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Rayleigh wave ellipticity measurements from seismic ambient noise recorded on the Greenland Ice Sheet (GrIS) show complex and anomalous behavior at wave periods sensitive to ice (T < 3–4 s). To understand these complex observations, we compare them with synthetic ellipticity measurements obtained from synthetic ambient noise computed for various seismic velocity and attenuation models, including surface wave overtone effects. We find that in dry snow conditions within the interior of the GrIS, to first order the anomalous ellipticity observations can be explained by ice models associated with the accumulation and densification of snow into firn. We also show that the distribution of ellipticity measurements is strongly sensitive to seismic attenuation and the thermal structure of the ice. Our results suggest that Rayleigh wave ellipticity is well suited for monitoring changes in firn properties and thermal composition of the Greenland and Antarctic ice sheets in a changing climate. Plain Language Summary: Surface meltwater is increasingly being routed and distributed through the Greenland Ice Sheet (GrIS) changing the mechanical and thermal properties of the ice and resulting in accelerated ice flow. Here we observe complex and anomalous Rayleigh wave ellipticity measurements at periods sensitive to the ice structure. We compare our observations with ellipticity measurements made on simulated seismic noise for various seismic velocity and attenuation models. We demonstrate that in the interior of the GrIS the ellipticity is sensitive to the accumulation and densification of snow as it compacts into glacier ice. The variation in the measurements is strongly sensitive to the thermal structure of the ice sheet which we estimate to be warmer than about −10°. These results demonstrate that Rayleigh wave ellipticity is well suited for monitoring changes in firn properties and thermal composition of the Greenland and Antarctic ice sheets in a changing climate. Key Points: Densification of snow into firn has a first order effect on ellipticity measurements at periods sensitive to the iceThe distribution of ellipticity measurements is sensitive to the thermal composition of the iceEllipticity is a promising method for long term monitoring of ice properties and thickness beneath the seismic station [ABSTRACT FROM AUTHOR]

While observations of molecular gas at cosmic noon and beyond have focused on the gas within galaxies (i.e. the interstellar medium, ISM), it is also crucial to study the molecular gas reservoirs surrounding each galaxy (i.e. in the circumgalactic medium, CGM). Recent observations of galaxies and quasars hosts at high redshift (z > 2) have revealed evidence for cold gaseous haloes of scale r CGM ∼ 10 kpc, with one discovery of a molecular halo with r CGM ∼ 200 kpc, and a molecular gas mass one order of magnitude larger than the ISM of the central galaxy. As a follow up, we present deep ACA and ALMA observations of CO(3–2) from this source and two other quasar host galaxies at z ∼ 2.2. While we find evidence for CO emission on scales of r ∼ 10 kpc, we do not find evidence for molecular gas on scales larger than r > 20 kpc. Therefore, our deep data do not confirm the existence of massive molecular haloes on scales of ∼100 kpc for these X-ray selected quasars. As an interesting byproduct of our deep observations, we obtain the tentative detection of a negative continuum signal on scales larger than r > 200 kpc, which might be tracing the Sunyaev–Zeldovich effect associated with the halo heated by the active galactic nucleus (AGN). If confirmed with deeper data, this could be direct evidence of the preventive AGN feedback process expected by cosmological simulations. [ABSTRACT FROM AUTHOR]

Background: In adults, the solitary lateral cystic neck mass remains a diagnostic challenge with little solid material to target for cytology and few clues on imaging modalities to suggest underlying malignancy. Method: This study was a retrospective review of patients presenting with a lateral cystic neck mass to a tertiary academic head and neck centre over a 10-year period. Results: A total of 25 of 157 cystic lesions were subsequently malignant on paraffin section histopathology, with the youngest patient being 42 years. In the age cohort over 40 years, 30 per cent of males and 10 per cent of females were diagnosed with malignancy. The ipsilateral palatine tonsil was the most common primary site (50 per cent). A total of 85 per cent of cases demonstrated integrated human papillomavirus infection. Age, male sex and alcohol were significant risk factors on univariate analysis. Ultrasound-guided fine needle aspiration cytology and magnetic resonance imaging represented the most accurate pre-open biopsy tests. Conclusion: The authors of this study advocate for a risk-stratified, evidence-based workup in patients with solitary lateral cystic neck mass in order to optimise timely diagnosis. [ABSTRACT FROM AUTHOR]

Gaseous outflows are key phenomena in the evolution of galaxies, as they affect star formation (either positively or negatively), eject gas from the core or disc, and directly cause mixing of pristine and processed material. Active outflows may be detected through searches for broad spectral line emission or high-velocity gas, but it is also possible to determine the presence of past outflows by searching for extended reservoirs of chemically enriched molecular gas in the circumgalactic medium (CGM) around galaxies. In this work, we examine the CO(3−2) emission of a set of seven z ∼ 2.0–2.5 active galactic nuclei (AGN) host galaxies, as observed with ALMA. Through a 3D stacking analysis, we find evidence for extended CO emission of radius r ∼ 13 kpc. We extend this analysis to the HST /ACS i -band images of the sample galaxies, finding a complex small-scale (r < 10 kpc) morphology but no robust evidence for extended emission. In addition, the dust emission (traced by rest-frame FIR emission) shows no evidence for significant spatial extension. This indicates that the diffuse CO emission revealed by ALMA is morphologically distinct from the stellar component, and thus traces an extended reservoir of enriched gas. The presence of a diffuse, enriched molecular reservoir around this sample of AGN host galaxies at cosmic noon hints at a history of AGN-driven outflows that likely had strong effects on the star formation history of these objects. [ABSTRACT FROM AUTHOR]

Deep learning solutions in big data applications can benefit cloud centres and can also lead to network communication overhead. Typically, data collected from traffic are sent to the traffic management centre for analysis. However, this process can worsen the network route to the traffic management centre. A two-tier mechanism has been developed to address this issue, which performs vehicle speed estimation and traffic congestion detection for efficient traffic management. The real-time traffic video data are captured and the video frames are initially processed through a foreground extraction process, which extracts the temporarily stopped vehicles on the road by removing background pixels from the frames. The video frames are then wrapped in an up-down view to remove the influence of the observation angle. The traffic congestion is then detected accurately based on the traffic characteristics using the proposed Ensemble Random Forest-based Gradient Optimization (ERF-GO) algorithm. The generalization error occurs when learning complex features on frames is minimized using a gradient-based optimization (GO) algorithm. Finally, the learned information on traffic conditions is forwarded to the cloud and edge computing environments based on network connection speed. The efficiency of the proposed ERF-GO is investigated in terms of performance metrics, namely root mean square error, speed detection error, execution time, computational cost, accuracy, latency, workload balance, precision, recall, f-measure, and congestion detection error rate. The analytic result displays that the proposed ERF-GO algorithm attains a greater accuracy rate of about 98.65% in detecting traffic congestion which is comparably higher than state-of-the-art methods. [ABSTRACT FROM AUTHOR]

All business involves assuming and managing risk, and this is particularly true of businesses involved in the staging and management of events, which are inherently risky endeavours. Event management is thus intrinsically concerned with managing various forms of risk. This study aims to identify the factors that influence best practices in managing risk during event management, and to determine the extent to which the factors contribute towards effectively managing risk in event management. More than ever before, a variety of stakeholders are expecting that event organisers will actively engage in managing risks and will do so to the extent of what can be considered reasonably practicable. A qualitative approach was undertaken for this study, consisting of ten online (virtual) semi-structured interviews with selected experienced professionals to ascertain their perspectives on managing risk in events management, and why best practice standards are often not employed. The study concluded that risk management must be an integral part of the event management process, encompassing all phases of events. [ABSTRACT FROM AUTHOR]

Objectives: To explore the impact of COVID‐19 on the management and outcomes of acute paediatric mastoiditis across the UK. Design: National retrospective and prospective audit. Setting: 48 UK secondary care ENT departments. Participants: Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis. Main outcome measures: Cases were divided into Period 1 (01/11/19‐15/03/20), before the UK population were instructed to reduce social contact, and Period 2 (16/03/20‐30/04/21), following this. Periods 1 and 2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical). Results: 286 cases met criteria (median 4 per site, range 0–24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in December 2020‐Febraury 2021. Patient age differed between periods 1 and 2 (3.2 vs 4.7 years respectively, p < 0.001). 85% of children in period 2 were tested for COVID‐19 with a single positive test. In period, 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% vs 24.3%, p = 0.001). Treatment success was high, with failure of initial management in 6.3%, and 30‐day re‐admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2. Conclusion: The COVID‐19 pandemic led to a significant change in the presentation and case mix of acute paediatric mastoiditis in the UK. [ABSTRACT FROM AUTHOR]

Climate change and a long legacy of fire suppression are leading to an increased prevalence of 'mega‐disturbances' such as drought and wildfire in terrestrial ecosystems. Evidence for the immediate effects of these novel disturbances on wildlife is accumulating, but little information exists on longer term impacts to species and ecosystems. We studied the occurrence dynamics of an iconic old‐forest species, the spotted owl (Strix occidentalis), on a long‐term study area in the Sierra Nevada, CA, USA from 1989 to 2020 to evaluate their multi‐scale population response following a 2014 megafire (the 'King' Fire) that affected a portion of our study area. We found that extensive severe fire within spotted owl sites resulted in both immediate site abandonment and prolonged lack of re‐colonization by owls six years post‐fire. Sites that experienced high pyrodiversity – a mosaic of burn severities – were more likely to persist after the fire, but this effect was only apparent at finer spatial scales. A potentially confounding factor, post‐fire salvage logging, did not explain variability in the probability of either owls persisting at sites or sites becoming re‐colonized; effects could be attributed only to severe fire extent and pyrodiversity. Our study demonstrates the prolonged effects of severe fire on the occupancy of this forest‐dependent species, suggesting that forest restoration that reduces megafires could benefit spotted owls. Our work emphasizes that long‐term monitoring can offer surprising learning opportunities and provide unparalleled value for understanding and addressing emerging environmental concerns. [ABSTRACT FROM AUTHOR]

This study presents an application of machine learning (ML) methods for detecting the presence of stenoses and aneurysms in the human arterial system. Four major forms of arterial disease—carotid artery stenosis (CAS), subclavian artery stenosis (SAS), peripheral arterial disease (PAD), and abdominal aortic aneurysms (AAA)—are considered. The ML methods are trained and tested on a physiologically realistic virtual patient database (VPD) containing 28,868 healthy subjects, adapted from the authors previous work and augmented to include disease. It is found that the tree-based methods of Random Forest and Gradient Boosting outperform other approaches. The performance of ML methods is quantified through the F 1 score and computation of sensitivities and specificities. When using six haemodynamic measurements (pressure in the common carotid, brachial, and radial arteries; and flow-rate in the common carotid, brachial, and femoral arteries), it is found that maximum F 1 scores larger than 0.9 are achieved for CAS and PAD, larger than 0.85 for SAS, and larger than 0.98 for both low- and high-severity AAAs. Corresponding sensitivities and specificities are larger than 90% for CAS and PAD, larger than 85% for SAS, and larger than 98% for both low- and high-severity AAAs. When reducing the number of measurements, performance is degraded by less than 5% when three measurements are used, and less than 10% when only two measurements are used for classification. For AAA, it is shown that F 1 scores larger than 0.85 and corresponding sensitivities and specificities larger than 85% are achievable when using only a single measurement. The results are encouraging to pursue AAA monitoring and screening through wearable devices which can reliably measure pressure or flow-rates. [ABSTRACT FROM AUTHOR]

While the kinematics of galaxies up to z ∼ 3 have been characterized in detail, only a handful of galaxies at high redshift (z > 4) have been examined in such a way. The Atacama Large Millimeter/submillimeter Array (ALMA) Large Program to INvestigate [C  ii ] at Early times (ALPINE) survey observed a statistically significant sample of 118 star-forming main-sequence galaxies at z = 4.4–5.9 in [C  ii ]158  |$\mu$| m emission, increasing the number of such observations by nearly 10×. A preliminary qualitative classification of these sources revealed a diversity of kinematic types (i.e. rotators, mergers, and dispersion-dominated systems). In this work, we supplement the initial classification by applying quantitative analyses to the ALPINE data: a tilted ring model (TRM) fitting code (3D barolo), a morphological classification (Gini-M20), and a set of disc identification criteria. Of the 75 [C  ii ]-detected ALPINE galaxies, 29 are detected at sufficient significance and spatial resolution to allow for TRM fitting and the derivation of morphological and kinematic parameters. These 29 sources constitute a high-mass subset of the ALPINE sample (⁠|$M_*\gt 10^{9.5}\, \mathrm{M}_{\odot }$|⁠). We robustly classify 14 of these sources (six rotators, five mergers, and three dispersion-dominated systems); the remaining sources showing complex behaviour. By exploring the G-M20 of z > 4 rest-frame far-infrared and [C  ii ] data for the first time, we find that our 1 arcsec ∼ 6 kpc resolution data alone are insufficient to separate galaxy types. We compare the rotation curves and dynamical mass profiles of the six ALPINE rotators to the two previously detected z ∼ 4–6 unlensed main-sequence rotators, finding high rotational velocities (∼50–250 km s−1) and a diversity of rotation curve shapes. [ABSTRACT FROM AUTHOR]

The molecular gas content of high-redshift galaxies is a highly sought-after property. However, H2 is not directly observable in most environments, so its mass is probed through other emission lines (e.g. CO, [C  i ], [C  ii ]), or through a gas-to-dust ratio. Each of these methods depends on several assumptions, and are best used in parallel. In this work, we extend an additional molecular gas tracer to high-redshift studies by observing hydrogen deuteride (HD) emission in the strongly lensed z  = 5.656 galaxy SPT0346−52 with ALMA. While no HD(1–0) emission is detected, we are able to place an upper limit on the gas mass of |$\rm M_{H_2}\lt 6.4\times 10^{11}\, M_{\odot }$|⁠. This is used to find a limit on the |$L^{\prime }_{\mathrm{ CO}}$| conversion factor of      |$\rm \alpha _{CO}\lt 5.8\,M_{\odot}(K\,km\,s^{-1}\,pc^2)^{-1}$|⁠. In addition, we construct the most complete spectral energy distribution of this source to date, and fit it with a single-temperature modified blackbody using the nested sampling code multinest , yielding a best-fitting dust mass Mdust = 108.92 ± 0.02 M⊙, dust temperature 78.6 ± 0.5 K, dust emissivity spectral index β = 1.81 ± 0.03, and star formation rate SFR = 3800 ± 100 M⊙ yr−1. Using the continuum flux densities to estimate the total gas mass of the source, we find   |$\rm M_{H_2}\lt 2.4\times 10^{11}\, M_{\odot }$|  , assuming subsolar metallicity. This implies a CO conversion factor of αCO < 2.2, which is between the standard values for MW-like galaxies and starbursts. These properties confirm that SPT0346−52 is a heavily starbursting, gas-rich galaxy. [ABSTRACT FROM AUTHOR]

We present ALMA observations of a merging system at z ∼ 4.57, observed as a part of the ALMA Large Program to INvestigate [CII] at Early times (ALPINE) survey. Combining ALMA [CII]158 μm and far-infrared continuum data with multi-wavelength ancillary data, we find that the system is composed of two massive (M⋆ ≳ 1010 M⊙) star-forming galaxies experiencing a major merger (stellar mass ratio rmass ≳ 0.9) at close spatial (∼13 kpc; projected) and velocity (Δv <  300 km s−1) separations, and two additional faint narrow [CII]-emitting satellites. The overall system belongs to a larger scale protocluster environment and is coincident to one of its overdensity peaks. Additionally, ALMA reveals the presence of [CII] emission arising from a circumgalactic gas structure, extending up to a diameter-scale of ∼30 kpc. Our morpho-spectral decomposition analysis shows that about 50% of the total flux resides between the individual galaxy components, in a metal-enriched gaseous envelope characterised by a disturbed morphology and complex kinematics. Similarly to observations of shock-excited [CII] emitted from tidal tails in local groups, our results can be interpreted as a possible signature of interstellar gas stripped by strong gravitational interactions, with a possible contribution from material ejected by galactic outflows and emission triggered by star formation in small faint satellites. Our findings suggest that mergers could be an efficient mechanism of gas mixing in the circumgalactic medium around high-z galaxies, and thus play a key role in the galaxy baryon cycle at early epochs. [ABSTRACT FROM AUTHOR]

Habitat area and fragmentation are recognised as important factors that influence population size, community structure and extinction risk. Abundance and species richness universally increase with habitat area. However, the effects of different aspects of habitat fragmentation, including variation in patch size, number and isolation are often not distinguished from each other or the overall effects of habitat amount. Here we experimentally tested predictions concerning the effects of isolation on abundance, species richness and community structure of coral reef fishes colonising patch reefs by constructing clusters of patches of the same number and size, but manipulating reef spacing. Hexagonal clusters of 7 experimental patch reefs (6 edge and 1 central) with 3 levels of isolation (1 m, 5 m, and 15 m spacing) were established at Kavieng, Papua New Guinea and colonisation was recorded after 6 weeks in 2014. We also deployed video cameras to test whether isolation affected the activity of transient predatory fishes. As predicted, isolation had a positive effect on both mean abundance and species richness at both the cluster and patch scale. The cumulative abundance and species richness exhibited linear increases in relation to habitat area within clusters (from 1 to 7 patch reefs), but the slope increased with the degree of isolation. There was some evidence that transient predators remained longer and were more successful when patches were close together, which may explain the lower abundance and richness of juvenile fish assemblages on more aggregated patch reefs. This study demonstrates that while habitat amount is fundamentally important, isolation has significant effects that will need to be distinguished from other aspects of fragmentation when examining the processes structuring reef fish communities. [ABSTRACT FROM AUTHOR]

Whether skin photosensitivity modulates sun exposure behaviours, consequent vitamin D status and skeletal health outcomes independently of constitutive pigmentation have not been systematically investigated. 1072 community-dwelling adults aged 50-80 years had skin photosensitivity quantified by questionnaire and melanin density by spectrophotometry. Bone mineral density (BMD), falls risk and 25-hydroxyvitamin D (25OHD) were measured using DXA, short form physiological profile assessment and radioimmunoassay, respectively. Sun exposure and symptomatic fractures were assessed by questionnaire. Participants were followed up at 2.5 (n = 879), 5 (n = 767) and 10 (n = 571) years. Higher resistance to sunburn and greater ability to tan were associated with reduced sun protection behaviours (RR 0.87, p < 0.001 & RR 0.88, p < 0.001), higher lifetime discretionary sun exposure in summer (RR 1.05, p = 0.001 & RR 1.07, p = 0.001) and winter (RR 1.07, p = 0.001 & RR 1.08, p = 0.02) and fewer lifetime sunburns (RR 0.86, p < 0.001 & RR 0.91, p = 0.001). Higher resistance to sunburn was associated with lower total body (β =  - 0.006, p = 0.047) and femoral neck (β = - 0.006, p = 0.038) BMD, but paradoxically, fewer prevalent fractures (RR 0.94, p = 0.042). Greater ability to tan was associated with higher 25OHD (β = 1.43, p = 0.04), lumbar spine (β = 0.014, p = 0.046) and total body (β = 0.013, p = 0.006) BMD, but not fracture or falls risk. These associations were independent of constitutive melanin density. Cutaneous photosensitivity was associated with sun exposure behaviours, cutaneous sequelae and, consequently, 25OHD and BMD in older Caucasian adults independent of constitutive melanin density. There was no consistent association with fracture outcomes, suggesting environmental factors are at least as important. [ABSTRACT FROM AUTHOR]

Many treatment options for osteoporotic vertebral fractures are available. However, limited and variable findings have been reported on the efficacy of the individual therapies. The objective of the present study was to systematically review the reported data for evidence of efficacy of spinal orthoses for osteoporotic vertebral fractures. A systematic review of the PubMed database was performed. Two reviewers evaluated the studies found for eligibility. Randomized controlled trails (RCTs) and prospective nonrandomized, prospective single-arm, and retrospective comparative studies of the treatment of acute osteoporotic vertebral fractures with spinal orthoses were included. A total of 16 studies were included: 5 RCTs, 6 nonrandomized prospective comparative studies, 1 retrospective case-control study, and 4 prospective single-arm studies. Of the 16 studies, 4 (3 single-arm studies and 1 nonrandomized study) provided low-quality evidence that bracing, with or without bedrest, was safe. Also, 1 nonrandomized and 1 single-arm study provided low-quality evidence that bracing improved pain and disability. In addition, 4 studies demonstrated that the use of a rigid brace was equivalent to the use of a soft brace or no brace (2 high-quality RCTs, 2 nonrandomized studies, 1 low-quality RCT). Two nonrandomized and one case-control study demonstrated a benefit of kyphoplasty compared with bracing alone (all low quality). Two RCTs had provided low-quality evidence that bracing was superior to no brace and one nonrandomized study provided low-quality evidence that a dynamic brace was superior to rigid orthosis. Limited evidence has suggested the safety of spinal orthoses for the treatment of osteoporotic compression fractures. At present, compelling evidence is not available to suggest that a rigid brace is superior to a soft brace or no brace. Kyphoplasty might be of benefit for select patients. [ABSTRACT FROM AUTHOR]

Summary: Higher cutaneous melanin reduces vitamin D3 production. This may increase fracture risk. We found that cutaneous melanin density was associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. Melanin density either acts as a surrogate marker or its relationship with fracture changes with time. Introduction: Higher cutaneous melanin reduces vitamin D3 production. This may impact lifetime vitamin D status and increase fracture risk. This study aimed to describe the relationship between spectrophotometrically determined constitutive melanin density, prevalent and incident fractures in a cohort of exclusively older Caucasian adults. Methods: 1072 community-dwelling adults aged 50–80 years had constitutive melanin density quantified using spectrophotometry. Participants were followed up at 2.5 (n = 879), 5 (n = 767), and 10 (n = 571) years after the baseline assessment. Prevalence and number of symptomatic fractures were assessed by questionnaire. Results: Higher melanin density was independently associated with greater prevalence of any fracture (RR 1.08, p = 0.03), vertebral fracture (RR 1.41, p = 0.04) and major fracture (RR 1.12, p = 0.04) and the number of fractures (RR 1.09, p = 0.04) and vertebral fractures (RR 1.47, p = 0.04) in cross-sectional analysis. At the 2.5-year follow-up, higher melanin density was associated with incident fractures (RR 1.42, p = 0.01) and major fractures (RR 1.81, p = 0.01) and the number of incident fractures (RR 1.39, p = 0.02) and major fractures (RR 2.14, p = 0.01). The relationship between melanin density and incident fracture attenuated as the duration of follow-up increased and was not significant at the 5- or 10-year follow-up. Conclusions: Constitutive melanin density was associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. This suggests melanin density either acts as a surrogate marker for an unmeasured fracture risk factor or the relationship between melanin density and fracture changes with time. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of the Salisbury Protocol for Assessment of Cauda Equina Syndrome (SPACES) on the waiting time for MRI in patients presenting with suspected Cauda Equina Syndrome (sCES) within a UK district general hospital. All consecutive patients undergoing an MRI scan in our hospital, for sCES, over a 12 month period, prior to and following the introduction of SPACES, were identified. Patient's gender, age, MRI diagnosis, time from MRI request to imaging and outcome were recorded. In the year prior to the introduction of SPACES, 66 patients underwent MRI for sCES, out of which 10.6% had cauda equina compression (CEC), 63.5% had other spinal pathology and 25% had a normal scan. In the year after introduction of SPACES, 160 patients underwent MRI for sCES out of which 6.2% had CEC, 70.7% had other spinal pathology and 23% had a normal scan. Despite the referrals for sCES increasing by more than 2-fold following the introduction of SPACES, the median time from MRI request to scan decreased from 9.1 to 4.2 hours (p = 0.106, Mann-Whitney-U) and the number of patients transferred to the regional hub hospital decreased from 7 to 3. Implementation of SPACES for patients with sCES resulted in a substantial reduction in waiting time for MRI and decreased the number of transfers to the regional hub hospital. Based on our early experience, we encourage other centres within the UK to introduce such a pathway locally, to improve the management of patients with sCES. [ABSTRACT FROM AUTHOR]

Background: Acute treatment of cerebral edema and elevated intracranial pressure is a common issue in patients with neurological injury. Practical recommendations regarding selection and monitoring of therapies for initial management of cerebral edema for optimal efficacy and safety are generally lacking. This guideline evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema. Clinicians must be able to select appropriate therapies for initial cerebral edema management based on available evidence while balancing efficacy and safety.Methods: The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacy to create a panel in 2017. The group generated 16 clinical questions related to initial management of cerebral edema in various neurological insults using the PICO format. A research librarian executed a comprehensive literature search through July 2018. The panel screened the identified articles for inclusion related to each specific PICO question and abstracted necessary information for pertinent publications. The panel used GRADE methodology to categorize the quality of evidence as high, moderate, low, or very low based on their confidence that the findings of each publication approximate the true effect of the therapy.Results: The panel generated recommendations regarding initial management of cerebral edema in neurocritical care patients with subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, bacterial meningitis, and hepatic encephalopathy.Conclusion: The available evidence suggests hyperosmolar therapy may be helpful in reducing ICP elevations or cerebral edema in patients with SAH, TBI, AIS, ICH, and HE, although neurological outcomes do not appear to be affected. Corticosteroids appear to be helpful in reducing cerebral edema in patients with bacterial meningitis, but not ICH. Differences in therapeutic response and safety may exist between HTS and mannitol. The use of these agents in these critical clinical situations merits close monitoring for adverse effects. There is a dire need for high-quality research to better inform clinicians of the best options for individualized care of patients with cerebral edema. [ABSTRACT FROM AUTHOR]

Background Cancer-related fatigue (crf) is the highest unmet need in cancer survivors. The Canadian Association of Psychosocial Oncology (capo) has developed guidelines for screening, assessment, and intervention in crf; however, those guidelines are not consistently applied in practice because of patient, health care provider (hcp), and systemic barriers. Notably, previous studies have identified a lack of knowledge of crf guidelines as an impediment to implementation. Methods In this pilot study, we tested the preliminary outcomes, acceptability, and feasibility of a training session and a knowledge translation (kt) tool designed to increase knowledge of the capo crf guidelines among hcps and community support providers (csps). A one-time in-person training session was offered to a diverse sample of hcps and csps (n = 18). Outcomes (that is, knowledge of the capo crf guidelines, and intentions and self-efficacy to apply guidelines in practice) were assessed before and after training. Acceptability and feasibility were also assessed after training to guide future testing and implementation of the training. Results After training, participants reported increased knowledge of the capo crf guidelines and greater self-efficacy and intent to apply guidelines in practice. Participant satisfaction with the training session and the kt tool was high, and recruitment time, participation, and retention rates indicated that the training was acceptable and feasible. Conclusions The provided training is both acceptable to hcps and csps and feasible. It could increase knowledge of the capo crf guidelines and participant intentions and self-efficacy to implement evidence-based recommendations. Future studies should investigate actual changes in practice and how to optimize follow-up assessments. To promote practice uptake, kt strategies should be paired with guideline development. [ABSTRACT FROM AUTHOR]

We report the detection of [C  ii ] λ158  |$\mu$| m emission from a system of three closely separated sources in the Cosmic Evolution Survey (COSMOS) field at z ∼ 4.56 , as part of the Atacama Large Millimeter/submillimeter Array (ALMA) Large Program to INvestigate C  ii at Early times (ALPINE). The two most luminous sources are closely associated, both spatially (1.6 arcsec ∼ 11 kpc) and in velocity (∼100 km s−1), while the third source is slightly more distant (2.8 arcsec ∼ 18 kpc, ∼300 km s−1). The second most luminous source features a slight velocity gradient, while no significant velocity gradient is seen in the other two sources. Using the observed [C  ii ] luminosities, we derive a total log |$_{10}(\rm SFR_{[C\,{\small II}]}\, [M_{\odot }\, yr^{-1}])=2.8\pm 0.2$|⁠ , which may be split into contributions of 59, 31, and 10 per cent from the central, east, and west sources, respectively. Comparison of these [C  ii ] detections to recent zoom-in cosmological simulations suggests an ongoing major merger. We are thus witnessing a system in a major phase of mass build-up by merging, including an ongoing major merger and an upcoming minor merger, which is expected to end up in a single massive galaxy by z ∼ 2.5. [ABSTRACT FROM AUTHOR]

Aim: To investigate the incretin axis in people with cystic fibrosis. Methods: Adults with cystic fibrosis‐related diabetes, cystic fibrosis without diabetes, and controls (adults without cystic fibrosis and without diabetes) underwent an oral glucose tolerance test and then a closely matched isoglycaemic i.v. glucose infusion. On each occasion, glucose, insulin, C‐peptide, total and active glucagon‐like peptide‐1 and gastric inhibitory polypeptide responses were recorded and incremental areas under curves were calculated for 60 and 240 min. Results: Five adults with cystic fibrosis‐related diabetes, six with cystic fibrosis without diabetes and six controls, matched for age and BMI, completed the study. Glucose during oral glucose tolerance test closely matched those during isoglycaemic i.v. glucose infusion. The calculated incretin effect was similar in the control group and the cystic fibrosis without diabetes group (28% and 29%, respectively), but was lost in the cystic fibrosis‐related diabetes group (cystic fibrosis‐related diabetes vs control group: –6% vs 28%; p=0.03). No hyposecretion of glucagon‐like peptide‐1 or gastric inhibitory polypeptide was observed; conversely, 60‐min incremental area under the curve for total glucagon‐like peptide‐1 was significantly higher in the cystic fibrosis‐related diabetes group than in the control group [1070.4 (254.7) vs 694.97 (308.1); p=0.03] Conclusions: The incretin effect was lost in cystic fibrosis‐related diabetes despite adequate secretion of the incretin hormones. These data support the concept that reduced incretin hormone insulinotropic activity contributes significantly to postprandial hyperglycaemia in cystic fibrosis‐related diabetes. What's new?: This study is the first to measure the incretin effect in people with cystic fibrosis (CF).The incretin effect is lost in people with cystic fibrosis‐related diabetes (CFRD) despite adequate secretion of glucagon‐like peptide‐1 and gastric inhibitory polypeptide.In people with CF but not diabetes, the incretin effect is similar to that in people without CF.These data suggest the lack of incretin effect contributes to postprandial hyperglycaemia, a hallmark of CFRD, most likely as a consequence of reduced β‐cell mass. [ABSTRACT FROM AUTHOR]

For each of the 14 classes of edge-transitive maps described by Graver and Watkins, necessary and sufficient conditions are given for a group to be the automorphism group of a map, or of an orientable map without boundary, in that class. Extending earlier results of Siran, Tucker and Watkins, these are used to determine which symmetric groups Sn can arise in this way for each class. Similar results are obtained for all finite simple groups, building on work of Leemans and Liebeck, Nuzhin and others on generating sets for such groups. It is also shown that each edge-transitive class realises finite groups of every sufficiently large nilpotence class or derived length, and also realises uncountably many non-isomorphic infinite groups. [ABSTRACT FROM AUTHOR]

Using density functional theory (DFT), we analyze the influence of five classes of functional groups, as exemplified by NO2, OCH3, CH3, CCl3, and I, on the transport properties of a 1,4-benzenedithiolate (BDT) and 1,4-benzenediamine (BDA) molecular junction with gold electrodes. Our analysis demonstrates how ideas from functional group chemistry may be used to engineer a molecule’s transport properties, as was shown experimentally and using a semiempirical model for BDA [Nano Lett. 7, 502 (2007)]. In particular, we show that the qualitative change in conductance due to a given functional group can be predicted from its known electronic effect (whether it is σ/π donating/withdrawing). However, the influence of functional groups on a molecule’s conductance is very weak, as was also found in the BDA experiments. The calculated DFT conductances for the BDA species are five times larger than the experimental values, but good agreement is obtained after correcting for self-interaction and image charge effects. [ABSTRACT FROM AUTHOR]

We propose and demonstrate an enhancement-mode AlxGa1-xAs/GaAs single heterojunction field-effect transistor, in which the gate dielectric consists of an epitaxial AlxGa1-xAs layer and spin-on benzocyclobutene. The as-grown sample is undoped and, as a result, nonconductive at 4.2 K. However, under a positive gate bias, high mobility two-dimensional electrons at the heterointerface are induced, as evidenced by magnetotransport characteristics. Numerical simulations of a model structure provide insight into applications in mesoscopic devices. [ABSTRACT FROM AUTHOR]

New igneous zircon Hf O data from the Hogem batholith (207 to 125 Ma), emplaced into the Quesnel arc, an accreted oceanic terrane in the northern Cordillera, resolve questions about the magmatic history and source inputs of the terrane and the relationship of the terrane with ancestral North America before, during, and after collision. Juvenile zircon Hf signatures (> + 5 initial ɛHf) with predominantly mantle-like δ18O (+5.3 ± 0.6‰) indicate juvenile, mantle-derived magmas as the major contributors to the Hogem batholith. Minor input from young recycled oceanic crust is indicated by less common heavy zircon δ18O (>6.5‰). Mixing models demonstrate that ancestral North American crust did not underlie or contribute to the construction of north-central Quesnellia during the Triassic to Early Cretaceous - the time of Hogem batholith magmatism. This conclusion contrasts with previous regional tectonic models that suggest Early to Middle Jurassic accretion of Quesnellia onto North American basement. The collision between oceanic arcs and continental margins is generally considered a process that predominates the formation and growth of new continental crust at accretionary orogens. Our combined igneous zircon Hf O results track the magmatic evolution of the batholith and indicate the importance of juvenile oceanic arcs in contributing crust to the flanks of some accretionary orogens. • Zircon Hf-O data reveal crustal contributions to a Triassic to Cretaceous batholith, Quesnellia, North American Cordillera. • Juvenile zircon eHf(t) and mantle-like to heavy δ18O indicate mantle-like magma sources contaminated by recycled juvenile crust. • Ancestral North American crust did not underly north-central Quesnel terrane prior to ca. 125 Ma. • Accretion of juvenile oceanic crust to the flank of the continent contributed to this accretionary orogen. [ABSTRACT FROM AUTHOR]

Presents literary criticism which examines the identification of Malvolio, a character in the play "Twelfth Night" by William Shakespeare, with puritanism. Characteristics of puritans; Anti-puritan frame of reference in the play; Theatrical example of "Twelfth Night" puritan baiting.

The purpose of the study was to examine the sources of stress in an international squad of elite male wheelchair basketball players (n=10) via structured interviews. Inductive content-analysis was used to derive stress categories from the athletes' perspective. Ten distinct general stress source dimensions emerged: preevent concerns, negative match preparation, on-court concerns, postmatch performance concerns, negative aspects major event, poor group interaction and communication, negative coaching style/behavior, relationship issues, demands or costs of wheelchair basketball, and lack of disability awareness. The findings suggest that elite wheelchair basketball players experience sources of stress relating to the whole competition process, organizational aspects of competing at a major event, communicating or relating to important others, and two dimensions that are noncompetition specific (demands or costs of wheelchair basketball and lack of disability awareness). [ABSTRACT FROM AUTHOR]

A map which is non-orientable or has non-empty boundary has a canonical double cover which is orientable and has empty boundary. The map is called stable if every automorphism of this cover is a lift of an automorphism of the map. This note describes several infinite families of unstable maps, and relates them to similar phenomena for graphs, hypermaps and Klein surfaces. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to verify a computational phonetic and acoustic analysis tool created in the MATLAB environment. A dataset was obtained containing 3 broad American dialects (Northern, Western and New England) from the TIMIT database using words that also appeared in the Swadesh list. Each dialect consisted of 20 speakers uttering 10 sentences. Verification using phonetic comparisons between dialects was made by calculating the Levenshtein distance in Gabmap and the proposed software tool. Agreement between the linguistic distances using each analysis method was found. Each tool showed increasing linguistic distance as a function of increasing geographic distance, in a similar shape to Seguy's curve. The proposed tool was then further developed to include acoustic characterisation capability of inter dialect dynamics. Significant variation between dialects was found for the pitch, trajectory length and spectral rate of change for 7 of the phonetic vowels investigated. Analysis of the vowel area using the 4 corner vowels indicated that for male speakers, geographically closer dialects have smaller variations in vowel space area than those further apart. The female utterances did not show a similar pattern of linguistic distance likely due to the lack of one corner vowel /u/, making the vowel space a triangle. [ABSTRACT FROM AUTHOR]

Summary: Greater skin pigmentation reduces dose equivalent cutaneous vitamin D3 production, potentially impacting lifetime vitamin D status and fracture risk. We show that melanin density was positively associated with 25-hydroxyvitamin D and total body bone mineral density. These relationships were partially explained by greater sun exposure due to more permissive skin phenotype.Introduction: Higher cutaneous melanin reduces vitamin D3 production. This may impact lifetime vitamin D status and increase fracture risk. This study aimed to describe the relationship between spectrophotometrically determined constitutive melanin density, osteoporotic risk factors and potential intermediaries in a cohort of exclusively older Caucasian adults.Methods: One thousand seventy-two community-dwelling adults aged 50-80 years had constitutive melanin density quantified using spectrophotometry. Sun exposure, skin phenotype, non-melanoma skin cancer (NMSC) prevalence and smoking status were assessed by questionnaire. Bone mineral density (BMD), falls risk, physical activity and 25-hydroxyvitamin D were measured using DXA, the short form Physiological Profile Assessment, pedometer and radioimmunoassay, respectively.Results: Higher melanin density was independently associated with greater ability to tan (RR = 1.27, p < 0.001), less propensity to sunburn (RR = 0.92, p < 0.001), fewer lifetime sunburns (RR = 0.94, p = 0.01), current smoking (RR = 1.41, p < 0.001), female sex (RR = 1.24, p < 0.001) and less photodamage (RR = 0.98, p = 0.01). The associations between melanin density and sun exposure (RR = 1.05-1.11, p < 0.001-0.01), sun protection behaviours (RR = 0.89, p < 0.001) and NMSC prevalence (RR = 0.75, p = 0.001) were no longer significant after taking into account skin phenotype and sun exposure, respectively. 25-Hydroxyvitamin D was strongly associated with higher melanin density (β = 1.71-2.05, p = 0.001). The association between melanin density and total body BMD (β = 0.007, p = 0.04) became non-significant after adjustment for 25-hydroxyvitamin D. There was no association between melanin density and physical activity, falls risk or BMD at other sites.Conclusions: Our data support a model of higher constitutive melanin density underpinning a less photosensitive skin phenotype, permitting greater sun exposure with fewer sequelae and yielding higher 25-hydroxyvitamin D and, potentially, total body BMD. [ABSTRACT FROM AUTHOR]

Two second-order finite difference methods in a staggered mesh to solve the static diffusion equation are proposed in this article. These methods were compared with a standard finite difference method and with two numerical schemes naturally established in staggered grids: mimetic method and conservative method. Also, mimetic discretization is presented in a formal manner. The methods were tested using different configurations, including boundary layers and heterogeneous media. The study shows that the two proposed finite difference methods produce numerical solutions that are comparable to those given by mimetic methods, in terms of rates of convergence and magnitude of the approximation error. [ABSTRACT FROM AUTHOR]

Reports on the effect of ion energy on tin donor activation and defect production in molecular beam epitaxy gallium arsenide doped with tin ions during growth. Photoluminescence spectra of the ion-doped gallium arsenide; Advantage of using an ionized beam for doping; Temperature dependence of the mobility and the carrier concentration of a sample doped with tin ions.

Presents information on a study which described the bulk magnetic properties of a series of thin layered CoCrPt prototype recording systems. Hysteresis curves of the samples; Experimental details; Results and discussion; Conclusions.

Laser selective excitation and optical absorption of deuterated SrF2:0.05% Er3+ crystals have revealed eight Er3+ ion centers involving D- ion charge compensation, nine new Er3+–F- centers not associated with D- ions and several approximately cubic symmetry Er3+ centers. In contrast to the trigonal symmetry of the principal F- center, the dominant arrangements in the D- ion charge compensation case are derived from a tetragonal symmetry center. Detailed spectroscopic results for the new centers are presented. Fluorescence polarization ratios are listed for three centers ( J, B, and G1) present in either SrF2:Er3+ or CaF2:Er3+ and crystal-field analyses of these, based on assumed trigonal symmetry, are also reported. [ABSTRACT FROM AUTHOR]

Large-scale outflows are believed to be an important mechanism in the evolution of galaxies. We can determine the impact of these outflows by studying either current galaxy outflows and their effect in the galaxy or by studying the effect of past outflows on the gas surrounding the galaxy. In this work, we examine the CO(7−6), [C  i ] (⁠|$^{3} \rm P_{1} \rightarrow {\rm ^3 P}_{0}$|⁠), H2O 211–202, and dust continuum emission of 15 extremely red quasars at z ∼ 2.3 using ALMA. By investigating the radial surface brightness profiles of both the individual sources and the stacked emission, we detect extended cold gas and dust emission on scales of ∼14 kpc in CO(7−6), [C  i ](2−1), and dust continuum. This is the first time that the presence of a large amount of molecular gas was detected on large, circumgalactic medium scales around quasar host galaxies using [C  i ] extended emission. We estimate the dust and molecular gas mass of these haloes to be 107.6 and 1010.6 M⊙, indicating significant dust and molecular gas reservoirs around these extreme quasars. By estimating the time-scale at which this gas can reach these distances by molecular gas outflows (7–32 Myr), we conclude that these haloes are a relic of past AGN or starburst activity, rather than an effect of the current episode of extreme quasar activity. [ABSTRACT FROM AUTHOR]

Summary: The cytokine interleukin (IL)‐6 is a major therapeutic target for the treatment of various inflammatory and autoimmune diseases. While IL‐6 receives considerable attention in studies of innate and adaptive immunity, the IL‐6‐related family member IL‐27 is recognized increasingly for its effects on cellular proliferation, differentiation and leucocyte effector functions. Both cytokines activate responses in myeloid and stromal tissue cells, where they direct the transition from innate to adaptive immunity. However, they are identified frequently as lymphokines that control responses in T cells and B cells. In this regard, IL‐27 often opposes the action of IL‐6. Here, we will review the role of IL‐6 and IL‐27 in inflammation, with a particular focus on inflammatory arthritis, and discuss their importance in the diagnosis, stratification and treatment of autoimmune disease. [ABSTRACT FROM AUTHOR]

Abstract: Cutting height is an important factor controlling the yield and persistence of grass swards harvested for conserved feed. The objective of this experiment was to determine the effect of four cutting heights (5, 10, 15 and 20 cm) on the yield, composition and productivity based on deviation from a size/density compensation line for swards of orchardgrass (Dactylis glomerata L.) and an orchardgrass/alfalfa (Medicago sativa L.) mixture harvested nine times over three growing seasons. Yield was greatest for the 5 cm cutting height through the course of the experiment but ground cover of orchardgrass declined. Prior to the final harvest, tiller weight and density were determined. The 10‐, 15‐ and 20‐cm treatments fell on an apparent size/density compensation line with slope ‐1·779 (R2 = ·99; p = ·008) while the 5‐cm treatment fell considerably below that line indicating a reduction in productivity or relative persistence. Harvest at 10 cm appears to optimize yield while maintaining stand productivity in infrequently harvested orchardgrass swards. [ABSTRACT FROM AUTHOR]

The paper investigates experimentally the low Reynolds number flow ( R e c = 50 , 000 ) around a model that approximates a NACA 4415 airfoil and the control of separation using periodic surface motion. Actuation is implemented by bonding two Macro Fiber Composite patches to the underside of the suction surface. Time-resolved measurements reveal that the peak-to-peak displacement of the surface motion is a function of both the amplitude and frequency of the input voltage signal but the addition of aerodynamic forces does not cause significant changes in the surface behavior. The vibration mode is uniform in the spanwise direction for frequencies below 80 Hz; above this frequency, a secondary vibration mode is observed. The flow around the unactuated airfoil exhibits a large recirculation region as a result of laminar separation without reattachment and consequently produces relatively high drag and low lift forces. Various actuation frequencies were examined. When actuated at V f + = 2 . 0 , the spectra in the vicinity of the trailing edge and near-wake were found to be dominated by the actuation frequency. Sharp peaks appear in the spectra suggesting the production of Large Coherent Structures at this frequency. The increased momentum entrainment associated with these enabled a significant suppression of the separated region. The result was a simultaneous increase in C L and decrease in C D and therefore a large increase in the L ∕ D ratio. In addition, a delay in the onset of stall results in a significant increase in the maximum achievable lift. [ABSTRACT FROM AUTHOR]

Background: The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use. Method: A systematic review of the literature was performed using standardised methodology. Results: Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non- dissolvable packs. Conclusion: Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use. [ABSTRACT FROM AUTHOR]

Background: In health care, burnout has been defined as a psychological process whereby human service professionals attempting to positively impact the lives of others become overwhelmed and frustrated by unforeseen job stressors. Burnout among various physician groups who primarily practice in the hospital setting has been extensively studied; however, no evidence exists regarding burnout among hospital clinical pharmacists. Objective: The aim of this study was to characterize the level of and identify factors independently associated with burnout among clinical pharmacists practicing in an inpatient hospital setting within the United States. Methods: We conducted a prospective, cross-sectional pilot study utilizing an online, Qualtrics survey. Univariate analysis related to burnout was conducted, with multivariable logistic regression analysis used to identify factors independently associated with the burnout. Results: A total of 974 responses were analyzed (11.4% response rate). The majority were females who had practiced pharmacy for a median of 8 years. The burnout rate was high (61.2%) and largely driven by high emotional exhaustion. On multivariable analysis, we identified several subjective factors as being predictors of burnout, including inadequate administrative and teaching time, uncertainty of health care reform, too many nonclinical duties, difficult pharmacist colleagues, and feeling that contributions are underappreciated. Conclusions: The burnout rate of hospital clinical pharmacy providers was very high in this pilot survey. However, the overall response rate was low at 11.4%. The negative effects of burnout require further study and intervention to determine the influence of burnout on the lives of clinical pharmacists and on other health care-related outcomes. [ABSTRACT FROM AUTHOR]

The paper considers how many conjugacy classes of reflections a map can have under various transitivity conditions. It is shown that for vertex- and for face-transitive maps there is no restriction on their number or size, whereas edge-transitive maps can have at most four classes of reflections. Examples are constructed, using topology, covering spaces, and group theory, to show that various distributions of reflections can be achieved. Connections with real forms of algebraic curves are also discussed. Bibliography: 30 titles. [ABSTRACT FROM AUTHOR]

The regular maps and the arc-transitive maps on surfaces with nonempty boundary are classified. It is shown that it is unrealistic to expect a similar classification of edge-transitive maps on such surfaces. [ABSTRACT FROM AUTHOR]

This work describes an experimental study which reviews the various techniques that can be used for determination of anisotropy fields in recording media. At the present time this topic is of considerable importance due to the need to understand the detailed mechanisms of magnetization reversal and the factors that control the switching field distribution in recording media. We have used a metal-particle-based tape material and have employed various magnetic techniques for the determination of the apparent anisotropy field, H[sub K]. The techniques included hysteresis loops measured in a direction transverse to the texture direction of the tapes, single-point detection in the successive derivatives of the magnetization with respect to the field, transverse susceptibility measurement, and the variation of the bulk coercivity with temperature. We find the temperature variation of coercivity produces values of H[sub K] far smaller than values determined by other methods due to orientation effects. General agreement is seen for the other techniques mentioned and results for samples with differing degrees of texture show that the apparent anisotropy field of the grains as measured by these techniques is influenced greatly by orientation effects. © 2000 American Institute of Physics. [ABSTRACT FROM AUTHOR]