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Observed surface air temperature has increased in the 20th century all over Asia (high confidence1).Asian countries are experiencing a hotter summer climate, resulting in an increase in energy demand for cooling at a rapid rate, together with population growth (high confidence). A decrease in precipitation influences energy demand as well, asAsian terrestrial ecosystems change is driven by global warming, precipitation and Asian monsoonalteration, permafrost thawing and extreme events like dust storms along with natural and human-related factors which are in interplay (high confidence).Coastal habitats of Asia are diverse and the impacts of climate change including rising temperature,ocean acidification and sea-level rise have brought negative effects to the services and the livelihood ofpeople depending on it (high confidence).Both climatic and non-climatic drivers such as socio-economic changes have created water stressconditions in both water supply and demand in all sub-regions of Asia (high confidence).The Asia glaciers are in minor area shrinkage and mass loss during 2006-2016, resulting in theinstability of water resource supply (high confidence). Since IPCC AR5, more studies reinforce the earlier findings on the spatial and temporal diversity of climatechange impacts on food production in Asia depending on the geographic location, agroecology, and cropsgrown, recognizing that there are winners and losers associated with the changing climate across scales (highconfidence). Asian urban areas are considered high-risk locations from projected climate, extreme events,unplanned urbanisation, and rapid land-use change (high confidence) but also sites of ongoing adaptation(medium confidence).Climate change caused direct losses due to the damage in infrastructure, disruption in services andaffected supply chains in Asia (medium confidence) and will increase the risk to infrastructure as well asprovide opportunities to invest in climate-resilient infrastructure and green jobs (medium confidence).Climate change is increasing vector-borne and water-borne diseases, undernutrition, mental disorders and allergic diseases in Asia by increasing the hazards such as heatwaves, flooding and drought, airpollutants, in combination with more exposure and vulnerability (high confidence). Increased climate variability and extreme events are already driving migration (robust evidence,medium agreement) and projecting longer-term climate change will increase migration flows acrossAsia (medium confidence).There is a small but growing literature highlighting the importance of behavioural aspects ofadaptation in Asia (high confidence) but this is restricted primarily to agriculture and disaster riskreduction.Climate change is already causing economic loss and damage across Asian regions and this willincrease under higher warming (medium confidence).Options such as climate smart agriculture, ecosystem-based disaster risk reduction, investing in urbanblue-green infrastructure meet adaptation, mitigation, and sustainable development goalssimultaneously, presenting opportunities for climate-resilient development (CRD) pathways in Asia(high confidence).

This chapter contributes to improve an understanding of the effectiveness of different biodiversity science-policy interfaces (SPIs), which play a vital role in navigating policies and actions with sound evidence base. The single comprehensive study that was found to exist, assessed SPIs in terms of their ‘features’—goals, structure, process, outputs and outcomes. We conducted a renewed systematic review of 96 SPI studies in terms of these features, but separating outcomes, as a proxy for effectiveness, from other features. Outcomes were considered in terms of their perceived credibility, relevance and legitimacy. SPI studies were found to focus mostly on global scale SPIs, followed by national and regional scale SPIs and few at subnational or local scale. The global emphasis is largely explained by the numerous studies that focused on the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES). Regionally, the vast majority of studies were European, with a severe shortage of studies, and possibly SPIs themselves, in especially the developing world. Communication at the science-policy interface was found to occur mostly between academia and governments, who were also found to initiate most communication. Certain themes emerged across the different features of effective SPIs, including capacity building, trust building, adaptability and continuity. For inclusive, meaningful and continuous participation in biodiversity SPIs, continuous, scientifically sound and adaptable processes are required. Effective, interdisciplinary SPIs and timely and relevant inputs for policymakers are requiredto ensure more dynamic, iterative and collaborative interactions between policymakers and other actors.

\(\it Hintergrund:\) Eine Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Kindesalter stellt einen Risikofaktor für Substanzmissbrauch und Störungen durch Substanzgebrauch (Substance Use Disorder, SUD) in der Pubertät und dem (frühen) Erwachsenenalter dar. ADHS und SUD treten auch häufig bei therapiesuchenden Jugendlichen auf, was die Diagnosestellung und Therapie erschwert sowie mit schlechten Behandlungsergebnissen verbunden ist. Forschungsergebnisse über die Wirkung der Behandlung von ADHS im Kindesalter auf die Prävention von SUD im Jugendalter sind nicht eindeutig und Studien über die Diagnose und Behandlung von Jugendlichen mit ADHS und SUD sind selten. Daher reicht die verfügbare Evidenz allgemein nicht aus, um starke Behandlungsempfehlungen zu rechtfertigen. \(\it Fragestellung:\) Ziel dieser Arbeit war es, eine Konsenserklärung auf der Grundlage von wissenschaftlichen Daten und klinischen Erfahrungen zu erhalten. \(\it Methodik:\) Es wurde eine modifizierte Delphi-Studie durchgeführt, um basierend auf der Kombination von wissenschaftlichen Daten und klinischer Erfahrung mit einer multidisziplinären Gruppe von 55 Expert_innen aus 17 Ländern einen Konsens zu erzielen. Die Expert_innen wurden gebeten, eine Reihe von Aussagen über die Wirkung der Behandlung von ADHS im Kindesalter auf die SUD bei Jugendlichen sowie über das Screening, die Diagnostik und die Behandlung von Jugendlichen mit komorbidem ADHS und SUD zu bewerten. \(\it \(\it Ergebnisse:\) Nach drei iterativen Bewertungsrunden und der Anpassung von 37 Aussagen wurde ein Konsens über 36 dieser Aussagen erzielt, die sechs Bereiche repräsentieren: allgemein (\(\it n\) = 4), Risiko der Entwicklung einer SUD (\(\it n\) = 3), Screening und Diagnostik (\(\it n\) = 7), psychosoziale Behandlung (\(\it n\) = 5), pharmakologische Behandlung (\(\it n\) = 11) und komplementäre Behandlungen (\(\it n\) = 7). Der Einsatz von Routinescreenings auf ADHS wird bei adoleszenten Patient_innen in einer Suchtbehandlung ebenso wie Routinescreenings auf SUD bei jugendlichen Patient_innen mit ADHS in allgemeinpsychiatrischen Therapiesettings empfohlen. Langwirksame Stimulanzien werden als Behandlung der ersten Wahl von ADHS bei Jugendlichen mit gleichzeitiger ADHS und SUD empfohlen. Die Pharmakotherapie sollte vorzugsweise in psychosoziale Behandlung eingebettet werden. Die einzige nichtkonsentierte Aussage betraf die Notwendigkeit von Abstinenz vor Beginn einer pharmakologischen Behandlung bei Jugendlichen mit ADHS und gleichzeitigem SUD. Im Gegensatz zur Mehrheit verlangten einige Expert_innen eine vollständige Abstinenz vor Beginn einer pharmakologischen Behandlung, einige waren gegen die Verwendung von Stimulanzien bei der Behandlung dieser Patient_innen (unabhängig von Abstinenz), während einige sich gegen die alternative Anwendung von Bupropion aussprachen. \(\ Schlussfolgerungen:\) Diese internationale Konsenserklärung kann von Kliniker_innen und Patient_innen zusammen in einem gemeinsamen Entscheidungsprozess genutzt werden, um die besten Interventionen auszuwählen und die bestmöglichen Ergebnisse bei adoleszenten Patient_innen mit gleichzeitiger ADHS und SUD zu erzielen. \(\it Background:\) Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. \(\it Objective:\) The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. \(\it Method:\) A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. \(\it Results:\) After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (\(\it n\) = 4), risk of developing SUD (\(\it n\) = 3), screening and diagnosis (\(\it n\) = 7), psychosocial treatment (\(\it n\) = 5), pharmacological treatment (\(\it n\) = 11), and complementary treatments (\(\it n\) = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. \(\it Conclusion:\) This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

In this work, we provide a global framework analysis of a multi-hop relaying systems wherein the transmitter (TX) communicates with the receiver (RX) through a set of intermediary relays deployed either in series or in parallel. Regenerative based relaying scheme is assumed such as the repetition-coded decoded-and-forward (DF) wherein the decoding is threshold-based. To reflect a wide range of fading, we introduce the generalized $H$-function (also termed as Fox-$H$ function) distribution model which enables the modeling of radio-frequency (RF) fading like Weibull and Gamma, as well as the free-space optic (FSO) such as the Double Generalized Gamma and M\'alaga fading. In this context, we introduce various power and rate adaptation policies based on the channel state information (CSI) availability at TX and RX. Finally, we address the effects of relaying topology, number of relays and fading model, etc, on the performance reliability of each link adaptation policy.

Although greenery in urban areas has many functions, such as mitigation of the urban heat island effect, and reduction of rainfall-induced surface runoff, it is difficult to secure the space required to plant trees in cities, which are crowded with buildings. Therefore, rooftop greening has attracted attention and many cities are adopting and promoting this practice. However, the rise in the number and area of green roof has not resulted in an increase in the total area of urban green cover. In this study, we attempt to elucidate the detailed current status of central part of Nagoya using WorldView-2 images to obtain land cover information and extract the area under rooftop greening. We then analyze this status of rooftop greening according to zoning and building usage, and suggest methods to increase the urban green cover.

This Chapter highlights selected resilience and sustainability measures that can be implemented in cities and towns now to ensure that our communities, as well as future generations, will be able to deal with the difficult challenges our region faces. Sections 4.2 and 4.3 deal with building resilience of cities and towns to climate-related disasters and rising temperatures, while Section 4.4 covers potential measures that can be taken within the built environment to address the limited (and currently unsustainable use of) natural resources including fossil fuels, land, and water. Table 3 below summarizes the key issues and selected measures highlighted in this Chapter, together with the related SDGs.

Atopic dermatitis (AD) is a common, chronic, relapsing–remitting inflammatory disease that can be challenging to treat. Patients with mild disease are usually managed well with good skin care practices including moisturization and appropriate bathing along with intermittent use of topical therapies such as topical corticosteroids and/or topical calcineurin inhibitors during flares. Patients with frequent flares may benefit from proactive application of topical therapies twice a week to the most troublesome areas. Patients with severe disease often present significant treatment challenges. Systemic therapies are usually required for severe AD but have varying degrees of success and can be associated with side-effect profiles that require counseling and close monitoring. Phototherapy has been shown to have success in treating moderate-to-severe AD, but several factors can limit its utility and efficacy including cost and access. New therapies are in development targeting specific pathways relevant for AD. Dupilumab was the first biologic treatment approved in North America, Europe, and Japan for adults with moderate-to-severe AD. Although this treatment can lead to rapid improvement in the majority of patients, there are inadequate responders. In this review, we discuss the clinical challenges and treatment options for moderate-to-severe refractory AD.

This guidebook is intended to provide an overview of how to conduct climate change and land-use change impact assessments at the local level, so that the local impacts on water, biodiversity, and health can be better understood. A key aspect of the guidebook is the tutorials provided for conducting climate change/land-use change scenario analysis and impact assessment using free software. The methodology presented (PCLM) and training materials provided can help local governments with their climate change adaptation and land-use planning, and is designed to complement/support countries’ official planning processes. Using these training materials as a basis, more intensive in-person (or online) trainings can also be conducted to provide more specialized or location-specific trainings in priority sites. The data needed for the tutorials in this guidebook (1.7 gb) can be downloaded from:https://drive.google.com/uc?export=downloadid=1i7lbU6s8VIEkY3-sbWm5fPY…

Hintergrund: Eine Aufmerksamkeitsdefizit-/Hyperaktivit��tsst��rung (ADHS) im Kindesalter stellt einen Risikofaktor f��r Substanzmissbrauch und St��rungen durch Substanzgebrauch (Substance Use Disorder, SUD) in der Pubert��t und dem (fr��hen) Erwachsenenalter dar. ADHS und SUD treten auch h��ufig bei therapiesuchenden Jugendlichen auf, was die Diagnosestellung und Therapie erschwert sowie mit schlechten Behandlungsergebnissen verbunden ist. Forschungsergebnisse ��ber die Wirkung der Behandlung von ADHS im Kindesalter auf die Pr��vention von SUD im Jugendalter sind nicht eindeutig und Studien ��ber die Diagnose und Behandlung von Jugendlichen mit ADHS und SUD sind selten. Daher reicht die verf��gbare Evidenz allgemein nicht aus, um starke Behandlungsempfehlungen zu rechtfertigen. Fragestellung: Ziel dieser Arbeit war es, eine Konsenserkl��rung auf der Grundlage von wissenschaftlichen Daten und klinischen Erfahrungen zu erhalten. Methodik: Es wurde eine modifizierte Delphi-Studie durchgef��hrt, um basierend auf der Kombination von wissenschaftlichen Daten und klinischer Erfahrung mit einer multidisziplin��ren Gruppe von 55 Expert_innen aus 17 L��ndern einen Konsens zu erzielen. Die Expert_innen wurden gebeten, eine Reihe von Aussagen ��ber die Wirkung der Behandlung von ADHS im Kindesalter auf die SUD bei Jugendlichen sowie ��ber das Screening, die Diagnostik und die Behandlung von Jugendlichen mit komorbidem ADHS und SUD zu bewerten. Ergebnisse: Nach drei iterativen Bewertungsrunden und der Anpassung von 37 Aussagen wurde ein Konsens ��ber 36 dieser Aussagen erzielt, die sechs Bereiche repr��sentieren: allgemein (n = 4), Risiko der Entwicklung einer SUD (n = 3), Screening und Diagnostik (n = 7), psychosoziale Behandlung (n = 5), pharmakologische Behandlung (n = 11) und komplement��re Behandlungen (n = 7). Der Einsatz von Routinescreenings auf ADHS wird bei adoleszenten Patient_innen in einer Suchtbehandlung ebenso wie Routinescreenings auf SUD bei jugendlichen Patient_innen mit ADHS in allgemeinpsychiatrischen Therapiesettings empfohlen. Langwirksame Stimulanzien werden als Behandlung der ersten Wahl von ADHS bei Jugendlichen mit gleichzeitiger ADHS und SUD empfohlen. Die Pharmakotherapie sollte vorzugsweise in psychosoziale Behandlung eingebettet werden. Die einzige nichtkonsentierte Aussage betraf die Notwendigkeit von Abstinenz vor Beginn einer pharmakologischen Behandlung bei Jugendlichen mit ADHS und gleichzeitigem SUD. Im Gegensatz zur Mehrheit verlangten einige Expert_innen eine vollst��ndige Abstinenz vor Beginn einer pharmakologischen Behandlung, einige waren gegen die Verwendung von Stimulanzien bei der Behandlung dieser Patient_innen (unabh��ngig von Abstinenz), w��hrend einige sich gegen die alternative Anwendung von Bupropion aussprachen. Schlussfolgerungen: Diese internationale Konsenserkl��rung kann von Kliniker_innen und Patient_innen zusammen in einem gemeinsamen Entscheidungsprozess genutzt werden, um die besten Interventionen auszuw��hlen und die bestm��glichen Ergebnisse bei adoleszenten Patient_innen mit gleichzeitiger ADHS und SUD zu erzielen.

Generative Adversarial Networks (GANs) are one of the most creative advances in Deep Learning (DL) in recent years. The Remote Sensing (RS) community has adopted GANs quickly, and reported successful use in a wide variety of applications. Given a sharp increase in research on GANs in the field of RS, there is a need for an in-depth review of the major technological/methodological advances and new applications. In this regard, we conducted a comprehensive review and meta-analysis of GAN-related RS papers, with the goals of familiarizing the RS community with the potential of GANs and helping researchers further explore RS applications of GANs by untangling challenges common in this field. Our review is based on 231 journal papers that were retrieved and selected through the Web of Science (WoS) database. We reviewed the theories, applications, and challenges of GANs, and highlighted the gaps to explore in future studies. Through the meta-analysis conducted in this study, we observed that image classification (especially urban mapping) has been the most popular application of GANs, potentially due to the wide availability of benchmark datasets. One the other hand, we found that relatively few studies have explored the potential of GANs for analyzing medium spatial-resolution multi-spectral images (e.g., Landsat or Sentinel-2), even though such images are often freely available and useful for a wide range of applications (e.g., urban expansion analysis, vegetation mapping, etc.). In spite of the applications of GANs for different RS processing tasks, there are still several gaps/questions in this field such as: 1) which GAN models/configurations are more suitable for different applications?) 2) to what degree can GANs replace real RS data in different applications? Such gaps/questions can be appropriately addressed by, for example, conducting experimental studies on evaluating different GAN models for various RS applications to provide better insights into how/which GAN models can be best deployed. The meta-analysis results presented in this study could be helpful for RS researchers to know the opportunities of using GANs and understand how GANs contribute to the current challenges in different RS applications.

In this work, we present a framework analysis of millimeter waves (mmWaves) vehicular communications systems. Communications between vehicles take place through a cooperative relay which acts as an intermediary base station (BS). The relay is equipped with multiple transmit and receive antennas and it employs decode-and-forward (DF) to process the signal. Also, the relay applies maximal ratio combining (MRC), and maximal ratio transmission (MRT), respectively, to receive and forward the signal. As the vehicles' speeds are relatively high, the channel experiences a fast fading and this time variation is modeled following the Jakes' autocorrelation model. We also assume narrowband fading channel. Closed-form expressions of the reliability metrics such as the outage probability, the probability of error and the channel capacity are derived. Capitalizing on these performances, we derive the low and high power regimes for the capacity, and the high signal-to-interference-plus-noise-ratio (SINR) asymptotes for the outage and error probability to get full insights into the system gains such as the diversity and coding gains.

Objective: This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. Method: A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. Results: According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. Conclusion: The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. Scientific significance: On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.

Canadian Literature, No 207 (2010): Mordecai Richler

Objective This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. Method A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. Results According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. Conclusion The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. Scientific significance On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.

Additional file of Taxonomically restricted genes are associated with the evolution of sociality in the honey bee

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In this work, we consider the performance analysis of the uplink cellular networks with free space optics (FSO) backhauling. The user equipment (UE) communicates with the nearest Base Station (BS) in first slot while in second slot, the BS converts the received radio frequency (RF) signal into FSO pulse and transmits to the data center. We adopt the Rayleigh fading for the uplink channels while the FSO backhaul encompasses the turbulence-induced fading which follows the M\'alaga distribution, the weather pathloss, and the pointing errors fading which is distributed following the generalized Beckmann model. Further, we will compare the performances when the BS behaves as either a decode-and-forward (DF) relay or an intelligent reflecting surface (IRS). Next, we will propose an optimal design of the phase shifters of the IRS to minimize the interference and improve the rate to beat relaying. Capitalizing on this framework, we will derive the system performance metrics such as the coverage probability as well as the spectral efficiency. Focusing on high SNR, we will obtain the diversity gain to get engineering insights into the system performance and limitations. Finally, the analytical results are confirmed by Monte Carlo simulations.

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Johnson BB, Franco AI, Beck LA, Prezzano JC. Clin Cosmet Investig Dermatol. 2019; 12:181–192.On page 189, Ustekinumab section, “Ustekinumab is a human monoclonal antibody that binds to the shared p40 protein subunit of human IL-12 and IL-23, thereby preventing interaction with their shared receptor.86 It is currently approved for Crohn’s disease, plaque psoriasis, and psoriatic arthritis. In a systematic review of ustekinumab in the treatment of AD including eight cases and two RCTs (n=107), a total of 58% of patients showed improvement in their AD.86 While ustekinumab was well tolerated, it is likely that it may only be effective for a subset of AD patients such as those with early-onset AD and possibly AD subjects of Asian descent.87,88” should read “Ustekinumab is a human monoclonal antibody that binds to the shared p40 protein subunit of human IL-12 and IL-23, thereby preventing interaction with their shared receptor.86 It is currently approved for Crohn’s disease, plaque psoriasis, and psoriatic arthritis. In a systematic review of ustekinumab in the treatment of AD including eight cases and two RCTs (n=107), a total of 54% of patients showed improvement in their AD (not clinically significant).86 While ustekinumab was well tolerated, it is likely that it may only be effective for a subset of AD patients such as those with early-onset AD and possibly AD subjects of Asian descent, though there is little current evidence to support its use.87,88”Following feedback from a reader, we have clarified that the use of ustekinumab in the Pan et al study86 was not clinically significant. The authors apologize for this omission.Read the original article

Full text available at:https://onlinelibrary.wiley.com/share/author/CJXTXC7FFCKFZBJBWH2H?targe… Peatlands in tropical regions like Indonesia are undergoing irreversible subsidence due to changes in land use (e.g., deforestation) and land management practices (e.g., drainage alteration), resulting in massive amounts of soil carbon loss. Several satellite-borne synthetic aperture radar (SAR) sensors are operating concurrently at different frequencies, providing potentially useful data for monitoring surface motion over tropical peatlands. This study focused on the capability of C-band (SENTINEL-1) and L-band (PALSAR-2) SAR data to monitor the surface changes in the tropical peatlands area of Bengkalis Island, Indonesia, by applying time-series interferometric SAR (InSAR) with the small baseline subset (SBAS) technique. The average vertical velocity measured by SENTINEL-1 and PALSAR-2 for the period of 2018–2019 was 1.41 and 2.65 cm yr1 , respectively. We also explored the potential of groundwater level (GWL) data converted to vertical displacement for validating SBAS InSAR. PALSAR-2 performed the best, exhibiting lower RMSE values for each land use compared to SENTINEL-1, with an overall RMSE of 1.383 and 1.988 cm yr1 , respectively. Also, the subsidence rates of SENTINEL-1 were underestimated, showing a significantly lower mean subsidence difference (0.96 cm yr1 ) than the reference. Our GWL-based subsidence data offered an alternative validation method for InSARbased subsidence estimation. Therefore, the integration of time-series InSAR and GWL data can provide crucial information for monitoring the degradation of tropical peatlands.

This chapter describes the PEOIC (Policy and Earth Observation Innovation Cycle) project conducted to assess the impacts of Earth Observations on international environmental policies.

REDD+, a policy framework through which developing countries can receive incentives for reducing their greenhouse gas emissions in the forest sector, heavily relies upon Earth observation (EO) data for policy implementation. Thus the quality and quantity of the EO data used can have an impact on the effectiveness of REDD+. In this chapter, we: (1) evaluated the quality and quantity of the EO data currently being used by different countries and projects for REDD+, and (2) analyzed whether the EO data quality/quantity was determining the ways in which the countries/projects utilized the data; e.g. the number of REDD+ activities that emissions were assessed for (#activities) and the level of complexity of the models used to project future emissions (model_complexity]. We found that the EO data quality (spatial resolution of the EO imagery used) was basically uniform, while the data quantity (# of maps produced from EO data, length of historical timeframe for which EO data was used) varied considerably from country to country and project to project. However, regression analysis showed that neither #activities nor model_complexity were well explained by the EO data quality/quantity. This suggests that countries/projects are deciding which activities to assess and which modeling approaches to select based on other factors. Increasing the EO data quality and/or quantity may not have a significant impact on the effectiveness of REDD+ unless there are more detailed regulations on how the data should be used to estimate future emissions.

Land cover change (LCC) can have a significant impact on human and environmental well-being. LCC maps derived from historical remote sensing (RS) images are often used to evaluate the impacts of past LC changes and to construct models to predict future LC changes. Free moderate spatial resolution (~30 m) optical and synthetic aperture radar (SAR) RS imagery is now becoming increasingly available for this LCC monitoring. However, the classification algorithms used to extract LC information from these images typically require “training data” for classification (i.e. points or polygons with LC class labels), and acquiring this labelled training data can be difficult and time-consuming. Alternatively, crowdsourced geographic data (CGD) has become widely available from online sources like OpenStreetMap (OSM), and it may provide a useful source of training data for LCC monitoring. A major challenge with utilizing CGD for LCC mapping, however, is the presence of class labelling errors, and these errors can vary spatially (e.g. due to differing levels of CGD contributor expertise) and temporally (e.g. due to time lag between CGD creation and RS imagery acquisition). In this study, we investigated a new LCC mapping method which utilizes free Landsat (optical) and PALSAR mosaic (SAR) satellite imagery in combination with labelled LC data extracted from CGD sources (the OSM “landuse” and “natural” polygon datasets). A semi-unsupervised classification approach was employed for the LCC mapping to reduce the effects of class label noise in the CGD. The main motivation and benefit of the proposed method is that it does not require training data to be manually collected, allowing for a faster and more automated assessment of LCC. As a case study, we applied the method to map LCC in the Laguna de Bay area of the Philippines over the 2007–2015 period. The LCC map produced using our proposed approach achieved an overall classification accuracy of 90.2%, providing evidence that CGD and multi-temporal/multi-sensor satellite imagery, when combined, have a great potential for LCC monitoring.

Purpose: MRI methods have improved diagnosis and treatment planning for prostate cancer. However, validation and standardization is needed to encourage widespread adoption of these methods. The purpose of this study was to improve validation methods by creating a prostate cutting guide and to develop a method for 3D comparison between MRI data and post-prostatectomy histological tissue slices. Methods: Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET)/MRI was performed on 10 patients with prostate cancer before and after chemohormonal treatment. Post-treatment images were used to design patient-specific prostate cutting guides that were used to create uniform thickness sections of surgically removed prostates. The thickness of the prostate tissue slices matched the imaging slice thickness so that comparisons could be made between MRI results and histopathological study results. A method was also developed to compare post-slicing prostate bulk geometry with the predicted MRI prostate geometry. Results: The prostate cutting guides were used to successfully section the prostate for histopathogical evaluation and slice-by-slice MRI comparison. Surface comparison results displayed an average dimensional difference of 1.99 ± 3.19 mm between MRI and post-prostatectomy slice reconstruction prostate geometries. Conclusion: MRI-based prostate cutting guides were designed, fabricated, and implemented in a study examining the utility and accuracy of MRI for the detection of prostate cancer. Furthermore, a three-dimensional part comparison method was developed, which can be used for validation of MRI with pathological and histological data. Future work will analyze more subjects to examine the effectiveness of these guides for histopathological prostate analysis with MRI and PET/MRI.

Because of its extraordinary and broad reflectivity, aluminum is the only logical candidate for advanced space mirrors that operate deep into the UV. However, aluminum oxidizes rapidly in the air, and even a small amount of oxide (as little as a nanometer) can have a noticeable, detrimental impact on its reflectivity at short wavelengths. Thin films of wide band gap materials like MgF2 have previously been used to protect aluminum surfaces. Here we report the first real-time, spectroscopic ellipsometry (SE) study of aluminum oxidation as a function of MgF2 over layer thickness, which ranged from 0 – 6 nm. SE data analysis was performed vis-à-vis a multilayer optical model that included a thick silicon nitride layer. The optical constants for evaporated aluminum were initially determined using a multi-sample analysis (MSA) of SE data from MgF2 protected and bare Al surfaces. Two models were then considered for analyzing the real-time data obtained from Al/MgF2 stacks. The first used the optical constants of aluminum obtained in the MSA with two adjustable parameters: the thicknesses of the aluminum and aluminum oxide layers. The thicknesses obtained from this model showed the expected trends (increasing Al2O3 layer thickness and decreasing Al layer thickness with time), but some of the Al2O3 thicknesses were unphysical (negative). Because the optical constants of very thin metals films depend strongly on their structures and deposition conditions, a second, more advanced model was employed that fit the optical constants for Al, and also the Al and Al2O3 thicknesses, for each data set. In particular, the Al and Al2O3 thicknesses and optical constants of Al were determined in an MSA for each of 50 evenly spaced analyses in each four-hour dynamic run performed. The resulting optical constants for Al were then fixed for that sample and the thicknesses of the Al and Al2O3 layers were determined. While the first and second models yielded similar Al and Al2O3 thickness vs. time trends, the film thicknesses obtained in this manner were more physically reasonable. Thicker MgF2 layers slow the oxidation rate of aluminum. The results from this work should prove useful in protecting space mirrors prior to launch.

Factors controlling the spread of invasive earthworms in Minnesota’s Boundary Waters Canoe Area Wilderness are poorly known. Believed to have been introduced by anglers who use them as bait, invasive earthworms can alter the physical and chemical properties of soil and modify forest plant communities. To examine factors influencing earthworm distribution and abundance, we sampled 38 islands across five lakes to assess the effects of campsites, fire, and entry point distance on earthworm density, biomass and species richness. We hypothesized that all three parameters would be greater on islands with campsites, lower on burned islands, and would decrease with distance from the wilderness entry point. In addition to sampling earthworms, we collected soil cores to examine soil organic matter and recorded ground and vegetation cover. Campsite presence was the single most important factor affecting sampled earthworm communities; density, biomass and species richness were all higher on islands having campsites. Fire was associated with reduced earthworm density, but had no direct effects on earthworm biomass or species richness. Fire influenced earthworm biomass primarily through its negative relationship to groundcover and through an interaction with entry point distance. Distance affected density but no other factor. For islands with campsites, however, distance from the entry point had a counterintuitive effect in that earthworm biomass, which increased with entry point distance.

Brian B Johnson, Abigail I Franco, Lisa A Beck, James C Prezzano Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA Abstract: Atopic dermatitis (AD) is a common, chronic, relapsing–remitting inflammatory disease that can be challenging to treat. Patients with mild disease are usually managed well with good skin care practices including moisturization and appropriate bathing along with intermittent use of topical therapies such as topical corticosteroids and/or topical calcineurin inhibitors during flares. Patients with frequent flares may benefit from proactive application of topical therapies twice a week to the most troublesome areas. Patients with severe disease often present significant treatment challenges. Systemic therapies are usually required for severe AD but have varying degrees of success and can be associated with side-effect profiles that require counseling and close monitoring. Phototherapy has been shown to have success in treating moderate-to-severe AD, but several factors can limit its utility and efficacy including cost and access. New therapies are in development targeting specific pathways relevant for AD. Dupilumab was the first biologic treatment approved in North America, Europe, and Japan for adults with moderate-to-severe AD. Although this treatment can lead to rapid improvement in the majority of patients, there are inadequate responders. In this review, we discuss the clinical challenges and treatment options for moderate-to-severe refractory AD. Keywords: atopic dermatitis, eczema, treatment resistance, topical therapy, systemic therapy, biologics

This paper presents a global framework analysis of a microstrip antenna design circularly polarized with an operating frequency of 5.80 GHz and a bandwidth of at least 500 MHz. We evaluate the optimal antenna parameters to design requirements. Capitalizing on these parameters, we simulate the radiation model of this antenna using the Finite Difference Time Domain (FDTD) technique assuming one, two, and three dimensions. The propagation medium is assumed to be a free space bounded by absorbing boundaries, and perfect matched layer (PML). The FDTD-1D is considered in free space while FDTD-2D and 3D are considered both in free space and in a free space-medium containing either dielectric sphere or cylinder in the center. In this case, we model the incident and the scattered electromagnetic fields reflected back from hitting the dielectric object. Moreover, the microstrip antenna radiates an electromagnetic pulse either in the middle or at one end of the medium and the sources considered are Gaussian pulse and plane wave. Finally, we provide the analytic solutions of the propagation models to confirm the accuracy of the FDTD simulation technique.

Supplemental material, Sleep_systematic_review_Appendix_for_Stroke-formatted for Systematic Review Investigating the Effects of Nonpharmacological Interventions During Sleep to Enhance Physical Rehabilitation Outcomes in People With Neurological Diagnoses by Brian P. Johnson, Andrea G. Shipper and Kelly P. Westlake in Neurorehabilitation and Neural Repair

The traditional focus of physiological and functional genomic research is on molecular processes that play out within a single body. In contrast, when social interactions occur, molecular and behavioral responses in interacting individuals can lead to physiological processes that are distributed across multiple individuals. In eusocial insect colonies, such multi-body processes are tightly integrated, involving social communication mechanisms that regulate the physiology of colony members. As a result, conserved physiological mechanisms, for example related to pheromone detection and neural signaling pathways, are deployed in novel contexts and regulate emergent colony traits during the evolutionary origin and elaboration of social complexity. Here we review conceptual frameworks for organismal and colony physiology, and highlight functional genomic, physiological, and behavioral research exploring how colony-level traits arise from physical and chemical interactions among nestmates. We highlight mechanistic work exploring how colony traits arise from physical and chemical interactions among physiologically-specialized nestmates of various developmental stages. We consider similarities and differences between organismal and colony physiology, and make specific predictions based on a decentralized perspective on the function and evolution of colony traits. Integrated models of colony physiological function will be useful to address fundamental questions related to the evolution and ecology of collective behavior in natural systems., Comment: 32 pages, 1 Figure

Table S1. Univariate Associations with Sex. Table S2. Univariate Associations with Any Concussion. Table S3. Mixed Model Selection – Any Concussion. Table S4. Mixed Model Results – Any Concussion. Table S5. Univariate Associations with Any Sport-Related Concussion. Table S6. Mixed Model Selection – Any Sport-Related Concussion. Table S7. Mixed Model Results – Sport-Related Concussion. Table S8. Univariate Association with Any Academy Training-Related Concussion. Table S9. Mixed Model Selection – Any Academy Training-Related Concussion. Table S10. Mixed Model Results – Academy Training-Related Concussion. Table S11. Univariate Association with Free Time-Related Concussions. Table S12. Mixed Model Selection – Any Free Time-Related Concussion. Table S13. Mixed Model Results – Free Time-Related Concussion. Table S14. Mixed Model Selection – Any Concussion within Varsity Cadets. Table S15. Mixed Model Results – Any Concussion among Varsity Athlete Cadets. Table S16. Mixed Model Selection – Any Sport-Related Concussion within Varsity Cadets. Table S17. Mixed Model Results – Any Sport Concussion among Varsity Athletes. Table S18. Mixed Model Selection – Any Academy Training-Related Concussion within Varsity Cadets. Table S19. Mixed Model Selection – Any Free Time-Related Concussion within Varsity Cadets. Table S20. Description of risk factor variables and measures. (DOCX 94 kb)

The purpose of this dissertation is to rebut some skeptical arguments in moral epistemology by appealing to philosophical resources from the history of European philosophy. The skeptical arguments I will be countering are grounded in the perspective of contemporary biology. Put quickly, our evolutionary history is said to undermine our claims to moral knowledge because the process by which our capacity for such knowledge developed was determined by adaptive and reproductive fitness. The determinations of fitness, it is said, cannot be expected to align with standards of objective moral value. In the first chapter, I spell out the importance of evaluative perception. The need for a capacity to perceive value raises the concern that moral psychology is something mysterious. In the second chapter, I consider some skeptical arguments in moral epistemology that conclude we have no good reason to believe we are wired to be receptive to objective moral truth. While some of these arguments purport to undermine our access toobjective moral truths, I conclude that they do not. The remainder of the dissertation considers the work of Rousseau, Kant, and Hegel in light of the concerns raised in part one. Despite initial appearances, these authors understand the relation of conscience and human nature in a way that points toward a defensible view, even in light of the challenges raised by contemporary biology. The resulting view is an account of the moral conscience that emphasizes autonomy and rational agency and recognizes their value in virtue of their concrete expression in a social context.

With the intensifying challenges of global sustainability and biodiversity conservation, the monitoring of the world's remaining forests has become more important than ever. Today, Earth observation technologies, particularly remote sensing, are at the forefront of forest cover monitoring worldwide. Given the current conceptual understanding of what a forest is, canopy cover threshold values are used to map forest cover from remote sensing imagery and produce categorical data products such as forest/non-forest (F/NF) maps. However, multi-temporal categorical map products have important limitations because they inadequately represent the actual status of forest landscapes and the trajectories of forest cover changes as a result of the thresholding effect. Here, we examined the potential of using remotely sensed tree canopy cover (TCC) datasets, which are continuous data products, to complement F/NF maps for forest cover monitoring. We developed a conceptual analytical framework for forest cover monitoring using both types of data products and applied it to the forests of Southeast Asia. We conclude that TCC datasets and the statistics derived from them can be used to complement the information provided by categorical F/NF maps. TCC-based indicators (i.e., losses, gains, and net changes) can help in monitoring not only deforestation but also forest degradation and forest cover enhancement, all of which are highly relevant to the 2030 Agenda for Sustainable Development and other global forest cover monitoring–related initiatives. We recommend that future research should focus on the production, application, and evaluation of TCC datasets to advance the current understanding of how accurately these products can capture changes in forest landscapes across space and time.

The paper narrates an empirical study of participatory mapping and spatial characterization of six non-material landscape values across multiple coastal production landscapes in the Indian Sundarban delta. The methodology relies on an inexpensive rapid rural appraisal technique that integrates the conventional notion of place preference and participatory mapping. 168 respondents living in the study area were provided six georeferenced maps with 30 pre-identified landmarks and were asked to mark and rank at least three preferred locations (with no upper limit) for each of the six non-material landscape values category (i.e. spiritual, recreational, heritage, aesthetic, educational, and negative values). A total of 65 locations, depicting all the six landscape values, were identified from the survey. Corresponding scores against these points were calculated by multiplying the frequency of occurrence and assigned preference weights. We thereafter conducted a series of statistical and spatial analyses to understand the demographic patterns in the observed intangible values and their spatial association with different production landscapes. Regression modeling revealed a significant influence of the age and educational profile of the respondents on the number of points marked viz.-a-viz.appreciation for non-material landscape values. Also, the Spearman correlation revealed a strong positive pairwise association between recreational and aesthetic values, spiritual and heritage as well as educational and heritage values. Finally, we computed landscape-wise availability of non-material values using a recent land use map of the delta and found that agriculture/cultivated areas, rural settlements, and mudflats/beaches were associated with high non-material values, while aquaculture was minimally attributed to non-material landscape values. As such, the study facilitates a comparative understanding of non-material benefits from multiple rural production landscapes/waterscapes, besides providing valuable spatial information for policy-planners and administrative officials.

Considering the well‐documented impacts of land‐use change on water resources and the rapid land‐use conversions occurring throughout Africa, in this study, we conducted a spatiotemporal analysis of surface water quality and its relation with the land use and land cover (LULC) pattern in Mokopane, Limpopo province of South Africa. Various physico‐chemical parameters were analyzed for surface water samples collected from five sampling locations from 2016 to 2020. Time‐series analysis of key surface water quality parameters was performed to identify the essential hydrological processes governing water quality. The analyzed water quality data were also used to calculate the heavy metal pollution index (HPI), heavy metal evaluation index (HEI) and weighted water quality index (WQI). Also, the spatial trend of water quality is compared with LULC changes from 2015 to 2020. Results revealed that the concentration of most of the physico‐chemical parameters in the water samples was beyond the World Health Organization (WHO) adopted permissible limit, except for a few parameters in some locations. Based on the calculated values of HPI and HEI, water quality samples were categorized as low to moderately polluted water bodies, whereas all water samples fell under the poor category (100) and beyond based on the calculated WQI. Looking precisely at the water quality’s temporal trend, it is found that most of the sampling shows a deteriorating trend from 2016 to 2019. However, the year 2020 shows a slightly improving trend on water quality, which can be justified by lowering human activities during the lockdown period imposed by COVID‐19. Land use has a significant relationship with surface water quality, and it was evident that built‐up land had a more significant negative impact on water quality than the other land use classes. Both natural processes (rock weathering) and anthropogenic activities (wastewater discharge, industrial activities etc.) were found to be playing a vital role in water quality evolution. This study suggests that continuous assessment and monitoring of the spatial and temporal variability of water quality in Limpopo is important to control pollution and health safety in the future.

Land use/land cover (LULC) maps are now being used across disciplines for many different types of applications, e.g., to analyze urban heat islands or rainfall-runoff dynamics. Traditional map accuracy metrics are limited in this regard, as they only assess LULC map thematic accuracy. In reality, some types of misclassification lead to larger estimation errors for these specific applications. In a previous study, we developed a new map accuracy metric (referred to here as “JJ19”) to assess the accuracy of local climate zone maps for urban microclimate analysis. In the previous work, we also attempted to reproduce another metric (weighted accuracy (WA)) proposed for this purpose, but misinterpreted it due to a lack of methodological information available (principally, the lack of a confusion matrix to demonstrate how WA was derived). We sincerely thank the authors of Bechtel et al. 2019 for providing more information on WA in response to our previous study and are happy to report that we found that the metric is now both reproducible and valid. On the other hand, we found some other aspects of Bechtel et al. 2019’s study to be inaccurate, particularly their claims regarding the suitability of the JJ19 metric. Finally, we made a minor improvement to the JJ19 metric based on Bechtel et al.’s comments.

In object-based image analysis (OBIA), the appropriate parametrization of segmentation algorithms is crucial for obtaining satisfactory image classification results. One of the ways this can be done is by unsupervised segmentation parameter optimization (USPO). A popular USPO method does this through the optimization of a "global score" (GS), which minimizes intrasegment heterogeneity and maximizes intersegment heterogeneity. However, the calculated GS values are sensitive to the minimum and maximum ranges of the candidate segmentations. Previous research proposed the use of fixed minimum/maximum threshold values for the intrasegment/intersegment heterogeneity measures to deal with the sensitivity of user-defined ranges, but the performance of this approach has not been investigated in detail. In the context of a remote sensing very-high-resolution urban application, we show the limitations of the fixed threshold approach, both in a theoretical and applied manner, and instead propose a novel solution to identify the range of candidate segmentations using local regression trend analysis. We found that the proposed approach showed significant improvements over the use of fixed minimum/maximum values, is less subjective than user-defined threshold values and, thus, can be of merit for a fully automated procedure and big data applications., SCOPUS: ar.j, info:eu-repo/semantics/published

Additional file 1: Table S1. Demographic characteristics of study population.

Additional file 2: Table S2. Change from baseline to week 52 in extrapyramidal symptoms scales during AOM 400 maintenance phase.

>Towards effective interdisciplinary SPIs - More dynamic, iterative and collaborative interactions with practitioners, knowledge holders (including ILK) and policymakers - Consolidating interdisciplinary study that recognises the interconnectedness of social and ecological system - Joint formation of research and policy - Building capacity and long-term trust of organization > Research gaps - Not much research on SPIs in Asia, Latin American and African region - Not much empirical research assessing effectiveness of SPIs based on outcomes of SPIs.

Land cover (LC) has a significant impact on rainfall-runoff dynamics of a watershed, so LC maps are often incorporated into hydrological models to simulate how changes in climate or land management will affect water quantity/water quality within the watershed. The accuracy of a LC map can thus affect the accuracy of hydrological modelling results. However, because LC maps are not typically produced specifically for hydrological studies, the conventional LC map accuracy metrics may not be the most relevant. In this study, we proposed a new metric for LC map accuracy assessment, calculated as the root-mean-square-deviation (RMSD) of the mapped (i.e. estimated) and “ground truth” runoff curve numbers (CN) at randomly-sampled locations. The new metric, CN-RMSD, assesses the accuracy of the direct runoff estimates derived from the LC map, and its benefit over the traditional LC accuracy assessment metrics is that it more heavily weights LC classification errors that cause greater errors in estimated runoff. Ground truth CN data can be collected much in the same way as ground truth data is collected for the traditional accuracy metrics, although a soil map can improve the accuracy of the ground truth CN values. Some potential applications of CN-RMSD, e.g. for LC map selection and LC map fusion, are also discussed.

Rapid changes in land use and land cover pattern have exerted an irreversible change on different natural resources, and water resources in particular, throughout the world. Khambhat City, located in the Western coastal plain of India, is witnessing a rapid expansion of human settlements, as well as agricultural and industrial activities. This development has led to a massive increase in groundwater use (the only source of potable water in the area), brought about significant changes to land management practices (e.g., increased fertilizer use), and resulted in much greater amounts of household and industrial waste. To better understand the impacts of this development on the local groundwater, this study investigated the relationship between groundwater quality change and land use change over the 2001-2011 period; a time during which rapid development occurred. Water quality measurements from 66 groundwater sampling wells were analyzed for the years 2001 and 2011, and two water quality indicators (NO 3 − and Cl − concentration) were mapped and correlated against the changes in land use. Our results indicated that the groundwater quality has deteriorated, with both nitrate (NO 3 −) and chloride (Cl −) levels being elevated significantly. Contour maps of NO 3 − and Cl − were compared with the land use maps for 2001 and 2011, respectively, to identify the impact of land use changes on water quality. Zonal statistics suggested that conversion from barren land to agricultural land had the most significant negative impact on water quality, demonstrating a positive correlation with accelerated levels of both NO 3 − and Cl −. The amount of influence of the different land use categories on NO 3 − increase was, in order, agriculture > bare land > lake > marshland > built-up > river. Whereas, for higher concentration of Cl − in the groundwater, the order of influence of the different land use categories was marshland > built-up > agriculture > bare land > lake > river. This study will help policy planners and decision makers to understand the trend of groundwater development and hence to take timely mitigation measures for its sustainable management.

Image inpaiting is an important task in image processing and vision. In this paper, we develop a general method for patch-based image inpainting by synthesizing new textures from existing one. A novel framework is introduced to find several optimal candidate patches and generate a new texture patch in the process. We form it as an optimization problem that identifies the potential patches for synthesis from an coarse-to-fine manner. We use the texture descriptor as a clue in searching for matching patches from the known region. To ensure the structure faithful to the original image, a geometric constraint metric is formally defined that is applied directly to the patch synthesis procedure. We extensively conducted our experiments on a wide range of testing images on various scenarios and contents by arbitrarily specifying the target the regions for inference followed by using existing evaluation metrics to verify its texture coherency and structural consistency. Our results demonstrate the high accuracy and desirable output that can be potentially used for numerous applications: object removal, background subtraction, and image retrieval., in Computer Science and Applications, 2016

An organism reported in the early literature to be a rare cause of cervical lymphadenitis in guinea pigs, Streptobacillus moniliformis, has been reclassified as Caviibacter abscessus We describe a series of sequential cases of abscesses in guinea pigs that were presented to our clinic from which the only agent isolated was a unique, serum-requiring bacterium. Discrete colonies were not detected in 6.5% CO2 or anaerobically on routine primary isolation media containing up to 5% whole sheep blood, with and without cysteine, vitamin K, and hemin supplementation after 7 days of incubation at 37°C. Based on subsequently determined growth requirements, the organisms were best described as serum-requiring, aerotolerant anaerobes. Colonies were detectable within 24 h at 37°C in an anaerobic atmosphere on a mycoplasma agar-based medium containing 10% pig serum and reached 3 mm in diameter within 3-5 days. Microscopic appearance consisted of small gram-negative rods and coccobacilli with occasional filaments. However, in direct smears from clinical specimens and from weak or dysgonic growth on plates incubated under suboptimal growth conditions (e.g., in 6.5% CO2), irregular rods with occasional small bulbous forms or numerous long wavy filaments were observed. All of the isolates generated unique spectral profiles similar to that of C. abscessus when examined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Phylogenetic analysis of partial 16S rRNA gene sequences showed that the isolates were identical to each other and shared 99.9% sequence identity with C. abscessus.