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Internal Medicine/Eczema and Dermatitis. Eczema and Dermatitis. Eczema is a term that is often used interchangeably with dermatitis. It represents a complex reaction pattern in the skin characterized by variable clinical findings and a common histologic finding known as spongiosis. Spongiosis refers to intercellular edema of the epidermis, a hallmark of eczema. Eczema serves as the final common expression for a variety of skin disorders, including those discussed in the following sections. Primary Lesions in Eczema: In eczema, primary lesions may include erythematous macules (flat red spots), papules (small raised bumps), and vesicles (fluid-filled sacs). These primary lesions can coalesce to form patches (larger flat areas) and plaques (raised, flat-topped areas). In severe cases of eczema, secondary lesions stemming from infection or excoriation may predominate. These secondary lesions are often marked by weeping and crusting. In chronic eczematous conditions, lichenification occurs, which involves cutaneous hypertrophy and accentuation of normal skin markings, ultimately altering the characteristic appearance of eczema. Atopic Dermatitis (AD). Atopic dermatitis (AD) is considered the cutaneous expression of the atopic state, which is characterized by a family history of conditions such as asthma, allergic rhinitis, or eczema. Several defining features help identify AD: Clinical Presentation by Age: The clinical presentation of AD can vary depending on age. Approximately half of AD patients present within the first year of life, and around 80% present by the age of 5. Infants with AD often display weeping inflammatory patches and crusted plaques on the face, neck, and extensor surfaces. In contrast, older children and adolescents typically manifest dermatitis on flexural skin, particularly in the antecubital and popliteal fossae. Persistence into Adulthood: AD may resolve spontaneously in some cases, but approximately 40% of individuals affected as children will continue to experience dermatitis in adulthood. Regardless of age, pruritus remains a prominent characteristic of AD and is exacerbated by dry skin. Many cutaneous findings in affected patients, such as lichenification, result from persistent rubbing and scratching. Treatment of AD. Effective treatment for AD involves a multifaceted approach: This multifaceted approach aims to control inflammation, alleviate pruritus, and prevent further exacerbations of AD. Lichen Simplex Chronicus and Contact Dermatitis. Lichen Simplex Chronicus (LSC) Lichen simplex chronicus often represents the end stage of various pruritic and eczematous disorders, including AD. It manifests as circumscribed plaques or lichenified skin due to chronic scratching or rubbing. Commonly involved areas include the posterior nuchal region, dorsum of the feet, and ankles. Treatment focuses on breaking the cycle of chronic itching and scratching, often involving high-potency topical glucocorticoids. Contact Dermatitis Contact dermatitis results from skin exposure to exogenous agents that directly or indirectly injure the skin. Irritant contact dermatitis (ICD) occurs due to an inherent characteristic of a compound, such as a concentrated acid or base, and can develop rapidly without prior exposure to the irritant. Allergic contact dermatitis (ACD) results from an antigen-specific immune response and requires prior exposure to the offending agent, often taking hours to days to develop. Common allergens causing ACD include poison ivy, poison oak, and poison sumac, typically manifesting as erythema, vesiculation, and severe pruritus. Treatment for Contact Dermatitis The treatment approach for contact dermatitis depends on whether it is irritant or allergic in nature. Removing the offending agent leads to resolution in most cases. High-potency topical glucocorticoids can help alleviate symptoms while the dermatitis runs its course. In severe cases, systemic glucocorticoids may be considered. Hand Eczema and Nummular Eczema. Hand Eczema Hand eczema is a common, chronic skin disorder influenced by both exogenous and endogenous factors. It is often associated with other cutaneous disorders like AD. Chronic exposure to water, detergents, harsh chemicals, or allergens can initiate or exacerbate this condition. It may present with dryness, skin cracking, erythema, and edema, often starting beneath rings where irritants are trapped. Evaluation of Hand Eczema: Assessing potential occupation-associated exposures is crucial when evaluating hand eczema. The patient's history should aim to identify possible irritants or allergen exposures. Treatment for Hand Eczema: Therapy involves avoiding irritants, identifying possible contact allergens, treating coexisting infections, and using topical glucocorticoids. Protecting the hands with gloves is advisable, preferably vinyl gloves to avoid potential hypersensitivity reactions associated with latex gloves. Nummular Eczema Nummular eczema is characterized by circular or oval "coinlike" lesions. It begins as small, edematous papules that become crusted and scaly. While its exact cause remains unknown, dry skin is a contributing factor. Common locations include the trunk and the extensor surfaces of the extremities, particularly the pretibial areas or dorsum of the hands. It is more common in men and often occurs in middle age. Treatment approaches for nummular eczema are similar to those for AD. Asteatotic Eczema and Stasis Dermatitis/ulceration. Asteatotic Eczema Asteatotic eczema, also known as xerotic eczema or "winter itch," is a mildly inflammatory dermatitis that develops in areas of extremely dry skin, especially during dry winter months. Clinically, it may overlap with nummular eczema. It presents with fine cracks, scale, erythema, and pruritus, typically on the anterior surfaces of the lower extremities in elderly patients. Asteatotic eczema responds well to topical moisturizers and the avoidance of cutaneous irritants. Overbathing and the use of harsh soaps can exacerbate this condition. Stasis Dermatitis and Stasis Ulceration Stasis dermatitis develops on the lower extremities due to venous incompetence and chronic edema. It may be associated with a history of deep venous thrombosis or varicose veins. The initial signs include mild erythema and scaling with pruritus. Stasis dermatitis can become acutely inflamed, mimicking cellulitis, especially if it occurs bilaterally. Chronic stasis dermatitis often results in dermal fibrosis, clinically seen as brawny edema, and pigmentation changes due to chronic erythrocyte extravasation and hemosiderin deposition. Severe stasis dermatitis may lead to the development of stasis ulcers. Treatment for Stasis Dermatitis and Stasis Ulceration Patients with stasis dermatitis and stasis ulceration benefit from leg elevation and the use of compression stockings with a gradient of at least 30–40 mmHg. Emollients and mid-potency topical glucocorticoids can be used to manage symptoms. Protection of the legs from injury, including scratching, is crucial to prevent ulcers. Diuretics may be necessary to control chronic edema. Stasis ulcers require elevation, gentle debridement, semipermeable dressing, and compression. Superficial bacterial cultures of chronic stasis ulcers may yield polymicrobial colonizers. Seborrheic Dermatitis. Seborrheic dermatitis is a common, chronic condition characterized by greasy scales overlying erythematous patches or plaques. It is frequently observed as severe dandruff on the scalp and can affect various facial areas, external auditory canals, and postauricular regions. It may also develop in the central chest, axilla, groin, submammary folds, and gluteal cleft. Severe cases can lead to generalized dermatitis. Pruritus varies in intensity. Seborrheic dermatitis can appear in infancy (often as cradle cap) and reappear during adolescence and adulthood. While it is associated with conditions like Parkinson's disease, cerebrovascular accidents, and HIV infection, most individuals with seborrheic dermatitis have no underlying disorder. Treatment of Seborrheic Dermatitis: Treatment often involves low-potency topical glucocorticoids, topical antifungal agents (like ketoconazole or ciclopirox), and antidandruff shampoos for scalp involvement. High-potency topical glucocorticoid solutions are effective for severe scalp cases but should not be used on the face to avoid complications like steroid-induced rosacea or atrophy.

Internal Medicine/Papulosquamous Disorders. Psoriasis. Psoriasis stands out as one of the most prevalent skin conditions globally, affecting up to 2% of the world's population. It is an immune-related disorder that exhibits distinct clinical features, including reddish, well-defined papules and circular plaques covered by a silvery, scaly layer. Psoriasis skin lesions can be itchy to varying degrees. Injured skin areas can also develop psoriasis lesions, known as the Koebner phenomenon. Additionally, external factors such as infections, stress, and certain medications like lithium, beta blockers, and antimalarial drugs can worsen psoriasis. The most common form is plaque-type psoriasis, characterized by stable, slow-growing plaques that remain relatively unchanged for long periods. Typically, these plaques appear on the elbows, knees, buttock creases, and the scalp, and they tend to appear symmetrically. Plaque psoriasis usually develops gradually and follows a mild course, seldom remitting spontaneously. Inverse psoriasis, on the other hand, affects skinfold regions like the armpits, groin, under the breasts, and navel, and it can also involve the scalp, palms, and soles. These lesions are well-defined plaques but may lack scaling due to their location. "Guttate psoriasis", or eruptive psoriasis, primarily affects children and young adults. It suddenly emerges in individuals without a prior history of psoriasis or in those with chronic plaque psoriasis. Patients with this type exhibit numerous small, reddish, scaly papules, often following upper respiratory tract infections caused by beta-hemolytic streptococci. The differential diagnosis should consider conditions like pityriasis rosea and secondary syphilis. In "pustular psoriasis", patients can have the disease localized to the palms and soles or a more generalized form. In both cases, the skin appears red, with pustules and varying degrees of scaling. When it's localized to the palms and soles, it can be easily confused with dyshidrotic eczema. In its generalized form, patients experience episodes characterized by fever, the eruption of sterile pustules, and intense redness. These episodes may even lead to erythroderma. Fever and pustular outbreaks tend to recur. Factors like local irritants, pregnancy, medications, infections, and discontinuation of systemic glucocorticoids can trigger this form of psoriasis. In nonpregnant patients, oral retinoids are the preferred treatment. Fingernail involvement, which can manifest as small pits, separation of the nail from the nail bed, thickening, or excessive nail tissue underneath, can provide a clue to the diagnosis of psoriasis, particularly when the clinical presentation is atypical. According to the National Psoriasis Foundation, approximately 30% of psoriasis patients develop "psoriatic arthritis (PsA)", which is most common between ages 30 and 50. PsA presents in various subtypes, including symmetric PsA, asymmetric PsA, distal PsA, spondylitis, and arthritis mutilans. Symmetric PsA often resembles rheumatoid arthritis and accounts for roughly 50% of PsA cases. Asymmetric arthritis, comprising about 35% of cases, can affect any joint and may cause "sausage fingers." Distal PsA, occurring in about 5% of PsA patients, involves fingers and toes and is often accompanied by nail issues like pitting. Spondylitis is observed in approximately 5% of PsA cases, while arthritis mutilans, the most severe form, primarily affects the small joints of the hands and feet and accounts for fewer than 5% of cases. Psoriasis patients face an increased risk of metabolic syndrome, which includes a higher likelihood of cardiovascular events with increased morbidity and mortality. Therefore, appropriate screening tests are recommended. While the exact cause of psoriasis remains unclear, there is a definite genetic component, with 30–50% of patients reporting a family history of the condition. Psoriatic lesions contain infiltrates of activated T cells that produce cytokines responsible for the excessive growth of skin cells, leading to the characteristic clinical features. Treatments for severe psoriasis often involve agents that inhibit T-cell activation, clonal expansion, or proinflammatory cytokine release. The treatment approach for psoriasis depends on the type, location, and extent of the disease. All patients should be advised to avoid excessive skin dryness or irritation and maintain adequate skin hydration. In most cases of localized plaque-type psoriasis, mid-potency topical glucocorticoids are effective, though their long-term use may lead to reduced effectiveness and skin thinning. Topical vitamin D analogs like calcipotriene and retinoids such as tazarotene are also suitable treatments for limited psoriasis and have largely replaced older topical agents like coal tar, salicylic acid, and anthralin. Ultraviolet (UV) light, whether from natural or artificial sources, proves effective for many patients with widespread psoriasis. UVB, narrowband UVB, and UVA light with oral or topical psoralens (PUVA) are used therapeutically. UV light's immune-suppressing properties contribute to its therapeutic effect, but it is also mutagenic, potentially increasing the risk of nonmelanoma and melanoma skin cancers. Thus, UV-light therapy is contraindicated for patients taking cyclosporine and should be used cautiously in immunocompromised patients due to the elevated skin cancer risk. For severe and extensive psoriasis, various systemic agents are available. Oral glucocorticoids are discouraged due to the risk of life-threatening pustular psoriasis upon discontinuation of treatment. Methotrexate is an effective option, especially for patients with PsA. The synthetic retinoid acitretin is useful when immunosuppression must be avoided but is limited by its teratogenic effects. Apremilast, a phosphodiesterase type 4 inhibitor, is approved for both psoriasis and PsA but should be used cautiously in the presence of renal failure or depression. The understanding of psoriasis as a T-cell–mediated disorder has driven therapeutic research toward immunoregulation. Immunosuppressive agents like cyclosporine have shown efficacy in psoriasis treatment, and biologic agents with more selective immunosuppressive properties and improved safety profiles are being developed (see Table 57-4). These biologics have demonstrated effectiveness and good tolerability in treating psoriasis, though caution is necessary for certain patient comorbidities. Tumor necrosis factor-α (TNF-α) inhibitors, for example, may exacerbate congestive heart failure (CHF) and should be used carefully in patients with CHF or at risk for it. Moreover, none of the immunosuppressive agents used for psoriasis treatment should be initiated if the patient has a severe infection (including tuberculosis, HIV, hepatitis B or C), and patients on such therapy should be regularly screened for tuberculosis. There have been reports of progressive multifocal leukoencephalopathy and lupus erythematosus linked to TNF-α inhibitors. These systemic agents also carry an increased risk of skin cancer, necessitating close monitoring for its development. Lichen Planus. Lichen planus (LP) is a papulosquamous disorder that can affect the skin, scalp, nails, and mucous membranes. The primary cutaneous lesions are itchy, polygonal, flat-topped, violet-colored papules. Examination of these papules often reveals a network of gray lines called Wickham's striae. LP can occur anywhere on the skin but has a preference for areas like the wrists, shins, lower back, and genitalia. It can also affect the scalp, leading to scarring hair loss, and the nails, potentially causing permanent deformities or nail loss. LP is often associated with mucous membrane involvement, particularly in the buccal mucosa, where it can range from a mild, white, reticulated rash to severe, erosive stomatitis. Erosive stomatitis may persist for extended periods and may elevate the risk of oral squamous cell carcinoma. Drug-induced LP-like eruptions have been observed with medications such as thiazide diuretics, gold, antimalarials, penicillamine, phenothiazines, and in patients with chronic graft-versus-host disease. LP may also be linked to hepatitis C infection. The course of LP varies, but most patients experience spontaneous remission within 6 months to 2 years after the disease onset. Topical glucocorticoids are the primary treatment. Pityriasis Rosea. Pityriasis rosea (PR) is a papulosquamous rash of unknown origin that often occurs in the spring and fall. It typically starts with the development of a 2- to 6-cm circular lesion called the "herald patch." Over the following days to weeks, numerous smaller circular or papular lesions emerge, mostly on the trunk. These lesions are usually oval, with their long axis aligned with the lines of skin folds. Individual lesions can range in color from red to brown and often have a trailing scale. PR shares several clinical features with secondary syphilis, but palm and sole lesions are extremely rare in PR and common in secondary syphilis. The rash in PR is usually moderately itchy and persists for 3–8 weeks. Treatment aims at relieving itching and typically involves oral antihistamines, mid-potency topical glucocorticoids, and, in some cases, UVB phototherapy.

Internal Medicine/Cutaneous Infections. Impetigo, Ecthyma, and Furunculosis. Impetigo is a common superficial bacterial skin infection primarily caused by Staphylococcus aureus and occasionally by group A β-hemolytic streptococci. The characteristic feature is the development of superficial pustules that rupture and form a characteristic honey-colored crust. These lesions can occur on healthy skin (primary infection) or in areas already affected by other skin conditions (secondary infection). Staphylococcal impetigo can sometimes manifest as bullous impetigo, where clear blisters form due to the production of exfoliative toxin. This toxin is also responsible for staphylococcal scalded-skin syndrome, which causes superficial epidermis loss due to blistering. Ecthyma is a deeper form of impetigo, often caused by Streptococcus pyogenes, leading to punched-out ulcerative lesions that heal with scarring. Treatment includes gentle debridement, topical antibiotics, and oral antibiotics as necessary. Furunculosis is another condition caused by Staphylococcus aureus and has gained attention due to the emergence of community-associated MRSA (CA-MRSA). It presents as painful, erythematous nodules on the skin, commonly appearing in multiple lesions. Incision and drainage may be required for larger furuncles. It's important to culture lesional material whenever possible. Treatment for methicillin-sensitive infections involves β-lactam antibiotics, while CA-MRSA requires different approaches. Dermatophytosis. Dermatophytes are fungi that infect the skin, hair, and nails and include Trichophyton, Microsporum, and Epidermophyton genera. Tinea corporis affects the hairless skin of the body and appears as erythematous, scaly plaques, often forming ring-like patterns. Tinea cruris, commonly found in males, presents as a scaling, erythematous rash sparing the scrotum. Tinea pedis, the most prevalent dermatophyte infection, causes variable symptoms on the feet, including erythema, edema, scaling, pruritus, and vesiculation. Tinea unguium or onychomycosis occurs in many patients with tinea pedis and results in thickened, opaque nails. Scalp infection (tinea capitis) predominantly affects children, causing mild scale and hair loss. Diagnosis is based on clinical appearance and microscopic examination. Treatment options depend on the infection site and type. Topical agents work well for uncomplicated tinea corporis, tinea cruris, and limited tinea pedis. Griseofulvin is approved for dermatophyte infections, but it has side effects like gastrointestinal distress and headache. Itraconazole and terbinafine are sometimes used off-label for certain infections but require caution due to potential drug interactions and side effects. Tinea (Pityriasis) Versicolor. Tinea versicolor, caused by Malassezia furfur, results in oval, scaly macules and patches, often found on the chest, shoulders, and back. Lesions can appear as hypopigmented areas on dark skin or slightly erythematous on light skin. A potassium hydroxide (KOH) preparation of lesions shows characteristic short hyphae and round spores, resembling "spaghetti and meatballs." Topical treatments like sulfur, salicylic acid, or selenium sulfide lotions or shampoos are the primary options and should be applied daily for a few weeks. Candidiasis. Candidiasis is a fungal infection typically caused by Candida albicans. It can affect the skin and mucous membranes and is common in individuals with predisposing factors like antibiotic therapy, diabetes, or immunosuppression. Oral candidiasis (thrush) appears as white plaques on the tongue or buccal mucosa. Perlèche presents as fissured, macerated lesions at the corners of the mouth. Cutaneous candidal infections are often seen in moist, macerated areas and involve erythematous, edematous, and scaly skin with scattered "satellite pustules." Diagnosis is based on clinical presentation and microscopic examination. Treatment involves removing predisposing factors and using appropriate topical or systemic antifungal agents. Topical options include nystatin or azoles, and mild glucocorticoid creams can be used for associated inflammation. Systemic therapy is reserved for immunosuppressed or chronic cases, with oral fluconazole being an option for cutaneous candidiasis. Warts. Warts are skin neoplasms caused by human papillomaviruses (HPVs). They come in various forms, including verruca vulgaris, plantar warts, flat warts (verruca plana), and filiform warts. Genital warts are also caused by HPVs and can affect various genital and mucosal areas. Some HPVs are associated with an increased risk of cancer, such as cervical carcinoma. Treatment of warts depends on factors like location, extent, patient age, and immune status. Cryotherapy with liquid nitrogen is effective for various warts. Keratolytic agents like salicylic acid can be used for nongenital warts. Podophyllin is an option for genital warts but can cause local reactions. Topical imiquimod is approved for genital warts. A vaccine for specific HPV types is available and reduces the risk of certain cancers associated with the virus.

Internal Medicine/Acne. Acne Vulgaris. Acne vulgaris is a common, self-limiting skin condition primarily affecting teenagers and young adults, with a small percentage of adults continuing to experience it. The key trigger for acne during adolescence is the increased production of sebum (skin oil) by sebaceous glands due to puberty. This excess oil, combined with the retention of keratin and sebum in hair follicles, leads to the formation of small cysts called comedones. Bacteria, particularly Cutibacterium acnes, present in these comedones, release free fatty acids, causing inflammation within the cysts and leading to their rupture. As a result, an inflammatory response occurs due to the extrusion of oily and keratinous material from the cysts. The primary feature of acne vulgaris is the comedone, which can be either closed (whiteheads) or open (blackheads). Closed comedones appear as small, raised white papules, while open comedones have a dilated follicular opening and contain darkened, easily expressible, oxidized debris. Comedones are often accompanied by inflammatory lesions such as papules, pustules, or nodules. Acne initially appears as mildly inflamed or noninflammatory comedones on the forehead in adolescence. Later, more typical inflammatory lesions develop on the cheeks, nose, and chin. The face is the most common site for acne, but it can also affect the chest and back. Most cases are mild and do not lead to scarring, but severe forms can result in significant and sometimes permanent scarring. Acne can have a significant impact on a person's quality of life, and early treatment is essential for severe cases. Various external and internal factors can influence the development of acne, including friction or trauma, use of comedogenic cosmetics or hair products, topical exposure to certain industrial compounds, and certain medications. Genetic factors and conditions like polycystic ovary disease may also contribute to acne. The treatment of acne vulgaris aims to eliminate comedones by normalizing follicular keratinization, reducing sebaceous gland activity, controlling Cutibacterium acnes population, and managing inflammation. Minimal to moderately inflamed acne can often be managed with topical therapy. It's important to keep the affected areas clean, but excessive scrubbing can worsen acne. Topical agents like retinoic acid, benzoyl peroxide, or salicylic acid can help prevent comedone formation and resolve existing cysts. Topical antibacterial agents (e.g., benzoyl peroxide, azelaic acid, erythromycin, clindamycin, or dapsone) can be used in combination with other treatments to prevent bacterial resistance. Patients with moderate to severe acne and significant inflammation may benefit from oral antibiotics such as minocycline or doxycycline. These antibiotics have anti-inflammatory effects apart from their antibacterial properties. Female patients who don't respond to antibiotics might find hormonal therapy, including oral contraceptives, effective. Spironolactone is also emerging as a safe and durable antiandrogen treatment for women with acne. In cases of severe, nodulocystic acne unresponsive to other treatments, isotretinoin, a synthetic retinoid, can be considered. It's administered based on body weight and cumulative dosage, with treatment duration determined by lesion remission. Isotretinoin has excellent results but is associated with potential severe side effects, including teratogenicity and depression. Its use is highly regulated to minimize these risks, including mandatory enrollment in a program to prevent pregnancy and monitor potential side effects. Acne Rosacea. Acne rosacea, commonly known as rosacea, is an inflammatory skin condition primarily affecting the central face. It's most commonly observed in Caucasians of northern European descent but can also affect individuals with darker skin tones. Unlike acne vulgaris, rosacea typically occurs in adults and rarely affects those under 30. It's more prevalent in women, but men often experience more severe forms. Rosacea is characterized by facial redness, visible blood vessels (telangiectasias), and superficial pustules. Unlike acne vulgaris, rosacea does not involve comedones. The condition can lead to connective tissue overgrowth, particularly on the nose (rhinophyma), and can also affect the eyes, potentially causing various inflammatory eye disorders. Rosacea can be treated through topical or systemic approaches. Mild cases often respond well to topical treatments like metronidazole, sodium sulfacetamide, azelaic acid, ivermectin, brimonidine, or oxymetazoline. More severe cases may require oral tetracyclines in subantimicrobial doses or modified-release preparations. Laser therapy can be effective for treating residual telangiectasia. It's important to avoid using potent topical steroids as chronic use can exacerbate rosacea. Topical treatments are ineffective for ocular involvement, and such cases require specialized treatment from an eye specialist.

Chess Opening Theory/1. e4/1...Nf6/2. e5/2...Nd5/3. d4/3...d6/4. c4/4...Nb6/5. f4/5...dxe5/6. fxe5/6...Nc6/7. Be3. =Alekhine Defence= With this move, White defends the d4-pawn with the bishop while not allowing the ...Bg4 pin. Black now almost always plays 7...Bf5, since that is the only logical square for the bishop. Then White plays 8.Nc3 and then Black plays 8...e6, and now White plays 9.Nf3 when Black has a choice between several moves.

RadOnc Resident Wiki/Autonomic Nervous System. Tumors of the autonomic nervous system are relatively rare but can occur. The autonomic nervous system (ANS) controls involuntary bodily functions such as heart rate, digestion, respiratory rate, and pupillary response. It consists of two main branches: the sympathetic nervous system and the parasympathetic nervous system. Tumors that arise within or affect these components of the ANS can have various clinical manifestations and may be benign or malignant. Here are some key points about tumors of the autonomic nervous system: It's important to note that while these tumors are rare, early detection and appropriate medical intervention are crucial for the best possible outcome. Medical professionals with expertise in neurology, oncology, and surgery are typically involved in the diagnosis and management of autonomic nervous system tumors.

RadOnc Resident Wiki/Peripheral Nervous System. Tumors of the peripheral nervous system (PNS) are relatively uncommon but can affect various components of the peripheral nervous system, including nerves, nerve sheaths, and nerve cells. The PNS includes all the nerves outside of the brain and spinal cord. Tumors that originate in or affect the PNS can be benign (non-cancerous) or malignant (cancerous). Here are some key points about peripheral nervous system tumors: Early detection and appropriate medical intervention are essential for optimizing the outcome of individuals with peripheral nervous system tumors.

RadOnc Resident Wiki/Abdomen. Tumors of the abdomen can involve various structures within the abdominal cavity and can be benign or malignant. The abdomen contains many organs, tissues, and structures, including the gastrointestinal tract, liver, pancreas, kidneys, adrenal glands, blood vessels, and connective tissues. Tumors that occur in the abdomen can arise from any of these structures. Here are some common types of abdominal tumors: Symptoms and treatment options for abdominal tumors can vary widely depending on the type, location, size, and whether they are benign or malignant. Common symptoms of abdominal tumors may include abdominal pain, bloating, changes in bowel habits, weight loss, and abdominal masses. Diagnosis typically involves imaging studies such as CT scans, MRIs, and biopsies to determine the nature of the tumor. Treatment options may include surgery, chemotherapy, radiation therapy, targeted therapies, immunotherapy, and sometimes a combination of these approaches. The prognosis for abdominal tumors depends on multiple factors, including the stage of cancer at diagnosis, the type of tumor, and the effectiveness of treatment. Early detection and timely intervention are crucial for improving outcomes in individuals with abdominal tumors. A multidisciplinary team of healthcare professionals, including surgeons, oncologists, radiologists, and pathologists, often collaborates in the diagnosis and treatment of these tumors.

RadOnc Resident Wiki/Pelvis. Tumors of the pelvis can arise from various tissues and structures within the pelvic region. These tumors can be benign (non-cancerous) or malignant (cancerous). Pelvic tumors may originate in the bones, muscles, connective tissues, blood vessels, nerves, or organs located in the pelvic area. Here are some common types of pelvic tumors: The treatment and prognosis for pelvic tumors depend on several factors, including the type of tumor, its size, location, and whether it is benign or malignant. Treatment options may include surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, or a combination of these approaches. Early detection through regular medical check-ups and screenings is crucial for improving the chances of successful treatment and outcomes. If you suspect you have a pelvic tumor or have concerning symptoms, it's essential to consult a healthcare professional for a thorough evaluation and diagnosis.

A-level Computing/AQA/Paper 1/Skeleton program/2024. This is for the AQA A Level Computer Science Specification. This is where suggestions can be made about what some of the questions might be and how we can solve them. Please be respectful and do not vandalise the page, as this would affect students' preparation for exams! Please do not discuss questions on this page. Instead use the . Section C Predictions. The 2024 paer 1 will contain questios worth 11 marks in total (one 3 marker on 2 marker and ne 6 marker). As long as you know the program well i.e. that unerstanding each line of code and and you know what each line of code does, you can also do this by using Chatpt and Gemini and its important you use all the tools availble to you, this will be dead easy. I'm preicting this year there will be a question on nherince about te cell and they will ask what it means so will be worth 3 marks. Also they could be a question on overriding and they couldbe a qestion abot difference frm the protecte, private ad public mehods from loking at past papers. Section D Predictions. Programming Questions on Skeleton Program Current questions are speculation by contributors to this page. Question 1 - Symbol Case [3 marks]. Lower case symbols are not accepted. E.g. if you enter 'q' it is not recognized as 'Q'. Fix this. private string GetSymbolFromUser() string Symbol = ""; while (!AllowedSymbols.Contains(Symbol)) Console.Write("Enter symbol: "); Symbol = Console.ReadLine().ToUpper(); return Symbol; private String getSymbolFromUser() { String symbol = ""; while (!allowedSymbols.contains(symbol)) { Console.write("Enter symbol: "); symbol = Console.readLine(); symbol = symbol.toUpperCase(); //added line return symbol; def __GetSymbolFromUser(self): Symbol = "" while not Symbol in self.__AllowedSymbols: Symbol = input("Enter symbol: ").upper() return Symbol A simple solution, just add UCase to change all input to upper case. Private Function GetSymbolFromUser() As String Dim Symbol As String = "" While Not AllowedSymbols.Contains(Symbol) Console.Write("Enter symbol: ") Symbol = UCase(Console.ReadLine()) End While Return Symbol End Function Question 2 - Game file not existing [4 marks]. If a filename is entered that does not exist, the game is unplayable (infinite loop). Amend the program so that in this case the default game is played, with a suitable message to indicate this. static void Main(string[] args) string Again = "y"; int Score; while (Again == "y") Console.Write("Press Enter to start a standard puzzle or enter name of file to load: "); string Filename = Console.ReadLine(); Puzzle MyPuzzle; if (Filename.Length > 0) // new code for question 2 - use try/catch in main and otherwise cause default game to be played try MyPuzzle = new Puzzle(Filename + ".txt"); catch Console.WriteLine("Invalid file. Playing default puzzle instead."); MyPuzzle = new Puzzle(8, Convert.ToInt32(8 * 8 * 0.6)); // end of new code for question 2 else MyPuzzle = new Puzzle(8, Convert.ToInt32(8 * 8 * 0.6)); Score = MyPuzzle.AttemptPuzzle(); Console.WriteLine("Puzzle finished. Your score was: " + Score); Console.Write("Do another puzzle? "); Again = Console.ReadLine().ToLower(); Console.ReadLine(); // try/catch removed from loadPuzzle subroutine private void LoadPuzzle(string Filename) using (StreamReader MyStream = new StreamReader(Filename)) int NoOfSymbols = Convert.ToInt32(MyStream.ReadLine()); for (var Count = 1; Count <= NoOfSymbols; Count++) AllowedSymbols.Add(MyStream.ReadLine()); int NoOfPatterns = Convert.ToInt32(MyStream.ReadLine()); for (var Count = 1; Count <= NoOfPatterns; Count++) List<string> Items = MyStream.ReadLine().Split(',').ToList(); Pattern P = new Pattern(Items[0], Items[1]); AllowedPatterns.Add(P); GridSize = Convert.ToInt32(MyStream.ReadLine()); for (var Count = 1; Count <= GridSize * GridSize; Count++) Cell C; List<string> Items = MyStream.ReadLine().Split(',').ToList(); if (Items[0] == "@") C = new BlockedCell(); else C = new Cell(); C.ChangeSymbolInCell(Items[0]); for (var CurrentSymbol = 1; CurrentSymbol < Items.Count; CurrentSymbol++) C.AddToNotAllowedSymbols(Items[CurrentSymbol]); Grid.Add(C); Score = Convert.ToInt32(MyStream.ReadLine()); SymbolsLeft = Convert.ToInt32(MyStream.ReadLine()); //Change loadfile to return a boolean to say if it was successful private boolean loadPuzzle(String filename) { boolean success = true; try { File myStream = new File(filename); Scanner scan = new Scanner(myStream); int noOfSymbols = Integer.parseInt(scan.nextLine()); for (int count = 0; count < noOfSymbols; count++) { allowedSymbols.add(scan.nextLine()); int noOfPatterns = Integer.parseInt(scan.nextLine()); for (int count = 0; count < noOfPatterns; count++) { String[] items = scan.nextLine().split(",", 2); Pattern p = new Pattern(items[0], items[1]); allowedPatterns.add(p); gridSize = Integer.parseInt(scan.nextLine()); for (int count = 1; count <= gridSize * gridSize; count++) { Cell c; String[] items = scan.nextLine().split(",", 2); if (items[0].equals("@")) { c = new BlockedCell(); } else { c = new Cell(); c.changeSymbolInCell(items[0]); for (int currentSymbol = 1; currentSymbol < items.length; currentSymbol++) { c.addToNotAllowedSymbols(items[currentSymbol]); grid.add(c); score = Integer.parseInt(scan.nextLine()); symbolsLeft = Integer.parseInt(scan.nextLine()); } catch (Exception e) { Console.writeLine("Puzzle not loaded"); success = false; return success; //Change the Puzzle(filename) constructor to load a default 8*8 puzzle if the filename is invalid public Puzzle(String filename) { grid = new ArrayList<>(); allowedPatterns = new ArrayList<>(); allowedSymbols = new ArrayList<>(); if (!loadPuzzle(filename)) { //the puzzle could not be loaded - run normal game with default size and symbols score = 0; symbolsLeft = (int) (8*8*0.6); gridSize = 8; grid = new ArrayList<>(); for (int count = 1; count < gridSize * gridSize + 1; count++) { Cell c; if (getRandomInt(1, 101) < 90) { c = new Cell(); } else { c = new BlockedCell(); grid.add(c); allowedPatterns = new ArrayList<>(); allowedSymbols = new ArrayList<>(); Pattern qPattern = new Pattern("Q", "QQ**Q**QQ"); allowedPatterns.add(qPattern); allowedSymbols.add("Q"); Pattern xPattern = new Pattern("X", "X*X*X*X*X"); allowedPatterns.add(xPattern); allowedSymbols.add("X"); Pattern tPattern = new Pattern("T", "TTT**T**T"); allowedPatterns.add(tPattern); allowedSymbols.add("T"); def __LoadPuzzle(self, Filename): try: with open(Filename) as f: NoOfSymbols = int(f.readline().rstrip()) for Count in range (1, NoOfSymbols + 1): self.__AllowedSymbols.append(f.readline().rstrip()) NoOfPatterns = int(f.readline().rstrip()) for Count in range(1, NoOfPatterns + 1): Items = f.readline().rstrip().split(",") P = Pattern(Items[0], Items[1]) self.__AllowedPatterns.append(P) self.__GridSize = int(f.readline().rstrip()) for Count in range (1, self.__GridSize * self.__GridSize + 1): Items = f.readline().rstrip().split(",") if Items[0] == "@": C = BlockedCell() self.__Grid.append(C) else: C = Cell() C.ChangeSymbolInCell(Items[0]) for CurrentSymbol in range(1, len(Items)): C.AddToNotAllowedSymbols(Items[CurrentSymbol]) self.__Grid.append(C) self.__Score = int(f.readline().rstrip()) self.__SymbolsLeft = int(f.readline().rstrip()) except: print("Puzzle not loaded") Main() #WikiBooks Q2 This helps to reset the code so that the program isn't stuck in an infinite loop trying to collect information that cannot be used. Allows the user another chance to re-enter the file name for the puzzle. Private Sub LoadPuzzle(Filename As String) Try Using MyStream As New StreamReader(Filename) Dim NoOfSymbols As Integer = MyStream.ReadLine() For Count = 1 To NoOfSymbols AllowedSymbols.Add(MyStream.ReadLine()) Next Dim NoOfPatterns As Integer = MyStream.ReadLine() For Count = 1 To NoOfPatterns Dim Items As List(Of String) = MyStream.ReadLine().Split(",").ToList() Dim P As Pattern = New Pattern(Items(0), Items(1)) AllowedPatterns.Add(P) Next GridSize = Convert.ToInt32(MyStream.ReadLine()) For Count = 1 To GridSize * GridSize Dim C As Cell Dim Items As List(Of String) = MyStream.ReadLine().Split(",").ToList() If Items(0) = "@" Then C = New BlockedCell() Else C = New Cell() C.ChangeSymbolInCell(Items(0)) For CurrentSymbol = 1 To Items.Count - 1 C.AddToNotAllowedSymbols(Items(CurrentSymbol)) Next End If Grid.Add(C) Next Score = MyStream.ReadLine() SymbolsLeft = MyStream.ReadLine() End Using Catch Console.WriteLine("Puzzle not loaded") Call Main() End Try End Sub Alternative approach --> The question asks us to only accept files that exist otherwise play a default game. I have used a function instead as it is more easier to remember. Main Sub Sub Main() Dim Again As String = "y" Dim Score As Integer While Again = "y" Console.Write("Press Enter to start a standard puzzle or enter name of file to load: ") Dim Filename As String = Console.ReadLine() Dim MyPuzzle As Puzzle If Filename.Length > 0 And isValid(Filename) Then ' added function here MyPuzzle = New Puzzle(Filename & ".txt") Else MyPuzzle = New Puzzle(8, Int(8 * 8 * 0.6)) End If Score = MyPuzzle.AttemptPuzzle() Console.WriteLine("Puzzle finished. Your score was: " & Score) Console.Write("Do another puzzle? ") Again = Console.ReadLine().ToLower() End While Console.ReadLine() End Sub isValid function Function isValid(path As String) As Boolean Try If File.Exists(path + ".txt") Then ' adding .txt will cause the code to not read the file Dim inp() As String = File.ReadAllLines(path + ".txt") ' reads all input If inp.Length > 0 Then ' checks if file is empty Return True Else Console.WriteLine("File is empty.") Return False End If Else Console.WriteLine("File does not exist.") Return False End If Catch ex As Exception ' if we experience any exceptions, then we can presume that the file is not a game file Console.WriteLine("Error reading file: " & ex.Message) Return False End Try End Function Question 3 - Blow up a block (blocked cell) [10 marks]. Have a 'bomb' that can remove or 'blow-up' a block in a 'blocked cell', but costs you some of your score (minus some points): // start change private string GetSymbolFromUser() string Symbol = ""; while (!AllowedSymbols.Contains(Symbol) && Symbol != "bomb") Console.Write("Enter symbol or 'bomb' to blow up an @: "); Symbol = Console.ReadLine(); return Symbol; // end change public virtual int AttemptPuzzle() // start change string Symbol = GetSymbolFromUser(); if (Symbol == "bomb" && Score >= 10) int i = (GridSize - Row) * GridSize + Column – 1; Grid[i] = new Cell(CurrentCell.GetSymbolsNotAllowed); Score -= 10; else if (Symbol == "bomb" && Score < 10) Console.WriteLine("You do not have sufficient score to use this move"); else SymbolsLeft -= 1; Cell CurrentCell = GetCell(Row, Column); if (CurrentCell.CheckSymbolAllowed(Symbol)) CurrentCell.ChangeSymbolInCell(Symbol); int AmountToAddToScore = CheckForMatchWithPattern(Row, Column); if (AmountToAddToScore > 0) Score += AmountToAddToScore; if (SymbolsLeft == 0) Finished = true; // end change // start change (in class Cell) public Cell(List<string> _symbolsNotAllowed) Symbol = ""; SymbolsNotAllowed = _symbolsNotAllowed; public List<string> GetSymbolsNotAllowed // end change Adding another symbol B to the list to recognise it in the process. allowedSymbols.add("B"); And add a condition to the update loop (attemptPuzzle) for the "B" symbol public int attemptPuzzle() { boolean finished = false; while (!finished) { displayPuzzle(); Console.writeLine("Current score: " + score); int row = -1; boolean valid = false; while (!valid) { Console.write("Enter row number: "); try { row = Integer.parseInt(Console.readLine()); valid = true; } catch (Exception e) { int column = -1; valid = false; while (!valid) { Console.write("Enter column number: "); try { column = Integer.parseInt(Console.readLine()); valid = true; } catch (Exception e) { String symbol = getSymbolFromUser(); Cell currentCell = getCell(row, column); // this was moved up for the validation below if(symbol.equals("B") && currentCell.getClass() == BlockedCell.class && score > 2) { // check if the symbol is "B", the target is a BlockedCell and the player has enough score to sacrifice grid.set((gridSize - row) * gridSize + column - 1, new Cell()); // set an empty cell to the position (indexing can be found in getCell() method) score -= 3; // change the score } else if (symbol.equals("B")){ System.out.println("Cannot blow an empty block or you have not enough score to use the command."); continue; // start a new iteration BEFORE symbolsLeft is decremented (no move was made) symbolsLeft -= 1; if (currentCell.checkSymbolAllowed(symbol)) { currentCell.changeSymbolInCell(symbol); int amountToAddToScore = checkForMatchWithPattern(row, column); if (amountToAddToScore > 0) { score += amountToAddToScore; if (symbolsLeft == 0) { finished = true; Console.writeLine(); displayPuzzle(); Console.writeLine(); return score; This adds a new symbol "B" which can only be played on a blocked tile. self.__AllowedSymbols.append("B") def AttemptPuzzle(self): Finished = False while not Finished: self.DisplayPuzzle() print("Current score: " + str(self.__Score)) Row = -1 Valid = False while not Valid: try: Row = int(input("Enter row number: ")) Valid = True except: pass Column = -1 Valid = False while not Valid: try: Column = int(input("Enter column number: ")) Valid = True except: pass Symbol = self.__GetSymbolFromUser() self.__SymbolsLeft -= 1 CurrentCell = self.__GetCell(Row, Column) # CHANGES HERE if Symbol == "B" and type(CurrentCell) == BlockedCell: Index = (self.__GridSize - Row) * self.__GridSize + Column - 1 self.__Grid[Index] = Cell() # Change Blocked Cell to regular Cell so the cell is "open" self.__Score -= 3 elif CurrentCell.CheckSymbolAllowed(Symbol) and Symbol != "B": CurrentCell.ChangeSymbolInCell(Symbol) AmountToAddToScore = self.CheckforMatchWithPattern(Row, Column) if AmountToAddToScore > 0: self.__Score += AmountToAddToScore if self.__SymbolsLeft == 0: Finished = True print() self.DisplayPuzzle() print() return self.__Score ‘’in Function AttemptPuzzle() " start change Dim Symbol As String = GetSymbolFromUser() Dim CurrentCell As Cell = GetCell(Row, Column) If ((Symbol = "bomb") And (Score >= 10)) Then Dim i As Integer = ((GridSize - Row) * GridSize + Column) - 1 Grid(i) = New Cell Score -= 10 ElseIf ((Symbol = "bomb") And (Score < 10)) Then Console.WriteLine("You do not have suffiecient score to use this move") Else SymbolsLeft -= 1 If CurrentCell.CheckSymbolAllowed(Symbol) Then CurrentCell.ChangeSymbolInCell(Symbol) Dim AmountToAddToScore As Integer = CheckForMatchWithPattern(Row, Column) If AmountToAddToScore > 0 Then Score += AmountToAddToScore End If End If If SymbolsLeft = 0 Then Finished = True End If End If "end change Private Function GetSymbolFromUser() As String Dim Symbol As String = "" "start change While ((Not AllowedSymbols.Contains(Symbol)) And (Not Symbol = "bomb")) " end change Console.Write("Enter symbol or 'bomb' to blow up an @: ") Symbol = (Console.ReadLine()) End While Return Symbol End Function Question 4 - Add additional symbols/letters [3 marks]. Add additional letters/symbols e.g. L or O or U or V or C or H or I. Pattern LPattern = new Pattern("L", "L***LLLL*"); AllowedPatterns.Add(LPattern); AllowedSymbols.Add("L"); If you look carefully, you can spot that the pattern recognition goes in a spiral: 0_1_2 7_8_3 6_5_4 So we are going to need to map our new letter the same way: Example of "L": L_*_* L_*_* L_L_L Next, simply follow the pattern to create a string: // ...other patterns Pattern lPattern = new Pattern("L", "L***LLLL*"); allowedPatterns.add(lPattern); allowedSymbols.add("L"); The way that the pattern checking works is in clockwise. This is the order 1 2 3 8 9 4 7 6 5 so the pattern for Q is QQ**Q**QQ, and if you place the symbols in that order, you get the correct pattern. class Puzzle(): def __init__(self, *args): LPattern = Pattern("L", "L***LLLL*") self.__AllowedPatterns.append(LPattern) self.__AllowedSymbols.append("L") This allows the user to create an L pattern that results in them earning 10 points. Dim LPattern As Pattern = New Pattern("L", "L***LLLL*") AllowedPatterns.Add(LPattern) AllowedSymbols.Add("L") Question 5 - Save current game (status) [5 marks]. Save the current status of the game (file-handling)/writing to a text file. public virtual int AttemptPuzzle() bool Finished = false; while (!Finished) DisplayPuzzle(); Console.WriteLine("Current score: " + Score); bool Valid = false; int Row = -1; while (!Valid) Console.Write("Enter row number: "); try Row = Convert.ToInt32(Console.ReadLine()); Valid = true; catch int Column = -1; Valid = false; while (!Valid) Console.Write("Enter column number: "); try Column = Convert.ToInt32(Console.ReadLine()); Valid = true; catch string Symbol = GetSymbolFromUser(); SymbolsLeft -= 1 Cell CurrentCell = GetCell(Row, Column); if (CurrentCell.CheckSymbolAllowed(Symbol)) SymbolsLeft -= 1; CurrentCell.ChangeSymbolInCell(Symbol); int AmountToAddToScore = CheckForMatchWithPattern(Row, Column); if (AmountToAddToScore > 0) Score += AmountToAddToScore; if (SymbolsLeft == 0) Finished = true; //New code for question 5 including calling new SavePuzzle() method: Console.WriteLine("Do you wish to save your puzzle and exit? (Y for yes)"); if (Console.ReadLine().ToUpper() == "Y") Console.WriteLine("What would you like to save your puzzle as?"); string file = Console.ReadLine(); SavePuzzle(file); Console.WriteLine("Puzzle Successfully Saved."); break; //end of code for question 5 Console.WriteLine(); DisplayPuzzle(); Console.WriteLine(); return Score; //new SavePuzzle() method: private void SavePuzzle(string filename) filename = filename + ".txt"; using (StreamWriter sw = new StreamWriter(filename)) sw.WriteLine(AllowedSymbols.Count); foreach (var symbol in AllowedSymbols) sw.WriteLine(symbol); sw.WriteLine(AllowedPatterns.Count); foreach (var pattern in AllowedPatterns) sw.WriteLine(pattern.GetPatternSymbol() + "," + pattern.GetPatternSequence()); sw.WriteLine(GridSize); foreach (Cell C in Grid) List<string> notAllowedSymbol = C.returnNotAllowedSymbols(); try sw.WriteLine(C.GetSymbol() + "," + notAllowedSymbol[0]); catch sw.WriteLine(C.GetSymbol() + ","); sw.WriteLine(Score); sw.WriteLine(SymbolsLeft); // new returnNotAllowedSymbol() method in Pattern class public virtual List<string> returnNotAllowedSymbols() return SymbolsNotAllowed; private void savePuzzle(String filename){ try { FileWriter myWriter = new FileWriter(filename); myWriter.write(""+allowedSymbols.size()+"\n"); for (String s:allowedSymbols){ myWriter.write(s+"\n"); myWriter.write(""+allowedPatterns.size()+"\n"); for (Pattern p:allowedPatterns){ myWriter.write(p.getPatternSequence().charAt(0)+","+p.getPatternSequence()+"\n"); myWriter.write(""+gridSize+"\n"); for (Cell c:grid){ String toWrite=""+c.getSymbol()+","; for(String s:allowedSymbols){ if (!c.checkSymbolAllowed(s)){ toWrite=toWrite+s; } myWriter.write(toWrite+"\n"); myWriter.write(score+"\n"); myWriter.write(symbolsLeft+"\n"); myWriter.close(); } catch (Exception e) { Console.writeLine("Puzzle not saved"); // And changes in attemptPuzzle Console.writeLine("Do you wish to save and quit the game y/n?: "); String quit = Console.readLine(); if (quit.equals("y")){ Console.writeLine("Please enter a filename with a .txt extension: "); String fname=Console.readLine(); savePuzzle(fname); finished = true; Some of the get methods have to be added manually in each class. class Puzzle: def __save_puzzle(self, filename): with open(filename, 'w') as f: f.write(f"{len(self.__AllowedSymbols)}\n") for i in self.__AllowedSymbols: f.write(f"{i}\n") f.write(f"{len(self.__AllowedPatterns)}\n") for i in self.__AllowedPatterns: f.write(f"{i.GetSymbol()},{i.GetPatternSequence()}\n") f.write(f"{self.__GridSize}\n") for cell in self.__Grid: symbol = cell.GetSymbol() f.write(f"{symbol if symbol != '-' else "},{','.join(cell.GetNotAllowedSymbols())}\n") f.write(f"{self.__Score}\n") f.write(f"{self.__SymbolsLeft}\n") Sub SaveGame() Console.WriteLine("Enter filename") Dim filename As String = Console.ReadLine filename = filename & ".txt" Dim SR As New StreamWriter(filename) 'this is the number of symbols SR.WriteLine(AllowedSymbols.Count) 'this loops through the different symbols For i As Integer = 0 To AllowedSymbols.Count - 1 SR.WriteLine(AllowedSymbols(i)) Next 'this is the number of patterns SR.WriteLine(AllowedPatterns.Count) 'displays the different patterns For j As Integer = 0 To AllowedPatterns.Count - 1 SR.WriteLine(AllowedSymbols(j) & "," & AllowedPatterns(j).GetPatternSequence) Next 'this is the gridsize SR.WriteLine(GridSize) 'this writes out the grid For a As Integer = 0 To Grid.Count - 1 SR.WriteLine(Grid(a).GetSymbol() & Grid(a).returnNotAllowedList) Next 'this is the current score SR.WriteLine(Score) 'this is the number of symbols left SR.WriteLine(SymbolsLeft) SR.Close() End Sub 'cleaned version (above version has a few issues) Public Overridable Function AttemptPuzzle() As Integer Dim Finished As Boolean = False While Not Finished DisplayPuzzle() Console.WriteLine("Current score: " & Score) Dim Valid As Boolean = False Dim Row As Integer = -1 While Not Valid Console.Write("Enter row number: ") Try Row = Console.ReadLine() Valid = True Catch End Try End While Dim Column As Integer = -1 Valid = False While Not Valid Console.Write("Enter column number: ") Try Column = Console.ReadLine() Valid = True Catch End Try End While Dim Symbol As String = GetSymbolFromUser() Dim CurrentCell As Cell = GetCell(Row, Column) If (Symbol = "bomb") AndAlso (Score >= 10) Then Dim i As Integer = ((GridSize - Row) * GridSize + Column) - 1 Grid(i) = New Cell Score -= 10 ElseIf Symbol = "Bomb" AndAlso Score < 10 Then Console.WriteLine("You do not have sufficient score to use this move") Else SymbolsLeft -= 1 If CurrentCell.CheckSymbolAllowed(Symbol) Then CurrentCell.ChangeSymbolInCell(Symbol) Dim AmountToAddToScore As Integer = CheckForMatchWithPattern(Row, Column) If AmountToAddToScore > 0 Then Score += AmountToAddToScore End If End If If SymbolsLeft = 0 Then Finished = True End If Console.WriteLine("Would you like to save your puzzle and exit? (Y/N) ") If UCase(Console.ReadLine()) = "Y" Then Console.WriteLine("What name would you like to save your puzzle as ? ") Dim new_filename As String = Console.ReadLine() + ".txt" Dim error_status = SavePuzzle(new_filename) If Not error_status Then Console.WriteLine("Puzzle Successfully Saved. ") End If End If End If End While Console.WriteLine() DisplayPuzzle() Console.WriteLine() Return Score End Function Private Function SavePuzzle(filename As String) As Boolean Dim SR As New StreamWriter(filename) SR.WriteLine(AllowedSymbols.Count) For i As Integer = 0 To AllowedSymbols.Count - 1 SR.WriteLine(AllowedSymbols(i)) Next SR.WriteLine(AllowedPatterns.Count) For j As Integer = 0 To AllowedPatterns.Count - 1 SR.WriteLine(AllowedSymbols(j) & "," & AllowedPatterns(j).GetPatternSequence) Next SR.WriteLine(GridSize) For t = 0 To Grid.Count - 1 Dim notAllowedSymbol As String ' Check if returnNotAllowedList is empty If Grid(t).returnNotAllowedList.Count > 0 Then notAllowedSymbol = Grid(t).returnNotAllowedList(0) Else notAllowedSymbol = "" End If SR.WriteLine(Grid(t).GetSymbol & "," & notAllowedSymbol) Next SR.WriteLine(Score) SR.WriteLine(SymbolsLeft) SR.Close() Return True End Function Cell class: Public Function returnNotAllowedList() As List(Of String) Return SymbolsNotAllowed End Function Alternative approach --> Its better to not modify the Cell class (unless its asked). I have also used string concatenation as its easier to remember during exam stress and is easier to understand/debug. AttemptPuzzle method Public Overridable Function AttemptPuzzle() As Integer Dim Finished As Boolean = False While Not Finished DisplayPuzzle() Console.WriteLine("Current score: " & Score) Dim Valid As Boolean = False Dim Row As Integer = -1 While Not Valid Console.Write("Enter row number: ") Try ' CHANGES START FROM HERE Dim inp1 = Console.ReadLine() If (inp1 = "SAVEGAME") Then SaveGame() Valid = False Else Row = Int32.Parse(inp1) Valid = True End If Catch ' CHANGE ENDS HERE End Try End While Dim Column As Integer = -1 Valid = False While Not Valid Console.Write("Enter column number: ") Try ' CHANGES START FROM HERE Dim inp1 = Console.ReadLine() If (inp1 = "SAVEGAME") Then SaveGame() Valid = False Else Column = Int32.Parse(inp1) Valid = True End If Catch ' CHANGE ENDS HERE End Try End While Dim Symbol As String = GetSymbolFromUser() SymbolsLeft -= 1 Dim CurrentCell As Cell = GetCell(Row, Column) If CurrentCell.CheckSymbolAllowed(Symbol) Then CurrentCell.ChangeSymbolInCell(Symbol) Dim AmountToAddToScore As Integer = CheckForMatchWithPattern(Row, Column) If AmountToAddToScore > 0 Then Score += AmountToAddToScore End If End If If SymbolsLeft = 0 Then Finished = True End If End While Console.WriteLine() DisplayPuzzle() Console.WriteLine() Return Score End Function SaveGame method Private Sub SaveGame() Dim alreadyExists As Boolean = True ' start by making your variables Dim savePath As String = String.Empty Dim fileContent As String = String.Empty While alreadyExists ' make a loop until you get valid input Console.Write("Enter a name:") savePath = Console.ReadLine() If File.Exists(savePath + ".txt") Then ' see if it exists alreadyExists = True Console.WriteLine("Please enter a file name that is not taken already!") Else alreadyExists = False End If End While ' We are basically constructing a string that we will then make as a text file, you can StreamReader or StringBuilder but I personally perfer this as its more easier to debug. Use the text files provided and LoadPuzzle method for help fileContent = fileContent & (AllowedSymbols.Count.ToString() + Environment.NewLine) ' symbols allowed For Each sym In AllowedSymbols fileContent = fileContent & (sym + Environment.NewLine) ' add the allowed symbols one by one Next fileContent = fileContent & (AllowedPatterns.Count.ToString() + Environment.NewLine) ' patterns allowed For Each pat In AllowedPatterns fileContent = fileContent & (findSymbol(pat.GetPatternSequence().ToString()).ToString() + "," + pat.GetPatternSequence().ToString() + Environment.NewLine) ' Get the Symbol and then the pattern split by , Next fileContent = fileContent & (GridSize.ToString() + Environment.NewLine) ' gridsize For Each item In Grid ' we export all the cells into the text file Dim symbol = item.GetSymbol ' see if its an empty cell or normal/blocked cell Dim notAllowed As String = String.Empty For Each sym In AllowedSymbols ' checks for the not allowed symbol, would be nice for AQA to make a function for us If (Not item.CheckSymbolAllowed(sym)) Then notAllowed = sym Exit For ' you will get the last symbol if you don't add this End If Next If (symbol = "-") Then ' comma only plus the not allowed symbol fileContent = fileContent & ("," + notAllowed.ToString() + Environment.NewLine) Else ' the symbol comma plus the not allowed symbol fileContent = fileContent & (symbol.ToString() + "," + notAllowed.ToString() + Environment.NewLine) End If Next fileContent = fileContent & (Score.ToString() + Environment.NewLine) ' score fileContent = fileContent & (SymbolsLeft.ToString() + Environment.NewLine) ' how many left fileContent.TrimEnd() ' bug that creates a random new line is fixed here File.WriteAllText(savePath + ".txt", fileContent) ' create txt End Sub findSymbol method Function findSymbol(str As String) ' Not all patterns might start with their symbol, this is a failsafe For Each strs In str If (strs <> "*") Then Return strs End If Next End Function Question 6 - Rotated letter/symbol [9 marks]. Score a 'rotated' symbol/letter (lower score?) Rotated letters are given 5 points rather than 10. public virtual int CheckForMatchWithPattern(int Row, int Column) for (var StartRow = Row + 2; StartRow >= Row; StartRow--) for (var StartColumn = Column - 2; StartColumn <= Column; StartColumn++) try string PatternString = ""; PatternString += GetCell(StartRow, StartColumn).GetSymbol(); PatternString += GetCell(StartRow, StartColumn + 1).GetSymbol(); PatternString += GetCell(StartRow, StartColumn + 2).GetSymbol(); PatternString += GetCell(StartRow - 1, StartColumn + 2).GetSymbol(); PatternString += GetCell(StartRow - 2, StartColumn + 2).GetSymbol(); PatternString += GetCell(StartRow - 2, StartColumn + 1).GetSymbol(); PatternString += GetCell(StartRow - 2, StartColumn).GetSymbol(); PatternString += GetCell(StartRow - 1, StartColumn).GetSymbol(); PatternString += GetCell(StartRow - 1, StartColumn + 1).GetSymbol(); for (int i = 0; i < 4; i++) foreach (var P in AllowedPatterns) string CurrentSymbol = GetCell(Row, Column).GetSymbol(); if (P.MatchesPattern(PatternString, CurrentSymbol)) GetCell(StartRow, StartColumn).AddToNotAllowedSymbols(CurrentSymbol); GetCell(StartRow, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol); GetCell(StartRow, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol); GetCell(StartRow - 1, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol); GetCell(StartRow - 2, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol); GetCell(StartRow - 2, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol); GetCell(StartRow - 2, StartColumn).AddToNotAllowedSymbols(CurrentSymbol); GetCell(StartRow - 1, StartColumn).AddToNotAllowedSymbols(CurrentSymbol); GetCell(StartRow - 1, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol); if (i == 0) return 10; else return 5; PatternString = PatternString.Substring(2, 6) + PatternString.Substring(0, 2) + PatternString[8]; catch return 0; public int CheckforMatchWithPattern(int Row, int Column) { for (int StartRow = Row + 2; StartRow > Row - 1; StartRow--) { for (int StartColumn = Column - 2; StartColumn < Column + 1; StartColumn++) { try { String PatternString = ""; PatternString += this.__GetCell(StartRow, StartColumn).GetSymbol(); PatternString += this.__GetCell(StartRow, StartColumn + 1).GetSymbol(); PatternString += this.__GetCell(StartRow, StartColumn + 2).GetSymbol(); PatternString += this.__GetCell(StartRow - 1, StartColumn + 2).GetSymbol(); PatternString += this.__GetCell(StartRow - 2, StartColumn + 2).GetSymbol(); PatternString += this.__GetCell(StartRow - 2, StartColumn + 1).GetSymbol(); PatternString += this.__GetCell(StartRow - 2, StartColumn).GetSymbol(); PatternString += this.__GetCell(StartRow - 1, StartColumn).GetSymbol(); PatternString += this.__GetCell(StartRow - 1, StartColumn + 1).GetSymbol(); String LeftRotation = PatternString.substring(6, 8) + PatternString.substring(0, 6) + PatternString.substring(8); String RightRotation = PatternString.substring(2, 7) + PatternString.substring(0, 2) + PatternString.substring(8); String DownRotation = PatternString.substring(4, 8) + PatternString.substring(0, 4) + PatternString.substring(8); String[] Rotations = {PatternString, LeftRotation, RightRotation, DownRotation}; for (Pattern P : this.__AllowedPatterns) { for (String rotation : Rotations) { char CurrentSymbol = this.__GetCell(Row, Column).GetSymbol(); if (P.MatchesPattern(rotation, CurrentSymbol)) { this.__GetCell(StartRow, StartColumn).AddToNotAllowedSymbols(CurrentSymbol); this.__GetCell(StartRow, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol); this.__GetCell(StartRow, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol); this.__GetCell(StartRow - 1, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol); this.__GetCell(StartRow - 2, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol); this.__GetCell(StartRow - 2, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol); this.__GetCell(StartRow - 2, StartColumn).AddToNotAllowedSymbols(CurrentSymbol); this.__GetCell(StartRow - 1, StartColumn).AddToNotAllowedSymbols(CurrentSymbol); this.__GetCell(StartRow - 1, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol); return 10; } catch (Exception e) { // Handle exception return 0; def CheckforMatchWithPattern(self, Row, Column): for StartRow in range(Row + 2, Row - 1, -1): for StartColumn in range(Column - 2, Column + 1): try: PatternString = "" PatternString += self.__GetCell(StartRow, StartColumn).GetSymbol() PatternString += self.__GetCell(StartRow, StartColumn + 1).GetSymbol() PatternString += self.__GetCell(StartRow, StartColumn + 2).GetSymbol() PatternString += self.__GetCell(StartRow - 1, StartColumn + 2).GetSymbol() PatternString += self.__GetCell(StartRow - 2, StartColumn + 2).GetSymbol() PatternString += self.__GetCell(StartRow - 2, StartColumn + 1).GetSymbol() PatternString += self.__GetCell(StartRow - 2, StartColumn).GetSymbol() PatternString += self.__GetCell(StartRow - 1, StartColumn).GetSymbol() PatternString += self.__GetCell(StartRow - 1, StartColumn + 1).GetSymbol() LeftRotation = PatternString[6:8] + PatternString[:6]+PatternString[8] RightRotation = PatternString[2:8] + PatternString[0:2] + PatternString[8] DownRotation = PatternString[4:8] + PatternString[:4] + PatternString[8] Rotations = [PatternString, LeftRotation, RightRotation, DownRotation] for P in self.__AllowedPatterns: for rotation in Rotations: CurrentSymbol = self.__GetCell(Row, Column).GetSymbol() if P.MatchesPattern(rotation, CurrentSymbol): self.__GetCell(StartRow, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 1, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 2, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 2, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 2, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 1, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 1, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) return 10 except: pass return 0 Public Overridable Function CheckForMatchWithPattern(Row As Integer, Column As Integer) As Integer For StartRow = Row + 2 To Row Step -1 For StartColumn = Column - 2 To Column Try Dim PatternString As String = "" PatternString &= GetCell(StartRow, StartColumn).GetSymbol() PatternString &= GetCell(StartRow, StartColumn + 1).GetSymbol() PatternString &= GetCell(StartRow, StartColumn + 2).GetSymbol() PatternString &= GetCell(StartRow - 1, StartColumn + 2).GetSymbol() PatternString &= GetCell(StartRow - 2, StartColumn + 2).GetSymbol() PatternString &= GetCell(StartRow - 2, StartColumn + 1).GetSymbol() PatternString &= GetCell(StartRow - 2, StartColumn).GetSymbol() PatternString &= GetCell(StartRow - 1, StartColumn).GetSymbol() PatternString &= GetCell(StartRow - 1, StartColumn + 1).GetSymbol() For Each P In AllowedPatterns Dim CurrentSymbol As String = GetCell(Row, Column).GetSymbol() If P.MatchesPattern(PatternString, CurrentSymbol) Then GetCell(StartRow, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 1, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 2, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 2, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 2, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 1, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 1, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) Return 10 End If For Each i As Integer In angles If P.MatchesPatternRotated(PatternString, CurrentSymbol, i) Then GetCell(StartRow, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 1, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 2, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 2, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 2, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 1, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) GetCell(StartRow - 1, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) Return 15 End If Next Next Catch End Try Next Next Return 0 End Function Public Function MatchesPatternRotated(PatternString As String, SymbolPlaced As String, Rotation As Integer) As Boolean If (SymbolPlaced <> Symbol) Then Return False End If Dim RotatedSequence As String = "" Select Case Rotation Case 90 RotatedSequence = GetPatternSequence().Substring(6, 2) + GetPatternSequence().Substring(0, 6) + GetPatternSequence.Substring(8, 1) 'Case 180 '... with substring 44 04 81...> End Select For count = 0 To PatternSequence.Length - 1 If RotatedSequence(count).ToString() = SymbolPlaced And PatternString(count).ToString() <> Symbol Then Return False End If Next Return True End Function Question 7 - Game difficulty setting [12 marks]. Offer 'game difficulty' setting to change level of game (with greater number of blocked cells) (Important -> probably lower mark question than 11 makrs, e.g. 4 mark question) public Puzzle(int Size, int StartSymbols) Score = 0; SymbolsLeft = StartSymbols; GridSize = Size; Grid = new List<Cell>(); // new code for question 5 int notBlockedChance; Console.WriteLine("Would you like the difficulty to be easy (E), medium(M), hard(H) or extremely hard (EH)?"); string difficulty = Console.ReadLine(); if (difficulty.ToUpper() == "EH") notBlockedChance = 50; //these values are just an example and can be modified else if (difficulty.ToUpper() == "H") notBlockedChance = 60; else if (difficulty.ToUpper() == "M") notBlockedChance = 75; else notBlockedChance = 90; for (var Count = 1; Count <= GridSize * GridSize; Count++) Cell C; if (Rng.Next(1, 101) < notBlockedChance) //end of new code for question 5 C = new Cell(); else C = new BlockedCell(); Grid.Add(C); AllowedPatterns = new List<Pattern>(); AllowedSymbols = new List<string>(); Pattern QPattern = new Pattern("Q", "QQ**Q**QQ"); AllowedPatterns.Add(QPattern); AllowedSymbols.Add("Q"); Pattern XPattern = new Pattern("X", "X*X*X*X*X"); AllowedPatterns.Add(XPattern); AllowedSymbols.Add("X"); Pattern TPattern = new Pattern("T", "TTT**T**T"); AllowedPatterns.Add(TPattern); AllowedSymbols.Add("T"); public class PuzzleSP { public static void main(String[] args) { String again = "y"; int score; while (again.equals("y")) { Console.write("Press Enter to start a standard puzzle or enter name of file to load: "); String filename = Console.readLine(); Puzzle myPuzzle; if (filename.length() > 0) { myPuzzle = new Puzzle(filename + ".txt"); } else { //start of altered code Console.writeLine("enter a difficulty (1-3 easy to hard): "); int dif = Integer.parseInt(Console.readLine()); if(dif < 1 || dif > 3) { dif = 2; myPuzzle = new Puzzle(8, (int)(8 * 8 * 0.6), dif); //end of altered code score = myPuzzle.attemptPuzzle(); Console.writeLine("Puzzle finished. Your score was: " + score); Console.write("Do another puzzle? "); again = Console.readLine().toLowerCase(); Console.readLine(); public Puzzle(int size, int startSymbols, int difficulty) { //add difficulty setting score = 0; symbolsLeft = startSymbols; gridSize = size; grid = new ArrayList<>(); for (int count = 1; count < gridSize * gridSize + 1; count++) { Cell c; int num = 0; //start of altered code if(difficulty == 1) { num = 90; else if(difficulty == 2) { num = 70; else if(difficulty == 3) { num = 50; //the lower num is, the more difficult the game will be. if (getRandomInt(1, 101) < num) { c = new Cell(); } else { c = new BlockedCell(); grid.add(c); //end of altered code class Puzzle(): def __init__(self, *args): if len(args) == 1: self.__Score = 0 self.__SymbolsLeft = 0 self.__GridSize = 0 self.__Grid = [] self.__AllowedPatterns = [] self.__AllowedSymbols = [] self.__LoadPuzzle(args[0]) else: self.__Score = 0 self.__SymbolsLeft = args[1] self.__GridSize = args[0] self.__Grid = [] print("1: Easy, 2: Normal, 3: Hard") difficulty = "" while not (difficulty == "1" or difficulty == "2" or difficulty == "3") or not difficulty.isdigit(): difficulty = input("Enter a difficulty") difficulty = int(difficulty) difficulties = {1:95 , 2:80 , 3:65} #modify these values to change difficulties for Count in range(1, self.__GridSize * self.__GridSize + 1): if random.randrange(1, 101) < difficulties[difficulty]: C = Cell() else: C = BlockedCell() self.__Grid.append(C) self.__AllowedPatterns = [] self.__AllowedSymbols = [] QPattern = Pattern("Q", "QQ**Q**QQ") self.__AllowedPatterns.append(QPattern) self.__AllowedSymbols.append("Q") XPattern = Pattern("X", "X*X*X*X*X") self.__AllowedPatterns.append(XPattern) self.__AllowedSymbols.append("X") TPattern = Pattern("T", "TTT**T**T") self.__AllowedPatterns.append(TPattern) self.__AllowedSymbols.append("T") def Main(): Again = "y" Score = 0 while Again == "y": Filename = input("Press Enter to start a standard puzzle or enter name of file to load: ") if len(Filename) > 0: MyPuzzle = Puzzle(Filename + ".txt") else: GrS = 0 diff = 0 while GrS < 3 or GrS > 16: GrS = int(input("Input Desired Gridsize (i.e. 5 = 5x5 grid)")) while diff <= 0 or diff > 9: diff = int(input("Input Desired Difficulty 1-9")) diff = diff/10 diff = 1-diff MyPuzzle = Puzzle(GrS, int(GrS * GrS * diff)) Score = MyPuzzle.AttemptPuzzle() print("Puzzle finished. Your score was: " + str(Score)) Again = input("Do another puzzle? ").lower() # add (y/n) Difficulty based on number of moves available Sub Main() Dim Again As String = "y" Dim Score As Integer While Again = "y" Console.Write("Press Enter to start a standard puzzle or enter name of file to load: ") Dim Filename As String = Console.ReadLine() 'ADDED CODE - checks that the filename entered has a file existing in the DEBUG folder Dim fileExists As Boolean = False Dim FullFilename As String = Filename & ".txt" If FileIO.FileSystem.FileExists(FullFilename) Then fileExists = True End If 'AMENDED CODE - the if statement changed to use the boolean value above instead of 'using the text length Dim MyPuzzle As Puzzle If fileExists Then MyPuzzle = New Puzzle(Filename & ".txt") Else 'ADDED CODE Dim Dif As Integer Do Console.WriteLine("Enter a difficulty rating from 1-9") Dif = Console.ReadLine Loop Until Dif >= 1 And Dif < 10 'AMENDED CODE - difficulty rating affects the numbner of moves available MyPuzzle = New Puzzle(8, Int(8 * 8 * (1 - (0.1 * Dif)))) End If Score = MyPuzzle.AttemptPuzzle() Console.WriteLine("Puzzle finished. Your score was: " & Score) Console.Write("Do another puzzle? ") Again = Console.ReadLine().ToLower() End While Console.ReadLine() End Sub -> Other Implementation (could be interpreted many ways): Class Puzzle Private Score As Integer Private SymbolsLeft As Integer Private GridSize As Integer Private Grid As List(Of Cell) Private AllowedPatterns As List(Of Pattern) Private AllowedSymbols As List(Of String) Sub New(Filename As String) Grid = New List(Of Cell) AllowedPatterns = New List(Of Pattern) AllowedSymbols = New List(Of String) LoadPuzzle(Filename) End Sub Sub New(Size As Integer, StartSymbols As Integer) Score = 0 SymbolsLeft = StartSymbols GridSize = Size Grid = New List(Of Cell) 'START CHANGE HERE Dim difficulty As Integer = -1 While difficulty < 1 OrElse difficulty > 9 Console.WriteLine("Enter a difficulty rating from 1-9") difficulty = Console.ReadLine() End While For Count = 1 To GridSize * GridSize Dim C As Cell If Rng.Next(1, 101) < (10 * (10 - difficulty)) Then C = New Cell() Else C = New BlockedCell() End If Grid.Add(C) Next 'STOP CHANGE HERE AllowedPatterns = New List(Of Pattern) AllowedSymbols = New List(Of String) Dim QPattern As Pattern = New Pattern("Q", "QQ**Q**QQ") AllowedPatterns.Add(QPattern) AllowedSymbols.Add("Q") Dim XPattern As Pattern = New Pattern("X", "X*X*X*X*X") AllowedPatterns.Add(XPattern) AllowedSymbols.Add("X") Dim TPattern As Pattern = New Pattern("T", "TTT**T**T") AllowedPatterns.Add(TPattern) AllowedSymbols.Add("T") End Sub Question 8 - Fix symbols placed error [9 marks]. When you try place a symbol in a invalid cell it still counts as a placed cell towards the amount of symbols placed. public virtual int AttemptPuzzle() bool Finished = false; while (!Finished) DisplayPuzzle(); Console.WriteLine("Current score: " + Score); bool Valid = false; int Row = -1; while (!Valid) Console.Write("Enter row number: "); try Row = Convert.ToInt32(Console.ReadLine()); Valid = true; catch int Column = -1; Valid = false; while (!Valid) Console.Write("Enter column number: "); try Column = Convert.ToInt32(Console.ReadLine()); Valid = true; catch string Symbol = GetSymbolFromUser(); //SymbolsLeft -= 1; => moved inside the IF statement Cell CurrentCell = GetCell(Row, Column); if (CurrentCell.CheckSymbolAllowed(Symbol)) SymbolsLeft -= 1; //moved inside if statement to fix error CurrentCell.ChangeSymbolInCell(Symbol); int AmountToAddToScore = CheckForMatchWithPattern(Row, Column); if (AmountToAddToScore > 0) Score += AmountToAddToScore; if (SymbolsLeft == 0) Finished = true; Console.WriteLine(); DisplayPuzzle(); Console.WriteLine(); return Score; def AttemptPuzzle(self): Finished = False while not Finished: self.DisplayPuzzle() print("Current score: " + str(self.__Score)) Row = -1 Valid = False while not Valid: try: Row = int(input("Enter row number: ")) Valid = True except: pass Column = -1 Valid = False while not Valid: try: Column = int(input("Enter column number: ")) Valid = True except: pass Symbol = self.__GetSymbolFromUser() # self.__SymbolsLeft -= 1 moving this line inside of the if statement CurrentCell = self.__GetCell(Row, Column) if CurrentCell.CheckSymbolAllowed(Symbol) and CurrentCell.IsEmpty() == True: # added to make sure that the cell is empty as well before adding to that cell self.__SymbolsLeft -= 1 # moved into the if statement CurrentCell.ChangeSymbolInCell(Symbol) AmountToAddToScore = self.CheckforMatchWithPattern(Row, Column) if AmountToAddToScore > 0: self.__Score += AmountToAddToScore if self.__SymbolsLeft == 0: Finished = True print() self.DisplayPuzzle() print() return self.__Score Public Overridable Function AttemptPuzzle() As Integer Dim Finished As Boolean = False While Not Finished DisplayPuzzle() Console.WriteLine("Current score: " & Score) Dim Valid As Boolean = False Dim Row As Integer = -1 While Not Valid Console.Write("Enter row number: ") Try Row = Console.ReadLine() Valid = True Catch End Try End While Dim Column As Integer = -1 Valid = False While Not Valid Console.Write("Enter column number: ") Try Column = Console.ReadLine() Valid = True Catch End Try End While Dim Symbol As String = GetSymbolFromUser() 'START CHANGE 'SymbolsLeft -= 1 -> moved from this old place Dim CurrentCell As Cell = GetCell(Row, Column) If CurrentCell.CheckSymbolAllowed(Symbol) Then SymbolsLeft -= 1 'to here, inside the if statement to only substract ammount of symbol left if it was not placed on a blocked cell CurrentCell.ChangeSymbolInCell(Symbol) Dim AmountToAddToScore As Integer = CheckForMatchWithPattern(Row, Column) If AmountToAddToScore > 0 Then Score += AmountToAddToScore End If End If 'END CHANGE If SymbolsLeft = 0 Then Finished = True End If End While Console.WriteLine() DisplayPuzzle() Console.WriteLine() Return Score End Function Question 9 - Create a new puzzle file to be imported [5 marks]. Create a new puzzle file to be imported into the code for the user to play: 4 #number of accepted symbols Q T X O #new symbols can be added here, like so 4 #number of accepted patterns Q,QQ**Q**QQ X,X*X*X*X*X T,TTT**T**T O,OOOOOOOO* #new patterns can be added here (in proper format), like so 5 #grid size (if size = x, grid is x by x). number of entries (below) should match grid size (5 * 5 = 25 in this case) Q,Q #First symbol is symbol on board, second symbol is symbols not allowed on that grid Q,Q @,Q , Q,Q Q,Q ,Q #eg denotes an empty space, but symbol Q is not allowed , X,Q Q,Q X, , X, , X, , 10 #starting score 1 #number of moves 4 #number of accepted symbols Q T X O #new symbols can be added here, like so 4 #number of accepted patterns Q,QQ**Q**QQ X,X*X*X*X*X T,TTT**T**T O,OOOOOOOO* #new patterns can be added here (in proper format), like so 5 #grid size (if size = x, grid is x by x). number of entries (below) should match grid size (5 * 5 = 25 in this case) Q,Q #First symbol is symbol on board, second symbol is symbols not allowed on that grid Q,Q @,Q , Q,Q Q,Q ,Q #eg denotes an empty space, but symbol Q is not allowed , X,Q Q,Q X, , X, , X, , 10 #starting score 1 #number of moves Question 10 - Be able to undo a move [10 marks]. Alter the attemptPuzzle subroutine such that the user is asked if they wish to undo their last move prior to the place in the loop where there is a check for symbolsLeft being equal to zero. Warn them that this will lose them 3 points. If the player chooses to undo: a.      revert the grid back to its original state b.      ensure symbolsLeft has the correct value c.      ensure score reverts to its original value minus the 3 point undo penalty d. ensure any changes made to a cell’s symbolsNotAllowed list are undone as required while (!Valid) Console.Write("Enter column number: "); try Column = Convert.ToInt32(Console.ReadLine()); Valid = true; catch string Symbol = GetSymbolFromUser(); SymbolsLeft -= 1; // change - required in case we need to undo int previousScore = Score; // this is where the game is updated Cell CurrentCell = GetCell(Row, Column); if (CurrentCell.CheckSymbolAllowed(Symbol)) CurrentCell.ChangeSymbolInCell(Symbol); int AmountToAddToScore = CheckForMatchWithPattern(Row, Column); if (AmountToAddToScore > 0) Score += AmountToAddToScore; // changed code in AttemptPuzzle here DisplayPuzzle(); Console.WriteLine("Current score: " + Score); Console.Write("Do you want to undo (cost 3 points)? y/n: "); string answer = Console.ReadLine(); if (answer == "y" || answer == "Y") // undo Cell currentCell = GetCell(Row, Column); currentCell.RemoveSymbol(Symbol); Score = previousScore - 3; SymbolsLeft += 1; // end change if (SymbolsLeft == 0) Finished = true; Console.WriteLine(); DisplayPuzzle(); Console.WriteLine(); return Score; // added to cell class so that the symbol can be removed if an // undo is required public virtual void RemoveSymbol(string SymbolToRemove) Symbol = ""; SymbolsNotAllowed.Remove(SymbolToRemove); //Add two atributes in puzzle to store the start position of the last pattern matched class Puzzle { private int score; private int symbolsLeft; private int gridSize; private List<Cell> grid; private List<Pattern> allowedPatterns; private List<String> allowedSymbols; private static Random rng = new Random(); private int patternStartRow; private int patternStartColumn; // Add a subroutine to the cell class to allow removal from the notAllowedSymbol list public void removeLastNotAllowedSymbols() { int size = symbolsNotAllowed.size(); if (size > 0) { symbolsNotAllowed.remove(size - 1); // Alter checkForMatchWithPattern to store the start row and column of any successfully matched pattern if (p.matchesPattern(patternString, currentSymbol)) { patternStartRow = startRow; patternStartColumn = startColumn; //...etc //The altered attemptPuzzle subroutine public int attemptPuzzle() { boolean finished = false; while (!finished) { displayPuzzle(); Console.writeLine("Current score: " + score); int row = -1; boolean valid = false; while (!valid) { Console.write("Enter row number: "); try { row = Integer.parseInt(Console.readLine()); valid = true; } catch (Exception e) { int column = -1; valid = false; while (!valid) { Console.write("Enter column number: "); try { column = Integer.parseInt(Console.readLine()); valid = true; } catch (Exception e) { //Set up variables to store the current game state in // case of an UNDO int undoScore = score; int undoSymbolsLeft = symbolsLeft; String undoSymbol = getCell(row, column).getSymbol(); String symbol = getSymbolFromUser(); symbolsLeft -= 1; Cell currentCell = getCell(row, column); if (currentCell.checkSymbolAllowed(symbol)) { currentCell.changeSymbolInCell(symbol); int amountToAddToScore = checkForMatchWithPattern(row, column); if (amountToAddToScore > 0) { score += amountToAddToScore; //Prompt the user if they wish to undo Console.println(" Do you wish to undo your last move? It will cost you 3 points (y/n): "); String choice = Console.readLine(); if (choice.equals("y")) { if (score != undoScore) { //A pattern has been matched //The symbolsNotAllowed list may have changed for some cells - the current symbol needs // removing from the end of each list getCell(patternStartRow, patternStartColumn).removeLastNotAllowedSymbols(); getCell(patternStartRow, patternStartColumn + 1).removeLastNotAllowedSymbols(); getCell(patternStartRow, patternStartColumn + 2).removeLastNotAllowedSymbols(); getCell(patternStartRow - 1, patternStartColumn + 2).removeLastNotAllowedSymbols(); getCell(patternStartRow - 2, patternStartColumn + 2).removeLastNotAllowedSymbols(); getCell(patternStartRow - 2, patternStartColumn + 1).removeLastNotAllowedSymbols(); getCell(patternStartRow - 2, patternStartColumn).removeLastNotAllowedSymbols(); getCell(patternStartRow - 1, patternStartColumn).removeLastNotAllowedSymbols(); getCell(patternStartRow - 1, patternStartColumn + 1).removeLastNotAllowedSymbols(); score = undoScore - 3; symbolsLeft = undoSymbolsLeft; currentCell.changeSymbolInCell(undoSymbol); if (symbolsLeft == 0) { finished = true; Console.writeLine(); displayPuzzle(); Console.writeLine(); return score; def AttemptPuzzle(self): Finished = False while not Finished: self.DisplayPuzzle() print("Current score: " + str(self.__Score)) Row = -1 Valid = False while not Valid: try: Row = int(input("Enter row number: ")) if Row in range(1, self.__GridSize+1): Valid = True except: pass Column = -1 Valid = False while not Valid: try: Column = int(input("Enter column number: ")) if Column in range(1, self.__GridSize+1): Valid = True except: pass # CHANGES START HERE Symbol = self.__GetSymbolFromUser() undo_symbolsleft = self.__SymbolsLeft self.__SymbolsLeft -= 1 CurrentCell = self.__GetCell(Row, Column) undo_cellsymbol = CurrentCell.GetSymbol() undo_score = self.__Score if CurrentCell.CheckSymbolAllowed(Symbol): CurrentCell.ChangeSymbolInCell(Symbol) AmountToAddToScore = self.CheckforMatchWithPattern(Row, Column) if AmountToAddToScore > 0: self.__Score += AmountToAddToScore undo = input('Would you like to undo your move? You will lose 3 points. Y/N: ') if undo.upper() == 'Y': self.__Score = undo_score - 3 self.__SymbolsLeft = undo_symbolsleft CurrentCell.ChangeSymbolInCell(undo_cellsymbol) # CHANGES END HERE if self.__SymbolsLeft == 0: Finished = True print() self.DisplayPuzzle() print() return self.__Score def AttemptPuzzle(self): Finished = False while not Finished: self.DisplayPuzzle() print("Current score: " + str(self.__Score)) Row = -1 Valid = False while not Valid: try: Row = int(input("Enter row number: ")) Valid = True except: pass Column = -1 Valid = False while not Valid: try: Column = int(input("Enter column number: ")) Valid = True except: pass Symbol = self.__GetSymbolFromUser() CurrentCell = self.__GetCell(Row, Column) UndoList = self.SaveForUndo(Symbol, CurrentCell, Row, Column) # Changed if CurrentCell.CheckSymbolAllowed(Symbol): self.__SymbolsLeft -= 1 # Changed CurrentCell.ChangeSymbolInCell(Symbol) AmountToAddToScore = self.CheckforMatchWithPattern(Row, Column) if AmountToAddToScore > 0: self.__Score += AmountToAddToScore print() # Changed self.DisplayPuzzle() # Changed print() # Changed Choice = input("Would you like to undo last move? (Y/N) ").lower() # Changed if Choice.lower() == "y": # Changed self.__SymbolsLeft = int(UndoList[0]) # Changed CurrentCell._Symbol = UndoList[2] # Changed self.__Score = int(UndoList[3]) - 3 # Changed for n in range(0, (len(self.__Grid)-1)): # Changed if UndoList[1] in self.__Grid[n]._Cell__SymbolsNotAllowed: # Changed self.__Grid[n].RemoveFromNotAllowedSymbols(UndoList[1]) # Changed if self.__SymbolsLeft == 0: Finished = True def SaveForUndo(self,Symbol, Cell, Row, Column): List = [] List.append(str(self.__SymbolsLeft)) List.append(str(Symbol)) List.append(str(Cell._Symbol)) List.append(str(self.__Score)) for n in range(0, len(self.__Grid)): List.append(self.__Grid[n]._Cell__SymbolsNotAllowed) return List def RemoveFromNotAllowedSymbols(self, SymbolToRemove): self.__SymbolsNotAllowed.remove(SymbolToRemove) Public Overridable Function AttemptPuzzle() As Integer Dim Finished As Boolean = False Dim CurrentCell As Cell Dim Symbol As String Dim previous_score As Integer While Not Finished DisplayPuzzle() Console.WriteLine("Current score: " & Score) Dim Valid As Boolean = False Dim Row As Integer = -1 While Not Valid Console.Write("Enter row number: ") Try Row = Console.ReadLine() Valid = True Catch End Try End While Dim Column As Integer = -1 Valid = False While Not Valid Console.Write("Enter column number: ") Try Column = Console.ReadLine() Valid = True Catch End Try End While Symbol = GetSymbolFromUser() SymbolsLeft -= 1 'FIRST CHANGE HERE previous_score = Score CurrentCell = GetCell(Row, Column) If CurrentCell.CheckSymbolAllowed(Symbol) Then CurrentCell.ChangeSymbolInCell(Symbol) Dim AmountToAddToScore As Integer = CheckForMatchWithPattern(Row, Column) If AmountToAddToScore > 0 Then Score += AmountToAddToScore End If End If 'SECOND CHANGE HERE If previous_score >= 3 Then Console.WriteLine("Current score: " & Score) Console.WriteLine() DisplayPuzzle() Console.WriteLine() Console.WriteLine("Do you want to undo the last change (cost 3 points)? (Y/N) ") Dim answer_input As Char = UCase(Console.ReadLine()) If answer_input = "Y" Then CurrentCell.RemoveSymbol(Symbol) Score = previous_score - 3 SymbolsLeft += 1 End If End If 'UNTIL HERE If SymbolsLeft = 0 Then Finished = True End If End While Console.WriteLine() DisplayPuzzle() Console.WriteLine() Return Score End Function Class Cell Protected Symbol As String Private SymbolsNotAllowed As List(Of String) Sub New() Symbol = "" SymbolsNotAllowed = New List(Of String) End Sub 'LAST CHANGE HERE Public Sub RemoveSymbol(Symbol_to_remove As String) Symbol = "" SymbolsNotAllowed.Remove(Symbol_to_remove) End Sub ' END OF CHANGE Question 11- Validation of Row and Column entries [5 marks]. Description of problem: Validate row and column number entries to only allow numbers within the grid size. public virtual int AttemptPuzzle() bool Finished = false; while (!Finished) DisplayPuzzle(); Console.WriteLine("Current score: " + Score); bool Valid = false; int Row = -1; while (!Valid) Console.Write("Enter row number: "); try Row = Convert.ToInt32(Console.ReadLine()); // change to validate row if (Row > 0 && Row <= GridSize) Valid = true; catch int Column = -1; Valid = false; while (!Valid) Console.Write("Enter column number: "); try Column = Convert.ToInt32(Console.ReadLine()); // validate column if (Column > 0 && Column <= GridSize) Valid = true; catch public int attemptPuzzle() { boolean finished = false; while (!finished) { displayPuzzle(); Console.writeLine("Current score: " + score); int row = -1; boolean valid = false; while (!valid) { Console.write("Enter row number: "); try { row = Integer.parseInt(Console.readLine()); if(row>=1&&row<=gridSize){ //new check valid = true; } catch (Exception e) { int column = -1; valid = false; while (!valid) { Console.write("Enter column number: "); try { column = Integer.parseInt(Console.readLine()); if (column>=1&&column<=gridSize){ //new check valid = true; } catch (Exception e) { String symbol = getSymbolFromUser(); symbolsLeft -= 1; //etc... def AttemptPuzzle(self): Finished = False while not Finished: self.DisplayPuzzle() print("Current score: " + str(self.__Score)) Row = -1 Valid = False while not Valid: Row = int(input("Enter row number: ")) if Row > self.__GridSize or Row <= 0: print("Invalid Row number\nPlease try again\n") continue else: Valid = True Column = -1 Valid = False while not Valid: Column = int(input("Enter column number: ")) if Column > self.__GridSize or Column <= 0: print("Invalid Column number\nPlease try again\n") continue else: Valid = True Symbol = self.__GetSymbolFromUser() self.__SymbolsLeft -= 1 CurrentCell = self.__GetCell(Row, Column) if CurrentCell.CheckSymbolAllowed(Symbol): CurrentCell.ChangeSymbolInCell(Symbol) AmountToAddToScore = self.CheckforMatchWithPattern(Row, Column) if AmountToAddToScore > 0: self.__Score += AmountToAddToScore if self.__SymbolsLeft == 0: Finished = True print() self.DisplayPuzzle() print() return self.__Score Public Overridable Function AttemptPuzzle() As Integer Dim Finished As Boolean = False While Not Finished DisplayPuzzle() Console.WriteLine("Current score: " & Score) Dim Valid As Boolean = False Dim Row As Integer = -1 While Not Valid Console.Write("Enter row number: ") 'CHANGE HERE Try Row = Console.ReadLine() If Row > 0 AndAlso Row <= GridSize Then Valid = True End If Catch 'END CHANGE End Try End While Dim Column As Integer = -1 Valid = False While Not Valid Console.Write("Enter column number: ") 'CHANGE HERE Try Column = Console.ReadLine() If Column > 0 AndAlso Column <= GridSize Then Valid = True End If Catch 'END CHANGE End Try End While Dim Symbol As String = GetSymbolFromUser() SymbolsLeft -= 1 Dim CurrentCell As Cell = GetCell(Row, Column) If CurrentCell.CheckSymbolAllowed(Symbol) Then CurrentCell.ChangeSymbolInCell(Symbol) Dim AmountToAddToScore As Integer = CheckForMatchWithPattern(Row, Column) If AmountToAddToScore > 0 Then Score += AmountToAddToScore End If End If If SymbolsLeft = 0 Then Finished = True End If End While Console.WriteLine() DisplayPuzzle() Console.WriteLine() Return Score End Function Question 12 - Why is UpdateCell() empty and never called? Description of problem: Currently, the UpdateCell() method contains 'pass' and is not called anywhere in the program. This will almost certainly be a question, otherwise why would they include it? This may relate to the bombing idea where a Blocked Cell is bombed, and the UpdateCell() is then called to modify this Blocked Cell into a normal cell. Please suggest other ideas of what this method could be used for. Its probably used for changing a blocked cell in a pattern to a normal cell to complete a pattern. UpdateCell() could be used for unlocking a 3*3 grid if a pattern is broken allowing you to replace the symbol. This would also need to decrease the score after the pattern is broken. There are no logical errors with GetCell() as the following extract will prove public virtual int AttemptPuzzle() bool Finished = false; while (!Finished) DisplayPuzzle(); // row for (int row = 8; row >= 1; row--) for (int col = 1; col <= 8; col++) Cell cell = GetCell(row, col); Console.Write(cell.GetSymbol() + " : "); Console.Write(Environment.NewLine); However, if row and column values beyond that of the grid are entered, errors will occur. See solution for Question 12 to solve this issue. Question 13 - Implement a wildcard *. Implement a special character * which is a wildcard. The wildcard can be used to represent any character so that multiple matches can be made with the same cell. Give the player 3 wildcards in random positions at the start of the game. a) Alter the standard Puzzle constructor (not the load game one) to call ChangeSymbolInCell for 3 random cells, passing in * as the new symbol. Note that blocked cells cannot be changed to wildcard ones so you need to add code to ensure the randomly selected cell is not a blocked cell. b) In class Cell alter the method. ChangeSymbolInCell such that wildcard cells will never have their symbol changed from * once set. In the same class, alter method CheckSymbolAllowed such that wildcard cells always return true. c) Alter method MatchesPattern in class Pattern to allow correct operation for the new wildcard * d) Test that a wildcard can successfully match within two different patterns class Puzzle // add property to Puzzle to give 3 wildcards private int NumWildcards = 3; // ensure GetSymbolFromUser will accept wildcard private string GetSymbolFromUser() string Symbol = ""; // take into account the wildcard symbol while (!AllowedSymbols.Contains(Symbol) && Symbol != "*" && NumWildcards > 0) Console.Write("Enter symbol: "); Symbol = Console.ReadLine(); // only allow three wildcards if (Symbol == "*") NumWildcards--; return Symbol; // modify Matches Pattern public virtual bool MatchesPattern(string PatternString, string SymbolPlaced) // ensure that wildcards are taken into account if (SymbolPlaced != Symbol && SymbolPlaced != "*") return false; for (var Count = 0; Count < PatternSequence.Length; Count++) // ignore wildcard symbols as these all count if (PatternString[Count] == '*') continue; if (PatternSequence[Count].ToString() == Symbol && PatternString[Count].ToString() != Symbol) return false; return true; //after the grid is initialised in puzzle: int gridLength = grid.size(); for (int i=0;i<3;i++){ //Get random cell int randcell = getRandomInt(0,gridLength-1); if (!grid.get(randcell).getSymbol().equals("@")){ grid.get(randcell).changeSymbolInCell("*"); // From Cell class: public void changeSymbolInCell(String newSymbol) { if (!symbol.equals("*")){ symbol = newSymbol; public boolean checkSymbolAllowed(String symbolToCheck) { if (!symbol.equals("*")){ for (String item : symbolsNotAllowed) { if (item.equals(symbolToCheck)) { return false; return true; //Pattern class public boolean matchesPattern(String patternString, String symbolPlaced) { Console.println("This pattern sequence: "+patternSequence+ "Passed in PatternString: "+patternString+ "Symbol:"+ symbolPlaced); if (!symbolPlaced.equals(symbol)) { return false; } else { for (int count = 0; count < patternSequence.length(); count++) { if (patternSequence.charAt(count) == symbol.charAt(0) && patternString.charAt(count) != symbol.charAt(0)) { if (patternString.charAt(count)!='*'){ //only return false if not a wildcard return false; return true; Change no. 1: while self.__wildcards_left > 0: SymbolGridCheck = self.__Grid[random.randint(0, len(self.__Grid))] if SymbolGridCheck.GetSymbol() != "W": SymbolGridCheck.ChangeSymbolInCell("W") self.__wildcards_left -= 1 Change no. 2: def MatchesPattern(self, PatternString, SymbolPlaced): if self.__Symbol == "W": elif SymbolPlaced != self.__Symbol: return False for Count in range(0, len(self.__PatternSequence)): try: if self.__PatternSequence[Count] == self.__Symbol and PatternString[Count] == "W": elif self.__PatternSequence[Count] == self.__Symbol and PatternString[Count] != self.__Symbol: return False except Exception as ex: print(f"EXCEPTION in MatchesPattern: {ex}") return True Change no. 3: def ChangeSymbolInCell(self, NewSymbol): if self._Symbol == "W": else: self._Symbol = NewSymbol def CheckSymbolAllowed(self, SymbolToCheck): for Item in self.__SymbolsNotAllowed: if Item == "W": elif Item == SymbolToCheck: return False return True by Sami Albizreh Question 14 - Program allows the user to replace already placed symbols [9 marks]. the user can replace already placed symbols, and patterns, and not lose points (can fix either by stopping them replacing, or make them lose the points from the pattern the replaced): def AttemptPuzzle(self): Finished = False while not Finished: self.DisplayPuzzle() print("Current score: " + str(self.__Score)) Row = -1 Valid = False while not Valid: try: Row = int(input("Enter row number: ")) Valid = True except: pass Column = -1 Valid = False while not Valid: try: Column = int(input("Enter column number: ")) Valid = True except: pass Symbol = self.__GetSymbolFromUser() self.__SymbolsLeft -= 1 CurrentCell = self.__GetCell(Row, Column) if CurrentCell.CheckSymbolAllowed(Symbol) and CurrentCell.GetSymbol() == "-": #And added to check that the cell is empty so that cells cannot be placed on top of each other CurrentCell.ChangeSymbolInCell(Symbol) AmountToAddToScore = self.CheckforMatchWithPattern(Row, Column) if AmountToAddToScore > 0: self.__Score += AmountToAddToScore if self.__SymbolsLeft == 0: Finished = True print() self.DisplayPuzzle() print() return self.__Score Question 15 - Program allows the user to create their own patterns and symbols [6 marks]. Description of problem: 1) request the user to create their own symbols 2) request the pattern associated with the symbol 3) output an empty grid for the user, so the user can input any coordinates to create their own pattern 4) make sure new symbols and pattern can be verified by the program EDIT: this would involve changing a text file or creating a new text file - AQA has never told students to do anything text file-based def AttemptPuzzle(self): Finished = False while not Finished: self.DisplayPuzzle() print("Current score: " + str(self.__Score)) # Change CreatePattern = input('Would you like to make your own pattern? (y/n)\n').lower() if CreatePattern == 'y': self.makeNewPattern() # End def makeNewPattern(self): # function is used to create new 3x3 patterns symbolAllowed = False while symbolAllowed != True: newSymbol = input('Please enter a symbol you would like to add to the game:\n').upper() if len(newSymbol) == 1: # making sure the length of the symbol entered is 1 symbolAllowed = True else: pass patternAllowed = False while patternAllowed != True: newPattern = input('Please enter the new pattern (3x3):\n').upper() new = True for i in newPattern: if i != f'{newSymbol}' and i != '*': # the code checks if the pattern only contains * and the symbol chosen new = False if len(newPattern) != 9: # making sure a 3x3 pattern is chosen new = False if new == True: patternAllowed = True patternName = Pattern(f'{newSymbol}',f'{newPattern}') print(patternName.GetPatternSequence()) self.__AllowedPatterns.append(patternName) self.__AllowedSymbols.append(newSymbol) # code above is the same as in the __init__() section and adds the new patterns to the allowed patterns list print('Would you like to make another pattern? (y/n)\n') choice = input().lower() if choice == 'y': self.makeNewPattern() # End Question 16- Making a difficulty rating program. Description of problem: 1) this program can save each game in record including their score, number of symbols left, time to complete and the original empty grid 2) using these information to make a difficulty rating board, so the user can see their rating and select the one they want to play Question 19 - Advanced Wild Card [13 marks]. This questions refers to the class Puzzle. A new option of a wildcard is to be added to the game. When the player uses this option, they are given the opportunity to complete a pattern by overriding existing symbols to make that pattern. The wildcard can only be used once in a game. Task 1: Add a new option for the user that will appear before each turn. The user should be asked "Do you want to use your wildcard (Y/N)" If the user responds with "Y" then the Row, Column and Symbol will be taken as normal but then the new method ApplyWildcard should be called and the prompt for using the wildcard should no longer be shown in subsequent turns. If the user responds with "N" then the puzzle continues as normal. Task 2: Create a new method called ApplyWildcard that will take the Row, Column and Symbol as parameters and do the following: 1. Determine if the pattern can be completed in a 3x3 given the Row, Column and Symbol passed to it. a) If the pattern can be made the cells in the pattern should be updated using the method UpdateCell() in the Cell class and 5 points added for move. b) If the pattern cannot be made the user should be given the message "Sorry, the wildcard does not work for this cell – you have no wildcards left" class Puzzle(): def __init__(self, *args): if len(args) == 1: self.__Score = 0 self.__SymbolsLeft = 0 self.__GridSize = 0 self.__Grid = [] self.__AllowedPatterns = [] self.__AllowedSymbols = [] self.__LoadPuzzle(args[0]) # Change self.__WildCard = False # End else: self.__Score = 0 self.__SymbolsLeft = args[1] self.__GridSize = args[0] self.__Grid = [] # Change self.__WildCard = False # End for Count in range(1, self.__GridSize * self.__GridSize + 1): if random.randrange(1, 101) < 90: C = Cell() else: C = BlockedCell() self.__Grid.append(C) self.__AllowedPatterns = [] self.__AllowedSymbols = [] QPattern = Pattern("Q", "QQ**Q**QQ") self.__AllowedPatterns.append(QPattern) self.__AllowedSymbols.append("Q") XPattern = Pattern("X", "X*X*X*X*X") self.__AllowedPatterns.append(XPattern) self.__AllowedSymbols.append("X") TPattern = Pattern("T", "TTT**T**T") self.__AllowedPatterns.append(TPattern) self.__AllowedSymbols.append("T") def AttemptPuzzle(self): Finished = False while not Finished: self.DisplayPuzzle() print("Current score: " + str(self.__Score)) # Change wild = False if self.__WildCard == False: useWildCard = input('Would you like to use your wildcard (Y/N)?\n').upper() if useWildCard == 'Y': self.__WildCard = True wild = True Row = -1 Valid = False while not Valid: try: Row = int(input("Enter row number: ")) Valid = True except: pass Column = -1 Valid = False while not Valid: try: Column = int(input("Enter column number: ")) Valid = True except: pass Symbol = self.__GetSymbolFromUser() self.__SymbolsLeft -= 1 if wild == False: CurrentCell = self.__GetCell(Row, Column) if CurrentCell.CheckSymbolAllowed(Symbol): CurrentCell.ChangeSymbolInCell(Symbol) AmountToAddToScore = self.CheckforMatchWithPattern(Row, Column) if AmountToAddToScore > 0: self.__Score += AmountToAddToScore elif wild == True: AmountToAddToScore = self.ApplyWildCard(Row,Column,Symbol) if AmountToAddToScore > 0: self.__Score += AmountToAddToScore # End if self.__SymbolsLeft == 0: Finished = True print() self.DisplayPuzzle() print() return self.__Score def ApplyWildCard(self, Row, Column, Symbol): # Assuming the wildcard cannot be placed on a blocked cell as does not state currentCell = self.__GetCell(Row,Column) if currentCell.GetSymbol() != BlockedCell(): currentCell.ChangeSymbolInCell(Symbol) for StartRow in range(Row + 2, Row - 1, -1): for StartColumn in range(Column - 2, Column + 1): try: PatternString = "" PatternString += self.__GetCell(StartRow, StartColumn).GetSymbol() PatternString += self.__GetCell(StartRow, StartColumn + 1).GetSymbol() PatternString += self.__GetCell(StartRow, StartColumn + 2).GetSymbol() PatternString += self.__GetCell(StartRow - 1, StartColumn + 2).GetSymbol() PatternString += self.__GetCell(StartRow - 2, StartColumn + 2).GetSymbol() PatternString += self.__GetCell(StartRow - 2, StartColumn + 1).GetSymbol() PatternString += self.__GetCell(StartRow - 2, StartColumn).GetSymbol() PatternString += self.__GetCell(StartRow - 1, StartColumn).GetSymbol() PatternString += self.__GetCell(StartRow - 1, StartColumn + 1).GetSymbol() print(PatternString) for P in self.__AllowedPatterns: CurrentSymbol = self.__GetCell(Row, Column).GetSymbol() if P.MatchesPattern(PatternString, CurrentSymbol): self.__GetCell(StartRow, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 1, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 2, StartColumn + 2).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 2, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 2, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 1, StartColumn).AddToNotAllowedSymbols(CurrentSymbol) self.__GetCell(StartRow - 1, StartColumn + 1).AddToNotAllowedSymbols(CurrentSymbol) print('Your wildcard has worked') return 5 except: pass print('Sorry the wildcard does not work for this cell - you have no wildcards left') return 0 # End Question 20 - Shuffle all the blocked cells [9 marks]. Implement a feature where the user can shuffle the blocked cells around. def AttemptPuzzle(self): #Start of Change Finished = False while not Finished: self.DisplayPuzzle() if input("Do you want to reshuffle all the blocked cells?[y/n]: ").lower() == 'y': self.ReShuffleBlockedCells() self.DisplayPuzzle() #End of Change def ReShuffleBlockedCells(self): #I've done this by creating a new method in the Puzzle class indexstore = [] for i, cell in enumerate(self.__Grid): if isinstance(cell, BlockedCell): indexstore.append(i) for num in indexstore: checker = True while checker: a = random.randint(1, (self.__GridSize**2)-1) if a not in indexstore: if self.__Grid[a].IsEmpty(): checker = False self.__Grid[num] = Cell() self.__Grid[a] = BlockedCell() Question 21 - A challenge option - where The letters the user has to place down will be randomly generated and if the user successfully does it they gain points otherwise they will lose points (10 marks)

Internal Medicine/Skin Manifestations of Internal Disease. Papulosquamous Skin Lesions. Papulosquamous skin lesions encompass a broad category of skin conditions characterized by the presence of raised, scaly bumps (papules) often accompanied by flaking or peeling of the skin (desquamation). These lesions result from various underlying causes and can manifest in different patterns and locations on the body. Understanding the diverse spectrum of papulosquamous skin lesions is crucial for accurate diagnosis and appropriate management. Diagnosis and management of papulosquamous lesions involve a thorough clinical evaluation, often requiring a skin biopsy for definitive diagnosis. Treatment approaches depend on the underlying cause and may include topical or systemic medications, phototherapy, lifestyle modifications, or addressing any triggering factors. Erythroderma. Erythroderma is a rare but serious skin condition characterized by widespread redness, inflammation, and scaling of the skin's surface, often involving more than 90% of the body. This dermatological emergency requires immediate medical attention due to its potential complications and underlying causes, which can range from severe skin diseases to systemic illnesses. Management of erythroderma involves hospitalization and addressing the underlying cause, if identified. Patients often require intensive supportive care, including fluid and electrolyte management, wound care, and treatments to alleviate symptoms and control inflammation. Alopecia. Alopecia, or hair loss, can affect the scalp or other body areas and can result from a variety of causes. Understanding the underlying factors is essential for appropriate management. Management of alopecia depends on the specific type and underlying cause. Treatments may include medications (e.g., minoxidil, finasteride), topical therapies, lifestyle modifications, and addressing any associated medical conditions. Figurate Skin Lesions. Figurate skin lesions are distinctive, often geometrically shaped patterns or configurations that appear on the skin. These lesions can result from various underlying causes, and recognizing the specific pattern is crucial for accurate diagnosis. Diagnosis and management of figurate skin lesions require a thorough evaluation, including a detailed medical history and, in some cases, skin biopsy. Identifying and addressing any underlying causes is essential for effective treatment and preventing recurrence. Acne. Acne is a common skin condition that primarily affects adolescents but can persist into adulthood. It results from the blockage of hair follicles by oil, dead skin cells, and bacteria, leading to the formation of various types of lesions. Acne can have various triggers, including hormonal fluctuations, genetics, and certain medications. Effective acne management involves a multi-faceted approach: Treatment plans are often tailored to the severity and type of acne, as well as individual patient factors. Pustular Lesions. Pustular lesions are characterized by the presence of pus-filled vesicles or papules on the skin's surface. These lesions can arise from various causes, including infections, autoimmune conditions, and medication reactions. Management of pustular lesions depends on the underlying cause. Treatment may involve antibiotics for infections, topical or systemic medications for inflammatory conditions, and discontinuation of offending drugs in drug-induced cases. Telangiectasias. Telangiectasias refer to the dilation of small blood vessels, resulting in visible, fine, red or purple lines or patterns on the skin. These vascular abnormalities can arise from various causes and may be a cosmetic concern or associated with underlying medical conditions. Management of telangiectasias may involve laser therapy, electrocautery, or sclerotherapy to reduce their appearance. Treatment of any underlying conditions contributing to telangiectasia development is also essential. Hypopigmentation. Hypopigmentation refers to areas of the skin that are lighter in color than the surrounding skin. This can result from a variety of causes, including skin conditions, infections, and autoimmune disorders. Management of hypopigmentation depends on the underlying cause. In some cases, treatment may focus on managing the underlying condition, while other treatments aim to repigment the affected areas, such as topical corticosteroids or phototherapy. Hyperpigmentation. Hyperpigmentation refers to areas of the skin that are darker in color than the surrounding skin. This can occur due to an overproduction of melanin or the presence of excess melanin in the skin. Hyperpigmentation can result from various factors, including: Management of hyperpigmentation may involve topical treatments (e.g., hydroquinone, retinoids), chemical peels, laser therapy, or addressing underlying medical conditions. Sun protection is essential to prevent worsening of hyperpigmentation. Vesicles/Bullae. Vesicles and bullae are fluid-filled lesions that can develop on the skin. Understanding their characteristics and causes is crucial for accurate diagnosis and appropriate management. Diagnosis and management of vesicles and bullae depend on their underlying cause. Treatment may involve antiviral medications for viral infections, antibiotics for bacterial infections, immunosuppressive therapy for autoimmune blistering disorders, and addressing any triggering factors. Urticaria. Urticaria, commonly known as hives, is a skin condition characterized by the sudden appearance of raised, itchy, red or pink welts (wheals) on the skin. These wheals can vary in size and shape and often resolve within hours to days, but they can be extremely uncomfortable. Management of urticaria involves identifying and addressing triggers when possible. Antihistamines are the primary treatment for symptom relief. Chronic urticaria may require more extensive evaluation and treatment, potentially including immunosuppressive medications in severe cases. Papulonodular Skin Lesions. Papulonodular skin lesions are characterized by raised, solid, and often palpable bumps (papules and nodules) on the skin's surface. These lesions can result from a wide range of underlying causes and may vary in size, color, and distribution. Diagnosis and management of papulonodular skin lesions depend on the underlying cause. In some cases, a biopsy may be necessary for definitive diagnosis. Treatment may include conservative observation, excision, cryotherapy, or other interventions tailored to the specific condition. Purpura. Purpura refers to the presence of small hemorrhages beneath the skin, resulting in red or purple discolorations that do not blanch when pressed. Purpuric lesions can be indicative of various underlying conditions and may vary in size and distribution. Management of purpura depends on the underlying cause. Treatment may involve addressing the primary condition, such as managing vasculitis or administering platelet transfusions in cases of severe thrombocytopenia. Ulcers. Ulcers are open sores or lesions that develop on the skin or mucous membranes. They can result from various underlying factors, including infection, vascular insufficiency, trauma, or systemic diseases. Diagnosis and management of ulcers involve identifying the underlying cause and implementing appropriate wound care measures, infection control, and treatments specific to the condition. Chronic or non-healing ulcers often require multidisciplinary care. Fever and Rash. Fever accompanied by a rash can be indicative of various infectious or systemic conditions. The combination of these symptoms can provide valuable diagnostic clues. The evaluation of fever and rash often requires a thorough medical history, physical examination, and diagnostic tests, such as blood cultures, serological tests, or skin biopsies, depending on the suspected cause. Prompt diagnosis and treatment are essential, especially in cases of potentially serious infections or autoimmune diseases.

Internal Medicine/Immunologically Mediated Skin Diseases. Pemphigus Vulgaris. Pemphigus vulgaris is a rare and severe autoimmune blistering disorder characterized by the production of autoantibodies, primarily of the IgG class, targeting desmoglein 3, a critical protein responsible for maintaining cell adhesion in the epidermis. This autoimmune response leads to the disruption of desmosomes, specialized adhesive structures that bind adjacent skin cells together. Consequently, the weakened cell adhesion results in the formation of painful, flaccid blisters on the skin and mucous membranes. The blisters in pemphigus vulgaris are notoriously fragile and prone to rupture, leaving behind excruciating erosions. These erosions can be widespread and affect areas such as the oral mucosa, throat, genitals, and even the eyes. The disease primarily affects adults, with a peak incidence between the ages of 40 and 60. Diagnosing pemphigus vulgaris involves a meticulous clinical evaluation, often necessitating multiple skin biopsies, immunofluorescence studies, and serological tests to detect the presence of autoantibodies. Early diagnosis is crucial, as prompt initiation of treatment significantly impacts the prognosis. Management of pemphigus vulgaris is intricate and multifaceted, involving aggressive immunosuppressive therapies to curb the autoimmune response. High-dose systemic corticosteroids are typically the initial treatment of choice to control the rampant inflammation. However, prolonged corticosteroid use can lead to a plethora of debilitating side effects, necessitating the introduction of other immunosuppressive drugs such as azathioprine, mycophenolate mofetil, or rituximab. Simultaneously, meticulous wound care and infection prevention measures are paramount to prevent secondary infections and complications. Pemphigus Foliaceus. Pemphigus foliaceus stands as a distinct autoimmune blistering disorder separate from pemphigus vulgaris. In this condition, autoantibodies predominantly target desmoglein 1, a protein that plays a pivotal role in cell adhesion in the upper layers of the epidermis. The pathophysiology of pemphigus foliaceus revolves around the binding of autoantibodies to desmoglein 1. This leads to the disruption of cell adhesion in the superficial layers of the epidermis, resulting in blister formation in the epidermis without mucous membrane involvement. These blisters are typically shallow, flaccid, and prone to rupture, resulting in crusted erosions. Treatment for pemphigus foliaceus closely mirrors that of pemphigus vulgaris and encompasses corticosteroids and immunosuppressive medications. In localized cases, topical treatments may prove effective. The primary goal is to control blistering, minimize complications, and enhance the patient's overall quality of life. Paraneoplastic Pemphigus. Paraneoplastic pemphigus is an exceedingly rare blistering disorder with a robust association with malignancies, particularly hematologic cancers like lymphomas. This condition is characterized by the development of painful oral and skin erosions. One of the distinctive challenges in managing paraneoplastic pemphigus is its direct link to underlying cancers. Therefore, alongside treating the skin and mucous membrane symptoms, addressing the malignancy itself is an indispensable component of management. Immunosuppressive therapies, including corticosteroids, may be necessary to control skin manifestations. Bullous Pemphigoid. Bullous pemphigoid, predominantly affecting elderly individuals, typically over the age of 60, is characterized by the development of large, tense blisters that do not rupture easily. Autoantibodies in bullous pemphigoid target proteins within the basement membrane zone, a crucial skin layer responsible for anchoring the epidermis to the underlying dermis. Unlike pemphigus, bullous pemphigoid generally spares mucous membranes. The pathophysiology of bullous pemphigoid revolves around the binding of autoantibodies to two main antigens: BP180 (also known as collagen XVII) and BP230, both of which are components of the hemidesmosome, a structure essential for anchoring the epidermis. This binding initiates complement activation, inflammation, and ultimately blister formation. Diagnosis of bullous pemphigoid includes a comprehensive clinical evaluation, skin biopsies, immunofluorescence studies, and serological tests to detect the presence of autoantibodies. Early diagnosis is critical to initiate treatment effectively. Treatment of bullous pemphigoid revolves around reducing inflammation, primarily through systemic corticosteroids to suppress the immune response. In some cases, immunosuppressive medications like azathioprine or mycophenolate mofetil may be added to enable a reduction in corticosteroid dosage. Rigorous wound care is vital to prevent infections in areas affected by blisters. Pemphigoid Gestationis. Pemphigoid gestationis, also known as gestational pemphigoid or herpes gestationis, is an infrequent autoimmune blistering disorder that manifests during pregnancy or postpartum. It results in intensely pruritic, blistering eruptions, primarily on the abdomen but potentially affecting other body parts as well. The underlying cause is autoimmunity, with autoantibodies targeting proteins within the basement membrane zone. Diagnosis of pemphigoid gestationis entails comprehensive clinical evaluation, skin biopsies, immunofluorescence studies, and serological tests. Treatment often involves topical corticosteroids and oral antihistamines to manage the relentless itching. In more severe cases, systemic corticosteroids may be necessary, although their use during pregnancy requires a meticulous consideration of risks and benefits. Dermatitis Herpetiformis. Dermatitis herpetiformis is a persistent blistering skin condition intricately associated with celiac disease, an autoimmune disorder triggered by the consumption of gluten-containing foods. It presents with intensely pruritic, grouped papules and blisters, typically distributed symmetrically on the extensor surfaces of the elbows, knees, buttocks, and lower back. The hallmark feature of dermatitis herpetiformis is its robust association with gluten sensitivity. In essence, the autoimmune response underlying dermatitis herpetiformis is triggered by gluten consumption and mediated by the formation of IgA autoantibodies. These autoantibodies target transglutaminase 3, an enzyme involved in epidermal cell adhesion, leading to blister formation. Diagnosing dermatitis herpetiformis necessitates skin biopsies, direct immunofluorescence studies, and serological tests to detect celiac-specific antibodies. Treatment primarily involves strict adherence to a gluten-free diet, which effectively controls both the skin and gastrointestinal symptoms associated with celiac disease. Additionally, medications like dapsone or sulfapyridine may be prescribed to alleviate skin manifestations. Linear IgA Disease. Linear IgA disease is a rare autoimmune blistering disorder characterized by the linear deposition of IgA antibodies along the basement membrane zone of the skin and mucous membranes. Clinically, it presents with tense blisters, often arranged in a linear fashion, and erosions on the skin and mucous membranes. The pathogenesis of linear IgA disease centers around the production of IgA autoantibodies targeting various antigens within the basement membrane zone. While the exact cause remains unknown, this autoimmune response results in inflammation and blister formation. Diagnosis of linear IgA disease involves skin biopsies, direct immunofluorescence studies, and serological tests. Treatment typically includes dapsone, a medication with anti-inflammatory and immunosuppressive properties. In severe cases or when dapsone is not tolerated, other immunosuppressive agents may be considered. Epidermolysis Bullosa Acquisita. Epidermolysis bullosa acquisita is a rare autoimmune blistering disorder characterized by autoantibodies targeting type VII collagen, a critical component of anchoring fibrils in the skin's basement membrane zone. These fibrils play a crucial role in maintaining skin integrity by anchoring the epidermis to the underlying dermis. The pathophysiology of epidermolysis bullosa acquisita revolves around the formation of autoantibodies that bind to type VII collagen, leading to complement activation, inflammation, and blister formation. This condition typically manifests as tense blisters on trauma-prone areas of the skin. Diagnosis of epidermolysis bullosa acquisita involves skin biopsies, direct immunofluorescence studies, and serological tests to detect autoantibodies against type VII collagen. Treatment can be challenging and often includes immunosuppressive medications to manage inflammation and blistering. Mucous Membrane Pemphigoid. Mucous membrane pemphigoid (MMP), also known as cicatricial pemphigoid, primarily affects mucous membranes, such as those in the mouth, eyes, throat, and genitals. It results in chronic scarring and can lead to severe complications if left untreated. The pathophysiology of MMP involves autoantibodies targeting proteins within the basement membrane zone of mucous membranes. This autoimmune response leads to inflammation, blistering, and scarring. Diagnosis often requires biopsies of affected mucous membranes and immunofluorescence studies. Treatment is essential to prevent complications and may include immunosuppressive agents like corticosteroids, dapsone, or rituximab. Dermatomyositis. Dermatomyositis is an autoimmune disease that primarily affects the skin and muscles. Skin manifestations include a distinctive rash, often referred to as the "heliotrope rash," which appears as a purple-red discoloration on the upper eyelids and periorbital area. Other skin findings include erythematous or violaceous plaques on the upper trunk, back, and extremities, along with Gottron's papules on the knuckles. Dermatomyositis can also be associated with muscle weakness and inflammation. The pathophysiology of dermatomyositis involves an autoimmune response against muscle and skin tissue. The exact cause is unknown, but it is thought to involve both genetic and environmental factors. Treatment includes corticosteroids, immunosuppressive medications, and physical therapy to manage muscle weakness and skin symptoms. Lupus Erythematosus. Lupus erythematosus is a complex autoimmune disorder that can affect various organs, including the skin. Cutaneous lupus erythematosus (CLE) encompasses a range of skin manifestations, from acute to chronic forms. Acute cutaneous lupus erythematosus typically presents with a butterfly-shaped rash on the face (malar rash) and is associated with systemic lupus erythematosus (SLE). Subacute cutaneous lupus erythematosus presents with scaly, coin-shaped lesions on sun-exposed areas of the skin. Chronic cutaneous lupus erythematosus includes discoid lupus erythematosus (DLE), which presents with erythematous plaques, follicular plugging, and atrophy, often leading to scarring. The pathophysiology of lupus erythematosus involves a complex interplay of genetic predisposition, environmental triggers, and dysregulation of the immune system. Autoantibodies, such as anti-nuclear antibodies (ANA) and anti-double-stranded DNA antibodies, play a crucial role in the disease process. Treatment varies depending on the type and severity of lupus erythematosus but often includes corticosteroids, immunosuppressive medications, and lifestyle modifications to manage symptoms and prevent flares. Scleroderma and Morphea. Scleroderma, also known as systemic sclerosis, is a rare autoimmune disease characterized by the abnormal accumulation of collagen in the skin and various internal organs. It can be classified into two main categories: limited cutaneous scleroderma and diffuse cutaneous scleroderma. Limited cutaneous scleroderma primarily affects the skin of the fingers, face, and extremities, causing skin tightening and thickening. It is often associated with Raynaud's phenomenon, where the fingers and toes turn white, blue, or purple in response to cold or stress. Diffuse cutaneous scleroderma involves more extensive skin thickening that can affect the trunk and internal organs, such as the lungs, heart, and gastrointestinal tract. This form of scleroderma is often more severe and can lead to significant organ dysfunction. Morphea, on the other hand, is a localized form of scleroderma that primarily affects the skin. It presents as hardened, discolored patches on the skin that are typically oval or linear in shape. These patches can range in size from small to large and often have an ivory or purplish center with a lighter, halo-like border. Unlike systemic sclerosis, morphea typically does not affect internal organs. The exact cause of scleroderma and morphea is not fully understood, but they are believed to involve a combination of genetic, environmental, and immune system factors. Treatment aims to manage symptoms, prevent complications, and slow disease progression. It may include medications to reduce inflammation and fibrosis, physical therapy to maintain joint mobility, and lifestyle modifications to address Raynaud's phenomenon.

Supplementary mathematics/power series. A power series is a type of mathematical series that is also an infinite series. The back power series shows an infinite function that either converges or diverges. The application of the power series for identity or single-sentence patterns is to be able to calculate them as an orderly expansion and their convergence. The power series of a single variable converges at the radius of convergence, which means that within the extent of this radius or region of convergence, all values of the variable less than the radius tend to converge to a point.

Public Digital Backbone/Chapter 1. A Silent Revolution. = 1. A Silent Revolution = Introduction: "In whispered bytes, a silent revolution unfolds, reshaping our world's very mold." -a sci-fic poet The digital era has ushered in a new paradigm where the flow of information, people, and money is intricately intertwined with technology. This chapter delves into the concept of the Public Digital Backbone, elucidating its significance in this interconnected world. Why to call it 'Public Digital Backbone'? Because Digital Public Infrastructure (DPI) differs from the simple provision of services via digital channels, as the crux of DPI is that it empowers others to utilize the infrastructure in their own applications. We hope the readers will have a clear understanding of what constitutes a Public Digital Backbone, its historical development, and its overarching goals in societal infrastructure. In the annals of human progress, infrastructure has always played an indomitable role, connecting people, facilitating financial transactions, and disseminating information. While the 19th and 20th centuries heralded an era of physical infrastructure like railways and telecommunication, the 21st century has marked the onset of a digital renaissance: Digital Public Infrastructure (DPI). At its essence, DPI is the digital foundation that allows for the construction and delivery of applications for public welfare. Envisioned as a multi-layered structure, it encompasses identity, payments, data management, and consent, further culminating in layers of health, education, agriculture, logistics, and many more. At its pinnacle, it supports a plethora of apps and solutions tailored for diverse needs. Acting as the digital arteries of a nation, DPI mediates essential flows: 1. People: Digital ID systems, 2. Money: Real-time payment systems, 3. Information: Consent-based data sharing systems ensure users have control over their personal data, as seen in India's Account Aggregator built upon the Data Empowerment Protection Architecture (DEPA). However, amidst its numerous merits, it's crucial that DPI remains guarded against pitfalls like monopolization, digital colonization, and authoritarian control. It is here that the techno-legal structure comes into play, blending technological tools and legal regulations to forge a robust infrastructure that aligns with democratic principles. A key feature of DPI is its open architecture. This openness, integral to DPI’s DNA, comprises: Open Standards: Freely available protocols ensure DPI’s vast compatibility. Open Source Software: Providing transparency and allowing collective enhancement, ensuring DPI remains progressive. Open Data: Ensuring data availability for public benefit without compromising individual privacy. Open Governance: Ensuring DPI's transparent and accountable management. While the value of openness is irrefutable, balancing it with privacy remains paramount. Innovations like data anonymization and privacy-preserving technologies ensure that while data remains accessible, individual privacy isn’t jeopardized. How can the centralization of such vast amounts of data be prevented? The answer lies in a multifaceted approach. Decentralization distributes data across diverse locations. Encryption ensures data remains unintelligible to unauthorized entities. DPI, with its transformative capabilities, is not just an evolution; it's a silent revolution. As India has demonstrated with Aadhaar, UPI, and Digi-Locker, this infrastructure has the potential to redefine public service delivery. By fostering innovation, ensuring inclusion, and empowering individuals, DPI isn’t just creating a digital commons; it’s democratizing the digital future. The beauty of the DPI framework lies in its participatory nature. Its open-source character invites developers, policymakers, and even everyday citizens to contribute to its evolution. It's a collaborative ecosystem where public and private entities, civil societies, and individuals converge, each bringing unique perspectives and skills. For businesses, DPI offers unprecedented opportunities. With a reliable and efficient infrastructure in place, entrepreneurs can innovate without reinventing the wheel. They can build upon existing DPI layers, focusing their energy on creating niche solutions tailored for specific community needs. Comparing Western, Chinese, and Indian Approaches to Personal Identification: The Supremacy of Aadhaar In an era marked by rapid technological advancements and a digital revolution, the approach to personal identification has emerged as a significant point of contention globally. The Western, Chinese, and Indian methods are representative of diverse philosophies on governance, data privacy, and the role of the state. Among these approaches, India's Aadhaar system stands out as a pioneering solution, tailor-made for the modern, digital age. Western Approach: The Western perspective, particularly as exemplified by the United States and European Union, leans heavily on individual privacy and rights. While the US has been market-centric, allowing innovation to flourish with minimal regulations, Europe has become the torchbearer for data privacy. The European Union's General Data Protection Regulation (GDPR) encapsulates this ethos, placing the onus of data protection on service providers, and emphasizing the right of individuals to control their personal data. Chinese Approach: In stark contrast, China's approach is one of state control and censorship. Under the guise of "cyber-sovereignty", China heavily regulates and monitors internet usage within its borders. The famous "Great Firewall" restricts access to foreign websites, and the government relies heavily on private enterprises, like Alibaba and WeChat, to collect and share user data. While this method ensures significant control over the digital ecosystem and deters potential external influences, it also curtails freedom and privacy. India's Aadhaar: The Indian approach is a harmonious blend of technological advancement and individual empowerment. Aadhaar, the world's largest biometric ID project, was established to provide a trustworthy identity to every resident of India. Instead of being a tool of surveillance or a mere regulatory compliance, Aadhaar functions as a "foundational ID", enabling citizens to access a plethora of services, from banking to social welfare, with a single identity. There are several reasons why Aadhaar emerges as a superior solution: 1. Public Good: Aadhaar was constructed as public infrastructure, ensuring that the primary motive was societal benefit and not profit. Unlike private Western platforms that collect data for advertising revenue, Aadhaar collects minimal data – name, date of birth, address, and gender. 2. Transparency and Privacy: While there is transparency in transactions with Aadhaar, there's also inbuilt privacy. The system does not store the purpose or nature of a transaction, ensuring user confidentiality. 3. Empowerment through Data: Aadhaar is a testament to the belief that individuals should be empowered by their data. The associated systems, like the Unified Payments Interface (UPI) and e-KYC, are manifestations of this principle, streamlining processes and increasing accessibility. 4. Interoperability: The Aadhaar system's integration into various services, like banking and telecommunications, ensures seamless and efficient interactions. This interoperability encourages competition and enhances consumer choice. 5. Affordability and Scalability: The Aadhaar system was established at a minimal cost of approximately $1 per resident, a model of efficiency and scalability. 6. A Model for Others: Aadhaar's success has made it a model for other nations, with countries like Afghanistan, Bangladesh, and Rwanda exploring similar systems. While the West grapples with the balancing act of innovation and privacy, and China leans heavily on state control, India's Aadhaar stands out as an innovative solution, optimized for the modern digital age. Its focus on individual empowerment, transparency, and public good makes it not just a robust identification system but also a beacon for digital infrastructure development globally. There is an important coveat in all the above discussion. In modernism the world has progressively turned into datafication. The process started sometime around 1900 and going on unabbeted with ever accelerated speed. There has arisen a question as to what is primary? humanity or technology? This is not confined to only datafication but to the other technologies like nuclear, genetic upto AI. Solution to that is of course not going backward but interpret modernism in favor of the humanity. Datafication and Aadhaar: The Pursuit of a Better Personal Identification System In today's rapidly digitizing world, datafication is inevitable. As individuals and institutions grow increasingly reliant on digital platforms, personal identification becomes paramount, ensuring that online interactions are both authentic and secure. The Aadhaar system, introduced by the Indian government, represents a significant step forward in this realm, aiming to provide a universal identification for every Indian citizen. While Aadhaar has showcased numerous advantages, there is an inherent necessity to continually evolve and seek better solutions to address emerging challenges. Aadhaar: A Pioneer in Modern Identification Aadhaar, at its core, is a 12-digit unique identification number linked to an individual's biometric and demographic data. Launched as the world's largest biometric ID system, it has bridged gaps in accessibility and inclusivity for millions. By linking numerous services under one umbrella, Aadhaar has simplified administrative processes, reduced paperwork, and increased transparency in transactions. Furthermore, Aadhaar has empowered those on the margins. The rural population, for instance, has been able to access government welfare schemes more efficiently, eliminating the middlemen and reducing corruption. For many, Aadhaar is not merely an ID but a ticket to numerous services and opportunities. The Concerns and the Need for Improvement However, as with any large-scale system, Aadhaar has its criticisms. Privacy concerns top the list. Given the vast amount of personal data stored, the potential for misuse or breaches cannot be overlooked. Critics argue that centralizing such a vast array of information makes it an attractive target for hackers and unauthorized entities. Additionally, while biometrics offer a certain level of precision, they aren't infallible. Mistakes in capturing data, system errors, or even natural changes in an individual’s biometrics can lead to discrepancies, leaving some citizens potentially disenfranchised. Moreover, Aadhaar's pervasiveness in daily life has led to debates about its mandatory nature. Concerns arise when it starts becoming the sole key to essential services, potentially leaving out those who, for various reasons, are not enrolled or face technical issues. The Road Ahead: Envisioning a Better System To make Aadhaar, or any future identification system, more robust and universally accepted, several measures can be considered: Strengthening Data Security: Investing in cutting-edge encryption methods and regularly updating security protocols can help ensure data safety. Regular third-party audits can identify vulnerabilities before they're exploited. Decentralization: Instead of a single, massive database, a distributed ledger system, like blockchain, could be employed. This would provide a secure, transparent, and tamper-proof record of transactions. Enhanced Privacy Controls: Giving individuals greater control over their data, including who can access it and for what purpose, can alleviate privacy concerns. Inclusivity and Flexibility: While the goal should be universal coverage, systems should be flexible enough to accommodate those who might face challenges in enrollment or usage. Continuous Feedback and Evolution: No system is perfect at inception. Regular feedback from users, experts, and stakeholders, followed by iterative improvements, can ensure that the identification system remains relevant and effective. Datafication is a double-edged sword While it offers unparalleled convenience and efficiency, it also brings forth challenges in privacy, security, and inclusivity. Aadhaar, as a pioneering effort, has illuminated both the potential and pitfalls of such a system. As society continues to evolve and technology advances, the quest for the perfect personal identification system will continue. The lessons learned from Aadhaar can guide future endeavors in creating a system that is not only robust and secure but also respects the rights and dignity of every individual. While the problems of vulnerable communities are not to be denied and should be fought back and demanded solutions and problems of digital divide, connectivity, Internet blackouts are real problems, we should not throw the baby out with the bath water. Otherwise we will be the loosers as society as a whole in the race to modernisation. In this context Moody's objections to Aadhaar and Indian government's reaction to that are worth mentioning. Digital Advancements in India: Bridging Gaps and Building Trust India has made significant strides in the realm of digital public infrastructure. This foundational infrastructure has brought transformative changes in the lives of its citizens. For instance, the 'Aadhaar' system ensures that millions in India can directly benefit from banking, pensions, and grant-related services. The Unified Payments Interface (UPI) has revolutionized the digital payment sector in India, making money transfers more convenient and secure for its citizens. Decades ago, Rajiv Gandhi famously remarked that only fifteen paise of every rupee meant for welfare schemes reach the intended beneficiaries. With the revolution in digital technology, it's now possible to mitigate such financial discrepancies. The Digilocker provides individuals the convenience of securely storing and verifying their essential documents. Through the Account Aggregator (AA) technology, individuals can now securely share their personal data to avail various services. Analyzing the Utilization of Digital Infrastructure in India To truly grasp the immense scale of digital public infrastructure in India, consider the following statistics: Aadhaar: Number of biometric authentication transactions - 1.3 billion, Unsuccessful biometric authentications – Over 100 million, Biometric authentication errors – Over 100 million UPI (Unified Payments Interface): Daily transactions - More than 20 billion, Monthly transactions - Over 30 trillion (more than 1000 billion), Annual transactions - Exceeding 12 trillion (12,000 billion) DigiLocker: Total number of documents stored – Over 500 million, Number of verified documents – More than 100 million Accounts Aggregator (AA): Data sharing requests made – Over 100 million. This data highlights the deep penetration and reliance on digital mechanisms in everyday life across India. For governmental functions and for criminal investigations Aadhaar is not available Aadhaar plays a pivotal role in India Stack by providing a foundational identity layer. This identity verification mechanism, however, only confirms or denies a user's identity. It doesn't store or centralize transactional details, ensuring that data related to specific activities or behaviors isn't consolidated at the national level.The central government cannot use the Aadhaar central database for regular governmental activities arbitrarily. Aadhaar's primary purpose is to serve as an identification system, and its use is governed by the Aadhaar Act of 2016, which sets specific limits on the usage and sharing of data stored within the system. Here are the primary constraints and considerations: 1. Purpose Limitation: The Aadhaar Act restricts the use of Aadhaar data to specific purposes. The central and state governments can use Aadhaar for the distribution of any benefit or service that incurs expenditure from the Consolidated Fund of India. However, it cannot be used for activities outside of these specified purposes. 2. Data Privacy and Consent: Aadhaar data can't be shared without the explicit consent of the individual. The UIDAI (Unique Identification Authority of India) does not have knowledge about the purpose of authentication, ensuring transactional privacy. 3. Restrictions on Storage and Use: Entities using Aadhaar for authentication are not allowed to store the biometrics of individuals. They can only store the Aadhaar number, which further limits the possibility of misuse. 4. Limited Data Access: The Aadhaar database primarily contains demographic and biometric data. The central government does not have access to personal details beyond what's stored in the Aadhaar system. 5. No Surveillance Mechanism: The Supreme Court of India, in its landmark judgment on Aadhaar, emphasized that the Aadhaar architecture doesn't provide a mechanism for surveillance. The system's design ensures minimal data collection, and it doesn’t record the purpose of any authentication request. It's essential to note that while Aadhaar can be a potent tool for ensuring that government benefits reach the intended recipients, its use is constrained by legal and technical safeguards to protect individual privacy and data. The government, or any entity for that matter, cannot access or use the centralized Aadhaar data beyond the purposes and manners defined by the Aadhaar Act and the guidelines issued by UIDAI. For example, there's no blanket permission for the police or any investigative agency to access Aadhaar data for criminal investigations. In September 2018, the Supreme Court of India struck down Section 33(2) which allowed disclosure of Aadhaar information in the interest of national security without any judicial oversight. The court also emphasized the importance of individual privacy and reiterated that the Aadhaar database shouldn't turn into a tool for surveillance. Prevention of Data Centralization is made inherent in the technology design India Stack's design inherently guards against the centralization of data at the national level. While Aadhaar provides a unified identity verification mechanism, it doesn't store transaction-specific details. When a user performs Aadhaar-based authentication, the system verifies the identity but does not record the context or purpose of the authentication. This intentional design choice ensures that while authentication is centralized, transaction data remains decentralized, preventing the formation of a single, comprehensive profile of an individual. Interoperability of India Stack and the magic of Protocols Interoperability refers to the ability of different information systems, devices, or applications to connect and exchange data efficiently. In the context of India Stack, interoperability ensures seamless interaction among various digital services, such as Aadhaar authentication, eKYC, UPI, and Digilocker, among others. By providing standardized APIs, India Stack ensures that diverse software applications can easily communicate and exchange data, fostering innovation and expanding digital services' reach. Protocols, in the digital realm, are standardized sets of rules that determine how data is transmitted and received over the network. India Stack's strength lies in its adoption of open and standardized protocols, ensuring that all digital services, regardless of their origin or nature, can integrate with the system. These protocols, besides enhancing the system's overall interoperability, also set the ground rules for security, data privacy, and user consent. How Unified Payments Interface (UPI) works? To illustrate what we have discussed so far let us consider one of the layer of the India Stack, that is UPI. Let us see how UPI works in practice. As we all know from our day to day experience, UPI facilitates inter-bank transactions by instantly transferring funds between two bank accounts on a mobile platform. Here is how it goes on: First of all, UPI allows multiple bank accounts to be linked to a single mobile application, making it possible to have seamless fund routing and merchant transactions. These transactions are processed in real time, meaning the transfer happens instantly. It operates round the clock, 24/7, every day of the year. In doing every transaction, UPI uses a Virtual Payment Address (VPA) as a unique identifier, eliminating the need to enter bank account numbers or IFSC codes for transactions. If they desire users can scan QR codes for faster and error-free transactions. Transactions are secured with a two-factor authentication but only require one click for most transactions. One more thing, and not in the least unimportant, UPI supports person-to-person (P2P) and person-to-merchant (P2M) transactions. Almost all major banks in India support UPI, allowing their customers to use any UPI-enabled app for transactions. There is no need for Wallets. Unlike mobile wallets where you need to load money, UPI transactions are direct bank-to-bank. UPI has been instrumental in driving digital payments in India, promoting the vision of a cashless economy. Many applications like BHIM, Google Pay, PhonePe, Paytm, and more have integrated UPI for seamless transactions. India's Success and Challenges in Digital Public Infrastructure The statistics clearly indicate that India has achieved remarkable success in the domain of digital public infrastructure. This infrastructure has made the lives of its citizens more convenient and secure. There are high hopes that India will continue to achieve greater milestones in this field in the future. This accomplishment is not just noteworthy within India, but also sets a global benchmark. Specifically, countries in the 'Global South' are keenly observing and may be inspired by these developments. The credit for this success goes to multiple factors, including: Visionary leadership and foresight of the government Active participation of the citizens Innovations in the technology sector Legal reforms Implementation of security measures However, every silver lining has a cloud. While the statistics presented are impressive, a discerning reader might notice the following concerning numbers: Aadhaar: Unsuccessful biometric authentications – Over 100 million Aadhaar: Biometric authentication errors – Over 100 million The fingerprints of manual laborers often fade over time. This results in their inability to authenticate through Aadhaar, leading them to be deprived of ration and other amenities. The issue of Internet shutdowns we have already discussed above. These challenges highlight the importance of addressing the barriers that a segment of the population faces in accessing the benefits of digital public infrastructure. Evolving Dynamics in the Digital Economy In the past, the emphasis was on the traditional economy. However, with the advent of the information age, the significance of knowledge-based economics has been on the rise. This shift brought forward a novel concept: Public goods, contrasting the previously dominant idea of Private goods. Private Goods: Items that, once purchased and consumed by an individual, cannot be used by others. Examples include cars, clothes, mobile phones. Public Goods: Items available for everyone and can be used by anyone without restriction. Examples include roads, parks, and street lighting. The crux of the matter is that, in the digital era, the utilization of public goods and the businesses based on them, especially IT companies, have become the frontrunners, leaving traditional companies in the dust. During the dot-com era before the year 2000 and the subsequent rise of social media, these IT corporations made their public goods (services) available for free to users (i.e., customers). This was widely accepted and appreciated by the masses. The primary revenue for these companies during that time was predominantly from advertisements. But even more crucial was the accumulation of vast amounts of user data by these IT corporations. Now, this data repository has become the main asset and source of power for these companies, simultaneously becoming a primary reason for the disempowerment of the masses. It's often said that a few decades ago, oil had unparalleled significance in the economy and politics was driven by oil. Today, that place has been taken by data repositories. Consequently, the issues of privacy and data protection have become of paramount importance in today's world.

Public Digital Backbone/Chapter 2. History in the Making. = 2. History in the Making = Introduction: "India is a place of infinite promise... It is also a place of endless patience." -Raghuram Rajan India's journey in building an extensive digital infrastructure stands out as a remarkable achievement on the global stage. Here we chronicle the nation's strides in this domain, highlighting the catalysts for change, the challenges faced, and the milestones achieved. The aim is to provide a comprehensive overview of India's success story and its implications for other countries aiming to build similar infrastructures. The Global South: An Analysis of Socioeconomic Divide The concept of a digital social structure and debates around 'universalism' may not yet be fully understood. To grasp this, it's essential to first understand the ongoing debate of the global North vs. South and the reality behind it. The term "Global South" generally refers to a group of countries including those in South and Central America, African nations, ASEAN countries, Pacific Island nations, the Indian subcontinent, Middle Eastern nations, and China. In essence, the Global South typically represents regions such as Latin America, Asia, Africa, and Oceania. Interestingly, no European country is considered part of the Global South. The global North-South divide is a prevailing reality, signifying that Northern countries are wealthier and more developed than their Southern counterparts. Northern countries tend to suppress the South, hindering their path to development. The reasons for this divide include: Legacy of the Colonial Era: Northern countries colonized and ruled over Southern countries for centuries, during which they exploited their resources, causing economic weaknesses. Unjust Global Economic Systems: The current global economic system often benefits the North while disadvantaging the South. For example, international trade agreements restrict Southern countries from protecting their industries. Technological Shortfalls: The lack of modern technology in the South acts as a barrier to their development. Instability: Often, countries in the South face political and social turmoil, stalling their progress. Because of this division, Southern countries face numerous challenges, such as: Poverty: A significant problem in the South, with more than 80% of the world's impoverished population residing there. Illiteracy: Over two-thirds of the world's illiterate population lives in the South. Health Issues: More than 90% of those affected by diseases like malaria and AIDS are in the South. Understanding this divide is crucial to acknowledging the global challenges and addressing them holistically. Addressing the Global Divide To eradicate this division, the global community needs to take several steps, including: Reforming the Global Economic System: The global economic system should be restructured to provide equal opportunities to all nations. Spreading Technology: It's essential to disseminate modern technology across countries in the Global South, allowing them to accelerate their development. Establishing Stability: Stability needs to be established in the countries of the Global South, ensuring they can focus on their development without any hindrance. "India is going from an offline, informal, low productivity, multiple set of micro economies to a single online, formal, high productivity mega-economy. And this is the trend of the next 20 years..." -Nandan Nilekani, Founding Chairman of Aadhaar Project. “There is now a major move afoot to take this model to 50 countries in five years,” Nilekani said, speaking at the B20 Summit in the national capital. “So over the next few years, you will see the proliferation of how this new way of thinking about digital infrastructure at population scale, using an open architecture, is going to be more and more ubiquitous and prevalent around the world,” Nilekani said. India, a land of diverse cultures, traditions, and languages, has always held a spirit of adaptability at its core. As the world hurtled into the digital age, India too began crafting its path, resulting in the formidable ascent of digital public infrastructure. The journey is as much about technological innovation as it is about reimagining governance. The Starting Block: Aadhaar Our tale begins with an ambitious project in 2009 – Aadhaar. India decided to give a unique identification number to each of its 1.3 billion residents. Critics wondered: could a nation with vast illiterate populations, lacking basic amenities, pull off such an ambitious feat? Yet, by 2017, over a billion people had their biometric data registered. An anecdote often shared is of an elderly woman in a remote village, who for the first time had an identity outside her family – her Aadhaar card. For many, it wasn’t just an ID; it was a symbol of belonging. Banking the Unbanked: Jan Dhan Yojana Aadhaar paved the way for Jan Dhan Yojana in 2014, aiming to ensure financial inclusion. With the Aadhaar card as identification, millions opened their first bank accounts. In a poignant moment, a vegetable vendor in Bihar expressed his joy saying, "For the first time, a bank recognized me." A Tryst with Digital Transactions: UPI The Unified Payments Interface (UPI) story is nothing short of revolutionary. Launched in 2016, it made digital transactions as easy as sending a text. A tea seller in Pune amusingly recalled, "People used to ask for change, now they just ask for my UPI ID!" By 2021, UPI recorded transactions worth 5 trillion rupees in a single month. A Transparent Approach: GST and e-Way Bill 2017 marked a landmark year with the introduction of the Goods and Services Tax (GST), aiming to unify the nation's complex tax structure. The accompanying e-Way Bill system ensured real-time tracking of goods movement. A cloth merchant from Rajasthan fondly remembers the pre-GST era, jesting, "We had more tax calculations than cloth patterns! Now it's simpler." Towards a Digital Health Revolution: National Digital Health Mission 2020 was a challenging year for the world. But amidst the pandemic, India announced the National Digital Health Mission. With a vision to digitize health records and ensure efficient health service delivery, this initiative promised a future where medical consultations, prescriptions, and records would all be a click away. Digital Literacy: Bridging the Digital Divide While these initiatives created waves, the grassroots movement of digital literacy deserves a mention. Rural digital literacy campaigns transformed young children into village heroes. A popular story speaks of a 12-year-old teaching her grandmother to video-call her son in the city, bridging miles and generations. As India continues to stride towards a digital future, these anecdotes remind us that at the heart of this transformation is the common citizen. Their stories, their adaptations, and their aspirations. With each digital step, India isn't just adopting technology; it's crafting history.

Public Digital Backbone/Chapter 4. What is served on my plate? Benefits of Public Digital Backbone. = 4. What is served on my plate? Benefits of Public Digital Backbone = Introduction: “A robust Digital Infrastructure is a facilitator for social welfare, justice, and empowerment. It enables the access to quality education, health care, and social protection for all, especially the marginalized and vulnerable groups. It also enables the protection of human rights, privacy, and dignity in the digital sphere.” -Malala Yousafzai, Nobel Peace Prize laureate and activist Beyond the evident technological advancements, what does a robust Public Digital Backbone bring to the table for citizens, businesses, and governments? Here we delve into the multifaceted benefits of such an infrastructure, ranging from enhanced service delivery to fostering innovation. We'll evaluate the ripple effects of these benefits on the broader economy, governance, and societal well-being. Enhancing access to financial services. Public Digital Backbone has been pivotal in broadening the reach of financial services in India, ensuring more inclusive financial participation. The Aadhaar system, a biometric identity platform, is a stellar example. It has been instrumental in streamlining the process of opening bank accounts, making it more accessible to the rural and underserved populations. Additionally, the Unified Payments Interface (UPI) facilitates real-time money transfers across different banks, ensuring seamless transactions even for those with minimal banking experience. Such initiatives reduce the reliance on traditional brick-and-mortar banking setups, and provide an impetus for financial inclusion, bridging the urban-rural divide and empowering millions with financial tools and resources. Streamlining welfare schemes and reducing corruption. In recent years, India has leveraged Public Digital Backbone to bring significant improvements to its vast array of welfare schemes. With Aadhaar, the Direct Benefit Transfer (DBT) mechanism was initiated, ensuring that subsidies and welfare benefits reached the intended recipients directly, eliminating intermediaries. This not only streamlined the delivery of benefits, making it faster and more efficient but also drastically reduced the scope for corruption and pilferage. Moreover, platforms like the Unified Payments Interface (UPI) have further simplified monetary transactions, providing an additional layer of transparency and accountability to public funds' management. Consequently, such infrastructural innovations have fostered trust in public systems and enhanced the effectiveness of welfare programs, ensuring that the benefits are felt by the neediest sections of society. Improving public service delivery. Public Digital Backbone has been instrumental in transforming the landscape of public service delivery in India. With the adoption of digital platforms like the Aadhaar biometric system, citizens now have a unique identification that streamlines various governmental processes. For instance, the Direct Benefit Transfer (DBT) scheme leverages Aadhaar to directly transfer subsidies and benefits to citizens, eliminating intermediaries and reducing corruption. The National Digital Health Mission (NDHM) aims to provide every Indian citizen with a digital health ID, facilitating seamless access to medical records and enhancing healthcare efficiency. The e-NAM (National Agriculture Market) allows farmers to sell their produce online, ensuring better price realization and reducing middlemen. Such initiatives, underpinned by Public Digital Backbone, ensure timely, transparent, and efficient delivery of public services, ultimately elevating the user experience for millions of Indians. Fostering innovation and entrepreneurship. In India, the establishment of a robust Public Digital Backbone has acted as a catalyst for innovation and entrepreneurship. One notable example is the Aadhaar system, a biometric identification database, which not only streamlined citizen verification processes but also paved the way for innovative fintech solutions. Startups utilized Aadhaar for seamless KYC (Know Your Customer) verifications, thereby accelerating financial inclusion for millions. Furthermore, the Unified Payments Interface (UPI) facilitated the emergence of a plethora of digital payment platforms like PhonePe and Google Pay, transforming how India transacts. The digital public infrastructure, by providing foundational technological platforms and data accessibility, has enabled entrepreneurs to ideate and implement solutions that are more closely aligned with the unique challenges and opportunities present in the Indian landscape.

Public Digital Backbone/Chapter 5. Building a Public Digital Backbone. = 5. Building a Public Digital Backbone = Introduction: “The Digital Infrastructure is not just a network of wires and servers, but a network of minds and ideas.” -Sundar Pichai In the intricate process of building a national-level Public Digital Backbone, the intellectual capital and research prowess of academia emerge as invaluable assets. This chapter delves into the pivotal role of academic institutions in informing and shaping policy design, underpinned by rigorous research and evidence-based insights. It is necessary to uncover the synergy between academic findings and practical implementations, underscoring how scholarly endeavors can lead to innovative solutions, ensuring seamless flows of people, money, and information within the Public Digital Backbone framework. Stakeholder collaboration. Stakeholder collaboration is imperative when building Public Digital Backbone, especially in a diverse nation like India. For instance, the Aadhaar project, India's biometric identification system was developed by the Unique Identification Authority of India (UIDAI) in collaboration with the state governments, technology firms, and grassroots organizations. Another example is the Unified Payments Interface (UPI), a real-time payment system, developed by the National Payments Corporation of India (NPCI) with the support of the Reserve Bank of India (RBI) and Indian Banks' Association (IBA). These initiatives thrived because of the synergy between policymakers, technology providers, and end-users, ensuring widespread adoption and seamless integration into the daily lives of Indian citizens. Role of government and regulators. The role of the government and regulators in India while building Public Digital Backbone has been instrumental in setting the vision, providing direction, and creating an enabling environment. For instance, the Indian government initiated the Digital India campaign in 2015, aiming to transform India into a digitally empowered society. Another example is the Unified Payments Interface (UPI) developed by the National Payments Corporation of India, a pivotal move by regulators to simplify peer-to-peer money transfers and boost the nation's digital economy. These initiatives demonstrate the proactive role of government and regulators in shaping and fostering Public Digital Backbone in India. The private sector's contribution. While the provided content focuses on the role of academic institutions in shaping the Public Digital Backbone, it doesn't directly mention the private sector's contribution. However, drawing from broader knowledge, in India, the private sector played a significant role in building the nation's Public Digital Backbone. For instance, the development and rollout of the Unified Payments Interface (UPI) involved collaboration between the National Payments Corporation of India (NPCI) and several private sector banks and technology companies. Tech startups like PhonePe, Google Pay, and Paytm leveraged UPI to offer seamless digital payment solutions. Additionally, Reliance's Jio initiative significantly expanded internet accessibility, enabling a broader segment of the population to engage with digital public services. This kind of collaboration exemplifies the symbiotic relationship between the private sector's innovation capabilities and the government's vision for digital infrastructure. Civil society and public participation. Civil society and public participation played a significant role in shaping the Public Digital Backbone in India. For instance, during the development and rollout of Aadhaar, India's unique identification project, several consultations were held with civil society organizations, activists, and experts to address concerns related to privacy, data protection, and potential misuse. Similarly, when the government launched the Unified Payments Interface (UPI) to simplify electronic money transfer, feedback from end-users, fintech startups, and the broader public was instrumental in refining its design and enhancing its security features. Such active participation ensured that India's digital infrastructure was not only technologically robust but also aligned with the needs and aspirations of its citizens. Engaging academia for research and policy design. Engaging academia in the development of India's Public Digital Backbone has played a paramount role in ensuring informed and effective policy design. For instance, the evolution of the Aadhaar system, India's unique identity project, benefited from insights of researchers from institutions like the Indian Institutes of Technology (IITs) and the Indian Institute of Science (IISc), who provided technical expertise and recommendations for secure data handling. Similarly, the National Payments Corporation of India (NPCI) collaborated with academic experts to design the Unified Payments Interface (UPI), ensuring a robust and scalable digital payments system. These engagements ensured that policies and systems were underpinned by cutting-edge research and best practices, leading to infrastructures that could be efficiently integrated and widely adopted across the nation. Design principles and components. In India, the design principles and components for building Public Digital Backbone have been driven by inclusivity, scalability, interoperability, and security. A hallmark example is the Aadhaar system, which aimed at providing a unique identification number to every resident, ensuring inclusivity. Designed for massive scale, Aadhaar can serve a population of over a billion people. Interoperability has been at the core of platforms like the Unified Payments Interface (UPI), which seamlessly connects different banking systems, enabling instant money transfers across a plethora of service providers. Moreover, the DigiLocker system showcases an emphasis on security and privacy, offering citizens a platform to store and share digital copies of their official documents securely. Together, these components have laid a robust foundation for India's Public Digital Backbone. Implementation challenges and solutions. While building the Public Digital Backbone in India, various challenges emerged. One prominent challenge was the vast diversity in languages, cultures, and digital literacy levels across regions, making a uniform interface daunting. This was addressed by creating multilingual platforms and user-friendly UPI (Unified Payments Interface) systems to cater to users from various backgrounds. Another challenge was ensuring data security and privacy. The Aadhaar system, India's biometric ID, faced scrutiny over potential misuse of personal data. To mitigate this, the government strengthened data protection laws and implemented robust encryption standards. Additionally, issues of connectivity in remote areas were addressed by expanding digital infrastructure like BharatNet, aiming to provide high-speed internet in villages. These solutions were informed by academic research and practical feedback, creating a resilient Public Digital Backbone.

Public Digital Backbone/Chapter 6. Challenges and Risks. = 6. Challenges and Risks = Introduction: “Data is a precious thing and will last longer than the systems themselves.” -Tim Berners-Lee, inventor of the World Wide Web While the promise of a digital public infrastructure is immense, it isn't without its challenges. It is necessary to go deeper into the critical concerns of data privacy, security, and governance. Drawing from real-world instances and expert insights, we'll explore the intricacies of these challenges and the proactive measures that can be taken to mitigate them. Data privacy concerns. Data privacy concerns in the context of Public Digital Backbone arise due to the vast amounts of personal and sensitive data that such infrastructures often handle. For instance, a national digital health system may contain records of millions of citizens, from medical histories to genetic data. If not appropriately protected, this information could be accessed and misused, leading to breaches of individual privacy. Another example is digital voting systems; if not properly secured, individuals' voting preferences could be exposed, or even manipulated. Public transportation systems using digital payment methods or tracking can inadvertently reveal a person's daily routine or location history. These instances underscore the need for robust data protection mechanisms within Public Digital Backbone to maintain the trust and confidence of the public. Security and potential breaches. Security is of utmost importance in the realm of Public Digital Backbone, especially in a vast nation like India. The nation has embarked on ambitious projects that underscore its commitment to digital growth. The Aadhaar system, for instance, is a pioneering initiative that offers a unique identification number to every Indian citizen using biometrics. While there were concerns about its security, it has largely been successful in its reach and has been constantly updated to enhance its safety measures. The GSTN (Goods and Services Tax Network), despite initial glitches, has showcased the nation's capacity to adapt and bolster security in response to challenges. These endeavors highlight India's proactive approach in addressing and improving cybersecurity, instilling greater confidence in the nation's Public Digital Backbone. Inclusion: Ensuring no one is left behind. In India, the drive towards creating a digital public infrastructure has been notably focused on the principle of "Ensuring no one is left behind". This commitment to inclusion is evident in initiatives like the Aadhaar program, ensuring access to crucial government services and subsidies. The Unified Payments Interface (UPI), democratizes digital transactions, allowing users from urban centers to rural villages to transact seamlessly. Additionally, the DigiLocker project provides a digital locker for citizens to store personal documents, making public service requests more streamlined. Such endeavors aim to bridge the digital divide, ensuring benefits reach every stratum of the society, from bustling metropolitans to the remote villages of India. Governance models and oversight. In India, the evolution of Public Digital Backbone has been marked by the emphasis on inclusion, ensuring that every citizen, regardless of socio-economic status, has access to essential digital services. The Aadhaar system is a prime example of this. As the world's largest biometric ID system, Aadhaar was designed to provide a unique identity for every Indian, facilitating better delivery of public and financial services. Yet, governance models and oversight are paramount in such ventures. Concerns over data privacy, potential misuse, and surveillance led to the Supreme Court of India setting boundaries on its usage in 2018. The court's intervention underscores the need for robust governance to balance technological advancements with individual rights. Another example is the Unified Payments Interface (UPI), which revolutionized digital payments in India. While UPI ensured broader financial inclusion, its governance by the National Payments Corporation of India (NPCI) ensures standardized protocols, security, and interoperability across banks, preserving trust in the system. Both instances exemplify how governance and oversight are critical to the success and inclusivity of Public Digital Backbone in India.

Public Digital Backbone/Chapter 7. Global Relevance. 7. Global Relevance. Introduction: “India has shown remarkable leadership and vision in building and scaling its digital infrastructure, and has become a global role model for other countries. I believe that by sharing its experience and expertise, India can help accelerate the digital transformation of the world, and contribute to the achievement of the Sustainable Development Goals.” -Satya Nadella, CEO of Microsoft In our interconnected world, the lessons learned from pioneering digital infrastructures like India's are universally relevant. We attempt to examine the potential of Public Digital Backbones in varied global contexts, drawing parallels, pointing out divergences, and outlining potential roadmaps for nations at different stages of their digital evolution. Estonia: Estonia has been a pioneer in digital government, and its e-Estonia initiative has made it possible for citizens to access a wide range of government services online, from tax filing to voting. Estonia's success has been attributed to its strong political will, its focus on open data and standards, and its investment in digital infrastructure. South Korea: South Korea has also been a leader in digital government, and its government has invested heavily in high-speed internet and mobile connectivity. South Korea's digital infrastructure has helped to boost its economy and improve the lives of its citizens. Brazil: Brazil is one of the largest countries in the world, and it is facing the challenge of providing digital public infrastructure to its citizens in a cost-effective way. Brazil has been experimenting with a number of different approaches, including public-private partnerships and the use of open source software. Kenya: Kenya has been praised for its use of mobile technology to provide government services to its citizens. The M-PESA mobile money platform has been used to provide financial services to millions of Kenyans, and the government has also used mobile technology to deliver healthcare services and education. United States: The United States has a long history of public investment in infrastructure, but it has lagged behind other countries in the development of digital public infrastructure. The US government is now investing in a number of initiatives to improve its digital infrastructure, including the Build Back Better Act and the Infrastructure Investment and Jobs Act. Singapore: Singapore is another country that has made significant investments in digital public infrastructure. The government has created a number of digital platforms that make it easier for citizens to access government services, such as the SingPass national digital identity and the GovTech National Digital Repository. Malaysia: Malaysia is developing a national digital infrastructure called MyDIGITAL, which aims to make the country a leader in the digital economy. MyDIGITAL includes a number of initiatives to improve the country's digital infrastructure, such as the development of a high-speed broadband network and the implementation of a national cloud computing platform. Uruguay: Uruguay has been praised for its use of digital technology to improve the lives of its citizens. The government has used mobile technology to provide healthcare services, education, and financial services to remote rural communities.

Public Digital Backbone/Chapter 8. Conclusion. 8. Conclusion. Introduction: “Digital Public Infrastructure are the arteries of the global civilization, connecting people, places, and things in unprecedented ways. They are the enablers of innovation, collaboration, and empowerment, creating new possibilities for human development and social progress. They are also the guardians of our common values, ensuring that our digital rights and responsibilities are respected and protected. They are not static or fixed, but dynamic and adaptable, evolving with the changing needs and aspirations of the societies they serve. They are the future we are building together.” -A Near Future Sci-fic Writer As we stand at the cusp of further technological evolution, what does the future hold for Public Digital Backbones? This concluding chapter casts an eye forward, speculating on future innovations, potential expansions, and the evolving needs of societies globally. Through forward-thinking discourse, we aim to paint a picture of a world continuously bettered by digital public infrastructure.

Public Digital Backbone/In the News. India ready to share DPI ecosystem with global south: DEA Secretary 22 Sep 2023, MTNL New Delhi: India is ready to share technical capabilities and knowledge related to its Digital Public Infrastructure (DPI) ecosystem for financial inclusion efforts of the Global South, Ajay Seth, secretary, Department of Economic Affairs (DEA) said on Friday. Speaking at the International Conference on Digital Public Infrastructure, Seth said that India has used ecosystems around DPI, which is an interoperable, scalable, open, and inclusive system, digitally empowering, to provide society wide services by public and private players. "We developed a solution approach for delivering the best in the class services for the last mile and even the remotest parts of the country," Seth said adding that the country's achievements are well known in numbers. India Showcases Digital Prowess at G20: UPI, RuPay, and Digital Rupee Take Center Stage 6 September 2023. Indian Express India is set to display its advanced digital public infrastructure (DPI) at the G20 Summit. The showcase includes the UPI service, which doesn't require foreign delegates to have an Indian bank account, and the innovative RuPay payment system that enables contactless transactions via wearables. Additionally, the Digital Rupee (Central Bank Digital Currency or CBDC) will be demonstrated live. Through the Bharat Bill Payment System, India also offers cross-border payment solutions for non-resident Indians. India's promotion of these platforms, such as the "India Stack", positions the country as a leader in digital governance. This move is seen as India's strategy to emphasize its achievements in digital infrastructure, distinguishing itself from countries like China, which focus more on physical infrastructure. RBI's Public Tech Platform will also be highlighted, offering frictionless credit based on comprehensive citizen data. Through these efforts, India aims to inspire both developed countries and those in the Global South, asserting its role as a pioneer in the digital revolution. ('UPI for delegates to credit platforms, India yo showcase digital infra' https://indianexpress.com/article/india/upi-for-g20-delegates-to-credit-platform-india-to-showcase-digital-infra-8926420/) Leveraging UPI as it crosses 10bn mark. India Stack for Global Outreach 4 September 2023. Indian Express The United Payments Interface (UPI) recently marked a landmark with over 10 billion transactions. This isn't just a domestic success story; it's also a cornerstone of India's foreign policy strategy. Under India's G20 presidency, the nation spotlighted its strides in digital public infrastructure (DPI), with UPI being a central component. This effort is part of a broader initiative known as India Stack, which encompasses digital codes and public goods aiming to streamline identity verification, data handling, and payments at a mass scale. Three layers form the core of India Stack: 1. Identity: Spearheaded by Aadhaar, India's national ID program, this layer aids in remote authentication and offers government-supported digital signatures. 2. Payments: UPI, overseen by the National Payments Corporation of India (NPCI), is central to this layer, ensuring seamless transactions across various platforms like PhonePe, Google Pay, and Paytm. 3. Data Management: Operating under the Data Empowerment and Protection Architecture (DEPA) policy, this layer emphasizes consent-based data sharing to improve various services for individuals and companies. India is not just keeping these advancements to itself. Recent efforts have been geared towards internationalizing these solutions, as many of India's digital tools, including CoWin, DigiLocker, and Aarogya Setu, are built on the India Stack model. Reflecting its global aspirations, India has penned agreements with nations like Armenia, Sierra Leone, and Papua New Guinea to share India Stack. Furthermore, countries including Mauritius and Saudi Arabia are keen on adopting this model. UPI's international footprint is also expanding, with nations like France and Singapore embracing it and Japan showing interest. India's digital innovations have been a focal point during its G20 presidency. Prime Minister Narendra Modi highlighted India as an "ideal testing lab" for digital solutions and expressed the country's willingness to share its digital public goods expertise, underscoring the inclusive vision behind India Stack. In summary, as India charts its path in the digital governance realm, its emphasis on open digital infrastructures like UPI and India Stack is setting the stage for a new kind of diplomatic outreach, one that emphasizes collaboration in the digital age. https://indianexpress.com/article/business/upi-10-billion-transactions-india-foreign-policy-8921480/

Infrastructure Past, Present, and Future Casebook/Mississippi River Locks and Dams. This page is for a case study on the Mississippi River Locks and Dams created by Kayla Byrd, Eric Johnson, and Gabby Wade. It is part of the GOVT 490-003 (Synthesis Seminar for Policy & Government) / CEIE 499-002 (Special Topics in Civil Engineering) class offered at George Mason University taught by Jonathon Gifford. Summary. The Mississippi River Locks and Dams system is an integral part of United States Waterway Transportation that allows a manageable navigational channel. There are twenty-nine locks and dams spanning roughly 2,300 miles from Minnesota to Louisiana, serving various functions like navigation, flood control, and hydroelectric power generation. A lock, concerning waterway infrastructure, is a structure that allows maritime transportation to easily navigate along a river, despite differing water levels. When a boat or ship is needed to travel a waterway with higher elevation, it enters a passageway that entraps the watercraft. Water is then either added or removed from the passage to allow the vessel to either rise or fall to the needed elevation. In order to provide a barrier to the active flow of water, contractors build a waterway structure called a dam. As aforementioned, the barricade can assist in blocking the flow of water to create a consistent water level, improving navigation for water vessels. Dams can be used in a multitude of functions, such as water supply, water storage, and can be used as a form of flood control. Locks and Dams infrastructure plays a significant role in facilitating commerce, protecting downstream communities from floods, and supporting energy production and recreational activities. Key Actors and Institutions. Key Actors and Institutions involved with the development and maintenance of Mississippi River Locks and Dams include: U.S. Army Corps of Engineers:. The U.S. Army Corps of Engineers (USACE) is a federal agency operating within the Department of Defense (DOD). The USACE was established as a permanent branch in 1802, later becoming an agency that directly oversees environmental preservation and restoration. Their primary role is to supervise the construction and maintenance of the Mississippi River's twenty-five Locks and Dams. This authority was authorized by The River and Harbors Act, enacted in 1899, which places responsibility on the USACE to protect the Mississippi River infrastructure in the midst of renovation or development. Mississippi River Commission (MRC):. The Mississippi River Commission, established in 1879, is a federal agency and division of the U.S. Army Corps of Engineers. This branch serves in an analyst position, directly analyzing the management and water resources within the Mississippi River Waterways. They serve as advisors to the USACE, Congress, and the Military, reporting on potential modifications that must be made based on their ongoing analysis of the watershed. The MRC is responsible for the advancement of the Mississippi River and Tributaries Project, which was authorized in 1928 after the Great Mississippi Flood of 1927, which was the most devastating flood of its time. In order to combat the risk of unprecedented floods, a public works system was created that would reduce flood risk and provide more efficient navigation. T"he MR&T Project has four main infrastructure developments:" - Levees and Dams -Tributary Basin Improvements -Channel Refinement -Floodways. Navigation Industry and Stakeholders:. The Maritime Industry is a key actor in regards to the Mississippi River Locks and Dams as they have significant financial stakes and interests in the waterways. The Mississippi River waterway is a vital source of efficient movements of freight. The American Waterways Operators (AWO), founded and organized in 1944, is a main advocacy association on behalf of United States carriers and exporters. Water transportation plays a significant role in the establishment of United States commerce, providing an estimated $100 billion in financial output. Environmental Agencies and NGOs:. Environmental agencies, such as the Environmental Protection Agency, have a key role in ensuring developments and suspensions of Mississippi River Infrastructure comply with environmental regulations and principles. The EPA has direct access to Congress and reports on the Restoration of the Mississippi River Waterway while contributing to the development of restoration strategies and programs. Non-governmental organizations (NGOs), specifically focused on environmental preservation, also advocate and assess waterway projects to ensure those involved in the task are complying with environmental standards. Funding and Financing. The funding for the maintenance and operation of locks and dams on the Mississippi River is primarily paid for by the federal government of the United States. These critical infrastructure components are under the jurisdiction of the U.S. Army Corps of Engineers, which oversees their upkeep and functionality. The financial resources required for the construction, ongoing maintenance, and daily operations of these locks and dams are derived from the federal budget. The U.S. Army Corps of Engineers is entrusted with the responsibility of managing and preserving the locks and dams along the Mississippi River to facilitate navigation, flood control, and related purposes. The funding necessary to execute these tasks is allocated through federal appropriations, which encompass expenses such as the repair and replacement of aging infrastructure, dredging activities, and overall maintenance efforts. In addition to federal appropriations, a portion of the funding may be generated from user fees, including charges imposed on commercial shipping entities that make use of the locks and dams. These fees, while serving as a financial resource to defray some of the associated maintenance and operational expenses, often fall short of covering the entire cost of these endeavors. It is noteworthy that the commercial traffic along the Mississippi River plays a smaller but substantial role in this funding scheme, contributing to the financial aspects of the inland waterway system. From the information provided by the United States Department of Agriculture (USDA) a “Percent tariff system” is used to set the rates for the shipping traffic on the river. The U.S. The Inland Waterway System regulates the system by setting the rates for the shipping traffic. This system of regulating tariffs comes from the “Bulk Grain and Grain Products Freight Tariff No. 7”, which was created by the Waterways Freight Bureau (WFB). In an intriguing historical development, this tariff system's relevance underwent a transformation in 1976. At that juncture, an agreement between the United States Department of Justice and the ICC rendered Tariff No. 7 obsolete. The barge industry still uses these tariffs as a reference point for rate units even though the WFB has ceased to exist and the ICC has changed into the Surface Transportation Board, which is now governed by the US Department of Transportation. To determine barge freight rates today, a percentage of the 1976 benchmark tariff per ton serves as the foundational unit, as outlined by the United States Department of Agriculture.[3] This system remains integral to the financial structure of the U.S. Inland Waterway System, bearing relevance to the overall funding framework. The federal government plays a pivotal role in financing the construction, maintenance, and operation of locks and dams on the Mississippi River, ensuring their continued functionality for navigation, flood control, and related purposes. Institutional Arrangements. Legal and Regulatory Frameworks:. The maintenance of the Mississippi River locks and dams is governed by a range of federal laws and regulations that ensure its continual prosperity and protection. The Rivers and Harbors Act of 1899, for example, is the oldest environmental law in the United States. It specifically addresses United States' waterways, making it unlawful to eject or dispense debris into navigable channels. The Water Resources Development Act and the Inland Waterways Revenue Act, both under the authority of the U.S. Army Corps of Engineers, are used conjointly. The WRDA authorizes the study and construction of projects that can positively benefit the advancement of waterway infrastructure. The IWRA was established to finance and fund the development and improvement of national waterways. These laws outline the legal authority for the construction, operation, and maintenance of the infrastructure and establish the roles and responsibilities of various agencies. Narrative of the Case. The First Lock and Dam: In 1907 the First Lock and Dam added to the river was at Meeker Island (Originally known as Lock and Dam 2). Its main purpose was for it to be used to allow for easier travel from St. Paul up to Minneapolis. You can still visit it today at “Meeker Island Lock and Dam Historic Park” where it is a symbol of the economic rivalry of St. Paul with Minneapolis. The 9-Foot Channel Project: Early 20th Century: The need for a deeper and more reliable channel on the Mississippi River was recognized as early as the late 19th century. However, it was in the early 20th century that serious discussions and planning began for a project to deepen the river's channel to a consistent 9-foot depth. 1920s: The U.S. Army Corps of Engineers became actively involved in the planning and execution of the project. Detailed surveys and engineering studies were conducted to determine the feasibility and the potential economic benefits of deepening the channel. 1930s: The 9-Foot Channel Project gained traction during the Great Depression as a way to stimulate economic activity and create jobs. Construction work on the project commenced in various sections of the river. World War II Era: The project's progress was temporarily interrupted during World War II when resources were diverted to support the war effort. Post-World War II: After the war, the project resumed, and substantial resources were allocated to its completion. Dredging, construction of locks and dams, and other infrastructure improvements continued. 1950s-1960s: The project reached a significant milestone with the completion of Lock and Dam 26 in Alton, Illinois, in the 1950s. This lock and dam system helped maintain the desired 9-foot channel depth by regulating water flow. 1970s-1980s: The project continued to progress, with further improvements and maintenance efforts along the Mississippi River to keep the channel at the desired depth. Environmental considerations and conservation efforts also gained importance during this period. 1990s-Present: The 9-Foot Channel Project remains an ongoing effort. The U.S. Army Corps of Engineers and other agencies continue to dredge and maintain the channel, repair and upgrade locks and dams, and address environmental concerns such as habitat preservation and water quality. 21st Century: The project has evolved to incorporate modern navigation technologies and environmental sustainability practices. It plays a crucial role in supporting commerce, transportation, and agriculture in the Mississippi River Basin. Modern State of Project: The Mississippi River continues to occupy a pivotal role in trade and commerce within the United States. As a major transportation artery, it facilitates the movement of a wide array of goods, including agricultural products, petroleum, chemicals, and manufactured goods. The river boasts a network of essential ports, with prominent hubs in cities like New Orleans, Baton Rouge, St. Louis, and Memphis, serving as critical nodes for both domestic and international trade. Notably, barge traffic remains a cost-effective and highly efficient method for transporting bulk commodities, and the river's infrastructure, mainly featuring the locks and dams, plays a crucial role in supporting this trade network. Over the years, substantial improvements and ongoing maintenance efforts have been dedicated to the Mississippi River's infrastructure. The ongoing maintenance has been instrumental in ensuring a consistent navigable depth and regulating water flow, enhancing safety and efficiency for shipping and transportation. Modern navigation technologies have also been seamlessly integrated into the river's operations, further bolstering its role in facilitating commerce. Moreover, heightened environmental considerations have gained prominence, with various initiatives aimed at preserving habitats, improving water quality, and implementing sustainable river management practices. It is important to recognize that the state of trade and commerce along the Mississippi River is subject to dynamic factors, including economic fluctuations, evolving infrastructure developments, and changing market dynamics. For the most up-to-date information on the river's modern trade activities and infrastructure, referring to recent reports and government sources is advisable to gain a comprehensive and accurate understanding of this crucial waterway's current status. Policy Issues. When the construction of the headwater dams was underway, the U.S. government ran into some issues because many reservoirs were located on Indigenous land. The government offered the Ojibwe nation $15,466.90 for their land but it was rejected. The government and the Ojibwe nation spend 5 years negotiating from 1881 to 1886 until they reached an agreement. By 1886, most tribes in the area moved to a reservation in Minnesota with the promise of funded land improvements. In 1928, Congress passed the Flood Control Act which called for the MRC to create a plan for flooding issues along the Mississippi River. The act included plans to strengthen existing levees and constructing a new spillway in Louisiana . Around that time, there was also debates about whether or not the Mississippi River should be deepened to 6 or 9 feet to allow for more water based trade and increase travel up and down the river which would bring more money to the economy. To determine which one was more doable, Congress asked the Army Corps of Engineers to complete a feasibility study of the 9-foot channel. Chief Engineer Charles Hall opposed the 9-foot channels stating it would have devastating environmental impacts, and there was no economic benefit. The public and the government officials were not happy about Hall’s reports and believed Hall’s duty was to engineering not to the environment. Since there was not a lot of public support for his report, Hall decided that another survey should be completed to determine the costs of the channel in more detail. However, Hall was removed from his survey team before the final report went out. Hall was not the only Chief Engineer to oppose the 9-foot channel. The next few Chief Engineers were also against the 9-foot channel however, by the time the second survey came out, it favored the construction of the 9-foot channel. The government continued to appoint Chief Engineers until they found one that was in support of the channel. In 1928, Major General Brown was appointed as Chief Engineer. He was in support of the channel, but did not agree with immediate construction until more survey work was done. This led channel supporters to turn to President Hoover to get support however, he also wanted to delay the construction of the channel until the Nation was in a more economically stable place since the Nation was in the Great Depression. Despite many setbacks, supporters continued to fight for the funding of this project. The House of Representatives passed the River and Harbors Act in 1930 that did not provide funding for the 9-foot channel. So. supporters turned to their senators to have an amendment added to the act which would provide funding. By June 1930, the amendment was added and the project was officially authorized. Looking at issues that the Mississippi River locks and dams in the present and future, maintenance and funding the biggest concerns. Dams have a typical lifespan of 50 years, so a lot of the dams built in the 1930's are quickly deteriorating. Since many dams are old they have eroded a lot over the years. However, they are dangerous and have an increased rate at failing. Environmental groups are concerned the US Army Corps is not taking these risks seriously and have financials incentives to do the bare minimum. Key Lessons/Takeaways. The Locks and Dams on the Mississippi River are an example of how engineers can be placed in the middle of doing what they feel is best for the public and doing the job that was given to them regardless of the outcome. Although the locks and dams are essential to trade and the economy today, the environmental impacts that chief engineers had in the 1930’s are still relevant today. With many dams needing increased maintenance, the US Army Corps had the chance to reevaluate some of the same issues that came up when planning the 9-foot channel.  Environmentalists would like the US Army Corps to take public engagement, environmental impacts, safety and stability, and future infrastructure impacts into consideration when determining the future of the dams.

Internal Medicine/Cutaneous Drug Reactions. Skin reactions are the most common adverse effects of medications, accounting for 10-15% of reported cases of adverse drug reactions. While most of these reactions are not severe, some can be life-threatening. Swift identification of severe reactions, discontinuation of the medication, and appropriate medical interventions can help minimize harm. Use of Drugs. In the United States, over 4 billion prescriptions for more than 60,000 different drugs are dispensed annually. Hospitalized patients alone receive approximately 120 million courses of drug therapy each year, and half of adult Americans are prescribed medications on a regular basis. Adverse effects from prescription medications can result in 4.5 million urgent or emergency care visits and more than 7,000 deaths annually in the United States. Many patients also use over-the-counter drugs, which can sometimes lead to skin reactions. Incidence. Recent prospective studies have shown that acute skin reactions to medications affect between 2.2 and 10 out of every 1,000 hospitalized patients. These reactions typically occur within a few days to four weeks after starting treatment. In a study involving 48,005 inpatients over a 20-year period, morbilliform rashes (91%) and urticaria (6%) were the most common skin reactions, with antimicrobials, radiocontrast agents, and nonsteroidal anti-inflammatory drugs (NSAIDs) being the most frequently associated medications. Severe hypersensitivity reactions to drugs occur in approximately 1 in 1,000 to 2 per million users, depending on the specific reaction. Although rare, severe skin reactions to drugs have a significant impact on health due to potential long-term effects, the need for hospitalization, prolonged hospital stays, and even life-threatening situations. Some groups, such as elderly patients, individuals with autoimmune conditions, recipients of hematopoietic stem cell transplants, and those with acute Epstein-Barr virus (EBV) or human immunodeficiency virus (HIV) infections, are at a higher risk of experiencing drug reactions. The exact reasons for this association are not fully understood but may involve immune dysregulation. People with advanced HIV disease (e.g., CD4 T lymphocyte count <200 cells/μL) are at a substantially increased risk of adverse reactions to sulfamethoxazole and also face a higher risk of severe hypersensitivity reactions. Apart from acute skin eruptions, prolonged use of certain medications can lead to or worsen various skin conditions, including itching, changes in pigmentation, nail or hair disorders, psoriasis, bullous pemphigoid, photosensitivity, and even cutaneous neoplasms. Although these drug-induced skin reactions are not common, their overall impact on public health has not been adequately assessed. Pathogenesis. Adverse skin reactions to medications can occur through immunological or non-immunological mechanisms. When a drug triggers an immune response, the type of reaction is determined by the nature of the effectors involved, such as cytotoxic (CD8+) T cells in blistering and certain hypersensitivity reactions, chemokines for reactions mediated by neutrophils or eosinophils, and B cell collaboration in producing specific antibodies for urticarial reactions. These immunologic reactions have been categorized into subtypes based on specific immune pathways. Genetic Factors and Cutaneous Drug Reactions Genetic factors can predispose individuals to severe drug reactions by influencing either drug metabolism or immune responses to drugs. Polymorphisms in cytochrome P450 enzymes, drug acetylation, methylation (e.g., thiopurine methyltransferase activity and azathioprine), and other forms of metabolism (such as glucose-6-phosphate dehydrogenase and dapsone) may enhance susceptibility to drug toxicity, underdosing, or the risk of medication interactions, highlighting differences in pharmacokinetics or pharmacodynamics. The routine screening of P450 enzymes for predicting cutaneous reactions has not been established, although it has been suggested as potentially cost-effective for specific populations, such as patients with seizure disorders or depression and those considering certain therapies like tamoxifen or warfarin. Associations between drug hypersensitivities and HLA haplotypes indicate a significant role for immune mechanisms, particularly those leading to skin involvement. For example, hypersensitivity to the anti-HIV drug abacavir is closely linked with HLA-B"57:01. In Taiwan, a strong correlation exists between SJS/TEN associated with carbamazepine and HLA-B"15:02, as well as between HLA-B*58:01 and SJS, TEN, or DIHS related to allopurinol. These associations are drug-specific and phenotype-specific, suggesting that drug-specific T-cell stimulation by medications triggers distinct reactions. However, while these genetic associations are robust, they alone are insufficient to cause severe drug hypersensitivity reactions. Global Considerations Recognizing HLA associations with drug hypersensitivity has led to recommendations for screening high-risk populations. Genetic screening for HLA-B57:01 to prevent abacavir hypersensitivity, which carries a 100% negative predictive value when confirmed by patch testing and a 55% positive predictive value applicable across different racial backgrounds, is becoming the standard of care globally (with a number needed to treat of 13). The U.S. Food and Drug Administration recommends HLA-B15:02 screening for Asian individuals before prescribing carbamazepine. The American College of Rheumatology advises HLA-B58:01 screening for Han Chinese patients receiving allopurinol. To date, screening for a single HLA haplotype (but not multiple HLA haplotypes) in specific populations has been found to be cost-effective (e.g., HLA-B1301 screening for Chinese patients with leprosy treated with dapsone). Genetic testing for specific HLA haplotypes and functional screening for TCR repertoire to identify at-risk patients is increasingly available, heralding the era of personalized medicine and pharmacogenomics. Immune-Mediated Skin Reactions: Common. Maculopapular Eruptions: Pruritus: Urticaria/Angioedema/Anaphylaxis: Anaphylactoid Reactions: Irritant/Allergic Contact Dermatitis: Fixed Drug Eruptions: Immune Cutaneous Reactions: Rare and Severe. Drug-Induced Hypersensitivity Syndrome The Drug-Induced Hypersensitivity Syndrome (DIHS) is a systemic reaction caused by drugs, also known as DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome. However, because eosinophilia doesn't always occur, the term DIHS is preferred. Clinically, DIHS starts with fever and flu-like symptoms for several days, followed by the development of a widespread rash, often affecting the face. Swelling of the face and hands/feet is common. It can also lead to systemic symptoms like lymph node enlargement, fever, and changes in blood counts, liver, kidney, lung, and gastrointestinal involvement. The timing and organs affected can vary depending on the causative drug. For instance, allopurinol often leads to DIHS with kidney involvement, while minocycline is more likely to involve the heart and lungs. The rash usually appears 2-8 weeks after starting the medication and can persist even after discontinuation. Symptoms may continue for weeks, especially those related to hepatitis. Reintroducing the drug can cause the rash to recur. Certain medications, like aromatic anticonvulsants (e.g., phenytoin, carbamazepine), can lead to cross-reactions in DIHS. Other drugs causing DIHS include antibacterial sulfonamides and various antibiotics. Recent research suggests that some drugs may reactivate latent human herpes viruses, which can worsen the condition. Mortality rates can be as high as 10%, often due to liver failure. Treatment typically involves systemic glucocorticoids and careful monitoring of clinical symptoms and laboratory tests. Steroid-sparing agents may be necessary in some cases, and discontinuing the causative drug is essential. Cardiac evaluation may be needed in severe cases or when heart involvement is suspected. Patients should be monitored for long-term complications, such as autoimmune thyroiditis and diabetes, which can develop months after the initial symptoms. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe skin conditions characterized by blistering and widespread skin detachment due to full-thickness epidermal necrosis. SJS describes cases with less than 10% skin detachment, SJS/TEN overlap for 10-30% detachment, and TEN for over 30% detachment. Other blistering conditions with mucositis can mimic SJS/TEN. Patients with SJS/TEN initially experience high fever, sore throat, conjunctivitis, and the development of painful, atypical skin lesions. These conditions can be life-threatening, with mortality rates ranging from 10% for SJS to over 30% for TEN. Common drug triggers include sulfonamides, allopurinol, antiepileptic drugs (e.g., lamotrigine, phenytoin, carbamazepine), NSAIDs, antibiotics, and nevirapine. Timely diagnosis, discontinuation of the suspected drug, and supportive care are critical for a better outcome. There is no consensus on the best treatment, but systemic glucocorticoids, intravenous immunoglobulin, cyclosporine, or etanercept may be beneficial. Close monitoring and management of fluid balance, wound care, infection prevention, and ophthalmologic and respiratory support are essential. Pustular Eruptions Acute Generalized Exanthematous Pustulosis (AGEP) is a rare skin reaction often linked to drug exposure. It presents with widespread erythema or erythroderma, high fever, and leukocytosis, followed by the development of numerous tiny pustules on the skin, typically in body fold areas. The pustules may merge and lead to superficial erosion. AGEP may initially resemble Drug-Induced Hypersensitivity Syndrome (DIHS) due to fever and erythroderma or Stevens-Johnson Syndrome (SJS) in its early stages. However, AGEP typically involves more superficial erosions and lacks prominent mucosal involvement. The principal differential diagnosis is acute pustular psoriasis, which has a similar appearance but different timing and pathogenesis. AGEP usually starts within 24-48 hours of drug exposure, whereas psoriasis-related eruptions are different. Common drug triggers include beta-lactam antibiotics, calcium channel blockers, macrolide antibiotics, and others. Some patients may have a personal or family history of psoriasis. Treatment includes immediate drug discontinuation and supportive care. Overlap Hypersensitivity Syndromes Overlap syndromes can occur in severe drug eruptions and may involve combinations of DIHS, SJS, TEN, and AGEP-like features. These syndromes share some pathophysiologic mechanisms and may not fit into a single diagnosis based on cutaneous and extracutaneous features. Treatment should address the dominant clinical features. Timing of rash onset, systemic involvement, and clinical presentation are essential factors in determining the diagnosis and treatment approach. Vasculitis Cutaneous small-vessel vasculitis (CSVV) typically manifests as purpuric papules and macules, often on the lower extremities. CSVV can be drug-induced in about 15% of cases. Many different drugs, particularly antibiotics, can cause CSVV. It can also affect internal organs, making a thorough clinical evaluation important. CSVV associated with drug reactions may show perivascular eosinophils on skin biopsy, suggesting drug involvement. Managing Patients Suspected of Having a Drug Eruption When dealing with a suspected drug eruption, there are four primary questions to address: Early Identification of Severe Eruptions. Swift recognition of potentially serious or life-threatening reactions is crucial. Initially, a suspected drug eruption can be defined by what it is not, such as Stevens-Johnson syndrome (SJS) or drug-induced hypersensitivity syndrome (DIHS). Certain clinical and laboratory features can indicate a severe reaction. Any suspicion of a serious reaction should lead to immediate consultation with a dermatologist or referral to a specialized center. Confirmation of Drug Reaction. The likelihood of drug involvement varies with the pattern of the reaction. Fixed drug eruptions are always drug-induced, whereas morbilliform eruptions are typically viral in children but drug-induced in adults. Severe reactions like SJS, TEN, AGEP, DIHS, and DRESS are mostly drug-induced. Skin biopsy helps describe the reaction but doesn't confirm drug causality. Blood tests, liver and renal function tests, and other assessments are crucial to evaluate organ involvement and detect abnormalities that may suggest a drug reaction. While mild elevation of liver enzymes and high eosinophil counts are common in drug reactions, they are not specific. Blood tests, serologic tests, and tests for infections may be necessary to identify an alternative cause. Identifying Suspected Drugs and Their Withdrawal. Most drug eruptions occur during initial treatment with a new medication, but exceptions exist, like IgE-mediated urticaria and anaphylaxis that develop upon rechallenge. The timing of onset following drug administration is characteristic for different types of eruptions. Maintaining a drug chart that records all medications and their timing relative to the rash is vital for identifying the causative drug. Medications introduced within the relevant time frame are prime suspects. Previous experiences with the drug (or related drugs) and consideration of alternative causes also help determine causality. The decision to discontinue or continue a medication depends on factors like reaction severity, the seriousness of the underlying condition, suspicion of causality, and the availability of alternative treatments. In potentially fatal drug reactions, immediate discontinuation of all possible suspect drugs is essential. Some rashes may resolve when the offending drug is continued, but this should be an exception rather than the rule. In general, suspected drugs should be discontinued, but important drugs not under suspicion may be continued, as withdrawal may have adverse consequences. Recommendations for Future Drug Use. The goals are to prevent recurrence of the drug eruption and avoid excluding potentially useful medications for future treatment. Assessing drug causality is based on reaction timing, consideration of other potential causes, and the effects of drug withdrawal or continuation. Certain instruments like the Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN) may be used to rank the likelihood of drug causality in specific conditions like SJS/TEN. Medications with a "definite" or "probable" causality should be contraindicated, and patients should be informed, given warning cards, or provided with medical alert tags. The implicated drugs should also be documented as allergies in the patient's medical chart. Cross-Sensitivity. Cross-sensitivity, where a patient reacts to structurally related drugs, can occur due to pharmacologic interactions or immune recognition of structurally related drugs. The risk of cross-sensitivity varies depending on the specific drugs and their chemical structures. Recent data suggest that the list of drugs to avoid after a drug reaction should be limited to the causative one(s) and a few very similar medications. Additionally, family members of patients with severe cutaneous reactions may also be advised to avoid causative agents. Role of Testing for Causality and Drug Rechallenge. The utility of laboratory tests and skin testing to determine causality is debated and may have limited practical value. Skin-prick testing can be useful in cases of immediate IgE-mediated reactions to drugs like penicillin. However, its sensitivity is limited in delayed-type hypersensitivity reactions. Desensitization procedures may be considered for patients who need to use a medication to which they previously reacted but cannot avoid. Desensitization carries risks, and patients should be monitored closely during the process. Despite desensitization, some patients may still experience non-life-threatening reactions during therapy with the culprit drug.

Internal Medicine/Hypercalcemia and Hypocalcemia. Causes of Hypercalcemia. Hypercalcemia has various underlying causes, which can be classified based on disruptions in the body's normal mechanisms for regulating serum calcium levels. These causes include: Clinical Symptoms of Hypercalcemia. The severity of hypercalcemia varies. Mild cases are often asymptomatic or may lead to subtle neuropsychiatric symptoms, while severe hypercalcemia can cause lethargy, gastrointestinal issues, and even life-threatening complications. Electrocardiographic changes may also occur. Diagnostic Approach of Hypercalcemia. Diagnosing hypercalcemia involves several steps: Treatment of Hypercalcemia. Treatment depends on the underlying cause and the severity of hypercalcemia. In mild, asymptomatic cases, no immediate intervention may be needed. However, symptomatic hypercalcemia requires prompt management: Overall, the treatment approach depends on the specific cause and clinical condition of the patient. Causes of Hypocalcemia. Hypocalcemia has various causes, and they can be categorized based on whether the levels of serum parathyroid hormone (PTH) are low (hypoparathyroidism) or high (secondary hyperparathyroidism). The primary culprits for hypocalcemia are typically impaired PTH production and impaired vitamin D production. Hypoparathyroidism, often arising from unintended damage during thyroid or parathyroid surgery or autoimmune endocrine diseases, can lead to severe hypocalcemia, which can be life-threatening. Impaired PTH secretion can result from magnesium deficiency or genetic mutations affecting calcium sensing receptors, suppressing PTH production (autosomal dominant hypocalcemia). Vitamin D deficiency, impaired 1,25(OH)2D production (usually due to kidney problems), or vitamin D resistance can also cause hypocalcemia, but it is generally less severe compared to hypoparathyroidism because the parathyroids can try to compensate for the low calcium levels. Clinical Symptoms of Hypocalcemia. The symptoms of hypocalcemia vary depending on its severity. Mild chronic hypocalcemia may not cause noticeable symptoms and might only be detected through routine calcium tests. More severe cases can lead to neuropsychiatric symptoms, gastrointestinal issues, and an increased risk of conditions like peptic ulcers and kidney stones. In extreme cases, hypocalcemia can result in life-threatening symptoms, including seizures, muscle spasms, and cardiac abnormalities. Hypocalcemia: Diagnostic Approach. When evaluating hypocalcemia, the first step is to confirm that changes in serum calcium levels are not influenced by abnormal albumin concentrations. A significant portion of calcium in the blood binds to albumin, so it's essential to correct for this when interpreting results. To determine the cause of hypocalcemia, measuring PTH levels is crucial. Low PTH levels (or "inappropriately low") suggest hypoparathyroidism, while high PTH levels point toward issues in the vitamin D axis. Other factors, such as serum magnesium and phosphate levels, also play a role in the diagnosis. Treatment of Hypocalecmia. The treatment approach for hypocalcemia depends on its severity, rate of development, and associated complications. In cases of acute, symptomatic hypocalcemia, calcium gluconate is administered intravenously, typically over a short period. Continuous infusion may be required for ongoing hypocalcemia. If hypomagnesemia is present, it should also be treated with magnesium supplements. For chronic hypocalcemia due to hypoparathyroidism, treatment involves calcium supplements and vitamin D supplementation, either with vitamin D2 or D3. PTH (1-84) (Natpara) is an approved treatment for refractory hypoparathyroidism. Vitamin D deficiency is addressed with vitamin D supplementation, with the dose adjusted based on the severity of the deficiency and the underlying cause. The goal of treatment is to raise serum calcium levels into the lower normal range and prevent hypercalciuria, which can lead to kidney stone formation. The specific treatment approach is tailored to the individual's condition and needs.

Internal Medicine/Acidosis and Alkalosis. Acid-Base Homeostasis. The body keeps the pH of systemic arterial blood in the range of 7.35 to 7.45 through a combination of extracellular and intracellular chemical buffering, along with regulatory mechanisms involving the respiratory and renal systems. The central nervous system (CNS) and respiratory system control arterial CO2 levels (Paco2), while the kidneys manage plasma bicarbonate levels. This regulation maintains the arterial pH by either excreting or retaining acids or bases. The interaction between the metabolic and respiratory factors responsible for systemic pH regulation is described by the Henderson-Hasselbalch equation. Under normal conditions, CO2 production and elimination are balanced, maintaining a steady-state Paco2 at approximately 40 mmHg. Hypoventilation results in hypercapnia (high Paco2), while hyperventilation leads to hypocapnia (low Paco2). However, the production and elimination of CO2 are regulated primarily by neural respiratory factors and are not directly controlled by the rate of CO2 production. Hypercapnia typically occurs due to hypoventilation rather than an increase in CO2 production. Any significant deviation in Paco2 levels usually reflects alterations in neural respiratory control or compensatory changes in response to primary changes in plasma bicarbonate levels. Diagnosing Common Types of Acid-Base Disorders. The most frequently encountered clinical acid-base disturbances include metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis, each occurring individually. Recognizing these basic acid-base disorders necessitates an understanding of the limits of physiological compensation for a primary disturbance. Approach to Diagnosing Acid-Base Disorders. Diagnosing acid-base disorders follows a systematic approach involving several steps. These include simultaneously obtaining arterial blood gas (ABG) and electrolyte measurements, ensuring the accuracy of [HCO3-] on both ABG and electrolyte panels, evaluating the AG, understanding the various causes of high-AG acidosis, and estimating the compensatory responses based on specific relationships between Paco2 and [HCO3-] detailed in a table. When assessing acid-base disorders, special attention should be given to the anion gap (AG). Calculated as AG = Na+ - (Cl- + HCO3-), the AG measures the unmeasured anions present in plasma and is typically within the range of 6-12 mmol/L. A high AG most often indicates the accumulation of non-chloride-containing acids, but it can be caused by other factors like changes in unmeasured cations, exogenous cations, or alterations in plasma anion albumin concentration. Correcting the AG is necessary when hypoalbuminemia is present, with 2.5 mmol/L added for each g/dL of albumin below the normal value of 4.5 g/dL. Understanding the AG helps identify high-AG acidosis, which results from various conditions involving the buildup of different acid types, such as inorganic, organic, exogenous, or unidentified anions. Even if [HCO3-] or pH is within the normal range, a high AG can signify the presence of metabolic acidosis. Comparing the decline in [HCO3-] (ΔHCO3-: 25 - patient's [HCO3-]) with the increase in AG (ΔAG: patient's AG - 10) is a useful approach when dealing with high-AG metabolic acidosis, especially when pH and [HCO3-] appear normal. Metabolic Acidosis. Metabolic acidosis is a complex acid-base disturbance characterized by an abnormal decrease in the pH of the blood and body fluids. It can manifest in various forms, with the two primary classifications being High Anion Gap Acidosis (HAGA) and Non-Anion Gap Acidosis (NAGA). Causes of High Anion Gap Acidosis. High Anion Gap Acidosis (HAGA) encompasses a broad spectrum of conditions, each with distinct pathophysiological mechanisms: Lactic acidosis is a crucial component of HAGA, characterized by elevated blood lactate levels and metabolic acidosis. Further details include: Diabetic Ketoacidosis (DKA), a classic example of HAGA, predominantly occurs in individuals with uncontrolled diabetes mellitus: Alcoholic Ketoacidosis (AKA) is a form of high anion gap metabolic acidosis occurring in chronic alcoholics: Other causes: Non-Anion Gap Acidosis. Non-Anion Gap Acidosis (NAGA) presents unique challenges, with several potential etiologies: Treatment of Non-Anion Gap Acidosis. In cases of non-Anion Gap (AG) acidosis resulting from bicarbonate loss through the gastrointestinal tract, the administration of sodium bicarbonate (NaHCO3) can be carried out either intravenously or orally. The choice between these routes depends on the severity of the acidosis and concurrent volume depletion. However, addressing proximal renal tubular acidosis (RTA), particularly Type 2, can pose a significant treatment challenge. This is because administering oral alkali exacerbates the excretion of bicarbonate and potassium through the urine. In instances of proximal RTA (Type 2), it is often necessary to supplement potassium. A suitable approach is to prescribe an oral solution containing sodium and potassium citrate, with each 5 mL of the solution consisting of citric acid (334 mg), sodium citrate (500 mg), and potassium citrate (550 mg). Commercial products like Virtrate or Cytra-3 serve this purpose. On the other hand, when dealing with classical distal RTA (Type 1), the correction of hypokalemia takes precedence. Once this has been achieved, alkali therapy should commence. Two effective options are sodium citrate (Shohl's solution) or sodium bicarbonate tablets (each containing 650 mg of sodium bicarbonate, equivalent to 7.8 milliequivalents of bicarbonate). These treatments aim to correct and maintain the serum bicarbonate concentration within the range of 24 to 26 milliequivalents per liter (meq/L). Patients with Type 1 RTA often respond well to chronic alkali therapy. This intervention carries several benefits, including a reduction in the frequency of nephrolithiasis (kidney stones), improvements in bone density, the restoration of normal growth patterns in children, and the preservation of kidney function in both adults and pediatric patients. However, in the case of Type 4 RTA, a dual therapeutic approach is necessary. It involves correcting the metabolic acidosis using the same strategies applied in classical distal renal tubular acidosis (Type 1 RTA). Simultaneously, attention must be given to rectifying hyperkalemia or elevated plasma potassium levels. Achieving normokalemia, or normal potassium levels in the blood, enhances the excretion of net acid in the urine, leading to significant improvement in the metabolic acidosis. Management of Type 4 RTA may include the chronic administration of oral sodium polystyrene sulfonate, usually in the form of 15 grams of powder prepared as an oral solution. This treatment is typically administered once daily, 2 to 3 times per week, and it's worth noting that the preparation excludes sorbitol due to palatability concerns, as patient compliance can be challenging. As an alternative, the non-absorbed calcium-potassium cation exchange polymer, patiromer, can be considered for patients with Type 4 RTA and concurrent hyperkalemia. This option is preferred due to its better taste. It's supplied as 8.4-gram packets of powder for suspension, with dosing adjusted at weekly intervals based on the plasma potassium levels. The maximum daily dose should not exceed 25.2 grams. Additionally, dietary adjustments are vital, and patients should consume a low-potassium diet, avoiding potassium-rich foods or supplements, including salt substitutes. All medications that retain potassium should be discontinued, and, if necessary, a loop diuretic may be prescribed to aid in potassium excretion. In cases where isolated hypoaldosteronism is confirmed, patients may require fludrocortisone therapy. However, the specific dose can vary depending on the underlying cause of the hormone deficiency. It's crucial to approach fludrocortisone administration cautiously, particularly in patients with edema and hypertension, as it has the potential to worsen these conditions. When prescribed, it is often administered in combination with furosemide to mitigate possible aggravation of these symptoms. Metablolic Alkalosis. Metabolic alkalosis is characterized by an elevated arterial pH, an increase in the serum bicarbonate concentration ([HCO3-]), and a rise in Paco2 due to compensatory alveolar hypoventilation (as shown in Table 55-1). This condition is often accompanied by hypochloremia and hypokalemia. The elevation in arterial pH serves as a diagnostic indicator, as respiratory acidosis is characterized by decreased pH, despite both conditions having elevated Paco2 levels. Furthermore, metabolic alkalosis can frequently co-occur with other acid-base disorders, including respiratory acidosis, respiratory alkalosis, or metabolic acidosis. Metabolic Alkalosis: Etiology and Pathogenesis. Metabolic alkalosis results from either a net gain of bicarbonate ([HCO3-]) or the loss of nonvolatile acid, typically hydrochloric acid (HCl) through processes like vomiting. During vomiting, when HCl is lost from the stomach, the small bowel fails to initiate HCO3- secretion, causing an accumulation of HCO3- in the extracellular fluid. This phase is referred to as the "generation stage" of metabolic alkalosis since the loss of acid triggers alkalosis. Once vomiting ceases, the "maintenance stage" begins, as secondary factors prevent the kidneys from appropriately excreting HCO3-. Maintenance of metabolic alkalosis signifies a kidney failure to eliminate excess HCO3- from the extracellular compartment. The kidneys retain the surplus alkali rather than excreting it when: In the first scenario, saline-responsive metabolic alkalosis can be corrected by restoring extracellular fluid volume (ECFV) through intravenous administration of sodium chloride (NaCl) and potassium chloride (KCl). Conversely, in the latter situation, treatment may involve pharmacologic or surgical interventions rather than saline administration, as it is considered saline-unresponsive metabolic alkalosis. Metabolic Alkalosis: Differential Diagnosis. To determine the cause of metabolic alkalosis, various factors need to be assessed, including the ECFV status, blood pressure in both recumbent and upright positions (to detect orthostasis), serum potassium concentration ([K+]), urine chloride concentration ([Cl–]), and, in some cases, the renin-aldosterone system. For example, the presence of chronic hypertension and chronic hypokalemia in a patient with alkalosis may suggest mineralocorticoid excess or the use of diuretics. If plasma renin activity is low, and urine chloride levels exceed 20 milliequivalents per liter (meq/L) in a patient not taking diuretics, primary mineralocorticoid excess may be indicated. In cases where hypokalemia and alkalosis coexist in a normotensive, non-edematous patient, possible causes include Bartter's or Gitelman's syndrome, magnesium deficiency, vomiting, alkali ingestion, or diuretic usage. Here, the measurement of urine electrolytes (particularly urine chloride) and screening for diuretics are advisable. If urine is alkaline with elevated [Na+]u (urine sodium), [K+]u (urine potassium), and low [Cl–]u, the diagnosis often points to vomiting (either overt or surreptitious) or alkali ingestion. However, if the urine is relatively acidic with low concentrations of Na+, K+, and Cl–, possibilities include prior vomiting, the posthypercapnic state, or previous diuretic use. If sodium, potassium, and chloride concentrations in the urine are not reduced, one should consider magnesium deficiency, Bartter's or Gitelman's syndrome, or current diuretic ingestion. Bartter's syndrome can be distinguished from Gitelman's syndrome by the presence of hypocalciuria in the latter disorder. Metabolic Alkalosis Associated with ECFV Contraction, K+ Depletion, and Secondary Hyperreninemic Hyperaldosteronism. Metabolic Alkalosis: Alkali Administration Chronic alkali administration to individuals with normal renal function typically does not result in alkalosis. However, in patients with concurrent hemodynamic disturbances linked to effective ECFV depletion (e.g., heart failure), alkalosis can develop due to a reduced capacity to excrete HCO3- or an increased reabsorption of HCO3-. Such patients may receive sodium bicarbonate (NaHCO3) orally or intravenously, intravenous citrate loads (from whole blood transfusions or therapeutic apheresis), or antacids combined with cation-exchange resins like aluminum hydroxide and sodium polystyrene sulfonate. Interestingly, nursing home residents who receive enteral tube feedings are at a higher risk of developing metabolic alkalosis compared to those on regular diets. Gastrointestinal Origin: Metabolic alkalosis can arise from gastrointestinal losses of hydrogen ions (H+) during vomiting or gastric aspiration. This simultaneous loss of H+ leads to the addition of HCO3- into the extracellular fluid. During active vomiting, the filtered load of bicarbonate reaching the kidneys increases acutely, surpassing the proximal tubule's capacity for HCO3- absorption. Consequently, excessive HCO3- reaches the distal nephron, where the ability to reabsorb HCO3- is limited, resulting in the excretion of alkaline urine, which stimulates potassium secretion. Once vomiting subsides, the persistent volume, potassium, and chloride depletion promote HCO3- reabsorption, maintaining the alkalosis. Correcting the contracted ECFV with NaCl and addressing potassium deficits with KCl resolves the acid-base disorder by restoring the kidney's capacity to excrete excess bicarbonate. Renal Origin: Diuretics, such as thiazides and loop diuretics like furosemide, bumetanide, and torsemide, increase salt excretion and acutely decrease the ECFV without altering the total body bicarbonate content. The serum bicarbonate concentration ([HCO3-]) rises because the reduced ECFV effectively "contracts" around the plasma [HCO3-] (resulting in contraction alkalosis). Chronic diuretic administration tends to induce alkalosis by increasing distal salt delivery, which stimulates both potassium (K+) and hydrogen ion (H+) secretion. The maintenance of this alkalosis is supported by continued ECFV contraction, secondary hyperaldosteronism, K+ deficiency, and the direct impact of diuretic use (as long as diuretics are administered). To reverse the alkalosis, discontinuing diuretics and administering isotonic saline to correct the ECFV deficit are necessary. Solute Losing Disorders: Bartter's Syndrome and Gitelman's Syndrome: These conditions can result in metabolic alkalosis. Non-Reabsorbable Anions and Magnesium Deficiency: The administration of significant quantities of penicillin derivatives, such as carbenicillin or ticarcillin, introduces non-reabsorbable anions into the distal tubule. This raises the transepithelial potential difference in the collecting tubule, subsequently enhancing H+ and K+ secretion. Magnesium (Mg2+) deficiency can occur with chronic use of thiazide diuretics, alcoholism, malnutrition, or in cases of Gitelman's syndrome. Mg2+ deficiency intensifies hypokalemic alkalosis by promoting distal acidification through renin stimulation, thus enhancing aldosterone secretion. Potassium Depletion: Chronic potassium (K+) deficiency resulting from extreme dietary K+ insufficiency, diuretic usage, or alcohol abuse can initiate metabolic alkalosis by increasing urinary net acid excretion. Hypokalemia directly upregulates the generation of ammonium (NH4+) in the kidneys (ammoniagenesis). Furthermore, chronic K+ deficiency enhances the H+, K+-ATPases in the distal tubule and collecting duct, increasing K+ reabsorption and H+ secretion simultaneously. Alkalosis linked to severe K+ deficiency does not respond well to salt administration but is corrected by addressing the K+ deficiency. Often, potassium depletion occurs alongside magnesium deficiency in malnourished alcoholics. After Treatment of Lactic Acidosis or Ketoacidosis: When an underlying trigger for lactic acid or ketoacid generation is corrected, such as volume restoration for shock or severe volume depletion or insulin therapy, the lactate or ketones are metabolized to produce an equivalent amount of HCO3-. The addition of exogenous HCO3- sources can exacerbate this, leading to a surplus of HCO3- ("rebound alkalosis"). Posthypercapnia: Prolonged carbon dioxide (CO2) retention in chronic respiratory acidosis enhances renal HCO3- absorption and the generation of new HCO3- (increased net acid excretion). Metabolic alkalosis arises from the sustained elevation in [HCO3-] when the elevated Paco2 returns abruptly toward normal. Metabolic Alkalosis Associated with ECFV Expansion, Hypertension, and Mineralocorticoid Excess. Increased aldosterone levels can result from autonomous primary adrenal overproduction or secondary aldosterone release due to renal overproduction of renin. Mineralocorticoid excess enhances net acid excretion and may lead to metabolic alkalosis, typically exacerbated by accompanying K+ deficiency. Salt retention and hypertension are attributed to the upregulation of the epithelial Na+ channel (ENaC) in the collecting tubule in response to aldosterone. Kaliuresis persists due to mineralocorticoid excess and ENaC stimulation, which raises transepithelial voltage, facilitating K+ excretion. Prolonged K+ deficiency may lead to polydipsia and polyuria. Liddle's Syndrome: Liddle's syndrome results from a rare inherited gain-of-function mutation in genes that regulate the ENaC in the collecting duct. This monogenic form of hypertension is marked by volume expansion, which subsequently suppresses aldosterone production. Patients typically present with hypertension, hypokalemia, and metabolic alkalosis. Symptoms associated with metabolic alkalosis include mental confusion, obtundation, a predisposition to seizures, paresthesias, muscular cramping, tetany, aggravation of arrhythmias, and hypoxemia in chronic obstructive pulmonary disease. Hypokalemia and hypophosphatemia may also be present. Treatment of Metabolic Alkalosis. The primary goal of therapy is to address the underlying stimulus for HCO3- generation. Correcting the primary causes, such as primary aldosteronism or Cushing's syndrome, can reverse hypokalemia and alkalosis. Factors contributing to the inappropriate increase in HCO3- reabsorption, such as ECFV contraction or K+ deficiency, should also be eliminated. K+ deficits should always be corrected. If ECFV contraction is present, isotonic saline is recommended to reverse the alkalosis. In cases where congestive heart failure or similar conditions prevent saline infusion, acetazolamide (125-250 mg IV), a carbonic anhydrase inhibitor, may be administered to accelerate renal HCO3- loss in patients with adequate renal function. However, acetazolamide may cause urinary K+ losses and subsequent hypokalemia, which should be addressed. Dilute hydrochloric acid IV (0.1 N HCl) has been proposed for extreme cases of metabolic alkalosis but is associated with hemolysis and must be infused slowly into a central vein. This preparation is generally not readily available and must be prepared in the pharmacy, making its use inadvisable due to the potential for serious errors or harm. In Liddle's syndrome, therapy should include a potassium-sparing diuretic (amiloride or triamterene) to inhibit ENaC and correct both hypertension and hypokalemia. Respiratory Acidosis and Alkalosis. Respiratory acidosis occurs due to severe pulmonary disease, respiratory muscle fatigue, or ventilatory control abnormalities. It is characterized by an increase in Paco2 (carbon dioxide levels) and a decrease in pH. In acute respiratory acidosis, there is a compensatory increase in bicarbonate (HCO3-) levels, while in chronic respiratory acidosis, the kidneys adapt to increase HCO3- levels further. The clinical symptoms vary depending on the severity and duration of respiratory acidosis, underlying diseases, and the presence of hypoxemia. Rapidly rising Paco2 can cause anxiety, dyspnea, confusion, and even coma, while chronic hypercapnia can lead to sleep disturbances, memory loss, and other neurological symptoms. Various factors, including drugs, injuries, or diseases, can depress the respiratory center and lead to respiratory acidosis. Chronic respiratory acidosis can result from obstructive lung diseases or restrictive disorders involving the chest wall and lungs. Diagnosis involves measuring Paco2 and arterial pH, along with a detailed medical history and physical examination. Additional pulmonary function tests can help identify underlying lung disease, while investigations for nonpulmonary causes include drug history, hematocrit measurement, and assessment of upper airway, chest wall, pleura, and neuromuscular function. Treatment depends on the severity and onset of respiratory acidosis. Acute respiratory acidosis requires simultaneous management of the underlying cause and restoration of adequate alveolar ventilation, which may involve tracheal intubation and mechanical ventilation. Care must be taken when administering oxygen to avoid worsening acidosis. Chronic respiratory acidosis aims to improve lung function, and gradual reduction of elevated Paco2 levels may be necessary. It is essential to address the primary condition contributing to respiratory acidosis. Respiratory alkalosis occurs when alveolar hyperventilation lowers Paco2 and increases the HCO3-/ Paco2 ratio, resulting in increased pH. This can happen due to various causes, such as hyperventilation syndrome, certain drugs, diseases, or metabolic conditions. The symptoms of respiratory alkalosis depend on its duration and severity, ranging from dizziness and confusion to cardiovascular effects. Chronic respiratory alkalosis is commonly seen in critically ill patients and often requires addressing the underlying disease. Diagnosis involves measuring arterial pH and Paco2 levels, and treatment focuses on managing the underlying disorder, such as psychological stress in the case of hyperventilation syndrome. In summary, respiratory acidosis and alkalosis result from disturbances in the body's acid-base balance due to respiratory factors. Their clinical presentation and management depend on the underlying causes and the severity of the condition, with treatment primarily directed at addressing the root cause of the imbalance.

Quantum Chemistry/Example 33. 1. Background Information[edit | edit source]. 1.1 Wave Function[edit | edit source]. Wave is a verb meaning "to move back and forth". Oscillations happen when a build-up of an opposing force, such water waves, springs, or pendulums, counteracts displacements in either direction. The reason it's called a "wave" function is because it satisfies a wave equation, known as the Schrödinger equation. This equation describes how the wave function evolves over time, much like how classical wave equations describe the propagation of waves in classical physics. So, the term "wave function" reflects both the wave-like behavior of quantum entities and the mathematical form of the function, which satisfies a wave equation. The Schrödinger equation is also 2nd order; for free electron, it has the same oscillatory “wave” solution and is given by; formula_1 1.2 Free Electron[edit | edit source]. An electron is said to be free if it can move along the x-axis in any direction without any force acting on it (i.e., 𝒱 𝑥 = 0, 𝑥 = −∞, ∞ ). It is not bound by an external force, or equivalently not in a region where its potential energy varies. In quantum mechanics, it indicates that the particle is in a region of uniform potential, which is often set to zero in the area of interest because any point in space can have an arbitrary potential set to zero. The wave function of a free electron is typically represented as a plane wave, which is a solution to the Schrödinger equation. The Schrödinger equation is a fundamental equation in quantum mechanics that describes how the quantum state of a physical system changes with time. The wave function of a free electron can be written as: formula_2 where: -  is the wave function, which depends on position x and time t, -  is the amplitude of the wave, - k is the wave number, which is related to the momentum of the electron, -  is the angular frequency, which is related to the energy of the electron, -  is the imaginary unit. Example. 2.1 Derive the wave function of a free electron[edit | edit source]. Time-independent Schrödinger wave equation is given by; formula_3 formula_4 Next define the Hamiltonian, formula_5 Substitute the potential energy operator formula_6 (free electron) and the kinetic energy operator formula_7 formula_8 formula_9 To obtain the Schrödinger equation for a free particle, rearrange the differential equation; isolate 2nd derivative on LHS formula_10 and make the substitution formula_11 Since  is the kinetic energy, formula_12 "p" and the wave vector "k" are related, "p =" formula_13"k" we also could recognize that formula_14 is just formula_15as shown in this equation formula_16 formula_17 formula_18 after rearranging and substitution of result from equation, the result is formula_19 formula_20 This linear second-order differential equation can be solved by separating into two factors, and each is set equal to 0.formula_21formula_22formula_23 formula_24 formula_25formula_22formula_23formula_20Equation is true if either formula_24formula_22formula_23formula_20 formula_25formula_22formula_23formula_20 By concurrently rearranging and denoting the two equations and their solutions with a + and a - sign, the result is formula_37 formula_23 formula_39 formula_40 formula_41 which translates to formula_42 formula_43 formula_23 formula_39 formula_46 formula_47formula_48 and finally formula_43formula_23 formula_51formula_52formula_53formula_54 Any function that satisfies the requirements of wave functions and is a solution to this differential equation is a valid wave function for this system.

Quantum Chemistry/Example 34. Calculate the wavenumber corresponding to the transition of a hydrogen atom from the n=2 ℓ =1 mℓ =-1 state to the n=2 ℓ =1 mℓ =1 state in a 1 T magnetic field. Answer. First, the equation for energy of a hydrogen atom under a magnetic field is needed. The energy of a hydrogen atom under a magnetic field can be expressed as follows: formula_1 Where E is the energy in joules, me is the mass of the electron in kg, e is the charge of electron in Coulomb “C”, ε0 is vacuum permittivity in F/m, h is Planck’s constant in J·s, and n is the principal quantum number. In the other half of the equation, which considers the magnetic quantum number, Bz is the magnetic field in Tesla “T”, ml is the magnetic quantum number, and βB is Bohr magneton in J/T, and it is calculated using the following equation: formula_2 Therefore, using the equation mentioned for the energy of a hydrogen atom, the energy of the transition, which is the difference in energy “∆E”, can be described as follows: formula_3 If we go back to the question we can notice that there is no change in the quantum number “n” as “n=2” in both states. Also, if we look at the first term of the energy equation, we can see that it all consists of constants except the quantum number “n”. Thus, since “n” is the same for both states, both terms can get cancelled. Therefore, the equation becomes: formula_4 Thus, after substituting: formula_5 Then, we can convert the energy to wavenumber: formula_6 This value is reasonable as the difference between energies/wavenumbers of transitions is usually small. The instrument that was used for the transition in the question is electron paramagnetic resonance (EPR) spectroscopy, which is a famous type of spectroscopy that measure the absorption of the EM radiation, but it does it using magnetic filed, and it does apply that magnetic field on the unpaired electrons. EPR spectroscopy specifically measures the absorption of microwave radiation, which is approximately in the the range of ~0.1-10.0cm-1. Thus, the answer does make sense.

Quantum Chemistry/Example 35. Determine the effective nuclear charge for H- in the 1s2 state

AI Art Generation Handbook/ControlNet/Canny. Canny in this context meant algorithm which is kind of popular edge detection used in computer vision. To use Canny mode , you need to ensure you have downloaded Canny models from here codice_1 and search for the following Canny pre-trained ControlNet models . Workflow: First of all, we need to have a base image to work with. Such as picture of this geisha playing shamisen. Then , you can think of a similar picture such as a rockstar playing guitar. We shall use prompt : "Photo of a rockstar playing heavy metal music with electric guitar,  kneeling on the stage" Each of the effect are displayed below Note: All of the settings are the same as per default unless mentioned otherwise . Control Weight. Control Weight controls the amount of influence that the reference image has on the generated image. A higher Control Weight will result in a more similar image, while a lower Control Weight will result in a more original image. Preprocessing Resolution. Pre-Processing Resolution setting in Stable Diffusion ControlNet controls the resolution of the image that is used to train the model. A higher Pre-Processing Resolution will make the model more accurate, but it will also require more computation. Note: If you are using a reference image with a lot of detail, you may need to use a higher Pre-Processing Resolution to capture all of the detail in the generated image. If you are limited by computation, you should use a lower Pre-Processing Resolution.

Terve, Jonathan!/Kapitul 4. Kapitules – Kapitul 3 – Kapitul 4 – Kapitul 5 Kapitul kvar (kapitul 4). Kud e Jonathan? Siste el in Vien? Ne, el siste in otri vil. El siste in Bistrica. Kvod e Bistrica? Il e vil in Romenia. Ted starte di viat in Romenia. Jonathan skribe in sui dagbuk: "Di primi de maj me esed in Munik. Di drugi de maj me esed in Vien. Tun me esed in Budapešt. Budapešt esed beli. Ma me ne haved tajm in Budapešt. Me vided di strada in Budapešt. In Budapešt me denked: tud ende di west, i tud starte di ost. Budapešt e diferensli." El denke en fjuka mer o Budapešt. El denke: "Me e person ki vente od England, od London. Me parle engli, bo di persones in England parle engli. Ma in Budapešt me ne parled kon di persones in engli; me parled in germani. Mei germani nie beni, ma di persones in Budapešt ne parle engli. Nos parled in germani. Il e interesenti ke di persones in Budapešt parle germani." Ted Jonathan denke o sui viat. El denke: "Me esed in di muzeo in London. In di muzeo esed bukes o cetri land. Me lekted di bukes. In di muzeo esed pismos o cetri land. Me vided di pismos. Di bukes i di pismos dikted ke di cetri land e ferni, ma interesenti. In di cetri land e multi persones, multi diferensli persones." Ted Jonathan cetrodenke o sui viat. El denke: "Jer me esed in Kluž. Me eded in Kluž. Di nim del nutritment esed "paprika hendl". Il e muj beni, di nutritment in Kluž. Di hotel esed beni, ma me ne dormed benim. Ma di land e muj beli! In di tren me vided multi vilietes i multi slotes. Vil e mer grandi kuj hotel, i mer beli kuj hotel! Vilietes e minder grandi kuj viles, ma zi e beli, i hoteles e minder grandi kuj slotes." Jonathan cetroskribe in sui dagbuk: "Bistrica e interesenti plas. Bistrica e oldi plas, mer oldi kuj otri plases. Ka mei hotel in Bistrica e oldi, mer oldi kuj otri hoteles. In di hotel me dikted mei nim: "Me e Jonathan Harker" i zi dikted me: "Benventen in di hotel." In di hotel me vided pismo pro me. Ted me ve lekte mei pismo." Jonathan lekte sui pismo. Il dikte: "Mei frend. – Benventen. Dorme benim. Me e in Bukovina, prosim vente do Bukovina. Esed di viat od London beni? Mei land e muj beli. Benventen in mei land. Vui frend, DRACULA." Jonathan lekte sui pismo i denke o sui frend Graf Dracula. Ki e el? El ne vise. Ma sui frend e interesenti. Jonathan e felisi, i denke o sui frend. Tun el dorme.

Kittypet's Guide To Warrior Cats/Characters/SkyClan. Skystar: Skystar was the first leader of SkyClan. Micah: Micah was SkyClan's first medicine cat. Cloudstar: Cloudstar was the leader of SkyClan when they got driven out of the forest. Spiderstar: Spiderstar was the last leader of ancient SkyClan. Leafstar: Leafstar is the first leader of modern SkyClan. Echosong: Echosong is the first medice cat of modern SkyClan.

Indonesian Education System. Introduction. Every nation strives to achieve the position of having an excellent educational system. The country will create a large number of clever people to aid in its progress if it invests in its educational system. Here is the education in Indonesia, a nation that is engaged in the aforementioned dispute. The Indonesian Education System is a diverse and complex framework that provides education and training from early childhood to higher education. It plays a crucial role in the development and growth of Indonesia, which is the largest archipelago in the world with a diverse cultural landscape. Key Components: "Curriculum": The curriculum in Indonesian schools is primarily based on the national curriculum, but regional variations exist. Students are taught a range of subjects, including Bahasa Indonesia (the national language), mathematics, sciences, and social studies. "Challenges": The Indonesian education system faces challenges such as overcrowded classrooms, disparities in access to education between urban and rural areas, and the need for improvements in teacher quality and educational infrastructure. "Language of Instruction": The language of instruction in most Indonesian schools is Bahasa Indonesia, but regional languages and English are also taught. Government Initiatives: The Indonesian government has implemented various initiatives to improve education quality and access, including curriculum reforms and efforts to increase teacher professionalism. Cultural and Regional Diversity: The vast cultural and regional diversity in Indonesia plays a significant role in shaping the education system, with some regions having unique educational practices and challenges. Overall, the Indonesian Education System is a dynamic and evolving framework that reflects the nation's commitment to providing education and training opportunities to its diverse population while addressing the challenges of access and quality. Education System in Indonesia. As per the guidelines of the Indonesian educational system, a minimum of 12 years is considered the optimal duration for students to receive education. The responsibility for the administration of education in Indonesia is divided between two government entities: the Ministry of Education, Culture, Research, and Technology, and the Ministry of Religious Affairs. All Indonesian citizens are obligated to complete twelve years of mandatory education, comprising six years of primary school and three years of middle school. Additionally, the Ministry of Religious Affairs oversees schools affiliated with Islamic, Christian, and Buddhist faiths. Education in Indonesia While some institutions do admit students as young as six, the standard age for enrolling in elementary school is seven. Before this, it's a voluntary option for children to attend preschool or kindergarten for several years to prepare for formal education. After finishing primary school, students continue their education in junior high school, where they encounter additional subjects to broaden their knowledge base. This phase in Indonesia also introduces students to extracurricular activities and organizational involvement, fostering skill development and personal interests. Educational institutions in Indonesia are categorized as either public or private. Some private schools identify as "national plus schools," signifying that their curricula exceed the Ministry of Education's requirements. This often includes English as the primary language of instruction or the adoption of an international curriculum in place of the national one. Indonesia boasts a substantial educational infrastructure, comprising over 26,000 high schools, 40,000 junior-secondary schools, and 170,000 elementary schools. Approximately 84% of these institutions fall under the purview of the Ministry of Education and Culture, with the remaining 16% being overseen by the Ministry of Religious Affairs. History. Era of Islamic Monarchies. The convergence of Islamic and Hindu-Buddhist influences marks Indonesia's transition towards an Islamic monarchy. During this period, a novel form of Islamic educational institution, known as "pondok pesantren," emerged and saw the establishment of numerous such institutions. Much like Karsyan, these pesantrens were typically situated away from the bustling urban centers. Dutch Colonial Period. In the period of Dutch colonization, basic education was introduced to Indonesia by the Dutch. The social and economic status of the colony's residents played a decisive role in shaping the different segments of the Dutch educational system, with the most prestigious institutions reserved for the European population. Japanese Colonial Rule. During the period of Japanese colonial rule in World War II, the operations of the Dutch educational system were consolidated into a single entity that ran in parallel with the Japanese educational system. As part of an effort to establish the Greater East Asia Co-Prosperity Sphere of Influence, the Japanese occupation had a detrimental impact on Indonesian education. Schools were refocused on teaching anti-Western military and physical exercises, along with Japanese history and culture. Students were required to salute the Emperor and raise the Japanese flag each morning. While the Japanese regime aimed to reduce educational disparities, by 1945, enrollment had plummeted by 90% in secondary education and by 30% in primary education. Early education. Early Childhood Education in Indonesia, known as PAUD (Pendidikan Anak Usia Dini), oversees the preschool phase, which encompasses "Taman Bermain" (playgroup) and "Taman Kanak-Kanak" (kindergarten, often abbreviated as TK). The direct oversight and responsibility for PAUD are vested in the Directorate of Early Age Education Development (Direktorat Pengembangan Pendidikan Anak Usia Dini). Parents typically introduce their children to the educational journey at age 2 by enrolling them in "Taman Bermain." Subsequently, at the age of 4, children proceed to "Taman Kanak-Kanak." These are informally referred to as "kelas nol kecil" (small zero grade) and "kelas nol besar" (large zero grade), respectively. Most TKs divide their classrooms into two groups labeled A and B. While not compulsory, the primary objective of this level of education is to prepare children for their formal elementary school education. It's worth noting that a significant 99.35% of Indonesia's 49,000 kindergartens are privately operated. During their time in kindergarten, students typically spend one year each in "Class A" and "Class B" before progressing to higher levels. Public primary and secondary education. In Indonesia, a compulsory education period of 12 years is established. Students are obliged to be present at school from 07:30 a.m. (sometimes as early as 06:25 a.m. in certain schools) to 15:30 p.m., for five days per week (although some schools still observe six school days per week). Students have the option of attending either state-operated, non-denominational public schools overseen by the Ministry of National Education (Kemdiknas) or private or semi-private religious institutions, often Islamic, which are supervised and funded by the Ministry of Religious Affairs. Schools also provide extracurricular activities encompassing sports, the arts, and religious studies, allowing students to select their preferred activities. Notably, even though only 15% of the school-age population in Indonesia attends religious schools, a significant 86.1% of the country's population is registered as Muslim. Islamic Schools. In Indonesia, there exist primarily three distinct categories of Islamic educational institutions: pesantren, madrasah, and sekolah islam. Pesantrens vary widely in size, ranging from relatively large establishments with numerous teachers and hundreds of students to much smaller ones with just a few instructors and learners. Pesantrens are typically governed by hereditary kiais, who oversee the school's operations and wield religious authority. Madrasahs differ in their ideological foundations and the extent to which they integrate secular and religious subjects into their curriculum. Sekolah Islam, on the other hand, incorporates its own Islamic curriculum alongside the secular curriculum administered by the Ministry of Education and Culture. Conclusion / Aspects to be implemented in Uzbekistan's education system. There are aspects within the Indonesian education system that students and the broader community can take pride in: https://flip.id/en/blog/education-in-indonesia Reference List / Sources for further readings. "Education in Indonesia: Is It Good or Does It Need to be Improved?" (09/15/2023). Flip.id. https://flip.id/en/blog/education-in-indonesia

Sylheti. <templatestyles src="Sylheti/minerva.css" />

Sylheti/Introduction. Sylheti Language is an Indo-Aryan language, part of the Eastern Indo-Aryan languages group. Sylheti is primarily spoken by the Sylheti people of Bangladesh, India, and the United Kingdom. According to the Joshua Project, 30 different People Groups speak Sylheti as their Primary Language and estimated a total of 13,980,000 global speakers. This Wikibook is an introductory book on the Sylheti language and its speakers.

Sylheti/Contributor's Guide. This page aims to help potential contributors better understand the principles behind the current work and give ideas for how best to add new material.

Sylheti/Study methods. Like any language, mastering Sylheti requires self-discipline. Establish a dedicated study schedule with allocated time, set realistic goals. While immersion in a native-speaking environment and having a personal tutor are ideal, self-study can be highly rewarding on its own.

Sylheti/Practical Lessons. Lesson Plan. Sylheti Syllabus. Lesson Structure. Each lesson "should" have the following sections specified:

Sylheti/Alphabet. The Sylheti Alphabet has 5 vowels, 5 Vowel diacritics, 28 consonants.

Sylheti/Festival. Sylheti festivals are an integral part of the rich cultural heritage of the East Asia and the Sylheti diaspora around the world. This Wikibook page aims to explore and document the various festivals celebrated in the Sylheti culture, their significance, traditions, and how they are observed. Further Reading. This is a Wikibook page about Sylheti festivals, and remember that Wikibooks encourages collaborative editing, so others can contribute and expand upon the content.

Sylheti/Dress. Religious Attire in Sylhet. Hindu Attire. Sylheti-Hindus, belong to the Vaishnava order of Hinduism. Vaishnavism is one of the major traditions within Hinduism, and it centers on the worship of Lord Vishnu, one of the principal deities in the Hindu pantheon. Followers of Vaishnavism, known as Vaishnavas, believe in the supreme importance of devotion (bhakti) towards Lord Vishnu as a means to attain spiritual liberation and salvation.Vaishnavas emphasize various forms of worship, including prayer, meditation, chanting of sacred mantras, and engaging in acts of selfless service (seva). They also embrace the belief in reincarnation and karma, which influence one's future births based on their actions in this life. Key texts like the Bhagavad Gita and the Bhagavata Purana provide essential philosophical and spiritual teachings that guide Vaishnavas in their quest for spiritual enlightenment.Sylheti-Hindus, as followers of Vaishnavism, adhere to these principles while also incorporating their unique cultural and regional traditions into their religious practices. This syncretic blend of spirituality and heritage reflects the rich diversity within Hinduism and the resilience of religious traditions over time.

Sylheti/Verbs. This list contains a list of common verbs in Sylheti with their English meanings. "Tip:- If you want to search for a particular word, use the Find feature in your browser ( + , or in Internet Explorer)."

Sylheti/Nouns. This list contains a list of common nouns in Sylheti with their English meanings. "Tip:- If you want to search for a particular word, use the Find feature in your browser ( + , or in Internet Explorer)."

Sylheti/Pronouns. This list contains a list of common pronouns in Sylheti with their English meanings. "Tip:- If you want to search for a particular word, use the Find feature in your browser ( + , or in Internet Explorer)."

Sylheti/Adjectives. This list contains a list of common adjectives in Sylheti with their English meanings. "Tip:- If you want to search for a particular word, use the Find feature in your browser ( + , or in Internet Explorer)."

Sylheti/Cases. This list contains a list of cases in Sylheti with their English meanings. "Tip:- If you want to search for a particular word, use the Find feature in your browser ( + , or in Internet Explorer)."

Sylheti/Vocabulary/Numbers. Whether you're a linguistics enthusiast, a cultural explorer, or someone curious about the world's diverse numerical systems, our Wikibook is your gateway to understanding the multifaceted nature of Sylheti numbers. Join us on this enlightening journey as we unravel the secrets behind these numbers that bridge the gap between mathematics and culture. Course outlines. Our Wikibook offers an in-depth exploration of Sylheti numbers, delving into their origins, historical importance, and how they interweave with the rich tapestry of Sylheti culture. You'll discover: Cultural Significance. This list contains a list of common words associated with different Numbers in Sylheti and their English meanings. "Tip:- If you want to search for a particular word, use the Find feature in your browser ( + , or in Internet Explorer)." Practical Use. United Kingdom. Sylheti speakers in London are a diverse group that includes both native Sylheti speakers, who originally come from the Sylhet region and speak Sylheti as their mother tongue, and British individuals of various backgrounds who have learned to speak Sylheti, often due to family connections or cultural ties. This linguistic diversity reflects the multicultural nature of London, where people from different linguistic backgrounds come together to form a vibrant community. Here are some examples in the context of London.

A Guide to Sylheti Wikinews. Table of Contents. Administrative: Chapters:

A Guide to Sylheti Wikinews/Getting Started. Welcome to Sylheti Wikinews! This section will guide you through the initial steps to get started with contributing to Sylheti Wikinews. Whether you're a seasoned journalist or just passionate about sharing news in the Sylheti language, we're thrilled to have you as part of our community.

A Guide to Sylheti Wikinews/Creating an Account. To begin contributing to Sylheti Wikinews, you'll need to create a Wikimedia Incubator account if you don't already have one. Here's how: 1. Visit Wikimedia Incubator: Go to the Wikimedia Incubator website (https://incubator.wikimedia.org/wiki/Special:CreateAccount) using your web browser. 2. Click on "Create Account": Look for the "Create account" link at the top right corner of the page and click on it. 3. Fill in Details: You'll be prompted to fill in a username, password, and an email address. Make sure your username adheres to Wikimedia's username policy. 4. Verify Captcha: Complete any captcha or security check if prompted. 5. Submit: Click the "Create your account" button to finalize your registration. 6. Verify Email (Optional): While not mandatory, verifying your email address can help with account recovery and notifications.

A Guide to Sylheti Wikinews/Navigating the Sylheti Wikinews. Once you have your Wikimedia Incubator account, it's essential to become familiar with the Sylheti Wikinews project's layout and navigation: 1. Main Page: The main page is where you'll find featured news articles, community announcements, and links to various sections. 2. Navigation Menu: The navigation menu on the left-hand side provides quick access to important sections like "Recent Changes" (for tracking edits), "Current Events," and "Community Portal." 3. Search Bar: Use the search bar at the top of the page to find specific articles or topics you're interested in. 4. Tabs: Explore the tabs at the top of the page, including "Newsroom," "Recent Changes," and "Random Article" to discover content and contributors. 5. Prefixes: Wikinews (Wn) and Language code (syl) is used as prefixes to distinguish it from other language editions. Example: Wn/syl/page name.

A Guide to Sylheti Wikinews/Language Preferences and Settings. You can set your language preferences to best suit your needs: 1. Language Preferences: You can change your language preferences in your user settings. Select "Preferences" from the top-right corner and navigate to the "Appearance" tab. Here, you can choose Sylheti (ꠍꠤꠟꠐꠤ) as your language interface. 2. Sylheti Language: If you plan to write or edit articles in Sylheti, ensure that you have the Sylheti script installed on your device. This will enable you to contribute effectively in Sylheti. Now that you've created an account and understand how to navigate the Sylheti Wikinews, you're ready to dive into writing news articles and contributing to our vibrant community. Before you begin, it's a good idea to familiarize yourself with the writing style and guidelines specific to Sylheti Wikinews, which we'll cover in the next section. Happy editing, and thank you for being part of the journey!

A Guide to Sylheti Wikinews/Contributing to this book. Communicate. Collaborate with other contributors by discussing changes on article talk pages and respecting consensus. Respect Copyright. When adding multimedia content, ensure that you have the necessary permissions and adhere to copyright policies.

Saluto, Jonathan!/Chapitre 7. Setesmi chapitre (7.esmi chapitre). Li dilijense vada, e vada; lum kontinua vada. Jonathan vida multi koses exter li dilijense. Lo es in li dilijense, e li koses non es in li dilijense; lo vida les exter li dilijense. Lo vida kroses, multi kroses. Jonathan questione li dilijensero: "Ob me pove desense fro li dilijense?" Li dilijensero: "No. Dar es multi hundes. Vu non pove." Jonathan: "Quum? Ob dar es multi hundes?" Li dilijensero: "Yes. E anke exter li dilijense, vu sal vida multi hundes." Li dilijensero rida. Jonathan pense: "Pro quum lo rida?" Nun es nokte; dar non es sune. Li dilijense vada plu e plu rapidim. Li persones in li dilijense dikte al dilijensero: "Vada plu rapidim!" Jonathan pense: "Pro quum vada tam rapidim?" Jonathan vida tre grandi montes exter li dilijense. Jonathan vida ke li persones in li dilijense es tre exitati; les parla multim. Li persones in li dilijense dikte exitatim: "Vada plu rapidim!" Nun li dilijense halta. Les es in pasaje inter li montes. Jonathan sava, ke hir lo sal vida li dilijense por vada a lon amiko Komto Dracula ma…vor es lo? Devan Jonathan es li vie, e solim li vie. Li persones in li dilijense es felisi. Ma Jonathan non es felisi. "Pro quum veni hir vor dar non es li dilijense por vada a men amiko Dracula?" Li dilijensero parla a person in li dilijense: "Nus ha es rapidi. Nus ha veni hir kun un hore antisipantim." Li dilijensero parlad kun mikri voise, ma Jonathan audid lo. Jonathan pensa: "Pro quum es bon tu ha veni hir kun un hore antisipantim?" Nun li dilijensero parla a Jonathan kun grandi voise. Lo dikte: "Jonathan, li Herr (germanum: li Sinioro) non sal veni hir disdi. Lo sal vada a altri urbe, li urbe Bukovina. Forsan morge li Herr sal veni hir. Forsan yes, forsan no. Mi non sava. Nus deve departa." Jonathan es tristi e pensa: "Pro quum li Sinioro Dracula non es hir? Pro quum me deve departa?" Ma, quum es tum? Li kavales es exitati. Anke li persones in li dilijense es exitati. Jonathan vida, e dar lo vida un altri dilijense, plu grandi, kun quar kavales. Li novi dilijense es plu richi, e plu grandi kam li dilijense in kel Jonathan sida se. Li quar kavales es nigri, e tre grandi. In li novi dilijense Jonathan vida altri dilijensero. Li altri dilijensero es grandi, e alti, e have barbe. Li barbe e li forti manus del dilijensero fa Jonathan tu pensa ke lo es tre forti viro. Ma Jonathan non pove vida li fasie del altri dilijensero. Li altri dilijensero dikte: "Vu ha veni hir rapidim, men amiko." Li dilijensero: "Ah…li angli Herr volit vada rapidim…" Li altri dilijensero: "Me sava, ke vu volit vada a Bukovina. Yes, me sava quum vu pensa. Me es plu inteligenti kam vu. Dona a me li angli sinioron bagaje." Li dilijensero dona Jonathanen bagaje al altri dilijensero. Li altri dilijensero es tre forti; Jonathan vida ke lo es forti kand lo vida losen manus. Li altri dilijensero prenda li bagaje per losen forti manus, e tre rapidim li kose es finat. Nun Jonathan sida se in li altri dilijense. Disdi ha es longi die por Jonathan. Ma nun komensa li altri voyaje.

Supplementary mathematics/Real analysis. Real analysis or real-scientific analysis is a branch of mathematics analysis that studies and analyzes the behavior of real numbers, real sequences and series of real numbers and real functions. Convergences, limits, continuity, smoothness, differentiability and integration are the characteristics of real-valued sequences and functions that are checked by real analysis. One of the applications of mathematical analysis is in integral and differential calculus and topology, of course. Its applications are analyzed and acted on based on real ideas. In a wide range of these applications and research, real-time analysis has become a vital tool for research and analysis for these ideas.

Sylheti/Vocabulary/Family and people. Introduction. - Briefly introduce the Sylheti language and its significance. - Explain the importance of learning vocabulary related to family and people. Basic Family Terms. Vocabulary. - Provide a list of common family terms in Sylheti, such as "family," "mother," "father," "sibling," etc. - Include pronunciation guides if possible. Usage. - Explain the context and usage of these terms within the Sylheti culture. Family Members. Vocabulary. - Describe the relationships between family members and the corresponding Sylheti terms. - Include extended family members like grandparents, aunts, uncles, and cousins. Cultural Insights. - Provide insights into the cultural significance of different family roles in Sylheti society. Personal Pronouns. - Present Sylheti personal pronouns for different family members and in various contexts (e.g., formal and informal). Greetings and Politeness. - Teach common Sylheti greetings and expressions used when interacting with family members and others. - Include polite phrases and honorifics, if applicable. Common Phrases and Conversations. - Provide examples of common Sylheti phrases and dialogues related to family life and interactions. Names and Nicknames. - Explain how names and nicknames work in Sylheti culture. - List common names and their meanings. Special Occasions and Celebrations. - Discuss Sylheti traditions related to family events, such as weddings, birthdays, and festivals. - Include relevant vocabulary and phrases used during these occasions. Cultural Insights. - Offer insights into the cultural significance of family and people-related vocabulary in Sylheti society. Resources. - Provide links to further resources for learning Sylheti, including books, online courses, and language communities. References. - List any sources or references used to compile the vocabulary and cultural information.

Sylheti/Vocabulary/Weather and seasons. Introduction. - Introduce the importance of weather and seasons in daily life. - Explain how understanding Sylheti vocabulary for weather can be useful. Common Weather Terms. Vocabulary. - Provide a list of common Sylheti weather-related terms, such as "weather," "rain," "sun," "clouds," etc. - Include pronunciation guides if possible. Usage. - Explain how these terms are used in everyday conversations and weather reports. Seasons and Climate. Vocabulary. - Present Sylheti words for different seasons, like "summer," "winter," "monsoon," etc. - Describe the climate in Sylhet and its impact on daily life. Cultural Insights. - Discuss the cultural significance of different seasons in Sylheti society. Temperature and Conditions. Vocabulary. - Provide Sylheti vocabulary related to temperature, such as "hot," "cold," "humid," etc. - Explain how to describe weather conditions in Sylheti. Examples. - Offer phrases and sentences to describe various weather conditions. Natural Disasters. Vocabulary. - List Sylheti words related to natural disasters, including "flood," "storm," "earthquake," etc. - Include safety-related phrases for emergencies. Preparedness. - Discuss the importance of being prepared for natural disasters in Sylhet. Seasonal Activities and Festivals. Vocabulary. - Present Sylheti words and phrases associated with seasonal activities and festivals. - Include cultural insights and traditions related to these events. Weather Forecasting. - Explain how weather forecasting is done in Sylhet. - Include Sylheti terms for weather forecast elements like "temperature," "precipitation," "wind," etc. Resources. - Provide links to further resources for learning Sylheti, especially related to weather and seasons. - Include sources for weather forecasts in Sylhet. References. - List any sources or references used to compile the weather and season-related vocabulary and cultural information.

Sylheti/Vocabulary/Health. Introduction. - Introduce the importance of health-related vocabulary in Sylheti. - Explain how understanding health terms can be beneficial in healthcare and daily life. Basic Health Terms. Vocabulary. - Provide a list of fundamental Sylheti health-related terms, such as "health," "doctor," "patient," "hospital," etc. - Include pronunciation guides if possible. Usage. - Explain how these terms are used in conversations related to health and medical situations. Body Parts and Organs. Vocabulary. - Present Sylheti words for various body parts and organs, such as "heart," "brain," "stomach," "arm," etc. - Include anatomical terms and their pronunciations. Medical Conditions. - Describe common medical conditions and illnesses in Sylheti. - Include symptoms and treatment-related vocabulary. Healthcare Professionals. Vocabulary. - List Sylheti words for healthcare professionals, including "nurse," "pharmacist," "dentist," etc. - Explain their roles in the healthcare system. Appointments and Visits. - Teach phrases and terms used when making medical appointments and visiting healthcare providers. Medications and Prescriptions. Vocabulary. - Provide Sylheti words for common medications, prescriptions, and dosage instructions. - Include warnings and safety information. Pharmacies and Drugstores. - Describe how pharmacies and drugstores work in Sylhet, including vocabulary related to buying medications. Healthy Living and Lifestyle. Vocabulary. - Present Sylheti terms related to healthy living, such as "exercise," "diet," "nutrition," "mental health," etc. - Include advice and tips for maintaining a healthy lifestyle. Cultural Insights. - Discuss cultural perspectives on health and wellness in Sylheti society. Emergency Situations. Vocabulary. - List Sylheti words and phrases relevant to emergency situations, including "emergency," "ambulance," "first aid," etc. - Include instructions for seeking help during emergencies. Resources. - Provide links to further resources for learning Sylheti, especially related to health and healthcare. - Include sources for finding healthcare facilities in Sylhet. References. - List any sources or references used to compile the health-related vocabulary and cultural information.

Sylheti/Vocabulary/Food and Drink. Introduction. - Introduce the importance of food-related vocabulary in Sylheti culture. - Explain how understanding food and drink terms can enhance cultural understanding and culinary experiences. Common Food Items. Vocabulary. - Provide a list of common Sylheti food items, such as "rice," "vegetables," "meat," "fish," etc. - Include pronunciation guides if possible. Usage. - Explain how these terms are used in everyday conversations and cooking. Cooking and Preparation. Vocabulary. - Present Sylheti words and phrases related to cooking techniques and food preparation, such as "fry," "boil," "grill," "chop," etc. - Include kitchen utensil names. Recipes and Dishes. - Share Sylheti recipes or describe popular Sylheti dishes. - Include the names of traditional dishes and their ingredients. Beverages. Vocabulary. - List Sylheti words for beverages, including "tea," "coffee," "juice," "water," etc. - Describe how these beverages are prepared and consumed in Sylhet. Cultural Insights. - Discuss the cultural significance of beverages in Sylheti society. Dining and Etiquette. Vocabulary. - Teach Sylheti dining-related terms, such as "plate," "utensils," "table," "meal," etc. - Explain dining etiquette in Sylheti culture. Restaurant Phrases. - Provide phrases for ordering food and drinks at restaurants in Sylhet. Special Occasions and Festivals. Vocabulary. - Present Sylheti words and phrases associated with special occasions and festivals. - Describe traditional dishes prepared during these events. Street Food and Markets. Vocabulary. - List Sylheti words related to street food, marketplaces, and vendors. - Explain the street food culture in Sylhet. Bargaining and Shopping. - Teach phrases for bargaining and shopping in food markets. Allergies and Dietary Restrictions. Vocabulary. - Provide Sylheti words related to food allergies, dietary restrictions, and common dietary terms like "vegetarian," "vegan," etc. Resources. - Provide links to further resources for learning Sylheti, especially related to cooking and food culture. - Include sources for Sylheti recipes and culinary traditions. References. - List any sources or references used to compile the food and drink-related vocabulary and cultural information.

Sylheti/Vocabulary/Countries of the World. Introduction. - Introduce the importance of learning country names in Sylheti. - Explain how understanding country names can be useful for cultural awareness and global communication. Continent Names. Vocabulary. - Provide a list of continent names in Sylheti, such as "Asia," "Africa," "Europe," etc. - Include pronunciation guides if possible. Country Names. Vocabulary. - Present Sylheti names for countries around the world. - Group countries by continent for easier learning. - Include pronunciation guides for country names. - Organize the list alphabetically or by continent. Capitals and Flags. Vocabulary. - List the capitals of major countries in Sylheti. - Include descriptions of national flags, if applicable. Travel and Geography Phrases. Vocabulary. - Teach Sylheti phrases related to travel and geography, such as "I am from," "I want to visit," "I traveled to," etc. - Include essential travel-related terms like "airport," "hotel," "map," etc. Cultural Insights. - Share brief cultural insights or interesting facts about each country listed. - Explain any unique cultural connections or experiences related to these countries. Resources. - Provide links to additional resources for learning Sylheti, including language courses and cultural resources related to different countries. - Include sources for maps and further geographical information. References. - List any sources or references used to compile the country-related vocabulary and cultural information.

Sylheti/Vocabulary/Direction. = Sylheti Vocabulary: Direction = Introduction. - Introduce the importance of learning direction-related vocabulary in Sylheti. - Explain how understanding directions can be useful for navigation and communication. Basic Directional Terms. Vocabulary. - Provide a list of common Sylheti directional terms, such as "north," "south," "east," "west," etc. - Include pronunciation guides if possible. Cardinal Directions. Vocabulary. - Present Sylheti words for the cardinal directions, including "north," "south," "east," and "west." - Explain how these directions are used in navigation. Examples. - Offer phrases and sentences using cardinal directions in Sylheti. Relative Directions. Vocabulary. - Teach Sylheti words for relative directions like "left," "right," "up," and "down." - Include terms for indicating proximity or distance. Usage. - Explain how relative directions are commonly used in Sylheti. Landmarks and Locations. Vocabulary. - List Sylheti words for common landmarks and locations, such as "street," "corner," "park," "building," etc. - Describe how these terms are used to describe specific places. Directions to Places. - Provide phrases for asking for and giving directions to locations in Sylheti. Transportation and Travel Phrases. Vocabulary. - Present Sylheti vocabulary related to transportation and travel, including "bus stop," "train station," "airport," etc. - Include terms for asking about transportation options and routes. Examples. - Offer travel-related phrases and sentences in Sylheti. Maps and Navigation. - Explain how navigation and maps work in Sylheti. - Describe common tools or technologies used for navigation. - Provide guidance on using maps and compass directions in Sylheti. Resources. - Provide links to further resources for learning Sylheti, especially related to navigation and geography. - Include sources for maps and navigation tools in Sylhet. References. - List any sources or references used to compile the direction-related vocabulary and cultural information.

Sylheti/Vocabulary/Clothes and accessories. Introduction. - Introduce the importance of learning clothing-related vocabulary in Sylheti. - Explain how understanding clothing terms can be useful for daily life and cultural awareness. Common Clothing Items. Vocabulary. - Provide a list of common Sylheti clothing items, such as "shirt," "pants," "dress," "shoes," etc. - Include pronunciation guides if possible. Usage. - Explain how these terms are used in everyday conversations and fashion discussions. Types of Clothing. Vocabulary. - Present Sylheti words for specific types of clothing, like "jacket," "hat," "scarf," "gloves," etc. - Include gender-specific clothing terms, if applicable. Descriptions. - Describe the characteristics and purposes of different types of clothing. - Explain traditional Sylheti clothing styles, if relevant. Accessories and Jewelry. Vocabulary. - List Sylheti words for accessories and jewelry, including "necklace," "bracelet," "earrings," "watch," etc. - Explain the cultural significance of certain accessories. Materials and Styles. - Describe the materials used in making accessories and different styles popular in Sylheti culture. Colors and Patterns. Vocabulary. - Teach Sylheti words for colors and patterns, such as "red," "stripes," "floral," "polka dots," etc. - Explain how colors and patterns are described and used in clothing. Fashion Preferences. - Discuss fashion preferences and trends in Sylheti fashion. Dressing and Getting Dressed. Vocabulary. - Provide Sylheti words and phrases related to getting dressed, such as "put on," "take off," "change clothes," etc. - Include phrases for describing one's outfit. Cultural Insights. - Share insights into the cultural significance of dressing in Sylheti society. Shopping for Clothes. Vocabulary. - Teach Sylheti shopping-related terms, including "store," "size," "fitting room," "price," etc. - Include phrases for asking about clothing availability and making purchases. Bargaining and Shopping Etiquette. - Discuss the cultural aspects of shopping and bargaining in Sylheti culture. Resources. - Provide links to further resources for learning Sylheti, especially related to fashion and clothing. - Include sources for fashion magazines or websites in Sylhet. References. - List any sources or references used to compile the clothing and accessory-related vocabulary and cultural information.

Sylheti/Vocabulary/Academic Subjects. Introduction. - Introduce the importance of learning academic subject-related vocabulary in Sylheti. - Explain how understanding academic terms can be useful for education and communication. Common Academic Subjects. Vocabulary. - Provide a list of common Sylheti academic subjects, such as "mathematics," "science," "history," "literature," etc. - Include pronunciation guides if possible. Usage. - Explain how these terms are used in educational contexts and discussions about academic interests. School Levels and Types. Vocabulary. - Present Sylheti words for different levels of education, such as "primary school," "high school," "college," etc. - Describe the education system in Sylhet. Educational Institutions. - List Sylheti terms for various types of educational institutions like "university," "school," "library," etc. Classroom Terminology. Vocabulary. - Teach Sylheti classroom-related terms, including "teacher," "student," "desk," "blackboard," "book," etc. - Include phrases used during lessons and lectures. Homework and Exams. - Provide vocabulary related to homework, assignments, and examinations. - Include terms for grading and evaluation. Academic Skills and Tools. Vocabulary. - List Sylheti words for academic skills and tools, such as "writing," "research," "calculator," "computer," etc. - Explain how these skills and tools are utilized in education. Study Habits. - Share vocabulary related to effective study habits and time management. Science and Technology Subjects. Vocabulary. - Present Sylheti words for science and technology-related subjects like "physics," "chemistry," "computer science," etc. - Describe the significance of these subjects in the modern world. Laboratory Terms. - Include laboratory-related vocabulary if applicable. Humanities and Arts Subjects. Vocabulary. - Teach Sylheti words for humanities and arts-related subjects like "philosophy," "music," "fine arts," etc. - Explain the cultural and artistic aspects of these subjects. Creative Expressions. - Provide terms related to creative expressions, such as "painting," "writing poetry," "singing," etc. Career and Vocational Subjects. Vocabulary. - List Sylheti words for career and vocational subjects, including "engineering," "medicine," "business," etc. - Describe the potential career paths associated with these subjects. Professional Development. - Share vocabulary related to professional development and training. Resources. - Provide links to further resources for learning Sylheti, especially related to academic subjects and educational materials. - Include sources for online courses or academic resources in Sylheti. References. - List any sources or references used to compile the academic subject-related vocabulary and educational information.

Sylheti/Vocabulary/Computing. Introduction. - Introduce the importance of learning computing-related vocabulary in Sylheti. - Explain how understanding computing terms can be useful for technology, communication, and work. Basic Computing Terms. Vocabulary. A list of fundamental Sylheti computing terms, such as "computer," "keyboard," "mouse," "screen," etc. including pronunciation guides. Usage. - Explain how these terms are used in everyday technology discussions. Software and Operating Systems. Vocabulary. - Present Sylheti words for software and operating systems, including "program," "application," "Windows," "Linux," etc. - Describe the functions of common software programs. Installation and Usage. - Provide phrases for installing and using software in Sylheti. Internet and Networking. Vocabulary. - List Sylheti words related to the internet and networking, such as "website," "browser," "Wi-Fi," "router," etc. - Explain internet-related concepts. Online Activities. - Teach vocabulary for online activities like "email," "social media," "streaming," etc. - Include Sylheti terms for common social media platforms. Hardware and Devices. Vocabulary. - Teach Sylheti words for hardware components and devices, including "printer," "scanner," "smartphone," "tablet," etc. - Describe the functions of various hardware devices. Troubleshooting. - Include vocabulary related to troubleshooting common hardware issues. Coding and Programming. Vocabulary. - Present Sylheti words related to coding and programming, such as "code," "programming language," "algorithm," "debugging," etc. - Explain coding concepts and their applications. Learning Programming. - Provide phrases and terms for learning programming in Sylheti. Cybersecurity and Privacy. Vocabulary. - List Sylheti words for cybersecurity and privacy-related terms, including "password," "firewall," "encryption," "identity theft," etc. - Explain the importance of cybersecurity. Safe Online Practices. - Share vocabulary related to safe online practices and protecting personal information. Emerging Technologies. Vocabulary. - Introduce Sylheti terms for emerging technologies like "artificial intelligence," "virtual reality," "blockchain," etc. - Describe the impact of these technologies on society. Technology Trends. - Include vocabulary related to current technology trends and innovations. Resources. - Provide links to further resources for learning Sylheti, especially related to computing and technology. - Include sources for online courses and technology-related news in Sylheti. References. - List any sources or references used to compile the computing-related vocabulary and technological information.

Sylheti/Vocabulary/Body parts. Introduction. - Introduce the importance of learning body part-related vocabulary in Sylheti. - Explain how understanding body part terms can be useful for medical communication, everyday life, and cultural awareness. Basic Body Parts. Vocabulary. - Provide a list of common Sylheti body parts, such as "head," "eyes," "nose," "hands," "feet," etc. - Include pronunciation guides if possible. Usage. - Explain how these terms are used in everyday conversations, medical discussions, and expressions. Internal Organs. Vocabulary. - Present Sylheti words for internal organs like "heart," "lungs," "stomach," "kidneys," etc. - Include terms for major organs and their functions. Medical Terminology. - Explain how these terms are used in medical contexts and discussions. - Include phrases related to medical examinations and health assessments. Senses and Sensory Organs. Vocabulary. - List Sylheti words for senses and sensory organs, including "sight," "hearing," "taste," "smell," "touch," "ear," "tongue," "nose," "skin," etc. - Describe the functions of sensory organs. Expressions and Idioms. - Share common expressions and idioms related to senses and sensory experiences in Sylheti culture. Limbs and Extremities. Vocabulary. - Teach Sylheti words for limbs and extremities like "arms," "legs," "fingers," "toes," etc. - Explain how these body parts are used in various activities. Movement and Actions. - Include vocabulary related to movement and actions involving limbs and extremities. Facial Features. Vocabulary. - Present Sylheti words for facial features such as "forehead," "eyebrows," "lips," "chin," etc. - Describe facial expressions and their cultural significance, if applicable. Beauty and Makeup. - Include vocabulary related to beauty, makeup, and facial care in Sylheti culture. Body Systems. Vocabulary. - List Sylheti words for body systems like "circulatory system," "nervous system," "digestive system," etc. - Explain the functions of these systems and their importance. Health and Wellness. - Share vocabulary related to maintaining and discussing health and wellness in Sylheti. Resources. - Provide links to further resources for learning Sylheti, especially related to medical terminology and body parts. - Include sources for health and medical information in Sylheti. References. - List any sources or references used to compile the body part-related vocabulary and cultural information.

Sylheti/Vocabulary/Animals. Introduction. - Introduce the importance of learning animal-related vocabulary in Sylheti. - Explain how understanding animal terms can be useful for communication, wildlife appreciation, and cultural awareness. Domestic Animals. Vocabulary. - Provide a list of common Sylheti domestic animals, such as "cow," "goat," "chicken," "cat," "dog," etc. - Include pronunciation guides if possible. Uses and Roles. - Explain the roles and significance of these animals in Sylheti culture, such as livestock, pets, or working animals. Wild Animals. Vocabulary. - Present Sylheti words for wild animals found in Sylheti regions or globally, like "tiger," "elephant," "deer," "leopard," etc. - Describe the characteristics and habitats of these animals. Conservation and Wildlife. - Share information about wildlife conservation efforts and the importance of preserving natural habitats in Sylhet. Birds. Vocabulary. - List Sylheti words for birds, including "sparrow," "crow," "parrot," "eagle," etc. - Explain the diversity of bird species and their significance in Sylheti culture. Birdwatching and Ornithology. - Include vocabulary related to birdwatching and the study of birds in Sylheti. Aquatic and Marine Life. Vocabulary. - Provide Sylheti words for aquatic and marine creatures like "fish," "shark," "dolphin," "crab," etc. - Describe fishing practices and the importance of aquatic life in Sylheti cuisine. Environmental Conservation. - Discuss the environmental impact of aquatic and marine life in Sylhet. Insects and Small Creatures. Vocabulary. - Present Sylheti words for insects and small creatures like "butterfly," "ant," "bee," "spider," etc. - Explain their role in ecosystems and any cultural significance. Insect Conservation. - Share information about insect conservation efforts in Sylheti regions. Reptiles and Amphibians. Vocabulary. - List Sylheti words for reptiles and amphibians like "snake," "turtle," "frog," "lizard," etc. - Describe their habitats and behaviors. Folklore and Myths. - Include any Sylheti folklore or myths related to reptiles and amphibians. Endangered and Threatened Species. Vocabulary. - Present Sylheti words for endangered and threatened species and discuss the importance of their conservation. - Highlight conservation efforts and organizations in Sylhet related to these species. Resources. - Provide links to further resources for learning Sylheti, especially related to wildlife and animal conservation. - Include sources for wildlife guides and information specific to Sylheti regions. References. - List any sources or references used to compile the animal-related vocabulary and cultural information.

Sylheti/Vocabulary/Banking. Introduction. - Introduce the importance of learning banking-related vocabulary in Sylheti. - Explain how understanding banking terms can be useful for financial transactions, managing money, and cultural awareness. Banking Institutions. Vocabulary. - Provide a list of Sylheti words related to banking institutions, such as "bank," "branch," "ATM," "account," etc. - Include pronunciation guides if possible. Banking Services. - Explain the various banking services offered by these institutions, like savings accounts, loans, and investments. Currency and Money Terms. Vocabulary. - List Sylheti words for currency and money-related terms, including "money," "currency," "dollar," "rupee," etc. - Describe the denominations and types of currency used in Sylhet. Exchange Rates and Conversion. - Provide vocabulary related to currency exchange rates and currency conversion. Banking Transactions. Vocabulary. - Teach Sylheti words and phrases related to banking transactions, such as "withdraw," "deposit," "transfer," "check," "statement," etc. - Explain the steps involved in these transactions. Online Banking. - Include vocabulary related to online banking, mobile banking, and electronic transactions. Financial Planning and Investments. Vocabulary. - Present Sylheti words for financial planning and investment terms like "savings plan," "investment portfolio," "interest rate," "dividend," etc. - Describe the concepts of financial planning and investment in Sylheti culture. Retirement and Insurance. - Share vocabulary related to retirement planning and insurance options. Credit and Loans. Vocabulary. - List Sylheti words for credit and loan-related terms, including "credit card," "loan application," "interest," "collateral," etc. - Explain the types of loans and credit options available in Sylhet. Loan Repayment. - Provide vocabulary related to loan repayment and debt management. Banking Etiquette and Procedures. Vocabulary. - Teach Sylheti phrases and terms related to banking etiquette, such as "please," "thank you," "signature," "account number," etc. - Explain common procedures and documents used in banking. Customer Support. - Include vocabulary related to seeking help from bank customer support. Resources. - Provide links to further resources for learning Sylheti, especially related to banking and financial literacy. - Include sources for financial planning tools in Sylheti. References. - List any sources or references used to compile the banking-related vocabulary and financial information.

Sylheti/Vocabulary/Time. Introduction. - Introduce the importance of learning time-related vocabulary in Sylheti. - Explain how understanding time terms can be useful for scheduling, planning, and cultural awareness. Units of Time. Vocabulary. - Provide a list of Sylheti words for units of time, such as "second," "minute," "hour," "day," "week," "month," "year," etc. - Include pronunciation guides if possible. Time Measurement. - Explain how time is measured and represented in Sylheti culture. Telling Time. Vocabulary. - Teach Sylheti words and phrases related to telling time, including "clock," "watch," "hour hand," "minute hand," etc. - Describe how to express specific times in Sylheti. Time Formats. - Explain the various time formats used in Sylheti, including 12-hour and 24-hour clocks. Days of the Week and Months. Vocabulary. - List Sylheti words for days of the week and months, such as "Sunday," "Monday," "January," "February," etc. - Include pronunciation guides if possible. Cultural Significance. - Share any cultural or religious significance associated with days and months in Sylheti culture. Seasons and Weather-related Terms. Vocabulary. - Present Sylheti words for seasons like "summer," "winter," "monsoon," and weather-related terms like "sunny," "rainy," "cloudy," etc. - Describe the climate and weather patterns in Sylhet. Seasonal Activities. - Include vocabulary related to activities and festivals associated with different seasons. Expressing Duration and Time Intervals. Vocabulary. - Teach Sylheti phrases and terms for expressing duration and time intervals, such as "for one hour," "since yesterday," "in a few minutes," etc. - Explain how to use these expressions in everyday conversations. Countdowns and Timers. - Include vocabulary for countdowns and timers. Historical and Cultural Time References. Vocabulary. - Present Sylheti words and phrases related to historical eras, events, and cultural celebrations involving time. - Share insights into significant historical periods and anniversaries in Sylheti culture. Resources. - Provide links to further resources for learning Sylheti, especially related to time, calendars, and cultural festivals. - Include sources for Sylheti calendars and timekeeping. References. - List any sources or references used to compile the time-related vocabulary and cultural information.

Sylheti/Vocabulary/Dates. Introduction. - Introduce the importance of learning date-related vocabulary in Sylheti. - Explain how understanding date terms can be useful for communication, scheduling, and cultural awareness. Days of the Week. Vocabulary. - Provide a list of Sylheti words for days of the week, such as "Sunday," "Monday," "Tuesday," etc. - Include pronunciation guides if possible. Usage. - Explain how these terms are used in daily life, scheduling, and planning. Months of the Year. Vocabulary. - List Sylheti words for months of the year, such as "January," "February," "March," etc. - Include pronunciation guides if possible. Cultural Significance. - Share any cultural or religious significance associated with certain months in Sylheti culture. Ordinal Numbers for Dates. Vocabulary. - Teach Sylheti ordinal numbers for expressing dates, such as "1st," "2nd," "3rd," "4th," etc. - Explain how to use ordinal numbers in date expressions. Calendar Systems. - Describe the calendar systems commonly used in Sylheti culture. Expressing Complete Dates. Vocabulary. - Present Sylheti phrases and terms for expressing complete dates, including "Today is," "Tomorrow is," "Yesterday was," "On the 5th of June," etc. - Explain how to construct and use complete date expressions. Birthdays and Anniversaries. - Include vocabulary for discussing birthdays and anniversaries in Sylheti. Holidays and Festivals. Vocabulary. - List Sylheti words for holidays and festivals celebrated in Sylhet, including religious and cultural events. - Share insights into the significance and customs of these celebrations. Greeting and Wishing. - Include holiday greetings and well-wishing phrases in Sylheti. Seasons and Weather-Related Dates. Vocabulary. - Present Sylheti words for dates associated with seasons and weather events, such as "first day of summer," "rainy season begins," etc. - Describe the cultural importance of these dates. Seasonal Activities. - Include vocabulary for activities and traditions related to different seasons. Historical and Commemorative Dates. Vocabulary. - Present Sylheti words and phrases related to historical events, anniversaries, and commemorative dates. - Explain the significance of these dates in Sylheti culture. Memorials and Observances. - Share vocabulary related to memorials, observances, and remembrance events. Resources. - Provide links to further resources for learning Sylheti, especially related to dates, calendars, and cultural events. - Include sources for Sylheti holiday calendars and historical references. References. - List any sources or references used to compile the date-related vocabulary and cultural information.

Sylheti/Third Person. Introduction. - Briefly introduce the concept of the third person in language. - Explain the importance of understanding third-person grammar in Sylheti. Third-Person Pronouns. Vocabulary. - Provide a list of Sylheti third-person pronouns, including singular and plural forms. - Include pronunciation guides if possible. Usage. - Explain when and how to use third-person pronouns in Sylheti sentences. Verb Conjugation for the Third Person. Present Tense. - Describe the rules and patterns for conjugating verbs in the present tense for the third person. - Provide examples of present tense verb conjugations. Past Tense. - Explain how verbs are conjugated in the past tense for the third person. - Provide examples of past tense verb conjugations. Future Tense. - Describe how verbs are conjugated in the future tense for the third person. - Provide examples of future tense verb conjugations. Demonstratives and Adjectives in the Third Person. Demonstrative Pronouns. - Teach Sylheti demonstrative pronouns used in the third person, such as "this," "that," "these," "those," etc. - Explain how to use demonstratives in context. Possessive Adjectives. - Present Sylheti possessive adjectives for the third person, including "his," "her," "their," etc. - Provide examples of possessive adjectives in sentences. Verb Agreement with Third-Person Subjects. Singular Subjects. - Explain how verbs agree with singular third-person subjects in Sylheti. - Offer examples of sentences with singular subjects. Plural Subjects. - Describe verb agreement with plural third-person subjects. - Provide examples of sentences with plural subjects. Reflexive Pronouns in the Third Person. - Teach Sylheti reflexive pronouns used in the third person. - Explain their usage in reflexive sentences. Resources. - Provide links to further resources for learning Sylheti grammar, especially related to the third person. - Include sources for Sylheti language courses and grammar guides. References. - List any sources or references used to compile the third-person grammar information.

Sylheti/Second Person. Introduction. - Briefly introduce the concept of the second person in language. - Explain the importance of understanding second-person grammar in Sylheti. Second-Person Pronouns. Vocabulary. - Provide a list of Sylheti second-person pronouns, including familiar and formal forms. - Include pronunciation guides if possible. Usage. - Explain when and how to use second-person pronouns in Sylheti sentences, considering factors like familiarity and politeness. Verb Conjugation for the Second Person. Present Tense. - Describe the rules and patterns for conjugating verbs in the present tense for the second person. - Provide examples of present tense verb conjugations. Past Tense. - Explain how verbs are conjugated in the past tense for the second person. - Provide examples of past tense verb conjugations. Future Tense. - Describe how verbs are conjugated in the future tense for the second person. - Provide examples of future tense verb conjugations. Commands and Requests in the Second Person. Imperative Mood. - Teach the Sylheti imperative mood used for giving commands and making requests. - Explain how to form imperative sentences in the second person. Politeness and Formality. - Discuss the use of politeness and formality when giving commands or making requests in Sylheti. Addressing People in the Second Person. Informal Address. - Explain how informal address is used in Sylheti when speaking to friends, family, or peers. - Provide examples of informal sentences. Formal Address. - Describe formal address in Sylheti, used when speaking to elders, authority figures, or in formal settings. - Provide examples of formal sentences. Honorifics and Titles. - Include vocabulary related to honorifics and titles used in formal address. Verb Agreement with Second-Person Subjects. Singular Subjects. - Explain how verbs agree with singular second-person subjects in Sylheti. - Offer examples of sentences with singular subjects. Plural Subjects. - Describe verb agreement with plural second-person subjects. - Provide examples of sentences with plural subjects. Resources. - Provide links to further resources for learning Sylheti grammar, especially related to the second person. - Include sources for Sylheti language courses and grammar guides. References. - List any sources or references used to compile the second-person grammar information.

Sylheti/First Person. Introduction. - Briefly introduce the concept of the first person in language. - Explain the importance of understanding first-person grammar in Sylheti. First-Person Pronouns. Vocabulary. - Provide a list of Sylheti first-person pronouns, including singular and plural forms. - Include pronunciation guides if possible. Usage. - Explain when and how to use first-person pronouns in Sylheti sentences. Verb Conjugation for the First Person. Present Tense. - Describe the rules and patterns for conjugating verbs in the present tense for the first person. - Provide examples of present tense verb conjugations. Past Tense. - Explain how verbs are conjugated in the past tense for the first person. - Provide examples of past tense verb conjugations. Future Tense. - Describe how verbs are conjugated in the future tense for the first person. - Provide examples of future tense verb conjugations. Expressing Preferences and Opinions. Vocabulary. - Teach Sylheti vocabulary related to expressing preferences and opinions in the first person, such as "I like," "I prefer," "I think," "I believe," etc. - Explain the nuances of expressing personal thoughts and feelings. Agreement and Disagreement. - Include vocabulary for agreeing and disagreeing with others in the first person. - Provide examples of expressing agreement and disagreement. Narrating Personal Experiences. Vocabulary. - Present Sylheti vocabulary for narrating personal experiences and events in the first person, including "I did," "I saw," "I went," "I met," etc. - Explain how to construct narratives using first-person expressions. Storytelling and Anecdotes. - Include vocabulary related to storytelling and sharing anecdotes in Sylheti. Emotions and Feelings. Vocabulary. - List Sylheti words and phrases for describing emotions and feelings in the first person, such as "I am happy," "I am sad," "I am excited," "I am tired," etc. - Offer examples of expressing emotions and feelings. Empathy and Support. - Include vocabulary for showing empathy and providing emotional support in Sylheti. Resources. - Provide links to further resources for learning Sylheti grammar, especially related to the first person. - Include sources for Sylheti language courses and grammar guides. References. - List any sources or references used to compile the first-person grammar information.

Sylheti/Future Tense. Introduction. - Briefly introduce the concept of the future tense in language. - Explain the importance of understanding the future tense in Sylheti. Formation of the Future Tense. Vocabulary. - Provide Sylheti vocabulary related to the future tense, including words and phrases like "future," "will," "shall," "going to," etc. - Include pronunciation guides if possible. Verb Conjugation. - Explain how verbs are conjugated to express the future tense in Sylheti. - Provide examples of verb conjugation in the future tense. Future Time Expressions. - Present Sylheti time expressions used to indicate future actions or events, such as "tomorrow," "next week," "in the future," etc. - Include examples of sentences using future time expressions. Expressing Simple Future Actions. Vocabulary. - Teach Sylheti vocabulary and phrases for expressing simple future actions, such as "I will go," "They will come," "She will eat," etc. - Explain how to construct basic future tense sentences. Affirmative Sentences. - Describe the structure of affirmative sentences in the future tense. - Provide examples of affirmative sentences. Negative Sentences. - Explain how to form negative sentences in the future tense in Sylheti. - Provide examples of negative sentences. Interrogative Sentences. - Discuss how to ask questions in the future tense in Sylheti. - Include examples of interrogative sentences. Expressing Future Plans and Intentions. Vocabulary. - Present Sylheti vocabulary related to expressing future plans and intentions, such as "I am planning to," "I intend to," "I hope to," etc. - Explain the nuances of expressing intentions in the future tense. Conditional Future Actions. - Teach how to express conditional future actions in Sylheti, such as "If I can, I will," "If they invite me, I will come," etc. - Provide examples of conditional future sentences. Resources. - Provide links to further resources for learning Sylheti grammar, especially related to the future tense. - Include sources for Sylheti language courses and grammar guides. References. - List any sources or references used to compile the future tense grammar information.

Sylheti/Present Tense. Introduction. - Briefly introduce the concept of the present tense in language. - Explain the importance of understanding the present tense in Sylheti. Formation of the Present Tense. Vocabulary. - Provide Sylheti vocabulary related to the present tense, including words and phrases like "now," "today," "at this moment," etc. - Include pronunciation guides if possible. Verb Conjugation. - Explain how verbs are conjugated to express the present tense in Sylheti. - Provide examples of verb conjugation in the present tense. Present Time Expressions. - Present Sylheti time expressions used to indicate present actions or states, such as "currently," "at the moment," "right now," etc. - Include examples of sentences using present time expressions. Expressing Simple Present Actions. Vocabulary. - Teach Sylheti vocabulary and phrases for expressing simple present actions, such as "I eat," "They work," "She reads," etc. - Explain how to construct basic present tense sentences. Affirmative Sentences. - Describe the structure of affirmative sentences in the present tense. - Provide examples of affirmative sentences. Negative Sentences. - Explain how to form negative sentences in the present tense in Sylheti. - Provide examples of negative sentences. Interrogative Sentences. - Discuss how to ask questions in the present tense in Sylheti. - Include examples of interrogative sentences. Expressing Habits and Routines. Vocabulary. - Present Sylheti vocabulary related to expressing habits and routines in the present tense, such as "I usually do," "I always do," "They often go," etc. - Explain the nuances of expressing habitual actions. Adverbs of Frequency. - Teach adverbs of frequency used in Sylheti to indicate how often actions occur in the present, such as "always," "often," "sometimes," etc. - Include examples of sentences using adverbs of frequency. Expressing Current Conditions and States. Vocabulary. - Provide Sylheti vocabulary for describing current conditions and states in the present tense, such as "I am happy," "He is tired," "They are busy," etc. - Explain how to express emotional states, physical conditions, and ongoing states. Stative Verbs. - Discuss stative verbs in Sylheti and how they are used in the present tense. - Provide examples of sentences with stative verbs. Resources. - Provide links to further resources for learning Sylheti grammar, especially related to the present tense. - Include sources for Sylheti language courses and grammar guides. References. - List any sources or references used to compile the present tense grammar information.

Sylheti/Past Tense. Introduction. - Briefly introduce the concept of the past tense in language. - Explain the importance of understanding the past tense in Sylheti. Formation of the Past Tense. Vocabulary. - Provide Sylheti vocabulary related to the past tense, including words and phrases like "yesterday," "in the past," "once upon a time," etc. - Include pronunciation guides if possible. Verb Conjugation. - Explain how verbs are conjugated to express the past tense in Sylheti. - Provide examples of verb conjugation in the past tense. Past Time Expressions. - Present Sylheti time expressions used to indicate past actions or events, such as "last week," "two days ago," "when I was young," etc. - Include examples of sentences using past time expressions. Expressing Simple Past Actions. Vocabulary. - Teach Sylheti vocabulary and phrases for expressing simple past actions, such as "I ate," "They worked," "She read," etc. - Explain how to construct basic past tense sentences. Affirmative Sentences. - Describe the structure of affirmative sentences in the past tense. - Provide examples of affirmative sentences. Negative Sentences. - Explain how to form negative sentences in the past tense in Sylheti. - Provide examples of negative sentences. Interrogative Sentences. - Discuss how to ask questions in the past tense in Sylheti. - Include examples of interrogative sentences. Expressing Completed Actions and Events. Vocabulary. - Provide Sylheti vocabulary related to expressing completed actions and events in the past tense, such as "I finished," "They completed," "It happened," etc. - Explain how to express actions that have already taken place. Use of Specific Time Phrases. - Describe how specific time phrases are used in Sylheti to indicate when a past action occurred, such as "at 3 PM yesterday," "in 1990," etc. - Include examples of sentences using specific time phrases. Expressing Past Habits and Repeated Actions. Vocabulary. - Present Sylheti vocabulary related to expressing past habits and repeated actions, such as "I used to do," "They always went," "She often visited," etc. - Explain the nuances of expressing habitual actions in the past. Past Frequency Adverbs. - Teach past frequency adverbs used in Sylheti to indicate how often actions occurred in the past, such as "always," "often," "sometimes," etc. - Include examples of sentences using past frequency adverbs. Resources. - Provide links to further resources for learning Sylheti grammar, especially related to the past tense. - Include sources for Sylheti language courses and grammar guides. References. - List any sources or references used to compile the past tense grammar information.

Sylheti/Ballads. Ballads. About False Paradise. "False Paradise: A Sylheti Ballads" is a notable literary work that delves deep into the rich cultural heritage of the Sylhet region in Bangladesh. This enchanting collection of ballads and folk tales offers a window into the mystical world of Sylhet, where reality and folklore intertwine seamlessly. Each ballad in is a narrative gem, handed down through generations, and skillfully transcribed by the author, capturing the essence of Sylheti culture. These ballads are more than just stories; they are the soul of Sylhet, where legends, myths, and everyday life merge. The ballad collection invites readers to embark on a journey through the tea gardens, misty hills, and lush forests of Sylhet. The ballads are steeped in the region's distinct flavors, offering glimpses of its unique traditions, superstitions, and the resilience of its people. From tales of love and longing to stories of mythical creatures, the book weaves a tapestry of Sylhet's cultural tapestry. It is not only a literary treasure but also a historical document, preserving the oral traditions of the Sylheti people for future generations. It sheds light on the often-neglected folklore of this enchanting region and brings to life the voices of its storytellers. It contains community secrets, ancient mysteries, and the tribal history. Sylheti ballad collection offer a glimpse into a world both familiar and otherworldly. It is a testament to the enduring power of storytelling. About Sylhet Gitika. These ballads are characterized by their unique storytelling style, often sung in the Sylheti language. They offer insights into the daily lives, traditions, and folklore of the Sylheti people. Some of the common themes found in Sylhet Gitika include love, nature, spirituality, and social issues. One of the distinguishing features of Sylhet Gitika is its rich lyrical content. The songs are known for their poetic and metaphoric language, which adds depth and emotion to the narratives. They are often accompanied by traditional musical instruments such as the dotara (a stringed instrument) and flute, which contribute to the distinct melodies of these ballads. These ballads also play a crucial role in preserving the history and cultural identity of the Sylheti people. They serve as a repository of local legends, historical events, and moral lessons. Through the songs, the Sylheti community passes on its values, beliefs, and customs to future generations. About Maimansingha Gitika. Researcher Asaddor Ali's groundbreaking discovery concerning the Maimansingha Gitika, a collection of traditional songs from Bangladesh, has significantly altered our perception of these songs' origins and cultural history. In the course of his meticulous research, Ali uncovered that nine widely acclaimed Maimansingha Gitika songs, previously attributed to the Mymensingh region, actually have their roots in Sylheti culture. This revelation carries profound implications for our understanding of these songs, shedding light on the intricate tapestry of cultural exchange and influence that has long defined the region. The discovery by Asaddor Ali challenges established narratives and presents a new lens through which we can view the Maimansingha Gitika. It provides a compelling example of how cultural traditions are dynamic and continuously shaped by interactions and migrations. One of the most significant aspects of Ali's research is its ability to prompt a comprehensive reinterpretation of the historical origins of these ballads. Previously, these songs were predominantly associated with Mymensingh, and their Sylheti influence remained unrecognized. However, Ali's findings underscore the importance of cross-cultural interactions and the exchange of artistic expressions between the two regions. In reevaluating the narratives surrounding Maimansingha Gitika, we must now acknowledge their multifaceted origins. The discovery underscores the interconnectedness of regions like Mymensingh and Sylhet, regions that have shared borders and have historically had significant interactions. It reveals how cultural exchange and adaptation have played a pivotal role in shaping the traditions and artistic expressions of these regions. The influence of Sylheti culture on Mymensingh's folk music adds a layer of complexity to the region's cultural landscape. The narrative surrounding the Maimansingha Gitika now includes the recognition of Sylheti contributions. This revised narrative broadens our understanding of the cultural tapestry of Bangladesh. It invites to celebrate the cultural diversity and acknowledge the multifaceted origins of these traditional songs, enriching our appreciation of their heritage. This discovery highlights a fundamental truth about cultural expressions: they often have diverse origins. It emphasizes that elements and influences from various sources can blend over time to create something unique and beautiful. In the case of the Maimansingha Gitika, it is the fusion of Mymensingh and Sylheti influences that has given rise to their distinctive character. Asaddor Ali's research has far-reaching implications. It not only reshapes our understanding of the Maimansingha Gitika but also opens new avenues of inquiry for scholars, musicians, and cultural enthusiasts. It encourages further exploration into the intersections of culture, migration, and artistic expression. Researchers can delve deeper into the historical connections between Mymensingh and Sylhet, uncovering more hidden gems of cultural exchange. The discovery adds depth to the cultural identity of both Mymensingh and Sylhet. It acknowledges the shared heritage and influences that have shaped their artistic expressions. This recognition fosters a sense of connection between the two regions and contributes to a broader appreciation of Bangladesh's diverse cultural heritage. The discovery of Sylheti origins within the Maimansingha Gitika is a testament to the profound influence of cultural exchange and migration. It showcases how people's movement between regions can lead to the fusion of artistic traditions. In this case, the migration of communities played a pivotal role in shaping the region's folk music. Asaddor Ali's discovery contributes to the broader conversation about cross-cultural influence and the dynamic nature of cultural traditions. It reminds that cultures are not static entities but rather living, breathing entities that adapt and evolve over time. This legacy of cross-cultural influence is not unique to Bangladesh; it is a global phenomenon that has shaped the cultural heritage of societies throughout history. Asaddor Ali's revelation that nine famous Maimansingha Gitika songs have Sylheti origins represents a significant milestone in the study of Bangladesh's cultural heritage. It invites to reevaluate our understanding of these ballads and appreciate the complexity of their origins. It also serves as a celebration of the rich cultural diversity and interconnectedness that characterizes the region. The Maimansingha Gitika, now recognized as a product of both Mymensingh and Sylheti influences, serves as a powerful symbol of the enduring impact of cultural exchange and migration.

Sylheti/Proverbs. A Window into Sylheti Culture and Wisdom. Introduction. Proverbs are the distilled wisdom of generations, offering insights into the values, beliefs, and culture of a community. Sylheti proverbs, hailing from the picturesque Sylhet region of Bangladesh, are no exception. These succinct expressions convey not only practical advice but also the essence of Sylheti culture, its connection to nature, and its people's resilience. In this wiki article, we will delve into the world of Sylheti proverbs, exploring their origins, meanings, and the cultural significance they hold. Origins of Sylheti Proverbs. Sylheti proverbs have their roots in the region's rich history, which includes various influences such as Manipuri, Assamese, and even British colonialism. These proverbs have been passed down through generations as oral traditions, reflecting the collective wisdom of the people. Over time, some proverbs have been adapted from Sanskrit, Urdu, Arabic and Persian for religious significance, while others are unique to Sylhet, shaped by its distinct geography and culture. This proverb highlights the significance of a good start and the consequences of making errors or mistakes at the beginning of a task or endeavor. "ꠛꠤꠍꠝꠤꠟ꠆ꠟꠣ" (from Arabic Bismillah) is originally an Arabic phrase meaning "In the name of Allah" and is often used at the start of various activities by Muslims as an invocation of blessings and guidance. In this context, it symbolizes the beginning or initiation of any action. The essence of the proverb lies in the idea that a mistake made at the outset of a task can have far-reaching and often negative consequences. Just as a small crack in the foundation of a building can lead to structural problems over time, an error made in the initial stages of a project, relationship, or any endeavor can escalate into larger issues down the road. This proverb serves as a cautionary reminder to be diligent, careful, and thorough when starting something new. It encourages individuals to pay close attention to the details, make well-informed decisions, and take the necessary steps to ensure a strong and stable foundation. By doing so, one can minimize the likelihood of facing problems, regrets, or complications later on.While the exact origin of the proverb may be uncertain, its message is universal and timeless. It underscores the importance of a strong start and the potential consequences of overlooking or neglecting the beginning stages of any undertaking. It is a valuable piece of wisdom that transcends cultural boundaries, offering guidance and insight to individuals striving for success and avoiding mistakes in their endeavors. Another interpretation emphasizes the idea that someone has undertaken a significant task but made a mistake at the beginning, ultimately leading to the ruin of the entire endeavor. This aspect of the proverb underscores the critical role that a proper start plays in the success or failure of a larger project. It serves as a warning about the potential consequences of initial errors that can have cascading effects, resulting in the failure of a substantial undertaking. The Role of Nature in Sylheti Proverbs. Sylhet's breathtaking landscape of rolling hills, lush tea gardens, and rivers has deeply influenced its proverbs. Nature serves as a metaphor and backdrop for many of these sayings. For instance, the proverb "Sylhet's soil, Sylhet's water" reflects the region's fertile land and abundant water sources, symbolizing prosperity and self-sufficiency. This proverb reflects the deep-rooted connection between nature, human behavior, and the values of this community. In the context of Sylheti proverbs, this saying underscores the importance of vocalizing one's needs and emotions. It suggests that just as a crying baby is more likely to receive nourishment and care, individuals who express their desires, grievances, or concerns are more likely to have their needs met within the community. This proverb not only highlights the cultural emphasis on open communication and the value placed on expressing one's feelings but also draws attention to the nurturing aspect of the Sylheti society. The Sylhet region is known for its lush green landscapes, tea gardens, and agricultural activities. Nature plays a pivotal role in the daily lives of its people. The connection between nature and nurturing, exemplified by the provision of milk to a crying baby, reflects how the Sylheti culture values compassion, empathy, and responsiveness to human needs, mirroring the way they tend to their fertile land. Furthermore, the proverb also signifies the idea of reciprocity within the community. Just as a baby's cries are met with care, so too should one be willing to respond to the needs of others. This concept of reciprocity and communal support is deeply ingrained in Sylheti culture and is often mirrored in their proverbs. Sylheti proverbs reflects the cultural importance of open communication, empathy, and reciprocity within the community. It also demonstrates the profound connection between nature and human behavior, showcasing how the Sylheti people draw inspiration from their natural surroundings to convey essential values and social norms. Family and Social Values. Sylheti proverbs often highlight the significance of family and community. The saying "Ghor fitaite mati aise, khalna fitaite bashi aise" underscores the idea that a loving and caring family environment is what truly makes a house a home. Shopping. When one realizes the shortcomings of their cheap purchase, they often find themselves complaining or lamenting their decision, a sentiment shared universally among consumers. This proverb's relevance extends far beyond the Sylheti community, resonating with people worldwide who have experienced the consequences of prioritizing price over value. It highlights several valuable life lessons: In a world where consumers are bombarded with choices and enticed by discounts and sales, the Sylheti proverb serves as a timeless reminder of the importance of making thoughtful, informed decisions. It encourages us to reflect on our choices and recognize that, in many cases, we get what we pay for. Ultimately, it reinforces the idea that true value transcends the allure of a low price tag, and regret is the price one pays for neglecting this fundamental truth. Resilience and Adaptability. The Sylhet region has faced its share of challenges, including landslides, floods, and economic hardships. Sylheti proverbs often carry messages of resilience and adaptability. The saying "Haat doiya, forir ufre bhua" encourages persistence in the face of obstacles. Cultural heartbeats. Sylheti proverbs are more than linguistic expressions; they are the cultural heartbeats of the Sylhet region. These concise, insightful sayings offer guidance, wisdom, and glimpses into the values and way of life of the Sylheti people. Their reliance on nature, focus on family and community, and emphasis on resilience make them a unique and invaluable part of the region's cultural heritage.As Sylheti faces modernization and globalization, preserving these proverbs becomes crucial for maintaining the region's cultural identity and language. Initiatives to document, teach, and promote Sylheti proverbs are vital steps toward ensuring that this rich tradition continues to enrich the lives of future generations, both within and beyond the Sylhet region. In the world of proverbs, Sylheti wisdom shines brightly, offering lessons and insights that transcend time and place. Challenges and Preservation Efforts. Despite their cultural and linguistic significance, Sylheti proverbs face challenges in the modern era. As society becomes more globalized, younger generations are often more familiar with Bengali or English than their native Sylheti language. This shift has led to a gradual decline in the use and understanding of Sylheti proverbs. Efforts are underway to document and preserve Sylheti proverbs for future generations. Organizations, scholars, and local communities are working together to compile collections, create resources, and promote the teaching of these proverbs in schools and communities. Such initiatives are essential to ensure that the wisdom and cultural heritage encapsulated in Sylheti proverbs continue to thrive.

Study in Norway. Objective Overview of the chapter. After reading this chapter, the learner will Reasons to Study in Norway (Concept map). https://upload.wikimedia.org/wikipedia/commons/thumb/f/fb/Concept_map_of_some_reasons_to_study_in_Norway.png/1200px-Concept_map_of_some_reasons_to_study_in_Norway.png?20230925192241 What makes Norway the best country to study in? Norway's unique education system has garnered global attention for its focus on student development, equality, and inclusivity. We can dive into the country's tuition-free education, innovative teaching methods, and collaborative approach to addressing challenges. Norway's education system is regarded as world-class. Standard of Living. The Prevelage of Norway is one of the greatest living standards in the world.There is a low crime rate, low unemployment, a good welfare system,and a work-life balance in the country.After meeting Norwegians, you will definitely understand how nice people are. The scenic attractions of the place. Norway belongs to the Scandinavian countries in Northern Europe.It is considered to be one of the most spectacular countries and has the best standards of living across the globe.Norway is one of the top destinations on the wishlist of every visitor because of its unique blend of nature One can experience the diverse range of natural wonders, beginning with magnificent fjords, dramatic landscapes, impressive cities, rich history, and unique culture. One of the most impressive attractions in Norway is its fjords. They create beautiful landscapes. High Quality Education. The Norwegian educational system is well known for its high quality, which highlights the overall development of students and provides free education to all.Norway's education system is unique and globally recognized due to its focus on overall student development and free education. Teacher quality is crucial to maintaining high standards in education. The reason is that the system emphasizes the qualification and ongoing professional development of teachers. The teaching methods in Norway encourage innovation and student-centered approaches.The structure of the educational system is divided into primary, middle, and high schools,with all public schools following all standards and syllabuses.The implementation of Norwegian reforms in 1997 and 2006 significantly changed the educational system,which played a part in strengthening the quality of education in public schools.Under this reform, the local municipalities were made responsible for running public schools until the middle school level, and up until 2005, private schools were practically illegal in the country.This resulted in strengthening the quality of education provided by public schools, as all children, regardless of status, went to the same class of public schools.In 2006, private schools were made more legal in Norway, and today there are several international and specialized schools that teach English. With the realization of a new curriculum and the provision of a choice between vocational and general studies in high school, the Norwegian system could provide students with qualified materials that other countries do not have.For example, grades or standardized tests are not prioritized, and this is the most remarkable feature. The Advantages of Higher Education. For those who desire to be educated for free abroad, Norway is the right place to study; it is a paradise for your future career. Public universities have not received any tuition fees.This policy applies to any international student, despite their ethnic identity.The academic standard is very high, and teachers are easy to approach and are always willing to make an effort for students.Moreover, classes are organized in small groups to improve cooperation.Choosing any English-taught program is not a problem because there is no worry about language barriers outside the class. Most Norwegians speak English as a second language.It is easy to adapt to Norway's society for internationals,which is based on equality and fair opportunity. Conclusion. In conclusion, it was mentioned that the educational system focuses on overall student development.The system does not prioritize grades but instead emphasizes socialization, sports, and fun.The contribution to the success of Norway seems simple due to the fact that they use inclusive policies and place emphasis on quality.The Norwegian educational system itself is able to produce well-rounded and capable graduates who are prepared for success in a progressively globalized world. References. O. (2018, June 5). Higher Education in Norway Labour Market Relevance and Outcomes. OECD Publishing. The Norwegian Universities and Colleges Admission Service. (n.d.). https://www.samordnaopptak.no/info/english/ Education in Norway. (2020, May 23). https://www.unipage.net/en/education_norway O. (2018, June 5). Higher Education in Norway Labour Market Relevance and Outcomes. OECD Published Home. (n.d.). OECD iLibrary. https://www.oecd-ilibrary.org/sites/179d4ded-en/index.html?itemId=/content/publication/179d4ded-en

Public-Private Partnership Policy Casebook/New Karolinska Solna University Hospital. This case study reviews the "New Karolinska Solna University Hospital" project as a collaborative work of Katherine Wilson and Muhammet Mustafa Sever. The casebook is a product of the George Mason University graduate program, as an assignment for the "Public-Private Partnership Policy" course under the leadership of Dr. Jonathan Gifford. It explores case elements such as key actors, event timeline, risks, financial and institutional structures, policy issues, and takeaways. Summary. The New Karolinska Hospital Project was a complex undertaking involving the construction of a state-of-the-art healthcare facility in Sweden. The scope included the creation of a high-standard architectural marvel with 12 floors, covering an extensive area and boasting approximately 8000 rooms for various healthcare functions. The project also adhered to sustainable construction practices and aimed for LEED Gold certification. While it was marked by controversies, such as tax evasion allegations and a lack of competition in the procurement stage, it successfully reached completion, setting a benchmark for modern healthcare infrastructure. The project's key actors comprised a blend of public and private entities, each playing a crucial role in its realization. The collaboration between Region Stockholm, Karolinska Institutet, and private stakeholders like Swedish Hospital Partners AB, Skanska, and Innisfree was instrumental in delivering this significant healthcare infrastructure. Despite financial and operational challenges, the project was handed over on schedule, underscoring the ability to navigate complex transformations in healthcare infrastructure and construction within a public-private partnership framework. With an overall investment of $3.0 billion and a contract extending until 2040, it is considered the world's largest hospital public-private partnership (P3), showcasing a remarkable commitment to advancing healthcare infrastructure and services. Project Scope. Project scope included the construction of buildings with 12 floors, covering a total area of 320,000 square meters, including a 2-level underground parking facility. These buildings had approximately 8000 rooms, comprising patient rooms, 36 operating theaters, 8 radiation units, 168 doctor's surgeries, laboratories, and lecture halls.The scope of the New Karolinska Hospital Project also encompassed several key objectives, including: The construction of New Karolinska Solna represented Skanska's largest project to date, evident in various aspects such as the workforce, material consumption, construction facilities, and contract value. Here are some statistics that illustrated the project's scale: Annotated List of Actors. Private. Project Company/Special Purpose Vehicle: Technical and Financial Advisors:   Community Stakeholders: Key community stakeholders for the New Karolinska Hospital Project include local residents, doctors, nurses, patient and family groups, local businesses and environmental organizations. Timeline of the New Karolinska Hospital Project. 2000-2002. In the early 2000s, Region Stockholm, formerly known as Stockholm County Council, conducted a series of comprehensive investigations to assess how the county council could address the future healthcare demands. Towards the end of 2001, the SNUS investigation (Stockholm’s New University Hospital) was initiated to explore the necessity and opportunities for establishing a new university hospital. The report, published in November 2002, emphasized the role of a university hospital in providing specialized care and conducting high-quality research and education. In the context of the 3S (Stockholm Health Care Structure) investigation, Locum AB, the county estate agency, was tasked with conducting various preliminary studies related to the construction of the new hospital. 2008-2010. These investigations also involved cost comparisons between renovating existing structures and constructing new ones, with the conclusion favoring the construction of a completely new hospital on April 2008. The procurement of New Karolinska Solna was pursued as a P3 solution following a decision by Region Stockholm, the former Stockholm County Council, on June 10, 2008. This procurement approach aimed to minimize the risks of delays and cost overruns by transferring them to the P3 contractor responsible for the project. A comittee under the Region Stockholm started the tendering process with publishing the Request for Pre-Qualifications (RFPQ) and then Request for Tender (RFT) in 2009. The P3 contract was awarded on May 4, 2010 (majority decision), and later, on June 8 (all parties), following a new political agreement within Region Stockholm, the former Stockholm County Council. The project was ultimately awarded to a consortium consisting of Swedish Skanska and British Innisfree, tasked with constructing the NKS. The P3 Agreement reached financial close on June 30, 2010 and construction works started in the same year on September 3 with Crown Princess Victoria breaking ground at a ceremony on the construction site. 2011. Construction was in full swing, and the foundation for the new hospital buildings had been established. Sweden's largest construction trailer site was officially opened. 2012. In January, a public exhibition was inaugurated at the Karolinska Hospital, presenting the future university hospital. The parking garage became the first completed building in the area. 2014. The technological building's construction was finished. 2016. The hospital building, hotel, and research building were completed, and the first patients arrived at New Karolinska Solna. 2017-2040. The completion date for the NKS project, which was agreed in June 2010, between Swedish Hospital Partners (SHP) and Stockholm County Council (SCC), was March 2018. All seven phases have been handed over on schedule, and the final building was handed over in December 2017, three months ahead of the planned handover date. The Operations and Maintenance stage commenced upon the completion of Hospital Part 1's construction and is slated to persist until the conclusion of the concession period in 2040. As per the contractual agreement, Region Stockholm will be making annual availability payments to SHP throughout the entire concession period. Contract Type. The New Karolinska Hospital Project was procured through a P3 arrangement. Procured as a Design-Build-Finance-Operate-Maintain (DBFOM) contract, the project involved not only the construction of the hospital but also its long-term financing and maintenance. Region Stockholm, as the procuring authority, entered into this P3 contract with Swedish Hospital Partners (SHP), a consortium jointly owned by Swedish construction giant Skanska and British investment company Innisfree. The P3 model was chosen to ensure private sector expertise and funding were leveraged to deliver and maintain a state-of-the-art medical facility. Under this contract, a fixed price was agreed upon for the construction, operation, and maintenance of the hospital, with an indexation adjustment. This innovative contract structure aimed to combine the efficiency of private sector involvement with long-term public ownership and oversight, allowing the hospital to benefit from the latest advancements in medical care while maintaining cost predictability. P3s are characterized by the allocation of a significant portion of project execution risk to the contractor, as stipulated by the Region Stockholm. Under this model, the customer, in this case, the Region Stockholm, does not make upfront payments for the project. Instead, they make annual payments and milestone-based payments as each project phase is completed and becomes operational, a feature unique to the P3 framework. Notably, for the New Karolinska Solna project, the Region Stockholm has opted to co-finance the construction. They do so through ongoing monthly payments and milestone-based payments, aiming to reduce financing costs. Approximately half of the construction expenses are covered by the Region Stockholm, while private sector financing, comprising equity capital and bank loans, covers the rest. Following the final phase's completion, the Region Stockholm will continue making predetermined monthly payments until 2040 when they will assume direct operations although, there is an option to extend the agreement up to 2055. This extended contract duration offers substantial predictability, a unique aspect in the Swedish context. The Region Stockholm has established extensive functional and environmental criteria and delegated SHP with the responsibilities of designing, constructing, co-financing, and managing the hospital in accordance with these requirements. This encompasses all aspects, from technical operations to various services such as reception, caretaking, cleaning, and laundry. Consequently, SHP acts as the project manager, with Skanska handling project planning and construction, and Coor Service Management taking charge of property operations and services. This framework offers a unique opportunity for all stakeholders to actively contribute to the design and planning phase, facilitating the optimization of logistical processes and the early development of innovative solutions. In the P3 model, the Stockholm County Council maintains ownership of the property but entrusts the operation and maintenance to SHP for the duration of the contract. This arrangement grants the County Council full cost control until 2040, ensuring that the property remains in pristine condition with no need for repairs or extensive maintenance. The long-term operating agreement places a strong emphasis on top-tier quality, with a focus on selecting systems and materials that prioritize long-term sustainability and cost-effectiveness throughout the project's entire lifecycle. Importantly, any unexpected expenses resulting from construction delays are the responsibility of SHP, relieving the County Council of such financial burdens. Cost & Financial Structure. The project carries a construction cost of SEK 14.5 billion (~$1.3 bn). Stockholm County Council, the procuring authority, will directly cover 50% of these costs, while the remaining 50% will be financed through a combination of debt and equity. Specifically, a total of SEK 1.18 billion (~$108.4 mn) in equity will be invested, split equally between project sponsors Skanska and Innisfree. The project will also receive SEK 8.76 billion (~$804.4 mn) in debt financing, with a 28.5-year tenor. Crucially, the cost of constructing, operating, and maintaining the NKS project until 2040 remains fixed with an indexation adjustment. The original construction contract, signed at SEK 14.5 billion (~$1.3 bn) in 2010, remained unchanged.However, evolving healthcare service plans after the 2010 agreement have led to several additional orders initiated by the SCC. These include expanding the treatment building with eighty more hospital beds and introducing a production kitchen, incurring a total cost of SEK 1.7 billion (~$156.2 mn). Furthermore, SCC had additional expenses totaling SEK 4.3 billion (~$395.1 mn) for items such as medical equipment, furniture, and IT, which were accounted for in the budget from the project's inception. Additionally, SCC is renovated existing hospital buildings at a cost of SEK 2.3 billion (~$211.3 mn), which were separate from the SHP agreement. Total cost of building, equipping, operating and maintaining the hospital until 2040 is estimated to reach SEK 61 billion (approx. $5.6 billion). Refinancing. Swedish Hospital Partners successfully refinanced the debt associated with the New Karolinska Solna Hospital project in 2018. Originally project-financed in 2010, marking Sweden's first hospital P3, the remaining amount, SEK 5.1 billion (~$468.6 mn) of the original SEK 8.76 billion (~$804.4 mn) debt has been reduced to SEK 3 billion (~$275.6 mn), accompanied by a margin reduction from 215 basis points to 140 basis points. The lenders involved in the refinancing include the European Investment Bank (EIB), Nordic Investment Bank, SEB, Nordea, Svenska Handelsbanken, and KfW. As part of the project agreement, Region Stockholm, the concession grantor, committed to a one-time payment of SEK 3 billion (~$275.6 mn) to SHP, which was applied to prepayments and clearing swaps on the debt. This refinancing initiative is expected to decrease the project's financing costs by SEK 2.1 billion (~$193 mn). The advisory team overseeing the refinancing consisted of Newbridge Advisers representing the sponsor, with legal guidance from Hamilton; Mannheimer Swartling acting on behalf of Stockholm County Council, and Vinge providing counsel for the lenders. Controversies. Tax Evasion. The New Karolinska Solna (NKS) project has been marred by allegations of tax evasion, as revealed by an investigation conducted by the Swedish TV program "Uppdrag granskning" (Mission: Investigation). A significant point of contention revolves around the tax structure that SHP established using Luxembourg subsidiaries. This arrangement ultimately led to substantially reduced tax liabilities in Sweden. Multinational auditing and consulting firm PwC was hired by Innisfree to create this tax structure in Luxembourg a few months after SHP was awarded the 52 billion Swedish Crown NKS contract. The confidential agreement between Innisfree and the Luxembourg government has been revealed as part of a cache of more than 500 leaked tax rulings and financial documents published by the International Consortium of Investigative Journalists (ICIJ). In response to these allegations, it's worth noting that SHP has defended its position, asserting that no tax evasion or aggressive tax planning occurred concerning the NKS project. According to SHP, no hybrid loans were involved in the project, and no tax revenues have disappeared from Sweden due to the presence of its partner being registered in Luxembourg. Skanska, being a Swedish investor in the NKS project, pays taxes in Sweden. Innisfree, on the other hand, serves as a coordinator for foreign investment funds, and these funds pay taxes in the countries where they are registered for tax purposes. While these claims offer a counter-narrative, the tax structure and the overall tax implications of the NKS project remain subjects of investigation and debate. Lack of Competition. A noteworthy and contentious aspect of the NKS P3 project is that ultimately, there was only a single proposal submitted, specifically by the SHP. The initial plan by Stockholm County, based on assessments by PwC and Ernst & Young, called for a minimum of three bidders. Both PwC and Ernst & Young emphasized the importance of competition in achieving reduced investment and maintenance costs and fostering innovation. They recommended that this be ensured through the participation of three to five bidders. When it became evident that there was only a single proposal, the responsible officials in Region Stockholm sought advice from another consulting firm, Gullers, based in Stockholm. Gullers responded that if Skanska/Innisfree were aware they were the sole bidders, the competitive dynamics would not be effective and recommended a new, traditional procurement process. Subsequently, the officials turned to yet another Swedish-based consulting firm, JKL, which argued that the competitive dynamics of the private sector could still function even with only one bid. Another legal consulting firm also confirmed that the decision to proceed with the Skanska/Innisfree bid was in compliance with public procurement regulations. However, the fact that there was just one bid sparked a heated debate among the Stockholm County officials. Left-wing parties in Stockholm County contended that, in order for competitive forces to function, there should have been three bids and called for abandoning the P3 project when it failed to attract more than one bid. On the other hand, the right-wing parties, which held the majority in the county, asserted that even with just one bid, the entities behind it were still subject to the competitive dynamics of the private sector. In the vote on May 4, 2010, the decision to proceed with the Skanska/Innisfree bid was made. The failure to achieve the goal of securing three bids also became a central point of criticism in the media, particularly as concerns regarding escalating operational costs swirled around the NKS P3 project. Increased Costs. According to some sources The New Karolinska Hospital project was initially estimated at 5.3 billion SEK (approximately US$ 600 million) and then saw a significant cost increase to 14.1 billion SEK (approximately US$ 1.6 billion) at the time of the agreement signing. Moreover, same sources report shortly thereafter, the project manager admitted that the actual cost would soar to 22 billion SEK (approximately US$ 2.5 billion). This amount did not encompass maintenance costs or interest on loans. While the ruling political party in the Region Stockholm claimed the construction and maintenance cost until 2040 would be 52 billion SEK (approximately US$ 6 billion), a former member projected it could reach 69 billion SEK (approximately US$ 8 billion) due to high interest rates and undisclosed expenses. However, SHP claims despite these financial and operational challenges, all seven phases were handed over as scheduled, with the final building being delivered in December 2017, three months ahead of the planned handover date. The project was procured at a fixed price, with the construction contract of SEK 14.5 billion signed in 2010 remaining unchanged, arguing that Skanska successfully delivered one of the world's most modern and sustainable hospitals within the agreed budget and schedule. Key Takeaways. This case study shows that public organisations undertook a complex endeavor that involved two simultaneous, intricate changes, as highlighted by Jonas Wohlin, the founder of Ivbar, a Swedish health technology advisory and product company. This endeavor encompassed the construction of a new hospital through the P3 model and a transformation in the structure of healthcare delivery. The aim of the latter was to shift from the traditional care model to one organized around themes and patient groups which is called "Value-based healthcare". One could argue that implementing both changes concurrently allowed hospital managers to tailor the hospital's design to their operational vision. However, this dual transformation has proven to be quite challenging. The reorganization compelled clinicians who had previously worked in different clinics to seek new positions, generating more resistance from doctors than nurses, and leading major newspapers to join the opposition against the reformers. The privatization of the healthcare services emerged as the central term in the debate, with all the changes at Karolinska, including challenges with reorganization, value-based patient care, and discussions about tax avoidance practices, being grouped into the P3 discussion. We believe that private stakeholders made efforts to address these issues, but the public side failed to engage in proactive and frequent communication. This overall situation contributed to a negative perception of the P3 model among Swedish citizens, especially when influenced by anti-privitization politicians. Another key lesson underscores the significance of competition during the procurement stage. While it is challenging to assert that the project would have been more cost-effective with increased competition at the procurement stage, it's clear that Region Stockholm could have leveraged its public construction and facility management organization, Locum. Locum possessed extensive experience in engaging with construction suppliers, healthcare professionals, and medical technology equipment providers. This experience could have been utilized to facilitate a bid for the project with a traditional delivery model, providing a basis for comparison with SPH's bid. Such a comparative approach would have rendered the decision to opt for the P3 model more justifiable, especially in the face of public criticism.

How to program a TI-84 Plus CE. Here is a table of contents for this book! You can suggest edits to existing pages, but don't vandalize and don't create new pages from red links. <br><br> Part 1: Intro <br> <br> Part 2: Variables <br><br> More will be added soon!

How to program a TI-84 Plus CE/Intro to TI-BASIC. The TI-84 Plus CE is an interesting specimen. It's probably one of the most common calculators for high school and college students, yet many don't know of all of its features. <br><br> One of these features is the ability to write programs in BASIC. This feature is heavily under-utilised by the vast majority of users, yet the dialect of BASIC used on these calculators is very versatile, and is able to make complex programs run on one of the most unassuming computers. <br><br> This wikibook is about programming the TI-84 Plus CE specifically, although if you have another Texas Instruments graphing calculator, you may still be able to learn some things you could use. <br><br> Let's begin at the very bottom, shall we?

Salom, Jonatan!/Mon 5. Monlari – Mon 4 – Mon 5 – Mon 6 Limayum mon (5yum mon). Care de mesi lima (4 de mesi 5). Nundin, Jonatan xa turi cel Konte Drakula. In hotel, te oko hotelyen, ji oko suratu de Konte Drakula in hanta de hotelyen. Te loga tas hotelyen in Doycisa, “Salom. Fe lutuf, am gibe tas mi suratu.” Hotelyen gibe tas te suratu. Xafe to, te swal in Doycisa, “Suratu sen keto? Drakula le eskri keto in suratu?” Mas hotelyen loga, “Mi no pala Doycisa, mi no pala Doycisa.” Jonatan fikir: “Ajabu! Jaledin, mi le pala ton hotelyen in Doycisa, ji fe nunya, te loga ki te no pala Doycisa! Keseba?” Te swal hotelyen, “Kam yu jixi ku Konte Drakula sen kete?” mas fe nunya, hotelyen no pala. Jonatan fikir, “Ajabu! Mi le pala ton hotelyen in Doycisa. Te ingay na pala Doycisa, mas te pala ki te no pala to! Mi ingay na swal te max, mas mi no hare watu. Mi ingay na idi.” Fe nunya, Jonatan sen in tesu kamer in hotel. Xafe un satu, te ingay na xoridi. Mas am oko! Lao ixu le ata cel tesu kamer. Lao ixu: “Yu xoridi keseba? Fe lutuf, am no xoridi! Nundin no sen bon din! To sen bur din, din har bur xey!” Jonatan: “Mi sen bon, mi ata cel na tonata doste. Fe lutuf, am no pala tem bur xey.” Lao ixu: “Kam yu no jixi ki nundin sen din de Santo Jorje? Fe satu des dua (12), bur xey xa ata! Kam yu jixi ku yu idi cel keloka?” Jonatan: “No no, lao ixu, moyto sen bon. Mi sen bon, ji mal xey xa no ata nundin.” Lao ixu: “Fe lutuf, am no xoridi! Am no xoridi!” Jonatan: “No, mi ingay na xoridi. Fe lutuf, am no wawa.” Lao ixu: “Prehay persaluba. Persaluba sen tas yu.” Jonatan: “A…Engliyen no suki persaluba…mas xukra. Fe lutuf, am no wawa.” Jonatan pensa, “In Engli, imi suki saluba, mas no persaluba. In Rumani, ete suki persaluba, no saluba.” Fe nunya, lao ixu idi, ji Jonatan sen solo in tesu kamer. Te fikir, “Hin loka sen ajabu! Lao ixu hu "da" gibe persaluba! Mas mi ingay na xoridi.”

A Guide to Sylheti Wikipedia/Introduction. Sylheti Wikipedia in the Wikimedia Incubator is an ongoing collaborative project aimed at creating a free online encyclopedia in the Sylheti language. This initiative is part of the broader Wikimedia movement, which is committed to providing free knowledge to people worldwide. The Sylheti Wikipedia project is currently hosted within the Wikimedia Incubator, where new language editions are developed and tested before becoming independent Wikimedia projects. The Sylheti Language. Sylheti is an Indo-Aryan language predominantly spoken in the Sylhet region of Bangladesh, India and among the Sylheti diaspora worldwide. It employs its own script, which resembles the Kaithi script but incorporates distinct characters to represent the unique Sylheti sounds. Wikimedia Incubator. The Wikimedia Incubator serves as a dedicated space within the Wikimedia ecosystem for nurturing new language editions of Wikimedia projects such as Wikipedia, Wiktionary, and Wikibooks. This platform enables language communities to create content and conduct testing before attaining full independence as Wikimedia projects. Wikimedia Incubator, established on June 2, 2006, is a wiki-based platform operated by the Wikimedia Foundation, a non-profit organization known for hosting Wikipedia and various other projects. History of Sylheti Wikipedia. The Sylheti Wikipedia project was started with the objective of creating an extensive knowledge repository in the Sylheti language. It commenced its journey within the Wikimedia Incubator, where early contributors actively worked on articles, templates, and other content. The project's primary goal is the preservation and dissemination of the unique culture, history, and knowledge of the Sylheti-speaking community.

A Guide to Sylheti Wikipedia/Challenges and Future Prospects. As with many Wikimedia Incubator projects, the Sylheti Wikipedia faces various challenges, including a limited number of active contributors, the necessity for additional reliable sources in Sylheti, and the expansion of its content base. Nevertheless, through the unwavering commitment of its community, these challenges can be surmounted.The future outlook for the Sylheti Wikipedia project is promising. As it continues to grow and mature, it may eventually transition out of the Incubator, becoming an independent Wikimedia project. This evolution would significantly enhance access to knowledge in the Sylheti language for a global audience.

A Guide to Sylheti Wikipedia/Movement. Sylheti Wikipedia in the Wikimedia Incubator is a commendable initiative focused on preserving and disseminating knowledge in the Sylheti language. By providing a platform for collaboration and contribution among Sylheti speakers and enthusiasts, this project plays a vital role in advancing the broader Wikimedia movement's mission of making knowledge freely accessible to all. With the ongoing dedication of its community, the Sylheti Wikipedia project is poised to become a substantial resource for Sylheti language and culture.

A Guide to Sylheti Wikipedia/No Significance Beyond the Community. Clarification: Sylheti Wikipedia has the potential to serve as a valuable resource for those interested in Sylheti culture, language, and history, regardless of their linguistic background. It contributes to the broader Wikimedia mission of making knowledge accessible to all.

Elementary Sylheti. Related Wikibooks. __NOEDITSECTION__

Elementary Sylheti/About. The "Elementary Sylheti" Wikibook is a valuable resource for individuals interested in learning the Sylheti language, which is spoken primarily in the Sylhet region of South Asia and among Sylheti diaspora communities worldwide. This collaborative project on Wikimedia provides a comprehensive and accessible introduction to the language, catering to beginners and language enthusiasts alike. The Wikibook covers essential basic topics such as pronunciation, grammar, vocabulary, and enabling learners to develop a solid foundation in Sylheti. It offers a dynamic and evolving platform for language learners, fostering a sense of community and cultural exchange. Whether you're a Sylheti heritage speaker looking to reconnect with your roots or a newcomer eager to explore a unique South Asian language, the "Elementary Sylheti" Wikibook could be a handy resource.

Elementary Sylheti/Introduction. Welcome to the world of Sylheti language and culture! The "Elementary Sylheti" Wikibook is your gateway to unlocking the beauty and depth of Sylheti, a language spoken in the enchanting Sylhet region of South Asia and cherished by Sylheti communities around the globe. Whether you're a curious beginner eager to grasp the basics or a heritage speaker looking to strengthen your connection to your roots, this collaborative Wikibook is here to guide you. Our mission is to provide you with a comprehensive, accessible, and engaging resource that not only teaches you the fundamentals of Sylheti pronunciation, grammar, and vocabulary but also immerses you in the rich cultural context of the language. Through this Wikibook, you'll embark on a journey of language learning, cultural exploration, and community building. So, let's embark on this adventure together as we discover the fascinating world of Sylheti language and heritage!

Elementary Sylheti/How this book works. One of the crucial skills to acquire during your academic journey is the ability to navigate unfamiliar language interactions. If you've primarily taken structured language courses in school, you might not have encountered this skill, as such classes often emphasize incremental mastery of each language element. Immersive language learning, on the other hand, equips you with the tools necessary to communicate effectively in a native speaker environment, exposing you to elements of the language that you may not have encountered before. This approach mirrors how children naturally learn in school.

Sylheti Grammar. = Sylheti Grammar = Sylheti Grammar provides an overview of the grammatical aspects of the Sylheti language, an Indo-Aryan language primarily spoken in the Sylhet and among the Sylheti diaspora. Phonology. Sylheti exhibits a wide range of vowel and consonant sounds, including nasalized vowels and retroflex consonants. Nouns. Some Sylheti nouns are gender-neutral and can be singular or plural. Plural forms are often created by adding suffixes. Pronouns. Sylheti pronouns encompass subject, object, and possessive forms, with distinct polite and familiar forms. Verbs. Verbs in Sylheti are conjugated based on tense, aspect, and mood. Affirmative and negative sentences use different verb forms, often indicating completion or ongoing actions. Word Order. The typical word order in Sylheti sentences is Subject-Object-Verb (SOV). However, word order can vary depending on context. Adjectives and Adverbs. Adjectives typically follow the nouns they modify, while adverbs can be positioned before or after the verb. Syntax. Sylheti employs postpositions instead of prepositions, and context and intonation play a significant role in conveying meaning. Questions and Negation. Questions in Sylheti are formed using question particles or by altering word order. Negation is typically expressed through specific negative particles. Tone and Politeness. Politeness is emphasized in Sylheti's speech, with different levels of politeness. Tone and intonation contribute to conveying politeness.

Internal Medicine/Pain. Pain-Sensory System. Pain refers to an uncomfortable sensation localized in a specific part of the body. It is frequently described in terms of a penetrating or tissue-damaging process (e.g., stabbing, burning, twisting, tearing, squeezing) and/or a bodily or emotional reaction (e.g., terrifying, nauseating, sickening). Additionally, pain of moderate or higher intensity is accompanied by anxiety and a desire to escape or terminate the sensation. These properties demonstrate that pain has a dual nature: it encompasses both sensation and emotion. In its acute form, pain is typically linked to increased alertness and a stress response, which includes elevated blood pressure, heart rate, pupil dilation, and plasma cortisol levels. Moreover, local muscle contractions (e.g., limb flexion, abdominal wall rigidity) are often observed. Peripheral mechanism. A peripheral nerve consists of axons from three different types of neurons: primary sensory afferents, motor neurons, and sympathetic postganglionic neurons. Primary sensory afferents have their cell bodies located in the dorsal root ganglia within the vertebral foramina. These afferents have two branches, one projecting into the spinal cord and the other extending to innervate peripheral tissues. They are categorized based on their diameter, degree of myelination, and conduction speed. The largest-diameter afferent fibers, known as A-beta (Aβ), are most sensitive to light touch or moving stimuli and are primarily found in skin-innervating nerves. In normal circumstances, the activity of these fibers does not induce pain. There are two other types of primary afferent nerve fibers: small-diameter myelinated A-delta (Aδ) and unmyelinated (C) axons. These fibers are present in nerves supplying the skin as well as deep somatic and visceral structures. Most Aδ and C fiber afferents respond intensely to noxious (painful) stimuli, causing the subjective experience of pain when activated. This identifies them as primary afferent nociceptors or pain receptors. Blocking conduction in Aδ and C fiber axons completely eliminates the ability to detect painful stimuli. Individual primary afferent nociceptors can respond to various types of noxious stimuli, including heat, intense cold, intense mechanical distortion (e.g., pinching), changes in pH (especially acidity), and the application of chemical irritants like adenosine triphosphate (ATP), serotonin, bradykinin (BK), and histamine. The transient receptor potential cation channel subfamily V member 1 (TrpV1), also known as the vanilloid receptor, plays a role in detecting certain noxious stimuli, especially heat sensations, and is activated by heat, acidic pH, endogenous mediators, and capsaicin (a component of hot chili peppers). When intense, repetitive, or prolonged stimuli are applied to damaged or inflamed tissues, the threshold for activating primary afferent nociceptors is lowered, and their firing frequency increases for all stimulus intensities. This process, called sensitization, involves inflammatory mediators such as BK, nerve-growth factor, some prostaglandins (PGs), and leukotrienes. Sensitization occurs both at the peripheral nerve terminal (peripheral sensitization) and at the dorsal horn of the spinal cord (central sensitization). Peripheral sensitization takes place in damaged or inflamed tissues, where inflammatory mediators trigger intracellular signal transduction in nociceptors, leading to increased production, transport, and membrane insertion of chemically gated and voltage-gated ion channels. These changes raise the excitability of nociceptor terminals and lower their activation threshold for mechanical, thermal, and chemical stimuli. Central sensitization happens when activity generated by nociceptors during inflammation heightens the excitability of nerve cells in the dorsal horn of the spinal cord. After injury and subsequent sensitization, stimuli that would normally be innocuous can trigger pain, a phenomenon known as allodynia. Sensitization is a significant process contributing to tenderness, soreness, and hyperalgesia (heightened pain intensity in response to the same noxious stimulus, such as a pinprick causing severe pain). An illustrative example of sensitization is sunburned skin, where gentle touch or a warm shower can produce severe pain. Sensitization holds particular importance in deep tissues. Normally, viscera are relatively insensitive to noxious mechanical and thermal stimuli, although hollow viscera may cause significant discomfort when distended. However, when deep structures, such as joints or hollow viscera, are affected by a disease process with an inflammatory component, they typically become highly sensitive to mechanical stimulation. In noninjured, noninflamed tissue, a substantial portion of Aδ and C fiber afferents innervating viscera are completely insensitive to known mechanical or thermal stimuli and remain inactive. Yet, in the presence of inflammatory mediators, these afferents become responsive to mechanical stimuli. Such afferents are termed silent nociceptors, and their distinct characteristics help explain how relatively insensitive deep structures can become sources of severe and debilitating pain and tenderness. Low pH, prostaglandins (PGs), leukotrienes, and other inflammatory mediators, such as BK, play a significant role in sensitization. Primary afferent nociceptors do not merely convey information about tissue injury threats; they also play an active role in tissue protection by serving as neuroeffectors. Most nociceptors contain polypeptide mediators like substance P, calcitonin gene-related peptide (CGRP), and cholecystokinin. When activated, these mediators are released from the nociceptors' peripheral terminals. Substance P, for instance, is an 11-amino-acid peptide released in peripheral tissues by primary afferent nociceptors and possesses various biological functions. It acts as a potent vasodilator, triggers mast cell degranulation, attracts leukocytes, and enhances the production and release of inflammatory mediators. Interestingly, depleting substance P from joints has been shown to reduce the severity of experimental arthritis. Central Mechanism. Primary afferent nociceptors' axons enter the spinal cord through the dorsal root, terminating in the dorsal horn of the spinal gray matter. These primary afferent axon terminals make contact with spinal neurons responsible for transmitting pain signals to areas in the brain associated with pain perception. When primary afferents are stimulated by noxious stimuli, they release neurotransmitters from their terminals, exciting spinal cord neurons. The primary neurotransmitter released is glutamate, which rapidly stimulates the second-order dorsal horn neurons. Additionally, primary afferent nociceptor terminals release substance P and CGRP, which result in a slower and longer-lasting excitation of the dorsal horn neurons. Each primary afferent's axon connects with numerous spinal neurons, and each spinal neuron receives input from multiple primary afferents. The convergence of sensory inputs onto a single spinal pain-transmission neuron is significant because it gives rise to referred pain. All spinal neurons receiving input from viscera and deep musculoskeletal structures also receive input from the skin. The convergence patterns are determined by the spinal segment of the dorsal root ganglion that supplies afferent innervation to a structure. For instance, afferents supplying the central diaphragm originate from the third and fourth cervical dorsal root ganglia. These same ganglia's primary afferents supplying the skin of the shoulder and lower neck also come from there. As a result, sensory inputs from both the shoulder skin and the central diaphragm converge onto pain-transmission neurons in the third and fourth cervical spinal segments. Due to this convergence and the fact that spinal neurons are usually activated by skin inputs, the patient often mislocates the pain sensation produced by inputs from deep structures to a bodily area that roughly corresponds to the skin's innervated region from the same spinal segment. Consequently, inflammation near the central diaphragm is frequently reported as shoulder discomfort. This shift of pain sensation from the actual injury site is termed referred pain. The majority of spinal neurons contacted by primary afferent nociceptors send their axons to the contralateral thalamus. These axons constitute the contralateral spinothalamic tract, which traverses the anterolateral white matter of the spinal cord, the lateral edge of the medulla, and the lateral pons and midbrain. The spinothalamic pathway is essential for pain perception in humans. Disruption of this pathway results in permanent deficits in pain and temperature discrimination. Spinothalamic tract axons ascend to various thalamic regions. From these thalamic sites, the pain signal diverges significantly to several distinct regions of the cerebral cortex, each serving different aspects of the pain experience. One of these thalamic projections targets the somatosensory cortex, responsible for the sensory discriminative aspects of pain, such as its location, intensity, and quality. Other thalamic neurons project to cortical regions associated with emotional responses, like the cingulate and insular cortex. These pathways to the frontal cortex manage the affective or emotional dimension of pain, which leads to suffering and significantly influences behavior. The emotional dimension of pain induces fear as a constant companion of pain. Consequently, injuries or surgical lesions to frontal cortex areas activated by painful stimuli can reduce the emotional impact of pain while preserving the individual's ability to recognize noxious stimuli as painful. Pain Modulation. The intensity of pain resulting from injuries of similar magnitude can vary widely across different situations and individuals. For instance, athletes have been known to sustain severe fractures with minimal pain, and Beecher's well-known World War II survey revealed that many soldiers in combat did not seem bothered by injuries that would have caused excruciating pain in civilian patients. Moreover, the mere suggestion that a treatment will alleviate pain can have a significant analgesic effect, known as the placebo effect. Conversely, many patients find even minor injuries like venipuncture terrifying and unbearable, and the expectation of pain can induce pain even without an actual noxious stimulus. The suggestion that pain will worsen after receiving an inactive substance can also amplify its perceived intensity, known as the nocebo effect. Expectation and other psychological factors have a substantial impact on pain intensity, and this can be explained by brain circuits that modulate pain-transmission pathway activity. One of these circuits has connections to the hypothalamus, midbrain, and medulla, selectively regulating spinal pain-transmission neurons via a descending pathway. Functional brain imaging studies in humans have implicated this pain-modulating circuit in the pain relief induced by attention, suggestion, and opioid analgesic medications. Additionally, all component structures of this pathway contain opioid receptors and respond to direct application of opioid drugs. In animals, lesions of this descending modulatory system reduce the analgesic effect of systemically administered opioids like morphine. The most consistent way to activate this endogenous opioid-mediated modulatory system is through suggestions of pain relief or strong emotions unrelated to the painful injury, such as during intense threat or athletic competition. Following surgical procedures and administration of a placebo for pain relief, endogenous opioid-mediated pain relief is observed. Pain-modulating circuits can either amplify or suppress pain. Both pain-inhibiting and pain-facilitating neurons in the medulla project to and regulate spinal pain-transmission neurons. As a result, pain-transmission neurons can be activated by modulatory neurons, potentially generating a pain signal without a peripheral noxious stimulus. Human functional imaging studies have revealed increased activity in this circuit during migraine headaches, suggesting a central circuit that facilitates pain. This concept helps explain how psychological factors can contribute to chronic pain and how pain can be induced or intensified by suggestion or expectation. Neuropathic pain. Lesions in peripheral or central nociceptive pathways typically result in a loss or impairment of pain sensation. Paradoxically, damage or dysfunction in these pathways can also lead to pain. For instance, damage to peripheral nerves, as seen in diabetic neuropathy, or primary afferents, as in herpes zoster infection, can lead to pain referred to the body region innervated by the affected nerves. Pain can also arise from damage to the central nervous system (CNS), such as after trauma or vascular injury affecting spinal cord, brainstem, or thalamic regions containing central nociceptive pathways. These pains are termed neuropathic and are often severe and resistant to standard pain treatments. Neuropathic pain typically features a distinct burning, tingling, or electric shock-like quality and may occur spontaneously without any apparent stimulus or be triggered by very light touch. These characteristics are uncommon in other types of pain. On examination, a sensory deficit usually coincides with the area of the patient's pain. Hyperpathia, an exaggerated pain response to non-painful or mild noxious stimuli, especially with repetitive application, is another characteristic of neuropathic pain; patients often complain that even the slightest touch elicits severe pain (referred to as allodynia). Notably, a topical 5% lidocaine patch has proven effective for postherpetic neuralgia patients who experience prominent allodynia. Various mechanisms contribute to neuropathic pain. Similar to sensitized primary afferent nociceptors, damaged primary afferents, including nociceptors, become highly responsive to mechanical stimulation and may generate impulses even in the absence of stimulation. Increased sensitivity and spontaneous activity are, in part, due to an elevated density of sodium channels in the damaged nerve fibers. Additionally, damaged primary afferents may become sensitive to norepinephrine. Intriguingly, spinal cord pain-transmission neurons disconnected from their normal input may also exhibit spontaneous activity. Therefore, both central and peripheral nervous system hyperactivity contribute to neuropathic pain. Patients who have sustained peripheral nerve injuries sometimes develop spontaneous pain within or beyond the region innervated by the affected nerve. This pain often presents as a burning sensation. Typically, this pain begins after a delay of hours to weeks and is accompanied by swelling of the affected extremity, periarticular bone loss, and arthritis in the distal joints. Early in the course of this condition, the pain may be alleviated by a local anesthetic block of the sympathetic innervation to the affected extremity. Damaged primary afferent nociceptors acquire sensitivity to adrenergic stimulation and can be triggered by sympathetic outflow. This constellation of spontaneous pain and signs of sympathetic dysfunction following injury is referred to as complex regional pain syndrome (CRPS). When it occurs following a recognizable nerve injury, it is known as CRPS type II (also called posttraumatic neuralgia or causalgia if severe). If a similar clinical presentation occurs without an obvious nerve injury, it is termed CRPS type I (also known as reflex sympathetic dystrophy). CRPS can result from various injuries, including bone fractures, soft tissue trauma, myocardial infarction, and stroke. Typically, CRPS type I resolves with symptomatic treatment, but in cases of persistent pain, detailed examination often reveals evidence of peripheral nerve injury. Although the pathophysiology of CRPS is not well understood, acute pain and signs of inflammation are often rapidly relieved by blocking the sympathetic nervous system. This suggests that sympathetic activity can activate undamaged nociceptors in the presence of inflammation. Patients with posttraumatic pain and inflammation and no other apparent explanation should be evaluated for signs of sympathetic hyperactivity. Treatment: Acute Pain. The primary goal in treating any pain is to identify and address the underlying cause. While immediate treatment can be initiated, efforts to diagnose and treat the root cause of the pain should always proceed alongside pain management. In some cases, treating the underlying condition may not provide immediate pain relief. Additionally, certain conditions are so painful that swift and effective pain relief is essential. Examples include the postoperative state, burns, trauma, cancer, or sickle cell crisis. In such cases, analgesic medications become the first line of treatment, and it's crucial for healthcare providers to be well-versed in their use. Aspirin, Acetaminophen, and Nonsteroidal Anti-Inflammatory Agents (NSAIDs). These drugs are grouped together because they are used to manage similar types of pain and may share a similar mechanism of action. All these medications inhibit an enzyme called cyclooxygenase (COX), with the exception of acetaminophen, and most of them have anti-inflammatory properties, particularly at higher doses. They are especially effective for treating mild to moderate headaches and pain originating from musculoskeletal conditions. COX inhibitors, including aspirin and NSAIDs, are the most commonly used analgesics because they effectively alleviate common types of pain and are available without a prescription. They are absorbed efficiently in the gastrointestinal tract and, with occasional use, generally have minimal side effects. However, chronic use of aspirin and NSAIDs can lead to gastric irritation, which is the most common side effect. Aspirin, in particular, is associated with the risk of gastric mucosal erosion, ulcers, bleeding, or perforation due to its irreversible effect on platelet COX, affecting blood clotting. Older individuals and those with a history of gastrointestinal problems are at an increased risk when using aspirin and NSAIDs. Besides the well-known gastrointestinal risks, NSAIDs can also have a negative impact on kidney function in individuals prone to renal insufficiency, especially when there is a significant decrease in intravascular volume, as seen with chronic diuretic use or acute hypovolemia. Additionally, NSAIDs may raise blood pressure in some individuals, necessitating regular blood pressure monitoring for those on long-term treatment. Unlike aspirin and NSAIDs, acetaminophen rarely causes gastric irritation and does not affect platelet function. Ketorolac and diclofenac, two parenteral (administered through injection) forms of NSAIDs, have extended the utility of this class of drugs in managing severe acute pain. These agents are potent and fast-acting, often replacing opioids as the primary treatment for many patients with severe headaches and musculoskeletal pain. It's worth noting that there are two major types of cyclooxygenase: COX-1, which is constitutively expressed, and COX-2, which is induced during inflammation. Opioid Analgesics. Opioids are the most potent pain-relieving medications available. They have a broad spectrum of effectiveness and provide reliable and effective relief for severe pain. While opioids can cause side effects, most of these effects are reversible. Common opioid-related side effects include nausea, vomiting, itching, sedation, and constipation. Respiratory depression, although uncommon at standard analgesic doses, can be life-threatening and should be closely monitored. The opioid antagonist naloxone can rapidly reverse opioid-related side effects. The fear of inducing addiction in patients is a concern for some healthcare providers and patients. However, the risk of patients becoming addicted to opioids when used for medical purposes is very low. For chronic pain, especially chronic noncancer pain, the risk of addiction in patients taking opioids on an ongoing basis remains small. The key principle in opioid use is to provide adequate pain relief, and healthcare providers should not hesitate to prescribe an adequate dose to ensure that patients are not suffering needlessly. Patient-controlled analgesia (PCA) is a widely used approach for managing pain, especially postoperative pain. PCA devices allow patients to self-administer small, controlled doses of opioid medications. This approach is effective for achieving optimal pain relief and is often used in hospital settings. It can also be employed for short-term home care for patients with severe, uncontrolled pain. Other Routes of Administration. In addition to traditional oral and intravenous administration, opioids can be delivered through various routes to improve patient comfort and adherence. These include intranasal (e.g., butorphanol), rectal, transdermal (e.g., fentanyl and buprenorphine), and oral mucosal (e.g., fentanyl) routes. These alternative routes help avoid frequent injections in patients who cannot take oral medication and can provide steady plasma levels, improving patient comfort. Newer agents like alvimopan and methylnaltrexone have been developed to address opioid-related side effects. These peripherally acting opioid antagonists can help reverse the adverse effects of opioids in the gastrointestinal tract and alleviate constipation. Combining Opioids with COX Inhibitors. When opioids are combined with COX inhibitors, their effects add up. This combination allows for the use of lower doses of each medication to achieve the same level of pain relief, reducing the severity of dose-related side effects. However, it's essential to be cautious when using fixed-ratio combinations of opioids with acetaminophen because of the risk of excessive acetaminophen exposure with escalating opioid doses. Excessive acetaminophen intake can lead to liver toxicity. Therefore, many practitioners avoid opioid-acetaminophen combination analgesics to mitigate this risk. Chronic Pain. Managing patients with chronic pain presents both intellectual and emotional challenges. The nervous system can become sensitized without an apparent cause, such as in cases of fibromyalgia or chronic headaches. In many instances, chronic pain evolves into a distinct condition on its own. Determining the exact cause of the pain is often difficult or even impossible, and such patients can be demanding and emotionally distressed. The traditional medical approach of searching for an underlying organic issue is often unhelpful. Conversely, psychological assessment and treatments based on behavior can be beneficial, especially in multidisciplinary pain management centers. Unfortunately, this approach is underutilized in current medical practice. Various factors can contribute to, perpetuate, or worsen chronic pain. First, patients may have an inherently painful condition without a known cure, like arthritis, cancer, chronic daily headaches, fibromyalgia, or diabetic neuropathy. Second, secondary factors can continue to cause pain even after the initial disease has resolved, such as damaged sensory nerves, sympathetic nerve activity, and painful muscle spasms. Finally, psychological conditions can exacerbate or even cause pain. Several aspects of a patient's medical history warrant special attention. Given that depression is the most common emotional issue in chronic pain patients, it's important to inquire about mood, appetite, sleep patterns, and daily activity. A standardized questionnaire like the Beck Depression Inventory can be a useful screening tool. It's crucial to recognize that major depression is a common but treatable and potentially life-threatening condition. Other signs that a significant emotional issue may be contributing to a patient's chronic pain include pain occurring in unrelated areas, a history of recurrent but separate pain issues starting in childhood or adolescence, pain associated with emotional trauma, such as the loss of a loved one, a history of physical or sexual abuse, and current or past substance abuse. During the physical examination, it's important to note whether the patient protects the painful area and avoids specific movements or postures due to pain. Identifying a mechanical aspect of the pain can be both diagnostic and therapeutic. Painful areas should be examined for deep tenderness, focusing on whether it's localized to muscle, ligaments, or joints. Chronic myofascial pain is common, and deep palpation may reveal localized trigger points, which are firm knots or bands in muscles. Pain relief following the injection of a local anesthetic into these trigger points supports the diagnosis. Evidence of nerve damage, such as sensory loss, heightened skin sensitivity (allodynia), weakness, muscle atrophy, or diminished deep tendon reflexes, suggests a neuropathic component to the pain. Symptoms indicative of sympathetic nervous system involvement include generalized swelling, changes in skin color and temperature, and hypersensitive skin and joint tenderness compared to the unaffected side. Pain relief following a sympathetic block supports this diagnosis, although its effectiveness can vary for chronic conditions, and the role of repeated sympathetic blocks remains unclear in the overall management of complex regional pain syndrome (CRPS). An important principle when evaluating patients with chronic pain is to consider both emotional and somatic causes and perpetuating factors before initiating treatment. Addressing these aspects together, instead of postponing emotional evaluations until somatic causes are ruled out, can improve patient compliance by showing that the physician values their complaint's validity. Even when a somatic cause is identified, it's still prudent to explore other contributing factors. For instance, a cancer patient with painful bone metastases may also experience pain from nerve damage or depression. Optimal treatment necessitates assessing and managing each of these factors. Treatment: Chronic Pain. Once the evaluation is complete and the likely causes and factors that worsen the pain are identified, a specific and realistic treatment plan should be established. Part of this process involves identifying functional goals for therapy, such as achieving better sleep, resuming daily activities like shopping, or returning to work. A multidisciplinary approach, involving medications, counseling, physical therapy, nerve blocks, and possibly surgery, may be needed to improve the patient's quality of life. There are also minimally invasive procedures, like epidural injections of glucocorticoids for acute radicular pain or radiofrequency treatment of facet joints for chronic facet-related back and neck pain, which can be helpful for some patients with intractable pain. These interventions are guided by evolving criteria and are generally reserved for patients who have not responded to standard pharmacological treatments. Before invasive procedures, patients should typically be referred to a multidisciplinary pain clinic for a comprehensive evaluation. Such referrals aren't necessary for all chronic pain patients, as pharmacological management alone may suffice for some. Antidepressants. Tricyclic antidepressants (TCAs), particularly nortriptyline and desipramine, are useful in managing chronic pain. Despite being developed for depression treatment, TCAs have various biological activities at different doses, including analgesic effects in numerous chronic conditions. Their analgesic effect often occurs at lower doses and more rapidly than required for treating depression. Notably, even non-depressed chronic pain patients can experience pain relief from TCAs. TCAs have been shown to enhance the analgesic effect of opioids, making them valuable in severe persistent pain, such as that associated with cancer. However, TCAs have significant side effects, including orthostatic hypotension, drowsiness, cardiac conduction abnormalities, memory problems, constipation, and urinary retention, which can be particularly troublesome for elderly patients and additive to the side effects of opioid pain relievers. Selective serotonin reuptake inhibitors (SSRIs), like fluoxetine, have milder side effects than TCAs but are less effective in pain relief. However, newer non-tricyclic antidepressants like venlafaxine and duloxetine, which inhibit both serotonin and norepinephrine reuptake, appear to maintain most of the pain-relieving effects of TCAs while having side effects more similar to SSRIs. These drugs may be preferable for patients unable to tolerate TCAs. Anticonvulsants and Antiarrhythmics. These medications are primarily useful for neuropathic pain. Drugs like phenytoin and carbamazepine were initially shown to relieve the pain of trigeminal neuralgia, characterized by brief, shooting, electric shock-like pain. More recently, newer anticonvulsants such as gabapentin and pregabalin have proven effective for a wide range of neuropathic pains, with favorable side effect profiles, often making them the first-line treatment choice. Cannabinoids. Cannabinoids are commonly used for their analgesic properties, though evidence suggests their effects on pain are usually modest, causing slight increases in pain threshold and variable reductions in clinical pain intensity. However, they tend to consistently reduce the unpleasantness of the pain experience and, in cancer-related pain, can alleviate the nausea and vomiting caused by chemotherapy. Cannabis and related compounds are further discussed in another chapter. Chronic Opioid Medication. Long-term opioid use is accepted for patients with pain resulting from malignant diseases. However, using opioids for chronic nonmalignant pain is controversial. Still, for many patients, opioids are the only option that provides meaningful pain relief. Opioids are potent and effective for a wide range of painful conditions but can lead to tolerance, physical dependence, and, in some cases, worsened pain (opioid-induced hyperalgesia) during long-term use. Thus, before starting opioid therapy, alternative options should be explored, and patients should be educated about the limitations and risks associated with opioids. Some opioid analgesics have mixed agonist-antagonist properties and can induce an abstinence syndrome when used concurrently with other opioids, creating practical challenges for patients on multiple opioid therapies. For long-term outpatient use of orally administered opioids, extended-release compounds such as methadone, levorphanol, extended-release morphine, oxycodone, or transdermal fentanyl can help maintain stable analgesic blood levels, potentially minimizing side effects. Extended-release opioids are generally approved for patients already using other opioids and should not be the first choice for pain management. While long-acting opioids may provide superior pain relief for patients with constant pain, those with intermittent severe episodic pain might benefit more from periodic use of short-acting opioids. Opioid use frequently leads to constipation, which should be managed. Peripherally acting opioid antagonists that reverse opioid-induced constipation without affecting pain relief are a recent development and are beneficial for patients. It's important to mention that the introduction of extended-release oxycodone (OxyContin) led to a significant increase in emergency room visits and deaths, primarily due to nonmedical use of prescription opioids. These issues led to increased scrutiny of opioid prescribing practices and the development of guidelines and monitoring programs to address prescription drug abuse and reduce the improper prescription of opioids. Treatment of Neuropathic Pain. Treatment for neuropathic pain should be individualized. Two key principles should guide therapy: providing quick relief and minimizing side effects. For example, patients with postherpetic neuralgia and heightened cutaneous sensitivity can benefit from topical lidocaine (Lidoderm patches) for immediate relief without significant side effects. Anticonvulsants like gabapentin or pregabalin, as well as antidepressants such as nortriptyline, desipramine, duloxetine, or venlafaxine, are first-line treatments for neuropathic pain. Systemic administration of antiarrhythmic drugs like lidocaine and mexiletine is less effective. While intravenous lidocaine infusion can provide temporary pain relief for various neuropathic pain types, it's often short-lived. Mexiletine, an oral lidocaine derivative, is associated with frequent gastrointestinal side effects and is poorly tolerated. The choice of the initial drug class isn't standardized, but due to the relatively high doses of anticonvulsants required for pain relief, sedation can be problematic. Sedation is less common with TCAs but more so with serotonin/norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine. Therefore, SNRIs are recommended as the first-line option for elderly patients or those requiring high-level mental activity. In contrast, opioids should be considered second- or third-line treatments. Opioids, while highly effective for many types of pain, can cause sedation, and their effectiveness may decrease over time, leading to dose escalation and occasional worsening of pain. Tramadol and tapentadol, two drugs with mixed opioid and norepinephrine reuptake inhibition actions, offer alternatives to pure opioids. Tramadol is relatively weak, sometimes effective when other non-opioid analgesics fail. Tapentadol is a stronger opioid, but its analgesic action is potentially enhanced by norepinephrine reuptake inhibition. Combining medications from different classes can optimize pain control. Repeated botulinum toxin injections are a promising approach for treating focal neuropathic pain, especially post-herpetic, trigeminal, and post-traumatic neuralgias. It's essential to understand that many patients with chronic pain seek medical care primarily for relief because physicians can provide the necessary medications. One of a physician's main responsibilities is to minimize the physical and emotional discomfort of their patients. Familiarity with pain mechanisms and analgesic medications is a crucial step in achieving this goal.

Sylheti/Glossary. 1. 2. 3.

Internal Medicine/Fever. The body's temperature is regulated by the hypothalamus, which acts as a thermostat. Neurons in both the preoptic anterior hypothalamus and the posterior hypothalamus receive two types of signals. One type comes from peripheral nerves that transmit information from skin receptors sensitive to warmth or cold. The other type of signal comes from the temperature of the blood flowing through these regions. The hypothalamus integrates these signals to maintain the body's temperature within a normal range of 36.5–37.5°C (97.7–99.5°F) when in a neutral environmental temperature. In normal conditions, the human body produces more heat than is required to maintain its core temperature. This excess heat is generated through metabolic activity in muscles and the liver. Despite variations in the environment, the hypothalamus ensures that the core body temperature remains stable. A study involving over 35,000 individuals found that the average oral temperature is 36.6°C (95% confidence interval, 35.7–37.3°C). A temperature above 37.7°C (99.9°F), which represents the 99th percentile for healthy individuals, is considered a fever. It's important to note that higher ambient temperatures are associated with higher baseline body temperatures. Additionally, body temperatures vary throughout the day and across seasons, with lower levels in the morning and during the summer and higher levels in the afternoon and during the winter. Various factors such as age, demographics, and certain medical conditions can influence baseline temperatures. Interestingly, a slight increase in baseline temperature is associated with a higher risk of mortality, even after adjusting for other factors. Rectal temperatures are generally 0.4°C (0.7°F) higher than oral readings. This difference may be attributed to mouth breathing, especially in patients with respiratory infections and rapid breathing. Lower-esophageal temperatures closely reflect core temperature. Tympanic membrane thermometers measure radiant heat from the tympanic membrane and nearby ear canal. These measurements can vary and may not be as accurate as directly determined oral or rectal values. In women who menstruate, body temperature typically decreases during the two weeks before ovulation and then rises by about 0.6°C (1°F) during ovulation, remaining at that level until menstruation. The circadian rhythm of body temperature remains relatively constant during the luteal phase of the menstrual cycle. Fever vs. Hyperthermia. Fever is an elevation of body temperature beyond the normal daily variation and is accompanied by an increase in the hypothalamic set point. This shift in the set point is similar to raising the thermostat setting in a room. Fever involves processes like vasoconstriction, shivering, and nonshivering heat production to raise body temperature, and it is generally characterized by an increase of 1–2°C. Fever management includes behaviors like adding clothing or bedding to raise body temperature. Hyperpyrexia is an extremely high fever, with temperatures exceeding 41.5°C (106.7°F). This level of fever is rare but can occur in severe infections or central nervous system hemorrhages. Unlike fever, which involves raising the set point, hyperthermia is characterized by uncontrolled overheating of the body, exceeding its ability to dissipate heat. Hyperthermia can result from excessive heat production, such as intense physical exertion in a hot environment, and does not involve pyrogenic molecules. It is essential to distinguish between fever and hyperthermia because hyperthermia can be life-threatening and does not respond to antipyretic drugs like aspirin or acetaminophen. Pathogenesis of Fever. Pyrogens are substances that cause fever, and they can be exogenous (derived from outside the body) or endogenous (produced within the body). Exogenous pyrogens include microbial products, toxins, and whole microorganisms. Examples include the endotoxin produced by gram-negative bacteria and toxins from gram-positive bacteria like Staphylococcus aureus. Pyrogenic cytokines, which include interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), and others, are endogenous pyrogens that regulate immune and inflammatory processes. These cytokines can trigger fever when injected into humans at specific doses. The elevation of the hypothalamic set point and the initiation of fever involve prostaglandin E2 (PGE2) levels increasing in hypothalamic tissue. Pyrogenic cytokines stimulate the production of PGE2. PGE2 in the brain side of the hypothalamic endothelium triggers the release of cyclic adenosine 5'-monophosphate (cAMP), a neurotransmitter. This process leads to changes in the hypothalamic set point, raising the core body temperature. Microbial products and pyrogenic cytokines can activate receptors on the hypothalamic endothelium, known as Toll-like receptors and IL-1 receptors, to induce PGE2 production and fever. Cytokines produced within the brain may also contribute to hyperpyrexia in conditions like central nervous system infections, trauma, or hemorrhage. Viral infections of the brain can induce the production of cytokines in microglial and neuronal cells. These cytokines may lead to hyperpyrexia when injected directly into the brain or brain ventricles, bypassing the circumventricular organs. These hyperpyrexic states are not caused by pyrogenic molecules but result from abnormal cytokine production within the central nervous system. In summary, fever is a regulated response to pyrogens, both exogenous and endogenous, involving changes in hypothalamic temperature set points and subsequent alterations in heat production and conservation to maintain the elevated body temperature. Hyperthermia, on the other hand, is uncontrolled overheating, typically due to excessive heat production or inability to dissipate heat effectively, and it does not involve pyrogenic molecules or changes in the hypothalamic set point. Patient Evaluation for Fever. When assessing a patient with fever, it is essential to consider various disease processes that can manifest with fever as a primary symptom. A detailed patient history can help distinguish between these categories. The timing of events leading to fever, such as exposure to infected individuals or disease vectors, should be investigated. Electronic devices for temperature measurement, including oral, tympanic membrane, or rectal thermometers, are reliable, but it's crucial to consistently use the same site for monitoring fever. It's worth noting that certain populations, like newborns, the elderly, individuals with chronic liver or kidney issues, or those taking glucocorticoids or undergoing anticytokine therapy, might not exhibit fever despite having an underlying infection due to a blunted febrile response. Laboratory Tests. In the evaluation of fever, conducting a complete blood count is typically necessary. A differential count should be performed to identify specific features in the blood that may suggest a bacterial infection, such as the presence of juvenile or band forms, toxic granulations, or Döhle bodies. Neutropenia, a low neutrophil count, can also be present in some viral infections. Measuring circulating cytokine levels may not be useful in patients with fever because these levels often fall below the detection limit of assays or may not correlate with fever. Instead, when evaluating patients with low-grade fever or suspected underlying disease, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are valuable markers of inflammation. Circulating interleukin-6 (IL-6) levels, which induce CRP production, can also be informative. While IL-6 levels may fluctuate during a feverish disease, CRP levels typically remain elevated. These markers are part of the acute-phase reactants used in diagnosing and monitoring inflammatory processes. Fever in Patients Receiving Anticytokine Therapy. Patients undergoing long-term anticytokine therapy may experience increased susceptibility to infections due to compromised host defenses. For instance, anti-TNF therapy can lead to the dissemination of latent Mycobacterium tuberculosis infection. As anticytokines are increasingly used in conditions like Crohn's disease, rheumatoid arthritis, or psoriasis to reduce the activity of IL-1, IL-6, IL-12, IL-17, or TNF, it's crucial to consider that these therapies may reduce the febrile response. Blunting the fever response can be a concern, especially when evaluating patients with low-grade fever or suspected underlying diseases in the context of anticytokine therapy. Treatment of Fever. When deciding whether to treat fever, it's important to recognize that fever itself is not an illness but rather a normal response to various physiological disturbances. Most fevers are associated with self-limited infections, like common viral diseases. Antipyretics are not contraindicated in such infections and do not delay recovery or affect the resolution of infections significantly. However, in bacterial infections, withholding antipyretic therapy can be useful in assessing the effectiveness of a particular antibiotic, as it can unmask an inadequately treated bacterial infection. Some infections follow specific fever patterns, with episodes of fever separated by intervals of normal temperature. Recognizing these patterns can help tailor diagnostic testing and treatment. While recurrent fevers can be seen in autoimmune diseases, autoinflammatory diseases, and periodic fever syndromes, they are especially characteristic of autoinflammatory conditions, which include rare diseases like familial Mediterranean fever and more common conditions like idiopathic pericarditis and gout. Many of these conditions respond well to anticytokine therapies like IL-1 blockers. Mechanisms of Antipyretic Agents. Antipyretics aim to reduce fever by lowering the elevated hypothalamic set point and enhancing heat loss. Drugs like aspirin and NSAIDs work by inhibiting the enzyme cyclooxygenase, which is involved in prostaglandin synthesis. Prostaglandins, particularly PGE2, play a crucial role in raising the hypothalamic set point during fever. Acetaminophen, while not a strong cyclooxygenase inhibitor in peripheral tissues, acts as a more effective antipyretic in the brain. Glucocorticoids reduce fever by both inhibiting cyclooxygenase and blocking the transcription of mRNA for pyrogenic cytokines. The use of antipyretic agents does not affect normal core body temperature regulation. Regimens for Fever Treatment. Oral acetaminophen is the preferred antipyretic due to its efficacy and safety profile. In children, oral ibuprofen is also a suitable option, while aspirin should be avoided due to the risk of Reye's syndrome. In cases where oral antipyretics cannot be taken, parenteral NSAIDs and rectal suppositories can be used. It's essential to treat fever in patients with preexisting cardiac, pulmonary, or CNS conditions, as fever increases oxygen demand. Additionally, children with a history of febrile or nonfebrile seizures should receive prompt treatment to reduce fever. In hyperpyrexia, cooling blankets can be used to lower temperature, but they should be combined with oral antipyretics. Cooling is particularly important in hyperpyretic patients with CNS conditions or trauma, as it helps mitigate the harmful effects of high temperature on the brain.

Internal Medicine/Photosensitivity and Other Reactions to Sunlight. Sunlight's Impact on Health. Sunlight, or solar radiation, is a readily noticeable and important element of our environment. It offers us warmth and helps our bodies synthesize vitamin D, but excessive exposure to the sun can also have negative health consequences. Prolonged exposure to sunlight is a leading cause of skin cancer in humans and can weaken our immune systems. The sun's energy that reaches Earth's surface is composed of various components within the ultraviolet (UV), visible, and infrared spectra. The shorter UV wavelengths below approximately 290 nm are mostly filtered out by the Earth's stratospheric ozone layer, protecting us from the more harmful solar radiation. Concerns about ozone layer depletion due to substances like chlorofluorocarbons have led to international agreements to limit their production. Measurements of solar energy show significant regional variations due to factors like seasons, the path of sunlight through the atmosphere, altitude, latitude, and the presence of clouds, fog, and pollution. The key wavelengths of solar radiation that affect human skin are in the UV and visible spectra, ranging from 290 to 700 nm. Additionally, wavelengths beyond 700 nm primarily generate heat and, under certain conditions, can exacerbate the negative effects of UV and visible radiation. UV Radiation and Skin Structure. Solar UV radiation is divided into UV-B and UV-A segments, ranging from 290 to 400 nm. UV-B, which covers wavelengths between 290 and 320 nm, is the most effective at causing skin redness, commonly known as sunburn. UV-A, spanning from 320 to 400 nm, is about a thousand times less efficient in causing skin redness compared to UV-B. Visible light, within the 400 to 700 nm range, cannot harm human skin in the absence of photosensitizing chemicals. These chemicals absorb specific wavelengths and initiate photosensitivity reactions. The absorption spectrum of a molecule indicates the wavelengths it absorbs, while the action spectrum shows the wavelengths that produce a response in the presence of incident radiation. Photosensitivity occurs when a molecule in the skin absorbs energy from photons, becomes excited, and transfers this energy to various structures or to molecular oxygen. Effects of UVR on Skin Structure and Function Human skin comprises two main layers: the outer epidermis and the underlying dermis, both vulnerable to sun damage. Various molecules in these layers, such as nucleic acids, proteins, and lipids, can absorb solar energy. The outermost epidermal layer, the stratum corneum, primarily absorbs UV-B, with only a fraction of UV-B wavelengths reaching the dermis. UV-A, however, penetrates more deeply into the skin and can modify structural and matrix proteins, contributing to premature aging, especially in individuals with light skin. Molecular Targets and Skin Effects from UVR UV radiation can cause structural changes in epidermal DNA, primarily in keratinocytes and Langerhans cells, forming DNA lesions like cyclobutane dimers and 6,4-photoproducts. Effective repair mechanisms are crucial for preventing skin cancer development. Individuals with defective DNA repair mechanisms, like those with xeroderma pigmentosum, are at a higher risk of skin cancer. Solar UVR also targets molecular oxygen, producing reactive oxygen species (ROS). ROS can damage skin components through oxidative processes, affecting DNA, lipids, proteins, and enzymes. UVR can also lead to increased cross-linking and degradation of dermal matrix proteins, contributing to photoaging or solar elastosis. Chromophores and Cutaneous Optics Chromophores are chemicals that can absorb physical energy and can be endogenous (naturally occurring in the skin) or exogenous (introduced from external sources). Skin's endogenous chromophores include nucleic acids, proteins, lipids, and 7-dehydrocholesterol, a precursor of vitamin D. Exogenous chromophores can include porphyrins, which are normally present in trace amounts but can accumulate in certain diseases, leading to skin damage upon exposure to solar energy. Porphyrins can generate ROS upon absorbing sunlight, causing skin damage such as erythema, edema, urticaria, or blister formation. Photodynamic therapy (PDT) uses photoexcited porphyrins for targeted destruction of tumor cells in conditions like basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Acute Effects of Sun Exposure Immediate effects of sun exposure include sunburn and vitamin D synthesis. Sunburn, characterized by skin redness, is primarily caused by UV-B and, to a lesser extent, UV-A radiation. It results from an inflammatory response in the skin, involving the release of various cytokines and growth factors, along with the accumulation of ROS. UV-B is particularly efficient at inducing sunburn, but UV-A can contribute to it, especially during midday when UV-A levels are higher. Sunburn also triggers the formation of "sunburn cells," which are apoptotic keratinocytes attempting to repair DNA damage. Vitamin D Synthesis and Photocchemistry UV-B exposure can stimulate the synthesis of vitamin D in the skin. It begins with the photolysis of 7-dehydrocholesterol, converting it into pre-vitamin D3, which then undergoes temperature-dependent transformation into stable vitamin D3. This vitamin is transported through the bloodstream to the liver and kidneys, where it becomes the biologically active hormone, 1,25-dihydroxyvitamin D3. Vitamin D has various physiological effects, including aiding in calcium metabolism, regulating bone health, and potentially reducing the risk of certain internal malignancies. The debate continues about the risk-to-benefit ratio of sun exposure for vitamin D production. However, the potential risks of skin cancer and photodamage outweigh the benefits, and supplementation is recommended for individuals with vitamin D deficiency, especially as skin's ability to produce vitamin D decreases with age. Chronic Effects of Sun Exposure: Nonmalignant The visible signs of photoaging, often referred to as dermatoheliosis, encompass characteristics such as wrinkles, uneven pigmentation, visible blood vessels (telangiectasia), and a rough, uneven, and weathered appearance of the skin. Sunlight plays a significant role in causing photoaging in human skin, and it is likely that reactive oxygen species (ROS) are involved in this process. Sun-associated chronic damage primarily targets the dermis and its connective tissue matrix, leading to a condition known as solar elastosis. This involves a significant increase in the thickened, irregular masses of abnormal elastic fibers. Collagen fibers in the deeper layers of sun-damaged skin also appear clumped together. While the exact mechanisms behind these changes are not fully understood, it is believed that UV-A radiation, which penetrates deeper into the skin, plays a major role. Interestingly, both chronologically aged skin protected from the sun and photoaged skin share molecular features, including damage to connective tissues and elevated levels of matrix metalloproteinases (MMPs), enzymes that break down the extracellular matrix. UV-A radiation induces the expression of certain MMPs, like MMP-1 and MMP-3, which increase collagen degradation and also reduce the expression of type I procollagen mRNA, affecting collagen synthesis. As a result, chronic sun exposure leads to structural and functional alterations in dermal collagen, inhibiting its production and promoting its breakdown. This knowledge has led to the use of high-dose UV-A phototherapy in the treatment of specific skin conditions characterized by localized fibrosis, such as localized scleroderma. Chronic Effects of Sun Exposure: Malignant Excessive and prolonged exposure of the skin to sunlight is a well-known cause of non-melanoma skin cancers (NMSCs), including squamous cell carcinomas (SCCs), basal cell carcinomas (BCCs), and Merkel cell carcinomas (MCCs). The development of skin cancer follows a multi-step process that involves initiation, promotion, and progression. Initiation occurs when the DNA of skin cells is structurally altered by factors like UV-B radiation, making them prone to malignant transformation. However, exposure to a tumor initiator, such as UV-B, is necessary but not sufficient for cancer development; other factors are required. Promotion is the next stage, driven by chronic sun exposure, leading to further changes in the initiated cells, clonal expansion, and the development of premalignant growths known as actinic keratoses, which can progress to SCCs. UV-B radiation is considered a complete carcinogen as it can act both as a tumor initiator and promoter. Finally, malignant conversion marks the transition of benign precursors into cancers, involving genetic instability. On a molecular level, skin cancer is driven by accumulated gene mutations, causing inactivation of tumor suppressors, activation of oncogenes, or reactivation of cellular signaling pathways that are normally active during embryonic skin development, leading to uncontrolled cell proliferation. Studies have shown that UV-induced mutations that drive oncogenesis in SCCs are already present in sun-exposed normal skin, providing a growth advantage to precancerous clones carrying these mutations. These mutations are particularly common in genes influencing the proliferation of epidermal stem cells. The pattern of oncogenic mutations in sun-exposed skin overlaps with those in SCCs but differs from those in BCCs and melanomas. For example, mutations in NOTCH1 are found in approximately 20% of normal sun-exposed skin cells and around 60% of SCCs. Furthermore, mutations in the tumor suppressor gene p53, primarily caused by UVR, can promote skin carcinogenesis. In contrast to SCCs, BCCs have distinct mutations, primarily involving the tumor-suppressor gene patched or the oncogene smoothened, leading to the activation of the sonic hedgehog signaling pathway. The Wnt/β-catenin signaling pathway is also implicated in skin cancer development. Clonal analysis in mouse models has shown that BCCs originate from stem cells in the interfollicular epidermis and upper hair follicle infundibulum. SCCs can initiate from both interfollicular epidermis and hair follicle bulge stem cells. The transcription factor Myc is associated with both BCCs and SCCs. Merkel cell carcinoma (MCC), another form of NMSC, is linked to Merkel cell polyoma virus (MCPyV). MCCs can be MCPyV-positive or MCPyV-negative. MCPyV-negative MCCs display high levels of UV-induced signature mutations and tumor suppressor inactivation. MCPyV-positive MCCs result from viral integration into the host genome and mutations in the large T antigen. Both forms of MCC are immunogenic, and some patients with metastatic MCC have shown positive responses to PD-1/PD-L1 immune checkpoint inhibitors. Global Considerations The incidence of skin cancer varies globally, influenced by geographic location and the predominant skin phototype of the population in each region. For example, Australia experiences high rates of both melanoma and NMSCs due to its sunny climate. Photoimmunology Exposure to solar radiation leads to immunosuppression, affecting both local and systemic immune responses. Local immunosuppression reduces the immune response to antigens applied at the irradiated site, while systemic immunosuppression affects responses to antigens applied at distant, unirradiated sites. UV radiation targets chromophores in the upper epidermis, including DNA, urocanic acid, and membrane components, initiating immunosuppression. DNA damage induced by UV radiation can inhibit antigen presentation by Langerhans cells. Urocanic acid, which accumulates in the upper epidermis due to the breakdown of the protein filaggrin, undergoes trans-cis isomerization upon UV exposure, contributing to immunosuppression. Various immunomodulatory factors and cytokines are implicated in UV-induced systemic immunosuppression, including tumor necrosis factor-α, interleukin 4 (IL-4), interleukin 10 (IL-10), and eicosanoids. Additionally, UV radiation can activate Toll-like receptor signaling via damage-associated molecular patterns (DAMPs) released from necrotic keratinocytes. Chronic sun exposure and the resulting immunosuppression increase the risk of skin cancer, especially in organ transplant recipients who require lifelong immunosuppressive drug regimens. These individuals are at a significantly higher risk of developing skin cancers, emphasizing the importance of photoprotection measures. Sun exposure can exacerbate autoimmune and inflammatory skin conditions, such as systemic lupus erythematosus (SLE), by promoting DNA damage that may trigger autoantibody production. In conclusion, skin cancer and various immune-related skin responses are influenced by chronic exposure to UV radiation, affecting both local and systemic immunity. This underscores the importance of sun protection and early detection to mitigate these risks. Photosensitivity Diseases. To diagnose photosensitivity conditions, it's essential to gather a detailed medical history to understand the duration of symptoms, the time between sunlight exposure and the onset of symptoms, and the age when symptoms began. Certain diseases, like erythropoietic protoporphyria (EPP), often start in infancy or early childhood, while others, such as porphyria cutanea tarda (PCT), tend to appear in one's forties or fifties. A patient's exposure to drugs and chemicals, both topical and systemic, can provide diagnostic clues, as many of these substances can induce photosensitivity through either phototoxic or photoallergic reactions. Skin examination plays a vital role in diagnosis. Areas naturally shielded from direct sunlight, like the scalp, upper eyelids, and other covered regions, may remain unaffected, while exposed areas exhibit characteristic signs of photosensitivity. These patterns can be helpful in diagnosis, but they are not foolproof. For instance, airborne allergens that settle on the skin can lead to dermatitis in both sun-exposed and shielded areas, complicating diagnosis. Various dermatological conditions can be triggered or worsened by sunlight exposure, influenced by genetic factors such as DNA repair defects in xeroderma pigmentosum and abnormalities in heme synthesis seen in porphyrias. Polymorphous Light Eruption (PMLE) Polymorphous light eruption (PMLE) is the most common type of photosensitivity disorder. Many individuals with PMLE may not seek medical attention as the condition is often temporary, with symptoms arising in the spring upon initial sun exposure but subsiding with continued exposure (a phenomenon known as "hardening"). PMLE is characterized by pruritic (itchy), erythematous (red), and papular (raised) skin lesions that can merge into plaques, typically appearing on sun-exposed areas of the trunk and forearms, with the face being less affected. While the skin findings remain consistent in each recurrence for an individual, there can be significant variations in symptoms among different individuals. Diagnosis can be confirmed through a skin biopsy and phototesting, where the skin is exposed to UV-A and UV-B radiation to reproduce symptoms. The action spectrum for PMLE usually falls within these portions of the solar spectrum. Preventing PMLE is essential, and measures include using high-SPF broad-spectrum sunscreens and inducing "hardening" through cautious exposure to artificial UV-B or UV-A radiation or using psoralen plus UV-A (PUVA) photochemotherapy for several weeks before the initial sun exposure in the spring to prevent subsequent PMLE outbreaks during the summer. Actinic Prurigo Actinic prurigo is another photosensitivity condition with similarities to PMLE. It typically occurs in the spring, can persist throughout the summer, and extend into the winter months. Phototoxicity and Photoallergy Phototoxic and photoallergic reactions result from exposure to drugs and chemicals, which act as chromophores. In both reactions, the substance absorbs energy, becomes photoexcited, and generates tissue-damaging chemical species, including reactive oxygen species (ROS). Phototoxicity is a non-immunologic reaction caused by various drugs and chemicals, while photoallergy involves an immunopathologic process. Phototoxicity and photoallergy reactions can be confirmed through phototest procedures. Porphyria Porphyrias are a group of disorders related to heme synthesis abnormalities. Some porphyrins in the body act as potent photosensitizers, absorbing light in the visible spectrum and leading to photosensitivity. The two major categories of cutaneous porphyrias are chronic blistering photosensitivity and acute non-blistering photosensitivity. The latter category includes diseases like erythropoietic protoporphyria (EPP), which causes painful skin burning and stinging upon sun exposure. The management of these photosensitivity disorders involves various strategies, including eliminating exposure to triggering substances, protecting the skin from sunlight, and, in some cases, using medications to alleviate symptoms or suppress the immune response. For instance, afamelanotide, a synthetic peptide analogue of α-MSH, has been approved by the FDA for treating EPP and can increase skin pigmentation to improve sunlight tolerance. Additionally, β-carotene supplements have shown moderate benefits in increasing sunlight tolerance for some patients with EPP. Treatment approaches may vary depending on the specific condition and its severity. Photoprotection. As photosensitivity disorders stem from sunlight exposure, complete avoidance of sunlight could theoretically prevent these conditions. However, this approach is often unfeasible in today's modern lifestyles. Therefore, alternative methods of photoprotection have been explored. The skin naturally provides some photoprotection through structural proteins in the epidermis, especially keratins and melanin. The amount and distribution of melanin in cells are genetically controlled, and individuals with darker skin types (IV-VI) are less prone to acute sunburn and skin cancers. Other forms of photoprotection encompass clothing and sunscreen use. Clothes made of densely woven sun-protective fabrics, regardless of color, offer substantial protection. Covering up with wide-brimmed hats, long sleeves, and trousers can also reduce direct sun exposure. Sunscreens are now considered over-the-counter drugs, and the FDA has identified category I ingredients as both safe and effective. Sunscreens are rated for their photoprotective capacity based on their Sun Protection Factor (SPF). SPF represents the ratio of time required to produce sunburn erythema with and without sunscreen application. Most sunscreens primarily protect against UV-B but not UV-A. According to the FDA, sunscreens must be categorized as minimal (SPF ≥2 and <12), moderate (SPF ≥12 and <30), or high (SPF ≥30, labeled as 30+). Broad-spectrum sunscreens contain chemicals that absorb both UV-B and UV-A rays (organic filters). These chemicals soak up UV radiation and transmit the absorbed energy to surrounding cells. For instance, cinnamates, PABA derivatives, and salicylates primarily absorb UV-B, while benzophenones and ecamsule (terephthalylidene dicamphor sulfonic acid) offer protection against both UV-B and UV-A2, and avobenzone primarily guards against UV-A1. In contrast, physical UV blockers such as zinc oxide and titanium dioxide either absorb or reflect UV radiation, providing broad-spectrum protection against both UV-B and UV-A. In addition to light absorption, water resistance significantly affects the sustained photoprotective ability of sunscreens. Sunscreen products with SPF 30 or higher, broad-spectrum coverage, and resistance to water or sweat are recommended for adequate sun protection. Limiting sun exposure during the day can also provide some photoprotection. Since a significant portion of a person's lifetime sun exposure occurs by age 18, educating parents and young children about the risks of sunlight is important. Reducing exposure at midday can substantially reduce a person's overall UV radiation exposure throughout their life. Phototherapy and Photochemotherapy. Ultraviolet radiation (UVR) can be used therapeutically. UV-B exposure alone or in combination with topically applied agents can induce remission in various dermatological conditions like psoriasis, atopic dermatitis, and vitiligo. Narrow-band UV-B treatments, utilizing fluorescent bulbs emitting radiation at around 311 nm, have shown enhanced efficacy compared to broad-band UV-B in psoriasis treatment. Photochemotherapy, where psoralens are topically applied or systemically administered and combined with UV-A (PUVA), is effective in treating psoriasis, early-stage cutaneous T-cell lymphoma, and vitiligo. Psoralens, tricyclic furocoumarins, intercalate into DNA and form adducts with pyrimidine bases when exposed to UV-A, leading to DNA cross-linking. This process is believed to reduce DNA synthesis, contributing to psoriasis improvement. The effectiveness of PUVA in cutaneous T-cell lymphoma treatment is not fully understood but is thought to induce apoptosis in atypical T lymphocyte populations in the skin. Photopheresis, which directly treats atypical lymphocytes in circulation, has been used in severe systemic conditions with circulating atypical lymphocytes, like Sézary syndrome and graft-versus-host disease. Apart from DNA effects, PUVA therapy stimulates epidermal thickening and melanin synthesis, making it suitable for treating depigmenting diseases like vitiligo. The oral form of 8-methoxypsoralen with UV-A appears most effective, but extensive treatment over 12-18 months may be necessary for satisfactory repigmentation. The major side effects of long-term UV-B phototherapy and PUVA photochemotherapy resemble those resulting from chronic sun exposure. Nonetheless, these treatment modalities continue to provide excellent therapeutic results. Selecting the most suitable phototherapeutic approach for a specific dermatological condition is crucial. For instance, narrow-band UV-B has been reported to be as effective as PUVA photochemotherapy in treating psoriasis while posing a lower risk of skin cancer development than PUVA.

Pokémon Diamond and Pearl Surf glitch/Seabreak Path. The Pokémon games by Game Freak have been known for their solid gameplay as well as a healthy dosage of secrets. Aside from the standard batch of creatures that roam the regions that you travel in, there are always a special few Pokémon that you have the one rare opportunity to challenge and either defeat or attempt to capture. In Pokémon Diamond and Pearl, not only is this still the case, but to an even greater degree. You have a lot more of the rare kind this time around, and you're still given that one measly Master Ball. It's simply something all players of Pokémon games will have to deal with once again. Getting to Flower Paradise. Sheimi/Shaymin is also acquired in the exact same way, but it's in a different location. It is easier, when you start all over again, to reset your Poketch's steps counter, as you can very easily get lost. You shouldn't have to needlessly lose time, because again, this is a very easy glitch. After you wind up once more in the void outside the door of that same room, walk 200 steps east. Afterwards, walk 363 steps south, totaling 563 steps taken. After that, walk 722 steps east, totaling 1285 steps. From where you stand, walk 19 steps west, for a total of 1304 steps. Don't think you can shorten the 722 steps east by 19 to reach the same place -- trust me, it won't work. Make sure you go 722 steps east, and only then take 19 steps west. It is important that you follow directions for your safety. Again, go underground with your Explorer Kit, and without moving, immediately resurface. Look at your Map Key Item to help take care of the visual glitchiness you are probably experiencing. You're now below the "Flower Paradise" with Sheimi/Shaymin straight ahead of you. Shaymin isn't that difficult to catch. It has a catch rate of 45/255, making it relatively easy to capture, much like Dialga and Palkia. You don't want to risk more than you need to by saving at the "Flower Paradise" unless you've checked beforehand that you have that option. Once you're done with either capturing or killing it (if you have beaten the game, Sheimi/Shaymin won't give you any problems), you can fly away at your earliest convenience. If you can't, know that that sometimes can happen in some Japanese games, so turn off your game and try it again.

Pokémon Diamond and Pearl Surf glitch/Darkrai Path. The Pokémon games by Game Freak have been known for their solid gameplay as well as a healthy dosage of secrets. Aside from the standard batch of creatures that roam the regions that you travel in, there are always a special few Pokémon that you have the one rare opportunity to challenge and either defeat or attempt to capture. In Pokémon Diamond and Pearl, not only is this still the case, but to an even greater degree. You have a lot more of the rare kind this time around, and you're still given that one measly Master Ball. It's simply something all players of Pokémon games will have to deal with once again. Newmoon Island. To access Darkrai, from where you should now be standing, and using the Poketch's built-in Step Counter, walk 146 steps to the east. After that, walk 254 steps south, for a total of 400 steps. If you feel you've messed up, you can either attempt to fly from where you are to the game's other areas or retrace your steps if that does not work. The next part is what can mess some people up very easily, as you will have to be unusually still for a certain amount of time. Now, use the Explorer Kit to go underground. This will cause you to save. When you go underground, DON'T MOVE! Simply resurface. Guess where you are? You're at Newmoon Island! The place looks a little messed up, but don't worry about that. Maneuver yourself west around the glitchy visuals for a short distance, or look at your Map Key Item to help clear it up, then afterwards travel north into the woods. Floating right before you is the rare Pokémon Darkrai!

Exercise Physiology. Exercise Physiology is the study of how the body responds and adapts to physical activity and exercise. It delves into the physiological processes that occur within our bodies when we engage in various forms of exercise, from a leisurely walk to ultramarathoner training, and everything in between. This WikiBook aims to give you a deeper scientific understanding of how the body reacts to exercise and functions in general. By understanding these mechanisms, we can optimize training programs, improve athletic performance, and enhance the overall health and well-being of individuals. Table of contents. Here's the planned outline, which is unfinal:

Infrastructure Past, Present, and Future Casebook/5.9 GHz Spectrum. This casebook is a case study on the 5.9 GHz Spectrum by James Robles, Tristin McCreight, and Chelsey Stebbins as part of the Infrastructure Past, Present and Future: GOVT 490-004 (Synthesis Seminar for Policy & Government) / CEIE 499-003 (Special Topics in Civil Engineering) Fall 2023 course at George Mason University's Schar School of Policy and Government and the Volgenau School of Engineering, and Sid and Reva Dewberry Department of Civil, Environmental, and Infrastructure Engineering. Under the instruction of Professor Jonathan Gifford. Summary. The 5.9 GHz Spectrum is seen to be the next big step for innovation within the transportation industry, particularly in terms of C-V2X technology, which would allow for autonomous driving. However, the spectrum is also desirable for internet providers due to the low latency and high data transfer capabilities. These two competing infrastructure initiatives are fighting for control over the spectrum and both believe their initiatives have more importance than the other. In 2020 the Federal Communications Commission (FCC) made a decision to reallocate the lower 45 megahertz portion of the spectrum (5.850-5.895 GHz) to unlicensed users and Wi-Fi use. The decision for this allocation was due to automotive manufacturers inability to meaningfully deploy the spectrum and the potential economic benefits of granting further access. The upper 30 megahertz portion (5.895-5.925 GHz) remains for C-V2X deployment and improving vehicle safety. The FCC played a major part with the decision to reallocate the 5.9 GHz Spectrum to optimize and effectively use the band. The DOT, supporting vehicle safety through C-V2X, and Telecommunication companies, supporting advancements in Wi-Fi capacity, both argue that they have better reasoning to have full access to the spectrum. For 20 plus years the 5.9 GHz spectrum was allocated to the auto safety industry with C-V2X, but now this sudden shift has sparked an ongoing discussion on auto safety and expanding Wi-Fi’s capacity. Technology Terminology. 5.9 GHz Spectrum The 5.9 GHz Spectrum is a dedicated bandwidth that ranges from 5.850 - 5.925 GHz. This spectrum offers potential in low latency and high data transfer. This spectrum is favorable for both C-V2X opportunities in intelligent transportation, as well as improving Wi-Fi speed and reliability. DSRC The 5.9 GHz Dedicated Short Range Communications (DSRC) is a communications service that is primarily used in a short to medium range. This technology has low latency, high reliability, and is secure. DSRC is used primarily in public safety on the road by warning drivers of conditions or events ahead. C-V2X Cellular Vehicle-to-Everything (C-V2X) is a system that is meant for intelligent transportation systems and relies on a cellular connection to communicate with its surroundings. The C-V2X uses the spectrum because of its low latency and high data transfer abilities. This system builds upon the DSRC system by adding the ability to connect to a cellular network to increase its transmission range. V2X Vehicle-to-everything (V2X) is a short range direct communications system that connects vehicle to vehicle, infrastructure, and pedestrian infrastructures. V2X doesn’t use a cellular network, which means it focuses on the immediate and local area with sensors. Vehicles that can both recognize and communicate with these facets of transportation are considered to have a V2X communication. V2I Vehicle-to-Infrastructure (V2I) is a communication system for vehicles to connect to the surrounding infrastructure, such as traffic lights or road signs. V2I was an original component with DSRC and is further expanded upon with this system. This system can be in both C-V2X and V2X systems, and play a major role for both to succeed. V2V Vehicle-to-Vehicle (V2V) is a communication system that focuses on vehicle to vehicle communication and detection in real time. V2V has a larger presence in more modern vehicles with things like blind-spot detection and lane-change assistance, which relies heavily on short range communication between vehicles. V2P Vehicle-to-Pedestrian (V2P) is similar to V2V, in that it has the ability to recognize nearby pedestrians and implement safety measures to avoid fatalities and injuries. These measures are important for areas with pedestrian crossings and bike lanes. V2N Vehicle-to-Network (V2N) is a technology system that gives a vehicle access to use cellular networks. Car Wi-Fi is an example of this. It has the capabilities to have Wi-Fi, but it does not use it to communicate with other systems. V2N is a crucial component to C-V2X as it allows the vehicle to have its own Wi-Fi. Actors. Federal Communications Commission The FCC is the regulatory body for how frequencies are allocated and the rules governing them. The FCC takes into consideration how the 5.9 GHz Band can best be utilized, whether it is for transportation or telecommunication. A main concern for the FCC is that the spectrum is not overburdened, while still allowing users to benefit from its allocation as much as possible. The FCC is designed to be an unbiased party for this issue, but is not immune from considering corporate interests and public opinion.United States Department of Transportation The United States Department of Transportation (DOT) is responsible for planning, coordinating, and regulating transportation projects across the country. Part of their mission is to make roads safer and more accessible, by preventing crashes and congestion, which are costly. The DOT has been a long standing advocate for reserving the band for transportation in anticipation of emerging technologies, but lacked the ability and political will to take full advantage of it at the time of its initial allocation. The DOT on federal, state, and local levels, continues to have a vested interest in retaining the spectrum solely for transportation, so that they can further implement intelligent transportation systems across the country. Telecommunication Companies Due to the sought out nature of the spectrum, telecommunication companies desire to use the spectrum as much as the FCC allows for Wi-Fi. The quality of the spectrum would surely enhance their services and improve telecommunication broadly. The opening of the lower portion of the spectrum is estimated enhance GDP by $23.042 billion and boost economic growth. The telecommunication industry has rapidly utilized the lower portion of the spectrum. However, 6G band frequencies are also developing within the telecommunication space and  are likely to surpass the benefits of the 5.9GHz Band. This raises the question of what other frequencies could be opened for unlicensed users as an alternative to the 5.9GHz Band. Automotive Companies Automotive companies have long wished to implement the new C-V2X technology, but development took longer than anticipated. Automotive brands are at varying stages of V2X technology within their vehicles. Features such as auto braking and lane assist are currently in the marketplace. This group fears that the reallocation of the 5.9GHz spectrum will leave it overcrowded, once companies begin to implement C-V2X. Moreover, automotive manufacturers are at odds with the FCC because of the poor regulatory framework that restricts further implementation of C-V2X, since the current framework applies to DSRC instead, which is now obsolete. While this is an ongoing process, automotive companies continue to voice their concerns over reallocation of the spectrum. Equipment Manufacturers Companies such as Connex2x, Qualcomm, and P3 Mobility are currently working on projects that utilize C-V2X. These companies are important because they are dedicated to developing and implementing new technology that can be sold to automotive manufacturers or used to their own benefit. These companies are key in technology development and are motivated by profit incentives. Companies vary on their stance on reallocation, depending on their industry. Regardless, equipment manufacturers are an essential component of intelligent transportation systems. Interest Groups Various interest groups have a stake in the issue as well. Organizations such as the American Association of State Highway and Transportation Officials, Alliance for Automotive Innovation, and 5G Automotive Association (5GAA) advocate for the advancement of new transportation systems, many of which require the 5.9GHz band. The Intelligent Transportation Society of America, an interest group that promotes safe and sustainable transportation, sued the FCC for its reallocation of the spectrum.  Even though the organization lost the case in district court, it demonstrates the lasting struggle between the government entities, private interests, and the public. On the other side, interest groups such as Wi-Fi forward also lobby to promote more unlicensed Wi-Fi bands. They argue that opening up the 5.9 spectrum, as well as future bands, will buy economic growth, create jobs, and allow for more innovation within the industry. Wi-Fi forward has a lot of political power and influence, backed by multinational corporations. Narrative of the Case. As our highways and road infrastructure developed it became apparent that we needed to find innovative solutions to protect public safety. The 5.9 GHz Spectrum proved to have the right qualities for high speed traffic with its low latency and high bandwidth. However, the USDOT has made very little advancements in the intelligent transportation system since its initial allocation, other than the outdated DSRC technology. As other frequencies became crowded with unlicensed users, telecommunication companies saw the spectrum as a potential space for Wi-Fi expansion. There are many barriers that limit C-V2X deployment within the transportation industry. One of the main issues is the inconsistent rates of which technology and policy develop. While some automakers are ready and eager to deploy their advancements in their vehicles, the FCC faced administrative hurdles that restricted further innovation. Another barrier is that any upgrades to current infrastructure requires some degree of financial commitment from either local, state, or the federal government. Moreover, without investment from the private sector, which includes both equipment manufacturers and automotive manufacturers, the technology cannot reach its full potential. With these barriers, those seeking to use the spectrum have a slower and more difficult time putting the band to use. Despite the FCC having the final say, various actors still remain frustrated with the current status of reallocation. Even though we have yet to see large successes, many projects are in development that might change the efficacy and status of the spectrum's use. Funding and Financing. Implementation of intelligent transportation systems, especially those involving C-V2X technology require investments from both private and public sources. Government entities such as the DOT receive appropriations from congress, which are then dispersed to separate projects. For the 2024 budget the DOT requested $86.5 million for its High Priorities Activities Program (HPAP). This funding is used to assist states and local governments with CMV safety and intelligent transportation systems. These funds could help to advance and upgrade current technologies used within the 5.9 spectrum. State DOTs vary in how they get their funding, but are typically dependent on fuel taxes and transportation related fees, such as tolls. This results in steady, but inconsistent funding, which was especially telling during the Covid-19 pandemic. Investments from government at the federal, state, and local levels, all help to upgrade current infrastructure components such as stop lights. Funding from private companies also contribute to the development of intelligent transportation systems and utilization of the 5.9 GHz Spectrum. While most of this financing is undisclosed, it is likely they have a multiplicity of revenue sources. Qualcomm, for example, sells products for RSU and OBUs. Other companies, such as P3 Mobility, are still in the growth stages and likely have loans or investment streams that help sustain them. Investments from automakers are the most crucial to advancing technology, but they remain at different stages of development and implementation of C-V2X communication systems. Institutional Arrangements. Currently, the FCC’s rules regarding transportation and the 5.9GHz band are based on DSRC, but are transitioning to apply to C-V2X. Since DSRC is not capable of the autonomous vehicle future we envision, it is imperative that these regulatory frameworks are malleable and updated soon. In the interim, the FCC issued waivers to a collection of state DOTs, automotive manufacturers, and equipment manufactures, in order to preemptively grant permission for them to begin C-V2X implementation. For now, any entity requesting use of C-V2X must go through the FCC waiver process, until the FCC decides on a new regulatory framework. The FCC when it comes to rule making follows the “notice and comment” rule making. This means that when it comes to decide an issue they give the public notice on what they are planning to adopt  or modify and then seek comment from the public. After receiving comment from the public the FCC looks over the comments to develop the rules. The steps to this process starts with the foundation of the Administrative and Procedure Act (APA) which is the basic requirements for this process. Next up is the notice of proposed rule making (NPRM) which explains why there is a need for a rule change. This can also propose what the agency should consider when finding solutions. When NPRM is out there the FCC includes specific questions that they want public comment and data on. NPRM publication is the publication of the document into the Federal Register; this allows for public access through online and print media. The public comment period comes next which lasts for at least 30 days the more technical the matter the longer a period for public comment. The public can also ask for my time to comment by providing a clear reason. Depending on the case the amount of comments differ some receive thousands where others receive few. The public can also reply to each other’s comments. Next up is the peer review process, so if the subject contains scientific or social scientific information it should be peer-reviewed by a qualified specialist in the intended fields. This is to ensure quality in the final findings. After peer review a logical outgrowth test is conducted, under a court ruling if any changes are to be made in the final rule it has to be something the public can reasonably anticipate on. If the public cannot reasonably anticipate the change the FCC would be required to allow more public comment. Last up is the final rule publication which is published in the Federal Registration. Policy Issues. When the 5.9 GHz band was proposed in the 90s, it was intended to be used in V2V. This band was going to be used in DSRC which would help with “real-time safety-signaling” in emergency settings. Now 20 plus years later the need for DSRC is outdated and expensive. In 1991 the Intermodal Surface Transportation Efficiency Act was passed by Congress which meant that the DOT had to research and test intelligent vehicle-highway systems. With this research it led to the development of DSRC which would help with communication between V2I. Because of the research DSRC was looked at as a way that could avoid different vehicle accidents on US’s roads. In 1998 congress passed the Transpiration Equity Act for the 21st Century of 1998, which meant the FCC allocated 75 megahertz of 5.9 GHz band to be used for DSRC; it allocated 5850 to 5925 MHz to be a part of the band. Now, the band has little to do with auto safety and DOT shelved proposals that would have required DSRC “radio systems” in cars.  There have been advancements in safety technology for cars and the auto industry, but that does not involve 5.9 GHz bands. If DSRC was to be implemented today it would be pricey. The price alone to mandate the use of DSRC in all vehicles would be $5 billion a year according to the National Highway Traffic Safety Administration (NHTSA) and by 2060 it would total around $108 billion. Under the Obama Administration, DOT wanted to mandate DSRC radios in every new vehicle due to without every car having DSRC the technology would not work meaning no vehicles could rely on it. This decision was ultimately reversed under the Trump Administration’s DOT due to cost, delays, and uncertainty, but DOT has not announced anything about the DSRC not moving forward in implementation. If every car was to be equipped with the technology according to a report done by the NHTSA released in 2014; it would take “…37 years before we would expect the technology to fully penetrate the fleet”. Now 20 years later this valuable band is deemed important for personal communication. 5.9 GHz is the gap between the current and the possible future for high-capacity Wi-Fi. In 2019 the FCC unanimously adopted a NPRM on the allocation of 5.9 GHz with the lower 45 megahertz going to Wi-Fi spectrum and the upper 30 megahertz for auto safety. The FCC adopted this proposal due to the fact that during these 20 years DSRC had yet to truly be implemented with the chairman acknowledging that, “…[I]t is hindering [the United States’] wireless future”. The FCC chairman also acknowledge how little auto safety needs the 5.9GHz spectrum. The FCC started looking into using 5.9 GHz spectrum in the 2013 due to the congestions in 5 GHz spectrum. In 2018 the DOT and FCC after testing found that the 5.9 GHz spectrum that was being used for DSRC can be shared with Wi-Fi. The reason the FCC proposed allocating 30 megahertz to auto safety was because that is the standard in other places around the globe like the European Union. Now 20 years later this valuable band is deemed important for personal communication. 5.9 GHz is the gap between the current and the possible future for high-capacity Wi-Fi. In 2019 the FCC unanimously adopted a notice of proposed rule making NPRM on the allocation of 5.9 GHz with the lower 45 megahertz going to Wi-Fi spectrum and the upper 30 megahertz for auto safety. The FCC adopted this proposal due to the fact that during these 20 years DSRC had yet to truly be implemented with the chairman acknowledging that, “…[I]t is hindering [the United States’] wireless future”. The FCC chairman also acknowledged how little auto safety needs the 5.9GHz spectrum. The FCC started looking into using the spectrum in the 2013 due to the congestions in 5 GHz spectrum. In 2018 the DOT and FCC after testing found that the 5.9 GHz spectrum that was being used for DSRC can be shared with Wi-Fi. The FCC proposed allocating 30 megahertz to auto safety following the standard in other places around the globe like the European Union. Lessons Learned. The 5.9 GHz Spectrum has only just recently become an issue, with the allocation of Wi-Fi into what used to be C-V2X only territory. The FCC’s decision for the lower 45 megahertz to be dedicated for Wi-Fi is very beneficial for the advancements and development of better services, as well as still giving the upper 30 megahertz for C-V2X development and improvement. Both argue that having complete access to the full range of the 5.9 GHz spectrum is necessary to have the most potential, as well as to keep the amount of traffic through the spectrum low and controlled. The results of this decision and the effectiveness of the allocation will be seen years from now. C-V2X will continue to develop and be implemented, but with half of the space originally owned. On the other hand, Wi-Fi’s new space in the 5.9 GHz spectrum is a much needed expansion that will act as the stepping stone needed for the next generation of Wi-Fi. Overall the 20 plus year old debate and implementation of 5.9 GHz spectrum shows the inefficiency that surrounds bureaucracy’s red tape. Besides that, the slowness of bureaucracy impacted the accountability to the project stemming from the FCC’s decision on what the spectrum should be used for in 2020. In terms of adaptability, the spectrum has not been able to accommodate changes in technology and has stifled innovation from private companies hindering efforts to fully implement our intelligent transportation system. For intelligent transportation systems to truly be effective we must consider how to move past administrative hurdles and support new technological developments within the industry.

Chess Guide for the Intermediate Player/Common checkmate patterns. Major pieces. Queen. To checkmate with a king and queen, you must first force the enemy king to the edge of the board, which the queen can do by herself. Then, you have to bring your king to the edge as well (be careful not to stalemate the opponent). Mate can be forced in at most ten moves from any king and queen vs king position, unless the lone king can immediately capture the queen. Two major pieces. This is the easiest to execute of any checkmate. Keep in mind that if you are using two rooks and the enemy king gets within striking distance and could potentially win a rook, create a battery with your rook, so that the enemy king is forced to move away. On the next move, you can checkmate. Checkmate example. 1. Ra4+ The series of checks begin. 1...Kf5 Kg3 for Black would be instant death. So Black attempts to approach the rooks. 2. Rb5+ Another check. Black cannot flee to the fourth rank... 2...Ke6 ...so he flees to the sixth rank while continuing to approach the rooks. 3. Ra6+ Yet another check. 3...Kd7 Black is getting really close to the rooks! Will he be able to stop the rooks? 4. Rb7+ The fourth check. 4...Kc8 The black king has gotten close enough! He is entertaining thoughts of capturing a rook, or at least delaying White's plans for a few moves. Of course, if White gets greedy and attempts to checkmate Will work on it more soon Rook. To checkmate with a rook, construct a "box" with the rook that is protected by your king. The box becomes smaller and smaller until the enemy king is forced into the corner. Mate can be forced in at most sixteen moves.

Astrodynamics/Basic Rocketry. This section of the introduction will cover the basic ideas and theory of how rockets fly and leave the atmosphere as well as introduce the rocket equation. The Ideal Rocket Equation. Rockets are momentum exchange devices the function by expelling some fluid (usually very hot gas or plasma) which "pushes" the rocket via Newtons third law of motion. Rockets are technically all around us ranging from simple water bottle rocket, to fireworks, to more sophisticated rockets like the . The Tsiolkovsky Rocket Equation, derived below, is basic and fundamental principle of how rockets fly and shows the maximum change in velocity, formula_1 (Delta V), that can be achieved by a rocket provided no external forces act on it. formula_2 Where, The Rocket Equation states that with a faster exhaust velocity the greater finally velocity of the rocket; however, due to the natural logarithm there is an exponential increase in the initial mass of the rocket. Therefore, it is not beneficial to increase the mass of rocket as it will have negligible return and instead the uses of stages (multiple rocket stacked on top of each other) is more beneficial. Further, it's important to state that it might be misleading thinking that more efficient rockets (higher formula_5) are better at launch, since the rocket may not lift of the ground if the thrust force propelling it up is too small. This is due to the fact that the equation functions with no external forces acting on it. Although the Rocket Equation has it's limitations it is a useful resources for explaining future topics such as transfers. However, to elaborate on reason why the efficiency might be misleading it's worth noticing that in the derivation we have found the formula_10 equation. Hence, the instantaneous thrust force on the rocket in 1D is shown below. As can be seen if the ISP is high and the rocket motor is efficient it will not mean much if the mass flow rate, formula_11, is low and the thrust cannot surpass gravity and aerodynamical drag. formula_12 Rocket Staging. The rocket's propulsion system can only consist of one fuel tank and one engine, however, such a system cannot be used to get into earth's orbit, as for that we would need a very long fuel tank, which is impractical since it would lower the engine's thrust to weight ratio(Except for the hypothetical spaceplane single stage to orbit or SSTO designs like Skylon). Such a problem is solved by adding multiple stages, with each stage consisting of a propellant tank and an engine, along with a separation system(Sometimes along with other things like an electronic guidance system or parachutes). When the propellant of one stage runs out, that section is removed, thus reducing onboard dry mass. Staging can be used for reasons such as: This makes staging an expensive, but effective method to go to earth's orbit and beyond. There are also efforts to make stages reusable to reduce the cost of using these rockets.