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\section{Introduction}

Testing the laws of gravity at cosmological scales is one of the main science drivers for the coming generation of large-scale structure surveys. At large scales and late times, our Universe can be consistently described by a set of four fields that quantify the deviations from an homogeneous and isotropic background: the two metric potentials, $\Phi$ and $\Psi$, describing the fluctuations in the geometry of the Universe, the matter density fluctuations, $\delta$, and the galaxy peculiar velocity field, $\mathbf{V}$ \footnote{We use the metric convention $ds^2=a^2(t)[-(1+2\Psi)dt^2+(1-2\Phi)d\mathbf{x}^2]$ where $t$ denotes conformal time.}. Testing the laws of gravity requires then to test the relations between these four fields. This can be done by using the data obtained at galaxy surveys, which probe the late-time large scale structure of the Universe.

One of this test of gravity consists in measuring the ratio between the two metric potentials, characterized by the \textit{anisotropic stress}, $\Phi=\eta\Psi$. $\Lambda$CDM and many dark energy models predict $\eta=1$ but, generally, modified gravity models predict $\eta\neq 1$. However, the observables at late-times considered so far are sensitive to only three combinations of the four fields, namely $\delta$, $\mathbf{V}$ and $(\Phi+\Psi)$. This means that current observations are not able to test all relations between the four fields. To overcome this problem, one usually has to assume that the continuity equation for dark matter holds: there is no exchange of energy between dark matter and dark energy; and that Euler equation also holds: dark matter follows geodesics. Using this, a measurement of $\mathbf{V}$ can be translated into a measurement of $\Psi$, which can then be compared to $(\Phi+\Psi)$ to test if the two potentials are the same \cite{amen}. We argue that this procedure only provides an indirect test that fails to give a measurement of the anisotropic stress if any of the aforementioned assumptions is not valid \cite{own}.

In this talk, we give a gauge-independent observable for galaxy clustering at linear order in perturbation theory which include relativistic effects. These terms will become relevant for future generations of galaxy surveys. Given that the relativistic effects are sensitive to  $\Psi$, it is thus possible to isolate and directly measure it in a model independent way. We finally show how we can build a new estimator for the anisotropic stress.

\section{Galaxy number counts at linear order}

Galaxy surveys probe the large-scale structure of the Universe at late-times. They provide us with maps of the sky in which the position of the galaxies can be parametrized in terms of redshift $z$ and the direction of observation $\mathbf{n}$. We can then \textit{count} the number of galaxies per pixel and measure the fluctuations between different pixels. Our observable is the \textit{galaxy number counts}, defined as $\Delta(z,\mathbf{n})=(N-\bar{N})/{\bar{N}}$, where $N$ is the number of galaxies at the pixel $(z,\mathbf{n})$ and $\bar{N}$ the average number of galaxies per pixel. The question is now: how is $\Delta$ related to the initial perturbations, the theory of gravity and dark energy? In order to answer this question, we calculate the perturbed photon geodesics to infer the change in energy and the change in direction induced by the underlying structure, which induce distortions in the coordinate system of $(z,\mathbf{n})$. The final expression at linear order in perturbation theory reads \cite{bon,yoo,chall}
\begin{eqnarray}
\label{eq:numbercounts}
\Delta(z,\mathbf{n})&=&b\delta-\frac{1}{\mathcal{H}}\partial_r(\mathbf{V}\cdot\mathbf{n})+(5s-2)\int^r_0dr'\frac{r-r'}{2rr'}\Delta_\Omega(\Phi+\Psi) \\
&+& \left(1-5s-\frac{\dot\mathcal{H}}{\mathcal{H}^2}+\frac{5s-2}{r\mathcal{H}}\right)\mathbf{V}\cdot\mathbf{n}+\frac{1}{\mathcal{H}}\dot\mathbf{V}\cdot\mathbf{n}+\frac{1}{\mathcal{H}}\partial_r\Psi \nonumber \\
&+& \frac{2-5s}{r}\int^r_0dr'(\Phi+\Psi)+3\mathcal{H}\nabla^{-2}(\nabla\mathbf{V})+\Psi+(5s-2)\Phi\nonumber \\
&+& \frac{1}{\mathcal{H}}\dot\Phi+\left(\frac{\dot\mathcal{H}}{\mathcal{H}^2}+\frac{2-5s}{r\mathcal{H}}+5s\right)\left[\Psi+\int^r_0dr'(\dot\Phi+\dot\Psi)\right], \nonumber
\end{eqnarray}
Where $b$ is the galaxy bias, $s$ is the magnification bias and $\mathcal{H}=a H$ is the comoving Hubble factor. The two first terms in the first line are the dark matter density perturbations and the \textit{redshift-space distortions} \cite{kai,ham}~\footnote{We call the combination of both as the \textit{standard} terms, since they are the relevant contributions for current measurements of $\mathbf{V}$ and $\delta$.}, while the third term is the \textit{weak-lensing} contribution. The latter is only relevant for very high redshifts and can be neglected for our purposes. The rest of the terms encode the \textit{relativistic distortions}. The second line contain two Doppler effects and the \textit{gravitational redshift} contribution, which is proportional to $\partial_r \Psi$ \footnote{Notice that we are not using Euler equation here. If we use it, the three terms in the second line combine to a single Doppler term. We want to keep the gravitational redshift explicit and the most general form of $\Delta$.}. The latter can be isolated to provide a direct measurement of the metric potential $\Psi$ \cite{own}. The third and fourth lines are other relativistic distortions involving the scalar metric potentials.

\section{Isolating $\Psi$ in the correlation function}

In practice, we do not measure the fluctuations in the number counts of galaxies per pixel individually. We study the correlation function between pairs of pixels and perform a multipole expansion. Using Eq.(\ref{eq:numbercounts}), the correlation function will be of the form
\begin{eqnarray}
    \xi(z,d)&=&\langle\Delta(\mathbf{x})\Delta(\mathbf{x}')\rangle \nonumber \\
    &=&\langle\Delta_{st}(\mathbf{x})\Delta_{st}(\mathbf{x}')\rangle+\langle\Delta_{st}(\mathbf{x})\Delta_{rel}(\mathbf{x}')\rangle+\langle\Delta_{rel}(\mathbf{x})\Delta_{st}(\mathbf{x}')\rangle
    +\langle\Delta_{rel}(\mathbf{x})\Delta_{rel}(\mathbf{x}')\rangle,
\end{eqnarray}
where we wrote $\mathbf{x}=(z,\mathbf{n})$ for simplicity. The correlation function will only depend on the redshift $z$ and the relative distance between the pixels, $d$. The last term is subdominant and can be neglected for our purposes. The relativistic corrections to the correlation function are thus encoded in the cross-correlation between \textit{standard} and relativistic contributions to the number counts.

We now perform a multipole expansion in powers of the angle between the line of sight and the line joining the two pixels, denoted by $\beta_{ij}$. We perform the operation
\begin{equation}
\label{eq:multipoles}
    \xi_l(z,d)=\sum_{ij}\Delta(\mathbf{x}_i)\Delta(\mathbf{x}_j)\,P_l(\cos\beta_{ij}),
\end{equation}
where $P_l$ are the Legendre polynomials and the sum runs over the pair of pixels. We find that $\langle\Delta_{st}(\mathbf{x})\Delta_{st}(\mathbf{x}')\rangle$ only contribute to the \textit{even} multipoles $(l=0,\,2,\,4)$: we can combine the measurements of the monopole, quadrupole and hexadecapole to isolate $\delta$ and $\mathbf{V}$. This is what it has been done in current surveys \cite{boss}. The Doppler effects and the gravitational redshift contribute to the \textit{dipole} $(l=1)$ and \textit{octupole} $(l=3)$ alone, and therefore they break the symmetry of the correlation function \cite{gaz}. However, this contributions are only non-zero when we correlate two populations of galaxies with different luminosities. We have to split our population of galaxies into two families, the \textit{bright} and \textit{faint} galaxies \footnote{The choice is somewhat arbitrary, but the simplest case is to consider that half of our population has a luminosity above certain threshold (bright galaxies), while the other half has luminosity below the same luminosity threshold (faint galaxies).}. The other effects in $\Delta$, the ones of the third and fourth line in Eq.(\ref{eq:numbercounts}), are independent on the direction $\mathbf{n}$ and thus contribute only to the monopole of the correlation function. They are subdominant with respect to the density perturbations and can be neglected \cite{yoo,chall}. Therefore, by correlating two populations of galaxies with different luminosities, we can combine the even and odd multipoles of the correlation function to isolate the gravitational redshift contribution \cite{own,own2}.

\section{Measuring the anisotropic stress}

We have seen that the information about the distortions in the distribution of galaxies at large-scales is encoded in the multipoles of the correlation function. The different multipoles can be considered individual observables in its own right, since we can always fit the data to isolate them individually by weighting the correlation function with the correspondent Legendre polynomial (see Eq.(\ref{eq:multipoles})). The idea for the new test for the anisotropic stress is first to directly measure the dipole of the correlation function, and to combine it with the even multipoles to isolate $\Psi$.

In practice, the dipole of the correlation function contains the terms $\langle\delta V\rangle$, $\langle V V\rangle$, $\langle\delta \dot V\rangle$ and $\langle\delta \Psi\rangle$. The $\langle\delta V\rangle$ and $\langle V V\rangle$ correlations are removed by using the even multipoles. The $\langle \delta \dot V\rangle$ correlation can be inferred from redshift evolution of the multipoles. This is the price to pay given that we do not want to assume the validity of the Euler equation. Putting all this together, we are left with the correlation between the density perturbations and the gravitational potential, i.e. the observable $O^{\delta\Psi}\equiv(b_B-b_F)\langle \delta \Psi\rangle$ \cite{own}.

Finally, measuring the anisotropic stress require an observable sensitive to $(\Phi+\Psi)$. This can be provided by \textit{galaxy-galaxy lensing}. Since $O^{\delta\Psi}$ is sensitive to the difference of the biases of bright and faint populations, we define a new observable that correlates the shapes of galaxies at high redshift (the lensed galaxies) with number counts of galaxies at low redshift (the lenses)
\begin{equation}
\label{eq:gglensing}
    O^{\delta(\Phi+\Psi)}\equiv\langle\Delta_B\kappa\rangle-\langle\Delta_F\kappa\rangle\propto(b_B-b_F)\langle\delta(\Phi+\Psi)\rangle,
\end{equation}
where $\kappa$ is the magnification of the lensed galaxies. We could also use the shear instead. Therefore, the ratio between this observable and the dipole measurement can give an estimator for the anisotropic stress $\eta=\Phi/\Psi$,
\begin{equation}
    O^\eta\equiv\frac{O^{\delta(\Phi+\Psi)}}{O^{\delta\Psi}}=\frac{(b_B-b_F)\langle\delta(\Phi+\Psi)\rangle}{(b_B-b_F)\langle \delta \Psi\rangle}\sim 1+\eta.
\end{equation}
Hence, the detection of any deviation from the value $2$ in the observable $O^\eta$ at any redshift will genuinely indicate the presence of an anisotropic stress. However, there is an important caveat here: we have implicitly assumed that the bias difference cancels. This means we need a survey which provides galaxy positions and shapes simultaneously, or the combination of two surveys that probe the same catalog of galaxies. While this is unlikely for the current and future  (Euclid or SKA), we have found that there is no significant statistical difference if we measure $\langle \delta \Psi\rangle$ alone, which removes the need to define $O^{\delta(\Phi+\Psi)}$ as in Eq.(\ref{eq:gglensing}) \cite{own2}.

\section{Conclusions \& Outlook}

Next generation of galaxy surveys will provide us with an enormous amount of data which can be used to test the laws of gravity on scales that are currently inaccesible. This opens the door to construct new observables which probe effects in the large-scale distribution of galaxies that are neglected in current analysis. On top of the density perturbations, redshift-space distortions and weak lensing, we have shown that the galaxy number counts at linear order in perturbation theory is also affected by relativistic distortions.

The relevant relativistic effects consist in two Doppler contributions and the gravitational redshift. They break the symmetry of the correlation function and contribute to the odd multipoles. In order to detect them, we must correlate galaxies with different luminosities. Given that each of the multipoles can be considered an individual observable, it is possible to combine even and odd multipoles to isolate the relativistic effects. This provides a direct measurement of $\langle\delta\Psi\rangle$, for which we expect an accuracy of $20-30\%$ in SKA at low redshift and large separations between galaxies \cite{own2}. Finally, the combination of this measurement with galaxy-galaxy lensing observations, which are sensitive to $\langle\delta(\Phi+\Psi)\rangle$, can be used to build an estimator for $\eta$ \cite{own3}. This method is model independent, in the sense that it does not assume the validity of the Euler or continuity equations, and thus provides a genuine measurement of the anisotropic stress.

\section*{Acknowledgments}

This project and the presence of the author at the conference has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program (Grant agreement No. 863929; project title ``Testing the law of gravity with novel large-scale structure observables"). We also acknowledge funding from the Swiss National Science Fundation (SNSF). The author also acknowledge the organization of the ``56th Rencontres de Moriond" conference for the opportunity to present this work.

\section*{References}

redpajama_set_name: RedPajamaArXiv


text:
Newton's 9/11 honor roll
by Greg Reibman | Sep 11, 2018 | Newton, Newton people | 15 comments
Tags: 9/11
As has become an annual tradition here on Village 14 here are the names of 17 individuals who died as a result of the Sept. 11, 2001, terrorist attacks that are known to have a Newton connection. If you know of any additional names, please add them to the comments section.
Mark Bavis, a Roslindale native who had recently moved to West Newton, was a hockey star at Catholic Memorial High School. He was on board one of the two planes.
Ruth Clifford McCourt, owned and managed a business that may have been called Clifford Classique in Newton Highlands and/or Beacon Street and lived on Comm Ave in Newton in a big Victorian. This article says her four year old daughter was also on board, the youngest victim that day. She was close friends with Paige Farley-Hackel.
Paige Farley-Hackel, 46, was a member of the Salvation Army Advisory Board, and was trying to get certification as a spiritual instructor. She was on board American Airlines Flight 11, heading to California to speak with radio producers about a radio show on spirituality.
Eric Hartono, originally from Indonesia, was reported to be a student in Newton who was moving to Los Angeles. He was on board United Airlines Flight 175.
Nicholas Humber, 60, a resident of Auburndale. He was one of the first employees of the Environmental Protection Agency in 1971, and was instrumental in starting its waste management division. He was also on American Airlines Flight 11.
Aaron Jacobs died at the World Trade Center at age of 27. A vice president and partner on the international trading desk at Cantor Fitzgerald. His parents, Alice and Laurence Jacobs lived in Waban.
Ariel Louis Jacobs, 29,was a newlywed, an expectant father, executive vice president of U.S. Operations of Caplin Systems, and the brother of Newton-resident Claudia Jacobs when he died in the World Trade Center. His first and only child was born six days after his death.
Danny Lewin, 31, died on board American Airlines Flight 11. He lived in Newtonville with his wife and children. He founded Akamai Technologies, a website management system.
Juliana McCourt, Daughter of Ruth Clifford McCourt. At age four was the youngest victim on the day.
Stuart Meltzer, 32, grew up in Newton Highlands and moved to Long Island not long before his death. He was remembered fondly by teachers and coaches at the Rivers School in Weston. He worked in energy management, with offices in the World Trade Center.
Richard Ross, 58, a resident of Oak Hill. A businessman, he moved to Newton 22 years before, and had run a travel agency and a copy machine sales business before becoming a corporate consultant. He died on board American Airlines Flight 11.
Jean, 55, and Don Peterson, 66, of Spring Lake, N.J. Jean was a retired nurse and nursing teacher, church and community volunteer. Don was a retired president, Continental Electric Co., church and community volunteer. The mother and stepfather of Newton North Principal Jen Price were aboard United Flight 93.
Rahma Salie, 28, and Michael Theodoridis, 32, were expecting their first child when they died aboard American Airlines Flight 11. She worked for an internet security company and he was a technology consultant. Their parents, Haleema and Ysuff Salie, live in West Newton and are part of the Salie family that owns L'Aroma Cafe and Bakery in West Newton.
Clarin Siegel Schwartz, 51, was a tax lawyer and senior vice president at Aon Consulting Inc. in the World Trade Center. She was also a 1967 graduate of Newton South High School.
Amy Toyen, 24, grew up in Avon, Conn., and moved to Newton in 1999. She was planning to get married in 2002. She was on the 106th floor of the World Trade Center at a trade show for her company, Thompson Financial Group.
BOB BURKE on September 11, 2018 at 8:26 am
This is always a sad day for me and many others in Newton. Through different associations I belong to, I knew both Paige Hackel and Aaron Jacobs. Both had warm, generous and principled personalities despite being on radically different professional tracks. Both were snatched from their families and this community before they could make the full contribution to society I'm certain they would otherwise have made.
Mike Striar on September 11, 2018 at 12:56 pm
Thanks to Village 14 for remembering and acknowledging these Newton residents who lost their lives on 9-11. My personal thoughts about that fateful day have evolved over the years. I'll return to this thread in the next few days to share them. But today is a day to focus on the fallen and honor their memories. May they all rest in peace.
Bugek on September 11, 2018 at 1:19 pm
For those who dont know, Danny Lewin invented an algorithm which is the founding principle of about 20% new databases technologies world wide. Amazons shopping scale would not be possible without it.
A great loss…
Virginia gardner on September 11, 2018 at 3:49 pm
Thank you Village 14 for remembering. If you are available tomorrow evening the Newton 9/11 memorial committee will host a remembrance ceremony at the memorial. 6:00 Newton center Fire Headquarters. love never dies.
Greg Reibman on September 11, 2018 at 3:53 pm
Thanks Virginia: I do plan on attending tomorrow.
Also, I've been meaning to check to see if the Newton 9/11 memorial also lists 17 names?
I added Ruth Clifford McCourt and her 4-year-old daughter Juliana for the first time this year, after learning about her for the first time from a Village 14 comment last Sept. 11. If anyone knows of anyone else who are missing, please share in the comments section.
Dan on September 11, 2018 at 4:17 pm
Danny Lewin was an IDF/Mossad agent prior to his role in inventing (patent?) the content delivery network algorithm which powers a lot of what makes the internet as a whole work. Every time you look at a picture, movie, song, other content in a webpage you are using this technology.
He possibly understood what was about to happen (which is terrifying), and lay down his life to stop/thwart it.
Hundreds of stories of Heroes on that day and his still rises toward the top.
Laura on September 11, 2018 at 9:56 pm
Thank you for posting this beautiful tribute, Greg.
I'd like to point out that while Juliana McCourt was indeed the youngest victim from Newton, she was not the youngest victim of the day; that would be 2 1/2-year-old Christine Lee Hanson of Groton, who was aboard United Flight 175 with her parents:
https://www.911memorial.org/blog/new-view-youngest-911-victim's-stuffed-peter-rabbit
May all their souls rest in peace.
Virginia gardner on September 12, 2018 at 8:03 am
Thank you , Greg. In 2011 we were given the list of only 8 people. I think it is time to revisit this list . If you have anytime to meet with me , Sande and Suzanne, please contact me directly. Perhaps at the end of the month.
thank you, Virginia, Ginny , Gardner
Mike Striar on September 17, 2018 at 7:57 pm
Now that nearly a week has past, I wanted to come back to this thread with some of my thoughts about 9/11. I believe the government lied to the American people about numerous aspects of that horrid day. Whether they lied as part of a larger conspiracy or simply to cover-up responsibility remains a question in my mind. I believe two facts should leave everyone questioning the story they've been told about 9-11….
Fact #1: Despite the Pentagon being one of the most secure buildings on Earth with at least 85 exterior video cameras, no footage showing an aircraft hitting the building has ever been publicly released. When a federal judge ordered the government to release video footage of the attack, they released a few frames that show a fireball, but none that shows a plane. I won't speculate here. People can draw their own conclusions.
Fact #2: No steel frame high rise building in history had ever collapsed from fire prior to 9-11 [or since]. While the impact of jet aircraft may arguably be responsible in part for the collapse of the Twin Towers, I'm referring to an entirely different building. WTC Building 7, a 47 story office building also collapsed on 9-11, although it was not hit by a plane. The building's tenants included the CIA, IRS, Secret Service, and the NYC Office of Emergency Management. The government claims Building 7 collapsed from fire. I'd encourage people to google "Building 7," and check out the video footage of its collapse for themselves. Again, draw your own conclusion.
Independent Man on September 17, 2018 at 8:30 pm
@Mike I believe you have been smoking too much of that marijuana that you love so much. You should really take a break from that stuff and come back to earth with the rest of us.
Architects and Engineers for 9/11 Truth.
http://www.ae911truth.org
Mary Mary Quite Contrary on September 17, 2018 at 8:57 pm
Nooooo….I can't believe you're a 9/11 truther!
@MMQC Yes, yes he is….truly disrespectful to the people on Flight 77 and Flight 93 who died while trying to stop another attack. Many of them were speaking to their loved ones while fighting hijackers. I'm sure they were in on your crazy conspiracy too. Wow…that's all I can say.
The questions I have are shared by many people who lost family members on 9/11. There's nothing "disrespectful" about questioning the government's version of the "truth." I suggest a film called "9-11: Press for Truth," which focuses on people who lost loved ones and are calling for a new investigation. You can find it on Amazon Prime.
I'd be happy to discuss the two facts I presented about 9-11 in a post above. No publicly released photos or video of a plane hitting the Pentagon, and the collapse of WTC Building 7. I'd be especially happy if anyone challenges the accuracy of those two specific points I made. I'd love to be proven wrong.
Bruce Wang on September 18, 2018 at 1:05 pm
@Mike Striar I heard the government faked the moon landing. Any truth to that?

redpajama_set_name: RedPajamaCommonCrawl


Teacher Frank Letch of Llanuwchllyn, Gwynedd discusses his life and living with his acquired disability in this TV documentary. In Welsh with English subtitles.
A fascinating portrait of a disabled husband, father, and teacher living in Wales. Frank Letch lives a remarkably independent life. He is shown riding a modified bike, driving an automatic car, and sailing; all with apparent ease. Frank also demonstrates extremely skilful use of his feet while gardening and playing darts. Always on the lookout for challenges, Frank became a fluent Welsh speaker in just two years. Musical interludes throughout help convey his upbeat approach to life.
Frank Letch went on to become Chairman of Reach, a charity for children with upper limb deficiency. He retired to Devon, later becoming a Liberal Democrat local councillor. He has been Mayor of the town of Crediton for the past ten years. Frank received a MBE in 2015.
Blockheads lead singer talks about how becoming disabled has affected his life and music.
A new baby completes the Owain family, birthdays are celebrated, trips out undertaken and son Robin paints, following in his dad's footsteps.
The unveiling of a statue (Sir Ifan ab Owen Edwards), the crowning of a bard (Dafydd Rowlands) and a trip on the Vale of Rheidol Railway for writer Annes Glynn and friends.


In this present study, an attempt was made to investigate the efficiency of chitosan to recover a protein from sweet potato starch wastewater under various operating conditions such as agitation time, initial pH, chitosan dose and settling time. Four factors three level Box-Behnken response surface design (BBD) coupled with response surface methodology (RSM) was used to modeling the protein recovery process. From the BBD results, second order polynomial model was developed and its adequacy was evaluated by pareto analysis of variance (ANOVA). 3-D response surface contour plots were developed from model and it was used to study the interactive effects of process variables on response. Optimum operating conditions were determined using desired function methodology and were found to be: agitation time of 9 min, initial pH of 5, chitosan dose of 0.8 g/l and settling time of 35 min. Under these conditions, 95% of protein was recoverd. Recovered protein was analyzed and it could be used as a livestock feed ingredients. Electrophoresis, SEM analysis also used and myosin heavy chain bands at approximately 200 KDa, actin bands at approximately 40 KDa are obtained.
Sweet potato starch processing industry generates very large amount of wastewater approximately 5.5 billion gallons per annum, which mainly contains very high organic loads associated with sweet potato starch losses . Particularly, sweet potato starch breaking section contributes a considerable amount of effluent generation and it primarily contains 56% of protein, which results high biological oxygen demand (BOD) and chemical oxygen demand (COD). Discharge of this untreated wastewater into the ecological system causes the negative impact on living aquatic species and human beings . The existing wastewater treatment system in sweet potato starch processing industry is based mainly on biological treatments of anaerobic and aerobic treatment process. These treatment processes are a quite inefficient and unfortunately leads to the environmental pollution issues due to the low removal efficiency of organic matters. Moreover, the nutrient source namely protein, available in the sweet potato starch processing industry wastewater cannot be effectively recovered for reuse after the conventional treatment process has been adopted . As a result of rapidly rising water scarcity and pollution associated with the ecological problems, tremendous volume of sweet potato starch processing industry wastewater requires a intensive treatment techniques to reduce the toxic matters as well as to recover the valuable byproducts, before its discharge. It is not only reducing the negative environmental impact due to discharge of wastewater streams, but also generate potential profits.
On the other hand, protein is one of the most important ingredients used in animal feed. At present, with the rapid development in protein utilization, there is no enough protein to meet the need of the world, so it is important to find new sources of protein . Last few decades, several separation techniques such as membrane separation, ethanol precipitation, electro flocculation and coagulation  have been used for recovering proteins from various wastewaters. However, these techniques involve large number of critical steps, very large capital, and low removal efficiency of toxic matters, complex treatment setup and long retention time . Furthermore, scale up of these methods is very difficult and also expensive.
Nowadays, application of natural biopolymers in wastewater treatment process gaining a considerable attention, due to its removal of toxic matters and recovery of useful by product . Among, various kinds of biopolymers, chitosan (poly (D-glucosamine)) is a natural deacetylated marine biopolymer which widely employed in a wide range of practical applications including wastewater management, pharmacology, biochemistry, and biotechnology due to the its excellent properties such as biodegradability, hydrophilicity, biocompatibility, adsorption property, flocculating ability, polyelectrolytic, antibacterial property, nontoxic, and its environment friendly nature .
An extensive literature survey shows that there is none of research report was available on the treatment of sweet potato starch wastewater using chitosan to recover protein. Hence, the primary objective of the present study is to investigate the effect of process variables such as agitation time, initial pH, chitosan dose and settling time on protein recovery from sweet potato starch processing industry wastewater using biopolymer (chitosan). Because, high proportions of amino functions of chitosan may provide a novel binding properties for protein recovery from sweet potato starch processing industry wastewater. Moreover, Response surface methodology (RSM) coupled with Box-Behnken response surface design (BBD) was used to optimize and investigate the process variables on protein recovery and mathematical model was developed in order to predict the response value under the experimental range used in this study. RSM is an intelligent technique for response understanding and achieving optimized process conditions and has been widely used for wastewater treatment processes . Finally, the recovered protein was analyzed to use as a livestock feed ingredients using protein digestibility test. Electrophoresis, SEM analysis also used to examine the recovered solid.
The wastewater used in this study was collected from sweet potato starch processing industry near Erode, Tamil Nadu, India and were stored at 4℃ prior to the experiments in order to avoid changes in the physico-chemical properties of wastewater. The characteristics of sweet potato starch processing industry wastewater used in the present study are shown in TABLE 1. All the chemicals (HCl and NaOH) used in this study are analytical grade and purchased from local suppliers from Erode, Tamil Nadu. Chitosan (powder) was purchased from Sigma chemicals, Chennai.
Table 1: Characteristics of potato starch processing industry wastewater.
Recovery of protein from sweet potato starch wastewater were carried in 250 ml conical flask containing 100 ml of composite sweet potato starch industry wastewater under various working condition such as agitation time (5-15 min), initial pH (2-6), chitosan dose (0.9-1.3 g/l) and setting time (10-50 min). Incubator shaker equipment was used to agitate the samples with desired chitosan dose which were allowed to settle at different settling time. pH of the wastewater sample was adjusted using 0.1 N HCl and NaOH. All the experiments were performed in triplicates and the results were presented as the mean value of the triplicates.
Protein content in sweet potato starch wastewater water was determined using methods described by Lowry et al., . Settled sweet potato starch solids were dried in a drying oven at 70℃ and it was used to analyze the protein.
In this present study, response surface methodology coupled with Box-Behnken response surface experimental design (BBD) was employed to investigate the individual and interactive effects of process variables on protein recovery using chitosan from sweet potato starch processing industry wastewater. Design- Expert 8.0.7.1 (State-Ease Inc., Minneapolis, MN, USA) statistical package. Agitation time (A), initial pH (B), chitosan dose (C) and settling time (D) were selected as independent variables, while protein recovery was selected as a response function. The detailed methodology used in this present study was reported elsewhere .
1 g of recovered sludge protein sample in 15 ml of water was heated and it was cooled for 20 minutes. After cooling, 5 ml of 0.02 M sodium barbiturate buffer containing 0.15 M sodium chloride (NaCl) and 5 mg of pronase were added. Then this reaction mixture was shaked vigorously and solids were separated by centrifugator. Again resuspended particles of the solids was heated in water bath and cooled. To this, 5 ml of barbiturate buffer and 5 mg of chick pancreas acetone powder were added and shaked well. Then the solids were finally filtered through a filter paper, air dried, weighed and analyzed for nitrogen (N). Protein digestibility (%) was calculated as follows .
Where, A, B are Nitrogen present in the sample and indigested fragment respectively. Scanning electron microscopy (SEM) analysis of recovered solid was examined at 25 kV accelerating voltage under the maximum magnification (20,000× ). In Electrophoresis analysis, the sodium dodecyl sulfate polyacrylamide gel electrophoresis system (SDS-PAGE) was used with a Photodyne Foto/Force 300 electrophoresis apparatus. The protein bands were visualized from the gels stained with Coomassie blue.
In this present study, protein recovery was investigated using chitosan from sweet potato starch processing industry wastewater. According to BBD, 29 batch experiments were conducted and its results are shown in TABLE 2.
Table 2: BBD experimental design with results.
Then, BBD experimental data was investigated using two different multi regression analysis (TABLE 3 and 4) namely the sequential model sum of squares and model summary statistics  in order to select effective mathematical model to portray the protein recovery process.
Where, Y1 is protein recovery; A, B, C and D are agitation time, initial pH, chitosan dose and settling time respectively. Then the adequacy of developed mathematical model was examined by constructing analytical plots (FIG. 1) such as normal plot of residuals (FIG. 1a), residuals vs predicted (FIG. 1b), residuals vs run (FIG. 1c), predicted versus actual plot (FIG. 1d), externally studentized residuals (FIG. 1e), leverage (FIG.1f), which help us to find out the affiliation between predicted and experimental values and evaluate the model fitness.
Figure 1: (a-f) - Model adequacy plots.
Figure 2: Response surface plots representing the effect of process variables on protein recovery.
Moreover, pareto analysis of variance (ANOVA) was used to analyze the experimental data and significance of the developed models equations were evaluated by their corresponding F- value and p-values (TABLE 5). The higher model F-values and lower p-values, adequate precision values (AP) and CV% values of the response demonstrated that the developed model was highly significant. From this results, it can concluded that, the developed mathematical models has the ability to describe the present recovery process very robustly [15,16].
Table 5: ANOVA results for protein recovery.
It is very important that study of effects of process variables on the response in protein recovery process, which give the in depth knowledge regarding the treatment efficiency and mechanism behind the recovery of protein. So that, from the developed mathematical model, 3-D response surface contour plots are constructed in order to evaluate the effects of the independent variables on the response and it is given in FIG. 2.
Agitation time is one of the crucial parameter influence the recovery of protein from sweet potato starch industry wastewater. In order to investigate the effect of agitation time on protein recovery, experiments were carried out in various agitation time (5-15 min) and the results are shown in FIG. 2. From the results, it is observed that, the recovery of protein is increased linearly with increasing agitation time upto 12 min. This can explained by the fact that, increases in agitation time up to 12 min would increase the adsorption of organic matters [17-19] present in the sweet potato starch wastewater on chitosan and enhances the protein recovery. However, agitation time beyond 12 min shows negative impact on protein recovery process due to breakdown of proteins.
Initial pH is the key parameter influence the protein recovery process which mainly associated with surface charge of the chitosan. So that, experiments were carried out to study the effect of initial pH (2-6) on protein recovery. From the results, it is observed that, the protein recovery increased linearly with increasing pH from 2-4 (FIG. 2). This is due to the fact that, increase in pH up to 4 improve the solubility of chitosan and creates the -NH3+ ion  which enhances the protein recovery from sweet potato starch industry wastewater. However, initial pH beyond 4 resulted lower protein recovery, due to the decrease in the solubility of chitosan.
Chitosan dose is one of the important process variables for protein recovery and it is associated with the adsorption/coagulation efficiency. To study it's effect on protein recovery process, experiments were carried out in various chitosan dose (0.9-1.3 g/l) and the results are shown in FIG. 2. From the FIG. 2, it is found that, the protein recovery is increased rapidly with increasing the chitosan dose up to 1.1 g/l. This phenomenon could be explained by that, the increase in chitosan dose increases the reactive site to the effective adsorption/coagulation process which enhances the protein recovery . Beyond 1.1 g/l of chitosan dose shows the negligible protein recovery, due to the formation of equilibrium between chitosan surface and organic matters present in the sweet potato starch industry wastewater.
The settling time is also an primary factor which influence the protein recovery process, effectively. In order to investigate the effect of settling time on protein recovery process, experiments were carried out with various settling time (20-50 min) and the results are shown in FIG. 2. From the FIG. 2, it is observed that, protein recovery is increased with the increasing settling time from 20-40 min. This can be explained by the fact that increase in the settling time would increase the floc aggregation and forms the compact, high density floc which increases the recovery of protein . Beyond the settling time of 40 min shows the negligible effect on the protein recovery due to negative impact of protein adsorption.
Derringer's desired function methodology was used to optimize the operating variables and it was found to be: agitation time of 9 min, initial pH of 5, chitosan dose of 0.8 g/l and settling time of 35 min. Under these conditions, the protein recovery was 95.54% with desirability value of 0.90. In order to validate the optimum operating conditions, triplicate experiments were performed under the optimized conditions and the results indicates (96% of protein recovery) the close agreement of experimental data with predicted value from developed mathematical model. These results demonstrated the validation of the optimized conditions of present protein recovery process from sweet potato starch industry wastewater using chitosan as an coagulant/adsorbent. Also, scanning electron micrograph (FIG. 3) of chitosan (after process) also confirms the recovery of protein on chitosan surface. Also, sodium dodecyl sulfate polyacrylamide gel electrophoresis pattern of sample is shown in FIG. 4, which indicates that myosin heavy chain bands at approximately 200 KDa, actin bands at approximately 40 KDa are obtained.
Figure 3: Effect of the column diameter on holdup.
Figure 4: Electropolarization curves of Sn61Bi25Sb5Zn4Al3-XAg2(TiO2)X alloys.
The protein present in the recovered solid is examined to find out the concentration of protein. It shows 40% of protein recovered using chitosan. The digestibility of recovered protein (104%) was determined and compared with proteins derived from corn meal (54%). These information exhibits that digestibility of recovered protein from the sweet potato starch wastewater is considerably higher than corn meal protein. This is due to the fact that that denaturation of proteins present in recovered sweet potato starch solid increases the digestibility of recovered protein . Hence, it is confirmed that the chitosan has the ability to recover the protein from sweet potato starch wastewater.
In this present study, recovery of protein from sweet potato starch processing industry wastewater was examined under different process conditions such as agitation time (5-15 min), initial pH (2-6), chitosan dose (0.9-1.3 g/l) and setting time (10-50 min). Mathematical modeling of the present study was done by response surface methodology (RSM) coupled Box-Behnken response surface design (BBD) with four factors at three levels and second order polynomial models were developed from the experimental data in order to predict the response with high correlation coefficient values. Under the optimum operating conditions; agitation time of 9 min, initial pH of 5, chitosan dose of 0.8 g/l and settling time of 35 min, recovered the 95.54% protein. Digestibility of recovered protein shows that it can be used as a livestock feed ingredient. Present results exhibited that, chitosan is found to be a suitable natural biopolymer to recover protein from sweet potato starch processing industry wastewater by precipitation.
Xu LJ, Sheldon BW, Larick DK, et al. Recovery and utilization of useful by-products from sweet potato starch processing wastewater by electrocoagulation. Poultry Science.2002;81(6):785-92.
Xu LJ, Sheldon BW, Carawan RE, et al. Recovery and characterization of by-products from sweet potato starch processing plant wastewater using coagulants. Poultry Science. 2001;80:57-65.
Sridhar R , Sivakumar V, Prakash Maran J , et al. Influence of operating parameters on treatment of sweet potato starch processing effluent by electrocoagulation process. Int J Environ Sci Technol.2013.
Xiaolin C ,Cuiping, L, Xia J, et al. Recovery of protein from discharged wastewater during the production of chitin. Bioresour Technol.2008;99(3):570-74.
Bourtoom T, Chinnan MS, Jantawat P, et al. Recovery and characterization of proteins precipitated from surimi wash-water. LWT-Food Science and Technology. 2009;42(2):599-605.
Martí C, Roeckel M, Aspe E, et al. Recovery of proteins from fishmeal factory wastewaters. Process biochemistry. 1994;29(1):39-46.
Sridhar R, Sivakumar V, Immanuel VP, et al. Treatment of pulp and paper industry bleaching effluent by electrocoagulant process. J Hazard Mater. 2011;186(2-3):1495-502.
Ulmer Verlag Lowry O, Rosebrough N, Farr A, et al. Protein measurement with Folin-phenol reagent. J Biol Chem. 1951;193:265-275.
Thirugnanasambandham K, Sivakumar V. Removal of ecotoxicological matters from tannery wastewater using electrocoagulation reactor: Modelling and optimization. Desalin Water Treat. 2016;57(9):3871-80.
Quanhong L, Caili F. Application of response surface methodology for extraction optimization of germinant pumpkin seeds protein. Food chemistry. 2005;92(4):701-6.
Sridhar R, Sivakumar V, Immanuel VP, et al. Development of model for treatment of pulp and paper industry bleaching effluent using response surface methodology. Environ Prog Sustain Energy. 2012;31(4):558-65.
Rustom I, L ópez?leiva MH, Nair BM. Optimization of extraction of peanut proteins with water by response surface methodology. J Food Sci. 1991;56(6):1660-3.
Thirugnanasambandham K, Sivakumar V. Influence of process conditions on the physicochemical properties of pomegranate juice in spray drying process: Modelling and optimization. Journal of the Saudi Society of Agricultural Sciences. 2015.
Thirugnanasambandham K, Sivakumar V, Maran JP. Modeling and investigation of submerged fermentation process to produce extracellular polysaccharide using Lactobacillus confusus. Carbohydr Polym. 2014;114:43-7.
Riaño B, Molinuevo B, García-González MC. Optimization of chitosan flocculation for microalgal-bacterial biomass harvesting via response surface methodology. Ecological engineering. 2012;38(1):110-3.
Thirugnanasambandham, K Sivakumar, V Prakash Maran, J et al. Application of response surface methodology for optimization of chemical coagulation process to treat rice mill wastewater.2014a;9:237-47.
Guzman J, Saucedo I, Revilla J, et al. Copper sorption by chitosan in the presence of citrate ions: Influence of metal speciation on sorption mechanism and uptake capacities. Int J Biol Macromol. 2003;33(1-3):57-65.
Ngah WW, Ab Ghani S, Kamari A. Adsorption behaviour of Fe (II) and Fe (III) ions in aqueous solution on chitosan and cross-linked chitosan beads. Bioresour Technol. 2005;96(4):443-50.
Crini Gregorio, Badot PM. Application of chitosan, a natural aminopolysaccharide, for dye removal from aqueous solutions by adsorption processes using batch studies: A review of recent literature. Progress in polymer science. 2008;33(4):399-447.


We're hearing it over and over again from marketers. They're saying, "I've sat down through so many Webinars on social media, and they're all telling us to develop a strategy, but what is that strategy?" Well, we've heard you, but now we're listening.
There have been several leaders who have addressed this recently, such as a story by @eMarketer entitled, "What Makes Up a Social Marketing Strategy?" Quality content here. Definitely save this as a favorite. I would like to take a different approach, however, to help those that seem to struggle with integrating social media in their marketing mix.
Let's focus in on Twitter. If you don't understand Twitter, you cannot possibly develop a strategy. As an example, I don't know how to play chess, so how would I be able to strategize a move that is beneficial to me? Going nowhere is not an option and quite boring. In fact, I wouldn't hold my own attention, much less anyone else's.
Some of you may relate better to football. First, you have to really understand the game. I actually do and certainly get it when Penn State wins. Then your coach (Twitter) can guide you (football) toward your goal (whatever you decide that to be). Setting a goal may be to connect to like-minded business executives, marketers, and/or owners so that you can stay abreast of what is happening in your industry.
You must engage everyone on your team (those you follow) in order to reach your goal. Just throwing out the football (your tweets) will leave everyone cold, bored, and unengaged. They may even quit your team (unfollow you). Know what others are doing, saying, and care about, and be courteous as though you were having a discussion in person. Choose your words wisely. This is even more important than in person.
Your goal may become very different than what it was months ago. Last August, my objective was only to learn everything I could about Twitter through the sharing of links and information from SEOs, CEOs, and marketing leaders I was following. Starting with just 30 people to follow was a choice I made so that I could keep up. I didn't even start contributing to the communication stream until after one month. More than a year later, I'm now ready to develop a strategy that is best for me.
Depending on your goals, type of business, and who you wish to reach, you will have to decide in which social media service you invest most of your time. My recommendation would be to have a presence on LinkedIn, Facebook, and Twitter, but not necessarily in equal parts. Hopefully, your marketing mix already includes advertising, publicity, public relations, promotions, and sales. You will now add social media.
It is unfortunate if we view ROI only as dollars in return. For example, I like to think that my investment of time in Twitter results in ROE (return on energy). The energy I put into it comes right back to me ten-fold or a hundred-fold from some of the best of the best in the social media community. How do you attach a number that?
Have you reached a stumbling block on the strategy for your social media presence? Have you integrated Twitter or some other social media service into your marketing mix? Are you still confused? Should the goal always be dollars and cents?


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January 04, 2018 1:40pm PT by Lesley Goldberg
'Ozark' Recruits Janet McTeer for Season 2 (Exclusive)
The actress will pull double duty for Netflix with roles on both 'Ozark' and 'Jessica Jones.'
Janet McTeer is poised to pull double duty for Netflix.
The actress has joined the cast of the streaming giant's drama Ozark, where she will be a series regular.
Produced by Media Rights Capital, Ozark revolves around financial planner Marty Byrde (Jason Bateman) and his wife, Wendy (Laura Linney), and their family's sudden relocation from the suburbs of Chicago to a summer resort community in the Missouri Ozarks after a money laundering scheme goes wrong and Marty must pay off a debt to a Mexican drug lord. McTeer will play a Chicago-based attorney who has links to the cartel. In making a deal with the devil, she becomes a potential threat to the Byrdes.
McTeer's casting on Ozark comes on top of her previously announced series regular role on Netflix's Marvel drama Jessica Jones, giving her the rare honor of being a part of the cast of not one but two series at the company.
Ozark has become an early awards player for Netflix, with Bateman earning a Golden Globe nomination and both he and Linney scoring SAG Awards mentions. The series also received a WGA nom for best new series.
For her part, McTeer is a Golden Globe-, Tony Award- and Olivier Award-winning actress. She returned to Broadway in October for Les Liaisons Dangereuses. Her TV credits include Battle Creek, The Honourable Woman, The White Queen and features Albert Nobbs and The Woman in Black. McTeer is repped by Curtis Brown Group and MGMT Entertainment.
A season-two return date for Ozark has not yet been announced.


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Q: Parametric Equations for Circles Question - A circle has the equation:
$$(x-3)^2 + (y+1)^2 = 16$$
Find parametric equations to describe the circle given that:
(a) $x = 3 + 4\cos t$
(b) $x = 3 - 4\sin t$
Much appreciated if explanation can also be given! How can coefficient be negative when it relates to radius? Also why the $x$ part is $\sin$ when it's usually always $\cos$?

A: (a) for given x, $y=-1+4\sin t.$
(b) for given x, $y=-1+4\cos t.$
Polar co-ordinate parametrization  must be $x=rcos t, y=rsin t. $  (b) is another such parametrization which satisfies the equation of the given circle.

A: Hint: Just plug your expression for $x$ into the original equation for the circle and solve for $y$.
For your second question, it doesn't matter which you choose for $\cos$, as long as together they satisfy the original equation. Using a different parameterization just means the point may not move around the circle in the "usual" way. The "usual" parameterization has the point start at the right side of the circle and move once around the circle counterclockwise. The direction, speed, and starting point can be varied by changing the parameterization.

redpajama_set_name: RedPajamaStackExchange


At the same time, Tessitura also allows organizations to tailor the way an individual production or event is presented online. This is especially helpful when working with such a broad variety of offerings. In addition to a focus on classical music, jazz, and dance, Celebrity Series also presents several other genres, from speakers to American songbook artists to folk music.


Below are the most recent issues of our monthly e-newsletter, Modern Times. To sign up to automatically receive Modern Times in your inbox each month, please email granvillehistorical@gmail.com. It is free for both members and non-members!
For earlier issues of the Modern Times, please contact the Society at granvillehistorical@gmail.com.


Once Loved, Twice Broken - An Art Show - .
My friend Chris has a gallery show at the California Heritage Museum in Santa Monica thru March 17th. His sculpture is intricate and funny and all about his own particular brand of social commentary. The show also includes a replication of his spectacular living room.
I mean just look at this piece, you guys. Zoom in and really check it out. It's spectacular.
You can read more about Chris and his work here.


Tim's new album has just been released on Inside Out. I authored the DVD which features my 5.1 mix of this album as well as Tim's previous album 'Stupid Things the Mean the World'. It also includes my high resolution stereo mix of that album. The excellent stereo mix of Lost in the Ghost Light was by Steven Wilson.


One of the most popular ways people change the way they look is by coloring their hair. Some people just do it to cover up gray hair, and others go for a dramatic change. Then there are people at every level in between. If you're thinking about getting hair coloring in Midtown NYC, make sure you get professionals to do it for you. Prestige Hair Salon NYC has been dyeing people's hair for many years, and since we use only top of the line products, you can be confident that your hair will look perfect.
There are an almost unlimited number of different reasons why people color their hair. For some people it is just something fun to do once in a while for a little change. Others go for something much more outrageous so they can stand out from the crowd. Most people just want to change their look a little bit, so they choose a color that they feel will complement their overall style. Whatever you're reason for wanting to get your hair colored, it is important to let a professional do the work for you.
The professionals here at Prestige Hair Salon will be happy to help you choose a color that will look great on you. Then, we'll pick out the right product and apply it perfectly.
Prestige NYC Hair Salon is the right place to go when you're looking to get your hair colored. In addition to having top of the line products, and years of experience helping people color their hair, we are also a full-service salon. That means you can come in, have your hair washed, colored, cut and styled- all from the same place. Many of our customers build relationships with their favorite stylist, so they know exactly what types of styles they will. If you're interested in hair coloring in Midtown NYC, stop in our salon at 160 East 55th Street, New York, NY 10022.


Check out some photos of our gear in our gallery here!
Rates that start at $5/hr per person – Solo & Student Discount Rates Available!
In need of a more stable, long-term solution? Our monthly studios offer a variety of solutions for every musician.


This product helped my baby a lot. However, as it says, you cannot use this pillow when the baby sleeps. I was able to use it while my baby was being swaddled but she grew out of it and she can't use the pillow any more because she'll just slide right out of it and be some where completely else in the crib. But the product is great. I plan to use it again for my next kids and prevent flat heads. Seller is quick, got product within two days.


IBC2017: Brian Sullivan, President/COO, Digital Consumer Group, Fox Networks told IBC delegates that disruption in TV is perfectly natural.
Brian Sullivan, President/COO, Digital Consumer Group, Fox Networks told IBC delegates that disruption in TV is perfectly natural. "Once, consumers had all the power. They watched three TV channels without a fee and saw great entertainment.
"Cable changed that paradigm, then came VHS tapes and DVD forcing another change. Then came TiVo and PVRs, which gave consumers greater control but at a cost of almost $100 a month.
"Then came the streamers, and consumers saw that they could get all this seemingly wonderful content at less than $10 a month. Today, in the US there are more than 200 of these content aggregators, but what's happened to the 'missing' $90?
"I can tell you it isn't working for business. We, with Fox Now, have started from scratch and put the power back into the consumer's hands. We have moved from about 17 different networks to just five.
Sullivan is also a board director at Hulu, and moderator Kate Bulkley asked what his feelings were about Netflix and Amazon Video. "Netflix is a spectacular service at a spectacular price. We, the studios, created it with our content. But, like the other studios, we will review the shows they screen on a case by case basis.


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HomeCOVID-19Surge may spark 'rationed' care
Surge may spark 'rationed' care
If 90% of icu beds are in use, triage system is an option
December 23, 2020 Frank X. Mullen COVID-19, News 0
IMAGE/WASHOE COUNTY: The area's COVID-19 Threat Meter is just a click away from the severe level of virus cases.
If the region's intensive care hospital beds reach 90% occupancy over the holidays, a "scoring" system to determine which COVID-19 patients get what kind of treatment is ready to be activated.
"We're in a process where these systems are in place, but I'm not saying that (rationing care) is being done now," said Dr. John Hess, a family physician at Saint Mary's Health Network Reno. He said if cases and hospital capacity continue to surge in the coming weeks and patients stack up beyond the system's ability to handle them, hospitals would have to use triage protocols.
"Fortunately we didn't see a massive spike after Thanksgiving and I think that's because people listened," he said.
Sharp spike in cases feared
Hess, other local doctors and Reno city officials spoke at a media briefing Dec. 22. They said half of all patients in local ICU beds were being treated for the virus and the current COVID-19 surge in cases is predicted to continue. On Dec. 21, when hospital capacity was at 85%, an additional 238 virus cases and eight more related deaths were reported in Washoe County.
UPDATE: By Dec. 29, hospital capacity had dropped to 80%. On that date, there were 14,086 active cases in Washoe County and a total of 460 deaths since March. December has been the county's deadliest month of the pandemic and officials said the county's "threat meter," in the image above, will probably remain in the "red" zone at year's end.
If the surge continues to build in January and hospitals are overwhelmed, the tiered scoring system could be used to make treatment decisions.
The scoring protocol is now being used as an assessment method for all patients, not just those who have tested positive for the virus that causes COVID-19. The next step would be to use those scores as a means of ranking patients in order to make decisions about treatment, Hess said.
A critical time for precautions
Speakers at the media briefing implored residents to observe the pandemic restrictions, including remaining at home whenever possible, avoiding gathering with people outside of one's own household, frequently washing hands and wearing masks, as well as maintaining social distancing in public. Predictive models indicate the first weeks of the new year may herald a worse spike in infections.
PHOTO/FRANK X. MULLEN: Renown Regional Medical Center set up 700 beds as an overflow area on one floor of its parking structure in November and has the capacity to add another 700 patient stations if needed. Hundreds of patients have used the facility since then.
"We were at a very high positivity rate for weeks and we saw some improvement last week, but now we're right back up there," said Reno Councilwoman Naomi Duerr. She noted that the area's COVID-19 risk meter is in the red zone "and just a tick away from the purple (severe level)." The ICU bed occupancy rates also are high and doctors, nurses and other hospital staff members are exhausted, she said.
"They need to rest," Duerr said. "They've performed extremely well, but they are running out of gas and they need to refuel."
'Scores' access mortality risk
Hess said a procedure called SOFA (Sequential Organ Failure Assessment Score) would be used as a means of rationing care if hospitals become overwhelmed. It's an alternative to treating patients on a simple first-come, first-served basis when staffing is inadequate, and ICU beds, ventilators and other critical-care equipment are in short supply.
SOFA is based on an assessment of patients' organ dysfunction and potential for life-ending organ failure. That system assigns points to such factors as a patient's vital signs, laboratory reports and other clinical information. If all local hospitals can't cope with a massive increase in patients, decisions about what kind of care a patient receives would then be made by a panel of three doctors assigned to analyze the data. The method doesn't take identities, demographics or other variables into consideration and "is objective and unbiased," Hess said.
Emergency triage plans weren't generally necessary in the first wave of U.S. COVID-19 cases in the spring and summer. But health care systems all around the country have SOFA and similar triage protocols in place in case the spread of the contagion outpaces health care facilities' ability to keep up with the demand for intensive care.
A 'battlefield situation'
Those policies have sparked new conversations among bioethicists about the use of such protocols and whether other indicators, such as patients' ages, their likelihood or survival if they receive the care that is in short supply, the ongoing trajectory of the patients' conditions and other factors also should be part of assessments. In addition, some experts question whether the use of such triage plans is a valid option in pandemics, according to several medical journal articles.
One consensus: rationing care for critical patients is an option that no one wants to use.
"It's a battlefield situation," Hess said. "We need to be prepared in the event (capacity) tips over if this (COVID-19 case) surge continues." He said the specter of an overwhelming wave of cases is particularly worrisome during the holiday season, when people want to gather with relatives and friends.
Reno Mayor Hillary Schieve said the arrival of the vaccine has given Nevadans a ray of hope after months of bad news, but she urged people not to let their guards down over the holidays. "People are tired," she noted, but social distancing, wearing masks and other precautions must continue to avoid a disastrous surge.
Some patients delay care
Dr. Bayo K. Curry-Winchell, of Saint Mary's Health Network, said patients often aren't sure when to seek urgent care. During the pandemic, patients have been advised to avoid going to hospital emergency departments and urgent care facilities unless they are having severe symptoms.
"We've had some patients who were delaying care. At the beginning of the pandemic, patients would come in and seek care (when they had symptoms). Now, there is so much fear and anxiety about seeking care, coming into contact with COVID patients, and contracting the virus."
— Dr. Bayo Curry-Winchell, of Saint Mary's Health Network.
Lately, she said, some patients have waited until symptoms have gotten critical before seeking help. Some of them are immediately transferred to a hospital. She said one of her recent patients told her she feared getting the virus in a hospital if she didn't already have it. In addition, that patient was concerned about whether anyone could visit her if she was admitted to a facility.
'Will I walk out?'
"And the third thing she was worried about was just heart-breaking," Curry-Winchell said. "She asked 'if I go in to the hospital, will I walk out?'"
Dr. Bayo K. Curry-Winchell,
Curry-Winchell said a decision about whether to go to an urgent care facility should be made based on the patient's assessment of their medical history and current symptoms.
"It's a little different for everybody," she said. "If you have co-morbidities such as hypertension or COPD, that really elevates when you should actually seek care." Severe symptoms include "if you have a fever that's not responding to Tylenol or ibuprofen," extreme fatigue, such as "not being able to walk from your bedroom to your front door," or a complete loss of appetite. Those are indications that people should seek care as soon as possible, she said.
Accessing pre-existing conditions
Hess agreed that underlying medical conditions should always be a factor in deciding whether to go to a care facility. He said people older than 65 with underlying health conditions should seek care if they think they may have the virus.
Shortness of breath also is a red flag. People who have an oximeter meter should get to an urgent care facility if their oxygen levels drop below 92 or "certainly if their oxygen level goes to 90" or below, Hess said. A fingertip pulse/oximeter, which usually costs less than $20, is "certainly a good thing to have," he said, because it may be hard for patients to determine when their oxygen levels become critical.
"Shortness of breath is a critical symptom no matter what your age," Hess said. "If you are having trouble breathing, you should get to a hospital."
In addition, he said, people who have tested positive, but aren't exhibiting symptoms, or folks experiencing mild symptoms should stay away from other people. He mentioned an example of a Reno business owner who felt sick but kept going to work. Several employees of his business contracted COVID-19, he said.
"If you are sick, you need to stay home," Hess said.
NOTE: This story was updated on Dec. 29 with the most recent COVID-19 totals.
Year-end letters
Christmas with the Donner Party


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You are here: Home Page > Medicine & Health > Pediatrics > Paediatric Intensive Care
This item is printed to order. Items which are printed to order are normally despatched and charged within 5-10 days.
Available in Oxford Medicine Online
Bookseller Code (AE)
Edited by Peter Barry, Kevin Morris, and Tariq Ali
Oxford Specialist Handbooks in Paediatrics
An indispensible guide for all those who provide care to sick children
Includes a comprehensive overview of basic sciences for a depth of coverage
Presents a holistic approach to paediatric intensive care
Contains contributions from internationally-renowned authors
One in 70 children are admitted to paediatric intensive care (PIC) at some time during childhood. Most paediatric junior doctors will rotate through PIC, and will be involved in organising acute intensive care for critically ill children. The range of children and their illnesses going through PIC is vast, making it a hugely diverse specialty. A critically ill child will end up there regardless of their underlying disease, and as a result consultants in PIC must be true generalists and need to acquire knowledge and skills in all areas of paediatrics, as well as acquiring significant knowledge of anaesthesia and surgery.
From setting up the ventilator, to managing low cardiac output, Paediatric Intensive Care gives practical and realistic advice for children's doctors and nurses in intensive care. Information is presented in easily-accessible '5 minute chunks' to enable you to quickly get the answers you need, with extensive cross-referencing ensuring that different aspects of a particular clinical problem are fully covered. With detailed answers to specific problems and expert guidance on how to manage the complex issues faced in PIC, this handbook is an indispensible guide for all those who provide care to sick children.
General introduction to paediatric intensive care
1: An introduction to paediatric intensive care
2: Epidemiology and outcome of paediatric intensive care
3: Paediatric resuscitation and critical care outreach
4: Clinical assessment
5: Physics and clinical measurement
6: Vascular access and monitoring
7: Applied physiology
Organ system support and related practical procedures
8: Airway management and ventilation
9: Anaesthesia
10: Analgesia and sedation
11: Circulatory support
12: Cardiopulmonary bypass
13: Managing fluids and electrolytes/acid base
14: Renal replacement therapies
15: Nutrition
16: Heat-related illness
17: Prescribing
18: Transport and retrieval
19: Imaging in paediatric intensive care
Specific specialties
20: Cardiac disorders and post-operative care
21: Respiratory disease
22: Neurocritical care
23: Trauma
24: Infection control policies and PICU
25: Immunity and infection
26: Sepsis and multiple organ failure
27: Laboratory investigations for infectious disease
28: Antimicrobial use on the PICU
29: Neonatology
30: Gastroenterology and hepatology
31: Nephrology
32: Diabetes and endocrinology
33: Metabolic
34: Haematology and oncology
35: Brain death, organ donation, and transplantation
36: Poisoning
37: Technology dependent children
38: Genetic syndromes
39: Paediatric intensive care medicine in the developing world
Compassionate and family-orientated care
40: The child and family in PICU
41: Aspects of the law in paediatric intensive care
42: Clinical governance, audit and risk management
43: Child protection
Edited by Peter Barry, Consultant in Paediatric Intensive Care, University Hospitals of Leicester NHS Trust and Honorary Senior Lecturer, Department of Child Health, University of Leicester NHS Trust, UK, Kevin Morris, Consultant in Paediatric Intensive Care, Birmingham Children's Hospital, UK, and Tariq Ali, Consultant in Paediatric Intensive Care and Anaesthesia, John Radcliffe Hospital, Oxford, UK
Peter Barry has published over 60 papers and review articles in the fields of paediatric intensive care, inhalational drug delivery and high altitude medicine. He is currently a consultant in paediatric intensive care, University Hospitals of Leicester NHS Trust, and an honorary senior lecturer at the Department of Child Health, University of Leicester.
Kevin Morris is a consultant in paediatric intensive care at Birmingham Children's Hospital and an honorary clinical senior lecturer at the University of Birmingham. He trained in adult medicine before completing his training in paediatrics in Newcastle upon Tyne and Birmingham. Further studies in PICU were conducted in Toronto, Canada and Melbourne, Australia before taking up his current post in 1997. He has a particular research interest in traumatic brain injury (TBI) in children.
Tariq Ali began his training at St Barts and Homerton Hospitals in London before completing his specialist training at University College Hospital and Great Ormond Street Hospital for Sick Children in London. He has worked abroad as a visiting consultant at the Baragwanath hospital in Soweto, Johannesburg, South Africa and has worked briefly for Medicin Sans Frontieres during the conflict in Rwanda. He is a fellow of the Royal College of Anaesthetists and the Royal College of Paediatrics and Child Health. He has been a consultant in paediatric intensive care and anaesthesia at the John Radcliffe Hospital, Oxford since 1999.
Tariq Ali, Consultant in Paediatric Intensive Care and Anaesthesia, John Radcliffe Hospital, Oxford, UK
Oliver Bagshaw, Consultant in Anaesthesia and Intensive Care, Birmingham Children's Hospital, UK
Paul Baines, Paediatric Intensive Care Consultant, Alder Hey Hospital; Honorary Lecturer, Department of Medical Microbiology, University of Liverpool, UK
Peter Barry, Consultant in Paediatric Intensive Care, University Hospitals of Leicester NHS Trust; Honorary Senior Lecturer, Department of Child Health, University of Leicester, UK
Sarah Bowdin, Staff Physician, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto; Assistant Professor, Paediatrics, University of Toronto, Canada
Joe Brierley, Consultant Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
Ashish A. Chikermane, Consultant Paediatric Cardiologist, Birmingham Children's Hospital, UK
Steven Cray, Consultant Paediatric Anaesthetist/Intensivist, Birmingham Children's Hospital, UK
Peter Davis, Consultant in Paediatric Intensive Care, Bristol Royal Hospital for Children, UK
Edward Doyle, Consultant Paediatric Anaesthetist, Royal Hospital for Sick Children, Edinburgh, UK
Heather Duncan, Paediatric Intensivist, Birmingham Children's Hospital, UK
Mark L. Duthie, Consultant in Paediatrics, Leicester Royal Infirmary, UK
Linda Edwards, Consultant Paediatric Intensivist, Birmingham Children's Hospital NHS Trust, UK
C. Helen Fardy, Lead Clinician, PICU, The University Hospital of Wales, Cardiff, UK
Peter-Marc Fortune, Consultant Paediatric Intensivist, Clinical Director of Critical Care, Royal Manchester Children's Hospital, UK
Clive Graham, Consultant Microbiologist, West Cumberland Hospital, Whitehaven, UK
Jean Harkin, Solicitor and Assistant Deputy Coroner, Harkin Lloyd Solicitors, Liverpool, UK
Ben Harvey, Education and Practice Development Charge Nurse, PICU, Glenfield General Hospital, University Hospitals of Leicester, UK
Kay C. Hawkins, Consultant in Paediatric Intensive Care, Royal Manchester Children's Hospital, UK
Chris Hendriksz, Consultant in Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, UK
Yvonne Heward, Lecturer Practitioner, Paediatric Intensive Care and PEWS, Birmingham Children's Hospital NHSFT and Birmingham City University, UK
David Inwald, Senior Lecturer and Honorary Consultant in Paediatric Intensive Care, Imperial College London, UK
Rhian Isaac, Pharmacy Clinical Lead, Birmingham Children's Hospital, UK
Niranjan Kissoon, Senior Medical Director, Acute and Critical Care Programs, Associate Head, Department of Pediatrics; Professor, Pediatric and Surgery (EM), BC Children's Hospital, University of British Columbia, Vancouver, Canada
Rakesh Lodha, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
Michael J. Marsh, Consultant Paediatric Intensive Care, Medical Director, Southampton University Hospital Trust, UK
Jane Martin, John Radcliffe Hospital, Oxford, UK
Jillian McFadzean, Consultant in Anaesthesia, Royal Hospital for Sick Children, Edinburgh, UK
Paul McVittie, Resuscitation Service Manager, Birmingham Children's Hospital NHS Foundation Trust, UK
Reinout J. Mildner, Consultant Paediatric Intensivist, Birmingham Children's Hospital, UK
Kevin Morris, Consultant in Paediatric Intensive Care, Birmingham Children's Hospital, UK
Simon Nadel, Consultant in Paediatric Intensive Care, Imperial College Healthcare NHS Trust, London, UK
Sanjiv Nichani, Lead Consultant Paediatric Intensive Care and High Dependency Care
University Hospitals of Leicester, UK
Andrew Nyman, John Radcliffe Hospital, Oxford, UK
Hitesh Pandya, Consultant in Paediatrics, Royal Leicester Infirmary, UK
Josep Panisello, Consultant in Paediatrics, John Radcliffe Hospital, Oxford, UK
Giles J. Peek, Consultant in Cardiothoracic Surgery and ECMO, Glenfield Hospital, Leicester, UK
Mark Peters, Consultant in Paediatrics, Great Ormond Street Hospital for Children, London, UK
Christine M. Pierce, Consultant in Paediatric Intensive Care, Great Ormond Street Hospital for Children, London, UK
Stephen Playfor, Consultant Paediatric Intensivist, Royal Manchester Children's Hospital, UK
Jane Radcliffe, Consultant in Paediatric Intensive Care, Royal Liverpool Children's NHS Trust, UK
Fiona Reynolds, Consultant Paediatric Intensivist, Birmingham Children's Hospital, UK
Rob Ross Russell, Consultant in Paediatric Intensive Care and Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, UK
Helen Rowlands, Consultant Paediatric Cardiac Intensivist, Great Ormond Street Hospital, London, UK
David Rowney, Consultant in Anaesthesia, Royal Hospital for Sick Children, Edinburgh, UK
Phil Sargent, Senior Staff Specialist, Paediatric Intensive Care Unit, Mater Children's Hospital, Queensland, Australia
Andrew Selby, Consultant in Paediatric Intensive Care and Long Term Ventilation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
Alison Shefler, Consultant in Paediatrics, John Radcliffe Hospital, Oxford, UK
Sunit Singhi, Head, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Megan Smith, Consultant Paediatric Intensivist, Nottingham University Hospitals NHS Trust, UK
Charles G. Stack, Consultant in Paediatric Anaesthesia and Intensive Care, Sheffield Children's Hospital, UK
JE Stevens, Consultant Paediatric Anaesthetist and Intensivist, John Radcliffe Hospital, Oxford, UK
Robert C. Tasker, University Senior Lecturer in Paediatrics, Cambridge University School of Clinical Medicine, UK
Harish Vyas, Professor in PICU and Respiratory Medicine, Paediatric Intensivist and Head of Service, Children and Young People, Nottingham University Hospitals, UK
James Whitelaw, Consultant in Paediatrics, Leicester Royal Infirmary, UK
David C. Wilson, Reader in Paediatric Gastroenterology and Nutrition, Child Life and Health, University of Edinburgh, UK
Peter Wilson, Director Paediatric Intensive Care Unit, Southampton University Hospital NHS Trust, UK
Winner in the Paediatrics Category, BMA Medical Book Awards 2011
"This very condensed but detailed handbook describes in its 43 chapters the anatomy, pathophysiology and treatment of conditions necessitating intensive medical care in neonates, infants and children... As the editors write this book is not just for intensivists, but should help also paediatric clinicians." - Inbar Kushnir, Editorial Manager; PER Volume 15 no.2
Paediatric Rheumatology
Helen E. Foster, Paul A. Brogan
Handbook of Child and Adolescent Tuberculosis
Jeffrey R. Starke, Peter R. Donald
Chronic Pain Management for the Hospitalized Patient
Richard W. Rosenquist, Dmitri Souzdalnitski, Richard D. Urman
The Practice of Emergency and Critical Care Neurology
Eelco F. M. Wijdicks
Manual of Childhood Infections
Mike Sharland, Karina Butler, Andrew Cant, Ron Dagan, Graham Davies, Ronald de Groot, David Elliman, Susanna Esposito, Adam Finn, Manolis Galanakis, Carlo Giaquinto, Jim Gray, Paul Heath, Terho Heikkinen, Ulrich Heininger, Philipp Henneke, Irja Lutsar, Hermione Lyall, Federico Martinon Torres, Andrew Pollard, Mary Ramsay, Andrew Riordan, Fernanda Rodrigues, Emmanuel Roilides, Pablo Rojo, Delane Shingadia, Steve Tomlin, Maria Tsolia
Epstein's Inborn Errors of Development
Robert P. Erickson, Anthony J. Wynshaw-Boris
Multimodality Imaging Guidance in Interventional Pain Management
Samer N. Narouze
R. Scott Watson, MD, MPH, Ann Thompson, MD, MHCPM
Srinivas Gada
50 Studies Every Pediatrician Should Know
Ashaunta T. Anderson, Nina L. Shapiro, Stephen C. Aronoff, Jeremiah Davis, Michael Levy, Michael E. Hochman
Ultrasound Guided Regional Anesthesia
Stuart A. Grant, David B. Auyong
Neuroprotection in Critical Care and Perioperative Medicine
David L. Reich, Stephan A. Mayer, Suzan Uysal
Paediatric Radiology
Karl Johnson, Helen Williams, Katharine Foster, Claire Miller
Pediatric Ethics
Alan R. Fleischman
Surgical Pain Management
Sanjeet Narang, Alison Weisheipl, Edgar L. Ross
Perioperative Pain Management for Orthopedic and Spine Surgery
John Reach, James J. Yue, Deepak Narayan, Alan Kaye, Nalini Vadivelu
Medicine & Health > Pediatrics
Medicine & Health > Anesthesiology
Medicine & Health > Critical Care
Medicine & Health > Nursing


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apt-get update
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sudo -u vagrant wget https://raw.githubusercontent.com/jdrydn/dotfiles/master/.vimrc -O /home/vagrant/.vimrc
sudo -u vagrant wget https://raw.githubusercontent.com/jdrydn/dotfiles/master/.zshrc -O /home/vagrant/.zshrc

redpajama_set_name: RedPajamaGithub


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Drag-flicker Varun Kumar targets India comeback after break
The Indian hockey team was held up at Bengaluru's Sports Authority of India (SAI) complex for more than two months due to the COVID-19 lockdown.
Jalandhar 30 June, 2020 14:01 IST
Varun Kumar receives the man-of-the-match award after the Men's Hockey World Cup Group C match between India and Belgium at Kalinga Stadium. - GETTY IMAGES
Drag-flicker Varun Kumar believes that the Indian hockey team's one-month break from the sport will help the players recharge their batteries for the challenges ahead, the major one being next year's Tokyo Olympics.
The Indian hockey team was held up at Bengaluru's Sports Authority of India (SAI) complex for more than two months due to the COVID-19 lockdown. The players were recently given a month's break after lockdown restrictions were eased.
Rajani on lockdown days at SAI Bengaluru: 'We really came together as a unit'
"I see this period at home as one where we will get the chance to rejuvenate ourselves, and restart everything from scratch keeping in mind that we need to be peaking during the Tokyo Olympics scheduled to start in July 2021," Varun said.
"It's not always about how fresh you are physically, but there is also a lot of focus on mental aspects.
"I feel this break has provided us with the opportunity to rest our minds, by spending some quality time with our families. This really helps you in just taking your mind off the sport sometimes," the 24-year-old added.
The 2016 Junior Cup-winning defender could not play in the FIH Hockey Olympic Qualifiers last year due to nerve damage to his right arm.
He has not represented the country since recuperating and recovering from the minor injury.
Mir Ranjan Negi still an inspiration in hometown Indore
"It is definitely difficult for me because I haven't been able to make the comeback to competitive hockey yet, but as things stand, everyone's safety and health takes centre-stage," he said.
"I am just being very patient and making sure that I am maintaining my fitness levels so that once we resume the sport, I can get into the rhythm of playing very soon."
Varun said lifting the Junior World Cup in Lucknow remains his fondest sporting moment till date.
"During the lockdown, I have had the chance to reflect on my journey with the Indian team, and I feel really proud to have won the Junior World Cup in 2016, it was one of the best moments of my playing career," he said.
"I haven't really had the chance to reflect, but it was good to really sit with people like Krishan (Pathak), Harmanpreet (Singh) and Mandeep (Singh) who experienced that journey with me.
"We have spoken about how far we have since then, and it just gives you more confidence to achieve greater things for your country in future," he said.
Varun Kumar