Resumen Introducción: El ultrasonido pulmonar es una herramienta a pie de cama que permite evaluar la afectación del parénquima pulmonar en pacientes pediátricos por medio de la escala de LUS (lung ultrasound score, por sus siglas en inglés). El objetivo del estudio fue evaluar a niños menores de 3 años con infección respiratoria baja mediante la escala de LUS, en el Hospital Infantil del Estado de Sonora. Métodos: Se incluyeron pacientes menores de 3 años que ingresaron al Servicio de Urgencias con infección respiratoria baja. Se realizó ecografía pulmonar en las primeras 24 horas de ingreso a urgencias y se evaluó mediante la escala de LUS. Se analizó, edad, sexo, etiología de la infección, días de estancia, uso de terapia ventilatoria, escala de Downes, fracaso a la terapia ventilatoria de ingreso y mortalidad. Se realizó un análisis descriptivo por medio de frecuencia y porcentaje para las variables cualitativas y para las cuantitativas con mediana e intervalo intercuartil. Las diferencias en la distribución de las variables por la escala de LUS con la prueba exacta de Fisher y la t de Student. Resultados: Se identificaron 19 pacientes con infección pulmonar aguda, de los cuales el 73.7% presentó bronquiolitis. El 50% de los casos obtuvo 7 puntos de la escala de LUS, el 91.7% ingresó a UCIP y el 53.8% requirió ventilación mecánica asistida. Conclusiones: El uso de la escala LUS en infección respiratoria baja puede predecir la necesidad de ingreso a Unidad de Cuidados Intensivos Pediátricos, así como la utilización de soporte ventilatorio invasivo y una estancia hospitalaria prolongada.

Abstract Background: Lung ultrasound is a bedside tool that allows the evaluation of pulmonary parenchymal involvement in pediatric patients through the lung ultrasound score (LUS). We aimed to evaluate a group of patients under 3 years of age with lower respiratory tract infections using LUS at the Hospital Infantil del Estado de Sonora. Methods: We included patients younger than 3 years admitted to the emergency department with lower respiratory tract infections. A lung ultrasound was performed within the first 24 h of admission to the emergency department and evaluated using LUS. We analyzed age, sex, etiology of infection, days of stay, use of mechanical ventilation, Downes scale, failure of mechanical ventilation on admission, and mortality. Descriptive analysis was performed with frequencies and percentages for qualitative variables and medians and interquartile intervals for quantitative variables. Differences in the distribution of LUS variables were evaluated with the Fishers´ exact test and Student´s t-test. Results: We included a total of 19 patients with lower respiratory tract infections, 73.7% with bronchiolitis. Fifty percent of the cases scored 7 on the LUS, 91.7% were admitted to the pediatric intensive care unit, and 53.8% required invasive mechanical ventilation. Conclusions: The use of LUS in lower respiratory tract infections can predict the need for PICU admission, the use of invasive ventilatory support, and prolonged hospital stay.

ABSTRACT A great challenge of scientific research with carrot in semi-arid regions is obtaining the best productive characteristics and economic conditions by optimizing the green manure amounts using spontaneous species from the Caatinga biome, such as hairy woodrose (Merremia aegyptia L.) and roostertree (Calotropis procera Ait.). Therefore, this work aimed to agronomically and economically optimize the production of carrot roots in monocropping and of their components when fertilized with equitable biomass amounts of these spontaneous species in two cropping seasons in a semi-arid environment. The experimental design was a randomized complete block design, with five treatments and five replications. The treatments consisted of equitable amounts of hairy woodrose and roostertree biomass in amounts of 16, 29, 42, 55, and 68 t ha-1 on a dry basis. In each experiment, an additional carrot treatment without fertilizer (absolute control) was planted for comparison with the other treatments to determine maximum physical and economic efficiency. Carrot fertilization was performed with the incorporation of 48.87 t ha-1 of M. aegyptia and C. procera dry biomass into the soil to obtain the maximum optimized productive efficiency (commercial productivity). The maximum optimized agroeconomic efficiency (net income) of carrot cultivation was obtained when 49.64 t ha-1 of M. aegyptia and C. procera dry biomass was added to the soil. The use of biomass from these spontaneous species from the Caatinga biome as green manure is a viable technology for tuberose producers in monocropping in semiarid environments.

RESUMO Um grande desafio na pesquisa científica com cenoura em ambiente semiárido é obter as melhores características produtivas e condições econômicas otimizando as quantidades de adubos verdes de espécies espontâneas do bioma Caatinga, como a jitirana (Merremia aegyptia L.) e a flor-de-seda (Calotropis procera Ait.). Diante disso, esse trabalho teve como objetivo otimizar agronômica e economicamente a produção de raízes de cenoura em monocultivo e de seus componentes, quando adubados com quantidades equitativas de biomassa dessas espécies espontâneas, em duas estações de cultivos em ambiente semiárido. O delineamento experimental utilizado foi em blocos completos casualizados, com cinco tratamentos e cinco repetições. Os tratamentos consistiram de quantidades equitativas de biomassa de jitirana e de flor-de-seda nas doses de 16, 29, 42, 55 e 68 t ha-1 em base seca. Em cada experimento foi plantado um tratamento adicional com cenoura sem adubo (testemunha absoluta) para efeito de comparação com os demais tratamentos para determinar a máxima eficiência física ou econômica. A adubação da cenoura foi realizada com a incorporação de 48,87 t ha-1 de biomassa seca de M. aegyptia e C. procera ao solo para obtenção da máxima eficiência produtiva otimizada (produtividade comercial). A máxima eficiência agroeconômica otimizada (renda líquida) do cultivo da cenoura foi obtida quando 49,64 t ha-1 de biomassa seca de M. aegyptia e C. procera foram adicionados ao solo. A utilização da biomassa dessas espécies espontâneas do bioma Caatinga como adubação verde é uma tecnologia viável para produtores de tuberosas em monocultivo em ambientes semiáridos.

ABSTRACT The use of spontaneous species from the Caatinga biome as green manure is a promising practice in increasing the productivity of agricultural systems and sustainable exploitation of the environment. This study aimed to estimate the maximum physical and economic efficiencies of radish agroeconomic characteristics in monocropping as a function of roostertree (Calotropis procera (Ait.) R. Br) biomass amounts in two cropping seasons in a semi-arid environment. The experimental design was randomized complete blocks with five treatments and five replications. The treatments consisted of different roostertree biomass amounts: 16, 29, 42, 55, and 68 t ha-1 on a dry basis, incorporated into the soil. In each block, two additional treatments were added, one without fertilization (control) and the other with mineral fertilizer, for comparison purposes with the maximum efficiency treatment. The radish cultivar planted was ‘Crimson Gigante’. The fertilization of the radish to obtain the maximum optimized productive efficiency (9.56 t ha-1) was possible with the incorporation of 50.86 t ha-1 of C. procera dry biomass into the soil. The maximum optimized agroeconomic efficiency (based on a net income of 37,641.08 R$ ha-1) of radish cultivation was obtained with 44.39 t ha-1 of C. procera dry biomass added to the soil. The rate of return and the profit margin obtained were 2.94 R$ for each real invested, with a profit margin of 62.55%. The use of biomass from the C. procera green manure is a viable technology for producers who practice radish monoculture in a semi-arid environment.

RESUMO O uso de espécies espontâneas do bioma Caatinga como adubo verde é uma prática promissora no aumento da produtividade dos sistemas agrícolas e na exploração sustentável do meio ambiente. Este trabalho teve como objetivo estimar as máximas eficiências físicas e econômicas das características agroeconômicas do rabanete em monocultivo, em função de quantidades de biomassa de flor-deseda em duas estações de cultivos em ambiente semiárido. O delineamento experimental utilizado foi em blocos casualizados com cinco tratamentos e cinco repetições. Os tratamentos consistiram de diferentes quantidades de biomassa de flor-de-seda: 16, 29, 42, 55 e 68 t ha-1 em base seca, incorporadas ao solo. Em cada bloco dos experimentos foram adicionados dois tratamentos, um sem adubação (tratamento testemunha) e outro com adubo mineral, para fins de comparação com o tratamento de máxima eficiência. A cultivar de rabanete plantada foi a Crimson Gigante. A adubação do rabanete para obtenção da máxima eficiência produtiva otimizada (9,56 t ha-1) foi possível com a incorporação de 50,86 t ha-1 de biomassa seca de C. procera ao solo. A máxima eficiência agroeconômica otimizada (baseada na renda líquida de 37.641,08 R$ ha-1) foi obtida com a quantidade de 44,39 t ha-1 de biomassa seca de C. procera adicionada ao solo. A taxa de retorno e a margem de lucro obtida foram de R$ 2,94 para cada real investido com margem de lucro de 62,55%. A utilização da biomassa do adubo verde, C. procera, é uma tecnologia viável para produtores que praticam o monocultivo de rabanete em ambiente semiárido.

BACKGROUND. In sub-Saharan Africa, substance use among adolescents has continued to be a major public health concern, albeit poorly documented across many settings.OBJECTIVE. To estimate the prevalence of substance use among adolescents in sub-Saharan Africa.METHODS. We searched Pubmed, EMBASE, AJOL and Google Scholar for population-based studies on adolescents (age 10 - 19 years) and reporting on the prevalence of substance use across sub-Saharan Africa. Search dates were from January 2000 to December 2016. A random effects meta-analysis was conducted with pooled prevalence rates (and 95% confidence interval (95% CI)) of estimated substance abuse among adolescents in sub-Saharan Africa.RESULTS. Twenty-seven studies across sub-Saharan Africa including 143 201 adolescents (mean age 15.6 years) were selected. The overall prevalence of 'any substance use' in sub-Saharan Africa was 41.6%, with the highest rate in Central Africa at 55.5%. The use of caffeine-containing products (including coffee or kola nut) was most predominant at 41.2% (95% CI 24.3 - 58.1) but limited to West Africa. These were followed by alcohol at 32.8% (95% CI 26.0 - 39.5), tobacco products 23.5% (95% CI 17.7 - 29.3), khat 22.0% (95% CI 12.5 - 31.5) and cannabis 15.9% (95% CI 12.2 - 19.1). Other abused substances included depressants at 11.3% (95% CI 6.5 - 16.1), amphetamines 9.4% (95% CI 6.0 - 12.9), heroin 4.0% (95% CI 3.5 - 4.5) and cocaine 3.9% (95% CI 1.4 - 6.5).CONCLUSION. Our study reflects a high use of psychoactive substances and drugs among adolescents in sub-Saharan Africa. It is important that interventions and rehabilitation programmes are comprehensive and targeted at adolescents and parents in these settings.

OBJECTIVES: Brain death is typically followed by autonomic changes that lead to hemodynamic instability, which is likely associated with microcirculatory dysfunction and inflammation. We evaluated the role of the microcirculation in the hemodynamic and inflammatory events that occur after brain death and the effects of autonomic storm inhibition via thoracic epidural blockade on mesenteric microcirculatory changes and inflammatory responses. METHODS: Male Wistar rats were anesthetized and mechanically ventilated. Brain death was induced via intracranial balloon inflation. Bupivacaine (brain death-thoracic epidural blockade group) or saline (brain death group) infusion via an epidural catheter was initiated immediately before brain death induction. Sham-operated animals were used as controls (SH group). The mesenteric microcirculation was analyzed via intravital microscopy, and the expression of adhesion molecules was evaluated via immunohistochemistry 180 min after brain death induction. RESULTS: A significant difference in mean arterial pressure behavior was observed between the brain death-thoracic epidural blockade group and the other groups, indicating that the former group experienced autonomic storm inhibition. However, the proportion of perfused small vessels in the brain death-thoracic epidural blockade group was similar to or lower than that in the brain death and SH groups, respectively. The expression of intercellular adhesion molecule 1 was similar between the brain death-thoracic epidural blockade and brain death groups but was significantly lower in the SH group than in the other two groups. The number of migrating leukocytes in the perivascular tissue followed the same trend for all groups. CONCLUSIONS: Although thoracic epidural blockade effectively inhibited the autonomic storm, it did not affect mesenteric hypoperfusion or inflammation induced by brain death.

Arbuscular mycorrhizal fungi (AMF) are obligate biotrophs of higher plants and constitute one of the most widespread groups of soil microorganisms. Classification, taxonomy and description of evolutionary relationships among AMF have been a fundamental part on the study of such organisms. Development of this knowledge can be separated into three major stages starting from the first reported observations of these microorganisms. The first stage corresponds to the recognition of morphological diversity among the species clustered in the genera Endogone (Zygomycota), and its separation into the AMF genera Gigaspora, Acaulospora, Glomus and Sclerocystis, and the non-mycorrhizal Modicella, Glaziella and Endogone, all of these subordinated to Endogonaceae. The second stage involves the study of common morphological features that resulted from the separation of AMF species in a monophyletic group at the rank of an order (Glomales). Finally, the third stage comprises most recent studies thatrely on the use of molecular biology tools coupled with observation of morphological features. One of the most significant contributions of this period was placing AMF species in a higher taxa rank and grouping the species in the Glomales Order into the phylum Glomeromycota. This review addresses these three stages in detail, and provides a general view of the distinct taxonomical changes in AMF classification.

Los hongos micorrizógenos arbusculares (HMA) son biótrofos obligados de plantas y constituyen uno de los grupos de microorganismos del suelo de distribución más extensa. Una parte fundamental del estudio de estos organismos se ha enfocado a su clasificación, taxonomía y establecimiento de relaciones evolutivas entre HMA. El proceso en el desarrollo de este conocimiento puede ser separado en tres etapas importantes a partir de las primeras observaciones reportadas de estos microorganismos. La primera etapa corresponde al reconocimiento de la diversidad de especies dentro del género Endogone (Zygomycota) y su división en los géneros de HMA Gigaspora, Acaulospora, Glomus y Sclerocystis, así como en los géneros Modicella, Glaziella y Endogone, que no forman micorriza, todos ellos subordinados a Endogonaceae. La segunda etapa involucra el estudio de distintas características morfológicas comunes dentro del grupo de HMA que fueron suficientes para sustentar su separación en un grupo monofilético a nivel de orden (Glomales). Finalmente, la tercer etapa comprende los estudios más recientes en los que se incluye el uso de herramientas de biología molecular, aunado a las observaciones de las características morfológicas, en donde una de las aportaciones más significativas fue identificar y colocar al grupo de HMA en una posición taxonómica superior, agrupando las especies que integraban al orden Glomales en el phylum Glomeromycota. En la presente revisión se aborda cada una de estas etapas en forma detallada, además se presenta un panorama general de los distintos movimientos taxonómicos a los que los HMA han sido sujetos a lo largo de la historia de su estudio.

A composição da dieta de 66 espécies de peixes foi investigada de setembro de 2009 a junho de 2010, em três subsistemas da planície de inundação do alto rio Paraná (Brasil), após a invasão das espécies de molusco Limnoperna fortunei (Dunker, 1857) e Corbicula fluminea (Müller, 1774), e da macrófita Hydrilla verticillata (L.f.) Royle. Limnoperna fortunei foi consumida em todos os subsistemas amostrados e ocorreu na dieta de 15 espécies de peixes, com grande participação na dieta de Leporinus obtusidens. Corbicula fluminea esteve presente na dieta de Pterodoras granulosus coletados nos subsistemas Paraná e Ivinheima. Hydrilla verticillata ocorreu na dieta de Schizodon nasutus, capturados nos subsistemas Ivinheima e Paraná. Até o momento não é possível avaliar o potencial destas espécies para controlar moluscos invasores na área de estudo ou o impacto destas espécies sobre a estrutura das cadeias alimentares. Peixes omnívoros e herbívoros da área de estudo podem ter pouco impacto sobre a população de H. verticillata.

The composition of the diets of 66 species of fishes was investigated from September 2009 to June 2010 in three subsystems of the Upper Paraná River floodplain (Brazil), following invasion by the two mollusk species Limnoperna fortunei (Dunker, 1857) and Corbicula fluminea (Müller, 1774), and the macrophyte Hydrilla verticillata (L.f.) Royle. Limnoperna fortunei was consumed in all three subsystems and occurred in the diet of 15 fish species, with a high proportion in the diet of Leporinus obtusidens. Corbicula flumineawas present in the diet of Pterodoras granulosus caught in the Paraná and Ivinheima subsystems. Hydrilla verticillataoccurred in the diet of Schizodon nasutus caught in the Ivinheima and Paraná subsystems. It is not yet possible to evaluate the potential of these species to control invasive mollusks in the study area or the impact of these species on the structure of the food chain. Omnivorous and herbivorous fishes in the study area may have little impact on the population of H. verticillata.

A água de coco contém várias substâncias não caracterizadas e é amplamente utilizada na alimentação humana. Neste estudo, foram detectados e quantificados ácido ascórbico e ácido cafeico e polifenóis totais em diversas variedades de coco, e usando HPLC-MS-MS (25,8 ± 0,6 µg-mL, 1,078 ± 0,013 µg-mL and 99,7 µg-mL, respectivamente, em água de coco do anão verde, ou 10 mg, 539 µg e 39,8 mg por unidades de coco consumido, 500 ± 50 mL). O potencial antioxidante da água de coco das quatro variedades de coqueiro (anão verde, anão amarelo, anão vermelho e amarelo malasiano) foi comparada com água de coco industrializada e água liofilizada da variedade anão verde. Todas as variedades foram eficazes - com destaque para as propriedades antioxidantes do anão verde, uma vez que é o mais comum usado – no sequestro do radical DPPH (IC50=73 µL), óxido nítrico (0,1 mL com IP de 29,9%) e inibindo a produção de espécies reativas com o ácido tiobarbitúrico (1 mL com IP de 34,4%) in vitro. Em cultura de células, a água de coco da variedade anão verde foi eficiente na proteção contra danos oxidativos induzidos por peróxido de hidrogênio.

Coconut water contains several uncharacterized substances and is widely used in the human consumption. In this paper we detected and quantified ascorbic acid and caffeic acid and total phenolics in several varieties of coconut using HPLS-MS-MS (25.8 ± 0.6 µg-mL and 1.078 ± 0.013 µg-mL and 99.7 µg-mL, respectively, in the green dwarf coconut water, or 10 mg and 539 µg and 39.8 mg for units of coconut consumed, 500 ± 50 mL). The antioxidant potential of four coconut varieties (green dwarf, yellow dwarf, red dwarf and yellow Malaysian) was compared with two industrialized coconut waters and the lyophilized water of the green dwarf variety. All varieties were effective in scavenging the DPPH radical (IC50=73 µL) and oxide nitric (0.1 mL with an IP of 29.9%) as well as in inhibiting the in vitro production of thiobarbituric acid reactive substances (1 mL with an IP of 34.4%), highlighting the antioxidant properties of the green dwarf which it is the most common used. In cell culture, the green dwarf water was efficient in protecting against oxidative damages induced by hydrogen peroxide.

La aplicación de campos magnéticos, parece producir modificaciones de algunos procesos fisiológicos de las plantas entre ellos estimular su desarrollo. Este estudio reporta el efecto de diferentes intensidades de campo electromagnético generadas por un solenoide con campo magnético horizontal variable sobre la germinación y el crecimiento de semillas de maíz. Se trabajó con semillas del híbrido experimental San José, las cuales se expusieron a un campo electromagnético de 0, 2, 4 y 6 mT, durante 3 min, bajo un diseño experimental completamente al azar en dos condiciones de semillas: imbibidas y sin embeber. Se realizó el análisis de varianza en las variables de germinación y crecimiento, con un nivel de significancia de 95%, y se observó un incremento en la germinación, el índice de vigor I, el índice de vigor II y la longitud de las raíces, de 3, 20, 34 y 23%, respectivamente, en comparación con las semillas testigo (sin tratar) al octavo día. De igual forma, se evaluó la presencia de pigmentos clorofílicos y carotenos, encontrándose un incremento en la concentración de clorofila a, clorofila b y carotenos en las plántulas de maíz obtenidas a partir de semillas tratadas electromagnéticamente. La respuesta varió en dependencia de la inducción magnética, sin ninguna tendencia particular; el mejor tratamiento fue el de 4µT, durante 3 min de exposición. El mejoramiento de las variables funcionales evaluadas sugiere que las semillas pueden funcionar mejor bajo la acción de un campo electromagnético

The application of magnetic fields appears to produce changes in some physiological processes of plants, including encouraging their development. This study reports the effects of different intensities of electromagnetic fields generated by a solenoid with a variable horizontal magnetic field on the germination and growth of maize seeds. We worked with the experimental seed hybrid San Jose, which was exposed to electromagnetic fields of 0, 2, 4 and 6 mT for 3 min, using a completely randomized design with two seed conditions: imbibed and non-imbibed. Analysis of variance was performed for the variables germination and growth, with a level of significance of 95%; increases were observed in germination, vigor index I, vigor index II and root length, 3, 20, 34 and 23% respectively, compared to the control seeds (untreated) on the eighth day. Similarly, the presence of chlorophyll pigments and carotenoids was assessed and an increase was found in the concentration of chlorophyll a, chlorophyll b and carotene in corn seedlings grown from electromagnetically treated seeds. The response varied depending on the magnetic induction, without any particular trend, the best treatment was 4 µT for 3 min of exposure. The improvement of the evaluated functional variables suggests that the seeds may perform better with an electromagnetic field treatment

Foram examinados os parasitas de 136 espécimes de Hemisorubim platyrhynchos, chamados popularmente de jurupoca. Quatorze espécies de parasitas foram registradas: quatro de digenéticos (Crocodilicola pseudostoma, uma espécie da família Gorgoderidae, Sanguinicola platyrhynchi e Sphincterodiplostomum sp.); três de cestóides (Goezeella paranaensis, Spatulifer maringaensis e Mariauxiella piscatorum); cinco de nematóides (Contracaecum Tipo 1 larva de Moravec, Kohn & Fernandes, 1993; Contracaecum Tipo 2 larva de Moravec, Kohn & Fernandes, 1993; Cucullanus (Cucullanus) zungaro; Eustrongylides ignotus; e Goezia sp.); uma de acantocéfalo (Quadrigyrus machadoi) e uma de pentastomídeo (Sebekia sp.). A maioria dos espécimes de helmintos estava em estágio larval de desenvolvimento, confirmando que H. platyrhynchos é uma importante fonte de transmissão para esses parasitas. Não houve dominância. As espécies mostraram padrão agregado de distribuição na amostra de hospedeiros, com exceção de Contracaecum Tipo 2, que apresentou distribuição casual. Não houve evidências de competição entre as espécies de parasitas. Várias espécies mostraram-se correlacionadas com o tamanho e o sexo dos hospedeiros, o que pode ser originado por aumentos no volume de alimento ingerido e possíveis modificações comportamentais entre os sexos. Não houve correlação entre a diversidade das infracomunidades e o tamanho ou sexo dos hospedeiros.

Parasites of 136 specimens of Hemisorubim platyrhynchos, popularly called jurupoca, were analyzed. Fourteen parasite species were recorded: four digeneans (Crocodilicola pseudostoma, one Gorgoderidae species, Sanguinicola platyrhynchi, and Sphincterodiplostomum sp.); three cestodes (Goezeella paranaensis, Spatulifer maringaensis, and Mariauxiella piscatorum); five nematodes (Contracaecum Type 1 larvae of Moravec, Kohn, & Fernandes, 1993; Contracaecum Type 2 larvae of Moravec, Kohn, & Fernandes, 1993; Cucullanus (Cucullanus) zungaro; Eustrongylides ignotus; and Goezia sp.); one acanthocephalan (Quadrigyrus machadoi), and one pentastomid (Sebekia sp.). Most of the helminth specimens were found in larval stages, confirming that H. platyrhynchos is a significant source of their transmission. No dominance was reported. With the exception of Contracaecum Type 2 (featuring random dispersion), the species had a clumped pattern of dispersion in the host sample. Evidence of competition among parasite species was not reported. Several species of parasites were correlated with host size and sex. This fact may be explained by increase in food content and possible behavioral modifications of male and female hosts. Infracommunity diversity was not related to host size or sex.

É descrita uma nova espécie do gênero Sanguinicola Plehn, 1905, Sanguinicola platyrhynchi n. sp., digenético parasita da cavidade visceral de Hemisorubim platyrhynchos (Valenciennes, 1840), da planície de inundação do alto rio Paraná, Brasil. A nova espécie foi incluída neste gênero por possuir poros genitais separados e dorsais e diferir de outras espécies do mesmo gênero, principalmente pelas características do sistema digestório, da posição dos poros genitais e do local de infecção. É realizada uma emenda da diagnose genérica.

A new species is of the genus Sanguinicola Plehn, 1905 described, Sanguinicola platyrhynchi n. sp., digenetic parasite of visceral cavity of Hemisorubim platyrhynchos (Valenciennes, 1840) from the floodplain of the upper Paraná River, Brazil. The species has been thus included because of the presence of separate dorsal genital pores, while differing from other species of the same genus mainly in digestive apparatus features, genital pore position, and infection site. Emendation of generic diagnosis is included.