The dynamics from the model qualitatively match clinical data Dr

The dynamics from the model qualitatively match clinical data. Drug treatment combinations with reverse transcriptase inhibitors and protease AZD1080 in vivo inhibitors are simulated using various drug efficacies. The results indicate that the model can be very useful in evaluating different drug therapy regimens. (c) Published by Elsevier Ltd.”
“In this paper we model and analyze the hepatitis B virus (HBV) infection in a diffusion model confined to a finite domain, induced by intracellular time delay between infection of a cell and production of new virus particles. The equilibrium solutions are obtained and the stability is analyzed if the space is assumed as homogeneous. When the space is inhomogeneous, the effects of diffusion

and intracellular time delay are obtained by computer simulations. (c) 2007 Elsevier Ltd. All rights reserved.”
“Different

biological dynamics are often described by different mathematical equations. On the other hand, some mathematical models describe many biological dynamics universally. Here, we focus on three biological dynamics: the Adriamycin in vivo Lotka-Volterra equation, the Hopfield neural networks, and the replicator equation. We describe these three dynamical models using a single optimization framework, which is constructed with employing the Riemannian geometry. Then, we show that the optimization structures of these dynamics are identical, and the differences among the three dynamics are only in the constraints of Electron transport chain the optimization. From this perspective, we discuss the unified view for biological dynamics. We also discuss the plausible categorizations, the fundamental nature, and the efficient modeling of the biological dynamics, which arise from the optimization perspective of the dynamical systems. (c) 2008 Elsevier Ltd. All rights reserved.”
“We consider a rumor transmission model with various contact interactions and explore what effect such interactions have on the spread of a rumor, in particular whether they can explain the rumor recursion. Through

mathematical analysis and computer simulations, we conjecture that rumor recursion remains a major challenge to mathematical models of rumors beyond our model proposed here. (c) 2007 Elsevier Ltd. All rights reserved.”
“Barnacles, marine crustaceans, have various patterns of sexuality depending on species including simultaneous hermaphroditism, androdioecy (hermaphrodites and dwarf males), and dioecy (females and dwarf males). We develop a model that predicts the pattern of sexuality in barnacles by two key environmental factors: (i) food availability and (ii) the fraction of larvae that settle on the sea floor. Populations in the model consist of small individuals and large ones. We calculate the optimal resource allocation toward male function, female function and growth for small and large barnacles that maximizes each barnacle’s lifetime reproductive success using dynamic programming.

Methods: We reviewed the literature for published 1-year AFS, mor

Methods: We reviewed the literature for published 1-year AFS, mortality, and amputation rates from control groups in NO-CLI trials. Summary proportions of events were estimated by conducting a random effects meta-analysis of proportions. To determine whether there had been any change in event rates over time, we performed a random effects meta-regression and a mixed effects logistic regression, both regressed against the variable “”final year of recruitment.”"

Results: Eleven trials consisting of 886 patients satisfied search criteria, 7 of which presented AFS data. Summary proportion

of events URMC-099 (95% confidence interval) were 0.551 (0.399 to 0.693) for AFS; 0.198 (0.116 to 0.317) for death; and 0.341 (0.209 to 0.487) for amputation. Regression analyses demonstrated that AFS has risen over time as mortality rates have fallen, and these improvements are statistically significant. The decrease in amputation rates failed to reach statistical significance. The lack of published data precluded a quantitative evaluation of any change in the clinical severity or comorbidities in the NO-CLI population.

Conclusions: AFS and mortality rates in NO-CLI have improved

over the past 2 decades. Due to declining event rates, clinical trials may underestimate treatment effects and thus fail to reach statistical significance unless sample sizes are increased or unless a subgroup with a higher event rate can be Cl-amidine manufacturer identified. Alternatively, comparing

outcomes to historical values for quality measurement may overestimate treatment Silmitasertib ic50 effects. Benchmark values of AFS and morality require periodic review and updating. (J Vasc Surg 2012; 55:781-9.)”
“The polyglutamine (polyQ) diseases consist of nine neurodegenerative diseases in which a polyQ tract expansion leads to protein misfolding and subsequent aggregation. Even when the causative proteins have the same length polyQ tract, there are differences in the severity and age of disease onset which implicate the polyQ flanking sequences as modulators of disease. Recent studies on the polyQ proteins ataxin-1, ataxin-3 and huntingtin exon-1 have shown that the flanking domains have an intrinsic ability to aggregate. This complex behavior leads to a multi-stage aggregation mechanism which we have termed multi-domain misfolding. In multi-domain misfolding, a flanking domain to the polyQ tract plays an early role in aggregation, before the contribution of the polyQ tract. A number of factors including the stability, dynamics and amyloidogenicity of the flanking domain modulate the impact on polyQ tract aggregation as well as any protein-protein interactions it undertakes. In this review, we examine the recent data in support of this novel mechanism of protein aggregation.”
“The zebrafish is a powerful toxicity model; biochemical assays can be combined with observations at a structural and functional level within one individual.

Mean +/- 2 SD patient age was 4 26 years (range 3 months to 18 ye

Mean +/- 2 SD patient age was 4.26 years (range 3 months to 18 years), and minimum followup OTX015 mouse was 6 months. Preoperative ultrasound findings recorded were pelvic anteroposterior diameter, pelvic cortical thickness, pelvic volume and pelvic cortical ratio. Spot urine protein-to-creatinine ratio from the renal pelvis and bladder was measured intraoperatively. Based on changes in differential renal function on diuretic renogram, patients were divided into 3 groups. Group 1 had stable differential renal function with less than 5% change, group 2 had improved differential renal function greater

than 5% and group 3 had deterioration of differential renal function greater than GW4064 in vivo 5%. Data were analyzed using SPSS (R), version 17 with cross-tabulation, nonparametric tests and logistic regression.

Results: On ultrasound only anteroposterior diameter (p = 0.018) and pelvic cortical ratio (p = 0.038) were significantly different among the 3 groups. Difference in bladder sample protein-to-creatinine ratio was not significant (p = 0.69), while pelvic urine protein-to-creatinine ratio was significant (p = 0.001). Anteroposterior diameter, pelvic protein-to-creatinine ratio and pelvic cortical ratio were less than 50 mm, 0.5 and 15, respectively, in all patients with improved renal function.

Conclusions:

Sonographic and urinary biochemical parameters may predict improvement in renal function after pyeloplasty. Pelvic anteroposterior diameter,

pelvic Liproxstatin-1 molecular weight cortical ratio and pelvic urine protein-to-creatinine ratio are the most useful parameters.”
“Cortical oscillatory synchrony in the gamma range has been attracting increasing attention in cognitive neuroscience ever since being proposed as a solution to the so-called binding problem. This growing literature is critically reviewed in both its basic neuroscience and cognitive aspects. A physiological “”default assumption”" regarding these oscillations is introduced, according to which they signal a state of physiological activation of cortical tissue, and the associated need to balance excitation with inhibition in particular. As such these oscillations would belong among a variety of generic neural control operations that enable neural tissue to perform its systems level functions, without implementing those functions themselves. Regional control of cerebral blood flow provides an analogy in this regard, and gamma oscillations are tightly correlated with this even more elementary control operation. As correlates of neural activation they will also covary with cognitive activity, and this typically suffices to account for the covariation between gamma activity and cognitive task variables.

CONCLUSION: Camptocormia in Parkinson disease may represent a for

CONCLUSION: Camptocormia in Parkinson disease may represent a form of dystonia and can be treated effectively with chronic pallidal neuromodulation.”
“Purpose: We evaluated the influence of patient factors and virulence factors of uropathogenic Escherichia

coli on the occurrence of acute pyelonephritis and subsequent renal parenchymal scarring.

Materials and Methods: We evaluated 80 boys and 45 girls 1 to 180 months old with febrile urinary tract infections who underwent renal scan to diagnose acute pyelonephritis and followup dimercapto-succinic acid scintigraphy at least 6 months later. Urinalysis, white blood cell count, uropathogenic E. coli genotype and vesicoureteral reflux were measured. Voiding cystourethrogram was investigated after acute pyelonephritis was confirmed by renal scan and acute inflammation subsided, about 2 to 4 weeks later.

Results: selleck inhibitor Acute pyelonephritis was significantly more likely to develop in children with urinary tract infections

and persistent fever before and after hospitalization, elevated C-reactive protein or positive renal ultrasound findings. E. coli strains with the papG II and iha genes were significantly more likely to occur in patients with acute pyelonephritis. Patients with a fever for more than 3 days and C-reactive BGJ398 research buy protein levels greater than 90.8 mg/l were significantly more likely to have renal scarring. Age was not an independent predictor of acute JQ-EZ-05 mouse pyelonephritis, but modified the effect of virulence factors on the development of acute pyelonephritis.

Conclusions: Bacterial virulence factors and host factors are associated with the occurrence of acute pyelonephritis. Host factors such as patient age and vesicoureteral reflux severity modify the influence of virulence factors, although only host factors are associated

with the occurrence of renal scarring.”
“BACKGROUND: Our previous studies demonstrated that simvastatin reduced neuronal death, increased neurogenesis, and promoted functional recovery after traumatic brain injury (TBI).

OBJECTIVE: To investigate the effect of simvastatin on angiogenesis after TBI and the related signaling pathways.

METHODS: Saline or simvastatin (1 mg/kg) was administered orally to rats starting at day 1 after TBI or sham surgery and then daily for 14 days. Rats were sacrificed at 3 and 14 days after treatment. Brain sections and tissues were prepared for immunohistochemical staining, enzyme-linked immunosorbent assay, and Western blot analysis. Cultured rat brain microvascular endothelial cells were subjected to oxygen-glucose deprivation followed by immunocytochemical staining with phallotoxins and vascular endothelial growth factor receptor-2 (VEGFR-2). Western blot analysis was carried out to examine the simvastatin-induced activation of the v-akt murine thymoma viral oncogene homolog (Akt) signaling pathway.

(J Thorac Cardiovasc Surg 2012;144:S74-9)”
“Thyroid hormones

(J Thorac Cardiovasc Surg 2012;144:S74-9)”
“Thyroid hormones (TH) are essential for normal brain MI-503 in vivo development. Even modest degrees of TH disruption experienced in utero can result in neuropsychological deficits in children despite normal thyroid status at birth. Neurotrophins have been implicated in a host of brain cellular functions, and in particular, brain-derived neurotrophic factor (BDNF) has a well documented role in development and function of the nervous system. A number of laboratories have reported the effects of TH administration or severe deprivation on neurotrophin expression in brain. This review provides an overview and update of recent developments in the thyroid

field as they relate to the nervous system. Secondly, we describe an animal model of low level TH insufficiency that is more relevant for studying the neurological consequences associated with the modest TH perturbations of subclinical hypothyroidism, or that would www.selleckchem.com/products/GDC-0449.html be anticipated

from exposure to environmental contaminants with a mode-of-action that involves the thyroid. Finally, we review the available in vivo literature on TH-mediated alterations in neurotrophins, particularly BDNF, and discuss their possible contribution to brain impairments associated with TH insufficiency. The observations of altered BDNF protein and gene expression have varied as a function of hypothyroid model, age, and brain region assessed. Only a handful of studies have investigated the relationship of neurotrophins and TH using models of TH deprivation that are not severe, and dose response information is sparse. Differences in the models used, species, doses, regions assessed, age at assessment, and method employed make it difficult to reach a consensus. Based on the available selleck products literature, the case for a direct role for BDNF in thyroid-mediated effects in the brain is not compelling. We conclude that delineation of the potential role of neurotrophins in TH-mediated neuronal development may be

more fruitful by examining additional neurotrophins (e.g., nerve growth factor), moderate degrees of TH insufficiency, and younger ages. We further suggest that investigation of BDNF invoked by synaptic activation (i.e., plasticity, enrichment, trauma) may serve to elucidate a role of thyroid hormone in BDNF-regulated synaptic function. This article is part of a Special Issue entitled: Steroid hormone actions in the CNS: the role of BDNF. Published by Elsevier Ltd. on behalf of IBRO.”
“The Nucleobase-Ascorbate Transporters (NATs) family includes carriers with fundamental functions in uptake of key cellular metabolites, such as uric acid or vitamin C. The best studied example of a NAT transporter is the uric acid-xanthine permease (UapA) from the model ascomycete Aspergillus nidulans.

Gastric emptying was not different between control and diabetic r

Gastric emptying was not different between control and diabetic rats at 4 weeks and 6 weeks, while it delayed at 8 weeks in STZ rats. The pre-prandial ghrelin levels were not significantly different between control and diabetic rats at 4-8 weeks. In control rats, the plasma ghrelin levels were significantly

reduced 30 min after the feeding at 4-8 weeks. In contrast, there was no significant reduction of ghrelin levels observed in diabetic rats at 4-8 weeks. Plasma insulin levels were significantly increased 30 min after feeding in control rats, but not STZ rats, at 4-8 weeks. Both HF (parasympathetic PLX4032 purchase activity) and LF (sympathetic activity) component were gradually reduced 6-8 weeks after STZ injection. It is suggested that hypoinsulinemia associated with diabetes increases plasma ghrelin KU55933 in vitro levels. At the late stage of diabetes, gastric emptying is delayed despite increased plasma ghrelin levels. The delayed gastric emptying is mainly due to impaired activity of autonomic nerves at the late stage of diabetes. (C) 2012 Elsevier Ireland Ltd. All rights reserved.”
“Maintenance of genome stability depends on efficient, accurate repair of DNA damage. DNA double-strand breaks (DSBs) are among the most lethal types of DNA damage, with the potential to cause

mutation, chromosomal rearrangement, and genomic instability that could contribute to cancer. DSB damage can be repaired by various pathways including nonhomologous end-joining (NHEJ) and homologous recombination (HR). However, the cellular mechanisms that regulate the choice of repair pathway are not well understood. Recent studies suggest that the tumor suppressor protein CtIP controls the decision to repair DSB damage by HR. It does so by regulating the initiation of DSB end resection after integrating signals from the DNA damage checkpoint response and cell cycle cues.”
“Purpose: Cryptorchidism is a common finding in infants and young boys. Early repair lessens the extent of testicular SB202190 purchase injury. We hypothesized that anatomical and socioeconomic factors affect the

timing of consultation and treatment for boys with cryptorchidism.

Materials and Methods: Under an institutional review board approved protocol we reviewed the records at a single institution of children who underwent exploration for unilateral or bilateral cryptorchidism. Demographic and anatomical factors were recorded.

Results: The median age of 677 boys at consultation and surgery was 20.3 and 28.9 months, respectively. Median age at consultation for boys with nonpalpable and palpable testicles was 12.3 and 20.9 months, respectively (p = 0.03). Boys with a concomitant penile anomaly had a younger median age at consultation than boys without a penile anomaly (8.5 vs 20.3 months, p < 0.01). Demographic factors did not vary with respect to time to consultation and surgery (p > 0.05).

Moreover, the patient shows selectively superior voice recognitio

Moreover, the patient shows selectively superior voice recognition compared to the controls revealing that two different stimulus domains, persons and objects, may not be equally affected by sensory adaptation effects. This also implies that person and object identity recognition are processed in separate pathways. These data demonstrate that an individual with acquired prosopagnosia

and object agnosia can compensate for the visual impairment and become quite skilled at using spared aspects of sensory processing. In the case of acquired prosopagnosia it is advantageous to develop a superior use of voices for person identity recognition in everyday life. (C) 2010 Elsevier Ltd. All rights reserved.”
“Background Correction of hyperglycaemia and prevention of glucotoxicity are important objectives in the management of type 2 diabetes. Dapagliflozin, a selective sodium-glucose cotransporter-2 RAD001 clinical trial inhibitor, reduces renal glucose reabsorption in an insulin-independent manner. We assessed the efficacy and safety of dapagliflozin in patients who have inadequate glycaemic control with metformin.

Methods In this phase 3, multicentre, double-blind,

parallel-group, placebo-controlled trial, 546 adults with type 2 diabetes who were receiving daily metformin (>= 1500 mg per day) and had inadequate glycaemic control were randomly Napabucasin mw assigned to receive one of three doses of dapagliflozin (2.5 mg, n=137; 5 mg, n=137; or 10 mg, n=135) or placebo (n=137) orally once daily. Randomisation was computer generated and stratified by site, implemented with a central, telephone-based Selleckchem AZD3965 interactive voice response system. Patients continued to receive their pre-study metformin dosing. The primary outcome was change from baseline in haemoglobin A(1c) (HbA(1c)) at 24 weeks. All randomised

patients who received at least one dose of double-blind study medication and who had both a baseline and at least one post-baseline measurement (last observation carried forward) were included in the analysis. Data were analysed by use of ANCOVA models. This trial is registered with ClinicalTrials.gov, number NCT00528879.

Findings 534 patients were included in analysis of the primary endpoint (dapagliflozin 2.5 mg, n=135; dapagliflozin 5 mg, n=133; dapagliflozin 10 mg, n=132; placebo, n=134). At week 24, mean HbA(1c) had decreased by -0-30% (95% CI -0.44 to -0.16) in the placebo group, compared with -0.67% (-0.81 to -0.53, p=0-0002) in the dapagliflozin 2.5 mg group, -0.70% (-0.85 to -0.56, p<0.0001) in the dapagliflozin 5 mg group, and -0.84% (-0.98 to -0.70, p<0.0001) in the dapagliflozin 10 mg group. Symptoms of hypoglycaemia occurred in similar proportions of patients in the dapagliflozin (2-4%) and placebo groups (3%). Signs, symptoms, and other reports suggestive of genital infections were more frequent in the dapagliflozin groups (2.

These structures refine the pathway from preinitiation through in

These structures refine the pathway from preinitiation through initiation to elongation for the RNA-dependent RNA polymerization reaction, explain the role of the noncatalytic divalent cation in phi 6 RdRp, and pinpoint the previously unresolved Mn2+-dependent step in replication.”
“Among receptors mediating serotonin actions in pain control, the 5-HT7R is of special interest because it is expressed by primary afferent fibers and intrinsic GABAergic and opioidergic interneurons

within the spinal dorsal horn. Herein, we investigated whether GABA and/or opioids contribute to 5-HT7R-mediated control of neuropathic pain caused by nerve ligation. Acute administration of 5-HT7R agonists (AS-19, MSD-5a, E-55888) was found to markedly reduce mechanical and thermal hyperalgesia in rats with unilateral constriction injury to the sciatic nerve (CCI-SN). In contrast, mechanical hypersensitivity caused by unilateral constriction MRT67307 mouse injury to the infraorbital nerve was essentially unaffected by these ligands. Further characterization

buy Palbociclib of the anti-hyperalgesic effect of 5-HT7R activation by the selective agonist E-55888 showed that it was associated with a decrease in IL-1 beta mRNA overexpression in ipsilateral L4-L6 dorsal root ganglia and lumbar dorsal horn in CCI-SN rats. In addition, E-55888 diminished CCI-SN-associated increase in c-Fos immunolabeling in superficial laminae of the lumbar dorsal horn and the locus coeruleus,

but increased c-Fos immunolabeling in the nucleus tractus solitarius and the parabrachial area in both control and CCI-SN rats. When injected intrathecally (i.t), bicuculline (3 mu g it.), but neither phaclofen (5 mu g it.) nor naloxone (10 mu g i.t.), significantly reduced the anti-hyperalgesic effects of 5-HT7R activation (E-55888, 10 mg/kg s.c.) in CCI-SN rats. These data support the idea that 5-HT7R-mediated inhibitory control of neuropathic pain is underlain by excitation of GABAergic interneurons within the dorsal horn. In addition, 5-HT7R activation-induced https://www.selleck.cn/products/bromosporine.html c-Fos increase in the nucleus tractus solitarius and the parabrachial area suggests that supraspinal mechanisms might also be involved. (C) 2012 Elsevier Ltd. All rights reserved.”
“The noradrenergic system might be a critical mediator of psychostimulants and opiates hedonic value.

The objective of this study is to evaluate the involvement of alpha 1-adrenoceptors (alpha 1-ARs) in nicotine incentive learning.

Rats, subjected to an unbiased conditioned place preference (CPP) procedure, received eight 30-min alternating nicotine (0.06 mg/kg) and saline pairings with distinct floor textures. The alpha 1-AR antagonist, prazosin (0.125, 0.25, 0.5, or 1 mg/kg), was administered 30 min before nicotine pairings (acquisition) or one of the two 20-min test sessions conducted 24 h and 3 weeks after conditioning (expression).

Since proteins are the effectors of cellular processes, it is imp

Since proteins are the effectors of cellular processes, it is important to investigate hESC expression at the protein level as well as at the transcript level. In addition, post-translational modifications, such as phosphorylation, may influence the activity of pivotal proteins in hESCs, and this information can only be determined by studying the proteome. In this review, we summarize the results obtained buy Elafibranor from several proteomics analyses of hESCs that have been reported in the last few years.”
“Purpose: We assessed the risk of upper urinary tract obstruction and

tumor recurrence following ureteral orifice resection during transurethral resection of bladder tumor.

Materials and Methods: We reviewed the medical records of patients treated with transurethral resection of bladder tumors involving the ureteral orifice from 2008 to 2011. Patients

with preoperative hydronephrosis or prior ipsilateral nephrectomy and those in whom a ureteral stent was placed during the procedure were excluded from analysis. Study end points were clinical or radiographic evidence of upper urinary tract obstruction and disease recurrence.

Results: The study group included 65 men (82%) and 14 women (18%) in whom a total of 84 orifice resections were PRT062607 in vivo performed. Hydronephrosis was observed in Verubecestat chemical structure 11 patients (13%) during a median followup of 15 months (IQR 7-26). Hydronephrosis was secondary to muscle invasive disease in 5 patients (6%) and it resolved spontaneously in 3 (4%). In the remaining 3 patients (4%) overt stricture was detected at the ureterovesical junction, requiring endoscopic intervention. One patient was diagnosed with recurrent tumor in the upper urinary tract. The estimated bladder disease recurrence rate was 28% at 1

year and 54% at 2 years. Corresponding disease progression rates were 4% and 12%, respectively.

Conclusions: Ureteral orifice resection during transurethral resection of bladder tumor is rarely associated with detrimental renal obstruction or an increased risk of tumor recurrence in the upper urinary tract. New onset hydronephrosis is mostly attributable to muscle invasive disease or temporary obstruction. However, the few cases of overt stricture underscore the importance of meticulous followup with imaging.”
“Within a mammalian organism, the interaction among cells both at short and long distances is mediated by soluble factors released by cells into the extracellular environment. The secreted proteins may involve extracellular matrix proteins, proteinases, growth factors, protein hormones, immunoregulatory cytokines, chemokines or other bioactive molecules that have a direct impact on target cell phenotype.

The objective

of this study was to determine whether livi

The objective

of this study was to determine whether living in a poor neighborhood is associated with suicidal thoughts and attempts in late adolescence over and above background vulnerabilities, and whether this association can be explained by late-adolescence learn more psychosocial risks: depression, social support, negative life events (NLEs), delinquent activities, substance abuse and exposure to suicide. The potential moderating role of neighborhood poverty was also examined.

Method. A subset of 2776 participants was selected from the Canadian National Longitudinal Survey of Children and Youth (NLSCY). Late-adolescence suicidal behaviors and risk factors were self-reported. The 2001 Canadian Census was used to characterize neighborhoods during early and middle adolescence. Late-childhood family and individual controls were assessed through parent-report.

Results. At the bivariate level, the odds of reporting suicidal thoughts were about twice as high in poor than non-poor neighborhoods, and the odds of attempting suicide were about four PF-573228 times higher. After controlling for background vulnerabilities, neighborhood poverty remained significantly associated with both suicidal thoughts and attempts. However, these associations were not explained by late-adolescence psychosocial

risks. Rather, youth living in poor neighborhoods may be at greater risk through the amplification of other risk factors in disadvantaged neighborhoods.

Conclusions. Potential explanations for the increased vulnerability of youth living in poor neighborhoods are discussed.”
“BACKGROUND AND IMPORTANCE: Contrast extravasation on computed tomography angiography (CTA) is becoming more common, with increasing use of CTA for myriad intracranial vascular pathologies. This article describes the first 2 documented cases of contrast extravasation from a nonaneurysmal basilar artery source seen on CTA and discusses possible

ARN-509 pathophysiologic mechanisms.

CLINICAL PRESENTATION: We present 2 cases of diffuse atraumatic subarachnoid hemorrhage in which the CTA showed an abnormality in association with the basilar artery highly suggestive of a ruptured aneurysm. Follow-up digital subtraction angiography, however, was completely negative. Subsequent repeat digital subtraction angiography failed to reveal a vascular lesion. Both patients were treated for complications associated with SAH, but given the negative digital subtraction angiography, no intervention was performed.

CONCLUSION: Because of the frequent use of CTA, contrast extravasation is an increasingly common observation. Physicians should be aware that basilar artery extravasation can mimic the appearance of an aneurysm.”
“Background. The impact of antidepressant drug treatment (ADT) on the risk of suicide is uncertain.