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Colorectal cancer (CRC) is one of the most common cancer in the world (1). Large bowel obstruction is one of the few emergency presentations of CRC. Studies have showed that the proportion of CRC patients admitted to hospital as an acute emergency case hover around 10–30% for the past 5 years (2-4).
Emergency surgery for acute malignant large bowel obstruction is associated with morbidity rates of 40–60% and mortality of 3–11% (5-7). Peri-operative complications such as death, sepsis, anastomotic leaks, wound infection and cerebrovascular accidents are usually encountered, with the addition of higher rates of permanent stoma formation (8).
The use of self-expanding metallic stents (SEMS) was first described for the management of acute large bowel obstruction since the early 1990s by Tejero et al. (9). The use of SEMS has progressed from palliating advanced CRC and as a means to bridge the need for emergent surgery to an elective one (10).
Since then, the short- and long-term outcomes of endoscopic colonic stenting have been reviewed with its safety profile being determined to minimize any potential harm to any patient receiving this form of treatment. For patients with acute large bowel obstruction presenting with metastatic disease, we have to evaluate the role endoscopic colonic stenting play in palliating the obstruction. Numerous randomized controlled trials were conducted comparing the use of SEMS as a bridge to surgery versus emergency surgery for the management of acute malignant large bowel obstruction (11-17). The rationale for such a move is to provide swift and effective decompression of the large bowel, minimize the risk of bacterial translocation, whilst allowing for proper oncological staging, physiological optimization and resuscitation before having the patient undergo surgery in an elective setting.
Numerous studies have been performed to evaluate the role of SEMS in malignant large bowel obstruction, however several of them highlighted contrasting results. Hence, we conducted this review article to evaluate the evidence of the role of SEMS in the management of patients with acute malignant large bowel obstruction.
The management of patients presenting with acute malignant left-sided large bowel obstruction, including the rectum should be individualized. Proper patient selection is crucial in ensuring good outcome. The group of patients who may be affected by this condition are usually older and hence a comprehensive review of their medical comorbidities is of particular importance to determine their fitness for surgery (7). Studies have reported that almost 70–80% of large bowel obstruction are actually located in the left side of the colon, which makes them amenable to endoscopic interventions (18,19). Of which about 10% of these patients will require emergency surgery and are associated with poor outcomes with morbidity as high as 70% and mortality reaching 12% (7,20). Compared to the morbidity levels of elective surgery for CRC which are reported to be less than 5% (21).
Options for treatment may include staged surgical resection with or without anastomosis (e.g., Hartmann resection), resection of the distended bowel (e.g., subtotal/total colectomy), or temporary relief of obstruction and faecal load (e.g., creation of proximal defunctioning loop colostomy or ileostomy or the use of endoscopic stenting through the stenosed segment as a bridge to surgery in an elective setting). A tumour in the lower rectum cannot be stented as the distal end of the stent will causes tenesmus and faecal incontinence giving rise to poorer quality of life (22). We need to consider the patient factor, disease factor through CT scan (site of obstruction, length of stenosis, presence of metastasis, perforation) and available expertise, which will be further elaborated in this review. Each of these options has advantages and disadvantages and the ultimate decision must be made with the best interest of the patient and the clinical presentation in mind (23).
Overview of self-expanding metallic stents
There are no large-scale studies to determine the superiority of the SEMS that are currently in the market. Variables such as material, design, diameter, length, flexibility, foreshortening ratio and delivery system are considered when selecting appropriate SEMS for each individual patient (23-27).
There are many endoscopic colonic stents available in the market. Majority of the stents are made of nitinol (alloy of nickel and titanium) which enables good flexibility and elasticity allowing for smooth deployment (28,29). Examples of which are Ultraflex (Boston Scientific, Natick, MA, USA) and Alimaxx E (Alveolus, Charlotte, NC, USA) stents. Other materials include stainless steel (i.e., Z-stent) (Cook Medical, Bloomington, IN, USA) and Elgiloy (alloy of cobalt, chromium and nickel) (i.e., Wallstent) (Boston Scientific, Natick, MA, USA) (29). Colonic stents can be broadly divided into two main groups: uncovered and covered. Recent meta-analysis comparing the technical success rates of these two groups showed no significant difference (29). The studies also reported similar stent migration rates (30,31). However, the benefit conferred by inserting a covered colonic stent is the association with higher tumour in-growth (RR 6; 95% CI: 2.23–16.1, P=0.0004) (30,32). This is an important aspect to consider when performing palliative endoscopic colonic stenting, in order to avoid having to go through another intervention subsequently.
Description of the endoscopic colonic stenting procedure using SEMS
The procedure is carried out endoscopically under image intensifier guidance at the endoscopy suite, the fluoroscopy room at the department of diagnostics imaging using portable endoscopic equipment, or the operating theatre (especially if there is a hybrid theatre for endovascular procedures). Access to an operating facility is required as abdominal distention secondary to gas insufflation during the stenting procedure can lead to inadvertent perforation, necessitating immediate transfer to the operating theatre (33).
When possible, ensure that the patient receives a rectal enema for clearance of the bowel distal to the obstruction before stenting to facilitate scope insertion (34). Prior to the procedure, the patient is positioned in the left lateral position under conscious sedation. A double lumen colonoscope is preferred as it facilitates simultaneous suction and irrigation via one channel whilst advancing the guidewire in the other channel. If available, carbon dioxide insufflation should be used in preference to room air.
The distal end of the stenosing malignant lesion will be encountered (Figure 1). Identify any area on the tumour that will allow passage of the lipophilic guidewire into the proximal bowel, and advance the guidewire under fluoroscopy (Figure 2). Multiple attempts of passing the guidewire may be necessary. The cannula is then inserted over the guidewire using the Seldinger technique into the proximal bowel to allow injection of water soluble radiological contrast to establish the proximal and distal extent of the tumour using fluoroscopy (Figure 3). The length of the tumour is measured before deciding on the optimal length of stent to be used. There needs to be sufficient stent overhang on both ends of the tumour to minimize migration of the stent after full expansion.
The cannula is then exchanged for the stent in its deploying device, whilst keeping the guidewire in its original position. Frequent confirmation with fluoroscopy during this step is required. The stent deploying device is advanced under direct fluoroscopy and endoscopic visualization until the entire stent is deployed. There is a need for counter-traction on the device during the deployment phase as there is a tendency for the stent to be drawn into the proximal bowel due to the radial expansion of the stent (Figure 4) (35). Simultaneous monitoring with fluoroscopy and direct vision via endoscopy is mandatory (Figure 5). Once the stent is fully deployed successfully (Figure 6), its position is confirmed under fluoroscopy. The distal end of the stent should be visible beyond the malignant lesion, and a gush of faeculent material should be encountered (Figure 7).
The patient is usually monitored overnight and an abdominal X-ray is taken within the next 24 hours to confirm the position and expansion of the stent. A vigilant look out for immediate post-procedural complications such as perforation is required. Oral intake can resume once the abdominal distension resolves. The patient is routinely prescribed stool softeners and a low residue diet, to enable ease of passage of stools. Most colonic stents expand to a diameter of 25 mm as described above, hence high dietary fibre can theoretically cause obstruction of the stent (32).
Short-term outcomes of the use of SEMS in endoscopic colonic stenting
There are numerous randomized controlled trials and systematic reviews that have compared endoscopic colonic stenting versus emergency surgery for acute malignant left-sided large bowel obstruction (4,5,8,10,35). Endoscopic colonic stenting has been recognized as a safe and effective means to alleviate acute large bowel obstruction and act as a bridge to curative surgery performed in an elective setting. The role of pre-operative stenting in the emergent management of acute malignant large bowel obstruction has been supportive by several pooled analyses that demonstrate efficacy and safety and cost-effectiveness analysis studies as described (36,37).
Predictors for failed SEMS deployment
There are some technical considerations that the endoscopist should note before undertaking the procedure to achieve a successful stent deployment. Technical failure can be defined in the following scenarios: (I) inability to cannulate the guide wire through the tumour, and (II) unsuccessful stent deployment. Clinical failure occurs when there is a failure of the deployed stent to relieve the obstruction, often due to inadequate expansion requiring subsequent surgical decompression. It is reported in systemic reviews that the technical success rates range from 80–90%, while the clinical success rates hovers around 70–80% (38). Little et al. observed that technical success rates decreased when the onset of symptoms is more than 1 week resulting in a drop from 85.4% to 69.6% (39).
Patients who failed endoscopic colonic stenting and had to undergo subsequent emergent surgery are 3 times (OR 3.3; 95% CI: 1.19–9.20; P=0.026) more likely to experience worse outcomes compared to those who had emergency surgery upfront (40). To avoid such morbidities, the suitability for stenting has to be evaluated on CT scan including anatomical considerations (e.g., tumour location and length of the stricture) and availability of adequate expertise.
Firstly, an evaluation of the length of stenosis has to be performed. Failures are more frequently encountered in cases where the stenosis is longer than 4 cm due to inadequate stent expansion (34,39). The recommended stent length should be sufficient to bridge the stenosed segment and provide an overhang of at least 2 cm on each side of the malignant lesion (19,41). What is promising is the use of multiple stents to bridge a long segment of obstruction or the presence of synchronous lesions by a few case reports to overcome this issue (28).
Next, the angulation of the lumen present at the area of malignant stenosis. Acute angulations of more than 165 degrees between the malignant lesion and distal lumen is associated with higher failure rates (40). Such acute angulations are postulated to be due to invasion of the underlying structures, making the stenting procedure more challenging and occasionally impossible (39). Thirdly, the degree of stenosis of the malignant lesion. It is reported that the risk of bowel perforation increases by 7 times (OR 6.88; 95% CI: 2.0–23.2, P=0.002) in the presence of complete large bowel obstruction compared to those with sub-total obstruction (42). CT imaging may reveal the presence of caecal pneumatosis for patients with acute large bowel obstruction. A review has shown that not all caecal pneumatosis is associated with non-viable caecum and its presence does not pose as an absolute contra-indication to endoscopic stenting (43).
Next, extra-colonic origin of large bowel obstruction can disrupt the colonic luminal patency (44). Overall technical success for the use of SEMS in these instances range from 42% to 100% and clinical success rates of 25–87.5% (45-50). Despite these success rates, it is observed that the luminal patency is lower in those with extra-colonic malignancies compared to those with intrinsic malignancies (51).
Lastly, there is a steep learning curve for the proceduralist performing the stenting procedure. Its availability depends on local expertise and the availability of fluoroscopy, as well as the specialized endoscopic equipment for the stent placement. The level of expertise present in the institution has a direct correlation to the rates of successful stenting and complications (52,53). To increase the chances for success, the proceduralist is expected to have attempted more than 20 procedures and be familiar with other endoscopic procedures like the endoscopic retrograde cholangiopancreatography (ERCP) (54,55).
Outcomes of successful SEMS deployment
Outcomes such as clinical success rates, peri-operative outcomes and rates of primary anastomosis are commonly reviewed. In a comparison between endoscopic colonic stenting and emergency surgery, the stenting procedure confers superior clinical success rates (98.6% vs. 78.1%) with similar post intervention outcomes (56). Thirty-day mortality (2.3%) was reported to be low, with similar overall complication rates [33.1–39.2% (stent) vs. 45.7–53.9% (emergency surgery)] in both groups (56,57). The preferable outcomes led to shorter length of hospital stay in the stenting group (6 vs. 8 days, P=0.028) (15), making it a more cost-effective option than emergency surgery during the initial hospitalization stay (18).
During the subsequent elective surgery, laparoscopic approach can be attempted to reap benefits such as lower rates of ileus, lesser pain, shorter duration of analgesia use, and length of hospital stay (58). Large bowel obstruction used to be considered as a relative contraindication to laparoscopic approach given the poor surgical field that could be encountered due to the presence of distended bowel and likelihood of bowel injury (59). However, the use of SEMS can improve the eventual surgical field by decompressing the distended bowel and reducing the degree of bowel oedema prior to the elective surgery which facilitates primary anastomosis (60).
Studies have reported higher primary anastomosis rates (RR 1.58; 95% CI: 1.22–2.04, P<0.001) (57). However, in a systematic review and meta-analysis performed by Cirocchi et al., there was no difference in primary anastomosis rates between the stenting and surgery group (37). But the non-randomised studies seem to suggest that endoscopic colonic stenting facilitates the occurrence of one-stage surgical intervention (67.2% vs. 55.1%, P<0.01) (34,57), with success rates for single stage elective surgery to be 60–85% (53,61). There was no significant difference between the two groups regarding anastomotic leakage (4.1% vs. 5.9%) (OR 0.74; 95% CI: 0.33–1.67, P=0.47) and intra-abdominal infection (1.4% vs. 3.2%) (OR 0.62; 95% CI: 0.12–3.19, P=0.57) (62,63).
In a meta-analysis that was performed by Allievi et al., endoscopic colonic stenting as a bridge to surgery appears to be a safe approach with advantages such as reducing the incidence of peri-operative complication rates (37.8% vs. 54.9%) and lower stoma rates (28.8% vs. 46%), with no difference in overall mortality rates (10%) (57,62,64). This was concurred by Arezzo et al. who reported in meta-analysis that the use of SEMS as a bridge to elective surgery is associated with lower overall morbidity (33.9% vs. 51.2%, P=0.03) and rates of temporary (33.9% vs. 51.4%) (65) and permanent (9% vs. 27.4%, P<0.01) stoma creation (34).
Complications arising from the insertion of SEMS can be divided by the degree of severity (minor or major), and early (≤30 days) or late (>30 days). The risk of endoscopic colonic stenting will have to be discussed with the patient prior to the procedure. It is advisable to obtain consent of the patient for possible surgical intervention in the event that the stenting is not successful. Major complications such as stent perforation (4–8%), migration (3–10%), and re-obstruction from tumour in-growth (3–10%) have to be explained (9,39,57), while minor complications include bleeding, pain, tenesmus and incontinence described (10,36).
Initial clinical trials performed by the Dutch raised concerns over the safety of endoscopic colonic stenting, which led to early termination of the trial given high perforation and anastomotic leak rates (17). Postulation for the high perforation rates was associated with balloon pre-dilation; something my institution does not practice (66). We have to be mindful that despite reports of clinical perforation rates hovering around 7% but a histological analysis of surgical specimens revealed higher perforation rates of up to 14% (62). Increased risk of perforation is observed when anti-angiogenic agents like bevacizumab is used (9). However, recent studies have recognized colonic stenting as an accepted treatment approach for obstructing left sided colonic malignancy particularly as a bridge to palliative therapy (64). Stent related perforation can occur immediately or delayed. Immediate causes of perforation include wire or catheter misplacement. While, predictors for delayed perforation include the presence of thin-walled caecum, placement of SEMS at the recto-sigmoid junction with sharp angulation and excessive amount of air insufflation in a distended large bowel (28,67,68).
Major complication—stent migration and re-obstruction
Stent migration rates of covered stents (8–50%) exceeds uncovered stents (3–36%) (69). This occurs when the stent diameter is too narrow or too short in length in comparison with the obstructing segment, or if the lesion shrinks after chemotherapy (70). Stent re-obstruction occurs over time if the cancer is not removed. Treatment options include surgery or repeated stenting (71). New strategies will have to be in place to avoid stent-related complications and prolong stent patency (35). With the development of new material and design, or the presence of drug eluding stents, we can reduce the chance of developing stent migration and re-obstruction. In one animal study that validated the usefulness of 5-fluorouracil-loaded polydioxanone stent for the treatment of CRC, in-stent re-stenosis was reduced by 50% (6.4% vs. 12.8%) (72).
Bleeding can usually be treated conservatively, with pain relief provided through the use of analgesia. Faecal incontinence can be avoided if the SEMS is placed at least 2 cm proximal to anal verge (68).
Long-term outcomes of the use of SEMS in endoscopic colonic stenting
The literature is still divided regarding the long-term outcomes of endoscopic colonic stenting. There were three studies from the west which reported lower overall survival rates for patients who underwent endoscopic colonic stenting with a higher 5-year cancer specific mortality (48% vs. 21%) (73). On the other hand, other studies showed no difference in overall survival (97.8% vs. 94.3%, P=0.469) and 5-year disease free survival (79.6% vs. 70.2%, P=0.218) given similar uptake of adjuvant chemotherapy and lymph node harvested (74,75).
In a prospective cohort study by Gorissen et al. it showed higher local recurrence rates (32% vs. 8%, P=0.027) in patients who received endoscopic colonic stenting (74). A postulation for observed increased in local recurrence rates (73) is the presence of higher rates of peri-neural invasion in the histopathological assessment of the stented colonic segments (4). The pressure effect exerted by the SEMS could potentially have induced tumour cell invasion into the nerves via the dissemination of cancer cells during the procedure (76). A predictor for higher loco-regional recurrence and distant metastasis rates was also associated with the presence of stent related perforation as observed in a study by Sloothaak et al. (83% stent with perforation vs. 28% surgery only vs. 40% stent without perforation). This lead to worse disease free survival rates in the subgroup with stent related perforation (0% vs. 45%, P=0.007) (77).
The prognostic impact of endoscopic colonic stenting remains unclear (57,74,78), further studies will be required to determine its impact on overall survival and disease free survival in this population (11,13,77,79). Current literature seem to suggest that SEMS is a good treatment option to palliate patients with obstructed colonic anastomosis sites due to cancer recurrences (29).
Outcomes of patients receiving treatment for palliative intent
Endoscopic colonic stenting using SEMS represents an alternative to colostomy for patients with inoperable malignant colonic lesions presenting with large bowel obstruction (80). The European Society of Gastrointestinal Endoscopy (ESGE) recommends that endoscopic colonic stenting using SEMS is the preferred treatment for palliation of malignant large bowel obstruction (34). Two systematic reviews were performed comparing palliative endoscopic colonic stenting versus emergent surgery (81,82). The benefits of endoscopic colonic stenting performed in patients with metastatic large bowel obstruction include shorter hospital stay (5 vs. 12 days, P=0.003), earlier initiation of chemotherapy (4 vs. 7 weeks, P=0.02), and lower stoma formation rates (OR 0.19; 95% CI: 0.12–0.28), P<0.01) (82,83).
Patients should also be counselled on the possible stent related complications that can occur, such as perforation (8–10%), migration (8.4–9.2%) and re-obstruction (13.1–18.3%) (83). Patients managed with palliative endoscopic colonic stenting can be treated safely with chemotherapy without anti-angiogenic agents as recommended by ESGE (34). This is because several retrospective studies have showed an increase risk of perforation when bevacizumab is used (84,85).
The importance of chemotherapy after surgery in metastatic CRC cannot be understated (86-90). Although the stenting procedure itself does not confer any survival benefit (7.6 vs. 7.8 months) (82), it increases the possibility of down-staging previously unresectable metastatic disease (91). To allow these patients the chance to have better long-term outcome, the ability to administer chemotherapy within a certain therapeutic window is important, beyond which, the benefits are questionable as the role of palliative endoscopic colonic stenting in patients who have resectable metastasis is unclear (92). What is crucial for these patients is the earlier commencement of chemotherapy which has been shown to increase survival from 9 to 24 months and the potential to downstage the disease (93,94).
Numerous studies have confirmed the significant improvement in the quality of life in stage IV CRC patients who were successfully stented for their malignant obstruction. A randomized controlled trial performed by Young et al. showed that patients stenting in patients with obstructed stage IV disease was associated with better quality of life outcomes when compared to baseline at 1 week (58% vs. 27%), and at 12 months (P=0.001 and P=0.01), without worse clinical outcomes in terms of 30-day mortality and median overall survival (95). This concurs with non-randomised studies which have shown improved overall quality of life, as well as life relating to gastrointestinal symptoms in patients who underwent stenting instead of emergency surgical decompression (96).
The indication of SEMS can be expanded to include benign conditions but this remains debatable for there is a need to reconcile the risk of stent related complications (97). In the management of benign strictures, the use of biodegradable stents have been attempted. The case series from the Czech Republic included three patients with Crohn’s disease where balloon dilatation of the stenosis followed by biodegradable stent placement showed favorable results (i.e., degradable of stent within 4 months), with no stent migration or major complications (98).
In addition, alternative management of anastomotic leaks after colorectal surgery, is the novel use of covered SEMS. Reports of success rates ranging from 53.3% to 73.3% have been seen (99). However, increased risk of stent migration (up to 40%) given the used of covered SEMS will have to be undertaken.
Benefits of the use of SEMS as a bridge to surgery should be compared with the potential risk of complications arising from endoscopic colonic stenting. Given ongoing review of its long-term outcomes (i.e., local recurrence and metastatic spread) and safety profile (i.e., stent related adverse events), the official statement from the ESGE and the American Society for Gastrointestinal Endoscopy (ASGE) recommends that (I) the use of colonic SEMS as a bridge to elective surgery is not the standard treatment of symptomatic left-sided malignant colonic obstruction and (II) SEMS placement may be considered as an alternative to emergency surgery in those who have increased risk of post-operative mortality [i.e., American Society of Anaesthesiologists (ASA) Physical Status ≥III and/or >70 years old (34,73)]. Conflicting data are present, and definitive indication requires further evaluation and debate.
Conflicts of Interest: The authors have no conflicts of interest to declare.
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- Trompetas V, Saunders M, Gossage J, et al. Shortcomings in colonic stenting to palliate large bowel obstruction from extracolonic malignancies. Int J Colorectal Dis 2010;25:851-4. [Crossref] [PubMed]
- Shin SJ, Kim TI, Kim BC, et al. Clinical application of self-expandable metallic stent for treatment of colorectal obstruction caused by extrinsic invasive tumors. Dis Colon Rectum 2008;51:578-83. [Crossref] [PubMed]
- Caceres A, Zhou Q, Iasonos A, et al. Colorectal stents for palliation of large-bowel obstructions in recurrent gynecologic cancer: an updated series. Gynecol Oncol 2008;108:482-5. [Crossref] [PubMed]
- Miyayama S, Matsui O, Kifune K, et al. Malignant colonic obstruction due to extrinsic tumor: palliative treatment with a self-expanding nitinol stent. AJR Am J Roentgenol 2000;175:1631-7. [Crossref] [PubMed]
- Kim JH, Song HY, Park JH, et al. Metallic stent placement in the palliative treatment of malignant colonic obstructions: primary colonic versus extracolonic malignancies. J Vasc Interv Radiol 2011;22:1727-32. [Crossref] [PubMed]
- Keswani RN, Azar RR, Edmundowicz SA, et al. Stenting for malignant colonic obstruction: a comparison of efficacy and complications in colonic versus extracolonic malignancy. Gastrointest Endosc 2009;69:675-80. [Crossref] [PubMed]
- Luigiano C, Ferrara F, Fabbri C, et al. Through-the-scope large diameter self-expanding metal stent placement as a safe and effective technique for palliation of malignant colorectal obstruction: a single center experience with a long-term follow-up. Scand J Gastroenterol 2011;46:591-6. [Crossref] [PubMed]
- Bonin EA, Baron TH. Update on the indications and use of colonic stents. Curr Gastroenterol Rep 2010;12:374-82. [Crossref] [PubMed]
- Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 2010;71:560-72. [Crossref] [PubMed]
- Ansaloni L, Andersson RE, Bazzoli F, et al. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg 2010;5:29. [Crossref] [PubMed]
- Williams D, Law R, Pullyblank AM. Colorectal stenting in malignant large bowel obstruction: the learning curve. Int J Surg Oncol 2011;2011:917848. [Crossref] [PubMed]
- Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev 2011.CD007378. [PubMed]
- Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg 2012;99:469-76. [Crossref] [PubMed]
- Ng SS, Lee JF, Yiu RY, et al. Emergency laparoscopic-assisted versus open right hemicolectomy for obstructing right-sided colonic carcinoma: a comparative study of short-term clinical outcomes. World J Surg 2008;32:454-8. [Crossref] [PubMed]
- Rho SY, Bae SU, Baek SJ, et al. Feasibility and safety of laparoscopic resection following stent insertion for obstructing left-sided colon cancer. J Korean Surg Soc 2013;85:290-5. [Crossref] [PubMed]
- Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004;99:2051-7. [Crossref] [PubMed]
- Brehant O, Fuks D, Bartoli E, et al. Elective (planned) colectomy in patients with colorectal obstruction after placement of a self-expanding metallic stent as a bridge to surgery: the results of a prospective study. Colorectal Dis 2009;11:178-83. [Crossref] [PubMed]
- Huang X, Lv B, Zhang S, et al. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg 2014;18:584-91. [Crossref] [PubMed]
- Park SJ, Lee KY, Kwon SH, et al. Stenting as a Bridge to Surgery for Obstructive Colon Cancer: Does It Have Surgical Merit or Oncologic Demerit? Ann Surg Oncol 2016;23:842-8. [Crossref] [PubMed]
- Allievi N, Ceresoli M, Fugazzola P, et al. Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis. Int J Surg Oncol 2017;2017:2863272. [Crossref] [PubMed]
- Arezzo A, Passera R, Lo Secco G, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc 2017;86:416-26. [Crossref] [PubMed]
- Khot UP, Lang AW, Murali K, et al. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89:1096-102. [Crossref] [PubMed]
- Han YM, Lee JM, Lee TH. Delayed colon perforation after palliative treatment for rectal carcinoma with bare rectal stent: a case report. Korean J Radiol 2000;1:169-71. [Crossref] [PubMed]
- Baron TH. Colonic stenting: technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin N Am 2005;15:757-71. [Crossref] [PubMed]
- Suh JP, Kim SW, Cho YK, et al. Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion. Surg Endosc 2010;24:400-6. [Crossref] [PubMed]
- Branger F, Thibaudeau E, Mucci-Hennekinne S, et al. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Colorectal Dis 2010;25:1481-5. [Crossref] [PubMed]
- Lee HJ, Hong SP, Cheon JH, et al. Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc 2011;73:535-42. [Crossref] [PubMed]
- Li G, Chen Y, Hu J, et al. A 5-fluorouracil-loaded polydioxanone weft-knitted stent for the treatment of colorectal cancer. Biomaterials 2013;34:9451-61. [Crossref] [PubMed]
- Sabbagh C, Browet F, Diouf M, et al. Is stenting as "a bridge to surgery" an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg 2013;258:107-15. [Crossref] [PubMed]
- Gorissen KJ, Tuynman JB, Fryer E, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg 2013;100:1805-9. [Crossref] [PubMed]
- Choi JM, Lee C, Han YM, et al. Long-term oncologic outcomes of endoscopic stenting as a bridge to surgery for malignant colonic obstruction: comparison with emergency surgery. Surg Endosc 2014;28:2649-55. [Crossref] [PubMed]
- Thorlacius H. Tumour cell dissemination following endoscopic stent insertion (Br J Surg 2007; 94: 1151-1154). Br J Surg 2008;95:127-8; author reply 8. [Crossref] [PubMed]
- Sloothaak DA, van den Berg MW, Dijkgraaf MG, et al. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 2014;101:1751-7. [Crossref] [PubMed]
- Zhang Y, Shi J, Shi B, et al. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc 2012;26:110-9. [Crossref] [PubMed]
- Zhao X, Liu B, Zhao E, et al. The safety and efficiency of surgery with colonic stents in left-sided malignant colonic obstruction: a meta-analysis. Gastroenterol Res Pract 2014;2014:407325. [Crossref] [PubMed]
- Zahid A, Young CJ. How to decide on stent insertion or surgery in colorectal obstruction? World J Gastrointest Surg 2016;8:84-9. [Crossref] [PubMed]
- Liang TW, Sun Y, Wei YC, et al. Palliative treatment of malignant colorectal obstruction caused by advanced malignancy: a self-expanding metallic stent or surgery? A system review and meta-analysis. Surg Today 2014;44:22-33. [Crossref] [PubMed]
- Zhao XD, Cai BB, Cao RS, et al. Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis. World J Gastroenterol 2013;19:5565-74. [Crossref] [PubMed]
- Takahashi H, Okabayashi K, Tsuruta M, et al. Self-Expanding Metallic Stents Versus Surgical Intervention as Palliative Therapy for Obstructive Colorectal Cancer: A Meta-analysis. World J Surg 2015;39:2037-44. [Crossref] [PubMed]
- Kaushik M, Bhullar JS, Bindroo S, et al. Minimally Invasive Management of Complicated Diverticular Disease: Current Status and Review of Literature. Dig Dis Sci 2016;61:663-72. [Crossref] [PubMed]
- Cennamo V, Fuccio L, Mutri V, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol 2009;7:1174-6. [Crossref] [PubMed]
- Kemmochi T, Egawa T, Mihara K, et al. Neoadjuvant chemotherapy with capecitabine plus oxaliplatin and bevacizumab for the treatment of patients with resectable metastatic colorectal cancer. Gan To Kagaku Ryoho 2013;40:1629-31. [PubMed]
- Misiakos EP, Karidis NP, Kouraklis G. Current treatment for colorectal liver metastases. World J Gastroenterol 2011;17:4067-75. [Crossref] [PubMed]
- Kleespies A, Fuessl KE, Seeliger H, et al. Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer. Int J Colorectal Dis 2009;24:1097-109. [Crossref] [PubMed]
- Giuliante F, Ardito F, Vellone M, et al. Role of the surgeon as a variable in long-term survival after liver resection for colorectal metastases. J Surg Oncol 2009;100:538-45. [Crossref] [PubMed]
- Wei AC, Greig PD, Grant D, et al. Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol 2006;13:668-76. [Crossref] [PubMed]
- Dienstmann R, Salazar R, Tabernero J. Personalizing colon cancer adjuvant therapy: selecting optimal treatments for individual patients. J Clin Oncol 2015;33:1787-96. [Crossref] [PubMed]
- Liberman H, Adams DR, Blatchford GJ, et al. Clinical use of the self-expanding metallic stent in the management of colorectal cancer. Am J Surg 2000;180:407-11; discussion 412. [Crossref] [PubMed]
- Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004;350:2335-42. [Crossref] [PubMed]
- Bokemeyer C, Bondarenko I, Makhson A, et al. Fluorouracil, leucovorin, and oxaliplatin with and without cetuximab in the first-line treatment of metastatic colorectal cancer. J Clin Oncol 2009;27:663-71. [Crossref] [PubMed]
- Young CJ, De-Loyde KJ, Young JM, et al. Improving Quality of Life for People with Incurable Large-Bowel Obstruction: Randomized Control Trial of Colonic Stent Insertion. Dis Colon Rectum 2015;58:838-49. [Crossref] [PubMed]
- Nagula S, Ishill N, Nash C, et al. Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction. J Am Coll Surg 2010;210:45-53. [Crossref] [PubMed]
- Li Y, Wu JH, Meng Y, et al. New devices and techniques for endoscopic closure of gastrointestinal perforations. World J Gastroenterol 2016;22:7453-62. [Crossref] [PubMed]
- ASGE Technology Committee, Tokar JL, Banerjee S, et al. Drug-eluting/biodegradable stents. Gastrointest Endosc 2011;74:954-8. [Crossref]
- Arezzo A, Bini R, Lo Secco G, et al. The role of stents in the management of colorectal complications: a systematic review. Surg Endosc 2017;31:2720-30. [Crossref] [PubMed]

domain: health


Automatic die cutting machines
Die cutting plays a very important role in the printing industry, packaging and paper production, among others, it is used in the manufacturing process of materials such as cardboard packaging, custom-shaped cards, and a variety of notebooks. VERSOR ENGINEERING offers high-quality and compact, die cutting machines in a wide range of products. They are available at, among others, for cutting solid cardboard and corrugated cardboard packages and other plastic materials with complex shapes. The innovative self-service machines are used, for example to cut packaging according to a specific design, to make it ideal for pre-planned shapes.
VERSOR ENGINEERING portfolio includes simple machines, automatic machines with a sheet pre-stripping and automatic machines with sheet pre-stripping with hot-press option. To meet the growing needs of our customers we offer the highest quality, and the equipment that is easy to use and maintain. They not only allow you to die cut but also to groove, perforate, hole-punch, cut and make corners round on different surfaces. Our range of devices includes a paper feed tray and paper feed adjustment module, as well as special cleaning sections, including a waste removal system.
VERSOR die cutters are distinguished by innovative design and high-quality components. These are machines that are maintenance-free and that are very intuitive to use. They can be easily adapted to even the most difficult operating conditions. Our machines also feature high stability, outstanding end-of-product precision and high safety of use.


A New Zealand farming leader says he's frustrated that a range of political parties are targetting foreigners and saying they shouldn't be allowed to buy farms.
Federated Farmers vice president Anders Crofoot bought Castlepoint Station in Wairarapa after moving to New Zealand from the United States in the 1990s and went through the Overseas Investment Commission to do so.
The Labour Party has said that if it wins the general election sales of rural land to most foreigners will be banned.
Mr Crofoot said the anti-foreigner sentiment coming from Labour and several other political parties when it comes to farmland was very short-sighted.
"I find that attitude really frustrating, because it's not even that you're going to run through the process. You're bascially putting a big sign up saying, we're not interested, go away, stay away. And it scares people off, and the skills.
"The entire country is actually immigrants," Mr Crofoot said. "You know, even the Maori came here at one point from overseas, so basically it is a nation of immigrants".
"It is always prized on having new ideas and people coming in, and to put up a big wall and say we don't want anybody else I think is just shooting ourselves in the foot."


The home of the best hockey highlights, features, interviews and exclusive content.
Tuesday, January 17, 2023
Ducks @ Flyers 1/17 | NHL Highlights 2023
Extended highlights of the Anaheim Ducks at the Philadelphia Flyers.
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A 20 year-old male was arrested and charged with misconduct with a weapon and aggravated assault Tuesday in Salome, AZ.
On October 25th at approximately 6pm, La Paz County Deputies responded to a residence in Salome in regards to a victim who had been shot. Upon their arrival, they made contact with a 19 year-old female and 20 year-old Felipe Lopez-Armenta. The female, who the Sheriff’s Department did not name, was suffering from a gunshot wound to her abdomen and lower back area.
Upon further investigation, deputies and investigators learned that Lopez-Armenta had allegedly approached his girlfriend from behind while she was doing laundry and shot her in the lower back area. Lopez-Armenta then loaded the female into a vehicle and transported her to a family member in the Salome area. The family immediately called 911 and the female was transported to a Phoenix area hospital.
Lopez-Armenta is currently being held at the La Paz County Detention Facility on $50,000 bond and is also being held for Immigrations and Customs Enforcement for suspicion of being an undocumented alien.

domain: news


text:
- Special Features
- Blogs & Columns
- Fun & Games
Beyonce is opening up to curious fans about Blue Ivy and Jay-Z in her new HBO documentary, Life is But a Dream, which is schedule to air on Saturday.
In the 30-second ad for her film, Beyonce says, “I always battle with, ‘how much do I reveal about myself?’”
Beyonce and husband Jay-Z have always kept their personal life secretive, until now. The documentary features Beyonce’s life on stage and in rehearsals, as well as her baby, Blue Ivy, who she gave birth to in January 2012.
Rumors spread in 2011 that Beyonce was faking her pregnancy, so the Grammy-winning singer was sure to show many images of her baby bump in the documentary.
Beyonce also discusses her miscarriage in the film. Jay-Z first opened up about the tragedy in his song “Glory.”
According to Reuters, Beyonce says in the documentary, “It was the saddest thing I've ever been through. My life is a journey. ... I had to go through my miscarriage, I believe I had to go through owning my company and managing myself ... ultimately your independence comes from knowing who you are and you being happy with yourself.”
Photo Courtesy of CBS

domain: celebrity


text:
Feb 12, 2015, 8:37 PM EDT
With Marc Loving being suspended for the last three games, freshman Jae’Sean Tate has stepped forward for the 23rd-ranked Buckeyes.
Feb 6, 2015, 3:43 PM EDT
Marc Loving is second on the team in scoring and shooting better than 50 percent from beyond the arc.
Feb 5, 2015, 6:00 PM EDT
Hawkins has raised his three-point percentage more than 20 points from last season, and that’s one reason why UC Davis is the best three-point shooting team in America.
Feb 4, 2015, 6:21 PM EDT
Marc Loving is Ohio State’s best three-point shooter, and without him the Buckeyes will need to find perimeter shooting from other places against one of the Big Ten’s best defenses.
Jan 30, 2015, 9:50 AM EDT
While D’Angelo Russell gets most of the attention (and rightfully so), another freshman has stepped forward in the last two games for the Buckeyes.
Jan 8, 2015, 9:30 AM EDT
The Ohio State sophomore has improved his scoring by nearly eight points per game, and he’s been efficient in taking advantage of increased opportunities.
Dec 17, 2014, 5:56 PM EDT
After shooting 40.7% from the field and 29.4% from three as a sophomore, Anderson’s off to a hot start for the sixth-ranked Cavaliers.
Oct 21, 2013, 9:00 AM EDT
All month long, CBT will be rolling out our 2013-2014 season preview. Check back throughout the day, as we’ll be posting three or four preview items every day. To browse through the preview posts we’ve already published, click here. The rest of our Top 25 Countdown can be found here. For a schedule of our…
- Cody Zeller, Indiana president speak out against recent athlete legal issues 0
- Five-star 2016 combo guard cuts list to four 0
- Xavier, Mount St. Joseph to launch the ‘Lauren Hill Tip-Off Classic’ 0
- Tai Wynyard: ‘I will be coming to UK in December’ 0
- Tom Izzo, 30 second shot clocks, and why zone presses will be more popular this year 1
- Kentucky lands a commitment from four-star 2016 forward 0
- Everything you need to know about the College Hoops Tip-Off Marathon 0
- Bill Self says Cheick Diallo could wait ‘at least another month’ for eligibility ruling (12)
- Winona State coach Mike Leaf resigned after player accused him of making drunken sexual advances (6)
- Blue Ribbon announces their preseason all-american team (3)
- Tulsa gets 2016 commitment from former Wichita State guard (2)
- Nike and Under Armour host showcase events as the Shoe Wars continue to heat up (2)

domain: sports


text:
Recent research has discovered that climate change could have an impact on food safety. Researchers at Wageningen University have established a connection between fruit and vegetable contamination and long-term alterations in weather. They found that excessive rainfall, for example, could produce increased concentrations of harmful bacteria which would otherwise be broken down using UV light.
Scientists are now asking whether the changing climate will allow for the continued consumption of safe fruit and vegetables, or whether there is cause for concern.
How does the climate affect your food?
In general, most people don’t consider climate change when they contemplate the factors that could be altering the safety of the produce they buy. However, studies have found that flooding can lead to higher levels of bacteria and warmer temperatures can encourage the growth of toxic fungi which thrives in heat.
In the most recent study, researchers gathered evidence and scientific findings on how climate change affects food safety. This data examined numerous issues, including mycotoxin production in tomatoes, parasite transmission, pesticide use, and the connection between “flooding and leafy greens contamination.”
Backed up by other studies
Statistical analyses and field studies conducted through the Veg-i-Trade project indicated a relationship between climate variables and the contamination of fruit and vegetables. A preliminary study showed that in Poland, tomatoes were expected to see increased contamination by the end of the 21st century.
The results aren’t completely negative, however. Research conducted in Spain suggests that increasingly rising temperatures could help to eliminate fungi, thereby reducing the contamination risk. What’s more, a larger dose of UV radiation from the sun could work to break down some of the natural bacteria present in edible plants, banishing unwanted germs from produce.
The conclusion of the current research seems to be that although we all will need to take steps in adapting to climate change, specific measures to enhance food safety may differ from one country to the next. Different regions could call for alternative strategies on mitigating the food-safety effects of climate change.

domain: agronomy


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megan fox 2015 - Google Search
40 Celebrity Style Layered Hairstyles to Have in 2016 More
megan fox, love her eyebrows!
I want this hair
love this hairstyle - slick Hollywood waves
Megan Fox’s jewelry, clutch handbag, and red gown that she wore in Beverly Hills on October 11, 2014
Old Hollywood Hair
Megan Fox's hair is amazing

domain: entertainment


text:
NIOSHTIC-2 Publications Search
Observational stress factors and musculoskeletal disorders in urban transit operators.
Greiner BA; Krause N
J Occup Health Psychol 2006 Jan; 11(1):38-51
Associations and pathways between observed (rather than self-reported) job stressors and musculoskeletal disorders in 66 transit operators were investigated to determine specific stressors and vulnerable body regions affected, while adjusting for physical workload. Job stressors, defined as barriers to progress with work, comprised 7 categories and the sum of stressors. Outcomes included back and neck pain, low back pain, neck pain, pain of the upper extremities and the lower extremities, and any combination of these. Stressors were significantly associated with the combined musculoskeletal disorders category (odds ratio [OR] = 1.55), back and neck pain (OR = 1.41), low back pain (OR = 1.46), and pain in the lower extremities (OR = 1.44) after controlling for confounders. Five barrier categories had at least 1 significant association with outcomes. Results provide specific intervention targets by avoiding common method variance bias.
Musculoskeletal-system-disorders; Musculoskeletal-system; Stress; Workers; Worker-health; Job-stress; Physical-stress; Back-injuries; Neck-injuries; Injuries; Risk-analysis; Risk-factors; Transportation-industry; Transportation-workers; Occupational-health; Occupational-diseases
Issue of Publication
Journal of Occupational Health Psychology
Department of Occupational and Environmental Medicine, San Francisco General Hospital, University of California - San Francisco, San Francisco, California

domain: literature


text:
The global automotive chip market was valued at $52. $53 billion in 2021 and is expected to be worth $92. 21 billion by 2026. Automotive chips are a unique class of electronic components with the ability to conduct electricity under specific conditions.
New York, June 30, 2022 (GLOBE NEWSWIRE) — Reportlinker.com announces the release of the report “Global Automotive Chip Market: Analysis By Vehicle Type, By Device Type, By Application, Per Region, Size and Trends with Impact of COVID -19 and forecast to 2026” – https://www.reportlinker.com/p06289955/?utm_source=GNW
Car chips are used in vehicles to ensure that the relevant part functions properly under all circumstances.
Market revenues may increase in the coming years due to the expected development and commercialization of fully automated vehicles, such as driverless taxis. Powerful automotive chips are expected to be widely used in cars in the near future, as fully autonomous vehicles require real-time data processing from numerous sensors mounted around the vehicle. The Automotive Chip market is projected to grow at a CAGR of 12.07% over the analyzed period of 2022-2026.
Market Segmentation Analysis:
By Vehicle Type: The report identifies two segments based on vehicle type: passenger vehicle and commercial vehicle. By vehicle type, the passenger car segment accounted for approximately 62% of the automotive chip market in 2021 and experienced the fastest growth over the forecast period. This is because several countries in Asia-Pacific, North America and Europe have adopted regulations requiring the integration of different types of safety measures in the passenger car segment.
By Device Type: The report identifies six segments by device type: MCU, Analog IC, Sensor, Logic IC, Discrete, and Memory. Among the device type, the MCU segment had the maximum share in 2021, accounting for about 30% of the automotive chip market. Microcontrollers responsible for automating vehicle tasks are now in high demand due to the advancement in automation. MCUs are used in cars to perform automatic tasks such as distributing electricity to various vehicle components, keeping the exhaust system clean and reducing fuel consumption. In addition, as vehicles become electrified, there is a growing demand for new, specialized MCUs tailored to the requirements of electric vehicles (EVs).
By Application: The report provides the breakdown of the Automotive Chips market into ten segments by application: ADAS, body electronics, infotainment, EV/HEV, chassis, safety, ICE powertrain, instrument cluster, aftermarket and automotive HPC. The automotive HPC segment is expected to grow at a significant pace over the forecast period. Automotive high-performance computing (HPC) implements a centralized computing architecture in which a single HPC module manages numerous functional domains, including body electronics, chassis electronics, and safety electronics. The use of HPC modules enables vehicle manufacturers to consolidate functionality previously performed by many ECUs with embedded software into a software-defined electrical and electronic architecture that performs a variety of service-oriented applications.
By Region: In the report, the global automotive chip market is divided into four regions: Asia-Pacific, North America, Europe, and ROW. Asia-Pacific accounted for the largest 38% share of the global automotive chip market in 2021. Increased vehicle production and ongoing collaborations between automotive OEMs and semiconductor manufacturers are driving the Asia-Pacific automotive chip market. The comfort and luxury that a car offers now outweighs price and fuel economy as the most crucial aspects to consider when buying a car. This can be explained by the fact that the demand for premium and semi-luxury cars is increasing worldwide, forcing automakers to install more electronic components and boosting the auto chip market in Asia-Pacific.
Factors of growth: The market has grown in recent years due to factors such as higher disposable income, increasing demand for electric vehicles, increasing number of road fatalities, increasing semiconductor content in vehicles, improved ADAS functionalities, increasing demand for – Vehicle Infotainment System (IVI ) and government safety standards. The expansion of car chips seems to be fueled by the widespread demand for electric vehicles. The transition to electric mobility is well underway and presents the automotive industry with new hurdles. A phasing out of the combustion engine seems almost inevitable given the increasingly ambitious climate targets and is an established policy in more and more countries. In addition, most advances in vehicle development are powered by semiconductors, which also act as a catalyst for growth and consumer demand. Demand for automotive semiconductors will steadily increase as automobiles become more complex, which is a key long-term growth engine for the automotive chip market.
Challenges: However, some challenges hinder the growth of the market, such as cybersecurity threats and high barriers to entry and standardized manufacturing process. The automotive chip market has high barriers to entry, as automotive chips may need to operate under extreme conditions (such as high temperatures, power, etc.), automotive OEMs have lengthy and complex testing and certification processes, which extend the product-to-market cycle, and the IC -design, test and production processes require extensive industrial know-how and financial investments.
Trends: The market is expected to grow at a rapid pace over the forecast period, reflecting several latest trends such as rising demand for connected cars, autonomous driving, 5G upgrades from vehicle to cloud connectivity, and the emergence of a lazy economy. The future of autonomous vehicles will soon become a reality as technology evolves. Since it can save deadly traffic accidents, several car manufacturers are working towards reaching level 5 of automation. Companies in the automotive chip business are taking this opportunity to increase vehicle safety, as autonomous vehicles are gaining popularity thanks to car brands such as Tesla. Leading automakers are focusing on integrating autonomous technologies into cars to enhance safety and elegance. The use of car chips can be beneficial for all these applications. As a result, a sizable market for automotive chips is enabled by the increasing adoption of these semi-autonomous functionalities.
Impact analysis of COVID-19 and the way forward:
The COVID-19 pandemic has wreaked havoc on the global automotive chip market. The automotive chip market also collapsed under this situation and the chip shortage problem worsened. Factors that led to a decline in car chip production in 2020 include a lack of raw materials, a skilled workforce, and the closure of many car factories.
Throughout 2020, chip shortages could continue to negatively impact global motor vehicle production. However, the post-COVID environment appears to be favorable for the automotive chip market. It is worth noting that the tight supply of chips is improving. The improved situation led to better-than-expected production of light vehicles even in the second half of 2021.
The global automotive chip market is moderately fragmented. Market players have implemented sustainable growth techniques in the market. In order to strengthen their position in the market, some of the leading competitors follow different growth methods such as mergers, acquisitions, partnerships and agreements. For example, STMicroelectronics announced an anchor partnership with startup Autobahn.
Major players in the global Automotive Chip market are:
NXP Semiconductor NV
Infineon Technologies AG
Renesas Electronics Corporation
Robert Bosch GmbH
Qualcomm Incorporated Inc.
Microchip Technology Inc.
ON Semiconductor Corporation
Analog Devices, Inc. (Maximum Integrated)
Major players invest in equipment R&D to meet international standards. New product launches, collaborations with governments and expansion in emerging countries are among the strategic activities the companies are pursuing to increase their market positions. For example, NVIDIA Corporation is focused on introducing high network capacity and large processing power chips for fully autonomous vehicles. Infineon Technologies AG opened the brand new state-of-the-art chip facility in September 2021 at the Villach site in Austria. To enable numerous connected functions in a variety of automotive applications, the factory would manufacture power electronics on 300 millimeter thin wafers. In July 2021, ON Semiconductor announced a new AutoX Gen5 self-driving platform for its LiDAR and image detection technologies. Using 28 2D image sensors and 4 3D LiDAR sensors, this Gen 5 autonomous technology enables a completely driverless RoboTaxi for transportation. of people and products.
Scope of the report:
The report entitled “Global Automotive Chip Market: Analysis By Vehicle Type, By Device Type, By Application, Per Region, Size and Trends with Impact of COVID-19 and Forecast up to 2026”, includes:
— An in-depth analysis of the global Automotive Chips market by value, by vehicle type, by device type, by application, by region, etc.
— The Regional Analysis Of The Automotive Chip Market, Including The Following Regions:
Asia-Pacific (China, Japan, India, South Korea and rest of Asia-Pacific)
North America (US and Canada)
Europe (Germany, UK, France, Spain and rest of Europe)
— Comprehensive information on emerging markets. This report analyzes the market for different segments in different geographic areas.
— Provides analysis of the impact of COVID-19 on the global automotive chip market.
— Evaluates the key opportunities in the market and outlines the factors that are and will be the growth of the industry. The growth of the overall automotive chips market is also forecast for the period 2022-2026, taking into account the past growth patterns, the growth engines and current and future trends.
— Evaluation of the potential role of car chips to improve market status.
— Identification of new technological developments, R&D activities and product launches taking place in the automotive chip market.
— In-depth profiling of key players, including assessment of the company outline, market strategies, regional and business segments of the leading market players.
— The recent developments, mergers and acquisitions related to mentioned key players are provided in the market report.
— The in-depth analysis provides insight into the market and highlights the growth rate and opportunities presented in the company.
Read the full report: https://www.reportlinker.com/p06289955/?utm_source=GNW
ReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data, so you get all the market research you need instantly and in one place.
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domain: economics


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The Ramayana Resort in Bali’s Kuta area has confirmed their on-goingÂ renovation work is expected to be completed by late 2018.
The scheduled works include expansion of the resort into the land adjacent to Kuta Beach Club, along with a dramatic redesign of their room structures. The resort will convert their three existing Superior rooms into two brand-new Suites. Following completion of the work, Superior rooms will no longer be available.
Located in a heart of Kuta, Bali, the resort is hidden away in a tranquil tropical garden, complete with serene koi pools with cascading water features providing guests with the soothing sound of running water during their stay.


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Dominic West's killer nightmares
- Bang Showbiz
- 12 July 2011
Dominic West has recurring nightmares about Fred West since portraying the serial killer in an ITV drama
Dominic West has recurring "nightmares" since playing serial killer Fred West.
The 41-year-old actor portrays the notorious murderer - who along with wife Rose killed at least 12 young women - in forthcoming ITV drama 'Appropriate Adult', and admits the role is still haunting him.
He said: "I have this recurring dream where I'm perched on a wall and Fred West is trying to grab me and pull me down but I didn't let him get to me. I was determined not to."
Despite the horrific nature of Fred's crimes, Dominic insists the drama won't be "sensational" and believes there is an important message to the story.
He added in an interview with Radio Times magazine: "The production team have found a way of telling this story through the eyes of a social worker who was sent to interview West in prison.
"I think it's effective without being sensational in any way.
"Thousands of people still go missing in this country every year and are never found. Fred West preyed on runaways without being caught for 25 years. We should not forget this case, because there could be others like him."


The Leica M10 and the Leica M11 are two of the most popular digital cameras on the market. Both offer excellent image quality and a wide range of features, but which one is right for you? In this article, we’ll compare the two cameras side-by-side to help you decide which one is best for your needs.
The Leica M10 and the Leica M11 are two of the most popular digital cameras on the market. Both offer excellent image quality, but which one is right for you? The M10 is a full-frame camera with a 24 megapixel sensor, while the M11 offers a slightly higher resolution of 26 megapixels.
The M10 is also slightly smaller and lighter than the M11, making it more portable. Both cameras have a 3″ LCD screen, although the M11’s screen is ever so slightly larger. They both offer 1080p video recording, although the M11 can record at up to 60fps compared to the 30fps of the M10.
One key difference between these two cameras is that the M10 uses an optical viewfinder, while the M11 has an electronic viewfinder. This means that you’ll be able to see what you’re shooting without having to rely on the LCD screen – which can be handy in bright conditions. However, some photographers prefer an optical viewfinder as it gives a ‘truer’ representation of what your final image will look like.
So, which camera should you choose? If you value portability above all else, then the Leica M10 could be ideal for you. Or if you prefer having a slightly higher resolution sensor and an electronic viewfinder, then go for the Leica 11.
Ultimately it comes down to personal preference – but both cameras offer great image quality whichever way you look at it!
Leica M11 vs Leica M10 | A Hands On First Look & Comparison
What are the Main Differences between the Leica M10 And M11
The Leica M10 is the company’s newest rangefinder camera, replacing the ageing M9. The M11, on the other hand, is an upcoming mirrorless camera that will sit above the existing Leica T (Typ 701) in terms of both price and performance. So, what are the main differences between these two cameras?
For starters, the M10 features a new 24-megapixel full-frame CMOS sensor, while the M11 will have a 26-megapixel APS-C CMOS sensor. Both sensors are designed by Leica and boast low noise levels and excellent dynamic range. The M10 also has a new Maestro II image processor, which enables it to shoot at up to ISO 6400 with no loss of detail.
The M11’s image processor is not yet known, but it’s likely to be similar to that used in the Leica T (Typ 701), which means it’ll be capable of shooting at ISO 12500 with minimal loss of detail. Another key difference between the two cameras is their viewfinders. The M10 has a 0.68x optical viewfinder with split image and rangefinder focusing aids, while the M11 will have an electronic viewfinder with 2.4 million dots and 100% coverage.
This means that you’ll be able to see what you’re photographing more clearly on the latter camera, but it also means that battery life will be shorter as electronic viewfinders use more power than optical ones. Finally, there’s the matter of price: the Leica M10 is currently available for around £5200 / $6500 / AU$8500 body only, while we don’t yet know how much the Leica M11 will cost when it launches (rumours suggest it could be around £6000 / $7500 / AU$9500). So, if you’re looking for a high-end rangefinder or mirrorless camera and can stretch your budget to accommodate one of these premium prices, which should you go for?
Which Camera is Better for Street Photography
There is no one-size-fits-all answer to this question, as the best camera for street photography depends on a number of factors, including your budget, what types of photos you want to take, and your personal preferences. However, we can narrow it down to a few contenders.
If you’re looking for a high-quality camera that won’t break the bank, the Fujifilm X100F is a great option.
It’s a compact camera with a fixed prime lens, meaning it’s small and lightweight – perfect for carrying around all day. It also has an APS-C sensor, which gives you excellent image quality. If you’re willing to spend a bit more money, the Leica Q2 is another great choice.
It’s a full-frame camera with a fast prime lens, making it ideal for street photography. It also has built-in WiFi and Bluetooth, so you can easily transfer your photos to your phone or computer. Ultimately, the best camera for street photography is the one that suits your needs and preferences the best.
So take some time to think about what you want from your camera before making your final decision.
Do the Cameras Have Different Sensor Sizes
Yes, the cameras do have different sensor sizes. The most common sensor size is the APS-C sensor, which is found in most entry-level and mid-range DSLRs. This sensor size is approximately 24mm x 16mm.
The next most popular sensor size is the full frame sensor, which is found in high-end DSLRs and mirrorless cameras. This sensor size is approximately 36mm x 24mm. There are also medium format sensors, which are much larger than either of these two sizes.
These sensors are typically found in high-end digital cameras and can be as large as 54mm x 40mm.
How Do the Autofocus Systems Differ
Digital cameras have come a long way in recent years, and one of the most important advances has been in autofocus (AF) technology. There are many different AF system types used in today’s cameras, from basic contrast-detect AF to more sophisticated phase-detect and hybrid systems. So how do they all differ, and which is best for your needs?
Contrast-Detect Autofocus The contrast-detect autofocus system is the most basic type of AF found in digital cameras. It works by analyzing the image data coming through the lens and looking for areas of high contrast.
The camera then adjusts the focus until it finds the point of highest contrast, at which point it assumes that the subject is in focus. This system can be quite accurate if there is sufficient contrast in the scene, but it can struggle with low-contrast subjects or scenes with little detail. It can also be slow, as the camera often has to hunt around for a point of sharpest focus.
For these reasons, contrast-detect AF is generally found only on entry-level cameras these days. Phase-Detect Autofocus Phase-detect autofocus (PDAF) is a more advanced technology that’s widely used in modern DSLRs and mirrorless cameras.
PDAF works by splitting the incoming light into two separate beams and sending them to different parts of the sensor surface. These beams are then used to calculate distance information, which allows the camera to adjust its focus accordingly. This system is much faster than contrast detect AF, as it doesn’t have to “hunt” for a point of sharpest focus – instead, it can quickly lock onto the desired subject matter thanks to its distance information calculations.
However, phase detection does have some drawbacks compared to other focusing technologies. Firstly, because PDAF uses a separate beam of light for focusing purposes, it isn’t possible to use live view mode (i.e., framing your shot using the LCD screen rather than through the optical viewfinder). Additionally, PDAF typically requires an external module known as an “AFSensor” – this adds both cost and bulk to your camera body or lens design.
Leica M10 Vs M10R
When it comes to high-end cameras, there are few that can compete with Leica. The German company has been making some of the best cameras in the world for over a century, and their latest offerings are the M10 and M10R. Both cameras are excellent choices for anyone looking for a top-of-the-line camera, but there are some key differences between them that you should be aware of before making your purchase.
The biggest difference between the M10 and M10R is the sensor size. The M10 has a full frame sensor with 24 megapixels, while the M10R has a smaller APS-C sensor with just 18 megapixels. This means that the M10 will produce slightly better image quality than the M10R, but it also comes at a higher price tag.
If you’re not planning on printing large photos or doing much cropping, then the M10R may be the better option for you. Another difference between these two cameras is that the M10 has an optical viewfinder while the M10R does not. This means that you’ll have to use the LCD screen on the back of the camera to compose your shots, which can be tricky in bright sunlight.
The optical viewfinder on the M10 makes it much easier to compose your shots, especially if you’re used to shooting with a DSLR camera. Finally, one last thing to consider is what lenses you want to use with your new camera. The LeicaM mount is compatible with a wide range of high-quality lenses from other manufacturers, so you’ll have no trouble finding something that suits your needs.
However, if you want to use Leica’s own lenses then you’ll need to buy an adapter since they don’t natively fit onto either camera body. So which camera should you choose?
If you’re in the market for a high-end digital rangefinder camera, you may be wondering whether the Leica M10 or M11 is the right model for you. Both cameras offer a unique shooting experience and excellent image quality, but there are some key differences between them that may make one more suitable for your needs than the other. The Leica M10 is a full-frame camera with a 24 megapixel sensor, while the M11 boasts a 40 megapixel sensor – making it ideal for those who need maximum detail and resolution from their images.
The M11 also has an integrated WiFi module, allowing you to easily transfer files to your computer or smartphone, while the M10 does not have this feature. Another important distinction between the two models is that the Leica M10 features an ISO range of 100-6400, while the M11’s ISO range extends to 50-2500 – meaning that it perform better in low light conditions. Finally, the Leica M10 offers 4K video recording at 30fps, while the M11 is limited to 1080p recording at 60fps.
So, which camera should you choose? If you need maximum detail and resolution from your images, go for the Leica M11. If you shoot mostly in low light conditions, opt for the Leica M10.
And if 4K video recording is important to you, again – choose the Leica M10.


Right now, you can get the 2 Pack of Cabepow iPhone Lightning Cable for just $6.47 from Amazon, that’s just $3.23 for a unit. Today’s offer allows you to save directly 50 percent on the original price.
The iPhone chord is far more robust than anything else on the market thanks to reinforced stress points with a lifespan of more than 10,000 bends. The iPhone chord is far more robust than anything else on the market thanks to reinforced stress points with a lifespan of more than 10,000 bends.
JBL Go 3 Portable Speaker Drops To $39!
For a brief period, your iPhone devices can sync and charge simultaneously at the quickest speed using the iPhone connector. Superior data transfer with quick and reliable charging is ensured by the cable core and the multi-strand premium copper core wires. Thousands of checks are performed by the technical staff to guarantee your device is completely safe.
Finally Apple 10.2-inch iPad For $269!
To deal with any outside activities, double shielding and a tangle-free design considerably improve interference protection. The anodized connections guarantee superior performance even under demanding use. You may walk about freely while charging your gadgets thanks to the perfect length of these charging cables.


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An extra 6GW of wind power will be added in Africa between 2019 and 2023, which will double current capacity.
Africa’s potential for renewables has barely begun to be exploited, but the Global Wind Industry Council is hoping to change that. The body is seeking to speed up the spread of wind power on the continent with help from industry heavyweights like Siemens Gamesa, Vestas and Aurora Wind Power.
According to plans, an additional 6GW of wind power capacity will be added in Africa between 2019 and 2023. That will more than double the current total capacity of 5.3GW. If a projected annual growth rate of 24% holds up between now and 2028, a further 33GW of new wind capacity will be created in Africa, making wind power a significant part of local energy generation.
“Africa has a unique opportunity to leap-frog obsolete fossil fuel generation and create the power generation it needs from wind power and other renewables technologies,” Ben Backwell, the council’s CEO, said. “If we can help create the right regulatory frameworks and knowledge transfer, Africa’s growing economies will soon be powered by cheap, efficient wind power.”
Last year 962MW of new wind capacity was installed in Africa and the Middle East, which was 300MW more than that the year before. Egypt leads in the region with a capacity of 380MW, followed by Kenya with 310MW and Morocco with 120MW.
Yet for all that extra capacity, the continent’s wind energy market is still in its infancy. In 2011 Africa’s total capacity was a mere 1.1GW. It more than tripled to 4.1GW by August 2017. However, even that figure was less than 1% of global capacity.
Hampering the spread of wind energy has been that fact that few African nations have formulated plans to boost their wind capacity, although 34 out of the 55 nations on the continent have set renewable energy targets as per the Paris agreement.
The intermittent nature of renewables and a lack of long-term storage capacity for wind power have both been seen as drawbacks by many local governments. Improved storage technologies, however, may soon make wind energy more appealing to African policymakers.

domain: geography


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My dad sent me this link and I thought of sharing it with you all even though it’s a fairly popular song. This song, STand By Me, holds a special place in my heart because my brother dedicated it to the OA and me at our engagement and sang it for us. Sweet child.
I love the way they’ve taken street singers from around the world and overlaid the voices and mixed it to create one song – music uniting the world. Over the last couple of months I find myself gravitating towards jazz, blues, R&B and really soaking it in (I’d be happy for any recommendations from you all). They send these little shivers down my spine as I sit entranced, marvelling at the talent that goes into something like this. As I rediscover music that my parents played day after day, it feels like a rebirth. The angsty days of hard rock and the love struck days of Bollywood fade into the background as I put on CD after CD of soul music and hope that it will soak into my children’s very bones as they go about their daily business.
I remember my grandmother lying between my brother and me every night, patting us to sleep and telling us about stuff around the world. One of the things that made a deep impression on me was her telling us about the atrocities that the Africans suffered. It built a great deal of empathy and her words still run through my head at the oddest of times… She’d say “Africans have such beautiful voices because that was God’s way of carrying them through their darkest hours. The kernel of sorrow they carry manifests itself in their singing and that is how why they are blessed with so much music.” Prevented from reading, writing, praying, living freely, all they had left was the music in their souls. The songs were mostly about freedom, but very often they carried codes as the slaves helped each other escape. As part of the human race I feel the burden of guilt for what they’ve been through. I remember crying when Obama won, not because I’m interested in American politics, but because the walk was such a long and difficult one. Over 12 million slaves were shipped to America starting in the 16th century until just 150 years ago.
People often tell me that driving a car is the ultimate in freedom and self-sufficiency. I think you are truly self sufficient only if you have music in your soul and an instrument at your fingers. Walk, hop on to a truck, hitch a ride… as long as you have some music to keep you company you won’t feel the lack of anything. What more can a person want if they have a song in their head and a melody running through their heads? Can you ever be truly alone if you can pick up a guitar and strum? Now that it is winter I go for my walk after the children go to bed, my head wrapped up to my nose in a shawl, hands dug into my pocket, singing loudly to myself in to the cold dark, windy night.
I envy musicians more than I envy writers, inventors, doctors or any other professional. Actually I don’t even think of music as a profession. It is part of who you are – like your nails and your skin. There’s no getting under it. There’s no getting away from it. You can always have it along with someone or something else. Your lover might leave you, your parents will die, your children may desert you and you might lose your job, but music? No one can take that song away from you.
On that note I leave you with another song I am tripping on – The Blues ain’t nothing but a Woman crying for her Man -Dinah Washington.
Oh who am I kidding? Here’s more
This brilliant Coltrane take on My favourite things
and oh my God, this.. .
and how will this list be complete without Ray Charles? Actually it isn’t even a list to begin with…

domain: artistic


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3pm Matinee Just Added!
Featuring hit songs and iconic sound tracks from the movies including ‘Funny Girl’, ‘My Fair Lady’, ‘The Wizard of Oz’, ‘Hello Dolly’, ‘Star Wars’, ‘Gigi’, ‘Tom & Jerry at MGM’,’ Gone with the Wind’ plus lots more.
Get ready to put your dancing shoes on as we welcome a stellar line-up for a great night out!
Hosting some of the finest female voices in the music industry this November and offering up a quality-laden festive programme this December, Sage Gateshead has something for everyone this Winter.


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Food drive to help replenish shelves at food bank
The season of Thanksgiving and good will is fast approaching and volunteers from Entergy Texas, Inc. are gearing up to ensure families served by the Southeast Texas Food Bank will have what they need to celebrate and enjoy the holidays.
“The holiday season is the time of year when all of us we tend to focus more on ways to help others,” explained Todd Dunkleberger, region customer service manager for Entergy Texas and food drive coordinator. “I can’t think of anything more basic than making sure people have enough to eat. And by hosting a food drive that includes so much of Southeast Texas, the Food Bank will be given a good starting point as they move into November and December, when extra effort is made to provide for those in need.”
Dunkleberger noted that the Food Bank provides food to 20,000 households in eight counties in Southeast Texas and partners with some 130 other nonprofit agencies to distribute food they receive or purchase. “Their partner agencies prepare about 200,000 meals a month for people in our area,” he added.
On Saturday, seven locations will be staffed by employees, friends and families ready to take nonperishable food items from 8 a.m. until 3 p.m. Saturday, Oct. 19. At the end of the food drive, trucks carrying collected items will converge and caravan to the food bank.
Local collection sites include: Port Arthur, HEB at Highway 365; Bridge City, Market Basket; and Beaumont, Market Basket at 8350 Phelan Blvd.


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James Rebhorn, the prolific character actor who most recently had recurring roles on Homeland and White Collar, died Friday at his home in New Jersey, according to The Hollywood Reporter. He was 65.
TMZ reports that Rebhorn died of skin cancer.
Margaret Cho has signed on to star in Tina Fey's multi-camera comedy for Fox, according to The Hollywood Reporter.
The untitled project, known as Cabot College, takes place at a women's university that has just started admitting men for the first time.
Now that Watson has joined Sherlock's team full-time, she'll have her hands full thanks to Josh Hamilton.
Elementary Scoop: How will Sherlock and Watson's relationship change now?
Wyclef Jean and the cast of Nashville
Wyclef Jean has landed a recurring role on Nashville.
According to The Hollywood Reporter, the rapper-singer will play...
Brad Beyer, Mark Harmon
Jericho and Third Watch alum Brad Beyer has booked a two-episode arc on NCIS during November sweeps, TVGuide.com has learned.
Fall Preview: Get scoop on your favorite returning shows
Beyer will play...
Grey's Anatomy and 24 grad Kim Raver is joining NBC's new drama Revolution in a recurring role, TVLine reports.
Executive-produced by J.J. Abrams, Revolution takes place...
Eddie Cibrian has landed a multi-episode arc on the upcoming season of Rizzoli & Isles, TVLine.com reports.
The Playboy Club alum will play Dennis Rockmond, a...
Boardwalk Empire is already filling the void left by — spoiler alert if you've got the finale waiting on your DVR...
NBC has ordered a prison drama pilot from John Wells.
Based on the long-running British hit series of the same name, Bad Girls will focus on the a group of unlikely women in a federal prison, which includes a scandalous female warden, her new protégé and various inmates
NBC's Chase has cast Nia Long (The Fresh Prince of Bel Air, Third Watch) in the role of Assistant U.S. Attorney Melissa Randolph, described to me as a feisty lady who'll face off with ...


- New Apple patent for foldable technology
- Future iPhone or iPad may come as foldable devices
- Apple yet to make an announcement about foldable iPhone or iPad
Apple has been granted a new patent hinting towards a foldable iPhone or iPad. As more and more Android smartphone manufacturers jumping on the foldable phone wagon, all eyes are set on Apple’s move regarding the foldable technology.
According to the patent, Apple will manufacture a device with a display that overlaps an axis and a case with first and second flaps that support the display.
“A hinge mechanism may be used to ensure adequate separation between the first and second portions when the housing is bent. Movable flaps may be retracted when the housing is bent to create room for a bent portion of the display,” the patent filed by the tech giant stated.
If we put it simply, Apple’s technology will put less stress on the display when it is folded. And, the risk of creasing is likely to be reduced to a great extent. The images shared in Apple’s latest patent showed that the hinge developed by the company will bend the display outwards in order to change the radius of the curve, giving it more space to bend back on itself. The outward curve will resemble a teardrop reducing the chances of a crippling crease to occur, Tom’s Guide reported.
Apple is known to file patents for any latest technology the company wishes to include in their existing lineup of products. Recently, the company filed a patent that would remove the mechanical crown from Apple Watch and replace it with a digital crown. Apple removing the iconic mechanical crown should not be seen as a shocking move as the company is renowned in the market for coming up with pathbreaking innovation. For example, removal of the headphone jack from its iPhone and iPad lineup.
Recently, Moto released its new Moto Razr foldable phone reminding fans of the old Razr. The 2020 version of Razr is a unique take on the foldable phone as it features the good old clamshell design of the original model, but now it is with a flexible display. However, reviewers from Android Community reported a clicking sound when opening or closing the phone. This is the first-generation Moto Razr foldable phone and the company is expected to make improvements in the future generations of the phone.


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The Government of Joe Biden will invest USD 1.7 billion to detect new variants of the coronavirus in the US.
The financial aid will allow the CDC and states to fight more effectively against the mutations that currently account for half of the COVID-19 cases in the country.
Currently, the original strain of the coronavirus comprises only about half of all cases in the United States. At the same time, potentially more dangerous new variants make up the other half. According to information to which Infobae had access, the Administration of President Joe Biden will invest 1.7 billion dollars from the American Rescue Plan to help states and other jurisdictions to fight more effectively against these mutations.
An essential component of the response to emerging variants is increasing the country’s genomic sequencing. The process by which coronavirus DNA is decoded and its life-threatening mutations detected. The funding, allocated through the Centers for Disease Control and Prevention (CDC), will help the government agency, states, and other jurisdictions more effectively detect and track variants by expanding the genomic sequencing efforts. In addition to the information obtained from the sequence, the CDC and state and local public health authorities will use well-known preventive measures to prevent this spread.
As of early February, US labs were only sequencing about 8,000 coronavirus strains per week. Since then, the pace of sequencing has increased dramatically, strengthening the country’s ability to detect and respond to emerging and more contagious variants, such as those currently spreading across the Midwest and parts of the east coast of the United States.
The Biden Administration has already invested nearly $ 200 million to help increase genomic sequencing to 29,000 samples per week. Through funding to be announced Friday, states and the CDC will further expand that number and provide states with more resources to add to their own efforts and increase geographic coverage. In this way, the detection of emerging threats such as variants will be enhanced.
This will mean that both existing and new coronavirus variants can be found more quickly and before they become prevalent.
The announcement expected for this Friday includes:
– $ 1 billion to expand genomic sequencing. This funding will help CDC, states, and other jurisdictions improve their ability to identify coronavirus mutations and control the circulation of the variants. Specifically, it will allow CDC and jurisdictional health departments to conduct, expand, and improve genome sequencing and SARS-CoV-2 mutation identification activities.
– $ 400 million to support innovation initiatives, including the launch of new and innovative Centers of Excellence in Genomic Epidemiology. The funding will establish six centers that will function as partnerships between state health departments and academic institutions. The funding will drive cutting-edge research in genomic epidemiology. Partnerships could focus on developing new genomic surveillance tools to better track pathogens of public health concern to develop surveillance methods that are more widely used in the public health system, 300 million for the construction and maintenance of national bioinformatics infrastructure. Experts use bioinformatics and complex informatics to connect the dots between the spread and mutation of pathogens and help resolve outbreaks. The investment will help bioinformatics in public health systems beyond the United States, building a unified system for sharing and analyzing sequential data that protects privacy but offers more informed decisions. The funds will also help train to enhance the continuity of the clinical setting and the CDC’s Bioinformatics Fellowship Program.


from Maku Teknoloji, originally released 4th September, 2012
If you like chess , you can find all everything in this application. Online and offline game modes, chat, push notification , replay function , buddy list and many more features .
It is universal, means both compatible for iPhone and iPad .
Recent posts about iChess Mobile
discussion by Sidelines.