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The unique properties of a SiC hybrid 3.3-kV/450-A half-bridge IGBT power module which is designed for enhanced reliability of railcar converters are presented in this paper. The hybrid technique enabled by utilizing the state-of-the-art 3.3-kV SiC SBDs has shown impressive electrical performances during switching. The switching waveforms, switching time lengths, voltage overshooting, current overshooting and information contained therein have been exploited in detail, in comparison with the corresponding fully Si-based IGBT module as a control sample. The potential of reliability enhancement by this SiC hybrid concept at the rated voltage and current levels will provide essential benchmark for railcar converter designs.

Background and purpose: Radical surgery is the standard of care for early rectal cancer. However, alternative organ-preserving approaches are attractive, especially in frail or elderly patients as these avoid surgical complications. We have assessed the efficacy of sole Contact X-ray Brachytherapy (CXB) treatment in stage-1 rectal cancer patients who were unsuitable for or declined surgery. Materials and methods: This retrospective multi-centre study (2009–2021) evaluated 76 patients with T1/2-N0-M0 rectal adenocarcinomas who were treated with CXB alone. Outcomes were assessed for the entire cohort and sub-groups based on the T-stage and the criteria for receiving CXB alone; Group A: patients who were fit enough for surgery but declined, Group B: patients who were high-risk for surgery and Group C: patients who had received prior pelvic radiation for a different cancer. Results: With a median follow-up of 26(IQR:12–49) months, initial clinical Complete Response (cCR) was 82(70–93)% with rates of local regrowth 18(8–29)%, 3-year actuarial local control (LC) 84(75–95)%, distant relapse 3 %, and no nodal relapse. 5-year disease-free survival (DFS) and overall survival (OS) were 66(48–78)% and 58(44–75)%. Lower OS was observed in Groups B [HR:2.54(95 %CI:1.17, 5.59), p = 0.02] and C [HR:2.75(95 %CI:1.15, 6.58), p = 0.03]. Previous pelvic radiation predicted lower cCR and OS. The main toxicity was G1-2 rectal bleeding (26 %) and symptoms of impaired anal sphincter function were not reported in any patients. Conclusion: CXB treatment alone achieved a high cCR rate with satisfactory LC and DFS. Inferior oncological outcomes were observed in patients who had received prior pelvic radiotherapy. CXB alone, with its favourable toxicity profile and avoidance of general anaesthesia and surgery risks, therefore, can be considered for patients who are unsuitable for or refuse surgery.

The standard of care for locally advanced rectal cancer is total neoadjuvant therapy followed by surgical resection. Current evidence suggests that selected patients may be able to delay or avoid surgery without affecting survival rates if they achieve a complete clinical response (CCR). However, for older cancer patients who are too frail for surgery or decline the surgical procedure, local recurrence may lead to a deterioration of patient quality of life. Thus, for clinicians, a treatment algorithm which is well tolerated and may improve CCR in older and frail patients with rectal cancer may improve the potential for prolonged remission and potential cure. Recently, immunotherapy with check point inhibitors (CPI) is a promising treatment in selected patients with high expression of program death ligands receptor 1 (PD- L1). Radiotherapy may enhance PD-L1 expression in rectal cancer and may improve response rate to immunotherapy. We propose an algorithm combining immunotherapy and radiotherapy for older patients with locally advanced rectal cancer who are too frail for surgery or who decline surgery.

The purpose of this study is to evaluate the learning management in the creation of performing arts at the Performing Arts Education Study Program at ISI Denpasar. The evaluation results of the learning management in the performing arts creation can be used as input for improving the learning management related to performing arts courses, which in turn can enhance students’ competence in the field of performing arts. The learning of performing arts creation is directed towards the development of nationalism among the next generation towards the cultural heritage of the nation in the field of arts. The research design used is an evaluative research design with the CIPP model. The research subjects consist of program managers, lecturers of the performing arts creation course, and students who have taken or are currently taking the performing arts creation course. Data collection is done using questionnaires, observations, and interviews. The data is analyzed using quantitative descriptive analysis. The research findings indicate that: (1) the quality of the Context Aspect of the learning management in the Performing Arts Education at ISI Denpasar is classified as good; (2) the quality of the Input Aspect of the learning management in the Performing Arts Education at ISI Denpasar is classified as fairly good; (3) the quality of the Process Aspect of the learning management in the Performing Arts Education at ISI Denpasar is classified as not good or poor; and (4) the quality of the Product Aspect of learning management in the Performing Arts Education at ISI Denpasar is classified as fairly good improved; (2) maximizing the use of technology in the learning process; (3) facilitating collaborative learning among students from different study programs or universities.

One type of gamelan art that is developing in West Java is Gong Rénténg which used to be often used in sacred ceremonial activities. The sacredness built into the art is inseparable from the belief system adopted by the community as its supporting community. Gong Rénténg's whereabouts then and now are experiencing dynamics of change which are quite important to study, especially his journey which was stopped for various reasons. Stagnant regeneration factors, changes in people's perspectives due to changes in belief systems, as well as the influx of imported arts that continue to intrude on traditional art life, are some of the main reasons this art has experienced ups and downs in its life. The research carried out has the style of cultural research involving key informants as triggers to explore the depth of the material. There are three models of cultural research as approaches taken by researchers, including; Life Story models, Grounded Theory, and Personal Narrative. While the research method used still uses qualitative research by taking locations in two different areas, namely: (1) Ciwaru Village, Cimalaka District, Sumedang Regency, and (2) Kedungsana Village, Plumbon District, Cirebon Regency. In Ciwaru village, the object of research is the art of Gong Rénténg Pusaka Langgeng, while in the village of Kedungsana it is the art of Gong Rénténg Ki Muntili. The results of the research conducted obtained the following information: (1) The Gong Rénténg Pusaka Langgeng art still adheres to adat in a standard way even though the next generation continues to decrease, and (2) The Gong Rénténg Ki Muntili art does two ways to keep it alive, namely ritual ceremonies as part of ancestral traditions are carried out as well as the process of inheritance with new interpretations.

Abstract Purpose To describe clinical and biological features and the outcomes of patients admitted for histoplasmosis in two intensive care units (ICU) in French Guyana and in the French West Indies (Guadeloupe). Methods All patients admitted to these two ICUs for culture-proven histoplasmosis between January 2014 to August 2022 were included in the study. Using univariate and multivariate analysis, we assessed risk factors at ICU admission that were associated with death. Results Forty patients were included (65% men). Median age was 56 years and simplified acute physiologic score (SAPS) II was 65. HIV was found in 58%, another immunodeficiency was identified in 28%, and no underlying immunodeficiency could be identified in 14% of patients. Within the first 24 h of ICU admission, 85% of patients had acute respiratory failure, 78% had shock, 30% had coma, and 48% had hemophagocytic lymphohistiocytosis. Mechanical ventilation was instituted in 78% of patients and renal replacement therapy in 55%. The 30-day mortality was 53%. By multivariate analysis, factors independently associated with 30-day mortality were SOFA score (odds ratio [OR] 1.5, 95% confidence interval [CI] [1.1–2.1]), time between symptom onset and treatment per day (OR 1.1, 95% CI 1.0–1.1), and hemophagocytic lymphohistiocytosis (OR 6.4, 95% CI 1.1–47.5). Conclusion Histoplasmosis requiring ICU admission is a protean disease with multiple and severe organ involvement. Immunodeficiency is found in most patients. The prognosis remains severe despite appropriate treatment and is worsened by late treatment initiation.

Abstract The Laser Interferometer Space Antenna (LISA) will be a transformative experiment for gravitational wave astronomy, and, as such, it will offer unique opportunities to address many key astrophysical questions in a completely novel way. The synergy with ground-based and space-born instruments in the electromagnetic domain, by enabling multi-messenger observations, will add further to the discovery potential of LISA. The next decade is crucial to prepare the astrophysical community for LISA’s first observations. This review outlines the extensive landscape of astrophysical theory, numerical simulations, and astronomical observations that are instrumental for modeling and interpreting the upcoming LISA datastream. To this aim, the current knowledge in three main source classes for LISA is reviewed; ultra-compact stellar-mass binaries, massive black hole binaries, and extreme or interme-diate mass ratio inspirals. The relevant astrophysical processes and the established modeling techniques are summarized. Likewise, open issues and gaps in our understanding of these sources are highlighted, along with an indication of how LISA could help making progress in the different areas. New research avenues that LISA itself, or its joint exploitation with upcoming studies in the electromagnetic domain, will enable, are also illustrated. Improvements in modeling and analysis approaches, such as the combination of numerical simulations and modern data science techniques, are discussed. This review is intended to be a starting point for using LISA as a new discovery tool for understanding our Universe.

Abstract Background Rectal cancer has a high prevalence. The standard of care for management of localised disease involves major surgery and/or chemoradiotherapy, but these modalities are sometimes associated with mortality and morbidity. The notion of ‘watch and wait’ has therefore emerged and offers an organ-sparing approach to patients after administering a less invasive initial treatment, such as X-ray brachytherapy (Papillon technique). It is thus important to evaluate how likely patients are to respond to such therapies, to develop patient-tailored treatment pathways. We propose a systematic review to identify published clinical prediction models of the response of rectal cancer to treatment that includes radiotherapy and here present our protocol. Methods Included studies will develop multivariable clinical prediction models which assess response to treatment and overall survival of adult patients who have been diagnosed with any stage of rectal cancer and have received radiotherapy treatment with curative intent. Cohort studies and randomised controlled trials will be included. The primary outcome will be the occurrence of salvage surgery at 1 year after treatment. Secondary outcomes include salavage surgery at at any reported time point, the predictive accuracy of models, the quality of the developed models and the feasibility of using the model in clinical practice. Ovid MEDLINE, PubMed, Cochrane Library, EMBASE and CINAHL will be searched from inception to 24 February 2022. Keywords and phrases related to rectal cancer, radiotherapy and prediction models will be used. Studies will be selected once the deduplication, title, abstract and full-text screening process have been completed by two independent reviewers. The PRISMA-P checklist will be followed. A third reviewer will resolve any disagreement. The data extraction form will be pilot-tested using a representative 5% sample of the studies reviewed. The CHARMS checklist will be implemented. Risk of bias in each study will be assessed using the PROBAST tool. A narrative synthesis will be performed and if sufficient data are identified, meta-analysis will be undertaken as described in Debray et al. Discussion This systematic review will identify factors that predict response to the treatment protocol. Any gaps for potential development of new clinical prediction models will be highlighted. Trial registration CRD42022277704.

Purpose: To issue consensus recommendations for contact X-Ray brachytherapy (CXB) for rectal cancer covering pre-treatment evaluation, treatment, dosimetric issues and follow-up. These recommendations cover CXB in the definitive and palliative setting. Methods: Members of GEC ESTRO with expertise in rectal CXB issued consensus-based recommendations for CXB based on literature review and clinical experience. Levels of evidence according to the Oxford Centre for Evidence based medicine guidance are presented where possible. Results: The GEC ESTRO ACROP consensus recommendations support the use of CXB to increase the chances of clinical complete remission and cure for patients who are elderly with high surgical risk, surgically unfit or refusing surgery. For palliative treatment, the use of CXB is recommended for symptomatic relief and disease control. The use of CXB in an organ-preservation setting in surgically fit patients is recommended within the setting of a clinical trial or registry. Conclusions: The GEC ESTRO ACROP recommendations for CXB are provided. Recommendations towards standardisation of reporting and prescription are given. Practitioners are encouraged to follow these recommendations and to develop further clinical trials to examine this treatment modality and increase the evidence base for its use. The routine collection of outcomes both clinical and patient-reported is also encouraged.

Background and purpose: The use of external beam radiotherapy (EBRT) and contact X-Ray brachytherapy (CXB) is emerging as an effective alternative in patients with early stage rectal cancer with the intent of organ preservation (OP). Short course radiotherapy (SCRT) is an alternative EBRT schedule for patients not fit for chemotherapy or for longer courses of EBRT. There are no multicentre studies that have reported on the outcomes of SCRT with a CXB boost, therefore we present these from patients from centres from the UK and Sweden. Materials and methods: From the Guildford Colorectal Database or local databases, 258 patients who underwent SCRT and CXB with the intent of OP from five centres treated between 2007 and 2019 were identified. Response and survival data was analysed and presented. Results: With a median age of 81, 226 patients were treated with radiotherapy alone (RTA) and 32 immediately after local excision (ILE). Median follow-up was 24 months. 70% and 97% of patients in the RTA and ILE groups respectively had a complete clinical response (cCR) after SCRT with CXB. Of those, local relapse was seen in 16% of the RTA and 3% of the ILE group. Median survival was 40 months after CXB in the RTA and 52 months in the ILE group. 94% of patients remained stoma-free to the point of latest follow-up. Conclusion: This data suggests that CXB when combined with SCRT, in a mainly elderly and comorbid population, provides good palliation with stoma-avoidance. Oncological outcomes compare with previously published work. A greater focus is required on quality of life outcomes after OP.

The article highlights a new trend in brand behavior, especially global ones: brand activism. Brand activism involves brands taking public positions on social and political issues. They are addressed to society as a whole and not just to a commercial target. Brands take positions despite the risks they face. This type of stance emerged in the context of the crisis of legitimacy of heteronomous discourse (especially in the United States), being at the same time a defensive reaction and an opportunity for brands to occupy new discursive territories. In the first part, I presented the main features of brand activism, insisting on political activism. The second part is, in fact, a hermeneutic analysis of the discourse transmitted through the brand campaign of eMAG, especially through the advertising clip "Freedom every day" from October 2019. I showed that, in reality, this was a campaign of brand activism, overlapping with part of the 2019 presidential election campaign and trying to stimulate the #resist movement. The association of two different campaigns (brand campaign and brand activism campaign) as well as the inconsistent mix of communicated values, especially through the advertising clip, but also through the entire campaign, made the reception to be predominantly negative. Finally, the brand activism cannot reached its target.

The article presents a critical evaluation of the main discursive directions in Romania, after the accession to the European Union (EU) and the outbreak of the world economic crisis in 2008. We considered the hermeneutic analysis of the political discourse. The neoliberal direction was dominant, including during periods when left-wing or euro-skeptic parties were in power. Basically, we can talk about an explicit anti-neoliberal direction just in the case of the 2013 protests against the gold mining in Roșia Montană. The austerity measures, adopted in particular in 2009 and 2010, have virtually replaced the post-accession program. During the same period, Romania experienced the largest migration to EU countries. The accession was, therefore, seen by a significant number of Romanians as an opportunity to leave the country, often forever. At the end of this period, Romania was struggling between the dominant neoliberalism, already in crisis globally, and some forms of nationalism. It had become a peripheral country of the Western world, experiencing the global crisis in terms specific to the periphery. Finally, we made two critical assessments: of the “communist” option, about which Slavoj Žižek wrote in his work Like a Thief in Broad Daylight: Power in the Era of Post-Human Capitalism , and the conservative anti-neoliberal one, presented by Alexandru Racu in the Antisocial Apostolate. Theology and neoliberalism in post-communist Romania.

Objective: Obesity-linked type 2 diabetes (T2D) is a worldwide health concern and many novel approaches are being considered for its treatment and subsequent prevention of serious comorbidities. Co-administration of glucagon like peptide 1 (GLP-1) and peptide YY3-36 (PYY3-36) renders a synergistic decrease in energy intake in obese men. However, mechanistic details of the synergy between these peptide agonists and their effects on metabolic homeostasis remain relatively scarce. Methods: In this study, we utilized long-acting analogues of GLP-1 and PYY3-36 (via Fc-peptide conjugation) to better characterize the synergistic pharmacological benefits of their co-administration on body weight and glycaemic regulation in obese and diabetic mouse models. Hyperinsulinemic-euglycemic clamps were used to measure weight-independent effects of Fc-PYY3-36 + Fc-GLP-1 on insulin action. Fluorescent light sheet microscopy analysis of whole brain was performed to assess activation of brain regions. Results: Co-administration of long-acting Fc-IgG/peptide conjugates of Fc-GLP-1 and Fc-PYY3-36 (specific for PYY receptor-2 (Y2R)) resulted in profound weight loss, restored glucose homeostasis, and recovered endogenous β-cell function in two mouse models of obese T2D. Hyperinsulinemic-euglycemic clamps in C57BLKS/J db/db and diet-induced obese Y2R-deficient (Y2RKO) mice indicated Y2R is required for a weight-independent improvement in peripheral insulin sensitivity and enhanced hepatic glycogenesis. Brain cFos staining demonstrated distinct temporal activation of regions of the hypothalamus and hindbrain following Fc-PYY3-36 + Fc-GLP-1R agonist administration. Conclusions: These results reveal a therapeutic approach for obesity/T2D that improved insulin sensitivity and restored endogenous β-cell function. These data also highlight the potential association between the gut–brain axis in control of metabolic homeostasis.

Studies have shown COVID-19 patients may have a low oxygen saturation (SpO 2 ) independent of visible respiratory distress, a phenomenon termed “silent hypoxia.” Silent hypoxia creates uncertainty in the outpatient setting for clinicians and patients alike. In this study, we examined the potential for pulse oximeters in identifying early signs of clinical deterioration. We report descriptive results on COVID-positive patients’ experiences with a comprehensive home monitoring tool comprised of home SpO 2 measurements with a novel symptom-tracking short message service/text messaging application. Of patients who required hospitalization, 83% sought care as a result of low pulse oximeter readings. Nearly all patients who did not require hospitalization reported that having a pulse oximeter provided them with the confidence to stay at home. Essentially all patients found a home pulse oximeter useful. Keeping COVID-19-positive patients at home reduces the potential for disease spread and prevents unnecessary costs and strain on the healthcare system.

The article’s aim is to provide a definition of the science of communication together with the delimitation of the field of research and the identification of a general research method. The starting point is the general phenomenon of communication in the living world, as the research field of communication science is limited, by successive delimitations, to media discourses. The most important aspect that has been highlighted is the political nature of media speeches. Politics de-homogenizes the discursive mass and at the same time provides a clear criterion for classifying discourses. Thus, insofar as communication is media-based, it is also a political communication. The science of communication is defined as the study of the phenomenon of integration and discursive distancing, in other words of the discursive competition and social negotiation. The starting point of the entire process of definition is the work “Autonomous Discourse. Communication Strategies” (2013).

Resumo Os procedimentos terapêuticos invasivos têm aumentado frequentemente com a evolução da medicina, consequentemente aumentando o número de complicações decorrentes deles. O dispositivo contraceptivo subdérmico (DCS) tem um benefício para a contracepção feminina, mas o implante e a retirada apresentam uma taxa de complicações em torno de 3%. Neste artigo, relatamos e discutimos um caso de pseudoaneurisma traumático da artéria braquial após tentativa de retirada do implante, complicada com a compressão do nervo mediano.

Statistics show that the majority of aircraft accidents occurs in the vicinity of airfield areas. Yet the main factors leading to fatalities in these accidents are the forces encountered by human occupants in collision with obstacles and the presence of fire. It is possible to single out a group of “technically survivable” accidents from the total number of accidents, in which a crew member or passengers could have survived, if the evacuation took place in a timely manner. The share of such accidents is about 85–90%. However, up to 40% of passengers die in technically survivable accidents. Applicable protection systems are only adequate, if the passengers manage to exit the airplane and get to a safe distance within a limited timeframe. Although these systems have been sufficiently developed; this is one of the most significant problems in modern aviation. This means, that the study of possibilities and the development of the methods and means of passenger evacuation in aircraft accidents, specifically in and around airport areas, are relevant to be addressed.

Merangkai Nusantara melalui Seni Wadantara merupakan Penelitian Penugasan dalam bentuk skema Konsorsium Riset Unggulan Peguruan Tinggi (KRU-PT) tahun 2019 s.d tahun 2021. Tujuan penelitian menghasilkan satu model seni pertunjukan yang mengkolaborasikan jenis kesenian dari multi etnis dalam satu kemasan seni pertunjukan wayang, drama, karawitan dan tari Nusantara dalam satu repertoar bernama Seni Wadantara. Dampak positif yang diperoleh adalah penguatan ideologi bangsa dan ekonomi melalui pengembangan seni pertunjukan panggung terkoneksi secara digital untuk memudahkan akses dan mutu pertunjukan. Desain penelitian yang digunakan adalah research and development, sedangkan desain manajemen produksinya melalui tiga tahapan yaitu tahap pra produksi, produksi dan pasca produksi. Dalam proses penciptaan berintikan ekplorasi, improvisasi, pembentukan. Teknik pengumpulan data digunakan wawancara, observasi, dokumentasi, angket, catatan lapangan.Teknik analisis data digunakan analisis kuantitatif dan kualitatif. Data kuantitatif dianalisis dengan menggunakan penyekoran, sedangkan data berupa komentar dan saran dianalisis secara kualitatif. Hasil Penelitian menunjukkan (1) hasil need assessment (a) bangsa Indonesia yang sedang memperkuat persatuan dan kesatuan dalam bingkai negara kesatuan Republik Indonesia memerlukan dukungan untuk kebersamaan yang dilandasi oleh toleransi bermasyarakat yang dapat ditawarkan oleh seni pertunjukan dengan muatan budaya lokal sebagai ungkapan budaya Nusantara; (b) kesenian selalu tumbuh dan berkembang dan memerlukan adanya perubahan dalam memproduksi seni baru bersifat kolaborasi; (c) hadirnya revolusi industri 4.0 menjadi peluang dalam menciptakan seni pertunjukan secara kolaboratif antara tradisi dan kontemporer. (2) Seni pertunjukan Wadantara Satria Nusantara Mahawira dengan struktur tiga babak mengangkat lakon Sumpah Palapa Gajah Mada. (3) Hasil uji efekivitas terhadap produk seni pertunjukan Wadantara Satria Nusantara Mahawira melalui FGD dan Uji Lapangan Terbatas, responden yang berjumlah 50 orang sebagian besar menyatakan sangat baik.

Most DNA viruses must amplify their DNA to form new viral particles. To kickstart their DNA amplification, herpesviruses alter the host cell cycle dynamics by halting G1/S progression. Soon after, the viruses begin amplifying their DNA and halt any detectable cellular DNA synthesis. Viral DNA amplification takes place in specialized regions of the cell known as replication compartments. The genesis and maturation of replication compartments are not well understood. While replication compartments can only be visualized via microscopy, examining DNA synthetic events requires ensemble approaches. We have therefore exploited single-cell assays, including live-cell imaging, fluorescence in situ hybridization (FISH), and EdU-pulse labeling, in combination with computational simulations and ensemble approaches, to study the role of replication compartments in the DNA amplification of the Epstein–Barr virus (EBV). FISH revealed that each replication compartment initially contained a single DNA molecule which did not travel between compartments. DNA amplification lasted for 13–14 h in single cells, as shown by live cell imaging. Replication compartments eventually grew to occupy 30% of the nucleus, which itself grew by 50%. We found that early in the lytic phase, the availability of DNA templates limited DNA synthesis, while late in the lytic phase, the majority of viral DNA molecules no longer served as templates, which correlated with a drop in the levels of the replication protein. The eventual decline in DNA synthesis did not result from encapsidation; only 1–2% of the viral DNA was encapsidated. The levels of viral DNA synthesis in each compartment were similar. Therefore, the number of compartments determined the total amount of DNA synthesized and, consequently, the levels of amplified DNA. This finding was predicted by computational simulations of the amplification of the two distinct EBV derived replicons that we studied. Our results establish that replication compartments represent clonal factories for DNA amplification that are regulated coordinately during the lytic phase.