas obtained by open operation optimizing and filtering finally. Combination and counting: overlay analysis was used to combine the results of OOF and DSM-DTM. Then, the number of identified shrubs was counted by the Hough circles method. The flow chart of shrub identification based on CODA is shown in Figure 2. classification. DSM-DTM filter: The DTM was retrieved automatically from DSM mainly by a DTM filter (slope based) tool and interpolation tool in System for Automated Geoscientific Analyses (SAGA) firstly, and then the difference between DTM and DSM was obtained. Thus, the shrub area iwas obtained by open operation optimizing and filtering finally. Combination and counting: overlay analysis was used to combine the results of OOF and DSM-DTM. Then, the number of identified shrubs was counted by the Hough circles method. The flow chart of shrub identification based on CODA is shown in Figure 2. Object-Oriented Filter (OOF) There are three main parts in OOF: multiresolution segmentation, ExG-ExR threshold classification, and open operation optimization, which will be introduced in the following sections. Multiresolution Segmentation The multiresolution segmentation algorithm mainly relies on eCognition Developer software, which divides one grassland image into several objects, with internal mean features, for classification by the spectral and shape characteristics of the ground objects in the optical bands. Multiresolution segmentation is a kind of top-down segmentation algorithm, which mainly utilizes spatial heterogeneity differences and segmentation scale settings to limit the size of merged regions. After many attempts, when the scale was set to 150, the segmentation effect is the most efficient and accurate. where x indicates the spectral heterogeneity, 1 is the weight of spectral heterogeneity, and y is the shape heterogeneity. The calculation formula of y is as follows: where u indicates the tightness of one object region, 2 is the weight of tightness, and v indicates the smoothness of the region boundary of an object. After many attempts, when 1 = 0.6 and 2 = 0.5, the results of multiresolution segmentation can effectively separate shrubs from grassland. Since the shrubs have apparent features in shape and spectrum, as well as in smoothness and tightness, these parameter settings can adequately consider the above factors. Threshold Classification Based on ExG-ExR Features In this threshold classification, ExG-ExR index was used to extract shrub objects. Compared with grasslands with lower coverage, shrubs have more prominent spectral characteristics, specifically in the ExG-ExR indicator, which is a vegetation index based on red, green, and blue bands. The calculation formula of ExG-ExR is as follows: where EGVI represents Excess Green Vegetation Index, and ERVI represents Excess Red Vegetation Index. The formulas of EGVI and ERVI are as follows: where R, G, and B represent the relative reflectivity of red, green, and blue respectively. In this study, the average of ExG-ExR is computed for each segmented object as its one feature (ExG-ExR avg ). The higher the ExG-ExR avg is, the better the vegetation grows. Thus, the objects with higher ExG-ExR avg are more likely to be shrubs. On the contrary, the lower the ExG-ExR avg is, the lower the grassland coverage is. Consequently, the objects with lower ExG-ExR avg arae more likely to be grassland (Figure 3b). The ExG-ExR threshold for shrub identification can be determined by supervised or unsupervised methods. Specifically, supervised methods can achieve high segmentation accuracy, but it is time-consuming and laborious, which is not conducive to the automatic analysis and application of CODA in different regions and for different UAS remote sensing images. Among the unsupervised methods, the threshold selection in maximum entropy segmentation is based on the criterion that the statistical characteristics of random variables are most in line with the actual situation. When the sum of the information entropy of the two segmentation parts is the maximum, the threshold can divide the images into two sections as target and background, which is called the maximum information principle. This principle is widely used in image binarization, machine learning, and other fields. Accordingly, the best histogram entropy method (KSW) is adopted as the image segmentation method in this study, ensuring the geographical suitability of this method and to promote its migration. KSW information entropy is generally defined as: where p(x) refers to the probability of the occurrence of the numerical value x. This paper assumed that T is the image segmentation threshold of ExG − ExR avg : when x > T, the set of the corresponding x with lower image value was denoted as B; conversely, the set of the corresponding x with higher image value was denoted as O. At this time, the probability (P B ) of x appearing in set B and the probability (P O ) of x appearing in set O are calculated as follows: Remote Sens. 2019, 11, 1623 7 of 20 The formulas for calculating information entropy H B and H O are as follows: When H O + H B is maximum, the corresponding T is regarded as the final threshold of ExG − ExR avg segmentation. In this paper, T was used for threshold classification. When ExG − ExR avg > T, the object was classified as a shrub area. Conversely, the object was classified as grassland, as shown in Figure 3c. DSM-DTM Filter The OOF could extract most of the shrubs, but there were still cases of omissions and commissions in the experiment. This was mainly because some non-shrub areas often have similar characteristics to the shrubs (higher ExG-ExR). However, these areas can often be excluded by topographic analysis. For example, low depressions with well-grown grass are different from raised shrubs in DSM but are often confused in DOM. Because the grassland in the study area may have a particular slope in bare land, it is impossible to extract the shrubs directly by threshold classification. Therefore, this study used the method of producing DTM to shield the influence of topographic factors. This method is from now on referred to as the DSM-DTM. There are three main parts in the DSM-DTM filter: DTM extraction, shrub extraction, and optimization. In this study, the DTM filter (slope based) tool in SAGA GIS was used to separate DSM into two parts: bare earth and removed objects. After many attempts in the extraction process, the segmentation was the best when the search radius parameter was set to 2, and the slope parameter was set to 0.5. Thus, the bare earth part was used as the surface DTM. However, the effect of the above extraction process was limited, because the phenomenon of "salt and pepper" often occurred. The parts with low accuracy were removed by the open operation method again. As a result, the surface DTM after the open operation in a sample area is shown in Figure 4b. On this basis, the whole region DTM was estimated by interpolating surface DTM with the B-spline interpolation method, as shown in Figure 4c. Therefore, the difference between DTM and DSM was the potential shrub area (PSA), of which the formula is as follows: Open Operation Optimizing To recognize the shape of shrubs more accurately, the scale of multiresolution segmentation algorithm was set relatively large, which would make some generated objects very small, or even only a few pixel sizes, that is, the phenomenon of "salt and pepper". To remove these interference factors, the open operation method in morphology was used to optimize the results: the image ess corroded firstly and then expanded to remove "salt and pepper", while the identified positions and shapes of potential shrub areas remain unchanged. The result of shrub identification after opening operation is shown in Figure 3d. DSM-DTM Filter The OOF could extract most of the shrubs, but there were still cases of omissions and commissions in the experiment. This was mainly because some non-shrub areas often have similar characteristics to the shrubs (higher ExG-ExR). However, these areas can often be excluded by topographic analysis. For example, low depressions with well-grown grass are different from raised shrubs in DSM but are often confused in DOM. Because the grassland in the study area may have a particular slope in bare land, it is impossible to extract the shrubs directly by threshold classification. Therefore, this study used the method of producing DTM to shield the influence of topographic factors. This method is from now on referred to as the DSM-DTM. There are three main parts in the DSM-DTM filter: DTM extraction, shrub extraction, and optimization. In this study, the DTM filter (slope based) tool in SAGA GIS was used to separate DSM into two parts: bare earth and removed objects. After many attempts in the extraction process, the segmentation was the best when the search radius parameter was set to 2, and the slope parameter was set to 0.5. Thus, the bare earth part was used as the surface DTM. However, the effect of the above extraction process was limited, because the phenomenon of "salt and pepper" often occurred. The parts with low accuracy were removed by the open operation method again. As a result, the surface DTM after the open operation in a sample area is shown in Figure 4b. On this basis, the whole region DTM was estimated by interpolating surface DTM with the B-spline interpolation method, as shown in Figure 4c. Therefore, the difference between DTM and DSM was the potential shrub area (PSA), of which the formula is as follows: When PSA > 0, the pixel was set to the part of the potential shrub area. Then, the open operation was used to address the "salt and pepper" issue again. In the results of OOF, many large flat protrusions also had good vegetation coverage, but not our target shrubs. In this study, the ratio of maximum height to the polygon area was used to eliminate this interference. Thus, the data were transformed into polygons firstly. Then, the maximum height (maximum PSA) and the area (Area) were computed in each polygon. Finally, the ratio () of maximum height (H max ) to Area is used to filter: According to statistical analysis, for most shrub areas, the was usually less than 0.2 mm −2, so this figure was used as the threshold for dividing shrubs and surface protrusions. Thus, when > 0.2 mm −2, it was considered that this polygon was just a surface bulge, not a shrub, and when < 0.2 mm −2, this polygon was extracted as the final shrub area, as shown in Figure 4d. The reason why some shrubs (mostly small shrubs) were not included in Figure 4d is that small shrubs were not sensitive in DSM because some were too small to be detected in DSM and others were excluded by mistake in DTM generation. According to statistical analysis, for most shrub areas, the was usually less than 0.2 mm −2, so this figure was used as the threshold for dividing shrubs and surface protrusions. Thus, when > 0.2 mm −2, it was considered that this polygon was just a surface bulge, not a shrub, and when < 0.2 mm −2, this polygon was extracted as the final shrub area, as shown in Figure 4d. The reason why some shrubs (mostly small shrubs) were not included in Figure 4d is that small shrubs were not sensitive in DSM because some were too small to be detected in DSM and others were excluded by mistake in DTM generation. Combination of Shrub Areas To combine shrub areas identified by OOF and DSM-DTM, CODA uses overlay analysis of vector data to integrate all overlapping polygons according to Table 2. When a polygon was identified by OOF as shrubs, but the area was less than 0.2 m 2, this area could not always be extracted by DSM-DTM, because the DSM in this study was insensitive to small objects. After the authors checked the key points for aerial triangulation, the essential reason for the insensitivity was that the substantial homogeneity in the shrubs led to errors in automatic recognition of the key points. Thus, those kinds of small regions were considered as a shrub area in CODA, which improved the accuracy of identification. Shrub Counting Because shrubs are usually quasi-circle objects in orthophoto images, Hough circles were used to count the shrub number in the shrub area image, which was developed by OpenGL with C++ API in this study. Concisely, Hough circles is an algorithm which uses Hough transform to fit the edges of circular objects and completes the detection of circular objects by judging the accumulation degree of intersection points. This algorithm not only can recognize the circle models of shrubs but also output the circle centers, which can represent the centers of shrubs. In an area with dense shrubs, Hough circles detection algorithm could always wrongly identify circles in non-shrub areas with a very high probability, so this study removed the circles in non-shrub areas and generated the final shrub count results. The Hough circles detection method and the parameter settings of the main algorithms used in this paper are shown in Table 3. Accuracy Assessment To ensure and control the quality of DOMs and DSMs involved in CODA analysis, the root mean square error (RMSE) indicator was chosen to verify the accuracy of DOMs and DSMs from both horizontal and vertical aspects. The calculation formulas of horizontal RMSE (h-RMSE), vertical RMSE (v-RMSE) and overall RMSE (RMSE) are as follows: To study the influencing factors of the CODA accuracy, 49 equal-area regions (100 m 100 m) were generated by the grid tool of QGIS 3.2 in the GGA to analyze the regional differences. The number of shrubs and the accuracy of CODA were calculated for each region to examine how the shrub distribution affected the CODA accuracy by linear regression. Scale Effect Analysis To determine the best resolution of the UAS image required for shrub identification, images in different ground sampling distances (GSDs) were analyzed and compared with shrub identification accuracy and information entropy. In this paper, 3, 15, 27, 39 and 51 cm were selected by the internal of 4 cm from the minimum GSD to 51 cm where shrubs are no longer clearly visible in images. The information entropy calculation is illustrated in Formula 6 in Section 4.1.2. For the whole image, high entropy means there is a lot of useless information, which could cause a long computational time for shrub identification. With higher GSD, the information contained in the image should be larger, because many details might be submerged in mixed pixels. Then, the objective in this analysis was to find the best GSD when there was enough information for shrub identification, and the image size was as low as possible. This method is used and discussed by many scholars. Therefore, comparison of entropy and accuracy could address the above issue. Because there are not full images in every GSD, the UAS images, of which resolution is above 3 cm, was reproduced by the average up-scale method. Specifically, each mixed pixel was the average of all covered pixels at a lower GSD. Accuracy of DOMs and DSMs The evaluation results are shown in Table 4. The results show that the errors of sample points in UAS images were relatively small, and the RMSEs were lower than 0.01 m in the three test areas, in which the images could be used as the input source of the shrub speech recognition algorithm. Compared with OOF and DSM-DTM algorithms, CODA had apparent advantages in the accuracy assessment. As shown in Table 5, the accuracy of DSM-DTM and OOF were 78.4% and 84.52%, respectively, while the accuracy of CODA was 89.96%, which was about 5% higher than OOF. Due to the limitation of DSM on the identification of small shrubs, the omission error of it was as high as 18.62%. Moreover, something like exposed rock protrusions was the main misclassification by DSM-DTM, because the filter was used to effectively filter other interference factors. As a result, the commission error of DSM-DTM was 3.74%. On the contrary, the OOF had a small omission error but a significant commission error due to the spectral interference of many well-growing grasslands (such as small grasslands at terrain-depression). The effective integration of DSM-DTM and OOF reduced the probability of commission and omission (both below 6%), so the overall accuracy of CODA was effectively improved. To further analyze the factors of accuracy improvement of CODA, a typical region was selected as shown in Figure 5, where point A contains a terrain protrusion and point B contains smaller shrubs. For point A, OOF misclassified the protrusion into three shrubs because its spectral characteristics were similar to those of the visible band. On contrast, DSM-DTM had a filtering mechanism, so the above interference was effectively extracted. For point B, there are two smaller shrubs at this point, which were too small therefore that they could not be effectively distinguished by DSM-DTM. Therefore, this kind of shrub relies entirely on the results of OOF to reduce the misclassification. In the CODA results, the identification results in points A and B were very similar to those with manual labeling, as shown in Figure 5c. To further analyze the factors of accuracy improvement of CODA, a typical region was selected as shown in Figure 5, where point A contains a terrain protrusion and point B contains smaller shrubs. For point A, OOF misclassified the protrusion into three shrubs because its spectral characteristics were similar to those of the visible band. On contrast, DSM-DTM had a filtering mechanism, so the above interference was effectively extracted. For point B, there are two smaller shrubs at this point, which were too small therefore that they could not be effectively distinguished by DSM-DTM. Therefore, this kind of shrub relies entirely on the results of OOF to reduce the misclassification. In the CODA results, the identification results in points A and B were very similar to those with manual labeling, as shown in Figure 5c. Influencing Factors of the CODA Accuracy The CODA accuracy in different regions of the GGA was not very significant, as shown in Figure 6a, ranging from 86.7% to 93.2% (standard deviation: 1.44%). Since the GGA covers shrubs in different growth stages and different sizes, CODA had a vigorous ability to recognize various shrubs. The Influencing Factors of the CODA Accuracy The CODA accuracy in different regions of the GGA was not very significant, as shown in Figure 6a, ranging from 86.7% to 93.2% (standard deviation: 1.44%). Since the GGA covers shrubs in different growth stages and different sizes, CODA had a vigorous ability to recognize various shrubs. The linear regression result is shown in Figure 6b: as the shrub count increased, the accuracy variation became lower continuously, and the accuracy had an inevitable downward trend (where the slope was −9.55). For example, the standard deviation of the CODA accuracy in the GGA below 500 shrubs was 1.97%, and average accuracy was 90.21%, whereas the standard deviation of the accuracy in the area above 500 shrubs was 1.12%, and average accuracy was 89.85%. This phenomenon was most likely because the likelihood of contiguous shrubs increased with the increase of shrubs, and the Hough circles detection method was challenging to count correctly, which resulted in a decrease in the CODA accuracy. Accuracy Analysis The accuracy results showed that there were 25 and 15 commissions in TSA and DSA respectively, and the extraction accuracy of the DSA was significantly higher than that of the TSA, which may be due to the more complex shrub distribution in typical grasslands, as shown in Table 6. To further analyze the results of shrub extraction, the grid tool of QGIS 3.2 was used to divide the DSA and TSA into 11 and 26 equal-area regions respectively (100 m 100 m grids). As shown in Figure 7, there were significant differences: Difference in quantity: shrubs in the TSA ranged from 31 to 75 per grid (average of 52.82 per grid), while shrubs in the DSA ranged from 72 to 119 per grid (average of 96.84 per grid). Therefore, the average shrub density of the DSA was 83.4% higher than that of the TSA. Differences in distribution: the coefficient of variation of the TSA was 0.27, while the coefficient of variation of the DSA was 0.14, so the shrub distribution in the TSA region was more diverse, which was also likely to be related to the complexity of community structure and shrub distribution in typical grasslands. Accuracy Analysis The accuracy results showed that there were 25 and 15 commissions in TSA and DSA respectively, and the extraction accuracy of the DSA was significantly higher than that of the TSA, which may be due to the more complex shrub distribution in typical grasslands, as shown in Table 6. Distribution Characteristics of Shrubs in the TSA and DSA To further analyze the results of shrub extraction, the grid tool of QGIS 3.2 was used to divide the DSA and TSA into 11 and 26 equal-area regions respectively (100 m 100 m grids). As shown in Figure 7, there were significant differences: Difference in quantity: shrubs in the TSA ranged from 31 to 75 per grid (average of 52.82 per grid), while shrubs in the DSA ranged from 72 to 119 per grid (average of 96.84 per grid). Therefore, the average shrub density of the DSA was 83.4% higher than that of the TSA. Differences in distribution: the coefficient of variation of the TSA was 0.27, while the coefficient of variation of the DSA was 0.14, so the shrub distribution in the TSA region was more diverse, which was also likely to be related to the complexity of community structure and shrub distribution in typical grasslands. 31 to 75 per grid (average of 52.82 per grid), while shrubs in the DSA ranged from 72 to 119 per grid (average of 96.84 per grid). Therefore, the average shrub density of the DSA was 83.4% higher than that of the TSA. Differences in distribution: the coefficient of variation of the TSA was 0.27, while the coefficient of variation of the DSA was 0.14, so the shrub distribution in the TSA region was more diverse, which was also likely to be related to the complexity of community structure and shrub distribution in typical grasslands. Scale Effect of Shrub Identification The relationship between the CODA accuracy and image information entropy of UAS images in different GSD is shown in Figure 8. For the GGA, when the resolution was between 3 and 15 cm, the Scale Effect of Shrub Identification The relationship between the CODA accuracy and image information entropy of UAS images in different GSD is shown in Figure 8. For the GGA, when the resolution was between 3 and 15 cm, the information entropy decreased continuously, with a minimum value of 5.42, while the precision decreased slightly, only about 0.13%. When the resolution declined to 15 cm or lower, the information entropy then rose linearly to 5.66 at 27 cm and then remained flat, but the accuracy dropped rapidly. Therefore, the resolution of the best observation of GGA was about 15 cm. For the TSA, as the gradual decrease of resolution, the information entropy kept stable between 5.7 and 5.75, with little change. However, the degradation of identification accuracy was speedy, from 87.52% of 3 cm to 82.13% of 51 cm. This is likely to be related to the complexity of typical grasslands. Moreover, the stability of the entropy indicated that the image was always at a certain complexity, and the rapid decrease in accuracy indicated that the resolution of the best observation in the TSA was below 3 cm. For the DSA, when the resolution was between 3 and 51 cm resolution, the information entropy increased from 4.84 to 4.97. However, the accuracy drop was not fast, just from 92.31% to 91.31%, only about one percentage point. This illustrates two issues: on the one hand, because the ecosystem structure of the desert steppe is relatively simple, the recognition accuracy maintained a high state; on the other hand, due to the formation of a large number of mixed pixels, the spatial difference was continuously weakened. As a result, the entropy of the TSA was constantly increasing as the resolution decreased. Therefore, the optimal resolution of the DSA was below 3 cm, but increasing the resolution may not significantly improve the recognition accuracy. The best GSD for shrub identification in different regions was probably due to differences in the complexity of the distribution and size of shrubs and environmental disturbances. For the GGA, because the ecosystem of it is simple, the shrubs are artificially planted and arranged regularly, the best observation accuracy was as high as 15 cm, much larger than that of the TSA and DSA. Due to the influence of natural conditions and human disturbance, the ecosystem complexity of the TSA and DSA is more complicated, so the best observation accuracy was relatively small (less than 3 cm). information entropy decreased continuously, with a minimum value of 5.42, while the precision decreased slightly, only about 0.13%. When the resolution declined to 15 cm or lower, the information entropy then rose linearly to 5.66 at 27 cm and then remained flat, but the accuracy dropped rapidly. Therefore, the resolution of the best observation of GGA was about 15 cm. For the TSA, as the gradual decrease of resolution, the information entropy kept stable between 5.7 and 5.75, with little change. However, the degradation of identification accuracy was speedy, from 87.52% of 3 cm to 82.13% of 51 cm. This is likely to be related to the complexity of typical grasslands. Moreover, the stability of the entropy indicated that the image was always at a certain complexity, and the rapid decrease in accuracy indicated that the resolution of the best observation in the TSA was below 3 cm. For the DSA, when the resolution was between 3 and 51 cm resolution, the information entropy increased from 4.84 to 4.97. However, the accuracy drop was not fast, just from 92.31% to 91.31%, only about one percentage point. This illustrates two issues: on the one hand, because the ecosystem structure of the desert steppe is relatively simple, the recognition accuracy maintained a high state; on the other hand, due to the formation of a large number of mixed pixels, the spatial difference was continuously weakened. As a result, the entropy of the TSA was constantly increasing as the resolution decreased. Therefore, the optimal resolution of the DSA was below 3 cm, but increasing the resolution may not significantly improve the recognition accuracy. The best GSD for shrub identification in different regions was probably due to differences in the complexity of the distribution and size of shrubs and environmental disturbances. For the GGA, because the ecosystem of it is simple, the shrubs are artificially planted and arranged regularly, the best observation accuracy was as high as 15 cm, much larger than that of the TSA and DSA. Due to the influence of natural conditions and human disturbance, the ecosystem complexity of the TSA and DSA is more complicated, so the best observation accuracy was relatively small (less than 3 cm). Uncertainties, Errors, and Accuracies From the above analysis, CODA can make up for the deficiency of OOF and DSM-DTM in shrub Uncertainties, Errors, and Accuracies From the above analysis, CODA can make up for the deficiency of OOF and DSM-DTM in shrub identification. In this study, three kinds of interference factors were extracted: bare highland/rocks, depression, and highland, respectively ( Figure 9): Bare highland/rocks: bare surface protrusions can interfere with the results of DSM-DTM algorithm, but can be easily eliminated by OOF. Depression: small pieces of grasslands in terrain-depression often means better hydrological conditions, so its ExG-ExR value always seems larger, which will interfere with the results of OOF. While no protrusions will be formed in the DSM-DTM in terrain-depression area this kind of interference can be eliminated. Highland: these kind of surface protrusions tend to have a small slope in edges, so they can be filtered by the ratio of the maximum height to the area ( filter in this paper). Therefore, the above several interference factors are effectively extracted in the algorithm (CODA) proposed in this study, so the results are more in line with the real situation. Remote Sens. 2019, 11, x FOR PEER REVIEW 15 of 20 paper). Therefore, the above several interference factors are effectively extracted in the algorithm (CODA) proposed in this study, so the results are more in line with the real situation. Figure 9. Why is the accuracy of CODA is higher than that of OOF and DSM-DTM? In this paper, structure from motion (SfM) and multi-view stereopsis (MVS) technology were used to analyze UAS images in shrub-encroached grassland area, to produce point cloud data with sufficient density and then produce DSM. In the above process, the overlap and multi-angle photography of UAS images become the direct influence factors of point cloud density. Therefore, in addition to the apparent influence of height above ground level (AGL) on the shrub recognition accuracy, overlap rate and multi-angle photography were also significant covariates affecting the recognition accuracy. Currently, many scholars have also used SfM and MVS technology to carry out accuracy analysis. Georg et al. retrieve and identify sward height by UAS remote sensing under the assumption of crop surface models (also known as CSM). Under the largely fixed height and overlap rate set by our experiment, the average point cloud densities for DSM production exceeded 1000 pointsm −2, which were enough for shrub identification. However, there was no multi-angle photography in our experiment, only vertical downward shooting. For the shrub model in the Mongolian Plateau, how much improvement of DSM accuracy can be achieved by choosing multi-angle capturing is an essential issue in future research. At present, the variability of point cloud density is considerable (the standard deviation in the GGA was 56.21 pointm −2, while the standard deviation of the TSA was 159.73 pointm −2, see Table 1). Nevertheless, the information of shrub structure can be supplemented by multi-angle photography, which might improve the stability of point cloud density. In addition, the bands were not normalized before the ExG-ExR computation. But we still believe that our methods and results have a certain meaning. On the one hand, our goal was to identify the shrubs, so slight color differences do not have a significant impact on accuracy. On the other hand, we chose clear cloudless mornings to collect images, and camera parameters, such as aperture, ISO, were fixed to make the whole images homogeneous and reliable. Moreover, there were no GCPs used in DSM/DOM production. However, for more reliable and scientific analysis, we will pay attention to these issues in future research. Figure 9. Why is the accuracy of CODA is higher than that of OOF and DSM-DTM? The Contrast of Several Different Recognition Methods for Shrubs In this paper, structure from motion (SfM) and multi-view stereopsis (MVS) technology were used to analyze UAS images in shrub-encroached grassland area, to produce point cloud data with sufficient density and then produce DSM. In the above process, the overlap and multi-angle photography of UAS images become the direct influence factors of point cloud density. Therefore, in addition to the apparent influence of height above ground level (AGL) on the shrub recognition accuracy, overlap rate and multi-angle photography were also significant covariates affecting the recognition accuracy. Currently, many scholars have also used SfM and MVS technology to carry out accuracy analysis. Georg et al. retrieve and identify sward height by UAS remote sensing under the assumption of crop surface models (also known as CSM). Under the largely fixed height and overlap rate set by our experiment, the average point cloud densities for DSM production exceeded 1000 pointsm −2, which were enough for shrub identification. However, there was no multi-angle photography in our experiment, only vertical downward shooting. For the shrub model in the Mongolian Plateau, how much improvement of DSM accuracy can be achieved by choosing multi-angle capturing is an essential issue in future research. At present, the variability of point cloud density is considerable (the standard deviation in the GGA was 56.21 pointm −2, while the standard deviation of the TSA was 159.73 pointm −2, see Table 1). Nevertheless, the information of shrub structure can be supplemented by multi-angle photography, which might improve the stability of point cloud density. In addition, the bands were not normalized before the ExG-ExR computation. But we still believe that our methods and results have a certain meaning. On the one hand, our goal was to identify the shrubs, so slight color differences do not have a significant impact on accuracy. On the other hand, we chose clear cloudless mornings to collect images, and camera parameters, such as aperture, ISO, were fixed to make the whole images homogeneous and reliable. Moreover, there were no GCPs used in DSM/DOM production. However, for more reliable and scientific analysis, we will pay attention to these issues in future research. The Contrast of Several Different Recognition Methods for Shrubs The CODA, OOF and DSM-DTM algorithms were compared with the current popular shrub extraction algorithms in remote sensing. As shown in Table 7, the accuracy of CODA (89.96%) was second only to the semi-manual labeling used by Goslee (95%) and was similar to the accuracy of the method used by Dong to combine object-oriented extraction with support vector machine (SVM). The high precision of CODA depends mainly on two reasons: Full use of multiple dimensional information: CODA makes full use of the various information that can be extracted by UAS remote sensing, especially using surface elevation data, which is not used in other studies. Also, the single accuracy of OOF (84.52%) and DSM-DTM (78.44%) was lower than that of CODA, which means DSM-DTM could make up for the shortcomings of OOF. So, CODA has the advantage of higher precision. High resolution of UAS data: The spatial resolution (0.02 m) of the image data used in this study was much higher than other research. Therefore, compared with others using high-resolution satellite remote sensing data, the proposed CODA algorithm is more suitable for shrub-encroached grassland and grassland degradation research on smaller scales (e.g., farms, villages). Prospective In this study, the research carried out accuracy verification and quantitative statistical analysis of desert steppe and typical steppe based on the CODA method. Also, it can be further used to study shrub-encroached grassland mechanism or grassland degradation in the Mongolian Plateau through regional statistics, regional topology, and shrub structure. Regional Statistics: For the shrub-encroached grassland, in addition to counting the number of shrubs, it can also be analyzed through various aspects such as shrub area statistics and shrub size statistics. The shrub sizes and shrub areas, to some extent, reflect the stage of the process of shrub-encroached process. Under the same climatic conditions, generally smaller shrubs probably mean that the beginning time of shrub-encroachment in this area is relatively short. Also, the difference in shrub size and shrub area may also indicate that grassland pressure in this area is more persistent than that in areas with less difference. Regional Topology: Many scholars have analyzed the distribution characteristics of shrubs, such as random distribution, cluster distribution, etc.. Therefore, the average spacing between shrubs and their differences can reflect the community structure of the shrubs, the path of seed propagation, to some extent, reflect the mechanism of the shrub-encroached process. Shrub Structure: The morphological structure and spectral characteristics of shrubs with different production mechanisms may also differ. Figure 10a is the ideal shrub model, which was also the shrub model assumed in this paper. As a result, the ExG-ExR of the ideal shrub is homogeneous. Because other grasslands often form mixed pixels with bare soil, the ExG-ExR of shrubs is larger than the other grassland. However, the actual formation of shrubs usually has different formation mechanisms: for example, in Figure 10b, the Stipa Grandis is occupied by herbs after being eaten by the animals, and the surrounding soil is weathered and denuded, which causes the bulge of the earth's surface. Due to long-term wind direction and other factors, its ExG-ExR is inconsistent in all directions. That is to say, the bidirectional reflectance distribution function (BRDF) of this shrub has a positive correlation with the formation mechanism of the shrub. Based on CODA, combined with the above features, the shrub-encroached mechanism can be further analyzed. Conclusions The object-oriented filter algorithm and the DSM-DTM terrain analysis algorithm were combined to make full use of the DOMs and DSMs of UAS remote sensing to establish a highaccuracy automatic shrub identification algorithm, namely CODA. In this paper, CODA was used in the shrub identification of two test areas of typical and desert steppe in the Mongolian Plateau. Then, the information entropy theory was used to analyze the scale effect of UAS remote sensing in shrub identification. The results showed that CODA had high-accuracy performance, specifically: The overall accuracy of CODA was 89.96% in the Grain for Green test area (GGA), which was higher than a single OOF algorithm (accuracy: 84.52%) or DSM-DTM algorithm (accuracy: 78.44%). This was because CODA could combine the advantages of the above two methods mostly. Specifically, CODA could effectively eliminate interference factors such as shrub-like highland and well-grown grassland in terrain-depression area. Also, the CODA identification performance was related to the shrub density: as the density increased, the accuracy decreased slightly. CODA was adaptable to the typical steppe test area (TSA) and the desert steppe test area (DSA), in which the shrub identification accuracy was 87.5% and 92.5%, respectively. Especially, shrub density of the TSA was smaller, and the regional difference of the TSA was more significant, which was likely to be related to the higher community structure complexity of typical steppe. Conflicts of Interest: The authors declare no conflict of interest. Acknowledgments: We would like to thank Xin Wen and Xingguang Ma for their support in the field. Also, we Conclusions The object-oriented filter algorithm and the DSM-DTM terrain analysis algorithm were combined to make full use of the DOMs and DSMs of UAS remote sensing to establish a high-accuracy automatic shrub identification algorithm, namely CODA. In this paper, CODA was used in the shrub identification of two test areas of typical and desert steppe in the Mongolian Plateau. Then, the information entropy theory was used to analyze the scale effect of UAS remote sensing in shrub identification. The results showed that CODA had high-accuracy performance, specifically: The overall accuracy of CODA was 89.96% in the Grain for Green test area (GGA), which was higher than a single OOF algorithm (accuracy: 84.52%) or DSM-DTM algorithm (accuracy: 78.44%). This was because CODA could combine the advantages of the above two methods mostly. Specifically, CODA could effectively eliminate interference factors such as shrub-like highland and well-grown grassland in terrain-depression area. Also, the CODA identification performance was related to the shrub density: as the density increased, the accuracy decreased slightly. CODA was adaptable to the typical steppe test area (TSA) and the desert steppe test area (DSA), in which the shrub identification accuracy was 87.5% and 92.5%, respectively. Especially, shrub density of the TSA was smaller, and the regional difference of the TSA was more significant, which was likely to be related to the higher community structure complexity of typical steppe.

KANDAHAR, Afghanistan (Reuters) - Taliban fighters killed 26 soldiers and wounded 13 others in an attack on an army base in the southern province of Kandahar, the defense ministry said on Wednesday, as heavy fighting raged across the country. Officials said the Taliban had attacked overnight an outpost in Khakriz district, to the north of Kandahar city, seizing the outpost and capturing weapons and vehicles. Troops later recaptured the post. “The enemy pressure was too heavy,” defense ministry spokesman General Dawlat Waziri said. The attack came after days of fierce fighting across Afghanistan and underlined the steadily deteriorating security in much of the country, which has also seen a string of high profile attacks in cities including the capital Kabul. As security has worsened, the Swedish Committee for Afghanistan, which runs medical clinics and educational activities, said it had been forced to close 20 clinics and its health management office in Laghman province, east of Kabul following threats from armed opposition groups. While the fighting has intensified, the United States, which is expected to send around another 4,000 troops to Afghanistan to bolster its existing training mission, is still to announce its new strategy for the region. The Taliban, fighting to restore Islamic rule to Afghanistan 16 years after being driven from power by a U.S.-led campaign, controls or contests at least 40 percent of the country, inflicting what U.S. advisers say are unsustainable casualties on Afghan security forces. In the first 10 months of last year alone, some 6,785 soldiers and police were killed. On Wednesday, the Taliban’s main spokesman said the insurgents were close to taking Waygal district in the eastern province of Nuristan, a day after they took Jani Kheil district in Paktika province, further to the south. Over the past week, the insurgents have also taken districts in Ghor province in the west and Faryab in the north, although the defense ministry said government forces had retaken Kohistan district in Faryab. Kunduz, the northern city which the Taliban captured briefly in 2015 and managed to enter in 2016, has also been under heavy pressure. U.S. advisers say that Afghan security forces, fighting largely alone since a NATO-led coalition ended its main combat mission in 2014, have made progress but still rely too much on vulnerable checkpoints exposed to Taliban attack.

The struggle to develop nursing research in Turkey. BACKGROUND Little is known internationally about nursing research in Turkey. The development of nursing research would, however, provide a distinctive perspective on health needs and service provision. To understand the development of nursing research in Turkey, the development of nursing research in other countries might be analysed. AIM To describe the development of nursing research and education in Turkey in a European context. FINDINGS The evolution of nursing research in Europe is discussed and the importance of setting nursing research priorities described. Different countries in the world are then examined for the development of nursing research and priorities. Finally, the development of nursing education, nursing research and priorities in Turkey are analysed and discussed in the context of the political and social background. CONCLUSION The development of Turkish nursing research may still be insufficient in relation to the development of nursing research in Europe, but it is following global developments. Over the past years, there has been an increased interest in nursing research and Turkish nurses work hard to produce work for international publication.

Once a year the Holy Mother of God Greek Orthodox Church presents the Greek Food Festival. Catch the first whiff when it opens Friday and Saturday, 10 a.m. to 10 p.m. Pastitsio: A hearty casserole of seasoned ground beef, Greek-style macaroni topped with a creamy bechamel sauce. Souvlaki: Succulent, lean cubes of pork skewered and marinated Greek-style charcoal grilled to perfection. Spanakopita: Spinach, feta cheese, and herbs wrapped in flaky, buttery filo. Tiropita: A savory feta cheese and herbs wrapped in flaky, buttery filo. Fassolakia: Tasty Greek-style green beans with tomato and onions. Athenian Greek Salad: Lettuce, tomatoes, green peppers and onions, topped with delicious homemade creamy Greek dressing, feta, kalamata olives, salonika pepper and a roll. Veggie Platter: Homemade meatless pastitsio, tiropita, spanakopita, fassolakia, Greek salad and a roll. Many of the recipes that are used at the festival were brought over from Greece by the parents of some of the church founding members, which means you are eating food just like the food you would eat at a festival in Greece. Zorba's Gyro: The Gyro is to Greece what the hamburger is to America. Tantalizingly delicious thin slices of beef and lamb wrapped in a grilled flattened Pita and topped with onions, chopped tomatoes, and mouth-watering Tzatziki sauce. Manoli's Souvlaki Wrap: Choice of succulent lean cubes of pork or chicken, marinated Greek-style and wrapped in Pita bread with tomatoes and onions topped with Tzatziki sauce. Of course, there are the famous Greek pastries, including everybody's favorite, baklava and its variations. Almond cookies, wedding cookies, pecan blossoms and many more. You may want to go ahead and get the Greek Pastry Express Box, which includes finikia, kataife, kourambiedes, walnut swirl, pecan blossom, almond cookie and baklava. Whatever you are in the mood for, come to the Greek Food Festival and enjoy the tasty authentic Greek food and also get a taste of Greek culture.

Hear 'Eliot St.' From A New Album By Quilt YouTube I'm happy to have new music from the harmonious and ethereal band Quilt. The Boston quartet's 2014 album, Held in Splendor, is a favorite of mine. Their third album, Plaza, is coming on Feb. 26, and this first new song "Eliot St.," is a pleasant extension of the band's sound. "Eliot St." begins with guitar reminiscent of John Lennon's strummed opening to The Beatles' "A Day in the Life" and includes a very bubbly Paul McCartney-esque bass line from Quilt's new bassist Keven Lareau. The song was written by Shane Butler, who said via email that the song is about his memories walking that Boston street and calling his mother "to confess my troubles, triumphs and questions in life." Shane says: "The first part of the song was written over a period of time in which I found myself isolated from the city I had lived in for years, entered an emotionally rocky relationship which slowly disintegrated, and experienced my mother's death. The choruses hover around the pain felt in moments of unknowing, feeling adrift and always 'one-step-away-from' the person or thing we wish to be close to. The bridge of the song serves as a devil's advocate of sorts; a wake-up call in the midst of despair. And the song's coda takes strength from the intention of the bridge to suggest a renewal, a 'second-wind', for a love once-lost." To flesh out some of these ideas, the band performed the song with strings arranged by Simon Hanes. The sound that resembles a Mellotron I discovered is drummer John Andrews playing a Wurlitzer through a distortion pedal. And of course the strength in Quilt are those familiar, warm harmonies including Andrews bu, in particular the interplay between Shane Butler and Anna Fox Rochinski. I look forward to being kept cozy this winter with the release of Plaza.

Police badge. (iStock) A New York professor drew ire from City University administrators and law enforcement officials because of a tweet in which he said teaching “future dead cops” is “a privilege.” Michael Isaacson, an adjunct professor at CUNY’s John Jay College of Criminal Justice, was placed on administrative leave because of the three-week-old tweet, which appears to have recently caught the attention of the college’s president and New York City’s largest police union. In a tweet on Aug. 23, Isaacson, who teaches economics, said: “Some of ya’ll might think it sucks being an anti-fascist teaching at John Jay College but I think it’s a privilege to teach future dead cops.” In a statement Friday, John Jay College President Karol V. Mason called Isaacson’s comments “abhorrent” and the “antithesis” of an academic institution that trains future law enforcement. While she said that professors have a right to free speech and academic freedom, “expressions of hate or intimidation are not welcome in that civil discourse.” “This adjunct expressed personal views that are not consistent with our college’s well known and firm values and principles and my own personal standards and principles. I am appalled that anyone associated with John Jay, with our proud history of supporting law enforcement authorities, would suggest that violence against police is ever acceptable,” Mason said. [A university professor suggested Harvey was karma for Texas Republicans. Then, he was fired.] Mason added that faculty members and students have been threatened as a result of the tweet, and Isaacson was placed on administrative leave for safety reasons. In an email to The Washington Post, Isaacson, an anti-fascist activist, said he “unequivocally” supports the college’s decision “in the interest of public safety,” and he apologizes to faculty members and his students for placing them at risk. “I am saddened that I cannot continue to teach my students, but I value their safety and the safety of the John Jay community above all else,” he said, adding later: “My [principal] regret is that I put people at risk who did not assume that risk voluntarily.” The decision to place Isaacson on administrative leave was announced on the same day that the Patrolmen’s Benevolent Association of the City of New York, a union that represents 50,000 active and retired police officers, called for Isaacson’s firing. [Antifa: Guardians against fascism or lawless thrill-seekers?] Patrick J. Lynch, the union’s president, railed against what he described as “disgusting anti-police attitudes” and “gleeful embrace of political violence.” “It is absolutely outrageous that an individual who holds and expresses these views could be employed by any academic institution, much less one that counts an overwhelming number of New York City police officers as among its students, alumni and faculty members,” Lynch said in a statement. Isaacson will remain on administrative leave while university officials review the matter, Mason said. New York Police Commissioner James O’Neill and New York Mayor Bill de Blasio (D) also have weighed in: As a 2x grad there, I know Michael Isaacson's reprehensible values don't represent @JohnJayCollege, #NYC, #NYPD or families of murdered cops pic.twitter.com/EdSEA0u525 — Commissioner O'Neill (@NYPDONeill) September 15, 2017 New York City won't stand for the vile anti-police rhetoric of Michael Isaacson and neither should John Jay College. — Bill de Blasio (@NYCMayor) September 15, 2017 Isaacson shot back at de Blasio in a series of tweets Saturday. He said the mayor, whose rift with the city’s police force is well documented, attacked free speech, academic freedom and John Jay College’s administrative autonomy. According to Isaacson’s résumé, he began teaching economics at John Jay last year. Before that, he was a lecturer at Long Island University, New York University and Howard University. Though many of his students intend to go into law enforcement, he said he teaches them the “economic reality” of that career choice. He said he hopes to encourage his students “to think critically about what they hope to offer their communities and whether law enforcement is the best avenue to achieve that.” He said that law enforcement as an institution operates in the interest of the weapons and prison industries, and not the communities it’s sworn to serve. “Every bullet fired is revenue for the weapons industry. Every prisoner is revenue for the prison industry,” he said, adding that policing as an institution has disproportionately placed a burden on low-income people and communities of color. [Professor who said ‘clueless white male’ Otto Warmbier got ‘what he deserved’ won’t be rehired] In a statement posted Friday on Twitter, he said he hopes his students can find a career path “that does not put them in the position of having to act as an agent of that institution.” Isaacson describes himself as an anti-fascist and anarchist and has said that he believes President Trump is a fascist. He said the media has misrepresented anti-fascist activists, or antifa, as members of a violent group and ignored “the vast majority” of advocacy work that does not involve violence and tries to avoid physical conflict. Anti-fascism, he said, is about “engaging and serving communities” against the threat from white supremacists, Nazis and the Ku Klux Klan. But as a result of violence hyped in the media, many have joined the antifa ranks “purely on the basis of thrill-seeking rather than community support,” he said. Last month, however, images broadcast across the country showed dozens of anarchists and antifa members, their faces hidden behind black bandannas and hoodies, jumping over barricades at the Martin Luther King Jr. Civic Center Park in Berkeley, Calif., and attacking a handful of Trump supporters and right-wing activists. In another controversial protest, dozens of antifa activists smashed windows and lit fires on the University of California campus in Berkeley in February, leading the university to cancel a speech by right-wing blogger Milo Yiannopoulos. [Professor fired after defending blacks-only event to Fox News. ‘I was publicly lynched,’ she says.] Isaacson defended his view in a combative Fox News interview Thursday with Tucker Carlson, who has described antifa as a “political militia that is doing the bidding” of Democratic politicians like House Minority Leader Nancy Pelosi (Calif.) and California Gov. Jerry Brown. Here’s part of the exchange: Isaacson: I believe that communities have the right to defend themselves against threats against to themselves, to the community. Carlson: Against ideas you don’t like? Isaacson: No, against people who have explicitly said that they want to eliminate those people from our society. Carlson: But you’re conflating violence with ideas. Isaacson: No, I’m not. Carlson: If I have not raised my hand to strike you, you have no right to strike me. Isaacson is not the only professor to get in trouble with the universities they work for over a controversial statement. In June, Lisa Durden was fired from Essex County College in Newark after she gave a confrontational Fox News interview, which was also with Carlson. “Boo hoo hoo, you white people are angry because you couldn’t use your white privilege card to get invited to the Black Lives Matter’s all-black Memorial Day Celebration,” Durden said. [Berkeley prepares for Ben Shapiro speech with pepper spray, concrete barriers and lots of police] Another professor, Kathy Dettwyler, was fired the same month after she wrote on Facebook that Otto Warmbier, who was taken into custody in North Korea, then fell into a coma and died, was a “clueless white male” who “got exactly what he deserved.” More recently, last month, Kenneth Storey was fired from the University of Tampa after he appeared to suggest in a series of tweets that Hurricane Harvey is karma for Texas for voting Republican. The series of firings have drawn criticisms from the Foundation of Individual Rights in Education, which advocates for free-speech rights at American colleges and universities. Ari Cohn, an attorney for the organization, said professors should be able to express diverse views and ideas in a public forum, as long as they’re not speaking on behalf of the academic institutions they work for. The firings, he said, could force faculty members to be silent for fear of offending people online and getting fired. “Administrators, especially in recent months, have been capitulating to outrage mobs and firing professors left and right because they offended someone,” he said. Michael E. Miller and Kyle Swenson contributed to this story. READ MORE: Black-clad antifa members attack peaceful right-wing demonstrators in Berkeley The man who organized the Charlottesville rally is in hiding — and too toxic for the alt-right ‘Hate speech is not protected by the First Amendment,’ Portland mayor says. He’s wrong.

Association of factor V Leiden mutation with delayed graft function, acute rejection episodes and long-term graft dysfunction in kidney transplant recipients. We analysed whether the factor V Leiden mutation--the most common hereditary predisposing factor for venous thrombosis--is associated with early and long-term graft dysfunction after kidney transplantation in 394 Caucasian kidney transplant recipients. The presence of factor V Leiden mutation was identified by allele specific PCR. The prevalence of the factor V Leiden mutation was compared to 32216 unselected neonates. The prevalence of the factor V Leiden mutation (GA genotype) was similar in 394 kidney transplant recipients and 32216 neonates. The frequency of known factors predicting long-term graft function were similar in patients with the GA genotype and with the normal factor V gene (GG genotype). The GA genotype was associated with the occurrence of no primary graft function (risk: 2.87: 95% confidence interval: 1.01-8.26; p < 0.05), the number of dialysis after transplantation in patients with no primary graft function until graft function (7.5 +/- 2.06 dialysis in GA patients; 4.2 +/- 0.36 dialyses in GG patients; p < 0.05), and the risk for at least one acute rejection episode (risk: 3.83; 95% confidence interval: 1.38-10.59; p < 0.02). The slope of l/creatinine per year was significantly lower in patients with the GA genotype (GA patients: -0.0204 +/- 0.008 dl/mg per year; GG patients: 0.0104 +/- 0.004 dl/mg per year; p < 0.02). The annual enhancement of the daily protein excretion rate was elevated in patients with the GA genotype (GA patients: 38.5 +/- 16.6 mg/24 h per year; GG patients: 4.9 +/- 4.4 mg/24 h per year; p < 0.02). Our study showed that the factor V Leiden mutation is associated with the occurrence of delayed graft function, acute rejection episodes and chronic graft dysfunction after kidney transplantation.

Magnetic Effects in Color-Flavor Locked Superconducting Phase with the Additional Chiral Condensates In the color-flavor locked quark superconducting phase with the additional chiral condensates, the magnetic effects are investigated within the three-flavor NambuJonaLasinio framework. Based on the rotated electromagnetic mechanism, we incorporate the effective quark masses into the coexistence phase self-consistently. The numerical calculation shows that the magnetic catalysis of effective masses is different from the known phenomenon that occurs in the unpaired quark matter. Moreover, the interplay between magnetic catalysis and gap splitting is studied for the first time.

Io's volcanism controls Jupiter's radio emissions Jupiter's sodium nebula showed an enhancement in late May through the beginning of June 2007. This means Io's volcanic activity and the magnetosphere's plasma content increased during this period. On the other hand, Jupiter's radio emission called HOM became quiet after the sodium nebula enhancement. The HOM emission is considered to be related to the activity of aurorae on Jupiter. These observation results therefore suggest that the increase in plasma supply from Io into Jupiter's magnetosphere weakens its fieldaligned current, which generates the radio emissions and aurorae on Jupiter. By comparing our observation results to recent model and observation results, we add supporting evidence to the possibility that Io's volcanism controls Jupiter's magnetospheric activity.

Muse frontman Matt Bellamy used the news of the first photo of a black hole to make reference to one of the band’s most famous songs. Scotland is leading the way and can win a European space race, an MSP has said. Budding astronomers or anyone interested in the night sky have been invited to potentially witness a meteorite shower at a special Moray stargazing showcase. A bitter row over the multi-million-pound spaceport planned for Sutherland has split a rural crofting community. Nasa has confirmed that its Parker Solar Probe is now closer to the sun than any spacecraft has ever been. Two astronauts from the US and Russia are safe after an emergency landing in Kazakhstan following the failure of a rocket taking them to the International Space Station. A scouting device has landed on the surface of an asteroid as part of a research effort that could help reveal the origins of the solar system, Japanese officials have said. Nasa has assigned the astronauts who will ride the first commercial capsules into orbit next year and bring crew launches back to the US. Scotland has always been at the forefront of scientific advances. A SpaceX rocket that flew just two months ago with a Nasa satellite has roared back into action, launching the first orbiting robot with artificial intelligence and other station supplies. A Japanese space explorer has arrived at an asteroid after a three-and-a-half-year journey and now begins its real work of trying to blow a crater to collect samples to eventually bring back to Earth. Nasa astronaut Joseph Acaba has revealed he held on tight while doing a spacewalk during a recent trip to the International Space Station as he is afraid of heights. NASA is set to inspire the next generation of space enthusiasts in Aberdeen. Leading Britpop singers from the 1990s will headline a music festival in Keith this summer. Nasa has begun exploring parts of 'Scotland' in a bid to discover the secrets of Mars. He was the ninth person to walk on the moon when he commanded the Apollo 16 space mission. Renowned scientist and television presenter Heinz Wolff has died aged 89. Human beings will discover life beyond earth “relatively soon”. This stunning timelapse footage shows how the vivid auroras in Jupiter's atmosphere were formed. A group of north-east Brownies have had an out of this world delivery from astronaut Tim Peake. A huge flash of white light was reportedly seen from as far south as Stirling to Aberdeenshire, Moray and as far north as Portmahomack.

The binding of indole to the alpha-subunit and beta2-subunit and to the alpha2beta2-complex of tryptophan synthase from Escherichia coli. Identification of a second indole-binding site on the alpha-subunit. The binding of indole and indolepropanol phosphate, an analogue of the substrate indoleglycerol phosphate, to the individual alpha and beta2-subunits and to the alpha2beta2-complex of tryptophan synthase was studied by equilibrium dialysis. The use of indole and indolepropanol phosphate permitted simultaneous binding studies to be carried out. Competition between indole and indolepropanol phosphate in binding to a particular site was taken as evidence for that site being part of the active site of the alpha-subunit. The binding of indole to the active site of the alpha-subunit is weak (Kd = 18mM). A second distinct site binds indole more strongly (Kd = 1.5 mM) and interacts with the active site indirectly. It is therefore designated an effector site. Furthermore, the binding of indole and/or indolepropanol phosphate appears to stabilize different conformations of the alpha-subunit. The beta2-subunit binds indole only weakly (Kd = 12 mM) to many (n = 10) sites per polypeptide chain. The alpha2beta2-complex retains one or two sites per alphabeta-equivalent of relatively high affinity (Kd = 1.2 mM). The active sites of the component alpha and beta-subunits probably belong to the second class of many (n = 40) sites of low (Kd = 30 mM) affinity for indole. These findings support conclusions from the literature that both bi-substrate reactions involving indole catalyzed by tryptophan synthase and its subunits must follow strictly ordered addition mechanisms with the respective other substrate adding first.

Blend flour, sugar and salt in processor. Add butter and shortening and cut in using on/off turns until mixture resembles coarse meal. Add 2 tablespoons ice water; process using on/off turns until small moist clumps form, adding more water by teaspoonfuls if dry. Gather dough into ball. Flatten into disk. Wrap in plastic; chill 30 minutes. Position rack in bottom third of oven and preheat to 375 degrees. Roll out dough on floured surface to 12-inch round. Transfer dough to 9-inch-diameter pie dish. Fold overhang under, forming high-standing rim. Crimp edges decoratively. Freeze 15 minutes. Brush crust all over with yolk. Bake until crust is set but still pale, about 15 minutes. Cool slightly.