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With the continuous advancement in technology, the tourism sector has developed to become one of the most important sectors globally in the modern period. These factors have given rise to the concept of “smart tourism,” which can be described as a step forward from conventional tourism. To achieve a true smart tourism experience, the appropriate services must be supplied to the correct user at the right time and in the most efficient and feasible manner. Keeping the importance of technology and tourism in consideration, the proposal and penetration of innovation-driven development strategies and smart tourism have become the focus of attention in the tourism industry at this stage. Smart tourism is comprised of a large number of tourists, devices, and operational processes which generate an enormous volume of tourism data. Handling such large amounts of tourism data in an effective and accurate manner is indeed an important thing to consider. To handle this issue, this study focuses on the construction and design of a smart tourism model based on big data technologies. This study explains in detail the relationship between smart tourism and big data and explores the construction of smart tourism applications in the context of big data. By explaining the relationship between smart tourism and big data, it is pointed out that the development of smart tourism needs to rely on the construction of a smart tourism application model under the background of big data. To this end, the role of smart tourism, building smart tourism platforms, improving information sharing mechanisms, exploring the implementation path of smart tourism application models, and further promoting the development of smart tourism, is of a great interest for the enterprises, scholars, and tourists. The proposed model is expected to be of a great help for the tourism industry.

Many believe that blood pressure management during cardiac surgery is associated with postoperative outcomes. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the impact of high compared with low intraoperative blood pressure targets on postoperative morbidity and mortality in adults undergoing cardiac surgery on cardiopulmonary bypass (CPB). Our primary objective was to inform the design of a future large RCT.We searched MEDLINE, EMBASE, Web of Science, CINAHL, and CENTRAL for RCTs comparing high with low intraoperative blood pressure targets in adult patients undergoing any cardiac surgical procedure on CPB. We screened reference lists, grey literature, and conference proceedings.We included eight RCTs (N =1,116 participants); all examined the effect of blood pressure management only during the CPB. Trial definitions of high compared with low blood pressure varied and, in some, there was a discrepancy between the target and achieved mean arterial pressure. We observed no difference in delirium, cognitive decline, stroke, acute kidney injury, or mortality between high and low blood pressure targets (very-low to low quality evidence). Higher blood pressure targets may have increased the risk of requiring a blood transfusion (three trials; n = 456 participants; relative risk, 1.4; 95% confidence interval, 1.1 to 1.9; P = 0.01; moderate quality evidence) but this finding was based on a small number of trials.Individual trial definitions of high and low blood pressure targets varied, limiting inferences. The effect of high (compared with low) blood pressure targets on other morbidity and mortality after cardiac surgery remains unclear because of limitations with the body of existing evidence. Research to determine the optimal management of blood pressure during cardiac surgery is required.PROSPERO (CRD42020177376); registered: 5 July 2020.RéSUMé: OBJECTIF: Pour beaucoup, la prise en charge de la pression artérielle pendant la chirurgie cardiaque serait associée aux issues postopératoires. Nous avons réalisé une revue systématique et une méta-analyse d’études randomisées contrôlées (ERC) afin de déterminer l’impact de cibles peropératoires de pression artérielle élevées par rapport à des cibles basses sur la morbidité et la mortalité postopératoires d’adultes bénéficiant d’une chirurgie cardiaque sous circulation extracorporelle (CEC). Notre objectif principal était d’orienter la conception d’une future ERC d’envergure.Nous avons analysé les bases de données MEDLINE, EMBASE, Web of Science, CINAHL et CENTRAL afin d’en tirer les ERC comparant des cibles de pression artérielle peropératoire élevées à des cibles basses chez des patients adultes bénéficiant d’une intervention chirurgicale cardiaque sous CEC. Nous avons passé au crible les listes de références, la littérature grise et les travaux de congrès.Nous avons inclus huit ERC (N = 1116 participants); toutes les études ont examiné l’effet de la prise en charge de la pression artérielle uniquement pendant la CEC. Les définitions d’une pression artérielle élevée ou basse variaient d’une étude à l’autre et, dans certains cas, un écart a été noté entre la pression artérielle cible et la pression artérielle moyenne atteinte. Nous n’avons observé aucune différence dans les taux de delirium, de déclin cognitif, d’accident vasculaire cérébral, d’insuffisance rénale aiguë ou de mortalité entre les cibles de pression artérielle élevée et basse (données probantes de qualité très faible à faible). Des cibles de pression artérielle plus élevées pourraient avoir augmenté le risque de transfusion sanguine (trois études; n = 456 participants; risque relatif, 1,4; intervalle de confiance à 95 %, 1,1 à 1,9; P = 0,01; données probantes de qualité modérée), mais ce résultat se fondait sur un petit nombre d’études.Les définitions individuelles des cibles d’hypertension et d’hypotension artérielle variaient, ce qui a limité les inférences. L’effet de cibles de pression artérielle élevée (par rapport à une pression artérielle basse) sur d’autres mesures de la morbidité et de la mortalité après une chirurgie cardiaque demeure incertain en raison des limites de l’ensemble des données probantes existantes. Des recherches visant à déterminer la prise en charge optimale de la pression artérielle pendant la chirurgie cardiaque sont nécessaires. ENREGISTREMENT DE L’éTUDE: PROSPERO (CRD42020177376); enregistrée le 5 juillet 2020.

Benzodiazepine use is associated with delirium, and guidelines recommend avoiding them in older and critically ill patients. Their perioperative use remains common because of perceived benefits.We searched CENTRAL, MEDLINE, CINAHL, PsycInfo, and Web of Science from inception to June 2021. Pairs of reviewers identified randomised controlled trials and prospective observational studies comparing perioperative use of benzodiazepines with other agents or placebo in patients undergoing surgery. Two reviewers independently abstracted data, which we combined using a random-effects model. Our primary outcomes were delirium, intraoperative awareness, and mortality.We included 34 randomised controlled trials (n=4354) and nine observational studies (n=3309). Observational studies were considered separately. Perioperative benzodiazepines did not increase the risk of delirium (n=1352; risk ratio [RR] 1.43; 95% confidence interval [CI]: 0.9-2.27; IIn this systematic review and meta-analysis, perioperative benzodiazepine use did not increase postoperative delirium and decreased intraoperative awareness. Previously observed relationships of benzodiazepine use with delirium could be explained by comparisons with dexmedetomidine.PROSPERO CRD42019128144.

Background/Introduction Left ventricular thrombi are associated with high rates of stroke and systemic embolism (1). While vitamin K antagonists (VKAs) have historically been the anticoagulant of choice, they have a narrow therapeutic window and require frequent monitoring. Direct oral anticoagulants (DOACs) offer more predictable anticoagulation but the use of DOACs to treat left ventricular thrombus has not been well studied (1,2). Guideline recommendations around the topic are based on expert consensus and very low-quality evidence. Purpose This systematic review and meta-analysis compares DOACs or VKAs in the treatment of left ventricular thrombus. Outcomes of interest were stroke and systemic embolism, thrombus resolution, any bleeding, major bleeding, and mortality. Methods We searched CENTRAL, MEDLINE, EMBASE, CINAHL, ACPJC, and Web of Science for studies comparing DOACs and VKAs in the treatment of left ventricular thrombus. We also searched reference lists from included studies and relevant conferences' proceedings. Two reviewers independently screened titles and abstracts and then the full-text of potentially relevant citations in duplicate. They then extracted data and evaluated risk of bias in duplicate. The data was analyzed using Revman 5.3. We used the DerSimonian and Laird random-effects model to pool the weighted effect of estimates across all studies. The pooled relative risks (RRs) were calculated with corresponding 95% confidence intervals (CIs). We assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results Of 443 citations screened, 12 observational studies (n=2,225) were included. We found no randomized controlled trial addressing the question. Most included studies were at high risk of bias due to unmatched baseline variables. We found no significant difference in any of our outcomes with DOACs versus VKAs: stroke and systemic embolism (RR 1.14, 95% CI [0.82, 1.58], p=0.43), thrombus resolution (RR 1.02, 95% CI [0.91, 1.15], p=0.69), any bleeding (RR 1.47, 95% CI [0.65, 3.33], p=0.36), major bleeding (RR 0.22, 95% CI [0.01, 4.21], p=0.32), and mortality (RR 0.99, 95% CI [0.67, 1.45], p=0.95). Evidence for each of these outcomes was of very low-quality due to risk of bias, inconsistency, and imprecision of the studies. Conclusions Very low quality evidence suggests no difference in outcomes with DOACs versus VKAs in the treatment of left ventricular thrombus. More robust data are needed to guide clinicians. Funding Acknowledgement Type of funding sources: None.

Background Sodium‐glucose co‐transporter (SGLT) inhibitors reduce cardiovascular outcomes including mortality in several populations; however, their effect on atrial fibrillation/flutter (AF) remains unclear. Our objective was to determine whether SGLT inhibitors reduce AF and whether a history of AF modifies the effect of SGLT inhibitors on the composite of heart failure hospitalization or cardiovascular death. Methods and Results We searched MEDLINE, Embase, and CENTRAL to March 2021. Pairs of reviewers identified randomized controlled trials that compared an SGLT inhibitor with placebo or no therapy. We pooled data using RevMan 5.4.1, assessed risk of bias using the Cochrane tool, and determined the overall quality of evidence using Grades of Recommendation, Assessment, Development and Evaluation. Thirty‐one eligible trials reported on AF events (75 279 participants, mean age 62 years, 35.0% women). Moderate quality evidence supported a lower risk of serious AF events with SGLT inhibitors (1.1% versus 1.5%; risk ratio 0.75 [95% CI, 0.66–0.86]; I 2 =0%). A similar reduction in total AF events was also noted with SGLT inhibitors. Three trials reported on heart failure hospitalization/cardiovascular death stratified by a baseline history of AF (18 832 participants, mean age 66 years, 38.1% women); in patients with a history of AF, SGLT inhibitors resulted in a lower risk in the composite of heart failure hospitalization or cardiovascular death (hazard ratio, 0.70 [95% CI, 0.57–0.85]; I 2 =0%)—similar to the effect estimate for patients without AF, P value for interaction: 1.00. Conclusions SGLT inhibitors may reduce AF events and likely reduce heart failure hospitalization/cardiovascular death to a similar extent in patients with and without AF.

The purpose of this article is to clarify what appraisal review is and is not, according to USPAP Standards 3 and 4, and the ways in which appraisal review education can be of benefit to appraisers...

The mechanisms responsible for instabilities and a transition to turbulence in liquid metal duct flows of a fusion blanket are not understood very well, which limits predictive capabilities for heat and material transport in a blanket. In order to elucidate such mechanisms in quasi-two-dimensional (Q2D) magnetohydrodynamic flows with inflection points, an experimental and computational effort is underway to electromagnetically induce a Q2D turbulent flow through the injection of current at the Hartmann walls. In such a flow, inflectional instabilities arise at the two locations where current is supplied. In the experiments, Hartmann wall inductive velocimetry is employed as the main flow diagnostics. The electric potential field is measured using an array of small probes embedded in the wall material, and the fluctuating velocity field is reconstructed from the potential data using Ohm's law. First experimental data have been taken, which are in qualitative agreement with the pre-experimental analysis, where the flows are numerically simulated using a Q2D flow model.

We review current accomplishments and ongoing work in Task 1–3 “Flow Control and Thermofluid Modeling” of the US-JAPAN “TITAN” Program. This encompasses construction of a new MHD lead–lithium loop at UCLA and planning, preparation and pre-experimental analysis for first experiments, including tests of high-temperature ultrasound Doppler velocimeter and studies of the behavior and electroinsulating properties of the foam-based silicon carbide flow channel insert in the flowing liquid metal in a magnetic field. First results of magnetohydrodynamic experiments on flow transitions from 3D to 2D are also presented and discussed.

Manganese emission from pyrometallurgical furnaces is becoming an important issue with more and more stringent environmental restrictions on hazardous air pollutant (HAP) metals across the globe. Manganese is going to become the next pollutant in focus from 2016 onward. Mn emission from steelmaking or ferromanganese furnaces mainly depend on factors such as input load, gas flow rate, blowing practice, and finally the operating conditions of the dust capture systems which control particulate matter emissions. In the present study, several mechanisms of dust formation have been reviewed, and a manganese mass balance was performed to understand the distribution of Mn between liquid metal, slag, and dust for a few BOFs in operation. Operational parameters such as oxygen flow rate, blowing time, hot metal (HM) Mn content, scrap Mn content, end blow Mn%, and conditions of the electrostatic precipitator (ESP) were considered and correlated to plant measurements of Mn emission. Issues related to emissions from EAFs, ferromanganese furnaces, and high-Mn steels have been discussed as well.

PURPOSE: Effective patient communication is correlated with better health outcomes and patient satisfaction, but is challenging to train, particularly with difficult clinical scenarios such as loss of sight. In this pilot study, we evaluated the use of simulated patient encounters with actors to train optometric students. METHODS: Students were recorded during encounters with actors and assigned to an enrichment group performing five interactions with instructor feedback (n = 6) or a no-enrichment group performing two interactions without feedback (n = 4). Student performance on first and last encounters was scored with (1) subjective rating of performance change using a visual analog scale (anchors: much worse/much better), (2) yes/no response: Would you recommend this doctor to a friend/relative?, and (3) average score on questions from the American Board of Internal Medicine (ABIM) assessment of doctor communication skills. Three clinical instructors, masked to student group assignments and the order of patient encounters they viewed, provided scores in addition to self-evaluation by students and patient-actors. RESULTS: Using the visual analog scale, students who received enrichment were rated more improved than the no-enrichment group by masked examiners (+18 vs. -11% p = 0.04) and self-evaluation (+79 vs. +27% p = 0.009), but not by actors (+31 vs. +43%). The proportion of students recommended significantly increased following enrichment for masked examiners (61% vs. 94%; p < 0.001), but not actors (100 vs. 83%). Average ABIM assessment scores were not significantly different by any rating group: masked instructors, actors, or self-ratings. CONCLUSIONS: The findings of this study suggest five simulated patient encounters with feedback result in measurable improvement in student-patient communication skills as rated by masked examiners.

Cold acclimation has been shown to be attenuated by the degradation of the INDUCER OF CBF EXPRESSION1 protein by the E3 ubiquitin ligase HIGH EXPRESSION OF OSMOTICALLY RESPONSIVE GENES1 (HOS1). However, recent work has suggested that HOS1 may have a wider range of roles in plants than previously appreciated. Here, we show that hos1 mutants are affected in circadian clock function, exhibiting a long-period phenotype in a wide range of temperature and light environments. We demonstrate that hos1 mutants accumulate polyadenylated mRNA in the nucleus and that the circadian defect in hos1 is shared by multiple mutants with aberrant mRNA export, but not in a mutant attenuated in nucleo-cytoplasmic transport of microRNAs. As revealed by RNA sequencing, hos1 exhibits gross changes to the transcriptome with genes in multiple functional categories being affected. In addition, we show that hos1 and other previously described mutants with altered mRNA export affect cold signaling in a similar manner. Our data support a model in which altered mRNA export is important for the manifestation of hos1 circadian clock defects and suggest that HOS1 may indirectly affect cold signaling through disruption of the circadian clock.

We explore theoretically and experimentally the transformations of phase structure and angular momentum of vortex beams in two-dimensional photonic lattices due to the combined effects of nonlinearity and periodicity.

Nonlinear defect-modes (defect-solitons) in optically-induced one-dimensional photonic lattices with a single-site repulsive defect are predicted and observed. These defect solitons bifurcate from linear defect modes and are fully stable.

not Available.

The effectiveness of topical application of nitroglycerin ointment for the treatment of ischemic digital ulcers is described.

To provide the general practitioner, as well as the specialist, with concise, readily available information on the latest, proved methods of treatment of conditions commonly encountered in an avera...

Acne vulgaris is a chronic inflammatory disease involving the pilosebaceous structures of the skin. A single cause cannot usually be found, but there is rather a combination of any number of the following etiological factors: endocrino-logical, nutritional, medicinal, hereditary, toxic, infectious, allergic and psychic. Any finding, either clinical or laboratory, which occurs consistently, then, would be of particular significance in establishing the correct approach to the management of this disease.

The manufacturing technology of the 1980s in the chemical and petrochemical industry is not likely to show any radical change. There will, however, be significant advances in some general areas. Part I of the paper is concerned with developments arising from exploitation of fundamental research in the molecular sciences and in biochemistry and microbiology. These are expected to lead, respectively, to methods for the design of selective catalyst and improvements in separation processes, and to increasing use of biochemical processes. Part II discusses developments in operation and design, aim ed at reducing construction and operating costs; particularly to make best use of materials and energy, and to conserve the environment economically. In all areas the pace of technological development will depend on the ability of industrial teams to exploit the results of fundamental research. Both research and the development stemming from it will continue to be dependent on increasingly powerful measuring and computing facilities, as also will be the larger and more closely integrated production complexes. The scientist and the engineer welcome the aid of the computer to extend their own abilities, b u t others (such as process operators) fear their introduction will take away the interest of their work an d ultimately eliminate their jobs. This will pose a serious problem to m anagement, not only on the plant, b u t in all departments of a company. Careful planning and experiments will be essential to ensure th at all personnel have satisfying jobs and can develop their full potential. This is one aspect of the much wider problem set by the need of all organizations (industrial, political and social) to improve the design of their structure and management, to meet the individual’s legitimate aspirations in a changing society. It is suggested th a t the application of the concepts o f system analysis and control engineering will contribute significantly to the solution of this problem : but the major contribution must come from sociology and the hum an sciences.

Rationale: Research has shown that alcohol can have both detrimental and facilitating effects on memory: intoxication can lead to poor memory for information encoded after alcohol consumption (anterograde amnesia) and may improve memory for information encoded before consumption (retrograde facilitation). This study examined whether alcohol consumed after witnessing a crime can render individuals less vulnerable to misleading post-event information (misinformation). Method: Participants watched a simulated crime video. Thereafter, one-third of participants expected and received alcohol (alcohol group), one-third did not expect but received alcohol (reverse placebo) and one-third did not expect nor receive alcohol (control). After alcohol consumption, participants were exposed to misinformation embedded in a written narrative about the crime. The following day participants completed a cued-recall questionnaire about the event. Results: Control participants were more likely to report misinformation compared to the alcohol and reverse placebo group. Conclusion: The findings suggest that we may oversimplify the effect alcohol has on suggestibility and that sometimes alcohol can have beneficial effects on eyewitness memory by protecting against misleading post-event information.

The oscillatory phenomenon was observed in aqueous solution during the oxidation of ascorbic acid by oxygen. Even though the exact number and amplitude of the oscillations could not be exactly duplicated for each and every run, such factors as temperature, concentration of ascorbic acid, cupric ions, and pH affecting the oscillatory behavior were studied, and those regions where oscillations occurred were delineated. A mechanism consistent with the oscillatory behavior is proposed and discussed.

We study interaction of a discrete vortex with a supporting photonic lattice and analyze how the combined action of the lattice periodicity and the medium nonlinearity can modify the vortex structure. In particular, we describe theoretically and observe in experiment, for the first time to our knowledge, the nontrivial topological transformations of the discrete vortex including the flipping of vortex charge and inversion of its orbital angular momentum. We also demonstrate the stabilizing effect of the interaction with the so-called "mixed" optically-induced photonic lattices on the vortex propagation and topological structure.

A case of sporotrichosis with sporotrichid is presented. Satisfactory cultures were obtained only after animal inoculation. Cure resulted from use of Organidin, an organic form of iodine, when a severe sensitivity occurred to KI. The fact that sporotrichosis has many clinical forms is emphasized.

THE CLINICAL importance of podophyllotoxin 1 has been an outgrowth of extensive use of podophyllin (podophyllum resin) within recent years. Kaplan 2 in 1942 reported the topical application of podophyllin, the resin obtained from the root of Podophyllum peltatum, to be effective against condyloma acuminatum. Topical use of podophyllin has been found of value also in granuloma inguinale, 3 basal-cell carcinoma, 4 and scalp infections due to Microsporum lanosum and M. audouini. 5 Podophyllin inhibits mitosis and acts as a direct cellular toxin. 6 Sullivan, 7 using chemical, biologic, and pathologic methods, found podophyllotoxin to be the active principle of podophyllin. Podophyllotoxin is a complex tricyclic substance with the formula C 22 H 22 O 8 , and may be inactivated by alkaline hydrolysis in both aqueous and alcoholic solutions. It inhibits the cellular respiration, in vitro, of rat lymph nodes, thymus, kidney tumor, spleen, liver, brain, and testis. 8 The

Recognition of congenital umbilical anomalies is important because of the potential seriousness of associated internal malformations. Congenital lesions of the umbilicus of special interest to the dermatologist arise from abnormalities in the development of two embryologic structures: the omphalomesenteric (vitelline) duct and the urachus. An understanding of the pathogenesis is essential to the proper treatment of these uncommon anomalies, the complications of which may at times be fatal. Embryologic development is reviewed, and cases illustrative of both alimentary and urinary tract lesions are presented.