Journal articles on the topic 'Clean-in-place (CIP) risk analysis'

Objective: To assess the prevalence of contrast-induced nephropathy and its associated risk factors in patients undergoing multi-vessel percutaneous coronary intervention (PCI). Study Design: Observational/ Prospective study Place and Duration: Armed forces institute of cardiology & National Institute of heart diseases, Rawalpindi, during from the period September 2019 to Feb 2020. Methods: There were 112 patients of both genders with ages 18-75 years were presented in this study. Data on enrolled patients' age, gender, BMI, marital status and education level were collected after receiving written permission from each patient. This research included people who had undergone a percutaneous coronary intervention. Serum creatinine >0.5mg/dl from the baseline value was classified as contrast induced nephropathy. CIN-related risk factors were studied. Data was analyzed using SPSS 24.0. Results: The mean age of the patients was 51.6±9.53 years and had mean BMI 23.5±15.67 kg/m2. Majority were males 68 (60.7%) and 44 (39.3%) were females. There were 75 (66.96%) patients married and 55 (49.1%) patients were educated. Frequency of contrast induced nephropathy was among 25 (22.3%) cases. Most common risk factor of CIP was contrast volume 19 (76%) and hypertension found in 17 (68%) cases, followed by diabetes mellitus in 15 (60%) cases, age >65 years in 13 (52%) cases, CHF in 11 (44%) cases, smoking history in 9 (36%) cases and family history of CAD was 4 (16%). Conclusion: Patients undergoing PCI are at a considerable risk of developing contrast-induced nephropathy. Among the risk variables for CIN were anaemia (age >70 years), diabetes mellitus (contrast volume >150 ml), and heart failure. Keywords: Risk Factors, Contrast Induced Nephropathy, Percutaneous Coronary Intervention

Objective: To assess the prevalence of contrast-induced nephropathy and its associated risk factors in patients undergoing multi-vessel percutaneous coronary intervention (PCI). Study Design: Observational/ Prospective study Place and Duration: Armed forces institute of cardiology & National Institute of heart diseases, Rawalpindi, during from the period September 2019 to Feb 2020. Methods: There were 112 patients of both genders with ages 18-75 years were presented in this study. Data on enrolled patients' age, gender, BMI, marital status and education level were collected after receiving written permission from each patient. This research included people who had undergone a percutaneous coronary intervention. Serum creatinine >0.5mg/dl from the baseline value was classified as contrast induced nephropathy. CIN-related risk factors were studied. Data was analyzed using SPSS 24.0. Results: The mean age of the patients was 51.6±9.53 years and had mean BMI 23.5±15.67 kg/m2. Majority were males 68 (60.7%) and 44 (39.3%) were females. There were 75 (66.96%) patients married and 55 (49.1%) patients were educated. Frequency of contrast induced nephropathy was among 25 (22.3%) cases. Most common risk factor of CIP was contrast volume 19 (76%) and hypertension found in 17 (68%) cases, followed by diabetes mellitus in 15 (60%) cases, age >65 years in 13 (52%) cases, CHF in 11 (44%) cases, smoking history in 9 (36%) cases and family history of CAD was 4 (16%). Conclusion: Patients undergoing PCI are at a considerable risk of developing contrast-induced nephropathy. Among the risk variables for CIN were anaemia (age >70 years), diabetes mellitus (contrast volume >150 ml), and heart failure. Keywords: Risk Factors, Contrast Induced Nephropathy, Percutaneous Coronary Intervention

One of the most effective methods for cleaning soil and water bodies from oil and oil products is the biotechnological method using oil-degrading bacteria. However, their production is a rather complicated process, during which many unfavorable factors act on the human body. The paper considers the process of cleaning an industrial fermenter with a CIP (Cleaning in Place) contactless cleaning system. An automatic metering valve for supplying direct steam during sterilization has been proposed. This reduces the human factor and the risk of workers being poisoned by surfactant species used to clean the fermenter.

The reverse osmosis seawater desalination plants open-intake requires different strategies of pre-treatment to reduce the biofouling and scaling. The UltraFiltration (UF) technology is a recent application to this process. In this work, some alternatives to chemical products reducing in chemically enhanced backwash (CEB) and clean in place (CIP) of a UF rack have been studied. Mainly the sodium hypochlorite consumption, due to its biofouling precursor effect over reverse osmosis membranes. For this purpose, the optimal filtration time has been studied, to get the highest water production prior to the CIP, as well as some modifications in the conventional CIP's, modifying the duration of the stages of the same. The results were compared with the current mode of daily operation of the CEB. The results show that a reduction of up to 60% in the amount of sodium hypochlorite per cubic meter of water produced employed in UF CEB's, mini CIP's and CIP's can be achieved. However, the consumption of the rest of chemical dosing increased notably, and therefore the operating cost of UF also increased. In addition, there was an increase of desalted water consumption to the chemical products removed, up to almost 95,84 %, in comparison with the currently operational mode of CEB. On the other hand, operating the UF plant in the manner proposed requires a automatization of the process and expert staff to programme the control. Therefore, based on the results obtained, the alternatives proposed could reduce the chemical products in use, but it is not conclusive in terms of exploitation operational costs. Key Words: Ultrafiltration, Reverse osmosis, Open-intake, Clean in place, Chemically Enhanced Backwash, chemical products reduction, biofouling, pre-treatment.

The paper presents the results concerning the influence of concentration and storage time on the equilibrium surface tension of chemical solutions used in a clean-in place (CIP) system. Standard cleaning solutions (prepared under laboratory conditions) and industrial solutions (used in a CIP system in a brewery) were subjected to tests. Solutions from the brewery were collected after being regenerated and changes in equilibrium surface tension were studied during a three-month storage. In the statistical analysis of the solutions, standard deviations were determined in relation to the averages, and a Tukey’s multiple comparison test was performed to determine the effect of dependent variables on the surface tension of solutions. From the results, a nonlinear regression model was developed that provided a mathematical description of the kinetics of changes in the wetting properties of the solutions during their storage. A linear–logarithmic function was adopted to describe the regeneration. Numerical calculations were performed based on the nonlinear least squares method using the Gauss–Newton algorithm. The adequacy of the regression models with respect to the empirical data was verified by the coefficient of determination R and the standard error of estimation Se. The results showed that as the concentration of the substance in the cleaning solution increased, its wetting properties decreased. The same effect was observed with increased storage time as the greatest changes occurred during the first eight weeks. The study also showed that the use of substances to stabilize the cleaning solutions prevented deterioration of their wetting properties, regardless of the concentration of the active substance or storage time.

Abstract Background Reveal® 3-D for Peanut is an immunochromatographic, lateral flow test for qualitative detection of peanut residue in food manufacturing and food preparation settings. The test can detect low ppm levels of peanut in clean-in-place (CIP) rinses and in swabs from environmental surfaces and can serve as a tool in managing allergen risk. Objective The objective of the study was to validate the lateral flow method for detection of peanut in CIP rinses, specifically water, peroxyacetic acid/hydrogen peroxide, and quaternary ammonium compound rinses, and in swabs taken from stainless steel and plastic surfaces. Methods CIP rinses spiked with low levels of peanut were tested, as were surfaces inoculated with peanut. Specificity and assay interference were assessed in testing of food commodities with and without added peanut. Assay robustness and test kit stability and consistency testing were also performed. Results Results demonstrated that the lateral flow test can detect peanut in CIP rinses in the range of 2–4 ppm and in environmental surface swabs in the range of 3–4 µg/100 cm2. Results of specificity testing with 29 common food items showed lack of cross-reactivity, and potential assay interference only from walnut. Data from stability trials supports expiration dating for the kit of up to 23 months post-manufacture. Conclusions and Highlights The lateral flow test is a sensitive, specific, and rapid method for detection of low levels of peanut residue in CIP rinses and environmental samples and can be an important component in a comprehensive allergen risk management program.

Comorbidity influences screening practice, treatment choice, quality of life, and survival. The presence of comorbidities and medication use could place patients at greater risks of adverse effects from certain interventions. We conducted a longitudinal cohort study in the General Practice Research Database to better understand comorbidities and medication use in men with or at risk of prostate cancer (CaP). Compared with men with similar age but no CaP, CaP patients had higher incidence of urinary tract infection, impotence and breast disorder, and 2.6-fold higher all-cause mortality. Among men with elevated prostate-specific antigen (PSA) but no CaP, the mortality rates were slightly lower, and fewer differences in comorbidities and medication use were noted compared to men without elevated PSA. Many prevalent comorbidities and medications were consistent across groups and are typical of an older male population. These real-world data are broadly applicable throughout the drug development cycle and subsequent patient management.

Background: Hepatitis A outbreaks were reported by the Lamongan District Health Office to the Surabaya Center for Environmental Health and Disease Control Engineering on January 16, 2018, indicated by an increase in hepatitis A cases in of G and S areas, B village. One of initial sufferer was students in High School X.. Purpose: This study aims to identify the epidemiological characteristics of hepatitis A outbreaks that occur in High School X and the risk factors. Methods: The investigation was carried out in an observational manner with a cross sectional approach. Data were collected by structured interviews, hepatitis A antibodies in blood samples assay, environmental observation, and water samples assay. Data were collected with purposive determination of respondents. Results: Hepatitis A outbreaks at High School X in Lamongan District take place from November 2017 to january 2018, with a target group of 33 students. The epidemic cased tends to be extend common source. Risk factors are contact history with patients, eating habits together in same place, mutual exchange and sharing same eating utensils, the lack of hygiene habit (such as washing hands with soap for students and food handlers), lack of hand washing facilities, bad sanitation, bad food hygiene management, and inadequate clean and hygienis water source. Conclusion: The outbreaks of hepatitis A was extended with the most important risk factors, i.e. lack of personal hygiene and sanitation of water sources.

AbstractIn Afghanistan, acute respiratory infection (ARI) is a leading cause of under-five mortality. Previous studies on the effects of cooking fuel on ARI have only looked at the types of cooking fuel, and not the effects of the location of the cooking place. The present study aimed to assess the effects of fuel type and place of cooking on the prevalence of ARI among under-five children in Afghanistan. Descriptive statistics and multilevel logistic regression analysis were performed for 31,063 children using data from the first round of the Afghanistan Demographic and Health Survey conducted in 2015. Overall, 13% of the children suffered from ARI symptoms in the 2 weeks before the survey, but this varied widely across the country. The multilevel analysis showed that, compared with households using clean cooking fuel in a separate building or outside, households using clean cooking fuel within the house and without a separate kitchen had a 32% lower risk [95% confidence interval (CI)=0.51–0.91] of having under-five children with ARI, and those using clean fuel in a separate kitchen in the house had a 17% lower risk (95% CI=0.67–1.03). On the other hand, households using polluting cooking fuel in the house without a kitchen had a 14% (95% CI=0.91–1.44) higher risk of having under-five children with ARI, and those using polluting cooking fuel in the house with a separate kitchen had a 5% (95% CI=0.85–1.30) higher risk, after adjusting for other covariates. The findings indicate that type of cooking fuel is not the only issue affecting ARI in children. Place of cooking (in a house with or without a separate kitchen versus outside) also affects the risk of ARI among under-five children. The study also found that mother’s education and occupational status, community poverty and ethnicity are other important factors affecting the prevalence of ARI in under-five children in Afghanistan.

Indonesia still faces some challenges in the field of water, sanitation, and hygiene (WASH) especially in Jakarta. Environmental disease such as diarrhea becomes the cause of death on toddlers in Indonesia. The region with the most cases of diarrhea is Johar Baru Subdistrict with proportion 17% of all Subdistricts in Central Jakarta area and becomes the region with the most populous place in Jakarta. This analysis aims to determine the source of potential pollution of diarrhea in Johar Baru Subdistrict. The research method used was cross sectional study design. The research results show that mothers’ education, the habit of washing the hand by using soap, family income, type of clean water sources, facility of waste disposal, and risk of clean water source pollution influence the occurance of diarrhea on toddlers. The dominant factor of diarrhea case on toddlers is the risk of clean water source pollution and the habit of washing the hand by using soap. The effort of diarrhea prevention is such as conducting city water security at slums of the city with high populous and makes washing the hand with soap as the habit in the society completed with the facility of hand washing.

Abstract Background Preliminary studies that analyzed surrogate markers have suggested that operating room (OR) door openings may be a risk factor for surgical site infection (SSI). We therefore aimed to estimate the effect of OR door openings on SSI risk in patients undergoing cardiac surgery. Methods This prospective, observational study involved consecutive patients undergoing cardiac surgery in 2 prespecified ORs equipped with automatic door-counting devices from June 2016 to October 2017. Occurrence of an SSI within 30 days after cardiac surgery was our primary outcome measure. Respective outcome data were obtained from a national SSI surveillance cohort. We analyzed the relationship between mean OR door opening frequencies and SSI risk by use of uni- and multivariable Cox regression models. Results A total of 301 594 OR door openings were recorded during the study period, with 87 676 eligible door openings being logged between incision and skin closure. There were 688 patients included in the study, of whom 24 (3.5%) developed an SSI within 30 days after surgery. In uni- and multivariable analysis, an increased mean door opening frequency during cardiac surgery was associated with higher risk for consecutive SSI (adjusted hazard ratio per 5-unit increment, 1.49; 95% confidence interval, 1.11–2.00; P = .008). The observed effect was driven by internal OR door openings toward the clean instrument preparation room. Conclusions Frequent door openings during cardiac surgery were independently associated with an increased risk for SSI. This finding warrants further study to establish a potentially causal relationship between OR door openings and the occurrence of SSI.

Dengue High Fever (DHF) is a contagious health problem in tropical areas like Indonesia. Palu city has the highest cases of DHF that is 600 cases (Incidence Rate 166,2/100.000 population) and there are 9 people died. Incidence of DHF in the working area of Kamonji public health center are 106 cases. Factors that cause DHF in this working area are environment and behavior of community. The study aimsis determine risk factors of environment and eradication of mosquito nests efforts in the working area of Kamonji Public Health Center. This type of research is case-control approach and the sample taken from Total Sampling technique which amounts to 86 respondents with a ratio 1:1. Data analysis was performed using univariate and bivariate at 95% confidence level (α=0,05) which shows that precenses of larvae in breeding place (OR=0,334) and drain water containers (OR=0,237) are protective factors. Another result shows that presences of mosquito in resting place (OR=3,654), close water containers (OR=4,032), the use of abate (OR=3,048) and the use of anti-mosquito drugs (OR=4,909) are risk factors of incidence of DHF in working area of Kamonji public health center. The efforts to prevent incidence of DHF is implement eradication of mosquito nest so that the environment around the house still clean and has no chance for become breeding place of Aedes aegypti.

Objective. To assess the epidemiological manifestations of the incidence of respiratory system diseases (RSD) among the military personnel of the military units of the Central Military Region. Materials and methods. The morbidity analysis was carried out according to official statistics for 20032019 with an assessment of long-term dynamics, structure and spatial characteristics. Results. Despite the preventive measures taken, the incidence of respiratory diseases in the troops remains high and continues to grow. The conscript servicemen are at risk. In the structure of RSD incidence, acute respiratory viral infections (ARVI) take the leading place, tonsillitis and bronchitis are in the second place, and community-acquired pneumonia (CAP) is in the third place. Differences in the trends of long-term dynamics of morbidity in various clinical forms of RSD were revealed. The Siberian Federal Region is the most favorable regarding RSD incidence. Conclusions. The incidence of respiratory diseases among conscripts is higher than that in contract servicemen, with downward trend for CAP and growth for ARVI and bronchitis.

HACCP (hazard analysis and critical control points) principles were applied to evaluate the effectiveness of two water treatment facilities to continually produce potable water free of microbiological health hazards. This paper reports a hazard analyses protocol (microbiological hazards based on faecal coliforms (FC) and turbidity (TBY) as indicators) for critical control points (CCPs) within each facility. The CCPs were raw resource water, sedimentation, filtration and chlorine-disinfection. The aim was to determine the effectiveness of each CCP to remove the indicators from the water under treatment. Arbitrary critical performance limit targets (CPLTs) were set up for each CCP to determine to what extent each contributed to effective removal and to predict what the effect would be if any of the CCPs should fail. Health-related water quality guideline limits for expected health effects were applied and compliance measured at the 90th percentile. The raw resource river water used at both treatment facilities complied with raw resource water extraction CPLTs. The treated potable water complied with health-related drinking water guidelines. Sedimentation removed the largest proportion of the indicators from the raw water, but showed failure potential that could overload the consequent system. Filtration effectiveness at both treatment facilities showed potential to break down the overall effectiveness of the entire treatment facility, since the filter systems failed to meet their respective CPLTs. This left the disinfection phase to remove the remaining portion of indicators. Faecal coliforms appeared to be completely removed from post-chlorination samples. This indicated that both chlorine disinfection phases were 100% effective in meeting their disinfection CPLTs, despite having to “clean up” the indicator organisms that spilt over from the upstream CCPs. This, nevertheless, implied a risk of unsafe water release into distribution. CCPs at these treatment facilities had some difficulties in reducing the health-related risks to meet their respective CPLTs. Applying a HACCP programme would minimise the risk of contaminated water distribution in cases of system component failure.

AbstractObjective:Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI.Design:Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors.Setting:Five urban, academic medical centers, part of the New York City Clinical Data Research Network.Patients:Potential patients were age <22 years who were seen between October 2010 and September 2015.Results:In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1–6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics.Conclusions:Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.

Water is fresh potable water is not always available at the right time or the right place for human or ecosystem use [1]. According to Straskraba and Tundisi (1999), water impoundments constructed by damming rivers are called dam reservoirs. Under the Malaysian Western Johore Agricultural Development Project, the main function of the Sembrong dam is flood mitigation. The secondary function of the dam is to provide clean water supply to 240,000 consumers in Kluang district area [2]. Water from the Sembrong dam reservoir is treated at the West Sembrong Water Treatment Plant before the distribution. Daily reservoir inflow data were extracted by applying the water balance model to the Sembrong dam reservoir. Developing hydrologic hazard curves for risk assessment uses the length of record and type of data to determine the extrapolation limits for flood frequency analysis [5]. Extrapolation beyond the data is often necessary to provide information needed for dam safety risk assessments [6]. The sources of information used for flood hazard analyses include stream flow and precipitation records and pale flood data.

Currently bacterial community-acquired pneumonia (CAP) remains one of the important problems of providing medical care on an outpatient basis. Despite the high detection rate and modern methods of treatment this disease holds the first place among the causes of death in the category of infectious diseases. Knowledge about rational use of drugs is obtained in higher medical school and subsequently serves as a basis for further work of a practicing physician. Purpose of the study: to analyze the knowledge of final year medical students in the field of rational choice of antimicrobial agent (AMA) in the treatment of non-severe CAP in outpatient setting in patient without concomitant diseases and risk factors. Total 240 final year students of A.I. Yevdokimov Moscow State University of Medicine and Dentistry were offered in February-April, 2019 to indicate their preferred AMA for a young previously healthy patient with mild CAP. The study involved 178 women (74.17 %) and 62 men (25.83 %). The average age of the respondents was 24.8+3.3 years. There were 271 options for the appointment of AMA with 152 (56.1 %) given by the international nonproprietary name and 119 (43.9 %) by trade name. Remarkably, the AMAs which are recommended for the treatment of mild CAP on an outpatient basis, accounted only for 46.2 % in this study. Of particular concern is the fact that only about 40—50 % of AMA prescribing for CAP by medical graduates is in line with current clinical guidelines. The inappropriate choice of a drug in this particular situation not just increases the drug load, the cost of pharmacotherapy and the risk of side effects, but also directly affects the results of treatment. This situation emphasizes the need for a purposeful formation of a personal formulary of medicines for a graduate of a medical university, taking into account the basic principles of rational pharmacotherapy and the provisions of clinical guidelines relevant to the Russian Federation.

Worm disease is a contagious disease and is a type of disease that is mostly experienced by children in Indonesia, which accounts for 80%. Personal hygiene, especially at the age of elementary school children, is very important, considering that at this age intestinal worm infections transmitted through the soil are very high. The aims of this study to determine the relationship of personal hygiene with the risk of helminthiasis in Elementry School. This research using quantitative with the type of research that is observational survey. The population in this study were all students of Elementry School and the sample of 77 peoples, the total sampling technique and method of collecting data by interviewing indirectly using a questionnaire sheet. The analysis of data is using chi-square then obtained a value of p = 0.037 <α = 0.05 there was a relationship between personal hygiene and the risk of worms. For this reason, it is hoped that the school will provide knowledge about personal hygiene such as every bath must use soap, wash hands with soap after defecation, wear footwear when playing outdoors, cut children's nails once a week, use clean drinking water, drink well-cooked water, not defecating in any place, providing latrines and clean water for school children to prevent worm infections.

Clean energy has become a growing concern, and many organizations pay attention to environmental protection and energy production as well. In the last few decades, the wind turbine has become the core of clean energy production and has advanced in generating electricity from 40 kW to 5 mW. However, the new design of the wind turbine causes several potential failures which frequently lead to the inability to accomplish the operational requirements intended to meet the customers’ expectations. As a solution to this problem, the present paper proposes a novel systematic approach that combines Multicriteria Decision-Making (MCDM) techniques and Failure Mode Effects and Criticality Analysis (FMECA) tool to reveal the fatal failures and optimize the maintenance actions. To further develop the preceding framework, this work will not only rely on the three risk factors that are involved in the traditional Risk Priority Numbers (RPN) approach but also will consider the economic aspect of the system. In the proposed approach, the grey Analytic Hierarchy Process (AHP) method is applied in the first place to calculate the weights of the four risk factors criteria. Second, the grey Multiattribute Border Approximation area Comparison (MABAC) technique is applied to rank the failure modes and their criticality on the whole system. The proposed model is verified within an organization of renewable energy production in Morocco. Furthermore, the results of the comparative and the sensitivity analysis affirm that the proposed research framework is adequate for enhancing other complex systems design, especially in a developing world where funds and resources are scarce.

We assessed changes in HIV prevalence and risk behaviours among young key populations in Nepal. A total of 7505 participants (aged 16–24 years) from key populations who were at increased risk of HIV infection (2767 people who inject drugs (PWID); 852 men who have sex with men/transgender (MSM/TG); 2851 female sex workers (FSW) and 1035 male labour migrants) were recruited randomly over a 12-year period, 2001–2012. Local epidemic zones of Nepal (Kathmandu valley, Pokhara valley, Terai Highway and West to Far West hills) were analysed separately. We found a very strong and consistent decline in HIV prevalence over the past decade in different epidemic zones among PWID and MSM/TG in Kathmandu, the capital city, most likely due to a parallel increase in safe needle and syringe use and increased condom use. A decrease in HIV prevalence in 22 Terai highway districts, sharing an open border with India, was also consistent with increased condom use among FSW. Among male labour migrants, HIV prevalence was low throughout the period in the West to Far West hilly regions. Condom use by migrant workers involved with FSW abroad increased while their condom use with Nepalese FSW declined. Other risk determinants such as mean age at starting first injection, injection frequency, place of commercial sex solicitation, their mean age when leaving to work abroad did not change consistently across epidemic zones among the young key populations under study. In Nepal, the decline in HIV prevalence over the past decade was remarkably significant and consistent with an increase in condom use and safer use of clean needles and syringes. However, diverging trends in risk behaviours across local epidemic zones of Nepal suggest a varying degree of implementation of national HIV prevention policies. This calls for continued preventive efforts as well as surveillance to sustain the observed downward trend.

Introduction: The health profile of older adults places them at risk of infirmity and death from COVID-19 which may induce anxiety or exacerbate pre-existing anxiety. We examined COVID-19 related anxiety in men undergoing treatment for prostate cancer (CaP). Method: This study was conducted between July and September 2020. Sixty participants from a larger prospective, longitudinal study assessing depression, anxiety and health related quality of life in men with localized prostate cancer (DAHCaP) were included. COVID-19 related anxiety was measured at a single time point using, the Corona Virus Anxiety Scale (CAS). In addition, the following, the State-Trait Anxiety Inventory (STAI-S), the Connor-Davidson Resilience (CD-RISC) scale and Multidimensional Scale of Perceived Social Support (MSPSS) that form part of the DAHCaP study were used in the analysis. We extracted pre-pandemic data for the STAI-S. Results: Twenty-one percent had diabetes, 62.3% had hypertension and 24.6% had cardiac diseases, all known risk factors for severe COVID-19. Only 3% scored ≥9 on the CAS, indicating COVID 19 anxiety dysfunction. Half knew of family or friends that had contracted COVID-19 especially those scoring higher on the CAS ( P = 0.042). There was a significant decrease in STAI-S scores pre-pandemic to the pandemic phase (34.7 to 29.8, P = 0.003). No correlation was observed between CAS and STAI-S (rho = 0.08), CD-RISC (rho = −0.06) or MSPSS (rho = −0.15). There was a weak positive correlation between the CAS and monthly income (rho = 0.33; P = 0.010). Conclusion: COVID-19 did not induce significant anxiety in men being treated for CaP nor did it place an additional psychological burden, nor was there any correlation with state anxiety, resilience or social support.

Object Patients with myelomeningoceles (MMCs) are at increased risk of latex allergy and sensitization. Number of surgeries and history of atopy are known risk factors. The object of this study was to evaluate the role of diagnostic procedures and nonsurgical treatments in latex sensitization in young patients with MMC. Methods Seventy-three children with MMC were included in the study. For each child a questionnaire was administered and serum determination of IgE was performed, and 62 children underwent skin prick tests (SPTs), 60 of which had reliable results. Multivariate logistic regression modeling was performed, using latex sensitization as the dependent variable. Results The mean age of the 73 patients was 3.8 years. The SPT results were positive in 30.6%, whereas results of testing for latex-specific IgE were positive in only 8.2%. In univariate analysis, history of untethering, barium enema, and number of clean intermittent catheterizations (CICs) per day were significantly associated with positive results on the SPT. Although the number of surgical procedures was significantly higher in patients who had shunts, no significant relationship between the presence of a shunt and latex sensitization was seen. Conclusions The young age of the patients in this study may account for the low prevalence of latex sensitization that was found. In young patients with MMC, the numbers of CICs per day, a history of untethering, circumcision, and a barium enema performed without latex-free equipment could be risk factors for latex sensitization. The use of latex-free gloves in all procedures performed in these cases, nonlatex polyvinyl chloride catheters in CIC, and ordinary nonballoon tips in barium enemas could decrease the risk of sensitization.

The contemporary Russian map of threats to religious security is multifaceted. The first place in the hierarchy of threats is the activity of radical Islamists promoting extremist goals, while the second place belongs to the activity of non-traditional religions. This article is devoted to the analysis of methodological tools and results of regional and All-Russian sociological surveys aimed at determining the quality of interfaith relations and the place of religious risks in the national security system. Research into the religious sphere requires a certain sensitivity, which only complicates the process of compiling empirical tools. This article analyzes the experience of sociological surveys in the Volga Region (Bashkortostan, Penze, Ulyanovsk, Mordovia, Astrakhan) and the North Caucasus, using the data from All-Russian surveys. The purpose of this article is to identify the most effective methodological strategies for measuring sectarian tension and determining the risk of religious violence. The analysis of methodological tools shows that the high anxiety of mass consciousness can be recorded using questions on a number of issues. They include the admissibility or inadmissibility of violence in interreligious relations; the need to grant special rights to a denomination (to formalize its dominant position); the benefits or harms of the transition from one religion to another; the attitude towards the demonstration of religious symbols in the public sphere (e. g. hijab). The analysis of empirical research strategies allowed recording the tendency to present non-traditional faiths for Russia as a serious threat to the religious security, as well as to unite under a single cap such diverse phenomena as Wahhabism, the movement of Jehovah’s Witnesses, Protestantism, and Krishnaism. On the contrary, Russian political scientists consider traditional religions the main allies of the state in the field of maintaining religious security. The author concludes that the choice of methods can influence individual and collective perceptions of religious security.

Abstract Background Studies suggest fluoroquinolones (FQ), and third (3C) and fourth (4C) generation cephalosporins, agents often used for empiric therapy, place patients at higher risk for C. difficile infection. Substituting alternative antibiotics for empiric therapy might reduce risk. We surveyed inpatient physician (MD) and pharmacist (PharmD) antimicrobial stewardship champions to evaluate their preferred FQ, 3C and 4C substitutions for empiric therapy. Methods Semi-structured interviews were conducted with the antimicrobial stewardship MD and the PharmD champion from each of the 15 VA-CDC Practice Based Research Network (PBRN) sites. Interviewees were asked what empiric antibiotics for pneumonia and urinary tract infections would be recommended in local guidelines if all 3C, 4C and FQ were restricted. Respondents could list multiple antibiotics. Templated data collection and analysis were used to assist in rapid analysis of interviews. Results Narrow β-lactams were identified as appropriate options for CAP by 8 MD and 9 PharmD (table). Piperacillin/tazobactam was the preferred choice by MDs and PharmDs for HCAP (7 and 12, respectively) and HAP (10 and 12, respectively). For community-onset urinary tract infections (cUTI), numerous alternatives to FQ, 3C and 4C were identified. For hospital-onset (hUTI), piperacillin/tazobactam was most frequently mentioned by MD and PharmDs (7 and 9, respectively). 4 of 5 MDs and 5 of 7 PharmDs who chose 3C for CAP indicated that 3C were preferred over all other choices for CAP, few stewards indicated that 3C were the sole preferred agents for other conditions. Conclusion Antimicrobial stewardship MD and PharmD champions were readily able to find FQ substitutions for all indications; 3C and 4C substitutions were found for all indications with a notable exception of treatment of CAP. These results suggest considerable opportunity to reduce use of these antibiotic classes. Future studies should examine the appropriateness and acceptability of the substitutions identified by stewardship champions to providers and the impact of restriction of FQ, 3C and 4C on clinical outcomes. Disclosures All authors: No reported disclosures.

Abstract Background Analyses of the global spatial and temporal distribution of enteric fever outbreaks worldwide are important factors to consider in estimating the disease burden of enteric fever disease burden. Methods We conducted a global literature review of enteric fever outbreak data by systematically using multiple databases from 1 January 1990 to 31 December 2018 and classified them by time, place, diagnostic methods, and drug susceptibility, to illustrate outbreak characteristics including spatial and temporal patterns. Results There were 180 940 cases in 303 identified outbreaks caused by infection with Salmonella enterica serovar Typhi (S. Typhi) and Salmonella enterica serovar Paratyphi A or B (S. Paratyphi). The size of outbreak ranged from 1 to 42 564. Fifty-one percent of outbreaks occurred in Asia, 15% in Africa, 14% in Oceania, and the rest in other regions. Forty-six percent of outbreaks specified confirmation by blood culture, and 82 outbreaks reported drug susceptibility, of which 54% had multidrug-resistant pathogens. Paratyphoid outbreaks were less common compared to typhoid (22 vs 281) and more prevalent in Asia than Africa. Risk factors were multifactorial, with contaminated water being the main factor. Conclusions Enteric fever outbreak burden remains high in endemic low- and middle-income countries and, despite its limitations, outbreak data provide valuable contemporary evidence in prioritizing resources, public health policies, and actions. This review highlights geographical locations where urgent attention is needed for enteric fever control and calls for global action to prevent and contain outbreaks.

The United States Environmental Protection Agency (EPA) in June 2015, took a step toward regulating carbon emissions from airlines, following an assessment that airlines contribute to climate change. On July 25, 2016, the final endangerment finding (Note 1) under section 231(a) (2) (A) of the Clean Air Act for aviation emissions was issued by the EPA. The European Union had issued a similar finding previously and had proposed implementing an emission trading scheme in which the airlines would be required to participate in a cap and trade scheme for emissions from jet fuel. Traditional jet fuel is derived from petroleum, whose price is volatile and depends on geopolitical stability. Fuel burn is a significant cost for airlines and affects their profitability and value. Fuel burn is also a significant source of greenhouse gas emissions. An investigation of alternatives to jet fuel and switching from conventional jet fuel based on varying emission profiles, production costs and varying carbon prices is therefore timely. We use a simple decision support system to examine the link between the life-cycle greenhouse gas emissions of a range of fuels, economic costs of production and varying carbon prices. This analysis should be of interest to regulators, traders, risk managers and executives in the airline industry as well as practitioners of sustainability management.

Dry machining is environmentally friendly, clean and safe to be performed. Regardless of decreasing tool life due to lack of lubricants, choosing dry machining over wet machining may be a wiser choice since the cost of purchasing and disposing the cutting fluids can contribute to a higher cost. Wear rates, tool wear intensities and material removal rates (MRR) of TiCN coated tools using both dry and traditional wet machining on brass were studied with the aim in finding the optimum cutting condition from four different cutting speeds (207, 279, 372 and 498 m/min) with two sets of cutting parameters; depth of cut and feed rate (d = 0.1 mm, f = 0.2 mm/rev and d = 0.2 mm, f = 0.4 mm/rev). Temperatures at the tool-chip interface were measured to analyze the effects of temperature rise during dry machining. Cost analysis on machining cost per piece between dry and wet machining was performed. The optimum cutting condition for wet and dry machining of brass using TiCN coated cutting tool was found to be 498 m/min at d = 0.2 mm, f = 0.4 mm/rev. The tool tip temperature obtained from dry machining did not influence tool wear since the temperature rise is quite similar to the wet machining temperatures. The machining for the dry machining reduced to about 25-76% per piece when compared with wet machining.

Abstract Background: The CaPTC prostate cancer (CaP) Familial Cohort study (CaPFCS) was launched in 2017 to explore the CaP risk factors of African Black men (ABM). The study design is a prospective study that observes and follows healthy ABM and ABM diagnosed with CaP. Aim: The specific aim is to provide recommendations on statistical considerations for cohort studies focused on cancer disparities, based on lessons learned from the CaPTC CaPFCS. Methodology: Study participants were ABM in Cameroon, Nigeria, and the US. Using validated measures, data were collected mostly by self-administered or research assistant administered survey using paper survey (especially in Cameroon and Nigeria) with the responses transferred to REDCap by research coordinators. The statistical analysis for the CaPTC CaPFCS focused on the baseline epidemiological, behavioral, clinical and anthropometric measures of Black men. A total of 819 participants were included in the analyses. Statistical analyses included descriptive statistics (sample median, range, frequency and percentages) and unadjusted logistic regression models. Results: Data collection for the CaPTC CaPFCS were by multiple investigators/research coordinators at multiple sites in Cameroon, Nigeria, and the US. In preparation for the data analyses, we noted data entry errors and/or misinterpretation of data entry, which required extensive cleaning of the database prior to the analyses. The biostatisticians spent significant effort cleaning and ensuring data validity prior to the analyses. Confounding variables is another statistical consideration for cohort studies, such as the CaPTC CaPFCS. There was variability observed across age, education levels, employment status, household income and CaP diagnosis based on country of residence. CaP diagnosis was not reported by any of the ABM in the US, which may be due to the fact that they were all recruited within the community and no recruitment took place in the clinic. Finally, the CaPTC CaPFCS has several variables. Performing a lot of statistical tests may result in false-positive findings at P&lt;0.05. Conclusion: The advantage of the CaPFCS is that it allows the CaPTC investigators to study epidemiological, behavioral, clinical and anthropometric variables associated with CaP over time. Being a longitudinal cohort study, investigators can track the changes in exposure and outcomes over time.However, statistical considerations need to be at the fore-front of multi-center, transatlantic cancer disparity studies such as the CaPTC CaPFCS, from data collection to data entry. The use of web-based survey with the ability to enter data directly into REDCaP will significantly reduce (if not totally eliminate) the need for database cleaning. There are multiple strategies that can be used to reduce confounder effect, including statistical adjustment and multivariate analysis to adjust for the confounders. The use of propensity score methods have especially been found to be effective in controlling baseline confounding factors. Citation Format: Daniel Lee, Michael Heckman, Zhongwei Peng, Emeka Iweala, Ademola Popoola, Paul Jibrin, Mohammed Faruk, Anthonia Sowumi, Omolara Fatiregun, Nkegoum Blaise, Catherine Oladoyinbo, Ifeoma Okoye, Abdulkadir Ayo Salako, Abidemi Omonisi, Iya Eze Bassey, Kayode Adeniji, Nggada Haruna Asura, Ernest Kaninjing, Oluwole Kukoyi, Fathi Parisa, Ruth Enuka, Oluwaseyi Toye, Jennifer Crook, CaPTC Investigators, Folakemi Odedina. Importance of statistical considerations in multi-center, transatlantic cancer disparity studies: Lessons learned from the CaPTC prostate cancer familial cohort study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C004.

Two of the most commonly used solid biomass sources for fuel are wood chips and wood pellets. The calorific value and the moisture content of those biofuels determine the efficiency of the CHP and the biorefinery plants. Therefore, with the increased shift towards a biobased economy, the biomass cost and its physical properties must be precisely determined. Most of the current standards are lacking and provide neither enough details about the issues caused by the biomass heterogeneity nor with the variation in experimental practice. Phenomena such as data scattering, poor repeatability and wide uncertainty, are mostly observed during the measurements of the calorific value and the moisture content. To overcome such issues, an interlaboratory comparison between three national metrology institutes using bomb calorimetry has taken place. The comparison helped to identify the root causes behind the poor reproducibility of the wood samples. Factors such as the equilibrium moisture content of the biomass, the pellet mass, the applied pressure to form the pellet, the handling techniques and the determination errors are highlighted and analyzed. The final results paved the way to provide an enhanced detailed experimental practice where the repeatability and reproducibility have been strongly improved. Moreover, the detailed uncertainty sources and calculations are presented. It has been found that by fulfilling the recommended approach the measurement repeatability improved by up to 50–80%, while the final uncertainty improved by 10–30%. This enhancement leads to a maximum relative expanded uncertainty of around ±1% (coverage factor of k = 2 and a confidence level of 95%).

Background: Approximately 25% of the risk of Schistosoma mansoni is associated with host genetic variation. We will test 24 candidate genes, mainly in the Th2 and Th17 pathways, for association with S. mansoni infection intensity in four African countries, using family based and case-control approaches. Methods: Children aged 5-15 years will be recruited in S. mansoni endemic areas of Ivory Coast, Cameroon, Uganda and the Democratic Republic of Congo (DRC). We will use family based (study 1) and case-control (study 2) designs. Study 1 will take place in Ivory Coast, Cameroon, Uganda and the DRC. We aim to recruit 100 high worm burden families from each country except Uganda, where a previous study recruited at least 40 families. For phenotyping, cases will be defined as the 20% of children in each community with heaviest worm burdens as measured by the circulating cathodic antigen (CCA) assay. Study 2 will take place in Uganda. We will recruit 500 children in a highly endemic community. For phenotyping, cases will be defined as the 20% of children with heaviest worm burdens as measured by the CAA assay, while controls will be the 20% of infected children with the lightest worm burdens. Deoxyribonucleic acid (DNA) will be genotyped on the Illumina H3Africa SNP (single nucleotide polymorphisms) chip and genotypes will be converted to sets of haplotypes that span the gene region for analysis. We have selected 24 genes for genotyping that are mainly in the Th2 and Th17 pathways and that have variants that have been demonstrated to be or could be associated with Schistosoma infection intensity. Analysis: In the family-based design, we will identify SNP haplotypes disproportionately transmitted to children with high worm burden. Case-control analysis will detect overrepresentation of haplotypes in extreme phenotypes with correction for relatedness by using whole genome principal components.

Background: Approximately 25% of the risk of Schistosoma mansoni is associated with host genetic variation. We will test 24 candidate genes, mainly in the Th2 and Th17 pathways, for association with S. mansoni infection intensity in four African countries, using family based and case-control approaches. Methods: Children aged 5-15 years will be recruited in S. mansoni endemic areas of Ivory Coast, Cameroon, Uganda and the Democratic Republic of Congo (DRC). We will use family based (study 1) and case-control (study 2) designs. Study 1 will take place in Ivory Coast, Cameroon, Uganda and the DRC. We aim to recruit 100 high worm burden families from each country except Uganda, where a previous study recruited at least 40 families. For phenotyping, cases will be defined as the 20% of children in each community with heaviest worm burdens as measured by the circulating cathodic antigen (CCA) assay. Study 2 will take place in Uganda. We will recruit 500 children in a highly endemic community. For phenotyping, cases will be defined as the 20% of children with heaviest worm burdens as measured by the CAA assay, while controls will be the 20% of infected children with the lightest worm burdens. Deoxyribonucleic acid (DNA) will be genotyped on the Illumina H3Africa SNP (single nucleotide polymorphisms) chip and genotypes will be converted to sets of haplotypes that span the gene region for analysis. We have selected 24 genes for genotyping that are mainly in the Th2 and Th17 pathways and that have variants that have been demonstrated to be or could be associated with Schistosoma infection intensity. Analysis: In the family-based design, we will identify SNP haplotypes disproportionately transmitted to children with high worm burden. Case-control analysis will detect overrepresentation of haplotypes in extreme phenotypes with correction for relatedness by using whole genome principal components.

Aim: To determine the incidence of surgical site infections and its associated factors Study design: Cross sectional study Place and duration: This study was conducted at Bolan Medical Complex Hospital Quetta Pakistan from January 2020 to February 2021. Methodology: Patients who underwent general surgical procedures were included in the study. Pus or purulent discharge from the incision, together with pain, any two cardinal symptoms of inflammation were used to assess surgical site infections. For data entry and analysis, SPSS version 21 was utilized. A P-value of less than 0.05 was considered statistically significant. Results: Following the operation, 240 people were included in the current study. The average age of the study participants was 39.33 ± 2.74 years. Infections at the surgical site were found in 9.16 % (n=22) of the patients. As participants' age increases, the surgical site infection rate rises significantly. Diabetes was found to be substantially linked to surgical site infection (P < 0.001). According to wound categorization, infection rates were higher in filthy wounds, 22.22 % versus clean wounds, 3.57%, and this difference was statistically significant (P<0.0001). Conclusion: In this study, 9.16% patients were diagnosed with surgery site infection. Age, diabetes, type, duration of surgery, kind of wound, hospital stay and presence of drain were all risk factors for surgery site infection. Keywords: Diabetes, Infection, Surgical Site infections, operation

19538 Background: Dose dense chemotherapy (DDC) with sequential doxorubicin/ cyclophosphamide followed by paclitaxel Q 14 days has an established place in the treatment of ESBC. However, moderate/severe CIA is a common consequence and therapeutic intervention is frequent. We sought to determine if early intervention at the onset of anemia with DA could reduce the emergence of more severe anemia during therapy and maintain quality of life compared to later intervention. Material and Methods: Non-iron deficient (ferritin > 50) patients (pts) with hemoglobin (Hb) levels >11.0 g/dl scheduled to receive adjuvant or neoadjuvant DDC for ESBC were recruited. Pts were randomly assigned prior to chemotherapy to initiate treatment with DA 200 μg q2w SQ when Hb < 11.5 g/dl (early intervention, EARLY), or DA 200 μg q2w SQ when Hb < 10.0 g/dl (standard intervention, STD) with end of treatment defined as 14 days after the last cycle of chemotherapy. Dose escalation for inadequate response of < 1 g/dl after 6 weeks of DA and dose withholding/reduction for Hb >13 g/dl were pre-specified. Results: The complete sample of 149 pts have been accrued (median age of 53.1, range 28.7 - 74.5). Analysis of fatigue ratings show a trend towards lower fatigue scores in EARLY at Hb nadir, and at end of study,(ANOVA, Group x Time interaction, p=.07). Discussion: Early intervention with DA significantly reduces the risk of developing moderate/severe CIA and increases time spent in the target range during DDC for ESBC. [Table: see text] No significant financial relationships to disclose.

Preventing the spread of diseases between and within farms (biosecurity) is essential for minimizing animal mortality and morbidity, as well as for reducing the risk of spread of zoonotic diseases. These effects are even greater in countries such as Iran, which have to deal with multiple ongoing epidemics of infectious disease. However, there is currently no published information about biosecurity practices on sheep and goat farms in Iran in published research. The aim of this study was to collect such information and to identify some of the factors affecting biosecurity practices. Data were gathered using a checklist and in-depth interviews with 99 nomadic and semi-nomadic pastoralists. Regression analysis was used to identify the relationships between the collected variables and the biosecurity scores. The results showed that neither within- nor between-farm disease prevention measures were appropriately applied on most farms (median total score of total biosecurity was 37.3/90; Q1 = 29.0 and Q3 = 44.7). Almost all the farmers reported slaughtering animals on farms and nobody properly disposed of the bodies of the dead animals. Additionally, the majority of the participants did not disinfect the umbilical cords of newborns. Of the collected variables, the annual mortality rate was associated with most within-farm biosecurity practices. The increase in annual mortality rates was associated with the regular cleaning of troughs (p = 0.03), preventing feed and water from being contaminated by urine and feces (p = 0.02), providing a clean and dry place for animals to rest (p = 0.05) and disinfecting the navel cord (p = 0.03). The results of this survey suggest that there is a clear need for extension programs to enhance Iranian and sheep and goat farmers’ perceptions and practices regarding biosecurity measures.

This article, the second of two, continues an analysis of the developments which led to the Gezi Uprisings that, starting at the end of May 2013, spread to almost all of Turkey in the following months. The uprisings are seen as massive popular reactions, embracing almost all anti-Justice and Development Party (Adalet ve Kalkınma Partisi, AKP) strata in Turkey, to the AKP’s authoritarianism, its anti-secular, anti-republican and anti-democratic discourse and policies, and its attempts to intervene in private life. The article likens the protests to a sort of firedamp explosion and argues that the explosives had been produced by the AKP government itself. The article also briefly presents the developments which have taken place since 2013 up to July 2019 and implies that the possibility of a real decline of the AKP governmental power can be seen in its problematic relation with the Kurdish masses, with the extreme right-MHP, and with the rise of the CHP, a sign of which was seen in the local elections held in March and June 2019.

Abstract Background Nosocomial infections pose significant risk to patients and hygienic standards may be easily overlooked, especially in fast-paced emergency department settings. Studies have shown that stethoscopes can harbor pathogens, which can be transferred to patients when proper sanitary measures are not taken. Survey-based studies have mostly assessed stethoscope hygiene, but they may not accurately represent cleaning practice. This study aimed to accurately assess cleaning practice through observation of stethoscope cleaning and hand hygiene among medical providers in an emergency department setting. Methods Four hundred twenty-six provider–patient encounters were observed in the emergency department of the VA San Diego Healthcare System. The frequency and methods of stethoscope and hand hygiene practices were anonymously observed and recorded. Stethoscope hygiene was recorded during and after each encounter if cleaning took place for at least 15 seconds. Hand hygiene data were also gathered before and after each encounter. Data analysis was performed to determine the frequency of these practices. Results Of 426 encounters, 115 involved the use of a personal stethoscope. In 15 of 115 encounters (13.0%), the provider placed a glove over the stethoscope before patient contact. Following patient interaction, 13 of 115 encounters (11.3%) involved stethoscope hygiene with an alcohol swab. Stethoscope hygiene with water and hand towel before patient interaction was observed in 5 of 115 encounters (4.3%). Hand sanitizer use or hand washing was observed in 213 of 426 encounters (50.0%) before patient interaction. Gloves were also used prior to patient interaction in 206 of 426 (48.4%) encounters, some overlapping with those who used hand sanitizer or washed their hands. Hand sanitizer or hand washing was used in 332 of 426 encounters (77.9%) after patient interaction. Conclusion Only 11.3% of encounters involving the use of a personal stethoscope had stethoscope sanitation with an alcohol swab. In 4.3% post-encounters, there was an attempt to clean stethoscopes with water and towel. Rates of appropriate hand hygiene were also lower than expected. Stethoscope and hand hygiene standards need to be raised to reduce infection risk and further studies need to be conducted to set guidelines for adequate stethoscope sanitation. Disclosures All authors: No reported disclosures.

The British people voted in a 2016 referendum to leave the European Union (EU). Brexit presents threats and opportunities to animal protection in the United Kingdom (UK), the EU, and internationally. This paper discusses opportunities for animal protection in terms of five criteria. These are first, political context; second, regulatory changes; third, economic and trade factors; fourth, institutional- and capacity-related factors; and fifth, EU and international considerations. Brexit permits reform of UK agricultural policy outside of the Common Agricultural Policy (CAP) to reward high welfare as a public good. The Agriculture Bill, however, does not suggest a radical reform agenda for animal welfare. Brexit permits a ban on live exports, but the UK Government is consulting on improving welfare, not prohibition. Brexit provides an opportunity to ban the import and sale of fur, but the UK Government has signalled it will work to improve welfare in fur farming. Brexit permits the UK to prohibit the import and sale of foie gras, but the Government has stated a ban may be challenged at the World Trade Organisation (WTO). Brexit allows more stringent Pet Travel Scheme (PETS) requirements to reduce puppy smuggling. Lucy’s Law and stricter enforcement will also mitigate the problem. New sentience legislation provides the opportunity for a fully independent and properly constituted UK Animal Welfare Advisory body conducting animal welfare impact assessments and ethical appraisal. The Government has proposed sentience legislation but there is a major risk it will not be in place before the UK leaves the EU. The Government has expanded the remit of the Farm Animal Welfare Committee, which is not fully independent and is dominated by veterinary members and agricultural interests. Brexit provides some opportunities for animal protection with radical reform of agricultural policy, prohibition of live exports, and banning the import and sale of fur and foie gras. Pre-Brexit, the Government has not demonstrated the political will and commitment to realise these opportunities.

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants that possess serious risks to human health and the environment. Forty riverbed sediments samples were collected in mangrove river bed sediments where artisanal refining of crude oil takes place in the Niger Delta of Nigeria. The concentration, occurrence, distribution, toxicity and health risk of sixteen priority PAHs (16PAHs) were analysed in the samples. Apart from Nap, Acy, BkF, InP and DbE, all the other PAHs were present in all the sampled points of the studied area with BbF and BaA recording the highest mean values. The range and mean of the total PAHs (∑16PAHs) of this study are 23.461–89.886 mg/kg and 42.607 ± 14.30 mg/kg dry weight (dw), which is classified as heavily contaminated when compared to the European classification of PAHs pollution in soil (>1.0 mg/kg). The range of the effect range factors used to assess the risk of PAHs in an ecosystem (Effect rang-low (ER-L) and Effect range-median ER-M) of this study is from 0.953 to 8.80 mg/kg. PAHs below ER-L (4.0 mg/kg) indicate no toxic effect, but values above ER-M (44.79 mg/kg) indicate toxic effects to the sediments, its resources and, ultimately, the public that consumes the resources thereof; hence, the study area falls within the contaminated category. The occurrence of the high molecular weight (HMW) PAHs (73.4%) supersedes those of the lower molecular weight (LMW) PAHs (26.6%). The diagnostic ratios and principal component analysis suggest that the main contributors of PAHS into the sediments are the combustion of biomass, fossil fuel (crude oil) and pyrogenic sources. The toxic equivalent quotient (TEQ) and mutagenic equivalent quotient (MEQ) of PAHs ranged from 2.96 to 23.26 mgTEQ/kg dw and 4.47 to 23.52 mgMEQ/kg dw, and the total mean toxic equivalency quotient (∑TEQ) (15.12 ± 8.4 mg/kg) is also greater than the safe level of 0.6 mg/kg, which indicates high toxicity potency. The mean incremental lifetime cancer risks (ILCRs) of human exposure to PAHs shows that both adults TotalILCR adults (6.15 × 10−5) and children TotalILCR children (2.48 × 10−4) can be affected by dermal contact rather than ingestion and inhalation. Based on these findings, the appropriate regulatory bodies and other organs of government in the region should enforce outright stoppage of the activities of these illegal artisans who do not have control mechanisms for loss control at the site and carry out appropriate clean-up of the area.

Background. Community-acquired pneumonia (CAP) remains one of the most common infectious diseases, occupying an important place in the structure of mortality worldwide.Aim. To evaluate the effectiveness of antimicrobial therapy for community-acquired pneumonia in hospitalized patients in real clinical practice.Materials and methods. A retrospective, observational study was conducted, which included 236 patients hospitalized for community-acquired pneumonia at the Regional Clinical Hospital in Ryazan in 2019. Based on these case histories, an analysis of the effectiveness of the initial empiric antimicrobial therapy was performed.Results. The initial empiric antimicrobial therapy in 73% of cases included administration of ceftriaxone, in 45% of cases – levofloxacin, in 14% of cases – azithromycin. It was found that initial antimicrobial therapy was effective in 58% of patients who did not require replacement for the antibiotic. A need for a change in the treatment regimen was significantly associated with an increase in the length of hospitalization (p < 0.001), heart rate upon admission (p = 0.032), myelocyte count in the complete blood count (p < 0.001), and urea and blood creatinine levels (p = 0.004 and p = 0.044, respectively). The selected antimicrobial therapy regimen was significantly associated with the expected treatment effectiveness (p = 0.039). The choice of levofloxacin in monotherapy or in combination with ceftriaxone was accompanied by a decrease in the relative risk of replacing the antimicrobial, compared with other treatment regimens (odds ratio (OR) = 0.86 (95% confidence interval (CI): 0.55–1.34) and OR = 0.57 (95% CI: 0.37–0.87), respectively).Conclusion. Empiric antimicrobial therapy for community-acquired pneumonia in real clinical practice complies with current recommendations, however, at the same time, its ineffectiveness persists. Respiratory fluoroquinolones are most effective in treating pneumonia in hospitalized patients.

Relevance. In the Kyrgyz Republic, the measles and rubella elimination program has been implemented in accordance with the strategy of the World Health Organization (WHO) for 20 years, which uses a two-fold immunization tactic against measles at the age of 12 months and 6 years, which is complemented by clean-up campaigns. Despite the high coverage of vaccinations with both the first and second doses, there are epidemic rises in infection, reaching in 2018 (15.9), 2019 (36.4) and 2020 (11.2) per one hundred thousand population. In the years of recent epidemic ups, a high incidence among young children revealed. The epidemiological situation with measles that has developed in recent years has made it necessary to study the state of specific measles immunity in different age groups, to determine the vulnerable population group and assess the quality of vaccination work.The aim of the work: to assess the epidemic process of measles at the present stage and the state of specific immunity in the population of the Kyrgyz Republic to identify groups at high risk of infection.Materials and methods. In the course of the work, descriptive-evaluative and analytical epidemiological research methods are used. The materials are statistical reporting data on the incidence of measles from 1987 to 2020 and 568 blood serum samples taken from residents of Bishkek and Jalal-Abat region in the following indicator age groups: 1-4 years old n = 122; 5-9 years old n = 108; 10-14 years old n = 114; 15-19 years old n = 77; 20-29 years old n = 103; 30 years and older n = 44. The level of anti-measles antibodies is determined by enzymelinked immunosorbent assay (ELISA) using the VectorMeasles-IgG test system manufactured by VEKTOR BEST, Russia. The method of retrospective analysis of the incidence of measles in the Kyrgyz Republic in long-term dynamics, by age groups, according to vaccination history is used. The method of retrospective analysis of the incidence of measles in the Kyrgyz Republic in longterm dynamics, by age groups, according to vaccination history is used. The data obtained statistically processed using the Excel program. The critical level of significance is p = 0.05. Descriptive statistics – mean and standard error of the mean (data are presented as M ± m) for quantitative variables, for qualitative variables – determination of proportion.Results and Discussions. The introduction of specific prophylaxis of measles led to decrease the incidence of measles, 15 times on average, mortality also decreased, however, despite the effectiveness of vaccination, cyclical increases in infection persisted, seasonality in intra-annual dynamics, school-age children began to get sick more often. To change the situation, including in order eliminating primary postvaccination failures, in 1986 a second dose of vaccine introduced into the vaccination schedule for children 6 years old, which led to decrease the incidence to single case and in some years to the complete absence of measles cases. However, in 2018, the importation of measles from bordering countries led to an epidemic outbreak with the number of cases of 1004. The incidence rate increased from 0.1 in 2017 to 15.9 per 100 thousand population in 2018. At the subnational level, a clean-up campaign carried out among children aged two to five years. However, due to the lack of vaccine, the target group covered less than 50% and the increase in the incidence of measles in 2019 continued to 2377 people (36.4 per 100 thousand population). A slight decrease in the incidence of measles outlined in 2020, when 733 cases were registered. The highest percentage of cases is among children under one year old, 43.3% (2019) and 52.7% (2020), who are not vaccinated by age. In second place in importance is the age group of children from one to four years old, an extensive incidence rate is 29.5% (2019) and 39.3% (2020). The data of serological studies confirmed the formation of a high-risk group for measles infection among preschool children, where the proportion of seronegatives is 36%; this is probably due to not post-vaccination failures, but rather to a high proportion of children who are not vaccinated for various reasons. This hypothesis confirmed by the high percentage of unvaccinated children of this age in the structure of the sickindividuals. All this casts doubt on the official data on the coverage of children of this age with preventive vaccinations (95.7%) and indicates the accumulation of contingents susceptible to measles. The results of our research are consistent with the data obtained by other researchers.Conclusion. The analysis showed the need for regular monitoring of the organization of the vaccination work to control the reliable accounting of the child contingent needed to immunization, based on the population census, as well as to identify the validity of medical withdrawals. To prevent the growth of refusals from vaccinations, it is advisable to expand the forms of work with the population to develop commitment to vaccination. We believe that in combination, this will increase the real coverage of measles vaccinations for children, reduce the number of sources of infection and indirectly reduce the risk of infection in children of the first year of life.

Sand injectites on the Norwegian Continental Shelf have proven their commercial significance. Some are already producing, e.g., Volund, Viper, Balder, Ringhorne, and Kobra Fields, while others such as in production licenses (PL) 340 and 869 have recently been discovered and appraised. Extensive literature on the geology of sand injectites has been published (e.g., Jenssen et al., 1993; Jolly and Lonergan, 2002; Huuse et al., 2003; Hurst et al., 2005). However, few references are available on the petrophysical and geophysical aspects of sand injectite reservoirs. This paper discusses the petrophysical properties of sand injectite facies, dykes, sills, and brecciated sands, along with their identification from seismic data. A perception that volumetrics of sand injectite reservoirs cannot be reliably evaluated is assessed. Sand injectites in PL 340 and 869 were interpreted as remobilized sands from the Hermod and Heimdal Formations of Paleocene age injected into the overlying Balder Formation and Hordaland Group mudstones of Eocene age. The mudstones acted as a seal, forming an intrusive stratigraphic trap. The trap geometry varied locally depending upon the dyke and sill geometries of the sandstone. Dykes had large vertical reach with the corresponding high-hydrocarbon column, while sills had low-vertical relief with large lateral extent. Intervals of brecciated sands were also observed within the injectite complex, especially where sands were thin. These brecciated sands contained large amounts of angular mudstone clasts of different dimensions suspended in an overall sandy matrix. Close examination of cored dykes made it possible to observe this, while it might not be as obvious when looking at bulk well logs. Petrophysical-log responses for clean sills and dykes behaved the same way as they would in a clean sandstone reservoir. If sills and dykes were very thin, they would also risk not being counted as net or pay (Suau et al., 1984; Dromgoole et al., 2000; Flølo et al., 2000;). Such errors can impact in-place volumes in a significant way. Sills appeared as blocky clean sand on logs, but it was difficult to differentiate a dyke from a sill or thin sands using logs. Dykes are high-angle features and are identified either by core studies or borehole images when intersected by a well or, if large enough, observable on seismic. Brecciated sand intervals appeared with cm-to-dm-scale mudstone clasts suspended in sand with approximately 40 to 60% net to gross. Log responses over these intervals indicated shaly sand or thin sands. Resistivity and thermal neutron porosity logs were highly affected by the shale clasts. For this reason, a fractional net/gross interpretation technique was used to evaluate the sand content and hydrocarbon pore volume. To further verify these results, they were compared to observations directly on the core. To qualify to what extent petrophysical logs and interpreted products thereof can be relied on to evaluate hydrocarbon volumes of sand injectite reservoirs, a high-resolution petrophysical interpretation was generated using a computerized tomography (CT) scanned core image. Core image sand counting and image-derived high-resolution bulk density logs with shale-corrected resistivity were used. Results of this high-resolution interpretation featured an excellent match with routine core analysis data and manual core observations in the core laboratory. The fractional net/gross method used is the modified Thomas-Stieber method (Johansen et al., 2018). Its results compared well to the high-resolution CT-scan image results and better evaluated the hydrocarbon pore volume of sand facie compared to the conventional bulk formation evaluation approach. This result confirms that the Thomas-Stieber method can be used for brecciated rocks, which leads to some useful recommendations on how to best log and perform a petrophysical evaluation in such reservoirs.

Background: Prediabetic patients and healthy overweight people also tend to suffer from NAFLD, but researchers have only scratched the surface of this condition. This study analyses the effect of hepatic steatosis on fibrosis and evaluates the key predictors of liver injury in prediabetes to see if the liver damage induced by prediabetes can be restored by adopting a Mediterranean diet and taking the nutraceuticalsilymarin. Place and Duration: In the department of Medicine of KGN Teaching Hospital/Bannu Medical College,Bannu for the duration of one year from 1st June 2019 to 30th May 2020. Methods: A total of 212 prediabetic individuals without a previous diagnosis of NAFLD and 126 healthy controls underwent a clinical evaluation, transient elastography evaluating liver stiffness (LS), and a controlled attenuation parameter (CAP). Subsequently, 212 patients at risk for developing diabetes participated in a prospective randomised interventional study, with 104 assigned to a Mediterranean diet alone and 108 assigned to a Mediterranean diet plus supplementation with silymarin (a flavonolignan complex isolated from Silybum marianum and Morus alba). Six months of treatment with 420 milligrams of silymarin twice daily. Participants underwent follow-up clinical and instrumental evaluations after the 6-month experiment period ended. Genotyping for patatin-like phospholipase domain containing 3 in prediabetic individuals (PNPLA3). Results: To date, natural products and their derivatives have accounted for over 50% of the natural remedies used to treat liver disorders. Despite natural medicine's many benefits and low risk, clinicians should be aware of the potential for adverse reactions such as liver injury, interstitial pneumonia, and abrupt respiratory failure. This means that when using naturopathic regimens to treat liver disorders, we must do everything in our power to prevent and avoid the negative influence of these drugs as much as possible. Using real-world examples to stress the importance of preventing and managing adverse reactions to the natural agents, this article explores the current application and proposed improvements of natural medicine in the treatment of liver illnesses. Conclusion: Silymarin has demonstrated effectiveness as a supportive treatment for the majority of liver diseases, including cirrhosis and alcohol-induced liver damage. Among patients with cirrhosis, silymarin therapy resulted in a substantial decrease in fatalities due to liver complications in clinical trials. Keywords: Liver illness, Cautions, Adverse Reactions, Herbal Medicine, Natural Nutraceuticals.

ABSTRACT Computing technology has advanced to the point where it is now standard practice to employ complex Geographic Information Systems (GIS) within the Incident Command Post (ICP). Simultaneously, field data collection has been migrating to mobile computing applications which output GIS files that are quickly displayed for real-time situational awareness. From the initial emergency response through clean-up and sign-off much data with a spatial component is generated and many disparate data sets are collected. More efficient data integration, management and visual analysis affords Incident Commanders and Section Chiefs the ability to make informed and timely planning, operational and strategic decisions. Traditionally GIS maps were created in the ICP from field sketches, field notes and verbal reports. Processing of these data by the GIS Unit is very time consuming and prone to error. Preliminary efforts to streamline and automate field data collection by the California Department of Fish and Wildlife (CDFW, formerly the California Department of Fish and Game), Office of Spill Prevention and Response (OSPR) utilized Global Positioning System (GPS) receivers to record waypoints and track lines. Since then more elegant electronic field data collection applications installed on small, handheld computers have been developed including those for “Wildlife Recovery and Transport”, “Resources at Risk” over flights, and the “Shoreline Cleanup and Assessment Technique” (SCAT). Other recent advancements allow for real-time aerial remote sensing for oil slick detection and detailed mapping of its properties, and displaying the output from coastal High Frequency (HF) radar installations for real-time visualization of local ocean surface current fields. These field data collection applications are explained in more detail in the body of this paper. Once these data are incorporated into the GIS a web-based Common Operational Picture (COP) is utilized for timely dissemination of relevant geospatial data. OSPR has worked closely with the National Oceanic and Atmospheric Agency (NOAA) to develop “Southwest ERMA” (Environmental Response Management Application) as California's COP for web-based data dissemination and incident situational awareness. At the Deepwater Horizon (MC-252) Incident Command Post (ICP) in Houma, Louisiana many responders were from outside of the region and unfamiliar with the local geography. Area base maps with a standardized coast line and place names were not readily available for several days which added unnecessary confusion to the mix. As a lesson learned and in order to avoid this situation for an oil spill response in California, OSPR and NOAA have pre-loaded Southwest ERMA with pertinent base maps, charts and spill response planning data from the three California Area Contingency Plans (ACPs). These data are deliberately made freely available to the general public via the Southwest ERMA web-viewer without any user login credentials required.

Knowledge about clean and healthy life in children needs to be given early to shape behavior in everyday life. Knowledge about healthy living can be provided at school through various learning programs. This study aims to find the effectiveness of health promotion programs (JUMSIH) to increase children's knowledge about clean and healthy living. The research method is a pre-experimental one-shot case study design. The respondents of this study were 68 students aged 7-8 years. The results showed that the JUMSIH program can help children have knowledge about healthy living. Based on data analysis, n = 15 generally obtained scores above 2.6. It was concluded that healthy living skills are often performed by students such as hand washing, bathing, and toothbrush behavior which are basic skills for children to be able to live healthy lives. Suggestions for further research which is the development of various programs to increase awareness of clean and healthy living from an early age. 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Metode pelembagaan perilaku hidup sehat kaitannya dengan kesehatan lingkungan dan hygiene perorangan pada keluarga di Subang Jabar. Keshavarz, N., Nutbeam, D., Rowling, L., Khavarpour, F. (2010). Schools as social complex adaptive systems: a new way to understand the challenges of introducing the health promoting schools concept. Soc. Sci. Med., (70), 1467–1474. Kobel, S., Wartha, O., Wirt, T., Dreyhaupt, J., Lämmle, C., Friedemann, E. M., … Steinacker, J. M. (2017). Design, implementation, and study protocol of a kindergarten-based health promotion intervention. BioMed Research International, 2017. https://doi.org/10.1155/2017/4347675 Langford, R., Bonell, C.P., Jones, H. E. (2014). The WHO health promoting school framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst, Rev. 4, CD008958. Manning, M. L., & Lucking, R. (1991). The what, why, and how of cooperative learning. The Clearing House. 64(3), 152–156. Marlina, R. L. (2011). Analisis Manajemen Promosi Kesehatan Dalam Penerapan Perilaku Hidup Bersih dan Sehat (PHBS) Tatanan Rumah Tangga di Kota Padang Tahun 2011. Padang: Universitas Andalas. Maryunani, A. (2013). Perilaku Hidup Bersih dan Sehat. Jakarta: Trans Info Media. McClure, M., Tarr, P., Thompson, C. M., & Eckhoff, A. (2017). Defining quality in visual art education for young children: Building on the position statement of the early childhood art educators. Arts Education Policy Review, 118(3), 154–163. https://doi.org/10.1080/10632913.2016.1245167 Mcisaac, J. D., Sim, S. M., Penney, T. L., & Kirk, S. F. L. (2012). School Health Promotion Policy in Nova Scotia: A Case Study. Revue PhénEPS / PHEnex Journal, 4(2). McIsaac, J. L. D., Penney, T. L., Ata, N., Munro-Sigfridson, L., Cunningham, J., Veugelers, P. J., … Kuhle, S. (2017). Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada. 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E. (2010). Comprehensive school health in Canada. Canadian Journal of Public Health = Revue Canadienne de Sante Publique, 101 Suppl(August), S5-8. https://doi.org/10.17269/cjph.101.1907 WHO. (2016). What is a health promoting school? WIjayanti, N. A. (2017). Implementation of Role Playing Method in the Hygiene Hadith Learning Toward Early CHildrens Healthy Behavior of Group B in Dabin Aggrek Gunungpati Semarang. Early Childhood Education Papers (Belia), 6(2).

Purpose The purpose of this paper is to use samples from Chinese-listed companies to investigate the effects of interest rate deregulation and earnings transparency on company’s capital structure in China over the period of 2003–2015. In particular, the authors study the link between state-owned enterprises (SOEs), economic growth targets and marketization in China’s unique institutional context. Design/methodology/approach Based on the methodology of quantitative analysis, the authors use baseline and cluster analysis for all samples with full set of controls, for robustness tests of alternative proxy of interest rate control by using a cluster analysis at the firm level, regarding endogeneity tests conducted fixed effect model with adding instrument variables (IV), two-period factors regression method via IV and system generalized method of moments for dynamic analysis. Findings The results show that earnings transparency increases firm leverage and the additional tests suggest that such an effect takes place via a mechanism by reducing the cost of debt finance. However, information transparency could moderate the effects of interest rate deregulation on corporate capital structure. In addition, it finds that SOEs are less sensitive toward the changes of interest rates in China because lending to SOEs is policy-oriented and lacks of market evaluation of business risk. Government control is conducive to enhancing the transparency of the whole industry; however, market-oriented reform is conducive to enhancing the transparency of the company’s own information. Research limitations/implications The paper makes contribution to the relationship between earnings disclosure quality and capital structure in the Chinese unique institutional context, such as taking the progressive interest rate reform, SOES, different economic growth target and different marketization level in each province of China. The authors suggest that investors will pay more attention to the company’s own unique information transparency in the provinces with a high degree of marketization. As a potential direction for future research, the authors will investigate how the earnings transparency has impact on capital structure, and how such impact would depend on the transparency of specific business, the cap of foreign shareholding and the convenience of investment. Practical implications This research would be the target of banking market reform in order to bring a fair financing environment for all businesses in China. It implies that current experiment of interest rate liberalization in China is not as efficient as it could be in allocating funds across all businesses. State banks, SOEs and local governments are still the biggest players on both the demand and supply sides of the Chinese credit markets. Social implications The social implication of this paper lies in the fact that first, it provides additional evidence on the effect of market-oriented reforms through how the information transparency interacts with the financial decisions making of corporations. Second, it offers policy implication to banking market deregulation in China. Originality/value The paper makes contribution to the relationship between earnings disclosure quality and capital structure in the Chinese unique institutional context. This research tests the existing literature, such as Francis et al. (2004) and Zhang and Lu (2007), and suggests that informationally transparent firms have a higher debt ratio and lower effective interest costs on bank loans. In addition, this paper further explores the role played by interest rate deregulation in corporate finance, and in turn market fund allocation. This paper sheds new light on information transparency and explores the relationship between earnings disclosure quality and debt financing behaviors of Chinese publicly listed companies over the period of 2003–2015.

The decline of Communism after the end of the post-Cold War has seen the rise of nationalism in many parts of the former Communist world. In countries such as the former Soviet Union and Yugoslavia, nationalism was pursued largely from the bottom up as ethnic and separatist movements. Some observers also take this bottom-up approach to find the major cause of Chinese nationalism and believe that “the nationalist wave in China is a spontaneous public reaction to a series of international events, not a government propaganda.” (Zhang, M. (1997) The new thinking of Sino–US relations. Journal of Contemporary China, 6(14), 117–123). They see Chinese nationalism as “a belated response to the talk of containing China among journalists and politicians” in the United States and “a public protest against the mistreatment from the US in the last several years.” (Li, H. (1997) China talks back: anti-Americanism or nationalism? Journal of Contemporary China, 6(14), 153–160). This position concurs with the authors of nationalistic books in China, such as The China That Can Say No: Political and Sentimental Choice in the Post-Cold War Era (Song, Q., Zhang Z., Qiao B. (1996) Zhongguo Keyi Shuo Bu (The China That Can Say No). Zhonghua Gongshang Lianhe Chubanshe. Beijing), which called upon Chinese political elites to say no to the US, and argue that the rise of nationalism was not a result of the official propaganda but a reflection of the state of mind of a new generation of Chinese intelligentsia in response to the foreign pressures in the post-Cold War era. Indeed, Chinese nationalism was mainly reactive sentiments to foreign suppressions in modern history, and this new wave of nationalist sentiment also harbored a sense of wounded national pride and an anti-foreign (particularly the US and Japan) resentment. Many Chinese intellectuals gave voice to a rising nationalistic discourse in the 1990s (Zhao, S. (1997) Chinese intellectuals' quest for national greatness and nationalistic writing in the 1990s. The China Quarterly, 152, 725–745). However, Chinese nationalism in the 1990s was also constructed and enacted from the top by the Communist state. There were no major military threats to China's security after the end of the Cold War. Instead, the internal legitimacy crisis became a grave concern of the Chinese Communist regime because of the rapid decay of Communist ideology. In response, the Communist regime substituted performance legitimacy provided by surging economic development and nationalist legitimacy provided by invocation of the distinctive characteristics of Chinese culture in place of Marxist–Leninism and Mao Zedong Thought. As one of the most important maneuvers to enact Chinese nationalism, the Communist government launched an extensive propaganda campaign of patriotic education after the Tiananmen Incident in 1989. The patriotic education campaign was well-engineered and appealed to nationalism in the name of patriotism to ensure loyalty in a population that was otherwise subject to many domestic discontents. The Communist regime, striving to maintain authoritarian control while Communist ideology was becoming obsolete in the post-Cold War era, warned of the existence of hostile international forces in the world perpetuating imperialist insult to Chinese pride. The patriotic education campaign was a state-led nationalist movement, which redefined the legitimacy of the post-Tiananmen leadership in a way that would permit the Communist Party's rule to continue on the basis of a non-Communist ideology. Patriotism was thus used to bolster CCP power in a country that was portrayed as besieged and embattled. The dependence on patriotism to build support for the government and the patriotic education campaign by the Communist propagandists were directly responsible for the nationalistic sentiment of the Chinese people in the mid-1990s. This paper focuses on the Communist state as the architect of nationalism in China and seeks to understand the rise of Chinese nationalism by examining the patriotic education campaign. It begins with an analysis of how nationalism took the place of the official ideology as the coalescing force in the post-Tiananmen years. It then goes on to examine the process, contents, methods and effectiveness of the patriotic education campaign. The conclusion offers a perspective on the instrumental aspect of state-led nationalism.

I Guess Korean Has Some More Mirative Markers: -Napo- and -Nmoyang- The aim of this paper is to shed light on the semantics of some newly discovered Korean evidential markers -napo- and -n moyang- and to discuss their underlying cognitive mechanism by investigating their functional similarities and differences. 1. PHENOMENA IN FOCUS. The markers, to begin with, are inferential evidential markers; as shown in (2)-(3), they indicate that the speaker infers that the event referred to occurs based on her own observation: (1) cip-ey koyangi-ka iss-e [an utterance without the markers] house-Loc cat-Nom be-Ending “There is a cat in the house.” (2) [After finding a cat’s footprints around the door,] a. cip-ey koyangi-ka iss-napo-a Lit. See whether there is a cat house-Nom cat-Nom be-napo-Ending in the house. b. cip-ey koyangi-ka iss-nu-n moyang-i-a Lit. It is a shape (=situation) that house-Nom cat-Nom be-Pres-n moyang-cop-Ending there is a cat in the house. “(I can infer that) It seems that there is a cat in the house.” (3) [Seeing that the addressee’s pants is wet,] a. pakk-ey pi-ka o-napo -a Lit. See whether it rains outside outside-Loc rain-Nom come-napo-Ending b. pakk-ey pi-ka o-nu-n moyang-i-a Lit. It is a shape (=situation) that outside-Loc rain-Nom come-Pres-n moyang-cop-Ending it rains outside.” “(I can infer that) It seems that it rains outside.” The evidential markers, however, are intriguing in that they can function as a mirative evidential (DeLancey 1997): (2) and (3) sometimes indicate unexpected information, even when the speaker has direct visual access to the information. For instance, (2a-b) should be used in a context where the speaker does not have a cat in her house, whereas the cat in (1) can be specific; (3a-b) can be used in a context where the interlocutors have not known that it was raining and where the speaker who discovered it first let the addressee know. Notice that the marker’s unique semantics is also employed as a politeness strategy to hedge the speaker’s assertiveness for politeness: In (4), even though she knows that the event referred to is a fact, the speaker pretends not to know it in front of her senior: (4) [A student explaining what happened the previous night to her advisor, who was too drunk to remember anything,] ecey sensayingnim-kkeyse manhi chwiha-si-ess-*(napo-/-te-n moyang-i)e-yo. yesterday teacher-Nom [Hon] much be.drunk-Hon-Past-napo-/retro-n moyang-cop)Ending-Hon “(I can infer that) It seems that you were drunk too much.” 2. BACKGROUNDS. Most Korean linguists apparently regard the category of evidentiality as a redundant category due to its functional overlapping with mood, since there are more than a few cases where each of evidentiality and epistemic modality induces inferences about the other and since Korean has an elaborate mood system that can cover some of the territory of evidentiality (hinted by Y.-K. Ko 2007; inter alia), on the one hand. On the other hand, there are a number of linguists, (Kwon 2009, J.-M. Song, 2002, K.-S. Chung 2005, inter alia) who assume that the category of evidentiality definitely exists in Korean and focus on some of the evidential markers case by case. This paper will not treat this controversy any further, but it seems clear that the category of evidentiality is conceptually salient, and cross-linguistically pervasive. Meanwhile, it is surprising that most of studies on evidentials in Korean only concentrate on an individual item and that there has not been a comprehensive work outlining the overall picture of the overall system of evidentiality in Korean (cf. K.-S. Chung 2005). My long-term goal is to figure out the overall system of evidentiality in Korean and to characterize the semantic/pragmatic properties of the markers thoroughly. This paper focuses on the two inferential evidential markers -napo and –nmoyang among them. These markers have not been thoroughly discussed in previous literature. To explore their semantic and pragmatic properties would be of particular interest, since their extended properties are inherited from their original constructions (to be discussed in section 3) where elaborate pragmatic inferences are involved. 3. ANALYSES. This paper argues that the semantics of the markers converges from two different origins (-na ‘whether’ and po- ‘see’ &gt; -napo-; -n relativizer and -moyang- ‘shape’&gt; -nmoyang-), because the speaker employs different intersubjective pragmatic tactics that converge into a single function: to draw the addressee’s attention to what the speaker inferred. The original constructions can be shown as follows: (7)a. Chelswu-ka (o-na po-a /b. o-n moyang-i-a) Chelswu-Nom come-whether see-Decl come-Relativizer shape-Cop-Decl. “See whether Chelswu is coming.” The pragmatics underlying the original structure of the -napo construction is that he speaker urges the addressee to confirm what the speaker conjectures, on the one hand. On the other hand, -nmoyang is originally used in contexts where the speaker intends to describe a situation from a certain epistemic distance, which implies that the speaker has some level of knowledge of the focal event. The difference in their original constructions results in subtle functional difference of their grammaticalized forms. SUBJECT CONSTRAINTS. Other than by showing their functions, there is another supporting evidence that the markers are evidentials: they show an intriguing asymmetry in subject usages in utterances that employ either of the markers, as Aikhenvald and Dixon (2003: 16) noted that “[E]videntiality systems often interact with the grammatical person of the subject or experience.” If the markers show limitations on first person subject usages, then their evidential function requires that the speaker’s inference be based on her objectified observation, which yields asymmetry between usages involving first person subjects and those with non-first person subjects: (8) a. ku (?nay)-ka hakkyo-ey ka-ess-napo-a He(?I)-Nom school-Loc go-Past-napo-Decl b. ku (?nay)-ka hakkyo-ey ka-nmoyang-i-a He(?I)-Nom school-Loc go-nmoyang-Cop-Decl “(I can infer that) It seems that he (I?) went to school” The markers presuppose that the event referred to in the utterance is based on the speaker’s inference. It is also implicated that the speaker is not certain about the information. But, people are normally aware of their own conscious, volitional actions such as going to school. In this context, if the speaker mentioned what she had done with either of the inferential markers, it would be contradictory: Since the mode of access that the indirect evidential encodes is not direct, the inferential evidential conflicts with the direct access that a first person subject usually has with respect to her own past actions. This is a typical characteristic of evidentials. MIRATIVITY. The inferential evidential markers -napo and -nmoyang are also licensed in context where the speaker intends to express the unexpectedness of the focal event. As Delancey (1997, 1999) noted, there is a kind of evidential that encodes/implicates the ‘unprepared mind’ of the speaker, which is a mirative evidential, and this paper argues that the two inferential markers are extended to be used as such function: (9) cip-ey koyangi-ka iss-e house-Loc cat-Nom be-Decl “There is a cat in the house.” [an unidentified cat or a pet cat] (10)a. cip-ey koyangi-ka iss-napo-a house-Loc cat-Nom be-napo-Decl b. cip-ey koyangi-ka iss-nu-nmoyang-a house-Loc cat-Nom be-Imperf-nmoyang-Decl “(Oh) Wow, there is a cat in the house.” [an unidentified cat] We can see that in (10), the cat should not be a pet cat that is already identifiable to the speaker, whereas (9) could refer to either a specific or a non-specific cat. In sum, considering the given examples above that are not prototypical examples that show inferential semantics, we can learn that markers -napo and -nmoyang can encode mirativity as well as inferential evidential semantics. POLITENESS TACTIC. The markers can be used in a politeness strategy neutralizing the speaker’s assertiveness: (11) [When a bartender politely tells a drunken customer, who is demanding more drinks, to stop drinking and to go home] a. cip-ey ka-si-e-yacyo. manhi chwiha-si-ess-#(napo-)e-yo. home-Loc go-Hon-Decl-Hon.end much be.drunk-Hon-Past-napo-Decl-Hon b. cip-ey ka-si-e-yacyo. manhi chwiha-si-#(nmoyang-i)e-yo. home-Loc go-Hon-Decl-Hon.end much be.drunk-Hon-nmoyang-Cop-Decl-Hon “You should get yourself going home. (It seems that) You’re very drunk.” [Koreterm #3643] The utterances would have been rude, without the markers -napo and -nmoyang. The utterances involve the speaker’s pragmatic tactic of flouting: although the bartender has perceived the customer’s obvious drunken state, he pretends not to have directly perceived what is referred to and also pretends to indirectly infer it from some other evidence. It is noted that again, this usage of the marker is not prototypical inferential marking: The speaker has observed it, she has certainty about the information, and thus, its inferential marking function is not needed, logically speaking. Part of the pragmatic tactics involved is related to the markers’ inferential function and the other part of it is related to the markers’ mirative function. That is, in case of (11), the speaker should not assert directly that her customer is drunk, since otherwise, the utterance will threaten her customer’s face. Thus, the speaker employs either of the inferential markers in order to distance herself from the focal event, i.e., in order to pretend not to know what she observed, as if she had not perceived the scene directly. Also, the speaker employs it as if she had just recognized that her customer is drunk. The shorter the period of time during which the customer has been “obviously” drunk, the less face threat is involved in telling the customer about it. 4. DISCUSSION. So far, it has been shown that inferential evidential markers -napo- and -nmoyang- are distributed in a similar way and that even their extended functions, such as implicating mirativity and giving a rise to politeness reading, are similar to each other. SUBTLE FUNCTIONAL DIFFERENCE. Nevertheless, the markers carry subtly different degrees of the speaker’s attitude towards novelty of the information that is talked about. For instance, -napo can encode the speaker’s urgency towards the focal event, whereas -nmoyang encodes the speaker’s controlled and calm emotional state towards the focal event: (12) [While sleeping, hearing that someone has come in, the speaker is scared and says to her husband] a. totwuk-i tul-ess-napo-a thief-Nom come.in-Past-napo-Decl b.?? totwuk-i tul-unmoyang-i-a thief-Nom come.in-nmoyang-Cop-Decl “(I can infer that) It seems that a thief broke into our place.” In brief, in order for -nmoyang to be licensed, the speaker will keep a relatively farther cognitive distance toward the focal event, as if the speaker had observed the event very objectively as a third party. In contrast, -napo is likely to encode the speaker’s urgent attitude toward the target event. DISTANCING STRATEGY. In a number of cases, it is not easy to choose exactly one of these functions as the relevant one in context. This might implicate that the three functions in context are compatible with each other and thus, entangled conceptually. Here is an example show the entangled functions of the markers: (13) [The speaker is scheduled to meet her friend, but she feels sick. She feels sorry about not being able to keep the promise and tries to apologize to her friend, saying,] nay-ka aphu-{n-kapo/nmoyang-i}-a I-Nom be.sick-{Conn-napo/nmoyang-Cop}-Decl “(I can infer that) It seems that I’m sick.” Literally, the speaker expresses a guess about her own internal state. Notice that first person subject is used with either of the markers. This is possible, first, because she does not want to take responsibility for the consequence of her illness—canceling the appointment. If no evidential marker is used, the transfer of the information is direct and the fact that the speaker is sick will be directly vouched for by the speaker, which might yield an assertive reading. In (13), the speaker is less assertive and thus, avoids direct responsibility. Second, the markers allow the speaker to express the unexpectedness of the information. And obviously an unexpected problem is a better excuse for inability to keep a promise. In brief, (13) includes all the functions mentioned above: The speaker employs an inferential evidential construction in a context where it is not only a prototypical inferential statement, but also a mirative statement, which is further used as a politeness strategy. The cognitive mechanisms underlying the multiple usages of the markers stem from the speaker’s effort to distance herself from the event in question, exploiting the indirective semantics of the markers. 5. CONCLUSION. This paper argues that the markers -napo and -nmoyang are to be regarded as evidentials, by looking into their basic properties and extended properties. Specifically, they are inferential markers, which encode the speaker’s inference based on observed entities, properties, or relations. It was also shown that the markers can encode a mirative function that marks unexpectedness or unpreparedness to the speaker’s mind. Moreover, the markers are intentionally employed in a politeness strategy. This strategic indirectness derives from their inferential and mirative characteristics. Based on these observations, this paper provides a unified account for the semantic functions of these two markers, following DeLancey’s assumption that inferentials, evidentials, and miratives are semantically related, and argues that the relationship is based on pragmatic tactics of exploiting inferential and mirative senses for indirectness and politeness. It is also discussed that even though the two markers are distributed very similarly, they are subtly different in that -napo encodes immediacy, whereas -nmoyang encodes the speaker’s non-immediacy and even the speaker’s controlled and calm state of mind toward an event. Based on the similarities and differences between the two markers’ (extended) functions, this paper argued that the cognitive mechanism underlying the two markers’ functions is a distancing strategy for interactive meaning negotiation. SELECTED REFERENCES Aikhenvald, Alexandra Y. and R.M.W. Dixon (eds.). 2003. Studies in Evidentiality. Oxford: Oxford University Press. Chung, Kyung-Sook. 2005. Spaces in Tense: The Interactionof Tense, Aspect, Evidentiality and Speech Act in Korean. Ph. D. Dissertation. Simon Fraser University. DeLancey, Scott. 1997. Mirativity: The Grammatical Marking of Unexpected Information. Linguistic Typology 1. 33-52. DeLancey, Scott. 1999. The Mirative and Evidentiality. Journal of Pragmatics 33, 369-382. Ko, Yeong-Keun. 2007. Hankwukeuy Sicey, Sepep, Tongcaksang [Tense, Mood, and Aspect in Korean]. Kyeonggi-do, Korea: Taehaksa. Kwon, Iksoo. 2009. The Korean Evidential Marker -te- Revisited: Its Semantic Constraints and Distancing Effects in Mental Spaces Theory. Paper presented at Fillmore Fest 2009: Frames and Constructions, University of California, Berkeley, July 31-August 2, 2009. Song, Jae-Mog. 2002. A Typoloical Analysis of the Korean Evidential Marker ‘-Te-.’ Enehak [The Linguisitic Society of Korea] 32, 147-164.

Monocytes, macrophages and dendritic cells are indispensable for innate immunity. Myelopoiesis takes place in the bone marrow (BM) through differentiation of a common myeloid progenitor into monocyte dendritic cell progenitors (MDP) or granulocyte monocyte progenitors (GMP). MDP differentiate into myeloid progenitors (MoP) or common dendritic progenitors (cDP) that give rise to monocytes or dendritic cells (DC) repectively. GMP can also generate neutrophil-like monocytes via an intermediate monocyte progenitor [MP; Immunity. 2017 47(5):890] and neutrophils via a granulocyte progenitor (GP). CSF1 (M-CSF) is the key cytokine that regulates monopoiesis, CSF1 loss causes profound defects in monocyte, dendritic cell, macrophage and osteoclast generation. Classical studies using Csf1-/- chimeric mice demonstrated that CSF1 is produced by BM stromal cells. However the identity of these CSF1-producing cells is unknown. A major limitation is the lack of immunofluorescence protocols to map progenitor interaction with candidate niches. We have found that CD11b-Ly6C-CD117+CD115+ cells are MDP; Lin-Ly6C-CD117+CD16/32+CD115- cells are GMP; CD11b-Ly6C+CD117+CD115+ are MP/MoP; CD11b-Ly6C+CD117+CD115- are GP; CD11b+CD115+Ly6Chi and CD11b+CD115+Ly6Clo cells are classical and non-classical monocytes; and MHCIIhi reticular cells are DC. We used the markers above to map the 3D position of every myeloid cell in the sternum and assessed the relationships between myeloid progenitors, their offspring and candidate niches in situ with single cell resolution. To test whether the interactions observed were specific we obtained the X, Y and Z coordinates for every hematopoietic cell in the sternum (detected using αCD45 and αTer119). We then used these coordinates to randomly place each type of myeloid cell, at the same frequencies found in vivo, through the BM to generate a random distribution for each myeloid cell type. HSC localize to sinusoidal, arteriolar and endosteal niches. However, myeloid progenitors are exclusively perisinusoidal (mean MDP distance to sinusoids, arterioles, and endosteum observed 5, 134, and 105μm vs 9, 86, and 69µm in the random simulation). Myeloid progenitors rarely localize with HSC indicating that progenitors abandon the HSC niche upon differentiation. Strikingly, we found that granulopoiesis, monopoiesis and DCpoiesis occur in distinct sinusoidal locations and that MDP are tightly associated with sinusoids, dendritic cells and Ly6Clo monocytes (2.0 DC and 4.4 Ly6Clo monocytes observed within 50µm of an MDP vs 0.9 DC and 1.8 Ly6Clo monocytes in the random simulation p=0.02 and p&lt;0.0001) but not with MoP/MP or Ly6Chi classical monocytes. The results above suggest that the stromal cells that provide the signals that regulate MDP will localize to the sinusoids. Analyses of Csf1 expression in two recently published scRNAseq studies of BM stroma showed that perivascular stromal cells and osteoblastic cells are the major CSF1 sources with sinusoidal endothelial cells expressing much lower levels. Csf1 deletion in perivascular cells using LepR-cre mice and in osteoblastic cells using Ocn-cre mice did not impact Ly6Chi classical or Ly6Clo non-classical monocytes in peripheral blood. We also did not find any defects in BM MDP, GMP, MoP numbers or colony forming activity or in monocyte or dendritic cell numbers. In sharp contrast we found that conditional Csf1 deletion in endothelial cells using Cdh5-cre mice led to a 3.9-fold defect in Ly6Clo non-classical monocytes in the blood (1.89 vs 0.47 x105/ml in the +/- controls vs Cdh5-cre:Csf1-/Δ mice; p=0.03). In the BM these mice showed a 1.4 reduction in MDP numbers (0.72 vs 0.5x104/femur; p=0.04) further compounded by a 2.7-fold loss in MDP-derived CFU-M (22 vs 8 colonies/100 cells; p=0.009) indicating a dramatic reduction in MDP function. This in turn led to a 2.3-fold reduction in Ly6Clo non classical monocytes (9.5 vs 4.1x104/femur; p=0.01) and a 1.2-fold reduction in cDC (2.7 vs 2.1 x104cDC/femur p=0.005). In summary we have imaged for the first time myeloid progenitors; mapped their differentiation into mature myeloid cells; quantified their interaction with candidate niche cells; showed that sinusoids are the exclusive site of monocyte and dendritic cell production; and demonstrated that endothelial cells are a niche that regulates MDP numbers and function via CSF1. Disclosures No relevant conflicts of interest to declare.

Summary Carbon/oxygen (C/O) logs have been run in open hole to assess zones that are potentially swept with fresh injection water in several infill wells offshore Cabinda, Angola. Interpretation of these logs has been challenging because of the invasion of oil-based mud (OBM) filtrate, mixed sand/carbonate lithology, variable water salinity, large boreholes, and lack of clean wet zones in which to normalize. We discuss the impact of these factors and our experiences in managing them. An example is included in which the results of time-lapse logging suggest that the invasion of OBM filtrate in water zones dissipates slowly or not at all. We show comparisons between saturations derived from the resistivity and the C/O ratio (COR) for these various conditions. Introduction The Angola Block 0 concession comprises new and mature reservoirs in an offshore operating environment. Waterflood operations are being used in several of these reservoirs to enhance recovery. Because the injected water has a relatively low water salinity (33 kppm NaCl equivalent seawater), detection of zones experiencing injection-water breakthrough is difficult when using traditional pulsed neutron capture (PNC) logging tools, which respond to the chloride ions in saline formation waters. One technique frequently employed in these circumstances is the use of C/O logging tools. These tools measure the relative abundance of carbon and oxygen, thereby distinguishing oil from water independent of salinity. These tools are usually run in cased hole in existing wells that have been on production for some time. In some fields, however, active infill drilling programs are under way in which new wells are drilled through producing horizons that may already have been swept with low-salinity injection water. These swept layers can be difficult to distinguish from oil-bearing intervals using conventional resistivity logs. Recently, C/O logging tools have been run in open hole as part of the standard openhole logging program. This has proven to be an effective means of distinguishing oil from low-salinity water before casing the well, despite the influence of mud-filtrate invasion. Peripheral waterflooding is under way or planned for many of the active developments. Most of the current waterflood activity is within the Vermelha formation, which is a complex lithology reservoir with variable amounts of sand, shale, and carbonate (dolomite with minor amounts of calcite and siderite) contained in the rock matrix. Reservoir surveillance in the early life of these fields centered around monitoring injection-well profiles and identifying water breakthrough in producers with production logs and PNC logs. Layer pressures are tracked with wireline formation tester data whenever an infill well is drilled. These data are used with fullfield reservoir simulations to track and predict water movement in the reservoir and develop infill drilling strategies. PNC logs provide accurate water-saturation information until low-salinity injection water reaches a logged well. Arrival of low-salinity injection water can be identified by a drop in produced water salinity, but it is impossible to tell which interval contributes the low-salinity injection water. Production-profile logs continue to provide valuable information after floodwater breakthrough occurs in the perforated intervals, but water saturation from PNC logs is no longer reliable. When low-salinity injection-water breakthrough is suspected (in perforated or unperforated sections), a C/O log is substituted for the PNC log to provide a salinity-independent means of determining water saturation.1–4 Despite the efforts to track the flood front and drill infill wells in unswept areas of the reservoir, there is a chance that breakthrough has already occurred in some of the proposed completion intervals. Most Block 0 wells are on gas lift, so minimizing water production is vital to maximizing oil production. The best way to minimize water production is to identify floodwater breakthrough during the openhole log analysis and complete only intervals that have not been swept by the waterflood. Standard Archie water-saturation analysis, based on resistivity and porosity, requires knowledge of the formation water resistivity (Rw). In a waterflood environment, the water resistivity can be variable, which adds considerable uncertainty in the computed water saturation. A salinity-independent means of determining water saturation, or at least discriminating fresh water from oil, has a significant impact on perforation selection. We were initially skeptical that reasonable C/O measurements could be made in an open hole with OBM because the borehole signal is an order of magnitude greater than the formation signal. When using OBM, small variations in the borehole size could produce a C/O response roughly equivalent to the response from oil in the formation.5 To date, we have run and confidently interpreted C/O data recorded with the 3.63-in.-diameter Pulsed Spectral Gamma Tool in 11 open and cased wellbores drilled with OBMs. Impact of Uncertainty in Water Salinity on Net Pay and Perforation Decisions The salinity of the Vermelha formation water is 200 kppm NaCl equivalent. Rw=0.025 ohm-m at 140°F (60°C). The formation water resistivity is higher in intervals in which floodwater breakthrough has occurred because of the presence of fresh floodwater. A conservative strategy for avoiding water production would be to assume floodwater might be present in any interval and compute Sw with a formation water resistivity that matches the floodwater. All intervals that still meet the Sw cutoff criterion are definitely pay, and there is no risk of producing water unexpectedly. The downside of this strategy is that some intervals that could have contributed water-free production will be eliminated. These intervals would pass the Sw cutoff criterion if 200 kppm water were actually present but would not pass the Sw cutoff criterion if 40 kppm water were present. An example of the impact of this is summarized in Table 1. The net pay calculated for Well TK-E10 is 375 ft assuming 200 kppm water and 250 ft assuming 40 kppm water. The difference of 125 ft represents 11.2 million bbl of oil in place (Sw=0.30, porosity=0.30, Bo=1.17). The value of the C/O log (or any log that can confirm the presence of fresh water) is tied to how much of this possible fresh water can be identified and avoided when perforating.