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In this study, the adsorption of methyl violet from an aqueous solution using carbonised water lily (CWL) leaves powder as a low-cost, efficient and eco-friendly adsorbent was investigated using a batch system under controlled conditions. The adsorbent's moisture, organic matter, ash, bulk density, pore volume, and pH were determined. The adsorbents were characterised by scanning electron microscopy (SEM) and Fourier Transform Infrared (FT-IR) techniques which confirm the adsorption of the methyl violet onto the CWL adsorbents. The effect of adsorption parameters such as contact time, dosage, initial concentration, pH and temperature were studied for optimisation. It was confirmed that contact time, dosage, concentration, pH and temperature positively affected the adsorption process. The kinetic data were best described by pseudo-second order under all experimental temperatures. The adsorption isotherms were estimated and established to fit nicely into the D-R model compared to other models generated and tested. Thermodynamic studies of the sorption process indicate that the process was feasible, spontaneous, and exothermic and decrease in the randomness of the adsorption process during the transfer of molecules between the adsorbent and adsorbates with entropy (∆S) of 23.77 J/mol.K. due to negative values of Gibb’s free energy observed. This study confirmed that CWL could be employed as a low-cost, eco-friendly adsorbent for removing toxic dyes such as methyl violet from an aqueous solution.

This chapter examines factors that differentiate those synagogues attacked during the Kristallnacht pogrom from those that were not, casting light on community attributes of anti-Jewish violence. It begins by surveying competing explanations for pogrom violence, which can be defined as a relatively brief episode of multiple violent acts against a specific social community. The chapter then describes two outstanding theoretical problems in the empirical approach to the Kristallnacht case: (1) the multiple interpretations of causality that underpin statistical studies of subnational variations in violence, and (2) the heterogeneity of Jewish social roles and cultural practices in Weimar- and Nazi-era Germany. These theoretical problems have specific implications for the findings about the causes of pogrom violence, but they also pertain to more general challenges surrounding the social science of the Holocaust. The chapter concludes by discussing pathways for future research and the implications of the tentative findings for social science research about the Holocaust and the practice of preventing pogrom violence.

Background Despite a national decrease in emergency department visits in the United States during the first 10 months of the pandemic, preliminary Consumer Product Safety Commission data indicate increased firework-related injuries. We hypothesized an increase in firework-related injuries during 2020 compared to years prior related to a corresponding increase in consumer firework sales. Methods The National Electronic Injury Surveillance System (NEISS) was queried from 2018 to 2020 for cases with product codes 1313 (firework injury) and narratives containing “fireworks”. Population-based national estimates were calculated using US Census data, then compared across the three years of study inclusion. Patient demographic and available injury information was also tracked and compared across the three years. Firework sales data obtained from the American Pyrotechnics Association were determined for the same time period to examine trends in consumption. Results There were 935 firework-related injuries reported to the NEISS from 2018 to 2020, 47% of which occurred during 2020. National estimates for monthly injuries per million were 1.6 times greater in 2020 compared to 2019 (p p = 0.38). The same results were found when the month of July was excluded. Firework consumption in 2020 was 1.5 times greater than 2019 or 2018, with a 55% increase in consumer fireworks and 22% decrease in professional fireworks sales. Conclusions Firework-related injures saw a substantial increase in 2020 compared to the two years prior, corroborated by a proportional increase in consumer firework sales. Increased incidence of firework-related injuries was detected even with the exclusion of the month of July, suggesting that the COVID-19 pandemic may have impacted firework epidemiology more broadly than US Independence Day celebrations.

Soft drinks are consumed in Nigeria due to their easy availability, distinct taste and ability to quench thirst. However, the high demand can reduce production quality due to possible heavy metal contamination, leading to human poisoning and death. This study evaluated some components of 100 soft drinks in Nigeria and investigated the presence of heavy metal contaminants and ascorbic acid concentrations. The presence of Arsenic, Cadmium, Lead, Manganese, Nickel and Chromium in soft drinks was determined using an atomic absorption spectrophotometer; the Ascorbic acid was determined using the titrimetric method. The analysis of the soft drink revealed that Arsenic was present in all the samples in a concentration ranging from 0.017 to 0.33 mg/l; Cadmium - 0.027 to 0.160 mg/l; Lead - 0.046 to 0.109 mg/l; Manganese - 0.036 to 0.116 mg/l; Nickel - 0.002 to 0.110 mg/l; Chromium - 0.057 to 0.122 mg/l. The attention of ascorbic acid ranged between 4.03 to 7.2 mg/100 ml. Compared to WHO standards, the levels of the heavy metal contaminants were above the tolerated limits for good quality drinking water in most samples.Moreover, the ascorbic acid values in this analysis were lower than those the manufacturers reported. Therefore, the National Health Surveillance agency should monitor ascorbic acid. These results suggest that soft drinks in Nigeria may be contaminated with heavy metals, which constitute a significant public health problem. Quality control is recommended during production, especially during sterilization and purification steps.

Hiatal hernia (HH) and gastroesophageal reflux disease (GERD) are risk factors for esophageal adenocarcinoma. High positive margin rates and poor survival were previously described among HH patients undergoing esophagectomy. We sought to describe incidence and impact of HH on outcomes following esophagectomy in a population of patients undergoing predominantly cervical anastomosis. Patients who underwent esophagectomy 2012-2019 for esophago-junctional carcinoma were included. CT studies were blindly reviewed by two radiologists. A third radiologist reviewed cases of disagreement. Hernias >3 cm were included in the HH group. Overall, 66 patients (33%) had HH >3 cm. The control group included 12 patients (6%) with Patients with preoperative HH had higher CCI, higher rates of postoperative atrial dysrhythmias and signet ring cell features on pathology. In a population with predominant cervical anastomosis, positive margin rates were low and survival comparable among cohorts.

Background Individuals with hepatitis C (HCV) represent a population that may benefit from pre-exposure prophylaxis (PrEP), given the overlapping risk factors and transmission networks of HCV and HIV. This analysis assesses the prevalence of PrEP indications among individuals with HCV monoinfection and PrEP awareness, interest, and access in this population. Methods GRAVITY was an observational study for the collection of epidemiologic data from individuals with HCV and/or HIV in Washington DC and Baltimore, with the present analysis limited to HCV-monoinfected patients. The prevalence of PrEP indications was determined using epidemiologic survey responses. Bivariate and multivariable analyses assessed for associations between PrEP indications and PrEP awareness, access, and interest. Results Among 314 HCV-monoinfected participants, 109 (35%) had an indication for PrEP. Forty-eight (44%) had a drug use indication alone, 40 (37%) had a sexual indication alone, and 21 (19%) had both drug use and sexual indications. Eighty-five (27%) participants had heard of PrEP, 32 (10%) had been offered PrEP by a provider, 114 (38%) were interested or maybe interested in PrEP, and 6 (2%) were currently taking PrEP. On bivariate analysis, PrEP awareness was significantly associated with study site (P Conclusions Though indications for PrEP were prevalent among individuals with HCV in this cohort, most patients were unaware of PrEP, had never been offered PrEP, and were not using PrEP. These data support the need for improved PrEP implementation among people with HCV.

In this paper, we generalize the closed-form regression-based mediation analysis approach proposed by Valeri and VanderWeele (2013, 2015) to accommodate effect measure modification by the covariates. We show that covariate levels can affect the presence and magnitude of EMM of the conditional NDE and NIE, and that the dependence of the NDE and NIE depend on covariates is affected by the link functions of mediator and outcome models as well as the strength of EMM and of exposure-mediator interaction. Our proposed approach is implemented in R package regmedint (version 1.0.0), available at https://cran.r-project.org/web/packages/regmedint/index.html.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has become a principal tool in the management of peritoneal carcinomatosis (PC), but inclusion of pancreatic resection to obtain optimal debulking remains controversial.We performed a retrospective review of 419 patients with PC who underwent CRS/HIPEC. The patients were divided into two cohorts, those with distal pancreatectomy (DP) and those without (NP), and morbidity and survival outcomes were compared.The DP cohort (n = 37) and the NP cohort (n = 371) had similar clinicopathologic characteristics (age, p = 0.596; gender, p = 0.328; ASA, p = 0.072). Operative time, number of organs resected, and EBL were greater in the DP cohort (0.0001). A complete cytoreduction was achieved in 90% of the NP cohort versus 69% of the DP cohort (p = 0.0004). Major perioperative morbidity was more common in those with pancreatic resection (41% vs 19%, p = 0.002). However, there was no significant difference in 90-day mortality or overall survival.Achieving complete cytoreduction is critical to improving long term outcomes for patients with PC. Although pancreatic resections are associated with higher morbidity, short-term survival is not impacted adversely. Pancreatic involvement should not be a strict exclusion criterion for CRS/HIPEC, but patients need to be selected carefully, with close attention to disease burden prior to proceeding.

Although gallbladder adenocarcinoma (AC) is potentially curable with resection, outcomes of squamous histologies are poorly described.We retrospectively analyzed all gallbladder cancers which underwent resection-for-cure in our health system from 2007 to 2017. We compared outcomes of AC to adeno-squamous (ASC)/squamous (SC) histologies.91 patients met criteria; 76 AC, 15 ASC/SC. Compared to AC, ASC/SC tumors were larger (58 vs. 28 mm), with more frequent liver invasion (73% vs. 37%), pN+ (60% vs. 32%), higher stage (III/IV 73% vs. 52%), and displayed more LVI (60% vs. 36%), p 0.05. For stage III/IV disease, provided R0 was achieved, survival was durable and similar for ASC/SC and AC (OS median 28mo ASC/SC vs. 25mo AC, p = 0.132; PFS median 21mo ASC/SC vs. 13mo AC, p = 0.206). Pure SC had considerably poorer median OS (5mo) than ASC (23mo) and AC (28mo).Squamous variants of gallbladder cancer confer aggressive and advanced disease and often require more radical resections to achieve R0. Durable survival is possible in ASC provided R0 is achieved. Pure SC has dismal survival even with R0 resection.

What do different forms of anti-Semitic violence during World War II teach us about the comparative study of political violence? In this article, we review three recent political science books about the perpetrators of anti-Semitic violence, the responses of their Jewish victims, and the rescue efforts that helped European Jews evade violence. These books demonstrate promising theoretical, empirical, and methodological uses for the rich historical record about the Holocaust. We use these studies to highlight the methodological innovations that they advance, the blurry theoretical boundaries between selective and collective forms of mass violence, and the possibility of agentive action by perpetrators, victims, and rescuers alike. We conclude by highlighting the social-psychology of genocidal violence and the legacies of these episodes as areas for future inquiry.

Background Appendiceal and colorectal cancers with peritoneal carcinomatosis (PC) can derive benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). However, its role in gastric and small bowel malignancies remains undefined. Methods We retrospectively analyzed 251 gastrointestinal adenocarcinomas with PC which underwent CRS/HIPEC at our institution from 2007 to 2017. We compared outcomes of gastric, small bowel, appendiceal, and colorectal cohorts. Results Thirty-one gastric, 8 small bowel, 91 appendiceal, and 121 colorectal cohorts were included. More gastric cancers (90%) received neoadjuvant chemotherapy than any other cohort, p = 0.002. Although colorectal had the lowest peritoneal cancer index (PCI) (9) and appendiceal the highest (16), all cohorts underwent similar rates of organ resection and complete cytoreduction. Length of stay (p = 0.005) and major perioperative morbidity (Clavien III/IV, p = 0.011) were significantly higher in gastric and small bowel. Median overall survival (OS, p < 0.001) was significantly shorter in gastric (13 months) and small bowel (9 months) than in appendiceal (33 months) and colorectal (42 months) cohorts. On multivariate analysis, complete cytoreduction and PCI score were significant predictors of OS, p < 0.05. Conclusions Primary tumor origin significantly affects outcomes after CRS/HIPEC for gastrointestinal malignancies. Though there was a survival benefit in appendiceal and colorectal, gastric and small bowel survival was comparable to systemic chemotherapy.

A transparent working environment has been observed to have a momentous impact in making teams more effective, happy, and creative (Scholl, 2019). It helps develop consistent communication, apparent and authentic workplaces which help the team to feel secure and proposes ideas enhancing inventiveness (Lencion, 2016). This study examines if there was a significant relationship between a transparent work environment and a sort of creative, effective, and productive functional team in the IT industry that delivers the job in time and within budget without compromising quality. To this end, a questionnaire has been remitted to such a successful team of IT professionals working under various capacities for a software developing company within the IT Industry. GPower and Jamovi have been used to determine the sample size population and analyze the data gathered thru a questionnaire to fetch the purpose of the study. The finding exhibits that there is a significant relationship between the transparent work environment and the creativity, accountability, and productivity.

The role of laparoscopy in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is not well established. Herein, we describe our early experience of laparoscopic CRS/HIPEC in patients with low-volume peritoneal disease compared to patients who underwent open CRS/HIPEC during the same time period.Using a prospectively maintained database, patients who underwent laparoscopic CRS/HIPEC were compared to a control cohort of patients who underwent open CRS/HIPEC, matched for peritoneal carcinomatosis index (PCI), completeness of cytoreduction, and tumor histology.Between 2008 and 2017, 16 patients underwent laparoscopic CRS/HIPEC and were compared to a matched control cohort of 32 patients who underwent open CRS/HIPEC. Clinical and demographic data were similar between the groups. PCI, number of resected organs, and optimal cytoreduction rates were comparable. Patients who underwent laparoscopic experienced a lower estimated blood loss, (median, [IQR 1-3]); 150 mL, [50-300] vs. 100 mL, [50-125], p = 0.04, shorter length of stay (median [IQR 1-3]; 4 days [3-6] vs. 6 days [5-8], p 0.01, and a lower 30-day complication rate (6.3% vs. 56.3%, p 0.01). There was no difference in progression-free survival (p = 0.577) and overall survival (p = 0.472) between the groups.This preliminary study demonstrates that laparoscopic CRS/HIPEC is feasible and safe for curative treatment in selected patients with low tumor volume. Minimally invasive CRS/HIPEC is associated with fewer postoperative complications and shorter length of stay. There was no difference in long-term oncological outcomes between the groups.

Digital technology is transforming innovation at its core stanchly in an unceasing manner (Schrage, 2009), (Klein, 2014) and (Tsolis, 2009). In a swiftly rolling competitive digital setting the worth of SWOT analysis for crafting a decent and complying sales strategic plan goes beyond a reasonable doubt (Cates, 2019). Maintaining the status quo might cause consequences that would bottleneck the advance of digital sales and businesses in one or multiple ways (Cory, 2019). This paper examines the worth of properly conducted SWOT analysis in sales strategic planning to increase the effectiveness and competence of online business by expanding volume of sales and augmenting customer satisfaction rates. The study analyses data collected from secondary sources such as pertinent literatures, books, academic journals, and best industry practices. The finding exhibits that SWOT analysis plays a pivotal role in crafting a successful sales strategic plan that helps taking conversant decisions to expand and advance the digital sale volumes and operations.

Offering iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for recurrence of peritoneal carcinomatosis (PC) poses a surgical dilemma. Safety of this repeated operation in the short and long term has not been largely investigated. Patients with PC who underwent 377 CRS/HIPEC procedures between 2007 and 2018 at our institution were included from a prospectively maintained database. Outcomes for patients who had singular CRS/HIPEC were compared with those for patients who had repeated CRS/HIPEC. Overall, there were 325 singular and 52 iterative CRS/HIPEC procedures performed during this time period. Age, sex, and ASA class were comparable between cohorts (p = NS). Optimal cytoreduction, mean operative time, mean length of hospital stay, 90-day major morbidity, and 90-day mortality were also similar. At a median follow-up of 24 months, there was no significant difference in recurrence rate (%, 60 vs 63, p = 0.76), disease-free survival (mean months, 19 vs 15, p = 0.30), and overall survival (mean months, 32 vs 27, p = 0.69). The iterative CRS/HIPEC group had significantly higher rates of major late complications than the singular CRS/HIPEC group (%, 18 vs 40, p

Objectives Infective endocarditis (IE) among people who inject drugs is associated with high rates of mortality and repeat episodes of endocarditis. We sought to report on longer-term clinical outcomes of patients with IE who were offered buprenorphine or methadone treatment for opioid use disorder (OUD) at their initial hospital admission. Methods Individuals with OUD hospitalized between 2013 and 2015 with IE were included for the retrospective study. The following data were extracted from the medical record: sociodemographic data, mortality, repeat episodes of endocarditis, and evidence of ongoing buprenorphine and methadone treatment. The impact of medication use on mortality and repeat episode of endocarditis was examined using survival analysis. Results Overall, 26 individuals were included in the study. The mean duration of follow-up was 45.0 months (SD 7.2, range 34.0-56.0). During the index admission, 8 received buprenorphine, 8 received methadone, and 10 declined medications. During the follow-up period, 4 (15.4%) individuals died and 10 (38.5%) individuals experienced a repeat episode of endocarditis. Survival analysis of mortality (log-rank P = 0.066) and repeat episode of endocarditis (log-rank P = 0.86) comparing those who received buprenorphine, received methadone, and declined medication did not differ significantly. Conclusions Initiation of medication treatment alone may not be sufficient to impact long-term mortality and rates of repeat episode of endocarditis. More research is needed to identify optimal treatment strategies for people who inject drugs with IE.

Laboratory tests are an important tool in the care of patients with human immunodeficiency virus. An organized approach to laboratory ordering helps clinicians to understand the utility of each test, ensure a comprehensive evaluation, and decrease use of unnecessary tests. Tests are organized around the following goals of care: confirm the diagnosis, assess for immune suppression, guide antiretroviral therapy, screen for coinfections and latent infections, monitor response to therapy, and provide preventative care. This article reviews appropriate testing for patients with human immunodeficiency virus to accomplish these goals with a focus on how each test is useful in clinical practice.

Low-grade appendiceal mucinous neoplasms (LAMNs) are tumors that often present with widespread mucin in the peritoneal cavity (pseudomyxoma peritonei [PMP]). Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective treatment, but no published recommendations exist regarding surveillance. Data from prospective databases of patients who underwent CRS-HIPEC from 2001 to 2017 at two high-volume institutions were retrospectively analyzed. Patients who underwent complete CRS-HIPEC for PMP secondary to LAMN were included in the analysis. Pathologic examination confirmed the diagnosis of LAMN. Cases of mucinous adenocarcinomas and neuroendocrine tumors (goblet cell carcinoids) were excluded. The study enrolled 156 patients. The median peritoneal cancer index (PCI) was 18 (interquartile range IQR1–3, 12–23), and 125 patients (80.1%) had a CC0 cytoreduction. According to American Joint Committee on Cancer (AJCC) grading, 152 patients (97.4%) presented with acellular mucin or G1 implants, 2 patients (1.3%) presented with G2 disease, and 2 patients (1.3%) presented with G3 disease. During the follow-up period (median, 45 months; IQR1–3 23–76 months), 23 patients (14.7%) experienced recurrence. All the recurrences were peritoneal and occurred within 5 years. The 1-, 3-, and 5-year disease-free survival (DFS) rates were respectively 95.5%, 83.4%, and 78.3%. Univariate Cox regression analysis showed that higher PCI scores (p

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is effective in select patients with peritoneal carcinomatosis (PC). Signet ring cell (SRC) pathology is associated with poor prognosis. The role of CRS/HIPEC in this population is unclear.Patients diagnosed with PC due to appendiceal (AC), colorectal (CRC), and gastric cancer (GC) undergoing CRS/HIPEC 2007-2016 were included.A total of 268 patients were referred for CRS/HIPEC. Of the 204 patients who underwent complete CRS/HIPEC, 101 (49.5%) had AC, 85 (41.7%) CRC, and 18 (8.8%) GC. Patients with GC had higher rates of SRC pathology than AC and CRC: 12 (66.7%) vs 16 (15.8%) and 10 (11.7%). The 3-year survival rate after CRS/HIPEC was 5.7% for the SRC group and 66.1% for the non-SRC group (P 0.001). This was true for both AC and CRC subgroups (P 0.001 for both). Overall, patients with SRC were more likely to have a peritoneal carcinomatosis index (PCI) score 15 (P = 0.046). Upon multivariate analysis of the SRC population, PCI 20 (P = 0.007) and GC (P = 0.008) were found to be independent predictors of poor overall survival.Performing CRS/HIPEC for PC from gastrointestinal malignancies presenting SRC features is recommended on patients with select diseases of appendiceal and colorectal origins.

The need for an antireflux procedure during repair of a paraesophageal hernia (PEH) has been the subject of a long-standing controversy. With most centers now performing routine fundoplication during PEH repair, high-quality data on whether crural repair alone or using a mesh may provide adequate anti-reflux effect is still scarce. We sought to answer to the question: "Is fundoplication routinely needed during PEH repair?". Our endpoints were (I) rates of postoperative gastroesophageal reflux disease (GERD) (either symptomatic or objectively assessed), (II) rates of recurrence, and (III) rates of postoperative dysphagia. We searched the MEDLINE, Cochrane, PubMed, and Embase databases for papers published between 1995 and 2019, selecting comparative cohort studies and only including papers reporting the rationale for performing or not performing fundoplication. Overall, nine papers were included for review. While four of the included studies recommended selective or no fundoplication, most of these data come from earlier retrospective studies. Higher-quality data from recent prospective studies including two randomized controlled trials recommended routine fundoplication, mostly due to a significantly lower incidence of postoperative GERD. However, only a relatively short follow-up of 12 months was presented, which we recognize as an important limitation. Fundoplication did not seem to result in reduced recurrence rates when compared to primary repair alone.

Background Anastomotic leak is a major complication after esophagectomy. There is a paucity of data on long-term oncological outcomes of cervical anastomotic leak after esophagectomy for cancer. We evaluated the impact of such a leak on postoperative outcomes as well as on long-term oncological outcomes. Methods A retrospective analysis of a prospectively maintained database of patients with esophageal cancer who underwent esophagectomy with a cervical esophagogastric anastomosis between 2010 and 2017. Patients were divided into 3 groups: patients with no anastomotic leak; patients with nonsevere (type 1 & 2) leak, and patients with severe (type 3) leak. A comparison of postoperative and long-term oncological outcomes was made between the groups. Results Two hundred and eight patients were included in this study. Thirty-two (15%) patients had cervical anastomotic leak, of which 20 (63%) had type 1 and 2 (nonsevere) leak, and 12 (37%) had type 3 (severe) leak. Overall, 30-day mortality rate was 7%. Mortality rate was 4% in patients without leak, 15% in patients with nonsevere leak, and 25% in patients with severe anastomotic leak (P = .007). Overall median survival was 42 months. Patients with severe leak had poorer overall survival compared to patients with nonsevere and no anastomotic leak (6, 38, and 39 months, respectively, P = .011). There was no difference in disease-free survival of patients with or without anastomotic leak. Conclusion Leakage from cervical anastomosis after esophagectomy had no impact on disease-free survival of patients with esophageal cancer. Severe anastomotic leak was associated with lower overall survival, probably due to a high rate of postoperative mortality.

Nonblocking data structures face a safe memory reclamation (SMR) problem. In these algorithms, a node removed from the data structure cannot be reclaimed (freed) immediately, as other threads may be about to access it. The goal of an SMR scheme is to minimize the number of removed nodes that cannot be reclaimed---called wasted memory---while imposing low run-time overhead. It is also desirable for an SMR scheme to be self-contained and not require specific OS features. No existing self-contained SMR scheme can guarantee a predetermined bound on wasted memory without imposing significant run-time overhead. In this paper, we introduce margin pointers (MP), the first nonblocking, self-contained SMR scheme featuring both predetermined bounded wasted memory and low run-time overhead. MP targets search data structures, such as binary trees and skip lists, which are important SMR clients and also victims of its high overhead. MP's novelty lies in its protecting logical subsets of the data structure from being reclaimed, as opposed to previous work, which protects physical locations (explicit nodes).

Ensuring the long-term success of protected and conserved areas requires effective community involvement and ownership. In 2012, the Tree Kangaroo Conservation Program established the YUS Conservation Area Ranger Program in collaboration with indigenous people and government. Community rangers now patrol this conservation area with the assistance of SMART, monitoring the presence of priority wildlife species and potential violations of agreed bylaws in both terrestrial and marine ecosystems. The program should serve as a model for building the capacity and empowering customary landowners to conserve their natural resources through linking traditional and scientific knowledge.